Monthly Archives: March 2015

More pieces in the prostate puzzle

Simon Crompton

Simon Crompton

When are the costs of surgery too great? It’s long been a burning question in prostate cancer, and papers presented over the past few days at the European Association of Urology’s conference in Madrid have added a few more pieces to the risk versus benefits jigsaw.

Speaking recently to Per-Anders Abrahamsson, the association’s Secretary General, for an article to be published in Cancer World, I was told about the current gaping holes in research in prostate cancer. For example, there is no randomised trial comparing radiation therapy with surgery – which constantly gets in the way of good clinical decision-making.

Clinicians and patients are also short of information to weigh about the long-term side effects of treatments – and research presented at EAU showed that the evidence that clinicians currently act on might also be misleading. Take the incidence of erectile dysfunction following prostate removal surgery. The standard way of measuring erectile dysfunction is by the International Index of Erectile Function (IIEF), but researchers from the Herlev Hospital in Copenhagen realised that this might not take into account the sudden change in erectile dysfunction brought about by prostate surgery.

So they added another simple question to the survey: “Is your erectile function as good as before the surgery? (yes/no)”

The difference it made to responses from prostate surgery patients was striking. Responding to the IIEF survey without the additional question, nearly 24% of patients registered no decline in their erectile function after surgery. But when they were asked the additional question, just 7% said their erections were as good as before surgery.

That’s quite a difference for quite a lot of people. Such evidence could have a major influence on decisions about whether or not to have a radical prostatectomy.

Also presented at the conference was evidence about another kind of cost associated with prostate surgery: urinary incontinence. A team of doctors from the University of Nijmegen, the Netherlands, have used health insurance data to reveal the extent of post-operative incontinence and the costs of dealing with it. On a purely financial basis, the information is interesting enough: the average cost of incontinence pads is €210 each year (another study calculated that the 20 year additional cost of incontinence for a man after prostate surgery is close to €50,000).

But more important were the findings about the percentage of men suffering urinary incontinence in the first year after a urology procedure or follow-up. For men undergoing watchful waiting/active surveillance, it was 8%. For those undergoing prostate removal it was 80%, persisting into a second year for 40%.

Patient information about prostate surgery rarely specifies such figures, often offering vague reassurance that “most men” see a quick improvement in continence after surgery – as if it would be wrong to frighten them too much. As more evidence becomes available to fill in the picture on complex decisions, it’s only right that it should be shared with those it affects most.

The genetic dilemma: prevention lags behind science

Isabel Centeno

Guest Blogger – Isabel Centeno, Psycho-oncologist and cancer patient advocate, Monterrey, México.

 

 

I use to work with breast cancer patients and their families and I´ve noticed that although genetic testing becomes gradually more accessible and better known in my country it is not well accepted; not even considered as a means of prevention.

A new generation of men and women are at risk (even though we know only 10% of breast cancers are hereditary) and the information they receive is “examine your breasts yourself!!”.  This seems too late or at least too risky.

Is it a moral issue or an economic one? Or is it something else?

I don´t have the answer but it is a fact that economic issues play an important role in decisions. How many Mexicans could pay for a genetic test? Who has the money to take preventative action even if the outcome is positive against hereditary cancer?

Medical breakthroughs occur faster than changes in medical and public policy. Psychological and economic issues mean that changes in population behaviour take time and many people die in the meantime.

There are many cancer deaths that could have been prevented but weren´t. Even though we work in the health care industry and are trying to inform and support families and patients we cannot push any further to speed up solutions we know are available.

We welcome contributions to this blog. If you have a topic you would like to write about, please send your post to Corinne Hall – chall@eso.net You can find our guidelines here – How to write a blog

 

We say “epidemic”, they say “breakthrough”: reframing the global cancer debate

anna portrait  picThe World Economic Forum, with its mission of “improving the state of the world through public–private cooperation” is where leading international figures from politics, business and civic society meet for informal discussions about the big global threats and opportunities of the day.

Getting cancer onto the Davos 2015 agenda was therefore a milestone, for which much credit should go to Franco Cavalli, a leading medical oncologist who chairs the World Oncology Forum and is a former president of the Union for International Cancer Control.

It should have been a great opportunity to engage global decision makers in discussions that have taken place within the cancer community about developing a response to the relentless global rise in cancer incidence, which is now the biggest cause of death along with cardiovascular disease.

However, while Davos did table sessions on cancer, they were not designed to discuss the strategic policy response the cancer community is calling for, and Cavalli, who had a seat at the table, came away with mixed feelings about what had been achieved.

Framing the debate

Last September, Cavalli was invited to participate in a pre-Davos panel on the topic Cancer: the Next Global Epidemic? to see if this would be suitable for inclusion on the full agenda. Alongside him were Chris Wild, Director of the WHO International Agency for Research on Cancer, Aaron Motsoaledi, the South African Health Minister, and Helmy Eltoukhy, a “technology pioneer” developing liquid cancer biopsies.

Early feedback was positive – cancer control seemed to have secured its place. However, when confirmation came at the end of December 2014, the focus had radically changed.

Any ambition for global action to support governments to sustainably expand access to early detection, treatment and care, had gone missing.

In its place were two sessions that focused on medical breakthroughs.

One of these, Cancer: Pathways to a Cure, framed the question as: “What breakthroughs in prevention and therapy offer a glimpse of a cancer-free future?

The other, titled A New Era in the Fight against Cancer, asked: “How will breakthroughs in specialized care and immunotherapy transform the future of cancer treatment?”

As Cavalli explains in the forthcoming issue of Cancer World, it proved hard to focus the discussion on what will make most difference to the 12 million people who develop cancer each year. Leading figures from research and the biomedical industry were keener to talk about their achievements, hopes and ambitions than to question the real-world impact of their work.

“It was a very difficult environment to present what we want to achieve,” said Cavalli.

There was an opportunity to discuss a possible policy response in a third session, the Globalization of Chronic Disease, but here the focus was entirely on promoting healthy environments and lifestyles, which doesn’t address the needs of people who develop cancers, many of which are not preventable.

Whose problem?

It is interesting to contrast the technological framing of the cancer sessions, with sessions on infectious diseases, which carried titles like “Confronting the Challenge of Catastrophic Outbreaks” and “Pandemics: Whose Problem?

The words indicate crisis, urgency, action, and a global responsibility – the responsibility world leaders previously accepted in setting up the Global Fund to Fight AIDS, Tuberculosis and Malaria, which has transformed access to information, affordable treatment and care.

As Cavalli argues in the forthcoming article, many leading political figures want a similar coordinated global initiative to tackle cancer, but their voices are not yet heard loudly enough.

His message to Davos? “We’ll be back!”