Call for better cancer fertility take care of young women

By James Gallagher Health and science reporter, BBC News

The take care of younger women needing cancer treatment that could damage their probabilities of having children must be improved, researchers say.

A study of 290 young patients inside the UK showed fertility was frequently not discussed before treatment.

Writing within the journal Pediatric Blood and Cancer, researchers also highlighted issues of the way in which the difficulty was approached by doctors.

The Teenage Cancer Trust said doctors had an obligation to tell patients.

Radiotherapy and chemotherapy can severely damage a person’s sperm or eggs and should leave the patient unable to have children.

Freezing a man’s sperm before treatment is comparatively easy, and the young men within the study were largely proud of how their future fertility was handled.

However, collecting and storing eggs is more difficult and is typically impossible if treatment should start immediately.

The researchers on the University of Sheffield and The Children’s Hospital within the city interviewed people in 2011 who have been diagnosed with cancer between the ages of 13 and 22. The implications were compared with patients having a similar treatment in 2004.

In both groups, about two-thirds of girls could remember actually having a discussion concerning the impact on their chance of kids and the way their fertility may be preserved.

In 2004, the conversation happened after treatment had already started 62% of the time. In 2011 this improved to 31% of cases, the study said.

It also suggested that the majority younger women were unhappy with the style the doctors cited the problem and there has been no clear improvement between 2004 and 2011.

Dr Allan Pacey, from the University of Sheffield, said fertility preservation was often not a practical option if cancer treatment had to start immediately.

He told the BBC: “It is a really stressful time and oncologists are doing a great job, however the words doctors use might possibly be either quite sensitive or insensitive.

“We’ve changed practice, but we haven’t got any better at helping these women.”

‘Fundamental right’

Dr Dan Yeomanson, a expert paediatric oncologist for Sheffield Children’s NHS Foundation Trust, said the study highlighted important gaps inside the care of teenagers and teens with cancer.

He said: “This study highlights the necessity to discuss fertility issues with young patients, especially females, before treatment begins even supposing there aren’t any options available for fertility preservation.

“Given the wealth of knowledge that should accept before treatment begins, you can actually see why fertility issues are often not handled in addition to they can be.”

About 2,100 children aged 15-24 are diagnosed with cancer once a year inside the UK.

Simon Davies, the executive executive of the Teenage Cancer Trust charity, said: “Adolescents have a fundamental right to be made privy to the fertility problems cancer treatments may cause.

“Fertility is something many teens won’t also have considered yet and it’s incredibly important that these issues are discussed and that each one options are understood.

“Health professionals have an obligation to provide clear information regarding the entire long run effects of treatments and hopefully this work may help keep this front of mind for those working with youngsters with cancer.”

Warning over NHS competition rules from reform doctor

A leading architect of the government’s NHS changes in England has warned they are undermined by new rules opening the health service to more competition.

Dr Michael Dixon told GPs’ journal Pulse that regulations on tendering out services must be rephrased.

Meanwhile, greater than 1,000 doctors have written to the Daily Telegraph claiming the legislation makes “virtually everything” of the NHS open to personal firms.

The government insisted there has been no policy to privatise NHS services.

Budget responsibility

Dr Dixon said clinicians would feel the entire process were “a total waste of time” unless the guidelines were changed.

He said he feared GPs “will walk” from your entire clinical commissioning process if this was not done.

The regulations are currently before Parliament, with the reforms taking effect in a month.

New local clinician-led organisations will take over responsibility for far of the health budget.

The rules for purchasing services set out within the regulations ban unnecessary restrictions on competition and say all providers – NHS or otherwise – must be treated equally.

‘Eye off ball’

Critics have said it is a blueprint for privatisation and goes against government assurances.

Dr Dixon have been a number one champion of the changes, but he’s worried that the proposed rules will mean doctors could get slowed down within the procurement process as opposed to getting on with making services better for patients.

He said the risk with the present wording of the guidelines “is that it sort of feels to position an obligation upon the commissioner to head for competition with all contracts which can be made”.

Dr Dixon said: “The purpose of clinical commissioning was to innovate to revamp, to attempt and make sure that we do more outside of hospital and in primary care.

“Now, if that’s their aim and so they start getting slowed down in matters of problems with whether they are being competitive, that’s going to take their eye off the ball.”

‘Nail in coffin’

In their letter to the Telegraph, the doctors and health-care workers called on MPs to force a debate and vote down the proposal.

They wrote: “We’re serious about the government’s proposed secondary legislation (under Section 75 of the Health and Social Care Act) to force virtually every little thing of the English NHS to be spread out to the non-public sector to bid for its contracts.

“These regulations were proposed on 13 February and may become law on 1 April unless MPs first insist on a debate after which vote them down.

“Parliament doesn’t normally debate or vote in this style of regulation, but it surely is feasible. We urge parliamentarians to force a debate and vote in this issue to forestall another nail within the coffin of a publicly provided NHS free from the motive of corporate profit.”

The government said the principles were about ensuring the method was fair to all concerned.

Labour said the regulations ought to be withdrawn at once.

Ricky Grover: ‘Binge eating has scarred my liver’

By Claire Bates BBC Science

When actor Ricky Grover, 51, was asked to participate in a TV programme testing for 3 serious medical conditions he had no qualms in signing up.

‘I was due an MOT anyway because it have been many years since my last check-up,’ he said.

‘I was expecting to pass them with flying colours like I had done until now.’

But the previous EastEnders star was in for a bad surprise.

The show Long Live Britain was investigating heart disease, liver disease and kind 2 diabetes, the hidden killers that are accountable for 200,000 deaths inside the UK every year.

And tests revealed Mr Grover was showing signs of 2 of them. A skin-prick test revealed he had Type 2 diabetes while an MRI scan showed scarring, referred to as fibrosis, on his liver.

‘It was a genuine shock,’ the actor and comedian said.

‘I thought it was only big drinkers that had issues of their liver, however it seems obesity is an incredible cause.’

Weighing over 21st when he signed as much as the programme, Ricky admits he was a ‘big bloke.’ But he thought the actual fact he didn’t drink much alcohol and had a comparatively nutritious diet would protect him.

‘I have always eaten healthy food but my problem is I’m a binger,’ Mr Grover explained.

‘I get cravings for sugar, it’s an addiction actually. If i used to be watching TV with a bag of chocolates i could not stop after taking the 1st bite.

‘Also doing this show revealed that my portions were too big. i believed it was fine to eat half a chicken for a meal, but i used to be told I should just be having one thigh.’

The actor’s Body Mass Index reading, which measures weight when compared with height, revealed he was classed as ‘morbidly obese.’

‘The weight had crept on, it was hard to maintain track of it because it went up and down lots,’ Mr Grover said.

Being obese puts extra strain at the liver and might cause an accumulation of fat within the organ. Over the years this may increase the chance of developing scarring called liver fibrosis, which in turn can result in a lack of function referred to as cirrhosis. Obesity also increases the danger of developing Type 2 diabetes.

The actor also admitted he had experienced some typical diabetes symptoms but chose to disregard them.

‘I put my symptoms all the way down to age and stress’

‘I had noticed a little bit numbness in my feet, felt thirsty quite a bit and went to the toilet within the night, but I put it right down to age and stress,’ he said.

Taking part in Long Live Britain finally forced Mr Grover to take a protracted hard have a look at his health.

He was taken to a recycling centre to illustrate how eating an excessive amount of fat prevents the liver from functioning properly and met Lorraine, who had end stage liver failure and was expecting a transplant.

‘Out of everything that visit really hit home,’ Mr Grover said.

‘I realised it was make or break time. Luckily for me I must be capable of control my diabetes with diet and exercise for now. My liver also isn’t too damaged so it may repair itself if I do the best things.

‘I’ve been given a second chance.’

Since making the show Ricky has started doing daily half-hour boxing sessions with an individual trainer.

‘Being an actor could be very stressful, so it has been good for that besides,’ he said.

‘I also walk my dog Bubba-Joe, but he’s eight-years-old now so he is taking his time.’

He has also tackled his diet.

‘I’ve got juicers, blenders, food dehydrators, all types!’ he said.

‘My house feels like a white goods store. This morning I drank an enormous juice and i have got some almond nuts and fruit with me. It’s about planning daily to overcome the cravings. I’m feeling really positive.’

With his wife and daughter’s support, Ricky has lost greater than a stone and says he has got five more to head.

‘The some thing i might say after doing this programme is it’s really important that folks have regular check-ups,’ Mr Grover said.

‘That way you may nip problems inside the bud.’

Ricky Grover’s story is featured on Long Live Britain, at 9pm, Monday 22nd July on BBC One

Late-stage breast cancer survival ‘lower in UK’

Women with late-stage breast cancer have lower survival rates within the UK than five other high-income countries, including Sweden and Canada, suggests a study within the British Journal of Cancer.

In the united kingdom, 28% of ladies with probably the most advanced cancers survived for 3 years, compared with 42% in Sweden.

Researchers checked out greater than 250,000 women diagnosed between 2000 and 2007.

Cancer Research UK questioned whether women were receiving the very best treatment.

The study, executed by the International Cancer Benchmarking Partnership, investigated whether international differences in survival may be explained by delays in diagnosis.

Led by researchers on the London School of Hygiene and Tropical Medicine, the study analysed data on women from Australia, Canada, Denmark, Norway and Sweden as much as three years after diagnosis.

For all stages of breast cancer, the study found that three-year survival was 87-89% within the UK and Denmark, and 91-94% inside the other four countries.

One-year survival varied less, from 94.3% within the UK to 98.4% in Sweden.

But for girls with one of the most advanced breast cancers, one-year survival ranged from 53% inside the UK to 67% in Sweden – and there has been still a 14% difference between the united kingdom and Sweden in three-year survival for people with late-stage breast cancer.

In the united kingdom, similar proportions of ladies were diagnosed inside the early stages as in lots of the other countries. Twelve months after diagnosis, survival for ladies with early-stage breast cancer was near to 100% in all six countries.

It was just for women with late-stage breast cancer that survival percentages were lower inside the UK.

This means that lower overall breast cancer survival inside the UK isn’t because women are being diagnosed at a later stage than in other countries, the study says.

Missing information

In Denmark, only 30% of girls with breast cancer were diagnosed at an early stage, compared with 42-45% elsewhere.

This means that low overall breast cancer survival in Denmark – the sole country that had not fully implemented a countrywide breast screening programme before 2007 – was as a consequence of women being diagnosed at a later stage of disease.

Generally, women eligible for screening (typically 50-69-year-olds) are diagnosed at an earlier stage than younger and older women.

The UK also had the top proportion of girls with missing details about their stage at diagnosis.

The study also found that international differences in survival were also wider for older women.

Three-year survival was 4% higher in Sweden (96%) than within the UK (92%) for girls aged 50-69, but for ladies aged 70 years or more, the adaptation was 12% (Sweden 91% compared with 79% within the UK).

These findings suggest that older women with breast cancer and ladies with more advanced disease can be treated less aggressively within the UK than inside the other five countries.

Dr Sarah Walters, lead author from the Cancer Research UK Cancer Survival Group on the London School of Hygiene and Tropical Medicine, said the explanations for low overall survival within the UK and Denmark were different and needed different solutions.

“The roll-out of national mammography screening would be expected to enhance overall survival in Denmark.

“Inside the UK, we should always now investigate whether the treatment of ladies with later-stage breast cancer meets international standards. There may be particular concern that this isn’t the case, especially for older women.”

Sara Hiom, Cancer Research UK’s director of early diagnosis, said international comparisons were useful in helping to comprehend what was influencing cancer survival.

“We’re starting to see some important clues now, but while we’re closing the survival gap for breast cancer, UK women continue to fare worse than in these other countries.

“We all know that UK women diagnosed with breast cancer are usually not routinely given CT scans to envision if the disease has spread, that may mean we are not always accurately staging more advanced disease.

But we also have to investigate the chance that fewer women with later stage breast cancer within the UK receive the simplest treatment for his or her circumstances.”

Eluned Hughes, head of public health at Breakthrough Breast Cancer, said: “If breast cancer survival rates matched an appropriate in Europe, 1,000 extra lives will be saved in England alone, so work to bridge the space is essential.”

Health Ombudsman to analyze more NHS complaints

By Simon Cox BBC Radio 4’s The Report

The Parliamentary and Health Service Ombudsman is promising to research 10 times as many cases this year because it did last year.

It is in line with criticism concerning the selection of cases the taken on.

The ombudsman is the overall port of demand patients in England who’re unhappy with a hospital’s original handling in their complaint.

It says it’s going to investigate around 4,000 cases in the next year but and not using a more money or staff.

In 2012-13, the ombudsman received 16,000 complaints in regards to the NHS.

It took a more in-depth examine 3,770 of those and investigated 377, which was a 5% drop at the previous year.

Patients’ organisations have criticised the small variety of cases the ombudsman formally investigates – around 3% of complaints.

Sir Brian Jarman, a professional on hospital mortality data and Emeritus Professor of medication at Imperial College London, said he was horrified when he checked out the variety of complaints the ombudsman was investigating.

“The remainder of them are effectively thrown into an electronic waste paper basket,” he said.

“i used to be amazed that they did not investigate more. We should always use complaints as gold dust.”

‘Finding it difficult’

After she was appointed head of the PHSO in 2012, Dame Julie Mellor undertook a review of the organisation.

Following feedback from patients she decided to extend the collection of investigations to around 4,000 a year but with none increase to the Ombudsman’s £33m budget.

She said it was possible to work with their existing finances because they’d changed the way in which they work.

“We’re just doing it differently. Like other bodies we’re doing more with less,”

But Charlotte Leslie MP, a Conservative member of the Commons Health Select Committee is sceptical this is achieved.

“The more apologetic they’re and the more they voice their failures, the more sceptical we become,” she said.

“We’ve heard all of it before, we really should see results.”

She believes the organisation may take the cases it has previously checked out and rebrand them as investigations.

But Dame Julie Mellor says she doesn’t agree, “Up to now people weren’t getting a proper and final adjudication on their complaint and that is the difference.”

In September the Labour MP Ann Clwyd will present a report back to the prime minister on how NHS hospitals investigate complaints.

Sir Bruce Keogh, the medical director of NHS England, believes the present system should change because the ombudsman is struggling to deal with the demands put on it by patients.

He suggested it’s going to only tackle the main serious complaints.

“In the event that they do not get a tight response from the hospital they must go on to the ombudsman and the ombudsman in my opinion doesn’t have enough capacity for that,” he said.

Prior to 2009, hospital complaints can be taken up with the regulator, the Care Quality Commission (CQC), before going to the health ombudsman.

Sir Bruce believes it’d be worth going back to this technique again.

“We may ask the CQC whether or not they have an appetite for taking over complaints which trusts can’t close satisfactorily after which giving the overall say to the ombudsman only in really tricky cases.”

Thriving cancer’s ‘chaos’ explained

By James Gallagher Health and science reporter, BBC News

The way cancers make a chaotic mess in their genetic code on the way to thrive have been explained by UK researchers.

Cancer cells can differ hugely within a tumour – it helps them develop tips on how to resist drugs and spread around the body.

A study within the journal Nature showed cells that used up their raw materials became “stressed” and made mistakes copying their genetic code.

Scientists said supplying the cancer with more fuel to grow may very well make it less dangerous.

Most normal cells within the human body contain 46 chromosomes, or bundles of genetic code. However, some cancerous cells could have greater than 100 chromosomes.

And the pattern is inconsistent – pick a number of neighbouring cells and so they could each have different chromosome counts.

This diversity helps tumours adapt to become untreatable and colonise new parts of the body. Devising ways of forestalling a cancer from becoming diverse is a growing field of analysis.

Chaos from order

Scientists on the Cancer Research UK London Research Institute and the University College London Cancer Institute was attempting to crack how cancers become so diverse inside the first place.

It have been thought that after a cancer cell split to create two new cells, the chromosomes weren’t split evenly between both.

However, lead researcher Prof Charles Swanton’s tests on bowel cancer showed “little or no evidence” that was the case.

Instead the study showed the matter came from making copies of the cancer’s genetic code.

Cancers are driven to make copies of themselves, however, if cancerous cells run out of the building blocks in their DNA they develop “DNA replication stress”.

The study showed the strain brought about errors and tumour diversity.

Prof Swanton told the BBC: “It’s like constructing a building without enough bricks or cement for the principles.

“However, in the event you delivers the building blocks of DNA you may reduce the replication stress to restrict the range in tumours, that could be therapeutic.”

He admitted that it “just seems wrong” that providing the fuel for a cancer to grow may be therapeutic.

However, he said this proved that replication stress was the issue and that new tools can be developed to tackle it.

Future studies will investigate whether an identical stress causes diversity in other varieties of tumour.

The research team identified three genes often lost in diverse bowel cancer cells, which have been critical for the cancer plagued by DNA replication stress. All were located on one region of chromosome 18.

Prof Nic Jones, Cancer Research UK’s chief scientist, said: “This region of chromosome 18 is lost in lots of cancers, suggesting this process is not only seen in bowel cancers.

“Scientists can now start searching for how to prevent this happening within the first place or turning this instability against cancers.”

Bain Capital buys stake in UK government blood company

The government has sold an 80% stake in blood products company Plasma Resources UK to a US private equity firm.

Bain Capital paid £230m for almost all stake within the company, which provides the NHS with treatments for haemophilia and immune deficiencies.

It said it should change the firm into “a UK-based life sciences champion”.

But former Health Minister Lord Owen said sensitive health assets shouldn’t be owned by an organization without shareholders and “answerability”.

Plasma is a straw-coloured blood component that acts as a clotting agent.

It isn’t sourced from UK donors, on medical advice because the emergence of “mad cow disease”, but is imported from a US-based company.

Investment needed

Plasma Resources UK (PRUK) turns it into life-saving treatments, a number of that are supplied to the NHS, and others sold outside the united kingdom. It’s not connected to the National Blood Service, which blood donors supply.

The company supplies 30% of plasma products utilized by the NHS – the alternative 70% are sourced from other organisations, based overseas. Half PRUK’s sales also are made overseas.

The government announced plans to sell it off in January, saying private sector investment was had to “support the corporate and its employees inside the next phase of the company’s development”.

It said that was one of the best ways of allowing PRUK – a holding company that comes with the united kingdom-based Bio Products Laboratory Limited and the united states plasma supply company, DCI Biologicals Inc – “to grow and prevail in a longtime and highly competitive global industry”.

An Edinburgh plant which manufactured blood products shut in 2007 and there have been concerns in regards to the way forward for the BPL lab in Elstree, Hertfordshire, without more investment.

The government also said the sale would get advantages patients, by allowing more treatments to be developed and allowing lab facilities in Elstree to “keep pace with the newest technology”.

Health Minister Dan Poulter said: “This deal will make sure that patients may have access to top quality plasma products for years yet to come and it’s excellent news that Bain are investing in medicine and the life science industry within the UK.

“Bain Capital was chosen following a good and open competitive process which checked out who offered the correct deal for patients, and to make sure future employment on the company.”

But crossbench peer Lord Owen, who sought to make the united kingdom self-sufficient in blood supplies when he was a Labour health minister inside the 1970s, told BBC Radio 4’s Today programme that the sale was “extraordinary”.

“Remember this was bought by the Labour government in 2002, as a result of danger to contamination of blood supplies by CJD – which most people will think about as mad cow disease – and it was bought for the NHS and owned by the NHS.

“It really is being sold to a personal equity capital – this isn’t a public company with shareholders and public responsibilities and answerability.

Lord Owen, who was at the advisory board of a non-public equity firm – Terra Firma – said private equity had its uses but added: “What they basically do is fatten it up over many years, put money into order to sell at very high substantial prices.”

He said that, while the govt. might make a profit, there have been concerns in regards to the level of corporate governance of a sensitive health asset.

“Is there no limit to how this government will privatise assets?” he said.

Bain Capital – founded by, among others, former US presidential candidate Mitt Romney in 1984 – didn’t respond on to Lord Owen’s comments.

Track record

But it said it planned to remodel PRUK into “a UK-based life sciences champion” and planned to take a position greater than £50m within the UK, “supporting jobs and security of supply of important medications for the NHS”.

The firm said it had an unrivalled track record in healthcare investment – it owns a stake in HCA, which controls about 160 hospitals within the US and US pharmaceutical giant Quintiles, whose European headquarters is in Reading.

It said the govt. , which is able to keep a 20% stake within the company, will “share in future value creation” – that may involve having a representative at the board.

Robin Marshall, managing director of Bain Capital in London, said: “We’re delighted to be partnering with the dep. of Health in this opportunity.

“To enable PRUK to fulfil its potential and become a globally competitive, UK-headquartered life sciences champion, we intend to embark on a considerable capital investment plan of greater than £50m to extend production capacity, refurbish and maintain the prevailing facilities, develop new products and expand the company’s international reach.”