According to a new study, published in The Lancet today, cancer patients in England, Wales and Northern Ireland have lower survival rates than those in Australia, Canada, Sweden and Norway.
This is the first study in a programme to investigate international survival disparities, with the aim of informing health policy to raise standards and reduce inequalities in survival.
The scientists analysed data on 2.4 million cancer patients in the UK (not including Scotland), Australia, Canada, Denmark, Norway and Sweden focusing on cancers of breast, bowel, lung and ovarian. They examined the survival rate at 1 and 5 years between 1995 and 2007 and found that in some cases survival rates in the UK are more than 10% lower than Europe, Australia and Canada particularly in the first year after diagnosis. In the 5-year survival rate, UK was the worst in bowel, lung and breast cancer. Denmark also lags behind, though generally its outcomes were not as bad as the UK's.
The authors said, "Differences in individual, health-system and clinical factors - such as public awareness of cancer, diagnostic delay, stage, comorbidity and access to optimum treatment - are all potential explanations for the overall differences in relative survival. The patterns are consistent with late diagnosis or differences in treatment, particularly in Denmark and the UK, and in patients aged 65 years and older".
Cancer Research UK urges the government to focus on early diagnosis and on improving equitable access to treatment. It also urges collecting reliable and good quality information nationally in order to understand the extent of the problem and identify the causes of the survival gap within the UK and other countries.
Source: Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995—2007 (the International Cancer Benchmarking Partnership): an analysis of population-based cancer registry data. The Lancet, Early Online Publication, 22 December 2010
Wednesday, December 22, 2010
Thursday, December 09, 2010
Should healthy middle-aged people take daily aspirin ?
Studies have shown that aspirin, a commonly used painkiller, is linked to reductions in heart attacks and strokes, but it can irirtate the stomach and cause serious internal bleeding particularly in elderly people.
According to a new Oxford Univeristy study, published in The Lancet last week, taking a daily low dose of aspirin for reduced cancer deaths during and after the trials and the benefit increased with duration of treatment.
The researchers examined the data of 8 trials that looked at the effects of daily dose of aspirin on preventing heart attacks involving over 25,000 people. They found that aspirin reduced cancer deaths by 20% during the trial, but after 5 years, death rates were 34% lower for all cancer deaths. They also found the risk of all cancer deaths over a period of 20 years remained 20% lower for those who had taken aspirin, about 40% for bowel cancer, 30% for lung cancer, 10% for prostate cancer and 60% for oesophageal cancer. But there were not enough women participants to determine if daily aspirin could reduce breast, ovarian or endometrial cancer deaths.
The lead researcher said this study confirms the results of the previous study that found aspirin has preventive effect against cancer and has demonstrated a major new benefit of the drug. He believes that the findings have implications for guidelines on use of aspirin and the most benefit would be seen for those start taking aspirin between the age of 40 - 50 and continue for 25 years.
The previous study by the same authors, also published in The Lancet in October 2010, showed that a low dose of aspirin, 75mg per day taken for several years, reduced deaths due to colorectal cancer. However, opinions were divided on the result of the study.
Some said that the study did not give a balanced view of the effect of the treatment because it did not report the potential harms. The protective effects against cardiovascular disease were thought to be small for healthy adults. Some advised that aspirin should not be used to prevent heart attacks and strokes in "healthy" people as the risks outweigh potential benefits. Others said more research is needed before recommending taking aspirin to reduce cancer deaths.
Source: Rothwell PM, Fowkes FGR, Belch JFF, et al. Effect of daily aspirin on long-term risk of death due to cancer: analysis of individual patient data from randomised trials. The Lancet. 2010 Jan 7. [Epub ahead of print] Online publication 7 December 2010 ( f/t via Athens)
Previous studies :
Rothwell PM, Wilson M, Elwin C-E et al. Long-term effect of aspirin on colorectal cancer incidence and mortality: 20-year follow-up of five randomised trials. The Lancet 2010, Early Online Publication, October 22 (f/t via Athens)
Benamouzig R, Uz B. Aspirin to prevent colorectal cancer: time to act? The Lancet 20110, Early Online Publication, 22 October (f/t via Athens)
Have you washed your hands - another study on patient safety
Since the report by the Institute of Medicine in 2000 that found high rates of medical mistakes in the US, most US hospitals had made efforts to improve patient safety. A new study, published in the NEJM found that patient harm in hospitals has not decreased over time!
Harvard researchers reviewed 2341 admission records obtained from 10 randomly selected hospitals in North Carolina between 2002 and 2007, they found 588 incidents of patient harm, ie 25.1 harms per 100 admissions, resulting from medical procedures, medications, or other causes.
The study found that infections was one of the most common complications, 42.7% required longer hospital stay for treatment, eg infected surgical incision. The types of patient harm varied widely and included falls, injury during surgery, low blood pressure and low blood sugar. Most of the complications were temporary and treatable, but 3% were permanent, eg brain damage from a stroke ( could have been prevented after an operation), 8.5% were life-threatening and 2.4% "caused or contributed to a patient's death."
The study's lead author, Dr. Christopher Landrigan, said "these harms are still very common, and there's no evidence that they're improving". Many of the problems were caused by the hospitals' failure to use protective measures that have been proven to improve care including computerizing patient records and drug prescription orders, using checklists for surgical procedures and other methods. He noted that the frequency of medical errors and injuries has been underestimated and there is a need for a mandatory monitoring system.
Some experts on hospital safety said heathcare providers should have a culture of strong communication and teamwork and it is essential that hospitals be more open about reporting problems. Some suggest that patients need cultural change too in ensuring their own safety, eg discussing about drug interactions with the doctor or asking if the doctor has washed his/her hands!
In the US, 27 state laws require public reporting of hospital-acquired infection rates. In 2005, all hospitals in New York were required by legislation to report hospital-acquired infections to the NY State Department of Health. In 2009, the NY Department of Health issued a state-wide report on hospital-by-hospital infection rates. They said that the information will help patients make more informed choices and allow hospitals to compare with other providers.
In the UK, despite promoting hand hygiene among staff, patients and visitors in NHS Trusts in England and Wales to reduce hospital acquired infections, infection rates and resulting harm are still very high.
In June 2010, the Health Secretary, Andrew Lansley, announced that as part of the new government's information revolution, infection figures for all hospitals in England will be published on a weekly basis from July on the government website . By making the data available to patients as well as hospital managers, he said people can make comparisons between different hospitals and healthcare organisations.
Have you washed your hands? Would you be offended if a patient or a colleague asks if you have washed your hands? What's your veiw?
Source : Temporal Trends in Rates of Patient Harm Resulting from Medical Care. N Engl J Med 2010; 363:2124-2134 ( full text via Athens )
Harvard researchers reviewed 2341 admission records obtained from 10 randomly selected hospitals in North Carolina between 2002 and 2007, they found 588 incidents of patient harm, ie 25.1 harms per 100 admissions, resulting from medical procedures, medications, or other causes.
The study found that infections was one of the most common complications, 42.7% required longer hospital stay for treatment, eg infected surgical incision. The types of patient harm varied widely and included falls, injury during surgery, low blood pressure and low blood sugar. Most of the complications were temporary and treatable, but 3% were permanent, eg brain damage from a stroke ( could have been prevented after an operation), 8.5% were life-threatening and 2.4% "caused or contributed to a patient's death."
The study's lead author, Dr. Christopher Landrigan, said "these harms are still very common, and there's no evidence that they're improving". Many of the problems were caused by the hospitals' failure to use protective measures that have been proven to improve care including computerizing patient records and drug prescription orders, using checklists for surgical procedures and other methods. He noted that the frequency of medical errors and injuries has been underestimated and there is a need for a mandatory monitoring system.
Some experts on hospital safety said heathcare providers should have a culture of strong communication and teamwork and it is essential that hospitals be more open about reporting problems. Some suggest that patients need cultural change too in ensuring their own safety, eg discussing about drug interactions with the doctor or asking if the doctor has washed his/her hands!
In the US, 27 state laws require public reporting of hospital-acquired infection rates. In 2005, all hospitals in New York were required by legislation to report hospital-acquired infections to the NY State Department of Health. In 2009, the NY Department of Health issued a state-wide report on hospital-by-hospital infection rates. They said that the information will help patients make more informed choices and allow hospitals to compare with other providers.
In the UK, despite promoting hand hygiene among staff, patients and visitors in NHS Trusts in England and Wales to reduce hospital acquired infections, infection rates and resulting harm are still very high.
In June 2010, the Health Secretary, Andrew Lansley, announced that as part of the new government's information revolution, infection figures for all hospitals in England will be published on a weekly basis from July on the government website . By making the data available to patients as well as hospital managers, he said people can make comparisons between different hospitals and healthcare organisations.
Have you washed your hands? Would you be offended if a patient or a colleague asks if you have washed your hands? What's your veiw?
Source : Temporal Trends in Rates of Patient Harm Resulting from Medical Care. N Engl J Med 2010; 363:2124-2134 ( full text via Athens )
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