cancer cascade workshop the studio, glasgow 1st december … · 2016-12-09 · cancer cascade...

Cancer Cascade Workshop

The Studio, Glasgow

1st December 2016

Dr Richard RoopeRCGP and Cancer Research UK Cancer Clinical Champion

Senior Clinical Advisor Cancer Research UK


What’s new?


What’s new?• Breast cancer presentation• Very brief intervention• Colorectal paper • E-cigarettes• New CRUK Stats/infographics• Dismantling Scottish QOF• Formation of GP Clusters


What’s new?• BBC News 08.11.16 (NIHR Conference)• Breast cancer presentation


http://www.bbc.co.uk/news/health-37894360


What’s new?UCL Researchers:1 in 6 cases of breast cancer begin with non-lump symptoms

Cancer Cascade WorkshopNICE NG12 2015

2 week breast referral pathway:• aged 30 and over and have an unexplained breast lump• aged 50 and over with any of the following symptoms in one

nipple only: • discharge • retraction • other changes of concern. [new 2015] • skin changes that suggest breast cancer• aged 30 and over with an unexplained lump in the axilla.

[new 2015]• Consider non-urgent referral in people aged under 30

with an unexplained breast lump with or without pain. See also recommendations 1.16.2 and 1.16.3 for information about seeking specialist advice. [new 2015]


What’s new?Very brief advice


What’s new?Very brief advice

http://www.bbc.co.uk/news/health-37717594


What’s new?Very brief advice: 12 months later average weight loss:• Advice alone: 1.0kg • Advice with Tier 2 referral: 2.4 kg

• 1 in 4 lost 5% body weight• 1 in 10 lost 10% body weight


What’s new?"The impact is pretty substantial given the effort - 30 seconds - that went into it.

"If we were year-on-year to knock 2.4kg off the heaviest people in society then that would have a very big effect in health terms.“ Prof Paul Aveyard


What’s new?No such thing as “heavy bones”


What’s new?No such thing as “heavy bones”

https://www.google.co.uk/search?q=heavy+bones+mri&biw=1440&bih=770&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjB_f6SgZnQAhUJDMAKHQoFBusQ_AUIBigB#imgdii=fhmxHroHSCs8KM%3A%3BfhmxHroHSCs8KM%3A%3B6LKV_QYXM9BJiM%3A&imgrc=fhmxHroHSCs8KM%3A

Colorectal cancer – when to refer?

• When did we refer?


• When did we refer? Variably


• When did we refer? Variably across CCGs

http://www.ncin.org.uk/publications/routes_to_diagnosis (accessed 2.10.16)

http://www.ncin.org.uk/publications/routes_to_diagnosis


• When did we refer? Variably (across time)


• When did we refer? Variably (across time) – improving!




• 1 year survival

http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-

type/bowel-cancer/survival#heading-Two Last accessed 28.9.16


http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer/survival#heading-Two



http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-

type/bowel-cancer/survival#heading-Two Last accessed 28.9.16

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CRC cancer rates per 100,000

Incidence Mortality

http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer/survival#heading-Two


• When did we refer? Variably – why is this important?




• When did we refer? Variably – why is this important?


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All routes Screening Two Week Wait GP referral Other OutpatientInpatient Elective Emergency… Unknown

Relative survival estimates by presentation route and survival time, Colorectal, 2006-2013

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36-month



• What are the “key” symptoms?


• What are the “key” symptoms for colon cancer?

• Rank order for symptoms reported or findings in 30 days prior to diagnosis:

Option A1. Rectal bleeding2. Change in bowel habit3. Weight loss4. Abdominal pain5. Anaemia

Option B1. Abdominal pain2. Anaemia3. Rectal bleeding4. Change in bowel habit5. Weight loss

Option C1. Abdominal pain2. Weight loss3. Rectal bleeding4. Change in bowel habit5. Anaemia

Option D1. Rectal bleeding2. Anaemia3. Change in bowel habit4. Abdominal pain5. Weight loss





Option B1. Abdominal pain2. Anaemia3. Rectal bleeding4. Change in bowel habit5. Weight loss



Discuss and choose which is correct ranking.



Option B1. Rectal bleeding2. Anaemia3. Change in bowel habit4. Abdominal pain5. Weight loss


http://www.nature.com/bjc/journal/v115/n7/pdf/bjc2016250a.pdf




Option B1. Abdominal pain 15.7%2. Anaemia 6.2%3. Rectal bleeding 4.4%4. Change in bowel habit 2.5%5. Weight loss 1.8%


30 days pre-Δ 12 months - 30 days pre-Δ1. Abdominal pain 15.7% 25.1%2. Anaemia 6.2% 19.2%3. Rectal bleeding 4.4% 9.4%4. Change in bowel habit 2.5% 5.5%5. Weight loss 1.8% 3.1%




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1.Abdominalpain

2.Anaemia 3.Rectalbleeding

4.Change inbowel habit

5.Weight loss

Frequency of symptoms in colon cancer

30 days pre-Δ 12 months - 30 days pre-Δ






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1.Abdominalpain



5.Weight loss

Frequency of symptoms 30 days pre-diagnosis in colon cancer

Non-EP EP

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1.Abdominalpain



5.Weight loss

Frequency of symptoms in rectal cancer

30 days pre-Δ 12 months - 30 days pre-Δ




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1.Abdominalpain



5.Weight loss

Frequency of symptoms 30 days pre-diagnosis in rectal cancer

Non-EP EP




Cancer Cascade WorkshopE-cigarettes

Cancer Cascade WorkshopE-cigarettes – RCGP November Clinical News


E-cigarettesToxicity:• Smoking tobacco: >7000 chemicals1

• Vaping: 42 chemicals2 – though will vary

1. http://www.cdc.gov/tobacco/data_statistics/sgr/2010/consumer_booklet/chemicals_smoke/2. http://www.gaspforair.org/gasp/gedc/pdf/E-CigSmoke.pdf


E-cigarettesToxicity:

Eur Addict Res 2014;20:218-225


E-cigarettesConcerns:1. Entry into smoking?2. Safety?3. Is it effective in cessation?4. Is passive vaping of concern?5. Should we wait for more research?


E-cigarettesConcerns:1. Entry into smoking?

• Use in children is rare – of those who do, most are ex-smokers

• Youth smoking: 1996 13% 2014 3%1

1. Smoking drinking and drug use among young people in England 2014, HSCIC, www.hscic.gov.uk/pubs/sdd14

http://www.hscic.gov.uk/pubs/sdd14


E-cigarettesConcerns:1. Entry into smoking?2. Safety?

• Long term safety profile not yet known –but much safer than cigarettes1

• PHE report 95% safer than cigarettes2

1. McRobbie H, Bullen C, Hartmann-Boyce J, Hajek P. Electronic cigarettes for smoking cessation and reduction. Cochrane Database of Systematic Reviews 2014, Issue 12. Art. No.: CD010216. DOI:

2. www.gov.uk/government/uploads/system/uploads/attachment_data/file/454517/Ecigarettes_a_firm_foundation_for_evidence_based_policy_and_practice.pdf


E-cigarettesConcerns:1. Entry into smoking?2. Safety?3. Is it effective in cessation?

• Since 2013 ECs are England’s most successful quitting aid1

1. Smoking Toolkit Study www.smokinginengland.info

http://www.smokinginengland.info/


E-cigarettesConcerns:1. Entry into smoking?2. Safety?3. Is it effective in cessation?4. Is passive vaping of concern?

• No identified hazards to bystanders1

1. McRobbie H, Bullen C, Hartmann-Boyce J, Hajek P. Electronic cigarettes for smoking cessation and reduction. Cochrane Database of Systematic Reviews 2014, Issue 12. Art. No.: CD010216. DOI:


E-cigarettesConcerns:1. Entry into smoking?2. Safety?3. Is it effective in cessation?4. Is passive vaping of concern?5. Should we wait for more research?

• No – the benefits are so larger, there are lives to be saved…


E-cigarettesPosition statement now adopted


Cigarette smoking prevalence

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https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/541959/Local_tobacco_control_profiles_indicators_at_a_glance_August_2016.pdf accessed 6.10.16http://www.smokinginengland.info/latest-statistics/ Accessed 6.10.16

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/541959/Local_tobacco_control_profiles_indicators_at_a_glance_August_2016.pdf

http://www.smokinginengland.info/latest-statistics/


% of smokers trying to stop

www.smokinginengland.info/latest-statistics


Cigarette smoking prevalence


What’s new?• New CRUK Stats/infographics

http://www.cancerresearchuk.org/about-cancer/causes-of-cancer/smoking-and-cancer/how-to-stop-smoking last accessed 26.11.16


New CRUK Stats/infographics

http://www.cancerresearchuk.org/about-cancer/causes-of-cancer/smoking-and-cancer/how-to-stop-smoking



http://www.cancerresearchuk.org/about-cancer/causes-of-cancer/diet-and-cancer/how-healthy-eating-prevents-cancer last accessed 8.10.16

http://www.cancerresearchuk.org/about-cancer/causes-of-cancer/diet-and-cancer/how-healthy-eating-prevents-cancer



http://www.cancerresearchuk.org/about-cancer/causes-of-cancer/physical-activity-and-cancer/how-physical-activity-prevents-cancer last accessed 8.10.16

http://www.cancerresearchuk.org/about-cancer/causes-of-cancer/physical-activity-and-cancer/how-physical-activity-prevents-cancer



https://pbs.twimg.com/media/B2uE_6vCQAAB_pK.png last accessed 8.10.16

https://pbs.twimg.com/media/B2uE_6vCQAAB_pK.png



http://www.cancerresearchuk.org/prod_consump/groups/cr_common/@cah/@gen/documents/image/cr_123923.png last accessed 8.10.16

http://www.cancerresearchuk.org/prod_consump/groups/cr_common/@cah/@gen/documents/image/cr_123923.png



http://publications.cancerresearchuk.org/downloads/Product/prostate_screening_info.pdf last accessed 8.10.16

http://publications.cancerresearchuk.org/downloads/Product/prostate_screening_info.pdf


• Dismantling Scottish QOF• Formation of GP Clusters


• Dismantling Scottish QOF• Formation of GP ClustersRCGP Publication:Setting the strategy for Quality in Scotland’s General Practices


RCGP Publication:Setting the strategy for Quality in Scotland’s General Practices

file:///D:/Users/The%20Roopes/Downloads/Setting%20the%20Strategy%20for%20Quality%20for%20Scotlands%20general%20practices%20%20Final.pdf


RCGP Publication:Setting the strategy for Quality in Scotland’s General Practices

RCGP Scotland is committed to building QI activities into the role of all members of the primary health care team and to the inclusion of the patient/public voice in designing QI activities at all levels from individual practices to national organisations.


What’s new?• Breast cancer presentation• Very brief intervention• Colorectal paper • E-cigarettes• New CRUK Stats/infographics• Dismantling Scottish QOF• Formation of GP Clusters


What’s new?• LOTS…!!!


What’s new?• LOTS…!!!

KEEPCALM

EXCITINGTIMES AHEAD

!!

cancer cascade workshop the studio, glasgow 1st december … · 2016-12-09 · cancer cascade...

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