The Thin End

The Thin End has referred to the 'hidden' health cost of the COVID pandemic in previous articles.  Clearing the decks to prevent the National Health Service being overwhelmed meant that others had their diagnosis and treatment put on hold.  What the government should do now is to learn the lesson to build resilience into the system.  Else, we are saving the lives of those directly affected by a pandemic while allowing the health and lives of others to be lost.  This has been particularly evident in cancer services.  It is challenging to see the real ethics of that choice.  Sacrificing Peter to save Paul is not the best approach.   On the contrary, it had all the hallmarks of a panic response.  NHS England has now prioritised cancer services, but an analysis produced this month by The Institute for Public Policy Research (IPPR) says that the UK government must now use the opportunity of restarting cancer services in the NHS to "build back better." ...

New research indicates that taking vitamin D supplements may help prevent a potentially serious side effect of a revolutionary form of anti-cancer therapy. The findings are published early online in CANCER , a peer-reviewed journal of the American Cancer Society (ACS). An important capacity of the immune system is its ability to distinguish between normal cells in the body and those it sees as “foreign.” This lets the immune system attack the foreign cells while leaving the normal cells alone. To do this, it uses “checkpoints.” Immune checkpoints are molecules on certain immune cells that need to be activated (or inactivated) to start an immune response. Immune checkpoint inhibitors help the immune system recognize and combat cancer cells, and although these treatments have helped many patients and have prolonged lives, they can cause side effects such as colitis, an inflammatory reaction in the colon.  “Immune checkpoint inhibitor-induced colitis can limit the use of such life-sav...

Family history has always been important in medical diagnosis and treatment.  In the treatment of cancers, early detection can improve the chances of survival.  Now a new study published online in  CANCER  shows the importance of family history in the detection and prevention of colorectal cancer. In the analysis that included information on adults diagnosed with colorectal cancer between 40 and 49 years of age, almost all patients could have been diagnosed earlier if they had been screened according to current family history–based screening guidelines.  In many countries, colorectal cancer rates are rising in adults under 50 years of age. To identify those at risk, current guidelines recommend early screening for colorectal cancer among individuals with a family history of the disease. For example, for individuals with a first-degree relative with colorectal cancer, several medical societies recommend initiating screening at 40 years of age or 10 ye...

For many years I served on NHS research ethics committees.  One aspect of clinical trials that always concerned us was how representative any trial was of the population.  This matters a great deal, as biased samples may give erroneous results or miss results that are of crucial importance   Now, new research has revealed bias and stereotyping among clinical and research professionals who recruit patients to enrol in cancer clinical trials. The findings are published online in CANCER , a peer-reviewed journal of the American Cancer Society (ACS). It is important to include diverse patients in clinical trials to ensure that the results will apply to patients in the general population. One form of bias is in the selection of those on the trail.  The proportion of racial and ethnic minorities participating in cancer clinical trials is persistently lower than the proportion of minorities in the U.S. population at large.  This has the potential for g...

The incidence of liver cancer is rising worldwide.  Now new research suggests this is being driven by the rise in obesity.  The new research reveals rising rates of liver cancer around the world, despite advances aimed at preventing the disease. The findings are published,   CANCER , the journal of the American Cancer Society.  To obtain trends and estimates of liver cancer by age, sex, region, and cause,  Dr Xingdong Chen,  of Fudan University in China, and his colleagues examined 1990–2017 data from the Global Burden of Disease Study covering 195 countries and territories. Globally, liver cancer cases diagnosed before the age of 30 years decreased from 17,381 in 1990 to 14,661 in 2017, but they increased in people aged 30–59 years and 60 years and older from 216,561 and 241,189 in 1990 to 359,770 and 578,344 in 2017, respectively. When applying age adjustments (to allow populations to be compared when the age profiles of the populations are ...

Events in childhood influence profoundly how we cope with poor health as adults.  Now, a new study shows that those who experienced childhood trauma are more likely to have advanced cancer in later life. Among individuals with head and neck cancer, those who experienced childhood trauma were more likely to have advanced cancer, to have higher alcohol consumption, and to experience symptoms of anxiety and depression. Published early online in CANCER , a peer-reviewed journal of the American Cancer Society, the findings indicate that childhood trauma history should be considered during treatment for head and neck cancers. Stress, anxiety and depression Individuals may experience high levels of stress, anxiety, and depression during and after cancer diagnosis and treatment.  Because human social interaction and emotional expression depend largely on the structural and functional integrity of the head and neck region, the diagnosis and treatment of HNC have...