Advice to Trusts on maintaining cancer treatment during the COVID-19 response

Second phase of NHS response to COVID-19 for cancer services
NHS England 8 June 2020

Advice to Trusts on maintaining cancer treatment during the COVID-19 response
NHS England 30 March 2020

• Advice around continuing cancer care during the response to the COVID-19 emergency.
• Includes reorganisation of cancer care centres, management of 2WW referrals, and Clinical guide for the management of non-coronavirus patients requiring acute treatment: Cancer
• Cancer surgery hubs recommended
1. Central triage point within a local cancer system
2. Consolidation of cancer surgery on ‘clean’ sites 
3. Clinical guide for the management of non-coronavirus patients requiring acute treatment: Cancer 

ICNARC report on COVID-19 in critical care

Report on COVID-19 in critical care
Intensive Care National Audit and Research Centre (ICNARC) updated 1 May 2020

• This report presents analyses of data on patients critically ill with confirmed COVID-19 reported to ICNARC from critical care units participating in the Case Mix Programme (the national clinical audit covering all NHS adult, general intensive care and combined intensive care/high dependency units in England, Wales and Northern Ireland, plus some additional specialist and non-NHS critical care units).

COVID-19 Information and Resources for cancer

COVID-19 [Cancer] Information and Resources
West Midlands Cancer Alliance, updated 24 April 2020

• Includes a collection of guidelines to support cancer services during the COVID-19 pandemic from professional bodies eg Association of Breast Surgery at The Royal College of Surgeons of England and British Association of Urological Surgeons and relating to cancer related procedures.

Shoulder replacement surgery for osteoarthritis and rotator cuff tear arthropathy.

Shoulder replacement surgery for osteoarthritis and rotator cuff tear arthropathy.
Cochrane Database of Systematic Reviews 21 April 2020, Issue 4. Art. No.: CD012879. DOI: 10.1002/14651858.CD012879.pub2.

• Conclusion: Although it is an established procedure, no high‐quality randomised trials have been conducted to determine whether shoulder replacement might be more effective than other treatments for osteoarthritis or rotator cuff tear arthropathy of the shoulder. We remain uncertain about which type or technique of shoulder replacement surgery is most effective in different situations.

Estimating excess mortality in people with cancer and multimorbidity in the COVID-19 emergency [Preprint]

Estimating excess mortality in people with cancer and multimorbidity in the COVID-19 emergency [Preprint]
ResearchGate accessed 29 April 2020 DOI: 10.13140/RG.2.2.34254.82242

• "The model estimated 6,270 excess deaths at 1 year in England."
• "In England, the proportion of patients with incident cancer with≥1 comorbidity was 65.2%. The number of comorbidities was strongly associated with can-cer mortality risk. "

Read a commentary on this research  here:

Deaths in people with cancer could rise by at least 20%
Imperial College Health Data Research Hub for Cancer 29 April 2020

Gene therapy for haemophilia

Gene therapy for haemophilia.
Cochrane Database of Systematic Reviews 28 April 2020, Issue 4. Art. No.: CD010822. DOI: 10.1002/14651858.CD010822.pub4.

• "We found no trials to provide reliable evidence about the risks or benefits of gene therapy for haemophilia."

Increased number of reported cases of novel presentation of multisystem inflammatory disease

Increased number of reported cases of novel presentation of multisystem inflammatory disease
Paediatric Intensive Care Society 27 April 2020

• Discussion of the link between a small rise in the number of cases of critically ill children presenting with an unusual clinical picture and COVID-19.

Cancer patients in England: diagnostic intervals - commentary

Cancer patients in England: diagnostic intervals
PHE 21 April 2020

• Population-based statistics on diagnostic intervals for cancer patients for 24 cancer types diagnosed in 2014 and 2015 in England. 
• This commentary accompanies an interactive tool that presents these diagnostic intervals and frequencies by age at diagnosis, stage at diagnosis, broad ethnic group, Charlson comorbidity index, income deprivation, sex and Cancer Alliance. 
• It includes new insights by ethnicity, stage and comorbidity.

Rare Diseases Advisory Group (RDAG): Terms of reference

Rare Diseases Advisory Group (RDAG): Terms of reference
NHS England 10 March 2020

• Terms of reference for the Rare Diseases Advisory Group (RDAG).

Clinical guide for the management of essential cancer surgery for adults during the coronavirus pandemic

Specialty guides for patient management during the coronavirus pandemic: Clinical guide for the management of essential cancer surgery for adults during the coronavirus pandemic
Academy of Medical Royal Colleges 7 April 2020

• This supplementary guidance, which builds on the experience in China, Italy and London, supports cancer services on the prioritisation and management of essential cancer surgery 2 | Clinical guide for the management of essential cancer surgery for adults during the coronavirus pandemic for adults during the COVID-19 emergency.

Adult liver transplantation: A UK clinical guideline

Adult liver transplantation: A UK clinical guideline
British Society of Gastroenterology 4 April 2020

• Part 1 of this guideline has dealt with all aspects of liver transplantation up to the point of placement on the waiting list. Part 2 explains the organ allocation process, organ donation and organ type and how this influences the choice of recipient.

Tele-Critical Care: An Update From the Society of Critical Care Medicine Tele-ICU Committee.

Tele-Critical Care: An Update From the Society of Critical Care Medicine Tele-ICU Committee.
Crit Care Med. 2020 Apr;48(4):553-561. doi: 10.1097/CCM.0000000000004190.

• This article provides insight into tele-critical care's (TCC) evolving prevalence, functions, emerging trends, technologies, new applications, outcomes, and barriers. This term accommodates the concept that TCC services can be provided to locations beyond the physical confines of an ICU, or even a hospital.

Abstract:

Big data registries in spine surgery research: the lurking dangers

Big data registries in spine surgery research: the lurking dangers
BMJ Evidence-Based Medicine 22 March 2020. doi: 10.1136/bmjebm-2019-111333

• Spine surgery research has benefited from the use of national databases and registries. However inappropriate use of these registries continues to be a growing concern as potentially false or inaccurate conclusions can adversely impact clinical practice. Knowledge of methodological requirements in the use and analyses of registry data is essential to ensuring quality evidence with proper interpretation.

Head and neck cancer in the digital age: an evaluation of mobile health applications

Head and neck cancer in the digital age: an evaluation of mobile health applications
BMJ Innovations 2020;6:13-17. 12 March 2020

• This study was performed to assess the performance of three popular ‘artificial intelligence’ symptom checkers currently available to the public (Babylon (London), Your.md (London) and Ada (Ada Health GmbH, Munich) and evaluate their accuracy as a screening tool for head and neck cancer symptoms.

Abstract

Artificial intelligence for analysing CT brain scans

Artificial intelligence for analysing CT brain scans
NICE Medtech innovation briefing [MIB207] 17 March 2020

• Review of six AI software packages designed to automatically detect and notify healthcare professionals of abnormalities after analysis of brain CT scans. Includes costs.

Critical care transition programs on readmission or death: A systematic review and meta-analysis

Critical care transition programs on readmission or death: A systematic review and meta-analysis
Acta Anaesthesiologica Scandinavica;13 March 2020 DOI: 10.1111/aas.13591

• A review of interventions (eg, critical care transition programs) developed to improve the clinical handover between the ICU and the ward found 15 low quality observational studies, and no clear benefit in terms of reducing risk of readmission or death after ICU discharge.

Abstract

Proton beam therapy: perspectives on the NHS clinical service and research programme.

Proton beam therapy: perspectives on the National Health Service England clinical service and research programme.
British Journal of Radiology; Mar 2020; vol. 93 (no. 1107); p. 20190873

• A discussion of the role of the NHS Proton Beam Therapy service in the UK, first opened in 2018.
• See the NHS England website for Proton beam therapy evidence statements

Abstract:

Specialised complex surgery for urinary incontinence and vaginal and uterine prolapse (16 years and above)

Service specification: Specialised complex surgery for urinary incontinence and vaginal and uterine prolapse (16 years and above)
NHS England 27 February 2020

• This service specification describes specialised complex surgery services for urinary incontinence and vaginal and uterine prolapse.

Evidence for a dedicated non-specific symptoms pathway

Cross-sectional study using primary care and cancer registration data to investigate patients with cancer presenting with non-specific symptoms
BMJ Open 2020;10:e033008. 10 January 2020. doi: 10.1136/bmjopen-2019-033008

• Patients with non-specific symptoms have not typically had access to a dedicated referral pathway. To address this imbalance, ACE piloted the Multidisciplinary Diagnostic Centre (MDC) concept in England over the period 2017-2018. To better understand the current experience of this cohort of patients ACE linked cancer registrations from 2014 with primary care information from the National Cancer and Diagnosis Audit. This paper compares MDC-similar patients (those with non-specific symptoms) to those who had a symptom which would usually result in an urgent referral.
• Analyses showed that non-specific symptoms patients were more likely to be diagnosed at stage 4, have multiple visits to the GP and experience longer primary care intervals. Differences in the diagnostic pathway show that patients with symptoms mirroring the MDC referral criteria could benefit from a new referral pathway.