Second-generation colon capsule endoscopy (CCE-2) for the detection of colorectal polyps

Second-generation colon capsule endoscopy (CCE-2) for the detection of colorectal polyps
Scottish Health Technologies Group Recommendation August 2020

• Clinical and cost effectiveness of PillCam™ Colon-2 (second-generation colon capsule endoscopy (CCE-2)), compared with optical colonoscopy or computed tomographic colonography (CTC), for identifying colorectal polyps in adults with signs or symptoms of colorectal cancer or at increased risk of colorectal cancer.

The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK

The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study.
Lancet Oncol 2020, 20 July 2020; https://doi.org/10.1016/S1470-2045(20)30388-0
See Online/Comment https://doi.org/10.1016/S1470-2045(20)30391-0

• In this study the authors estimate the impact of delays in diagnosis on cancer survival outcomes in four major tumour types: breast cancer, colorectal cancer, oesophageal cancer, and lung cancer. For these four tumour types, these data correspond with 3291–3621 additional deaths across the scenarios within 5 years.

Routes to Cancer Diagnosis data

Routes to Cancer Diagnosis 2010-2017
National Cancer Registration and Analysis Service (NCRAS) 14 July 2020

• Routes to Diagnosis categorises the pathways that lead to a patient’s diagnosis of cancer. These results provide an overview of the results for 2006 to 2017, showing the trends over time for all malignant neoplasms (excluding non-melanoma skin cancer) and a snapshot of results in 2017 for female breast, colorectal, lung and prostate cancers.
• One of the aspects highlighted by Routes to Diagnosis is the inequality in how people are diagnosed. A study by Herbert and others found that age and deprivation affect the route to diagnosis. Older people continue to make up the bulk of those diagnosed as an emergency presentation, and those who are more deprived are also more likely to be diagnosed through this route.

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.

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

Clinical standards - Faster Dignosis Standard

Clinical Review of Standards: Progress Update
NHS England / Improvement Board meeting 30 January 2020

• The paper notes the progress to date and the latest learning from the Clinically-led Review of NHS Access Standards, including cancer proposals.
• Initial testing during phase one focused on demonstrating that there is no detriment either to patients or overall operational performance in moving to the Faster Diagnosis Standard, with phase two focussing more specifically on the impact of interventions to improve 28-day performance. This review will make its final recommendations in respect of cancer in the spring of 2020.

Rapid cancer diagnosis for patients with vague symptoms: a cost-effectiveness studyRapid cancer diagnosis for patients with vague symptoms: a cost-effectiveness study

Rapid cancer diagnosis for patients with vague symptoms: a cost-effectiveness study
British Journal of General Practice 2020; 70 (692): e186-e192. DOI: https://doi.org/10.3399/bjgp20X708077
Data from a pilot study at Neath Port Talbot Hospital indicates that a Rapid Diagnosis Centre for patients presenting with vague or non-specific symptoms suspicious of cancer in primary care reduces time to diagnosis and provides excellent value for money if run at ≥80% capacity.

Abstract

The 28 Day Faster Diagnosis Standard (FDS)

The 28 Day Faster Diagnosis Standard (FDS)
RM Partners February 2020

• A description of the Faster Diagnosis Standard for cancer.

Making the Case for the early and Rapid Diagnosis of Lung Cancer

Early Diagnosis Matters: Making the Case for the early and Rapid Diagnosis of Lung Cancer
UK Lung Cancer Coalition (UKLCC) January 2020

• The majority of lung cancer patients are diagnosed at a late stage of the disease. This report looks at various issues which could achieve early diagnosis in a higher proportion of patients, from awareness campaigns to the aim of establishing a national screening programme and improving primary care access to diagnostic tests.

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.

International evaluation of an AI system for breast cancer screening

International evaluation of an AI system for breast cancer screening
Nature v577, p89–94 (1 January 2020)

• DeepMind and Google Health have developed a new AI system to help doctors detect breast cancer early. The researchers trained an algorithm on mammogram images from female patients in the US and UK, and it performed better than human radiologists.

National Prostate Cancer Audit Short Report – Prostate Biopsy

National Prostate Cancer Audit Short Report – Prostate Biopsy
HQIP 13 December 2019

• This report assesses how prostate biopsies are performed across England, comparing the risk of complications between transrectal (TR) biopsies and transperineal (TP) biopsies using nationwide data from the National Prostate Cancer Audit (NPCA) and Hospital Episode Statistics (HES). It also examines how the risk of complications is affected by the biopsy approach.
• The report finds that the proportion of men undergoing a TP biopsy has nearly doubled within 3 years (14% – 25%).

The association between cancer outcomes and time intervals to diagnosis and treatment

The association between cancer outcomes and time intervals to diagnosis and treatment
Healthcare Improvement Scotland, SHTG team, updated October 2019

• A review of the evidence around the association between cancer outcomes and time intervals to diagnosis and treatment was inconclusive due to heterogeneity across the evidence base. Well conducted systematic reviews were identified for head and neck cancers, colon cancer and prostate cancer

MRI for patients with CIEDs: simplifying complexity with a ‘one-stop’ service model

MRI for patients with cardiac implantable electronic devices: simplifying complexity with a ‘one-stop’ service model
BMJ Quality & Safety 2019;28:853-858, 19 September 2019

• MRI scanning for patients with cardiac implantable electronic devices (CIEDs) requires some additional steps to be taken both prior to imaging and on attendance. 
• A one stop service model [Barts Hospital NHS Trust, London] whereby CIEDs could be reprogrammed and scans acquired at a single location on a single visit is described, including workforce impact, and development of a standard booking protocol. No additional equipment or other fixed costs were needed. After 2 years, scan volume was over 20 times the national average with a lower waiting time, and while maintaining total departmental activity.

Rapid Diagnostic Centres: Vision and 2019/20 Implementation Specification

Rapid Diagnostic Centres: Vision and 2019/20 Implementation Specification
NHS England 25 July 2019

• This document outlines the vision and approach for how Rapid Diagnostic Centres will develop and support the transformation of cancer diagnosis services over time. It also provides an implementation specification for Cancer Alliances to begin setting up Rapid Diagnostic Centres in 2019/20. 
• The RDC service model has evolved from the Multidisciplinary Diagnostic Centre (MDC) service model.
• See Diagnosing cancer earlier and faster (NHS England)

Whole-body MRI is effective for identifying metastatic disease in colorectal cancer patients - prospective Streamline C trial

Whole-body MRI is effective for identifying metastatic disease in colorectal cancer patients - prospective Streamline C trial
NIHR Signal 23 July 2019

• Initial investigation which includes whole-body magnetic resonance imaging (MRI) is as good as standard pathways for detecting metastatic disease in adults with newly diagnosed colorectal cancer. The study also found that whole-body MRI reduces the number of investigations needed, the length of the staging process, and costs less than standard pathways.
• Current NICE guidance recommends a sequence of investigations for staging, with MRI only recommended after biopsies and other imaging investigations. This study suggests that MRI could be used earlier in the process, instead of the currently recommended investigations. However, any changes to guidance would need to take into account the availability of this resource.
• Study: The Streamline C trial was a prospective, multicentre trial done in 16 hospitals in England between 26 March 26 2013 and 19 Aug 2016. Eligible patients were 18 years or older, with newly diagnosed colorectal cancer, 1020 patients were screened for eligibility. 370 patients were recruited, 299 of whom completed the trial.

Whole-body MRI scans are as accurate as standard imaging pathways for lung cancer staging - the Streamline L trial.

Whole-body MRI scans are as accurate as standard imaging pathways for lung cancer staging - the prospective Streamline L trial.
NIHR Signal 23 July 2019

• Using whole-body magnetic resonance imaging (WB-MRI) in the initial investigation pathway is as good as standard pathways for detecting metastatic disease in adults with non-small-cell lung cancer. The study (Streamline L trial) also found that WB-MRI used for diagnosis and staging is quicker, cheaper and requires fewer other investigations than standard pathways.
• Current NICE guidance recommends a sequence of investigations for staging – assessing the extent of cancer in order to plan appropriate treatment. MRI of different areas of the body is only recommended after other imaging investigations. This study suggests that whole-body MRI could have a role earlier in the pathway.
• Study: The Streamline L trial was a prospective, multicentre trial done in 16 hospitals in Englandca rried out between 26 Feb 2013 and 5 Sept 2016. 976 patients were screened for eligibility. 353 patients were recruited, 187 of whom completed the trial.

Seven things we learnt by measuring the length of cancer diagnostic pathways

Seven things we learnt by measuring the length of cancer diagnostic pathways [blogpost]
PHE 1 July 2019

• Commentary on analysis of data for secondary care diagnostic intervals (SCDIs) for cancer patients in England diagnosed in 2014-2015.
• SCDI data can be viewed and downloaded from a Cancer Data online tool, which displays different cancer types by demographic factors and Cancer Alliance. Using this tool, it is possible to understand how these intervals vary across different stages of disease, age, sex, ethnicity, comorbidities, levels of deprivation, routes to diagnosis and in different parts of England, to support initiatives to diagnose cancer faster within the NHS.

Genomics: the power, potential and pitfalls of the new technologies and how they are transforming healthcare

Genomics: the power, potential and pitfalls of the new technologies and how they are transforming healthcare
Clin Med 1 July 2019 vol. 19 no. 4269-272

• Through five patient-focused scenarios with accompanying interviews, this article showcases new genomic technologies while highlighting the inherent challenges associated with complex genomic data.
• Case study 5 describes the use of genomics to indicate an inherited predisposition to colorectal cancer (personalised medicine).

Which cancers would benefit most from earlier diagnosis?

Which cancers would benefit most from earlier diagnosis?
ONS 18 June 2019

• While all cancers would benefit from earlier diagnosis, there are some cancers where earlier diagnosis would have a greater impact on survival. Colorectal and kidney cancer patients would see the greatest increase in their chances of survival if they were diagnosed at an earlier stage, data shows.
• The report includes proportion of people diagnosed at each stage, and overall net-survival for prostate, breast, kidney, colorectal, ovary and lung cancers.