US cancer death rates continue to fall as 5-year survival rates rise – study

Cancer death rates in the United States are continuing to fall and the five-year survival rates of those diagnosed with the disease have risen, research shows.

The Annual Report to the Nation on the Status of Cancer, published on Friday, also shows a decline in incidence of cancer among men in recent years, although it remained stable among women.

Death rates from 2010 to 2014 decreased for 11 of the 16 most common types of cancer in men and for 13 of the 18 most common types of cancer in women, including lung, colorectal, female breast, and prostate cancers.

The authors, from the American Cancer Society, the Centers for Disease Control and Prevention, the National Cancer Institute and the North American Association of Central Cancer Registries (NAACCR) suggest a decline in smoking – down more than 50% over the last 50 years – as well as improved early detection and more effective treatment helped bring about the fall.

But they warn that smoking continues to pose a threat along with obesity, rates of which are at 20% or or more in every state.

NAACCR executive director Betsy Kohler said. “The continued drops in overall cancer death rates in the United States are welcome news, reflecting improvements in prevention, early detection, and treatment.

“But this report also shows us that progress has been limited for several cancers, which should compel us to renew our commitment to efforts to discover new strategies for prevention, early detection, and treatment, and to apply proven interventions broadly and equitably.”

The report, published in the Journal of the National Cancer Institute, showed that death rates increased for cancers of the liver, pancreas, and brain in men and for liver and uterine cancer in women.

Overall, cancer death rates decreased by 1.8% per year in men and 1.4% a year in women.

During the period 1999 to 2013, cancer incidence rates in men fell by 2.3%, according to the study.

Compared with cases diagnosed between 1975 and 1977, five-year survival for cancers diagnosed in 2006 to 2012 increased significantly for all manifestations of the disease bar cervical and uterine cancer.

The greatest absolute increases in survival (25% or greater) were seen in prostate and kidney cancers, non-Hodgkin lymphoma, myeloma (bone marrow cancer) and leukaemia.

Further improvements in survival prospects are expected in the wake of recent advances in precision medicine and immunotherapy for late stage cancers. But the authors warn that the high cost of new cancer drugs – up to $ 10,000 (£8,000) per month – may put them out of reach even to Medicare-insured patients, who would still be left with a bill for around 20% of the drug’s cost.

US cancer death rates continue to fall as 5-year survival rates rise – study

Women are capable of choosing whether to continue a pregnancy | Letters

We congratulate Diana Johnston for introducing her bill (New bill to challenge UK’s Victorian-era abortion law, 14 March) and are delighted it was passed by 172 to 142 votes. As a 10-minute rule bill, it has no chance of becoming law, but it is important in starting the debate about whether, after 50 years, it is time to revisit the 1967 Abortion Act. It is time to treat abortion like any other medical procedure, and control it with regulation and the GMC. It is wrong that three women have been jailed or had a suspended sentence, and that doctors responding to women’s requests may face criminal prosecution. Many people (and even some gynaecologists) do not realise abortion is a criminal offence unless it conforms with the conditions set out in the Act. Up to 80% of people polled believe the woman should make the decision in consultation with her doctor and 90% of a random sample of gynaecologists surveyed in 2015 said that the woman should make the decision to end her pregnancy. It is time for women to be treated as autonomous adults capable of making their own decisions about continuing a pregnancy, a view that the some tabloid newspapers seem incapable of understanding.
Wendy Savage
Co-ordinator, Doctors for a Woman’s Choice on Abortion

• Join the debate – email guardian.letters@theguardian.com

• Read more Guardian letters – click here to visit gu.com/letters

Women are capable of choosing whether to continue a pregnancy | Letters

In NHS management being fired means you continue working for more money

When I had to leave my role as a senior NHS manager, I discovered that the health service has a well-used but little-known system for easing people out of top jobs. And I learned that it doesn’t work well for anyone: trusts, our healthcare system, managers, patients or the taxpayer.

It’s quite common for senior leaders to have to step down, even when there are no performance issues and their actions haven’t risked patient safety. Sometimes, as in any sector, people simply end up in jobs that aren’t right for them. And just as often, managers, keen to support NHS bodies through difficult change projects, take on tasks that prove impossible to accomplish.

My case is typical. Individual hospitals are being pushed to group together in larger organisations, centralising specialist care and closing some common services with overlapping coverage. And the timetables for these ambitious reforms are sometimes built around political cycles, rather than good medical care or change management. I ended up overseeing a major change programme – but the deadline was unrealistic, and staff shortages were so acute that we couldn’t recruit enough experienced medics. After a period we got things under control; but senior management made clear that they wanted a change of leadership, believing that it would draw a line in the sand and signal a fresh start.

In the private sector, I’d have been given a fat pay-off and sent on my way. But in UK public healthcare it’s not acceptable to spend taxpayers’ money that way, and departing managers have nowhere else to go: the NHS is the only game in town. So I was summoned to a meeting, and offered a sideways move into a national role at NHS Improvement: the agency responsible for improving practice across the health service.

I soon learned that most such roles at NHS Improvement are one-year contracts, where people do useful work that is rarely followed through into delivery. Working there, some people apply for other NHS jobs and eventually move into senior roles elsewhere in the system. But many, wounded by their treatment and unsure of their chances in the job market, instead use the role as a springboard into interim work; and the NHS is desperately short of skilled, experienced leaders, so it ends up paying them £1,000 a day to plug gaps in its management structures.

Many people offered a one-year job at NHS Improvement would instead be willing to take a less senior job with their current employer, if it meant a permanent job and the chance to stay in the locality. But few are offered this option, and there’s a stigma attached to dropping grades. It’s seen as a sign of personal failure, and there’s an expectation that careers only ever go upwards – which, in these days of long careers and merging organisations, isn’t realistic.

Political leaders and senior management need to recognise that, while not all appointments work out, these people still have skills the NHS needs. And they should understand that failing in an impossible job is a verdict on the job, not the person. After all, those jobs only become impossible because managers are trying to both keep their staff happy, and push through the systemic changes required by national policymakers. The NHS needs to reform, and ministers have a democratic mandate to reshape the system; but currently, the best way to protect your career is to keep your head down, build support among your staff, and resist risky reforms.

With budgets in decline, demand rising, a growing recruitment crisis, and an endless series of new policies and organisational changes, it’s easy for organisations to become over-stretched and leaders to fall out of favour. If the NHS wants people to be ambitious in these very difficult jobs, it shouldn’t push those who run into trouble into temporary non-jobs – and then into an interims market where the NHS must rent their skills back at exorbitant cost.

National leaders need to be more open about the difficulty of succeeding in these hugely challenging jobs, and do everything they can to retain good managers who’ve taken a step back – offering them permanent employment in less high-profile roles. Then people would be more willing to take on the most difficult jobs in NHS management, and there would be less gaps in management grades. That, in turn, would cut the interims bill and improve continuity in organisations that can ill afford excessive staff costs and unstable leadership.

The current system evolved to help protect NHS staff while facilitating necessary leadership changes, but it’s a huge waste of talent as well as money. Politicians and the Department of Health need to be more open, both about the flaws in redeployment processes, and about the pressures that brought us to this point. That would take courage; but if they’re ready to have that conversation, the benefits will be felt by patients and taxpayers as well as NHS managers and policymakers.

If you would like to write a blogpost for Views from the NHS frontline, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

In NHS management being fired means you continue working for more money

The police can’t continue to pick up the pieces of Britain’s mental health cuts | Ian Blair

In my time as the deputy and then commissioner of the Metropolitan police, my primary concerns were with terrorism and issues around diversity. But a constant problem for my officers was dealing with people exhibiting psychotic behaviour in public, which seemed to be getting worse. A main driver of this was the inadequacy and local unpredictability of mental health services.

Since I left office in 2008 the situation has deteriorated more dramatically than I could have imagined, with the latest report suggesting that police across England and Wales are now using powers under section 136 of the 1983 Mental Health Act 50% more than they did a decade ago – nearly 30,000 times in 2014-15. These numbers are a symptom of a crisis in mental health provision.

Section 136 is the power given to police officers to remove individuals who appear to be exhibiting signs of acute mental distress from public places to what is described as “a place of safety”. This should be a hospital but, in an emergency, can be a police station.

There is a similarity here with the much more widely understood crisis in social care for the elderly, with too many simply frail people staying in hospital when they should be being looked after at home. The closure of many psychiatric hospitals in the 1980s under the policy of “care in the community” has put pressure on mental health provision, while the increased geographical mobility of many families makes care by relatives much more challenging

But the real issue, both in social care and mental health, is that money is being spent on crisis-handling rather than on prevention.

The police and hospital A&E units have, in the past decade, become the only 24-hour public services for people in crisis. The police have had severe funding cuts but are still there at the end of a telephone. Anyone working in the NHS will admit that the government’s vaunted “parity of esteem” between physical and mental health has not been honoured, particularly for young people. Meanwhile local authority budgets, which part-fund child and adolescent mental health service and community health teams, have not been protected at all.

In my early service in the 1970s it was a rare sight to see a cell door open with an officer sitting outside, watching

This means funds for services that would have previously been available are being rationed on the basis of seriousness of need. Adult care provision is being refused by cash-strapped local authorities to hundreds of thousands of people who would have previously received it; now they will only get it when their incapacities worsen to the point where they end up in A&E, then in a ward from which they cannot be released because there is no adult social care service to support their recovery at home.

I have lost count of the number of officers dealing with distressed young people – and of friends and acquaintances whose children are so ill as to be taken by police to local psychiatric institutions only to be assessed as not ill enough to be given a bed. All of these are therefore released into the care of community mental health services, whose budgets have also not been protected. Over 200 people took their own life last year while under the care of such services, which lack sufficient resources to prevent difficulties becoming disasters.

Last year the government announced that police cells should never be used for the housing of mentally ill people. Fine, but announcing that something is forbidden is not the same as providing an alternative, as was highlighted during prime minister’s questions last week.

In my early service in the 1970s it was a rare sight in a police station to see a cell door open with an officer sitting outside, watching over a vulnerable person with mental health problems because there was nowhere more suitable to take him or her. Later, it became less rare. Contrary to the government’s intention, that sight will probably remain commonplace for some time, as will cases on the street where officers end up dealing with psychotic individuals without sufficient backup from mental health professionals. It is interesting that the chief constable of Devon and Cornwall is reported to be threatening to sue his local NHS trusts over a lack of mental health beds.

The social care crisis will affect most of us in the coming years, whether as patients or as relatives. Such experiences can be deeply distressing and long-lasting, but unless more money is put into mental health provision, both in residential care and in the community, significant numbers of people will suffer; and families will face the acute and agonising dilemma of how to look after someone at home whose psychotic state is unpredictable, occasionally violent and sometimes self-harming.

Meanwhile the police will continue working to provide a service for which they were not and are not designed. When Robert Peel, who founded the Metropolitan Police in the 1820s, said the police are “only members of the public who are paid to give full-time attention to duties which are incumbent on every citizen in the interests of community welfare”, I don’t think he envisaged them as community mental health workers.

The Home Office judges the success or failure of individual police services by reductions in crime – not on dealing with mental health crises – but unless NHS and council-run mental health services are adequately funded, too much police time will continue to be taken up with a task they are ill-equipped to perform, and which risks jeopardising their role as protectors of the community from crime and terror.

The police can’t continue to pick up the pieces of Britain’s mental health cuts | Ian Blair

Safety worries continue to be above three-man or woman IVF | Ted Morrow

Human embryo at forty days. Photograph: Carolina Biological/Corbis

Later on this year, parliament is anticipated to debate a alter to the law that would let a reproductive treatment named mitochondrial substitute (MR) into fertility clinics. A current review of proof by the United kingdom fertility regulator, the Human Fertilisation and Embryology Authority, stated that this experimental strategy is “not unsafe”. But although the aim of the process is noble – to eliminate human mitochondrial ailments, which have an effect on around 1 in four,000 men and women – a amount of essential safety issues continue to be unresolved.

Evolutionary concept predicts a mismatch in between the DNA in the donor’s mitochondria and the mother’s nuclear DNA, with potentially serious and unpredictable consequences for any embryo designed utilizing MR, an concern my colleagues and I wrote about last 12 months. When MR is carried out experimentally, it has been proven to alter the metabolic process and cognitive capacity of mice. In other species it benefits in male sterility, diminished survival, accelerated ageing and modifications the expression of numerous hundreds of genes. But there is a lack of data from species a lot more closely connected to humans – a gap in our information that we felt would be sensible to fill before proceeding to clinical trials.

The issue of mismatching arises due to the fact of the peculiar way mitochondrial DNA (mtDNA) is inherited through mothers only, offering an possibility every generation for the mtDNA and some of her nuclear DNA to be passed on collectively. This allows organic assortment, nature’s good quality control mechanism, to weed out combinations of interacting mitochondrial and nuclear DNA that are not compatible with a single one more. Over prolonged evolutionary timescales within populations, the two genomes will become matched or “coadapted” to one yet another. MR breaks these coadapted genomes apart, providing rise to a range of damaging results. The particular style of the experiments needed to detect mismatching is particularly essential. They normally involve manipulating a number of distinct mitochondrial types and creating observations in many people. With no these attributes the capacity to detect mismatching is bad. So whilst demonstrations that MR is technically feasible (with the production of four macaques in 2009), it is not ample to rule out the probability that the types of effects seen in other species will not be located in primates or people.

The HFEA appear unconvinced that the coevolutionary process for which there is evidence is true, contemplating “this kind of hypothetical issues to be extremely unlikely”.

The report, passed to the Department of Health on the 2 June 2014, discusses a number of other technical issues connected to the security of the technique, and even outlines a quantity of areas for which far more data is essential. But for the issue of mismatching, they do not advise any more study. This is regarding, as it appears a realistic security concern is getting ignored.

From my perspective as an evolutionary biologist, a frequent thread in the debate so far is that people are somehow particular circumstances, despite the reality that the same set of mitochondrial genes are found from yeast to humans, and that the evolutionary theory is a general one, applying even to plants. This suggests to me that greater exposure to and integration of current evolutionary ideas in the training of biomedical scientists would be beneficial. This is not a new suggestion a whole discipline called Darwinian medication is gradually gaining traction, with the aim of providing health care professionals the capacity to far better predict ailment threat.

It also appears that if evolutionary biologists were incorporated earlier in the consultation procedure, there may have been far more cautious conclusions about the security of MR. The inertia behind the regulatory procedure, collectively with the resistance from biomedical researchers to contemplate evolutionary arguments, is substantial. I propose that in the long term policy makers would do effectively to cast a broader net when searching for experience and evolutionary biologists themselves ought to engage much more with policy makers.

Scientists are usually urged to grow to be more concerned in building proof-primarily based policy, and so it is relatively perplexing to see that when concept and proof are presented they are roundly dismissed as irrelevant or trivial. Evolutionary biology can offer you a excellent deal of understanding about the planet around us, such as ourselves. We need to make use of that expertise.

• Ted Morrow is an evolutionary biologist at the University of Sussex

Safety worries continue to be above three-man or woman IVF | Ted Morrow

Hospitals continue to fail individuals at end of life

Hectic nursing employees frequently will not have adequate time to dedicate to individuals nearing the finish of lifestyle, says John Hughes. Photograph: Alamy

NHS England not too long ago published the Leadership Alliance’s response to the Neuberger assessment of the Liverpool Care Pathway (LCP). 1 Chance To Get It Right sets out five priorities for care for dying people which underpin the necessity to personalise decision generating in the situation of dying folks and their family members.

The LCP tips were designed by the Royal Liverpool University hospital and the Marie Curie Hospice in Liverpool with the aim of assisting hospital staff give men and women who are dying the same kind of high-high quality care provided to individuals in hospices. Even so, as the Neuberger report, and much more not too long ago the Royal University of Physicians’ Nationwide Care of the Dying Audit highlighted, the hospital sector continues to fail men and women nearing end of lifestyle, and their families – compounding their distress at a traumatic and tough time.

So what is going so wrong in our hospitals? And how will the new priorities change factors?

The problems are numerous and complex. Busy hospitals focus on treating individuals who will recover at the expense of assisting these who are dying hard pressed nursing employees concerned with the all-consuming tasks of admitting and discharging individuals have little time to devote to people whose problem needs small energetic intervention. Crucially, for people patients for whom deterioration and death on a hospital ward is, sadly, unavoidable, an investment in nursing “time to care” is an absolute requirement. There is also an underlying culture in the acute sector exactly where clinicians are “in handle” in contrast, pros in hospices and the neighborhood technique caring in a much more holistic way – and defer a lot more naturally to the issues and wishes of individuals and their households.

Rethinking the management of sufferers, whose demands are a lot more usually about care than remedy, is extended overdue.

The skills of palliative care clinicians in the recognition and acceptance of the inevitability of approaching death should be an integral portion of “organ distinct” specialities exactly where several of the issues look to lie. This will outcome in earlier and more truthful discussions with sufferers and households about management possibilities and place of care decisions and, consequently, decrease hospitalisation and lengths of stay.

As to the 2nd question: although the new Priorities for Care are laudable, as we have argued during the assessment of the LCP, minor if something will change unless people at the frontline of care delivery are equipped to put them into practice. And this demands an investment in training and coaching.

Higher top quality care does not come cheap and if NHS England and the Division of Overall health wish to stay away from even more embarrassing reviews on the management of vulnerable and dying people in our acute hospitals, politicians have to accept the accountability to open the discussion about how money is spent on healthcare rather than how cash can be saved.

John Hughes is healthcare director at Sue Ryder

Are you a member of our on the internet local community? Join the Healthcare Professionals Network to acquire regular emails and exclusive delivers.

Hospitals continue to fail individuals at end of life