The association of cancer survival with four socioeconomic indicators: a longitudinal study of the older population of England and Wales 1981–2000

BACKGROUND: Many studies have found socioeconomic differentials in cancer survival. Previous studies have generally demonstrated poorer cancer survival with decreasing socioeconomic status but mostly used only ecological measures of status and analytical methods estimating simple survival. This study investigate socio-economic differentials in cancer survival using four indicators of socioeconomic status; three individual and one ecological. It uses a relative survival method which gives a measure of excess mortality due to cancer. METHODS: This study uses prospective record linkage data from The Office for National Statistics Longitudinal Study for England and Wales. The participants are Longitudinal Study members, recorded at census in 1971 and 1981 and with a primary malignant cancer diagnosed at age 45 or above, between 1981 and 1997, with follow-up until end 2000. The outcome measure is relative survival/excess mortality, compared with age and sex adjusted survival of the general population. Relative survival and Poisson regression analyses are presented, giving models of relative excess mortality, adjusted for covariates. RESULTS: Different socioeconomic indicators detect survival differentials of varying magnitude and definition. For all cancers combined, the four indicators show similar effects. For individual cancers there are differences between indicators. Where there is an association, all indicators show poorer survival with lower socioeconomic status. CONCLUSION: Cancer survival differs markedly by socio-economic status. The commonly used ecological measure, the Carstairs Index, is adequate at demonstrating socioeconomic differentials in survival for combined cancers and some individual cancers. A combination of car access and housing tenure is more sensitive than the ecological Carstairs measure at detecting socioeconomic effects on survival – confirming Carstairs effects where they occur but additionally identifying effects for other cancers. Social class is a relatively weak indicator of survival differentials

Treatment of Canine Osseous Tumors with Photodynamic Therapy: A Pilot Study

Photodynamic therapy uses nonthermal coherent light delivered via fiber optic cable to locally activate a photosensitive chemotherapeutic agent that ablates tumor tissue. Owing to the limitations of light penetration, it is unknown whether photodynamic therapy can treat large osseous tumors. We determined whether photodynamic therapy can induce necrosis in large osseous tumors, and if so, to quantify the volume of treated tissue. In a pilot study we treated seven dogs with spontaneous osteosarcomas of the distal radius. Tumors were imaged with MRI before and 48 hours after treatment, and the volumes of hypointense regions were compared. The treated limbs were amputated immediately after imaging at 48 hours and sectioned corresponding to the MR axial images. We identified tumor necrosis histologically; the regions of necrosis corresponded anatomically to hypointense tissue on MRI. The mean volume of necrotic tissue seen on MRI after photodynamic therapy was 21,305 mm3 compared with a pretreatment volume of 6108 mm3. These pilot data suggest photodynamic therapy penetrates relatively large canine osseous tumors and may be a useful adjunct for treatment of bone tumors

Transforming cancer outcomes in England: earlier and faster diagnoses, pathways to success, and empowering alliances

Christopher J Harrison,1 Roger G Spencer,2 David C Shackley3 1University of Manchester Division of Cancer Sciences, The Christie NHS Foundation Trust, Manchester, UK; 2Chief Executive’s Office, The Christie NHS Foundation Trust, Manchester, UK; 3University of Manchester Division of Cancer Sciences, Greater Manchester Cancer, Manchester, UK Abstract: Cancer outcomes and patient experience in England have never been better but survival remains worse than in comparable countries. Differences in stage at diagnosis and, to a lesser extent, access to optimal treatments are likely to be the most important factors. The national cancer plan emphasizes earlier and faster diagnosis and the creation of cancer alliances providing strategic leadership and coordination. Earlier diagnosis is being promoted by national awareness campaigns designed to overcome fatalism and perceived barriers to consulting a general practitioner as well as improvements to existing screening programs and the introduction of more targeted screening such as Lung Health Checks. These are supported by local social marketing campaigns in which trained volunteers support and advise others about cancer and cancer care. The epidemiology of symptoms in general practice provides an organizing framework for cancer diagnostic pathways. Alliances are implementing a broader model of cancer diagnostic clinics at a larger scale taking into account the different needs of patients with 1) obvious alert symptoms, 2) low risk but not no risk symptoms, and 3) serious but not specific symptoms. Faster diagnosis is being promoted by the introduction of a Faster Diagnosis Standard requiring patients are given a diagnosis of cancer or have it ruled out within 28 days of referral. The three cancer alliances forming the National Cancer Vanguard together with NHS England are publishing clinically led evidence-based Timed Diagnostic Pathways which show how the drastic changes needed can be achieved. Cancer alliances have been successful in developing clinical cancer pathways which need support by improved commissioning and regulatory approaches which align clinical pathways with financial and performance ratings. Clinical leadership has been essential but further focus is needed on making sure that performance and regulatory approaches give proper attention and encouragement to earlier and faster diagnosis. Keywords: cancer, pathways, outcomes, vanguard, diagnosis, rapi

Variation in the prevalence of urinary catheters: a profile of National Health Service patients in England

Introduction Harm from catheter-associated urinary tract infections is a common, potentially avoidable, healthcare complication. Variation in catheter prevalence may exist and provide opportunity for reducing harm, yet to date is poorly understood. This study aimed to determine variation in the prevalence of urinary catheters between patient groups, settings, specialities and over time. Methods A prospective study (July 2012 to April 2016) of National Health Service (NHS) patients surveyed by healthcare professionals, following a standardised protocol to determine the presence of a urinary catheter and duration of use, on 1 day per month using the NHS Safety Thermometer. Results 1314 organisations (253 NHS trusts) and 9 266 284 patients were included. Overall, 12.9% of patients were catheterised, but utilisation varied. There was higher utilisation of catheters in males (15.7% vs 10.7% p&lt;0.001) and younger people (18–70 year 14.0% vs &gt;70 year 12.8% p&lt;0.001), utilisation was highest in hospital settings (18.6% p&lt;0.001), particularly in critical care (76.6% p&lt;0.001). Most catheters had been in situ &lt;28 days (72.9% p&lt;0.001). No clinically significant changes were seen over time in any setting or specialty. Conclusion Catheter prevalence in patients receiving NHS-funded care varies according to gender, age, setting and specialty, being most prevalent in males, younger people, hospitals and critical care. Utilisation has changed only marginally over 46 months, and further guidance is indicated to provide clarity for clinicians on the insertion and removal of catheters to supplement the existing guidance on care.</p

Variation in the prevalence of urinary catheters: a profile of National Health Service patients in England

Introduction Harm from catheter-associated urinary tract infections is a common, potentially avoidable, healthcare complication. Variation in catheter prevalence may exist and provide opportunity for reducing harm, yet to date is poorly understood. This study aimed to determine variation in the prevalence of urinary catheters between patient groups, settings, specialities and over time. Methods A prospective study (July 2012 to April 2016) of National Health Service (NHS) patients surveyed by healthcare professionals, following a standardised protocol to determine the presence of a urinary catheter and duration of use, on 1 day per month using the NHS Safety Thermometer. Results 1314 organisations (253 NHS trusts) and 9 266 284 patients were included. Overall, 12.9% of patients were catheterised, but utilisation varied. There was higher utilisation of catheters in males (15.7% vs 10.7% p70 year 12.8% p Conclusion Catheter prevalence in patients receiving NHS-funded care varies according to gender, age, setting and specialty, being most prevalent in males, younger people, hospitals and critical care. Utilisation has changed only marginally over 46 months, and further guidance is indicated to provide clarity for clinicians on the insertion and removal of catheters to supplement the existing guidance on care.</p

Homology Modeling of Human c-Butyric Acid Transporters and the Binding of Pro-Drugs 5-Aminolevulinic Acid and Methyl Aminolevulinic Acid Used in Photodynamic Therapy

Photodynamic therapy (PDT) is a safe and effective method currently used in the treatment of skin cancer. In ALA-basedPDT, 5-aminolevulinic acid (ALA), or ALA esters, are used as pro-drugs to induce the formation of the potent photosensitizerprotoporphyrin IX (PpIX). Activation of PpIX by light causes the formation of reactive oxygen species (ROS) and toxicresponses. Studies have indicated that ALA and its methyl ester (MAL) are taken up into the cells via c-butyric acid (GABA)transporters (GATs). Uptake via GATs into peripheral sensory nerve endings may also account for one of the few adverseside effects of ALA-based PDT, namely pain. In the present study, homology models of the four human GAT subtypes wereconstructed using three x-ray crystal structures of the homologous leucine transporter (LeuT) as templates. Binding of thenative substrate GABA and the possible substrates ALA and MAL was investigated by molecular docking of the ligands intothe central putative substrate binding sites in the outward-occluded GAT models. Electrostatic potentials (ESPs) of theputative substrate translocation pathway of each subtype were calculated using the outward-open and inward-openhomology models. Our results suggested that ALA is a substrate of all four GATs and that MAL is a substrate of GAT-2, GAT-3and BGT-1. The ESP calculations indicated that differences likely exist in the entry pathway of the transporters (i.e. inoutward-open conformations). Such differences may be exploited for development of inhibitors that selectively targetspecific GAT subtypes and the homology models may hence provide tools for design of therapeutic inhibitors that can beused to reduce ALA-induced pain.<p><em>©</em>2013 Baglo et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</p