MOVEMBER: Prostate cancer

Movember is an annual event involving the growing of moustaches during the month of November to raise awareness of men’s health issues, such as prostate cancer, testicular cancer, and men’s suicide.

Movember-Foundation-Logo

At M3 we wanted to use this opportunity to share with you a very interesting article published by the Queen’s University Belfast about the world’s largest research study using a diagnostic test developed by Almac Diagnostics. The goal is to understand better the biology of prostate cancer tumours, which could lead to a transformation in how prostate cancer is diagnosed and treated.

 

Transforming prostate cancer treatment

Whether a prostate cancer patient has a slow-growing or aggressive tumour will affect the type of treatment required. It is only through understanding the type and genetics of the particular cancer tumour that clinicians will be able to put an effective treatment plan in place.

Lead researcher, Dr Suneil Jain from the Centre for Cancer Research & Cell Biology at Queen’s University Belfast explains: “Current diagnosis of prostate cancer involves biopsies, scans and blood tests to determine how aggressive the cancer is and subsequently to develop an appropriate treatment plan. Doctors repeatedly report that these tools aren’t always effective in determining how aggressive the cancer is, which can mean it is difficult to decide on the best treatment for an individual patient.”

Global Personalised medicine company Almac Diagnostics has developed a gene expression biomarker, known as Metastatic Assay, which aims to quickly diagnose the type of prostate cancer. The test analyses the genetics of the tumour enabling clinicians to understand the type of tumour, whether it is a slow-growing or aggressive and if the latter, to what extent.

Researchers at Queen’s University Belfast led the world’s largest study of this kind, using Metastatic Assay on prostate biopsies from 248 patients who had previously been treated for prostate cancer. The research findings, published in Annals of Oncology, found the diagnostic test to be more effective than the standard clinical tests.

Professor Richard Kennedy, Global VP and Medical Director at Almac Diagnostics and McClay Professor in Medical Oncology at Queen’s University Belfast commented: “The assay has now proven to be superior to conventional clinical tests at predicting aggressive disease in two independent studies, the first of which used surgical tissue, while this study used tissue taken from needle biopsy. We believe it will play an important role in identifying men who may benefit from treatment intensification.”

Treatment options available to prostate cancer patients include radiotherapy, chemotherapy, brachytherapy and hormone therapy. Although radiotherapy is often used to effectively treat patients with prostate cancer, 20- 30% of patients can relapse within five years.

Dr Jain explains: “The relapse of many prostate patients could be avoided through undergoing more intensive treatment including higher dosages of radiotherapy. There are also potential side-effects associated with administering more intensive treatment so a test that enables us to deliver the right treatment to the right patient would be extremely beneficial in clinical practice.”

The project was funded by Prostate Cancer UK and the Movember Centre of Excellence, a joint venture between Queen’s University Belfast and academic colleagues in Manchester.

Dr Iain Frame, Director of Research at Prostate Cancer UK said: “This research could provide clinicians with the answers they need to identify which cancers are likely to spread and give men peace of mind that the decision they make regarding their treatment is the right one. It’s still early days but it’s great to see how the work taking place at the Movember Centres of Excellence has the potential to bring about real change for men. We look forward to further results.”

 

All rights belong to the Queen’s University Belfast.

Movember logo belongs to the Movember foundation.

Talking to… Dr Suhail Hussain

Our Doctors talkDr Suhail Hussain is a keen advocate of holistic and patient centred care, coupled with physicians’ continuing education. He balances work as a portfolio GP for the NHS and private sectors and is a senior tutor at three major London medical schools.

 

Can you tell us a little bit about your routine during a regular week and how you cope with the workloads faced by physicians in the UK?

My work is very varied, as I am what’s known in the UK as a portfolio GP, which is becoming an increasingly common phenomenon. This involves the practitioner undertaking several diverse (sometimes unrelated) roles. Some years ago, I worked as a partner in a community based primary care clinic, where I had my own list of patients to whom I provided care. I would see patients every day in scheduled clinics and occasionally visit some at home.

Following this, I undertook a period of out of hours work (evenings and weekends) for a couple of years. However, for the last three years I’ve been working as a portfolio GP. As mentioned, this involves several diverse roles. For me, this encompasses work as a locum, medico-legal work, one day working in a service called “rapid response”, online consulting and a weekly private clinic.

When working as a locum I might provide holiday or sickness cover in a surgery  where, on any given day a regular doctor is away. The medico-legal work entails seeing and examining patients who have been involved in road traffic accidents for example, and preparing written reports on my findings. The work in rapid response, which I find personally very rewarding, involves working with nurses to provide a home-visiting service that is designed to reduce hospital admissions, visiting patients who perhaps can’t be seen by their own GP, due to their time constraints. These days can be quite quiet, and it means that I can spend time teaching nurses and helping them with their professional development.

I also do online consulting, which is becoming more common in the UK. I work from home and patients log in to an app for a consultation. This has its advantages for the patients in terms of ease of access and diagnosis for simple problems where we can talk about managing such issues or I can refer them on.

Once a week I carry out a private clinic (www.cpmedicalclinic.com/team-members/dr-suhail-hussain). Working as a portfolio GP means sometimes my schedule changes every week, which means I must be very organised to make sure I don’t overbook or under book myself!

Regarding online consultations, what would be the advantages and disadvantages of it?

The advantages for the patient are that they can contact the doctor at their convenience from their phone, during their lunch break, for example. There are limitations though – while we can see them on a screen, we can’t carry out a physical examination such as listening to their chest or palpating their abdomen. Consequently, this might mean more time spent by the patient in total, trying to resolve their problem, as they have spent time on the video conference and then have to make an appointment with their GP for a chest/abdo examination etc.

For other things it can be a great time saver e.g. if someone wanted an orthopaedic referral for their knee, then although ideally, I would always prefer to see them in person, that kind of thing can be done by video, as they’ll get examined by whoever they’re referred to as well.

What about the home visits?

Home visits are a distinctive element of primary care in the UK. I always tell my students that home visits often give you a lot of information and an irreplaceable insight into the patient and their condition. Often revealing facets of their disease that are not immediately apparent when they come to see you in clinic. I’m not sure how home visits work in other countries, but in the UK, they are unique to general practice.

For example, I saw a lady who was admitted several times for falls. When I went to visit her at home I could see that in addition to her severe osteoarthritis, the house was very cluttered, which meant she was tripping and then falling. I would never have known that having just seen her in the surgery. As a result of this I was able to request occupational therapists to come and make adaptations to her home which reduced her falling frequency.

You are a sort of advocate for GPs continuing to improve their knowledge and not getting “lost” in their routine. What would be your suggestions for doing so?

If you’re in a regular practice it’s easier to keep up to date with your education, however as a locum or portfolio GP it can be more difficult to keep up to date with CME. I run a group with a friend of mine where we meet every 6 weeks or so, with an invited speaker, and have a discussion with 10-15 attendees each time. You can also attend education days at hospitals or learn around patient cases you see.

I am currently in the process of setting up an online portal of educational resources for primary care physicians (www.gpeducationacademy.co.uk).

 You work as a medical tutor at three London medical schools (UCL, Imperial College and Bart’s). How do you expect Brexit will affect these and other medical schools in the UK regarding both staff and students?

Brexit will be a very bad thing for the medical profession – overseas nursing applications have dropped drastically recently, and that will be common across the profession, with overseas doctors (and other healthcare professionals) not wanting to come and work in the UK.

If universities applications are restricted access to overseas students then they will also lose a lot of income and, I think, a great deal of diversity. Diversity enriches your learning experience and helps with patient care as you get used to dealing with a wider group of people from different cultures and backgrounds.

 How long have you been a medical tutor? During these years, have you noticed many changes in medical education?

I have worked as a medical tutor over the past 9 years and I’ve seen quite a few changes. When I was at medical school we learned lots of facts, were examined on them rote fashion, and were then expected to apply those facts to clinical work. Now, medical students learn fewer facts, but learn via problem-based approach, around a case in small groups. This means they should have a more holistic approach to the patient. However, it can also mean the knowledge is lesser, and unless a student is very self-motivated then they may struggle with the less structured learning.

When I’m teaching we’ll look at the case, and I’ll ask them what their diagnosis/management is. Then I will challenge their responses and encourage them to go back to basics and apply the pathophysiology to the clinical context. I think it’s important that they understand the aetiology of the symptom; working on first principles to try to derive the answer.

You work for the NHS and in the private sector. What are the main differences regarding the way you are able to relate to the patients in each environment? 

I do want to say how great I think the NHS is, and that there are very few healthcare systems in the world where everyone has access to everything at the point of need. From a general practice point of view though, the amount of work we have to do and the volume of patients we have to see is increasing almost exponentially, whilst the amount of time we have to do it in is becoming less and less. This makes it very hard to meet unrealistic patient demands. Patient expectations are becoming greater and greater, and they often present with minor ailments which increases the strain on the service.

By contrast my private appointments are thirty minutes as opposed to ten. I have time to sit and talk with patients, take a very detailed history, do an examination, and discuss, in depth, their management and treatment, so they understand why I’m suggesting what I have, which means their adherence will be better.

What is your opinion on charging patients for NHS services as a way to avoid overloading the system?

 I think that the NHS is a fantastic service and that it should remain free at the point of need, and don’t think charging is a good idea. We could look at patients being removed from lists if they regularly miss appointments, and obviously if people can afford private treatment then there’s that option.

Is there any particular issue related to healthcare or general practice in the UK you would like to address?

I think the message I’d like to convey is that the NHS is a fantastic institution, and that primary care physicians provide the vast majority face to face health care. Ninety per cent of all patient care, is provided in the primary care setting. The government need to acknowledge this fact and improve the funding of general practice, as well as methods of recruitment and retention. Many GPs are retiring in their mid-fifties and graduating students are not going into general practice, which means under-staffing will become chronic. I hope that real measures are taken to maintain and promote what we have, rather than carve it up and dismantle it.

Airbnb-style stays for post-operative patients

Last week M3 conducted a survey in regards to the NHS trialling Airbnb-style stays for post-operative patients to ease hospital ‘bed-blocking’.

The scheme aims to offer an alternative to hospitals and care homes for patients who have had minor operations and are ready for discharge.

These patients would instead recuperate in nearby private houses, earning the homeowners up to £1,000 a month. This scheme, which is being piloted in Essex, aims to tackle bed shortages and save money, but has been criticised by healthcare professionals who warn it would give too much responsibility to untrained members of the public.

You can see the results of this survey below:

Airbnb

post-operative patients

NHS

By registering with M3 Global Research you will receive the Monthly Pulse directly to your inbox and you will be able to give your opinion about relevant healthcare related issue and compare your thoughts with your colleagues around the World.

Single-Payer Healthcare System

Welcome to the October edition of ‘Inside M3 Insights’!

This month, we are sharing the results of one insider survey carried out by MDLinx, with nearly 900 physicians and advanced practice clinicians in the United States.

The purpose of this survey was to find out what healthcare professionals think about the latest healthcare reform, which was carried out by the Republicans to replace the Affordable Care Act.

The survey asked for a comparison between the multiple-payer system and a single-payer system sych as Medicare for All model proposed by Sen. B. Sanders.

If you’re not part of M3 Global Research’s medical panel yet, we invite you to register and share your thoughts and opinions with the wider medical community

You can access the results of the study below.

 

Inside M3 Insights

OCTOBER 11: World Obesity Day

World Obesity Day

New figures indicate the annual cost of treating the consequences of obesity will reach US$1.2 trillion globally by 2025.

11th October is World Obesity Day and is marked in 2017 for the third time. It was launched to stimulate discussion and support practical actions to help people achieve and maintain a healthy weight and reverse the global obesity crisis.

The World Obesity Federation along with global health leaders, including The Lancet and the World Health Organization, shine a spotlight on staggering costs and continued impact of obesity, including new data showing the continued increase in childhood obesity and the financial consequences of untreated obesity at all ages.

New World Obesity Federation data demonstrates how investing in the prevention, early intervention and treatment of obesity is a cost-effective action for governments and health services. Investment can also help to achieve the 2025 targets set by the World Health Organization to halt the rise in obesity and to achieve a 25% relative reduction in mortality from NCDs.

healthy weight

Untreated, obesity is responsible for a significant proportion of non-communicable diseases (NCDs) including heart disease, diabetes, liver disease and many types of cancer. The global annual medical cost of treating these serious consequences of obesity is expected to reach US$1.2 trillion per year by 2025 .

The World Obesity Federation is using World Obesity Day, 11th October, to urge governments, health service providers, insurers and philanthropic organisations to prioritise investment in tackling obesity.  This means:

1) Investing in treatment services to support people affected by obesity

2) Early intervention to improve the success of treatment and

3) Prevention to reduce the need for treatment.

For more information, access the World Obesity Day website.

*All rights belong to the World Obesity Federation. We would like to thank the World Obesity Federation for sharing this content with us.