Sunday, 14 January 2018

£100 gene tests could identify men with three times the chance of deadly prostate cancer...

New £100 tests could identify men with three times the average risk of developing deadly prostate cancer.
Scientists have discovered 54 genetic markers which predispose men to suffer from the most aggressive form of the disease.
The research, published in the BMJ, developed a prediction tool by analysing more than 200,000 gene variants from more than 30,000 men, to find those most closely linked with the aggressive form of the disease.
On average one in eight men will develop prostate cancer during their lifetimes.
The majority of cases will develop slowly in old age, and never prove fatal.  
But current screening methods are unreliable, meaning thousands of men undergo unnecessary biopsies, hormone treatment and traumatic surgery for slow-growing tumours which were harmless.
The new risk tool, tested on more than 6,000 men, found those with scores in the top two percent had almost three times the risk of aggressive prostate cancer, compared with average risk.
The discovery by US scientists means such men could be closely monitored, and targeted for screening, with thousands more saved from needless tests, biopsies and treatment.
Researchers from the Center for Multimodel Imaging and Genetics, in La Jolla, California, said such tests could be offered relatively cheaply - decades before prostate cancer was likely to develop.
The study, also involving the Insitute of Cancer Research and the Royal Marsden Hospital, found the methods were far more accurate than checking family histories at predicting the likelihood of aggressive disease.
British researchers said the gene tests could cost health services less than £100 per patient.
Prostate cancer is the most common form of cancer for men in the UK, with 47,000 diagnoses annually.
Researchers said those found to be at heightened risk would be encouraged to have blood tests which check for raised levels of a protein called prostate-specific antigen (PSA).
Currently, the NHS does not have a national screening for PSA testing, but men aged 50 or over can have tests if they ask for them.
Researcher Dr Tyler Seibert said: “These results are really useful because they can guide men and medical professionals, to see who should be being screened often - maybe annually - and who are in such low-risk groups that they could skip screening altogether.”
The cancer specialist said: “For those in the most high-risk groups, I would also be thinking about starting screening earlier, perhaps in their 30s.”
Charities welcomed the research but said further tests were needed to show that risks could be detected at a younger age.
Dr Matthew Hobbs, deputy director of research at Prostate Cancer UK said the findings “add another piece to the jigsaw” in the search for a test which could be used routinely.
“In the meantime, any man at risk of prostate cancer should have a conversation with his doctor about whether he should have the PSA blood test,” he said.
It comes as the NHS was accused of taking a "backwards step" in breast cancer care after recommending that a genetic test which could help almost 10,000 women should no longer be funded. The Oncotype DX test - which helps to predict the risk of breast cancer recurrence and whether or not a patient would benefit from chemotherapy - was previously recommended for use for certain women on the NHS.

Man prostate 
Prostate cancer treatment can involve hormone therapy CREDIT: ALAMY
But in new draft guidance, the National Institute for Health and Care Excellence (Nice) said it did not recommend routine use of the test, along with several others, to inform such decisions.
Nice said the cost-effectiveness of the tests was “highly uncertain”.
Baroness Delyth Morgan, chief executive at the charity Breast Cancer Now, said the move was a “backwards step”.
"Tumour profiling tests like these can help accurately predict the risk of breast cancer returning, aiding doctors and patients in decisions about whether chemotherapy is necessary and enabling some women to safely avoid its grueling side-effects.
"It's therefore very disappointing that Nice has been unable to recommend any of these prognostic tools to help guide chemotherapy use on the NHS,” she said.

Research information: Daily Telegraph January 2018

Thursday, 4 January 2018

What the dying teach me

This wonderful experience by my good friend Susan Dustin shines a light on a subject that many find difficult to embrace...

Of Amens and Inclusion….
Working with religious clergy within the end of life settings I have noticed a frequent overriding need to become more human and a tad less saintly! Conversely, for laypeople, the need to actualize a greater sense of meaning and spirituality greatly increases. I have no empirical evidence to back my claims, but rather recurring observations have piqued my curiosity! 
It is understandable that for those of us who are novices as our lives draw to an end and our bodies begin to fail and fall away our spiritual persona comes to the fore. We may possibly seek to give or receive forgiveness from others. Our need to know that our life has been of value; that we have loved and are loved in kind may also carry greater significance. There may be a return to or seeking out of a religious foundation in order to securely embrace an afterlife. 
I have no doubt that the clergy also experiences similar things, but perhaps being that a large part of their lives have been spent in such pursuits they’ve ticked a few of the “be right with God and karma” boxes. Obviously religious traditions and practices bring great sustenance to the pious during the time they prepare to discard their earthly robes and enter another realm. However, perhaps to obtain a holistic life-balance, a need to be close to the family and friends once denounced as worldly, immerges. 
Today, I had the opportunity to sit bedside with a nigh-on octogenarian and highly respected Abbott of a nearby Buddhist temple. Increasing symptoms of metastasized cancer necessitated his recent hospitalization, a serious operation, and the fitting of a colostomy bag. Addressing him in a religiously respectful manner while referring to myself as a layperson I introduced myself and asked if could visit with him. He readily agreed. In full patient mode, he told me what he understood of his illness, his operation, and showed me his colostomy bag. He informed me that the pain had been unbearable and that now thankfully it was much better. He was waiting to hear what the doctor suggested next. Moving him on from a medical show and tell, we became more personal. He told me that he had been an Abbott for as long as I had lived in Thailand. We had unknowingly been neighbors for several years. He had been born a Muslim within a community attached to a mosque that my daughter played in as a child. As a young boy, when his Muslim father died, his mother, as a Buddhist, had him enter monkhood to earn merit for her departed husband. He liked it so much he stayed on. I asked if he thought he had unwittingly fulfilled his destiny. He chuckled as he affirmed that he had. As we chatted, discovering the things we shared in common, a trainee nurse listened on amused as she busily injected medications through a syringe port in his hand. 
At one point, I don’t know what made me ask the sweet-looking young nurse what she was injecting into her patient, but I did. Facing me and ignoring the Abbott she answered, “Potassium”. I asked her to explain the need for potassium to the Abbott himself. She couldn’t. So I did and by so doing drew her into our conversation. I gently proceeded to tell her in a friendly and informal manner that each time she met with any of her patients she could always enlighten them as to what she was doing. Not only would she better remember what she was learning but would also provide her charges an empowered part in their own treatment. I explained that if we are able to understand what treatments and medications were used for and how they basically worked within our bodies then the power of positive expectation would possibly assist treatment and outcome. “At the very least the patient would feel included” I whispered. The Abbott became animated and heartily nodded at me in agreement as I covered the need to engage those within our care, especially their minds with a sense of understanding if they so wished to know. “For out of our thinking springs much!” I concluded. 
The encouraging change that came over my elderly “sacred orange-robed friend” was noticeable. I realized that he, like any of us, wanted to know what was being done to his body. He desired to be talked to in a humanly engaging manner and not only treated as the patient in bed number 12, nor even as a holy man who should have already ticked all of his boxes. 
A group of visiting monks signaled it was time for me to take my leave, but not before promising to return to continue our conversation. 
Today, I better understood that whether a religious devotee or otherwise, whether in full health or when facing life-shortening struggles, there lies a common essential requirement of needing to be seen, heard, and recognized. From criminal to Abbott, each of us deserves to be treated humanely in order to be pain-free and have our symptoms managed so that we are comfortable. Beyond basic care, our yearnings to retain dignity as we are nurtured, supported, validated, loved, and respected in our most vulnerable of states must also be met. To do so is very possibly comingling the sacred and the practical in a balanced manner of holy and whole!

Susan Dustin - January 2018