Can the NHS survive? This is one thing that has been on my mind for many years, but particularly since covid. We can all argue about why we are in this position, but we are! It will be a close run thing, if we can bring our NHS back from where we are today. Personally I believe that it is political will, to destroy it. Otherwise why would there be such little concern for the service and it’s staff? Healthcare in the UK may be so problematic, that it is now too expensive for the public purse? Below I have laid out some of the issues to be urgently considered.

Introduction:

The National Health Service (NHS) has long been a symbol of pride for the United Kingdom, providing healthcare services to its citizens since its inception in 1948. However, in recent years, concerns about the sustainability and future of the NHS have emerged. In this blog post, we will delve into the challenges, and potential solutions facing the NHS. Analysing whether it will be able to survive and continue serving the needs of the UK population.

Rising Demand and Funding Pressures

The NHS faces the constant challenge of rising demand for healthcare services, due to various factors such as an aging population, increasing prevalence of chronic diseases, and advancements in medical treatments. This surge in demand, puts immense pressure on the NHS, exacerbating funding constraints, and stretching resources thin. To ensure the NHS’s survival, it is crucial to address these challenges, through long-term funding commitments, innovative financing models, and proactive health promotion strategies.

The aging population in the UK has led to a significant increase in the number of individuals requiring healthcare services. As people live longer, they tend to develop more complex conditions, leading to higher demand for specialized care. Additionally, the rising prevalence of chronic diseases further burdens the NHS as these require ongoing management.

Technological Advancements and Digital Transformation

Moreover, constant advancements in medical treatments and technologies, have expanded healthcare possibilities. But often come with a hefty price tag. New medications, equipment, and procedures contribute to rising healthcare costs. The NHS must balance, providing the latest treatments, whilst managing its finances effectively.

While technology presents opportunities, through digitization and automation, to streamline processes and improve patient care. Implementing these, requires substantial investment, robust cybersecurity, and comprehensive training for healthcare professionals. Efforts should ensure vulnerable populations are not left behind, during the NHS’s digital transformation.

Workforce Crisis and Staffing Shortages

The NHS has been grappling with a workforce crisis. With shortages of healthcare professionals partly due to increasing workloads, burnout, and limited funding for training and recruitment. Addressing these challenges by targeting recruitment, improving retention strategies, and investing in professional development is vital to secure the NHS’s survival.

The demanding nature of healthcare work, has led to increased burnout and high turnover rates, making it difficult to retain experienced staff. Moreover, limited funding for training and recruitment, exacerbates this problem. Investing in workforce programs, improving working conditions, and providing adequate support systems can contribute to a more resilient workforce.

Political Will and Public Support

The survival of the NHS, is linked to political will and public support. Policymakers must prioritize healthcare in their agendas, and allocate sufficient resources to ensure the NHS’s sustainability. Fostering public awareness and support can also drive necessary policy changes.

Maintaining public support requires transparent communication, about the complexities of funding and resources. By making healthcare a priority, policymakers can enact policies supporting the NHS’s long-term sustainability through strategic investments.

Potential Solutions for a Sustainable Future

To ensure the NHS’s survival, a long-term funding commitment is needed, to meet rising demand. Exploring financing models, like public-private partnerships can help bridge funding gaps. Investing in preventive care and public health initiatives can also alleviate the burden by reducing the need for costly interventions.

Embracing technology advancements and digitization, can enhance efficiency and effectiveness. Targeted recruitment, improved retention strategies, and professional development investment are essential to address the workforce crisis.

Conclusion

While the NHS faces numerous challenges, viable solutions of long-term funding, technology adoption, workforce strategies, and political support can pave the way for a sustainable future. We must recognize the NHS’s importance, and work towards its preservation, ensuring accessible, high-quality care for generations.

Our NHS has gone backwards in at least the last 10 years. Therefore, even if we can save it, we won’t again have a service we can be proud of, for possibly 20 years, if you include sorting out it’s decaying infrastructure too. The policy that we have seen, has not saved our country money, but cost it so much! Both financially, and the welfare of our people. We are now more reliant on big pharma than we were. Was that the plan all along? If you think that inequality is bad now, don’t even give any thought to private healthcare!

As always these are my personal thoughts and opinions based on my experiences. Please feel free to share your own below.

The 2023 American Society of Clinical oncology (ASCO) Breakthrough meeting will be held in person and online August 3 to 5 in Yokohama, Japan. This meeting shines a light on the cutting-edge advances that are transforming cancer care in Asia and beyond. Research highlighted at ASCO Breakthrough will explore how new technologies may intersect with clinical care today to improve patients’ lives and well-being.

You can learn more about research from this meeting by following the #ASCOBT23 hashtag on Twitter.

Below are summaries of 4 studies that will be presented at the meeting:

Stool DNA test accurately detects gastrointestinal cancers and identifies tumor location

Who does this study affect: People at risk for gastrointestinal cancers.

What did this study find: A study out of China found that a new, noninvasive multi-target stool DNA test was able to accurately detect gastrointestinal (GI) cancers and identify the location where the cancer started.

GI cancers are cancers that affect the body’s GI tract, which is the bodily system involved in swallowing and digesting food, absorbing nutrients, and removing waste from the body. These cancers include cancer.net/cancer-types/bile-duct-cancer-cholangiocarcinoma”>bile duct cancer, colorectal cancer, esophageal cancer, pancreatic cancer, and stomach cancer, among others. Overall, GI cancers make up one-fourth of cancer cases around the world, according to the World Health Organization.

While tests using either stool (feces) or Blood have been approved by the U.S. Food and Drug Administration for the early detection of colorectal cancer, there are currently no similar tests approved for the early detection of other GI cancers. Stool tests are noninvasive, and most people can do the test at home. In this study, researchers wanted to learn whether using a new stool DNA test could detect and locate more GI cancers early.

The study included 124 Chinese people who had been diagnosed with GI cancer but had not received treatment, as well as 92 people who did not have cancer but received GI cancer-related examinations every 3 years.

The study showed that the test was able to accurately detect GI cancers and identify the location where the cancer started. Overall, of the patients who had cancer, 79% tested positive for cancer with the test, and of the patients who did not have cancer, 96% tested negative for cancer. Of the 4 participants who did not have cancer but received a positive result from the test, 3 were diagnosed with advanced adenomas, which are benign tumors that can become cancerous, and 1 person was pregnant.

For each of the specific GI cancer types included in the study, the test positively identified 71% of colorectal cancer cases, 83% of stomach cancer cases, 75% of esophageal cancer cases, 81% of pancreatic cancer cases, and 91% of ampullary cancer cases. Ampullary cancer is cancer of the ampulla of Vater, which is where the pancreatic duct and bile duct meet and empty into the first part of the small intestine.

The researchers also evaluated how effective the test was in identifying the type of GI cancer, which is called sensitivity. Sensitivity is the percentage of people with cancer who were correctly identified by the test as having cancer. The sensitivity of the test was 88% for colorectal cancer, 91% for stomach cancer, 88% for esophageal cancer, 90% for pancreatic cancer, and 95% for ampullary cancer.

What does this mean for patients: This noninvasive stool DNA test could help detect different GI cancers early and accurately, including the location where the cancer started.

“Stool is a promising sample for GI cancer detection because it contains the host’s exfoliated cells and circulating-free DNA derived from GI cancer cells. Our study aims to develop a noninvasive, multi-target stool DNA methylation test for the early detection and localization of GI cancers.”

—      lead study author Li-Yue Sun, MD
Guangdong Second Provincial General Hospital
Guangzhou, China

Exercise helps improve sexual health for people with prostate cancer 

Who does this study affect: People with cancer.net/cancer-t%C3%BDpes/prostate-cancer“>prostate cancer.

What did this study find: Results from a randomized, controlled clinical trial from Australia found that patients who followed a supervised exercise program had improved sexual health. Prostate cancer and its treatment can lead to problems with sexual health, including erectile dysfunction and a loss of sexual desire. These sexual side effects may be temporary, but some can last for a long time. Side effects that change sexual health can affect a person mentally, emotionally, and physically.

In this study, the researchers wanted to see whether supervised resistance and aerobic exercise given in the clinic would improve sexual health. Aerobic exercise is also known as cardio, and it is the type of exercise that raises your heart rate. Resistance exercise is also called strength training. The researchers also wanted to explore whether adding a type of counseling called psychosexual therapy would help.

The study included 112 men with prostate cancer who had or were receiving cancer treatment and who had concerns about problems with sexual health. This study was done at exercise clinics that were connected to universities between 2014 and 2018. The participants were divided into 3 study groups. Group 1 included 39 people who received 6 months of supervised resistance and aerobic exercise in a group setting for 3 days per week. The 36 patients in Group 2 received the same exercise program plus psychosexual therapy. The 37 patients in Group 3 received usual care for prostate cancer, which does not include supervised exercise instruction.

The researchers evaluated whether the participants in Groups 1 and 2 were more satisfied with their sexual function than those in Group 3. To do this, participants were asked to complete a questionnaire called the International Index of Erectile Function (IIEF), which scores a person’s sexual ability and satisfaction with sexual activity. Those who participated in the supervised exercise program had a 5.1-point increase in their ability to have an erection of the penis compared with a 1.0-point increase in those who received usual care. Those who received supervised exercise also were more satisfied with sexual intercourse. Their satisfaction with sex increased by 2.2 points, compared with 0.2 points for those who received usual care. The psychosexual therapy, which was self-managed, did not add any improvements for the participants.

What does this mean for patients? Supervised resistance and aerobic exercise improved ability to have an erection and satisfaction with sexual intercourse for patients with prostate cancer.

“Nearly half of patients with prostate cancer report having unmet sexual health care needs, highlighting the lack of current health care services to adequately address the demand for management of sexual dysfunction after prostate cancer treatment. Our study shows that these patients can immediately benefit from supervised exercise interventions to improve their sexual health and that exercise should be considered as an integral part of treatment for prostate cancer.”  

—lead study author Daniel Abido Galvao, PhD
Edith Cowan University
Perth, Australia 

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Artificial intelligence can accurately identify cervical precancerous lesions during colposcopy

Who does this study affect: People at increased risk for cancer.net/cancer-types/cervical-cancer“>cervical cancer.

What did this study find: A study out of Japan found that a new artificial intelligence (AI)-based model can accurately identify cervical intraepithelial neoplasia (CIN) lesions from videos taken during colposcopy. CIN, which may also be called cervical dysplasia, is an abnormal growth of cells on the cervix, which is part of the female reproductive system. While some of these abnormal cells may go away without treatment, others may eventually become cervical cancer.

A colposcopy is a procedure used to find cancerous or abnormal cells in the cervix, vagina, or vulva. A colposcopy may be recommended for people who received abnormal results following a Pap test so the doctor can confirm and diagnose certain problems, including CIN. During a colposcopy, the doctor may also perform a biopsy, which is the removal of a small amount of tissue for examination under a microscope, to determine whether abnormal areas found during the colposcopy may be cancerous or precancerous.

Extensive colposcopy training is required to teach doctors how to accurately detect CIN and perform more precise biopsies of suspicious areas. In this study, researchers wanted to learn whether an AI-based model could be used to accurately identify precancerous lesions from colposcopy results and help guide where biopsies should be performed.

Researchers conducted an analysis using 8,341 videos recorded during colposcopies from 2013 to 2019. The videos included 7 early-stage cervical cancer cases, 203 CIN3 cases, 276 CIN2 cases, and 456 CIN1 cases. CIN1 lesions have the lowest risk of becoming cancer, while CIN3 lesions have the highest risk of becoming cancer.

Researchers then trained the AI-based lesion detection model by showing it videos of 60 cases of cervical cancer and CIN3. The AI-based model was then shown 150 cases to test how accurately it could diagnose CIN lesions and cervical cancer.

The study found that the AI-based model was able to identify cervical precancerous lesions with high accuracy. In identifying lesions, the model had:

• A sensitivity of 85% for CIN3 lesions, 86% for CIN2 lesions, and 87% for CIN1 lesions. Sensitivity is the percentage of people with a lesion who were correctly identified by the model as having a lesion.

• A specificity of 73% for CIN3 lesions, 67% for CIN2 lesions, and 70% for CIN1 lesions. Specificity is the percentage of people who did not have a lesion and were correctly identified by the model as not having a lesion.

• An area under the curve of 89% for the lesion area for CIN3 lesions and of 81% for both CIN2 and CIN1 lesions. The area under the curve indicates the overall accuracy of the model.

• An accuracy of 95% for the number of lesions identified among CIN3 lesions, 93% for CIN2 lesions, and 97% for CIN1 lesions.

The model was also able to display a heatmap of the affected area with the highest acetic acid intensity, indicating where it was most likely for abnormal cells to be found, that corresponded with the actual biopsy location.

What does this mean for patients: For people who require a colposcopy after receiving abnormal Pap test results, an AI-based model may be helpful in accurately identifying cervical precancerous lesions, thus improving early detection and likelihood of curative therapy. This model could be especially useful in places where there may be fewer doctors trained in reading colposcopy results.

“Currently, there is no certification system for performing colposcopies in Japan, and the quality and interpretation of these examinations varies. Our study aimed to develop an artificial intelligence (AI)-based tool that reproduced colposcopy examination techniques of specialists to be used as a diagnostic aid by accurately identifying CIN lesions and guiding tissue sampling locations.”

—      lead study author Akihiko Ueda, MD
Kyoto University
Kyoto, Japan

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Liquid biopsy may help find common cancers before symptoms develop

Who does this study affect: People who have a moderate to high risk of cancer but no symptoms.

What did this study find: Results from the K-DETEK clinical trial in Vietnam have shown that a type of liquid biopsy called SPOT-MAS (Screening for the Presence Of Tumor by Methylation And Size) may be useful for detecting certain common cancers in people with no symptoms. The SPOT-MAS only looks for the 5 most common cancers in Vietnam: liver, breast, colorectal, stomach, and lung cancer. It is a type of liquid biopsy called a multiple cancer early detection test or MCED.

The researchers in this study wanted to see if the SPOT-MAS test could be used to successfully find early cases of cancer among Vietnamese people. This study includes 10,000 people aged 40 years or older with no symptoms of cancer but moderate to high risk of developing cancer. It was conducted in 13 large hospitals and 1 research institute in Vietnam. The participants were observed at 6 and 12 months. When the researchers analyzed the data, they had completed analyses for 2,795 study participants.   They found that the SPOT-MAS correctly detected cancer in 60% of cases, meaning that for every 100 positive tests, 60 of them will actually have cancer. In addition, the test was able to correctly identify the tumor’s location in 83.3% of cases. If SPOT-MAS detected cancer, then a patient received additional testing by doctors to confirm whether they really had cancer and then guide treatment decisions.

cancer screening tools, such as mammography and colonoscopy, usually only test for a single type of cancer and require separate appointments and procedures. In some parts of the world, this makes cancer screening difficult. Giving a single Blood test to screen people for several common types of cancer may be a convenient way to find cancer in people before they develop symptoms.

What does this mean for patients? The SPOT-MAS may be a helpful tool for initially screening people for common types of cancer, particularly in lower- and middle-income countries.

“Common screening methods are often invasive, inaccessible, and involve separate procedures to screen individual cancer types. Affordable, accessible, noninvasive multicancer screening tests are needed for early detection, especially in a lower-middle income country like Vietnam. Our study provides clinical evidence for the applicability of the SPOT-MAS circulating tumor DNA-based assay as a complementary method in early cancer detection.”  

—senior study author Le Son Tran, PhD
Medical Genetics Institute
Ho Chi Minh City, Vietnam 

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This July, families who recently lost a loved one to cancer came together at Memorytown USA in Mount Pocono, PA for cancerCare’s free annual Healing Hearts Family Bereavement Camp. 19 families and close to 40 children and adolescents, ages 4-17, attended this year’s camp from July 14-16.

After families arrived on Friday night, they had the opportunity to gather for dinner, play games, make s’mores and dance to music, courtesy of DJ Angelo. Returning children, once again, sat together at their own table, and made more room for the larger number of children this year. “Seeing that was just amazing because instead of one table, it was two tables,” shared Kathy Nugent, cancerCare’s Senior Director of Regional Programs.

This year’s camp theme was the ocean, and families made sea-themed memory jars and collages about their loved ones on Saturday. Adults gathered in support groups while children and adolescents gathered in age-specific groups.

Younger children were read “Always Remember,” by Cece Meng, donated by the Light One Little Candle Foundation. They were also taught a dance by cancerCare social worker Nikki Molfetas and decorated canvas bags and memory stones. Meanwhile, older children and teens wrote lyrics to “Hope Floats,” a song composed by Sarah Paul, cancerCare’s Director of Clinical Programs.

The families participated in horseback riding at Mountain Creek Riding Stables, fishing, crafts, lawn games and water activities, which included a sea turtle-themed sprinkler system. They also gathered for a memorial service where the children’s’ groups performed and they were able to honor their loved ones.

Saturday night, they also participated in karaoke. But “Karaoke was not just karaoke,” noted Cecilia Kuepper, cancerCare‘s Healing Hearts Program Coordinator. “It’s those connections that you make and how the kids are just being kids in that moment.”

On Sunday, adults attended a resilience panel, where people who had experienced similar losses gave the attendees hope and inspiration. “It’s really inspirational for them to listen to these stories because it gives them hope that their children will be okay and that they will be okay,” said Kathy. “They see a life moving forward.”

The children had the opportunity to learn and speak about the different emotions they were experiencing with cancerCare social workers. Younger children released their emotions with kickboxing taught by Kat Morano, cancerCare‘s Education Outreach Coordinator, while older children participated in meditation guided by Nikki. They also built, decorated and flew sea turtle kites.

The weekend ended with a closing ceremony where attendees were invited to share their thoughts and gratitude and received gifts including sea turtle-themed wind chimes and bracelets.

“Having the interactions with other families experiencing loss had a healing effect on my own family,” one attendee shared. “We left camp feeling hope, not hopeless.”

One parent shared, “The kids are more open to talking to us about our loss and how they feel since the camp. I’m glad the camp helped normalize it for us and our children.”

“All the families expressed their gratitude and were so happy to have met others who are experiencing similar loss,” Kathy shared. “There were lots of laughs and tears but everyone went home feeling uplifted.”

The Healing Hearts Family Bereavement Camp would not be possible without our volunteers, partners and supporters. Special thanks to Eisai, our primary sponsor, as well as our other supporters, including the Lillian Schenck Foundation, Valley Hospital Foundation, DeAnna Stark Pasciuto Memorial Fund – Northern New Jersey Community Foundation and Genmab. We would like to thank the Giving Doll Foundation for the donation of dolls and the Light One Little Candle Foundation for the donation of books for the children. We would also like to thank Memorytown USA for providing excellent services and meals to our families, staff and volunteers as well as Mountain Creek Riding Stables for hosting horseback riding.

Like all of cancerCare‘s services, the Healing Hearts Family Bereavement Camp is made available to families completely free of charge. Please consider making a contribution to help support families coping with the loss of a loved one. You can also contact Kathy Nugent at 201-301-6809 or knugent@cancercare.org should you wish to make a charitable contribution.

cancer: A breakthrough study” title=”Variants in core promoter interfere with the cis–trans interaction and the organization of transcriptional initiation complex, leading to increased or decreased transcription initiation. Green line represents wild-type and red line represents mutant. Credit: Genes & Diseases” width=”357″ height=”271″/>

TNBC is a particularly aggressive subtype of breast cancer, characterized by the absence of three key receptors: estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). Approximately 10–20% of all breast cancers are TNBC. TNBC patients face a poorer prognosis due to the lack of specific drug targets. Therefore, the discovery of new factors influencing the development and progression of TNBC is crucial for improving patient outcomes.

A study published in Genes & Diseases centered on the core promoter, a DNA region surrounding the transcription start site (TSS), for the potential roles of genetic variation in core promoter in abnormal gene expression in TNBC. Core promoters contain multiple highly conserved cis-motifs interacting with different transcriptional factors like RNA polymerase II, TFIIB, and TFIID.

This interaction forms the transcription initiation complex to regulate transcriptional initiation. Genetic variation in the core promoter sequences could interfere with this interaction therefore the proper organization of the transcriptional initiation complex, causing altered transcription initiation and pathological consequences.

Researchers hypothesized that core promoter in TNBC could be highly mutable in contributing to its abnormal gene expression. To test their theory, they analyzed the genomes of 279 TNBC patients using a method called Exome-based Variant Detection in Core-promoters (EVDC).

After filtering out normal genomic polymorphisms, researchers discovered a staggering 19,427 recurrent somatic variants and 1,694 recurrent germline variants in the core promoters of various genes, many of which are known to be oncogenes and tumor suppressors.

The analysis of RNA-seq data from breast cancer revealed altered gene expression in hundreds of these affected genes, providing substantial evidence that core promoter variation could significantly influence gene expression. The researchers further compared these findings with core promoter variation data from 610 unclassified breast cancers. Interestingly, the core promoter variants in TNBC were highly TNBC-specific, suggesting that these variations could contribute significantly to the unique characteristics of TNBC.

This study makes a clear case that the core promoter is mutable and can significantly contribute to the development of cancer, in particular TNBC. While it sheds light on an entirely new aspect of cancer research, there is still much to uncover.

The complex, dynamic nature of gene expression and the variety of mechanisms that can influence it, including epigenetic modification and variation in distal regulatory regions, means that this is just the beginning. The researchers concluded that core promoter variation could provide a new paradigm for studying the mechanisms behind abnormal gene expression in cancer.

While this study focused on TNBC, future research could potentially uncover similar roles of core promoter variation in other types of cancer, leading to even broader applications for cancer detection and treatment.

Provided by
Chongqing Medical University