Miracle molecule offers new hope to prostate cancer patients

• By John von Radowitz in London Tuesday December 29 2009 Courtesy of The Irish Independent

A miracle molecule has been discovered that offers the hope of saving men with currently incurable prostate cancer.The "monoclonal" antibody which helps identify and neutralise foreign invaders or other potential sources of danger such as early stage and advanced tumours.As well as attacking the disease directly, it also helps the immune system to identify and destroy cancer cells. In addition, tagging the molecule with a radioactive marker could enable doctors to track spreading prostate cancer, revealing precisely where in the body it is growing.

A "significant reduction" in tumour growth rate was seen in mice injected with the antibody, known as F77. After 10 days, the average size of tumours in treated mice had grown from 30 cubic millimetres to 79.7 cubic millimetres. In untreated mice they grew to 195.8 cubic millimetres.Each year around 35,000 men in the UK are diagnosed with prostate cancer, and 10,000 die from the disease. Initially, spreading prostate cancer can be kept under control with therapies that prevent tumour growth being fuelled by androgen male hormones.

But eventually most prostate cancers stop being hormone-sensitive. Few treatment options are then possible and progress of the disease is rapid and lethal.Up to 45pc of patients with local prostate cancer relapse after curative treatments such as surgery and radiotherapy, and their disease begins to spread, or "metastasise".

The five-year survival rate for patients with metastatic prostate cancer is only 34pc.Although the new research is at a very early stage, it raises the prospect of an effective treatment for non-hormone-sensitive advanced prostate cancer for the first time.Writing in the journal 'Proceedings of the National Academy of Sciences', the US scientists said the F77 antibody showed "promising potential for diagnosis and treatment of prostate cancer, especially for androgen-independent metas-tatic prostate cancer".The researchers, led by Dr Mark Greene from the University of Pennsylvania School of Medicine in Philadelphia, pointed out that while antibodies were already being used to tackle other diseases such as lymphoma and breast cancer, those suitable for use against prostate cancer were rare.

Two under investigation were both ineffective. F77, on the other hand, targeted the most aggressive cancers and responded to those both sensitive and insensitive to male hormones.Dr Sarah Cant, head of policy and campaigns at The Prostate Cancer Charity in the UK, said: "We need to remember that this is very early research that has only been carried out in cells grown in the laboratory and in mice. Any potential therapy would need to undergo more refinement, and large-scale clinical trials would be needed before it could be proven that this is safe.

The Irish Times - Tuesday, December 29, 2009

Harney seeks plan for elective surgery

MARTIN WALL

THE MINISTER for Health Mary Harney has told the HSE that she wants it to develop plans for all hospitals to comply with a set of national protocols around the admission, discharge and care of patients for elective procedures.In a confidential letter to the chairman of the HSE, Liam Downey, setting out her priorities for 2010, Ms Harney said that it was unacceptable that there should be wide variations in the way common elective procedures are handled between different hospitals.She said the Department of Health had recently analysed data for a 12-month period in 2008/09 regarding common elective procedures. She said that this had found, for example, that for hip replacements the average length of stay in hospitals that undertook significant numbers of such procedures ranged from seven to 18 days.

“For repair of inguinal hernia procedures, the proportion of cases treated on a day basis ranges from 84 to 0 per cent. Where the procedure is undertaken predominantly on an in-patient basis, average lengths of stay in excess of two days are common,” Ms Harney said.“For cataract procedures, again there is substantial variation between hospitals in the proportion of such treatment provided on a day basis, with one hospital reporting 100 per cent. Where the treatment is carried out on an in-patient basis, lengths of stay of two or more days are not uncommon.”Ms Harney said that, while the information concerned was relatively “high level in nature”, it suggested that there was much potential for increased efficiency in hospital processes and practices and that a strong focus on performance management was required.Ms Harney told Mr Downey: “I am sure you agree that it is not acceptable that such wide variations in practice should occur, unless justified by the clinical circumstances of a particular case. I wish the HSE in 2010 to develop clear plans so that, consistent with the delivery of safe and effective care, admission, discharge and other elements of the care process for elective treatment are the subject of clear national protocols and procedures with which all hospitals are required to comply.”Ms Harney said treatments widely accepted as suitable for performance on a day basis should be a particular focus.The Minister also told Mr Downey that one of her main priorities for next year is the implementation of the Fair Deal nursing home support scheme.She said it was essential that the HSE and individual hospitals maintained “a sharp focus” on ensuring compliance with the terms of the new consultants’ contract, especially in relation to the level of private practice activity permitted.The Minister also said the HSE should give priority to the implementation of recommendations in the Ryan report.Ms Harney maintained that urgent attention should be given to enhancing probity assurance measures under the various demand-led schemes.“Questions relating to probity under the Dental Treatment Services Scheme (DTSS) have been aired in the media in recent times. I believe that there is a need to strengthen leadership and management of the DTSS and the Public Dental Service, perhaps through the appointment of a clinical lead,” she said.

Page last updated at 00:42 GMT, Monday, 28 December 2009
Courtesy of BBC news
 
Disinfectants 'train' superbugs to resist antibiotics 
 
Disinfectant could teach bacteria methods of resistance
Disinfectants could effectively train bacteria to become resistant to antibiotics, research suggests.
Scientists know bacteria can become inured to disinfectant, but research increasingly shows the same process may make them resistant to certain drugs.
This can occur even with an antibiotic the bacteria have not been exposed to.
Writing in Microbiology, the National University of Ireland team, who focused on a common hospital bacterium, urges a rethink of how infections are managed.
Scientists in Galway found that by adding increasing amounts of disinfectant to cultures of pseudomonas aeruginosa in the lab, the bacteria learnt to resist not only the disinfectant but also ciprofloxacin - a commonly-prescribed antibiotic - even without being exposed to it.
The researchers report the bacteria had adapted to pump out anti-microbial agents - be they a disinfectant or an antibiotic - from their cells.
The adapted bacteria also had a mutation in their DNA that allowed them to resist ciprofloxacin-type antibiotics specifically.
Residue from incorrectly diluted disinfectants left on hospital surfaces could promote the growth of antibiotic-resistant bacteria

Dr Gerard Fleming
Pseudomonas aeruginosa is a bacterium most likely to infect those who are already seriously ill.
It can cause a wide range of infections, particularly among those with weak immune systems such as HIV or cancer patients, as well as people with severe burns, diabetes or cystic fibrosis.
Surface disinfectants are used to prevent its spread - but if the bacteria manage to survive and go on to infect patients, antibiotics are used to treat them.
Bacteria that could resist both these control points could be a serious threat to hospital patients, the study said.
At the high concentration levels generally employed this was unlikely to be a problem - but "in principle this means that residue from incorrectly diluted disinfectants left on hospital surfaces could promote the growth of antibiotic-resistant bacteria", said study author Dr Gerard Fleming.
"What is more worrying is that bacteria seem to be able to adapt to resist antibiotics without even being exposed to them."
Disinfectants may not just be the problem, they may also be the cure
Dr Gerry McDonnell
There is an increasing body of research that raises concerns about the effects on antibiotic resistance of disinfectants and antiseptics.
An EU report published earlier this year stressed the importance of the "appropriate and prudent" use of disinfectants to minimise the risk that bacteria become resistant to both forms of defence.
It also emerged this year that treatments in hospitals in Brazil had been compromised by a bacterium, mycobacterium massiliense, which had developed resistance to a common sterilisation fluid and a number of antibiotics used to treat the subsequent infections.
"This was very significant because it was really the first incident related to resistance to a biocide which led to clinical failure, which is new," said Dr Gerry McDonnell, a researcher in the field.
"This really needs to be an area of active investigation and debate. But it's worth bearing in mind that disinfectants may not just be the problem, they may also be the cure."
Research was published this year showing that the disinfecting wipes used to protect against MRSA could in fact spread the bug, as the solution contained was often not sufficient to kill all the bacteria picked up, and hospital staff often used the same wipe to clean more than one surface.

On the long road back to health
27 December 2009 By Aileen O’Meara Courtesy of The Sunday Business Post

With the economic crisis having a dire impact on the public finances, the high spending health service got off relatively lightly in 2009.
The health unions and their members might not agree - and the seeds may well have been sown for a year of industrial unrest not seen since the 1980s - but there were no major surprises, and some real improvements in several areas.
Familiar themes dominated the 2009 health agenda: the reconfiguration of hospital services; consultants’ pay and their private income; the slow pace of reform in work practices; the impact of spending cuts on patients; criticism of the performances of health minister Mary Harney and HSE chief executive Brendan Drumm; and a new concern - the swine flu pandemic.
On balance, it was a fairly good year for Harney. The consultants’ contract was finally agreed and introduced, and a new clinical management model was introduced in hospitals.
While she rarely admitted it, the deal was over-generous in its €200,000 plus annual salary and allowances, and the department is still withholding the final increase, one that will probably never be paid. Instead, consultants quietly took the pain of tax increases and wage cuts like everyone else on the public pay bill, and knew they stood little chance of getting it back.
However, as was revealed to the Oireachtas health committee in recent months, the strict 20 per cent limit on consultants’ private work in the new contract is being widely breached, particularly in hospitals outside Dublin, where a shortage of private beds is pushing insured patients into public beds.
It is difficult to understand how the minister’s policy of reducing consultants’ access to private patients in public hospitals squares with the obvious lack of private beds in many areas.Problems in A&E departments remain unresolved in some hospitals, with lengthy trolley waits for ill patients in unsuitable emergency departments, and an ongoing shortage of homecare packages to enable patients to go home.
The issue of equal access to consultants and hospital care remains unresolved. It is still the case that those who can afford health insurance can jump the queues in a range of locations.
Waiting times for outpatient appointments for potential cancers or non-emergency treatments remain lengthy for some public patients, a problem not yet resolved by the National Treatment Purchase Fund or the HSE’s own performance management systems.
There is a growing consensus about the case for universal health insurance, which has been supported by Fine Gael and Labour.
Fine Gael launched its own Fair Care plan during the year, an ambitious but untested plan for universal health insurance paid for by a combination of public funds and insurance fees, with a wider role for primary care in the prevention and treatment of illnesses.
While the experts differ about the cost of such a scheme - and how long and how disruptive its implementation would be - Fine Gael has denied that it represents the privatisation of healthcare delivery in Ireland. However, Harney’s other big idea - the Fair Deal scheme for funding nursing home places for the elderly - is finally up and running.
While it is still early days for the scheme, it could well become her lasting legacy.
Harney was widely criticised for linking family income to nursing home care, but the Fair Deal scheme is, in fact, far more equitable than its predecessor.
It recognises the realities of funding the growing numbers of dependent elderly in the population now and in the future.
Thanks to Harney’s success in persuading Professor Tom Keane to return from Canada to head the National Cancer Control Programme, the eight regional cancer centres are now in place.
Dozens of small surgical units have closed, and, while the people of Sligo, Tralee and Castlebar are still critical of this development, high-level political support for Keane’s actions remained unwavering during the year.
Harney avoided any major banana skins in the budget this year, having learned a hard political lesson from the mess which was the handling of the over-70smedical cards the year before.
The opposition provided few real alternatives to the Harney vision for health, with the exception of the Fair Care plan. Fine Gael’s Dr James Reilly’s passion for the role of primary care was evident, but his predictable criticism of the minister offered few alternatives to spending more money, an option which is no longer available.
When the controversy over the waiting times for scoliosis patients in Crumlin Children’s Hospital was raging - with daily stories of sick children in real pain - Reilly blamed the minister, instead of looking at how Crumlin’s managers and doctors were managing their resources to solve the problem.
Meanwhile, it was definitely not a year that Drumm will want to remember, when he looks back at his time at the helm of the HSE. He came into conflict with his own board when he tried to reorganise the HSE’s awkward administrative structures, and was forced to accept an unsuitable compromise in the division of organisational responsibilities.
But the devolution of decision making to four regions is going ahead.
Drumm and his advisers allowed the growing criticism of his acceptance of a €70,000 bonus to get out of control, making the chief executive look defensive and out of touch in a climate where hospital wards were closing and temporary staff were being let go to balance budgets.
It was not Drumm’s fault that the HSE board had delayed a decision on the bonus for months on end, but he could have come out and defended his acceptance of the payment at a time when tens of thousands of people were losing their jobs. Few were surprised when Drumm announced that he would not be seeking to renew his five-year contract in 2010.
The big health unions did not have a good year either, watching helplessly in the dark days of late November and early December as their carefully hatched plan for 12 unpaid leave days in return for wide-ranging work practice changes was rejected in Government Buildings. Siptu, Impact, the Irish Nurses’ Organisation, the Irish Medical Organisation and the Irish Hospital Consultants’ Association learned that the mood of the country had turned against pay increases for public servants in return for greater productivity.
Instead, the public wanted to see improved services for the same or reduced pay levels in recognition of the real advantages that public servants had.
In the health services, though, the moratorium on staff appointments and promotions is already having a detrimental impact , with continuing deadlock on the redeployment of many staff into new areas as the HSE drills through administrative arrangements that are now redundant. There are almost 2,000 fewer staff on the HSE payroll this year, and that number will continue to fall.
It is unlikely that the unions will persuade their members to opt for an all-out strike, and they are more likely to introduce disruptive work-to-rule campaigns at local level instead. This would have the effect of slowing work and increasing stress levels, especially at management level.
It was not a good year for community pharmacists, as the HSE and the government stood their ground and forced significant reductions in their fees for dispensing drugs at community level. The HSE, despite criticisms, managed to provide an alternative community pharmacy service for long enough to force the pharmacists to climb down.
The HSE also did well in its response to the H1N1 swine flu pandemic. Although H1N1 has so far turned out to be relatively mild, the public information campaign led by the HSE was successful in communicating the essential messages, while the vaccine campaign has been rolled out at a steady pace.
While many GPs struggled with delayed delivery of vaccines, and were left to deal with much of the frontline responsibility, fears that the HSE’s management of this new challenge would be chaotic and sub-standard proved unfounded.
It is still too early to assess the impact of the new regionalised structures in the HSE, and whether they will improve the quality of services management.
The HSE remains an opaque organisation, with little transparency in its decision making, scant information about how decisions are made and no accountability. An ineffective Oireachtas health committee, the only public forum for questioning HSE managers, doesn’t help.
Next year could perhaps bring a new strain of swine flu, and will definitely bring a new chief executive for the HSE, a role that will suit someone not afraid of accepting a poison chalice.
It is also likely that the Department of Health’s secretary-general , Michael Scanlon, will move on - and it is also possible that, by this time next year, we may have a different Minister for Health.
 

Page last updated at 00:00 GMT, Sunday, 27 December 2009
Courtesy of BBC News
 
Study blames two genes for aggressive brain cancer 
Glioblastoma is a deadly form of brain cancer
Scientists have discovered two genes that appear responsible for one of the most aggressive forms of brain cancer.
Glioblastoma multiforme rapidly invades the normal brain, producing inoperable tumours, but scientists have not understood why it is so aggressive.
 

The latest study, by a Columbia University team, published in Nature, pinpoints two genes.
The researchers say that the findings raise hopes of developing a treatment for the cancer.
It means we are no longer wasting time developing drugs against minor actors in brain cancer - we can now attack the major players
Dr Antonio Iavarone
Columbia University
The genes - C/EPB and Stat3 - are active in about 60% of glioblastoma patients.
They appear to work in tandem to turn on many other genes that make brain cells cancerous.
Patients in the study whose tumours showed evidence of both genes being active died within 140 weeks of diagnosis.
In contrast, half of patients without activity from these genes were alive after that time.
 

Master controls
Lead researcher Dr Antonio Iavarone described the two genes as the disease's master control knobs.
He said: "When simultaneously activated, they work together to turn on hundreds of other genes that transform brain cells into highly aggressive, migratory cells.
"The finding means that suppressing both genes simultaneously, using a combination of drugs, may be a powerful therapeutic approach for these patients, for whom no satisfactory treatment exists."
When the researchers silenced both genes in human glioblastoma cells, it completely blocked their ability to form tumours when injected in a mouse.
 

The Columbia team is now attempting to develop drugs they hope will achieve the same effect.
Using state-of-the-art techniques, they effectively mapped out the comprehensive and highly complex network of molecular interactions driving the behaviour of glioblastoma cells.
Dr Iavarone said: "The identification of C/EPB and Stat3 came as a complete surprise to us, since these genes had never been implicated before in brain cancer
"From a therapeutic perspective, it means we are no longer wasting time developing drugs against minor actors in brain cancer - we can now attack the major players."
 

Nell Barrie, science information officer at Cancer Research UK, said: "This research is exciting, as it sheds light on the key changes that drive cells in the brain to become glioblastoma cells.
"By finding out exactly how healthy cells turn into cancer cells, scientists hope to find clues for preventing or reversing the process.
"The technique used in this study should help scientists to understand these changes in other types of cancer, leading to new and more personalised treatment approaches in the future."

Page last updated at 00:03 GMT, Saturday, 26 December 2009
Courtesy of BBC news 
Troubleshooters that block cancer
 
The research was carried out on breast cancer cells
Scientists have shown how a family of "limpet-like" proteins play a crucial role in repairing the DNA damage which can lead to cancer.
They hope the finding could pave the way for a new type of drug which could help kill cancer cells, and promote production of healthy replacements.
The proteins seem to have a remarkable ability to zero in on damaged areas.
The breakthrough, uncovered independently by two teams, appears in the journal Nature.
The family of Small Ubiquitin-like Modifier (SUMO) proteins track down sites in the body where DNA damage has occurred.
This is the first step towards developing drugs which may protect normal cells from the side effects of chemotherapy, or improve the effectiveness of current breast cancer treatments
Dr Jo Morris
King's College London
They attach themselves to normal proteins, and guide them in to fix the genetic faults.
Using this method, the proteins are even able to repair double strand DNA breaks - the most severe type of DNA damage.
When their work is done, the proteins detach themselves and move on.

Breast cancer gene
One of the study teams was able to follow this process of repair taking place on the BRCA1 gene, which, if damaged, is associated with a very high risk of breast cancer.
SUMO was shown to attach to the damaged gene, and switch it back on - helping prevent breast cancer forming.
Researcher Dr Jo Morris, from King's College London, said: "This new insight is the first step towards developing drugs which may protect normal cells from the side effects of chemotherapy, or improve the effectiveness of current breast cancer treatments."
Dr Lesley Walker, of Cancer Research UK, which part-funded the study, said: "DNA damage, particularly double strand DNA breaks, are a fundamental cause of cancer and we know that people who have mutations in the BRCA1 gene have a higher risk of developing some kinds of cancer.
"Discovering that these limpet-like proteins play such an important role in repair may provide new opportunities to stop cancer from growing."
But she added: "This is an extremely complex and intricate biological process so it may be many years before we can use this knowledge to safely intervene and help treat cancer patients."

Galway researchers make breast-cancer breakthrough

Tuesday, December 22, 2009 - 08:36 AM Courtesy of THe Irish Examiner

Researchers at NUI Galway have made a breakthrough for breast cancer sufferers.
They scientists have found a blood test that can identify how a woman is responding to treatment.
It is also hoped the test could work as an early-warning" system if the illness comes back.
Following more work, it is thought the new test could be in routine use within the next two years.

The Irish Times
Tuesday, December 22, 2009
Hospitals face penalties over waiting list mismanagement
MARTIN WALL, Industry Correspondent
 

MINISTER FOR Health Mary Harney has urged the Health Service Executive (HSE) to put in place a system of financial rewards and penalties to encourage hospitals to manage their waiting lists effectively.In a letter sent to the chairman of the HSE, Liam Downey, in late October, the Minister said she wanted the organisation to develop and implement a plan to address long-term waiting lists, both in terms of on- going validation and to ensure that patients did not have to wait unnecessarily long for treatment.

In the latter case, I would ask your board to develop proposals for a set of incentives/ disincentives that would encourage hospitals to manage waiting lists effectively, with particular reference to the issue of those waiting for longer than 12 months, she said.Ms Harney described the issue of patients who had been on public hospital waiting lists for hospital treatment, some for more than a year, as a continuing problem. However, she pointed out that the number of such patients had fallen from 4,637 in December 2007 to 1,178 in September 2009.

She said information provided by the National Treatment Purchase Fund (NTPF) revealed that five hospitals accounted for more than 60 per cent of those on inpatient waiting lists for longer than 12 months. She said another five hospitals accounted for a further 20 per cent of such patients.The NTPF points out that a number of hospitals are not adhering to the agreed waiting list guidelines, which results in an overstatement of the numbers actually awaiting a service. The data indicates, for example, that the details of over half [53 per cent] of all those on a waiting list for more than a year are awaiting clerical/administrative follow-up by individual hospitals, and a further 8 per cent have already declined offers of treatment by the NTPF at least once.These situations underline the importance of all hospitals maintaining accurate, up-to-date waiting lists in accordance with the NTPF guidelines, so that the true number of patients who need treatment can be established and they can receive an appropriate service, she said.

The Minister said that where it was considered clinically appropriate that patients should be treated in the hospital on whose waiting list they already were placed, arrangements should be made to provide them with the required service as soon as possible, given the small numbers involved.Ms Harneys letter followed a report earlier this year carried out by the States spending watchdog, the Comptroller and Auditor General, which found that fewer than 10 per cent of people listed as waiting longest for elective treatment in hospital were available for treatment under the NTPF.

It said the most common reason for unavailability for NTPF treatment (37-46 per cent of cases) arose from the failure of hospital administration to follow up patients who had not responded to a previous contact, for example, the offer of a hospital admission date

.In November 2008, three hospitals accounted for almost half of the numbers in this category Letterkenny General (340), AMNCH Tallaght (228) and Sligo General (200).

Warning on sale of codeine products

[Posted: Mon 21/12/2009 by Niall Hunter, Editor] Courtesy of Irish Health

Pharmacists have been warned to take precautions in selling codeine-containing medications to the public.

The pharmacy regulator, the Pharmaceutical Society of Ireland (PSI) has stressed that codeine-containing tablets must not be accessible to the public for self-selection and therefore must be stored in an area of the pharmacy where patients cannot self-select, either physically or visually.

The PSI in new guidelines, also says these medicines must only be supplied by or under the personal supervision of a qualified pharmacist working in the pharmacy. Under the law, codeine-containing products can only be sold in pharmacies and are not for sale in supermarkets or other retail outlets.The new guidance also states that codeine medicines should only be used when considered necessary and for the shortest period necessary.Patients should be advised of the importance of adhering to the recommended dose and duration of use and should be informed of the risks of developing tolerance and dependence, the guidelines state.

Patients should, according to the PSI, also be advised of added risks from "combination' products, such as painkillers containing codeine and another drugs such as paracetamol or ibuprofen, and should be counselled about other potential side effects.The guidance also states that patients should be facilitated in obtaining medical assistance for any health problems related to misuse.The advertising of these medicines to the public is prohibited, and this includes window displays, in-pharmacy displays, shelf stickers and promotional leaflets.The guideline shave been produced by the PSI with the Irish Pharmaceutical Healthcare Association, which represents pharmaceutical comnpanies

Page last updated at 03:51 GMT, Monday, 21 December 2009
 Courtesy of BBC News
Cervical cancer link to early sex 
 
Sexually transmitted infection, HPV, causes most cases of cervical cancer
Having sex at an early age has been linked with double the risk of developing cervical cancer.
An investigation into why poorer women have a higher risk of the disease found they tended to have sex around four years earlier than more affluent women.
It had been thought that the disparity was due to low screening uptake in poorer areas, but the study found this was not the most important factor.
The latest findings are published in the British Journal of Cancer.
Although the difference in cervical cancer incidence between rich and poor - across the world - had been noted for many years, it was not clear why this is the case.
Especially as rates of infection with human papillomavirus (HPV) - the sexually transmitted infection linked with the vast majority of cervical cancers - seemed to be similar across all groups.
The study, by the International Agency for Research on Cancer, of nearly 20,000 women, confirmed that the higher rates of cervical cancer were not linked to higher HPV levels.
Although women can be infected by HPV at any age, infections at a very young age may be especially dangerous as they have more time to cause damage that eventually leads to cancer
Dr Lesley Walker, Cancer Research UK
But what it did reveal is that the two-fold increased risk was largely explained by women from poorer backgrounds starting to have sex at a younger age.
The age at which a woman had her first baby was also an important factor.
Screening was found to have some effect on the level of risk.
But the number of sexual partners a woman has and smoking did not account for any of the difference.
Lag time
Study leader, Dr Silvia Franceschi, said the findings were not restricted to adolescence and the risk of cervical cancer was also higher in women who had their first sexual intercourse at 20 rather than 25 years.
"In our study, poorer women had become sexually active on average four years earlier.
"So they may have also been infected with HPV earlier, giving the virus more time to produce the long sequence of events that are needed for cancer development."
Dr Lesley Walker, director of cancer information at Cancer Research UK, said the study raised some interesting questions.
"Although women can be infected by HPV at any age, infections at a very young age may be especially dangerous as they have more time to cause damage that eventually leads to cancer.
"Importantly, the results back up the need for the HPV vaccination to be given in schools at an age before they start having sex, especially among girls in deprived areas."

Cancer services transformed but challenges remain
20 December 2009 By Aileen O’Meara Courtesy of THe Sunday Business Post

When Elaine and Louise Keogh’s father was dying of cancer in their Clonakilty home in April 2008, the women vowed to help their father to die a dignified death at home. Their mother had died unexpectedly in hospital a year earlier, denying them the opportunity to care for her until the end.
As their father’s condition worsened, the Skibbereen based palliative care team helped the family during the day, but the nights became very difficult for the women.
Neither could sleep when their father became distressed.
This all changed when Nurse Lily from the Irish Cancer Society’s Night Nursing service came to help. ‘‘She was brilliant," said Louise of the free service.
‘‘She could take care of Dad during the night, and we could rest a little. She could administer morphine, move him and turn him, and talk to him. It made such a difference. For Elaine and myself, she was there for us too."
The Irish Cancer Society service is one example of the progress being made in cancer care in this country. Another was the opening last week of the eighth and final regional state-of-the-art cancer centre at Cork University Hospital.
Since the arrival of Professor Tom Keane to head the ambitious transformation of cancer services here, many doubted he would achieve his targets within two years. However, cancer services have been rationalised into eight specialist centres, reduced from the 33 just two years ago.
Despite what the people say in centres that lost out - such as Tralee and Sligo - the ambitious rationalisation plan has succeeded. As he prepares to leave Ireland and return to his family and work in Canada, Keane and other senior cancer specialists predict that Ireland will soon be in the ‘‘premier league’’ of cancer services in the world, confident that the survival outcomes for cancer sufferers in Ireland will be among the best within a few years.
Stories like the misdiagnosis of breast cancers in Limerick and Portlaoise, which dominated the headlines two years ago, should never recur. Cancers are now treated by multidisciplinary teams, with hospitals working to standards overseen by the Health Information and Quality Authority.
The eight regional centres are in Beaumont, the Mater, St Vincent’s and St James’s hospitals in Dublin; Cork University Hospital; Waterford Regional; Limerick Regional; and Galway University Hospital. A weakness of the geography of the plan (decided in advance of Keane’s arrival) is the absence of any major centre north of a line from Dublin to Galway, and the failure to take on the dominant Dublin hospitals and move at least one centre to the north-east or north midlands.
Meanwhile, the bigger picture in Ireland is challenging.
As the population ages, it is estimated that cancer cases will double by 2015, although the survival rates are improving and the incidence of cancers is falling in the population.
At present, 20,000 Irish people develop cancer each year, of which 7,500 die, while 60 per cent of all cancer patients die within five years of diagnosis.
Other developments are going ahead. The Breastcheck screening programme is being introduced nationally, to a high standard, and the cervical cancer screening programme is belatedly being rolled out by the National Cancer Screening Service (NCSS), after a ten year pilot programme in the Midwest.
But the decision by health minister Mary Harney to withhold sanction for a national cervical cancer vaccine for young girls has been widely criticised.
At a cost of €10million, it was not a major saving for the department.
Furthermore, even though it is over two years since the National Cancer Forum called for a bowel cancer screening programme, it is not likely to be announced until next year.
Harney promised that a plan would be announced shortly after the budget, and it will be supported with the help of €1 million from the Irish Cancer Society.
It will take a further two years to get the screening programme under way, while the waiting times for appointments for patients with possible bowel cancer is still too long, according to the Irish Cancer Society. Finding the resources for the screening programme, and its infrastructure, will be problematic.
While the Breastcheck capital programme is continuing, the Department of Health wants increased capacity for colonoscopies to be provided ‘‘within existing resources’’, heaping pressure on a HSE already struggling to cope with increased demand on reduced budgets.
In the meantime, the gaps remaining in the services for cancer patients are being partially met by local and national charities, such as the Irish Cancer Society, the Irish Hospice Foundation and local cancer support centres and groups.
Their services are also being affected by the deep recession, while the number seeking their services continues to rise. The Keoghs’ father was just one of the 1,642 patients who availed of the Irish Cancer Society (ICS) flagship service in 2008; over 2,000 patients in the final stages of terminal cancer will have benefited from the free service this year.
However, John McCormack, chief executive of the ICS, said it was facing a 12 per cent drop in income this year.
‘‘We receive no state support for these services, but demand for night nursing and welfare support for families on the cancer journey is rising," McCormack said.
‘‘We give immediate cash assistance for practical support for transport or childcarewhen money is needed quickly to cope with a cancer diagnosis."

'Radioactive bullet' treatment offers hope to cancer sufferers By Chris Irvine Wednesday December 16 2009 Courtesy of The Irish Independent

A 'radioactive bullet' cancer therapy could offer new hope to untreatable Hodgkin's lymphoma patients after an experiment found two thirds responded to the treatment. The treatment, which finds and destroys tumours using the 'bullets', showed improvements in two-thirds of the 15 patients taking part in the pilot study, either responding completely or partially to the drugs. One patient is still disease-free two years later. The new therapy, called CHT25, uses an antibody that targets tumour cells linked to a radioactive particle. The antibody delivers the radioactive isotope to sites of disease in the body where it selectively kills lymphoma cells. Tumours remain exposed to radioactivity for at least four days, but there is little damage to healthy cells. Scientists are now planning a bigger Phase II trial with larger numbers of patients after the results were published in the jrounal Clinical Cancer Research. Father-of-two Vija Vijayamonohar, was diagnosed with Hodgkin's lymphoma 10 years ago. Following chemotherapy treatment, he thought he had beaten the disease, but discovered it had returned three years ago. Following the CHT25 trial, he has now been given the all-clear. "I was delighted to be part of the trial," he told The Evening Standard. "I know it was one of the most up-to-date treatments and iw as a great success for me. "Now I'm leading a normal life and enjoying my time with my family." Around 1,600 people develop Hodgkin's lymphoma every year. It occurs when certain white blood cells in the lymph nodes become cancerous. It has a high cure rate, causing around 300 deaths a year, but some cases fail to respond to treatment such as radiotherapy and chemotherapy. Professor Richard Begent, head of Cancer Research UK's Experimental Cancer Medicine Centre at University College London, who helped develop the treatment, said the initial resulted were "very encouraging". The pilot study indicated that people with a different type of cancer called T-cell lymphoma may also benefit from the therapy. "There is an urgent need for new treatments for Hodgkin's lymphoma and T-cell lymphoma because a number of patients develop drug resistance to the therapy options already out there," said Prof Begent. The Phase II trial will be conducted at Cancer Research UK centres in London, Manchester and Southampton.

Page last updated at 18:00 GMT, Wednesday, 16 December 2009
 Courtesy of BBC News
 
Scientists crack 'entire genetic code' of cancer 
By Michelle Roberts Health reporter, BBC News 

Scientists have unlocked the entire genetic code of two of the most common cancers - skin and lung - a move they say could revolutionise cancer care.
Not only will the cancer maps pave the way for blood tests to spot tumours far earlier, they will also yield new drug targets, say the Wellcome Trust team.
Scientists around the globe are now working to catalogue all the genes that go wrong in many types of human cancer.
The UK is looking at breast cancer, Japan at liver and India at mouth.
China is studying stomach cancer, and the US is looking at cancers of the brain, ovary and pancreas.
These catalogues are going to change the way we think about individual cancers
Wellcome Trust scientist Professor Michael Stratton
The International Cancer Genome Consortium scientists from the 10 countries involved say it will take them at least five years and many hundreds of thousands of dollars to complete this mammoth task.
But once they have done this, patients will reap the benefits.
Professor Michael Stratton, who is the UK lead, said: "These catalogues are going to change the way we think about individual cancers.
"By identifying all the cancer genes we will be able to develop new drugs that target the specific mutated genes and work out which patients will benefit from these novel treatments.
"We can envisage a time when following the removal of a cancer cataloguing it will become routine."
It could even be possible to develop MoT-style blood tests for healthy adults that can check for tell-tale DNA patterns suggestive of cancer.
Russian roulette
The scientists found the DNA code for a skin cancer called melanoma contained more than 30,000 errors almost entirely caused by too much sun exposure.
Most of the time the mutations will land in innocent parts of the genome, but some will hit the right targets for cancer
Wellcome Trust researcher Dr Peter Campbell
The lung cancer DNA code had more than 23,000 errors largely triggered by cigarette smoke exposure.
From this, the experts estimate a typical smoker acquires one new mutation for every 15 cigarettes they smoke.
Although many of these mutations will be harmless, some will trigger cancer.
Wellcome Trust researcher Dr Peter Campbell, who conducted this research, published in the journal Nature, said: "It's like playing Russian roulette.
"Most of the time the mutations will land in innocent parts of the genome, but some will hit the right targets for cancer."
By quitting smoking, people could reduce their cancer risk back down to "normal" with time, he said.
The suspicion is lung cells containing mutations are eventually replaced with new ones free of genetic errors.
By studying the cancer catalogues in detail, the scientists say it should be possible to find exactly which lifestyle and environmental factors trigger different tumours.
Treatment and prevention
Tom Haswell, who was successfully treated 15 years ago for lung cancer, believes the research will benefit the next generation:
"For future patients I think it's tremendous news because hopefully treatments can be targeted to their particular genome mutations, hopefully... reducing some of the side effects we get".
Cancer experts have applauded the work.
The Institute of Cancer Research said: "This is the first time that a complete cancer genome has been sequenced and similar insights into other cancer genomes are likely to follow.
"As more cancer genomes are revealed by this technique, we will gain a greater understanding of how cancer is caused and develops, improving our ability to prevent, treat and cure cancer."
Professor Carlos Caldas, from Cancer Research UK's Cambridge Research Institute called the research "groundbreaking".
"Like molecular archaeologists, these researchers have dug through layers of genetic information to uncover the history of these patients' disease.
"What is so new in this study is the researchers have been able to link particular mutations to their cause.
"The hope and excitement for the future is that we will eventually have detailed picture of how different cancers develop, and ultimately how better to treat and prevent them."

New cancer fear in CT scans

• By Steve Connor in London Tuesday December 15 2009 Courtesy of The Irish Independent

THE latest generation of hospital scanners could be far more dangerous than previously believed, according to a study showing that as many as one in 80 people could be at risk of developing cancer as a result of being scanned.

Computed tomography (CT) scanners produce a much higher dose of radiation than conventional X-rays and the latest research suggests that the extra exposure could result in a 10-fold greater risk of cancer than is usually cited, scientists said.

Two studies into the growing use of CT scanners in the US have identified wide variations in the radiation dose that patients receive, with some people receiving 13 times the level of radiation received by other CT patients, depending on their conditions.

The scientists believe that the additional risks posed by CT scanners could result in thousands of extra cases of cancer caused by the relatively high exposure to the X-rays they use.

Researcher Rebecca Smith-Bindman of the University of California San Francisco said: "In our study, the risk of getting cancer in certain groups of patients for certain kinds of scans was as high as one in 80." (© Independent News Service)

Women are more likely to visit GP

• By Eilish O'Regan Monday December 14 2009 Courtesy of THe Irsih Independent

ABOUT seven in 10 of Irish adults have been to see a GP at least once in the past year.Rates increase with age and women are more likely to visit their doctor than men, according to the latest report from the Department of Health.Around one in 10 of us have been diagnosed at some point with high blood pressure while diseases of the circulatory system and cancer continue to be the main conditions causing death.Obesity is one of the major challenges which faces the health services into the future.

Terminally ill dont want to die at home

By Eilish O'Regan Courtesy of The Irish Independent Monday December 14 2009

Only one-third of terminally ill patients who were cared for at home wanted to die there, according to new research.The study, conducted by Dr Sinead Kelly of St Luke's Hospital in Dublin, challenged the belief that all terminally ill patients would prefer to be cared for or die in their own home.She said the study of 58 terminally ill people showed that 91pc of them opted to be cared for at home but only one-third wanted to die there. Another third would have preferred to die in a hospice in-patient unit and a further 12.5pc were undecided."It may be that patients wanted to protect their families at the end of their lives and don't wish to be a burden on them or leave sad memories in the home," said Dr Kelly.

The findings are included in A Picture of Health, which is a compendium of studies funded by the Health Research Board.She added: "They may also have a positive view of hospice care through their own experience or the experiences of others."

Currently only 64pc of patients succeeded in dying in their place of choice and others should not act as "gatekeepers" in deciding for them, said Dr Kelly.n

Health cuts come in under the radar
13 December 2009 By Aileen O’Meara Courtesy of The Sunday Business Post

After weeks of careful public preparation, with the most contentious elements already clearly signalled, the announcement of a €1 billion cut in health spending barely made the headlines.
Minister for Health Mary Harney and her senior officials kept their fingers crossed that the new 50 cent charge for prescriptions -with a €10monthly limit - would be criticised but not too much.
The €20 increase in the threshold for Drugs Payment Scheme (DPS) limit was low enough to stop people marching in the streets.
These increases were softened by the decision not to increase A&E hospital charges or the charges for private and semi-private beds in public hospitals.
After last year’s public revolt and massive political row generated by the removal of the automatic entitlement to the over-70s medical card, the government very carefully negotiated through the maze of health benefits to find savings and prepare the public well in advance.
As predicted, most of the savings of €1.013 billion in the €15 billion health budget came from a range of pay-related measures, not least significant reductions in income for the 111,600 staff who work in the health services, including direct employees, hospital consultants and health professionals.
The cuts - or savings, as the minister referred to them - are made up as follows: pay savings: €659 million; cost reductions: €283 mi l l ion; and income collection and charges: €117 million.

Pay cuts

Pay cuts of between 5 per cent and 8 per cent will yield most of the pay savings, but the fees of professionals will face a further, as yet unspecified, reduction in the coming months.
The moratorium on staff recruitment and promotion will continue. Already there are more than 1,700 vacancies in the Health Service Executive (HSE) - a small number in the overall scheme of things, but gaps in services are already being felt. Last week’s breakdown in the pay talks with trade unions means the deadlock over agreement on the early retirement of a further 500 or so staff - mostly nurses - will continue.
The government took a calculated risk that well-paid hospital consultants would not complain too much about the 15 per cent cut in their salaries, having received a massive hike in pay with their new contract over a year ago.
The Irish Hospital Consultants Association (IHCA) was quick to issue a public reminder that a final pay increase in the new contract was still outstanding, meaning a real salary cut of up to 30 per cent. The IHCA has not ruled out taking action on the matter.
The bigger health unions - the Irish Nurses Organisation (INO), Irish Medical Organisation (IMO), Impact and Siptu - are still discussing plans to campaign against the pay cuts, officially ignoring last week’s invitation by the HSE’s HR director, Sean McGrath, to reopen talks on changing work practices.
In a letter to staff, he pointed out that health union leaders had found away of implementing more flexible work practices, including a longer working day and a seven-day roster.
It is unlikely that there will be any real move in that direction until the New Year at the earliest. What’s far more likely is a campaign of work stoppages and disruption by the health unions in response to the pay cuts, with an emphasis on the plight of lower-paid workers in the health service at clerical and nursing level.

Cost reductions

Drugs came under the microscope when officials went seeking cost reductions. The state’s drugs bill increased by nearly 40 per cent, or €300million, which is unsustainable. A new drugs price reduction agreement with pharmaceutical companies is expected to yield savings of €141 million, along with the €133 million saved through reductions in community pharmacy fees.
Legislation is also planned for generic substitution and reference pricing in the future.
The HSE is due to find economies worth €106 million through efficiencies in procurement of services, including insurance and legal services.

New charges

Further income, while not significant, will come from new charges. The 50c prescription charge for medical card and community drugs schemes will yield €15 million in 2010 and €25 million in a full year, but doctors in the IMO have quest ion e d how it will be administered, and at what cost.
The income from the charge will be low to begin with, but it is also aimed at influencing demand and prescribing patterns. A total of 48 million items were prescribed under the GMS (medical card scheme) in 2008 alone. The €20 increase in the monthly threshold for the drugs payment scheme is expected to yield €27 million.
 

Health’s capital budget, while cut by €37 million, provides €484 million for continued upgrading of health infrastructure, with assurances that major building programmes, such as the new children’s hospital, are going ahead as planned.
A further €97 million will boost the nascent Fair Deal nursing home scheme, but the additional €10 million for homecare packages is unlikely to cover increased demand. The additional €20 million for the cancer programme will include the beginning of a national screening programme for colorectal cancer.
 

The detail of how Budget 2010 will affect the frontline health services will not be known for several months yet.
The HSE is in the process of finalising its service plan for 2010, which the minister will ratify in January.
Despite the crisis in the public finances, the health services continue to expand capacity and output, while under constant pressure to stay within budgets. The HSE is a leaner organisation than it was three years ago, but there is little room for manoeuvre except in one area: pay.
The one major disappointment in the budget for many doctors and health experts was the decision - on economic grounds - to reduce excise duty on alcohol when the recognised abuse of alcohol, especially among younger people, is directly linked to high levels of suicide, mental health problems, social harms and rape.
As Minister for Health, Mary Harney made little effort to argue that reducing the price of drink might keep shoppers in the Republic, but it is a retrograde step for the health services and for the health of the nation.
 

Breast care programme fails to hit its targets

• By Eilish O'Regan Health Correspondent Friday December 11 2009 Courtesy of The Irish Independent

The number of women who were called for admission to hospital within three weeks of being diagnosed with cancer through Breastcheck was below target last year. The annual report of the screening service, which offers free X-rays to women aged between 50 and 64, showed 81.7pc were offered hospital admission within three weeks, although the target is 90pc.More than 3,500 "well women" who were screened by Breastcheck since 2000 discovered they had cancer after taking up the invitation for a mammogram.

Breastcheck began in the east, north east and midlands areas of the country in 2000 and, although it is now in every county, not all women in the south and west have received their first invitation for free screening.The report stated yesterday that 3,500 cases of breast cancer were picked up in the 276,000 women who underwent mammograms since the year 2000, including 672 last year.The report showed, however, that while the overall take-up rate to avail of the mammogram was 77.4pc -- above target -- it was as low as 68.2pc among women in their mid to late 50s.It pointed out that 2008 saw the same pattern as in previous years, with the uptake highest in younger women who received their first invitation. The proportion of women who were re-invited for screening within 27 months of their invitation to a previous first mammogram was 86.5pc, below the 90pc target. The rate of women who took up the invitation having already undergone screening was 90pc.Breastcheck chief executive Tony O'Brien said: "Of women invited for screening in 2008, 672 were diagnosed with a cancer, with 527 of these invasive. This represents a major increase in cancer detection." He added that last year 39,802 of the women screened were new to the programme and 52,259 women had received at least one Breastcheck mammogram. "Uptake of invitation to screening, at 77.4pc, remains above the programme target of 70pc; however, uptake rates are continually and carefully monitored to ensure the high level of acceptance of invitation to screening is maintained."

Harmful

Since screening began in the southern and western regions in December 2007 to October 2009, over 67,000 women have had a Breastcheck mammogram.He said while there had been some controversy recently about the harmful effects of over-diagnosis of DCIS -- the most common form of non-invasive cancer -- the number of women with low-grade forms of this cancer represented less than 3pc of the total cancers detected. Meanwhile, one of the country's three health insurers dropped its prices yesterday in the wake of the Budget decisions which will hit people's incomes. Hibernian Aviva Health has announced it will reduce the cost of its level two hospital plan back to the price it was prior to an increase implemented in October.

Page last updated at 00:03 GMT, Friday, 11 December 2009
 Courtesy of BBC News
 
Alcohol link to breast cancer recurrence 
 
Breast cancer is the most common cancer in the UK
Women who have had breast cancer should stick to three alcoholic drinks or less a week to reduce the chance of the disease returning, researchers suggest.
A US study of 1,900 women who had recovered from breast cancer found that moderate drinking was linked to a 30% higher risk of recurrence.
The eight-year study found the strongest link in women who were post-menopausal or overweight.
UK charities said alcohol is known to increase the risk of cancer in general.
Presenting the research at the American Association for Cancer Research breast cancer conference, the researchers said few studies had been done on the risk of alcohol consumption and the recurrence of cancer.

The good news is that alcohol consumption is something we can change
Dr Caitlin Palframan, policy manager, Breakthrough Breast Cancer
The study looked at women diagnosed with breast cancer between 1997 and 2000, and compared recurrence of the disease in those who drank alcohol with those who abstained.
Over the course of the research there were 349 breast cancer recurrences.
The increased risk found in those who drank at least three to four drinks a week was apparent regardless of the type of alcohol drunk.
But alcohol consumption was not associated with overall mortality.

Informed choice

Study leader Dr Marilyn Kwan, from the Kaiser Permanente Division of Research in Oakland, California, said other studies were needed to check the validity of the findings.
But she added: "These results can help women make more informed decisions about lifestyle choices after a diagnosis of breast cancer.
"Women previously diagnosed with breast cancer should consider limiting their consumption of alcohol to less than three drinks per week, especially women who are postmenopausal and overweight or obese."
Dr Caitlin Palframan, policy manager at Breakthrough Breast Cancer, said it would advise women to be aware of how much alcohol they consumed and to drink in moderation.
"We already know that regularly drinking alcohol can increase a woman's chances of developing breast cancer.
"This study may suggest that alcohol consumption could also play a role in the likelihood of the disease coming back.
"The good news is that alcohol consumption is something we can change."
Dr Jodie Moffat, health information manager at Cancer Research UK, said: "It's important to understand the things that influence the odds of breast cancer returning, but as yet we can't say for sure that alcohol plays a part in this.
"We already know that alcohol increases the chances of developing several different types of cancer, including breast cancer - so cutting down on alcohol is certainly an important thing people can do to reduce their cancer risk."

BreastCheck detected over 3,500 cancers

[Posted: Thu 10/12/2009 by Joanne McCarthy] Courteesy of Irish Health.com

BreastCheck, the National Breast Screening Programme, provided free mammograms to 92,061 women aged 50 to 64 in 2008 and early 2009, it has confirmed.
Since the screening programme began, BreastCheck has provided almost 560,000 mammograms to over 276,000 women and detected over 3,500 breast cancers.
Of the women screened, 4,119 were recalled for further assessment. Some 672 women were diagnosed with breast cancer, representing 7.3 cancers per 1,000 women screened, compared to six cancers per 1,000 women screened in 2007.
The overall rate of acceptance of invitation to screening was 77.4%, which is in excess of the programme target of 70%.
“During 2008 and early 2009, BreastCheck provided a fully quality assured mammogram to the highest number of women since the programme began. Ninety two thousand and sixty one women aged 50 to 64 accepted their BreastCheck invitation, representing a 38% increase on the previous year,” said Tony O’Brien, chief executive officer of the National Cancer Screening Service (NCSS), adding that he is delighted that a truly national breast screening service is offered to women in Ireland.

BreastCheck operates a fully digital mammography screening service. Mr O’Brien while there has been some controversy recently regarding the potential harmful effects of over-diagnosis of DCIS (the most common type of non-invasive breast cancer) through mammographic screening, the results show that for women invited in 2008 the number of low grade DCIS detected represented less than 3% of total cancers detected, or 2.1 per 10,000 women screened.
Evidence has shown that many intermediate and high grade DCIS progress to invasive cancers over time if left untreated. These represent the majority of DCIS detected by BreastCheck.

NATIONAL CANCER SCREENING SERVICE WELCOMES CONFIRMATION OF INTRODUCTION OF COLORECTAL CANCER SCREENING PROGRAMME

The National Cancer Screening Service (NCSS) today welcomes confirmation from the Minister for Health and Children, Ms Mary Harney TD, that a national, population-based colorectal cancer screening programme is to be introduced for men and women in Ireland.The NCSS has been working closely with the Minister and her officials at the Department of Health and Children in recent weeks, to examine ways in which the NCSS can deliver a quality assured, timely and cost effective national programme.As the Minister has confirmed, there will be a full and detailed briefing on the organisation and implementation of a national colorectal cancer screening programme provided in the coming days

9th December 2009

Harney outlines health cuts

[Posted: Wed 09/12/2009 by Joanne McCarthy] Courtesy of Irish Health.com

Health Minister Mary Harney has outlined the health estimates for next year as part of today's Budget.

There will to be no increases in charges for day, inpatient and long stay services in hospitals, and there is to be no increase in the charge for attending A&E. Charges for private beds in public hospitals are also not being increased.

However, the monthly threshold for the Drugs Payment Scheme is to be increased from €100 to €120 from January 1, and medical card holders and those on the long-term illness scheme will pay 50 cent for each item they receive on prescription, with a monthly ceiling of €10 on payments.

The Health Minister said that the €400 million worth of savings in the health area would be made up from €283 million cost reductions for drugs and dental treatment, €75 million from collecting outstanding income and €42 million from increased charges.

Health sector workers, including hospital consultants, will see their pay cut. Furthermore, a further reduction in fees payable to some health professionals (excluding pharmacists) is planned.

Next year, an extra €230million will be provided for demand-led schemes such as additional medical cards. There will also be an additional €97 million allocated to the Fair Deal nursing home scheme. An additional €10 million will be put towards home care packages and an additional €20 million will be given to the cancer control programme, which will include the roll out of a national bowel cancer screening programme.

Total day-to-day health spending for 2010 will be €14.8 billion, compared to a €15.6 billion out-turn in spending for 2009.

Page last updated at 00:03 GMT, Thursday, 10 December 2009
Courtesy of BBC news
Trial launched into neuroblastoma child cancer 
 
Neuroblastoma affects the nervous system
Scientists are to test if boosting the immune system can prevent the return of the childhood cancer neuroblastoma.
The disease - a cancer of developing nervous system tissue - is most often found in under-fives and accounts for about a sixth of child cancer deaths.
The European trial builds on early promising results from a US study which found immunotherapy improved the chances of survival from the disease.
Cancer Research UK is funding the trial for 160 UK children over four years.

The cancer develops in specialised nerve cells, called neural crest cells.
These primitive cells are involved in the development of the nervous system and other tissues.

 CASE STUDY
 
Sophie McGuire developed symptoms soon after her second birthday in January this year. Initially doctors thought she had a virus affecting her hips, but her condition deteriorated - she was constantly tired and lost a lot of weight.
After extensive tests she was diagnosed with advanced neuroblastoma in April. Scans showed she had cancerous tissue wrapped around the arteries leading to her kidneys, and secondary cancer in her arms, legs and pelvis.
She has had regular chemotherapy and blood transfusions at London's Great Ormond Street Hospital.
At one point she required intensive care after her lungs became dangerously inflamed, and she was unable to eat anything by mouth for several months.
Her father James said: "We are obviously pleased that this new part of the trial has been launched and Sophie will be part of it."
 

 Tumours often develop in one of the adrenal glands but may also form in nerve tissues in the neck, chest, abdomen, or pelvis.
Overall, six out of 10 children are successfully treated through treatment such as surgery and chemotherapy - but the prognosis is not as good for children with advanced forms of the disease.
Doctors estimate about 40 children per year in the UK would be eligible for - and potentially benefit from - the new treatment.
It works by hunting down neuroblastoma cells that have survived conventional treatment and attaching antibodies to specific molecules on their surface.
These antibodies then mobilise the body's immune defences to attack and destroy the cells.
The UK arm of the trial - part of a larger European one, and funded by the charity Cancer Research UK - will run in all 20 childhood cancer clinical trial centres across the UK, recruiting 160 children over the next four years.
 

Lead researcher Dr Penelope Brock, a consultant paediatric oncologist at Great Ormond Street Hospital, said: "Early results from the US trial found that children who received the immunotherapy treatment had less chance of the disease coming back two years later, compared with the patients who did not receive the immunotherapy.
"We need to build on these results and devise better immunotherapy approaches that improve survival further."
The UK trial - in which all eligible children will receive immunotherapy - will attempt to reduce the severe side effects seen in the US study.
James McGuire from Harrow Weald in North London, has a two-year-old daughter, Sophie, who will take part in the trial.
He said: "Based on the positive outcomes from the earlier trial, I am hopeful that this treatment will play a critical role in saving Sophie's life."
This trial will be open to high-risk neuroblastoma patients who are nine months from diagnosis and within four months of the last round of aggressive treatment to control the tumour.

First cancer 'atlas' shows higher incidence in cities

Rural lifestyle helps to lower risk of illness

• By Eilish O'Regan, Health Correspondent Tuesday December 01 2009 Courtesy of THe Irish Independent

STRIKING geographical differences in the incidence of some cancers have emerged in the first "atlas" of the disease in Ireland.

An examination of cancers diagnosed between 1994 and 2003 showed a higher incidence for all malignant forms of the disease around Dublin and Cork and some other urban areas. Regions with more agricultural workers have a lower risk of disease.

The incidence of all cancers -- excluding non-melanoma skin cancer -- was higher than average in a band running across the north-east and north-midlands from Dublin to Sligo.

The higher incidence of cancer in urban areas is partly linked to social deprivation and lifestyle factors such as smoking and poor diet.

More densely populated areas consistently had a higher risk of cancer than those that were sparsely populated, the report from the National Cancer Registry of Ireland shows.

The risk of almost all cancers analysed was higher in areas with the highest proportion of elderly people living on their own -- this may be due to lifestyle including poorer diet and higher alcohol intake.

The report reveals a higher-than-average incidence of bowel cancer in Cork city and this also extended to the far south-west. It was also higher in the north and centre of the country in a broad band from Dublin through the north-east to Donegal.

The incidence of lung cancer in both sexes was higher in Leinster, most markedly in Dublin, Kildare and Wicklow.

For breast cancer there was a modest variation but it was highest in the major urban areas, with the exception of Limerick. A slight increase was seen in west Cork, north Kerry and large areas in the east-midlands, while within Dublin it was more prominent in the south-east of the capital.

Prostate cancer was highest around the major urban centres, which has been linked to more testing.

Stomach cancer showed the strongest pattern of "clustering" with higher incidence seen in the area stretching from Dublin through Louth, Monaghan and Cavan.

Cervical cancer was seen more around Dublin as well as down the eastern side of the country with a lower incidence in Cork, Kerry and Donegal.

Variations

Commenting on the possible reasons for the variations, the report pointed out that many of the risk factors for cancer were not yet known and therefore the differences could not be fully explained.

The variations do not mean a particular location itself caused the cancer but instead are likely to reflect socio-economic differences in the population, exposure to risk factors and access to or uptake of cancer screening.

"It is generally accepted that it is predominantly the result of differences in well-known risk factors such as tobacco smoking, alcohol drinking, obesity, diet and sexual behaviour" said director Dr Harry Comber.

"We recommend a national research programme to explore, at the individual level, the relationship of known and suspected risk factors to cancer risk and to search for unknown risk factors," he added.

- Eilish O'Regan, Health Correspondent

Irish Independent

New prostate cancer treatment launched

[Posted: Tue 01/12/2009 by Joanne McCarthy] Courtesy of Irish Health

A drug described as the first new treatment option for advanced prostate cancer in 20 years is being launched in Ireland today.

According to its manufacturers, Firmagon decreases the production of testosterone in the body, which prostate cancer is dependent on for its growth.

In clinical trials, Firmagon reduced testosterone significantly faster than existing treatments for prostate cancer. Slowing the growth of a tumour by reducing testosterone levels in the body enables it to be treated with radiotherapy or surgery.

Approximately 2,407 Irish men are diagnosed with prostate cancer every year. The National Cancer Registry estimates that there will be a 275% increase in the incidence of prostate cancer by 2020, resulting in approximately 3,768 new cases of the disease every year.

Prof John Fitzpatrick, consultant urologist at the Mater Hospital, Dublin, highlighted that reducing levels of testosterone is the most important issue to address when treating advanced prostate cancer.

“There are treatments available that achieve this but not at the same speed as Firmagon. This is a significant advancement that will be welcomed by the medical community,” he said.

Prostate cancer develops in the prostate, a gland in the male reproductive system. Symptoms of prostate cancer include passing urine more often, especially at night; pain or difficulty when passing urine; trouble starting or stopping the flow of urine; the feeling of not having emptied bladder; frequent pain in lower back, hips or upper thighs; trouble having or keeping an erection and blood in urine or sperm.

Firmagon will be marketed in Ireland by Ferring Pharmaceuticals.

Cancer linked to deprivation

[Posted: Tue 01/12/2009 by Niall Hunter, Editor] Courtesy of Irish Health

Cancer levels around reland are linked to deprivation levels in particular areas, according to new statistics.

A report from the National Cancer Registry published today shows that for most cancers, there is significant geographical variation in risk based on where you live.

Most cancers, the report says, show either a positive or negative relationship with area deprivation scores.

More densely populated areas consistently had a higher risk of cancer than those that were sparsely populated.

The risk of cancer was higher in areas with the highest proportion of elderly people living on their own.

The Registry's Atlas of Cancer in Ireland 1994 to 2003 stressed that well-known risk factors such as smoking, alcohol, obesity, diet and sexual behaviour implicated in cancer incidence.

However, the registry also said many factors that can lead to cancer are not yet known, or are poorly understood, and some of the patterns in cancer risk observed in the report could not be explained on the basis of what is currently known.

It called for a national research programme to explore the relationship of known and suspected risk factors for cancer and to search for so far unknown factors.

The Irish Times - Tuesday, December 1, 2009

Funding is not the issue
Increased spending does not necessarily lead to better results for patients, the Pfizer/ Irish Times healthcare debate is told

THE IRISH health service has an exceptionally large budget which has very little to do with the provision of healthcare, Trinity College Dublin economist Dr Sean Barrett has said.
Dr Barrett said he believed the €16 billion annual State spend on health and the further €4 billion currently spent by consumers on private doctors, med- ication and other charges, did not represent value for money.
He said Ireland was now spending 15 per cent of GNP on health – the same level as the US and almost twice that of the UK. In return for this considerable spend, Dr Barrett said the health service had recruited 67 per cent more staff in the period since 1996, but the number of hospital beds had increased by only 13 per cent.
Speaking during the final Pfizer/ Irish Times healthcare debate, held at the Science Gallery in Trinity College Dublin last week, Dr Barrett said that since 1996 the number of medical staff had increased by 55 per cent, the number of nurses by a quarter, health and social care workers increased by 159 per cent, while the numbers employed in management and administration went up by 45 per cent.
The debate on the motion, “This house believes that reduced health spending should not lead to poorer healthcare”, was attended by about 100 people on Wednesday night.
Dr Barrett, supporting the motion, said consultants were richly rewarded and that their numbers had increased by 60 per cent.
“When they awarded the €250,000 contract to consultants, one of their representatives was reported as saying, ‘This is a Mickey Mouse of an award’. Let’s all go to Walt Disney if that’s a Mickey Mouse award for a 33-hour week,” he said.
He went on to say that consultants also earned a considerable amount for seeing private patients and that he thought “private practice in a public hospital is something that really has to be looked at”.
Dr Barrett pointed out that in St Vincent’s Hospital, Dublin, there were 479 beds, 150 consultants, a rate of 1.3 beds per doctor and 0.5 beds per nurse.
“We have one of the most expensive health services you will find anywhere. Compared to 1997 we have 114,000 people doing the work of 68,000. It has a voracious appetite for earning . . . It has a very large budget that has very little to do with healthcare.”
In response, Stephen McMahon, chairman of the Irish Patients’ Association, said that surely if the annual spend on health was too much, then areas such as mental health and cystic fibrosis care would not be lagging, and money would have been available to fund a cervical cancer vaccination programme.
 

Mr McMahon said patients were wary of the health system for four primary reasons: a lack of clinical governance; the risks from being prescribed medication incorrectly; the danger of poor management decisions; and the inequality of access to services.
He said if enough was being spent on health, public patients should not wait months for appointments which private patients could attend in a matter of days, should not spend prolonged periods on trolleys and time waiting step-down care, and should not be at risk of catching infections such as MRSA or C diff .
 

Speaking for the motion, Sean Byrne, an economics lecturer at Dublin Institute of Technology, said international evidence suggested that increased spending on healthcare did not necessarily lead to better results for patients.
Mr Byrne said medical care was a contributor to better health, but that other factors, such as increasing educational standards and broadening income levels, would generate better results in the long term.
He said there needed to be both a consumption and investment in people’s health and that, while personal tastes and preferences were a factor, those who looked after themselves were most likely to reap the greatest rewards.
Mr Byrne also noted the level of spending on health in the US and said extra spending did not necessarily benefit those who were sick. He said the majority of terminally ill children in the US died in hospital rather than at home because of the higher cost and higher intensity approach to healthcare there.
“There is this notion that if you have the technology and you have the facilities and the expertise they have to be used, and you can be shoved into them regardless of whether they are best for you.”

In response, Fine Gael health spokesman Dr James Reilly said recent cutbacks in spending had resulted in even worse results from the health service here. Dr Reilly said there was a 70 per cent increase in delayed discharges this year as facilities to move convalescing patients on to had been scaled back.
He said waiting lists were growing, more patients were spending time on trolleys and the number of cancelled operations and attempts to scale back the medical card scheme for over-70s were other unreasonable consequences of health cutbacks.
 

Dr Reilly said the HSE was founded in an “impossible” situation which resulted in about 3,000 people not knowing what their role was when the former health boards merged. This disorganisation, he said, resulted in scandals such as misread X-rays and undiagnosed cases of cancer. “That approach is anathema to me and [Fine Gael] wants to see real change,” he said.
Dr Reilly said patients should be seen as the central figure to healthcare and not as a cost burden, and that clearly the health sector was not operating as it should be if operations were being cancelled because of budgetary overruns.
In summation, the debate chairman, Irish Times assistant editor Fintan O’Toole, said both sides seemed to agree there was “a great deal of waste, a great deal of inefficiency and a great deal of extravagance” within the current health system. He said it could be argued that if money were taken from the system, similar results should be achievable.
However, he said it remained to be seen if wastefully spent funds could be directed into more worthy practices or if reorganising spending could generate greater efficiencies while protecting the needs of patients.
When asked if they agreed with or opposed the motion, the vast majority of the audience indicated that reduced health spending should not lead to poorer healthcare, prompting Mr O’Toole to declare the supporting argument victorious.

[Donegal Action for Cancer Care] [About  DACC] [Next County Meeting] ["Cancer-You Are Not Alone"] [Financial support for cancer patients] [Cancer Related Sites] [Letterkenny General Hospital] [Annual Report 09] [Local Radio 2010] [Local News 2010] [National News March] [National News Feb 2011] [Recent events 2010] [Upcoming Events] [Just for you!]