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HealthScot An independent publication from www.canongate.org

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The ÂŁ100m cancer services plan

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Boosting early detection rates

Distributed with The Times Scotland 21 November 2016

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Lessons learned on waiting times

Scottish Cancer Conference special

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The robot will see you now

Sweet and sour

Why sugar should be treated like smoking in the battle to prevent cancer


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healthscot BRIEFING

21 November 2016

Health Scot

Major award for anti-smoking charity boss

HealthScot is an independent publication by Canongate Communications Contents

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The chief executive of anti-smoking charity ASH Scotland will today be presented with a major award. Sheila Duffy is one of the leading forces behind the campaign to make Scotland smoke-free. She has won the Scottish Cancer Foundation’s £10,000 prize in recognition of her role in helping to reduce the burden of cancer in Scotland. She will be presented with the award – known as the Evans Forrest medal and now in its second year – at today’s Scottish Cancer Conference in Edinburgh. Duffy said: “I am greatly honoured to receive this award, especially in 2016 as we celebrate ten years of smoke-free indoor spaces. Tobacco is the single biggest preventable cause of cancer, and working to put cigarettes out of sight, out of mind and out of fashion must be a priority going forward. “ASH Scotland plans to use the prize money to engage with smokers and ex-smokers living in challenging circumstances where smoking rates are high, and to find out more about their experiences of using and quitting tobacco. This is a gap in current knowledge, and will help shape and inform our community engagement.

3: £100m cancer plan 5: Early detection 6: Obesity 8: Waiting times 10: Research 11: Technology

“The national ambition is that a child born this

year will grow up and reach the age of 18 smokefree. Achieving this will prevent future cancers, and directly reduce health inequalities.” Professor Bob Steele is chairman of the board of directors at the Scottish Cancer Foundation. He is also head of cancer research and professor of surgery at Ninewells hospital and school of medicine in Dundee. He will be speaking about the future of cancer surgery at the conference. Praising Duffy’s work, he said: “The work Sheila has done is exemplary; ASH Scotland has been working towards a smoke-free environment for many years – and every strand of smoking activity has been targeted. Sheila and ASH Scotland thoroughly deserve this prize.”

EDITOR Will Peakin 0131 561 7364 will@futurescot.com DEPUTY EDITOR Kevin O’Sullivan 0131 561 7364 kevin@futurescot.com Reporter Nicola Stow

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Sheila Duffy has won the Scottish Cancer Foundation’s £10,000 prize in recognition of her role to help reduce the burden of cancer in Scotland

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Fifth of cancer patients face workplace discrimination Research reveals some cancer patients even feel guilty for taking time off for appointments By Nicola Stow One in five Scots who return to work following a cancer diagnosis face “appalling” discrimination from employers and colleagues, research by the charity Macmillan reveals. The survey also showed that 24 per cent of sufferers – all in work when diagnosed – returned to work before they felt ready. And a third of Scots patients reported feeling guilty for taking time off for medical appointments. Janice Preston, head of Macmillan Services in Scotland, said: “For many people living with cancer, returning to work is hugely important. As well as helping them manage financially, we know it helps people feel more in control of their lives again and brings

a sense of normality which can boost their recovery. “It is therefore appalling that, in too many cases, help to stay in employment is not always offered to people living with cancer who want to work and are able to do so, leaving them with little choice but to leave. During what is already a stressful and difficult time, they should be able to rely on the full support and understanding of their employer.” Lynn Laing, of Edinburgh, was diagnosed with breast cancer in 2010 and had a mastectomy, followed by chemotherapy and radiotherapy. She had a teenage son and a husband in temporary employment and felt pressurised to return to her job as a receptionist in a medical practice in Danderhall, Edinburgh. She said: “I think the pressure to return to work was the money. The money was drying up, there was hardly anything coming in. I was pressurised a bit in going back to work because of the money situation. I think if I didn’t have any money worries I probably would have given myself a wee bit

longer to recover. I was still getting treatment when I returned.” Meanwhile, a pioneering support service for cancer patients in Glasgow has helped almost 2,000 people since it began in 2014. Improving the Cancer Journey (ICJ) is a unique service which ensures people in the city are automatically offered financial, emotional and practical support when they are diagnosed with cancer. The project, which is a partnership between Macmillan Cancer Support, Glasgow City Council and NHS

“It is appalling that help to stay in employment is not always offered”

Greater Glasgow and Clyde, is the first of its kind in the UK. ICJ has been praised for its approach and has won awards. The Scottish Government included ICJ in its first cancer plan as a model of best practice and pledged £9m to roll similar services out across the country. Bailie Braat, city treasurer at Glasgow City Council, said: “We already believed in the value of this project and the city’s partnership with Macmillan because we could see the positive difference they were making to the lives of Glaswegians with a cancer diagnosis every single day. “However, it is still a huge boost to the whole team to see that belief endorsed so emphatically in this independent evaluation. Through the drive, determination and creativity of an exceptional group of people, this partnership has transformed cancer care in Glasgow and blazed a trail across the UK for high-quality, integrated services that are focused exactly where they should be: on the people who need them most.”


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21 November 2016

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£100m plan to improve cancer services in Scotland Cancer is becoming more prevalent as our population ages, but as a society, there’s much we can do to improve people’s survival chances, writes health secretary, Shona Robison Most of us will have been touched by cancer at one point in our lives. Whether it has been experiencing the disease personally, or helping friends and family members through a diagnosis, we all know the impact cancer can have. While cancer is likely to become more prevalent as our population ages, there is much we can do as a society to improve our understanding of cancer, lessen its impact and improve people’s survival chances. In Scotland, we have already made some important headway on this – with deaths from cancer having dropped by 11% in the last 10 years. And we are taking forward a range of new actions to build on this progress. Ahead of this year’s Scottish Cancer Conference I’d like to set out a few of these below. This year, the Scottish Government

published our five-year cancer strategy, Beating Cancer: Ambition and Action, which sets out how we plan to improve the prevention, detection, diagnosis, treatment and aftercare of those affected by cancer. It is our blueprint to help reduce inequality and to improve both the experiences, and ultimately outcomes, for people with cancer. Through this strategy, we plan to spend £100 million over the next five years to improve cancer services. A large proportion of this investment will be spent at the earlier stages of

the treatment pathway, with millions going to screening, diagnostics, surgical treatments and new radiotherapy equipment and services. This will help to build up capacity in the system and ensure everyone in Scotland gets equally timely access to the highest possible quality of cancer care. While excellent treatment is probably the most important thing that people expect from the NHS, we also know that they highly value the emotional and practical support services that can help them live with cancer. In Scotland’s first ever Cancer Patient Experience Survey, published earlier this year, this was one of the key themes that emerged. That is why, as part of our strategy, we’ll be investing £9 million to support access to health and social care services during and after treatment. For example, we’ll fund Link Workers to provide support in some of our most deprived communities and invest in improvements across the palliative care sector - supporting targeted action on training and education.

Shona Robison, cabinet secretary for health and sport

Improvements in data collection and analysis are also fundamentally important to how we drive change in our cancer services across the NHS. Our investment in the Innovative Healthcare Delivery Programme and the establishment of the Scottish Cancer Intelligence Framework will support data sharing, often in real time, to improve person-centred care, quality healthcare delivery, performance management and research. Another key strand of the Scottish Government’s work is in improving our ability to detect cancer at an early stage. This will make a huge difference towards achieving our ambition of increasing survival from cancer. Our Detect Cancer Early Programme, which has been running since 2012, has this important aim at its heart. The Programme combines improve-

ments at a service level with visible and hard-hitting social marketing campaigns that encourages people to attend screening appointments when invited and get any possible symptoms of cancer checked out sooner rather than later. It has a specific focus in reducing inequalities and raising awareness among people living in some of the most deprived areas of Scotland. This approach has proved successful. Since Detect Cancer Early began, there has been a 16.4 per cent increase in the proportion of breast, lung and bowel cancers diagnosed among people living in the most deprived areas of Scotland – the biggest increase of any socio-economic group. In addition, the largest increase in bowel screening uptake has been amongst males in the most deprived areas and there’s been a 44.1per cent increase in stage one lung cancer

“Another key strand of the Scottish Government’s work is in improving our ability to detect cancer at an early stage. This will make a huge difference towards achieving our ambition of increasing survival from cancer” diagnoses in patients from the most deprived areas. Of course there’s still more to be done – the ‘bowel movement’ continues to sweep the country, building momentum as those who have taken their bowel screening test encourage others to do so. I’m joining them today and would encourage anyone reading this to take their bowel screening test when it comes through their letter box – or encourage family and friends to do so. It could save their life. The initial campaign phase saw

an additional 3,000 tests returned, compared to the same time period the previous year, so we’re keen to build on results like this moving forward – ensuring people are informed about their screening decision and are empowered to seek help if they have a worry or concern.

Next month will also be Lung Cancer Awareness Month and we will see Detect Cancer Early’s social marketing campaign – fronted by Sir Alex Ferguson – back on air. It’ll be prompting people with a cough for three weeks or more to see their GP. And later this year, the Scottish Government will be launching a new campaign to boost the number of women attending their cervical screening appointments, as the data shows we have more to do in this area. We’ll take this forward alongside our work on early stage detection of breast, lung and bowel cancers – and continue our successful campaign approach of targeting a reduction in health inequalities. By working together with our partners across the health, care and third sectors, we can all collectively help to bring cancer down to size.

Bravery of ‘dancing sunshine’ leukaemia survivor honoured By Nicola Stow This time last year, four-year-old Lydia Yilmaz was unable to walk after being diagnosed with leukaemia while on a family holiday in Turkey. Now, after enduring four rounds of gruelling chemotherapy, the youngster is in remission and embracing her favourite passion – salsa dancing. Lydia’s remarkable courage has earned her a Kids & Teens award, as new figures released by Cancer Research UK show the rate of children dying from the disease in Scotland has fallen by 36 per cent in the last 20 years. Lydia’s parents, Selen Yilmaz, 33, and Ozgur Yilmaz, 34, said they’re

hugely proud of their “dancing sunshine”. Selen, of Glasgow, said: “I call Lydia my dancing sunshine. She’s loving dancing again and life has somehow come back to our family. “When your child is diagnosed with cancer you have no idea when or how that will happen. It was traumatic but right from the start we were surrounded by amazing people who made Lydia laugh, gave her strength and made her happy. “We are truly grateful to that

mighty army of angels, our family and friends who gave Lydia positive energy and love. There have been times that it was Lydia who kept me going. She is a naturally happy person. Even when she

felt too weak to walk, she still smiled.” The family, who moved to Scotland from Turkey in 2012, know only too well how crucial new developments in treatments are in helping children and adults survive cancer. Dance teacher Selen recalls vividly the moment their lives were turned upside down on November 17 last year after tests revealed Lydia had acute lymphoblasticleukaemia, a type of blood cancer Her family were visiting family in Istanbul when Lydia first complained of sore legs and feeling exhausted. Bruises on her body, a high temperature, nose bleeds and swollen gums raised alarm bells so they went to Acibadem Hospital for tests. Mum, Selen said: “That night was the longest night of my life. They

ordered a blood test then another one as the doctor wanted to double check the results. Lydia’s blood counts were so low that we found ourselves in the special care unit. The doctor on call alerted the specialist who came rushing to the hospital.” Cancer Research UK Kids & Teens is now urging relatives and friends of other young cancer patients and survivors to nominate them for the star accolade in the run-up to Christmas. A spokeswoman said: “Although we’re losing fewer young lives to cancer, a lot more needs to be done to find new and better treatments. And as more children survive cancer, it’s especially important that we concentrate on improving their quality of life after treatment.”

Selen Yilmaz with daughter Lydia. “Life has somehow come back to our family,” she says


detection

21 November 2016

We need to talk about cancer Mum’s tragic cancer death at 44 has inspired MSP to campaign for screening age to be lowered in Scotland By Nicola Stow MSP Miles Briggs knows only too well the heartache of losing a loved one to cancer. He was only seven when his mum Joan passed away in a hospice following a brave battle against the devastating disease. “I was a young boy when my mum died,” recalled Mr Briggs, now the Conservatives’ public health spokesman. “She had breast cancer - and it was the hardest thing ever to hit my family. I don’t remember a huge amount about it as I was only seven, but my two older sisters were teenagers at the time, so it was incredibly tough for them. At the same time, we rallied round as a family. We had to. “I remember going to the hospice to see Mum – and I remember noticing how kind and helpful the staff were. And like anyone else who has gone through that awful experience, we are eternally grateful for the support we received.” Joan was just 44 when she died in 1990. And while the pain of losing his mother at such a young age will never leave Briggs, it has inspired him to campaign for better support for cancer patients. In his latest crusade, the politician is urging Scottish ministers to consider lowering the age of breast screening for women. The politician, also co-convenor of the parliament’s cross party group on cancer, has written to health secretary Shona Robison, calling for the age of screening to be reduced from 50 to 40. He said: “My mum’s cancer was not diagnosed early. Back then there wasn’t as much awareness about cancer as there is nowadays. People were not so clued-up on how to check for symptoms such as lumps – and Mum was not in the screening population. I think lowering the screening age to 40 could potentially pick up a different aspect of the population who are getting breast cancer but who are not part of the screening process. “More and more women under the age of 50 are now being diagnosed with breast cancer, and it’s only right that we lower the screening ages to help deal with this.” At present all women between 50 and 70 are invited for breast screening

as part of the NHS Breast Screening Programme. In England, however, trials are ongoing to include women between the ages of 47 and 73. Briggs added: “Detecting cancer early is vital for improving survival rates, and it’s essential that we offer it to those likely to develop the disease. “With trials of an extended age range ongoing south of the border, I can see no reason why the Scottish government couldn’t introduce a similar programme in Scotland.” Earlier this year, the Scottish

Government launched its new £100 million cancer strategy, aimed at improving detection, diagnosis, treatment and aftercare in the next five to 10 years. The plan contains more than 50 action points to tackle the disease, which is still Scotland’s biggest killer. And although Briggs acknowledges there are “many good aspects” to the strategy, he also warned Scotland has a “post code lottery” regarding cancer services. “I welcome the renewal of the strategy and I’m hoping we’ll see progress over the next few years,” he said. “But we really do have to ensure the Scottish Government are held to account to that. And this is where, in parliament, the health committee and the cross party group will study the strategy and highlight where focus is needed. To some extent Scotland has a post code lottery when it comes to cancer

“I was a young boy when my mum died. She had breast cancer – and it was the hardest thing ever to hit my family”

services – and, for me, that is totally unacceptable. Therefore, we (the cross party group) are going to focus on that aspect and press the case for investment or intervention where health boards are failing.” One issue requiring urgent attention, said Briggs, is the waiting time crisis in which hundreds of cancer patients are facing “unacceptable” delays for treatment. New figures released in September revealed only 89.7 per cent of people who were urgently referred between April and June began treatment within 62 days – falling far short of the Scottish Government’s target of 95 per cent. Just two of the country’s 14 regional health boards met the target. “For most people, once they’ve had a cancer diagnosis it’s all about time,” said Briggs. “The clock is ticking and fear and stress begins to build up – for both the patient and his or her family. Therefore, it’s important that we speed up times as much as we can. “We need flexibility in the system in order to get patients through as quickly as possible. We have a system that is supposed to be patient-focussed, but unfortunately it doesn’t feel like that for some patients. And this parliament has a great opportunity to change that - because there really is a consensus to put cancer, and cancer treatment and survival at the top of the agenda.” Another area where the government could make improvements is by assessing its public awareness strategies. Briggs would like to see more information on screening available in places such as pubs and job centres to encourage Scots, particularly men, to speak more openly about cancer. He explained: “A lot of cancer survivors come to the cross party group meetings. They tell stories of how they’ve encouraged other people to go and get symptoms checked and, ultimately, it has saved their life. Conversely, what is so harrowing is when you hear stories of those who have ignored symptoms and have subsequently died. “As a country we need to talk about our health more to each other. We’re a population which tends not to tell each other our health problems. We whisper about such things. Over time we need to address this, especially for Scottish men and boys. “We haven’t moved on in terms of screening. For example, people are presenting with prostate cancer at a far later stage and are not picking up on the screening profiles available.

And we really need to do something about that. We need to make it normal for people to talk about cancer and screening. “We have all these cancer awareness days, but that’s just for one day a year. We receive leaflets in the post about cancer and screening, but most people put them in the bin. Why not make this information available in pubs? Why doesn’t every pub get sent bowel and prostate screening information to display on the bar? Maybe then, people might, over a pint and a chat, decide to take the information away with them.” Official figures show that in 2014, 31,711 people were diagnosed with cancer in Scotland, up from 27,820 in 2014. Lung cancer remains the most common in Scotland, followed by breast cancer. Since the launch of the government’s £30 million detect Cancer Early (DCE) campaign in 2013, seven per cent of patients in Scotland diagnosed with the earliest stage of lung cancer (stage 1) has increased by over a third overall to 35.8 per cent. But are public information

campaigns effective? Briggs is not convinced. “I’m increasingly starting to question the effectiveness of public health campaigns,” he said. “They maybe work well for middle class health services and the worried well. But for some of the more vulnerable people living in Scotland’s most deprived communities, I don’t think the message is reaching them. And I’m referring to all health campaigns, not just those relating to cancer.” Citing the 1991 Back to Sleep campaign as an example, he added: “The campaign, surrounding cot death, sent out the simple message of: baby wakes up during the night, turn baby onto his or her back. As a result, middle class infant mortality dropped to a European average within months. But, in stark contrast, it took almost 15 years for the death rate to reach a low and stable

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Conservative MSP Miles Briggs with mum Joan, who died of breast cancer in 1990 rate in deprived communities. “Some strategies are not delivering the outcome we’re looking for, so there has to be a redoubling of efforts to tackle these issues and ring them all together. We need to focus not only on patient-focussed health care, but also on early intervention – even by talking about people’s health before they are born. “But how do we build a happy, healthy community in Scotland? One where people are not presenting with a disease but thinking about a discussion. It’s difficult because the health service is a huge machine. It’s almost a crisis health service we have in Scotland – and public information only goes so far.” Briggs also praised the work of Scotland’s cancer charities and stressed the importance of providing emotional support for cancer patients. He said: “I’ve met a few people affected by cancer who said they felt as though they were on their own. I don’t want anyone to feel as though they’re on their own regarding cancer services. This is a huge issue for me; it’s not just – someone’s got cancer, we need to treat it, it’s also about what support does that patient need? “Scotland has so many great cancer charities – and I take my hat off to them for the tremendous work they do, day in, day out. “I think Scotland has the potential to be the best country to live in for cancer diagnosis, treatment and survival and, if it’s terminal, then palliative care. And that’s what we need to try to deliver. “The cross-party group has a really good reputation. And we need to make sure it punches above its weight and does not just talk shop, but pushes the issues that the government might neglect or can’t get on the agenda.”


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healthscot cancer prevention

83,000 children are overweight when they start primary school. That’s an extra large problem.

21 November 2016

Charity wants action to combat the biggest preventable cause of cancer after smoking By Nicola Stow Last month a Cancer Research UK study highlighted the shocking truth about Scotland’s growing obesity problem, revealing that almost 83,000 children are overweight or obese when they start primary school. The figures, based on the weight of four and five-year-olds, were published as the charity launched its Scale Down Cancer Campaign demanding urgent action to tackle its root causes. To further enforce the message, the leading cancer charity staged photographs depicting a shop selling only extra large children’s clothes, because XL uniforms are “becoming the norm”. Professor Linda Bauld, Cancer Research UK’s prevention expert, says being overweight or obese is the single biggest preventable cause of cancer after smoking, linked to an estimated 18,100 UK cases per year. Yet worryingly, almost three out of four Scots are not aware of the association. The health campaigner wants sugarloaded drinks to be made as socially unacceptable as smoking following research showing Scots households spend over a quarter more than the UK as a whole on fizzy drinks. While she welcomes the UK Government’s impending ‘sugar tax’, due to be implemented in 2018, she says it does not go far enough. “Smoking is still the biggest preventable cause of cancer,

but obesity is rapidly catching up,” she explains. “Most people in Scotland don’t make the link between being overweight or obese as a risk factor for cancer and that’s worrying. Likewise, it is really very worrying that children as young as four are entering primary school carrying too much weight. “We should be concerned too about the picture this paints for the health of the nation as we know that obese children are around five times more likely to become obese adults. Obesity is also linked to 13 types of cancer including bowel, breast and pancreatic. If left unchecked, we run the risk of obesity becoming a crippling burden on society and the NHS. “It’s taken us 50 years to reduce smoking rates from 80 per cent in men in 1950 to less than one in five. It’s not just that it went out of fashion, we took comprehensive action, pushing at a number of different buttons. The big four for me are, price, promotion, the place of sale and the content of products themselves.” Professor Bauld, who is based at Stirling University, has also called for billboard ads and sponsorship deals with soft drink companies to be banned. “At the moment the Scottish Government is legislating on banning electronic cigarettes and removing all the billboard advertising for e-cigarettes, so we know that they have the power to make that change.” Figures show that one in four adults and up to one in three children in Scotland are obese. Teenagers between the ages of 11 and 18 consume about three times the amount of sugar recommend-


cancer prevention

21 November 2016

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Nurse Kirsty Thomasson used to be a size 18 (below) and slimmed down to size 8 (right). Now she is backing the Scale Down Cancer campaign

As part of its obesity-focused children’s campaign Cancer Research UK created a fictional shop window selling only XL uniforms ed by official government guidelines. The move to introduce a sugar levy – announced by former chancellor George Osborne in March and a key part of UK Government’s childhood obesity strategy- was hailed by health campaigners as a significant step in the battle against the problem. The tax is aimed chiefly at high sugar drinks, particularly fizzy drinks and fruit drinks, while milk-based drinks will be excluded. There will be two bands: one for total sugar content above 5g per 100 millilitres, and a higher band for the most sugary drinks with more than 8g per 100 millilitres. Drinks which would currently fall under the higher rate include full-strength Irn Bru, Coca-Cola, Pepsi and Lucozade Energy. Professor Bauld said: “Shockingly, sugary drinks are the biggest source of sugar for young people in Scotland, making up about 30 per cent of their total intake, with households spending around a quarter more than other UK nations on soft drinks. Which means the benefits of the sugar tax would be greater in Scotland. “

“Shockingly, sugary drinks are the biggest source of sugar for young people in Scotland”

Citing Mexico’s successful introduction of a similar levy, Professor Bauld added: ‘One example which proves a sugar levy does have an impact is in Mexico, which has some of the highest rates of obesity in the world. The evaluation of that levy is quite promising; the government made a commitment to put the revenue back into the provision of free drinking water for schools and community centres. The volume of sales of sugary drinks went down by about 12 per cent in the first year after the levy was introduced.” But while the sugar levy was welcomed, the UK Government was criticised for abandoning plans to ban advertisements for unhealthy foods before the 9pm watershed. It also threw out plans to ban junk food from supermarket checkouts. The chancellor said the English share of the sugar levy proceeds would be used to double funding for sports in school. The Scottish government

is hoping to launch its own strategy early next year – and Cancer Research UK is calling on ministers to take a more robust approach, as professor Bauld explained: “Recent decreases in physical activity don’t account for rising obesity levels alone. Diet is an essential factor and tackling consumption of junk food should be a priority. The plan was published by the UK government but there is so much more that could be done in Scotland. “Obviously we were very disappointed at UK level to see Westminster government’s child obesity strategy watered down to a very weak plan. But now we have the opportunity to influence the Scottish government. It

has committed to this diet and obesity strategy. Westminster has to legislate on watershed advertising, but as part of its expected obesity strategy, we would urge the Scottish Government to do better and take action on some forms of junk food marketing, including on very cheap unhealthy foods. “We would like to see multi-buy promotions on crisps and and sugary foods stopped – and this is something that can be done by Scottish Government in partnership with Food Standards Scotland. “We would also like to see more research on price issues (English figures show promotions increase the amount people buy by one fifth). And we would also like input from the health service, such as more information on healthy eating and diet. And for there to be healthier food in hospitals, as opposed to all those vending machines.” But as professor Bauld pointed out, in order to really tackle the scourge of childhood obesity, the message has to reach parents. She said: “Cancer Research is not just interested in tackling childhood obesity. One of the reasons why adult weight is so important is, if parents are heavier, they are more likely to have children who are overweight or obese. One of the most effective things we can do to improve childhood obesity is to encourage adults to have healthy weight. It’s about healthy role modelling and creating a healthy home environment. “Because all those measures – price, promotion, the place of sale and the content of products also have an impact on adults – they affect the whole population.”

Case study

When Kirsty’s trousers burst at the seams she decided to it was time to lose weight. Now she’s fit and full of energy Inverurie nurse and mum-of-three Kirsty Thomasson is backing the Scale Down Cancer campaign. She was, until recently, very overweight. Being a busy mum, the 33-yearold found herself reaching for convenience food and snacks, piling on the weight, until she was 13 stone and a size 18. It was when her trousers burst at the seams while she was at a soft play centre with her children that a tearful and embarrassed Kirsty decided it was time to take action. Thanks to the support of her local Scottish Slimmers class, Kirsty is now a healthier nine stone 4lb and a trim size eight. Kirsty now feels she has more energy for her children Cameron, four, three-year-old Arran and 17-monthold Lewis. She said: “I think advertising does influence what you buy, that’s why the junk food companies invest in it. “If I saw a poster for a sugary snack, or an advert on TV, then it

would definitely have encouraged me to put a particular biscuit or a fizzy drink in my shopping basket – especially if it was part of a ‘buy one get one free’ offer. “I think we are all so busy, and we’re bombarded with adverts for junk food all the time, that Scotland has become a fast food nation. “And, as a nurse, I see the awful consequences of what obesity can do to your health all the time. I think it’s awful that so many children now are obese and it’s about time we all took responsibility and did something about it.” Kirsty added: “It’s important to me to be a good role model for my children but it didn’t seem right that, while I was asking them to eat fruit and vegetables, I was reaching for convenience food. “With young children to look after, it’s so easy to reach for junk food when you feel you don’t have time to cook something healthy.”


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healthscot WAITING TIMES

21 November 2016

“Sixty-two days is quite a tight timescale, but for the patient, that is a long time – they’re sitting at home worrying and waiting on answers. Therefore, we have to make sure that we can absolutely meet that target – and this is something I’m totally passionate about” Margaret Kelly, cancer services manager at NHS Lanarkshire

How to cut treatment delays: Planning, teamwork and ‘chapping on doors’ How two health boards are bucking the national trend on cancer waiting times By Nicola Stow Figures released in September showed scores of vulnerable cancer patients are facing delays for diagnosis and treatment – because 12 of Scotland’s 14 health boards failed to meet a key waiting time target. The statistics revealed between April and June, 89 per cent of people urgently referred began treatment within 62 days – less than the Scottish Government’s target of 95 per cent. Health chiefs also missed the 62-day treatment target for nine out of 10 common cancers. Breast cancer was the only form for which the target was met, with 96.4 per cent of patients treated within the two-month referral. Cancer charities reacted with fury to the outcome. Cancer Research UK’s senior public affairs manager in Scotland, Gregor McNie, said: “At a time when cancer is Scotland’s most

common cause of death, it’s unacceptable that this target hasn’t been met. “Patients must be diagnosed and treated swiftly if they are to have the best chance of survival.” The latest performance marks the worst quarterly results since records began in 2010. However, two health boards- NHS Lanarkshire and NHS Borders- did meet the target, treating 95.4 per cent and 97.2 per cent respectively of cancer patients within 62 days. HealthScot spoke to bosses at both boards to find out how they go about achieving – and maintaining – this success. Former nurse Margaret Kelly, can-

cer services manager at NHS Lanarkshire, says communication, being able to prioritise and robust teamwork are key factors when it comes to sustaining a “slick process” – one that has seen the board meet the government’s 95 per cent target since her appointment in 2007. She said: “As cancer services manager it is my job to make sure every single patient is meeting all the deadlines set and the agreed patient pathways – and the team oversees that on a daily basis. Sixty-two days is quite

a tight timescale, but for the patient, that is a long time – they’re sitting at home worrying and waiting on answers. Therefore, we have to make sure that we can absolutely meet that target – and this is something I’m totally passionate about. “I meet with the team throughout the week. We have a process – if anything is out of synch, if there are delays, then this is escalated up to me. For example, if the capacity at the radiology department cannot offer a patient an appointment time that suits our agreement, they would flag this up to me and I would have to make sure that appointment is made.” But, as Ms Kelly points out, patients’ “journeys” can vary in length depending on the form of cancer. “All cancers are different, so the pathway for a head or neck tumour may be completely different from a lung cancer pathway,” she said. “Obviously, the aim is to get the diagnosis as quickly as possible and we timetable everything to know when we’re going to give the diagnosis, who is going to give the diagnosis and treatment times for the patient. It’s a mixed journey for each tumour group because each has its own set of diagnostic investigations. We need to be working

very closely with the radiology team and pharmacy team; we need to interact with a whole raft of people that relate to that person’s cancer journey. It’s about having good relationships with them all and collectively doing the right thing. “For radiotherapy important steps need to be taken between referral and first treatment. The radiotherapy department needs at least two weeks to plan, so I have to ensure our special services at the hospital give the cancer centre enough time to do what they need to do to get the patient in on time. Therefore, they cannot refer a patient for radiotherapy on day 60 with the expectation that the atient will be seen on time.” According to Ms Kelly, NHS Lanarkshire handles most referrals during the winter months. She also said cancers are being diagnosed earlier since the Scottish Government launched its Detect Cancer Early campaign in 2012. “We haven’t seen a marked rise in referrals but cancers are being diagnosed earlier and it’s often seasonal,” she explained. “We see more referrals in the winter as this is the time when people are needing chest X-rays. The public are more aware and are acting

on symptoms sooner, which means we can get them on a treatment pathway sooner. “The Detect Cancer Early campaign has helped in that we’ve been able to diagnose them at the earlier stages, which means we have more opportunity to get them on a curative treatment plan. “Our expectation is that the patient should be seen within 14 days of referral. And if we can’t achieve that then we do something about it. We have a very slick process. My tracking supervisor will go to the waiting times meeting to make sure our voice as the cancer team is heard by all the relevant teams. We will also have a team meeting, attended by the clinical leads - and we talk about a range of things from policy to finance to the cancer pathway.” But as Ms Kelly attests, maintain-

ing such a level of high performance is a challenge. And she admits, occasionally, things do go wrong. “We don’t get it right all of the time,” she said. “Occasionally we might have a breach patient where we haven’t met the target. If this does happen we have to act fast. We need to analyse the situation, identify who we need to speak to and discuss what we could do differ-


WAITING TIMES

21 November 2016

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9

“The key is to offer a time of service because, if a patient is worried, if they’ve had symptoms for two weeks, we want to see them so we can hopefully assuage their fears or provide them with diagnosis and support as soon as possible” Andrew Murray, medical director at NHS Borders

ently - because we would not want it to happen again. “If we do have a situation where a patient isn’t going to make it to surgery before the breach date, I would go and chap doors and ask: ‘What can we do to make sure this doesn’t happen again?’ But for some tumour groups that can be very difficult because they’ve run out of capacity. However, we’ve made a few changes over the years to make that challenge less. For example, we introduced CT colonography for patients over 75, which is less invasive than colonoscopy.” But what can Scotland’s 12 health boards that failed to meet the target do to improve their performance? Ms Kelly said: “I don’t know whether any of the other boards have changed how they work. At a recent conference a boss from another board asked my advice. I’m willing to help anyone – and if anyone wants to come in and watch how we do things, they’re more than welcome. “We haven’t changed our process since 2007. We feel we’ve got a positive message and I know Scottish government is proud of us, too. But we now need to sustain that standard. And that’s a challenge - but we’re going to do it.” Andrew Murray, Medical Director

at NHS Borders and a former cancer surgeon, said it was “not infrequent” for 100 per cent of patients urgently referred to begin treatment within 62 days. Like Margaret, he attributes this success to careful planning and maintaining robust links between GPs and secondary care colleagues. And although he stresses NHS Borders’ performance is by no means an “accident”, he said being a “relatively small board” makes it easier to track referred patients. He said: “We have very clear guidelines and we work really hard at emphasising these guidelines and feeding back to GPs. We make it as straight forward as possible for GPs to refer

patients they’re concerned about - and to monitor those patients closely. “We don’t have particularly low numbers of people with concerning symptoms. But we do have slightly different demographics in our area. We’re slightly better off. And because we’re a relatively small board, we’re able to spot quickly when things are not aligning well. For example, when people are not getting their tests and there’s a backlog. Recently we had a bit of a backlog build up for people needing an endoscopy. Our manager spotted this early and we were able to bring in more capacity to make sure we could clear the backlog. It’s about active management and being able to prioritise – to prioritise our sickest patients suffering from cancer.” Dr Murray added: “The key is to offer a time of service because, if a patient is worried, if they’ve had symptoms for two weeks, we want to see them so we can hopefully assuage their fears or provide them with diagnosis and support as soon as possible. We’re consistently meeting 100 per cent of urgent referrals, which is a really good news story for NHS Borders and its patients.” Dr Murray was also quick to praise the work of neighbouring board NHS Lothian, which provides radiotherapy services for Borders cancer patients. “Some treatments - complex surgery and radiotherapy for cancer patients – are delivered by our partners at NHS Lothian, so I wouldn’t want to play down the part they play in helping us meet the target. We have very close links with our colleagues and they play their part by ensuring our patients get the treatments they need. This requires us to have good multi-disciplinary teams to manage clinical networks with NHS Lothian. “Radiotherapy is one area in which, as a board, we’d like to be able to improve upon. Radiotherapy is very taxing in itself, without the hour-long train journey to Edinburgh. So we’d love to be able to deliver this treatment locally for our patients.”

Case study

Janet Brodie believes early diagnosis and swift treatment of her breast cancer saved her life

Fitness enthusiast Janet Brodie discovered she had breast cancer after her doctor claimed her chest pain was caused by a hula hoop injury. The 56-year-old, of Portobello, Edinburgh, had visited her GP several times because she had been suffering a persistent pain after being hit by a hula hoop during a fitness class. Although Janet, an accounts clerk, initially thought the injury was to blame, she changed her mind after seeing a breast cancer awareness television advert featuring Elaine C Smith. She was seen by specialists at the Western General Hospital in Edinburgh where she received a mammogram, ultrasound and a biopsy. Unfortunately, the results revealed Janet was indeed suffering from breast cancer and grueling surgery and chemotherapy followed. She has now been clear of cancer since 2013. But she maintains that swift action taken by hospital medics ultimately saved her life. Janet, who recently met her hero Elaine C Smith when she took part in a breast cancer awareness video for the Scottish Government, said: “The two weeks waiting to see a specialist while I worried if I had breast cancer were the longest days and a really anxious time. It was a nightmare fearing the worst. “I had been suffering pain for six months before it dawned on me that breast cancer and not the hula hoop might be to blame. To know that all the time the clock was ticking and the cancer was spreading is frightening. “I think that if a GP refers someone to a specialist to find out if they have cancer, then the patient should receive the tests they need quickly. “I believe I owe my life to the swift treatment I received. For that I’m incredibly grateful.”


10 healthscot RESEARCH

Bloodwise: beating blood cancer in Scotland Blood cancer is the fifth most common cancer and the third biggest cancer killer in Scotland, claiming more lives than breast and prostate cancer. Around 2,200 people are diagnosed with a blood cancer such as leukaemia, lymphoma or myeloma each year in Scotland. The blood cancer charity Bloodwise is working to develop more effective treatments by funding world-leading laboratory research and running groundbreaking clinical trials in Scotland. There are 137 different types of blood cancers, which means developing effective treatments is a challenge, especially for some rarer types. But through support for research to develop more tailored treatment for blood cancers and coordinating efforts in testing these innovations, progress is being made in many of these diseases. The Beatson West of Scotland Cancer Centre is leading the way in delivering clinical trials for potentially lifesaving blood cancer treatments. It is one of 13 hospitals across the UK that make up the Bloodwise Trials Acceler-

21 November 2016 Clinical trials establish how safe a new treatment is and whether it’s potentially better than current ones

ation Programme (TAP). TAP provides centralised support for efficient setup of trials and a network of centres to recruit the number of patients needed to obtain reliable results. Clinical trials establish how safe a new treatment is and whether it’s potentially better than current ones. Coordinating and running the same trials across the TAP network greatly accelerates the process of getting the best treatments into routine medical care.

The trial is looking at whether it is safe to combine a new TKI drug called ponatinib with the chemotherapy usually used at this stage. It is hoped that this drug combination could increase survival rates of CML patients who have reached this advanced phase.

There are currently seven dif-

ferent TAP trials open at the Beatson, which serves as a recruitment hub for the whole of Scotland. One trial, led by Professor Mhairi Copland in Glasgow, is looking to improve treatment for patients with chronic myeloid leukaemia (CML), a typically slow-developing blood cancer. The outlook for CML patients has been transformed in the last decade with the introduction drugs called tyrosine kinase inhibitors (TKIs), which can control the disease in its slow-growing phase. TKIs are taken as

daily tablets and allow the majority of patients to live a relatively normal life. If treatment stops working, however, patients can progress to an advanced fast-growing phase, where effective treatment options are limited and survival rates are poor.

Bloodwise wants to deliver genuine cures for all patients – TKI treatment is usually life-long, patients can suffer debilitating side effects, and sometimes the drugs stop working and patients relapse. The charity is funding laboratory research to develop a long term cure for CML by targeting the disease at its roots. While TKIs can keep CML in check, they are not able to kill the cancer stem cells that sustain the disease. Researchers at the University of Glasgow, led by Professor Tessa Holyoake and Dr

David Vetrie, have shown in the lab that drugs that block an abnormally active set of genes in CML are highly effective at selectively killing CML stem cells. The next step is to develop these targeted drug combinations to a stage at which they can be tested in patients. This is just some of the work Bloodwise supports in all types of blood cancer, both in Scotland and around the UK. Success so far in CML shows what can be achieved. High-quality laboratory research, coupled with efficient clinical trials will, with the help of the charity’s supporters, continue to improve the outlook for all blood cancer patients in Scotland and elsewhere. To find out more about the work of Bloodwise in Scotland visit www.bloodwise.org.uk/scotland

£3 million boost for cutting-edge tumour research development and growth. She said: “We know that epigenetic ‘tags’ are important in controlling when cells grow and divide. But little is known about how these ‘tags’ are replaced after cell division or about the role – if any – this ‘replacing’ plays in tumour development.” She hopes her research will provide new information about how tumours form, which could help develop new cancer treatments in the future. She added: “By understanding the mechanisms that replace these tags, we are hopeful we can identify new players in tumour development that have the potential to lead to new therapies.”

By Nicola Stow Two researchers in Scotland have received £3 million to support their ground-breaking work into how tumours develop and survive. Cancer Research UK has awarded Edinburgh scientist Dr Noor Gammoh, 33, £1.64 million to study the most common type of brain tumour. And Dr Constance Alabert, 36, has been given £1.34 to bring research into how tumours develop at the University of Dundee. Both scientists have been awarded prestigious Cancer Research UK career development fellowships. The charity has funded only three such awards in the UK this year.

World leaders in research have

The fellowships are given to

outstanding scientists to support them in establishing their own independent cancer research group. Dr Gammoh and her new Edinburgh team will investigate one of the most common types of brain tumour, called glioblastoma. They aim to find out whether glioblastoma cells grow, survive and become resistant to treatment by using a “self-recycling” system that allows them to recycle old, damaged parts of the cells. Around 265 people are diagnosed with glioblastoma in the brain every year in Scotland. Dr Gammoh said: “If we find that

Doctors Constance Alabert, left, and Noor Gammoh and are researching how tumours develop and survive this ‘self-recycling’ mechanism is important in glioblastoma, we could use this information to develop new treatments for the disease that target this mechanism. “We urgently need to find new treatments for brain tumours that will improve survival. I’m so pleased to have been awarded this fellowship because it will allow me to test my ideas in the lab, and potentially find new ways to

help more people survive this disease.” Dr Alabert and her research group in Dundee will study if the mechanisms cells use to maintain their identity and function during and after cell division – for example how skin cells remain skin cells – play a role in how cancers develop and grow. One of the ways cells control whether genes are turned “on” or “off”

is by placing epigenetic “tags” on their DNA. But when cells are dividing, these “tags” are removed, meaning they need to be put back once cells have finished dividing. Dr Alabert and her team will try to identify and understand the mechanisms cells use to put these “tags” back in the right place after cells have divided, and to find out whether they play a role in tumour

been discovered through the charity’s fellowship awards and the work they produce is of the highest international quality. Karen Noble, Cancer Research UK’s head of training and fellowships, said: “To ensure we make a real difference in our fight against cancer, particularly hard-to-treat cancers like brain tumours, we need to recruit the best people and help them develop at every stage of their career. “Our fellows make crucial discoveries that increase our fundamental understanding of cancer, and help develop innovative new cancer medicines, tests and treatments.”


TECHNOLOGY

21 November 2016

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Professors Alan McNeill (left) and Bob Reuben (right) with their robot for prostate cancer surgery

Giving surgeons a robotic sense of touch Professor Bob Reuben, of Heriot-Watt University’s school of engineering and physical sciences, and Professor Alan McNeill, a urological surgeon at Western General Hospital, have been collaborating in joint mechanical engineering clinical research on prostate disease for over 15 years

By Bob Reuben and Alan McNeilL A diagnosis of cancer is always worrying and prostate cancer, the most common male cancer in Scotland, has its own concerns for patients in relation to treatment and its possible long-term implications. The charity Prostate Scotland was established in 2006 to raise awareness about prostate diseases and provide information to patients and their families. Over the last three years it has been working with the Scottish Government to secure access to the latest treatments for prostate cancer for men in Scotland. Its Blue Horizon Robot Appeal, in partnership with the Scottish Government and NHS Scotland, has now ensured that robotassisted surgery is available to men in all Scottish cancer networks. Robotic-assisted surgery offers many benefits. The surgeon controls a surgical robot to remove the prostate through small incisions in the patient’s abdomen. Keyhole surgery of this type allows the patient to recover more rapidly and the robotic surgical system makes it easier for the surgeon to undertake this complex and delicate operation. The technology and engineering involved is both truly impressive and a rapidly developing area which offers opportunities for additional capabilities. Currently, for example, robotic

assisted surgery does not offer surgeons any sense of touch, leaving them reliant on visual information. There is therefore a need for improved tactile feedback, which is where existing developments by a partnership between medics and engineers could provide real benefits. Collaborative research between engineers from Heriot-Watt University and surgeons at NHS Lothian/University of

Edinburgh has developed a method of mechanically palpating human soft tissue, using micro-mechanical probes to assess tissue ‘quality’, or stiffness. They focused particularly on diseases of the prostate and have shown that mechanical palpation or touch can differentiate between benign and malignant prostate tissue, a valuable additional tool for robotic assisted surgery. Led by us, the group has received funding from the Engineering & Physical Sciences Research Council, The Urology Foundation/John Black Charitable Foundation and the Medical Research Council. As well as showing that their technology can indeed be used to diagnose whether prostate tissue is cancerous or not, the group is continuing to miniaturise it for use in robotic surgical platforms. This presents a number of engineer-

“The potential impact of the work is huge, including the possibility of being able to detect and monitor cancer nondestructively at an early stage which could lead to real breakthroughs in clinical practice.”

ing and biomedical challenges, such as making stiffness measurements at ever smaller scales, down to cell-level, in the living surgical environment and interpreting these measurements in clinical terms. The potential impact of the work is huge, including the possibility of being able to detect and monitor cancer non-destructively at an early stage which could lead to real breakthroughs in clinical practice. We have now established a start-up company, Palpation Diagnostics Ltd, which has received Horizon 2020 Phase 1 funding to undertake a feasibility study and market research. This showed a real demand for a device to help in the diagnosis of men with prostate cancer and the company is looking for further funding to develop their device to market. It’s an exciting time for the team,

seeing that a device we’ve been working to develop for some years could be added to existing, successful robotic surgical platforms to provide a step change in this rapidly developing field in the management of prostate cancer. Robotic assisted keyhole surgery is a tremendous tool, allowing surgeons to work with great precision even at a remove. The current systems rely on surgeons working with purely visual information. Cancer changes the texture of the prostate and so touch can be very useful in helping surgeons be even more precise. The palpation tool uses micromechanical technology to provide the surgeon with more information about prostate tissue during an operation than they could get even if they could actually handle it. The recent introduction of robotassisted laparoscopic radical prostatectomy by the department of urology at the Western General Hospital presents a further opportunity for collaborative working between healthcare professionals, engineers and industry.


WE NEED TO TAKE ACTION ON OBESITY. RIGHT NOW. Obesity is the single biggest cause of preventable cancer in Scotland after smoking. It’s linked to 13 different types of cancer: Larger circles indicate cancers with more UK cases linked to being overweight or obese

Number of linked cases are currently being calculated and will be available in 2017

Oesophagus

Breast after menopause Pancreas

Kidney

Meningioma

(a type of brain tumour)

Thyroid Liver Upper stomach Gallbladder

Bowel Womb Yet Scotland is the heaviest of the UK nations. That’s why we’re calling for a comprehensive strategy to tackle obesity in Scotland.

PREVENT OBESITY. PREVENT CANCER. #ScaleDownCancer Registered Charity in England and Wales (1089464), Scotland (SC041666) and the Isle of Man (1103). Registered Company limited by guarantee in England and Wales (4325234) and registered in the Isle of Man (5713F).

Ovarian Myeloma

(a type of blood cancer)

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