Potential NHS service closures, staff shortages leading to more painful hysteroscopies, and new immunotherapies for rectal and pancreatic cancers – this week’s Friday Five
Financial pressures may cause potential NHS service closures
NHS providers have warned that due to financial pressures, trusts may have to close services and ‘streamline’ them to single sites.
A survey published by NHSP, which represents trust leaders, found that three quarters of respondents believed 2.5% is the maximum realistic target for average efficiency, this is a worrying contrast with the target of 4% this year that they face. This financial year sees an end to more generous financial arrangements that were introduced during the pandemic as well as inflation adding additional pressure resulting in a real-terms core funding cut.
Saffron Cordery, interim CEO of NHSP comments: ‘These efficiency levels are incredibly high – eye-watering, really – for many trusts. Thinking about how they’re going to tackle that whilst maintaining the appropriate level of service and the appropriate quality, and about how they’re going to then push to working in systems, is really challenging.’
‘Too many women’ are not being offered a general anaesthetic for hysteroscopies, a painful diagnostic test, due to staff shortages, leaving them to endure pain which campaigners describe as ‘barbaric’.
Campaign Against Painful Hysteroscopies conducted a survey which found that 80% of respondents (around 240 women) who had a hysteroscopy since 2021 reported that they were not told they could have a general anaesthetic prior to the procedure. This is despite the fact that the Royal College of Obstetricians and Gynaecologists said all pain relief options should be discussed with patients, including general anaesthetic. A spokeswoman for the campaign says that staff shortages are to blame for anaesthetic option not being offered and that these need to be addressed.
Helen Hughes, chief executive of Patient Safety Learning, has commented: ‘We are hearing from too many women that they are not being given the full information about the procedure. It damages their trust and makes them worry about accessing future services… It’s distressing that despite what we know, [the guidance] is not being implemented properly. Informed consent is essential for patient safety as well as a legal requirement.”
Rectal cancer drug trial results in remission in every patient
A recent trial of a new drug for rectal adenocarcinoma, dostarlimab, has resulted in complete remission in all 18 patients who participated. After 6 months of treatment and 6 months of follow up, all tests and scans performed showed no evidence of tumours. All patients remain cancer free 2 years later.
Dostarlimab is an immunotherapy which works by ‘unmasking’ cancer cells and allowing them to be identified and destroyed by the immune system. The trial was designed for cancer patients with a specific genetic mutation, known as ‘mismatch repair deficiency’, where tumour cells are more susceptible to destruction by the body’s immune response. Researchers on the trial say that results still need to be replicated, but these results hold promise for a potential new avenue in treating early stages of rectal adenocarcinoma in patients with this mutation.
The trial was led by Dr Luis A. Diaz Jr, who said to The New York Times “I believe this is the first time this has happened in the history of cancer”.
Personalised vaccines for pancreatic cancer may prevent tumours returning
Results from another recent cancer trial have shown promise for ‘personalised vaccines’ to treat cancer, specifically preventing tumours from coming back after surgery. Half of the 16 participants with early-stage pancreatic cancer were cancer free 18 months after participating in the trial. Pancreatic cancer is a deadly form of cancer that is difficult to treat with traditional therapies. According to statistics by Cancer Research UK, just 25% of people survive the cancer for longer than 1 year, and 7% survive for longer than 5 years.
Each patient in the trial was given a vaccine that was individually tailored to the unique genetic profile of their tumour. This strategy aimed to trigger the immune system to kill the cancer cells, and utilises the same technology used by the Pfizer-BioNTech Covid vaccine. 8 doses of the vaccine were given to patients after they underwent surgery to remove their tumours. The vaccine triggered an immune response in 8 patients, and these 8 patients were cancer free after 18 months.
Dr Vinod Balachandran, leader of the trial says “Pancreatic cancer has been the poster child for a cancer that is very difficult to treat with traditional chemotherapies and immunotherapies…Any ability to treat pancreatic cancer with a new therapy hopefully paves the way for us to now test [mRNA cancer vaccines] more broadly.”
A biodegradable gel to repair heart attack damage has been developed by British researchers. This breakthrough has potential to improve health of millions of heart attack survivors globally. The gel, developed by researchers at the University of Manchester, can be injected directly into the beating heart to help injected cells grow new tissue.
Professor James Leiper, an associate medical director at the British Heart Foundation says “This new injectable technology harnesses the natural properties of peptides to potentially solve one of the problems that has hindered this type of therapy for years. If the benefits are replicated in further research and then in patients, these gels could become a significant component of future treatments to repair the damage caused by heart attacks.”