We asked SCPN friends and advisors to tell us about a report/paper/findings/work on cancer screening and prevention that has been published this year and has made them stop and think. The works span a wide range of areas from very detailed scientific investigation, reviews of physical activities, and blogs of model work. We find them a complete inspiration. When only 3% of the NCRI research budget is spent on prevention and virtually nil on implementation research; these papers provide a window on some of the very good reasons why cancer screening and prevention should be a leading part of cancer control research.

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Susan Moug is a consultant colorectal surgeon and Honorary Clinical Associate Professor based at Royal Alexandra Hospital in Paisley. She specialises in the treatment of colorectal cancer and is principal investigator on the Chief Scientist Office funded REx Trial, looking at the feasibility of performing a walking programme in patients undergoing chemo-radiotherapy for rectal cancer. Susan is also a member of the NCRI Colorectal Cancer Clinical Studies Group and is keen to develop surgical trials in Scotland to improve outcomes for patients with colorectal cancer.

Susan’s nominated papers of the year are:

  1. Barberan-Garcia et al. (2017) ‘Personalised pre-habilitation in high-risk patients undergoing elective major abdominal surgery: a randomised blinded controlled trial’ in Annals of Surgery. Available at: https://insights.ovid.com/pubmed?pmid=28489682
  2. Nashat Wanis et al. (2017) ‘Do moderate surgical treatment delays influence survival in colon cancer?’ in Disease of the Colon and Rectum. Available at: https://insights.ovid.com/pubmed?pmid=29112559

Susan chose these papers because…

“It has been an exciting and progressive year for prehabilitation in cancer surgery, which is why I have chosen two complimentary papers. My first paper of is from Spain where 144 patients undergoing major abdominal surgery were randomised to a prehab group or a standard care group. All these patients had conditions that made them ‘high risk’ for complications after major surgery and are a population that has often been excluded from other prehab work. The authors found significant improvements in aerobic capacity AND a significant reduction in post-operative complications in the prehab group only (31% vs 62%) providing a strong case for prehab. However, the mean duration of this prehab was 6 weeks that we would not be able to achieve with our time-to-treatment targets of 31 days from diagnosis. So the question is should we be delaying our surgery to optimise patients’ outcomes?

This has always been controversial, but enter Paper 2 that assessed whether delays to surgery compromised disease-free or overall survival in 908 patients with colon cancer. The authors found that moderate delays of 30 or 60 or even 90 days did not negatively effect long-term survival.  So what’s the take home message here? These papers may be providing the first evidence that prehabilitation should be considered ‘first treatment’ for patients with cancer to improve their surgical recovery, with the delay to surgery not compromising their cancer-related outcome.

 

If you experience any difficulties accessing the paper, please don’t hesitate to get in touch with us at scpn@cancerpreventionscotland.org.uk