1. health and fitness
2. disease
3. cancer

IMAGE: ALAMY
FOR PRACTICE NURSES
COUPLES MORE LIKELY
TO GET HEALTHY TOGETHER
Issue 11
April 2015
People are far more likely to make lasting positive lifestyle
changes such as getting fit if their partner does the same.
So how can practice nurses harness this information?
P
INSIDE THIS ISSUE:
PREVENTION
AGENDA
An in-depth look at the role
of lifestyle in preventing cancer
PLUS: A free poster to display
in your practice
MORE THAN
MEETS THE EYE
Thinking differently about cancer
presentation in practice
RECEIVE THIS
BY EMAIL
to help us cut print costs. Contact:
cancerinsightnurse@cancer.org.uk
Cancer Research UK, Angel Building,
407 St John Street, London EC1V 4AD
eople are more likely to be successful
in making healthy lifestyle choices
such as quitting smoking if their partner
makes a positive change too.
This is according to research funded
by CRUK and published in JAMA Internal
Medicine that looked at 3,722 couples over
the age of 50 who were taking part in the
English Longitudinal Study of Ageing.
Among the smokers in the group, about
half managed to quit if their partner gave up
smoking at the same time, compared with
just 8% of those whose partners continued to
smoke. (See table below for more results.)
Dr Julie Sharp, CRUK’s Head of Health
Information, said: ”Getting some support can
help people take up good habits. Friends or
colleagues trying to lose weight, for example,
could encourage each other by joining up for
a run or a swim at lunchtime or after work.
The more people can help and encourage
each other the better.”
She added: ”Making lifestyle changes can
make a big difference to our health and
cancer risk.”
Nurses are ideally placed to encourage
individuals to buddy up and try to change
their lifestyles. We would love to hear if
this is something you are already doing
in your practice. Do you have a stop-
smoking group or organise a walking
club, for instance?
Please email us at cancerinsightnurse@
cancer.org.uk, as your ideas could inspire
other practice nurses.
For more information on lifestyle and
cancer risk, turn to our In Focus section.
HEALTHY LIVING IN PRACTICE
Helen and Adrian Dalton run a walking
group at Datchet Health Centre,
Berkshire, where Adrian was a GP
before retirement. Helen says:
“Adrian and I have always enjoyed
walking so he, together with other
practice staff, started the group in 2006
to encourage patients to exercise more
and to enjoy some of the wonderful
local walks. When we started, some of
our members had difficulty completing
a five- or six-mile walk.
“Several have since lost weight and
walk more regularly. We are now a
group of 26, and make new members
welcome too. Although the group was
formed to improve general fitness and
health – and for enjoyment – we are
aware that a healthy diet and exercise
can decrease the risk of getting cancer.”
Action taken
Success rate with partner
who took same action
Success rate with partner
who remained unhealthy
Stopping smoking
48% (men) / 50% (women)
8% (men) / 8% (women)
Physical activity
67% / 66%
26% / 24%
Weight loss
26% / 36%
10% / 15%
PN011/Apr 15
Front_page.indd 1
18/03/2015 12:51
CANCER RESEARCH
FC
PN ISSUE 11
210X297
6
EDITOR‘S LETTER
P
ractice nurses need
medals. From cradle to
grave you are expected
to be the one-stop shop for all
health questions. To help you
find answers for your cancer
patients, remember we have
an award-winning website,
cancerhelp.org.uk. You will find information
about cancer in plain English, plus the latest
research and how to find a clinical trial.
Our respected blog at scienceblog.
cancerresearchuk.org has articles covering
a wide range of topics, from explaining
more about why PSA is not a screening
programme for men to the things we can
do to reduce cancer risk – which you will
IN BRIEF
notice is the main theme of this
issue of Cancer Insight.
Nurses are educationalists,
supporting patients to live longer
and healthier lives. At CRUK,
prevention is top of our agenda,
but the good news is that more
people who do get cancer are
managing and living with it in the same
way as they might with diabetes or heart
disease. Not many people know that. Spread
the word – your patients need to know!
And as ever, please share your
practice and ideas with us. Email
cancerinsightnurse@cancer.org.uk
Gwen Kaplan
Cancer Awareness Lead Trainer
BEHIND THE HEADLINES
THE DAILY MAIL
‘TWO THIRDS OF SMOKERS
WILL DIE FROM THE HABIT’
IMAGE: THINKSTOCK
The Daily Mail reported on an Australian study that found that
67% of deaths among people who had smoked for 38-39
years on average were from smoking-related illness. Earlier
estimates had been closer to 50%. The figure can’t necessarily
be generalised for smokers in the UK, but they do reinforce
the need to continue reducing smoking rates here. For our
perspective on this story, go to cruk.org/ci-2in3smokers
PULSE
‘GP EXPERTS‘ CRITICISM
OF NICE GUIDELINES’
New guidance from the National Institute
for Health and Care Excellence on
diagnosing bladder cancer has come
under fire from GP urology experts, who
felt it might make it harder to refer young
patients. Pulse reported on a new campaign
(shoutoutaboutbladdercancer.org), quoting
a spokesman saying: “We have concerns over
the age restrictions, but also the fact they
don’t mention other factors such as dysuria,
or storage symptoms with haematuria.”
For more on the Be Clear on Cancer
campaign go to cruk.org/ci-bloodinpee
FOUR
TYPES OF
PANCREATIC
CANCER
IDENTIFIED
AWARENESS
CAMPAIGNS
WORK! MORE
PEOPLE ARE
VISITING THEIR
GP WITH CANCER
CONCERNS
THE ROLE OF
DNA REPAIR
PROCESSES
IN CANCER
TREATMENT
cruk.org/ci-pancreatic4
cruk.org/ci-awareness
cruk.org/ci-dna-repair
23.indd 2
STANDARD
PACKS TO
BECOME REALITY
MPs have voted in
favour of standard cigarette packs, a
landslide victory with 367 MPs for and
113 against. This is a fantastic result and a
huge victory for public health. Standard
packs could be on the shelves in England
by May 2016.
This decision by Parliament helps us
move towards our aim of a tobacco-free
generation. Standard packaging means all
cigarette and hand-rolling packs will look
the same, in a standard shape without
branding, design or a logo. Our evidence
shows that this makes cigarettes less
attractive to both adults and children –
and will help prevent young people from
taking up smoking, ultimately saving lives.
Read more at cruk.org/standard-packs
and check out the conversation on
Twitter: #packetracket
TALK CONFIDENTLY
ABOUT CANCER
CRUK’s interactive Talk Cancer training is
continuing to benefit hundreds of health
professionals across the UK. Over the past
year we’ve trained more practice nurses
and other practice staff than ever before,
equipping and empowering them to
incorporate raising cancer awareness into
their everyday roles, and to have open
discussions about cancer.
A new workshop, called Talk Cancer:
Train-the-Presenter, focuses on preparing
trainees to confidently deliver short cancer
awareness presentations. Workshops can
be commissioned by local organisations,
or individuals can sign up to a variety of
courses happening across the UK.
To find out more or to book your place
on a workshop, visit cruk.org/talkcancer
18/03/2015 12:53
CANCER RESEARCH
02
PN ISSUE 11
210X297
6
FOR PRACTICE NURSES
Issue 11 April 2015
“I NOW FEEL MUCH
MORE CONFIDENT
ABOUT EXPLAINING
THE RISKS”
HPV VACCINE UPDATE
The Joint Committee on Vaccination
and Immunisation (JCVI) has
recommended that men who have
sex with men are offered the HPV
vaccination, in addition to girls in year
8 (ages 12-13). The JCVI is now looking
into how this could be introduced, and
SHONA,
PRACTICE NURSE
is continuing to investigate whether HPV
vaccination should also be offered to all
boys aged 12 and 13.
In September last year, girls in the
routine school-age HPV vaccination
programme started being offered a twodose schedule instead of three. This was
based on evidence showing two doses
is no less effective than three. This could
improve uptake of the vaccine, and it will
be less costly to deliver, but it is important
that the long-term efficacy of two doses
continues to be monitored.
CRUK CHIEF TO PLOT
CANCER CARE FOR
NEXT FIVE YEARS
Our Chief
Executive, Harpal
Kumar, has
been appointed
independent Chair
of a taskforce to
work out how
England can
best tackle the
challenges that cancer will bring over
the coming years.
The Cancer Taskforce includes cancer
clinicians, members of the Royal Colleges
of GPs and Surgeons, charity leaders,
Public Health England and the NHS. This
summer, it will publish a five-year plan
that aims to deliver better prevention,
swifter diagnosis, and better treatment,
care and aftercare for all cancer patients.
Read more at cruk.org/ci-taskforce
IMAGE: ALAMY
The long-term
efficacy of two
doses should
continue to be
monitored
HRT AND OVARIAN CANCER RISK
New research has found an increased risk of ovarian cancer
among women who take HRT for less than five years. So what
does this mean in terms of a woman’s decision to use HRT?
T
he cancer risk associated with
hormone replacement therapy (HRT)
has made the news recently, so you
may be fielding questions from patients
about the safety of this treatment.
While we already know HRT can alter a
woman’s risk of breast, ovarian and womb
cancer, it is effective at reducing symptoms
of menopause and many factors are at
play in any decision to use it. This story was
widely – and in some cases inaccurately –
reported, so here we aim to give you the
facts so you can help your patients to make
informed decisions.
WHAT DOES THIS MEAN FOR
WOMEN WHO TAKE HRT?
For every 1,000 women who start taking
HRT from age 50 for five years, there will be
one extra case of ovarian cancer compared
with women who never took HRT. Although
the risk of ovarian cancer decreases over
time after stopping treatment, women who
used HRT for five years or more still had a
slightly increased risk of the disease more
than five years after stopping.
HOW DOES THIS CHANGE WHAT
WE ALREADY KNEW?
Research had already shown an increased risk
of ovarian cancer for women using HRT for
longer than five years, but the study shows
there is also a risk for women using HRT for
less time than this, which changes how risks
should be communicated to patients to help
them make an informed decision.
WHAT WAS THE RESEARCH?
This was a study by researchers at the
University of Oxford who are partly
funded by CRUK. It combined and
analysed the results from 52 studies
that collectively involved 21,488
women from North America, Europe
and Australia. Published in The Lancet,
it is the largest analysis on HRT and
ovarian cancer to date.
WHAT SHOULD WE TELL PATIENTS?
WHAT WERE THE FINDINGS?
Women using HRT for less than five years
were around 40% more likely to develop
ovarian cancer than women who had
never used HRT – although the absolute
risk remains small.
23.indd 3
Ovarian cancer is slightly more common
among women who take HRT even for short
amounts of time. But, whether to take HRT
is a personal choice. Although HRT carries a
modest risk, it is also an effective treatment
for menopausal symptoms. If a woman is
thinking of stopping or starting HRT they
should speak to their GP. More information
on cancer risk and HRT is at cruk.org/ci-hrt
18/03/2015 12:53
CANCER RESEARCH
03
PN ISSUE 11
210X297
6
IMAGE: ALAMY
IN FOCUS: PREVENTING CANCER
WHAT ARE
THE ODDS?
The lifetime cancer risk for
a person born after 1960 in
the UK is now 1 in 2 – so what
role can prevention play?
R
esearch from CRUK has shown that
1 in 2 people born in the UK after 1960
will be diagnosed with cancer during
their lifetime. But although the number of
people getting cancer is going up, we’re still
making progress: more people are beating
cancer today than ever before. Survival in
the UK has doubled in the past 40 years and
now, half of people diagnosed will survive
their cancer for 10 years or more.
The main reason for the increasing cancer
risk is our longer life expectancy, but there is
another factor at play here too. The lifestyles
we now live are also driving this increase.
For example, more people are now obese in
England than in the past.
But this lifestyle-driven increase is also
a great opportunity for intervention, with
CRUK scientists calculating that more
than 4 in 10 cancers could be prevented
through healthier lifestyles1.
PUBLIC AWARENESS IS LOW
Although nothing can guarantee
someone won’t develop cancer, living
a healthier life can stack the odds greatly
against it. The main preventable risk
factors for cancer (see box, right) will
come as no surprise to practice nurses,
but CRUK’s Cancer Awareness Measure
(cruk.org/cam) has shown that awareness
among the UK public of many of these
links is fairly low.
For example, when asked to name
things that could increase a person’s risk of
developing cancer, only 14% of the British
public said being overweight. And the step
MORE
THAN 4 IN 10
CANCERS COULD
BE PREVENTED
THROUGH
LIFESTYLE
CHANGES
from knowledge to behaviour change
isn’t necessarily an easy one. This is where
healthcare professionals can make a huge
difference in helping people to change their
habits for the healthier.
Not every appointment is an ideal
moment for an in-depth lifestyle analysis,
but once you’re looking for opportunities,
you might find chances to sow the seeds
of change in your patients.
TOP 6 PREVENTION FACTORS
Many patients aren’t aware of the fact
that the following lifestyle choices
reduce the risk of cancer:
• Not smoking
• Keeping a healthy weight
• Eating a healthy, balanced diet
• Cutting back on alcohol
• Staying safe in the sun
• Keeping active
THE BIGGER PICTURE
Most of the lifestyle changes that can help
reduce the risk of cancer have much wider
benefits for people’s health too. Smoking,
unhealthy diets, being overweight, alcohol
and physical inactivity are linked to other
common diseases such as cardiovascular
disease and type II diabetes. Research from
the EPIC Norfolk cohort including nearly
20,200 people aged 45-79 found that those
who didn’t smoke, moderated their alcohol
intake, were active and got their five-a-day
lived on average 14 years longer than those
who didn’t. Healthier lifestyles could make a
huge difference to the UK’s health profile in
years to come.
Practice nurses have great opportunities
to talk with patients about the lifestyle
choices they’re making, and help raise
awareness of how these can influence
their cancer risk as well as their risk of other
diseases. When it comes to healthy living,
the size of the prize is huge. »
1. Calculated by the Cancer Research UK Statistical Information Team, based on figures from Parkin DM, Boyd L, Darby SC, Mesher D, Sasieni P, Walker LC. The Fraction of Cancer Attributable to Lifestyle and
Environmental Factors in the UK in 2010. Br J Cancer 2011; 105, (S2):Si-S81
In_Focus.indd 4
18/03/2015 13:02
CANCER RESEARCH
04
PN ISSUE 11
210X297
6
IN FOCUS: PREVENTING CANCER
WHAT YOUR
PRACTICE CAN DO
...and how CRUK can help you
»
PRACTICAL TIPS
FOR PRACTICE NURSES
3. Take advantage of life-changing events
Practice nurses are in the privileged position
1. Help patients make manageable
of being able to talk to people at ‘teachable
commitments to change in the face
moments’ in their lives. People at certain
of media hype
milestones – for example, pregnant or
Some of your patients might want to
menopausal women – may be more
change aspects of their lifestyles but
interested than usual in their lifestyle and
struggle to put it into practice. We know
its impact on their health. These ‘teachable
that small, manageable changes that fit
moments’ can act as a springboard and help
into people’s lifestyles are easier to stick to
to open up conversations about lifestyle and
and more likely to work in the long term
health, giving you an opportunity to provide
as they become a habit. Steering
patients with excellent health
your patients away from
information at a time it’s
”TRYING
TO
the quick-fix, ‘miracle’
likely to make an impact.
EDUCATE PATIENTS IS
solutions prevalent
SOMETHING THAT PRACTICE
in the media and
4. Understand the
NURSES
FACE DAILY, SO THESE challenges
online and providing
TIPS ARE VERY RELEVANT
them with reliable
There are lots of other
AND USEFUL”
information and
influences on people’s
ANITA,
advice can help
lives, from adverts to
PRACTICE NURSE
them stick with
the logistics of day-totheir plans and make a
day life. Cancer prevention
change that lasts.
needs to go beyond the choices
people make and address the environment
2. Guide them over the first hurdle
that determines the choices and the
via support services
opportunities available to them in the first
For many people, a helping hand
place. You can help by making sure patients
over the first barriers can make a big
are aware of the links between lifestyle risk
difference. Whether that means making an
factors and disease, and helping them make
appointment with the smoking cessation
informed choices about their health.
service in your clinic, sharing information
about a local weight loss support group or
simply leaflets and local support contacts
and services, a patient can leave your surgery
having already taken action towards change.
READ MORE IN FOCUS
FEATURES ONLINE:
E-cigarettes
cruk.org/e-cigarettes-infocus
FREE POSTER
OUR HELPLINE: FOR
FURTHER SUPPORT, YOUR
PATIENTS CAN SPEAK TO
ONE OF OUR SPECIALIST
CANCER NURSES
4 IN 10 CANCERS
Attached to
this page is
a two-sided
poster on the
most important
factors in cancer
prevention.
Tear it off and
display the
simple or in-depth
version in your practice
CAN BE PREVENTED
These are proven ways to reduce the risk of cancer.
Larger circles indicate greater impact on cancer risk.
KEEP
LIFESTYLE
A
HEALTHY
WEIGHT
BE SMOKE FREE
EAT FRUIT
& VEG
5-
a-da
y or m
o re
DRINK
LESS
T
R
n d su nsc
OTHER
n d un nece
ss
EA
ESS SA
TL
MINIMISE
RISKS AT
WORK
C
B&
-ray s
ON
A
yx
R A DI
ar
TI
IS E
na
H
V,
M
do
HP
Y
RT
TIVE
AC
MINIMISE
CERTAIN
INFECTIONS
BR
D
IF E A S T F E EE
P O S SIBL
I
M I N ra
s
M
TI
M IN I
N
E S MISE A H
PENT O N
suc h a
Tobacco and cancer
cruk.org/tobacco-infocus
BE
HIGH
TA
EABRE DIET
FI
EAT LESS
PROCESSED
& RED MEAT
n
re e
.P
su
ch a
s a s b e sto s
tis
sh
MA
.A
g,
NS
ea
vo
BE
SU
clot hin
ad
LT
Use
id s u n b e d s
ALCOHOL
Obesity, weight and cancer
cruk.org/obesity-infocus
ylo
ri, E B
V, H IV,
He
pa
ti
Let’s beat cancer sooner
cruk.org/health
Alcohol and cancer
cruk.org/alcohol-infocus
• Display the poster attached to this
issue of Cancer Insight in your practice.
• Promote local services such as weight
loss and smoking cessation – display
their leaflets and sign-up information.
• Have simple advice to hand. CRUK’s
lifestyle leaflets are people-focused,
evidence-based and full of ready-touse tips. Download or order them at
cruk.org/preventionhealthylifestyles
• Point patients toward reliable sources.
There’s a lot of health information out
there – not all of it good. Encourage
patients to consult NHS Choices
or our website cruk.org/health
We’re accredited by the Information
Standard, an independent kite mark that
recognises good quality information.
• Create a healthy lifestyles champion in
your practice to add to what you do.
• Make sure everyone in your practice is
comfortable talking about prevention,
from the receptionist to GPs. Our
Talk Cancer training (see page 2) will
equip and empower staff – building
knowledge, skills and confidence to talk
about cancer – and includes healthy
lifestyles and cancer prevention. Email
talkcancer@cancer.org.uk or visit
cruk.org/talkcancer
Call freephone:
0808 800 4040
In_Focus.indd 5
18/03/2015 13:02
CANCER RESEARCH
05
PN ISSUE 11
210X297
6
FOR PRACTICE NURSES
Issue 11 April 2015
IN BRIEF
BRIEF
BREAST AWARENESS
Taking time to regularly check your breasts
is a popular health message aimed at
promoting early detection of breast cancer.
However, from research we know that
regular self-checks don’t reduce the risk of
dying from breast cancer, and people who
do regularly check are more likely to have
investigations of benign lesions.
This doesn’t mean that you shouldn’t
encourage breast awareness. Women
should know what is normal for them,
and if they see any unusual or persistent
changes to their breasts, contact the
surgery. There’s just no need to check
breasts regularly in a set way.
WHAT TO LOOK OUT FOR
MORE THAN MEETS THE EYE?
Spotting cancer isn’t all about finding lumps. Any unusual or
persistent changes that aren’t normal for your patient should
ring alarm bells. The trick is to ask the right questions...
• A new lump or thickening in one
breast or armpit
• Any puckering, dimpling or redness
of the skin
• Changes to the position or
appearance of the nipple, a rash or
nipple discharge
• Pain or discomfort that is new to
you and felt only on one side
HELP BEAT CHILDHOOD CANCER
Kids & Teens is our exciting new campaign
to raise more money for research into
cancers affecting children, teens and
young adults. All income raised will fund
research into kinder treatments and cures.
Every day around 10 young people in
the UK are diagnosed with cancer. More
children are surviving than ever before –
in the 1960s only 1 child in 4 survived, and
today that figure is 3 in 4. But this is not
enough, and we know that research holds
the key to more children surviving and
living longer, healthier lives.
Find out more at cruk.org/kidsandteens
ith more than 200 types of cancer,
coughing could be caused by cancer.
it can be difficult to spot – and
• Patients aren’t always going to use the
almost impossible to memorise –
same words to describe signs that need
every possible symptom. And, many of these
extra investigation. Look out for signs that a
symptoms could be completely unrelated
patient is normalising or accommodating
to cancer. But anything that is unusual or
symptoms, or just putting it down to
persistent merits further investigation. Asking
getting older. While it’s important to keep
your patients ‘Is that normal for you?’ or ‘How in perspective that most symptoms won’t
be down to cancer, considering whether
long has this been around for?’ are great
it could be is an important part of
ways to understand if they might have
helping to spot cancer early.
something serious going on and
• Repeated use of over-theneed to see the GP.
CHANCES ARE
counter medicines could
Here are a few more things
IT’S SOMETHING
be a sign that there’s more
to look out for:
to a patient’s symptoms
• A lump is one of the most
MUCH LESS
than meets the eye. This
well known signs of cancer,
SERIOUS THAN
could be an opportunity to
but any unusual or persistent
CANCER
have a conversation about
change to the body could
symptoms your patient is
be a warning sign. Chances are
experiencing and whether they’ve
it’s something much less serious
had them checked out.
than cancer, but practice nurses are in a
Recognising bodily changes is key in
great position to encourage patients to get
helping to diagnose cancer sooner, and
to know what’s normal for them and report
nurses have a key role to play in making sure
anything unusual or persistent. And it’s
patients get the right investigations at the
definitely not just about lumps. Things like
right time. For more on this, visit
a sore that won’t heal or any unexplained
cruk.org/spotcancerearly
bleeding, bloating, pain, hoarseness or
Registered charity in England and Wales (1089464) and Scotland (SC041666). Copyright ©2015 Cancer Research UK
W
• A change in shape, size or feel of
the breast
We pioneer life-saving research
to bring forward the day when all
cancers are cured.
From our volunteers and supporters to our scientists,
doctors and nurses, we’re all here to save more
lives and prevent, control and cure all cancers.
Let's beat cancer sooner
cruk.org
Back_page.indd 6
18/03/2015 13:02
CANCER RESEARCH
06
PN ISSUE 11
210X297
6
Poster.indd 7
16/03/2015 16:39
CANCER RESEARCH
POSTER
PN ISSUE 11
210X297
6
4 IN 10 CANCERS
CAN BE PREVENTED
These are proven ways to reduce the risk of cancer.
Larger circles indicate greater impact on cancer risk.
KEEP
LIFESTYLE
A
HEALTHY
WEIGHT
BE SMOKE FREE
EAT FRUIT
& VEG
5-
a-da
y or m o
re
DRINK
LESS
sh
ad
ea
M
AR
nd suns
EAT LESS
vo
T
NS
e
c re
BE
EA
TIVE
AC
PROCESSED
& RED MEAT
.A
g,
SU
clot hin
BE
HIGH
TA
EABRE DIET
FI
ESS SA
TL
n
OTHER
MINIMISE
RISKS AT
WORK
n d un nece
ss
B&
C
.P
su
ch a
s a s b e sto s
tis
ON
yx
TI
Y
RT
RA
ar
na
DIA
H
V,
do
IS E
HP
I
M I N ra
s
suc h a
M
TI
BR
D
IF E A S T F E EE
P O S SIBL
M
-ray s
MINIMISE
CERTAIN
INFECTIONS
M IN I
N
E S MISE A H
PENT O N
LT
Use
id s u n b e d s
ALCOHOL
ylo
ri, E B
He
V, H IV,
pa
ti
Let’s beat cancer sooner
cruk.org/health
Poster.indd 8
16/03/2015 16:39
CANCER RESEARCH
POSTER
PN ISSUE 11
210X297
6