Register for Updates on Cancer and Lifestyle on 29th September in London

Medical charity the FPM is organising a one-day meeting on Updates on Cancer on 29th September at the Royal Society of Medicine, 1 Wimpole Street, London. 

Register online

Abstract submission online

Consultant Oncologist Professor Robert Thomas will discuss the evidence on benefits of lifestyle and nutrition after cancer, at a one-day meeting on Updates on Cancer on 29th September at the Royal Society of Medicine, 1 Wimpole Street, London organised by the FPM.

He said: “With 1:3 getting cancer and 3 million people living with the consequences of this disease at any one time in the UK, and the cost of care increasing, the case for developing effective, self-help initiatives has never been stronger.”

His talk “summarises the international evidence, which shows that physical activity, nutrition and other lifestyle strategies can substantially reduce the risk of relapse and minimise numerous late effects ranging from fatigue, weight gain, anxiety, hot flushes, arthralgia.”

He added that his talk will “highlight the biological processes that take place in the body after a healthy lifestyle, which can have direct and indirect anti-cancer effects. By looking only at the scientific evidence, it breaks down the myths behind which foods to avoid and which to eat more of. It discusses the risks the benefits, of mineral and vitamin supplements and highlights the potential benefits of boosting the anti-cancer polyphenols in our diet. It summarises the results of the world’s largest double blind randomised study of a polyphenol rich food supplement Pomi-T, developed and tested with the help of the UK government’s National Cancer Research Network (NCRN).”

Professor Robert Thomas is a Consultant Oncologist at Bedford and Addenbrooke’s Hospitals, a Professor of applied biology and exercise science Coventry University, a senior clinical tutor at Cambridge University. He is editor of the lifestyle and cancer website (Cancernet.co.uk) and designed the 1^st UK approved qualification in cancer rehabilitation. He wrote the evidence review for the UK’s National Cancer Survivorship Initiative, chairs the Macmillan Cancer Support Exercise advisory committee and directs an dynamic research unit, which has designed numerous studies which been published across the world. For these, and other, efforts to improve the long term wellbeing of patients he was awarded the British Oncology Association Oncologist of the Year, the Hospital Doctor Magazine UK Doctor of the Year and the Royal College, Frank Ellis Medal.

Southampton researcher Dr Lisa Loughney will discuss the benefits of exercise for people undergoing cancer treatment. 

Neoadjuvant treatment is treatment given as a first step to shrink a tumor before the main treatment e.g. surgery or radiotherapy.

In her 2016 paper on this theme she noted that neoadjuvant cancer treatment decreases physical fitness and low levels of physical fitness are associated with poor surgical outcome. She added that exercise training can stimulate skeletal muscle adaptations, such as increased mitochondrial content and improved oxygen uptake capacity that may contribute to improving physical fitness. She has therefore evaluated the evidence in support of exercise training in people with cancer undergoing the “dual hit” of neoadjuvant cancer treatment and surgery.

Dr Loughney works in the National Institute of Health Research’s Respiratory Biomedical Research Unit at the University Hospital of Southampton’s  NHS Foundation Trust.

Wendy French will discuss her Poet-in-Residency year at the UCLH MacMillan Cancer Centre.

Working with patients, sharing in their hopes and fears, tracking the everyday endeavours of a vital medical hub, Wendy French found herself drawn into lives in which blood tests, diagnosis, chemotherapy and hope become as much part of the human experience as cappuccino and Vivaldi on the radio.

Her residency resulted in publication of ‘Thinks itself a Hawk’. In the collection, one life, that of Zipora, a Jewish woman whose origins lay in the darkest days of the twentieth century, is chosen for particular attention for its power to place everyday experience in large frames, but also for the brightness with which it reminds us that everyday life is unique and important.

Wendy French was Poet in Residence at the Macmillan Centre UCLH from April 2014-2015. Her collaboration with Jane Kirwan resulted in the book Born in the NHS, published in 2013. She won the inaugural 2010 Hippocrates Poetry and Medicine prize for the NHS section in 2010 and was awarded the Hippocrates NHS second prize in 2011. She has two chapbooks and two further collections of poetry published, Splintering the Dark (2005), and surely you know this (2009). She previously worked twenty years with children and adults with mental health problems and was head of the Maudsley and Bethlem Hospital School. She has also worked with people with aphasia/dysphasia, helping them to recover their use of language through poetry.

This one day symposium will include further sessions on:

• risk factors for cancer
• evidence for effective strategies aimed at preventing cancer
• medical humanities to support patients undergoing treatment for cancer

Waistline and increased risk of premature death: what's so new?

@HealthMed The latest European Society of Cardiology Congress in Munich coincided with the last days of a Gallery of the Modern exhibition of caricatures by Munich satirist Karl Arnold:  amongst them a striking 1922 image of a stylish corpulent man said for 20 years not to have been able to see his feet. Then a social observation, it is of course now well recognized that the frankly obese are at high risk of diabetes, heart disease, stroke and other medical conditions.

At first sight surprising, that there should have been major interest from scientists and the press in new US research presented at the 2012 heart Congress linking a larger waistline to premature death; and not just from a beer belly, but for anyone with a body shape with above normal waist to hip circumference.  What’s so unusual? Surely everyone knows that being overweight increases risk of serious medical problems.

What did these American researchers do? They looked at the strength of the link between different measures of obesity and risk of early death. In the research, lead by Professor  Francisco Lopez-Jimenez from the Mayo Clinic, almost 13,000 American men and women were studied for around 14 years, within a cohort study: the Third National Health and Nutrition Examination Survey (NHANESIII). There were around 2500 deaths of which around 1100 were from cardiovascular causes. The researchers measured body-mass index (BMI), a general measure of fatness, and waist-to-hip ratio (WHR), a measure of central obesity. This meant they were able to include people not currently considered obese based on BMI, but who had a relatively large belly, as well as those overweight both based on BMI and abdominal girth. The surprising finding of the study was that, compared to subjects with normal BMI and WHR, the group with normal BMI but relatively high central fat not only had a high death rate (2.8 times for cardiovascular disease and 2.1 times for all causes), but their risk of premature death was much higher than participants who were obese based on BMI (1.4 times normal cardiovascular risk).

It is already well established that abdominal fat is particularly deadly in relation to risk of heart disease. This new NHANESIII research in addition reported that increasing waist-hip ratio is linked to earlier death from all causes, not just for heart disease. It also provided objective data of the graded increase in risk as abdominal fat and waist-hip ratio increases.

What messages to take from this study? Obvious questions include whether it is reliable and if so generalizable from US to European and other international populations. As a prospective observational study, the results are open to bias – i.e. factors co-incidentally present in the larger waisted people may have been responsible e.g. the type of diet causing the central overweight rather than distribution of the fat itself.

However the authors reported that their findings were similar after adjusting for other well-known risk factors for premature heart disease and death, such age, male gender, ethnicity, socio-economic factors, smoking, hypertension, and diabetes.  Furthermore, this new report from Munich supported the previous systematic review by the authors noting similar findings in patients with coronary artery disease: i.e. central obesity a much stronger link  than BMI to premature death.

Reasons for the observed health risks are thought to include major regional differences in types chemicals secreted by fat from different parts of the body. Unlike fat padding in other part of the body, abdominal (or visceral fat) makes chemicals that promote resistance to insulin, increasing risk of diabetes, an important risk factor for heart disease. This fat also makes inflammatory chemicals that can accelerate damage to arteries, leading to atheroma (deposits of fat and abnormal cells – from the Greek for ‘porridge lump’) in the arterial walls. This both reduces blood flow to vital organs, and increases the likelihood of a clot forming to cause critical narrowing or complete blockage of an artery, a major cause of heart attack and stroke. There is also  evidence that in contrast there may also be a protective metabolic profile associated with the presence of lower body fat.

These findings add to increasing concern about health risks from central overweight and stress the importance of preventive measures, even if BMI is within the normal range. Health professionals need to make the public aware of these risks and explain what preventive measures may help. The good news is that losing excess central weight is practical through a healthy, lower calorie diet, combined with regular aerobic exercise, reduces major risk factors for heart disease: reduces cholesterol, decreases blood pressure and reduces risk of diabetes, and lowers risk of heart and other serious diseases. Other reasons for benefits may include better metabolic profile from the increase in muscle mass with exercise, and the improved tissue nutrition resulting from generation of more micro-vessels.

Calculate your waist-hip ratio.

Calculate your BMI.

Helpful free software to help with exercise, diet and weight loss.

The parapharmacy: business, health, and safety of the patient and the public

Parapharmacie - a 'new' word noted on the streets of Arles, a lively, walled French town in south Provence, near the Camargue coast, and echoed in many variants in the medieval Besancon, within a tight meander of the Doubs, near the Swiss border. Parapharmacie sounds more professional than the English 'Health and Beauty' variant. This in fact not so new idea seems to go back at least to the early 1980s, with deregulation of certain aspects of French pharmacy sales. Instances of 'Parapharmacie' include local provision as stand alone stores, as well as sections of a conventional pharmacy or a designated area in a supermarket - as well as an international presence within online parapharmacie outlets.
Unlike for pharmacists, there is no formal specific qualification for the parapharmacist, whose shop window offers a range of health care and personal hygiene-associated provision, including phytotherapy and dietary supplements. Medicines, dressings and herbal remedies listed in the pharmacopeia require pharmacy training, however 34 plant extracts can be sold by parapharmacists - but not as combinations. These include extracts of bramble, camomile, violets and mauve. An attractive business model, with reportedly a 30-40% profit margin permitted - more attractive than the 15-20% for prescription only medicines; and without the training overheads of conventional pharmacies. But the concept raises similar concerns to OTC (over the counter medicine) outlets in general. And what about drug interactions between herbals and conventional medicines? And the problem that intake of nutrients above the recommended daily intake can be harmful? In practice a parapharmacy may work alongside a pharmacy, with professional pharmacist available. However even by 2009 around 250 parapharmacies were operating online. Hence this is now a well-established international approach to engaging the public in new ways to access health care and hygiene products. I'm sure that it goes without saying that the vast majority of parapharmacies are highly professional in their activities. The message for the public is to ask for professional advice when seeking health care products, and in particular to seek reassurance that remedies bought 'over the counter' from non-pharmacy sources, including parapharmacies, do not pose a risk from interactions with prescribed medicines or because of known medical problems. To paraphrase Benjamin Franklin (from another context) 'keep your eyes wide open', however professional sounding the source of aids to health and hygiene.