Alarming number of cancer medics suffering burnout and stress

Alarming numbers of cancer doctors experience high levels of burnout, stress, sleep problems and depression, with some resorting to alcohol or sedatives to cope, research suggests.

Meta-analysis of 43 existing studies, published on Friday in Psycho-Oncology, revealed that many oncologists were struggling with the burden of dealing with suffering patients, distressed relatives and heavy workloads. It found that a third of cancer doctors were suffering from high burnout, defined as high emotional exhaustion, and a quarter had mental health problems.

The authors, from the department of organisational psychology at Birkbeck, University of London, stressed that patients were not at risk but urged doctors to be kinder to themselves.

Caroline Kamau said: “We don’t want the medical community to stigmatise distress in medical practice. A significant problem is doctors are afraid of admitting to these things. Of all the people they should be the most compassionate but they have had to soldier on and this leads to people feeling they may not be able to admit to it. Their feelings are a normal human reaction to the things doctors have to go through, particularly oncologists.”

The research considered studies from 14 countries, including the UK, US, Brazil, Australia, Japan and France, carried out between 1990 and 2014. Despite differing health systems and workloads (for example, workloads tend to be lighter in the US than in the UK), the authors said the results were consistent.

The paper highlights the fact that oncologists experience more frequent patient death than do other specialities, that they mostly work in excess of 60 hours, that they remain on call outside their formal working hours and work in a profession where understaffing is a problem.

As the studies asked different questions, the responses varied in number. Ten different studies identified stress levels among oncologists varying between 42% and 69% from a total of 1,203 responses. The burnout question was answered by more than 2,000 oncologists across the studies, and almost 5,000 responses were gathered on mental illness.

Much smaller samples found that up to 30% of oncologists drank alcohol in a problematic way – generally defined in the studies in question as drinking four or more times a week – and up to 20% were said to take “hypnotic drugs” such as sedatives, or medication to relieve anxiety or insomnia, although the authors stressed that this was outside working hours.

They say that the solution to the problems highlighted by their study should come from within the oncology community in the shape of a peer-to-peer/mentor support network.

The study’s co-author Asta Medisauskaite said: “Occupational distress reduces career satisfaction, affects patient care and increases the chances of cancer doctors switching to another area of medicine. We want to highlight that improving workload and support for oncologists could improve patient care, reduce talent loss from the field of oncology, and could ultimately impact clinical outcomes for cancer patients.”

Alarming number of cancer medics suffering burnout and stress

Charities warn of "alarming" rise in cancer check waits

“Final month, the NHS missed the cancer therapy target for the first time ever and these delays have clearly played a element in that. All the progress made on cancer care in the last decade is now at risk.”

Duleep Allirajah, head of policy at Macmillan Cancer Support stated the trends have been “alarming”.

He said: “The NHS is under strain and cancer dangers becoming overlooked and not provided the concentrate it demands. Every single individual hospital has a accountability to meet these targets, or they danger putting a patient’s very best possibility of survival at chance. Nonetheless, this government and the following also require to consider accountability.

Mark Flannagan, chief executive of the charity Beating Bowel Cancer stated no-one ought to have to wait six weeks for this kind of tests, which could decrease their survival probabilities .

He said: “These new figures are unacceptable and the NHS needs to do much more to enhance diagnostic referral to secondary care for cancer patients.”

An NHS England spokesman mentioned: “Timeliness of diagnosis and treatment is what individuals anticipate and is essential to supplying high high quality care. The vast majority of patients get their exams promptly with most patients waiting significantly less than three weeks from referral, despite the quantity of tests increasing by nearly 58,000 when in contrast to the same period final yr.”

Charities warn of "alarming" rise in cancer check waits

What Can Be Accomplished About Baseball"s Alarming Tommy John Surgery Improve?

Is it time to refer to the baseball elbow injury that outcomes in Tommy John surgeries as an epidemic?  There have been approximately fifty Tommy John surgeries on expert baseball players in 2013.  The number of specialist baseball players opting for Tommy John surgical procedure in 2014 is at forty-5.  The impact of that variety is felt when it is regarded that Key League Baseball has not even reached the midpoint in the 2014 championship season.

“Tommy John surgical treatment is on a record speed this 12 months for elite degree pitchers,” said Dr. John Knight of The Hand and Wrist Institute.  ”This damage is quite possibly a profession ender at any level.  The age for UCL injuries is dropping as pitchers are throwing as well hard and also many pitches.  The dilemma is the culture of growing competition to get to the pro degree requiring pitchers at an early age to throw with maximum work.”

UCL is quick for ulnar collateral ligament, and injuries to that ligament are identified to trigger an early termination to a baseball player’s profession.  The truth that Main League Baseball will soon have as several gamers struggling from this kind of injuries and opting for Tommy John surgical treatment before the 2014 All-Star break as the league had in the entirety of the 2013 championship season leaves a lot of concerned about the tension becoming positioned on baseball gamers.

MLB pitcher Dustin McGowan had Tommy John surgical treatment right after six commences in Double-A  (Photo credit score: Wikipedia)

The American Sports activities Medication Institute (ASMI) is not frightened to label the proliferation of Tommy John injuries as an epidemic.  In a position statement launched in Could 2014, the ASMI implies that the epidemic is largely connected to UCL issues in gamers that arose when they have been adolescent amateurs.

“To have a opportunity of stemming the tide of Tommy John injuries, one has to start off with youngsters initial touching a baseball,” added Dr. Knight.  ”Children as early as four years old are throwing a hefty baseball.  They are throwing too much.  They are throwing with greatest velocity as there has been an more than emphasis on far more is far better.  All of this leads to enhance stress and torque across the development plates and ligaments in a establishing elbow, likely setting up the elbow for greatest weakening of the soft tissues and inability to hold up more than time.  The prevention should begin in the establishing years with specific attention to pitch counts in innings and video games, limiting the variety of innings pitched and higher attention to appropriate biomechanics.”

The ASMI offers a record of 9 suggestions for specialist pitchers to minimize the risk of possessing to undergo Tommy John injury.  The suggestions contain not constantly pitching with one hundred% energy and becoming wary of pitching in winter league baseball.

A Tommy John surgery epidemic is not only devastating from a healthcare-relevant place, but also can serve as a main setback for specialist baseball organizations.  Despite some who declare that going under the knife truly improves the performance of baseball players, it at least serves as a short-term setback for teams that need to have their best prospective customers to perform these days.  Further, the studies that declare Tommy John surgical procedure improves functionality in excess of time might be heavily flawed.

Darren Heitner is a attorney and the Founder of South Florida-based HEITNER LEGAL, P.L.L.C., which has a target on Sports activities Law and Contracts.

What Can Be Accomplished About Baseball"s Alarming Tommy John Surgery Improve?

Wholemeal bread is made up of "alarming" sugar levels

The Telegraph analysed 15 wholemeal and brown loaves offered by major supermarkets, as nicely as their equivalent white items.

All of the loaves have sugars which naturally happen in the bread. Even so, further sugar was included in the components of ten of the brown and wholemeal loaves.

In 5 circumstances the brown or wholemeal loaves contained a form of additional sugar, even though the white equivalent loaf did not.

Makers mentioned the sugar was required to “mask” the “bitter” taste of wholemeal flour, insisting the ingredient appeared only in “negligible” amounts.

Nonetheless, Dr Aseem Malhotra, a cardiologist and science director of Action on Sugar, a campaign group, explained: “There is that there is totally no necessity for extra sugar and it should not be integrated as any part of a balanced diet plan – just an occasional treat which we can all get pleasure from.”

He added: “Brown bread is believed to be healthier than white bread since of the fibre but the ranges of sugar in some of these items is alarming.

“The principal aim of Action On Sugar is to get the meals sector to lessen additional sugar by 40 per cent in the next four many years which will halt the weight problems epidemic. As this investigation has uncovered brown bread is definitely no exception.”

Ian Marber, a nutritionist, stated: “It is especially surprising to locate added sugar in wholemeal loaves as they have a ‘healthier’ aura.

“As sugar would seem to be additional to mostly brown wholemeal loaves I can’t assist questioning if it is been added to promote much more. Wholemeal contains a tiny far more fibre than white bread and so it’s deemed superior from a dietary standpoint. To some extent the addition of sugar counteracts that.”

The findings come following a separate evaluation by The Telegraph earlier this month located that numerous low body fat foods promoted as healthy-eating alternatives contained more sugar than their “full fat” equivalents – in some situations far more than 5 times as significantly. A study of 100 popular low or non-fat grocery objects from significant supermarkets identified that dozens contained at least two teaspoons of total sugar in a single serving.

In complete 31 varieties of bread have been surveyed as portion of the new examination. Of the 15 white loaves which had been analysed, only 4 contained extra sugar, with the remainder only containing sugar that happens naturally in the bread.

The 5 wholemeal loaves which contained added sugar when their white equivalents did not included Hovis’ wholemeal bread, which is made up of extra caramelised sugar, Warburtons’ wholemeal, which is made up of dextrose, and Kingsmill “great everyday” wholemeal, which seems to have more sugar than yeast.

Some bread ranges integrated added sugar in each the wholemeal and white types, like Jackson’s “Yorkshire’s champion” farmhouse loaves and Asda’s wheat-free bread.

A spokesman for Hovis said: “Sugar is only added to element of our selection, and it is only additional to counteract the bitterness from the bran and to make the solution far more palatable.

“The tips from nutritionists is to eat wholemeal bread, due to the positive aspects of wholegrain consumption and fibre amounts in wholemeal bread. Including a small sugar indicates that more individuals are most likely to make the move to wholemeal. This is why we do it.”

A spokesman for Warburtons explained: “Wholemeal bread recipes, be it for baking at residence or in a big bakery, include a small sugar to mask the bitter taste of the wholemeal flour. It is a negligible volume.

“In truth, the regular individual would have to eat about one hundred slices of bread or 5 loaves a day to get anywhere close to eating the Guideline Every day Amount of sugar. All Warburtons breads are reduced in sugar and give shoppers with distinct nutrients such as fibre, calcium, iron and B vitamins which are all vital in our diet plans.”

A spokesman for Kingsmill stated: “Our Kingsmill Tasty Wholemeal bread does have a extremely tiny amount of additional sugar in the recipe to aid round out the much more bitter notes in wholemeal – but with just four.3g of sugar per 100g of bread, this is still a lower-sugar food.

“We are conscious that as a nation we need to have to cut back on our sugar intake but bread is not a main source of sugar in the United kingdom diet. Kingsmill has adopted the Government’s front-of-pack colour coding scheme and all of our breads are rated as ‘green’ for sugars.”

Wholemeal bread is made up of "alarming" sugar levels

Alcohol, smoking and obesity fuel "alarming" global cancer surge

A concerted global effort to tackle the causes of cancer linked to lifestyle, such as alcohol abuse, sugar consumption and obesity, has been urged on Monday by the World Health Organisation as it predicted that the number of new cases could soar by 70% to nearly 25 million a year over the next two decades.

Half of these cases are preventable, says the UN’s public health arm in its World Cancer Report, because they are linked to lifestyle. It is implausible to think we can treat our way out of the disease, say the authors, arguing that the focus must now be on preventing new cases.

Even the richest countries will struggle to cope with the spiralling costs of treatment and care for patients, and the lower income countries, where numbers are expected to be highest, are ill-equipped for the burden to come.

The incidence of cancer globally has increased from 12.7m new cases in 2008 to 14.1m in 2012, when there were 8.2m deaths. By 2032, it is expected to hit almost 25m a year – a 70% increase.

The biggest burden will be in low- and middle-income countries, where the population is increasing and living longer. They are hit by two types of cancers – first, those triggered by infections, such as cervical cancers, which are still very prevalent in poorer countries that do not have screening, let alone the HPV vaccine.

Second, there are increasingly cancers associated with the lifestyles of more affluent countries “with increasing use of tobacco, consumption of alcohol and highly processed foods and lack of physical activity”, writes Margaret Chan, director general of WHO, in an introduction to the report.

Dr Christopher Wild, director of the International Agency for Research on Cancer (IARC) and joint author of the report, said when people know his job, they asked whether a cure for cancer had been found, yet few think about preventing the disease in the first place.

“Despite exciting advances, the report shows that we cannot treat our way out of the cancer problem. More commitment to prevention and early detection is desperately needed in order to complement improved treatments and address the alarming rise in the cancer burden globally.”

His co-author, Dr Bernard Stewart from the University of New South Wales, talked of “the crucial role of prevention in combatting the tidal wave of cancer” and called for discussion on how to encourage people to change their lifestyles, including a tax on sugared drinks, which could be one possible brake on cancers caused by obesity and lack of physical exercise.

The world had moved on from what Stewart called a “naive approach” to smoking, which causes lung and other cancers, and once was limited to handing out leaflets and haranguing people to give up. He cited the global tobacco control treaty from the WHO, which incentivises governments to pass laws banning smoking in public places.

The World Cancer Report, an 800-page volume on the state of cancer knowledge, which is the first for five years, must open up the debate, said Stewart.

“In relation to alcohol, for instance, we are all aware of the effects of being intoxicated but there is a burden of disease not talked about because it is not recognised,” he said.

The report shows that alcohol-attributable cancers were responsible for a total of 337,400 deaths worldwide in 2010, mostly among men.

The majority were liver cancer deaths, but drinking alcohol is also a risk for cancers of the mouth, oesophagus, bowel, stomach, pancreas, breast and others.

“Labelling and availability and the price of alcohol should all be on the agenda,” said Stewart.

So should taxation of sugar-sweetened drinks, he said. The report calls for efforts to reduce the amount of cola, lemonade and other drinks containing substantial amounts of added sugar to become a high priority. Obesity, said Stewart, was a greater risk for diabetes than cancer, but cancer awareness was so great in our communities that the cancer risk was likely to put more pressure on politicians to act.

Lung cancer is the most commonly diagnosed form of the disease among men (16.7% of cases) and the biggest killer (23.6% of deaths), says the IARC report. Breast cancer is the most common diagnosis in women (25.2%) and caused 14.7% of deaths, which is a drop and now only just exceeds lung cancer deaths in women (13.8%). Bowel, prostate and stomach cancer are the other most common diagnoses.

Some of the causes of the rise in breast cancer are not amenable to change – women choosing to have fewer children and to have them later in life increase their risk. But increased breast feeding is protective. “There are some things we can change,” said Wild. “There is increasing evidence for the role of alcohol consumption in breast cancer and some evidence for obesity, particularly in post-menopausal women.”

In low- and middle-income countries, cancer rates could be brought down by relatively simple interventions. About 80% of cervical cancer deaths are in the developing world, but now there is a vaccine against human papillomavirus (HPV) which causes most cases and is routinely given to UK schoolgirls. Cheap and simple screening techniques could detect cases early, when they are treatable.

There are also vaccines against hepatitis B, which could prevent many liver cancers. Infections are responsible for about 16% of all cancers.

Wild said the next most urgent goal – after stopping the further spread of the smoking habit – was to find ways to diagnose breast cancer early in poor countries where mammography equipment and people trained to operate the machines and interpret the X-rays were not affordable.

The least developed regions will bear the brunt of the cancer increase in the coming years. More than 60% of cases and 70% of deaths occur in Africa, Asia and Central and South America.

Cancer Research UK said the predicted steep rise in cancers was shocking and so was the fact that half were preventable. It called on governments to take action, such as banning “glitzy packs” of cigarettes that attract children.

Jean King, Cancer Research UK’s director of tobacco control, said: “People can cut their risk of cancer by making healthy lifestyle choices, but it’s important to remember that the government and society are also responsible for creating an environment that supports healthy lifestyles. It’s clear that if we don’t act now to curb the number of people getting cancer, we will be at the heart of a global crisis in cancer care within the next two decades.”

Alcohol, smoking and obesity fuel "alarming" global cancer surge

NHS care watchdog warns of "alarming" culture

On Saturday The Telegraph disclosed how practically half of NHS hospitals assume to end the fiscal year in debt, with a combined £330 million “black hole” in their finances by the end of March.

A series of scandals has shaken public trust in the health support, not least at Stafford Hospital in which there were hundreds of “excess” deaths as sufferers suffered appalling maltreatment and neglect.

Final year, a public inquiry into the Stafford scandal heard how a nurse who tried to tell hospital managers that waiting instances were being manipulated was threatened and left afraid to travel alone.

Police are also investigating claims that personnel at Colchester Hospital University NHS Foundation Trust have been “pressured or bullied” into falsifying waiting list information and hiding long waits for cancer sufferers.

In his write-up, Mr Prior highlights the treatment of whistleblowers, saying the NHS is failing to pay attention to people who challenge bad care and champion the rights of patients. He says those who consider to speak out are also typically “ostracised” by their colleagues and managers.

On bullying, he reveals the final results of a survey of one hundred,000 NHS workers which found 1 in 4 had complained about their treatment method.

Mr Prior, a former hospital chairman, suggests he has discovered himself “trapped in a paradox” when it comes to the NHS, arguing that while it can be “overwhelmingly kind” as nicely as experienced, parts of the well being service have created a culture “that stigmatises and ostracises these who increase worries or complaints”.

He writes: “Too usually, it delights in the ritual humiliation of people deemed to fail, tolerates and institutionalises outdated doing work practices and outdated-fashioned hierarchies and can virtually motivate “managers” and “clinicians” to occupy opposing camps.

“I adore the NHS – am typically overwhelmed by the kindness, care and capabilities of those who perform in it – and yet am also often shocked by some of the behaviour I see.”

The former Conservative Party deputy chairman, who was chairman of Norfolk and Norwich University Hospitals Foundation Believe in for twelve years, calls for a main restructuring of well being care provision.

He says he wants to see far more successful hospitals taking in excess of failing counterparts, closer integration with neighborhood solutions and more use of the private sector for NHS-funded care. “We need significant transformational change without it the NHS will deliver bad care, and in the long run, go bust,” he writes.

“We want a lot more competition to drive up requirements of care much more entrants into the industry from private-sector firms, the voluntary sector and other care companies.

“Perhaps most crucially, we need to have to adjust the culture.”

Saturday’s disclosure of a £330 million hole in trusts’ finances included sixteen trusts forecasting deficits of in between £10 million and £50 million each.

Quickly right after Mr Prior took up his post as CQC chairman last year, the regulator’s prior management was accused of a “cover-up” and failing to effectively investigate hospital scandals due to the fact it was too near to the final Labour government. Jeremy Hunt, the Well being Secretary, has provided the regulator new powers to guarantee it operates totally independently from government.

Just just before Christmas, Mr Prior ruffled feathers when he employed this independence to state, in an interview with The Telegraph, that the NHS had been taken care of as a nationwide religion for far as well prolonged.

He stated Mr Hunt was “crazy” to intervene immediately to demand explanations when hospitals miss waiting targets.

In this report, he goes even more – suggesting the NHS would execute better if the waiting targets which were launched by Labour were discarded completely. He writes: “We want the Government to modify the way it holds the NHS to account: an finish to trusts getting blind-sided by waiting targets that miss the level, skew priorities and have unintended consequences.”

A Division for Wellness spokesman mentioned: “We are clear that targets have to never come just before clinical want – and based on clinical tips, we have scrapped a amount of them.

“Even so, it is appropriate that patients have certainty about how prolonged they can expect to wait for healthcare treatment when they are sick. In truth, regardless of the NHS treating more men and women than ever, waiting times are low and stable and there are 35,000 fewer patients waiting longer than 18 weeks than in Might 2010.

“We are focusing on bad care like never ever ahead of.”

Þ Response occasions to 999 calls have risen in the previous two many years, with ambulances in some elements of England taking virtually two minutes longer to reach individuals in want of urgent support, figures present. Nine of the eleven regional NHS ambulance providers noticed a rise in response occasions.

NHS care watchdog warns of "alarming" culture

Weight problems soars to "alarming" amounts in building countries

There are some 900 million obese men and women in building nations, data demonstrates. Photograph: Jose Luis Pelaez/Getty/Mix Photographs

The extent of the world’s weight problems epidemic has been thrown into stark relief as a report from the Overseas Growth Institute (ODI) puts the number of obese and obese grownups in developing countries at far more than 900 million.

Long term Diets, an analysis of public information about what the world eats, says there are nearly twice as a lot of obese people in bad nations as in wealthy ones. In 2008, the figures have been 904 million in developing nations, in which most of the world’s people dwell, compared with 557 million in industrialised nations.

“The growing charges of obese and weight problems in creating nations are alarming,” stated the report’s writer, ODI analysis fellow Steve Wiggins. “On existing trends, globally, we will see a enormous enhance in the quantity of folks struggling particular varieties of cancer, diabetes, strokes and heart attacks, putting an huge burden on public healthcare programs.”

The report warns that governments are not undertaking enough to tackle the increasing crisis, partly due to politicians’ reluctance to interfere at the dinner table, the strong influence of farming and meals lobbies and a massive gap in public awareness of what constitutes a healthful diet plan.

In accordance to the report, obese and obesity prices since 1980 have almost doubled in China and Mexico, and risen by a third in South Africa, which now has a higher fee than the United kingdom. Regionally, north Africa, the Middle East and Latin America all have overweight and obese prices on a par with Europe.

Workers set up lights on a giant McDonald’s sign in Beijing. Diet programs in China are proportionally richer in animal products than in the 1960s. Photograph: AP

“The evidence is properly established: weight problems, collectively with the extreme consumption of body fat and salt, is linked to the growing worldwide incidence of non-communicable ailments, which includes some cancers, diabetes, heart condition and stroke,” says the report. “What has transformed is that the vast majority of men and women who are obese or obese these days can be found in the developing rather than the produced world.”

The report highlights a paradox in the building globe. As properly as obesity, under-consumption remains a problem for hundreds of hundreds of thousands of folks in bad nations, where progress on decreasing stunting – reduced height to age – has been slow. Up to a third of infants in the creating globe are stunted.

Variables behind the boost in weight problems include rising incomes and urbanisation, which have a tendency to lead to diets wealthy in animal create, fat, salt and sugar and the a variety of influences of globalisation, amid them advertising and the media, on diets. But the report cautions against jumping to conclusions that nationwide diet programs are converging on a single international norm.

In China, for instance, diet plans, are proportionally richer in animal products and vegetables than in the 1960s, but sugar consumption remains lower. In contrast, Thailand has skilled an enhance in the per-head consumption of starchy roots and pulses as effectively as fruit, which Thais consume far more than animal goods.

This selection in diet plans carries specified implications, the report argues. Globalisation will not – in the medium term – location enormous restrictions on the scope for policy action, and policy needs to start where folks are, in terms of their preferences and traditions. “Trajectories are not preordained there is scope to influence the evolution of diet to get far better outcomes for health and agriculture,” says the report.

Yet, Wiggins acknowledges that governments have been timid in staking out positions on diet plan. “Who desires to take on the foods business?” he explained. “Then there is the moral and ethical dimension: individuals would not like the government to inform us what to place on the dinner table.”

Thai villagers sell fruit at a floating industry in Ratchaburi. Fruit consumption has risen in Thailand, the report says. Photograph: Apichart Weerawong/AP

This is not to conclude that diet regime policy have to be timid, says the report, even if that is, apparently, the public mood. It contrasts government reluctance to act on diet programs with robust action to restrict smoking. Although diet program is a much more diverse concern than smoking, says the report, there may be scope for governments to get more incremental measures that could pave the way for the public to accept some thing wants to be completed if potential health costs are to be contained.

Some governments have managed to alter diet programs for the better. South Korea has enhanced fruit and vegetable consumption through a publicity, social advertising and marketing and training campaign, like coaching of ladies to put together classic minimal-excess fat, large-vegetable meals. Denmark banned trans fats, which have made its McDonald’s amid the healthiest in the planet. Further back, the introduction of rationing in the United kingdom for the duration of the 2nd world war ensured that the poorest individuals have been capable to consume a balanced diet regime.

But these are the exceptions. For the most part, diet plans are increasingly unhealthy – with an increase in the consumption of sugar. Sugar and sweetener consumption has risen around the world by more than a fifth per individual from 1961 to 2009.

Less than a third of nations are consuming significantly less than the advisable prime limit of 50g of sugar a day per man or woman, and 69 countries have common per capita sugar consumption of a lot more than double this suggested upper limit. The world’s prime sugar consumers incorporate the US, Belgium, the Netherlands, New Zealand, Costa Rica and Mexico.

Fat consumption remains a concern. Amongst creating countries the highest consumption of excess fat is in east Asia and southern Africa. Even so, industrialised countries even now have considerably greater amounts of body fat consumption – often much more than double their building counterparts.

Weight problems soars to "alarming" amounts in building countries