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Pancreatic cancer in the UK
Editorial
Reuters
The Arab uprisings and health
For future talks that will be held by ECOHOST see http:// www.lshtm.ac.uk/events/ date/2011/10
Last week, the European Centre on Health of Societies in Transition (ECOHOST, a centre within the London School of Hygiene and Tropical Medicine, directed by Prof Martin McKee), together with The Lancet, held its first Global Health Lab on current and urgent issues in international health. The opening meeting addressed the wave of revolutions currently taking place in the Arab world. Khalid Koser is an associate fellow of Chatham House. He described the present atrocious situation in Libya for 1 million people who had been displaced since the conflict in that country had begun. This migration crisis has had global impact—not least the shock of Europe’s resistance when faced with more than 42 000 migrants who arrived in Malta and Lampedusa. Hundreds of thousands of Libyans migrated to Tunisia and Egypt, and 150 000 were internally displaced. Many of these migrants are now returning home. Yet there remain health and humanitarian concerns. In the short term, protection of displaced people, refugees, and asylum seekers is an urgent necessity. Zied Mhirsi is a doctor and a radio show host
who brought the voice of the Tunisian street to the country’s dictators. Tunisia is still a country in crisis. Despite achieving its Millennium Development Goals, one doctor in ten is unemployed. Physicians under dictatorship were harassed by government officials for treating protesters. Although there is a new era of freedom in Tunisia, a health crisis is looming. Hospitals are already worse now than before the revolution. There is hope. Health is now beginning to be a subject for political discussion. People are slowly building health services. What can one make of events in the Arab world today? In Egypt, a dictator has gone, but the country is not fully free of dictatorship. In Tunisia, there is still fear of fundamentalists. Libya is being colonised by the West for oil. There are special concerns about threats to health, and threats to women’s health in particular. The Arab uprisings have offered new opportunities for millions of people. But those opportunities will be thwarted if health systems are not protected and strengthened. ■ The Lancet
Corbis
Pancreatic cancer in the UK
For the Pancreatic Cancer UK report see http://www. pancreaticcancer.org.uk/ media/100292/report_final_for_ web.pdf
1050
On Sept 7, the charity Pancreatic Cancer UK released Study for Survival 2011, a report that makes uncomfortable reading. Patients in the UK with pancreatic cancer have a 5-year survival rate of only 3%, the lowest for any cancer. This survival rate has remained unchanged for 40 years, and is one of the lowest in the developed world, lagging behind some other European countries, the USA, Canada, and Australia. Pancreatic cancer causes 5% of all cancer deaths in the UK, but attracts less than 1% of overall cancer research funding. Late diagnosis and heterogeneous treatment approaches are two possible reasons for the poor pancreatic cancer outcomes in the UK. Almost 80% of patients are diagnosed with advanced disease when cure is unlikely, even though 25% of patients have symptoms up to a year before being diagnosed and 42% of patients see a general practitioner three or more times before being referred to a specialist. Less than 10% of all patients are offered major surgery that could cure the disease. And a third of patients do not have access to a clinical nurse specialist, which compromises their quality of care.
The report highlights several actions needing immediate implementation: improvement in the national pancreatic cancer risk assessment algorithm, reform of existing referral guidelines, enhanced communication and collaboration between hospitals and specialist pancreatic cancer centres, greater funding for pancreatic cancer research, and increased participation in clinical trials. The report does not cover prevention although about 80 000 of the 304 000 cancers diagnosed yearly in the UK are preventable. For example, waist circumference (a measure of adiposity) is a risk factor for pancreatic cancer that has been rising steadily in the UK since the 1970s. Increased awareness of pancreatic cancer at the national level is a move in the right direction, but international collaboration is needed to implement a political and public focus on the disease. Early diagnosis and improved treatment must become the standard of care for patients with pancreatic cancer in the UK and worldwide. ■ The Lancet www.thelancet.com Vol 378 September 17, 2011
Reuters
The Arab uprisings and health
For future talks that will be held by ECOHOST see http:// www.lshtm.ac.uk/events/ date/2011/10
Last week, the European Centre on Health of Societies in Transition (ECOHOST, a centre within the London School of Hygiene and Tropical Medicine, directed by Prof Martin McKee), together with The Lancet, held its first Global Health Lab on current and urgent issues in international health. The opening meeting addressed the wave of revolutions currently taking place in the Arab world. Khalid Koser is an associate fellow of Chatham House. He described the present atrocious situation in Libya for 1 million people who had been displaced since the conflict in that country had begun. This migration crisis has had global impact—not least the shock of Europe’s resistance when faced with more than 42 000 migrants who arrived in Malta and Lampedusa. Hundreds of thousands of Libyans migrated to Tunisia and Egypt, and 150 000 were internally displaced. Many of these migrants are now returning home. Yet there remain health and humanitarian concerns. In the short term, protection of displaced people, refugees, and asylum seekers is an urgent necessity. Zied Mhirsi is a doctor and a radio show host
who brought the voice of the Tunisian street to the country’s dictators. Tunisia is still a country in crisis. Despite achieving its Millennium Development Goals, one doctor in ten is unemployed. Physicians under dictatorship were harassed by government officials for treating protesters. Although there is a new era of freedom in Tunisia, a health crisis is looming. Hospitals are already worse now than before the revolution. There is hope. Health is now beginning to be a subject for political discussion. People are slowly building health services. What can one make of events in the Arab world today? In Egypt, a dictator has gone, but the country is not fully free of dictatorship. In Tunisia, there is still fear of fundamentalists. Libya is being colonised by the West for oil. There are special concerns about threats to health, and threats to women’s health in particular. The Arab uprisings have offered new opportunities for millions of people. But those opportunities will be thwarted if health systems are not protected and strengthened. ■ The Lancet
Corbis
Pancreatic cancer in the UK
For the Pancreatic Cancer UK report see http://www. pancreaticcancer.org.uk/ media/100292/report_final_for_ web.pdf
1050
On Sept 7, the charity Pancreatic Cancer UK released Study for Survival 2011, a report that makes uncomfortable reading. Patients in the UK with pancreatic cancer have a 5-year survival rate of only 3%, the lowest for any cancer. This survival rate has remained unchanged for 40 years, and is one of the lowest in the developed world, lagging behind some other European countries, the USA, Canada, and Australia. Pancreatic cancer causes 5% of all cancer deaths in the UK, but attracts less than 1% of overall cancer research funding. Late diagnosis and heterogeneous treatment approaches are two possible reasons for the poor pancreatic cancer outcomes in the UK. Almost 80% of patients are diagnosed with advanced disease when cure is unlikely, even though 25% of patients have symptoms up to a year before being diagnosed and 42% of patients see a general practitioner three or more times before being referred to a specialist. Less than 10% of all patients are offered major surgery that could cure the disease. And a third of patients do not have access to a clinical nurse specialist, which compromises their quality of care.
The report highlights several actions needing immediate implementation: improvement in the national pancreatic cancer risk assessment algorithm, reform of existing referral guidelines, enhanced communication and collaboration between hospitals and specialist pancreatic cancer centres, greater funding for pancreatic cancer research, and increased participation in clinical trials. The report does not cover prevention although about 80 000 of the 304 000 cancers diagnosed yearly in the UK are preventable. For example, waist circumference (a measure of adiposity) is a risk factor for pancreatic cancer that has been rising steadily in the UK since the 1970s. Increased awareness of pancreatic cancer at the national level is a move in the right direction, but international collaboration is needed to implement a political and public focus on the disease. Early diagnosis and improved treatment must become the standard of care for patients with pancreatic cancer in the UK and worldwide. ■ The Lancet www.thelancet.com Vol 378 September 17, 2011