Prof. Robert Thomas, Kembridžo profesorius, onkologas, rašytojas. Pranešimas skirtas POLA tarptautinei konferencijai „Kaip pagerinti komunikaciją tarp gydytojo ir paciento?“ (2017-10-19)

1. Improving communication culture in the
UK
Professor Robert Thomas

2. Why bother?

4. 320 patient Cambridge &
Bedford survey
Unsatisfied 69%
320 patient Cambridge &
Bedford survey
Unsatisfied 69%
Thomas EJCC (2000)8:19
Interdisciplinary group Italy 75%
The audit commission. London 63%
The National cancer Alliance, UK 70%
Interdisciplinary group Italy 75%
The audit commission. London 63%
The National cancer Alliance, UK 70%

5. Supportive care guidance
Aims:
•Create patient satisfaction
•Aid communication research
•Change lifestyle behaviours
•Better outcomes
Thomas R et al Clin Onc (2004) 16: 420

6. Advanced communications skills
Mandatory all UK doctors

7. 200 patient pre-treatment
questionnaire survey
What level of information do you want:
• All 77%
• Only positive 8%
• Let the doctor decide 15%
More relevant take home information
What level of information do you want:
• All 77%
• Only positive 8%
• Let the doctor decide 15%
More relevant take home information

9. Patients forchemotherapy or radiotherapyPatients forchemotherapy or radiotherapy
TRIAL DESIGN
Written informedconsent + Randomisation 1:1Written informedconsent + Randomisation 1:1
HAD scoreHAD score
Leaflets + videoLeaflets + video Leaflets - novideoLeaflets - novideo
Chemotherapy or RadiotherapyChemotherapy or Radiotherapy
HAD score andinformation satisfactionquestionnaireHAD score andinformation satisfactionquestionnaire
Results (significant):
•Improved understanding
•Improved satisfaction:
 Reduced anxiety
 Reduced depression
Thomas R, EJC 36, 2000, 1536-43.
214 patients pre radiotherapy or chemotherapy

10. Keep-Healthy.com

11. Keep-healthy.com

12. Satisfied 50%
Very Unsatisfied 48%
98%
Satisfied 50%
Very Unsatisfied 48%
98%
2017

15. So what?

17. 2012 2016

18. Benefits of physical
activity after cancer
Symptoms:
Fatigue, hot flushes, peripheral neuropathy,
weight gain, cognitive loss, arthritis, diabetes,
heart disease.
Outcomes:
2-4 hrs/wk linked to 30-40% reduction in relapse
Thomas et al BJMP 2015; 7 (1) 2-9.

19. • £1 billion statins
• £774m anti-BP drugs
• £800m diabetic drugs
• £78m laxatives
• £660m anti-indigestion
National cost of lifestyle disease

20. Why are the majority of patients
not exercising even when they
understand the benefits?

23. - Conduct scientific evidence reviews
- Conduct Lifestyle surveys on patients
- Conduct Randomised Controlled Trials
Universities
•Cambridge
•Coventry
•Cranfield
•Bedfordshire
•Bond Australia
•California UCLA
Patient groups
•Macmillan
•Prostate Action
•Bowel cancer research
•Beating Bowel Cancer
•Maggie’s Centres
Hospitals
•Addenbrooke’s
•Bedford
•Royal Marsden
•UCLH
•Bristol
Health groups
•Elevate
•Cycling weekly
•The Wright Foundation
•Food Matters Live
•BSIO
Primrose Oncology Lifestyle Research Unit

26. Ranking of side effects

27. Self help strategy

28. OTC supplementation - women

29. Which OTCS?
Evening primrose 45%
Starflower oil 25%
Glucosamine / Chondroitin 41%
Fish oils 27%
Multivitamins 26%
Polyphenol rich 6%

31. Supplements for arthritis
Glucosamine – 13 RCT - 2 Meta-analysis - Doubtful benefit
.
Chondroitin - 22 RCT - 2 meta-analysis - Doubtful benefit
Fish oils - 17 RCT Rheumatoid arthritis benefits but not OA
Wandel et al meta-analysis. BMJ 2010; 341.
Towheed et al Cochrane Database Sys Rev 2005; 18(2):CD002946
Reichenbach et al Anns of Int Med 2007; 146(8):580
Cleland 2006, Fortin 1995

32. Mineral & Vitamin supplements
• SU.VI.MAX: RCT - Vit C, E&A, Se & Zn - reduction ca prostate [Hercberg].
• CARET: Beta carotene & retinol - Lung ca worse [Omenn]
• ATBC : Alpha tocopherol & beta carotene - Lung ca worse [Heinonen]
• HPF: Men taking Zn 100mg/day - prostate ca worse [Leitzmann]
• SELECT : Vit E & selenium- prostate ca worse [Klein].
• CV247: RCT - no benefit of Cu, Mg Vit C over lifestyle on PSA [Thomas]
• Post MI folate trial: prostate ca worse [Ebbing, Figueiredo].
• Australian skin trial: U shape; high beta carotene & vit E worse [Heinen]
• EPIC : U shape; too low and high folate intake worse [Chuang].

33. 1. Anti-inflammatory properties, which reduce the discomfort and stiffness
[Mitchel]
2. Anti-oxidant properties, which protect the joint from oxidative damage
[Giovannucci, Stivala].
3. Anti-apoptopic effects on chondrocytes reducing cartilage degeneration
[Shen].
4. Modulation metalloproteinases – remodels cartilage in arthritic joints
[Dahlberg, Brinckerhoff].
Polyphenol rich foods
Populations who eat these foods have a lower incidence of arthritis and
laboratory studies show they have cartilage protecting properties:

34. Thomas et al The Pomi-T study Prostate cancer & Prostate diseases 2014
2014, (17)Thomas et al. J Lifestyle Med. 2015 (1) 01
Pomi-T trial

35. “ Since taking Pomi-T have noticed is a
great improvement my arthritis - I can
touch my toes easily for the first time in
years”

37. A double blind RCT of phytochemical rich food
for arthralgia post hormonal treatments
(EudraCT 2015-002018-66)

38. american
jornal

40. Double blind RCT of a polyphenol rich nail bed balm to
help chemotherapy induced onycholysis
The UK polybalm study
Known properties:
•anti-inflammatory,
•analgesic,
•anti-oxidant
•anti-microbial 1,2,3
.
Refs:
1.Delaquis: Antimicrobial activity - essential oils. Int J Food Micr 74(1-2):2002
2.Smith-Palmer: Antimicrobial plant essential oils. Applied Micro26(2):2002
3.Baratta: Antimicro & antioxidant of essential oils. Flav & Frag J 13(4):, 2001

42. Results
Polybalm study 2017

43. Better communication:
•Greater patient satisfaction
•Better understanding of treatment options
•Lower anxiety & depression
•Better compliance
•Less litigation
•Better working environment
•More patient involvement clinical research
•Better outcomes and reduced toxicity
•Change lifestyle behaviours
Conclusions

44. Our ongoing research programme