The ‘metabolic’ health of younger adults is worse than that of previous generations, exposing them to greater risks of cardiovascular disease.

A large cohort study from the Netherlands found the incidence of obesity, high blood pressure and high cholesterol were much higher among adults in their twenties and thirties than formerly.

This increase in risk factors for diabetes, stroke and heart disease could offset the advantage of reduced incidence of lung cancer from the decline in smoking.

The researchers analysed data on more than 6,000 individuals in a cohort study that began in 1987, with follow-up examinations after six, 11 and 16 years, measuring body weight, blood pressure and total cholesterol level.

The subjects were divided into ten-year age groups to help determine whether there were ‘generation shifts’ in risk profile.

The results showed that while the prevalence of obesity and hypertension increased with age, the younger generations had a higher prevalence of these risk factors than those 10 years had shown at the same age. For example:

• incidence of overweight among men in their thirties had increased over 11 years from 40% to 52%

• incidence of hypertension had increased between generations in both sexes

• incidence of diabetes had increased between generations in men.

The investigators concluded that “the more recently born adult generations are doing worse than their predecessors”.

Lead study author Gerben Hulsegge commented that in terms of the prevalence of obesity, the younger generation was “15 years ahead” of the older.

He predicted: “We are likely to see a shift in non-communicable disease from smoking-related diseases such as lung cancer to obesity-related diseases such as diabetes.” As a result, he warned, increases in life expectancy could level off.

NICE has failed to recommend Pfizer’s Xalkori (crizotinib) for previously treated anaplastic-lymphoma-kinase-positive advanced non-small-cell lung cancer in new draft guidance.

An independent Appraisal Committee decided the drug did not meet NICE’s end-of-life treatment criteria so its cost exceeded the limit deemed cost-effective for NHS use.

Sir Andrew Dillon, NICE Chief Executive, said that although the clinical benefits of Xalkori had been recognised the high cost of the drug meant it could not be considered as a treatment option.

NICE usually recommends clinically effective treatments that cost up to at a maximum of up to £30,000 per quality adjusted life year (QALY) – the methodology current used to assess value.

If certain treatments meet the criteria to be considered under NICE’s supplementary advice for end-of-life treatments a higher cost per QALY may be accepted. The highest cost per QALY NICE has recommended has been around £50,000.

However, NICE’s Appraisal Committee concluded that the most plausible cost per QALY for Xalkori would be somewhere between £63,800 and £181,100 when compared with existing treatments and between £51,700 and £80,500 when compared with best supportive care.

“We have already recommended a number of treatments for the various stages of non-small-cell lung cancer,” said Sir Andrew Dillon. “However, although the independent committee that considered the evidence found crizotinib to be clinically effective treatment for ALK-positive non-small-cell lung cancer, even if the supplementary advice to the Committee for life-extending treatments had applied, crizotinib could not be considered a cost-effective use of NHS.”

NICE’s guidance is now open for consultation.

Eli Lilly’s Alimta (pemetrexed) has not been recommended in new draft guidance as a maintenance treatment option for non-small-cell lung cancer (NSCLC).

NICE recognised the effectiveness of the treatment but said the potential gain for patients is less than the NHS is being asked to pay for the drug.

A disappointed Sir Andrew Dillon said the Institute can only recommend treatments “which are both clinically and cost effective” for the NHS.

The Institute calculates that the average cost of the treatment is approximately £11,640.

Lung cancer is one of the most common cancers in the UK. NSCLC is the most common type of lung cancer and accounts for around 80% of all cases.

Alimta was being considered as a maintenance treatment option following induction therapy with the drug and cisplatin. It is already recommended as a first line treatment option for NSCLC and as a maintenance treatment option following platinum-based chemotherapy in combination with gemcitabine, paclitaxel or docetaxel.

“Alimta is already recommended as maintenance treatment following a different first line treatment,” said Sir Andrew Dillon. “However, in this case, as maintenance treatment following pemetrexed and cisplatin, although effective, the potential gain for patients is less but the cost to the NHS remains the same.

“It is disappointing not to be able to recommend pemetrexed in our preliminary guidance.”

Lack of access to specialists is a major factor in the UK’s high lung cancer mortality rates, according to the UK Lung Cancer Coalition.

The coalition, which includes doctors, pharmaceutical companies and patient groups, has produced an “aspirational” guide to delivering lung cancer care.

Late diagnosis, poorly structured care teams and a “nihilistic view” of the patient’s prognosis were also identified as reducing patient survival rates.

The coalition’s Dream MDT report makes 30 recommendations for delivering lung cancer diagnosis, treatment and care through multidisciplinary teams (MDTs).

The report says these recommendations “should challenge lung cancer practice to strive to exceed, rather than simply meet, NICE guidelines”.

The UK has 240 lung cancer MDTs but too few specialists and a culture of low expectation, the coalition argues. Its recommendations include:

• A Lung Cancer Nurse Specialist should play a key role in ensuring optimal care for each patient.

• Transfer of care from secondary to primary care needs to be improved, with the GP informed of the patient’s progress at all stages.

• Each patient should be assigned a specialist lung cancer physician to manage their treatment.

• The MDT should deliver a two-stage process: diagnosis and treatment.

• Patients should know at all times what the next step is in their care pathway.

According to the coalition, about a third of NHS lung cancer patients do not have access to lung cancer specialist nurses or physicians.

By following the recommendations, the NHS could save 10% of the lives currently being lost to lung cancer, the coalition argued.

While smoking cessation programmes have reduced the incidence of lung cancer, prognosis for those diagnosed with the condition is usually poor.

A new chemotherapy technique that isolates the liver for treatment has been used with UK patients for the first time.

The ‘chemo-bath’ technique could allow much higher doses to be used without side-effects such as hair loss and infertility.

Experts believe the same approach could be used to treat inoperable cancers in the kidney, pancreas or even lung.

Two patients at Southampton General Hospital have been treated for metastatic liver cancer with the ‘chemo-bath’ technique, resulting in tumour reduction with minimal side-effects.

Whereas traditional chemotherapy exposes the entire body to the drug’s effects, the ‘chemo-bath’ confines almost all the dose to the targeted organ.

The organ is isolated by inflating balloons inside the proximal and distal blood vessels before the drug is injected; the drug is then filtered out of the organ before the circulation is restored.

Radiologist Dr Brian Stedman (pictured) said: “To cut off an organ from the body for 60 minutes, soak it in a high dose of drug and then filter the blood almost completely clean before returning is truly groundbreaking.

“Previously, the outlook for patients specifically suffering from cancer which has spread to the liver has been poor because standard chemotherapy’s effect is limited by the unwanted damage the drug causes to the rest of the body.”

Dr Stedman said that although the technique was “in its infancy” and may need further refinement, it holds out the prospect of application to a number of organs where metastatic tumours are inoperable.

The technique is being tested in other EU countries and in the US.

Over two-thirds of brain cancers, and a third of all cancers, in NHS patients aged over 70 are only diagnosed following emergency hospital admissions.

A study by the National Cancer Intelligence Network found that elderly patients made up two-thirds of the patients whose cancers were diagnosed by that route.

Importantly, it found that patients were far less likely to survive a year if their diagnosis came through A&E rather than an outpatient referral.

According to the study, which looked at 750,000 patients in England, 70% of brain cancers, 55% of pancreatic cancers and 52% of liver cancers in patients aged over 70 were diagnosed via emergency admissions in 2006–8.

Also, 39% of all lung cancers were only diagnosed after an A&E admission.

Study co-author Sara Hiom, Director of Information at Cancer Research UK, said: “We don’t yet know the reasons that lie behind these stark figures, but we urgently need to understand why there is such a great proportion.”

Possible explanations were that elderly patients were “reluctant to bother their doctor,” she said, or that doctors were dismissing symptoms as ‘old age’. In some cases the A&E admissions were emergency GP referrals.

According to Professor Sir Mike Richards, the National Cancer Director, improved awareness of the symptoms of hard-to-detect cancers could reduce the need for emergency diagnoses.

“A public awareness campaign run in Leeds showed that the proportion of emergency presentations can be reduced,” he noted. “Correspondingly more patients were diagnosed through the urgent outpatient route.”

NHS Cumbria is to re-launch its Cough Cough campaign in September following the success of last year’s project in tackling lung cancer in the region.

Nearly fifty local residents referred for tests were diagnosed with the disease following last year’s campaign – a 61% rise compared to the same period in 2010.

Dr Rebecca Wagstaff, Deputy Director of Public Health, NHS Cumbria, said that long-term survival rates in the region “are not good enough” and it was important residents were encouraged to visit their local GP if they noticed any underlying symptoms.

The campaign aimed to raise awareness of the early signs and symptoms of the disease and the importance of an early diagnosis.

It was developed in partnership with Cumbria’s GPs, cancer nurses,  public health teams and hospital consultants.

Radio adverts, posters, leaflets and high profile advertising, including local residents who have been diagnosed with the disease, will be used again during the campaign.

In 2010, more than 300 people in Cumbria died from the disease. Lung cancer is one of the biggest cancer killers in the UK.

Roche’s Tarceva (erlotinib) has been recommended in final guidance as a first-line option for people with EGFR mutation-positive non-small-cell lung cancer (NSCLC).

NICE’s independent Appraisal Committee concluded the treatment was a clinical and cost effective use of NHS resources, when supplied under an agreed Patient Access Scheme.

Professor Carole Longson, Director of the Centre for Health Technology Evaluation at NICE, said the Institute was “pleased to be able to recommend another treatment option for this stage of the disease.”

As part of the appraisal, the Committee discussed the results from the updated analysis comparing Tarceva with Iressa. On balance, the Committee concluded, the sums of money either spent or saved are small given the uncertainties associated with the data.

Therefore, when supplied under the Patient Access Scheme, Tarceva is recommended as an option with patients who have locally advanced or metastatic EGFR-TK mutation-positive NSCLC.

Elderly patients with inoperable non-small-cell lung cancer (NSCLC) have been shown to benefit from a combination of chemotherapy and radiotherapy.

In a Japanese trial, patients aged over 70 who received daily carboplatin with radiotherapy lived significantly longer than those given radiotherapy alone.

The trial, published in The Lancet, is the first to support the use of concurrent chemoradiotherapy in elderly and severely ill patients.

The study divided 200 participants with inoperable NSCLC randomly into two groups, receiving radiotherapy or chemoradiotherapy.

The overall survival for the chemoradiotherapy arm was 22.4 months, significantly longer than for the radiotherapy arm (16.9 months).

Most of the patients given chemoradiotherapy suffered some toxic effects, but the researchers judged the treatment to be “feasible and tolerable” and concluded that it “should be considered for this population”.

According to Shinji Atagi of Kinki-chuo Chest Medical Center, Osaka, Japan, elderly people were “under-represented” in previous trials of combined therapy. “This trial is the first to show that combined therapy can safely improve the outcome of stage III NSCLC in elderly patients,” he said.

However, Juan Wisnivesky of Mount Sinai School of Medicine, New York and Gary Strauss of Tufts Medical Center, Boston, warned: “Additional validation of the present findings is needed before concurrent chemoradiation can be considered standard of care in elderly patients.”

Roche’s Tarceva (erlotinib) has been recommended in final draft guidance as a first-line option for people with EGFR mutation-positive non-small-cell lung cancer (NSCLC).

The decision comes after Roche provided NICE with additional data on the clinical and cost effectiveness of Tarceva when supplied under an agreed Patient Access Scheme (PAS).

Professor Carole Longson, Director of the Centre for Health Technology Evaluation at NICE, said the health regulator is “pleased to recommend another treatment” for NSCLC.

NICE recently recommended Iressa (gefitinib) as a first-line treatment for NSCLC. Roche were unable to provide any clinical data comparing Tarceva with Iressa, but specialists confirmed the two were similar and equally effective.

Tarceva and Iressa work differently to chemotherapy. The oral treatments are known as “target agents” due to the way they block certain processes in the cancer cells.

Data supplied by Roche showed Tarceva showed longer progression-free survival and similar overall survival compared with current treatment options. It expects that NICE’s recommendation will benefit approximately 11% of patients with NSCLC.

The PAS agreed between Roche and the DH may mean that Tarceva is supplied to the NHS free of charge in certain circumstances. Tarceva will be made available at a single cost of £12,200 per patient irrespective of the duration of treatment. However, Roche will only invoice the health service after the third monthly pack of Tarceva is supplied. Any patients who receive only one or two months of treatment will receive the drug without the NHS being charged.