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Bowel cancer is the UK’s second largest cause of death
from cancer, killing around 50 people a day. It affects men and women
equally and
one in five cases are under the age of 60 years. Of those who are diagnosed
with the disease, 90 per cent will survive if it is caught early. However,
symptoms are often ignored — whether through fear, ignorance or
embarrassment — and around 50 per cent of people are not expected
to live for more than five years after diagnosis.
The charity Beating Bowel Cancer, along with the Royal Pharmaceutical
Society, has produced practice guidance for community pharmacists to
help them when advising
on suspected, or diagnosed, bowel cancer.
Beating Bowel Cancer runs public awareness campaigns to highlight the disease
and its symptoms, promote early diagnosis and encourage open access to treatment
choice for those affected by bowel cancer. This week, it began piloting
a bowel
cancer public health campaign in 975 community pharmacies across England (p575).
Beating Bowel Cancer targeted GPs in an information campaign in February.
One of the reasons for the timing of the campaign is the roll out of the NHS
bowel cancer screening programme. In England, the programme began in April 2006
for men and women aged
60 to 69 years and is being rolled out by region over
three years (PJ, 6 August 2005, p156). A similar initiative for men
and women
in Scotland aged between 50 and 74 years began in March this year (PJ, 3 September
2005, p274) and in Wales screening is likely to start towards the end of 2008.
Every two years those in the relevant age bracket and registered with a GP receive
a screening kit by post. A stool sample is taken and the kit returned to a central
laboratory for analysis.
“If people receive a bowel cancer screening kit through the post but they
do not
know what bowel cancer is, they are not going to take it seriously,” Tara
MacDowel, head of communications at Beating Bowel Cancer, told The Journal. Pharmacies
are an obvious place for people to receive information about bowel cancer, she
says. People visit pharmacies to buy medicines or seek advice for conditions
like irritable bowel syndrome or piles, so it is important that pharmacists are
aware of symptoms that might indicate something more serious, she adds.
Paul Gimson, lead pharmacist for long term care at the Society, explains that
there are many opportunities for pharmacists to raise awareness of, and to identify,
the early warning signs of bowel cancer. For example, during medicines use reviews,
when giving advice on over-the-counter products and when counselling on prescription
medicines.
“The symptoms of bowel cancer should be at the back of pharmacists’ minds
whenever they consult with a patient. We hope that this practice guidance will
help pharmacists down a route of questioning that they may not have considered
before,” says Mr Gimson.
The community pharmacy contract requires pharmacists to increase public knowledge
about key healthy lifestyle messages. These lifestyle messages, such as eating
a healthy diet, taking regular exercise, stopping smoking and reducing alcohol
intake, can reduce the risk of developing bowel cancer. It is also essential
that pharmacists explain to customers the importance of knowing their bodies
so that they can learn to recognise changes in their bowel habits, the guidance
says.
Geoff Saunders, Macmillan cancer network pharmacist, Greater Manchester and Cheshire
Cancer Network, who reviewed the practice guidance, emphasises that pharmacists
should reassure people that not everyone with symptoms will be diagnosed with
bowel cancer. However, pharmacists should stress that symptoms should be taken
seriously and patients should be referred to their GP if appropriate (see Panel
below). Most advice will be opportunistic, he says, since it will be difficult
for
pharmacists to identify at-risk groups, such as those with a family history
of the disease.
When to refer patients
Not everyone with bowel cancer will have symptoms and the symptoms
may vary. However, there are five common, higher-risk symptoms
that should prompt referral to a GP:
• A persistent change in bowel habit, especially going more
often or looser for several weeks
• Bleeding from the anus without obvious reason
• Abdominal pain, especially if severe
• A definite palpable right-sided abdominal mass
• Unexplained iron-deficiency anaemia
If any of these symptoms appear persistently for more than four
to six weeks a patient should be referred to his or her GP.
The guidance advises that pharmacists give consideration to the
side effects of other medicines patients may be taking since
these may be similar to the symptoms of bowel cancer. |
In future, says Mr Saunders, more patients with bowel cancer may be
managed in the community due to the availability of oral chemotherapy
drugs. If this happens,
community pharmacists’ knowledge of the disease and its treatment will
need to increase enormously.
The practice guidance, supported by an educational grant from Roche, will be
sent to all community pharmacists in Britain with this week’s Pharmaceutical
Journal. It is also available online (PDF 320K).
Predictive value of symptoms
Research published in BMJ Online First (10 May, www.bmj.com)
suggests that new onset of certain alarm symptoms is associated
with an
increased likelihood of diagnosis with a related cancer, especially
in men and in people over 65 years old.
Researchers analysed data from 762,325 patients for first occurrence
of four symptoms and subsequent diagnosis of cancer: rectal bleeding
(colorectal cancer); haematuria (urinary tract neoplasm); haemoptysis
(bronchial carcinoma); and dysphagia (oesophageal malignancies).
They found rectal bleeding in men and women had a positive predictive
value for colorectal cancer of 2.4 per cent and 2.0 per cent,
respectively, within three years of symptoms. Rectal bleeding
was associated with
high rates of cancer diagnosis during the 90 days immediately
after presentation. However, the researchers warn that their
epidemiological
data need to be considered within the context of clinical presentation. |
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The
Pharmaceutical Journal