Tag: treatment

Skin Cancer Awareness Month: NHS Lothian patients share experiences

Two patients have spoken out on Skin Cancer Awareness Month about the difference NHS Lothian’s treatment has made to their lives. 

Alan Vannan, 62 from Peebles, was diagnosed with squamous cell carcinoma (SCC), the second most common skin cancer, and has been administered with immunotherapy for two years.

Prior to this, patients like Alan with advanced SCC who’ve exhausted other treatment, such as surgery and radiotherapy, wouldn’t have had other options.

Alan said: “It started with a lump on my neck and cheek, so I went to the GP. 

“When I saw the doctor at St John’s, he took one look and diagnosed it as skin cancer and said they’d need to operate on it quickly. A Macmillian nurse, who’s been brilliant, called me on the way home.

“Processing what people are telling you after a cancer diagnosis can be the most difficult part. 

“Next was the surgery followed by radiotherapy, which wasn’t easy. Beforehand, I always thought of skin cancer as something minor and easily treated.”

Unfortunately, after his treatment, Alan received the news that the cancer hadn’t gone away.

Alan continued: “That was a difficult time. They couldn’t operate further. It came as a bit of a shock. Mentally, it was hard to process. They told me I had months left and that’s when I went to Dr Mackenzie. 

“I was given immunotherapy and it’s the best thing that’s happened to me. I’ve gone from being told I had months to it being two years later. 

“As soon as I started taking the drug the wound healed up. For me, it’s been absolutely fantastic. Every time I’ve got a scan I expected it to get worse, but it never has.

“I can’t praise the staff highly enough. The nurses, surgeons, radiologists and oncologists at the Western General and St John’s, and the Macmillian nurses, have all been amazing.”

Dr Joanna Mackenzie, Consultant Clinical Oncologist at Edinburgh Cancer Centre (above), said: “We’re always looking for ways to improve how we support our patients, and this has been a huge step forward in our management of difficult skin cancers. 

“To see it make such a difference to people like Alan who, just a few years ago, we wouldn’t have had the tools to help is really fulfilling for us as a team. 

“We’re also looking to conduct research to see if immunotherapy can be used at an earlier stage to help a wider number of patients with SCC.”

NHS Lothian last year also invested in a new superficial x-ray machine which treats basal cell carcinoma (BCC), the most common type of skin cancer. 

The machine is used for patients where surgery is not the preferred option, which can be due to other health conditions or the location of the cancer. 

BCC is rarely life-threatening but is typically seen on the face and attacks surrounding healthy tissue, sometimes leading to deformity. 

Lynda Gordon, 74, from Joppa, said: “About two years ago, I woke up with a hole at the end of my nose, so I contacted the GP.

“I was referred to the hospital at Lauriston and had an appointment to meet with a plastic surgeon, an oncologist and a dermatologist at the Joint Cutaneous Oncology Clinic. 

“It was diagnosed as a BCC and I chose to receive radiotherapy.

“An operation would have required taking skin from elsewhere and because I’ve had that before, with an SCC in 2017, I couldn’t go through that again.

“I went for the procedure at the cancer centre in February with this new machine. 

“I went every weekday for one week. Staff are lovely and make sure to explain everything. It only takes about two minutes each time. 

“The healing process was a bit unpleasant but three to four weeks later it settled, and my nose is looking absolutely fine. I’m really pleased with the results. 

“The care provided by staff is just brilliant.”

This Skin Cancer Awareness Month, NHS Lothian is also urging everyone to take simple precautions when enjoying the sun.

Dr Mackenzie continued: “It’s easy for us to think that, because we see many months of cold weather, the summer months can’t cause too much damage. 

“But whether at home or abroad, we all need to make the effort to protect our skin. 

“Simple ways to do so are avoiding the sun at peak times and wearing high-factor sunscreen as well as hats, sunglasses and clothing which covers sensitive areas more prone to sun damage.

“Please contact your GP if you’re concerned about any unusual changes to your skin.”

Stroke Association warns number of untreated strokes likely to rise due to rise in Omicron cases

The UK’s largest stroke charity is warning people not to delay seeking treatment for stroke due to fear of Omicron

The Stroke Association is concerned that public fear of increasing COVID-19 rates, due to the Omicron variant, is likely to see a similar drop in stroke admissions seen in Scotland at the start of the pandemic. 

During the first wave of the pandemic there was a significant decrease in admissions to stroke wards, when the COVID-19 infection rate rose rapidly. The Stroke Association’s Recoveries at Risk report found this was due to patient worries over catching COVID-19 or being a burden on the NHS. Nearly a third (32%) of people who survived a stroke between March and June 2020 said they delayed seeking medical attention due to COVID-19.

This year, with the added impact of reported ambulance delays, this is likely to intensify feelings of being a burden on the NHS, causing people to delay seeking medical treatment.

To add to this potential crisis, new data shows that this year, more people are living with unmanaged hypertension (high blood pressure) and other major stroke risk factors due to fewer regular in-person appointments where cardiovascular conditions (like high blood pressure) are spotted.

Hypertension is the biggest risk factor for stroke, contributing to 55.4% of stroke cases. This means that the stroke rate could rise this Christmas as more people live with unmanaged hypertension than in previous years.

In Scotland there are almost 10,000 strokes a year and 128,000 stroke survivors. A stroke is a medical emergency which is caused by a blockage or bleed in the brain cutting off blood supply. Stroke is fatal in over one in seven (15 %) patients.

The main treatments for stroke, thrombolysis and thrombectomy, must be delivered as soon as possible within four and a half hours of symptoms starting, which is why is it vital to call 999 as soon as any sign of stroke appears. Stroke is the UK’s fourth biggest killer and the leading cause of adult disability.

Key stats:

  • Of those who delayed seeking emergency medical attention, 42% hadn’t wanted to burden emergency services
  • And 34% of those who delayed seeking emergency medical attention were afraid of catching COVID-19 in hospital.

John Watson, Associate Director Scotland of the Stroke Association said: “When COVID cases rise as quickly as they are doing now, that sets off alarm bells at our charity and everyone involved in the treatment of stroke. More Omicron cases is likely to mean more preventable deaths and disability due to stroke, as people delay seeking emergency medical attention.

“We know that people get scared to go to hospital when cases rise but stroke is a life-threatening condition. Fear of catching COVID and feeling like a burden on the NHS stopped people calling 999 in the past. This is likely to be even worse this Christmas due to the news about ambulance delays. Stroke is an emergency medical condition and should be treated as an emergency from the moment you ring 999.

“You have to remember that stroke is a brain attack and when you see any of the FAST signs of stroke in someone, this means that their brain is dying. You must raise the alarm; you must call 999 immediately.

“After nearly two years in the pandemic we know that many people haven’t had their high blood pressure diagnosed because there haven’t been as many regular, in-person appointments with medical professionals such as GPs. That means more people are living with undetected high blood pressure and are at high risk of stroke. As a result, we could see even more people having a stroke this Christmas than in previous years.”

John continues: “Stroke clinicians and nurses as well as paramedics and therapists have worked tirelessly throughout the pandemic to maintain stroke services. Everyone at our charity is thankful for their hard work and support.”

Signs of stroke (FAST test)

Face – Can the person smile? Has their face fallen on one side?
Arms – Can the person raise both arms and keep them there?
Speech problems – Can the person speak clearly and understand what you say? Is their speech slurred?
Time – If you see any single one of these signs, it’s time to call 999

MHRA approves Xevudy (sotrovimab), a COVID-19 treatment found to cut deaths and hospitalisation by 79%

This monoclonal antibody – the second to be authorised by the Medicines and Healthcare products Regulatory Agency – is for people with mild to moderate COVID-19 who are at high risk of developing severe disease.

Another COVID-19 treatment, Xevudy (sotrovimab), has today been approved by the Medicines and Healthcare products Regulatory Agency (MHRA) after it was found to be safe and effective at reducing the risk of hospitalisation and death in people with mild to moderate COVID-19 infection who are at an increased risk of developing severe disease.

This follows a rigorous review of its safety, quality and effectiveness by the UK regulator and the government’s independent expert scientific advisory body, the Commission on Human Medicines, making it the second monoclonal antibody therapeutic to be approved following Ronapreve.

Developed by GSK and Vir Biotechnology, sotrovimab is a single monoclonal antibody. The drug works by binding to the spike protein on the outside of the COVID-19 virus. This in turn prevents the virus from attaching to and entering human cells, so that it cannot replicate in the body.

In a clinical trial, a single dose of the monoclonal antibody was found to reduce the risk of hospitalisation and death by 79% in high-risk adults with symptomatic COVID-19 infection.

Based on the clinical trial data, sotrovimab is most effective when taken during the early stages of infection and so the MHRA recommends its use as soon as possible and within five days of symptom onset.

Like molnupiravir, it has been authorised for use in people who have mild to moderate COVID-19 infection and at least one risk factor for developing severe illness. Such risk factors include obesity, older age (>60 years), diabetes mellitus, or heart disease.

Unlike molnupiravir, sotrovimab is administered by intravenous infusion over 30 minutes. It is approved for individuals aged 12 and above who weigh more than 40kg.

It is too early to know whether the omicron variant has any impact on sotrovimab’s effectiveness but the MHRA will work with the company to establish this.

Dr June Raine, MHRA Chief Executive said: “I am pleased to say that we now have another safe and effective COVID-19 treatment, Xevudy (sotrovimab), for those at risk of developing severe illness.

“This is yet another therapeutic that has been shown to be effective at protecting those most vulnerable to COVID-19, and signals another significant step forward in our fight against this devastating disease.

“With no compromises on quality, safety and effectiveness, the public can trust that the MHRA have conducted a robust and thorough assessment of all the available data.”

Professor Sir Munir Pirmohamed, Chair of the Commission on Human Medicines, said: “The Commission on Human Medicines and its COVID-19 Therapeutics Expert Working Group has independently reviewed the data and agrees with the MHRA’s regulatory approval of Xevudy (sotrovimab).

“When administered in the early stages of infection, sotrovimab was found to be effective at reducing the risk of hospitalisation and death in high-risk individuals with symptomatic COVID-19. Based on the data reviewed by the Commission and its expert group, it is clear sotrovimab is another safe and effective treatment to help us in our fight against COVID-19.”

Sotrovimab is not intended to be used as a substitute for vaccination against COVID-19.

The government and the NHS will confirm how this COVID-19 treatment will be deployed to patients in due course.

New £6.2m Renal Dialysis Unit opens at the Western General

A new £6.2 million Renal Dialysis Unit has opened in Edinburgh serving patients from the north and west of the city. Located at the Western General Hospital, the state-of-the art facility is designed to meet projected rising demand for dialysis services, while being more comfortable and welcoming for patients.  

It will ensure patients who need kidney dialysis have access to the latest equipment in modern, bright and spacious surroundings.  

The new building replaces a smaller unit, which was over 30 years old, and very cramped. It has increased the number of dialysis stations from 9 to 12. Now up to 72 patients can be treated in the unit.  

Dialysis involves filtering waste products and excess fluid from a patient’s blood when their kidneys stop working properly. The most common form of dialysis, haemodialysis, takes on average four hours per session and is typically carried out three times a week.  

Dr Caroline Whitworth, Consultant Nephrologist explains: “Patients can expect to spend between 12 and 18 hours per week on dialysis so having a welcoming, peaceful and comfortable place to do dialysis is really important. 

“We’re already seeing the positive impact this fantastic new facility is having on patients and staff.  The clinical areas is as light and airy as possible, but also more peaceful, giving patients a much better experience. The unit will be a great benefit for patients for years to come.” 

Bill Aitken, a renal patient, started experiencing symptoms of kidney failure in his early 30s. An avid football player he first noticed that something was wrong when his fitness started to deteriorate. He has been a patient with NHS Lothian for over 25 years. He says:  “I’ve been in and out of treatment at both the Royal and the Western General.  This feels light years away from the previous unit.

“It’s very nice and bright and has cracking views out the window to Edinburgh Castle and the Old Town. When we’re dialysing, we’re there for a long time so it makes a huge difference to be doing it in modern, pleasant surroundings.” 

The Renal Dialysis Unit is one of several new projects at the Western General Hospital to transform services and create more space, comfort and privacy for patients. It was funded by NHS Lothian Capital Investment, constructed by Robertson Construction on behalf of RMF Health, and designed by HLM Architects. 

David Cairns, regional managing director, Robertson Construction Central East, said: “The new renal unit is one of several projects we have delivered at the Western General Hospital, on behalf of RMF Health, over the last 2 years whilst the hospital has remained a live environment.  We’re also progressing a number of other projects with RMF Health which will provide first class facilities for the hospital.”   

The capital development team worked closely with NHS Lothian’s official charity, Edinburgh & Lothians Health Foundation, to integrate creative enhancements of the environment into the design, helping to ensure that the unit was not only clinically functional but also aesthetically pleasing.  

Jane Ferguson, Director of Edinburgh & Lothians Health Foundation, explains: “The involvement of our Arts in Health and Wellbeing team from the start of this project really demonstrates the importance that NHS Lothian has placed on art and design as an essential part of their capital projects.

“They recognise how much of an impact the environment and surroundings can have on patient and staff wellbeing. We were delighted to work together to take forward creative and innovative ways to enhance the space, and I think the end result is a welcoming, restful environment which creates privacy, distraction and diversion while patients receive treatment.” 

Liver disease diagnosis in Scotland ‘is a postcode lottery’

New research published today in a leading GP journal shows that large parts of Scotland do not have an effective way of identifying people with liver disease, resulting in late diagnosis.

The research, produced from a survey undertaken by the British Liver Trust, used a Freedom of Information request, and shows for the first time how many areas across the country have little or no formal structures in place for detecting and managing liver disease and liver cancer.

The mapped survey results (see below) also show huge swathes of the UK (marked in red) do not have any effective patient pathway in place. This is in sharp contrast to other chronic conditions such as diabetes and heart disease, where patients receive standardised care.

Figure 1 Areas in red have no pathway in place. Amber denotes areas with a partial pathway or pathway in development. Green areas have a full pathway in place. Areas in black did not respond.

Three quarters of people in the UK are currently diagnosed when it is too late for effective intervention or treatment and one in four people diagnosed late in hospital sadly die within a couple of months.

The charity is now calling for earlier detection of liver disease and better patient care across all regions of the UK to be prioritized, and is working to influence healthcare commissioners.

Dr Helen Jarvis, Clinical Advisor for the British Liver Trust and lead author of the research, says: “Anyone who has liver disease, or is at risk of getting it, should get the medical care and advice they need no matter where in the country they live. 

“The publication of this new data shows that, unfortunately, in the UK this is not yet the case. There are pockets of good practice, but there are also many areas that do not have a consistent approach to testing for and diagnosing liver disease. It shouldn’t be a postcode lottery.

“GPs and other healthcare professionals in primary care are doing a fantastic job under a lot of pressure, but in many areas, they’re working within a system that doesn’t allow them to detect and treat liver disease effectively. 

“Unfortunately, many GPs also report a lack confidence and knowledge when it comes to managing the condition. Sadly, this means that in many cases, people with liver disease are diagnosed far too late when treatment options are limited. This had led to thousands of avoidable deaths.

“The liver is an incredibly resilient organ, but only up to a point. Symptoms of liver disease often only appear once damage has progressed and the liver is starting to fail. However, 90% of liver disease is preventable and, in many cases, it’s reversable if caught in time. That’s why early detection and prevention are key.”

Pamela Healy OBE, Chief Executive of the British Liver Trust, said: “Shockingly, deaths due to liver disease have more than doubled in the last 20 years and the condition is expected to overtake heart disease as the biggest cause of premature death in the UK in the next few years.

“Obesity, alcohol and viral hepatitis are the three main risk factors for preventable liver disease.

“We need to take urgent action to stop this silent killer in its tracks. Although the results of our research are very concerning, we do know that there are areas of good practice and that the changes we’re calling for are entirely possible and will save many lives. 

“We now need to take what’s working well in those areas with good liver patient care and apply them in others so that every person with liver disease gets the best possible care, no matter where in the UK they live.”