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This Week in the British Medical Journal: Apr 18, 2011


In the British Medical Journal this week, Nigel Hawkes says the number of deaths after surgery for bowel cancer in England is much higher than was previously thought. According to a new study, five English medical centers, or trusts, had rates of death within 30 days of surgery that were "significantly worse" than the average for England from 2003 to 2006. Three trusts had better than average death rates during that time. However, new data for 2007 and 2008 — not included in the study — shows that the poorly performing trusts got better, and the good performers got worse so that none were significantly different from the average, Hawkes says. "The picture is an improving one: mortality within 30 days of surgery was 6.8 percent in 1998 but 5.8 percent in 2006, with the bulk of the improvement coming in 2005 and 2006," he adds. "Although there is no equivalent nationwide study from elsewhere, 30 day death rates from population studies in Scandinavia, Canada, and the United States range from 2.7 percent to 5.7 percent."

Also in the British Medical Journal this week, researchers in the Netherlands present findings from a study examining the experiences and attitudes of health professionals toward the provision of chemotherapy to end-stage cancer patients. The researchers interviewed 14 physicians and 13 nurses who care for patients with metastatic cancer, and found that although both groups considered the patients' wellbeing as paramount, the doctors were more inclined to offer further chemotherapy, while the nurses were more likely to "express their doubts about further treatment." The use of chemotherapy at the end of life could be explained by patients' attitudes of not giving up, and clinicians' tendency to reinforce that attitude. "To rebalance the ratio of quantity of life to quality of life, input from other health professionals, notably nurses, may be necessary," the authors add.

Finally in the British Medical Journal this week, the University of Colorado's Ross Camidge reviews Siddhartha Mukherjee's book, The Emperor of All Maladies: A Biography of Cancer, calling it a "compelling story of man's checkered but unrelenting progress against the darkest of foes." The book is a look at the history of oncology, tracking the "interplay" between humanity and cancer, and the revelations and discoveries that have allowed humanity to keep fighting the disease, Camidge says. "The book is strongest and most gripping when it considers the science, art, and politics of cancer over the past 100 years," he adds. "The Emperor of All Maladies ... could help us all to take a step back, see the bigger picture, and keep both our medical and human fires alive."

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