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Elderly at risk of hospitalisation due to depression

28 December 2016

Elderly at risk of hospitalisation due to depression

The Oral Health Foundation is calling for greater emotional support of elderly mouth cancer patients following a new study which has shown that they are at a significantly high risk of being admitted to hospital due to depression. 

The research, published in Gerodontology, found that men over the age of fifty who were suffering from mouth cancer were 56% more likely to be admitted to hospital with depression1.

Leading charity, the Oral Health Foundation, believe many of these emotional issues come as a result of the significant problems mouth cancer patients face due to the nature of their treatment, which often affects the ability to communicate, eat, drink and even breath.

The charity is appealing to the family, friends and carers of mouth cancer sufferers to be vigilant as to their emotional state and to try and offer them the support they need to help them avoid any psychological problems which could affect the outcome of their treatment.

Speaking on the issue Dr Nigel Carter OBE, CEO of the Oral Health Foundation, said: "This research is extremely concerning when you consider that most people who are diagnosed with mouth cancer are men over the age of 50. We must be alert to this issue and offer comprehensive emotional support, even before they are diagnosed.

"A patient's emotional state has such a huge impact on the potential outcome of their illness. Research shows that many mouth cancer patients who are suffering from depression are less likely to participate in important treatment decisions and to seek the medical and emotional support needed to achieve a positive outcome in their illness."

When looking at data covering all ages, the research found that all male head and neck cancer (HNC) patients were 28% more likely to be admitted to hospital with depression while for women the problem was even larger, with a 31% increase in likelihood of hospital admission.

"The very nature of mouth cancer treatment is undoubtedly a major issue here," added Dr Carter. "It can deprive sufferers of many of the basic things which we often take for granted, simple things like the ability to say hello or have a conversation, or feed themselves, or even breath have such a huge impact that it is unsurprising that many patients are at risk of depression.

"We have to all be alert to this problem. I am urging patients to reach out to their friends, family and carers if they feel they need of any support and also to get into contact with cancer support groups, such as The Swallows or Macmillan, who can help them come to terms with elements of their illness."

Latest statistics from Cancer Research UK revealed head and cancers have increased by 68% over the last 20 years. Now diagnosed in 11,449 Brits a year, it is now one of very few cancers which is continuing to see a rise in the number of cases.

Hip pain may be 'hangover from evolution'

Scientists at the University of Oxford say a hangover from evolution could help explain why humans get so much shoulder, hip and knee pain.

And if current trends continue they predict the humans of the future could be at even greater risk.

They studied 300 specimens from different species spanning 400 million years to see how bones changed subtly over millennia.

The changes came as man began standing up straight on two legs.

Other researchers have noticed similar evolutionary quirks in humans. Some people prone to lower back problems, for example, could have spines closer in shape to those of our nearest ape relative - the chimpanzee.

Dr Paul Monk, who led the research at the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, was interested to explore why patients in his clinic came in with similar orthopaedic problems.

"We see certain things very commonly in hospital clinics - pain in the shoulder with reaching overhead, pain in the front of the knee, arthritis of the hip, and in younger people we see some joints that have a tendency to pop out.

"We wondered how on earth we have ended up with this bizarre arrangement of bones and joints that allows people to have these problems.

"And it struck us that the way to answer that is to look backwards through evolution."

The team took detailed CT scans of 300 ancient specimens housed at the Natural History Museum in London, in Oxford, and the Smithsonian Institution in Washington.

Bringing the data together, they were able to create a library of 3D models, and spot changes to the shapes of single bones over millions of years.

As species evolved from moving around on four legs to standing up on two, for example, researchers say the so-called neck of the thigh bone grew broader to support the extra weight.

And studies show that the thicker the neck of the thigh bone, the more likely it is that arthritis will develop.

Scientists say this is one potential reason why humans are susceptible to so much hip pain.

The team then used their data to hazard a guess at the shape of human bones 4,000 years in the future - although they admit there are many uncertainties in future times that could not be accounted for.

Dr Monk said: "What is interesting is if we try and move these trends forward, the shape that is coming has an even broader neck and we are trending to more and more arthritis."

In the shoulder, scientists found that a natural gap - which tendons and blood vessels normally pass through - got narrower over time.

The narrower space makes it more difficult for tendons to move and might help explain why some people experience pain when they reach overhead, say the scientists.

Using these predictions, the researchers suggest joint replacements of the future will have to be re-designed to accommodate the evolving shapes.

But they say it is not all bad news - the right physiotherapy and working on maintaining a good posture can help mitigate some of the downsides of our design.

Doctors confirm 200-year-old diagnosis

Doctors have confirmed a diagnosis made more than 200 years ago by one of medicine's most influential surgeons.

John Hunter had diagnosed a patient in 1786 with a "tumour as hard as bone".

Royal Marsden Hospital doctors analysed patient samples and case notes, which were preserved at the museum named after him - the Hunterian in London.

As well as confirming the diagnosis, the cancer team believe Mr Hunter's centuries-old samples may give clues as to how cancer is changing over time.

"It started out as a bit of fun exploration, but we were amazed by John Hunter's insight," Dr Christina Messiou told the BBC News website.

Mr Hunter became surgeon to King George III in 1776 and is one of the surgeons credited with moving the medical discipline from butchery to a science.

He's also rumoured to have given himself gonorrhoea as an experiment while writing a book about venereal diseases.

His huge medical collection is now housed at the Hunterian Museum at the Royal College of Surgeons.

It includes his colourful notes describing a man who arrived at St George's Hospital, in 1786, with a hard swelling on his lower thigh.

"It appeared to be a thickening of the bone, it was increasing very rapidly... On examining the diseased part, it was found to consist of a substance surrounding the lower part of the thigh bone, of the tumour kind, which seemed to originate from the bone itself."

Mr Hunter amputated the man's leg and he recovered briefly for four weeks.

"From this time he began to lose flesh and sink gradually, his breathing more and more difficult," the notes continued.

The patient died seven weeks after the operation and an autopsy discovered bony tumours had spread to his lungs, the lining of the heart and on the ribs.

More than 200 years later, the samples fell under the gaze of Dr Christina Messiou.

She said: "Just looking at the specimens, the diagnosis of osteosarcoma came very quickly to me and John Hunter's write up was amazingly astute and fits with what we know about the behaviour of the disease.

"The large volumes of new bone formation and the appearance of the primary tumour are really characteristic of osteosarcoma."

She went to get a second opinion from her colleagues at the Royal Marsden in central London.

And in an out-of-hours session at the hospital they used modern day scanning technology to confirm the centuries old diagnosis.

Dr Messiou, whose speciality is sarcoma, told the BBC: "I think his diagnosis is really impressive and in fact his management of the patient followed similar principles to what we would have done in the modern day."

But she says the exciting stage of the research is still to come.

They are now going to compare more of Hunter's historical samples with contemporary tumours - both microscopically and genetically - to see if there are any differences.

Dr Messiou told the BBC: "It's a study of cancer evolution over 200 years and if we're honest we don't really know what we're going to find.

"But it would be interesting to see if we can link lifestyle risk factors with any differences that we see between historical and current cancers.

"So we've got big ambitions for the specimens."

Writing in the British Medical Journal, the Royal Marsden team apologised for delay in analysing the samples from 1786 and the obvious breach of cancer waiting times, but point out their hospital was not built until 1851.

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