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Slack R, Young C, Rushton L. Occupational cancer in Britain. Nasopharynx and sinonasal cancers. Br J Cancer 2012; 107 Suppl 1:S49-55. [PMID: 22710679 PMCID: PMC3384014 DOI: 10.1038/bjc.2012.118] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Bevan R, Young C, Holmes P, Fortunato L, Slack R, Rushton L. Occupational cancer in Britain. Gastrointestinal cancers: liver, oesophagus, pancreas and stomach. Br J Cancer 2012; 107 Suppl 1:S33-40. [PMID: 22710677 PMCID: PMC3384018 DOI: 10.1038/bjc.2012.116] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Gurka MK, Tse G, Unger KR, Haddad NG, Marshall J, Johnson C, Ley L, Slack R, Pishvaian MJ, Collins SP. Quality of life and acute radiation toxicity following hypofractionated stereotactic body radiation therapy with concurrent full-dose gemcitabine for unresectable pancreatic adenocarcinoma. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.4_suppl.336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
336 Background: Quality of life (QoL) is of paramount importance when cure is not obtainable. The aim of this study is to report QoL outcomes and acute radiation toxicity in patients with pancreatic cancer treated with stereotactic body radiation therapy (SBRT) and concurrent gemcitabine. Methods: This prospective study reviewed the charts of 10 patients with locally advanced, unresectable pancreatic cancer treated with SBRT and 6 cycles of gemcitabine. The primary tumor and adjacent para-aortic nodes received a total dose of 2500 cGy in 500 cGy fractions on consecutive days between cycles 1 and 2 of gemcitabine. QoL was assessed on the 1st day of each cycle using the EORTC QLQ-C30 and EORTC QLQ-PAN26 questionnaires. Wilcoxon rank sum test was used to determine statistical significance between QoL scores. Toxicity was graded by NCI Common Terminology Criteria for Adverse Events, Version 3.0. Results: The median age was 62.5 years. All patients completed the prescribed SBRT. Median overall survival was 13 months (range 5- 17). QoL scores at baseline compared to immediately after SBRT showed an increase in the following symptoms: fatigue, nausea/vomiting (N/V) and anorexia, which were statistically significant (P < 0.05). These were not statistically different from baseline by cycle 3 except N/V. No symptoms were significantly improved after radiation therapy; however, there was a trend towards improvement in back pain, night pain and abdominal discomfort. Functional scales declined after treatment, but not significantly. Global QoL did not significantly change from baseline. There were no grade 3 or 4 acute toxicities related to SBRT. Conclusions: Hypofractionated SBRT with concurrent gemcitabine is feasible for locally advanced, unresectable pancreatic cancer. There is a temporary increase in selected symptoms due to radiation which resolve within one month. This may be an improvement compared to conventional fractionated radiation due to shorter duration of symptoms related to radiation treatment.
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Pishvaian M, Slack R, Charabaty A, Ley L, Berzcel L, Nakles R, Jha R, Jackson P, Haddad N, Collins S. Stereotactic Body Radiation Therapy (SBRT) with Concurrent Full-Dose Gemcitabine for Locally Advanced Pancreatic Cancer: A Pilot Trial Demonstrating Safety. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.1814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Rushton L, Hutchins S, Bagga S, Bevan R, Brown T, Cherrie J, Holmes P, Fortunato L, Slack R, Van Tongeren M, Young C. O2-5.5 Estimation of the burden of occupational cancer in Great Britain. J Epidemiol Community Health 2011. [DOI: 10.1136/jech.2011.142976a.74] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sexton M, Baker J, Perkins R, Nakagawa K, Jucha B, Baker D, Slack R, Arora S, Plankey M. O3-S3.04 Self-administered Neisseria gonorrheae and Chlamydia trachomatis testing in the pharynx and rectum among men who have sex with men in Washington, DC. Sex Transm Infect 2011. [DOI: 10.1136/sextrans-2011-050109.118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Lee B, Slack R, Hwang JJ, Steadman K, Harter W, Davidson BJ, Newkirk KA, Shields PG, Goldman R, Deeken JF. Association of pharmacogenetic variations in ABCG2 with cisplatin toxicity in patients with head and neck squamous cell carcinoma. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.5586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Pishvaian MJ, Slack R, Witkiewicz A, He AR, Hwang JJ, Hankin A, Dorsch-Vogel K, Kuda D, McAndrew T, Weiner LM, Marshall J, Brody JR. A phase II study of the PARP inhibitor ABT-888 plus temozolomide in patients with heavily pretreated, metastatic colorectal cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3502] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Pishvaian MJ, Slack R, Witkiewicz A, He AR, Hwang JJ, Hankin A, Ley L, Apte SK, Littman SJ, Weiner LM, Marshall J, Brody JR. A phase I/II study of the PARP inhibitor, ABT-888 plus 5-fluorouracil and oxaliplatin (modified FOLFOX-6) in patients with metastatic pancreatic cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.tps170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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He AR, Hwang JJ, Marshall J, Pishvaian M, Slack R, Weiner LM, Wellstein A. A phase II study of lapatinib and capecitabine in second line treatment of locally advanced/metastatic pancreatic cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e14542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Paulden M, Rodgers M, Griffin S, Slack R, Duffy S, Ingram JR, Woolacott N, Sculpher M. Alitretinoin for the treatment of severe chronic hand eczema. HEALTH TECHNOLOGY ASSESSMENT (WINCHESTER, ENGLAND) 2011; 14 Suppl 1:39-46. [PMID: 20507802 DOI: 10.3310/hta14suppl1/06] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This paper presents a summary of the evidence review group (ERG) report into the clinical effectiveness and cost-effectiveness of alitretinoin for the treatment of adults with severe chronic hand eczema refractory to topical steroid treatment in accordance with the licensed indication, based upon the evidence submission from Basilea Pharmaceuticals Ltd to the National Institute for Health and Clinical Excellence (NICE) as part of the single technology appraisal process. The clinical evidence came from a single placebo-controlled randomised controlled trial of daily treatment with alitretinoin for 12-24 weeks, with follow-up for a further 24 weeks, in patients with severe chronic hand eczema (CHE) unresponsive to topical steroids. A statistically significantly greater proportion of patients using alitretinoin achieved the primary end point of clear or almost clear hands by week 24 than did those with placebo. Dose-dependent headache was the most commonly reported adverse event in patients treated with alitretinoin. Serious adverse events were rare, but alitretinoin was associated with increases in both total cholesterol and triglycerides, which has implications for risks of future cardiovascular events. The manufacturer submitted a de novo decision analytic model to estimate, over a time horizon of 3 years, the cost-effectiveness of alitretinoin versus the other relevant comparators identified by NICE. In response to the points of clarification put to it by the ERG regarding the initial submission, the manufacturer provided additional evidence and a revised decision analytic model with a 'placebo' arm. In the manufacturer's original submission to NICE, the base-case incremental cost-effectiveness ratios (ICERs) reported for alitretinoin were 8614 pounds per quality-adjusted life-year (QALY) versus ciclosporin, -469 pounds per QALY versus psoralen + UVA (with alitretinoin dominant) and 10,612 pounds per QALY versus azathioprine. These ICERs decreased as the time horizon was extended in sensitivity analyses. In patients with hyperkeratotic CHE and in women of child-bearing potential, the ICER remained below 20,000. pounds When the health-related quality of life (HRQoL) values used in the model were replaced with those derived from an alternative study, these ICERs increased significantly (to 22,312 pounds per QALY for alitretinoin versus azathioprine). In the revised model, alitretinoin was reported to have an ICER of 12,931 pounds per QALY gained versus supportive care (placebo). However, the model underestimates the costs of treatment associated with alitretinoin. The manufacturer assumed that patients receiving alitretinoin visited the dermatologist every 4 weeks and ceased treatment as soon as they responded to it. If, in practice, patients would receive treatment for longer than this, then the manufacturer's model will have significantly underestimated the costs to the NHS. Additional analyses undertaken by the ERG produced ICERs close to 30,000 pounds per QALY gained for alitretinoin versus supportive care. This was largely due to uncertainty surrounding the impact of alitretinoin on HRQoL. The placebo-controlled trials conducted to date have established that alitretinoin can be efficacious for the treatment of severe CHE refractory to topical steroids, but longer term follow-up of trials or the implementation of registries is required to better establish the longer term efficacy or safety of alitretinoin. NICE recommended the use of alitretinoin for patients with severe CHE and a Dermatology Life Quality Index (DLQI) score of at least 15. Treatment was recommended to be stopped as soon as an adequate response was observed, or if CHE remained severe at 12 weeks, or if response was inadequate at 24 weeks.
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Unger K, Howard M, Slack R, Hartmann D, Newirk K, Davidson B, Berkowitz F, Steadman K, Deeken J, Harter K. HPV-positive Status Predicts for Improved Outcomes in Head and Neck Squamous Cell Carcinoma after Concurrent Cetuximab and Radiation Therapy. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Howard M, Slack R, Hartmann DP, Harter WA, Newkirk KA, Davidson BJ, Berkowitz F, Steadman K, Lockard D, Deeken JF. Improved outcomes in HPV+ versus HPV- locally advanced head and neck squamous cell carcinoma (LAH&NSCC) when treated with cetuximab and concurrent radiation. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e16023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Paulden M, Rodgers M, Griffin S, Slack R, Duffy S, Ingram JR, Woolacott N, Sculpher M. Alitretinoin for the treatment of severe chronic hand eczema. Health Technol Assess 2010. [DOI: 10.3310/hta14suppl1-06] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This paper presents a summary of the evidence review group (ERG) report into the clinical effectiveness and cost-effectiveness of alitretinoin for the treatment of adults with severe chronic hand eczema refractory to topical steroid treatment in accordance with the licensed indication, based upon the evidence submission from Basilea Pharmaceuticals Ltd to the National Institute for Health and Clinical Excellence (NICE) as part of the single technology appraisal process. The clinical evidence came from a single placebo-controlled randomised controlled trial of daily treatment with alitretinoin for 12–24 weeks, with follow-up for a further 24 weeks, in patients with severe chronic hand eczema (CHE) unresponsive to topical steroids. A statistically significantly greater proportion of patients using alitretinoin achieved the primary end point of clear or almost clear hands by week 24 than did those with placebo. Dose-dependent headache was the most commonly reported adverse event in patients treated with alitretinoin. Serious adverse events were rare, but alitretinoin was associated with increases in both total cholesterol and triglycerides, which has implications for risks of future cardiovascular events. The manufacturer submitted a de novo decision analytic model to estimate, over a time horizon of 3 years, the cost-effectiveness of alitretinoin versus the other relevant comparators identified by NICE. In response to the points of clarification put to it by the ERG regarding the initial submission, the manufacturer provided additional evidence and a revised decision analytic model with a ‘placebo’ arm. In the manufacturer’s original submission to NICE, the base-case incremental cost-effectiveness ratios (ICERs) reported for alitretinoin were £8614 per quality-adjusted life-year (QALY) versus ciclosporin, –£469 per QALY versus psoralen + UVA (with alitretinoin dominant) and £10,612 per QALY versus azathioprine. These ICERs decreased as the time horizon was extended in sensitivity analyses. In patients with hyperkeratotic CHE and in women of child-bearing potential, the ICER remained below £20,000. When the health-related quality of life (HRQoL) values used in the model were replaced with those derived from an alternative study, these ICERs increased significantly (to £22,312 per QALY for alitretinoin versus azathioprine). In the revised model, alitretinoin was reported to have an ICER of £12,931 per QALY gained versus supportive care (placebo). However, the model underestimates the costs of treatment associated with alitretinoin. The manufacturer assumed that patients receiving alitretinoin visited the dermatologist every 4 weeks and ceased treatment as soon as they responded to it. If, in practice, patients would receive treatment for longer than this, then the manufacturer’s model will have significantly underestimated the costs to the NHS. Additional analyses undertaken by the ERG produced ICERs close to £30,000 per QALY gained for alitretinoin versus supportive care. This was largely due to uncertainty surrounding the impact of alitretinoin on HRQoL. The placebo-controlled trials conducted to date have established that alitretinoin can be efficacious for the treatment of severe CHE refractory to topical steroids, but longer term follow-up of trials or the implementation of registries is required to better establish the longer term efficacy or safety of alitretinoin. NICE recommended the use of alitretinoin for patients with severe CHE and a Dermatology Life Quality Index (DLQI) score of at least 15. Treatment was recommended to be stopped as soon as an adequate response was observed, or if CHE remained severe at 12 weeks, or if response was inadequate at 24 weeks.
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Steadman K, Robey R, Creswell K, Slack R, Deeken J. Abstract 3320: Head & neck cancer stem cells express drug resistance transporters but do not display a resistant phenotype. Cancer Res 2010. [DOI: 10.1158/1538-7445.am10-3320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The cancer stem cell (CSC) hypothesis holds that CSCs generate tumor daughter cells via asymmetric cell division, evade immune surveillance, and are resistant to anticancer treatment, and thus remain viable to regenerate a population of malignant clones after therapy. While CSCs’ inherent resistance to chemotherapy is a central tenet of the cancer stem cell hypothesis, little research has focused on this critical question.
Methods: Identification and separation of putative head and neck cancer squamous cell carcinoma (H&N SCC) CSCs was performed via flow cytometry of the SCC9 cell line using both Hoechst 33342 dye (‘side population’) and antibodies against CD44, CD2, CD3, CD10, CD16, CD18, CD31, CD64, and CD140b (‘CD44+/lineage-‘). Expression of genes characterizing a stem cell phenotype as well as drug transporters known to mediate chemotherapy drug resistance was measured via RT-PCR and compared between subpopulations. The SCC9 cell line was incubated with various chemotherapy agents in attempt to enrich the CSC subpopulation, including cisplatin, paclitaxel, ixabepilone, depsipeptide, methotrexate, SN38, and topotecan, followed by flow cytometric sorting. The resultant CSC subpopulation was compared between drug treated and untreated controls to determine whether the previous drug exposure enriched the CSC subpopulation.
Results: Use of Hoechst dye did not identify a ‘side population,’ likely due to low expression of the ABCG2 transporter in H&N CSCs. Using CD44+/lineage- markers, a CSC subpopulation representing 8.5% on average of total cells was identified. Variant expression of stem cell genes in this subpopulation included ACTC1, BMP3, CCND2, COL9A1, DLL3, FGF3, GDF2, GDF3, PDX1, KRT15, SOX1, TERT, and WNT1. Significant expression of drug transporters in the CSC subpopulation included ABCA3, SLC16A2, SLC16A3, SLC22A1, SLC28A2, SLC2A1, SLC25A13, and SLCO1B3. ABCB1 expression was increased in the CSC subpopulation but still showed relatively low RNA expression. There was no difference in expression of ABCC1 and ABCG2. Incubation with cytotoxic agents at various concentrations (IC25 to IC75) for 24 to 96 hours showed no clear pattern of enriching or depletion of the CSC subpopulation.
Conclusion: CD44+/lineage- can identify a putative CSC subpopulation in H&NSCC which preferentially expresses stem cell pathway genes as well as drug transporters. This increased transporter expression does not, however, induce a drug resistance phenotype in this in vitro cell line model. Other in vitro and/or in vivo methodologies should be explored to better analyze and characterize treatment resistance of CSCs in order to further test the validity of the cancer stem cell hypothesis.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 3320.
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Ryanne Wu R, Lindenberg PA, Slack R, Noone AM, Marshall JL, He AR. Evaluation of hypertension as a marker of bevacizumab efficacy. J Gastrointest Cancer 2010; 40:101-8. [PMID: 19921473 DOI: 10.1007/s12029-009-9104-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Predictive factors for efficacy of vascular endothelial growth factor pathway-targeted therapies have not been identified or confirmed. Hypertension has been observed as a side effect to anti-vascular endothelial growth factor therapy. The goal of our study was to retrospectively assess if hypertension induced during treatment with bevacizumab was associated with clinical outcome in metastatic colorectal cancer patients treated with bevacizumab. PATIENTS AND METHODS We conducted a retrospective chart review of patients with colorectal cancer treated with bevacizumab at Lombardi Comprehensive Cancer Center from 2004 to 2008. RESULTS Eighty-four patients with metastatic colorectal cancer were eligible. Eighteen patients (21%) developed grades 3 hypertension. Twelve patients (14%) developed grade 2 hypertension. Six patients (7%) developed grade 1 hypertension. Median overall survival (OS) was 29 months and progression-free survival (PFS) was 10 months. Patients with any grade hypertension while on bevacizumab had an adjusted hazard ratio for death of 0.32 (p = 0.03) and adjusted risk of progression of 51% (p = 0.02) compared to those without hypertension (HTN). When stratified by metastatic disease, patients presenting with metastases who developed HTN had better OS and PFS (p = 0.03 and 0.01.) Among patients without metastases at diagnosis, those with HTN on bevacizumab had better OS and PFS but results were not statistically significant (p = 0.60 and 0.62, respectively). CONCLUSIONS Our data indicate that bevacizumab-induced hypertension may represent an interesting prognostic factor for clinical outcome in advanced colorectal cancer patients receiving bevacizumab.
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Shroufi A, Copping J, Musonda P, Vivancos R, Langden V, Armstrong S, Slack R. Influenza vaccine uptake among staff in care homes in Nottinghamshire: a random cluster sample survey. Public Health 2009; 123:645-9. [PMID: 19875140 DOI: 10.1016/j.puhe.2009.09.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Revised: 07/13/2009] [Accepted: 09/22/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To establish uptake of influenza vaccine amongst care home clinical staff in Greater Nottingham, and to investigate what could be done to improve vaccine uptake in this group. STUDY DESIGN Postal questionnaire surveys were used. In the first instance, a total sample survey was used. In the second instance, a sample of care home staff was surveyed, randomized at the care home level. METHODS A postal questionnaire completed by care home matrons was used to obtain a preliminary estimate of staff vaccine uptake. Individual staff questionnaires were then used to validate this finding, and measure attitudes, beliefs and behaviours associated with vaccination. RESULTS Vaccine uptake among those working in care homes with nursing was found to be low. Vaccine uptake was higher in homes with a policy recommending vaccination of staff. Most respondents who had received vaccination reported that they had done so because of an existing medical condition, rather than because of being a healthcare worker. A statistically significant relationship (P=0.02) was found between individuals' reported beliefs on how well they could resist influenza and their vaccination status. CONCLUSIONS All care homes for the elderly should have a vaccination policy which recommends staff vaccination. Educational campaigns, vaccination in the workplace and free provision of the influenza vaccine may help to improve vaccine uptake in this group.
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Gillett S, Hopkins C, Slack R, Browne J. A pilot study of the SNOT 22 score in adults with no sinonasal disease. Clin Otolaryngol 2009; 34:467-9. [DOI: 10.1111/j.1749-4486.2009.01975.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hopkins C, Gillett S, Slack R, Lund VJ, Browne JP. Psychometric validity of the 22-item Sinonasal Outcome Test. Clin Otolaryngol 2009; 34:447-54. [PMID: 19793277 DOI: 10.1111/j.1749-4486.2009.01995.x] [Citation(s) in RCA: 987] [Impact Index Per Article: 65.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Baker J, Plankey M, Josayma Y, Elion R, Chiliade P, Shahkolahi A, Menna M, Miniter K, Slack R, Yang Y, Masterman B, Margolick JB. The prevalence of rectal, urethral, and pharyngeal Neisseria gonorrheae and Chlamydia trachomatis among asymptomatic men who have sex with men in a prospective cohort in Washington, D.C. AIDS Patient Care STDS 2009; 23:585-8. [PMID: 19591608 DOI: 10.1089/apc.2008.0277] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sun JF, Wu RR, Norris C, Noone AM, Amankwa-Sakyi M, Slack R, Marshall JL. Safety of chronic low-dose capecitabine as maintenance therapy in gastrointestinal cancers. GASTROINTESTINAL CANCER RESEARCH : GCR 2009; 3:134-140. [PMID: 19742139 PMCID: PMC2739638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Accepted: 06/11/2009] [Indexed: 05/28/2023]
Abstract
BACKGROUND Maintenance chemotherapy is not routinely used in gastrointestinal (GI) cancers. Capecitabine is an oral formulation that is enzymatically converted to 5-fluorouracil preferentially in tumor tissue. We hypothesize that capecitabine could be used as a long-term maintenance therapy to improve outcomes in patients with high-risk GI cancers following standard chemotherapy regimens. METHODS We conducted a retrospective study to assess the toxicity of maintenance capecitabine in 28 patients with a variety of advanced GI malignancies. Capecitabine 1,000 mg twice daily without interruption was used for the first 11 patients. The dose was reduced to 1,000 mg twice daily 5 days per week in 8 patients who developed hand-foot syndrome. The remaining patients began treatment on the same abbreviated schedule. All documented clinical adverse events were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (v3.0, 2003). RESULTS Main toxicities were grade 1/2 fatigue and hand-foot syndrome. Only one grade 3 toxicity was observed and no grade 4 toxicities were seen. We also observed a significant increase in red blood cell mean corpuscular volume in participants, which may have potential use as a biomarker to monitor therapeutic response. CONCLUSIONS Fixed therapeutic doses of oral capecitabine 1,000 mg twice daily, 5 days on, 2 days off, can be administered chronically with a high level of safety and should be explored in larger prospective studies to demonstrate efficacy in GI malignancies, especially pancreatic and metastatic colorectal cancers.
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Loprinzi CL, Sloan J, Stearns V, Slack R, Iyengar M, Diekmann B, Kimmick G, Lovato J, Gordon P, Pandya K, Guttuso T, Barton D, Novotny P. Newer antidepressants and gabapentin for hot flashes: an individual patient pooled analysis. J Clin Oncol 2009; 27:2831-7. [PMID: 19332723 PMCID: PMC2698018 DOI: 10.1200/jco.2008.19.6253] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Accepted: 12/19/2008] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Nonhormonal treatment options have been investigated as treatments for hot flashes, a major clinical problem in many women. Starting in 2000, a series of 10 individual double-blind placebo-controlled studies has evaluated newer antidepressants and gabapentin for treating hot flashes. This current project was developed to conduct an individual patient pooled analysis of the data from these published clinical trials. PATIENTS AND METHODS Individual patient data were collected from the various study investigators who published their study results between 2000 and 2007. Between-study heterogeneity for study characteristics and patient populations was tested via chi2 tests before a pooled analysis. The primary end point, the change in hot flash activity from baseline to week 4, for each agent was calculated via both weighted and unweighted approaches, using the size of the study as the weight. Basic summary statistics were produced for hot flash score and frequency using the following three statistics: raw change, percent reduction, and whether or not a 50% reduction was achieved. RESULTS This study included seven trials of newer antidepressants and three trials of gabapentin. The optimal doses (defined by individual study results) of the newer antidepressants paroxetine, venlafaxine, fluoxetine, and sertraline decreased hot flash scores by 41%, 33%, 13%, and 3% to 18% compared with the corresponding placebo arms, respectively. The three gabapentin trials decreased hot flashes by 35% to 38% compared with the corresponding placebo arms. CONCLUSION Some newer antidepressants and gabapentin, within 4 weeks of therapy initiation, decrease hot flashes more than placebo.
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Slack R, O'Grady F. Malcolm John Lewis. West J Med 2009. [DOI: 10.1136/bmj.b1676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cruden N, Harding S, Flapan A, Graham C, Wild S, Slack R, Pell J, Newby D. Cardiovascular outcomes in patients with drug eluting coronary stents undergoing non-cardiac surgery. Heart Lung Circ 2009. [DOI: 10.1016/j.hlc.2009.05.503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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