What Do Cancer Patients Value? A Unique Experience at Maggie's Cancer Caring Centre in Hong Kong

Background: Maggie's Cancer Caring Centre in Hong Kong (“Maggie's HK”) adopted a person-centered approach advocated by Maggie Keswick Jencks, who was the founder and a cancer patient. Witnessing first-hand that many psychosocial needs of a cancer patient could not be met through the existing medical system, Maggie created a blueprint for a purposefully-designed architecture and the services complementary to the existing system. The centre aims to empower people affected by cancer, be they cancer patients or caregivers, to live with, live through and live beyond cancer via informational and psychological consultations, psychosocial support programs and a therapeutic environment. People in need are welcome to drop-in anytime to use the centre while all services/programs are free and no referral/appointment is needed. As this patient-oriented drop-in service, integrated multidisciplinary approach and the therapeutic architecture, as one of a kind would conceptually make people feel at home, feel respected, see themselves as a person rather than a patient, and gain confidence in facing and walking through the cancer journey, how does this translate into practice in Maggie's HK? Aim: To examine the uniqueness of Maggie's HK cancer care service, especially the patient-oriented drop-in service and the purposefully-designed environment, this study investigated cancer patients' related experience at Maggie's HK and its influences on their cancer adjustment and adaptive coping in the community. Methods: A qualitative study design was adopted. Thirteen semistructured focus group interviews, each with 5-6 cancer patients/care-givers at Maggie's HK, were held from August 2016 to January 2017. Each interview lasted from 1.5 to 2.5 hours and were audio recorded then transcribed verbatim. Different themes were generated through repeated readings and content analysis with constant comparison. Results: Three main themes regarding the unique experiences of the drop-in service model under a purposefully-designed environment at Maggie's HK were emerged from the focus groups: Creating a sense of home for the centre users. Users reported the centre is like their second home giving them a sense of autonomy, security, trust and comfort. Empowering users to deal with uncertainties. Users reported the (drop-in) service helps to reduce their fear, worries and doubts. Providing a nurturing context for users' needs. Users reported the design of the physical environment has catered to their specific needs at different moments in time. Conclusion: The study reveals that the innovative model of patient-oriented drop-in service under a therapeutic physical environment at Maggie's HK contributes significantly a positive experience and impact on cancer patients in the reduction of their fear and worries, while enhancing their role as active participants in their care. There is also a developed sense of autonomy, security and confidence in the cancer journey.

First Results from the DEAP-3600 Dark Matter Search with Argon at SNOLAB

This Letter reports the first results of a direct dark matter search with the DEAP-3600 single-phase liquid argon (LAr) detector. The experiment was performed 2 km underground at SNOLAB (Sudbury, Canada) utilizing a large target mass, with the LAr target contained in a spherical acrylic vessel of 3600 kg capacity. The LAr is viewed by an array of PMTs, which would register scintillation light produced by rare nuclear recoil signals induced by dark matter particle scattering. An analysis of 4.44 live days (fiducial exposure of 9.87 ton day) of data taken during the initial filling phase demonstrates the best electronic recoil rejection using pulse-shape discrimination in argon, with leakage <1.2×10^{-7} (90% C.L.) between 15 and 31  keV_{ee}. No candidate signal events are observed, which results in the leading limit on weakly interacting massive particle (WIMP)-nucleon spin-independent cross section on argon, <1.2×10^{-44}  cm^{2} for a 100  GeV/c^{2} WIMP mass (90% C.L.).

Paediatric pain management: knowledge, attitudes, barriers and facilitators among nurses - integrative review

AIMS

To identify and synthesize evidence regarding the knowledge and attitudes of nurses, and barriers and facilitators to effective pain assessment and management in infants and children.

BACKGROUND

Pain among children is a common experience. Relief from pain is a fundamental human right, yet hospitalized children continue to experience unrelieved pain. Provision of effective pain management is an integral part of the nurse's role.

METHODS

Guided by Whittemore & Knafl's five-stage framework, primary peer-reviewed studies published in English between 2000 and 2018 were searched using CINAHL, PubMed, ProQuest, PsycINFO and Scopus. The initial search yielded 292 papers. Twenty-seven papers were included in this review: quantitative (n = 18), qualitative (n = 5) and mixed-methods (n = 4).

RESULTS

Findings showed that nurses internationally have poor knowledge and attitudes of basic pain assessment and management principles. Barriers to effective pain management include the absence of pain education and assessment tools, parents' reluctance to report pain and insufficient prescription of analgesia by physicians. Facilitators for the effective management of pain include parental participation in care, trusting and respectful relationships between nurses and children, and adequate nurse-patient ratios.

CONCLUSION

The review findings suggest a need to improve education for nurses, doctors and the patients' family in relation to paediatric pain management, communication and interprofessional collaborations. There is a need to maximize facilitators and overcome barriers, such as those identified in this review, to ensure the quality of paediatric pain management.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Nursing and health policy should mandate the prioritization of paediatric pain management and the clinical roles and responsibilities of the interdisciplinary team members. Undergraduate, postgraduate and in-service education for nurses and other health professionals should also address paediatric pain management. In-service education on paediatric pain management should be compulsory for all health professionals caring for children.

Disease-free and overall survival at 3.5 years for neoadjuvant bevacizumab added to docetaxel followed by fluorouracil, epirubicin and cyclophosphamide, for women with HER2 negative early breast cancer: ARTemis Trial

Background

The ARTemis trial previously reported that addition of neoadjuvant bevacizumab (Bev) to docetaxel (D) followed by fluorouracil, epirubicin and cyclophosphamide (D-FEC) in HER2 negative breast cancer improved the pathological complete response (pCR) rate. We present disease-free survival (DFS) and overall survival (OS) with central pathology review.

Patients and methods

Patients were randomized to 3 cycles of D followed by 3 cycles of FEC (D-FEC), ±4 cycles of Bev (Bev + D-FEC). DFS and OS were analyzed by treatment and by central pathology reviewed pCR and Residual Cancer Burden (RCB) class.

Results

A total of 800 patients were randomized [median follow-up 3.5 years (IQR 3.2–4.4)]. DFS and OS were similar across treatment arms [DFS hazard ratio (HR)=1.18 (95% CI 0.89–1.57), P = 0.25; OS HR = 1.26 (95% CI 0.90–1.76), P = 0.19). Both local pathology report review and central histopathology review confirmed a significant improvement in DFS and OS for patients who achieved a pCR [DFS HR = 0.38 (95% CI 0.23–0.63), P < 0.001; OS HR = 0.43 (95% CI 0.24–0.75), P = 0.003]. However, significant heterogeneity was observed (P = 0.02); larger improvements in DFS were obtained with a pCR achieved with D-FEC than a pCR achieved with Bev + D-FEC. As RCB class increased, significantly worse DFS and OS was observed (P for trend <0.0001), which effect was most marked in the ER negative group.

Conclusions

The addition of short course neoadjuvant Bev to standard chemotherapy did not demonstrate a DFS or OS benefit. Achieving a pCR with D-FEC is associated with improved DFS and OS but not when pCR is achieved with Bev + D-FEC. At the present time therefore, Bev is not recommended in early breast cancer.

ClinicalTrials.gov number

NCT01093235.

Abstract P2-08-02: Novel tumor suppressor regulating the PI3K/AKT pathway in breast cancer

Breast cancer affects approximately 1 in 8 women over the course of their lifetime. Of the many genes and pathways deregulated by this heterogeneous disease, alterations of members in the PI3K/AKT pathway are present in approximately 20% of all cases, making it one of the more frequently mutated pathways in breast cancer. The PI3K/AKT pathway is well known to be involved in essential cellular processes necessary for cancer development and progression, including altered proliferation, metabolism, and cell survival. Previous studies have made it well known that the activation of AKT is regulated through its phosphorylation, but recent studies have also shown that AKT can also be regulated via ubiquitination, leading to AKT hyperactivation. However, the mechanism and players involved in this process are not well understood. Better understanding of these pathways could inform on better potential therapeutics to target this disease.

Recent work in our lab has identified GPS2, a member of the NCoR/SMRT complex, as a regulator of the insulin-signaling pathway through the inhibition of AKT ubiquitination by Ubc13. As many human cancers frequently have an increase in activated AKT, here we explore the potential of GPS2 as a tumor suppressor in the context of breast cancer and hope to elucidate the mechanism by which AKT ubiquitination regulates its activation.

Citation Format: Chan S, Cardamone MD, Perissi V. Novel tumor suppressor regulating the PI3K/AKT pathway in breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-08-02.

Phase II study of buparlisib (BKM120) and trastuzumab in patients with HER2+ locally advanced or metastatic breast cancer resistant to trastuzumab-based therapy

PURPOSE

A Phase Ib study in patients with trastuzumab-resistant, human epidermal growth factor receptor-2- (HER2)-positive advanced breast cancer defined the recommended Phase II dose of buparlisib as 100 mg/day in combination with 2 mg/kg weekly trastuzumab, and reported preliminary signs of clinical activity. Here we present results from the Phase II portion.

METHODS

Patients with trastuzumab-resistant, HER2-positive advanced breast cancer received buparlisib plus trastuzumab. Study endpoints included safety/tolerability and antitumour activity. The study was extended to include a Phase Ib dose-escalation phase, in which patients with progressive brain metastases also received capecitabine.

RESULTS

In the Phase II portion, of 50 patients treated with buparlisib and trastuzumab, the most common (≥ 30%) all-grade adverse events (AEs) were diarrhoea (54%), nausea (48%), decreased appetite, increased alanine aminotransferase (36% each), increased aspartate aminotransferase (34%), fatigue, rash (32% each), cough and hyperglycemia (30% each). One (2%) patient achieved complete response and four (8%) patients had confirmed partial responses [PR; including two patients with phosphatidylinositol 3-kinase (PI3 K) pathway-activated tumours]. Overall response rate (ORR) was 10%: the primary endpoint (ORR ≥ 25%) was therefore not met. In the Phase Ib portion, all patients with measurable brain lesions at baseline showed tumour shrinkage to some degree; due to low enrollment, maximum tolerated dose of buparlisib in combination with trastuzumab and capecitabine was not determined.

CONCLUSION

Buparlisib plus trastuzumab, as a chemotherapy-free regimen, demonstrated an acceptable safety profile but limited efficacy in patients with heavily pretreated, trastuzumab-resistant HER2-positive breast cancer, and in patients with progressive brain metastases also receiving capecitabine.