Recruitment of patients into head and neck clinical trials: acceptability of studies to patients from perspective of the research team

We reviewed longitudinal recruitment data to assess recruitment into head and neck cancer trials, and to identify factors that could influence this and affect their acceptability to patients. We retrieved data from the prospective computerised database (2009-2016) to measure acceptability to patients using the recruitment:screening ratio, and compared observational with interventional studies, single specialty (or site) with multispecialty (or site) studies, and "step-up" randomisation with "non-inferiority" randomisation designs. A total of 1283 patients were screened and 583 recruited. The recruitment:screening ratio for all National Institute for Health Research (NIHR) portfolio studies combined was 0.47 (486/1133). Studies that involved treatment by several specialties or at several sites had a significantly adverse impact on acceptability (p=0.01). Recruitment into non-inferiority randomised controlled studies was lower than that into step-up randomised studies (p=0.06). The complexity of a study's design did not compromise recruitment. Treatment across several specialties or several sites and perceived non-inferiority designs, reduced the acceptability of some trials.

Abstract P6-11-08: Chemotherapy-induced peripheral neuropathy and quality of life among breast cancer survivors

Introduction: Breast cancer survivors are at risk for long-term chemotherapy-induced peripheral neuropathy (PN), which has few treatment options and can affect quality of life. We examined 1) the presence and severity of PN and its correlates among 442 metastatic (MBC) and 238 breast cancer (BC) survivors who received chemotherapy, and 2) provider communication, preparation, and confidence in managing treatment side effects (SEs). Methods: MBC and BC survivors enrolled in the Cancer Support Community's Cancer Experience Registry reported history of chemotherapy-induced PN and how disruptive (0=not at all; 4=very much) PN was to daily life. Participants also reported cancer-related distress (CancerSupportSource®, a 25-item measure with a 4-item depression/anxiety risk subscale) and quality of life (QoL; PROMIS-29). We examined the association between PN history, PN disruption, distress, risk for depression/anxiety, and worse QoL (PROMIS subscales >1SD from norms) with multivariate linear and logistic regression, adjusting for metastatic disease and number of comorbidities. We also explored associations between PN disruption, provider communication, preparation, and confidence in managing SEs. Results: Mean age was 55y (SD=10); 89% non-Hispanic White; 43% had ≥2 comorbidities. More MBC patients (66%) experienced PN than BC (54%; chi2=8.9, p<.01). Severity of PN disruption did not differ by metastatic disease; 30% of all participants indicated PN was quite a bit or very disruptive to daily life. Experiencing PN was associated with greater distress (beta=6.6, p<.001) and increased likelihood of risk for depression/anxiety (OR=1.77, 95% CI=1.26-2.48). The odds for worse sleep disturbance, pain interference, physical function, social role function, depression, fatigue, and anxiety were greater among those experiencing PN than not (n=266; ORs: 6.95-1.90 respectively; ps<.05). After controlling for metastatic status and number of comorbidities in separate regression analyses, greater PN disruption was associated with greater distress and risk for depression/anxiety (semipartial rs=.12-.19, p<.01) and poorer QoL (semipartial rs=.22-.34, ps<.05), except for sleep disturbance where the relationship was not linear. Many survivors wished they received more help managing short-term SEs (39%) and long-term SEs (55%). Nearly one-third (32%) noted their provider had not suggested ways to cope with SEs and 33% were not confident in their ability to cope with SEs. Greater PN disruption was associated with wanting more help managing short-term SEs (n=121; p<.05) and not being counseled on ways to cope with SEs by the health care team (p<.05). Conclusion: Chemotherapy-induced peripheral neuropathy is associated with poorer functional outcomes and symptom burden among breast cancer survivors, whether or not their breast cancer has metastasized. Many survivors do not feel confident in coping with side effects and want more support in side effect management, yet a substantial proportion note their provider did not discuss coping strategies with them. Without effective pharmacologic intervention for PN, providers are encouraged to assess and refer survivors to appropriate supportive services, and PN should be considered as a meaningful endpoint in clinical studies.

Citation Format: Zaleta AK, Miller MF, Johnson J, McManus S, Buzaglo JS. Chemotherapy-induced peripheral neuropathy and quality of life among breast cancer survivors [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 P6-11-08.

Evaluation of the Osteoinductive Capacity of Canine Demineralized Bone Matrix in Heterotopic Muscle Sites of Athymic Rats

The osteoinductive capacity of canine demineralized bone matrix (DBM), implanted in epaxial muscle sites of athymic rats, was evaluated using calcium content and histomorphometry at two, four and six weeks after implantation. Results of this study confirm that DBM, derived from canine sources, does possess significant osteoinductive ability since histological examination revealed the presence of new cartilage, bone, or both, at 21/24 implantation sites. The osteogenesis induced by canine DBM continued as an active, cumulative process throughout the six week investigation period. The mean percentage of total induced osteogenic components including new, live cartilage, woven bone, lamellar bone and bone marrow cellular elements, was significantly greater after six weeks than after two weeks of implantation (p <0.01). Comparison of histomorphometric point counts at two, four and six weeks of implantation supported the conclusion that bone for mation as induced by canine DBM, proceeds primarily via an endochondral ossification pathway. Although the amount of calcium deposited in tissues harvested from DBM implanted sites tended to increase as implantation time lengthened, there was not a statistically significant correlation between calcium content and the level of osteogenic activity seen histologically (r = 0.32, p = 0.13).

The osteoinductive capacity of canine demineralized bone matrix (DBM), implanted in ep-axial muscle sites of athymic rats, was evaluated using calcium content and histomorphometry at two, four and six weeks after implantation. Results of this investigation confirm that DBM, derived from canine sources, does possess significant osteo-inductive ability and that bone formation proceeds primarily via a pathway of endochondral ossification.

International validation of the European Organisation for Research and Treatment of Cancer QLQ-BRECON23 quality-of-life questionnaire for women undergoing breast reconstruction

Background

The aim was to carry out phase 4 international field-testing of the European Organisation for Research and Treatment of Cancer (EORTC) breast reconstruction (BRECON) module. The primary objective was finalization of its scale structure. Secondary objectives were evaluation of its reliability, validity, responsiveness, acceptability and interpretability in patients with breast cancer undergoing mastectomy and reconstruction.

Methods

The EORTC module development guidelines were followed. Patients were recruited from 28 centres in seven countries. A prospective cohort completed the QLQ-BRECON15 before mastectomy and the QLQ-BRECON24 at 4–8 months after reconstruction. The cross-sectional cohort completed the QLQ-BRECON24 at 1–5 years after reconstruction, and repeated this 2–8 weeks later (test–retest reliability). All participants completed debriefing questionnaires.

Results

A total of 438 patients were recruited, 234 in the prospective cohort and 204 in the cross-sectional cohort. A total of 414 reconstructions were immediate, with a comparable number of implants (176) and donor-site flaps (166). Control groups comprised patients who underwent two-stage implant procedures (72, 75 per cent) or delayed reconstruction (24, 25 per cent). Psychometric scale validity was supported by moderate to high item-own scale and item-total correlations (over 0·5). Questionnaire validity was confirmed by good scale-to-sample targeting, and computable scale scores exceeding 50 per cent, except nipple cosmesis (over 40 per cent). In known-group comparisons, QLQ-BRECON24 scales and items differentiated between patient groups defined by clinical criteria, such as type and timing of reconstruction, postmastectomy radiotherapy and surgical complications, with moderate effect sizes. Prospectively, sexuality and surgical side-effects scales showed significant responsiveness over time (P &lt; 0·001). Scale reliability was supported by high Cronbach's α coefficients (over 0·7) and test–retest (intraclass correlation more than 0·8). One item (finding a well fitting bra) was excluded based on high floor/ceiling effects, poor test–retest and weak correlations in factor analysis (below 0·3), thus generating the QLQ-BRECON23 questionnaire.

Conclusion

The QLQ-BRECON23 is an internationally validated tool to be used alongside the EORTC QLQ-C30 (cancer) and QLQ-BR23 (breast cancer) questionnaires for evaluating quality of life and satisfaction after breast reconstruction.

Students' opinions on welfare and ethics issues for companion animals in Australian and New Zealand veterinary schools

OBJECTIVE

To determine what veterinary students in Australia and New Zealand consider important competences in companion animal welfare and ethics (AWE) required on their first day of practice, and to explore how their priorities relate to gender and stage of study.

METHODS

Undergraduate students at all veterinary schools in Australia and New Zealand were sent an online survey. A subset of questions required participants to rank the importance of preselected AWE topics pertaining to companion animals. Data were analysed to determine differences in the way students of different gender or academic stage prioritised each of these AWE topics.

RESULTS

Of 3220 currently enrolled students, 851 participated in the survey: 79% were female, 17% male, 4% unspecified. Ranking of the AWE topics, from highest to lowest importance, was: neutering, companion animal husbandry, euthanasia, behaviour and training, animal breeding, over-servicing in relation to animal needs and cosmetic surgery. Female students consistently ranked competency in AWE issues surrounding neutering more highly than male students (P = 0.006). Students in senior years of study ranked the importance of competency in animal abuse/hoarding (P = 0.048), shelter medicine (P = 0.012) and animal breeding (P = 0.002) less highly than those in junior years.

CONCLUSIONS

Australasian veterinary students placed more importance on competency in AWE issues associated with clinical practice (such as neutering and euthanasia) than on professional behaviours (such as over-servicing and animal breeding). However, we consider that emphasis should still be placed on developing graduate competency in the latter categories to reflect growing societal concerns about companion animal over-supply and inappropriate professional conduct.

Nonequilibrium Chromosome Looping via Molecular Slip Links

We propose a model for the formation of chromatin loops based on the diffusive sliding of molecular slip links. These mimic the behavior of molecules like cohesin, which, along with the CTCF protein, stabilize loops which contribute to organizing the genome. By combining 3D Brownian dynamics simulations and 1D exactly solvable nonequilibrium models, we show that diffusive sliding is sufficient to account for the strong bias in favor of convergent CTCF-mediated chromosome loops observed experimentally. We also find that the diffusive motion of multiple slip links along chromatin is rectified by an intriguing ratchet effect that arises if slip links bind to the chromatin at a preferred "loading site." This emergent collective behavior favors the extrusion of loops which are much larger than the ones formed by single slip links.

Reversal of aberrant PI3K/Akt signaling by Salubrinal in a GalT-deficient mouse model

Classic Galactosemia is an autosomal recessive disorder caused by deleterious mutations in the GALT gene, which encodes galactose-1 phosphate uridylyltransferase enzyme (GALT: EC 2.7.7.12). Recent studies of primary skin fibroblasts isolated from the GalT-deficient mice demonstrated a slower growth rate, a higher level of endoplasmic reticulum (ER) stress, and down-regulation of the Phosphoinositide 3 kinase/Protein kinase B (PI3K/Akt) signaling pathway. In this study, we compared the expression levels of the PI3K/Akt signaling pathway in normal and GalT-deficient mouse tissues. In mutant mouse ovaries, phospho-Akt [pAkt (Ser473)] and pGsk3β were reduced by 62.5% and 93.5%, respectively (p<0.05 versus normal controls). In mutant cerebella, pAkt (Ser473) and pGsk3β were reduced by 62%, 50%, respectively (p<0.05). To assess the role of ER stress in the down-regulation of PI3K/Akt signaling, we examined if administration of Salubrinal, a chemical compound that alleviates ER stress, to GalT-deficient fibroblasts and animals could normalize the pathway. Our results demonstrated that Salubrinal effectively reversed the down-regulated PI3K/Akt signaling pathway in the mutant cells and animals to levels close to those of their normal counterparts. Moreover, we revealed that Salubrinal can significantly slow down the loss of Purkinje cells in the cerebella, as well as the premature loss of primordial ovarian follicles in young mutant mice. These results open the door for a new therapeutic approach for the patients with Classic Galactosemia.

Simulating topological domains in human chromosomes with a fitting-free model

We discuss a polymer model for the 3D organization of human chromosomes. A chromosome is represented by a string of beads, with each bead being "colored" according to 1D bioinformatic data (e.g., chromatin state, histone modification, GC content). Individual spheres (representing bi- and multi-valent transcription factors) can bind reversibly and selectively to beads with the appropriate color. During molecular dynamics simulations, the factors bind, and the string spontaneously folds into loops, rosettes, and topologically-associating domains (TADs). This organization occurs in the absence of any specified interactions between distant DNA segments, or between transcription factors. A comparison with Hi-C data shows that simulations predict the location of most boundaries between TADs correctly. The model is "fitting-free" in the sense that it does not use Hi-C data as an input; consequently, one of its strengths is that it can - in principle - be used to predict the 3D organization of any region of interest, or whole chromosome, in a given organism, or cell line, in the absence of existing Hi-C data. We discuss how this simple model might be refined to include more transcription factors and binding sites, and to correctly predict contacts between convergent CTCF binding sites.

Collaborating to Compete: Blood Profiling Atlas in Cancer (BloodPAC) Consortium

The cancer community understands the value of blood profiling measurements in assessing and monitoring cancer. We describe an effort among academic, government, biotechnology, diagnostic, and pharmaceutical companies called the Blood Profiling Atlas in Cancer (BloodPAC) Project. BloodPAC will aggregate, make freely available, and harmonize for further analyses, raw datasets, relevant associated clinical data (e.g., clinical diagnosis, treatment history, and outcomes), and sample preparation and handling protocols to accelerate the development of blood profiling assays.

Spontaneous polarization field-enhanced charge separation for an iron oxide photo-catalyst

Hierarchically assembled photocatalysts consisting of iron oxide and zinc oxide with a nanosheet structure exhibited an enhanced photocurrent density in water splitting.