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Zhang L, Wu Q, Wang X, Zhu X, Shi Y, Wu CJJ. Factors impacting early mobilization according to the Enhanced Recovery After Surgery guideline following gastrointestinal surgery: A prospective study. Geriatr Gerontol Int 2024; 24:234-239. [PMID: 38169113 DOI: 10.1111/ggi.14799] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 11/30/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024]
Abstract
AIM Evidence shows that early mobilization according to the Enhanced Recovery After Surgery guideline promotes postoperative recovery in gastrointestinal cancer patients undergoing gastrointestinal surgery. However, compliance with the guideline in clinical settings remains low. This study aimed to investigate the factors influencing early mobilization after surgery. METHODS A prospective research design was used. Data from 470 patients with gastrointestinal cancer who underwent gastrointestinal surgery between February 2021 and July 2022 were collected. RESULTS More than half (53.6%) of the patients met the criteria for early mobilization. Females (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.02-2.29), age 〉70 years (OR, 1.76; 95% CI, 1.09-2.86), low level of education (OR, 1.98; 95% CI, 1.12-3.95), and ≥4 catheters (OR, 1.86; 95% CI, 1.25-2.76) were barriers to early mobilization. CONCLUSIONS Sex, age, education, and the number of catheters were found to be significant factors associated with non-early mobilization after gastrointestinal surgery. Geriatr Gerontol Int 2024; 24: 234-239.
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Affiliation(s)
- Lin Zhang
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Qian Wu
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xiayun Wang
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xiaoping Zhu
- School of Nursing, University of Tongji, Shanghai, China
| | - Yan Shi
- School of Nursing, University of Tongji, Shanghai, China
| | - Chiung-Jung Jo Wu
- School of Health, University of the Sunshine Coast, Petrie, Queensland, Australia
- Royal Brisbane and Women's Hospital (RBWH), Herston, Queensland, Australia
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Morrison-Jones V, West M. Post-Operative Care of the Cancer Patient: Emphasis on Functional Recovery, Rapid Rescue, and Survivorship. Curr Oncol 2023; 30:8575-8585. [PMID: 37754537 PMCID: PMC10527900 DOI: 10.3390/curroncol30090622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/16/2023] [Accepted: 09/13/2023] [Indexed: 09/28/2023] Open
Abstract
A cancer diagnosis and its subsequent treatments are life-changing events, impacting the patient and their family. Treatment options available for cancer care are developing at pace, with more patients now able to achieve a cancer cure. This is achieved through the development of novel cancer treatments, surgery, and modern imaging, but also as a result of better understanding treatment/surgical trauma, rescue after complications, perioperative care, and innovative interventions like pre-habilitation, enhanced recovery, and enhanced post-operative care. With more patients living with and beyond cancer, the role of survivorship and quality of life after cancer treatment is gaining importance. The impact cancer treatments can have on patients vary, and the "scars" treatments leave are not always visible. To adequately support patients through their cancer journeys, we need to look past the short-term interactions they have with medical professionals and encourage them to consider their lives after cancer, which often is not a reflection of life before a cancer diagnosis.
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Affiliation(s)
- Victoria Morrison-Jones
- Hepato-Biliary Surgery Unit, University Hospitals Southampton, Tremona Road, Southampton SO16 6YD, UK;
| | - Malcolm West
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- Complex Cancer and Exenterative Service, University Hospitals Southampton, Tremona Road, Southampton SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, Perioperative and Critical Care Theme, University Hospitals Southampton, Tremona Road, Southampton SO16 6YD, UK
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Moon J, Garfinkle R, Zelkowitz P, Dell'Aniello S, Vasilevsky CA, Brassard P, Boutros M. Incidence and Factors Associated With Mental Health Disorders in Patients With Rectal Cancer Post-Restorative Proctectomy. Dis Colon Rectum 2023; 66:1203-1211. [PMID: 37399122 DOI: 10.1097/dcr.0000000000002744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
BACKGROUND Most patients with rectal cancer experience bowel symptoms post-restorative proctectomy. The incidence of mental health disorders post-restorative proctectomy and its association with bowel symptoms are unknown. OBJECTIVES This study aimed 1) to describe the incidence of mental health disorders in patients who underwent restorative proctectomy for rectal cancer and 2) to study the association between incident mental health disorders and bowel dysfunction after surgery. DESIGN This retrospective cohort study used the Clinical Practice Research Datalink and Hospital Episode Statistics databases. SETTINGS The databases were based in the United Kingdom. PATIENTS All adult patients who underwent restorative proctectomy for a rectal neoplasm between 1998 and 2018 were included. MAIN OUTCOME MEASURES The primary outcome was an incident mental health disorder. The associations between bowel, sexual, and urinary dysfunctions and incident mental health disorders were studied using Cox proportional hazard regression models. RESULTS In total, 2197 patients who underwent restorative proctectomy were identified. Of 1858 patients without preoperative bowel, sexual, or urinary dysfunction, 1455 had no preoperative mental health disorders. In this cohort, 466 patients (32.0%) developed incident mental health disorders following restorative proctectomy during 6333 person-years of follow-up. On multivariate Cox regression, female sex (adjusted HR 1.30; 95% CI, 1.06-1.56), metastatic disease (adjusted HR 1.57; 95% CI, 1.14-2.15), incident bowel dysfunction (adjusted HR 1.41, 95% CI, 1.13-1.77), and urinary dysfunction (adjusted HR 1.57; 95% CI, 1.16-2.14) were found to be associated with developing incident mental health disorders post-restorative proctectomy. LIMITATIONS This study was limited by its observational study design and residual confounding. CONCLUSIONS Incident mental health disorders after restorative proctectomy for rectal cancer are common. The presence of bowel and urinary functional impairment significantly increases the risk of poor psychological outcomes among rectal cancer survivors. CON LOS TRASTORNOS DE SALUD MENTAL EN PACIENTES CON CNCER DE RECTO POSTERIOR A PROCTECTOMA RESTAURADORA ANTECEDENTES: La mayoría de los pacientes con cáncer de recto experimentan síntomas intestinales después de la proctectomía restauradora. Se desconoce la incidencia de trastornos de salud mental posteriores a la proctectomía restauradora y su asociación con síntomas intestinales.OBJETIVOS: Los objetivos de nuestro estudio son: a) describir la incidencia de trastornos de salud mental en pacientes sometidos a proctectomía restauradora por cáncer de recto; b) estudiar la asociación entre los trastornos de salud mental incidentes y la disfunción intestinal después de la cirugía.DISEÑO: Este fue un estudio de cohorte retrospectivo que utilizó las bases de datos Clinical Practice Research Datalink y Hospital Episode Statistics.ENTORNO CLÍNICO: Las bases de datos se basaron en el Reino Unido.PACIENTES: Se incluyeron todos los pacientes adultos que se sometieron a una proctectomía restauradora por una neoplasia rectal entre 1998 y 2018.PRINCIPALES MEDIDAS DE VALORACIÓN: El resultado primario fue un trastorno de salud mental incidente. Las asociaciones entre la disfunción intestinal, sexual y urinaria y los trastornos de salud mental incidentes se estudiaron utilizando modelos de regresión de riesgos proporcionales de Cox.RESULTADOS: En total, se identificaron 2.197 pacientes que se sometieron a proctectomía restauradora. De 1.858 pacientes sin disfunción intestinal, sexual o urinaria preoperatoria, 1.455 personas tampoco tenían trastornos de salud mental preoperatorios. En esta cohorte, 466 (32,0 %) pacientes desarrollaron trastornos de salud mental incidentes después de la PR durante 6333 años-persona de seguimiento. En la regresión multivariada de Cox, sexo femenino (HRa 1,30, IC 95% 1,06-1,56), enfermedad metastásica (HRa 1,57, IC 95% 1,14-2,15) e incidencia intestinal (HRa 1,41, IC del 95 %: 1,13 a 1,77) y la disfunción urinaria (aHR 1,57, IC del 95 %: 1,16 a 2,14) se asociaron con el desarrollo de trastornos de salud mental incidentes después de la proctectomía restauradora.LIMITACIONES: Este estudio estuvo limitado por el diseño del estudio observacional y la confusión residual.CONCLUSIÓN: Los trastornos de salud mental incidentes después de la proctectomía restauradora para el cáncer de recto son comunes. La presencia de deterioro funcional intestinal y urinario aumenta significativamente el riesgo de malos resultados psicológicos entre los sobrevivientes de cáncer de recto. (Traducción- Dr. Ingrid Melo ).
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Affiliation(s)
- Jeongyoon Moon
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada. Centre for Clinical Epidemiology, Lady Davis Institute-Jewish General Hospital; Department of Epidemiology and Biostatistics and Department of Medicine, McGill University, Montreal, QC, Canada
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Kovoor JG, Jacobsen JHW, Stretton B, Bacchi S, Gupta AK, Claridge B, Steen MV, Bhanushali A, Bartholomeusz L, Edwards S, Asokan GP, Asokan G, McGee A, Ovenden CD, Hewitt JN, Trochsler MI, Padbury RT, Perry SW, Wong ML, Licinio J, Maddern GJ, Hewett PJ. Depression after stoma surgery: a systematic review and meta-analysis. BMC Psychiatry 2023; 23:352. [PMID: 37217917 DOI: 10.1186/s12888-023-04871-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 05/15/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Depression is the leading cause of global disability and can develop following the change in body image and functional capacity associated with stoma surgery. However, reported prevalence across the literature is unknown. Accordingly, we performed a systematic review and meta-analysis aiming to characterise depressive symptoms after stoma surgery and potential predictive factors. METHODS PubMed/MEDLINE, Embase, CINAHL and Cochrane Library were searched from respective database inception to 6 March 2023 for studies reporting rates of depressive symptoms after stoma surgery. Risk of bias was assessed using the Downs and Black checklist for non-randomised studies of interventions (NRSIs), and Cochrane RoB2 tool for randomised controlled trials (RCTs). Meta-analysis incorporated meta-regressions and a random-effects model. REGISTRATION PROSPERO, CRD42021262345. RESULTS From 5,742 records, 68 studies were included. According to Downs and Black checklist, the 65 NRSIs were of low to moderate methodological quality. According to Cochrane RoB2, the three RCTs ranged from low risk of bias to some concerns of bias. Thirty-eight studies reported rates of depressive symptoms after stoma surgery as a proportion of the respective study populations, and from these, the median rate across all timepoints was 42.9% 42.9% (IQR: 24.2-58.9%). Pooled scores for respective validated depression measures (Hospital Anxiety and Depression Score (HADS), Beck Depression Inventory (BDI), and Patient Health Questionnaire-9 (PHQ-9)) across studies reporting those scores were below clinical thresholds for major depressive disorder according to severity criteria of the respective scores. In the three studies that used the HADS to compare non-stoma versus stoma surgical populations, depressive symptoms were 58% less frequent in non-stoma populations. Region (Asia-Pacific; Europe; Middle East/Africa; North America) was significantly associated with postoperative depressive symptoms (p = 0.002), whereas age (p = 0.592) and sex (p = 0.069) were not. CONCLUSIONS Depressive symptoms occur in almost half of stoma surgery patients, which is higher than the general population, and many inflammatory bowel disease and colorectal cancer populations outlined in the literature. However, validated measures suggest this is mostly at a level of clinical severity below major depressive disorder. Stoma patient outcomes and postoperative psychosocial adjustment may be enhanced by increased psychological evaluation and care in the perioperative period.
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Affiliation(s)
- Joshua G Kovoor
- University of Adelaide, Adelaide, South Australia, Australia.
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
- Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.
- Royal Adelaide Hospital, Adelaide, South Australia, Australia.
- Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia.
- Health and Information, Adelaide, South Australia, Australia.
| | | | - Brandon Stretton
- University of Adelaide, Adelaide, South Australia, Australia
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- University of Adelaide, Adelaide, South Australia, Australia
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
| | - Aashray K Gupta
- University of Adelaide, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Brayden Claridge
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Matthew V Steen
- Glenside Health Services, Adelaide, South Australia, Australia
| | - Ameya Bhanushali
- University of Adelaide, Adelaide, South Australia, Australia
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Lorenz Bartholomeusz
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Suzanne Edwards
- University of Adelaide, Adelaide, South Australia, Australia
| | - Gayatri P Asokan
- Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
| | - Gopika Asokan
- University of Adelaide, Adelaide, South Australia, Australia
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Amanda McGee
- Stoma Care Services, Adelaide, South Australia, Australia
| | - Christopher D Ovenden
- University of Adelaide, Adelaide, South Australia, Australia
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
| | - Joseph N Hewitt
- University of Adelaide, Adelaide, South Australia, Australia
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
| | - Markus I Trochsler
- University of Adelaide, Adelaide, South Australia, Australia
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Robert T Padbury
- Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
| | - Seth W Perry
- State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Ma-Li Wong
- State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Julio Licinio
- Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
- State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Guy J Maddern
- University of Adelaide, Adelaide, South Australia, Australia
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Peter J Hewett
- University of Adelaide, Adelaide, South Australia, Australia
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
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5
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Calman L, Turner J, Fenlon D, Permyakova NV, Wheelwright S, Patel M, Din A, Winter J, Richardson A, Smith PWF, Foster C. Prevalence and determinants of depression up to 5 years after colorectal cancer surgery: results from the ColoREctal Wellbeing (CREW) study. Colorectal Dis 2021; 23:3234-3250. [PMID: 34679253 PMCID: PMC9298990 DOI: 10.1111/codi.15949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/03/2021] [Accepted: 06/17/2021] [Indexed: 01/15/2023]
Abstract
AIM Depression experienced by people with colorectal cancer (CRC) is an important clinical problem affecting quality of life. Recognition of depression at key points in the pathway enables timely referral to support. This study aimed to examine depression before and 5 years after surgery to examine its prevalence and identify determinants. METHOD The ColoREctal Wellbeing (CREW) study is a prospective UK cohort study involving 872 adults with nonmetastatic CRC recruited before surgery with curative intent. Questionnaires completed before surgery and 3, 9, 15, 24, 36, 48 and 60 months after surgery captured socio-demographics and assessed depression (Centre for Epidemiologic Studies Depression Scale, CES-D) and other psychosocial factors. Clinical details were also gathered. We present the prevalence of clinically significant depression (CES-D ≥ 20) over time and its predictors assessed before and 2 years after surgery. RESULTS Before surgery, 21.0% of the cohort reported CES-D ≥ 20 reducing to 14.7% 5 years after surgery. Presurgery risk factors predicting subsequent depression were clinically significant depression and anxiety, previous mental health service use, low self-efficacy, poor health, having neoadjuvant treatment and low social support. Postsurgery risk factors at 2 years predicting subsequent depression were clinically significant depression, negative affect, cognitive dysfunction, accommodation type and poor health. CONCLUSION Depression is highly pervasive in people with CRC, exceeding prevalence in the general population across follow-up. Our findings emphasize the need to screen and treat depression across the pathway. Our novel data highlight key risk factors of later depression at important and opportune time points: before surgery and at the end of routine surveillance. Early recognition and timely referral to appropriate support is vital to improve long-term psychological outcomes.
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Affiliation(s)
- Lynn Calman
- School of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Joshua Turner
- School of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Deborah Fenlon
- College of Human and Health SciencesSwansea UniversitySwanseaUK
| | | | | | - Mubarak Patel
- Division of Health SciencesUniversity of WarwickWarwickUK
| | - Amy Din
- School of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Jane Winter
- School of Health SciencesUniversity of SouthamptonSouthamptonUK,University Hospitals Southampton NHS TrustSouthamptonUK
| | - Alison Richardson
- School of Health SciencesUniversity of SouthamptonSouthamptonUK,University Hospitals Southampton NHS TrustSouthamptonUK
| | - Peter W. F. Smith
- Social Statistics and DemographySocial SciencesUniversity of SouthamptonSouthamptonUK
| | - Claire Foster
- School of Health SciencesUniversity of SouthamptonSouthamptonUK
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6
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Kamposioras K, Saunders M, Jonathan Lim KH, Marti K, Anderson D, Cutting M, McCool D, Connell J, Simpson L, Hasan J, Braun M, Lavin V, Mullamitha S, Barriuso J. The Impact of Changes in Service Delivery in Patients With Colorectal Cancer During the Initial Phase of the COVID-19 Pandemic. Clin Colorectal Cancer 2020; 20:e120-e128. [PMID: 33384244 PMCID: PMC7718777 DOI: 10.1016/j.clcc.2020.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/22/2020] [Accepted: 11/29/2020] [Indexed: 02/08/2023]
Abstract
Background The Coronavirus disease 2019 (COVID-19) pandemic has imposed significant changes in cancer service delivery resulting in increased anxiety and distress in both patients and clinicians. We aimed to investigate how these changes have been perceived by patients diagnosed with colorectal cancer and identify determinants of increased anxiety. Patients and Methods An anonymized 32-item survey in the specialized lower gastrointestinal cancer outpatient clinics at a tertiary cancer center in North West England between May 18 and July 1, 2020. Self-reported anxiety was based on the General Anxiety Disorder-7 screening tool. Results Of 143 participants who completed the survey (response rate, 67%), 115 (82%) were male, and the median age group was 61 to 70 years. A total of 112 (78%) participants had telephone consultation (83% met needs), and 57 (40%) had radiologic scan results discussed over the phone (96% met needs). In total, 23 (18%) participants were considered to have anxiety (General Anxiety Disorder-7 score ≥ 5), with 7 (5.5%) scoring for moderate or severe anxiety. Those concerned about getting COVID-19 infection, and worried COVID-19 would have effect on their mental health, and affect their experience of cancer care, were most likely to have anxiety (P < .05, multivariate analysis). The majority did not feel they needed support during this phase of the pandemic. Participants felt that friends and family had been very supportive, but less so the primary care services (P < .05). Conclusions The findings of this survey suggest that some of the service changes implemented may have already improved the overall experience of cancer care among patients with colorectal cancer at our institute. Reassuringly, the incidence of participants with moderate to severe anxiety levels during the peak of COVID-19 in the United Kingdom was much lower than anticipated. Importantly, patients were much more concerned about their cancer treatment than COVID-19, emphasizing the need to continue to provide comprehensive cancer care even with a “second wave” of COVID-19.
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Affiliation(s)
| | - Mark Saunders
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Kok Haw Jonathan Lim
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom; Department of Immunology and Inflammation, Imperial College London, Commonwealth Building, The Hammersmith Hospital, London, United Kingdom
| | - Kalena Marti
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Daniel Anderson
- Department of Psycho-Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Mark Cutting
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Danielle McCool
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Jacqueline Connell
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Lilly Simpson
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Jurjees Hasan
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Michael Braun
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Victoria Lavin
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Saifee Mullamitha
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Jorge Barriuso
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom; Manchester Cancer Research Centre, Manchester, United Kingdom
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