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Biran A, Dobson C, Rees C, Brooks-Pearson R, Cunliffe A, Durrant L, Hancock J, Ludlow H, Neilson L, Wilson A, Sharp L. From pelvic radiation to social isolation: a qualitative study of survivors' experiences of chronic bowel symptoms after pelvic radiotherapy. J Cancer Surviv 2024:10.1007/s11764-023-01527-6. [PMID: 38182936 DOI: 10.1007/s11764-023-01527-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/20/2023] [Indexed: 01/07/2024]
Abstract
PURPOSE We explored survivors' experiences of chronic bowel symptoms following pelvic radiotherapy, strategies employed in living with these symptoms, effects on daily activities, and roles at home and in the workplace. METHODS Semi-structured interviews were conducted with 28 individuals (10 gynaecological, 14 prostate, four anal/rectal cancer survivors) who had completed pelvic radiotherapy at least six months prior to data collection and who had experience of bowel symptoms during this post-treatment period. Reflexive thematic analysis was undertaken. RESULTS We propose four themes describing a process leading from experience of symptoms to withdrawal from activities and roles. These are (1) losing control (the experience of unintended anal leakage or discharge); (2) experiencing embarrassment and fear (the experience of embarrassment or fear of embarrassment as a result of discharge becoming public); (3) managing and reacting (acting to reduce the likelihood of discharge or to prevent this becoming public); and (4) restriction and withdrawal (avoiding specific activities or situations so as to reduce or remove the risk of embarrassment). Returning to the workplace presented additional challenges across these themes. CONCLUSIONS Impacts of chronic bowel symptoms can be severe. Survivors employ a variety of methods and strategies in living with their symptoms. Some of these support continued role fulfilment but some constitute a withdrawal from pre-treatment roles. Current healthcare provision and statutory protections fail to fully meet needs following pelvic radiotherapy. IMPLICATIONS FOR CANCER SURVIVORS There is a need to develop and implement evidence-based services and supported self-management programmes for survivors experiencing chronic bowel problems post-radiotherapy.
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Affiliation(s)
- A Biran
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - C Dobson
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - C Rees
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - R Brooks-Pearson
- Northern Centre for Cancer Care, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - A Cunliffe
- South East London Cancer Alliance, London, UK
| | - L Durrant
- Somerset NHS Foundation Trust, Taunton, UK
| | - J Hancock
- North Tees and Hartlepool NHS Foundation Trust, Stockton-On-Tees, UK
| | - H Ludlow
- Cardiff & Vale University Health Board, Cardiff, UK
| | - L Neilson
- Department of Gastroenterology, South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK
| | - A Wilson
- The Royal Marsden NHS Foundation Trust, London, UK
| | - L Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK.
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Cunliffe A, Gran S, Ali U, Grindlay D, Lax SJ, Williams HC, Burden-Teh E. Can atopic eczema and psoriasis coexist? A systematic review and meta-analysis. Skin Health Dis 2021; 1:e29. [PMID: 35664974 PMCID: PMC9060081 DOI: 10.1002/ski2.29] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 12/03/2022]
Abstract
Importance Previous studies report both coexistence and mutual exclusivity of atopic eczema (AE) and psoriasis, but these have not been appraised systematically. Knowledge of such disease association throws light on disease mechanisms and may influence therapeutic choices. Objective To summarise evidence for AE and psoriasis occurring in the same person at the same point in time. Planned primary outcome was the incidence, prevalence or risk of psoriasis or eczema. Methods Ovid MEDLINE and Ovid Embase were searched from inception to 1st February 2020. The search strategy was built around the key terms ‘atopic eczema’, ‘psoriasis’ and ‘co‐existence’. Observational studies (cohort, case‐control, cross‐sectional and case‐series) with a minimum of 10 consecutive patients were included. There were no restrictions on participants, geography or language. Studies were selected, data extracted and critically appraised by two independent reviewers. Data were extracted on the method of diagnosis: health professional (dermatologist, criteria, other), self‐reported, not specified. Study quality was assessed using validated Joanna Brigg's Institute critical appraisal tools. A random‐effects model was used to combine studies. The effect of study quality on the pooled estimate was investigated using stratification. Heterogeneity was explored by subgroup analysis. Results This review included 31 studies and 20 523 individuals with psoriasis and 1 405 911 with AE. Eight studies reported the prevalence of AE in those with psoriasis and values ranged from 0.17% to 20%: the pooled prevalence was 2% (95% confidence interval [CI]: 1, 3). Seven studies reported the prevalence of psoriasis in those with AE and values ranged from 0.3% to 12.6%; the pooled prevalence was 2% (95% CI: 1, 3). Ten studies were assessed as low risk of bias. Geographical area, method of diagnosis, setting and whether the assessment of diagnosis was blinded, partly contributed to the heterogeneity. Conclusions This review provides some evidence for the coexistence of AE and psoriasis. Clinicians should be aware of coexistence at diagnosis, when selecting therapies and when reviewing poor response to treatment.
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Affiliation(s)
- A Cunliffe
- Nottingham University Hospitals NHS Trust Nottingham UK
| | - S Gran
- Centre of Evidence Based Dermatology School of Medicine University of Nottingham Nottingham UK
| | - U Ali
- Centre of Evidence Based Dermatology School of Medicine University of Nottingham Nottingham UK
| | - D Grindlay
- Centre of Evidence Based Dermatology School of Medicine University of Nottingham Nottingham UK
| | - S J Lax
- Centre of Evidence Based Dermatology School of Medicine University of Nottingham Nottingham UK
| | - H C Williams
- Nottingham University Hospitals NHS Trust Nottingham UK.,Centre of Evidence Based Dermatology School of Medicine University of Nottingham Nottingham UK
| | - E Burden-Teh
- Nottingham University Hospitals NHS Trust Nottingham UK.,Centre of Evidence Based Dermatology School of Medicine University of Nottingham Nottingham UK
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Cunliffe A, Dobson J, Swallow G, Ravenscroft J, Tang TS. Taipan snake venom time for antiphospholipid syndrome solves a 20-year diagnostic challenge. Clin Exp Dermatol 2020; 45:805-808. [PMID: 32432361 DOI: 10.1111/ced.14229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2020] [Indexed: 01/06/2023]
Affiliation(s)
- A Cunliffe
- Department of Dermatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - J Dobson
- Department of Dermatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - G Swallow
- Department of, Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - J Ravenscroft
- Department of Dermatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - T S Tang
- Department of Dermatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Naufahu J, Alzaid F, Fiuza Brito M, Doslikova B, Valencia T, Cunliffe A, Murray JF. Melanin-concentrating hormone in peripheral circulation in the human. J Endocrinol 2017; 232:513-523. [PMID: 28053003 DOI: 10.1530/joe-16-0240] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 01/04/2017] [Indexed: 12/14/2022]
Abstract
Melanin-concentrating hormone (MCH) is a hypothalamic neuropeptide with a well-characterised role in energy homeostasis and emergent roles in diverse physiologic functions such as arousal, mood and reproduction. Work to date has predominantly focused on its hypothalamic functions using animal models; however, little attention has been paid to its role in circulation in humans. The aims of this study were to (a) develop a radioimmunoassay for the detection of MCH in human plasma; (b) establish reference ranges for circulating MCH and (c) characterise the pattern of expression of circulating MCH in humans. A sensitive and specific RIA was developed and cross-validated by RP-HPLC and MS. The effective range was 19.5-1248 pg MCH/mL. Blood samples from 231 subjects were taken to establish a reference range of 19.5-55.4 pg/mL for fasting MCH concentrations. There were no significant differences between male and female fasting MCH concentrations; however, there were correlations between MCH concentrations and BMI in males and females with excess fat (P < 0.001 and P = 0.020) and between MCH concentrations and fat mass in females with excess fat (P = 0.038). Plasma MCH concentrations rose significantly after feeding in a group of older individuals (n = 50, males P = 0.006, females P = 0.023). There were no robust significant correlations between fasting or post-prandial MCH and resting metabolic rate, plasma glucose, insulin or leptin concentrations although there were correlations between circulating MCH and leptin concentrations in older individuals (P = 0.029). These results indicate that the role of circulating MCH may not be reflective of its regulatory hypothalamic role.
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Affiliation(s)
- J Naufahu
- Faculty of Science and TechnologyUniversity of Westminster, London, UK
| | - F Alzaid
- Faculty of Science and TechnologyUniversity of Westminster, London, UK
| | - M Fiuza Brito
- Faculty of Science and TechnologyUniversity of Westminster, London, UK
| | - B Doslikova
- Faculty of Science and TechnologyUniversity of Westminster, London, UK
| | - T Valencia
- Faculty of Science and TechnologyUniversity of Westminster, London, UK
| | - A Cunliffe
- Faculty of Science and TechnologyUniversity of Westminster, London, UK
| | - J F Murray
- Faculty of Science and TechnologyUniversity of Westminster, London, UK
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Smith C, Cunliffe A, Al-Hallaq H, Armato S. SU-E-J-113: Effects of Deformable Registration On First-Order Texture Maps Calculated From Thoracic Lung CT Scans. Med Phys 2015. [DOI: 10.1118/1.4924200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Anthony G, Cunliffe A, Castillo R, Pham N, Guerrero T, Armato S, Al-Hallaq H. SU-E-J-251: Incorporation of Pre-Therapy 18F-FDG Uptake with CT Texture Features in a Predictive Model for Radiation Pneumonitis Development. Med Phys 2015. [DOI: 10.1118/1.4924337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Cunliffe A, Armato S, Castillo R, Pham N, Guerrero T, Al-Hallaq H. TU-A-12A-04: Quantitative Texture Features Calculated in Lung Tissue From CT Scans Demonstrate Consistency Between Two Databases From Different Institutions. Med Phys 2014. [DOI: 10.1118/1.4889250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Cunliffe A, Contee C, White B, Justusson J, Armato S, Malik R, Al-Hallaq H. TU-F-BRF-03: Effect of Radiation Therapy Planning Scan Registration On the Dose in Lung Cancer Patient CT Scans. Med Phys 2014. [DOI: 10.1118/1.4889321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Cunliffe A, Armato S, Fei X, Tuohy R, Al-Hallaq H. WE-C-103-09: Investigation of Demons Deformable Registration-Based Methods to Measure Lung CT Texture Change Over Time. Med Phys 2013. [DOI: 10.1118/1.4815558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Ludwig M, Cunliffe A, Al-Hallaq H, Armato S. TU-A-218-05: Evaluation of Image Registration Using Landmark Matching and Texture Analysis. Med Phys 2012. [DOI: 10.1118/1.4735899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Cunliffe A, Al-Hallaq H, Labby Z, Pelizzari C, Sensakovic W, Armato S. SU-E-I-03: Evaluation of CT Texture Feature Changes Following Deformable Lung Registration. Med Phys 2011. [DOI: 10.1118/1.3611575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Yenice K, Partouche J, Cunliffe A, Farrey K, Weichselbaum R, Salama J. Analysis of Radiation Pneumonitis (RP) Incidence in a Phase I Stereotactic Body Radiotherapy (SBRT) Dose Escalation Study for Multiple Metastases. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cunliffe A, Obeid OA, Powell-Tuck J. A placebo controlled investigation of the effects of tryptophan or placebo on subjective and objective measures of fatigue. Eur J Clin Nutr 1998; 52:425-30. [PMID: 9683395 DOI: 10.1038/sj.ejcn.1600581] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To examine the effect of L-tryptophan administration on subjective and objective measures of fatigue in healthy volunteers. SUBJECTS Six healthy volunteers (4M:2F) were recruited from staff and students at the College. SETTING Department of Human Nutrition, St. Bartholomews and the Royal London School of Medicine and Dentistry. DESIGN Subjects were tested for central and peripheral fatigue using a visual analogue scale, flicker fusion frequency, grip strength, reaction time and wrist ergometry. In addition, plasma free tryptophan concentrations and Trp:LNAA ratio were determined. Measurements were made before, and at 1, 2, 3 and 4 h after drinking one of two test drinks. The drinks were of either caffeine free diet Coca-Cola (placebo) or caffeine free diet Coca-Cola plus L-tryptophan (30 mg/kg: active drink). Each of the six subjects was tested after placebo and active drink with a one week washout period between test days. RESULTS Subjective fatigue was significantly increased following tryptophan compared to placebo (P < 0.002), and objective measures of central fatigue were significantly increased by tryptophan compared to placebo (flicker fusion frequency: P < 0.001; reaction time P < 0.001). No significant changes in grip strength were found following tryptophan compared to placebo, but a significant increase in ergometric work output was seen (P < 0.001). CONCLUSION Tryptophan ingestion in the quantity 30 mg/kg leads to increased subjective and central fatigue. Increases in work output observed following tryptophan may be as a result of a reduced perception of discomfort during ergometry.
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Affiliation(s)
- A Cunliffe
- Department of Human Nutrition, St Bartholomew's and Royal London School of Medicine and Dentistry, Queen Mary and Westfield College
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Hughes R, Cunliffe A, Young-Martos F. Evaluating software development effort model-building techniques for application in a real-time telecommunications environment. ACTA ACUST UNITED AC 1998. [DOI: 10.1049/ip-sen:19983370] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
OBJECTIVES To assess the changes in measures of fatigue after meals of varying composition, and to compare the relation of the fatigue with changes in the plasma tryptophan:large neutral amino acids (Trp:LNAA) ratio. SUBJECTS Sixteen healthy volunteers were recruited from staff and students at the College. DESIGN Subjects were tested for central and peripheral fatigue using a visual analogue scale, flicker fusion frequency, grip strength, reaction time and wrist ergometry. In addition, plasma amino acid concentrations and Trp:LNAA ratio were determined. Measurements were made before, and at 1, 2, 3 and 4 h after drinking one of three liquid test meals. The meals were isoenergetic (1672 kJ) and were of mixed carbohydrate, fat and protein, or of pure carbohydrate or pure fat. SETTING Department of Human Nutrition. RESULTS Subjects consuming the pure carbohydrate meal reported more subjective feelings of fatigue and had slower reaction times. Aspects of central fatigue were greater in subjects consuming a pure fat meal. The Trp:LNAA ratio was depressed in those consuming a pure fat or mixed meal and raised only after pure carbohydrate. CONCLUSIONS Central and subjective fatigue may be influenced by raised plasma free tryptophan to competitor amino acid ratios induced by carbohydrate intake but other aspects of central arousal are affected by fat intake.
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Affiliation(s)
- A Cunliffe
- Department of Human Nutrition, St Bartholomew's, London
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