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Holt F, Probert J, Liu Z, Duane F, Ntentas G, Darby S, Dodwell D, Coles C, Haviland J, Kirby A, Taylor C. Proton beam therapy for early breast cancer: a systematic review and quantitative synthesis of adverse clinical outcomes. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01474-5] [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: 11/19/2022]
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Ranger A, Dunlop A, Hansen VN, Princewill G, Landeg S, Donovan EM, Harris EJ, McNair HA, Haviland J, Kirby AM. A Randomised Phase II Clinical Trial Comparing the Deliverability and Acute Toxicity of Wide Tangent versus Volumetric Modulated Arc Therapy to the Breast and Internal Mammary Chain. Clin Oncol (R Coll Radiol) 2022; 34:526-533. [PMID: 35597698 DOI: 10.1016/j.clon.2022.03.020] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 02/18/2022] [Accepted: 03/28/2022] [Indexed: 11/03/2022]
Abstract
AIMS Inclusion of the internal mammary chain in the radiotherapy target volume (IMC-RT) improves disease-free and overall survival in higher risk breast cancer patients, but increases radiation doses to heart and lungs. Dosimetric data show that either modified wide-tangential fields (WT) or volumetric modulated arc therapy (VMAT) together with [AQ1]voluntary deep inspiration breath hold (vDIBH) keep mean heart doses below 4 Gy in most patients. However, the impact on departmental resources has not yet been documented. This phase II clinical trial compared the time taken to deliver IMC-RT using either WT and vDIBH or VMAT and vDIBH, together with planning time, dosimetry, set-up reproducibility and toxicity. MATERIALS AND METHODS Left-sided breast cancer patients requiring IMC-RT were randomised to receive either WT(vDIBH) or VMAT radiotherapy. The primary outcome was treatment time, powered to detect a minimum difference of 75 min (5 min/fraction) between techniques. The population mean displacement, systematic error and random error for cone beam computed tomography chest wall matches in three directions of movement were calculated. Target volume and organ at risk doses were compared between groups. Side-effects, including skin (Radiation Therapy Oncology Group), lung and oesophageal toxicity (Common Terminology Criteria for Adverse Events v 4.03) rates, were compared between the groups over 3 months. Patient-reported outcome measures, including shoulder toxicity at baseline, 6 months and 1 year, were compared. RESULTS Twenty-one patients were recruited from a single UK centre between February 2017 and January 2018. The mean (standard deviation) total treatment time per fraction for VMAT treatments was 13.2 min (1.7 min) compared with 28.1 min (3.3 min) for WT(vDIBH). There were no statistically significant differences in patient set-up errors in between groups. The average mean heart dose for WT(vDIBH) was 2.6 Gy compared with 3.4 Gy for VMAT(vDIBH) (P = 0.13). The mean ipsilateral lung V17Gy was 32.8% in the WT(vDIBH) group versus 34.4% in the VMAT group (P = 0.2). The humeral head (mean dose 16.8 Gy versus 2.8 Gy), oesophagus (maximum dose 37.3 Gy versus 20.1 Gy) and thyroid (mean dose 22.0 Gy versus 11.2 Gy) all received a statistically significantly higher dose in the VMAT group. There were no statistically significant differences in skin, lung or oesophageal toxicity within 3 months of treatment. Patient-reported outcomes of shoulder toxicity, pain, fatigue, breathlessness and breast symptoms were similar between groups at 1 year. CONCLUSION VMAT(vDIBH) and WT(vDIBH) are feasible options for locoregional breast radiotherapy including the IMC. VMAT improves nodal coverage and delivers treatment more quickly, resulting in less breath holds for the patient. This is at the cost of increased dose to some non-target tissues. The latter does not appear to translate into increased toxicity in this small study.
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Affiliation(s)
- A Ranger
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK.
| | - A Dunlop
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - V N Hansen
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - G Princewill
- The Royal Marsden NHS Foundation Trust, London, UK
| | - S Landeg
- The Royal Marsden NHS Foundation Trust, London, UK
| | | | - E J Harris
- The Institute of Cancer Research, London, UK
| | - H A McNair
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - J Haviland
- The Institute of Cancer Research, London, UK
| | - A M Kirby
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
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Wheatley D, Haviland J, Patel J, Sydenham M, Alhasso A, Chan C, Cleator S, Coles C, Donovan E, Kirby A, Kirwan C, Nabi Z, Sawyer E, Somaiah N, Syndikus I, Venables K, Yarnold J, Brunt A, Bliss J. OC-0101 First results of FAST-Forward phase 3 RCT nodal substudy: 3-year normal tissue effects. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02477-x] [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: 11/29/2022]
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Haviland J. SP-0179 Learning from patients. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03894-4] [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: 11/17/2022]
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Brunt A, Haviland J, Sydenham M, Al-hasso A, Bloomfield D, Chan C, Churn M, Cleator S, Coles C, Emson M, Goodman A, Griffin C, Harnett A, Hopwood P, Kirby A, Kirwan C, Morris C, Sawyer E, Somaiah N, Syndikus I, Wilcox M, Zotova R, Wheatley D, Bliss J, Yarnold J. OC-0595: FAST-Forward phase 3 RCT of 1-week hypofractionated breast radiotherapy:3-year normal tissue effects. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30905-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Haviland J, Yarnold J, Bliss J, Hopwood P, Wilcox M. Reply to Goodare et al. Re: Do Patient-reported Outcome Measures Agree with Clinical and Photographic Assessments of Normal Tissue Effects after Breast Radiotherapy? Clin Oncol (R Coll Radiol) 2016; 28:665-6. [PMID: 27477124 DOI: 10.1016/j.clon.2016.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 07/13/2016] [Indexed: 11/29/2022]
Affiliation(s)
- J Haviland
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - J Yarnold
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - J Bliss
- ICR-CTSU, Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | - P Hopwood
- ICR-CTSU, Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | - M Wilcox
- Independent Cancer Patients' Voice, London, UK
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Coles CE, Donovan E, Haviland J, Yarnold J. Intensity-modulated Radiotherapy for the Treatment of Breast Cancer. Clin Oncol (R Coll Radiol) 2013; 25:215. [PMID: 23207073 DOI: 10.1016/j.clon.2012.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 11/06/2012] [Indexed: 10/27/2022]
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Rodrigues DN, Somaiah N, Daley F, Davies S, Rakha E, A'Hern R, Haviland J, Sydenham M, Owen R, Reis-Filho J, Yarnold JR. Abstract P3-06-09: Test of association between Ki67 index of early breast cancer and local relapse after adjuvant hypofractionated radiotherapy. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p3-06-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: There is a strong inverse association between the proliferation indices of early- and late-responding normal tissues and their sensitivity to radiotherapy fraction size. The aim of this study is to test for association between Ki67 index and the fractionation sensitivity of breast cancer. The hypothesis is that tumours with high Ki67 indices are relatively insensitive to fraction size and be over-represented in tumours relapsing after hypofractionated, radiotherapy.
Methods: Between 1986 and 2003, the START pilot and START A trials tested 2 test dose levels of a 13-fraction regimen (3.0 or 3.3 Gy & 3.0 or 3.2 Gy fractions, respectively) in 5 weeks against 25 fractions of 2.0 Gy following primary surgery for early breast cancer. Primary tumour blocks of patients with local tumour relapse were collected for immunohistochemistry (IHC) for Ki67 (manual counting in whole sections), HER2, ER & PR (Allred quick scores in tissue sections). Ki67 was assumed to be log normally distributed with a standard deviation of 0.5–0.9. Assuming evaluable blocks for 240 patients, a standardised detectable difference of 0.45 (90%+ power, 5% significance level) corresponded to a detectable difference in geometric means of 5–10%.
Results: From a total of 3646 patients entered into the START pilot and START A trials, 261 local tumour relapses were recorded at a median follow up of 8.4 years (range 0.9–17.5) and 7.2 (range 0.7–11.9) years respectively. Blocks from 213 patients were recovered, of which 176 were evaluable by IHC. There was no significant difference in proliferation between tumours relapsing after conventional and hypofractionated radiotherapy, with mean Ki67 scores of 7.63 (95%CI: 5.06–11.5) and 5.33 (95CI%: 3.86–7.35), respectively. Mean Ki67 scores in 48 primary triple negative tumours (TNT) that relapsed locally were 15.74 (95%CI: 8.53–29.06) after conventional and 7.52 (95%CI: 3.51–16.1) after hypofractionated radiotherapy, but TNT were equally represented (28%) in both groups.
Conclusion: An association between proliferative indices and fractionation sensitivity in breast tumours has not been demonstrated. If confirmed, it suggests that genetic and epigenetic features unrelated to proliferation are sources of inter-tumour variation in fractionation sensitivity.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-06-09.
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Affiliation(s)
- DN Rodrigues
- Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom; Institute of Cancer Research, Sutton, Surrey, United Kingdom; University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom; Cheltenham General Hospital, Cheltenham, United Kingdom
| | - N Somaiah
- Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom; Institute of Cancer Research, Sutton, Surrey, United Kingdom; University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom; Cheltenham General Hospital, Cheltenham, United Kingdom
| | - F Daley
- Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom; Institute of Cancer Research, Sutton, Surrey, United Kingdom; University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom; Cheltenham General Hospital, Cheltenham, United Kingdom
| | - S Davies
- Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom; Institute of Cancer Research, Sutton, Surrey, United Kingdom; University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom; Cheltenham General Hospital, Cheltenham, United Kingdom
| | - E Rakha
- Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom; Institute of Cancer Research, Sutton, Surrey, United Kingdom; University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom; Cheltenham General Hospital, Cheltenham, United Kingdom
| | - R A'Hern
- Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom; Institute of Cancer Research, Sutton, Surrey, United Kingdom; University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom; Cheltenham General Hospital, Cheltenham, United Kingdom
| | - J Haviland
- Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom; Institute of Cancer Research, Sutton, Surrey, United Kingdom; University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom; Cheltenham General Hospital, Cheltenham, United Kingdom
| | - M Sydenham
- Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom; Institute of Cancer Research, Sutton, Surrey, United Kingdom; University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom; Cheltenham General Hospital, Cheltenham, United Kingdom
| | - R Owen
- Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom; Institute of Cancer Research, Sutton, Surrey, United Kingdom; University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom; Cheltenham General Hospital, Cheltenham, United Kingdom
| | - J Reis-Filho
- Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom; Institute of Cancer Research, Sutton, Surrey, United Kingdom; University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom; Cheltenham General Hospital, Cheltenham, United Kingdom
| | - JR Yarnold
- Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom; Institute of Cancer Research, Sutton, Surrey, United Kingdom; University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom; Cheltenham General Hospital, Cheltenham, United Kingdom
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Abstract
PURPOSE The purpose of this study was to analyse the impact of coping response on survival of breast cancer by using a new method of assessing coping. METHOD Adjustment to cancer was assessed using a revised measure in a large cohort of breast cancer patients (N = 578) followed up over a period of 10 years. Impact of coping response measured early in the disease process (<4 months from primary diagnosis of early-stage breast cancer) was assessed, and survival analyses were undertaken including known clinical staging data and cancer treatment details. RESULTS After 5 years of follow-up from primary diagnosis, the effect of prior 'negative adjustment' was statistically significantly linked to increased risk of death and relapse of breast cancer, and for the 10-year analysis, this result remained for both risk of death and relapse. There was no statistically significant effect on survival of the novel 'positive adjustment' response. CONCLUSIONS Coping with cancer was assessed using a new methodology and is linked to an adverse impact of negative adjustment on overall survival. Positive adjustment was unrelated to survival. The current study strengthens previous evidence that there is a link between survival and coping response. The question remains of how coping response might affect physical outcome. It is considered that coping response likely impacts survival through the mediating effects on lifestyle and health behaviour that may contribute to an adverse prognosis.
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Affiliation(s)
- M Watson
- Royal Marsden NHS Foundation Trust, Sutton, UK.
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Winters ZE, Haviland J, Balta V, Benson J, Reece-Smith A, Betambeau N. Integration of patient-reported outcome measures with key clinical outcomes after immediate latissimus dorsi breast reconstruction and adjuvant treatment. Br J Surg 2012; 100:240-51. [PMID: 23175286 DOI: 10.1002/bjs.8959] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2012] [Indexed: 11/08/2022]
Abstract
BACKGROUND Clinical evidence on patient-reported outcome measures (PROMS) in breast reconstruction is lacking. The aim of this study was to evaluate PROMs in implant-assisted latissimus dorsi (LDI) or tissue-only autologous latissimus dorsi (ALD) flap reconstruction in relation to complications and adjuvant treatments. METHODS This was a prospective cohort study involving six UK centres. Eligible patients had primary early-stage breast cancer. The European Organization for Research and Treatment of Cancer quality-of-life questionnaire (QLQ)-C30 and QLQ-BR23, Functional Assessment of Cancer Therapy-Breast Cancer scale (FACT-B), Body Image Scale, and Hospital Anxiety and Depression Scale were completed before operation and at 3, 6 and 12 months after surgery. RESULTS A total of 182 patients (82 LDI and 100 ALD) were recruited between 2007 and 2010 with symptomatic (59·9 per cent) or screen-detected (39·6 per cent) cancers. Some 64·3 per cent had lymph node-negative disease; 30 per cent of the LDI group had radiotherapy, compared with 53·0 per cent in the ALD group (P = 0·004). Early complications up to 3 months after surgery were reported in 66 and 51·0 per cent of patients in the LDI and ALD groups respectively (P = 0·062) and long-term complications (4-12 months) in 48 and 45·0 per cent (P = 0·845). Role functioning and pain (P = 0·002 for both) were adversely affected in the ALD group compared with results in the LDI group, with no significant effects of radiotherapy on any health-related quality of life (HRQL). Chemotherapy and early complications adversely affected HRQL, which improved between 3 and 12 months after surgery (P < 0·010 for all). CONCLUSION There is evidence of similar HRQL between types of latissimus dorsi breast reconstruction for up to a year after surgery. There appear to be no overarching effects for radiotherapy after mastectomy on the specific HRQL domains studied in the short term. The identification of variables that affect HRQL is important, including their integration into the analysis of PROMs.
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Affiliation(s)
- Z E Winters
- Breast Reconstruction Quality of Life and Clinical Outcomes Research Group, School of Clinical Sciences, University of Bristol and University Hospitals of Bristol NHS Foundation Trust, Bristol Royal Infirmary, Bristol, UK.
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Winters ZE, Haviland J, Reece-Smith A, Betambeau N, Choudhry K, Chaudhry A, Mills J, Benson J, Galea M, MacMannus P, Nicholson S, Weiler-Mithoff E, Rayter Z, Thomson HJ. P2-16-01: A Multi-Centre Prospective Cohort Study Evaluating Health Related Quality of Life after Types of Immediate Latissimus Dorsi (LD) Breast Reconstruction. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p2-16-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Evidence for the clinical effectiveness of breast reconstruction based on Patient Reported Outcome Measures (PROMS) is lacking. Methodology evaluating PROMS after types of breast reconstruction has been poor with respect to study design, statistics, missing data and absence of prospective documentation of pre-defined complication data in a systematic review of all studies since 19781. Furthermore, there is no reliable data on the effects of associated radiotherapy (RT) in this context. As a prelude to a proposed randomised trial in breast reconstruction, our aim was to conduct a ‘robust’ cohort study evaluating the effects of either implant-assisted LD (LDI) or tissue only (ALD) LD flap reconstruction in relation to key determinants including clinico-pathological parameters, complications and treatment schedules over a 36 month period.
Methods: An MREC approved prospective longitudinal cohort study involving 6 centres commenced in early 2007. Serial PROMS using the EORTC QLQ-C30, BR-23, FACT-B, BIS and HADS, were completed pre-operatively and at 3, 6, 12, 24 and 36 months after surgery. Data up to 12 months were included in this analysis as data were sparse beyond this point; follow-up is ongoing. Demographic and clinical data were compared between the surgical groups. Generalised estimating equations were used to investigate demographic and clinical predictors of HRQL over time.
Results: A total of 189 patients (107-ALD, 82-LDI) were recruited, with a mean age of 50 years (range 22–70). Baseline questionnaires were completed by 149 (79%) women, with 167 (88%) available at 12 months. Patients in the ALD group had a higher BMI (mean 27.3 versus 25.2 in LDI, p=0.001) and a greater likelihood of post-mastectomy RT (52% versus 30% in LDI, p=0.004).
Only role functioning (p=0.001) and pain (p=0.003) were significantly adversely affected in the ALD v LDI group, with no statistically significant effects from PMRT on HRQL, although chemotherapy impaired global QoL (p<0.001) and social functioning (p=0.001), and increased fatigue (p=0.007). Early complications (< 3 months) significantly impaired HRQL in general, as did poor baseline scores (p<0.01 for various subscales). Significant improvements over time were noted for global QoL, role and social functioning, fatigue, pain and breast symptoms (p<0.001 for all).
Conclusion: There is increasing evidence of clinical equipoise between types of LD breast reconstruction and despite acknowledged cosmetic disadvantages the overall effects of PMRT on HRQL are minimal. The identification of important variables that may affect HRQL is crucial in all studies evaluating the effects of surgery on PROMS. Their integration into study results is essential for correct interpretation of clinically based assessments. This remains a challenging aspect in cohort studies, and emphasises the need for pragmatism in design of trials in the field.
1. Winters ZE, Benson JR, Pusic AL. Annals of Surgery 2010;252(6):929–42
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-16-01.
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Affiliation(s)
- ZE Winters
- 1University Hospitals Bristol NHS Foundation Trust, Bristol, Avon, South West, United Kingdom; Clinical Trials & Statistics Unit, The Institute of Cancer Research, Sutton, London, Sutton Surrey, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, East Anglia, United Kingdom; Western General NHS Foundation Trust Swindon, Swindon, South West, United Kingdom; Hull and East Yorkshire Hospitals NHS Trust, Hull, East Yorkshire, United Kingdom; York Hospitals NHS Trust, York, East Yorkshire, United Kingdom; NHS Greater Glasgow and Clyde, Canniesburn, Glasgow, Scotland, United Kingdom
| | - J Haviland
- 1University Hospitals Bristol NHS Foundation Trust, Bristol, Avon, South West, United Kingdom; Clinical Trials & Statistics Unit, The Institute of Cancer Research, Sutton, London, Sutton Surrey, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, East Anglia, United Kingdom; Western General NHS Foundation Trust Swindon, Swindon, South West, United Kingdom; Hull and East Yorkshire Hospitals NHS Trust, Hull, East Yorkshire, United Kingdom; York Hospitals NHS Trust, York, East Yorkshire, United Kingdom; NHS Greater Glasgow and Clyde, Canniesburn, Glasgow, Scotland, United Kingdom
| | - A Reece-Smith
- 1University Hospitals Bristol NHS Foundation Trust, Bristol, Avon, South West, United Kingdom; Clinical Trials & Statistics Unit, The Institute of Cancer Research, Sutton, London, Sutton Surrey, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, East Anglia, United Kingdom; Western General NHS Foundation Trust Swindon, Swindon, South West, United Kingdom; Hull and East Yorkshire Hospitals NHS Trust, Hull, East Yorkshire, United Kingdom; York Hospitals NHS Trust, York, East Yorkshire, United Kingdom; NHS Greater Glasgow and Clyde, Canniesburn, Glasgow, Scotland, United Kingdom
| | - N Betambeau
- 1University Hospitals Bristol NHS Foundation Trust, Bristol, Avon, South West, United Kingdom; Clinical Trials & Statistics Unit, The Institute of Cancer Research, Sutton, London, Sutton Surrey, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, East Anglia, United Kingdom; Western General NHS Foundation Trust Swindon, Swindon, South West, United Kingdom; Hull and East Yorkshire Hospitals NHS Trust, Hull, East Yorkshire, United Kingdom; York Hospitals NHS Trust, York, East Yorkshire, United Kingdom; NHS Greater Glasgow and Clyde, Canniesburn, Glasgow, Scotland, United Kingdom
| | - K Choudhry
- 1University Hospitals Bristol NHS Foundation Trust, Bristol, Avon, South West, United Kingdom; Clinical Trials & Statistics Unit, The Institute of Cancer Research, Sutton, London, Sutton Surrey, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, East Anglia, United Kingdom; Western General NHS Foundation Trust Swindon, Swindon, South West, United Kingdom; Hull and East Yorkshire Hospitals NHS Trust, Hull, East Yorkshire, United Kingdom; York Hospitals NHS Trust, York, East Yorkshire, United Kingdom; NHS Greater Glasgow and Clyde, Canniesburn, Glasgow, Scotland, United Kingdom
| | - A Chaudhry
- 1University Hospitals Bristol NHS Foundation Trust, Bristol, Avon, South West, United Kingdom; Clinical Trials & Statistics Unit, The Institute of Cancer Research, Sutton, London, Sutton Surrey, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, East Anglia, United Kingdom; Western General NHS Foundation Trust Swindon, Swindon, South West, United Kingdom; Hull and East Yorkshire Hospitals NHS Trust, Hull, East Yorkshire, United Kingdom; York Hospitals NHS Trust, York, East Yorkshire, United Kingdom; NHS Greater Glasgow and Clyde, Canniesburn, Glasgow, Scotland, United Kingdom
| | - J Mills
- 1University Hospitals Bristol NHS Foundation Trust, Bristol, Avon, South West, United Kingdom; Clinical Trials & Statistics Unit, The Institute of Cancer Research, Sutton, London, Sutton Surrey, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, East Anglia, United Kingdom; Western General NHS Foundation Trust Swindon, Swindon, South West, United Kingdom; Hull and East Yorkshire Hospitals NHS Trust, Hull, East Yorkshire, United Kingdom; York Hospitals NHS Trust, York, East Yorkshire, United Kingdom; NHS Greater Glasgow and Clyde, Canniesburn, Glasgow, Scotland, United Kingdom
| | - J Benson
- 1University Hospitals Bristol NHS Foundation Trust, Bristol, Avon, South West, United Kingdom; Clinical Trials & Statistics Unit, The Institute of Cancer Research, Sutton, London, Sutton Surrey, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, East Anglia, United Kingdom; Western General NHS Foundation Trust Swindon, Swindon, South West, United Kingdom; Hull and East Yorkshire Hospitals NHS Trust, Hull, East Yorkshire, United Kingdom; York Hospitals NHS Trust, York, East Yorkshire, United Kingdom; NHS Greater Glasgow and Clyde, Canniesburn, Glasgow, Scotland, United Kingdom
| | - M Galea
- 1University Hospitals Bristol NHS Foundation Trust, Bristol, Avon, South West, United Kingdom; Clinical Trials & Statistics Unit, The Institute of Cancer Research, Sutton, London, Sutton Surrey, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, East Anglia, United Kingdom; Western General NHS Foundation Trust Swindon, Swindon, South West, United Kingdom; Hull and East Yorkshire Hospitals NHS Trust, Hull, East Yorkshire, United Kingdom; York Hospitals NHS Trust, York, East Yorkshire, United Kingdom; NHS Greater Glasgow and Clyde, Canniesburn, Glasgow, Scotland, United Kingdom
| | - P MacMannus
- 1University Hospitals Bristol NHS Foundation Trust, Bristol, Avon, South West, United Kingdom; Clinical Trials & Statistics Unit, The Institute of Cancer Research, Sutton, London, Sutton Surrey, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, East Anglia, United Kingdom; Western General NHS Foundation Trust Swindon, Swindon, South West, United Kingdom; Hull and East Yorkshire Hospitals NHS Trust, Hull, East Yorkshire, United Kingdom; York Hospitals NHS Trust, York, East Yorkshire, United Kingdom; NHS Greater Glasgow and Clyde, Canniesburn, Glasgow, Scotland, United Kingdom
| | - S Nicholson
- 1University Hospitals Bristol NHS Foundation Trust, Bristol, Avon, South West, United Kingdom; Clinical Trials & Statistics Unit, The Institute of Cancer Research, Sutton, London, Sutton Surrey, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, East Anglia, United Kingdom; Western General NHS Foundation Trust Swindon, Swindon, South West, United Kingdom; Hull and East Yorkshire Hospitals NHS Trust, Hull, East Yorkshire, United Kingdom; York Hospitals NHS Trust, York, East Yorkshire, United Kingdom; NHS Greater Glasgow and Clyde, Canniesburn, Glasgow, Scotland, United Kingdom
| | - E Weiler-Mithoff
- 1University Hospitals Bristol NHS Foundation Trust, Bristol, Avon, South West, United Kingdom; Clinical Trials & Statistics Unit, The Institute of Cancer Research, Sutton, London, Sutton Surrey, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, East Anglia, United Kingdom; Western General NHS Foundation Trust Swindon, Swindon, South West, United Kingdom; Hull and East Yorkshire Hospitals NHS Trust, Hull, East Yorkshire, United Kingdom; York Hospitals NHS Trust, York, East Yorkshire, United Kingdom; NHS Greater Glasgow and Clyde, Canniesburn, Glasgow, Scotland, United Kingdom
| | - Z Rayter
- 1University Hospitals Bristol NHS Foundation Trust, Bristol, Avon, South West, United Kingdom; Clinical Trials & Statistics Unit, The Institute of Cancer Research, Sutton, London, Sutton Surrey, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, East Anglia, United Kingdom; Western General NHS Foundation Trust Swindon, Swindon, South West, United Kingdom; Hull and East Yorkshire Hospitals NHS Trust, Hull, East Yorkshire, United Kingdom; York Hospitals NHS Trust, York, East Yorkshire, United Kingdom; NHS Greater Glasgow and Clyde, Canniesburn, Glasgow, Scotland, United Kingdom
| | - HJ Thomson
- 1University Hospitals Bristol NHS Foundation Trust, Bristol, Avon, South West, United Kingdom; Clinical Trials & Statistics Unit, The Institute of Cancer Research, Sutton, London, Sutton Surrey, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, East Anglia, United Kingdom; Western General NHS Foundation Trust Swindon, Swindon, South West, United Kingdom; Hull and East Yorkshire Hospitals NHS Trust, Hull, East Yorkshire, United Kingdom; York Hospitals NHS Trust, York, East Yorkshire, United Kingdom; NHS Greater Glasgow and Clyde, Canniesburn, Glasgow, Scotland, United Kingdom
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Yarnold J, Owen R, Haviland J. VOLUME EFFECTS FOR LATE ADVERSE EFFECTS AFTER ADJUVANT BREAST RADIOTHERAPY. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)71721-2] [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: 10/14/2022]
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13
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Winters Z, Mills J, Haviland J, Reece-Smith A, Greenslade M, Benson J, Galea M, McManus P, Nicholson S, Weiler-Mithoff E, Rayter Z, Balta V, Thomson H. O-92 A multi centre prospective longitudinal study evaluating health related quality of life after immediate Latissimus dorsi (LD) breast reconstruction. EJC Suppl 2010. [DOI: 10.1016/j.ejcsup.2010.06.093] [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: 11/15/2022] Open
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14
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Winters Z, Haviland J, Mills J, Benson J, Galea M, McManus P, Nicholson S, Weiler-Mithoff E, Rayter Z, Thomson H. 378 A multicentre prospective longitudinal study establishing level II evidence of health related quality of life after types of immediate latissimus dorsi (LD) breast reconstruction. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)70404-3] [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: 11/29/2022] Open
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15
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Corner J, Yardley J, Maher EJ, Roffe L, Young T, Maslin-Prothero S, Gwilliam C, Haviland J, Lewith G. Patterns of complementary and alternative medicine use among patients undergoing cancer treatment. Eur J Cancer Care (Engl) 2010; 18:271-9. [PMID: 19432919 DOI: 10.1111/j.1365-2354.2007.00911.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study aimed to assess the prevalence of complementary and alternative medicine (CAM) use in a representative cancer population prior to and within 6 months of diagnosis. A total of 304 newly diagnosed cancer patients from two UK cancer centres completed a postal survey. Of them, 100 patients (32.9%) used CAM before their cancer diagnosis, 59 of these CAM users continued post diagnosis. Twenty-nine individuals who had not used CAM before began to use it after their cancer diagnosis, creating a total of 88 (28.9%) CAM users in this sample. Reasons for not using CAM included lack of interest, lack of information or endorsement from professionals and satisfaction with conventional care. For those using CAM before diagnosis but not afterwards, the most common reason was a lack of expert guidance on what was safe to use. The use of CAM medicines bought from health food and other retail outlets was high. Complementary and alternative medicine use in cancer patients is common and demonstrates a complex pattern, but CAM use is not significantly greater than in the general population. Some patients purchase CAM medicines without seeking medical advice, thus risking drug interactions. Research to generate information on safety and efficacy of CAM is required.
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Affiliation(s)
- J Corner
- School of Nursing and Midwifery, University of Southampton, Highfield, Southampton, UK.
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16
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Winters Z, Mills J, Haviland J, Reece-Smith A, Greenslade M, Benson J, Galea M, MacMannus P, Nicholson S, Weiler-Mithoff E, Rayter Z, Thomson H. A Multi Centre Prospective Longitudinal Study Establishing Level II Evidence of Health Related Quality of Life after Types of Immediate Latissimus Dorsi (LD) Breast Reconstruction. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-3106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: NICE recommends that the majority of women undergoing mastectomy should be offered immediate breast reconstruction with its potential benefits to improve health related quality of life (HRQL). A systematic review shows poor and conflicting evidence with a lack of 'hard' data to best inform both clinicians and their patients. Our aim was to evaluate the effects of implant-assisted LD (LDI) versus autologous LD (ALD) breast reconstruction on HRQL over 36 months. Recently, with the exception of the USA Breast-Q module there is a lack of a validated Breast reconstruction questionnaire.Methods: An MREC approved prospective longitudinal cohort study involving 6 centres commenced in early 2007. Serial patient reported outcome measures using the EORTC C30 (global QoL, physical functioning, fatigue, pain), BR-23 (breast and arm symptoms), 10 item Body Image Scale (BIS) and HADS, were completed pre-operatively and at 3, 6, 12, 24 and 36 months after surgery. Overall cosmetic satisfaction of the breast reconstruction was measured by a study-specific question on a 5 point Likert scale. Generalised estimating equations were used to assess change over time and differences between treatment groups.The Spearman's rank correlation coefficient was used to assess associations between patient reported cosmetic satisfaction with BIS and breast symptoms.Results: 118 patients (65 – ALD, 53 – LDI) were recruited to the study with a mean age of 50 years (range 22-70). Compliance with questionnaires at all time points was between 85-90%. There were no significant differences in HRQL domains between LDI and ALD, except a tendency for worse pain with ALD (p=0.06). Significant improvements over time were seen for overall HRQL (p<0.001), fatigue (p<0.001), breast symptoms (p=0.04), arm symptoms (p=0.001), as well as anxiety (p=0.017) and depression (p<0.001). Preliminary data shows that overall cosmetic satisfaction was significantly correlated with better body image and fewer breast symptoms. The study is ongoing in terms of 24 and 36 months follow-up and the evaluation of RT.Conclusion: There is an important need for cumulative clinical evidence in this field on which to base patient informed consent and clinical recommendations. Further analyses will assess whether there is an independent effect of RT on HRQL. A validated EORTC breast reconstruction module is in development.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3106.
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Affiliation(s)
- Z. Winters
- 1University Hospitals Bristol NHS Foundation Trust, South West, United Kingdom
| | - J. Mills
- 2Clinical Trials and Statistics Unit, London, United Kingdom
| | - J. Haviland
- 2Clinical Trials and Statistics Unit, London, United Kingdom
| | - A. Reece-Smith
- 1University Hospitals Bristol NHS Foundation Trust, South West, United Kingdom
| | - M. Greenslade
- 1University Hospitals Bristol NHS Foundation Trust, South West, United Kingdom
| | - J. Benson
- 3Addenbrooke's Hospital Cambridge NHS Foundation Trust, United Kingdom
| | - M. Galea
- 4Western General NHS Foundation Trust, United Kingdom
| | - P. MacMannus
- 5Hull and Yeast Yorkshire Hospitlas NHS Trust, United Kingdom
| | | | | | - Z. Rayter
- 1University Hospitals Bristol NHS Foundation Trust, South West, United Kingdom
| | - H. Thomson
- 1University Hospitals Bristol NHS Foundation Trust, South West, United Kingdom
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Abstract
The study aimed to improve understanding of the natural history and impact of hot flushes after breast cancer. Data were collected from women participating in an RCT of relaxation to reduce the incidence of flushes from breast cancer follow-up clinics from two hospitals in South-East England. Repondents were 150 women experiencing hot flushes following completion of primary treatment for breast cancer. This study utilized a flush diary, the Hot Flushes and Night Sweats Questionnaire (HFNSQ), Functional Assessment of Cancer Therapy with Endocrine Subscale (FACT-ES) and Spielberger State/Trait Anxiety Index (STAI) as the main outcome measures. The study found that in this sample, 51 (34%) women experienced flushes more than five years after diagnosis and 75 (50%) more than 5 years after menopause. Sleep disruption occurred in 90 women (72% of those that returned diaries), affecting half of the nights they recorded. The mean problem rating on the HFNSQ was 4.85 out of 10. A peak incidence of flushes was apparent around 10 a.m. in women taking tamoxifen. It was concluded that hot flushes after breast cancer may be long-lasting and cause sleeping difficulties for many women. Tamoxifen may affect the diurnal pattern of flushes. After breast cancer, the duration of flushes, potential distress and disruption to women's lives should not be underestimated and appropriate interventions should be offered.
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Affiliation(s)
- D R Fenlon
- School of Nursing & Midwifery, University of Southampton, Highfield, Southampton, Hampshire, UK.
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18
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Brunt A, Sydenham M, Bliss J, Coles C, Gothard L, Harnett A, Haviland J, Syndikus I, Wheatley D, Yarnold J. 7LBA A 5-fraction regimen of adjuvant radiotherapy for women with early breast cancer: first analysis of the randomised UK FAST trial (ISRCTN62488883, CRUKE/04/015). EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)72026-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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19
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Martin S, Mannino M, Rostom A, Tait D, Donovan E, Eagle S, Haviland J, Yarnold J. Acute toxicity and 2-year adverse effects of 30 Gy in five fractions over 15 days to whole breast after local excision of early breast cancer. Clin Oncol (R Coll Radiol) 2008; 20:502-5. [PMID: 18556186 DOI: 10.1016/j.clon.2008.04.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Revised: 04/23/2008] [Accepted: 04/24/2008] [Indexed: 12/17/2022]
Abstract
AIMS A pilot study was undertaken with the aim of documenting acute skin reactions and 2-year late adverse effects of a five-fraction course of adjuvant whole breast radiotherapy delivered over 15 days after local tumour excision of early breast cancer. MATERIALS AND METHODS Thirty women with early invasive breast cancer aged>or=50 years with a pathological tumour size<3 cm, complete microscopic resection, negative axillary node status and no requirement for cytotoxic therapy were prescribed 30 Gy in five fractions over 15 days to the whole breast using tangential 6-10 MV X-ray beams and three-dimensional dose compensation with written informed consent. Post-surgical baseline photographs of the breasts were taken, and acute skin erythema and moist desquamation were each scored weekly for 7 weeks using four-point graded scales (grade 0=none, 1=mild, 2=moderate, 3=severe). This was followed by an annual clinical assessment, including repeat photographs at 2 years. RESULTS Nine patients (30%, 95% confidence interval 14.7-49.4%) developed grade 2 erythema, with the remaining 21 patients developing milder degrees of reaction. Four (13.3%, 95% confidence interval 3.7-30.7) patients developed moist desquamation, grade 1 in three women and grade 2 in the fourth. At 2 years after treatment, 23/30 (77%) patients scored no change in photographic breast appearance compared with the pre-treatment baseline; seven (23%, 95% confidence interval 9.9-42.3) scored a mild change in breast appearance, and none developed a marked change. After a mean follow-up of 3.1 years (standard deviation 0.37, range 2.1-3.9 years) there have been no ipsilateral local tumour relapses. CONCLUSIONS Further evaluation of a five-fraction regimen of adjuvant whole breast radiotherapy in a phase III randomised trial is justified, including a regimen delivered in a total of 5 days.
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Affiliation(s)
- S Martin
- Department of Radiotherapy, Royal Marsden Hospital, Downs Road, Sutton, UK
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20
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Mills J, Sumo G, Haviland J, Bliss J, Hopwood P. Age, clinical and psychological associations with fatigue following radiotherapy for early breast cancer – Results from 2208 women in the UK Standardisation of Breast Radiotherapy Trials (START) on behalf of the START Trial Management Group. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)70530-5] [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: 10/22/2022] Open
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21
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Sydenham M, Haviland J, Bliss J, Gothard L, Tait D, Yarnold J. 2081 POSTER Scoring photographic assessment of normal tissue effects after radiotherapy for early breast cancer – a comparison of two different methods. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)70843-1] [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: 10/22/2022] Open
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22
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Hopwood P, Sumo G, Mills J, Haviland J, Bliss J. 1106 POSTER Prevalence, patterns and predictors of mood disorders in early breast cancer: results from 2208 women in the UK Standardisation of Breast Radiotherapy Trial (START). EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)70625-0] [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: 11/26/2022] Open
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23
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Hopwood P, Sumo G, Mills J, Haviland J, Bliss J, Yarnold J. 1100 POSTER Body image and breast symptoms in early breast cancer: first results of the UK standardisation of breast radiotherapy (START) trials. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)70619-5] [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: 11/16/2022] Open
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24
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Lawton P, Aird E, Bliss J, Haviland J, Magee B, Sydenham M, Venables K, Yarnold J. 2037 POSTER The effect of hypofractionation and radiation dosimetry on the incidence of symptomatic rib fractures in women treated with radiotherapy for early breast cancer in the UK standardisation of breast radiotherapy (START) Trials. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)70799-1] [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: 10/22/2022] Open
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25
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Sydenham M, Haviland J, Gothard L, Tait D, Yarnold J. Scoring Photographic Assessment of Normal Tissue Effects after Radiotherapy for Early Breast Cancer. Clin Oncol (R Coll Radiol) 2007. [DOI: 10.1016/j.clon.2007.01.422] [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: 10/23/2022]
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26
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Coombes RC, Howell A, Emson M, Peckitt C, Gallagher C, Bengala C, Tres A, Welch R, Lawton P, Rubens R, Woods E, Haviland J, Vigushin D, Kanfer E, Bliss JM. High dose chemotherapy and autologous stem cell transplantation as adjuvant therapy for primary breast cancer patients with four or more lymph nodes involved: long-term results of an international randomised trial. Ann Oncol 2005; 16:726-34. [PMID: 15817602 DOI: 10.1093/annonc/mdi166] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [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: 11/14/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess whether a short course of anthracycline containing chemotherapy followed by high dose therapy with autologous stem-cell support improves disease-free and overall survival as compared with conventional, anthracycline containing chemotherapy, in patients with primary breast cancer and four or more histologically involved lymph nodes. PATIENTS AND METHODS Two hundred and eighty one patients entered into a randomised clinical trial were allocated to receive standard, conventional treatment (5-fluorouracil, epirubicin and cyclophosphamide-FEC for six cycles) or FEC for three cycles followed by high dose therapy consisting of cyclophosphamide, thiotepa and carboplatin and stem cell rescue (HDT). To be eligible, patients had to be free of overt metastatic disease and be < or =60 years of age. Analyses were according to intention to treat. RESULTS At a median follow up of 68 months, 118 patients have experienced a relapse or death from breast cancer (62 in the FEC followed by HDT arm and 56 in the conventional FEC arm) and a total of 100 patients have died (54 in the FEC followed by HDT arm and 46 in the conventional FEC arm). No significant difference was observed in relapse-free survival [hazard ratio 1.06, 95% CI 0.74-1.52, p = 0.76] or overall survival [hazard ratio 1.18, 95% CI 0.80-1.75, p = 0.40]. Five patients died from treatment related causes, three as a consequence of HDT and two in the conventional FEC arm. CONCLUSIONS At the present time, no benefit has been observed from replacing three cycles of conventional chemotherapy with the HDT regimen described here. Patients should continue to receive conventional chemotherapy as adjuvant therapy for breast cancer.
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Affiliation(s)
- R C Coombes
- Cancer Research UK Department of Cancer Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, London.
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27
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Bailey C, Corner J, Addington-Hall J, Kumar D, Haviland J. Older patients' experiences of treatment for colorectal cancer: an analysis of functional status and service use. Eur J Cancer Care (Engl) 2004; 13:483-93. [PMID: 15606716 DOI: 10.1111/j.1365-2354.2004.00555.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [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: 11/24/2022]
Abstract
Age and ageing are an important part of the context within which the care and treatment of people with cancer is provided. More information is needed about the effects of cancer treatment on the lives of older people following inpatient care. We conducted a 3-year study in which older people with colorectal cancer completed a detailed questionnaire on multidimensional function and service use before and after elective treatment. Here we present an analysis of changes in functional status and service use over the pre- to post-treatment period, and set out a detailed picture of older people's experiences before and after treatment. In total, 337 patients with colorectal adenocarcinoma aged 58-95 years were interviewed before treatment using the OARS Multidimensional Functional Assessment Questionnaire (OMFAQ), Rotterdam Symptom Checklist (RSCL) and a severity of morbidity score. Study end points were defined as post-treatment functional status, symptom distress, severity of morbidity and frequency of service use. Pre- and post-treatment data were compared using matched analyses. Logistic regression was used to assess associations between age and the main outcome measures, and frequency of service use after treatment was compared between age groups using the chi2 test. Overall, patients experienced both positive and negative outcomes following treatment. It was notable that patients aged > or = 75 years showed improvement in only one of the principal outcome measures. Patterns of service use following treatment suggest that support at home is a key issue for patients. With the exception of nursing care, however, help at home is provided on a majority of occasions by families themselves. This raises important questions about how much preparation patients and families receive or would like before they leave hospital after treatment for cancer. A collaborative, family-centred approach to meeting people's needs is called for in the months following inpatient care.
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Affiliation(s)
- C Bailey
- University of Southampton, School of Nursing and Midwifery, Highfield, Southampton, UK.
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28
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Johnston SRD, Gumbrell LA, Evans TRJ, Coleman RE, Smith IE, Twelves CJ, Soukop M, Rea DW, Earl HM, Howell A, Jones A, Canney P, Powles TJ, Haynes BP, Nutley B, Grimshaw R, Jarman M, Halbert GW, Brampton M, Haviland J, Dowsett M, Coombes RC. A Cancer Research (UK) randomized phase II study of idoxifene in patients with locally advanced/metastatic breast cancer resistant to tamoxifen. Cancer Chemother Pharmacol 2004; 53:341-8. [PMID: 14722733 DOI: 10.1007/s00280-003-0733-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2003] [Accepted: 10/09/2003] [Indexed: 11/27/2022]
Abstract
Idoxifene is a novel selective oestrogen receptor modulator (SERM) which had greater binding affinity for the oestrogen receptor (ER) and reduced agonist activity compared with tamoxifen in preclinical studies. In a randomized phase II trial in 56 postmenopausal patients with progressive locally advanced/metastatic breast cancer we assessed whether idoxifene showed evidence of activity compared with an increased 40 mg/day dose of tamoxifen in patients who had previously demonstrated resistance to the standard 20 mg/day dose of tamoxifen. Of 47 patients eligible for response (25 idoxifene, 22 tamoxifen), two partial responses and two disease stabilizations (SD) for >6 months were seen with idoxifene (overall clinical benefit rate 16%, 95% CI 4.5-36.1%). The median duration of clinical benefit was 9.8 months. In contrast, no objective responses were seen with the increased 40 mg/day dose of tamoxifen, although two patients had SD for 7 and 14 months (clinical benefit rate 9%, 95% CI 1.1-29.2%). Idoxifene was well tolerated and the reported possible drug-related toxicities were similar in frequency to those with tamoxifen (hot flushes 13% vs 15%, mild nausea 20% vs 15%). Endocrine and lipid analysis in both groups showed a similar significant fall in serum follicle-stimulating hormone and luteinizing hormone after 4 weeks, together with a significant rise in sex hormone binding globulin levels and 11% reduction in serum cholesterol levels. In conclusion, while idoxifene was associated with only modest evidence of clinical activity in patients with tamoxifen-resistant breast cancer, its toxicity profile and effects on endocrine/lipid parameters were similar to those of tamoxifen.
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Affiliation(s)
- S R D Johnston
- Cancer Research UK, Lincoln's Inn Fields, London, WC2A 3PX, UK
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29
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Bailey C, Corner J, Addington-Hall J, Kumar D, Nelson M, Haviland J. Treatment decisions in older patients with colorectal cancer: the role of age and multidimensional function. Eur J Cancer Care (Engl) 2003; 12:257-62. [PMID: 12919305 DOI: 10.1046/j.1365-2354.2003.00409.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [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: 11/20/2022]
Abstract
The aim of the study was to investigate the role of age and multidimensional functional status in treatment decisions in older patients with colorectal cancer. Three hundred and thirty-seven patients aged 58-95 years with adenocarcinoma of the colon or rectum were interviewed before and after treatment using the OARS Multidimensional Functional Assessment Questionnaire (OMFAQ), a self-reported severity of morbidity scale, and the Rotterdam Symptom Checklist (RSCL). The OMFAQ rates five dimensions of function: social resources, economic resources, mental and physical health and self-care capacity. The likelihood of patients with Duke's C colorectal cancer receiving adjuvant chemotherapy decreased significantly with age (P = 0.001, trend). Differences in treatment received were not explained by differences in morbidity, economic, mental or physical function, self-care capacity, or any of the RSCL measures. After controlling for age, Duke's C patients who received adjuvant chemotherapy were less impaired in social resources than Duke's C patients who did not (P = 0.06). No other significant pre-treatment differences in functional status were found. Differences in age and social resources exist between patients who do and do not receive adjuvant chemotherapy. Care should be taken to ensure that patients are not excluded from treatment with known survival benefits because of their age, and the question of providing appropriate social support during adjuvant chemotherapy should be re-examined.
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Affiliation(s)
- C Bailey
- Centre for Cancer and Palliative Care Studies, Institute of Cancer Research, Sutton, Surrey, UK.
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30
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Bailey C, Corner J, Addington-Hall J, Kumar D, Haviland J. 1105 Older patients' experiences of colorectal cancer: functional status and service use following treatment. EJC Suppl 2003. [DOI: 10.1016/s1359-6349(03)91131-1] [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: 11/29/2022] Open
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31
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Abstract
The objective of this study was to describe patients' and informal carers' perceptions of care received and services offered following a diagnosis of primary lung cancer. We prepared a prospective, national, mail questionnaire survey of 466 patients with a diagnosis of primary lung cancer and a lay carer of their choice. The setting was 24 randomly chosen hospitals throughout the UK, from a range of urban (n = 11) and rural settings (n = 13). The majority (76%/159) of responders were recipients of care from cancer units. Two hundred and nine patients (45%) with primary lung cancer and 70 (15%) lay carers completed questionnaires. The main results that we found were that key areas of unmet need were most apparent during periods away from acute service sectors, with as few as 40% of patients reporting having received as much help as they needed from community services. The greatest onus of care for patients fell to lay carers, but only 29% of patients identified their lay carers as having needs in relation to their illness. Where patients received all their diagnostic tests in one hospital they were significantly more likely to wait less time between first seeing their general practitioner (GP) and being told their diagnosis (P = 0.0001) than patients who had to attend more than one hospital during their diagnostic work-up period. Fifty per cent of patients reported experiencing some degree of breathlessness even at rest, but only 15% reported having received any advice on living with it. Less than a quarter (23%) of hospital consultants identified anxiety as a key problem for patients with lung cancer, but 66% of patients identified it as such. Hospital staff largely overlook the needs of informal carers, who derive support from a small, mainly community oriented group of professionals, but accessing help is problematic and is dependent on local resources and a need to be proactive. Our conclusions are that developments in service provision for patients with lung cancer and their informal carers need to focus on six key areas: development of strategies to encourage patients to present earlier to their GP; ongoing evaluation of rapid diagnostic clinics; development and evaluation of a lung cancer care coordinator role; evaluation of innovations in delivery of nursing care in the community; development of local guidelines to facilitate equitable access to palliative care and social services; and evaluation of supportive strategies targeted at lay carers.
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Affiliation(s)
- M Krishnasamy
- Centre for Cancer and Palliative Care Studies, Institute of Cancer Research, Cotswold Road, Sutton, Surrey SM2 5NG, UK.
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32
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Drouin SM, Kildsgaard J, Haviland J, Zabner J, Jia HP, McCray PB, Tack BF, Wetsel RA. Expression of the complement anaphylatoxin C3a and C5a receptors on bronchial epithelial and smooth muscle cells in models of sepsis and asthma. J Immunol 2001; 166:2025-32. [PMID: 11160252 DOI: 10.4049/jimmunol.166.3.2025] [Citation(s) in RCA: 159] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The presence of the complement-derived anaphylatoxin peptides, C3a and C5a, in the lung can induce respiratory distress characterized by contraction of the smooth muscle walls in bronchioles and pulmonary arteries and aggregation of platelets and leukocytes in pulmonary vessels. C3a and C5a mediate these effects by binding to their specific receptors, C3aR and C5aR, respectively. The cells that express these receptors in the lung have not been thoroughly investigated, nor has their expression been examined during inflammation. Accordingly, C3aR and C5aR expression in normal human and murine lung was determined in this study by immunohistochemistry and in situ hybridization. In addition, the expression of these receptors was delineated in mice subjected to LPS- and OVA-induced models of inflammation. Under noninflamed conditions, C3aR and C5aR protein and mRNA were expressed by bronchial epithelial and smooth muscle cells of both human and mouse lung. C3aR expression increased significantly on both bronchial epithelial and smooth muscle cells in mice treated with LPS; however, in the OVA-challenged animals only the bronchial smooth muscle cells showed increased C3aR expression. C5aR expression also increased significantly on bronchial epithelial cells in mice treated with LPS, but was not elevated in either cell type in the OVA-challenged mice. These results demonstrate the expression of C3aR and C5aR by cells endogenous to the lung, and, given the participation of bronchial epithelial and smooth muscle cells in the pathology of diseases such as sepsis and asthma, the data suggest a role for these receptors during lung inflammation.
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MESH Headings
- Aerosols
- Amino Acid Sequence
- Animals
- Antigens, CD/biosynthesis
- Antigens, CD/genetics
- Asthma/immunology
- Asthma/metabolism
- Asthma/pathology
- Bronchi/blood supply
- Bronchi/immunology
- Bronchi/metabolism
- Bronchi/pathology
- Cells, Cultured
- Complement C3a/metabolism
- Complement C5a/metabolism
- Disease Models, Animal
- Endotoxemia/immunology
- Endotoxemia/metabolism
- Endotoxemia/pathology
- Humans
- Injections, Intraperitoneal
- Lipopolysaccharides/administration & dosage
- Lung/cytology
- Lung/immunology
- Lung/metabolism
- Membrane Proteins
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- Molecular Sequence Data
- Muscle, Smooth/immunology
- Muscle, Smooth/metabolism
- Muscle, Smooth/pathology
- Muscle, Smooth, Vascular/immunology
- Muscle, Smooth, Vascular/metabolism
- Muscle, Smooth, Vascular/pathology
- Ovalbumin/administration & dosage
- Ovalbumin/immunology
- Receptor, Anaphylatoxin C5a
- Receptors, Complement/biosynthesis
- Receptors, Complement/genetics
- Respiratory Mucosa/blood supply
- Respiratory Mucosa/immunology
- Respiratory Mucosa/metabolism
- Respiratory Mucosa/pathology
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Affiliation(s)
- S M Drouin
- University of Texas-Houston Institute of Molecular Medicine for the Prevention of Human Diseases, and Department of Biochemistry and Molecular Biology, Houston, TX 77030, USA
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33
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Abstract
Over the past three years 15 children have been admitted to the paediatric intensive care unit (PICU) at Addenbrooke's hospital suspected of having non-accidental injuries; presentation was diverse and often mild and out of proportion to the degree of morbidity seen at discharge and follow up. When compared with a group of similar aged children admitted to the PICU with severe head injury caused by accidental impact trauma, the differences in morbidity were profound. It is suggested that these differences are explained in part by the predominant repetitive rotational forces experienced during severe shaking compared with the translocational forces that the head experiences during impact injuries. This anecdotal evidence supports the theory that shaking alone may cause severe intracranial injury. Thus campaigns should continue to increase public and doctors' awareness that shaking may be dangerous.
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Affiliation(s)
- J Haviland
- Paediatric Department, Addenbrooke's Hospital, Cambridge
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34
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Brehm DM, Vite CH, Steinberg HS, Haviland J, van Winkle T. A retrospective evaluation of 51 cases of peripheral nerve sheath tumors in the dog. J Am Anim Hosp Assoc 1995; 31:349-59. [PMID: 7552669 DOI: 10.5326/15473317-31-4-349] [Citation(s) in RCA: 98] [Impact Index Per Article: 3.4] [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: 01/25/2023]
Abstract
Fifty-one cases of canine peripheral nerve sheath tumors were reviewed. Signalment, presenting clinical signs, duration of clinical signs, physical and neurological examination findings, results of diagnostic procedures, type of surgery performed, tumor location, relapse-free intervals and survival times, and causes of death were evaluated. Tumors were divided into three anatomical groups: tumors involving nerves distal to the brachial or lumbosacral plexus (Peripheral Group), tumors involving nerves of the brachial or lumbosacral plexus (Plexus Group), and tumors involving the vertebral canal (Root Group). The most common clinical findings were unilateral forelimb lameness and muscle atrophy. The most useful diagnostic tests were myelography and electromyography. Although there was no significant difference, dogs in the Root Group tended to have shorter relapse-free intervals and survival times than dogs in the Plexus Group. The overall prognosis for surgical management of peripheral nerve sheath tumors is guarded to poor.
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Affiliation(s)
- D M Brehm
- Department of Small Animal Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia 19104-6010, USA
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35
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Haviland J. From medical apartheid to siyazamile in the Eastern Cape province. A medical student's elective period in South Africa. J R Coll Physicians Lond 1994; 28:576-8. [PMID: 7884719 PMCID: PMC5401086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- J Haviland
- Department of Medicine, Royal London Hospital
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36
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Haviland J. Computerized nosocomial infection analysis. Hosp Top 1975; 53:26, 28-9. [PMID: 1126728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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