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Rodgers K, Jones A, Carlin A, Redsell S, Andreyev J. Starting a career in research nursing during a global pandemic. Br J Nurs 2024; 33:266-270. [PMID: 38446509 DOI: 10.12968/bjon.2024.33.5.266] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
In the spring of 2020, two nurses (KR and AJ) commenced their research nurse careers amid the SARS-Cov-2 (COVID-19) global pandemic. This reflective article discusses their experiences of beginning a clinical research nursing career, presented as a case study of their learning journey, rather than detailing the randomised controlled trial they delivered via GP practices. The main study compared standard care to nurse-led management of irritable bowel syndrome, the details of which will be published separately. The article identifies three overarching concepts: 'Green as grass, keen as mustard', 'Spires and steeples', and 'Down the rabbit hole'. The article offers insight from the two nurses for other professionals contemplating a career in research.
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Affiliation(s)
- Kay Rodgers
- Research Nurse and Queen's Nurse, Lincolnshire Community Health Services, Lincoln, at the time of the study
| | - Anna Jones
- Research Nurse, Lincolnshire Community Health Services, Lincoln, at the time of the study
| | - Alexandra Carlin
- Assistant Professor, Assessment Co-ordinator, Adult Nursing, BSc Nursing, School of Health Sciences, The University of Nottingham
| | - Sarah Redsell
- Professor of Children's Community and Public Health, Associate Deputy Head of School: Research, School of Health Sciences, The University of Nottingham
| | - Jervoise Andreyev
- Consultant Gastroenterologist, United Lincolnshire NHS Trust; Honorary Professor, The School of Medicine, University of Nottingham. Chief Investigator; The Lincolnshire Poacher Study, Lincolnshire Community Health Services
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Pucher P, Coombes A, Evans O, Taylor J, Moore J, White A, Lagergren J, Baker C, Kelly M, Kelly M, Gossage J, Dunn J, Zeki S, Byrne B, Andreyev J, Davies A. P-OGC21 Patient perspectives on symptoms of importance and preferences for follow-up after major upper gastro-intestinal cancer surgery. Br J Surg 2021. [DOI: 10.1093/bjs/znab430.149] [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: 11/13/2022]
Abstract
Abstract
Background
Long-lasting symptoms and reductions in quality of life are common after oesophago-gastric surgery. Post-operative follow-up has traditionally focussed on tumour recurrence and survival, but there is a growing need to also identify and treat functional sequelae to improve patients’ recovery.
Methods
An electronic survey was circulated via a British national charity for patients undergoing oesophago-gastric surgery and their families. Patients were asked about post-operative symptoms they deemed important to their quality of life, as well as satisfaction and preferences for post-operative follow-up. Differences between satisfied and dissatisfied patients with reference to follow-up were assessed.
Results
Among 362 respondents with a median follow-up of 58 months since surgery (range 3-412), 36 different symptoms were reported as being important to recovery and quality of life after surgery, with a median 13 symptoms per patient. Most (84%) respondents indicated satisfaction with follow-up. Unsatisfied patients were more likely to have received shorter follow-up than 5 years (27% among unsatisfied patient vs. 60% among satisfied patients, p < 0.001and were less likely to have seen a dietitian as part of routine follow-up (37% vs. 58%, p = 0.005).
Conclusions
This patient survey highlights preferences with regard to follow-up after oesophago-gastrectomy. Longer follow-up and dietician involvement improved patient satisfaction. Patients reported being concerned by a large number of gastrointestinal and non-gastrointestinal symptoms, highlighting the need for multidisciplinary input and a consensus on how to manage the poly-symptomatic patient.
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Affiliation(s)
- Philip Pucher
- Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
- St Thomas's Hospital, London, United Kingdom
| | | | - Orla Evans
- St Thomas's Hospital, London, United Kingdom
| | | | | | | | - Jesper Lagergren
- St Thomas's Hospital, London, United Kingdom
- Karolinska Institutet, Stockholm, Sweden
| | - Cara Baker
- St Thomas's Hospital, London, United Kingdom
| | - Mark Kelly
- St Thomas's Hospital, London, United Kingdom
| | - Mark Kelly
- St Thomas's Hospital, London, United Kingdom
| | | | - Jason Dunn
- St Thomas's Hospital, London, United Kingdom
| | | | - Ben Byrne
- St Thomas's Hospital, London, United Kingdom
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Farnell DJJ, Staffurth J, Sivell S, Ahmedzai S, Andreyev J, Green J, Sanders DS, Ferguson CJ, Pickett S, Muls A, O'Shea R, Campbell SH, Taylor SE, Nelson A. The ALERT-B questionnaire: A screening tool for the detection of gastroenterological late effects after radiotherapy for prostate cancer. Clin Transl Radiat Oncol 2020; 21:98-103. [PMID: 32072031 PMCID: PMC7016329 DOI: 10.1016/j.ctro.2020.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/02/2020] [Indexed: 01/03/2023] Open
Abstract
ALERT-B provides an effective screening tool for gastroenterological late effects. 84.4% and 95.7% of patients demonstrated complications at 6 and 12 months post-treatment. ROC curves at baseline indicated an AUC of 0.867 compared to the GSRS diarrhoea subscale. ROC curves at baseline indicated an AUC of 0.765 compared to the EPIC bowel subscale.
There is an increasing need to measure treatment-related side effects in normal tissues following cancer therapy. The ALERT-B (Assessment of Late Effects of RadioTherapy - Bowel) questionnaire is a screening tool that is composed of four items related specifically to bowel symptoms. Those patients that respond with a “yes” to any of these items are referred on to gastroenterologist in order to improve the long-term consequences of these side effects of radiological treatment. Here we wish to test the ability of this questionnaire to identify these subsequent gastroenterological complications by tracking prostate cancer patients that were positive with respect to ALERT-B. We also carry out receiver-operator curve (ROC) analysis for baseline data for an overall ALERT-B questionnaire score with respect to subscale data for the Gastrointestinal Symptom Rating Scale (GSRS) and the Expanded Prostate Cancer Index Composite (EPIC-26) questionnaire. 84.4% and 95.7% of patients identified by the ALERT-B questionnaire demonstrated complications diagnosed at 6 and 12 months post-treatment, respectively. ROC curve analysis of baseline data showed that ALERT-B detected clinically relevant levels of side effects established at baseline by the GSRS diarrhoea subscale (AUC = 0.867, 95% CI = 0.795 to 0.926) and at the minimally important level of side effects for the EPIC bowel subscale (AUC = 0.765, 95% CI = 0.617 to 0.913). These results show that ALERT-B provides a simple and effective screening tool for identifying gastroenterological complications after treatment for prostate cancer.
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Affiliation(s)
- D J J Farnell
- School of Dentistry, Cardiff University, Cardiff, United Kingdom
| | - J Staffurth
- Velindre Cancer Centre, Cardiff, United Kingdom.,Cardiff University, Cardiff, United Kingdom
| | - S Sivell
- Marie Curie Palliative Care Research Centre, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - S Ahmedzai
- National Institute for Health Research, Clinical Research Network - Cancer Cluster Office, University of Leeds, Leeds, United Kingdom
| | - J Andreyev
- Department of Gastroenterology, Lincoln County Hospital, Lincoln, United Kingdom
| | - J Green
- Institute of Medical Education, School of Medicine, Cardiff University and Department of Gastroenterology, University Hospital Llandough, Cardiff and Vale UHB, Vale of Glamorgan, Cardiff, United Kingdom
| | - D S Sanders
- University of Sheffield Medical School, Sheffield, United Kingdom
| | - C J Ferguson
- University of Sheffield Medical School, Sheffield, United Kingdom
| | - S Pickett
- Swansea Centre for Health Economics, Swansea University, Swansea, United Kingdom
| | - A Muls
- Royal Marsden Hospital, Fulham Road, London, United Kingdom
| | - R O'Shea
- Marie Curie Palliative Care Research Centre, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - S H Campbell
- Marie Curie Palliative Care Research Centre, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - S E Taylor
- Macmillan Cancer Survivorship Research Group, Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - A Nelson
- Marie Curie Palliative Care Research Centre, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
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Li F, Morgan A, McCullagh A, Johnson A, Giles C, Greenfield D, Crawford G, Gath J, Lyons J, Andreyev J, Tobutt J, Tugwell J, Robb K, Cove-Smith L, Bennister L, Doyle N, Lee N, Nash R, Simcock R, Stephens R, Best S, Moug S, Staley K, Regan S, Ellis P, Griffiths S, Lewis I. Abstract 3348: Top 10 living with and beyond cancer research priorities. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-3348] [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
More and more people are living with the consequences of cancer and its treatment (living with and beyond cancer), yet the level of relevant research is low compared to other types of cancer research in the UK. NCRI aims to increase the level of research in this area and to ultimately improve the lives of those affected by cancer. Undefined research priorities in this broad area has been a barrier to research. The 2015 NHS Independent Cancer Taskforce report also recommends defining research priorities and to enable this research to happen. To address this barrier the NCRI has undertaken a James Lind Alliance Priority Setting Partnership (PSP) to identify priorities that matter most to people affected by cancer and the health and social care professionals.A PSP consists of patients and carers, health and social care professionals. PSPs have several stages and begin with a UK-wide survey to gather questions about uncertainties in living with and beyond cancer. Once the results were analysed, an interim exercise takes place to further prioritise the uncertainties. The last stage is a final workshop where partners debate and finally arrive at a top 10 list of shared uncertainties.The living with and beyond cancer PSP received 3500 questions submitted by people affected by cancer and healthcare professionals. Through a 18-month established rigorous process, the questions are prioritised down to the Top 10 living with and beyond cancer priorities for research in June 2018. This is the first time that clear research priorities have been identified in this area. They are the most impactful research questions that will help improve the lives of people affected by cancer. The Top 10 uncertainties will be publicised widely to ensure that researchers and those who fund research really understand what matters to people affected by cancer. The top uncertainties will be promoted to many research organizations and relevant funders in the UK. We anticipate they will directly influence future research.
Citation Format: Feng Li, Adrienne Morgan, Angela McCullagh, Anne Johnson, Ceinwen Giles, Diana Greenfield, Graeme Crawford, Jacqui Gath, Jane Lyons, Jervoise Andreyev, Jonathan Tobutt, Julia Tugwell, Karen Robb, Laura Cove-Smith, Lindsey Bennister, Natalie Doyle, Nicolas Lee, Rebecca Nash, Richard Simcock, Richard Stephens, Sabine Best, Susan Moug, Kristina Staley, Sandra Regan, Patricia Ellis, Stuart Griffiths, Ian Lewis. Top 10 living with and beyond cancer research priorities [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3348.
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Affiliation(s)
- Feng Li
- 1National Cancer Research Institute, London, United Kingdom
| | | | - Angela McCullagh
- 3National Cancer Research Institute Consumer Forum, London, United Kingdom
| | | | | | - Diana Greenfield
- 6Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Graeme Crawford
- 7Bangor Health Centre, Northern Ireland, Bangor, United Kingdom
| | - Jacqui Gath
- 2Independent Cancer Patients' Voice, London, United Kingdom
| | | | - Jervoise Andreyev
- 9United Lincolnshire Hospitals NHS Trust, Lincolnshire, United Kingdom
| | | | - Julia Tugwell
- 3National Cancer Research Institute Consumer Forum, London, United Kingdom
| | - Karen Robb
- 11Transforming Cancer Services Team in London, London, United Kingdom
| | | | | | - Natalie Doyle
- 14The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Nicolas Lee
- 15Macmillan Cancer Support, London, United Kingdom
| | - Rebecca Nash
- 15Macmillan Cancer Support, London, United Kingdom
| | - Richard Simcock
- 16Brighton and Sussex University Hospital Trust, Brighton, United Kingdom
| | - Richard Stephens
- 3National Cancer Research Institute Consumer Forum, London, United Kingdom
| | | | - Susan Moug
- 18Royal Alexandra Hospital Paisley, Glasgow, United Kingdom
| | | | - Sandra Regan
- 20NIHR Oxford Health Biomedical Research Centre, Oxford, United Kingdom
| | | | | | - Ian Lewis
- 1National Cancer Research Institute, London, United Kingdom
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Faisal A, Baber W, Rana Z, Andreyev J. Gastrointestinal side effects of cancer treatment: are we making any progress? Clin Med (Lond) 2019. [DOI: 10.7861/clinmedicine.19-3s-s61] [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: 11/27/2022]
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Staffurth J, Sivell S, Ahmedzai S, Andreyev J, Farnell D, Green J, Sanders D, Ferguson C, Pickett S, Smith L, Cohen D, O'Shea R, Campbell S, Taylor S, Nelson A. The Impact of Specialized Gastroenterology Services for Late Pelvic Radiation Disease: Results from the Prospective Multicenter EAGLE Study. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.06.068] [Citation(s) in RCA: 1] [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: 11/16/2022]
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Otter S, Wedlake L, McNair H, Lawes R, Juman C, Andreyev J, Stewart A, Gulliford S. Defining Bowel and Nonsigmoid Bowel Dose Volume Constraints for Pelvic Radiation Therapy in GI Malignancies. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.226] [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: 10/28/2022]
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Kurien M, Thurgar E, Davies A, Akehurst R, Andreyev J. Challenging current views on bile acid diarrhoea and malabsorption. Frontline Gastroenterol 2018; 9:92-97. [PMID: 29588835 PMCID: PMC5868445 DOI: 10.1136/flgastro-2017-100808] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 04/05/2017] [Accepted: 05/06/2017] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND In 2012, the National Institute for Health and Care Excellence (NICE) assessed guidance (DG7) on the use of tauroselcholic (75selenium) acid (also known as SeHCAT) for the investigation of diarrhoea due to bile acid malabsorption (BAM) in patients with IBS-D and in patients with Crohn's disease who have not had an ileal resection. NICE concluded that tauroselcholic (75selenium) acid was recommended for use in research only. NICE will be reviewing the decision to update the guidance for tauroselcholic (75selenium) acid, for these populations, in March 2017. AIM Our aim is to summarise advances in BAM, also known as bile acid diarrhoea (BAD), and encourage clinicians to re-evaluate their understanding of this disorder. APPROACH We review the prevalence, diagnosis and treatment of BAD/BAM. We describe the new evidence available since the original NICE review in 2012, and discuss the economic issues associated with failure to diagnose or to treat BAD/BAM accurately. EVIDENCE UPDATE There is new and compelling evidence available since DG7, which shows that tauroselcholic (75selenium) acid scanning is a powerful tool in the diagnosis of BAD/BAM. We summarise published prevalence data (approximately 1% prevalence in the UK, as suggested by clinical practice diagnosis rates), and highlight that the true prevalence of BAD/BAM could be far greater than this. CONCLUSION We present evidence that challenges current opinion about this disorder, and we commend both clinicians and health technology assessment (HTA) agencies for being open to arguments and new evidence in any future HTAs.
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Affiliation(s)
- Matthew Kurien
- Academic Unit of Gastroenterology, Department of Infection, Immunity and Cardiovascular Sciences, University of Sheffield, Sheffield, UK
| | | | | | | | - Jervoise Andreyev
- The GI and Nutrition Team, The Royal Marsden NHS Foundation Trust, London, UK
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Abstract
This article explores the transition from a clinical nurse specialist (CNS) towards developing advanced clinical practice skills within a gastrointestinal consequences of cancer clinic. It presents data on the first 50 patients assessed by the CNS from a prospective service evaluation, demonstrating how this informed the nurse's future learning. There is high demand for advanced clinical practice skills to address unmet health needs and improve the quality, efficiency, and sustainability of healthcare services. However, a literature review found no literature on developing advanced clinical practice skills in this setting. Emerging themes from the service evaluation focused on barriers and enablers, ongoing support, organisational commitment and working in a multidisciplinary team. Blended learning provided both structured and opportunistic learning, embedding both formal and tacit knowledge, as roles require increasing flexibility. Clinical supervision and reflective practice were key in maintaining professional and peer support.
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Affiliation(s)
- Caroline Gee
- Senior Clinical Nurse Specialist GI Consequences of Cancer Treatment, Royal Marsden Hospital, London
| | - Jervoise Andreyev
- Consultant Gastroenterologist, United Lincolnshire Hospitals NHS Trust, Lincoln
| | - Ann Muls
- Macmillan Nurse Consultant GI Consequences of Cancer Treatment, Royal Marsden Hospital, London
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Muls A, Andreyev J, Lalondrelle S, Taylor A, Norton C, Hart A. Systematic Review: The Impact of Cancer Treatment on the Gut and Vaginal Microbiome in Women With a Gynecological Malignancy. Int J Gynecol Cancer 2017; 27:1550-1559. [PMID: 28590950 PMCID: PMC5571893 DOI: 10.1097/igc.0000000000000999] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND AIM Worldwide, 1,470,900 women are diagnosed yearly with a gynecological malignancy (21,000 in the UK). Some patients treated with pelvic radiotherapy develop chronic changes in their bowel function. This systematic review summarizes current research on the impact of cancer treatment on the gut and vaginal microbiome in women with a gynecological malignancy. METHODS The Preferred reporting Items for Systematic Reviews and Meta-analyses guidelines for systematic reviews were used to ensure transparent and complete reporting. Quantitative studies exploring the gut or vaginal microbiome in this patient cohort were included. Animal studies were excluded. There were no language restrictions. RESULTS No studies examined the possible effects of surgery or chemotherapy for gynecological cancers on the gut or vaginal microbiome.Three prospective cohort studies were identified using sequencing of changes in the gut microbiome reporting on a total of 23 women treated for gynecological cancer. All studies included patients treated with radiotherapy with a dosage ranging from 43.0 to 54.0 Gy. Two studies assessed gastrointestinal toxicity formally; 8 women (57%) developed grade 2 or 3 diarrhea during radiotherapy. The outcomes suggest a correlation between changes in the intestinal microbiome and receiving radiotherapy and showed a decrease in abundance and diversity of the intestinal bacterial species. Before radiotherapy, those who developed diarrhea had an increased abundance of Bacteroides, Dialister, and Veillonella (P < 0.01), and a decreased abundance of Clostridium XI and XVIII, Faecalibacterium, Oscillibacter, Parabacteroides, Prevotella, and unclassified bacteria (P < 0.05). CONCLUSION The limited evidence to date implies that larger studies including both the vaginal and gut microbiome in women treated for a gynecological malignancy are warranted to explore the impact of cancer treatments on the microbiome and its relation to developing long-term gastrointestinal toxicity. This may lead to new avenues to stratify those at risk and explore personalized treatment options and prevention of gastrointestinal consequences of cancer treatments.
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Affiliation(s)
- Ann Muls
- *The Royal Marsden NHS Foundation Trust, London; †Department of Nursing, King's College London, Waterloo; and ‡Faculty of Medicine, Department of Surgery and Cancer, Imperial College London, London, UK
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Taylor S, Demeyin W, Muls A, Ferguson C, Farnell DJJ, Cohen D, Andreyev J, Green J, Smith L, Ahmedzai S, Pickett S, Nelson A, Staffurth J. Improving the well-being of men by Evaluating and Addressing the Gastrointestinal Late Effects (EAGLE) of radical treatment for prostate cancer: study protocol for a mixed-method implementation project. BMJ Open 2016; 6:e011773. [PMID: 27697869 PMCID: PMC5073602 DOI: 10.1136/bmjopen-2016-011773] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Radiotherapy treatment for prostate cancer can cause bowel problems, which may lead to severe difficulties for cancer survivors including limiting travel, work or socialising. These symptoms can appear at any time following radiotherapy. This study focuses on the early identification and protocol-based management of effects known to cause long-term, or even permanent, changes to the well-being of prostate cancer survivors. The rationale of this study is to improve the care offered to men and their families following pelvic radiotherapy for prostate cancer. METHOD AND ANALYSIS Implementation research methodology will be used to adopt a multicomponent intervention at three UK centres. The intervention package comprises a standardised clinical assessment of relevant symptoms in oncology outpatient clinics and rapid referral to an enhanced gastroenterological service for patients identified with bowel problems. Gastroenterology staff will be trained to use an expert-practice algorithm of targeted gastroenterology investigations and treatments. The evaluation of the intervention and its embedding within local practices will be conducted using a mixed-methods design. The effect of the new service will be measured in terms of the following outcomes: acceptability to staff and patients; quality of life; symptom control and cost-effectiveness. Data collection will take place at baseline, 6 months (±2 months), and 12 months (±2 months) after entry into the study. ETHICS AND DISSEMINATION The study has ethical approval from the North West-Liverpool East Research Ethics Committee and the appropriate NHS governance clearance. All participants provide written informed consent. The study team aim to publish the results of the study in peer-reviewed journals as well as at national and international conferences. TRIAL REGISTRATION NUMBER UKCRN16974.
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Affiliation(s)
- Sophia Taylor
- Marie Curie Palliative Care Research Centre, School of Medicine, Cardiff University, Cardiff, UK
| | - Weyinmi Demeyin
- Specialist Unit for Review Evidence, Cardiff University, Cardiff, UK
| | - Ann Muls
- Gastroenterology Unit, Royal Marsden Hospital, London, UK
| | - Catherine Ferguson
- Department of Oncology, Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - David Cohen
- Faculty of Life Sciences and Education, Health Economics and Policy Research Unit (HEPRU), University of South Wales, Cardiff, UK
| | | | - John Green
- Department of Gastroenterology, University Hospital of Llandough, Cardiff, UK
| | | | - Sam Ahmedzai
- Department of Oncology, University of Sheffield, Sheffield, UK
| | - Sara Pickett
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Annmarie Nelson
- Marie Curie Palliative Care Research Centre, School of Medicine, Cardiff University, Cardiff, UK
| | - John Staffurth
- Velindre Cancer Centre, Cardiff, UK
- Institute of Cancer and Genetics, Cardiff University, Cardiff, UK
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Taylor SE, Muls A, Andreyev J, Green J, Farnell D, Smith L, Ahmedzai SAMH, Pickett S, Ferguson C, Fitzsimmons D, Cambell S, O'Shea R, Nelson A, Staffurth J. Late effects of pelvic radiation treatment (EAGLE study). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.3_suppl.159] [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: 11/20/2022] Open
Abstract
159 Background: Radiotherapy treatment for prostate cancer can cause severe long –term bowel problems, including limiting travel, work or socialising. Around half of patients suffer from late effects, appearing more than six months after radiotherapy. These symptoms often remain unmonitored in follow up care, despite the existence of effective treatment if referred to gastroenterology departments. This study focuses on the early identification and treatment of neglected late effect symptoms. Methods: Novel healthcare interventions are often difficult to embed in local clinical settings. Implementation research methodology will be used to evaluate experiences of a multi-component intervention aimed at prompting referrals to an enhanced gastroenterology service, making real time adjustments as needed, with the ultimate aim of successfully embedding the intervention into practice across the UK. The intervention, introduced in three UK centres, comprises a brief, standardised clinical assessment of relevant symptoms and rapid referral to a gastroenterological service, with staff trained to use a validated investigation and treatment algorithm. Evaluation of the intervention and its acceptability within local practices will be conducted using longitudinal mixed methods research. All prostate cancer patients attending follow up clinics, meeting the eligibility criteria will be invited to be screened (n = 300) and offered a referral to gastroenterology if appropriate. A cost effectiveness analysis of health-related quality of life and resource utilisation data will be undertaken and contrasts made between participants and a comparison group. Results: Interim results will focus on interview data from healthcare professionals and how they are working locally to embed practice, sharing learning points with other locations whilst working towards a sustainable service. Conclusions: This study evaluates the effectiveness of an enhanced assessment and treatment service spanning oncology and gastroenterology services in improving the outcome of men with prostate cancer after radiotherapy. Successful implementation will act as examples of best practice for a network of centres of excellence in this area.
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Affiliation(s)
| | - Ann Muls
- Royal Marsden Hospital, London, United Kingdom
| | - Jervoise Andreyev
- Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - John Green
- Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - Damian Farnell
- Cardiff University School of Dentistry, Cardiff, United Kingdom
| | - Lesely Smith
- Macmillan Cancer Support, London, United Kingdom
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Andreyev J. SP-0029: GI consequences of cancer treatment: the past, the present and the future: a clinical perspective. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40029-5] [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: 11/29/2022]
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Moorcraft SY, Marriott C, Peckitt C, Cunningham D, Chau I, Starling N, Watkins D, Andreyev J, Rao S. A prospective patient (pt) survey on clinical trials. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.3_suppl.707] [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: 11/20/2022] Open
Abstract
707 Background: Recruitment to clinical trials can be challenging. We conducted a patient survey to improve our understanding of pts’ views and experiences of clinical trials and what aspects could be improved. Methods: Pts who had been approached about participation in any clinical trial in the Gastrointestinal (GI) and Lymphoma Unit at the Royal Marsden were prospectively invited to complete a questionnaire about their views and experiences of cancer research. Results: Between August 2013 and July 2014, 276 pts (90% GI, 10% lymphoma) received 298 clinical trial pt information sheets (PIS) and were asked to complete a questionnaire. 263 respondents (Res) consented to a trial and 249 of these (95%) completed the questionnaire (65 for clinical trials of an investigational medicinal product (CTIMP), 156 for non-CTIMPs and 28 for molecular pre-screening trials). 25 Res declined a trial and 10 of these completed the questionnaire. Of the 249 Res who consented to a trial, 96% were glad to be approached about clinical trials. 90% of Res felt the PIS was easy to understand and rated the verbal explanation of the trial as excellent/good. 10 Res who declined a trial felt the verbal explanation was excellent/good and that the PIS was easy to understand. The mean total PIS length (including sub-studies) was 17 pages (range 3-50 pages). 9% of Res who consented to a trial felt the PIS was too long. Regarding CTIMP trials, 48-50% of Res would have liked more information on trial drugs and any additional research procedures, 28-30% were neutral and 20-24% did not want more information. 75% of Res would consider participating in studies requiring a research biopsy and 78% would donate their tissue for genetic research. 79% of pre-screening trial Res, 66% of non-CTIMP trial Res and 54% of CTIMP trial Res would have been willing to consent to the trial on the day they received the PIS. 75% of Res (including 89% of CTIMP Res) believed pts should be told trial results, even if results are not available for many years. Conclusions: The majority of pts are willing to be approached regarding clinical trials. A high proportion of pts would consider studies involving research biopsies. New strategies for tailoring additional trial information according to the patient and informing pts of trial results should be explored.
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Affiliation(s)
- Sing Yu Moorcraft
- Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - Cheryl Marriott
- Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - Clare Peckitt
- Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - David Cunningham
- Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - Ian Chau
- Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - Naureen Starling
- Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - David Watkins
- Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - Jervoise Andreyev
- Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - Sheela Rao
- Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
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Sena Teixeira Mendes L, D. Attygalle A, Cunningham D, Benson M, Andreyev J, Gonzales-de-Castro D, Wotherspoon A. CD4-positive small T-cell lymphoma of the intestine presenting with severe bile-acid malabsorption: a supportive symptom control approach. Br J Haematol 2014; 167:265-9. [DOI: 10.1111/bjh.12953] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
| | | | | | - Martin Benson
- Gastrointestinal Unit; Royal Marsden Hospital; Sutton UK
| | | | - David Gonzales-de-Castro
- Department of Molecular Pathology; Institute of Cancer Research; Centre for Molecular Pathology/Royal Marsden Hospital; Sutton UK
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Andreyev J. Late Effects of Cancer Treatment in Adult Patients. Nutr Cancer 2013. [DOI: 10.1002/9781118788707.ch9] [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: 11/08/2022]
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Thomas R, Holm M, Williams M, Bowman E, Bellamy P, Andreyev J, Maher J. Lifestyle Factors Correlate with the Risk of Late Pelvic Symptoms after Prostatic Radiotherapy. Clin Oncol (R Coll Radiol) 2013; 25:246-51. [DOI: 10.1016/j.clon.2012.11.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 10/25/2012] [Accepted: 10/29/2012] [Indexed: 01/29/2023]
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Covington JA, Wedlake L, Andreyev J, Ouaret N, Thomas MG, Nwokolo CU, Bardhan KD, Arasaradnam RP. The detection of patients at risk of gastrointestinal toxicity during pelvic radiotherapy by electronic nose and FAIMS: a pilot study. Sensors (Basel) 2012; 12:13002-18. [PMID: 23201982 PMCID: PMC3545553 DOI: 10.3390/s121013002] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Revised: 09/10/2012] [Accepted: 09/10/2012] [Indexed: 12/31/2022]
Abstract
It is well known that the electronic nose can be used to identify differences between human health and disease for a range of disorders. We present a pilot study to investigate if the electronic nose and a newer technology, FAIMS (Field Asymmetric Ion Mobility Spectrometry), can be used to identify and help inform the treatment pathway for patients receiving pelvic radiotherapy, which frequently causes gastrointestinal side-effects, severe in some. From a larger group, 23 radiotherapy patients were selected where half had the highest levels of toxicity and the others the lowest. Stool samples were obtained before and four weeks after radiotherapy and the volatiles and gases emitted analysed by both methods; these chemicals are products of fermentation caused by gut microflora. Principal component analysis of the electronic nose data and wavelet transform followed by Fisher discriminant analysis of FAIMS data indicated that it was possible to separate patients after treatment by their toxicity levels. More interestingly, differences were also identified in their pre-treatment samples. We believe these patterns arise from differences in gut microflora where some combinations of bacteria result to give this olfactory signature. In the future our approach may result in a technique that will help identify patients at "high risk" even before radiation treatment is started.
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Affiliation(s)
- James A. Covington
- School of Engineering, University of Warwick, Coventry CV4 7AL, UK; E-Mails: (N.O.); (M.G.T.)
| | - Linda Wedlake
- Department of Nutrition and Dietetics and the GI Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK; E-Mails: (L.W.); (J.A.); (R.P.A.)
| | - Jervoise Andreyev
- Department of Nutrition and Dietetics and the GI Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK; E-Mails: (L.W.); (J.A.); (R.P.A.)
| | - Nathalie Ouaret
- School of Engineering, University of Warwick, Coventry CV4 7AL, UK; E-Mails: (N.O.); (M.G.T.)
| | - Matthew G. Thomas
- School of Engineering, University of Warwick, Coventry CV4 7AL, UK; E-Mails: (N.O.); (M.G.T.)
- MOAC Doctoral Training Centre, University of Warwick, Coventry CV4 7AL, UK
| | - Chuka U. Nwokolo
- University Hospital Coventry & Warwickshire, Coventry CV2 2DX, UK; E-Mail:
| | - Karna D. Bardhan
- Department of Gastroenterology, Rotherham General Hospital, Rotherham S60 2UD, UK; E-Mail:
- Clinical Sciences Research Institute, University of Warwick, Coventry CV2 2DX, UK
| | - Ramesh P. Arasaradnam
- University Hospital Coventry & Warwickshire, Coventry CV2 2DX, UK; E-Mail:
- Clinical Sciences Research Institute, University of Warwick, Coventry CV2 2DX, UK
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Dignan FL, Scarisbrick JJ, Cornish J, Clark A, Amrolia P, Jackson G, Mahendra P, Taylor PC, Shah P, Lightman S, Fortune F, Kibbler C, Andreyev J, Albanese A, Hadzic N, Potter MN, Shaw BE. Organ-specific management and supportive care in chronic graft-versus-host disease. Br J Haematol 2012; 158:62-78. [DOI: 10.1111/j.1365-2141.2012.09131.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
| | | | | | - Andrew Clark
- Bone Marrow Transplant Unit; Beatson Oncology Centre; Gartnavel Hospital; Glasgow
| | - Persis Amrolia
- Department of Bone Marrow Transplantation; Great Ormond Street Hospital; London
| | - Graham Jackson
- Department of Haematology; Freeman Road Hospital; Newcastle
| | - Prem Mahendra
- Department of Haematology; University Hospital Birmingham; Birmingham
| | - Peter C. Taylor
- Department of Haematology; Rotherham General Hospital; Rotherham
| | - Pallav Shah
- Department of Respiratory Medicine; Royal Brompton Hospital; London
| | - Sue Lightman
- University College London/Institute of Opthalmology; Moorfields Eye Hospital; London
| | - Farida Fortune
- Department of Oral Medicine; Barts and the London NHS Trust; London
| | | | - Jervoise Andreyev
- Department of Medicine; The Royal Marsden NHS Foundation Trust; London
| | | | - Nedim Hadzic
- Paediatric Liver Service & Institute of Liver Studies; King's College Hospital; London
| | - Michael N. Potter
- Section of Haemato-oncology; The Royal Marsden NHS Foundation Trust; London
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Harris V, Benton B, Sohaib A, Dearnaley D, Andreyev J. 7032 POSTER Bile Acid Malabsorption After Intensity Modulated Radiotherapy for Prostate Cancer. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71983-9] [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: 10/17/2022]
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Abstract
Bile acid malabsorption (BAM) is never life threatening but can cause chronic symptoms. A survey of senior British gastroenterologists was conducted to examine their approach to patients with potential BAM. Of the 706 gastroenterologists contacted, 62% replied. Gastroenterologists see on average 500 new patients in clinic annually; 34% have chronic diarrhoea and 1% are diagnosed with BAM. In those with chronic diarrhoea, 6% of gastroenterologists investigate for BAM first line, while 61% consider the diagnosis only in selected patients or not at all. Sixty-one per cent of patients are diagnosed with type 1 BAM (secondary to terminal ileal disease), 22% have type 2 (idiopathic bile acid malabsorption) and 15% type 3 (unrelated to terminal ileal disease). Only one third of gastroenterologists use a definitive diagnostic test for BAM. BAM (particularly type 2) is under-diagnosed because it is frequently not considered and even when considered, many patients are not subjected to definitive diagnostic testing.
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Affiliation(s)
- Usman Khalid
- Department of Medicine, Royal Marsden Hospital, London
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Gulliford SL, Partridge M, Sydes MR, Andreyev J, Dearnaley DP. A comparison of dose-volume constraints derived using peak and longitudinal definitions of late rectal toxicity. Radiother Oncol 2010; 94:241-7. [PMID: 20096945 DOI: 10.1016/j.radonc.2009.12.019] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [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: 10/23/2009] [Revised: 12/14/2009] [Accepted: 12/20/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND PURPOSE Accurate reporting of complications following radiotherapy is an important part of the feedback loop to improve radiotherapy techniques. The definition of toxicity is normally regarded as the maximum or peak (P) grade of toxicity reported over the follow-up period. An alternative definition (integrated longitudinal toxicity (ILT)) is proposed which takes into account both the severity and the duration of the complication. METHODS AND MATERIALS In this work, both definitions of toxicity were used to derive dose-volume constraints for six specific endpoints of late rectal toxicity from a cohort of patients who received prostate radiotherapy in the MRC RT01 trial. The dose-volume constraints were derived using ROC analysis for 30, 40, 50, 60, 65 and 70 Gy. RESULTS Statistically significant dose-volume constraints were not derived for all dose levels tested for each endpoint and toxicity definition. However, where both definitions produced constraints, there was generally good agreement. Variation in the derived dose-volume constraints was observed to be larger between endpoints than between the two definitions of toxicity. For one endpoint (stool frequency (LENT/SOM)) statistically significant dose-volume constraints were only derived using ILT. CONCLUSIONS The longitudinal definition of toxicity (ILT) produced results consistent with those derived using peak toxicity and in some cases provided additional information which was not seen by analysing peak toxicity alone.
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Affiliation(s)
- Sarah L Gulliford
- Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, UK.
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Abstract
Gastrointestinal symptoms after pelvic radiotherapy, which affect quality of life, are substantially more common than generally recognised and are frequently poorly managed. These symptoms develop because radiation can induce change in one or more specific physiological functions in widely separated parts of the gastrointestinal tract that lie in the path of the radiotherapy beam. Radiation-induced changes are not confined by normal anatomical boundaries. Furthermore, pre-existing subclinical disease might be destabilised because of minor gastrointestinal changes induced by radiotherapy. New diseases might manifest after radiotherapy and be confused with symptoms induced by radiotherapy. Different functional deficits might cause the same symptoms. Many patients have more than one cause for their symptoms, which sometimes need very different treatments. Simple diagnostic tests that are used in other contexts, if applied appropriately to patients with new gastrointestinal symptoms after radiotherapy, can identify the underlying causes of new-onset symptoms. Starting treatment without knowing the cause of the symptom is commonly ineffective because prediction of the combination of treatments needed is difficult. Evidence suggests that many patients have unusual but highly treatable malfunctions of gastrointestinal physiology, which if correctly diagnosed may enable a patient with difficult symptoms to be helped.
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Andreyev J, Gillespie C, Goode C, Hackett C. The Problems and Expectations of Patients with Radiation-induced Bowel Injury. Clin Oncol (R Coll Radiol) 2007. [DOI: 10.1016/j.clon.2007.01.334] [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: 11/30/2022]
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Goode C, Gillespie C, Hackett C, Andreyev J. Patients' Perspectives of the Impact of Gastrointestinal Symptoms after Pelvic Radiotherapy. Clin Oncol (R Coll Radiol) 2006. [DOI: 10.1016/j.clon.2006.03.010] [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: 11/26/2022]
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Abstract
Radiation induced bowel damage affects 6000 individuals annually in the UK, with a negative impact on quality of life. Our understanding of how to treat these patients is dismally lacking an evidence base. Fibrosis seems to be the unifying underlying cause for most symptoms. Progress in understanding the development and treatment of fibrosis in these patients might have important consequences for patients with other causes of fibrosis in the gastrointestinal tract.
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Affiliation(s)
- J Andreyev
- Department of Medicine and Therapeutics, Imperial College Faculty of Medicine, Chelsea and Westminster Hospital, 369 Fulham Rd, London SW10 9NH, UK.
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Patel SM, Cohen P, Pickering MC, Gazzard BG, Andreyev J. Successful treatment of acute haemorrhagic cytomegalovirus colitis with ganciclovir in an individual without overt immunocompromise. Eur J Gastroenterol Hepatol 2003; 15:1055-60. [PMID: 12923383 DOI: 10.1097/00042737-200309000-00020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Affiliation(s)
- C Brenner
- Department of Radiology, Imperial College Faculty of Medicine, Chelsea and Westminster Hospital, London, UK
| | - Z Amin
- Department of Radiology, Imperial College Faculty of Medicine, Chelsea and Westminster Hospital, London, UK
| | - A C Wotherspoon
- Department of Histopathology, Royal Marsden Hospital, London, UK
| | - P Vlavianos
- Department of Medicine and Therapeutics, Imperial College Faculty of Medicine, Chelsea and Westminster Hospital, London, UK
| | - J Andreyev
- Department of Medicine and Therapeutics, Imperial College Faculty of Medicine, Chelsea and Westminster Hospital, London, UK
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Kelleher M, Tebbutt NC, Cunningham D, Andreyev J, Allen M, Hill M, Norman A. Mitomycin C, carboplatin and protracted venous infusion 5-fluorouracil in advanced oesophago-gastric and pancreatic cancer: results of two phase II studies. Clin Oncol (R Coll Radiol) 2003; 15:92-7. [PMID: 12801044 DOI: 10.1053/clon.2002.0173] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/11/2022]
Abstract
Cisplatin is an active palliative chemotherapy agent in advanced upper gastrointestinal cancer, but it is associated with significant non-haematological toxicity. Substitution of cisplatin by carboplatin in combination chemotherapy regimens may reduce these adverse effects. These two phase II studies evaluated the efficacy and toxicity of the combination of mitomycin C (MMC) 7 mg/m2 q 6 weekly, carboplatin area under the concentration-time curve 5 mg/ml/min q 3 weekly and protracted venous infusion 5-fluorouracil (5FU) 300 mg/m2/day (McarboF) in advanced upper gastrointestinal cancer. Between October 1998 and June 2000, 31 patients were enrolled in the studies, 23 patients in the oesophago-gastric study and eight patients in the pancreatic study. Although non-haematological toxicity was modest, both protocols were closed prematurely because of excessive haematological toxicity and frequent treatment delays. The overall incidence of grade 3/4 neutropenia and thrombocytopenia was 39 and 52%, respectively. The McarboF combination showed significant activity with an overall response rate of 52% in advanced oesophago-gastric cancer. Palliative benefit was also evident with improvement in symptoms of pain and weight loss in over 79 and 50% of patients in the oesophago-gastric study and pancreatic study, respectively. Median overall survival times were 10.6 and 6.6 months for patients with oesophago-gastric and pancreatic cancer, respectively. The McarboF regimen showed promising activity in advanced upper gastrointestinal cancer, with modest non-haematological side-effects. This combination merits further evaluation with modification of the dose and schedule of carboplatin and MMC in order to reduce the severity of haematological toxicity.
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Tebbutt NC, Norman AR, Cunningham D, Hill ME, Tait D, Oates J, Livingston S, Andreyev J. Intestinal complications after chemotherapy for patients with unresected primary colorectal cancer and synchronous metastases. Gut 2003; 52:568-73. [PMID: 12631671 PMCID: PMC1773619 DOI: 10.1136/gut.52.4.568] [Citation(s) in RCA: 167] [Impact Index Per Article: 8.0] [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] [Indexed: 12/11/2022]
Abstract
BACKGROUND The role of palliative resection of the primary tumour in patients who present with metastatic colorectal cancer is unclear. AIMS This study compared the incidence of major intestinal complications in such patients who received chemotherapy treatment with or without prior palliative resection of the primary tumour. PATIENTS The incidence of intestinal obstruction, perforation, fistula formation, and gastrointestinal haemorrhage, and the requirement for abdominal radiotherapy in patients with metastatic colorectal cancer treated at a single institution over a 10 year period was determined. RESULTS Eighty two patients received initial treatment with chemotherapy without resection of the primary tumour (unresected group) and 280 patients had undergone prior resection (resected group). In the unresected group, the incidence of peritonitis, fistula formation, and intestinal haemorrhage was 2.4% (95% confidence interval (CI) 0.3-8.5%), 3.7% (95% CI 0.8-10.3%), and 3.7% (95% CI 0.8-10.3%), respectively, and was not significantly different from the resected group. Intestinal obstruction affected 13.4% (95% CI 6.9-22.7%) of patients in the unresected group and 13.2% (95% CI 9.2-17.2%) of patients in the resected group. More patients in the unresected group required >/=3 blood transfusions (14.6% v 7.5%; p=0.048) and abdominal radiotherapy (18.3% v 9.6%; p=0.03) than the resected group. CONCLUSIONS The incidence of major intestinal complications in patients with unresected colorectal cancer and synchronous metastases who receive initial treatment with chemotherapy is low. Chemotherapy may be successfully used as initial treatment for such patients with no increased risk of most major intestinal complications compared with patients who have undergone initial resection of the primary tumour.
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Affiliation(s)
- N C Tebbutt
- Gastrointestinal Unit, Royal Marsden Hospital, London and Surrey, UK
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Denton A, Forbes A, Andreyev J, Maher EJ. Non surgical interventions for late radiation proctitis in patients who have received radical radiotherapy to the pelvis. Cochrane Database Syst Rev 2002:CD003455. [PMID: 11869662 DOI: 10.1002/14651858.cd003455] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Chronic radiation proctitis (inflammation of the rectum) may develop after the completion of pelvic radiotherapy. Presently there is no recommended standard management. OBJECTIVES To assess the effects of various non-surgical treatment options for the management of late chronic radiation proctitis. SEARCH STRATEGY We searched the Cochrane Controlled Trials Register, issue 1, 2001, MEDLINE 1966 to 2001, EMBASE 1980 to 2001, CANCERCD 1980 to 2001, Science Citation Index 1991 to 2001, CINAHL 1982 to 2001, as well as sources of grey literature. We also hand searched relevant textbooks and contacted experts in the field. SELECTION CRITERIA Studies (preferentially randomised controlled trials) of interventions for the non-surgical management of late radiation proctitis in patients who have undergone pelvic radiotherapy as part of their cancer treatment. DATA COLLECTION AND ANALYSIS The inclusion criteria were independently applied by two of the reviewers (AD and EJM) and where there was disagreement this was resolved by involving a third reviewer to form a consensus. MAIN RESULTS Six randomised controlled trials were included. None of the trials compared anti-inflammatories with placebo. However rectal sucralfate showed greater clinical improvement for proctitis than anti-inflammatories (odds ratio 14.00, 95% confidence interval 1.46 to 134.26; n=1 study), though no difference was seen for endoscopic improvement (odds ratio 2.74, 95% confidence interval 0.64 to 11.76, n=1 study). The addition of metronidazole to the anti-inflammatory regime also appeared to improve the response rate, as measured by the reduction in rectal bleeding, diarrhoea, erythema and ulceration (n=1 study). Similarly rectal hydrocortisone appeared to be more effective than rectal betamethasone for clinical improvement although no difference was seen in endoscopic improvement (n=1 study). Short chain fatty acid enemas did not appear to be effective compared to placebo (n=2 studies). In the comparison of the heater probe and bipolar electrocautery (n=1 study), there was no discernible difference for severe bleeding after one year, but the heater probe demonstrated a greater increase in the haematocrit and reduced transfusion requirements. REVIEWER'S CONCLUSIONS Late radiation complications are a relatively rare manifestation, with many potential carers and poor diagnostic criteria. Although certain interventions look promising and may be effective (such as rectal sucralfate, adding metronidazole to the anti-inflammatory regime and heater probes), single small studies (even if well conducted) provide insufficient evidence. The episodic and variable nature of late radiation proctitis also requires placebo controlled studies to establish whether particular treatments are effective. Regional or centralised registers of radiation toxicity should be established so that interventions can be administered in the setting of multi-centre trials with specific entry criteria, formal baseline and therapeutic assessments providing standardised outcome data including quality of life evaluations.
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Affiliation(s)
- A Denton
- Centre for Cancer Treatment, Mount Vernon Hospital, Rickmansworth Rd, Northwood, Middlesex, UK, HA6 2RN.
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Webb A, Scott-Mackie P, Cunningham D, Norman A, Andreyev J, O'Brien M, Bensted J. The prognostic value of serum and immunohistochemical tumour markers in advanced gastric cancer. Eur J Cancer 1996; 32A:63-8. [PMID: 8695243 DOI: 10.1016/0959-8049(95)00504-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.6] [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: 02/01/2023]
Abstract
Using a prospectively acquired database of 290 patients with advanced gastric adenocarcinoma, the prognostic significance of serum levels of carcinoembryonic antigen (CEA) (237 patients), alphafeto protein (AFP) (164 patients), beta-human chorionic gonadotrophin (beta HCG) (165 patients), CA19-9 (64 patients) and CA125 (104 patients) and tissue staining for C-erb B-2 (160 patients) and beta HCG (160 patients) was investigated. Serum was taken prior to 5-fluorouracil (5FU)-based chemotherapy and immunohistochemistry was performed on diagnostic specimens. In the univariate analysis, tumour markers of poor prognosis were CEA > or = 5 micrograms/l (P = 0.01; median survival (MS) 42 versus 35 weeks), serum beta HCG > or = 4 U/l (P = 0.02; MS 42 versus 25 weeks), CA125 > or = 35 U/ml (P = 0.03; MS 43 versus 31 weeks) and CA125 > or = 350 U/ml (P = 0.001; MS 42 versus 17 weeks). Other significant factors were poor performance status, the presence of metastases and poorly differentiated tumour histology. Tumours markers of poor prognosis in the multivariate analysis were serum beta HCG > or = 4 IU/l [hazard ratio (HR) 1.7; 95% confidence interval (CI) 2.8-1.1] and CA125 > or = 350 U/ml (HR 2.2; CI 4.2-1.2). There was a degree of subgroup variability in this model but, in general, other factors correlating with a poor survival were poor performance status, metastases and poorly differentiated tumour histology. This is the largest prognostic study of each tumour marker in advanced disease and demonstrates that serum beta HCG and CA125 in gastric cancer prior to chemotherapy do convey an independent poor prognosis which may reflect not just tumour burden but aggressive biology.
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Affiliation(s)
- A Webb
- Cancer Research Campaign Section of Medicine, Royal Marsden Hospital, Sutton, Surrey, U.K
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Andreyev J, Ross P, Cunningham D, Norman A, Padhani A. 561 ECF is a low toxicity regimen that can downstage squamous oesophageal cancer. Eur J Cancer 1995. [DOI: 10.1016/0959-8049(95)95815-n] [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: 10/27/2022]
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Webb A, Scott-Mackie P, Cunningham D, Norman A, Andreyev J, O'Brien M, Bensted J. The prognostic value of CEA, beta HCG, AFP, CA125, CA19-9 and C-erb B-2, beta HCG immunohistochemistry in advanced colorectal cancer. Ann Oncol 1995; 6:581-7. [PMID: 8573538 DOI: 10.1093/oxfordjournals.annonc.a059248] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.1] [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: 01/31/2023] Open
Abstract
BACKGROUND Evaluation of the prognostic significance of a group of tumour markers and their ability to predict response to chemotherapy may allow better targeting of palliative treatment in advanced colorectal cancer. PATIENTS AND METHODS Using a prospectively acquired database of 377 patients (pts) with advanced colorectal adenocarcinoma, the prognostic significance of serum CEA (342 pts), beta HCG (203 pts), AFP (208 pts), CA125 (150 pts), CA-19-9 (76 pts) as well as C-erb B-2 (197 pts). Serum markers were taken prior to 5-FU based chemotherapy and immunohistochemistry was performed on diagnostic samples RESULTS Tumour markers of poor prognostic significance in the univariate analysis were CEA > or = 5 micrograms/l (p = 0.006; median survival (MS 59 weeks vs 38 weeks) and CA125 > or = 35 U/ml (p = 0.01 MS 51 weeks vs. 30 weeks). Tumour markers elevated at greater than 10 times the normal value which correlated with a poor prognosis were CEA (p = 0.001; MS 47 weeks vs. 35 weeks), Serum beta HCG (p < 0.0001; MS 44 weeks vs. 7 weeks) and CA125 (p < 0.0001; MS 38 weeks vs. 15 weeks). Poor performance status ( > 2) and poorly differentiated tumour histology were also correlated to poor survival. In the multivariate analysis, tumour markers of independent poor prognosis were CEA > or = 5 micrograms/l (Hazard Ratio (HR) 1.8; 95% Confidence Internal (CI) 2.8-1.2), CEA > or = 50 micrograms/l (HR 1.6; CI 2.1-1.2), CA125 > or = 35 U/ml (HR 1.5; CI 2.3-1.0), CA 125 > or = 350 U/ml (HR 5.0; CI 9.6-2.6) and serum BHCG > or = 0 IU/l (HR 11.7; CI 30-4.5). Poor performance status (HR 6.7-5.0) and poorly differentiated histology (HR 2.8-1.0) were the other important factors in the model. No pretreatment tumour marker correlated with response to chemotherapy. CONCLUSIONS This is the largest prognostic study of each tumour marker in advanced disease and it clarifies previous conflicting reports. Serum AFP, CA19-9 and immunohistochemical stains beta HCG and C-erb B-2 have no prognostic significance. Serum CEA, beta HCG, CA125 in advanced colorectal cancer prior to chemotherapy do convey an independent poor prognosis which may reflect not just tumour burden but aggressive biology.
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Affiliation(s)
- A Webb
- Cancer Research Campaign Section of Medicine, Royal Marsden Hospital, Sutton, Surrey, U.K
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