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Montague E, Roques T, Spencer K, Burnett A, Lourenco J, Thorp N. How Long Does Contouring Really Take? Results of the Royal College of Radiologists Contouring Surveys. Clin Oncol (R Coll Radiol) 2024; 36:335-342. [PMID: 38519383 DOI: 10.1016/j.clon.2024.03.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/07/2024] [Indexed: 03/24/2024]
Abstract
AIMS The success and safety of modern radiotherapy relies on accurate contouring. Understanding the time taken to complete radiotherapy contours is critical to informing workforce planning and, in the context of a workforce shortfall, advocating for investment in technology and multi-professional skills mix. We aimed to quantify the time taken to delineate target volumes for radical radiotherapy. MATERIALS AND METHODS The Royal College of Radiologists circulated two electronic surveys via email to all clinical oncology consultants in the UK. The individual case survey requested anonymous data regarding the next five patients contoured for radical radiotherapy. The second survey collected data on respondents' usual practice in radiotherapy contouring. RESULTS The median time to contour one radiotherapy case was 85 minutes (IQR = 50-131 minutes). Marked variability between and within tumour sites was evident: paediatric cancers took the most time (median = 210 minutes, IQR = 87.5 minutes), followed by head and neck and gynaecological cancers (median = 120 minutes, IQR = 71 and 72.5 minutes respectively). Breast cancer contouring required the least time (median = 43 minutes, IQR = 60 minutes). Radiotherapy technique, inclusion of nodes and 4D CT planning were associated with longer contouring times. A non-medical professional was involved in contouring in 65% of cases, but clinical oncology consultants were involved in target volume delineation in 90% of cases, and OARs in 74%. Peer review took place in 46% of cases with 56% of consultants reporting no time for peer review in their job plan. CONCLUSION Contouring for radical radiotherapy is complex and time-consuming, and despite increasing involvement of non-medical professionals, clinical oncology consultants remain the primary practitioners. Peer review practice is variable and time is often a limiting factor. Many factors influence the time required for contouring, and departments should take these factors and the need for peer-review into account when developing job plans.
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Affiliation(s)
- E Montague
- Royal College of Radiologists, 63 Lincoln's Inn Fields, London, UK; Leeds Cancer Centre, St James's University Hospital, Beckett Street, Leeds, UK
| | - T Roques
- Royal College of Radiologists, 63 Lincoln's Inn Fields, London, UK; Norfolk and Norwich University Hospitals Foundation Trust, Colney Ln, Norwich, UK
| | - K Spencer
- Leeds Cancer Centre, St James's University Hospital, Beckett Street, Leeds, UK; Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - A Burnett
- Royal College of Radiologists, 63 Lincoln's Inn Fields, London, UK; Weston Park Hospital, Whitham Road, Sheffield, UK
| | - J Lourenco
- Royal College of Radiologists, 63 Lincoln's Inn Fields, London, UK
| | - N Thorp
- Royal College of Radiologists, 63 Lincoln's Inn Fields, London, UK; The Christie NHS Foundation Trust, Wilmslow Road, Manchester, UK.
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Borrelli AM, Birch RJ, Spencer K. How does staff and patient feedback on hospital quality relate to mortality outcomes? A provider-level national study. Health Serv Manage Res 2024; 37:115-122. [PMID: 37368436 DOI: 10.1177/09514848231179182] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
This study aimed to use national data to examine the relationship between staff and inpatient survey results (National Health Service (NHS) Friends and Family Test (FFT)) and assess how these align with more traditional measurements of hospital quality as captured by the summary hospital mortality indicator (SHMI). Provider level FFT responses were obtained for 128 English non-specialist acute providers for staff and inpatients between April 2016 and March 2019. Multilevel linear regression models assessed the relationship between staff and patient FFT recommendations, and separately how SHMI related to each of staff and patient FFT recommendations. A total of 1,536 observations were recorded across all providers and financial quarters. Patients were more likely to recommend their provider (95.5%) than staff (76.8%). In multivariable regression, a statistically significant association was observed between staff and patient FFT recommendations. A statistically significant negative relationship was also observed between staff FFT recommendations and SHMI. The association between SHMI and staff FFT recommendations suggests that staff feedback tools may provide a useful analogue for providers in potential need of intervention and improvement in care. For patients meanwhile, qualitative approaches and hospital organisations working in partnership with patients may provide better opportunities for patients to drive improvement.
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Affiliation(s)
- Antonio Michael Borrelli
- Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, South Yorkshire, Sheffield S5 7AT, UK
| | - Rebecca J Birch
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Katie Spencer
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
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3
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Wakeham K, Cooper T, Rowbottom C, Chalmers AJ, Spencer K, Price P, Quinlan S. Towards world-class radiotherapy in the UK: time for transformation. Lancet Oncol 2024; 25:418-419. [PMID: 38408465 DOI: 10.1016/s1470-2045(24)00103-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 02/28/2024]
Affiliation(s)
- Katie Wakeham
- Department of Radiotherapy, Barts Health National Health Service Trust, London EC1A 7BE, UK.
| | | | - Carl Rowbottom
- West Midlands Imaging Network, Birmingham, UK; Clatterbridge Cancer Centre, NHS Foundation Trust, Liverpool, UK
| | | | - Katie Spencer
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Pat Price
- Radiotherapy UK, London, UK; Department of Surgery and Cancer, Imperial College London, London, UK
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Price G, Peek N, Eleftheriou I, Spencer K, Paley L, Hogenboom J, van Soest J, Dekker A, van Herk M, Faivre-Finn C. An Overview of Real-World Data Infrastructure for Cancer Research. Clin Oncol (R Coll Radiol) 2024:S0936-6555(24)00108-0. [PMID: 38631976 DOI: 10.1016/j.clon.2024.03.011] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/27/2024] [Accepted: 03/13/2024] [Indexed: 04/19/2024]
Abstract
AIMS There is increasing interest in the opportunities offered by Real World Data (RWD) to provide evidence where clinical trial data does not exist, but access to appropriate data sources is frequently cited as a barrier to RWD research. This paper discusses current RWD resources and how they can be accessed for cancer research. MATERIALS AND METHODS There has been significant progress on facilitating RWD access in the last few years across a range of scales, from local hospital research databases, through regional care records and national repositories, to the impact of federated learning approaches on internationally collaborative studies. We use a series of case studies, principally from the UK, to illustrate how RWD can be accessed for research and healthcare improvement at each of these scales. RESULTS For each example we discuss infrastructure and governance requirements with the aim of encouraging further work in this space that will help to fill evidence gaps in oncology. CONCLUSION There are challenges, but real-world data research across a range of scales is already a reality. Taking advantage of the current generation of data sources requires researchers to carefully define their research question and the scale at which it would be best addressed.
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Affiliation(s)
- G Price
- Division of Cancer Sciences, University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK.
| | - N Peek
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK; The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge, Cambridge, UK
| | - I Eleftheriou
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
| | - K Spencer
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK; National Disease Registration Service, NHS England, UK
| | - L Paley
- National Disease Registration Service, NHS England, UK
| | - J Hogenboom
- Department of Radiation Oncology (Maastro), GROW-School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - J van Soest
- Department of Radiation Oncology (Maastro), GROW-School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands; Brightlands Institute for Smart Society (BISS), Faculty of Science and Engineering, Maastricht University, Maastricht, The Netherlands
| | - A Dekker
- Department of Radiation Oncology (Maastro), GROW-School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - M van Herk
- Division of Cancer Sciences, University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK
| | - C Faivre-Finn
- Division of Cancer Sciences, University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK
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Roberts T, Uwenedi G, Bruton R, McIlroy G, Damery S, Sylla P, Logan N, Scott S, Lau M, Elzaidi A, Plass S, Mallick S, Spencer K, Stephens C, Bentley C, Pratt G, Zuo J, Paneesha S, Willett B, Moss P, Parry H. Enhancement of Omicron-specific immune responses following bivalent COVID-19 booster vaccination in patients with chronic lymphocytic leukaemia. Blood Cancer J 2024; 14:22. [PMID: 38272915 PMCID: PMC10810811 DOI: 10.1038/s41408-023-00940-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/21/2023] [Accepted: 10/27/2023] [Indexed: 01/27/2024] Open
Affiliation(s)
- Thomas Roberts
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | - Grace Uwenedi
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | - Rachel Bruton
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | - Graham McIlroy
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
- University Hospitals Birmingham, Edgbaston, Birmingham, B15 2GW, UK
| | - Sarah Damery
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Panagiota Sylla
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | - Nicola Logan
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, G61 1QH, UK
| | - Sam Scott
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, G61 1QH, UK
| | - May Lau
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | - Ahmed Elzaidi
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | - Siobhan Plass
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | - Soumyajit Mallick
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | - Katie Spencer
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | - Christine Stephens
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | - Christopher Bentley
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | - Guy Pratt
- University Hospitals Birmingham, Edgbaston, Birmingham, B15 2GW, UK
| | - Jianmin Zuo
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | | | - Brian Willett
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, G61 1QH, UK
| | - Paul Moss
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
- University Hospitals Birmingham, Edgbaston, Birmingham, B15 2GW, UK
| | - Helen Parry
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK.
- University Hospitals Birmingham, Edgbaston, Birmingham, B15 2GW, UK.
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Pickwell-Smith BA, Spencer K, Sadeghi MH, Greenley S, Lind M, Macleod U. Where are the inequalities in colorectal cancer care in a country with universal healthcare? A systematic review and narrative synthesis. BMJ Open 2024; 14:e080467. [PMID: 38171631 PMCID: PMC10773363 DOI: 10.1136/bmjopen-2023-080467] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/23/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE Patients diagnosed with colorectal cancer living in more deprived areas experience worse survival than those in more affluent areas. Those living in more deprived areas face barriers to accessing timely, quality healthcare. These barriers may contribute to socioeconomic inequalities in survival. We evaluated the literature for any association between socioeconomic group, hospital delay and treatments received among patients with colorectal cancer in the UK, a country with universal healthcare. DESIGN MEDLINE, EMBASE, CINAHL, CENTRAL, SCIE, AMED and PsycINFO were searched from inception to January 2023. Grey literature, including HMIC, BASE and Google Advanced Search, and forward and backward citation searches were conducted. Two reviewers independently reviewed titles, abstracts and full-text articles. Observational UK-based studies were included if they reported socioeconomic measures and an association with either hospital delay or treatments received. The QUIPS tool assessed bias risk, and a narrative synthesis was conducted. The review is reported to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. RESULTS 41 of the 7209 identified references were included. 12 studies evaluated 7 different hospital intervals. There was a significant association between area-level deprivation and a longer time from first presentation in primary care to diagnosis. 32 studies evaluated treatments received. There were socioeconomic inequalities in surgery and chemotherapy but not radiotherapy. CONCLUSION Patients with colorectal cancer face inequalities across the cancer care continuum. Further research is needed to understand why and what evidence-based actions can reduce these inequalities in treatment. Qualitative research of patients and clinicians conducted across various settings would provide a rich understanding of the complex factors that drive these inequalities. Further research should also consider using a causal approach to future studies to considerably strengthen the interpretation. Clinicians can try and mitigate some potential causes of colorectal cancer inequalities, including signposting to financial advice and patient transport schemes. PROSPERO REGISTRATION NUMBER CRD42022347652.
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Affiliation(s)
| | - Katie Spencer
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | | | - Michael Lind
- University of Hull, Hull, UK
- Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
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Parry H, Bruton R, Uwenedi G, Roberts T, Sylla P, Cook J, Elzaidi A, Lau M, Drury T, Bray A, Mallick S, Spencer K, Bentley C, McIlroy G, Scott S, Logan N, Zuo J, Willett B, Moss P. Robust generation of neutralising antibodies against Omicron variants following bivalent mRNA booster vaccine in elderly people aged >80 years. J Infect 2024; 88:48-50. [PMID: 37660756 DOI: 10.1016/j.jinf.2023.08.014] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/05/2023]
Affiliation(s)
- Helen Parry
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
| | - Rachel Bruton
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
| | - Grace Uwenedi
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
| | - Thomas Roberts
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
| | - Panagiota Sylla
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
| | - Jonathan Cook
- Centre for Statistics in Medicine, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX3 7LD, UK
| | - Ahmed Elzaidi
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
| | - May Lau
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
| | - Tamsin Drury
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
| | - Alexander Bray
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
| | - Soumyajit Mallick
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK; University Hospitals Birmingham, Edgbaston, Birmingham, UK; Centre for Statistics in Medicine, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX3 7LD, UK; MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow G61 1QH, UK
| | - Katie Spencer
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
| | - Christopher Bentley
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
| | - Graham McIlroy
- University Hospitals Birmingham, Edgbaston, Birmingham, UK
| | - Sam Scott
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow G61 1QH, UK
| | - Nicola Logan
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow G61 1QH, UK
| | - Jianmin Zuo
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
| | - Brian Willett
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow G61 1QH, UK
| | - Paul Moss
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK.
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Shamsesfandabadi P, Ponnapalli S, Spencer K, Patel A, Yin Y, Abel S, Beriwal S, Wegner RE, Patel AK, Horne ZD. CT vs. MRI: Which is More Accurate in Grading Rectal Wall Infiltration after Hydrogel Spacer Placement for Prostate Cancer Patients? Int J Radiat Oncol Biol Phys 2023; 117:e436-e437. [PMID: 37785418 DOI: 10.1016/j.ijrobp.2023.06.1608] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The purpose of this study was to evaluate the incidence and severity of rectal wall infiltration (RWI) in prostate cancer patients after rectal hydrogel spacer implantation, a commonly used procedure to minimize rectal radiation exposure during prostate radiotherapy. The study aimed to determine correlation of RWI using computed tomography (CT) scans and magnetic resonance imaging (MRI) scans in order to determine the optimal post-placement imaging modality. MATERIALS/METHODS This retrospective study was conducted on 370 patients diagnosed with localized prostate cancer who underwent rectal hydrogel spacer placement from 2020 to 2022. CT scans were performed on all patients, with a smaller subset also undergoing MRI scans. The images were independently evaluated by three radiation oncologists to grade RWI levels using a standardized scoring system based on CT and MRI images after hydrogel placement. The levels were categorized as 0 (no RWI), 1 (focal RWI), 2 (moderate RWI), and 3 (significant RWI). RESULTS Any grade of RWI was identified in 79.8% of men with the majority (41%) being RWI grade 1. The median time for CT scans was 9 days after hydrogel spacer placement and 14.5 days for MRI scans. For the subset of patients with both CT and MRI scans after spacer (mostly SpaceOAR Vue), RWI was detected in 58.33% of patients based on CT and 61.11% of patients based on MRI. Table 1 shows the mean percentage of patients with each score of RWI for each imaging modality. MRI was more likely to lead to a designation of RWI of any grade compared to CT and more often led to detection of RWI grades 2-3. CONCLUSION Our findings demonstrate that the incidence and severity of RWI may be higher than previously reported in clinical trials and that MRI may be a more sensitive imaging modality. Caution is needed in the utilization of rectal spacer gels given the potential for complications with misplacement prior to radiation therapy. Further study is warranted to determine the potential impact of low-grade RWI on the safety of subsequent treatment.
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Affiliation(s)
- P Shamsesfandabadi
- Allegheny Health Network Cancer Institute, Department of Radiation Oncology, Pittsburgh, PA
| | - S Ponnapalli
- Drexel University College of Medicine, Philadelphia, PA
| | - K Spencer
- Drexel University College of Medicine, Philadelphia, PA
| | - A Patel
- Drexel University College of Medicine, Philadelphia, PA
| | - Y Yin
- Allegheny Health Network, Pittsburgh, PA
| | - S Abel
- Allegheny Health Network Cancer Institute, Department of Radiation Oncology, Pittsburgh, PA
| | - S Beriwal
- Allegheny Health Network Cancer Institute, Department of Radiation Oncology, Pittsburgh, PA
| | - R E Wegner
- Allegheny Health Network Cancer Institute, Department of Radiation Oncology, Pittsburgh, PA
| | - A K Patel
- Allegheny Health Network Cancer Institute, Department of Radiation Oncology, Pittsburgh, PA
| | - Z D Horne
- Allegheny Health Network Cancer Institute, Department of Radiation Oncology, Pittsburgh, PA
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Eijwoudt S, Andrews T, McErlain-Naylor SA, Stewart T, Spencer K. Internal and external workload in national and international netball competition. J Sports Sci 2023; 41:1573-1579. [PMID: 38078436 DOI: 10.1080/02640414.2023.2283661] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/08/2023] [Indexed: 12/18/2023]
Abstract
Differences in workload exist between netball playing positions and competition levels, but no research has compared workloads experienced by the same elite players during national and international competitions. This study collected internal (heart rate) and external (PlayerLoad·min-1) workload data per match quarter from 44 players during a national competition and 12 players during an international competition. Nine players played in both competitions. Linear mixed models compared percentage of match quarter in each heart rate zone and PlayerLoad·min-1 between competitions for each playing position. Workloads against low- and high-ranked international opponents were also compared. Internal workloads were greater in national compared to international competition for GD and WD positions. PlayerLoad·min-1 was significantly higher by 8-13% in the national competition for positions WD and C, and by 5-8% in the international competition for GD and GA. Positional differences may indicate a role of the team's tactical style of play. Workloads were generally greater against higher- rather than lower-ranked international opponents. These results indicate that tactical factors in combination with playing position and opposition characteristics should be considered when preparing physically for matches.
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Affiliation(s)
- S Eijwoudt
- Faculty of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - T Andrews
- School of Sport and Recreation, Sport Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
| | - S A McErlain-Naylor
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - T Stewart
- School of Sport and Recreation, Sport Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
- Human Potential Centre, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
| | - K Spencer
- School of Sport and Recreation, Sport Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
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10
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Defourny N, Mackenzie P, Spencer K. Health Services Research in Brachytherapy: Current Understanding and Future Challenges. Clin Oncol (R Coll Radiol) 2023; 35:548-555. [PMID: 36941146 DOI: 10.1016/j.clon.2023.03.001] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/20/2023] [Accepted: 03/01/2023] [Indexed: 03/09/2023]
Abstract
Brachytherapy is an integral component of cancer care. Widespread concerns have been expressed though about the need for greater brachytherapy availability across many jurisdictions. Yet, health services research in brachytherapy has lagged behind that in external beam radiotherapy. Optimal brachytherapy utilisation, to help inform expected demand, have not been defined beyond the New South Wales region in Australia, with few studies having reported observed brachytherapy utilisation. There is also a relative lack of robust cost and cost-effectiveness studies, making investment decisions in brachytherapy even more uncertain and challenging to justify, despite its key role in cancer control. As the range of indications for brachytherapy expands, providing organ/function preservation for a wider range of diagnoses, there is an urgent need to redress this balance. By outlining the work undertaken in this area to date, we highlight its importance and explore where further study is required.
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Affiliation(s)
- N Defourny
- Division of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, Manchester Academic Health Science Centre, Manchester, UK.
| | - P Mackenzie
- Royal Australian and New Zealand College of Radiologists (RANZCR), The University of New South Wales, Sydney, Australia; Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute, Sydney, Australia; St Andrew's Hospital, Toowoomba, Queensland, Australia
| | - K Spencer
- University of Leeds Faculty of Medicine and Health, Academic Unit of Health Economics, Leeds Institute of Health Sciences, Leeds, UK
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11
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Sandhu S, Sharpe M, Findlay Ú, Roe C, Broggio J, Spencer K, Thackray K. Cohort profile: radiotherapy dataset (RTDS) in England. BMJ Open 2023; 13:e070699. [PMID: 37339842 DOI: 10.1136/bmjopen-2022-070699] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
PURPOSE The purpose of the Radiotherapy Dataset (RTDS) is to collect consistent and comparable data across all providers of National Health Service (NHS)-funded radiotherapy and to provide intelligence for service planning, commissioning, clinical practice and research. PARTICIPANTS The RTDS is a mandated dataset requiring providers to collect and submit data monthly for patients treated in England. Data is available from 01 April 2009 to 2 months behind the calendar month.The National Disease Registration Service (NDRS) started receiving data from 01 April 2016. Prior to this, the National Clinical Analysis and Specialised Applications Team (NATCANSAT) were responsible for the RTDS. NDRS holds a copy of the NATCANSAT data for English NHS providers.The RTDS contains clinical information on the primary disease being treated, modality and intent of treatment, dose fractionation and hospital appointment details. Due to constraints in RTDS coding, linkage to the English National Cancer Registration dataset is beneficial. FINDINGS TO DATE The RTDS has been linked to the English National Cancer Registration and Systemic Anti-Cancer Therapy (SACT) datasets and to Hospital Episode Statistics (HES) to provide a more complete picture of the patient cancer pathway. Findings include a study to compare outcomes for patients treated with radical radiotherapy, an investigation of factors influencing 30-day mortality, assessing sociodemographic variation in the use of treatment and a study to assess the service impact of the COVID-19 pandemic. A range of other studies have been completed or are ongoing currently. FUTURE PLANS The RTDS can be used for a variety of functions including cancer epidemiological studies to investigate inequalities in treatment access; provide service planning intelligence; monitor clinical practice; and support clinical trial design and recruitment. Collection is to continue indefinitely, with regular updates to the data specification to enable capture of more detailed information on radiotherapy planning and delivery.
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Affiliation(s)
- Sabrina Sandhu
- National Disease Registration Service (NDRS), NHS England, Leeds, UK
| | - Michael Sharpe
- National Disease Registration Service (NDRS), NHS England, Leeds, UK
| | - Úna Findlay
- National Disease Registration Service (NDRS), NHS England, Leeds, UK
- Medical Exposures Group, UKHSA, Chilton, UK
| | - Catherine Roe
- National Disease Registration Service (NDRS), NHS England, Leeds, UK
| | - John Broggio
- National Disease Registration Service (NDRS), NHS England, Leeds, UK
| | - Katie Spencer
- National Disease Registration Service (NDRS), NHS England, Leeds, UK
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Spencer K. Identifying the unseen and unmet; using data to target blind spots in cancer care. J Cancer Policy 2023; 35:100409. [PMID: 36736489 DOI: 10.1016/j.jcpo.2023.100409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/24/2023] [Accepted: 01/24/2023] [Indexed: 02/05/2023]
Affiliation(s)
- Katie Spencer
- Leeds Institute of Health Sciences, University of Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK; National Radiotherapy Dataset, NHS Digital, UK
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Ashley L, Surr C, Kelley R, Price M, Griffiths AW, Fowler NR, Giza DE, Neal RD, Martin C, Hopkinson JB, O'Donovan A, Dale W, Koczwara B, Spencer K, Wyld L. Cancer care for people with dementia: Literature overview and recommendations for practice and research. CA Cancer J Clin 2022; 73:320-338. [PMID: 36512303 DOI: 10.3322/caac.21767] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 07/17/2022] [Revised: 10/02/2022] [Accepted: 11/01/2022] [Indexed: 12/14/2022] Open
Abstract
As many countries experience population aging, patients with cancer are becoming older and have more preexisting comorbidities, which include prevalent, age-related, chronic conditions such as dementia. People living with dementia (PLWD) are vulnerable to health disparities, and dementia has high potential to complicate and adversely affect care and outcomes across the cancer trajectory. This report offers an overview of dementia and its prevalence among patients with cancer and a summary of the research literature examining cancer care for PLWD. The reviewed research indicates that PLWD are more likely to have cancer diagnosed at an advanced stage, receive no or less extensive cancer treatment, and have poorer survival after a cancer diagnosis. These cancer disparities do not necessarily signify inappropriately later diagnosis or lower treatment of people with dementia as a group, and they are arguably less feasible and appropriate targets for care optimization. The reviewed research indicates that PLWD also have an increased risk of cancer-related emergency presentations, lower quality processes of cancer-related decision making, accessibility-related barriers to cancer investigations and treatment, higher experienced treatment burden and higher caregiver burden for families, and undertreated cancer-related pain. The authors propose that optimal cancer care for PLWD should focus on proactively minimizing these risk areas and thus must be highly person-centered, with holistic decision making, individualized reasonable adjustments to practice, and strong inclusion and support of family carers. Comprehensive recommendations are made for clinical practice and future research to help clinicians and providers deliver best and equitable cancer care for PLWD and their families.
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Affiliation(s)
- Laura Ashley
- School of Humanities and Social Sciences, Leeds Beckett University, Leeds, UK
| | - Claire Surr
- Centre for Dementia Research, Leeds Beckett University, Leeds, UK
| | - Rachael Kelley
- Centre for Dementia Research, Leeds Beckett University, Leeds, UK
| | - Mollie Price
- School of Humanities and Social Sciences, Leeds Beckett University, Leeds, UK
| | | | - Nicole R Fowler
- Indiana University Center for Aging Research at Regenstrief Institute, Indianapolis, Indiana, USA
| | - Dana E Giza
- Joan and Stanford Alexander Division of Geriatric and Palliative Medicine, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Richard D Neal
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Charlene Martin
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | | | - Anita O'Donovan
- Applied Radiation Therapy Trinity (ARTT), Discipline of Radiation Therapy, School of Medicine, Trinity St. James's Cancer Institute, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - William Dale
- Center for Cancer and Aging, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Bogda Koczwara
- Department of Medical Oncology, Flinders Medical Centre & Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | | | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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Borrelli A, Spencer K, Birch R. Adjusting for comorbidity in observational cancer studies: A systematic review to assess alignment between index and study. Int J Oncol 2022; 62:9. [DOI: 10.3892/ijo.2022.5457] [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: 04/28/2022] [Accepted: 07/05/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Antonio Borrelli
- Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, South Yorkshire, Sheffield S5 7AT, UK
| | - Katie Spencer
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK
| | - Rebecca Birch
- Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds LS2 9NL, UK
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Howdon D, van den Hout W, van der Linden Y, Spencer K. Replacing performance status with a simple patient-reported outcome in palliative radiotherapy prognostic modelling. Clin Transl Radiat Oncol 2022; 37:137-144. [PMID: 36247687 PMCID: PMC9554755 DOI: 10.1016/j.ctro.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/21/2022] [Accepted: 09/25/2022] [Indexed: 11/29/2022] Open
Abstract
Background and purpose Prognostication is key to determining care in advanced incurable cancer. Although performance status (PS) has been shown to be a strong prognostic predictor, inter-rater reliability is limited, restricting models to specialist settings. This study assessed the extent to which a simple patient-reported outcome measure (PROM), the EQ-5D, may replace PS for prognosis of patients with bone metastases. Materials and methods Data from 1,011 patients in the Dutch Bone Metastasis Study were used. Cox proportional hazards models were developed to investigate the prognostic value of models incorporating PS alone, the EQ-5D SC dimension alone, all EQ-5D dimensions and EQ-VAS, and finally all dimensions and PS. Three prognostic groups were identified and performance assessed using the Harrell's C-index and Altman-Royston index of separation. Results Replacing performance status (PS) with the self-care (SC) dimension of the EQ-5D provides similar model performance. In our SC-based model, three groups are identified with median survival of 86 days (95 % CI 76-101), 174 days (95 % CI 145-213), and 483 days (95 % CI 431-539). Whilst not statistically significantly different, the C-index was 0.706 for the PS-only model, 0.718 for SC-only and 0.717 in our full model, suggesting patient-report outcome models perform as well as that based on PS. Conclusion Prognostic performance was similar across all models. The SC model provides prognostic value similar to that of PS, particularly where a prognosis of<6 months is considered. Larger, more contemporaneous studies are needed to assess the extent to which PROMs may be of prognostic value, particularly where specialist assessment is less feasible.
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Affiliation(s)
- Daniel Howdon
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, Clarendon Way, Woodhouse, Leeds LS2 9LU, UK
| | | | - Yvette van der Linden
- Dept of Radiotherapy/Centre of Expertise in Palliative Care, Leiden University Medical Centre, the Netherlands
| | - Katie Spencer
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, Clarendon Way, Woodhouse, Leeds LS2 9LU, UK
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, UK
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Page AJ, Spencer K, Mulvey MR, Laird BJ, Bennett MI. Non-steroidal anti-inflammatory drugs (NSAIDs) in cancer pain: A database analysis to determine recruitment feasibility for a clinical trial. Palliat Med 2022; 36:1440-1445. [PMID: 36113099 PMCID: PMC9596945 DOI: 10.1177/02692163221122263] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Insufficient evidence exists to support or refute use of NSAIDs for managing cancer pain. Palliative physicians support a placebo-controlled trial of NSAIDs as strong opioid adjuncts for cancer-induced bone pain as the most pragmatic design to benefit clinical practice. AIM We aimed to determine patient numbers receiving palliative radiotherapy for cancer-induced bone pain, estimate the suitability of NSAID prescription and determine survival, guiding future trial feasibility. DESIGN A retrospective observational database analysis was undertaken using 5 years of routinely collected regional radiotherapy and healthcare data, filtered to achieve a cohort with cancer-induced bone pain. Demographics and survival were linked to available serology and co-morbidity data. SETTING/PARTICIPANTS Data was sourced from the regional Leeds Cancer Centre, a tertiary care setting. Patients who underwent palliative single fraction 8 gray (Gy) radiotherapy treatment for cancer-induced bone pain were included, totalling 2411 over 5 years. RESULTS A mean of 478 patients received palliative radiotherapy for cancer-induced bone pain annually. Median age (IQR) was 70 (62-77); negatively skewed (-0.69). 65.3% died within 1 year of radiotherapy; 48.0% within 6 months. Age was not associated with survival on univariable analysis (HR 0.999 (95% CI 0.996-1.003)). Serology from 1063 patients (44.2%) were available; eGFR was ⩾60 mL/min/1.73 m2 in 83.0%. From available data (1352 pts; 51.6% of sample), 20.2% had a coded co-morbidity contra-indicating NSAIDs. Combining serology and co-morbidities, 68.5% could be considered for NSAID prescription. CONCLUSIONS Patient numbers at a regional radiotherapy centre support the feasibility of trial recruitment. Available serology and co-morbidity data suggest two-thirds may be suitable for NSAID prescription.
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Affiliation(s)
- Andrew J Page
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Katie Spencer
- University of Leeds Faculty of Medicine and Health, Academic Unit of Health Economics, Leeds Institute of Health Sciences, Leeds, UK
| | - Matthew R Mulvey
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Barry Ja Laird
- Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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17
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Coleman E, Radix AE, Bouman WP, Brown GR, de Vries ALC, Deutsch MB, Ettner R, Fraser L, Goodman M, Green J, Hancock AB, Johnson TW, Karasic DH, Knudson GA, Leibowitz SF, Meyer-Bahlburg HFL, Monstrey SJ, Motmans J, Nahata L, Nieder TO, Reisner SL, Richards C, Schechter LS, Tangpricha V, Tishelman AC, Van Trotsenburg MAA, Winter S, Ducheny K, Adams NJ, Adrián TM, Allen LR, Azul D, Bagga H, Başar K, Bathory DS, Belinky JJ, Berg DR, Berli JU, Bluebond-Langner RO, Bouman MB, Bowers ML, Brassard PJ, Byrne J, Capitán L, Cargill CJ, Carswell JM, Chang SC, Chelvakumar G, Corneil T, Dalke KB, De Cuypere G, de Vries E, Den Heijer M, Devor AH, Dhejne C, D'Marco A, Edmiston EK, Edwards-Leeper L, Ehrbar R, Ehrensaft D, Eisfeld J, Elaut E, Erickson-Schroth L, Feldman JL, Fisher AD, Garcia MM, Gijs L, Green SE, Hall BP, Hardy TLD, Irwig MS, Jacobs LA, Janssen AC, Johnson K, Klink DT, Kreukels BPC, Kuper LE, Kvach EJ, Malouf MA, Massey R, Mazur T, McLachlan C, Morrison SD, Mosser SW, Neira PM, Nygren U, Oates JM, Obedin-Maliver J, Pagkalos G, Patton J, Phanuphak N, Rachlin K, Reed T, Rider GN, Ristori J, Robbins-Cherry S, Roberts SA, Rodriguez-Wallberg KA, Rosenthal SM, Sabir K, Safer JD, Scheim AI, Seal LJ, Sehoole TJ, Spencer K, St Amand C, Steensma TD, Strang JF, Taylor GB, Tilleman K, T'Sjoen GG, Vala LN, Van Mello NM, Veale JF, Vencill JA, Vincent B, Wesp LM, West MA, Arcelus J. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. Int J Transgend Health 2022; 23:S1-S259. [PMID: 36238954 PMCID: PMC9553112 DOI: 10.1080/26895269.2022.2100644] [Citation(s) in RCA: 455] [Impact Index Per Article: 227.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person.
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Affiliation(s)
- E Coleman
- Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - A E Radix
- Callen-Lorde Community Health Center, New York, NY, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - W P Bouman
- Nottingham Centre for Transgender Health, Nottingham, UK
- School of Medicine, University of Nottingham, Nottingham, UK
| | - G R Brown
- James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
- James H. Quillen VAMC, Johnson City, TN, USA
| | - A L C de Vries
- Department of Child and Adolescent Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M B Deutsch
- Department of Family & Community Medicine, University of California-San Francisco, San Francisco, CA, USA
- UCSF Gender Affirming Health Program, San Francisco, CA, USA
| | - R Ettner
- New Health Foundation Worldwide, Evanston, IL, USA
- Weiss Memorial Hospital, Chicago, IL, USA
| | - L Fraser
- Independent Practice, San Francisco, CA, USA
| | - M Goodman
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - J Green
- Independent Scholar, Vancouver, WA, USA
| | - A B Hancock
- The George Washington University, Washington, DC, USA
| | - T W Johnson
- Department of Anthropology, California State University, Chico, CA, USA
| | - D H Karasic
- University of California San Francisco, San Francisco, CA, USA
- Independent Practice at dankarasic.com
| | - G A Knudson
- University of British Columbia, Vancouver, Canada
- Vancouver Coastal Health, Vancouver, Canada
| | - S F Leibowitz
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - H F L Meyer-Bahlburg
- New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University, New York, NY, USA
| | | | - J Motmans
- Transgender Infopunt, Ghent University Hospital, Gent, Belgium
- Centre for Research on Culture and Gender, Ghent University, Gent, Belgium
| | - L Nahata
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
- Endocrinology and Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - T O Nieder
- University Medical Center Hamburg-Eppendorf, Interdisciplinary Transgender Health Care Center Hamburg, Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, Hamburg, Germany
| | - S L Reisner
- Harvard Medical School, Boston, MA, USA
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - C Richards
- Regents University London, UK
- Tavistock and Portman NHS Foundation Trust, London, UK
| | | | - V Tangpricha
- Division of Endocrinology, Metabolism & Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Atlanta VA Medical Center, Decatur, GA, USA
| | - A C Tishelman
- Boston College, Department of Psychology and Neuroscience, Chestnut Hill, MA, USA
| | - M A A Van Trotsenburg
- Bureau GenderPRO, Vienna, Austria
- University Hospital Lilienfeld-St. Pölten, St. Pölten, Austria
| | - S Winter
- School of Population Health, Curtin University, Perth, WA, Australia
| | - K Ducheny
- Howard Brown Health, Chicago, IL, USA
| | - N J Adams
- University of Toronto, Ontario Institute for Studies in Education, Toronto, Canada
- Transgender Professional Association for Transgender Health (TPATH)
| | - T M Adrián
- Asamblea Nacional de Venezuela, Caracas, Venezuela
- Diverlex Diversidad e Igualdad a Través de la Ley, Caracas, Venezuela
| | - L R Allen
- University of Nevada, Las Vegas, NV, USA
| | - D Azul
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - H Bagga
- Monash Health Gender Clinic, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
| | - K Başar
- Department of Psychiatry, Hacettepe University, Ankara, Turkey
| | - D S Bathory
- Independent Practice at Bathory International PLLC, Winston-Salem, NC, USA
| | - J J Belinky
- Durand Hospital, Guemes Clinic and Urological Center, Buenos Aires, Argentina
| | - D R Berg
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - J U Berli
- Oregon Health & Science University, Portland, OR, USA
| | - R O Bluebond-Langner
- NYU Langone Health, New York, NY, USA
- Hansjörg Wyss Department of Plastic Surgery, New York, NY, USA
| | - M-B Bouman
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Plastic Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - M L Bowers
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mills-Peninsula Medical Center, Burlingame, CA, USA
| | - P J Brassard
- GrS Montreal, Complexe CMC, Montreal, Quebec, Canada
- Université de Montreal, Quebec, Canada
| | - J Byrne
- University of Waikato/Te Whare Wānanga o Waikato, Hamilton/Kirikiriroa, New Zealand/Aotearoa
| | - L Capitán
- The Facialteam Group, Marbella International Hospital, Marbella, Spain
| | | | - J M Carswell
- Harvard Medical School, Boston, MA, USA
- Boston's Children's Hospital, Boston, MA, USA
| | - S C Chang
- Independent Practice, Oakland, CA, USA
| | - G Chelvakumar
- Nationwide Children's Hospital, Columbus, OH, USA
- The Ohio State University, College of Medicine, Columbus, OH, USA
| | - T Corneil
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
| | - K B Dalke
- Penn State Health, PA, USA
- Penn State College of Medicine, Hershey, PA, USA
| | - G De Cuypere
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
| | - E de Vries
- Nelson Mandela University, Gqeberha, South Africa
- University of Cape Town, Cape Town, South Africa
| | - M Den Heijer
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Endocrinology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - A H Devor
- University of Victoria, Victoria, BC, Canada
| | - C Dhejne
- ANOVA, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - A D'Marco
- UCTRANS-United Caribbean Trans Network, Nassau, The Bahamas
- D M A R C O Organization, Nassau, The Bahamas
| | - E K Edmiston
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - L Edwards-Leeper
- Pacific University, Hillsboro, OR, USA
- Independent Practice, Beaverton, OR, USA
| | - R Ehrbar
- Whitman Walker Health, Washington, DC, USA
- Independent Practice, Maryland, USA
| | - D Ehrensaft
- University of California San Francisco, San Francisco, CA, USA
| | - J Eisfeld
- Transvisie, Utrecht, The Netherlands
| | - E Elaut
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
- Department of Clinical Experimental and Health Psychology, Ghent University, Gent, Belgium
| | - L Erickson-Schroth
- The Jed Foundation, New York, NY, USA
- Hetrick-Martin Institute, New York, NY, USA
| | - J L Feldman
- Institute for Sexual and Gender Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - A D Fisher
- Andrology, Women Endocrinology and Gender Incongruence, Careggi University Hospital, Florence, Italy
| | - M M Garcia
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Departments of Urology and Anatomy, University of California San Francisco, San Francisco, CA, USA
| | - L Gijs
- Institute of Family and Sexuality Studies, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | | | - B P Hall
- Duke University Medical Center, Durham, NC, USA
- Duke Adult Gender Medicine Clinic, Durham, NC, USA
| | - T L D Hardy
- Alberta Health Services, Edmonton, Alberta, Canada
- MacEwan University, Edmonton, Alberta, Canada
| | - M S Irwig
- Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - A C Janssen
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - K Johnson
- RMIT University, Melbourne, Australia
- University of Brighton, Brighton, UK
| | - D T Klink
- Department of Pediatrics, Division of Pediatric Endocrinology, Ghent University Hospital, Gent, Belgium
- Division of Pediatric Endocrinology and Diabetes, ZNA Queen Paola Children's Hospital, Antwerp, Belgium
| | - B P C Kreukels
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - L E Kuper
- Department of Psychiatry, Southwestern Medical Center, University of Texas, Dallas, TX, USA
- Department of Endocrinology, Children's Health, Dallas, TX, USA
| | - E J Kvach
- Denver Health, Denver, CO, USA
- University of Colorado School of Medicine, Aurora, CO, USA
| | - M A Malouf
- Malouf Counseling and Consulting, Baltimore, MD, USA
| | - R Massey
- WPATH Global Education Institute
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - T Mazur
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- John R. Oishei Children's Hospital, Buffalo, NY, USA
| | - C McLachlan
- Professional Association for Transgender Health, South Africa
- Gender DynamiX, Cape Town, South Africa
| | - S D Morrison
- Division of Plastic Surgery, Seattle Children's Hospital, Seattle, WA, USA
- Division of Plastic Surgery, Department of Surgery, University of Washington Medical Center, Seattle, WA, USA
| | - S W Mosser
- Gender Confirmation Center, San Francisco, CA, USA
- Saint Francis Memorial Hospital, San Francisco, CA, USA
| | - P M Neira
- Johns Hopkins Center for Transgender Health, Baltimore, MD, USA
- Johns Hopkins Medicine Office of Diversity, Inclusion and Health Equity, Baltimore, MD, USA
| | - U Nygren
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Speech and Language Pathology, Medical Unit, Karolinska University Hospital, Stockholm, Sweden
| | - J M Oates
- La Trobe University, Melbourne, Australia
- Melbourne Voice Analysis Centre, East Melbourne, Australia
| | - J Obedin-Maliver
- Stanford University School of Medicine, Department of Obstetrics and Gynecology, Palo Alto, CA, USA
- Department of Epidemiology and Population Health, Stanford, CA, USA
| | - G Pagkalos
- Independent PracticeThessaloniki, Greece
- Military Community Mental Health Center, 424 General Military Training Hospital, Thessaloniki, Greece
| | - J Patton
- Talkspace, New York, NY, USA
- CytiPsychological LLC, San Diego, CA, USA
| | - N Phanuphak
- Institute of HIV Research and Innovation, Bangkok, Thailand
| | - K Rachlin
- Independent Practice, New York, NY, USA
| | - T Reed
- Gender Identity Research and Education Society, Leatherhead, UK
| | - G N Rider
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - J Ristori
- Andrology, Women Endocrinology and Gender Incongruence, Careggi University Hospital, Florence, Italy
| | | | - S A Roberts
- Harvard Medical School, Boston, MA, USA
- Division of Endocrinology, Boston's Children's Hospital, Boston, MA, USA
| | - K A Rodriguez-Wallberg
- Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - S M Rosenthal
- Division of Pediatric Endocrinology, UCSF, San Francisco, CA, USA
- UCSF Child and Adolescent Gender Center
| | - K Sabir
- FtM Phoenix Group, Krasnodar Krai, Russia
| | - J D Safer
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Center for Transgender Medicine and Surgery, New York, NY, USA
| | - A I Scheim
- Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
| | - L J Seal
- Tavistock and Portman NHS Foundation Trust, London, UK
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - K Spencer
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - C St Amand
- University of Houston, Houston, TX, USA
- Mayo Clinic, Rochester, MN, USA
| | - T D Steensma
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - J F Strang
- Children's National Hospital, Washington, DC, USA
- George Washington University School of Medicine, Washington, DC, USA
| | - G B Taylor
- Atrium Health Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Charlotte, NC, USA
| | - K Tilleman
- Department for Reproductive Medicine, Ghent University Hospital, Gent, Belgium
| | - G G T'Sjoen
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
- Department of Endocrinology, Ghent University Hospital, Gent, Belgium
| | - L N Vala
- Independent Practice, Campbell, CA, USA
| | - N M Van Mello
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - J F Veale
- School of Psychology, University of Waikato/Te Whare Wānanga o Waikato, Hamilton/Kirikiriroa, New Zealand/Aotearoa
| | - J A Vencill
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - B Vincent
- Trans Learning Partnership at https://spectra-london.org.uk/trans-learning-partnership, UK
| | - L M Wesp
- College of Nursing, University of Wisconsin MilwaukeeMilwaukee, WI, USA
- Health Connections Inc., Glendale, WI, USA
| | - M A West
- North Memorial Health Hospital, Robbinsdale, MN, USA
- University of Minnesota, Minneapolis, MN, USA
| | - J Arcelus
- School of Medicine, University of Nottingham, Nottingham, UK
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
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Neal J, Lim F, Aix S, Viteri S, Santoro A, Spencer K, Fang B, Khrizman P, Kim J, Subbiah V, Sudhagoni R, Samaraweera L, Andrianova L, Felip E. EP08.02-081 Cabozantinib Plus Atezolizumab in First or Second-Line Advanced NSCLC and Previously-Treated EGFR Mutant Advanced NSCLC. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.763] [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: 11/25/2022]
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Jones CM, Walls G, Spencer K. Growing Evidence for a Need for a Greater Emphasis on Oncology Teaching in Medical School Curricula. Clin Oncol (R Coll Radiol) 2022; 34:e446. [PMID: 35780006 DOI: 10.1016/j.clon.2022.06.005] [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: 05/23/2022] [Accepted: 06/15/2022] [Indexed: 11/25/2022]
Affiliation(s)
- C M Jones
- Department of Oncology, University of Cambridge, Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - G Walls
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK; Cancer Centre, Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK
| | - K Spencer
- Radiotherapy Research Group, Faculty of Medicine & Health, University of Leeds, Leeds, UK; Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Palmeri M, Mehnert J, Silk A, Jabbour S, Ganesan S, Popli P, Riedlinger G, Stephenson R, de Meritens A, Leiser A, Mayer T, Chan N, Spencer K, Girda E, Malhotra J, Chan T, Subbiah V, Groisberg R. Real-world application of tumor mutational burden-high (TMB-high) and microsatellite instability (MSI) confirms their utility as immunotherapy biomarkers. ESMO Open 2022; 7:100336. [PMID: 34953399 PMCID: PMC8717431 DOI: 10.1016/j.esmoop.2021.100336] [Citation(s) in RCA: 82] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 09/30/2021] [Accepted: 11/14/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction Microsatellite instability (MSI) testing and tumor mutational burden (TMB) are genomic biomarkers used to identify patients who are likely to benefit from immune checkpoint inhibitors. Pembrolizumab was recently approved by the Food and Drug Administration for use in TMB-high (TMB-H) tumors, regardless of histology, based on KEYNOTE-158. The primary objective of this retrospective study was real-world applicability and use of immunotherapy in TMB/MSI-high patients to lend credence to and refine this biomarker. Methods Charts of patients with advanced solid tumors who had MSI/TMB status determined by next generation sequencing (NGS) (FoundationOne CDx) were reviewed. Demographics, diagnosis, treatment history, and overall response rate (ORR) were abstracted. Progression-free survival (PFS) was determined from Kaplan–Meier curves. PFS1 (chemotherapy PFS) and PFS2 (immunotherapy PFS) were determined for patients who received immunotherapy after progressing on chemotherapy. The median PFS2/PFS1 ratio was recorded. Results MSI-high or TMB-H [≥20 mutations per megabase (mut/MB)] was detected in 157 adults with a total of 27 distinct tumor histologies. Median turnaround time for NGS was 73 days. ORR for most recent chemotherapy was 34.4%. ORR for immunotherapy was 55.9%. Median PFS for patients who received chemotherapy versus immunotherapy was 6.75 months (95% confidence interval, 3.9-10.9 months) and 24.2 months (95% confidence interval, 9.6 months to not reached), respectively (P = 0.042). Median PFS2/PFS1 ratio was 4.7 in favor of immunotherapy. Conclusion This real-world study reinforces the use of TMB as a predictive biomarker. Barriers exist to the timely implementation of NGS-based biomarkers and more data are needed to raise awareness about the clinical utility of TMB. Clinicians should consider treating TMB-H patients with immunotherapy regardless of their histology. This retrospective study examined the real-world use of immune checkpoint inhibitors (ICIs) in TMB/MSI-high patients with a diverse set of cancer types. TMB is an emerging tumor-agnostic biomarker for response to treatment with ICIs that may expand personalized cancer care. ICIs remain underutilized as a first-line therapy for TMB/MSI-H patients without specific histologic approval for ICIs. The PFS2 to PFS1 ratio was 4.7, favoring immunotherapy over chemotherapy even as a second-line therapy. Our study reinforces the real-world evidence that TMB is a valid surrogate marker for MSI and can predict response to ICIs.
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21
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Walls GM, Houlihan OA, Mooney C, Prince R, Spencer K, Lyons C, Cole AJ, McAleer JJ, Jones CM. Radiation oncology teaching provision and practice prior to and during the first wave of the COVID-19 pandemic in medical schools in the United Kingdom and the Republic of Ireland: a cross-sectional survey. Br J Radiol 2021; 94:20210614. [PMID: 34705530 PMCID: PMC8631035 DOI: 10.1259/bjr.20210614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/20/2021] [Accepted: 10/04/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Radiotherapy is a key cancer treatment modality but is poorly understood by doctors. We sought to evaluate radiation oncology (RO) teaching in medical schools within the United Kingdom (UK) and Republic of Ireland (RoI), as well as any impacts on RO teaching delivery from the coronavirus disease 2019 (COVID-19) pandemic. METHODS A bespoke online survey instrument was developed, piloted and distributed to oncology teaching leads at all UK and RoI medical schools. Questions were designed to capture information on the structure, format, content and faculty for RO teaching, as well as both the actual and the predicted short- and long-term impacts of COVID-19. RESULTS Responses were received from 29/41 (71%) UK and 5/6 (83%) RoI medical schools. Pre-clinical and clinical oncology teaching was delivered over a median of 2 weeks (IQR 1-6), although only 9 (27%) of 34 responding medical schools had a standalone RO module. RO teaching was most commonly delivered in clinics or wards (n = 26 and 25 respectively). Few medical schools provided teaching on the biological basis for radiotherapy (n = 11) or the RO career pathway (n = 8), and few provide teaching delivered by non-medical RO multidisciplinary team members. There was evidence of short- and long-term disruption to RO teaching from COVID-19. CONCLUSIONS RO teaching in the UK and RoI is limited with minimal coverage of relevant theoretical principles and little exposure to radiotherapy departments and their non-medical team members. The COVID-19 pandemic risks exacerbating trainee doctors' already constrained exposure to radiotherapy. ADVANCES IN KNOWLEDGE This study provides the first analysis of radiotherapy-related teaching in the UK and RoI, and the first to explore the impact of the COVID-19 pandemic on radiationoncology teaching.
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Affiliation(s)
| | | | | | - Rebecca Prince
- Radiotherapy Research Group, Faculty of Medicine & Health, University of Leeds, Leeds, UK
| | | | - Ciara Lyons
- Department of Radiation Oncology, Cork University Hospital, Cork, Ireland
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Mamidanna S, Neibart S, Chundury A, Sayan M, Alexander H, August D, Berim L, Boland P, Grandhi M, Gulhati P, Gupta K, Hochster H, Kennedy T, Langan R, Minacapelli C, Spencer K, Nosher J, Jabbour S. Survival Outcomes of Patients With Unresectable Hepatocellular Carcinoma Secondary to Viral vs. Non-Viral Etiologies Treated with Definitive Radiotherapy. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.398] [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: 12/01/2022]
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Mamidanna S, Neibart S, Chundury A, Sayan M, Alexander H, August D, Berim L, Boland P, Grandhi M, Gulhati P, Gupta K, Hochster H, Kennedy T, Langan R, Minacapelli C, Spencer K, Nosher J, Jabbour S. Comparing Acute Toxicities of Patients With Unresectable Hepatocellular Carcinoma Treated With Definitive Proton vs. Photon-Based Radiotherapy. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.399] [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: 10/20/2022]
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24
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Neibart S, Mamidanna S, Chundury A, Sayan M, Alexander H, August D, Berim L, Boland P, Grandhi M, Gulhati P, Kennedy T, Langan R, Spencer K, Jabbour S. Predictors of Undergoing Surgical Resection after Neoadjuvant Chemoradiotherapy for Borderline Resectable and Resectable Pancreatic Adenocarcinoma. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.413] [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]
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Curtin G, McCarthy S, Cooney C, Spencer K, Thompson M. 948 Feasibility Study of a Drive-Through Influenza Vaccination Clinic for Patients-At-Risk & Their Contacts. Br J Surg 2021. [PMCID: PMC8524481 DOI: 10.1093/bjs/znab259.758] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background There are 3-5 million cases of severe influenza-like illness globally each year, and up to 650,000 related deaths. This high prevalence rate proves to be a heavy burden on the healthcare system with >3,000 hospitalisations and >150 ICU admissions annually. Immunisation is gold-standard for the prevention of influenza outbreaks. The HSE Influenza Immunisation Strategy allocates vaccines to be administered in primary care to patients at-risk and their contacts. However, due to the COVID-19 pandemic, this has become a logistical challenge. We aimed to design and test a drive-through influenza vaccine clinic at a large GP practice in Cork. Method We designed and implemented an online booking system for at-risk patients and their contacts. 1-minute drive-through time slots were available to book for up to 6 people per vehicle. The primary measurement was the number of patients vaccinated with a secondary measurement of time spent vaccinating these patients. Results The pilot clinic occurred on 10/10/2020 with over 600 patients-at-risk & their contacts receiving the influenza vaccination over a time period of 10 hours. The capacity of this clinic was limited by the supply of vaccines. We estimate that 1,800 people could be vaccinated over the same time period with adequate vaccine supply. Conclusions A drive-through influenza vaccination clinic can be efficiently run using an online booking system and serves as a safe, efficient, and convenient way for patients-at-risk & their contacts to receive vaccinations. This system can be rolled out efficiently each winter for influenza vaccination and could be expanded to deliver mass vaccination for SARS-CoV-2.
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Affiliation(s)
- G Curtin
- University College Cork, Cork, Ireland
| | - S McCarthy
- Ballycotton Medical Centre, Cork, Ireland
| | - C Cooney
- Imokilly Medical Centre, Cork, Ireland
| | - K Spencer
- Imokilly Medical Centre, Cork, Ireland
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Defourny N, Spencer K, Tunstall D, Cosgrove V, Kirkby K, Henry A, Lievens Y, Hall P. OC-0058 Impact of increased hypofractionation on treatment cost. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06752-9] [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: 10/20/2022]
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27
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Stone PC, Kalpakidou A, Todd C, Griffiths J, Keeley V, Spencer K, Buckle P, Finlay D, Vickerstaff V, Omar RZ. The Prognosis in Palliative care Study II (PiPS2): A prospective observational validation study of a prognostic tool with an embedded qualitative evaluation. PLoS One 2021; 16:e0249297. [PMID: 33909630 PMCID: PMC8081241 DOI: 10.1371/journal.pone.0249297] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 03/15/2021] [Indexed: 11/18/2022] Open
Abstract
Background Prognosis in Palliative care Study (PiPS) models predict survival probabilities in advanced cancer. PiPS-A (clinical observations only) and PiPS-B (additionally requiring blood results) consist of 14- and 56-day models (PiPS-A14; PiPS-A56; PiPS-B14; PiPS-B56) to create survival risk categories: days, weeks, months. The primary aim was to compare PIPS-B risk categories against agreed multi-professional estimates of survival (AMPES) and to validate PiPS-A and PiPS-B. Secondary aims were to assess acceptability of PiPS to patients, caregivers and health professionals (HPs). Methods and findings A national, multi-centre, prospective, observational, cohort study with nested qualitative sub-study using interviews with patients, caregivers and HPs. Validation study participants were adults with incurable cancer; with or without capacity; recently referred to community, hospital and hospice palliative care services across England and Wales. Sub-study participants were patients, caregivers and HPs. 1833 participants were recruited. PiPS-B risk categories were as accurate as AMPES [PiPS-B accuracy (910/1484; 61%); AMPES (914/1484; 61%); p = 0.851]. PiPS-B14 discrimination (C-statistic 0.837) and PiPS-B56 (0.810) were excellent. PiPS-B14 predictions were too high in the 57–74% risk group (Calibration-in-the-large [CiL] -0.202; Calibration slope [CS] 0.840). PiPS-B56 was well-calibrated (CiL 0.152; CS 0.914). PiPS-A risk categories were less accurate than AMPES (p<0.001). PiPS-A14 (C-statistic 0.825; CiL -0.037; CS 0.981) and PiPS-A56 (C-statistic 0.776; CiL 0.109; CS 0.946) had excellent or reasonably good discrimination and calibration. Interviewed patients (n = 29) and caregivers (n = 20) wanted prognostic information and considered that PiPS may aid communication. HPs (n = 32) found PiPS user-friendly and considered risk categories potentially helpful for decision-making. The need for a blood test for PiPS-B was considered a limitation. Conclusions PiPS-B risk categories are as accurate as AMPES made by experienced doctors and nurses. PiPS-A categories are less accurate. Patients, carers and HPs regard PiPS as potentially helpful in clinical practice. Study registration ISRCTN13688211.
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Affiliation(s)
- P. C. Stone
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London (UCL), London, United Kingdom
- * E-mail:
| | - A. Kalpakidou
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London (UCL), London, United Kingdom
| | - C. Todd
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - J. Griffiths
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - V. Keeley
- Palliative Medicine Department, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, United Kingdom
| | - K. Spencer
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - P. Buckle
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London (UCL), London, United Kingdom
| | - D. Finlay
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London (UCL), London, United Kingdom
| | - V. Vickerstaff
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London (UCL), London, United Kingdom
| | - R. Z. Omar
- Department of Statistical Science, University College London (UCL), London, United Kingdom
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Stone P, Vickerstaff V, Kalpakidou A, Todd C, Griffiths J, Keeley V, Spencer K, Buckle P, Finlay D, Omar RZ. Prognostic tools or clinical predictions: Which are better in palliative care? PLoS One 2021; 16:e0249763. [PMID: 33909658 PMCID: PMC8081205 DOI: 10.1371/journal.pone.0249763] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/25/2021] [Indexed: 01/29/2023] Open
Abstract
PURPOSE The Palliative Prognostic (PaP) score; Palliative Prognostic Index (PPI); Feliu Prognostic Nomogram (FPN) and Palliative Performance Scale (PPS) have all been proposed as prognostic tools for palliative cancer care. However, clinical judgement remains the principal way by which palliative care professionals determine prognoses and it is important that the performance of prognostic tools is compared against clinical predictions of survival (CPS). METHODS This was a multi-centre, cohort validation study of prognostic tools. Study participants were adults with advanced cancer receiving palliative care, with or without capacity to consent. Key prognostic data were collected at baseline, shortly after referral to palliative care services. CPS were obtained independently from a doctor and a nurse. RESULTS Prognostic data were collected on 1833 participants. All prognostic tools showed acceptable discrimination and calibration, but none showed superiority to CPS. Both PaP and CPS were equally able to accurately categorise patients according to their risk of dying within 30 days. There was no difference in performance between CPS and FPN at stratifying patients according to their risk of dying at 15, 30 or 60 days. PPI was significantly (p<0.001) worse than CPS at predicting which patients would survive for 3 or 6 weeks. PPS and CPS were both able to discriminate palliative care patients into multiple iso-prognostic groups. CONCLUSIONS Although four commonly used prognostic algorithms for palliative care generally showed good discrimination and calibration, none of them demonstrated superiority to CPS. Prognostic tools which are less accurate than CPS are of no clinical use. However, prognostic tools which perform similarly to CPS may have other advantages to recommend them for use in clinical practice (e.g. being more objective, more reproducible, acting as a second opinion or as an educational tool). Future studies should therefore assess the impact of prognostic tools on clinical practice and decision-making.
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Affiliation(s)
- P. Stone
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London (UCL), London, United Kingdom
| | - V. Vickerstaff
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London (UCL), London, United Kingdom
| | - A. Kalpakidou
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London (UCL), London, United Kingdom
| | - C. Todd
- Faculty of Biology, Medicine and Health, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - J. Griffiths
- Faculty of Biology, Medicine and Health, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - V. Keeley
- Palliative Medicine Department, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, United Kingdom
| | - K. Spencer
- Faculty of Biology, Medicine and Health, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - P. Buckle
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London (UCL), London, United Kingdom
| | - D. Finlay
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London (UCL), London, United Kingdom
| | - R. Z. Omar
- Department of Statistical Science, University College London (UCL), London, United Kingdom
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Low JL, Huang Y, Sooi K, Ang Y, Chan ZY, Spencer K, Jeyasekharan AD, Sundar R, Goh BC, Soo R, Yong WP. Low-dose pembrolizumab in the treatment of advanced non-small cell lung cancer. Int J Cancer 2021; 149:169-176. [PMID: 33634869 PMCID: PMC9545741 DOI: 10.1002/ijc.33534] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 10/07/2020] [Revised: 01/01/2021] [Accepted: 02/10/2021] [Indexed: 12/24/2022]
Abstract
A dose of 200 mg 3‐weekly of pembrolizumab was approved by the Food and Drug Administration (FDA) as treatment for advanced non‐small cell lung cancer (NSCLC) without oncogenic drivers. This is despite evidence showing no difference in efficacy with 2 mg/kg. Our study aimed to assess the efficacy of a lower fixed dose of 100 mg, which is closer to 2 mg/kg weight‐based dose in an average‐sized Asian patient. All patients receiving pembrolizumab for advanced NSCLC from January 2016 to March 2020 in National University Hospital, Singapore, were included in this retrospective observational study. The effect of pembrolizumab 100 mg (Pem100) vs 200 mg (Pem200) upon survival outcomes, toxicity and cost were examined. One hundred fourteen patients received pembrolizumab. Sixty‐five (57%) and 49 (43%) received Pem100 and Pem200, respectively. There was no difference in progression‐free survival (PFS) and overall survival (OS) between Pem100 vs Pem200 as a single agent (PFS: 6.8 vs 4.2 months, hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.36‐1.46, P = .36; 9 month OS: 58% vs 63%, HR 1.08, 95% CI 0.48‐2.41, P = .86) and when combined with chemotherapy (9‐month PFS: 60% vs 50%, HR0.84, 95% CI 0.34‐2.08, P = .71; 9‐month OS: 85% vs 58%, HR 0.27, 95% CI 0.062‐1.20, P = .09). No significant difference in response rate or ≥G3 immune‐related toxicities between Pem100 and Pem200 was observed. A cost minimisation analysis evaluating the degree of cost savings related to drug costs estimated a within study cost saving of SGD4,290,912 and cost saving per patient of SGD39,942 in the Pem100 group. A 100 mg of pembrolizumab appears to be effective with reduction in cost. A randomised trial should be done to investigate a lower dose of pembrolizumab.
What's new?
Pembrolizumab, a monoclonal antibody directed against the PD‐1 receptor, has received FDA approval for the treatment of lung cancer at a fixed dose of 200 mg every 3 weeks. However, doses above 2 mg/kg show a lack of benefit, calling for further evaluation in Asian populations. This retrospective observational study demonstrates the efficacy of a lower fixed dose of pembrolizumab (100 mg every 3 weeks) compared with standard‐dose pembrolizumab. The results also confirm the clinical activity of pembrolizumab at a lower dose than 2 mg/kg every 3 weeks, which could provide considerable cost savings to patients and the health system.
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Affiliation(s)
- Jia Li Low
- Department of Haematology-Oncology, National University Cancer Institute Singapore (NCIS), Singapore, Singapore
| | - Yiqing Huang
- Department of Haematology-Oncology, National University Cancer Institute Singapore (NCIS), Singapore, Singapore
| | - Kenneth Sooi
- Department of Haematology-Oncology, National University Cancer Institute Singapore (NCIS), Singapore, Singapore
| | - Yvonne Ang
- Department of Haematology-Oncology, National University Cancer Institute Singapore (NCIS), Singapore, Singapore
| | - Zhi Yao Chan
- Department of Haematology-Oncology, National University Cancer Institute Singapore (NCIS), Singapore, Singapore.,Department of Pharmacy, National University Hospital, National University Health System, Singapore, Singapore
| | - Katie Spencer
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Anand Devaprasath Jeyasekharan
- Department of Haematology-Oncology, National University Cancer Institute Singapore (NCIS), Singapore, Singapore.,Cancer Science Institute, Singapore (CSI), Singapore, Singapore
| | - Raghav Sundar
- Department of Haematology-Oncology, National University Cancer Institute Singapore (NCIS), Singapore, Singapore
| | - Boon Cher Goh
- Department of Haematology-Oncology, National University Cancer Institute Singapore (NCIS), Singapore, Singapore.,Cancer Science Institute, Singapore (CSI), Singapore, Singapore
| | - Ross Soo
- Department of Haematology-Oncology, National University Cancer Institute Singapore (NCIS), Singapore, Singapore.,Cancer Science Institute, Singapore (CSI), Singapore, Singapore
| | - Wei Peng Yong
- Department of Haematology-Oncology, National University Cancer Institute Singapore (NCIS), Singapore, Singapore.,Cancer Science Institute, Singapore (CSI), Singapore, Singapore
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Morris EJA, Goldacre R, Spata E, Mafham M, Finan PJ, Shelton J, Richards M, Spencer K, Emberson J, Hollings S, Curnow P, Gair D, Sebag-Montefiore D, Cunningham C, Rutter MD, Nicholson BD, Rashbass J, Landray M, Collins R, Casadei B, Baigent C. Impact of the COVID-19 pandemic on the detection and management of colorectal cancer in England: a population-based study. Lancet Gastroenterol Hepatol 2021; 6:199-208. [PMID: 33453763 PMCID: PMC7808901 DOI: 10.1016/s2468-1253(21)00005-4] [Citation(s) in RCA: 205] [Impact Index Per Article: 68.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND There are concerns that the COVID-19 pandemic has had a negative effect on cancer care but there is little direct evidence to quantify any effect. This study aims to investigate the impact of the COVID-19 pandemic on the detection and management of colorectal cancer in England. METHODS Data were extracted from four population-based datasets spanning NHS England (the National Cancer Cancer Waiting Time Monitoring, Monthly Diagnostic, Secondary Uses Service Admitted Patient Care and the National Radiotherapy datasets) for all referrals, colonoscopies, surgical procedures, and courses of rectal radiotherapy from Jan 1, 2019, to Oct 31, 2020, related to colorectal cancer in England. Differences in patterns of care were investigated between 2019 and 2020. Percentage reductions in monthly numbers and proportions were calculated. FINDINGS As compared to the monthly average in 2019, in April, 2020, there was a 63% (95% CI 53-71) reduction (from 36 274 to 13 440) in the monthly number of 2-week referrals for suspected cancer and a 92% (95% CI 89-95) reduction in the number of colonoscopies (from 46 441 to 3484). Numbers had just recovered by October, 2020. This resulted in a 22% (95% CI 8-34) relative reduction in the number of cases referred for treatment (from a monthly average of 2781 in 2019 to 2158 referrals in April, 2020). By October, 2020, the monthly rate had returned to 2019 levels but did not exceed it, suggesting that, from April to October, 2020, over 3500 fewer people had been diagnosed and treated for colorectal cancer in England than would have been expected. There was also a 31% (95% CI 19-42) relative reduction in the numbers receiving surgery in April, 2020, and a lower proportion of laparoscopic and a greater proportion of stoma-forming procedures, relative to the monthly average in 2019. By October, 2020, laparoscopic surgery and stoma rates were similar to 2019 levels. For rectal cancer, there was a 44% (95% CI 17-76) relative increase in the use of neoadjuvant radiotherapy in April, 2020, relative to the monthly average in 2019, due to greater use of short-course regimens. Although in June, 2020, there was a drop in the use of short-course regimens, rates remained above 2019 levels until October, 2020. INTERPRETATION The COVID-19 pandemic has led to a sustained reduction in the number of people referred, diagnosed, and treated for colorectal cancer. By October, 2020, achievement of care pathway targets had returned to 2019 levels, albeit with smaller volumes of patients and with modifications to usual practice. As pressure grows in the NHS due to the second wave of COVID-19, urgent action is needed to address the growing burden of undetected and untreated colorectal cancer in England. FUNDING Cancer Research UK, the Medical Research Council, Public Health England, Health Data Research UK, NHS Digital, and the National Institute for Health Research Oxford Biomedical Research Centre.
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Affiliation(s)
- Eva J A Morris
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Big Data Institute, University of Oxford, Oxford, UK.
| | - Raphael Goldacre
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Big Data Institute, University of Oxford, Oxford, UK
| | - Enti Spata
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Big Data Institute, University of Oxford, Oxford, UK
| | - Marion Mafham
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Big Data Institute, University of Oxford, Oxford, UK
| | - Paul J Finan
- Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute for Medical Research at St James's, University of Leeds, Leeds, UK
| | | | | | - Katie Spencer
- Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Jonathan Emberson
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Big Data Institute, University of Oxford, Oxford, UK
| | | | | | | | - David Sebag-Montefiore
- Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute for Medical Research at St James's, University of Leeds, Leeds, UK
| | - Chris Cunningham
- Department of Colorectal Surgery, Oxford University Hospitals, Oxford, UK
| | - Matthew D Rutter
- Population Health Sciences Institute, University of Newcastle, Newcastle, UK; Department of Gastroenterology, North Tees University Hospital NHS Trust, Stockton on Tees, UK
| | - Brian D Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Martin Landray
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Big Data Institute, University of Oxford, Oxford, UK
| | - Rory Collins
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Big Data Institute, University of Oxford, Oxford, UK
| | - Barbara Casadei
- Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, UK
| | - Colin Baigent
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Big Data Institute, University of Oxford, Oxford, UK
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Spencer K, Jones CM, Girdler R, Roe C, Sharpe M, Lawton S, Miller L, Lewis P, Evans M, Sebag-Montefiore D, Roques T, Smittenaar R, Morris E. The impact of the COVID-19 pandemic on radiotherapy services in England, UK: a population-based study. Lancet Oncol 2021; 22:309-320. [PMID: 33493433 PMCID: PMC7825861 DOI: 10.1016/s1470-2045(20)30743-9] [Citation(s) in RCA: 105] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/26/2020] [Accepted: 12/02/2020] [Indexed: 12/30/2022]
Abstract
Background The indirect impact of the COVID-19 pandemic on cancer outcomes is of increasing concern. However, the extent to which key treatment modalities have been affected is unclear. We aimed to assess the impact of the pandemic on radiotherapy activity in England. Methods In this population-based study, data relating to all radiotherapy delivered for cancer in the English NHS, between Feb 4, 2019, and June 28, 2020, were extracted from the National Radiotherapy Dataset. Changes in mean weekly radiotherapy courses, attendances (reflecting fractions), and fractionation patterns following the start of the UK lockdown were compared with corresponding months in 2019 overall, for specific diagnoses, and across age groups. The significance of changes in radiotherapy activity during lockdown was examined using interrupted time-series (ITS) analysis. Findings In 2020, mean weekly radiotherapy courses fell by 19·9% in April, 6·2% in May, and 11·6% in June compared with corresponding months in 2019. A relatively greater fall was observed for attendances (29·1% in April, 31·4% in May, and 31·5% in June). These changes were significant on ITS analysis (p<0·0001). A greater reduction in treatment courses between 2019 and 2020 was seen for patients aged 70 years or older compared with those aged younger than 70 years (34·4% vs 7·3% in April). By diagnosis, the largest reduction from 2019 to 2020 in treatment courses was for prostate cancer (77·0% in April) and non-melanoma skin cancer (72·4% in April). Conversely, radiotherapy courses in April, 2020, compared with April, 2019, increased by 41·2% in oesophageal cancer, 64·2% in bladder cancer, and 36·3% in rectal cancer. Increased use of ultra-hypofractionated (26 Gy in five fractions) breast radiotherapy as a percentage of all courses (0·2% in April, 2019, to 60·6% in April, 2020; ITS p<0·0001) contributed to the substantial reduction in attendances. Interpretation Radiotherapy activity fell significantly, but use of hypofractionated regimens rapidly increased in the English NHS during the first peak of the COVID-19 pandemic. An increase in treatments for some cancers suggests that radiotherapy compensated for reduced surgical activity. These data will assist health-care providers in understanding the indirect consequences of the pandemic and the role of radiotherapy services in minimising these consequences. Funding None.
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Affiliation(s)
- Katie Spencer
- Faculty of Medicine and Health, University of Leeds, Leeds, UK; Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | - Christopher M Jones
- Faculty of Medicine and Health, University of Leeds, Leeds, UK; Faculty of Biological Sciences, University of Leeds, Leeds, UK; Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Rebecca Girdler
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Catherine Roe
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Michael Sharpe
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Sarah Lawton
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Louise Miller
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Philippa Lewis
- NHS England, London, UK; Royal College of Radiologists, London, UK
| | | | - David Sebag-Montefiore
- Faculty of Medicine and Health, University of Leeds, Leeds, UK; Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Tom Roques
- Royal College of Radiologists, London, UK; Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Rebecca Smittenaar
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Eva Morris
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Spencer K, Hall P, Henry A, Velikova G, Whalley S, Birch R, Le Calvez K, Williams M, Morris E. PH-0522: Fractionation and early mortality in palliative radiotherapy across the English NHS. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00544-2] [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: 10/22/2022]
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Barton M, Batumalai V, Spencer K. Health Economic and Health Service Issues of Palliative Radiotherapy. Clin Oncol (R Coll Radiol) 2020; 32:775-780. [DOI: 10.1016/j.clon.2020.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/19/2020] [Accepted: 06/18/2020] [Indexed: 01/31/2023]
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Spencer K, Bojke C, Henry A, Velikova G, Morris E, Van der Linden Y, Van den Hout W, Hall P. OC-0079: Can SABR for painful bone metastases ever be cost-effective in the NHS? Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00105-5] [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: 10/22/2022]
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Jones CM, Spencer K. Nurturing a Research-active Clinical Oncology Workforce: A Trainee Perspective. Clin Oncol (R Coll Radiol) 2020; 33:e39-e43. [PMID: 32636144 DOI: 10.1016/j.clon.2020.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/16/2020] [Indexed: 11/30/2022]
Affiliation(s)
- C M Jones
- Radiotherapy Research Group, Faculty of Medicine & Health, University of Leeds, Leeds, UK; Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK; School of Molecular & Cellular Biology, Faculty of Biological Sciences, University of Leeds, Leeds, UK.
| | - K Spencer
- Radiotherapy Research Group, Faculty of Medicine & Health, University of Leeds, Leeds, UK; Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Health Sciences, Faculty of Medicine & Health, University of Leeds, Leeds, UK
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Luzin V, Spiridonov P, Spencer K, Gnaupel-Herold T. Neutron Diffraction Study of Macrostress and Microstress in Al-Al 2O 3-Based Corrosion Protection Coating Obtained by Cold Spray (Dynamic Metallization). J Therm Spray Technol 2020; 29:10.1007/s11666-020-01077-8. [PMID: 37720693 PMCID: PMC10502611 DOI: 10.1007/s11666-020-01077-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 06/21/2020] [Indexed: 09/19/2023]
Abstract
Protective coatings based on an Al-Al2O3 metal matrix composite (MMC) were sprayed using dynamic metallization (DM), a low-pressure cold spray variant. A series of samples approximately 1 mm in thickness were sprayed using different spray process parameters (temperature, velocity) and different feedstock powder compositions (Al, Zn, Al2O3). This resulted in MMCs of different phase compositions and slightly different physical conditions of coating formation. The through-thickness residual stresses that accumulate in coatings during the spray process were studied using neutron diffraction in all phases comprising the MMCs. The overall residual stress in the coating (macrostress) was compressive, which is in good agreement with the data on residual stress observed in other cold spray coatings, accumulating as a result of the peening process. However, due to the slightly elevated spray temperature characteristic of DM in comparison with other cold spray variants, thermal stresses are also present and play an equally important role in the accumulation of residual stress in each phase. Because of the multi-phase composition and thermal mismatch between the metal and ceramic components of the MMC, inter-phase microstresses also accumulate. A micro-mechanical explanation of the observed tensile microstress in Al/Zn versus compressive stress in Al2O3 is proposed.
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Affiliation(s)
- V. Luzin
- Australian Nuclear Science and Technology Organisation, Lucas Heights, NSW 2232, Australia
- School of Engineering, The University of Newcastle, Callaghan, NSW 2308, Australia
| | | | - K. Spencer
- BHP Billiton, BMA Coal, 71 Eagle St, Brisbane, QLD 4000, Australia
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Ahmed A, Williams DJ, Cheed V, Middleton LJ, Ahmad S, Wang K, Vince AT, Hewett P, Spencer K, Khan KS, Daniels JP. Pravastatin for early-onset pre-eclampsia: a randomised, blinded, placebo-controlled trial. BJOG 2019; 127:478-488. [PMID: 31715077 PMCID: PMC7063986 DOI: 10.1111/1471-0528.16013] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [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] [Accepted: 11/04/2019] [Indexed: 01/20/2023]
Abstract
Objective Women with pre‐eclampsia have elevated circulating levels of soluble fms‐like tyrosine kinase‐1 (sFlt‐1). Statins can reduce sFlt‐1 from cultured cells and improve pregnancy outcome in animals with a pre‐eclampsia‐like syndrome. We investigated the effect of pravastatin on plasma sFlt‐1 levels during pre‐eclampsia. Design Blinded (clinician and participant), proof of principle, placebo‐controlled trial. Setting Fifteen UK maternity units. Population We used a minimisation algorithm to assign 62 women with early‐onset pre‐eclampsia (24+0–31+6 weeks of gestation) to receive pravastatin 40 mg daily (n = 30) or matched placebo (n = 32), from randomisation to childbirth. Primary outcome Difference in mean plasma sFlt‐1 levels over the first 3 days following randomisation. Results The difference in the mean maternal plasma sFlt‐1 levels over the first 3 days after randomisation between the pravastatin (n = 27) and placebo (n = 29) groups was 292 pg/ml (95% CI −1175 to 592; P = 0.5), and over days 1–14 was 48 pg/ml (95% CI −1009 to 913; P = 0.9). Women who received pravastatin had a similar length of pregnancy following randomisation compared with those who received placebo (hazard ratio 0.84; 95% CI 0.50–1.40; P = 0.6). The median time from randomisation to childbirth was 9 days (interquartile range [IQR] 5–14 days) for the pravastatin group and 7 days (IQR 4–11 days) for the placebo group. There were three perinatal deaths in the placebo‐treated group and no deaths or serious adverse events attributable to pravastatin. Conclusions We found no evidence that pravastatin lowered maternal plasma sFlt‐1 levels once early‐onset pre‐eclampsia had developed. Pravastatin appears to have no adverse perinatal effects. Tweetable abstract Pravastatin does not improve maternal plasma sFlt‐1 or placental growth factor levels following a diagnosis of early preterm pre‐eclampsia #clinicaltrial finds. Pravastatin does not improve maternal plasma sFlt‐1 or placental growth factor levels following a diagnosis of early preterm pre‐eclampsia #clinicaltrial finds.
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Affiliation(s)
- A Ahmed
- Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, UK.,King Fahad Centre for Medical Research, King Abdulaziz University, Jeddah, Saudi Arabia
| | - D J Williams
- UCL EGA Institute for Women's Health, University College London Hospitals NHS Foundation Trust, London, UK
| | - V Cheed
- Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - L J Middleton
- Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - S Ahmad
- Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, UK
| | - K Wang
- Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, UK
| | - A T Vince
- Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - P Hewett
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - K Spencer
- Barking, Havering & Redbridge University Hospitals NHS Trust, Romford, UK
| | - K S Khan
- Queen Mary University of London, London, UK
| | - J P Daniels
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Nottingham, UK
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Kim R, Chaves J, Kavan P, Fakih M, Kortmansky J, Spencer K, Wong L, Tehfe M, Li J, Lee M, Mayo C, Marinello P, Chiorean E. Pembrolizumab (pembro) plus mFOLFOX or FOLFIRI in patients with metastatic colorectal cancer (mCRC): KEYNOTE-651 cohorts B and D. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.085] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Affiliation(s)
- Katie Spencer
- Institute of Cancer and Pathology, University of Leeds, Leeds LS9 7TF, UK.
| | - Eva Morris
- Cancer Epidemiology Group, University of Leeds, Leeds LS9 7TF, UK
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Spencer K, Velikova G, Henry A, Westhoff P, Hall PT, van der Linden YM. Net Pain Relief After Palliative Radiation Therapy for Painful Bone Metastases: A Useful Measure to Reflect Response Duration? A Further Analysis of the Dutch Bone Metastasis Study. Int J Radiat Oncol Biol Phys 2019; 105:559-566. [PMID: 31344434 PMCID: PMC6859481 DOI: 10.1016/j.ijrobp.2019.07.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/10/2019] [Accepted: 07/04/2019] [Indexed: 12/11/2022]
Abstract
Purpose Pain response rates are equivalent after single 8 Gy and fractionated palliative radiation therapy for bone metastases. Reirradiation remains more frequent after a single fraction, although this does not simply reflect pain recurrence. Given the possible role of stereotactic radiation therapy in providing durable pain control, measures of durability are required. Net pain relief (NPR), the proportion of remaining life spent with pain response, may provide this. This study assesses the use of NPR as an outcome measure after palliative radiation therapy for bone metastases. Methods and Materials This is a secondary analysis of data collected in the Dutch Bone Metastasis Study, a randomized trial comparing palliative radiation therapy delivered as 8 Gy in a single fraction and 24 Gy in 6 fractions. NPR was assessed by survival cohorts, treatment regimen, and primary diagnoses. The consequences of missing data upon the use of NPR in future studies were considered within sensitivity analyses. Results Patients whose pain improved after palliative radiation therapy experienced improvement for 56.6% of their remaining lives. Missing responses in questionnaires mean the range of uncertainty in NPR is 36.1% to 62.1%. When response beyond reirradiation was excluded, NPR after treatments of single-fraction 8 Gy and 24 Gy in 6 fractions was 49.0% and 56.5%, respectively (P = .004). Differential willingness to reirradiate may be influencing this outcome. When response beyond reirradiation was included, this difference was not seen (NPR of 55.4% vs 57.7%, respectively [P = .191]). Conclusions Patients who responded to conventional radiation therapy experienced improved pain control for approximately half of their remaining life. NPR may provide valuable information in assessing pain response durability. Missing data are, however, inevitable in this population. This must be minimized and the consequences recognized and reported. Additionally, reirradiation protocols and the frequency and duration of trial follow-up may have a significant impact upon this outcome, requiring careful consideration during trial design if NPR is to be used in future studies.
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Affiliation(s)
- Katie Spencer
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom; Leeds Cancer Centre, Leeds NHS Teaching Hospitals Trust, Leeds, Leeds, United Kingdom.
| | - Galina Velikova
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom; Leeds Cancer Centre, Leeds NHS Teaching Hospitals Trust, Leeds, Leeds, United Kingdom
| | - Ann Henry
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom; Leeds Cancer Centre, Leeds NHS Teaching Hospitals Trust, Leeds, Leeds, United Kingdom
| | - Paulien Westhoff
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Pe Ter Hall
- Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom
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Birch RJ, Taylor JC, Downing A, Spencer K, Finan PJ, Audisio RA, Carrigan CM, Selby PJ, Morris EJA. Rectal cancer in old age -is it appropriately managed? Evidence from population-based analysis of routine data across the English national health service. Eur J Surg Oncol 2019; 45:1196-1204. [PMID: 30661923 PMCID: PMC6602152 DOI: 10.1016/j.ejso.2019.01.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 12/05/2018] [Accepted: 01/02/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND There is significant debate as to where to draw the line between undertreating older rectal cancer patients and minimising treatment risks. This study sought to examine the use of radical rectal cancer treatments and associated outcomes in relation to age across the English NHS. METHODS Patient, tumour and treatment characteristics for all patients diagnosed with a first primary rectal cancer in England between 1st April 2009 and 31st December 2014 were obtained from the CORECT-R data repository. Descriptive analyses and adjusted logistic regression models were undertaken to examine any association between age and the use of major resection and post-surgical outcomes. Funnel plots were used to show variation in adjusted rates of major resection. RESULTS The proportion of patients who underwent a major surgical resection fell from 66.5% to 31.7%, amongst those aged <70 and aged ≥80 respectively. After adjustment, 30-day post-operative mortality, failure to rescue and prolonged length of stay were significantly higher among the oldest group when compared to the youngest. Patient reported outcomes were not significantly worse amongst older patients. Significant variation was observed in adjusted surgical resection rates in the oldest patients between NHS Trusts. The probability of death due to cancer was comparable across all age groups. CONCLUSIONS Older patients who are selected for surgery have good outcomes, often comparable to their younger counterparts. Significant variation in the treatment of older patients could not be explained by differences in measured characteristics and required further investigation.
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Affiliation(s)
- Rebecca J Birch
- Cancer Epidemiology Group, Leeds Institute for Data Analytics, Worsley Building, University of Leeds, LS2 9NL, UK.
| | - John C Taylor
- Cancer Epidemiology Group, Leeds Institute for Data Analytics, Worsley Building, University of Leeds, LS2 9NL, UK
| | - Amy Downing
- Cancer Epidemiology Group, Leeds Institute for Data Analytics, Worsley Building, University of Leeds, LS2 9NL, UK
| | - Katie Spencer
- Cancer Epidemiology Group, Leeds Institute for Data Analytics, Worsley Building, University of Leeds, LS2 9NL, UK; Leeds Cancer Centre, Bexley Wing, St James's University Teaching Hospital, Leeds, LS9 7TF, UK
| | - Paul J Finan
- Cancer Epidemiology Group, Leeds Institute for Data Analytics, Worsley Building, University of Leeds, LS2 9NL, UK
| | - Riccardo A Audisio
- Department of Surgery, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Christopher M Carrigan
- Cancer Epidemiology Group, Leeds Institute for Data Analytics, Worsley Building, University of Leeds, LS2 9NL, UK
| | - Peter J Selby
- Leeds Institute of Cancer and Pathology, St James's University Hospital, Leeds, LS9 7TF, UK
| | - Eva J A Morris
- Cancer Epidemiology Group, Leeds Institute for Data Analytics, Worsley Building, University of Leeds, LS2 9NL, UK
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Jones CM, Spencer K, Hitchen C, Pelly T, Wood B, Hatfield P, Crellin A, Sebag-Montefiore D, Goody R, Crosby T, Radhakrishna G. Hypofractionated Radiotherapy in Oesophageal Cancer for Patients Unfit for Systemic Therapy: A Retrospective Single-Centre Analysis. Clin Oncol (R Coll Radiol) 2019; 31:356-364. [PMID: 30737068 DOI: 10.1016/j.clon.2019.01.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 04/17/2018] [Revised: 11/24/2018] [Accepted: 12/06/2018] [Indexed: 02/06/2023]
Abstract
AIMS Chemoradiotherapy (CRT) is established as a superior treatment option to definitive radiotherapy in the non-surgical management of oesophageal cancer. For patients precluded from CRT through choice or comorbidity there is little evidence to guide delivery of single-modality radiotherapy. In this study we outline outcomes for patients unfit for CRT who received a hypofractionated radiotherapy (HRT) regimen. MATERIALS AND METHODS A retrospective UK single-centre analysis of 61 consecutive patients with lower- or middle-third adenocarcinoma (OAC; 61%) or squamous cell carcinoma of the oesophagus managed using HRT with radical intent between April 2009 and 2014. Treatment consisted of 50 Gy in 16 fractions (n = 49, 80.3%) or 50-52.5 Gy in 20 fractions (n = 12, 19.7%). Outcomes were referenced against a contemporaneous comparator cohort of 80 (54% OAC) consecutive patients managed with conventionally fractionated CRT within the same centre. RESULTS Three-year and median overall survival were, respectively, 56.9% and 29 months with HRT compared with 55.5% and 26 months for CRT; adjusted hazard ratio 0.79 (95% confidence interval 0.48-1.28). Grade 3 and 4 toxicity rates were low at 16.4% (n = 10) for those receiving HRT and 40.2% (n = 32) for the CRT group. In patients with OAC, CRT delivered superior overall survival (hazard ratio 0.46; 95% confidence interval 0.25-0.85) and progression-free survival (hazard ratio 0.45; 95% confidence interval 0.23-0.88) when compared with HRT. CONCLUSIONS The HRT regimen described here was safe and tolerable in patients unable to receive CRT, and delivered promising survival outcomes. The use of HRT for the treatment of oesophageal cancer, both alone and as a sequential or concurrent treatment with chemotherapy, requires further study. New precision radiotherapy technologies may provide additional scope for improving outcomes in oesophageal cancer using HRT-based approaches and should be evaluated.
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Affiliation(s)
- C M Jones
- Radiotherapy Research Group, Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK; School of Molecular & Cellular Biology, Faculty of Biological Sciences, University of Leeds, Leeds, UK; Leeds Institute of Medical Research at St James's, Faculty of Medicine & Health, University of Leeds, Leeds, UK
| | - K Spencer
- Radiotherapy Research Group, Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Medical Research at St James's, Faculty of Medicine & Health, University of Leeds, Leeds, UK; Leeds Institute of Health Sciences, Faculty of Medicine & Health, University of Leeds, Leeds, UK
| | - C Hitchen
- School of Medicine, Faculty of Medicine & Health, University of Leeds, Leeds, UK
| | - T Pelly
- School of Medicine, Faculty of Medicine & Health, University of Leeds, Leeds, UK
| | - B Wood
- School of Medicine, Faculty of Medicine & Health, University of Leeds, Leeds, UK
| | - P Hatfield
- Radiotherapy Research Group, Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Crellin
- Radiotherapy Research Group, Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - D Sebag-Montefiore
- Radiotherapy Research Group, Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Medical Research at St James's, Faculty of Medicine & Health, University of Leeds, Leeds, UK
| | - R Goody
- Radiotherapy Research Group, Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - T Crosby
- Velindre Cancer Centre, Velindre Hospital, Cardiff, UK
| | - G Radhakrishna
- Radiotherapy Research Group, Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK.
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Ellenger K, Flatley M, Spencer K, Clarke K, Franks K, Jain P. P2.04-21 Real World Experience of Immune Checkpoint Inhibitors In NSCLC: Our First 10 Months Experience at Leeds Cancer Centre, UK. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1245] [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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Spencer K, Kennedy M, Lummis K, Ellames D, Snee M, Brunelli A, Franks K, Callister M. PV-0476: Equivalent cancer-specific survival following surgical resection or SABR for stage I lung cancer. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30786-2] [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: 11/16/2022]
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Spencer K, Van den Hout W, Henry A, Morris E, Velikova G, Hall P, Tubeuf S, Van der Linden Y. PO-0847: Pain response and quality of life with survival post palliative radiotherapy for bone metastases. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31157-5] [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: 10/14/2022]
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Affiliation(s)
- Katie Spencer
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds LS2 9NL, UK
| | - Rhona Parrish
- Garforth Medical Centre, Garforth, Leeds LS25 1HB, UK
| | - Rachael Barton
- Queen's Centre for Oncology and Haematology, Castle Hill Hospital, Cottingham HU16 5JQ, UK
| | - Ann Henry
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds LS2 9NL, UK
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Adam A, Spencer K. A near-fatal case of emphysematous pyelonephritis: Embracing the new management ‘gold standard’ – Saving the life while saving the kidney! African Journal of Urology 2017. [DOI: 10.1016/j.afju.2016.08.003] [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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Tataru D, Spencer K, Jack R, Bates A, Wieczorek A, Lind M, Lüchtenborg ML. P3.07-011 Geographical Variation in the Use of Radiotherapy and Surgical Resection for Treatment of Non-Small Cell Lung Cancer in England. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.2202] [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: 11/30/2022]
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Kennedy MPT, Lummis KL, Spencer K, Franks K, Snee M, Callister MEJ. S64 Rates and sites of recurrence following radical treatment of stage I lung cancer. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.70] [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: 11/04/2022]
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