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El Badri S, Tahir B, Balachandran K, Bezecny P, Britton F, DeSouza K, Hills D, Moe M, Pigott T, Proctor A, Shah Y, Simcock R, Stansfeld A, Synowiec A, Theodoulou M, Verrill M, Wadhawan A, Harper-Wynne C, Wilson C. 245P Palbociclib combined with aromatase inhibitors (AIs) in women ≥75 years with oestrogen receptor positive (ER+ve), human epidermal growth factor receptor 2 negative (HER2-ve) advanced breast cancer: A real-world multicentre UK study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Morgan JL, Shrestha A, Reed MWR, Herbert E, Bradburn M, Walters SJ, Martin C, Collins K, Ward S, Holmes G, Burton M, Lifford K, Edwards A, Ring A, Robinson T, Chater T, Pemberton K, Brennan A, Cheung KL, Todd A, Audisio R, Wright J, Simcock R, Thomson AM, Gosney M, Hatton M, Green T, Revill D, Gath J, Horgan K, Holcombe C, Winter MC, Naik J, Parmeschwar R, Wyld L. Bridging the age gap in breast cancer: impact of omission of breast cancer surgery in older women with oestrogen receptor-positive early breast cancer on quality-of-life outcomes. Br J Surg 2021; 108:315-325. [PMID: 33760065 PMCID: PMC10364859 DOI: 10.1093/bjs/znaa125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/15/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Primary endocrine therapy may be an alternative treatment for less fit women with oestrogen receptor (ER)-positive breast cancer. This study compared quality-of-life (QoL) outcomes in older women treated with surgery or primary endocrine therapy. METHODS This was a multicentre, prospective, observational cohort study of surgery or primary endocrine therapy in women aged over 70 years with operable breast cancer. QoL was assessed using European Organisation for Research and Treatment of cancer QoL questionnaires QLQ-C30, -BR23, and -ELD14, and the EuroQol Five Dimensions 5L score at baseline, 6 weeks, and 6, 12, 18, and 24 months. Propensity score matching was used to adjust for baseline variation in health, fitness, and tumour stage. RESULTS The study recruited 3416 women (median age 77 (range 69-102) years) from 56 breast units. Of these, 2979 (87.2 per cent) had ER-positive breast cancer; 2354 women had surgery and 500 received primary endocrine therapy (125 were excluded from analysis due to inadequate data or non-standard therapy). Median follow-up was 52 months. The primary endocrine therapy group was older and less fit. Baseline QoL differed between the groups; the mean(s.d.) QLQ-C30 global health status score was 66.2(21.1) in patients who received primary endocrine therapy versus 77.1(17.8) among those who had surgery plus endocrine therapy. In the unmatched analysis, changes in QoL between 6 weeks and baseline were noted in several domains, but by 24 months most scores had returned to baseline levels. In the matched analysis, major surgery (mastectomy or axillary clearance) had a more pronounced adverse impact than primary endocrine therapy in several domains. CONCLUSION Adverse effects on QoL are seen in the first few months after surgery, but by 24 months these have largely resolved. Women considering surgery should be informed of these effects.
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Affiliation(s)
- J L Morgan
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - A Shrestha
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - M W R Reed
- Brighton and Sussex Medical School, Brighton, UK
| | - E Herbert
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - M Bradburn
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - S J Walters
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - C Martin
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - K Collins
- Faculty of Health and Wellbeing, Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK
| | - S Ward
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, Sheffield, UK
| | - G Holmes
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, Sheffield, UK
| | - M Burton
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - K Lifford
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - A Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - A Ring
- Department of Medical Oncology, Royal Marsden Hospital, London, UK
| | - T Robinson
- Department of Cardiovascular Sciences and National Institute for Health Research Biomedical Research Centre, University of Leicester, Cardiovascular Research Centre, Glenfield General Hospital, Leicester, UK
| | - T Chater
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - K Pemberton
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - A Brennan
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, Sheffield, UK
| | - K L Cheung
- School of Medicine, University of Nottingham, Royal Derby Hospital, Derby, UK
| | - A Todd
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - R Audisio
- Department of Surgery, University of Gothenberg, Sahlgrenska Universitetssjukhuset, Gothenberg, Sweden
| | - J Wright
- Brighton and Sussex Medical School, Brighton, UK
| | - R Simcock
- Brighton and Sussex Medical School, Brighton, UK
| | - A M Thomson
- Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - M Gosney
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - M Hatton
- Sheffield Teaching Hospitals NHS Foundation Trust, Weston Park Hospital, Sheffield, UK
| | - T Green
- North Trent Cancer Research Network Consumer Research Panel, Sheffield, UK
| | - D Revill
- North Trent Cancer Research Network Consumer Research Panel, Sheffield, UK
| | - J Gath
- North Trent Cancer Research Network Consumer Research Panel, Sheffield, UK
| | - K Horgan
- Department of Breast Surgery, Bexley Cancer Centre, St James's University Hospital, Leeds, UK
| | - C Holcombe
- Department of Breast Surgery, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - M C Winter
- Sheffield Teaching Hospitals NHS Foundation Trust, Weston Park Hospital, Sheffield, UK
| | - J Naik
- Department of General Surgery, Pinderfields Hospital, Mid Yorkshire NHS Foundation Trust, Wakefield, UK
| | - R Parmeschwar
- Department of Breast Surgery, University Hospitals of Morecambe Bay, Lancaster, UK
| | - L Wyld
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
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Wyld L, Reed MWR, Collins K, Burton M, Lifford K, Edwards A, Ward S, Holmes G, Morgan J, Bradburn M, Walters SJ, Ring A, Robinson TG, Martin C, Chater T, Pemberton K, Shrestha A, Nettleship A, Murray C, Brown M, Richards P, Cheung KL, Todd A, Harder H, Brain K, Audisio RA, Wright J, Simcock R, Armitage F, Bursnall M, Green T, Revell D, Gath J, Horgan K, Holcombe C, Winter M, Naik J, Parmeshwar R, Gosney M, Hatton M, Thompson AM. Bridging the age gap in breast cancer: cluster randomized trial of two decision support interventions for older women with operable breast cancer on quality of life, survival, decision quality, and treatment choices. Br J Surg 2021; 108:499-510. [PMID: 33760077 PMCID: PMC10364907 DOI: 10.1093/bjs/znab005] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/04/2020] [Accepted: 12/28/2020] [Indexed: 11/14/2022]
Abstract
BACKGROUND Rates of surgery and adjuvant therapy for breast cancer vary widely between breast units. This may contribute to differences in survival. This cluster RCT evaluated the impact of decision support interventions (DESIs) for older women with breast cancer, to ascertain whether DESIs influenced quality of life, survival, decision quality, and treatment choice. METHODS A multicentre cluster RCT compared the use of two DESIs against usual care in treatment decision-making in older women (aged at least ≥70 years) with breast cancer. Each DESI comprised an online algorithm, booklet, and brief decision aid to inform choices between surgery plus adjuvant endocrine therapy versus primary endocrine therapy, and adjuvant chemotherapy versus no chemotherapy. The primary outcome was quality of life. Secondary outcomes included decision quality measures, survival, and treatment choice. RESULTS A total of 46 breast units were randomized (21 intervention, 25 usual care), recruiting 1339 women (670 intervention, 669 usual care). There was no significant difference in global quality of life at 6 months after the baseline assessment on intention-to-treat analysis (difference -0.20, 95 per cent confidence interval (C.I.) -2.69 to 2.29; P = 0.900). In women offered a choice of primary endocrine therapy versus surgery plus endocrine therapy, knowledge about treatments was greater in the intervention arm (94 versus 74 per cent; P = 0.003). Treatment choice was altered, with a primary endocrine therapy rate among women with oestrogen receptor-positive disease of 21.0 per cent in the intervention versus 15.4 per cent in usual-care sites (difference 5.5 (95 per cent C.I. 1.1 to 10.0) per cent; P = 0.029). The chemotherapy rate was 10.3 per cent at intervention versus 14.8 per cent at usual-care sites (difference -4.5 (C.I. -8.0 to 0) per cent; P = 0.013). Survival was similar in both arms. CONCLUSION The use of DESIs in older women increases knowledge of breast cancer treatment options, facilitates shared decision-making, and alters treatment selection. Trial registration numbers: EudraCT 2015-004220-61 (https://eudract.ema.europa.eu/), ISRCTN46099296 (http://www.controlled-trials.com).
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Affiliation(s)
- L Wyld
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - M W R Reed
- Brighton and Sussex Medical School, Falmer, Brighton, UK
| | - K Collins
- College of Health, Wellbeing and Life Sciences, Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK
| | - M Burton
- College of Health, Wellbeing and Life Sciences, Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK
| | - K Lifford
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - A Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - S Ward
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, Sheffield, UK
| | - G Holmes
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, Sheffield, UK
| | - J Morgan
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - M Bradburn
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - S J Walters
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - A Ring
- Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - T G Robinson
- Department of Cardiovascular Sciences and NIHR Biomedical Research Centre, University of Leicester, Cardiovascular Research Centre, Glenfield General Hospital, Leicester, UK
| | - C Martin
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - T Chater
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - K Pemberton
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - A Shrestha
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - A Nettleship
- EpiGenesys, University of Sheffield, Sheffield, UK
| | - C Murray
- EpiGenesys, University of Sheffield, Sheffield, UK
| | - M Brown
- EpiGenesys, University of Sheffield, Sheffield, UK
| | - P Richards
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, Sheffield, UK
| | - K L Cheung
- University of Nottingham, Royal Derby Hospital, Derby, UK
| | - A Todd
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - H Harder
- Brighton and Sussex Medical School, Falmer, Brighton, UK
| | - K Brain
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - R A Audisio
- University of Gothenberg, Sahlgrenska Universitetssjukhuset, Gothenberg, Sweden
| | - J Wright
- Brighton and Sussex Medical School, Falmer, Brighton, UK
| | - R Simcock
- Brighton and Sussex Medical School, Falmer, Brighton, UK
| | | | - M Bursnall
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - T Green
- Yorkshire and Humber Consumer Research Panel (yhcrp.org.uk), Leeds, UK
| | - D Revell
- Yorkshire and Humber Consumer Research Panel (yhcrp.org.uk), Leeds, UK
| | - J Gath
- Yorkshire and Humber Consumer Research Panel (yhcrp.org.uk), Leeds, UK
| | - K Horgan
- Department of Breast Surgery, Bexley Cancer Centre, St James's University Hospital, Leeds, UK
| | - C Holcombe
- Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - M Winter
- Weston Park Hospital, Sheffield, UK
| | - J Naik
- Pinderfields Hospital, Mid Yorkshire NHS Foundation Trust, Wakefield, UK
| | - R Parmeshwar
- University Hospitals of Morecambe Bay, Lancaster, UK
| | - M Gosney
- Royal Berkshire NHS Foundation Trust, Reading, UK
| | - M Hatton
- Weston Park Hospital, Sheffield, UK
| | - A M Thompson
- Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
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Pereira I, Katz M, Simcock R, Saeed H. P09.34 Curating Online Journal Clubs to Advance Global Oncology Lung Cancer Care. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.462] [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: 10/21/2022]
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Morris L, Thiruthaneeswaran N, O'Donovan A, Simcock R, Cree A, Turner S, Agar M. PO-1263: What every radiation oncologist should know about geriatric oncology: A global expert consensus. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01281-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hadjiyiannakis D, Dimitroyannis D, Eastlake L, Peedell C, Tripathi L, Simcock R, Vyas A, Deutsch E, Chalmers AJ. Personal View: Low-Dose Lung Radiotherapy Should be Evaluated as a Treatment for Severe COVID-19 Lung Disease. Clin Oncol (R Coll Radiol) 2020; 33:e64-e68. [PMID: 32829986 PMCID: PMC7427522 DOI: 10.1016/j.clon.2020.08.003] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 07/28/2020] [Accepted: 08/07/2020] [Indexed: 02/08/2023]
Affiliation(s)
- D Hadjiyiannakis
- Lancashire Teaching Hospitals, NHS Foundation Trust, Preston, UK; NIHR Lancashire Clinical Research Facility, Preston, UK
| | | | - L Eastlake
- University Hospitals Plymouth NHS Trust, Plymouth, UK.
| | - C Peedell
- James Cook University Hospital, Middlesbrough, UK
| | - L Tripathi
- Lancashire Teaching Hospitals, NHS Foundation Trust, Preston, UK; NIHR Lancashire Clinical Research Facility, Preston, UK
| | - R Simcock
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - A Vyas
- Lancashire Teaching Hospitals, NHS Foundation Trust, Preston, UK
| | - E Deutsch
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Université Paris, Villejuif, France
| | - A J Chalmers
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
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Lorimer CF, Simcock R. Multimorbidity and Cancer: the Patient as a Whole Being. Clin Oncol (R Coll Radiol) 2020; 32:549-550. [PMID: 32684504 DOI: 10.1016/j.clon.2020.06.020] [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: 06/23/2020] [Accepted: 06/30/2020] [Indexed: 01/18/2023]
Affiliation(s)
- C F Lorimer
- Sussex Cancer Centre, Brighton and Sussex NHS Trust, Brighton, UK.
| | - R Simcock
- Sussex Cancer Centre, Brighton and Sussex NHS Trust, Brighton, UK
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Abstract
Oncologists should recognise the need to move beyond the Eastern Cooperative Oncology Group Performance Status (ECOG PS) score. ECOG PS is a longstanding and ubiquitous feature of oncology. It was evolved 40 years ago as an adaption of the 70-year-old Karnofsky performance score. It is short, easily understood and part of the global language of oncology. The wide prevalence of the ECOG PS attests to its proven utility and worth to help triage patient treatment. The ECOG PS is problematic. It is a unidimensional functional score. It is mostly physician assessed, subjective and therefore open to bias. It fails to account for multimorbidity, frailty or cognition. Too often the PS is recorded only once in wilful ignorance of a patient's changing physical state. As modern oncology offers an ever-widening array of therapies that are ‘personalised’ to tumour genotype, modern oncologists must strive to better define patient phenotype. Using a wider range of scoring and assessment tools, oncologists can identify deficits that may be reversed or steps taken to mitigate detrimental effects of treatment. These tools can function well to identify those patients who would benefit from comprehensive assessment. This overview identifies the strengths of ECOG PS but highlights the weaknesses and where these are supported by other measures. A strong recommendation is made here to move to routine use of the Clinical Frailty Score to start to triage patients and most appropriately design treatments and rehabilitation interventions.
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Affiliation(s)
- R Simcock
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
| | - J Wright
- Brighton and Sussex Medical School, Brighton, UK
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Morris L, Turner S, Thiruthaneeswaran N, O'Donovan A, Agar M, Simcock R. EP-1646 Radiation Oncology for the Older Person: Defining international standards for trainee education. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32066-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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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Dearman C, Okorie M, Simcock R. Oncology is Missing out on the FOAM Party. Clin Oncol (R Coll Radiol) 2019; 31:133-134. [DOI: 10.1016/j.clon.2018.11.005] [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] [Received: 10/19/2018] [Accepted: 11/08/2018] [Indexed: 10/27/2022]
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DeSouza K, Zammit R, Simpson L, Watson L, Bracewell K, Whitfield C, Bloomfield D, Simcock R, Sinha R, Westwell S, Moss C, Moss A, Sham J, Patel G. Defining the Older Patient Population (>65 Years) Treated for Metastatic Breast Cancer (mBC) Within the Sussex Cancer Network. Clin Oncol (R Coll Radiol) 2018. [DOI: 10.1016/j.clon.2018.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Jenkins V, Farewell V, May S, Catt S, Matthews L, Shilling V, Dickson J, Simcock R, Fallowfield L. Do drugs offering only PFS maintain quality of life sufficiently from a patient's perspective? Results from AVALPROFS (Assessing the 'VALue' to patients of PROgression Free Survival) study. Support Care Cancer 2018; 26:3941-3949. [PMID: 29845422 PMCID: PMC6182366 DOI: 10.1007/s00520-018-4273-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 05/15/2018] [Indexed: 01/03/2023]
Abstract
Purpose Trials of novel drugs used in advanced disease often show only progression-free survival or modest overall survival benefits. Hypothetical studies suggest that stabilisation of metastatic disease and/or symptom burden are worth treatment-related side effects. We examined this premise contemporaneously using qualitative and quantitative methods. Methods Patients with metastatic cancers expected to live > 6 months and prescribed drugs aimed at cancer control were interviewed: at baseline, at 6 weeks, at progression, and if treatment was stopped for toxicity. They also completed Functional Assessment of Cancer Therapy (FACT-G) plus Anti-Angiogenesis (AA) subscale questionnaires at baseline then monthly for 6 months. Results Ninety out of 120 (75%) eligible patients participated: 41 (45%) remained on study for 6 months, 36 progressed or died, 4 had treatment breaks, and 9 withdrew due to toxicity. By 6 weeks, 66/69 (96%) patients were experiencing side effects which impacted their activities. Low QoL scores at baseline did not predict a higher risk of death or dropout. At 6-week interviews, as the side effect severity increased, patients were significantly less inclined to view the benefit of cancer control as worthwhile (X2 = 50.7, P < 0.001). Emotional well-being initially improved from baseline by 10 weeks, then gradually returned to baseline levels. Conclusion Maintaining QoL is vital to most patients with advanced cancer so minimising treatment-related side effects is essential. As side effect severity increased, drugs that controlled cancer for short periods were not viewed as worthwhile. Patients need to have the therapeutic aims of further anti-cancer treatment explained honestly and sensitively. Electronic supplementary material The online version of this article (10.1007/s00520-018-4273-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- V Jenkins
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School (BSMS), University of Sussex, Falmer, Brighton, BN1 9RX, UK.
| | - V Farewell
- MRC Biostatistics Unit, University of Cambridge, School of Clinical Medicine, Robinson Way, Cambridge, CB2 0SR, UK
| | - S May
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School (BSMS), University of Sussex, Falmer, Brighton, BN1 9RX, UK
| | - S Catt
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School (BSMS), University of Sussex, Falmer, Brighton, BN1 9RX, UK
| | - L Matthews
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School (BSMS), University of Sussex, Falmer, Brighton, BN1 9RX, UK
| | - V Shilling
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School (BSMS), University of Sussex, Falmer, Brighton, BN1 9RX, UK
| | - J Dickson
- Mount Vernon Cancer Centre, Mount Vernon Hospital, Northwood, Middlesex, HA6 2RN, UK
| | - R Simcock
- Sussex Cancer Centre, Brighton & Sussex University Hospitals, Brighton, BN2 5DA, UK
| | - L Fallowfield
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School (BSMS), University of Sussex, Falmer, Brighton, BN1 9RX, UK
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Fallowfield L, May S, Matthews L, Jenkins V, Mackay J, Arbon A, Hack B, Hall J, Harper-Wynne C, Hinde S, Moss A, Thanopoulou E, Westwell S, Wlaszly D, Simcock R, Patel G, Bloomfield D. Enhancing decision-making about adjuvant chemotherapy in ER+, HER2- early breast cancer (EBC) following EndoPredict testing. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx362.039] [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: 11/13/2022] Open
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Keeping ST, Tempest MJ, Stephens SJ, Carroll SM, Simcock R, Jones TM, Shaw R. The cost of oropharyngeal cancer in England: A retrospective hospital data analysis. Clin Otolaryngol 2017; 43:223-229. [PMID: 28734109 DOI: 10.1111/coa.12944] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To estimate the total costs of treating head and neck cancers, specifically oropharyngeal, laryngeal and oral cavity cancer, in secondary care facilities in England during the period 2006/2007 to 2010/2011. DESIGN Patient records were extracted from an English hospital database to estimate the number of patients treated for oropharyngeal, laryngeal and oral cavity cancer in England. Identified resource use was linked to published United Kingdom cost estimates to quantify the reimbursement of treatment through the Payment by Results system. SETTING Retrospective hospital data analysis. PARTICIPANTS From the hospital data, patient records of patients treated for oropharyngeal, laryngeal and oral cavity cancer were selected. MAIN OUTCOME MEASURES Annual total costs of treatment, stratified by inpatient and outpatient setting and by male and female patients. RESULTS From 2006/2007 to 2010/2011, total costs of treatment across the three head and neck cancer sites were estimated to be approximately £309 million, with 90% attributable to inpatient care (bundled costs). Oropharyngeal cancer accounted for 37% of total costs. Costs and patient numbers increased over time, largely due to a rise in oropharyngeal cancer, where total costs increased from £17.21 million to £30.32 million, with over 1400 (52%) more inpatients treated in 2010/11 compared to 2006/07. CONCLUSIONS In 4 years, the number of patients with oropharyngeal cancer receiving some form of inpatient care increased by more than half, and associated costs increased by three quarters. This reinforces the case for prevention and early detection strategies to help contain this epidemiological and economic burden.
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Affiliation(s)
- S T Keeping
- Sanofi Pasteur MSD, Mallards Reach, Maidenhead, UK
| | | | | | - S M Carroll
- Sanofi Pasteur MSD, Mallards Reach, Maidenhead, UK
| | - R Simcock
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - T M Jones
- University of Liverpool, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - R Shaw
- University of Liverpool, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
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Simcock R, Jones TM. The Changing Landscape of Head and Neck Cancer: New Challenges, New Opportunities. Clin Oncol (R Coll Radiol) 2016; 28:411-2. [PMID: 27105675 DOI: 10.1016/j.clon.2016.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 03/17/2016] [Indexed: 10/21/2022]
Affiliation(s)
- R Simcock
- Sussex Cancer Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
| | - T M Jones
- University of Liverpool, Liverpool, UK
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Simcock R, Husain Z, Katz M. EP-1956: Twitter as a tool for radiotherapy medical education: The #radonc Journal Club. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)33207-8] [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: 10/21/2022]
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Fallowfield L, May S, Matthews L, Simcock R, Jenkins V. 1509 Oncologists' decision making about novel therapies for patients with metastatic disease. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30599-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tighe D, Cavilla S, Simcock R. Pulmonary lymphangitic carcinomatosis from head and neck squamous cell carcinoma. Int J Oral Maxillofac Surg 2014; 43:806-10. [DOI: 10.1016/j.ijom.2013.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 12/12/2013] [Accepted: 12/18/2013] [Indexed: 11/25/2022]
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Simcock R. SP-0003: Elective nodal irradiation: CTV= Cautious Target Volume. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30108-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Burcombe R, Chan S, Simcock R, Samanta K, Percival F, Barrett-Lee P. Abstract P4-12-23: Subcutaneous trastuzumab (Herceptin™) in patients with HER-2 positive early breast cancer: A UK time and motion study in comparison with intravenous formulation. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p4-12-23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Aim:
To quantify active healthcare professional (HCP) time and costs associated with subcutaneous (SC) and intravenous (IV) infusion administration of trastuzumab (Herceptin) in the treatment of patients with HER2-positive early breast cancer within the adjuvant PrefHer trial; secondly, to measure patient time in the care unit and patient chair time for both routes of administration.
Methods:
A UK multi-centre prospective, observational time and motion study was conducted alongside the PrefHer trial (ClinicalTrials.gov id: NCT01401166). Trained observers measured the duration of each SC and IV related task HCPs undertook and recorded patient time in the chemotherapy unit and treatment chair. The type and quantity of medical consumables used with each route of administration were also collected. 24 patient episodes were recorded (12 SC, 12 IV). Mean total administration time was calculated as the mean sum of task times, for both IV and SC formulations. The mean cost of each route of administration was calculated as the mean cost of HCP time plus the mean cost of consumables used. HCP time was costed using data from the Personal Social Services Research Unit. Consumables were costed using hospital pharmacy data and online sources.
Results:
Mean active HCP time for IV preparation and administration was 92.6 minutes compared with 24.6 minutes for SC administration. The mean cost for IV preparation and administration was £144.96 (£132.05 of HCP time and £12.92 of consumables) versus £33.15 (£31.99 of HCP time and £1.17 of consumables) for SC administration. Mean time spent by patients in the care unit and treatment chair was 94.5 minutes and 75 minutes respectively for IV, and 30.3 minutes and 19.8 minutes for SC.
SC administration of trastuzumab could translate to a HCP time saving of 68 minutes (34.5 minutes of preparation time and 33.5 minutes of administration time) (versus IV) with a total cost saving of £111.81 per patient episode. This equates to a potential saving of £2012.58 over a full course of adjuvant trastuzumab treatment (18 cycles).
Conclusion:
Substituting IV infusion with SC administration of trastuzumab may lead to a substantial reduction in active HCP time, consumable use and overall cost. The reduced patient chair and unit time could provide increased capacity within existing resources.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-12-23.
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Affiliation(s)
- R Burcombe
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, Kent, United Kingdom; Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, Sussex, United Kingdom; Roche Products Ltd, Welwyn Garden City, United Kingdom; pH Associates Ltd, Marlow, United Kingdom; Velindre Cancer Centre, Cardiff, United Kingdom
| | - S Chan
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, Kent, United Kingdom; Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, Sussex, United Kingdom; Roche Products Ltd, Welwyn Garden City, United Kingdom; pH Associates Ltd, Marlow, United Kingdom; Velindre Cancer Centre, Cardiff, United Kingdom
| | - R Simcock
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, Kent, United Kingdom; Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, Sussex, United Kingdom; Roche Products Ltd, Welwyn Garden City, United Kingdom; pH Associates Ltd, Marlow, United Kingdom; Velindre Cancer Centre, Cardiff, United Kingdom
| | - K Samanta
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, Kent, United Kingdom; Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, Sussex, United Kingdom; Roche Products Ltd, Welwyn Garden City, United Kingdom; pH Associates Ltd, Marlow, United Kingdom; Velindre Cancer Centre, Cardiff, United Kingdom
| | - F Percival
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, Kent, United Kingdom; Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, Sussex, United Kingdom; Roche Products Ltd, Welwyn Garden City, United Kingdom; pH Associates Ltd, Marlow, United Kingdom; Velindre Cancer Centre, Cardiff, United Kingdom
| | - P Barrett-Lee
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, Kent, United Kingdom; Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, Sussex, United Kingdom; Roche Products Ltd, Welwyn Garden City, United Kingdom; pH Associates Ltd, Marlow, United Kingdom; Velindre Cancer Centre, Cardiff, United Kingdom
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Simcock R, Fallowfield L, Monson K, Solis-Trapala I, Parlour L, Langridge C, Jenkins V. ARIX: a randomised trial of acupuncture v oral care sessions in patients with chronic xerostomia following treatment of head and neck cancer. Ann Oncol 2012; 24:776-83. [PMID: 23104718 DOI: 10.1093/annonc/mds515] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Radiation treatment of head and neck cancer can cause chronic xerostomia which impairs patients' quality of life. The study reported here examined the efficacy of acupuncture in alleviating xerostomia symptoms especially dry mouth. PATIENTS AND METHODS A total of 145 patients with chronic radiation-induced xerostomia >18 months after treatments were recruited from seven UK cancer centres. The study employed a randomised crossover design with participants receiving two group sessions of oral care education and eight of acupuncture using standardised methods. Patient-reported outcome (PROs) measures were completed at baseline and weeks 5, 9, 13, 17, and 21. The primary outcome was improvement in dry mouth. OBJECTIVE saliva measurements were also carried out. RESULTS Acupuncture compared with oral care, produced significant reductions in patient reports of severe dry mouth (OR = 2.01, P = 0.031) sticky saliva (OR = 1.67, P = 0.048), needing to sip fluids to swallow food (OR = 2.08, P = 0.011) and in waking up at night to drink (OR = 1.71, P = 0.013). There were no significant changes in either stimulated or unstimulated saliva measurements over time. CONCLUSION Eight sessions of weekly group acupuncture compared with group oral care education provide significantly better relief of symptoms in patients suffering from chronic radiation-induced xerostomia.
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Affiliation(s)
- R Simcock
- Department of Oncology, Brighton and Sussex University Hospitals Trust, Sussex Cancer Centre, Brighton
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Simcock R, Goldsworthy S, Chalmers A, Tremlett J. ABDUCTING BOTH ARMS IMPROVES STABILITY DURING BREAST RADIOTHERAPY: THE BI ARM STUDY IN BREAST RADIOTHERAPY. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)73195-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ring A, Simcock R, Mitra S, Bloomfield D, King J, Simpson S, Sadler G, Webb A. Infusion of trastuzumab maintenance doses over 30 minutes. Ann Oncol 2008; 19:1509-1510. [PMID: 18539615 DOI: 10.1093/annonc/mdn390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Ring
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton; Eastbourne District General Hospital, Eastbourne.
| | - R Simcock
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton
| | - S Mitra
- Worthing Hospital, Worthing, West Sussex
| | - D Bloomfield
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton
| | - J King
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton
| | - S Simpson
- Worthing Hospital, Worthing, West Sussex
| | - G Sadler
- Conquest Hospital, St Leonards on Sea, UK
| | - A Webb
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton
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Simcock R. Hepatobiliary tumours. Practitioner 2001; 245:668-74. [PMID: 11524939] [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] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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