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Aldecoa C, Bettelli G, Bilotta F, Sanders RD, Aceto P, Audisio R, Cherubini A, Cunningham C, Dabrowski W, Forookhi A, Gitti N, Immonen K, Kehlet H, Koch S, Kotfis K, Latronico N, MacLullich AMJ, Mevorach L, Mueller A, Neuner B, Piva S, Radtke F, Blaser AR, Renzi S, Romagnoli S, Schubert M, Slooter AJC, Tommasino C, Vasiljewa L, Weiss B, Yuerek F, Spies CD. Update of the European Society of Anaesthesiology and Intensive Care Medicine evidence-based and consensus-based guideline on postoperative delirium in adult patients. Eur J Anaesthesiol 2024; 41:81-108. [PMID: 37599617 PMCID: PMC10763721 DOI: 10.1097/eja.0000000000001876] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Postoperative delirium (POD) remains a common, dangerous and resource-consuming adverse event but is often preventable. The whole peri-operative team can play a key role in its management. This update to the 2017 ESAIC Guideline on the prevention of POD is evidence-based and consensus-based and considers the literature between 01 April 2015, and 28 February 2022. The search terms of the broad literature search were identical to those used in the first version of the guideline published in 2017. POD was defined in accordance with the DSM-5 criteria. POD had to be measured with a validated POD screening tool, at least once per day for at least 3 days starting in the recovery room or postanaesthesia care unit on the day of surgery or, at latest, on postoperative day 1. Recent literature confirmed the pathogenic role of surgery-induced inflammation, and this concept reinforces the positive role of multicomponent strategies aimed to reduce the surgical stress response. Although some putative precipitating risk factors are not modifiable (length of surgery, surgical site), others (such as depth of anaesthesia, appropriate analgesia and haemodynamic stability) are under the control of the anaesthesiologists. Multicomponent preoperative, intra-operative and postoperative preventive measures showed potential to reduce the incidence and duration of POD, confirming the pivotal role of a comprehensive and team-based approach to improve patients' clinical and functional status.
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Affiliation(s)
- César Aldecoa
- From the Department of Anaesthesia and Postoperative Critical Care, Hospital Universitario Rio Hortega, Valladolid, Spain (CA), Department of Biomedical Studies, University of the Republic of San Marino, San Marino (GB), Department of Anesthesiology, Critical Care and Pain Medicine, 'Sapienza' University of Rome, Rome, Italy (FB, AF, LM), Specialty of Anaesthetics & NHMRC Clinical Trials Centre, University of Sydney & Department of Anaesthetics and Institute of Academic Surgery, Royal Prince Alfred Hospital (RDS), Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt Universität zu Berlin, Campus Charité Mitte, and Campus Virchow Klinikum (CDS, SK, AM, BN, LV, BW, FY), Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (PA), Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy (PA), Department of Surgery, Institute of Clinical Sciences, Sahlgrenska University Hospital, Göteborg, Sweden (RA), Geriatria, Accettazione Geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy (AC), School of Biochemistry and Immunology and Trinity College Institute of Neuroscience, Trinity College, Dublin, Ireland (CC), First Department of Anaesthesiology and Intensive Care Medical University of Lublin, Poland (WD), Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland (KI), Section of Surgical Pathophysiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (HK), Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Poland (KK), Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia (NG, NL, SP, SR), Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy (NL, SP), Edinburgh Delirium Research Group, Ageing and Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom (AMJM), Department of Anaesthesia and Intensive Care, Nykoebing Hospital; University of Southern Denmark, SDU (SK, FR), Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia (ARB), Center for Intensive Care Medicine, Luzerner Kantonsspital, Lucerne, Switzerland (ARB), Department of Health Science, Section of Anesthesiology, University of Florence (SR), Department of Anaesthesia and Critical Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy (SR), School of Health Sciences, Institute of Nursing, ZHAW Zurich University of Applied Science, Winterthur, Switzerland (MS), Departments of Psychiatry and Intensive Care Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (AJCS), Department of Neurology, UZ Brussel and Vrije Universiteit Brussel, Brussels, Belgium (AJCS) and Dental Anesthesia and Intensive Care Unit, Polo Universitario Ospedale San Paolo, Department of Biomedical, Surgical and Odontoiatric Sciences, University of Milano, Milan, Italy (CT)
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Quddus R, Banks J, Morgan JL, Martin C, Reed MW, Walters S, Cheung KL, Todd A, Audisio R, Green T, Revell D, Gath J, Horgan K, Holcombe C, Parmeshwar R, Thompson A, Wyld L. Outcomes of complex oncoplastic breast surgery in older women. Analysis of data from the Age Gap cohort study. Eur J Surg Oncol 2023; 49:107075. [PMID: 37774649 DOI: 10.1016/j.ejso.2023.107075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/28/2023] [Accepted: 09/12/2023] [Indexed: 10/01/2023]
Abstract
KEY WORDS Breast cancer, mastectomy, breast conserving surgery, post-mastectomy reconstruction, older women, quality of life.
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Affiliation(s)
- Ratul Quddus
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Jessica Banks
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Jenna L Morgan
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Charlene Martin
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | | | - Stephen Walters
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, UK
| | - Kwok Leung Cheung
- University of Nottingham, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3DT, UK
| | - Annaliza Todd
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Riccardo Audisio
- University of Gothenberg, Sahlgrenska Universitetssjukhuset, 41345, Göteborg, Sweden
| | - Tracy Green
- Yorkshire and Humber Consumer Research Panel, UK
| | | | - Jacqui Gath
- Yorkshire and Humber Consumer Research Panel, UK
| | - Kieran Horgan
- Dept of Breast Surgery, Bexley Cancer Centre, St James's University Hospital, Leeds, LS9 7TF, UK
| | - Chris Holcombe
- Liverpool University Hospitals Foundation Trust, Prescott Street, Liverpool, L7 8 XP, UK
| | - Rishi Parmeshwar
- University Hospitals of Morecambe Bay, Royal Lancashire Infirmary Ashton Road, Lancaster, Lancashire, LA1 4RP, UK
| | - Alastair Thompson
- Department of Surgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX, USA
| | - L Wyld
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK.
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Audisio R, Balducci L, Monfardini S, Peccatori FA, Rostoft S, van Leeuwen B. Should cancer treatment stop at the age of 75? J Am Geriatr Soc 2023; 71:3342-3344. [PMID: 37224400 DOI: 10.1111/jgs.18420] [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: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/26/2023]
Affiliation(s)
- Riccardo Audisio
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska University Hospital, Göteborg, Sweden
| | | | - Silvio Monfardini
- European School of Oncology Program on the History of European Oncology, Milan, Italy
| | - Fedro A Peccatori
- Gynecologic Oncology Department, European Institute of Oncology IRCCS, Milan, Italy
| | - Siri Rostoft
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
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Giusti F, Martos C, Trama A, Bettio M, Sanvisens A, Audisio R, Arndt V, Francisci S, Dochez C, Ribes J, Fernández LP, Gavin A, Gatta G, Marcos-Gragera R, Lievens Y, Allemani C, De Angelis R, Visser O, Van Eycken L. Cancer treatment data available in European cancer registries: Where are we and where are we going? Front Oncol 2023; 13:1109978. [PMID: 36845700 PMCID: PMC9944949 DOI: 10.3389/fonc.2023.1109978] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/20/2023] [Indexed: 02/10/2023] Open
Abstract
Population-based cancer registries are responsible for collecting incidence and survival data on all reportable neoplasms within a defined geographical area. During the last decades, the role of cancer registries has evolved beyond monitoring epidemiological indicators, as they are expanding their activities to studies on cancer aetiology, prevention, and quality of care. This expansion relies also on the collection of additional clinical data, such as stage at diagnosis and cancer treatment. While the collection of data on stage, according to international reference classification, is consolidated almost everywhere, data collection on treatment is still very heterogeneous in Europe. This article combines data from a literature review and conference proceedings together with data from 125 European cancer registries contributing to the 2015 ENCR-JRC data call to provide an overview of the status of using and reporting treatment data in population-based cancer registries. The literature review shows that there is an increase in published data on cancer treatment by population-based cancer registries over the years. In addition, the review indicates that treatment data are most often collected for breast cancer, the most frequent cancer in women in Europe, followed by colorectal, prostate and lung cancers, which are also more common. Treatment data are increasingly being reported by cancer registries, though further improvements are required to ensure their complete and harmonised collection. Sufficient financial and human resources are needed to collect and analyse treatment data. Clear registration guidelines are to be made available to increase the availability of real-world treatment data in a harmonised way across Europe.
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Affiliation(s)
- Francesco Giusti
- European Commission, Joint Research Centre (JRC), Ispra, Italy,Belgian Cancer Registry, Brussels, Belgium,*Correspondence: Francesco Giusti, ;
| | - Carmen Martos
- European Commission, Joint Research Centre (JRC), Ispra, Italy,Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain
| | - Annalisa Trama
- Evaluative Epidemiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Manola Bettio
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | - Arantza Sanvisens
- Epidemiology Unit and Girona Cancer Registry, Catalan Institute of Oncology, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia; Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Riccardo Audisio
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Volker Arndt
- Epidemiological Cancer Registry Baden-Württemberg (M110) & Unit of Cancer Survivorship (C071), Division of Clinical Epidemiology and Aging Research (C070), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Silvia Francisci
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità, Rome, Italy
| | | | - Josepa Ribes
- Catalan Cancer Plan, Department of Health of Catalonia, Hospitalet del Llobregat, Barcelona, Spain
| | - Laura Pareja Fernández
- Catalan Cancer Plan, Department of Health of Catalonia, Hospitalet del Llobregat, Barcelona, Spain
| | - Anna Gavin
- Northern Ireland Cancer Registry, Centre for Public Health, Queen’s University Belfast, Belfast, Ireland
| | - Gemma Gatta
- Evaluative Epidemiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rafael Marcos-Gragera
- Epidemiology Unit and Girona Cancer Registry, Catalan Institute of Oncology, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia; Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Claudia Allemani
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Roberta De Angelis
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Otto Visser
- Department of Registration, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands
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Noad M, Jenna L M, Wyld L, Holmes G, Martin C, Walters SJ, Kwok-Leung C, Malcolm R, Audisio R. Study to determine the accuracy of the PREDICT online tool in a cohort of older women (≥70) with operable breast cancer. European Journal of Surgical Oncology 2023. [DOI: 10.1016/j.ejso.2022.11.283] [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: 02/25/2023]
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Wyld L, Reed MWR, Collins K, Ward S, Holmes G, Morgan J, Bradburn M, Walters S, Burton M, Lifford K, Edwards A, Brain K, Ring A, Herbert E, Robinson TG, Martin C, Chater T, Pemberton K, Shrestha A, Nettleship A, Richards P, Brennan A, Cheung KL, Todd A, Harder H, Audisio R, Battisti NML, Wright J, Simcock R, Murray C, Thompson AM, Gosney M, Hatton M, Armitage F, Patnick J, Green T, Revill D, Gath J, Horgan K, Holcombe C, Winter M, Naik J, Parmeshwar R. Improving outcomes for women aged 70 years or above with early breast cancer: research programme including a cluster RCT. Programme Grants Appl Res 2022. [DOI: 10.3310/xzoe2552] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
In breast cancer management, age-related practice variation is widespread, with older women having lower rates of surgery and chemotherapy than younger women, based on the premise of reduced treatment tolerance and benefit. This may contribute to inferior outcomes. There are currently no age- and fitness-stratified guidelines on which to base treatment recommendations.
Aim
We aimed to optimise treatment choice and outcomes for older women (aged ≥ 70 years) with operable breast cancer.
Objectives
Our objectives were to (1) determine the age, comorbidity, frailty, disease stage and biology thresholds for endocrine therapy alone versus surgery plus adjuvant endocrine therapy, or adjuvant chemotherapy versus no chemotherapy, for older women with breast cancer; (2) optimise survival outcomes for older women by improving the quality of treatment decision-making; (3) develop and evaluate a decision support intervention to enhance shared decision-making; and (4) determine the degree and causes of treatment variation between UK breast units.
Design
A prospective cohort study was used to determine age and fitness thresholds for treatment allocation. Mixed-methods research was used to determine the information needs of older women to develop a decision support intervention. A cluster-randomised trial was used to evaluate the impact of this decision support intervention on treatment choices and outcomes. Health economic analysis was used to evaluate the cost–benefit ratio of different treatment strategies according to age and fitness criteria. A mixed-methods study was used to determine the degree and causes of variation in treatment allocation.
Main outcome measures
The main outcome measures were enhanced age- and fitness-specific decision support leading to improved quality-of-life outcomes in older women (aged ≥ 70 years) with early breast cancer.
Results
(1) Cohort study: the study recruited 3416 UK women aged ≥ 70 years (median age 77 years). Follow-up was 52 months. (a) The surgery plus adjuvant endocrine therapy versus endocrine therapy alone comparison: 2854 out of 3416 (88%) women had oestrogen-receptor-positive breast cancer, 2354 of whom received surgery plus adjuvant endocrine therapy and 500 received endocrine therapy alone. Patients treated with endocrine therapy alone were older and frailer than patients treated with surgery plus adjuvant endocrine therapy. Unmatched overall survival and breast-cancer-specific survival were higher in the surgery plus adjuvant endocrine therapy group (overall survival: hazard ratio 0.27, 95% confidence interval 0.23 to 0.33; p < 0.001; breast-cancer-specific survival: hazard ratio 0.41, 95% confidence interval 0.29 to 0.58; p < 0.001) than in the endocrine therapy alone group. In matched analysis, surgery plus adjuvant endocrine therapy was still associated with better overall survival (hazard ratio 0.72, 95% confidence interval 0.53 to 0.98; p = 0.04) than endocrine therapy alone, but not with better breast-cancer-specific survival (hazard ratio 0.74, 95% confidence interval 0.40 to 1.37; p = 0.34) or progression-free-survival (hazard ratio 1.11, 95% confidence interval 0.55 to 2.26; p = 0.78). (b) The adjuvant chemotherapy versus no chemotherapy comparison: 2811 out of 3416 (82%) women received surgery plus adjuvant endocrine therapy, of whom 1520 (54%) had high-recurrence-risk breast cancer [grade 3, node positive, oestrogen receptor negative or human epidermal growth factor receptor-2 positive, or a high Oncotype DX® (Genomic Health, Inc., Redwood City, CA, USA) score of > 25]. In this high-risk population, there were no differences according to adjuvant chemotherapy use in overall survival or breast-cancer-specific survival after propensity matching. Adjuvant chemotherapy was associated with a lower risk of metastatic recurrence than no chemotherapy in the unmatched (adjusted hazard ratio 0.36, 95% confidence interval 0.19 to 0.68; p = 0.002) and propensity-matched patients (adjusted hazard ratio 0.43, 95% confidence interval 0.20 to 0.92; p = 0.03). Adjuvant chemotherapy improved the overall survival and breast-cancer-specific survival of patients with oestrogen-receptor-negative disease. (2) Mixed-methods research to develop a decision support intervention: an iterative process was used to develop two decision support interventions (each comprising a brief decision aid, a booklet and an online tool) specifically for older women facing treatment choices (endocrine therapy alone or surgery plus adjuvant endocrine therapy, and adjuvant chemotherapy or no chemotherapy) using several evidence sources (expert opinion, literature and patient interviews). The online tool was based on models developed using registry data from 23,842 patients and validated on an external data set of 14,526 patients. Mortality rates at 2 and 5 years differed by < 1% between predicted and observed values. (3) Cluster-randomised clinical trial of decision support tools: 46 UK breast units were randomised (intervention, n = 21; usual care, n = 25), recruiting 1339 women (intervention, n = 670; usual care, n = 669). There was no significant difference in global quality of life at 6 months post baseline (difference –0.20, 95% confidence interval –2.7 to 2.3; p = 0.90). In women offered a choice of endocrine therapy alone or surgery plus adjuvant endocrine therapy, knowledge about treatments was greater in the intervention arm than the usual care arm (94% vs. 74%; p = 0.003). Treatment choice was altered, with higher rates of endocrine therapy alone than of surgery in the intervention arm. Similarly, chemotherapy rates were lower in the intervention arm (endocrine therapy alone rate: intervention sites 21% vs. usual-care sites 15%, difference 5.5%, 95% confidence interval 1.1% to 10.0%; p = 0.02; adjuvant chemotherapy rate: intervention sites 10% vs. usual-care site 15%, difference 4.5%, 95% confidence interval 0.0% to 8.0%; p = 0.013). Survival was similar in both arms. (4) Health economic analysis: a probabilistic economic model was developed using registry and cohort study data. For most health and fitness strata, surgery plus adjuvant endocrine therapy had lower costs and returned more quality-adjusted life-years than endocrine therapy alone. However, for some women aged > 90 years, surgery plus adjuvant endocrine therapy was no longer cost-effective and generated fewer quality-adjusted life-years than endocrine therapy alone. The incremental benefit of surgery plus adjuvant endocrine therapy reduced with age and comorbidities. (5) Variation in practice: analysis of rates of surgery plus adjuvant endocrine therapy or endocrine therapy alone between the 56 breast units in the cohort study demonstrated significant variation in rates of endocrine therapy alone that persisted after adjustment for age, fitness and stage. Clinician preference was an important determinant of treatment choice.
Conclusions
This study demonstrates that, for older women with oestrogen-receptor-positive breast cancer, there is a cohort of women with a life expectancy of < 4 years for whom surgery plus adjuvant endocrine therapy may offer little benefit and simply have a negative impact on quality of life. The Age Gap decision tool may help make this shared decision. Similarly, although adjuvant chemotherapy offers little benefit and has a negative impact on quality of life for the majority of older women with oestrogen-receptor-positive breast cancer, for women with oestrogen-receptor-negative breast cancer, adjuvant chemotherapy is beneficial. The negative impacts of adjuvant chemotherapy on quality of life, although significant, are transient. This implies that, for the majority of fitter women aged ≥ 70 years, standard care should be offered.
Limitations
As with any observational study, despite detailed propensity score matching, residual bias cannot be excluded. Follow-up was at median 52 months for the cohort analysis. Longer-term follow-up will be required to validate these findings owing to the slow time course of oestrogen-receptor-positive breast cancer.
Future work
The online algorithm is now available (URL: https://agegap.shef.ac.uk/; accessed May 2022). There are plans to validate the tool and incorprate quality-of-life and 10-year survival outcomes.
Trial registration
This trial is registered as ISRCTN46099296.
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 10, No. 6. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
- Jasmine Breast Centre, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | | | - Karen Collins
- Faculty of Health and Wellbeing, Department of Allied Health Professions, Collegiate Cresent Campus, Sheffield Hallam University, Sheffield, UK
| | - Sue Ward
- Department of Health and Social Care Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Geoff Holmes
- Department of Health and Social Care Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Jenna Morgan
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
- Jasmine Breast Centre, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | - Mike Bradburn
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Stephen Walters
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Maria Burton
- Faculty of Health and Wellbeing, Department of Allied Health Professions, Collegiate Cresent Campus, Sheffield Hallam University, Sheffield, UK
| | - Kate Lifford
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Adrian Edwards
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Kate Brain
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | | | - Esther Herbert
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Thompson G Robinson
- Department of Cardiovascular Sciences, University of Leicester, Cardiovascular Research Centre, Glenfield General Hospital, Leicester, UK
| | - Charlene Martin
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
- Jasmine Breast Centre, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | - Tim Chater
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Kirsty Pemberton
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Anne Shrestha
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
- Jasmine Breast Centre, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | | | - Paul Richards
- Department of Health and Social Care Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Alan Brennan
- Department of Health and Social Care Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Annaliza Todd
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
- Jasmine Breast Centre, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | | | - Riccardo Audisio
- Sahlgrenska Universitetssjukhuset, University of Gothenburg, Göteborg, Sweden
| | | | | | | | | | | | - Margot Gosney
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | | | | | - Julietta Patnick
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Tracy Green
- Yorkshire and Humber Research Network Consumer Research Panel, Sheffield, UK
| | - Deirdre Revill
- Yorkshire and Humber Research Network Consumer Research Panel, Sheffield, UK
| | - Jacqui Gath
- Yorkshire and Humber Research Network Consumer Research Panel, Sheffield, UK
| | | | - Chris Holcombe
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Matt Winter
- Breast Unit, Weston Park Hospital, Sheffield, UK
| | - Jay Naik
- Breast Unit, Pinderfields Hospital, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Rishi Parmeshwar
- Breast Unit, Royal Lancaster Infirmary, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK
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7
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van der Hage J, Sandrucci S, Audisio R, Wyld L, Søreide K, Amaral T, Audisio R, Bahadoer V, Beets G, Benstead K, Berge Nilsen E, Bol K, Brandl A, Braun J, Cufer T, Dopazo C, Edhemovic I, Eriksen JG, Fiore M, van Ginhoven T, Gonzalez-Moreno S, van der Hage J, Hutteman M, Masannat Y, Onesti EC, Rau B, De Reijke T, Rubio I, Ruurda J, Sandrucci S, Soreide K, Stattner S, Trapani D, D'Ugo D, Vriens M, Wyld L, Zahl Eriksson AG. The ESSO core curriculum committee update on surgical oncology. Eur J Surg Oncol 2021; 47:e1-e30. [PMID: 34657781 DOI: 10.1016/j.ejso.2021.10.003] [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: 09/23/2021] [Revised: 09/29/2021] [Accepted: 10/05/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Surgical oncology is a defined specialty within the European Board of Surgery within the European Union of Medical Specialists (UEMS). Variation in training and specialization still occurs across Europe. There is a need to align the core knowledge needed to fulfil the criteria across subspecialities in surgical oncology. MATERIAL AND METHODS The core curriculum, established in 2013, was developed with contributions from expert advisors from within the European Society of Surgical Oncology (ESSO), European Society for Radiotherapy and Oncology (ESTRO) and European Society of Medical Oncology (ESMO) and related subspeciality experts. RESULTS The current version reiterates and updates the core curriculum structure needed for current and future candidates who plans to train for and eventually sit the European fellowship exam for the European Board of Surgery in Surgical Oncology. The content included is not intended to be exhaustive but, rather to give the candidate an idea of expectations and areas for in depth study, in addition to the practical requirements. The five elements included are: Basic principles of oncology; Disease site specific oncology; Generic clinical skills; Training recommendations, and, lastly; Eligibility for the EBSQ exam in Surgical Oncology. CONCLUSIONS As evidence-based care for cancer patients evolves through research into basic science, translational research and clinical trials, the core curriculum will evolve, mature and adapt to deliver continual improvements in cancer outcomes for patients.
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Affiliation(s)
- Jos van der Hage
- Department of Surgery, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands.
| | - Sergio Sandrucci
- Surgical Oncology Unit, City of Health and Science, University of Turin, Turin, Italy
| | - Riccardo Audisio
- Department of Surgery, Sahlgrenska University Hospital, University of Gothenburg, Sweden
| | - Lynda Wyld
- Department of Oncology and Metabolism, Sheffield University, Sheffield, United Kingdom
| | - Kjetil Søreide
- Department of Gastrointestinal Surgery, HPB unit, Stavanger University Hospital, Stavanger, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | | | - Teresa Amaral
- Dermatology, Eberhard Karls Universitat Tubingen, Tubingen, Germany
| | | | - Viren Bahadoer
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Geerard Beets
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Kim Benstead
- Gloucestershire Oncology Centre, Cheltenham General Hospital, United Kingdom
| | - Elisabeth Berge Nilsen
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway
| | - Kalijn Bol
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Andreas Brandl
- Department of Surgery, Campus Virchow-Klinikum and Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany; Digestive Unit, Champalimaud Foundation, Lisbon, Portugal
| | - Jerry Braun
- Department of Thoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Tanja Cufer
- University Clinic Golnik, University of Ljubljana, 4204 Ljubljana, Slovenia
| | - Cristina Dopazo
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ibrahim Edhemovic
- Department of Surgery, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Jesper Grau Eriksen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Marco Fiore
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Tessa van Ginhoven
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | | | - Jos van der Hage
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Merlijn Hutteman
- Department of Thoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Yazan Masannat
- University of Aberdeen, School of Medicine, Medical Science and Nutrition, Aberdeen, UK
| | - Elisa Concetta Onesti
- Department of Clinical and Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Beate Rau
- Department of General Surgery, Charité University of Berlin, Berlin, Germany
| | - Theo De Reijke
- Department of Urology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Isabel Rubio
- Breast Surgical Oncology, Clínica Universidad de Navarra, Madrid, Universidad de Navarra, Spain
| | - Jelle Ruurda
- Visceral Sarcoma Surgery Unit, Città della Salute e della Scienza, Turin, Italy
| | - Sergio Sandrucci
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - Kjetil Soreide
- Department of Surgery, Salzkammergutklinikum, Standort Vöcklabruck, Oberösterreich, Austria
| | - Stefan Stattner
- Department of Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria; New drugs development for innovative therapies, European Institute of Oncology, IRCCS, Milano, Italy
| | - Dario Trapani
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, 00168 Rome, Italy
| | - Domenico D'Ugo
- Department of Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Menno Vriens
- Department of Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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Borras JM, Corral J, Aggarwal A, Audisio R, Espinas JA, Figueras J, Naredi P, Panteli D, Pourel N, Prades J, Lievens Y. Innovation, value and reimbursement in radiation and complex surgical oncology: Time to rethink. Eur J Surg Oncol 2021; 48:967-977. [PMID: 34479744 DOI: 10.1016/j.ejso.2021.08.018] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND PURPOSE Complex surgery and radiotherapy are the central pillars of loco-regional oncology treatment. This paper describes the reimbursement schemes used in radiation and complex surgical oncology, reports on literature and policy reviews. MATERIAL AND METHODS A systematic review of the literature of the reimbursement models has been carried out separately for radiotherapy and complex cancer surgery based on PRISMA guidelines. Using searches of PubMed and grey literature, we identified articles from scientific journals and reports published since 2000 on provider payment or reimbursement systems currently used in radiation oncology and complex cancer surgery, also including policy models. RESULTS Most European health systems reimburse radiotherapy using a budget-based, fee-for-service or fraction-based system; while few reimburse services according to an episode-based model. Also, the reimbursement models for cancer surgery are mostly restricted to differences embedded in the DRG system and adjustments applied to the fees, based on the complexity of each surgical procedure. There is an enormous variability in reimbursement across countries, resulting in different incentives and different amounts paid for the same therapeutic strategy. CONCLUSION A reimbursement policy, based on the episode of care as the basic payment unit, is advocated for. Innovation should be tackled in a two-tier approach: one defining the common criteria for reimbursement of proven evidence-based interventions; another for financing emerging innovation with uncertain definitive value. Relevant clinical and economic data, also collected real-life, should support reimbursement systems that mirror the actual cost of evidence-based practice.
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Affiliation(s)
- Josep M Borras
- University of Barcelona, Spain; Catalonian Cancer Plan, Department of Health, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.
| | - Julieta Corral
- Catalonian Cancer Plan, Department of Health, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Ajay Aggarwal
- Guy's and St. Thomas' Hospital NHS Trust, United Kingdom
| | - Riccardo Audisio
- Department of Surgery, Sahlgrenska University Hospital, University of Gothenburg, Sweden
| | - Josep Alfons Espinas
- Catalonian Cancer Plan, Department of Health, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Josep Figueras
- European Observatory on Health Systems and Policies, Belgium
| | - Peter Naredi
- Department of Surgery, Sahlgrenska University Hospital, University of Gothenburg, Sweden
| | - Dimitra Panteli
- Department of Health Care Management, Technische Universität Berlin, Germany
| | | | - Joan Prades
- Catalonian Cancer Plan, Department of Health, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital & Ghent University, Belgium
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9
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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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Martin C, Shrestha A, Morgan J, Bradburn M, Herbert E, Burton M, Todd A, Walters S, Ward S, Holmes G, Reed M, Collins K, Robinson TG, Ring A, Cheung KL, Audisio R, Gath J, Revell D, Green T, Lifford K, Edwards A, Chater T, Pemberton K, Wyld L. Treatment choices for older women with primary operable breast cancer and cognitive impairment: Results from a prospective, multicentre cohort study. J Geriatr Oncol 2021; 12:705-713. [PMID: 33353856 DOI: 10.1016/j.jgo.2020.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/16/2020] [Accepted: 12/09/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVES The presence of dementia co-existing with a diagnosis of breast cancer may render management more challenging and have a substantial impact on oncological outcomes. The aim of this study was to examine the treatment and outcomes of older women with co-existing cognitive impairment and primary breast cancer. MATERIALS AND METHODS A prospective, multicentre UK cohort study of women aged 70 years or over with primary operable breast cancer. Patients with and without cognitive impairment were compared to assess differences in treatment and survival outcomes. RESULTS In total, 3416 women were recruited between 2013 and 2018. Of these, 478 (14%) had a diagnosis of dementia or cognitive impairment, subcategorised as mild, moderate and severely impaired. Up to 85% of women with normal cognition underwent surgery compared to 74%, 61% and 40% with mild, moderate, and severe impairment (p = 0.001). Among women at higher risk of recurrence, the uptake of chemotherapy was 25% for cognitively normal women compared to 20%, 22% and 12% for mild, moderate and severe impairment groups (p = 0.222). Radiotherapy use was similar in the subgroups. Although patients with cognitive impairment had shorter overall survival (HR: 2.10, 95% CI: 1.77-2.50, p < 0.001), there were no statistically significant differences in breast cancer specific or progression-free survival. CONCLUSION Cognitive impairment appears to play a significant part in deciding how to treat older women with breast cancer. Standard treatment may be over-treatment for some women with severe dementia and careful consideration must be given to a more tailored approach in these women.
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Affiliation(s)
- Charlene Martin
- Department of Oncology and Metabolism, University of Sheffield, The Medical School, Beech Hill Road, Sheffield S10 2RX, UK
| | - Anne Shrestha
- Department of Oncology and Metabolism, University of Sheffield, The Medical School, Beech Hill Road, Sheffield S10 2RX, UK
| | - Jenna Morgan
- Department of Oncology and Metabolism, University of Sheffield, The Medical School, Beech Hill Road, Sheffield S10 2RX, UK
| | - Michael Bradburn
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Esther Herbert
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Maria Burton
- Centre for Health and Social Care Research, Sheffield Hallam University, Collegiate Crescent, Sheffield, UK
| | - Annaliza Todd
- Department of Oncology and Metabolism, University of Sheffield, The Medical School, Beech Hill Road, Sheffield S10 2RX, UK
| | - Stephen Walters
- Centre for Health and Social Care Research, Sheffield Hallam University, Collegiate Crescent, Sheffield, UK
| | - Sue Ward
- Department of Health Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Geoffrey Holmes
- Department of Health Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Malcolm Reed
- Brighton and Sussex Medical School, Falmer, Brighton, UK
| | - Karen Collins
- Centre for Health and Social Care Research, Sheffield Hallam University, Collegiate Crescent, Sheffield, UK
| | - Thompson G Robinson
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, The Glenfield Hospital, Leicester LE3 9QP, UK
| | - Alistair Ring
- Breast Unit, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Kwok-Leung Cheung
- School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Uttoxeter Road, Derby DE22 3DT, UK
| | - Riccardo Audisio
- Department of Surgery, Institute of Clinical Sciences, Blå Stråket 5, Sahlgrenska University Hospital, 413 45 Göteborg, Sweden
| | - Jacqui Gath
- Yorkshire and Humber Consumer Research Panel, UK
| | | | - Tracy Green
- Yorkshire and Humber Consumer Research Panel, UK
| | - Kate Lifford
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK
| | - Adrian Edwards
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK
| | - Tim Chater
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Kirsty Pemberton
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield, The Medical School, Beech Hill Road, Sheffield S10 2RX, UK.
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11
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Wyld L, Reed MWR, Morgan J, Collins K, Ward S, Holmes GR, Bradburn M, Walters S, Burton M, Herbert E, Lifford K, Edwards A, Ring A, Robinson T, Martin C, Chater T, Pemberton K, Shrestha A, Brennan A, Cheung KL, Todd A, Audisio R, Wright J, Simcock R, Green T, Revell D, Gath J, Horgan K, Holcombe C, Winter M, Naik J, Parmeshwar R, Patnick J, Gosney M, Hatton M, Thomson AM. Bridging the age gap in breast cancer. Impacts of omission of breast cancer surgery in older women with oestrogen receptor positive early breast cancer. A risk stratified analysis of survival outcomes and quality of life. Eur J Cancer 2020; 142:48-62. [PMID: 33220653 PMCID: PMC7789991 DOI: 10.1016/j.ejca.2020.10.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/14/2020] [Accepted: 10/06/2020] [Indexed: 11/24/2022]
Abstract
Background Age-related breast cancer treatment variance is widespread with many older women having primary endocrine therapy (PET), which may contribute to inferior survival and local control. This propensity-matched study determined if a subgroup of older women may safely be offered PET. Methods Multicentre, prospective, UK, observational cohort study with propensity-matched analysis to determine optimal allocation of surgery plus ET (S+ET) or PET in women aged ≥70 with breast cancer. Data on fitness, frailty, cancer stage, grade, biotype, treatment and quality of life were collected. Propensity-matching (based on age, health status and cancer stage) adjusted for allocation bias when comparing S+ET with PET. Findings A total of 3416 women (median age 77, range 69–102) were recruited from 56 breast units—2854 (88%) had ER+ breast cancer: 2354 had S+ET and 500 PET. Median follow-up was 52 months. Patients treated with PET were older and frailer than patients treated with S+ET. Unmatched overall survival was inferior in the PET group (hazard ratio, (HR) 0.27, 95% confidence interval (CI) 0.23–0.33, P < 0.001). Unmatched breast cancer–specific survival (BCSS) was also inferior in patients treated with PET (HR: 0.41, CI: 0.29–0.58, P < 0.001 for BCSS). In the matched analysis, PET was still associated with an inferior overall survival (HR = 0.72, 95% CI: 0.53–0.98, P = 0.04) but not BCSS (HR = 0.74, 95% CI: 0.40–1.37, P = 0.34) although at 4–5 years subtle divergence of the curves commenced in favor of surgery. Global health status diverged at certain time points between groups but over 24 months was similar when adjusted for baseline variance. Interpretation For the majority of older women with early ER+ breast cancer, surgery is oncologically superior to PET. In less fit, older women, with characteristics similar to the matched cohort of this study (median age 81 with higher comorbidity and functional impairment burdens, the BCSS survival differential disappears at least out to 4–5 year follow-up, suggesting that for those with less than 5-year predicted life-expectancy (>90 years or >85 with comorbidities or frailty) individualised decision making regarding PET versus S+ET may be appropriate and safe to offer. The Age Gap online decision tool may support this decision-making process (https://agegap.shef.ac.uk/). Trial registration number ISRCTN: 46099296. Propensity matched study of women >70 with breast cancer comparing surgery or PET Unmatched analysis found surgery improves overall & disease-specific survival. Matched analysis (stage, age, health, frailty) found similar disease-specific survival Surgery led to adverse events in 19% & negative impacts on QoL and physical function Less fit women >85 may be offered PET to reduce morbidity, without survival detriment
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Affiliation(s)
- Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK.
| | | | - Jenna Morgan
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Karen Collins
- College of Health, Wellbeing and Life Sciences, Department of Allied Health Professions, Sheffield Hallam University, Collegiate Cresent Campus, Sheffield, UK
| | - Sue Ward
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, UK
| | - Geoffrey R Holmes
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, UK
| | - Mike Bradburn
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, UK
| | - Stephen Walters
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, UK
| | - Maria Burton
- College of Health, Wellbeing and Life Sciences, Department of Allied Health Professions, Sheffield Hallam University, Collegiate Cresent Campus, Sheffield, UK
| | - Esther Herbert
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, UK
| | - Kate Lifford
- Division of Population Medicine, Cardiff University, 8th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, 8th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Alistair Ring
- The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Thompson Robinson
- Department of Cardiovascular Sciences and NIHR Biomedical Research Centre, University of Leicester, Cardiovascular Research Centre, The Glenfield General Hospital, Leicester, LE3 9QP, UK
| | - Charlene Martin
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Tim Chater
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, UK
| | - Kirsty Pemberton
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, UK
| | - Anne Shrestha
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Alan Brennan
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, UK
| | - Kwok L Cheung
- University of Nottingham, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3DT, UK
| | - Annaliza Todd
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Riccardo Audisio
- University of Gothenberg, Sahlgrenska Universitetssjukhuset, 41345 Göteborg, Sweden
| | - Juliet Wright
- Brighton and Sussex Medical School, Falmer, Brighton, UK
| | | | - Tracy Green
- Yorkshire and Humber Consumer Research Panel, UK
| | | | - Jacqui Gath
- Yorkshire and Humber Consumer Research Panel, UK
| | - Kieran Horgan
- Dept of Breast Surgery, Bexley Cancer Centre, St James's University Hospital, Leeds, LS9 7TF, UK
| | - Chris Holcombe
- Liverpool University Hospitals Foundation Trust, Prescott Street, Liverpool L7 8 XP, UK
| | - Matt Winter
- Weston Park Hospital, Whitham Rd, Sheffield S10 2SJ, UK
| | - Jay Naik
- Pinderfields Hospital, Mid Yorkshire NHS Foundation Trust, Aberford Rd, Wakefield, UK
| | - Rishi Parmeshwar
- University Hospitals of Morecambe Bay, Royal Lancashire Infirmary Ashton Road, Lancaster, Lancashire, LA1 4RP, UK
| | - Julietta Patnick
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Margot Gosney
- Royal Berkshire NHS Foundation Trust, Reading, RG1 5AN, UK
| | | | - Alastair M Thomson
- Department of Surgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX, USA
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12
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Morgan J, Holmes G, Martin C, Ward S, Walters S, Cheung K, Audisio R, Reed M, Wyld L. Quality of life outcomes following breast surgery in older women with operable breast cancer: Analysis of the Bridging the Age Gap study. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30598-0] [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: 10/23/2022]
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13
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Morgan J, Holmes G, Martin C, Ward S, Walters S, Cheung K, Audisio R, Reed M, Wyld L. Variation in the rates of surgical treatment of older women with operable breast cancer between UK breast units: Analysis of the Bridging the Age Gap Study. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30597-9] [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: 11/25/2022]
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14
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Morgan J, Holmes G, Ward S, Martin C, Burton M, Audisio R, Leung-Cheung K, Ring A, Reed M, Wyld L. P065: "Bridging the age gap in breast cancer": An analysis of the decision-making preferences of older women with operable breast cancer in the UK. Eur J Surg Oncol 2020. [DOI: 10.1016/j.ejso.2020.03.104] [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: 10/24/2022] Open
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Montroni I, Ugolini G, Saur N, Spinelli A, Rostoft S, Ercolani G, Jaklitsh MT, Van Leeuwen B, de Liguori Carino N, Ferrari G, Ghignone F, Garutti A, Di Candido FR, Somasundar P, Foca F, Vertogen B, Nanni O, Audisio R. Regaining a satisfactory quality of life and predicting functional decline after major cancer surgery in older adults: The Geriatric Oncology Surgical Assessment and Functional rEcovery after Surgery (GOSAFE) study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.12051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
12051 Background: Older cancer patients value quality of life (QoL) and functional outcomes as much as survival but surgical studies lack specific data. The international, multicenter GOSAFE study (ClinicalTrials.gov NCT03299270) aims to evaluate patients’ QoL and functional recovery (FR) after cancer surgery and to assess predictors of FR Methods: GOSAFE prospectively collected functional and clinical data before and after major elective cancer surgery on senior adults (≥70 years). Surgical outcomes were recorded (30, 90, and 180 days post-operatively) with QoL (EQ-5D-3L) and FR (Activities of Daily Living (ADL), Timed Up and Go (TUG) and MiniCog), 26 centers enrolled patients from February 2017 to April 2019. Results: 942 patients underwent a major cancer resection. Median age was 78 (range 70-95); 52.2% males, ASA III-IV 49%. 934 (99%) lived at home, 51% lived alone, and 87% were able to go out. Patients dependent (ADL < 5) were 8%. Frailty was detected by means of G8 ≤14 in 68.8% and fTRST ≥2 in 37% of patients. Major comorbidities (CCI > 6) were reported in 36% and 21% had cognitive impairment according to MiniCog (2.2% self-reported). 25% had > 3 kg weight loss, 27% were hospitalized in the last 90 days, 54% had ≥3 medications (6% none). Postoperative overall morbidity was 39.1% (30 day) and 22.5% (90 day), but Clavien-Dindo III-IV complications were only 13.4% and 6.9% respectively. 30/90/180-day mortality was 3.6/6/8.9% (10/30/33% in patients with severe functional disability). At 3 months after surgery, QoL was stable/improved (mean EQ-5D index 0.78 was equivalent before vs. after surgery, while the EQ-5D VAS score > 60 raised from 74.3% at baseline to 80.2%, p < 0.01). 76.6% experienced postoperative FR/stability. Logistic regression analysis showed that ASA 3-4, CCI≥7 and CD III-IV complications are significantly associated with functional decline while a G8 > 14 has a positive association with functional recovery. Age is not associated with functional outcomes. Conclusions: The largest prospective study on older patients undergoing structured frailty assessment before and after major elective cancer surgery has shown that QoL remains stable/improves after cancer surgery. The majority of patients return to independence and G8 can predict functional recovery. Older patients with multiple comorbidities, high ASA score or postoperative severe complications are likely to functionally deteriorate after oncologic surgery Clinical trial information: NCT03299270 .
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Affiliation(s)
| | | | - Nicole Saur
- University of Pennsylvania, Perelman School of Medicine, Department of Surgery, Division of Colon and Rectal Surgery, Philadelphia, USA, Philadelphia, PA
| | - Antonino Spinelli
- Division of Colon and Rectal Surgery, Humanitas Clinical and Research Center, Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | | | - Giorgio Ercolani
- U.O. Chirurgia Generale e Terapie Oncologiche Avanzate Ospedale "GB.Morgagni-L.Pierantoni", AUSL Romagna, Forli, Italy
| | | | - Barbara Van Leeuwen
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Nicola de Liguori Carino
- HPB Unit, Manchester Royal Infirmary, Central Manchester University Hospitals, Manchester, United Kingdom
| | | | - Federico Ghignone
- Colorectal Surgery, General Surgery, Ospedale per Gli Infermi, Faenza, Italy
| | | | | | | | - Flavia Foca
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Bernadette Vertogen
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRCCS, Meldola, Italy
| | - Oriana Nanni
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Riccardo Audisio
- University of Gothenburg-Institute of Clinical Sciences, Gothenburg, Sweden
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George J, Morgan J, Martin C, Shrestha A, Sue W, Holmes G, Bradburn M, Burton M, Chater T, Pemberton K, Nettleship A, Walters S, Ring A, Robinson T, Cheung KL, Audisio R, Reed M, Wyld L, Bridging the Age Gap Trial Management Group. Bridging the Age Gap in Breast Cancer - Analysis of the Complication Rates of Surgery in Older Women. Eur J Surg Oncol 2020. [DOI: 10.1016/j.ejso.2019.11.089] [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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Audisio R, Donnelly P, Evans A, Marshall A, Ramirez M, Higgins H, Young A, Dunn J. MAMMO-50: Mammographic surveillance in breast cancer patients over 50 years of age. Eur J Surg Oncol 2020. [DOI: 10.1016/j.ejso.2019.11.468] [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: 10/25/2022] Open
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18
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Noordhoek I, Bastiaannet E, Meershoek-Klein Kranenbarg E, Espinosa-Bravo M, Mátrai Z, Zhygulin A, Irmejs A, Mavioso C, Meani F, González E, Yeniay L, Allweis T, Rogowski K, Rodrigues dos Santos C, Mora H, Ponzone R, Samorani D, van de Velde C, Audisio R, Rubio I. Preliminary results of the international nipple sparing mastectomy registry – a EURECCA project. Eur J Surg Oncol 2020. [DOI: 10.1016/j.ejso.2019.11.467] [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: 11/28/2022] Open
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Montroni I, Ugolini G, Spinelli A, Ercolani G, Jacklitsh MT, Rostoft S, Somasundar PS, Van Leeuwen B, de Liguori Carino N, Saur NM, Ferrari G, Ghignone F, Sermonesi G, Di Candido FR, Foca F, Zingaretti C, Vertogen B, Audisio R. Outcomes that matter to patients: The Geriatric Oncology Surgical Assessment and Functional rEcovery after Surgery (GOSAFE) study—Analysis of 471 patients. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.11511] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11511 Background: Older cancer patients value functional outcomes as much as survival but surgical studies lack functional recovery (FR) data. The international, multicenter GOSAFE study (ClinicalTrials.gov NCT03299270) aims to evaluate patients’ quality of life (QoL)and FR after cancer surgery and to assess predictors of FR. Methods: GOSAFE prospectively collects functional and clinical data before and after major elective cancer surgery on senior adults (≥70 years). Surgical outcomes are recorded (30 days, 90 days, and 180 dayspost-operatively) with QoL(EQ-5D-3L) and FR (Activities of Daily Living (ADL) + Timed Up and Go (TUG) + MiniCog), 28centers are prospectively enrolling patients; accrual ends February 2019. Results: 643 patients underwent major cancer surgery with curative(94%) or palliative (6%) intent (February 2017-September 2018). Median age was 78(range 70-94); 51.6% males, ASA III-IV 52%. Patients dependent (ADL < 5) were 8%. Frailty was detected by G8 > 14 in 32% and fTRST≥2 in 36% of patients. 639 (99%) lived at home, 32% lived alone, and 88% were able to go out. Major comorbidities (CCI > 6) were detected in 36% and 22% had cognitive impairment according to MiniCog (5% self-reported). 26% had > 3 kg weight loss, 30% were hospitalized in the last 90 days, 45% had ≥3 medications (6% none). For 471 patients, a 90-day comprehensive evaluation was available. Postoperative morbidity was 42% (30 day) and 63.3% (90 day), but Clavien-Dindo III-IV complications were only 11.2% and 17.6%. 90-day mortality was 7.4% (5% 30-day). QoL improved 90 days after surgery (mean EQ-5D index from 0.76 to 0.80). Patients with EQ-5D VAS score > 60 raised from 73.9% at baseline to 82.8% at 90 days. 29% had complete FR (ADL score > 4, MiniCog > 2, TUG < 20). Decreased functional capacity was seen in 23.4% of patients alive at 90-days. Conclusions: GOSAFE is the largest prospective study on older cancer patients undergoing major surgery. Interim analysis reports decreased functional capacity in a quarter of patients. The study will allow clinicians to associate clinical outcomes with individual factors of the preoperative assessment and create a user-friendly tool to predict outcomes that matter to patients.
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Affiliation(s)
- Isacco Montroni
- Colorectal Surgery Unit, Ospedale per gli Infermi di Faenza, AUSL Romagna, Faenza, Italy
| | - Giampaolo Ugolini
- Colorectal Surgery Unit, Ospedale per gli Infermi di Faenza, AUSL Romagna, Faenza, Italy
| | - Antonino Spinelli
- Division of Colon and Rectal Surgery, Humanitas Clinical and Research Center, Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - Giorgio Ercolani
- U.O. Chirurgia Generale e Terapie Oncologiche Avanzate Ospedale "GB.Morgagni-L.Pierantoni", AUSL Romagna, Forli, Italy
| | | | | | | | - Barbara Van Leeuwen
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Nicola de Liguori Carino
- HPB Unit, Manchester Royal Infirmary, Central Manchester University Hospitals, Manchester, United Kingdom
| | - Nicole M. Saur
- University of Pennsylvania Perelman School of Medicine, Pennsylvania Hospital, Philadelphia, PA
| | | | - Federico Ghignone
- Colorectal Surgery, General Surgery, Ospedale per gli Infermi, Faenza, Italy
| | - Giacomo Sermonesi
- Colorectal Surgery General Surgery Ospedale per gli Infermi, Faenza, Italy
| | | | - Flavia Foca
- IRCCS-IRST (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori), Meldola, Italy
| | - Chiara Zingaretti
- Unità di Biostatistica e Sperimentazioni Cliniche, IRCCS/IRST Meldola, Ravenna, Italy
| | - Bernadette Vertogen
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRCCS, Meldola, Italy
| | - Riccardo Audisio
- University of Gothenburg - Institute of Clinical Sciences, Gothenburg, Sweden
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Morgan J, George J, Ward S, Holmes G, Burton M, Chater T, Bradburn M, Martin C, Shrestha A, Cheung KL, Audisio R, Reed M, Wyld L. 05. Bridging the Age Gap in Breast Cancer - analysis of the impact of Comorbidity, Dementia and Frailty on the rates of surgery in older women. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2019.01.191] [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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21
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Lievens Y, Audisio R, Banks I, Collette L, Grau C, Oliver K, Price R, Aggarwal A. ESMO-MCBS: setting the record straight - Authors' reply. Lancet Oncol 2019; 20:e193. [PMID: 30942180 DOI: 10.1016/s1470-2045(19)30166-4] [Citation(s) in RCA: 1] [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] [Received: 02/25/2019] [Revised: 02/26/2019] [Accepted: 02/26/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent B-9000, Belgium.
| | - Riccardo Audisio
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ian Banks
- Patient Advisory Committee, European Cancer Organisation, Brussels, Belgium
| | - Laurence Collette
- Statistics Department, European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Cai Grau
- Department of Oncology and Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | | | - Richard Price
- Policy Division, European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Ajay Aggarwal
- Department of Clinical Oncology, Guy's & St Thomas' NHS Trust, London, UK; Institute of Cancer Policy, King's College London, London, UK
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Are C, McMasters KM, Giuliano A, Yanala U, Balch C, Anderson BO, Berman R, Audisio R, Kovacs T, Savant D, Toprani R, Amira G, Sallam I, Baek JH, Baek MJ, Park DJ, Beulo GQ, Rocha EB, Said HM, Cheema M, AliKhan A, Mack L, Chen G, Quadros CA, Reis T, de Castro Ribeiro HS, Zippel D, Ramirez AL, Seto Y, Yoshida K, Mori M. Global Forum of Cancer Surgeons: Perspectives on Barriers to Surgical Care for Cancer Patients and Potential Solutions. Ann Surg Oncol 2019; 26:1577-1582. [PMID: 30911947 DOI: 10.1245/s10434-019-07301-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Chandrakanth Are
- Society of Surgical Oncology, Rosemont, IL, USA. .,Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, 68198, USA.
| | | | | | - Ujwal Yanala
- Society of Surgical Oncology, Rosemont, IL, USA.,Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | | | | | | | | | - Tibor Kovacs
- European Society of Surgical Oncology, Brussels, Belgium
| | | | | | - Gamal Amira
- Egyptian Society of Surgical Oncology, Cairo, Egypt
| | | | - Jeong Heum Baek
- Korean Society of Surgical Oncology, Goyang-si, Gyeonggi-do, South Korea
| | - Moo-Jun Baek
- Korean Society of Surgical Oncology, Goyang-si, Gyeonggi-do, South Korea
| | - Do Joong Park
- Korean Society of Surgical Oncology, Goyang-si, Gyeonggi-do, South Korea
| | - Gregorio Quintero Beulo
- Sociedad Mexicana de Oncologia, Mexico City, Mexico.,Latin America Society of Surgical Oncology, Salvador, Bahia, Brazil
| | - Enrique Bargallo Rocha
- Sociedad Mexicana de Oncologia, Mexico City, Mexico.,Latin America Society of Surgical Oncology, Salvador, Bahia, Brazil
| | - Hector Martinez Said
- Sociedad Mexicana de Oncologia, Mexico City, Mexico.,Latin America Society of Surgical Oncology, Salvador, Bahia, Brazil
| | | | - Abul AliKhan
- Pakistan Society of Surgical Oncology, Lahore, Pakistan
| | - Lloyd Mack
- Canadian Society of Surgical Oncology, Toronto, ON, Canada
| | - Gong Chen
- Chinese Society of Clinical Oncology, Beijing, China
| | - Claudio Almeida Quadros
- Latin America Society of Surgical Oncology, Salvador, Bahia, Brazil.,Brazilian Society of Surgical Oncology, Rio de Janeiro, Brazil
| | - Tarcisio Reis
- Latin America Society of Surgical Oncology, Salvador, Bahia, Brazil.,Brazilian Society of Surgical Oncology, Rio de Janeiro, Brazil
| | - Heber Salvador de Castro Ribeiro
- Latin America Society of Surgical Oncology, Salvador, Bahia, Brazil.,Brazilian Society of Surgical Oncology, Rio de Janeiro, Brazil
| | | | | | - Yasuyuki Seto
- Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | | | - Masaki Mori
- Japanese Society of Gastroenterological Surgery, Tokyo, Japan
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Athanasiou I, Reed MW, Shrestha A, Cheung KL, Audisio R, Collins K, Wyld L. Abstract P2-14-06: Withdrawn. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-14-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was withdrawn by the authors.
Citation Format: Athanasiou I, Reed MW, Shrestha A, Cheung K-L, Audisio R, Collins K, Wyld L. Withdrawn [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-14-06.
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Affiliation(s)
- I Athanasiou
- Yorkshire and Humber Deanery, Sheffield, United Kingdom; University of Sussex, Brighton, United Kingdom; The University of Sheffield, Sheffield, United Kingdom; University of Notthingham, Nottinghanm, United Kingdom; University of Liverpool, Liverpool, United Kingdom; Sheffield Hallam University, Sheffield, United Kingdom
| | - MW Reed
- Yorkshire and Humber Deanery, Sheffield, United Kingdom; University of Sussex, Brighton, United Kingdom; The University of Sheffield, Sheffield, United Kingdom; University of Notthingham, Nottinghanm, United Kingdom; University of Liverpool, Liverpool, United Kingdom; Sheffield Hallam University, Sheffield, United Kingdom
| | - A Shrestha
- Yorkshire and Humber Deanery, Sheffield, United Kingdom; University of Sussex, Brighton, United Kingdom; The University of Sheffield, Sheffield, United Kingdom; University of Notthingham, Nottinghanm, United Kingdom; University of Liverpool, Liverpool, United Kingdom; Sheffield Hallam University, Sheffield, United Kingdom
| | - K-L Cheung
- Yorkshire and Humber Deanery, Sheffield, United Kingdom; University of Sussex, Brighton, United Kingdom; The University of Sheffield, Sheffield, United Kingdom; University of Notthingham, Nottinghanm, United Kingdom; University of Liverpool, Liverpool, United Kingdom; Sheffield Hallam University, Sheffield, United Kingdom
| | - R Audisio
- Yorkshire and Humber Deanery, Sheffield, United Kingdom; University of Sussex, Brighton, United Kingdom; The University of Sheffield, Sheffield, United Kingdom; University of Notthingham, Nottinghanm, United Kingdom; University of Liverpool, Liverpool, United Kingdom; Sheffield Hallam University, Sheffield, United Kingdom
| | - K Collins
- Yorkshire and Humber Deanery, Sheffield, United Kingdom; University of Sussex, Brighton, United Kingdom; The University of Sheffield, Sheffield, United Kingdom; University of Notthingham, Nottinghanm, United Kingdom; University of Liverpool, Liverpool, United Kingdom; Sheffield Hallam University, Sheffield, United Kingdom
| | - L Wyld
- Yorkshire and Humber Deanery, Sheffield, United Kingdom; University of Sussex, Brighton, United Kingdom; The University of Sheffield, Sheffield, United Kingdom; University of Notthingham, Nottinghanm, United Kingdom; University of Liverpool, Liverpool, United Kingdom; Sheffield Hallam University, Sheffield, United Kingdom
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Rubio I, Wyld L, Kovacs T, Leidenius M, Kolacinska A, Marotti L, Bianca S, Cardoso M, Biganzoli L, Audisio R. Variability in breast cancer surgery training across Europe: An ESSO-EUSOMA International Survey. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Are C, McMasters KM, Giuliano A, Balch C, Anderson BO, Berman R, Audisio R, Kovacs T, Savant D, Toprani R, Amira G, Sallam I, Baek JH, Baek MJ, Park DJ, Beulo GQ, Bargallo Rocha E, Said HM, Cheema M, AliKhan A, Mack L, Chen G, Quadros CA, Reis T, de Castro Ribeiro HS, Zippel D, Leon Ramirez A. Global Forum of Cancer Surgeons: A Steady Voice for Cancer Surgeons to Improve Surgical Care for Cancer Patients Globally. Ann Surg Oncol 2018; 25:2114-2116. [PMID: 29881928 DOI: 10.1245/s10434-018-6553-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Indexed: 11/18/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Tibor Kovacs
- European Society of Surgical Oncology, Brussels, Belgium
| | | | | | - Gamal Amira
- Egyptian Society of Surgical Oncology, Cairo, Egypt
| | | | - Jeong Heum Baek
- Korean Society of Surgical Oncology, Goyang-si, Gyeonggi-do, South Korea
| | - Moo-Jun Baek
- Korean Society of Surgical Oncology, Goyang-si, Gyeonggi-do, South Korea
| | - Do Joong Park
- Korean Society of Surgical Oncology, Goyang-si, Gyeonggi-do, South Korea
| | | | - Enrique Bargallo Rocha
- Sociedad Mexicana de Oncologia, Mexico City, Mexico.,Latin America Society of Surgical Oncology, Salvador, Bahia, Brazil
| | - Hector Martinez Said
- Sociedad Mexicana de Oncologia, Mexico City, Mexico.,Latin America Society of Surgical Oncology, Salvador, Bahia, Brazil
| | | | - Abul AliKhan
- Pakistan Society of Surgical Oncology, Lahore, Pakistan
| | - Lloyd Mack
- Canadian Society of Surgical Oncology, Toronto, ON, Canada
| | - Gong Chen
- Chinese Society of Clinical Oncology, Beijing, China
| | - Claudio Almeida Quadros
- Latin America Society of Surgical Oncology, Salvador, Bahia, Brazil.,Brazilian Society of Surgical Oncology, Salvador, Bahia, Brazil
| | - Tarcisio Reis
- Latin America Society of Surgical Oncology, Salvador, Bahia, Brazil.,Brazilian Society of Surgical Oncology, Salvador, Bahia, Brazil
| | - Heber Salvador de Castro Ribeiro
- Latin America Society of Surgical Oncology, Salvador, Bahia, Brazil.,Brazilian Society of Surgical Oncology, Salvador, Bahia, Brazil
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Athanasiou I, Reed M, Shrestha A, Cheung KL, Audisio R, Collins K, Wyld L. Characteristics and outcomes of older women with breast cancer undergoing breast reconstruction: Analysis of the age gap trial. Eur J Surg Oncol 2018. [DOI: 10.1016/j.ejso.2018.02.034] [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: 10/16/2022] Open
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27
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Shrestha A, Martin C, Burton M, Collins K, Holmes G, Ward S, Audisio R, Chater T, Pemberton K, Robinson T, Cheung K, Ring A, Walters S, Reed M, Gath J, Green T, Revell D, Wyld L. Comparison of quality of life of older women treated with surgery or primary endocrine therapy for early breast cancer: propensity score matched analysis of a large prospective multicentre cohort study. Eur J Cancer 2018. [DOI: 10.1016/s0959-8049(18)30261-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Athanasiou I, Reed M, Shrestha A, Cheung KL, Audisio R, Wyld L. Characteristics and outcomes of older women with breast cancer undergoing breast reconstruction: Analysis of the Age Gap Trial. Eur J Surg Oncol 2018. [DOI: 10.1016/j.ejso.2018.01.021] [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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29
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Are C, Caniglia A, Malik M, Smith L, Cummings C, Lecoq C, Berman R, Audisio R, Wyld L. Global variations in the level of cancer-related research activity and correlation to cancer-specific mortality: Proposal for a global curriculum. Eur J Surg Oncol 2018; 44:43-52. [DOI: 10.1016/j.ejso.2017.07.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 07/30/2017] [Indexed: 10/18/2022] Open
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30
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Are C, Caniglia A, Mohammed M, Smith L, Cummings C, Lecoq C, Berman R, Audisio R, Wyld L. Global Variations in the Level of Cancer-Related Research Activity and Correlation to Cancer-Specific Mortality: Proposal for a Global Curriculum. Ann Surg Oncol 2017; 25:594-603. [DOI: 10.1245/s10434-017-6276-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Indexed: 11/18/2022]
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31
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van Dam P, Tomatis M, Marotti L, Heil J, Mansel R, Rosselli del Turco M, van Dam P, Casella D, Bassani L, Danei M, Denk A, Egle D, Emons G, Friedrichs K, Harbeck N, Kiechle M, Kimmig R, Koehler U, Kuemmel S, Maass N, Mayr C, Prové A, Rageth C, Regolo L, Lorenz-Salehi F, Sarlos D, Singer C, Sohn C, Staelens G, Tinterri C, Audisio R, Ponti A, Badbanchi F, Catalano G, Cretella E, Daniaux M, Emons A, van Eygen K, Ettl J, Gatzemeier W, Kern P, Schneeweiss A, Stoeblen F, Van As A, Wuerstlein R, Zanini V. Time trends (2006–2015) of quality indicators in EUSOMA-certified breast centres. Eur J Cancer 2017; 85:15-22. [DOI: 10.1016/j.ejca.2017.07.040] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 05/31/2017] [Accepted: 07/25/2017] [Indexed: 12/21/2022]
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Strasser F, Arends J, Laviano A, Georgiou N, Audisio R, Sawyer M, Kaasa S. Current perspectives of healthcare providers on weight loss and supportive nutritional care in cancer patients. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx388.037] [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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Collins K, Reed M, Lifford K, Burton M, Edwards A, Ring A, Brain K, Harder H, Robinson T, Cheung KL, Morgan J, Audisio R, Ward S, Richards P, Martin C, Chater T, Pemberton K, Nettleship A, Murray C, Walters S, Bortolami O, Armitage F, Leonard R, Gath J, Revell D, Green T, Wyld L. Bridging the age gap in breast cancer: evaluation of decision support interventions for older women with operable breast cancer: protocol for a cluster randomised controlled trial. BMJ Open 2017; 7:e015133. [PMID: 28760787 PMCID: PMC5642653 DOI: 10.1136/bmjopen-2016-015133] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION While breast cancer outcomes are improving steadily in younger women due to advances in screening and improved therapies, there has been little change in outcomes among the older age group. It is inevitable that comorbidities/frailty rates are higher, which may increase the risks of some breast cancer treatments such as surgery and chemotherapy, many older women are healthy and may benefit from their use. Adjusting treatment regimens appropriately for age/comorbidity/frailty is variable and largely non-evidence based, specifically with regard to rates of surgery for operable oestrogen receptor-positive disease and rates of chemotherapy for high-risk disease. METHODS AND ANALYSIS This multicentre, parallel group, pragmatic cluster randomised controlled trial (RCT) (2015-18) reported here is nested within a larger ongoing 'Age Gap Cohort Study' (2012-18RP-PG-1209-10071), aims to evaluate the effectiveness of a complex intervention of decision support interventions to assist in the treatment decision making for early breast cancer in older women. The interventions include two patient decision aids (primary endocrine therapy vs surgery/antioestrogen therapy and chemotherapy vs no chemotherapy) and a clinical treatment outcomes algorithm for clinicians. ETHICS AND DISSEMINATION National and local ethics committee approval was obtained for all UK participating sites. Results from the trial will be submitted for publication in international peer-reviewed scientific journals. IRAS REFERENCE 115550. TRIAL REGISTRATION NUMBER European Union Drug Regulating Authorities Clinical Trials (EudraCT) number 2015-004220-61;Pre-results. Sponsor's Protocol Code Number Sheffield Teaching Hospitals STH17086. ISRCTN 32447*.
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Affiliation(s)
- Karen Collins
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - Malcolm Reed
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Kate Lifford
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Maria Burton
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - Adrian Edwards
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | | | - Katherine Brain
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | | | - Thompson Robinson
- Department of Cardiovascular Sciences, Leicester Royal Infirmary, Infirmary Square, Leicester, UK
| | - Kwok Leung Cheung
- School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Nottingham, UK
| | - Jenna Morgan
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | | | - Susan Ward
- Department of Health Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Paul Richards
- Department of Health Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Charlene Martin
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- University of Sheffield, Sheffield, UK
| | - Tim Chater
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Kirsty Pemberton
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Anthony Nettleship
- Department of Epigenesys, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Christopher Murray
- Department of Epigenesys, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Stephen Walters
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Oscar Bortolami
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | | | | | - Jacqui Gath
- Yorkshire and Humberside (formerly North Trent Cancer Network) Consumer Research Panel, Sheffield, UK
| | - Deirdre Revell
- Yorkshire and Humberside (formerly North Trent Cancer Network) Consumer Research Panel, Sheffield, UK
| | - Tracy Green
- Yorkshire and Humberside (formerly North Trent Cancer Network) Consumer Research Panel, Sheffield, UK
| | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- University of Sheffield, Sheffield, UK
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Aapro M, Astier A, Audisio R, Banks I, Bedossa P, Brain E, Cameron D, Casali P, Chiti A, De Mattos-Arruda L, Kelly D, Lacombe D, Nilsson PJ, Piccart M, Poortmans P, Riklund K, Saeter G, Schrappe M, Soffietti R, Travado L, van Poppel H, Wait S, Naredi P. Identifying critical steps towards improved access to innovation in cancer care: a European CanCer Organisation position paper. Eur J Cancer 2017; 82:193-202. [PMID: 28692951 DOI: 10.1016/j.ejca.2017.04.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 03/30/2017] [Accepted: 04/03/2017] [Indexed: 12/25/2022]
Abstract
In recent decades cancer care has seen improvements in the speed and accuracy of diagnostic procedures; the effectiveness of surgery, radiation therapy and medical treatments; the power of information technology; and the development of multidisciplinary, specialist-led approaches to care. Such innovations are essential if we are to continue improving the lives of cancer patients across Europe despite financial pressures on our healthcare systems. Investment in innovation must be balanced with the need to ensure the sustainability of healthcare budgets, and all health professionals have a responsibility to help achieve this balance. It requires scrutiny of the way care is delivered; we must be ready to discontinue practices or interventions that are inefficient, and prioritise innovations that may deliver the best outcomes possible for patients within the limits of available resources. Decisions on innovations should take into account their long-term impact on patient outcomes and costs, not just their immediate costs. Adopting a culture of innovation requires a multidisciplinary team approach, with the patient at the centre and an integral part of the team. It must take a whole-system and whole-patient perspective on cancer care and be guided by high-quality real-world data, including outcomes relevant to the patient and actual costs of care; this accurately reflects the impact of any innovation in clinical practice. The European CanCer Organisation is committed to working with its member societies, patient organisations and the cancer community at large to find sustainable ways to identify and integrate the most meaningful innovations into all aspects of cancer care.
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Affiliation(s)
| | | | | | - Ian Banks
- ECCO Patient Advisory Committee (PAC)
| | | | | | | | | | | | | | | | - Denis Lacombe
- European Organisation for Research and Treatment of Cancer (EORTC)
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Morgan JL, Walters SJ, Collins K, Robinson TG, Cheung KL, Audisio R, Reed MW, Wyld L. What influences healthcare professionals' treatment preferences for older women with operable breast cancer? An application of the discrete choice experiment. Eur J Surg Oncol 2017; 43:1282-1287. [PMID: 28237423 DOI: 10.1016/j.ejso.2017.01.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 10/20/2016] [Revised: 12/14/2016] [Accepted: 01/08/2017] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Primary endocrine therapy (PET) is used variably in the UK as an alternative to surgery for older women with operable breast cancer. Guidelines state that only patients with "significant comorbidity" or "reduced life expectancy" should be treated this way and age should not be a factor. METHODS A Discrete Choice Experiment (DCE) was used to determine the impact of key variables (patient age, comorbidity, cognition, functional status, cancer stage, cancer biology) on healthcare professionals' (HCP) treatment preferences for operable breast cancer among older women. Multinomial logistic regression was used to identify associations. RESULTS 40% (258/641) of questionnaires were returned. Five variables (age, co-morbidity, cognition, functional status and cancer size) independently demonstrated a significant association with treatment preference (p < 0.05). Functional status was omitted from the multivariable model due to collinearity, with all other variables correlating with a preference for operative treatment over no preference (p < 0.05). Only co-morbidity, cognition and cancer size correlated with a preference for PET over no preference (p < 0.05). CONCLUSION The majority of respondents selected treatment in accordance with current guidelines, however in some scenarios, opinion was divided, and age did appear to be an independent factor that HCPs considered when making a treatment decision in this population.
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Affiliation(s)
- J L Morgan
- Academic Unit of Surgical Oncology, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK.
| | - S J Walters
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - K Collins
- Centre for Health and Social Care Research, Sheffield Hallam University, Collegiate Crescent, Sheffield, S10 2BA, UK
| | - T G Robinson
- Department of Cardiovascular Sciences, University of Leicester, Robert Kilpatrick Clinical Sciences Building, P.O. Box 65, Leicester, LE2 7LX, UK
| | - K-L Cheung
- School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Uttoxeter Road, Derby, DE22 3DT, UK
| | - R Audisio
- Department of Surgery, University of Liverpool, St Helens Teaching Hospital, Marshalls Cross Road, St Helens, WA9 3DA, UK
| | - M W Reed
- Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9PX, UK
| | - L Wyld
- Academic Unit of Surgical Oncology, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
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Strasser F, Audisio R, Laviano A, Georgiou N, Fearon K. Supportive and palliative nutritional care for cancer patients (pts) with malnutrition and cachexia – a survey of healthcare providers (HCPs). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw390.51] [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: 11/12/2022] Open
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Zaman O, Richards P, Ward S, Bortolami O, Collins K, Cheung K, Robinson T, Audisio R, Reed M, Wyld L. 83. Risk factors for surgical morbidity in older women with breast cancer: An interim analysis of the Bridging the Age Gap in Breast Cancer Study. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.06.089] [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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Caballero C, Carrion Alvarez L, Rivoire M, Nilsson H, Staettner S, Gruenberger T, Malik H, Rahbari N, Mauer M, Kataoka K, Atasoy A, Ducreux M, Audisio R, Poston G, Evrard S. 80. EORTC-1409: An EORTC-ESSO prospective colorectal liver metastasis database with an integrated quality assurance program (CLIMB) NCT02218801. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.06.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Balch CM, Poston GJ, Coit D, Audisio R. Training a new generation of surgeons worldwide who are also oncologists. Chin Clin Oncol 2016; 5:58. [DOI: 10.21037/cco.2016.07.02] [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: 06/13/2016] [Accepted: 06/20/2016] [Indexed: 11/06/2022]
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Are C, Caniglia A, Malik M, Cummings C, Lecoq C, Berman R, Audisio R, Wyld L. Variations in training of surgical oncologists: Proposal for a global curriculum. Eur J Surg Oncol 2016; 42:767-78. [DOI: 10.1016/j.ejso.2016.04.004] [Citation(s) in RCA: 8] [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: 04/19/2016] [Revised: 04/19/2016] [Accepted: 04/19/2016] [Indexed: 10/21/2022] Open
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Are C, Caniglia A, Malik M, Cummings C, Lecoq C, Berman R, Audisio R, Wyld L. Variations in Training of Surgical Oncologists: Proposal for a Global Curriculum. Ann Surg Oncol 2016; 23:1769-81. [PMID: 27120186 DOI: 10.1245/s10434-016-5238-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Indexed: 11/18/2022]
Affiliation(s)
- C Are
- Division of Surgical Oncology, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
| | - A Caniglia
- University of Nebraska Medical Center College of Medicine, Omaha, NE, USA
| | - M Malik
- University of Nebraska Medical Center College of Medicine, Omaha, NE, USA
| | - C Cummings
- Society of Surgical Oncology, Rosemont, IL, USA
| | - C Lecoq
- European Society of Surgical Oncology, Brussels, Belgium
| | - R Berman
- Division of Surgical Oncology, Department of Surgery, New York University School of Medicine, New York, NY, USA
| | - R Audisio
- St Helens Teaching Hospital, University of Liverpool, St Helens, UK
| | - L Wyld
- University of Sheffield, Doncaster, UK
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Sullivan R, Alatise OI, Anderson BO, Audisio R, Autier P, Aggarwal A, Balch C, Brennan MF, Dare A, D'Cruz A, Eggermont AMM, Fleming K, Gueye SM, Hagander L, Herrera CA, Holmer H, Ilbawi AM, Jarnheimer A, Ji JF, Kingham TP, Liberman J, Leather AJM, Meara JG, Mukhopadhyay S, Murthy SS, Omar S, Parham GP, Pramesh CS, Riviello R, Rodin D, Santini L, Shrikhande SV, Shrime M, Thomas R, Tsunoda AT, van de Velde C, Veronesi U, Vijaykumar DK, Watters D, Wang S, Wu YL, Zeiton M, Purushotham A. Global cancer surgery: delivering safe, affordable, and timely cancer surgery. Lancet Oncol 2016; 16:1193-224. [PMID: 26427363 DOI: 10.1016/s1470-2045(15)00223-5] [Citation(s) in RCA: 396] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 08/07/2015] [Accepted: 08/07/2015] [Indexed: 12/20/2022]
Abstract
Surgery is essential for global cancer care in all resource settings. Of the 15.2 million new cases of cancer in 2015, over 80% of cases will need surgery, some several times. By 2030, we estimate that annually 45 million surgical procedures will be needed worldwide. Yet, less than 25% of patients with cancer worldwide actually get safe, affordable, or timely surgery. This Commission on global cancer surgery, building on Global Surgery 2030, has examined the state of global cancer surgery through an analysis of the burden of surgical disease and breadth of cancer surgery, economics and financing, factors for strengthening surgical systems for cancer with multiple-country studies, the research agenda, and the political factors that frame policy making in this area. We found wide equity and economic gaps in global cancer surgery. Many patients throughout the world do not have access to cancer surgery, and the failure to train more cancer surgeons and strengthen systems could result in as much as US $6.2 trillion in lost cumulative gross domestic product by 2030. Many of the key adjunct treatment modalities for cancer surgery--e.g., pathology and imaging--are also inadequate. Our analysis identified substantial issues, but also highlights solutions and innovations. Issues of access, a paucity of investment in public surgical systems, low investment in research, and training and education gaps are remarkably widespread. Solutions include better regulated public systems, international partnerships, super-centralisation of surgical services, novel surgical clinical trials, and new approaches to improve quality and scale up cancer surgical systems through education and training. Our key messages are directed at many global stakeholders, but the central message is that to deliver safe, affordable, and timely cancer surgery to all, surgery must be at the heart of global and national cancer control planning.
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Affiliation(s)
- Richard Sullivan
- Institute of Cancer Policy, King's Health Partners Comprehensive Cancer Centre, London, UK; King's Centre for Global Health, King's Health Partners and King's College London, London, UK.
| | | | - Benjamin O Anderson
- University of Washington School of Medicine, Seattle, WA, USA; Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | | | - Ajay Aggarwal
- Institute of Cancer Policy, King's Health Partners Comprehensive Cancer Centre, London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK; London School of Hygiene & Tropical Medicine, London, UK
| | - Charles Balch
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Anna Dare
- Centre for Global Health Research, St Michael's Hospital, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Anil D'Cruz
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | | | - Kenneth Fleming
- Green Templeton College, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Trust, Oxford, UK
| | - Serigne Magueye Gueye
- University Cheikh Anta Diop, Dakar, Senegal; Grand Yoff General Hospital, Dakar, Senegal
| | - Lars Hagander
- Paediatric Surgery and Global Paediatrics, Department of Paediatrics, Lund University, Lund, Sweden
| | - Cristian A Herrera
- Cabinet of the Minister, Ministry of Health, Santiago, Chile; Department of Public Health, School of Medicine, Pontificia Universidad Católica, Santiago, Chile
| | - Hampus Holmer
- Paediatric Surgery and Global Paediatrics, Department of Paediatrics, Lund University, Lund, Sweden
| | - André M Ilbawi
- University of Texas MD Anderson Cancer Centre, Houston, TX, USA; Union for International Cancer Control, Geneva, Switzerland
| | - Anton Jarnheimer
- Paediatric Surgery and Global Paediatrics, Department of Paediatrics, Lund University, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Jia-Fu Ji
- Peking University Cancer Hospital and Institute, Beijing, China; Chinese Anti-Cancer Association, Tianjin, China
| | | | | | - Andrew J M Leather
- King's Centre for Global Health, King's Health Partners and King's College London, London, UK
| | - John G Meara
- Program in Global Surgery and Social Change, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Swagoto Mukhopadhyay
- Program in Global Surgery and Social Change, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Shilpa S Murthy
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard School of Public Health, Boston, MA, USA; Department of General Surgery, Indiana University, Bloomington, IN, USA
| | | | - Groesbeck P Parham
- Department of Obstetrics and Gynecology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA; University of Zambia, Lusaka, Zambia
| | - C S Pramesh
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Robert Riviello
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard School of Public Health, Boston, MA, USA
| | - Danielle Rodin
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Luiz Santini
- INCA (Brazilian National Cancer Institute), Rio de Janeiro, Brazil
| | | | - Mark Shrime
- Program in Global Surgery and Social Change, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert Thomas
- Department of Health & Human Services, Melbourne, VIC, Australia
| | - Audrey T Tsunoda
- Gyne-Oncology Department, Barretos Cancer Hospital, Barretos, Brazil
| | - Cornelis van de Velde
- Department of Surgical Oncology, Endocrine and Gastrointestinal Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | | | | | - David Watters
- Deakin University, Geelong, VIC, Australia; Barwon Health, Geelong, VIC, Australia
| | - Shan Wang
- Peking University People's Hospital, Beijing, China; Chinese College of Surgeons, Beijing, China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangzhou, China; Guangdong Academy of Medical Sciences, Guangzhou, China; Chinese Society of Clinical Oncology, Beijing, China
| | - Moez Zeiton
- Sadeq Institute, Tripoli, Libya; Trauma and Orthopaedic Rotation, North-West Deanery, Manchester, UK
| | - Arnie Purushotham
- Institute of Cancer Policy, King's Health Partners Comprehensive Cancer Centre, London, UK; King's Centre for Global Health, King's Health Partners and King's College London, London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK
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Strasser F, Audisio R, Laviano A, Georgiou N, Fearon K. 1606 Nutritional support in cancer - more formal recommendations are required. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30694-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sullivan R, Olusegun I, Anderson B, Audisio R, Autier P, Aggarwal A, Balch C, Brennan M, Dare A, D'Cruz A, Eggermont A, Fleming K, Hagander L, Herrera C, Ilbawi A, Ji J, Kingham T, Liberman J, Leather A, Meara J, Murthy S, Omar S, Parham G, Pramesh C, Riviello R, Rodin D, Santini L, Shrikhande S, Shrime M, Thomas R, Tsunoda A, Watters D, Wang S, Wu Y, Van de Velde F, Veronesi U, Zeiton M, Purushotham A. 9LBA Delivering safe and affordable cancer surgery to all - a Lancet Oncology Commission. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31933-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Morgan J, Collins K, Robinson T, Cheung KL, Audisio R, Reed M, Wyld L. Healthcare professionals' preferences for surgery or primary endocrine therapy to treat older women with operable breast cancer. Eur J Surg Oncol 2015; 41:1234-42. [DOI: 10.1016/j.ejso.2015.05.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 04/25/2015] [Accepted: 05/18/2015] [Indexed: 10/23/2022] Open
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Morgan JL, Burton M, Collins K, Lifford KJ, Robinson TG, Cheung KL, Audisio R, Reed MW, Wyld L. The balance of clinician and patient input into treatment decision-making in older women with operable breast cancer. Psychooncology 2015; 24:1761-6. [PMID: 26043439 DOI: 10.1002/pon.3853] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/16/2015] [Accepted: 04/27/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Primary endocrine therapy (PET) is an alternative to surgery for oestrogen receptor positive operable breast cancer in some older women. However the decision to offer PET involves complex trade-offs and is influenced by both patient choice and healthcare professional (HCP) preference. This study aimed to compare the views of patients and HCPs about this decision and explore decision-making (DM) preferences and whether these are taken into account during consultations. METHODS This multicentre, UK, mixed methods study had three components: (a) questionnaires to older women undergoing counseling about breast cancer treatment options which assessed their DM preferences and realities; (b) qualitative interviews with older women with operable breast cancer offered a choice of either surgery or PET and (c) qualitative interviews with HCPs (both of which focused on DM preferences in this setting). RESULTS Thirty-three patients and 34 HCPs were interviewed. A range of opinions about patient involvement in DM were identified. Patients indicated varying preferences for DM involvement which were variably taken into account by HCPs. These qualitative findings were broadly supported by the questionnaire results. Most patients (536/729; 73.5%) achieved their preferred DM style; however, the remainder felt that their DM preferences had not been taken into consideration. CONCLUSIONS These results suggest that whilst many older women achieve their desired level of DM engagement, some do not, raising the possibility that they may be making choices which are not concordant with their treatment preferences.
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Affiliation(s)
- Jenna L Morgan
- Academic Unit of Surgical Oncology, University of Sheffield Medical School, Beech Hill Road, Sheffield, UK
| | - Maria Burton
- Centre for Health and Social Care Research, Sheffield Hallam University, Collegiate Crescent, Sheffield, UK
| | - Karen Collins
- Centre for Health and Social Care Research, Sheffield Hallam University, Collegiate Crescent, Sheffield, UK
| | - Kate J Lifford
- Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK
| | - Thompson G Robinson
- University of Leicester, Department of Cardiovascular Sciences, Robert Kilpatrick Clinical Sciences Building, Leicester, UK
| | - Kwok-Leung Cheung
- School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Uttoxeter Road, Derby, UK
| | - Riccardo Audisio
- Department of Surgery, University of Liverpool, St Helens Teaching Hospital, Marshalls Cross Road, St Helens, UK
| | - Malcolm W Reed
- Academic Unit of Surgical Oncology, University of Sheffield Medical School, Beech Hill Road, Sheffield, UK
| | - Lynda Wyld
- Academic Unit of Surgical Oncology, University of Sheffield Medical School, Beech Hill Road, Sheffield, UK
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Morgan J, Walters S, Collins K, Robinson T, Cheung KL, Audisio R, Reed M, Wyld L. P082. What influences clinicians' treatment preferences for older women with operable breast cancer? An application of the discrete choice experiment. Eur J Surg Oncol 2015. [DOI: 10.1016/j.ejso.2015.03.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Ghignone F, Ugolini G, Montroni I, Zattoni D, Somasundar P, Audisio R, Huisman M, Veronose G. State of the art in the assessment and management of oncogeriatric surgical patients. Results from the SIOG surgical task force survey among ESSO and SSO members. J Geriatr Oncol 2014. [DOI: 10.1016/j.jgo.2014.09.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hoppe S, Tsaranazy A, Poston G, Audisio R, Collet D, Mathoulin-Pélissier S, Evrard S. Place de la recherche clinique dans les pratiques des chirurgiens oncologiques européens. Rev Epidemiol Sante Publique 2014. [DOI: 10.1016/j.respe.2014.05.119] [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] Open
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Kaidar-Person O, Poortmans P, Klimberg S, Haviland J, Offersen B, Audisio R, Yarnold J. Haste makes waste: are the data regarding TARGIT-A IORT ready for prime time? Breast Cancer Res Treat 2014; 147:221-2. [PMID: 25048466 DOI: 10.1007/s10549-014-3032-5] [Citation(s) in RCA: 2] [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] [Received: 05/19/2014] [Accepted: 06/09/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Orit Kaidar-Person
- Division of Oncology, Rambam Health Care Campus, POB 9602, 31096, Haifa, Israel,
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