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Furtak LJ, Labbé I, Zitrin A, Greene JE, Dayal P, Chemerynska I, Kokorev V, Miller TB, Goulding AD, de Graaff A, Bezanson R, Brammer GB, Cutler SE, Leja J, Pan R, Price SH, Wang B, Weaver JR, Whitaker KE, Atek H, Bogdán Á, Charlot S, Curtis-Lake E, van Dokkum P, Endsley R, Feldmann R, Fudamoto Y, Fujimoto S, Glazebrook K, Juneau S, Marchesini D, Maseda MV, Nelson E, Oesch PA, Plat A, Setton DJ, Stark DP, Williams CC. A high black-hole-to-host mass ratio in a lensed AGN in the early Universe. Nature 2024; 628:57-61. [PMID: 38354833 DOI: 10.1038/s41586-024-07184-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 02/08/2024] [Indexed: 02/16/2024]
Abstract
Early JWST observations have uncovered a population of red sources that might represent a previously overlooked phase of supermassive black hole growth1-3. One of the most intriguing examples is an extremely red, point-like object that was found to be triply imaged by the strong lensing cluster Abell 2744 (ref. 4). Here we present deep JWST/NIRSpec observations of this object, Abell2744-QSO1. The spectroscopy confirms that the three images are of the same object, and that it is a highly reddened (AV ≃ 3) broad emission line active galactic nucleus at a redshift of zspec = 7.0451 ± 0.0005. From the width of Hβ (full width at half-maximum = 2,800 ± 250 km s-1), we derive a black hole mass ofM BH = 4 - 1 + 2 × 1 0 7 M ⊙ . We infer a very high ratio of black-hole-to-galaxy mass of at least 3%, an order of magnitude more than that seen in local galaxies5 and possibly as high as 100%. The lack of strong metal lines in the spectrum together with the high bolometric luminosity (Lbol = (1.1 ± 0.3) × 1045 erg s-1) indicate that we are seeing the black hole in a phase of rapid growth, accreting at 30% of the Eddington limit. The rapid growth and high black-hole-to-galaxy mass ratio of Abell2744-QSO1 suggest that it may represent the missing link between black hole seeds6 and one of the first luminous quasars7.
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Affiliation(s)
- Lukas J Furtak
- Physics Department, Ben-Gurion University of the Negev, Be'er-Sheva, Israel.
| | - Ivo Labbé
- Centre for Astrophysics and Supercomputing, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Adi Zitrin
- Physics Department, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Jenny E Greene
- Department of Astrophysical Sciences, Princeton University, Princeton, NJ, USA
| | - Pratika Dayal
- Kapteyn Astronomical Institute, University of Groningen, Groningen, The Netherlands
| | - Iryna Chemerynska
- Institut d'Astrophysique de Paris, CNRS, Sorbonne Université, Paris, France
| | - Vasily Kokorev
- Kapteyn Astronomical Institute, University of Groningen, Groningen, The Netherlands
| | - Tim B Miller
- Department of Astronomy, Yale University, New Haven, CT, USA
- Center for Interdisciplinary Exploration and Research in Astrophysics (CIERA) and Department of Physics and Astronomy, Northwestern University, Evanston, IL, USA
| | - Andy D Goulding
- Department of Astrophysical Sciences, Princeton University, Princeton, NJ, USA
| | | | - Rachel Bezanson
- Department of Physics and Astronomy and PITT PACC, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gabriel B Brammer
- Cosmic Dawn Center (DAWN), Niels Bohr Institute, University of Copenhagen, Copenhagen, Denmark
| | - Sam E Cutler
- Department of Astronomy, University of Massachusetts, Amherst, MA, USA
| | - Joel Leja
- Department of Astronomy and Astrophysics, The Pennsylvania State University, University Park, PA, USA
- Institute for Computational and Data Sciences, The Pennsylvania State University, University Park, PA, USA
- Institute for Gravitation and the Cosmos, The Pennsylvania State University, University Park, PA, USA
| | - Richard Pan
- Department of Physics and Astronomy, Tufts University, Medford, MA, USA
| | - Sedona H Price
- Department of Physics and Astronomy and PITT PACC, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bingjie Wang
- Department of Astronomy and Astrophysics, The Pennsylvania State University, University Park, PA, USA
- Institute for Computational and Data Sciences, The Pennsylvania State University, University Park, PA, USA
- Institute for Gravitation and the Cosmos, The Pennsylvania State University, University Park, PA, USA
| | - John R Weaver
- Department of Astronomy, University of Massachusetts, Amherst, MA, USA
| | - Katherine E Whitaker
- Cosmic Dawn Center (DAWN), Niels Bohr Institute, University of Copenhagen, Copenhagen, Denmark
- Department of Astronomy, University of Massachusetts, Amherst, MA, USA
| | - Hakim Atek
- Institut d'Astrophysique de Paris, CNRS, Sorbonne Université, Paris, France
| | - Ákos Bogdán
- Center for Astrophysics ∣ Harvard & Smithsonian, Cambridge, MA, USA
| | - Stéphane Charlot
- Institut d'Astrophysique de Paris, CNRS, Sorbonne Université, Paris, France
| | - Emma Curtis-Lake
- Centre for Astrophysics Research, Department of Physics, Astronomy and Mathematics, University of Hertfordshire, Hatfield, UK
| | | | - Ryan Endsley
- Department of Astronomy, The University of Texas at Austin, Austin, TX, USA
| | - Robert Feldmann
- Institute for Computational Science, University of Zurich, Zurich, Switzerland
| | - Yoshinobu Fudamoto
- Waseda Research Institute for Science and Engineering, Faculty of Science and Engineering, Waseda University, Shinjuku, Tokyo, Japan
- National Astronomical Observatory of Japan, Mitaka, Tokyo, Japan
| | - Seiji Fujimoto
- Department of Astronomy, The University of Texas at Austin, Austin, TX, USA
| | - Karl Glazebrook
- Centre for Astrophysics and Supercomputing, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Stéphanie Juneau
- NSF's National Optical-Infrared Astronomy Research Laboratory, Tucson, AZ, USA
| | - Danilo Marchesini
- Department of Physics and Astronomy, Tufts University, Medford, MA, USA
| | - Micheal V Maseda
- Department of Astronomy, University of Wisconsin-Madison, Madison, WI, USA
| | - Erica Nelson
- Department for Astrophysical and Planetary Science, University of Colorado, Boulder, CO, USA
| | - Pascal A Oesch
- Cosmic Dawn Center (DAWN), Niels Bohr Institute, University of Copenhagen, Copenhagen, Denmark
- Department of Astronomy, University of Geneva, Versoix, Switzerland
| | - Adèle Plat
- Steward Observatory, University of Arizona, Tucson, AZ, USA
| | - David J Setton
- Department of Physics and Astronomy and PITT PACC, University of Pittsburgh, Pittsburgh, PA, USA
| | - Daniel P Stark
- Steward Observatory, University of Arizona, Tucson, AZ, USA
| | - Christina C Williams
- NSF's National Optical-Infrared Astronomy Research Laboratory, Tucson, AZ, USA
- Steward Observatory, University of Arizona, Tucson, AZ, USA
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Atek H, Labbé I, Furtak LJ, Chemerynska I, Fujimoto S, Setton DJ, Miller TB, Oesch P, Bezanson R, Price SH, Dayal P, Zitrin A, Kokorev V, Weaver JR, Brammer G, Dokkum PV, Williams CC, Cutler SE, Feldmann R, Fudamoto Y, Greene JE, Leja J, Maseda MV, Muzzin A, Pan R, Papovich C, Nelson EJ, Nanayakkara T, Stark DP, Stefanon M, Suess KA, Wang B, Whitaker KE. Most of the photons that reionized the Universe came from dwarf galaxies. Nature 2024; 626:975-978. [PMID: 38418911 DOI: 10.1038/s41586-024-07043-6] [Citation(s) in RCA: 1] [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: 08/16/2023] [Accepted: 01/08/2024] [Indexed: 03/02/2024]
Abstract
The identification of sources driving cosmic reionization, a major phase transition from neutral hydrogen to ionized plasma around 600-800 Myr after the Big Bang1-3, has been a matter of debate4. Some models suggest that high ionizing emissivity and escape fractions (fesc) from quasars support their role in driving cosmic reionization5,6. Others propose that the high fesc values from bright galaxies generate sufficient ionizing radiation to drive this process7. Finally, a few studies suggest that the number density of faint galaxies, when combined with a stellar-mass-dependent model of ionizing efficiency and fesc, can effectively dominate cosmic reionization8,9. However, so far, comprehensive spectroscopic studies of low-mass galaxies have not been done because of their extreme faintness. Here we report an analysis of eight ultra-faint galaxies (in a very small field) during the epoch of reionization with absolute magnitudes between MUV ≈ -17 mag and -15 mag (down to 0.005L⋆ (refs. 10,11)). We find that faint galaxies during the first thousand million years of the Universe produce ionizing photons with log[ξion (Hz erg-1)] = 25.80 ± 0.14, a factor of 4 higher than commonly assumed values12. If this field is representative of the large-scale distribution of faint galaxies, the rate of ionizing photons exceeds that needed for reionization, even for escape fractions of the order of 5%.
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Affiliation(s)
- Hakim Atek
- Institut d'Astrophysique de Paris, CNRS, Sorbonne Université, Paris, France.
| | - Ivo Labbé
- Centre for Astrophysics and Supercomputing, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Lukas J Furtak
- Physics Department, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Iryna Chemerynska
- Institut d'Astrophysique de Paris, CNRS, Sorbonne Université, Paris, France
| | - Seiji Fujimoto
- Department of Astronomy, The University of Texas at Austin, Austin, TX, USA
| | - David J Setton
- Department of Physics and Astronomy and PITT PACC, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tim B Miller
- Center for Interdisciplinary Exploration and Research in Astrophysics (CIERA) and Department of Physics and Astronomy, Northwestern University, Evanston, IL, USA
| | - Pascal Oesch
- Department of Astronomy, University of Geneva, Versoix, Switzerland
- Cosmic Dawn Center (DAWN), Niels Bohr Institute, University of Copenhagen, Copenhagen, Denmark
| | - Rachel Bezanson
- Department of Physics and Astronomy and PITT PACC, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sedona H Price
- Department of Physics and Astronomy and PITT PACC, University of Pittsburgh, Pittsburgh, PA, USA
| | - Pratika Dayal
- Kapteyn Astronomical Institute, University of Groningen, Groningen, The Netherlands
| | - Adi Zitrin
- Centre for Astrophysics and Supercomputing, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Vasily Kokorev
- Kapteyn Astronomical Institute, University of Groningen, Groningen, The Netherlands
| | - John R Weaver
- Department of Astronomy, University of Massachusetts, Amherst, MA, USA
| | - Gabriel Brammer
- Cosmic Dawn Center (DAWN), Niels Bohr Institute, University of Copenhagen, Copenhagen, Denmark
| | | | - Christina C Williams
- NSF's National Optical-Infrared Astronomy Research Laboratory, Tucson, AZ, USA
- Steward Observatory, University of Arizona, Tucson, AZ, USA
| | - Sam E Cutler
- Department of Astronomy, University of Massachusetts, Amherst, MA, USA
| | - Robert Feldmann
- Institute for Computational Science, University of Zurich, Zurich, Switzerland
| | - Yoshinobu Fudamoto
- Waseda Research Institute for Science and Engineering, Faculty of Science and Engineering, Waseda University, Tokyo, Japan
- National Astronomical Observatory of Japan, Tokyo, Japan
| | - Jenny E Greene
- Department of Astrophysical Sciences, Princeton University, Princeton, NJ, USA
| | - Joel Leja
- Department of Astronomy and Astrophysics, The Pennsylvania State University, University Park, PA, USA
- Institute for Computational and Data Sciences, The Pennsylvania State University, University Park, PA, USA
- Institute for Gravitation and the Cosmos, The Pennsylvania State University, University Park, PA, USA
| | - Michael V Maseda
- Department of Astronomy, University of Wisconsin, Madison, WI, USA
| | - Adam Muzzin
- Department of Physics and Astronomy, York University, Toronto, Ontario, Canada
| | - Richard Pan
- Department of Physics and Astronomy, Tufts University, Medford, MA, USA
| | - Casey Papovich
- Department of Physics and Astronomy, Texas A&M University, College Station, TX, USA
- George P. and Cynthia Woods Mitchell Institute for Fundamental Physics and Astronomy, Texas A&M University, College Station, TX, USA
| | - Erica J Nelson
- Department for Astrophysical and Planetary Science, University of Colorado, Boulder, CO, USA
| | - Themiya Nanayakkara
- Centre for Astrophysics and Supercomputing, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Daniel P Stark
- Steward Observatory, University of Arizona, Tucson, AZ, USA
| | - Mauro Stefanon
- Departament d'Astronomia i Astrofìsica, Universitat de València, Valencia, Spain
| | - Katherine A Suess
- Department of Astronomy and Astrophysics, University of California, Santa Cruz, CA, USA
- Kavli Institute for Particle Astrophysics and Cosmology and Department of Physics, Stanford University, Stanford, CA, USA
| | - Bingjie Wang
- Department of Astronomy and Astrophysics, The Pennsylvania State University, University Park, PA, USA
- Institute for Computational and Data Sciences, The Pennsylvania State University, University Park, PA, USA
- Institute for Gravitation and the Cosmos, The Pennsylvania State University, University Park, PA, USA
| | - Katherine E Whitaker
- Cosmic Dawn Center (DAWN), Niels Bohr Institute, University of Copenhagen, Copenhagen, Denmark
- Department of Astronomy, University of Massachusetts, Amherst, MA, USA
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3
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Bozovic Spasojevic I, Ferrari A, De Munter J, Gamble A, Konsoulova-Kirova A, Rizvi K, Schneider C, Balsat M, Castleton A, Gofti-Laroche L, Kienesberger A, Timmermann B, Vormoor J, Saloustros E, Stark DP. Have we made progress in taking care of adolescents and young adults with cancer? Results of a European multi-professional survey. Tumori 2023; 109:546-554. [PMID: 37486101 DOI: 10.1177/03008916231183477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
BACKGROUND It is well documented that traditional health care models do not meet the specific needs of Adolescents and Young Adults (AYA) cancer patients. METHODS We explore a map of the development of age-specific AYA cancer care across Europe, from the perspective of healthcare professionals with an interest in AYA care, in order to understand the specific challenges and map progress over time. An on-line survey was developed by international professional cancer organisations. RESULTS We had 377 respondents from 60 countries. The majority of respondents were physicians 298 (79%), a minority of survey respondents (39, 10.4%) work exclusively with AYA patients, most respondents declared substantial and routine clinical service collaborations to provide care and treatment to AYA with cancer. Policy for the multidisciplinary management of AYA cancer patients commonly appears in Europe now, and was reported by 234 (78.52%) respondents. Specific professional training for AYA cancer care is not uniformly available. CONCLUSION There is considerable opportunity for many organisations to work together in raising the profile of AYA cancer related issues, in providing education and in encouraging research and collaboration.
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Affiliation(s)
- Ivana Bozovic Spasojevic
- Medical Oncology Department, Institute for Oncology and Radiology of Serbia, Belgrade, Republic of Serbia
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Johan De Munter
- University Hospital Ghent Cancer Center, Ghent, Belgium
- European Oncology Nursing Society
| | - Ashley Gamble
- Children's Cancer and Leukaemia Group, Leicester, UK
| | | | | | | | - Marie Balsat
- Department of Hematology, Lyon-Sud Hospital, Hospices Civils de Lyon, Lyon, France
| | | | - Leila Gofti-Laroche
- Department of Public Health-University of Grenoble Alps, AYA Unit-Centre Hospitalier Universitaire de Grenoble Alpes, Grenoble, France
| | | | - Beate Timmermann
- University Medicine Essen, Clinic for Particle Therapy, West German Proton Therapy Center Essen, Essen, Germany
| | - Josef Vormoor
- Princess Máxima Center for Pediatric Oncology and University Medical Center Utrecht, Netherlands
| | | | - Daniel P Stark
- Leeds Institute of Medical Research, School of Medicine, University of Leeds, Leeds, UK
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4
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Fern LA, Greenwood M, Smith S, Brand S, Coleman N, Stark DP, Murray MJ. Pre-Implementation Assessment of the Acceptability of Using Circulating microRNAs for Follow-Up of Malignant Germ-Cell Tumors. Clin Genitourin Cancer 2021; 19:381-387. [PMID: 33846102 DOI: 10.1016/j.clgc.2021.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/08/2020] [Accepted: 03/07/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND MicroRNAs from the miR-371~373 and miR-302/367 clusters, particularly miR-371a-3p, are promising biomarkers for blood-based diagnosis and disease monitoring of malignant germ cell tumors (GCTs) and are nearing clinical implementation. These biomarkers have superior sensitivity and specificity compared with current markers alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG). We explored patient acceptability of using circulating microRNAs to replace multiple serial computed tomography (CT) scans in malignant GCT follow-up. PATIENTS AND METHODS Two workshops involved interactive presentations and focus groups. Discussions were digitally recorded and transcribed verbatim. Qualitative thematic analysis of transcripts identified the key themes. RESULTS Prior to the workshops, potential participants expressed concern about the adoption of new blood tests due to personal experiences of the limitations of existing (AFP/HCG) markers. Twelve males (22-57 years of age; currently, 26-59 years of age) with a malignant GCT diagnosis participated; all were in follow-up. Three had experienced recurrence. Participants had cumulative exposure of between 1 and 15 CT scans. Data saturation was reached at the second workshop; five themes emerged underpinning preference for microRNA testing versus CT scans: (1) increased sensitivity and safety, (2) reduced financial costs, (3) reduced time for testing and results, (4) practicalities, and (5) reduced anxiety. However, some participants perceived an increased diagnostic capacity of CT scans versus blood testing. CONCLUSION This first user consultation of circulating microRNA testing for future malignant GCT follow-up suggests high acceptability with potential patient and healthcare system benefits.
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Affiliation(s)
- Lorna A Fern
- Oncology Division, University College London Hospitals NHS Foundation Trust, London, UK; National Cancer Research Institute Teenage and Young Adult and Germ Cell Research Group, London, UK.
| | | | - Shievon Smith
- Department of Medical Oncology, St Bartholomew's Hospital, London, UK
| | - Susan Brand
- It's in the Bag Charity, Bristol Haematology and Oncology Centre, Bristol, UK
| | | | - Daniel P Stark
- National Cancer Research Institute Teenage and Young Adult and Germ Cell Research Group, London, UK; Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK
| | - Matthew J Murray
- National Cancer Research Institute Teenage and Young Adult and Germ Cell Research Group, London, UK; Department of Pathology, University of Cambridge, Cambridge, UK; Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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5
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D'Ambrosio L, Touati N, Blay JY, Grignani G, Flippot R, Czarnecka AM, Piperno-Neumann S, Martin-Broto J, Sanfilippo R, Katz D, Duffaud F, Vincenzi B, Stark DP, Mazzeo F, Tuchscherer A, Chevreau C, Sherriff J, Estival A, Litière S, Sents W, Ray-Coquard I, Tolomeo F, Le Cesne A, Rutkowski P, Stacchiotti S, Kasper B, Gelderblom H, Gronchi A. Doxorubicin plus dacarbazine, doxorubicin plus ifosfamide, or doxorubicin alone as a first-line treatment for advanced leiomyosarcoma: A propensity score matching analysis from the European Organization for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group. Cancer 2020; 126:2637-2647. [PMID: 32129883 DOI: 10.1002/cncr.32795] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [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: 09/11/2019] [Revised: 01/05/2020] [Accepted: 01/24/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND The optimal treatment for advanced leiomyosarcoma is still debated. Given histotype-specific prospective controlled data lacking, this study retrospectively evaluated doxorubicin plus dacarbazine, doxorubicin plus ifosfamide, and doxorubicin alone as first-line treatments for advanced/metastatic leiomyosarcoma treated at European Organization for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group (EORTC-STBSG) sites. METHODS The inclusion criteria were a confirmed histological diagnosis, treatment between January 2010 and December 2015, measurable disease (Response Evaluation Criteria in Solid Tumors 1.1), an Eastern Cooperative Oncology Group performance status ≤2, and an age ≥ 18 years. The endpoints were progression-free survival (PFS), overall survival (OS), and overall response rate (ORR). PFS was analyzed with methods for interval-censored data. Patients were matched according to their propensity scores, which were estimated with a logistic regression model accounting for histology, grade, age, sex, performance status, tumor site, and tumor extent. RESULTS Three hundred three patients from 18 EORTC-STBSG sites were identified. One hundred seventeen (39%) received doxorubicin plus dacarbazine, 71 (23%) received doxorubicin plus ifosfamide, and 115 (38%) received doxorubicin. In the 2:1:2 propensity score-matched population (205 patients), the estimated median PFS was 9.2 months (95% confidence interval [CI], 5.2-9.7 months), 8.2 months (95% CI, 5.2-10.1 months), and 4.8 months (95% CI, 2.3-6.0 months) with ORRs of 30.9%, 19.5%, and 25.6% for doxorubicin plus dacarbazine, doxorubicin plus ifosfamide, and doxorubicin alone, respectively. PFS was significantly longer with doxorubicin plus dacarbazine versus doxorubicin (hazard ratio [HR], 0.72; 95% CI, 0.52-0.99). Doxorubicin plus dacarbazine was associated with longer OS (median, 36.8 months; 95% CI, 27.9-47.2 months) in comparison with both doxorubicin plus ifosfamide (median, 21.9 months; 95% CI, 16.7-33.4 months; HR, 0.65; 95% CI, 0.40-1.06) and doxorubicin (median, 30.3 months; 95% CI, 21.0-36.3 months; HR, 0.66; 95% CI, 0.43-0.99). Adjusted analyses retained an effect for PFS but not for OS. None of the factors selected for multivariate analysis had a significant interaction with the received treatment for both PFS and OS. CONCLUSIONS This is the largest retrospective study of first-line treatment for advanced leiomyosarcoma. In the propensity score-matched population, doxorubicin and dacarbazine showed favorable activity in terms of both ORR and PFS and warrants further evaluation in prospective trials.
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Affiliation(s)
- Lorenzo D'Ambrosio
- Department of Oncology, University of Turin, Turin, Italy.,Sarcoma Unit, Division of Medical Oncology, Candiolo Cancer Institute-FPO, IRCCS, Candiolo, Italy
| | - Nathan Touati
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - Jean-Yves Blay
- Leon Berard Center and Claude Bernard Lyon I University, EURACAN, LYRICAN, Lyon, France
| | - Giovanni Grignani
- Sarcoma Unit, Division of Medical Oncology, Candiolo Cancer Institute-FPO, IRCCS, Candiolo, Italy
| | - Ronan Flippot
- Department of Medicine, Gustave Roussy, Villejuif Cedex, France
| | - Anna M Czarnecka
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Institute-Oncology Center, Gliwice, Poland.,Department of Experimental Pharmacology, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | | | - Javier Martin-Broto
- Virgen del Rocio University Hospital, Institute of Biomedicine Research/CSIC/University of Seville, Seville, Spain
| | - Roberta Sanfilippo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Daniela Katz
- Oncology Department, Sharett Institute of Oncology, Hadassah-Hebrew University, Jerusalem, Israel
| | - Florence Duffaud
- Medical Oncology - University Hospital Timone, Aix-Marseille University, Marseille, France
| | - Bruno Vincenzi
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Daniel P Stark
- St James's Institute of Oncology, Leeds Institute of Cancer and Pathology, University of Leeds and Leeds Teaching Hospitals National Health Service Trust, Leeds, United Kingdom
| | - Filomena Mazzeo
- Medical Oncology, Clinique Universitaire Saint-Luc, Woluwe-Saint-Lambert, Belgium
| | - Armin Tuchscherer
- Department of Internal Medicine I, University Hospital Cologne, Cologne, Germany
| | - Christine Chevreau
- Claudius Regaud Institute, University Cancer Institute of Toulouse, Toulouse, France
| | - Jenny Sherriff
- Cancer Centre, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | | | - Saskia Litière
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - Ward Sents
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - Isabelle Ray-Coquard
- Leon Berard Center and Claude Bernard Lyon I University, EURACAN, LYRICAN, Lyon, France
| | - Francesco Tolomeo
- Sarcoma Unit, Division of Medical Oncology, Candiolo Cancer Institute-FPO, IRCCS, Candiolo, Italy
| | - Axel Le Cesne
- Department of Medicine, Gustave Roussy, Villejuif Cedex, France
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Institute-Oncology Center, Gliwice, Poland.,Department of Experimental Pharmacology, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | - Silvia Stacchiotti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Bernd Kasper
- Sarcoma Unit, Interdisciplinary Tumor Center, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, Netherlands
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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6
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Li CK, Dalvi R, Yonemori K, Ariffin H, Lyu CJ, Farid M, Gonzales-Santos JRN, Zhou Q, Bielack S, Brugieres L, Blondeel A, Essiaf S, Peccatori FA, Jezdic S, Stark DP, Douillard JY, Saloustros E, Mountzios G. Care of adolescents and young adults with cancer in Asia: results of an ESMO/SIOPE/SIOP Asia survey. ESMO Open 2019; 4:e000467. [PMID: 31231565 PMCID: PMC6555609 DOI: 10.1136/esmoopen-2018-000467] [Citation(s) in RCA: 13] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/22/2019] [Accepted: 02/08/2019] [Indexed: 11/30/2022] Open
Abstract
Background Adolescents and young adults (AYAs) with cancer require dedicated management encompassing both adult and paediatric cancer services. Following a European survey, the European Society for Medical Oncology, the European Society for Paediatric Oncology and the Asian continental branch of International Society of Paediatric Oncology undertook a similar survey to assess AYA cancer care across Asia. Methods A link to the online survey was sent to healthcare professionals (HCPs) in Asia interested in AYA cancer care. Questions covered the demographics and training of HCPs, their understanding of AYA definition, availability and access to specialised AYA services, the support and advice offered during and after treatment, and factors of treatment non-compliance. Results We received 268 responses from 22 Asian countries. There was a striking variation in the definition of AYA (median lower age 15 years, median higher age 29 years). The majority of the respondents (78%) did not have access to specialised cancer services and 73% were not aware of any research initiatives for AYA. Over two-thirds (69%) had the option to refer their patients for psychological and/or nutritional support and most advised their patients on a healthy lifestyle. Even so, 46% did not ask about smokeless tobacco habits and only half referred smokers to a smoking cessation service. Furthermore, 29% did not promote human papillomavirus vaccination for girls and 17% did not promote hepatitis B virus vaccination for high-risk individuals. In terms of funding, 69% reported governmental insurance coverage, although 65% reported that patients self-paid, at least partially. Almost half (47%) reported treatment non-compliance or abandonment as an issue, attributed to financial and family problems (72%), loss of follow-up (74%) and seeking of alternative treatments (77%). Conclusions Lack of access to and suboptimal delivery of AYA-specialised cancer care services across Asia pose major challenges and require specific interventions.
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Affiliation(s)
- Chi Kong Li
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong SAR, Hong Kong
| | - Rashmi Dalvi
- Department of Pediatrics and Hematology-Oncology, Bombay Hospital Institute of Medical Sciences and SRCC Children's Hospital, Mumbai, India
| | - Kan Yonemori
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hany Ariffin
- Department of Paediatrics, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Chuhl Joo Lyu
- Department of Paediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Mohamad Farid
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Julieta Rita N Gonzales-Santos
- Department of Paediatrics, De La Salle University Medical and Health Sciences Institute, Dasmarinas, Cavite, Philippines
| | - Qing Zhou
- Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Stefan Bielack
- Zentrum für Kinder, Jugend und Frauenmedizin Pädiatrie 5, KlinikumStuttgart - Olgahospital, Stuttgart, Germany
| | - Laurence Brugieres
- Children and Adolescent Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Anne Blondeel
- Department of Scientific Programme Coordination, European Society for Paediatric Oncology (SIOPE), Brussels, Belgium
| | - Samira Essiaf
- Department of Scientific Programme Coordination, European Society for Paediatric Oncology (SIOPE), Brussels, Belgium
| | | | - Svetlana Jezdic
- Scientific and Medical Division, European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - Daniel P Stark
- Department of Oncology, Leeds Institute of Medical Research at St James's, and Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jean-Yves Douillard
- Scientific and Medical Division, European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | | | - Giannis Mountzios
- 2nd Department of Oncology, Henry Dunant Hospital Center, Athens, Greece
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7
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Shaikh F, Stark DP, Dang H, Xia C, Krailo MD, Stenning SP, Pashankar FD, Rodriguez-Galindo C, Olson TA, Hale J, Depani S, Stoneham S, Nicholson J, Murray M, Amatruda JF, Billmire DF, Fonseca A, Frazier AL. Outcomes of adolescent males with extracranial malignant germ cell tumors compared with children and young adults: A report from the Malignant Germ Cell Tumors International Consortium (MaGIC) group. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.10022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
10022 Background: Adolescents with extracranial malignant germ cell tumors (GCTs) are often treated on the same regimens developed for children, but more closely resemble the clinical characteristics of young adult patients. We sought to determine whether event-free survival (EFS) for adolescents with GCTs was more like that of children or young adults. Methods: We assembled an individual patient database of ten GCT trials: seven conducted by pediatric cooperative groups and three by an adult group. We selected male patients aged 0-30 years old treated with platinum-based chemotherapy for non-seminomatous malignant GCTs of the testis, retroperitoneum, or mediastinum. We categorized age-group as children (0 to < 11 years), adolescents (11 to < 18 years), or young adults (18 to < 30 years old). We compared EFS among age groups, and adjusted for calculated IGCCCG risk-group using Cox proportional hazards analysis. Results: 593 patients met inclusion criteria, of whom 90 were children, 109 were adolescents, and 394 were young adults. The 5-year EFS for adolescents (72%; CI = 62-79%) was significantly lower than for children (90%; CI = 81-95%, p = 0.003) and for young adults (88%; CI = 84-91%, p < 0.001). Risk-group was significantly associated with EFS in the adolescent age-group (p = 0.002). In a Cox multivariable analysis, the difference between adolescents and children remained statistically significant (HR = 0.30, p = 0.001), but the difference between adolescents and young adults did not (HR 0.66, p = 0.114). Conclusions: EFS for adolescent patients with extracranial malignant GCTs was similar to young adults but significantly worse than children. This finding may have important implications for how adolescent patients are treated.
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Affiliation(s)
| | | | - Ha Dang
- Children's Oncology Group, Monrovia, CA
| | | | | | - Sally Patricia Stenning
- Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
| | | | | | | | - Juliet Hale
- Newcastle upon Tyne Hospitals Trust, Newcastle upon Tyne, United Kingdom
| | | | - Sara Stoneham
- Department of Pediatric and Adolescent Oncology, University College Hospital, London, United Kingdom
| | | | - Matthew Murray
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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8
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Bright CJ, Reulen RC, Winter DL, Stark DP, McCabe MG, Edgar AB, Frobisher C, Hawkins MM. Risk of subsequent primary neoplasms in survivors of adolescent and young adult cancer (Teenage and Young Adult Cancer Survivor Study): a population-based, cohort study. Lancet Oncol 2019; 20:531-545. [PMID: 30797674 PMCID: PMC6494975 DOI: 10.1016/s1470-2045(18)30903-3] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/20/2018] [Accepted: 11/22/2018] [Indexed: 12/12/2022]
Abstract
Background Few studies have investigated the risks of subsequent primary neoplasms after adolescent and young adult (AYA) cancer. We investigated the risks of specific subsequent primary neoplasms after each of 16 types of AYA cancer. Methods The Teenage and Young Adult Cancer Survivor Study is a population-based cohort of 200 945 survivors of cancer diagnosed when aged 15–39 years in England and Wales from Jan 1, 1971, to Dec 31, 2006. The cohort was established using cancer registrations from the Office for National Statistics and the Welsh Cancer registry. Follow-up was from 5-year survival until the first occurrence of death, emigration, or study end date (Dec 31, 2012). In this analysis, we focus on the risk of specific subsequent primary neoplasms after 16 types of AYA cancer: breast; cervical; testicular; Hodgkin lymphoma (female); Hodgkin lymphoma (male); melanoma; CNS (intracranial); colorectal; non-Hodgkin lymphoma; thyroid; soft-tissue sarcoma; ovarian; bladder; other female genital; leukaemia; and head and neck cancer. We report absolute excess risks (AERs; per 10 000 person-years) and cumulative incidence of specific types of subsequent primary neoplasm after each type of AYA cancer. Findings During the 2 631 326 person-years of follow-up (median follow-up 16·8 years, IQR 10·5–25·2), 12 321 subsequent primary neoplasms were diagnosed in 11 565 survivors, most frequently among survivors of breast cancer, cervical cancer, testicular cancer, and Hodgkin lymphoma. AERs of any subsequent primary neoplasms were 19·5 per 10 000 person-years (95% CI 17·4–21·5) in survivors of breast cancer, 10·2 (8·0–12·4) in survivors of cervical cancer, 18·9 (16·6–21·1) in survivors of testicular cancer, 55·7 (50·4–61·1) in female survivors of Hodgkin lymphoma, and 29·9 (26·3–33·6) in male survivors of Hodgkin lymphoma. The cumulative incidence of all subsequent primary neoplasms 35 years after diagnosis was 11·9% (95% CI 11·3–12·6) in survivors of breast cancer, 15·8% (14·8–16·7) in survivors of cervical cancer, 20·2% (18·9–21·5) in survivors of testicular cancer, 26·6% (24·7–28·6) in female survivors of Hodgkin lymphoma, and 16·5% (15·2–18·0) in male survivors of Hodgkin lymphoma. In patients who had survived at least 30 years from diagnosis of cervical cancer, testicular cancer, Hodgkin lymphoma in women, breast cancer, and Hodgkin lymphoma in men, we identified a small number of specific subsequent primary neoplasms that account for 82%, 61%, 58%, 45%, and 41% of the total excess number of neoplasms, respectively. Lung cancer accounted for a notable proportion of the excess number of neoplasms across all AYA groups investigated. Interpretation Our finding that a small number of specific subsequent primary neoplasms account for a large percentage of the total excess number of neoplasms in long-term survivors of cervical, breast, and testicular cancer, and Hodgkin lymphoma provides an evidence base to inform priorities for clinical long-term follow-up. The prominence of lung cancer after each of these AYA cancers indicates the need for further work aimed at preventing and reducing the burden of this cancer in future survivors of AYA cancer. Funding Cancer Research UK, National Institute for Health Research, Academy of Medical Sciences, and Children with Cancer UK.
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Affiliation(s)
- Chloe J Bright
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - David L Winter
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Daniel P Stark
- Leeds Institute of Medical Research at St James's, School of Medicine, St James's University Hospital, Leeds, UK
| | - Martin G McCabe
- Division of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Clare Frobisher
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Michael M Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
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9
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D'Ambrosio L, Touati N, Blay JY, Grignani G, Flippot R, Czarnecka AM, Piperno-Neumann S, Martin Broto J, Sanfilippo R, Katz D, Duffaud F, Vincenzi B, Kasper B, Stark DP, Mazzeo F, Tuchscherer A, Litiere S, Sents W, Gelderblom H, Gronchi A. Doxorubicin plus dacarbazine (DoDa), doxorubicin plus ifosfamide (DI) or doxorubicin alone (Do) as first line treatment for advanced leiomyosarcoma (LMS): A retrospective study from the EORTC Soft Tissue and Bone Sarcoma Group (STBSG). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.11574] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Lorenzo D'Ambrosio
- University of Torino, Department of Oncology, Torino, Italy, Torino, Italy
| | - Nathan Touati
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Jean-Yves Blay
- University Claude Bernard Lyon I, Centre Leon Berard, Lyon, France
| | - Giovanni Grignani
- Sarcoma Unit, Division of Medical Oncology, Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Italy
| | | | | | | | - Javier Martin Broto
- Virgen del Rocio University Hospital, Institute of Biomedicine Research (IBIS)/CSIC/Universidad de Sevilla, Seville, Spain
| | - Roberta Sanfilippo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Daniela Katz
- Oncology Institute, Assaf Harofeh Medical Center, Zrifin, Israel
| | | | - Bruno Vincenzi
- Department of Medical Oncology, University Campus Bio-Medico of Rome, Rome, Italy
| | - Bernd Kasper
- University of Heidelberg, Mannheim University Medical Center, ITM - Interdisciplinary Tumor Center Mannheim, Sarcoma Unit, Mannheim, Germany
| | - Daniel P. Stark
- St James's Institute of Oncology, Leeds Institute of Cancer and Pathology, University of Leeds and Leeds Teaching Hospitals NHS Trust, Bexley Wing, St James's Hospital, Leeds, United Kingdom
| | - Filomena Mazzeo
- Medical Oncology, Clinique Universitaire Saint-Luc, Institut Roi Albert II, Brussels, Belgium
| | - Armin Tuchscherer
- Department I of Internal Medicine, University Hospital Cologne, Köln, Germany
| | - Saskia Litiere
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Ward Sents
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | | | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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10
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Saloustros E, Stark DP, Michailidou K, Mountzios G, Brugieres L, Peccatori FA, Jezdic S, Essiaf S, Douillard JY, Bielack S. The care of adolescents and young adults with cancer: results of the ESMO/SIOPE survey. ESMO Open 2017; 2:e000252. [PMID: 29018578 PMCID: PMC5604713 DOI: 10.1136/esmoopen-2017-000252] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 08/10/2017] [Accepted: 08/11/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction Adolescents and young adults (AYA) with cancer require dedicated clinical management and care. Little is known about the training and practice of European healthcare providers in regard to AYA and the availability of specialised services. Methods A link to an online survey was sent to members of the European Society for Medical Oncology (ESMO) and the European Society for Paediatric Oncology (SIOPE). The link was also sent to ESMO National Representatives and circulated to other European oncology groups. Questions covered the demographics and clinical training of respondents, their definition of AYA, education about AYA cancer, access to specialised clinical and supportive care, research and further education. Data from Europe were analysed by region. Results Three hundred tweenty two questionnaires were submitted and we focused on data from the 266 European healthcare professionals. Responses revealed considerable variation both within and between countries in the definition of AYA. Over two-thirds of respondents did not have access to specialised centres for AYA (67%), were not aware of research initiatives focusing on AYA with cancer (69%) and had no access to specialist services for managing the late effects of treatment (67%). The majority of the respondents were able to refer AYA patients to professional psychological support and specialised social workers. However, more than half had no access to an age-specialised nurse or specialised AYA education. Overall, 38% of respondents reported that their AYA patients did not have access to fertility specialists. This figure was 76% in Eastern Europe. Lack of specialised AYA care was particularly evident in Eastern and South-Eastern Europe. Conclusion There is important underprovision and inequity of AYA cancer care across Europe. Improving education and research focused on AYA cancer care should be a priority.
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Affiliation(s)
- Emmanouil Saloustros
- Oncology Unit, General Hospital of Heraklion 'Venizelio', Heraklion, Crete, Greece
| | | | | | - Giannis Mountzios
- Department of Medical Oncology, 251 General Airforce Hospital, Athens, Greece
| | | | - Fedro Alessandro Peccatori
- Fertility & Procreation Unit, Gynecologic Oncology Department, European Institute of Oncology, Milan, Italy
| | - Svetlana Jezdic
- European Society for Medical Oncology, Viganello-Lugano, Switzerland
| | - Samira Essiaf
- European Society for Paediatric Oncology (SIOPE), Brussels, Belgium
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11
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Fairley L, Stark DP, Yeomanson D, Kinsey SE, Glaser AW, Picton SV, Evans L, Feltbower RG. Access to principal treatment centres and survival rates for children and young people with cancer in Yorkshire, UK. BMC Cancer 2017; 17:168. [PMID: 28257637 PMCID: PMC5336656 DOI: 10.1186/s12885-017-3160-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 03/01/2017] [Indexed: 11/10/2022] Open
Abstract
Background Principal Treatment Centres (PTC) were established to provide age-appropriate care as well as clinical expertise for children and young people with cancer. However, little is known about the effects of specialist treatment centres on survival outcomes especially for teenagers and young adults. This population-based study aimed to describe access to PTC and the associated trends in survival for 0–24 year olds accounting for stage of disease at presentation and treatment. Methods Patients diagnosed from 1998–2009 aged 0–24 years were extracted from the Yorkshire Specialist Register of Cancer in Children and Young People, including information on all treating hospitals, followed-up until 31st December 2014. The six commonest cancer types were included: leukaemia (n = 684), lymphoma (n = 558), CNS tumours (n = 547), germ cell tumours (n = 364), soft tissue sarcomas (n = 171) and bone tumours (n = 163). Treatment was categorised into three groups: ‘all’, ‘some’ or ‘no’ treatment received at a PTC. Treatment at PTC was examined by diagnostic group and patient characteristics. Overall survival was modelled using Cox regression adjusting for case-mix including stage, treatment and other socio-demographic and clinical characteristics. Results Overall 72% of patients received all their treatment at PTC whilst 13% had no treatment at PTC. This differed by diagnostic group and age at diagnosis. Leukaemia patients who received no treatment at PTC had an increased risk of death which was partially explained by differences in patient case-mix (adjusted Hazard Ratio (HR) = 1.73 (95%CI 0.98–3.04)). Soft tissue sarcoma patients who had some or no treatment at PTC had better survival outcomes, which remained after adjustment for patient case-mix (adjusted HR = 0.48 (95%CI 0.23–0.99)). There were no significant differences in outcomes for other diagnostic groups (lymphoma, CNS tumours, bone tumours and germ cell tumours). For leukaemia patients survival outcomes for low risk patients receiving no treatment at PTC were similar to high risk patients who received all treatment at PTC, implying a benefit for care at the PTC. Conclusion This study demonstrates that for leukaemia patients receiving treatment at a PTC is associated with improved survival that may compensate for a poorer prognosis presentation. However, further information on risk factors is needed for all diagnostic groups in order to fully account for differences in patient case-mix. Electronic supplementary material The online version of this article (doi:10.1186/s12885-017-3160-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lesley Fairley
- Division of Epidemiology and Biostatistics, School of Medicine, Worsley Building, University of Leeds, Clarendon Way, Leeds, UK, LS2 9JT.
| | - Daniel P Stark
- St James's Institute of Oncology, Leeds Institute of Cancer and Pathology, University of Leeds and Leeds Teaching Hospitals NHS Trust, Bexley Wing, St James's Hospital, Beckett Street, Leeds, LS9 7TF, UK
| | - Daniel Yeomanson
- Paediatric Oncology and Haematology Department, Sheffield Children's Hospital, Western Bank, Sheffield, S10 2TH, UK
| | - Sally E Kinsey
- St James's Institute of Oncology, Leeds Institute of Cancer and Pathology, University of Leeds and Leeds Teaching Hospitals NHS Trust, Bexley Wing, St James's Hospital, Beckett Street, Leeds, LS9 7TF, UK.,Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK
| | - Adam W Glaser
- St James's Institute of Oncology, Leeds Institute of Cancer and Pathology, University of Leeds and Leeds Teaching Hospitals NHS Trust, Bexley Wing, St James's Hospital, Beckett Street, Leeds, LS9 7TF, UK
| | - Susan V Picton
- Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK
| | - Linda Evans
- Sheffield Teaching Hospitals NHS Foundation Trust, Weston Park Hospital, Whitham Road, Sheffield, S10 2SJ, UK
| | - Richard G Feltbower
- Division of Epidemiology and Biostatistics, School of Medicine, Worsley Building, University of Leeds, Clarendon Way, Leeds, UK, LS2 9JT
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12
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Abstract
The pattern of cancer seen in young people changes with increasing age, transitioning from childhood- to adult-type cancer in adolescence and the third decade. The risk factors, presentation and biology of cancer in young adults differ from those in the older adult population. Factors of particular significance in adolescents and young adults (AYAs) include genetic predisposition to adult-type cancer, diagnostic uncertainty, long-term morbidity and considerations of fertility. New systemic therapies are being introduced that can prolong life and even increase the chance of cure, but the impact on AYAs is uncertain, as these patients are often under-represented in clinical trials. Here, we discuss the management of AYAs with 3 of the most common cancers affecting adults, when they emerge in the AYA populations, and therefore are currently met by medical oncologists - breast cancer, colorectal cancer and melanoma.
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13
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Desandes E, Stark DP. Epidemiology of Adolescents and Young Adults with Cancer in Europe. Progress in Tumor Research 2016; 43:1-15. [DOI: 10.1159/000447037] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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14
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Zitrin A, Labbé I, Belli S, Bouwens R, Ellis RS, Roberts-Borsani G, Stark DP, Oesch PA, Smit R. Ly
α
EMISSION FROM A LUMINOUS
z
= 8.68 GALAXY: IMPLICATIONS FOR GALAXIES AS TRACERS OF COSMIC REIONIZATION. ACTA ACUST UNITED AC 2015. [DOI: 10.1088/2041-8205/810/1/l12] [Citation(s) in RCA: 153] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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15
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O'Hara C, Moran A, Whelan JS, Hough RE, Stiller CA, Stevens MCG, Stark DP, Feltbower RG, McCabe MG. Trends in survival for teenagers and young adults with cancer in the UK 1992-2006. Eur J Cancer 2015. [PMID: 26219688 PMCID: PMC4571927 DOI: 10.1016/j.ejca.2015.06.112] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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] [Indexed: 11/16/2022]
Abstract
Background Although relatively rare, cancer in teenagers and young adults (TYA) is the most common disease-related cause of death and makes a major contribution to years of life lost in this age group. There is a growing awareness of the distinctive needs of this age group and drive for greater understanding of how outcomes can be improved. We present here the latest TYA survival trends data for the United Kingdom (UK). Methods Using national cancer registry data, we calculated five-year relative survival for all 15–24 year olds diagnosed with cancer or a borderline/benign CNS tumour in the UK during the periods 1992–1996, 1997–2001 and 2002–2006. We analysed trends in survival for all cancers combined and for eighteen specified groups that together represent the majority of TYA cancers. We compared our data with published data for Europe, North America and Australia. Results Five-year survival for all cancers combined increased from 75.5% in 1992–1996 to 82.2% in 2002–2006 (P < 0.001). Statistically significant improvements were seen for all disease groups except osteosarcoma, rhabdomyosarcoma, non-gonadal and ovarian germ cell tumours and ovarian and thyroid carcinomas. During the earliest time period, females had significantly better survival than males for five of the twelve non-gender-specific disease groups. By the latest period, only melanomas and non-rhabdomyosarcoma soft tissue sarcomas had differential survival by gender. Survival in the UK for the most recent period was generally similar to other comparable countries. Conclusion Five-year survival has improved considerably in the UK for most cancer types. For some disease groups, there has been little progress, either because survival already approaches 100% (e.g. thyroid carcinomas) or, more worryingly for some cancers with poor outcomes, because they remain resistant to existing therapy (e.g. rhabdomyosarcoma). In addition, for a number of specific cancer types and for cancer as a whole males continue to have worse outcomes than females.
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Affiliation(s)
- C O'Hara
- Clinical Outcomes Unit, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
| | - A Moran
- Public Health England, The Palatine Centre, 63-65 Palatine Road, Withington, Manchester M20 3LJ, UK
| | - J S Whelan
- NIHR University College London Hospitals Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2PG, UK
| | - R E Hough
- NIHR University College London Hospitals Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2PG, UK
| | - C A Stiller
- Public Health England, 4150 Chancellor Court, Oxford Business Park South, Oxford OX4 2GX, UK
| | - M C G Stevens
- School of Clinical Sciences, University of Bristol, Level 6, UHB Education Centre, Upper Maudlin Street, Bristol BS2 8AE, UK
| | - D P Stark
- Leeds Institute of Cancer and Pathology, Cancer Genetics Building, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK
| | - R G Feltbower
- Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, Worsley Building, Clarendon Way, LS2 9JT, UK
| | - M G McCabe
- Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, University of Manchester, Young Oncology Unit, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK.
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16
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Jakes AD, Marec-Berard P, Phillips RS, Stark DP. Critical Review of Clinical Practice Guidelines for Fertility Preservation in Teenagers and Young Adults with Cancer. J Adolesc Young Adult Oncol 2014; 3:144-152. [PMID: 25538859 PMCID: PMC4270154 DOI: 10.1089/jayao.2014.0032] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: The 5-year survival of teenagers and young adults (TYAs; 13-24 years old) with cancer has continued to rise, but as a result more patients experience late effects of treatment, such as infertility. Advice regarding fertility preservation in relation to cancer is provided in numerous clinical practice guidelines, but the rigor of their development is unclear. Methods: A systematic search was undertaken for clinical practice guidelines regarding fertility preservation in TYAs with cancer. All guidelines were reviewed according to the Appraisal of Guidelines for Research and Evaluation (AGREE-II) criteria. Five out of 13 identified guidelines scored over 75% in the "rigor of development" section and were further appraised. Content, scope, and consistencies between recommendations were also examined. Results: All five of the reviewed guidelines encouraged oncologists to have discussions with their patients about potential fertility issues associated with treatment and available fertility preservation methods. The cryopreservation of sperm, oocytes, and embryos were all recommended as first-line interventions in postpubertal patients. Recommendations surrounding pre- or peripubescent adolescents were few, with many techniques only recommended as part of a clinical trial. The risk of subfertility associated with different treatment regimens was poorly described. Conclusions: The methodology and development of guidelines describing fertility preservation in TYA cancer patients varied greatly. Methodological quality did not clearly influence key recommendations. Those involved with the development of guidelines are encouraged to clearly define their development methods to allow users to be confident of the quality.
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Affiliation(s)
- Adam D. Jakes
- Leeds Institute of Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | | | - Robert S. Phillips
- Centre for Reviews and Dissemination, University of York, York, United Kingdom
| | - Daniel P. Stark
- Leeds Institute of Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
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17
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Schenker MA, Ellis RS, Konidaris NP, Stark DP. LINE-EMITTING GALAXIES BEYOND A REDSHIFT OF 7: AN IMPROVED METHOD FOR ESTIMATING THE EVOLVING NEUTRALITY OF THE INTERGALACTIC MEDIUM. ACTA ACUST UNITED AC 2014. [DOI: 10.1088/0004-637x/795/1/20] [Citation(s) in RCA: 207] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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18
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van Laar M, Stark DP, McKinney P, Parslow RC, Kinsey SE, Picton SV, Feltbower RG. Population mixing for leukaemia, lymphoma and CNS tumours in teenagers and young adults in England, 1996-2005. BMC Cancer 2014; 14:698. [PMID: 25248916 PMCID: PMC4180542 DOI: 10.1186/1471-2407-14-698] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 09/17/2014] [Indexed: 01/12/2023] Open
Abstract
Background Little aetiological epidemiological research has been undertaken for major cancers occurring in teenagers and young adults (TYA). Population mixing, as a possible proxy for infectious exposure, has been well researched for childhood malignancies. We aimed to investigate effects of population mixing in this older age group using an English national cancer dataset. Methods Cases of leukaemia, lymphoma and central nervous system (CNS) tumours amongst 15–24 year olds in England (diagnosed 1996–2005) were included in the study. Data were obtained by ward of diagnosis and linked to 1991 census variables including population mixing (Shannon index); data on person-weighted population density and deprivation (Townsend score) were also used and considered as explanatory variables. Associations between TYA cancer incidence and census variables were investigated using negative binomial regression, and results presented as incidence rate ratios (IRR) with 95% confidence intervals (CI). Results A total of 6251 cases of leukaemia (21%), lymphoma (49%) and CNS tumours (30%) were analysed. Higher levels of population mixing were associated with a significant decrease in the incidence of CNS tumours (IRR = 0.83, 95% CI = 0.75-0.91), accounted for by astrocytomas and ‘other CNS tumours’; however, there was no association with leukaemia or lymphoma. Incidence of CNS tumours and lymphoma was 3% lower in more deprived areas (IRR = 0.97, 95% CI = 0.96-0.99 and IRR = 0.97, 95% CI =0.96-0.98 respectively). Population density was not associated with the incidence of leukaemia, lymphoma or CNS tumours. Conclusions Our results suggest a possible role for environmental risk factors with population correlates in the aetiology of CNS tumours amongst TYAs. Unlike studies of childhood cancer, associations between population mixing and the incidence of leukaemia and lymphoma were not observed.
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Affiliation(s)
| | | | | | | | | | | | - Richard G Feltbower
- Division of Epidemiology and Biostatistics, School of Medicine, Worsley Building, Clarendon Way, University of Leeds, Leeds LS2 9JT, UK.
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van Laar M, Glaser A, Phillips RS, Feltbower RG, Stark DP. The impact of a managed transition of care upon psychosocial characteristics and patient satisfaction in a cohort of adult survivors of childhood cancer. Psychooncology 2013; 22:2039-45. [PMID: 23401266 DOI: 10.1002/pon.3248] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [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: 07/24/2012] [Revised: 01/02/2013] [Accepted: 01/03/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Many adult survivors of childhood cancer receive care in paediatric departments, despite national policy to transition their care to adult services. When long-term follow-up care for survivors of childhood cancer in our region moved from a paediatric to an adult environment in 2009, we prospectively assessed the impact of this change on patient satisfaction. METHODS Questionnaire data were collected in paediatric and adult clinical environments regarding the level of satisfaction with care and potential mediators: quality of life, psychological health and social difficulties. Predictors of satisfaction and optimum longitudinal risk-based care were described using path analysis and compared with previously described models. RESULTS There was no significant difference in satisfaction between the paediatric and adult settings. Short waiting times and increased understanding of the purpose of follow-up were significantly associated with increased satisfaction. Those with a higher perception of health problems and those that were older were more likely to not attend all of their clinic appointments. CONCLUSIONS Within our service, transition to adult care did not impact significantly upon patient satisfaction. Shorter waits and knowing why participants were attending the clinic increased satisfaction. Joint working between adult and paediatric cancer professionals enabled adult survivors of childhood cancer to receive highly satisfactory care in adult services.
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Affiliation(s)
- M van Laar
- Paediatric Epidemiology Group, Division of Epidemiology, University of Leeds, Leeds, UK
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Grimison PS, Chatfield MD, Mazhar D, Toner GC, Chester JD, Stockler MR, Stark DP, Thomson DB, Shamash J, Friedlander M, White J, Gebski V, Wason J, Boland AL, Rimmer YL, McDonald A, Gurney H, Rosenthal M, Singhal N, Williams MV. Accelerated BEP for metastatic germ cell tumors: Combined analysis of Australian and U.K. phase I/II trials. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.4531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4531 Background: Standard chemotherapy for advanced germ cell tumors is 3-weekly BEP (bleomycin, etoposide, cisplatin). 5-year overall survival is > 90% in good risk disease, but only ~80% in intermediate and ~ 60% in poor risk disease. Accelerated versions of standard regimens have proven more effective in other malignancies. We aimed to determine tolerability and activity of accelerated (2-weekly) BEP by combining data from two single arm, multi-center, phase I/II trials. Methods: The UK trial (n=16) included patients with intermediate and poor risk metastatic germ cell tumours. The Australian trial (n=45) also included patients with radiologically measurable good risk disease. BEP chemotherapy was repeated every 2 weeks for 4 cycles (3 cycles for good risk). The Australian and UK regimens differed for cisplatin (20mg/m2 D1-5; 50mg/m2 D1-2), etoposide (100mg/m2 D1-5; 165mg/m2 D1-3), bleomycin (30kIU weekly x 12 or 9; 30kIU at 4-6 day intervals x 12), and pegylated G-CSF (6mg D6; 6mg D4) respectively. Primary endpoint for combined analysis was 2-year progression-free survival. Results: 61 patients were enrolled from 2004-09 (UK) and 2008-10 (Australia). 17 had poor risk, 28 intermediate risk, 16 good risk disease. Median follow-up is 27 months (range 6 to 81). Adverse events are presented in the table. 45 of 61 patients (74%) achieved a complete response to chemotherapy +/- surgery (9 of 17 poor risk (53%), 20 of 28 intermediate risk (71%), 16 of 16 good risk disease (100%)). 11 of 61 patients have relapsed. 2 patients have died of disease (both intermediate risk). 2 year overall survival is 98%. 2 year progression-free survival is 65% for poor risk, 86% for intermediate risk, and 92% for good risk disease. Conclusions: Efficacy data are promising, particularly for intermediate and poor risk disease. Adverse events appear comparable to standard BEP. These results provide the rationale for an international trial randomised trial comparing accelerated and standard versions of BEP. [Table: see text]
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Affiliation(s)
| | - Mark D. Chatfield
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | | | - Guy C. Toner
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | | | | | | | | | | | - Jeff White
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Australia
| | - James Wason
- Biostatistics Unit, Medical Research Council, Cambridge, United Kingdom
| | - Amy L Boland
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | | | - Angus McDonald
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
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Seligmann JF, Hall P, Hamilton P, Lord SR, Baxter P, Marples M, Stark DP. D-dimers as a tumor marker in GIST: Can it reduce the frequency of CT scanning in patients receiving palliative imatinib? J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.4_suppl.119] [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
119 Background: Treatment with palliative imatinib has improved outcomes in advanced GISTs, with a reported 2 year PFS of 50%. Guidelines suggest monitoring during imatinib by CT scan at 12 week intervals. There are no validated biomarkers to assist in disease evaluation. High d-dimer levels are associated with poor prognosis in several cancers and are predictive of disease progression during chemotherapy. In the diagnosis of venous thromboembolism, low D-dimer levels have a high negative predictive value (npv) for thrombosis. We investigated whether low d-dimers have a clinically useful npv for GIST progression. Methods: We retrospectively identified all patients treated with palliative Imatinib for GIST in a single tertiary referral centre using a systematic search of an electronic clinical database. Every 12 weeks during treatment patients were assessed by clinical evaluation, CT and a d-dimer measurement (HemosIL HS assay). The prognostic value of d-dimers was assessed by Cox regression. The clinical utility of d-dimers as a biomarker for radiological progression (rPD) was evaluated using radio operator curve (ROC) analysis. Results: 50 patients treated between Jan 2002 and June 2011 met criteria for inclusion. D-dimers were prognostic for progression free survival and overall survival, when analysed by level or over time (p <0.05). Over 460 clinical observations with CT and d-dimer were analysed. Scans demonstrating rPD were associated with higher d-dimer levels and a rising trend (p <0.05). D-dimer levels <1000 had a npv for rPD of 85%. An asymptomatic patient with a d-dimer level <1000 and a falling level over time was seen in 32% of observations, and had a npv for rPD of 92%. Conclusions: D-dimers may have a useful role in disease monitoring for GIST patients treated with palliative imatinib, particularly as a negative predictor of progression. This may reduce the burden of CT scanning in a useful percentage of patients but will require further validation.
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Affiliation(s)
- Jenny F. Seligmann
- St. James's Institute of Oncology, Leeds, United Kingdom; University of Leeds, Leeds, United Kingdom
| | - Peter Hall
- St. James's Institute of Oncology, Leeds, United Kingdom; University of Leeds, Leeds, United Kingdom
| | - Patrick Hamilton
- St. James's Institute of Oncology, Leeds, United Kingdom; University of Leeds, Leeds, United Kingdom
| | - Simon Richard Lord
- St. James's Institute of Oncology, Leeds, United Kingdom; University of Leeds, Leeds, United Kingdom
| | - Paul Baxter
- St. James's Institute of Oncology, Leeds, United Kingdom; University of Leeds, Leeds, United Kingdom
| | - Maria Marples
- St. James's Institute of Oncology, Leeds, United Kingdom; University of Leeds, Leeds, United Kingdom
| | - Daniel P. Stark
- St. James's Institute of Oncology, Leeds, United Kingdom; University of Leeds, Leeds, United Kingdom
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Murray MJ, Fern LA, Stark DP, Eden TO, Nicholson JC. Breaking down barriers: improving outcomes for teenagers and young adults with germ cell tumours. Oncol Rev 2011. [DOI: 10.4081/95] [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: 11/23/2022] Open
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Murray MJ, Fern LA, Stark DP, Eden TO, Nicholson JC. Breaking down barriers: improving outcomes for teenagers and young adults with germ cell tumours. Oncol Rev 2011. [DOI: 10.4081/oncol.2009.201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Teenagers and young adults (TYA) with cancer have complex and evolving needs which are unique to this patient group. The TYA age-group have outcomes that are not improving over time, lagging behind both adult and children’s cancers in their rate of improvement in recent years...
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van Laar M, McKinney PA, Stark DP, Glaser A, Kinsey SE, Lewis IJ, Picton SV, Richards M, Norman PD, Feltbower RG. Survival trends of cancer amongst the south Asian and non-south Asian population under 30 years of age in Yorkshire, UK. Cancer Epidemiol 2011; 36:e13-8. [PMID: 21908244 DOI: 10.1016/j.canep.2011.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 08/12/2011] [Accepted: 08/17/2011] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Several studies have shown differences in survival trends between ethnic groups across adults with cancer in the UK. It is unclear whether these differences exist exclusively in the older adult population or whether they begin to emerge in children and young adults. METHODS Subjects (n=3534) diagnosed with cancer under 30 years of age in Yorkshire between 1990 and 2005 were analysed. Differences in survival rates for diagnostic subgroups were estimated by ethnic group (south Asian or not) using Kaplan-Meier estimation and Cox regression. RESULTS When compared to non-south Asians (all other ethnic groups excluding south Asians) a significant increased risk of death was seen for south Asians with leukaemia (hazard ratio (HR)=1.75; 95% confidence interval (CI)=1.11-2.76) and lymphoma (HR=2.05; 95% CI=1.09-3.87), whereas south Asians with solid tumours other than central nervous system tumours had a significantly reduced risk of death(HR=0.50; 95% CI=0.28-0.89). This was independent of socioeconomic deprivation. CONCLUSION We found evidence of poorer survival outcomes for south Asians compared to non-south Asian children and young adults with leukaemia and lymphoma, but better outcomes for south Asian children and young adults with other solid tumours. This needs to be explained, and carefully addressed in the on-going development of cancer services.
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Affiliation(s)
- M van Laar
- Paediatric Epidemiology Group, Division of Epidemiology, Room 8.49, Worsley Building, Clarendon Way, University of Leeds, LS2 9NL, UK.
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Feltbower RG, Siller C, Woodward E, McKinney PA, Picton SV, Joffe J, Stark DP. Treatment and survival patterns for germ cell tumors among 13- to 24-year olds in Yorkshire, UK. Pediatr Blood Cancer 2011; 56:282-8. [PMID: 21157895 DOI: 10.1002/pbc.22794] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Accepted: 07/20/2010] [Indexed: 11/10/2022]
Abstract
BACKGROUND Teenage and young adult (TYA) patient care can fall into gaps between adult and children's services. Increasingly UK TYA multi-disciplinary teams manage germ cell tumors (GCT) in locally agreed collaborations and age ranges. Patterns of care are changing rapidly. However, between disciplines protocols define different assessment and management in GCT. We aimed to document changes in incidence, treatment, and survival since 1990, to record the baseline to which future trends can be compared. PROCEDURE Details were extracted from the UK population-based Yorkshire Specialist Cancer Register on 237 TYA aged 13-24 years diagnosed with a GCT between 1990 and 2004, followed-up until 2009. Incidence and survival patterns were assessed using Poisson and Cox regression. RESULTS Testicular (n = 190; 80%) and ovarian (n = 22; 9%) GCT were the most common malignancies, and 90% of GCT occurred aged 17-24 years. The overall incidence rate was 26.9 per million person years. Rates increased significantly by 4.0% (95% CI: 1.0-7.1%) per year on average. The most common treatment modality was surgery combined with chemotherapy (49%). Initial treatment changed significantly over time (P = 0.003) and by age (P = 0.005). There were significant differences in the management of stage 1 testicular tumors by age. Among 13- to 16-year olds, 56% were treated exclusively in adult departments. Five-year survival rates were 93-95% for gonadal GCT, and 70-75% for other sites. Survival did not differ by age (P = 0.65) or period (P = 0.41). CONCLUSIONS The age-related differences observed in the approach to GCT treatment suggest a collaborative approach to the models of care among TYA is required.
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Affiliation(s)
- Richard G Feltbower
- Pediatric Epidemiology Group, Centre for Epidemiology and Biostatistics, University of Leeds, Leeds, UK.
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Feltbower RG, McNally RJQ, Kinsey SE, Lewis IJ, Picton SV, Proctor SJ, Richards M, Shenton G, Skinner R, Stark DP, Vormoor J, Windebank KP, McKinney PA. Epidemiology of leukaemia and lymphoma in children and young adults from the north of England, 1990-2002. Eur J Cancer 2008; 45:420-7. [PMID: 19004628 DOI: 10.1016/j.ejca.2008.09.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Revised: 09/15/2008] [Accepted: 09/25/2008] [Indexed: 01/26/2023]
Abstract
AIM We aimed to describe and contrast the epidemiology of haematological malignancies among 0-14 and 15-24-year-olds in northern England from 1990 to 2002 and compare clinical trial entry by age group. PATIENTS AND METHODS Incidence rates were examined by age, sex and period of diagnosis and differences were tested using Poisson regression. Differences and trends in survival were assessed using Cox regression. RESULTS 1680 subjects were included comprising 948 leukaemias and 732 lymphomas. Incidence rates for acute lymphoblastic leukaemia were significantly higher for 0-14 compared to 15-24-year-olds, whilst Hodgkin lymphoma showed the reverse. No significant changes in incidence were observed. 60% of leukaemia patients aged 15-24 years entered trials compared to 92% of 0-14-year-olds. Survival rates were significantly lower and improved less markedly over time for 15-24 compared to 0-14-year-olds, particularly for leukaemia. CONCLUSIONS Trial accrual rates need to be improved amongst 15-24-year-olds and a more structured follow-up approach adopted for this unique population.
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Affiliation(s)
- Richard G Feltbower
- University of Leeds, Paediatric Epidemiology Group, Centre for Epidemiology and Biostatistics, Worsley Building, Clarendon Way, Leeds LS2 9JT, UK.
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Stark DP, Swinbank AM, Ellis RS, Dye S, Smail IR, Richard J. The formation and assembly of a typical star-forming galaxy at redshift z ≈ 3. Nature 2008; 455:775-7. [DOI: 10.1038/nature07294] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Accepted: 07/21/2008] [Indexed: 11/09/2022]
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Smith AB, Wright EP, Rush R, Stark DP, Velikova G, Selby PJ. Rasch analysis of the dimensional structure of the Hospital Anxiety and Depression Scale. Psychooncology 2006; 15:817-27. [PMID: 16353288 DOI: 10.1002/pon.1015] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The Hospital Anxiety and Depression Scale (HADS) has been used extensively in cancer patients to identify psychological distress. Reports of the factor structure and screening performance of the instrument vary. Rasch models allow an assessment of the structure of a questionnaire by identifying item fit. Removal of misfitting items may improve both the dimensionality and efficacy of screening questionnaires. A Rasch analysis of the HADS-T and subscales was used to explore the factor structure, dimensionality and screening efficacy. A total of 1855 patients completed a touchscreen version of the HADS, including 381 patients who had received a psychiatric interview (SCAN/PSE). These data were analysed using Rasch models, and the screening efficacy at identifying cases of psychological distress and anxiety and depression evaluated. The results demonstrated that the structure of the HADS-T and subscales was unidimensional. Three items from the HADS-T, and one from each of the subscales demonstrated misfit. Screening efficacy for the HADS-T and subscales was modest. However, removal of misfitting items had little impact on screening, demonstrating that items could potentially be omitted, if required. The item range covered a narrow spectrum of psychological distress, predominantly higher levels of distress. Additional items have to be added if screening for moderate to mild distress is to be improved for cancer patients.
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Affiliation(s)
- A B Smith
- Cancer Research UK-Psychosocial and Clinical Practice Group, St. James's University Hospital, Leeds LS9 7TF, UK.
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Abstract
Anxiety is common in cancer patient populations, and must often initially be recognized and managed by cancer care professionals. This article reviews the recent oncology and mental health literature on anxiety. The aim is to help those involved in cancer patient care who are not specialists in mental health to understand the nature of anxiety, and discriminate morbid from normal anxiety. We review recent research into the association of anxiety with events during diagnosis and management of cancer, highlighting the importance of the meaning of events to an individual as an important factor in making people anxious. Lastly we review management strategies which might be used by cancer care professionals, in particular the importance of an awareness of specific patterns of communication which may alleviate or maintain anxiety for some cancer patients.
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Affiliation(s)
- D P Stark
- ICRF Department of Medical Oncology, St James's University Hospital, Beckett Street, Leeds, LS9 7TF
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Stiegler M, Blankenship J, Stark DP, Nieto A, Holmes F, Konow A, Dyment PG. Forum. PHYSICIAN SPORTSMED 1990; 18:32-8. [PMID: 27447581 DOI: 10.1080/00913847.1990.11710131] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A Forum for Our Readers Jim Blankenship, MD Danville, Pennsylvania Forum is intended to provide a sounding board for our readers. Perhaps you have a special way to treat a common medical problem, or you may want to air your views on a controversial topic. You may object to an article that we have published, or you may want to support one. You may have a new trend to report, identified through an interesting case or a series of patients. Whatever your ideas, we invite you to send them to us. Illustrative figures are welcomed. Address correspondence to Forum, THE PHYSICIAN AND SPORTSMEDICINE, 4530 W 77th St, Minneapolis, MN 55435.
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Affiliation(s)
| | | | | | - A Nieto
- c Tectrix Fitness Equipment Irvine , California
| | - F Holmes
- e StairMaster Exercise Systems Tulsa , Oklahoma
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