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Ng CA, Luckett T, Mulhern B, Kee D, Lai-Kwon J, Joshua AM. What matters most to people with metastatic uveal melanoma? A qualitative study to inform future measurement of health-related quality of life. Melanoma Res 2024; 34:248-257. [PMID: 38469755 PMCID: PMC11045555 DOI: 10.1097/cmr.0000000000000961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/10/2024] [Indexed: 03/13/2024]
Abstract
Metastatic uveal melanoma (mUM) is a rare cancer with poor prognosis, but novel treatments are emerging. Currently, there are no mUM-specific health-related quality of life (HRQL) questionnaires available for clinical research. We aimed to explore how mUM and its treatment affect HRQL and assess the content validity of existing questionnaires. Participants were patients with mUM and healthcare professionals involved in their care. Qualitative data were collected using semi-structured interviews and focus groups. Data collection and analysis used an integrative approach involving inductive questions/coding to elicit new concepts and deductive questions/coding based on domains of existing HRQL questionnaires. Initial interviews/focus groups focussed on HRQL questionnaires designed for patients with uveal melanoma or liver metastases. As new concepts were elicited, domains and items from other questionnaires were subsequently added. Seventeen patients and 16 clinicians participated. HRQL concerns assessed by uveal melanoma-specific questionnaires were largely resolved by the time of metastasis. The Functional Assessment of Cancer Therapy - Immunotherapy Module (FACT-ICM) adequately captured most immunotherapy-related side effects during initial treatment cycles. However, most patients emphasised emotional impacts over physical ones, focussing on the existential threat posed by disease amidst uncertainty about treatment accessibility and effectiveness. Patients were also concerned with treatment burden, including time commitment, travel, need for hospitalisation, and expenses. The relative importance of HRQL issues varied over time and across treatment modalities, with no single questionnaire being sufficient. Pending further development and psychometric testing, clinical researchers may need to take a modular approach to measuring the HRQL impacts of mUM.
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Affiliation(s)
- Carrie-Anne Ng
- Centre for Health Economics Research and Evaluation (CHERE), Faculty of Health, University of Technology Sydney
| | - Tim Luckett
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, NSW
| | - Brendan Mulhern
- Centre for Health Economics Research and Evaluation (CHERE), Faculty of Health, University of Technology Sydney
| | - Damien Kee
- Department of Medical Oncology, Austin Health
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria
| | - Julia Lai-Kwon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria
- Melanoma Institute Australia, The University of Sydney
| | - Anthony M. Joshua
- Melanoma Institute Australia, The University of Sydney
- The Kinghorn Cancer Centre, Saint Vincent’s Hospital, Darlinghurst, NSW, Australia
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Egeler M, Lai-Kwon J, Tissier R, Fraterman I, Kuijpers A, Van Houdt W, Wilgenhof S, Rao A, Sandhu S, Lee R, Eriksson H, van Leeuwen M, de Ligt K, van Akkooi A, van de Poll-Franse L. Real-world health-related quality of life outcomes for patients with resected stage III/IV melanoma treated with adjuvant anti-PD1 therapy. Eur J Cancer 2024; 200:113601. [PMID: 38340383 DOI: 10.1016/j.ejca.2024.113601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND While adjuvant therapy with anti-programmed cell death protein-1 (anti-PD1) for patients with resected stage III/IV melanoma has been shown to improve recurrence-free survival, the overall survival benefit remains uncertain. This study aims to evaluate the impact of adjuvant anti-PD1 therapy on the health-related quality of life (HRQOL) of patients with resected stage III/IV melanoma METHODS: Data was used from two melanoma registries in Australia and the Netherlands. Patients with resected stage III/IV melanoma treated with adjuvant anti-PD1 who completed a baseline and at least one post-baseline HRQOL assessment were included. HRQOL was assessed using the EORTC QLQ-C30 at baseline, 3, 6, and 12 months. Established thresholds were used for interpreting changes in QLQ-C30 scores. RESULTS 92 patients were included. Mean symptom and functioning scores improved or remained stable at 12 months compared to baseline. However, a substantial proportion of patients experienced a clinically significant decline in role (39%, μ = -50.8), social (41%, μ = -32.7), or emotional (50%, μ = -25.1) functioning at 12 months compared to baseline. Younger patients were more likely to experience clinically significant deteriorations in role (OR=1.07, 95% CI: 1.02-1.13, p < 0.01) and social (OR=1.06, 95% CI: 1.01-1.11, p = 0.013) functioning. CONCLUSION A significant proportion of patients with resected stage III/IV melanoma who received adjuvant anti-PD1 experienced clinically significant declines in role, social and emotional functioning at 12 months compared to baseline. This highlights the HRQOL issues that may arise during adjuvant anti-PD1 therapy which may require supportive care intervention.
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Affiliation(s)
- Mees Egeler
- Department of Psychosocial Oncology and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - Julia Lai-Kwon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Renaud Tissier
- Department of Psychosocial Oncology and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Itske Fraterman
- Department of Psychosocial Oncology and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Anke Kuijpers
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Winan Van Houdt
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Sofie Wilgenhof
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Aparna Rao
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Shahneen Sandhu
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Rebecca Lee
- Department of Medical Oncology, Christie NHS Foundation Trust, Manchester, UK, University of Manchester, Manchester, UK
| | - Hanna Eriksson
- Theme Cancer, Unit of Head-Neck-, Lung-, and Skin Cancer, Skin Cancer Center, Karolinska University Hospital, SE-17176 Stockholm, Sweden; Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Marieke van Leeuwen
- Department of Psychosocial Oncology and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Kelly de Ligt
- Department of Psychosocial Oncology and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Lonneke van de Poll-Franse
- Department of Psychosocial Oncology and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
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Lai-Kwon J, Rutherford C, Jefford M, Gore C, Best S. Using Implementation Science Frameworks to Guide the Use of Electronic Patient-Reported Outcome Symptom Monitoring in Routine Cancer Care. JCO Oncol Pract 2024; 20:335-349. [PMID: 38206290 DOI: 10.1200/op.23.00462] [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: 07/26/2023] [Revised: 11/02/2023] [Accepted: 11/20/2023] [Indexed: 01/12/2024] Open
Abstract
PURPOSE Electronic patient-reported outcomes (ePROs) are an evidence-based means of detecting symptoms earlier and improving patient outcomes. However, there are few examples of successful implementation in routine cancer care. We conducted a qualitative study to identify barriers and facilitators to implementing ePRO symptom monitoring in routine cancer care using the Consolidated Framework for Implementation Research (CFIR). METHODS Participants were adult patients with cancer, their caregivers, or health care professionals involved in ePRO monitoring or processes. Focus groups or individual interviews were conducted using a semistructured approach informed by the CFIR. Data were analyzed deductively using the CFIR. Barriers were matched to theory-informed implementation strategies using the CFIR-Expert Recommendations for Implementing Change (ERIC) matching tool. RESULTS Thirty participants were interviewed: 22 females (73%), aged 31-70 years (28, 94%), comprising patients (n = 8), caregivers (n = 2), medical oncologists (n = 4), nurses (n = 4), hospital leaders (n = 6), clinic administrators (n = 2), pharmacists (n = 2), and information technology specialists (n = 2). Barriers pertaining to four CFIR domains were identified and several were novel, including the challenge of adapting ePROs for different anticancer treatments. Facilitators pertaining to all CFIR domains were identified, such as leveraging acceptability of remote care post-COVID-19 to drive implementation. Conducting consensus discussions with stakeholders to tailor ePROs to the local setting, identifying/preparing individual and group-level champions, and assessing readiness for change (including leveraging technological advances and increased confidence in using remote monitoring post-COVID-19) were the most frequently recommended implementation strategies. CONCLUSION The CFIR facilitated identification of known and novel barriers and facilitators to implementing ePRO symptom monitoring in routine cancer care. Implementation strategies summarized in a conceptual framework will be used to codesign an ePRO symptom monitoring system for immunotherapy side effects.
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Affiliation(s)
- Julia Lai-Kwon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Claudia Rutherford
- Cancer Care Research Unit (CCRU), Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Michael Jefford
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Claire Gore
- Department of Psychology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Stephanie Best
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
- Department of Psychology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Australian Genomics, Murdoch Childrens Research Institute, Melbourne, Australia
- Victorian Comprehensive Cancer Centre Alliance, Melbourne, Australia
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Lopez J, Lai-Kwon J, Molife R, Welsh L, Tunariu N, Roda D, Fernández-García P, Lladó V, McNicholl AG, Rosselló CA, Taylor RJ, Azaro A, Rodón J, Sludden J, Veal GJ, Plummer R, Urruticoechea A, Lahuerta A, Mujika K, Escribá PV. A Phase 1/2A trial of idroxioleic acid: first-in-class sphingolipid regulator and glioma cell autophagy inducer with antitumor activity in refractory glioma. Br J Cancer 2023; 129:811-818. [PMID: 37488446 PMCID: PMC10449773 DOI: 10.1038/s41416-023-02356-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 06/25/2023] [Accepted: 06/28/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND The first-in-class brain-penetrating synthetic hydroxylated lipid idroxioleic acid (2-OHOA; sodium 2-hydroxyoleate), activates sphingomyelin synthase expression and regulates membrane-lipid composition and mitochondrial energy production, inducing cancer cell autophagy. We report the findings of a multicentric first-in-human Phase 1/2A trial (NCT01792310) of 2-OHOA, identifying the maximum tolerated dose (MTD) and assessing safety and preliminary efficacy. METHODS We performed an open-label, non-randomised trial to evaluate the safety, tolerability, pharmacokinetics, pharmacodynamics and anti-tumour activity of daily oral treatment with 2-OHOA monotherapy (BID/TID) in 54 patients with glioma and other advanced solid tumours. A dose-escalation phase using a standard 3 + 3 design was performed to determine safety and tolerability. This was followed by two expansion cohorts at the MTD to determine the recommended Phase-2 dose (RP2D). RESULTS In total, 32 recurrent patients were enrolled in the dose-escalation phase (500-16,000 mg/daily). 2-OHOA was rapidly absorbed with dose-proportional exposure. Treatment was well-tolerated overall, with reversible grade 1-2 nausea, vomiting, and diarrhoea as the most common treatment-related adverse events (AEs). Four patients had gastrointestinal dose-limiting toxicities (DLTs) of nausea, vomiting, diarrhoea (three patients at 16,000 mg and one patient at 12,000 mg), establishing an RP2D at 12,000 mg/daily. Potential activity was seen in patients with recurrent high-grade gliomas (HGG). Of the 21 patients with HGG treated across the dose escalation and expansion, 5 (24%) had the clinical benefit (RANO CR, PR and SD >6 cycles) with one exceptional response lasting >2.5 years. CONCLUSIONS 2-OHOA demonstrated a good safety profile and encouraging activity in this difficult-to-treat malignant brain-tumour patient population, placing it as an ideal potential candidate for the treatment of glioma and other solid tumour malignancies. CLINICAL TRIAL REGISTRATION EudraCT registration number: 2012-001527-13; Clinicaltrials.gov registration number: NCT01792310.
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Affiliation(s)
- Juanita Lopez
- The Royal Marsden Hospital and the Institute of Cancer Research, Sutton, UK.
| | - Julia Lai-Kwon
- The Royal Marsden Hospital and the Institute of Cancer Research, Sutton, UK
| | - Rhoda Molife
- The Royal Marsden Hospital and the Institute of Cancer Research, Sutton, UK
| | - Liam Welsh
- The Royal Marsden Hospital and the Institute of Cancer Research, Sutton, UK
| | - Nina Tunariu
- The Royal Marsden Hospital and the Institute of Cancer Research, Sutton, UK
| | - Desamparados Roda
- The Royal Marsden Hospital and the Institute of Cancer Research, Sutton, UK
| | | | | | | | | | | | | | | | | | - Gareth J Veal
- Northern Centre for Cancer Care, Newcastle upon Tyne, UK
| | - Ruth Plummer
- Northern Centre for Cancer Care, Newcastle upon Tyne, UK
| | | | | | - Karmele Mujika
- Gipuzkoa Cancer Unit, OSID-Onkologikoa, San Sebastián, Spain
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Lai-Kwon J, Dushyanthen S, Seignior D, Barrett M, Buisman-Pijlman F, Buntine A, Woodward-Kron R, McArthur G, Kok DL. Designing a wholly online, multidisciplinary Master of Cancer Sciences degree. BMC Med Educ 2023; 23:544. [PMID: 37525150 PMCID: PMC10391849 DOI: 10.1186/s12909-023-04537-1] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/25/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Improving oncology-specific knowledge and skills of healthcare professionals is critical for improving the outcomes of people with cancer. Many current postgraduate education offerings may be inaccessible to busy professionals, contain minimal consumer input or do not focus on the multidisciplinary nature of cancer care. In response to these needs, a Master of Cancer Sciences degree was developed. Our aim is to describe the development of the Master of Cancer Sciences. METHODS We describe the development of the Master of Cancer Sciences, including its theoretical and its pedagogical underpinnings. RESULTS Our approach to curriculum design was guided by Kern's Six-Step Approach to Medical Curriculum and underpinned by the Seven Principles of Online Learning. These approaches were further underpinned by the Cognitive Theory of Multimedia Learning which informed our approach to audio and visual information design. The pedagogy is interactive, experiential, interprofessional and importantly, includes consumers as educators. In practice, learning activities include peer feedback, multidisciplinary team meeting simulations, group work and clinical role plays. The online environment was visually shaped through infographics, high-quality educational videos and gamification. CONCLUSION We have designed a Master of Cancer Sciences that is one of the first wholly online, cancer-specific Masters' programs. Its industry-led curriculum using evidence-based pedagogical choices utilises a range of novel digital formats and integrates the consumer perspective to provide a holistic overview of the field. Quantitative and qualitative evaluation of learning outcomes is ongoing.
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Affiliation(s)
- Julia Lai-Kwon
- Victorian Comprehensive Cancer Centre (VCCC) Alliance, Melbourne, Australia
- Department of Medical Education, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
- Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, 3000, Australia
| | - Sathana Dushyanthen
- Centre for Digital Transformation of Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - David Seignior
- Melbourne School of Professional and Continuing Education, University of Melbourne, Melbourne, Australia
| | - Michelle Barrett
- Victorian Comprehensive Cancer Centre (VCCC) Alliance, Melbourne, Australia
| | - Femke Buisman-Pijlman
- Melbourne School of Professional and Continuing Education, University of Melbourne, Melbourne, Australia
| | - Andrew Buntine
- Melbourne School of Professional and Continuing Education, University of Melbourne, Melbourne, Australia
| | - Robyn Woodward-Kron
- Department of Medical Education, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Grant McArthur
- Victorian Comprehensive Cancer Centre (VCCC) Alliance, Melbourne, Australia
- Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, 3000, Australia
- Department of Clinical Pathology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia
| | - David L Kok
- Victorian Comprehensive Cancer Centre (VCCC) Alliance, Melbourne, Australia.
- Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, 3000, Australia.
- Department of Clinical Pathology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia.
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Lynch FA, Rodin G, Jefford M, Duffy M, Lai-Kwon J, Heynemann S, Mileshkin L, Briggs L, Burke J, Leigh L, Spelman T, Ftanou M. Evaluation of Managing Cancer and Living Meaningfully (CALM) in people with advanced non-small cell lung cancer treated with immunotherapies or targeted therapies: protocol for a single-arm, mixed-methods pilot study. BMJ Open 2023; 13:e072322. [PMID: 37524546 PMCID: PMC10391815 DOI: 10.1136/bmjopen-2023-072322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
INTRODUCTION People with advanced non-small cell lung cancer (NSCLC) treated with immunotherapies (IT) or targeted therapies (TT) may have improved outcomes in a subset of people who respond, raising unique psychological concerns requiring specific attention. These include the need for people with prolonged survival to reframe their life plans and tolerate uncertainty related to treatment duration and prognosis. A brief intervention for people with advanced cancer, Managing Cancer and Living Meaningfully (CALM), could help people treated with IT or TT address these concerns. However, CALM has not been specifically evaluated in this population. This study aims to evaluate the acceptability and feasibility of CALM in people with advanced NSCLC treated with IT or TT and obtain preliminary evidence regarding its effectiveness in this population. METHODS AND ANALYSIS Twenty people with advanced NSCLC treated with IT or TT will be recruited from Peter MacCallum Cancer Centre, Melbourne, Australia. Participants will complete three to six sessions of CALM delivered over 3-6 months. A prospective, single-arm, mixed-methods pilot study will be conducted. Participants will complete outcome measures at baseline, post-intervention, 3 months and 6 months, including Patient Health Questionnaire, Death and Dying Distress Scale, Functional Assessment of Cancer Therapy General and Clinician Evaluation Questionnaire. The acceptability of CALM will be assessed using patient experiences surveys and qualitative interviews. Feasibility will be assessed by analysis of recruitment rates, treatment adherence and intervention delivery time. ETHICS AND DISSEMINATION Ethics approval has been granted by the Peter MacCallum Cancer Centre Human Research Ethics Committee (HREC/82047/PMCC). Participants with cancer will complete a signed consent form prior to participation, and carers and therapists will complete verbal consent. Results will be made available to funders, broader clinicians and researchers through conference presentations and publications. If CALM is found to be acceptable in this cohort, this will inform a potential phase 3 trial.
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Affiliation(s)
- Fiona Anne Lynch
- Psychosocial Oncology Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Psychology Department, Andrew Love Cancer Centre, Barwon Health, Geelong, Victoria, Australia
| | - Gary Rodin
- Global Institute of Psychosocial, Palliative and End-of- Life Care (GIPPEC), Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Michael Jefford
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Health Services Research and Implementation Science, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Mary Duffy
- Lung Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Julia Lai-Kwon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Sarah Heynemann
- Department of Medical Oncology, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia
| | - Linda Mileshkin
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
- Lung Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Lisa Briggs
- Patient Representative, Melbourne, Victoria, Australia
| | - John Burke
- Patient Representative, Melbourne, Victoria, Australia
| | - Lilian Leigh
- Patient Representative, Sydney, New South Wales, Australia
| | - Tim Spelman
- Department of Health Services Research and Implementation Science, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Burnet Institute, Melbourne, Victoria, Australia
| | - Maria Ftanou
- Psychosocial Oncology Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
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Lai-Kwon J, Inderjeeth AJ, Lisy K, Sandhu S, Rutherford C, Jefford M. Corrigendum to 'Impact of immune checkpoint inhibitors and targeted therapy on health-related quality of life of people with stage III and IV melanoma: a mixed-methods systematic review [European Journal of Cancer 184 (2023) 83-105]. Eur J Cancer 2023:112937. [PMID: 37393172 DOI: 10.1016/j.ejca.2023.112937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2023]
Affiliation(s)
- Julia Lai-Kwon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia.
| | | | - Karolina Lisy
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia; Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Shahneen Sandhu
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Claudia Rutherford
- Cancer Nursing Research Unit (CNRU), Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Sydney Quality of Life Office, School of Psychology, Faculty of Science, The University of Sydney, Sydney, Australia
| | - Michael Jefford
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia; Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
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Thompson JR, Lai-Kwon J, Morton RL, Guminski AD, Gonzalez M, Atkinson V, Sandhu S, Brown MP, Menzies AM, McArthur GA, Lo SN, Long GV, Bartula I. Health-related quality of life in patients with melanoma brain metastases treated with immunotherapy. Immunotherapy 2023; 15:593-610. [PMID: 37132182 DOI: 10.2217/imt-2022-0262] [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] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
Aims: To describe the health-related quality of life (HRQoL) of melanoma brain metastasis (MBM) patients throughout the first 18 weeks of ipilimumab-nivolumab or nivolumab treatment. Materials & methods: HRQoL data (European Organisation for Research and Treatment of Cancer's Core Quality of Life Questionnaire, additional Brain Neoplasm Module, and EuroQol 5-Dimension 5-Level Questionnaire) were collected as a secondary outcome of the Anti-PD1 Brain Collaboration phase II trial. Mixed linear modeling assessed changes over time, whereas the Kaplan-Meier method was used to determine median time to first deterioration. Results: Asymptomatic MBM patients treated with ipilimumab-nivolumab (n = 33) or nivolumab (n = 24) maintained baseline HRQoL. MBM patients with symptoms or leptomeningeal/progressive disease treated with nivolumab (n = 14) reported a statistically significant trend toward improvement. Conclusion: MBM patients treated with either ipilimumab-nivolumab or nivolumab did not report a significant deterioration in HRQoL within 18 weeks of treatment initiation. Clinical trial registration: NCT02374242 (ClinicalTrials.gov).
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Affiliation(s)
- Jake R Thompson
- Melanoma Institute of Australia, The University of Sydney, Wollstonecraft, New South Wales, 2065, Australia
| | - Julia Lai-Kwon
- Department of Medical Oncology, Peter MacCallum Cancer Center, Melbourne, Victoria, 3000, Australia
| | - Rachael L Morton
- Melanoma Institute of Australia, The University of Sydney, Wollstonecraft, New South Wales, 2065, Australia
- National Health and Medical Research Council Clinical Trials Center, Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, 2050, Australia
| | - Alexander D Guminski
- Melanoma Institute of Australia, The University of Sydney, Wollstonecraft, New South Wales, 2065, Australia
- Royal North Shore & Mater Hospitals, Sydney, New South Wales, 2065, Australia
| | - Maria Gonzalez
- Melanoma Institute of Australia, The University of Sydney, Wollstonecraft, New South Wales, 2065, Australia
| | - Victoria Atkinson
- Princess Alexandra Hospital, Woolloongabba, Queensland, 4102, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, 4072, Australia
| | - Shahneen Sandhu
- Department of Medical Oncology, Peter MacCallum Cancer Center, Melbourne, Victoria, 3000, Australia
| | - Michael P Brown
- Translational Oncology Laboratory, Center for Cancer Biology, SA Pathology & University of South Australia, Adelaide, South Australia, 5001, Australia
- Cancer Clinical Trials Unit, Royal Adelaide Hospital, Adelaide, South Australia, 5000, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, 5005, Australia
| | - Alexander M Menzies
- Melanoma Institute of Australia, The University of Sydney, Wollstonecraft, New South Wales, 2065, Australia
- Royal North Shore & Mater Hospitals, Sydney, New South Wales, 2065, Australia
- Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, 2006, Australia
| | - Grant A McArthur
- Department of Medical Oncology, Peter MacCallum Cancer Center, Melbourne, Victoria, 3000, Australia
| | - Serigne N Lo
- Melanoma Institute of Australia, The University of Sydney, Wollstonecraft, New South Wales, 2065, Australia
- Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, 2006, Australia
| | - Georgina V Long
- Melanoma Institute of Australia, The University of Sydney, Wollstonecraft, New South Wales, 2065, Australia
- Royal North Shore & Mater Hospitals, Sydney, New South Wales, 2065, Australia
- Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, 2006, Australia
- Charles Perkins Center, The University of Sydney, Sydney, New South Wales, 2006, Australia
| | - Iris Bartula
- Melanoma Institute of Australia, The University of Sydney, Wollstonecraft, New South Wales, 2065, Australia
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Lai-Kwon J, Cohen JE, Lisy K, Rutherford C, Girgis A, Basch E, Jefford M. The Feasibility, Acceptability, and Effectiveness of Electronic Patient-Reported Outcome Symptom Monitoring for Immune Checkpoint Inhibitor Toxicities: A Systematic Review. JCO Clin Cancer Inform 2023; 7:e2200185. [PMID: 37220322 DOI: 10.1200/cci.22.00185] [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] [Received: 12/02/2022] [Revised: 03/07/2023] [Accepted: 03/30/2023] [Indexed: 05/25/2023] Open
Abstract
PURPOSE Increasing use of immune checkpoint inhibitors (ICIs) in routine cancer care will increase the incidence of immune-related adverse events (irAEs). Systems are needed to support remote monitoring for irAEs. Electronic patient-reported outcome (ePRO) symptom monitoring systems can help monitor and manage symptoms and side effects. We assessed the content and features of ePRO symptom monitoring systems for irAEs, and their feasibility, acceptability, and impact on patient outcomes and health care utilization. METHODS A systematic literature search was conducted in May 2022 on MEDLINE, Embase, PsycINFO, and Cochrane Central Register of Controlled Trials. Quantitative and qualitative data relevant to the review questions were extracted and synthesized in tables. RESULTS Seven papers describing five ePRO systems were included. All systems collected PROs between clinic visits. Two of five used validated symptom questionnaires, 3/5 provided prompts to complete questionnaires, 4/5 provided reminders to self-report, and 3/5 provided clinician alerts for severe/worsening side effects. Four of five provided coverage of ≥26/30 irAEs in the ASCO irAE guideline. Feasibility and acceptability were demonstrated with consent rates of 54%-100%, 17%-27% of questionnaires generating alerts, and adherence rates of 74%-75%. One paper showed a reduction in grade 3-4 irAEs, treatment discontinuation, clinic visit duration, and emergency department presentations, while another showed no difference in these outcomes or the rate of steroid use. CONCLUSION There is preliminary evidence of the feasibility and acceptability of ePRO symptom monitoring for irAEs. However, further studies are needed to confirm the impact on ICI-specific outcomes, such as the frequency of grade 3-4 irAEs and duration of immunosuppression. Suggestions for the content and features of future ePRO systems for irAEs are provided.
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Affiliation(s)
- Julia Lai-Kwon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Jordan E Cohen
- Liverpool Hospital, South-Western Sydney Local Health District, Sydney, NSW, Australia
| | - Karolina Lisy
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Claudia Rutherford
- Sydney Quality of Life Office, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
- Cancer Care Research Unit (CCRU), Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Afaf Girgis
- South-West Sydney Clinical Campuses, University of New South Wales Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Ethan Basch
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Michael Jefford
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
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10
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Looman EL, Cheng PF, Lai-Kwon J, Morgan L, Wakkee M, Dummer R, Dimitriou F. Health-related quality of life in survivors of advanced melanoma treated with anti-PD1-based immune checkpoint inhibitors. Cancer Med 2023. [PMID: 37119050 DOI: 10.1002/cam4.5967] [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] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 03/11/2023] [Accepted: 04/06/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) have significantly improved survival in advanced melanoma but are associated with immune-related adverse events (irAEs). This single center, cross-sectional survey aimed to describe the long-term symptom burden and impact on health-related quality of life (HRQL) of advanced melanoma patients with sustained disease control following treatment with ICIs. METHODS Advanced melanoma patients (stage IIB, III or IV, AJCCv8), treated with anti-PD1-based ICIs, who were off-treatment and had at least 6 months follow-up from their last infusion with an ongoing response in the metastatic setting or no evidence of disease recurrence in the adjuvant setting. A paper-based questionnaire, consisting of the EORTC QLQ-C30, EORTC QLQ-FA12, and the PRO-CTCAE was administered. RESULTS Of 90 participants, 61 (68%) completed the questionnaire; 40 received single-agent anti-PD1, and 21 anti-PD1/anti-CTLA4. Thirty-three (54%) were treated in the adjuvant setting. At the time of enrolment, 31 (51%) participants had active treatment for a previous irAE. Overall, 18/61 (30%) participants reported long-term symptoms and trouble in physical and emotional functioning. Physical fatigue was common and interfered with daily activities (n = 12, 20%). In the PRO-CTCAE questionnaire, muscle ache (n = 12, 20%) and joint ache (n = 9, 15%) were commonly reported. Despite this, participants reported overall good health (6.00, range 2.00-7.00) and reasonable level of HRQL (6.00, range 3.00-7.00). DISCUSSION Melanoma survivors experience long-term symptoms in physical and psychosocial HRQL domains after ICI treatment. These results underline the importance to address existing gaps in survivorship care, implement these findings in clinical practice and increase awareness for long-term symptoms in these patients.
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Affiliation(s)
- E L Looman
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - P F Cheng
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - J Lai-Kwon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - L Morgan
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - M Wakkee
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - R Dummer
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - F Dimitriou
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
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11
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Sodergren SC, Johnson CD, Gilbert A, Darlington AS, Cocks K, Guren MG, Rivin Del Campo E, Brannan C, Christensen P, Chu W, Chung H, Dennis K, Desideri I, Gilbert DC, Glynne-Jones R, Jefford M, Johansson M, Johnsson A, Juul T, Kardamakis D, Lai-Kwon J, McFarlane V, Miguel IMC, Nugent K, Peters F, Riechelmann RP, Turhal NS, Wong S, Vassiliou V. International Validation of the EORTC QLQ-ANL27, a Field Study to Test the Anal Cancer-Specific Health-Related Quality-of-Life Questionnaire. Int J Radiat Oncol Biol Phys 2023; 115:1155-1164. [PMID: 36402360 DOI: 10.1016/j.ijrobp.2022.11.002] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/26/2022] [Accepted: 11/01/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE The European Organisation for Research and Treatment of Cancer (EORTC) health-related quality of life questionnaire for anal cancer (QLQ-ANL27) supplements the EORTC cancer generic measure (QLQ-C30) to measure concerns specific to people with anal cancer treated with chemoradiotherapy. This study tested the psychometric properties and acceptability of the QLQ-ANL27. METHODS AND MATERIALS People with anal cancer were recruited from 15 countries to complete the QLQ-C30 and QLQ-ANL27 and provide feedback on the QLQ-ANL27. Item responses, scale structure (multitrait scaling, factor analysis), reliability (internal consistency and reproducibility) and sensitivity (known group comparisons and responsiveness to change) of the QLQ-ANL27 were evaluated. RESULTS Data from 382 people were included in the analyses. The EORTC QLQ-ANL27 was acceptable, comprehensive, and easy to complete, taking an average 8 minutes to complete. Psychometric analyses supported the EORTC QLQ-ANL27 items and reliability (Cronbach's α ranging from 0.71-0.93 and test-retest coefficients above 0.7) and validity of the scales (particularly nonstoma bowel symptoms and pain/discomfort). Most scales distinguished people according to treatment phase and performance status. Bowel (nonstoma), pain/discomfort, and vaginal symptoms were sensitive to deteriorations over time. The stoma-related scales remained untested because of low numbers of people with a stoma. Revisions to the scoring and question ordering of the sexual items were proposed. CONCLUSIONS The QLQ-ANL27 has good psychometric properties and is available in 16 languages for people treated with chemoradiotherapy for anal cancer. It is used in clinical trials and has a potential role in clinical practice.
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Affiliation(s)
| | | | - Alexandra Gilbert
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, United Kingdom
| | | | - Kim Cocks
- KCStats Consultancy, Cheshire, United Kingdom
| | - Marianne G Guren
- Department of Oncology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Eleonor Rivin Del Campo
- Department of Radiation Oncology, Tenon University Hospital, Sorbonne University, Paris, France
| | | | | | - William Chu
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Hans Chung
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Kristopher Dennis
- The Ottawa Hospital Cancer Centre, Ottawa, Canada; Department of Radiology, University of Ottawa, Ottawa, Canada
| | - Isacco Desideri
- Radiotherapy Department, University of Florence, Florence, Italy
| | - Duncan C Gilbert
- Sussex Cancer Centre, Royal Sussex County Hospital, Eastern Road, Brighton, United Kingdom
| | | | - Michael Jefford
- Departments of Medical Oncology and Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Mia Johansson
- Department of Oncology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Department of Oncology, University of Gothenburg, Gothenburg, Sweden
| | - Anders Johnsson
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Therese Juul
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Dimitrios Kardamakis
- Department of Radiation Oncology, University of Patras Medical School, Patras, Greece
| | - Julia Lai-Kwon
- Departments of Medical Oncology and Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Vicky McFarlane
- University Hospital Southampton, Southampton, United Kingdom
| | | | - Karen Nugent
- University Hospital Southampton, Southampton, United Kingdom
| | - Femke Peters
- Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | | | - Shun Wong
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Vassilios Vassiliou
- Department of Radiation Oncology, Bank of Cyprus Oncology Center, Nicosia, Cyprus
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12
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Lai-Kwon J, Jacques S, Carlino M, Benannoune N, Robert C, Allayous C, Baroudjian B, Lebbe C, Zimmer L, Eroglu Z, Topcu TO, Dimitriou F, Haydon A, Lo SN, Menzies AM, Long GV. Efficacy of ipilimumab 3mg/kg following progression on low dose ipilimumab in metastatic melanoma. Eur J Cancer 2023; 186:12-21. [PMID: 37018924 DOI: 10.1016/j.ejca.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/15/2023] [Accepted: 03/04/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Differing doses of ipilimumab (IPI) are used in combination with an anti-PD1 antibody in advanced melanoma. There is no data on the outcomes of patients who progress following low-dose IPI (< 3 mg/kg) and are subsequently treated with IPI 3 mg/kg (IPI3). We conducted a multicentre retrospective survey to assess the efficacy of this strategy. METHODS Patients with resected stage III, unresectable stage III or IV melanoma who received low dose IPI (< 3 mg/kg) with an anti-PD1 antibody with recurrence (neo/adjuvant) or progressive disease (metastatic), who then received IPI3± anti-PD1 antibody were eligible. Best investigator-determined Response Evaluation Criteria in Solid Tumours response, progression-free survival (PFS) and overall survival (OS) were analysed. RESULTS Total 36 patients received low-dose IPI with an anti-PD1 antibody, 18 (50%) in the neo/adjuvant and 18 (50%) in the metastatic setting. Of which, 20 (56%) had primary resistance and 16 (44%) had acquired resistance. All patients received IPI3 for unresectable stage III or IV melanoma; median age 60 (29-78), 18 (50%) M1d disease, 32 (89%) Eastern Cooperative Oncology Group performance status 0-1. Around 35 (97%) received IPI3 with nivolumab and 1 received IPI3 alone. The response rate to IPI3 was 9/36 (25%). In patients with primary resistance, the response rate was 6/20 (30%). After a median follow-up of 22 months (95% CI: 15-27 months), the median PFS and OS were not reached in patients who responded; 1-year PFS and OS were 73% and 100%, respectively. CONCLUSIONS IPI3 following recurrence/progression on low dose IPI has clinical activity, including in primary resistance. IPI dosing is therefore critical in a subset of patients.
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13
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Egeler MD, van Leeuwen M, Fraterman I, van den Heuvel NMJ, Boekhout AH, Lai-Kwon J, Wilthagen EA, Eriksson H, Haanen JB, Wilgenhof S, Ascierto PA, van Akkooi ACJ, van de Poll-Franse LV. Common toxicities associated with immune checkpoint inhibitors and targeted therapy in the treatment of melanoma: A systematic scoping review. Crit Rev Oncol Hematol 2023; 183:103919. [PMID: 36736511 DOI: 10.1016/j.critrevonc.2023.103919] [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: 07/08/2022] [Revised: 11/23/2022] [Accepted: 01/20/2023] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION This systematic scoping review compares the toxicities experienced by patients receiving immune checkpoint inhibitors (ICIs) or targeted therapy (TT) for stage III (resected and unresectable) and stage IV melanoma. METHODS OVID Medline, Embase, and PsycInfo were searched to identify Phase III trials reporting toxicities of FDA-approved ICIs and TT for advanced melanoma. AEs that were reported by ≥ 10% of patients in the evaluated trials were included. RESULTS Toxicity profiles of 11208 patients from 24 studies were reviewed. The rate of AEs was lower with ICIs compared to TT. However, ICIs were associated with higher rates of long-term or permanent AEs compared to TT, where toxicities generally were shortterm and reversible with treatment discontinuation. CONCLUSION The toxicity profiles of ICIs and TT vary substantially. Whilst the rate of AEs was lower with ICIs than during TT, it was also associated with higher rates of potentially chronic AEs.
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Affiliation(s)
- Mees D Egeler
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - Marieke van Leeuwen
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Itske Fraterman
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Noelle M J van den Heuvel
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Annelies H Boekhout
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Julia Lai-Kwon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Erica A Wilthagen
- Scientific Information Service, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Hanna Eriksson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Medical Unit Head-Neck-, Lung-, Skin Cancer, Skin Cancer Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - John B Haanen
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Sofie Wilgenhof
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Paolo A Ascierto
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Napoli, Italy
| | - Alexander C J van Akkooi
- Melanoma Institute Australia, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Lonneke V van de Poll-Franse
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands; Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, Tilburg, the Netherlands
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14
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Lai-Kwon J, Heynemann S, Hart NH, Chan RJ, Smith TJ, Nekhlyudov L, Jefford M. Evolving Landscape of Metastatic Cancer Survivorship-Reconsidering Clinical Care, Policy, and Research Priorities for the Modern Era. J Clin Oncol 2023:JCO2202212. [PMID: 36848622 DOI: 10.1200/jco.22.02212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Affiliation(s)
- Julia Lai-Kwon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Sarah Heynemann
- Department of Medical Oncology, St Vincent's Hospital, Melbourne, VIC, Australia.,Sydney Health Ethics, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Nicolas H Hart
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.,Centre for IMPACCT, School of Sport, Exercise and Rehabilitation, Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia.,Exercise Medicine Research Institute, School of Medical and Health Science, Edith Cowan University, Perth, WA, Australia.,Institute for Health Research, The University of Notre Dame Australia, Perth, WA, Australia
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Thomas J Smith
- Division of General Internal Medicine, Section of Palliative Medicine, Johns Hopkins Medical Institutions, New York, NY.,Sidney Kimmel Comprehensive Cancer Centre, Johns Hopkins Hospital, Baltimore, MD
| | | | - Michael Jefford
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
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15
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Lai-Kwon J, Inderjeeth AJ, Lisy K, Sandhu S, Rutherford C, Jefford M. Impact of immune checkpoint inhibitors and targeted therapy on health-related quality of life of people with stage III and IV melanoma: a mixed-methods systematic review. Eur J Cancer 2023; 184:83-105. [PMID: 36907021 DOI: 10.1016/j.ejca.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/19/2023]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICI) and targeted therapies (TT) have significantly improved disease control and survival in people with stage III and IV cutaneous melanoma. Understanding the impact of therapy on health-related quality of life (HRQL) is vital for treatment decision-making and determining targets for supportive care intervention. We conducted a mixed-methods systematic review to synthesise the impact of ICIs and TT on all domains of HRQL in these populations. METHODS A systematic literature search was conducted in April 2022 on MEDLINE, PsycINFO, Embase and the Cochrane Central Register of Controlled Trials. Quantitative and qualitative data relevant to the review question were extracted and synthesised in tables according to setting (adjuvant versus metastatic), treatment type (ICI versus TT) and HRQL issue. RESULTS Twenty-eight papers describing 27 studies were included: 15 randomised controlled trials (RCTs), four cohort studies, four single arm cross-sectional studies, two qualitative studies, one case control study and one mixed-methods study. In four studies of people with resected stage III melanoma, adjuvant pembrolizumab and dabrafenib-trametinib did not clinically or statistically change HRQL compared to baseline. In 17 studies of people with unresectable stage III/IV melanoma, inconsistencies in the impact of ICI on symptoms, functioning and overall HRQL were noted across different study designs. TT was associated with improvements in symptoms, functioning and HRQL across six studies. CONCLUSION This review highlights the key physical, psychological and social issues experienced by people with stage III and IV melanoma treated with ICI and TT. Inconsistencies in the impact of ICI on HRQL were observed in different study designs. This highlights the need for treatment-specific patient-reported outcome measures for determining the impact of these therapies on HRQL and real-world data to inform treatment decision-making and appropriate supportive care interventions.
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Affiliation(s)
- Julia Lai-Kwon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia.
| | | | - Karolina Lisy
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia; Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Shahneen Sandhu
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Claudia Rutherford
- Cancer Nursing Research Unit (CNRU), Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Sydney Quality of Life Office, School of Psychology, Faculty of Science, The University of Sydney, Sydney, Australia
| | - Michael Jefford
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia; Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
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16
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Flore J, Kokanović R, Broom A, Heynemann S, Lai-Kwon J, Jefford M. Entanglements and imagined futures: The subject(s) of precision in oncology. Soc Sci Med 2023; 317:115608. [PMID: 36549013 DOI: 10.1016/j.socscimed.2022.115608] [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: 03/24/2022] [Revised: 12/02/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022]
Abstract
Precision oncology holds an increasingly powerful social function. In the era of precision, how people encounter, live with, and experience cancer, how they imagine their lives, how they navigate treatment regimens, and experience side effects, have been radically transformed. Innovations in oncology - in this case precision-related - are always more-than-clinical; their circulation exceeds the laboratory and the hospital, but what this 'circulation of innovation' produces has been thus far opaque. To begin to comprehend what is emergent at the cancer-precision nexus in people's everyday lives, we draw on qualitative interviews with twenty people diagnosed with metastatic non-small cell lung cancer undergoing immunotherapy and/or targeted therapy and we discuss how precision inflects survivorship, entangles subjects in chronic living, and induces novel temporalities. Through such inflections of survivorship, precision innovation re-shapes expectations and possibilities, and sometimes enacts new, unexpected (or, for some, unwanted) futures. Such illness and survivorship narratives indicate the importance of orientating the social science scholarship toward considerations of temporality and entanglements for comprehending precision innovation in oncology. And in doing so, provide a nuanced account of how innovations unsettle and recast, rather than unravel, the normative scene of cancer.
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Affiliation(s)
- Jacinthe Flore
- Social and Global Studies Centre, School of Global, Urban and Social Studies, RMIT University, Melbourne, Victoria, Australia.
| | - Renata Kokanović
- Social and Global Studies Centre, School of Global, Urban and Social Studies, RMIT University, Melbourne, Victoria, Australia
| | - Alex Broom
- Sydney Centre for Healthy Societies, School of Social and Political Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Sarah Heynemann
- Department of Medical Oncology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Julia Lai-Kwon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Michael Jefford
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
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17
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Dempsey K, Saw R, Bartula I, Lo S, Lawn C, Pennington T, Spillane A, Boyle F, Dong S, Dieng M, Milne D, Seaman L, Saks D, Lai-Kwon J, Thompson JR, Morton R. Embedding electronic patient-reported outcome measures into routine care for patients with stage III MELanoma (ePROMs-MEL): protocol for a prospective, longitudinal, mixed-methods pilot study. BMJ Open 2022; 12:e066852. [PMID: 36600423 PMCID: PMC9772660 DOI: 10.1136/bmjopen-2022-066852] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The benefits of patient-reported feedback, using questionnaires that allow patients to report how they feel and function without any interpretation from healthcare professionals, are well established. However, patient-reported outcomes measures (PROMs) are not routinely collected in patients with melanoma in Australia. The aim of this study is to evaluate the feasibility and acceptability of implementing electronic PROMs (ePROMs) into routine care from the perspectives of patients with stage III melanoma and their treating clinical team. METHODS AND ANALYSIS A minimum of 50 patients and 5 clinicians will be recruited to this prospective, longitudinal pilot study (ePROMs-MELanoma). The study uses a mixed-methods approach (quantitative PROMs questionnaires and end-of-study surveys with qualitative interviews) and commenced in May 2021 in surgical and medical melanoma clinics at two sites in metropolitan Sydney, Australia. The primary outcomes are measures of feasibility and acceptability, comprising descriptive questionnaire completion statistics, and proportion of patients who reported that these PROMs were easy to complete and measured items they considered important. Clinician and clinic staff views will be canvassed on the appropriateness of these PROMs for their patients, change in referral practice and uptake and incorporation into routine practice. Secondary aims include measurement of improvements in patients' emotional and physical health and well-being, and utility of real-time data capture and clinician feedback. All participants will complete the Distress Thermometer and EQ-5D-5L questionnaires in the clinic using a tablet computer at baseline and two to three subsequent follow-up appointments. Participants who report a score of 4 or higher on the Distress Thermometer will be triaged to complete an additional three questionnaires: the QLQ-C30, Depression, Anxiety and Stress Scale and Melanoma Concerns Questionnaire-28. Results will be generated in real time; patients with psychosocial distress or poor quality of life will discuss possible referral to appropriate allied health services with their clinician. Thematic analysis of interviews will be conducted. ETHICS AND DISSEMINATION Ethics approval obtained from St Vincent's Hospital Human Research Ethics Committee on 19 September 2019 (2019/ETH10558), with amendments approved on 8 June 2022. Patient consent is obtained electronically prior to questionnaire commencement. Dissemination strategies will include publication in peer-reviewed journals and presentation at international conferences, tailored presentations for clinical societies and government bodies, organisational reporting through multidisciplinary meetings and research symposia for local clinicians and clinic staff, and more informal, lay reports and presentations for consumer melanoma representative bodies and patient participants and their families. TRIAL REGISTRATION NUMBER ACTRN12620001149954.
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Affiliation(s)
- Kathy Dempsey
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Robyn Saw
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia
| | - Iris Bartula
- Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia
| | - Serigne Lo
- Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia
| | - Craig Lawn
- Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia
| | - Thomas Pennington
- Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia
| | - Andrew Spillane
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia
| | - Frances Boyle
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia
| | - Skye Dong
- Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia
| | - Mbathio Dieng
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Donna Milne
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Linda Seaman
- Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia
| | - Dina Saks
- Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia
| | - Julia Lai-Kwon
- Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia
| | | | - Rachael Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia
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18
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Lai-Kwon J, Vanderbeek AM, Minchom A, Lee Aiyegbusi O, Ogunleye D, Stephens R, Calvert M, Yap C. Using Patient-Reported Outcomes in Dose-Finding Oncology Trials: Surveys of Key Stakeholders and the National Cancer Research Institute Consumer Forum. Oncologist 2022; 27:768-777. [PMID: 35762393 PMCID: PMC9438918 DOI: 10.1093/oncolo/oyac117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/26/2022] [Indexed: 11/24/2022] Open
Abstract
Background Patient-reported adverse events may be a useful adjunct for assessing a drug’s tolerability in dose-finding oncology trials (DFOT). We conducted surveys of international stakeholders and the National Cancer Research Institute (NCRI) Consumer Forum to understand attitudes about patient-reported outcome (PRO) use in DFOT. Methods A 35-question survey of clinicians, trial managers, statisticians, funders, and regulators of DFOT was distributed via professional bodies examining experience using PROs, benefits/barriers, and their potential role in defining tolerable doses. An 8-question survey of the NCRI Consumer Forum explored similar themes. Results International survey: 112 responses from 15 September–30 November 2020; 103 trialists [48 clinicians (42.9%), 38 statisticians (34.0%), 17 trial managers (15.2%)], 7 regulators (6.3%), 2 funders (1.8%)]. Most trialists had no experience designing (73, 70.9%), conducting (52, 50.5%), or reporting (88, 85.4%) PROs in DFOT. Most agreed that PROs could identify new toxicities (75, 67.0%) and provide data on the frequency (86, 76.8%) and duration (81, 72.3%) of toxicities. The top 3 barriers were lack of guidance regarding PRO selection (73/103, 70.9%), missing PRO data (71/103, 68.9%), and overburdening staff (68/103, 66.0%). NCRI survey: 57 responses on 21 March 2021. A total of 28 (49.1%) were willing to spend <15 min/day completing PROs. Most (55, 96.5%) preferred to complete PROs online. 61 (54.5%) trialists and 57 (100%) consumers agreed that patient-reported adverse events should be used to inform dose-escalation decisions. Conclusion Stakeholders reported minimal experience using PROs in DFOT but broadly supported their use. Guidelines are needed to standardize PRO selection, analysis, and reporting in DFOT.
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Affiliation(s)
- Julia Lai-Kwon
- Drug Development Unit, The Institute of Cancer Research and Royal Marsden Hospital, London, UK
| | - Alyssa M Vanderbeek
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, Sutton, UK
| | - Anna Minchom
- Drug Development Unit, The Institute of Cancer Research and Royal Marsden Hospital, London, UK
| | - Olalekan Lee Aiyegbusi
- Centre for Patient-Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, UK
| | | | | | - Melanie Calvert
- Centre for Patient-Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, UK.,Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, UK.,National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, NIHR Surgical Reconstruction and Microbiology Research Centre and NIHR Applied Research Collaborative West Midlands, University of Birmingham, Birmingham, UK
| | - Christina Yap
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, Sutton, UK
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19
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Emery J, Butow P, Lai-Kwon J, Nekhlyudov L, Rynderman M, Jefford M. Management of common clinical problems experienced by survivors of cancer. Lancet 2022; 399:1537-1550. [PMID: 35430021 DOI: 10.1016/s0140-6736(22)00242-2] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 01/23/2022] [Accepted: 02/03/2022] [Indexed: 12/16/2022]
Abstract
Improvements in early detection and treatment have led to a growing prevalence of survivors of cancer worldwide. Models of care fail to address adequately the breadth of physical, psychosocial, and supportive care needs of those who survive cancer. In this Series paper, we summarise the evidence around the management of common clinical problems experienced by survivors of adult cancers and how to cover these issues in a consultation. Reviewing the patient's history of cancer and treatments highlights potential long-term or late effects to consider, and recommended surveillance for recurrence. Physical consequences of specific treatments to identify include cardiac dysfunction, metabolic syndrome, lymphoedema, peripheral neuropathy, and osteoporosis. Immunotherapies can cause specific immune-related effects most commonly in the gastrointestinal tract, endocrine system, skin, and liver. Pain should be screened for and requires assessment of potential causes and non-pharmacological and pharmacological approaches to management. Common psychosocial issues, for which there are effective psychological therapies, include fear of recurrence, fatigue, altered sleep and cognition, and effects on sex and intimacy, finances, and employment. Review of lifestyle factors including smoking, obesity, and alcohol is necessary to reduce the risk of recurrence and second cancers. Exercise can improve quality of life and might improve cancer survival; it can also contribute to the management of fatigue, pain, metabolic syndrome, osteoporosis, and cognitive impairment. Using a supportive care screening tool, such as the Distress Thermometer, can identify specific areas of concern and help prioritise areas to cover in a consultation.
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Affiliation(s)
- Jon Emery
- Centre for Cancer Research and Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia.
| | - Phyllis Butow
- PoCoG and CeMPED, School of Psychology SoURCe, Institute of Surgery, University of Sydney, Sydney, NSW, Australia
| | | | - Larissa Nekhlyudov
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Meg Rynderman
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Michael Jefford
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia; Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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20
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Lai-Kwon J, Kelly B, Lane S, Biviano R, Bartula I, Brennan F, Kivikoski I, Thompson J, Dhillon HM, Menzies A, Long GV. Feasibility, acceptability, and utility of a nurse-led survivorship program for people with metastatic melanoma (MELCARE). Support Care Cancer 2022; 30:9587-9596. [PMID: 36136246 PMCID: PMC9492451 DOI: 10.1007/s00520-022-07360-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/10/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Immune checkpoint inhibitors (ICIs) and targeted therapy (TT) have improved the survival of people with metastatic melanoma. We assessed the feasibility, acceptability, and utility of a novel model of nurse-led, telehealth-delivered survivorship care (MELCARE) for this survivor group. METHODS People ≥ 18 years diagnosed with unresectable stage III or stage IV melanoma who were ≥ 6 months post initiation of ICI/TT with a radiological response suggestive of a long-term response to ICI/TT were recruited from a specialist melanoma centre in Australia. All participants received MELCARE, a nurse-led survivorship program involving two telehealth consultations 3 months apart, needs assessment using the Distress Thermometer (DT) and Problem List, and creation of a survivorship care plan. Feasibility, acceptability, and utility were assessed using rates of consent and study completion, time taken to complete each component of MELCARE, the Acceptability of Intervention Measure (AIM), and a customised utility survey. RESULTS 31/54 (57%) people consented. Participants were male (21, 68%), with a median age of 67 (range: 46-82). Eleven (35%) were receiving/had received ipilimumab and nivolumab and 27 (87%) had ceased treatment. Feasibility was demonstrated with 97% completing MELCARE. Utility was demonstrated on a customised survey and supported by a reduction in the mean DT score (initial: 5.6, SD: 2.9; follow-up: 1.5, SD: 1.2). Acceptability was demonstrated on 3/4 AIM items. CONCLUSION MELCARE was feasible and acceptable with high levels of utility. However, the consent rate was 57% indicating some people do not require support. Future studies should consider MELCARE's optimal timing, resourcing, and cost-effectiveness.
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Affiliation(s)
| | - Brooke Kelly
- Melanoma Patients Australia, Varsity Lakes, Australia
| | - Sarah Lane
- Melanoma Institute Australia, Sydney, Australia
| | | | - Iris Bartula
- Melanoma Institute Australia, Sydney, Australia ,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | | | | | | | - Haryana M. Dhillon
- Centre for Medical Psychology & Evidence-Based Decision-Making, School of Psychology, Faculty of Science, University of Sydney, Sydney, Australia ,Psycho-Oncology Cooperative Group, School of Psychology, Faculty of Science, University of Sydney, Sydney, Australia
| | - Alexander Menzies
- Melanoma Institute Australia, Sydney, Australia ,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia ,Royal North Shore Hospital, Sydney, Australia ,Mater Hospital, Sydney, Australia
| | - Georgina V. Long
- Melanoma Institute Australia, Sydney, Australia ,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia ,Royal North Shore Hospital, Sydney, Australia ,Mater Hospital, Sydney, Australia
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21
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Pal A, Stapleton S, Yap C, Lai-Kwon J, Daly R, Magkos D, Baikady BR, Minchom A, Banerji U, De Bono J, Karikios D, Boyle F, Lopez J. Study protocol for a randomised controlled trial of enhanced informed consent compared to standard informed consent to improve patient understanding of early phase oncology clinical trials (CONSENT). BMJ Open 2021; 11:e049217. [PMID: 34489282 PMCID: PMC8422487 DOI: 10.1136/bmjopen-2021-049217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 08/11/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Early phase cancer clinical trials have become increasingly complicated in terms of patient selection and trial procedures-this is reflected in the increasing length of participant information sheets (PIS). Informed consent for early phase clinical trials has been contentious due to the potential ethical issues associated with performing experimental research on a terminally ill population which has exhausted standard treatment options. Empirical studies have demonstrated significant gaps in patient understanding regarding the nature and intent of these trials. This study aims to test whether enhanced informed consent for patient education can improve patient scores on a validated questionnaire testing clinical trial comprehension. METHODS AND ANALYSIS This is a randomised controlled trial that will allocate patients who are eligible to participate in one of four investigator-initiated clinical trials at the Royal Marsden Drug Development Unit to either a standard arm or an experimental arm, stratified by age and educational level. The standard arm will involve the full length trial PIS, followed by electronic or paper administration of the Quality of Informed Consent Questionnaire Parts A and B (QuIC-A and QuIC-B). The experimental arm will involve the full length trial PIS, exposure to a two-page study aid and 10 online educational videos, followed by administration of the QuIC-A and QuIC-B. The primary endpoint will be the difference (using a one-sided two-sample t-test) in the QuIC-A score, which measures objective understanding, between the standard and experimental arm. Accrual target is at least 17 patients per arm to detect an 8 point difference (80% power, alpha 0.05). ETHICS AND DISSEMINATION Ethics approval was granted by the National Health Service Health Research Authority on 15 June 2020-IRAS Project ID 277065, Protocol Number CCR5165, REC Reference 20/EE/0155. Results will be disseminated via publication in a relevant journal. TRIAL REGISTRATION NUMBER NCT04407676; Pre-results.
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Affiliation(s)
- Abhijit Pal
- Institute of Cancer Research, London, UK
- Drug Development Unit, Royal Marsden Hospital Sutton, London, UK
- The University of Sydney, Sydney, New South Wales, Australia
| | - Sarah Stapleton
- Drug Development Unit, Royal Marsden Hospital Sutton, London, UK
| | - Christina Yap
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
- Clinical Trials and Statistics Unit, Institute of Cancer Research, London, UK
| | - Julia Lai-Kwon
- Institute of Cancer Research, London, UK
- Drug Development Unit, Royal Marsden Hospital Sutton, London, UK
| | - Robert Daly
- Institute of Cancer Research, London, UK
- Drug Development Unit, Royal Marsden Hospital Sutton, London, UK
| | - Dimitrios Magkos
- Institute of Cancer Research, London, UK
- Drug Development Unit, Royal Marsden Hospital Sutton, London, UK
| | - Bindumalini Rao Baikady
- Institute of Cancer Research, London, UK
- Drug Development Unit, Royal Marsden Hospital Sutton, London, UK
| | - Anna Minchom
- Institute of Cancer Research, London, UK
- Drug Development Unit, Royal Marsden Hospital Sutton, London, UK
| | - Udai Banerji
- Institute of Cancer Research, London, UK
- Drug Development Unit, Royal Marsden Hospital Sutton, London, UK
| | - Johann De Bono
- Institute of Cancer Research, London, UK
- Drug Development Unit, Royal Marsden Hospital Sutton, London, UK
| | - Deme Karikios
- The University of Sydney, Sydney, New South Wales, Australia
| | - Frances Boyle
- The University of Sydney, Sydney, New South Wales, Australia
| | - Juanita Lopez
- Institute of Cancer Research, London, UK
- Drug Development Unit, Royal Marsden Hospital Sutton, London, UK
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22
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Nan Tie E, Lai-Kwon J, Rtshiladze MA, Na L, Bozzi J, Read T, Atkinson V, Au-Yeung G, Long GV, McArthur GA, Sandhu S, Saw R, Walpole E, Menzies A, Smithers M, Gyorki DE. Efficacy of immune checkpoint inhibitors for in-transit melanoma. J Immunother Cancer 2021; 8:jitc-2019-000440. [PMID: 32376722 PMCID: PMC7223285 DOI: 10.1136/jitc-2019-000440] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The efficacy of immune checkpoint inhibitors (ICI) in metastatic melanoma is well established. However, there are limited data regarding their efficacy in in-transit melanoma (ITM). This study assessed the efficacy of ICI in patients with ITM. METHODS A retrospective review of patients with ITM commenced on an ICI between March 2013 and February 2018 at three tertiary centers in Australia. Patients were excluded if they had previous or synchronous distant metastases. Overall response rate (ORR), progression-free survival (PFS) and overall survival (OS) were based on a composite of radiological and clinical assessments. RESULTS Fifty-four patients were included: 27 (50%) female; median age 75 (range 26-94); 12 (22%) stage IIIB, 40 (74%) stage IIIC and 2 (4%) stage IIID; 10 (19%) BRAF mutant. Forty (74%) received single-agent anti-PD-1 (pembrolizumab or nivolumab), 8 (15%) single agent anti-CTLA-4 (ipilimumab), 5 (9%) combination anti-PD-1/anti-CTLA-4 (ipilimumab and nivolumab or pembrolizumab) and 1 (2%) combination anti-PD-L1 (atezolizumab) and MEK inhibitor (cobimetinib). The median follow-up was 15 months (2-46).ORR to ICI was 54%: 14 (26%) complete responses; 15 (28%) partial responses; 9 (17%) stable disease; 16 (30%) progressive disease. Thirteen (46%) responders had only one ITM lesion. ORR was 58% for single-agent anti-PD-1, 38% for single-agent anti-CTLA4 and 40% for anti-PD-1/anti-CTLA-4. The median PFS was 11.7 months (6.6-not reached). 1-year and 2-year PFS were 48% and 39%, respectively,. Fourteen progressed locoregionally and 11 progressed distantly. The median OS was not reached. 1-year and 2-year OS were 85% and 63%, respectively. No clinicopathological features were associated with ORR. CONCLUSIONS AND RELEVANCE ICI produce objective responses in ITM and should be considered in patients with unresectable ITM or disease recurrence.
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Affiliation(s)
- Emilia Nan Tie
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Julia Lai-Kwon
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | - Lumine Na
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - James Bozzi
- Melanoma Institute Australia, North Sydney, New South Wales, Australia
| | - Tavis Read
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | | | - George Au-Yeung
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Georgina V Long
- Melanoma Institute Australia, North Sydney, New South Wales, Australia
| | | | - Shahneen Sandhu
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,The University of Melbourne, Melbourne, Victoria, Australia
| | - Robyn Saw
- Melanoma Institute Australia, North Sydney, New South Wales, Australia
| | - Euan Walpole
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Alexander Menzies
- Melanoma Institute Australia, North Sydney, New South Wales, Australia
| | - Mark Smithers
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - David E Gyorki
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia .,The University of Melbourne, Melbourne, Victoria, Australia
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23
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Lai-Kwon J, Tiu C, Pal A, Khurana S, Minchom A. Moving beyond epidermal growth factor receptor resistance in metastatic non-small cell lung cancer - a drug development perspective. Crit Rev Oncol Hematol 2021; 159:103225. [DOI: 10.1016/j.critrevonc.2021.103225] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/05/2021] [Accepted: 01/16/2021] [Indexed: 01/08/2023] Open
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24
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Baird R, Oliveira M, Gil EMC, Patel MR, Bermejo de las Heras B, Ruiz-Borrego M, García-Corbacho J, Armstrong A, Banerji U, Twelves C, Boni V, Incorvati J, Kabos P, Cohen AL, de Paula B, Rodríguez MC, Wang JS, Hernando C, Gonzalez AF, Ruiz IV, Lai-Kwon J, Afghani A, Vaklavas C, Brier T, Fox S, Kirova B, Klinowska T, Leach C, Lindemann JPO, Mather R, Maudsley R, Morrow CJ, Sathiyayogan N, Sykes A, Zhang L, Hamilton E. Abstract PS11-05: Updated data from SERENA-1: A Phase 1 dose escalation and expansion study of the next generation oral SERD AZD9833 as a monotherapy and in combination with palbociclib, in women with ER-positive, HER2-negative advanced breast cancer. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps11-05] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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
Background: AZD9833 is an oral selective estrogen receptor (ER) antagonist and degrader (SERD) in Phase 2 clinical development for the treatment of ER+ HER2− breast cancer. Here we report data from Parts C and D of the ongoing Phase 1 study (SERENA-1) examining AZD9833 in combination with palbociclib, together with updated data from Parts A and B examining AZD9833 monotherapy. Methods: SERENA-1 (NCT03616587) is an ongoing open-label Phase 1 study of AZD9833 in pre- and post-menopausal women with ER+, HER2− advanced breast cancer who have previously received ≥1 endocrine therapy and ≤2 prior chemotherapies. Prior treatment with fulvestrant and/or CDK4/6 inhibitors was permitted. The primary objective is to determine the safety and tolerability of once daily (QD) AZD9833, with dose-limiting toxicities (DLTs) in the first 28 days defining the maximum tolerated dose. Secondary objectives include anti-tumor response (including circulating tumor [ct] DNA response) and pharmacokinetics. Parts A (escalation) and B (expansion) assess AZD9833 as a monotherapy, and Parts C (escalation) and D (expansion) assess AZD9833 in combination with palbociclib. Results: At a data cut-off of March 24 2020, 17 patients had received either 150 mg or 300 mg AZD9833 in combination with palbociclib, given according to its product labeling. Eighty patients had received AZD9833 monotherapy at doses of 25, 75, 150, 300, and 450 mg QD. In patients treated with AZD9833 and palbociclib, treatment-related adverse events (AEs; experienced by ≥10% of patients) included visual disturbances*, bradycardia*, asthenia, anemia, QTcF prolongation, nausea, neutropenia, decreased white blood cell count, and vomiting (*combined terms). All instances of AZD9833-related bradycardia were Grade 1. One DLT was observed in the 150 mg cohort: CTCAE Grade 2 visual disturbances, which began on Cycle 1 Day 8 and resolved by Cycle 1 Day 9 following dose interruption. The patient restarted treatment on Cycle 1 Day 15 at 75 mg and continued this dose until data cut-off. No causally related AEs led to discontinuation of AZD9833. The tolerability of AZD9833 with palbociclib was consistent with the observed tolerability profile of AZD9833 monotherapy, and the known tolerability profile of palbociclib. Pharmacokinetic analysis showed similar AZD9833 exposure for monotherapy and palbociclib combination therapy. Similarly, palbociclib exposure was comparable with simulations using a published population pharmacokinetic model. In Part A, ESR1 hotspot mutations were detected in ctDNA at baseline in 26/56 (46%) patients; 13/26 (50%) of these patients achieved a partial response or stable disease at 24 weeks, including 5/10 (50%) with a Y537S ESR1 mutation. Further, in patients with ESR1 mutations and samples available for longitudinal ctDNA analysis, 17/20 (85%) exhibited a reduction or loss of mutant ESR1 on treatment with AZD9833. Efficacy data to be presented include objective response rate and clinical benefit rate at 24 weeks. Of note, unconfirmed partial responses have been observed in Part C after the data cut-off for this abstract. Conclusions: AZD9833 continues to show an encouraging efficacy and dose-dependent safety profile as a monotherapy or in combination with palbociclib. A Phase 2 study comparing the efficacy and safety of three doses of AZD9833 versus fulvestrant (NCT04214288), and a Phase 2 pre-surgical ‘window of opportunity’ study (EUDRA-CT; 2019-003706-2) are ongoing.
Citation Format: Richard Baird, Mafalda Oliveira, Eva Maria Ciruelos Gil, Manish R Patel, Begoña Bermejo de las Heras, Manuel Ruiz-Borrego, Javier García-Corbacho, Anne Armstrong, Udai Banerji, Chris Twelves, Valentina Boni, Jason Incorvati, Peter Kabos, Adam L Cohen, Bruno de Paula, Marta Capelán Rodríguez, Judy S Wang, Christina Hernando, Alejandro Falcón Gonzalez, Ivan Victoria Ruiz, Julia Lai-Kwon, Anosheh Afghani, Christos Vaklavas, Tim Brier, Steven Fox, Bistra Kirova, Teresa Klinowska, Chris Leach, Justin PO Lindemann, Richard Mather, Rhiannon Maudsley, Christopher J Morrow, Nitharsan Sathiyayogan, Andy Sykes, Li Zhang, Erika Hamilton. Updated data from SERENA-1: A Phase 1 dose escalation and expansion study of the next generation oral SERD AZD9833 as a monotherapy and in combination with palbociclib, in women with ER-positive, HER2-negative advanced breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS11-05.
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Affiliation(s)
- Richard Baird
- 1Cancer Research UK, Cambridge Centre, Cambridge, United Kingdom
| | - Mafalda Oliveira
- 2Breast Cancer Center, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Manish R Patel
- 4Florida Cancer Specialists/Sarah Cannon Research Institute/Sarasota Memorial Hospital, Sarasota, FL
| | - Begoña Bermejo de las Heras
- 5Department of Medical Oncology, Hospital Clinico Universitario of Valencia, Biomedical Research Institute (INCLIVA), Valencia, Spain
| | | | | | - Anne Armstrong
- 8The Christie NHS Foundation Trust and the Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
| | - Udai Banerji
- 9Drug Development Unit, The Institute of Cancer Research and The Royal Marsden Hospital, London, United Kingdom
| | - Chris Twelves
- 10St. James’s Hospital and University of Leeds, Leeds, United Kingdom
| | - Valentina Boni
- 11START Madrid, Centro Integral Oncologico Clara Campal (CIOCC), Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - Jason Incorvati
- 12Fox Chase Cancer Center, East Norriton-Hospital Outpatient Center, Philadelphia, PA
| | - Peter Kabos
- 13Division of Medical Oncology, University of Colorado, Boulder, CO
| | - Adam L Cohen
- 14Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Bruno de Paula
- 1Cancer Research UK, Cambridge Centre, Cambridge, United Kingdom
| | | | - Judy S Wang
- 4Florida Cancer Specialists/Sarah Cannon Research Institute/Sarasota Memorial Hospital, Sarasota, FL
| | - Christina Hernando
- 5Department of Medical Oncology, Hospital Clinico Universitario of Valencia, Biomedical Research Institute (INCLIVA), Valencia, Spain
| | | | | | - Julia Lai-Kwon
- 8The Christie NHS Foundation Trust and the Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
| | | | | | - Tim Brier
- 17Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | - Steven Fox
- 17Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | - Bistra Kirova
- 17Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | - Teresa Klinowska
- 18Late Development, Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | - Chris Leach
- 17Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | - Justin PO Lindemann
- 17Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | - Richard Mather
- 17Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | - Rhiannon Maudsley
- 17Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | - Christopher J Morrow
- 17Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | | | - Andy Sykes
- 19BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom
| | - Li Zhang
- 19BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom
| | - Erika Hamilton
- 20Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN
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Lynch FA, Katona L, Jefford M, Smith AB, Shaw J, Dhillon HM, Ellen S, Phipps-Nelson J, Lai-Kwon J, Milne D, Russell L, Dax V, Diggens J, Kent H, Button-Sloan A, Elliott J, Shackleton M, Burridge H, Ftanou M. Feasibility and Acceptability of Fear-Less: A Stepped-Care Program to Manage Fear of Cancer Recurrence in People with Metastatic Melanoma. J Clin Med 2020; 9:jcm9092969. [PMID: 32937942 PMCID: PMC7565154 DOI: 10.3390/jcm9092969] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/29/2020] [Accepted: 09/08/2020] [Indexed: 12/27/2022] Open
Abstract
Immunotherapies and targeted therapies have revolutionised treatment of metastatic melanoma and improved survival rates. However, survivors treated with novel therapies are vulnerable to high levels of fear of cancer recurrence or progression (FCR). Existing FCR interventions have rarely been trialled in people with advanced cancer. The current study aimed to evaluate the acceptability and feasibility of Fear-Less: a stepped-care model to treat FCR in people with metastatic melanoma treated with immunotherapy or targeted therapy. Sixty-one outpatients with metastatic melanoma were screened using the Fear of Cancer Recurrence Inventory Short Form (FCRI-SF) and Fear of Progression Questionnaire Short Form (FoP-Q-SF). Survivors with subthreshold FCR were stratified to a self-management intervention while those with clinical levels of FCR were provided with an individual therapy, Conquer Fear. Survivor experience surveys and rescreening were administered post-intervention completion. Results indicated that Fear-Less was an acceptable and feasible FCR intervention. Results provided preliminary support for the potential impact of Fear-Less in reducing FCR. Fear-Less is a promising first step in providing an acceptable and feasible stepped-care model to treat FCR in survivors with metastatic disease.
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Affiliation(s)
- Fiona A Lynch
- Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia; (S.E.); (V.D.); (J.D.); (J.E.); (M.F.)
- Correspondence: ; Tel.: +61-3-8559-8236
| | - Lynda Katona
- Department of Psychology and Consultation Liaison Psychiatry, Alfred Health, Melbourne, VIC 3004, Australia; (L.K.); (H.K.)
| | - Michael Jefford
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia; (M.J.); (J.L.-K.)
- Australian Cancer Survivorship Centre, Melbourne, VIC 3000, Australia
- Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC 3010, Australia;
| | - Allan Ben Smith
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Kensington, NSW 2052, Australia;
| | - Joanne Shaw
- Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, The University of Sydney, Sydney, NSW 2006, Australia; (J.S.); (H.M.D.)
| | - Haryana M Dhillon
- Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, The University of Sydney, Sydney, NSW 2006, Australia; (J.S.); (H.M.D.)
- Centre for Medical Psychology & Evidence-based Decision-making, School of Psychology, The University of Sydney, Sydney, NSW 2006, Australia
| | - Steve Ellen
- Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia; (S.E.); (V.D.); (J.D.); (J.E.); (M.F.)
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Jo Phipps-Nelson
- Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC 3010, Australia;
- Health Services and Implementation Science, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia;
| | - Julia Lai-Kwon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia; (M.J.); (J.L.-K.)
| | - Donna Milne
- Health Services and Implementation Science, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia;
- Department of Skin and Melanoma Service, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
| | - Lahiru Russell
- School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Geelong, VIC 3217, Australia;
- Centre for Quality and Patient Safety—Eastern Health Partnership, Box Hill, VIC 3128, Australia
| | - Victoria Dax
- Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia; (S.E.); (V.D.); (J.D.); (J.E.); (M.F.)
| | - Justine Diggens
- Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia; (S.E.); (V.D.); (J.D.); (J.E.); (M.F.)
| | - Holly Kent
- Department of Psychology and Consultation Liaison Psychiatry, Alfred Health, Melbourne, VIC 3004, Australia; (L.K.); (H.K.)
| | - Alison Button-Sloan
- Melanoma Patients Australia, Melbourne, VIC 3000, Australia;
- Melanoma Research Victoria Consumer Reference Group, Melbourne, VIC 3000, Australia
- Australian Melanoma Consumer Alliance, Melbourne, VIC 3000, Australia
| | - Jane Elliott
- Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia; (S.E.); (V.D.); (J.D.); (J.E.); (M.F.)
| | - Mark Shackleton
- Department of Medical Oncology, Alfred Health, Melbourne, VIC 3004, Australia; (M.S.); (H.B.)
- Department of Medicine, Monash University, Melbourne, VIC 3010, Australia
| | - Hayley Burridge
- Department of Medical Oncology, Alfred Health, Melbourne, VIC 3004, Australia; (M.S.); (H.B.)
| | - Maria Ftanou
- Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia; (S.E.); (V.D.); (J.D.); (J.E.); (M.F.)
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia
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Lisy K, Lai-Kwon J, Ward A, Sandhu S, Kasparian NA, Winstanley J, Boyle F, Gyorki D, Lacey K, Bishop J, Jefford M. Patient-reported outcomes in melanoma survivors at 1, 3 and 5 years post-diagnosis: a population-based cross-sectional study. Qual Life Res 2020; 29:2021-2027. [PMID: 32140919 DOI: 10.1007/s11136-020-02464-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE There is a lack of population-based data describing patient reported outcomes (PROs) in melanoma survivors which could guide the development of interventions and resources. This study assessed overall quality of life (QoL), self-reported symptoms and unmet information needs in melanoma survivors 1, 3 or 5 years post-diagnosis. METHODS A cross-sectional postal survey was conducted in Victoria, Australia, with eligible melanoma survivors identified from a population-based cancer registry. Patient-reported outcome measures included the EuroQoL 5-Dimension 5-Level (EQ-5D-5L), and self-reported symptoms, difficulties and information needs. Associations between demographic, disease and care-related factors and QoL were also assessed. RESULTS A total of 476 melanoma survivors participated in the study (response rate 46.5%). Anxiety and depressive symptoms were more prevalent in survivors compared to the general population (30.7% vs 21.6%; p < 0.01). Fear of cancer recurrence (48.3%) and fear of cancer spreading (37.8%) were the most commonly reported symptom items, and approximately one in five melanoma survivors had unmet information needs related to psychological aspects of living with melanoma. Recurrent melanoma, living in a nursing home, chronic comorbidities, and melanoma diagnosed at > 2 mm thickness were associated with lower QoL. CONCLUSION A large proportion of melanoma survivors reported ongoing quality of life deficits, fear of cancer recurrence, as well as unmet information needs up to 5 years after diagnosis. Patients may benefit from tailored informational resources and interventions that address the psychological aspects of living with and beyond melanoma.
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Affiliation(s)
- Karolina Lisy
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia.
- Australian Cancer Survivorship Centre, a Richard Pratt Legacy, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia.
| | - Julia Lai-Kwon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Andrew Ward
- The Social Research Centre, Melbourne, VIC, Australia
| | - Shahneen Sandhu
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Nadine A Kasparian
- Cincinnati Children's Center for Heart Disease and the Developing Mind, Heart Institute and the Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Julie Winstanley
- Patricia Ritchie Centre for Cancer Care and Research, The Mater Hospital, University of Sydney, Sydney, NSW, Australia
| | - Frances Boyle
- Patricia Ritchie Centre for Cancer Care and Research, The Mater Hospital, University of Sydney, Sydney, NSW, Australia
| | - David Gyorki
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Surgery, The University of Melbourne, Parkville, VIC, Australia
| | - Karen Lacey
- Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
| | - Jim Bishop
- Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
| | - Michael Jefford
- Australian Cancer Survivorship Centre, a Richard Pratt Legacy, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
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Lai-Kwon J, Khoo C, Lo S, Milne D, Mohamed M, Raleigh J, Smith K, Lisy K, Sandhu S, Jefford M. The survivorship experience for patients with metastatic melanoma on immune checkpoint and BRAF-MEK inhibitors. J Cancer Surviv 2019; 13:503-511. [PMID: 31165342 DOI: 10.1007/s11764-019-00770-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 05/21/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE Immune checkpoint inhibitors (ICI) and BRAF and MEK inhibitors (BMi) have improved survival in metastatic melanoma (MM). However, the experience of long-term responders remains undescribed. This study characterised survivorship issues faced by long-term responders to ICI or BMi. METHODS Patients with MM, aged ≥ 18 years old, ≥ 6 months post-ICI or BMi initiation with an objective response or stable disease. A 72-question survey assessed physical and psychological effects, impact on lifestyle, access to information, satisfaction with care, and availability of supports. RESULTS One hundred and five of 120 (88%) patients completed the survey (ICI 69/BMI 36). For the ICI cohort, 39 (57%) were receiving ongoing treatment, 17 ceased due to toxicity and 13 due to a sustained response. For the BMi cohort, 31 (85%) were receiving ongoing treatment, 4 ceased due to toxicity and 1 due to a sustained complete response. At data cut-off on 18 December 2018, median PFS (range) was 2.5 years (1.3-8.5) for ICI and 3.1 years (0.6-7.3) for BMi. Long-term toxicities included dry/itchy skin (ICI 51, 74%/ BMi 25, 69%), arthralgias (ICI 30, 58%/ BMi 23, 64%) and fatigue (ICI 62, 90%/ BMi 33, 92%). Psychological morbidity was common, including anxiety awaiting results (ICI 50, 72%/ BMi 29, 81%), fear of melanoma recurring or progressing (ICI 56, 81%/ BMi 31, 86%) or death (ICI 44, 64%/ BMi 26, 72%). CONCLUSION MM survivors experience chronic treatment toxicities and frequently report psychological concerns. IMPLICATIONS FOR CANCER SURVIVORS Survivors may benefit from discussions regarding long-term toxicities and tailored psychological supports.
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Affiliation(s)
- Julia Lai-Kwon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia
| | - Chloe Khoo
- Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia
| | - Serigne Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Institute for Research and Medical Consultations, University of Dammam, Dammam, Kingdom of Saudi Arabia
| | - Donna Milne
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia
| | - Mustafa Mohamed
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia
| | - Jeanette Raleigh
- Research Division, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia
| | - Kortnye Smith
- Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia
| | - Karolina Lisy
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia
| | - Shahneen Sandhu
- Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia
| | - Michael Jefford
- Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia.
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia.
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia.
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Sahu A, Jefford M, Lai-Kwon J, Thai A, Hicks RJ, Michael M. CAPTEM in Metastatic Well-Differentiated Intermediate to High Grade Neuroendocrine Tumors: A Single Centre Experience. J Oncol 2019; 2019:9032753. [PMID: 30915122 PMCID: PMC6402194 DOI: 10.1155/2019/9032753] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 01/27/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Capecitabine-temozolomide (CAPTEM) has significant activity in patients (pts) with metastatic low grade pancreatic neuroendocrine tumors (NETs). However, there is limited data regarding its activity in pts with metastatic well-differentiated intermediate and high grade pancreatic and nonpancreatic NETs. The objective of this study was to assess the functional imaging response, survival, and tolerability of CAPTEM in this population. METHODS A retrospective audit of pts with metastatic well-differentiated intermediate (WHO grade 2) or high grade (WHO grade 3) NETs treated at Peter MacCallum Cancer Centre between March 2013 and March 2017. Pts received capecitabine 750 mg/m2 orally twice daily (bd) from days1 to 14 and temozolomide 100 mg/m2 bd from days 10 to 14 every 28 days. Data regarding functional imaging response, progression-free and overall survival, and toxicities was collected. RESULTS Thirty-two pts received a median of 6 cycles (range: 2-16) of CAPTEM for grade 2 (n=21, 66%) or grade 3 (n=11, 34%), Ki67 <55% (n= 7, 21.9%) or Ki67 ≥55% (n= 4, 12.5 %) NET. Primary site included gastroenteropancreatic (n= 17, 53%), lung (n= 12, 37.5%), and unknown origin (n = 3, 9.4%). Twenty-two percent received CAPTEM as first-line therapy. After a median of 31 months of follow-up, the two-year overall survival (OS) was 42%, with a median OS of 24 months. There was a trend towards improved median progression-free survival (PFS) in pts with low grade 3 (Ki67<55%) versus high grade 3 (Ki67 ≥55%) NETs (15 vs 4 months, p= 0.11). Ten (31.3%) experienced grade 3/4 toxicity, with nausea (15.6%), thrombocytopaenia (12.5%), and fatigue (9.4%) the most common toxicities reported. CONCLUSION CAPTEM has significant activity in patients with metastatic grades 2 and 3 NETs with manageable toxicity. The PFS benefit observed in the grade 3 subgroup with Ki67<55% warrants further evaluation in a larger randomized trial.
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Affiliation(s)
- Arvind Sahu
- Department of Cancer Medicine, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC 3000, Australia
- Department Of Medical Oncology, Goulburn Valley Health, Shepparton VIC 3630, Australia
- Department of Rural Health, Melbourne Medical School, The University of Melbourne, Shepparton, VIC, Australia
| | - Michael Jefford
- Department of Cancer Medicine, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC 3000, Australia
- Neuroendocrine Unit, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne VIC 3000, Australia
| | - Julia Lai-Kwon
- Department of Cancer Medicine, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC 3000, Australia
| | - Alesha Thai
- Department of Cancer Medicine, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC 3000, Australia
| | - Rodney J. Hicks
- Neuroendocrine Unit, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne VIC 3000, Australia
- Department of Cancer Imaging, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne VIC 3000, Australia
| | - Michael Michael
- Department of Cancer Medicine, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC 3000, Australia
- Neuroendocrine Unit, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne VIC 3000, Australia
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Abstract
This commentary provides an overview of the evolving field of radiomics, which aims to noninvasively augment clinical prognostic nomograms, correlate imaging phenotypes, and support clinical decision‐making.
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Affiliation(s)
- Julia Lai-Kwon
- Department of Cancer Medicine, Peter MacCallum Cancer Centre, Parkville, Australia
| | - Shankar Siva
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Parkville, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia
| | - Jeremy Lewin
- Department of Cancer Medicine, Peter MacCallum Cancer Centre, Parkville, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia
- ONTrac at Peter Mac Victorian Adolescent & Young Adult Cancer Service, Peter MacCallum Cancer Centre, Parkville, Australia
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Jefford M, Kinnane N, Howell P, Nolte L, Galetakis S, Bruce Mann G, Naccarella L, Lai-Kwon J, Simons K, Avery S, Thompson K, Ashley D, Haskett M, Davies E, Whitfield K. Implementing novel models of posttreatment care for cancer survivors: Enablers, challenges and recommendations. Asia Pac J Clin Oncol 2015; 11:319-27. [PMID: 26245952 DOI: 10.1111/ajco.12406] [Citation(s) in RCA: 28] [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] [Accepted: 05/15/2015] [Indexed: 11/29/2022]
Abstract
AIM The American Society of Clinical Oncology and US Institute of Medicine emphasize the need to trial novel models of posttreatment care, and disseminate findings. In 2011, the Victorian State Government (Australia) established the Victorian Cancer Survivorship Program (VCSP), funding six 2-year demonstration projects, targeting end of initial cancer treatment. Projects considered various models, enrolling people of differing cancer types, age and residential areas. We sought to determine common enablers of success, as well as challenges/barriers. METHODS Throughout the duration of the projects, a formal "community of practice" met regularly to share experiences. Projects provided regular formal progress reports. An analysis framework was developed to synthesize key themes and identify critical enablers and challenges. Two external reviewers examined final project reports. Discussion with project teams clarified content. RESULTS Survivors reported interventions to be acceptable, appropriate and effective. Strong clinical leadership was identified as a critical success factor. Workforce education was recognized as important. Partnerships with consumers, primary care and community organizations; risk stratified pathways with rapid re-access to specialist care; and early preparation for survivorship, self-management and shared care models supported positive project outcomes. Tailoring care to individual needs and predicted risks was supported. Challenges included: lack of valid assessment and prediction tools; limited evidence to support novel care models; workforce redesign; and effective engagement with community-based care and issues around survivorship terminology. CONCLUSION The VCSP project outcomes have added to growing evidence around posttreatment care. Future projects should consider the identified enablers and challenges when designing and implementing survivorship care.
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Affiliation(s)
- Michael Jefford
- Australian Cancer Survivorship Centre, A Richard Pratt Legacy, Peter MacCallum Cancer Centre, Melbourne, Australia.,Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Nicole Kinnane
- Australian Cancer Survivorship Centre, A Richard Pratt Legacy, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Paula Howell
- North Eastern Melbourne Integrated Cancer Service (NEMICS), Melbourne, Australia
| | - Linda Nolte
- Australian Cancer Survivorship Centre, A Richard Pratt Legacy, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Spiridoula Galetakis
- Cancer Strategy and Development, Department of Health and Human Services, State Government of Victoria, Melbourne, Australia
| | - Gregory Bruce Mann
- Department of Surgery, University of Melbourne, Melbourne, Australia.,The Breast Service, Royal Melbourne and Royal Women's Hospital, Melbourne, Australia
| | - Lucio Naccarella
- Systems and Workforce Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Julia Lai-Kwon
- Australian Cancer Survivorship Centre, A Richard Pratt Legacy, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Katherine Simons
- North Eastern Melbourne Integrated Cancer Service (NEMICS), Melbourne, Australia
| | - Sharon Avery
- Malignant Haematology and Stem Cell Transplantation Service, The Alfred, Melbourne, Australia
| | - Kate Thompson
- ONTrac at Peter Mac, Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - David Ashley
- The Andrew Love Cancer Centre, Barwon Health, Geelong, Victoria, Australia.,School of Medicine, Deakin University, Geelong, Victoria, Australia
| | | | - Elise Davies
- Cancer Strategy and Development, Department of Health and Human Services, State Government of Victoria, Melbourne, Australia
| | - Kathryn Whitfield
- Cancer Strategy and Development, Department of Health and Human Services, State Government of Victoria, Melbourne, Australia
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Weiland TJ, Jelinek GA, Lai-Kwon J, Chong AH. In reply to: ‘Study key words are inclusion criteria and should be shared for interpretation’. Australas J Dermatol 2015; 56:139-41. [DOI: 10.1111/ajd.12324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Tracey J Weiland
- Emergency Practice Innovation Centre; St Vincent's Hospital; Melbourne Victoria Australia
- Faculty of Medicine Dentistry and Health Sciences; University of Melbourne; Melbourne Victoria Australia
| | - George A Jelinek
- Emergency Practice Innovation Centre; St Vincent's Hospital; Melbourne Victoria Australia
- Faculty of Medicine Dentistry and Health Sciences; University of Melbourne; Melbourne Victoria Australia
| | - Julia Lai-Kwon
- Department of Medicine (Dermatology); St Vincent's Hospital; Melbourne Victoria Australia
| | - Alvin H Chong
- Department of Medicine (Dermatology); St Vincent's Hospital; Melbourne Victoria Australia
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32
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Lai-Kwon J, Ly L, Su JC, Nixon R, Tam MM. Unsuspected allergic contact dermatitis to alcohol swabs following neurosurgery. Australas J Dermatol 2014; 55:296-8. [DOI: 10.1111/ajd.12201] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 05/15/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Julia Lai-Kwon
- Contact Dermatitis Clinic; Skin and Cancer Foundation; Melbourne Victoria Australia
| | - Lena Ly
- Contact Dermatitis Clinic; Skin and Cancer Foundation; Melbourne Victoria Australia
| | - John C Su
- Eastern Health Clinical School; Monash University; Melbourne Victoria Australia
- Occupational Dermatology Research and Education Centre; Skin and Cancer Foundation; Melbourne Victoria Australia
| | - Rosemary Nixon
- Department of Dermatology; Royal Children's Hospital; Melbourne Victoria Australia
| | - Mei Mui Tam
- Contact Dermatitis Clinic; Skin and Cancer Foundation; Melbourne Victoria Australia
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Succar L, Lai-Kwon J, Nikolic-Paterson DJ, Rangan GK. Induction monotherapy with sirolimus has selected beneficial effects on glomerular and tubulointersititial injury in nephrotoxic serum nephritis. Int J Nephrol Renovasc Dis 2014; 7:303-13. [PMID: 25071375 PMCID: PMC4111659 DOI: 10.2147/ijnrd.s64202] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The study aimed to test the hypothesis that therapeutic treatment with a mammalian target of rapamycin complex 1 inhibitor reduces renal cell proliferation and attenuates glomerular and tubulointerstitial injury in the early phase of nephrotoxic serum nephritis (NSN) in rats. Methods Male Wistar-Kyoto rats received a single tail-vein injection of sheep anti-rat glomerular basement membrane serum (day 0) and were treated with vehicle or sirolimus (0.25 mg/kg/day by subcutaneous injection) from day 1 until day 14. Results Treatment with sirolimus attenuated kidney enlargement by 41% (P<0.05), improved endogenous creatinine clearance by 50% (P<0.05), and reduced glomerular and tubulointerstitial cell proliferation by 53% and 70%, respectively, (P<0.05 compared to vehicle) in rats with NSN. In glomeruli, sirolimus reduced segmental fibrinoid necrosis by 69%, autologous rat immunoglobulin G deposition, glomerular capillary tuft enlargement, and periglomerular myofibroblast (α-smooth muscle actin-positive cells) accumulation (all P<0.05) but did not significantly affect glomerular crescent formation (P=0.15), macrophage accumulation (P=0.25), or the progression of proteinuria. In contrast, sirolimus preserved tubulointerstitial structure and attenuated all markers of injury (interstitial ED-1- and α-smooth muscle actin-positive cells and tubular vimentin expression; all P<0.05). By immunohistochemistry and Western blot analysis, sirolimus reduced the glomerular and tubulointerstitial expression of phosphorylated (Ser 235/236) S6-ribosomal protein (P<0.05). Conclusion Induction monotherapy with sirolimus suppressed target of rapamycin complex 1 activation, renal cell proliferation, and injury during the early stages of rodent NSN, but the degree of histological protection was more consistent in the tubulointerstitium than the glomerular compartment.
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Affiliation(s)
- Lena Succar
- Centre for Transplant and Renal Research, Westmead Millennium Institute, University of Sydney, Westmead Hospital, Sydney, NSW, Australia
| | - Julia Lai-Kwon
- Centre for Transplant and Renal Research, Westmead Millennium Institute, University of Sydney, Westmead Hospital, Sydney, NSW, Australia
| | - David J Nikolic-Paterson
- Department of Nephrology and Monash University Department of Medicine, Monash Medical Centre, Clayton, VIC, Australia
| | - Gopala K Rangan
- Centre for Transplant and Renal Research, Westmead Millennium Institute, University of Sydney, Westmead Hospital, Sydney, NSW, Australia
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Scott DA, Evered LA, Gerraty RP, MacIsaac A, Lai-Kwon J, Silbert BS. Cognitive dysfunction follows left heart catheterisation but is not related to microembolic count. Int J Cardiol 2014; 175:67-71. [DOI: 10.1016/j.ijcard.2014.04.235] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 04/19/2014] [Accepted: 04/22/2014] [Indexed: 01/13/2023]
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