Oncology

Screening for colorectal cancer in defunctioned colons (2018)

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Type of publication:
Journal article

Author(s):
*Akbar, Fayyaz; Quyn, Aaron; Steele, Robert

Citation:
Journal of medical screening; Dec 2018; vol. 25 (no. 4); p. 178-182

Abstract:
OBJECTIVES Population-based colorectal (bowel) cancer screening using faecal occult blood tests leads to a reduction in cause-specific mortality. However, in people where the colon is defunctioned, the use of standard faecal occult blood test is not appropriate. The aim of this study was to examine the current trends of clinical practice for colorectal cancer screening in people with defunctioned colons.METHODS An online survey was performed using SurveyMonkey. All members of the Association of Coloproctology of Great Britain and Ireland were invited by email to participate. Reminders were sent to non-responders and partial responders till six weeks. All responses were included in our analysis. RESULTS Of the 206 (34.59%) questionnaires completed, all questions were answered in 110 (55.8%). Among responders, 94 (85.4%) were colorectal consultant surgeons, 72% had worked in their current capacity for more than five years, and 105 (50.9%) had encountered colorectal cancer in defunctioned colons during their career. Some 72.2% of responders stated that a screening test for colorectal cancer in patients with defunctioned colons was currently not offered, or that they did not know whether or not it was offered in their area.CONCLUSIONS Bowel screening in the United Kingdom is currently not offered to 72.2% of the age appropriate population with defunctioned colons. Among responding colorectal surgeons, 50% had encountered colorectal cancer in such patients. There is considerable variability in clinical practice regarding the optimal age for onset of screening, time interval, and the optimal modality to offer for screening in such cases.

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Can Improving Working Partnerships with Primary Care Prevent Avoidable Emergency Admissions for Patients with Lung Cancer? (2018)

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Type of publication:
Conference abstract

Author(s):
Morley J.; Anderson V.; Beattie V.; Clayton K.; Denby D.; Eaton M.; Glover S.; Griffiths A.; Maddock N.; *McAdam J.; Morgan S.; Rees P.; Perkins T.; Phillips S.; Pugh B.; Roberts J.; Robinson W.; Rose P.

Citation:
Journal of Thoracic Oncology; Oct 2018; vol. 13 (no. 10)

Abstract:
Background: A literature search was performed. Primary Care Professionals (PCP'S) and National Lung Cancer Forum for Nurses (NLCFN) members were surveyed. Patients with a known diagnosis of lung cancer and their carers were interviewed following emergency care admissions. Lung Cancer Nurse Specialists (LCNS) from 15 NHS Trusts/Health Boards (HB) throughout the United Kingdom participated in data collection between May and August 2017. Method: A literature search (CINAHL, Embase, Proquest, PubMed, Medline) was performed. 120 PCP's from 7 CCG's/HB were surveyed to ask how and why they would contact a LCNS; any difficulties experienced contacting a LCNS and what support the LCNS could provide. 86 (72%) responded. 27 patients and their carers from 5 NHS/HB who were admitted as an emergency with a symptom related to their lung cancer were interviewed by a LCNS. A questionnaire was sent to all NLCFN members, asking "What do you do in your current practice to help prevent avoidable emergency hospital attendances?" Result: There was no published literature specific to the project aim. 46 (53%) PCP's knew how to contact the LCNS, 24 (28%) did not and 16 (19%) were unaware the service existed. PCP's reported that the LCNS could improve communication and provide education and specialist advice to help reduce avoidable emergency admissions. Following review by the LCNS, 25 (92%) of emergency admissions were deemed necessary. 2 (8%) patients contacted 999, with the rest seeking advice from the LCNS, Acute Oncology Service or GP prior to admission. 282 NLCFN members were surveyed with 59 respondents. Findings highlighted wide variations in practice, although a number of common themes were evident. Proactive communication with patients and HCP's and timely referrals and signposting were key to identifying and addressing potential problems as early as possible. Conclusion: This small data sample suggests that patients were admitted appropriately. The NLCFN survey highlighted the role of the LCNS in providing expert specialist knowledge and advice to patients and Health Care Professionals throughout the patients journey. PCP's expressed that they would like to know more about the role of the LCNS and would value better means of communication, advice and specialist support to improve patient care.

Radiotherapy to the primary tumour for newly diagnosed, metastatic prostate cancer (STAMPEDE): a randomised controlled phase 3 trial (2018)

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Type of publication:
Randomised controlled trial

Author(s):
Parker, Christopher C; James, Nicholas D; Brawley, Christopher D; Clarke, Noel W; Hoyle, Alex P; Ali, Adnan; Ritchie, Alastair W S; Attard, Gerhardt; Chowdhury, Simon; Cross, William; Dearnaley, David P; Gillessen, Silke; Gilson, Clare; Jones, Robert J; Langley, Ruth E; Malik, Zafar I; Mason, Malcolm D; Matheson, David; Millman, Robin; Russell, J Martin; Thalmann, George N; Amos, Claire L; Alonzi, Roberto; Bahl, Amit; Birtle, Alison; Din, Omar; Douis, Hassan; Eswar, Chinnamani; Gale, Joanna; Gannon, Melissa R; Jonnada, Sai; Khaksar, Sara; Lester, Jason F; O'Sullivan, Joe M; Parikh, Omi A; Pedley, Ian D; Pudney, Delia M; Sheehan, Denise J; *Srihari, Narayanan Nair; Tran, Anna T H; Parmar, Mahesh K B; Sydes, Matthew R; Systemic Therapy for Advanced or Metastatic Prostate cancer: Evaluation of Drug Efficacy (STAMPEDE) investigators

Citation:
Lancet, Volume 392, Issue 10162, 1–7 December 2018, Pages 2353-2366

Abstract:
BACKGROUND Based on previous findings, we hypothesised that radiotherapy to the prostate would improve overall survival in men with metastatic prostate cancer, and that the benefit would be greatest in patients with a low metastatic burden. We aimed to compare standard of care for metastatic prostate cancer, with and without radiotherapy. METHODS We did a randomised controlled phase 3 trial at 117 hospitals in Switzerland and the UK. Eligible patients had newly diagnosed metastatic prostate cancer. We randomly allocated patients open label in a 1:1 ratio to standard of care (control group) or standard of care and radiotherapy (radiotherapy group). Randomisation was stratified by hospital, age at randomisation, nodal involvement, WHO performance status, planned androgen deprivation therapy, planned docetaxel use (from December, 2015), and regular aspirin or non-steroidal anti-inflammatory drug use. Standard of care was lifelong androgen deprivation therapy, with up front docetaxel permitted from December, 2015. Men allocated radiotherapy received either a daily (55 Gy in 20 fractions over 4 weeks) or weekly (36 Gy in six fractions over 6 weeks) schedule that was nominated before randomisation. The primary outcome was overall survival, measured as the number of deaths; this analysis had 90% power with a one-sided α of 2·5% for a hazard ratio (HR) of 0·75. Secondary outcomes were failure-free survival, progression-free survival, metastatic progression-free survival, prostate cancer-specific survival, and symptomatic local event-free survival. Analyses used Cox proportional hazards and flexible parametric models, adjusted for stratification factors. The primary outcome analysis was by intention to treat. Two prespecified subgroup analyses tested the effects of prostate radiotherapy by baseline metastatic burden and radiotherapy schedule. This trial is registered with ClinicalTrials.gov, number CT00268476. FINDINGS Between Jan 22, 2013, and Sept 2, 2016, 2061 men underwent randomisation, 1029 were allocated the control and 1032 radiotherapy. Allocated groups were balanced, with a median age of 68 years (IQR 63-73) and median amount of prostate-specific antigen of 97 ng/mL (33-315). 367 (18%) patients received early docetaxel. 1082 (52%) participants nominated the daily radiotherapy schedule before randomisation and 979 (48%) the weekly schedule. 819 (40%) men had a low metastatic burden, 1120 (54%) had a high metastatic burden, and the metastatic burden was unknown for 122 (6%). Radiotherapy improved failure-free survival (HR 0·76, 95% CI 0·68-0·84; p<0·0001) but not overall survival (0·92, 0·80-1·06; p=0·266). Radiotherapy was well tolerated, with 48 (5%) adverse events (Radiation Therapy Oncology Group grade 3-4) reported during radiotherapy and 37 (4%) after radiotherapy. The proportion reporting at least one severe adverse event (Common Terminology Criteria for Adverse Events grade 3 or worse) was similar by treatment group in the safety population (398
[38%] with control and 380 [39%] with radiotherapy). INTERPRETATION Radiotherapy to the prostate did not improve overall survival for unselected patients with newly diagnosed metastatic prostate cancer. FUNDING Cancer Research UK, UK Medical Research Council, Swiss Group for Clinical Cancer Research, Astellas, Clovis Oncology, Janssen, Novartis, Pfizer, and Sanofi-Aventis.

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Results of a multicentre randomised controlled trial of cochlear-sparing intensity-modulated radiotherapy versus conventional radiotherapy in patients with parotid cancer (COSTAR; CRUK/08/004) (2018)

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Type of publication:
Journal article

Author(s):
Nutting , Morden JP, Beasley M, Bhide S, Cook A, De Winton E, Emson M, Evans M, Fresco L, Gollins S, Gujral D, Harrington K, Joseph M, Lemon C, Luxon L, van den Blink Q, Mendes R, Miah A, Newbold K, Prestwich R, Robinson M, Sanghera P, Simpson J, Sivaramalingam M, *Srihari NN, Sydenham M, Wells E, Witts S, Hall E; COSTAR Investigators.

Citation:
European Journal of Cancer; Nov 2018; vol. 103 ; p. 249-258

Abstract:
Purpose: About 40-60% of patients treated with post-operative radiotherapy for parotid cancer experience
ipsilateral sensorineural hearing loss. Intensity-modulated radiotherapy (IMRT) can reduce radiation dose to the cochlea. COSTAR, a phase III trial, investigated the role of cochlear-sparing IMRT (CS-IMRT) in reducing hearing loss. Methods: Patients (pT1-4 N0-3 M0) were randomly assigned (1:1) to 3-dimensional conformal radiotherapy (3DCRT) or CS-IMRT by minimisation, balancing for centre and radiation dose of 60Gy or 65Gy in 30 daily fractions. The primary end-point was proportion of patients with sensorineural hearing loss in the ipsilateral cochlea of >=10 dB bone conduction at 4000 Hz 12 months after radiotherapy compared using Fisher's exact test. Secondary end-points included hearing loss at 6 and 24 months, balance assessment, acute and late toxicity, patient-reported quality of life, time to recurrence and survival. Results: From Aug 2008 to Feb 2013, 110 patients (54 3DCRT; 56 CS-IMRT) were enrolled from 22 UK centres. Median doses to the ipsilateral cochlea were 3DCRT: 56.2Gy and CS-IMRT: 35.7Gy (p < 0.0001). 67/110 (61%) patients were evaluable for the primary end-point; main reasons for non-evaluability were non-attendance at follow-up or incomplete audiology assessment. At 12 months, 14/36 (39%) 3DCRT and 11/31 (36%) CS-IMRT patients had >=10 dB loss (p = 0.81). No statistically significant differences were observed in hearing loss at 6 or 24 months or in other secondary end-points including patient-reported hearing outcomes. Conclusion: CS-IMRT reduced the radiation dose below the accepted tolerance of the cochlea, but this did not lead to a reduction in the proportion of patients with clinically relevant hearing loss.

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A patient centred, self-management app providing digital support and follow up care for citizens with prostate cancer (2018)

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Type of publication:
Conference abstract

Author(s):
*Elves A.; *Dunk S.; *Perry S.; *Srihari N.; Khanduri S.; Redgrave R.; Pope R.

Citation:
Journal of Clinical Urology; Jun 2018; vol. 11 ; p. 26

Abstract:
Introduction: The challenges of increasing cancer survivors, National Survivorship Programme/Recovery package and drive to stratified care combined with funding and workforce constraints require novel approaches to follow-up care. We describe a web-based App facilitating stratified care through remote patient self management for patients undergoing follow-up for prostate cancer. Method: Patients with stable prostate cancer were eligible for recruitment. The App was offered as a replacement to face to face follow-up or for communication and support. App functionalities include remote follow-up, self-reporting of disease/treatment effects, multimedia information/sign posting and secure messaging to a clinical nurse specialist. Outcomes included up-take, use of App functionalities, number of follow-ups delivered, escalations in care and user satisfaction. Results: One hundred and twenty patients identified were eligible for the App. Sixty five patients recruited gen-erated 342 messages and 627 patient self-reported disease/treatment effect entry sessions providing 3036 readings. Sexual health and hormone side effects were most common reported issues.Sixty-six per cent of users were over 69 years. Forty four patients received digital follow-up over the 10 month period. Clinician concerns about disease progression or user lack of internet access or device were the principle obstacle to recruitment. Conclusion: The App was safe and allowed patients to provide feedback upon symptoms, wellbeing and interact proactively with their healthcare team on an ad hoc basis as well as regular follow-up. This fundamental change in approach to delivery of clinical care has wider application to a range of urological conditions.

Over 70s breast cancer management: A single institute experience (2018)

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Type of publication:
Conference abstract

Author(s):
Dube M.; Talaat A.; *Rastall S.; *Przyczyna A.; *Usman T.

Citation:
European Journal of Surgical Oncology; Jun 2018; vol. 44 (no. 6); p. 898

Abstract:
Introduction: With increasing life expectancy, awareness and improved referral system more women over the age of 70 (70+) are diagnosed with breast cancer. NICE guidelines recommended standard treatment of breast cancer irrespective of age and decision rather based on co-morbidities and frailty. To review our compliance with NICE guidelines we audited management of breast cancer of 70+ women over a period of five years. Methods: Retrospective case note analysis of 833 70+ women with breast cancer diagnosed from April 2010 to March 2015. Breast MDT recommendations, reason for choice of treatment, co-morbidities and performance status recorded. Results: Out of 2729 breast cancer diagnosis 30% (833) were 70+. The median age was 78. Surgery was the treatment of choice in all five years and is represented by 60% in year one, four and five; 55% in year two; 45% in year three. Primary endocrine treatment was the next treatment of choice among 28% in year one, 23% in year two, 30% in year three, 20% in year four, and 25% in year five. Offer and acceptance adjuvant treatments have increased in year wise analysis. Conclusions: We have noticed a shift towards surgery from primary endocrine therapy in year wise analysis. There has been an increase of number of 70+ patients diagnosed with breast cancer. Inclusion of performance status had improved offer of adjuvant treatment in the last year of the study. More individualised and evidence based management recommended to offer appropriate treatment in this age group.

Adding abiraterone or docetaxel to long-term hormone therapy for prostate cancer: directly randomised data from the STAMPEDE multi-arm, multi-stage platform protocol (2018)

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Type of publication:
Journal article

Author(s):
Sydes, M R; Spears, M R; Mason, M D; Clarke, N W; Dearnaley, D P; de Bono, J S; Attard, G; Chowdhury, S; Cross, W; Gillessen, S; Malik, Z I; Jones, R; Parker, C C; Ritchie, A W S; Russell, J M; Millman, R; Matheson, D; Amos, C; Gilson, C; Birtle, A; Brock, S; Capaldi, L; Chakraborti, P; Choudhury, A; Evans, L; Ford, D; Gale, J; Gibbs, S; Gilbert, D C; Hughes, R; McLaren, D; Lester, J F; Nikapota, A; O'Sullivan, J; Parikh, O; Peedell, C; Protheroe, A; Rudman, S M; Shaffer, R; Sheehan, D; Simms, M; *Srihari, N; Strebel, R; Sundar, S; Tolan, S; Tsang, D; Varughese, M; Wagstaff, J; Parmar, M K B; James, N D; STAMPEDE Investigators

Citation:
Annals of Oncology : Official Journal of the European Society for Medical Oncology; May 2018; vol. 29 (no. 5); p. 1235-1248

Abstract:
 Background Adding abiraterone acetate with prednisolone (AAP) or docetaxel with prednisolone (DocP) to standard-of-care (SOC) each improved survival in systemic therapy for advanced or metastatic prostate cancer: evaluation of drug efficacy: a multi-arm multi-stage platform randomised controlled protocol recruiting patients with high-risk locally advanced or metastatic PCa starting long-term androgen deprivation therapy (ADT). The protocol provides the only direct, randomised comparative data of SOC+AAP versus SOC+DocP. Method Recruitment to SOC+DocP and SOC+AAP overlapped November 2011 to March 2013. SOC was long-term ADT or, for most non-metastatic cases, ADT for≥2years and RT to the primary tumour. Stratified randomisation allocated pts 2:1:2 to SOC; SOC+docetaxel 75mg/m2 3-weekly×6+prednisolone 10mg daily; or SOC+abiraterone acetate 1000mg+prednisolone 5mg daily. AAP duration depended on stage and intent to give radical RT. The primary outcome measure was death from any cause. Analyses used Cox proportional hazards and flexible parametric models, adjusted for stratification factors. This was not a formally powered comparison. A hazard ratio (HR) <1 favours SOC+AAP, and HR>1 favours SOC+DocP. Results A total of 566 consenting patients were contemporaneously randomised: 189 SOC+DocP and 377 SOC+AAP. The patients, balanced by allocated treatment were: 342 (60%) M1; 429 (76%) Gleason 8-10; 449 (79%) WHO performance status 0; median age 66years and median PSA 56ng/ml. With median follow-up 4years, 149 deaths were reported. For overall survival, HR=1.16 (95% CI 0.82-1.65); failure-free survival HR=0.51 (95% CI 0.39-0.67); progression-free survival HR=0.65 (95% CI 0.48-0.88); metastasis-free survival HR=0.77 (95% CI 0.57-1.03); prostate cancer-specific survival HR=1.02 (0.70-1.49); and symptomatic skeletal events HR=0.83 (95% CI 0.55-1.25). In the safety population, the proportion reporting≥1 grade 3, 4 or 5 adverse events ever was 36%, 13% and 1% SOC+DocP, and 40%, 7% and 1% SOC+AAP; prevalence 11% at 1 and 2 years on both arms. Relapse treatment patterns varied by arm. Conclusions This direct, randomised comparative analysis of two new treatment standards for hormone-naïve prostate cancer showed no evidence of a difference in overall or prostate cancer-specific survival, nor in other important outcomes such as symptomatic skeletal events. Worst toxicity grade over entire time on trial was similar but comprised different toxicities in line with the known properties of the drugs.Trial registration Clinicaltrials.gov: NCT00268476.

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A pilot experience in using a digital app to follow-up prostate cancer patients in Shropshire, UK (2018)

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Type of publication:
Conference abstract

Author(s):
*Phan Y.; *Loh A.; *Anandakumar A.; *Umranikar S.; *Elves A.

Citation:
European Urology, Supplements; Mar 2018; vol. 17 (no. 2)

Abstract:
Introduction & Objective: It is not uncommon for patients with cancer to experience physical, mental and social distress, forming a significant burden that has a negative impact on their quality of life. We have piloted a digital app called VitruCare in our hospital in order to address these issues in patients with prostate cancer. More importantly, the app also serves as a communication tool between the hospital medical team and the patients. Materials and Methods: Patients with prostate cancer were invited to use VitruCare in our pilot study. 53 users were followed prospectively. Data on various domains such as "My Goals", "My Lifestyle", "My Priorities", "My Diaries", and "How Do I Feel Today" were analysed retrospectively. Results: The users of this application have a median age of 72.5 years old. 14% have nodal or bone metastasis, and median time since treatment is 48 months. 60% have completed the lifestyle questionnaire and "How Do I Feel Today" trackers. 20% of the users who completed the lifestyle questionnaire reported anxiety. 42% have used the diary function and 47% have used the secured messaging function. Usage of the lifestyle questionnaire, "How Do I Feel Today" trackers, secured messaging and diary functions does not appear to be age related. Patients who have been treated and further away from treatment in time are more likely to be used the app. Conclusions: The level of engagement in this pilot study reflects the willingness of patients to utilize this innovative app that has the potential to monitor the well-being of patients with prostate cancer out with the constraints of a fixed clinic appointment.

A pilot experience in using a digital app to follow-up prostate cancer patients in Shropshire, UK (2017)

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Type of publication:
Conference abstract

Author(s):
*Phan Y.; *Loh A.; *Anandakumar A.; *Umranikar S.; *Elves A.

Citation:
Journal of Endourology; Sep 2017; vol. 31, S2

Abstract:
Introduction & Objective: It is not uncommon for patients with cancer to experience physical, mental and social distress, forming a significant burden that has a negative impact on their quality of life. We have piloted a digital app called VitruCare in our hospital in order to address these issues in patients with prostate cancer. More importantly, the app also serves as a communication tool between the hospital medical team and the patients. Materials and Methods: Patients with prostate cancer were invited to use VitruCare in our pilot study. 53 users were followed prospectively. Data on various domains such as "My Goals", "My Lifestyle", "My Priorities", "My Diaries", and "How Do I Feel Today" were analysed retrospectively. Results: The users of this application have a median age of 72.5 years old. 14% have nodal or bone metastasis, and median time since treatment is 48 months. 60% have completed the lifestyle questionnaire and "How Do I Feel Today" trackers. 20% of the users who completed the lifestyle questionnaire reported anxiety. 42% have used the diary function and 47% have used the secured messaging function. Usage of the lifestyle questionnaire, "How Do I Feel Today" trackers, secured messaging and diary functions does not appear to be age related. Patients who have been treated and further away from treatment in time are more likely to be used the app. Conclusions: The level of engagement in this pilot study reflects the willingness of patients to utilize this innovative app that has the potential to monitor the well-being of patients with prostate cancer out with the constraints of a fixed clinic appointment.

3 versus 6 months of adjuvant oxaliplatin-fluoropyrimidine combination therapy for colorectal cancer (SCOT): an international, randomised, phase 3, non-inferiority trial (2018)

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Type of publication:
Randomised controlled trial

Author(s):
Iveson TJ, Kerr RS, Saunders MP, Cassidy J, Hollander NH, Tabernero J, Haydon A, Glimelius B, Harkin A, Allan K, McQueen J, Scudder C, Boyd KA, Briggs A, Waterston A, Medley L, Wilson C, Ellis R, Essapen S, Dhadda AS, Harrison M, Falk S, Raouf S, Rees C, Olesen RK, Propper D, Bridgewater J, Azzabi A, Farrugia D, Webb A, Cunningham D, Hickish T, Weaver A, Gollins S, Wasan HS, Paul J. [SaTH was one of the sites this trial took place at]

Citation:
Lancet Oncology 2018 Apr;19(4):562-578

Abstract:
BACKGROUND: 6 months of oxaliplatin-containing chemotherapy is usually given as adjuvant treatment for stage 3 colorectal cancer. We investigated whether 3 months of oxaliplatin-containing chemotherapy would be non-inferior to the usual 6 months of treatment.
METHODS: The SCOT study was an international, randomised, phase 3, non-inferiority trial done at 244 centres. Patients aged 18 years or older with high-risk stage II and stage III colorectal cancer underwent central randomisation with minimisation for centre, choice of regimen, sex, disease site, N stage, T stage, and the starting dose of capecitabine. Patients were assigned (1:1) to receive 3 months or 6 months of adjuvant oxaliplatin-containing chemotherapy. The chemotherapy regimens could consist of CAPOX (capecitabine and oxaliplatin) or FOLFOX (bolus and infused fluorouracil with oxaliplatin). The regimen was selected before randomisation in accordance with choices of the patient and treating physician. The primary study endpoint was disease-free survival and the non-inferiority margin was a hazard ratio of 1·13. The primary analysis was done in the intention-to-treat population and safety was assessed in patients who started study treatment. This trial is registered with ISRCTN, number ISRCTN59757862, and follow-up is continuing.
FINDINGS: 6088 patients underwent randomisation between March 27, 2008, and Nov 29, 2013. The intended treatment was FOLFOX in 1981 patients and CAPOX in 4107 patients. 3044 patients were assigned to 3 month group and 3044 were assigned to 6 month group. Nine patients in the 3 month group and 14 patients in the 6 month group did not consent for their data to be used, leaving 3035 patients in the 3 month group and 3030 patients in the 6 month group for the intention-to-treat analyses. At the cutoff date for analysis, there had been 1482 disease-free survival events, with 740 in the 3 month group and 742 in the 6 month group. 3 year disease-free survival was 76·7% (95% CI 75·1-78·2) for the 3 month group and 77·1% (75·6-78·6) for the 6 month group, giving a hazard ratio of 1·006 (0·909-1·114, test for non-inferiority p=0·012), significantly below the non-inferiority margin. Peripheral neuropathy of grade 2 or worse was more common in the 6 month group (237 [58%] of 409 patients for the subset with safety data) than in the 3 month group (103 [25%] of 420) and was long-lasting and associated with worse quality of life. 1098 serious adverse events were reported (492 reports in the 3 month group and 606 reports in the 6 month group) and 32 treatment-related deaths occurred (16 in each group).
INTERPRETATION: In the whole study population, 3 months of oxaliplatin-containing adjuvant chemotherapy was non-inferior to 6 months of the same therapy for patients with high-risk stage II and stage III colorectal cancer and was associated with reduced toxicity and improved quality of life. Despite the fact the study was underpowered, these data suggest that a shorter duration leads to similar survival outcomes with better quality of life and thus might represent a new standard of care.
FUNDING: Medical Research Council, Swedish Cancer Society, NETSCC, and Cancer Research UK.

Link to full-text [Open access - no password required]

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