Oncology

Addition of Docetaxel to First-line Long-term Hormone Therapy in Prostate Cancer (STAMPEDE): Modelling to Estimate Long-term Survival, Quality-adjusted Survival, and Cost-effectiveness (2018)

Posted on by

Type of publication:
Journal article

Author(s):
Woods B.S.; Sideris E.; Sculpher M.J.; Sydes M.R.; Gannon M.R.; Parmar M.K.B.; Millman R.; Alzouebi M.; Attard G.; Dearnaley D.P.; Birtle A.J.; Brock S.; Cathomas R.; Chakraborti P.R.; Cook A.; Cross W.R.; Gale J.; Gibbs S.; Graham J.D.; Hughes R.; Jones R.J.; Laing R.; Mason M.D.; Matheson D.; McLaren D.B.; O'Sullivan J.M.; Parikh O.; Parker C.C.; Peedell C.; Protheroe A.; Ritchie A.W.S.; Robinson A.; Russell J.M.; Simms M.S.; *Srihari N.N.; Srinivasan R.; Staffurth J.N.; Sundar S.; Thalmann G.N.; Tolan S.; Tran A.T.H.; Tsang D.; Wagstaff J.; James N.D.

Citation:
European Urology Oncology; Dec 2018; vol. 1 (no. 6); p. 449-458

Abstract:
BACKGROUND: Results from large randomised controlled trials have shown that adding docetaxel to the
standard of care (SOC) for men initiating hormone therapy for prostate cancer (PC) prolongs survival for those with metastatic disease and prolongs failure-free survival for those without. To date there has been no formal assessment of whether funding docetaxel in this setting represents an appropriate use of UK National Health Service (NHS) resources.
OBJECTIVE(S): To assess whether administering docetaxel to men with PC starting long-term hormone therapy is cost-effective in a UK setting.
DESIGN, SETTING, AND PARTICIPANTS: We modelled health outcomes and costs in the UK NHS using data collected within the STAMPEDE trial, which enrolled men with high-risk, locally advanced metastatic or recurrent PC starting first-line hormone therapy. INTERVENTION: SOC was hormone therapy for >=2 yr and radiotherapy in some patients. Docetaxel (75mg/m2) was administered alongside SOC for six three-weekly cycles. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The model generated lifetime predictions of costs, changes in survival duration, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). RESULTS AND LIMITATIONS: The model predicted that docetaxel would extend survival (discounted quality-adjusted survival) by 0.89 yr (0.51) for metastatic PC and 0.78 yr (0.39) for nonmetastatic PC, and would be cost-effective in metastatic PC (ICER 5514/QALY vs SOC) and nonmetastatic PC (higher QALYs, lower costs vs SOC). Docetaxel remained cost-effective in nonmetastatic PC when the assumption of no survival advantage was modelled.
CONCLUSION(S): Docetaxel is cost-effective among patients with nonmetastatic and metastatic PC in a UK setting. Clinicians should consider whether the evidence is now sufficiently compelling to support docetaxel use in patients with nonmetastatic PC, as the opportunity to offer docetaxel at hormone therapy initiation will be missed for some patients by the time more mature survival data are available. PATIENT SUMMARY: Starting docetaxel chemotherapy alongside hormone therapy represents a good use of UK National Health Service resources for patients with prostate cancer that is high risk or has spread to other parts of the body.

Local experience at DGH shows combination Pertuzumab and Herceptin nearly doubles PCR rate of Neo-adjuvant Chemotherapy (NAC) in HER2 positive breast cancer (2018)

Posted on by

Type of publication:
Poster presentation

Author(s):
*Blossom Lake, *Donna Appleton, *Abel Zachariah, *Habib Khan, *Kerry Flemming, *Jennifer Neill, *Laura Pettit

Citation:
Presented at BASO: The Association for Cancer Surgery

Link to poster [PDF]

Breast Reconstruction Affects Coping Mechanisms in Breast Cancer Survivors (2019)

Posted on by

Type of publication:
Journal article

Author(s):
*Lake, Blossom; Fuller, Heidi R; *Rastall, Sarah; *Usman, Tamoor

Citation:
Indian Journal of Surgery; Feb 2019; vol. 81 (no. 1); p. 43-50

Abstract:
Coping strategies used by women with breast cancer are vital for adjustment to their disease. Whilst it is clear that factors such as age at diagnosis, social support and ethnicity can influence coping mechanisms, there is currently no information about whether breast reconstruction changes mechanisms of coping for such patients. The aims of this study, therefore, were to determine how women who have had immediate breast reconstruction and mastectomy cope, compared to those who have mastectomy alone, and whether there are differences in coping mechanisms due to breast reconstruction surgery. This was a retrospective cohort study, using a standardised questionnaire called the Brief Cope Scale. Inclusion criteria was the following: all women
who had immediate breast reconstruction and mastectomy in Shropshire from 2003 to 2014 for ductal carcinoma in situ or node-negative invasive breast cancer. Each patient was matched for year of diagnosis, adjuvant therapy and age to one woman who had mastectomy alone. Two hundred thirty-four questionnaires were sent with a 58% response rate. Significantly more patients from the reconstruction cohort coped by active coping (T value 1.66, P value 0.04) compared to those in the mastectomy alone cohort. In contrast, significantly more patients in the mastectomy alone cohort coped by active venting compared to the reconstruction cohort (T value 1.71, P value 0.04). This study indicates for the first time that breast reconstruction may alter coping mechanisms in breast cancer survivors. Awareness of these coping mechanisms will enable clinicians to provide appropriate, individualised support.

Screening for colorectal cancer in defunctioned colons (2018)

Posted on by

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.

Link to full-text [no password required]

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

Posted on by

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)

Posted on by

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.

Link to full-text [NHS OpenAthens account required]

Altmetrics

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)

Posted on by

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.

Altmetrics

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

Posted on by

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.