1
|
Khetrapal P, Bains PS, Jubber I, Ambler G, Williams NR, Brew-Graves C, Sridhar A, Ta A, Kelly JD, Catto JWF. Digital Tracking of Patients Undergoing Radical Cystectomy for Bladder Cancer: Daily Step Counts Before and After Surgery Within the iROC Randomised Controlled Trial. Eur Urol Oncol 2024; 7:485-493. [PMID: 37852921 DOI: 10.1016/j.euo.2023.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/11/2023] [Accepted: 09/25/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Efforts to improve recovery after radical cystectomy (RC) are needed. OBJECTIVE To investigate wrist-worn wearable activity trackers in RC participants. DESIGN, SETTING, AND PARTICIPANTS An observational cohort study was conducted within the iROC randomised trial. INTERVENTION Patients undergoing RC at nine cancer centres wore wrist-based trackers for 7 days (d) at intervals before and after surgery. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Step counts were compared with participant and operative features, and recovery outcomes. RESULTS AND LIMITATIONS Of 308 participants, 284 (92.2%) returned digital activity data at baseline (median 17 d [interquartile range: 8-32] before RC), and postoperatively (5 [5-6] d) and at weeks 5 (43 [38-43] d), 12 (94 [87-106] d), and 26 (192 [181-205] d) after RC. Compliance was affected by the time from surgery and a coronavirus disease 2019 pandemic lockdown (return rates fell to 0-7%, chi-square p < 0.001). Step counts dropped after surgery (mean of 28% of baseline), before recovering at 5 weeks (wk) (71% of baseline) and 12 wk (95% of baseline; all analysis of variance [ANOVA] p < 0.001). Baseline step counts were not associated with postoperative recovery or death. Patients with extended hospital stays had reduced postoperative step counts, with a difference of 2.2 d (95% confidence interval: 0.856-3.482 d) between the lowest third and highest two-third tertiles (linear regression analysis; p < 0.001). Additionally, they spent less time out of the hospital within 90 d of RC (80.3 vs 74.3 d, p = 0.013). Lower step counts at 5, 12, and 26 wk were seen in those seeking medical help and needing readmission (ANOVA p ≤ 0.002). CONCLUSIONS Baseline step counts were not associated with recovery. Lower postoperative step counts were associated with longer length of stay at the hospital and postdischarge readmissions. Studies are required to determine whether low step counts can identify patients at a risk of developing complications. PATIENT SUMMARY Postoperative step counts appear to be a promising tool to identify patients in the community needing medical help or readmission. More work is needed to understand which measures are most useful and how best to collect these.
Collapse
Affiliation(s)
- Pramit Khetrapal
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital, London, UK
| | - Parasdeep S Bains
- Division of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Sheffield, UK
| | - Ibrahim Jubber
- Division of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Sheffield, UK; Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, UK
| | - Norman R Williams
- Surgical & Interventional Trials Unit (SITU), Division of Surgery & Interventional Science, University College London, London, UK
| | - Chris Brew-Graves
- UCL Centre for Medical Imaging, Division of Medicine, University College London, London, UK
| | - Ashwin Sridhar
- Department of Urology, University College London Hospital, London, UK
| | - Anthony Ta
- Department of Urology, University College London Hospital, London, UK
| | - John D Kelly
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital, London, UK
| | - James W F Catto
- Division of Surgery & Interventional Science, University College London, London, UK; Division of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Sheffield, UK; Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
| |
Collapse
|
2
|
Rogers Z, Glaser A, Catto JWF, Bottomley S, Jubber I, Kotwal S, Brittain P, Gill J, Rogers MA, Dooldeniya MD, Koenig P, Cresswell J, Chahal R, Bryan N, Smith NJ, Pritchard K, Abbasi Z, Mason SJ, Absolom K, Downing A. Health-related quality of life after a diagnosis of bladder cancer: a longitudinal survey over the first year. BJU Int 2024; 133:460-473. [PMID: 38031657 DOI: 10.1111/bju.16242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
OBJECTIVES To describe the health-related quality of life (HRQoL) of patients in a prospective 12-month observational cohort study of new bladder cancer diagnoses and compare with national cancer and general population surveys. PATIENTS AND METHODS A prospective UK study in patients with new bladder cancer diagnoses at 13 NHS Trusts. The HRQoL data were collected at 3, 6, 9 and 12 months. Questionnaires used included: the EuroQoL five Dimensions (EQ-5D), European Organisation for Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ)-30-item core, EORTC QLQ-24-item non-muscle-invasive bladder cancer, and EORTC QLQ-30-item muscle-invasive bladder cancer. Results were compared with the Cancer Quality of Life Survey and Health Survey for England. RESULTS A total of 349 patients were recruited, 296 (85%) completed the first (baseline) and 233 (67%) the final survey. The patients underwent transurethral resection of bladder tumour (TURBT) ± intravesical therapy (238 patients, 80%), radical cystectomy/radiotherapy (51, 17%) or palliation (seven, 2%). At baseline, patients needing radical treatment reported worse HRQoL including lower social function (74.2 vs 83.8, P = 0.002), increased fatigue (31.5 vs 26.1, P = 0.03) and more future worries (39.2 vs 29.4, P = 0.005) than patients who underwent TURBT. Post-treatment surveys showed no change/improvements for patients who underwent TURBT but deterioration for the radically treated cohort. At final survey, reports were similar to baseline, regardless of treatment. Radically treated patients continued to report poorer HRQoL including issues with body image (23.4 vs 12.5, P = 0.007) and male sexual function (75.8 vs 40.4, P < 0.001) compared to those who underwent TURBT. Radically treated patients reported lower EQ-5D utility scores and more problems with usual activities than the general population. DISCUSSION Patients undergoing TURBT can be reassured regarding HRQoL following treatment. However, those requiring radical treatment report greater changes in HRQoL with the need for appropriate clinical and supportive care to minimise the impact of treatments.
Collapse
Affiliation(s)
- Zoe Rogers
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Adam Glaser
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
- Leeds Children's Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - James W F Catto
- Division of Clinical Medicine, University of Sheffield, Sheffield, UK
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Sarah Bottomley
- Division of Clinical Medicine, University of Sheffield, Sheffield, UK
| | - Ibrahim Jubber
- Division of Clinical Medicine, University of Sheffield, Sheffield, UK
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Sanjeev Kotwal
- Pyrah Department of Urology, St James University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Paul Brittain
- Department of Urology, The York Hospital, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| | - Jonathan Gill
- Department of Urology, Harrogate and District NHS Foundation Trust, Harrogate, UK
| | - Mark A Rogers
- Department of Urology, Scunthorpe General Hospital, Northern Lincolnshire and Goole NHS Foundation Trust, Scunthorpe, UK
| | | | - Philip Koenig
- Department of Urology, Airedale NHS Foundation Trust, Keighley, UK
| | - Jo Cresswell
- Department of Urology, South Tees Hospitals NHS Foundation Trust, James Cook University Hospital, Middlesborough, UK
| | - Rohit Chahal
- Department of Urology, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Nicolas Bryan
- Department of Urology, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
| | - Nick J Smith
- Department of Urology, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Kelly Pritchard
- Department of Urology, Chesterfield Royal Hospital NHS Foundation Trust, Chesterfield, UK
| | - Zahir Abbasi
- Department of Urology, The Rotherham NHS Foundation Trust, Rotherham, UK
| | - Samantha J Mason
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Kate Absolom
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Amy Downing
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| |
Collapse
|
3
|
Price G, Peek N, Eleftheriou I, Spencer K, Paley L, Hogenboom J, van Soest J, Dekker A, van Herk M, Faivre-Finn C. An Overview of Real-World Data Infrastructure for Cancer Research. Clin Oncol (R Coll Radiol) 2024:S0936-6555(24)00108-0. [PMID: 38631976 DOI: 10.1016/j.clon.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/27/2024] [Accepted: 03/13/2024] [Indexed: 04/19/2024]
Abstract
AIMS There is increasing interest in the opportunities offered by Real World Data (RWD) to provide evidence where clinical trial data does not exist, but access to appropriate data sources is frequently cited as a barrier to RWD research. This paper discusses current RWD resources and how they can be accessed for cancer research. MATERIALS AND METHODS There has been significant progress on facilitating RWD access in the last few years across a range of scales, from local hospital research databases, through regional care records and national repositories, to the impact of federated learning approaches on internationally collaborative studies. We use a series of case studies, principally from the UK, to illustrate how RWD can be accessed for research and healthcare improvement at each of these scales. RESULTS For each example we discuss infrastructure and governance requirements with the aim of encouraging further work in this space that will help to fill evidence gaps in oncology. CONCLUSION There are challenges, but real-world data research across a range of scales is already a reality. Taking advantage of the current generation of data sources requires researchers to carefully define their research question and the scale at which it would be best addressed.
Collapse
Affiliation(s)
- G Price
- Division of Cancer Sciences, University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK.
| | - N Peek
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK; The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge, Cambridge, UK
| | - I Eleftheriou
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
| | - K Spencer
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK; National Disease Registration Service, NHS England, UK
| | - L Paley
- National Disease Registration Service, NHS England, UK
| | - J Hogenboom
- Department of Radiation Oncology (Maastro), GROW-School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - J van Soest
- Department of Radiation Oncology (Maastro), GROW-School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands; Brightlands Institute for Smart Society (BISS), Faculty of Science and Engineering, Maastricht University, Maastricht, The Netherlands
| | - A Dekker
- Department of Radiation Oncology (Maastro), GROW-School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - M van Herk
- Division of Cancer Sciences, University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK
| | - C Faivre-Finn
- Division of Cancer Sciences, University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK
| |
Collapse
|
4
|
Toren P, Wilkins A, Patel K, Burley A, Gris T, Kockelbergh R, Lodhi T, Choudhury A, Bryan RT. The sex gap in bladder cancer survival - a missing link in bladder cancer care? Nat Rev Urol 2024; 21:181-192. [PMID: 37604983 DOI: 10.1038/s41585-023-00806-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/23/2023]
Abstract
The differences in bladder cancer outcomes between the sexes has again been highlighted. Uncommon among cancers, bladder cancer outcomes are notably worse for women than for men. Furthermore, bladder cancer is three to four times more common among men than among women. Factors that might explain these sex differences include understanding the importance of haematuria as a symptom of bladder cancer by both clinicians and patients, the resultant delays in diagnosis and referral of women with haematuria, and health-care access. Notably, these factors seem to have geographical variation and are not consistent across all health-care systems. Likewise, data relating to sex-specific treatment responses for patients with non-muscle-invasive or muscle-invasive bladder cancer are inconsistent. The influence of differences in the microbiome, bladder wall thickness and urine dwell times remain to be elucidated. The interplay of hormone signalling, gene expression, immunology and the tumour microenvironment remains complex but probably underpins the sexual dimorphism in disease incidence and stage and histology at presentation. The contribution of these biological phenomena to sex-specific outcome differences is probable, albeit potentially treatment-specific, and further understanding is required. Notwithstanding these aspects, we identify opportunities to harness biological differences to improve treatment outcomes, as well as areas of fundamental and translational research to pursue. At the level of policy and health-care delivery, improvements can be made across the domains of patient awareness, clinician education, referral pathways and guideline-based care. Together, we aim to highlight opportunities to close the sex gap in bladder cancer outcomes.
Collapse
Affiliation(s)
- Paul Toren
- CHU de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Anna Wilkins
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
- The Royal Marsden Hospitals NHS Trust, London, UK
| | - Keval Patel
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Amy Burley
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Typhaine Gris
- CHU de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Roger Kockelbergh
- University Hospitals of Leicester NHS Trust, Leicester, UK
- Action Bladder Cancer UK, Tetbury, UK
| | - Taha Lodhi
- Division of Cancer Sciences, University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | - Ananya Choudhury
- Division of Cancer Sciences, University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | - Richard T Bryan
- Action Bladder Cancer UK, Tetbury, UK.
- Bladder Cancer Research Centre, Institute of Cancer & Genomic Sciences, University of Birmingham, Birmingham, UK.
| |
Collapse
|
5
|
Byrnes KG, Bhatt NR, Ippoliti S, Varma R, Asif A, Kerdegari N, Nathan A, Gallagher K, Khadhouri S, Kasivisvinathan V. Introducing WASHOUT: A Large-scale Observational Study of Inpatient Haematuria. Eur Urol Focus 2024:S2405-4569(24)00017-8. [PMID: 38388216 DOI: 10.1016/j.euf.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/31/2024] [Indexed: 02/24/2024]
Abstract
WASHOUT is an international, multicentre, prospective observational study aiming to describe the management of unscheduled haematuria admissions. Preregistration can be done using the following link: https://redcap.link/WASHOUT.
Collapse
Affiliation(s)
- Kevin G Byrnes
- British Urology Researchers in Training (BURST), London, UK; Division of Surgery and Interventional Science, University College London, London, UK.
| | - Nikita R Bhatt
- British Urology Researchers in Training (BURST), London, UK; Freeman Hospital, Newcastle upon Tyne, UK
| | - Simona Ippoliti
- British Urology Researchers in Training (BURST), London, UK; Hull University Teaching Hospitals, Hull, UK
| | - Raghav Varma
- British Urology Researchers in Training (BURST), London, UK; West Midlands Deanery, UK
| | - Aqua Asif
- British Urology Researchers in Training (BURST), London, UK; Division of Surgery and Interventional Science, University College London, London, UK
| | - Nikki Kerdegari
- British Urology Researchers in Training (BURST), London, UK; School of Medical Education, King's College London, London, UK
| | - Arjun Nathan
- British Urology Researchers in Training (BURST), London, UK; Division of Surgery and Interventional Science, University College London, London, UK
| | - Kevin Gallagher
- British Urology Researchers in Training (BURST), London, UK; Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, Western General Hospital, Edinburgh, UK
| | - Sinan Khadhouri
- British Urology Researchers in Training (BURST), London, UK; School of Medicine, University of St Andrews, St Andrews, UK; Victoria Hospital, Kirkcaldy, NHS Fife, UK
| | - Veeru Kasivisvinathan
- British Urology Researchers in Training (BURST), London, UK; Division of Surgery and Interventional Science, University College London, London, UK
| |
Collapse
|
6
|
Liedberg F, Hagberg O, Aljabery F, Gårdmark T, Jahnson S, Jerlström T, Ströck V, Söderkvist K, Ullén A, Bobjer J. Diagnostic pathways and treatment strategies in upper tract urothelial carcinoma in Sweden between 2015 and 2021: a population-based survey. Scand J Urol 2024; 59:19-25. [PMID: 38226846 DOI: 10.2340/sju.v59.16281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/20/2023] [Indexed: 01/17/2024]
Abstract
OBJECTIVE To report national data on diagnostics and treatment of upper tract urothelial carcinoma (UTUC) from the Swedish National Registry of Urinary Bladder Cancer (SNRUBC). PATIENTS AND METHODS Data from 2015 to 2021 were retrieved, and descriptive analyses were performed regarding incidence, diagnostic modalities, preoperative tumor staging, quality indicators for treatment including the use of standardized care pathways (SCP) and multidisciplinary tumor boards (MDTB). Time trends were explored for the study period. RESULTS Registrations included 1,213 patients with renal pelvic cancer and 911 patients with ureteric cancer with a median age of 74 (interquartile range [IQR] 70-77) and 75 (IQR 71-78) years, respectively. Incidence rates of UTUC were stable, as were proportions of curative treatment intent. Median number of days from referral to treatment was 76 (IQR 57-99) and 90 (IQR 72-118) days, respectively, for tumors of the renal pelvis and ureter, which remained unchanged after introduction of SCP in 2016. Noticeable trends included stable use of kidney-sparing surgery and increased use of MDTB. For radical nephroureterectomy (RNU), robot-assisted technique usage increased even for non-organ-confined tumors (cT3-4) and in one out of three patients undergoing RNU a bladder cuff excision was not registered. CONCLUSIONS The population-based SNRUBC with high coverage contributes to the knowledge about UTUC with granular and generalizable data. The present study reveals a high proportion of patients not subjected to curatively intended treatment and suggests unmet needs to shorten lead times to treatment and use of bladder cuff excision when performing radical surgery for UTUC in Sweden.
Collapse
Affiliation(s)
- Fredrik Liedberg
- Department of Urology Skåne University Hospital, Malmö, Sweden; Institution of Translational Medicine, Lund University, Malmö, Sweden
| | - Oskar Hagberg
- Institution of Translational Medicine, Lund University, Malmö, Sweden
| | - Firas Aljabery
- Department of Clinical and Experimental Medicine, Division of Urology, Linköping University, Linköping, Sweden
| | - Truls Gårdmark
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Staffan Jahnson
- Department of Clinical and Experimental Medicine, Division of Urology, Linköping University, Linköping, Sweden
| | - Tomas Jerlström
- Department of Urology, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Viveka Ströck
- Department of Urology, Sahlgrenska University Hospital and Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | | | - Anders Ullén
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Pelvic Cancer, Genitourinary Oncology and Urology unit, Karolinska University Hospital, Stockholm, Sweden
| | - Johannes Bobjer
- Department of Urology Skåne University Hospital, Malmö, Sweden; Institution of Translational Medicine, Lund University, Malmö, Sweden.
| |
Collapse
|
7
|
Catto JWF, Rogers Z, Downing A, Mason SJ, Jubber I, Bottomley S, Conner M, Absolom K, Glaser A. Lifestyle Factors in Patients with Bladder Cancer: A Contemporary Picture of Tobacco Smoking, Electronic Cigarette Use, Body Mass Index, and Levels of Physical Activity. Eur Urol Focus 2023; 9:974-982. [PMID: 37080801 DOI: 10.1016/j.euf.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/06/2023] [Accepted: 04/02/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Little is known about contemporary lifestyle choices in patients with bladder cancer (BC). These choices include carcinogenic risk factors and could affect fitness to receive treatments. OBJECTIVE To evaluate the contemporary lifestyle choices in BC patients. DESIGN, SETTING, AND PARTICIPANTS Self-reported surveys from participants diagnosed with BC in the previous 10 yr captured smoking patterns, e-cigarette use, physical activity using the GODIN Leisure-Time Exercise Questionnaire, long-term conditions (LTCs), relationship status, sociodemographics, and body mass index (BMI; height and weight). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Findings were compared with the general population and men with prostate cancer. RESULTS AND LIMITATIONS Completed surveys were received from 2092 participants. Most respondents were ex-smokers (61% vs 10% current vs 29% never). The use of e-cigarettes was uncommon (9%) and at lower rates than the age-equivalent general population. Passive smoke exposure was frequent (48%). Most participants (68%) were "insufficiently active" using the GODIN criteria and less physically active than the age-equivalent general population. Most respondents (44%) were classified as overweight (BMI 25-29.99) or obese (22%, BMI >30). Lifestyle factors varied with age, sex, socioeconomic deprivation, and LTCs. Younger participants were less likely to smoke (p < 0.001), more likely to have used e-cigarettes (p < 0.001), but more likely to have had passive smoke exposure (p = 0.008). Those from less affluent areas were more likely to smoke (p < 0.001), have used e-cigarettes (p < 0.001), and have had passive smoke exposure (p = 0.02). Females were less likely to be smokers (p < 0.001) but more likely to have been exposed to passive smoke (p < 0.001). CONCLUSIONS Persons affected by BC often have smoking exposures and high BMI, and are insufficiently active. Rates of e-cigarette use were lower than in the general population. Efforts to improve quality of life in this cohort should include wider advocation of smoking cessation, perhaps including the use of e-cigarettes, and programmes to increase exercise and reduce BMI. PATIENT SUMMARY We looked at the lifestyle choices, such as smoking, e-cigarette use, physical activity levels, and obesity, of patients following a bladder cancer diagnosis. We conclude that this population would benefit from healthy lifestyle interventions.
Collapse
Affiliation(s)
- James W F Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK; Department of Urology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK; Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
| | - Zoe Rogers
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK; Leeds Institute for Data Analytics, University of Leeds, Leeds, UK.
| | - Amy Downing
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK; Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Samantha J Mason
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Ibrahim Jubber
- Academic Urology Unit, University of Sheffield, Sheffield, UK; Department of Urology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK; Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Sarah Bottomley
- Academic Urology Unit, University of Sheffield, Sheffield, UK; Department of Urology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Mark Conner
- School of Psychology, University of Leeds, Leeds, UK
| | - Kate Absolom
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK; Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Adam Glaser
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK; Leeds Institute for Data Analytics, University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| |
Collapse
|
8
|
Catto JW, North B, Goff M, Carter A, Sleeth M, Mandrik O, Chilcott J, Sasieni P, Cumberbatch MGK. Protocol for the YORKSURe prospective multistage study testing the feasibility for early detection of bladder cancer in populations with high disease-specific mortality risk. BMJ Open 2023; 13:e076612. [PMID: 37678944 PMCID: PMC10496676 DOI: 10.1136/bmjopen-2023-076612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/31/2023] [Indexed: 09/09/2023] Open
Abstract
INTRODUCTION Around 25% of patients with bladder cancer (BCa) present with invasive disease. Non-randomised studies of population-based screening have suggested reductions in BCa-specific mortality are possible through earlier detection. The low prevalence of lethal disease in the general population means screening is not cost-effective and there is no consensus on the best strategy. Yorkshire has some of the highest mortality rates from BCa in England. We aim to test whether population screening in a region of high mortality risk will lead to a downward stage-migration of aggressive BCa, improved survival and is cost-effective. METHODS AND ANALYSIS YORKSURe is a tiered, randomised, multicohort study to test the feasibility of a large BCa screening randomised controlled trial. In three parallel cohorts, participants will self-test urine (at home) up to six times. Results are submitted via a mobile app or freephone. Those with a positive result will be invited for further investigation at community-based early detection clinics or within usual National Health Service (NHS) pathways. In Cohort 1, we will post self-testing kits to research engaged participants (n=2000) embedded within the Yorkshire Lung Screening Trial. In Cohort 2, we will post self-testing kits to 3000 invitees. Cohort 2 participants will be randomised between haematuria and glycosuria testing using a reveal/conceal design. In Cohort 3, we will post self-testing kits to 500 patients within the NHS pathway for investigation of haematuria. Our primary outcomes are rates of recruitment and randomisation, rates of positive test and acceptability of the design. The study is currently recruiting and scheduled to finish in June 2023. ETHICS AND DISSEMINATION The study has received the following approvals: London Riverside Research Ethics Committee (22/LO/0018) and Health Research Authority Confidentiality Advisory Group (20/CAG/0009). Results will be made available to providers and researchers via publicly accessible scientific journals. TRIAL REGISTRATION NUMBER ISRCTN34273159.
Collapse
Affiliation(s)
- James Wf Catto
- Department of Urology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
- Division of Clinical Medicine, University of Sheffield, Sheffield, UK
| | - Bernard North
- Cancer Prevention Trials Unit, King's College London, London, UK
| | - Megan Goff
- Cancer Prevention Trials Unit, King's College London, London, UK
| | - Abigail Carter
- Cancer Prevention Trials Unit, King's College London, London, UK
| | - Michelle Sleeth
- Cancer Prevention Trials Unit, King's College London, London, UK
| | - Olena Mandrik
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Jim Chilcott
- Health Economics and Decision Science, University of Sheffield, Sheffield, UK
| | - Peter Sasieni
- Cancer Prevention Trials Unit, King's College London, London, UK
| | - Marcus G K Cumberbatch
- Department of Urology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
- Division of Clinical Medicine, University of Sheffield, Sheffield, UK
| |
Collapse
|