Medical Student Perspectives on Undergraduate Oncology Education in the UK

AIMS

The British Oncology Network for Undergraduate Societies (BONUS) surveyed students who attended an oncology revision day to determine their views on the current quantity, quality and type of curriculum-based oncology teaching they have experienced.

MATERIALS AND METHODS

Students attending two BONUS revision days received a questionnaire assessing their experience of oncology teaching within the medical curriculum and interest in pursuing a future career in oncology using a 10-point Likert scale. Data were collected with informed consent to be anonymised and used for research. Student demographics and qualitative and quantitative data about experiences of oncology education were analysed.

RESULTS

In total, 451 students registered to attend the revision days. After removal of duplicates, non-responders and non-UK participants, responses from 153 students studying across years 1-6 at 22 UK medical schools were analysed. The mean quantity of oncology lectures students reported receiving was 8.9 hours and the mean quantity of clinic/ward-based oncology teaching was 7.5 hours. Ninety (62.1%) of the 145 students who responded to the relevant question reported that they had received dedicated teaching in oncology. Students who had received dedicated oncology teaching reported a statistically significantly higher mean quality 6.1 (95% confidence interval 5.6-6.5) versus 5.0 (95% confidence interval 4.3-5.5; P = 0.003) and quantity 5.2 (95% confidence interval 4.7-5.6) versus 4.3 (95% confidence interval 3.7-4.9; P = 0.03) of oncology teaching compared with those who had not received this.

CONCLUSION

Appropriate oncology education is essential for all medical students due to the high prevalence of cancer. All future doctors need the appropriate knowledge and communication skills to care for cancer patients. Our analysis provides quantitative evidence to support the value of specialist oncology teaching within the medical school curriculum in improving student-reported experience. National student-led revision days and events may widen interest in a future career in oncology and aid collaboration between oncology societies. It is important for the general undergraduate medical curriculum to integrate specialty content. An integrated curriculum should facilitate a holistic approach that spans prevention, screening, treatment and palliation rather than being split by subspeciality.

1005 Antibiotic-Impregnated Calcium Sulfate Beads Are Not Effective in the Primary Prevention of Infection in Open Femur and Tibia Fractures

Introduction

Infection is a major complication of open fractures. Antibiotic-impregnated calcium sulfate (AICS) beads are widely used as an adjuvant to systemic antibiotics. Whilst their efficacy in the secondary prevention of infection is established, we present the first retrospective study evaluating AICS beads in the primary prevention of infection in open fractures.

Method

214 open femur and tibia fractures in 207 patients were reviewed over a seven-year period. 148 fractures received only systemic antibiotic prophylaxis. 66 fractures also received AICS beads. The occurrence of acute infection (wound infection and acute osteomyelitis) was recorded, as well as that of long-term complications (chronic osteomyelitis, non-union and death).

Results

Fractures that received AICS with systemic antibiotics had an overall acute infection rate of 42% (28/66), compared to 43% (63/148) in fractures that received only systemic antibiotics (p > 0.05). There was no significant difference in infection rate even when fractures were stratified by Gustilo-Anderson grade. There was also no significant difference in the rate of long-term complications.

Conclusions

Our results indicate that the adjuvant use of AICS beads is not effective for the primary prevention of acute infection or long-term complications in open leg fractures. Further research is needed to elucidate the factors influencing the outcomes of AICS use.

A case of ANCA-associated vasculitis presenting de novo in pregnancy, successfully treated with rituximab

Antineutrophil cytoplasm antibody (ANCA)-associated vasculitides are rare small vessel vasculitides of unknown cause. The pathogenic role of MPO-ANCA in the vasculitides has been supported using various animal models, with B-cells playing a role in the disease pathogenesis. Pregnancy in the presence of an autoimmune disease such as vasculitis is often associated with significant morbidity. Little is known about the outcomes when women present with de novo vasculitis during pregnancy, and the appropriate management of such presentations is unclear. We describe a case of a 33-year-old female presenting in her second pregnancy with new onset ANCA vasculitis at 12 weeks' gestation. She was successfully treated with prednisolone and rituximab, and delivered a healthy 2.8 kg boy at 36 weeks' gestation with no clinical manifestations of vasculitis or neutropenia in the neonate.

Effect of docetaxel duration on clinical outcomes: exploratory analysis of CLEOPATRA, a phase III randomized controlled trial

Background

Combination pertuzumab, trastuzumab, and docetaxel (D) is considered standard first-line treatment of human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer. This post hoc, exploratory analysis of CLEOPATRA study data evaluated the clinical effects of D treatment duration within this regimen. The clinical benefits of pertuzumab and trastuzumab by different durations of D treatment were also evaluated.

Patients and methods

Patients with HER2-positive metastatic breast cancer received trastuzumab and D plus pertuzumab or placebo. Clinical outcomes were analyzed by the number of D cycles that patients received (<6D, 6D, or >6D). Progression-free survival (PFS) and overall survival (OS) for each treatment arm within each D cycle group were estimated using the Kaplan-Meier approach. Time-dependent, multivariate Cox regression was applied to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for HER2-targeted therapy and D cycle groups.

Results

Overall, 804 patients received <6D (n = 119), 6D (n = 210), or >6D (n = 475) cycles. After adjusting for pertuzumab benefits versus placebo (PFS HR = 0.61, 95% CI 0.51-0.74, P < 0.0001; OS HR = 0.60, 95% CI, 0.49-0.74, P < 0.0001), >6D versus 6D cycles was not associated with statistically significant improvements in PFS (HR = 0.80, 95% CI 0.63-1.01, P = 0.0640) or OS (HR = 0.88, 95% CI 0.69-1.12, P = 0.3073). Consistent improvements in PFS and OS were observed with pertuzumab versus placebo, irrespective of D duration. The HRs for PFS were 0.395, 0.615, and 0.633 for <6D, 6D, and >6D cycles, respectively (P < 0.05 for all D cycle groups). Corresponding HRs for OS were 0.577, 0.700, and 0.612, respectively (P < 0.05 for <6D and >6D).

Conclusions

After accounting for pertuzumab benefits, more than six cycles of D treatment was not associated with significant improvements in either PFS or OS compared with six cycles. The addition of pertuzumab to trastuzumab improved clinical outcomes versus trastuzumab plus placebo, regardless of D treatment duration.

ClinicalTrials.gov identifier

NCT00567190.

Efficacy and safety of titrated canagliflozin in patients with type 2 diabetes mellitus inadequately controlled on metformin and sitagliptin

AIMS

To evaluate the efficacy and safety of titrated canagliflozin, a sodium glucose co-transporter 2 inhibitor, in patients with type 2 diabetes mellitus (T2DM) inadequately controlled on metformin and sitagliptin.

METHODS

In this randomized, double-blind study, patients with T2DM (N = 218) on metformin ≥1500 mg/day and sitagliptin 100 mg received canagliflozin 100 mg or placebo. After 6 weeks, the canagliflozin dose was increased from 100 to 300 mg (or from placebo to matching placebo) if all of the following criteria were met: baseline estimated glomerular filtration rate ≥70 ml/min/1.73 m(2) ; fasting self-monitored blood glucose ≥5.6 mmol/l (≥100 mg/dl); and no volume depletion-related adverse events (AEs) within 2 weeks before dose increase. Endpoints included change in glycated haemoglobin (HbA1c) at week 26 (primary); proportion of patients achieving HbA1c <7.0%; and changes in fasting plasma glucose (FPG), body weight and systolic blood pressure (SBP). Safety was assessed using AE reports.

RESULTS

Overall, 85.4% of patients were titrated to canagliflozin 300 mg or matching placebo (mean ± standard deviation time to titration 6.2 ± 0.8 weeks). At week 26, canagliflozin (pooled 100 and 300 mg) demonstrated superiority in HbA1c reduction versus placebo (-0.91% vs. -0.01%; p < 0.001). Canagliflozin provided significant reductions in FPG, body weight and SBP compared with placebo (p < 0.001). The overall AE incidence was 39.8 and 44.4% for canagliflozin and placebo, respectively. Canagliflozin was associated with an increased incidence of genital mycotic infections.

CONCLUSIONS

Titrated canagliflozin significantly improved HbA1c, FPG, body weight and SBP, and was generally well tolerated over 26 weeks in patients with T2DM as add-on to metformin and sitagliptin.

Abstract P4-14-27: Effect of docetaxel duration on clinical outcomes: Results from the phase III trial CLEOPATRA

Introduction:

In the CLEOPATRA study, pertuzumab (P) plus trastuzumab (T) and docetaxel (D) significantly improved median progression-free survival (PFS) and overall survival (OS) compared with placebo (Pla) plus T and D in pts with HER2-positive metastatic breast cancer. Study treatment was given every 3 weeks until disease progression (PD) or unacceptable toxicity. D starting dose was 75 mg/m2 and could be escalated or reduced per protocol. A minimum of 6 cycles of D was recommended. If D was discontinued, patients could continue P+T or Pla+T. To evaluate the potential association between D duration and clinical outcomes, we conducted post hoc exploratory analyses of the CLEOPATRA study.

Methods:

As of 11 Feb 2014 data cutoff, the safety population analyzed included 804 pts (396 Pla+T+D; 408 P+T+D) who received at least one dose of any study medication. Exposure and clinical outcomes of study treatment groups are presented by dichotomized subgroup of pts who received &lt;6 cycles of D and those who received more than 6 cycles. Median PFS and OS were estimated using Kaplan-Meier methods. Cox regression analyses were used to estimate hazard ratios (HRs).

Results:

The median number of D cycles received was 8 for both arms. Forty-one % of pts received &lt;6 (14% &lt;6; 27% exactly 6) and 59% received &gt;6 cycles.

Docetaxel Duration and Clinical Outcomes D &lt;6 cycles (n=329, 41%)D &gt;6 cycles (n=475, 59%) Pla+T+D (n=159)aP+T+D (n=170)aPla+T+D (n=237)P+T+D (n=238)Treatment Exposure#D Cycle, median (range)6 (1,6)6 (1,6)10 (7,42)10 (7,52)# Study Treatment Cycle, median (range)7 (1,78)14 (1,90)19 (7,92)28 (7,96)Duration of Study Treatment in month, median (range)6 (1,54)10 (1,63)14 (5,67)19 (5,68)Clinical OutcomesPFS in month, median (range)8.2 (6.2,9.0)12.5 (10.5,20.7)14.5 (12.6,17.2)22.8 (17.7,N/A)95% CIHR=0.59 (0.44,0.79)HR=0.65 (0.50,0.84)OS in month, median (range)29.8 (22.2,39.2)48.9 (36.8,N/A)46.7 (39.4,53.0)N/A (56.4,N/A)95% CIHR=0.67 (0.45,0.90)HR=0.62 (0.47,0.81)N/A=not available aTwo pts in each group had missing D cycle

Treatment Discontinuation Summary D &lt;6 cyclesD &gt;6 cycles Pla+T+D (n=159)P+T+D (n=170)Pla+T+D (n=237)P+T+D (n=238)D discontinuation before stopping anti-HER2 agents (n,%)90 (57)118 (69)180 (76)196 (82)Reason (n,%)    AE/intercurrent illness34 (38)27 (23)60 (33)72 (37)Patient reasonb3 (3)5 (4)5 (3)8 (4)Standard practice36 (40)59 (50)65 (36)41 (21)Adequate therapy12 (13)22 (19)36 (20)59 (30)Other1 (1)1 (1)9 (5)11 (6)Missing4 (4)4 (3)5 (3)5 (3)Discontinuation of all study treatment (T+D+Pla or P), n159170237238Reason (n,%)    AE/intercurrent illness15 (9)22 (13)25 (11)32 (13)Death10 (6)5 (3)4 (2)2 (1)Disease progression111 (70)110 (65)182 (77)154 (65)Patient reasonb17 (11)16 (9)12 (5)14 (6)Other6 (4)16 (9)12 (5)35 (15)Missing0 (0)1 (1)2 (1)1 (1)bIncluded failure to return, refused treatment, withdrawal, protocol violation

Conclusions:

Consistent with the overall study results, addition of P to T+D showed significant improvement in clinical outcomes regardless of whether &lt;6 or &gt;6 cycles of D were received. In the poster, three subgroup (&lt;6, 6 and &gt;6 D cycles) analyses and time-dependent Cox regression analysis to capture the dynamic variations in D exposure will be presented.

Citation Format: Miles D, Fung A, Yoo B, Knott A, Heeson S, Portera C, Swain S. Effect of docetaxel duration on clinical outcomes: Results from the phase III trial CLEOPATRA. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-14-27.

Long-term efficacy and safety of canagliflozin over 104 weeks in patients aged 55-80 years with type 2 diabetes

AIMS

The long-term efficacy and safety of canagliflozin, a sodium glucose co-transporter 2 inhibitor, was evaluated over 104 weeks in patients aged 55-80 years with type 2 diabetes mellitus (T2DM) inadequately controlled on a stable antihyperglycaemic agent regimen.

METHODS

In this randomized, double-blind, phase III study, patients received canagliflozin 100 or 300 mg or placebo once daily during a 26-week core period (N = 714) and a 78-week extension period (n = 624). Efficacy endpoints at week 104 included change from baseline in glycated haemoglobin (HbA1c), fasting plasma glucose (FPG) and systolic blood pressure, and percent change from baseline in body weight and fasting plasma lipids. Safety was assessed by adverse event (AE) reports.

RESULTS

At week 104, canagliflozin 100 and 300 mg were associated with reductions in HbA1c versus placebo (-0.32 and -0.43% vs 0.17%, respectively; overall mean baseline, 7.7%) and more patients achieved HbA1c <7.0% with canagliflozin 100 and 300 mg than with placebo (35.8 and 41.9% vs 20.3%, respectively). Reductions in FPG, body weight and systolic blood pressure, and increases in high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were seen with canagliflozin compared with placebo. The overall incidence rates of AEs over 104 weeks were 88.0, 89.8 and 86.1% with canagliflozin 100 and 300 mg and placebo, respectively; serious AE rates were low across treatment groups. The incidence rates of urinary tract infections, genital mycotic infections and osmotic diuresis- and volume depletion-related AEs were higher with canagliflozin than with placebo.

CONCLUSION

Canagliflozin improved glycaemic control, reduced body weight and systolic blood pressure, and was generally well tolerated in patients aged 55-80 years with T2DM over 104 weeks.

Musculoskeletal pitfalls and pseudotumours in the pelvis: a pictorial review for body imagers

Many musculoskeletal abnormalities in the pelvis are first seen by body imagers while reviewing pelvic cross-sectional studies, and some of these abnormalities may mimic malignancy or another aggressive process. This article describes nine musculoskeletal pseudotumours and interpretative pitfalls that may be seen on CT, MRI and ultrasound imaging of the pelvis. Awareness of these pitfalls and pseudotumours may help avoid misdiagnosis and prevent inappropriate intervention or management.

Tooth wear and associated risk factors in a sample of Australian primary school children

BACKGROUND

Anecdotally, tooth wear is increasing, perhaps attributable to diet. The irreversible surface loss may result in sensitivity and loss of form and function. Little data exist on the prevalence of tooth wear in Australian children. This study investigated consumption of potentially erosive foods and drinks, examining the prevalence, distribution of tooth wear and associations in a sample of children.

METHODS

Parents of 350, 6-12-year-olds reported their child's oral hygiene, dietary intake, medical and dental histories; 154 children (subsample) were examined. Associations were studied with single and multivariable analyses.

RESULTS

Tooth wear was parentally reported for 17% (59 children of the study population) and observed in 66% (102 of the subsample), particularly affecting primary teeth. Significant risk factors for parentally reported tooth wear were: consuming 2-4 cups soft drink/day (OR = 9.52), citrus flavoured sweets/gums ≥1/day (5.10), citrus fruits 1-2/wk (4.28); tooth grinding (5.32); medical condition present (2.48); male gender (2.80). Drinking 2-4 cups fruit juice/day was a significant risk factor for both parentally reported (3.23) and observed tooth wear (3.97).

CONCLUSIONS

Tooth wear appeared under-reported as some parents were unaware their child's teeth were affected. Significant risk factors for tooth wear were identifiable from children's histories. Risk factors should be addressed early so that tooth wear in the primary dentition does not affect permanent teeth.

Fluorescent Detection of Oral Pathogens by a Solid-Phase Immunoassay on PDMS

We have developed an array of sensors for the oral pathogen Streptococcus mutans (S. mutans) using an enzymelinked linked immunosorbent assay (ELISA) on a polydimethylsiloxane (PDMS) device. The model bacterial analyte, S. mutans, has been implicated in the initiation and progression of dental caries. The PDMS was modified with 3-aminopropyltriethoxysilance (APTS) and glutaraldehyde to covalently crosslink monoclonal anti-S. mutans immunoglobulin G (IgG) to the sensor surface. Successful IgG immobilization was verified by AFM and fluorescence imaging. Colloidal bacteria were captured on the sensor surface and labeled with immuno-active quantum dots (QDs), whose fluorescence was excited by an LED and detected by a CCD. The system was capable of detecting S. mutans concentrations as low as 6 10⁶cells/ml in a 20 &#956;l sample. This work represents a stable foundation for the development of a chair side diagnostic system capable of specific and sensitive detection of pathogens directly from oral fluid.