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Hanna CR, Lemmon E, Hall PS, Ennis H, Morris E, McLoone P, Boyd KA, Jones RJ. Cancer Trial Impact: Understanding Implementation of the Short Course Oncology Treatment (SCOT) Trial Findings in colorectal cancer at a National Level. Clin Oncol (R Coll Radiol) 2022; 34:554-560. [PMID: 35370039 DOI: 10.1016/j.clon.2022.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/16/2022] [Accepted: 03/16/2022] [Indexed: 11/28/2022]
Abstract
AIMS The Short Course Oncology Treatment (SCOT) trial indicated that 3 months of adjuvant doublet chemotherapy was non-inferior to 6 months of treatment for patients with colorectal cancer, with considerably less toxicity. The SCOT trial results were disseminated in June 2017. The aim of this study was to understand if SCOT trial findings were implemented in Scotland. MATERIALS AND METHODS A retrospective analysis was carried out on a dataset derived from a source population of 5.4 million people. Eligible patients were those with stage II or III colorectal cancer who received adjuvant chemotherapy. Logistic regression was applied to understand the extent of practice change to a 3-month adjuvant chemotherapy duration after the SCOT trial results were disseminated. Interrupted time series analysis was used to visualise differences in prescribing trends before and after June 2017 for the overall cohort, and by SCOT trial eligibility. RESULTS In total, 2310 patients were included in the study; 1957 and 353 treated pre- and post-June 2017, respectively. The median treatment duration decreased from 21 weeks (interquartile range 14-24) prior to June 2017 to 12 weeks (interquartile range 12-21 weeks) after June 2017 (P < 0.001). The proportion of patients receiving over 3 months of adjuvant treatment decreased from 75% to 42% (P < 0.001). This change was most noticeable for patients who met the SCOT trial eligibility criteria, and specifically for those with low-risk stage III disease and those treated with capecitabine and oxaliplatin (CAPOX). Although practice change occurred in all locations, there were differences between regions that could be explained by pre-SCOT trial prescribing trends. DISCUSSION A significant change in chemotherapy prescribing occurred after dissemination of the SCOT trial results. National, real-world data can be used to capture the extent of implementation of clinical trial results. In this case, implementation was aligned with clinical trial subgroup findings. This type of analysis could be conducted to evaluate the impact of other clinical trials.
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Affiliation(s)
- C R Hanna
- CRUK Glasgow Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK.
| | - E Lemmon
- Edinburgh Health Economics, Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - P S Hall
- Edinburgh Health Economics, Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK; Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, UK
| | - H Ennis
- Edinburgh Health Economics, Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - E Morris
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - P McLoone
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - K A Boyd
- Health Economics & Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - R J Jones
- CRUK Glasgow Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
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Slevin F, Hanna CR, Appelt A, Cunningham C, Marijnen CAM, Sebag-Montefiore D, Muirhead R. The Long and the Short of it: the Role of Short-course Radiotherapy in the Neoadjuvant Management of Rectal Cancer. Clin Oncol (R Coll Radiol) 2022; 34:e210-e217. [PMID: 34955376 DOI: 10.1016/j.clon.2021.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/05/2021] [Accepted: 12/07/2021] [Indexed: 11/29/2022]
Abstract
Total mesorectal excision is the cornerstone of treatment for rectal cancer. Multiple randomised trials have shown a reduction in local recurrence rates with the addition of preoperative radiotherapy, either as a 1-week hypofractionated short-course (SCRT) or a conventionally fractionated long-course (LCRT) schedule with concurrent chemotherapy. There is also increasing interest in the addition of neoadjuvant chemotherapy to radiotherapy with the aim of improving disease-free survival. The relative use of SCRT and LCRT varies considerably across the world. This is reflected in, and is probably driven in part by, disparity between international guideline recommendations. In addition, different approaches to treatment may exist both between and within countries, with variation related to patient, disease and treatment centre and financial factors. In this review, we will specifically focus on the use of SCRT for the treatment of rectal cancer. We will discuss the literature base and current guidelines, highlighting the challenges and controversies in clinical application of this evidence. We will also discuss potential future applications of SCRT, including its role in optimisation and intensification of treatment for rectal cancer.
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Affiliation(s)
- F Slevin
- Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - C R Hanna
- Beatson West of Scotland Cancer Centre, Glasgow, UK; CRUK Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - A Appelt
- Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - C Cunningham
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - C A M Marijnen
- Netherlands Cancer Institute, Amsterdam, the Netherlands; Leiden University Medical Center, Leiden, the Netherlands
| | - D Sebag-Montefiore
- Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - R Muirhead
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
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Hanna CR, O'Cathail SM, Graham JS, Saunders M, Samuel L, Harrison M, Devlin L, Edwards J, Gaya DR, Kelly CA, Lewsley LA, Maka N, Morrison P, Dinnett L, Dillon S, Gourlay J, Platt JJ, Thomson F, Adams RA, Roxburgh CSD. Correction to: Durvalumab (MEDI 4736) in combination with extended neoadjuvant regimens in rectal cancer: a study protocol of a randomised phase II trial (PRIME-RT). Radiat Oncol 2021; 16:230. [PMID: 34857017 PMCID: PMC8638219 DOI: 10.1186/s13014-021-01941-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Catherine R Hanna
- Cancer Research UK Glasgow Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Level 0, 1053 Great Western Road, Glasgow, G12 0YN, UK.
| | - Sean M O'Cathail
- Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - Janet S Graham
- Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - Mark Saunders
- The Christie NHS Foundation Trust, Wilmslow Rd, Manchester, M20 4BX, UK
| | | | - Mark Harrison
- Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood, HA6 2RN, UK
| | - Lynsey Devlin
- Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - Joanne Edwards
- Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Bearsden, G61 1QH, UK
| | - Daniel R Gaya
- Gastroenterology Unit, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, 4th Floor Walton Building, Castle Street, Glasgow, G4 0SF, UK
| | - Caroline A Kelly
- Cancer Research UK Glasgow Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Level 0, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - Liz-Anne Lewsley
- Cancer Research UK Glasgow Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Level 0, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - Noori Maka
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Paula Morrison
- Snr Pharmacist Clinical Trials Oncology R&I, Research and Innovation, Dykebar Hospital, NHS Greater Glasgow and Clyde, Ward 11, Grahamston Road, Paisley, PA2 7DE, UK
| | - Louise Dinnett
- Cancer Research UK Glasgow Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Level 0, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - Susan Dillon
- Cancer Research UK Glasgow Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Level 0, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - Jacqueline Gourlay
- Cancer Research UK Glasgow Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Level 0, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - Jonathan J Platt
- Department of Radiology, NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
| | - Fiona Thomson
- Institute of Cancer Sciences, University of Glasgow, Glasgow, G61 1QH, UK
| | - Richard A Adams
- Centre for Trials Research Cardiff University Heath Park, Cardiff University and Velindre NHS Trust, Cardiff, UK
| | - Campbell S D Roxburgh
- Institute of Cancer Sciences, Glasgow Royal Infirmary, University of Glasgow, Room 2.57, Level 2, New Lister Building, Glasgow, G31 2ER, UK
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Lemmon E, Hanna CR, Hall P, Morris EJA. Health economic studies of colorectal cancer and the contribution of administrative data: A systematic review. Eur J Cancer Care (Engl) 2021; 30:e13477. [PMID: 34152043 DOI: 10.1111/ecc.13477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 03/23/2021] [Accepted: 05/17/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Several forces are contributing to an increase in the number of people living with and surviving colorectal cancer (CRC). However, due to the lack of available data, little is known about the implications of these forces. In recent years, the use of administrative records to inform research has been increasing. The aim of this paper is to investigate the potential contribution that administrative data could have on the health economic research of CRC. METHODS To achieve this aim, we conducted a systematic review of the health economic CRC literature published in the United Kingdom and Europe within the last decade (2009-2019). RESULTS Thirty-seven relevant studies were identified and divided into economic evaluations, cost of illness studies and cost consequence analyses. CONCLUSIONS The use of administrative data, including cancer registry, screening and hospital records, within the health economic research of CRC is commonplace. However, we found that this data often come from regional databases, which reduces the generalisability of results. Further, administrative data appear less able to contribute towards understanding the wider and indirect costs associated with the disease. We explore several ways in which various sources of administrative data could enhance future research in this area.
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Affiliation(s)
- Elizabeth Lemmon
- Edinburgh Health Economics, University of Edinburgh, Edinburgh, UK
| | - Catherine R Hanna
- CRUK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Peter Hall
- Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK
| | - Eva J A Morris
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Hanna CR, Robles-Zurita JA, Briggs A, Harkin A, Kelly C, McQueen J, Allan K, Pearson S, Hollander H, Glimelius B, Salazar R, Segelov E, Saunders M, Iveson T, Jones RJ, Boyd KA. Three Versus Six Months of Adjuvant Doublet Chemotherapy for Patients With Colorectal Cancer: A Multi-Country Cost-Effectiveness and Budget Impact Analysis. Clin Colorectal Cancer 2021; 20:236-244. [PMID: 33992542 DOI: 10.1016/j.clcc.2021.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/19/2021] [Accepted: 04/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Short Course Oncology Treatment (SCOT) trial demonstrated non-inferiority, less toxicity, and cost-effectiveness from a UK perspective of 3 versus 6 months of oxaliplatin-based chemotherapy for patients with colorectal cancer. This study assessed the cost-effectiveness of shorter treatment and the budget impact of implementing trial findings from the perspectives of all countries recruited to SCOT: Australia, Denmark, New Zealand, Spain, Sweden, and the United Kingdom. PATIENTS AND METHODS Individual cost-utility analyses were performed from the perspective of each country. Resource, quality of life, and survival estimates from the SCOT trial (N = 6065) were used. Probabilistic sensitivity analysis and subgroup analyses were undertaken. Using undiscounted costs from these cost-utility analyses, the impact on country-specific healthcare budgets of implementing the SCOT trial findings was calculated over a 5-year period. The currency used was US dollars (US$), and 2019 was the base year. One-way and scenario sensitivity analysis addressed uncertainty within the budget impact analysis. RESULTS Three months of treatment were cost saving and cost-effective compared to 6 months from the perspective of all countries. The incremental net monetary benefit per patient ranged from US$8972 (Spain) to US$13,884 (Denmark). The healthcare budget impact over 5 years for the base-case scenario ranged from US$3.6 million (New Zealand) to US$61.4 million (UK) and totaled over US$150 million across all countries. CONCLUSION This study has widened the transferability of results from the SCOT trial, showing that shorter treatment is cost-effective from a multi-country perspective. The vast savings from implementation could fully justify the investment in conducting the SCOT trial.
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Affiliation(s)
- Catherine R Hanna
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, Scotland.
| | - Jose A Robles-Zurita
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Andrew Briggs
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Andrea Harkin
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, Scotland
| | - Caroline Kelly
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, Scotland
| | - John McQueen
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, Scotland
| | - Karen Allan
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, Scotland
| | - Sarah Pearson
- Oncology Clinical Trials Office, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Henrik Hollander
- Department of Oncology, Zealand University Hospital, Naestved, Denmark
| | - Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Ramon Salazar
- Departament of Medical Oncology, Catalon Institute of Oncology, Oncobell Program, Bellvitge Biomedical Research Institute (IDIBELL)-CIBERONC, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Eva Segelov
- Monash Health and Monash University, Clayton, Victoria, Australia
| | - Mark Saunders
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Tim Iveson
- Southampton General Hospital, University Hospital Southampton, Southampton, United Kingdom
| | - Robert J Jones
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, Scotland
| | - Kathleen A Boyd
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
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Hanna CR, O’Cathail SM, Graham JS, Saunders M, Samuel L, Harrison M, Devlin L, Edwards J, Gaya DR, Kelly CA, Lewsley LA, Maka N, Morrison P, Dinnett L, Dillon S, Gourlay J, Platt JJ, Thomson F, Adams RA, Roxburgh CSD. Durvalumab (MEDI 4736) in combination with extended neoadjuvant regimens in rectal cancer: a study protocol of a randomised phase II trial (PRIME-RT). Radiat Oncol 2021; 16:163. [PMID: 34446053 PMCID: PMC8393812 DOI: 10.1186/s13014-021-01888-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/16/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Advances in multi-modality treatment of locally advanced rectal cancer (LARC) have resulted in low local recurrence rates, but around 30% of patients will still die from distant metastatic disease. In parallel, there is increasing recognition that with radiotherapy and systemic treatment, some patients achieve a complete response and may avoid surgical resection, including in many cases, the need for a permanent stoma. Extended neoadjuvant regimes have emerged to address these concerns. The inclusion of immunotherapy in the neoadjuvant setting has the potential to further enhance this strategy by priming the local immune microenvironment and engaging the systemic immune response. METHODS PRIME-RT is a multi-centre, open label, phase II, randomised trial for patients with newly diagnosed LARC. Eligible patients will be randomised to receive either: short course radiotherapy (25 Gray in 5 fractions over one week) with concomitant durvalumab (1500 mg administered intravenously every 4 weeks), followed by FOLFOX (85 mg/m2 oxaliplatin, 350 mg folinic acid and 400 mg/m2 bolus 5-fluorouracil (5-FU) given on day 1 followed by 2400 mg/m2 5-FU infusion over 46-48 h, all administered intravenously every 2 weeks), and durvalumab, or long course chemoradiotherapy (50 Gray to primary tumour in 25 fractions over 5 weeks with concomitant oral capecitabine 825 mg/m2 twice per day on days of radiotherapy) with durvalumab followed by FOLFOX and durvalumab. The primary endpoint is complete response rate in each arm. Secondary endpoints include treatment compliance, toxicity, safety, overall recurrence, proportion of patients with a permanent stoma, and survival. The study is translationally rich with collection of bio-specimens prior to, during, and following treatment in order to understand the molecular and immunological factors underpinning treatment response. The trial opened and the first patient was recruited in January 2021. The main trial will recruit up to 42 patients with LARC and commence after completion of a safety run-in that will recruit at least six patients with LARC or metastatic disease. DISCUSSION PRIME-RT will explore if adding immunotherapy to neoadjuvant radiotherapy and chemotherapy for patients with LARC can prime the tumour microenvironment to improve complete response rates and stoma free survival. Sequential biopsies are a key component within the trial design that will provide new knowledge on how the tumour microenvironment changes at different time-points in response to multi-modality treatment. This expectation is that the trial will provide information to test this treatment within a large phase clinical trial. Trial registration Clinicaltrials.gov NCT04621370 (Registered 9th Nov 2020) EudraCT number 2019-001471-36 (Registered 6th Nov 2020).
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Affiliation(s)
- Catherine R. Hanna
- Cancer Research UK Glasgow Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Level 0, 1053 Great Western Road, Glasgow, G12 0YN UK
| | - Sean M. O’Cathail
- Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, 1053 Great Western Road, Glasgow, G12 0YN UK
| | - Janet S. Graham
- Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, 1053 Great Western Road, Glasgow, G12 0YN UK
| | - Mark Saunders
- The Christie NHS Foundation Trust, Wilmslow Rd, Manchester, M20 4BX UK
| | | | - Mark Harrison
- Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood, HA6 2RN UK
| | - Lynsey Devlin
- Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow, G12 0YN UK
| | - Joanne Edwards
- Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Bearsden, G61 1QH UK
| | - Daniel R. Gaya
- Gastroenterology Unit, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, 4th Floor Walton Building, Castle Street, Glasgow, G4 0SF UK
| | - Caroline A. Kelly
- Cancer Research UK Glasgow Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Level 0, 1053 Great Western Road, Glasgow, G12 0YN UK
| | - Liz-Anne Lewsley
- Cancer Research UK Glasgow Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Level 0, 1053 Great Western Road, Glasgow, G12 0YN UK
| | - Noori Maka
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, 1345 Govan Road, Glasgow, G51 4TF UK
| | - Paula Morrison
- Snr Pharmacist Clinical Trials Oncology R&I, Research & Innovation, Dykebar Hospital, NHS Greater Glasgow & Clyde, Ward 11, Grahamston Road, Paisley, PA2 7DE UK
| | - Louise Dinnett
- Cancer Research UK Glasgow Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Level 0, 1053 Great Western Road, Glasgow, G12 0YN UK
| | - Susan Dillon
- Cancer Research UK Glasgow Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Level 0, 1053 Great Western Road, Glasgow, G12 0YN UK
| | - Jacqueline Gourlay
- Cancer Research UK Glasgow Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Level 0, 1053 Great Western Road, Glasgow, G12 0YN UK
| | - Jonathan J. Platt
- Department of Radiology, NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF UK
| | - Fiona Thomson
- Institute of Cancer Sciences, University of Glasgow, Glasgow, G61 1QH UK
| | - Richard A. Adams
- Centre for Trials Research Cardiff University Heath Park, Cardiff University and Velindre NHS Trust, Cardiff, UK
| | -
Campbell S. D. Roxburgh
- Institute of Cancer Sciences, Glasgow Royal Infirmary, University of Glasgow, Room 2.57, Level 2, New Lister Building, Glasgow, G31 2ER UK
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Hanna CR, Boyd KA, Wincenciak J, Graham J, Iveson T, Jones RJ, Wilson R. Do clinical trials change practice? A longitudinal, international assessment of colorectal cancer prescribing practices. Cancer Treat Res Commun 2021; 28:100445. [PMID: 34425469 DOI: 10.1016/j.ctarc.2021.100445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/08/2021] [Accepted: 08/10/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Over half of the 1.5 million individuals globally who are diagnosed with colorectal cancer (CRC) present with stage II-III disease. Understanding clinician attitudes towards treatment for this group is paramount to contextualise real-world outcomes and plan future trials. The aim of this study was to assess clinician awareness of trials assessing the optimal duration of CRC adjuvant therapy, their attitudes towards shorter treatment and their self-reported practice. METHODS A survey was developed using OnlineSurveys® and distributed to clinicians in April 2019, with a follow-up survey disseminated to a subset of respondents in August 2020. Microsoft Excel® and Stata® were used for analysis. RESULTS 265 clinicians replied to the first survey, with the majority aware of findings from the International Duration Evaluation of Adjuvant Therapy collaboration and contributory trials. Practice change was greatest for patients under 70 with low-risk stage III CRC, with most uncertainty around using 3-months of doublet chemotherapy for high-risk stage II disease. In August 2020, clinicians (n = 106) were more likely to use 3-months of FOLFOX for low-risk stage III disease and 3-months of CAPOX for stage II disease compared to April 2019. There was no indication that the COVID-19 pandemic had enduring changes on treatment decisions beyond those made in response to trial evidence. DISCUSSION Clinicians use a risk-stratified approach to treat CRC the adjuvant setting. Lower utilisation of doublet chemotherapy for older and stage II patients has affected the extent of trial implementation. Active dialogue regarding how trial results apply to these groups may improve consensus.
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Affiliation(s)
- Catherine R Hanna
- CRUK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow CRUK Clinical Trials Unit Glasgow, 1042 Great Western Road, Glasgow G12 0YN, United Kingdom.
| | - Kathleen A Boyd
- Health Economic and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow 1 Lilybank Gardens, Glasgow G12 8RZ, United Kingdom
| | - Joanna Wincenciak
- School of Education, University of Glasgow 1 Eldon St, Glasgow G3 6NH, United Kingdom
| | - Janet Graham
- Beatson West of Scotland Cancer Centre and Institute of Cancer Sciences, University of Glasgow 1053 Great Western Road, G12 0YN Wolfson Wohl Cancer Research Centre, Glasgow, United Kingdom.
| | - Timothy Iveson
- University of Southampton University Hospital NHS Foundation Trust, Tremona Road, Southampton SO16 0YD, United Kingdom.
| | - Robert J Jones
- CRUK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow CRUK Clinical Trials Unit Glasgow, 1042 Great Western Road, Glasgow G12 0YN, United Kingdom
| | - Richard Wilson
- Beatson West of Scotland Cancer Centre and Institute of Cancer Sciences, University of Glasgow 1053 Great Western Road, G12 0YN Wolfson Wohl Cancer Research Centre, Glasgow, United Kingdom
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Hanna CR, O'Cathail SM, Graham J, Adams R, Roxburgh CS. Immune Checkpoint Inhibition as a Strategy in the Neoadjuvant Treatment of Locally Advanced Rectal Cancer. J Immunother Precis Oncol 2021; 4:86-104. [PMID: 35663532 PMCID: PMC9153256 DOI: 10.36401/jipo-20-31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 06/15/2023]
Abstract
The treatment of locally advanced rectal cancer (LARC) has seen major advances over the past 3 decades, with multimodality treatment now standard of care. Combining surgical resection with radiotherapy and/or chemotherapy can reduce local recurrence from around 20% to approximately 5%. Despite improvements in local control, distant recurrence and subsequent survival rates have not changed. Immune checkpoint inhibitors have improved patient outcomes in several solid tumor types in the neoadjuvant, adjuvant, and advanced disease setting; however, in colorectal cancer, most clinical trials have been performed in the metastatic setting and the benefits confined to microsatellite instability-high tumors. In this article, we review the current preclinical and clinical evidence for using immune checkpoint inhibition in the treatment of LARC and discuss the rationale for specifically exploring the use of this therapy in the neoadjuvant setting. We summarize and discuss relevant clinical trials that are currently in setup and recruiting to test this treatment strategy and reflect on unanswered questions that still need to be addressed within future research efforts.
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Affiliation(s)
- Catherine R. Hanna
- Cancer Research United Kingdom Clinical Trials Unit, Glasgow, Scotland
- Institute of Cancer Sciences, University of Glasgow, Glasgow, Scotland
- Beatson West of Scotland Cancer Centre, Glasgow, Scotland
| | - Séan M. O'Cathail
- Institute of Cancer Sciences, University of Glasgow, Glasgow, Scotland
- Beatson West of Scotland Cancer Centre, Glasgow, Scotland
| | - Janet Graham
- Institute of Cancer Sciences, University of Glasgow, Glasgow, Scotland
- Beatson West of Scotland Cancer Centre, Glasgow, Scotland
| | - Richard Adams
- Centre for Trials Research, Cardiff University and Velindre Cancer Centre, Cardiff, Wales
| | - Campbell S.D. Roxburgh
- Institute of Cancer Sciences, University of Glasgow, Glasgow, Scotland
- Glasgow Royal Infirmary, Glasgow, Scotland
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Hanna CR, Slevin F, Appelt A, Beavon M, Adams R, Arthur C, Beasley M, Duffton A, Gilbert A, Gollins S, Harrison M, Hawkins MA, Laws K, O'Cathail S, Porcu P, Robinson M, Sebag-Montefiore D, Teo M, Teoh S, Muirhead R. Intensity-modulated Radiotherapy for Rectal Cancer in the UK in 2020. Clin Oncol (R Coll Radiol) 2021; 33:214-223. [PMID: 33423883 PMCID: PMC7985673 DOI: 10.1016/j.clon.2020.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/13/2020] [Accepted: 12/11/2020] [Indexed: 12/15/2022]
Abstract
AIMS Preoperative (chemo)radiotherapy followed by total mesorectal excision is the current standard of care for patients with locally advanced rectal cancer. The use of intensity-modulated radiotherapy (IMRT) for rectal cancer is increasing in the UK. However, the extent of IMRT implementation and current practice was not previously known. A national survey was commissioned to investigate the landscape of IMRT use for rectal cancer and to inform the development of national rectal cancer IMRT guidance. MATERIALS AND METHODS A web-based survey was developed by the National Rectal Cancer IMRT Guidance working group in collaboration with the Royal College of Radiologists and disseminated to all UK radiotherapy centres. The survey enquired about the implementation of IMRT with a focus on the following aspects of the workflow: dose fractionation schedules and use of a boost; pre-treatment preparation and simulation; target volume/organ at risk definition; treatment planning and treatment verification. A descriptive statistical analysis was carried out. RESULTS In total, 44 of 63 centres (70%) responded to the survey; 30/44 (68%) and 36/44 (82%) centres currently use IMRT to treat all patients and selected patients with rectal cancer, respectively. There was general agreement concerning several aspects of the IMRT workflow, including patient positioning, use of intravenous contrast and bladder protocols. Greater variation in practice was identified regarding rectal protocols; use of a boost to primary/nodal disease; target volume delineation; organ at risk delineation and dose constraints and treatment verification. Delineation of individual small bowel loops and daily volumetric treatment verification were considered potentially feasible by most centres. CONCLUSION This survey identified that IMRT is already used to treat rectal cancer in many UK radiotherapy centres, but there is heterogeneity between centres in its implementation and practice. These results have been a valuable aid in framing the recommendations within the new National Rectal Cancer IMRT Guidance.
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Affiliation(s)
- C R Hanna
- CRUK Clinical Trials Unit, University of Glasgow, Glasgow, UK; Beatson West of Scotland Cancer Centre, Glasgow, UK.
| | - F Slevin
- University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Appelt
- University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - M Beavon
- Royal College of Radiologists, London, UK
| | - R Adams
- Velindre Cancer Centre, Cardiff, UK
| | - C Arthur
- The Christie NHS Foundation Trust, Manchester, UK
| | - M Beasley
- University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Duffton
- CRUK Clinical Trials Unit, University of Glasgow, Glasgow, UK; Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - A Gilbert
- University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - S Gollins
- North Wales Cancer Treatment Centre, Glan Clwyd Hospital, Rhyl, UK
| | - M Harrison
- Mount Vernon Cancer Centre, Northwood, UK
| | - M A Hawkins
- Medical Physics and Biochemical Engineering, University College London, London, UK
| | - K Laws
- Aberdeen Cancer Centre, Aberdeen Royal Infirmary, Aberdeen, UK
| | - S O'Cathail
- CRUK Clinical Trials Unit, University of Glasgow, Glasgow, UK; Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - P Porcu
- Royal Free London NHS Foundation Trust, London, UK
| | - M Robinson
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - D Sebag-Montefiore
- University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - M Teo
- University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - S Teoh
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - R Muirhead
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Hanna CR, Lemmon E, Ennis H, Jones RJ, Hay J, Halliday R, Clark S, Morris E, Hall P. Creation of the first national linked colorectal cancer dataset in Scotland: prospects for future research and a reflection on lessons learned. Int J Popul Data Sci 2021; 6:1654. [PMID: 34007905 PMCID: PMC8111382 DOI: 10.23889/ijpds.v6i1.1654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Current understanding of cancer patients, their treatment pathways and outcomes relies mainly on information from clinical trials and prospective research studies representing a selected sub-set of the patient population. Whole-population analysis is necessary if we are to assess the true impact of new interventions or policy in a real-world setting. Accurate measurement of geographic variation in healthcare use and outcomes also relies on population-level data. Routine access to such data offers efficiency in research resource allocation and a basis for policy that addresses inequalities in care provision. OBJECTIVE Acknowledging these benefits, the objective of this project was to create a population level dataset in Scotland of patients with a diagnosis of colorectal cancer (CRC). METHODS This paper describes the process of creating a novel, national dataset in Scotland. RESULTS In total, thirty two separate healthcare administrative datasets have been linked to provide a comprehensive resource to investigate the management pathways and outcomes for patients with CRC in Scotland, as well as the costs of providing CRC treatment. This is the first time that chemotherapy prescribing and national audit datasets have been linked with the Scottish Cancer Registry on a national scale. CONCLUSIONS We describe how the acquired dataset can be used as a research resource and reflect on the data access challenges relating to its creation. Lessons learned from this process and the policy implications for future studies using administrative cancer data are highlighted.
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Affiliation(s)
- Catherine R Hanna
- CRUK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, 1042 Great Western Road, Glasgow, G12 OYN
| | - Elizabeth Lemmon
- Edinburgh Health Economics, University of Edinburgh,NINE BioQuarter 9 Little France Road Edinburgh EH16 4UX
| | - Holly Ennis
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, NINE, 9 Little France Road, Edinburgh BioQuarter, Edinburgh EH16 4UX
| | - Robert J Jones
- CRUK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, 1042 Great Western Road, Glasgow, G12 OYN
| | - Joy Hay
- Electronic Data Research and Innovation Service (eDRIS) Public Health Scotland, NINE BioQuarter 9 Little France Road Edinburgh EH16 4UX
| | - Roger Halliday
- University of Glasgow and Chief Statistician, Scottish Government, St Andrew’s house, Regent Road, Edinburgh, EH1 3DG
| | - Steve Clark
- Patient Public Group Member, Bowel Cancer Intelligence (BCI) UK, University of Leeds, LIDA, Worsely Building, Leeds, LS2 9JT
| | - Eva Morris
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Big Data Institute, Nuffield Department of Population Health, University of Oxford, Old Road Campus OX3 7LF
| | - Peter Hall
- Edinburgh Cancer Research Centre and Edinburgh Health Economics, University of Edinburgh, Western General Hospital, Crewe Road South, Edinburgh EH4 2XR
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Hanna CR, Robb KA, Blyth KG, Jones RJ, Chalmers AJ. Clinician Attitudes to Using Low-Dose Radiation Therapy to Treat COVID-19 Lung Disease. Int J Radiat Oncol Biol Phys 2021; 109:886-890. [PMID: 33309910 PMCID: PMC7726525 DOI: 10.1016/j.ijrobp.2020.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/02/2020] [Accepted: 12/04/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE Current treatments for coronavirus disease 2019 (COVID-19) lung disease have limited efficacy. Low-dose radiation therapy (LDRT) has received both interest and criticism as a potential treatment for this condition. In this qualitative study we explored clinicians' perspectives to identify barriers to testing LDRT in clinical trials and implementing it in clinical practice. METHODS AND MATERIALS Semistructured interviews were undertaken with 6 clinicians from 3 medical disciplines. Interviews were recorded, transcribed verbatim, and analyzed thematically, using a framework approach. Common themes regarding barriers to using LDRT for COVID-19 lung disease were identified from the data. RESULTS Three categories of barriers emerged: (1) the potential to do harm to the patient, including difficulty in predicting harm and lack of existing data to inform quantification of risks; (2) the feasibility of trialing this novel treatment strategy in the clinical setting, in particular trial design and recruitment, patient selection and buy-in from relevant clinician groups; and (3) the logistics of delivering the treatment, in particular risks of transmission to other patients and resources required for patient transfer. CONCLUSIONS This study identified several barriers that may impede the evaluation and subsequent implementation of LDRT as a treatment for COVID-19 lung disease, from the perspectives of clinicians in 3 relevant specialties. By documenting and articulating these concerns, we hope to enhance discussion of why these barriers exist, and enable them to be addressed in a proactive manner to facilitate research into the potential benefits of radiation treatment for patients with COVID-19 lung disease going forward.
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Affiliation(s)
- Catherine R Hanna
- Institute of Cancer Sciences, University of Glasgow, Glasgow, Scotland; CRUK Clinical Trials Unit, Glasgow, Scotland.
| | - Kathryn A Robb
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Kevin G Blyth
- Institute of Cancer Sciences, University of Glasgow, Glasgow, Scotland
| | - Robert J Jones
- Institute of Cancer Sciences, University of Glasgow, Glasgow, Scotland; CRUK Clinical Trials Unit, Glasgow, Scotland
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12
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Hanna CR, Boyd KA, Jones RJ. Evaluating cancer research impact: lessons and examples from existing reviews on approaches to research impact assessment. Health Res Policy Syst 2021; 19:36. [PMID: 33706777 PMCID: PMC7953786 DOI: 10.1186/s12961-020-00658-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 11/09/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Performing cancer research relies on substantial financial investment, and contributions in time and effort from patients. It is therefore important that this research has real life impacts which are properly evaluated. The optimal approach to cancer research impact evaluation is not clear. The aim of this study was to undertake a systematic review of review articles that describe approaches to impact assessment, and to identify examples of cancer research impact evaluation within these reviews. METHODS In total, 11 publication databases and the grey literature were searched to identify review articles addressing the topic of approaches to research impact assessment. Information was extracted on methods for data collection and analysis, impact categories and frameworks used for the purposes of evaluation. Empirical examples of impact assessments of cancer research were identified from these literature reviews. Approaches used in these examples were appraised, with a reflection on which methods would be suited to cancer research impact evaluation going forward. RESULTS In total, 40 literature reviews were identified. Important methods to collect and analyse data for impact assessments were surveys, interviews and documentary analysis. Key categories of impact spanning the reviews were summarised, and a list of frameworks commonly used for impact assessment was generated. The Payback Framework was most often described. Fourteen examples of impact evaluation for cancer research were identified. They ranged from those assessing the impact of a national, charity-funded portfolio of cancer research to the clinical practice impact of a single trial. A set of recommendations for approaching cancer research impact assessment was generated. CONCLUSIONS Impact evaluation can demonstrate if and why conducting cancer research is worthwhile. Using a mixed methods, multi-category assessment organised within a framework, will provide a robust evaluation, but the ability to perform this type of assessment may be constrained by time and resources. Whichever approach is used, easily measured, but inappropriate metrics should be avoided. Going forward, dissemination of the results of cancer research impact assessments will allow the cancer research community to learn how to conduct these evaluations.
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Affiliation(s)
- Catherine R. Hanna
- CRUK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Kathleen A. Boyd
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Robert J. Jones
- CRUK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
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13
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Hanna CR, Blyth KG, Burley G, Carmichael S, Evans C, Hinsley S, Khadra I, Khoo S, Lewsley LA, Jones RR, Sharma R, Taladriz-Sender A, Thomson EC, Scott JT. Glasgow Early Treatment Arm Favirpiravir (GETAFIX) for adults with early stage COVID-19: A structured summary of a study protocol for a randomised controlled trial. Trials 2020; 21:935. [PMID: 33213530 PMCID: PMC7675389 DOI: 10.1186/s13063-020-04891-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 11/11/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The GETAFIX trial will test the hypothesis that favipiravir is a more effective treatment for COVID-19 infection in patients who have early stage disease, compared to current standard of care. This study will also provide an important opportunity to investigate the safety and tolerability of favipiravir, the pharmacokinetic and pharmacodynamic profile of this drug and mechanisms of resistance in the context of COVID-19 infection, as well as the effect of favipiravir on hospitalisation duration and the post COVID-19 health and psycho-social wellbeing of patients recruited to the study. TRIAL DESIGN GETAFIX is an open label, parallel group, two arm phase II/III randomised trial with 1:1 treatment allocation ratio. Patients will be randomised to one of two arms and the primary endpoint will assess the superiority of favipiravir plus standard treatment compared to standard treatment alone. PARTICIPANTS This trial will recruit adult patients with confirmed positive valid COVID-19 test, who are not pregnant or breastfeeding and have no prior major co-morbidities. This is a multi-centre trial, patients will be recruited from in-patients and outpatients from three Glasgow hospitals: Royal Alexandra Hospital; Queen Elizabeth University Hospital; and the Glasgow Royal Infirmary. Patients must meet all of the following criteria: 1. Age 16 or over at time of consent 2. Exhibiting symptoms associated with COVID-19 3. Positive for SARS-CoV-2 on valid COVID-19 test 4. Point 1, 2, 3, or 4 on the WHO COVID-19 ordinal severity scale at time of randomisation. (Asymptomatic with positive valid COVID-19 test, Symptomatic Independent, Symptomatic assistance needed, Hospitalized, with no oxygen therapy) 5. Have >=10% risk of death should they be admitted to hospital as defined by the ISARIC4C risk index: https://isaric4c.net/risk 6. Able to provide written informed consent 7. Negative pregnancy test (women of childbearing potential*) 8. Able to swallow oral medication Patients will be excluded from the trial if they meet any of the following criteria: 1. Renal impairment requiring, or likely to require, dialysis or haemofiltration 2. Pregnant or breastfeeding 3. Of child bearing potential (women), or with female partners of child bearing potential (men) who do not agree to use adequate contraceptive measures for the duration of the study and for 3 months after the completion of study treatment 4. History of hereditary xanthinuria 5. Other patients judged unsuitable by the Principal Investigator or sub-Investigator 6. Known hypersensitivity to favipiravir, its metabolites or any excipients 7. Severe co-morbidities including: patients with severe hepatic impairment, defined as: • greater than Child-Pugh grade A • AST or ALT > 5 x ULN • AST or ALT >3 x ULN and Total Bilirubin > 2xULN 8. More than 96 hours since first positive COVID-19 test sample was taken 9. Unable to discontinue contra-indicated concomitant medications This is a multi-centre trial, patients will be recruited from in-patients and outpatients from three Glasgow hospitals: Royal Alexandra Hospital; Queen Elizabeth University Hospital; and the Glasgow Royal Infirmary. INTERVENTION AND COMPARATOR Patients randomised to the experimental arm of GETAFIX will receive standard treatment for COVID-19 at the discretion of the treating clinician plus favipiravir. These patients will receive a loading dose of favipiravir on day 1 of 3600mg (1800mg 12 hours apart). On days 2-10, patients in the experimental arm will receive a maintenance dose of favipiravir of 800mg 12 hours apart (total of 18 doses). Patients randomised to the control arm of the GETAFIX trial will receive standard treatment for COVID-19 at the discretion of the treating clinician. MAIN OUTCOMES The primary outcome being assessed in the GETAFIX trial is the efficacy of favipiravir in addition to standard treatment in patients with COVID-19 in reducing the severity of disease compared to standard treatment alone. Disease severity will be assessed using WHO COVID 10 point ordinal severity scale at day 15 +/- 48 hours. All randomised participants will be followed up until death or 60 days post-randomisation (whichever is sooner). RANDOMISATION Patients will be randomised 1:1 to the experimental versus control arm using computer generated random sequence allocation. A minimisation algorithm incorporating a random component will be used to allocate patients. The factors used in the minimisation will be: site, age (16-50/51-70/71+), history of hypertension or currently obsess (BMI>30 or obesity clinically evident; yes/no), 7 days duration of symptoms (yes/no/unknown), sex (male/female), WHO COVID-19 ordinal severity score at baseline (1/2or 3/4). BLINDING (MASKING) No blinding will be used in the GETAFIX trial. Both participants and those assessing outcomes will be aware of treatment allocation. NUMBERS TO BE RANDOMISED (SAMPLE SIZE) In total, 302 patients will be randomised to the GETAFIX trial: 151 to the control arm and 151 to the experimental arm. There will be an optional consent form for patients who may want to contribute to more frequent PK and PD sampling. The maximum number of patients who will undergo this testing will be sixteen, eight males and eight females. This option will be offered to all patients who are being treated in hospital at the time of taking informed consent, however only patients in the experimental arm of the trial will be able to undergo this testing. TRIAL STATUS The current GETAFIX protocol is version 4.0 12th September 2020. GETAFIX opened to recruitment on 26th October 2020 and will recruit patients over a period of approximately six months. TRIAL REGISTRATION GETAFIX was registered on the European Union Drug Regulating Authorities Clinical Trials (EudraCT) Database on 15th April 2020; Reference number 2020-001904-41 ( https://www.clinicaltrialsregister.eu/ctr-search/trial/2020-001904-41/GB ). GETAFIX was registered on ISRCTN on 7th September 2020; Reference number ISRCTN31062548 ( https://www.isrctn.com/ISRCTN31062548 ). FULL PROTOCOL The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (see Additional file 2).
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Affiliation(s)
- Catherine R. Hanna
- CRUK Clinical Trials Unit, University of Glasgow, Glasgow, UK
- NHS Greater Glasgow & Clyde, Glasgow, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Kevin G. Blyth
- NHS Greater Glasgow & Clyde, Glasgow, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | | | | | - Carol Evans
- CRUK Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | | | | | - Saye Khoo
- Department of Pharmacology, University of Liverpool, Liverpool, UK
| | | | - Robert R. Jones
- CRUK Clinical Trials Unit, University of Glasgow, Glasgow, UK
- NHS Greater Glasgow & Clyde, Glasgow, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Raman Sharma
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Emma C. Thomson
- MRC-University of Glasgow Centre for Virus Research, Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Janet T. Scott
- NHS Greater Glasgow & Clyde, Glasgow, UK
- MRC-University of Glasgow Centre for Virus Research, Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
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Hanna CR, Gatting LP, Boyd KA, Robb KA, Jones RJ. Evidencing the impact of cancer trials: insights from the 2014 UK Research Excellence Framework. Trials 2020; 21:486. [PMID: 32503612 PMCID: PMC7275320 DOI: 10.1186/s13063-020-04425-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/16/2020] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION An impactful clinical trial will have real-life benefits for patients and society beyond the academic environment. This study analyses case studies of cancer trials to understand how impact is evidenced for cancer trials and how impact evaluation can be more routinely adopted and improved. METHODS The United Kingdom (UK) Government allocates research funding to higher-education institutions based on an assessment of the institutions' previous research efforts, in an exercise known as the Research Excellence Framework (REF). In addition to each institution's journal publications and research environment, for the first time in 2014, allocation of funding was also dependent on an evaluation of the wider, societal impact of research conducted. In the REF2014, impact assessment was performed by evaluation of impact case studies. In this study, case studies (n = 6637) submitted by institutions for the REF2014 were accessed and those focussing on cancer trials were identified. Manual content analysis was then used to assess the characteristics of the cancer trials discussed in the case studies, the impact described and the methods used by institutions to demonstrate impact. RESULTS Forty-six case studies describing 106 individual cancer trials were identified. The majority were phase III randomised controlled trials and those recruiting patients with breast cancer. A list of indicators of cancer trial impact was generated using the previous literature and developed inductively using these case studies. The most common impact from a cancer trial identified in the case studies was on policy, in particular citation of trial findings in clinical guidelines. Impact on health outcomes and the economy were less frequent and health outcomes were often predicted rather than evidenced. There were few descriptions identified of trialists making efforts to maximise trial impact. DISCUSSION Cancer trial impact narratives for the next REF assessment exercise in 2021 can be improved by evidencing actual rather than predicted Impact, with a clearer identification of the beneficiaries of cancer trials and the processes through which trial results are used. Clarification of the individuals responsible for performing impact evaluations of cancer trials and the provision of resources to do so needs to be addressed if impact evaluation is to be sustainable.
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Affiliation(s)
- Catherine R Hanna
- CRUK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, 1053 Great Western Road, Glasgow, G12 OYN, UK.
| | - Lauren P Gatting
- Institute of Health and Wellbeing, University Of Glasgow Gartnavel Royal Hospital, Admin Building, 1st Floor, 1055 Great Western Road, Glasgow,, G12 0XH, UK
| | - Kathleen Anne Boyd
- Institute of Health and Wellbeing, University Of Glasgow Gartnavel Royal Hospital, Admin Building, 1st Floor, 1055 Great Western Road, Glasgow,, G12 0XH, UK
| | - Kathryn A Robb
- Institute of Health and Wellbeing, University Of Glasgow, Health Economics and Health Technology Assessment, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK
| | - Rob J Jones
- CRUK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, 1053 Great Western Road, Glasgow, G12 OYN, UK
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15
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Hanna CR, Lynskey DM, Wadsley J, Appleyard SE, Anwar S, Miles E, Gower J, Hall E, Coles CE, Hanna GG. Radiotherapy Trial Set-up in the UK: Identifying Inefficiencies and Potential Solutions. Clin Oncol (R Coll Radiol) 2020; 32:266-275. [PMID: 31685377 DOI: 10.1016/j.clon.2019.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 09/04/2019] [Accepted: 09/26/2019] [Indexed: 11/17/2022]
Abstract
AIMS Radiotherapy clinical trials are integral to the development of new treatments to improve the outcomes of patients with cancer. A collaborative study by the National Cancer Research Institute Clinical and Translational Radiotherapy Research Working Group and the National Institute for Health Research was carried out to understand better if and why inefficiencies occur in the set-up of radiotherapy trials in the UK. MATERIALS AND METHODS Two online surveys collected information on the time taken for UK radiotherapy trials to reach key milestones during set-up and the research support currently being provided to radiotherapy centres to enable efficient clinical trial set-up. Semi-structured interviews with project managers and chief investigators identified better ways of working to improve trial set-up in the future. RESULTS The timelines for the set-up of 39 UK radiotherapy trials were captured in an online survey showing that the median time from grant approval to trial opening was 600 days (range 169-1172). There were 38 responses from radiotherapy centres to a survey asking about the current support provided for radiotherapy research. Most of these centres have more than one type of staff member dedicated to supporting radiotherapy research. The most frequent barrier to radiotherapy trial set-up identified was lack of physicists' time and lack of time for clinical oncologists to carry out research activities. Four main themes around trial set-up were identified from semi-structured interviews: the importance of communication and building relationships, the previous experience of the chief investigator and clinical trials units, a lack of resources and having the time and personnel required to produce trial documentation and to process trial approval requests. CONCLUSIONS This unique, collaborative project has provided up to date information about the current landscape of trial set-up and research support in the UK and identified several avenues on which to focus future efforts in order to support the excellent radiotherapy trial work carried out across the UK.
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Affiliation(s)
- C R Hanna
- CRUK Clinical Trials Unit, University of Glasgow, Glasgow, UK.
| | - D M Lynskey
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - J Wadsley
- Weston Park Cancer Centre, Sheffield, UK
| | | | - S Anwar
- National Institute for Health Research, Leeds, UK
| | - E Miles
- RTTQA Group, Mount Vernon Cancer Centre, Northwood, UK
| | - J Gower
- National Institute for Health Research, Leeds, UK
| | - E Hall
- The Institute of Cancer Research, London, UK
| | - C E Coles
- University of Cambridge, Cambridge, UK
| | - G G Hanna
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
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Affiliation(s)
- Theresa A Lawrie
- 1st Floor Education Centre, Royal United Hospital; Cochrane Gynaecological, Neuro-oncology and Orphan Cancer Group; Combe Park Bath UK BA1 3NG
| | - Catherine R Hanna
- University of Glasgow; Department of Oncology; Beatson West of Scotland Cancer Centre Great Western Road Glasgow Scotland UK G4 9DL
| | | | - Ashleigh Kernohan
- Newcastle University; Institute of Health & Society; Baddiley-Clark Building, Richardson Road Newcastle upon Tyne UK NE2 4AA
| | - Luke Vale
- Newcastle University; Institute of Health & Society; Baddiley-Clark Building, Richardson Road Newcastle upon Tyne UK NE2 4AA
| | - Helen Bulbeck
- brainstrust; Director of Services; 4 Yvery Court Castle Road Cowes Isle of Wight UK PO31 7QG
| | - Usama M Ali
- University of Oxford; Centre for Statistics in Medicine; 7 Dewsbury Road Luton Bedfordshire UK LU3 2HJ
| | - Robin Grant
- Western General Hospital; Edinburgh Centre for Neuro-Oncology (ECNO); Crewe Road Edinburgh Scotland UK EH4 2XU
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