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Carroll HK, Broderick A, McCarthy O, Bambury RM, Power DG, Collins DC, Connolly RM, Noonan SA, Collins D, Cunningham E, Kennedy M, O'Driscoll K, Nuzum D, Twomey K, O'Riordan A, O'Sullivan F, Roe C, Lowney AC, O'Leary MJ, O'Reilly S. Room to Improve: An Audit of In-Hospital End-of-Life Care for Oncology Patients in a Tertiary Cancer Centre in Ireland During the COVID-19 Pandemic. Omega (Westport) 2023:302228231196620. [PMID: 37670454 DOI: 10.1177/00302228231196620] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
The COVID-19 pandemic compounded isolation for patients through social distancing measures and staff shortages. We were concerned about the impact of COVID-19 on the quality of care provided at end-of-life in 2021 in a national cancer centre, and instigated the first ever review of the care of the dying. Quality of care was assessed retrospectively using a validated instrument developed by the United Kingdom's National Quality Board. Sixty-six patient deaths occurred in our cancer centre in 2021. The 'risk of dying' was documented in 65.2% of records. Palliative care services were involved in 77%, and pastoral care in 10.6%. What was important to the patient was documented in 24.2%. The 'quality-of-death' score was satisfactory for most but poor in 21.2%. Our study prompted change, including appointment of an end-of-life coordinator, development of a checklist to ensure comprehensive communication, expansion of the end-of-life committee to include junior doctors, and regular audit.
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Affiliation(s)
| | | | - Orfhlaith McCarthy
- Cork University Hospital, Cork, Ireland
- Marymount University Hospice, Cork, Ireland
| | - Richard M Bambury
- Cork University Hospital, Cork, Ireland
- Cancer Research, College of Medicine and Health University College, UCC, Cork, Ireland
| | - Derek G Power
- Cork University Hospital, Cork, Ireland
- Cancer Research, College of Medicine and Health University College, UCC, Cork, Ireland
| | - Dearbhaile C Collins
- Cork University Hospital, Cork, Ireland
- Cancer Research, College of Medicine and Health University College, UCC, Cork, Ireland
| | - Roisin M Connolly
- Cork University Hospital, Cork, Ireland
- Cancer Research, College of Medicine and Health University College, UCC, Cork, Ireland
| | - Sinead A Noonan
- Cork University Hospital, Cork, Ireland
- Cancer Research, College of Medicine and Health University College, UCC, Cork, Ireland
| | | | - Elaine Cunningham
- Cork University Hospital, Cork, Ireland
- Marymount University Hospice, Cork, Ireland
| | - Mary Kennedy
- Cork University Hospital, Cork, Ireland
- Marymount University Hospice, Cork, Ireland
| | | | - Daniel Nuzum
- Cork University Hospital, Cork, Ireland
- Marymount University Hospice, Cork, Ireland
| | | | | | | | | | - Aoife C Lowney
- Cork University Hospital, Cork, Ireland
- Marymount University Hospice, Cork, Ireland
| | - Mary Jane O'Leary
- Cork University Hospital, Cork, Ireland
- Marymount University Hospice, Cork, Ireland
| | - Seamus O'Reilly
- Cork University Hospital, Cork, Ireland
- Cancer Research, College of Medicine and Health University College, UCC, Cork, Ireland
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2
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McGovern J, Dolan RD, Simmons C, Daly LE, Ryan AM, Power DG, Fallon MT, Laird BJ, McMillan DC. Are CT-Derived Muscle Measurements Prognostic, Independent of Systemic Inflammation, in Good Performance Status Patients with Advanced Cancer? Cancers (Basel) 2023; 15:3497. [PMID: 37444607 DOI: 10.3390/cancers15133497] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
The present study examined the relationships between CT-derived muscle measurements, systemic inflammation, and survival in advanced cancer patients with good performance status (ECOG-PS 0/1). Data was collected prospectively from patients with advanced cancer undergoing anti-cancer therapy with palliative intent. The CT Sarcopenia score (CT-SS) was calculated by combining the CT-derived skeletal muscle index (SMI) and density (SMD). The systemic inflammatory status was determined using the modified Glasgow Prognostic Score (mGPS). The primary outcome of interest was overall survival (OS). Univariate and multivariate Cox regressions were used for survival analysis. Three hundred and seven patients met the inclusion criteria, out of which 62% (n = 109) were male and 47% (n = 144) were ≥65 years of age, while 38% (n = 118) were CT-SS ≥ 1 and 47% (n = 112) of patients with pre-study blood were inflamed (mGPS ≥ 1). The median survival from entry to the study was 11.1 months (1-68.1). On univariate analysis, cancer type (p < 0.05) and mGPS (p < 0.001) were significantly associated with OS. On multivariate analysis, only mGPS (p < 0.001) remained significantly associated with OS. In patients who were ECOG-PS 0, mGPS was significantly associated with CT-SS (p < 0.05). mGPS may dominate the prognostic value of CT-derived sarcopenia in good-performance-status patients with advanced cancer.
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Affiliation(s)
- Josh McGovern
- Academic Unit of Surgery, New Lister Building, Royal Infirmary, Glasgow G31 2ER, UK
| | - Ross D Dolan
- Academic Unit of Surgery, New Lister Building, Royal Infirmary, Glasgow G31 2ER, UK
| | - Claribel Simmons
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Louise E Daly
- Cork Cancer Research Centre, University College Cork, T12 YN60 Cork, Ireland
| | - Aoife M Ryan
- Cork Cancer Research Centre, University College Cork, T12 YN60 Cork, Ireland
| | - Derek G Power
- Department of Medical Oncology, Mercy and Cork University Hospital, T12 DC4A Cork, Ireland
| | - Marie T Fallon
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Barry J Laird
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Donald C McMillan
- Academic Unit of Surgery, New Lister Building, Royal Infirmary, Glasgow G31 2ER, UK
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3
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Cronin C, Iqbal S, Farooq AR, O'Dea P, Burke L, O'Reilly S, O'Mahony D, Power DG, Bambury RM, Collins DC. Real-world outcomes and toxicity of adjuvant chemotherapy in NSCLC: a single-center experience. Lung Cancer Manag 2023. [DOI: 10.2217/lmt-2022-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Aim: Adjuvant chemotherapy in NSCLC is associated with modest benefits and significant toxicity. We sought to evaluate the toxicity of adjuvant chemotherapy and disease-specific outcomes in a real-world population. Methods: We performed a retrospective analysis of patients undergoing adjuvant chemotherapy for NSCLC in an Irish center over a 7-year period. We described treatment-associated toxicity, recurrence-free survival and overall survival. Results: 62 patients underwent adjuvant chemotherapy. Treatment-associated hospitalisation occurred in 29% of patients. Relapse was recorded in 56% of patients and median recurrence-free survival was 27 months. Conclusion: High rates of disease recurrence and treatment-associated morbidity were observed in patients receiving adjuvant chemotherapy for NSCLC. Novel therapeutic strategies are required to improve outcomes in this population.
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Affiliation(s)
- Christopher Cronin
- Department of Medical Oncology, Cork University Hospital, Wilton, Co Cork, T12 EC8P, Ireland
| | - Shahid Iqbal
- Department of Medical Oncology, Cork University Hospital, Wilton, Co Cork, T12 EC8P, Ireland
| | - Abdul R Farooq
- Department of Medical Oncology, Cork University Hospital, Wilton, Co Cork, T12 EC8P, Ireland
| | - Pauline O'Dea
- Department of Medical Oncology, Cork University Hospital, Wilton, Co Cork, T12 EC8P, Ireland
| | - Louise Burke
- Department of Pathology, Cork University Hospital, Wilton, Co Cork, T12 EC8P, Ireland
| | - Seamus O'Reilly
- Department of Medical Oncology, Cork University Hospital, Wilton, Co Cork, T12 EC8P, Ireland
| | - Deirdre O'Mahony
- Department of Medical Oncology, Cork University Hospital, Wilton, Co Cork, T12 EC8P, Ireland
| | - Derek G Power
- Department of Medical Oncology, Cork University Hospital, Wilton, Co Cork, T12 EC8P, Ireland
| | - Richard M Bambury
- Department of Medical Oncology, Cork University Hospital, Wilton, Co Cork, T12 EC8P, Ireland
| | - Dearbhaile C Collins
- Department of Medical Oncology, Cork University Hospital, Wilton, Co Cork, T12 EC8P, Ireland
- University College Cork, College Road, Cork, T12 XF62, Ireland
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4
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O'Mahony D, Power SP, Power DG. Human epidermal growth factor receptor 2-positive metastatic gastric cancer in complete sustained remission with trastuzumab. Lancet 2023; 401:772. [PMID: 36870727 DOI: 10.1016/s0140-6736(23)00141-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 12/12/2022] [Accepted: 01/17/2023] [Indexed: 03/06/2023]
Affiliation(s)
- Denis O'Mahony
- Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland; Department of Medicine, University College Cork, Cork, Ireland.
| | - Stephen P Power
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Derek G Power
- Department of Medical Oncology, Cork University Hospital, Wilton, Cork, Ireland
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5
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Macanovic B, O’Reilly D, Harvey H, Hadi D, Cloherty M, O’Dea P, Power DG, Collins DC, Connolly RM, Bambury RM, O’Reilly S. A pilot project investigating the use of ONCOpatient®-An electronic patient-reported outcomes app for oncology patients. Digit Health 2023; 9:20552076231185428. [PMID: 37426594 PMCID: PMC10328053 DOI: 10.1177/20552076231185428] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 06/14/2023] [Indexed: 07/11/2023] Open
Abstract
Purpose To investigate the feasibility of implementing a remote patient monitoring system using an electronic patient-reported outcomes (ePROs) platform in a tertiary cancer center in the Republic of Ireland. Methods Patients receiving oral chemotherapy and oncology clinicians were invited to participate in the study. Patients were asked to submit weekly symptom questionnaires through an ePRO mobile phone application (app)-ONCOpatient®. Clinical staff were invited to use the ONCOpatient® clinician interface. After 8 weeks all participants submitted evaluation questionnaires. Results Thirteen patients and five staff were enrolled in the study. The majority of patients were female (85%) with a median age of 48 years (range 22-73). Most (92%) were enrolled over telephone requiring on average 16 minutes. Compliance with the weekly assessments was 91%. Alerts were triggered by 40% of patients who then required phone calls to aid with symptom management. At the end of study, 87% of patients reported they would use the app frequently, 75% reported that the platform met their expectations, and 25% that it exceeded their expectations. Similarly, 100% of staff reported they would use the app frequently, 60% reported that it met their expectations, and 40% that it exceeded their expectations. Conclusions Our pilot study showed that it is feasible to implement ePRO platforms in the Irish clinical setting. Small sample bias was recognized as a limitation, and we plan to confirm our findings on a larger cohort of patients. In the next phase we will integrate wearables including remote blood pressure monitoring.
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Affiliation(s)
- Bojan Macanovic
- Department of Medical Oncology, Cork University Hospital, Co. Cork, Ireland
| | - David O’Reilly
- Department of Medical Oncology, Cork University Hospital, Co. Cork, Ireland
| | - Harry Harvey
- Department of Medical Oncology, Cork University Hospital, Co. Cork, Ireland
| | - Danial Hadi
- Department of Medical Oncology, Cork University Hospital, Co. Cork, Ireland
| | - Maeve Cloherty
- Department of Medical Oncology, Cork University Hospital, Co. Cork, Ireland
| | - Pauline O’Dea
- Department of Medical Oncology, Cork University Hospital, Co. Cork, Ireland
| | - Derek G. Power
- Department of Medical Oncology, Cork University Hospital, Co. Cork, Ireland
- Cancer Research, UCC, University College Cork, Co. Cork, Ireland
| | - Dearbhaile C. Collins
- Department of Medical Oncology, Cork University Hospital, Co. Cork, Ireland
- Cancer Research, UCC, University College Cork, Co. Cork, Ireland
| | - Roisin M. Connolly
- Department of Medical Oncology, Cork University Hospital, Co. Cork, Ireland
- Cancer Research, UCC, University College Cork, Co. Cork, Ireland
| | - Richard M. Bambury
- Department of Medical Oncology, Cork University Hospital, Co. Cork, Ireland
- Cancer Research, UCC, University College Cork, Co. Cork, Ireland
| | - Seamus O’Reilly
- Department of Medical Oncology, Cork University Hospital, Co. Cork, Ireland
- Cancer Research, UCC, University College Cork, Co. Cork, Ireland
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6
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O'Connor C, Finnegan P, Power DG, Bennett M, Bourke JF. Pembrolizumab-associated erythema nodosum in the treatment of metastatic melanoma. Immunotherapy 2022; 14:1021-1026. [PMID: 35892257 DOI: 10.2217/imt-2021-0239] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A 66-year-old woman receiving pembrolizumab for metastatic melanoma presented with tender red nodules on her shins and forearms. Biopsy was consistent with erythema nodosum (EN). The eruption responded to oral minocycline and potent topical steroids. Subsequent investigations detected bihilar lymphadenopathy, biopsied as granulomatous lymphadenitis, confirming the diagnosis of pembrolizumab-associated sarcoidosis. Pembrolizumab was stopped for two cycles and was restarted without recrudescence of EN or bihilar lymphadenopathy. Immunotherapy-associated sarcoidosis is a rare but recognized adverse event related to therapy with immune checkpoint inhibitors. EN is an uncommon manifestation of immunotherapy-induced sarcoidosis. New-onset bihilar lymphadenopathy in the context of immunotherapy requires prompt histological evaluation to differentiate between immunotherapy-associated sarcoidosis and metastatic progression. We review the literature related to immunotherapy-associated EN.
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Affiliation(s)
- Cathal O'Connor
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, T12 X23H, Ireland.,Department of Medicine, University College Cork, Cork, T12 AK54, Ireland
| | - Paula Finnegan
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, T12 X23H, Ireland
| | - Derek G Power
- Department of Oncology, Cork University Hospital, Cork, T12 DC4A, Ireland.,Department of Medicine, University College Cork, Cork, T12 AK54, Ireland
| | - Mary Bennett
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, T12 X23H, Ireland.,Department of Medicine, University College Cork, Cork, T12 AK54, Ireland
| | - John F Bourke
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, T12 X23H, Ireland.,Department of Medicine, University College Cork, Cork, T12 AK54, Ireland
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7
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Keane F, Greally M, Horgan A, Duffy K, Lowery M, Martin P, Grogan L, Osman N, Power DG, Nasim S, O'Reilly EM, Leonard G. Consensus statement on the surveillance of patients with gastrointestinal malignancies. Ir J Med Sci 2022; 192:575-589. [PMID: 35616834 DOI: 10.1007/s11845-022-02987-y] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 03/16/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Improvements in early detection, screening and treatment of cancer have resulted in a significant improvement in cancer mortality and an increase in the number of cancer survivors globally. Accordingly, a significant rise in the number of cancer survivors in Ireland has been observed. The surveillance of survivors of gastrointestinal malignancies in Ireland is heterogeneous and represents an unmet need for standardisation. AIMS There are currently no national guidelines in Ireland to guide follow-up practices for these patients. The aim of this study was to establish homogeneity nationally with respect to follow-up of these patients by medical oncologists. METHODS/RESULTS A consensus group consisting of Irish oncologists with an interest in gastrointestinal malignancies was created to address this issue, and determined that it would be reasonable to adopt the NCCN guidelines for this purpose, but that this recommendation would not be prescriptive, and should be individualised to each patient. CONCLUSION We hope that this initiative may help to homogenise survivorship practices in this cohort of Irish patients, and may support the implementation of survivorship initiatives by the National Cancer Control Programme (NCCP).
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Affiliation(s)
- Fergus Keane
- University Hospital Galway, Newcastle Road, Galway, Ireland.
| | | | - Anne Horgan
- University Hospital Waterford, Dunmore Road, Waterford, Ireland
| | - Karen Duffy
- Letterkenny University Hospital, Kilmacrennan Road, Leterkenny, Donegal, Ireland
| | - Maeve Lowery
- St. James' Hospital, James Street, Dublin, Dublin 8, Ireland
| | - Petra Martin
- Midland Regional Hospital, Arden Road, Tullamore, Co. Offaly, Ireland
| | - Liam Grogan
- Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - Nemer Osman
- University Hospital Limerick, Dooradoyle, Co. Limerick, Ireland
| | - Derek G Power
- Cork University Hospital, Wilton Road, Cork, Co. Cork, Ireland
| | - Saira Nasim
- Midland Regional Hospital, Arden Road, Tullamore, Co. Offaly, Ireland
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8
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Palles C, West HD, Chew E, Galavotti S, Flensburg C, Grolleman JE, Jansen EAM, Curley H, Chegwidden L, Arbe-Barnes EH, Lander N, Truscott R, Pagan J, Bajel A, Sherwood K, Martin L, Thomas H, Georgiou D, Fostira F, Goldberg Y, Adams DJ, van der Biezen SAM, Christie M, Clendenning M, Thomas LE, Deltas C, Dimovski AJ, Dymerska D, Lubinski J, Mahmood K, van der Post RS, Sanders M, Weitz J, Taylor JC, Turnbull C, Vreede L, van Wezel T, Whalley C, Arnedo-Pac C, Caravagna G, Cross W, Chubb D, Frangou A, Gruber AJ, Kinnersley B, Noyvert B, Church D, Graham T, Houlston R, Lopez-Bigas N, Sottoriva A, Wedge D, Jenkins MA, Kuiper RP, Roberts AW, Cheadle JP, Ligtenberg MJL, Hoogerbrugge N, Koelzer VH, Rivas AD, Winship IM, Ponte CR, Buchanan DD, Power DG, Green A, Tomlinson IPM, Sampson JR, Majewski IJ, de Voer RM. Germline MBD4 deficiency causes a multi-tumor predisposition syndrome. Am J Hum Genet 2022; 109:953-960. [PMID: 35460607 PMCID: PMC9118112 DOI: 10.1016/j.ajhg.2022.03.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [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: 01/21/2022] [Accepted: 03/30/2022] [Indexed: 12/16/2022] Open
Abstract
We report an autosomal recessive, multi-organ tumor predisposition syndrome, caused by bi-allelic loss-of-function germline variants in the base excision repair (BER) gene MBD4. We identified five individuals with bi-allelic MBD4 variants within four families and these individuals had a personal and/or family history of adenomatous colorectal polyposis, acute myeloid leukemia, and uveal melanoma. MBD4 encodes a glycosylase involved in repair of G:T mismatches resulting from deamination of 5'-methylcytosine. The colorectal adenomas from MBD4-deficient individuals showed a mutator phenotype attributable to mutational signature SBS1, consistent with the function of MBD4. MBD4-deficient polyps harbored somatic mutations in similar driver genes to sporadic colorectal tumors, although AMER1 mutations were more common and KRAS mutations less frequent. Our findings expand the role of BER deficiencies in tumor predisposition. Inclusion of MBD4 in genetic testing for polyposis and multi-tumor phenotypes is warranted to improve disease management.
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Affiliation(s)
- Claire Palles
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Science, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Hannah D West
- Institute of Medical Genetics, Division of Cancer and Genetics, Cardiff University, School of Medicine, Cardiff, UK
| | - Edward Chew
- Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia
| | - Sara Galavotti
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Science, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | | | - Judith E Grolleman
- Department of Human Genetics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 Nijmegen, the Netherlands
| | - Erik A M Jansen
- Department of Human Genetics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 Nijmegen, the Netherlands
| | - Helen Curley
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Science, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Laura Chegwidden
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Science, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Edward H Arbe-Barnes
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK
| | - Nicola Lander
- Institute of Medical Genetics, Division of Cancer and Genetics, Cardiff University, School of Medicine, Cardiff, UK
| | - Rebekah Truscott
- Institute of Medical Genetics, Division of Cancer and Genetics, Cardiff University, School of Medicine, Cardiff, UK
| | - Judith Pagan
- Molecular Genetics Laboratory, South East Scotland Genetic Service, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK
| | - Ashish Bajel
- Peter MacCallum Cancer Center and Royal Melbourne Hospital, Victorian Comprehensive Cancer Centre, Parkville, VIC, Australia
| | - Kitty Sherwood
- Edinburgh Cancer Research Centre, IGMM, University of Edinburgh, Crewe Road, Edinburgh EH4 2XR, UK
| | - Lynn Martin
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Science, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Huw Thomas
- St Mark's Hospital, Imperial College London, London, UK
| | - Demetra Georgiou
- Genomic Medicine, Imperial College Healthcare Trust and North West Thames Regional Genetics Service, Northwick Park, Harrow, UK
| | | | - Yael Goldberg
- Raphael Recanati Genetic Institute, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David J Adams
- Wellcome Trust Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - Simone A M van der Biezen
- Department of Human Genetics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 Nijmegen, the Netherlands
| | - Michael Christie
- Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia; Colorectal Oncogenomics Group, Department of Clinical Pathology, Melbourne Medical School, The University of Melbourne, Parkville, VIC, Australia
| | - Mark Clendenning
- Colorectal Oncogenomics Group, Department of Clinical Pathology, Melbourne Medical School, The University of Melbourne, Parkville, VIC, Australia; University of Melbourne Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Parkville, VIC, Australia
| | - Laura E Thomas
- Institute of Life Sciences, Swansea University, Swansea SA28PP, UK
| | - Constantinos Deltas
- Center of Excellence in Biobanking and Biomedical Research and Molecular Medicine Research Center, University of Cyprus Medical School, Nicosia, Cyprus
| | - Aleksandar J Dimovski
- Center for Biomolecular Pharmaceutical Analyzes, UKIM Faculty of Pharmacy, 1000 Skopje, Republic of Macedonia
| | - Dagmara Dymerska
- Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Jan Lubinski
- Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Khalid Mahmood
- Colorectal Oncogenomics Group, Department of Clinical Pathology, Melbourne Medical School, The University of Melbourne, Parkville, VIC, Australia; University of Melbourne Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Parkville, VIC, Australia
| | - Rachel S van der Post
- Department of Pathology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 Nijmegen, the Netherlands
| | - Mathijs Sanders
- Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jürgen Weitz
- Department of Surgical Research, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Jenny C Taylor
- Oxford NIHR Biomedical Research Centre, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK
| | - Clare Turnbull
- Institute of Cancer Research, Cotswold Road, Sutton, Surrey SM2 5NG, UK
| | - Lilian Vreede
- Department of Human Genetics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 Nijmegen, the Netherlands
| | - Tom van Wezel
- Department of Pathology, Leiden University Medical Center, 2300 Leiden, the Netherlands
| | - Celina Whalley
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Science, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Claudia Arnedo-Pac
- Institute for Research in Biomedicine, The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Giulio Caravagna
- Institute of Cancer Research, Cotswold Road, Sutton, Surrey SM2 5NG, UK
| | - William Cross
- Cancer Institute, University College London, 72 Huntley Street, London WC1E 6BT, UK
| | - Daniel Chubb
- Institute of Cancer Research, Cotswold Road, Sutton, Surrey SM2 5NG, UK
| | - Anna Frangou
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK
| | - Andreas J Gruber
- Manchester Interdisciplinary Biocentre, University of Manchester, Manchester M1 7DN, UK
| | - Ben Kinnersley
- Institute of Cancer Research, Cotswold Road, Sutton, Surrey SM2 5NG, UK
| | - Boris Noyvert
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Science, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - David Church
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK
| | - Trevor Graham
- Barts Cancer Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Richard Houlston
- Institute of Cancer Research, Cotswold Road, Sutton, Surrey SM2 5NG, UK
| | - Nuria Lopez-Bigas
- Institute for Research in Biomedicine, The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Andrea Sottoriva
- Cancer Institute, University College London, 72 Huntley Street, London WC1E 6BT, UK
| | - David Wedge
- Manchester Interdisciplinary Biocentre, University of Manchester, Manchester M1 7DN, UK
| | - Mark A Jenkins
- University of Melbourne Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Parkville, VIC, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Roland P Kuiper
- Department of Human Genetics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 Nijmegen, the Netherlands; Princess Máxima Center for Pediatric Oncology, 3584 Utrecht, the Netherlands
| | - Andrew W Roberts
- Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia; Molecular Genetics Laboratory, South East Scotland Genetic Service, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK; University of Melbourne Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Parkville, VIC, Australia; University of Melbourne, Department of Medical Biology, 1G Royal Parade, Parkville, VIC 3052, Australia
| | - Jeremy P Cheadle
- Institute of Medical Genetics, Division of Cancer and Genetics, Cardiff University, School of Medicine, Cardiff, UK
| | - Marjolijn J L Ligtenberg
- Department of Human Genetics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 Nijmegen, the Netherlands; Department of Pathology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 Nijmegen, the Netherlands
| | - Nicoline Hoogerbrugge
- Department of Human Genetics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 Nijmegen, the Netherlands
| | - Viktor H Koelzer
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | - Andres Dacal Rivas
- Servicio de Digestivo, Hospital Lucus Augusti, Instituto de Investigación Sanitaria de Santiago, Lugo, Galicia, Spain
| | - Ingrid M Winship
- Genomic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Melbourne, VIC, Australia; Department of Medicine, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Clara Ruiz Ponte
- Fundación Pública Galega de Medicina Xenómica SERGAS, Grupo de Medicina Xenómica-USC, Instituto de Investigación Sanitaria de Santiago, Centro de Investigación Biomédica en Red de Enfermedades Raras, Santiago de Compostela, Galicia, Spain
| | - Daniel D Buchanan
- Colorectal Oncogenomics Group, Department of Clinical Pathology, Melbourne Medical School, The University of Melbourne, Parkville, VIC, Australia; University of Melbourne Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Parkville, VIC, Australia; Genomic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Derek G Power
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - Andrew Green
- Department of Clinical Genetics, Children's Health Ireland, Dublin, Ireland; School of Medicine University College, Dublin, Ireland
| | - Ian P M Tomlinson
- Edinburgh Cancer Research Centre, IGMM, University of Edinburgh, Crewe Road, Edinburgh EH4 2XR, UK.
| | - Julian R Sampson
- Institute of Medical Genetics, Division of Cancer and Genetics, Cardiff University, School of Medicine, Cardiff, UK.
| | - Ian J Majewski
- Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Richarda M de Voer
- Department of Human Genetics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 Nijmegen, the Netherlands
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9
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Peters N, Bambury RM, Power DG, McCarthy L, Lyons C, Kelly P, Jamaluddin MF. Radium-223 in the Treatment of Metastatic Castrate-Resistant Prostate Cancer. Ir Med J 2022; 115:536. [PMID: 35416462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background Radium 223 (Ra-223) has been successfully utilised for the treatment of men with metastatic castrate resistant prostate cancer (mCRPC). To date, no real world outcomes from its use in the Irish population have been described. Methods All men referred to our institution for Ra-223 from September 2016 to March 2019 were included. Patient demographics, treatments received, toxicities and outcomes were recorded. Overall survival (OS) and progression free survival (PFS) were analysed using the Kaplan-Meier method. Results Complete data was available for 54 men. Median age was 75 years (range 61-86 years). The median number of prior systemic treatments for mCRPC was 2 (range 0-4). Median ECOG performance status was 1 at the start of treatment and 2 at completion. The median number of Ra-223 cycles received was 4 with 37%(n=20) completing all 6 planned cycles. The most common treatment-related toxicity was fatigue seen in 52% of patients ( n=28). Improved pain scores were documented in 76% of men requiring opioid analgesia at the start of treatment. The median OS was 7 months. A good ECOG performance status, fewer than 6 bone metastases, normal alkaline phosphatase level at start of treatment and chemotherapy naivety were associated with improved OS. Conclusions Ra-223 is a moderately well tolerated palliative treatment amongst Irish men with mCRPC.
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Affiliation(s)
- N Peters
- Department of Medical Oncology, Cork University Hospital
| | - R M Bambury
- Department of Medical Oncology, Cork University Hospital
| | - D G Power
- Department of Medical Oncology, Cork University Hospital
| | - L McCarthy
- Department of Radiation Oncology, Cork University Hospital
| | - C Lyons
- Department of Radiation Oncology, Cork University Hospital
| | - P Kelly
- Department of Radiation Oncology, Cork University Hospital
- Department of Radiation Oncology, Bon Secours University Hospital
| | - M F Jamaluddin
- Department of Radiation Oncology, Cork University Hospital
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10
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O'Sullivan HM, Conroy M, Power DG, Bambury RM, O'Mahony D, Collins DC, O'Leary MJ, O'Reilly S. Immune Checkpoint Inhibitors and Palliative Care at the End of Life: An Irish Multicentre Retrospective Study. J Palliat Care 2022:8258597221078391. [PMID: 35129002 DOI: 10.1177/08258597221078391] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Background and Objectives: Immune checkpoint inhibitors (ICIs) have less toxicity than standard chemotherapy and are now standard of care for many patients with advanced cancer. A manageable side effect profile and potential for durable responses may lead to aggressive care of the palliative patient. We sought to evaluate palliative care input and ICI use at the end of life at two Irish cancer centres. Methods: We identified deceased patients who received at least one dose of an ICI between first of January 2013 to 31st of December 2018. A retrospective electronic chart review was performed. Results: The electronic records of 102 patients were analysed. Fifty eight percent were male and the median age of diagnosis of advanced disease was 60 years (range 17-78). Median time from last dose of ICI to death was 57 days (range 8-574) and 20% of patients died within 30 days of last dose of ICI. Most patients, 92%, were referred to palliative care. The median time from palliative care referral to death was 64 days (range 1- 1010). In the last 30 days of life, 39% of patients attended the emergency department (ED) and 46% had at least one hospital admission. Late palliative care referrals, ≤3 months before death, were associated with hospitalisations in the last month of life (64% vs. 36%, P = .02). Timing of palliative care referral did not affect ICI prescribing at the end of life (P = 0.38). ICI use in the last 30 days of life was not associated with increased ED presentations or hospitalisations at the end of life. Patients who received ICI in the last month had a higher likelihood of in-hospital death (43% vs. 16%, P = 0.02). Conclusions: ICI within 30 days of death was associated with dying in hospital but did not lead to more hospitalisations and emergency department presentations. Early palliative care did not affect ICI use but reduced hospitalisations at the end of life.
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Affiliation(s)
- H M O'Sullivan
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - M Conroy
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - D G Power
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
- Department of Medical Oncology, Mercy University Hospital, Cork, Ireland
| | - R M Bambury
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - D O'Mahony
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - D C Collins
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - M J O'Leary
- Department of Palliative Medicine, Marymount University Hospital and Hospice, Cork, Ireland
- Department of Palliative Medicine, Cork University Hospital, Cork, Ireland
| | - S O'Reilly
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
- Department of Medical Oncology, Mercy University Hospital, Cork, Ireland
- Cork Cancer Research Centre, University College Cork, Cork, Ireland
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11
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O’Riordan E, Bennett MW, Daly L, Power DG. The implication of BRAF mutation in advanced colorectal cancer. Ir J Med Sci 2022; 191:2467-2474. [PMID: 34877621 PMCID: PMC9672001 DOI: 10.1007/s11845-021-02689-x] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/09/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND Advanced colorectal cancer (CRC) is frequently a lethal disease. Mutations in the BRAF gene is a key driver in CRC pathogenesis and confers a poor prognosis. To date, Irish data on this molecular subtype of CRC is lacking. AIMS Our aim was to compare the natural history of Irish patients with BRAF (BRAFMUT) metastatic CRC with a control group of metastatic CRC patients without BRAF mutation (BRAFWT wild- type). METHOD A retrospective observational analysis of advanced CRC patients with known BRAFMUT was conducted by chart review. BRAFMUT patients were identified from the Cork University Hospital (CUH) histopathology database. Controls with known BRAFWT were randomly selected from the database. Demographic characteristics and clinicopathological data were recorded. Survival was assessed with Kaplan-Meier curve/Cox proportional hazard models. RESULTS Twenty patients with BRAFMUT and 36 with BRAFWT were studied. BRAFMUT were more likely female (75% vs 33%, p = 0.007) and right-sided (65% vs 31.4%, p = 0.033). Median overall survival was lower in BRAFMUT group (17.3 months (95% CI 0-40.8)) compared to patients with BRAFWT (median survival not reached, log rank p = 0.001). On multivariate analysis, BRAFMUT was independently associated with an increased risk of mortality (HR 12.76 (95% CI 3.15-51.7), p < 0.001). CONCLUSION BRAFMUT advanced colorectal cancer was associated with significantly reduced overall survival in this Irish CRC population. Knowledge of mutation status should now be considered standard of care and should dictate management. Surgeons should be aware of this genetic signature as the natural history of the disease may mitigate against an aggressive surgical strategy. A prospective study should be conducted to further corroborate these findings.
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Affiliation(s)
- Emma O’Riordan
- School of Medicine, University College Cork, Cork, Republic of Ireland
| | | | - Louise Daly
- School of Food & Nutritional Sciences, University College Cork, Cork, Republic of Ireland
| | - Derek G Power
- Department of Medical Oncology, Mercy & Cork University Hospitals, Cork, Republic of Ireland
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12
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Abstract
A 65-year-old female patient has a history of malignant triton tumour of the right upper lobe of the lung. She underwent right upper lobectomy and lymphadenectomy in May 2018. She presented in November 2019 with pathological fracture of the left proximal femur. It was not associated with neurofibromatosis. We decided to do an excisional biopsy of the mass and proximal femoral replacement followed by radiotherapy. Four months later, she presented with local recurrence. We organised a multidisciplinary team between the orthopaedic, histopathology and oncology teams. Then, we decided to treat her with chemotherapy. After 2 months of follow-up, she responded well to the chemotherapy with no further deterioration of her condition.
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Affiliation(s)
| | - Rehan Gul
- Orthopaedics, Cork University, Cork, Ireland
| | | | - Derek G Power
- Medical Oncology, Cork University Hospital Group, Cork, Ireland
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13
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Moloney C, Allen M, Power DG, M Bambury R, O'Mahony D, O'Donnell DM, O'Reilly S, Collins DC. Assessing the Quality of Care Delivered to Transgender and Gender Diverse Patients with Cancer in Ireland: A Case Series. Oncologist 2020; 26:e603-e607. [PMID: 33252154 DOI: 10.1002/onco.13618] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 11/13/2020] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION "Transgender" and "gender diverse" are umbrella terms encompassing those whose gender identities or expressions differ from those typically associated with the sex they were assigned at birth. There is scant global information on cancer incidence, outcome, and mortality for this cohort. This group may present with advanced cancer, have mistrust in health care services and report anxiety and depression at higher frequencies, a finding often seen in marginalized groups because of minority stress. MATERIALS AND METHODS Medical oncologists were contacted by secure email to identify patients who self-identify as transgender and gender diverse in three Irish hospitals. Five patients were identified. A retrospective chart review was conducted and a pseudonymized patient survey was distributed. RESULTS All patients included in our chart review (n = 5) were diagnosed with advanced disease on initial diagnosis. Two patients identified as men, two as women, and one as a transwoman. Two of five patients' health record charts reflected a name or gender change. Three patients had gender transitioning treatment postponed. Assessing comorbidities, it was seen that four patients required psychiatry input. Predominant issues noted in our patient survey by the two respondents (n = 2) were "mis-gendering," lack of a gender-neutral hospital environment, lack of inclusion in cancer groups, and barriers in changing name and/or sex on hospital records. CONCLUSION Components of care requiring revision include patient accessible pathways to change names and gender on health records, earlier access to psychological support and targeted screening and support groups. Resources for hospital staff to improve awareness of correct terminology and to provide gender neutral facilities are worthwhile. IMPLICATIONS FOR PRACTICE The implications for practice on an international level include patient-friendly pathways for changing hospital name and gender so that patients may feel comfortable using wristbands. The need for international screening guidelines for transgender patients and national transgender cancer support groups is highlighted. On a day-to-day level for providers, the correct use of pronouns makes a big difference to patients. Asking about preferred pronoun on first visit and noting on patient's file is worthwhile. It is important for providers to know that increased psychological support should be offered early on first clinic visit and engaged with as necessary when patient has a history of anxiety or depression. Providers should discuss openly that some gender transitioning treatment will be postponed because of cancer care and refer to both the physical and psychological sequelae of this. Asking transgender patients which room or bathroom they would prefer when rooms are gendered is essential.
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Affiliation(s)
- Carolyn Moloney
- Cork University Hospital, Cork, Ireland, Dublin, Ireland.,Mercy University Hospital, Cork, Ireland, Dublin, Ireland.,St James's University Hospital, Dublin, Ireland
| | - Margaret Allen
- Cork University Hospital, Cork, Ireland, Dublin, Ireland
| | - Derek G Power
- Cork University Hospital, Cork, Ireland, Dublin, Ireland.,Mercy University Hospital, Cork, Ireland, Dublin, Ireland
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14
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Affiliation(s)
- Timothy O'Brien
- Department of Medical Oncology, Cork University Hospital Group, Cork, Ireland
| | - Derek G Power
- Department of Medical Oncology, Cork University Hospital Group, Cork, Ireland
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15
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Daly LE, Dolan RD, Power DG, Ní Bhuachalla É, Sim W, Cushen SJ, Fallon M, Simmons C, McMillan DC, Laird BJ, Ryan AM. Determinants of quality of life in patients with incurable cancer. Cancer 2020; 126:2872-2882. [DOI: 10.1002/cncr.32824] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 09/19/2019] [Accepted: 01/24/2020] [Indexed: 12/25/2022]
Affiliation(s)
- Louise E. Daly
- School of Food and Nutritional Sciences College of Science, Engineering and Food Science University College Cork Cork Ireland
| | - Ross D. Dolan
- Academic Unit of Surgery University of Glasgow Glasgow United Kingdom
| | - Derek G. Power
- Department of Medical Oncology Mercy and Cork University Hospital Cork Ireland
| | - Éadaoin Ní Bhuachalla
- School of Food and Nutritional Sciences College of Science, Engineering and Food Science University College Cork Cork Ireland
| | - Wei Sim
- Academic Unit of Surgery University of Glasgow Glasgow United Kingdom
| | - Samantha J. Cushen
- School of Food and Nutritional Sciences College of Science, Engineering and Food Science University College Cork Cork Ireland
| | - Marie Fallon
- Edinburgh Cancer Research Centre Institute of Genetics and Molecular Medicine University of Edinburgh Edinburgh United Kingdom
| | - Claribel Simmons
- Edinburgh Cancer Research Centre Institute of Genetics and Molecular Medicine University of Edinburgh Edinburgh United Kingdom
| | | | - Barry J. Laird
- Edinburgh Cancer Research Centre Institute of Genetics and Molecular Medicine University of Edinburgh Edinburgh United Kingdom
| | - Aoife M. Ryan
- School of Food and Nutritional Sciences College of Science, Engineering and Food Science University College Cork Cork Ireland
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16
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Ryan AM, Prado CM, Sullivan ES, Power DG, Daly LE. Effects of weight loss and sarcopenia on response to chemotherapy, quality of life, and survival. Nutrition 2019; 67-68:110539. [PMID: 31522087 DOI: 10.1016/j.nut.2019.06.020] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/20/2019] [Indexed: 02/07/2023]
Abstract
It has frequently been shown that patients with cancer are one of the largest hospital patient groups with a prevalence for malnutrition. Weight loss is a frequent manifestation of malnutrition in patients with cancer. Several large-scale studies over the past 35 y have reported that involuntary weight loss affects 50% to 80% of these patients with the degree of weight loss dependent on tumor site and type and stage of disease. The aim of this review was to determine the consequences of malnutrition, weight loss, and muscle wasting in relation to chemotherapy tolerance, postoperative complications, quality of life, and survival in patients with cancer. The prognostic impact of weight loss on overall survival has long been recognised with recent data suggesting losses as little as 2.4% predicts survival independent of disease, site, stage or performance score. Recently the use of gold-standard methods of body composition assessment, including computed tomography, have led to an increased understanding of the importance of muscle abnormalities, such as low muscle mass (sarcopenia), and more recently low muscle attenuation, as important prognostic indicators of unfavourable outcomes in patients with cancer. Muscle abnormalities are highly prevalent (ranging from 10-90%, depending on cancer site and the diagnostic criteria used). Both low muscle mass and low muscle attenuation have been associated with poorer tolerance to chemotherapy; increased risk of postoperative complications; significant deterioration in a patients' performance status, and poorer psychological well-being, overall quality of life, and survival.
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Affiliation(s)
- Aoife M Ryan
- School of Food and Nutritional Sciences, College of Science, Engineering and Food Science, University College Cork, Ireland; Cork Cancer Research Centre, University College Cork, Cork, Ireland.
| | - Carla M Prado
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Erin S Sullivan
- School of Food and Nutritional Sciences, College of Science, Engineering and Food Science, University College Cork, Ireland; Cork Cancer Research Centre, University College Cork, Cork, Ireland
| | - Derek G Power
- Department of Medical Oncology, Mercy and Cork University Hospitals, Cork, Ireland
| | - Louise E Daly
- School of Food and Nutritional Sciences, College of Science, Engineering and Food Science, University College Cork, Ireland; Cork Cancer Research Centre, University College Cork, Cork, Ireland
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17
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Affiliation(s)
- Louise E Daly
- School of Food and Nutritional Science, Department of Science, Engineering and Food Science, University College Cork, Ireland.
| | - Aoife M Ryan
- School of Food and Nutritional Science, Department of Science, Engineering and Food Science, University College Cork, Ireland
| | - Derek G Power
- Department of Medical Oncology, Cork and Mercy University Hospital, Cork, Ireland
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18
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Greally M, Keane F, Power DG, Leonard GD. A Survey of Colorectal Cancer Surveillance Practices In Ireland, And Implementation of A Survivorship Care Plan Pilot Programme. Ir Med J 2019; 112:870. [PMID: 30892003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Aims The number of colorectal cancer (CRC) survivors in Ireland is rising. We aimed to survey current surveillance practices and pilot the use of survivorship care plans (SCPs) in the clinic. Methods An online survey was issued to medical oncologists (MOs) in designated cancer centres (DCC) and satellite centres. The SCP was piloted in CRC patients and a follow-up questionnaire assessing their views was issued. Results Responses from 8 DCC and satellite centres were obtained (n=13). Routine surveillance is practiced by 77% (n=10) and 69% (n=9) believe that the MO clinic is inappropriate for follow-up. Most think that the SCP is useful and that ANP-led surveillance clinics should be introduced. Of 16 patients who replied to the survey, most felt that the SCP was benecial. Sixty-two percent (n=10) were agreeable to GP follow-up using the SCP. Conclusion Surveillance practices in Ireland are heterogeneous. The SCP may be useful for streamlining follow-up practices nationally.
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Affiliation(s)
- M Greally
- Medical Oncology Department, University Hospital Galway, Galway
- Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, United States
| | - F Keane
- Medical Oncology Department, University Hospital Galway, Galway
| | - D G Power
- Medical Oncology Department, Cork and Mercy University Department, Cork
| | - G D Leonard
- Medical Oncology Department, University Hospital Galway, Galway
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19
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Cormican D, Kennedy C, Murphy S, Werner R, Power DG, Heffron CCBB. High concordance of BRAF mutational status in matched primary and metastatic melanoma. J Cutan Pathol 2018; 46:117-122. [DOI: 10.1111/cup.13393] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 10/31/2018] [Accepted: 11/11/2018] [Indexed: 01/27/2023]
Affiliation(s)
- David Cormican
- Department of Pathology; Cork University Hospital; Cork Ireland
- Department of Histopathology; School of Medicine, Trinity College; Dublin Ireland
| | - Ciaran Kennedy
- Department of Pathology; Cork University Hospital; Cork Ireland
| | - Sandra Murphy
- Department of Pathology; Cork University Hospital; Cork Ireland
| | - Reiltin Werner
- Department of Pathology; Cork University Hospital; Cork Ireland
| | - Derek G. Power
- Department of Medical Oncology; Cork University Hospital; Cork Ireland
- Department of Medicine; School of Medicine, University College Cork; Cork Ireland
| | - Cynthia C. B. B. Heffron
- Department of Pathology; Cork University Hospital; Cork Ireland
- Department of Pathology; School of Medicine, University College Cork; Cork Ireland
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20
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Daly LE, Ryan AM, Power DG. Response to "Loss of Muscle Mass During Chemotherapy Is Predictive for Poor Survival of Patients With Metastatic Colorectal Cancer". J Clin Oncol 2018; 34:3816-3817. [PMID: 27480154 PMCID: PMC5477930 DOI: 10.1200/jco.2016.68.8010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Louise E Daly
- Louise E. Daly and Aoife M. Ryan, University College Cork, Cork, Ireland; Derek G. Power, Cork University Hospital, Cork, Ireland
| | - Aoife M Ryan
- Louise E. Daly and Aoife M. Ryan, University College Cork, Cork, Ireland; Derek G. Power, Cork University Hospital, Cork, Ireland
| | - Derek G Power
- Louise E. Daly and Aoife M. Ryan, University College Cork, Cork, Ireland; Derek G. Power, Cork University Hospital, Cork, Ireland
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21
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Abstract
Merkel-cell carcinoma (MCC) is a rare but aggressive cutaneous malignancy arising most often in sun-exposed Caucasians who are immunosuppressed or the elderly. Patients with metastatic disease treated with chemotherapy have a median progression-free survival of just 3 months. This report describes a 58-year-old man with a background history of psoriasis treated with immunosuppressive therapy and subsequently diagnosed with metastatic MCC. Chemotherapy produced a partial response. Then, a novel immunotherapy agent, pembrolizumab, induced a complete response maintained for at least 19 months. Quality of life was unaffected, and toxicity from immunotherapy was minimal. At the time of writing, there was no clinical or radiological evidence of recurrence and treatment is ongoing.
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Affiliation(s)
- Timothy O’Brien
- Department of Medical Oncology, Mercy University Hospital, Cork, Ireland
| | - Derek G Power
- Department of Medical Oncology, Cork University Hospital Group, Cork, Ireland
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22
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Ní Bhuachalla ÉB, Daly LE, Power DG, Cushen SJ, MacEneaney P, Ryan AM. Computed tomography diagnosed cachexia and sarcopenia in 725 oncology patients: is nutritional screening capturing hidden malnutrition? J Cachexia Sarcopenia Muscle 2018; 9:295-305. [PMID: 29271097 PMCID: PMC5879969 DOI: 10.1002/jcsm.12258] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 08/15/2017] [Accepted: 10/02/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Nutrition screening on admission to hospital is mandated in many countries, but to date, there is no consensus on which tool is optimal in the oncology setting. Wasting conditions such as cancer cachexia (CC) and sarcopenia are common in cancer patients and negatively impact on outcomes; however, they are often masked by excessive adiposity. This study aimed to inform the application of screening in cancer populations by investigating whether commonly used nutritional screening tools are adequately capturing nutritionally vulnerable patients, including those with abnormal body composition phenotypes (CC, sarcopenia, and myosteatosis). METHODS A prospective study of ambulatory oncology outpatients presenting for chemotherapy was performed. A detailed survey incorporating clinical, nutritional, biochemical, and quality of life data was administered. Participants were screened for malnutrition using the Malnutrition Universal Screening Tool (MUST), Malnutrition Screening Tool (MST), and the Nutritional Risk Index (NRI). Computed tomography (CT) assessment of body composition was performed to diagnose CC, sarcopenia, and myosteatosis according to consensus criteria. RESULTS A total of 725 patients (60% male, median age 64 years) with solid tumours participated (45% metastatic disease). The majority were overweight/obese (57%). However, 67% were losing weight, and CT analysis revealed CC in 42%, sarcopenia in 41%, and myosteatosis in 46%. Among patients with CT-identified CC, the MUST, MST, and NRI tools categorized 27%, 35%, and 7% of them as 'low nutritional risk', respectively. The percentage of patients with CT-identified sarcopenia and myosteatosis that were categorised as 'low nutritional risk' by MUST, MST and NRI were 55%, 61%, and 14% and 52%, 50%, and 11%, respectively. Among these tools, the NRI was most sensitive, with scores <97.5 detecting 85.8%, 88.6%, and 92.9% of sarcopenia, myosteatosis, and CC cases, respectively. Using multivariate Cox proportional hazards models, NRI score < 97.5 predicted greater mortality risk (hazard ratio 1.8, confidence interval: 1.2-2.8, P = 0.007). CONCLUSIONS High numbers of nutritionally vulnerable patients, with demonstrated abnormal body composition phenotypes on CT analysis, were misclassified by MUST and MST. Caution should be exercised when categorizing the nutritional risk of oncology patients using these tools. NRI detected the majority of abnormal body composition phenotypes and independently predicted survival. Of the tools examined, the NRI yielded the most valuable information from screening and demonstrated usefulness as an initial nutritional risk grading system in ambulatory oncology patients.
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Affiliation(s)
- Éadaoin B Ní Bhuachalla
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland.,Cork Cancer Research Centre, University College Cork, Cork, Ireland
| | - Louise E Daly
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Derek G Power
- Department of Medical Oncology, Mercy and Cork University Hospital, Cork, Ireland
| | - Samantha J Cushen
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Peter MacEneaney
- Department of Radiology, Mercy University Hospital, Cork, Ireland
| | - Aoife M Ryan
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland.,Cork Cancer Research Centre, University College Cork, Cork, Ireland
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23
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Daly LE, Ní Bhuachalla ÉB, Power DG, Cushen SJ, James K, Ryan AM. Loss of skeletal muscle during systemic chemotherapy is prognostic of poor survival in patients with foregut cancer. J Cachexia Sarcopenia Muscle 2018; 9:315-325. [PMID: 29318756 PMCID: PMC5879982 DOI: 10.1002/jcsm.12267] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 08/18/2017] [Accepted: 10/12/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Malnutrition, weight loss, and muscle wasting are common in patients with foregut cancers (oesophagus, stomach, pancreas, liver, and bile ducts) and are associated with adverse clinical outcomes. However, little is known about the changes in body composition that occur in these patients during chemotherapy and its impacts clinical outcomes. PATIENTS AND METHODS A prospective study of adult foregut cancer patients undergoing chemotherapy between 2012 and 2016 was conducted. Computed tomography images were evaluated for cross-sectional skeletal muscle area (SMA) and adipose tissue area (ATA) at two time points [interval 118 days (IQR 92-58 days)]. Longitudinal changes in SMA and ATA were examined using paired t-tests. Sarcopenia and low muscle attenuation (MA) were defined using published cut-points. Cox proportional hazards models were used to estimate mortality hazard ratios for key predictors. RESULTS A total of 225 foregut cancer patients were included (67% male, median age 66 years). At baseline, 40% were sarcopenic, 49% had low MA, and 62% had cancer cachexia. Longitudinal analysis (n = 163) revealed significant reductions in SMA [-6.1 cm2 (3.9%)/100 days, P < 0.001]. Patients treated with neoadjuvant chemotherapy experienced greater losses in SMA and skeletal muscle mass compared with patients receiving palliative chemotherapy [-6.6 cm2 (95%, confidence interval, CI: -10.2 to -3.1), P < 0.001 and -1.2 kg (95% CI: -1.8 to -0.5), P < 0.001, respectively]. Neither sarcopenia nor low MA at baseline was associated with reduced survival. A loss of SMA >6.0%/100 days (highest fourth) independently predicted overall survival in patients receiving palliative chemotherapy [hazard ratio: 2.66, (95% CI: 1.42 to 4.97), P = 0.002]. CONCLUSIONS Patients with foregut cancers, particularly those treated with neoadjuvant chemotherapy, experience significant losses of muscle during chemotherapy. A high level of SMA loss is prognostic of reduced survival in patients treated with palliative chemotherapy. Multimodal interventions to stabilize or increase muscle mass and influence outcome warrant further investigation.
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Affiliation(s)
- Louise E. Daly
- School of Food and Nutritional Sciences, College of Science, Engineering and Food ScienceUniversity College CorkCorkIreland
- APC Microbiome InstituteUniversity College CorkCorkIreland
| | - Éadaoin B. Ní Bhuachalla
- School of Food and Nutritional Sciences, College of Science, Engineering and Food ScienceUniversity College CorkCorkIreland
- Cork Cancer Research CentreUniversity College CorkCorkIreland
| | - Derek G. Power
- Department of Medical OncologyMercy and Cork University HospitalsCorkIreland
| | - Samantha J. Cushen
- School of Food and Nutritional Sciences, College of Science, Engineering and Food ScienceUniversity College CorkCorkIreland
| | - Karl James
- Department of RadiologyCork University HospitalCorkIreland
| | - Aoife M. Ryan
- School of Food and Nutritional Sciences, College of Science, Engineering and Food ScienceUniversity College CorkCorkIreland
- Cork Cancer Research CentreUniversity College CorkCorkIreland
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Ariffin NA, Nason GJ, Omer SI, Considine SW, Sweeney P, Power DG. Post-Chemotherapy Retroperitoneal Lymph Node Dissection in Patients with Non-Seminomatous Germ Cell Tumour (NSGCT). Ir Med J 2017; 110:647. [PMID: 29465837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Diabetic retinopathy is a significant complication of diabetes, and the most common cause of blindness in people under the age of 65. The National Diabetic Retinal Screening Programme (Diabetic RetinaScreen) was established to detect sight threatening retinopathies. The purpose of this cross-sectional study is to determine the barriers to the uptake of Diabetic RetinaScreen, to investigate discrepancies in attendance, if any, between patients whose diabetes care is delivered in a large tertiary referral hospital out-patient setting or in general practice, and to evaluate general practitioner's satisfaction with the service. Older age (OR 1.023, 95% CI 1.001 to 1.046) and complications of diabetes, excluding ocular complications, (OR 2.741, 95% CI 1.158 to 6.489) were associated with increased attendance at Diabetic RetinaScreen. Online referral is now available and the preferred method of referral. Efforts to encourage younger patients who do not yet have complications of diabetes may be beneficial.
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Affiliation(s)
- N A Ariffin
- Department of Urology, Mercy University Hospital, Cork, Ireland
- Department of Medical Oncology, Mercy University Hospital, Cork, Ireland
| | - G J Nason
- Department of Urology, Mercy University Hospital, Cork, Ireland
| | - S I Omer
- Department of Urology, Mercy University Hospital, Cork, IrelandHospital
| | - S W Considine
- Department of Urology, Mercy University Hospital, Cork, IrelandHospital
| | - P Sweeney
- Department of Urology, Mercy University Hospital, Cork, IrelandHospital
| | - D G Power
- Department of Medical Oncology, Mercy University Hospital, Cork, Ireland
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Walsh EM, O'Kane GM, Cadoo KA, Graham DM, Korpanty GJ, Power DG, Carney DN. Is chemotherapy always required for cancer in pregnancy? An observational study. Ir J Med Sci 2017; 186:875-881. [PMID: 28477329 DOI: 10.1007/s11845-017-1602-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 03/24/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cancer in pregnancy is relatively rare, but the incidence is increasing. Several studies show that cytotoxic agents are safe to use in pregnancy from the second trimester onwards. AIMS This study assesses the maternal and foetal outcomes of cancers diagnosed during pregnancy. In particular, it focuses on a subset of women who elected to defer systemic chemotherapy until after delivery. This study examines if all cancers need to be treated during pregnancy or if, in certain cases, treatment can be safely deferred until after full-term delivery. METHODS This is a retrospective observational study of women diagnosed with cancer during pregnancy in an Irish cancer centre over a 27-year period. All women diagnosed with cancer during pregnancy who were referred to the medical oncology department for consideration of chemotherapy were included in this study. Medical and pharmacy records were extensively reviewed. RESULTS Twenty-five women were diagnosed with cancer in pregnancy and referred to medical oncology for consideration of systemic chemotherapy. Sixteen women (64%) commenced chemotherapy during pregnancy, seven women (28%) did not receive chemotherapy while pregnant, but commenced treatment immediately after delivery, and two (8%) did not receive any systemic chemotherapy at all. Of the seven women who commenced chemotherapy after delivery, six (85.7%) were diagnosed before 30/40 gestation. There were three cases of Hodgkin's lymphoma, two breast cancers and one ovarian cancer. After a median follow-up of 12 years, all six mothers remain disease-free. CONCLUSIONS This study identified a select cohort of patients that did not receive chemotherapy during pregnancy. There were no adverse outcomes to mothers due to delayed treatment.
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Affiliation(s)
- E M Walsh
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland.
| | - G M O'Kane
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland.,Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - K A Cadoo
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland.,Breast Cancer Medicine Service, Memorial Sloan Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY, USA
| | - D M Graham
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland.,Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK
| | - G J Korpanty
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - D G Power
- Department of Medical Oncology, Cork University Hospital and Mercy University Hospital, Cork, Ireland
| | - D N Carney
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
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Daly LE, Power DG, Ryan AM. Reply to 'Higher rate of severe toxicities in obese patients receiving dose-dense (dd) chemotherapy according to unadjusted body surface area: results of the prospectively randomized GAIN study' by J. Furlanetto et al. Ann Oncol 2017; 28:1161-1162. [PMID: 28453698 DOI: 10.1093/annonc/mdx055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- L E Daly
- Department of Food and Nutritional Science, University College Cork, Cork, Ireland
| | - D G Power
- Department of Medical Oncology, Cork and Mercy University Hospital, Cork, Ireland
| | - A M Ryan
- Department of Food and Nutritional Science, University College Cork, Cork, Ireland
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Hussain SA, Ansari J, Huddart R, Power DG, Lyons J, Wylie J, Vilarino-Varlela M, Elander NO, McMenemin R, Pickering LM, Faust G, Chauhan S, Jackson RJ. VICTOR: Vinflunine in advanced metastatic transitional cell carcinoma of the urothelium: A retrospective analysis of the use of vinflunine in multi-centre real life setting as second line chemotherapy through Free of Charge Programme for patients in the UK and Ireland. Int J Oncol 2017; 50:768-772. [PMID: 28098864 PMCID: PMC5358710 DOI: 10.3892/ijo.2017.3847] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 09/23/2016] [Accepted: 11/14/2016] [Indexed: 11/05/2022] Open
Abstract
There is no standard of care in the UK or Ireland for second-line chemotherapy for patients with advanced transitional cell carcinoma (TCCU). Vinflunine is approved for TCCU patients who have failed a platinum-based regimen, and is standard of care in Europe but is not routinely available in the UK. Data were collected retrospectively on patients who received vinfluine as a second-line treatment. The aims were to document the toxicity and efficacy in a real life setting. Data were collected on 49 patients from 9 sites across the UK and Ireland [median age, 64 (IQR, 57-70) years, 33 males]. All patients had advanced metastatic TCCU. Thirteen patients had bone or liver metastases, 4 patients had PS 2 and 11 patients had HB <10. Median vinflunine administration was 3.5 cycles (range 1-18). Most common grade 3-4 toxicities were constipation (4 patients) and fatigue (3 patients). Partial response rate was 29% (14 PR, 11 SD, 19 PD, 4 NE, 1 not available). Median OS was 9.1 (6.0, 12.7) months. Results are consistent with real life data from Europe. Toxicity is further reduced with prophylactic laxative and oral antibiotics. Vinflunine is an efficient and tolerable second line treatment in advanced TCCU.
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Affiliation(s)
- Syed A. Hussain
- University of Liverpool, Liverpool L69 3GA
- The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral CH63 4JY
| | | | - Robert Huddart
- Institute of Cancer Research and Royal Marsden Hospital, Sutton, Surrey SM2 5NG, UK
| | - Derek G. Power
- The Mercy University Hospital, Wilton, Cork T12 WE28, Republic of Ireland
| | | | - James Wylie
- The Christie NHS Foundation Trust, Manchester M20 4BX
| | | | - Nils O. Elander
- University of Liverpool, Liverpool L69 3GA
- The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral CH63 4JY
| | - Rhona McMenemin
- Northern Centre for Cancer Care, Freeman Hospital, High Heaton, Newcastle upon Tyne NE7 7DN
| | | | - Guy Faust
- Northampton General Hospital Trust, Cliftonville, Northampton NN1 5BD, UK
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Collins DC, Velázquez-Kennedy K, Deady S, Brady AP, Sweeney P, Power DG. National Incidence, Management and Survival of Urachal Carcinoma. Rare Tumors 2016; 8:6257. [PMID: 27746878 PMCID: PMC5064294 DOI: 10.4081/rt.2016.6257] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 02/10/2016] [Accepted: 02/15/2016] [Indexed: 12/31/2022] Open
Abstract
Urachal carcinoma is an uncommon cancer whose rarity has precluded its study and evidence-based management strategies are lacking. This study assessed all urachal carcinomas in Ireland and clinical parameters in order to improve understanding. Urachal carcinomas diagnosed from 1994 to 2011 were identified from the National Cancer Registry in Ireland. Data obtained included patient age, gender, diagnostic year, pathology, tumor stage, patient treatment strategies and survival. Twenty-six urachal carcinomas were identified, the majority being adenocarcinoma. This comprised 0.3% of all invasive bladder tumors. Patients were predominantly male (62%) and over 50 years of age (58%). Twenty-two patients (85%) underwent surgery, with only six (23%) undergoing chemotherapy. On average, median overall survival was 2.6 years (range 0-15.2 yrs). Survival was longer in women (5 vs. 1.9 yrs), patients under 50 years of age (3.6 vs. 1.9 yrs), those without confirmed metastasis (4.1 vs. 0.7 yrs) and those who received chemotherapy (3.6 vs. 2.6 yrs). The overall survival of urachal carcinoma in Ireland is less than expected from published literature. This study highlights the need for centralization of rare tumors with international collaboration to identify the optimal treatment strategy and improve outcome.
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Affiliation(s)
| | | | - Sandra Deady
- National Cancer Registry Ireland , Cork, Ireland
| | - Adrian P Brady
- Department of Radiology, Mercy University Hospital , Cork, Ireland
| | - Paul Sweeney
- Department of Uro-Oncological Surgery, Mercy University Hospital , Cork, Ireland
| | - Derek G Power
- Department of Medical Oncology, Cork University Hospital , Cork, Ireland
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Affiliation(s)
- Emily C Harrold
- Emily C. Harrold, Patrick J. Nicholson, David J. Tuite, and Derek G. Power, Cork University Hospital, Wilton, County Cork, Ireland
| | - Patrick J Nicholson
- Emily C. Harrold, Patrick J. Nicholson, David J. Tuite, and Derek G. Power, Cork University Hospital, Wilton, County Cork, Ireland
| | - David J Tuite
- Emily C. Harrold, Patrick J. Nicholson, David J. Tuite, and Derek G. Power, Cork University Hospital, Wilton, County Cork, Ireland
| | - Derek G Power
- Emily C. Harrold, Patrick J. Nicholson, David J. Tuite, and Derek G. Power, Cork University Hospital, Wilton, County Cork, Ireland
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Brady C, O'Connor K, Power DG. Androgen Deprivation Therapy and Risk of Alzheimer's Disease: Importance of Holistic Geriatric Oncology Assessment. J Clin Oncol 2016; 34:2803-4. [PMID: 27298422 DOI: 10.1200/jco.2016.67.8169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Derek G Power
- Cork University Hospital and Mercy University Hospital, Cork, Ireland
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31
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Gill KS, Fernandes P, O'Donovan TR, McKenna SL, Doddakula KK, Power DG, Soden DM, Forde PF. Glycolysis inhibition as a cancer treatment and its role in an anti-tumour immune response. Biochim Biophys Acta Rev Cancer 2016; 1866:87-105. [PMID: 27373814 DOI: 10.1016/j.bbcan.2016.06.005] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 06/29/2016] [Accepted: 06/30/2016] [Indexed: 12/23/2022]
Abstract
Increased glycolysis is the main source of energy supply in cancer cells that use this metabolic pathway for ATP generation. Altered energy metabolism is a biochemical fingerprint of cancer cells that represents one of the "hallmarks of cancer". The immune system can prevent tumour growth by eliminating cancer cells but this editing process ultimately results in poorly immunogenic cells remaining allowing for unchallenged tumour growth. In this review we look at the glycolysis pathway as a target for cancer treatments. We also examine the interplay between the glycolysis modulation and the immune response as an anti-cancer therapy.
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Affiliation(s)
- Kheshwant S Gill
- Cork Cancer Research Centre, Western Gateway Building, University College Cork, Cork, Ireland; Cardiothoracic Surgery Department, Cork University Hospital, Cork, Ireland
| | - Philana Fernandes
- Cork Cancer Research Centre, Western Gateway Building, University College Cork, Cork, Ireland
| | - Tracey R O'Donovan
- Cork Cancer Research Centre, Western Gateway Building, University College Cork, Cork, Ireland
| | - Sharon L McKenna
- Cork Cancer Research Centre, Western Gateway Building, University College Cork, Cork, Ireland
| | | | - Derek G Power
- Cork Cancer Research Centre, Western Gateway Building, University College Cork, Cork, Ireland; Department of Medical Oncology, Mercy University Hospital, Grenville Place, Cork, Ireland
| | - Declan M Soden
- Cork Cancer Research Centre, Western Gateway Building, University College Cork, Cork, Ireland
| | - Patrick F Forde
- Cork Cancer Research Centre, Western Gateway Building, University College Cork, Cork, Ireland.
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Cushen SJ, Power DG, Murphy KP, McDermott R, Griffin BT, Lim M, Daly L, MacEneaney P, O' Sullivan K, Prado CM, Ryan AM. Impact of body composition parameters on clinical outcomes in patients with metastatic castrate-resistant prostate cancer treated with docetaxel. Clin Nutr ESPEN 2016; 13:e39-e45. [DOI: 10.1016/j.clnesp.2016.04.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 03/30/2016] [Accepted: 04/01/2016] [Indexed: 01/06/2023]
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Murphy KP, Crush L, O’Neill SB, Foody J, Breen M, Brady A, Kelly PJ, Power DG, Sweeney P, Bye J, O’Connor OJ, Maher MM, O’Regan KN. Feasibility of low-dose CT with model-based iterative image reconstruction in follow-up of patients with testicular cancer. Eur J Radiol Open 2016; 3:38-45. [PMID: 27069978 PMCID: PMC4811850 DOI: 10.1016/j.ejro.2016.01.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 01/18/2016] [Accepted: 01/20/2016] [Indexed: 12/22/2022] Open
Abstract
PURPOSE We examine the performance of pure model-based iterative reconstruction with reduced-dose CT in follow-up of patients with early-stage testicular cancer. METHODS Sixteen patients (mean age 35.6 ± 7.4 years) with stage I or II testicular cancer underwent conventional dose (CD) and low-dose (LD) CT acquisition during CT surveillance. LD data was reconstructed with model-based iterative reconstruction (LD-MBIR). Datasets were objectively and subjectively analysed at 8 anatomical levels. Two blinded clinical reads were compared to gold-standard assessment for diagnostic accuracy. RESULTS Mean radiation dose reduction of 67.1% was recorded. Mean dose measurements for LD-MBIR were: thorax - 66 ± 11 mGy cm (DLP), 1.0 ± 0.2 mSv (ED), 2.0 ± 0.4 mGy (SSDE); abdominopelvic - 128 ± 38 mGy cm (DLP), 1.9 ± 0.6 mSv (ED), 3.0 ± 0.6 mGy (SSDE). Objective noise and signal-to-noise ratio values were comparable between the CD and LD-MBIR images. LD-MBIR images were superior (p < 0.001) with regard to subjective noise, streak artefact, 2-plane contrast resolution, 2-plane spatial resolution and diagnostic acceptability. All patients were correctly categorised as positive, indeterminate or negative for metastatic disease by 2 readers on LD-MBIR and CD datasets. CONCLUSIONS MBIR facilitated a 67% reduction in radiation dose whilst producing images that were comparable or superior to conventional dose studies without loss of diagnostic utility.
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Affiliation(s)
- Kevin P. Murphy
- Department of Radiology, Cork University Hospital, Cork, Ireland
- Department of Radiology, University College Cork, Cork, Ireland
- Department of Radiology, Mercy University Hospital, Cork, Ireland
| | - Lee Crush
- Department of Radiology, University College Cork, Cork, Ireland
- Department of Radiology, Mercy University Hospital, Cork, Ireland
| | - Siobhan B. O’Neill
- Department of Radiology, Cork University Hospital, Cork, Ireland
- Department of Radiology, Mercy University Hospital, Cork, Ireland
| | - James Foody
- Department of Electrical and Electronic Engineering, University College Cork, Cork, Ireland
| | - Micheál Breen
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Adrian Brady
- Department of Radiology, Mercy University Hospital, Cork, Ireland
| | - Paul J. Kelly
- Department of Radiation Oncology, Cork University Hospital, Cork, Ireland
| | - Derek G. Power
- Department of Medical Oncology, Cork and Mercy University Hospitals, Cork, Ireland
| | - Paul Sweeney
- Department of Urology, Mercy University Hospital, Cork, Ireland
| | - Jackie Bye
- General Electric Healthcare Technologies, Herdfordshire, UK
| | - Owen J. O’Connor
- Department of Radiology, Cork University Hospital, Cork, Ireland
- Department of Radiology, University College Cork, Cork, Ireland
- Department of Radiology, Mercy University Hospital, Cork, Ireland
| | - Michael M. Maher
- Department of Radiology, Cork University Hospital, Cork, Ireland
- Department of Radiology, University College Cork, Cork, Ireland
- Department of Radiology, Mercy University Hospital, Cork, Ireland
| | - Kevin N. O’Regan
- Department of Radiology, Cork University Hospital, Cork, Ireland
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van den Hurk K, Balint B, Toomey S, O'Leary PC, Unwin L, Sheahan K, McDermott EW, Murphy I, van den Oord JJ, Rafferty M, FitzGerald DM, Moran J, Cummins R, MacEneaney O, Kay EW, O'Brien CP, Finn SP, Heffron CCBB, Murphy M, Yela R, Power DG, Regan PJ, McDermott CM, O'Keeffe A, Orosz Z, Donnellan PP, Crown JP, Hennessy BT, Gallagher WM. High-throughput oncogene mutation profiling shows demographic differences in BRAF mutation rates among melanoma patients. Melanoma Res 2015; 25:189-99. [PMID: 25746038 DOI: 10.1097/cmr.0000000000000149] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Because of advances in targeted therapies, the clinical evaluation of cutaneous melanoma is increasingly based on a combination of traditional histopathology and molecular pathology. Therefore, it is necessary to expand our knowledge of the molecular events that accompany the development and progression of melanoma to optimize clinical management. The central objective of this study was to increase our knowledge of the mutational events that complement melanoma progression. High-throughput genotyping was adapted to query 159 known single nucleotide mutations in 33 cancer-related genes across two melanoma cohorts from Ireland (n=94) and Belgium (n=60). Results were correlated with various clinicopathological characteristics. A total of 23 mutations in 12 genes were identified, that is--BRAF, NRAS, MET, PHLPP2, PIK3R1, IDH1, KIT, STK11, CTNNB1, JAK2, ALK, and GNAS. Unexpectedly, we discovered significant differences in BRAF, MET, and PIK3R1 mutations between the cohorts. That is, cases from Ireland showed significantly lower (P<0.001) BRAF(V600E) mutation rates (19%) compared with the mutation frequency observed in Belgian patients (43%). Moreover, MET mutations were detected in 12% of Irish cases, whereas none of the Belgian patients harbored these mutations, and Irish patients significantly more often (P=0.027) had PIK3R1-mutant (33%) melanoma versus 17% of Belgian cases. The low incidence of BRAF(V600E)(-) mutant melanoma among Irish patients was confirmed in five independent Irish cohorts, and in total, only 165 of 689 (24%) Irish cases carried mutant BRAF(V600E). Together, our data show that melanoma-driving mutations vary by demographic area, which has important implications for the clinical management of this disease.
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Affiliation(s)
- Karin van den Hurk
- aOncoMark Ltd, NovaUCD bDepartment of Medical Oncology, Royal College of Surgeons cUCD School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin Departments of dPathology eSurgery fMedical Oncology, St Vincent's University Hospital gDepartment of Histopathology, Royal College of Surgeons in Ireland Education and Research Centre, Beaumont Hospital hDepartment of Histopathology, St James's Hospital iDepartment of Histopathology, Trinity College, Dublin jDepartment of Pathology, Cork University Hospital, Cork Departments of kSurgery lMedical Oncology, University Hospital Galway mDepartment of Medicine, National University of Ireland Galway nDepartment of Histopathology, University Hospital Galway, Galway, Ireland oDepartment of Pathology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands pLaboratory of Morphology and Molecular Pathology, Katholieke Universiteit Leuven, Leuven, Belgium
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Ryan AM, Cushen S, Schellekens H, Bhuachalla EN, Burns L, Kenny U, Power DG. Poor awareness of risk factors for cancer in Irish adults: results of a large survey and review of the literature. Oncologist 2015; 20:372-8. [PMID: 25746344 PMCID: PMC4391772 DOI: 10.1634/theoncologist.2014-0453] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [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: 11/20/2014] [Accepted: 01/15/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Knowledge of cancer risk factors is unknown in Ireland. An understanding of risk factors could help inform cancer prevention programs. AIMS AND METHODS A 48-question online survey was designed to gather data to assess levels of public knowledge about cancer risk factors. RESULTS There were 748 participants (648 women, 100 men). Mean age was 37 years (range: 18-74 years). For the public, 81% were concerned about developing cancer; however, 20% believed that cancer is unavoidable if a family history exists, 27% believed that >50% of cancers are inherited, and 54% believed that 10%-20% of cancers are inherited; 20% were unaware that risk increases with age. The top five risk factors listed by respondents were smoking (87%), diet (76%), genetics (47%), alcohol (42%), and obesity (33%). Only 32% of the public were aware that obesity is a risk factor, and 33% did not think the location of fat was important. Moreover, 29% and 48% believed that risk could be increased by wearing a tight bra and by a blow to the breast, respectively. In addition, 85% and 86% believed that stress and that mobile phones, respectively, "strongly" increase risk; 12% believed that luck is important in avoiding cancer; 35% thought that "detox" diets could reduce risk; and 61% believed that organic food reduces risk. The majority were aware that physical activity of 30 minutes per day can reduce risk. CONCLUSION A sizable portion of the population is misinformed about cancer risk. Most participants were aware of classic risk factors (e.g., smoking, diet); however, many overestimated risk attributable to genetics, environment, and stress and underestimated age, obesity, and sunlight. One in seven participants believed that lifetime risk of cancer is not modifiable.
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Affiliation(s)
| | | | - Harriët Schellekens
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | | | - Lisa Burns
- School of Food and Nutritional Sciences and
| | | | - Derek G Power
- Department of Medical Oncology, Mercy University Hospital, Cork, Ireland
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Sullivan CJ, Murphy KP, McLaughlin PD, Twomey M, O'Regan KN, Power DG, Maher MM, O'Connor OJ. Radiation exposure from diagnostic imaging in young patients with testicular cancer. Eur Radiol 2014; 25:1005-13. [PMID: 25500962 DOI: 10.1007/s00330-014-3507-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 10/30/2014] [Accepted: 11/13/2014] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Risks associated with high cumulative effective dose (CED) from radiation are greater when imaging is performed on younger patients. Testicular cancer affects young patients and has a good prognosis. Regular imaging is standard for follow-up. This study quantifies CED from diagnostic imaging in these patients. METHODS Radiological imaging of patients aged 18-39 years, diagnosed with testicular cancer between 2001 and 2011 in two tertiary care centres was examined. Age at diagnosis, cancer type, dose-length product (DLP), imaging type, and frequency were recorded. CED was calculated from DLP using conversion factors. Statistical analysis was performed with SPSS. RESULTS In total, 120 patients with a mean age of 30.7 ± 5.2 years at diagnosis had 1,410 radiological investigations. Median (IQR) surveillance was 4.37 years (2.0-5.5). Median (IQR) CED was 125.1 mSv (81.3-177.5). Computed tomography accounted for 65.3 % of imaging studies and 98.3 % of CED. We found that 77.5 % (93/120) of patients received high CED (>75 mSv). Surveillance time was associated with high CED (OR 2.1, CI 1.5-2.8). CONCLUSIONS Survivors of testicular cancer frequently receive high CED from diagnostic imaging, mainly CT. Dose management software for accurate real-time monitoring of CED and low-dose CT protocols with maintained image quality should be used by specialist centres for surveillance imaging. KEY POINTS • CT accounted for 98.3 % of CED in patients with testicular cancer. • Median CED in patients with testicular cancer was 125.1 mSv • High CED (>75 mSv) was observed in 77.5 % (93/120) of patients. • Dose tracking and development of low-dose CT protocols are recommended.
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Affiliation(s)
- C J Sullivan
- Department of Radiology, Cork and Mercy University Hospitals, Wilton, Cork, Ireland
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O'Brien MA, Power DG, Clover AJP, Bird B, Soden DM, Forde PF. Local tumour ablative therapies: Opportunities for maximising immune engagement and activation. Biochim Biophys Acta Rev Cancer 2014; 1846:510-23. [DOI: 10.1016/j.bbcan.2014.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 09/05/2014] [Accepted: 09/20/2014] [Indexed: 12/12/2022]
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Kelly CM, El Bassiouni M, Bennett MW, Crush L, McEneaney P, O'Suilleabhain C, Power DG. Borderline resectable pancreatic adenocarcinoma, is conversion therapy realistic? Acta Oncol 2014; 53:1268-71. [PMID: 24739060 DOI: 10.3109/0284186x.2014.887856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Ciara M Kelly
- Department of Medical Oncology, Mercy University Hospital , Cork , Ireland
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Abstract
The introduction of targeted therapy has ushered in the era of personalized medicine in cancer therapy. The increased understanding of tumor heterogeneity has led to the determination of specific targets that can be exploited in treatment. This review highlights approved drugs in different therapeutic classes, including tyrosine kinase inhibitors, mammalian target of rapamycin inhibitors, drugs targeted to the human epidermal growth factor receptor 2, BRAF-mutation targeted drugs, anti-epidermal growth factor receptor inhibitors, and anti-vascular endothelial growth factor therapy. There have not been elderly patient-specific trials of these therapies. Most of the data are extrapolated from larger trials in which older patients generally were a fraction of the participants. Therapeutic recommendations are made on the basis of this analysis with the recognition that the older clinical trial participants may not be representative of patients seen in daily practice. Patient selection and geriatric evaluation are critical for appropriate drug selection, dosing, and monitoring. With care, these therapies are a major step forward in the safe and effective treatment of older patients with cancer.
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Affiliation(s)
- Ciara M Kelly
- Ciara M. Kelly and Derek G. Power, Mercy University Hospital, Cork, Ireland; and Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, Commack, NY
| | - Derek G Power
- Ciara M. Kelly and Derek G. Power, Mercy University Hospital, Cork, Ireland; and Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, Commack, NY
| | - Stuart M Lichtman
- Ciara M. Kelly and Derek G. Power, Mercy University Hospital, Cork, Ireland; and Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, Commack, NY.
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O'Reilly A, Ryan S, MacEneaney P, O'Reilly SP, Cronin S, Power DG. Lhermitte's phenomenon and platinum, beware of latency. Oncol Res Treat 2014; 37:591-4. [PMID: 25342510 DOI: 10.1159/000365539] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 05/25/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Lhermitte's sign (LS) is characterized by electric shock-like sensations, spreading along the spine in a cervico-caudal direction and into the arms and legs. It is felt upon flexion of the neck and reflects a myelopathy resulting from damage to sensory axons at the dorsal columns of the cervical spinal cord. In patients with cancer, LS can occur due to direct tumour involvement of the spine or in relation to radiotherapy. Chemotherapy-related LS has only rarely been reported. CASE REPORT We present the case of a 44-year-old patient treated with platinum- and etoposide-based chemotherapy for metastatic seminoma, who subsequently developed severe disabling LS. The severity and duration of LS in this case exceeds prior reports. We review the literature on chemotherapy-related LS and discuss the practice implications. CONCLUSION Neuropathy and LS related to cisplatin-based chemotherapy can result in significant adverse effects. Raised awareness of this complication could aid sub-phenotyping of the population most at risk and assist strategies to avert discomfort and disability post chemotherapy.
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Affiliation(s)
- Aine O'Reilly
- Department of Medical Oncology, Mercy University Hospital, Cork, Ireland
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Graham DM, O'Connor KM, Hinchion J, Coate LE, Burke L, Power DG. Mucoepidermoid carcinoma of lung masquerading as urothelial carcinoma of bladder. Rep Pract Oncol Radiother 2014; 19:62-4. [PMID: 24936321 DOI: 10.1016/j.rpor.2013.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 05/21/2013] [Accepted: 07/08/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Mucoepidermoid carcinoma (MEC) of the lung is a rare subtype of non-small cell lung cancer. There is no consensus regarding optimal management for this disease. CASE REPORT We present a case of MEC of the lung in a 75 year-old female with a history of superficial urothelial carcinoma of the bladder. The patient was found to have an asymptomatic lung mass. Initial biopsy suggested metastatic recurrence of urothelial carcinoma and therefore, cisplatin and gemcitabine chemotherapy was administered prior to surgical resection. Pathological analysis of the resected specimen confirmed a diagnosis of stage IIIA MEC with focal high-grade features including transitional cell-like areas. Adjuvant radiotherapy was administered due to a positive microscopic resection margin. No chemotherapy was given due to lack of supporting data. The patient developed widespread metastatic disease 3 months following completion of radiotherapy and died 1 month later. CONCLUSION This case demonstrates the possibility of dual pathology in cases where metastatic disease is suspected. The use of small tissue samples may complicate diagnosis due to the heterogeneity of malignant tumours.
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Affiliation(s)
- Donna M Graham
- Department of Medical Oncology, Mercy University Hospital, Cork, Ireland
| | - Kate M O'Connor
- Department of Pathology, Cork University Hospital, Cork, Ireland
| | - John Hinchion
- Department of Cardiothoracic Surgery, Cork University Hospital, Cork, Ireland
| | - Linda E Coate
- Department of Medical Oncology, Mid-Western Regional Hospital, Dooradoyle, Limerick, Ireland
| | - Louise Burke
- Department of Pathology, Cork University Hospital, Cork, Ireland
| | - Derek G Power
- Department of Medical Oncology, Mercy University Hospital, Cork, Ireland
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Keegan N, Keane F, Cuffe S, Cunningham M, Ravi N, Lee G, Kennedy MJ, Grogan W, O'Neill B, Power DG, Leonard G, Keane MM, Small C, Parker I, Moulton B, O'Reilly S, Reynolds JV. ICORG 10-14: Neo-AEGIS: A randomized clinical trial of neoadjuvant and adjuvant chemotherapy (modified MAGIC regimen) versus neoadjuvant chemoradiation (CROSS protocol) in adenocarcinoma of the esophagus and esophagogastric junction. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.tps4145] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Fionnuala Keane
- ICORG All Ireland Cooperative Oncology Research Group, Dublin, Ireland
| | - Sinead Cuffe
- St. James's Hospital, Trinity College Dublin, Dublin, Ireland
| | | | | | | | - M. John Kennedy
- St. James's Hospital, Trinity College Dublin, Dublin, Ireland
| | | | - Brian O'Neill
- St. Luke’s Radiation Oncology Network, Dublin, Ireland
| | | | | | - Maccon M. Keane
- Department of Medical Oncology, University College Hospital Galway, Galway, Ireland
| | - Cormac Small
- Department of Radiation Oncology, University College Hospital Galway, Galway, Ireland
| | - Imelda Parker
- ICORG All Ireland Cooperative Oncology Research Group, Dublin, Ireland
| | - Brian Moulton
- ICORG All Ireland Cooperative Oncology Research Group, Dublin, Ireland
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Murphy KP, Kennedy MP, Barry JE, O'Regan KN, Power DG. New-Onset Mediastinal and Central Nervous System Sarcoidosis in a Patient with Metastatic Melanoma Undergoing CTLA4 Monoclonal Antibody Treatment. Oncol Res Treat 2014; 37:351-3. [DOI: 10.1159/000362614] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 12/11/2013] [Indexed: 11/19/2022]
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Ryan SA, Lowney AC, Murphy M, Kelly PJ, Power DG. Prophylactic cranial irradiation: 5 years on. BMJ Support Palliat Care 2014; 4:84-6. [PMID: 24644777 DOI: 10.1136/bmjspcare-2012-000356] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
With advances in cancer management, patients are living with the long-term sequelae of both cancer and its treatment. This era of cancer survivorship poses unique challenges to the interdisciplinary cancer team in terms of management and prevention of treatment-related toxicities. This paper describes the case of a 55-year-old patient with neurocognitive disturbance as a result of prophylactic cranial irradiation (PCI). Five years after a diagnosis of small cell lung cancer, she is now an inpatient at a specialist palliative care unit. The current evidence for PCI and for potentially modifiable risk factors for neurocognitive disturbance as a consequence of PCI is explored.
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Affiliation(s)
- Stephen A Ryan
- Deparment of Neurology, Mercy University Hospital, Cork, Ireland
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Graham DM, Plant WD, Mayer NJ, Power DG. Metastatic germ cell tumour following renal transplantation. ACTA ACUST UNITED AC 2013; 36:760-2. [PMID: 24356568 DOI: 10.1159/000356837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Treatment of germ cell tumours with cisplatin-based chemotherapy results in cure for the majority of patients. There is, however, a small but significant mortality rate, reported to be higher in patients with multiple co-morbidities. CASE REPORT We report our management of a renal transplant patient with spina bifida, who was diagnosed with stage IIIC, poor-risk, non-seminomatous germ cell carcinoma. A marker-negative partial response, which has been maintained more than 2 years following completion of treatment, was seen following chemotherapy with cisplatin and etoposide. Performance status has been preserved at pre-treatment levels. CONCLUSION Administration of cisplatin-based chemotherapy is feasible for treatment of renal transplant patients with advanced non-seminomatous germ cell tumours. Treatment strategies require careful planning and monitoring. Dose modifications may be required. This case highlights a favourable outcome in spite of multiple obstacles to ideal management.
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Affiliation(s)
- Donna M Graham
- Department of Medical Oncology, Cork University Hospital, Ireland
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47
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Bambury RM, Battley JE, McCarthy A, Brady C, O'Reilly S, Kelly PJ, O'Brien F, Sweeney P, Fleming S, Mayer NJ, Power DG. Translocation Renal Cell Carcinomas: An Evolving Entity and a Member of the Microphthalmia Transcription Factor-Associated Family of Tumors. Clin Genitourin Cancer 2013; 11:357-61. [DOI: 10.1016/j.clgc.2012.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 11/27/2012] [Accepted: 12/08/2012] [Indexed: 11/26/2022]
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48
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Teo M, Crotty GF, O'Súilleabháin C, Ridgway PF, Conlon KC, Power DG, McDermott RS. Identification of distinct phenotypes of locally advanced pancreatic adenocarcinoma. J Gastrointest Cancer 2013; 44:73-8. [PMID: 22829058 DOI: 10.1007/s12029-012-9419-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND A significant number of pancreatic ductal adenocarcinoma present as locally advanced disease. Optimal treatment remains controversial. We sought to analyze the clinical course of locally advanced pancreatic adenocarcinoma (LAPC) in order to identify potential distinct clinical phenotypes. METHODS Patients (pts) diagnosed with LAPC who survived >2 months were identified from institutional databases. Clinical details were collected. Sequential re-staging scans were reviewed. Progression-free survival (PFS), time from progression to death (TTD), and overall survival (OS) were estimated with Kaplan-Meier method and compared with log-rank test. RESULTS Between 2005 and 2011, 40 pts were identified. Median age was 66 yrs (range, 43-74) and 60 % (n=24) were male. All pts received chemotherapy. Median OS was 11.3 months. Twenty patients (50 %) had local progression only (LP) and 16 (40 %) had metastatic progression (MP) at first documentation of progression, while four patients (10 %) had stable disease. PFS was 4.0 vs 5.6 months (hazard ratio (HR) 0.97; 95 % CI 0.49-1.93, p=0.94) for LP and MP, respectively. Three of the patients with LP (15 %) eventually developed metastatic disease after a median of 4.2 months (3.7-9.6). For MP patients, five had concurrent local progression. Sites of disease were lung (eight), peritoneum (five), liver (three), and bone (one). TTD for LP and MP was 5.6 vs 1.4 months (HR 0.62; 95 % CI 0.28-1.39, p=0.24) and OS was 13.2 vs 8.0 months (HR 0.59; 95 % CI 0.28-1.25, p=0.017), respectively. CONCLUSIONS We identified two subgroups of LAPC with distinctive behavior, one local dominant progression with low predilection for metastases and another with rapid metastatic development and worse survival. Early recognition of these phenotypes might allow a more tailored treatment approach to improve outcome.
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Affiliation(s)
- Minyuen Teo
- Department of Medical Oncology, Adelaide & Meath Hospital incorporating National Children's Hospital, Tallaght, Dublin, Ireland.
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49
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Bambury RM, Teo MY, Power DG, Yusuf A, Murray S, Battley JE, Drake C, O'Dea P, Bermingham N, Keohane C, Grossman SA, Moylan EJ, O'Reilly S. The association of pre-treatment neutrophil to lymphocyte ratio with overall survival in patients with glioblastoma multiforme. J Neurooncol 2013; 114:149-54. [PMID: 23780645 DOI: 10.1007/s11060-013-1164-9] [Citation(s) in RCA: 153] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 05/26/2013] [Indexed: 12/28/2022]
Abstract
Neutrophil-lymphocyte ratio (NLR) is a marker of systemic inflammatory response and its elevation has recently been shown to be a poor prognostic factor in many malignancies including colon, prostate and bladder cancer. The primary aim of this study was to assess the prognostic impact of NLR in a clinically annotated cohort of patients with glioblastoma multiforme (GBM). We hypothesised that elevated NLR would be associated with worse prognosis. Between 2004 and 2009, 137 patients had surgery for GBM and were assessed for consideration of adjuvant therapy at our institution. Of these, 84 patients with an evaluable pre-corticosteroid full blood count result were identified and included in the final analysis. Median overall survival was 9.3 months (range 0.7-82.1). On univariate analysis, age >65 years, gender, ECOG performance status ≥2, frontal tumour, extent of surgical resection, completion of adjuvant chemoradiation protocol and NLR > 4 were significantly correlated with overall survival. Patients with NLR > 4, had a worse median overall survival at 7.5 months versus 11.2 months in patients with NLR ≤ 4 (hazard ratio 1.6, 95 % CI 1.00-2.52, p = 0.048). On multivariate analysis NLR > 4 remained an independent prognostic indicator for poor outcome. These data are an important reminder of the potential relevance of host immunity in GBM. In our cohort, NLR > 4 conferred a worse prognosis independent of other well established prognostic factors. If validated in other cohorts NLR may prove to be a useful addition in predicting prognosis in GBM patients. The demonstration that host immunity plays a role in GBM biology suggests that investigation of emerging therapies which modulate host immune response are warranted in this disease.
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Affiliation(s)
- R M Bambury
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland.
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Ullah K, O'Reilly A, Power DG, O'Connor TM. A case series of patients on chemotherapy with dyspnoea and pulmonary infiltrates. BMJ Case Rep 2013; 2013:bcr-2013-009105. [PMID: 23744855 DOI: 10.1136/bcr-2013-009105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Clinicians often assume that patients who develop pulmonary symptoms and radiographic infiltrates while receiving cytotoxic chemotherapy have opportunistic pulmonary infection or chemotherapy-related interstitial lung disease. We describe two cases of rare complications of commonly used chemotherapeutic agents (gemcitabine-induced eosinophilic pneumonia and rituximab-induced hypersensitivity pneumonitis) that vindicate this assumption but a third case of scleroderma-associated interstitial lung disease that became clinically manifest in a patient who was receiving chemotherapy. The latter case highlights the need for vigilance for other causes of interstitial lung disease in patients receiving chemotherapy.
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Affiliation(s)
- Khalil Ullah
- Department of Respiratory Medicine, Mercy University Hospital, Cork, Ireland
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