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Harmer V, Harbeck N, Boyle F, Werutsky G, Ammendolea C, El Mouzain D, Marshall D, Thomas C, Heidenreich S, Lu H, Dionne PA, Gao M, Aubel D, Pathak P, Ryan M. P263 Patients’ perspectives on treatments for HR+/HER2– early breast cancer: developing a quantitative patient preference survey. Breast 2023. [DOI: 10.1016/s0960-9776(23)00381-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
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Murray N, Francis P, Zdenkowski N, Wilcken N, Boyle F, Gebski V, Tiley S, Gilham L, Dawson SJ, Loi S, Redfern A, Lombard J, Spillane A, Shadbolt C, Badger H. 91MO Randomized trial of neoadjuvant chemotherapy with or without concurrent aromatase inhibitor therapy to downstage ER+ve breast cancer: Breast Cancer Trials Group ANZ 1401 ELIMINATE trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Toi M, Boyle F, Im YH, Reinisch M, Molthrop D, Jiang Z, Wei R, Sapunar F, Grimes B, Nabinger S, Johnston S. 59MO Adjuvant abemaciclib combined with endocrine therapy (ET): Efficacy results in monarchE cohort 1. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Rugo HS, O'Shaughnessy J, Boyle F, Toi M, Broom R, Blancas I, Gumus M, Yamashita T, Im YH, Rastogi P, Zagouri F, Song C, Campone M, San Antonio B, Shahir A, Hulstijn M, Brown J, Zimmermann A, Wei R, Johnston S, Reinisch M, Tolaney SM. Adjuvant Abemaciclib Combined with Endocrine Therapy for High Risk Early Breast Cancer: Safety and Patient-Reported Outcomes From the monarchE Study. Ann Oncol 2022; 33:616-627. [PMID: 35337972 DOI: 10.1016/j.annonc.2022.03.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [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: 01/18/2022] [Revised: 03/07/2022] [Accepted: 03/11/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In monarchE, abemaciclib plus endocrine therapy (ET) as adjuvant treatment of hormone receptor-positive, human epidermal growth factor 2-negative, high risk, early breast cancer demonstrated a clinically meaningful improvement in invasive disease-free survival versus ET alone. Detailed safety analyses conducted at a median follow-up of 27 months and key patient-reported outcomes (PRO) are presented. PATIENTS AND METHODS The safety population included all patients who received at least one dose of study treatment (n=5591). Safety analyses included incidence, management, and outcomes of common and clinically relevant adverse events (AEs). Patient-reported health-related quality-of-life, ET symptoms, fatigue, and side effect burden were assessed. RESULTS The addition of abemaciclib to ET resulted in higher incidence of Grade≥3 AEs (49.7% vs 16.3% with ET alone), predominantly laboratory cytopenias (e.g., neutropenia [19.6%]) without clinical complications. Abemaciclib-treated patients experienced more serious adverse events (SAEs; 13.3% vs 7.8%). Discontinuation of abemaciclib and/or ET due to AEs occurred in 18.5% of patients, mainly due to Grade1/2 AEs (66.8%). AEs were managed with comedications (e.g., antidiarrheals), abemaciclib dose holds (61.7%), and/or dose reductions (43.4%). Diarrhea was generally low grade (Grade1/2: 77%); Grade2/3 events were highest in the first month (20.5%), most short-lived (≤7 days) and did not recur. Venous thromboembolic events (VTE) were higher with abemaciclib+ET (2.5%) vs ET (0.6%); in the abemaciclib arm, increased VTE risk was observed with tamoxifen vs AIs (4.3% vs 1.8%). PROs were similar between arms, including being 'bothered by side effects of treatment', except for diarrhea. At ≥3 months, most patients reporting diarrhea reported "a little bit" or "somewhat". CONCLUSION In patients with high risk EBC, adjuvant abemaciclib+ET has an acceptable safety profile and tolerability is supported by PRO findings. Most AEs were reversible and manageable with comedications and/or dose modifications, consistent with the known abemaciclib toxicity profile.
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Affiliation(s)
- H S Rugo
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, USA.
| | - J O'Shaughnessy
- Baylor University Medical Center, Texas Oncology, US Oncology, Dallas TX, USA
| | - F Boyle
- Patricia Ritchie Centre for Cancer Care and Research, Mater Hospital, Sydney; University of Sydney, Sydney, Australia
| | - M Toi
- Kyoto University Hospital, Kyoto, Japan
| | - R Broom
- Auckland City Hospital, Auckland, New Zealand
| | - I Blancas
- Hospital Universitario Clínico San Cecilio, Granada, Spain; Medicine Department. University of Granada, Spain
| | - M Gumus
- Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | | | - Y-H Im
- Division of Hematology/Medical Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - P Rastogi
- University of Pittsburgh/UPMC, NSABP Foundation, Pittsburgh, USA
| | - F Zagouri
- National and Kapodistrian University of Athens, Department of Clinical Therapeutics, School of Medicine, Athens, Greece
| | - C Song
- Fujian Medical University Union Hospital, Fujian, China
| | - M Campone
- Institut de Cancérologie de l'Ouest, Centre René Gauducheau, Nantes / Saint-Herblain, France
| | | | - A Shahir
- Eli Lilly and Company, Indianapolis, USA
| | - M Hulstijn
- Eli Lilly and Company, Indianapolis, USA
| | - J Brown
- Eli Lilly and Company, Indianapolis, USA
| | | | - Ran Wei
- Eli Lilly and Company, Indianapolis, USA
| | - S Johnston
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - M Reinisch
- Breast Unit, Kliniken Essen-Mitte, Essen, Germany
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Cameron B, Webber K, Li H, Bennett B, Boyle F, de Souza P, Wilcken N, Lynch J, Friedlander M, Goldstein D, Lloyd A. Genetic associations of fatigue and other symptoms following breast cancer treatment: A prospective study. Brain Behav Immun Health 2021; 10:100189. [PMID: 34589724 PMCID: PMC8474532 DOI: 10.1016/j.bbih.2020.100189] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/04/2020] [Accepted: 12/06/2020] [Indexed: 12/30/2022] Open
Abstract
Background Cancer-related fatigue, mood disturbances, pain and cognitive disturbance are common after adjuvant cancer therapy, but vary considerably between individuals despite common disease features and treatment exposures. A genetic basis for this variability was explored in a prospective cohort. Methods Physical and psychological health of women were assessed prospectively following therapy for early stage breast cancer with self-report questionnaires. Participation in a genetic association sub-study was offered. Indices for the key symptom domains of fatigue, pain, depression, anxiety, and neurocognitive difficulties were empirically derived by principal components analysis from end-treatment questionnaires, and then applied longitudinally. Genetic associations were sought with functional single nucleotide polymorphisms (SNPs) in pro- and anti-inflammatory cytokine genes - tumour necrosis factor (TNF)-α (−308 GG), interferon (IFN)-ɣ (+874 TA), interleukin (IL)-10 (1082 GA and −592 CA), IL-6 (−174 GC), IL-1β (−511 GA). Results Questionnaire data was available for 210 participants, of whom 111 participated in the genetic sub-study. As expected, symptom domain scores generally improved over several months following treatment completion. Tumour and adjuvant treatment related factors were unassociated with either severity or duration of the individual symptom domains, but severity of symptoms at end-treatment was strongly associated with duration for each domain (all p < 0.05). In multivariable analyses, risk genotypes were independently associated with: fatigue with IL-6 -174 GG/GC and IL-10 -1082 GG; depression and anxiety with IL-10 -1082 AA; neurocognitive disturbance: TNF-α −308 GG; depression IL-1β (all p < 0.05). The identified SNPs also had cumulative effects in prolonging the time to recovery from the associated symptom domain. Conclusions Genetic factors contribute to the severity and duration of common symptom domains after cancer therapy. Common symptoms following breast cancer treatment can be grouped into symptom domains. Symptom domains are useful to describe patterns and trajectories of symptoms following breast cancer treatment. Cytokine gene polymorphisms are associated with the severity and duration of symptom domains following cancer treatment. The symptom severity at final treatment predicts the duration of symptoms.
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Affiliation(s)
- B. Cameron
- The Kirby Institute, UNSW, Sydney, Australia
- Corresponding author. The Kirby Institute, University of New South Wales, Sydney, Australia.
| | - K. Webber
- Prince of Wales Hospital Clinical School, Sydney, Australia
| | - H. Li
- The Kirby Institute, UNSW, Sydney, Australia
| | - B.K. Bennett
- Prince of Wales Hospital Clinical School, Sydney, Australia
| | - F. Boyle
- Patricia Ritchie Cancer Care Centre, Mater Hospital, Sydney, Australia
| | - P. de Souza
- Southside Cancer Care Centre, St George Hospital, Sydney, Australia
| | - N. Wilcken
- Westmead Hospital Cancer Care Centre, Sydney, Australia
| | - J. Lynch
- St George Hospital, Sydney, Australia
| | - M. Friedlander
- Prince of Wales Hospital Cancer Centre, Sydney, Australia
| | - D. Goldstein
- The Kirby Institute, UNSW, Sydney, Australia
- Prince of Wales Hospital Clinical School, Sydney, Australia
| | - A.R. Lloyd
- The Kirby Institute, UNSW, Sydney, Australia
- Prince of Wales Hospital Clinical School, Sydney, Australia
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Cardoso F, Paluch-Shimon S, Senkus E, Curigliano G, Aapro MS, André F, Barrios CH, Bergh J, Bhattacharyya GS, Biganzoli L, Boyle F, Cardoso MJ, Carey LA, Cortés J, El Saghir NS, Elzayat M, Eniu A, Fallowfield L, Francis PA, Gelmon K, Gligorov J, Haidinger R, Harbeck N, Hu X, Kaufman B, Kaur R, Kiely BE, Kim SB, Lin NU, Mertz SA, Neciosup S, Offersen BV, Ohno S, Pagani O, Prat A, Penault-Llorca F, Rugo HS, Sledge GW, Thomssen C, Vorobiof DA, Wiseman T, Xu B, Norton L, Costa A, Winer EP. 5th ESO-ESMO international consensus guidelines for advanced breast cancer (ABC 5). Ann Oncol 2020; 31:1623-1649. [PMID: 32979513 PMCID: PMC7510449 DOI: 10.1016/j.annonc.2020.09.010] [Citation(s) in RCA: 654] [Impact Index Per Article: 163.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 01/09/2023] Open
Affiliation(s)
- F Cardoso
- Breast Unit, Champalimaud Clinical Centre/Champalimaud Foundation, Lisbon, Portugal.
| | - S Paluch-Shimon
- Sharett Division of Oncology, Hadassah University Hospital, Jerusalem, Israel
| | - E Senkus
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
| | - G Curigliano
- Department of Oncology and Hemato-Oncology, European Institute of Oncology, IRCCS, Division of Early Drug Development, University of Milan, Milan, Italy
| | - M S Aapro
- Breast Center, Clinique de Genolier, Genolier, Switzerland
| | - F André
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France
| | - C H Barrios
- Latin American Cooperative Oncology Group (LACOG), Grupo Oncoclínicas, Porto Alegre, Brazil
| | - J Bergh
- Department of Oncology-Pathology, Karolinska Institute & University Hospital, Stockholm, Sweden
| | - G S Bhattacharyya
- Department of Medical Oncology, Salt Lake City Medical Centre, Kolkata, India
| | - L Biganzoli
- Department of Medical Oncology, Nuovo Ospedale di Prato - Istituto Toscano Tumori, Prato, Italy
| | - F Boyle
- The Pam McLean Centre, Royal North Shore Hospital, St Leonards, Australia
| | - M-J Cardoso
- Breast Unit, Champalimaud Clinical Centre/Champalimaud Foundation, Lisbon, Portugal; Nova Medical School, Lisbon, Portugal
| | - L A Carey
- Department of Hematology and Oncology, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, USA
| | - J Cortés
- IOB Institute of Oncology, Quiron Group, Madrid & Barcelona, Spain; Department of Oncology, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - N S El Saghir
- Division of Hematology Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - M Elzayat
- Europa Donna, The European Breast Cancer Coalition, Milan, Italy
| | - A Eniu
- Interdisciplinary Oncology Service (SIC), Riviera-Chablais Hospital, Rennaz, Switzerland
| | - L Fallowfield
- SHORE-C, Brighton & Sussex Medical School, University of Sussex, Brighton, UK
| | - P A Francis
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - K Gelmon
- Medical Oncology Department, BC Cancer Agency, Vancouver, Canada
| | - J Gligorov
- Breast Cancer Expert Center, University Cancer Institute APHP, Sorbonne University, Paris, France
| | - R Haidinger
- Brustkrebs Deutschland e.V., Munich, Germany
| | - N Harbeck
- Breast Centre, Department of Obstetrics and Gynaecology, University of Munich (LMU), Munich, Germany
| | - X Hu
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - B Kaufman
- Department of Oncology, Sheba Medical Center, Ramat Gan, Israel
| | - R Kaur
- Breast Cancer Welfare Association Malaysia, Petaling Jaya, Malaysia
| | - B E Kiely
- NHMRC Clinical Trials Centre, Sydney Medical School, Sydney, Australia
| | - S-B Kim
- Department of Oncology, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, South Korea
| | - N U Lin
- Susan Smith Center for Women's Cancers - Breast Oncology Center, Dana-Farber Cancer Institute, Boston, USA
| | - S A Mertz
- Metastatic Breast Cancer Network, Inverness, USA
| | - S Neciosup
- Department of Medical Oncology, National Institute of Neoplastic Diseases, Lima, Peru
| | - B V Offersen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - S Ohno
- Breast Oncology Centre, Cancer Institute Hospital, Tokyo, Japan
| | - O Pagani
- Medical School, Geneva University Hospital, Geneva, Switzerland
| | - A Prat
- Department of Medical Oncology, Hospital Clinic of Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Barcelona; Department of Medicine, University of Barcelona, Barcelona
| | - F Penault-Llorca
- Department of Biopathology, Centre Jean Perrin, Clermont-Ferrand, France; University Clermont Auvergne/INSERM U1240, Clermont-Ferrand, France
| | - H S Rugo
- Breast Oncology Clinical Trials Education, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, USA
| | - G W Sledge
- Division of Oncology, Stanford School of Medicine, Stanford, USA
| | - C Thomssen
- Department of Gynaecology, Martin Luther University Halle-Wittenburg, Halle, Germany
| | - D A Vorobiof
- Oncology Research Unit, Belong.Life, Tel Aviv, Israel
| | - T Wiseman
- Department of Applied Health Research in Cancer Care, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - B Xu
- Department of Medical Oncology, Cancer Hospital Chinese Academy of Medical Sciences, Beijing, China
| | - L Norton
- Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - A Costa
- European School of Oncology, Milan, Italy; European School of Oncology, Bellinzona, Switzerland
| | - E P Winer
- Susan Smith Center for Women's Cancers - Breast Oncology Center, Dana-Farber Cancer Institute, Boston, USA
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Johnston S, Harbeck N, Hegg R, Toi M, Martin M, Shao Z, Campone M, Hamilton E, Sohn J, Guarneri V, Cortes J, Neven P, Boyle F, Smith I, Frenzel M, Headley D, Wei R, Cox J, O'Shaughnessy J, Rastogi P. 2MO Abemaciclib in high risk early breast cancer. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.023] [Citation(s) in RCA: 1] [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] [Indexed: 11/28/2022] Open
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Johnston S, Harbeck N, Hegg R, Toi M, Martin M, Shao Z, Campone M, Hamilton E, Sohn J, Guarneri V, Cortés J, Neven P, Boyle F, Smith I, Headley D, Wei R, Frenzel M, Cox J, O'Shaughnessy J, Rastogi P. LBA5_PR Abemaciclib in high risk early breast cancer. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2238] [Citation(s) in RCA: 1] [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] [Indexed: 11/24/2022] Open
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Pal A, Stapleton S, Lai-Kwon J, Simoes N, Minchom A, Banerji U, de Bono J, Karikios D, Boyle F, Lopez J. 1886P Quantifying quality of informed consent (IC) in patients enrolled in phase I (ph I) oncology clinical trials with a validated instrument (QuIC Parts A, B) in a large United Kingdom phase I trials unit. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1533] [Citation(s) in RCA: 1] [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] [Indexed: 11/29/2022] Open
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Mueller V, Paplomata E, Hamilton E, Zelnak A, Fehrenbacher L, Jakobsen E, Curtit E, Boyle F, Brix E, Brenner A, Ferrario C, Munoz-Mateu M, Arkenau T, Gelmon K, Cameron D, Curigliano G, DeBusk K, Ramos J, An X, Wardley A. 275O Impact of tucatinib on health-related quality of life (HRQoL) in patients with HER2+ metastatic breast cancer (MBC) with and without brain metastases (BM). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Flenady V, Weller M, Boyle F, Middleton P. Consistent evidenced based information for women about fetal movements is important. Women Birth 2020; 33:e576. [PMID: 32139184 DOI: 10.1016/j.wombi.2020.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 02/01/2020] [Indexed: 11/29/2022]
Affiliation(s)
- V Flenady
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia.
| | - M Weller
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia
| | - F Boyle
- Institute for Social Science Research, The University of Queensland, Brisbane, Australia
| | - P Middleton
- Women and Kids, South Australian Health and Medical Research Institute, Adelaide, Australia
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12
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Pinto A, Adams S, Ahring K, Allen H, Almeida MF, Garcia-Arenas D, Arslan N, Assoun M, Atik Altınok Y, Barrio-Carreras D, Belanger Quintana A, Bernabei SM, Bontemps C, Boyle F, Bruni G, Bueno-Delgado M, Caine G, Carvalho R, Chrobot A, Chyż K, Cochrane B, Correia C, Corthouts K, Daly A, De Leo S, Desloovere A, De Meyer A, De Theux A, Didycz B, Dijsselhof ME, Dokoupil K, Drabik J, Dunlop C, Eberle-Pelloth W, Eftring K, Ekengren J, Errekalde I, Evans S, Foucart A, Fokkema L, François L, French M, Forssell E, Gingell C, Gonçalves C, Gökmen Özel H, Grimsley A, Gugelmo G, Gyüre E, Heller C, Hensler R, Jardim I, Joost C, Jörg-Streller M, Jouault C, Jung A, Kanthe M, Koç N, Kok IL, Kozanoğlu T, Kumru B, Lang F, Lang K, Liegeois I, Liguori A, Lilje R, Ļubina O, Manta-Vogli P, Mayr D, Meneses C, Newby C, Meyer U, Mexia S, Nicol C, Och U, Olivas SM, Pedrón-Giner C, Pereira R, Plutowska-Hoffmann K, Purves J, Re Dionigi A, Reinson K, Robert M, Robertson L, Rocha JC, Rohde C, Rosenbaum-Fabian S, Rossi A, Ruiz M, Saligova J, Gutiérrez-Sánchez A, Schlune A, Schulpis K, Serrano-Nieto J, Skarpalezou A, Skeath R, Slabbert A, Straczek K, Giżewska M, Terry A, Thom R, Tooke A, Tuokkola J, van Dam E, van den Hurk TAM, van der Ploeg EMC, Vande Kerckhove K, Van Driessche M, van Wegberg AMJ, van Wyk K, Vasconcelos C, Velez García V, Wildgoose J, Winkler T, Żółkowska J, Zuvadelli J, MacDonald A. Weaning practices in phenylketonuria vary between health professionals in Europe. Mol Genet Metab Rep 2018; 18:39-44. [PMID: 30705824 PMCID: PMC6349955 DOI: 10.1016/j.ymgmr.2018.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 10/12/2018] [Revised: 11/14/2018] [Accepted: 11/14/2018] [Indexed: 12/22/2022] Open
Abstract
Background In phenylketonuria (PKU), weaning is considered more challenging when compared to feeding healthy infants. The primary aim of weaning is to gradually replace natural protein from breast milk or standard infant formula with solids containing equivalent phenylalanine (Phe). In addition, a Phe-free second stage L-amino acid supplement is usually recommended from around 6 months to replace Phe-free infant formula. Our aim was to assess different weaning approaches used by health professionals across Europe. Methods A cross sectional questionnaire (survey monkey®) composed of 31 multiple and single choice questions was sent to European colleagues caring for inherited metabolic disorders (IMD). Centres were grouped into geographical regions for analysis. Results Weaning started at 17–26 weeks in 85% (n = 81/95) of centres, >26 weeks in 12% (n = 11/95) and < 17 weeks in 3% (n = 3/95). Infant's showing an interest in solid foods, and their age, were important determinant factors influencing weaning commencement. 51% (n = 48/95) of centres introduced Phe containing foods at 17–26 weeks and 48% (n = 46/95) at >26 weeks. First solids were mainly low Phe vegetables (59%, n = 56/95) and fruit (34%, n = 32/95). A Phe exchange system to allocate dietary Phe was used by 52% (n = 49/95) of centres predominantly from Northern and Southern Europe and 48% (n = 46/95) calculated most Phe containing food sources (all centres in Eastern Europe and the majority from Germany and Austria). Some centres used a combination of both methods. A second stage Phe-free L-amino acid supplement containing a higher protein equivalent was introduced by 41% (n = 39/95) of centres at infant age 26–36 weeks (mainly from Germany, Austria, Northern and Eastern Europe) and 37% (n = 35/95) at infant age > 1y mainly from Southern Europe. 53% (n = 50/95) of centres recommended a second stage Phe-free L-amino acid supplement in a spoonable or semi-solid form. Conclusions Weaning strategies vary throughout European PKU centres. There is evidence to suggest that different infant weaning strategies may influence longer term adherence to the PKU diet or acceptance of Phe-free L-amino acid supplements; rendering prospective long-term studies important. It is essential to identify an effective weaning strategy that reduces caregiver burden but is associated with acceptable dietary adherence and optimal infant feeding development.
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Affiliation(s)
- A Pinto
- Birmingham Women's and Children's Hospital, Birmingham, UK
| | - S Adams
- Royal Victoria Infirmary, Newcastle, UK
| | - K Ahring
- Department of PKU, Kennedy Centre, Department of Paediatrics and Adolescents Medicine, Copenhagen University Hospital, Glostrup, Denmark
| | - H Allen
- Sheffield Children's NHS Foundation Trust, UK
| | - M F Almeida
- Centro de Genética Médica, Centro Hospitalar Universitário do Porto (CHP), Porto, Portugal.,Unit for Multidisciplinary Research in Biomedicine, Abel Salazar Institute of Biomedical Sciences, University of Porto-UMIB/ICBAS/UP, Porto, Portugal.,Centro de Referência na área de Doenças Hereditárias do Metabolismo, Centro Hospitalar Universitário do Porto - CHP, Porto, Portugal
| | - D Garcia-Arenas
- Congenital and Metabolic Disease Unit, Gastroenterology, Hepatology and Pediatric Nutrition Unit, Sant Joan de Déu Hospital, Barcelona, Spain
| | - N Arslan
- Division of Pediatric Metabolism and Nutrition, Dokuz Eylul University Faculty of Medicine, Izmır, Turkey
| | - M Assoun
- Hôpital Necker enfants Malades, Centre de référence des maladies héréditaires du métabolisme, Paris, France
| | - Y Atik Altınok
- Pediatric Metabolism Department, Ege University Medical Faculty, Izmir, Turkey
| | - D Barrio-Carreras
- Servicio de Pediatria, Unidad de Enfermedades Mitocondriales-Metabolicas Hereditarias, Hospital 12 de Octubre, Madrid, Spain
| | - A Belanger Quintana
- Servicio de Pediatria, Hospital Ramon y Cajal Madrid, Unidad de Enfermedades Metabolicas, Spain
| | - S M Bernabei
- Division of Artificial Nutrition, Children's Hospital Bambino Gesù, Rome, Italy
| | | | - F Boyle
- National Centre for Inherited Metabolic Disorders, Temple Street Children's University Hospital, Italy
| | - G Bruni
- Meyer Children's hospital, Florence, Italy
| | | | | | - R Carvalho
- Hospital Divino Espírito Santo, Ponta Delgada, Portugal
| | - A Chrobot
- Children Voievodship Hospital, Bydgoszcz, Poland
| | - K Chyż
- Institute of Mother and Child, Warsaw, Poland
| | - B Cochrane
- Royal Hospital for Children, Glasgow, UK
| | - C Correia
- CHLC- Hospital Dona Estefânia, Lisboa, Portugal
| | | | - A Daly
- Birmingham Women's and Children's Hospital, Birmingham, UK
| | - S De Leo
- Department of Human Neuroscience, Sapienza University of Rome - Policlinico Umberto I of Rome, Italy
| | | | - A De Meyer
- Center of Metabolic Diseases, University Hospital, Antwerp, Belgium
| | - A De Theux
- IPG (Institut de Pathologie et de Genetique), Charleroi, Belgium
| | - B Didycz
- University Children's Hospital, Cracow, Poland
| | | | - K Dokoupil
- Dr. von Hauner Children's Hospital of the University of Munich, Germany
| | - J Drabik
- University Clinical Center in Gdansk, Poland
| | - C Dunlop
- Royal Hospital for Children Edinburgh, UK
| | | | - K Eftring
- Queen Silivia's Children's Hospital Gothenburg, Sweden
| | - J Ekengren
- Queen Silivia's Children's Hospital Gothenburg, Sweden
| | - I Errekalde
- Hospital Universitario de Cruces, Vizcaya, Spain
| | - S Evans
- Birmingham Women's and Children's Hospital, Birmingham, UK
| | - A Foucart
- Cliniques universitaires Saint-Luc, Belgium
| | - L Fokkema
- UMC Utrecht Wilhelmina Children's Hospital, Netherlands
| | - L François
- centre de référence des maladies héréditaires du métabolisme, Hôpital Universitaire Robert-Debré, Paris, France
| | - M French
- University Hospitals of Leicester NHS Trust, UK
| | - E Forssell
- Karolinska University Hospital, Stockholm, Sweden
| | | | | | - H Gökmen Özel
- İhsan Doğramacı Children's Hospital, Hacettepe University, Turkey
| | - A Grimsley
- Royal Belfast Hospital for Sick Children, Northern Ireland, UK
| | - G Gugelmo
- Department of Pediatrics, Inherited Metabolic Diseases Unit, University Hospital of Verona, Italy
| | - E Gyüre
- Albert Szent-Györgyi Clinical Centre, Hungary
| | - C Heller
- Kinder- und Jugendklinik Erlangen, Germany
| | - R Hensler
- Klinikum Stuttgart Olgahospital, Germany
| | - I Jardim
- Centro Hospitalar Lisboa Norte - H. Sta Maria - Unidade de Doenças Metabólicas, Portugal
| | - C Joost
- University Children's Hospital, University Medical Center Hamburg Eppendorf, Germany
| | - M Jörg-Streller
- Universitätsklinik Innsbruck department für Kinder- und Jugendheilkunde, Austria
| | | | - A Jung
- Charite, Virchow Klinikum Berlin, Germany
| | - M Kanthe
- Skane University Hospital, Sweden
| | - N Koç
- Child's Health and Diseases Hematology Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - I L Kok
- UMC Utrecht Wilhelmina Children's Hospital, Netherlands
| | - T Kozanoğlu
- İstanbul University İstanbul Faculty of Medicine, Turkey
| | - B Kumru
- Cengiz Gökçek Maternity and Children's Hospital, Gaziantep, Turkey
| | - F Lang
- University Hospital Mainz, Villa metabolica, Germany
| | - K Lang
- Ninewells Hospital, Dundee, Scotland, UK
| | | | - A Liguori
- Division of Artificial Nutrition, Children's Hospital Bambino Gesù, Rome, Italy
| | - R Lilje
- Oslo University Hospital, Norway
| | - O Ļubina
- Children's Clinical University Hospital, Riga, Latvia
| | | | - D Mayr
- Universitätsklinik für Jugend und Kinderheilkunde, Müllner Hauptstr, Salzburg, Austria
| | - C Meneses
- Hospital de Santo Espírito da Ilha Terceira, EPER, Portugal
| | - C Newby
- Bristol Royal Hospital for Children, UK
| | - U Meyer
- Clinic for Paediatric Kidney-, Liver and Metabolic Diseases, Medical School Hannover, Germany
| | - S Mexia
- Centro Hospitalar Lisboa Norte - H. Sta Maria - Unidade de Doenças Metabólicas, Portugal
| | - C Nicol
- Royal Victoria Infirmary, Newcastle, UK
| | - U Och
- Metabolic Department, University Hospital Muenster, Center for Pediatrics, Germany
| | - S M Olivas
- Congenital and Metabolic Disease Unit, Gastroenterology, Hepatology and Pediatric Nutrition Unit, Sant Joan de Déu Hospital, Barcelona, Spain
| | - C Pedrón-Giner
- Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - K Plutowska-Hoffmann
- The Independent Public Clinical Hospital, Medical University of Silesia in Katowice John Paul II Upper Silesian Child Health Centre, Poland
| | - J Purves
- Royal Hospital for Children Edinburgh, UK
| | - A Re Dionigi
- Department of Pediatrics, San Paolo Hospital, ASST Santi Paolo e Carlo, University of Milan, Italy
| | - K Reinson
- Tartu University Hospital, United Laboratories, Department of Genetics, Italy
| | - M Robert
- Hôpital Universitaire des Enfants, Reine Fabiola, Bruxelles, Belgium
| | | | - J C Rocha
- Centro de Genética Médica, Centro Hospitalar Universitário do Porto (CHP), Porto, Portugal.,Centro de Referência na área de Doenças Hereditárias do Metabolismo, Centro Hospitalar Universitário do Porto - CHP, Porto, Portugal.,Centre for Health Technology and Services Research (CINTESIS), Portugal
| | - C Rohde
- Hospital for Children and Adolescents, Department of Women and Child Health, University Hospitals, University of Leipzig, Germany
| | - S Rosenbaum-Fabian
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - A Rossi
- Division of Inherited Metabolic Diseases, Reference Centre Expanded Newborn Screening, Department of Woman's and Child's Health, University Hospital of Padua, Italy
| | - M Ruiz
- Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain
| | - J Saligova
- Children's Faculty Hospital, Kosice, Slovakia
| | - A Gutiérrez-Sánchez
- Congenital and Metabolic Disease Unit, Gastroenterology, Hepatology and Pediatric Nutrition Unit, Sant Joan de Déu Hospital, Barcelona, Spain
| | - A Schlune
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital Duesseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - K Schulpis
- Agia Sophia Childrens' Hospital, Athens, Greece
| | | | - A Skarpalezou
- Institute of Child Health, "A. Sophia" Children's Hospital, Athens
| | - R Skeath
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - A Slabbert
- Evelina Children's Hospital, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - K Straczek
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age Pomeranian Medica University, Poland
| | - M Giżewska
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age Pomeranian Medica University, Poland
| | - A Terry
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - R Thom
- Royal Belfast Hospital for Sick Children, Northern Ireland, UK
| | - A Tooke
- Nottingham Children's Hospital, UK
| | - J Tuokkola
- Clinical Nutrition Unit, Internal Medicine and Rehabilitation and Pediatric Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - E van Dam
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Dietetics, Groningen, the Netherlands
| | | | | | | | | | - A M J van Wegberg
- Department of Gastroenterology and Hepatology - Dietetics, Radboud University Medical Centre, Nijmegen, Netherlands
| | - K van Wyk
- Manchester University NHS Foundation Trust, UK
| | | | - V Velez García
- Unit of Nutrition and Metabolopathies, Hospital La Fe, Valencia, Spain
| | | | - T Winkler
- Klinik für Kinder- und Jugendmedizin, Carl-Thiem-Klinikum gGmbH Cottbus, Germany
| | - J Żółkowska
- Institute of Mother and Child, Warsaw, Poland
| | - J Zuvadelli
- Department of Pediatrics, San Paolo Hospital, ASST Santi Paolo e Carlo, University of Milan, Italy
| | - A MacDonald
- Birmingham Women's and Children's Hospital, Birmingham, UK
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13
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Shakespeare C, Merriel A, Bakhbakhi D, Baneszova R, Barnard K, Lynch M, Storey C, Blencowe H, Boyle F, Flenady V, Gold K, Horey D, Mills T, Siassakos D. Parents' and healthcare professionals' experiences of care after stillbirth in low- and middle-income countries: a systematic review and meta-summary. BJOG 2018; 126:12-21. [PMID: 30099831 DOI: 10.1111/1471-0528.15430] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Stillbirth has a profound impact on women, families, and healthcare workers. The burden is highest in low- and middle-income countries (LMICs). There is need for respectful and supportive care for women, partners, and families after bereavement. OBJECTIVE To perform a qualitative meta-summary of parents' and healthcare professionals' experiences of care after stillbirth in LMICs. SEARCH STRATEGY Search terms were formulated by identifying all synonyms, thesaurus terms, and variations for stillbirth. Databases searched were AMED, EMBASE, MEDLINE, PsychINFO, BNI, CINAHL. SELECTION CRITERIA Qualitative, quantitative, and mixed method studies that addressed parents' or healthcare professionals' experience of care after stillbirth in LMICs. DATA COLLECTION AND ANALYSIS Studies were screened, and data extracted in duplicate. Data were analysed using the Sandelowski meta-summary technique that calculates frequency and intensity effect sizes (FES/IES). MAIN RESULTS In all, 118 full texts were screened, and 34 studies from 17 countries were included. FES range was 15-68%. Most studies had IES 1.5-4.5. Women experience a broad range of manifestations of grief following stillbirth, which may not be recognised by healthcare workers or in their communities. Lack of recognition exacerbates negative experiences of stigmatisation, blame, devaluation, and loss of social status. Adequately developed health systems, with trained and supported staff, are best equipped to provide the support and information that women want after stillbirth. CONCLUSIONS Basic interventions could have an immediate impact on the experiences of women and their families after stillbirth. Examples include public education to reduce stigma, promoting the respectful maternity care agenda, and investigating stillbirth appropriately. TWEETABLE ABSTRACT Reducing stigma, promoting respectful care and investigating stillbirth have a positive impact after stillbirth for women and families in LMICs.
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Affiliation(s)
- C Shakespeare
- School of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Department of Women and Children's Health, The Chilterns, Southmead Hospital, Bristol, UK
| | - A Merriel
- School of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Department of Women and Children's Health, The Chilterns, Southmead Hospital, Bristol, UK
| | - D Bakhbakhi
- School of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Department of Women and Children's Health, The Chilterns, Southmead Hospital, Bristol, UK
| | - R Baneszova
- 2nd Department of Obstetrics and Gynaecology, Faculty of Medicine, University Hospital Bratislava, Comenius University, Bratislava, Slovakia
| | - K Barnard
- Library and Knowledge Service, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - M Lynch
- Department of Women and Children's Health, The Chilterns, Southmead Hospital, Bristol, UK
| | - C Storey
- International Stillbirth Alliance, Bristol, UK
| | - H Blencowe
- London School of Hygiene and Tropical Medicine, London, UK
| | - F Boyle
- Centre of Research Excellence in Stillbirth, Mater Research Institute, University of Queensland, South Brisbane, Qld, Australia
| | - V Flenady
- Centre of Research Excellence in Stillbirth, Mater Research Institute, University of Queensland, South Brisbane, Qld, Australia
| | - K Gold
- Department of Medicine, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - D Horey
- La Trobe University, Bundoora, Vic., Australia
| | - T Mills
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - D Siassakos
- School of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Department of Women and Children's Health, The Chilterns, Southmead Hospital, Bristol, UK
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14
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Pinto A, Adams S, Ahring K, Allen H, Almeida MF, Garcia-Arenas D, Arslan N, Assoun M, Atik Altınok Y, Barrio-Carreras D, Belanger Quintana A, Bernabei SM, Bontemps C, Boyle F, Bruni G, Bueno-Delgado M, Caine G, Carvalho R, Chrobot A, Chyż K, Cochrane B, Correia C, Corthouts K, Daly A, De Leo S, Desloovere A, De Meyer A, De Theux A, Didycz B, Dijsselhof ME, Dokoupil K, Drabik J, Dunlop C, Eberle-Pelloth W, Eftring K, Ekengren J, Errekalde I, Evans S, Foucart A, Fokkema L, François L, French M, Forssell E, Gingell C, Gonçalves C, Gökmen Özel H, Grimsley A, Gugelmo G, Gyüre E, Heller C, Hensler R, Jardim I, Joost C, Jörg-Streller M, Jouault C, Jung A, Kanthe M, Koç N, Kok IL, Kozanoğlu T, Kumru B, Lang F, Lang K, Liegeois I, Liguori A, Lilje R, Ļubina O, Manta-Vogli P, Mayr D, Meneses C, Newby C, Meyer U, Mexia S, Nicol C, Och U, Olivas SM, Pedrón-Giner C, Pereira R, Plutowska-Hoffmann K, Purves J, Re Dionigi A, Reinson K, Robert M, Robertson L, Rocha JC, Rohde C, Rosenbaum-Fabian S, Rossi A, Ruiz M, Saligova J, Gutiérrez-Sánchez A, Schlune A, Schulpis K, Serrano-Nieto J, Skarpalezou A, Skeath R, Slabbert A, Straczek K, Giżewska M, Terry A, Thom R, Tooke A, Tuokkola J, van Dam E, van den Hurk TAM, van der Ploeg EMC, Vande Kerckhove K, Van Driessche M, van Wegberg AMJ, van Wyk K, Vasconcelos C, Velez García V, Wildgoose J, Winkler T, Żółkowska J, Zuvadelli J, MacDonald A. Early feeding practices in infants with phenylketonuria across Europe. Mol Genet Metab Rep 2018; 16:82-89. [PMID: 30101073 PMCID: PMC6082991 DOI: 10.1016/j.ymgmr.2018.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 06/07/2018] [Accepted: 07/27/2018] [Indexed: 01/15/2023] Open
Abstract
Background In infants with phenylketonuria (PKU), dietary management is based on lowering and titrating phenylalanine (Phe) intake from breast milk or standard infant formula in combination with a Phe-free infant formula in order to maintain blood Phe levels within target range. Professionals use different methods to feed infants with PKU and our survey aimed to document practices across Europe. Methods We sent a cross sectional, survey monkey® questionnaire to European health professionals working in IMD. It contained 31 open and multiple-choice questions. The results were analysed according to different geographical regions. Results Ninety-five centres from 21 countries responded. Over 60% of centres commenced diet in infants by age 10 days, with 58% of centres implementing newborn screening by day 3 post birth. At diagnosis, infant hospital admission occurred in 61% of metabolic centres, mainly in Eastern, Western and Southern Europe. Breastfeeding fell sharply following diagnosis with only 30% of women still breast feeding at 6 months. 53% of centres gave pre-measured Phe-free infant formula before each breast feed and 23% alternated breast feeds with Phe-free infant formula. With standard infant formula feeds, measured amounts were followed by Phe-free infant formula to satiety in 37% of centres (n = 35/95), whereas 44% (n = 42/95) advised mixing both formulas together. Weaning commenced between 17 and 26 weeks in 85% centres, ≥26 weeks in 12% and < 17 weeks in 3%. Discussion This is the largest European survey completed on PKU infant feeding practices. It is evident that practices varied widely across Europe, and the practicalities of infant feeding in PKU received little focus in the PKU European Guidelines (2017). There are few reports comparing different feeding techniques with blood Phe control, Phe fluctuations and growth. Controlled prospective studies are necessary to assess how different infant feeding practices may influence longer term feeding development.
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Affiliation(s)
- A Pinto
- Birmingham Women's and Children's Hospital, Birmingham, UK
| | - S Adams
- Royal Victoria Infirmary, Newcastle, UK
| | - K Ahring
- Department of PKU, Kennedy Centre, Copenhagen University Hospital, Glostrup, Denmark
| | - H Allen
- Sheffield Children's NHS Foundation Trust, UK
| | - M F Almeida
- Centro de Genética Médica, Centro Hospitalar do Porto (CHP), Porto, Portugal.,Unit for Multidisciplinary Research in Biomedicine, Abel Salazar Institute of Biomedical Sciences, University of Porto-UMIB/ICBAS/UP, Porto, Portugal.,Centro de Referência na área de Doenças Hereditárias do Metabolismo, Centro Hospitalar do Porto - CHP, Porto, Portugal
| | - D Garcia-Arenas
- Congenital and Metabolic Disease Unit, Gastroenterology, Hepatology and Pediatric Nutrition Unit, Sant Joan de Déu Hospital, Barcelona, Spain
| | - N Arslan
- Dokuz Eylul University Faculty of Medicine, Division of Pediatric Metabolism and Nutrition, Izmır, Turkey
| | - M Assoun
- Centre de référence des maladies héréditaires du métabolisme, Hôpital Necker enfants Malades, Paris, France
| | - Y Atik Altınok
- Pediatric Metabolism Department, Ege University Medical Faculty, Izmir, Turkey
| | - D Barrio-Carreras
- Unidad de Enfermedades Mitocondriales-Metabolicas Hereditarias. Servicio de Pediatría, Hospital 12 de Octubre, Madrid, Spain
| | - A Belanger Quintana
- Unidad de Enfermedades Metabolicas, Servicio de Pediatria, Hospital Ramon y Cajal Madrid, Spain
| | - S M Bernabei
- Children's Hospital Bambino Gesù, Division of Artificial Nutrition, Rome, Italy
| | | | - F Boyle
- National Centre for Inherited Metabolic Disorders, Temple Street Children's University Hospital, Ireland
| | - G Bruni
- Meyer Children's Hospital, Florence, Italy
| | | | | | - R Carvalho
- Hospital Divino Espírito Santo, Ponta Delgada, Portugal
| | - A Chrobot
- Children Voievodship Hospital, Bydgoszcz, Poland
| | - K Chyż
- Institute of Mother and Child, Warsaw, Poland
| | - B Cochrane
- Royal Hospital for Children, Glasgow, UK
| | - C Correia
- CHLC- Hospital Dona Estefânia, Lisboa, Portugal
| | | | - A Daly
- Birmingham Women's and Children's Hospital, Birmingham, UK
| | - S De Leo
- Department of Human Neuroscience, Sapienza University of Rome - Policlinico Umberto I of Rome, Italy
| | | | - A De Meyer
- Center of Metabolic Diseases, University Hospital, Antwerp, Belgium
| | - A De Theux
- IPG (Institut de Pathologie et de Genetique), Charleroi, Belgium
| | - B Didycz
- University Children's Hospital, Cracow, Poland
| | | | - K Dokoupil
- Dr. von Hauner Children's Hospital of the University of Munich, Germany
| | - J Drabik
- University Clinical Center in Gdansk, Poland
| | - C Dunlop
- Royal Hospital for Children Edinburgh, UK
| | | | - K Eftring
- Queen Silivia's Children's Hospital Gothenburg, Sweden
| | - J Ekengren
- Queen Silivia's Children's Hospital Gothenburg, Sweden
| | - I Errekalde
- Hospital Universitario de Cruces, Vizcaya, Spain
| | - S Evans
- Birmingham Women's and Children's Hospital, Birmingham, UK
| | - A Foucart
- Cliniques universitaires Saint-Luc, Belgium
| | - L Fokkema
- UMC Utrecht, Wilhelmina Children's Hospital, Netherlands
| | - L François
- Hôpital Universitaire Robert-Debré, Centre de référence des maladies héréditaires du métabolisme, Paris, France
| | - M French
- University Hospitals of Leicester NHS Trust, UK
| | - E Forssell
- Karolinska University Hospital, Stockholm, Sweden
| | | | | | - H Gökmen Özel
- Hacettepe University, İhsan Doğramacı Children's Hospital, Turkey
| | - A Grimsley
- Royal Belfast Hospital for Sick Children, Northern Ireland, UK
| | - G Gugelmo
- Department of Pediatrics, Inherited Metabolic Diseases Unit, University Hospital of Verona, Italy
| | - E Gyüre
- Albert Szent-Györgyi Clinical Centre, Hungary
| | - C Heller
- Kinder- und Jugendklinik Erlangen, Germany
| | - R Hensler
- Klinikum Stuttgart Olgahospital, Germany
| | - I Jardim
- Centro Hospitalar Lisboa Norte - H. Sta Maria - Unidade de Doenças Metabólicas, Portugal
| | - C Joost
- University Children's Hospital, University Medical Center Hamburg Eppendorf, Germany
| | - M Jörg-Streller
- Universitätsklinik Innsbruck department für Kinder- und Jugendheilkunde, Austria
| | | | - A Jung
- Charite, Virchow Klinikum Berlin, Germany
| | - M Kanthe
- Skane University Hospital, Sweden
| | - N Koç
- University of Health Sciences, Ankara Child's Health and Diseases Hematology Oncology Training and Research Hospital, Turkey
| | - I L Kok
- UMC Utrecht, Wilhelmina Children's Hospital, Netherlands
| | - T Kozanoğlu
- İstanbul University İstanbul Faculty of Medicine, Turkey
| | - B Kumru
- Gaziantep Cengiz Gökçek Maternity and Children's Hospital, Turkey
| | - F Lang
- University Hospital Mainz, Villa metabolica, Germany
| | - K Lang
- Ninewells Hospital, Dundee, UK
| | | | - A Liguori
- Children's Hospital Bambino Gesù, Division of Artificial Nutrition, Rome, Italy
| | - R Lilje
- Oslo University Hospital, Norway
| | - O Ļubina
- Children's Clinical University Hospital, Riga, Latvia
| | - P Manta-Vogli
- Inborn Errors of Metabolism Department, Institute of Child Health, Athens, Greece
| | - D Mayr
- Universitätsklinik für Jugend und Kinderheilkunde, Müllner Hauptstr, Salzburg, Austria
| | - C Meneses
- Hospital de Santo Espírito da Ilha Terceira, EPER, Portugal
| | - C Newby
- Bristol Royal Hospital for Children, UK
| | - U Meyer
- Medical School Hannover, Clinic for Paediatric Kidney- Liver and Metabolic Diseases, Germany
| | - S Mexia
- Centro Hospitalar Lisboa Norte - H. Sta Maria - Unidade de Doenças Metabólicas, Portugal
| | - C Nicol
- Royal Victoria Infirmary, Newcastle, UK
| | - U Och
- University Hospital Muenster, Center for Pediatrics, Metabolic Department, Germany
| | - S M Olivas
- Congenital and Metabolic Disease Unit, Gastroenterology, Hepatology and Pediatric Nutrition Unit, Sant Joan de Déu Hospital, Barcelona, Spain
| | - C Pedrón-Giner
- Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - K Plutowska-Hoffmann
- The Independent Public Clinical Hospital, No. 6 of the Medical University of Silesia in Katowice John Paul II Upper Silesian Child Health Centre, Poland
| | - J Purves
- Royal Hospital for Children Edinburgh, UK
| | - A Re Dionigi
- Department of Pediatrics, San Paolo Hospital, ASST Santi Paolo e Carlo, University of Milan, Italy
| | | | - M Robert
- Hôpital Universitaire des Enfants, Reine Fabiola, Bruxelles, Belgium
| | | | - J C Rocha
- Centro de Genética Médica, Centro Hospitalar do Porto (CHP), Porto, Portugal.,Centro de Referência na área de Doenças Hereditárias do Metabolismo, Centro Hospitalar do Porto - CHP, Porto, Portugal.,Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, Portugal.,Centre for Health Technology and Services Research (CINTESIS), Portugal
| | - C Rohde
- Hospital for Children and Adolescents, Department of Women and Child Health, University Hospitals, University of Leipzig, Germany
| | - S Rosenbaum-Fabian
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - A Rossi
- Division of Inherited Metabolic Diseases, Reference Centre Expanded Newborn Screening, Department of Woman's and Child's Health, University Hospital of Padua, Italy
| | - M Ruiz
- Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain
| | - J Saligova
- Children's Faculty Hospital, Kosice, Slovakia
| | - A Gutiérrez-Sánchez
- Congenital and Metabolic Disease Unit, Gastroenterology, Hepatology and Pediatric Nutrition Unit, Sant Joan de Déu Hospital, Barcelona, Spain
| | - A Schlune
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital Duesseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - K Schulpis
- Inborn Errors of Metabolism Department, Institute of Child Health, Athens, Greece
| | | | - A Skarpalezou
- Institute of Child Health, "A. Sophia" Children's Hospital, Athens, Greece
| | - R Skeath
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - A Slabbert
- Evelina Children's Hospital, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - K Straczek
- Clinic of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age Pomeranian Medica University, Poland
| | - M Giżewska
- Clinic of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age Pomeranian Medica University, Poland
| | - A Terry
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - R Thom
- Royal Belfast Hospital for Sick Children, Northern Ireland, UK
| | - A Tooke
- Nottingham Children's Hospital, UK
| | - J Tuokkola
- Clinical Nutrition Unit, Internal Medicine and Rehabilitation and Pediatric Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - E van Dam
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Dietetics, Groningen, Netherlands
| | | | | | | | | | - A M J van Wegberg
- Department of Gastroenterology and Hepatology - Dietetics, Radboud University Medical Centre, Nijmegen, Netherlands
| | - K van Wyk
- Manchester University NHS Foundation Trust, UK
| | | | - V Velez García
- Unit of Nutrition and Metabolopathies, Hospital La Fe, Valencia, Spain
| | | | - T Winkler
- Klinik für Kinder- und Jugendmedizin, Carl-Thiem-Klinikum gGmbH Cottbus, Germany
| | - J Żółkowska
- Institute of Mother and Child, Warsaw, Poland
| | - J Zuvadelli
- Department of Pediatrics, San Paolo Hospital, ASST Santi Paolo e Carlo, University of Milan, Italy
| | - A MacDonald
- Birmingham Women's and Children's Hospital, Birmingham, UK
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15
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Moore HCF, Unger JM, Phillips KA, Boyle F, Hitre E, Moseley A, Porter D, Francis PA, Goldstein LJ, Gomez HL, Vallejos CS, Partridge AH, Dakhil SR, Garcia AA, Gralow J, Lombard JM, Forbes JF, Martino S, Barlow WE, Fabian CJ, Minasian L, Meyskens FL, Gelber RD, Hortobagyi GN, Albain KS. Abstract P1-15-01: Final analysis of SWOG S0230/Prevention of early menopause study (POEMS). Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-15-01] [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: 11/16/2022]
Abstract
Abstract
BACKGROUND: The SWOG S0230/POEMS study demonstrated a 70% reduction in ovarian failure (OF) with goserelin coadministration during chemotherapy (CT) for ER-negative early breast cancer (BC; Moore H et al, NEJM 2015). Goserelin use was also associated with more pregnancies as well as favorable disease free survival (DFS) and overall survival (OS). Here we report the final analysis after 5 years of follow-up.
METHODS: Premenopausal women age <50 with stage I-IIIA ER/PR-negative BC to be treated with cyclophosphamide-containing CT were randomized to receive standard CT with or without monthly goserelin 3.6 mg SQ starting at least 1 week prior to the first CT dose. The primary endpoint was OF at 2-years, defined as amenorrhea for the prior 6 months and post-menopausal FSH. Secondary endpoints included pregnancies, disease free survival (DFS) and overall survival (OS). An unplanned analysis of rate of menses recovery at 2 years (presence of menses within 6 months of the 2 year time-point or pregnancy within the first 2 years) was also conducted. OF and pregnancy endpoints were analyzed using multivariable logistic regression adjusting for stratification factors (age and CT regimen); DFS and OS were examined using multivariable Cox regression, adjusting for stratification factors and stage. Two-sided p-values are reported unless otherwise specified in accordance with protocol design.
RESULTS: Among 257 randomized participants, 218 were eligible and evaluable. One hundred thirty-six eligible and evaluable patients had OF data and 186 had menstrual data. Median age was 37.7 years. Among the 136 patients with OF data, the odds ratio (OR) for OF at 2 years was 0.30 (95% CI 0.1-0.98; one-sided p=0.023) comparing CT with goserelin to standard CT alone. Among 186 patients with menstrual data, 80% recovered menses by 2 years in the goserelin arm compared with 70% in the standard arm (OR=1.74, 95% CI: 0.83-3.66, p=0.15). Pregnancies, DFS and OS are reported for all 218 eligible and evaluable patients. With a median follow-up of 5.1 years, 22% of patients in the goserelin group had at least one pregnancy compared with 12% in the standard group (OR 2.38, 95% CI 1.08-5.26, p=0.03). Cumulative incidence of pregnancy at 5 years is 23% in the goserelin arm compared with 12% in the standard group. Five-year Kaplan-Meier DFS estimates are 88% in the goserelin arm compared with 79% in the standard arm (HR=0.50, p=0.05). Five-year OS is 92% with goserelin versus 83% in the standard arm (HR=0.47, p=0.06). Including all 257 randomized patients, HR for DFS and OS are 0.67 and 0.48 (p=0.18 and p=0.05).
CONCLUSION: Ovarian suppression with goserelin during chemotherapy for hormone receptor-negative breast cancer reduces OF risk and, after 5 years of follow-up, continues to be associated with more pregnancies and improved survival compared with chemotherapy without goserelin.
SUPPORT: NIH/NCI grant awards CA189974, CA180888, CA180819, CA074362; AstraZeneca
Citation Format: Moore HCF, Unger JM, Phillips K-A, Boyle F, Hitre E, Moseley A, Porter D, Francis PA, Goldstein LJ, Gomez HL, Vallejos CS, Partridge AH, Dakhil SR, Garcia AA, Gralow J, Lombard JM, Forbes JF, Martino S, Barlow WE, Fabian CJ, Minasian L, Meyskens FL, Gelber RD, Hortobagyi GN, Albain KS. Final analysis of SWOG S0230/Prevention of early menopause study (POEMS) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-15-01.
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Affiliation(s)
- HCF Moore
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - JM Unger
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - K-A Phillips
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - F Boyle
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - E Hitre
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - A Moseley
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - D Porter
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - PA Francis
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - LJ Goldstein
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - HL Gomez
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - CS Vallejos
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - AH Partridge
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - SR Dakhil
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - AA Garcia
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - J Gralow
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - JM Lombard
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - JF Forbes
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - S Martino
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - WE Barlow
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - CJ Fabian
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - L Minasian
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - FL Meyskens
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - RD Gelber
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - GN Hortobagyi
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
| | - KS Albain
- Cleveland Clinic, Cleveland, OH; SWOG Statiscial Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Sydney, Sidney, NSW, Australia; National Institute of Oncology, Budapest, Hungary; Aukland Regional Cancer Center and Blood Service, Auckland, New Zealand; Fox Chace Cancer Center, Philadelphia, PA; Instituto de Enfermedades Neoplasicas, Lima, Peru; Oncosalud SAC, Lima, Peru; Dana Farber Cancer Institute, Boston, MA; Cancer Center of Kansas, Wichita, KS; Louisiana State University Health Sciences Center, New Orleans, LA; Seattle Cancer Care Alliance, Seattle, WA; Calvary Mater Newcastle, Waratah, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Callaghan, NSW, Australia; The Angeles Clinic and Research Institute, Santa Monica, CA; University of Kansas, Westwood, KS; National Cancer Institute, Bethesda, MD; University of California at Irvine, Orange, CA; University of Texas MD Anderson Cancer Center, Houston,
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Winters ZE, Afzal M, Rutherford C, Holzner B, Rumpold G, da Costa Vieira RA, Hartup S, Flitcroft K, Bjelic-Radisic V, Oberguggenberger A, Panouilleres M, Mani M, Catanuto G, Douek M, Kokan J, Sinai P, King MT, Spillane A, Snook K, Boyle F, French J, Elder E, Chalmers B, Kabir M, Campbell I, Wong A, Flay H, Scarlet J, Weis J, Giesler J, Bliem B, Nagele E, del Angelo N, Andrade V, Assump¸ão Garcia D, Bonnetain F, Kjelsberg M, William-Jones S, Fleet A, Hathaway S, Elliott J, Galea M, Dodge J, Chaudhy A, Williams R, Cook L, Sethi S, Turton P, Henson A, Gibb J, Bonomi R, Funnell S, Noren C, Ooi J, Cocks S, Dawson L, Patel H, Bailey L, Chatterjee S, Goulden K, Kirk S, Osborne W, Harter L, Sharif MA, Corcoran S, Smith J, Prasad R, Doran A, Power A, Devereux L, Cannon J, Latham S, Arora P, Ridgway S, Coulding M, Roberts R, Absar M, Hodgkiss T, Connolly K, Johnson J, Doyle K, Lunt N, Cooper M, Fuchs I, Peall L, Taylor L, Nicholson A. International validation of the European Organisation for Research and Treatment of Cancer QLQ-BRECON23 quality-of-life questionnaire for women undergoing breast reconstruction. Br J Surg 2017; 105:209-222. [PMID: 29116657 DOI: 10.1002/bjs.10656] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 03/02/2017] [Accepted: 06/23/2017] [Indexed: 11/12/2022]
Abstract
Abstract
Background
The aim was to carry out phase 4 international field-testing of the European Organisation for Research and Treatment of Cancer (EORTC) breast reconstruction (BRECON) module. The primary objective was finalization of its scale structure. Secondary objectives were evaluation of its reliability, validity, responsiveness, acceptability and interpretability in patients with breast cancer undergoing mastectomy and reconstruction.
Methods
The EORTC module development guidelines were followed. Patients were recruited from 28 centres in seven countries. A prospective cohort completed the QLQ-BRECON15 before mastectomy and the QLQ-BRECON24 at 4–8 months after reconstruction. The cross-sectional cohort completed the QLQ-BRECON24 at 1–5 years after reconstruction, and repeated this 2–8 weeks later (test–retest reliability). All participants completed debriefing questionnaires.
Results
A total of 438 patients were recruited, 234 in the prospective cohort and 204 in the cross-sectional cohort. A total of 414 reconstructions were immediate, with a comparable number of implants (176) and donor-site flaps (166). Control groups comprised patients who underwent two-stage implant procedures (72, 75 per cent) or delayed reconstruction (24, 25 per cent). Psychometric scale validity was supported by moderate to high item-own scale and item-total correlations (over 0·5). Questionnaire validity was confirmed by good scale-to-sample targeting, and computable scale scores exceeding 50 per cent, except nipple cosmesis (over 40 per cent). In known-group comparisons, QLQ-BRECON24 scales and items differentiated between patient groups defined by clinical criteria, such as type and timing of reconstruction, postmastectomy radiotherapy and surgical complications, with moderate effect sizes. Prospectively, sexuality and surgical side-effects scales showed significant responsiveness over time (P < 0·001). Scale reliability was supported by high Cronbach's α coefficients (over 0·7) and test–retest (intraclass correlation more than 0·8). One item (finding a well fitting bra) was excluded based on high floor/ceiling effects, poor test–retest and weak correlations in factor analysis (below 0·3), thus generating the QLQ-BRECON23 questionnaire.
Conclusion
The QLQ-BRECON23 is an internationally validated tool to be used alongside the EORTC QLQ-C30 (cancer) and QLQ-BR23 (breast cancer) questionnaires for evaluating quality of life and satisfaction after breast reconstruction.
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Affiliation(s)
- Z E Winters
- Breast Cancer Surgery Patient-Reported and Clinical Outcomes Research Group, University of Bristol, School of Clinical Sciences, Southmead Hospital, Bristol, UK
- Surgical and Interventional Trials Unit, Division of Surgical Sciences, University College London, London, UK
- Quality of Life Office, School of Psychology, Faculty of Science, University of Sydney, New South Wales, Australia
| | - M Afzal
- Breast Cancer Surgery Patient-Reported and Clinical Outcomes Research Group, University of Bristol, School of Clinical Sciences, Southmead Hospital, Bristol, UK
| | - C Rutherford
- Quality of Life Office, School of Psychology, Faculty of Science, University of Sydney, New South Wales, Australia
| | - B Holzner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria
| | - G Rumpold
- Department of Medical Psychology, Evaluation Software Development, Rum, Austria
| | | | - S Hartup
- St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - K Flitcroft
- Breast and Surgical Oncology, Poche Centre, University of Sydney, New South Wales, Australia
| | - V Bjelic-Radisic
- Department of Breast Surgery and Gynaecology, Medical University Graz, Graz, Austria
| | - A Oberguggenberger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria
| | - M Panouilleres
- Department of Plastic Surgery, Besançon University Hospital, Besançon, France
| | - M Mani
- Department of Surgical Sciences, Plastic and Reconstructive Surgery, Uppsala University, Uppsala, Sweden
| | - G Catanuto
- Multidisciplinary Breast Care, Cannizzaro Hospital, Catania, Italy
| | - M Douek
- Department of Surgical Oncology, Guy's Hospital, London, London, UK
| | - J Kokan
- Cancer Resource Centre, Macclesfield Hospital, Macclesfield, UK
| | - P Sinai
- Breast Cancer Surgery Patient-Reported and Clinical Outcomes Research Group, University of Bristol, School of Clinical Sciences, Southmead Hospital, Bristol, UK
| | - M T King
- Quality of Life Office, School of Psychology, Faculty of Science, University of Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine, University of Sydney, New South Wales, Australia
| | - A Spillane
- Poche Centre, Sydney, New South Wales, Australia
| | - K Snook
- Poche Centre, Sydney, New South Wales, Australia
| | - F Boyle
- Poche Centre, Sydney, New South Wales, Australia
| | - J French
- The Crown Princess Mary Westmead Breast Cancer Centre and Specialist Services, Sydney, New South Wales, Australia
| | - E Elder
- The Crown Princess Mary Westmead Breast Cancer Centre and Specialist Services, Sydney, New South Wales, Australia
| | - B Chalmers
- The Crown Princess Mary Westmead Breast Cancer Centre and Specialist Services, Sydney, New South Wales, Australia
| | - M Kabir
- The Crown Princess Mary Westmead Breast Cancer Centre and Specialist Services, Sydney, New South Wales, Australia
| | | | - A Wong
- Waikato Hospital, Hamilton, New Zealand
| | - H Flay
- Waikato Hospital, Hamilton, New Zealand
| | - J Scarlet
- Waikato Hospital, Hamilton, New Zealand
| | - J Weis
- University of Freiburg, Freiberg, Germany
| | - J Giesler
- University of Freiburg, Freiberg, Germany
| | - B Bliem
- Medical University Graz, Graz, Austria
| | - E Nagele
- Medical University Graz, Graz, Austria
| | | | - V Andrade
- Barretos Cancer Hospital, Sao Paolo, Brazil
| | | | - F Bonnetain
- Besançon University Hospital, Besançon, France
| | | | - S William-Jones
- Clinical Research Network, West Midlands, Queen-s Hospital, Burton upon Trent, UK
| | - A Fleet
- Clinical Research Network, West Midlands, Queen-s Hospital, Burton upon Trent, UK
| | - S Hathaway
- Clinical Research Network, West Midlands, Queen-s Hospital, Burton upon Trent, UK
| | - J Elliott
- Clinical Research Network, West Midlands, Queen-s Hospital, Burton upon Trent, UK
| | - M Galea
- Cancer Research Unit, Great Western Hospital, Swindon, UK
| | - J Dodge
- Cancer Research Unit, Great Western Hospital, Swindon, UK
| | - A Chaudhy
- Cancer Research Unit, Great Western Hospital, Swindon, UK
| | | | - L Cook
- Guy's Hospital, London, UK
| | | | - P Turton
- Leeds Teaching Hospital, Leeds, UK
| | - A Henson
- Leeds Teaching Hospital, Leeds, UK
| | - J Gibb
- Leeds Teaching Hospital, Leeds, UK
| | - R Bonomi
- Worthing Hospital, Western Sussex Hospitals, Worthing, UK
| | - S Funnell
- Worthing Hospital, Western Sussex Hospitals, Worthing, UK
| | - C Noren
- Worthing Hospital, Western Sussex Hospitals, Worthing, UK
| | - J Ooi
- Royal Bolton Hospital, Bolton, UK
| | - S Cocks
- Royal Bolton Hospital, Bolton, UK
| | - L Dawson
- Royal Bolton Hospital, Bolton, UK
| | - H Patel
- Royal Bolton Hospital, Bolton, UK
| | - L Bailey
- Royal Bolton Hospital, Bolton, UK
| | | | | | - S Kirk
- Salford Royal Hospital, UK
| | | | | | | | | | - J Smith
- Stepping Hill Hospital, Stockport, UK
| | - R Prasad
- Royal AlbertEdward Infirmary, Wigan, UK
| | - A Doran
- Royal AlbertEdward Infirmary, Wigan, UK
| | - A Power
- Royal AlbertEdward Infirmary, Wigan, UK
| | | | - J Cannon
- Royal AlbertEdward Infirmary, Wigan, UK
| | - S Latham
- Royal AlbertEdward Infirmary, Wigan, UK
| | - P Arora
- Tameside General Hospital, Ashton-under-Lyne, UK
| | - S Ridgway
- Tameside General Hospital, Ashton-under-Lyne, UK
| | - M Coulding
- Tameside General Hospital, Ashton-under-Lyne, UK
| | - R Roberts
- Tameside General Hospital, Ashton-under-Lyne, UK
| | - M Absar
- North ManchesterGeneral Hospital, Manchester, UK
| | - T Hodgkiss
- North ManchesterGeneral Hospital, Manchester, UK
| | - K Connolly
- North ManchesterGeneral Hospital, Manchester, UK
| | - J Johnson
- North ManchesterGeneral Hospital, Manchester, UK
| | - K Doyle
- North ManchesterGeneral Hospital, Manchester, UK
| | - N Lunt
- Cancer Resource Centre, Macclesfield Hospital, Macclesfield, UK
| | - M Cooper
- Bristol Breast Care Centre, Southmead Hospital, Bristol, UK
| | - I Fuchs
- Bristol Breast Care Centre, Southmead Hospital, Bristol, UK
| | - L Peall
- Bristol Breast Care Centre, Southmead Hospital, Bristol, UK
| | - L Taylor
- Bristol Breast Care Centre, Southmead Hospital, Bristol, UK
| | - A Nicholson
- Bristol Breast Care Centre, Southmead Hospital, Bristol, UK
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17
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Smith K, Winstanley J, Boyle F, O'Reilly A, White M, Antill YC. Madarosis: a qualitative study to assess perceptions and experience of Australian patients with early breast cancer treated with taxane-based chemotherapy. Support Care Cancer 2017; 26:483-489. [PMID: 28831569 DOI: 10.1007/s00520-017-3852-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 09/27/2016] [Accepted: 08/15/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE Eyebrow and eyelash loss (madarosis) is a common and distressing side effect of chemotherapy for which no protective strategies have yet been developed. The purpose of this study was to develop an overview of perceptions and experiences of women undergoing taxane-based treatment for early breast cancer. METHODS A total of 25 women with a diagnosis of invasive early breast cancer participated in a focus group (n = 5), ages ranging from 35 to 64 (median 50), all had completed therapy with a taxane-based chemotherapy treatment. This focus group used targeted questions to explore participants' perceptions and experience of madarosis during and following chemotherapy and identified issues associated with impact of madarosis on quality of life (QoL). Thematic analysis was conducted to identify important issues experienced by participants. RESULTS Seven themes emerged from the data: (1) timing of regrowth and permanent changes, (2) meaning/importance of eyebrow/eyelashes, (3) preparedness/information given, (4) impact of the hair loss of self, (5) impact of hair loss on others, (6) physiological side effects of loss of eyebrows/eyelashes, and (7) management of loss of eyebrows/eyelashes. In addition, participants noted physical symptoms of eye irritation during their treatment that they attributed to madarosis. CONCLUSION This study highlights the significant impact of madarosis on patients, providing the first published analysis of patient's attitude and perception of eyelash and eyebrow loss during chemotherapy. Further research in this area is required and will be benefitted from the development of a dedicated instrument/questionnaire that can capture and measure the impact of madarosis on QoL and allow development of clinical trial strategies.
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Affiliation(s)
- K Smith
- Cabrini Hospital, Medical Oncology, Melbourne, Australia. .,Peter MacCallum Cancer Centre, Medical Oncology, 305 Grattan St, Melbourne, VIC, 3000, Australia.
| | - J Winstanley
- Patricia Ritchie Centre for Cancer Care and Research, University of Sydney-The Mater Hospital, Medical Oncology, Sydney, Australia
| | - F Boyle
- Patricia Ritchie Centre for Cancer Care and Research, University of Sydney-The Mater Hospital, Medical Oncology, Sydney, Australia
| | - A O'Reilly
- Patricia Ritchie Centre for Cancer Care and Research, University of Sydney-The Mater Hospital, Medical Oncology, Sydney, Australia
| | - M White
- Cabrini Hospital, Medical Oncology, Melbourne, Australia.,Monash Medical Centre, Medical Oncology, Melbourne, Australia
| | - Y C Antill
- Cabrini Hospital, Medical Oncology, Melbourne, Australia
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18
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Vivat B, Young TE, Winstanley J, Arraras JI, Black K, Boyle F, Bredart A, Costantini A, Guo J, Irarrazaval ME, Kobayashi K, Kruizinga R, Navarro M, Omidvari S, Rohde GE, Serpentini S, Spry N, Van Laarhoven HWM, Yang GM. The international phase 4 validation study of the EORTC QLQ-SWB32: A stand-alone measure of spiritual well-being for people receiving palliative care for cancer. Eur J Cancer Care (Engl) 2017; 26. [PMID: 28776784 DOI: 10.1111/ecc.12697] [Citation(s) in RCA: 17] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2017] [Indexed: 12/18/2022]
Abstract
The EORTC Quality of Life Group has just completed the final phase (field-testing and validation) of an international project to develop a stand-alone measure of spiritual well-being (SWB) for palliative cancer patients. Participants (n = 451)-from 14 countries on four continents; 54% female; 188 Christian; 50 Muslim; 156 with no religion-completed a provisional 36-item measure of SWB plus the EORTC QLQ-C15-PAL (PAL), then took part in a structured debriefing interview. All items showed good score distribution across response categories. We assessed scale structure using principal component analysis and Rasch analysis, and explored construct validity, and convergent/divergent validity with the PAL. Twenty-two items in four scoring scales (Relationship with Self, Relationships with Others, Relationship with Someone or Something Greater, and Existential) explained 53% of the variance. The measure also includes a global SWB item and nine other items. Scores on the PAL global quality-of-life item and Emotional Functioning scale weakly-moderately correlated with scores on the global SWB item and two of the four SWB scales. This new validated 32-item SWB measure addresses a distinct aspect of quality-of-life, and is now available for use in research and clinical practice, with a role as both a measurement and an intervention tool.
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Affiliation(s)
- B Vivat
- Marie Curie Palliative Care Research Department, Division of Psychiatry, Faculty of Medical Sciences, University College London, London, UK
| | - T E Young
- Supportive Oncology Research Team, East & North Hertfordshire NHS Trust including Mount Vernon Cancer Centre, Northwood, Middlesex, UK
| | - J Winstanley
- Patricia Ritchie Centre for Cancer Care, University of Sydney, North Sydney, NSW, Australia
| | - J I Arraras
- Department of Oncology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - K Black
- St Gemma's Hospice, Leeds, UK
| | - F Boyle
- Patricia Ritchie Centre for Cancer Care, University of Sydney, North Sydney, NSW, Australia
| | - A Bredart
- Psycho-Oncology Unit, Institut Curie, Paris, France
| | - A Costantini
- Sant'Andrea Hospital Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - J Guo
- Palliative Ward, Shengjing Hospital, China Medical University, Shenyang, Liaoning, China
| | | | - K Kobayashi
- Department of Respiratory Medicine, Saitama Medical University International Medical Centre, Saitama, Japan
| | - R Kruizinga
- Medical Oncology Academic Medical Centre, Amsterdam, The Netherlands
| | - M Navarro
- Coordinadora del Centro de Apoyo para la Atención Integral, Division de Investigación Clínica, Instituto Nacional de Cancerologia, Mexico DF, Mexico
| | - S Omidvari
- Health Metrics Research Centre, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
| | - G E Rohde
- Faculty of Health & Sport Sciences, University of Agder & Sorlandet Hospital, Kristiansand, Norway
| | - S Serpentini
- Unit of Psychoncology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - N Spry
- Oncology Department, Faculty of Medicine Dentistry and Health Sciences, University of Western Australia, Crawley, WA, Australia
| | | | - G M Yang
- National Cancer Centre Singapore 2, Lien Centre for Palliative Care, Singapore
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19
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Hammarberg K, Sullivan E, Javid N, Duncombe G, Halliday L, Boyle F, Saunders C, Ives A, Dickinson J, Fisher J. Health care experiences among women diagnosed with gestational breast cancer. Eur J Cancer Care (Engl) 2017; 27:e12682. [DOI: 10.1111/ecc.12682] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2017] [Indexed: 11/30/2022]
Affiliation(s)
- K. Hammarberg
- Jean Hailes Research Unit; School of Public Health and Preventive Medicine; Monash University; Melbourne Vic. Australia
| | - E. Sullivan
- Faculty of Health; University of Technology Sydney; Sydney NSW Australia
| | - N. Javid
- Faculty of Health; University of Technology Sydney; Sydney NSW Australia
| | - G. Duncombe
- Exosome Biology Laboratory; Centre for Clinical Diagnostics; University of Queensland; Brisbane Qld Australia
- Centre for Clinical Research; Royal Brisbane and Women's Hospital; University of Queensland; Brisbane Qld Australia
| | - L. Halliday
- Faculty of Medicine and Health Sciences; Macquarie University; Sydney NSW Australia
| | - F. Boyle
- Patricia Ritchie Centre for Cancer Care and Research; Mater Hospital North Sydney; North Sydney NSW Australia
- University of Sydney; Sydney NSW Australia
| | - C. Saunders
- School of Surgery; The University of Western Australia; Perth WA Australia
| | - A. Ives
- Cancer Palliative Care Research and Evaluation Unit; School of Surgery; The University of Western Australia; Perth WA Australia
| | - J.E. Dickinson
- School of Women's and Infants’ Health; The University of Western Australia; Perth WA Australia
| | - J. Fisher
- Jean Hailes Research Unit; School of Public Health and Preventive Medicine; Monash University; Melbourne Vic. Australia
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20
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Azim HA, Sonnenblick A, Agbor-Tarh D, Bradbury I, Daly F, Huang Y, Dueck AC, Pritchard K, Wolff AC, Jackisch C, Lang I, Untch M, Smith I, Boyle F, Xu B, Gomez H, Perez E, Piccart M, de Azambuja E. Abstract PD5-07: The impact of early lapatinib-induced rash on disease-free and overall survival in patients treated within the ALTTO phase III randomized trial. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-pd5-07] [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: 11/16/2022]
Abstract
Abstract
Background: We have previously shown in a phase III neoadjuvant trial that early development of lapatinib-induced rash (i.e. within 6 weeks after lapatinib initiation) is independently associated with a higher chance of obtaining a pathological complete response (Azim et al; JCO 2013). In the current study, we aimed to investigate whether early lapatinib-induced rash is associated with improved survival in the context of a large phase III adjuvant trial.
Methods: This analysis is based on the ALTTO trial (BIG 2-06, Alliance N063D), in which patients with HER2-positive early breast cancer were randomized to adjuvant trastuzumab, lapatinib, their sequence or their combination for a total duration of 1 year. In this sub-study, we evaluated whether the development of rash (any grade) within 6 weeks of lapatinib initiation was associated with disease-free (DFS) and overall survival (OS). All analyses were tested in a multivariate model adjusted for treatment arm, treatment completion and trial stratification factors.
Results: A total of 6,098 lapatinib-treated patients were included in the current analysis; of whom 2,006 patients (32.9%) developed early lapatinib-induced rash, 1,025 (16.8%) developed rash after 6 weeks and 3,067 (50.3%) did not develop rash. No differences in patient characteristics were observed between the three groups apart from a higher frequency of younger patients (≤ 50) in the early rash group (54% vs. 47% and 44%, p<0.0001). At a median follow-up of 4.5 years, 876 (14.37%) and 377 (6.18%) patients in the lapatinib containing arms experienced a DFS and OS event, respectively. In a multivariate analysis confined to patients randomized to the lapatinib containing arms, the development of early rash was associated with improved DFS (HR: 0.80; 95%CI: 0.69-0.93, p=0.004) and OS (HR: 0.61; 95%CI: 0.48 - 0.78, p<0.001) compared to patients who did not develop early rash, with no interaction according to patient's age (p=0.9). No significant association was observed between the development of rash after 6 weeks of lapatinib initiation and survival. Compared to patients randomized to the trastuzumab alone arm (n=2,076), patients who developed early rash in the sequence (n=580) or combination (n=704) arms of trastuzumab/lapatinib had superior DFS (Sequence: HR 0.75 [95% CI: 0.58 – 0.98], p=0.034; Combination: HR 0.69 [95% CI: 0.54 – 0.89], p=0.005) and OS (Sequence: HR 0.57 [95%CI: 0.36 – 0.88], p=0.012; Combination: HR 0.59 [95% CI: 0.39 – 0.89], p=0.011). On the other hand, patients randomized to the lapatinib only arm who developed early rash (n=722) still had inferior DFS (HR 1.28 [95% CI: 1.04 – 1.59], p=0.02) with no difference in OS (HR: 0.95; 95%CI: 0.67 – 1.35, p=0.79) compared to patients randomized to the trastuzumab alone arm.
Conclusions: The results support our previous findings in the neoadjuvant setting that early development of skin rash within the first 6 weeks can identify patients who derive superior benefit of lapatinib treatment.
Citation Format: Azim Jr HA, Sonnenblick A, Agbor-Tarh D, Bradbury I, Daly F, Huang Y, Dueck AC, Pritchard K, Wolff AC, Jackisch C, Lang I, Untch M, Smith I, Boyle F, Xu B, Gomez H, Perez E, Piccart M, de Azambuja E. The impact of early lapatinib-induced rash on disease-free and overall survival in patients treated within the ALTTO phase III randomized trial. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr PD5-07.
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Affiliation(s)
- HA Azim
- Institut Jules Bordet, Belgium; Frontier Science Scotland, United Kingdom; Novartis; Mayo Clinic Cancer Center; Sunnybrook Odette Cancer Centre, Canada; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Sana Klinikum Offenbach, Germany; National Institute of Oncology, Hungary; Helios Klinikum Berlin-Buch, Germany; Royal Marsden Hospital, United Kingdom; Mater Hospital, Australia; Chinese Academy of Medical Sciences and Peking Union Medical College, China; Instituto Nacional de Enfermedades Neoplasicas Universidad Peruana Cayetano Heredia, Peru
| | - A Sonnenblick
- Institut Jules Bordet, Belgium; Frontier Science Scotland, United Kingdom; Novartis; Mayo Clinic Cancer Center; Sunnybrook Odette Cancer Centre, Canada; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Sana Klinikum Offenbach, Germany; National Institute of Oncology, Hungary; Helios Klinikum Berlin-Buch, Germany; Royal Marsden Hospital, United Kingdom; Mater Hospital, Australia; Chinese Academy of Medical Sciences and Peking Union Medical College, China; Instituto Nacional de Enfermedades Neoplasicas Universidad Peruana Cayetano Heredia, Peru
| | - D Agbor-Tarh
- Institut Jules Bordet, Belgium; Frontier Science Scotland, United Kingdom; Novartis; Mayo Clinic Cancer Center; Sunnybrook Odette Cancer Centre, Canada; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Sana Klinikum Offenbach, Germany; National Institute of Oncology, Hungary; Helios Klinikum Berlin-Buch, Germany; Royal Marsden Hospital, United Kingdom; Mater Hospital, Australia; Chinese Academy of Medical Sciences and Peking Union Medical College, China; Instituto Nacional de Enfermedades Neoplasicas Universidad Peruana Cayetano Heredia, Peru
| | - I Bradbury
- Institut Jules Bordet, Belgium; Frontier Science Scotland, United Kingdom; Novartis; Mayo Clinic Cancer Center; Sunnybrook Odette Cancer Centre, Canada; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Sana Klinikum Offenbach, Germany; National Institute of Oncology, Hungary; Helios Klinikum Berlin-Buch, Germany; Royal Marsden Hospital, United Kingdom; Mater Hospital, Australia; Chinese Academy of Medical Sciences and Peking Union Medical College, China; Instituto Nacional de Enfermedades Neoplasicas Universidad Peruana Cayetano Heredia, Peru
| | - F Daly
- Institut Jules Bordet, Belgium; Frontier Science Scotland, United Kingdom; Novartis; Mayo Clinic Cancer Center; Sunnybrook Odette Cancer Centre, Canada; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Sana Klinikum Offenbach, Germany; National Institute of Oncology, Hungary; Helios Klinikum Berlin-Buch, Germany; Royal Marsden Hospital, United Kingdom; Mater Hospital, Australia; Chinese Academy of Medical Sciences and Peking Union Medical College, China; Instituto Nacional de Enfermedades Neoplasicas Universidad Peruana Cayetano Heredia, Peru
| | - Y Huang
- Institut Jules Bordet, Belgium; Frontier Science Scotland, United Kingdom; Novartis; Mayo Clinic Cancer Center; Sunnybrook Odette Cancer Centre, Canada; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Sana Klinikum Offenbach, Germany; National Institute of Oncology, Hungary; Helios Klinikum Berlin-Buch, Germany; Royal Marsden Hospital, United Kingdom; Mater Hospital, Australia; Chinese Academy of Medical Sciences and Peking Union Medical College, China; Instituto Nacional de Enfermedades Neoplasicas Universidad Peruana Cayetano Heredia, Peru
| | - AC Dueck
- Institut Jules Bordet, Belgium; Frontier Science Scotland, United Kingdom; Novartis; Mayo Clinic Cancer Center; Sunnybrook Odette Cancer Centre, Canada; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Sana Klinikum Offenbach, Germany; National Institute of Oncology, Hungary; Helios Klinikum Berlin-Buch, Germany; Royal Marsden Hospital, United Kingdom; Mater Hospital, Australia; Chinese Academy of Medical Sciences and Peking Union Medical College, China; Instituto Nacional de Enfermedades Neoplasicas Universidad Peruana Cayetano Heredia, Peru
| | - K Pritchard
- Institut Jules Bordet, Belgium; Frontier Science Scotland, United Kingdom; Novartis; Mayo Clinic Cancer Center; Sunnybrook Odette Cancer Centre, Canada; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Sana Klinikum Offenbach, Germany; National Institute of Oncology, Hungary; Helios Klinikum Berlin-Buch, Germany; Royal Marsden Hospital, United Kingdom; Mater Hospital, Australia; Chinese Academy of Medical Sciences and Peking Union Medical College, China; Instituto Nacional de Enfermedades Neoplasicas Universidad Peruana Cayetano Heredia, Peru
| | - AC Wolff
- Institut Jules Bordet, Belgium; Frontier Science Scotland, United Kingdom; Novartis; Mayo Clinic Cancer Center; Sunnybrook Odette Cancer Centre, Canada; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Sana Klinikum Offenbach, Germany; National Institute of Oncology, Hungary; Helios Klinikum Berlin-Buch, Germany; Royal Marsden Hospital, United Kingdom; Mater Hospital, Australia; Chinese Academy of Medical Sciences and Peking Union Medical College, China; Instituto Nacional de Enfermedades Neoplasicas Universidad Peruana Cayetano Heredia, Peru
| | - C Jackisch
- Institut Jules Bordet, Belgium; Frontier Science Scotland, United Kingdom; Novartis; Mayo Clinic Cancer Center; Sunnybrook Odette Cancer Centre, Canada; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Sana Klinikum Offenbach, Germany; National Institute of Oncology, Hungary; Helios Klinikum Berlin-Buch, Germany; Royal Marsden Hospital, United Kingdom; Mater Hospital, Australia; Chinese Academy of Medical Sciences and Peking Union Medical College, China; Instituto Nacional de Enfermedades Neoplasicas Universidad Peruana Cayetano Heredia, Peru
| | - I Lang
- Institut Jules Bordet, Belgium; Frontier Science Scotland, United Kingdom; Novartis; Mayo Clinic Cancer Center; Sunnybrook Odette Cancer Centre, Canada; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Sana Klinikum Offenbach, Germany; National Institute of Oncology, Hungary; Helios Klinikum Berlin-Buch, Germany; Royal Marsden Hospital, United Kingdom; Mater Hospital, Australia; Chinese Academy of Medical Sciences and Peking Union Medical College, China; Instituto Nacional de Enfermedades Neoplasicas Universidad Peruana Cayetano Heredia, Peru
| | - M Untch
- Institut Jules Bordet, Belgium; Frontier Science Scotland, United Kingdom; Novartis; Mayo Clinic Cancer Center; Sunnybrook Odette Cancer Centre, Canada; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Sana Klinikum Offenbach, Germany; National Institute of Oncology, Hungary; Helios Klinikum Berlin-Buch, Germany; Royal Marsden Hospital, United Kingdom; Mater Hospital, Australia; Chinese Academy of Medical Sciences and Peking Union Medical College, China; Instituto Nacional de Enfermedades Neoplasicas Universidad Peruana Cayetano Heredia, Peru
| | - I Smith
- Institut Jules Bordet, Belgium; Frontier Science Scotland, United Kingdom; Novartis; Mayo Clinic Cancer Center; Sunnybrook Odette Cancer Centre, Canada; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Sana Klinikum Offenbach, Germany; National Institute of Oncology, Hungary; Helios Klinikum Berlin-Buch, Germany; Royal Marsden Hospital, United Kingdom; Mater Hospital, Australia; Chinese Academy of Medical Sciences and Peking Union Medical College, China; Instituto Nacional de Enfermedades Neoplasicas Universidad Peruana Cayetano Heredia, Peru
| | - F Boyle
- Institut Jules Bordet, Belgium; Frontier Science Scotland, United Kingdom; Novartis; Mayo Clinic Cancer Center; Sunnybrook Odette Cancer Centre, Canada; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Sana Klinikum Offenbach, Germany; National Institute of Oncology, Hungary; Helios Klinikum Berlin-Buch, Germany; Royal Marsden Hospital, United Kingdom; Mater Hospital, Australia; Chinese Academy of Medical Sciences and Peking Union Medical College, China; Instituto Nacional de Enfermedades Neoplasicas Universidad Peruana Cayetano Heredia, Peru
| | - B Xu
- Institut Jules Bordet, Belgium; Frontier Science Scotland, United Kingdom; Novartis; Mayo Clinic Cancer Center; Sunnybrook Odette Cancer Centre, Canada; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Sana Klinikum Offenbach, Germany; National Institute of Oncology, Hungary; Helios Klinikum Berlin-Buch, Germany; Royal Marsden Hospital, United Kingdom; Mater Hospital, Australia; Chinese Academy of Medical Sciences and Peking Union Medical College, China; Instituto Nacional de Enfermedades Neoplasicas Universidad Peruana Cayetano Heredia, Peru
| | - H Gomez
- Institut Jules Bordet, Belgium; Frontier Science Scotland, United Kingdom; Novartis; Mayo Clinic Cancer Center; Sunnybrook Odette Cancer Centre, Canada; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Sana Klinikum Offenbach, Germany; National Institute of Oncology, Hungary; Helios Klinikum Berlin-Buch, Germany; Royal Marsden Hospital, United Kingdom; Mater Hospital, Australia; Chinese Academy of Medical Sciences and Peking Union Medical College, China; Instituto Nacional de Enfermedades Neoplasicas Universidad Peruana Cayetano Heredia, Peru
| | - E Perez
- Institut Jules Bordet, Belgium; Frontier Science Scotland, United Kingdom; Novartis; Mayo Clinic Cancer Center; Sunnybrook Odette Cancer Centre, Canada; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Sana Klinikum Offenbach, Germany; National Institute of Oncology, Hungary; Helios Klinikum Berlin-Buch, Germany; Royal Marsden Hospital, United Kingdom; Mater Hospital, Australia; Chinese Academy of Medical Sciences and Peking Union Medical College, China; Instituto Nacional de Enfermedades Neoplasicas Universidad Peruana Cayetano Heredia, Peru
| | - M Piccart
- Institut Jules Bordet, Belgium; Frontier Science Scotland, United Kingdom; Novartis; Mayo Clinic Cancer Center; Sunnybrook Odette Cancer Centre, Canada; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Sana Klinikum Offenbach, Germany; National Institute of Oncology, Hungary; Helios Klinikum Berlin-Buch, Germany; Royal Marsden Hospital, United Kingdom; Mater Hospital, Australia; Chinese Academy of Medical Sciences and Peking Union Medical College, China; Instituto Nacional de Enfermedades Neoplasicas Universidad Peruana Cayetano Heredia, Peru
| | - E de Azambuja
- Institut Jules Bordet, Belgium; Frontier Science Scotland, United Kingdom; Novartis; Mayo Clinic Cancer Center; Sunnybrook Odette Cancer Centre, Canada; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Sana Klinikum Offenbach, Germany; National Institute of Oncology, Hungary; Helios Klinikum Berlin-Buch, Germany; Royal Marsden Hospital, United Kingdom; Mater Hospital, Australia; Chinese Academy of Medical Sciences and Peking Union Medical College, China; Instituto Nacional de Enfermedades Neoplasicas Universidad Peruana Cayetano Heredia, Peru
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van den Hurk CJG, Winstanley J, Young A, Boyle F. Measurement of chemotherapy-induced alopecia-time to change. Support Care Cancer 2015; 23:1197-9. [PMID: 25663579 DOI: 10.1007/s00520-015-2647-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 01/29/2015] [Indexed: 10/24/2022]
Abstract
Data on chemotherapy-induced alopecia (CIA) as a side effect of cancer treatment are scarce. CIA is given minimal attention in clinical trials and in the literature. However, when asking the patients with cancer for their opinion, CIA appears to have a major impact, particularly on body image and quality of life. Currently, there is no commonly used measure to evaluate CIA; It is time to improve the management and measurement of CIA.
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Affiliation(s)
- C J G van den Hurk
- Netherlands Comprehensive Cancer Organisation, Eindhoven, The Netherlands,
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22
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Flenady V, Boyle F, Koopmans L, Wilson T, Stones W, Cacciatore J. Meeting the needs of parents after a stillbirth or neonatal death. BJOG 2014; 121 Suppl 4:137-40. [PMID: 25236648 DOI: 10.1111/1471-0528.13009] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2014] [Indexed: 11/28/2022]
Abstract
The death of a child around the time of birth is one of the most profoundly distressing events any parent will experience. These deaths are not uncommon, but are often hidden, along with the grief of mothers, fathers and families. Social stigma and negative attitudes are inextricably linked to underreporting of babies’ deaths in low- and middle-income countries. A failure to recognise the value of these lost lives leads to disenfranchised grief and diminished preventive efforts to reduce stillbirth and neonatal deaths. Acknowledging these deaths to bring them ‘out of the shadows’17 and compassionate, respectful care for parents suffering perinatal loss, irrespective of country or resources, are critical to addressing the totality of the burden of this public health problem.
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Affiliation(s)
- V Flenady
- Translating Research into Practice Centre, Mater Research Institute, Mater Health Services, University of Queensland, South Brisbane, Qld, Australia; International Stillbirth Alliance, Bristol, UK
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Perez E, Holmes E, De Azambuja E, Dueck A, Baselga J, Viale G, Zujewski J, Goldhirsch A, Crescenzo R, Pritchard K, Wolff A, Jackisch C, Láng I, Untch M, Smith I, Boyle F, Xu B, Gomez H, Gelber R, Piccart M. Disease-Free Survival (Dfs) in the Lapatinib Alone Arm and Expanded Results of the Phase III Altto Trial (Big 2-06; Ncctg (Alliance) N063D) in the Adjuvant Treatment of Her2-Positive Early Breast Cancer (Ebc). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu438.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Juraskova I, Butow P, Bonner C, Bell ML, Smith AB, Seccombe M, Boyle F, Reaby L, Cuzick J, Forbes JF. Improving decision making about clinical trial participation - a randomised controlled trial of a decision aid for women considering participation in the IBIS-II breast cancer prevention trial. Br J Cancer 2014; 111:1-7. [PMID: 24892447 PMCID: PMC4090720 DOI: 10.1038/bjc.2014.144] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [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: 11/24/2013] [Revised: 02/11/2013] [Accepted: 02/24/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Decision aids may improve informed consent in clinical trial recruitment, but have not been evaluated in this context. This study investigated whether decision aids (DAs) can reduce decisional difficulties among women considering participation in the International Breast Cancer Intervention Study-II (IBIS-II) trial. METHODS The IBIS-II trial investigated breast cancer prevention with anastrazole in two cohorts: women with increased risk (Prevention), and women treated for ductal carcinoma in situ (DCIS). Australia, New Zealand and United Kingdom participants were randomised to receive a DA (DA group) or standard trial consent materials (control group). Questionnaires were completed after deciding about participation in IBIS-II (post decision) and 3 months later (follow-up). RESULTS Data from 112 Prevention and 34 DCIS participants were analysed post decision (73 DA; 73 control); 95 Prevention and 24 DCIS participants were analysed at follow-up (58 DA; 61 control). There was no effect on the primary outcome of decisional conflict. The DCIS-DA group had higher knowledge post decision, and the Prevention-DA group had lower decisional regret at follow-up. CONCLUSIONS This was the first study to evaluate a DA in the clinical trial setting. The results suggest DAs can potentially increase knowledge and reduce decisional regret about clinical trial participation.
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Affiliation(s)
- I Juraskova
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney 2006, Australia
| | - P Butow
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney 2006, Australia
| | - C Bonner
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney 2006, Australia
| | - M L Bell
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney 2006, Australia
| | - A B Smith
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney 2006, Australia
| | - M Seccombe
- Australia and New Zealand Breast Cancer Trials Group, Australia University of Newcastle, Newcastle 2306, Australia
| | - F Boyle
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney 2006, Australia
- Australia and New Zealand Breast Cancer Trials Group, Australia University of Newcastle, Newcastle 2306, Australia
- Pam McLean Centre, The University of Sydney, Sydney 2006, Australia
| | - L Reaby
- Australia and New Zealand Breast Cancer Trials Group, Australia University of Newcastle, Newcastle 2306, Australia
| | - J Cuzick
- Cancer Research UK, Department of Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine, Queen Mary College, University of London, London E1 4NS, UK
| | - J F Forbes
- Australia and New Zealand Breast Cancer Trials Group, Australia University of Newcastle, Newcastle 2306, Australia
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Butow P, Brown R, Aldridge J, Juraskova I, Zoller P, Boyle F, Wilson M, Bernhard J. Can consultation skills training change doctors' behaviour to increase involvement of patients in making decisions about standard treatment and clinical trials: a randomized controlled trial. Health Expect 2014; 18:2570-83. [PMID: 24975503 DOI: 10.1111/hex.12229] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Informed consent is required for both standard cancer treatments and experimental cancer treatments in a clinical trial. Effective and sensitive physician-patient communication about informed consent is difficult to achieve. Our aim was to train doctors in clear, collaborative and ethical communication about informed consent and evaluate the impact of training on doctor behaviour, stress and satisfaction. PARTICIPANTS AND METHODS Participants were 21 oncologists from 10 Australian/New Zealand (ANZ) centres and 41 oncologists from 10 Swiss/German/Austrian (SGA) centres. Oncologists were randomized to participate in a 1-day workshop or not. Patients were recruited before and after the training. Doctors were asked to submit 1-2 audiotaped consultations before and after training. Doctors completed outcome measures before and after completing the post-training cohort recruitment. RESULTS Ninety-five consultation interactions were audiotaped. Doctors strongly endorsed the training. ANZ intervention doctors demonstrated a significant increase in collaborative communication (P = 0.03). There was no effect of training on other doctor behaviours. Trained doctors did not demonstrate reduced stress and burnout. Patient outcomes are presented elsewhere. CONCLUSIONS Training can improve some aspects of the process of obtaining informed consent. Methods to increase the impact of training are required and may include longer training and more intensive follow-up.
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Affiliation(s)
- P Butow
- Centre for Medical Psychology and Evidence-based Decision-Making (CeMPED), University of Sydney, Sydney, NSW, Australia
| | - R Brown
- Department of Social and Behavioral Health, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - J Aldridge
- International Breast Cancer Study Group (IBCSG) Statistical Centre, Department of Biostatistics & Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - I Juraskova
- Centre for Medical Psychology and Evidence-based Decision-Making (CeMPED), University of Sydney, Sydney, NSW, Australia
| | - P Zoller
- Quality of Life Office, IBCSG Coordinating Center and Department of Medical Oncology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - F Boyle
- Pam McLean Centre, Northern Clinical School, University of Sydney, Sydney, NSW, Australia
| | - M Wilson
- Department of Social and Behavioral Health, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - J Bernhard
- Quality of Life Office, IBCSG Coordinating Center and Department of Medical Oncology, Inselspital, Bern University Hospital, Bern, Switzerland
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McCarthy N, Boyle F, Zdenkowski N, Bull J, Leong E, Simpson A, Kannourakis G, Francis PA, Chirgwin J, Abdi E, Gebski V, Veillard AS, Zannino D, Wilcken N, Reaby L, Lindsay DF, Badger HD, Forbes JF. Neoadjuvant chemotherapy with sequential anthracycline-docetaxel with gemcitabine for large operable or locally advanced breast cancer: ANZ 0502 (NeoGem). Breast 2014; 23:142-51. [PMID: 24393617 DOI: 10.1016/j.breast.2013.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 11/04/2013] [Accepted: 12/04/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Neoadjuvant chemotherapy has a sound rationale for use in women with large operable breast cancer, and achievement of pathological complete response (pCR) is prognostic. Epirubicin and cyclophosphamide followed by docetaxel is a standard chemotherapy regimen for early breast cancer. In metastatic breast cancer the combination of gemcitabine and a taxane has shown promising results. This phase II study investigated the efficacy and safety of incorporating gemcitabine into neoadjuvant therapy. METHODS Female patients with operable breast cancer that was clinically T2 (≥3 cm) or T3-4, N0-1, M0 were enrolled to receive 24 weeks of neoadjuvant chemotherapy using epirubicin and cyclophosphamide followed by docetaxel and gemcitabine, plus trastuzumab if HER2-positive. The primary endpoint was the pathological complete response (pCR) rate in the breast in separate HER2-negative and HER2-positive cohorts. Secondary endpoints included pCR in both the breast and axillary lymph nodes, clinical and radiological response rates, disease free survival and safety. RESULTS 81 patients were enrolled: 63 HER2-negative and 18 HER2-positive. 67 (84%) completed all cycles of chemotherapy, and 78 (96%) proceeded to surgery. pCR was achieved by 12 (20%) patients with HER2-negative, and 9 (53%) with HER2-positive disease. At the first interim analysis, addition of prophylactic G-CSF was recommended due to excess neutropenia. The HER2-negative cohort was closed to accrual because it did not meet the pre-specified target for pCR, and the HER2-positive cohort was closed due to slow accrual. At a median follow-up of 24 months, 12 of 81 (15%) patients had experienced a relapse of their breast cancer. CONCLUSION Neoadjuvant gemcitabine, when added to docetaxel, after epirubicin and cyclophosphamide, did not reach the pre-specified expectations for pCR rate in HER2-negative tumours. Excess neutropenia was observed, requiring growth factor support. Addition of gemcitabine to docetaxel in this schedule cannot be recommended. Australia and New Zealand Clinical Trials Registry (www.anzctr.org.au) registration number ACTRN12606000191594.
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Affiliation(s)
- N McCarthy
- Cancer Care Services, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Brisbane, QLD 4029, Australia; University of Queensland, Brisbane, QLD, Australia.
| | - F Boyle
- The Mater Hospital, Sydney, NSW, Australia; University of Sydney, Sydney, NSW, Australia
| | - N Zdenkowski
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia; University of Newcastle, Newcastle, NSW, Australia
| | - J Bull
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia
| | - E Leong
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia
| | - A Simpson
- Wellington Cancer Centre, Wellington Hospital, Wellington, New Zealand
| | - G Kannourakis
- Ballarat Oncology and Haematology Service, Ballarat, VIC, Australia
| | - P A Francis
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Department of Medicine, St. Vincent's Hospital, University of Melbourne, VIC, Australia
| | - J Chirgwin
- University of Newcastle, Newcastle, NSW, Australia; Box Hill Hospital, Box Hill, VIC, Australia; Maroondah Breast Clinic, Maroondah Hospital, Ringwood East, VIC, Australia; Monash University, VIC, Australia
| | - E Abdi
- Tweed Hospital, Tweed Heads, NSW, Australia; Griffith University- Gold Coast, Southport, QLD, Australia
| | - V Gebski
- National Health and Medical Research Council Clinical Trials Centre, Sydney, NSW, Australia
| | - A S Veillard
- National Health and Medical Research Council Clinical Trials Centre, Sydney, NSW, Australia
| | - D Zannino
- National Health and Medical Research Council Clinical Trials Centre, Sydney, NSW, Australia
| | - N Wilcken
- Westmead Cancer Care Centre, Westmead Hospital, University of Sydney, NSW, Australia
| | - L Reaby
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia
| | - D F Lindsay
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia
| | - H D Badger
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia
| | - J F Forbes
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia; University of Newcastle, Newcastle, NSW, Australia; Department of Surgical Oncology, Calvary Mater Newcastle, Newcastle, NSW, Australia
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Boyle F, Kemp A, Preen DB, Saunders C, Bulsara M, Malacova E, Roughead EE. Abstract P1-13-16: Women commencing with anastrozole, letrozole or tamoxifen: The impact of comorbidity and demographics on initial choice. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p1-13-16] [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: 11/16/2022]
Abstract
Abstract
Background: Australian clinical guidelines recommend post-surgical endocrine therapy for all women with early, hormone-dependent breast cancer. Guidelines specify tamoxifen as first-line therapy for pre-menopausal women, and either tamoxifen or an aromatase inhibitor for post-menopausal women depending on their risk of recurrence which is based on tumour size and other prognostic indicators. Tamoxifen and the aromatase inhibitors have different side effect profiles and therefore comorbidity may also influence choice of therapy. We examined comorbidities, and the clinical and demographic characteristics of women initiated on different endocrine therapies for breast cancer in Australian practice.
Method: We identified the first dispensing of tamoxifen, anastrozole or letrozole for women diagnosed with invasive breast cancer in the 45 and Up Study between January 2003 and December 2009 (n = 1383). Unit-level pharmacy and medical service claims, hospital separations, and Cancer Registry records were linked to self-reported data to determine menopause status at diagnosis, tumour size, age, change in subsidy restrictions, and specified comorbidities which may affect choice of therapy (i.e. arthritis, endometrial cancer, osteoporosis, thromboembolism). Chi-square tests and multivariate generalised linear models were used to compare the characteristics of post-menopausal women initiated on different therapies.
Results: The majority of pre-menopausal women commenced therapy with tamoxifen (93%). Tamoxifen was the predominant therapy for post-menopausal women with tumours ≤1cm (54%), and anastrozole most common for those with larger tumours (49%). Post-menopausal women with osteoporosis were less likely to commence an aromatase inhibitor compared with tamoxifen (anastrozole RR = 0.7, 95%CI = 0.5-0.9, P = 0.019; letrozole RR = 0.6, 95%CI = 0.3-0.9, P = 0.033) and those with arthritis were 1.6-times more likely to commence with letrozole than anastrozole (95%CI = 1.6-2.3, P = 0.004). Tamoxifen was more likely to be initiated in women with large tumours who also had comorbid arthritis or were aged ≥75 years. Changes in subsidy restrictions were associated with significant increases in the proportion of post-menopausal women commencing an aromatase inhibitor rather than tamoxifen (anastrozole RR = 7.0; letrozole RR = 18.5).
Conclusions: The findings show clinical guidelines regarding endocrine therapies are being followed in Australian practice, particularly in relation to menopause status and tumour size as a recurrence risk factor. The findings also indicate there is interplay of comorbidity and choice of therapy for older women and those with arthritis or osteoporosis.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-13-16.
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Affiliation(s)
- F Boyle
- The Mater Hospital, Sydney, New South Wales, Australia; The University of Western Australia, Perth, Western Australia, Australia; University of Notre Dame, Perth, Western Australia, Australia; University of South Australia, Adelaide, South Australia, Australia
| | - A Kemp
- The Mater Hospital, Sydney, New South Wales, Australia; The University of Western Australia, Perth, Western Australia, Australia; University of Notre Dame, Perth, Western Australia, Australia; University of South Australia, Adelaide, South Australia, Australia
| | - DB Preen
- The Mater Hospital, Sydney, New South Wales, Australia; The University of Western Australia, Perth, Western Australia, Australia; University of Notre Dame, Perth, Western Australia, Australia; University of South Australia, Adelaide, South Australia, Australia
| | - C Saunders
- The Mater Hospital, Sydney, New South Wales, Australia; The University of Western Australia, Perth, Western Australia, Australia; University of Notre Dame, Perth, Western Australia, Australia; University of South Australia, Adelaide, South Australia, Australia
| | - M Bulsara
- The Mater Hospital, Sydney, New South Wales, Australia; The University of Western Australia, Perth, Western Australia, Australia; University of Notre Dame, Perth, Western Australia, Australia; University of South Australia, Adelaide, South Australia, Australia
| | - E Malacova
- The Mater Hospital, Sydney, New South Wales, Australia; The University of Western Australia, Perth, Western Australia, Australia; University of Notre Dame, Perth, Western Australia, Australia; University of South Australia, Adelaide, South Australia, Australia
| | - EE Roughead
- The Mater Hospital, Sydney, New South Wales, Australia; The University of Western Australia, Perth, Western Australia, Australia; University of Notre Dame, Perth, Western Australia, Australia; University of South Australia, Adelaide, South Australia, Australia
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Thewes B, Bell ML, Butow P, Beith J, Boyle F, Friedlander M, McLachlan SA. Psychological morbidity and stress but not social factors influence level of fear of cancer recurrence in young women with early breast cancer: results of a cross-sectional study. Psychooncology 2013; 22:2797-806. [PMID: 24038525 DOI: 10.1002/pon.3348] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [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: 12/11/2012] [Revised: 06/09/2013] [Accepted: 06/10/2013] [Indexed: 11/12/2022]
Abstract
BACKGROUND Fear of cancer recurrence (FCR) is a common problem amongst survivors. Past research has shown that young women with breast cancer are particularly vulnerable to FCR, yet few previous studies have specifically examined FCR in this subgroup. AIMS The aim of the study is to explore the relationship between FCR, psychological morbidity and social factors. A secondary aim was to explore the relationship between clinical levels of FCR and generalised anxiety disorder (GAD) and hypochondriasis. METHOD Two hundred eighteen breast cancer survivors (aged 18-45 years at diagnosis) diagnosed at least 1 year prior were recruited through seven metropolitan oncology clinics and two breast cancer consumer groups. Participants completed a web-based questionnaire, which assessed FCR, psychological functioning, generalised anxiety, hypochondriasis and items exploring past cancer-related experiences, attitudes to future childbearing, social support and correlates were identified using linear regression. RESULTS Psychological morbidity scales measuring anxiety and psychological functioning and stressful life events were significantly associated with FCR in adjusted and unadjusted models (p < 0.0001). Past cancer experiences, children, social support and attitudes to childrearing were not associated with FCR. Among those with clinical levels of FCR (n = 152), 43% met screening criteria for hypochondriasis, and 36% met screening criteria for GAD. CONCLUSIONS This study shows psychological morbidity is associated with FCR, but the majority of women with high levels of FCR do not also meet the criteria for a clinical level of GAD or hypochondriasis. Understanding the factors that make young women vulnerable to FCR is important to help guide the development of FCR-specific interventions for this subgroup.
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Affiliation(s)
- B Thewes
- Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, University of Sydney, Sydney, New South Wales, Australia
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Cameron BA, Bennett B, Li H, Boyle F, deSouza P, Wilcken N, Friedlander M, Goldstein D, Lloyd AR. Post-cancer fatigue is not associated with immune activation or altered cytokine production. Ann Oncol 2012; 23:2890-2895. [PMID: 22674147 DOI: 10.1093/annonc/mds108] [Citation(s) in RCA: 15] [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: 10/06/2023] Open
Abstract
BACKGROUND Prolonged fatigue after cancer treatment is common. The pathophysiology of such post-cancer fatigue (PCF) is unknown, although cross-sectional studies suggest increased pro-inflammatory cytokine production. This study investigated the association between cytokine levels and fatigue from the time of treatment to 12 months later. PATIENTS AND METHODS A representative nested case-control series was derived from a prospective cohort of women treated for early-stage breast cancer, including 13 PCF cases and 15 matched control subjects who recovered uneventfully. Serum levels and in vitro production of the cytokines interleukin (IL)-1α, IL-2, interferon (IFN)-γ, IL-4, IL-6, IL-10, IL-12, and tumour necrosis factor (TNF)-β were measured by multiplex immunoassay in longitudinally collected samples. In addition, serum levels of neopterin and the anti-inflammatory regulators, IL-1 receptor antagonist, sIL-6R, and sTNF-rII, were assayed by enzyme-linked immunosorbent assay. Flow cytometric analysis of activated leukocyte subsets was performed. RESULTS No significant differences in any of these parameters were found between cases and control subjects. Cytokine levels and symptoms showed no clear correlation pattern. CONCLUSION The findings in this well-characterised subject group argue against the notion that PCF is mediated by peripheral inflammation.
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Affiliation(s)
- B A Cameron
- Infection and Inflammation Research Centre, School of Medical Sciences, University of New South Wales, Sydney.
| | - B Bennett
- Infection and Inflammation Research Centre, School of Medical Sciences, University of New South Wales, Sydney; Prince of Wales Clinical School, University of NSW, Sydney
| | - H Li
- Infection and Inflammation Research Centre, School of Medical Sciences, University of New South Wales, Sydney
| | - F Boyle
- Patricia Ritchie Centre, The Mater Hospital, Sydney
| | - P deSouza
- Cancer Care Centre, St George Hospital, Sydney
| | - N Wilcken
- Westmead and Nepean Hospitals, Sydney, Australia
| | - M Friedlander
- Prince of Wales Clinical School, University of NSW, Sydney
| | - D Goldstein
- Prince of Wales Clinical School, University of NSW, Sydney
| | - A R Lloyd
- Infection and Inflammation Research Centre, School of Medical Sciences, University of New South Wales, Sydney
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Cotter M, Boyle F, Khan A, Boo T, O’Connell B. Dissemination of extended-spectrum β-lactamase-producing Escherichia coli at home: a potential occupational hazard for healthcare workers? J Hosp Infect 2012; 80:100-1. [DOI: 10.1016/j.jhin.2011.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 10/18/2011] [Indexed: 10/15/2022]
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31
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Eagleson K, Justo R, Boyle F, Ware R, Johnson S. Health-Related Quality of Life and Congenital Heart Disease in Australia. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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McCarthy N, Boyle F, Bull J, Leong E, Simpson A, Kannourakis G, Gebski V, Forbes JF, Wilcken N, Lindsay DF, Badger HD. P3-14-28: ANZ 0502 NeoGem: A Phase II Trial Evaluating the Efficacy and Safety of Epirubicin and Cyclophosphamide Followed by Docetaxel with Gemcitabine (+ Trastuzumab If HER2 Positive) as Neoadjuvant Chemotherapy for Women with Large Operable or Locally Advanced Breast Carcinoma. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p3-14-28] [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: 11/16/2022]
Abstract
Abstract
Background
Neoadjuvant chemotherapy may provide an early indication of treatment effect and pathologic complete response (pCR) rate is a surrogate measure of disease-free and overall survival. Anthracyclines remain an important component of chemotherapy regimens for breast cancer (BC), adding a taxane conveys additional survival benefit. Gemcitabine (G) has established safety and efficacy in metastatic breast cancer (MBC) and combining G with docetaxel (D) shows preclinical synergy but not overlapping toxicities. In MBC, efficacy of trastuzumab (T) combined with single agent taxanes and G has been demonstrated for tumours that over-express human epidermal growth factor receptor 2 (HER2+). NeoGem aimed to evaluate the efficacy and safety of neoadjuvant epirubicin (E) and cyclophosphamide (C), followed by D and G +/− T (depending on HER2 status) in women with large operable or locally advanced BC.
Methods: Eligible patients (pts), ≥18 years, had unilateral, operable (at presentation) T2 (≥3cm), T3-4, N0-1, M0 primary BC, no prior chemotherapy or hormonal therapy and ECOG status 0–2. All pts received E (90mg/m2 i.v.) in combination with C (600mg/m2 i.v.) on day 1 q 21 for 4 cycles followed by D (75mg/m2 i.v.) on day 1 in combination with G (1000mg/m2 i.v.) on days 1 and 8 q 21 for 4 cycles. HER2+ pts received T (4mg/kg loading then 2mg/kg i.v.) concurrent with DG on days 1, 8 and 15 q 21 for 4 cycles. HER2+ pts received post-surgical T (6mg/kg) 3 weekly, for a total of one year of T therapy. Using a Simon's 2 stage trial design, the decision to proceed to stage 2 followed interim analysis of stage 1. Primary endpoint, pCR, was defined as no histologic evidence of invasive cancer in the breast. Secondary endpoint, pCRax, was defined as no histologic evidence of invasive cancer in the breast and axilla. EC followed by DG/DGT was expected to achieve a pCR rate of 35% in HER2 negative (HER2−) pts and 40% in HER2+, with the lowest limit of therapeutic efficacy being a pCR rate of 22% (HER2−) and 24% (HER2+). Hence 84 HER2− and 63 HER2+ pts were needed to detect significant differences in pCR rates (power 80%, 95% level of significance).
Results: Over 32 months 81 pts (63 HER2− and 18 HER2+) were enrolled, 78 (96% [61 HER2− and 17 HER2+]) proceeded to surgery. Of 78 pts, 21 (27%) achieved pCR and 19 (24%) achieved pCRax. Of the 61 HER2− pts, 12 (20% [95% CI: 12%-31%]) achieved pCR compared with 9 (53% [95%CI: 31%-74%]) of 17 HER2+ pts. Planned chemotherapy was completed by 67 pts (83%), 9 pts (11%) discontinued due to adverse events. Thirteen pts (16%) required DG dose reductions compared with 7 (8%) pts during EC; 57 (70%) pts had ≥ grade 3 neutropenia.
Conclusion: Efficacy in the HER2− cohort did not reach predetermined levels of significance (interim analysis); HER2+ recruitment proved too slow to continue. High haematological toxicity during DG, particularly neutropenia required use of supportive therapy (GCSF). Despite relatively small patient numbers, 53% pCR in the HER2+ cohort warrants further investigation.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-14-28.
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Affiliation(s)
- N McCarthy
- 1Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; The Mater Hospital, Sydney, New South Wales, Australia; Wellington Hospital, Wellington, New Zealand; Ballarat Oncology and Haematology Service, Ballarat, Victoria, Australia; NHMRC Clinical Trials Centre, Sydney, New South Wales, Australia; University of Newcastle, Newcastle, New South Wales, Australia; Calvary Mater Newcastle, Newcastle, New South Wales, Australia; Westmead Hospital, Sydney, New South Wales, Australia; Australian New Zealand Breast Cancer Trials Group, Newcastle, New South Wales, Australia
| | - F Boyle
- 1Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; The Mater Hospital, Sydney, New South Wales, Australia; Wellington Hospital, Wellington, New Zealand; Ballarat Oncology and Haematology Service, Ballarat, Victoria, Australia; NHMRC Clinical Trials Centre, Sydney, New South Wales, Australia; University of Newcastle, Newcastle, New South Wales, Australia; Calvary Mater Newcastle, Newcastle, New South Wales, Australia; Westmead Hospital, Sydney, New South Wales, Australia; Australian New Zealand Breast Cancer Trials Group, Newcastle, New South Wales, Australia
| | - J Bull
- 1Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; The Mater Hospital, Sydney, New South Wales, Australia; Wellington Hospital, Wellington, New Zealand; Ballarat Oncology and Haematology Service, Ballarat, Victoria, Australia; NHMRC Clinical Trials Centre, Sydney, New South Wales, Australia; University of Newcastle, Newcastle, New South Wales, Australia; Calvary Mater Newcastle, Newcastle, New South Wales, Australia; Westmead Hospital, Sydney, New South Wales, Australia; Australian New Zealand Breast Cancer Trials Group, Newcastle, New South Wales, Australia
| | - E Leong
- 1Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; The Mater Hospital, Sydney, New South Wales, Australia; Wellington Hospital, Wellington, New Zealand; Ballarat Oncology and Haematology Service, Ballarat, Victoria, Australia; NHMRC Clinical Trials Centre, Sydney, New South Wales, Australia; University of Newcastle, Newcastle, New South Wales, Australia; Calvary Mater Newcastle, Newcastle, New South Wales, Australia; Westmead Hospital, Sydney, New South Wales, Australia; Australian New Zealand Breast Cancer Trials Group, Newcastle, New South Wales, Australia
| | - A Simpson
- 1Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; The Mater Hospital, Sydney, New South Wales, Australia; Wellington Hospital, Wellington, New Zealand; Ballarat Oncology and Haematology Service, Ballarat, Victoria, Australia; NHMRC Clinical Trials Centre, Sydney, New South Wales, Australia; University of Newcastle, Newcastle, New South Wales, Australia; Calvary Mater Newcastle, Newcastle, New South Wales, Australia; Westmead Hospital, Sydney, New South Wales, Australia; Australian New Zealand Breast Cancer Trials Group, Newcastle, New South Wales, Australia
| | - G Kannourakis
- 1Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; The Mater Hospital, Sydney, New South Wales, Australia; Wellington Hospital, Wellington, New Zealand; Ballarat Oncology and Haematology Service, Ballarat, Victoria, Australia; NHMRC Clinical Trials Centre, Sydney, New South Wales, Australia; University of Newcastle, Newcastle, New South Wales, Australia; Calvary Mater Newcastle, Newcastle, New South Wales, Australia; Westmead Hospital, Sydney, New South Wales, Australia; Australian New Zealand Breast Cancer Trials Group, Newcastle, New South Wales, Australia
| | - V Gebski
- 1Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; The Mater Hospital, Sydney, New South Wales, Australia; Wellington Hospital, Wellington, New Zealand; Ballarat Oncology and Haematology Service, Ballarat, Victoria, Australia; NHMRC Clinical Trials Centre, Sydney, New South Wales, Australia; University of Newcastle, Newcastle, New South Wales, Australia; Calvary Mater Newcastle, Newcastle, New South Wales, Australia; Westmead Hospital, Sydney, New South Wales, Australia; Australian New Zealand Breast Cancer Trials Group, Newcastle, New South Wales, Australia
| | - JF Forbes
- 1Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; The Mater Hospital, Sydney, New South Wales, Australia; Wellington Hospital, Wellington, New Zealand; Ballarat Oncology and Haematology Service, Ballarat, Victoria, Australia; NHMRC Clinical Trials Centre, Sydney, New South Wales, Australia; University of Newcastle, Newcastle, New South Wales, Australia; Calvary Mater Newcastle, Newcastle, New South Wales, Australia; Westmead Hospital, Sydney, New South Wales, Australia; Australian New Zealand Breast Cancer Trials Group, Newcastle, New South Wales, Australia
| | - N Wilcken
- 1Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; The Mater Hospital, Sydney, New South Wales, Australia; Wellington Hospital, Wellington, New Zealand; Ballarat Oncology and Haematology Service, Ballarat, Victoria, Australia; NHMRC Clinical Trials Centre, Sydney, New South Wales, Australia; University of Newcastle, Newcastle, New South Wales, Australia; Calvary Mater Newcastle, Newcastle, New South Wales, Australia; Westmead Hospital, Sydney, New South Wales, Australia; Australian New Zealand Breast Cancer Trials Group, Newcastle, New South Wales, Australia
| | - DF Lindsay
- 1Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; The Mater Hospital, Sydney, New South Wales, Australia; Wellington Hospital, Wellington, New Zealand; Ballarat Oncology and Haematology Service, Ballarat, Victoria, Australia; NHMRC Clinical Trials Centre, Sydney, New South Wales, Australia; University of Newcastle, Newcastle, New South Wales, Australia; Calvary Mater Newcastle, Newcastle, New South Wales, Australia; Westmead Hospital, Sydney, New South Wales, Australia; Australian New Zealand Breast Cancer Trials Group, Newcastle, New South Wales, Australia
| | - HD Badger
- 1Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; The Mater Hospital, Sydney, New South Wales, Australia; Wellington Hospital, Wellington, New Zealand; Ballarat Oncology and Haematology Service, Ballarat, Victoria, Australia; NHMRC Clinical Trials Centre, Sydney, New South Wales, Australia; University of Newcastle, Newcastle, New South Wales, Australia; Calvary Mater Newcastle, Newcastle, New South Wales, Australia; Westmead Hospital, Sydney, New South Wales, Australia; Australian New Zealand Breast Cancer Trials Group, Newcastle, New South Wales, Australia
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O’Sullivan L, Boyle F, Kearney J. A retrospective analysis of synthetic protein prescription in Irish children with phenylketonuria. J Hum Nutr Diet 2011. [DOI: 10.1111/j.1365-277x.2011.01177_32.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lee CK, Hudson M, Stockler M, Coates AS, Ackland S, Gebski V, Lord S, Friedlander M, Boyle F, Simes RJ. A nomogram to predict survival time in women starting first-line chemotherapy for advanced breast cancer. Breast Cancer Res Treat 2011; 129:467-76. [PMID: 21445568 DOI: 10.1007/s10549-011-1471-9] [Citation(s) in RCA: 9] [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: 02/07/2011] [Accepted: 03/18/2011] [Indexed: 11/30/2022]
Abstract
Women starting first-line chemotherapy for advanced breast cancer have differing baseline characteristics and survival times. We sought to develop and validate a pragmatic prognostic nomogram to predict overall survival (OS) by using available clinical and laboratory data. The prognostic model was developed in a training cohort (n=693) from two first-line chemotherapy trials (ANZ8101 and ANZ8614) and validated in two other trials (ANZ0001 and ANZ9311) with 324 and 233 patients, respectively. The proportional-hazards model was constructed from pretreatment demographic and disease characteristics. Patients were classified into good (score <88), medium (88-157), and poor (>157) prognostic groups. A nomogram was constructed (n=1250) from the combined datasets of all four trials, based on the predictors identified in the training cohort. The nomogram predicted OS with a concordance index of 0.65 (95%CI, 0.62-0.67). Factors in the nomogram were age, performance status, estrogen receptor status, number of involved organs (lung, liver and brain), hemoglobin concentration, neutrophil count, and serum alkaline phosphatase. The median survival for good, medium, and poor prognosis was 15.4 months (95%CI, 12.7-19.1), 10.2 months (95%CI, 9.0-11.6), and 6.1 months (95%CI, 4.4-6.7), respectively. The actual and model-predicted probabilities of 18-month survival agreed well, after recalibration for the new baseline survival functions for each validation cohort. A nomogram combining seven readily available baseline characteristics enabled stratification of advanced breast cancer patients into three groups with significantly different survival times. This nomogram could be useful for individualising treatment and for stratifying patients in future randomized trials.
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Affiliation(s)
- C K Lee
- NHMRC Clinical Trials Centre, University of Sydney, Locked Bag 77, Camperdown, NSW 1450, Australia.
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Juraskova I, Butow P, Smith B, Seccombe M, Coates A, Boyle F, McCarthy N, Reaby L, Forbes JF. Abstract P5-09-01: Improving Informed Consent: Evaluating the First Decision Aid in a Clinical Trial Setting (IBIS-II Breast Cancer Prevention Trial). Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p5-09-01] [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: 11/16/2022]
Abstract
Abstract
Background: Recruitment to clinical trials is generally suboptimal, with both patients/consumers and clinicians reporting difficulties with the consent process. Decision Aids (DAs) are designed to facilitate doctor-patient communication and participation in decision-making, and may improve the consent process by ensuring patients/consumers make decisions that are informed and acted upon. While participant information sheets (PIS) provide information about the specific clinical trial, DAs present evidence-based information about all available management options (not just the clinical trial), including risks and benefits of each option. They also present both written and graphical forms of the information to enhance understanding, and explicit value clarification exercises to facilitate value-sensitive decisions. In screening and treatment settings, DAs have been found to reduce decisional conflict, improve patient knowledge, create more realistic expectations, and promote active decision-making without increasing anxiety. This RCT aimed to evaluate the efficacy of a DA for women at increased risk of breast cancer who are considering participation in the IBIS-II Prevention trial.
Methods: Women eligible for IBIS-II, who had not decided about participation, were invited to take part in the DA study. Participants from 12 Australian and New Zealand IBIS-II centres were randomised to receive either the standard IBIS-II information and consent materials alone (Control group, n=89), or in combination with a DA booklet (DA group, n=89). Participants completed standardised and purpose-designedmeasures 1 week and 3 months after deciding whether or not to participate in IBIS-II.
Results: In the Prevention arm, the majority of women (84%) reported the DA made it easier to understand IBIS-II compared to reading the PIS alone, and 89% recommended providing both the DA and PIS to potential IBIS-II participants. No group differences were detected in levels of decisional conflict or knowledge of IBIS-II/clinical trials in general, due to floor and ceiling effects respectively. Similarly, no group differences were found in levels of decisional regret and satisfaction at 3-month follow-up. Discussion: This is the first study to assess the effectiveness of DAs in a clinical trial setting. The use of DAs has been strongly endorsed by participating women and clinicians. Challenges of evaluating DAs in a Prevention breast cancer trial setting will be discussed. An RCT of a DA for the DCIS arm of IBIS-II is currently underway. The DAs have the potential to enhance the process of informed consent and reduce dropout rates in clinical trials.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-09-01.
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Affiliation(s)
- I Juraskova
- The University of Sydney, NSW, Australia; The University of Newcastle, NSW, Australia; Royal Brisbane Hospital, Brisbane, QLD, Australia
| | - P Butow
- The University of Sydney, NSW, Australia; The University of Newcastle, NSW, Australia; Royal Brisbane Hospital, Brisbane, QLD, Australia
| | - B Smith
- The University of Sydney, NSW, Australia; The University of Newcastle, NSW, Australia; Royal Brisbane Hospital, Brisbane, QLD, Australia
| | - M Seccombe
- The University of Sydney, NSW, Australia; The University of Newcastle, NSW, Australia; Royal Brisbane Hospital, Brisbane, QLD, Australia
| | - A Coates
- The University of Sydney, NSW, Australia; The University of Newcastle, NSW, Australia; Royal Brisbane Hospital, Brisbane, QLD, Australia
| | - F Boyle
- The University of Sydney, NSW, Australia; The University of Newcastle, NSW, Australia; Royal Brisbane Hospital, Brisbane, QLD, Australia
| | - N McCarthy
- The University of Sydney, NSW, Australia; The University of Newcastle, NSW, Australia; Royal Brisbane Hospital, Brisbane, QLD, Australia
| | - L Reaby
- The University of Sydney, NSW, Australia; The University of Newcastle, NSW, Australia; Royal Brisbane Hospital, Brisbane, QLD, Australia
| | - JF. Forbes
- The University of Sydney, NSW, Australia; The University of Newcastle, NSW, Australia; Royal Brisbane Hospital, Brisbane, QLD, Australia
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Abstract
BACKGROUND Many anticancer drugs are only available to Australian patients at a significant cost in the time preceding approval for government subsidy. Studies indicate that many oncologists find it difficult to discuss high-cost drugs (HCDs) with patients whom they believe are unable to afford treatment, thereby limiting treatment choices. We sought to identify the information needs and communication preferences of women with breast cancer regarding HCDs. PATIENTS AND METHODS An e-mail invitation was sent to 317 members of Breast Cancer Network Australia. Forty-seven subjects participated in telephone interviews on the basis of a structured questionnaire regarding personal experience with HCD discussions and information preferences. RESULTS Participants considered an out-of-pocket cost of $50/week to be a HCD. Only 28% had previously discussed HCD treatment with their oncologist; however, 96% of participants wanted to discuss an expensive drug as an option, even if they were unlikely able to afford it. CONCLUSIONS Women with breast cancer have a strong desire to be active participants in their cancer treatment and wish to be fully informed of potential treatment options, including HCDs. Nondisclosure of information, including HCDs, can result in patient dissatisfaction.
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Affiliation(s)
- E Kaser
- Northern Clinical School, University of Sydney, St Leonards, New South Wales
| | - J Shaw
- Pam McLean Cancer Communications Centre, University of Sydney, St Leonards, New South Wales
| | - M Marven
- Breast Cancer Network Australia, Melbourne, Victoria
| | - L Swinburne
- Breast Cancer Network Australia, Melbourne, Victoria
| | - F Boyle
- Northern Clinical School, University of Sydney, St Leonards, New South Wales; Pam McLean Cancer Communications Centre, University of Sydney, St Leonards, New South Wales; Breast Cancer Network Australia, Melbourne, Victoria; Patricia Ritchie Centre for Cancer Care and Research, Mater Hospital, Sydney, New South Wales, Australia.
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Boyle F, Morris D, O'Connor J, Delappe N, Ward J, Cormican M. First report of extended-spectrum-beta-lactamase-producing Salmonella enterica serovar Kentucky isolated from poultry in Ireland. Antimicrob Agents Chemother 2010; 54:551-3. [PMID: 19884382 PMCID: PMC2798478 DOI: 10.1128/aac.00916-09] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [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: 07/03/2009] [Revised: 08/28/2009] [Accepted: 10/20/2009] [Indexed: 11/20/2022] Open
Abstract
Therapy of invasive human salmonellosis is complicated by increasing antimicrobial resistance. Food animals are the principal source of infection with nontyphoid Salmonella. We report the emergence of broad-spectrum-cephalosporin resistance in Salmonella enterica serovar Kentucky in poultry in Ireland.
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Affiliation(s)
- F Boyle
- Department of Bacteriology, National University of Ireland, Galway, Ireland.
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Juraskova I, Butow P, Lopez A, Seccombe M, Coates A, Boyle F, McCarthy N, Reaby L, Forbes JF. Improving informed consent: pilot of a decision aid for women invited to participate in a breast cancer prevention trial (IBIS-II DCIS). Health Expect 2008; 11:252-62. [PMID: 18816321 PMCID: PMC5060455 DOI: 10.1111/j.1369-7625.2008.00498.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Patients and clinicians report difficulties with the process of informed consent to clinical trials and audiotape audits show that critical information is often omitted or poorly presented. Decision aids (DAs) may assist in improving consent. AIMS This study piloted a DA booklet for a high priority breast cancer prevention trial, IBIS-II DCIS, which compares the efficacy of an aromatase inhibitor (anastrozole) with tamoxifen in women who have had surgery for ductal carcinoma in situ (DCIS). METHOD Thirty-one Australian women participating in the IBIS-I breast cancer prevention trial and who are currently in follow-up agreed to read the IBIS-II DCIS participant information sheet and the DCIS DA booklet, complete a set of standardized questionnaires, and provide feedback on the DA via a semi-structured phone interview. RESULTS Women found the DA helpful in deciding about trial participation, reporting that it aided their understanding over and above the approved IBIS-II DCIS participant information sheet and was not anxiety provoking. Women's understanding of the rationale and methods of clinical trials and the IBIS-II DCIS trial was very good; with more than 80% of items answered correctly. The only areas that were not understood well were the concepts of randomization and blinding. CONCLUSIONS This study suggests that the DA will be acceptable to and valued by potential participants in the IBIS-II DCIS study. The revised DA is currently being evaluated prospectively in a randomized controlled trial. If successful, such DAs could transform the consent process to large clinical trials and may also reduce dropout rates.
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Affiliation(s)
- I Juraskova
- Medical Psychology Research Unit, School of Psychology, University of Sydney, Sydney, NSW, Australia.
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Gainford MC, Stockler MR, Butow P, Boyle F, Sullivan A, Beale P, Pendlebury S, Nowak AK, Duric VM. What caused your cancer? A survey of patients with early breast and bowel cancer. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.9563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Goldstein D, Bennett B, Cameron B, Boyle F, DeSouza P, Wilcken N, Friedlander M, Scott E, Hickie I, Lloyd AM A. A prospective cohort study of fatigue after adjuvant therapy for breast cancer: Association with hematologic, endocrine, and immune parameters. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.9596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Murphy J, Boyle F. Assessment of the effects of increasing levels of physiological realism in the computational fluid dynamics analyses of implanted coronary stents. Annu Int Conf IEEE Eng Med Biol Soc 2008; 2008:5906-5909. [PMID: 19164062 DOI: 10.1109/iembs.2008.4650559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Coronary stent implantation can improve blood flow in an artery that has been narrowed by the build up of arterial plaque. However, the implantation of the stent will change the geometry of the vessel wall. The haemodynamic effects of the stents presence and alteration of the vessel wall are unclear. The redistribution of flow induced vessel wall shear stress (WSS) and wall shear stress gradient (WSSG) may directly contribute to restenosis (re-blockage). Computational fluid dynamics (CFD) is used extensively to identify these parameters in stented vessels. However, simplifications to the model of the stented artery are common. In this paper, computational domains of stented arteries with increasing levels of physiological realism are created. CFD is used to predict the WSS and WSSG for each set of computational domains. Finally, the results show that certain simplifications are not valid for CFD analyses of implanted coronary stents.
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Affiliation(s)
- J Murphy
- Mechanical Engineering Department at the Dublin Institute of Technology, Ireland.
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Brown RF, Butow PN, Boyle F, Tattersall MHN. Seeking informed consent to cancer clinical trials; evaluating the efficacy of doctor communication skills training. Psychooncology 2007; 16:507-16. [PMID: 16986176 DOI: 10.1002/pon.1095] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [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: 11/08/2022]
Abstract
INTRODUCTION Clinical trials have come to be regarded as the gold standard for treatment evaluation. However, many doctors and their patients experience difficulties when discussing trial participation, leading to poor accrual to trials and questionable quality of informed consent. We have previously developed a communication skills training program based on a typology for ethical communication about Phase II and III clinical trials within four categories. The training program consisted of a 1 day experiential workshop that included didactic teaching, exemplary video and role play. The aim of this study was to evaluate the effectiveness of the communication skills training workshop. METHOD Oncologists were recruited from three major teaching hospitals conducting oncology outpatient clinics in three Australian capital cities. Ten oncologists and 90 of their adult cancer patients who were eligible for a Phase II or III clinical trial participated. Ninety informed consent consultations were audiotaped before (n = 59) and after (n = 31) training, and fully transcribed. The presence or absence of each domain component was coded and these were summed within categories. A coding manual was produced which enabled standardization of the coding procedure. Patients completed questionnaires before and after the consultation, and doctors completed a short measure of satisfaction after the consultation. RESULTS Doctors increased their use of some aspects of shared decision-making behavior (t(87) = -1.945, p = 0.05) and described some aspects of essential ethical/clinical information more commonly. In addition they used less coercive behaviors (z = -1.976, p = 0.048). However, they did not provide more clinical information or structure their consultations in the recommended fashion. Patients in the post-training cohort reported more positive attitudes to clinical trials, but other outcomes were not affected by the intervention. CONCLUSIONS This short training programme demonstrated limited success in improving the oncologist's communication skills when gaining informed consent. A larger randomized controlled trial of extended training is now underway.
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Affiliation(s)
- R F Brown
- Medical Psychology Research Unit, Blackburn Building D06, University of Sydney, Camperdown NSW, Australia.
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Duric VM, Stockler MR, Heritier S, Boyle F, Beith J, Sullivan A, Wilcken N, Coates AS, Simes RJ. Patients' preferences for adjuvant chemotherapy in early breast cancer: what makes AC and CMF worthwhile now? Ann Oncol 2005; 16:1786-94. [PMID: 16126738 DOI: 10.1093/annonc/mdi370] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.1] [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: 11/12/2022] Open
Abstract
BACKGROUND Studies of women who had adjuvant chemotherapy for early breast cancer 10-20 years ago showed that many judged small benefits sufficient to make it worthwhile. Indications, regimens and supportive care have changed. We sought the preferences of contemporary women who received similar chemotherapy. PATIENTS AND METHODS Ninety-seven consecutive consenting women who completed adjuvant chemotherapy for early breast cancer 3-34 months previously were interviewed. Preferences were elicited with a structured, scripted interview using the trade-off method. Women were presented with four hypothetical scenarios based on known life expectancies (5 and 15 years) and survival rates (65% and 85% at 5 years) without adjuvant chemotherapy. RESULTS Improvements of an additional year in life expectancy or 3% in survival rates were judged sufficient to make adjuvant chemotherapy worthwhile by 68-84% of women. Half the women judged 1 day or 0.1% sufficient to make adjuvant chemotherapy worthwhile. Recollections of better well-being during adjuvant chemotherapy, having dependants and having a friend or relative who died from cancer were independently associated with judging smaller benefits sufficient to make adjuvant chemotherapy worthwhile (all P < 0.05). CONCLUSIONS Preferences were highly variable, but the benefits judged sufficient to make adjuvant chemotherapy worthwhile were even smaller than those found in previous studies. Preferences were influenced by factors other than direct benefits and harms of chemotherapy.
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Affiliation(s)
- V M Duric
- NHMRC Clinical Trials Centre, University of Sydney,Camperdown, NSW 2050, Australia
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Duric V, Stockler MR, Butow P, Sharpe L, Heritier S, Beith J, Boyle F, Wilcken N, Coates A, Simes RJ. Comparing patients’ and their partners’ preferences for adjuvant chemotherapy (ACT) in early breast cancer (EBC). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.6074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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)
- V. Duric
- Univ of Sydney, Sydney, Australia; Sydney Cancer Ctr - RPA Hosp, Sydney, Australia; Mater and Royal North Shore Hospitals, Sydney, Australia; Nepean Hosp, Sydney, Australia; The Cancer Council Australia, Sydney, Australia; NHMRC Clin Trials Ctr, Sydney, Australia
| | - M. R. Stockler
- Univ of Sydney, Sydney, Australia; Sydney Cancer Ctr - RPA Hosp, Sydney, Australia; Mater and Royal North Shore Hospitals, Sydney, Australia; Nepean Hosp, Sydney, Australia; The Cancer Council Australia, Sydney, Australia; NHMRC Clin Trials Ctr, Sydney, Australia
| | - P. Butow
- Univ of Sydney, Sydney, Australia; Sydney Cancer Ctr - RPA Hosp, Sydney, Australia; Mater and Royal North Shore Hospitals, Sydney, Australia; Nepean Hosp, Sydney, Australia; The Cancer Council Australia, Sydney, Australia; NHMRC Clin Trials Ctr, Sydney, Australia
| | - L. Sharpe
- Univ of Sydney, Sydney, Australia; Sydney Cancer Ctr - RPA Hosp, Sydney, Australia; Mater and Royal North Shore Hospitals, Sydney, Australia; Nepean Hosp, Sydney, Australia; The Cancer Council Australia, Sydney, Australia; NHMRC Clin Trials Ctr, Sydney, Australia
| | - S. Heritier
- Univ of Sydney, Sydney, Australia; Sydney Cancer Ctr - RPA Hosp, Sydney, Australia; Mater and Royal North Shore Hospitals, Sydney, Australia; Nepean Hosp, Sydney, Australia; The Cancer Council Australia, Sydney, Australia; NHMRC Clin Trials Ctr, Sydney, Australia
| | - J. Beith
- Univ of Sydney, Sydney, Australia; Sydney Cancer Ctr - RPA Hosp, Sydney, Australia; Mater and Royal North Shore Hospitals, Sydney, Australia; Nepean Hosp, Sydney, Australia; The Cancer Council Australia, Sydney, Australia; NHMRC Clin Trials Ctr, Sydney, Australia
| | - F. Boyle
- Univ of Sydney, Sydney, Australia; Sydney Cancer Ctr - RPA Hosp, Sydney, Australia; Mater and Royal North Shore Hospitals, Sydney, Australia; Nepean Hosp, Sydney, Australia; The Cancer Council Australia, Sydney, Australia; NHMRC Clin Trials Ctr, Sydney, Australia
| | - N. Wilcken
- Univ of Sydney, Sydney, Australia; Sydney Cancer Ctr - RPA Hosp, Sydney, Australia; Mater and Royal North Shore Hospitals, Sydney, Australia; Nepean Hosp, Sydney, Australia; The Cancer Council Australia, Sydney, Australia; NHMRC Clin Trials Ctr, Sydney, Australia
| | - A. Coates
- Univ of Sydney, Sydney, Australia; Sydney Cancer Ctr - RPA Hosp, Sydney, Australia; Mater and Royal North Shore Hospitals, Sydney, Australia; Nepean Hosp, Sydney, Australia; The Cancer Council Australia, Sydney, Australia; NHMRC Clin Trials Ctr, Sydney, Australia
| | - R. J. Simes
- Univ of Sydney, Sydney, Australia; Sydney Cancer Ctr - RPA Hosp, Sydney, Australia; Mater and Royal North Shore Hospitals, Sydney, Australia; Nepean Hosp, Sydney, Australia; The Cancer Council Australia, Sydney, Australia; NHMRC Clin Trials Ctr, Sydney, Australia
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Lennox N, Taylor M, Rey-Conde T, Bain C, Purdie DM, Boyle F. Beating the barriers: recruitment of people with intellectual disability to participate in research. J Intellect Disabil Res 2005; 49:296-305. [PMID: 15816817 DOI: 10.1111/j.1365-2788.2005.00618.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND The health status of people with intellectual disability (ID) is poor, yet very little research has been done on their health needs. There are several barriers to performing this research. The aim of our research was to examine the significant barriers encountered in recruiting adults with ID to participate in research. METHODS Our project was a randomized controlled trial aiming to improve health advocacy of people with ID. We approached many organizations to recruit participants and kept records of our results. Recruitment was very low for the first 4 months. Then we adopted two new recruitment strategies--in-service telephone recruitment and meetings with prospective participants. We then monitored the subsequent recruitment rates. We also questioned participants about the difficulties they encountered when considering recruitment. RESULTS Initial recruitment of participants yielded less than one-third of the expected number. Additional strategies implemented were partially successful. Significant barriers to recruitment included several sectoral issues and the challenges arising from the research process. CONCLUSIONS While this population is a difficult one to reach for research, attempts to do so should not be abandoned, because the potential health benefits for this underserved group far outweigh the recruitment barriers experienced.
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Affiliation(s)
- N Lennox
- Queensland Centre for Intellectual and Developmental Disability, School of Population Health, Faculty of Health Sciences, The University of Queensland, Mater Hospital, South Brisbane, Queensland, 4101 Australia.
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Duric V, Stockler MR, Butow P, Sharpe L, Beith J, Sullivan A, Boyle F, Dhillon H, Coates AS, Simes RJ. Predictors of the benefits women consider necessary to make adjuvant chemotherapy (ACT) worthwhile for early breast cancer (EBC). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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)
- V. Duric
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia; Medical Psychology Unit, University of Sydney, Camperdown, NSW, Australia; Clinical Psychology Unit, University of Sydney, Camperdown, NSW, Australia; Sydney Cancer Centre, RPA & Concord Hospitals, Camperdown, NSW, Australia; Mater and Royal North Shore Hospitals, North Sydney, NSW, Australia; The Cancer Council Australia, Camperdown, NSW, Australia
| | - M. R. Stockler
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia; Medical Psychology Unit, University of Sydney, Camperdown, NSW, Australia; Clinical Psychology Unit, University of Sydney, Camperdown, NSW, Australia; Sydney Cancer Centre, RPA & Concord Hospitals, Camperdown, NSW, Australia; Mater and Royal North Shore Hospitals, North Sydney, NSW, Australia; The Cancer Council Australia, Camperdown, NSW, Australia
| | - P. Butow
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia; Medical Psychology Unit, University of Sydney, Camperdown, NSW, Australia; Clinical Psychology Unit, University of Sydney, Camperdown, NSW, Australia; Sydney Cancer Centre, RPA & Concord Hospitals, Camperdown, NSW, Australia; Mater and Royal North Shore Hospitals, North Sydney, NSW, Australia; The Cancer Council Australia, Camperdown, NSW, Australia
| | - L. Sharpe
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia; Medical Psychology Unit, University of Sydney, Camperdown, NSW, Australia; Clinical Psychology Unit, University of Sydney, Camperdown, NSW, Australia; Sydney Cancer Centre, RPA & Concord Hospitals, Camperdown, NSW, Australia; Mater and Royal North Shore Hospitals, North Sydney, NSW, Australia; The Cancer Council Australia, Camperdown, NSW, Australia
| | - J. Beith
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia; Medical Psychology Unit, University of Sydney, Camperdown, NSW, Australia; Clinical Psychology Unit, University of Sydney, Camperdown, NSW, Australia; Sydney Cancer Centre, RPA & Concord Hospitals, Camperdown, NSW, Australia; Mater and Royal North Shore Hospitals, North Sydney, NSW, Australia; The Cancer Council Australia, Camperdown, NSW, Australia
| | - A. Sullivan
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia; Medical Psychology Unit, University of Sydney, Camperdown, NSW, Australia; Clinical Psychology Unit, University of Sydney, Camperdown, NSW, Australia; Sydney Cancer Centre, RPA & Concord Hospitals, Camperdown, NSW, Australia; Mater and Royal North Shore Hospitals, North Sydney, NSW, Australia; The Cancer Council Australia, Camperdown, NSW, Australia
| | - F. Boyle
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia; Medical Psychology Unit, University of Sydney, Camperdown, NSW, Australia; Clinical Psychology Unit, University of Sydney, Camperdown, NSW, Australia; Sydney Cancer Centre, RPA & Concord Hospitals, Camperdown, NSW, Australia; Mater and Royal North Shore Hospitals, North Sydney, NSW, Australia; The Cancer Council Australia, Camperdown, NSW, Australia
| | - H. Dhillon
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia; Medical Psychology Unit, University of Sydney, Camperdown, NSW, Australia; Clinical Psychology Unit, University of Sydney, Camperdown, NSW, Australia; Sydney Cancer Centre, RPA & Concord Hospitals, Camperdown, NSW, Australia; Mater and Royal North Shore Hospitals, North Sydney, NSW, Australia; The Cancer Council Australia, Camperdown, NSW, Australia
| | - A. S. Coates
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia; Medical Psychology Unit, University of Sydney, Camperdown, NSW, Australia; Clinical Psychology Unit, University of Sydney, Camperdown, NSW, Australia; Sydney Cancer Centre, RPA & Concord Hospitals, Camperdown, NSW, Australia; Mater and Royal North Shore Hospitals, North Sydney, NSW, Australia; The Cancer Council Australia, Camperdown, NSW, Australia
| | - R. J. Simes
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia; Medical Psychology Unit, University of Sydney, Camperdown, NSW, Australia; Clinical Psychology Unit, University of Sydney, Camperdown, NSW, Australia; Sydney Cancer Centre, RPA & Concord Hospitals, Camperdown, NSW, Australia; Mater and Royal North Shore Hospitals, North Sydney, NSW, Australia; The Cancer Council Australia, Camperdown, NSW, Australia
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Abstract
Clinical trials have come to be regarded as the gold standard for treatment evaluation. However, many doctors and their patients experience difficulties when discussing trials, leading to poor accrual to trials and questionable quality of informed consent. We have previously developed a typology for ethical communication about Phase II and III clinical trials within four domains: (a) shared decision making, (b) sequencing information, (c) type and clarity of information, and (d) disclosure/coercion. The aim of this study was to compare current clinical practice when seeking informed consent with this typology. Fifty-nine consultations in which 10 participating oncologists sought informed consent were audiotaped. Verbatim transcripts were analysed using a coding system to (a) identify the presence or absence of aspects of the four domains and (b) rate the quality of aspects of two domains: (i) shared decision-making and (ii) type and clarity of information. Oncologists rarely addressed aspects of shared decision-making, other than offering to delay a treatment decision (78%). Moreover, many of these discussions scored poorly with respect to ideal content. The oncologists were rarely consistent with the sequence of information provision. A general rationale for randomising was only described in 46% of consultations. In almost one third of the consultations (28.8%) doctors made implicit statements favouring one option over another, either standard or clinical trial treatment. Doctors complied with some but not other aspects of a standard procedure for discussing clinical trials. This reflects the difficulty inherent in seeking ethical informed consent and the need for communication skills training for oncologists.
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Affiliation(s)
- R F Brown
- University of Sydney, Camperdown, NSW 2006, Australia.
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Abstract
In recent years there has been increased emphasis on involving people in decision-making about their medical care. However, few studies have addressed the questions of why women with cancer want information, and what they believe to be the important factors influencing their decision-making. In order to examine these questions 20 women with cancer were interviewed via telephone 2 weeks after their first consultation with one of 6 medical oncologists. Recruitment continued until informational redundancy was achieved. While women cited the risk of recurrence, life expectancy, side-effects, and quality of life as influencing their decisions, they placed at least as much emphasis on their personal relationship with the specialist. These 'personal' factors included: feeling that the doctor cared for, understood and respected them; that they could trust and have confidence in the doctor; that the doctor would give them enough time; that they would be listened to; and that the doctor would be open and honest. If these factors were felt to be present, many women were happy to accept the doctor's recommendation, confident that they would receive the optimum treatment. However, many women felt there was no decision to be made: further treatment must be undertaken to reduce risk, and minor variations in the treatment protocol were of little significance. These results underline the importance of establishing patient priorities and concerns before embarking on discussions about treatment.
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Affiliation(s)
- M J Henman
- Medical Psychology Unit, University of Sydney, NSW, Australia
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Boyle F, Chapman R, Hancox J. General practice care following miscarriage. Aust Fam Physician 2000; 29:197. [PMID: 10785983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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