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Laidsaar-Powell R, Giunta S, Butow P, Keast R, Koczwara B, Kay J, Jefford M, Turner S, Saunders C, Schofield P, Boyle F, Yates P, White K, Miller A, Butt Z, Bonnaudet M, Juraskova I. Development of Web-Based Education Modules to Improve Carer Engagement in Cancer Care: Design and User Experience Evaluation of the e-Triadic Oncology (eTRIO) Modules for Clinicians, Patients, and Carers. JMIR Med Educ 2024; 10:e50118. [PMID: 38630531 DOI: 10.2196/50118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 11/27/2023] [Accepted: 01/31/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Carers often assume key roles in cancer care. However, many carers report feeling disempowered and ill-equipped to support patients. Our group published evidence-based guidelines (the Triadic Oncology [TRIO] Guidelines) to improve oncology clinician engagement with carers and the management of challenging situations involving carers. OBJECTIVE To facilitate implementation of the TRIO Guidelines in clinical practice, we aimed to develop, iteratively refine, and conduct user testing of a suite of evidence-based and interactive web-based education modules for oncology clinicians (e-Triadic Oncology [eTRIO]), patients with cancer, and carers (eTRIO for Patients and Carers [eTRIO-pc]). These were designed to improve carer involvement, communication, and shared decision-making in the cancer management setting. METHODS The eTRIO education modules were based on extensive research, including systematic reviews, qualitative interviews, and consultation analyses. Guided by the person-based approach, module content and design were reviewed by an expert advisory group comprising academic and clinical experts (n=13) and consumers (n=5); content and design were continuously and iteratively refined. User experience testing (including "think-aloud" interviews and administration of the System Usability Scale [SUS]) of the modules was completed by additional clinicians (n=5), patients (n=3), and carers (n=3). RESULTS The final clinician module comprises 14 sections, requires approximately 1.5 to 2 hours to complete, and covers topics such as carer-inclusive communication and practices; supporting carer needs; and managing carer dominance, anger, and conflicting patient-carer wishes. The usability of the module was rated by 5 clinicians, with a mean SUS score of 75 (SD 5.3), which is interpreted as good. Clinicians often desired information in a concise format, divided into small "snackable" sections that could be easily recommenced if they were interrupted. The carer module features 11 sections; requires approximately 1.5 hours to complete; and includes topics such as the importance of carers, carer roles during consultations, and advocating for the patient. The patient module is an adaptation of the relevant carer module sections, comprising 7 sections and requiring 1 hour to complete. The average SUS score as rated by 6 patients and carers was 78 (SD 16.2), which is interpreted as good. Interactive activities, clinical vignette videos, and reflective learning exercises are incorporated into all modules. Patient and carer consumer advisers advocated for empathetic content and tone throughout their modules, with an easy-to-read and navigable module interface. CONCLUSIONS The eTRIO suite of modules were rigorously developed using a person-based design methodology to meet the unique information needs and learning requirements of clinicians, patients, and carers, with the goal of improving effective and supportive carer involvement in cancer consultations and cancer care.
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Affiliation(s)
- Rebekah Laidsaar-Powell
- Centre for Medical Psychology & Evidence-based Decision-making, School of Psychology, The University of Sydney, Sydney, Australia
- Psycho-Oncology Co-operative Research Group, The University of Sydney, Sydney, Australia
| | - Sarah Giunta
- Centre for Medical Psychology & Evidence-based Decision-making, School of Psychology, The University of Sydney, Sydney, Australia
| | - Phyllis Butow
- Centre for Medical Psychology & Evidence-based Decision-making, School of Psychology, The University of Sydney, Sydney, Australia
- Psycho-Oncology Co-operative Research Group, The University of Sydney, Sydney, Australia
| | - Rachael Keast
- Centre for Medical Psychology & Evidence-based Decision-making, School of Psychology, The University of Sydney, Sydney, Australia
| | - Bogda Koczwara
- Flinders Medical Centre, Adelaide, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Judy Kay
- School of Computer Science, The University of Sydney, Sydney, Australia
| | - Michael Jefford
- Health Services Research and Implementation Science, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Sandra Turner
- Department of Radiation Oncology, Westmead Hospital, Westmead, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Christobel Saunders
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Penelope Schofield
- Health Services Research and Implementation Science, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Psychology and Iverson Health Innovation Research Institute, Swinburne University, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - Frances Boyle
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Patricia Ritchie Centre for Cancer Care & Research, Mater Hospital, Sydney, Australia
| | - Patsy Yates
- Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Kate White
- Susan Wakil School of Nursing, The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Sydney, Australia
| | - Annie Miller
- Cancer Council New South Wales, Sydney, Australia
| | - Zoe Butt
- Centre for Medical Psychology & Evidence-based Decision-making, School of Psychology, The University of Sydney, Sydney, Australia
| | - Melanie Bonnaudet
- School of Computer Science, The University of Sydney, Sydney, Australia
- School of Electrical Engineering and Computer Science, Kungliga Tekniska högskolan Royal Institute of Technology, Stockholm, Sweden
| | - Ilona Juraskova
- Centre for Medical Psychology & Evidence-based Decision-making, School of Psychology, The University of Sydney, Sydney, Australia
- Psycho-Oncology Co-operative Research Group, The University of Sydney, Sydney, Australia
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Warland J, Pollock D, Collier A, Horey D, Boyle F. Parents' descriptions of labouring with an antepartum fetal death: Findings from the Birthing in Grief study. Aust N Z J Obstet Gynaecol 2024; 64:133-140. [PMID: 37833833 DOI: 10.1111/ajo.13759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Evidence to guide intrapartum care when an unborn baby has died is limited. AIMS To explore parents' experiences of care during labour of an antepartum stillbirth. MATERIALS AND METHODS Semi-structured interviews with 18 bereaved parents from across Australia. Content analysis was conducted. FINDINGS Two broad themes were identified: 'explaining every step' and 'helping us feel like parents.' Sub-themes under the first broad theme, 'explaining every step', were 'how and when information was given' and 'what happens next.' 'Like any other parent', 'feeling the pain' and 'everything is clouded' were sub-themes of the second broad theme. These findings mapped to current Australian clinical practice guidelines for bereavement care around stillbirth and neonatal death, ie good communication, recognition of parenthood, shared decision making and effective support. CONCLUSIONS This study on parents' experiences of labour with a fetal death in utero brings an important perspective to intrapartum care for this group. As far as we are aware, this study is the first to focus solely on this aspect of care. Our findings could be readily mapped to the four perinatal bereavement care goals. Parents wanted care providers to facilitate their choices, their sense of control, their autonomy and their agency. They wanted to feel that they had received the 'best' care available.
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Affiliation(s)
- Jane Warland
- UniSA Clinical and Health Sciences, UniSA, Adelaide, South Australia, Australia
| | - Danielle Pollock
- Evidence-Based Healthcare Research Division, JBI, Adelaide, South Australia, Australia
| | | | - Dell Horey
- Faculty of Science Agriculture Business and Law, University of New England, Armidale, New South Wales, Australia
| | - Frances Boyle
- Institute for Social Science Research, University of Queensland, Brisbane, Queensland, Australia
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Gnant M, Abdullah KL, Boyle F, Huang CS, Bickford K, Neunie S, Noble A, Nunn A, Sproat C, Harbeck N, Barrios C. Assessing Knowledge, Competence, and Performance Following Web-Based Education on Early Breast Cancer Management: Health Care Professional Questionnaire Study and Anonymized Patient Records Analysis. JMIR Form Res 2024; 8:e50931. [PMID: 38512328 PMCID: PMC10995792 DOI: 10.2196/50931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Web-based learning activities are key components of continuing medical education (CME) for health care professionals (HCPs). However, the published outcomes of web-based educational interventions for early breast cancer (EBC) are limited. OBJECTIVE This study aims to objectively assess knowledge, competence, and performance among HCPs following participation in 2 EBC-focused CME activities and to identify the remaining educational gaps. METHODS We developed 2 CME-accredited web-based educational activities addressing high-risk EBC, including integration of shared decision-making to optimize patient care (touchMDT) and stratification for early identification of high-risk patients and novel treatment strategies (touchPANEL DISCUSSION). Knowledge, competence, and performance were assessed before and after the activities against an expanded outcomes framework (levels 1-5) using self-reported questionnaires and an analysis of anonymized data extracted from patient records. RESULTS Six months after the launch of the activity, 7047 and 8989 HCP participants engaged with touchMDT and touchPANEL DISCUSSION, respectively. The overall satisfaction was 82% (a total score of 20.6 out of 25) for the touchMDT and 88% (a total score of 21.9 out of 25) for the touchPANEL DISCUSSION. For the evaluation of knowledge and competence (50 respondents before the activity and 50 learners after the activity), there was a significant increase in the mean number of correctly answered questions from pre- to postactivity (touchMDT: median 4.0, IQR 3.0-5.0 to median 5.5, IQR 4.0-7.0; mean 4.00, SD 1.39 to mean 5.30, SD 1.56 and touchPANEL DISCUSSION: median 4.0, IQR 4.0-5.0 to median 6.0, IQR 5.0-7.0; mean 4.32, SD 1.30 to mean 5.88, SD 1.49; both P<.001). A significant improvement in self-reported performance (50 respondents before the activity and 50 learners after the activity) was observed in a combined analysis of both activities (median 3.0, IQR 2.0-3.0 to median 4.0, IQR 3.0-5.0; mean 2.82, SD 1.08 to mean 4.16, SD 1.45; P<.001). Patient record analysis (50 respondents before the activity and 50 learners after the activity) showed that the HCPs used a range of measures to determine EBC recurrence risk and revealed no significant differences in adjuvant therapies used before and after the activity (P=.97 and P>.99 for Ki-67 <20% and Ki-67 ≥20% tumors, respectively). The remaining educational gaps included strategies for implementing shared decision-making in clinical practice and the use of genetic and biomarker testing to guide treatment selection. CONCLUSIONS Brief, web-based CME activities on EBC were associated with an improvement in HCP knowledge, competence, and self-reported performance and can help identify unmet needs to inform the design of future CME activities.
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Affiliation(s)
- Michael Gnant
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Khatijah Lim Abdullah
- Department of Nursing, School of Medical and Life Sciences, Sunway University, Selangor, Malaysia
| | - Frances Boyle
- Patricia Ritchie Centre for Cancer Care and Research, University of Sydney, Sydney, Australia
| | - Chiun-Sheng Huang
- Department of Surgery, National Taiwan University Hospital, Taipei City, Taiwan
| | - Katie Bickford
- touch Independent Medical Education Limited, Stockport, United Kingdom
| | - Sola Neunie
- touch Independent Medical Education Limited, Stockport, United Kingdom
| | - Alexander Noble
- touch Independent Medical Education Limited, Stockport, United Kingdom
| | - Anne Nunn
- touch Independent Medical Education Limited, Stockport, United Kingdom
| | - Caroline Sproat
- touch Independent Medical Education Limited, Stockport, United Kingdom
| | - Nadia Harbeck
- Breast Center, Department of Obstetrics & Gynecology and Comprehensive Cancer Center Munich, University Hospital of Munich Ludwig Maximilian, Munich, Germany
| | - Carlos Barrios
- Latin American Cooperative Group and Oncoclínicas Group, Hospital São Lucas da Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
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Rastogi P, O'Shaughnessy J, Martin M, Boyle F, Cortes J, Rugo HS, Goetz MP, Hamilton EP, Huang CS, Senkus E, Tryakin A, Cicin I, Testa L, Neven P, Huober J, Shao Z, Wei R, André V, Munoz M, San Antonio B, Shahir A, Harbeck N, Johnston S. Adjuvant Abemaciclib Plus Endocrine Therapy for Hormone Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative, High-Risk Early Breast Cancer: Results From a Preplanned monarchE Overall Survival Interim Analysis, Including 5-Year Efficacy Outcomes. J Clin Oncol 2024; 42:987-993. [PMID: 38194616 PMCID: PMC10950161 DOI: 10.1200/jco.23.01994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/18/2023] [Accepted: 11/09/2023] [Indexed: 01/11/2024] Open
Abstract
Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical trial updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.Two years of adjuvant abemaciclib combined with endocrine therapy (ET) resulted in a significant improvement in invasive disease-free survival (IDFS) and distant relapse-free survival (DRFS) that persisted beyond the 2-year treatment period in patients with hormone receptor-positive, human epidermal growth factor receptor 2-negative, node-positive, high-risk early breast cancer (EBC). Here, we report 5-year efficacy results from a prespecified overall survival (OS) interim analysis. In the intent-to-treat population, with a median follow-up of 54 months, the benefit of abemaciclib was sustained with hazard ratios of 0.680 (95% CI, 0.599 to 0.772) for IDFS and 0.675 (95% CI, 0.588 to 0.774) for DRFS. This persistence of abemaciclib benefit translated to continuous separation of the curves with a deepening in 5-year absolute improvement in IDFS and DRFS rates of 7.6% and 6.7%, respectively, compared with rates of 6% and 5.3% at 4 years and 4.8% and 4.1% at 3 years. With fewer deaths in the abemaciclib plus ET arm compared with the ET-alone arm (208 v 234), statistical significance was not reached for OS. No new safety signals were observed. In conclusion, abemaciclib plus ET continued to reduce the risk of developing invasive and distant disease recurrence beyond the completion of treatment. The increasing absolute improvement at 5 years is consistent with a carryover effect and further supports the use of abemaciclib in patients with high-risk EBC.
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Affiliation(s)
- Priya Rastogi
- UPMC Hillman Cancer Center and NSABP Foundation, Pittsburgh, PA
| | | | - Miguel Martin
- Hospital General Universitario Gregorio Marañon, Universidad Complutense, CIBERONC, GEICAM, Madrid, Spain
| | - Frances Boyle
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Javier Cortes
- International Breast Cancer Center (IBCC), Quironsalud Group, Barcelona, Spain
| | - Hope S. Rugo
- USCF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA
| | | | | | | | | | - Alexey Tryakin
- N.N. Blokhin Russian Cancer Research Center, Moscow, Russian Federation
| | | | - Laura Testa
- D'Or Institute for Research and Education (IDOR), São Paulo, Brazil
| | | | - Jens Huober
- Kantonsspital St Gallen, St Gallen, Switzerland
| | - Zhimin Shao
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Ran Wei
- Eli Lilly and Company, Indianapolis, IN
| | | | | | | | | | - Nadia Harbeck
- Comprehensive Cancer Centre München, LMU University Hospital, Munich, Germany
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Laidsaar-Powell R, Giunta S, Butow P, Turner S, Costa D, Saunders C, Koczwara B, Kay J, Jefford M, Schofield P, Boyle F, Yates P, White K, Sundaresan P, Varadarajan S, Juraskova I. An online intervention to improve oncology health professional self-efficacy in communicating with carers: Hybrid effectiveness-implementation evaluation of the eTRIO program. Patient Educ Couns 2024; 124:108251. [PMID: 38626502 DOI: 10.1016/j.pec.2024.108251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 04/18/2024]
Abstract
OBJECTIVES Many oncology health professionals (HPs) report communicating with carers as complex; and receive limited carer-relevant training. We developed an online HP education program for supporting and managing carer involvement (eTRIO). We aimed to assess whether HPs' self-efficacy in carer communication, knowledge, and decision-making preferences improve following eTRIO. Satisfaction and implementation potential were assessed. METHODS This type 1 hybrid effectiveness-implementation study used a pre-post single arm intervention design. HPs completed baseline measures, the eTRIO online module, and measures at 1- and 12-weeks post-intervention. Measures included: self-efficacy in carer communication (13-items), applied knowledge (7-items), preference for carer involvement in decisions (1-item). Fifteen of participants completed feedback interviews which underwent thematic analysis. User analytics were collected and analysed. RESULTS Fifty-six HPs completed baseline measures, 42 completed post- and follow-up measures. At baseline mean self-efficacy score was 88. HPs showed a statistically significant increase in self-efficacy post-intervention (mean = 105.8, CI [12.99, 20.47]), maintained at 12-weeks (mean = 101.1, CI [8.00, 15.72]). There were no changes in knowledge or decision-making preferences. Program engagement and satisfaction were high, 86.7% participants rated eTRIO as very/extremely helpful. CONCLUSIONS AND PRACTICE IMPLICATIONS eTRIO provided HPs with confidence to effectively engage with carers and manage complex situations such as family dominance. These gains are noteworthy, as conflict with families/carers contributes to HP burnout.
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Affiliation(s)
- Rebekah Laidsaar-Powell
- Centre for Medical Psychology & Evidence-based Decision-making, University of Sydney, Australia; Psycho-Oncology Co-operative Research Group, University of Sydney, Australia; School of Psychology, University of Sydney, Australia.
| | - Sarah Giunta
- Centre for Medical Psychology & Evidence-based Decision-making, University of Sydney, Australia; Psycho-Oncology Co-operative Research Group, University of Sydney, Australia; School of Psychology, University of Sydney, Australia
| | - Phyllis Butow
- Centre for Medical Psychology & Evidence-based Decision-making, University of Sydney, Australia; Psycho-Oncology Co-operative Research Group, University of Sydney, Australia
| | - Sandra Turner
- Department of Radiation Oncology, Westmead Hospital, Westmead, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Australia
| | - Daniel Costa
- School of Psychology, University of Sydney, Australia
| | - Christobel Saunders
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Australia
| | - Bogda Koczwara
- Flinders Medical Centre, Adelaide, Australia; Flinders University, Adelaide, Australia
| | - Judy Kay
- School of Computer Science, The University of Sydney, Sydney, Australia
| | - Michael Jefford
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
| | - Penelope Schofield
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Psychology, and Iverson Health Innovation Research Institute Swinburne University, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
| | - Frances Boyle
- Faculty of Medicine and Health, The University of Sydney, Australia; Patricia Ritchie Centre for Cancer Care & Research, Mater Hospital, Sydney, Australia
| | - Patsy Yates
- Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Kate White
- Susan Wakil School of Nursing, The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Australia
| | - Puma Sundaresan
- Trans Tasman Radiation Oncology Group, New South Wales, Australia; Sydney West Radiation Oncology Network, WSLHD, Sydney, Australia; Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Suganthy Varadarajan
- Department of Radiation Oncology, Westmead Hospital, Westmead, New South Wales, Australia; Blacktown Cancer and Haematology Centre, Blacktown Hospital, Blacktown, Australia
| | - Ilona Juraskova
- Centre for Medical Psychology & Evidence-based Decision-making, University of Sydney, Australia; Psycho-Oncology Co-operative Research Group, University of Sydney, Australia; School of Psychology, University of Sydney, Australia
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Lewis S, Newton G, Kenny K, Boyle F. The incurable self: Negotiating social bonds and dis/connection with metastatic breast cancer. Sociol Health Illn 2024; 46:295-314. [PMID: 37610256 DOI: 10.1111/1467-9566.13704] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/06/2023] [Indexed: 08/24/2023]
Abstract
As the culture of silence that once surrounded cancer has gradually given way to greater public awareness, normative visions of what cancer survivorship should entail have proliferated. These visions emphasise positivity and perseverance in pursuit of cure. While these visions provide comfort to many, for people with metastatic cancer, the emphasis on cure can undermine their sense of belonging to the broader collective of people living with cancer. Drawing on semi-structured interviews with 38 Australian women living with metastatic breast cancer, we explore how incurable cancer inflects understandings of self and transforms interpersonal relationships. Extending ideas around biosociality and belonging, we explore the tenuousness of social bonds, revealing how (in)visibility, (in)authenticity and (in)validation circulate within the daily lives of women with metastatic breast cancer. We conceptualise accounts according to four social bonds: (1) threatened bonds where a relationship is strained by misunderstanding, (2) severed bonds where a relationship is ruptured due to misunderstanding, (3) attuned bonds whereby a relationship is based on shared identification and (4) flexible social bonds when a relationship is based on mutual understanding. More broadly, we illustrate the persistence of normative visions of cancer survivorship and their enduring effects on those whom such visions exclude.
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Affiliation(s)
- Sophie Lewis
- Sydney School of Health Sciences, The University of Sydney, New South Wales, Sydney, Australia
| | - Giselle Newton
- Digital Cultures and Societies, University of Queensland, Queensland, Brisbane, Australia
| | - Katherine Kenny
- Sydney Centre for Healthy Societies, School of Social and Political Sciences, The University of Sydney, New South Wales, Sydney, Australia
| | - Frances Boyle
- Mater Hospital, North Sydney, New South Wales, Australia
- The University of Sydney, Sydney, New South Wales, Australia
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Li Z, Laginha KJ, Boyle F, Daly M, Dinner F, Hirsch P, Hobbs K, Kirsten L, Mazariego C, McAuley R, O'Brien M, O'Reilly A, Taylor N, Tobin L, Lewis S, Smith AL. Professionally led support groups for people living with advanced or metastatic cancer: a systematic scoping review of effectiveness and factors critical to implementation success within real-world healthcare and community settings. J Cancer Surviv 2024:10.1007/s11764-023-01515-w. [PMID: 38191752 DOI: 10.1007/s11764-023-01515-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/17/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE To examine the effectiveness of professionally led support groups for people with advanced or metastatic cancer, and identify factors critical to implementation success within real-world settings. METHODS Databases (MEDLINE; PsychINFO; CINAHL) and grey literature were searched for empirical publications and evaluations. Articles were screened for eligibility and data systematically extracted, charted and summarised using a modified scoping review methodology. Implementation factors were mapped using Proctor's implementation framework and the Consolidated Framework for Implementation Research 2.0. RESULTS A total of 1691 publications were identified; 19 were eligible for inclusion (8 randomised controlled trials, 7 qualitative studies, 2 cohort studies, 2 mixed methods studies). Most (n=18) studies focused on tumour-specific support groups. Evidence supported professionally led support groups in reducing mood disturbances (n=5), distress (i.e. traumatic stress, depression) (n=4) and pain (n=2). Other benefits included social connectedness (n=6), addressing existential distress (n=5), information and knowledge (n=6), empowerment and sense of control (n=2), relationships with families (n=2) and communication with health professionals (n=2). Thirteen studies identified factors predicting successful adoption, implementation or sustainment, including acceptability (n=12; 63%), feasibility (n=6; 32%) and appropriateness (n=1; 5%). Key determinants of successful implementation included group leaders' skills/experience, mode of operation, travelling distance, group composition and membership and resourcing. CONCLUSIONS Professionally led tumour-specific support groups demonstrate effectiveness in reducing mood disturbances, distress and pain among patients. Successful implementation hinges on factors such as leadership expertise, operational methods and resource allocation. IMPLICATIONS FOR CANCER SURVIVORS Professionally led support groups may fill an important gap in supportive care for people with advanced or metastatic cancer.
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Affiliation(s)
- Zhicheng Li
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Rm 111b, Edward Ford Building (A27), Camperdown, NSW, 2006, Australia
| | - Kitty-Jean Laginha
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Frances Boyle
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Michele Daly
- Cancer Institute NSW, Consumer Advisory Panel, Sydney, NSW, Australia
| | | | - Pia Hirsch
- Advanced Breast Cancer Group, Brisbane, Qld, Australia
| | - Kim Hobbs
- Westmead Centre for Gynaecological Cancers, Westmead, NSW, Australia
| | | | - Carolyn Mazariego
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | | | - Mary O'Brien
- Advanced Breast Cancer Group, Brisbane, Qld, Australia
| | | | - Natalie Taylor
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Lisa Tobin
- Breast Cancer Network Australia, Camberwell, VIC, Australia
| | - Sophie Lewis
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Andrea L Smith
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Rm 111b, Edward Ford Building (A27), Camperdown, NSW, 2006, Australia.
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Thompson JR, Fu H, Saw RPM, Sherman KA, Beedle V, Atkinson V, Boyle F, O'Sullivan NA, Martin LK, Bartula I. Supportive care needs in Australian melanoma patients and caregivers: results from a quantitative cross-sectional survey. Qual Life Res 2023; 32:3531-3545. [PMID: 37522941 PMCID: PMC10624748 DOI: 10.1007/s11136-023-03492-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE This study aimed to investigate the supportive care needs of Australian melanoma patients and their caregivers to form the basis for improving services. METHODS General and melanoma-related supportive care needs in melanoma patients were measured using the SCNS-SF34 and SCNS-M12 respectively, whereas caregivers completed the SCNS-P&C. Patients also completed the MCQ-28 and FCRI-9, with all participants completing the QLQ-C30, DASS-21, and questions measuring utilisation and preference for supportive health services. Multivariable stepwise logistic regression was used to identify variables associated with unmet needs in melanoma patients. RESULTS A total of 56 early-stage patients, 100 advanced-stage patients, and 37 caregivers participated. At least three-quarters ([Formula: see text] 75%) of each participant group reported at least one unmet need. Of the ten most reported unmet needs in each participant group, at least six ([Formula: see text] 60%) were related to psychological and emotional well-being, with access to a psychologist the most desired service (> 25%). Fear of cancer recurrence was equally prevalent in both patient groups at a level indicative of need for intervention. Advanced-stage patients reported significantly (p < 0.05) more unmet psychological, physical and daily living, and sexuality needs, and significantly (p < 0.05) worse functioning than early-stage patients. CONCLUSION Australian melanoma patients and caregivers report substantial unmet supportive care needs, particularly regarding their psychological and emotional well-being. Psychological and emotional well-being services, such as access to a clinical psychologist or implementation of patient-reported outcome measures, should be incorporated into routine melanoma care to address unmet patient and caregiver needs and improve well-being.
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Affiliation(s)
- Jake R Thompson
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
- Melanoma Institute Australia, The University of Sydney, 40 Rocklands Road, Wollstonecraft, Sydney, NSW, 2065, Australia.
| | - Hong Fu
- Department of Cancer Services, Princess Alexandra Hospital, University of Queensland, Woolloongabba, QLD, Australia
| | - Robyn P M Saw
- Melanoma Institute Australia, The University of Sydney, 40 Rocklands Road, Wollstonecraft, Sydney, NSW, 2065, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Kerry A Sherman
- School of Psychological Sciences, Macquarie University, Macquarie Park, NSW, Australia
| | | | - Victoria Atkinson
- Department of Cancer Services, Princess Alexandra Hospital, University of Queensland, Woolloongabba, QLD, Australia
| | - Frances Boyle
- Melanoma Institute Australia, The University of Sydney, 40 Rocklands Road, Wollstonecraft, Sydney, NSW, 2065, Australia
- Patricia Ritchie Centre for Cancer Care and Research, Mater Hospital, North Sydney, NSW, Australia
| | - Niamh A O'Sullivan
- Melanoma Institute Australia, The University of Sydney, 40 Rocklands Road, Wollstonecraft, Sydney, NSW, 2065, Australia
| | - Linda K Martin
- Melanoma Institute Australia, The University of Sydney, 40 Rocklands Road, Wollstonecraft, Sydney, NSW, 2065, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Iris Bartula
- Melanoma Institute Australia, The University of Sydney, 40 Rocklands Road, Wollstonecraft, Sydney, NSW, 2065, Australia
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Al‐Rikaby A, Sulaiman A, Thompson JR, Saw RPM, Boyle F, Taylor N, Carlino MS, Morton RL, Nieweg OE, Thompson JF, Bartula I. Telehealth follow-up consultations for melanoma patients during the COVID-19 pandemic: Patient and clinician satisfaction. Cancer Med 2023; 12:21373-21388. [PMID: 37930181 PMCID: PMC10726917 DOI: 10.1002/cam4.6679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 10/05/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic caused rapid implementation of telehealth for melanoma follow-up care in Australia. This study explores Australian melanoma patients and clinicians' level of satisfaction with telehealth. METHODS A cross-sectional study was conducted across three specialist melanoma centres in Sydney, Australia. Melanoma patients (all stages) and clinicians completed mixed methods surveys seeking socio-demographic and clinical information and questionnaires to assess satisfaction with telehealth. Additionally, patients completed measures of quality of life, fear of cancer recurrence and trust in their oncologist. Patients and clinicians provided open-ended responses to qualitative questions about their perceptions of telehealth. RESULTS One hundred and fifteen patients and 13 clinicians responded to surveys. Telephone was used by 109 (95%) patients and 11 (85%) clinicians. Fifty-seven (50%) patients and nine (69%) clinicians preferred face-to-face consultations, 38 (33%) patients and 3 (23%) clinicians preferred a combination of face-to-face and telehealth consultations. Five (4%) patients and nil clinicians preferred telehealth consultations. Patients diagnosed with early-stage melanoma, using telehealth for the first time, who have lower trust in their oncologist, and having higher care delivery, communication and supportive care concerns were likely to report lower satisfaction with telehealth. Open-ended responses were consistent between patients and clinicians, who reported safety, convenience and improved access to care as major benefits, while identifying personal, interpersonal, clinical and system-related disadvantages. DISCUSSION While telehealth has been widely implemented during COVID-19, the benefits identified by patients and clinicians may extend past the pandemic. Telehealth may be considered for use in conjunction with face-to-face consultations to provide melanoma follow-up care.
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Affiliation(s)
- Ali Al‐Rikaby
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Ahmad Sulaiman
- Melanoma Institute AustraliaThe University of SydneyNorth SydneyNew South WalesAustralia
| | - Jake R. Thompson
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Melanoma Institute AustraliaThe University of SydneyNorth SydneyNew South WalesAustralia
| | - Robyn P. M. Saw
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Melanoma Institute AustraliaThe University of SydneyNorth SydneyNew South WalesAustralia
- Department of Melanoma and Surgical OncologyRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
| | - Frances Boyle
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Melanoma Institute AustraliaThe University of SydneyNorth SydneyNew South WalesAustralia
- Patricia Ritchie Centre for Cancer Care and ResearchMater HospitalNorth SydneyNew South WalesAustralia
| | - Nicole Taylor
- Department of Medical OncologyWestmead and Blacktown HospitalsSydneyNew South WalesAustralia
| | - Matteo S. Carlino
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Melanoma Institute AustraliaThe University of SydneyNorth SydneyNew South WalesAustralia
- Department of Medical OncologyWestmead and Blacktown HospitalsSydneyNew South WalesAustralia
| | - Rachael L. Morton
- Melanoma Institute AustraliaThe University of SydneyNorth SydneyNew South WalesAustralia
- NHMRC Clinical Trials Centre, Faculty of Medicine and HealthThe University of SydneyCamperdown, SydneyNew South WalesAustralia
| | - Omgo E. Nieweg
- Melanoma Institute AustraliaThe University of SydneyNorth SydneyNew South WalesAustralia
- Department of Melanoma and Surgical OncologyRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
| | - John F. Thompson
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Melanoma Institute AustraliaThe University of SydneyNorth SydneyNew South WalesAustralia
- Department of Melanoma and Surgical OncologyRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
| | - Iris Bartula
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Melanoma Institute AustraliaThe University of SydneyNorth SydneyNew South WalesAustralia
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10
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Pal A, Smith B, Allan C, Karikios D, Boyle F. Improving Access to Cancer Clinical Trials for Patients From Culturally and Linguistically Diverse Backgrounds in Australia: A Survey of Clinical and Research Professionals. JCO Oncol Pract 2023; 19:1039-1047. [PMID: 37677123 DOI: 10.1200/op.23.00291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/05/2023] [Accepted: 08/01/2023] [Indexed: 09/09/2023] Open
Abstract
PURPOSE Patients with cancer from racial and ethnic minorities, referred to as culturally and linguistically diverse (CALD) in Australia, are significantly under-represented in cancer clinical trials. We performed a national survey of the Australian cancer clinical trials workforce to determine barriers and preferred solutions to address this inequity. METHODS A 15-item online survey containing both closed- and open-ended purpose-designed questions was created using REDCap. The survey was emailed to members of the Clinical Oncology Society of Australia, Medical Oncology Group of Australia, and Australian cancer cooperative trial groups, and promoted via Twitter. Descriptive analyses summarized quantitative data, and free-text entries underwent thematic analysis with NVivo Version 12. RESULTS Ninety one respondents completed the survey-with representation across Australia. Eighty-seven percent were directly involved in clinical trial recruitment. Sixty-eight percent were clinicians. Seventy-four percent of respondents did not collect routine data on CALD patient enrollment to cancer clinical trials. Communication (eg, lack of translated materials) and opportunity-related barriers (eg, exclusionary trial protocols) were the most frequently perceived barriers to recruitment. Additionally, qualitative analysis indicated that insufficient consultation time and difficulties accessing interpreters for patients with non-English language preference were significant barriers. Trial navigators and a generic cancer trial pamphlet available in multiple languages were judged the most likely solutions to improve recruitment. CONCLUSION This study articulates the Australian clinical trials workforce's perspective on current barriers and potential solutions to the under-representation of patients from CALD backgrounds on cancer clinical trials. The insights and solutions from this survey provide steps toward achieving equity in Australian cancer clinical trials.
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Affiliation(s)
- Abhijit Pal
- Liverpool Hospital, Sydney, NSW, Australia
- Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
- University of Sydney, Sydney, NSW, Australia
| | - Ben Smith
- Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
- South West Sydney Clinical Campuses, University of New South Wales, Sydney, NSW, Australia
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11
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Dempsey K, Mathieu E, Brennan M, Snook K, Hoffman J, Campbell I, Scarlet J, Flay H, Wong A, Boyle F, King M, Spillane A. Patient-reported health-related quality of life outcomes following mastectomy for breast cancer, with immediate, delayed or no breast reconstruction: Four-year follow-up from a prospective cohort study. Breast 2023; 71:122-131. [PMID: 37573653 PMCID: PMC10428140 DOI: 10.1016/j.breast.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/25/2023] [Accepted: 08/01/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Breast reconstruction (BR) improves women's health-related quality of life (HRQOL) following mastectomy for breast cancer, yet factors contributing to improved HRQOL remain unclear. This study aimed to explore the overall impact of mastectomy with or without BR on participants' perceptions of HRQOL over time in a cohort of women with high-risk breast cancer; to examine differences in mean HRQOL scores between immediate BR, delayed BR and no BR groups; to assess the influence of patient characteristics potentially associated with HRQOL scores; and to determine the feasibility of long-term collection of patient-reported outcome measures in clinical settings. METHODS A prospective, longitudinal study of 100 women with high-risk breast cancer who underwent mastectomy with or without breast reconstruction and were likely to require post-mastectomy radiotherapy. Four validated patient-reported questionnaires, comprising 21 outcome measures relating to HRQOL, administered at baseline and up to 4 years post-mastectomy. Demographic, clinical and surgical data extracted from patient medical records. RESULTS Consistently significant declines in perceptions of future health and arm symptoms, consistently significant improvements in treatment side effects, breast symptoms and fatigue, as well as significant improvements, compared to baseline, in social functioning and financial difficulties at 48 months. No significant differences in mean HRQOL scores between women given a choice of reconstructive options. CONCLUSION Similar trajectories of HRQOL scores were found in women with high-risk breast cancer who were offered a choice of BR. Informed choice may be an independent contributing factor in long-term maintenance of most HRQOL indicators at their pre-mastectomy levels.
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Affiliation(s)
- Kathy Dempsey
- The University of Sydney, Northern Clinical School, St Leonards, NSW, 2065, Australia; The University of Sydney, School of Public Health, Camperdown, NSW, 2006, Australia; Breast & Surgical Oncology at the Poche Centre. 40 Rocklands Rd, North Sydney, NSW, 2060, Australia.
| | - Erin Mathieu
- The University of Sydney, School of Public Health, Camperdown, NSW, 2006, Australia.
| | - Meagan Brennan
- The University of Sydney, Northern Clinical School, St Leonards, NSW, 2065, Australia; Breast & Surgical Oncology at the Poche Centre. 40 Rocklands Rd, North Sydney, NSW, 2060, Australia; University of Notre Dame Australia, School of Medicine, Darlinghurst, NSW, 2010, Australia.
| | - Kylie Snook
- The University of Sydney, Northern Clinical School, St Leonards, NSW, 2065, Australia; Breast & Surgical Oncology at the Poche Centre. 40 Rocklands Rd, North Sydney, NSW, 2060, Australia; The Mater Hospital, Rocklands Rd, North Sydney, NSW, 2060, Australia.
| | - Julia Hoffman
- Breast & Surgical Oncology at the Poche Centre. 40 Rocklands Rd, North Sydney, NSW, 2060, Australia.
| | - Ian Campbell
- Breast Care Centre & Research Office, Waikato Hospital, Hamilton, New Zealand; University of Auckland, Waikato Campus, Faculty of Health Sciences, New Zealand.
| | - Jenni Scarlet
- Breast Care Centre & Research Office, Waikato Hospital, Hamilton, New Zealand.
| | - Heather Flay
- Breast Care Centre & Research Office, Waikato Hospital, Hamilton, New Zealand.
| | - April Wong
- Breast & Surgical Oncology at the Poche Centre. 40 Rocklands Rd, North Sydney, NSW, 2060, Australia; University of Auckland, Waikato Campus, Faculty of Health Sciences, New Zealand; St Vincent's Health Network, Sydney, NSW, Australia.
| | - Frances Boyle
- The University of Sydney, Northern Clinical School, St Leonards, NSW, 2065, Australia; The Mater Hospital, Rocklands Rd, North Sydney, NSW, 2060, Australia; Patricia Ritchie Centre for Cancer Care & Research, Mater Hospital, North Sydney, NSW, 2060, Australia.
| | - Madeleine King
- The University of Sydney, School of Psychology, Camperdown, NSW, 2006, Australia.
| | - Andrew Spillane
- The University of Sydney, Northern Clinical School, St Leonards, NSW, 2065, Australia; Breast & Surgical Oncology at the Poche Centre. 40 Rocklands Rd, North Sydney, NSW, 2060, Australia; The Mater Hospital, Rocklands Rd, North Sydney, NSW, 2060, Australia; Royal North Shore Hospital, Reserve Rd, St Leonards, NSW, 2065, Australia.
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Batty K, Taylor AM, Bernard EJ, Diakos CI, Clarke SJ, Guminski A, Baron-Hay S, Boyle F, Pavlakis N, Chan DL. Metastatic primary breast neuroendocrine neoplasms: a case series. Intern Med J 2023; 53:1813-1818. [PMID: 36314732 DOI: 10.1111/imj.15961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/05/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Breast neuroendocrine neoplasms represent a rare subtype of breast cancer which have not been well studied or characterised, particularly in the metastatic setting. AIM To present clinicopathological characteristics, treatment and outcomes of a series of patients with metastatic neuroendocrine carcinoma of the breast and review the current literature. METHODS We performed a retrospective review to identify and describe patients with metastatic neuroendocrine carcinoma of the breast at our centre between 2011 and 2021. Medical records, pathology and imaging results were examined to evaluate the clinical and histopathological features as well as the treatment pathways and prognosis of these patients. RESULTS We present a series of seven female patients with metastatic neuroendocrine carcinoma of the breast, as defined by the World Health Organization classification, over a period of 10 years (2011-2021) from a single centre. Median age at diagnosis was 48 years (range 39-63). Six of seven tissue samples expressed synaptophysin and chromogranin and were also oestrogen and progesterone receptor positive; median Ki-67 index was 50% (range 20-90%). All seven patients had demonstrated avidity on 18 F-FDG PET imaging, and the six who underwent 68 Ga-DOTATATE PET all had significant avidity. Treatment modalities and sequencing varied, but all patients received chemotherapy during their disease course. Six patients received three or more lines of treatment. Median overall survival was 31.8 months (range 3.7-108.6). Median progression-free survival (PFS) with first-line therapy for metastatic disease was 5.8 months (range 1.8-37.8). CONCLUSIONS This series shows the use of multiple modalities in treating this disease, with different sequencing in different patients. Despite multiple modalities used in the first-line setting, first-line PFS remains short. Larger series and further molecular characterisation are required to aid clinicians in managing this condition and to guide optimal treatment sequencing to improve outcomes in this rare patient group.
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Affiliation(s)
- Kathleen Batty
- Medical Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Amelia M Taylor
- Medical Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Elizabeth J Bernard
- Nuclear Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Connie I Diakos
- Medical Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Bill Walsh Translational Cancer Research Laboratory, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Stephen J Clarke
- Medical Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Bill Walsh Translational Cancer Research Laboratory, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Alexander Guminski
- Medical Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Sally Baron-Hay
- Medical Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Frances Boyle
- Patricia Ritchie Centre for Breast Cancer Research, Mater Hospital, North Sydney and University of Sydney, The Mater Hospital, Sydney, New South Wales, Australia
- University of Sydney, Sydney, Australia
| | - Nick Pavlakis
- Medical Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Bill Walsh Translational Cancer Research Laboratory, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - David L Chan
- Medical Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Bill Walsh Translational Cancer Research Laboratory, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
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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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14
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Bamgbose O, Boyle F, Kean AC, Stefanescu BM, Wing S. Tolerability and Safety of Lacosamide in Neonatal Population. J Child Neurol 2023; 38:137-141. [PMID: 36972493 DOI: 10.1177/08830738231164835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Lacosamide is a newer antiepileptic medication used in refractory neonatal seizures with limited safety and efficacy data. This case series spans 4 years and includes 38 neonates cared for in the neonatal, pediatric, and cardiovascular intensive care units, who received lacosamide for refractory seizures. Because lacosamide affects atrioventricular node function in adults, among other metrics, electrocardiogram (ECG) changes were monitored closely in these neonates. Within this cohort, 2 neonates were found to have atrial bigeminy on ECG and telemetry. Otherwise, lacosamide was generally well tolerated with sleepiness being the most common symptom noted. This case series reports data on the tolerability of lacosamide and emphasizes the importance of monitoring key cardiac intervals with ECG before and after the use of lacosamide in this population.
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Affiliation(s)
- Olajumoke Bamgbose
- Child Neurology, Riley Child Neurology, 12250Indiana University School of Medicine, Indianapolis, IN , USA
| | - Frances Boyle
- Neonatology, Division of Neonatal-Perinatal Medicine, 12250Indiana University School of Medicine, Indianapolis, IN, USA
| | - Adam C Kean
- Pediatric Cardiology, Pediatric Cardiology, 12250Indiana University School of Medicine, Indianapolis, IN, USA
| | - Beatrice M Stefanescu
- Neonatology, Division of Neonatal-Perinatal Medicine, 12250Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sarah Wing
- Child Neurology, Riley Child Neurology, 12250Indiana University School of Medicine, Indianapolis, IN , USA
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15
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McCaffrey N, Cheah SL, Luckett T, Phillips JL, Agar M, Davidson PM, Boyle F, Shaw T, Currow DC, Lovell M. Treatment patterns and out-of-hospital healthcare resource utilisation by patients with advanced cancer living with pain: An analysis from the Stop Cancer PAIN trial. PLoS One 2023; 18:e0282465. [PMID: 36854021 PMCID: PMC9974128 DOI: 10.1371/journal.pone.0282465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/16/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND About 70% of patients with advanced cancer experience pain. Few studies have investigated the use of healthcare in this population and the relationship between pain intensity and costs. METHODS Adults with advanced cancer and scored worst pain ≥ 2/10 on a numeric rating scale (NRS) were recruited from 6 Australian oncology/palliative care outpatient services to the Stop Cancer PAIN trial (08/15-06/19). Out-of-hospital, publicly funded services, prescriptions and costs were estimated for the three months before pain screening. Descriptive statistics summarize the clinico-demographic variables, health services and costs, treatments and pain scores. Relationships with costs were explored using Spearman correlations, Mann-Whitney U and Kruskal-Wallis tests, and a gamma log-link generalized linear model. RESULTS Overall, 212 participants had median worst pain scores of five (inter-quartile range 4). The most frequently prescribed medications were opioids (60.1%) and peptic ulcer/gastro-oesophageal reflux disease (GORD) drugs (51.6%). The total average healthcare cost in the three months before the census date was A$6,742 (95% CI $5,637, $7,847), approximately $27,000 annually. Men had higher mean healthcare costs than women, adjusting for age, cancer type and pain levels (men $7,872, women $4,493, p<0.01) and higher expenditure on prescriptions (men $5,559, women $2,034, p<0.01). CONCLUSIONS In this population with pain and cancer, there was no clear relationship between healthcare costs and pain severity. These treatment patterns requiring further exploration including the prevalence of peptic ulcer/GORD drugs, and lipid lowering agents and the higher healthcare costs for men. TRIAL REGISTRATION ACTRN12615000064505. World Health Organisation unique trial number U1111-1164-4649. Registered 23 January 2015.
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Affiliation(s)
- Nikki McCaffrey
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Burwood Campus, Burwood, VIC, Australia
- * E-mail:
| | - Seong Leang Cheah
- Faculty of Health, IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation Sydney), University of Technology Sydney (UTS), Sydney, NSW, Australia
| | - Tim Luckett
- Faculty of Health, IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation Sydney), University of Technology Sydney (UTS), Sydney, NSW, Australia
| | - Jane L. Phillips
- Faculty of Health, IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation Sydney), University of Technology Sydney (UTS), Sydney, NSW, Australia
- Faculty of Health, School of Nursing, Queensland University of Technology, Kelvin Grove Brisbane, Queensland
| | - Meera Agar
- Faculty of Health, IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation Sydney), University of Technology Sydney (UTS), Sydney, NSW, Australia
| | - Patricia M. Davidson
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Frances Boyle
- Patricia Ritchie Centre for Cancer Care and Research, Mater Hospital North Sydney, and University of Sydney, Sydney, NSW, Australia
| | - Tim Shaw
- Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - David C. Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Melanie Lovell
- Department of Palliative Care, HammondCare, Greenwich Hospital, Sydney, NSW, Australia
- Northern Clinical School, University of Sydney, Sydney, NSW, Australia
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Beatty L, Kemp E, Butow P, Girgis A, Hulbert-Williams N, Kaambwa B, Schofield P, Turner J, Woodman R, Boyle F, Daly A, Jones A, Kiely B, Zdenkowski N, Koczwara B. Finding My Way-Advanced: can a web-based psychosocial intervention improve the mental quality of life for women with metastatic breast cancer vs attention-control? Study protocol of a randomised controlled trial. BMC Cancer 2022; 22:1353. [PMID: 36566189 PMCID: PMC9789659 DOI: 10.1186/s12885-022-10410-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/05/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Women living with metastatic breast cancer (MBC) are at risk of significantly impaired quality of life (QOL), symptom burden, distress and fear of progression, and unmet needs, yet they face barriers to accessing evidence-based psychosocial treatments. Our group therefore developed Finding My Way-Advanced (FMW-A), a web-based self-guided psychosocial program for women with MBC. This study aims to assess its efficacy in improving mental and other QOL domains, distress, fear of progression, unmet needs, and health service utilisation. METHODS The multi-site randomised controlled trial (RCT) will enrol 370 Australian participants. Eligible participants are adult (18 years +) women diagnosed with MBC, with a life expectancy of 6 months or more, with sufficient English-language literacy to provide informed consent. Participants will be identified, screened and referred from one of 10 Australian sites, or via self-referral in response to advertisements. Participants complete four online questionnaires: prior to accessing their program ('baseline'), 6 weeks later ('post-intervention'), then 3 months and 6 months post-intervention. Consenting participants will be randomised to either FMW-A (intervention), or Breast Cancer Network Australia's (BCNA) online/app resource My Journey (minimal intervention attention-control). This is a single-blind study, with randomisation computer-generated and stratified by site. FMW-A is a 6-module program addressing some of the most common issues experienced by women with MBC, with BCNA control resources integrated within the 'resources' section. All modules are immediately accessible, with an additional booster module released 10 weeks later. The primary outcome is mental QOL; statistical criteria for superiority is defined as a 4-point difference between groups at post-treatment. Secondary outcomes include other QOL domains, distress, fear of progression, health service use, intervention adherence, and user satisfaction. DISCUSSION This will be the first adequately powered RCT of a self-directed online intervention for women with MBC. If efficacious, FMW-A will help address two national key priorities for management of MBC - enhancing QOL and reducing symptom burden. FMW-A has the potential to address unmet needs and overcome access barriers for this overlooked population, while reducing health system burden. TRIAL REGISTRATION The study was registered prospectively with the ANZCTR on 29/10/2021. Trial ID ACTRN12621001482853p. https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382714&isReview=true.
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Affiliation(s)
- Lisa Beatty
- grid.1014.40000 0004 0367 2697Flinders University, Adelaide, Australia
| | - Emma Kemp
- grid.1014.40000 0004 0367 2697Flinders University, Adelaide, Australia
| | - Phyllis Butow
- grid.1013.30000 0004 1936 834XUniversity of Sydney, Sydney, Australia
| | - Afaf Girgis
- grid.1005.40000 0004 4902 0432University of NSW, Sydney, Australia
| | | | | | - Penelope Schofield
- grid.1027.40000 0004 0409 2862Swinburne University, Melbourne, Australia ,grid.1055.10000000403978434Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Jane Turner
- grid.1003.20000 0000 9320 7537University of Queensland, St Lucia, Australia
| | - Richard Woodman
- grid.1014.40000 0004 0367 2697Flinders University, Adelaide, Australia
| | | | - Anthony Daly
- grid.492269.20000 0001 2233 2629Cancer Council South Australia, Adelaide, Australia
| | - Amanda Jones
- Southern Adelaide Local Health Network, Bedford Park, Australia
| | - Belinda Kiely
- grid.460708.d0000 0004 0640 3353Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown, Australia
| | - Nicholas Zdenkowski
- grid.266842.c0000 0000 8831 109XUniversity of Newcastle, Newcastle, Australia
| | | | - Bogda Koczwara
- grid.1014.40000 0004 0367 2697Flinders University, Adelaide, Australia ,Southern Adelaide Local Health Network, Bedford Park, Australia
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17
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Dempsey K, Saw R, Bartula I, Lo S, Lawn C, Pennington T, Spillane A, Boyle F, Dong S, Dieng M, Milne D, Seaman L, Saks D, Lai-Kwon J, Thompson JR, Morton R. Embedding electronic patient-reported outcome measures into routine care for patients with stage III MELanoma (ePROMs-MEL): protocol for a prospective, longitudinal, mixed-methods pilot study. BMJ Open 2022; 12:e066852. [PMID: 36600423 PMCID: PMC9772660 DOI: 10.1136/bmjopen-2022-066852] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The benefits of patient-reported feedback, using questionnaires that allow patients to report how they feel and function without any interpretation from healthcare professionals, are well established. However, patient-reported outcomes measures (PROMs) are not routinely collected in patients with melanoma in Australia. The aim of this study is to evaluate the feasibility and acceptability of implementing electronic PROMs (ePROMs) into routine care from the perspectives of patients with stage III melanoma and their treating clinical team. METHODS AND ANALYSIS A minimum of 50 patients and 5 clinicians will be recruited to this prospective, longitudinal pilot study (ePROMs-MELanoma). The study uses a mixed-methods approach (quantitative PROMs questionnaires and end-of-study surveys with qualitative interviews) and commenced in May 2021 in surgical and medical melanoma clinics at two sites in metropolitan Sydney, Australia. The primary outcomes are measures of feasibility and acceptability, comprising descriptive questionnaire completion statistics, and proportion of patients who reported that these PROMs were easy to complete and measured items they considered important. Clinician and clinic staff views will be canvassed on the appropriateness of these PROMs for their patients, change in referral practice and uptake and incorporation into routine practice. Secondary aims include measurement of improvements in patients' emotional and physical health and well-being, and utility of real-time data capture and clinician feedback. All participants will complete the Distress Thermometer and EQ-5D-5L questionnaires in the clinic using a tablet computer at baseline and two to three subsequent follow-up appointments. Participants who report a score of 4 or higher on the Distress Thermometer will be triaged to complete an additional three questionnaires: the QLQ-C30, Depression, Anxiety and Stress Scale and Melanoma Concerns Questionnaire-28. Results will be generated in real time; patients with psychosocial distress or poor quality of life will discuss possible referral to appropriate allied health services with their clinician. Thematic analysis of interviews will be conducted. ETHICS AND DISSEMINATION Ethics approval obtained from St Vincent's Hospital Human Research Ethics Committee on 19 September 2019 (2019/ETH10558), with amendments approved on 8 June 2022. Patient consent is obtained electronically prior to questionnaire commencement. Dissemination strategies will include publication in peer-reviewed journals and presentation at international conferences, tailored presentations for clinical societies and government bodies, organisational reporting through multidisciplinary meetings and research symposia for local clinicians and clinic staff, and more informal, lay reports and presentations for consumer melanoma representative bodies and patient participants and their families. TRIAL REGISTRATION NUMBER ACTRN12620001149954.
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Affiliation(s)
- Kathy Dempsey
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Robyn Saw
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia
| | - Iris Bartula
- Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia
| | - Serigne Lo
- Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia
| | - Craig Lawn
- Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia
| | - Thomas Pennington
- Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia
| | - Andrew Spillane
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia
| | - Frances Boyle
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia
| | - Skye Dong
- Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia
| | - Mbathio Dieng
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Donna Milne
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Linda Seaman
- Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia
| | - Dina Saks
- Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia
| | - Julia Lai-Kwon
- Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia
| | | | - Rachael Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia
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18
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Wong V, de Boer R, Baron-Hay S, Blum R, Boyle F, Chua S, Clarke K, Cuff K, Green M, Lim E, Mok K, Nott L, Nottage M, Tafreshi A, Tsoi D, Uccellini A, Hong W, Gibbs P, Lok SW. Real-World Outcomes of Ribociclib and Aromatase Inhibitor Use in First Line Hormone Receptor Positive, HER2-Negative Metastatic Breast Cancer. Clin Breast Cancer 2022; 22:792-800. [PMID: 36151018 DOI: 10.1016/j.clbc.2022.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 08/25/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND International guidelines recommend combining a CDK4/6 inhibitor and endocrine therapy (ET) as first line treatment for hormone receptor (HR) positive, HER2 negative metastatic breast cancer (MBC). Results from MONALEESA-2 demonstrate superior progression free survival (PFS) and overall survival (OS) with ribociclib (CDK4/6 inhibitor) and ET compared to ET alone. Real world outcomes have yet to be reported. MATERIALS AND METHODS KARMA is a non-interventional registry of Australian patients receiving first-line treatment with ribociclib and aromatase inhibitor (AI), obtained via a Medicine Access Program (MAP) for HR+, HER2- MBC. Outcomes were compared with the ribociclib/letrozole cohort in MONALEESA-2. RESULTS Data from 160 patients at 17 sites was analysed. Median follow-up is 36.5 months. Compared to MONALEESA-2, patients were numerically younger (54.3 vs. 62 years), with higher rates of bone-only metastases (31% vs. 21%). A total of 63 of 160 (39%) patients remain on treatment. A total of 56% of patients had at least 1 dose reduction, with neutropenia (68%) and abnormal liver enzymes (17%) the most common reasons. A total of 17 of 160 (11%) discontinued treatment due to toxicity, with no treatment related deaths. Median PFS was not reached (95% CI 29.9- NR), with PFS at 12 months and 18 months being 76% and 67% respectively versus 25.3 months, 73% and 63% in MONALEESA-2. CONCLUSION The ribociclib and AI combination was well tolerated in this real-world setting. The KARMA registry cohort achieved a superior PFS (>36.5 months) to MONALEESA-2, potentially due to more favourable baseline disease characteristics. Less frequent assessment scheduling in this non trial setting may also contribute.
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Affiliation(s)
- Vanessa Wong
- Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.
| | - Richard de Boer
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Parkville, VIC, Australia; St Vincent's Private Hospital, Fitzroy, VIC, Australia
| | | | - Robert Blum
- Department of Medical Oncology, Bendigo Health, Bendigo, VIC, Australia
| | | | - Susan Chua
- Department of Medical Oncology, Eastern Health, Box Hill, VIC, Australia
| | - Kerrie Clarke
- Albury Wodonga Regional Cancer Centre, Albury Wodonga Health, East Albury, NSW, Australia
| | - Katharine Cuff
- Department of Medical Oncology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | | | - Elgene Lim
- St Vincent's Clinical School, University of New South Wales, NSW, Australia
| | - Kelly Mok
- Department of Medical Oncology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Louise Nott
- Department of Medical Oncology, Royal Hobart Hospital, Hobart, TAS, Australia
| | - Michelle Nottage
- Department of Medical Oncology, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Ali Tafreshi
- Wollongong Private Hospital, Wollongong, NSW, Australia
| | - Daphne Tsoi
- St John of God Subiaco Hospital, Subiaco, WA, Australia
| | - Anthony Uccellini
- Department of Medical Oncology, Olivia Newton-John Cancer and Wellness Centre, Austin Health, Heidelberg, VIC, Australia
| | - Wei Hong
- Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | - Peter Gibbs
- Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; Department of Medical Oncology, Western Health, Footscray, VIC, Australia
| | - Sheau Wen Lok
- Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, Parkville, VIC, Australia
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19
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Sullivan E, Safi N, Li Z, Remond M, Chen TYT, Javid N, Dickinson JE, Ives A, Hammarberg K, Anazodo A, Boyle F, Fisher J, Halliday L, Duncombe G, McLintock C, Wang AY, Saunders C. Perinatal outcomes of women with gestational breast cancer in Australia and New Zealand: A prospective population-based study. Birth 2022; 49:763-773. [PMID: 35470904 PMCID: PMC9790712 DOI: 10.1111/birt.12642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 02/22/2022] [Accepted: 04/07/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To determine the epidemiology, clinical management, and outcomes of women with gestational breast cancer (GBC). METHODS A population-based prospective cohort study was conducted in Australia and New Zealand between 2013 and 2014 using the Australasian Maternity Outcomes Surveillance System (AMOSS). Women who gave birth with a primary diagnosis of breast cancer during pregnancy were included. Data were collected on demographic and pregnancy factors, GBC diagnosis, obstetric and cancer management, and perinatal outcomes. The main outcome measures were preterm birth, maternal complications, breastfeeding, and death. RESULTS Forty women with GBC (incidence 7.5/100 000 women giving birth) gave birth to 40 live-born babies. Thirty-three (82.5%) women had breast symptoms at diagnosis. Of 27 women diagnosed before 30 weeks' gestation, 85% had breast surgery and 67% had systemic therapy during pregnancy. In contrast, all 13 women diagnosed from 30 weeks had their cancer management delayed until postdelivery. There were 17 preterm deliveries; 15 were planned. Postpartum complications included the following: hemorrhage (n = 4), laparotomy (n = 1), and thrombocytopenia (n = 1). There was one late maternal death. Eighteen (45.0%) women initiated breastfeeding, including 12 of 23 women who had antenatal breast surgery. There were no perinatal deaths or congenital malformations, but 42.5% of babies were preterm, and 32.5% were admitted for higher-level neonatal care. CONCLUSIONS Gestational breast cancer diagnosed before 30 weeks' gestation was associated with surgical and systemic cancer care during pregnancy and planned preterm birth. In contrast, cancer treatment was deferred to postdelivery for women diagnosed from 30 weeks, reflecting the complexity of managing expectant mothers with GBC in multidisciplinary care settings.
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Affiliation(s)
- Elizabeth Sullivan
- College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Nadom Safi
- College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Zhuoyang Li
- College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Marc Remond
- College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Tina Y. T. Chen
- Faculty of HealthUniversity of Technology SydneySydneyNew South WalesAustralia
| | - Nasrin Javid
- Faculty of HealthUniversity of Technology SydneySydneyNew South WalesAustralia
| | - Jan E. Dickinson
- Faculty of Health and Medical SciencesThe University of Western AustraliaPerthWestern AustraliaAustralia
| | - Angela Ives
- Faculty of Health and Medical Sciences, Medical SchoolThe University of Western AustraliaPerthWestern AustraliaAustralia
| | - Karin Hammarberg
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Antoinette Anazodo
- School of Women and ChildrenUniversity of New South WalesSydneyNew South WalesAustralia
| | - Frances Boyle
- Patricia Ritchie Centre for Cancer Care and ResearchMater Hospital Sydney, and University of SydneySydneyNew South WalesAustralia
| | - Jane Fisher
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Lesley Halliday
- School of Public Health and Community MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Greg Duncombe
- Faculty of Medicine, Centre for Clinical ResearchUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Claire McLintock
- National Women's HealthAuckland City HospitalAucklandNew Zealand
| | - Alex Y. Wang
- Faculty of HealthUniversity of Technology SydneySydneyNew South WalesAustralia
| | - Christobel Saunders
- Faculty of Health and Medical SciencesThe University of Western AustraliaPerthWestern AustraliaAustralia
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20
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Loi S, Karapetis CS, McCarthy N, Oakman C, Redfern A, White M, Khasraw M, Doval DC, Gore V, Alam M, Binko J, Lu DR, Kim S, Boyle F. Palbociclib plus letrozole as treatment for postmenopausal women with hormone receptor-positive/human epidermal growth factor receptor 2-negative advanced breast cancer for whom letrozole therapy is deemed appropriate: An expanded access study in Australia and India. Asia Pac J Clin Oncol 2022; 18:560-569. [PMID: 34908235 PMCID: PMC9787838 DOI: 10.1111/ajco.13653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/17/2021] [Indexed: 12/30/2022]
Abstract
AIM Palbociclib was approved in the United States in 2015 to treat estrogen receptor-positive/human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer (ABC). This study evaluated outcomes and safety in patients treated with palbociclib in Australia and India with hormone receptor-positive (HR+)/HER2- ABC before palbociclib became commercially available. METHODS Postmenopausal women (≥18 years) with HR+/HER2- ABC who were appropriate candidates for letrozole therapy received palbociclib 125 mg once daily for 21 days followed by 7 days off, and letrozole 2.5 mg once daily (continuous). Safety, tumor response, and patient-reported outcomes (Australian cohort) were evaluated. RESULTS In total, 252 patients received palbociclib plus letrozole (Australia, n = 152; India, n = 100). More patients in the Australian versus Indian cohort had received prior chemotherapy (advanced/metastatic setting: 45.9% vs. 32.0%), endocrine therapy (advanced/metastatic setting: 63.2% vs. 54.3%), and advanced/metastatic therapies (61.8% vs. 31.0%). The most frequently reported all-grade palbociclib-related treatment-emergent adverse events were neutropenia (66.7%), fatigue (35.3%), and stomatitis (26.6%); grade 3/4 neutropenia was reported as palbociclib-related in 62.7% of patients. Febrile neutropenia was reported in six patients (2.4%). Eight patients (3.2%) discontinued because of an adverse event. The objective response rate was 19.4% (95% CI, 14.7%-24.9%) overall and 2.3% in Australian patients with ≥2 lines of prior therapy for metastatic disease. Patient-reported quality of life scores were maintained throughout the study. CONCLUSIONS In an expanded access setting in Australia and India, palbociclib plus letrozole was well tolerated in patients with HR+/HER2- ABC, with a safety profile consistent with previous reports.
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Affiliation(s)
- Sherene Loi
- Peter MacCallum Cancer CentreMelbourneVictoriaAustralia
| | | | | | | | | | | | | | | | - Vinod Gore
- Sahyadri Super Specialty HospitalPuneMaharashtraIndia
| | | | | | | | | | - Frances Boyle
- Patricia Ritchie Centre for Cancer Care and ResearchMater HospitalNorth SydneyAustralia
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21
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Smith AL, Boyle F, Lewis S. Potential inequities in availability of care from breast care nurses: a qualitative study reporting the experiences and perspectives of women with metastatic breast cancer in Australia. BMC Health Serv Res 2022; 22:942. [PMID: 35869552 PMCID: PMC9308323 DOI: 10.1186/s12913-022-08269-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 06/21/2022] [Indexed: 12/24/2022] Open
Abstract
Background International consensus guidelines recommend patients with metastatic breast cancer have access to a nurse experienced in the treatment of metastatic breast cancer. This study aimed to explore women’s experiences of supportive care from breast care nurses, including their perspectives on the role breast care nurses currently play in providing support to people with metastatic breast cancer. Methods Multiple semi-structured qualitative interviews with 38 women with metastatic breast cancer in Australia. Data relating to nursing care were extracted and analysed using thematic analysis. Results Three themes were identified: (1) feeling that supportive care needs are unrecognised; (2) confusion about role and relevance of breast care nurse to those with metastatic breast cancer; (3) care from metastatic breast care nurses (when available) was appreciated, valued and beneficial. Participants’ experiences differed in relation to ease of access to, amount of contact with, and level of care provided by breast care nurses. Contact and care ranged from little or none to comprehensive and ongoing. A key system-level challenge was that the diversity of diagnostic and treatment pathways for metastatic breast cancer meant that no systematic means existed to support routine or regular contact between breast care nurses and participants. Participants who did report having access to a specialised metastatic breast care nurse placed considerable value on the care received. For these participants, care from the breast care nurse extended and complemented care from the oncologist and included much needed psychosocial and practical support. For these participants, the breast care nurse assumed the role of key contact and care coordinator and was valued for their availability, accessibility and responsiveness. High levels of trust developed between patient and breast care nurse. Conclusions Findings indicate that there may be gaps and inequities in supportive care in Australia for people diagnosed with metastatic breast cancer, a finding that supports earlier reports of limited access to breast care nurses for people with metastatic breast cancer in Australia. The specialised metastatic breast care nurse could potentially play a key role in addressing the high level of unmet supportive care needs and improve continuity of care for these patients.
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22
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Toi M, Boyle F, Im YH, Reinisch M, Molthrop D, Jiang Z, Wei R, Sapunar F, Grimes BR, Nabinger SC, Johnston SRD. Adjuvant Abemaciclib Combined with Endocrine Therapy: Efficacy Results in monarchE Cohort 1. Oncologist 2022; 28:e77-e81. [PMID: 36342342 PMCID: PMC9847542 DOI: 10.1093/oncolo/oyac234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 09/29/2022] [Indexed: 11/09/2022] Open
Abstract
The monarchE Cohort 1 patient population was enrolled based on high-risk clinicopathological features that can easily be identified as part of routine clinical breast cancer evaluation. Efficacy data from Cohort 1 demonstrate substantial evidence of benefit for adjuvant abemaciclib+ET in patients with HR+, HER2- early breast cancer at high risk of recurrence (ClinicalTrials.gov: NCT03155997 [monarchE]).
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Affiliation(s)
- Masakazu Toi
- Corresponding author: Masakazu Toi, PhD, Breast Cancer Unit, Kyoto University Hospital, Breast Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaracho, Sakyo-ku, Kyoto 606-8507, Japan; Tel: +81 75 751 3660; Fax: +81 75 751 3616; E-mail:
| | - Frances Boyle
- Patricia Ritchie Centre for Cancer Care and Research, Mater Hospital, Sydney, Australia,University of Sydney, Sydney, Australia
| | - Young-Hyuck Im
- Division of Hematology/Medical Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | - David Molthrop
- Hematology and Oncology, Florida Cancer Specialists & Research Institute, Orlando, FL, USA
| | - Zefei Jiang
- Department of Breast Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Ran Wei
- Lilly Corporate Center, Eli Lilly and Company, Indianapolis, IN, USA
| | - Francisco Sapunar
- Lilly Corporate Center, Eli Lilly and Company, Indianapolis, IN, USA
| | - Brenda R Grimes
- Lilly Corporate Center, Eli Lilly and Company, Indianapolis, IN, USA
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23
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Pal A, Daly R, Mohamedkhan S, Grochot R, Stapleton S, Yap C, Magkos D, Baikady BR, Minchom A, Banerji U, De Bono J, Karikios D, Boyle F, Lopez J. CONSENT - A Randomised Controlled Trial of Enhanced Informed Consent Compared to Standard Informed Consent to Improve Patient Understanding of Early Phase Oncology Clinical Trials – GBM Cohort (Nonrandomised) Analysis. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac200.060] [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: 11/12/2022] Open
Abstract
Abstract
AIMS
Early phase cancer clinical trials have become more complicated and patients often misunderstand their nature and purpose. CONSENT (NCT04407676) is a randomised controlled trial testing whether enhanced informed consent for patient education can improve comprehension – since patients with glioblastoma multiforme (GBM) have a higher rate of baseline cognitive impairment, we studied this group separately.
METHOD
GBM patients (from the ICE-CAP Phase 1 study - NCT03673787), underwent the schedule for the standard CONSENT arm - full length trial PIS, Quality of Informed Consent Questionnaire Parts A and B (QuIC-A and QuIC-B), experimental intervention (2 page study aid and 10 educational videos), and a repeat QuIC-A and QuIC-B. The primary endpoint for this subgroup was the difference in QuIC-A scores before and after the intervention using a paired t-test.
RESULTS
6 patients with GBM were recruited - 3 did not complete any study questionnaires. The three pre intervention QuIC-A scores were 70, 81, 88, with a mean of 75 (unit reference 76). The three pre intervention QuIC-B scores were 69, 62, 75 with a mean of 69 (unit reference is 91). Only one patient completed the post intervention questionnaire - their QuIC-A score moved from 88 to 100.
CONCLUSION
This study demonstrates the significant difficulties in studying comprehension in patients with GBM considering early phase trials. There is a need for creative multi-modality solutions to provide information to GBM patients considering clinical trials, and novel tools to assess the effectiveness of these solutions.
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Affiliation(s)
- Abhijit Pal
- Drug Development Unit, Royal Marsden Hospital , Sutton
| | - Robert Daly
- Drug Development Unit, Royal Marsden Hospital , Sutton
| | | | | | | | - Christina Yap
- Drug Development Unit, Royal Marsden Hospital , Sutton
| | | | | | - Anna Minchom
- Drug Development Unit, Royal Marsden Hospital , Sutton
| | - Udai Banerji
- Drug Development Unit, Royal Marsden Hospital , Sutton
| | | | | | | | - Juanita Lopez
- Drug Development Unit, Royal Marsden Hospital , Sutton
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24
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Maccora J, Garland SN, Ftanou M, Day D, White M, Lopez VA, Mortimer D, Diggens J, Phillips AJK, Wallace R, Alexander M, Boyle F, Stafford L, Francis PA, Bei B, Wiley JF. The sleep, cancer and rest (SleepCaRe) trial: Rationale and design of a randomized, controlled trial of cognitive behavioral and bright light therapy for insomnia and fatigue in women with breast cancer receiving chemotherapy. Contemp Clin Trials 2022; 120:106877. [PMID: 35961468 DOI: 10.1016/j.cct.2022.106877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Insomnia and fatigue symptoms are common in breast cancer. Active cancer treatment, such as chemotherapy, appears to be particularly disruptive to sleep. Yet, sleep complaints often go unrecognised and under treated within routine cancer care. The abbreviated delivery of cognitive behavioral therapy for Insomnia (CBTI) and bright light therapy (BLT) may offer accessible and cost-effective sleep treatments in women receiving chemotherapy for breast cancer. METHODS The Sleep, Cancer and Rest (SleepCaRe) Trial is a 6-month multicentre, randomized, controlled, 2 × 2 factorial, superiority, parallel group trial. Women receiving cytotoxic chemotherapy for breast cancer at tertiary Australian hospitals will be randomly assigned 1:1:1:1 to one of four, non-pharmacological sleep interventions: (a) Sleep Hygiene and Education (SHE); (b) CBTI; (c) BLT; (d) CBT-I + BLT combined and simultaneously delivered. Each sleep intervention is delivered over 6 weeks, and will comprise an introductory session, a mid-point phone call, and regular emails. The primary (insomnia, fatigue) and secondary (health-related quality of life, rest activity rhythms, sleep-related impairment) outcomes will be assessed via online questionnaires at five time-points: baseline (t0, prior to intervention), mid-point intervention (t2, Week 4), post-intervention (t3, Week 7), 3-months (t4, Week 18), and 6-months follow-up (t5, Week 30). CONCLUSIONS This study will report novel data concerning the comparative and combined efficacy of CBT-I and BLT during chemotherapy. Findings will contribute to the development of evidence-based early sleep and fatigue intervention during chemotherapy for breast cancer. Clinical trial information Registered with the Australian New Zealand Clinical Trials Registry (http://anzctr.org.au/), Registration Number: ACTRN12620001133921.
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Affiliation(s)
- Jordan Maccora
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Melbourne, VIC 3800, Australia.
| | | | - Maria Ftanou
- Peter MacCallum Cancer Centre, Melbourne, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | - Daphne Day
- Department of Oncology Monash Health, Melbourne, Australia; Monash University, Melbourne, Australia.
| | - Michelle White
- Department of Oncology Monash Health, Melbourne, Australia; Monash University, Melbourne, Australia.
| | | | - Duncan Mortimer
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Australia.
| | | | - Andrew J K Phillips
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Melbourne, VIC 3800, Australia.
| | - Rebecca Wallace
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Melbourne, VIC 3800, Australia.
| | - Marliese Alexander
- Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
| | | | - Lesley Stafford
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.
| | | | - Bei Bei
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Melbourne, VIC 3800, Australia; Centre for Women's Mental Health, Royal Women's Hospital, Melbourne, Australia.
| | - Joshua F Wiley
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Melbourne, VIC 3800, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia.
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25
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Lindeman GJ, Fernando TM, Bowen R, Jerzak KJ, Song X, Decker T, Boyle F, McCune S, Armstrong A, Shannon C, Bertelli G, Chang CW, Desai R, Gupta K, Wilson TR, Flechais A, Bardia A. VERONICA: Randomized Phase II Study of Fulvestrant and Venetoclax in ER-Positive Metastatic Breast Cancer Post-CDK4/6 Inhibitors - Efficacy, Safety, and Biomarker Results. Clin Cancer Res 2022; 28:3256-3267. [PMID: 35583555 PMCID: PMC9662928 DOI: 10.1158/1078-0432.ccr-21-3811] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/16/2021] [Accepted: 05/16/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Despite promising activity in hematopoietic malignancies, efficacy of the B-cell lymphoma 2 (BCL2) inhibitor venetoclax in solid tumors is unknown. We report the prespecified VERONICA primary results, a randomized phase II clinical trial evaluating venetoclax and fulvestrant in estrogen receptor (ER)-positive, HER2-negative metastatic breast cancer, post-cyclin-dependent kinase (CDK) 4/6 inhibitor progression. PATIENTS AND METHODS Pre-/postmenopausal females ≥18 years were randomized 1:1 to venetoclax (800 mg orally daily) plus fulvestrant (500 mg intramuscular; cycle 1: days 1 and 15; subsequent 28-day cycles: day 1) or fulvestrant alone. The primary endpoint was clinical benefit rate (CBR); secondary endpoints were progression-free survival (PFS), overall survival, and safety. Exploratory biomarker analyses included BCL2 and BCL extra-large (BCLXL) tumor expression, and PIK3CA circulating tumor DNA mutational status. RESULTS At primary analysis (cutoff: August 5, 2020; n = 103), venetoclax did not significantly improve CBR [venetoclax plus fulvestrant: 11.8% (n = 6/51; 95% confidence interval (CI), 4.44-23.87); fulvestrant: 13.7% (7/51; 5.70-26.26); risk difference -1.96% (95% CI, -16.86 to 12.94)]. Median PFS was 2.69 months (95% CI, 1.94-3.71) with venetoclax plus fulvestrant versus 1.94 months (1.84-3.55) with fulvestrant (stratified HR, 0.94; 95% CI, 0.61-1.45; P = 0.7853). Overall survival data were not mature. A nonsignificant improvement of CBR and PFS was observed in patients whose tumors had strong BCL2 expression (IHC 3+), a BCL2/BCLXL Histoscore ratio ≥1, or PIK3CA-wild-type status. CONCLUSIONS Our findings do not indicate clinical utility for venetoclax plus fulvestrant in endocrine therapy-resistant, CDK4/6 inhibitor-refractory metastatic breast tumors, but suggest possible increased dependence on BCLXL in this setting.
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Affiliation(s)
- Geoffrey J. Lindeman
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.,Cancer Biology and Stem Cells Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia.,Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia.,Corresponding Author: Geoffrey J. Lindeman, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia. Phone: 61-3-9345-2611; Fax: 61-3-9347-0852; E-mail:
| | - Tharu M. Fernando
- Oncology Biomarker Development, Genentech, Inc., South San Francisco, California
| | - Rebecca Bowen
- Medical Oncology, Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
| | - Katarzyna J. Jerzak
- Medical Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Canada
| | - Xinni Song
- Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, Canada
| | - Thomas Decker
- Hematology and Oncology, Onkologie Ravensburg, Ravensburg, Germany
| | - Frances Boyle
- Patricia Ritchie Centre for Cancer Care and Research, Mater Hospital, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Steve McCune
- Medical Oncology, Wellstar Health System, Marietta, Georgia
| | - Anne Armstrong
- Medical Oncology, The Christie NHS Foundation Trust and the University of Manchester, Manchester, United Kingdom
| | | | | | - Ching-Wei Chang
- PHC and Early Development Oncology Biostatistics, Genentech, Inc., South San Francisco, California
| | - Rupal Desai
- Oncology Biomarker Development, Genentech, Inc., South San Francisco, California
| | - Kushagra Gupta
- Biostatistics, IQVIA RDS (India) Private Ltd, Bangalore, India
| | - Timothy R. Wilson
- Oncology Biomarker Development, Genentech, Inc., South San Francisco, California
| | - Aulde Flechais
- Global PD Senior Clinical Scientist-Oncology, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Aditya Bardia
- Medical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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26
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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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27
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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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28
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Mizrahi D, Goldstein D, Kiernan MC, Robinson L, Pitiyarachchi O, McCullough S, Mendoza-Jones P, Grimison P, Boyle F, Park SB. Development and consensus process for a clinical pathway for the assessment and management of chemotherapy-induced peripheral neuropathy. Support Care Cancer 2022; 30:5965-5974. [PMID: 35394563 PMCID: PMC9135801 DOI: 10.1007/s00520-022-07024-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/29/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cancer patients treated with neurotoxic chemotherapy are at risk of developing neurological symptoms that can impact functional capacity and quality of life. However, there are no standardised pathways to assess and manage chemotherapy-induced peripheral neurotoxicity (CIPN). This study aimed to determine consensus on statements regarding a CIPN assessment and management clinical pathway. METHODS A CIPN clinical pathway (CIPN-path) was developed and reviewed by an expert multi-disciplinary panel and consumers. Agreement with 18 statements regarding four content themes (pretreatment review, screening and assessment, management and referral, and CIPN-path feasibility) were assessed by 70 Australian respondents (68 health professionals, 2 consumers), using a 2-stage Delphi survey process to reach consensus. Respondents rated statements using a 5-point Likert scale to determine the level of agreement, with consensus defined as ≥ 80% of respondents agreeing with each statement. RESULTS The consensus was reached for 14 of 18 items after stage 1 and all items after stage 2. Feedback was obtained for all items to refine the CIPN-path. There was an agreement on important characteristics of the CIPN-path, including pretreatment screening, regular patient-reported assessment, and a stepped-care approach to investigating and managing symptom burden. There was a lack of agreement on who should oversee CIPN assessment, which may differ according to the structure and resources of each site. CONCLUSIONS There was an overall agreement concerning the CIPN-path to assess and manage CIPN, which may be adapted accordingly to the resources of each clinic. The CIPN-path may assist teams across different health services in identifying CIPN symptoms, aiding decision-making, and reducing morbidity from CIPN.
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Affiliation(s)
- David Mizrahi
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia.,Faculty of Medicine and Health, Prince of Wales Clinical School, UNSW Sydney, Sydney, Australia
| | - David Goldstein
- Faculty of Medicine and Health, Prince of Wales Clinical School, UNSW Sydney, Sydney, Australia.,Department of Medical Oncology, Prince of Wales Hospital, Sydney, Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, The University of Sydney, Sydney, Australia.,Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Louisa Robinson
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, Australia
| | | | - Susan McCullough
- Translational Cancer Research Network Consumer Advisory Panel, Sydney, Australia
| | - Phil Mendoza-Jones
- Translational Cancer Research Network Consumer Advisory Panel, Sydney, Australia
| | - Peter Grimison
- Chris O'Brien Lifehouse, Sydney, Australia.,Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Frances Boyle
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Patricia Ritchie Centre for Cancer Care and Research, Mater Hospital, North Sydney, Australia
| | - Susanna B Park
- Brain and Mind Centre, The University of Sydney, Sydney, Australia.
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29
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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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30
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Safi N, Saunders C, Anazodo A, Dickinson JE, Boyle F, Ives A, Wang A, Li Z, Sullivan E. Clinical Decision Making in the Management of Breast Cancer Diagnosed During Pregnancy: A Review and Case Series Analysis. J Adolesc Young Adult Oncol 2021; 11:245-251. [PMID: 34813371 DOI: 10.1089/jayao.2021.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: To highlight the various options available for the management of breast cancer diagnosed during pregnancy by describing the investigations, treatment, and outcomes in relation to these women. Methods: This is a narrative review of the literature to describe the issues related to pregnancy and obstetric management in patients with breast cancer. It incorporates a description of six cases of women (aged 29-39 years) with a first-time diagnosis of breast cancer during pregnancy to illustrate a number of issues that need to be considered during different trimesters. Results: Of the six cases, two were diagnosed in each pregnancy trimester. A painless breast mass was the presenting symptom in five cases (83%). In all cases, breast ultrasound was the primary diagnostic imaging procedure. Chest X-ray was performed in 3 (50%) and computed tomography in 2 (33%). A core needle biopsy was performed in all cases, and sentinel lymph node biopsy in 3 (50%) cases. Four women had grade 3 tumor; five had estrogen receptor-positive tumors. Four women had breast surgery during pregnancy. Five women gave birth after the induction of labor and/or cesarean section. In all six cases, a multidisciplinary team was involved in the delivery of health care. Conclusion: Regular breast examinations are needed for all pregnant woman during prenatal visits. Breast ultrasonography should be offered if a breast lump or other symptoms are detected. Breast surgery can be safely performed during all pregnancy trimesters, and some systemic therapeutic agents can be administered safely in the second and third trimesters.
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Affiliation(s)
- Nadom Safi
- School of Public Health, University of Technology Sydney, Broadway, New South Wales, Australia.,Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Christobel Saunders
- Division of Surgery, Medical School, The University of Western Australia, Crawley, Western Australia, Australia
| | - Antoinette Anazodo
- School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia.,The Kids Cancer Centre, Sydney Children's Hospital, Sydney, Randwick, New South Wales, Australia.,Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Jan E Dickinson
- Division of Obstetrics and Gynaecology, Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Frances Boyle
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia.,Patricia Ritchie Centre for Cancer Care & Research, Mater Hospital, North Sydney, New South Wales, Australia
| | - Angela Ives
- Division of Surgery, Medical School, The University of Western Australia, Crawley, Western Australia, Australia
| | - Alex Wang
- School of Public Health, University of Technology Sydney, Broadway, New South Wales, Australia
| | - Zhuoyang Li
- Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Elizabeth Sullivan
- School of Public Health, University of Technology Sydney, Broadway, New South Wales, Australia.,Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
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31
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Oh B, Boyle F, Pavlakis N, Clarke S, Guminski A, Eade T, Lamoury G, Carroll S, Morgia M, Kneebone A, Hruby G, Stevens M, Liu W, Corless B, Molloy M, Libermann T, Rosenthal D, Back M. Emerging Evidence of the Gut Microbiome in Chemotherapy: A Clinical Review. Front Oncol 2021; 11:706331. [PMID: 34604043 PMCID: PMC8481611 DOI: 10.3389/fonc.2021.706331] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/25/2021] [Indexed: 01/28/2023] Open
Abstract
Increasing evidence suggests that the gut microbiome is associated with both cancer chemotherapy (CTX) outcomes and adverse events (AEs). This review examines the relationship between the gut microbiome and CTX as well as the impact of CTX on the gut microbiome. A literature search was conducted in electronic databases Medline, PubMed and ScienceDirect, with searches for "cancer" and "chemotherapy" and "microbiome/microbiota". The relevant literature was selected for use in this article. Seventeen studies were selected on participants with colorectal cancer (CRC; n=5), Acute Myeloid Leukemia (AML; n=3), Non-Hodgkin's lymphoma (n=2), breast cancer (BCa; n=1), lung cancer (n=1), ovarian cancer (n=1), liver cancer (n=1), and various other types of cancers (n=3). Seven studies assessed the relationship between the gut microbiome and CTX with faecal samples collected prior to (n=3) and following CTX (n=4) showing that the gut microbiome is associated with both CTX efficacy and toxicity. Ten other prospective studies assessed the impact of CTX during treatment and found that CTX modulates the gut microbiome of people with cancer and that dysbiosis induced by the CTX is related to AEs. CTX adversely impacts the gut microbiome, inducing dysbiosis and is associated with CTX outcomes and AEs. Current evidence provides insights into the gut microbiome for clinicians, cancer survivors and the general public. More research is required to better understand and modify the impact of CTX on the gut microbiome.
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Affiliation(s)
- Byeongsang Oh
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,Cancer Care Service, Mater Hospital, North Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,University of Kansas Medical Center, Kansas City, KS, United States
| | - Frances Boyle
- Cancer Care Service, Mater Hospital, North Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Nick Pavlakis
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Stephen Clarke
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Alex Guminski
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,Cancer Care Service, Mater Hospital, North Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Thomas Eade
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,Cancer Care Service, Mater Hospital, North Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Gillian Lamoury
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,Cancer Care Service, Mater Hospital, North Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Susan Carroll
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,Cancer Care Service, Mater Hospital, North Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Marita Morgia
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,Cancer Care Service, Mater Hospital, North Sydney, NSW, Australia
| | - Andrew Kneebone
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,Cancer Care Service, Mater Hospital, North Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - George Hruby
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,Cancer Care Service, Mater Hospital, North Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Mark Stevens
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,Cancer Care Service, Mater Hospital, North Sydney, NSW, Australia
| | - Wen Liu
- University of Kansas Medical Center, Kansas City, KS, United States
| | - Brian Corless
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Mark Molloy
- Bowel Cancer and Biomarker Laboratory, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Towia Libermann
- Beth Israel Deaconess Medical Center (BIDMC) Genomics, Proteomics, Bioinformatics and Systems Biology Center, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | | | - Michael Back
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,Cancer Care Service, Mater Hospital, North Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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32
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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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33
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Oh B, Boyle F, Pavlakis N, Clarke S, Eade T, Hruby G, Lamoury G, Carroll S, Morgia M, Kneebone A, Stevens M, Liu W, Corless B, Molloy M, Kong B, Libermann T, Rosenthal D, Back M. The Gut Microbiome and Cancer Immunotherapy: Can We Use the Gut Microbiome as a Predictive Biomarker for Clinical Response in Cancer Immunotherapy? Cancers (Basel) 2021; 13:cancers13194824. [PMID: 34638308 PMCID: PMC8508052 DOI: 10.3390/cancers13194824] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/17/2021] [Accepted: 09/22/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary The current review assessed the effects of the gut microbiome on clinical outcomes of immunotherapy and related adverse events (AEs) in cancer patients. Studies (n = 10) consistently reported that the gut microbiome prior to administering immune checkpoint inhibitors (ICIs) was associated with enhanced efficacy of ICIs and reduced AEs. Recent fecal microbiome transplant (FMT) studies demonstrated the modulatory effects of FMT on the composition and diversity of the gut microbiome in patients with refractory cancers and the potential to improve the efficacy of ICIs. Abstract Background: Emerging evidence suggests that gut microbiota influences the clinical response to immunotherapy. This review of clinical studies examines the relationship between gut microbiota and immunotherapy outcomes. Method: A literature search was conducted in electronic databases Medline, PubMed and ScienceDirect, with searches for “cancer” and “immunotherapy/immune checkpoint inhibitor” and “microbiome/microbiota” and/or “fecal microbiome transplant FMT”. The relevant literature was selected for this article. Results: Ten studies examined patients diagnosed with advanced metastatic melanoma (n = 6), hepatocellular carcinoma (HCC) (n = 2), non-small cell lung carcinoma (NSCLC) (n = 1) and one study examined combination both NSCLC and renal cell carcinoma (RCC) (n = 1). These studies consistently reported that the gut microbiome profile prior to administering immune checkpoint inhibitors (ICIs) was related to clinical response as measured by progression-free survival (PFS) and overall survival (OS). Two studies reported that a low abundance of Bacteroidetes was associated with colitis. Two studies showed that patients with anti-PD-1 refractory metastatic melanoma experienced improved response rates and no added toxicity when receiving fecal microbiota transplant (FMT) from patients with anti-PD-1 responsive disease. Conclusions: Overall, significant differences in the diversity and composition of the gut microbiome were identified in ICIs responders and non-responders. Our findings provide new insights into the value of assessing the gut microbiome in immunotherapy. Further robust randomized controlled trials (RCTs) examining the modulatory effects of the gut microbiome and FMT on ICIs in patients not responding to immunotherapy are warranted.
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Affiliation(s)
- Byeongsang Oh
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (N.P.); (S.C.); (T.E.); (G.H.); (G.L.); (S.C.); (M.M.); (A.K.); (M.S.); (B.C.); (B.K.); (M.B.)
- The Mater Hospital, North Sydney, NSW 2065, Australia;
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
- University of Kansas Medical Center, Kansas City, KS 66160-7601, USA;
- Correspondence:
| | - Frances Boyle
- The Mater Hospital, North Sydney, NSW 2065, Australia;
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Nick Pavlakis
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (N.P.); (S.C.); (T.E.); (G.H.); (G.L.); (S.C.); (M.M.); (A.K.); (M.S.); (B.C.); (B.K.); (M.B.)
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Stephen Clarke
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (N.P.); (S.C.); (T.E.); (G.H.); (G.L.); (S.C.); (M.M.); (A.K.); (M.S.); (B.C.); (B.K.); (M.B.)
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Thomas Eade
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (N.P.); (S.C.); (T.E.); (G.H.); (G.L.); (S.C.); (M.M.); (A.K.); (M.S.); (B.C.); (B.K.); (M.B.)
- The Mater Hospital, North Sydney, NSW 2065, Australia;
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - George Hruby
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (N.P.); (S.C.); (T.E.); (G.H.); (G.L.); (S.C.); (M.M.); (A.K.); (M.S.); (B.C.); (B.K.); (M.B.)
- The Mater Hospital, North Sydney, NSW 2065, Australia;
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Gillian Lamoury
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (N.P.); (S.C.); (T.E.); (G.H.); (G.L.); (S.C.); (M.M.); (A.K.); (M.S.); (B.C.); (B.K.); (M.B.)
- The Mater Hospital, North Sydney, NSW 2065, Australia;
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Susan Carroll
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (N.P.); (S.C.); (T.E.); (G.H.); (G.L.); (S.C.); (M.M.); (A.K.); (M.S.); (B.C.); (B.K.); (M.B.)
- The Mater Hospital, North Sydney, NSW 2065, Australia;
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Marita Morgia
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (N.P.); (S.C.); (T.E.); (G.H.); (G.L.); (S.C.); (M.M.); (A.K.); (M.S.); (B.C.); (B.K.); (M.B.)
- The Mater Hospital, North Sydney, NSW 2065, Australia;
| | - Andrew Kneebone
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (N.P.); (S.C.); (T.E.); (G.H.); (G.L.); (S.C.); (M.M.); (A.K.); (M.S.); (B.C.); (B.K.); (M.B.)
- The Mater Hospital, North Sydney, NSW 2065, Australia;
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Mark Stevens
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (N.P.); (S.C.); (T.E.); (G.H.); (G.L.); (S.C.); (M.M.); (A.K.); (M.S.); (B.C.); (B.K.); (M.B.)
- The Mater Hospital, North Sydney, NSW 2065, Australia;
| | - Wen Liu
- University of Kansas Medical Center, Kansas City, KS 66160-7601, USA;
| | - Brian Corless
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (N.P.); (S.C.); (T.E.); (G.H.); (G.L.); (S.C.); (M.M.); (A.K.); (M.S.); (B.C.); (B.K.); (M.B.)
| | - Mark Molloy
- Bowel Cancer and Biomarker Laboratory, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2065, Australia;
| | - Benjamin Kong
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (N.P.); (S.C.); (T.E.); (G.H.); (G.L.); (S.C.); (M.M.); (A.K.); (M.S.); (B.C.); (B.K.); (M.B.)
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Towia Libermann
- Harvard Medical School, Boston, MA 02115, USA; (T.L.); (D.R.)
- BIDMC Genomics, Proteomics, Bioinformatics and Systems Biology Center, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - David Rosenthal
- Harvard Medical School, Boston, MA 02115, USA; (T.L.); (D.R.)
| | - Michael Back
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (N.P.); (S.C.); (T.E.); (G.H.); (G.L.); (S.C.); (M.M.); (A.K.); (M.S.); (B.C.); (B.K.); (M.B.)
- The Mater Hospital, North Sydney, NSW 2065, Australia;
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
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Dempsey K, Mathieu E, Brennan M, Snook K, Hoffman J, Campbell I, Scarlet J, Flay H, Wong AZH, Boyle F, King M, Spillane A. The role of breast reconstruction choice on body image patient-reported outcomes at four years post-mastectomy for breast cancer: A longitudinal prospective cohort study. Psychooncology 2021; 31:54-61. [PMID: 34498358 DOI: 10.1002/pon.5776] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To examine the impact of breast reconstruction on women's perceptions of body image over time and to assess the influence of sociodemographic variables on body image. METHODS A prospective, longitudinal cohort study, using validated breast cancer-specific questionnaires, to compare patient-reported outcomes in women choosing immediate (n = 61), delayed (n = 16) or no (n = 23) breast reconstruction. RESULTS One hundred women completed baseline questionnaires that included items on body image; 30 women completed all four annual follow-up sets, while 20 women completed baseline only. The three groups were well matched at baseline and similar trajectories in body image measures were identified over 48 months in all groups. At 12 months post-mastectomy, significant changes were seen in eight of the 10 subscales; this reduced to seven subscales at 24 months and four at 36 months. By 48 months, only three subscales remained significantly different to baseline scores: women remained less vulnerable and had fewer limitations (improved outcomes); the one worse outcome was persistently higher levels of arm concern. Three of the sociodemographic variables (health insurance, age and employment status) showed significant inter-group differences at some time points. CONCLUSION These findings suggest women recover from the negative impact of mastectomy on body image within four years of surgery, whether they have immediate, delayed or no reconstruction. Our results provide some indirect evidence that having a choice of BR options is important, regardless of the choice made. Four years appears to be a suitable follow-up period for future studies in this area.
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Affiliation(s)
- Kathy Dempsey
- Breast & Surgical Oncology at the Poche Centre, North Sydney, New South Wales, Australia.,Northern Clinical School, The University of Sydney, St Leonards, New South Wales, Australia.,School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Erin Mathieu
- School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Meagan Brennan
- Breast & Surgical Oncology at the Poche Centre, North Sydney, New South Wales, Australia.,Northern Clinical School, The University of Sydney, St Leonards, New South Wales, Australia
| | - Kylie Snook
- Breast & Surgical Oncology at the Poche Centre, North Sydney, New South Wales, Australia.,Northern Clinical School, The University of Sydney, St Leonards, New South Wales, Australia.,The Mater Hospital, North Sydney, New South Wales, Australia
| | - Julia Hoffman
- Breast & Surgical Oncology at the Poche Centre, North Sydney, New South Wales, Australia
| | - Ian Campbell
- Breast Care Centre & Research Office, Waikato Hospital, Hamilton, New Zealand.,Faculty of Health Sciences, University of Auckland, Waikato Campus, New Zealand
| | - Jenni Scarlet
- Breast Care Centre & Research Office, Waikato Hospital, Hamilton, New Zealand
| | - Heather Flay
- Breast Care Centre & Research Office, Waikato Hospital, Hamilton, New Zealand
| | - April Z H Wong
- Breast & Surgical Oncology at the Poche Centre, North Sydney, New South Wales, Australia.,Breast Care Centre & Research Office, Waikato Hospital, Hamilton, New Zealand.,St Vincent's Health Network, Sydney, New South Wales, Australia
| | - Frances Boyle
- Northern Clinical School, The University of Sydney, St Leonards, New South Wales, Australia.,The Mater Hospital, North Sydney, New South Wales, Australia.,Patricia Ritchie Centre for Cancer Care & Research, Mater Hospital, North Sydney, New South Wales, Australia
| | - Madeleine King
- School of Psychology, The University of Sydney, Camperdown, New South Wales, Australia
| | - Andrew Spillane
- Breast & Surgical Oncology at the Poche Centre, North Sydney, New South Wales, Australia.,Northern Clinical School, The University of Sydney, St Leonards, New South Wales, Australia.,The Mater Hospital, North Sydney, New South Wales, Australia.,Royal North Shore Hospital, St Leonards, New South Wales, Australia
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Pal A, Stapleton S, Yap C, Lai-Kwon J, Daly R, Magkos D, Baikady BR, Minchom A, Banerji U, De Bono J, Karikios D, Boyle F, Lopez J. Study protocol for a randomised controlled trial of enhanced informed consent compared to standard informed consent to improve patient understanding of early phase oncology clinical trials (CONSENT). BMJ Open 2021; 11:e049217. [PMID: 34489282 PMCID: PMC8422487 DOI: 10.1136/bmjopen-2021-049217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 08/11/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Early phase cancer clinical trials have become increasingly complicated in terms of patient selection and trial procedures-this is reflected in the increasing length of participant information sheets (PIS). Informed consent for early phase clinical trials has been contentious due to the potential ethical issues associated with performing experimental research on a terminally ill population which has exhausted standard treatment options. Empirical studies have demonstrated significant gaps in patient understanding regarding the nature and intent of these trials. This study aims to test whether enhanced informed consent for patient education can improve patient scores on a validated questionnaire testing clinical trial comprehension. METHODS AND ANALYSIS This is a randomised controlled trial that will allocate patients who are eligible to participate in one of four investigator-initiated clinical trials at the Royal Marsden Drug Development Unit to either a standard arm or an experimental arm, stratified by age and educational level. The standard arm will involve the full length trial PIS, followed by electronic or paper administration of the Quality of Informed Consent Questionnaire Parts A and B (QuIC-A and QuIC-B). The experimental arm will involve the full length trial PIS, exposure to a two-page study aid and 10 online educational videos, followed by administration of the QuIC-A and QuIC-B. The primary endpoint will be the difference (using a one-sided two-sample t-test) in the QuIC-A score, which measures objective understanding, between the standard and experimental arm. Accrual target is at least 17 patients per arm to detect an 8 point difference (80% power, alpha 0.05). ETHICS AND DISSEMINATION Ethics approval was granted by the National Health Service Health Research Authority on 15 June 2020-IRAS Project ID 277065, Protocol Number CCR5165, REC Reference 20/EE/0155. Results will be disseminated via publication in a relevant journal. TRIAL REGISTRATION NUMBER NCT04407676; Pre-results.
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Affiliation(s)
- Abhijit Pal
- Institute of Cancer Research, London, UK
- Drug Development Unit, Royal Marsden Hospital Sutton, London, UK
- The University of Sydney, Sydney, New South Wales, Australia
| | - Sarah Stapleton
- Drug Development Unit, Royal Marsden Hospital Sutton, London, UK
| | - Christina Yap
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
- Clinical Trials and Statistics Unit, Institute of Cancer Research, London, UK
| | - Julia Lai-Kwon
- Institute of Cancer Research, London, UK
- Drug Development Unit, Royal Marsden Hospital Sutton, London, UK
| | - Robert Daly
- Institute of Cancer Research, London, UK
- Drug Development Unit, Royal Marsden Hospital Sutton, London, UK
| | - Dimitrios Magkos
- Institute of Cancer Research, London, UK
- Drug Development Unit, Royal Marsden Hospital Sutton, London, UK
| | - Bindumalini Rao Baikady
- Institute of Cancer Research, London, UK
- Drug Development Unit, Royal Marsden Hospital Sutton, London, UK
| | - Anna Minchom
- Institute of Cancer Research, London, UK
- Drug Development Unit, Royal Marsden Hospital Sutton, London, UK
| | - Udai Banerji
- Institute of Cancer Research, London, UK
- Drug Development Unit, Royal Marsden Hospital Sutton, London, UK
| | - Johann De Bono
- Institute of Cancer Research, London, UK
- Drug Development Unit, Royal Marsden Hospital Sutton, London, UK
| | - Deme Karikios
- The University of Sydney, Sydney, New South Wales, Australia
| | - Frances Boyle
- The University of Sydney, Sydney, New South Wales, Australia
| | - Juanita Lopez
- Institute of Cancer Research, London, UK
- Drug Development Unit, Royal Marsden Hospital Sutton, London, UK
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Jang A, Brown C, Lamoury G, Morgia M, Boyle F, Marr I, Clarke S, Back M, Oh B. The Effects of Acupuncture on Cancer-Related Fatigue: Updated Systematic Review and Meta-Analysis. Integr Cancer Ther 2021; 19:1534735420949679. [PMID: 32996339 PMCID: PMC7533944 DOI: 10.1177/1534735420949679] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Several studies have identified fatigue as one of the major symptoms experienced during and after cancer treatment. However, there are limited options to manage cancer related fatigue (CRF) with pharmacological interventions. Several acupuncture studies suggested that acupuncture has a positive impact on CRF. This review aims to assess the evidence of acupuncture for the treatment of CRF. Method Electronic database searches were conducted on 4 English databases (Medline, PubMed, Embase, and ScienceDirect). Search keywords were; “acupuncture” and “cancer,” or “cancer related fatigue.” Studies published as full text randomized controlled trials (RCTs) in English were included. Estimates of change in fatigue cores were pooled using a random effects meta-analysis where randomized comparisons were available for true acupuncture versus sham acupuncture and true acupuncture versus usual care. The quality of original papers were assessed using the Cochrane Collaboration’s tool for assessing risk of bias (ROB). Results Nine RCTs were selected for review with a total of 809 participants and a range of 13 to 302 participants within the studies. Six RCTs reported significant improvement of CRF for the acupuncture intervention compared to the control groups. Pooled estimates suggest Brief Fatigue Inventory scores are 0.93 points lower 95% CI (−1.65, −0.20) in true acupuncture versus sham acupuncture and 2.12 points lower 95% C (−3.21, −1.04) in true acupuncture versus usual care. Six studies had low risk of bias (ROB) and 3 studies had a moderate ROB predominantly in blinding of participants, blinding of assessors and incomplete data outcomes. Among the 9 RCTs, 2 studies have reported the occurrence of minor adverse effects (spot bleeding and bruising) related to acupuncture treatment. No serious adverse reactions related to acupuncture were reported. Conclusion The current literature review suggests that acupuncture has therapeutic potential in management of CRF for cancer survivors. Promotion of acupuncture in cancer care to manage CRF may improve the quality of life of cancer survivors.
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Affiliation(s)
- Andrew Jang
- Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Chris Brown
- Royal North Shore Hospital, St Leonards, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
| | - Gillian Lamoury
- Royal North Shore Hospital, St Leonards, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia.,The Mater Hospital, North Sydney, New South Wales, Australia
| | - Marita Morgia
- Royal North Shore Hospital, St Leonards, New South Wales, Australia.,The Mater Hospital, North Sydney, New South Wales, Australia
| | - Frances Boyle
- University of Sydney, Sydney, New South Wales, Australia.,The Mater Hospital, North Sydney, New South Wales, Australia
| | - Isobel Marr
- Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Stephen Clarke
- Royal North Shore Hospital, St Leonards, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
| | - Michael Back
- Royal North Shore Hospital, St Leonards, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia.,The Mater Hospital, North Sydney, New South Wales, Australia
| | - Byeongsang Oh
- Royal North Shore Hospital, St Leonards, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia.,The Mater Hospital, North Sydney, New South Wales, Australia
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Mueller V, Wardley A, Paplomata E, Hamilton E, Zelnak A, Fehrenbacher L, Jakobsen E, Curtit E, Boyle F, Harder Brix E, Brenner A, Crouzet L, Ferrario C, Muñoz-Mateu M, Arkenau HT, Iqbal N, Aithal S, Block M, Cold S, Cancel M, Hahn O, Poosarla T, Stringer-Reasor E, Colleoni M, Cameron D, Curigliano G, Siadak M, DeBusk K, Ramos J, Feng W, Gelmon K. Preservation of quality of life in patients with human epidermal growth factor receptor 2-positive metastatic breast cancer treated with tucatinib or placebo when added to trastuzumab and capecitabine (HER2CLIMB trial). Eur J Cancer 2021; 153:223-233. [PMID: 34214937 DOI: 10.1016/j.ejca.2021.05.025] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Abstract
AIMS In HER2CLIMB, tucatinib significantly improved progression-free and overall survival in patients with human epidermal growth factor receptor 2-positive (HER2+) metastatic breast cancer. We evaluated the impact of tucatinib on health-related quality of life (HR-QoL) in HER2CLIMB. METHODS Patients were randomised 2:1 to tucatinib or placebo combined with trastuzumab and capecitabine. Starting with protocol version 7, the EuroQol 5 Dimensions 5 Levels (EQ-5D-5L) questionnaire and EQ visual analogue scale (VAS) were administered at day 1 of cycle 1, every two cycles during cycles 3-9, every three cycles during cycle 12 and thereafter and at each patient's 30-day follow-up visit. RESULTS Among 364 patients eligible for HR-QoL assessment, 331 (91%) completed ≥1 assessment. EQ-VAS scores were similar for both arms at baseline and maintained throughout treatment. EQ-5D-5L scores were similar between the treatment arms, stable throughout therapy and worsened after discontinuing treatment. Risk of meaningful deterioration (≥7 points) on EQ-VAS was reduced 19% in the tucatinib vs. placebo arm (hazard ratio [HR]: 0.81; 95% confidence interval [CI]: 0.55, 1.18); the median (95% CI) time to deterioration was not reached in the tucatinib arm and was 5.8 months (4.3, -) in the placebo arm. Among patients with brain metastases (n = 164), risk of meaningful deterioration on EQ-VAS was reduced 49% in the tucatinib arm (HR: 0.51; 95% CI: 0.28, 0.93); the median (95% CI) time to deterioration was not reached in the tucatinib arm and was 5.5 months (4.2, -) in the placebo arm. CONCLUSIONS HR-QoL was preserved for patients with HER2+ metastatic breast cancer who were treated with tucatinib added to trastuzumab and capecitabine and maintained longer with tucatinib therapy than without it among those with brain metastases. CLINICAL TRIAL REGISTRATION NCT02614794.
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Affiliation(s)
- Volkmar Mueller
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Andrew Wardley
- Manchester Breast Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology Medicine & Health, University of Manchester, Manchester, UK
| | - Elisavet Paplomata
- Carbone Comprehensive Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Erika Hamilton
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN, USA
| | | | | | | | - Elsa Curtit
- University Hospital of Besançon, Besançon, France
| | | | | | - Andrew Brenner
- Mays Cancer Center at the UT Health San Antonio, San Antonio, TX, USA
| | | | | | - Montserrat Muñoz-Mateu
- Hospital Clinic de Barcelona, Translational Genomics and Targeted Therapeutics, Institut d'Investigacions Biomèdiques Pi i Sunyer-IDIBAPS, Barcelona, Spain
| | - Hendrik-Tobias Arkenau
- Sarah Cannon Research Institute UK and Cancer Institute, University College London, London, UK
| | - Nayyer Iqbal
- Saskatoon Cancer Centre, Saskatoon, Saskatchewan, Canada
| | - Sramila Aithal
- Cancer Treatment Centers of America / Eastern Regional Medical Center, Philadelphia, PA, USA
| | | | | | | | - Olwen Hahn
- University of Chicago Medical Center, Chicago, IL, USA
| | - Teja Poosarla
- Mitchell Cancer Institute, University of South Alabama, Mobile, AL, USA
| | - Erica Stringer-Reasor
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marco Colleoni
- IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - David Cameron
- Edinburgh Cancer Research Centre, IGMM, University of Edinburgh, Edinburgh, Scotland
| | - Giuseppe Curigliano
- European Institute of Oncology, IRCCS, and University of Milano, Milan, Italy
| | | | - Kendra DeBusk
- Health Economics Outcome Research, Seagen Inc., Bothell, WA, USA
| | - Jorge Ramos
- Clinical Development, Seagen Inc., Bothell, WA, USA
| | | | - Karen Gelmon
- British Columbia Cancer Agency - Vancouver Centre, Vancouver, BC, Canada
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Juraskova I, Laidsaar-Powell R, Keast R, Schofield P, Costa DS, Kay J, Turner S, Koczwara B, Saunders C, Jefford M, Yates P, Boyle F, White K, Miller A, Morton RL, Butt Z, Butow P. eTRIO trial: study protocol of a randomised controlled trial of online education modules to facilitate effective family caregiver involvement in oncology. BMJ Open 2021; 11:e043224. [PMID: 34049902 PMCID: PMC8166623 DOI: 10.1136/bmjopen-2020-043224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Informal family caregivers play a crucial role in cancer care. Effective caregiver involvement in cancer care can improve both patient and caregiver outcomes. Despite this, interventions improving the caregiver involvement are sparse. This protocol describes a randomised controlled trial evaluating the combined effectiveness of novel online caregiver communication education modules for: (1) oncology clinicians (eTRIO) and (2) patients with cancer and caregivers (eTRIO-pc). METHODS AND ANALYSIS Thirty medical/radiation/surgical oncology or haematology doctors and nurses will be randomly allocated to either intervention (eTRIO) or control (an Australian State Government Health website on caregivers) education conditions. Following completion of education, each clinician will recruit nine patient-caregiver pairs, who will be allocated to the same condition as their recruiting clinician. Eligibility includes any new adult patient diagnosed with any type/stage cancer attending consultations with a caregiver. Approximately 270 patient-caregiver pairs will be recruited. The primary outcome is caregiver self-efficacy in triadic (clinician-patient-caregiver) communication. Patient and clinician self-efficacy in triadic communication are secondary outcomes. Additional secondary outcomes for clinicians include preferences for caregiver involvement, perceived module usability/acceptability, analysis of module use, satisfaction with the module, knowledge of strategies and feedback interviews. Secondary outcomes for caregivers and patients include preferences for caregiver involvement, satisfaction with clinician communication, distress, quality of life, healthcare expenditure, perceived module usability/acceptability and analysis of module use. A subset of patients and caregivers will complete feedback interviews. Secondary outcomes for caregivers include preparedness for caregiving, patient-caregiver communication and caring experience. Assessments will be conducted at baseline, and 1 week, 12 weeks and 26 weeks post-intervention. ETHICS AND DISSEMINATION Ethical approval has been received by the Sydney Local Health District Human Research Ethics Committee (REGIS project ID number: 2019/PID09787), with site-specific approval from each recruitment site. Protocol V.7 (dated 1 September 2020) is currently approved and reported in this manuscript. Findings will be disseminated via presentations and peer-reviewed publications. Engagement with clinicians, media, government, consumers and peak cancer groups will facilitate widespread dissemination and long-term availability of the educational modules. TRIAL REGISTRATION NUMBER ACTRN12619001507178.
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Affiliation(s)
- Ilona Juraskova
- School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Faculty of Science, Camperdown, New South Wales, Australia
| | - R Laidsaar-Powell
- School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Faculty of Science, Camperdown, New South Wales, Australia
| | - Rachael Keast
- School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Faculty of Science, Camperdown, New South Wales, Australia
| | - Penelope Schofield
- Department of Psychology, and Iverson Health Innovation Research Institute, Swinburne University, Melbourne, Victoria, Australia
- Behavioural Sciences Unit, Health Services Research and Implementation Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - Daniel Sj Costa
- Pain Management Research Institute, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- School of Psychology, The University of Sydney, Camperdown, New South Wales, Australia
| | - Judy Kay
- School of Computer Science, The University of Sydney, Faculty of Engineering, Sydney, New South Wales, Australia
| | - Sandra Turner
- Department of Radiation Oncology, Westmead Hospital, Westmead, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Bogda Koczwara
- Flinders University School of Medicine, Adelaide, South Australia, Australia
| | - Christobel Saunders
- Division of Surgery, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Michael Jefford
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Patsy Yates
- Centre for Cancer and Palliative Care Outcomes, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Frances Boyle
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Patricia Ritchie Centre for Cancer Care & Research, Mater Hospital, Sydney, New South Wales, Australia
| | - Kate White
- Susan Wakil School of Nursing and Midwifery, Cancer Nursing Research Unit, University of Sydney, Faculty of Medicine and Health, Camperdown, New South Wales, Australia
| | - Annie Miller
- Cancer Information and Support Services Division, Cancer Council New South Wales, Woolloomooloo, New South Wales, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Faculty of Medicine and Health, Camperdown, New South Wales, Australia
| | - Zoe Butt
- School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Faculty of Science, Camperdown, New South Wales, Australia
| | - Phyllis Butow
- School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Faculty of Science, Camperdown, New South Wales, Australia
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Meiser B, Woodward P, Gleeson M, Kentwell M, Fan HM, Antill Y, Butow PN, Boyle F, Best M, Taylor N, Bell K, Tucker K. Pilot study of an online training program to increase genetic literacy and communication skills in oncology healthcare professionals discussing BRCA1/2 genetic testing with breast and ovarian cancer patients. Fam Cancer 2021; 21:157-166. [PMID: 33970363 PMCID: PMC8107020 DOI: 10.1007/s10689-021-00261-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/30/2021] [Indexed: 12/11/2022]
Abstract
The increasing use of genetic testing for BRCA1/2 and other pathogenic variants in the management of women with breast and ovarian cancer necessitates increased genetic literacy in oncology healthcare professionals. This pilot study aimed to evaluate an online training program to increase
genetic literacy and communication skills in Australian oncology healthcare professionals tasked with discussing and coordinating mainstream genetic testing with breast and ovarian cancer patients. A training website with embedded videos was developed. This study assesses the website’s acceptability and user-friendliness; suggestions for improvement were also elicited. Oncology healthcare professionals were recruited through relevant professional organisations, invited to the study by email, asked to work through the website and then complete an online questionnaire. Thirty-two oncology healthcare professionals completed the questionnaire after viewing the website. Nearly all participants were satisfied with the information contained in the program (very satisfied: n = 14/32, 44%, satisfied: n = 17/32, 53%, neither satisfied nor dissatisfied: n = 1/32, 3%) and reported that they had gained new skills (n = 29/32, 91%) and had increased confidence (n = 29/31, 94%) in communicating with breast and ovarian cancer patients about genetic testing. More than 93% (28/30) of participants endorsed the online program as clearly presented, informative, relevant and useful. This pilot study demonstrated high feasibility and acceptability of the training program to increase genetic literacy and communication skills in oncology healthcare professionals discussing genetic testing with breast and ovarian cancer patients. Further evidence from a randomised trial is needed to evaluate effects on changing clinical practice, improving patient outcomes, and cost-effectiveness.
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Affiliation(s)
- Bettina Meiser
- Psychosocial Research Group, Prince of Wales Clinical School, University of New South Wales (UNSW), Level 4, C25 Lowy Building, Sydney, NSW, 2052, Australia.
| | | | | | - Maira Kentwell
- Parkville Familial Cancer Clinic, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - Helen Mar Fan
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Yoland Antill
- Parkville Familial Cancer Clinic, Peter MacCallum Cancer Centre, Melbourne, Australia.,Family Cancer Clinic, Monash Health, Nursing and Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Phyllis N Butow
- Psycho-Oncology Co-Operative Research Group, Centre for Medical Psychology and Evidence-Based Decision-Making, The University of Sydney, Sydney, Australia
| | - Frances Boyle
- School of Medicine, University of Sydney, Sydney, Australia.,Pam McLean Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Megan Best
- Institute for Ethics and Society, University of Notre Dame, Sydney, Australia
| | - Natalie Taylor
- Cancer Research Division, Cancer Council of New South Wales, Sydney, Australia.,Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Katy Bell
- School of Public Health, The University of Sydney, Sydney, Australia
| | - Kathy Tucker
- Hereditary Cancer Clinic, Prince of Wales Hospital and Prince of Wales Clinical School, UNSW Sydney, Sydney, Australia
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Moreno-Aspitia A, Holmes EM, Jackisch C, de Azambuja E, Boyle F, Hillman DW, Korde L, Fumagalli D, Izquierdo MA, McCullough AE, Wolff AC, Pritchard KI, Untch M, Guillaume S, Ewer MS, Shao Z, Sim SH, Aziz Z, Demetriou G, Mehta AO, Andersson M, Toi M, Lang I, Xu B, Smith IE, Barrios CH, Baselga J, Gelber RD, Piccart-Gebhart M. Updated results from the international phase III ALTTO trial (BIG 2-06/Alliance N063D). Eur J Cancer 2021; 148:287-296. [PMID: 33765513 DOI: 10.1016/j.ejca.2021.01.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/14/2021] [Accepted: 01/24/2021] [Indexed: 01/03/2023]
Abstract
AIM To present the pre-specified analyses of >5-years follow-up of the Phase III ALTTO trial. PATIENTS AND METHODS 8381 patients with stage I-III HER2 positive breast cancer randomised to chemotherapy plus 1-year of trastuzumab (T), oral lapatinib (L; no longer evaluated), trastuzumab followed by lapatinib (T→L), and lapatinib + trastuzumab (L+T). The primary endpoint was disease-free survival (DFS). A secondary analysis examined DFS treatment effects by hormone receptor status, nodal status and chemotherapy timing; time to recurrence; overall survival (OS) and safety (overall and cardiac). RESULTS At a median follow-up of 6.9 years, 705 DFS events for L+T versus T were observed. Hazard Ratio (HR) for DFS was 0.86 (95% CI, 0.74-1.00) for L+T versus T and 0.93 (95% CI, 0.81-1.08) for T→L versus T. The 6-year DFS were 85%, 84%, and 82% for L+T, T→L, and T, respectively. HR for OS was 0.86 (95% CI, 0.70-1.06) for L+T versus T and 0.88 (95% CI, 0.71-1.08) for T→L versus T. The 6-year OS were 93%, 92%, and 91% for L+T, T→L, and T, respectively. Subset analyses showed a numerically better HR for DFS in favour of L+T versus T for the hormone-receptor-negative [HR 0.80 (95% CI, 0.64-1.00; 6-yr DFS% = 84% versus 80%)] and the sequential chemotherapy [HR 0.83 (95% CI, 0.69-1.00; 6-yr DFS% = 83% versus79%)] subgroups. CONCLUSION T+L did not significantly improve DFS and OS over T alone, both with chemotherapy, and, therefore, cannot be recommended for adjuvant treatment of early-stage HER2-positive breast cancer. TRIAL REGISTRATION clinicaltrials.gov Identifier NCT00490139.
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Affiliation(s)
| | - Eileen M Holmes
- Dundee Epidemiology and Statistics Unit, University of Dundee, Dundee, UK
| | - Christian Jackisch
- Department of Gynecology and Obstetrics, Sana Klinikum Offenbach GmbH, Offenbach am Main, Germany
| | - Evandro de Azambuja
- Institute Jules Bordet and l' Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - Frances Boyle
- Patricia Ritchie Centre for Cancer Care and Research, University of Sydney, Sydney, Australia
| | - David W Hillman
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - Larissa Korde
- Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | | | | | - Ann E McCullough
- Division of Anatomic Pathology, Mayo Clinic, Scottsdale, AZ, USA
| | | | | | | | - Sébastien Guillaume
- Institute Jules Bordet and l' Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - Michael S Ewer
- MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Zhimin Shao
- Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Sung Hoon Sim
- Center for Breast Cancer, National Cancer Centre, Gyeonggi-do, South Korea
| | - Zeba Aziz
- Allama Iqbal Medical College, Lahore, Pakistan
| | | | - Ajay O Mehta
- Central India Cancer Research Institute, Nagpur, Maharashtra, India
| | | | - Masakazu Toi
- Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Istvan Lang
- National Institute of Oncology, Budapest, Hungary
| | - Binghe Xu
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Ian E Smith
- The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Carlos H Barrios
- Latin American Cooperative Oncology Group (LACOG), Oncoclínicas, Porto Alegre, Brazil
| | - Jose Baselga
- Oncology Research and Development, Astra-Zeneca, Cambridge, UK
| | - Richard D Gelber
- Dana-Farber Cancer Institute, Harvard Medical School, Harvard TH Chan School of Public Health and Frontier Science Technology Research Foundation, Boston, MA, USA
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Timmins HC, Li T, Trinh T, Kiernan MC, Harrison M, Boyle F, Friedlander M, Goldstein D, Park SB. Weekly Paclitaxel-Induced Neurotoxicity in Breast Cancer: Outcomes and Dose Response. Oncologist 2021; 26:366-374. [PMID: 33523545 DOI: 10.1002/onco.13697] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/22/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Paclitaxel treatment produces significant peripheral neuropathy, but the time course of neuropathy development and outcomes are unclear. Dose reduction is the only strategy to prevent neurotoxicity, however, the impact of dose-reduction on neuropathy outcomes remains unknown. This study aimed to prospectively evaluated neuropathy development from weekly paclitaxel treatment and evaluate the impact of dose-reduction on post-treatment neuropathy outcomes. PATIENTS AND METHODS Breast cancer patients receiving paclitaxel (80mg/m2 ) weekly for 12-weeks were prospectively assessed using patient reported (Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity; FACTGOG-Ntx), clinical (Total Neuropathy Score clinical version; TNSc) and neurophysiological measures up to 12-months post completion. The impact of dose-reduction on post-treatment (3.6 ± 0.1 months) clinical and patient reported outcomes was evaluated in 105 weekly paclitaxel-treated patients. RESULTS Significant neuropathy was present by 6-weeks across patient-reported, clinical, and objective neurophysiological assessments, increasing in prevalence and severity over the treatment course. Limited recovery occurred, with significant neuropathy being maintained up to 12 months (p < .05). Patients who received dose reduction had worse patient reported (FACT-GOG-Ntx: 40.2 ± .1.4) and clinical neuropathy outcomes (TNSc: 4.3 ± 0.4) compared to those who received the full dose (FACT-GOG-Ntx: 45.9 ± 0.9; TNSc: 3.3 ± 0.3, p < .05). Patients who ceased treatment early demonstrated the worse deficits (TNSc: 5.0 ± 0.6; FACT-GOG-Ntx: 37.3 ± 2.7) compared to those who received the complete dose (TNSc: 3.5 ± 0.3; FACT-GOG-Ntx: 45.3 ± 0.9, p < .05). CONCLUSION Weekly paclitaxel produces symptomatic and objective neuropathy early in the treatment course which can persist. Dose reduction does not necessarily lead to more favorable neuropathy outcomes, with individual risk factors likely important in addition to cumulative dose. IMPLICATIONS FOR PRACTICE Weekly paclitaxel schedules are extensively used in breast cancer. Patients may develop symptomatic and objective neuropathy early in the treatment course, with these individuals requiring closer monitoring. Furthermore, neuropathy is a long-term sequela that may impact quality of life and require appropriate supportive services. Results suggest that dose reduction does not necessarily lead to better neuropathy outcomes. Understanding schedule-specific toxicity and risk factors for neuropathy will be critical to determining individualized treatment strategies and improving quality of life in breast cancer survivors.
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Affiliation(s)
- Hannah C Timmins
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Tiffany Li
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Terry Trinh
- Prince of Wales Clinical School, University of New South Wales, Kensington, Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia.,Royal Prince Alfred Hospital, Camperdown, Australia
| | - Michelle Harrison
- Chris O'Brien Lifehouse, Sydney, Australia.,Department of Medical Oncology, Liverpool Hospital, Liverpool, Australia
| | - Frances Boyle
- Chris O'Brien Lifehouse, Sydney, Australia.,Patricia Ritchie Centre for Cancer Care and Research, Mater Hospital, South Brisbane, Australia
| | - Michael Friedlander
- Prince of Wales Clinical School, University of New South Wales, Kensington, Australia.,Department of Medical Oncology, Prince of Wales Hospital, Randwick, Australia
| | - David Goldstein
- Prince of Wales Clinical School, University of New South Wales, Kensington, Australia.,Department of Medical Oncology, Prince of Wales Hospital, Randwick, Australia
| | - Susanna B Park
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Oh B, Van Der Saag D, Morgia M, Carroll S, Boyle F, Back M, Lamoury G. An Innovative Tai Chi and Qigong Telehealth Service in Supportive Cancer Care During the COVID-19 Pandemic and Beyond. Am J Lifestyle Med 2020; 15:475-477. [PMID: 34366746 DOI: 10.1177/1559827620983762] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Supportive cancer care services, including acupuncture and Tai Chi and Qigong (TQ), are offered to cancer patients to manage cancer symptoms and/or treatment-related adverse effects and improve quality of life during and after standard care. Normal face-to-face acupuncture and TQ group services were suspended during the coronavirus (COVID-19) pandemic to reduce the risk of transmission of infection and meet social distancing restriction guidelines. This led to a sudden shift from face-to-face sessions to telehealth sessions in the health care system. We report patients' experiences of TQ telehealth services as a new initiative developed for cancer care. We found that delivery of TQ telehealth is feasible and resulted in increased overall patient satisfaction with cancer care services during the lockdown. The delivery of TQ telehealth experiences and challenges are discussed.
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Affiliation(s)
- Byeongsang Oh
- GenesisCare, Mater Hospital, North Sydney, New South Wales, Australia
| | | | - Morita Morgia
- GenesisCare, Mater Hospital, North Sydney, New South Wales, Australia
| | - Susan Carroll
- GenesisCare, Mater Hospital, North Sydney, New South Wales, Australia
| | - Frances Boyle
- Patricia Ritchie Centre for Cancer Care, Mater Hospital, North Sydney, New South Wales, Australia
| | - Michael Back
- GenesisCare, Mater Hospital, North Sydney, New South Wales, Australia
| | - Gillian Lamoury
- GenesisCare, Mater Hospital, North Sydney, New South Wales, Australia
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43
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de Las Heras B, Saini KS, Boyle F, Ades F, de Azambuja E, Bozovic-Spasojevic I, Romano M, Capelan M, Prasad R, Pattu P, Massard C, Portera C, Saini ML, Singh BP, Venkitaraman R, McNally R, Leone M, Grande E, Gupta S. Cancer Treatment and Research During the COVID-19 Pandemic: Experience of the First 6 Months. Oncol Ther 2020; 8:171-182. [PMID: 32749634 PMCID: PMC7402077 DOI: 10.1007/s40487-020-00124-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Indexed: 02/07/2023] Open
Abstract
The coronavirus disease-2019 (COVID-19) pandemic has had a significant impact on patients with underlying malignancy. In this article, we summarize emerging data related to patients with cancer and COVID-19. Among patients with COVID-19, a higher proportion have an underlying diagnosis of cancer than seen in the general population. Also, patients with malignancy are likely to be more vulnerable than the general population to contracting COVID-19. Mortality is significantly higher in patients with both cancer and COVID-19 compared with the overall COVID-19-positive population. The early months of the pandemic saw a decrease in cancer screening and diagnosis, as well as postponement of standard treatments, which could lead to excess deaths from cancer in the future.
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Affiliation(s)
- Begoña de Las Heras
- Covance Inc., Princeton, NJ, USA
- Madrid Medical Doctors Association, Madrid, Spain
| | - Kamal S Saini
- Covance Inc., Princeton, NJ, USA.
- East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK.
| | | | - Felipe Ades
- Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Evandro de Azambuja
- Institut Jules Bordet, Brussels, Belgium
- Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | | | | | | | - Rajeev Prasad
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | | | | | | | | | | | | | | | | | | | - Sudeep Gupta
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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44
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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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Eakin EG, Reeves MM, Goode AD, Winkler EAH, Vardy JL, Boyle F, Haas MR, Hiller JE, Mishra GD, Jefford M, Koczwara B, Saunders CM, Chapman K, Hing L, Boltong AG, Lane K, Baldwin P, Millar L, McKiernan S, Demark-Wahnefried W, Courneya KS, Job J, Reid N, Robson E, Moretto N, Gordon L, Hayes SC. Translating research into practice: outcomes from the Healthy Living after Cancer partnership project. BMC Cancer 2020; 20:963. [PMID: 33023538 PMCID: PMC7539431 DOI: 10.1186/s12885-020-07454-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/23/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Healthy Living after Cancer (HLaC) was a national dissemination and implementation study of an evidence-based lifestyle intervention for cancer survivors. The program was imbedded into existing telephone cancer information and support services delivered by Australian state-based Cancer Councils (CC). We report here the reach, effectiveness, adoption, implementation, and maintenance of the program. METHODS In this phase IV study (single-group, pre-post design) participants - survivors of any type of cancer, following treatment with curative intent - received up to 12 nurse/allied health professional-led telephone health coaching calls over 6 months. Intervention delivery was grounded in motivational interviewing, with emphasis on evidence-based behaviour change strategies. Using the RE-AIM evaluation framework, primary outcomes were reach, indicators of program adoption, implementation, costs and maintenance. Secondary (effectiveness) outcomes were participant-reported anthropometric, behavioural and psychosocial variables including: weight; physical activity; dietary intake; quality-of-life; treatment side-effects; distress; and fear of cancer recurrence and participant satisfaction. Changes were evaluated using linear mixed models, including terms for timepoint (0/6 months), strata (Cancer Council), and timepoint x strata. RESULTS Four of 5 CCs approached participated in the study. In total, 1183 cancer survivors were referred (mostly via calls to the Cancer Council telephone information service). Of these, 90.4% were eligible and 88.7% (n = 791) of those eligible consented to participate. Retention rate was 63.4%. Participants were mostly female (88%), aged 57 years and were overweight (BMI = 28.8 ± 6.5 kg/m2). Improvements in all participant-reported outcomes (standardised effect sizes of 0.1 to 0.6) were observed (p < 0.001). The program delivery costs were on average AU$427 (US$296) per referred cancer survivor. CONCLUSIONS This telephone-delivered lifestyle intervention, which was feasibly implemented by Cancer Councils, led to meaningful and statistically significant improvements in cancer survivors' health and quality-of-life at a relatively low cost. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12615000882527 (registered on 24/08/2015).
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Affiliation(s)
- Elizabeth G Eakin
- The University of Queensland, Brisbane, QLD, Australia.
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston Road, Herston, QLD, 4006, Australia.
| | | | - Ana D Goode
- The University of Queensland, Brisbane, QLD, Australia
| | | | | | - Frances Boyle
- University of Sydney, Sydney, NSW, Australia
- Mater Hospital, Sydney, NSW, Australia
| | - Marion R Haas
- University of Technology Sydney, Sydney, NSW, Australia
| | - Janet E Hiller
- Swinburne University of Technology, Melbourne, VIC, Australia
| | - Gita D Mishra
- The University of Queensland, Brisbane, QLD, Australia
| | - Michael Jefford
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- University of Melbourne, Carlton, VIC, Australia
| | | | | | - Kathy Chapman
- University of Sydney, Sydney, NSW, Australia
- University of Newcastle, Newcastle, NSW, Australia
| | - Liz Hing
- Cancer Council New South Wales, Woolloomooloo, Australia
| | - Anna G Boltong
- University of Melbourne, Carlton, VIC, Australia
- Victorian Comprehensive Cancer Centre, Parkville, VIC, Australia
| | | | - Polly Baldwin
- Cancer Council South Australia, Adelaide, SA, Australia
| | - Lesley Millar
- University of Western Australia, Perth, WA, Australia
| | | | | | | | - Jennifer Job
- The University of Queensland, Brisbane, QLD, Australia
| | - Natasha Reid
- The University of Queensland, Brisbane, QLD, Australia
| | - Erin Robson
- The University of Queensland, Brisbane, QLD, Australia
| | - Nicole Moretto
- The University of Queensland, Brisbane, QLD, Australia
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Louisa Gordon
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Sandra C Hayes
- Griffith University, Menzies Health Institute Queensland, Brisbane, QLD, Australia
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Johnston SRD, Harbeck N, Hegg R, Toi M, Martin M, Shao ZM, Zhang QY, Martinez Rodriguez JL, Campone M, Hamilton E, Sohn J, Guarneri V, Okada M, Boyle F, Neven P, Cortés J, Huober J, Wardley A, Tolaney SM, Cicin I, Smith IC, Frenzel M, Headley D, Wei R, San Antonio B, Hulstijn M, Cox J, O'Shaughnessy J, Rastogi P. Abemaciclib Combined With Endocrine Therapy for the Adjuvant Treatment of HR+, HER2-, Node-Positive, High-Risk, Early Breast Cancer (monarchE). J Clin Oncol 2020; 38:3987-3998. [PMID: 32954927 PMCID: PMC7768339 DOI: 10.1200/jco.20.02514] [Citation(s) in RCA: 413] [Impact Index Per Article: 103.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Many patients with HR+, HER2- early breast cancer (EBC) will not experience recurrence or have distant recurrence with currently available standard therapies. However, up to 30% of patients with high-risk clinical and/or pathologic features may experience distant recurrence, many in the first few years. Superior treatment options are needed to prevent early recurrence and development of metastases for this group of patients. Abemaciclib is an oral, continuously dosed, CDK4/6 inhibitor approved for HR+, HER2- advanced breast cancer (ABC). Efficacy and safety of abemaciclib in ABC supported evaluation in the adjuvant setting. METHODS This open-label, phase III study included patients with HR+, HER2-, high-risk EBC, who had surgery and, as indicated, radiotherapy and/or adjuvant/neoadjuvant chemotherapy. Patients with four or more positive nodes, or one to three nodes and either tumor size ≥ 5 cm, histologic grade 3, or central Ki-67 ≥ 20%, were eligible and randomly assigned (1:1) to standard-of-care adjuvant endocrine therapy (ET) with or without abemaciclib (150 mg twice daily for 2 years). The primary end point was invasive disease-free survival (IDFS), and secondary end points included distant relapse-free survival, overall survival, and safety. RESULTS At a preplanned efficacy interim analysis, among 5,637 randomly assigned patients, 323 IDFS events were observed in the intent-to-treat population. Abemaciclib plus ET demonstrated superior IDFS versus ET alone (P = .01; hazard ratio, 0.75; 95% CI, 0.60 to 0.93), with 2-year IDFS rates of 92.2% versus 88.7%, respectively. Safety data were consistent with the known safety profile of abemaciclib. CONCLUSION Abemaciclib when combined with ET is the first CDK4/6 inhibitor to demonstrate a significant improvement in IDFS in patients with HR+, HER2- node-positive EBC at high risk of early recurrence.
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Affiliation(s)
| | - Nadia Harbeck
- Department of Obstetrics and Gynecology, Breast Center, LMU University Hospital, Munich, Germany
| | - Roberto Hegg
- Clinica Pesquisas e Centro São Paulo, São Paulo, Brazil
| | | | - Miguel Martin
- Hospital General Universitario Gregorio Marañon, Universidad Complutense, Ciberonc, GEICAM, Madrid, Spain
| | - Zhi Min Shao
- Fudan University Shanghai Cancer Center, Shanghai, China
| | | | | | - Mario Campone
- Institut de Cancérologie de l'Ouest Pays de la Loire, Saint Herblain-Angers, France
| | - Erika Hamilton
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN
| | | | - Valentina Guarneri
- Department of Surgery, Oncology, and Gastroenterology, University of Padova, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | | | - Frances Boyle
- Mater Hospital Sydney, Patricia Ritchie Centre for Cancer Care and Research, North Sydney, New South Wales, Australia
| | - Patrick Neven
- Universitaire Ziekenhuizen Leuven-Campus Gasthuisberg, Leuven, Belgium
| | - Javier Cortés
- IOB Institute of Oncology, Quiron Group, Madrid, Barcelona, and Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Jens Huober
- Breast Center, University of Ulm, Ulm, Germany
| | - Andrew Wardley
- NIHR Manchester Clinical Research Facility at The Christie, and Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, United Kingdom
| | | | - Irfan Cicin
- Trakya University Faculty of Medicine, Edirne, Turkey
| | - Ian C Smith
- Artios Pharma, Cambridge, United Kingdom.,Eli Lilly, Indianapolis, IN
| | | | | | | | | | | | | | | | - Priya Rastogi
- University of Pittsburgh, NSABP Foundation, Pittsburgh, PA
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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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