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Lyons J, Harada GK, Yeakel J, Cho M, Dayyani F, Smith B, Daly S, Nguyen N, Keshava H, Kuo JV, Seyedin SN. Evaluation of Metastatic Potential in Esophageal and Gastroesophageal Junction (GEJ) Cancer with Adherence to Elective Nodal Volume Guidelines: A Retrospective Analysis of Elective Nodal Irradiation. Int J Radiat Oncol Biol Phys 2023; 117:e320-e321. [PMID: 37785146 DOI: 10.1016/j.ijrobp.2023.06.2360] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) In 2015, expert guidelines on esophageal/GEJ cancer contouring for intensity-modulated radiation therapy (IMRT) were published in IJROBP, which delineate recommended elective nodal basins (celiac, para-aortic, gastrohepatic ligament, supraclavicular) to be irradiated depending on the primary tumor location. We hypothesize that incomplete coverage of these areas increases the risk of the development of distant failures. MATERIALS/METHODS Patients treated for non-metastatic esophageal or GEJ cancer with chemoradiotherapy pre-operatively or definitively from 2012 to 2021 were retrospectively identified from a single institution database. Radiation plans of eligible patients were then analyzed by tumor location. Plans were deemed guideline-compliant if radiation dose coverage, between 41.4 to 45 Gy, encompassed nodal basins recommended by the 2015 guidelines. The primary endpoint of this study was the overall rate of distant disease. Other endpoints included locoregional failures, defined as failures within the radiation field but outside of the primary tumor, and local failures within the gross tumor volume. Summary and descriptive statistics were used to define collected variables. Differences were measured using chi-square and Fisher's exact test for categorical variables and two-sided t-tests for continuous measures. Assessment of distant, locoregional, and local failures were assessed using univariate logistic regression with statistical significance at p < 0.05. RESULTS With a median follow-up of 25.0 months, 37 patients, with a median age of 66, were included in the study. Most patients were male (94.6%) with cT3 (54.1%), cN0 (43.2%), moderately differentiated (47.1%) adenocarcinoma (75.7%) located at the GEJ (56.8%). The median radiation dose used was 50.4 Gy, with the majority of patients receiving concurrent carboplatin and paclitaxel (83.8%). Four patients received induction chemotherapy and 20 (55.6%) underwent esophagectomy. When examining guideline compliance, 17 (46.0%) radiation plans demonstrated adequate ENI. The most common improperly covered nodal basin was para-aortic (65.0%), followed by gastrohepatic (30.0%). No patients with sufficient ENI coverage (0/17) developed distant failure compared to 45.0% (9/20) with insufficient coverage (p = 0.001). There were inappreciable differences in locoregional or local failure rates between those with and without complete ENI. Patients with complete ENI were more likely to be of larger craniocaudal length (p = 0.007) or have N2 disease (p = 0.003). When examining other tumor characteristics (histologic subtype, location, HER2 status, esophagectomy rate) of patients with and without complete ENI, no further differences were noted. CONCLUSION These results suggest that proper coverage of nodal basins, when indicated by expert guidelines, could improve distant metastasis. ENI analysis of previous prospective CRT studies for esophageal cancer could validate these findings.
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Affiliation(s)
- J Lyons
- University of California, Irvine School of Medicine, Irvine, CA
| | - G K Harada
- Department of Radiation Oncology, University of California - Irvine, Orange, CA
| | - J Yeakel
- Department of Radiation Oncology, University of California - Irvine, Orange, CA
| | - M Cho
- Division of Hematology/Oncology, Department of Medicine, University of California - Irvine, Orange, CA
| | - F Dayyani
- Division of Hematology/Oncology, Department of Medicine, University of California - Irvine, Orange, CA
| | - B Smith
- Department of General Surgery, University of California - Irvine, Orange, CA
| | - S Daly
- Department of General Surgery, University of California - Irvine, Orange, CA
| | - N Nguyen
- Department of General Surgery, University of California - Irvine, Orange, CA
| | - H Keshava
- Division of Cardiothoracic Surgery, Department of Surgery, University of California - Irvine, Orange, CA
| | - J V Kuo
- Department of Radiation Oncology, University of California - Irvine, Orange, CA
| | - S N Seyedin
- Department of Radiation Oncology, University of California - Irvine, Orange, CA
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Pisano CE, McBean B, Michmerhuizen AR, Chandler B, Pesch A, Ward C, Jungles K, The S, Lyons J, Spratt DE, Pierce LJ, Speers C. Transcriptomic Analysis to Uncover the Mechanism of Radiosensitization of AR-Positive Triple Negative Breast Cancers with AR Inhibition. Int J Radiat Oncol Biol Phys 2023; 117:e255. [PMID: 37784986 DOI: 10.1016/j.ijrobp.2023.06.1202] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The androgen receptor (AR) has been shown to drive tumor growth in triple negative breast cancers (TNBC), and previous work demonstrated AR inhibition as a strategy for radiosensitization in AR-positive (AR+) TNBC. Despite its role in radioresistance, the mechanistic role of AR in response to radiation therapy (RT) remains unknown, as does the benefit of 2nd generation anti-androgens in this context. We hypothesized that all 2nd generation anti-AR therapy would radiosensitize similarly and that canonical AR transcriptional function was responsible for radioresistance in these models. MATERIALS/METHODS Radiosensitization was assessed using 2nd generation AR antagonists (apalutamide, enzalutamide, and darolutamide) using clonogenic survival assays in MDA-MB-453, SUM185, MFM-223, and MDA-MB-231 cells at 2-6Gy. Cellular fractionation experiments were performed and quantitated to determine the location of the AR protein in cells treated with AR agonists +/- RT. RNA Seq was performed and transcriptomic approaches were used (Advaita iPathway analysis) to investigate AR-mediated effects in response to RT. RESULTS Inhibition with the 2nd generation anti-androgens enzalutamide and apalutamide is sufficient to radiosensitize AR+ TNBC models (rER: 1.34-1.41); while darolutamide had no effect on radiosensitivity (rER: 0.96-1.11). Additionally, TNBC cells with low AR expression were not radiosensitized by AR inhibition with any drug (rER: 0.96-1.03). While stimulation with the synthetic androgen methyltrienolone R1881 is sufficient to induce nuclear translocation of AR in AR+ TNBC cells, AR inhibition with enzalutamide, apalutamide, or darolutamide blocked AR nuclear translocation under growth conditions with charcoal stripped serum or fetal bovine serum. When cells are treated with R1881+RT, nuclear translocation of AR was induced at similar or greater levels compared to R1881 alone in AR+ TNBC cells. Combination treatment of RT with enzalutamide in the presence of hormones reduced nuclear localization of AR (32-39% reduction) compared to RT alone. RNA-sequencing after RT identified transcriptional changes potentially regulated by AR+RT, including changes in the NHEJ pathway genes. Additionally, pathway analyses in these models demonstrated changes in the MAPK/ERK signaling pathway, among others, that may regulate RT resistance in AR+ TNBC models. CONCLUSION Most 2nd generation anti-androgens confer radiosensitization in AR+ TNBC models with cellular localization changes of AR noted after RT. The known structural differences amongst 2nd generation anti-androgens may account for differences in radiosensitization noted. Furthermore, AR-mediated radioresistance may be due, at least in part, to downstream MAPK/ERK signaling. This work builds on the mechanistic understanding of AR-mediated radioresistance in AR+ TNBC and may expose vulnerabilities to overcome resistance to combination treatment with AR inhibition and RT.
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Affiliation(s)
- C E Pisano
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center and Case Western Reserve University, Cleveland, OH
| | - B McBean
- Department of Human Genetics, University of Michigan, Ann Arbor, MI
| | - A R Michmerhuizen
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - B Chandler
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - A Pesch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - C Ward
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - K Jungles
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - S The
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - J Lyons
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center and Case Western Reserve University, Cleveland, OH
| | - D E Spratt
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center and Case Western Reserve University, Cleveland, OH
| | - L J Pierce
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - C Speers
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center and Case Western Reserve University, Cleveland, OH
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Patel R, Pisano CE, Russo S, Speers C, Lyons J. Disparities in Acute Radiation-Related Pain and Dermatitis between Black and White Patients with Early-Stage Breast Cancer Receiving Adjuvant Radiation Following Breast Conserving Surgery. Int J Radiat Oncol Biol Phys 2023; 117:e48. [PMID: 37785519 DOI: 10.1016/j.ijrobp.2023.06.753] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Historically, black patients with cancer experience poor clinical outcomes and low quality of life due to inadequate screening and management of cancer-related treatment toxicities. There are limited data documenting racial disparities in acute radiation-related toxicities (ARRTs) for patients with early-stage breast cancer. Therefore, we compared ARRTs between Black (B) and White (W) patients receiving adjuvant radiation following breast conserving surgery (BCS). MATERIALS/METHODS This retrospective analysis included 317 patients with stage 0/1 breast cancer treated with adjuvant radiation between October 2019 and February 2022. 29% (N = 81) were B and 71% (N = 236) were W, with an average age of 65 (range: 32-88) for both. We abstracted weekly on-treatment-visit clinical notes (OTVs) completed by a nurse and radiation oncologist who utilized the Common Terminology Criteria for Adverse (CTCAE) v4.0 to evaluate each patient's pain score (scaled 0-10, 0 = no pain and 10 = worst), radiation dermatitis (RD; Grade 0-4), as well as non-CTCAE descriptors of pain and presence of hyperpigmentation or pruritus. We compared onset and severity of pain and rates of RD and pruritus between B and W patients. RESULTS The proportion reporting pain was significantly lower among B vs. W patients (43.8% vs. 63.6%; P = 0.002). Of patients qualitatively reporting pain, B patients were significantly more likely to have their pain scored as 0 than W patients (24.3% vs. 11.7%; P = 0.024). B patients had significantly lower median pain scores than W patients (P = 0.010), with a median score of 3 (interquartile range [IQR]: 0-5.5) vs. 5 (IQR: 4-8). B patients had a significantly longer time to pain identification than W patients (P = 0.027), with median time to pain of 10th fraction (IQR: 4-13.5) vs. 8th fraction (IQR: 4-11). Radiation dermatitis was graded as 0 (50.6% vs 8.5%; P<0.001), 1 (44.4% vs 82.6%; P<0.001), 2 (14.8% vs 15.3%, P = NS), and 3 (3.7% vs 0.4%; P = 0.023), with no grade 4 RD, amongst B and W patients, respectively. Of note, B patients experiencing mild hyperpigmentation were graded as 0. We found no statistically significant differences in incidence of pruritus. CONCLUSION Qualitative and quantitative analyses of ARRTs based on CTCAE v4.0 show discordance in pain scores and radiation dermatitis. The underscoring of pain amongst B patients suggests possible cultural hesitancy to report pain or implicit biases in evaluating pain suggesting the need for alternative ways to discuss and score pain in B patients. Our data suggests that CTCAE does not effectively assess radiation dermatitis in B patients. There are no descriptors of hyperpigmentation in grading of radiation dermatitis in CTCAE, which may lead to underreporting in dark-skinned individuals. Better assessment tools are needed to document ARRTs to ensure appropriate evaluation and treatment across all racial groups.
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Affiliation(s)
- R Patel
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center and Case Western Reserve University, Cleveland, OH
| | - C E Pisano
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center and Case Western Reserve University, Cleveland, OH
| | - S Russo
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center and Case Western Reserve University, Cleveland, OH
| | - C Speers
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center and Case Western Reserve University, Cleveland, OH
| | - J Lyons
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center and Case Western Reserve University, Cleveland, OH
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Sheikh S, Fane L, Choi S, Lyons J. Clinical Variables Impact Time to Inpatient Radiation Oncology Consultation for Spine Metastases: A Single Institution Study. Int J Radiat Oncol Biol Phys 2023; 117:e149. [PMID: 37784730 DOI: 10.1016/j.ijrobp.2023.06.967] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Timely initiation of treatment for patients presenting with spinal metastases is essential for optimal oncologic care. An important rate limiting step for many patients is initiation of radiation oncology consultation. MATERIALS/METHODS We performed a retrospective single institution study on adult inpatients with spine metastases with or without cord compression from 2018-2021. Variables related to inpatient care were collected. Our primary study endpoint was time to inpatient radiation consultation of less than or equal to 2 days. Our secondary study endpoint was time to magnetic resonance imaging (MRI) order less than or equal to 1 day. Multivariable logistic regression was utilized to determine which variables were associated with our study endpoints. P-values less than 0.05 were considered significant. RESULTS A total of 160 patients received inpatient care between 2018-2021. The median age of our study population was 68 years. One hundred twenty-one patients (75.6%) underwent initial MRI imaging of their spine. One hundred thirty-nine (86.9%) patients underwent inpatient radiation oncology consultation. Forty-seven patients (29.4%) were non-ambulatory on presentation The median time to inpatient radiation consultation was 1 day (interquartile range [IQR]: 1-3 days). Patients with a diagnosis of cancer at presentation were more likely to have an inpatient radiation consultation within two days (OR: 5.25, 95% CI: 1.64-17.38, p = 0.006). Spine MRIs ordered within 1 day were more likely to lead to radiation oncology consultation within 2 days of presentation (OR: 9.75, 95% CI: 1.83-61.78, p = 0.009). Similarly, surgical consultation within 1 day was more likely to lead to radiation oncology consultation within two days of presentation (OR: 6.60, 95% CI: 1.41 - 35.09, p = 0.019). There was a higher likelihood of ordering a spine MRI within 1 day of presentation for patients with difficulty ambulating (OR: 6.00, 95% CI: 1.78 - 27.51, p = 0.008). CONCLUSION Our analysis identifies cancer diagnosis, time to surgical consultation, time to MRI order, and ambulation status as influencing the time to inpatient radiation consultation and spine MRI orders. These variables should be taken into consideration to optimize care for inpatients with spine metastases and cord compression.
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Affiliation(s)
- S Sheikh
- University Hospitals Seidman Cancer Center, Cleveland, OH
| | - L Fane
- School of Medicine, Case Western Reserve University, Cleveland, OH
| | - S Choi
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center and Case Western Reserve University, Cleveland, OH
| | - J Lyons
- University Hospitals Seidman Cancer Center, Cleveland, OH
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Snooks H, Watkins A, Lyons J, Akbari A, Bailey R, Bethell L, Carson-Stevens A, Dale J, Edwards A, Emery H, Evans BA, Jolles S, John A, Kingston M, Porter A, Sewell B, Williams V, Lyons RA. Corrigendum to "Did the UK's public health shielding policy protect the clinically extremely vulnerable during the COVID-19 pandemic in wales? Results of EVITE immunity, a linked data retrospective study" [Public Health 218 (2023) 12-20]. Public Health 2023; 222:229. [PMID: 37463828 PMCID: PMC11021201 DOI: 10.1016/j.puhe.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Affiliation(s)
- H Snooks
- Swansea University, Medical School, ILS 2, Singleton Park, SA2 8PP, Swansea, UK.
| | - A Watkins
- Swansea University, Medical School, ILS 2, Singleton Park, SA2 8PP, Swansea, UK
| | - J Lyons
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, SA2 8PP, Swansea, UK
| | - A Akbari
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, SA2 8PP, Swansea, UK
| | - R Bailey
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, SA2 8PP, Swansea, UK
| | - L Bethell
- Swansea University, Medical School, ILS 2, Singleton Park, SA2 8PP, Swansea, UK
| | - A Carson-Stevens
- Cardiff University, Division of Population Medicine, University Hospital of Wales, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - J Dale
- The University of Warwick, Medical School, Coventry CV4 7AL, UK
| | - A Edwards
- Cardiff University, Division of Population Medicine, University Hospital of Wales, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - H Emery
- Swansea University, Medical School, ILS 2, Singleton Park, SA2 8PP, Swansea, UK
| | - B A Evans
- Swansea University, Medical School, ILS 2, Singleton Park, SA2 8PP, Swansea, UK
| | - S Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - A John
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, SA2 8PP, Swansea, UK
| | - M Kingston
- Swansea University, Medical School, ILS 2, Singleton Park, SA2 8PP, Swansea, UK
| | - A Porter
- Swansea University, Medical School, ILS 2, Singleton Park, SA2 8PP, Swansea, UK
| | - B Sewell
- Swansea University, School of Health and Social Care, Vivian Tower, Singleton Park, SA2 8PP, Swansea, UK
| | - V Williams
- Swansea University, Medical School, ILS 2, Singleton Park, SA2 8PP, Swansea, UK
| | - R A Lyons
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, SA2 8PP, Swansea, UK
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Snooks H, Watkins A, Lyons J, Akbari A, Bailey R, Bethell L, Carson-Stevens A, Edwards A, Emery H, Evans BA, Jolles S, John A, Kingston M, Porter A, Sewell B, Williams V, Lyons RA. Did the UK's public health shielding policy protect the clinically extremely vulnerable during the COVID-19 pandemic in Wales? Results of EVITE Immunity, a linked data retrospective study. Public Health 2023; 218:12-20. [PMID: 36933354 PMCID: PMC9928733 DOI: 10.1016/j.puhe.2023.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 08/08/2022] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 02/17/2023]
Abstract
INTRODUCTION The UK shielding policy intended to protect people at the highest risk of harm from COVID-19 infection. We aimed to describe intervention effects in Wales at 1 year. METHODS Retrospective comparison of linked demographic and clinical data for cohorts comprising people identified for shielding from 23 March to 21 May 2020; and the rest of the population. Health records were extracted with event dates between 23 March 2020 and 22 March 2021 for the comparator cohort and from the date of inclusion until 1 year later for the shielded cohort. RESULTS The shielded cohort included 117,415 people, with 3,086,385 in the comparator cohort. The largest clinical categories in the shielded cohort were severe respiratory condition (35.5%), immunosuppressive therapy (25.9%) and cancer (18.6%). People in the shielded cohort were more likely to be female, aged ≥50 years, living in relatively deprived areas, care home residents and frail. The proportion of people tested for COVID-19 was higher in the shielded cohort (odds ratio [OR] 1.616; 95% confidence interval [CI] 1.597-1.637), with lower positivity rate incident rate ratios 0.716 (95% CI 0.697-0.736). The known infection rate was higher in the shielded cohort (5.9% vs 5.7%). People in the shielded cohort were more likely to die (OR 3.683; 95% CI: 3.583-3.786), have a critical care admission (OR 3.339; 95% CI: 3.111-3.583), hospital emergency admission (OR 2.883; 95% CI: 2.837-2.930), emergency department attendance (OR 1.893; 95% CI: 1.867-1.919) and common mental disorder (OR 1.762; 95% CI: 1.735-1.789). CONCLUSION Deaths and healthcare utilisation were higher amongst shielded people than the general population, as would be expected in the sicker population. Differences in testing rates, deprivation and pre-existing health are potential confounders; however, lack of clear impact on infection rates raises questions about the success of shielding and indicates that further research is required to fully evaluate this national policy intervention.
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Affiliation(s)
- H Snooks
- Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK.
| | - A Watkins
- Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK.
| | - J Lyons
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, Swansea, SA2 8PP, UK.
| | - A Akbari
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, Swansea, SA2 8PP, UK.
| | - R Bailey
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, Swansea, SA2 8PP, UK.
| | - L Bethell
- Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK.
| | - A Carson-Stevens
- Cardiff University, Division of Population Medicine, Neuadd Meirionnydd, University Hospital of Wales, Heath Park, Cardiff, CF14 4YS, UK.
| | - A Edwards
- Cardiff University, Division of Population Medicine, Neuadd Meirionnydd, University Hospital of Wales, Heath Park, Cardiff, CF14 4YS, UK.
| | - H Emery
- Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK.
| | - B A Evans
- Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK.
| | - S Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK.
| | - A John
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, Swansea, SA2 8PP, UK.
| | - M Kingston
- Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK.
| | - A Porter
- Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK.
| | - B Sewell
- Swansea University, School of Health and Social Care, Vivian Tower, Singleton Park, Swansea, SA2 8PP, UK.
| | - V Williams
- Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK.
| | - R A Lyons
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, Swansea, SA2 8PP, UK.
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Chen E, Harris E, Amin A, Owusu C, Lyons J. Patterns of Regional Radiotherapy Following Breast Conserving Surgery in Hormone Receptor Positive Breast Cancer with Limited Nodal Disease: A Single Institutional Experience. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.706] [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: 11/30/2022]
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Vicini F, Winter K, Freedman G, Arthur D, Hayman J, Rosenstein B, Bentzen S, Li A, Lyons J, Tomberlin J, Seaward S, Cheston S, Coster J, Anderson B, Perera F, Poppe M, Petersen I, Bazan J, Moughan J, White J. NRG RTOG 1005: A Phase III Trial of Hypo Fractionated Whole Breast Irradiation with Concurrent Boost vs. Conventional Whole Breast Irradiation Plus Sequential Boost Following Lumpectomy for High Risk Early-Stage Breast Cancer. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.2320] [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: 11/16/2022]
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Kucia-Tran J, Bevan L, Chessari G, Fazal L, Ferrari N, Lyons J, Saini H, Wallis N, Ward G, Ahn M. Low SKP2 expression is predictive of sensitivity to an MDM2 antagonist in p53 wild-type AML. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01020-6] [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: 11/03/2022]
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Hindley C, Biondo A, Brothwood J, Dao K, Kandola N, Lyons J, Nakatsuru Y, Smyth T, Wagner S, Wallis N, Hearn K. A combination vertical inhibition approach with inhibitors of SHP2 and ERK provides improved activity in KRAS-mutant pancreatic and colorectal cancer models. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)00953-4] [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: 11/03/2022]
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Elumalai T, Barker C, Elliott T, Malik J, Tran A, Hudson A, Song YP, Patel K, Lyons J, Hoskin P, Choudhury A, Mistry H. Translation of Prognostic and Pharmacodynamic Biomarkers from Trial to Non-trial Patients with Metastatic Castration-resistant Prostate Cancer Treated with Docetaxel. Clin Oncol (R Coll Radiol) 2022; 34:e291-e297. [PMID: 35314092 DOI: 10.1016/j.clon.2022.01.040] [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: 04/28/2021] [Revised: 01/17/2022] [Accepted: 01/26/2022] [Indexed: 11/03/2022]
Abstract
AIMS We conducted a pooled analysis of four randomised controlled trials and a non-trial retrospective dataset to study the changes in serum prostate-specific antigen (PSA) concentrations during treatment and its impact on survival in men treated with docetaxel for metastatic castration-resistant prostate cancer. We also compared the outcomes and pre-treatment prognostic factors between trial and non-trial patients. MATERIALS AND METHODS Data were obtained from four randomised controlled trials and a non-trial cohort from a tertiary cancer centre. The PSA kinetics covariates chosen were absolute value (PSAT), best percentage change (BPCH) and tumour growth rate (K). The association between the covariates collected and overall survival was assessed within a Cox proportional hazards model. How well a covariate captured the difference between trial and non-trial patients was assessed by reporting on models with or without trial status as a covariate. RESULTS We reviewed individual datasets of 2282 patients. The median overall survival for trial patients was 20.4 (95% confidence interval 19.6-22.2) months and for the non-trial cohort was 12.4 (10.7-14.7) months (P < 0.001). Of the pre-treatment factors, we found that only lactate dehydrogenase fully captured the difference in prognosis between the trial and non-trial cohorts. All PSA kinetic metrics appeared to be prognostic in both the trial and non-trial patients. However, the effect size was reduced in non-trial versus trial patients (interaction P < 0.001). Of the time-dependent covariates, we found that BPCH best captured the difference between trial and non-trial patient prognosis. CONCLUSIONS The analysis presented here highlights how data from open-source trial databases can be combined with emerging clinical practice databases to assess differences between trial versus non-trial patients for particular treatments. These results highlight the importance of developing prognostic models using both pre-treatment and time-dependent biomarkers of new treatments.
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Affiliation(s)
- T Elumalai
- The Christie NHS Foundation Trust, Manchester, UK
| | - C Barker
- The Christie NHS Foundation Trust, Manchester, UK
| | - T Elliott
- Western General Hospital, Edinburgh Cancer Centre, Edinburgh, UK
| | - J Malik
- Western General Hospital, Edinburgh Cancer Centre, Edinburgh, UK
| | - A Tran
- The Christie NHS Foundation Trust, Manchester, UK
| | - A Hudson
- The Christie NHS Foundation Trust, Manchester, UK
| | - Y P Song
- The Christie NHS Foundation Trust, Manchester, UK
| | - K Patel
- The Christie NHS Foundation Trust, Manchester, UK
| | - J Lyons
- The Christie NHS Foundation Trust, Manchester, UK
| | - P Hoskin
- The Christie NHS Foundation Trust, Manchester, UK; University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK; Division of Cancer Sciences, University of Manchester, UK; Mount Vernon Cancer Centre, Northwood, UK; Division of Pharmacy, University of Manchester, Manchester, UK
| | - A Choudhury
- The Christie NHS Foundation Trust, Manchester, UK; University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK; Division of Cancer Sciences, University of Manchester, UK; Division of Pharmacy, University of Manchester, Manchester, UK
| | - H Mistry
- Division of Cancer Sciences, University of Manchester, UK; Division of Pharmacy, University of Manchester, Manchester, UK.
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12
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Lotan D, Oren D, Bae D, Mulcahy S, Atanda A, DeFilippis E, Fried J, Raikhelkar J, Clerkin K, Topkara V, Lin E, Colombo P, Sayer G, Yuzefpolskaya M, Lyons J, Uriel N. Shared Care Program for Left Ventricular Assist Device (LVAD) Patients: Clinical Experience and Interim Report. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1452] [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: 11/24/2022] Open
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13
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Lyons J, Gabbe BJ, Rawlinson D, Lockey D, Fry RJ, Akbari A, Lyons RA. Impact of a physician - critical care practitioner pre-hospital service in Wales on trauma survival: a retrospective analysis of linked registry data. Anaesthesia 2021; 76:1475-1481. [PMID: 33780550 DOI: 10.1111/anae.15457] [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] [Accepted: 02/22/2021] [Indexed: 01/02/2023]
Abstract
The Emergency Medical Retrieval and Transfer Service for Wales launched in 2015. This service delivers senior pre-hospital doctors and advanced critical care practitioners to the scene of time-critical life- and limb-threatening incidents to provide advanced decision-making and pre-hospital clinical care. The impact of the service on 30-day mortality was evaluated retrospectively using a data linkage system. The study included patients who sustained moderate-to-severe blunt traumatic injuries (injury severity score ≥ 9) between 27 April 2015 and 30 November 2018. The association between pre-hospital management by the Emergency Medical Retrieval and Transfer Service and 30-day mortality was assessed using multivariable logistic regression. In total, data from 4035 patients were analysed, of which 412 (10%) were treated by the Emergency Medical Retrieval and Transfer Service. A greater proportion of patients treated by the Emergency Medical Retrieval and Transfer Service had an injury severity score ≥ 16 and Glasgow coma scale ≤ 12 (288 (70%) vs. 1435 (40%) and 126 (31%) vs. 325 (9%), respectively). The unadjusted 30-day mortality rate was 11.7% for patients managed by the Emergency Medical Retrieval and Transfer Service compared with 9.6% for patients managed by standard pre-hospital care services. However, after adjustment for differences in case-mix, the 30-day mortality rate for patients treated by the Emergency Medical Retrieval and Transfer Service was 37% lower (adjusted odds ratio 0.63 (95%CI 0.41-0.97); p = 0.037). The introduction of an emergency medical retrieval service was associated with a reduction in 30-day mortality for patients with blunt traumatic injury.
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Affiliation(s)
- J Lyons
- Public Health Medicine (Health Data Research UK), Swansea University, Swansea, UK
| | - B J Gabbe
- Emergency and Trauma Research Unit, School of Public Health and Preventive Medicine at Monash University, Melbourne, Australia.,Public Health Medicine (Health Data Research UK), Swansea University, Swansea, UK
| | - D Rawlinson
- Emergency Medical Retrieval and Transfer Service (EMRTS) Cymru, Wales, UK.,Public Health Medicine (Health Data Research UK), Swansea University, Swansea, UK
| | - D Lockey
- Emergency Medical Retrieval and Transfer Service (EMRTS) Cymru, Wales, UK
| | - R J Fry
- GIS and Health Geographies, Public Health Medicine (Health Data Research UK), Swansea University, Swansea, UK
| | - A Akbari
- Public Health Medicine (Health Data Research UK), Swansea University, Swansea, UK
| | - R A Lyons
- Public Health Medicine (Health Data Research UK), Swansea University, Swansea, UK
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14
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Goyal S, Negrelli J, Lyons J, Liebo M. Association of Infection Rate in Heart Transplant Recipients with Combined Tacrolimus and Sirolimus at High versus Low Concentration. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.420] [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: 10/21/2022] Open
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15
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Kharouta M, Damico N, Miller M, Harris E, Lyons J. Impact of Axillary Lymph Node Dissection (ALND) on Survival in Patients with ypN1 Breast Cancer that receive Regional Nodal Irradiation (RNI): A National Cancer Database (NCDB) Analysis. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1140] [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: 10/23/2022]
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16
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Damico N, Lyons J, Kharouta M, Harris E. Effect of Radiation Therapy following Breast Conserving Surgery (BCS) in Women with Early Stage Breast Cancer and Low Oncotype DX Recurrence Scores (RS)TM. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1096] [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: 10/23/2022]
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17
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Munck J, Berdini V, Courtin A, East C, Heightman T, Hindley C, Kucia-Tran J, Lyons J, Martins V, Muench S, Murray C, Norton D, O’Reilly M, Reader M, Rees D, Rich S, Thompson N, Wilsher N, Woolford A, Wallis N. The clinical candidate, ASTX029, is a novel, dual mechanism ERK1/2 inhibitor and has potent activity in MAPK-activated cancer cell lines and in vivo tumor models. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)31218-1] [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: 11/30/2022]
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18
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Smyth T, Brothwood J, Fazal L, Hearn K, Hindley C, Johnson C, Jones M, Kandola N, Lyons J, Martins V, Miyadera K, Muench S, Munck J, Nakatsuru Y, Ochiiwa H, Saini H, Shah A, Wagner S, Wilsher N, Wallis N. Combined inhibition of SHP2 and ERK enhances anti-tumour effects in preclinical models. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)31194-1] [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: 11/28/2022]
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19
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Dildar B, Balata H, Evison M, Alonso A, Duerden R, Gerova N, Lyons J, Sharman A, Sinnott N, Booton R, Crosbie P. Outcome of pure ground glass and part-solid nodules in the Manchester ‘Lung Health Check’ screening pilot. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30040-4] [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: 10/25/2022]
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20
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Punjabi A, Hewitt K, Balata H, Sinnott N, Lyons J, Crosbie P, Gee C, Duerden R, Greaves M, Booton R, Sharman A, Evison M. Implementation and outcomes of the RAPID programme: addressing the front end of the lung cancer pathway in Manchester. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30080-5] [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: 10/25/2022]
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21
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Kahai R, Ullah M, Beech A, Cove-Smith L, Lyons J, Ng C. Are there any benefits to consumption of an oral nutritional supplement (ONS) ice lolly in lung cancer patients? Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30218-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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22
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Lange CE, Jennings SH, Diallo A, Lyons J. Canine papillomavirus types 1 and 2 in classical papillomas: High abundance, different morphological associations and frequent co-infections. Vet J 2019; 250:1-5. [PMID: 31383413 DOI: 10.1016/j.tvjl.2019.05.016] [Citation(s) in RCA: 5] [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: 05/28/2018] [Revised: 05/30/2019] [Accepted: 05/31/2019] [Indexed: 11/25/2022]
Abstract
Canine papillomatosis is mainly attributed to papillomavirus infections. Papillomavirus DNA is also frequently identified in healthy skin, and evidence of high papillomavirus diversity complicates this simplistic view of causality. The aim of this study was to determine how frequently canine papillomas contain papillomavirus DNA and express viral protein, and how these factors correlate to the histology and anatomic location. Fifty-three archived, formalin-fixed samples of canine papillomas and eight samples of other proliferative skin lesions from dogs were included. Samples were re-evaluated histologically, tested for papillomavirus L1-antigen using immunohistochemistry, and for papillomavirus DNA with PCR assays and molecular sequencing. Most papillomas from haired skin contained papillomavirus DNA (96%) and antigen (92%). Of oral papillomas, 88% were positive for both papillomavirus DNA and antigen. Approximately 50% of non-papilloma proliferations and papillomas from eyelid/conjunctiva specimens contained viral DNA, but antigen was present in only 12% of eyelid/conjunctiva papillomas and in none of the non-papilloma proliferations. The presence of viral antigen was highly correlated with histological indicators of viral infection, including intranuclear inclusions, koilocytes, cytoplasmatic vacuolation and dysplasia. The viruses found were mainly CPV1 and CPV2. CPV1 dominated in oral infections, while CPV2 dominated in cutaneous endophytic papillomas. Co-infections with CPV1 and CPV2 accounted for about 20% of all detected infections. These results support a role for papillomaviruses in canine cutaneous and oral, exophytic and endophytic papillomas and support previously raised doubts about their role in squamous papillomas from eyelid/conjunctiva specimens.
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Affiliation(s)
- C E Lange
- Department of Immunobiology, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA 02115, USA.
| | - S H Jennings
- Department of Biomedical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA 01536, USA
| | - A Diallo
- Department of Immunobiology, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA 02115, USA
| | - J Lyons
- Department of Biomedical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA 01536, USA
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23
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Ahmed M, Jackson S, Lyons J, Evison M, Holme J. Prophylactic antibiotics following local anaesthetic thoracoscopy: do they have a role? Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30208-9] [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: 11/30/2022]
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24
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Holme J, Rashed A, Chaudhry A, Mulla A, Wright J, Jackson S, Ahmed M, Evison M, Lyons J. To talc or not to talc: can thoracoscopists accurately predict malignancy and trapped lung? Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30115-1] [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: 10/27/2022]
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25
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Traverse-Healy L, Balata H, Blandin Knight S, Armitage C, Barber P, Colligan D, Elton P, Kirwan M, Lyons J, Mcwilliams L, Novasio J, Sharman A, Slevin K, Taylor S, Tonge J, Waplington S, Yorke J, Evison M, Booton R, Crosbie P. The impact of community-based lung cancer screening on smoking behaviour in a deprived population. Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30215-6] [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: 10/27/2022]
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26
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Mulla A, Al-Najjar H, Bailey S, Brown L, Martin J, Lyons J, Crosbie P, Booton R, Evison M. EBUS in lung cancer staging and diagnosis: service performance across a cancer alliance. Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30085-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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27
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Cheng A, Craig C, Summers Y, Taylor P, Califano R, Cove-Smith L, Woolf D, Duerden R, Sharman A, Lyons J, Crosbie P, Booton R, Evison M. Metachronous oligometastatic non-small cell lung cancer: are we selecting the appropriate patients for radical treatment? Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30128-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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28
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Lyons J, Wise L, Heeren T, Applebaum K, Ensrud K, Fredman L. INCIDENT FRACTURE AS A MEDIATOR OF THE ASSOCIATION BETWEEN BONE MINERAL DENSITY AND MORTALITY. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J Lyons
- Harvard Pilgrim HealthCare Institute
| | - L Wise
- Boston University School of Public Health
| | - T Heeren
- Boston University School of Public Health
| | - K Applebaum
- George Washington University Milken Institute School of Public Health
| | | | - L Fredman
- Boston University School of Public Health
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29
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Song Y, Morrison S, Lyons J, Patel K, Coyle C, Elliot P, Logue J, Tran A, Wylie J, Conroy R, Choudhury A. EP-1586: Docetaxel – Mitigating the high price of success. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31895-4] [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: 11/16/2022]
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30
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Morrison S, Lyons J, Conroy R. A Review of Chemotherapy Use in Metastatic Prostate Cancer. Clin Oncol (R Coll Radiol) 2018. [DOI: 10.1016/j.clon.2017.12.009] [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: 10/18/2022]
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31
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Jackson S, Evison M, Hewitt K, Lyons J, Holme J. IPC drainage by family members is as safe and effective as drainage by nurses. Lung Cancer 2018. [DOI: 10.1016/s0169-5002(18)30096-5] [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: 11/26/2022]
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32
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Takata K, Shemesh T, Kim S, Duong M, Lyons J, Sidharta S, Brown A, Nicholls S. Associations of Cardiovascular Risk Factors With Cholesterol Efflux Capacity in Indigenous Australians. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.825] [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: 11/26/2022]
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33
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Li A, Moughan J, White J, Freedman G, Arthur D, Galvin J, Xiao Y, McNulty S, Lyons J, Kavadi V, Fields M, Mitchell M, Anderson B, Lock M, Kokeny K, Bazan J, Currey A, Hijal T, Cheston S, Vicini F. Lessons Learned From the Two-Step QA Process in NRG Oncology/RTOG 1005, A Phase 3 Trial for Early-Stage Breast Cancer. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.533] [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: 11/17/2022]
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34
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Abbott AM, Valente SA, Loftus L, Tendulkar RD, Greif JM, Bethke KP, Donnelly ED, Lottich C, Ross DL, Friedman NB, Bedi CG, Joh JE, Kelemen P, Hoefer RA, Kang SK, Ruffer J, Police A, Fyles A, Graves GM, Willey SC, Tousimis EA, Small W, Lyons J, Grobmyer S, Laronga C. A multi-institutional analysis of intraoperative radiotherapy for early breast cancer: Does age matter? Am J Surg 2017; 214:629-633. [PMID: 28918848 DOI: 10.1016/j.amjsurg.2017.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 06/19/2017] [Accepted: 06/20/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Single-session intraoperative radiation therapy (IORT) minimizes treatment demands associated with traditional whole breast radiation therapy (WBRT) but outcomes on local disease control and morbidity among the elderly is limited. METHODS A multi-institutional retrospective registry was established from 19 centers utilizing IORT from 2007 to 2013. Patient, tumor, and treatment variables were analyzed for ages <70 and ≥70. RESULTS We evaluated 686 patients (<70 = 424; ≥70 = 262) who were margin and lymph node negative. Patients <70 were more likely to have longer operative time, oncoplastic closure, higher rates of IORT used as planned boost, and receive chemotherapy and post-operative WBRT. Wound complication rates were low and not significantly different between age groups. Median follow-up was 1.06 (range 0.51-1.9) years for < 70 and 1.01 (range 0.5-1.68) years for ≥ 70. There were 5 (0.73%) breast recurrences (4 in <70 and 1 ≥ 70, p = 0.65) and no axillary recurrences during follow-up. CONCLUSIONS IORT was associated with a low rate of wound complication and local recurrence on short-term follow-up in this cohort.
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Affiliation(s)
| | | | - L Loftus
- Moffitt Cancer Center, Tampa, USA
| | | | - J M Greif
- Alta Bates Summit Medical Center, Oakland, CA, USA
| | | | | | - C Lottich
- Community Physician Network Breast Care, Community Health Network, Indianapolis, IN, USA
| | - D L Ross
- Community Physician Network Breast Care, Community Health Network, Indianapolis, IN, USA
| | | | - C G Bedi
- Mercy Medical Center, Baltimore, MD, USA
| | - J E Joh
- Mercy Medical Center, Baltimore, MD, USA
| | - P Kelemen
- Ashikari Breast Center, Dobbs Ferry, NY, USA
| | - R A Hoefer
- The Sentara Dorothy G. Hoefer Comprehensive Breast Center, Newport News, VA, USA
| | - S K Kang
- The Sentara Dorothy G. Hoefer Comprehensive Breast Center, Newport News, VA, USA
| | - J Ruffer
- Advocate Good Shepherd Hospital, Barrington, IL, USA
| | - A Police
- University of California Irvine Medical Center, Irvine, CA, USA
| | - A Fyles
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - G M Graves
- Sutter Cancer Center, Sacramento, CA, USA
| | - S C Willey
- MedStar Georgetown University Hospital, Washington, DC, USA
| | - E A Tousimis
- MedStar Georgetown University Hospital, Washington, DC, USA
| | - W Small
- Loyola University, Maywood, IL, USA
| | - J Lyons
- The Cleveland Clinic, Cleveland, OH, USA
| | - S Grobmyer
- The Cleveland Clinic, Cleveland, OH, USA
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35
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Hussain S, Ansari J, Huddart R, Power D, Lyons J, Wylie J, Vilarino-Varela M, Elander N, McMenemin R, Pickering L, Faust G, Chauhan S, Jakson R. VICTOR: Vinflunine in advanced metastatic transitional cell carcinoma of the urothelium (TCCU): a retrospective analysis of the use of vinflunine in multi-centre real life setting as second line chemotherapy through free of charge programme (FOCP) for patients in the UK and Ireland. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw373.28] [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: 11/14/2022] Open
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36
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Carstairs K, Nguyen M, Fisher J, Vigilante M, Weglowski J, Hunter W, Lyons J, Awai H, Hollenbach K. 186 Pediatric Emergency Department Observation Unit Improves Emergency Department and Hospital Flow and Capacity During Highest Census Months. Ann Emerg Med 2016. [DOI: 10.1016/j.annemergmed.2016.08.199] [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: 10/20/2022]
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37
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Nguyen M, Hollenbach K, Vigilante M, Fisher J, Lyons J, Weglowski J, Hunter W, Awai H, Carstairs K. 236 Improved Outcomes for Pediatric Respiratory Patients Treated in a Pediatric Emergency Department Observation Unit. Ann Emerg Med 2016. [DOI: 10.1016/j.annemergmed.2016.08.250] [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: 11/15/2022]
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38
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Joska JA, Witten J, Thomas KG, Robertson C, Casson-Crook M, Roosa H, Creighton J, Lyons J, McArthur J, Sacktor NC. A Comparison of Five Brief Screening Tools for HIV-Associated Neurocognitive Disorders in the USA and South Africa. AIDS Behav 2016; 20:1621-31. [PMID: 26860536 DOI: 10.1007/s10461-016-1316-y] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [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] [Indexed: 01/14/2023]
Abstract
Screening for HIV-associated neurocognitive disorders (HAND) is important to improve clinical outcomes. We compared the diagnostic sensitivity and specificity of the mini-mental state examination, International HIV dementia scale (IHDS), Montreal cognitive assessment, Simioni symptom questionnaire and cognitive assessment tool-rapid version (CAT-rapid) to a gold standard neuropsychological battery. Antiretroviral-experienced participants from Cape Town, South Africa, and Baltimore, USA, were recruited. The sensitivity and specificity of the five tools, as well as those of the combined IHDS and CAT-rapid, were established using 2 × 2 contingency tables and ROC analysis. More than a third (65165) had symptomatic HAND. In detecting HIV-D, the CAT-Rapid had good sensitivity (94 %) and weak specificity (52 %) (cut-point ≤10), while the IHDS showed fair sensitivity (68 %) and good specificity (86 %) (cut-point ≤10). The combined IHDS and CAT-rapid showed excellent sensitivity and specificity for HIV-D at a cut-off score of ≤16 (out of 20; 89 and 82 %). No tool was adequate in screening for any HAND. The combination IHDS and CAT-rapid tool appears to be a good screener for HIV-D but is only fairly sensitive and poorly specific in screening for any HAND. Screening for milder forms of HAND continues to be a clinical challenge.
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Affiliation(s)
- J A Joska
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Groote Schuur Hospital, Anzio Road, Observatory, 7925, Cape Town, South Africa.
| | - J Witten
- ACSENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - K G Thomas
- ACSENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - C Robertson
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Groote Schuur Hospital, Anzio Road, Observatory, 7925, Cape Town, South Africa
| | - M Casson-Crook
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Groote Schuur Hospital, Anzio Road, Observatory, 7925, Cape Town, South Africa
| | - H Roosa
- Johns Hopkins University School of Medicine, Baltimore, USA
| | - J Creighton
- Johns Hopkins University School of Medicine, Baltimore, USA
| | - J Lyons
- Brigham and Women's Hospital, Boston, USA
| | - J McArthur
- Johns Hopkins University School of Medicine, Baltimore, USA
| | - N C Sacktor
- Johns Hopkins University School of Medicine, Baltimore, USA
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39
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Mahil J, Hughes C, Patel K, Lyons J, Elliott PA, Choudhury A, Conroy R. Febrile Neutropenia Rates in Men Treated with Docetaxel Chemotherapy for Metastatic Hormone-sensitive Prostate Cancer. Clin Oncol (R Coll Radiol) 2016; 28:612. [PMID: 27342950 DOI: 10.1016/j.clon.2016.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 06/08/2016] [Indexed: 10/21/2022]
Affiliation(s)
- J Mahil
- University of Manchester, Manchester, UK
| | - C Hughes
- The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - K Patel
- The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - J Lyons
- The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - P A Elliott
- The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - A Choudhury
- University of Manchester, Manchester, UK; The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - R Conroy
- The Christie Hospital NHS Foundation Trust, Manchester, UK
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Plumb J, Lyons J, Nørby K, Thomas M, Nørby E, Poms R, Bucchini L, Restani P, Kiely M, Finglas P. ePlantLIBRA: A composition and biological activity database for bioactive compounds in plant food supplements. Food Chem 2016; 193:121-7. [DOI: 10.1016/j.foodchem.2015.03.126] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 01/12/2015] [Accepted: 03/15/2015] [Indexed: 12/12/2022]
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Lyons J, O'Brien C, Krussel S, Finn S, Cuffe S, O'Connell F, Gately K. 10 Multiplex genotyping of matched EBUS TBNA and cfDNA samples in advanced NSCLC patients. Lung Cancer 2016. [DOI: 10.1016/s0169-5002(16)30027-7] [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: 11/26/2022]
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Joseph N, Dovedi SJ, Thompson C, Lyons J, Kennedy J, Elliott T, West CM, Choudhury A. Pre-treatment lymphocytopaenia is an adverse prognostic biomarker in muscle-invasive and advanced bladder cancer. Ann Oncol 2015; 27:294-9. [PMID: 26578732 DOI: 10.1093/annonc/mdv546] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [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: 07/13/2015] [Accepted: 10/28/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pre-treatment lymphocytopaenia may result from cytokines secreted by the tumour microenvironment in association with aggressive tumour biology. We sought to establish the prognostic significance of lymphocytopaenia in muscle-invasive and advanced bladder cancer. PATIENTS AND METHODS Seventy-four patients with muscle-invasive bladder cancer treated with radical chemoradiotherapy and 131 patients with advanced bladder cancer treated with palliative chemotherapy were included in the study. The absolute lymphocyte count on the first day of treatment was recorded. Invasive local or systemic recurrence in the muscle-invasive bladder cancer cohort and all-cause mortality in the advanced bladder cancer cohort were defined as survival end points. Receiver operating characteristic (ROC) curve analysis was utilized to determine the cut-off for defining lymphocytopaenia in the muscle-invasive bladder cancer cohort followed by multivariable analysis in a model evaluating the following variables: anaemia, neutrophilia, tumour stage, hydronephrosis and neoadjuvant chemotherapy. Subsequently, lymphocytopaenia was assessed in a multivariable model of the advanced bladder cancer cohort analysing the following prognostic variables: neutrophilia, anaemia, performance status and presence of bone or visceral metastases. A further analysis was carried out evaluating absolute lymphocyte count as a continuous variable. RESULTS An absolute lymphocyte count of 1.5 × 10(9)/l was determined as the cut-off on ROC curve analysis in the muscle-invasive bladder cancer cohort, and multivariate analysis revealed that only lymphocytopaenia was predictive for inferior outcome in this cohort. In the advanced bladder cancer cohort, lymphocytopaenia [hazard ratio (HR) 1.6, 95% confidence interval (CI) 1.1-2.4; P = 0.02] and performance status (HR 1.7, 95% CI 1.0-2.7; P = 0.047) were adverse prognostic factors in the binary variable multivariate model. Absolute lymphocyte count was the sole significant factor when analysed as a continuous variable (HR 0.66, 95% CI 0.5-0.87; P = 0.003). CONCLUSION Pre-treatment lymphocytopaenia is an independent adverse prognostic factor in both muscle-invasive and advanced bladder cancer. It may be a manifestation of cancer-induced immune suppression driving tumour progression.
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Affiliation(s)
| | - S J Dovedi
- The University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester
| | - C Thompson
- Department of Clinical Oncology, University Hospitals of Morecambe Bay NHS Foundation Trust, Morecambe, UK
| | - J Lyons
- Department of Clinical Oncology
| | | | | | - C M West
- The University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester
| | - A Choudhury
- Department of Clinical Oncology The University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester
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Fischer N, Church P, Lyons J, McPherson AC. A qualitative exploration of the experiences of children with spina bifida and their parents around incontinence and social participation. Child Care Health Dev 2015; 41:954-62. [PMID: 26010416 DOI: 10.1111/cch.12257] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [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] [Received: 04/24/2014] [Revised: 03/16/2015] [Accepted: 03/29/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Urinary incontinence is frequently experienced by children with spina bifida, putting them at increased risk for low self-esteem and impacting upon participation in home, school and leisure activities. However, little is known about children's experiences of these continence issues. OBJECTIVE This study explored the experiences of children and young people with spina bifida around continence issues, social participation and peer relationships, in order to identify potential areas of support healthcare professionals can provide. METHODS Children and youth aged 6-18 years with diagnoses of spina bifida and neurogenic bladder and their parents were invited to participate in semi-structured interviews. Descriptive thematic analysis was employed. RESULTS Eleven children (with a range of mobility levels, types of spina bifida and degrees of bladder control) and their parents participated in the study. Three broad themes were identified, which encompassed the following: (1) normal versus different; (2) independence, ownership and the road to continence; and (3) peer relationships and acceptance. DISCUSSION The experiences discussed by the children and parents in this study ranged from minimal impact of incontinence on their day-to-day living to significant social isolation and rejection. The stigma of incontinence was apparent in all interviews. Children and youth who were able to control their bladder with minimal accidents had greater independence and more opportunities for social participation. Healthcare professionals need to take into account that parents and their children may differ in attitudes and desires about the management of incontinence.
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Affiliation(s)
- N Fischer
- Department of Pediatrics, University of Calgary, AB, Canada
| | - P Church
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - J Lyons
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - A C McPherson
- Bloorview Research Institute, Toronto, ON, Canada.,Dalla Lana School of Public Health and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
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Kan C, Silverman P, Patel R, Lyons J. Risk of Radiation Pneumonitis in Node Positive Breast Cancer Patients Treated With Concurrent Paclitaxel. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.604] [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: 10/22/2022]
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Hussain S, Jackson R, Chauhan S, Ansari J, Huddart R, Harrold E, Power D, Lyons J, Wylie J, Vilarino-Varela M, Wilkinson D, McMenemin R, Pickering L, Faust G. 2632 VICTOR: Vinflunine in advanced metastatic transitional cell carcinoma of the urothelium (TCCU): A retrospective analysis of the use of Vinflunine in a multi-centre real life setting as second line chemotherapy through the free of charge programme (FOCP) for patients in the UK. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31449-6] [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: 11/26/2022]
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Hwang Y, Wu G, Feng J, Lyons J, Eng H, Wisniewski S, Hwang C, Sasso E, Segurado O, Moreland L. SAT0137 Disease Activity Measures Associate Differently with Demographics and Comorbidities in Patients with Rheumatoid Arthritis in Routine Practice Settings. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2805] [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: 11/04/2022]
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Hossain J, Du Y, Links J, Rahmim A, Karakatsanis N, Akhbardeh A, Lyons J, Frey EC. Estimation of dynamic time activity curves from dynamic cardiac SPECT imaging. Phys Med Biol 2015; 60:3193-208. [DOI: 10.1088/0031-9155/60/8/3193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Keer H, Smyth T, Courtin A, Hearn K, Lyons J, Wallis N, Oganesian A, Azab M. Combination of HSP90 inhibitor onalespib with crizotinib to treat or delay resistance in NSCLC: Preclinical and Clinical Investigations. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv081.6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Courtin A, Smyth A, Hearn K, Martins V, Lewis J, Thompson N, Lyons J, Wallis N. 518 The HSP90 inhibitor, AT13387, overcomes resistance to crizotinib and second generation ALK inhibitors. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70644-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Thompson C, Anandadas C, Liptrot T, Sanderson B, Lyons J, Stratford J, Tran A, Alam N, Livsey J, Wylie J, Elliott P, Logue J, Choudhury A. Tolerability of Neoadjuvant Chemotherapy and Concurrent Chemoradiation Therapy With Gemcitabine in Muscle Invasive Bladder Cancer: Physician and Patient-Reported Outcomes. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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