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Han J, Rolles M, Torabi F, Griffiths R, Bedston S, Akbari A, Burnett B, Lyons J, Greene G, Thomas R, Long T, Arnold C, Huws DW, Lawler M, Lyons RA. The impact of the COVID-19 pandemic on community prescription of opioid and antineuropathic analgesics for cancer patients in Wales, UK. Support Care Cancer 2023; 31:531. [PMID: 37606853 PMCID: PMC10444652 DOI: 10.1007/s00520-023-07944-8] [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: 02/07/2023] [Accepted: 07/12/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE Public health measures instituted at the onset of the COVID-19 pandemic in the UK in 2020 had profound effects on the cancer patient pathway. We hypothesise that this may have affected analgesic prescriptions for cancer patients in primary care. METHODS A whole-nation retrospective, observational study of opioid and antineuropathic analgesics prescribed in primary care for two cohorts of cancer patients in Wales, using linked anonymised data to evaluate the impact of the pandemic and variation between different demographic backgrounds. RESULTS We found a significant increase in strong opioid prescriptions during the pandemic for patients within their first 12 months of diagnosis with a common cancer (incidence rate ratio (IRR) 1.15, 95% CI: 1.12-1.18, p < 0.001 for strong opioids) and significant increases in strong opioid and antineuropathic prescriptions for patients in the last 3 months prior to a cancer-related death (IRR = 1.06, 95% CI: 1.04-1.07, p < 0.001 for strong opioids; IRR = 1.11, 95% CI: 1.08-1.14, p < 0.001 for antineuropathics). A spike in opioid prescriptions for patients diagnosed in Q2 2020 and those who died in Q2 2020 was observed and interpreted as stockpiling. More analgesics were prescribed in more deprived quintiles. This differential was less pronounced in patients towards the end of life, which we attribute to closer professional supervision. CONCLUSIONS We demonstrate significant changes to community analgesic prescriptions for cancer patients related to the UK pandemic and illustrate prescription patterns linked to patients' demographic background.
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Affiliation(s)
- Jun Han
- Population Data Science, Swansea University Medical School, Swansea, UK
- DATA-CAN, the UK's Health Data Research Hub for Cancer, London, UK
| | - Martin Rolles
- Population Data Science, Swansea University Medical School, Swansea, UK.
- South West Wales Cancer Centre, Swansea Bay University Health Board, Swansea, UK.
| | - Fatemeh Torabi
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Rowena Griffiths
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Stuart Bedston
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Swansea, UK
- DATA-CAN, the UK's Health Data Research Hub for Cancer, London, UK
| | - Bruce Burnett
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Jane Lyons
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Giles Greene
- Welsh Cancer Intelligence and Surveillance Unit, Public Health Wales, Cardiff, UK
| | - Rebecca Thomas
- Observatory and Cancer Analysis Team, Public Health Wales, Cardiff, UK
| | - Tamsin Long
- Observatory and Cancer Analysis Team, Public Health Wales, Cardiff, UK
| | - Cathy Arnold
- DATA-CAN, the UK's Health Data Research Hub for Cancer, London, UK
- Data Services, University of Leeds, Leeds, UK
| | - Dyfed Wyn Huws
- Welsh Cancer Intelligence and Surveillance Unit, Public Health Wales, Cardiff, UK
| | - Mark Lawler
- DATA-CAN, the UK's Health Data Research Hub for Cancer, London, UK
- Patrick G Johnston Centre for Cancer Research, Queens University Belfast, Belfast, UK
| | - Ronan A Lyons
- Population Data Science, Swansea University Medical School, Swansea, UK
- DATA-CAN, the UK's Health Data Research Hub for Cancer, London, UK
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Hollinghurst J, North L, Szakmany T, Pugh R, Davies GA, Sivakumaran S, Jarvis R, Rolles M, Pickrell WO, Akbari A, Davies G, Griffiths R, Lyons J, Torabi F, Fry R, Gravenor MB, Lyons RA. SARS-CoV-2 infection risk among 77,587 healthcare workers: a national observational longitudinal cohort study in Wales, United Kingdom, April to November 2020. J R Soc Med 2022; 115:467-478. [PMID: 35796183 PMCID: PMC9747896 DOI: 10.1177/01410768221107119] [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: 04/08/2021] [Accepted: 05/29/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To better understand the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among healthcare workers, leading to recommendations for the prioritisation of personal protective equipment, testing, training and vaccination. DESIGN Observational, longitudinal, national cohort study. SETTING Our cohort were secondary care (hospital-based) healthcare workers employed by NHS Wales (United Kingdom) organisations from 1 April 2020 to 30 November 2020. PARTICIPANTS We included 577,756 monthly observations among 77,587 healthcare workers. Using linked anonymised datasets, participants were grouped into 20 staff roles. Additionally, each role was deemed either patient-facing, non-patient-facing or undetermined. This was linked to individual demographic details and dates of positive SARS-CoV-2 PCR tests. MAIN OUTCOME MEASURES We used univariable and multivariable logistic regression models to determine odds ratios (ORs) for the risk of a positive SARS-CoV-2 PCR test. RESULTS Patient-facing healthcare workers were at the highest risk of SARS-CoV-2 infection with an adjusted OR (95% confidence interval [CI]) of 2.28 (95% CI 2.10-2.47). We found that after adjustment, foundation year doctors (OR 1.83 [95% CI 1.47-2.27]), healthcare support workers [OR 1.36 [95% CI 1.20-1.54]) and hospital nurses (OR 1.27 [95% CI 1.12-1.44]) were at the highest risk of infection among all staff groups. Younger healthcare workers and those living in more deprived areas were at a higher risk of infection. We also observed that infection rates varied over time and by organisation. CONCLUSIONS These findings have important policy implications for the prioritisation of vaccination, testing, training and personal protective equipment provision for patient-facing roles and the higher risk staff groups.
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Affiliation(s)
- Joe Hollinghurst
- Population Data Science and Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, Wales, United Kingdom, SA2 8PP
| | - Laura North
- Population Data Science and Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, Wales, United Kingdom, SA2 8PP
| | - Tamas Szakmany
- Critical Care Directorate, Grange University Hospital, Aneurin Bevan University Health Board, Llanyravon, Cwmbran, NP44 2XJ
| | - Richard Pugh
- Department of Anaesthesia, Intensive Care and Pain Medicine, Division of Population Medicine, Cardiff University, Heath Park Campus, Cardiff, CF14 4XN
| | - Gwyneth A Davies
- Population Data Science and Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, Wales, United Kingdom, SA2 8PP
| | - Shanya Sivakumaran
- Population Data Science and Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, Wales, United Kingdom, SA2 8PP
| | - Rebecca Jarvis
- Department of Anaesthetics, Glan Clwyd Hospital, Betsi Cadwaladr University Health Board
| | - Martin Rolles
- Digital Workforce, NHS Wales Shared Services Partnership
| | - W Owen Pickrell
- South West Wales Cancer Centre, Singleton Hospital, Swansea SA2 8QA
| | - Ashley Akbari
- Population Data Science and Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, Wales, United Kingdom, SA2 8PP
| | - Gareth Davies
- Population Data Science and Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, Wales, United Kingdom, SA2 8PP
| | - Rowena Griffiths
- Population Data Science and Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, Wales, United Kingdom, SA2 8PP
| | - Jane Lyons
- Population Data Science and Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, Wales, United Kingdom, SA2 8PP
| | - Fatemeh Torabi
- Population Data Science and Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, Wales, United Kingdom, SA2 8PP
| | - Richard Fry
- Population Data Science and Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, Wales, United Kingdom, SA2 8PP
| | - Mike B Gravenor
- Swansea University Medical School and Neurology Department, Morriston Hospital, Swansea Bay University Health Board
| | - Ronan A Lyons
- Population Data Science and Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, Wales, United Kingdom, SA2 8PP
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Han J, Akbari A, Torabi F, Griffiths R, Lyons J, Rolles M, Arnold C, Huws DW, Lawler M, Lyons R. Using population-scale medication data to evaluate the impact of the COVID-19 pandemic on the usage of analgesics by cancer patients. Int J Popul Data Sci 2022. [PMCID: PMC9645061 DOI: 10.23889/ijpds.v7i3.2108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Feeney L, Jain Y, Beasley M, Donnelly O, Kong A, Moleron R, Nallathambi C, Rolles M, Sanghera P, Tin A, Ulahannan D, Walter HS, Webster R, Metcalf R. Centralised RECIST Assessment and Clinical Outcomes with Lenvatinib Monotherapy in Recurrent and Metastatic Adenoid Cystic Carcinoma. Cancers (Basel) 2021; 13:cancers13174336. [PMID: 34503145 PMCID: PMC8431195 DOI: 10.3390/cancers13174336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 11/24/2022] Open
Abstract
Simple Summary Adenoid cystic carcinoma (ACC) is a rare cancer of the head and neck. Initial treatment may involve surgery and/or radiotherapy with the aim of removing the cancer and preventing spread to other parts of the body. In patients in whom ACC has recurred or spread, systemic therapies such as chemotherapy or immunotherapy have been shown to have minimal benefit and there are currently no recommended standard systemic treatment options. More recently, the targeted therapy lenvatinib has shown promising results in treating ACC patients. We aimed to summarise the real-world experience of lenvatinib use in ACC patients in the UK and found that although some patients obtained clinical benefit, there were no significant responses on radiological imaging by centralized assessment. Abstract Adenoid cystic carcinoma (ACC) is a rare cancer of secretory glands. Recurrent or metastatic (R/M) ACC is generally considered resistant to cytotoxic chemotherapy. Recent phase II studies have reported improved objective response rates (ORR) with the use of the multi-kinase inhibitor lenvatinib. We sought to evaluate real-world experience of R/M ACC patients treated with lenvatinib monotherapy within the UK National Health Service (NHS) to determine the response rates by Response Evaluation Criteria of Solid Tumour (RECIST) and clinical outcomes. Twenty-three R/M ACC patients from eleven cancer centres were included. All treatment assessments for clinical decision making related to drug therapy were undertaken at the local oncology centre. Central radiology review was performed by an independent clinical trial radiologist and blinded to the clinical decision making. In contrast to previously reported ORR of 12–15%, complete or partial response was not observed in any patients. Eleven patients (52.4%) had stable disease and 5 patients (23.8%) had progression of disease as the best overall response. The median time on treatment was 4 months and the median survival from discontinuation was 1 month. The median PFS and OS from treatment initiation were 4.5 months and 12 months respectively. Multicentre collaborative studies such as this are required to evaluate rare cancers with no recommended standard of care therapy and variable disease courses.
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Affiliation(s)
- Laura Feeney
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK; (L.F.); (Y.J.)
| | - Yatin Jain
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK; (L.F.); (Y.J.)
| | - Matthew Beasley
- Department of Oncology, University Hospitals Bristol NHS Foundation Trust, Bristol BS1 3NU, UK;
| | - Oliver Donnelly
- Department of Oncology, Portsmouth Hospitals University NHS Trust, Portsmouth PO6 3LY, UK;
| | - Anthony Kong
- Department of Oncology, Guys’ Campus, King’s College London, London SE5 9RS, UK;
- Department of Oncology, University Hospital Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK;
| | - Rafael Moleron
- Department of Oncology, Aberdeen Royal Infirmary NHS Grampian, Aberdeen AB25 5ZN, UK;
| | - Chandran Nallathambi
- Department of Oncology, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK; (C.N.); (D.U.)
| | - Martin Rolles
- Department of Oncology, Swansea Bay University Health Board, Port Talbot SA12 7BR, UK;
| | - Paul Sanghera
- Department of Oncology, University Hospital Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK;
| | - Aung Tin
- Department of Oncology, The James Cook Cancer Institute, The James Cook University Hospital, Middlesbrough TS4 3BW, UK;
| | - Danny Ulahannan
- Department of Oncology, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK; (C.N.); (D.U.)
| | - Harriet S. Walter
- Department of Oncology, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK;
| | - Richard Webster
- Department of Oncology, Velindre University NHS Trust, Cardiff CF15 7QZ, UK;
| | - Robert Metcalf
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK; (L.F.); (Y.J.)
- Correspondence: ; Tel.: +44-161-956-1167
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Dillon M, Adam Y, Pietrzak P, Rolles M, Bertelli G. Evolution of the Post-Surgical Breast Cancer Pathway for Adjuvant Treatments Following Introduction of Genomic Profiling for Selected Women with Hormone Receptor Positive, HER2 Negative Disease. Eur J Surg Oncol 2020. [DOI: 10.1016/j.ejso.2019.11.080] [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] Open
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Mehanna H, Robinson M, Hartley A, Kong A, Foran B, Fulton-Lieuw T, Dalby M, Mistry P, Sen M, O'Toole L, Al Booz H, Dyker K, Moleron R, Whitaker S, Brennan S, Cook A, Griffin M, Aynsley E, Rolles M, De Winton E, Chan A, Srinivasan D, Nixon I, Grumett J, Leemans CR, Buter J, Henderson J, Harrington K, McConkey C, Gray A, Dunn J. Radiotherapy plus cisplatin or cetuximab in low-risk human papillomavirus-positive oropharyngeal cancer (De-ESCALaTE HPV): an open-label randomised controlled phase 3 trial. Lancet 2019; 393:51-60. [PMID: 30449623 PMCID: PMC6319250 DOI: 10.1016/s0140-6736(18)32752-1] [Citation(s) in RCA: 586] [Impact Index Per Article: 117.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 10/17/2018] [Accepted: 10/18/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND The incidence of human papillomavirus (HPV)-positive oropharyngeal cancer, a disease affecting younger patients, is rapidly increasing. Cetuximab, an epidermal growth factor receptor inhibitor, has been proposed for treatment de-escalation in this setting to reduce the toxicity of standard cisplatin treatment, but no randomised evidence exists for the efficacy of this strategy. METHODS We did an open-label randomised controlled phase 3 trial at 32 head and neck treatment centres in Ireland, the Netherlands, and the UK, in patients aged 18 years or older with HPV-positive low-risk oropharyngeal cancer (non-smokers or lifetime smokers with a smoking history of <10 pack-years). Eligible patients were randomly assigned (1:1) to receive, in addition to radiotherapy (70 Gy in 35 fractions), either intravenous cisplatin (100 mg/m2 on days 1, 22, and 43 of radiotherapy) or intravenous cetuximab (400 mg/m2 loading dose followed by seven weekly infusions of 250 mg/m2). The primary outcome was overall severe (grade 3-5) toxicity events at 24 months from the end of treatment. The primary outcome was assessed by intention-to-treat and per-protocol analyses. This trial is registered with the ISRCTN registry, number ISRCTN33522080. FINDINGS Between Nov 12, 2012, and Oct 1, 2016, 334 patients were recruited (166 in the cisplatin group and 168 in the cetuximab group). Overall (acute and late) severe (grade 3-5) toxicity did not differ significantly between treatment groups at 24 months (mean number of events per patient 4·8 [95% CI 4·2-5·4] with cisplatin vs 4·8 [4·2-5·4] with cetuximab; p=0·98). At 24 months, overall all-grade toxicity did not differ significantly either (mean number of events per patient 29·2 [95% CI 27·3-31·0] with cisplatin vs 30·1 [28·3-31·9] with cetuximab; p=0·49). However, there was a significant difference between cisplatin and cetuximab in 2-year overall survival (97·5% vs 89·4%, hazard ratio 5·0 [95% CI 1·7-14·7]; p=0·001) and 2-year recurrence (6·0% vs 16·1%, 3·4 [1·6-7·2]; p=0·0007). INTERPRETATION Compared with the standard cisplatin regimen, cetuximab showed no benefit in terms of reduced toxicity, but instead showed significant detriment in terms of tumour control. Cisplatin and radiotherapy should be used as the standard of care for HPV-positive low-risk patients who are able to tolerate cisplatin. FUNDING Cancer Research UK.
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Affiliation(s)
- Hisham Mehanna
- Institute for Head and Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, UK.
| | | | | | - Anthony Kong
- Institute for Head and Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, UK
| | | | - Tessa Fulton-Lieuw
- Institute for Head and Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, UK
| | | | | | - Mehmet Sen
- St James's Institute of Oncology, Leeds, UK
| | - Lorcan O'Toole
- Queen's Centre for Oncology, Castle Hill Hospital, Cottingham, UK
| | - Hoda Al Booz
- Bristol Haematology and Oncology Centre, Bristol, UK
| | | | | | | | - Sinead Brennan
- St Luke's Hospital, Cancer Trials Ireland, and St Luke's Institute of Cancer Research, Dublin, Ireland
| | | | | | | | - Martin Rolles
- Abertawe Bro Morgannwg University Health Board, Port Talbot, UK
| | - Emma De Winton
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Andrew Chan
- University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | - Ioanna Nixon
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | | | - Jan Buter
- VU University Medical Centre, Amsterdam, Netherlands
| | | | - Kevin Harrington
- Institute of Cancer Research and Royal Marsden Hospital, London UK
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Velikova G, Williams LJ, Willis S, Dixon JM, Loncaster J, Hatton M, Clarke J, Kunkler IH, Russell NS, Alhasso A, Adamson D, Algurafi H, Allerton R, Anandadas C, Bahl A, Barraclough L, Barrett-Lee P, Barthakur U, Bedi C, Beresford M, Bishop J, Blackman G, Bliss P, Bloomfield D, Blunt M, Branson T, Brazil L, Brunt A, Chakrabarti A, Chittalie A, Churn M, Clarke J, Cleator S, Crellin P, Danwata F, De-Silva-Minor S, Dhadda A, Eicholz A, Fernando I, Forrest J, Fraser J, Geropantas K, Goodman A, Grieve R, Griffin M, Hadaki M, Hall A, Hatton M, Hicks J, Hignett S, Hogg M, Jyothirmayi R, Khan M, Kumar S, Lawton P, Lee D, Lewinski C, Lim C, Locke I, Loncaster J, Lumsden G, Lupton S, Magee B, Marshall J, Masinghe S, McGregor C, McLennan M, Memtsa P, Milanovic D, Misra V, Mithal N, Mukesh MB, Neal A, Needleman S, Persic M, Quigley M, Raj S, Riddle P, Ritchie D, Roberts F, Robson P, Roe H, Rolles M, Shah N, Sharma R, Sherwin E, Simmonds P, Skailles G, Skaria S, Soe W, Sripadam R, Stevens A, Stockdale A, Storey N, Storey N, Syndikus I, Thorp N, Thorp N, Upadhyay S, Varughese M, Walji N, Welch R, Wells T, Wolstenholme V, Wolstenholme V, Woodings P, Yuille F. Quality of life after postmastectomy radiotherapy in patients with intermediate-risk breast cancer (SUPREMO): 2-year follow-up results of a randomised controlled trial. Lancet Oncol 2018; 19:1516-1529. [DOI: 10.1016/s1470-2045(18)30515-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/29/2018] [Accepted: 07/02/2018] [Indexed: 11/12/2022]
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Griffiths R, Akbari A, Huws D, Lyons R, Rolles M, Vass J. Improving the quality of care pathways for sarcoma patients and the advantages of using WCISU’s (Welsh Cancer Intelligence Surveillance Unit) national cancer registry. Int J Popul Data Sci 2018. [DOI: 10.23889/ijpds.v3i4.773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
IntroductionSoft Tissue Sarcoma (STS) diagnosis is difficult due to its nature and the variability of its occurrence on the body. To improve patient outcomes a better understanding was needed of the care pathways experienced by the patient from initial presentation to final treatment.
Objectives and ApproachSeveral items of information are necessary, within the data, to identify a care pathway. A correct STS diagnosis, a presentation date or first investigation date, a diagnosis date and any subsequent treatment dates. Identifying cases in hospital data, using International Classification of Diseases (ICD10) codes - C40, C41, C47 and C49 - based on cancer site - can miss cases and cause difficulties when trying to distinguish the difference between the investigation and treatment stages. Having access to WCISU’s national cancer registry, proved advantageous and enabled the routine data to be validated.
ResultsAttempts to identify differences between investigative and treatment procedures using the procedure codes available in hospital data was unhelpful due to variations in coding.
However, WCISU’s national cancer registry records all cases of cancer diagnosed in Wales using both ICD10 and International Classification of Diseases for Oncology codes to record cancer morphology. In addition, it records the date of diagnosis and treatment start dates. Using the cancer registry it was possible to cross-check the cases extracted from the hospital data and identify the diagnosis and treatment dates. By matching the treatment dates back to the hospital data it then became possible to analyse the procedure codes to see how many treatments were being delivered, the type of treatment and the periods covered.
Conclusion/ImplicationsOnce accurate diagnosis and treatments dates were identified, it was possible to drill further into the hospital data to see the finer detail of the procedures the patient received. Utilising independent data sources made it possible to develop an enriched view of patient care pathways from diagnosis through to treatment.
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Moe M, Durrani S, Bertelli G, Pudney D, Rolles M, Askill C, Wagstaff J, Vigneswaran V, Rowley K, Parker K, Hatcher O, Phan M, Gwynne S, Banner R, Thayabaran D, Saiyed A, Taylor R. Er, Pr & Her2 Expression and Survival of Breast Cancer Patients with Brain Metastases (Brm) Treated with Whole Brain Radiotherapy (Wbrt) +/- Systemic Therapy - Single Centre Experience. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu329.15] [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: 11/13/2022] Open
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Holt S, Bertelli G, Humphreys I, Valentine W, Durrani S, Pudney D, Rolles M, Moe M, Khawaja S, Sharaiha Y, Brinkworth E, Whelan S, Jones S, Bennett H, Phillips CJ. A decision impact, decision conflict and economic assessment of routine Oncotype DX testing of 146 women with node-negative or pNImi, ER-positive breast cancer in the U.K. Br J Cancer 2013; 108:2250-8. [PMID: 23695023 PMCID: PMC3681004 DOI: 10.1038/bjc.2013.207] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [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: 12/27/2022] Open
Abstract
Background: Tumour gene expression analysis is useful in predicting adjuvant chemotherapy benefit in early breast cancer patients. This study aims to examine the implications of routine Oncotype DX testing in the UK. Methods: Women with oestrogen receptor positive (ER+), pNO or pN1mi breast cancer were assessed for adjuvant chemotherapy and subsequently offered Oncotype DX testing, with changes in chemotherapy decisions recorded. A subset of patients completed questionnaires about their uncertainties regarding chemotherapy decisions pre- and post-testing. All patients were asked to complete a diary of medical interactions over the next 6 months, from which economic data were extracted to model the cost-effectiveness of testing. Results: Oncotype DX testing resulted in changes in chemotherapy decisions in 38 of 142 (26.8%) women, with 26 of 57 (45.6%) spared chemotherapy and 12 of 85 (14.1%) requiring chemotherapy when not initially recommended (9.9% reduction overall). Decision conflict analysis showed that Oncotype DX testing increased patients' confidence in treatment decision making. Economic analysis showed that routine Oncotype DX testing costs £6232 per quality-adjusted life year gained. Conclusion: Oncotype DX decreased chemotherapy use and increased confidence in treatment decision making in patients with ER+ early-stage breast cancer. Based on these findings, Oncotype DX is cost-effective in the UK setting.
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Affiliation(s)
- S Holt
- Department of Breast Surgery, Prince Philip Hospital, Llanelli, Wales SA14 8QF, UK.
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Evans M, Newcombe R, Fiander A, Powell J, Rolles M, Thavaraj S, Robinson M, Powell N. Human Papillomavirus-associated oropharyngeal cancer: an observational study of diagnosis, prevalence and prognosis in a UK population. BMC Cancer 2013; 13:220. [PMID: 23634887 PMCID: PMC3644265 DOI: 10.1186/1471-2407-13-220] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [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: 01/21/2013] [Accepted: 04/25/2013] [Indexed: 11/18/2022] Open
Abstract
Background The incidence of Human Papillomavirus (HPV) associated oropharyngeal cancer (OPC) is increasing. HPV-associated OPC appear to have better prognosis than HPV-negative OPC. The aim of this study was to robustly determine the prevalence of HPV-positive OPC in an unselected UK population and correlate HPV positivity with clinical outcome. Methods HPV testing by GP5+/6+ PCR, In Situ Hybridisation (ISH) and p16 immunohistochemistry (IHC) was performed on 138 OPCs diagnosed in South Wales (UK) between 2001–06. Kaplan-Meier analysis was used to correlate HPV status with clinical outcome. Results Using a composite definition of HPV positivity (HPV DNA and p16 overexpression), HPV was detected in 46/83 (55%) samples where DNA quality was assured. Five year overall survival was 75.4% (95% CI: 65.2 to 85.5) in HPV-positives vs 25.3% (95% CI: 14.2 to 36.4) in HPV negatives, corresponding to a 78% reduction in death rate (HR 0.22, p < 0.001). HPV-positives had less locoregional recurrence but second HPV-positive Head and Neck primaries occurred. Poor quality DNA in fixed pathological specimens reduced both HPV prevalence estimates and the prognostic utility of DNA-based HPV testing methods. As a single marker, p16 was least affected by sample quality and correlated well with prognosis, although was not sufficient on its own for accurate HPV prevalence reporting. Conclusions This study highlights the significant burden of OPC associated with HPV infection. HPV positive cases are clinically distinct from other OPC, and are associated with significantly better clinical outcomes. A composite definition of HPV positivity should be used for accurate prevalence reporting and up-front DNA quality assessment is recommended for any DNA-based HPV detection strategy.
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Affiliation(s)
- Mererid Evans
- Velindre Cancer Centre, Whitchurch, Cardiff, CF14 2TL, UK
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12
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Caley A, Bertelli G, Rolles M, Wagstaff J, Moe M, Pudney D. 40 Adjuvant taxane chemotherapy is associated with a significant risk of febrile neutropenia. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)70071-9] [Citation(s) in RCA: 2] [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: 10/19/2022] Open
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13
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Shaffer R, Tyldesley S, Rolles M, Chia S, Mohamed I. Acute cardiotoxicity with concurrent trastuzumab and radiotherapy including internal mammary chain nodes: A retrospective single-institution study. Radiother Oncol 2009; 90:122-6. [DOI: 10.1016/j.radonc.2008.09.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Revised: 08/20/2008] [Accepted: 09/07/2008] [Indexed: 11/26/2022]
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14
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Milette MP, Rolles M, Wu J, Vellani R, Welsh M, Vollans E, Otto K. 7 Rotating aperture optimization: The dosimetric and delivery efficiencies of a novel radiotherapy technique for the treatment of recurrent nasopharyngeal cancer. Radiother Oncol 2006. [DOI: 10.1016/s0167-8140(06)80748-6] [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: 10/23/2022]
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15
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16
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Milette M, Rolles M, Otto K. TU-C-224A-06: Exploiting the Full Potential of MLC Based Aperture Optimization Through Collimator Rotation. Med Phys 2006. [DOI: 10.1118/1.2241530] [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: 11/07/2022] Open
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17
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Rolles M. Early use of dexamethasone in malignant spinal-cord compression: a missed opportunity? Clin Oncol (R Coll Radiol) 2005; 17:129-30. [PMID: 15830581 DOI: 10.1016/j.clon.2004.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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