1
|
Newton C, Graham R, Liberale V, Burnell M, Menon U, Mould T, Olaitan A, Macdonald N, Widschwendter M, Doufekas K, McCormack M, Mitra A, Arora R, Manchanda R. Outcomes of minimal access retroperitoneal para-aortic lymphadenectomy in patients with locally advanced cervical cancer. J OBSTET GYNAECOL 2024; 44:2344529. [PMID: 38708782 DOI: 10.1080/01443615.2024.2344529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/20/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND To evaluate outcomes of laparoscopic retroperitoneal para-aortic lymphadenectomy for stage 1b3-3b cervical cancer. METHODS Pathology databases searched for all para-aortic lymphadenectomy cases 2005-2016. Descriptive statistics were used to analyse baseline characteristics, cox models for treatment affect after accounting for variables, and Kaplan Meier curves for survival (STATA v15). RESULTS 191 patients had 1b3-3b cervical cancer of which 110 patients had Para-aortic lymphadenectomy. 8 (7.3%) patients stage 1b3, 82 (74.6%) stage 2b, and 20 (18.1%) stage 3b cervical cancer. Mean lymph node count 11.7 (SD7.6). The intra-operative and post-operative 30 day complication rates were 8.8% (CI: 4.3%, 15.7%) and 5.3% (CI: 1.9%, 11.2%) respectively.Para-aortic nodes were apparently positive on CT/MRI in 5/110 (5%) cases. Cancer was found in 10 (8.9%, CI: 4.3%, 15.7%) cases on histology, all received extended field radiotherapy. Only 2 were identified on pre-operative CT/MRI imaging. 3 of 10 suspected node-positive cases on CT/MRI had negative histology. Para-aortic lymphadenectomy led to alteration in staging and radiotherapy management in 8 (8%, CI: 3.7%, 14.6%) patients. Mean overall survival 42.81 months (SD = 31.79 months). Survival was significantly higher for women undergoing PAN (50.57 (SD 30.7) months) compared to those who didn't (31.27 (SD 32.5) months). CONCLUSION Laparoscopic retroperitoneal para-aortic lymphadenectomy is an acceptable procedure which can guide treatment in women with locally advanced cervical cancer.
Collapse
Affiliation(s)
- Claire Newton
- Gynaecology Oncology, University Hospitals Bristol NHS Foundation trust, Bristol, UK
- University of Bristol, Bristol, UK
- University College London Hospital NHS Foundation Trust, London, UK
| | - Radha Graham
- University College London Hospital NHS Foundation Trust, London, UK
| | - Viola Liberale
- University College London Hospital NHS Foundation Trust, London, UK
| | - Matthew Burnell
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Usha Menon
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Tim Mould
- University College London Hospital NHS Foundation Trust, London, UK
| | - Adeola Olaitan
- University College London Hospital NHS Foundation Trust, London, UK
| | - Nicola Macdonald
- University College London Hospital NHS Foundation Trust, London, UK
| | - Martin Widschwendter
- University College London Hospital NHS Foundation Trust, London, UK
- European Translational Oncology Prevention and Screening Institute, Leopold-Franzens-University of Innsbruck, Austria
| | - Kostas Doufekas
- University College London Hospital NHS Foundation Trust, London, UK
| | - Mary McCormack
- University College London Hospital NHS Foundation Trust, London, UK
| | - Anita Mitra
- University College London Hospital NHS Foundation Trust, London, UK
| | - Rupali Arora
- University College London Hospital NHS Foundation Trust, London, UK
| | - Ranjit Manchanda
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- The Royal London hospital, Barts Health NHS trust, London, UK
- Distinguished Infosys Chair in Oncology, All India institute of medical sciences (AIIMS), New Delhi, India
| |
Collapse
|
2
|
Gonzalez-Robles C, Bartlett M, Burnell M, Clarke CS, Haar S, Hu MT, Huxford B, Jha A, Lawton M, Noyce A, Piccini P, Pushparatnam K, Rochester L, Siu C, van Wamelen D, Williams-Gray CH, Zeissler ML, Zetterberg H, Carroll CB, Foltynie T, Weil RS, Schrag A. Embedding Patient Input in Outcome Measures for Long-Term Disease-Modifying Parkinson Disease Trials. Mov Disord 2024; 39:433-438. [PMID: 38140767 DOI: 10.1002/mds.29691] [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: 06/22/2023] [Revised: 10/30/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Clinical trials of disease-modifying therapies in PD require valid and responsive primary outcome measures that are relevant to patients. OBJECTIVES The objective is to select a patient-centered primary outcome measure for disease-modification trials over three or more years. METHODS Experts in Parkinson's disease (PD), statistics, and health economics and patient and public involvement and engagement (PPIE) representatives reviewed and discussed potential outcome measures. A larger PPIE group provided input on their key considerations for such an endpoint. Feasibility, clinimetric properties, and relevance to patients were assessed and synthesized. RESULTS Although initial considerations favored the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part III in Off, feasibility, PPIE input, and clinimetric properties supported the MDS-UPDRS Part II. However, PPIE input also highlighted the importance of nonmotor symptoms, especially in the longer term, leading to the selection of the MDS-UPDRS Parts I + II sum score. CONCLUSIONS The MDS-UPDRS Parts I + II sum score was chosen as the primary outcome for large 3-year disease-modification trials. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Cristina Gonzalez-Robles
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | | | - Matthew Burnell
- Medical Research Council Clinical Trials Unit, University College London, London, United Kingdom
| | - Caroline S Clarke
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Shlomi Haar
- Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Michele T Hu
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Brook Huxford
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Ashwani Jha
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Michael Lawton
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Alastair Noyce
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Paola Piccini
- Department of Brain Sciences, Imperial College London, London, United Kingdom
| | | | - Lynn Rochester
- Translational and Clinical Research Institute Clinical Ageing Research Unit, Newcastle University, Newcastle, United Kingdom
| | - Carroll Siu
- Expert by experience, Canterbury, United Kingdom
| | - Daniel van Wamelen
- Department of Neurology, Centre of Expertise for Parkinson and Movement Disorders, King's College London, London, United Kingdom
| | | | | | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - Camille B Carroll
- Translational and Clinical Research Institute Clinical Ageing Research Unit, Newcastle University, Newcastle, United Kingdom
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Thomas Foltynie
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Rimona S Weil
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Dementia Research Centre, Movement Disorders Centre, University College London, London, United Kingdom
| | - Anette Schrag
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| |
Collapse
|
3
|
Dilley J, Gentry-Maharaj A, Ryan A, Burnell M, Manchanda R, Kalsi J, Singh N, Woolas R, Sharma A, Williamson K, Mould T, Fallowfield L, Campbell S, Skates SJ, McGuire A, Parmar M, Jacobs I, Menon U. Ovarian cancer symptoms in pre-clinical invasive epithelial ovarian cancer - An exploratory analysis nested within the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). Gynecol Oncol 2023; 179:123-130. [PMID: 37980767 DOI: 10.1016/j.ygyno.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVE UKCTOCS provides an opportunity to explore symptoms in preclinical invasive epithelial ovarian cancer (iEOC). We report on symptoms in women with pre-clinical (screen-detected) cancers (PC) compared to clinically diagnosed (CD) cancers. METHODS In UKCTOCS, 202638 postmenopausal women, aged 50-74 were randomly allocated (April 17, 2001-September 29, 2005) 2:1:1 to no screening or annual screening till Dec 31,2011, using a multimodal or ultrasound strategy. Follow-up was through national registries. An outcomes committee adjudicated on OC diagnosis, histotype, stage. Eligible women were those diagnosed with iEOC at primary censorship (Dec 31, 2014). Symptom details were extracted from trial clinical-assessment forms and medical records. Descriptive statistics were used to compare symptoms in PC versus CD women with early (I/II) and advanced (III/IV/unable to stage) stage high-grade-serous (HGSC) cancer. ISRCTN-22488978; ClinicalTrials.gov-NCT00058032. RESULTS 1133 (286PC; 847CD) women developed iEOC. Median age (years) at diagnosis was earlier in PC compared to CD (66.8PC, 68.7CD, p = 0.0001) group. In the PC group, 48% (112/234; 90%, 660/730CD) reported symptoms when questioned. Half PC (50%, 13/26PC; 36%, 29/80CD; p = 0.213) women with symptomatic HGSC had >1symptom, with abdominal symptoms most common, both in early (62%, 16/26, PC; 53% 42/80, CD; p = 0.421) and advanced (57%, 49/86, PC; 74%, 431/580, CD; p = 0.001) stages. In symptomatic early-stage HGSC, compared to CD, PC women reported more gastrointestinal (change in bowel habits and dyspepsia) (35%, 9/26PC; 9%, 7/80CD; p = 0.001) and systemic (mostly lethargy/tiredness) (27%, 7/26PC; 9%, 7/80CD; p = 0.017) symptoms. CONCLUSIONS Our findings, add to the growing evidence, that we should reconsider what constitutes alert symptoms for early tubo-ovarian cancer. We need a more nuanced complex of key symptoms which is then evaluated and refined in a prospective trial.
Collapse
Affiliation(s)
- James Dilley
- Department of Gynaecological Oncology, Barts Health NHS Trust, London, UK
| | - Aleksandra Gentry-Maharaj
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, London, UK; Department of Women's Cancer, Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Andy Ryan
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, London, UK
| | - Matthew Burnell
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, London, UK
| | - Ranjit Manchanda
- Department of Gynaecological Oncology, Barts Health NHS Trust, London, UK; Wolfson Institute of Population Health, CRUK Barts Cancer Centre, Queen Mary University of London, London, UK
| | - Jatinderpal Kalsi
- Department of Women's Cancer, Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Naveena Singh
- Department of Cellular Pathology, Barts Health NHS Trust, London, UK
| | - Robert Woolas
- Department of Gynaecological Oncology, Queen Alexandra Hospital, Portsmouth, UK
| | - Aarti Sharma
- Department of Obstetrics and Gynaecology, University Hospital of Wales, Cardiff, UK
| | - Karin Williamson
- Department of Gynaecological Oncology, Nottingham University Hospitals, Nottingham, UK
| | - Tim Mould
- Department of Gynaecological Oncology, University College London Hospitals NHS Trust, London, UK
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Sussex, UK
| | | | - Steven J Skates
- Massachusetts General Hospital and Harvard Medical School, Harvard, MA, USA
| | | | - Mahesh Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, London, UK
| | - Ian Jacobs
- Department of Women's Cancer, Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Usha Menon
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, London, UK.
| |
Collapse
|
4
|
Calvert AH, Newell DR, Gumbrell LA, O'Reilly S, Burnell M, Boxall FE, Siddik ZH, Judson IR, Gore ME, Wiltshaw E. Carboplatin dosage: prospective evaluation of a simple formula based on renal function. J Clin Oncol 2023; 41:4453-4454. [PMID: 37757592 DOI: 10.1200/jco.22.02768] [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: 09/29/2023] Open
Abstract
A dosage formula has been derived from a retrospective analysis of carboplatin pharmacokinetics in 18 patients with pretreatment glomerular filtration rates (GFR) in the range of 33 to 136 mL/min. Carboplatin plasma clearance was linearly related to GFR (r = 0.85, P less than .00001) and rearrangements of the equation describing the correlation gave the dosage formula dose (mg) = target area under the free carboplatin plasma concentration versus time curve (AUC) x (1.2 x GFR + 20). In a prospective clinical and pharmacokinetic study the formula was used to determine the dose required to treat 31 patients (GFR range, 33 to 135 mL/min) with 40 courses of carboplatin. The target AUC was escalated from 3 to 8 mg carboplatin/mL/min. Over this AUC range the formula accurately predicted the observed AUC (observed/predicted ratio 1.24 +/- 0.11, r = 0.886) and using these additional data, the formula was refined. Dose (mg) = target AUC x (GFR + 25) is now the recommended formula. AUC values of 4 to 6 and 6 to 8 mg/mL. min gave rise to manageable hematological toxicity in previously treated and untreated patients, respectively, and hence target AUC values of 5 and 7 mg/mL min are recommended for single-agent carboplatin in these patient groups. Pharmacokinetic modeling demonstrated that the formula was reasonably accurate regardless of whether a one- or two-compartment model most accurately described carboplatin pharmacokinetics, assuming that body size did not influence nonrenal clearance. The validity of this assumption was demonstrated in 13 patients where no correlation between surface area and nonrenal clearance was found (r = .31, P = .30). Therefore, the formula provides a simple and consistent method of determining carboplatin dose in adults. Since the measure of carboplatin exposure in the formula is AUC, and not toxicity, it will not be influenced by previous or concurrent myelosuppressive therapy or supportive measures. The formula is therefore applicable to combination and high-dose studies as well as conventional single-agent therapy, although the target AUC for carboplatin will need to be redefined for combination chemotherapy.
Collapse
|
5
|
Menon U, Gentry-Maharaj A, Burnell M, Ryan A, Singh N, Manchanda R, Kalsi JK, Woolas R, Arora R, Casey L, Dawnay A, Sharma A, Williamson K, Apostolidou S, Fallowfield L, McGuire AJ, Campbell S, Skates SJ, Jacobs IJ, Parmar MKB. Tumour stage, treatment, and survival of women with high-grade serous tubo-ovarian cancer in UKCTOCS: an exploratory analysis of a randomised controlled trial. Lancet Oncol 2023; 24:1018-1028. [PMID: 37657461 DOI: 10.1016/s1470-2045(23)00335-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND In UKCTOCS, there was a decrease in the diagnosis of advanced stage tubo-ovarian cancer but no reduction in deaths in the multimodal screening group compared with the no screening group. Therefore, we did exploratory analyses of patients with high-grade serous ovarian cancer to understand the reason for the discrepancy. METHODS UKCTOCS was a 13-centre randomised controlled trial of screening postmenopausal women from the general population, aged 50-74 years, with intact ovaries. The trial management system randomly allocated (2:1:1) eligible participants (recruited from April 17, 2001, to Sept 29, 2005) in blocks of 32 using computer generated random numbers to no screening or annual screening (multimodal screening or ultrasound screening) until Dec 31, 2011. Follow-up was through national registries until June 30, 2020. An outcome review committee, masked to randomisation group, adjudicated on ovarian cancer diagnosis, histotype, stage, and cause of death. In this study, analyses were intention-to-screen comparisons of women with high-grade serous cancer at censorship (Dec 31, 2014) in multimodal screening versus no screening, using descriptive statistics for stage and treatment endpoints, and the Versatile test for survival from randomisation. This trial is registered with the ISRCTN Registry, 22488978, and ClinicalTrials.gov, NCT00058032. FINDINGS 202 562 eligible women were recruited (50 625 multimodal screening; 50 623 ultrasound screening; 101 314 no screening). 259 (0·5%) of 50 625 participants in the multimodal screening group and 520 (0·5%) of 101 314 in the no screening group were diagnosed with high-grade serous cancer. In the multimodal screening group compared with the no screening group, fewer were diagnosed with advanced stage disease (195 [75%] of 259 vs 446 [86%] of 520; p=0·0003), more had primary surgery (158 [61%] vs 219 [42%]; p<0·0001), more had zero residual disease following debulking surgery (119 [46%] vs 157 [30%]; p<0·0001), and more received treatment including both surgery and chemotherapy (192 [74%] vs 331 [64%]; p=0·0032). There was no difference in the first-line combination chemotherapy rate (142 [55%] vs 293 [56%]; p=0·69). Median follow-up from randomisation of 779 women with high-grade serous cancer in the multimodal and no screening groups was 9·51 years (IQR 6·04-13·00). At censorship (June 30, 2020), survival from randomisation was longer in women with high-grade serous cancer in the multimodal screening group than in the no screening group with absolute difference in survival of 6·9% (95% CI 0·4-13·0; p=0·042) at 18 years (21% [95% CI 15·6-26·2] vs 14% [95% CI 10·5-17·4]). INTERPRETATION To our knowledge, this is the first evidence that screening can detect high-grade serous cancer earlier and lead to improved short-term treatment outcomes compared with no screening. The potential survival benefit for women with high-grade serous cancer was small, most likely due to only modest gains in early detection and treatment improvement, and tumour biology. The cumulative results of the trial suggest that surrogate endpoints for disease-specific mortality should not currently be used in screening trials for ovarian cancer. FUNDING National Institute for Health Research, Medical Research Council, Cancer Research UK, The Eve Appeal.
Collapse
Affiliation(s)
- Usha Menon
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK.
| | - Aleksandra Gentry-Maharaj
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK; Department of Women's Cancer, Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Matthew Burnell
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Andy Ryan
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Naveena Singh
- Department of Cellular Pathology, Barts Health NHS Trust, London, UK
| | - Ranjit Manchanda
- Department of Gynaecological Oncology, Barts Health NHS Trust, London, UK; Wolfson Institute of Population Health, CRUK Barts Cancer Centre, Queen Mary University of London, London, UK
| | - Jatinderpal K Kalsi
- AGE Research Unit, School of Public Health Imperial College London, London, UK
| | - Robert Woolas
- Department of Gynaecological Oncology, Queen Alexandra Hospital, Portsmouth, UK
| | - Rupali Arora
- Department of Cellular Pathology, University College London Hospitals NHS Trust, London, UK
| | - Laura Casey
- Department of Cellular Pathology, Barts Health NHS Trust, London, UK
| | - Anne Dawnay
- Department of Clinical Biochemistry, Barts Health NHS Trust, London, UK
| | - Aarti Sharma
- Department of Obstetrics and Gynaecology, University Hospital of Wales, Cardiff, UK
| | - Karin Williamson
- Department of Gynaecological Oncology, Nottingham University Hospitals, Nottingham, UK
| | - Sophia Apostolidou
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | | | | | - Steven J Skates
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ian J Jacobs
- Department of Women's Cancer, Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Mahesh K B Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| |
Collapse
|
6
|
Menon U, Gentry-Maharaj A, Burnell M, Apostolidou S, Ryan A, Kalsi JK, Singh N, Fallowfield L, McGuire AJ, Campbell S, Skates SJ, Dawnay A, Parmar M, Jacobs IJ. Insights from UKCTOCS for design, conduct and analyses of large randomised controlled trials. Health Technol Assess 2023:1-38. [PMID: 37843101 PMCID: PMC10591208 DOI: 10.3310/cldc7214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
Abstract Randomised controlled trials are challenging to deliver. There is a constant need to review and refine recruitment and implementation strategies if they are to be completed on time and within budget. We present the strategies adopted in the United Kingdom Collaborative Trial of Ovarian Cancer Screening, one of the largest individually randomised controlled trials in the world. The trial recruited over 202,000 women (2001-5) and delivered over 670,000 annual screens (2001-11) and over 3 million women-years of follow-up (2001-20). Key to the successful completion were the involvement of senior investigators in the day-to-day running of the trial, proactive trial management and willingness to innovate and use technology. Our underlying ethos was that trial participants should always be at the centre of all our processes. We ensured that they were able to contact either the site or the coordinating centre teams for clarifications about their results, for follow-up and for rescheduling of appointments. To facilitate this, we shared personal identifiers (with consent) with both teams and had dedicated reception staff at both site and coordinating centre. Key aspects were a comprehensive online trial management system which included an electronic data capture system (resulting in an almost paperless trial), biobanking, monitoring and project management modules. The automation of algorithms (to ascertain eligibility and classify results and ensuing actions) and processes (scheduling of appointments, printing of letters, etc.) ensured the protocol was closely followed and timelines were met. Significant engagement with participants ensured retention and low rates of complaints. Our solutions to the design, conduct and analyses issues we faced are highly relevant, given the renewed focus on trials for early detection of cancer. Future work There is a pressing need to increase the evidence base to support decision making about all aspects of trial methodology. Trial registration ISRCTN-22488978; ClinicalTrials.gov-NCT00058032. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 16/46/01. The long-term follow-up UKCTOCS (2015 20) was supported by National Institute for Health and Care Research (NIHR HTA grant 16/46/01), Cancer Research UK, and The Eve Appeal. UKCTOCS (2001-14) was funded by the MRC (G9901012 and G0801228), Cancer Research UK (C1479/A2884), and the UK Department of Health, with additional support from The Eve Appeal. Researchers at UCL were supported by the NIHR UCL Hospitals Biomedical Research Centre and by the MRC Clinical Trials Unit at UCL core funding (MC_UU_00004/09, MC_UU_00004/08, MC_UU_00004/07). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the UK Department of Health and Social Care.
Collapse
Affiliation(s)
- Usha Menon
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Aleksandra Gentry-Maharaj
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Matthew Burnell
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Sophia Apostolidou
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Andy Ryan
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Jatinderpal K Kalsi
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Naveena Singh
- Department of Cellular Pathology, Barts Health NHS Trust, London, UK
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | | | | | - Steven J Skates
- Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Anne Dawnay
- Department of Clinical Biochemistry, Barts Health NHS Trust, London, UK
| | - Mahesh Parmar
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Ian J Jacobs
- Department of Women's Cancer, Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| |
Collapse
|
7
|
Menon U, Gentry-Maharaj A, Burnell M, Ryan A, Kalsi JK, Singh N, Dawnay A, Fallowfield L, McGuire AJ, Campbell S, Skates SJ, Parmar M, Jacobs IJ. Mortality impact, risks, and benefits of general population screening for ovarian cancer: the UKCTOCS randomised controlled trial. Health Technol Assess 2023:1-81. [PMID: 37183782 PMCID: PMC10542866 DOI: 10.3310/bhbr5832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
Background Ovarian and tubal cancers are lethal gynaecological cancers, with over 50% of the patients diagnosed at advanced stage. Trial design Randomised controlled trial involving 27 primary care trusts adjacent to 13 trial centres based at NHS Trusts in England, Wales and Northern Ireland. Methods Postmenopausal average-risk women, aged 50-74, with intact ovaries and no previous ovarian or current non-ovarian cancer. Interventions One of two annual screening strategies: (1) multimodal screening (MMS) using a longitudinal CA125 algorithm with repeat CA125 testing and transvaginal scan (TVS) as second line test (2) ultrasound screening (USS) using TVS alone with repeat scan to confirm any abnormality. The control (C) group had no screening. Follow-up was through linkage to national registries, postal follow-up questionnaires and direct communication with trial centres and participants. Objective To assess comprehensively risks and benefits of ovarian cancer screening in the general population. Outcome Primary outcome was death due to ovarian or tubal cancer as assigned by an independent outcomes review committee. Secondary outcomes included incidence and stage at diagnosis of ovarian and tubal cancer, compliance, performance characteristics, harms and cost-effectiveness of the two screening strategies and a bioresource for future research. Randomisation The trial management system confirmed eligibility and randomly allocated participants using computer-generated random numbers to MMS, USS and C groups in a 1:1:2 ratio. Blinding Investigators and participants were unblinded and outcomes review committee was masked to randomisation group. Analyses Primary analyses were by intention to screen, comparing separately MMS and USS with C using the Versatile test. Results 1,243,282 women were invited and 205,090 attended for recruitment between April 2001 and September 2005. Randomised 202,638 women: 50,640 MMS, 50,639 USS and 101,359 C group. Numbers analysed for primary outcome 202,562 (>99.9%): 50,625 (>99.9%) MMS, 50,623 (>99.9%) USS, and 101,314 (>99.9%) C group. Outcome Women in MMS and USS groups underwent 345,570 and 327,775 annual screens between randomisation and 31 December 2011. At median follow-up of 16.3 (IQR 15.1-17.3) years, 2055 women developed ovarian or tubal cancer: 522 (1.0% of 50,625) MMS, 517 (1.0% of 50,623) USS, and 1016 (1.0% of 101314) in C group. Compared to the C group, in the MMS group, the incidence of Stage I/II disease was 39.2% (95% CI 16.1 to 66.9) higher and stage III/IV 10.2% (95% CI -21.3 to 2.4) lower. There was no difference in stage in the USS group. 1206 women died of the disease: 296 (0.6%) MMS, 291 (0.6%) USS, and 619 (0.6%) C group. There was no significant reduction in ovarian and tubal cancer deaths in either MMS (p = 0.580) or USS (p = 0.360) groups compared to the C group. Overall compliance with annual screening episode was 80.8% (345,570/420,047) in the MMS and 78.0% (327,775/420,047) in the USS group. For ovarian and tubal cancers diagnosed within one year of the last test in a screening episode, in the MMS group, the sensitivity, specificity and positive predictive values were 83.8% (95% CI 78.7 to 88.1), 99.8% (95% CI 99.8 to 99.9), and 28.8% (95% CI 25.5 to 32.2) and in the USS group, 72.2% (95% CI 65.9 to 78.0), 99.5% (95% CI 99.5 to 99.5), and 9.1% (95% CI 7.8 to 10.5) respectively. The final within-trial cost-effectiveness analysis was not undertaken as there was no mortality reduction. A bioresource (UKCTOCS Longitudinal Women's Cohort) of longitudinal outcome data and over 0.5 million serum samples including serial annual samples in women in the MMS group was established and to date has been used in many new studies, mainly focused on early detection of cancer. Harms Both screening tests (venepuncture and TVS) were associated with minor complications with low (8.6/100,000 screens MMS; 18.6/100,000 screens USS) complication rates. Screening itself did not cause anxiety unless more intense repeat testing was required following abnormal screens. In the MMS group, for each screen-detected ovarian or tubal cancer, an additional 2.3 (489 false positives; 212 cancers) women in the MMS group had unnecessary false-positive (benign adnexal pathology or normal adnexa) surgery. Overall, 14 (489/345,572 annual screens) underwent unnecessary surgery per 10,000 screens. In the USS group, for each screen-detected ovarian or tubal cancer, an additional 10 (1630 false positives; 164 cancers) underwent unnecessary false-positive surgery. Overall, 50 (1630/327,775 annual screens) women underwent unnecessary surgery per 10,000 screens. Conclusions Population screening for ovarian and tubal cancer for average-risk women using these strategies should not be undertaken. Decreased incidence of Stage III/IV cancers during multimodal screening did not translate to mortality reduction. Researchers should be cautious about using early stage as a surrogate outcome in screening trials. Meanwhile the bioresource provides a unique opportunity to evaluate early cancer detection tests. Funding Long-term follow-up UKCTOCS (2015-2020) - National Institute for Health and Care Research (NIHR HTA grant 16/46/01), Cancer Research UK, and The Eve Appeal. UKCTOCS (2001-2014) - Medical Research Council (MRC) (G9901012/G0801228), Cancer Research UK (C1479/A2884), and the UK Department of Health, with additional support from The Eve Appeal. Researchers at UCL were supported by the NIHR UCL Hospitals Biomedical Research Centre and by MRC Clinical Trials Unit at UCL core funding (MR_UU_12023).
Collapse
Affiliation(s)
- Usha Menon
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Aleksandra Gentry-Maharaj
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Matthew Burnell
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Andy Ryan
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Jatinderpal K Kalsi
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - Naveena Singh
- Department of Cellular Pathology, Barts Health NHS Trust, London, UK
| | - Anne Dawnay
- Department of Clinical Biochemistry, Barts Health NHS Service Trust, London, UK
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | | | | | - Steven J Skates
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Mahesh Parmar
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Ian J Jacobs
- Department of Women's Health, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
8
|
Gonzalez-Robles C, Weil RS, van Wamelen D, Bartlett M, Burnell M, Clarke CS, Hu MT, Huxford B, Jha A, Lambert C, Lawton M, Mills G, Noyce A, Piccini P, Pushparatnam K, Rochester L, Siu C, Williams-Gray CH, Zeissler ML, Zetterberg H, Carroll CB, Foltynie T, Schrag A. Outcome Measures for Disease-Modifying Trials in Parkinson's Disease: Consensus Paper by the EJS ACT-PD Multi-Arm Multi-Stage Trial Initiative. J Parkinsons Dis 2023; 13:1011-1033. [PMID: 37545260 PMCID: PMC10578294 DOI: 10.3233/jpd-230051] [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] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Multi-arm, multi-stage (MAMS) platform trials can accelerate the identification of disease-modifying treatments for Parkinson's disease (PD) but there is no current consensus on the optimal outcome measures (OM) for this approach. OBJECTIVE To provide an up-to-date inventory of OM for disease-modifying PD trials, and a framework for future selection of OM for such trials. METHODS As part of the Edmond J Safra Accelerating Clinical Trials in Parkinson Disease (EJS ACT-PD) initiative, an expert group with Patient and Public Involvement and Engagement (PPIE) representatives' input reviewed and evaluated available evidence on OM for potential use in trials to delay progression of PD. Each OM was ranked based on aspects such as validity, sensitivity to change, participant burden and practicality for a multi-site trial. Review of evidence and expert opinion led to the present inventory. RESULTS An extensive inventory of OM was created, divided into: general, motor and non-motor scales, diaries and fluctuation questionnaires, cognitive, disability and health-related quality of life, capability, quantitative motor, wearable and digital, combined, resource use, imaging and wet biomarkers, and milestone-based. A framework for evaluation of OM is presented to update the inventory in the future. PPIE input highlighted the need for OM which reflect their experience of disease progression and are applicable to diverse populations and disease stages. CONCLUSION We present a range of OM, classified according to a transparent framework, to aid selection of OM for disease-modifying PD trials, whilst allowing for inclusion or re-classification of relevant OM as new evidence emerges.
Collapse
Affiliation(s)
| | | | | | | | - Matthew Burnell
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Burnell M, Gaba F, Sobocan M, Desai R, Sanderson S, Loggenberg K, Gessler S, Side L, Brady AF, Dorkins H, Wallis Y, Jacobs C, Legood R, Beller U, Tomlinson I, Wardle J, Menon U, Jacobs I, Manchanda R. Randomised trial of population-based BRCA testing in Ashkenazi Jews: long-term secondary lifestyle behavioural outcomes. BJOG 2022; 129:1970-1980. [PMID: 35781768 PMCID: PMC9796935 DOI: 10.1111/1471-0528.17253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 04/22/2022] [Accepted: 05/16/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Ashkenazi-Jewish (AJ) population-based BRCA testing is acceptable, cost-effective and amplifies primary prevention for breast & ovarian cancer. However, data describing lifestyle impact are lacking. We report long-term results of population-based BRCA testing on lifestyle behaviour and cancer risk perception. DESIGN Two-arm randomised controlled trials (ISRCTN73338115, GCaPPS): (a) population-screening (PS); (b) family history (FH)/clinical criteria testing. SETTING North London AJ-population. POPULATION/SAMPLE AJ women/men >18 years. EXCLUSIONS prior BRCA testing or first-degree relatives of BRCA-carriers. METHODS Participants were recruited through self-referral. All participants received informed pre-test genetic counselling. The intervention included genetic testing for three AJ BRCA-mutations: 185delAG(c.68_69delAG), 5382insC(c.5266dupC) and 6174delT(c.5946delT). This was undertaken for all participants in the PS arm and participants fulfilling FH/clinical criteria in the FH arm. Patients filled out customised/validated questionnaires at baseline/1-year/2-year/3-year follow-ups. Generalised linear-mixed models adjusted for covariates and appropriate contrast tests were used for between-group/within-group analysis of lifestyle and behavioural outcomes along with evaluating factors associated with these outcomes. Outcomes are adjusted for multiple testing (Bonferroni method), with P < 0.0039 considered significant. OUTCOME MEASURES Lifestyle/behavioural outcomes at baseline/1-year/2-year/3-year follow-ups. RESULTS 1034 participants were randomised to PS (n = 530) or FH (n = 504) arms. No significant difference was identified between PS- and FH-based BRCA testing approaches in terms of dietary fruit/vegetable/meat consumption, vitamin intake, alcohol quantity/ frequency, smoking behaviour (frequency/cessation), physical activity/exercise or routine breast mammogram screening behaviour, with outcomes not affected by BRCA test result. Cancer risk perception decreased with time following BRCA testing, with no difference between FH/PS approaches, and the perception of risk was lowest in BRCA-negative participants. Men consumed fewer fruits/vegetables/vitamins and more meat/alcohol than women (P < 0.001). CONCLUSION Population-based and FH-based AJ BRCA testing have similar long-term lifestyle impacts on smoking, alcohol, dietary fruit/vegetable/meat/vitamin, exercise, breast screening participation and reduced cancer risk perception.
Collapse
Affiliation(s)
- Matthew Burnell
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and MethodologyUniversity College LondonLondonUK
| | - Faiza Gaba
- Wolfson Institute of Population Health, Barts CRUK Cancer CentreQueen Mary University of LondonLondonUK,Department of Gynaecological OncologyBarts Health NH TrustLondonUK
| | - Monika Sobocan
- Wolfson Institute of Population Health, Barts CRUK Cancer CentreQueen Mary University of LondonLondonUK,Department of Gynaecological OncologyBarts Health NH TrustLondonUK
| | - Rakshit Desai
- Department of Gynaecological OncologyBarts Health NH TrustLondonUK
| | - Saskia Sanderson
- Behavioural Sciences UnitDepartment Epidemiology and Public HealthUniversity College LondonLondonUK
| | - Kelly Loggenberg
- Department Clinical GeneticsNorth East Thames Regional Genetics UnitGreat Ormond Street HospitalLondonUK
| | - Sue Gessler
- Department of Gynaecological OncologyInstitute for Women's HealthUniversity College LondonLondonUK
| | - Lucy Side
- University Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - Angela F. Brady
- Department Clinical GeneticsNorth West Thames Regional Genetics UnitNorthwick Park HospitalLondonUK
| | - Huw Dorkins
- St Peter's CollegeUniversity of OxfordOxfordUK
| | - Yvonne Wallis
- West Midlands Regional Genetics LaboratoryBirmingham Women's NHS Foundation TrustBirminghamUK,Depatment Clinical GeneticsWest Midlands Regional Genetics ServiceBirmingham Women's NHS Foundation TrustBirminghamUK
| | - Chris Jacobs
- Depatment Clinical GeneticsGuy's HospitalLondonUK,University of Technology SydneySydneyNew South WalesAustralia
| | - Rosa Legood
- Department of Health Services Research and PolicyLondon School of Hygiene & Tropical MedicineLondonUK
| | - Uziel Beller
- Department of GynaecologyShaare Zedek Medical CenterJerusalemIsrael
| | - Ian Tomlinson
- Institute of Cancer and Genomic SciencesUniversity of BirminghamBirminghamUK
| | - Jane Wardle
- Behavioural Sciences UnitDepartment Epidemiology and Public HealthUniversity College LondonLondonUK
| | - Usha Menon
- Department of Gynaecological OncologyBarts Health NH TrustLondonUK
| | - Ian Jacobs
- University of New South WalesSydneyNew South WalesAustralia
| | - Ranjit Manchanda
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and MethodologyUniversity College LondonLondonUK,Wolfson Institute of Population Health, Barts CRUK Cancer CentreQueen Mary University of LondonLondonUK,Department of Gynaecological OncologyBarts Health NH TrustLondonUK,Department of Health Services Research and PolicyLondon School of Hygiene & Tropical MedicineLondonUK,Department of GynaecologyAll India Institute of Medical SciencesNew DelhiIndia
| |
Collapse
|
10
|
Datta SS, Fraser L, Burnell M, Nasreen S, Ghosh M, Ojha A, Saha T, Mukhopadhyay A, Lanceley A, Menon U. Association of adult attachment with delays in accessing specialist care in women with ovarian cancer. J Psychosoc Oncol 2022; 40:491-505. [PMID: 35112658 DOI: 10.1080/07347332.2022.2025510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Advanced stage at diagnosis and delayed presentation are common in ovarian cancer (OC). The objective of the current study was to explore the association of adult attachment pattern with delays in accessing specialist oncology care in patients with OC. METHODS A cross-sectional structured interview study of patients with OC presenting to an Indian cancer center was undertaken. Consenting patients completed Experiences of Close Relationships-Relationship Style questionnaire (ECR-RS) and Medical Outcome Survey-Social Support Survey (MOS-SSS). Multivariate linear regression with "time to presentation to cancer specialist" as the dependent variable was undertaken. RESULTS In all, 132 of 155 (85%) patients with OC who were invited were interviewed. An increased ECR-RS attachment anxiety score (P = .01) and being part of a multigenerational extended household (P = .04) were both independently associated with delay in presentation to a cancer specialist. There was no association between delay in presentation and social support. CONCLUSIONS Among patients with OC, adult attachment may contribute to delays in presentation. It may be important for the cancer symptom awareness efforts in primary care to include educating physicians on recognizing and interacting with patients with insecure attachment styles. The association of delays in presentation for women with OC living in multigenerational extended households needs more indepth exploration. Supplemental data for this article is available online at https://doi.org/10.1080/07347332.2022.2025510 .
Collapse
Affiliation(s)
- Soumitra Shankar Datta
- Department of Palliative Care and Psycho-oncology, Tata Medical Centre, Kolkata, India.,MRC Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, UK
| | - Lindsay Fraser
- MRC Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, UK
| | - Matthew Burnell
- MRC Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, UK
| | - Shazia Nasreen
- Department of Palliative Care and Psycho-oncology, Tata Medical Centre, Kolkata, India
| | - Manisha Ghosh
- Department of Palliative Care and Psycho-oncology, Tata Medical Centre, Kolkata, India
| | - Aparupa Ojha
- Department of Palliative Care and Psycho-oncology, Tata Medical Centre, Kolkata, India
| | - Tania Saha
- Department of Palliative Care and Psycho-oncology, Tata Medical Centre, Kolkata, India
| | - Asima Mukhopadhyay
- Department of Gynaecological Oncology, Tata Medical Centre, Kolkata, India
| | - Anne Lanceley
- UCL EGA Institute for Women's Health, University College London, London, UK
| | - Usha Menon
- MRC Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, UK
| |
Collapse
|
11
|
Taylor JA, Burnell M, Ryana A, Karpinskyj C, Kalsi JK, Taylor H, Apostolidou S, Sharma A, Manchanda R, Woolas R, Campbell S, Parmar M, Singh N, Jacobs IJ, Menon U, Gentry-Maharaj A. Association of hysterectomy and invasive epithelial ovarian and tubal cancer: a cohort study within UKCTOCS. BJOG 2022; 129:110-118. [PMID: 34555263 PMCID: PMC7615389 DOI: 10.1111/1471-0528.16943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the association between hysterectomy with conservation of one or both adnexa and ovarian and tubal cancer. DESIGN Prospective cohort study. SETTING Thirteen NHS Trusts in England, Wales and Northern Ireland. POPULATION A total of 202 506 postmenopausal women recruited between 2001 and 2005 to the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) and followed up until 31 December 2014. METHODS Multiple sources (questionnaires, hospital notes, Hospital Episodes Statistics, national cancer/death registries, ultrasound reports) were used to obtain accurate data on hysterectomy (with conservation of one or both adnexa) and outcomes censored at bilateral oophorectomy, death, ovarian/tubal cancer diagnosis, loss to follow up or 31 December 2014. Cox proportional hazards regression models were used to assess the association. MAIN OUTCOME MEASURES Invasive epithelial ovarian and tubal cancer (WHO 2014) on independent outcome review. RESULTS Hysterectomy with conservation of one or both adnexa was reported in 41 912 (20.7%; 41 912/202 506) women. Median follow up was 11.1 years (interquartile range 9.96-12.04), totalling >2.17 million woman-years. Among women who had undergone hysterectomy, 0.55% (231/41 912) were diagnosed with ovarian/tubal cancer, compared with 0.59% (945/160 594) of those with intact uterus. Multivariable analysis showed no evidence of an association between hysterectomy and invasive epithelial ovarian/tubal cancer (hazard ratio 0.98, 95% CI 0.85-1.13, P = 0.765). CONCLUSIONS This large cohort study provides further independent validation that hysterectomy is not associated with alteration of invasive epithelial ovarian and tubal cancer risk. These data are important both for clinical counselling and for refining risk prediction models. TWEETABLE ABSTRACT Hysterectomy does not alter risk of invasive epithelial ovarian and tubal cancer.
Collapse
Affiliation(s)
- JA Taylor
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - M Burnell
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - A Ryana
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - C Karpinskyj
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - JK Kalsi
- Department of Women’s Cancer, Institute for Women’s Health, University College London, London, UK
- Department Epidemiology and Public Health, Institute of Epidemiology and Health Care, UCL, London, UK
| | - H Taylor
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, London, UK
| | - S Apostolidou
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - A Sharma
- Department of Obstetrics and Gynaecology, University Hospital of Wales, Cardiff, UK
| | - R Manchanda
- Barts Health NHS Trust and Wolfson Institute of Preventive Medicine, CRUK Barts Cancer Centre, Queen Mary University of London, London, UK
| | - R Woolas
- Department of Gynaecological Oncology, Queen Alexandra Hospital, Portsmouth, UK
| | | | - M Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - N Singh
- Department of Cellular Pathology, Barts Health NHS Trust, London, UK
| | - IJ Jacobs
- Department of Women’s Cancer, Institute for Women’s Health, University College London, London, UK
- University of New South Wales, Sydney, NSW, Australia
| | - U Menon
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - A Gentry-Maharaj
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| |
Collapse
|
12
|
Reisel D, Burnell M, Side L, Loggenberg K, Gessler S, Desai R, Sanderson S, Brady AF, Dorkins H, Wallis Y, Jacobs C, Legood R, Beller U, Tomlinson I, Wardle J, Menon U, Jacobs I, Manchanda R. Jewish cultural and religious factors and uptake of population-based BRCA testing across denominations: a cohort study. BJOG 2021; 129:959-968. [PMID: 34758513 DOI: 10.1111/1471-0528.16994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 09/11/2021] [Accepted: 09/30/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate the association of Jewish cultural and religious identity and denominational affiliation with interest in, intention to undertake and uptake of population-based BRCA (Breast Cancer Gene)-testing. DESIGN Cohort-study set within recruitment to GCaPPS-trial (ISRCTN73338115). SETTING London Ashkenazi-Jewish (AJ) population. POPULATION OR SAMPLE AJ men and women, >18 years. METHODS Participants were self-referred, and attended recruitment clinics (clusters) for pre-test counselling. Subsequently consenting individuals underwent BRCA testing. Participants self-identified to one Jewish denomination: Conservative/Liberal/Reform/Traditional/Orthodox/Unaffiliated. Validated scales measured Jewish Cultural-Identity (JI) and Jewish Religious-identity (JR). Four-item Likert-scales analysed initial 'interest' and 'intention to test' pre-counselling. Item-Response-Theory and graded-response models, modelled responses to JI and JR scales. Ordered/multinomial logistic regression modelling evaluated association of JI-scale, JR-scale and Jewish Denominational affiliation on interest, intention and uptake of BRCA testing. MAIN OUTCOME MEASURES Interest, intention, uptake of BRCA testing. RESULTS In all, 935 AJ women/men of mean age = 53.8 (S.D = 15.02) years, received pre-test education and counselling through 256 recruitment clinic clusters (median cluster size = 3). Denominational affiliations included Conservative/Masorti = 91 (10.2%); Liberal = 82 (9.2%), Reform = 135 (15.1%), Traditional = 212 (23.7%), Orthodox = 239 (26.7%); and Unaffiliated/Non-practising = 135 (15.1%). Overall BRCA testing uptake was 88%. Pre-counselling, 96% expressed interest and 60% intention to test. JI and JR scores were highest for Orthodox, followed by Conservative/Masorti, Traditional, Reform, Liberal and Unaffiliated Jewish denominations. Regression modelling showed no significant association between overall Jewish Cultural or Religious Identity with either interest, intention or uptake of BRCA testing. Interest, intention and uptake of BRCA testing was not significantly associated with denominational affiliation. CONCLUSIONS Jewish religious/cultural identity and denominational affiliation do not appear to influence interest, intention or uptake of population-based BRCA testing. BRCA testing was robust across all Jewish denominations. TWEETABLE ABSTRACT Jewish cultural/religious factors do not affect BRCA testing, with robust uptake seen across all denominational affiliations.
Collapse
Affiliation(s)
- D Reisel
- Institute for Women's Health, University College, London, UK
| | - M Burnell
- Institute for Women's Health, University College, London, UK
| | - L Side
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - K Loggenberg
- Institute for Women's Health, University College, London, UK
| | - S Gessler
- Institute for Women's Health, University College, London, UK
| | - R Desai
- Institute for Women's Health, University College, London, UK
| | - S Sanderson
- Behavioral Sciences Unit, Dept Epidemiology and Public Health, University College London, London, UK
| | - A F Brady
- North West Thames Regional Genetics Service, Northwick Park Hospital, Harrow, UK
| | - H Dorkins
- St Peter's College, University of Oxford, Oxford, UK
| | - Y Wallis
- West Midlands Regional Genetics Laboratory, Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | - C Jacobs
- Dept Clinical Genetics, Guy's Hospital, London, UK.,University of Technology Sydney, Ultimo, NSW, Australia
| | - R Legood
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - U Beller
- Department of Gynaecology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - I Tomlinson
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - J Wardle
- Behavioral Sciences Unit, Dept Epidemiology and Public Health, University College London, London, UK
| | - U Menon
- MRC Clinical Trials Unit, University College London, London, UK
| | - I Jacobs
- Institute for Women's Health, University College, London, UK.,University of New South Wales, Sydney, NSW, Australia
| | - R Manchanda
- MRC Clinical Trials Unit, University College London, London, UK.,Wolfson Institute of Population Health, CRUK Barts Centre, Queen Mary University of London, London, UK.,Department of Gynaecological Oncology, St Bartholomew's Hospital, London, UK
| |
Collapse
|
13
|
Menon U, Gentry-Maharaj A, Burnell M, Singh N, Ryan A, Karpinskyj C, Carlino G, Taylor J, Massingham SK, Raikou M, Kalsi JK, Woolas R, Manchanda R, Arora R, Casey L, Dawnay A, Dobbs S, Leeson S, Mould T, Seif MW, Sharma A, Williamson K, Liu Y, Fallowfield L, McGuire AJ, Campbell S, Skates SJ, Jacobs IJ, Parmar M. Ovarian cancer population screening and mortality after long-term follow-up in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a randomised controlled trial. Lancet 2021; 397:2182-2193. [PMID: 33991479 PMCID: PMC8192829 DOI: 10.1016/s0140-6736(21)00731-5] [Citation(s) in RCA: 263] [Impact Index Per Article: 87.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Ovarian cancer continues to have a poor prognosis with the majority of women diagnosed with advanced disease. Therefore, we undertook the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) to determine if population screening can reduce deaths due to the disease. We report on ovarian cancer mortality after long-term follow-up in UKCTOCS. METHODS In this randomised controlled trial, postmenopausal women aged 50-74 years were recruited from 13 centres in National Health Service trusts in England, Wales, and Northern Ireland. Exclusion criteria were bilateral oophorectomy, previous ovarian or active non-ovarian malignancy, or increased familial ovarian cancer risk. The trial management system confirmed eligibility and randomly allocated participants in blocks of 32 using computer generated random numbers to annual multimodal screening (MMS), annual transvaginal ultrasound screening (USS), or no screening, in a 1:1:2 ratio. Follow-up was through national registries. The primary outcome was death due to ovarian or tubal cancer (WHO 2014 criteria) by June 30, 2020. Analyses were by intention to screen, comparing MMS and USS separately with no screening using the versatile test. Investigators and participants were aware of screening type, whereas the outcomes review committee were masked to randomisation group. This study is registered with ISRCTN, 22488978, and ClinicalTrials.gov, NCT00058032. FINDINGS Between April 17, 2001, and Sept 29, 2005, of 1 243 282 women invited, 202 638 were recruited and randomly assigned, and 202 562 were included in the analysis: 50 625 (25·0%) in the MMS group, 50 623 (25·0%) in the USS group, and 101 314 (50·0%) in the no screening group. At a median follow-up of 16·3 years (IQR 15·1-17·3), 2055 women were diagnosed with tubal or ovarian cancer: 522 (1·0%) of 50 625 in the MMS group, 517 (1·0%) of 50 623 in the USS group, and 1016 (1·0%) of 101 314 in the no screening group. Compared with no screening, there was a 47·2% (95% CI 19·7 to 81·1) increase in stage I and 24·5% (-41·8 to -2·0) decrease in stage IV disease incidence in the MMS group. Overall the incidence of stage I or II disease was 39·2% (95% CI 16·1 to 66·9) higher in the MMS group than in the no screening group, whereas the incidence of stage III or IV disease was 10·2% (-21·3 to 2·4) lower. 1206 women died of the disease: 296 (0·6%) of 50 625 in the MMS group, 291 (0·6%) of 50 623 in the USS group, and 619 (0·6%) of 101 314 in the no screening group. No significant reduction in ovarian and tubal cancer deaths was observed in the MMS (p=0·58) or USS (p=0·36) groups compared with the no screening group. INTERPRETATION The reduction in stage III or IV disease incidence in the MMS group was not sufficient to translate into lives saved, illustrating the importance of specifying cancer mortality as the primary outcome in screening trials. Given that screening did not significantly reduce ovarian and tubal cancer deaths, general population screening cannot be recommended. FUNDING National Institute for Health Research, Cancer Research UK, and The Eve Appeal.
Collapse
Affiliation(s)
- Usha Menon
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK.
| | - Aleksandra Gentry-Maharaj
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Matthew Burnell
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Naveena Singh
- Department of Cellular Pathology, Barts Health NHS Trust, London, UK
| | - Andy Ryan
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Chloe Karpinskyj
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Giulia Carlino
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Julie Taylor
- Clinical Epidemiology, Institute of Health Informatics, University College London, London, UK
| | - Susan K Massingham
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Maria Raikou
- Department of Health Policy, London School of Economics and Political Science, London, UK; Department of Economics, University of Piraeus, Athens, Greece
| | - Jatinderpal K Kalsi
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - Robert Woolas
- Department of Gynaecological Oncology, Queen Alexandra Hospital, Portsmouth, UK
| | - Ranjit Manchanda
- Department of Gynaecological Oncology, Barts Health NHS Trust, London, UK; Wolfson Institute of Preventive Medicine, CRUK Barts Cancer Centre, Queen Mary University of London, London, UK
| | - Rupali Arora
- Department of Cellular Pathology, University College London Hospitals NHS Trust, London, UK
| | - Laura Casey
- Department of Cellular Pathology, Barts Health NHS Trust, London, UK
| | - Anne Dawnay
- Department of Clinical Biochemistry, Barts Health NHS Trust, London, UK
| | - Stephen Dobbs
- Department of Gynaecological Oncology, Belfast City Hospital, Belfast, UK
| | - Simon Leeson
- Department of Obstetrics and Gynaecology, Ysbyty Gwynedd, Bangor, UK
| | - Tim Mould
- Department of Gynaecological Oncology, University College London Hospitals NHS Trust, London, UK
| | - Mourad W Seif
- Division of Gynaecology and Cancer Sciences, St Mary's Hospital, Manchester, UK
| | - Aarti Sharma
- Department of Obstetrics and Gynaecology, University Hospital of Wales, Cardiff, UK
| | - Karin Williamson
- Department of Gynaecological Oncology, Nottingham City Hospital, Nottingham, UK
| | - Yiling Liu
- MGH Biostatistics, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer, SHORE-C, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Alistair J McGuire
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | | | - Steven J Skates
- MGH Biostatistics, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Ian J Jacobs
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK; Department of Women's Health, University of New South Wales, Sydney, NSW, Australia
| | - Mahesh Parmar
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| |
Collapse
|
14
|
Burnell M, Gentry-Maharaj A, Skates SJ, Ryan A, Karpinskyj C, Kalsi J, Apostolidou S, Singh N, Dawnay A, Woolas R, Fallowfield L, Campbell S, McGuire A, Jacobs IJ, Parmar M, Menon U. UKCTOCS update: applying insights of delayed effects in cancer screening trials to the long-term follow-up mortality analysis. Trials 2021; 22:173. [PMID: 33648562 PMCID: PMC7919310 DOI: 10.1186/s13063-021-05125-8] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 02/11/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND During trials that span decades, new evidence including progress in statistical methodology, may require revision of original assumptions. An example is the continued use of a constant-effect approach to analyse the mortality reduction which is often delayed in cancer-screening trials. The latter led us to re-examine our approach for the upcoming primary mortality analysis (2020) of long-term follow-up of the United Kingdom Collaborative Trial of Ovarian Cancer Screening (LTFU UKCTOCS), having initially (2014) used the proportional hazards (PH) Cox model. METHODS We wrote to 12 experts in statistics/epidemiology/screening trials, setting out current evidence, the importance of pre-specification, our previous mortality analysis (2014) and three possible choices for the follow-up analysis (2020) of the mortality outcome: (A) all data (2001-2020) using the Cox model (2014), (B) new data (2015-2020) only and (C) all data (2001-2020) using a test that allows for delayed effects. RESULTS Of 11 respondents, eight supported changing the 2014 approach to allow for a potential delayed effect (option C), suggesting various tests while three favoured retaining the Cox model (option A). Consequently, we opted for the Versatile test introduced in 2016 which maintains good power for early, constant or delayed effects. We retained the Royston-Parmar model to estimate absolute differences in disease-specific mortality at 5, 10, 15 and 18 years. CONCLUSIONS The decision to alter the follow-up analysis for the primary outcome on the basis of new evidence and using new statistical methodology for long-term follow-up is novel and has implications beyond UKCTOCS. There is an urgent need for consensus building on how best to design, test, estimate and report mortality outcomes from long-term randomised cancer screening trials. TRIAL REGISTRATION ISRCTN22488978 . Registered on 6 April 2000.
Collapse
Affiliation(s)
- Matthew Burnell
- MRC CTU at UCL, Institute of Clinical Trials and Methodology, University College London, 90 High Holborn, 2nd Floor, London, WC1V 6LJ, UK
| | - Aleksandra Gentry-Maharaj
- MRC CTU at UCL, Institute of Clinical Trials and Methodology, University College London, 90 High Holborn, 2nd Floor, London, WC1V 6LJ, UK
| | - Steven J Skates
- MGH Biostatistics, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Andy Ryan
- MRC CTU at UCL, Institute of Clinical Trials and Methodology, University College London, 90 High Holborn, 2nd Floor, London, WC1V 6LJ, UK
| | - Chloe Karpinskyj
- MRC CTU at UCL, Institute of Clinical Trials and Methodology, University College London, 90 High Holborn, 2nd Floor, London, WC1V 6LJ, UK
| | - Jatinderpal Kalsi
- Department of Women's Cancer, Institute for Women's Health, University College London, 84-86 Chenies Mews, London, WC1E 6HU, UK
| | - Sophia Apostolidou
- MRC CTU at UCL, Institute of Clinical Trials and Methodology, University College London, 90 High Holborn, 2nd Floor, London, WC1V 6LJ, UK
| | - Naveena Singh
- Department of Pathology, Barts Health National Health Service Trust, The Royal Hospital, Whitechapel Rd, London, E1 1BB, UK
| | - Anne Dawnay
- Department of Clinical Biochemistry, Barts Health National Health Service Trust, Barts Health, 4th floor, Pathology and Pharmacy, 80 Newark St, London, E1 2ES, UK
| | - Robert Woolas
- Department of Gynaecological Oncology, Queen Alexandra Hospital, Cosham, Portsmouth, Hampshire, PO6 3LY, UK
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer, Brighton and Sussex Medical School, University of Sussex, Science Park Road, Falmer, Brighton, BN1 9RX, UK
| | | | - Alistair McGuire
- Department of Social Policy, London School of Economics, Houghton Street, London, WC2A 2AE, UK
| | - Ian J Jacobs
- Department of Women's Cancer, Institute for Women's Health, University College London, 84-86 Chenies Mews, London, WC1E 6HU, UK
- University of New South Wales, Sydney, NSW, 2052, Australia
| | - Mahesh Parmar
- MRC CTU at UCL, Institute of Clinical Trials and Methodology, University College London, 90 High Holborn, 2nd Floor, London, WC1V 6LJ, UK
| | - Usha Menon
- MRC CTU at UCL, Institute of Clinical Trials and Methodology, University College London, 90 High Holborn, 2nd Floor, London, WC1V 6LJ, UK.
| |
Collapse
|
15
|
Kalsi J, Gentry-Maharaj A, Ryan A, Singh N, Burnell M, Massingham S, Apostolidou S, Sharma A, Williamson K, Seif M, Mould T, Woolas R, Dobbs S, Leeson S, Fallowfield L, Skates SJ, Parmar M, Campbell S, Jacobs I, McGuire A, Menon U. Performance Characteristics of the Ultrasound Strategy during Incidence Screening in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). Cancers (Basel) 2021; 13:cancers13040858. [PMID: 33670571 PMCID: PMC7922843 DOI: 10.3390/cancers13040858] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/04/2021] [Accepted: 02/09/2021] [Indexed: 11/16/2022] Open
Abstract
Randomised controlled trials of ovarian cancer (OC) screening have not yet demonstrated an impact on disease mortality. Meanwhile, the screening data from clinical trials represents a rich resource to understand the performance of modalities used. We report here on incidence screening in the ultrasound arm of UKCTOCS. 44,799 of the 50,639 women who were randomised to annual screening with transvaginal ultrasound attended annual incidence screening between 28 April 2002 and 31 December 2011. Transvaginal ultrasound was used both as the first and the second line test. Participants were followed up through electronic health record linkage and postal questionnaires. Out of 280,534 annual incidence screens, 960 women underwent screen-positive surgery. 113 had ovarian/tubal cancer (80 invasive epithelial). Of the screen-detected invasive epithelial cancers, 37.5% (95% CI: 26.9-49.0) were Stage I/II. An additional 52 (50 invasive epithelial) were diagnosed within one year of their last screen. Of the 50 interval epithelial cancers, 6.0% (95% CI: 1.3-16.5) were Stage I/II. For detection of all ovarian/tubal cancers diagnosed within one year of screen, the sensitivity, specificity, and positive predictive values were 68.5% (95% CI: 60.8-75.5), 99.7% (95% CI: 99.7-99.7), and 11.8% (95% CI: 9.8-14) respectively. When the analysis was restricted to invasive epithelial cancers, sensitivity, specificity and positive predictive values were 61.5% (95% CI: 52.6-69.9); 99.7% (95% CI: 99.7-99.7) and 8.3% (95% CI: 6.7-10.3), with 12 surgeries per screen positive. The low sensitivity coupled with the advanced stage of interval cancers suggests that ultrasound scanning as the first line test might not be suitable for population screening for ovarian cancer. Trial registration: ISRCTN22488978. Registered on 6 April 2000.
Collapse
Affiliation(s)
- Jatinderpal Kalsi
- Department of Women’s Cancer, Institute for Women’s Health, University College London, London WC1E 6HU, UK; (J.K.); (I.J.)
| | - Aleksandra Gentry-Maharaj
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London WC1V 6LJ, UK; (A.G.-M.); (A.R.); (M.B.); (S.M.); (S.A.); (M.P.)
| | - Andy Ryan
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London WC1V 6LJ, UK; (A.G.-M.); (A.R.); (M.B.); (S.M.); (S.A.); (M.P.)
| | - Naveena Singh
- Department of Pathology, Barts and the London, London E1 2ES, UK;
| | - Matthew Burnell
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London WC1V 6LJ, UK; (A.G.-M.); (A.R.); (M.B.); (S.M.); (S.A.); (M.P.)
| | - Susan Massingham
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London WC1V 6LJ, UK; (A.G.-M.); (A.R.); (M.B.); (S.M.); (S.A.); (M.P.)
| | - Sophia Apostolidou
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London WC1V 6LJ, UK; (A.G.-M.); (A.R.); (M.B.); (S.M.); (S.A.); (M.P.)
| | - Aarti Sharma
- Department of Obstetrics and Gynaecology, University Hospital of Wales, Cardiff CF14 4XW, UK;
| | - Karin Williamson
- Department of Gynaecological Oncology, Nottingham City Hospital, Nottingham NG5 1PB, UK;
| | - Mourad Seif
- Division of Gynaecology and of Cancer Services, St. Mary’s Hospital and University of Manchester, Manchester M13 9WL, UK;
| | - Tim Mould
- Department of Gynaecological Oncology, University College Hospital, London NW1 2BU, UK;
| | - Robert Woolas
- Department of Gynaecological Oncology, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK;
| | - Stephen Dobbs
- Department of Gynaecological Oncology, Belfast City Hospital, Belfast BT9 7AB, UK;
| | - Simon Leeson
- Department of Obstetrics and Gynaecology, Ysbyty Gwynedd, Bangor, Gwynedd LL57 2PW, UK;
| | - Lesley Fallowfield
- Cancer Research UK Sussex Psychosocial Oncology Group at Brighton & Sussex Medical School, University of Sussex, Falmer BN1 9PX, UK;
| | - Steven J. Skates
- Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Mahesh Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London WC1V 6LJ, UK; (A.G.-M.); (A.R.); (M.B.); (S.M.); (S.A.); (M.P.)
| | | | - Ian Jacobs
- Department of Women’s Cancer, Institute for Women’s Health, University College London, London WC1E 6HU, UK; (J.K.); (I.J.)
- Department of Women’s Health, University of New South Wales, Australia, Sydney 2052, Australia
| | - Alistair McGuire
- London School of Economics and Political Science, London WC2A 2AE, UK;
| | - Usha Menon
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London WC1V 6LJ, UK; (A.G.-M.); (A.R.); (M.B.); (S.M.); (S.A.); (M.P.)
- Correspondence: ; Tel.: +44-7670-4909
| |
Collapse
|
16
|
Kalsi JK, Ryan A, Gentry-Maharaj A, Margolin-Crump D, Singh N, Burnell M, Benjamin E, Apostolidou S, Habib M, Massingham S, Karpinskyj C, Woolas R, Widschwendter M, Fallowfield L, Campbell S, Skates S, McGuire A, Parmar M, Jacobs I, Menon U. Completeness and accuracy of national cancer and death registration for outcome ascertainment in trials-an ovarian cancer exemplar. Trials 2021; 22:88. [PMID: 33494753 PMCID: PMC7831170 DOI: 10.1186/s13063-020-04968-x] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 12/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a trend to increasing use of routinely collected health data to ascertain outcome measures in trials. We report on the completeness and accuracy of national ovarian cancer and death registration in the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). METHODS Of the 202,638 participants, 202,632 were successfully linked and followed through national cancer and death registries of Northern Ireland, Wales and England. Women with registrations of any of 19 pre-defined ICD-10 codes suggestive of tubo-ovarian cancer or notification of ovarian/tubal/peritoneal cancer from hospital episode statistics or trial sites were identified. Copies of hospital and primary care notes were retrieved and reviewed by an independent outcomes review committee. National registration of site and cause of death as ovarian/tubal/peritoneal cancer (C56/C57/C48) obtained up to 3 months after trial censorship was compared to that assigned by outcomes review (reference standard). RESULTS Outcome review was undertaken in 3110 women on whom notification was received between 2001 and 2014. Ovarian cancer was confirmed in 1324 of whom 1125 had a relevant cancer registration. Sensitivity and specificity of ovarian/tubal/peritoneal cancer registration were 85.0% (1125/1324; 95% CI 83.7-86.2%) and 94.0% (1679/1786; 95% CI 93.2-94.8%), respectively. Of 2041 death registrations reviewed, 681 were confirmed to have a tubo-ovarian cancer of whom 605 had relevant death registration. Sensitivity and specificity were 88.8% (605/681; 95% CI 86.4-91.2%) and 96.7% (1482/1533, 95% CI 95.8-97.6%), respectively. When multiple electronic health record sources were considered, sensitivity for cancer site increased to 91.1% (1206/1324, 95% CI 89.4-92.5%) and for cause of death 94.0% (640/681, 95% CI 91.9-95.5%). Of 1232 with cancer registration, 8.7% (107/1232) were wrongly designated as ovarian/tubal/peritoneal cancers by the registry and 4.0% (47/1172) of confirmed tubo-ovarian cancers were mis-registered. In 656 with death registrations, 7.8% (51/656) were wrongly assigned as due to ovarian/tubal/peritoneal cancers while 6.2% (40/645) of confirmed tubo-ovarian cancer deaths were mis-registered. CONCLUSION Follow-up of trial participants for tubo-ovarian cancer using national registry data will result in incomplete ascertainment, particularly of the site due in part to the latency of registration. This can be reduced by using other routinely collected data such as hospital episode statistics. Central adjudication by experts though resource intensive adds value by improving the accuracy of diagnoses. TRIAL REGISTRATION ISRCTN: ISRCTN22488978 . Registered on 6 April 2000.
Collapse
Affiliation(s)
- Jatinderpal K Kalsi
- Department of Women's Cancer, Institute for Women's Health, University College London, London, WC1E 6AU, UK
| | - Andy Ryan
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, 90 High Holborn, 2nd Floor, London, WC1V 6LJ, UK
| | - Aleksandra Gentry-Maharaj
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, 90 High Holborn, 2nd Floor, London, WC1V 6LJ, UK
| | - Danielle Margolin-Crump
- Department of Women's Cancer, Institute for Women's Health, University College London, London, WC1E 6AU, UK
| | - Naveena Singh
- Department of Cellular Pathology, Barts Health NHS Trust, London, E1 2ES, UK
| | - Matthew Burnell
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, 90 High Holborn, 2nd Floor, London, WC1V 6LJ, UK
| | | | - Sophia Apostolidou
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, 90 High Holborn, 2nd Floor, London, WC1V 6LJ, UK
| | - Mariam Habib
- Department of Women's Cancer, Institute for Women's Health, University College London, London, WC1E 6AU, UK
- Imperial Clinical Trials Unit, Imperial College London, London, W12 7RH, UK
| | - Susan Massingham
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, 90 High Holborn, 2nd Floor, London, WC1V 6LJ, UK
| | - Chloe Karpinskyj
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, 90 High Holborn, 2nd Floor, London, WC1V 6LJ, UK
| | - Robert Woolas
- Department of Gynaecological Oncology, Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK
| | - Martin Widschwendter
- Department of Women's Cancer, Institute for Women's Health, University College London, London, WC1E 6AU, UK
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Brighton, BN1 9RX, UK
| | | | - Steven Skates
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | | | - Max Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, 90 High Holborn, 2nd Floor, London, WC1V 6LJ, UK
| | - Ian Jacobs
- Department of Women's Cancer, Institute for Women's Health, University College London, London, WC1E 6AU, UK
- University of New South Wales, Sydney, NSW, 2052, Australia
| | - Usha Menon
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, 90 High Holborn, 2nd Floor, London, WC1V 6LJ, UK.
| |
Collapse
|
17
|
Gaba F, Robbani S, Singh N, McCluggage WG, Wilkinson N, Ganesan R, Bryson G, Rowlands G, Tyson C, Arora R, Saridogan E, Hanson H, Burnell M, Legood R, Evans DG, Menon U, Manchanda R. Preventing Ovarian Cancer through early Excision of Tubes and late Ovarian Removal (PROTECTOR): protocol for a prospective non-randomised multi-center trial. Int J Gynecol Cancer 2020; 31:286-291. [PMID: 32907814 DOI: 10.1136/ijgc-2020-001541] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2020] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Risk-reducing salpingo-oophorectomy is the 'gold standard' for preventing tubo-ovarian cancer in women at increased risk. However, when performed in pre-menopausal women, it results in premature menopause and associated detrimental health consequences. This, together with acceptance of the central role of the fallopian tube in etiopathogenesis of high-grade serous carcinoma, by far the most common type of tubo-ovarian cancer, has led to risk-reducing early salpingectomy with delayed oophorectomy being proposed as a two-step surgical alternative for pre-menopausal women declining/delaying oophorectomy. PRIMARY OBJECTIVE To evaluate the impact on sexual function of risk-reducing early salpingectomy, within a two-step, risk-reducing, early salpingectomy with delayed oophorectomy tubo-ovarian cancer prevention strategy in pre-menopausal women at increased risk of tubo-ovarian cancer. STUDY HYPOTHESIS Risk-reducing early salpingectomy is non-inferior for sexual and endocrine function compared with controls; risk-reducing early salpingectomy is superior for sexual/endocrine function, non-inferior for quality-of-life, and equivalent in satisfaction to the standard risk-reducing salpingo-oophorectomy. TRIAL DESIGN Multi-center, observational cohort trial with three arms: risk-reducing early salpingectomy with delayed oophorectomy; risk-reducing salpingo-oophorectomy; controls (no surgery). Consenting individuals undergo an ultrasound, serum CA125, and follicle-stimulating hormone measurements and provide information on medical history, family history, quality-of-life, sexual function, cancer worry, psychological well-being, and satisfaction/regret. Follow-up by questionnaire takes place annually for 3 years. Women receiving risk-reducing early salpingectomy can undergo delayed oophorectomy at a later date of their choosing, or definitely by the menopause. MAJOR INCLUSION/EXCLUSION CRITERIA Inclusion criteria: pre-menopausal; aged >30 years; at increased risk of tubo-ovarian cancer (mutation carriers or on the basis of a strong family history); completed their family (for surgical arms). EXCLUSION CRITERIA post-menopausal; previous bilateral salpingectomy or bilateral oophorectomy; pregnancy; previous tubal/ovarian/peritoneal malignancy; <12 months after cancer treatment; clinical suspicion of tubal/ovarian cancer at baseline. PRIMARY ENDPOINT Sexual function measured by validated questionnaires. SAMPLE SIZE 1000 (333 per arm). ESTIMATED DATES FOR COMPLETING ACCRUAL AND PRESENTING RESULTS It is estimated recruitment will be completed by 2023 and results published by 2027. TRIAL REGISTRATION NUMBER ISRCTN registry: 25 173 360 (https://doi.org/10.1186/ISRCTN25173360).
Collapse
Affiliation(s)
- Faiza Gaba
- Wolfson Institute of Preventive Medicine, Barts CRUK Cancer Centre, Queen Mary University of London, London, UK.,Department of Gynaecological Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | | | - Naveena Singh
- Barts Health NHS Trust, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - W Glenn McCluggage
- Department of Pathology, Royal Belfast Hospital; United Kingdom, Belfast, UK
| | - Nafisa Wilkinson
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Raji Ganesan
- Birmingham Women's Hospital NHS Foundation Trust, Birmingham, UK
| | | | | | | | - Rupali Arora
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ertan Saridogan
- Department of Gynaecology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Helen Hanson
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - Rosa Legood
- London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Ranjit Manchanda
- Wolfson Institute of Preventive Medicine, Barts CRUK Cancer Centre, Queen Mary University of London, London, UK .,Department of Gynaecological Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | | |
Collapse
|
18
|
Burnell M, Gentry‐Maharaj A, Glazer C, Karpinskyj C, Ryan A, Apostolidou S, Kalsi J, Parmar M, Campbell S, Jacobs I, Menon U. Serial endometrial thickness and risk of non-endometrial hormone-dependent cancers in postmenopausal women in UK Collaborative Trial of Ovarian Cancer Screening. Ultrasound Obstet Gynecol 2020; 56:267-275. [PMID: 31614036 PMCID: PMC7496247 DOI: 10.1002/uog.21894] [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] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/27/2019] [Accepted: 10/02/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Estrogen is a well-established risk factor for various cancers. It causes endometrial proliferation, which is assessed routinely as endometrial thickness (ET) using transvaginal ultrasound (TVS). Only one previous study, restricted to endometrial and breast cancer, has considered ET and the risk of non-endometrial cancer. The aim of this study was to explore the association between baseline and serial ET measurements and nine non-endometrial hormone-sensitive cancers, in postmenopausal women, using contemporary statistical methodology that attempts to minimize the biases typical of endogenous serial data. METHODS This was a cohort study nested within the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). In the ultrasound arm of UKCTOCS, 50639 postmenopausal women, aged 50-74, underwent annual TVS examination, of whom 38 105 had a valid ET measurement, no prior hysterectomy and complete covariate data, and were included in this study. All women were followed up through linkage to national cancer registries. The effect of ET on the risk of six estrogen-dependent cancers (breast, ovarian, colorectal, bladder, lung and pancreatic) was assessed using joint models for longitudinal biomarker and time-to-event data, and Cox models were used to assess the association between baseline ET measurement and these six cancers in addition to liver cancer, gastric cancer and non-Hodgkin's lymphoma (NHL). All models were adjusted for current hormone-replacement therapy (HRT) use, body mass index, age at last menstrual period, parity and oral contraceptive pill use. RESULTS The 38 105 included women had a combined total of 267 567 (median, 8; interquartile range, 5-9) valid ET measurements. During a combined total of 407 838 (median, 10.9) years of follow-up, 1398 breast, 351 endometrial, 381 lung, 495 colorectal, 222 ovarian, 94 pancreatic, 79 bladder, 62 gastric, 38 liver cancers and 52 NHLs were registered. Using joint models, a doubling of ET increased significantly the risk of breast (hazard ratio (HR), 1.21; 95% CI, 1.09-1.36; P = 0.001), ovarian (HR, 1.39; 95% CI, 1.06-1.82; P = 0.018) and lung (HR, 1.25; 95% CI, 1.02-1.54; P = 0.036) cancers. There were no statistically significant associations between ET and the remaining six cancers. CONCLUSION Postmenopausal women with high/increasing ET on TVS are at increased risk of breast, ovarian and lung cancer. It is important that clinicians are aware of these risks, as TVS is a common investigation. © 2019 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- M. Burnell
- MRC CTU, Institute of Clinical Trials and MethodologyUniversity College LondonLondonUK
| | - A. Gentry‐Maharaj
- MRC CTU, Institute of Clinical Trials and MethodologyUniversity College LondonLondonUK
| | - C. Glazer
- Department of Occupational and Environmental MedicineFrederiksberg‐Bispebjerg University HospitalCopenhagenNVDenmark
| | - C. Karpinskyj
- MRC CTU, Institute of Clinical Trials and MethodologyUniversity College LondonLondonUK
| | - A. Ryan
- MRC CTU, Institute of Clinical Trials and MethodologyUniversity College LondonLondonUK
- Department of Women's Cancer, Institute for Women's HealthUniversity College LondonLondonUK
| | - S. Apostolidou
- MRC CTU, Institute of Clinical Trials and MethodologyUniversity College LondonLondonUK
| | - J. Kalsi
- Department of Women's Cancer, Institute for Women's HealthUniversity College LondonLondonUK
| | - M. Parmar
- MRC CTU, Institute of Clinical Trials and MethodologyUniversity College LondonLondonUK
| | | | - I. Jacobs
- Department of Women's Cancer, Institute for Women's HealthUniversity College LondonLondonUK
- University of New South WalesSydneyAustralia
| | - U. Menon
- MRC CTU, Institute of Clinical Trials and MethodologyUniversity College LondonLondonUK
| |
Collapse
|
19
|
Dilley J, Burnell M, Gentry-Maharaj A, Ryan A, Neophytou C, Apostolidou S, Karpinskyj C, Kalsi J, Mould T, Woolas R, Singh N, Widschwendter M, Fallowfield L, Campbell S, Skates SJ, McGuire A, Parmar M, Jacobs I, Menon U. Ovarian cancer symptoms, routes to diagnosis and survival - Population cohort study in the 'no screen' arm of the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). Gynecol Oncol 2020; 158:316-322. [PMID: 32561125 PMCID: PMC7453382 DOI: 10.1016/j.ygyno.2020.05.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 05/03/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVE There are widespread efforts to increase symptom awareness of 'pelvic/abdominal pain, increased abdominal size/bloating, difficulty eating/feeling full and urinary frequency/urgency' in an attempt to diagnose ovarian cancer earlier. Long-term survival of women with these symptoms adjusted for known prognostic factors is yet to be determined. This study explored the association of symptoms, routes and interval to diagnosis and long-term survival in a population-based cohort of postmenopausal women diagnosed with invasive epithelial tubo-ovarian cancer (iEOC) in the 'no screen' (control) UKCTOCS arm. METHODS Of 101,299 women in the control arm, 574 were confirmed on outcome review to have iEOC between randomisation (2001-2005) and 31 December 2014. Data was extracted from medical notes and electronic records. A multivariable model was fitted for individual symptoms, time interval from symptom onset to diagnosis, route to diagnosis, speciality, morphological Type, age at diagnosis, year of diagnosis (period effect), stage, primary treatment, and residual disease. RESULTS Women presenting with symptoms listed in the NICE guidelines (HR1.48, 95%CI1.16-1.89, p = 0.001) or the modified Goff Index (HR1·68, 95%CI1·32-2.13, p < 0.0001) had significantly worse survival than those who did not. Each additional presenting symptom decreased survival (HR1·20, 95%CI1·12-1·28, p < 0.0001). In multivariable analysis, in addition to advanced stage, increasing residual disease and inadequate primary treatment, abdominal pain and loss of appetite/feeling full were significantly associated with increased mortality. CONCLUSIONS The ovarian cancer symptom indices identify postmenopausal women with a poorer prognosis. This study however cannot exclude the possibility of better outcomes in those who are aware and act on their symptoms.
Collapse
Affiliation(s)
- James Dilley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, UK
| | - Matthew Burnell
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, UK
| | - Aleksandra Gentry-Maharaj
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, UK
| | - Andy Ryan
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, UK
| | - Christina Neophytou
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, UK
| | - Sophia Apostolidou
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, UK
| | - Chloe Karpinskyj
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, UK
| | | | - Tim Mould
- University College London Hospital, UK
| | | | | | | | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, UK
| | | | - Steven J Skates
- Massachusetts General Hospital and Harvard Medical School, USA
| | | | - Mahesh Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, UK
| | - Ian Jacobs
- University of New South Wales, Australia
| | - Usha Menon
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, UK.
| |
Collapse
|
20
|
Gentry-Maharaj A, Blyuss O, Ryan A, Burnell M, Karpinskyj C, Gunu R, Kalsi JK, Dawnay A, Marino IP, Manchanda R, Lu K, Yang WL, Timms JF, Parmar M, Skates SJ, Bast RC, Jacobs IJ, Zaikin A, Menon U. Multi-Marker Longitudinal Algorithms Incorporating HE4 and CA125 in Ovarian Cancer Screening of Postmenopausal Women. Cancers (Basel) 2020; 12:E1931. [PMID: 32708856 PMCID: PMC7409061 DOI: 10.3390/cancers12071931] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/07/2020] [Accepted: 07/14/2020] [Indexed: 12/11/2022] Open
Abstract
Longitudinal CA125 algorithms are the current basis of ovarian cancer screening. We report on longitudinal algorithms incorporating multiple markers. In the multimodal arm of United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS), 50,640 postmenopausal women underwent annual screening using a serum CA125 longitudinal algorithm. Women (cases) with invasive tubo-ovarian cancer (WHO 2014) following outcome review with stored annual serum samples donated in the 5 years preceding diagnosis were matched 1:1 to controls (no invasive tubo-ovarian cancer) in terms of the number of annual samples and age at randomisation. Blinded samples were assayed for serum human epididymis protein 4 (HE4), CA72-4 and anti-TP53 autoantibodies. Multimarker method of mean trends (MMT) longitudinal algorithms were developed using the assay results and trial CA125 values on the training set and evaluated in the blinded validation set. The study set comprised of 1363 (2-5 per woman) serial samples from 179 cases and 181 controls. In the validation set, area under the curve (AUC) and sensitivity of longitudinal CA125-MMT algorithm were 0.911 (0.871-0.952) and 90.5% (82.5-98.6%). None of the longitudinal multi-marker algorithms (CA125-HE4, CA125-HE4-CA72-4, CA125-HE4-CA72-4-anti-TP53) performed better or improved on lead-time. Our population study suggests that longitudinal HE4, CA72-4, anti-TP53 autoantibodies adds little value to longitudinal serum CA125 as a first-line test in ovarian cancer screening of postmenopausal women.
Collapse
Affiliation(s)
- Aleksandra Gentry-Maharaj
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London WC1V 6LJ, UK; (A.G.-M.); (A.R.); (M.B.); (C.K.); (R.M.); (M.P.)
| | - Oleg Blyuss
- School of Physics, Astronomy and Mathematics, University of Hertfordshire, Hatfield AL10 9AB, UK;
- Department of Paediatrics and Paediatric Infectious Diseases, Sechenov First Moscow State Medical University, Moscow 119991, Russia;
| | - Andy Ryan
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London WC1V 6LJ, UK; (A.G.-M.); (A.R.); (M.B.); (C.K.); (R.M.); (M.P.)
| | - Matthew Burnell
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London WC1V 6LJ, UK; (A.G.-M.); (A.R.); (M.B.); (C.K.); (R.M.); (M.P.)
| | - Chloe Karpinskyj
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London WC1V 6LJ, UK; (A.G.-M.); (A.R.); (M.B.); (C.K.); (R.M.); (M.P.)
| | - Richard Gunu
- Department of Women’s Cancer, Institute for Women’s Health, University College London, London WC1E 6BT, UK; (R.G.); (J.K.K.); (J.F.T.); (I.J.J.)
| | - Jatinderpal K. Kalsi
- Department of Women’s Cancer, Institute for Women’s Health, University College London, London WC1E 6BT, UK; (R.G.); (J.K.K.); (J.F.T.); (I.J.J.)
| | - Anne Dawnay
- Clinical Biochemistry, Barts Health NHS Trust, London E1 8PR, UK;
| | - Ines P. Marino
- Department of Biology and Geology, Physics and Inorganic Chemistry, Universidad Rey Juan Carlos, 28933 Madrid, Spain;
| | - Ranjit Manchanda
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London WC1V 6LJ, UK; (A.G.-M.); (A.R.); (M.B.); (C.K.); (R.M.); (M.P.)
- Wolfson Institute of Preventive Medicine, Barts CRUK Cancer Centre, Queen Mary University of London, London EC1M 6BQ, UK
- Department of Gynaecological Oncology, St Bartholomew’s Hospital, Barts Health NHS Trust, London EC1A 7BE, UK
| | - Karen Lu
- University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA; (K.L.); (W.-L.Y.); (R.C.B.J.)
| | - Wei-Lei Yang
- University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA; (K.L.); (W.-L.Y.); (R.C.B.J.)
| | - John F. Timms
- Department of Women’s Cancer, Institute for Women’s Health, University College London, London WC1E 6BT, UK; (R.G.); (J.K.K.); (J.F.T.); (I.J.J.)
| | - Mahesh Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London WC1V 6LJ, UK; (A.G.-M.); (A.R.); (M.B.); (C.K.); (R.M.); (M.P.)
| | - Steven J. Skates
- Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA;
| | - Robert C. Bast
- University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA; (K.L.); (W.-L.Y.); (R.C.B.J.)
| | - Ian J. Jacobs
- Department of Women’s Cancer, Institute for Women’s Health, University College London, London WC1E 6BT, UK; (R.G.); (J.K.K.); (J.F.T.); (I.J.J.)
- University of New South Wales, Sydney 2052, Australia
| | - Alexey Zaikin
- Department of Paediatrics and Paediatric Infectious Diseases, Sechenov First Moscow State Medical University, Moscow 119991, Russia;
- Department of Women’s Cancer, Institute for Women’s Health, University College London, London WC1E 6BT, UK; (R.G.); (J.K.K.); (J.F.T.); (I.J.J.)
- Department of Applied Mathematics, Lobachevsky University of Nyzhniy Novgorod, Nizhniy Novgorod 603105, Russia
- Department of Mathematics, University College London, London WC1H 0AY, UK
| | - Usha Menon
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London WC1V 6LJ, UK; (A.G.-M.); (A.R.); (M.B.); (C.K.); (R.M.); (M.P.)
| |
Collapse
|
21
|
Trembling PM, Apostolidou S, Gentry-Maharaj A, Parkes J, Ryan A, Tanwar S, Burnell M, Harris S, Menon U, Rosenberg WM. The Enhanced Liver Fibrosis test is associated with liver-related outcomes in postmenopausal women with risk factors for liver disease. BMC Gastroenterol 2020; 20:104. [PMID: 32293289 PMCID: PMC7158048 DOI: 10.1186/s12876-020-01251-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 03/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic liver disease (CLD) is usually asymptomatic but earlier detection is critical to permit life-saving interventions for those at risk due to high alcohol consumption and increased body mass index (BMI). The aim of this study was to estimate the association between the Enhanced Liver Fibrosis (ELF) test and liver-related events (LRE) and its performance in predicting LRE in postmenopausal women with risk factors in a nested case-control study within the United Kingdom Trial of Ovarian Cancer Screening (UKCTOCS). METHODS In a cohort of 95,126 we performed a case-control study measuring ELF in blinded samples from 173 participants with self-reported high alcohol use and / or BMI ≥25 kg/m2 comprising all 58 cases who developed LRE and 115 controls matched for age, alcohol and BMI who did not develop LRE during median follow-up of 8.5 years. RESULTS Using Cox regression at an ELF threshold of 10.51 hazard ratios (HR) for LRE were 4.88 (95% confidence interval (CI) 2.37-10.03) (unadjusted model) and 4.62 (95% CI 2.12-10.08) (adjusted for deprivation and self-reported hypertension, heart disease, hypercholesterolaemia and diabetes). At a threshold of 9.8 HR for LRE were 2.21 (95% CI 1.22-3.97) (unadjusted model) and 2.18 (95% CI 1.19-4.01) (adjusted). ELF was evaluated as a time dependent variable by generating time-dependent Cox models; HRs at an ELF threshold of 10.51 were 1.94 (95% CI 1.10-3.39) (unadjusted) and 2.05 (95% CI 1.16-3.64) (adjusted) and at a threshold of 9.8 HRs were 1.85 (95% CI 1.09-3.15) (unadjusted) and 1.80 (95% CI 1.04-3.13) (adjusted). Area under the receiver operating characteristic curve for recruitment ELF predicting LRE was 0.58 (95% CI 0.49-0.68), and for second subsequent ELF 0.61 (95% CI 0.52-0.71). CONCLUSION This study demonstrates the association between ELF and CLD in postmenopausal women with risk factors for liver disease, creating the opportunity to intervene to reduce liver-related mortality and morbidity. Although larger studies are required, these results demonstrate the potential of ELF as a prognostic tool in health checks in primary care. TRIAL REGISTRATION This study is nested in UKCTOCS. UKCTOCS is registered as an International Standard Randomised Controlled Trial, number ISRCTN22488978. Registered 06/04/2000.
Collapse
Affiliation(s)
- Paul M. Trembling
- Division of Medicine, University College London, Institute for Liver and Digestive Health, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF UK
| | - Sophia Apostolidou
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, Faculty of Population Health Sciences, University College London, 2nd Floor, 90 High Holborn, London, WC1V 6LJ UK
| | - Aleksandra Gentry-Maharaj
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, Faculty of Population Health Sciences, University College London, 2nd Floor, 90 High Holborn, London, WC1V 6LJ UK
| | - Julie Parkes
- Primary Care and Population Sciences Academic Unit, Faculty of Medicine, University of Southampton, Level C, South Academic Block, University Hospital Southampton, Southampton, SO16 6YD UK
| | - Andy Ryan
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, Faculty of Population Health Sciences, University College London, 2nd Floor, 90 High Holborn, London, WC1V 6LJ UK
| | - Sudeep Tanwar
- Division of Medicine, University College London, Institute for Liver and Digestive Health, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF UK
| | - Matthew Burnell
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, Faculty of Population Health Sciences, University College London, 2nd Floor, 90 High Holborn, London, WC1V 6LJ UK
| | - Scott Harris
- Primary Care and Population Sciences Academic Unit, Faculty of Medicine, University of Southampton, Level C, South Academic Block, University Hospital Southampton, Southampton, SO16 6YD UK
| | - Usha Menon
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, Faculty of Population Health Sciences, University College London, 2nd Floor, 90 High Holborn, London, WC1V 6LJ UK
| | - William M. Rosenberg
- Division of Medicine, University College London, Institute for Liver and Digestive Health, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF UK
| |
Collapse
|
22
|
Gentry-Maharaj A, Burnell M, Dilley J, Ryan A, Karpinskyj C, Gunu R, Mallett S, Deeks J, Campbell S, Jacobs I, Sundar S, Menon U. Serum HE4 and diagnosis of ovarian cancer in postmenopausal women with adnexal masses. Am J Obstet Gynecol 2020; 222:56.e1-56.e17. [PMID: 31351062 PMCID: PMC7471839 DOI: 10.1016/j.ajog.2019.07.031] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/15/2019] [Accepted: 07/18/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Transvaginal ultrasound and serum CA125 are routinely used for differential diagnosis of pelvic adnexal mass. Use of human epididymis 4 was approved in the United States in 2011. However, there is scarcity of studies evaluating the additional value of human epididymis 4. OBJECTIVE The objective of the study was to evaluate the performance characteristics of transvaginal ultrasound, CA125, and human epididymis 4 for differential diagnosis of ovarian cancer in postmenopausal women with adnexal masses. STUDY DESIGN This was a cohort study nested within the screen arms of the multicenter randomized controlled trial, United Kingdom Collaborative Trial of Ovarian Cancer Screening, based in England, Wales, and Northern Ireland. In United Kingdom Collaborative Trial of Ovarian Cancer Screening, 48,230 women randomized to transvaginal ultrasound screening and 50,078 to multimodal screening (serum CA125 interpreted by Risk of Ovarian Cancer Algorithm with second line transvaginal ultrasound) underwent the first (prevalence) screen. Women with adnexal lesions and/or persistently elevated risk were clinically assessed and underwent surgery or follow-up for a median of 10.9 years. Banked samples taken within 6 months of transvaginal ultrasound from all clinically assessed women were assayed for human epididymis 4 and CA125. Area under the curve and sensitivity for diagnosing ovarian cancer of multiple penalized logistic regression models incorporating logCA125, log human epididymis 4, age, and simple ultrasound features of the adnexal mass were compared. RESULTS Of 1590 (158 multimodal, 1432 ultrasound) women with adnexal masses, 78 were diagnosed with ovarian cancer (48 invasive epithelial ovarian, 14 type I, 34 type II; 24 borderline epithelial; 6 nonepithelial) within 1 year of scan. The area under the curve (0.893 vs 0.896; P = .453) and sensitivity (74.4% vs 75.6% ;P = .564) at fixed specificity of 90% of the model incorporating age, ultrasound, and CA125 were similar to that also including human epididymis 4. Both models had high sensitivity for invasive epithelial ovarian (89.6%) and type II (>91%) cancers. CONCLUSION Our population cohort study suggests that human epididymis 4 adds little value to concurrent use of CA125 and transvaginal ultrasound in the differential diagnosis of adnexal masses in postmenopausal women.
Collapse
Affiliation(s)
- Aleksandra Gentry-Maharaj
- Medical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials and Methodology, University College London, London
| | - Matthew Burnell
- Medical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials and Methodology, University College London, London
| | - James Dilley
- Medical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials and Methodology, University College London, London
| | - Andy Ryan
- Medical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials and Methodology, University College London, London; Department of Women's Cancer, Institute for Women's Health, University College London, London
| | - Chloe Karpinskyj
- Medical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials and Methodology, University College London, London
| | - Richard Gunu
- Department of Women's Cancer, Institute for Women's Health, University College London, London
| | - Susan Mallett
- Institute of Applied Health Research, University of Birmingham, Birmingham, London
| | - Jon Deeks
- Institute of Applied Health Research, University of Birmingham, Birmingham, London
| | | | - Ian Jacobs
- Department of Women's Cancer, Institute for Women's Health, University College London, London; University of New South Wales, Sydney, New South Wales, Australia
| | - Sudha Sundar
- Pan Birmingham Gynaecological Cancer Centre, School of Cancer Sciences, City Hospital, Birmingham, United Kingdom
| | - Usha Menon
- Medical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials and Methodology, University College London, London.
| |
Collapse
|
23
|
Manchanda R, Burnell M, Gaba F, Desai R, Wardle J, Gessler S, Side L, Sanderson S, Loggenberg K, Brady AF, Dorkins H, Wallis Y, Chapman C, Jacobs C, Legood R, Beller U, Tomlinson I, Menon U, Jacobs I. Randomised trial of population‐based
BRCA
testing in Ashkenazi Jews: long‐term outcomes. BJOG 2019; 127:364-375. [PMID: 31507061 DOI: 10.1111/1471-0528.15905] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2019] [Indexed: 12/31/2022]
Affiliation(s)
- R Manchanda
- Wolfson Institute of Preventive Medicine Barts Cancer Institute Queen Mary University of London London UK
- Department of Gynaecological Oncology St Bartholomew's Hospital London UK
- MRC Clinical Trials Unit University College London London UK
| | - M Burnell
- MRC Clinical Trials Unit University College London London UK
| | - F Gaba
- Wolfson Institute of Preventive Medicine Barts Cancer Institute Queen Mary University of London London UK
| | - R Desai
- MRC Clinical Trials Unit University College London London UK
| | - J Wardle
- Behavioural Sciences Unit Department of Epidemiology and Public Health University College London London UK
| | - S Gessler
- MRC Clinical Trials Unit University College London London UK
| | - L Side
- University Hospital Southampton NHS Foundation Trust Southampton UK
| | - S Sanderson
- Behavioural Sciences Unit Department of Epidemiology and Public Health University College London London UK
| | - K Loggenberg
- North East Thames Regional Genetics Unit Department of Clinical Genetics Great Ormond Street Hospital London UK
| | - AF Brady
- North West Thames Regional Genetics Service Northwick Park Hospital Harrow UK
| | - H Dorkins
- St Peter's College University of Oxford Oxford UK
| | - Y Wallis
- West Midlands Regional Genetics Laboratory Birmingham Women's NHS Foundation Trust Birmingham UK
| | - C Chapman
- West Midlands Regional Genetics Service Department of Clinical Genetics Birmingham Women's NHS Foundation Trust Birmingham UK
| | - C Jacobs
- Department of Clinical Genetics Guy's Hospital London UK
- University of Technology Sydney Sydney NSW Australia
| | - R Legood
- Department of Health Services Research and Policy London School of Hygiene and Tropical Medicine London UK
| | - U Beller
- Department of Gynaecology Shaare Zedek Medical Centre Jerusalem Israel
| | - I Tomlinson
- Institute of Cancer and Genomic Sciences University of Birmingham Birmingham UK
| | - U Menon
- MRC Clinical Trials Unit University College London London UK
| | - I Jacobs
- University of New South Wales UNSW Sydney Sydney NSW Australia
| |
Collapse
|
24
|
Manchanda R, Burnell M, Gaba F, Sanderson S, Loggenberg K, Gessler S, Wardle J, Side L, Desai R, Brady AF, Dorkins H, Wallis Y, Chapman C, Jacobs C, Tomlinson I, Beller U, Menon U, Jacobs I. Attitude towards and factors affecting uptake of population-based BRCA testing in the Ashkenazi Jewish population: a cohort study. BJOG 2019; 126:784-794. [PMID: 30767407 DOI: 10.1111/1471-0528.15654] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate factors affecting unselected population-based BRCA testing in Ashkenazi Jews (AJ). DESIGN Cohort-study set within recruitment to the GCaPPS trial (ISRCTN73338115). SETTING North London AJ population. POPULATION OR SAMPLE Ashkenazi Jews women/men >18 years, recruited through self-referral. METHODS Ashkenazi Jews women/men underwent pre-test counselling for BRCA testing through recruitment clinics (clusters). Consenting individuals provided blood samples for BRCA testing. Data were collected on socio-demographic/family history/knowledge/psychological well-being along with benefits/risks/cultural influences (18-item questionnaire measuring 'attitude'). Four-item Likert-scales analysed initial 'interest' and 'intention-to-test' pre-counselling. Uni- and multivariable logistic regression models evaluated factors affecting uptake/interest/intention to undergo BRCA testing. Statistical inference was based on cluster robust standard errors and joint Wald tests for significance. Item-Response Theory and graded-response models modelled responses to 18-item questionnaire. MAIN OUTCOME MEASURES Interest, intention, uptake, attitude towards BRCA testing. RESULTS A total of 935 individuals (women = 67%/men = 33%; mean age = 53.8 (SD = 15.02) years) underwent pre-test genetic-counselling. During the pre-counselling, 96% expressed interest in and 60% indicated a clear intention to undergo BRCA testing. Subsequently, 88% opted for BRCA testing. BRCA-related knowledge (P = 0.013) and degree-level education (P = 0.01) were positively and negatively (respectively) associated with intention-to-test. Being married/cohabiting had four-fold higher odds for BRCA testing uptake (P = 0.009). Perceived benefits were associated with higher pre-counselling odds for interest in and intention to undergo BRCA testing. Reduced uncertainty/reassurance were the most important factors contributing to decision-making. Increased importance/concern towards risks/limitations (confidentiality/insurance/emotional impact/inability to prevent cancer/marriage ability/ethnic focus/stigmatisation) were significantly associated with lower odds of uptake of BRCA testing, and discriminated between acceptors and decliners. Male gender/degree-level education (P = 0.001) had weaker correlations, whereas having children showed stronger (P = 0.005) associations with attitudes towards BRCA testing. CONCLUSIONS BRCA testing in the AJ population has high acceptability. Pre-test counselling increases awareness of disadvantages/limitations of BRCA testing, influencing final cost-benefit perception and decision-making on undergoing testing. TWEETABLE ABSTRACT BRCA testing in Ashkenazi Jews has high acceptability and uptake. Pre-test counselling facilitates informed decision-making.
Collapse
Affiliation(s)
- R Manchanda
- Barts Cancer Institute, Queen Mary University of London, London, UK
- Department of Gynaecological Oncology, St Bartholomew's Hospital, London, UK
| | - M Burnell
- MRC Clinical Trials Unit, University College London, London, UK
| | - F Gaba
- Barts Cancer Institute, Queen Mary University of London, London, UK
- Department of Gynaecological Oncology, St Bartholomew's Hospital, London, UK
| | - S Sanderson
- Behavioural Sciences Unit, Department of Epidemiology and Public Health, University College London, London, UK
| | - K Loggenberg
- Department of Clinical Genetics, North East Thames Regional Genetics Unit, Great Ormond Street Hospital, London, UK
| | - S Gessler
- MRC Clinical Trials Unit, University College London, London, UK
| | - J Wardle
- Behavioural Sciences Unit, Department of Epidemiology and Public Health, University College London, London, UK
| | - L Side
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - R Desai
- MRC Clinical Trials Unit, University College London, London, UK
| | - A F Brady
- Department of Clinical Genetics, North West Thames Regional Genetics Unit, Northwick Park Hospital, London, UK
| | - H Dorkins
- St Peter's College, University of Oxford, Oxford, UK
| | - Y Wallis
- West Midlands Regional Genetics Laboratory, Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | - C Chapman
- Department of Clinical Genetics, West Midlands Regional Genetics Service, Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | - C Jacobs
- Department of Clinical Genetics, Guy's Hospital, London, UK
- University of Technology Sydney, Sydney, NSW, Australia
| | - I Tomlinson
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - U Beller
- Department of Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - U Menon
- MRC Clinical Trials Unit, University College London, London, UK
| | - I Jacobs
- University of New South Wales, UNSW Sydney, Sydney, NSW, Australia
| |
Collapse
|
25
|
Koutoukidis DA, Beeken RJ, Manchanda R, Burnell M, Ziauddeen N, Michalopoulou M, Knobf MT, Lanceley A. Diet, physical activity, and health-related outcomes of endometrial cancer survivors in a behavioral lifestyle program: the Diet and Exercise in Uterine Cancer Survivors (DEUS) parallel randomized controlled pilot trial. Int J Gynecol Cancer 2019; 29:531-540. [PMID: 30723098 DOI: 10.1136/ijgc-2018-000039] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 03/21/2018] [Revised: 08/18/2018] [Accepted: 08/31/2018] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To explore the effectiveness of a theory-based behavioral lifestyle intervention on health behaviors and quality of life in endometrial cancer survivors.' METHODS This was a secondary analysis of a randomized controlled pilot trial conducted in two UK hospitals enrolling disease-free stage I-IVA endometrial cancer survivors. Participants were allocated to an 8-week group-based healthy eating and physical activity intervention or usual care using 1:1 minimization. Participants were followed up at 8 and 24 weeks, with the 8-week assessment being blinded. Diet, physical activity, and quality of life were measured with the Alternative Healthy Eating Index 2010, Stanford 7-Day Physical Activity Recall, and the EORTC Quality of life Questionnaire Core 30, respectively. We analyzed all eligible participants using the intention-to-treat approach in complete cases, adjusting for baseline values, body mass index, and age. RESULTS We enrolled 60 of the 296 potentially eligible endometrial cancer survivors (May - December 2015). Fifty-four eligible participants were randomized to the intervention (n=29) or usual care (n=31), and 49 had complete follow-up data (n=24 in the intervention and n= 25 in usual care). Intervention adherence was 77%. At 8 weeks, participants in the intervention improved their diet compared to usual care (difference in Alternative Healthy Eating Index 2010 score 7.5 (95% CI: 0.1 to 14.9), P=0.046) but not their physical activity (0.1 metabolic equivalent-h/day 95% CI: (-1.6 to 1.8), P=0.879), or global quality of life score (5.0 (95% CI: -3.4 to 13.3), P=0.236). Global quality of life improved in intervention participants at 24 weeks (difference 8.9 (95% CI: 0.9 to 16.8), P=0.029). No intervention-related adverse events were reported. CONCLUSIONS The potential effectiveness of the intervention appeared promising. A future fully-powered study is needed to confirm these findings. TRIAL REGISTRATION NUMBER NCT02433080.
Collapse
Affiliation(s)
- Dimitrios A Koutoukidis
- Department of Women's Cancer, EGA Institute for Women's Health, University College London, London, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Rebecca J Beeken
- Department of Behavioural Science and Health, University College London, London, UK
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Ranjit Manchanda
- Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, London, UK
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Matthew Burnell
- Department of Women's Cancer, EGA Institute for Women's Health, University College London, London, UK
| | - Nida Ziauddeen
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, University of Cambridge, Cambridge, UK
- Academic Unit of Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Moscho Michalopoulou
- Department of Women's Cancer, EGA Institute for Women's Health, University College London, London, UK
- Department of Behavioural Science and Health, University College London, London, UK
| | - M Tish Knobf
- Department of Women's Cancer, EGA Institute for Women's Health, University College London, London, UK
- Acute Care/Health Systems Division, Yale University School of Nursing, West Haven, Connecticut, USA
| | - Anne Lanceley
- Department of Women's Cancer, EGA Institute for Women's Health, University College London, London, UK
| |
Collapse
|
26
|
Thomas DS, Gentry-Maharaj A, Ryan A, Fourkala EO, Apostolidou S, Burnell M, Alderton W, Barnes J, Timms JF, Menon U. Colorectal cancer ascertainment through cancer registries, hospital episode statistics, and self-reporting compared to confirmation by clinician: A cohort study nested within the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). Cancer Epidemiol 2019; 58:167-174. [PMID: 30616086 PMCID: PMC6363963 DOI: 10.1016/j.canep.2018.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 11/19/2018] [Accepted: 11/27/2018] [Indexed: 01/22/2023]
Abstract
Ninety-two & 99% of colorectal cancers were registered after one & six years. Hospital Episode Statistics tend to capture events unregistered after one year. Self-reporting by women aged ≥50 was less reliable and had low respondents. Electronic health records in the UK are suitable for studying colorectal cancer in women.
Background Electronic health records are frequently used for cancer epidemiology. We report on their quality for ascertaining colorectal cancer (CRC) in UK women. Methods Population-based, retrospective cohort study nested within the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). Postmenopausal women aged 50–74 who were diagnosed with CRC during 2001–11 following randomisation to the UKCTOCS were identified and their diagnosis confirmed with their treating clinician. The sensitivity and positive predictive value (PPV) of cancer and death registries, hospital episode statistics, and self-reporting were calculated by pairwise comparisons to the treating clinician’s confirmation, while specificity and negative predictive value were estimated relative to expected cases. Results Notification of CRC events were received for 1,085 women as of 24 May 2011. Responses were received from 61% (660/1,085) of clinicians contacted. Nineteen women were excluded (18 no diagnosis date, one diagnosed after cut-off). Of the 641 eligible, 514 had CRC, 24 had a benign polyp, and 103 had neither diagnosis. The sensitivity of cancer registrations at one- and six-years post-diagnosis was 92 (95% CI 90–94) and 99% (97–100), respectively, with a PPV of 95% (95% CI 92/93–97). The sensitivity & PPV of cancer registrations (at one-year post-diagnosis) & hospital episode statistics combined were 98 (96–99) and 92% (89–94), respectively. Conclusions Cancer and death registrations in the UK are a reliable resource for CRC ascertainment in women. Hospital episode statistics can supplement delays in cancer registration. Self-reporting seems less reliable.
Collapse
Affiliation(s)
- Darren S Thomas
- Women's Cancer, Institute for Women's Health, University College London, London WC1E 6BT, UK
| | - Aleksandra Gentry-Maharaj
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, London WC1V 6LJ, UK
| | - Andy Ryan
- Women's Cancer, Institute for Women's Health, University College London, London WC1E 6BT, UK; MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, London WC1V 6LJ, UK
| | | | - Sophia Apostolidou
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, London WC1V 6LJ, UK
| | - Matthew Burnell
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, London WC1V 6LJ, UK
| | | | | | - John F Timms
- Women's Cancer, Institute for Women's Health, University College London, London WC1E 6BT, UK
| | - Usha Menon
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, London WC1V 6LJ, UK.
| |
Collapse
|
27
|
Stott W, Gentry-Maharaj A, Ryan A, Amso N, Seif M, Jones C, Jacobs I, Parmar M, Menon U, Campbell S, Burnell M. Audit of transvaginal sonography of normal postmenopausal ovaries by sonographers from the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). F1000Res 2018; 7:1241. [PMID: 30345030 PMCID: PMC6173132 DOI: 10.12688/f1000research.15663.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2018] [Indexed: 01/12/2023] Open
Abstract
Background: We report on a unique audit of seven sonographers self-reporting high visualization rates of normal postmenopausal ovaries in the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). This audit was ordered by the trial's Ultrasound Management Subcommittee after an initiative taken in 2008 to improve the quality of scanning and the subsequent increase in the number of sonographers claiming very high ovary visualisation rates. Methods: Seven sonographers reporting high rates (>89%) of visualizing normal postmenopausal ovaries in examinations performed between 1 st January and 31 st December 2008 were identified. Eight experts in gynaecological scanning reviewed a random selection of exams performed by these sonographers and assessed whether visualization of both ovaries could be confirmed (cVR-Both) in the examinations. A random effects bivariate probit model was fitted to analyse the results. Results: The eight experts reviewed images from 357 examinations performed on 349 postmenopausal women (mean age 60.0 years, range 50.2-73.3) by the seven sonographers. The mean cVR-Both obtained from the model for these sonographers was 67.2% with a range of 47.6-86.5% (95%CI 63.9-70.5%). The range of cVR-Both between the experts was 47.3-88.3% and the intra-class correlation coefficient (ICC) for left and right ovary confirmation was 0.39. Conclusions: The audit suggests that self-reported visualization of postmenopausal ovaries is unreliable, as visualisation of both ovaries could not be confirmed in almost a third of examinations. The agreement for visualization of both ovaries based on review of a static image between experts and sonographers and between expert reviewers alone was only moderate. Further research is needed to develop reliable Quality Control metrics for transvaginal ultrasound.
Collapse
Affiliation(s)
- Will Stott
- Gynaecological Oncology, UCL EGA Institute of Women's Health, London, WC1E 6BT, UK
| | | | - Andy Ryan
- Gynaecological Oncology, UCL EGA Institute of Women's Health, London, WC1E 6BT, UK
| | - Nazar Amso
- Department of Obstetrics and Gynaecology, School of Medicine, Cardiff University, Cardiff, CF14 4XN, UK
| | - Mourad Seif
- Academic Unit of Obstetrics and Gynaecology, St. Mary’s Hospital, Manchester, UK
| | - Chris Jones
- Gynaecological Oncology, UCL EGA Institute of Women's Health, London, WC1E 6BT, UK
| | - Ian Jacobs
- Gynaecological Oncology, UCL EGA Institute of Women's Health, London, WC1E 6BT, UK
- University of New South Wales, Sydney, NSW, 2052, Australia
| | - Max Parmar
- Medical Research Council Clinical Trials Unit, University College London, London, WC1V 6LJ, UK
| | - Usha Menon
- Gynaecological Oncology, UCL EGA Institute of Women's Health, London, WC1E 6BT, UK
| | | | - Matthew Burnell
- Gynaecological Oncology, UCL EGA Institute of Women's Health, London, WC1E 6BT, UK
| |
Collapse
|
28
|
Manchanda R, Blyuss O, Gaba F, Gordeev VS, Jacobs C, Burnell M, Gan C, Taylor R, Turnbull C, Legood R, Zaikin A, Antoniou AC, Menon U, Jacobs I. Current detection rates and time-to-detection of all identifiable BRCA carriers in the Greater London population. J Med Genet 2018; 55:538-545. [PMID: 29622727 DOI: 10.1136/jmedgenet-2017-105195] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [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: 12/03/2017] [Revised: 03/19/2018] [Accepted: 03/22/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND BRCA carrier identification offers opportunities for early diagnoses, targeted treatment and cancer prevention. We evaluate BRCA- carrier detection rates in general and Ashkenazi Jewish (AJ) populations across Greater London and estimate time-to-detection of all identifiable BRCA carriers. METHODS BRCA carrier data from 1993 to 2014 were obtained from National Health Service genetic laboratories and compared with modelled predictions of BRCA prevalence from published literature and geographical data from UK Office for National Statistics. Proportion of BRCA carriers identified was estimated. Prediction models were developed to fit BRCA detection rate data. BRCA carrier identification rates were evaluated for an 'Angelina Jolie effect'. Maps for four Greater London regions were constructed, and their relative BRCA detection rates were compared. Models developed were used to predict future time-to-identify all detectable BRCA carriers in AJ and general populations. RESULTS Until 2014, only 2.6% (3072/111 742 estimated) general population and 10.9% (548/4985 estimated) AJ population BRCA carriers have been identified in 16 696 608 (AJ=190 997) Greater London population. 57% general population and 54% AJ mutations were identified through cascade testing. Current detection rates mirror linear fit rather than parabolic model and will not identify all BRCA carriers. Addition of unselected ovarian/triple-negative breast cancer testing would take >250 years to identify all BRCA carriers. Doubling current detection rates can identify all 'detectable' BRCA carriers in the general population by year 2181, while parabolic and triple linear rates can identify 'detectable' BRCA carriers by 2084 and 2093, respectively. The linear fit model can identify 'detectable' AJ carriers by 2044. We did not find an Angelina Jolie effect on BRCA carrier detection rates. There was a significant difference in BRCA detection rates between geographical regions over time (P<0.001). CONCLUSIONS The majority of BRCA carriers have not been identified, missing key opportunities for prevention/earlier diagnosis. Enhanced and new strategies/approaches are needed.
Collapse
Affiliation(s)
- Ranjit Manchanda
- Barts Cancer Institute, Queen Mary University of London, London, UK
- Department of Gynaecological Oncology, St Bartholomew's Hospital, London, UK
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - Oleg Blyuss
- Department of Mathematics and Department of Women's Cancer, University College London, London, UK
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Faiza Gaba
- Barts Cancer Institute, Queen Mary University of London, London, UK
- Department of Gynaecological Oncology, St Bartholomew's Hospital, London, UK
| | | | - Chris Jacobs
- Department of Clinical Genetics, Guy's Hospital, London, UK
- Graduate School of Health, University of Technology, Sydney, New South Wales, Australia
| | - Matthew Burnell
- Department of Mathematics and Department of Women's Cancer, University College London, London, UK
| | - Carmen Gan
- Department of Gynaecological Oncology, St Bartholomew's Hospital, London, UK
| | - Rohan Taylor
- South West Thames Molecular Genetics Diagnostic Laboratory, St George's University of London, London, UK
| | - Clare Turnbull
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Rosa Legood
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Alexey Zaikin
- Department of Mathematics and Department of Women's Cancer, University College London, London, UK
| | - Antonis C Antoniou
- Centre for Cancer Genetic Epidemiology, University of Cambridge, Strangeways Research Laboratory, Cambridge, UK
| | - Usha Menon
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - Ian Jacobs
- University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
29
|
Blyuss O, Burnell M, Ryan A, Gentry-Maharaj A, Mariño IP, Kalsi J, Manchanda R, Timms JF, Parmar M, Skates SJ, Jacobs I, Zaikin A, Menon U. Comparison of Longitudinal CA125 Algorithms as a First-Line Screen for Ovarian Cancer in the General Population. Clin Cancer Res 2018; 24:4726-4733. [PMID: 30084833 DOI: 10.1158/1078-0432.ccr-18-0208] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 05/01/2018] [Accepted: 06/28/2018] [Indexed: 12/31/2022]
Abstract
Purpose: In the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS), women in the multimodal (MMS) arm had a serum CA125 test (first-line), with those at increased risk, having repeat CA125/ultrasound (second-line test). CA125 was interpreted using the "Risk of Ovarian Cancer Algorithm" (ROCA). We report on performance of other serial algorithms and a single CA125 threshold as a first-line screen in the UKCTOCS dataset.Experimental Design: 50,083 post-menopausal women who attended 346,806 MMS screens were randomly split into training and validation sets, following stratification into cases (ovarian/tubal/peritoneal cancers) and controls. The two longitudinal algorithms, a new serial algorithm, method of mean trends (MMT) and the parametric empirical Bayes (PEB) were trained in the training set and tested in the blinded validation set and the performance characteristics, including that of a single CA125 threshold, were compared.Results: The area under receiver operator curve (AUC) was significantly higher (P = 0.01) for MMT (0.921) compared with CA125 single threshold (0.884). At a specificity of 89.5%, sensitivities for MMT [86.5%; 95% confidence interval (CI), 78.4-91.9] and PEB (88.5%; 95% CI, 80.6-93.4) were similar to that reported for ROCA (sensitivity 87.1%; specificity 87.6%; AUC 0.915) and significantly higher than the single CA125 threshold (73.1%; 95% CI, 63.6-80.8).Conclusions: These findings from the largest available serial CA125 dataset in the general population provide definitive evidence that longitudinal algorithms are significantly superior to simple cutoff values for ovarian cancer screening. Use of these newer algorithms requires incorporation into a multimodal strategy. The results highlight the importance of incorporating serial change in biomarker levels in cancer screening/early detection strategies. Clin Cancer Res; 24(19); 4726-33. ©2018 AACR.
Collapse
Affiliation(s)
- Oleg Blyuss
- Women's Cancer, Institute for Women's Health, University College London, Gower Street, London, United Kingdom
| | - Matthew Burnell
- Women's Cancer, Institute for Women's Health, University College London, Gower Street, London, United Kingdom
| | - Andy Ryan
- Women's Cancer, Institute for Women's Health, University College London, Gower Street, London, United Kingdom
| | - Aleksandra Gentry-Maharaj
- Women's Cancer, Institute for Women's Health, University College London, Gower Street, London, United Kingdom
| | - Inés P Mariño
- Women's Cancer, Institute for Women's Health, University College London, Gower Street, London, United Kingdom.,Departamento de Biología y Geología, Física y Química Inorgánica, Universidad Rey Juan Carlos, Madrid, Spain
| | - Jatinderpal Kalsi
- Women's Cancer, Institute for Women's Health, University College London, Gower Street, London, United Kingdom
| | - Ranjit Manchanda
- Women's Cancer, Institute for Women's Health, University College London, Gower Street, London, United Kingdom.,Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London
| | - John F Timms
- Women's Cancer, Institute for Women's Health, University College London, Gower Street, London, United Kingdom
| | - Mahesh Parmar
- Medical Research Council Clinical Trials Unit at UCL, London, United Kingdom
| | | | - Ian Jacobs
- Women's Cancer, Institute for Women's Health, University College London, Gower Street, London, United Kingdom.,Faculty of Medical and Human Sciences, 1.018 Core Technology Facility, University of Manchester, Manchester, United Kingdom.,Faculty of Medicine, UNSW Sydney, Kensington High Street, Sydney, Australia
| | - Alexey Zaikin
- Women's Cancer, Institute for Women's Health, University College London, Gower Street, London, United Kingdom.,Department of Mathematics, University College London, London, United Kingdom
| | - Usha Menon
- Women's Cancer, Institute for Women's Health, University College London, Gower Street, London, United Kingdom.
| |
Collapse
|
30
|
Trembling PM, Apostolidou S, Gentry-Maharaj A, Parkes J, Ryan A, Tanwar S, Burnell M, Menon U, Rosenberg WM. Association between skirt size and chronic liver disease in post-menopausal women: a prospective cohort study within the United Kingdom Trial of Ovarian Cancer Screening (UKCTOCS). BMC Public Health 2018; 18:409. [PMID: 29587697 PMCID: PMC5870222 DOI: 10.1186/s12889-018-5308-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 03/13/2018] [Indexed: 11/25/2022] Open
Abstract
Background We investigated the association between self-reported skirt size (SS) and change in SS, and incidence of chronic liver disease (CLD) in a prospective cohort study of women recruited to the UKCTOCS trial. Methods Women recruited to UKCTOCS in England without documented CLD self-reported their current UK SS during trial participation and were asked to recall their SS when aged in 20s (via completion of a questionnaire 3–5 years after recruitment). Participants were followed up via electronic health record linkage and hazard ratios (HR) calculated for incident liver-related events (LRE). Results Three hundred twenty-two (0.3%) of 94,124 women experienced a first LRE. Compared to SS ≤ 16, rates of LRE were higher in the SS ≥ 18 groups (both when aged in 20s and at questionnaire completion). Event rates were higher if there was no change in SS or an increase in SS, compared to a decrease in SS. In the models adjusted for potential confounders, HRs for LRE were higher in the groups of women reporting SS ≥ 18 both when aged in 20s (HR = 1.39 (95% CI; 0.87–2.23)) and at questionnaire completion (HR = 1.37 (95% CI; 1.07–1.75)). Compared to a decrease in SS, HRs were higher in the no change (HR = 1.78 (95% CI; 0.95–3.34)) and increase (HR = 1.80 (95% CI; 1.01–3.21)) groups. Conclusion CLD is associated with high SS and an increase in SS over time. These data suggest SS can be used in simple public health messages about communicating the risk of liver disease. Trial Registration UKCTOCS is registered as an International Standard Randomised Controlled Trial, number ISRCTN22488978. Registered 06/04/2000. Electronic supplementary material The online version of this article (10.1186/s12889-018-5308-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- P M Trembling
- Institute for Liver and Digestive Health, Division of Medicine, University College London, Royal Free Hospital, Rowland Hill Street, NW3 2PF, London, UK.
| | - S Apostolidou
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - A Gentry-Maharaj
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - J Parkes
- Public Health Sciences and Medical Statistics, Faculty of Medicine, University of Southampton, Southampton, UK
| | - A Ryan
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - S Tanwar
- Institute for Liver and Digestive Health, Division of Medicine, University College London, Royal Free Hospital, Rowland Hill Street, NW3 2PF, London, UK
| | - M Burnell
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - U Menon
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - W M Rosenberg
- Institute for Liver and Digestive Health, Division of Medicine, University College London, Royal Free Hospital, Rowland Hill Street, NW3 2PF, London, UK
| |
Collapse
|
31
|
Koutoukidis DA, Beeken RJ, Manchanda R, Michalopoulou M, Burnell M, Knobf MT, Lanceley A. Recruitment, adherence, and retention of endometrial cancer survivors in a behavioural lifestyle programme: the Diet and Exercise in Uterine Cancer Survivors (DEUS) parallel randomised pilot trial. BMJ Open 2017; 7:e018015. [PMID: 28993394 PMCID: PMC5640120 DOI: 10.1136/bmjopen-2017-018015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Healthy eating and physical activity may help endometrial cancer survivors (ECS) improve their quality of life. However, most ECS do not meet the relevant guidelines. This pilot trial aimed to test the study feasibility procedures for a definitive trial of a behavioural lifestyle programme. DESIGN AND SETTING This 24-week parallel two-arm randomised pilot trial took place in two hospitals in London, UK (April 2015-June 2016). PARTICIPANTS Sixty disease-free ECS within 3 years of diagnosis. INTERVENTIONS Participants were randomised using minimisation to receive the intervention or care as usual. The 'Shape-Up following cancer treatment' programme used self-monitoring, goal-setting, self-incentives, problem-solving and group social support for 12 hours over 8 weeks to help survivors improve their eating and physical activity. OUTCOME MEASURES The main outcome measures were recruitment, adherence, and retention rates. Further outcomes included barriers to participation and feedback on programme satisfaction. RESULTS Of the 296 potentially eligible ECS, 20% (n=60) were randomly allocated to the active intervention (n=29) or control group (n=31). Three participants in each arm were deemed ineligible after randomisation and excluded from analysis. Twenty participants (77%; 95% CI 61% to 93%) adhered to the intervention and provided generally favourable feedback. At 24 weeks, 25/26 (96%; 95% CI 89% to 100%) intervention and 24/28 (86%; 95% CI 73% to 99%) control participants completed their assessment. No intervention-related adverse events were reported. Among eligible survivors who declined study participation (n=83), inconvenience (78%; 95% CI 69% to 87%) was the most common barrier. CONCLUSIONS The trial was feasible to deliver based on the a priori feasibility criteria. Enhancing recruitment and adherence in a definitive trial will require designs that promote convenience and consider ECS-reported barriers. TRIAL REGISTRATION NUMBER NCT02433080; Pre-results. TRIAL FUNDING University College London, St. Bartholomew's Hospital Nurses League, and NIHR University College London Hospitals Biomedical Research Centre.
Collapse
Affiliation(s)
- Dimitrios A Koutoukidis
- Department of Women’s Cancer, EGA Institute for Women’s Health, University College London, London, UK
- Department of Behavioural Science and Health, University College London, London, UK
| | - Rebecca J Beeken
- Department of Behavioural Science and Health, University College London, London, UK
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Ranjit Manchanda
- Department of Women’s Cancer, EGA Institute for Women’s Health, University College London, London, UK
- Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, London, UK
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Moscho Michalopoulou
- Department of Women’s Cancer, EGA Institute for Women’s Health, University College London, London, UK
| | - Matthew Burnell
- Department of Women’s Cancer, EGA Institute for Women’s Health, University College London, London, UK
| | - M Tish Knobf
- Department of Women’s Cancer, EGA Institute for Women’s Health, University College London, London, UK
- Acute Care/Health Systems Division, Yale University School of Nursing, West Haven, Connecticut, USA
| | - Anne Lanceley
- Department of Women’s Cancer, EGA Institute for Women’s Health, University College London, London, UK
| |
Collapse
|
32
|
Menon U, McGuire AJ, Raikou M, Ryan A, Davies SK, Burnell M, Gentry-Maharaj A, Kalsi JK, Singh N, Amso NN, Cruickshank D, Dobbs S, Godfrey K, Herod J, Leeson S, Mould T, Murdoch J, Oram D, Scott I, Seif MW, Williamson K, Woolas R, Fallowfield L, Campbell S, Skates SJ, Parmar M, Jacobs IJ. The cost-effectiveness of screening for ovarian cancer: results from the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). Br J Cancer 2017; 117:619-627. [PMID: 28742794 PMCID: PMC5572177 DOI: 10.1038/bjc.2017.222] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 10/06/2016] [Revised: 05/23/2017] [Accepted: 06/21/2017] [Indexed: 11/25/2022] Open
Abstract
Background: To assess the within-trial cost-effectiveness of an NHS ovarian cancer screening (OCS) programme using data from UKCTOCS and extrapolate results based on average life expectancy. Methods: Within-trial economic evaluation of no screening (C) vs either (1) an annual OCS programme using transvaginal ultrasound (USS) or (2) an annual ovarian cancer multimodal screening programme with serum CA125 interpreted using a risk algorithm (ROCA) and transvaginal ultrasound as a second-line test (MMS), plus comparison of lifetime extrapolation of the no screening arm and the MMS programme using both a predictive and a Markov model. Results: Using a CA125–ROCA cost of £20, the within-trial results show USS to be strictly dominated by MMS, with the MMS vs C comparison returning an incremental cost-effectiveness ratio (ICER) of £91 452 per life year gained (LYG). If the CA125–ROCA unit cost is reduced to £15, the ICER becomes £77 818 per LYG. Predictive extrapolation over the expected lifetime of the UKCTOCS women returns an ICER of £30 033 per LYG, while Markov modelling produces an ICER of £46 922 per QALY. Conclusion: Analysis suggests that, after accounting for the lead time required to establish full mortality benefits, a national OCS programme based on the MMS strategy quickly approaches the current NICE thresholds for cost-effectiveness when extrapolated out to lifetime as compared with the within-trial ICER estimates. Whether MMS could be recommended on economic grounds would depend on the confirmation and size of the mortality benefit at the end of an ongoing follow-up of the UKCTOCS cohort.
Collapse
Affiliation(s)
- Usha Menon
- Department of Women's Cancer, Institute for Women's Health, University College London, London W1T 7DN, UK
| | - Alistair J McGuire
- LSE Health &Department of Social Policy, London School of Economics, London WC2A 2AE, UK
| | - Maria Raikou
- LSE Health &Department of Social Policy, London School of Economics, London WC2A 2AE, UK.,Department of Economics, University of Pireaus, Athens GR 18534, Greece
| | - Andy Ryan
- Department of Women's Cancer, Institute for Women's Health, University College London, London W1T 7DN, UK
| | - Susan K Davies
- Department of Women's Cancer, Institute for Women's Health, University College London, London W1T 7DN, UK
| | - Matthew Burnell
- Department of Women's Cancer, Institute for Women's Health, University College London, London W1T 7DN, UK
| | - Aleksandra Gentry-Maharaj
- Department of Women's Cancer, Institute for Women's Health, University College London, London W1T 7DN, UK
| | - Jatinderpal K Kalsi
- Department of Women's Cancer, Institute for Women's Health, University College London, London W1T 7DN, UK
| | - Naveena Singh
- Department of Gynaecological Oncology, Nottingham City Hospital, Nottingham NG5 1PB, UK
| | - Nazar N Amso
- Obstetrics and Gynaecology, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff CF14 4XN, UK
| | - Derek Cruickshank
- Department of Gynaecological Oncology, James Cook University Hospital, Middlesbrough TS4 3BW, UK
| | - Stephen Dobbs
- Department of Gynaecological Oncology, Belfast City Hospital, Belfast BT9 7AB, UK
| | - Keith Godfrey
- Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead NE9 6SX, UK
| | - Jonathan Herod
- Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead NE9 6SX, UK
| | - Simon Leeson
- Department of Gynaecological Oncology, Llandudno Hospital, North Wales LL30 1LB, UK
| | - Tim Mould
- Department of Gynaecological Oncology, Royal Free, London NW3 2QG, UK
| | - John Murdoch
- Department of Gynaecological Oncology, St. Michael's Hospital, Bristol BS2 8EG, UK
| | - David Oram
- Department of Gynaecological Oncology, St Bartholomew's Hospital, London EC1A 7BE, UK
| | - Ian Scott
- Department of Gynaecological Oncology, Royal Derby Hospital, Derby DE22 3NE, UK
| | - Mourad W Seif
- CMFT, St Mary's Hospital, Manchester M13 9WL, UK.,Institute of Cancer Sciences, The University of Manchester, Manchester M13 9PL, UK
| | - Karin Williamson
- Department of Gynaecological Oncology, Nottingham City Hospital, Nottingham NG5 1PB, UK
| | - Robert Woolas
- Department of Women's Cancer, Institute for Women's Health, University College London, London W1T 7DN, UK.,Department of Gynaecological Oncology, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK
| | - Lesley Fallowfield
- Sussex Health Outcomes Research &Education in Cancer (SHORE-C), Brighton &Sussex Medical School, University of Sussex, Falmer BN1 9RX, UK
| | | | - Steven J Skates
- MGH Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA.,Harvard Medical School, Boston, MA 02115, USA
| | - Mahesh Parmar
- Medical Research Council Clinical Trials Unit at University College London, London WC2B 6NH, UK
| | - Ian J Jacobs
- Department of Women's Cancer, Institute for Women's Health, University College London, London W1T 7DN, UK.,Department of Gynaecological Oncology, Nottingham City Hospital, Nottingham NG5 1PB, UK.,Obstetrics and Gynaecology, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff CF14 4XN, UK
| |
Collapse
|
33
|
Trembling PM, Apostolidou S, Gentry-Maharaj A, Parkes J, Ryan A, Tanwar S, Burnell M, Jacobs I, Menon U, Rosenberg WM. Risk of chronic liver disease in post-menopausal women due to body mass index, alcohol and their interaction: a prospective nested cohort study within the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). BMC Public Health 2017; 17:603. [PMID: 28659136 PMCID: PMC5490218 DOI: 10.1186/s12889-017-4518-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 06/20/2017] [Indexed: 01/09/2023] Open
Abstract
Background We investigated the risk of chronic liver disease (CLD) due to alcohol consumption and body mass index (BMI) and the effects of their interaction in a prospective cohort study of women recruited to the UKCTOCS trial. Methods 95,126 post-menopausal women without documented CLD were stratified into 12 groups defined by combinations of BMI (normal, overweight, obese) and alcohol consumption (none, <1–15, 16–20 and ≥21 units/week), and followed for an average of 5.1 years. Hazard ratios (HR) were calculated for incident liver-related events (LRE). Results First LREs were reported in 325 (0.34%) participants. Compared to women with normal BMI, HR = 1.44 (95% CI; 1.10–1.87) in the overweight group and HR = 2.25 (95% CI; 1.70–2.97) in the obese group, adjusted for alcohol and potential confounders. Compared to those abstinent from alcohol, HR = 0.70 (95% CI; 0.55–0.88) for <1–15 units/week, 0.93 (95% CI; 0.50–1.73) for 16–20 units/week and 1.82 (95% CI; 0.97–3.39) for ≥21 units/week adjusted for BMI and potential confounders. Compared to women with normal BMI drinking no alcohol, HR for LRE in obese women consuming ≥21 units/week was 2.86 (95% CI; 0.67–12.42), 1.58 (95% CI; 0.96–2.61) for obese women drinking <1–15 units/week and 1.93 (95% CI; 0.66–5.62) in those with normal BMI consuming ≥21 units/week after adjustment for potential confounders. We found no significant interaction between BMI and alcohol. Conclusion High BMI and alcohol consumption and abstinence are risk factors for CLD in post-menopausal women. However, BMI and alcohol do not demonstrate significant interaction in this group. Trial registration UKCTOCS is registered as an International Standard Randomised Controlled Trial, number ISRCTN22488978. Registered 06/04/2000. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4518-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Paul M Trembling
- Institute for Liver and Digestive Health, Division of Medicine, University College London, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK.
| | - Sophia Apostolidou
- Gynaecological Cancer Research Centre, University College London Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Aleksandra Gentry-Maharaj
- Gynaecological Cancer Research Centre, University College London Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Julie Parkes
- Public Health Sciences and Medical Statistics, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Andy Ryan
- Gynaecological Cancer Research Centre, University College London Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Sudeep Tanwar
- Institute for Liver and Digestive Health, Division of Medicine, University College London, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK
| | - Matthew Burnell
- Gynaecological Cancer Research Centre, University College London Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Ian Jacobs
- Gynaecological Cancer Research Centre, University College London Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.,Office of the President and Vice-Chancellor, The University of New South Wales, UNSW Sydney, Sydney, Australia
| | - Usha Menon
- Gynaecological Cancer Research Centre, University College London Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - William M Rosenberg
- Institute for Liver and Digestive Health, Division of Medicine, University College London, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK
| |
Collapse
|
34
|
Gentry-Maharaj A, Karpinskyj C, Glazer C, Burnell M, Bailey K, Apostolidou S, Ryan A, Lanceley A, Fraser L, Jacobs I, Hunter MS, Menon U. Prevalence and predictors of complementary and alternative medicine/non-pharmacological interventions use for menopausal symptoms within the UK Collaborative Trial of Ovarian Cancer Screening. Climacteric 2017; 20:240-247. [PMID: 28326899 PMCID: PMC5448394 DOI: 10.1080/13697137.2017.1301919] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 01/26/2017] [Accepted: 02/19/2017] [Indexed: 12/04/2022]
Abstract
OBJECTIVES The negative publicity about menopausal hormone therapy (MHT) has led to increased use of complementary and alternative medicines (CAM) and non-pharmacological interventions (NPI) for menopausal symptom relief. We report on the prevalence and predictors of CAM/NPI among UK postmenopausal women. METHOD Postmenopausal women aged 50-74 years were invited to participate in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). A total of 202 638 women were recruited and completed a baseline questionnaire. Of these, 136 020 were sent a postal follow-up-questionnaire between September 2006 and May 2009 which included ever-use of CAM/NPI for menopausal symptom relief. Both questionnaires included MHT use. RESULTS A total of 88 430 (65.0%) women returned a completed follow-up-questionnaire; 22 206 (25.1%) reported ever-use of one or more CAM/NPI. Highest use was reported for herbal therapies (43.8%; 9725/22 206), vitamins (42.6%; 9458/22 206), lifestyle approaches (32.1%; 7137/22 206) and phytoestrogens (21.6%; 4802/22 206). Older women reported less ever-use of herbal therapies, vitamins and phytoestrogens. Lifestyle approaches, aromatherapy/reflexology/acupuncture and homeopathy were similar across age groups. Higher education, Black ethnicity, MHT or previous oral contraceptive pill use were associated with higher CAM/NPI use. Women assessed as being less hopeful about their future were less likely to use CAM/NPI. CONCLUSION One in four postmenopausal women reported ever-use of CAM therapies/NPI for menopausal symptom relief, with lower use reported by older women. Higher levels of education and previous MHT use were positive predictors of CAM/NPI use. UKCTOCS Trial registration: ISRCTN22488978.
Collapse
Affiliation(s)
- A. Gentry-Maharaj
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
| | - C. Karpinskyj
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
| | - C. Glazer
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
- Department of Occupational and Environmental Medicine, Bispebjerg - Frederiksberg Hospital, Institute of Public Health, University of CopenhagenCopenhagenDenmark
| | - M. Burnell
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
| | - K. Bailey
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
| | - S. Apostolidou
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
| | - A. Ryan
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
| | - A. Lanceley
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
| | - L. Fraser
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
| | - I. Jacobs
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
- UNSW AustraliaSydneyAustralia
- Centre for Women's Health, Institute of Human Development, University of ManchesterManchesterUK
| | - M. S. Hunter
- Department of Psychology, Institute of Psychiatry, Guy’s Campus, King's College LondonLondonUK
| | - U. Menon
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
| |
Collapse
|
35
|
Gentry-Maharaj A, Glazer C, Burnell M, Ryan A, Berry H, Kalsi J, Woolas R, Skates SJ, Campbell S, Parmar M, Jacobs I, Menon U. Changing trends in reproductive/lifestyle factors in UK women: descriptive study within the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). BMJ Open 2017; 7:e011822. [PMID: 28264823 PMCID: PMC5353253 DOI: 10.1136/bmjopen-2016-011822] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE There has been considerable interest in the impact of reproductive factors on health but there are little data on how these have varied over time. We explore trends in reproductive/lifestyle factors of postmenopausal British women by analysing self-reported data from participants of the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). DESIGN Prospective birth cohort analysis. SETTING Population cohort invited between 2001 and 2005 from age-sex registers of 27 Primary Care Trusts in England, Wales and Northern Ireland and recruited through 13 National Health Service Trusts. PARTICIPANTS 202 638 postmenopausal women aged 50-74 years at randomisation to UKCTOCS between April 2001 and October 2005. INTERVENTIONS Women were stratified into the following six birth cohorts (1925-1929, 1930-1934, 1935-1939, 1940-1944, 1945-1949, 1950-1955) based on year of birth. Self-reported data on reproductive factors provided at recruitment were explored using tabular and graphical summaries to examine for differences between the birth cohorts. OUTCOME MEASURES Trends in mean age at menarche and menopause, use of oral contraceptives, change in family size, infertility treatments, tubal ligation and hysterectomy rates. RESULTS Women born between 1935 and 1955 made up 86% of the cohort. Median age at menarche decreased from 13.4 for women born between 1925 and 1929 to 12.8 for women born between 1950 and 1955. Increased use of the oral contraceptives, infertility treatments and smaller family size was observed in the younger birth cohorts. Tubal ligation rates increased for those born between 1925 and 1945, but this increase did not persist in subsequent cohorts. Hysterectomy rates (17-20%) did not change over time. CONCLUSIONS The trends seen in this large cohort are likely to reflect the reproductive history of the UK female postmenopausal population of similar age. Since these are risk factors for hormone-related cancers, these trends are important in understanding the changing incidence of these cancers. TRIAL REGISTRATION NUMBER International Standard Randomised Controlled Trial Number: 22488978.
Collapse
Affiliation(s)
| | - Clara Glazer
- Department of Women's Cancer, Institute for Women's Health, UCL, LondonUK
- Department of Occupational and Environmental Medicine, Frederiksberg-Bispebjerg University Hospital, Copenhagen, Denmark
| | - Matthew Burnell
- Department of Women's Cancer, Institute for Women's Health, UCL, LondonUK
| | - Andy Ryan
- Department of Women's Cancer, Institute for Women's Health, UCL, LondonUK
| | - Hannah Berry
- Department of Women's Cancer, Institute for Women's Health, UCL, LondonUK
| | - Jatinderpal Kalsi
- Department of Women's Cancer, Institute for Women's Health, UCL, LondonUK
| | - Robert Woolas
- Department of Gynaecological Oncology, Queen Alexandra Hospital, Portsmouth, UK
| | - Steve J Skates
- Massachusetts General Hospital Biostatistics, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Mahesh Parmar
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Ian Jacobs
- Department of Women's Cancer, Institute for Women's Health, UCL, LondonUK
- Centre for Women's Health, Institute of Human Development, University of Manchester, Manchester, UK
- University of New South Wales, Sydney, New South Wales, Australia
| | - Usha Menon
- Department of Women's Cancer, Institute for Women's Health, UCL, LondonUK
| |
Collapse
|
36
|
Rosenthal AN, Fraser LSM, Philpott S, Manchanda R, Burnell M, Badman P, Hadwin R, Rizzuto I, Benjamin E, Singh N, Evans DG, Eccles DM, Ryan A, Liston R, Dawnay A, Ford J, Gunu R, Mackay J, Skates SJ, Menon U, Jacobs IJ. Evidence of Stage Shift in Women Diagnosed With Ovarian Cancer During Phase II of the United Kingdom Familial Ovarian Cancer Screening Study. J Clin Oncol 2017; 35:1411-1420. [PMID: 28240969 PMCID: PMC5455461 DOI: 10.1200/jco.2016.69.9330] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [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: 01/23/2023] Open
Abstract
Purpose To establish the performance of screening with serum cancer antigen 125 (CA-125), interpreted using the risk of ovarian cancer algorithm (ROCA), and transvaginal sonography (TVS) for women at high risk of ovarian cancer (OC) or fallopian tube cancer (FTC). Patients and Methods Women whose estimated lifetime risk of OC/FTC was ≥ 10% were recruited at 42 centers in the United Kingdom and underwent ROCA screening every 4 months. TVS occurred annually if ROCA results were normal or within 2 months of an abnormal ROCA result. Risk-reducing salpingo-oophorectomy (RRSO) was encouraged throughout the study. Participants were observed via cancer registries, questionnaires, and notification by centers. Performance was calculated after censoring 365 days after prior screen, with modeling of occult cancers detected at RRSO. Results Between June 14, 2007, and May 15, 2012, 4,348 women underwent 13,728 women-years of screening. The median follow-up time was 4.8 years. Nineteen patients were diagnosed with invasive OC/FTC within 1 year of prior screening (13 diagnoses were screen-detected and six were occult at RRSO). No symptomatic interval cancers occurred. Ten (52.6%) of the total 19 diagnoses were stage I to II OC/FTC (CI, 28.9% to 75.6%). Of the 13 screen-detected cancers, five (38.5%) were stage I to II (CI, 13.9% to 68.4%). Of the six occult cancers, five (83.3%) were stage I to II (CI, 35.9% to 99.6%). Modeled sensitivity, positive predictive value, and negative predictive value for OC/FTC detection within 1 year were 94.7% (CI, 74.0% to 99.9%), 10.8% (6.5% to 16.5%), and 100% (CI, 100% to 100%), respectively. Seven (36.8%) of the 19 cancers diagnosed < 1 year after prior screen were stage IIIb to IV (CI, 16.3% to 61.6%) compared with 17 (94.4%) of 18 cancers diagnosed > 1 year after screening ended (CI, 72.7% to 99.9%; P < .001). Eighteen (94.8%) of 19 cancers diagnosed < 1 year after prior screen had zero residual disease (with lower surgical complexity, P = .16) (CI, 74.0% to 99.9%) compared with 13 (72.2%) of 18 cancers subsequently diagnosed (CI, 46.5% to 90.3%; P = .09). Conclusion ROCA-based screening is an option for women at high risk of OC/FTC who defer or decline RRSO, given its high sensitivity and significant stage shift. However, it remains unknown whether this strategy would improve survival in screened high-risk women.
Collapse
Affiliation(s)
- Adam N Rosenthal
- Adam N. Rosenthal, Lindsay S.M. Fraser, Susan Philpott, Ranjit Manchanda, Matthew Burnell, Philip Badman, Richard Hadwin, Ivana Rizzuto, Andy Ryan, Robert Liston, Jeremy Ford, Richard Gunu, Usha Menon, and Ian J. Jacobs, University College London Elizabeth Garrett Anderson Institute for Women's Health; Elizabeth Benjamin, University College London; Naveena Singh, Barts Health National Health Service Trust; Ranjit Manchanda, Barts Cancer Institute, Queen Mary University of London; Anne Dawnay, University College London Hospital; James Mackay, The University College London Cancer Institute, London; D. Gareth Evans, University of Manchester, St Mary's Hospital Manchester, Manchester; Diana M. Eccles, Southampton General Hospital, Southampton, United Kingdom; Steven J. Skates, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Ian J. Jacobs, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Lindsay S M Fraser
- Adam N. Rosenthal, Lindsay S.M. Fraser, Susan Philpott, Ranjit Manchanda, Matthew Burnell, Philip Badman, Richard Hadwin, Ivana Rizzuto, Andy Ryan, Robert Liston, Jeremy Ford, Richard Gunu, Usha Menon, and Ian J. Jacobs, University College London Elizabeth Garrett Anderson Institute for Women's Health; Elizabeth Benjamin, University College London; Naveena Singh, Barts Health National Health Service Trust; Ranjit Manchanda, Barts Cancer Institute, Queen Mary University of London; Anne Dawnay, University College London Hospital; James Mackay, The University College London Cancer Institute, London; D. Gareth Evans, University of Manchester, St Mary's Hospital Manchester, Manchester; Diana M. Eccles, Southampton General Hospital, Southampton, United Kingdom; Steven J. Skates, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Ian J. Jacobs, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Susan Philpott
- Adam N. Rosenthal, Lindsay S.M. Fraser, Susan Philpott, Ranjit Manchanda, Matthew Burnell, Philip Badman, Richard Hadwin, Ivana Rizzuto, Andy Ryan, Robert Liston, Jeremy Ford, Richard Gunu, Usha Menon, and Ian J. Jacobs, University College London Elizabeth Garrett Anderson Institute for Women's Health; Elizabeth Benjamin, University College London; Naveena Singh, Barts Health National Health Service Trust; Ranjit Manchanda, Barts Cancer Institute, Queen Mary University of London; Anne Dawnay, University College London Hospital; James Mackay, The University College London Cancer Institute, London; D. Gareth Evans, University of Manchester, St Mary's Hospital Manchester, Manchester; Diana M. Eccles, Southampton General Hospital, Southampton, United Kingdom; Steven J. Skates, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Ian J. Jacobs, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Ranjit Manchanda
- Adam N. Rosenthal, Lindsay S.M. Fraser, Susan Philpott, Ranjit Manchanda, Matthew Burnell, Philip Badman, Richard Hadwin, Ivana Rizzuto, Andy Ryan, Robert Liston, Jeremy Ford, Richard Gunu, Usha Menon, and Ian J. Jacobs, University College London Elizabeth Garrett Anderson Institute for Women's Health; Elizabeth Benjamin, University College London; Naveena Singh, Barts Health National Health Service Trust; Ranjit Manchanda, Barts Cancer Institute, Queen Mary University of London; Anne Dawnay, University College London Hospital; James Mackay, The University College London Cancer Institute, London; D. Gareth Evans, University of Manchester, St Mary's Hospital Manchester, Manchester; Diana M. Eccles, Southampton General Hospital, Southampton, United Kingdom; Steven J. Skates, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Ian J. Jacobs, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Matthew Burnell
- Adam N. Rosenthal, Lindsay S.M. Fraser, Susan Philpott, Ranjit Manchanda, Matthew Burnell, Philip Badman, Richard Hadwin, Ivana Rizzuto, Andy Ryan, Robert Liston, Jeremy Ford, Richard Gunu, Usha Menon, and Ian J. Jacobs, University College London Elizabeth Garrett Anderson Institute for Women's Health; Elizabeth Benjamin, University College London; Naveena Singh, Barts Health National Health Service Trust; Ranjit Manchanda, Barts Cancer Institute, Queen Mary University of London; Anne Dawnay, University College London Hospital; James Mackay, The University College London Cancer Institute, London; D. Gareth Evans, University of Manchester, St Mary's Hospital Manchester, Manchester; Diana M. Eccles, Southampton General Hospital, Southampton, United Kingdom; Steven J. Skates, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Ian J. Jacobs, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Philip Badman
- Adam N. Rosenthal, Lindsay S.M. Fraser, Susan Philpott, Ranjit Manchanda, Matthew Burnell, Philip Badman, Richard Hadwin, Ivana Rizzuto, Andy Ryan, Robert Liston, Jeremy Ford, Richard Gunu, Usha Menon, and Ian J. Jacobs, University College London Elizabeth Garrett Anderson Institute for Women's Health; Elizabeth Benjamin, University College London; Naveena Singh, Barts Health National Health Service Trust; Ranjit Manchanda, Barts Cancer Institute, Queen Mary University of London; Anne Dawnay, University College London Hospital; James Mackay, The University College London Cancer Institute, London; D. Gareth Evans, University of Manchester, St Mary's Hospital Manchester, Manchester; Diana M. Eccles, Southampton General Hospital, Southampton, United Kingdom; Steven J. Skates, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Ian J. Jacobs, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Richard Hadwin
- Adam N. Rosenthal, Lindsay S.M. Fraser, Susan Philpott, Ranjit Manchanda, Matthew Burnell, Philip Badman, Richard Hadwin, Ivana Rizzuto, Andy Ryan, Robert Liston, Jeremy Ford, Richard Gunu, Usha Menon, and Ian J. Jacobs, University College London Elizabeth Garrett Anderson Institute for Women's Health; Elizabeth Benjamin, University College London; Naveena Singh, Barts Health National Health Service Trust; Ranjit Manchanda, Barts Cancer Institute, Queen Mary University of London; Anne Dawnay, University College London Hospital; James Mackay, The University College London Cancer Institute, London; D. Gareth Evans, University of Manchester, St Mary's Hospital Manchester, Manchester; Diana M. Eccles, Southampton General Hospital, Southampton, United Kingdom; Steven J. Skates, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Ian J. Jacobs, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Ivana Rizzuto
- Adam N. Rosenthal, Lindsay S.M. Fraser, Susan Philpott, Ranjit Manchanda, Matthew Burnell, Philip Badman, Richard Hadwin, Ivana Rizzuto, Andy Ryan, Robert Liston, Jeremy Ford, Richard Gunu, Usha Menon, and Ian J. Jacobs, University College London Elizabeth Garrett Anderson Institute for Women's Health; Elizabeth Benjamin, University College London; Naveena Singh, Barts Health National Health Service Trust; Ranjit Manchanda, Barts Cancer Institute, Queen Mary University of London; Anne Dawnay, University College London Hospital; James Mackay, The University College London Cancer Institute, London; D. Gareth Evans, University of Manchester, St Mary's Hospital Manchester, Manchester; Diana M. Eccles, Southampton General Hospital, Southampton, United Kingdom; Steven J. Skates, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Ian J. Jacobs, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Elizabeth Benjamin
- Adam N. Rosenthal, Lindsay S.M. Fraser, Susan Philpott, Ranjit Manchanda, Matthew Burnell, Philip Badman, Richard Hadwin, Ivana Rizzuto, Andy Ryan, Robert Liston, Jeremy Ford, Richard Gunu, Usha Menon, and Ian J. Jacobs, University College London Elizabeth Garrett Anderson Institute for Women's Health; Elizabeth Benjamin, University College London; Naveena Singh, Barts Health National Health Service Trust; Ranjit Manchanda, Barts Cancer Institute, Queen Mary University of London; Anne Dawnay, University College London Hospital; James Mackay, The University College London Cancer Institute, London; D. Gareth Evans, University of Manchester, St Mary's Hospital Manchester, Manchester; Diana M. Eccles, Southampton General Hospital, Southampton, United Kingdom; Steven J. Skates, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Ian J. Jacobs, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Naveena Singh
- Adam N. Rosenthal, Lindsay S.M. Fraser, Susan Philpott, Ranjit Manchanda, Matthew Burnell, Philip Badman, Richard Hadwin, Ivana Rizzuto, Andy Ryan, Robert Liston, Jeremy Ford, Richard Gunu, Usha Menon, and Ian J. Jacobs, University College London Elizabeth Garrett Anderson Institute for Women's Health; Elizabeth Benjamin, University College London; Naveena Singh, Barts Health National Health Service Trust; Ranjit Manchanda, Barts Cancer Institute, Queen Mary University of London; Anne Dawnay, University College London Hospital; James Mackay, The University College London Cancer Institute, London; D. Gareth Evans, University of Manchester, St Mary's Hospital Manchester, Manchester; Diana M. Eccles, Southampton General Hospital, Southampton, United Kingdom; Steven J. Skates, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Ian J. Jacobs, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - D Gareth Evans
- Adam N. Rosenthal, Lindsay S.M. Fraser, Susan Philpott, Ranjit Manchanda, Matthew Burnell, Philip Badman, Richard Hadwin, Ivana Rizzuto, Andy Ryan, Robert Liston, Jeremy Ford, Richard Gunu, Usha Menon, and Ian J. Jacobs, University College London Elizabeth Garrett Anderson Institute for Women's Health; Elizabeth Benjamin, University College London; Naveena Singh, Barts Health National Health Service Trust; Ranjit Manchanda, Barts Cancer Institute, Queen Mary University of London; Anne Dawnay, University College London Hospital; James Mackay, The University College London Cancer Institute, London; D. Gareth Evans, University of Manchester, St Mary's Hospital Manchester, Manchester; Diana M. Eccles, Southampton General Hospital, Southampton, United Kingdom; Steven J. Skates, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Ian J. Jacobs, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Diana M Eccles
- Adam N. Rosenthal, Lindsay S.M. Fraser, Susan Philpott, Ranjit Manchanda, Matthew Burnell, Philip Badman, Richard Hadwin, Ivana Rizzuto, Andy Ryan, Robert Liston, Jeremy Ford, Richard Gunu, Usha Menon, and Ian J. Jacobs, University College London Elizabeth Garrett Anderson Institute for Women's Health; Elizabeth Benjamin, University College London; Naveena Singh, Barts Health National Health Service Trust; Ranjit Manchanda, Barts Cancer Institute, Queen Mary University of London; Anne Dawnay, University College London Hospital; James Mackay, The University College London Cancer Institute, London; D. Gareth Evans, University of Manchester, St Mary's Hospital Manchester, Manchester; Diana M. Eccles, Southampton General Hospital, Southampton, United Kingdom; Steven J. Skates, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Ian J. Jacobs, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Andy Ryan
- Adam N. Rosenthal, Lindsay S.M. Fraser, Susan Philpott, Ranjit Manchanda, Matthew Burnell, Philip Badman, Richard Hadwin, Ivana Rizzuto, Andy Ryan, Robert Liston, Jeremy Ford, Richard Gunu, Usha Menon, and Ian J. Jacobs, University College London Elizabeth Garrett Anderson Institute for Women's Health; Elizabeth Benjamin, University College London; Naveena Singh, Barts Health National Health Service Trust; Ranjit Manchanda, Barts Cancer Institute, Queen Mary University of London; Anne Dawnay, University College London Hospital; James Mackay, The University College London Cancer Institute, London; D. Gareth Evans, University of Manchester, St Mary's Hospital Manchester, Manchester; Diana M. Eccles, Southampton General Hospital, Southampton, United Kingdom; Steven J. Skates, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Ian J. Jacobs, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Robert Liston
- Adam N. Rosenthal, Lindsay S.M. Fraser, Susan Philpott, Ranjit Manchanda, Matthew Burnell, Philip Badman, Richard Hadwin, Ivana Rizzuto, Andy Ryan, Robert Liston, Jeremy Ford, Richard Gunu, Usha Menon, and Ian J. Jacobs, University College London Elizabeth Garrett Anderson Institute for Women's Health; Elizabeth Benjamin, University College London; Naveena Singh, Barts Health National Health Service Trust; Ranjit Manchanda, Barts Cancer Institute, Queen Mary University of London; Anne Dawnay, University College London Hospital; James Mackay, The University College London Cancer Institute, London; D. Gareth Evans, University of Manchester, St Mary's Hospital Manchester, Manchester; Diana M. Eccles, Southampton General Hospital, Southampton, United Kingdom; Steven J. Skates, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Ian J. Jacobs, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Anne Dawnay
- Adam N. Rosenthal, Lindsay S.M. Fraser, Susan Philpott, Ranjit Manchanda, Matthew Burnell, Philip Badman, Richard Hadwin, Ivana Rizzuto, Andy Ryan, Robert Liston, Jeremy Ford, Richard Gunu, Usha Menon, and Ian J. Jacobs, University College London Elizabeth Garrett Anderson Institute for Women's Health; Elizabeth Benjamin, University College London; Naveena Singh, Barts Health National Health Service Trust; Ranjit Manchanda, Barts Cancer Institute, Queen Mary University of London; Anne Dawnay, University College London Hospital; James Mackay, The University College London Cancer Institute, London; D. Gareth Evans, University of Manchester, St Mary's Hospital Manchester, Manchester; Diana M. Eccles, Southampton General Hospital, Southampton, United Kingdom; Steven J. Skates, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Ian J. Jacobs, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Jeremy Ford
- Adam N. Rosenthal, Lindsay S.M. Fraser, Susan Philpott, Ranjit Manchanda, Matthew Burnell, Philip Badman, Richard Hadwin, Ivana Rizzuto, Andy Ryan, Robert Liston, Jeremy Ford, Richard Gunu, Usha Menon, and Ian J. Jacobs, University College London Elizabeth Garrett Anderson Institute for Women's Health; Elizabeth Benjamin, University College London; Naveena Singh, Barts Health National Health Service Trust; Ranjit Manchanda, Barts Cancer Institute, Queen Mary University of London; Anne Dawnay, University College London Hospital; James Mackay, The University College London Cancer Institute, London; D. Gareth Evans, University of Manchester, St Mary's Hospital Manchester, Manchester; Diana M. Eccles, Southampton General Hospital, Southampton, United Kingdom; Steven J. Skates, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Ian J. Jacobs, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Richard Gunu
- Adam N. Rosenthal, Lindsay S.M. Fraser, Susan Philpott, Ranjit Manchanda, Matthew Burnell, Philip Badman, Richard Hadwin, Ivana Rizzuto, Andy Ryan, Robert Liston, Jeremy Ford, Richard Gunu, Usha Menon, and Ian J. Jacobs, University College London Elizabeth Garrett Anderson Institute for Women's Health; Elizabeth Benjamin, University College London; Naveena Singh, Barts Health National Health Service Trust; Ranjit Manchanda, Barts Cancer Institute, Queen Mary University of London; Anne Dawnay, University College London Hospital; James Mackay, The University College London Cancer Institute, London; D. Gareth Evans, University of Manchester, St Mary's Hospital Manchester, Manchester; Diana M. Eccles, Southampton General Hospital, Southampton, United Kingdom; Steven J. Skates, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Ian J. Jacobs, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - James Mackay
- Adam N. Rosenthal, Lindsay S.M. Fraser, Susan Philpott, Ranjit Manchanda, Matthew Burnell, Philip Badman, Richard Hadwin, Ivana Rizzuto, Andy Ryan, Robert Liston, Jeremy Ford, Richard Gunu, Usha Menon, and Ian J. Jacobs, University College London Elizabeth Garrett Anderson Institute for Women's Health; Elizabeth Benjamin, University College London; Naveena Singh, Barts Health National Health Service Trust; Ranjit Manchanda, Barts Cancer Institute, Queen Mary University of London; Anne Dawnay, University College London Hospital; James Mackay, The University College London Cancer Institute, London; D. Gareth Evans, University of Manchester, St Mary's Hospital Manchester, Manchester; Diana M. Eccles, Southampton General Hospital, Southampton, United Kingdom; Steven J. Skates, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Ian J. Jacobs, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Steven J Skates
- Adam N. Rosenthal, Lindsay S.M. Fraser, Susan Philpott, Ranjit Manchanda, Matthew Burnell, Philip Badman, Richard Hadwin, Ivana Rizzuto, Andy Ryan, Robert Liston, Jeremy Ford, Richard Gunu, Usha Menon, and Ian J. Jacobs, University College London Elizabeth Garrett Anderson Institute for Women's Health; Elizabeth Benjamin, University College London; Naveena Singh, Barts Health National Health Service Trust; Ranjit Manchanda, Barts Cancer Institute, Queen Mary University of London; Anne Dawnay, University College London Hospital; James Mackay, The University College London Cancer Institute, London; D. Gareth Evans, University of Manchester, St Mary's Hospital Manchester, Manchester; Diana M. Eccles, Southampton General Hospital, Southampton, United Kingdom; Steven J. Skates, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Ian J. Jacobs, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Usha Menon
- Adam N. Rosenthal, Lindsay S.M. Fraser, Susan Philpott, Ranjit Manchanda, Matthew Burnell, Philip Badman, Richard Hadwin, Ivana Rizzuto, Andy Ryan, Robert Liston, Jeremy Ford, Richard Gunu, Usha Menon, and Ian J. Jacobs, University College London Elizabeth Garrett Anderson Institute for Women's Health; Elizabeth Benjamin, University College London; Naveena Singh, Barts Health National Health Service Trust; Ranjit Manchanda, Barts Cancer Institute, Queen Mary University of London; Anne Dawnay, University College London Hospital; James Mackay, The University College London Cancer Institute, London; D. Gareth Evans, University of Manchester, St Mary's Hospital Manchester, Manchester; Diana M. Eccles, Southampton General Hospital, Southampton, United Kingdom; Steven J. Skates, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Ian J. Jacobs, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Ian J Jacobs
- Adam N. Rosenthal, Lindsay S.M. Fraser, Susan Philpott, Ranjit Manchanda, Matthew Burnell, Philip Badman, Richard Hadwin, Ivana Rizzuto, Andy Ryan, Robert Liston, Jeremy Ford, Richard Gunu, Usha Menon, and Ian J. Jacobs, University College London Elizabeth Garrett Anderson Institute for Women's Health; Elizabeth Benjamin, University College London; Naveena Singh, Barts Health National Health Service Trust; Ranjit Manchanda, Barts Cancer Institute, Queen Mary University of London; Anne Dawnay, University College London Hospital; James Mackay, The University College London Cancer Institute, London; D. Gareth Evans, University of Manchester, St Mary's Hospital Manchester, Manchester; Diana M. Eccles, Southampton General Hospital, Southampton, United Kingdom; Steven J. Skates, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Ian J. Jacobs, University of New South Wales Australia, Sydney, New South Wales, Australia
| | | |
Collapse
|
37
|
Mahendran S, Huxley J, Chang YM, Burnell M, Barrett D, Whay H, Blackmore T, Mason C, Bell N. Randomised controlled trial to evaluate the effect of foot trimming before and after first calving on subsequent lameness episodes and productivity in dairy heifers. Vet J 2017; 220:105-110. [DOI: 10.1016/j.tvjl.2017.01.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 01/10/2017] [Accepted: 01/11/2017] [Indexed: 10/20/2022]
|
38
|
Koutoukidis DA, Beeken RJ, Manchanda R, Burnell M, Knobf MT, Lanceley A. Erratum to: Diet and exercise in uterine cancer survivors (DEUS pilot) - piloting a healthy eating and physical activity program: study protocol for a randomized controlled trial. Trials 2017; 18:28. [PMID: 28100281 PMCID: PMC5244607 DOI: 10.1186/s13063-017-1776-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 01/05/2017] [Indexed: 01/09/2023] Open
Affiliation(s)
- Dimitrios A Koutoukidis
- Department of Women's Cancer, EGA Institute for Women's Health, University College London, London, UK
| | - Rebecca J Beeken
- Health Behaviour Research Centre, Department of Epidemiology & Public Health, University College London, London, UK
| | - Ranjit Manchanda
- Department of Women's Cancer, EGA Institute for Women's Health, University College London, London, UK
- Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, London, UK
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Matthew Burnell
- Department of Women's Cancer, EGA Institute for Women's Health, University College London, London, UK
| | - M Tish Knobf
- Department of Women's Cancer, EGA Institute for Women's Health, University College London, London, UK
- Acute Care/Health Systems Division, Yale University School of Nursing, New Haven, CT, USA
| | - Anne Lanceley
- Department of Women's Cancer, EGA Institute for Women's Health, University College London, London, UK.
| |
Collapse
|
39
|
Lanceley A, Berzuini C, Burnell M, Gessler S, Morris S, Ryan A, Ledermann JA, Jacobs I. Ovarian Cancer Follow-up: A Preliminary Comparison of 2 Approaches. Int J Gynecol Cancer 2017; 27:59-68. [PMID: 28002208 DOI: 10.1097/igc.0000000000000877] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The aim of the study was to perform a preliminary comparison of quality of life (QoL) and patient satisfaction in individualized nurse-led follow-up versus conventional medical follow-up in ovarian cancer. METHODS One hundred twelve women who received a diagnosis of ovarian, fallopian tube, or peritoneal cancer, completed primary treatment by surgery alone or with chemotherapy, irrespective of outcome with regard to remission, and expected survival of more than 3 months. Fifty-seven participants were randomized to individualized follow-up and 55 patients to conventional follow-up. Well-being was measured at baseline and at 3, 6, 12, and 24 months after randomization for QoL (QLQ-C30 [European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire], QLQ-Ov28), the Hospital Anxiety and Depression Scale (HADS), and a Patient Satisfaction Questionnaire (PSQ-III). The primary endpoints were the effects of follow-up on each of the scores (via hierarchical mixed-effects model) and on relapse-free time (via Cox model). The total cost of follow-up was compared between each group. RESULTS There was evidence for a QoL and patient satisfaction benefit for individualized versus standard follow-up (QLQ-C30, P = 0.013; 95% confidence interval, -0.03 to -0.001; PSQ-III P = 0.002; 95% confidence interval, -0.003 to -0.015; QLQ-Ov28, P = 0.14). Hospital Anxiety and Depression Scale data provided no evidence in favor of either treatment (P = 0.42). Delivered to protocol individualized follow-up resulted in a delay in the presentation of symptomatic relapse (P = 0.04), although the effect on survival in this study is unknown. Cost was £700 lower on average for the individualized follow-up group, but the difference was not statistically significant at the 5% level (P = 0.07). CONCLUSIONS Individualized follow-up was superior to conventional follow-up in 3 of the 4 QoL and patient satisfaction surveys in this preliminary study. Further prospective studies are needed in a larger population.Trial registration number is ISRCTN59149551.
Collapse
Affiliation(s)
- Anne Lanceley
- *Department of Women's Cancer, The UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London; †Centre for Biostatistics, The University of Manchester, Manchester; ‡University College London Hospitals (UCLH) Gynaecological Cancer Centre; §Department of Applied Health Research, University College London; ‖Cancer Research UK and UCL Cancer Trials Centre, University College London, London, United Kingdom; and ¶University of New South Wales, Sydney, New South Wales, Australia
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Mead S, Burnell M, Lowe J, Thompson A, Lukic A, Porter MC, Carswell C, Kaski D, Kenny J, Mok TH, Bjurstrom N, Franko E, Gorham M, Druyeh R, Wadsworth JDF, Jaunmuktane Z, Brandner S, Hyare H, Rudge P, Walker AS, Collinge J. Clinical Trial Simulations Based on Genetic Stratification and the Natural History of a Functional Outcome Measure in Creutzfeldt-Jakob Disease. JAMA Neurol 2016; 73:447-55. [PMID: 26902324 DOI: 10.1001/jamaneurol.2015.4885] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE A major challenge for drug development in neurodegenerative diseases is that adequately powered efficacy studies with meaningful end points typically require several hundred participants and long durations. Prion diseases represent the archetype of brain diseases caused by protein misfolding, the most common subtype being sporadic Creutzfeldt-Jakob disease (sCJD), a rapidly progressive dementia. There is no well-established trial method in prion disease. OBJECTIVE To establish a more powerful and meaningful clinical trial method in sCJD. DESIGN, SETTING, AND PARTICIPANTS A stratified medicine and simulation approach based on a prospective interval-cohort study conducted from October 2008 to June 2014. This study involved 598 participants with probable or definite sCJD followed up over 470 patient-years at a specialist national referral service in the United Kingdom with domiciliary, care home, and hospital patient visits. We fitted linear mixed models to the outcome measurements, and simulated clinical trials involving 10 to 120 patients (no dropouts) with early to moderately advanced prion disease using model parameters to compare the power of various designs. MAIN OUTCOMES AND MEASURES A total of 2681 assessments were done using a functionally orientated composite end point (Medical Research Council Scale) and associated with clinical investigations (brain magnetic resonance imaging, electroencephalography, and cerebrospinal fluid analysis) and molecular data (prion protein [PrP] gene sequencing, PrPSc type). RESULTS Of the 598 participants, 273 were men. The PrP gene sequence was significantly associated with decline relative to any other demographic or investigation factors. Patients with sCJD and polymorphic codon 129 genotypes MM, VV, and MV lost 10% of their function in 5.3 (95% CI, 4.2-6.9), 13.2 (95% CI, 10.9-16.6), and 27.8 (95% CI, 21.9-37.8) days, respectively (P < .001). Simulations indicate that an adequately powered (80%; 2-sided α = .05) open-label randomized trial using 50% reduction in Medical Research Council Scale decline as the primary outcome could be conducted with only 120 participants assessed every 10 days and only 90 participants assessed daily, providing considerably more power than using survival as the primary outcome. Restricting to VV or MV codon 129 genotypes increased power even further. Alternatively, single-arm intervention studies (half the total sample size) could provide similar power in comparison to the natural history cohort. CONCLUSIONS AND RELEVANCE Functional end points in neurodegeneration need not require long and very large clinical studies to be adequately powered for efficacy. Patients with sCJD may be an efficient and cost-effective group for testing disease-modifying therapeutics. Stratified medicine and natural history cohort approaches may transform the feasibility of clinical trials in orphan diseases.
Collapse
Affiliation(s)
- Simon Mead
- Medical Research Council Prion Unit, Department of Neurodegnerative Disease, University College London Institute of Neurology, London, England2National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College London Hospitals, NH
| | - Matthew Burnell
- Department of Statistical Science, Faculty of Mathematical and Physical Sciences, University College London, London, England
| | - Jessica Lowe
- National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College London Hospitals, NHS Trust, London, England
| | - Andrew Thompson
- National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College London Hospitals, NHS Trust, London, England
| | - Ana Lukic
- National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College London Hospitals, NHS Trust, London, England
| | - Marie-Claire Porter
- National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College London Hospitals, NHS Trust, London, England
| | - Christopher Carswell
- National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College London Hospitals, NHS Trust, London, England
| | - Diego Kaski
- National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College London Hospitals, NHS Trust, London, England
| | - Janna Kenny
- National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College London Hospitals, NHS Trust, London, England
| | - Tze How Mok
- National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College London Hospitals, NHS Trust, London, England
| | - Nina Bjurstrom
- National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College London Hospitals, NHS Trust, London, England
| | - Edit Franko
- National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College London Hospitals, NHS Trust, London, England
| | - Michele Gorham
- National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College London Hospitals, NHS Trust, London, England
| | - Ronald Druyeh
- Medical Research Council Prion Unit, Department of Neurodegnerative Disease, University College London Institute of Neurology, London, England
| | - Jonathan D F Wadsworth
- Medical Research Council Prion Unit, Department of Neurodegnerative Disease, University College London Institute of Neurology, London, England
| | - Zane Jaunmuktane
- Division of Neuropathology, National Hospital for Neurology and Neurosurgery, University College London Hospitals, NHS Trust, London, England
| | - Sebastian Brandner
- Division of Neuropathology, National Hospital for Neurology and Neurosurgery, University College London Hospitals, NHS Trust, London, England5Department of Neurodegenerative Disease, University College London Institute of Neurology, London, England
| | - Harpreet Hyare
- National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College London Hospitals, NHS Trust, London, England
| | - Peter Rudge
- Medical Research Council Prion Unit, Department of Neurodegnerative Disease, University College London Institute of Neurology, London, England2National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College London Hospitals, NH
| | - A Sarah Walker
- MRC Clinical Trials Unit at University College London, London, England
| | - John Collinge
- Medical Research Council Prion Unit, Department of Neurodegnerative Disease, University College London Institute of Neurology, London, England2National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College London Hospitals, NH
| |
Collapse
|
41
|
Jacobs IJ, Menon U, Ryan A, Gentry-Maharaj A, Burnell M, Kalsi JK, McGuire AJ, Parmar M, Skates SJ. Abstract CT104: Ovarian cancer screening and mortality in the UK collaborative trial of ovarian cancer screening (UKCTOCS): A randomised controlled trial. Clin Trials 2016. [DOI: 10.1158/1538-7445.am2016-ct104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
42
|
Menon U, Ryan A, Burnell M, Gentry-Maharaj A, Kalsi JK, Skates SJ, Parmar MKB, Jacobs IJ. Performance characteristics and stage distribution of invasive epithelial ovarian/tubal/peritoneal cancers in UKCTOCS. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.5507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Usha Menon
- University College London, Institute for Women's Health, London, United Kingdom
| | - Andy Ryan
- University College London, Institute for Womens Health, London, United Kingdom
| | - Matthew Burnell
- University College London/Institute for Womens Health, London, United Kingdom
| | | | - Jatinderpal K Kalsi
- University College London/Institute for Womens Health, London, United Kingdom
| | | | - Mahesh K B Parmar
- Medical Research Council, Clinical Trials Unit at University College London, London, United Kingdom
| | - Ian J Jacobs
- University of New South Wales, Sydney, Australia
| | | |
Collapse
|
43
|
Mastracci T, Carrell T, Constantinou J, Dias N, Martin-Gonzalez T, Katsargyris A, Modarai B, Resch T, Verhoeven E, Burnell M, Haulon S. Effect of Branch Stent Choice on Branch-related Outcomes in Complex Aortic Repair. J Vasc Surg 2016. [DOI: 10.1016/j.jvs.2016.03.005] [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]
|
44
|
Sheehan R, Gandesha A, Hassiotis A, Gallagher P, Burnell M, Jones G, Kerr M, Hall I, Chaplin R, Crawford MJ. An audit of the quality of inpatient care for adults with learning disability in the UK. BMJ Open 2016; 6:e010480. [PMID: 27091821 PMCID: PMC4838729 DOI: 10.1136/bmjopen-2015-010480] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES To audit patient hospital records to evaluate the performance of acute general and mental health services in delivering inpatient care to people with learning disability and explore the influence of organisational factors on the quality of care they deliver. SETTING Nine acute general hospital Trusts and six mental health services. PARTICIPANTS Adults with learning disability who received inpatient hospital care between May 2013 and April 2014. PRIMARY AND SECONDARY OUTCOME MEASURES Data on seven key indicators of high-quality care were collected from 176 patients. These covered physical health/monitoring, communication and meeting needs, capacity and decision-making, discharge planning and carer involvement. The impact of services having an electronic system for flagging patients with learning disability and employing a learning disability liaison nurse was assessed. RESULTS Indicators of physical healthcare (body mass index, swallowing assessment, epilepsy risk assessment) were poorly recorded in acute general and mental health inpatient settings. Overall, only 34 (19.3%) patients received any assessment of swallowing and 12 of the 57 with epilepsy (21.1%) had an epilepsy risk assessment. For most quality indicators, there was a non-statistically significant trend for improved performance in services with a learning disability liaison nurse. The presence of an electronic flagging system showed less evidence of benefit. CONCLUSIONS Inpatient care for people with learning disability needs to be improved. The work gives tentative support to the role of a learning disability liaison nurse in acute general and mental health services, but further work is needed to confirm these benefits and to trial other interventions that might improve the quality and safety of care for this high-need group.
Collapse
Affiliation(s)
- Rory Sheehan
- Division of Psychiatry, University College London, London, UK
| | - Aarti Gandesha
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | | | - Pamela Gallagher
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Matthew Burnell
- Faculty of Population Health Sciences, University College London, London, UK
| | - Glyn Jones
- Abertawe Bro Morgannwg University Health Board, Cardiff, UK
| | - Michael Kerr
- Welsh Centre for Learning Disabilities, Cardiff University, Cardiff, UK
| | - Ian Hall
- Tower Hamlets Community Learning Disability Service, London, UK
| | - Robert Chaplin
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Michael J Crawford
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
- Centre for Mental Health, Imperial College London, London, UK
| |
Collapse
|
45
|
Mastracci T, Carrell T, Constantinou J, Dias N, Martin-Gonzalez T, Katsargyris A, Modarai B, Resch T, Verhoeven E, Burnell M, Haulon S. Editor's Choice – Effect of Branch Stent Choice on Branch-related Outcomes in Complex Aortic Repair. Eur J Vasc Endovasc Surg 2016; 51:536-42. [DOI: 10.1016/j.ejvs.2015.12.046] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 12/29/2015] [Indexed: 11/29/2022]
|
46
|
Burnell M, Iyer R, Gentry-Maharaj A, Nordin A, Liston R, Manchanda R, Das N, Gornall R, Beardmore-Gray A, Hillaby K, Leeson S, Linder A, Lopes A, Meechan D, Mould T, Nevin J, Olaitan A, Rufford B, Shanbhag S, Thackeray A, Wood N, Reynolds K, Ryan A, Menon U. Benchmarking of surgical complications in gynaecological oncology: prospective multicentre study. BJOG 2016; 123:2171-2180. [DOI: 10.1111/1471-0528.13994] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2015] [Indexed: 11/26/2022]
Affiliation(s)
- M Burnell
- Department of Women's Cancer; Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
| | - R Iyer
- Department of Women's Cancer; Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
| | - A Gentry-Maharaj
- Department of Women's Cancer; Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
| | - A Nordin
- East Kent Gynaecological Oncology Centre; Queen Elizabeth the Queen Mother Hospital; Margate UK
| | - R Liston
- Department of Women's Cancer; Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
| | - R Manchanda
- Department of Women's Cancer; Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
- Department of Gynaecological Cancer; Barts Cancer Centre; Barts and the London NHS Trust; London UK
| | - N Das
- Department of Gynaecological Cancer; Royal Cornwall Hospitals NHS Trust; Truro UK
| | - R Gornall
- Department of Gynaecological Oncology; Cheltenham General Hospital; Cheltenham UK
| | - A Beardmore-Gray
- Department of Women's Cancer; Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
| | - K Hillaby
- Department of Gynaecological Oncology; Cheltenham General Hospital; Cheltenham UK
| | - S Leeson
- Department of Obstetrics and Gynaecology; BetsiCadwaladr University Health Board; Bangor UK
| | - A Linder
- Department of Gynaecological Oncology; The Ipswich Hospital NHS Trust; Ipswich Suffolk UK
| | - A Lopes
- Department of Gynaecological Cancer; Royal Cornwall Hospitals NHS Trust; Truro UK
| | | | - T Mould
- Department of Gynaecological Oncology; University College London Hospital NHS Foundation Trust; London UK
| | - J Nevin
- Pan Birmingham Gynaecological Cancer Centre; Birmingham City Hospital; Birmingham UK
| | - A Olaitan
- Department of Gynaecological Oncology; University College London Hospital NHS Foundation Trust; London UK
| | - B Rufford
- Department of Gynaecological Oncology; The Ipswich Hospital NHS Trust; Ipswich Suffolk UK
| | - S Shanbhag
- Department of Gynaecological Oncology; Glasgow Royal Infirmary; Glasgow UK
| | | | - N Wood
- Department of Gynaecological Oncology; Lancashire Teaching Hospitals NHS Foundation trust; Royal Preston Hospital; Preston UK
| | - K Reynolds
- Department of Gynaecological Cancer; Barts Cancer Centre; Barts and the London NHS Trust; London UK
| | - A Ryan
- Department of Women's Cancer; Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
| | - U Menon
- Department of Women's Cancer; Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
| |
Collapse
|
47
|
Manchanda R, Burnell M, Loggenberg K, Desai R, Wardle J, Sanderson SC, Gessler S, Side L, Balogun N, Kumar A, Dorkins H, Wallis Y, Chapman C, Tomlinson I, Taylor R, Jacobs C, Legood R, Raikou M, McGuire A, Beller U, Menon U, Jacobs I. Cluster-randomised non-inferiority trial comparing DVD-assisted and traditional genetic counselling in systematic population testing for BRCA1/2 mutations. J Med Genet 2016; 53:472-80. [DOI: 10.1136/jmedgenet-2015-103740] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 02/21/2016] [Indexed: 01/04/2023]
|
48
|
Koutoukidis DA, Beeken RJ, Manchanda R, Burnell M, Knobf MT, Lanceley A. Diet and exercise in uterine cancer survivors (DEUS pilot) - piloting a healthy eating and physical activity program: study protocol for a randomized controlled trial. Trials 2016; 17:130. [PMID: 26965165 PMCID: PMC4785620 DOI: 10.1186/s13063-016-1260-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 02/26/2016] [Indexed: 12/15/2022] Open
Abstract
Background Endometrial cancer survivors comprise a high-risk group for obesity-related comorbidities. Healthy eating and physical activity can lead to better health and well-being, but this population may experience difficulties adopting healthy lifestyle practices. Personalised behaviour change programmes that are feasible, acceptable and cost-effective are needed. The aim of this trial is to pilot a manualised programme about healthy eating and physical activity. Methods/design This is a phase II, individually randomized, parallel, controlled, two-site, pilot clinical trial. Adult endometrial cancer survivors (n = 64) who have been diagnosed with endometrial cancer within the previous 3 years and are not on active treatment will be invited to participate. Participants will be assigned in a 1:1 ratio through minimisation to either an 8-week, group-based, behaviour-change programme with weekly 90-min sessions about healthy eating and physical activity or usual care. The intervention will focus on self-monitoring, goal setting and self-rewards. Follow-up assessments will be conducted at 8 and 24 weeks from the baseline assessment. Primary feasibility outcomes will include rates of recruitment, adherence, and retention. Discussion The study results will inform the development of a definitive randomised controlled trial to test if the programme can improve the health and quality of life of this population. It will also provide guidance on costing the intervention and the health care resource use in this population. Trial Registration ClinicalTrials.gov identifier: NCT02433080, 20 April 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1260-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Dimitrios A Koutoukidis
- Department of Women's Cancer, EGA Institute for Women's Health, University College London, London, UK
| | - Rebecca J Beeken
- Health Behaviour Research Centre, Department of Epidemiology & Public Health, University College London, London, UK
| | - Ranjit Manchanda
- Department of Women's Cancer, EGA Institute for Women's Health, University College London, London, UK.,Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, London, UK.,Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Matthew Burnell
- Department of Women's Cancer, EGA Institute for Women's Health, University College London, London, UK
| | - M Tish Knobf
- Department of Women's Cancer, EGA Institute for Women's Health, University College London, London, UK.,Acute Care/Health Systems Division, Yale University School of Nursing, New Haven, CT, USA
| | - Anne Lanceley
- Department of Women's Cancer, EGA Institute for Women's Health, University College London, London, UK.
| |
Collapse
|
49
|
Jacobs IJ, Menon U, Ryan A, Gentry-Maharaj A, Burnell M, Kalsi JK, Amso NN, Apostolidou S, Benjamin E, Cruickshank D, Crump DN, Davies SK, Dawnay A, Dobbs S, Fletcher G, Ford J, Godfrey K, Gunu R, Habib M, Hallett R, Herod J, Jenkins H, Karpinskyj C, Leeson S, Lewis SJ, Liston WR, Lopes A, Mould T, Murdoch J, Oram D, Rabideau DJ, Reynolds K, Scott I, Seif MW, Sharma A, Singh N, Taylor J, Warburton F, Widschwendter M, Williamson K, Woolas R, Fallowfield L, McGuire AJ, Campbell S, Parmar M, Skates SJ. Ovarian cancer screening and mortality in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a randomised controlled trial. Lancet 2016; 387:945-956. [PMID: 26707054 PMCID: PMC4779792 DOI: 10.1016/s0140-6736(15)01224-6] [Citation(s) in RCA: 649] [Impact Index Per Article: 81.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Ovarian cancer has a poor prognosis, with just 40% of patients surviving 5 years. We designed this trial to establish the effect of early detection by screening on ovarian cancer mortality. METHODS In this randomised controlled trial, we recruited postmenopausal women aged 50-74 years from 13 centres in National Health Service Trusts in England, Wales, and Northern Ireland. Exclusion criteria were previous bilateral oophorectomy or ovarian malignancy, increased risk of familial ovarian cancer, and active non-ovarian malignancy. The trial management system confirmed eligibility and randomly allocated participants in blocks of 32 using computer-generated random numbers to annual multimodal screening (MMS) with serum CA125 interpreted with use of the risk of ovarian cancer algorithm, annual transvaginal ultrasound screening (USS), or no screening, in a 1:1:2 ratio. The primary outcome was death due to ovarian cancer by Dec 31, 2014, comparing MMS and USS separately with no screening, ascertained by an outcomes committee masked to randomisation group. All analyses were by modified intention to screen, excluding the small number of women we discovered after randomisation to have a bilateral oophorectomy, have ovarian cancer, or had exited the registry before recruitment. Investigators and participants were aware of screening type. This trial is registered with ClinicalTrials.gov, number NCT00058032. FINDINGS Between June 1, 2001, and Oct 21, 2005, we randomly allocated 202,638 women: 50,640 (25·0%) to MMS, 50,639 (25·0%) to USS, and 101,359 (50·0%) to no screening. 202,546 (>99·9%) women were eligible for analysis: 50,624 (>99·9%) women in the MMS group, 50,623 (>99·9%) in the USS group, and 101,299 (>99·9%) in the no screening group. Screening ended on Dec 31, 2011, and included 345,570 MMS and 327,775 USS annual screening episodes. At a median follow-up of 11·1 years (IQR 10·0-12·0), we diagnosed ovarian cancer in 1282 (0·6%) women: 338 (0·7%) in the MMS group, 314 (0·6%) in the USS group, and 630 (0·6%) in the no screening group. Of these women, 148 (0·29%) women in the MMS group, 154 (0·30%) in the USS group, and 347 (0·34%) in the no screening group had died of ovarian cancer. The primary analysis using a Cox proportional hazards model gave a mortality reduction over years 0-14 of 15% (95% CI -3 to 30; p=0·10) with MMS and 11% (-7 to 27; p=0·21) with USS. The Royston-Parmar flexible parametric model showed that in the MMS group, this mortality effect was made up of 8% (-20 to 31) in years 0-7 and 23% (1-46) in years 7-14, and in the USS group, of 2% (-27 to 26) in years 0-7 and 21% (-2 to 42) in years 7-14. A prespecified analysis of death from ovarian cancer of MMS versus no screening with exclusion of prevalent cases showed significantly different death rates (p=0·021), with an overall average mortality reduction of 20% (-2 to 40) and a reduction of 8% (-27 to 43) in years 0-7 and 28% (-3 to 49) in years 7-14 in favour of MMS. INTERPRETATION Although the mortality reduction was not significant in the primary analysis, we noted a significant mortality reduction with MMS when prevalent cases were excluded. We noted encouraging evidence of a mortality reduction in years 7-14, but further follow-up is needed before firm conclusions can be reached on the efficacy and cost-effectiveness of ovarian cancer screening. FUNDING Medical Research Council, Cancer Research UK, Department of Health, The Eve Appeal.
Collapse
Affiliation(s)
- Ian J Jacobs
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK; University of New South Wales, Sydney, NSW, Australia; Centre for Women's Health, Institute of Human Development, University of Manchester, Manchester, UK.
| | - Usha Menon
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK.
| | - Andy Ryan
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | | | - Matthew Burnell
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - Jatinderpal K Kalsi
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - Nazar N Amso
- Obstetrics and Gynaecology, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Sophia Apostolidou
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - Elizabeth Benjamin
- Research Department of Pathology, Cancer Institute, University College London Hospital, London, UK
| | - Derek Cruickshank
- Department of Gynaecological Oncology, James Cook University Hospital, Middlesbrough, UK
| | - Danielle N Crump
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - Susan K Davies
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - Anne Dawnay
- Clinical Biochemistry, University College London Hospital, London, UK
| | - Stephen Dobbs
- Department of Gynaecological Oncology, Belfast City Hospital, Belfast, UK
| | - Gwendolen Fletcher
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - Jeremy Ford
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK; Malomatia (Information, Communication and Technology QATAR) Qatari Shareholding Company, Qatar
| | - Keith Godfrey
- Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, Tyne and Wear, UK
| | - Richard Gunu
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - Mariam Habib
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK; Medical Research Council Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, London, UK
| | - Rachel Hallett
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK; School of Medical Sciences, Bangor University, Bangor, Gwynedd, UK
| | - Jonathan Herod
- Department of Gynaecology, Liverpool Women's Hospital, Liverpool, UK; Women's Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Howard Jenkins
- Department of Gynaecological Oncology, Royal Derby Hospital, Derby, UK
| | - Chloe Karpinskyj
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - Simon Leeson
- Department of Gynaecological Oncology, Llandudno Hospital, Gwynedd, UK
| | - Sara J Lewis
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - William R Liston
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - Alberto Lopes
- Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, Tyne and Wear, UK; Derriford Hospital, Plymouth, Devon, UK
| | - Tim Mould
- Department of Gynaecological Oncology, University College London Hospital, London, UK; Department of Gynaecological Oncology, Royal Free Hospital, London
| | - John Murdoch
- Department of Gynaecological Oncology, St Michael's Hospital, Bristol, UK
| | - David Oram
- Department of Gynaecological Oncology, St Bartholomew's Hospital, London, UK
| | - Dustin J Rabideau
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | - Karina Reynolds
- Department of Gynaecological Oncology, St Bartholomew's Hospital, London, UK
| | - Ian Scott
- Department of Gynaecological Oncology, Royal Derby Hospital, Derby, UK
| | - Mourad W Seif
- Central Manchester Foundation Trust, St Mary's Hospital, Manchester, UK; Institute of Cancer Sciences, University of Manchester, Manchester, UK
| | - Aarti Sharma
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK; Department of Gynaecological Oncology, University Hospital of Wales, Heath Park, Cardiff, UK
| | - Naveena Singh
- Department of Pathology, Barts Health National Health Service Trust, London, UK
| | - Julie Taylor
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - Fiona Warburton
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK; Public Health England, London, UK
| | - Martin Widschwendter
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - Karin Williamson
- Department of Gynaecological Oncology, Nottingham City Hospital, Nottingham, UK
| | - Robert Woolas
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK; Department of Gynaecological Oncology, Queen Alexandra Hospital, Portsmouth, Hampshire, UK
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer, Brighton and Sussex Medical School, University of Sussex, Sussex, UK
| | | | | | - Mahesh Parmar
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Steven J Skates
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| |
Collapse
|
50
|
Sharma A, Burnell M, Gentry‐Maharaj A, Campbell S, Amso NN, Seif MW, Fletcher G, Brunell C, Turner G, Rangar R, Ryan A, Jacobs I, Menon U. Quality assurance and its impact on ovarian visualization rates in the multicenter United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). Ultrasound Obstet Gynecol 2016; 47:228-35. [PMID: 26095052 PMCID: PMC4755159 DOI: 10.1002/uog.14929] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 04/28/2015] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To describe the quality assurance (QA) processes and their impact on visualization of postmenopausal ovaries in the ultrasound arm of a multicenter screening trial for ovarian cancer. METHODS In the United Kingdom Collaborative Trial of Ovarian Cancer Screening, 50 639 women aged 50-74 years were randomized to the ultrasound arm and underwent annual transvaginal ultrasound (TVS) examinations. QA processes were developed during the course of the trial and included regular monitoring of the visualization rate (VR) of the right ovary. Non-subjective factors identified previously as impacting on VR of the right ovary were included in a generalized estimating equation model for binary outcomes to enable comparison of observed vs adjusted VR between individual sonographers who had undertaken > 1000 scans during the trial and comparison between centers. Observed and adjusted VRs of sonographers and centers were ranked according to the highest VR. Analysis of annual VRs of sonographers and those of the included centers was undertaken. RESULTS Between June 2001 and December 2010, 48 230 of 50 639 women attended one of 13 centers for a total of 270 035 annual TVS scans. One or both ovaries were seen in 228 145 (84.5%) TVS scans. The right ovary was seen on 196 426 (72.7%) of the scans. For the 78 sonographers included in the model, the median difference between observed and adjusted VR was -0.7% (range, -7.9 to 5.9%) and the median change in VR rank after adjustment was 3 (range, 0-18). For the 13 centers, the median difference between observed and adjusted VR was -0.5% (range, -2.2 to 1%), with no change in ranking after adjustment. The median adjusted VR was 73% (interquartile range (IQR), 65-82%) for sonographers and 74.7% (IQR, 67.1-79.0%) for centers. Despite the increasing age of the women being scanned, there was a steady decrease in the number of sonographers with VR < 60% (21.4% in 2002 vs 2.0% in 2010) and an increase in sonographers with VR > 80% (14.3% in 2002 vs 40.8% in 2010). The median VR of the centers increased from 65.5% (range, 55.7-81.0%) in 2001 to 80.3% (range, 74.5-90.9%) in 2010. CONCLUSIONS A robust QA program can improve visualization of postmenopausal ovaries and is an essential component of ultrasound-based ovarian cancer screening trials. While VR should be adjusted for non-subjective factors that impact on ovarian visualization, subjective factors are likely to be the largest contributors to differences in VR.
Collapse
Affiliation(s)
- A. Sharma
- Gynaecological Cancer Research Center, Department of Women's Cancer, Institute for Women's HealthUniversity College LondonLondonUK
- Department of Gynaecological OncologyUniversity Hospital of WalesCardiffUK
| | - M. Burnell
- Gynaecological Cancer Research Center, Department of Women's Cancer, Institute for Women's HealthUniversity College LondonLondonUK
| | - A. Gentry‐Maharaj
- Gynaecological Cancer Research Center, Department of Women's Cancer, Institute for Women's HealthUniversity College LondonLondonUK
| | | | - N. N. Amso
- Institute for Translation, Innovation, Methodology and Engagement, School of MedicineCardiff UniversityCardiffUK
| | - M. W. Seif
- Academic Unit of Obstetrics and GynaecologySt Mary's HospitalManchesterUK
| | - G. Fletcher
- Gynaecological Cancer Research Center, Department of Women's Cancer, Institute for Women's HealthUniversity College LondonLondonUK
| | - C. Brunell
- Department of RadiologyUniversity College London HospitalsLondonUK
| | - G. Turner
- Department of RadiologyRoyal Derby HospitalDerbyUK
| | - R. Rangar
- Northern Gynaecological Oncology CenterQueen Elizabeth HospitalGatesheadUK
| | - A. Ryan
- Gynaecological Cancer Research Center, Department of Women's Cancer, Institute for Women's HealthUniversity College LondonLondonUK
| | - I. Jacobs
- Gynaecological Cancer Research Center, Department of Women's Cancer, Institute for Women's HealthUniversity College LondonLondonUK
- University of New South WalesSydneyNSWAustralia
| | - U. Menon
- Gynaecological Cancer Research Center, Department of Women's Cancer, Institute for Women's HealthUniversity College LondonLondonUK
| |
Collapse
|