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Harrop E, Liossi C, Jamieson L, Gastine S, Oulton K, Skene SS, Howard RF, Johnson M, Boyce K, Mitchell L, Jassal S, Anderson AK, Hain RDW, Hills M, Bayliss J, Soman A, Laddie J, Vickers D, Mellor C, Warlow T, Wong IC. Oral morphine versus transmucosal diamorphine for breakthrough pain in children: methods and outcomes: UK (DIPPER study) consensus. BMJ Support Palliat Care 2024; 13:e1019-e1028. [PMID: 34903585 PMCID: PMC10850727 DOI: 10.1136/bmjspcare-2021-003278] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/04/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVES No randomised controlled trials have been conducted for breakthrough pain in paediatric palliative care and there are currently no standardised outcome measures. The DIPPER study aims to establish the feasibility of conducting a prospective randomised controlled trial comparing oral and transmucosal administration of opioids for breakthrough pain. The aim of the current study was to achieve consensus on design aspects for a small-scale prospective study to inform a future randomised controlled trial of oral morphine, the current first-line treatment, versus transmucosal diamorphine. METHODS The nominal group technique was used to achieve consensus on best practice for mode of administration, dose regimen and a range of suitable pain intensity outcome measures for transmucosal diamorphine in children and young people with breakthrough pain. An expert panel of ten clinicians in paediatric palliative care and three parent representatives participated. Consensus was achieved when agreement was reached and no further comments from participants were forthcoming. RESULTS The panel favoured the buccal route of administration, with dosing according to the recommendations in the Association for Paediatric Palliative Medicine formulary (fifth Edition, 2020). The verbal Numerical Rating Scale was selected to measure pain in children 8 years old and older, the Faces Pain Scale-Revised for children between 4 and 8 years old, and Face, Legs, Activity, Cry and Consolability (FLACC)/FLACC-Revised as the observational tools. CONCLUSIONS The nominal group technique allowed consensus to be reached for a small-scale, prospective, cohort study and provided information to inform the design of a randomised controlled trial.
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Affiliation(s)
- Emily Harrop
- Helen and Douglas House Hospice, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Christina Liossi
- School of Psychology, University of Southampton, Southampton, UK
- Department of Psychology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Liz Jamieson
- Research Dept of Practice & Policy, University College London School of Pharmacy, London, UK
- UCLH-UCL Centre for Medicines Optimisation Research and Education, London, UK
| | - Silke Gastine
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Kate Oulton
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Simon S Skene
- Surrey Clinical Trials Unit, University of Surrey, Guildford, UK
- School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | - Richard F Howard
- Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Margaret Johnson
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Katherine Boyce
- Helen and Douglas House Hospice, Oxford, UK
- Flexicare Oxford & Abingdon, Oxford, UK
| | | | - Satbir Jassal
- Rainbows Hospice for Children and Young People, Loughborough, UK
| | - Anna-Karenia Anderson
- Paediatrics, Royal Marsden Hospital, Sutton, UK
- Shooting Star Children's Hospice, Guildford, UK
| | - Richard D W Hain
- All-Wales Managed Clinical Network in Paediatric Palliative Medicine, Cardiff and Vale University Health Board, Cardiff, UK
| | - Michelle Hills
- Martin House Hospice for Children and Young People, Boston Spa, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Julie Bayliss
- The Louis Dundas Centre, Oncology Outreach and Palliative Care, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Archana Soman
- Sheffield Children's Hospital, Sheffield, UK
- Bluebell Wood Children's Hospice, North Anston, UK
| | | | - David Vickers
- Medical Director, Cambridgeshire Community Services NHS Trust, St Ives, UK
- East Anglia's Children's Hospices, Cambridgeshire, UK
| | | | - Tim Warlow
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Naomi House and Jacksplace, Winchester, UK
| | - Ian Ck Wong
- Research Dept of Practice & Policy, University College London School of Pharmacy, London, UK
- UCLH-UCL Centre for Medicines Optimisation Research and Education, London, UK
- Department of Pharmacology and Pharmacy, The University of Hong Kong, Pok Fu Lam, Hong Kong
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Admojo L, Chidley P, Lin Y, Foroudi F, Jassal S, Loh S, Chew G, Bevington E, Ng S, Hyett A, Leech T, Ooi W, Chionh J, Chao M. Comparing Radiotherapy (RT) Late Toxicities to the Reconstructed DIEP Flap in Breast Cancer Patients Treated with Neoadjuvant RT (NART) vs. Post-Mastectomy RT (PMRT). Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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3
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Lin Y, Chidley P, Admojo L, Jassal S, Zantuck N, Foroudi F, Bevington E, Chew G, Hyett A, Loh S, Ng S, Leech T, Baker C, Law M, Ooi W, Yong C, Chao M. Pathological Complete Response and Oncological Outcomes in Locally Advanced Breast Cancers Treated with Neoadjuvant Radiotherapy: An Australian Perspective. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Liossi C, Greenfield K, Schoth DE, Mott C, Jassal S, Fraser LK, Rajapakse D, Howard RF, Johnson M, Anderson AK, Harrop E. A Systematic Review of Measures of Breakthrough Pain and Their Psychometric Properties. J Pain Symptom Manage 2021; 62:1041-1064. [PMID: 33933619 DOI: 10.1016/j.jpainsymman.2021.04.018] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/21/2021] [Accepted: 04/21/2021] [Indexed: 12/20/2022]
Abstract
CONTEXT Breakthrough pain (BTP) is common in cancer and other conditions yet there is a lack of validated BTP measurement tools. OBJECTIVES We aimed to identify all tools assessing or characterising BTP in patients of any age with any condition, and to critically appraise their psychometric properties. METHODS The Cochrane Library, PROSPERO, Embase, CINAHL, Medline, PsycINFO, Web of Science, Google Scholar, ProQuest, Evidence Search and OpenGrey were searched to identify all available tools used to assess BTP. A second search identified studies that had evaluated psychometric properties of tools identified in Search 1. Databases were searched from inception to November 2020. Studies were assessed using COSMIN criteria and GRADE guidelines. RESULTS Search 1 found 51 tools used to assess BTP. Search 2 found six tools that had a development study and/or a study evaluating a tool psychometric property. No tool had more than one study evaluating psychometric properties so a meta-analysis could not be conducted. Studies were of inadequate to very good quality. Only the Breakthrough Pain Assessment Tool (BAT) had sufficient content validity and at least low-quality evidence for sufficient internal consistency. CONCLUSION The BAT is recommended to characterise BTP in adults with cancer; its applicability to other conditions is unknown. The remaining tools need further evaluation. Only the Breakthrough Pain Questionnaire for Children was designed for children with cancer, but no psychometric properties were evaluated. There is a need for a tool to assess and characterise BTP in children with non-cancer diagnoses and those who cannot self-report.
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Affiliation(s)
- Christina Liossi
- School of Psychology, University of Southampton, Highfield, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, Psychological Medicine, London , UK.
| | | | - Daniel E Schoth
- School of Psychology, University of Southampton, Highfield, UK
| | - Christine Mott
- Hummingbird House Hospice and the Paediatric Palliative Care Service at Queensland Children's Hospital, Australia
| | | | - Lorna K Fraser
- Martin House Research Centre, University of York, York , UK
| | - Dilini Rajapakse
- Great Ormond Street Hospital for Children NHS Foundation Trust, The Louis Dundas Centre, London, UK
| | - Richard F Howard
- Great Ormond Street Hospital for Children NHS Foundation Trust, Department of Anaesthesia and Pain Medicine Level 4, London, UK
| | | | | | - Emily Harrop
- Helen & Douglas House Hospices, Oxford, Oxfordshire, UK; Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Headington, Oxford, UK
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Chao M, Baker C, Jassal S, Law M, Bevington E, Stoney D, Zantuck N, Chew G, Loh S, Hyett A, Guerrieri M, Ng M, Cokelek M, Neoh D, Yong C, Ho H, Tacey M, Lim Joon D, Khor R, Foroudi F. The Pathological Response of Her2+ Breast Cancer with Neoadjuvant Chemotherapy and Radiation Therapy. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chao M, Jassal S, Baker C, Tacey M, Law M, Loh S, Cheng M, Yong C, Zantuck N, Bevington E, Hyett A, Guerrieri M, Cokelek M, Brown B, Chipman M, Chew G, Yeo B, Lippey J, Neoh D, Lamoury G, Spillane A, Foley C, Kechagioglou P, Rolfo M, Foroudi F. OC-0330: Neoadjuvant breast radiotherapy for one stage mastectomy and autologous breast reconstruction. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00354-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Prescott K, Baxter E, Lynch C, Jassal S, Bashir A, Gray J. COVID-19: how prepared are front-line healthcare workers in England? J Hosp Infect 2020; 105:142-145. [PMID: 32339615 PMCID: PMC7195134 DOI: 10.1016/j.jhin.2020.04.031] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/21/2020] [Indexed: 11/04/2022]
Abstract
National efforts are underway to prepare the UK National Health Service (NHS) for the COVID-19 pandemic; however, the efficacy of these interventions is unknown. In view of this, a cross-sectional survey of front-line healthcare workers (HCWs) at two large acute NHS hospital trusts in England was undertaken to assess their confidence and perceived level of preparedness for the virus. The survey found that there has been moderate success in readying HCWs to manage COVID-19, but that more still needs to be done, particularly in relation to educating HCWs about laboratory diagnostics.
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Affiliation(s)
- K Prescott
- Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - E Baxter
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - C Lynch
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S Jassal
- Birmingham Women's and Childrens NHS Foundation Trust, Birmingham, UK
| | - A Bashir
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - J Gray
- Birmingham Women's and Childrens NHS Foundation Trust, Birmingham, UK
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Greenfield K, Holley S, Schoth DE, Bayliss J, Anderson AK, Jassal S, Rajapakse D, Fraser LK, Mott C, Johnson M, Wong I, Howard R, Harrop E, Liossi C. A protocol for a systematic review and meta-analysis to identify measures of breakthrough pain and evaluate their psychometric properties. BMJ Open 2020; 10:e035541. [PMID: 32229524 PMCID: PMC7170606 DOI: 10.1136/bmjopen-2019-035541] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Breakthrough pain is common in children and adults with cancer and other conditions, including those approaching end-of-life, although it is often poorly managed, possibly partly due to a lack of validated assessment tools. This review aims to (1) identify all available instruments measuring breakthrough pain in infants, children, adolescents or adults and (2) critically appraise, compare and summarise the quality of the psychometric properties of the identified instruments using COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria. METHODS AND ANALYSIS Two searches will be carried out between October 2019 and January 2020, one for each aim of the review. The Cochrane Library, International Prospective Register of Systematic Reviews, Embase, Cumulative Index of Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online (MEDLINE), PsycINFO, Web of Science Core Collection, Google Scholar, the ProQuest Dissertations & Theses Database, Evidence Search and OpenGrey databases will be searched from database inception until the date the search is conducted. Reference lists of eligible articles will be screened and authors in the field contacted. For search 1, articles will be screened by two reviewers by abstract, and full-text where necessary, to identify if a breakthrough pain assessment was used. Search 2 will then be conducted to identify studies evaluating measurement properties of these assessments. Two reviewers will screen articles from search 2 by title and abstract. All potentially relevant studies will be screened by full text by both reviewers. For search 2, data will be extracted in parallel with the quality assessment process, as recommended by COSMIN. Two reviewers will assess methodological quality using the COSMIN Risk of Bias checklist and the COSMIN updated criteria for good measurement properties. Findings will be summarised and, if possible, data will be pooled using meta-analysis. The quality of the evidence will be graded and summarised using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) guidelines. ETHICS AND DISSEMINATION Results of this review will be submitted for publication in a peer review journal and presented at conferences. PROSPERO REGISTRATION NUMBER CRD42019155583.
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Affiliation(s)
- Katie Greenfield
- School of Psychology, University of Southampton, Southampton, Hampshire, UK
| | - Simone Holley
- School of Psychology, University of Southampton, Southampton, Hampshire, UK
| | - Daniel Eric Schoth
- School of Psychology, University of Southampton, Southampton, Hampshire, UK
| | - Julie Bayliss
- The Louis Dundas Centre, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Satbir Jassal
- Paediatric Palliative Care, Rainbows Hospice for Children and Young People, Loughborough, Leicestershire, UK
| | - Dilini Rajapakse
- The Louis Dundas Centre, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Lorna Katharine Fraser
- Martin House Research Centre, Department of Health Sciences, University of York, York, UK
| | - Christine Mott
- Paediatric Palliative Care, Hummingbird House Hospice, Brisbane, Queensland, Australia
| | - Margaret Johnson
- Patient & Pubic Representative c/o Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Ian Wong
- School of Pharmacy, University College London, London, UK
| | - Richard Howard
- Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Emily Harrop
- Paediatric Palliative Care, Helen & Douglas House Hospice, Oxford, UK
- Paediatric Palliative Care, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Christina Liossi
- School of Psychology, University of Southampton, Southampton, Hampshire, UK
- Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Greenfield K, Holley S, Schoth DE, Harrop E, Howard R, Bayliss J, Brook L, Jassal S, Johnson M, Wong I, Liossi C. Barriers and facilitators experienced by patients, carers and healthcare professionals when managing symptoms in infants, children and young people at end-of-life: a mixed methods systematic review protocol. BMJ Open 2019; 9:e030566. [PMID: 31352426 PMCID: PMC6661662 DOI: 10.1136/bmjopen-2019-030566] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/12/2019] [Accepted: 06/21/2019] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION This protocol describes the objective and methods of a systematic review of barriers and facilitators experienced by patients, carers and healthcare professionals when managing symptoms in infants, children and young people (ICYP) at end-of-life. METHODS AND ANALYSIS The Cochrane Library, PROSPERO, CINAHL, MEDLINE, PsycINFO, Web of Science Core Collection, ProQuest Dissertations & Theses Database, Evidence Search and OpenGrey will be electronically searched. Reference screening of relevant articles and inquiries to researchers in the field will be undertaken. Studies will be selected if they apply qualitative, quantitative or mixed-methods designs to explore barriers and facilitators experienced by patients, carers and healthcare professionals when managing symptoms in ICYP at end-of-life.Articles will be screened by title and abstract by one reviewer with a second reviewer assessing 10% of the articles. Both reviewers will read and screen all remaining potentially relevant articles. For included articles, one reviewer will extract study characteristics and one will check this.Both reviewers will undertake independent quality assessments of included studies using established and appropriate checklists including The Critical Appraisal Skills Programme Qualitative Checklist; The evaluative criteria of credibility, transferability, dependability and confirmability; The Quality Assessment Tool for Quantitative Studies, and The Mixed Methods Appraisal Tool. Data synthesis methods will be decided after data extraction and assessment. ETHICS AND DISSEMINATION This review will inform our understanding of symptom management in ICYP at end-of-life. The findings will be reported in a peer-reviewed journal and presented at conferences. The study raises no ethical issues. PROSPERO REGISTRATION NUMBER CRD42019124797.
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Affiliation(s)
- Katie Greenfield
- Department of Psychology, University of Southampton, Southampton, UK
| | - Simone Holley
- Department of Psychology, University of Southampton, Southampton, UK
| | | | | | - Richard Howard
- Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Julie Bayliss
- The Louis Dundas Centre, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Lynda Brook
- Specialist Palliative Care Team, Alder Hey Children’s Hospital, Liverpool, UK
| | - Satbir Jassal
- Rainbows Hospice for Children and Young People, Loughborough, UK
| | - Margaret Johnson
- Patient Representative c/o Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Ian Wong
- School of Pharmacy, University College London, London, UK
| | - Christina Liossi
- Department of Psychology, University of Southampton, Southampton, UK
- Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Chao M, Spencer S, Kai C, Baker C, Jassal S, Law M, Cheng M, Zantuck N, Yu V, Stoney D, Loh S, Bevington E, Chew G, Hyett A, Guerrieri M, Ho H, Ng M, Wasiak J, Foroudi F. EP-1286 StrataXRT is non inferior to Mepitel Film in preventing radiation induced moist desquamation. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31706-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sulé-Suso J, Bisson J, Jassal S, Martínez M, Huxley N, Ellis C, Chambers D, Fields K, O'Donovan C, Edwards C, Vengalil S, Bhana R. PO-0834 Virtual imaging for patient information on radiotherapy planning and delivery for prostate cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31254-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Chao M, Foroudi F, Jassal S, Hyett A, Neoh D, Bevington E, Loh S, Zantuck N, Stoney D, Guerrieri M, Foley C, Grinsell D, Law M, Cheng M, Yu V, Chew G, Taylor K, David C, Chipman M, Baker C. Tumor down staging in high risk or locally advanced breast cancer patients undergoing neoadjuvant radiotherapy prior to definitive surgery and autologous breast reconstruction. Eur J Cancer 2018. [DOI: 10.1016/s0959-8049(18)30397-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chao M, Foroudi F, Jassal S, Hyett A, Neoh D, Bevington E, Stoney D, Zantuck N, Law M, Foley C, Guerrieri M, Grinsell D, Loh S, Chew G, Yu V, Cokelek M, Taylor K, Cheng M, Chipman M, Baker C. The use of neoadjuvant radiotherapy in high risk or locally advanced breast cancer patients prior to definitive surgery with mastectomy and autologous breast reconstruction does not impact on post operative surgical complications. Eur J Cancer 2018. [DOI: 10.1016/s0959-8049(18)30419-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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14
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Baker C, Chao MW, Jassal S, Neoh D, Bevington E, Hyett A, Grinsell D, Loh SW, Zantuck N, Stoney D, Foley C, Law M, Chew G, Yu V, Cheng M, Guerrieri M, Taylor K, Chipman M, Cokelek M, Lim Joon D, Foroudi F. Abstract P2-11-16: The safety and pathological impact of neoadjuvant radiotherapy for local advanced breast cancer undergoing mastectomy and autologous reconstruction. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-11-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction
Delayed breast reconstructions are preferred if post mastectomy radiotherapy is indicated due to lower complication rates compared to immediate permanent implant or autologous reconstructions (AR) but cosmetic outcomes are inferior. Radiotherapy has a deleterious effect on implants and autologous tissue and often an interim tissue expander is place which has inherent pain and complications.
However, neoadjuvant radiotherapy (NART) prior to surgery allows for definitive oncological surgery to be performed with an immediate AR in a single operation and the avoidance of a temporary expander. The aim of this study is to assess the safety and downstaging impact of NART.
Methods
This is a prospective review of patients who underwent NART at GenesisCare Victoria, the Austin and the Alfred hospital. 59 LABC patients (median age 49.2 years) were divided into two groups; clinically staged and pathologically staged for reporting. There were 15 pathologically staged patients (pStage 2A-3C) and 43 clinically staged patients (cStage 2A-3B). All patients initially underwent NACT, followed by NART (median dose 50.4Gy in 28 fractions) to the breast, supraclavicular fossa and level 3 axilla with or without coverage of their Level 1 and 2 axilla, and/or internal mammary nodes. Approximately 6 weeks after completing NART, patients underwent definitive surgery and AR.
Results
All patients completed their NART with minimal toxicity and no break in treatment. 55 patients had a skin-sparing mastectomy (SSM) and 3 patients had a modified radical mastectomy. All clinically staged patients underwent an AD. ARs with a DIEP flap were performed in the majority of patients (51). The average length of hospitalisation was 6.2 days.
The Miller Payne (MP) scoring index was used to record pathological responses in clinically staged patients. Overall 36 patients achieved significant downstaging of their disease, with MP scores of 5/5 for 20 and 4/5 for 16. Only 1 patient failed to achieve any downstaging with a MP score of 1/5. All 12 Her2 positive patients, 3/5 Triple negative patients and 5/26 Luminal A/B patients achieved a MP score of 5/5. All patients achieved R0 resection margins. This included 6 patients who had initial cT4 disease (cT4a X2, cT4b X1 and cT4d X3). 15 patients had initial cN2/3 disease and all successfully underwent their axillary dissections with R0 resections achieved. 10/15 had no involved axillary nodes with significant scarring seen in 6. 5/15 had residual involved nodes with significant scarring seen in 3 patients.
Post surgical toxicities were graded using Clavien-Dindo classification. 8 significant grade 3 toxicities were seen in 6 patients, with no grade 4 or 5 toxicities. No patients developed DVT or PE. No flap losses were seen.
Median follow up is 23 months. Cosmesis was rated as good to excellent in all cases. 1 patient developed simultaneous loco-regional and distant recurrence with another 3 patients developing distant metastases only.
Conclusion
This review demonstrated that NART is a safe technique, which has not lead to an increase in surgical complication rates or resulted in a detriment in cosmetic outcome. NART can achieve a shorter, simpler reconstructive journey for patients.
Citation Format: Baker C, Chao MW, Jassal S, Neoh D, Bevington E, Hyett A, Grinsell D, Loh SW, Zantuck N, Stoney D, Foley C, Law M, Chew G, Yu V, Cheng M, Guerrieri M, Taylor K, Chipman M, Cokelek M, Lim Joon D, Foroudi F. The safety and pathological impact of neoadjuvant radiotherapy for local advanced breast cancer undergoing mastectomy and autologous reconstruction [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-11-16.
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Affiliation(s)
- C Baker
- St Vincents Hospital, Melbourne, Victoria, Australia; Victorian Breast and Oncology Centre, Melbourne, Victoria, Australia; Genesis Care Cancer Centre, Melbourne, Victoria, Australia; Austin Hospital, Melbourne, Victoria, Australia; Maroondah Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - MW Chao
- St Vincents Hospital, Melbourne, Victoria, Australia; Victorian Breast and Oncology Centre, Melbourne, Victoria, Australia; Genesis Care Cancer Centre, Melbourne, Victoria, Australia; Austin Hospital, Melbourne, Victoria, Australia; Maroondah Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - S Jassal
- St Vincents Hospital, Melbourne, Victoria, Australia; Victorian Breast and Oncology Centre, Melbourne, Victoria, Australia; Genesis Care Cancer Centre, Melbourne, Victoria, Australia; Austin Hospital, Melbourne, Victoria, Australia; Maroondah Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - D Neoh
- St Vincents Hospital, Melbourne, Victoria, Australia; Victorian Breast and Oncology Centre, Melbourne, Victoria, Australia; Genesis Care Cancer Centre, Melbourne, Victoria, Australia; Austin Hospital, Melbourne, Victoria, Australia; Maroondah Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - E Bevington
- St Vincents Hospital, Melbourne, Victoria, Australia; Victorian Breast and Oncology Centre, Melbourne, Victoria, Australia; Genesis Care Cancer Centre, Melbourne, Victoria, Australia; Austin Hospital, Melbourne, Victoria, Australia; Maroondah Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - A Hyett
- St Vincents Hospital, Melbourne, Victoria, Australia; Victorian Breast and Oncology Centre, Melbourne, Victoria, Australia; Genesis Care Cancer Centre, Melbourne, Victoria, Australia; Austin Hospital, Melbourne, Victoria, Australia; Maroondah Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - D Grinsell
- St Vincents Hospital, Melbourne, Victoria, Australia; Victorian Breast and Oncology Centre, Melbourne, Victoria, Australia; Genesis Care Cancer Centre, Melbourne, Victoria, Australia; Austin Hospital, Melbourne, Victoria, Australia; Maroondah Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - SW Loh
- St Vincents Hospital, Melbourne, Victoria, Australia; Victorian Breast and Oncology Centre, Melbourne, Victoria, Australia; Genesis Care Cancer Centre, Melbourne, Victoria, Australia; Austin Hospital, Melbourne, Victoria, Australia; Maroondah Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - N Zantuck
- St Vincents Hospital, Melbourne, Victoria, Australia; Victorian Breast and Oncology Centre, Melbourne, Victoria, Australia; Genesis Care Cancer Centre, Melbourne, Victoria, Australia; Austin Hospital, Melbourne, Victoria, Australia; Maroondah Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - D Stoney
- St Vincents Hospital, Melbourne, Victoria, Australia; Victorian Breast and Oncology Centre, Melbourne, Victoria, Australia; Genesis Care Cancer Centre, Melbourne, Victoria, Australia; Austin Hospital, Melbourne, Victoria, Australia; Maroondah Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - C Foley
- St Vincents Hospital, Melbourne, Victoria, Australia; Victorian Breast and Oncology Centre, Melbourne, Victoria, Australia; Genesis Care Cancer Centre, Melbourne, Victoria, Australia; Austin Hospital, Melbourne, Victoria, Australia; Maroondah Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - M Law
- St Vincents Hospital, Melbourne, Victoria, Australia; Victorian Breast and Oncology Centre, Melbourne, Victoria, Australia; Genesis Care Cancer Centre, Melbourne, Victoria, Australia; Austin Hospital, Melbourne, Victoria, Australia; Maroondah Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - G Chew
- St Vincents Hospital, Melbourne, Victoria, Australia; Victorian Breast and Oncology Centre, Melbourne, Victoria, Australia; Genesis Care Cancer Centre, Melbourne, Victoria, Australia; Austin Hospital, Melbourne, Victoria, Australia; Maroondah Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - V Yu
- St Vincents Hospital, Melbourne, Victoria, Australia; Victorian Breast and Oncology Centre, Melbourne, Victoria, Australia; Genesis Care Cancer Centre, Melbourne, Victoria, Australia; Austin Hospital, Melbourne, Victoria, Australia; Maroondah Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - M Cheng
- St Vincents Hospital, Melbourne, Victoria, Australia; Victorian Breast and Oncology Centre, Melbourne, Victoria, Australia; Genesis Care Cancer Centre, Melbourne, Victoria, Australia; Austin Hospital, Melbourne, Victoria, Australia; Maroondah Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - M Guerrieri
- St Vincents Hospital, Melbourne, Victoria, Australia; Victorian Breast and Oncology Centre, Melbourne, Victoria, Australia; Genesis Care Cancer Centre, Melbourne, Victoria, Australia; Austin Hospital, Melbourne, Victoria, Australia; Maroondah Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - K Taylor
- St Vincents Hospital, Melbourne, Victoria, Australia; Victorian Breast and Oncology Centre, Melbourne, Victoria, Australia; Genesis Care Cancer Centre, Melbourne, Victoria, Australia; Austin Hospital, Melbourne, Victoria, Australia; Maroondah Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - M Chipman
- St Vincents Hospital, Melbourne, Victoria, Australia; Victorian Breast and Oncology Centre, Melbourne, Victoria, Australia; Genesis Care Cancer Centre, Melbourne, Victoria, Australia; Austin Hospital, Melbourne, Victoria, Australia; Maroondah Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - M Cokelek
- St Vincents Hospital, Melbourne, Victoria, Australia; Victorian Breast and Oncology Centre, Melbourne, Victoria, Australia; Genesis Care Cancer Centre, Melbourne, Victoria, Australia; Austin Hospital, Melbourne, Victoria, Australia; Maroondah Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - D Lim Joon
- St Vincents Hospital, Melbourne, Victoria, Australia; Victorian Breast and Oncology Centre, Melbourne, Victoria, Australia; Genesis Care Cancer Centre, Melbourne, Victoria, Australia; Austin Hospital, Melbourne, Victoria, Australia; Maroondah Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - F Foroudi
- St Vincents Hospital, Melbourne, Victoria, Australia; Victorian Breast and Oncology Centre, Melbourne, Victoria, Australia; Genesis Care Cancer Centre, Melbourne, Victoria, Australia; Austin Hospital, Melbourne, Victoria, Australia; Maroondah Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
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Cokelek M, Chao M, Foroudi F, Jassal S, Neoh D, Bevington E, Hyett A, Grinsell D, Loh S, Zantuck N, Stoney D, Foley C, Law M, Yu V, Chew G, Cheng M, Taylor K, Guerrieri M, Chipman M, Baker C. Sequence Reversal: Neoadjuvant Radiation Therapy for Locally Advanced Breast Cancer. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Laughlin G, Kritz-Silverstein D, Bergstrom J, Reas E, Jassal S, Barrett-Connor E, McEvoy L. VITAMIN D INSUFFICIENCY AND COGNITIVE TRAJECTORIES IN OLDER ADULTS: THE RANCHO BERNARDO STUDY. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1670] [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: 11/14/2022] Open
Affiliation(s)
- G.A. Laughlin
- University of California San Diego, La Jolla, California
| | | | - J. Bergstrom
- University of California San Diego, La Jolla, California
| | - E. Reas
- University of California San Diego, La Jolla, California
| | - S. Jassal
- University of California San Diego, La Jolla, California
| | | | - L.K. McEvoy
- University of California San Diego, La Jolla, California
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Sulé-Suso J, Finney S, Bisson J, Hammersley S, Jassal S, Knight C, Ellis C, Sargeant S, Lam K, Belcher J, Collins D, Bhana R, Adab F, O'Donovan C, Moloney A. EP-1461: Virtual imaging for patient information on radiotherapy planning and delivery. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32711-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Waxman BP, Jassal S. GS07 ABDOMINAL WALL COMPONENTS SEPARATION TECHNIQUE FOR CLOSURE OF VENTRAL DEFECTS ? INITIAL EXPERIENCE AND LESSONS LEARNT. ANZ J Surg 2007. [DOI: 10.1111/j.1445-2197.2007.04119_7.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Wang T, Izatt S, Dalglish C, Bargman J, Jassal S, Vas S, Oreopoulos D. Peritoneal dialysis in a nursing home: limited survival expectations. Clin Nephrol 2003; 60:373-4. [PMID: 14640246 DOI: 10.5414/cnp60373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Jassal S, Coli E, Roscoe J, Redelmeier D. Is Transplantation Really Better than Dialysis in the Elderly? Age Ageing 1998. [DOI: 10.1093/ageing/27.suppl_1.p30-a] [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: 11/12/2022] Open
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