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Derby S, Jackson MR, Williams K, Stobo J, Kelly C, Sweeting L, Shad S, Herbert C, Short SC, Williamson A, James A, Nowicki S, Bulbeck H, Chalmers AJ. Concurrent Olaparib and Radiation Therapy in Older Patients With Newly Diagnosed Glioblastoma: The Phase 1 Dose-Escalation PARADIGM Trial. Int J Radiat Oncol Biol Phys 2024; 118:1371-1378. [PMID: 38211641 DOI: 10.1016/j.ijrobp.2024.01.011] [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: 10/18/2023] [Revised: 01/04/2024] [Accepted: 01/04/2024] [Indexed: 01/13/2024]
Abstract
PURPOSE Patients with glioblastoma who are older or have poor performance status (PS) experience particularly poor clinical outcomes. At the time of study initiation, these patients were treated with short-course radiation therapy (40 Gy in 15 fractions). Olaparib is an oral inhibitor of the DNA repair enzyme poly (ADP-ribose) polymerase (PARP) that is well tolerated as a single agent but exacerbates acute radiation toxicity in extracranial sites. Preclinical data predicted that PARP inhibitors would enhance radiosensitivity in glioblastoma without exacerbating adverse effects on the normal brain. METHODS AND MATERIALS Phase 1 of the PARADIGM trial was a 3+3 dose-escalation study testing olaparib in combination with radiation therapy (40 Gy 15 fractions) in patients with newly diagnosed glioblastoma who were unsuitable for radical treatment either because they were aged 70 years or older (World Health Organization PS 0-1) or aged 18 to 69 years with PS 2. The primary outcome was the recommended phase 2 dose of olaparib. Secondary endpoints included safety and tolerability, overall survival, and progression-free survival. Effects on cognitive function were assessed via the Mini Mental State Examination. RESULTS Of 16 eligible patients (56.25% male; median age, 71.5 years [range, 44-78]; 75% PS 0-1), 1 dose-limiting toxicity was reported (grade 3 agitation). Maximum tolerated dose was not reached and the recommended phase 2 dose was determined as 200 mg twice daily. Median overall survival and progression-free survival were 10.8 months (80% CI, 7.3-11.4) and 5.5 months (80% CI, 3.9-5.9), respectively. Mini Mental State Examination plots indicated that cognitive function was not adversely affected by the olaparib-radiation therapy combination. CONCLUSIONS Olaparib can be safely combined with hypofractionated brain radiation therapy and is well tolerated in patients unsuitable for radical chemoradiation. These results enabled initiation of a randomized phase 2 study and support future trials of PARP inhibitors in combination with radiation therapy for patients with brain tumors.
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Affiliation(s)
- Sarah Derby
- School of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Mark R Jackson
- School of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Karin Williams
- School of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Jamie Stobo
- CRUK Glasgow Clinical Trials Unit, University of Glasgow, Glasgow, United Kingdom
| | - Caroline Kelly
- CRUK Glasgow Clinical Trials Unit, University of Glasgow, Glasgow, United Kingdom
| | - Lorna Sweeting
- CRUK Glasgow Clinical Trials Unit, University of Glasgow, Glasgow, United Kingdom
| | - Shumaila Shad
- CRUK Glasgow Clinical Trials Unit, University of Glasgow, Glasgow, United Kingdom
| | - Christopher Herbert
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Susan C Short
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, United Kingdom
| | | | - Allan James
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Stefan Nowicki
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | | | - Anthony J Chalmers
- School of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom.
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Hudson EM, Noutch S, Webster J, Brown SR, Boele FW, Al-Salihi O, Baines H, Bulbeck H, Currie S, Fernandez S, Hughes J, Lilley J, Smith A, Parbutt C, Slevin F, Short S, Sebag-Montefiore D, Murray L. Brain Re-Irradiation Or Chemotherapy: a phase II randomised trial of re-irradiation and chemotherapy in patients with recurrent glioblastoma (BRIOChe) - protocol for a multi-centre open-label randomised trial. BMJ Open 2024; 14:e078926. [PMID: 38458809 DOI: 10.1136/bmjopen-2023-078926] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2024] Open
Abstract
INTRODUCTION Glioblastoma (GBM) is the most common adult primary malignant brain tumour. The condition is incurable and, despite aggressive treatment at first presentation, almost all tumours recur after a median of 7 months. The aim of treatment at recurrence is to prolong survival and maintain health-related quality of life (HRQoL). Chemotherapy is typically employed for recurrent GBM, often using nitrosourea-based regimens. However, efficacy is limited, with reported median survivals between 5 and 9 months from recurrence. Although less commonly used in the UK, there is growing evidence that re-irradiation may produce survival outcomes at least similar to nitrosourea-based chemotherapy. However, there remains uncertainty as to the optimum approach and there is a paucity of available data, especially with regards to HRQoL. Brain Re-Irradiation Or Chemotherapy (BRIOChe) aims to assess re-irradiation, as an acceptable treatment option for recurrent IDH-wild-type GBM. METHODS AND ANALYSIS BRIOChe is a phase II, multi-centre, open-label, randomised trial in patients with recurrent GBM. The trial uses Sargent's three-outcome design and will recruit approximately 55 participants from 10 to 15 UK radiotherapy sites, allocated (2:1) to receive re-irradiation (35 Gy in 10 daily fractions) or nitrosourea-based chemotherapy (up to six, 6-weekly cycles). The primary endpoint is overall survival rate for re-irradiation patients at 9 months. There will be no formal statistical comparison between treatment arms for the decision-making primary analysis. The chemotherapy arm will be used for calibration purposes, to collect concurrent data to aid interpretation of results. Secondary outcomes include HRQoL, dexamethasone requirement, anti-epileptic drug requirement, radiological response, treatment compliance, acute and late toxicities, progression-free survival. ETHICS AND DISSEMINATION BRIOChe obtained ethical approval from Office for Research Ethics Committees Northern Ireland (reference no. 20/NI/0070). Final trial results will be published in peer-reviewed journals and adhere to the ICMJE guidelines. TRIAL REGISTRATION NUMBER ISRCTN60524.
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Affiliation(s)
- Eleanor M Hudson
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Samantha Noutch
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Joanne Webster
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Sarah R Brown
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Florien W Boele
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Helen Baines
- National Radiotherapy Trials QA (RTTQA) Group, Mount Vernon Cancer Centre, Northwood, UK
| | | | - Stuart Currie
- Department of Radiology, Leeds General Infirmary, Leeds, UK
| | - Sharon Fernandez
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Jane Hughes
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - John Lilley
- Department of Medical Physics, Leeds Cancer Centre, Leeds, UK
| | - Alexandra Smith
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | | | - Finbar Slevin
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK
| | - Susan Short
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK
| | | | - Louise Murray
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK
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3
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Millward CP, Keshwara SM, Armstrong TS, Barrington H, Bell S, Brodbelt AR, Bulbeck H, Dirven L, Grundy PL, Islim AI, Javadpour M, Koszdin SD, Marson AG, McDermott MW, Meling TR, Oliver K, Plaha P, Preusser M, Santarius T, Srikandarajah N, Taphoorn MJB, Turner C, Watts C, Weller M, Williamson PR, Zadeh G, Zamanipoor Najafabadi AH, Jenkinson MD. The outcomes measured and reported in intracranial meningioma clinical trials: A systematic review. Neurooncol Adv 2024; 6:vdae030. [PMID: 38596717 PMCID: PMC11003530 DOI: 10.1093/noajnl/vdae030] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
Background Meningioma clinical trials have assessed interventions including surgery, radiotherapy, and pharmacotherapy. However, agreement does not exist on what, how, and when outcomes of interest should be measured. To do so would allow comparative analysis of similar trials. This systematic review aimed to summarize the outcomes measured and reported in meningioma clinical trials. Methods Systematic literature and trial registry searches were performed to identify published and ongoing intracranial meningioma clinical trials (PubMed, Embase, Medline, CINAHL via EBSCO, and Web of Science, completed January 22, 2022). Reported outcomes were extracted verbatim, along with an associated definition and method of measurement if provided. Verbatim outcomes were deduplicated and the resulting unique outcomes were grouped under standardized outcome terms. These were classified using the taxonomy proposed by the "Core Outcome Measures in Effectiveness Trials" (COMET) initiative. Results Thirty published articles and 18 ongoing studies were included, describing 47 unique clinical trials: Phase 2 n = 33, phase 3 n = 14. Common interventions included: Surgery n = 13, radiotherapy n = 8, and pharmacotherapy n = 20. In total, 659 verbatim outcomes were reported, of which 84 were defined. Following de-duplication, 415 unique verbatim outcomes remained and were grouped into 115 standardized outcome terms. These were classified using the COMET taxonomy into 29 outcome domains and 5 core areas. Conclusions Outcome measurement across meningioma clinical trials is heterogeneous. The standardized outcome terms identified will be prioritized through an eDelphi survey and consensus meeting of key stakeholders (including patients), in order to develop a core outcome set for use in future meningioma clinical trials.
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Affiliation(s)
- Christopher P Millward
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Sumirat M Keshwara
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Terri S Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | | | | | - Andrew R Brodbelt
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Helen Bulbeck
- Brainstrust–The Brain Cancer People, Isle of Wight, UK
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Paul L Grundy
- Department of Neurosurgery, University Hospital Southampton, Southampton, UK
| | - Abdurrahman I Islim
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Mohsen Javadpour
- National Centre for Neurosurgery, Beaumont Hospital, Dublin, Ireland
| | | | - Anthony G Marson
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, UK
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Michael W McDermott
- Division of Neuroscience, Florida International University, Miami, Florida, USA
| | - Torstein R Meling
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Puneet Plaha
- International Brain Tumour Alliance, Tadworth, UK (K.O.).; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Matthias Preusser
- Division of Oncology, Department of Medicine, Medical University of Vienna, Vienna, Austria
| | - Thomas Santarius
- Department of Neurosurgery, Addenbrooke’s Hospital & University of Cambridge, Cambridge, UK
| | | | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Carole Turner
- Department of Neurosurgery, Addenbrooke’s Hospital & University of Cambridge, Cambridge, UK
| | - Colin Watts
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | | | - Gelareh Zadeh
- Department of Surgery, University of Toronto, Toronto, Canada
| | - Amir H Zamanipoor Najafabadi
- Department of Ophthalmology, Leiden University Medical Centre, Haaglanden Medical Center, Haga Teaching Hospitals, Leiden, The Netherlands
| | - Michael D Jenkinson
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
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Millward CP, Islim AI, Armstrong TS, Barrington H, Bell S, Brodbelt AR, Bulbeck H, Dirven L, Grundy PL, Javadpour M, Keshwara SM, Koszdin SD, Marson AG, McDermott MW, Meling TR, Oliver K, Plaha P, Preusser M, Santarius T, Srikandarajah N, Taphoorn MJB, Turner C, Watts C, Weller M, Williamson PR, Zadeh G, Zamanipoor Najafabadi AH, Jenkinson MD. The outcomes measured and reported in observational studies of incidental and untreated intracranial meningioma: A systematic review. Neurooncol Adv 2024; 6:vdae042. [PMID: 38596715 PMCID: PMC11003528 DOI: 10.1093/noajnl/vdae042] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
Background The clinical management of patients with incidental intracranial meningioma varies markedly and is often based on clinician choice and observational data. Heterogeneous outcome measurement has likely hampered knowledge progress by preventing comparative analysis of similar cohorts of patients. This systematic review aimed to summarize the outcomes measured and reported in observational studies. Methods A systematic literature search was performed to identify published full texts describing active monitoring of adult cohorts with incidental and untreated intracranial meningioma (PubMed, EMBASE, MEDLINE, and CINAHL via EBSCO, completed January 24, 2022). Reported outcomes were extracted verbatim, along with an associated definition and method of measurement if provided. Verbatim outcomes were de-duplicated and the resulting unique outcomes were grouped under standardized outcome terms. These were classified using the taxonomy proposed by the "Core Outcome Measures in Effectiveness Trials" (COMET) initiative. Results Thirty-three published articles and 1 ongoing study were included describing 32 unique studies: study designs were retrospective n = 27 and prospective n = 5. In total, 268 verbatim outcomes were reported, of which 77 were defined. Following de-duplication, 178 unique verbatim outcomes remained and were grouped into 53 standardized outcome terms. These were classified using the COMET taxonomy into 9 outcome domains and 3 core areas. Conclusions Outcome measurement across observational studies of incidental and untreated intracranial meningioma is heterogeneous. The standardized outcome terms identified will be prioritized through an eDelphi survey and consensus meeting of key stakeholders (including patients), in order to develop a Core Outcome Set for use in future observational studies.
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Affiliation(s)
- Christopher P Millward
- Institute of Systems, Molecular, & Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Abdurrahman I Islim
- Institute of Systems, Molecular, & Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Terri S Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | | | | | - Andrew R Brodbelt
- Institute of Systems, Molecular, & Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Helen Bulbeck
- Brainstrust – The Brain Cancer People, Isle of Wight, UK
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Paul L Grundy
- Department of Neurosurgery, University Hospital Southampton, Southampton, UK
| | - Mohsen Javadpour
- National Centre for Neurosurgery, Beaumont Hospital, Dublin, Ireland
| | - Sumirat M Keshwara
- Institute of Systems, Molecular, & Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | | | - Anthony G Marson
- Institute of Systems, Molecular, & Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Michael W McDermott
- Division of Neuroscience, Florida International University, Miami, Florida, USA
| | - Torstein R Meling
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kathy Oliver
- International Brain Tumour Alliance, Tadworth, UK
| | - Puneet Plaha
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Matthias Preusser
- Division of Oncology, Department of Medicine, Medical University of Vienna, Vienna, Austria
| | - Thomas Santarius
- Department of Neurosurgery, Addenbrooke’s Hospital & University of Cambridge, Cambridge, UK
| | - Nisaharan Srikandarajah
- Institute of Systems, Molecular, & Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Carole Turner
- Department of Neurosurgery, Addenbrooke’s Hospital & University of Cambridge, Cambridge, UK
| | - Colin Watts
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | | | - Gelareh Zadeh
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Amir H Zamanipoor Najafabadi
- Department of Ophthalmology, Leiden University Medical Centre, Haaglanden Medical Center, Haga Teaching Hospitals, Leiden and The Hague, The Netherlands
| | - Michael D Jenkinson
- Institute of Systems, Molecular, & Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
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Albarqouni L, Montori V, Jørgensen KJ, Ringsten M, Bulbeck H, Johansson M. Applying the time needed to treat to NICE guidelines on lifestyle interventions. BMJ Evid Based Med 2023; 28:354-355. [PMID: 37225391 DOI: 10.1136/bmjebm-2022-112225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/09/2023] [Indexed: 05/26/2023]
Affiliation(s)
- Loai Albarqouni
- Global Center for Sustainable Healthcare, Global Center for Sustainable Healthcare, Uddevalla, Sweden
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Robina, Queensland, Australia
| | - Victor Montori
- Global Center for Sustainable Healthcare, Global Center for Sustainable Healthcare, Uddevalla, Sweden
- The Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Karsten Juhl Jørgensen
- Global Center for Sustainable Healthcare, Global Center for Sustainable Healthcare, Uddevalla, Sweden
- Department of Clinical Research, Cochrane Denmark and Centre for Evidence-Based Medicine Odense (CEBMO), University of Southern Denmark, Odense, Denmark
| | - Martin Ringsten
- Cochrane Sweden, Skåne University Hospital, Lund, Sweden
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Helen Bulbeck
- Cochrane Consumer Network Executive, Brainstrust, Cowes, UK
| | - Minna Johansson
- Global Center for Sustainable Healthcare, Global Center for Sustainable Healthcare, Uddevalla, Sweden
- General Practice, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Boele FW, Butler S, Nicklin E, Bulbeck H, Pointon L, Short SC, Murray L. Communication in the context of glioblastoma treatment: A qualitative study of what matters most to patients, caregivers and health care professionals. Palliat Med 2023; 37:834-843. [PMID: 36734532 PMCID: PMC10227096 DOI: 10.1177/02692163231152525] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Patients with glioblastoma have a poor prognosis and treatment is palliative in nature from diagnosis. It is therefore critical that the benefits and burdens of treatments are clearly discussed with patients and caregivers. AIM To explore experiences and preferences around glioblastoma treatment communication in patients, family caregivers and healthcare professionals. DESIGN Qualitative design. A thematic analysis of semi-structured interviews. SETTING/PARTICIPANTS A total of 15 adult patients with glioblastoma, 13 caregivers and 5 healthcare professionals were recruited from Leeds Teaching Hospitals NHS Trust. RESULTS Four themes were identified: (1) Communication practice and preferences. Risks and side-effects of anti-tumour treatments were explained clearly, with information layered and repeated. Treatment was often understood to be 'the only option'. Understanding the impact of side-effects could be enhanced, alongside information about support services. (2) What matters most. Patients/caregivers valued being well-supported by a trusted treatment team, feeling involved, having control and quality of life. Healthcare professionals similarly highlighted trust, maintaining independence and emotional support as key. (3) Decision-making. With limited treatment options, trust and control are crucial in decision-making. Patients ultimately prefer to follow healthcare professional advice but want to be involved, consider alternatives and voice what matters to them. (4) Impact of COVID-19. During the pandemic, greater efforts to maintain good communication were necessary. Negative impacts of COVID-19 were limited, caregivers appeared most disadvantaged by pandemic-related restrictions. CONCLUSIONS In glioblastoma treatment communication, where prognosis is poor and treatmentwill not result in cure, building trusting relationships, maintaining a sense of control and being well-informed are identified as critical.
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Affiliation(s)
- Florien W Boele
- Leeds Institute of Medical Research, St James’s Hospital, University of Leeds, Leeds, UK
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Sean Butler
- Leeds Institute of Medical Research, St James’s Hospital, University of Leeds, Leeds, UK
| | - Emma Nicklin
- Leeds Institute of Medical Research, St James’s Hospital, University of Leeds, Leeds, UK
| | | | - Lucy Pointon
- Leeds Institute of Medical Research, School of Psychology, University of Leeds, Leeds, UK
| | - Susan C Short
- Leeds Institute of Medical Research, St James’s Hospital, University of Leeds, Leeds, UK
| | - Louise Murray
- Leeds Institute of Medical Research, St James’s Hospital, University of Leeds, Leeds, UK
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Rooney AG, Hewins W, Walker A, Mackinnon M, Withington L, Robson S, Torrens C, Hopcroft LEM, Clark A, Anderson G, Bulbeck H, Dunlop J, Welsh M, Dyson A, Emerson J, Cochrane C, Hill R, Carruthers J, Day J, Gillespie D, Hewitt C, Molinari E, Wells M, McBain C, Chalmers AJ, Grant R. Lifestyle coaching is feasible in fatigued brain tumor patients: A phase I/feasibility, multi-center, mixed-methods randomized controlled trial. Neurooncol Pract 2023; 10:249-260. [PMID: 37188163 PMCID: PMC10180387 DOI: 10.1093/nop/npac086] [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: 11/05/2022] Open
Abstract
Background There are no effective treatments for brain tumor-related fatigue. We studied the feasibility of two novel lifestyle coaching interventions in fatigued brain tumor patients. Methods This phase I/feasibility multi-center RCT recruited patients with a clinically stable primary brain tumor and significant fatigue (mean Brief Fatigue Inventory [BFI] score ≥ 4/10). Participants were randomized in a 1-1-1 allocation ratio to: Control (usual care); Health Coaching ("HC", an eight-week program targeting lifestyle behaviors); or HC plus Activation Coaching ("HC + AC", further targeting self-efficacy). The primary outcome was feasibility of recruitment and retention. Secondary outcomes were intervention acceptability, which was evaluated via qualitative interview, and safety. Exploratory quantitative outcomes were measured at baseline (T0), post-interventions (T1, 10 weeks), and endpoint (T2, 16 weeks). Results n = 46 fatigued brain tumor patients (T0 BFI mean = 6.8/10) were recruited and 34 were retained to endpoint, establishing feasibility. Engagement with interventions was sustained over time. Qualitative interviews (n = 21) suggested that coaching interventions were broadly acceptable, although mediated by participant outlook and prior lifestyle. Coaching led to significant improvements in fatigue (improvement in BFI versus control at T1: HC=2.2 points [95% CI 0.6, 3.8], HC + AC = 1.8 [0.1, 3.4], Cohen's d [HC] = 1.9; improvement in FACIT-Fatigue: HC = 4.8 points [-3.7, 13.3]; HC + AC = 12 [3.5, 20.5], d [HC and AC] = 0.9). Coaching also improved depressive and mental health outcomes. Modeling suggested a potential limiting effect of higher baseline depressive symptoms. Conclusions Lifestyle coaching interventions are feasible to deliver to fatigued brain tumor patients. They were manageable, acceptable, and safe, with preliminary evidence of benefit on fatigue and mental health outcomes. Larger trials of efficacy are justified.
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Affiliation(s)
- Alasdair G Rooney
- Centre for Clinical Brain Sciences, University of Edinburgh, UK
- The Robert Fergusson Unit, Royal Edinburgh Hospital, Edinburgh, UK
- Department of Clinical Neurosciences, Edinburgh Centre for Neuro-Oncology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - William Hewins
- Centre for Clinical Brain Sciences, University of Edinburgh, UK
- Department of Clinical Neurosciences, Edinburgh Centre for Neuro-Oncology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Amie Walker
- Centre for Clinical Brain Sciences, University of Edinburgh, UK
- Neuro-Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Mairi Mackinnon
- Neuro-Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Lisa Withington
- Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Sara Robson
- Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Claire Torrens
- Nursing, Midwifery, and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Lisa E M Hopcroft
- Scottish Clinical Trials Research Unit (SCTRU), Public Health Scotland, Edinburgh, UK
| | - Antony Clark
- Scottish Clinical Trials Research Unit (SCTRU), Public Health Scotland, Edinburgh, UK
| | | | | | - Joanna Dunlop
- Scottish Clinical Trials Research Unit (SCTRU), Public Health Scotland, Edinburgh, UK
- Community Rehabilitation and Brain Injury Service, Livingston, UK
- Department of Clinical Neurosciences, Edinburgh Centre for Neuro-Oncology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Michelle Welsh
- Scottish Clinical Trials Research Unit (SCTRU), Public Health Scotland, Edinburgh, UK
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, London, UK
| | - Aimee Dyson
- Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Julie Emerson
- Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | | | - Robert Hill
- Scottish Clinical Trials Research Unit (SCTRU), Public Health Scotland, Edinburgh, UK
| | - Jade Carruthers
- Scottish Clinical Trials Research Unit (SCTRU), Public Health Scotland, Edinburgh, UK
| | - Julia Day
- Scottish Clinical Trials Research Unit (SCTRU), Public Health Scotland, Edinburgh, UK
- Community Rehabilitation and Brain Injury Service, Livingston, UK
- Department of Clinical Neurosciences, Edinburgh Centre for Neuro-Oncology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - David Gillespie
- Centre for Clinical Brain Sciences, University of Edinburgh, UK
- Department of Clinical Neurosciences, Edinburgh Centre for Neuro-Oncology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Emanuela Molinari
- Institute of Neurosciences, Queen Elizabeth University Hospital, Glasgow, UK
| | - Mary Wells
- Scottish Clinical Trials Research Unit (SCTRU), Public Health Scotland, Edinburgh, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Catherine McBain
- Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Anthony J Chalmers
- Neuro-Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK
- Institute of Neurosciences, Queen Elizabeth University Hospital, Glasgow, UK
| | - Robin Grant
- Centre for Clinical Brain Sciences, University of Edinburgh, UK
- Department of Clinical Neurosciences, Edinburgh Centre for Neuro-Oncology, Royal Infirmary of Edinburgh, Edinburgh, UK
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Thomson DJ, Cruickshank C, Baines H, Banner R, Beasley M, Betts G, Bulbeck H, Charlwood F, Christian J, Clarke M, Donnelly O, Foran B, Gillies C, Griffin C, Homer JJ, Langendijk JA, Lee LW, Lester J, Lowe M, McPartlin A, Miles E, Nutting C, Palaniappan N, Prestwich R, Price JM, Roberts C, Roe J, Shanmugasundaram R, Simões R, Thompson A, West C, Wilson L, Wolstenholme J, Hall E. TORPEdO: A phase III trial of intensity-modulated proton beam therapy versus intensity-modulated radiotherapy for multi-toxicity reduction in oropharyngeal cancer. Clin Transl Radiat Oncol 2023; 38:147-154. [PMID: 36452431 PMCID: PMC9702982 DOI: 10.1016/j.ctro.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/18/2022] [Indexed: 11/23/2022] Open
Abstract
•There is a lack of prospective level I evidence for the use of PBT for most adult cancers including oropharyngeal squamous cell carcinoma (OPSCC).•TORPEdO is the UK's first PBT clinical trial and aims to determine the benefits of PBT for OPSCC.•Training and support has been provided before and during the trial to reduce variations of contouring and radiotherapy planning.•There is a strong translational component within TORPEdO. Imaging and physics data along with blood, tissue collection will inform future studies in refining patient selection for IMPT.
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Affiliation(s)
| | | | - Helen Baines
- Radiotherapy Trials QA Group (RTTQA), The Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Russell Banner
- Swansea Bay University Health Board, Swansea, United Kingdom
| | | | - Guy Betts
- Manchester University NHS Foundation Trust. Manchester, United Kingdom
| | - Helen Bulbeck
- Brainstrust – The Brain Cancer People, Cowes, United Kingdom
| | | | - Judith Christian
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Matthew Clarke
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Olly Donnelly
- Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom
| | - Bernadette Foran
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Callum Gillies
- University College Hospitals London NHS Foundation Trust, London, United Kingdom
| | - Clare Griffin
- The Institute of Cancer Research, London, United Kingdom
| | - Jarrod J. Homer
- Manchester University NHS Foundation Trust. Manchester, United Kingdom
| | - Johannes A. Langendijk
- University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Lip Wai Lee
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - James Lester
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Matthew Lowe
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | - Elizabeth Miles
- Radiotherapy Trials QA Group (RTTQA), Mount Vernon Hospital, Northwood, United Kingdom
| | - Christopher Nutting
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | - Robin Prestwich
- The Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - James M. Price
- The Christie NHS Foundation Trust, Manchester, United Kingdom
- The University of Manchester, Manchester, United Kingdom
| | - Clare Roberts
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Justin Roe
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Imperial College, London, United Kingdom
| | | | - Rita Simões
- Radiotherapy Trials QA Group (RTTQA), Mount Vernon Hospital, Northwood, United Kingdom
| | - Anna Thompson
- University College Hospitals London NHS Foundation Trust, London, United Kingdom
| | - Catharine West
- The University of Manchester, Manchester, United Kingdom
| | - Lorna Wilson
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Jane Wolstenholme
- Health Economics Research Centre, University of Oxford, United Kingdom
| | - Emma Hall
- The Institute of Cancer Research, London, United Kingdom
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9
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Retzer A, Baddeley E, Sivell S, Scott H, Nelson A, Bulbeck H, Seddon K, Grant R, Adams R, Watts C, Aiyegbusi OL, Kearns P, Rivera SC, Dirven L, Calvert M, Byrne A. Development of a core outcome set for use in adult primary glioma phase III interventional trials: A mixed methods study. Neurooncol Adv 2023; 5:vdad096. [PMID: 37719788 PMCID: PMC10503650 DOI: 10.1093/noajnl/vdad096] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Background Glioma interventional studies should collect data aligned with patient priorities, enabling treatment benefit assessment and informed decision-making. This requires effective data synthesis and meta-analyses, underpinned by consistent trial outcome measurement, analysis, and reporting. Development of a core outcome set (COS) may contribute to a solution. Methods A 5-stage process was used to develop a COS for glioma trials from the UK perspective. Outcome lists were generated in stages 1: a trial registry review and systematic review of qualitative studies and 2: interviews with glioma patients and caregivers. In stage 3, the outcome lists were de-duplicated with accessible terminology, in stage 4 outcomes were rated via a 2-round Delphi process, and stage 5 comprised a consensus meeting to finalize the COS. Patient-reportable COS outcomes were identified. Results In Delphi round 1, 96 participants rated 35 outcomes identified in stages 1 and 2, to which a further 10 were added. Participants (77/96) rated the resulting 45 outcomes in round 2. Of these, 22 outcomes met a priori threshold for inclusion in the COS. After further review, a COS consisting of 19 outcomes grouped into 7 outcome domains (survival, adverse events, activities of daily living, health-related quality of life, seizure activity, cognitive function, and physical function) was finalized by 13 participants at the consensus meeting. Conclusions A COS for glioma trials was developed, comprising 7 outcome domains. Additional research will identify appropriate measurement tools and further validate this COS.
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Affiliation(s)
- Ameeta Retzer
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration West Midlands (ARC WM), Birmingham, UK
- NIHR Birmingham Biomedical Research Centre (BRC), University of Birmingham, Birmingham, UK
| | - Elin Baddeley
- Marie Curie Palliative Care Research Centre, Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Stephanie Sivell
- Marie Curie Palliative Care Research Centre, Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Hannah Scott
- Division of Research and Evaluation, Office for Standards in Education, Childrens' Services and Skills (OFSTED), Bristol, UK
| | - Annmarie Nelson
- Marie Curie Palliative Care Research Centre, Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | | | | | - Robin Grant
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Richard Adams
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Colin Watts
- Institute of Cancer and Genomic Sciences, University of Birmingham, UK
| | - Olalekan Lee Aiyegbusi
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration West Midlands (ARC WM), Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre (BRC), University of Birmingham, Birmingham, UK
- NIHR Birmingham-Oxford Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
| | - Pamela Kearns
- Institute of Cancer and Genomic Sciences, University of Birmingham , UK
- NIHR Birmingham Biomedical Research Centre (BRC), University of Birmingham, Birmingham, UK
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham , UK
| | - Samantha Cruz Rivera
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration West Midlands (ARC WM), Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre (BRC), University of Birmingham, Birmingham, UK
- Midlands Health Data Research UK, Birmingham, UK
- NIHR Birmingham-Oxford Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
| | - Anthony Byrne
- Marie Curie Palliative Care Research Centre, Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
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10
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Plaha P, Camp S, Cook J, McCulloch P, Voets N, Ma R, Taphoorn MJB, Dirven L, Grech-Sollars M, Watts C, Bulbeck H, Jenkinson MD, Williams M, Lim A, Dixon L, Price SJ, Ashkan K, Apostolopoulos V, Barber VS, Taylor A, Nandi D. FUTURE-GB: functional and ultrasound-guided resection of glioblastoma - a two-stage randomised control trial. BMJ Open 2022; 12:e064823. [PMID: 36379652 PMCID: PMC9668053 DOI: 10.1136/bmjopen-2022-064823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Surgery remains the mainstay for treatment of primary glioblastoma, followed by radiotherapy and chemotherapy. Current standard of care during surgery involves the intraoperative use of image-guidance and 5-aminolevulinic acid (5-ALA). There are multiple other surgical adjuncts available to the neuro-oncology surgeon. However, access to, and usage of these varies widely in UK practice, with limited evidence of their use. The aim of this trial is to investigate whether the addition of diffusion tensor imaging (DTI) and intraoperative ultrasound (iUS) to the standard of care surgery (intraoperative neuronavigation and 5-ALA) impacts on deterioration free survival (DFS). METHODS AND ANALYSIS This is a two-stage, randomised control trial (RCT) consisting of an initial non-randomised cohort study based on the principles of the IDEAL (Idea, Development, Exploration, Assessment and Long-term follow-up) stage-IIb format, followed by a statistically powered randomised trial comparing the addition of DTI and iUS to the standard of care surgery. A total of 357 patients will be recruited for the RCT. The primary outcome is DFS, defined as the time to either 10-point deterioration in health-related quality of life scores from baseline, without subsequent reversal, progressive disease or death. ETHICS AND DISSEMINATION The trial was registered in the Integrated Research Application System (Ref: 264482) and approved by a UK research and ethics committee (Ref: 20/LO/0840). Results will be published in a peer-reviewed journal. Further dissemination to participants, patient groups and the wider medical community will use a range of approaches to maximise impact. TRIAL REGISTRATION NUMBER ISRCTN38834571.
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Affiliation(s)
- Puneet Plaha
- Department of Neursurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Sophie Camp
- Neurosurgery, Imperial College Healthcare NHS Trust, London, UK
| | - Jonathan Cook
- Oxford Clinical Trials Research Unit & Surgical Intervention Trials Unit, University of Oxford Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford, Oxfordshire, UK
| | - Peter McCulloch
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Natalie Voets
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, Oxfordshire, UK
| | - Ruichong Ma
- Department of Neursurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
- Department of Neurology, Haaglanden Medical Center Bronovo, Den Haag, Zuid-Holland, The Netherlands
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Matthew Grech-Sollars
- Department of Computer Sciences, UCL, London, UK
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Colin Watts
- Institute of Cancer and Genomic Studies, University of Birmingham, Birmingham, UK
- Department of Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Michael D Jenkinson
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, Merseyside, UK
- Department of Neurosurgery, Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - Matthew Williams
- Department of Clinical Oncology, Imperial College Healthcare NHS Trust, London, UK
| | - Adrian Lim
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - Luke Dixon
- Neuroradiology, Imperial College Healthcare NHS Trust, London, UK
| | - Stephen John Price
- Neurosurgery Division, Department of Clinical Neurosciences, Cambridge University, Cambridge, UK
| | | | | | - Vicki S Barber
- Oxford Clinical Trials Research Unit & Surgical Intervention Trials Unit, University of Oxford Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford, Oxfordshire, UK
| | - Amy Taylor
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Dipankar Nandi
- Neurosurgery, Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
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11
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Marshall C, Bulbeck H, Hudson R, Johnston B, Juwle S, McNally D, Talwar B, Young L, Woodward E. Cancer Experience of Care Improvement Collaboratives in the National Health Service in England. Patient Experience Journal 2022. [DOI: 10.35680/2372-0247.1670] [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: 11/06/2022] Open
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12
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Melhuish S, Bulbeck H. Allied Heath Professional Support in Adult Neuro-oncology; Before and During COVID. Neuro Oncol 2022. [PMCID: PMC9525850 DOI: 10.1093/neuonc/noac200.077] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS To understand the current levels of Allied Health Professional (AHP) provision within adult neuro-oncology in the UK, gain insight into perceived gaps and any impact of the COVID-19 pandemic on this provision, from the Health Care Professional’s (HCP) perspective. METHOD In collaboration with brainstrust (a brain tumour charity) and the author, a mixed-methods, on-line survey of HCPs working within adult neuro-oncology was designed, tested and distributed to HCPs registered on the charity’s HCP database. Quantitative data was analysed using simple descriptive statistics. Qualitative data was analysed using thematic analysis. RESULTS 51 HCPs from multiple roles and teams across the UK responded. 66% (34) reported a service delivery gap, including a lack of specialist AHP support, with high geographical variability. During the COVID-19 pandemic, 60.8% (31) respondents identified a reduction in access to AHP support. 58.8% (30) respondents reported a change in appointment modality, with an increase in telephone and video appointments and a decrease in face-to-face appointments and home visits. This modality change was highlighted as a possible cause of reduced HCP awareness of symptom progression that was also reported. CONCLUSION There is paucity of data regarding AHP provision within adult neuro-oncology and the impact of the COVID-19 pandemic on this provision. This study highlights concerns regarding overall specialist AHP support which reduced further during the COVID-19 pandemic. The impact on patients is unknown and highlights a need for further research to inform development of national guidelines for specialist AHP provision and the use of telehealth for this complex patient group.
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Affiliation(s)
- Sara Melhuish
- Dept Speech and Language Therapy, Royal Surrey County Hosptial , Guildford
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13
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Retzer A, Sivell S, Scott H, Nelson A, Bulbeck H, Seddon K, Grant R, Adams R, Watts C, Aiyegbusi OL, Kearns P, Cruz Rivera S, Dirven L, Baddeley E, Calvert M, Byrne A. Development of a core outcome set and identification of patient-reportable outcomes for primary brain tumour trials: protocol for the COBra study. BMJ Open 2022; 12:e057712. [PMID: 36180121 PMCID: PMC9528585 DOI: 10.1136/bmjopen-2021-057712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 07/18/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Primary brain tumours, specifically gliomas, are a rare disease group. The disease and treatment negatively impacts on patients and those close to them. The high rates of physical and cognitive morbidity differ from other cancers causing reduced health-related quality of life. Glioma trials using outcomes that allow holistic analysis of treatment benefits and risks enable informed care decisions. Currently, outcome assessment in glioma trials is inconsistent, hindering evidence synthesis. A core outcome set (COS) - an agreed minimum set of outcomes to be measured and reported - may address this. International initiatives focus on defining core outcomes assessments across brain tumour types. This protocol describes the development of a COS involving UK stakeholders for use in glioma trials, applicable across glioma types, with provision to identify subsets as required. Due to stakeholder interest in data reported from the patient perspective, outcomes from the COS that can be patient-reported will be identified. METHODS AND ANALYSIS Stage I: (1) trial registry review to identify outcomes collected in glioma trials and (2) systematic review of qualitative literature exploring glioma patient and key stakeholder research priorities. Stage II: semi-structured interviews with glioma patients and caregivers. Outcome lists will be generated from stages I and II. Stage III: study team will remove duplicate items from the outcome lists and ensure accessible terminology for inclusion in the Delphi survey. Stage IV: a two-round Delphi process whereby the outcomes will be rated by key stakeholders. Stage V: a consensus meeting where participants will finalise the COS. The study team will identify the COS outcomes that can be patient-reported. Further research is needed to match patient-reported outcomes to available measures. ETHICS AND DISSEMINATION Ethical approval was obtained (REF SMREC 21/59, Cardiff University School of Medicine Research Ethics Committee). Study findings will be disseminated widely through conferences and journal publication. The final COS will be adopted and promoted by patient and carer groups and its use by funders encouraged. PROSPERO REGISTRATION NUMBER CRD42021236979.
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Affiliation(s)
- Ameeta Retzer
- Centre for Patient Reported Outcomes Research, Institute for Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Centre, West Midlands, Birmingham, UK
| | - Stephanie Sivell
- Marie Curie Palliative Care Research Centre, Division of Population Medicine, Cardiff University School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Hannah Scott
- Cambridge Public Health, University of Cambridge School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Annmarie Nelson
- Marie Curie Palliative Care Research Centre, Division of Population Medicine, Cardiff University School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | | | | | - Robin Grant
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Richard Adams
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Colin Watts
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Olalekan Lee Aiyegbusi
- Centre for Patient Reported Outcomes Research, Institute for Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
| | - Pamela Kearns
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
| | - Samantha Cruz Rivera
- Centre for Patient Reported Outcomes Research, Institute for Applied Health Research, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden University, Leiden, The Netherlands
- Department of Neurology, Medical Centre Haaglanden, Den Haag, The Netherlands
| | - Elin Baddeley
- Marie Curie Palliative Care Research Centre, Division of Population Medicine, Cardiff University School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, Institute for Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Centre, West Midlands, Birmingham, UK
| | - Anthony Byrne
- Marie Curie Palliative Care Research Centre, Division of Population Medicine, Cardiff University School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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14
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Day J, Yust-Katz S, Cachia D, Wefel J, Tremont Lukats IW, Bulbeck H, Rooney AG. Interventions for the management of fatigue in adults with a primary brain tumour. Cochrane Database Syst Rev 2022; 9:CD011376. [PMID: 36094728 PMCID: PMC9466986 DOI: 10.1002/14651858.cd011376.pub3] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Fatigue is a common and disabling symptom in people with a primary brain tumour (PBT). The effectiveness of interventions for treating clinically significant levels of fatigue in this population is unclear. This is an updated version of the original Cochrane Review published in Issue 4, 2016. OBJECTIVES To assess the effectiveness and safety of pharmacological and non-pharmacological interventions for adults with PBT and clinically significant (or high levels) of fatigue. SEARCH METHODS For this updated review, we searched CENTRAL, MEDLINE and Embase, and checked the reference lists of included studies in April 2022. We also searched relevant conference proceedings, and ClinicalTrials.gov for ongoing trials. SELECTION CRITERIA We included randomised controlled trials (RCTs) that investigated any pharmacological or non-pharmacological intervention in adults with PBT and fatigue, where fatigue was the primary outcome measure. We restricted inclusion specifically to studies that enrolled only participants with clinically significant levels of fatigue to improve the clinical utility of the findings. DATA COLLECTION AND ANALYSIS Two review authors (JD, DC) independently evaluated search results for the updated search. Two review authors (JD, SYK) extracted data from selected studies, and carried out a risk of bias assessment. We extracted data on fatigue, mood, cognition, quality of life and adverse events outcomes. MAIN RESULTS The original review identified one study and this update identified a further two for inclusion. One study investigated the use of modafinil, one study the use of armodafinil and one study the use of dexamfetamine. We identified three ongoing studies. In the original review, the single eligible trial compared modafinil to placebo for 37 participants with a high- or low-grade PBT. One new study compared two doses of armodafinil (150 mg and 250 mg) to placebo for 297 people with a high-grade glioma. The second new study compared dexamfetamine sulfate to placebo for 46 participants with a low- or high-grade PBT. The evidence was uncertain for both modafinil and dexamfetamine regarding fatigue outcome measures, compared to controls, at study endpoint. Two trials did not reach the planned recruitment target and therefore may not, in practice, have been adequately powered to detect a difference. These trials were at a low risk of bias across most areas. There was an unclear risk of bias related to the use of mean imputation for one study because the investigators did not analyse the impact of imputation on the results and information regarding baseline characteristics and randomisation were not clear. The certainty of the evidence measured using GRADE was very low across all three studies. There was one identified study awaiting classification once data are available, which investigated the feasibility of 'health coaching' for people with a PBT experiencing fatigue. There were three ongoing studies that may be eligible for an update of this review, all investigating a non-pharmacological intervention for fatigue in people with PBT. AUTHORS' CONCLUSIONS There is currently insufficient evidence to draw reliable and generalisable conclusions regarding potential effectiveness or harm of any pharmacological or non-pharmacological treatments for fatigue in people with PBT. More research is needed on how best to treat people with brain tumours with high fatigue.
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Affiliation(s)
- Julia Day
- Edinburgh Centre for Neuro-Oncology (ECNO), Western General Hospital, Edinburgh, UK
| | - Shlomit Yust-Katz
- Sheba Medical Center, and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - David Cachia
- University of Massachusetts, Boston, Massachusetts, USA
| | - Jeffrey Wefel
- University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Ivo W Tremont Lukats
- Kenneth R. Peak Center for Brain and Pituitary Tumors, Houston Methodist Hospital, Houston, Texas, USA
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15
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Watts C, Savage J, Patel A, Mant R, Wykes V, Pohl U, Bulbeck H, Apps J, Sharpe R, Thompson G, Waldman AD, Ansorge O, Billingham L. Protocol for the Tessa Jowell BRAIN MATRIX Platform Study. BMJ Open 2022; 12:e067123. [PMID: 36378622 PMCID: PMC9462095 DOI: 10.1136/bmjopen-2022-067123] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 08/22/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Gliomas are the most common primary tumour of the central nervous system (CNS), with an estimated annual incidence of 6.6 per 100 000 individuals in the USA and around 14 deaths per day from brain tumours in the UK. The genomic and biological landscape of brain tumours has been increasingly defined and, since 2016, the WHO classification of tumours of the CNS incorporates molecular data, along with morphology, to define tumour subtypes more accurately. The Tessa Jowell BRAIN MATRIX Platform (TJBM) study aims to create a transformative clinical research infrastructure that leverages UK National Health Service resources to support research that is patient centric and attractive to both academic and commercial investors. METHODS AND ANALYSIS The TJBM study is a programme of work with the principal purpose to improve the knowledge of glioma and treatment for patients with glioma. The programme includes a platform study and subsequent interventional clinical trials (as separate protocols). The platform study described here is the backbone data-repository of disease, treatment and outcome data from clinical, imaging and pathology data being collected in patients with glioma from secondary care hospitals. The primary outcome measure of the platform is time from biopsy to integrated histological-molecular diagnosis using whole-genome sequencing and epigenomic classification. Secondary outcome measures include those that are process centred, patient centred and framework based. Target recruitment for the study is 1000 patients with interim analyses at 100 and 500 patients. ETHICS AND DISSEMINATION The study will be performed in accordance with the recommendations guiding physicians in biomedical research involving human subjects, adopted by the 18th World Medical Association General Assembly, Helsinki, Finland and stated in the respective participating countries' laws governing human research, and Good Clinical Practice. The protocol was initially approved on 18 February 2020 by West Midlands - Edgbaston Research Ethics Committee; the current protocol (v3.0) was approved on 15 June 2022. Participants will be required to provide written informed consent. A meeting will be held after the end of the study to allow discussion of the main results among the collaborators prior to publication. The results of this study will be disseminated through national and international presentations and peer-reviewed publications. Manuscripts will be prepared by the Study Management Group and authorship will be determined by mutual agreement. TRIAL REGISTRATION NUMBER NCT04274283, 18-Feb-2020; ISRCTN14218060, 03-Feb-2020.
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Affiliation(s)
- Colin Watts
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Joshua Savage
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK
| | - Amit Patel
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK
| | - Rhys Mant
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK
| | - Victoria Wykes
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ute Pohl
- Pathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - John Apps
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK
| | - Rowena Sharpe
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK
| | - Gerard Thompson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Adam D Waldman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Olaf Ansorge
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Lucinda Billingham
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK
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Baddeley E, Retzer A, Sivell S, Seddon K, Bulbeck H, Nelson A, Adams R, Grant R, Watts C, Aiyegbusi O, Rivera S, Kearns P, Dirven L, Calvert M, Byrne A. P09.04.B The importance of treatment tolerability for people with glioma: registry review and qualitative findings from the COBra Study. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Gliomas are the commonest form of primary brain tumour, accounting for 80% of malignant brain tumours. Gliomas represent a heterogeneous group of cancers with variable outcomes, traditionally graded from I to IV (least to most aggressive). The poor prognosis of some glioma patients and high symptom burden has led to a growing emphasis on their quality of survival. Maintaining cognitive function, physical function and other health-related quality of life aspects throughout the disease trajectory are key considerations, particularly for patients with aggressive forms of glioma. It is therefore important that glioma intervention studies collect data aligned with patient priorities that enables assessment of the net clinical benefit of treatments and facilitates informed decision-making. In particular, and of increasing recognition, is the importance of monitoring the incidence of adverse events during and after the course of an intervention, and understanding their impact upon patients, and patients’ own assessment of, tolerability.
Material and Methods
A trial registry review, a systematic review of the qualitative literature and semi-structured interviews with patients and caregivers were undertaken. Outcomes were extracted from these sources to formulate a longlist during the development of a core outcome set for glioma interventional trials (the COBra study).
Results
The registry review (n=91), systematic review (n=21) and semi-structured interviews (n=19) identified many important outcomes and concepts, one of which was tolerability. Tolerability, adverse events, toxicity or safety was reported to be collected as an outcome in 46 trials. Outcomes related to tolerability were identified from 7 articles included in the systematic review. Themes related to tolerability emerged from the qualitative interviews. These included tolerability of side effects of treatment; trade-offs of side effects versus potential benefits in deciding on, and willingness to, undertake further treatment; and self-directed strategies for coping.
Conclusion
There is a growing acknowledgement of the importance of treatment tolerability in the wider field of cancer research. In glioma research specifically, its significance is yet to be reflected in outcomes collected in trials. Our qualitative findings indicate tolerability is of high significance to patients and those close to them. Participants reported how their preconceptions and experience of tolerability influenced treatment decisions and treatment uptake. However, outcomes related to tolerability were collected in just over half of trials in our sample. Tolerability and items relating to the patients’ experience of adverse events should be collected and reported in trial findings to reflect patients’ priorities and enable informed treatment decisions.
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Affiliation(s)
- E Baddeley
- Cardiff University - Marie Curie Palliative Care Research Centre , Cardiff , United Kingdom
| | - A Retzer
- University of Birmingham - Centre for Patient Reported Outcomes Research , Birmingham , United Kingdom
| | - S Sivell
- Cardiff University - Marie Curie Palliative Care Research Centre , Cardiff , United Kingdom
| | - K Seddon
- Cardiff University - Marie Curie Palliative Care Research Centre , Cardiff , United Kingdom
| | - H Bulbeck
- Brainstrust , London , United Kingdom
| | - A Nelson
- Cardiff University - Marie Curie Palliative Care Research Centre , Cardiff , United Kingdom
| | - R Adams
- Cardiff University - Centre for Trials Research , Cardiff , United Kingdom
| | - R Grant
- University of Edinburgh , Edinburgh , United Kingdom
| | - C Watts
- University of Birmingham - Institute of Cancer and Genomic Sciences , Birmingham , United Kingdom
| | - O Aiyegbusi
- University of Birmingham - Centre for Patient Reported Outcomes Research , Birmingham , United Kingdom
| | - S Rivera
- University of Birmingham - Centre for Patient Reported Outcomes Research , Birmingham , United Kingdom
| | - P Kearns
- University of Birmingham - Cancer and Genomic Sciences , Birmingham , United Kingdom
| | - L Dirven
- Leiden University , Leiden , Netherlands
| | - M Calvert
- University of Birmingham - Centre for Patient Reported Outcomes Research , Birmingham , United Kingdom
| | - A Byrne
- Cardiff University - Marie Curie Palliative Care Research Centre , Cardiff , United Kingdom
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Grant R, Lessels S, Jenkinson M, Watts C, Marson A, Erridge S, Bulbeck H, Chisholm EM. 159 Lessons learned initiating a RCT using an approved drug in a new setting (SPRING Study). J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.188] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundTrials of approved medications for new indications are becoming increasingly common (repurposing). SPRING – Seizure Prophylaxis IN Glioma is a trial of prophylactic Levetiracetam in adults without prior history of seizure versus no AED. Significant delays were encountered in the set up phase.IssuesLegal contracts between Sponsor and NIHR/UCB (£1.76m) were prolonged.UCB (Belgium) would only transfer drug when ethics had been granted and BREXIT loomed. Company to package levetiracetam required national procurement exercise.Conflicting IRAS advice (Ireland, Scotland, England). Inclusion criteria included patients must have capacity. As patients could lose capacity during study this required Adults with Incapacity REC (Essex), secondary review in Scotland and screening for capacity at each visit. MHRA – mandated monitoring for suicidal ideation at each visit, and detail on contraception during study. HRA – suggested changes to the Patient Information Leaflet and a Schedule of Events Cost Attribution Template – requiring multiple substantial amendments.Neurosurgical centres may feed several oncological departments - site contracts are complex. Electronic eCRF takes time to build and test.ConclusionsConsider planning for longer set up phase in grant submissions. Views expressed are those of the author(s) and not necessarily those of the NHS, NIHR or DOHSC.robin.grant@luht.scot.nhs.uk
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Millward CP, Armstrong TS, Barrington H, Bell S, Brodbelt AR, Bulbeck H, Crofton A, Dirven L, Georgious T, Grundy PL, Islim AI, Javadpour M, Keshwara SM, Koszdin SD, Marson AG, McDermott MW, Meling TR, Oliver K, Plaha P, Preusser M, Santarius T, Srikandarajah N, Taphoorn MJB, Turner C, Watts C, Weller M, Williamson PR, Zadeh G, Zamanipoor Najafabadi AH, Jenkinson MD. Development of 'Core Outcome Sets' for Meningioma in Clinical Studies (The COSMIC Project): protocol for two systematic literature reviews, eDelphi surveys and online consensus meetings. BMJ Open 2022; 12:e057384. [PMID: 35534067 PMCID: PMC9086638 DOI: 10.1136/bmjopen-2021-057384] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 11/25/2022] Open
Abstract
INTRODUCTION Meningioma is the most common primary intracranial tumour in adults. The majority are non-malignant, but a proportion behave more aggressively. Incidental/minimally symptomatic meningioma are often managed by serial imaging. Symptomatic meningioma, those that threaten neurovascular structures, or demonstrate radiological growth, are usually resected as first-line management strategy. For patients in poor clinical condition, or with inoperable, residual or recurrent disease, radiotherapy is often used as primary or adjuvant treatment. Effective pharmacotherapy treatments do not currently exist. There is heterogeneity in the outcomes measured and reported in meningioma clinical studies. Two 'Core Outcome Sets' (COS) will be developed: (COSMIC: Intervention) for use in meningioma clinical effectiveness trials and (COSMIC: Observation) for use in clinical studies of incidental/untreated meningioma. METHODS AND ANALYSIS Two systematic literature reviews and trial registry searches will identify outcomes measured and reported in published and ongoing (1) meningioma clinical effectiveness trials, and (2) clinical studies of incidental/untreated meningioma. Outcomes include those that are clinician reported, patient reported, caregiver reported and based on objective tests (eg, neurocognitive tests), as well as measures of progression and survival. Outcomes will be deduplicated and categorised to generate two long lists. The two long lists will be prioritised through two, two-round, international, modified eDelphi surveys including patients with meningioma, healthcare professionals, researchers and those in caring/supporting roles. The two final COS will be ratified through two 1-day online consensus meetings, with representation from all stakeholder groups. ETHICS AND DISSEMINATION Institutional review board (University of Liverpool) approval was obtained for the conduct of this study. Participant eConsent will be obtained prior to participation in the eDelphi surveys and consensus meetings. The two systematic literature reviews and two final COS will be published and freely available. TRIAL REGISTRATION NUMBER COMET study ID 1508.
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Affiliation(s)
- Christopher P Millward
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Terri S Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | | | | | - Andrew R Brodbelt
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | | | - Anna Crofton
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | | | - Paul L Grundy
- Department of Neurosurgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Abdurrahman I Islim
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Mohsen Javadpour
- National Centre for Neurosurgery, Beaumont Hospital, Dublin, Ireland
| | - Sumirat M Keshwara
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Shelli D Koszdin
- Pharmacy, Veterans Affairs Healthcare System, Palo Alto, California, USA
| | - Anthony G Marson
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Michael W McDermott
- Division of Neuroscience, Florida International University, Miami, Florida, USA
| | - Torstein R Meling
- Department of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
| | - Kathy Oliver
- International Brain Tumour Alliance, Tadworth, UK
| | - Puneet Plaha
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Matthias Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Thomas Santarius
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, UK
| | - Nisaharan Srikandarajah
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Carole Turner
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, UK
| | - Colin Watts
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Michael Weller
- Department of Neurology, University of Zurich, Zurich, Switzerland
| | | | - Gelareh Zadeh
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Michael D Jenkinson
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
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19
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Millward CP, Armstrong TS, Barrington H, Brodbelt AR, Bulbeck H, Byrne A, Dirven L, Gamble C, Grundy PL, Islim AI, Javadpour M, Keshwara SM, Krishna ST, Mallucci CL, Marson AG, McDermott MW, Meling TR, Oliver K, Pizer B, Plaha P, Preusser M, Santarius T, Srikandarajah N, Taphoorn MJB, Watts C, Weller M, Williamson PR, Zadeh G, Zamanipoor Najafabadi AH, Jenkinson MD. Opportunities and challenges for the development of "core outcome sets" in neuro-oncology. Neuro Oncol 2022; 24:1048-1055. [PMID: 35287168 PMCID: PMC9248398 DOI: 10.1093/neuonc/noac062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Core Outcome Sets (COS) define minimum outcomes to be measured and reported in clinical effectiveness trials for a particular health condition/health area. Despite recognition as critical to clinical research design for other health areas, none have been developed for neuro-oncology. COS development projects should carefully consider: scope (how the COS should be used), stakeholders involved in development (including patients as both research partners and participants), and consensus methodologies used (typically a Delphi survey and consensus meeting), as well as dissemination plans. Developing COS for neuro-oncology is potentially challenging due to extensive tumor subclassification (including molecular stratification), different symptoms related to anatomical tumor location, and variation in treatment options. Development of a COS specific to tumor subtype, in a specific location, for a particular intervention may be too narrow and would be unlikely to be used. Equally, a COS that is applicable across a wider area of neuro-oncology may be too broad and therefore lack specificity. This review describes why and how a COS may be developed, and discusses challenges for their development, specific to neuro-oncology. The COS under development are briefly described, including: adult glioma, incidental/untreated meningioma, meningioma requiring intervention, and adverse events from surgical intervention for pediatric brain tumors.
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Affiliation(s)
- Christopher P Millward
- Corresponding Author: Christopher P. Millward, MRCS, MSc, MBBS, BSc, Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Lower Lane, Liverpool L9 7LJ, UK ()
| | - Terri S Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | | | - Andrew R Brodbelt
- Institute of Systems, Molecular, & Integrative Biology, University of Liverpool, Liverpool, UK,Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | | | - Anthony Byrne
- Department of Palliative Care, Cardiff and Vale UHB, Cardiff, UK,Marie Curie Research Centre, Cardiff University, Cardiff, UK
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands,Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Carrol Gamble
- Institute of Population Health, University ofLiverpool, Liverpool, UK
| | - Paul L Grundy
- Department of Neurosurgery, University HospitalSouthampton, Southampton,UK
| | - Abdurrahman I Islim
- Institute of Systems, Molecular, & Integrative Biology, University of Liverpool, Liverpool, UK,Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Mohsen Javadpour
- National Centre for Neurosurgery, Beaumont Hospital, Dublin, Ireland
| | - Sumirat M Keshwara
- Institute of Systems, Molecular, & Integrative Biology, University of Liverpool, Liverpool, UK,Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Sandhya T Krishna
- Department of Neurosurgery. Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Conor L Mallucci
- Department of Neurosurgery. Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Anthony G Marson
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | | | - Torstein R Meling
- Department of Neurosurgery, Geneva University Hospital, Geneva, Switzerland
| | | | - Barry Pizer
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Puneet Plaha
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Matthias Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Thomas Santarius
- Department of Neurosurgery, Addenbrooke’s Hospital & University of Cambridge, Cambridge, UK
| | - Nisaharan Srikandarajah
- Institute of Systems, Molecular, & Integrative Biology, University of Liverpool, Liverpool, UK,Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands,Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Colin Watts
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zürich, Switzerland
| | | | - Gelareh Zadeh
- Department of Surgery, University of Toronto, Toronto, Canada
| | - Amir H Zamanipoor Najafabadi
- University Neurosurgical Center Holland, Leiden University Medical Centre, Haaglanden Medical Center, Haga Teaching Hospitals, Leiden and The Hague, the Netherlands
| | - Michael D Jenkinson
- Institute of Systems, Molecular, & Integrative Biology, University of Liverpool, Liverpool, UK,Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
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Byrne A, Torrens-Burton A, Sivell S, Moraes FY, Bulbeck H, Bernstein M, Nelson A, Fielding H. Early palliative interventions for improving outcomes in people with a primary malignant brain tumour and their carers. Cochrane Database Syst Rev 2022; 1:CD013440. [PMID: 34988973 PMCID: PMC8733789 DOI: 10.1002/14651858.cd013440.pub2] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Primary malignant brain tumours can have an unpredictable course, but high-grade gliomas typically have a relentlessly progressive disease trajectory. They can cause profound symptom burden, affecting physical, neurocognitive, and social functioning from an early stage in the illness. This can significantly impact on role function and on the experiences and needs of informal caregivers. Access to specialist palliative and supportive care early in the disease trajectory, for those with high-grade tumours in particular, has the potential to improve patients' and caregivers' quality of life. However, provision of palliative and supportive care for people with primary brain tumours - and their informal caregivers - is historically ill-defined and ad hoc, and the benefits of early palliative interventions have not been confirmed. It is therefore important to define the role and effectiveness of early referral to specialist palliative care services and/or the effectiveness of other interventions focused on palliating disease impact on people and their informal caregivers. This would help guide improvement to service provision, by defining those interventions which are effective across a range of domains, and developing an evidence-based model of integrated supportive and palliative care for this population. OBJECTIVES To assess the evidence base for early palliative care interventions, including referral to specialist palliative care services compared to usual care, for improving outcomes in adults diagnosed with a primary brain tumour and their carers. SEARCH METHODS We conducted searches of electronic databases, CENTRAL, MEDLINE, CINAHL, Web of Science, and PsycINFO (last searched 16 November 2021). We conducted searches to incorporate both qualitative and quantitative search terms. In addition to this, we searched for any currently recruiting trials in ClinicalTrials.gov and in the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal, and undertook citation tracking via Scopus. We also handsearched reference lists of potentially eligible systematic review articles to identify any other relevant studies, contacted experts in the field and searched key authors via Web of Science and searched SIGLE (System of Information on Grey Literature in Europe). SELECTION CRITERIA We included studies looking at early referral to specialist palliative care services - or early targeted palliative interventions by other healthcare professionals - for improving quality of life, symptom control, psychological outcomes, or overall survival as a primary or secondary outcome measure. Studies included randomised controlled trials (RCTs), non-randomised studies (NRS), as well as qualitative and mixed-methods studies where both qualitative and quantitative data were included. Participants were adults with a confirmed radiological and/or histological diagnosis of a primary malignant brain tumour, and/or informal adult carers (either at individual or family level) of people with a primary malignant brain tumour. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methodological procedures for data extraction, management, and analysis. We used GRADE to assess the certainty of the evidence for symptom control, i.e. cognitive function. MAIN RESULTS We identified 9748 references from the searches, with 8337 remaining after duplicates were removed. After full-text review, we included one trial. There were no studies of early specialist palliative care interventions or of early, co-ordinated generalist palliative care approaches. The included randomised trial addressed a single symptom area, focusing on early cognitive rehabilitation, administered within two weeks of surgery in a mixed brain tumour population, of whom approximately half had a high-grade glioma. The intervention was administered individually as therapist-led computerised exercises over 16 one-hour sessions, four times/week for four weeks. Sessions addressed several cognitive domains including time orientation, spatial orientation, visual attention, logical reasoning, memory, and executive function. There were no between-group differences in outcome for tests of logical-executive function, but differences were observed in the domains of visual attention and verbal memory. Risk of bias was assessed and stated as high for performance bias and attrition bias but for selective reporting it was unclear whether all outcomes were reported. We considered the certainty of the evidence, as assessed by GRADE, to be very low. AUTHORS' CONCLUSIONS Currently there is a lack of research focusing on the introduction of early palliative interventions specifically for people with primary brain tumours, either as co-ordinated specialist palliative care approaches or interventions focusing on a specific aspect of palliation. Future research should address the methodological shortcomings described in early palliative intervention studies in other cancers and chronic conditions. In particular, the specific population under investigation, the timing and the setting of the intervention should be clearly described and the standardised palliative care-specific components of the intervention should be defined in detail.
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Affiliation(s)
- Anthony Byrne
- Cardiff and Vale University Health Board, Llandough Hospital, Penarth, UK
- Marie Curie Palliative Care Research Centre (MCPCRC), Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Anna Torrens-Burton
- Marie Curie Palliative Care Research Centre (MCPCRC), Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
- PRIME Centre Wales, Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Stephanie Sivell
- Marie Curie Palliative Care Research Centre (MCPCRC), Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Fabio Ynoe Moraes
- Department of Oncology, Division of Radiation Oncology, Kingston Health Sciences Centre, Kingston, Canada
| | | | - Mark Bernstein
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Annmarie Nelson
- Marie Curie Palliative Care Research Centre (MCPCRC), Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Helen Fielding
- Palliative Medicine, Abertawe Bro Morgannwg University Health Board, Swansea, UK
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21
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Albarqouni L, Ringsten M, Montori V, Jørgensen KJ, Bulbeck H, Johansson M. Evaluation of evidence supporting NICE recommendations to change people's lifestyle in clinical practice: cross sectional survey. BMJ Med 2022; 1:e000130. [PMID: 36936567 PMCID: PMC9978760 DOI: 10.1136/bmjmed-2022-000130] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 07/14/2022] [Indexed: 01/21/2023]
Abstract
Objectives To assess whether recommendations of individually oriented lifestyle interventions (IOLIs) in guidelines from the National Institute for Health and Care Excellence (NICE) were underpinned by evidence of benefit, and whether harms and opportunity costs were considered. Design Cross sectional survey. Setting UK. Data sources NICE guidelines and supporting evidence. Eligibility criteria All NICE pathways for IOLI recommendations (ie, non-drug interventions that healthcare professionals administer to adults to achieve a healthier lifestyle and improve health) were searched systematically on 26 August 2020. One author screened all retrieved pathways for candidate guidelines, while a second author verified these judgments. Two authors independently and in duplicate screened all retrieved guidelines and recommendations for eligibility, extracted data, and evaluated the evidence cited and the outcomes considered. Disagreements were noted and resolved by consensus. Results Within 57 guidelines, 379 NICE recommendations were found for IOLIs; almost all (n=374; 99%) recommended the lifestyle intervention and five (1%) recommended against the intervention. Of the 379 recommendations, 13 (3%) were supported by moderate or high certainty evidence of a beneficial effect on patient relevant outcomes (n=7; 2%) or surrogate outcomes (n=13; 3%). 19 (5%) interventions considered psychosocial harms, 32 (8%) considered physical harms, and one (<1%) considered the opportunity costs of implementation. No intervention considered the burden placed on individuals by these recommendations. Conclusion Few NICE recommendations of lifestyle interventions are supported by reliable evidence. While this finding does not contest the beneficial effects of healthy habits, guidelines recommending clinicians to try to change people's lifestyle need to be reconsidered given the substantial uncertainty about the effectiveness, harms, and opportunity costs of such interventions.
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Affiliation(s)
- Loai Albarqouni
- Institute for Evidence-Based Healthcare, Bond University Faculty of Health Sciences and Medicine, Gold Coast, QLD, Australia
| | | | - Victor Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Karsten Juhl Jørgensen
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, University of Southern Denmark, Odense, Denmark
| | - Helen Bulbeck
- Cochrane Consumer Network Executive, Brainstrust, Cowes, UK
| | - Minna Johansson
- Cochrane Sweden, Lund, Sweden
- Department of Public Health and Community Medicine, University of Gothenburg Institute of Medicine, Gothenburg, Sweden
- Global Center for Sustainable Healthcare, Uddevalla, Sweden
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22
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Dirven L, Vos ME, Walbert T, Armstrong TS, Arons D, van den Bent MJ, Blakeley J, Brown PD, Bulbeck H, Chang SM, Coens C, Gilbert MR, Grant R, Jalali R, Leach D, Leeper H, Mendoza T, Nayak L, Oliver K, Reijneveld JC, Le Rhun E, Rubinstein L, Weller M, Wen PY, Taphoorn MJB. Systematic review on the use of patient-reported outcome measures in brain tumor studies: part of the Response Assessment in Neuro-Oncology Patient-Reported Outcome (RANO-PRO) initiative. Neurooncol Pract 2021; 8:417-425. [PMID: 34277020 DOI: 10.1093/nop/npab013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The Response Assessment in Neuro-Oncology Patient-Reported Outcome (RANO-PRO) working group aims to provide guidance on the use of PROs in brain tumor patients. PRO measures should be of high quality, both in terms of relevance and other measurement properties. This systematic review aimed to identify PRO measures that have been used in brain tumor studies to date. Methods A systematic literature search for articles published up to June 25, 2020 was conducted in several electronic databases. Pre-specified inclusion criteria were used to identify studies using PRO measures assessing symptoms, (instrumental) activities of daily living [(I)ADL] or health-related quality of life (HRQoL) in adult patients with glioma, meningioma, primary central nervous system lymphoma, or brain metastasis. Results A total of 215 different PRO measures were identified in 571 published and 194 unpublished studies. The identified PRO measures include brain tumor-specific, cancer-specific, and generic instruments, as well as instruments designed for other indications or multi- or single-item study-specific questionnaires. The most frequently used instruments were the EORTC QLQ-C30 and QLQ-BN20 (n = 286 and n = 247), and the FACT-Br (n = 167), however, the majority of the instruments were used only once or twice (150/215). Conclusion Many different PRO measures assessing symptoms, (I)ADL or HRQoL have been used in brain tumor studies to date. Future research should clarify whether these instruments or their scales/items exhibit good content validity and other measurement properties for use in brain tumor patients.
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Affiliation(s)
- Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Maartje E Vos
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Tobias Walbert
- Department of Neurology and Neurosurgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institute of Health, Bethesda, Maryland, USA
| | - David Arons
- National Brain Tumor Society, Newton, Massachusetts, USA
| | - Martin J van den Bent
- Department of Neurology, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - Jaishri Blakeley
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Helen Bulbeck
- Brainstrust - The Brain Cancer People, Cowes, Isle of Wight, UK
| | - Susan M Chang
- Division of Neuro-Oncology, University of California San Francisco, San Francisco, California, USA
| | - Corneel Coens
- Statistical Department, European Organization for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - Mark R Gilbert
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institute of Health, Bethesda, Maryland, USA
| | - Robin Grant
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Rakesh Jalali
- Neuro-Oncology Disease Management Group, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Danielle Leach
- National Brain Tumor Society, Newton, Massachusetts, USA
| | - Heather Leeper
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institute of Health, Bethesda, Maryland, USA
| | - Tito Mendoza
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lakshmi Nayak
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Kathy Oliver
- International Brain Tumour Alliance, Tadworth, Surrey, UK
| | - Jaap C Reijneveld
- Department of Neurology and Brain Tumor Center Amsterdam, Amsterdam University Medical Centers (location VUmc), Amsterdam, the Netherlands.,Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands
| | - Emilie Le Rhun
- Departments of Neurosurgery, Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Larry Rubinstein
- Biometric Research Program, National Cancer Institute, Bethesda, Maryland, USA
| | - Michael Weller
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
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23
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Booth TC, Thompson G, Bulbeck H, Boele F, Buckley C, Cardoso J, Dos Santos Canas L, Jenkinson D, Ashkan K, Kreindler J, Huskens N, Luis A, McBain C, Mills SJ, Modat M, Morley N, Murphy C, Ourselin S, Pennington M, Powell J, Summers D, Waldman AD, Watts C, Williams M, Grant R, Jenkinson MD. A Position Statement on the Utility of Interval Imaging in Standard of Care Brain Tumour Management: Defining the Evidence Gap and Opportunities for Future Research. Front Oncol 2021; 11:620070. [PMID: 33634034 PMCID: PMC7900557 DOI: 10.3389/fonc.2021.620070] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/06/2021] [Indexed: 12/19/2022] Open
Abstract
Objectiv e To summarise current evidence for the utility of interval imaging in monitoring disease in adult brain tumours, and to develop a position for future evidence gathering while incorporating the application of data science and health economics. Methods Experts in 'interval imaging' (imaging at pre-planned time-points to assess tumour status); data science; health economics, trial management of adult brain tumours, and patient representatives convened in London, UK. The current evidence on the use of interval imaging for monitoring brain tumours was reviewed. To improve the evidence that interval imaging has a role in disease management, we discussed specific themes of data science, health economics, statistical considerations, patient and carer perspectives, and multi-centre study design. Suggestions for future studies aimed at filling knowledge gaps were discussed. Results Meningioma and glioma were identified as priorities for interval imaging utility analysis. The "monitoring biomarkers" most commonly used in adult brain tumour patients were standard structural MRI features. Interval imaging was commonly scheduled to provide reported imaging prior to planned, regular clinic visits. There is limited evidence relating interval imaging in the absence of clinical deterioration to management change that alters morbidity, mortality, quality of life, or resource use. Progression-free survival is confounded as an outcome measure when using structural MRI in glioma. Uncertainty from imaging causes distress for some patients and their caregivers, while for others it provides an important indicator of disease activity. Any study design that changes imaging regimens should consider the potential for influencing current or planned therapeutic trials, ensure that opportunity costs are measured, and capture indirect benefits and added value. Conclusion Evidence for the value, and therefore utility, of regular interval imaging is currently lacking. Ongoing collaborative efforts will improve trial design and generate the evidence to optimise monitoring imaging biomarkers in standard of care brain tumour management.
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Affiliation(s)
- Thomas C Booth
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom.,Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Gerard Thompson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Florien Boele
- Leeds Institute of Medical Research at St James's, St James's University Hospital, Leeds, United Kingdom.,Faculty of Medicine and Health, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | | | - Jorge Cardoso
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Liane Dos Santos Canas
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | | | - Keyoumars Ashkan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Nicky Huskens
- The Tessa Jowell Brain Cancer Mission, London, United Kingdom
| | - Aysha Luis
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom.,Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Catherine McBain
- Department of Oncology, Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Samantha J Mills
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Nick Morley
- Department of Radiology, Wales Research and Diagnostic PET Imaging Centre, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Caroline Murphy
- King's College Trials Unit, King's College London, London, United Kingdom
| | - Sebastian Ourselin
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Mark Pennington
- King's Health Economics, King's College London, London, United Kingdom
| | - James Powell
- Department of Oncology, Velindre Cancer Centre, Cardiff, United Kingdom
| | - David Summers
- Department of Neuroradiology, Western General Hospital, Edinburgh, United Kingdom
| | - Adam D Waldman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Colin Watts
- Birmingham Brain Cancer Program, University of Birmingham, Birmingham, United Kingdom.,University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Matthew Williams
- Department of Neuro-oncology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Robin Grant
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Michael D Jenkinson
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.,Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
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24
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Fountain DM, Bryant A, Barone DG, Waqar M, Hart MG, Bulbeck H, Kernohan A, Watts C, Jenkinson MD. Intraoperative imaging technology to maximise extent of resection for glioma: a network meta-analysis. Cochrane Database Syst Rev 2021; 1:CD013630. [PMID: 33428222 PMCID: PMC8094975 DOI: 10.1002/14651858.cd013630.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Multiple studies have identified the prognostic relevance of extent of resection in the management of glioma. Different intraoperative technologies have emerged in recent years with unknown comparative efficacy in optimising extent of resection. One previous Cochrane Review provided low- to very low-certainty evidence in single trial analyses and synthesis of results was not possible. The role of intraoperative technology in maximising extent of resection remains uncertain. Due to the multiple complementary technologies available, this research question is amenable to a network meta-analysis methodological approach. OBJECTIVES To establish the comparative effectiveness and risk profile of specific intraoperative imaging technologies using a network meta-analysis and to identify cost analyses and economic evaluations as part of a brief economic commentary. SEARCH METHODS We searched CENTRAL (2020, Issue 5), MEDLINE via Ovid to May week 2 2020, and Embase via Ovid to 2020 week 20. We performed backward searching of all identified studies. We handsearched two journals, Neuro-oncology and the Journal of Neuro-oncology from 1990 to 2019 including all conference abstracts. Finally, we contacted recognised experts in neuro-oncology to identify any additional eligible studies and acquire information on ongoing randomised controlled trials (RCTs). SELECTION CRITERIA RCTs evaluating people of all ages with presumed new or recurrent glial tumours (of any location or histology) from clinical examination and imaging (computed tomography (CT) or magnetic resonance imaging (MRI), or both). Additional imaging modalities (e.g. positron emission tomography, magnetic resonance spectroscopy) were not mandatory. Interventions included fluorescence-guided surgery, intraoperative ultrasound, neuronavigation (with or without additional image processing, e.g. tractography), and intraoperative MRI. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the search results for relevance, undertook critical appraisal according to known guidelines, and extracted data using a prespecified pro forma. MAIN RESULTS We identified four RCTs, using different intraoperative imaging technologies: intraoperative magnetic resonance imaging (iMRI) (2 trials, with 58 and 14 participants); fluorescence-guided surgery with 5-aminolevulinic acid (5-ALA) (1 trial, 322 participants); and neuronavigation (1 trial, 45 participants). We identified one ongoing trial assessing iMRI with a planned sample size of 304 participants for which results are expected to be published around winter 2020. We identified no published trials for intraoperative ultrasound. Network meta-analyses or traditional meta-analyses were not appropriate due to absence of homogeneous trials across imaging technologies. Of the included trials, there was notable heterogeneity in tumour location and imaging technologies utilised in control arms. There were significant concerns regarding risk of bias in all the included studies. One trial of iMRI found increased extent of resection (risk ratio (RR) for incomplete resection was 0.13, 95% confidence interval (CI) 0.02 to 0.96; 49 participants; very low-certainty evidence) and one trial of 5-ALA (RR for incomplete resection was 0.55, 95% CI 0.42 to 0.71; 270 participants; low-certainty evidence). The other trial assessing iMRI was stopped early after an unplanned interim analysis including 14 participants; therefore, the trial provided very low-quality evidence. The trial of neuronavigation provided insufficient data to evaluate the effects on extent of resection. Reporting of adverse events was incomplete and suggestive of significant reporting bias (very low-certainty evidence). Overall, the proportion of reported events was low in most trials and, therefore, issues with power to detect differences in outcomes that may or may not have been present. Survival outcomes were not adequately reported, although one trial reported no evidence of improvement in overall survival with 5-ALA (hazard ratio (HR) 0.82, 95% CI 0.62 to 1.07; 270 participants; low-certainty evidence). Data for quality of life were only available for one study and there was significant attrition bias (very low-certainty evidence). AUTHORS' CONCLUSIONS Intraoperative imaging technologies, specifically 5-ALA and iMRI, may be of benefit in maximising extent of resection in participants with high-grade glioma. However, this is based on low- to very low-certainty evidence. Therefore, the short- and long-term neurological effects are uncertain. Effects of image-guided surgery on overall survival, progression-free survival, and quality of life are unclear. Network and traditional meta-analyses were not possible due to the identified high risk of bias, heterogeneity, and small trials included in this review. A brief economic commentary found limited economic evidence for the equivocal use of iMRI compared with conventional surgery. In terms of costs, one non-systematic review of economic studies suggested that, compared with standard surgery, use of image-guided surgery has an uncertain effect on costs and that 5-ALA was more costly. Further research, including completion of ongoing trials of ultrasound-guided surgery, is needed.
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Affiliation(s)
- Daniel M Fountain
- Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK
| | - Andrew Bryant
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Damiano Giuseppe Barone
- Department of Clinical Neurosciences, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Mueez Waqar
- Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK
| | - Michael G Hart
- Academic Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrookes Hospital, Cambridge, UK
| | | | - Ashleigh Kernohan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Colin Watts
- Chair Birmingham Brain Cancer Program, University of Birmingham, Edgbaston, UK
| | - Michael D Jenkinson
- Department of Neurosurgery & Institute of Systems Molecular and Integrative Biology, The Walton Centre & University of Liverpool, Liverpool, UK
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25
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G Rooney A, Hewins W, Walker A, Withington L, Mackinnon M, Robson S, Green A, Anderson G, Bulbeck H, Torrens C, Emerson J, Dunlop J, Welsh M, McEleney T, Hopcroft L, Wells M, McBain C, Chalmers A, Grant R. INNV-27. BT-LIFE (BRAIN TUMOURS, LIFESTYLE INTERVENTIONS, AND FATIGUE EVALUATION): LESSONS LEARNED FROM RUNNING A NOVEL MULTI-SECTORAL RESEARCH TRIAL. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.510] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
BT-LIFE is a multi-centre RCT of novel lifestyle coaching treatments for fatigued brain tumour patients. To our knowledge it is also the first example of ‘multi-sectoral research’ to combine healthcare, private, and charity sectors in this population. To maximise learning, the trial team devised a structured reflection opportunity to ask, “What went well and what would we do differently next time?”
METHOD
After trial closedown we convened a six-hour ‘focus group’ for management, principle investigators, research assistants, interventionists, qualitative researchers, trial statisticians, and the funder. Discussion was structured using a ‘timeline’ wall-chart which attendees freely populated with post-it notes summarising learning points from the trial. Minutes were taken in duplicate.
RESULTS
In total n=19 team members contributed. Many points were study-specific and will be used internally to plan a larger trial. Among points of wider interest, examples of success included: using regular teleconferences to co-ordinate a cohesive and highly collaborative team; obtaining secure nhs.net email addresses to facilitate multi-sectoral communication; and the clear value of employing one part-time research assistant per centre instead of relying on busy clinical staff to recruit. General future learning points included: speak to the prospective sponsor and ethical committees when writing the grant application to avoid pitfalls and facilitate faster opening if funding is secured; consider preceding emails with a phone call to ‘lay the ground’ in time-sensitive situations; identify staff training requirements as early as possible and cascade aggressively; and be sensitive to the fact that inter-sectoral attitudes and practices may vary widely and need actively monitored and managed. Therefore frequent and secure communication, pro-active problem-spotting, and inter-sectoral value alignment appear critical for success.
CONCLUSION
BT-LIFE provides many useful lessons for anyone interested in running multi-sectoral research.
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Affiliation(s)
| | | | - Amie Walker
- University of Edinburgh, Glasgow, United Kingdom
| | | | | | - Sara Robson
- Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Aimee Green
- Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | | | | | - Julie Emerson
- Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Jo Dunlop
- Public Health Scotland, Edinburgh, United Kingdom
| | | | | | | | - Mary Wells
- Imperial College Healthcare NHS Trust, London, United Kingdom
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26
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Jenkinson M, Helmy A, Huckey H, Mills S, Grant R, Hughes D, Marson T, Tangney R, Bulbeck H, Ali U, Gamble C. RTID-10. SURGEONS TRIAL OF PROPHYLAXIS FOR EPILEPSY IN SEIZURE NAÏVE PATIENTS WITH MENINGIOMA: A RANDOMIZED CONTROLLED TRIAL (STOP ‘EM). Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.815] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Meningioma is the commonest primary brain tumour. 70% of patients are seizure-free at presentation, but approximately 12% will have seizures within 12 months of surgery. Seizures impact quality of life. Neurosurgeons administer prophylactic anti-epileptic drugs (AED) to prevent seizures despite a lack of evidence to support this. A meta-analysis of RCTs in brain tumours suggests that older AED may prevent seizures in the first week after surgery but not thereafter. There are no studies assessing newer AEDs in the prophylactic setting.
RESEARCH QUESTION
In patients with meningioma who have never had a seizure and are undergoing surgical resection, does prophylactic levetiracetam reduce the risk of developing seizures?
DESIGN
multi-centre, double-blind RCT in 20 UK centres. 1:1 randomisation of 14 days levetiracetam 500mg bd started one day before surgery compared to placebo.
PRIMARY OBJECTIVE
Determine whether 2 weeks prophylactic levetiracetam reduces the risk of developing seizures within 12 months of surgery compared to placebo.
ECONOMIC OBJECTIVE
Estimate cost-effectiveness of prophylactic levetiracetam.
SECONDARY OBJECTIVES
Determine effect of prophylaxis on time to first seizure and first convulsive seizure, whether prophylaxis affects quality of life and influences return to driving, safety of prophylaxis.
POPULATION
seizure-naïve meningioma undergoing surgery.
SAMPLE SIZE
seizure rate at 12 months is 12.3%. A 50% reduction is clinically beneficial. A two-group chi-squared test with 5% two-sided significance level will have 90% power to detect the difference between a Group 1 proportion of 0.12 and a Group 2 proportion of 0.06 when the sample size in each group is 477. Allowing for 5% dropout, 1004 patients will be recruited.
FUNDING
NIHR (£1.64M) award June 2020. Study opens March 2021.
TRANSLATIONAL RESEARCH
MRI, blood and tissue will be collected to explore risk factors for seizures.
CONCLUSIONS
study will provide class I evidence of the role of prophylactic levetiracetam in meningioma surgery.
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Affiliation(s)
| | - Adel Helmy
- Addenbrookes Hospital, Cambridge, United Kingdom
| | - Helen Huckey
- University of Liverpool, Liverpool, United Kingdom
| | | | | | | | - Tony Marson
- University of Liverpool, Liverpool, United Kingdom
| | | | | | - Usama Ali
- University of Oxford, Oxford, United Kingdom
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27
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Grant R, Dowswell T, Tomlinson E, Brennan PM, Walter FM, Ben-Shlomo Y, Hunt DW, Bulbeck H, Kernohan A, Robinson T, Lawrie TA. Interventions to reduce the time to diagnosis of brain tumours. Cochrane Database Syst Rev 2020; 9:CD013564. [PMID: 32901926 PMCID: PMC8082957 DOI: 10.1002/14651858.cd013564.pub2] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Brain tumours are recognised as one of the most difficult cancers to diagnose because presenting symptoms, such as headache, cognitive symptoms, and seizures, may be more commonly attributable to other, more benign conditions. Interventions to reduce the time to diagnosis of brain tumours include national awareness initiatives, expedited pathways, and protocols to diagnose brain tumours, based on a person's presenting symptoms and signs; and interventions to reduce waiting times for brain imaging pathways. If such interventions reduce the time to diagnosis, it may make it less likely that people experience clinical deterioration, and different treatment options may be available. OBJECTIVES To systematically evaluate evidence on the effectiveness of interventions that may influence: symptomatic participants to present early (shortening the patient interval), thresholds for primary care referral (shortening the primary care interval), and time to imaging diagnosis (shortening the secondary care interval and diagnostic interval). To produce a brief economic commentary, summarising the economic evaluations relevant to these interventions. SEARCH METHODS For evidence on effectiveness, we searched CENTRAL, MEDLINE, and Embase from January 2000 to January 2020; Clinicaltrials.gov to May 2020, and conference proceedings from 2014 to 2018. For economic evidence, we searched the UK National Health Services Economic Evaluation Database from 2000 to December 2014. SELECTION CRITERIA We planned to include studies evaluating any active intervention that may influence the diagnostic pathway, e.g. clinical guidelines, direct access imaging, public health campaigns, educational initiatives, and other interventions that might lead to early identification of primary brain tumours. We planned to include randomised and non-randomised comparative studies. Included studies would include people of any age, with a presentation that might suggest a brain tumour. DATA COLLECTION AND ANALYSIS Two review authors independently assessed titles identified by the search strategy, and the full texts of potentially eligible studies. We resolved discrepancies through discussion or, if required, by consulting another review author. MAIN RESULTS We did not identify any studies for inclusion in this review. We excluded 115 studies. The main reason for exclusion of potentially eligible intervention studies was their study design, due to a lack of control groups. We found no economic evidence to inform a brief economic commentary on this topic. AUTHORS' CONCLUSIONS In this version of the review, we did not identify any studies that met the review inclusion criteria for either effectiveness or cost-effectiveness. Therefore, there is no evidence from good quality studies on the best strategies to reduce the time to diagnosis of brain tumours, despite the prioritisation of research on early diagnosis by the James Lind Alliance in 2015. This review highlights the need for research in this area.
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Affiliation(s)
- Robin Grant
- Edinburgh Centre for Neuro-Oncology (ECNO), Western General Hospital, Edinburgh, UK
| | - Therese Dowswell
- C/o Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's Health, The University of Liverpool, Liverpool, UK
| | - Eve Tomlinson
- Cochrane Gynaecological, Neuro-oncology and Orphan Cancers, 1st Floor Education Centre, Royal United Hospital, Bath, UK
| | - Paul M Brennan
- Translational Neurosurgery Department, Western General Hospital, Edinburgh, UK
| | - Fiona M Walter
- Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, Bristol, UK
| | - David William Hunt
- Foundation School/Dept of Clinical and Experimental Medicine, Royal Surrey County Hospital/University of Surrey, Guildford, UK
| | | | - Ashleigh Kernohan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tomos Robinson
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
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28
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Price SJ, Joannides A, Plaha P, Afshari FT, Albanese E, Barua NU, Chan HW, Critchley G, Flannery T, Fountain DM, Mathew RK, Piper RJ, Poon MT, Rajaraman C, Rominiyi O, Smith S, Solomou G, Solth A, Surash S, Wykes V, Watts C, Bulbeck H, Hutchinson P, Jenkinson MD. Impact of COVID-19 pandemic on surgical neuro-oncology multi-disciplinary team decision making: a national survey (COVID-CNSMDT Study). BMJ Open 2020; 10:e040898. [PMID: 32801210 PMCID: PMC7430412 DOI: 10.1136/bmjopen-2020-040898] [Citation(s) in RCA: 16] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/29/2020] [Accepted: 07/31/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Pressures on healthcare systems due to COVID-19 has impacted patients without COVID-19 with surgery disproportionally affected. This study aims to understand the impact on the initial management of patients with brain tumours by measuring changes to normal multidisciplinary team (MDT) decision making. DESIGN A prospective survey performed in UK neurosurgical units performed from 23 March 2020 until 24 April 2020. SETTING Regional neurosurgical units outside London (as the pandemic was more advanced at time of study). PARTICIPANTS Representatives from all units were invited to collect data on new patients discussed at their MDT meetings during the study period. Each unit decided if management decision for each patient had changed due to COVID-19. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome measures included number of patients where the decision to undergo surgery changed compared with standard management usually offered by that MDT. Secondary outcome measures included changes in surgical extent, numbers referred to MDT, number of patients denied surgery not receiving any treatment and reasons for any variation across the UK. RESULTS 18 units (75%) provided information from 80 MDT meetings that discussed 1221 patients. 10.7% of patients had their management changed-the majority (68%) did not undergo surgery and more than half of this group not undergoing surgery had no active treatment. There was marked variation across the UK (0%-28% change in management). Units that did not change management could maintain capacity with dedicated oncology lists. Low volume units were less affected. CONCLUSION COVID-19 has had an impact on patients requiring surgery for malignant brain tumours, with patients receiving different treatments-most commonly not receiving surgery or any treatment at all. The variations show dedicated cancer operating lists may mitigate these pressures. STUDY REGISTRATION This study was registered with the Royal College of Surgeons of England's COVID-19 Research Group (https://www.rcseng.ac.uk/coronavirus/rcs-covid-research-group/).
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Affiliation(s)
- Stephen John Price
- Neurosurgery Division, Department of Clinical Neurosciences, Cambridge University, Cambridge, UK
| | - Alexis Joannides
- Neurosurgery Division, Department of Clinical Neurosciences, Cambridge University, Cambridge, UK
| | - Puneet Plaha
- Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK
| | - Fardad Taghizadeh Afshari
- Department of Neurosurgery, University Hospitals Coventry and Warwickshire National Health Service Trust, Coventry, UK
| | - Erminia Albanese
- Department of Neurosurgery, University Hospitals of North Midlands National Health Service Trust, Stoke-on-Trent, Staffordshire, UK
| | - Neil U Barua
- Department of Neurosurgery, North Bristol National Health Service Trust, Bristol, UK
| | - Huan Wee Chan
- Department of Neurosurgery, University Hospital Southampton National Health Service Foundation Trust, Southampton, UK
| | - Giles Critchley
- Department of Neurosurgery, Brighton and Sussex University Hospitals National Health Service Trust, Brighton, UK
| | - Thomas Flannery
- Department of Neurosurgery, Royal Victoria Hospital, Belfast, Northern Ireland, UK
| | - Daniel M Fountain
- Manchester Centre for Clinical Neurosciences, Salford Royal National Health Service Foundation Trust, Salford, UK
| | - Ryan K Mathew
- Department of Neurosurgery, Leeds General Infirmary, Leeds, UK
| | - Rory J Piper
- Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK
| | | | - Chittoor Rajaraman
- Department of Neurosurgery, Hull Royal Infirmary, Hull, Kingston upon Hull, UK
| | - Ola Rominiyi
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, UK
| | - Stuart Smith
- Department of Neurosurgery, Queen's Medical Centre, Nottingham, UK
| | - Georgios Solomou
- Department of Neurosurgery, University Hospitals Coventry and Warwickshire National Health Service Trust, Coventry, UK
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Anna Solth
- Department of Neurosurgery, Ninewells Hospital, Dundee, UK
| | - Surash Surash
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Victoria Wykes
- Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, UK
| | - Colin Watts
- Institute of Cancer and Genomic Studies, University of Birmingham, Birmingham, UK
| | | | - Peter Hutchinson
- Neurosurgery Division, Department of Clinical Neurosciences, Cambridge University, Cambridge, UK
| | - Michael D Jenkinson
- Department of Neurosurgery, The Walton Centre National Health Service Foundation Trust, Liverpool, UK
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29
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Fountain DM, Jenkinson MD, Bryant A, Vale L, Bulbeck H, Hart MG, Barone DG. Intraoperative imaging technology to maximise extent of resection for glioma: a network meta-analysis. Hippokratia 2020. [DOI: 10.1002/14651858.cd013630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Daniel M Fountain
- Manchester Centre for Clinical Neurosciences; Salford Royal NHS Foundation Trust; Salford UK
| | | | - Andrew Bryant
- Institute of Health & Society; Newcastle University; Newcastle upon Tyne UK
| | - Luke Vale
- Institute of Health & Society; Newcastle University; Newcastle upon Tyne UK
| | | | - Michael G Hart
- Academic Division of Neurosurgery, Department of Clinical Neurosciences; Addenbrookes Hospital; Cambridge UK
| | - Damiano Giuseppe Barone
- Department of Clinical Neurosciences; University of Cambridge School of Clinical Medicine; Cambridge UK
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30
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Grant R, Lawrie TA, Brennan PM, Walter FM, Ben-Shlomo Y, Hunt DW, Tomlinson E, Bulbeck H, Kernohan A, Robinson T, Vale L. Interventions to reduce the time to diagnosis of brain tumours. Hippokratia 2020. [DOI: 10.1002/14651858.cd013564] [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: 11/11/2022]
Affiliation(s)
- Robin Grant
- Western General Hospital; Edinburgh Centre for Neuro-Oncology (ECNO); Crewe Road Edinburgh Scotland UK EH4 2XU
| | - Theresa A Lawrie
- The Evidence-Based Medicine Consultancy Ltd; 3rd Floor Northgate House Upper Borough Walls Bath UK BA1 1RG
| | - Paul M Brennan
- Western General Hospital; Translational Neurosurgery Department; Edinburgh UK EH4 2XR
| | - Fiona M Walter
- University of Cambridge; Public Health & Primary Care; Strangeways Research Laboratory, Worts Causeway Cambridge UK CB1 8RN
| | - Yoav Ben-Shlomo
- Canynge Hall; Department of Social Medicine; Whiteladies Road Bristol UK BS8 2PR
| | - David William Hunt
- Royal Surrey County Hospital/University of Surrey; Foundation School/Dept of Clinical and Experimental Medicine; 10 Barrack Road Guildford Surrey UK GU2 9SR
| | - Eve Tomlinson
- 1st Floor Education Centre, Royal United Hospital; Cochrane Gynaecological, Neuro-oncology and Orphan Cancers; Combe Park Bath UK BA1 3NG
| | - Helen Bulbeck
- brainstrust; Director of Services; 4 Yvery Court Castle Road Cowes Isle of Wight UK PO31 7QG
| | - Ashleigh Kernohan
- Newcastle University; Institute of Health & Society; Baddiley-Clark Building, Richardson Road Newcastle upon Tyne UK NE2 4AA
| | - Tomos Robinson
- Newcastle University; Institute of Health & Society; Baddiley-Clark Building, Richardson Road Newcastle upon Tyne UK NE2 4AA
| | - Luke Vale
- Newcastle University; Institute of Health & Society; Baddiley-Clark Building, Richardson Road Newcastle upon Tyne UK NE2 4AA
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Hanna C, Lawrie TA, Rogozińska E, Kernohan A, Jefferies S, Bulbeck H, Ali UM, Robinson T, Grant R. Treatment of newly diagnosed glioblastoma in the elderly: a network meta-analysis. Cochrane Database Syst Rev 2020; 3:CD013261. [PMID: 32202316 PMCID: PMC7086476 DOI: 10.1002/14651858.cd013261.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND A glioblastoma is a fatal type of brain tumour for which the standard of care is maximum surgical resection followed by chemoradiotherapy, when possible. Age is an important consideration in this disease, as older age is associated with shorter survival and a higher risk of treatment-related toxicity. OBJECTIVES To determine the most effective and best-tolerated approaches for the treatment of elderly people with newly diagnosed glioblastoma. To summarise current evidence for the incremental resource use, utilities, costs and cost-effectiveness associated with these approaches. SEARCH METHODS We searched electronic databases including the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and Embase to 3 April 2019, and the NHS Economic Evaluation Database (EED) up to database closure. We handsearched clinical trial registries and selected neuro-oncology society conference proceedings from the past five years. SELECTION CRITERIA Randomised trials (RCTs) of treatments for glioblastoma in elderly people. We defined 'elderly' as 70+ years but included studies defining 'elderly' as over 65+ years if so reported. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods for study selection and data extraction. Where sufficient data were available, treatment options were compared in a network meta-analysis (NMA) using Stata software (version 15.1). For outcomes with insufficient data for NMA, pairwise meta-analysis were conducted in RevMan. The GRADE approach was used to grade the evidence. MAIN RESULTS We included 12 RCTs involving approximately 1818 participants. Six were conducted exclusively among elderly people (either defined as 65 years or older or 70 years or older) with newly diagnosed glioblastoma, the other six reported data for an elderly subgroup among a broader age range of participants. Most participants were capable of self-care. Study quality was commonly undermined by lack of outcome assessor blinding and attrition. NMA was only possible for overall survival; other analyses were pair-wise meta-analyses or narrative syntheses. Seven trials contributed to the NMA for overall survival, with interventions including supportive care only (one trial arm); hypofractionated radiotherapy (RT40; four trial arms); standard radiotherapy (RT60; five trial arms); temozolomide (TMZ; three trial arms); chemoradiotherapy (CRT; three trial arms); bevacizumab with chemoradiotherapy (BEV_CRT; one trial arm); and bevacizumab with radiotherapy (BEV_RT). Compared with supportive care only, NMA evidence suggested that all treatments apart from BEV_RT prolonged survival to some extent. Overall survival High-certainty evidence shows that CRT prolongs overall survival (OS) compared with RT40 (hazard ratio (HR) 0.67, 95% confidence interval (CI) 0.56 to 0.80) and low-certainty evidence suggests that CRT may prolong overall survival compared with TMZ (TMZ versus CRT: HR 1.42, 95% CI 1.01 to 1.98). Low-certainty evidence also suggests that adding BEV to CRT may make little or no difference (BEV_CRT versus CRT: HR 0.83, 95% CrI 0.48 to 1.44). We could not compare the survival effects of CRT with different radiotherapy fractionation schedules (60 Gy/30 fractions and 40 Gy/15 fractions) due to a lack of data. When treatments were ranked according to their effects on OS, CRT ranked higher than TMZ, RT and supportive care only, with the latter ranked last. BEV plus RT was the only treatment for which there was no clear benefit in OS over supportive care only. One trial comparing tumour treating fields (TTF) plus adjuvant chemotherapy (TTF_AC) with adjuvant chemotherapy alone could not be included in the NMA as participants were randomised after receiving concomitant chemoradiotherapy, not before. Findings from the trial suggest that the intervention probably improves overall survival in this selected patient population. We were unable to perform NMA for other outcomes due to insufficient data. Pairwise analyses were conducted for the following. Quality of life Moderate-certainty narrative evidence suggests that overall, there may be little difference in QoL between TMZ and RT, except for discomfort from communication deficits, which are probably more common with RT (1 study, 306 participants, P = 0.002). Data on QoL for other comparisons were sparse, partly due to high dropout rates, and the certainty of the evidence tended to be low or very low. Progression-free survival High-certainty evidence shows that CRT increases time to disease progression compared with RT40 (HR 0.50, 95% CI 0.41 to 0.61); moderate-certainty evidence suggests that RT60 probably increases time to disease progression compared with supportive care only (HR 0.28, 95% CI 0.17 to 0.46), and that BEV_RT probably increases time to disease progression compared with RT40 alone (HR 0.46, 95% CI 0.27 to 0.78). Evidence for other treatment comparisons was of low- or very low-certainty. Severe adverse events Moderate-certainty evidence suggests that TMZ probably increases the risk of grade 3+ thromboembolic events compared with RT60 (risk ratio (RR) 2.74, 95% CI 1.26 to 5.94; participants = 373; studies = 1) and also the risk of grade 3+ neutropenia, lymphopenia, and thrombocytopenia. Moderate-certainty evidence also suggests that CRT probably increases the risk of grade 3+ neutropenia, leucopenia and thrombocytopenia compared with hypofractionated RT alone. Adding BEV to CRT probably increases the risk of thromboembolism (RR 16.63, 95% CI 1.00 to 275.42; moderate-certainty evidence). Economic evidence There is a paucity of economic evidence regarding the management of newly diagnosed glioblastoma in the elderly. Only one economic evaluation on two short course radiotherapy regimen (25 Gy versus 40 Gy) was identified and its findings were considered unreliable. AUTHORS' CONCLUSIONS For elderly people with glioblastoma who are self-caring, evidence suggests that CRT prolongs survival compared with RT and may prolong overall survival compared with TMZ alone. For those undergoing RT or TMZ therapy, there is probably little difference in QoL overall. Systemic anti-cancer treatments TMZ and BEV carry a higher risk of severe haematological and thromboembolic events and CRT is probably associated with a higher risk of these events. Current evidence provides little justification for using BEV in elderly patients outside a clinical trial setting. Whilst the novel TTF device appears promising, evidence on QoL and tolerability is needed in an elderly population. QoL and economic assessments of CRT versus TMZ and RT are needed. More high-quality economic evaluations are needed, in which a broader scope of costs (both direct and indirect) and outcomes should be included.
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Affiliation(s)
- Catherine Hanna
- University of GlasgowDepartment of OncologyBeatson West of Scotland Cancer CentreGreat Western RoadGlasgowScotlandUKG4 9DL
| | - Theresa A Lawrie
- The Evidence‐Based Medicine Consultancy Ltd3rd Floor Northgate HouseUpper Borough WallsBathUKBA1 1RG
| | - Ewelina Rogozińska
- The Evidence‐Based Medicine Consultancy Ltd3rd Floor Northgate HouseUpper Borough WallsBathUKBA1 1RG
| | - Ashleigh Kernohan
- Newcastle UniversityInstitute of Health & SocietyBaddiley‐Clark Building, Richardson RoadNewcastle upon TyneUKNE2 4AA
| | - Sarah Jefferies
- Addenbrooke's HospitalDepartment of OncologyHills RoadCambridgeUKCB2 0QQ
| | - Helen Bulbeck
- brainstrustDirector of Services4 Yvery CourtCastle RoadCowesIsle of WightUKPO31 7QG
| | - Usama M Ali
- University of OxfordNuffield Department of Population HealthRoosevelt DriveOld Road CampusOxfordOxfordshireUKOX3 7LF
| | - Tomos Robinson
- Newcastle UniversityInstitute of Health & SocietyBaddiley‐Clark Building, Richardson RoadNewcastle upon TyneUKNE2 4AA
| | - Robin Grant
- Western General HospitalEdinburgh Centre for Neuro‐Oncology (ECNO)Crewe RoadEdinburghScotlandUKEH4 2XU
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Watts C, Apps J, Ansorg O, Savage J, Fox R, Chalmers A, Short SC, Thompson G, Waldman A, Capper D, Hargrave D, Brennan P, Smith S, Ashkan K, Wykes V, Kurian K, Jamal-Hanjani M, Swanton C, Buckle P, Bulbeck H, Stead LF, Vivanco I, Bowden S. RBTT-06. TESSA JOWELL BRAIN MATRIX STUDY: A BRITISH FEASIBILITY STUDY OF MOLECULAR STRATIFICATION AND TARGETED THERAPY TO OPTIMIZE THE CLINICAL MANAGEMENT OF PATIENTS WITH GLIOMA. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.918] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
In 2016 there were 5250 brain cancer deaths in the UK. Standard treatment is surgical resection followed by chemo-radiotherapy. In most cases of diffuse glioma, complete tumour resection is not feasible. Many chemotherapy drugs have untested penetration through the blood brain barrier, potentially leading to sub-therapeutic concentrations in the tumour. There is need to refine current treatment strategies in relation to the understanding of tumour biology, and rapidly introduce and evaluate novel therapeutic approaches and agents through delivering rigorous clinical trials. The TESSA JOWELL BRAIN MATRIX Study will evaluate the feasibility of delivering precision medicine for brain cancer patients within the NHS. A multicentre, platform feasibility study of 1200 patients with diffuse glioma will build on the 100,000 genome project to develop and evaluate an infrastructure to collect and integrate: 1) real time comprehensive integrated molecular analysis, including whole genome sequencing and epigenetic classification; 2) serial sampling and annotation of tumours; 3) collection of matched clinical data; 4) assessment of patient quality of life; 5) centralised radiological review and response assessment as per RANO criteria. Once developed this will allow rapid introduction of therapeutic trials to specific patient groups. Secondary objectives include: understanding the association between extent of resection and molecular stratification to refine the role of surgery; optimisation and harmonisation of protocols to best collect, manage and store tissue, clinical data, and radiological images in order to provide a resource for researchers, both within and outside of the study. Improve patient recruitment by identifying and removing recruitment barriers and improve the information and consent processes for patients. Promote the development of a national network with expertise in brain cancer. Enrolment of the first patient is expected in late 2019. For further information, please contact the Brain Matrix Trial Office BrainMatrix@trials.bham.ac.uk.
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Affiliation(s)
- Colin Watts
- University of Birmingham, Birmingham, United Kingdom
| | - John Apps
- University of Birmingham, Birmingham, United Kingdom
| | - Olaf Ansorg
- University of Oxford, Oxford, United Kingdom
| | - Josh Savage
- Birmingham Cancer CTU, Birmingham, United Kingdom
| | - Richard Fox
- Birmingham Cancer CTU, Birmingham, United Kingdom
| | | | - Susan C Short
- Leeds Institute of Medical Research at St James’s, Wellcome Trust Brenner Building, St. James’s University Hospital, Leeds, United Kingdom, Leeds, United Kingdom
| | | | - Adam Waldman
- University of Edinburgh, Edinburgh, United Kingdom
| | | | | | - Paul Brennan
- University of Birmingham, Edinburgh, United Kingdom
| | - Stuart Smith
- Nottingham University, Nottingham, United Kingdom
| | | | | | | | | | | | | | - Helen Bulbeck
- Braintrust, Cowes, Isles of Wight, England, United Kingdom
| | - Lucy F Stead
- Leeds Institute of Medical Research at St James’s, Wellcome Trust Brenner Building, St. James’s University Hospital, Leeds, United Kingdom, Leeds, United Kingdom
| | - Igor Vivanco
- Insitute of Cancer Research, London, United Kingdom
| | - Sarah Bowden
- Birmingham Cancer CTU, Birmingham, United Kingdom
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Byrne A, Sivell S, Moraes FY, Bulbeck H, Torrens-Burton A, Bernstein M, Nelson A, Fielding H. Early palliative interventions for improving outcomes in people with a primary malignant brain tumour and their carers. Hippokratia 2019. [DOI: 10.1002/14651858.cd013440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Anthony Byrne
- Llandough Hospital; Cardiff and Vale University Health Board; Penlan Road Penarth Vale of Glamorgan UK CF64 2XX
- School of Medicine, Cardiff University; Marie Curie Palliative Care Research Centre (MCPCRC), Division of Population Medicine; Cardiff UK
| | - Stephanie Sivell
- School of Medicine, Cardiff University; Marie Curie Palliative Care Research Centre (MCPCRC), Division of Population Medicine; Cardiff UK
| | - Fabio Ynoe Moraes
- Kingston Health Sciences Centre; Department of Oncology, Division of Radiation Oncology; Queen's University 25 King St W Kingston ON Canada K7L 5P9
| | - Helen Bulbeck
- brainstrust; Director of Services; 4 Yvery Court Castle Road Cowes Isle of Wight UK PO31 7QG
| | - Anna Torrens-Burton
- School of Medicine, Cardiff University; Marie Curie Palliative Care Research Centre (MCPCRC), Division of Population Medicine; Cardiff UK
| | - Mark Bernstein
- University of Toronto; Faculty of Medicine; Toronto Ontario Canada
| | - Annmarie Nelson
- School of Medicine, Cardiff University; Marie Curie Palliative Care Research Centre (MCPCRC), Division of Population Medicine; Cardiff UK
| | - Helen Fielding
- Abertawe Bro Morgannwg University Health Board; Palliative Medicine; Singleton Hospital Sketty Lane Swansea UK SA2 8QA
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Abstract
BACKGROUND The diagnosis and treatment of a brain or spinal cord tumour can have a huge impact on the lives of patients and their families with family caregiving often resulting in considerable burden and distress. Meeting the support needs of family caregivers is critical to maintain their emotional and physical health. Although support for caregivers is becoming more widely available, large-scale implementation is hindered by a lack of high-quality evidence for its effectiveness in the neuro-oncology caregiver population. OBJECTIVES To assess the effectiveness of supportive interventions at improving the well-being of caregivers of people with a brain or spinal cord tumour. To assess the effects of supportive interventions for caregivers in improving the physical and emotional well-being of people with a brain or spinal cord tumour and to evaluate the health economic benefits of supportive interventions for caregivers. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 7), MEDLINE via Ovid, and Embase via Ovid. We also handsearched relevant published conference abstracts (previous five years), publications in the two main journals in the field (previous year), searched for ongoing trials via ClinicalTrials.gov, and contacted research groups in the field. The initial search was in March 2017 with an update in August 2018 (handsearches completed in January 2019). SELECTION CRITERIA We included all randomised controlled trials (RCTs) where caregivers of neuro-oncology patients constituted more than 20% of the sample and which evaluated changes in caregiver well-being following any supportive intervention. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies and carried out risk of bias assessments. We aimed to extract data on the outcomes of psychological distress, burden, mastery, quality of patient-caregiver relationship, quality of life, and physical functioning. MAIN RESULTS In total, the search identified 2102 records, of which we reviewed 144 in full text. We included eight studies. Four interventions focused on patient-caregiver dyads and four were aimed specifically at the caregiver. Heterogeneity of populations and methodologies precluded meta-analysis. Risk of bias varied, and all studies included only small numbers of neuro-oncology caregivers (13 to 56 participants). There was some evidence for positive effects of caregiver support on psychological distress, mastery, and quality of life (low to very low certainty of evidence). No studies reported significant effects on caregiver burden or quality of patient-caregiver relationship (low to very low certainty of evidence). None of the studies assessed caregiver physical functioning. For secondary outcomes (patient emotional or physical well-being; health economic effects), we found very little to no evidence for the effectiveness of caregiver support. We identified five ongoing trials. AUTHORS' CONCLUSIONS The eight small-scale studies included employed different methodologies across different populations, with low certainty of evidence overall. It is not currently possible to draw reliable conclusions regarding the effectiveness of supportive interventions aimed at improving neuro-oncology caregiver well-being. More high-quality research is needed on support for family caregivers of people diagnosed, and living, with a brain or spinal cord tumour.
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Affiliation(s)
- Florien W Boele
- University of Leeds and Leeds Cancer CentreLeeds Institute of Health Sciences and Leeds Institute of Cancer and PathologyPOG, Level 3, Bexley WingSt James's Institute of OncologyLeedsUKLS9 7TF
| | - Alasdair G Rooney
- Edinburgh Centre for Neuro‐Oncology (ECNO)Department of Psychological MedicineWestern General HospitalCrewe Road SouthEdinburghScotlandUKEH4 2XU
| | - Helen Bulbeck
- brainstrustDirector of Services4 Yvery CourtCastle RoadCowesIsle of WightUKPO31 7QG
| | - Paula Sherwood
- University of PittsburghDepartment of Acute and Tertiary Care336 Victoria Building3500 Victoria StreetPittsburghMAUSA15261
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Sage W, Fernández-Méndez R, Crofton A, Gifford MJ, Bannykh A, Chrysaphinis C, Tingley E, Bulbeck H, Brahmbhatt M, Pickard JD, Walter FM, Brodbelt A, Price SJ, Joannides AJ. Defining unmet clinical need across the pathway of brain tumor care: a patient and carer perspective. Cancer Manag Res 2019; 11:2189-2202. [PMID: 30962709 PMCID: PMC6433107 DOI: 10.2147/cmar.s175886] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective The aim of this study was to determine the experience of patients with brain tumors and their carers across distinct parts of their treatment pathway and identify their views on potential service gaps in need of addressing. Methods A structured survey was administered at patient workshops across the UK and online through a charity newsletter. Answers to closed questions were analyzed using descriptive statistics, and open questions were examined using techniques of inductive content analysis. Results A total of 136 survey responses were received, representing patients with a variety of diagnoses and geographical locations (30 counties). There was a wide range of opinions on the provision of current neuro-oncology services. Key themes identified included a perceived lack of information provision, a gap in postdischarge psychological and neuropsychological supports, and an unmet willingness for involvement in research. Conclusion This national survey enhances our knowledge of current patient and carer experience within neuro-oncology services. A number of areas of unmet clinical need are highlighted providing a basis for informing future patient-centered service improvements and research.
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Affiliation(s)
- William Sage
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK,
| | | | - Anna Crofton
- Department of Neurosurgery, The Walton Centre, Liverpool, UK
| | | | | | | | | | | | - Mita Brahmbhatt
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK,
| | - John D Pickard
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK,
| | - Fiona M Walter
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Andrew Brodbelt
- Department of Neurosurgery, The Walton Centre, Liverpool, UK
| | - Stephen J Price
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK,
| | - Alexis J Joannides
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK,
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Ahmad SS, Crittenden MR, Tran PT, Kluetz PG, Blumenthal GM, Bulbeck H, Baird RD, Williams KJ, Illidge T, Hahn SM, Lawrence TS, Spears PA, Walker AJ, Sharma RA. Clinical Development of Novel Drug-Radiotherapy Combinations. Clin Cancer Res 2019; 25:1455-1461. [PMID: 30498095 PMCID: PMC6397668 DOI: 10.1158/1078-0432.ccr-18-2466] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [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] [Received: 08/24/2018] [Revised: 10/16/2018] [Accepted: 11/26/2018] [Indexed: 12/25/2022]
Abstract
Radiotherapy is a fundamental component of treatment for the majority of patients with cancer. In recent decades, technological advances have enabled patients to receive more targeted doses of radiation to the tumor, with sparing of adjacent normal tissues. There had been hope that the era of precision medicine would enhance the combination of radiotherapy with targeted anticancer drugs; however, this ambition remains to be realized. In view of this lack of progress, the FDA-AACR-ASTRO Clinical Development of Drug-Radiotherapy Combinations Workshop was held in February 2018 to bring together stakeholders and opinion leaders from academia, clinical radiation oncology, industry, patient advocacy groups, and the FDA to discuss challenges to introducing new drug-radiotherapy combinations to the clinic. This Perspectives in Regulatory Science and Policy article summarizes the themes and action points that were discussed. Intelligent trial design is required to increase the number of studies that efficiently meet their primary outcomes; endpoints to be considered include local control, organ preservation, and patient-reported outcomes. Novel approaches including immune-oncology or DNA-repair inhibitor agents combined with radiotherapy should be prioritized. In this article, we focus on how the regulatory challenges associated with defining a new drug-radiotherapy combination can be overcome to improve clinical outcomes for patients with cancer.
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Affiliation(s)
- Saif S Ahmad
- Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Marka R Crittenden
- Translational Radiation Research, Earle A. Chiles Research Institute, Providence Cancer Center, Portland, Oregon; The Oregon Clinic, Portland, Oregon
| | - Phuoc T Tran
- Department of Radiation Oncology and Molecular Radiation Sciences, Oncology and Urology, Johns Hopkins University, Baltimore, Maryland
| | - Paul G Kluetz
- FDA Oncology Center of Excellence, Silver Spring, Maryland
| | | | - Helen Bulbeck
- CTRad, National Cancer Research Institute, London, United Kingdom
| | - Richard D Baird
- Cambridge Breast Cancer Research Unit, University of Cambridge, Cambridge, United Kingdom
| | - Kaye J Williams
- Division of Pharmacy and Optometry, Manchester Cancer Research Centre, The University of Manchester, Manchester, United Kingdom
| | - Tim Illidge
- Division of Cancer Sciences, The University of Manchester, Manchester Academic Health Science Centre, NIHR Biomedical Research Centre, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Stephen M Hahn
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Theodore S Lawrence
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Patricia A Spears
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
| | - Amanda J Walker
- Department of Radiation Oncology, Wentworth Douglass Hospital and Seacoast Cancer Center, Dover, New Hampshire.
| | - Ricky A Sharma
- Radiation Oncology, NIHR University College London Hospitals Biomedical Research Centre, University College London Cancer Institute, University College London, London, United Kingdom.
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Jenkinson MD, Watts C, Marson AG, Hill R, Murray K, Vale L, Bulbeck H, Grant R. TM1-1 Seizure prophylaxis in gliomas (SPRING): a phase III randomised controlled trial comparing prophylactic levetiracetam versus no prophylactic anti-epileptic drug in glioma surgery. J Neurol Neurosurg Psychiatry 2019. [DOI: 10.1136/jnnp-2019-abn.25] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
ObjectivesThere is no consensus regarding the need for prophylactic anti-epileptic drug (AED) in seizure-naive newly-diagnosed glioma patients. Data regarding prophylactic AED use are scant and inconclusive from older, small studies that enrolled patients with brain metastases, benign tumours and gliomas. A definitive randomised controlled trial (RCT) is needed to determine whether the policy of prophylactic AED therapy reduces the risk of first seizures in this population.DesignMulti-centre RCT.SubjectsInclusion criteria: i. seizure-naive, ii. supratentorial glioma suitable for surgery (biopsy/resection), iii. age ≥16 years; iv. Karnofsky performance status >60.MethodsPatients are randomised 1:1. Levetiracetam 500 mg bd for 2 weeks, increased to 750 mg bd thereafter for 1 year. Non-blinded. No placebo. Primary Outcome: one year risk of first seizure. Secondary outcomes: time to first seizure, time to first tonic-clonic seizure, mood, fatigue, quality of life, progression free survival, overall survival and incremental cost per QALY. Estimate of 1 year seizure rate in glioma after surgery is 20%. Based on a reduction in seizure rate to 10% a total of 806 patients will be recruited.ResultsGrant awarded by NIHR. Feasibility questionnaire demonstrated prophylactic AED rarely used. Neurosurgeons willing to randomise. 15 UK centres have expressed interest in participating.ConclusionsSPRING will establish class I evidence for the use of seizure prophylaxis in glioma surgery. The trial will open to recruitment in January 2019.
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Affiliation(s)
- Theresa A Lawrie
- 1st Floor Education Centre, Royal United Hospital; Cochrane Gynaecological, Neuro-oncology and Orphan Cancer Group; Combe Park Bath UK BA1 3NG
| | - Catherine R Hanna
- University of Glasgow; Department of Oncology; Beatson West of Scotland Cancer Centre Great Western Road Glasgow Scotland UK G4 9DL
| | | | - Ashleigh Kernohan
- Newcastle University; Institute of Health & Society; Baddiley-Clark Building, Richardson Road Newcastle upon Tyne UK NE2 4AA
| | - Luke Vale
- Newcastle University; Institute of Health & Society; Baddiley-Clark Building, Richardson Road Newcastle upon Tyne UK NE2 4AA
| | - Helen Bulbeck
- brainstrust; Director of Services; 4 Yvery Court Castle Road Cowes Isle of Wight UK PO31 7QG
| | - Usama M Ali
- University of Oxford; Centre for Statistics in Medicine; 7 Dewsbury Road Luton Bedfordshire UK LU3 2HJ
| | - Robin Grant
- Western General Hospital; Edinburgh Centre for Neuro-Oncology (ECNO); Crewe Road Edinburgh Scotland UK EH4 2XU
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Bulbeck H, Broggio J, Doubleday P, Jones W, Rashbass J, Vernon S. THE STORY BEHIND THE DATA: DEVELOPING THE CONVERSATION ABOUT BRAIN CANCER DATA BEYOND TRADITIONAL INDICATORS. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy129.035] [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: 11/13/2022] Open
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Jenkinson M, Watts C, Vale L, Marson A, Bulbeck H, Grant R. SEIZURE PROPHYLAXIS IN GLIOMA - UK NEUROSURGICAL SURVEY AND CLINICAL TRIAL. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy129.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Jenkinson MD, Weber DC, Haylock BJ, Sherratt FC, Young B, Weller M, Bulbeck H, Culeddu G, Hughes DA, Brain A, Das K, Preusser M, Francis P, Gamble C. Letter to the Editor. Phase III randomized controlled trials are essential to properly evaluate the role of radiotherapy in WHO grade II meningioma. J Neurosurg 2018; 129:1104-1105. [DOI: 10.3171/2018.6.jns181418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Michael D. Jenkinson
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
- Institute of Translational Medicine, University of Liverpool, United Kingdom
| | - Damien C. Weber
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | | | - Frances C. Sherratt
- Institute of Psychology, Health and Society, University of Liverpool, United Kingdom
| | - Bridget Young
- Institute of Psychology, Health and Society, University of Liverpool, United Kingdom
| | | | - Helen Bulbeck
- brainstrust charity, Cowes, Isle of Wight, United Kingdom
| | - Giovanna Culeddu
- Centre for Health Economics and Medicines Evaluation, University of Bangor, United Kingdom; and
| | - Dyfrig A. Hughes
- Centre for Health Economics and Medicines Evaluation, University of Bangor, United Kingdom; and
| | - Alice Brain
- Clatterbridge Cancer Centre, Wirral, United Kingdom
| | - Kumar Das
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Matthias Preusser
- Comprehensive Cancer Centre Vienna, Medical University of Vienna, Austria
| | - Priya Francis
- Institute of Translational Medicine, University of Liverpool, United Kingdom
| | - Carrol Gamble
- Institute of Translational Medicine, University of Liverpool, United Kingdom
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Boele FW, Rooney AG, Bulbeck H, Sherwood PR. OS4.4 Interventions to help support caregivers of people with a brain or spinal cord tumour - a Cochrane systematic review. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.029] [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)
- F W Boele
- University of Leeds, Leeds, United Kingdom
| | - A G Rooney
- Edinburgh Centre for Neuro-Oncology, Western General Hospital, Edinburgh, United Kingdom
| | | | - P R Sherwood
- University of Pittsburgh, Pittsburgh, PA, United States
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Amos R, Bulbeck H, Burnet N, Crellin A, Eaton D, Evans P, Hall E, Hawkins M, Kirkby K, Mackay R, Sebag-Montefiore D, Sharma R. Proton Beam Therapy - the Challenges of Delivering High-quality Evidence of Clinical Benefit. Clin Oncol (R Coll Radiol) 2018; 30:280-284. [PMID: 29551566 DOI: 10.1016/j.clon.2018.02.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 02/19/2018] [Indexed: 12/11/2022]
Abstract
The use of proton beam therapy (PBT) offers the opportunity to improve greater conformality of radiotherapy treatment delivery in some patients. However, it is associated with a high capital cost and the need to build new dedicated facilities. We discuss how the global radiotherapy community can respond to the challenge of producing high-quality evidence of clinical benefit from PBT in adult patients. In the UK, the National Cancer Research Institute-funded Clinical and Radiotherapy Translational group has established the PBT Clinical Trial Strategy Group. An eight-point framework is described that can assist the development and delivery of high-quality clinical trials.
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Bulbeck H. What does the brain tumour community want to know about the behaviour and personality changes following a brain tumour diagnosis? Neuro Oncol 2018. [DOI: 10.1093/neuonc/nox237.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Jenkinson MD, Barone DG, Bryant A, Vale L, Bulbeck H, Lawrie TA, Hart MG, Watts C. Intraoperative imaging technology to maximise extent of resection for glioma. Cochrane Database Syst Rev 2018; 1:CD012788. [PMID: 29355914 PMCID: PMC6491323 DOI: 10.1002/14651858.cd012788.pub2] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Extent of resection is considered to be a prognostic factor in neuro-oncology. Intraoperative imaging technologies are designed to help achieve this goal. It is not clear whether any of these sometimes very expensive tools (or their combination) should be recommended as standard care for people with brain tumours. We set out to determine if intraoperative imaging technology offers any advantage in terms of extent of resection over standard surgery and if any one technology was more effective than another. OBJECTIVES To establish the overall effectiveness and safety of intraoperative imaging technology in resection of glioma. To supplement this review of effects, we also wished to identify cost analyses and economic evaluations as part of a Brief Economic Commentary (BEC). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 7, 2017), MEDLINE (1946 to June, week 4, 2017), and Embase (1980 to 2017, week 27). We searched the reference lists of all identified studies. We handsearched two journals, the Journal of Neuro-Oncology and Neuro-oncology, from 1991 to 2017, including all conference abstracts. We contacted neuro-oncologists, trial authors, and manufacturers regarding ongoing and unpublished trials. SELECTION CRITERIA Randomised controlled trials evaluating people of all ages with presumed new or recurrent glial tumours (of any location or histology) from clinical examination and imaging (computed tomography (CT) or magnetic resonance imaging (MRI), or both). Additional imaging modalities (e.g. positron emission tomography, magnetic resonance spectroscopy) were not mandatory. Interventions included intraoperative MRI (iMRI), fluorescence-guided surgery, ultrasound, and neuronavigation (with or without additional image processing, e.g. tractography). DATA COLLECTION AND ANALYSIS Two review authors independently assessed the search results for relevance, undertook critical appraisal according to known guidelines, and extracted data using a prespecified pro forma. MAIN RESULTS We identified four randomised controlled trials, using different intraoperative imaging technologies: iMRI (2 trials including 58 and 14 participants, respectively); fluorescence-guided surgery with 5-aminolevulinic acid (5-ALA) (1 trial, 322 participants); and neuronavigation (1 trial, 45 participants). We identified one ongoing trial assessing iMRI with a planned sample size of 304 participants for which results are expected to be published around autumn 2018. We identified no trials for ultrasound.Meta-analysis was not appropriate due to differences in the tumours included (eloquent versus non-eloquent locations) and variations in the image guidance tools used in the control arms (usually selective utilisation of neuronavigation). There were significant concerns regarding risk of bias in all the included studies. All studies included people with high-grade glioma only.Extent of resection was increased in one trial of iMRI (risk ratio (RR) of incomplete resection 0.13, 95% confidence interval (CI) 0.02 to 0.96; 1 study, 49 participants; very low-quality evidence) and in the trial of 5-ALA (RR of incomplete resection 0.55, 95% CI 0.42 to 0.71; 1 study, 270 participants; low-quality evidence). The other trial assessing iMRI was stopped early after an unplanned interim analysis including 14 participants, therefore the trial provides very low-quality evidence. The trial of neuronavigation provided insufficient data to evaluate the effects on extent of resection.Reporting of adverse events was incomplete and suggestive of significant reporting bias (very low-quality evidence). Overall, reported events were low in most trials. There was no clear evidence of improvement in overall survival with 5-ALA (hazard ratio 0.83, 95% CI 0.62 to 1.07; 1 study, 270 participants; low-quality evidence). Progression-free survival data were not available in an appropriate format for analysis. Data for quality of life were only available for one study and suffered from significant attrition bias (very low-quality evidence). AUTHORS' CONCLUSIONS Intra-operative imaging technologies, specifically iMRI and 5-ALA, may be of benefit in maximising extent of resection in participants with high grade glioma. However, this is based on low to very low quality evidence, and is therefore very uncertain. The short- and long-term neurological effects are uncertain. Effects of image-guided surgery on overall survival, progression-free survival, and quality of life are unclear. A brief economic commentary found limited economic evidence for the equivocal use of iMRI compared with conventional surgery. In terms of costs, a non-systematic review of economic studies suggested that compared with standard surgery use of image-guided surgery has an uncertain effect on costs and that 5-aminolevulinic acid was more costly. Further research, including studies of ultrasound-guided surgery, is needed.
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Affiliation(s)
- Michael D Jenkinson
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Lower Lane, Liverpool, Merseyside, UK, L9 7LJ
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Kearney A, Williamson P, Young B, Bagley H, Gamble C, Denegri S, Muir D, Simon NA, Thomas S, Elliot JT, Bulbeck H, Crocker JC, Planner C, Vale C, Clarke M, Sprosen T, Woolfall K. Priorities for methodological research on patient and public involvement in clinical trials: A modified Delphi process. Health Expect 2017; 20:1401-1410. [PMID: 28618076 PMCID: PMC5689224 DOI: 10.1111/hex.12583] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [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] [Accepted: 05/09/2017] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Despite increasing international interest, there is a lack of evidence about the most efficient, effective and acceptable ways to implement patient and public involvement (PPI) in clinical trials. OBJECTIVE To identify the priorities of UK PPI stakeholders for methodological research to help resolve uncertainties about PPI in clinical trials. DESIGN A modified Delphi process including a two round online survey and a stakeholder consensus meeting. PARTICIPANTS In total, 237 people registered of whom 219 (92%) completed the first round. One hundred and eighty-seven of 219 (85%) completed the second; 25 stakeholders attended the consensus meeting. RESULTS Round 1 of the survey comprised 36 topics; 42 topics were considered in round 2 and at the consensus meeting. Approximately 96% of meeting participants rated the top three topics as equally important. These were as follows: developing strong and productive working relationships between researchers and PPI contributors; exploring PPI practices in selecting trial outcomes of importance to patients; and a systematic review of PPI activity to improve the accessibility and usefulness of trial information (eg participant information sheets) for participants. CONCLUSIONS The prioritized methodological research topics indicate important areas of uncertainty about PPI in trials. Addressing these uncertainties will be critical to enhancing PPI. Our findings should be used in the planning and funding of PPI in clinical trials to help focus research efforts and minimize waste.
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Affiliation(s)
- Anna Kearney
- Clinical Trials Research Centre (CTRC)North West Hub for Trials MethodologyUniversity of LiverpoolLiverpoolUK
| | - Paula Williamson
- Clinical Trials Research Centre (CTRC)North West Hub for Trials MethodologyUniversity of LiverpoolLiverpoolUK
| | - Bridget Young
- Department of Psychological SciencesNorth West Hub for Trials MethodologyUniversity of LiverpoolLiverpoolUK
| | - Heather Bagley
- Clinical Trials Research Centre (CTRC)North West Hub for Trials MethodologyUniversity of LiverpoolLiverpoolUK
| | - Carrol Gamble
- Clinical Trials Research Centre (CTRC)North West Hub for Trials MethodologyUniversity of LiverpoolLiverpoolUK
| | - Simon Denegri
- School of Life and Medical SciencesUniversity College LondonLondonUK
| | - Delia Muir
- Leeds Institute of Clinical Trials Research (LICTR)University of LeedsLeedsUK
| | - Natalie A. Simon
- Public Involvement and EngagementHealth Care Research WalesCardiffUK
| | | | | | | | - Joanna C. Crocker
- Nuffield Department of Primary Care Health SciencesHealth Experiences InstituteUniversity of OxfordOxfordUK
| | - Claire Planner
- Centre for Primary CareUniversity of ManchesterManchesterUK
| | - Claire Vale
- MRC Clinical Trials UnitUniversity College LondonLondonUK
| | - Mike Clarke
- Centre for Public HealthQueen's University of BelfastBelfastUK
| | - Tim Sprosen
- Nuffield Department of Population HealthOxford UniversityOxfordUK
| | - Kerry Woolfall
- Department of Psychological SciencesNorth West Hub for Trials MethodologyUniversity of LiverpoolLiverpoolUK
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Majewska P, Ioannidis S, Raza MH, Tanna N, Bulbeck H, Williams M. Postprogression survival in patients with glioblastoma treated with concurrent chemoradiotherapy: a routine care cohort study. CNS Oncol 2017; 6:307-313. [PMID: 28990795 DOI: 10.2217/cns-2017-0001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 01/10/2023] Open
Abstract
Glioblastoma is the commonest malignant brain tumor in adults. Most patients develop progressive disease before they die. However, survival after developing progressive disease is infrequently reported. We identified patients with histologically proven disease who were treated with concurrent chemoradiotherapy during 2006-2013. We analyzed overall survival (OS), progression-free survival and postprogression survival (PPS) in relation to age, O6-methylguanine-DNA methyltransferase promoter methylation and extent of surgical resection. We identified 166 patients. Median survival was 13.5 months; 2-year OS was 21.7%. Median progression-free survival and PPS were 7.03 and 4.53 months, respectively. Age and extent of surgical resection were correlated with OS. Only the extent of surgical resection was associated with PPS. Our work suggests that the established prognostic factors for glioblastoma do not appear to help predict PPS.
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Affiliation(s)
- Paulina Majewska
- School of Medicine, Imperial College London, Exhibition Road, London, SW7 2AZ, UK
| | - Stefanos Ioannidis
- School of Medicine, Imperial College London, Exhibition Road, London, SW7 2AZ, UK
| | - Muhammad Hasan Raza
- Oncology Department, Charing Cross Hospital, Fulham Palace Rd, London, W6 8RF, UK
| | - Nikhil Tanna
- Oncology Department, Charing Cross Hospital, Fulham Palace Rd, London, W6 8RF, UK
| | - Helen Bulbeck
- Brainstrust, 4 Yvery Court, Castle Road, Cowes, Isle of Wight, PO31 7QG, UK
| | - Mathew Williams
- Oncology Department, Charing Cross Hospital, Fulham Palace Rd, London, W6 8RF, UK
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Kurian KM, Jenkinson MD, Brennan PM, Grant R, Jefferies S, Rooney AG, Bulbeck H, Erridge SC, Mills S, McBain C, McCabe MG, Price SJ, Marino S, Moyes E, Qian W, Waldman A, Vaqas B, Keatley D, Burchill P, Watts C. Brain tumor research in the United Kingdom: current perspective and future challenges. A strategy document from the NCRI Brain Tumor CSG. Neurooncol Pract 2017; 5:10-17. [PMID: 31385960 DOI: 10.1093/nop/npx022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The National Cancer Research Institute (NCRI) is a partnership of charity and government research funders whose purpose is to improve health and quality of life by accelerating progress in cancer-related research through collaboration. Under this umbrella, the NCRI Brain Tumor Clinical Studies Group is focused on improving clinical outcomes for adult patients with brain and central nervous system tumors, including those with brain metastasis from other primary sites. This document discusses the current state of clinical brain tumor research in the United Kingdom and the challenges to increasing study and trial opportunities for patients. The clinical research priorities are defined along with a strategy to strengthen the existing brain tumor research network, improve access to tissue and imaging and to develop the future leadership for brain tumor research in the United Kingdom. This strategy document may serve as a framework for other organizations and countries.
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Affiliation(s)
- Kathreena M Kurian
- Institute of Clinical Neurosciences, University of Bristol, Learning and Research Building, Southmead Hospital, Bristol
| | - Michael D Jenkinson
- Institute of Translational Medicine, University of Liverpool.,Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Paul M Brennan
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh
| | - Robin Grant
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh
| | - Sarah Jefferies
- Department of Oncology, Cambridge University Hospitals, Foundation Trust, Cambridge, CB2, UK
| | - Alasdair G Rooney
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh
| | | | - Sara C Erridge
- Edinburgh Centre for Neuro-Oncology, Edinburgh Cancer Centre, Western General Hospital, Edinburgh
| | - Samantha Mills
- Blizard Institute, Barts and The London Medical School, Queen Mary University of London, London, UK
| | - Catherine McBain
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Martin G McCabe
- Department of Clinical Oncology, The Christie NHS Foundation Trust Hospital, Manchester, UK
| | - Stephen J Price
- Department of Clinical Neurosciences, Division of Neurosurgery, University of Cambridge, UK
| | - Silvia Marino
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool and Informatics, Imaging and Data Sciences, University of Manchester
| | | | - Wendy Qian
- Cambridge Cancer Trials Centre
- Cambridge Clinical Trials Unit-Cancer Theme, Cambridge University Hospitals NHS Foundation Trust
| | - Adam Waldman
- Imaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Babar Vaqas
- Department of Surgery, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London
| | | | | | - Colin Watts
- Department of Clinical Neurosciences, Division of Neurosurgery, University of Cambridge, UK
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Jenkinson MD, Javadpour M, Haylock BJ, Young B, Bulbeck H, Farrell M, Preusser M, Hughes D, Gamble C, Weber D. P12.10 The ROAM / EORTC 1308 trial: Radiation versus observation following surgical resection of atypical meningioma - study update. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox036.368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Affiliation(s)
- Florien W Boele
- University of Leeds and Leeds Cancer Centre; Leeds Institute of Health Sciences and Leeds Institute of Cancer and Pathology; POG, Level 3, Bexley Wing St James's Institute of Oncology Leeds UK LS9 7TF
| | - Helen Bulbeck
- brainstrust; Director of Services; 4 Yvery Court Castle Road Cowes Isle of Wight UK PO31 7QG
| | - Catherine Browne
- Institute of Technology; Health and Social Sciences; North Campus Dromtracker, Tralee County Kerry Ireland
| | - Alasdair G Rooney
- Edinburgh Centre for Neuro-Oncology (ECNO); Department of Psychological Medicine; Western General Hospital Crewe Road South Edinburgh Scotland UK EH4 2XU
| | - Paula Sherwood
- University of Pittsburgh; Department of Acute and Tertiary Care; 336 Victoria Building 3500 Victoria Street Pittsburgh USA 15261
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