Now showing items 1-20 of 6693

    • Current status of immune checkpoint inhibition in early stage NSCLC

      Vansteenkiste, J; Wauters, E; Reymen, B; Ackermann, Christoph J; Peters, S; De Ruysscher, D; Respiratory Oncology Unit, University Hospital KU Leuven, Leuven; Belgium (2019)
      Immune checkpoint inhibition (ICI) immunotherapy has revolutionized the approach to metastatic non-small cell lung cancer (NSCLC). In particular, antibodies blocking the inhibitory immune checkpoints programmed death 1 (PD-1) and its ligand (PD-L1) are associated with higher response rates, improved overall survival and better tolerability as compared to conventional cytotoxic chemotherapy. Recently, ICI has moved from the second-line to the first-line setting for many patients with non-oncogene addicted NSCLC, either alone or in combination with chemotherapy. The next logical step is to examine this therapy in patients with non-metastatic NSCLC to improve long-term overall survival and cure rates. For patients with unresectable stage III NSCLC, ICI with durvalumab after concurrent chemoradiotherapy has brought a major improvement in 2-year progression-free and overall survival, which holds promise for an improved cure rate. As the relapse pattern in patients with completely resected early stage NSCLC is predominantly systemic, high expectations rest on the integration of ICI therapy in their treatment approach. A large number of studies with adjuvant or neo-adjuvant ICI are ongoing, and will be discussed here. The advent of stereotactic ablative radiotherapy (SABR) has brought a valid alternative treatment for patients unfit for or not willing to undergo surgery. Data on combining systemic therapy and SABR is virtually non-existent, but there is a strong biological rationale to combine radiotherapy and ICI therapy. Early findings in small feasibility studies are promising and now need to be explored in well-designed phase III trials.
    • Treatment-related toxicity using prostate-only versus prostate and pelvic lymph node intensity-modulated radiation therapy: a national population-based study

      Parry, MG; Sujenthiran, A; Cowling, TE; Nossiter, J; Cathcart, P; Clarke, Noel W; Payne, H; van der Meulen, J; Aggarwal, A; London School of Hygiene and Tropical Medicine, London, United Kingdom (2019)
      PURPOSE: There is a debate about the effectiveness and toxicity of pelvic lymph node (PLN) irradiation for the treatment of men with high-risk prostate cancer. This study compared the toxicity of intensity-modulated radiation therapy (IMRT) to the prostate and the pelvic lymph nodes (PPLN-IMRT) with prostate-only IMRT (PO-IMRT). MATERIALS AND METHODS: Patients with high-risk localized or locally advanced prostate cancer treated with IMRT in the English National Health Service between 2010 and 2013 were identified by using data from the Cancer Registry, the National Radiotherapy Dataset, and Hospital Episode Statistics, an administrative database of all hospital admissions. Follow-up was available up to December 31, 2015. Validated indicators were used to identify patients with severe toxicity according to the presence of both a procedure code and diagnostic code in patient Hospital Episode Statistics records. A competing risks regression analysis, with adjustment for patient and tumor characteristics, estimated subdistribution hazard ratios (sHRs) by comparing GI and genitourinary (GU) complications for PPLN-IMRT versus PO-IMRT. RESULTS: Three-year cumulative incidence in the PPLN-IMRT (n = 780) and PO-IMRT (n = 3,065) groups was 14% for both groups for GI toxicity, and 9% and 8% for GU toxicity, respectively. Patients receiving PPLN-IMRT and PO-IMRT had similar levels of severe GI (adjusted sHR, 1.00; 95% CI, 0.80 to 1.24; P = .97) and GU (adjusted sHR, 1.10; 95% CI, 0.83 to 1.46; P = .50) toxicity rates. CONCLUSION: Including PLNs in radiation fields for high-risk or locally advanced prostate cancer is not associated with increased GI or GU toxicity at 3 years. Additional follow-up is required to answer questions about its impact on late GU toxicity. Results from ongoing trials will provide insight into the anticancer effectiveness of PLN irradiation.
    • Shared decision-making for patients with advanced urological malignancies: evaluation of a joint urological-oncological clinic model

      Betschart, P; Babst, C; Schmid, S; Rothermundt, C; Abt, D; Schwab, C; Gillessen, Silke; Engeler, DS; Klingbiel, D; Schmid, HP; Omlin, A; Department of Urology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (2019)
      BACKGROUND: To provide rapid evaluation of patients with advanced urological malignancies, a joint urological-oncological clinic was initiated at our institution in January 2015. We present the first 3-year evaluation of this joint urological-oncological clinic in Switzerland. METHOD: We performed a retrospective analysis of the characteristics and treatment of all patients reviewed at the joint clinic between January 2015 and December 2017. Statistical analysis was performed by survival analysis. A patient satisfaction questionnaire was handed out to new patients (from April to September 2017). RESULTS: A total of 135 new patients were counseled in the joint clinic and 563 consultations were performed in the period from January 2015 to December 2017. The majority were men with prostate cancer (85%), followed by bladder cancer (9%), and renal cell carcinoma (4%). Men with newly diagnosed metastatic prostate cancer (n = 69) received ADT alone (57%), ADT with docetaxel or abiraterone (33%), and metastasis-directed therapy (10%). High rates of patient satisfaction were reported based on the questionnaire. CONCLUSIONS: The joint clinic model has been successfully implemented at our institution and continues on a weekly basis. The clinic is increasingly used, not only for newly diagnosed metastatic prostate cancer, but also for other complex uro-oncological cases. The clinic allows optimized oncological treatment without delay and with a reduced effort for patients.
    • Efficacy and safety of a bortezomib and reduced-intensity cytarabine-based protocol, TMC ALLR1, for relapsed childhood ALL in India

      Roy, P; Islam, R; Saha, D; Gogoi, M; Kumar, MD; Arora, N; Parihar, M; Krishnan, Shekhar; Saha, Vaskar; Department of Paediatric Haematology Oncology, Tata Translational Cancer Research Centre, Tata Medical Centre, Kolkata, India (2019)
      The feasibility of bortezomib (BZB) in induction and reduced cytarabine doses in intensification was evaluated in children with relapsed acute lymphoblastic leukaemia (rALL) at a single centre in India. Of 55 children with rALL, 23 received supportive care and 7 refused treatment, with a median survival of 2 (interquartile range 1-6) months. Twenty-two (88%) of 25 children who were treated achieved second remission and 9 (69%) of 13 had end-of-induction minimal residual disease of <10-4 . The lower cytarabine dose was associated with decreased hospitalisation. One-year event-free and overall survival for the treated group was 74á7% (95% confidence interval 52-88) and 79á6% (58-91) respectively.
    • Cosmetic assessment in brachytherapy (interventional radiotherapy) for breast cancer: a multidisciplinary review

      Tagliaferri, L; Lancellotta, V; Zinicola, T; Gentileschi, S; Sollena, P; Garganese, G; Guinot, J; Rembielak, Agata; Soror, T; Autorino, R; Cammelli, S; Gambacorta, M; Aristei, C; Valentini, V; Kovacs, G; Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia (2019)
      PURPOSE: This review was to focus on breast brachytherapy cosmetic assessment methods state of the art and to define the advantages and disadvantages related to. METHODS AND MATERIALS: We conducted a literature review of the major experience on breast brachytherapy cosmetic assessment methods in several databases (PubMed, Scopus, and Google Scholar databases). To identify the relevant works, a task force screened citations at title and abstract level to identify potentially relevant paper. An expert board reviewed and approved the text. The assessment systems were classified into three main groups: (1) the Oncological Toxicity Scales, (2) the Independent Patients Perspective Measures, (3) the Patient-Related Outcome Measures. Each cosmetic assessment method was evaluated following six parameters: (1) anatomical site, (2) advantages, (3) disadvantages, (4) subjective/objective, (5) quantitative/qualitative, (6) computers or pictures needs. RESULTS: Eleven assessment methods were selected. Three methods were classified as Oncological Toxicity Scale, six in the Independent Patients Perspective Measures classification, and two as Patient-Related Outcome Measures. Six methods are subjective, while eight are objective. Four systems are classified as quantitative, four as qualitative while three both. Five systems need informatics support. Moreover, each method was discussed individually reporting the main characteristics and peculiarities. CONCLUSIONS: Cosmesis is one major end point for the patient who has a malignancy of low lethal potential. In modern personalized medicine, there is a need for standardized cosmetic outcome assessments to analyze and compare the results of treatments. No gold standard methods currently exist. The result of this review is to summarize the various cosmesis methods, defining the strengths and weaknesses of each one and giving a line in research and clinical practice.
    • Development and validation of a combined hypoxia and immune prognostic classifier for head and neck cancer

      Brooks, J; Menezes, A; Ibrahim, M; Archer, L; Lal, N; Bagnall, C; von Zeidler, S; Valentine, H; Spruce, R; Batis, N; Bryant, J; Hartley, M; Kaul, B; Ryan, G; Bao, R; Khattri, A; Lee, S; Ogbureke, K; Middleton, G; Tennant, D; Beggs, A; Deeks, J; West, Catharine M; Cazier, J; Willcox, B; Seiwert, T; Mehanna, H; Institute of Head and Neck Studies and Education, University of Birmingham (2019)
      Purpose: Intratumoral hypoxia and immunity have been correlated with patient outcome in various tumor settings. However, these factors are not currently considered for treatment selection in head and neck cancer (HNC) due to lack of validated biomarkers. Here we sought to develop a hypoxia-immune classifier with potential application in patient prognostication and prediction of response to targeted therapy.Experimental Design: A 54-gene hypoxia-immune signature was constructed on the basis of literature review. Gene expression was analyzed in silico using the The Cancer Genome Atlas (TCGA) HNC dataset (n = 275) and validated using two independent cohorts (n = 130 and 123). IHC was used to investigate the utility of a simplified protein signature. The spatial distribution of hypoxia and immune markers was examined using multiplex immunofluorescence staining.Results: Unsupervised hierarchical clustering of TCGA dataset (development cohort) identified three patient subgroups with distinct hypoxia-immune phenotypes and survival profiles: hypoxialow/immunehigh, hypoxiahigh/immunelow, and mixed, with 5-year overall survival (OS) rates of 71%, 51%, and 49%, respectively (P = 0.0015). The prognostic relevance of the hypoxia-immune gene signature was replicated in two independent validation cohorts. Only PD-L1 and intratumoral CD3 protein expression were associated with improved OS on multivariate analysis. Hypoxialow/immunehigh and hypoxiahigh/immunelow tumors were overrepresented in "inflamed" and "immune-desert" microenvironmental profiles, respectively. Multiplex staining demonstrated an inverse correlation between CA-IX expression and prevalence of intratumoral CD3+ T cells (r = -0.5464; P = 0.0377), further corroborating the transcription-based classification.Conclusions: We developed and validated a hypoxia-immune prognostic transcriptional classifier, which may have clinical application to guide the use of hypoxia modification and targeted immunotherapies for the treatment of HNC.
    • Success rate of resuscitation after out-of-hospital cardiac arrest

      Ho, A; Mizubuti, G; Ho, Adrienne K; Wan, S; Sydor, D; Chung, D; Department of Anesthesiology and Perioperative Medicine, Queen's University, Canada (2019)
    • Data set for the reporting of carcinoma of the renal pelvis and ureter-nephroureterectomy and ureterectomy specimens: recommendations from the International Collaboration on Cancer Reporting (ICCR)

      Samaratunga, H; Judge, M; Delahunt, B; Srigley, J; Brimo, F; Comperat, E; Koch, M; Lopez-Beltran, A; Reuter, V; Shanks, Jonathan H; Tsuzuki, T; van der Kwast, T; Varma, M; Grignon, D; Aquesta UropathologyUniversity of Queensland School of Medicine, Brisbane (2019)
      Cancer reporting guidelines have been developed and utilized in many countries throughout the world. The International Collaboration on Cancer Reporting (ICCR), through an alliance of colleges and other pathology organizations in Australasia, United Kingdom, Ireland, Europe, USA, and Canada, has developed comprehensive standardized data sets to provide for global usage and promote uniformity in cancer reporting. Structured reporting facilitates provision of all necessary information, which ensures accurate and comprehensive data collection, with the ultimate aim of improving cancer diagnostics and treatment. The data set for primary carcinoma of the renal pelvis and ureter treated with nephroureterectomy or ureterectomy had input from an expert panel of international uropathologists. This data set was based on current evidence-based practice and incorporated information from the 2016 fourth edition of the World Health Organization (WHO) Bluebook on tumors of the urinary and male genital systems and the 2017 American Joint Committee on Cancer (AJCC) TNM staging eighth edition. This protocol applies to both noninvasive and invasive carcinomas in these locations. Reporting elements are considered to be essential (required) or nonessential (recommended). Required elements include operative procedure, specimens submitted, tumor location, focality and size, histologic tumor type, subtype/variant of urothelial carcinoma, WHO grade, extent of invasion, presence or absence of vascular invasion, status of the resection margins and lymph nodes and pathologic stage. The data set provides a detailed template for the collection of data and it is anticipated that this will facilitate appropriate patient management with the potential to foster collaborative research internationally.
    • A reply to Hurley et al. regarding Recipients receiving better HLA-matched hematopoietic cell transplantation grafts, uncovered by a novel HLA typing method, have superior survival: a retrospective study

      Mayor, N; Hayhurst, J; Turner, T; Szydlo, R; Shaw, B; Bultitude, W; Sayno, J; Tavarozzi, F; Latham, K; Anthias, C; Robinson, J; Braund, H; Danby, R; Perry, J; Wilson, MC; Bloor, Adrian; McQuaker, I; MacKinnon, S; Marks, D; Pagliuca, A; Potter, M; Potter, V; Russell, N; Thomson, K; Madrigal, J; Marsh, S; Anthony Nolan Research Institute, Royal Free Hospital London, UK (2019)
    • Real-world effectiveness and safety of pazopanib in patients with intermediate prognostic risk advanced renal cell carcinoma

      Procopio, G; Bamias, A; Schmidinger, M; Hawkins, Robert E; Sanchez, A; Estevez, S; Srihari, N; Kalofonos, H; Bono, P; Pisal, C; Hirschberg, Y; Dezzani, L; Ahmad, Q; Rodriguez, C; Jonasch, E; Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy (2019)
      INTRODUCTION: The objective of this study was to determine the effectiveness and safety of pazopanib in patients with intermediate-risk advanced/metastatic renal cell carcinoma in the PRINCIPAL study (NCT01649778). PATIENTS AND METHODS: Patients had clear-cell advanced/metastatic renal cell carcinoma and met intermediate-risk International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) and Memorial Sloan Kettering Cancer Center (MSKCC) criteria. Assessments included progression-free survival, overall survival, objective response rate, and safety. We also evaluated effectiveness based on number of risk factors, age, and performance status (PS), as well as safety in older and younger patients. RESULTS: Three hundred sixty three and 343 intermediate-risk MSKCC and IMDC patients were included, respectively. The median progression-free survival was 13.8 months (95% confidence interval [CI], 10.7-18.1 months) and 7.4 months (95% CI, 6.2-10.3 months) for patients with 1 and 2 MSKCC risk factors, respectively, and 13.1 months (95% CI, 10.7-18.1 months) and 8.1 months (95% CI, 6.4-10.7 months) for patients with 1 and 2 IMDC risk factors, respectively. The median overall survival was not reached and was 15.2 months (95% CI, 12.3-26.5 months) for patients with 1 and 2 MSKCC risk factors, respectively, and 33.9 months (95% CI, 33.9 months to not estimable) and 19.4 months (95% CI, 14.3 months to not estimable) with 1 and 2 IMDC risk factors, respectively. A lower overall response rate was observed with Eastern Cooperative Oncology Group PS ³ 2 (vs. PS < 2). All-grade treatment-related adverse events occurred in approximately 63% of patients, and the safety profile among older and younger patients was similar. CONCLUSIONS: Outcomes with pazopanib in intermediate-risk patients suggest that patients can be further stratified by number of risk factors (1 vs. 2) and Eastern Cooperative Oncology Group PS (< 2 vs. ³ 2) to more accurately predict outcomes.
    • Challenge of the unknown: how can we improve clinical outcomes in cancer of unknown primary?

      Conway, Alicia-Marie; Mitchell, Claire L; Cook, Natalie; The Christie NHS Foundation Trust, Manchester, United Kingdom (2019)
    • Prognostic and predictive value of AJCC-8 staging in the phase III EORTC1325/KEYNOTE-054 trial of pembrolizumab vs placebo in resected high-risk stage III melanoma

      Eggermont, A; Blank, C; Mandala, M; Long, G; Atkinson, V; Dalle, S; Haydon, A; Lichinitser, M; Khattak, A; Carlino, M; Sandhu, S; Larkin, J; Puig, S; Ascierto, P; Rutkowski, P; Schadendorf, D; Koornstra, R; Hernandez-Aya, L; Di Giacomo, A; van den Eertwegh, A; Grob, J; Gutzmer, R; Jamal, R; Lorigan, Paul C; Lupinacci, R; Krepler, C; Ibrahim, N; Kicinski, M; Marreaud, S; van Akkooi, A; Suciu, S; Robert, C; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France (2019)
      BACKGROUND: The American Joint Committee on Cancer-8 (AJCC) classification of melanoma was implemented in January 2018. It was based on data gathered when checkpoint inhibitors were not used as adjuvant therapy in stage III melanoma. The European Organization for Research and Treatment of Cancer (EORTC) 1325/KEYNOTE-054 double-blind phase III trial evaluated pembrolizumab vs placebo in AJCC-7 stage IIIA (excluding lymph node metastasis ²1 mm), IIIB or IIIC (without in-transit metastasis) patients after complete lymphadenectomy. PATIENTS, METHODS AND RESULTS: Patients (n = 1019) were randomised 1:1 to pembrolizumab 200 mg or placebo every 3 weeks (total of 18 doses, ?1 year). At 1.25-year median follow-up, pembrolizumab prolonged relapse-free survival (RFS) in the total population (1-year RFS rate: 75.4% vs 61.0%; hazard ratio [HR] 0.57; logrank P < 0.0001) and consistently in the AJCC-7 subgroups. Prognostic and predictive values of AJCC-8 for RFS were evaluated in this study. Patient distribution according to the AJCC-8 stage subgroups was 8% (IIIA), 34.7% (IIIB), 49.7% (IIIC), 3.7% (IIID) and 3.8% (unknown). AJCC-8 classification was strongly associated with RFS (HRs for stage IIIB, IIIC and IIID vs IIIA were 4.0, 5.7 and 12.2, respectively) but showed no predictive importance for the treatment comparison regarding RFS (test for interaction: P = 0.68). The 1-year RFS rate for pembrolizumab vs placebo and the HRs (99% confidence interval) within each AJCC-8 subgroup were as follows: stage IIIA (92.7% vs 92.5%; 0.76 [0.11-5.43]), IIIB (79.0% vs 65.5%; 0.59 [0.35-0.99]), IIIC (73.6% vs 53.9%; 0.48 [0.33-0.70]) and IIID (50.0% vs 33.3%; 0.69 [0.24-2.00]). CONCLUSIONS: AJCC-8 staging had a strong prognostic importance for RFS but no predictive importance: the RFS benefit of pembrolizumab was observed across AJCC-8 subgroups in resected high-risk stage III melanoma patients.
    • Sensitivity to change of the EORTC quality of life module measuring cancer related fatigue (EORTC QlQ-Fa12): results from the international psychometric validation

      Weis, J; Wirtz, M; Tomaszewski, K; Hammerlid, E; Arraras, J; Conroy, T; Lanceley, A; Schmidt, H; Singer, S; Pinto, M; Alm El-Din, M; Compter, I; Holzner, B; Hofmeister, D; Chie, W; Harle, Amelie S; Flechtner, H; Bottomley, A; University Clinic Center Freiburg, Comprehensive Cancer Center, Germany (2019)
      OBJECTIVE: The European Organisation for Research and Treatment of Cancer Quality of Life Group (EORTC QLG) has developed a multidimensional instrument measuring cancer-related fatigue, the EORTC QLQ-FA12. The analysis of sensitivity to change is an essential part of psychometric validation. With this study, we investigated the EORTC QLQ-FA12's sensitivity to change. METHODS: The methodology follows the EORTC guidelines of EORTC QLG for phase IV validation of modules. We included cancer patients undergoing curative and palliative treatment at t1 and followed them up prospectively over the course of their treatment (t2) and 4 weeks after completion of treatment (t3). Data were collected prospectively at 17 sites in 11 countries. Sensitivity to change was investigated using analysis of variance. RESULTS: A total sample of 533 patients was enrolled with various tumour types, different stages of cancer, and receiving either curative treatment (n=311) or palliative treatment (n=222). Over time all fatigue scores were significantly higher in the palliative treatment group compared with the curative group (p < .001). Physical fatigue increased with medium effect size over the course of treatment in the curative group (standardized response mean [SRM] (t1,t2) = 0.44]. After treatment physical [SRM (t2,t3) = 0.39], emotional [SRM (t2,t3)= 0.28] and cognitive fatigue (SRM [t2,t3] = 0.22) declined significantly in the curative group. In the palliative group, emotional (SRM [t2,t3] = 0.18) as well as cognitive [SRM [t2,t3] = 0.26) fatigue increases significantly. CONCLUSIONS: The EORTC-QLQ-FA12 proved to identify clinically significant changes in fatigue in the course of curative and palliative cancer treatment.
    • Anti-PD1 treatment of advanced melanoma: development of criteria for a safe stop

      Lorigan, Paul C; Eggermont, A; Division of Cancer Sciences, University of Manchester and Christie NHS Foundation Trust, Manchester, UK (2019)
    • Efficacy of PD-1-based immunotherapy after radiologic progression on targeted therapy in stage IV melanoma

      Kreft, S; Gesierich, A; Eigentler, T; Franklin, C; Valpione, Sara; Ugurel, S; Utikal, J; Haferkamp, S; Blank, C; Larkin, J; Garbe, C; Schadendorf, D; Lorigan, Paul C; Schilling, B; Department of Dermatology, Venereology and Allergology, University Hospital Wurzburg, Wurzburg, Germany (2019)
      OBJECTIVES: Targeted therapy (TT) is an effective treatment for advanced BRAFV600-mutated melanoma, but most patients eventually acquire resistance and progress. Here, we evaluated the outcome of second-line immune checkpoint blockade (ICB) after progression on dual BRAF and MEK inhibition. METHODS: Patients with metastatic melanoma progressing on combined BRAF + MEK inhibition and receiving second-line ICB between 2015 and 2019 in 9 tertiary referral centres were enrolled. Demographic and clinical data and blood counts of all patients were collected retrospectively. RESULTS: We identified 99 patients with stage IV melanoma receiving ICB (nivolumab, pembrolizumab [n = 39] or ipilimumab plus nivolumab [n = 60]) after progression on combined TT. The median progression-free survival was similar in the PD-1 and ipilimumab plus nivolumab group (2.6 months [95% confidence interval {CI}, 2.0-3.1] vs. 2.0 [95% CI, 1.4-2.6], p = 0.15). The objective response rate was 18.0% in the PD-1 and 15.0% in the ipilimumab plus nivolumab group (p = 0.70). The disease control rate was 25.7% for monotherapy and 18.3% for combined ICB (p = 0.39). The median overall survival was 8.4 months (95% CI, 5.1-11.7) for patients receiving PD-1 monotherapy and 7.2 months (95% CI, 5.2-9.1) for patients receiving ipilimumab plus nivolumab (p = 0.86). The latter was associated with a higher rate of treatment-related adverse events (AEs). No significant association of laboratory values or clinicopathological characteristics with response to second-line ICB was observed. CONCLUSIONS: PD-1 monotherapy and combined ipilimumab plus nivolumab show similar activity and outcome in patients with melanoma resistant to BRAF + MEK inhibition. However, combined ipilimumab plus nivolumab was associated with a higher rate of treatment-related AEs compared with monotherapy.
    • Early detection of HPV-associated oropharyngeal cancer - Authors' reply

      Graham, Donna; Prue, G; Baker, P; Nutting, C; Greenhouse, P; Lawler, M; Christie NHS Foundation Trust, Manchester, UK (2019)
    • Organ preservation in bladder cancer: an opportunity for truly personalized treatment

      Song, Yee Pei; McWilliam, Alan; Hoskin, Peter J; Choudhury, Ananya; Manchester Cancer Research Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK (2019)
      Radical treatment of many solid tumours has moved from surgery to multimodal organ preservation strategies combining systemic and local treatments. Trimodality bladder-preserving treatment (TMT) comprises maximal transurethral resection of the bladder tumour followed by radiotherapy and concurrent radiosensitizing treatment, thereby sparing the urinary bladder. From the patient's perspective, the choice of maintaining quality of life without a negative effect on the chances of cure and long-term survival is attractive. In muscle-invasive bladder cancer (MIBC), the evidence shows comparable clinical outcomes between patients undergoing radical cystectomy and TMT. Despite this evidence, many patients continue to be offered radical surgery as the standard-of-care treatment. Improvements in radiotherapy techniques with adaptive radiotherapy and advances in imaging translate to increases in the accuracy of treatment delivery and reductions in long-term toxicities. With the advent of novel biomarkers promising improved prediction of treatment response, stratification of patients for different treatments on the basis of tumour biology could soon be a reality. The future of oncological treatment lies in personalized medicine with the combination of technological and biological advances leading to truly bespoke management for patients with MIBC.
    • Communicative constructions of person-centred and non-person-centred caring in nurse-led consultations

      Siouta, E; Farrell, Carole; Chan, E; Walshe, C; Molassiotis, A; Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden (2019)
      PURPOSE: Nursing is theorised to be a component of person-centred care. Communicative constructions of person-centred caring are a topic that needs to be studied in consultations. The study aimed to explore how person-centred caring and non-person- centred caring are verbally constructed in consultations between patients and nurse. METHOD: This study was qualitative using audio-recorded observations from consultations with advanced nurse practitioners in nurse-led chemotherapy clinics from four hospitals in the UK through purposive sampling. Discourse analysis was used to identify communicative patterns in 45 non-participant observations of nurse consultations. RESULTS: The dominant discourse was a non-person-centred oriented discourse framed by the biomedical model. It was also possible to identify fragments of an alternative discourse-a person-oriented discourse localising health problems within the patient's personal and sociocultural context. CONCLUSIONS: The prominent use of a non-person-oriented discourse focusing on the medical/technical aspects of a patient's assessment/evaluation in consultations may make it difficult for patients to raise questions and concerns from their daily lives during consultations. However, fragments of a person-oriented discourse show that it is possible for nurses to allow a person-centred approach to the consultation. The pedagogical implications have to do with raising nurses' awareness of the role of evaluative language in enhancing person-centred communication with patients in clinical interactions.
    • Time to change the limited-stage paradigm for small cell lung cancer? - In reply

      Salem, Ahmed; Faivre-Finn, Corinne; Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom (2019)