Impact of comprehensive geriatric assessment on survival, function, and nutritional status in elderly patients with head and neck cancer: protocol for a multicentre randomised controlled trial (EGeSOR)

BACKGROUND: Survival is poorer in elderly patients with head and neck squamous cell carcinomas [HNSCCs] than in younger patients. Possible explanations include a contribution of co-morbidities to mortality, frequent refusal of standard therapy, and the use of suboptimal treatments due to concern about toxicities. The Comprehensive Geriatric Assessment [CGA] is a multidimensional assessment of general health that can help to customise treatment and follow-up plans. The CGA has been proven effective in several health settings but has not been evaluated in randomised studies of patients with cancer. Our aim here was to assess the impact of the CGA on overall survival, function, and nutritional status of elderly patients with HNSCC. METHODS/DESIGN: EGeSOR is an open-label, multicentre, randomised, controlled, parallel-group trial in patients aged 70 years or older and receiving standard care for HNSCC. The intervention includes four components: the CGA conducted by a geriatrician before cancer treatment, participation of the same geriatrician in cancer treatment selection, a standardised geriatric therapeutic intervention designed by the same geriatrician; and geriatric follow-up for 24 months. The primary endpoint, assessed after 6 months, is a composite criterion including death, functional impairment [Activities of Daily Living score decrease ≥2], and weight loss ≥10%. Secondary endpoints include progression-free survival, unscheduled admissions, quality of life, treatment toxicities, costs, and completion of the planned cancer treatment. A centralised online system is used to perform 1:1 randomisation with a minimisation algorithm for centre, age, T and N stages, and tumour site [oral, oropharyngeal, hypopharyngeal, or laryngeal]. The estimated sample size is 704 patients, who are being recruited by 14 centres in 9 French cities. DISCUSSION: EGeSOR is the first randomised trial of the CGA in elderly cancer patients. We expect the CGA to have direct clinical benefits on the management of elderly patients with HNSCC. If this expectation is fulfilled, the trial may lead to modifications of the management model for elderly patients with cancer. TRIAL REGISTRATION: Trial registration: NCT0202506

Ella Mills and Deliciously Ella on Instagram: The evolution of a successful entrepreneur and wellness brand

This thesis investigates from a visual social media studies perspective the increasingly popular practices of a highly active online actor, the influential plant-based food advocate and successful entrepreneur Ella Mills. Its aim is to document and analyse some ways in which popular Instagram visual narratives have contributed to the formation of plant-based eating practices, wellness discourses and lifestyle choices in the UK. The analysis proceeds in two steps. First, I use a combination of mixed methods to analyse 4,000 Instagram images from the Deliciously Ella account and their relevant captions from 17 January 2013 to 24 October 2018. The deliberate choice of a lengthy time frame involves a novel visual social media approach called “Comparative Instachronics”, which offers a new way of dealing with a single Instagram account. Second, I provide a deeper analysis of my visual sample by using several conceptual approaches such as a) authenticity, b) class, inequality and distinction, c) enrichment. Interpretation of the sample using these concepts allowed me to make an important discovery early enough in the research process: plant-based food, though integral to the nature of the Deliciously Ella business, is not the leading visual cue. On the contrary, food’s significance is mediated by other important factors, such as Mills’ personal health story and details of her family and personal life and those of people close to her. The central finding of this thesis is that the elements surrounding the visual imagery of plant-based food function as essential facilitators of the Deliciously Ella project and the brand’s evolution across time. By going beyond the visual material to analyse social media images as distinct items through lengthy periods of time, the thesis makes an original methodological contribution to visual social media studies