8 research outputs found
Ten-year mortality, disease progression, and treatment-related side effects in men with localised prostate cancer from the ProtecT randomised controlled trial according to treatment received
Background
The ProtecT trial reported intention-to-treat analysis of men with localised prostate cancer randomly allocated to active monitoring (AM), radical prostatectomy, and external beam radiotherapy.
Objective
To report outcomes according to treatment received in men in randomised and treatment choice cohorts.
Design, setting, and participants
This study focuses on secondary care. Men with clinically localised prostate cancer at one of nine UK centres were invited to participate in the treatment trial comparing AM, radical prostatectomy, and radiotherapy.
Intervention
Two cohorts included 1643 men who agreed to be randomised and 997 who declined randomisation and chose treatment.
Outcome measurements and statistical analysis
Analysis was carried out to assess mortality, metastasis and progression and health-related quality of life impacts on urinary, bowel, and sexual function using patient-reported outcome measures. Analysis was based on comparisons between groups defined by treatment received for both randomised and treatment choice cohorts in turn, with pooled estimates of intervention effect obtained using meta-analysis. Differences were estimated with adjustment for known prognostic factors using propensity scores.
Results and limitations
According to treatment received, more men receiving AM died of PCa (AM 1.85%, surgery 0.67%, radiotherapy 0.73%), whilst this difference remained consistent with chance in the randomised cohort (p = 0.08); stronger evidence was found in the exploratory analyses (randomised plus choice cohort) when AM was compared with the combined radical treatment group (p = 0.003). There was also strong evidence that metastasis (AM 5.6%, surgery 2.4%, radiotherapy 2.7%) and disease progression (AM 20.35%, surgery 5.87%, radiotherapy 6.62%) were more common in the AM group. Compared with AM, there were higher risks of sexual dysfunction (95% at 6 mo) and urinary incontinence (55% at 6 mo) after surgery, and of sexual dysfunction (88% at 6 mo) and bowel dysfunction (5% at 6 mo) after radiotherapy. The key limitations are the potential for bias when comparing groups defined by treatment received and changes in the protocol for AM during the lengthy follow-up required in trials of screen-detected PCa.
Conclusions
Analyses according to treatment received showed increased rates of disease-related events and lower rates of patient-reported harms in men managed by AM compared with men managed by radical treatment, and stronger evidence of greater PCa mortality in the AM group.
Patient summary
More than 95 out of every 100 men with low or intermediate risk localised prostate cancer do not die of prostate cancer within 10 yr, irrespective of whether treatment is by means of monitoring, surgery, or radiotherapy. Side effects on sexual and bladder function are better after active monitoring, but the risks of spreading of prostate cancer are more common
Functional and quality of life outcomes of localised prostate cancer treatments (prostate testing for cancer and treatment [ProtecT] study)
Objective
To investigate the functional and quality of life (QoL) outcomes of treatments for localised prostate cancer and inform treatment decision-making.
Patients and Methods
Men aged 50–69 years diagnosed with localised prostate cancer by prostate-specific antigen testing and biopsies at nine UK centres in the Prostate Testing for Cancer and Treatment (ProtecT) trial were randomised to, or chose one of, three treatments. Of 2565 participants, 1135 men received active monitoring (AM), 750 a radical prostatectomy (RP), 603 external-beam radiotherapy (EBRT) with concurrent androgen-deprivation therapy (ADT) and 77 low-dose-rate brachytherapy (BT, not a randomised treatment). Patient-reported outcome measures (PROMs) completed annually for 6 years were analysed by initial treatment and censored for subsequent treatments. Mixed effects models were adjusted for baseline characteristics using propensity scores.
Results
Treatment-received analyses revealed different impacts of treatments over 6 years. Men remaining on AM experienced gradual declines in sexual and urinary function with age (e.g., increases in erectile dysfunction from 35% of men at baseline to 53% at 6 years and nocturia similarly from 20% to 38%). Radical treatment impacts were immediate and continued over 6 years. After RP, 95% of men reported erectile dysfunction persisting for 85% at 6 years, and after EBRT this was reported by 69% and 74%, respectively (P < 0.001 compared with AM). After RP, 36% of men reported urinary leakage requiring at least 1 pad/day, persisting for 20% at 6 years, compared with no change in men receiving EBRT or AM (P < 0.001). Worse bowel function and bother (e.g., bloody stools 6% at 6 years and faecal incontinence 10%) was experienced by men after EBRT than after RP or AM (P < 0.001) with lesser effects after BT. No treatment affected mental or physical QoL.
Conclusion
Treatment decision-making for localised prostate cancer can be informed by these 6-year functional and QoL outcomes
Protocol for the implementation and evaluation of a community‐based behavior change intervention to reduce dietary salt intake in India
Abstract Excess dietary salt intake is well established as a leading cause of high blood pressure and associated cardiovascular disease, yet current salt intake in India is nearly 11 g per day, more than twice World Health Organization maximum recommended intake of 5 g per day. Although dietary survey data from India indicate that the main sources of dietary salt are salt added during cooking at home, and few salt reduction efforts have focused on interventions at the household level. As a result, there is little evidence of the effectiveness of behavior change programs to reduce salt intake at the household level. The study aims to develop and implement a community based behavioral change intervention to reduce salt intake delivered by front line community‐based health volunteers; and evaluate the preliminary effectiveness, acceptability, and feasibility of delivering a salt reduction behavior change program and potential to support future scale‐up. The study is a pre‐post intervention design, and outcomes will be evaluated from a random sample of 1500 participants from 28 villages in two primary health centers in Siddipet, Telangana. Primary outcome is change in salt‐related KAB (knowledge, attitude, and behavior) score, and secondary outcomes will be changes in salt intake measured by 24 h urinary sodium excretion and change in scores using the subscales of the COM‐B (“capability”, “opportunity”, “motivation” and “behavior”) tool. Findings will be used to inform future public health policies to support implementation of scalable community‐based interventions to reduce salt intake and control hypertension, the leading‐cause of death in India
The potential scalability of salt substitutes as an intervention to lower population sodium levels.
Reducing salt intake is one of the most cost-effective interventions to improve population health due to the subsequent reductions in blood pressure. Countries are introducing programs to lower salt consumption. Such programs usually focus on reducing salt in packaged foods and meals alongside campaigns to change consumer behavior. Thus, this paper provides an overview of the rationale for and evidence supporting the use of salt substitutes. Current approaches to salt reduction are insufficient, and more innovative solutions need to be identified. There is good evidence that salt substitutes, where some of the sodium is replaced with potassium, are effective to lower sodium total intake. The main challenge is to understand the pathways to market for salt substitutes. How do we implement programs to promote salt substitutes in different countries? What levels of government intervention are required? With more research and government investment, salt substitutes could be a game changer for increasing the impact of strategies to reduce population salt intake
The potential scalability of salt substitutes as an intervention to lower population sodium levels
Reducing salt intake is one of the most cost-effective interventions to improve population health due to the subsequent reductions in blood pressure. Countries are introducing programs to lower salt consumption. Such programs usually focus on reducing salt in packaged foods and meals alongside campaigns to change consumer behavior. Thus, this paper provides an overview of the rationale for and evidence supporting the use of salt substitutes. Cur-rent approaches to salt reduction are insufficient, and more innovative solutions need to be identified. There is good evidence that salt substitutes, where some of the sodium is replaced with potassium, are effective to lower sodium total intake. The main challenge is to understand the pathways to market for salt substitutes. How do we implement programs to promote salt substitutes in different countries? What levels of government intervention are required? With more research and government investment, salt substitutes could be a game changer for increasing the impact of strategies to reduce population salt intake
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Palaeontology from Australasia and beyond: Abstracts from Palaeo Down Under 3 Perth, Western Australia, July 2023
Palaeo Down Under 3 (PDU3), the now quadrennial conference of the Australasian Palaeontologists (AAP) association, was held in Perth, Western Australia, from the 10th-14th of July 2023. PDU3 showcased innovative research, outreach and education initiatives being conducted across Australasia and beyond by both local and international scientists. A total of 78 talks, 17 posters and 6 plenaries were presented across the five days, and covered a wide range of topics, geological timeframes, and fossil groups. AAP is proud to publish this compilation of PDU3 abstracts to illustrate the current and ongoing strength of Australasian palaeontology.
Sarah K. Martin [
[email protected]
], Geological Survey of Western Australia, Department of Energy, Mines, Industry Regulation and Safety, 100 Plain St, East Perth, Western Australia 6004, Australia; Michael Archer [
[email protected]
], School of Biological, Earth & Environmental Sciences, University of New South Wales, Sydney, New South Wales 2052, Australia; Heidi J. Allen [
[email protected]
], Geological Survey of Western Australia, Department of Energy, Mines, Industry Regulation and Safety, 100 Plain St, East Perth, Western Australia 6004, Australia; Daniel D. Badea [
[email protected]
], Faculty of Geography and Geology, "Alexandru Ioan Cuza" University, Bulevard "Carol I", Nr.11, 707006, Iași, Romania; Eleanor Beidatsch [
[email protected]
], Palaeoscience Research Centre, University of New England, Armidale, New South Wales 2351, Australia; Marissa J. Betts [
[email protected]
], Palaeoscience Research Centre/LLUNE, University of New England, Armidale, New South Wales 2351, Australia; Maria Blake [
[email protected]
], School of Earth, Atmosphere and Environment, Monash University, 9 Rainforest Walk, Clayton, Victoria 3800, Australia; Phillip C. Boan [
[email protected]
], University of California, Riverside, Geology 1242, 900 University Ave, Riverside, CA 92521, U.S.A.; Tory Botha [
[email protected]
], School of Biological Sciences, Molecular Life Sciences Building, North Terrace Campus, The University of Adelaide, Adelaide, South Australia 5005, Australia; Glenn A. Brock [
[email protected]
], School of Natural Sciences, Macquarie University, New South Wales 2109, Australia; Luke Brosnan [
[email protected]
], WA Organic and Isotope Geochemistry Centre, The Institute for Geoscience Research, School of Earth and Planetary Sciences, Building 500, Curtin University, Kent St, Bentley, Western Australia 6102, Australia; Jack Castle-Jones [
[email protected]
], School of Natural Sciences, Macquarie University, New South Wales 2109, Australia; Jonathan Cramb [
[email protected]
], Queensland Museum, PO Box 3300, South Brisbane BC, Queensland 4101, Australia; Vanesa L. De Pietri [
[email protected]
], School of Earth and Environment, University of Canterbury, Private Bag 4800, Christchurch 8140, New Zealand; Sherri Donaldson [
[email protected]
], School of Geosciences, University of Edinburgh, Grant Institute, The King's Buildings, James Hutton Road, Edinburgh, EH9 3FE, Scotland, U.K.; Elizabeth M. Dowding [
[email protected]
], Friedrich-Alexander-Universität Erlangen-Nürnberg, Loewenichstraße 28 91054 Erlangen, Germany; Ruairidh Duncan [
[email protected]
], Evans EvoMorph Lab, Room 226, 18 Innovation Walk, School of Biological Sciences, Monash University, Clayton, Victoria 3800, Australia; Amy L. Elson [
[email protected]
], WA Organic and Isotope Geochemistry Centre, The Institute for Geoscience Research, School of Earth and Planetary Sciences, Building 500, Curtin University, Kent St, Bentley, Western Australia 6102, Australia; Roy M. Farman [
[email protected]
], School of Biological, Earth and Environmental Sciences, University of New South Wales, Sydney, New South Wales 2052, Australia; Mahala A. Fergusen [
[email protected]
], School of Biological Sciences, Benham Building, North Terrace Campus, The University of Adelaide, Adelaide, South Australia 5005, Australia; Alyssa Fjeld [
[email protected]
], School of Biological Sciences, 18 Innovation Walk, Monash University, Clayton, Victoria 3800, and School of Natural Sciences, Macquarie University, New South Wales 2109, Australia; David Flannery [
[email protected]
], School of Earth and Atmospheric Sciences, Queensland University of Technology, 2 George St, Brisbane, Queensland 4000, Australia; Timothy G. Frauenfelder [
[email protected]
], University of New England, Armidale, New South Wales 2351, Australia; John D. Gorter [
[email protected]
], PO Box 711, Claremont, Western Australia 6910, Australia; Michelle Gray [
[email protected]
], School of Life and Environmental Sciences, Deakin University, Geelong, Victoria 3216, Australia; Nigel Gray [
[email protected]
], GPO Box 2902, Brisbane, Queensland 4001, Australia; Peter Haines [
[email protected]
], Geological Survey of Western Australia, Department of Energy, Mines, Industry Regulation and Safety, 100 Plain St, East Perth, Western Australia 6004, Australia; Lachlan J. Hart [
[email protected]
], Australian Museum Research Institute, 1 William Street, Sydney, New South Wales 2010, Australia; Brooke E. Holland [
[email protected]
], School of Biological Sciences, The University of Queensland, Brisbane, Queensland 4072, Australia; James D. Holmes [
[email protected]
], Department of Earth Sciences, Palaeobiology, Uppsala University, Villavägen 16, Uppsala 752 36, Sweden; Lars Holmer [
[email protected]
], Department of Earth Sciences, Palaeobiology, Uppsala University, Villavägen 16, Uppsala 752 36, Sweden; Ashleigh V.S. Hood [
[email protected]
], School of Geography, Earth and Atmospheric Sciences, University of Melbourne, Parkville, Victoria 3010, Australia; Alexey P. Ippolitov [
[email protected]]
, School of Geography, Environment and Earth Sciences, Victoria University of Wellington | Te Herenga Waka, 21 Kelburn Parade, Wellington 6012, New Zealand; Christine M. Janis [
[email protected]
], Bristol Palaeobiology Group, School of Earth Sciences, University of Bristol, Wills Memorial Building, Bristol, BS8 1RJ, U.K.; Benjamin P. Kear [
[email protected]
], The Museum of Evolution, Uppsala University, Norbyvägen 16, SE-752 36 Uppsala, Sweden; Sophie Kelly [
[email protected]
], School of Earth and Environment, University of Canterbury, Private Bag 4800, Christchurch 8140, New Zealand; Justin L. Kitchener [
[email protected]
], School of Environmental and Rural Science, University of New England, Armidale, New South Wales 2351, Australia; John R. Laurie [
[email protected]
], Geoscience Australia, Symonston, Australian Capital Territory 2601, and School of Natural Sciences, Macquarie University, North Ryde, New South Wales 2109, Australia; Lucy G. Leahey [
[email protected]
], The University of Queensland, Brisbane, Queensland 4072, Australia; John A. Long [
[email protected]
], College of Science and Engineering, Flinders University, PO Box 2100, Adelaide, South Australia 5001, Australia; Daniel Mantle [
[email protected]
], MGPalaeo, Unit 1, 5 Arvida Street, Malaga, Western Australia 6090, Australia; David McB. Martin [
[email protected]
], Geological Survey of Western Australia, Department of Energy, Mines, Industry Regulation and Safety, 100 Plain St, East Perth, Western Australia 6004, Australia; Chris Mays [
[email protected]
], School of Biological, Earth and Environmental Sciences, Environmental Research Institute, University College Cork, Distillery Fields, Cork T23 N73K, Ireland; Matthew R. McCurry [
[email protected]
], Australian Museum, 1 William St, Sydney, New South Wales 2010, Australia; Peter McGoldrick [
[email protected]
], CODES, University of Tasmania, Locked Bag 66, Hobart, Tasmania 7001, Australia; Corinne L. Mensforth [
[email protected]
], Flinders University, GPO Box 2100, Adelaide, South Australia 5001, Australia; Rhys D. Meyerkort [
[email protected]
], University of Western Australia, 35 Stirling Hwy, Crawley, Western Australia 6009, Australia; Christina Nielsen-Smith [
[email protected]
], School of Biological Sciences, The University of Queensland, Brisbane, Queensland 4072, Australia; Ryan Nel [
[email protected]
], Geology Department, Rhodes University, Grahamstown, South Africa; Jake Newman-Martin [
[email protected]
], Curtin University, Kent St, Bentley, Western Australia 6102, Australia; Yeongju Oh [
[email protected]
], Division of Earth Sciences, Korea Polar Research Institute, 26 Songdomirae-ro, Yeonsu-gu, 21990 Incheon, Republic of Korea, and Polar Science, University of Science and Technology, Daejeon, 34113, Republic of Korea; John R. Paterson [
[email protected]
], Palaeoscience Research Centre, School of Environmental and Rural Science, University of New England, Armidale, New South Wales 2351, Australia; Jacob Pears [
[email protected]
], School of Molecular and Life Sciences, Curtin University, Kent St, Bentley, Western Australia 6102, Australia; Stephen F. Poropat [
[email protected]
], Western Australian Organic and Isotope Geochemistry Centre, School of Earth and Planetary Science, Curtin University, Kent St, Bentley, Western Australia 6102, and Australian Age of Dinosaurs Museum of Natural History, Winton, Queensland 4735, Australia; Catherine M. Reid [
[email protected]
], School of Earth and Environment, University of Canterbury, Private Bag 4800, Christchurch 8140, New Zealand; R. Pamela Reid [
[email protected]
], Department of Marine Geosciences, Rosenstiel School of Marine, Atmospheric, and Earth Science, University of Miami, Miami, FL 33149, U.S.A., and Bahamas Marine EcoCentre, Miami, FL 3315