The effect of ovarian cancer screening on sexual activity and functioning: results from the UK collaborative trial of ovarian cancer screening RCT

Background: To examine the impact of multimodal (MMS) and ultrasound (USS) screening on the sexual activity and functioning of 22,966 women in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) RCT. Methods: Fallowfield’s Sexual Activity Questionnaire (FSAQ) was completed prior to randomisation, then annually in a random sample (RS) of women from MMS, USS and control groups. Any women in the study who required repeat screening due to unsatisfactory results formed an Events Sample (ES); they completed questionnaires following an event and annually thereafter. Results: Over time in the RS (n=1,339) there was no difference between the MMS and USS groups in sexual activity compared with controls. In the ES there were significant differences between the USS group (n=10,156) and the MMS group (n=12,810). The USS group had lower pleasure scores (mean difference = -0.14, P=0.046). For both groups women who had ≥2 repeat screens, showed a decrease in mean pleasure scores compared to their annual scores (mean difference = -0.16, P=0.005). Similarly mean pleasure scores decreased following more intensive screens compared to annual screening (mean difference= -0.09, P=0.046). Conclusion: Ovarian cancer screening did not affect sexual activity and functioning unless a woman had abnormal results and underwent repeated or higher level screening

Talking about risk in the context of genomic tests (TARGET): development and evaluation of an educational programme for clinicians

Purpose: Gene expression profiling (GEP) test scores calculate risks of recurrence and likely benefit of adjuvant chemotherapy in ER positive, HER2 negative, early stage breast cancer. As health literacy and numeracy skills in the general population are poor, healthcare professionals (HCPs) require a wide repertoire of communication skills to explain clearly risk of recurrence scores (RSs) and uncertainty. We developed and evaluated an educational program for HCPs discussing GEP test results and adjuvant treatment. Methods: Eight hour workshops contained elements aimed at improving knowledge, communication skills, and self-awareness; these included:- the science underpinning GEP tests, an interactive risk psychology lecture, exercises and facilitated group discussions regarding 7 filmed scenarios involving discussions about high, intermediate and low RSs. Attendees were recorded explaining RSs with patient simulators pre and post workshop. Researchers blinded to time-point, analysed recordings using a study specific scoring system. Primary objective outcomes were improvements post workshop in HCPs’ competence and confidence when communicating 17 pre-specified key information areas. We estimated odds ratios (OR) using conditional logistic regression to compare pre and post workshop scores. Results: 65 HCPs attended. Objective analyses revealed significant positive shifts post-workshop which included explaining:- GEP tests (OR=2.98; 95% CI, 1.38 to 6.42; P=.001), recurrence RSs (OR=3.99; 95% CI, 1.72 to 9.25; P<.001), benefits of chemotherapy (OR= 3.99; 95% CI, 1.82 to 8.75; P<.001; and harms OR=2.31; 95% CI, 1.37 to 3.92; P<.001) using jargon free language (OR=5.29; 95% CI, 2.27 to 12.35; P<.001). Patient simulator assessments also showed significant improvements as did HCPs’ self-assessments and ratings of their self-confidence when discussing different GEP tests with diverse patient types (P<.001). Conclusion: These short, intensive, interactive TARGET workshops significantly improved HCPs’ communication about GEP results in ways likely to promote more informed decision-making by patients about chemotherapy

Expression of NM23 in human melanoma progression and metastasis.

NM23 is a putative metastasis-suppressor gene for some human cancers. Here we have studied NM23 expression during melanoma progression using Northern blotting and immunocytochemistry. There was no significant difference in the average amounts of NM23 mRNA between cell lines derived from metastatic and primary melanomas. The level of NM23 mRNA was also determined for three pairs of poorly metastatic parental (P) and their highly metastatic variant (M) cell lines; the ratios for M/P were 1.2, 0.98 and 0.80. Next we used immunocytochemistry to study NM23 protein in normal skin, benign naevi and primary and metastatic melanomas. Melanocytes in all normal skin and benign samples were positive for NM23; however most primary melanomas (7/11) were not stained by the antibody. All metastatic melanoma samples (5/5) were positively stained. Findings were similar with an antiserum reactive with both forms of NM23 (H1 and H2), and with an antibody specific for NM23-H1. No relationship was apparent between NM23 immunoreactivity in primary tumours and their aggressiveness or prognosis. Hence, in contrast to the situation described for murine melanoma, the amount of NM23 mRNA or protein in human melanoma did not correlate inversely with metastasis

Reliable computational quantification of liver fibrosis is compromised by inherent staining variation

Biopsy remains the gold standard measure for staging liver disease, both to inform prognosis and to assess the response to a given treatment. Semiquantitative scores such as the Ishak fibrosis score are used for evaluation. These scores are utilised in clinical trials, with the US Food and Drug Administration mandating particular scores as inclusion criteria for participants and using the change in score as evidence of treatment efficacy. There is an urgent need for improved, quantitative assessment of liver biopsies to detect small incremental changes in liver architecture over the course of a clinical trial. Artificial intelligence (AI) methods have been proposed as a way to increase the amount of information extracted from a biopsy and to potentially remove bias introduced by manual scoring. We have trained and evaluated an AI tool for measuring the amount of scarring in sections of picrosirius red-stained liver. The AI methodology was compared with both manual scoring and widely available colour space thresholding. Four sequential sections from each case were stained on two separate occasions by two independent clinical laboratories using routine protocols to study the effect of inter- and intra-laboratory staining variation on these tools. Finally, we compared these methods to second harmonic generation (SHG) imaging, a stain-free quantitative measure of collagen. Although AI methods provided a modest improvement over simpler computer-assisted measures, staining variation both within and between labs had a dramatic effect on quantitation, with manual assignment of scar proportion the most consistent. Manual assessment also correlated the most strongly with collagen measured by SHG. In conclusion, results suggest that computational measures of liver scarring from stained sections are compromised by inter- and intra-laboratory staining. Stain-free quantitative measurement using SHG avoids staining-related variation and may prove more accurate in detecting small changes in scarring that may occur in therapeutic trials

Quality of survival: a new concept framework to assess the quality of prolonged life in cancer

Background: Improved cancer care means that more patients are surviving longer, but there is a need to examine how well patients survive. We conducted an exploratory analysis of a new conceptual framework termed ‘quality of survival’ (QoS) that delineates the quality of patients’ experience. Methods: This project included an electronic database search to investigate the survivorship landscape and to create a visual QoS map and semi-structured interviews with patients (n = 35), clinicians (n = 40), and payers (n = 7) to support the QoS map. QoS was discussed in the context of two tumor types, metastatic non-small cell lung cancer and metastatic melanoma. Results: Despite increased long-term survival, no specific definition of QoS exists. Patients reported many impacts that affect QoS, clinicians viewed QoS as relevant to treatment decisions, and payers felt it could help communicate different aspects relevant to the patient. Four interconnected QoS dimensions were developed (quality of life, survival, side effects, and economic impact), which vary in importance along the care continuum. Conclusion: QoS is a patient-centric concept that could help decision-making and patient communication. The QoS map could provide a framework to monitor patient experience and help patients frame what treatment attribute is most important to them at any point in the cancer continuum

Is it possible to improve the breaking bad news skills of residents when a relative is present? A randomised study.

peer reviewe

Talking About Risk in the Context of GEnomic Tests (TARGET): Development and evaluation of an educational program for clinicians

Purpose: Gene expression profiling (GEP) test scores calculate risks of recurrence and likely benefit of adjuvant chemotherapy in ER positive, HER2 negative, early stage breast cancer. As health literacy and numeracy skills in the general population are poor, healthcare professionals (HCPs) require a wide repertoire of communication skills to explain clearly risk of recurrence scores (RSs) and uncertainty. We developed and evaluated an educational program for HCPs discussing GEP test results and adjuvant treatment. Methods: Eight hour workshops contained elements aimed at improving knowledge, communication skills, and self-awareness; these included:- the science underpinning GEP tests, an interactive risk psychology lecture, exercises and facilitated group discussions regarding 7 filmed scenarios involving discussions about high, intermediate and low RSs. Attendees were recorded explaining RSs with patient simulators pre and post workshop. Researchers blinded to time-point, analysed recordings using a study specific scoring system. Primary objective outcomes were improvements post workshop in HCPs’ competence and confidence when communicating 17 pre-specified key information areas. We estimated odds ratios (OR) using conditional logistic regression to compare pre and post workshop scores. Results: 65 HCPs attended. Objective analyses revealed significant positive shifts post-workshop which included explaining:- GEP tests (OR=2.98; 95% CI, 1.38 to 6.42; P=.001), recurrence RSs (OR=3.99; 95% CI, 1.72 to 9.25; P<.001), benefits of chemotherapy (OR= 3.99; 95% CI, 1.82 to 8.75; P<.001; and harms OR=2.31; 95% CI, 1.37 to 3.92; P<.001) using jargon free language (OR=5.29; 95% CI, 2.27 to 12.35; P<.001). Patient simulator assessments also showed significant improvements as did HCPs’ self-assessments and ratings of their self-confidence when discussing different GEP tests with diverse patient types (P<.001). Conclusion: These short, intensive, interactive TARGET workshops significantly improved HCPs’ communication about GEP results in ways likely to promote more informed decision-making by patients about chemotherapy

Is it possible to improve residents breaking bad news skills? A randomised study assessing the efficacy of a communication skills training program

info:eu-repo/semantics/publishe

Treatment Experiences, Information Needs, Pain and Quality of Life in Men with Metastatic Castrate-resistant Prostate Cancer: Results from the EXTREQOL Study

Aims Delaying progression, ameliorating symptoms and maintaining quality of life (QoL) are primary aims of treatment for metastatic castrate-resistant prostate cancer (mCRPC). Real-world rather than clinical trial data about symptoms and side-effects are sparse. In EXTREQOL, patients' QoL, pain and information needs were recorded during treatment. Material and methods Men with mCRPC from 20 UK cancer centres starting various systemic mCRPC treatments completed QoL, pain and information needs questionnaires at baseline, 3 and 6 months. Results In total, 132 patients were recruited. Overall QoL declined significantly by 6 months (Functional Assessment of Cancer Therapy-Prostate [FACT-P] mean = –3.89, 95% confidence interval –6.7 to –1.05, P = 0.007; Trial Outcome Index [TOI] analysis mean = –3.10, 95% confidence interval –5.34 to –0.83, P = 0.007). Those who came off novel therapy and remained on luteinising hormone-releasing hormone agonist therapy alone had worse scores than patients receiving concomitant chemotherapy (Prostate Concerns Subscale mean difference = –4.45, 95% confidence interval –7.06 to –1.83, P = 0.001; TOI mean difference = –5.62, 95% confidence interval –10.97 to –0.26, P = 0.040). At 3 and 6 months, men who reported pain at baseline improved (43%, 40%), but for others pain levels remained the same (45%, 42%) or worsened (13%, 18%). Information regarding supportive care was lacking throughout the period of time on the study. Conclusion Most mCRPC treated patients experience reduced QoL and inadequate pain control. More help with pain management and better information provision regarding supportive care is warranted