The Optimisation of Pre-Chemotherapy Blood Assessments through Prognostic Modelling

Background: Evidence guiding pre-chemotherapy blood assessments would enable accurate patient-planning and support the growing numbers of patients treated with chemotherapy. The aim of this PhD was to guide chemotherapy providers on the appropriate timing of pre-treatment blood assessments and develop a prognostic model to predict dose delays, mitigating the need for multiple assessments. Methods and analysis: A literature review guided retrospective data collection of risk factors for cancer patients receiving chemotherapy from four hospitals in England. Descriptive analysis was used to demonstrate changes in laboratory values of pre-chemotherapy blood tests, specifically neutrophils, when taken at different times. Using multivariable logistic regression, the relationship between potential risk factors and the outcome of a chemotherapy dose-administration delay was determined. Results: The study included 4,604 patients (2,022 breast cancer patients, 1,904 colorectal cancer patients and 678 diffuse large B-cell lymphoma patients) between 1 January 2013 and 1 January 2018. Of these, 616 patients had two neutrophil values within 7 days of treatment. 23% of neutrophils assessed 4-6 days prior to treatment did not meet the required threshold; these were repeated nearer to the treatment time. Among all patients, 628 (14%) experienced a second cycle treatment delay of 7 days or more. Significant variability was noted in the rate of delays at different hospitals ranging from 8% for hospital 4 to 22% for hospital 1 (P<0.005). Fourteen risk factors were pre-selected for the development of the prognostic model and fair predictive performance (concordance index 0.67) with good calibration was found. A net benefit analysis demonstrated the model was most beneficial in predicting patients receiving treatment for colorectal cancer; here the model would have value in 50% of all patients. Conclusions: The use of prognostic modelling offers an alternative to understanding a patient’s likeliness to encounter a dose delay, aiding service providers to plan accordingly and negating the need for inappropriate blood tests

Histamine-2(H₂) Antagonists can be safely removed from standard Paclitaxel Pre-medication regimens

Aim: To investigate the rates of hypersensitivity reactions (HSRs), in patients receiving paclitaxel chemotherapy, with and without a Histamine-2 (H2) antagonists. / Method: This prospective, multi-centre, cohort study compared patients receiving paclitaxel treated with pre-medication regimens containing chlorphenamine, dexamethasone and an H2 antagonist versus patients treated without an H2 antagonist. Rates of HSRs were described and logistic multivariable regression was used to investigate any associations with H2 antagonist treatment, adjusting for confounding variables. / Results: 1043 were included in the study; of these, 638 (61%) patients received a H2 antagonist and 405 (49%) were not given a H2 antagonist. Incidence of HSR in the cohort treated with H2 antagonists was 11.31% (n=70) versus 9.86% (n=41) in the cohort without. There was no statistically significant difference between the rates of HSR observed in those receiving and not receiving a H2 antagonist (odds ratio 1.04, 95% CI 0.65, 1.66, P=0.9). / Conclusions: Results presented within the study are consistent with other recently published evidence to suggest that H2 antagonists do not confer any advantage as part of pre-medication regimens in reducing the incidence of HSR in patients treated with paclitaxel

Effect of statin treatment on the risk of cancer in patients with heart failure:A target trial emulation study

PURPOSE: A recent observational study suggested statins could reduce cancer diagnosis in patients with heart failure (HF). The findings need to be validated using robust epidemiological methods. This study aimed to evaluate the effect of statin treatment on the risk of cancer in patients with HF.METHODS: We conducted two target trial emulations using primary care data from IQVIA Medical Research Database-UK (2000 to 2019) with a clone-censor-weight design. The first emulated trial addressed the treatment initiation effect: initiating within 1 year versus not initiating a statin after the HF diagnosis. The second emulated trial addressed the cumulative exposure effect: continuing a statin for ≤3 years, 3-6 years, and &gt;6 years after initiation. The study outcomes were any incident cancer and site-specific cancer diagnoses. Weighted pooled logistic regression models were used to estimate 10-year risk ratios (RR). 95% confidence intervals (CIs) were estimated using non-parametric bootstrapping.RESULTS: The first emulated trial showed that, compared to no statin, statins did not reduce the cancer risk in patients with HF (RR, 1.05; 95% CI, 0.94-1.15). The second emulated trial showed that, compared to treatment ≤3 years, statins with longer durations did not reduce the cancer risk (3-6 years: RR, 0.94; 95% CI, 0.70-1.33. &gt;6 years: RR, 0.97; 95% CI, 0.79-1.26). No significant risk difference was observed on any site-specific cancer diagnoses.CONCLUSIONS: The results from the target trial emulations suggest that statin treatment is not associated with cancer risk in patients with HF.</p

Effect of statin treatment on the risk of cancer in patients with heart failure:A target trial emulation study

PURPOSE: A recent observational study suggested statins could reduce cancer diagnosis in patients with heart failure (HF). The findings need to be validated using robust epidemiological methods. This study aimed to evaluate the effect of statin treatment on the risk of cancer in patients with HF.METHODS: We conducted two target trial emulations using primary care data from IQVIA Medical Research Database-UK (2000 to 2019) with a clone-censor-weight design. The first emulated trial addressed the treatment initiation effect: initiating within 1 year versus not initiating a statin after the HF diagnosis. The second emulated trial addressed the cumulative exposure effect: continuing a statin for ≤3 years, 3-6 years, and &gt;6 years after initiation. The study outcomes were any incident cancer and site-specific cancer diagnoses. Weighted pooled logistic regression models were used to estimate 10-year risk ratios (RR). 95% confidence intervals (CIs) were estimated using non-parametric bootstrapping.RESULTS: The first emulated trial showed that, compared to no statin, statins did not reduce the cancer risk in patients with HF (RR, 1.05; 95% CI, 0.94-1.15). The second emulated trial showed that, compared to treatment ≤3 years, statins with longer durations did not reduce the cancer risk (3-6 years: RR, 0.94; 95% CI, 0.70-1.33. &gt;6 years: RR, 0.97; 95% CI, 0.79-1.26). No significant risk difference was observed on any site-specific cancer diagnoses.CONCLUSIONS: The results from the target trial emulations suggest that statin treatment is not associated with cancer risk in patients with HF.</p

Global changes to the chemotherapy service during the covid-19 pandemic.

PURPOSE: In response to the COVID-19 pandemic, changes to chemotherapy services were implemented as a means of managing imposed workload strains within health services and protecting patients from contracting COVID-19. Given the rapidly evolving nature of the pandemic many changes were rapidly adopted and were not substantiated by robust evidence. This study aimed to describe the changes adopted internationally to chemotherapy services, which may be used to guide future changes to treatment delivery. METHODS: A survey was developed to understand the impact of COVID-19 on the delivery of systemic anti-cancer therapies (SACT). It comprised 22 questions and examined the strategies implemented during the pandemic to prioritise and protect patients receiving SACT and the participants' professional opinion of the strategies employed. The survey was available in English, Spanish and French and was distributed via professional bodies. RESULTS: 129 responses were obtained from healthcare professionals working across 17 different countries. 45% of institutions had to implement treatment prioritisation strategies and all hospitals implemented changes in the delivery of treatment, including: reduction in treatments (69%), using less immunosuppressive agents (50%), allowing treatment breaks (14%) and switching to oral therapies (45%). Virtual clinic visits were perceived by participants as the most effective strategy to protect patients. CONCLUSIONS: The pandemic has forced chemotherapy healthcare professionals to adopt new ways of working by reducing health interactions. Many areas of research are needed following this period, including understanding patients' perceptions of risks to treatment, utilisation of oral treatments and the impact of treatment breaks on cancer outcomes

On the road and away from home: a systematic review of the travel experiences of cancer patients and their families

Purpose: Traveling for cancer care is difficult as patients might be suffering from the side effects of treatment, need to cover additional costs, and face disruption of daily life. The aim of this review was to synthesize the evidence on travel needs and experiences during cancer treatment from the point of view of patients and their families. Methods: This is a systematic review of the literature. The PRISMA statement was used to guide the reporting of the methods and findings. We searched for peer-reviewed articles in MEDLINE, CINAHL PLUS, and Web of Science and selected articles based on the following criteria: focused on patients and their families; presented findings from empirical studies; and examined travel and transport experiences for cancer screening, treatment, and related care. The MMAT was used to assess the quality of the studies. Results: A total of 16 articles were included in the review. Most of the studies used a qualitative design, were carried out in high-income countries and were conducted more than 10 years ago. Several problems were reported regarding travel and relocation: social and physical demands of transport, travel, and relocation; life disruption and loss of daily routines; financial impact; and anxieties and support needs when returning home. Conclusions: Patients and carers consistently reported lack of support when traveling, relocating, and returning home. Future research needs to explore patient experiences under current treatment protocols and healthcare delivery models, in a wider range of geographical contexts, and different stages of the patient pathway.Fil: Vindrola-Padros, Cecilia. Colegio Universitario de Londres; Reino UnidoFil: Brage, Eugenia. Universidad de Buenos Aires. Facultad de Filosofía y Letras; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Chambers, Pinkie. Colegio Universitario de Londres; Reino Unid