Trastuzumab (Herceptin®) podawany podskórnie: brytyjskie badanie porównujące techniczne aspekty metody z dożylnym leczeniem trastuzumabem u chorych na HER2-dodatniego raka piersi

Introduction: The aim of the study was firstly, to quantify active healthcare professional (HCP) time and costs associated with subcutaneous (SC) administration of trastuzumab (Herceptin®) compared with the standard intravenous infusion (IV) in the treatment of patients with HER2-positive early breast cancer within the adjuvant PrefHer trial setting; secondly, to measure patient time in the care unit and patient infusion chair time for both routes of administration. Material and methods: A UK multi-centre prospective, observational Time and Motion study was conducted alongside the PrefHer trial (ClinicalTrials.gov id: NCT01401166). Trained observers measured the duration of each SC and IV related task that HCPs undertook and recorded patient time in the chemotherapy unit and infusion chair. The type and quantity of medical consumables used with each route of administration were also collected. Twenty-four patient episodes were recorded (12 SC, 12 IV). Mean total administration time was calculated as the mean sum of task times, both for IV and SC formulations. The mean cost of each route of administration was calculated as the mean cost of HCP time plus the mean cost of consumables used. HCP time was costed using Personal Social Services Research Unit. Consumables were costed using hospital pharmacy data and online sources. Results: Mean active HCP time for IV. administration was 92.6 minutes compared with 24.6 minutes for SC administration. The mean cost for IV preparation and administration was £144.96 (£132.05 of HCP time and £12.92 of consumables) versus £33.15 (£31.99 of HCP time and £1.17 of consumables) for SC administration. Mean time spent in the care unit and in the infusion chair was 94.5 minutes and 75 minutes respectively for IV, and 30.3 minutes and 19.8 minutes for SC. SC administration of trastuzumab could translate to a time saving of 68 minutes (versus IV) with a total cost saving of £111.81 per patient episode. This equates to a potential saving of £2012.58 over a full course of adjuvant treatment (18 cycles). Conclusion: Substituting IV infusion with SC administration of trastuzumab may lead to a substantial reduction in active HCP time, patient chair and unit time, consumable use and overall costs. The reduced patient chair and unit time could provide increased capacity within existing resources.Wstęp: Celem pracy było: po pierwsze — ilościowe określenie czasu pracy pracownika opieki zdrowotnej (HCP) i kosztów związanych z podskórnym (s.c.) podawaniem trastuzumabu (Herceptin®) w porównaniu ze standardowym wlewem dożylnym (i.v.) w leczeniu chorych na HER2-dodatniego, wczesnego raka piersi, otrzymujących leczenie uzupełniające w badaniu PrefHer; po drugie zaś — ocena czasu spędzonego przez chorą w zakładzie opieki zdrowotnej oraz czasu zajęcia stanowiska do podawania leku dla obu metod leczenia. Materiał i metody: Analizowano przeprowadzone w Wielkiej Brytanii wieloośrodkowe, prospektywne badanie obserwacyjne metodyki pracy (Time&Motion), prowadzone równolegle do badania PrefHer (nr w bazie ClinicalTrials. gov NCT01401166). Przeszkoleni obserwatorzy mierzyli czas każdej czynności HCP związanej z podaniem trastuzumabu s.c. i i.v. oraz odnotowywali czas spędzony przez chorą na oddziale chemioterapii oraz czas zajęcia stanowiska do podawania leku do infuzji. Zbierano także dane na temat rodzaju i ilości materiałów medycznych zużytych w trakcie podania leku każdą z dróg. Zaraportowano 24 podania leku (12 s.c. i 12 i.v.). Zarówno w przypadku podawania s.c., jak i i.v. średni ogólny czas podania obliczano jako sumę średnich czasów poszczególnych czynności. Średni koszt każdego rutynowego podania obliczono jako średni koszt czasu pracy pracownika opieki zdrowotnej oraz średni koszt zużytych materiałów. Koszt czasu pracy pracownika opieki zdrowotnej obliczono na podstawie danych udostępnionych przez dział kadr i spraw socjalnych (Personal Social Services Research Unit). Wykorzystane materiały medyczne wyceniono na podstawie danych z apteki szpitalnej oraz źródeł dostępnych w Internecie. Wyniki: Średni czas pracy HCP dla podania i.v. wynosił 92,6 minuty, wobec 24,6 minuty dla podania s.c. Średni koszt przygotowania i podania wlewu i.v. wynosił 144,96 funtów (czas pracy pracownika 132,05 funtów i koszt materiałów 12,92 funtów) w porównaniu z 33,15 funtów (czas pracy pracownika 31,99 funtów i koszt materiałów 1,17 funtów) w przypadku podania s.c. Średni czas spędzony przez chorą w zakładzie opieki zdrowotnej oraz czas zajęcia stanowiska do infuzji wyniósł 94,5 i 75 minut oraz 30,3 i 19,8 minuty odpowiednio dla podania dożylnego i podskórnego. Podawanie trastuzumabu s.c. mogłoby się przełożyć na oszczędności czasu wynoszące 68 minut (w porównaniu z podaniem i.v.) oraz całkowite oszczędności kosztów wynoszące 111,81 funtów na każdego pacjenta. W sumie daje to potencjalne oszczędności wynoszące 2012,58 funtów w trakcie całego leczenia uzupełniającego (18 cykli). Wnioski: Zamiana sposobu podawania trastuzumabu z wlewu i.v. na iniekcję s.c. może prowadzić do znacznego skrócenia czasu pracy HCP, czasu spędzonego przez chorą w zakładzie opieki zdrowotnej, czasu zajęcia stanowiska do infuzji, zmniejszenia zużycia materiałów medycznych oraz kosztów ogólnych. Krótszy czas zajęcia stanowiska do podawania leków oraz skrócenie czasu przebywania chorej w zakładzie opieki zdrowotnej mogą zapewnić lepsze wykorzystanie istniejących zasobów systemu opieki zdrowotnej

#radonc: Growth of the Global Radiation Oncology Twitter Network

Introduction Social media connects people globally and may enhance access to radiation oncology information. We characterized the global growth of the radiation oncology Twitter community using the hashtag #radonc. Materials and Methods We analyzed all public tweets bearing the hashtag #radonc from 2014-2019 using Symplur Signals. We collected data on #radonc activity and growth, stakeholder distribution, user geolocation, and languages. We obtained global Twitter user data and calculated average annual growth rates for users and tweets. We analyzed growth rates by stakeholder. We conducted thematic analysis on a sample of tweets in each three-year period using frequently occurring two-word combinations. Results We identified 193,115 tweets including #radonc composed by 16,645 Twitter users. Globally, users wrote in 35 languages and came from 122 countries, with the known highest users from the United States, United Kingdom, and Spain. Use of #radonc expanded from 23 countries in 2014 to 116 in 2019. The average annual growth rate in #radonc users and tweets was 70.5% and 69.2%, respectively. The annual growth rate of #radonc users was significantly higher than for all Twitter users (p=0.004). While doctors were the source of 46.9% of all tweets, research and government organizations had annual increases in tweet volume of 84.6% and 211.4%, respectively. From 2014 to 2016, promotion of the radiation oncology community was the most active theme, though this dropped to 7th in 2017-2019 as discussion increased regarding aspects of radiation and treated disease sites. Conclusion Use of #radonc has grown rapidly into a global community. Focused discussion related to radiation oncology has outpaced the growth of general Twitter use, both among physicians and non-physicians. #radonc has grown into a self-sustaining community. Further research is necessary to define the risks and benefits of social media in medicine and to determine whether it adds value to oncology practice

Stay with the ‘FLO’: Evaluating a mobile texting service to enhance social work student retention while on placement

Practice placements are a trigger point for social work students dropping out of university. This small pilot study, explores the use of ‘FLO’, an automated text message service, to support social work students on their 70-day placement. Participants were asked to complete a FLO evaluation questionnaire and to attend a focus group to explore their experiences. Data were analysed using descriptive statistics and thematic analysis of focus group transcripts. Five key themes emerged: Student retention, sense of belonging and attendance; Importance of the initial text message; Frequency of FLO text messages and reminders; Stopping the FLO and the Future potential of FLO. Student retention was 100% during the placement period. Issues concerning the costs incurred by participants when sending reply text messages were also evident. The authors conclude that FLO, or other similar mobile technologies may be a useful addition to approaches to improve undergraduate social work student retention rates during placement. However, the correct focus and student involvement in designing the content of the text messages is critical

The care of older cancer patients in the United Kingdom

The ageing population poses new challenges globally. Cancer care for older patients is one of these challenges, and it has a significant impact on societies. In the United Kingdom (UK), as the number of older cancer patients increases, the management of this group has become part of daily practice for most oncology teams in every geographical area. Older cancer patients are at a higher risk of both under- and over-treatment. Therefore, the assessment of a patient’s biological age and effective organ functional reserve becomes paramount. This may then guide treatment decisions by better estimating a prognosis and the risk-to-benefit ratio of a given therapy to anticipate and mitigate against potential toxicities/difficulties. Moreover, older cancer patients are often affected by geriatric syndromes and other issues that impact their overall health, function and quality of life. Comprehensive geriatric assessments offer an opportunity to identify and address health problems which may then optimise one’s fitness and well-being. Whilst it is widely accepted that older cancer patients may benefit from such an approach, resources are often scarce, and access to dedicated services and research remains limited to specific centres across the UK. The aim of this project is to map the current services and projects in the UK to learn from each other and shape the future direction of care of older patients with cancer

Bridging the age gap: observational cohort study of effects of chemotherapy and trastuzumab on recurrence, survival and quality of life in older women with early breast cancer

Background: Chemotherapy improves outcomes for high risk early breast cancer (EBC) patients but is infrequently offered to older individuals. This study determined if there are fit older patients with high-risk disease who may benefit from chemotherapy. Methods: A multicentre, prospective, observational study was performed to determine chemotherapy (±trastuzumab) usage and survival and quality-of-life outcomes in EBC patients aged ≥70 years. Propensity score-matching adjusted for variation in baseline age, fitness and tumour stage. Results: Three thousands four hundred sixteen women were recruited from 56 UK centres between 2013 and 2018. Two thousands eight hundred eleven (82%) had surgery. 1520/2811 (54%) had high-risk EBC and 2059/2811 (73%) were fit. Chemotherapy was given to 306/1100 (27.8%) fit patients with high-risk EBC. Unmatched comparison of chemotherapy versus no chemotherapy demonstrated reduced metastatic recurrence risk in high-risk patients(hazard ratio [HR] 0.36 [95% CI 0.19–0.68]) and in 541 age, stage and fitness-matched patients(adjusted HR 0.43 [95% CI 0.20–0.92]) but no benefit to overall survival (OS) or breast cancer-specific survival (BCSS) in either group. Chemotherapy improved survival in women with oestrogen receptor (ER)-negative cancer (OS: HR 0.20 [95% CI 0.08–0.49];BCSS: HR 0.12 [95% CI 0.03–0.44]).Transient negative quality-of-life impacts were observed. Conclusions: Chemotherapy was associated with reduced risk of metastatic recurrence, but survival benefits were only seen in patients with ER-negative cancer. Quality-of-life impacts were significant but transient. Trial Registration: ISRCTN 46099296

Establishing a large prospective clinical cohort in people with head and neck cancer as a biomedical resource: head and neck 5000

BACKGROUND: Head and neck cancer is an important cause of ill health. Survival appears to be improving but the reasons for this are unclear. They could include evolving aetiology, modifications in care, improvements in treatment or changes in lifestyle behaviour. Observational studies are required to explore survival trends and identify outcome predictors. METHODS: We are identifying people with a new diagnosis of head and neck cancer. We obtain consent that includes agreement to collect longitudinal data, store samples and record linkage. Prior to treatment we give participants three questionnaires on health and lifestyle, quality of life and sexual history. We collect blood and saliva samples, complete a clinical data capture form and request a formalin fixed tissue sample. At four and twelve months we complete further data capture forms and send participants further quality of life questionnaires. DISCUSSION: This large clinical cohort of people with head and neck cancer brings together clinical data, patient-reported outcomes and biological samples in a single co-ordinated resource for translational and prognostic research

Patients' preferences for subcutaneous trastuzumab versus conventional intravenous infusion for the adjuvant treatment of HER2-positive early breast cancer: final analysis of 488 patients in the international, randomized, two-cohort PrefHer study

PrefHer revealed compelling and consistent patient preference for subcutaneous (s.c.) trastuzumab, regardless of delivery by single-use injection device or hand-held syringe. s.c. trastuzumab was well-tolerated and safety data, including immunogenicity, were consistent with previous reports. No new safety signals were identified compared with the known intravenous trastuzumab profile in early breast cance

Cost-Effectiveness Modeling of Surgery Plus Adjuvant Endocrine Therapy Versus Primary Endocrine Therapy Alone in UK Women Aged 70 and Over With Early Breast Cancer

Objectives: Approximately 20% of UK women aged 70+ with early breast cancer receive primary endocrine therapy (PET) instead of surgery. PET reduces surgical morbidity but with some survival decrement. To complement and utilize a treatment dependent prognostic model, we investigated the cost-effectiveness of surgery plus adjuvant therapies versus PET for women with varying health and fitness, identifying subgroups for which each treatment is cost-effective. Methods: Survival outcomes from a statistical model, and published data on recurrence, were combined with data from a large, multicenter, prospective cohort study of over 3400 UK women aged 70+ with early breast cancer and median 52-month follow-up, to populate a probabilistic economic model. This model evaluated the cost-effectiveness of surgery plus adjuvant therapies relative to PET for 24 illustrative subgroups: Age {70, 80, 90} × Nodal status {FALSE (F), TRUE (T)} × Comorbidity score {0, 1, 2, 3+}. Results: For a 70-year-old with no lymph node involvement and no comorbidities (70, F, 0), surgery plus adjuvant therapies was cheaper and more effective than PET. For other subgroups, surgery plus adjuvant therapies was more effective but more expensive. Surgery plus adjuvant therapies was not cost-effective for 4 of the 24 subgroups: (90, F, 2), (90, F, 3), (90, T, 2), (90, T, 3). Conclusion: From a UK perspective, surgery plus adjuvant therapies is clinically effective and cost-effective for most women aged 70+ with early breast cancer. Cost-effectiveness reduces with age and comorbidities, and for women over 90 with multiple comorbidities, there is little cost benefit and a negative impact on quality of life