Non-conventional dosing of oral anticancer agents in oncology and malignant haematology: a systematic review protocol

Background. Recent advances in cancer therapeutics have resulted in significantly improved overall survival and progression-free survival for patients. Targeted oral systemic anticancer therapies (SACT) offer a range of treatment approaches that differ from traditional cytotoxic chemotherapy: non-cytotoxic oral SACT target malignant disease continuously, have less broad and more favourable safety profiles, which can improve patients’ quality of life (QoL). Toxicities associated with daily oral SACT administration can, however, result in non-adherence and a reduced QoL. Non-conventional dosing of oral SACT, where unlicensed doses/schedules of drugs are prescribed, is one approach increasingly adopted by clinicians to reduce toxicities and subsequent non-adherence and to improve QoL. Guidance governing this practice is, however, limited. This systematic review aims to identify evidence about prescribing practices of, and outcomes from, non-conventional dosing of oral SACT in oncology and malignant haematology. Methods. A search using the following electronic databases will be conducted: Ovid MEDLINE, Ovid EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Cochrane Registry of Controlled Trials. Studies will be selected based on predefined inclusion/exclusion criteria. Critical appraisal will be conducted to identify potential biases, strengths and limitations of included studies. Extracted data will be tabulated to sort and summarise key findings. An initial literature search indicated that studies reporting non-standard dosing of oral SACT intervention studies are diverse and heterogeneous in study design. Extracted data will, therefore, be tabulated, and together with a narrative synthesis of integrated key findings, will be presented and discussed in reference to the strengths and weaknesses of the evidence base. If sufficient stratified data is available (e.g. age group, tumour type, disease stage) or intervention (drug, dosing schedule), sub-group analysis will be conducted to inform prescribing practice. Discussion. This review will identify relevant literature on the topic to inform prescribers working in oncology and malignant haematology. It will also analyse any evidence of the following outcomes: toxicity, treatment adherence and/or QoL outcomes for patients receiving non-standard doses of oral SACT. Limitations in the evidence base may arise from variability in both the type and quality of studies reviewed. Systematic Review Registration. PROSPERO CRD42017076195

A systematic review of non-standard dosing of oral anticancer therapies

Background. The use of oral systemic anticancer therapies (SACT) has increased and led to improved cancer survival outcomes, particularly with the introduction of small molecule targeted agents and immunomodulators. Oral targeted SACT are, however, associated with toxicities, which might result in reduced quality of life and non-adherence. To reduce treatment-related toxicity, the practice of non-standard dosing is increasing; however guidance to govern this practice is limited. A systematic review was conducted to identify evidence of, and outcomes from, non-standard dosing of oral SACT in oncology and malignant haematology. Methods. A comprehensive search of 78 oral SACT was conducted in the following databases: MEDLINE®, EMBASE®, Cochrane Library©, and Cumulative Index to Nursing and Allied Health Literature (CINAHL©). Studies were selected based on predefined inclusion/exclusion criteria, and were critically appraised. Extracted data were tabulated to summarise key findings. Due to diversity of study designs and heterogeneity of reported outcomes, studies were categorised and evidence was synthesised in three main themes: dose interruption; dose reduction; and other dosing strategies. Results. Thirty-four studies were eligible for inclusion: four clinical trials, fifteen cohort studies and fifteen case reports. Evidence for non-standard dosing was reported for eleven oral SACT. Dose interruptions were the most commonly reported strategy (14 studies); nine studies reported dose reductions; and eleven reported other dosing strategies. Eight retrospective cohort studies reported dose interruption of sunitinib in renal cell carcinoma and showed either similar or improved responses and survival outcomes, and fewer or equivalent high grade toxicities, compared to the standard schedule. Four cohort studies retrospectively evaluated dose reductions of imatinib, gefitinib or erlotinib, for chronic myeloid leukaemia and non-small cell lung cancer, respectively. Other dosing strategies included alternate-day dosing. The quality of the evidence was limited by the small sample size in many studies, retrospective study designs, and lack of reported toxicity and/or QoL outcomes. Conclusions. This review identified limited evidence to support current non-standard dosing strategies, but some of findings, e.g. dose interruption of sunitinib, warrant further investigation in large-scale prospective clinical trials

Dismantling the present and future threats of testicular cancer: a grounded theory of positive and negative adjustment trajectories

Testicular cancer commonly affects men in the prime of their lives. While survival rates are excellent, little previous research has examined men’s experiences of adjustment to survivorship. We aimed to explore this issue in younger testicular cancer survivors

Health professional perceptions of communicating with adolescents and young adults about bone cancer clinical trial participation

Purpose: Low recruitment of adolescents and young adults in cancer clinical trials is widely reported and may be linked to limited improvements in survival. Research to date does not adequately explain all underlying reasons for poor trial accrual. This paper reports health professional perceptions of communicating with adolescents and young adults with bone sarcoma about clinical trial participation. Methods: This study used narrative inquiry. Findings are reported from thematic analysis of in-depth interviews with eighteen multi-disciplinary health professionals working in a supra-regional bone and soft tissue sarcoma centre. Results: Participants described professional expertise, the development of specialist knowledge and skills, and strategies used to develop trusting relationships with adolescents and young adults with bone sarcoma. These factors were perceived to facilitate communication about clinical trial participation. Emergent themes were: having credibility through expertise of the team; developing specialist communication skills through reflection on practice; having inclusive approaches to education and training about clinical trials; individual communication styles used to form trusting relationships; using a patient-centred approach to connect with adolescents and young adults; creating time needed to form trusting relationships; and effective team working. Conclusions: We aligned findings of this study with characteristics of patientphysician trust and provide a basis for transferable recommendations. Our findings can be used to inform the development of age-specific, specialist communication skills and highlight health professional education needs about clinical trials. Additional research is needed to explore which elements of team working optimise improved clinical trial participation, in what contexts, and why

ECCO Essential Requirements for Quality Cancer Care : Soft Tissue Sarcoma in Adults and Bone Sarcoma. A critical review

Background: ECCO essential requirements for quality cancer care (ERQCC) are checklists and explanations of organisation and actions that are necessary to give high-quality care to patients who have a specific tumour type. They are written by European experts representing all disciplines involved in cancer care. ERQCC papers give oncology teams, patients, policymakers and managers an overview of the elements needed in any healthcare system to provide high quality of care throughout the patient journey. References are made to clinical guidelines and other resources where appropriate, and the focus is on care in Europe. Sarcoma: essential requirements for quality care Sarcomas - which can be classified into soft tissue and bone sarcomas - are rare, but all rare cancers make up more than 20% of cancers in Europe, and there are substantial inequalities in access to high-quality care. Sarcomas, of which there are many subtypes, comprise a particularly complex and demanding challenge for healthcare systems and providers. This paper presents essential requirements for quality cancer care of soft tissue sarcomas in adults and bone sarcomas. High-quality care must only be carried out in specialised sarcoma centres (including paediatric cancer centres) which have both a core multidisciplinary team and an extended team of allied professionals, and which are subject to quality and audit procedures. Access to such units is far from universal in all European countries. It is essential that, to meet European aspirations for high-quality comprehensive cancer control, healthcare organisations implement the requirements in this paper, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis and follow-up, to treatment, to improve survival and quality of life for patients. Conclusion: Taken together, the information presented in this paper provides a comprehensive description of the essential requirements for establishing a high-quality service for soft tissue sarcomas in adults and bone sarcomas. The ECCO expert group is aware that it is not possible to propose a 'one size fits all' system for all countries, but urges that access to multidisciplinary teams is guaranteed to all patients with sarcoma. (C) 2016 The Authors. Published by Elsevier Ireland Ltd.Peer reviewe

Increasing the expression of calcium-permeable TRPC3 and TRPC7 channels enhances constitutive secretion

The hTRPC [human TRPC (canonical transient receptor potential)] family of non-selective cation channels is proposed to mediate calcium influx across the plasma membrane via PLC (phospholipase C)-coupled receptors. Heterologously expressed hTRPC3 and hTRPC7 have been localized at the cell surface; however, a large intracellular component has also been noted but not characterized. In the present study, we have investigated the intracellular pool in COS-7 cells and have shown co-localization with markers for both the TGN (trans-Golgi network) and the cis-Golgi cisternae by immunofluorescence microscopy. Addition of BFA (Brefeldin A) to cells expressing hTRPC3 or hTRPC7 resulted in the redistribution of the Golgi component to the endoplasmic reticulum, indicating that this pool is present in both the Golgi stack and the TGN. Expression of either TRPC3 or TRPC7, but not TRPC1 or the cell surface marker CD8, resulted in a 2–4-fold increase in secreted alkaline phosphatase in the extracellular medium. Based on these results, we propose that an additional function of these members of the hTRPC family may be to enhance secretion either by affecting transport through the Golgi stack or by increasing fusion at the plasma membrane

Introductory lecture by Verna Lavender on cancer care

An introductory lecture on cancer, including its biology and treatment, and the role of the nurse in supporting patients and relatives affected by cancer

Acccountability in Practice

A Powerpoint presentation that defines accountability in practice and explores factors that impact on accountability

Neuromuscular junction signalling

A Powerpoint slide of an animated cartoon of acetylcholine signal transmission at a neuromuscular junction

Reflection for professional development

A powerpoint presentation that provides theories of reflection that facilitate professional development