Silent theatre 2 – Monday 4 November

12:40 pm-2:00 pm

Room: Hall 4


Programme session type(s): Silent theatre

An Analysis of Prognostic Biomarkers of the Systemic Inflammatory Response in Cancers of Unknown Primary
Speaker: Rebekah Patton
Affiliation: NHS Lothian, Edinburgh, UK

Abstract:

Cancers of unknown primary (CUP) represent between 3-5% of all malignancies worldwide. In favourable clinico-pathological subsets median survival is 24 months but can be as little as 1-3 months in ‘poor prognosis’ patients. To rationalise investigations and treatment appropriately it is essential to provide accurate prognostic data. Biomarkers of the systemic inflammatory response (albumin and CRP combined in the modified Glasgow prognostic score (mGPS)) predict survival in cancers with an established site. We sought to establish their prognostic utility in CUP.

Method

A prospective data collection was undertaken of patients with provisional or confirmed CUP (using NICE guideline definitions) referred to the CUP service at the Edinburgh Cancer Centre between 2010-2019. Patients with favourable clinico-pathological subgroups were excluded. mGPS at the time of clinical diagnosis was recorded. Survival, defined as the date of biopsy until death, or censorship if alive, was calculated.

Results

Data were available for 247 patients. Median survival was 2.2 months. 87% of patients had an elevated CRP (>10mg/l) at diagnosis. mGPS stratified median survival from 11.7 months with mGPS 0 to 1.6 with mGPS 2 (p<0.001). 77% of patients with mGPS 0 were alive at three months compared to only 30% of those with mGPS 2.

Conclusion

mGPS, a biomarker of the systemic inflammatory response, is a strong prognostic factor in patients with ‘poor prognosis’ CUP. This simple score, derived from routine blood tests, could be used alongside clinical assessment, standardised investigation and performance status to provide additional objective prognostic information. This may facilitate discussions with patients and assist decisions regarding further investigations and treatment. In patients with mGPS of 2 it may support early conversations about advanced care planning. We would advocate future work validating this finding in other cohorts of CUP patients, and, if supported, incorporating this biomarker into CUP clinical pathways and trials.

 

Digital questionnaires to help determine a face-to-face review for ‘on treatment’ oncology clinics
Speaker: Catherine Sharma
Affiliation: Nottingham University Hospitals NHS Trust

Abstract:

Oncology has increasing outpatient activity related to increased cancer incidence, better survival rates and more treatments. The use of digital forms to identify the need for a face-to-face appointment is one potential method that could deal with increasing demand. Our study’s aim was to assess the feasibility of digital questionnaires to detect the need for face-to-face review in clinics monitoring patients on treatment (‘on treatment clinics’).

Method

This study was performed in a regional oncology centre. Target clinics covered both systemic therapy and radiotherapy cohorts. The Common Terminology Criteria for Adverse Events (CTCAE) was adapted into patient-friendly language to form the basis for acute toxicity questionnaires; any response of grade 2 or above would flag for face-to-face review. The study involved digital toxicity questionnaires being answered by patients and their clinicians alongside face-to-face appointments. Patients and clinicians did not see each other’s results, which were not used for clinical decisions. Agreement between patients and clinicians was assessed through statistical analysis. Patient and staff feedback was also obtained.  

Results

90 patients took part in the study across 10 different treatment clinics. 96.7% of patients’ questionnaires flagged appropriately and no patients with severe toxicity would have been missed. 30% of participating patients could have been spared a face-to-face review and stratification by treatment revealed certain groups were more likely to suffer minimal toxicity, with 70% of single-agent immunotherapy patients and 40-50% of tyrosine kinase inhibitor patients having no significant physical or psychosocial issues. Patient and staff feedback showed high approval with the questionnaires and their potential for use in remote monitoring.

Conclusion

Digital side effect questionnaires can appropriately determine the need for face-to-face review in ‘on treatment’ clinics. Their use with specific treatment types could safely reduce the requirement for face-to-face review and we are now conducting an innovative remote pilot to investigate this further.

 

Dietary changes and nutritional support after a pelvic cancer diagnosis: a cross-sectional study.
Speaker: Georgios Saltaouras
Affiliation: Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University

Abstract:

Diet and nutrition is an important aspect of survivorship care that is not routinely addressed. Patients diagnosed with a cancer in the pelvis (anal, bladder, rectal and cancers of the reproductive organs) may benefit from dietary modifications that could improve treatment outcomes and quality of life, and may influence survival. This study aims to explore pelvic cancer survivors’ dietary habits and experiences of nutritional support after diagnosis.

Method

People diagnosed with a pelvic cancer, either undergoing (n=266) or having completed radiotherapy treatment 6-24 months previously (n=405), were invited to participate in a cross-sectional survey. Descriptive and multivariable logistic regression analyses were undertaken. Results are presented for the whole sample, as there were no significant differences between the two groups.

Results

254 (38%) survivors responded; median age 70 years. High overweight and obesity rates (39% and 24%, respectively) and presence of treatment side effects (e.g. bowel changes, appetite issues, fatigue) (82%) were observed. Two thirds of respondents (n=170) reported at least one dietary change since diagnosis. Most notable changes included increased intake of vegetables (33%) and fruit (33%) and reduction of sugary foods (48%) and alcohol (41%). Forty-three percent (n=108) received dietary support from the healthcare team, of which 67% (n=72) felt their needs to be well met. Receipt of support from the healthcare team was the only significant predictor of dietary change (OR 3.63, 95% CI: 1.82-7.23). Dietary support was mainly in the form of leaflets from specialist nurses. Sixty-eight percent (n=171) of respondents would like to receive additional dietary support in relation to cancer.

Conclusion

This study shows that survivors make dietary changes following a diagnosis of pelvic cancer and highlights an increased need and interest for nutrition information and support. Further development of support services in the area of nutrition is warranted.

Statin use and risk of liver cancer: evidence from two population-based studies.
Speaker: Kim Tu Tran
Affiliation: Queen’s University Belfast

Abstract:

Epidemiological studies of statin use and liver cancer risk have produced conflicting results.  We examined the association between statin use and risk of primary liver cancer in two large independent study populations taking account of important covariates and main indications of statins such as high cholesterol and chronic liver disease.

Method

We performed a nested case-control study within the Scottish Primary Care Clinical Informatics Unit (PCCIU) database.  Five controls were matched to cases with primary liver cancer and we used conditional logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for associations with statin use. We also conducted a prospective cohort study within the UK Biobank using self-reported statin use and cancer-registry recorded primary liver cancer outcomes. Cox regression was used to calculate hazard ratios (HRs) and 95% CIs.

Results

In the PCCIU case-control analysis, 434 liver cancer cases were matched to 2,103 controls. In the UK Biobank cohort, 182 out of 475,768 participants developed incident liver cancer. Statin use was associated with 39% lower risk of liver cancer in the PCCIU (adjusted OR 0.61, 95% CI 0.43-0.87). When we examined specific subtypes of liver cancer in the UK Biobank, statin use was associated with lower risk of hepatocellular carcinoma (adjusted HR, 0.48; 95% CI, 0.24-0.94) but not intrahepatic bile duct carcinoma (adjusted HR, 1.09; 95% CI, 0.45-2.64).

Conclusion

In conclusion, we found a consistent inverse relationship between statin use and risk of primary liver cancer which was only seen for hepatocellular carcinoma but not intrahepatic bile duct carcinoma.

Hospital activity before and after diagnosis of monoclonal gammopathy of undetermined significance (MGUS)
Speaker: Maxine Lamb
Affiliation: University of York, York, UK

Abstract:

Monoclonal gammopathy of undetermined significance (MGUS; ICD-O-3=9761/1) is a premalignant clonal disorder that progresses to myeloma at ~1% per year. Whilst MGUS is often diagnosed incidentally and other symptoms of myeloma are absent, several follow-up studies have reported relationships with co-morbidities and poor survival. Illness patterns before MGUS diagnoses have, however, not been examined in relation to those seen after diagnosis. Here we compare hospital activity of people with MGUS and patients with mature B-cell malignancies to that in the general population.

Method

The study is set within the UK’s Haematological Malignancy Research Network (HMRN, www.hmrn.org), which contains two established population-based cohorts: a patient cohort of haematological malignancies (cases), and a control cohort comprising 10 age-, sex- and area-matched individuals for cases diagnosed 01/01/2009-31/12/2015. HMRN operates with Section 251 support, and both cohorts are linked to national Hospital Episode Statistics. Inpatient and outpatient visits from five years before to three years after diagnosis were counted, excluding haematology.

Results

Over the study period, cases with MGUS (n=2,239) had significantly higher hospital activity rates compared to controls (n=22,390). Before diagnosis, monthly attendance rates per 100 persons averaged 30.6 (95%CI:30.3-30.9) among cases and 20.9 (20.9-21.0) in controls, with activity rates in the controls remaining constant over time. The difference was driven by outpatient attendances and activity in cases remained high after diagnosis. Outpatient specialties with high activity before diagnosis (including rheumatology, orthopaedics, dermatology and nephrology) were similar to those found after. This unusual pattern of activity was not seen in any other haematological malignancies or precursor conditions. 

Conclusion

MGUS patients have increased hospital activity unrelated to haematology several years before diagnosis, and the pattern is sustained after diagnosis. The underpinning specialities we observed are consistent with the post-diagnostic literature. That the pattern is evident at least five years before diagnosis impacts on causal and pathogenic hypotheses.             

Genome-wide association study of acute toxicity and quality of life in breast cancer patients treated by surgery and radiotherapy in the REQUITE cohort study
Speaker: Tim Rattay
Affiliation: University of Leicester, Leicester, UK

Abstract:

Clinically significant side-effects from radiotherapy following surgery affect around a quarter of breast cancer patients and may adversely affect breast cosmesis and quality of life (QoL).  If patients at high risk of local treatment toxicity could be identified at breast cancer diagnosis, this could be taken into account when discussing treatment options.  Genome wide association studies (GWAS) have facilitated discoveries in complex-trait genetics, biology of disease and translation towards new therapeutic interventions.  In the field of radiogenomics, several genetic associations have been replicated to date but the majority have been in relation to late toxicity. 

Method

Breast cancer patients (n = 2,071) were recruited following breast-conserving surgery across eight centres in the UK, Europe and North America into the multicentre REQUITE cohort study (www.requite.eu) between 2014 and 2016.  Patient, treatment, and toxicity data (CTCAE v4.0) were collected prospectively.  QoL data (EORTC-QLQ-C30 and –B23) were available for 1,750 patients at baseline and on completion of radiotherapy.

Results

All patients have been genotyped using Illumina OncoArrays which assays ~600,000 SNPs including a GWAS backbone and a similar number of cancer-specific SNPs, of which 2,000 were selected from previous radiogenomics studies.  Results from the GWAS will be presented.  By the end of radiotherapy, 24.2 % of patients experienced ≥ grade 2 erythema, 31.6 % ≥ grade 1 oedema, and 9.5 % acute desquamation (skin or wound breakdown).  Overall, QoL (global health status), fatigue, pain, and breast symptoms worsened significantly by the end of radiotherapy (≥ 10 point change from baseline, dichotomised) compared to baseline (p<0.01). 

Conclusion

These GWAS results can be used to develop or improve clinical predictive risk models for toxicity and change in QoL from breast surgery and radiotherapy.  This has the potential to provide clinicians with important information when planning breast cancer treatment, in order to reduce side-effects and optimise quality of life.

  

Barriers to accessing cancer services in England and Wales by adults with physical disabilities
Speaker: Dikaios Sakellariou
Affiliation: Cardiff University, Cardiff, UK

Abstract:

There is evidence that people with disabilities are less likely to utilise cancer screening services and report low satisfaction and barriers to accessing these services. The aim of this study was to explore barriers to accessing cancer services in England and Wales faced by adults with pre-existing physical disabilities

Method

Exploratory qualitative study, conducted between October 2017 and October 2018. Data were collected by semi-structured interviews (n=18), and analysed thematically.

Results

Study findings indicated that people with physical disabilities, who go on to develop cancer, report several barriers relating to the receipt of acceptable levels of cancer care. Participants perceived healthcare systems and staff to be inadequately prepared to address their needs. Participants felt that their physical disability was often ignored, despite its importance in their lives. Even when healthcare professionals acknowledged the existence of their disability, participants found that professionals were not always adequately equipped to manage its effects on their care overall, and on their cancer-related care specifically. Other obstacles reported were travelling to and from the hospital, and mobilising within healthcare facilities.

Conclusion

In order to effectively address the needs of people with disabilities effectively, it is necessary to move beyond an exclusively single-disease approach to cancer management. This is becoming increasingly important as the population ages and greater numbers of people are living with cancer and disability. For healthcare services to be inclusive they need to be relevant and patient-centred, considering, and not ignoring or minimising, the disability and its effects on treatment. Necessary steps to be taken include enabling better communication between the different specialists involved in patients’ care, raising awareness of how disability can affect cancer-related treatment, striving for more accessible environments, and, ultimately, ensuring cancer services are disability-inclusive.

Coffee consumption by type and risk of digestive cancer: A large prospective cohort study.
Speaker: Kim Tu Tran
Affiliation: Queen’s University Belfast

Abstract:

Inverse associations have been observed between coffee consumption and liver cancer but associations for other digestive cancers are unclear. Few previous studies have investigated coffee type (specifically instant or ground coffee) or a range of digestive cancer types within the one cohort. We therefore investigated coffee consumption by type and digestive cancer risks in a population-based cohort.

Method

The UK Biobank captured self-reported coffee consumption and cancer-registry recorded incident digestive cancers. Hazard ratios (HRs) and 95% CIs were calculated using Cox regression. Risk of every type of digestive cancer was investigated in association with coffee consumption by dose-response and by coffee type (decaffeinated, instant, ground).

Results

Over 7.5 years of follow-up, 3567 developed digestive cancer among 471,779 participants. There were 88 cases of hepatocellular carcinoma and a marked association was observed for hepatocellular carcinoma in coffee drinkers (HR 0.50, 95% CI 0.29, 0.87), which was similar for instant (HR 0.51, 95% CI 0.28, 0.93) and ground coffee (HR 0.47, 95% CI 0.20, 1.08). We did not observe significant consistently reduced risks of other individual digestive cancers amongst coffee drinkers.

Conclusion

We found some evidence that coffee consumption was inversely associated with hepatocellular carcinoma which was similar by coffee type.

Secondary analysis of routinely collected data from a specialist cancer rehabilitation service in South Wales, UK
Speaker: Judit Csontos
Affiliation: Cardiff University

Abstract:

Evidence suggests worldwide that cancer rehabilitation has a positive effect on cancer-related health problems, such as fatigue and reduced lung capacity. In South Wales (UK), a specialist cancer rehabilitation service has been collecting outcome data as part of routine assessment since 2014 to monitor changes in people’s fatigue and functional status. People are assessed before and after a 12-week therapeutic episode which could comprise hydrotherapy, Tai Chi, exercise classes and individual therapy based on people’s needs and preferences. However, the data collected have not yet been comprehensively analysed. The aim of this study was to explore the routinely collected data and investigate change in functional outcomes from 2014 until 2017.

Method

Descriptive statistics were derived from demographic data (cancer site, gender) and outcome measures to explore the data. Pre and post-assessment Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-F), Timed up and go (TUAG), pain, shortness of breath and quality of life visual analogue scale (VAS) were compared with Paired-samples t-test and Wilcoxon signed-rank test to look for significant change. Missing data was listwise deleted. The study was approved by London South – East Research Ethics Committee (17/LO/2123).

Results

The data contained 1645 case records. There was significant (two tailed p<0.05) change between pre and post-assessment in most of the outcome measures during episodes 1-3 in each year. Fatigue (e.g.: FACIT-FEp1/2014 n=55, MedianPre=24.00 and MedianPost=31.00 , T=1159, p=0.000, r=0.48), pain (e.g.: PainEp1/2014 n=32, MedianPre=6.25 and MedianPost=3.50 , T=30, p=0.000, r=-0.68) and TUAG (e.g.: TUAGEp1/2014 n=78, MedianPre=7.61 and MedianPost=6.92 , T=665.5, p=0.000, r=-0.49) reduced. This could indicate that cancer rehabilitation provided by a specialist service in South Wales has positive influence on people’s health. However, shortness of breath was not significant in most episodes and years.

Conclusion

Results imply that people could benefit from cancer rehabilitation provided by a specialist service in South Wales. However, change was mostly noticeable during early episodes (Ep1-3). This could indicate that people do not benefit from further interventions. Tailoring therapeutic episodes to individual needs may facilitate more effective use of resources.

Qualitative exploration of cancer rehabilitation in South Wales, UK from the perspectives of people affected by cancer and healthcare professionals
Speaker: Judit Csontos
Affiliation: Cardiff University

Abstract:

Physical and psychological consequences can develop as a result of cancer and its treatment affecting people’s lives. Cancer rehabilitation services have been found to have positive effect on quality of life and managing side effects worldwide. However, accessibility and lack of information on services can serve as barriers leaving people with unmet rehabilitation needs. The aim of this study was to investigate the value, barriers, and facilitators of two cancer rehabilitation services in South Wales from the perspective of healthcare professionals and people affected by cancer.

Method

Audio recorded, semi-structured, face-to-face interviews were conducted with a purposive sample of healthcare professionals (n=20), and people affected by cancer (n=15) at two specialist cancer rehabilitation services in South Wales. The study was approved by London South – East Research Ethics Committee (17/LO/2123). Written informed consent was obtained from every participant. Both healthcare professionals and people affected by cancer were asked questions about the value, meaning, barriers and facilitators of cancer rehabilitation. Interviews were transcribed verbatim and reflexive thematic analysis (Braun and Clarke 2006) was used to identify themes in the data.

Results

People affected by cancer (PABC) valued the expert knowledge, care and attention from healthcare professionals and the peer support during certain rehabilitation interventions. Exercise classes were highly regarded among PABC due to positive changes in their physical strength and mental health. However, accessibility and understaffing were addressed as barriers to service provision by both healthcare professionals and PABC. Lack of information on available services was reported by PABC, while healthcare professionals mentioned underfunding and cultural problems as barriers specific to them. Moreover, there was no consensus among participants on the meaning of rehabilitation, which could explain some of the barriers.

Conclusion

The findings of this study indicate that cancer rehabilitation is highly valued by people affected by cancer. However, these services are not always available for everyone, due to barriers related to the healthcare system and people’s own personal problems. Service promotion and education of both people affected by cancer and healthcare professionals may help in overcoming some of the barriers.

Detection of EGFR mutations in the plasma and urine of NSCLC EGFRm+ patients
Speaker: Ling Li
Affiliation: University of Exeter

Abstract:

Lung cancer is one of the most common and lethal types of cancer. Management of advanced non-small cell lung cancer (NSCLC) today is largely based on mutations. Tyrosine kinase inhibitors (TKIs) are approved and effective first-line therapy for stage IIIB/IV EGFR-mutation positive (EGFRm+) NSCLC. However, drug resistance is observed in clinic, often due to the development of a second mutation. Further research on the mechanisms through which resistance develops is required.

Due to disadvantages of repeating tissue in clinic, circulating tumour DNA (ctDNA) extracted from liquid biopsy is considered as an alternative for monitoring EGFR mutation status in NSCLC patients. However, clinical use has been limited due to lack of evidence in consistency between mutational analysis with ctDNA and with tissue.

Method

EGFR Del19, EGFR L858R and EGFR T790M mutations status along TKI treatment were studied in plasma and urine samples from at least 20 patients across 2 UK sites with stage IIIB/IV EGFRm+ NSCLC. Mutations were accessed by Digital Droplet PCR using ctDNA extracted from plasma and urine samples once a month for at least 12 months or until a secondary mutation developed. The mutations status was analysed and comparing with the initial TKI-treatment naïve mutation status. 

Results

We used 20 patients’ samples to investigate the EGFR mutation status, in which 6 patients had samples from enough timepoints (around 12month) till now. For the 6 patients’ samples, it showed that EGFR mutations status accessed by urine/plasma ctDNA was consistent with the diagnosis from tissue biopsy and TKI treatment progression. Additionally, 5 of the 6 patients showed second mutant development – EGFR T790M. 

Conclusion

Real time monitoring on EGFR mutation status is important in clinic to keep the tumour therapy personalised. Our study showed that urine/plasma ctDNA reflected the mutation status during the treatment and may help monitored the secondary mutation development in time. Liquid biopsy could be used to prospectively monitor mutational status of EGFR in patients treated with TKI.