Silent theatre 2 – Monday 4 November

3:35 pm-4:00 pm

Room: Hall 4


Programme session type(s): Silent theatre

Using a four-step co-design model to develop and test a peer led web-based resource (PLWR) to support informal carers of cancer patients.
Speaker: Olinda Santin
Affiliation: Queen’s University Belfast

Abstract:

1.5 million people aged 16 years and over in the UK are caring for someone affected by cancer. In response to rising informal cancer carer pressures, the team co-designed with cancer carers and health care professionals (HCP) a peer-led web-based resource (PLWR) to provide cancer carer specific practical and emotional advice on common carer issues. The acceptability of the resource was determined through user testing; examining carer’s experiences of using the PLWR and their ratings of the various components.

Method

A four step co-design model informed PLWR development. Content was developed through three cancer carer workshops and monthly meetings with an expert advisory team (n=12). User-testing was conducted via web-based survey and telephone interview. Descriptive statistics and thematic analysis were utilised. Google analytics explored site visits, commonly used components, and time spent using the PLWR.

Results

The PLWR was developed to deliver cancer carer information tailored to each stage of the illness trajectory regardless of cancer type, in the form of videoed personal experiences. From November-May 2018 there were 2,789 unique visits to the PLWR with 743 returners. The majority of time was spent on the full unclipped peer stories (414 views), and diagnosis specific information (159 views), with less time spent on bereavement, cancer treatment, or self-care (120 views each). Fifty-five individuals completed the resource evaluation, with 10 participating in telephone interviews. Fifty-four carers rated the resource as excellent, useful, and easy to use. The web-based videos were regarded as convenient and less burdensome than written information. The resource provided relevant information, potentially reducing isolation and uncertainty.

Conclusion

The content and design of the PLWR appears acceptable to cancer carers. The co-design model is an effective way to develop appropriate information for service users and could be utilised as a framework for development of other interventions in a variety of disease groups.

A single centre review of the NICE approved, standard of care, treatment cost savings for patients with metastatic castrate-resistant prostate cancer (mCRPC) enrolled in clinical trials
Speaker: Louisa McDonald
Affiliation: Guy’s and St Thomas’ NHS Foundation Trust, London, UK

Abstract:

When a patient is enrolled in a clinical trial, often the study sponsor will provide the standard of care treatment without charge to the study site, either as the comparator drug, to be used in combination with the investigational product or in the form of an extension study post licencing. A treatment cost saving can be seen based on the standard of care treatment the patient would have received.

For patients with metastatic castrate-resistant prostate cancer, the current NICE guidelines recommend the use of either Abiraterone (Zytiga) in combination with prednisone or prednisolone or Enzalutamide (Xtandi). The NICE approved treatment costs are £2,300 and £2,7934.67 respectively.

Method

The objective of the review was to analyse the treatment saving based on the standard of care treatment cost. The review looked at 5 industry sponsored studies at Guy’s and St Thomas’ (GSTT) between April 2015 and March 2018. The studies reviewed were for men with metastatic castrate-resistant prostate cancer (mCRPC) and all included either Abiraterone or Enzalutamide as a comparator, an open label extension study or as a cross over treatment.

The cost saving was calculated based on the number of patients randomised at GSTT, the length of time they were on study and the cost of the standard of care drug they would have received off trial, estimated using the NICE approved costings.

Results

The total treatment costs saved across 3 years was an estimated £1.4m, with an average per patient cost saving of approximately £25k per year.

Conclusion

Significant treatment cost savings were seen where patients were recruited onto clinical trials. In addition to the benefits to patients and future treatments, the economic impact of clinical trials on NHS trusts is vast. It is predicted that such savings will continue to increase with the licensing of more costly treatments such as immunotherapies.

Non-invasive methylation test to detect cervical pre-cancer in self-collected vaginal and urine specimens
Speaker: Belinda Nedjai
Affiliation: Queen Mary University of London, London, UK

Abstract:

The implementation of HPV testing as a primary screen will soon become the norm worldwide. Because HPV testing is a very sensitive method, but not specific enough, the choice of an appropriate triage strategy for hrHPV positive women will be one of the future key issues facing the cervical screening community. Clinician taken samples are the gold standard but self-sampling including urine may be a useful alternative. We have developed a triage classifier for the detection of CIN2+, based on DNA methylation of HPV16, HPV18, HPV31 and HPV33 and the human gene EPB41L3. We will test S5 classifier on two non-invasive specimens: a self-collected vaginal sample and urine. We aim to assess whether S5 can identify women who are CIN2+ using self-collected samples and comparing several collection devices.

Method

Women attending the colposcopy clinic at The Royal London Hospital as a consequence of abnormal screening cytology and/or a positive HPV result were recruited as part of the ‘Self-sampling for vaginal HPV. 503 women provided a urine sample using the Colli-Pee™ device. In total 600 women provided self-collected vaginal samples using either Flocked swab and Diagene or HerSwab and Qvintip. DNA was extracted, Bisulfite converted, followed by pyrosequencing assays for the 6 S5 markers. Average methylation was calculated to generate the S5 score.

Results

S5 showed a good and statistically significant separation between

Conclusion

We demonstrated that S5 can be successfully amplified in urine and vaginal self-collected samples and that the classifier is able to correctly identify CIN2+ women.

Metabolic functions of astrocytes are retained by glioblastoma stem-like cells and support glioblastoma growth in vivo
Speaker: Tobias Ackermann
Affiliation: Cancer Research UK Beatson Institute

Abstract:

In the brain glutamine serves as a precursor for the neurotransmitter glutamate. The neuron-released glutamate is cleared from the synapsis by astrocytes which convert it to glutamine via glutamine synthetase (GS). Thus, glutamine-glutamate metabolism is essential for brain’s normal function.

Method

Results

Glioblastoma, the most common and aggressive form of brain cancer, expresses GS at levels comparable to that of astrocytes. Consistently, we found that that naïve glioblastoma cells cultured in serum-free and physiologically relevant conditions, avidly uptake and consume glutamate from the extracellular environment and express high levels of GS, resembling normal astrocytes. To test if glutamine synthesis is advantageous for tumour growth we generated patient-derived orthotropic glioblastoma xenografts stably expressing a shRNA against GS. Upon GS knock down we detected a significant reduction in tumour volume and an extension in the survival of mice, which substantiate pro-tumorigenic role of GS in glioblastoma. Moreover we observed that at clinical endpoint all the tumours re-gained GS expression by selectively suppressing the expression of the targeting shRNA.  

Conclusion

While this further corroborated the selective advantage conferred by GS expression in GBM cells, it prevented us to directly address the metabolic role GS in tumours. To this aim we developed a novel inducible lentiviral system encoding for miRNA targeting specifically GS as well as iRFP (infra-red fluorescent protein) and luciferase. This model will allow us to investigate which metabolic reactions downstream of GS-derived glutamine, support glioblastoma growth in vivo. This may lead to the identification of new therapeutic targets, which extend beyond the normal role of GS in neurophysiology.