Time filter

Source Type

Newcastle upon Tyne, United Kingdom

Smith L.A.,Medical Research Matters | Cornelius V.R.,Medical Research Matters | Plummer C.J.,Freeman Hospital | Levitt G.,Great Ormond St Hospital for Sick Children NHS Trust | And 3 more authors.
BMC Cancer | Year: 2010

Background: We conducted a systematic review and meta-analysis to clarify the risk of early and late cardiotoxicity of anthracycline agents in patients treated for breast or ovarian cancer, lymphoma, myeloma or sarcoma.Methods: Randomized controlled trials were sought using comprehensive searches of electronic databases in June 2008. Reference lists of retrieved articles were also scanned for additional articles. Outcomes investigated were early or late clinical and sub-clinical cardiotoxicity. Trial quality was assessed, and data were pooled through meta-analysis where appropriate.Results: Fifty-five published RCTs were included; the majority were on women with advanced breast cancer. A significantly greater risk of clinical cardiotoxicity was found with anthracycline compared with non-anthracycline regimens (OR 5.43 95% confidence interval: 2.34, 12.62), anthracycline versus mitoxantrone (OR 2.88 95% confidence interval: 1.29, 6.44), and bolus versus continuous anthracycline infusions (OR 4.13 95% confidence interval: 1.75, 9.72). Risk of clinical cardiotoxicity was significantly lower with epirubicin versus doxorubicin (OR 0.39 95% confidence interval: 0.20, 0.78), liposomal versus non-liposomal doxorubicin (OR 0.18 95% confidence interval: 0.08, 0.38) and with a concomitant cardioprotective agent (OR 0.21 95% confidence interval: 0.13, 0.33). No statistical heterogeneity was found for these pooled analyses. A similar pattern of results were found for subclinical cardiotoxicity; with risk significantly greater with anthracycline containing regimens and bolus administration; and significantly lower risk with epirubicin, liposomal doxorubicin versus doxorubicin but not epirubicin, and with concomitant use of a cardioprotective agent. Low to moderate statistical heterogeneity was found for two of the five pooled analyses, perhaps due to the different criteria used for reduction in Left Ventricular Ejection Fraction. Meta-analyses of any cardiotoxicity (clinical and subclinical) showed moderate to high statistical heterogeneity for four of five pooled analyses; criteria for any cardiotoxic event differed between studies. Nonetheless the pattern of results was similar to those for clinical or subclinical cardiotoxicity described above.Conclusions: Evidence is not sufficiently robust to support clear evidence-based recommendations on different anthracycline treatment regimens, or for routine use of cardiac protective agents or liposomal formulations. There is a need to improve cardiac monitoring in oncology trials. © 2010 Smith et al; licensee BioMed Central Ltd. Source

Verrill M.,Northern Center for Cancer Care
Surgery (United Kingdom) | Year: 2016

Multimodality primary therapies for breast cancer combined with earlier detection have led to a sharp decline in the death rate from breast cancer in the UK over the last 40 years in the face of a rising incidence. The latest UK statistics from Cancer Research UK report 50,285 new cases of breast cancer in 2011 with 11,716 deaths from breast cancer recorded in 2012. Crudely, this equates to a cure rate in excess of 75% for all comers. Despite this good news, there are still significant numbers of women (and men) who suffer from either a local recurrence or metastatic disease following apparently successful treatment for early breast cancer (Stage I-III). Only a minority of individuals, 6.6% with the stage recorded at diagnosis, present with stage IV disease. This review considers the treatment options available to individuals with locally recurrent and advanced breast cancer (ABC). © 2016 Elsevier Ltd. All rights reserved. Source

Moor J.W.,Freeman Hospital | Patterson J.,Newcastle University | Kelly C.,Northern Center for Cancer Care | Paleri V.,Freeman Hospital
Clinical Oncology | Year: 2010

Aims: Patients with advanced squamous carcinoma of the head and neck who are treated with concurrent chemoradiotherapy schedules are often referred for gastrostomy tube (G-tube) insertion. Decision making to select appropriate patients is inconsistent and the factors that lead healthcare workers to make this recommendation are not well understood. Therefore, by means of a web-based questionnaire we sought the views of a variety of healthcare professionals as to their current practice with regard to various issues surrounding the recommendation of G-tube insertion use in these patients and analysed the responses with regard to decision making. Materials and methods: Questions were generated after discussion among and agreement from all members of a single National Health Service Trust head and neck multidisciplinary team and were hosted on a website. Appropriate individuals were identified through their governing body organisations and invited by e-mail to complete the questionnaire. The results were pooled and analysed. Results: Recommendations for gastrostomy were not based on tumour subsite. Four of 14 patient-related factors were significantly associated with the recommendation for gastrostomy. Medical and allied healthcare professionals (including nursing staff) significantly differed in their opinions as to the effect of G-tubes on the resumption of oral intake (P=0.009). Conclusions: There is no national consensus on which patients to recommend for gastrostomy and consideration should be given to the development of clinical decision-making models in an attempt to systematise the decision-making process. © 2010 The Royal College of Radiologists. Source

Cairns L.,Northern Center for Cancer Care
Nursing standard (Royal College of Nursing (Great Britain) : 1987) | Year: 2012

Breathlessness is one of the most common and difficult symptoms to manage in advanced cancer. Despite the development of non-pharmacological interventions and a shift away from a medical approach to its management, symptom control remains suboptimal. Practitioners need education and support to deliver the best possible care for patients experiencing breathlessness. This article provides an overview of the interventions available to improve quality of life for these patients and explores the need for greater implementation of non-pharmacological interventions. Source

The aim of this study was to compare the dose to organs at risk (OARs) from different craniospinal radiotherapy treatment approaches available at the Northern Centre for Cancer Care (NCCC), with a particular emphasis on sparing the bowel. Method: Treatment plans were produced for a pediatric medulloblastoma patient with inflammatory bowel disease using 3D conformal 6-MV photons (3DCP), combined 3D 6-MV photons and 18-MeV electrons (3DPE), and helical photon TomoTherapy (HT). The 3DPE plan was a modification of the standard 3DCP technique, using electrons to treat the spine inferior to the level of the diaphragm. The plans were compared in terms of the dose-volume data to OARs and the nontumor integral dose. Results: The 3DPE plan was found to give the lowest dose to the bowel and the lowest nontumor integral dose of the 3 techniques. However, the coverage of the spine planning target volume (PTV) was least homogeneous using this technique, with only 74.6% of the PTV covered by 95% of the prescribed dose. HT was able to achieve the best coverage of the PTVs (99.0% of the whole-brain PTV and 93.1% of the spine PTV received 95% of the prescribed dose), but delivered a significantly higher integral dose. HT was able to spare the heart, thyroid, and eyes better than the linac-based techniques, but other OARs received a higher dose. Conclusions: Use of electrons was the best method for reducing the dose to the bowel and the integral dose, at the expense of compromised spine PTV coverage. For some patients, HT may be a viable method of improving dose homogeneity and reducing selected OAR doses. © 2012 American Association of Medical Dosimetrists. Source

Discover hidden collaborations