TP6.1.5 The Importance of the Patient Voice in Metastatic Colorectal Cancer: A Qualitative Study

Abstract Aims Colorectal cancer is the fourth commonest cancer in the UK with a third presenting with synchronous liver metastases. Although there is a large body of clinical cohort data, there is no research exploring patient perspectives of disease. This qualitative phenomenological study explores the lived experiences of patients following treatment for synchronous disease. Methods Qualitative interviews used pre-prepared prompts encouraging open dialogue and were transcribed for thematic analysis. Results Four major themes emerged. (1) Experience of Cancer The initial diagnosis was recalled in vivid detail, with delays perceived negatively particularly if clinicians were dismissive about their concerns. Caregiver participation was valued in consultations. Patients with recurrence perceived chemotherapy as a method of control. (2) Patient Autonomy Patients describe a paternalistic relationship with their clinician and were satisfied with their management despite any complications or recurrence. There was little perception of pathway equipoise with some questioning any real choice particularly those with a symptomatic bowel primary. (3) Treatment Strategy Patients preferred a bowel-first strategy as a method of control, perceiving the primary to continually seed the body with metastases. Chemotherapy offered little reassurance for disease control. Synchronous resection was preferred but the greater potential for complications was appreciated. (4) Research No patients expressed ethical concerns about potential studies randomising to different surgical strategies. However, patients would not want a liver-first strategy. Conclusions This is the first qualitative study exploring patient perceptions of metastatic colorectal cancer. The importance of the first consultation outlining management is emphasised as a simple but important message.

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Medical Students’ Experience of Mindfulness Training in the UK: Well-Being, Coping Reserve, and Professional Development

Education Research International ◽

10.1155/2019/4021729 ◽

2019 ◽

Vol 2019 ◽

pp. 1-10 ◽

Cited By ~ 3

Author(s):

Alice Malpass ◽

Kate Binnie ◽

Lauren Robson

Keyword(s):

Medical Education ◽

Mental Health Problems ◽

Qualitative Interviews ◽

General Medical Council ◽

Well Being ◽

Mindfulness Training ◽

The Body ◽

Free Text ◽

Medical Council ◽

The Uk

Medical school can be a stressful experience for students, resulting in stress-related mental health problems. Policy recommendations from the General Medical Council (GMC), the body responsible for improving medical education in the UK, recommend the use of mindfulness training to increase well-being and resilience to stress. Students participating in an eight-week mindfulness training between Autumn 2011 and Spring 2015 were invited to complete a free text survey at the end of their mindfulness course. In addition, six qualitative interviews were conducted lasting between 60 and 90 minutes. Interviews used a topic guide and were recorded and transcribed verbatim. We used the framework approach to analyse the data. Students reported a new relationship to their thoughts and feelings which gave a greater sense of control and resiliency, an ability to manage their workload better, and more acceptance of their limitations as learners. The small group context was important. Students described improved empathy and communication skills through building inner awareness of thoughts and feelings, noticing judgments, and developing attentive observation. The findings show how resiliency and coping reserve can be developed within medical education and the role of mindfulness in this process. We present a conceptual model of a learnt cycle of specific vulnerability and describe how MBCT intercepts at various junctures in this self-reinforcing cycle through the development of new coping strategies that embrace an “allowed vulnerability.”

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Influence of Postoperative Changes in Sarcopenia on Long-Term Survival in Non-Metastatic Colorectal Cancer Patients

Cancers ◽

10.3390/cancers13102410 ◽

2021 ◽

Vol 13 (10) ◽

pp. 2410

Author(s):

Chungyeop Lee ◽

In-Ja Park ◽

Kyung-Won Kim ◽

Yongbin Shin ◽

Seok-Byung Lim ◽

...

Keyword(s):

Colorectal Cancer ◽

Metastatic Colorectal Cancer ◽

Cancer Patients ◽

Medical Center ◽

The Body ◽

Term Survival ◽

Postoperative Changes ◽

Asan Medical ◽

Colorectal Cancer Patients

The effect of perioperative sarcopenic changes on prognosis remains unclear. We conducted a retrospective cohort study with 2333 non-metastatic colorectal cancer patients treated between January 2009 and December 2012 at the Asan Medical Center. The body composition at diagnosis was measured via abdominopelvic computed tomography (CT) using Asan-J software. Patients underwent CT scans preoperatively, as well as at 6 months–1 year and 2–3 years postoperatively. The primary outcome was the association between perioperative sarcopenic changes and survival. According to sarcopenic criteria, 1155 (49.5%), 890 (38.2%), and 893 (38.3%) patients had sarcopenia preoperatively, 6 months–1 year, and 2–3 years postoperatively, respectively. The 5-year overall survival (OS) (95.8% vs. 92.1%, hazard ratio (HR) = 2.234, p < 0.001) and 5-year recurrence-free survival (RFS) (93.2% vs. 86.2%, HR = 2.251, p < 0.001) rates were significantly lower in patients with preoperative sarcopenia. Both OS and RFS were lower in patients with persistent sarcopenia 2–3 years postoperatively than in those who recovered (OS: 96.2% vs. 90.2%, p = 0.001; RFS: 91.1% vs. 83.9%, p = 0.002). In multivariate analysis, postoperative sarcopenia was confirmed as an independent factor associated with decreased OS and RFS. Pre- and postoperative sarcopenia and changes in the condition during surveillance were associated with oncological outcomes.

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Impact of biomarkers and primary tumor location on the metastatic colorectal cancer first-line treatment landscape in five European countries

Future Oncology ◽

10.2217/fon-2020-0976 ◽

2021 ◽

Author(s):

George Kafatos ◽

Victoria Banks ◽

Peter Burdon ◽

David Neasham ◽

Kimberly A Lowe ◽

...

Keyword(s):

Colorectal Cancer ◽

Metastatic Colorectal Cancer ◽

Primary Tumor ◽

Treatment Strategies ◽

Treatment Decisions ◽

Tumor Location ◽

First Line ◽

Primary Tumor Location ◽

The Uk ◽

Prognostic And Predictive Factors

Background: Advances in therapies for patients with metastatic colorectal cancer (mCRC) and improved understanding of prognostic and predictive factors have impacted treatment decisions. Materials & methods: This study used a large oncology database to investigate patterns of monoclonal antibody (mAb) plus chemotherapy treatment in France, Germany, Italy, Spain and the UK in mCRC patients treated in first line in 2018. Results: Anti-EGFR mAbs were most often administered to patients with RAS wild-type mCRC and those with left-sided tumors, while anti-VEGF mAbs were preferred in RAS mutant and right-sided tumors. Adopted treatment strategies differed between countries, largely due to reimbursement. Conclusion: Biomarker status and primary tumor location steered treatment decisions in first line. Adopted treatment strategies differed between participating countries.

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A cost-utility analysis of SIR-Spheres Y-90 resin microspheres versus best supportive care in the treatment of unresectable metastatic colorectal cancer refractory to chemotherapy in the UK

Journal of Medical Economics ◽

10.1080/13696998.2020.1839273 ◽

2020 ◽

pp. 1-10

Author(s):

V. K. Brennan ◽

F. Colaone ◽

S. Shergill ◽

R. F. Pollock

Keyword(s):

Colorectal Cancer ◽

Supportive Care ◽

Metastatic Colorectal Cancer ◽

Best Supportive Care ◽

Cost Utility ◽

Cost Utility Analysis ◽

Utility Analysis ◽

Resin Microspheres ◽

The Uk ◽

Unresectable Metastatic Colorectal Cancer

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PCN87 The Cost Effectiveness of Cetuximab (Erbitux) in the Third Line Treatment of Metastatic Colorectal Cancer in the UK

Value in Health ◽

10.1016/j.jval.2011.08.1188 ◽

2011 ◽

Vol 14 (7) ◽

pp. A450

Author(s):

R. Perard ◽

Y. Samyshkin ◽

A.L.G. Guillermin

Keyword(s):

Colorectal Cancer ◽

Cost Effectiveness ◽

Metastatic Colorectal Cancer ◽

Line Treatment ◽

The Third ◽

Third Line ◽

The Uk ◽

The Cost ◽

Third Line Treatment

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Real-world experience of trifluridine/tipiracil in patients with metastatic colorectal cancer: A multicenter United Kingdom study.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.4_suppl.668 ◽

2019 ◽

Vol 37 (4_suppl) ◽

pp. 668-668

Author(s):

Chara Stavraka ◽

Athanasios Pouptsis ◽

Paul Kabuubi ◽

Vasileios Angelis ◽

Alicja Synowiec ◽

...

Keyword(s):

Colorectal Cancer ◽

Metastatic Colorectal Cancer ◽

Real World ◽

Progression Free Survival ◽

Phase Iii ◽

Line Treatment ◽

Duration Of Treatment ◽

Third Line ◽

The Uk ◽

Third Line Treatment

668 Background: TAS-102 is an orally administered combination of the thymidine-based nucleic acid analogue, trifluridine and the thymidine phosphorylase inhibitor, tipiracil hydrochloride. Following the phase III RECOURSE study, it received approval as third line treatment for metastatic colorectal cancer showing significant improvement in overall and progression free survival and an acceptable toxicity profile. Methods: We performed a multicenter retrospective observational study of patients with metastatic colorectal cancer receiving TAS-102 as third line treatment between 2016 and 2018 in Cancer centers across the UK. Results: A total of 143 patients were included (94 men, 49 women). Median age was 68 years (35-82). All patients had received at least 2 lines of fluoropyrimidine-based chemotherapy doublet with oxaliplatin or irinotecan. About 90% of patients had ECOG ≥ 1. Median duration of treatment was 2.9 months (0.5-22.9), with a response rate of 1.6% and stable disease achieved in 24%. Median OS was 7 months (95% CI 5.84-8.15) and median PFS 2.6 months (95% CI 2.2-3.36). A dose reduction was required in 28% of patients, while 8% discontinued treatment due to toxicity. AEs reported included fatigue 81.3% (G3 16.8%), nausea 34.5% (G3 4.5%) and diarrhoea 25.5% (G3 1.8%). Neutropenia was common 50.4%, (≥ G3: 25.4%) with 4.2% cases of neutropenic fever while thrombocytopenia was less frequent 8.7% (≥ G3 1.8%). Conclusions: The OS, PFS and ORR observed in our real-world experience were consistent with the RECOURSE trial, though we noted a lower disease control rate. Overall, TAS-102 was well tolerated and the most prevalent adverse events seen in our patients were in keeping with those reported in the trial. Although severe toxicities were less frequent than the trial, we experienced higher rates of toxicity induced dose reductions and treatment cessations, which could reflect the differences between trial and real world populations. Further validation is warranted.

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