Linnea Olson: An Appreciation of a Giant (Preprint)

UNSTRUCTURED Reviewing the life and impact of the late Linnea Olson, a cancer patient advocate who helped shape cancer clinical trials

Perspectives and Expertise in Establishing a Therapeutic Drug Monitoring Programme for Challenging Childhood Cancer Patient Populations

The utility of Therapeutic Drug Monitoring (TDM) in the setting of childhood cancer is a largely underused tool, despite the common use of cytotoxic chemotherapeutics. While it is encouraging that modern advances in chemotherapy have transformed outcomes for children diagnosed with cancer, this has come at the cost of an elevated risk of life-changing long-term morbidity and late effects. This concern can limit the intensity at which these drugs are used. Widely used chemotherapeutics exhibit marked inter-patient variability in drug exposures following standard dosing, with fine margins between exposures resulting in toxicity and those resulting in potentially suboptimal efficacy, thereby fulfilling criteria widely accepted as fundamental for TDM approaches. Over the past decade in the UK, the paediatric oncology community has increasingly embraced the potential benefits of utilising TDM for particularly challenging patient groups, including infants, anephric patients and those receiving high dose chemotherapy. This has been driven by a desire from paediatric oncologists to have access to clinical pharmacology information to support dosing decisions being made. This provides the potential to modify doses between treatment cycles based on a comprehensive set of clinical information, with individual patient drug exposures being used alongside clinical response and tolerability data to inform dosing for subsequent cycles. The current article provides an overview of recent experiences of conducting TDM in a childhood cancer setting, from the perspectives of the clinicians, scientists and pharmacists implementing TDM-based dosing recommendations. The ongoing programme of work has facilitated investigations into the validity of current approaches to dosing for some of the most challenging childhood cancer patient groups, with TDM approaches now being expanded from well-established cytotoxic drugs through to newer targeted treatments.

Merging existing practices with new ones: the adjustment of organizational routines to using cancer patient pathways in primary healthcare

Background The introduction of new tools can bring unintended consequences for organizational routines. Cancer Patient Pathways (CPP) were introduced into the Swedish healthcare system in 2015 to shorten time to diagnosis and treatment. Primary healthcare (PHC) plays a central role since cancer diagnosis often begins in PHC units. Our study aimed to understand how PHC units adjusted organizational routines to utilizing CPPs. Method Six PHC units of varied size from both urban and rural areas in northern Sweden were included. Grounded theory method was used to collect and analyse group interviews at each unit. Nine group interviews with nurses and physicians, for a total of 41 participants, were performed between March and November 2019. The interviews focused on CPPs as tools, the PHC units’ routines and providers’ experiences with using CPPs in their daily work. Results Our analysis captured how PHC units adjusted organizational routines to utilizing CPPs by fusing existing practices with new practices to offer better quality of care. Specifically, three overarching organizational routines within the PHC units were identified. First, Manoeuvring diverse patient needs with easier patient flow, the PHC units handled the diverse needs of the population while simultaneously drawing upon CPPs to ease the patient flow within the healthcare system. Second, (Dis) integrating internal know-how, the PHC units drew upon internal competence even when PHC know-how was not taken into account by those driving the CPP initiative. Third, Coping with unequal relationships toward secondary care, the PHC units dealt with being in an unequal position while adopting CPPs instead further decreased possibilities to influence decision-making between care-levels. Conclusion Adopting CPPs as a tool within PHC units brought various unintended consequences in organizational routines. Our study from northern Sweden illustrates that the PHC know-how needs to be integrated into the healthcare system to improve the use of new tools as CPP. Further, the relationships between different levels of care should be taken in account when introducing new tools for healthcare. Also, when adopting innovations, unintended consequences need to be further explored empirically in diverse healthcare contexts internationally in order to generate deeper knowledge in the research area.

Combining MALDI-MS with Machine Learning for Metabolomic Characterization of Lung Cancer Patient Sera

An increasing amount of evidence have proven that serum metabolites can instantly reflect disease states. Therefore, sensitive and reproducible detection of serum metabolites in a high-throughput way is urgently desirable...

The Era of Covid-19; Its’ Impact on Cancer Patient Experience in Southwest Nigeria

Patients have developed a well-informed sense of validation concerning maintaining hygiene standards. The pandemic, somehow in disguise, presented the valuable perspective of life reflection and gratitude. The attitude of a majority of patients engaged was immensely that of a deep reflection of the privilege of having access to early diagnosis, treatment, and adequate support. However, the complaints of the past, knowing that they are alive and have hope to keep fighting on with gratitude and sense of acceptance. However, they wished that the experience of the social media – health engagement platform should continue as it provided a good level of the bridge of gap of information. The cost of treatment remains a major concern as it largely translates to possible dropout from treatment courses for most cancer patients who can’t afford the current cost. The concerns of the cancer patients and survivors during and after the covid-19 pandemic are similarly a concern to public health professionals worldwide. The need to aid their return to routine health care services is more important and therefore requires an urgent reorganization of cancer management services. An urgent intervention should be focused on patient re-orientation /pandemic control, staff training and retraining, awareness campaign, screening and result accessibility, special pandemic services, amongst others. The outcome reflected a very huge level of poor cancer patient experience in the public cancer treatment centres, while the reverse is the case with the private cancer treatment centres. This can be managed if an urgent intervention as proffered is implemented.