ERANET JTC 2011: Submission and Activation of an International Academic Translational Project in Advanced Breast Cancer. Experience From the ET-FES Study

Background: Academic research is important to face unmet medical needs. The Oncological community encounters many hurdles in setting up multicenter investigator-driven trials mainly due to administrative complexity. The purpose of a network organization at a multinational level is to facilitate clinical trials through standardization, coordination, and education for drug development and regulatory approval.Methods: The application of an European grant foresees the creation of a consortium which aims at facilitating multi-center academic clinical trials.Results: The ERA-NET TRANSCAN Call 2011 on “Validation of biomarkers for personalized cancer medicine” was released on December 2011. This project included Italian, Spanish, French and German centers. The approval process included Consortium constitution, project submission, Clinical Trial Submission, and activation on a national level. The different timescales for submitting study documents in each Country and the misalignment of objections by each Competent Authority CA, generated several requests for changes to the study documents which meant amendments had to be made; as requested by the 2001/20/EC Directive, the alignment of core documents is mandatory. This procedure impacted significantly on study activation timelines. Time to first patient in was 14, 10, 28, and 31 months from the date of submission in Italy, France, Spain, and Germany, respectively. Accrual was stopped on 22nd January 2021 due to an 18F FES shortage as the primary reason but also for having exceeded the project deadlines with consequent exhaustion of the funds allocated for the project.Conclusions: Pharmaceutical companies might be reluctant to fund research projects aimed at treatment individualization if the approval for a wider indication has already been achieved. Academic trials therefore become fundamental for promoting trials which are not attractive to big pharma. It was very difficult and time consuming to activate an academic clinical trial, for this reason, a study may become “old” as new drugs entered into the market. National institutions should promote the development of clinical research infrastructures and network with competence in regulatory, ethical, and legal skills to speed up academic research.

This is what life with cancer looks like: exploring experiences of adolescent and young adults with cancer using two visual approaches

Introduction Talking about illness experience can be challenging for adolescents and young adults (AYAs) with cancer. Visual tools, in addition to spoken language, might make this easier, such as rich pictures and photovoice. We aimed to obtain a comprehensive view of the cancer experience of AYAs by using rich pictures and photovoice. Methods AYAs (18–35 years old) who had any type of cancer, or were in remission from cancer, were eligible. AYAs drew rich pictures about their experience of living with cancer and explained these during subsequent interviews. Some of the AYAs also participated in photovoice and spent two days with a photographer to make photos about their illness experience. Rich pictures and photos were first analyzed separately, using open coding, after which the identified themes were compared. Results Twelve AYAs made rich pictures (RPs), of whom seven also participated in photovoice. The two most predominant themes emerging from the data were struggles related to the future and defining one’s identity. The AYAs expressed concerns for the future related to relationships, education, and employment. Relating to defining one’s identity, many AYAs expressed that the cancer had a negative impact on their body- and self-image. The main themes were visible in the RPs as well as in the photovoice; however, subtle differences in sub-themes were found. Conclusions We found that cancer has an effect on many aspects of AYAs’ lives. Further research on how the identified themes play a role in the lives of AYAs with cancer is needed.

Coping in patients with pancreatic cancer: a scoping review and narrative synthesis

IntroductionPancreatic cancer is a malignant disease with one of the highest cancer-specific mortality rates. Coping with it probably differs from other malignant diseases. This scoping review was intended to explore and characterise academic literature related to the coping in patients with pancreatic cancer.MethodsEight databases were searched for primary and secondary studies and reviews reporting on coping with pancreatic cancer (adenocarcinoma) in adults in English or German language, regardless of publication date or study design, which were then analysed and summarised by narrative synthesis.ResultsOf 1472 publications identified, 9 articles and book contributions published from 1989 to 2020 in the USA, Europe and Australia met the inclusion criteria. The two main aspects covered were the confrontation with coping tasks, and the reciprocally associated coping with these challenges. In particular, the coping tasks revealed some pancreatic cancer-specific features, such as an increased incidence of depression and anxiety or certain digestive problems, whereas applying of coping strategies seems to be more like the coping behaviours known from the literature for other severe or cancer diseases.ConclusionsPatients with pancreatic cancer experience various health issues and face various quality of life changes and coping tasks. Disease-specific contextual factors, usually consisting of late diagnosis at an advanced stage, rapid progression and often poor prognosis, as well as disease-specific challenges are major differences compared with other malignancies or serious illnesses. However, the coping strategies applied do not seem to differ in principle. Currently, no pancreatic cancer-specific coping model exists.

P-OGC40 Enhanced recovery after oesophagectomy at Oxford University Hospitals: the benefit of having a discharge target

Background Enhanced recovery after surgery (ERAS) is a multimodal approach to decreasing morbidity and accelerating return-of-function after major surgery. However, the majority of patients undergoing oesophagectomy for cancer experience some kind of complication, which extends their admission and causes pathway deviation. Thus, the value of having a discharge target (Day 8 at our institution) could be challenged. In this study we reviewed our experience using this pathway, with a focus on: (i) whether length of stay and morbidity has improved since pathway implementation (ii) describing the medical and non-medical reasons for extended admission (iii) identifying pre-operative predictors of pathway deviation. Methods A retrospective review of a prospectively maintained database was performed. Complications are recorded during routine clinical care using standardised definitions set out by the Esophageal Complications Consensus group, and are updated in the database at a weekly departmental meeting. Median and interquartile range were used for descriptors and differences tested with Mann-Whitney U test or Chi squared tests, using SPSS ver 26. Multivariable models were fitted to establish independent predictors of pathway deviation, using a binary logistic regression approach with bootstrapping. Results 150 of 448 patients met the 8-day target. Patients treated since 2018 were significantly more likely meet their discharge date (OR 1.28, P = 0.041) compared to 2015-2017, and have less complications. Surgical quality was unchanged. Thirty-day mortality increased but was still low (0.9% vs 1.8%, P = 0.067). Aside from having a complication (OR 4.15, P < 0.001), independent predictor of delayed discharge was female sex (OR 2.6, P = 0.003), squamous cell cancer histology (OR 2.8, P = 0.014) and low socio-economic status (OR 1.33, P = 0.014), but not age, smoking, BMI, co-morbidities and other baseline variables. Conclusions Enhanced recovery after oesophagectomy provides clear goals for the patient and multi-disciplinary team, however the target is often not met owing to the frequent nature of post-operative complications. Nonetheless these targets provide a culture for accelerated recovery, with steady improvement in short-term outcomes over time. A number of specific patient-groups are more likely to have extended admissions independent of complications, which has implications for optimising prehabilitation services. Overall , these findings suggest that having a discharge target is valuable, even though it often is not met.

The Intersection of Cancer, Geriatrics, and Gerontology: A Multidisciplinary Approach Across the Cancer Continuum

Despite the majority of cancer survivors being older adults, the connection between oncology, geriatrics, and gerontology remains unexplored. Our symposium will provide insights across the cancer continuum from prevention through survivorship as well as a comprehensive view of the connection between gerontological and geriatric factors in oncology. Specifically, we will discuss the biopsychosocial and behavioral factors among older adults with cancer, their effect on health outcomes, and how researchers and clinicians can intervene to improve health outcomes. The first abstract by Dr. Cadet found that despite a lack of knowledge of options and harms of cancer screening among older adults with low health literacy, there was a desire to understand more to better their health. The second abstract by Dr. Bhattacharyya found that older patients with cancer experience high levels of social isolation, loneliness, and fear that are heightened by individual and technology-based barriers to telehealth. The third abstract by Dr. Carroll found that breast cancer survivors with good sleep quality had less accelerated biological aging than those with sleep problems. The fourth abstract by Dr. Krok-Schoen utilized one of the largest datasets of older women, the Women’s Health Initiative, and found multiple gerontological and geriatric factors associated with physical activity among older female cancer survivors. Closing this symposium is Dr. Guida, a Program Director at the National Cancer Institute (NCI), who will profile the current research efforts, programmatic priorities, and current funding in aging and cancer. These multidisciplinary researchers and clinicians will provide a comprehensive symposium regarding geriatric oncology.

TRIPLE NEGATIVE BREAST CANCER, EXPERIENCE OF MILITARY HOSPITAL RABAT: ABOUT 52 CASES

Objective: to review the epidemiological, clinical, anatomopathological, biological, therapeutic and prognostic characteristics of this histo-prognostic subgroup, namely triple-negative breast cancer Material and Method: Our work consists of a retrospective study carried out at the military hospital of instruction Med v rabat between January 2010 and December 2017 on 52 cases of invasive breast carcinoma with a triple negative phenotype. Result: From an epidemiological point of view: a peak in frequency was noted between 45 and 50 years old, and 48.1% of patients still in genital activity. On the anatomo-pathological level: invasive ductal carcinoma is the most predominant type representing 68.3% of cases with an average tumor size of 30mm. Histopronostic grades II and III each represent 43.2% and 56.8% of cases. Therapeutically: more than 42.3% received conservative treatment and 57.7% underwent radical surgery of the Pateytype.Adjuvant systemic chemotherapy was given in 86.5% of cases and 5.8% received neoadjuvant chemotherapy On the evolutionary level, 17.3% or 9 cases developed systemic metastases with predilection for the lungs. Conclusion: Despite advances in treatments and the emergence of targeted therapies, breast cancer remains the leading cause of death in women. Current clinical and histological classifications do not fully establish the prognostic and predictive parameters of response to treatment.

Couples Coping with Cancer: Implications of Adaptive Process and Relationship Outcomes in Recent Findings for Marriage and Family Therapists and Medical Family Therapists

The majority of patients with cancer experience clinically significant levels of distress (Dyson et al., 2012; Kwak et al., 2013; Yanez, Garcia, Victorson, & Salsman, 2013) that varies by age at diagnosis, cancer type, and psychosocial needs. Across multiple oncology studies, it has been reported that relationships with family and friends are important sources of support throughout the cancer experience (e.g., Goodall, King, Ewing, Smith, & Kenny, 2012; Miedema, Zebrack, 2011). However, a close relationship can also be a source of distress for patients with cancer, particularly those who are emotionally unavailable or unable to handle stress (Synder & Pearse, 2010; Zebrack, Chesler, & Kaplan, 2010). Contributors to the oncology literature suggested that distress levels between patients and their partners are interrelated (Gregorio et al., 2012; Juth et al., 2015; Kim & Given, 2008; Segrin et al., 2007). Dyadic research that includes patients and their partners is necessary for developing programs and interventions better targeted at meeting patients’ and their partners’ needs. Yet, these factors and the exploration of adaptive processes have not been examined among couples who are facing cancer. In light of these facts, several implications are provided for clinical practice, future research, policy, and the field of medical family therapy based on the above-mentioned studies (Rajaei & Jensen, 2020; Rajaei et al., 2021a).

“Based on a true story” podcast: a journey into the world of young patients with cancer

This article describes a creative project undertaken by a group of adolescent and young adult patients with cancer as part of the Milan’s Youth Project, a scheme dedicated to young patients with cancer with the dual aim of optimizing medical aspects of their care and promoting a holistic approach to their needs. The project was based on audio recordings and focused on the theme of “the journey,” such as a holiday or an adventure, or as a metaphor of the cancer experience. The podcast installments were published on the main streaming platforms. Talking about their disease and how they feel is of importance for young patients to process their feelings surrounding the cancer experience and to find the inner resources they need to facilitate coping.