Cit a tio n fo r fin al p u blis h e d ve r sio n: H a m dy, F r e d di e C., Do n ov a n, Je n ny L., La n e, J. Ath e n e , M e t c alf e, C h ri s, D avis, Mi c h a el, T u r n er, E m m a L., M a r ti n, Ric h a r d M .

This is a repository copy of Effect of robot-assisted radical cystectomy with intracorporeal urinary diversion vs open radical cystectomy on 90-day morbidity and mortality among patients with bladder cancer : a randomized clinical trial.

In the 70 years following the first description of the benefits of surgical castration, despite advances in medical therapy e.g. cabazitaxel, enzalutamide, abiraterone, androgen deprivation therapy (ADT) remains the cornerstone of treatment for advanced prostate cancer. However, with increasing numbers of men undergoing PSA testing, the disease is being diagnosed earlier and the costs of ADT, with uncertain survival benefits and associated risks, have risen dramatically. Clinical studies of potent novel agents have shown survival benefits in advanced disease, but timing, risks and cost-effectiveness of treatment remain controversial. As new agents enter clinical practice, a comprehensive research strategy is essential to optimise benefits whilst minimising harm.

Liam (2018) Interventions for promoting habitual exercise in people living with and beyond cancer. Cochrane Database of Systematic Reviews (9).

Background The COVID-19 pandemic has forced many cancer services to consider a transition to a remote format of delivery that is largely untested. Accordingly, we sought to perform a systematic review of the effects of remotely delivered interventions to improve exercise behaviour in sedentary adults living with and beyond cancer. Methods Eligible studies were randomised controlled trials comparing a remotely delivered exercise intervention to a usual care comparison in sedentary people over 18 years old with a primary cancer diagnosis. Nine electronic databases were searched from inception to November 2020. Results The review included three trials, totalling 186 participants. Two of the included trials incorporated prescriptions that meet current aerobic exercise recommendations, one of which also meets the guidelines for resistance exercise. No trials reported an intervention adherence of 75% or more for a set prescription that meets current exercise guidelines. Conclusion There is little evidence suggesting that remote exercise interventions promote exercise behaviours or improve physical function in sedentary adults living with and beyond cancer. The development and evaluation of novel remote exercise interventions is needed to establish their usefulness for clinical practice. Given the social response to the COVID-19 pandemic, further research in this area is urgently needed.

ObjectivesRandomized controlled trials (RCTs) deliver robust internally valid evidence but generalizability is often neglected. Design features built into the Prostate testing for cancer and Treatment (ProtecT) RCT of treatments for localized prostate cancer (PCa) provided insights into its generalizability.Study Design and SettingPopulation-based cluster randomization created a prospective study of prostate-specific antigen (PSA) testing and a comprehensive-cohort study including groups choosing treatment or excluded from the RCT, as well as those randomized. Baseline information assessed selection and response during RCT conduct.ResultsThe prospective study (82,430 PSA-tested men) represented healthy men likely to respond to a screening invitation. The extended comprehensive cohort comprised 1,643 randomized, 997 choosing treatment, and 557 excluded with advanced cancer/comorbidities. Men choosing treatment were very similar to randomized men except for having more professional/managerial occupations. Excluded men were similar to the randomized socio-demographically but different clinically, representing less healthy men with more advanced PCa.ConclusionThe design features of the ProtecT RCT provided data to assess the representativeness of the prospective cohort and generalizability of the findings of the RCT. Greater attention to collecting data at the design stage of pragmatic trials would better support later judgments by clinicians/policy-makers about the generalizability of RCT findings in clinical practice.

Cit a tio n fo r fin al p u blis h e d ve r sio n: Do n ov a n, Je n ny L., H a m dy, F r e d di e C., La n e , J. At h e n e , Youn g, G r a c e J., M e t c alf e, C h ri s, Wals h, El e a n o r I., D avis, Mic h a el, S t e u a r t-F eildi n g, Tho m a s , Bl az e by, Ja n e M ., Ave ry, Ke r ry N. L., M a r ti n, Ric h a r d M ., Bollin a, P r a s a d , Do bl e, An d r ew, Do h e r ty, Ala n, Gill a t t, D avi d, G n a n a p r a g a s a m , Vinc e n t, H u g h e s , O w e n , Kock el b e r g h , Ro g er, Kyn a s t o n, H o w a r d ORCID: h t t p s://o r ci d.

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