No abstract

IntroductionSurgery is the standard of care for early-stage lung cancer, with stereotactic ablative body radiotherapy (SABR) a lower morbidity alternative for patients with limited physiological reserve. Comparisons of outcomes between these treatment options are limited by competing comorbidities and differences in pre-treatment pathological information. This study aims to address these issues by assessing both overall and cancer-specific survival for presumed stage I lung cancer on an intention-to-treat basis.MethodsThis retrospective intention-to-treat analysis identified all patients treated for presumed stage I lung cancer within a single large UK centre. Overall survival, cancer-specific survival, and combined cancer and treatment-related survival were assessed with adjustment for confounding variables using Cox proportional hazards and Fine–Gray competing risks analyses.Results468 patients (including 316 surgery and 99 SABR) were included in the study population. Compared with surgery, SABR was associated with inferior overall survival on multivariable Cox modelling (SABR HR 1.84 (95% CI 1.32–2.57)), but there was no difference in cancer-specific survival (SABR HR 1.47 (95% CI 0.80–2.69)) or combined cancer and treatment-related survival (SABR HR 1.27 (95% CI 0.74–2.17)). Combined cancer and treatment-related death was no different between SABR and surgery on Fine–Gray competing risks multivariable modelling (subdistribution hazard 1.03 (95% CI 0.59–1.81)). Non-cancer-related death was significantly higher in SABR than surgery (subdistribution hazard 2.16 (95% CI 1.41–3.32)).ConclusionIn this analysis, no difference in cancer-specific survival was observed between SABR and surgery. Further work is needed to define predictors of outcome and help inform treatment decisions.

Inflammatory bowel disease (IBD) affects many women of childbearing age. The course of IBD is closely related to pregnancy outcomes with poorly controlled IBD increasing the risk of prematurity, low weight for gestation, and fetal loss. As such, women with IBD face complex decision making weighing the risks of active disease versus those of medical treatments. This review summarizes the current evidence regarding the safety and efficacy of IBD treatments during pregnancy and lactation aiming to provide up-to-date guidance for clinicians. Over 50% of women have poor IBD- and pregnancy-related knowledge, which is associated with views contrary to medical evidence and voluntary childlessness. This review highlights the effects of poor patient knowledge and critically evaluates interventions for improving patient knowledge and outcomes.

No abstract

IntroductionThe non-vitamin k antagonist (VKA) oral anticoagulants (NOAC) comprise inhibitors of thrombin and factor Xa. They are being increasingly used in patients requiring long-term anticoagulation due to non-inferiority and relative ease of use when compared to VKA and low molecular weight heparin (LMWH). Prospective randomised studies testing the efficacy of NOACs have shown a possible increased risk of gastrointestinal (GI) bleeding. To clarify the risk of GI bleeding we performed a systematic review and Bayesian network meta-analysis.MethodsWe followed a pre-specified and peer reviewed PRISMA extension guidelines and checklist for reporting systematic reviews and network meta-analyses. A comprehensive search of the literature was performed to identify any study, prospective or retrospective, which compared NOAC with VKA or LMWH and reported on GI bleeding. Studies on all indications for these medications were included. We did not include studies which compared against placebo or antiplatelet medication. We performed a Bayesian random effects regression model. To estimate the effect of NOAC on GI bleeding we calculated incidence rate ratios (IRR) based on the number of patient years exposed to the medication. We grouped medications together by mechanism of action; VKA, LMWH, thrombin inhibitor or factor Xa inhibitor. Pre-planned subgroup analyses were performed on; indication, population, study design, GI bleed definition and NOAC dose.Abstract OC-016 Figure 1ResultsWe identified 35 studies reporting on 481, 534 patients exposed to 405, 026 patient years of anticoagulant medication. The overall GI bleeding incidence was 1.3 events per 100 patient years. We found no difference in the incidence rate of major GI bleeding when comparing NOAC medications with VKA and LMWH. This results was sustained on sensitivity analyses comparing observational and prospective trial data, the indication for anticoagulation and prophylactic versus therapeutic doses. When analysing all severities of GI bleeding, we found a statistically significant reduction when comparing Xa inhibitors with VKA (IRR 0.20, 95% CrI 0.05–0.65), and thrombin inhibitors (IRR 0.20, 95% CrI 0.05–0.67) respectively.ConclusionWe have shown that there is no difference in the risk of major GI bleeding when comparing NOAC, VKA and LMWH anticoagulation medications. There is a significant reduction in all GI bleeding events with the use of factor Xa inhibitors when compared to VKA and direct thrombin inhibitors.Disclosure of InterestNone Declared