Setting Research Priorities in Partnership with Patients to Provide Patient-centred Urological Cancer Care

Rossi, Sabrina; Fielding, Alison; Blick, Christopher; Handforth, C.; Brown, Janet; Stewart, Grant D.

doi:10.1016/j.eururo.2019.03.008

Cited by 14 publications

(16 citation statements)

References 7 publications

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“…After initiating the CUPISCO trial, two publications suggested that approximately 4%–5% of CUPs show morphology and IHC consistent with mRCC in the absence of a kidney lesion [14, 15] The authors claim that patients with CUP‐mRCC should be considered for RCC‐specific therapy. Contrast‐enhanced CT/MRI is the imaging modality of choice in the diagnosis of RCC and has a median sensitivity of 88% [25]. As the treatment approaches in mRCC and CUP differ, a pathological and radiological workup is crucial for such patients.…”

Section: Discussionmentioning

confidence: 99%

“…The authors claim that CUP-mRCC patients should be considered for RCC-specific therapy. Contrast-enhanced CT/MRI is the imaging modality of choice in the diagnosis of RCC and has a median sensitivity of 88% [26]. As the treatment approaches in mRCC and CUP differ, a pathological and radiological work-up is crucial for such patients.…”

confidence: 99%

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A Challenging Task: Identifying Patients with Cancer of Unknown Primary (CUP) According to ESMO Guidelines: The CUPISCO Trial Experience

et al. 2021

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Background. CUPISCO is an ongoing randomized phase II trial (NCT03498521) comparing molecularly-guided therapy versus platinum-based chemotherapy in patients newly diagnosed with 'unfavorable' cancer of unknown primary (CUP). Patients and Methods. Patients with an unfavorable CUP diagnosis, as defined by the European Society of Medical Oncology (ESMO), and available cancer tissue for molecular sequencing are generally eligible. Potential CUP patients entering screening undergo a review involving reference histopathology and clinical work-up by a central Eligibility Review team (ERT). Patients with "favorable" CUP, a strongly suspected primary site of origin, lack of tissue, or unmet inclusion criteria are excluded. Results. As of April 30, 2020, 628 patients had entered screening and 346 (55.1%) were screen failed. Screen fails were due to technical reasons (N=89), failure to meet inclusion/exclusion criteria not directly related to CUP diagnosis (N=89) and other reasons (N=33). 124 (35.8%) patients were excluded because unfavorable adeno-or poorly differentiated CUP could not be confirmed by the ERT. These cases were classified into 3 groups ineligible due to (i) histologic subtype, such as squamous and neuroendocrine, or favorable CUP; (ii) evidence of a possible primary tumor or (iii) non-carcinoma histology. Conclusions. Experience with CUPISCO has highlighted challenges with standardized screening in an international clinical trial and the difficulties in diagnosing unfavorable CUP. Re-confirmation of unfavorable CUP by an ERT in a clinical trial can result in many reasons for screen failures. By sharing this experience, we aim to foster understanding of diagnostic challenges and improve diagnostic pathology and clinical CUP algorithms. Implications for Practice:: A high unmet need exists for improved treatment of cancer of unknown primary (CUP); however, study in a trial setting is faced with the significant challenge of definitively distinguishing CUP from other cancer types. Here we report on our experience of this challenge so far in the ongoing CUPISCO trial, which compares treatments guided by patients' unique genetic signatures versus standard chemotherapy. The data presented will aid future decision-making regarding diagnosing true CUP cases; this will have far-reaching implications in the design, execution and interpretation of

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Section: Discussionmentioning

confidence: 99%

A Challenging Task: Identifying Patients with Cancer of Unknown Primary (CUP) According to ESMO Guidelines: The CUPISCO Trial Experience

et al. 2021

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“…However, over half of all patients with kidney cancer are asymptomatic at the early stages and over a quarter have evidence of metastases by the time of diagnosis when the five‐year survival rate is only 12% 9 . This has led to international interest among the scientific and lay community in developing a potential screening programme for this ‘silent’ cancer 10,11 . As for other screening programmes, the cost‐effectiveness of any programme would be highly dependent on prevalence of kidney cancer in those screened 12 .…”

Section: Introductionmentioning

confidence: 99%

Acceptability and potential impact on uptake of using different risk stratification approaches to determine eligibility for screening: A population‐based survey

Usher‐Smith

Harvey-Kelly

Rossi

et al. 2020

Health Expectations

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Background Using risk stratification approaches to determine eligibility has the potential to improve efficiency of screening. Objectives To compare the public acceptability and potential impact on uptake of using different approaches to determine eligibility for screening. Design An online population‐based survey of 668 adults in the UK aged 45‐79 including a series of scenarios in the context of a potential kidney cancer screening programme in which eligibility was determined by age, sex, age and sex combined, a simple risk score (age, sex, body mass index, smoking status), a complex risk score additionally incorporating family history and lifestyle, or a genetic risk score. Outcome measures We used multi‐level ordinal logistic regression to compare acceptability and potential uptake within individuals and multivariable ordinal logistic regression differences between individuals. Results Using sex, age and sex, or the simple risk score were less acceptable than age (P < .0001). All approaches were less acceptable to women than men. Over 70% were comfortable waiting until they were older if the complex risk score or genetics indicated a low risk. If told they were high risk, 85% would be more likely to take up screening. Being told they were low risk had no overall influence on uptake. Conclusions Varying the starting age of screening based on estimated risk from models incorporating phenotypic or genetic risk factors would be acceptable to most individuals and may increase uptake. Patient or Public Contribution Two members of the public contributed to the development of the survey and have commented on this paper.

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“…However, they also found that only a minority (29%) had personally experienced mpMRI and that few had any knowledge of the role that mpMRI might play in any new risk-stratification process. Whilst this work helps in understanding the views that men may have about mpMRI, it does not give enough detail to shape the way that this technology is both explained and delivered in practice [13,14]. A rigorous exploration of the perceptions that men have about the accuracy and utility of mpMRI would help to contribute to the resolution of many of the uncertainties and questions that still surround its use.…”

Section: Patient Perceptions Of Prostate Mpmrimentioning

confidence: 99%

Exploring Patient Views and Acceptance of Multiparametric Magnetic Resonance Imaging for the Investigation of Suspected Prostate Cancer (the PACT Study): A Mixed-Methods Study Protocol

Norris

Kasivisvanathan

Allen

et al. 2020

MPs

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BACKGROUND: The introduction of multiparametric magnetic resonance imaging (mpMRI) has improved the diagnosis of suspected prostate cancer, accurately risk-stratifying men before a biopsy. However, pre-biopsy mpMRI represents a significant deviation from the traditional approach of prostate specific antigen testing with subsequent systematic transrectal ultrasound-guided prostate biopsy and we have not yet explored the views of men who experience this new pathway. The purpose of the PACT study (PAtient views and aCceptance of mulTiparametric MRI) is to explore men’s perceptions of mpMRI. METHODS: PACT will be conducted at teaching hospitals in which mpMRI is central to the prostate cancer diagnostic pathway using a two-phase, mixed-methods, quantitative and qualitative approach. In phase I, men referred with suspected prostate cancer will complete detailed surveys to explore their views on the mpMRI-directed pathway compared to the traditional pathway and on what constitutes ‘significant’ prostate cancer. In phase II, these themes will be expanded upon with in-depth, semi-structured interviews. Qualitative data will be transcribed and thematically analysed, and quantitative questionnaire responses will be analysed statistically. DISCUSSION: PACT will provide the first detailed insight into patient perceptions on the use and acceptability of mpMRI. Furthermore, results from PACT will help contribute to the resolution of outstanding controversies that surround this technology.

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Setting Research Priorities in Partnership with Patients to Provide Patient-centred Urological Cancer Care

Cited by 14 publications

References 7 publications

A Challenging Task: Identifying Patients with Cancer of Unknown Primary (CUP) According to ESMO Guidelines: The CUPISCO Trial Experience

A Challenging Task: Identifying Patients with Cancer of Unknown Primary (CUP) According to ESMO Guidelines: The CUPISCO Trial Experience

Acceptability and potential impact on uptake of using different risk stratification approaches to determine eligibility for screening: A population‐based survey

Exploring Patient Views and Acceptance of Multiparametric Magnetic Resonance Imaging for the Investigation of Suspected Prostate Cancer (the PACT Study): A Mixed-Methods Study Protocol

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