In Vivo Models for the Performance and Safety of BAT-90, a Novel 90-Yttrium-based Internal Radiotherapy Platform.

BACKGROUND/AIM: BAT-90 is an innovative active implantable device designed for the irradiation of unresectable tumors (e.g., liver cancer) or surgical tumor beds, based on the combination of Yttrium-90 beta-emitting microspheres and a tissue adhesive hydrogel, currently used in cardio-vascular surgery. The rationale behind BAT-90 is to localize the Yttrium-90 activity on the administration site, while minimizing its body dispersion. MATERIALS AND METHODS: The effective induction of necrosis in the target injection area was tested in a pig liver model, whereas the safety of BAT-90 was assessed and demonstrated in biocompatibility tests for acute systemic toxicity, intracutaneous reactivity, delayed hypersensitivity and subcutaneous implantation. RESULTS: BAT-90 administration induced necrosis into the target site, while the safety experiments in the treated animals highlighted results very similar to the controls. CONCLUSION: BAT-90 could be considered as a safe and innovative treatment option for inoperable solid tumors of the liver.

A Novel Injectable Hydrogel Matrix Loaded With 90Y Microspheres for the Treatment of Solid Tumors.

BACKGROUND/AIM: The need to concentrate the anti-tumoral activity of 90Y only to the targeted tumor, while minimizing its off-target effects, led to the development of an innovative device (BAT-90) composed of a hydrogel matrix and 90Y microspheres. MATERIALS AND METHODS: This in vivo randomized study was planned to assess the efficacy, safety, and biodistribution of BAT-90 in 46 rabbits implanted with a VX2 tumor. The effects of BAT-90 were compared to those of 90Y microspheres and the hydrogel matrix. RESULTS: BAT-90 localized effectively the 90Y radiation in the injection site, minimizing dispersion of the microspheres in the target and distant organs of the treated animals. CONCLUSION: BAT-90 can be administered as an adjuvant treatment to clear surgical margins from any potential minimal residual disease, or as an alternative to other loco-regional treatments for non-resectable tumors.

Analysing the attributes of Comprehensive Cancer Centres and Cancer Centres across Europe to identify key hallmarks.

There is a persistent variation in cancer outcomes among and within European countries suggesting (among other causes) inequalities in access to or delivery of high-quality cancer care. European policy (EU Cancer Mission and Europe's Beating Cancer Plan) is currently moving towards a mission-oriented approach addressing these inequalities. In this study, we used the quantitative and qualitative data of the Organisation of European Cancer Institutes' Accreditation and Designation Programme, relating to 40 large European cancer centres, to describe their current compliance with quality standards, to identify the hallmarks common to all centres and to show the distinctive features of Comprehensive Cancer Centres. All Comprehensive Cancer Centres and Cancer Centres accredited by the Organisation of European Cancer Institutes show good compliance with quality standards related to care, multidisciplinarity and patient centredness. However, Comprehensive Cancer Centres on average showed significantly better scores on indicators related to the volume, quality and integration of translational research, such as high-impact publications, clinical trial activity (especially in phase I and phase IIa trials) and filing more patents as early indicators of innovation. However, irrespective of their size, centres show significant variability regarding effective governance when functioning as entities within larger hospitals.

Outcome Measures in Online Educational Videos.

As an education charity, it is vital for ecancer to understand how effective its educational videos are as educational tools. This includes understanding what effect the funding of the production of the video has, whether it was funded through an unrestricted educational grant from industry or it was funded by ecancer itself through its charitable funds. In this article, we have looked at four viewer engagement and satisfaction ratings in order to examine any differences. One hundred and twenty-three videos were examined in total recorded at six separate conferences over two years.

Mapping the cancer patient information landscape: A comparative analysis of patient groups across Europe and North America.

AIM: Little is known about how patient groups provide information for patients. We invited 838 patient groups from Europe and North America to participate in an online survey. METHODS: The survey covered: (i) availability, accessibility and quality of information provided; (ii) methods by which patient groups communicate; (iii) ways in which patient groups acquire information and confirm its veracity/accuracy; (iv) how people access information online. RESULTS: European patient groups were significantly less effective in providing medical-related information than their North American counterparts in: clinical trials, potential causes of cancer, medical research, diagnosis/screening, symptoms, treatments (all p < 0.0001); Recommendations of best practice/care (p < 0.03), healthcare services(p = 0.029) and complimentary medicine (p = 0.01). Clinical trials (p = 0.0006), medical research (p = 0.006) and diagnosis/screening (p = 0.0024) were also areas where North American patients were more likely to require medical-related information. Similar patterns emerged for non-medical information with nutrition (<0.0001), watchful waiting (p = 0.0003), self-management of care (p = 0.0003), prevention (p = 0.002) and emotional issues (p = 0.016) being less effectively communicated by European patient groups. Nutrition was also an area where North American patients were more likely to require non-medical-related information. The main barriers in accessing online information which showed differences between European and North American patients were: perceived lack of need, mainly due to faith in their doctors (p = 0.0001); limited access to the internet (p = 0.0005), limited computer skills (p = 0.02); and lower income (p = 0.027). CONCLUSION: These results emphasise the more mature nature of cancer patient engagement/information provision in North America, providing valuable insights and guidance to inform development of more robust and effective cancer patient information communication platforms in Europe.

Highlights from the ecancer Future Horizons in Lung Cancer conference, 1-2 September 2016: Focusing on the future of treatment for NSCLC and SCLC.

The 'Future Horizons in Lung Cancer' meeting was designed to bring leading scientists together alongside clinicians to discuss the most recent advances in lung cancer pathophysiology and treatment. The aim was to take those attending the event on a journey through decades of lung cancer research and understanding, with topics spanning from screening and surgical care to "omics" approaches for drug target and biomarker discovery. There were also several talks describing the role of radiotherapy in lung cancer and advancements in imaging techniques, aiding surgeons in their attempts to resect early lesions. Current standards of care were both challenged and celebrated, while new and innovative immunotherapies also came into the spotlight. The meeting, held over two days, attracted a high calibre of speakers and delegates from across the globe. There were 10 sessions in total focusing on the latest therapeutic advances and predictions for the future of lung cancer treatment. Highlights included a key note lecture from Dr Frances Shepherd packing 40 years of lung cancer research into a 40-minute presentation. Heated debates were had regarding the validity of maintenance therapy and immune checkpoint inhibitors that have taken the research community by storm. The latest developments in imaging, surgery, systemic and radiotherapy were presented over 10 sessions of exciting, innovative and stimulating presentations, leaving the audience lively yet pensive.

A web-based interactive tool to improve breast cancer patient centredness.

The uniqueness of a patient as determined by the integration of clinical data and psychological aspects should be the aspired aim of a personalized medicine approach. Nevertheless, given the time constraints usually imposed by the clinical setting, it is not easy for physicians to collect information about the patient's unique mental dimensions and needs related to her illness. Such information may be useful in tailoring patient-physician communication, improving the patient's understanding of provided information, her involvement in the treatment process, and in general her empowerment during and after the therapeutic journey. The primary objective of this study is to evaluate the effect of an interactive empowerment tool (IEm) on enhancing the breast cancer patient-physician experience, in terms of increasing empowerment, i.e. by providing physicians with a personalised patient's profile, accompanied by specific recommendations to advise them how to interact with each individual patient on the basis of her personal profile. The study will be implemented as a two-arm randomised controlled trial with 100 adult breast cancer patients who fill in the ALGA-BC questionnaire, a computerised validated instrument to evaluate the patient's physical and psychological characteristics following a breast cancer diagnosis. The IEm tool will collect and analyse the patient's answers in real time and send them, together with specific recommendations to the physician's computer immediately before physician's first encounter with the patient. Patients will be randomised to either the intervention group using the IEm tool or to a control group who will only fill in the questionnaire without taking advantage of the tool (physicians will not receive the patient's profile). The proposed approach is supposed to improve the patient-physician communication leading to increased patient participation in the therapeutic process as a consequence leading to improvement in patient empowerment and personalisation of care.

Lessons from the first ecancer symposium on angiogenesis in gastric cancer.

In March 2015, ecancer hosted a symposium at the European Institute of Oncology in Milan, Italy on the topic of angiogenesis in gastric cancer. During this meeting, leaders in the field focused on the latest research on the topic of angiogenesis in gastric cancer, delivering lectures combined with interactive question and answer (Q & A) sessions and a roundtable discussion with the meeting's chairs. Topics covered included biomarkers, imaging, and the current state of antiangiogenic drugs in gastric cancer. This report will provide an understanding of the relevance of angiogenesis in gastric cancer research, and clinical experiences from diverse perspectives.

Development and psychometric testing of a breast cancer patient-profiling questionnaire.

INTRODUCTION: The advent of "personalized medicine" has been driven by technological advances in genomics. Concentration at the subcellular level of a patient's cancer cells has meant inevitably that the "person" has been overlooked. For this reason, we think there is an urgent need to develop a truly personalized approach focusing on each patient as an individual, assessing his/her unique mental dimensions and tailoring interventions to his/her individual needs and preferences. The aim of this study was to develop and test the psychometric properties of the ALGA-Breast Cancer (ALGA-BC), a new multidimensional questionnaire that assesses the breast cancer patient's physical and mental characteristics in order to provide physicians, prior to the consultation, with a patient's profile that is supposed to facilitate subsequent communication, interaction, and information delivery between the doctor and the patient. METHODS: The specific validation processes used were: content and face validity, construct validity using factor analysis, reliability and internal consistency using test-retest reliability, and Cronbach's alpha correlation coefficient. The exploratory analysis included 100 primary breast cancer patients and 730 healthy subjects. RESULTS: The exploratory factor analysis revealed eight key factors: global self-rated health, perceived physical health, anxiety, self-efficacy, cognitive closure, memory, body image, and sexual life. Test-retest reliability and internal consistency were good. Comparing patients with a sample of healthy subjects, we also observed a general ability of the ALGA-BC questionnaire to discriminate between the two. CONCLUSION: The ALGA-BC questionnaire with 29 items is a valid instrument with which to obtain a patient's profile that is supposed to help physicians achieve meaningful personalized care which supplements biological and genetic analyses.

PACE Continuous Innovation Indicators-a novel tool to measure progress in cancer treatments.

Concerns about rising health care costs and the often incremental nature of improvements in health outcomes continue to fuel intense debates about 'progress' and 'value' in cancer research. In times of tightening fiscal constraints, it is increasingly important for patients and their representatives to define what constitutes 'value' to them. It is clear that diverse stakeholders have different priorities. Harmonisation of values may be neither possible nor desirable. Stakeholders lack tools to visualise or otherwise express these differences and to track progress in cancer treatments based on variable sets of values. The Patient Access to Cancer care Excellence (PACE) Continuous Innovation Indicators are novel, scientifically rigorous progress trackers that employ a three-step process to quantify progress in cancer treatments: 1) mine the literature to determine the strength of the evidence supporting each treatment; 2) allow users to weight the analysis according to their priorities and values; and 3) calculate Evidence Scores (E-Scores), a novel measure to track progress, based on the strength of the evidence weighted by the assigned value. We herein introduce a novel, flexible value model, show how the values from the model can be used to weight the evidence from the scientific literature to obtain E-Scores, and illustrate how assigning different values to new treatments influences the E-Scores. The Indicators allow users to learn how differing values lead to differing assessments of progress in cancer research and to check whether current incentives for innovation are aligned with their value model. By comparing E-Scores generated by this tool, users are able to visualise the relative pace of innovation across areas of cancer research and how stepwise innovation can contribute to substantial progress against cancer over time. Learning from experience and mapping current unmet needs will help to support a broad audience of stakeholders in their efforts to accelerate and maximise progress against cancer.

A golden anniversary: highlights of the 50th annual meeting of the American Society of Clinical Oncology.

The 50th Annual Meeting of the American Society of Clinical Oncology showed a shift in the culture of cancer research, moving towards multidisciplinary, integrated, and patient-centric work. Hormone-sensitive cancers were particularly highlighted at this meeting, and impressive strides were made in the previously underserved areas of the lung and thyroid cancer. Interestingly, immunotherapy was one of the strongest themes to emerge.

Development of interactive empowerment services in support of personalised medicine.

In an epoch where shared decision making is gaining importance, a patient's commitment to and knowledge about his/her health condition is becoming more and more relevant. Health literacy is one of the most important factors in enhancing the involvement of patients in their care. Nevertheless, other factors can impair patient processing and understanding of health information: psychological aspects and cognitive style may affect the way patients approach, select, and retain information. This paper describes the development and validation of a short and easy to fill-out questionnaire that measures and collects psycho-cognitive information about patients, named ALGA-C. ALGA-C is a multilingual, multidevice instrument, and its validation was carried out in healthy people and breast cancer patients. In addition to the aforementioned questionnaire, a patient profiling mechanism has also been developed. The ALGA-C Profiler enables physicians to rapidly inspect each patient's individual cognitive profile and see at a glance the areas of concern. With this tool, doctors can modulate the language, vocabulary, and content of subsequent discussions with the patient, thus enabling easier understanding by the patient. This, in turn, helps the patient formulate questions and participate on an equal footing in the decision-making processes. Finally, a preview is given on the techniques under consideration for exploiting the constructed patient profile by a personal health record (PHR). Predefined rules will use a patient's profile to personalise the contents of the information presented and to customise ways in which users complete their tasks in a PHR system. This optimises information delivery to patients and makes it easier for the patient to decide what is of interest to him/her at the moment.

Discordance between cancer prevalence and training: a need for an increase in oncology education.

The impact of cancer on healthcare is increasing. Therefore, it is key that all doctors receive oncology training. This study surveyed UK undergraduate medical schools to determine the extent of oncology training provided by their curricula. Data on foundation year (FY) and core medical training (CMT) programmes were obtained and analysed for the proportion of oncology posts. Of the responding medical schools, five (36%) had a defined period dedicated to oncology (mean 2 weeks). Four foundation schools were in London, with 10,094 FY posts in 1699 programmes. Of these, 1.5% of post and 8.7% of programmes were in oncology. For CMT offered by the London deanery specialty schools, 11% of CMT post and 48% of programmes included oncology. Oncology was included in 11% posts and 48% programmes offered by the London Deanery specialty schools. Our results show that < 50% of junior doctors receive dedicated undergraduate or postgraduate oncology training. An increase in oncology training is therefore urgently required.

Meeting the current and future challenges of oncology drug development.

This breakout session highlighted four distinct perspectives from leading individuals within patient advocacy, industry, an appraisal committee and physicians on the future and challenges faced by targeted therapy in HTA evaluation. Bringing together leaders from key stakeholders in the process, it gave participants the opportunity to examine how the same HTA evaluation process is interpreted from multiple perspectives. The presentation of an industry supported "Six Nation Public Opinion Survey of Cancer Knowledge and Attitudes" provided detailed insight into how the general public, patients and caregivers view cancer alongside various available and possible future therapies. An interactive 'perspectives activity' session provided all participants with an opportunity to think through and discuss the HTA process, and its challenges, from the four distinct positions involved. We declare that we have no conflicts of interest.

Understanding the impact of public policy on cancer research: a bibliometric approach.

With global spend on cancer research from the public sector now in excess of 14 billion euro, as well as the increasing burden of disease in market economies and low-middle income countries through changing demographics (ageing and population growth) cancer is now one of the most complex and global public policy issues. Using novel bibliometrics we have sought to investigate changes in research activity (total output), relative commitment and collaborations between countries/regions with similar healthcare and population and development parameters - United Kingdom, France, Germany, Canada and Sweden - to assess the utility of this policy research approach by analysing two different cohorts (1995-1999 and 2000-2004) to study the impact of changes on research publications as a surrogate for overall research activity.