Objective: Little is understood about the anxiety experienced by cancer patients undergoing radiotherapy or investigative imaging. Our aim was to identify sources of anxiety, the points along the cancer journey where anxiety occurred and methods to alleviate it.Methods: Six focus groups were conducted with cancer patients (n = 17), caregivers (n = 3) and healthcare practitioners (HCPs; n = 10) in the radiotherapy department.Patients described specific elements in the care pathway which induced anxiety, while HCPs focused on their perception of the patient experience. Thematic analysis was used to analyse data.Results: Three broad themes emerged: The Environment, The Individual and The Unknown. The physical environment of the hospital, inside the scanner for example, emerged as a key source of anxiety. The impact of cancer on patients' individual lives was significant, with many feeling isolated. The majority of participants described anxiety associated with the unknown. HCPs reported difficulty in identifying the anxious patient.Conclusions: Anxiety is experienced throughout the cancer pathway. Common sources include the physical environment and the uncertainty associated with having cancer. Identifying both anxiety-inducing factors, and the anxious patients themselves, is crucial to enable targeted interventions to alleviate anxiety.

Summary Background To assess the outcomes of patients with early esophageal cancer and high-grade dysplasia comparing esophagectomy, the historical treatment of choice, to endoscopic eradication therapy (EET). Methods Retrospective cohort study of consecutive patients with early esophageal cancer/high-grade dysplasia, treated between 2000 and 2018 at a tertiary center. Primary outcomes were all-cause and disease-specific mortality assessed by multivariable Cox regression and a propensity score matching sub analysis, providing hazard ratios (HR) with 95% confidence intervals (CI) adjusted for age, tumor grade (G1/2 vs. G3), tumor stage, and lymphovascular invasion. Secondary outcomes included complications, hospital stay, and overall costs. Results Among 269 patients, 133 underwent esophagectomy and 136 received EET. Adjusted survival analysis showed no difference between groups regarding all-cause mortality (HR 1.85, 95% CI 0.73, 4.72) and disease-specific mortality (HR 1.10, 95% CI 0.26, 4.65). In-hospital and 30-day mortality was 0% in both groups. The surgical group had a significantly higher rate of complications (Clavien–Dindo ≥3 26.3% vs. endoscopic therapy 0.74%), longer in-patient stay (median 14 vs. 0 days endoscopic therapy) and higher hospital costs(£16 360 vs. £8786 per patient). Conclusion This series of patients treated during a transition period from surgery to EET, demonstrates a primary endoscopic approach does not compromise oncological outcomes with the benefit of fewer complications, shorter hospital stays, and lower costs compared to surgery. It should be available as the gold standard treatment for patients with early esophageal cancer. Those with adverse prognostic features may still benefit from esophagectomy.

Post‐prostatectomy incontinence is an increasing problem that can have a devastating impact on men's lives. In this article the authors consider some of the options for management and discuss the efficacy as well as advantages and disadvantages of the different approaches to management that are currently available.

Summary The clinical value of multiple staging investigations for high-grade dysplasia or early adenocarcinoma of the esophagus is unclear. A single-center prospective cohort of patients treated for early esophageal cancer between 2000 and 2019 was analyzed. This coincided with a transition period from esophagectomy to endoscopic mucosal resection (EMR) as the treatment of choice. Patients were staged with computed tomography (CT), endoscopic ultrasound (EUS) and 2-deoxy-2-[18F]fluoro-d-glucose (FDG) positron emission tomography(PET)/CT. The aim of this study was to assess their accuracy and impact on clinical management. 297 patients with high-grade dysplasia or early adenocarcinoma were included (endoscopic therapy/EMR n = 184; esophagectomy n = 113 [of which a ‘combined’ group had surgery preceded by endoscopic therapy n = 23]). Staging accuracy was low (accurate staging EMR: CT 40.1%, EUS 29.6%, FDG-PET/CT 11.0%; Esophagectomy: CT 43.3%, EUS 59.7%, FDG-PET/CT 29.6%; Combined: CT 28.6%, EUS46.2%, FDG-PET/CT 30.0%). Staging inaccuracies across all groups that could have changed management by missing T2 disease were CT 12%, EUS 12% and FDG-PET/CT 1.6%. The sensitivity of all techniques for detecting nodal disease was low (CT 12.5%, EUS 12.5%, FDG-PET/CT0.0%). Overall, FDG-PET/CT and EUS changed decision-making in only 3.2% of patients with an early cancer on CT and low-risk histology. The accuracy of staging with EUS, CT and FDG-PET/CT in patients with high-grade dysplasia or early adenocarcinoma of the esophagus is low. EUS and FDG-PET/CT added relevant staging information over standard CT in very few cases, and therefore, these investigations should be used selectively. Factors predicting the need for esophagectomy are predominantly obtained from EMR histology rather than staging investigations.

Aim To compare Oesophagectomy and Endoscopic mucosal resection (EMR) short and long term outcomes of patients treated for early oesophageal cancer over a transition period in a single institution. Background and Methods Introduction of Endoscopic eradication therapy (EET) techniques in 2012 provided an alternative to oesophagectomy for high grade dysplasia (HGD) and early cancer. Historically the gold-standard treatment had been oesophagectomy, which is associated with significant post-operative morbidity and prolonged recovery, but offers a high chance of cure with additional benefit of regional lymphadenectomy. A single centre, contemporaneously maintained database of consecutive patients diagnosed with early oesophageal cancer and treated at a tertiary referral centre during 2000-2018 was analysed. Patients were discussed at MDT; histology was confirmed by 2 expert pathologists. Oesophagectomy was not preceded by neoadjuvant chemotherapy. Primary outcomes are overall and disease specific survival, secondary outcomes including hospital stay, complications and overall cost. Results 113 patients underwent oesophagectomy and 138 underwent EMR +/- further EET. Mean age for oesophagectomy 64.6 vs. EMR 71.6 years (p=<.0001). Mean follow up for oesophagectomy was 5.6 vs 2.4 years after EET. The proportion of T1 tumours was (HGD 25% vs 39%, T1a 17% vs 34%, T1b 43% vs 16%, p<0.001), poor differentiation (23% vs 5%, p<0.001), lymphovascular invasion (19% vs 4%, p<0.001) and Inpatient hospital stay (median 14 vs 1.5 days EMR; p=<.0001) was significantly higher in oesophagectomy group. In-hospital and 30 day mortality was 0%. Surgical group suffered more complications (Clavien-dindo ≥ 3) 26% vs. EMR 1%, p=<.0001. Cancer recurrence after oesophagectomy was 18% (local 4%, systemic 9%, mixed 5%) vs. 5% following EET (local). Overall survival showed no difference between both groups (HR 1.157 95%CI 0.62-2.16). Stage matched survival in HGD; T1a and T1b sub-groups didn´t significantly differ. Conclusion In a large consecutive series of patients treated during a transition period, overall survival was similar in both groups. Surgery was associated with prolonged recovery and significant post-operative morbidity. EMR should be available for HGD and early cancer patients as gold standard of care although patients with adverse prognostic features may still benefit from oesophagectomy.