Aims/hypothesis Gestational diabetes mellitus (GDM) is associated with an increased risk of pre-eclampsia, macrosomia and the future development of type 2 diabetes mellitus in both mother and child. Although an early and accurate prediction of GDM is needed to allow intervention and improve perinatal outcome, no single protein biomarker has yet proven useful for this purpose. In the present study, we hypothesised that multimarker panels of serum proteins can improve firsttrimester prediction of GDM among obese and non-obese women compared with single markers. Methods A nested case-control study was performed on firsttrimester serum samples from 199 GDM cases and 208 controls, each divided into an obese group (BMI ≥27 kg/m 2 ) and a non-obese group (BMI <27 kg/m 2 ). Based on their biological relevance to GDM or type 2 diabetes mellitus or on their previously reported potential as biomarkers for these diseases, a number of proteins were selected for targeted nano-flow liquid chromatography (LC) MS analysis. This resulted in the development and validation of a 25-plex multiple reaction monitoring (MRM) MS assay. Results After false discovery rate correction, six proteins remained significantly different (p<0.05) between obese GDM patients (n=135) and BMI-matched controls (n=139). These included adiponectin, apolipoprotein M and apolipoprotein D. Multimarker models combining protein levels and clinical data were then constructed and evaluated by receiver operating characteristic (ROC) analysis. For the obese, nonobese and all GDM groups, these models achieved marginally higher AUCs compared with adiponectin alone. Conclusions/interpretation Multimarker models combining protein markers and clinical data have the potential to predict women at a high risk of developing GDM.

BackgroundGuidelines have proposed that GPs should have a central role as coordinators of care and support patients with cancer during all stages of treatment, follow-up, and rehabilitation. Multidisciplinary video consultation involving the patient with cancer, the oncologist, and the GP may help to define roles and tasks, and this resulting clarity may enable greater support for patients with cancer.AimTo explore the consultation structure, content, and task clarification when a GP and an oncologist are attending a video consultation with a patient with cancer.Design & settingA qualitative study took place in the Region of Southern Denmark to investigate multidisciplinary video consultations, based on thematic analysis.MethodRecordings of 12 video consultations were analysed using the framework method. A combined deductive and inductive approach was undertaken. The deductive themes were selected based on a consultation guide given to the doctors before the consultations.ResultsThe study identified 15 themes, which were grouped into the following three categories: the implications of sharing a consultation; consultation structure; and health concerns.ConclusionMultidisciplinary video-based consultations with a patient and two health professionals succeeded in having a patient-centred communication style. In clarifying tasks between the GP and oncologist to support the patient, work-related issues and professional support for psychosocial challenges were always a task for the GP. Dissemination of this first-line evidence may improve acceptability among medical specialists and help assist GPs in supporting patients with cancer. However, focus on the involvement of relatives should be emphasised.

Disease progression during immunotherapy in colorectal cancer does not always indicate treatment failure. A case argues that carcinoembryonic antigen (CEA) may serve as an early marker to distinguish between pseudoprogression and real progression. Presentation of results from reintroduction of chemotherapy after progression on immunotherapy that suggest increased efficiency.

16 Background: Computed tomography (CT) scan is standard in preoperative local staging of colon cancer. Tumours with a deficient mismatch repair (dMMR) system are characterised by unique clinical and pathophysiologic aspects that may impact on the accuracy of the preoperative CT staging. Methods: Data from the Danish Colorectal Cancer Group national clinical database addressing a cohort of patients operated for stage I-III colon cancer in 2010-15 was analysed. The analyses of MMR status had been conducted consecutively through means of immunohistochemistry. All CT scans were blindly assessed by a certified radiologist. Results: Data from 590 patients, operated at a specialised cancer centre were available for analyses. A dMMR phenotype was detected in 135 (22.9%) of the patients. The overall correlation of the clinical and pathological T-category was significant for both groups. There was inferior correlation between cN and pN (p > 0.05) in pMMR cancers with a higher degree of over-staging assessed by CT-scan, compared to a significant correlation between cN and pN stage in pMMR cancers (p < 0.01). Of the 91 dMMR tumours judged node-positive by the preoperative CT scan, 59 (64.8%) showed no sign of metastatic involvement at the postoperative assessment. Conclusions: The accuracy of preoperative CT lymph node staging in colon cancer seems to differ depending on MMR status and may impact the clinical management including the neoadjuvant setting.

e21555 Background: Decisions about last-line treatment are challenging in oncology practice. The hope of prolonging life and reducing symptoms should be weighed against the time spend on treatment, side effects and cost. Standard oncology measures of effect such as median survival time and number needed to treat are not easily explained to patients. Postponement of symptoms or death has been shown to be superior to e.g. number needed to treat in communicating the benefit of treatment to patients. The aim of the present study was to develop a tool for shared decision making in last line treatment of patients with colorectal cancer. Methods: A literature review identified pivotal phase III trials about specific antineoplastic agents for metastatic colorectal cancer after standard treatments. Principles for determining the mean survival followed restricted mean survival time analysis. High-resolution survival curves were digitalized. Areas under the curves (AUC) were calculated for the experimental group and the control group. Results: Two drugs are approved for colorectal cancer after exposure to standard treatments; regorafenib and TAS102. AUC at one year for regorafenib was 30.1 weeks compared to 26.6 weeks for placebo resulting in a difference of 3.5 weeks. AUC at one year for TAS102 was 31.4 weeks compared to 25.7 weeks for placebo resulting in a difference of 5.7 weeks. Average time on treatment was 12 weeks for regorafenib and 14 weeks for TAS102. Risk of severe, medical significant or life-threatening (grade 3-4) adverse events increased from 14% to 54% (regorafenib) and from 52% to 69% (TAS102). Conclusions: Data was developed for shared decision making using restricted mean survival time. A patient with colorectal cancer after standard treatment can be advised: »This is a deadly disease irrespective of treatment. On average, taking medicine for about 12 weeks will postpone death for 4 to 6 weeks. Taking the medicine will cause 17 to 40 extra patients out of 100 experiencing severe or life-threatening side effects«. The concept of postponement will be further explored as a key component in patient empowerment for value based care.