a b s t r a c tIt is widely accepted that health professionals might sometimes underestimate cancer patients' needs for information on the complex process of radiotherapy (RT) planning and delivery. Furthermore, relatives might also feel excluded from the treatment of their loved ones. This pilot study was carried out in order to assess whether both patients and their relatives would welcome further information on RT planning and delivery using the virtual reality (VR) system VERT. One hundred and fifty patients with different types of cancer receiving radical RT were included in the study. Patients and relatives were shown using VERT on a one-to-one basis with an oncologist or a radiographer, a standard room where RT is given, a linear accelerator, and how RT is planned and delivered using their own planning CT Scans. Patients welcomed this information as it helped them to reduce their fears about RT. Relatives felt also more involved in the treatment of their loved one. The results obtained in this pilot study show that VR aids could become an important tool for delivering information on RT to both patients and relatives.© 2015 The College of Radiographers. Published by Elsevier Ltd. All rights reserved. IntroductionThere is clear evidence suggesting there is often a gap between the information provided to patients regarding their disease and management, and the amount of information patients wish to receive.1 Furthermore, it is not uncommon for clinicians to underestimate cancer patients' needs for information, 2 especially when the vast majority of cancer patients want to be thoroughly informed about their illness. 3 Despite this, there are still problems with respect to the provision of information which could satisfy most patients. 4 The importance of the provision of information to patients has been stressed by the Department of Health 5 stating that is a key requirement in current cancer services standards in the UK. However, it cannot be assumed that all patients want substantial information regarding their treatment as some might prefer to fully trust their doctor rather than being involved in taking any decisions that could affect their management. While several studies have addressed these issues, 6,7 further work is still required to improve the understanding of patients' needs. Furthermore, relatives might feel sometimes disengaged in the management of their loved ones and might consider themselves being excluded from several areas within the management process. The negative psychological impact upon partners and other relatives of cancer patients is well documented, 8 and such negative effect is (amongst many other factors) widely associated with lack of medical information given to them. It has long been argued that providing tailored information to relatives as well as patients in general cancer care is a positive aspect of the treatment process 9 and there is little doubt that such inclusionary practice should be encouraged in cancer care.A clear example where provision of information to patien...
The lung is the main organ of the respiratory system. Its purpose is to facilitate gas exchange (breathing). Mechanically, breathing may be described as the cyclic application of stresses acting upon the lung surface. These forces are offset by prominent stress-bearing components of lung tissue. These components result from the mechanical elastic properties of lung parenchyma. Various studies have been dedicated to understanding the macroscopic behaviour of parenchyma. This has been achieved through pressure-volume analysis, numerical methods, the development of constitutive equations or strain-energy functions, finite element methods, image processing and elastography. Constitutive equations can describe the elastic behaviour exhibited by lung parenchyma through the relationship between the macroscopic stress and strain. The research conducted within lung mechanics around the elastic and resistive properties of the lung has allowed scientists to develop new methods and equipment for evaluating and treating pulmonary pathogens. This paper establishes a review of mathematical studies conducted within lung mechanics, centering on the development and implementation of solid mechanics to the understanding of the mechanical properties of the lung. Under the classical theory of elasticity, the lung is said to behave as an isotropic elastic continuum undergoing small deformations. However, the lung has also been known to display heterogeneous anisotropic behaviour associated with large deformations. Therefore, focus is placed on the assumptions and development of the various models, their mechanical influence on lung physiology, and the development of constitutive equations through the classical and non-classical theory of elasticity. Lastly, we also look at lung blast mechanics. No explicit emphasis is placed on lung pathology.
335 Background: The RECORD Study is a real world data, prospective evaluation of clinical outcomes in patients with nmCRPC treated with Darolutamide. This study will increase the understanding of treatment response and management and in particular inform regarding use of next generation imaging in this setting. Methods: Patient data from 9 UK centres was collected based on the recommendation of NICE for Darolutamide as an option for the treatment of non-metastatic castrate resistant prostate cancer (nmCRPC) from November 2020. Data cut-off was 15 September 2022. The study is ongoing. Results: 87 patients were analysed with a median age of 78 (range 61-92). Median pre-treatment PSA and PSA doubling time (PSAdT) were 13 (range 1.99-110.6) mg/L and 5.05 (range 0.6 - 10) months. 42 patients (49.4%) had pre-treatment PSAdT of <6 months and 43 (50.6%) patients had PSAdT of ≥6 months (2 patients had no pre-treatment PSAdT data). 6 patients (6.90%) had next generation imaging prior to initiation of Darolutamide. Median duration of treatment on Darolutamide was 17 months for patients with pre-treatment PSAdT <6 months but median duration had not been reached for patients with pre-treatment PSAdT ≥6 months after 24 months of treatment, a significant difference p=0.018 (HR=0.385, 95% CI 0.17-0.88). 30 patients have come off treatment so far (34.5%); 21 (70%) for disease progression, 5 (16%) for a medical cause unrelated to the drug (e.g. COVID infection, reduced performance status secondary to pre-existing Parkinson's), 3 (10%) for unacceptable toxicity (rash, Grade3 fatigue, muscle aches, memory issues), and 1 patient died (unrelated). Conclusions: In the RECORD study, predominantly the diagnosis of nmCRPC is based on conventional imaging. The majority of patients respond and tolerate Darolutamide well, comparable with the ARAMIS trial. There is a significant difference between time on Darolutamide for those with pre-treatment PSAdT of <6 months compared with ≥6 months. Further long-term toxicity, MFS and OS data will continue to be collected prospectively within the study.
226 Background: Prostate cancer accounts for the 2nd most common cause of cancer deaths in males in the UK. Cabazitaxel (CBZ) is a third generation taxane with activity demonstrated even in docetaxel resistant cases. Results of the TROPIC study established survival benefit for CBZ in metastatic castrate resistant prostate cancer (mCRPC) patients but there was also a higher incidence of febrile neutropenia (FN) reported. We studied the efficacy of CBZ in mCRPC patients treated in our centre and assessed FN rates with the use primary granulocyte colony stimulating factor (GCSF) support. Methods: We conducted a retrospective audit of mCRPC patients treated with CBZ from January 2016 – January 2019. We analysed treatment outcomes, FN rates and potential prognostic factors. Results: There were 42 patients in total with a median age of 70 years (range; 54-91). The median follow up was 9.5 months (range; 2-34 months). Most of our patients had extensive disease, with bone and visceral metastases seen in 88% and 31% respectively. CBZ was given as second line treatment in 15 (35.7%) patients on progression following docetaxel and as third line in 27 (64.3%) patients. Majority of our patients (95%) had WHO PS of either 0 or 1. Median number of cycles of CBZ administered was 6 and 31% of patients completed 10 cycles of treatment. Median biochemical progression free survival (PFS) for patients who received at least 3 or more cycles of CBZ was 6 months and median overall survival (OS) was 11 months. Median OS for patients who received CBZ as 2nd line and 3rd line treatments were 9 and 13 months respectively. Patients with visceral metastases had a median OS of 9 months. Median OS for patients with Haemoglobin (Hb) ≥12gm/dl and lower Hb were 19 and 9 months respectively (p = 0.004). Patients in favourable prognostic group (Normal Hb, Normal albumin and no visceral metastases) had a median OS of 24 months compared to 10 months for those in less favourable group. There were no episodes of FN reported in our group with the use of primary GCSF prophylaxis. Conclusions: CBZ is effective as a 2nd or 3rd line treatment option in patients with mCRPC. Neutropenic complications can be significantly reduced with the use of primary GCSF prophylaxis. Low pre-treatment Hb seems to be a predictor for poor overall survival.
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