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A pilot study of a nurse delivered virtual outpatient clinic for patients with hepatocellular cancer (HCC)
ABSTRACTS tumour grade. Increases in choline, lactate and lipids, are found in higher grade tumours and are useful in assessing disease progression. We studied whether multiparametric MRI, utilising both conventional and advanced techniques, differentiated progression from pseudoprogession with sufficient certainty to guide further management. Method: 39 patients (Mean age 57.4 years (range 20e73 years); M:F ¼ 18:21) were newly-diagnosed with GBMs by WHO criteria, after biopsy or debulking surgery at Barts Health NHS Trust over an 18 month period between Oct 2013 and Mar 2015. Of these patients, 32 completed 60 Gy/30# external beam radiotherapy with concurrent temozolomide, with most continuing to adjuvant temozolomide treatment. Patients diagnosed with either progression or pseudoprogression on their end-of-treatment MRI were identified. Those studies utilising multiparametric MRI techniques within the imaging protocol were evaluated to determine their accuracy in assessing disease progression on imaging within 6 months of their post-treatment scan. Results: Of 32 patients who completed concurrent chemoradiotherapy, 26 had post-treatment imaging, 19 of which reported possible progression. Within this group, 11 patients underwent multiparametric MRI: 4 patients were identified with progression, confirmed on subsequent imaging; 7 patients were identified with pseudoprogression. Subsequent imaging confirmed no progression within 6 months in 4 cases, however 3 cases had progressed. Conclusion: In our centre, multiparametric MR imaging is useful in identifying progression in patients with glioblastoma, who have undergone chemoradiotherapy. In this cohort of patients those imaging methods were more reliable in identifying progression than pseudoprogression. http://dx.doi.org/10.1016/j.ejso.2016.07.120
425. Socioeconomic deprivation and the burden of head and neck cancer e Regional variations of incidence and mortality in Merseyside and Cheshire, North West, England Bilal G. Taib1, Jill Oakley2, Yvonne Daley3, Ian Hodge4, Paul Wright2, Ruth du Plessis5, Joseph Rylands6, David Taylor-Robinson7, Sue Povall7, Andrew Schache6, Richard Shaw6, Ann Dingle4, Terry Jones7 1 Royal Liverpool University Hospital, UK 2 Cheshire West and Chester Public Health Team, UK 3 Public Health England, UK 4 Cheshire and Merseyside Strategic Clinical Networks, UK 5 Cheshire and Merseyside Collaborative Service, UK 6 Aintree University Hospital, UK 7 University of Liverpool, UK Background: Regional variations in deprivation exist resulting in stark geographical gradients for some head and neck cancers. The Merseyside and Cheshire Cancer Network (MCCN) contains amongst the most deprived Local Authorities (LAs) in the country including Liverpool which was rated the most deprived LA in England in 2010. This study examines the distribution of disease burden across the region comparing it to national trends and several deprivation measures. Method: We undertook a descriptive study of data sourced from the UK Cancer Information Service combining it with indicators of deprivation and lifestyle at small geographical areas within the nine Local Authorities of Merseyside and Cheshire for cancers ICD C00-C14 and C30-32 within 3 cohorts 1998e2000, 2008e2010 and 2009e2011. Data from the North West of England, Greater Manchester and England were used as comparator regions and statistical analyses were made using 95% confidence intervals. To obtain a more detailed analyses Middle Super Output Area (MSOA) data was also used to map incidence and mortality rates within the region. Results: The incidence of head and neck cancer has increased across the region from 1998e2000 to 2008e2010 with a peak incidence for Liverpool males at 35 per 100,000 population which is higher than less economically developed regions in South America, the Indian subcontinent and South Africa.
S249 Five LAs (Liverpool, Sefton, Knowsley, Halton and Wirral) had statistically significantly higher HANC incidence rates than England but only Liverpool (7.6 per 1000,000 populations) had a statistically significantly higher mortality rate. Our data revealed that certain MSOAs contribute disproportionately to the significant effect of incidence and mortality within LAs. Income deprivation had the strongest correlation with both incidence (r ¼ 0.59) and mortality (r ¼ 0.53) of head and neck cancer. Conclusion: Our study emphasizes vast geographical variations within the MCCN which need to be addressed through public health measures. http://dx.doi.org/10.1016/j.ejso.2016.07.121
429. Endoscopic management of gastrointestinal bleeding in cancer patients with severe thrombocytopenia Paul Hampel1, Guilherme Piovezani Ramos2, Moritz Binder2, Manuel Braga Neto2, Dharma Sunjaya2, Badr Al Bawardy2, Elizabeth Rajan2 1 Mayo School of Graduate Medical Education, USA 2 Mayo Clinic, Rochester, MN, USA Background: Coagulation deficiencies, common in cancer patients, can lead to gastrointestinal bleeding (GIB) via vulnerable existing lesions. We aimed to describe the clinical presentation and corresponding locations of bleeding, as well as assess the utility of endoscopic management and the associated post-procedural course in cancer patients with severe thrombocytopenia (ST) and GIB. Method: Retrospective study; adult patients with active malignancy or post-bone marrow transplant and with a platelet count (PC) <50 103/mL at the time of GIB who underwent an inpatient endoscopic procedure within 24-hours of GIB were included. The primary outcomes of interest were median number of packed red blood cell (PRBC) and platelet transfusions pre- and post-procedure, rate of re-bleeding, and length of hospital stay. The secondary endpoints included 30-day mortality following the procedure. Results: 59 patients were included in the study. The mean age was 59years (19e92); 61% men. The most common etiology of ST was hematological malignancy (61%). The most common clinical presentation was melena (53%). Median PC and hemoglobin at time of GIB and prior to endoscopy was 39 103/mL (6e49 103/mL) and 7.9g/dL (3.9e11.7 g/dL), respectively. Bleeding location was identified in 58%, most commonly gastric ulcer (14%). Endoscopic intervention was performed in 52% of cases, most commonly clipping. There was a decrease in the median platelet and PRBC transfusion requirements before and after endoscopy (2 vs 1, p < 0.001) and (3 vs 2, p ¼ 0.001), respectively. Rebleeding rate within 30 days was 22%. Median hospital stay was 9 days. All-cause and GIB mortality at 30 days were 22% and 3.4%, respectively. Conclusion: In our cohort, endoscopic evaluation was able to be safely performed in cancer patients with GIB in the context of ST and was associated with a reduction in transfusion requirements (PRBC and platelets). These findings support the consideration of including endoscopic therapy as part of management in this clinical scenario. http://dx.doi.org/10.1016/j.ejso.2016.07.122
433. A pilot study of a nurse delivered virtual outpatient clinic for patients with hepatocellular cancer (HCC) Paul Ross1, Gillian Alkadhimi1, Preetha Aravind1, Christopher Jingree1, Abid Suddle1, Debashis Sarker2 1 King’s College Hospital NHS Foundation Trust, UK 2 King’s College London, UK Background: HCC is a rare tumour in the UK with approximately 3500 cases per annum. There are only 7 Liver Centres in the UK that offer all modalities of treatment, including transplantation. Consequently, patients are frequently travelling long distances to access combined
S250 hepatological and oncological care. The King’s College Hospital liver unit sees over 400 new patients per year with HCC from across the South of England. Method: A patient experience survey was undertaken amongst those attending the HCC clinic. A pilot was developed of a clinic delivered by a specialist HCC Clinical Nurse Specialist (CNS) with patient contact via skype. An evaluation including interviews and a survey formed part of the pilot. Results: 26 patients have participated in the pilot ranging in age from 30e70 years. Patients were receiving locoregional therapy, microwave ablation or sorafenib. 75% of the calls were planned and 25% were additional calls initiated by the patient. Calls range from 5e15 minutes in length. Initial feedback has demonstrated a high rate of patient satisfaction. Patients reported that it: 1.Reduced frequency of travel and associated fatigue; 2.Retains the value of face to face consultation whilst keeping the patient at home for visits where physical examination or investigations are not required; 3.Reduced carer burden and financial pressures. Benefits to the institution were also accrued in that some clinic slots are released for those needing to attend clinic Conclusion: Once challenges to establish the service were overcome there is overwhelming positive feedback from patients and carers, the CNS provider, colleagues and hospital management. As the service is continuing to expand and develop there is ongoing evaluation. http://dx.doi.org/10.1016/j.ejso.2016.07.123
440. We’ve got it covered. Mapping the activities of members of the NCRI Consumer Forum across the INVOLVE research cycle Richard Stephens NCRI, UK Background: The NCRI Consumer Forum is a UK-wide network of 82 cancer patients and carers. The 51 core members of the Consumer Forum are those who sit on NCRI’s strategic groups, such as the Clinical Studies Groups (CSGs) and CTRad. When an individual member completes a term of office, there is a conscious effort to retain them within the Forum and to redeploy their skills and experience elsewhere in cancer research. INVOLVE, the NIHR-funded organisation that supports public involvement in research, has defined 9 areas in the research cycle where the public can become involved in health research. It was decided to see if the involvement activities of Forum members covers all 9 areas and thus how widely the Forum’s work is embedded in cancer research. Method: As part of the NCRI Review of Consumer Involvement 2014e15, Consumers were asked to list their involvement activities. Every Consumer who sits on an NCRI CSG completes a template report before each meeting, updating their current activities. Regular email correspondence within the Forum encourages members to report and discuss their involvement activities, and the NCRI Consumer Admin Office maintains a spreadsheet to capture this information. The 9 INVOLVE areas of the research cycle are Prioritising, Commissioning, Designing, Managing, Undertaking, Analysing/Interpreting, Disseminating, Evaluating, and Identifying Topics. The involvement activities of Forum members were mapped against these headings. Results: The most common areas of activity are Managing and Undertaking (eg via CSGs or TSCs/TMGs). Designing, Evaluating and Identifying are well-covered (eg via CSGs and sub-groups) and involvement is increasing in Prioritising and Commissioning (eg via funding panels). The areas with fewest members declaring involvement are Analysing/Interpreting and Disseminating. Conclusion: Members of the NCRI Consumer Forum are involved at every stage of the research cycle and their work is embedded in UK cancer research.
ABSTRACTS http://dx.doi.org/10.1016/j.ejso.2016.07.124
441. Girls’ knowledge about HPV vaccine and cervical cancer Corina Chivu, Aileen Clarke, Gillian Hundt University of Warwick, UK Background: In 2008, the health departments of the United Kingdom implemented routine and catch-up HPV immunization programme in schools to reduce the incidence of cervical cancer. European studies conducted from 2007 to 2012 showed inconsistent results on HPV vaccine uptake in relation to girls’ age and ethnicity. Aim: To explore the views and experiences of students, teachers and health providers on the HPV vaccine to understand what practices influenced HPV vaccine uptake in secondary schools in a town in the West Midlands. Method: Data was collected through 47 semi-structured individual interviews with nine nurses, four school staff and 34 year 8 girls as well as through non-participant observations in 12 schools during the delivery of HPV vaccine between February and September 2013. The school staff and the girls were sampled from four secondary schools that accepted to participate in the study. Thematic analysis was employed to identify major themes. Results: Year 8 girls were aged 12e13 years. Some were Christian, Muslim and Hindu while others had no religion. The health professionals were nurse coordinators, school nurses, vaccinators, sexual health nurses and practice nurses. One of the main themes was related to the barriers to the vaccination. The HPV vaccine was promoted in a limited way in schools owing to time pressure in the curriculum for compulsory subjects. The girls found out about HPV vaccine during assemblies and in tutorials that focused on the vaccination process rather than the prevention of cervical cancer. There was a lack of belief that the HPV vaccine was effective or safe and the students were unaware of the relation between sexual behaviour and HPV. Conclusion: The majority of girls had a poor understanding of the role of HPV vaccine. The schools would need to create a supportive environment for dissemination of information about the HPV vaccine. http://dx.doi.org/10.1016/j.ejso.2016.07.125
442. Clinical features and histological subtypes of RCC. Single center experience Faisal Azam, Waleed Mohammed Al Selwi, Samir Taha Fotih, Osama Zeid Abduljalil, Ahmed Mohammed Wbari, Fahad Ibnshamsah, Faisal Azam King Fahad Specialist Hospital, Dammam, Saudi Arabia Background: Renal cell carcinoma (RCC) commonly occurs in elderly with a median age at diagnosis of 65 years. Clear cell is the most common histological type followed by papilary carcinoma. The present study is aimed at reviewing the main clinical and histological RCC subtypes at our tertiary Oncology center. Method: Retrospective review of clinical notes, electronic records and hospital cancer registry of patients (pts) with a RCC treated at a tertiary Oncology center from 2008e14. Results: A total of 92 patients were diagnosed with RCC. Median age at diagnosis was 55 (21e96) years. It was more prevalent in males (male:female ratio 1.5:1). The most common histological types was clear cell (n ¼ 62, 67%) followed chromophobe (n ¼ 17, 19%), papillary (n ¼ 4, 4%), medullary (n ¼ 2, 2%) and other rare types in 7 patients. Sarcomatoid transformation was mentioned in 5 (5.5%) specimens. 21 (23%) patients presented with metastatic disease and another 11 patients developed recurrent metastatic disease after initial treatment for primary RCC. The main sites of metastases were lungs (n ¼ 22, 69%), liver (n ¼ 12, 38%), bones (n ¼ 11, 34%) and nervous system (n ¼ 10, 31%). All (100%) patients
425. Socioeconomic deprivation and the burden of head and neck cancer e Regional variations of incidence and mortality in Merseyside and Cheshire, North West, England Bilal G. Taib1, Jill Oakley2, Yvonne Daley3, Ian Hodge4, Paul Wright2, Ruth du Plessis5, Joseph Rylands6, David Taylor-Robinson7, Sue Povall7, Andrew Schache6, Richard Shaw6, Ann Dingle4, Terry Jones7 1 Royal Liverpool University Hospital, UK 2 Cheshire West and Chester Public Health Team, UK 3 Public Health England, UK 4 Cheshire and Merseyside Strategic Clinical Networks, UK 5 Cheshire and Merseyside Collaborative Service, UK 6 Aintree University Hospital, UK 7 University of Liverpool, UK Background: Regional variations in deprivation exist resulting in stark geographical gradients for some head and neck cancers. The Merseyside and Cheshire Cancer Network (MCCN) contains amongst the most deprived Local Authorities (LAs) in the country including Liverpool which was rated the most deprived LA in England in 2010. This study examines the distribution of disease burden across the region comparing it to national trends and several deprivation measures. Method: We undertook a descriptive study of data sourced from the UK Cancer Information Service combining it with indicators of deprivation and lifestyle at small geographical areas within the nine Local Authorities of Merseyside and Cheshire for cancers ICD C00-C14 and C30-32 within 3 cohorts 1998e2000, 2008e2010 and 2009e2011. Data from the North West of England, Greater Manchester and England were used as comparator regions and statistical analyses were made using 95% confidence intervals. To obtain a more detailed analyses Middle Super Output Area (MSOA) data was also used to map incidence and mortality rates within the region. Results: The incidence of head and neck cancer has increased across the region from 1998e2000 to 2008e2010 with a peak incidence for Liverpool males at 35 per 100,000 population which is higher than less economically developed regions in South America, the Indian subcontinent and South Africa.
S249 Five LAs (Liverpool, Sefton, Knowsley, Halton and Wirral) had statistically significantly higher HANC incidence rates than England but only Liverpool (7.6 per 1000,000 populations) had a statistically significantly higher mortality rate. Our data revealed that certain MSOAs contribute disproportionately to the significant effect of incidence and mortality within LAs. Income deprivation had the strongest correlation with both incidence (r ¼ 0.59) and mortality (r ¼ 0.53) of head and neck cancer. Conclusion: Our study emphasizes vast geographical variations within the MCCN which need to be addressed through public health measures. http://dx.doi.org/10.1016/j.ejso.2016.07.121
429. Endoscopic management of gastrointestinal bleeding in cancer patients with severe thrombocytopenia Paul Hampel1, Guilherme Piovezani Ramos2, Moritz Binder2, Manuel Braga Neto2, Dharma Sunjaya2, Badr Al Bawardy2, Elizabeth Rajan2 1 Mayo School of Graduate Medical Education, USA 2 Mayo Clinic, Rochester, MN, USA Background: Coagulation deficiencies, common in cancer patients, can lead to gastrointestinal bleeding (GIB) via vulnerable existing lesions. We aimed to describe the clinical presentation and corresponding locations of bleeding, as well as assess the utility of endoscopic management and the associated post-procedural course in cancer patients with severe thrombocytopenia (ST) and GIB. Method: Retrospective study; adult patients with active malignancy or post-bone marrow transplant and with a platelet count (PC) <50 103/mL at the time of GIB who underwent an inpatient endoscopic procedure within 24-hours of GIB were included. The primary outcomes of interest were median number of packed red blood cell (PRBC) and platelet transfusions pre- and post-procedure, rate of re-bleeding, and length of hospital stay. The secondary endpoints included 30-day mortality following the procedure. Results: 59 patients were included in the study. The mean age was 59years (19e92); 61% men. The most common etiology of ST was hematological malignancy (61%). The most common clinical presentation was melena (53%). Median PC and hemoglobin at time of GIB and prior to endoscopy was 39 103/mL (6e49 103/mL) and 7.9g/dL (3.9e11.7 g/dL), respectively. Bleeding location was identified in 58%, most commonly gastric ulcer (14%). Endoscopic intervention was performed in 52% of cases, most commonly clipping. There was a decrease in the median platelet and PRBC transfusion requirements before and after endoscopy (2 vs 1, p < 0.001) and (3 vs 2, p ¼ 0.001), respectively. Rebleeding rate within 30 days was 22%. Median hospital stay was 9 days. All-cause and GIB mortality at 30 days were 22% and 3.4%, respectively. Conclusion: In our cohort, endoscopic evaluation was able to be safely performed in cancer patients with GIB in the context of ST and was associated with a reduction in transfusion requirements (PRBC and platelets). These findings support the consideration of including endoscopic therapy as part of management in this clinical scenario. http://dx.doi.org/10.1016/j.ejso.2016.07.122
433. A pilot study of a nurse delivered virtual outpatient clinic for patients with hepatocellular cancer (HCC) Paul Ross1, Gillian Alkadhimi1, Preetha Aravind1, Christopher Jingree1, Abid Suddle1, Debashis Sarker2 1 King’s College Hospital NHS Foundation Trust, UK 2 King’s College London, UK Background: HCC is a rare tumour in the UK with approximately 3500 cases per annum. There are only 7 Liver Centres in the UK that offer all modalities of treatment, including transplantation. Consequently, patients are frequently travelling long distances to access combined
S250 hepatological and oncological care. The King’s College Hospital liver unit sees over 400 new patients per year with HCC from across the South of England. Method: A patient experience survey was undertaken amongst those attending the HCC clinic. A pilot was developed of a clinic delivered by a specialist HCC Clinical Nurse Specialist (CNS) with patient contact via skype. An evaluation including interviews and a survey formed part of the pilot. Results: 26 patients have participated in the pilot ranging in age from 30e70 years. Patients were receiving locoregional therapy, microwave ablation or sorafenib. 75% of the calls were planned and 25% were additional calls initiated by the patient. Calls range from 5e15 minutes in length. Initial feedback has demonstrated a high rate of patient satisfaction. Patients reported that it: 1.Reduced frequency of travel and associated fatigue; 2.Retains the value of face to face consultation whilst keeping the patient at home for visits where physical examination or investigations are not required; 3.Reduced carer burden and financial pressures. Benefits to the institution were also accrued in that some clinic slots are released for those needing to attend clinic Conclusion: Once challenges to establish the service were overcome there is overwhelming positive feedback from patients and carers, the CNS provider, colleagues and hospital management. As the service is continuing to expand and develop there is ongoing evaluation. http://dx.doi.org/10.1016/j.ejso.2016.07.123
440. We’ve got it covered. Mapping the activities of members of the NCRI Consumer Forum across the INVOLVE research cycle Richard Stephens NCRI, UK Background: The NCRI Consumer Forum is a UK-wide network of 82 cancer patients and carers. The 51 core members of the Consumer Forum are those who sit on NCRI’s strategic groups, such as the Clinical Studies Groups (CSGs) and CTRad. When an individual member completes a term of office, there is a conscious effort to retain them within the Forum and to redeploy their skills and experience elsewhere in cancer research. INVOLVE, the NIHR-funded organisation that supports public involvement in research, has defined 9 areas in the research cycle where the public can become involved in health research. It was decided to see if the involvement activities of Forum members covers all 9 areas and thus how widely the Forum’s work is embedded in cancer research. Method: As part of the NCRI Review of Consumer Involvement 2014e15, Consumers were asked to list their involvement activities. Every Consumer who sits on an NCRI CSG completes a template report before each meeting, updating their current activities. Regular email correspondence within the Forum encourages members to report and discuss their involvement activities, and the NCRI Consumer Admin Office maintains a spreadsheet to capture this information. The 9 INVOLVE areas of the research cycle are Prioritising, Commissioning, Designing, Managing, Undertaking, Analysing/Interpreting, Disseminating, Evaluating, and Identifying Topics. The involvement activities of Forum members were mapped against these headings. Results: The most common areas of activity are Managing and Undertaking (eg via CSGs or TSCs/TMGs). Designing, Evaluating and Identifying are well-covered (eg via CSGs and sub-groups) and involvement is increasing in Prioritising and Commissioning (eg via funding panels). The areas with fewest members declaring involvement are Analysing/Interpreting and Disseminating. Conclusion: Members of the NCRI Consumer Forum are involved at every stage of the research cycle and their work is embedded in UK cancer research.
ABSTRACTS http://dx.doi.org/10.1016/j.ejso.2016.07.124
441. Girls’ knowledge about HPV vaccine and cervical cancer Corina Chivu, Aileen Clarke, Gillian Hundt University of Warwick, UK Background: In 2008, the health departments of the United Kingdom implemented routine and catch-up HPV immunization programme in schools to reduce the incidence of cervical cancer. European studies conducted from 2007 to 2012 showed inconsistent results on HPV vaccine uptake in relation to girls’ age and ethnicity. Aim: To explore the views and experiences of students, teachers and health providers on the HPV vaccine to understand what practices influenced HPV vaccine uptake in secondary schools in a town in the West Midlands. Method: Data was collected through 47 semi-structured individual interviews with nine nurses, four school staff and 34 year 8 girls as well as through non-participant observations in 12 schools during the delivery of HPV vaccine between February and September 2013. The school staff and the girls were sampled from four secondary schools that accepted to participate in the study. Thematic analysis was employed to identify major themes. Results: Year 8 girls were aged 12e13 years. Some were Christian, Muslim and Hindu while others had no religion. The health professionals were nurse coordinators, school nurses, vaccinators, sexual health nurses and practice nurses. One of the main themes was related to the barriers to the vaccination. The HPV vaccine was promoted in a limited way in schools owing to time pressure in the curriculum for compulsory subjects. The girls found out about HPV vaccine during assemblies and in tutorials that focused on the vaccination process rather than the prevention of cervical cancer. There was a lack of belief that the HPV vaccine was effective or safe and the students were unaware of the relation between sexual behaviour and HPV. Conclusion: The majority of girls had a poor understanding of the role of HPV vaccine. The schools would need to create a supportive environment for dissemination of information about the HPV vaccine. http://dx.doi.org/10.1016/j.ejso.2016.07.125
442. Clinical features and histological subtypes of RCC. Single center experience Faisal Azam, Waleed Mohammed Al Selwi, Samir Taha Fotih, Osama Zeid Abduljalil, Ahmed Mohammed Wbari, Fahad Ibnshamsah, Faisal Azam King Fahad Specialist Hospital, Dammam, Saudi Arabia Background: Renal cell carcinoma (RCC) commonly occurs in elderly with a median age at diagnosis of 65 years. Clear cell is the most common histological type followed by papilary carcinoma. The present study is aimed at reviewing the main clinical and histological RCC subtypes at our tertiary Oncology center. Method: Retrospective review of clinical notes, electronic records and hospital cancer registry of patients (pts) with a RCC treated at a tertiary Oncology center from 2008e14. Results: A total of 92 patients were diagnosed with RCC. Median age at diagnosis was 55 (21e96) years. It was more prevalent in males (male:female ratio 1.5:1). The most common histological types was clear cell (n ¼ 62, 67%) followed chromophobe (n ¼ 17, 19%), papillary (n ¼ 4, 4%), medullary (n ¼ 2, 2%) and other rare types in 7 patients. Sarcomatoid transformation was mentioned in 5 (5.5%) specimens. 21 (23%) patients presented with metastatic disease and another 11 patients developed recurrent metastatic disease after initial treatment for primary RCC. The main sites of metastases were lungs (n ¼ 22, 69%), liver (n ¼ 12, 38%), bones (n ¼ 11, 34%) and nervous system (n ¼ 10, 31%). All (100%) patients