- Email: [email protected]
Bladder cancer risk is associated with low serum 25-hydroxyvitamin D levels; a systematic review
ABSTRACTS 275. What is it about cancer that worries people? A population-based survey of adults in England Charlotte Vrinten, Laura Marlow, Jo Waller University College London, UK Background: Many people worry about cancer, which affects their engagement with cancer screening and early diagnosis (Hay et al., 2005). Worry can be motivating or deterring, depending on the focus of the worry (Consedine et al., 2004). For example, an undifferentiated fear of getting cancer may facilitate screening to obtain reassurance, while fear of screening outcomes may act as a deterrent. In this study, we examine the prevalence and population distribution of undifferentiated cancer worry and worries about specific cancer outcomes in the adult population in England. Method: We conducted a population-based survey of 2,048 adults aged 18e70 years in April 2016. Sociodemographic characteristics, undifferentiated cancer worry, and twelve specific cancer worries adapted from an existing scale, including emotional, physical, and social consequences of a cancer diagnosis (Vickberg, 2003), were assessed in face-to-face interviews. Results: Just over a third of respondents (38%) never worried about cancer, 55% worried occasionally or sometimes, and 7% often or very often. About two thirds were ‘quite a bit’ or ‘extremely’ worried about the threat to life and emotional upset caused by a cancer diagnosis. About half worried about surgery, radiation treatment, chemotherapy, and the loss of control over life. Worries about the social consequences seemed less prevalent: slightly less than half worried about financial problems or their social roles, while only about a quarter worried about how cancer would affect their identity, important relationships, gender role, and sexuality. Women and those who were younger worried more about cancer (p < .001). Ethnic minorities were less worried about the emotional and physical consequences of cancer, but more worried about its social consequences than White British respondents (p < .05). Conclusion: Insights into people’s cancer worries can serve as a starting point for examining how these worries affect early detection behaviours, and help allay undue worries in those who are deterred by them. http://dx.doi.org/10.1016/j.ejso.2016.07.088
283. Bladder cancer risk is associated with low serum 25hydroxyvitamin D levels; a systematic review Corina Chivu1, Janet Dunn1, Bland Rosemary1, Kieran Jefferson2, Donald MacDonald2, Gulnaz Iqbal1 1 University of Warwick, UK 2 University Hospital Coventry and Warwickshire, UK Background: Vitamin D deficiency (low levels of serum 25-hydroxyvitamin D; 25D) is associated with the development of some cancers. Although the mechanism is not well understood local conversion of 25D to active vitamin D (1,25-dihydroxyvitamin D; 1,25D) and the modification of tissue specific immune responses may be key; non-muscle-invasive bladder cancer is highly immunoresponsive. We have previously shown that bladder epithelial cells express functional vitamin D signalling and are able to synthesize sufficient 1,25D to stimulate a local immune response. To assess the clinical impact of serum 25D on the risk of bladder cancer we conducted a systematic review. Method: Studies were identified from Medline, Embase, Web of Science and Cochrane Library limited to English language, humans and 1995e2016. Studies included randomized controlled trials and observational studies, evaluating serum level of vitamin D (25D) and bladder cancer risk. Data in relation to characteristics of studies, participants, interventions, and outcomes were extracted by two independent reviewers. Reviews were excluded. Results: The initial search identified 287 citations. After removal of duplicates and title and abstract review 10 met the inclusion criteria. Following review of the full text, 3 further papers were excluded. Studies
S239 varied in the number of participants (500e9791), and point of vitamin D measurement (pre-diagnosis, diagnosis, or follow-up). Included studies were conducted between 2000 and 2016. Low vitamin D levels were associated with bladder cancer risk in 5 of the 7 studies. Importantly higher vitamin D levels also correlated with better survival and outcomes. Conclusion: These data demonstrate that bladder cancer risk correlates with serum 25D levels. We suggest that in order to maintain optimal immune surveillance within the bladder adequate levels of serum 25D are required for direct synthesis of 1,25D by bladder epithelial cells. We propose that vitamin D supplementation presents a new therapy for bladder cancer. http://dx.doi.org/10.1016/j.ejso.2016.07.089
284. Designing a practice-changing trial for a rare cancer population: The Rational MCC trial of first definitive treatment for Merkel cell carcinoma Rachel Blundred1, Christina Yap2, Carie Corner3, Pat Lawton4, Oliver Cassell5, Clair McGarr6, Ian Zealley7, Sarah Pirrie1, Sarah Bowden1, Jaspreet Babrah1, Simon Rodwell8, Catherine Harwood9, Neil Steven2 1 CR-UK Clinical Trials Unit, The University of Birmingham, UK 2 The University of Birmingham, UK 3 East and North Herts NHS Trust, UK 4 Nottingham University Hospital NHS Trust, UK 5 Oxford University Hospitals NHS Trust, UK 6 University Hospital Birmingham NHS Trust, UK 7 NHS Tayside, UK 8 Melanoma Focus, UK 9 Queen Mary University of London, UK Background: People with rare cancers need evidence-based treatment. Trials require large samples to disprove no difference in treatment effect. Rare cancers, like commoner malignancies, can be diverse affecting population selection and stratification in trial design and applicability of results. The aggressive skin cancer, Merkel cell carcinoma (MCC) affects <300, predominantly elderly, UK patients annually. Standard management with surgery and/or radiotherapy for loco-regional MCC is based on retrospective data. Method: The scientific design for a trial to improve outcomes for patients with MCC should meet the following specification: (i) feasible accrual 50/year over 5 years from UK sites (ii) clinically relevant (iii) informative on treatment decisions (iv) accommodate biological diversity including presence of an integrated virus, immune dysfunction, immune infiltration and somatic mutations (v) accommodate diverse pathways driven by clinical variation, uncertainty and opinion (vi) efficient use of investment to guide future research. Results: A single common question was selected comparing radical radiotherapy or surgery as first definitive treatment for the primary MCC. Observed data from 250 patients is predicted to be informative on individual decisions; providing clinicians and patients with probabilities that either treatment out-performs the other in reducing risk of locoregional failure (assuming 20% event rate). Eligibility is broad: patients with new MCC, excluding distant metastases. There are two components: (i) Rational Compare e the randomised trial. Variation in non-randomised interventions (excision biopsy, sentinel node biopsy, adjuvant radiotherapy) is permitted. Prospective data from an in-built feasibility phase will inform adaptations to reduce diversity in treatment pathways, (ii) Rational Review e an observational study and tissue collection from all patients with new MCC, including those ineligible for randomisation. Conclusion: The Rational MCC trial opened in May 2016. Data on the practical application of the scientific design will be presented. Prospective randomised trials for rare cancer populations should out-perform larger uncontrolled datasets in guiding treatment decisions.
283. Bladder cancer risk is associated with low serum 25hydroxyvitamin D levels; a systematic review Corina Chivu1, Janet Dunn1, Bland Rosemary1, Kieran Jefferson2, Donald MacDonald2, Gulnaz Iqbal1 1 University of Warwick, UK 2 University Hospital Coventry and Warwickshire, UK Background: Vitamin D deficiency (low levels of serum 25-hydroxyvitamin D; 25D) is associated with the development of some cancers. Although the mechanism is not well understood local conversion of 25D to active vitamin D (1,25-dihydroxyvitamin D; 1,25D) and the modification of tissue specific immune responses may be key; non-muscle-invasive bladder cancer is highly immunoresponsive. We have previously shown that bladder epithelial cells express functional vitamin D signalling and are able to synthesize sufficient 1,25D to stimulate a local immune response. To assess the clinical impact of serum 25D on the risk of bladder cancer we conducted a systematic review. Method: Studies were identified from Medline, Embase, Web of Science and Cochrane Library limited to English language, humans and 1995e2016. Studies included randomized controlled trials and observational studies, evaluating serum level of vitamin D (25D) and bladder cancer risk. Data in relation to characteristics of studies, participants, interventions, and outcomes were extracted by two independent reviewers. Reviews were excluded. Results: The initial search identified 287 citations. After removal of duplicates and title and abstract review 10 met the inclusion criteria. Following review of the full text, 3 further papers were excluded. Studies
S239 varied in the number of participants (500e9791), and point of vitamin D measurement (pre-diagnosis, diagnosis, or follow-up). Included studies were conducted between 2000 and 2016. Low vitamin D levels were associated with bladder cancer risk in 5 of the 7 studies. Importantly higher vitamin D levels also correlated with better survival and outcomes. Conclusion: These data demonstrate that bladder cancer risk correlates with serum 25D levels. We suggest that in order to maintain optimal immune surveillance within the bladder adequate levels of serum 25D are required for direct synthesis of 1,25D by bladder epithelial cells. We propose that vitamin D supplementation presents a new therapy for bladder cancer. http://dx.doi.org/10.1016/j.ejso.2016.07.089
284. Designing a practice-changing trial for a rare cancer population: The Rational MCC trial of first definitive treatment for Merkel cell carcinoma Rachel Blundred1, Christina Yap2, Carie Corner3, Pat Lawton4, Oliver Cassell5, Clair McGarr6, Ian Zealley7, Sarah Pirrie1, Sarah Bowden1, Jaspreet Babrah1, Simon Rodwell8, Catherine Harwood9, Neil Steven2 1 CR-UK Clinical Trials Unit, The University of Birmingham, UK 2 The University of Birmingham, UK 3 East and North Herts NHS Trust, UK 4 Nottingham University Hospital NHS Trust, UK 5 Oxford University Hospitals NHS Trust, UK 6 University Hospital Birmingham NHS Trust, UK 7 NHS Tayside, UK 8 Melanoma Focus, UK 9 Queen Mary University of London, UK Background: People with rare cancers need evidence-based treatment. Trials require large samples to disprove no difference in treatment effect. Rare cancers, like commoner malignancies, can be diverse affecting population selection and stratification in trial design and applicability of results. The aggressive skin cancer, Merkel cell carcinoma (MCC) affects <300, predominantly elderly, UK patients annually. Standard management with surgery and/or radiotherapy for loco-regional MCC is based on retrospective data. Method: The scientific design for a trial to improve outcomes for patients with MCC should meet the following specification: (i) feasible accrual 50/year over 5 years from UK sites (ii) clinically relevant (iii) informative on treatment decisions (iv) accommodate biological diversity including presence of an integrated virus, immune dysfunction, immune infiltration and somatic mutations (v) accommodate diverse pathways driven by clinical variation, uncertainty and opinion (vi) efficient use of investment to guide future research. Results: A single common question was selected comparing radical radiotherapy or surgery as first definitive treatment for the primary MCC. Observed data from 250 patients is predicted to be informative on individual decisions; providing clinicians and patients with probabilities that either treatment out-performs the other in reducing risk of locoregional failure (assuming 20% event rate). Eligibility is broad: patients with new MCC, excluding distant metastases. There are two components: (i) Rational Compare e the randomised trial. Variation in non-randomised interventions (excision biopsy, sentinel node biopsy, adjuvant radiotherapy) is permitted. Prospective data from an in-built feasibility phase will inform adaptations to reduce diversity in treatment pathways, (ii) Rational Review e an observational study and tissue collection from all patients with new MCC, including those ineligible for randomisation. Conclusion: The Rational MCC trial opened in May 2016. Data on the practical application of the scientific design will be presented. Prospective randomised trials for rare cancer populations should out-perform larger uncontrolled datasets in guiding treatment decisions.