Use genetic data to predict the best time of day to give radiotherapy to breast cancer patients, say researchers

University of Leicester | November 2018 | Use genetic data to predict the best time of day to give radiotherapy to breast cancer patients, say Researchers

Scientists from the University of Leicester followed two independent cohorts of patients with breast cancer being treated with radiotherapy (P equal to 879); where the researchers found that patients with variations of two genes were more likely to experience side effects if they received radiotherapy in the morning. 

The researchers explain that this is due to their circadian rhythms, with radiotherapy treatment in the morning causing worse acute toxicity for these patients.  They suggest that in future treatment it may be possible to reduce toxicity associated with breast cancer radiotherapy by identifying gene variants that affect circadian rhythm and tailoring treatment for appropriate morning or afternoon radiotherapy.

Professor Paul Symonds, a consultant oncologist at Leicester’s Hospitals and professor of clinical oncology at the University of Leicester said: “Our study found that some patients with a particular genetic profile are more at risk of side effects if given radiotherapy in the morning. This happens because the skin of these particular patients divides earlier in the day than others and dividing cells are more easily damaged by X-rays. This could allow an easy way to personalise treatment just by recommending what time of day a patient should be treated.”

The study was part-funded by the Breast Cancer Now charity and supported by funding from the European Union Seventh Framework Programme for research, technological development and demonstration (Source: University of Leicester).

Read the full article from the University of Leicester

Read and download the article Genetic Variants Predict Optimal Timing of Radiotherapy to Reduce Side-effects in Breast Cancer Patients from Clinical Oncology

Johnson, K., Chang-Claude, J., Critchley, A. M., Kyriacou, C., Lavers, S., Rattay, T., … & Talbot, C. J. (2018). Genetic variants predict optimal timing of radiotherapy to reduce side-effects in breast cancer patients. Clinical Oncology. https://doi.org/10.1016/j.clon.2018.10.001

Abstract

Aims

Radiotherapy is an important treatment for many types of cancer, but a minority of patients suffer long-term side-effects of treatment. Multiple lines of evidence suggest a role for circadian rhythm in the development of radiotherapy late side-effects.

Materials and methods

We carried out a study to examine the effect of radiotherapy timing in two breast cancer patient cohorts. The retrospective LeND cohort comprised 535 patients scored for late effects using the Late Effects of Normal Tissue-Subjective Objective Management Analytical (LENT-SOMA) scale. Acute effects were assessed prospectively in 343 patients from the REQUITE study using the CTCAE v4 scales. Genotyping was carried out for candidate circadian rhythm variants.


Results

In the LeND cohort, patients who had radiotherapy in the morning had a significantly increased incidence of late toxicity in univariate (P equal to 0.03) and multivariate analysis (P equal to 0.01). Acute effects in the REQUITE group were also significantly increased in univariate analysis after morning treatment (P equal to 0.03) but not on multivariate analysis.

Conclusion

Our results suggest that it may be possible to reduce toxicity associated with breast cancer radiotherapy by identifying gene variants that affect circadian rhythm and scheduling for appropriate morning or afternoon radiotherapy.

In the news:

The Telegraph Radiotherapy should be given at different times of day to reduce side effects, Leicester Uni study suggests

Breast Cancer Care launches Alexa tool to help women spot key signs

Breast Cancer Care (BCC) has launched a virtual tool on Amazon’s Alexa which shares information on the signs and symptoms of breast cancer | via Digital Health

The tool can help guide women through a breast check and highlight the eight most common signs and symptoms of breast cancer to look out for.

Addie Mitchell, clinical nurse specialist at BCC, told Digital Health News that she hoped the digital tool would help give women more confidence to check for breast cancer. She said: “It gives them the confidence and assurance of being able to check in their own home. Checking for symptoms of breast cancer can cause a lot of anxiety as they don’t know what to look for, but the Alexa tool can help by listing the eight common ones.”

Mitchell added that the Alexa tool will also prompt users who may think they have one or more of the symptoms to get it checked out by their GP.

Full story at Digital Health

Breast screening: leading a service

Information for local providers and commissioners on leading NHS breast screening services | Public Health England

This guidance sets out the principles for the organisation and leadership of local breast screening services.  The guidance is aimed at those who are responsible for making sure breast screening services are managed in a professional and effective way. This involves meeting agreed standards and continually striving to improve performance.

The guidance looks at the following areas:

1.Senior leadership team roles

2.Core management skills for the senior leadership team

3.Organisation of screening services

4.Breast screening service workforce

Full guidance: Breast screening: leading a service

The NHS breast screening programme (BSP) covers the screening pathway from identification of the eligible population to diagnosis of women with breast cancer.

Related content:  NHS breast screening (BSP) programme

Social media boost for breast screening

More women attend for breast screening thanks to success of digital inclusion project | NHS Digital

An NHS project using social media to improve health by boosting digital inclusion has led to a 13 per cent increase in first time attendances for breast screening in Stoke-on-Trent over four years.

The local initiative saw information about screening posted on Facebook community groups, which empowered and enabled women to make appointments by reducing their anxiety around breast examinations. It also allowed them to communicate quickly and easily with health practitioners to ask questions about the screening process.

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Through this project, the North Midlands Breast Screening Service promoted their Facebook page on local community groups which their target group – women aged over 50 – regularly visited.

The screening team posted information such as patients explaining about how the screening process works and how it has affected them, and videos showing the rooms where it takes place. Posts were designed to encourage women to share them and so spread the message about the benefits and importance of screening.

The service’s Facebook page also answered questions in the group and by direct messaging, enabling women to book appointments more easily.

Full detail: More women attend for breast screening thanks to success of digital inclusion project | NHS Digital

See also: Social media could help raise breast screening take-up | OnMedica

Boosting confidence after breast cancer

A case study showing how cancer survivors in Salisbury feel more confident and less fatigued after enhanced support to live better after cancer | via NHS England

A new breast cancer stratified follow-up pathway, to increase the support given to breast cancer survivors, was rolled out at Salisbury Hospital in 2016.

The pathway includes a Holistic Needs Assessment (HNA) followed by a two-hour Moving Forward group. Hosted by a Consultant and a nurse, it addresses immediate health and wellbeing concerns. Offered to everyone on the patient initiated follow up, the average rating on session usefulness is 4.45 out of five. The average self-reported confidence score is 4.65. However the support does not stop there, patients identified as requiring more support are referred to the Cancer wellbeing group.

This group meets once a week for seven weeks. Hosted by a Clinical Psychologist and Gym Instructor qualified in rehabilitation, each two hour session starts with wellbeing advice, such as finance and benefits, diet or mindfulness and ends with a suitable rehabilitation exercise session. Group members unable to participate in group exercise receive a personal rehabilitation exercise programme. Members can also access weekly swimming sessions in the hospital pool. The average satisfaction rating for the group is 4.5 out of five, while on average, members report fatigue on daily life scores reduced by one third.

Full detail at NHS England

Breast cancer survivors control their follow-up care in Maidstone

NHS England | August 2018 |Breast cancer survivors control their follow-up care in Maidstone

A new case study from NHS England highlights how patients with breast cancer in  are able to control  their own care in Maidstone, Kent.  The Open Access programme enables patients to have access to regular mammograms, support advice and appropriate clinical follow up up to five years following treatment for breast cancer. The programme recognises patients as individuals and that the way in which they want to be supported may change during their recovery, the team introduced an Open Access Programme, based upon a successful model in place at the Royal Marsden Hospital.

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Early results

  • A reduction of 3,000 breast outpatient appointments
  • Patients access suitable clinical appointments and contact their nurse appropriately.

Patient benefits

  • Timely referral to an appropriate clinician (ie surgeon, oncologist, nurse)
  • Appointments aligned to patient need or want
  • Fast access to the Cancer Nurse to answer questions and concerns.

Full story at NHS England 

National Audit of Breast Cancer in Older Patients: 2018 Annual Report

HQIP | June 2018 | National Audit of Breast Cancer in Older Patients: 2018 Annual Report

Health Quality Improvement Programme (HQIP) has  produced a report which presents information on the care received by women diagnosed between 1 January 2014 and 31 December 2016 in England and Wales. As well as describing how these patterns of care differ between women in the younger and older age groups, the report also distinguishes between three main groups of breast cancer – women with ductal carcinoma in situ, with early invasive disease , and with advanced disease.

HQIP
Image source: hqip.org.uk

The report is primarily written for clinicians, providers of breast cancer services, commissioners and healthcare regulators. A version for patients and the general public will be available in summer 2018 (Source: HQIP).

Further details are available from HQIP 

The report can be read in full here