Jack Patrick Gleeson

Background: Glioblastoma is the most common malignant brain tumour in adults and carries a poor prognosis despite advances in molecular characterisation and therapy. The 2021 World Health Organisation classification redefined glioblastoma as an IDH-wildtype diffuse astrocytic tumour with aggressive histological or molecular features. Standard of care therapy has changed little over the last two decades, and outcomes remain suboptimal, with considerable heterogeneity in survival influenced by clinical, molecular, and treatment-related factors. Aims: This study evaluates the clinical and molecular characteristics, treatment strategies, and survival outcomes for glioblastoma patients at Cork University Hospital from 2006–2023 to assess changes in management and outcomes. Methods: 494 patients were diagnosed with glioblastoma between 1st of January 2006 and 31st of December 2023. IDH mutant cases were excluded. Data was extracted from medical records, with survival analyses using the Kaplan–Meier method and COX proportional hazards model. Results: The median age was 63 years (range: 17–86). Increased availability of molecular markers was observed between the time periods. Median overall survival remained stable over time (2006–2010: 9.9 months; 2011–2014: 11.9 months; 2015–2019: 10.9 months; 2020–2023: 11.1 months), with no statistical significance between periods. On multivariate analysis, key prognostic factors included age at diagnosis, ECOG performance status, glucocorticoid use at baseline, MGMT methylation status, and completion of the adjuvant chemo-radiation. Conclusions: Despite advances in our understanding of the pathogenesis of glioblastoma, the mOS median overall survival in our real-world patient cohort did not improve over time. The findings emphasise the need for ongoing research efforts to improve outcomes in this lethal disease.

Background Over 100,000 men in Ireland are living with or beyond a cancer diagnosis, many with complex and evolving needs. Treatments such as androgen deprivation therapy negatively affect body composition, including muscle loss and fat gain. Group-based education with peer support, particularly when led by dietitians, is valued by prostate cancer survivors and may support positive behaviour change. Aim This protocol outlines the dietetic component of the Linking In with supports and Advice for Males impacted by Metastatic Cancer (LIAM Mc) Trial (NCT05946993) and describes the approach to assessing its feasibility in men with advanced or metastatic genitourinary cancer. Methods The LIAM Mc Trial is a 12-week multidisciplinary intervention for men aged ≥18 years with advanced or metastatic genitourinary cancer. The dietetic component includes five structured group education sessions based on the World Cancer Research Fund Recommendations and the Healthy Ireland Food Pyramid. One-on-one nutritional counselling is also offered. Dietary quality will be assessed via a cancer-specific dietary quality score and body composition will be assessed using bioelectrical impedance analysis, and ultrasound. Feasibility outcomes include recruitment, retention, attendance, acceptability, and the practicality of collecting outcome data. Conclusion This study will provide feasibility data to inform the future scaling of dietitian-led group education for men with metastatic cancer. It will also offer insights into the acceptability and potential impact of such interventions on diet quality and body composition, informing the design of a future definitive trial and contributing to models of survivorship care that prioritise nutrition and peer support. Clinical Trials Registration ClinicalTrials.gov (NCT05946993), registered on 10 th May 2023, and Cancer Trials Ireland (CTRIAL-IE 23-18).

Background: The significant increase in cancer survivorship rates necessitates a comprehensive, multidisciplinary approach to supportive care services. This study seeks to assess the feasibility of introducing a Men’s Health Initiative supportive care intervention program in Ireland. Methods: This is a single-arm feasibility study involving a 12-week men’s cancer survivorship programme alongside routine follow-up care in patients with advanced genitourinary malignancies. Men with advanced/metastatic genitourinary cancer (including prostate, kidney, urothelial tract, testicular or penile cancer), are eligible to enrol, with a target of 72 participants over a 2-year period. The intervention programme entails a twice-weekly physiotherapy-led exercise programme, along with dietetics, nursing, and psychosocial components, and regular signposting to additional available services. A Pilot Phase involving analysis of data from the first group of 6 participants to complete the programme is planned, before an Expansion Phase. Assessments will occur at baseline, on completion of the 12-week intervention, and 3 months post-intervention, and will include analyses of exercise/activity levels, body composition, muscle strength, psychological wellbeing, quality of life and resources utilised. The primary endpoints are to determine the feasibility and acceptability of introducing a men’s cancer survivorship intervention programme into routine follow-up care in patients with advanced genitourinary malignancies. Secondary endpoints include impact of the intervention programme on quality of life, cancer-related fatigue, maintenance of weight, changes in body composition and changes in dietary intake and diet quality over the study period, as well as self-care agency and its relationship to quality of life and symptoms experienced. A qualitative process evaluation will be undertaken to explore participants’ experiences, while an economic analysis will examine the healthcare resource utilization and costs associated with the intervention. The trial was peer-reviewed by the Irish Cancer Society. Discussion: The programme described in this protocol provides a supportive and safe environment for the introduction of self-care interventions using a small group-based format supported by individualised counselling according to the participant’s identified needs. The development and implementation of future supportive care programmes for men’s cancer survivorship will be guided by the findings of this study. Trial registrartion: ClinicalTrials.gov NCT05946993

Background: The improved survival rate for many cancers in high-income countries demands a coordinated multidisciplinary approach to survivorship care and service provision to ensure optimal patient outcomes and quality of life. This study assesses the feasibility of introducing a Men’s Health Initiative supportive care intervention programme in Ireland. Methods: This is a single-arm feasibility study involving a 12-week men’s cancer survivorship programme alongside routine follow-up care in patients with advanced genitourinary malignancies. Men with advanced/metastatic genitourinary cancer (including prostate, kidney, urothelial tract, testicular or penile cancer), are eligible to enrol, with a target of 72 participants over a 2-year period. The intervention programme entails a twice-weekly physiotherapy-led exercise programme, along with dietetics, nursing, and psychosocial components, and regular signposting to additional available services. A Pilot Phase involving analysis of data from the first group of 6 participants to complete the programme is planned, before an Expansion Phase. Assessments will occur at baseline, on completion of the 12-week intervention, and 6 months post-intervention, and will include analyses of exercise/activity levels, body composition, muscle strength, psychological wellbeing, quality of life and resources utilised. The primary endpoints are to determine the feasibility and acceptability of introducing a men’s cancer survivorship intervention programme into routine follow-up care in patients with advanced genitourinary malignancies. Secondary endpoints include impact of the intervention programme on quality of life, cancer-related fatigue, maintenance of weight, changes in body composition and changes in dietary intake and diet quality over the study period, as well as self-care agency and its relationship to quality of life and symptoms experienced. A process evaluation will capture the experiences of participation in the study, and the healthcare costs will be examined as part of the economic analysis. Ethical approval was granted in November 2022, with recruitment commencing in May 2023. Discussion: The programme described in this protocol provides a supportive and safe environment for the introduction of self-care interventions using a small group-based format supported by individualised counselling according to the participant’s identified needs. Findings will provide direction for the implementation of future supportive care programmes for men’s cancer survivorship care. ClinicalTrials.gov Identifier: NCT05946993 ; Cancer Trials Ireland #: CTRIAL-IE 23-18; Irish Cancer Society (ICS) Study reference: MHI22BAM, UCC Sponsor Study Code: 22052.

PURPOSE: Paclitaxel, ifosfamide, and cisplatin (TIP) is an established salvage regimen for germ cell tumors (GCT) on the basis of a phase II trial, but efficacy on a large patient cohort including patients with unfavorable risk features and long-term outcomes has not been reported. Herein, we report updated treatment efficacy and long-term follow-up with TIP. PATIENTS AND METHODS: Patients with GCT who received TIP after cisplatin-based chemotherapy were eligible. Favorable response (complete response or partial response with negative tumor markers), overall survival (OS) and progression-free survival (PFS) rates, relapse, and toxicity were determined. Disease was reclassified according to the International Prognostic Factor Study Group (IPFSG) score. RESULTS: Of the 104 patients, 87 had favorable risk factors and 17 had at least one unfavorable factor by Memorial Sloan Kettering Cancer Center (MSKCC) criteria. Ten patients were treated for a second gonadal primary GCT. With a median follow-up of 8.9 years, the 5-year PFS and OS rates were 66% (95% CI, 55 to 74) and 69% (95% CI, 59 to 77), respectively. Among 87 patients with favorable-risk disease, 69 (79%) achieved a favorable response with 5-year PFS and OS rates of 67% (95% CI, 56 to 76) and 72% (95% CI, 61 to 80), respectively. Among 17 patients with MSKCC unfavorable-risk disease, 13 (76%) achieved a favorable response with 5-year PFS and OS rates of 59% (95% CI, 33 to 78) and 56% (95% CI, 28 to 76), respectively. After IPFSG reclassification, 5-year PFS and OS rates for patients with ≤intermediate-risk disease were 75% (95% CI, 50 to 89) and 73% (95% CI, 55 to 85), respectively. CONCLUSION: TIP is an effective second-line regimen for patients with GCT. Similar outcomes were observed in patients with favorable- and unfavorable-risk disease. The randomized TIGER trial (ClinicalTrials.gov identifier: NCT02375204 ) comparing TIP with high-dose chemotherapy will determine the optimal second-line treatment approach.

Testicular germ cell tumor (GCT) is the most common solid tumor in adolescent and young adult men. Progress in the management of GCT has been made in the last 50 years, with a substantial improvement in cure rates for advanced disease, from 25% in the 1970s to nearly 80%. However, relapsed or platinum‐refractory disease occurs in a proportion, 20% of whom will die from disease progression. This article reviews the current evidence‐based treatments for extracranial GCT, the acute and chronic toxic effects that may result, and highlights contemporary advances and progress in the field.

Advanced pancreatic cancer is associated with a poor prognosis, often less than 1 year. Honest prognosis discussions guide early community palliative care services input, facilitating timely advance care planning and improving quality of life. The aims were to assess if patients were offered prognosis discussions and community palliative care services referral. A retrospective analysis of consecutive case-notes of new advanced pancreatic cancer patients was conducted. Chi-squared test assessed the association with prognosis discussion and community palliative care services referral. In total, 365 cases (60%) had a documented prognosis discussion at any time-point in the treatment pathway; 54.4% during the first appointment. The frequency of prognosis discussion was greater with nurse clinician review at first appointment (p < 0.001). In total, 171 patients (28.1%) were known to community palliative care services at the first appointment. Of those not known, 171 (39.1%) and 143 (32.7%) were referred at this initial time-point or later, respectively. There was a significant association between the referral to community palliative care services at first appointment and the reviewing professional (this was greatest for nurse clinicians (frequency 65.2%)) (p < 0.001), and also if reviewed by clinical nurse specialist at first visit or not (47.8% vs. 35.6%) (p < 0.01). Prognosis discussions were documented in approximately two-thirds of cases, highlighting missed opportunities. Prognosis discussion was associated with clinician review and was most frequent for nurse clinician, as was referral to community palliative care services. Clinical nurse specialist review increased referral to community palliative care services if seen at the initial visit. Multi-disciplinary review, specifically nursing, therefore, during the first consultation is imperative and additive. It should be considered best practice to offer and negotiate the content and timing of prognosis discussions with cancer patients, and revisit this offer throughout their treatment pathway. Greater attention to prognosis discussion documentation is recommended.

Purpose: To identify supportive care interventions for men with urological cancers. Methods: Experimental studies conducted among men with any urological cancer were eligible for inclusion. Academic Search Complete, CINAHL Plus with Full Text, MEDLINE, APA PsycArticles, APA PsycInfo, Social Sciences Full Text (H.W. Wilson), SocINDEX with Full Text, ERIC, Google Scholar and ClinicalTrials.gov were searched on 6 December 2022. No database limits were applied. The included studies were methodologically appraised. A narrative synthesis of the results was conducted. Results: Thirty studies were included with 10 categories of interventions identified. Over 300 outcomes were measured, and more than 100 instruments were used. Multicomponent interventions generally led to positive changes in physiological outcomes like body mass index, as well as exercise tolerance and quality of life. This change, however, was not sustained in the long term. Cognitive-behavioural interventions significantly improved psychological symptoms but seldom physical symptoms. Telephone and web-based interventions showed great promise in improving outcomes like depression, positive affect, negative affect, perceived stress, spiritual wellbeing and fatigue. Findings from physical activity/exercise-based interventions were promising for both, physical and psychological outcomes. Rehabilitative interventions were associated with significant improvements in quality of life, urinary symptoms and psychological symptoms, albeit in the short term. Mixed results were reported for nurse-led interventions, family-based interventions and nutritional interventions. Conclusion: All but one study focused exclusively on prostate cancer. The included studies were significantly heterogeneous. Multicomponent, cognitive-behavioural, telephone and web-based, physical activity/exercise-based and rehabilitative interventions showed great promise in improving various outcomes. This improvement, however, was often short-lived.