Emma G. Khoury

Background: It is increasingly recognized that frailty should be assessed and considered in treatment decision making in patients with cancer. This review and meta-analysis synthesizes existing evidence evaluating the association between baseline frailty and systemic anticancer treatment outcomes in adults with cancer. Methods: Five databases were systematically searched from database inception to January 2023 to identify prognostic factor studies (cohort or case-control design) reporting the associations between validated frailty assessments (pretreatment) and follow-up outcomes in adults with solid-organ malignancy undergoing systemic anticancer treatment. Risk of bias was assessed via Quality of Prognosis Studies in Systematic Reviews tool. Where appropriate, associations between frailty and outcomes (survival, toxicity, treatment tolerance, functional decline/quality of life, and hospitalization) were synthesized in meta-analysis and presented as forest plots. Results: A total of 58 studies met inclusion criteria. They were undertaken in a range of tumor sites and mainly in older patients and advanced and/or palliative disease settings. Most had low or moderate risk of bias. Nine frailty assessment tools were evaluated. Four outcomes were synthesized in meta-analysis, which demonstrated the prognostic value of 2 tools: Geriatric-8 (survival, treatment tolerance, hospitalization) and Vulnerable Elders Survey-13 (survival, toxicity, treatment tolerance). Overall pooled estimates indicate that frailty conveys an increased risk of mortality (hazard ratio [HR] = 1.68, 95% confidence interval [CI] = 1.41 to 2.00), toxicity (odds ratio [OR] 1.83, 95% CI = 1.24 to 2.68), treatment intolerance (OR = 1.68, 95% CI = 1.32 to 2.12), and hospitalization (OR = 1.94, 95% CI = 1.32 to 2.83). Conclusion: Simple, brief frailty assessments including Geriatric-8 and Vulnerable Elders Survey-13 are prognostic for a range of important outcomes in patients undergoing systemic anticancer treatment. Risk estimates should be used to support shared decision making.

Background: Recruitment in sexual health research is challenging. This study explores the potential of a Consent for Contact system (C4C) - generic consent for research contact - to improve participant recruitment and engagement in sexual health research. Our objectives were to understand patient and staff understanding of research, their views on a separate C4C system, and their preferences for its acceptability in a sexual health clinic setting. Methods: A two-stage study was conducted at a large urban UK sexual health clinic from November 2021 to July 2022. Stage one involved a self-completed questionnaire administered to all patients and staff. In Stage 2, semi-structured interviews (SSIs) further explored patient concerns and preferences. Survey data were analysed using chi-square and Fisher’s exact test and thematic analysis was applied to free-text responses and SSIs. Results: A total of 205/300 patient (68%) and 41/280 staff questionnaires (15%) were completed. Motivations for research participation included altruism and personal interest. Statistically significant differences were found between patients’ and staff members’ concerns on confidentiality and anticipated feeling of pressure to participate. The majority of staff ( n = 38, 93%) and half of patients ( n = 100, 49%) supported implementation of a sexual health C4C system. Participants recognised the potential benefits of a sexual health C4C system, including enhanced privacy and increased research opportunities. Concerns were raised about stigma, terminology, and signing-up methods. Conclusion: This study found the C4C system has the potential to enhance participant recruitment and engagement in sexual health research, but implementation support is narrowly divided with concerns around privacy and sign-up processes. These insights call for a patient-centred design approach, emphasising clear communication and privacy. Future research should focus on implementing and evaluating a sexual health C4C system to further explore their effectiveness and acceptability in different contexts.

Cancer is a disease associated with ageing. Managing cancer in older adults may prove challenging owing to pre-existing frailty, comorbidity, and wider holistic needs, as well as the unclear benefits and harms of standard treatment options. With the ongoing advances in oncology and the increasing complexity of treating older adults with cancer, the geriatric oncology field must be a priority for healthcare systems in education, research, and clinical practice. However, geriatric oncology is currently not formally taught in undergraduate education or postgraduate training programmes in the United Kingdom (UK). In this commentary, we outline the landscape of geriatric oncology undergraduate education and postgraduate training for UK doctors. We highlight current challenges and opportunities and provide practical recommendations for better preparing the medical workforce to meet the needs of the growing population of older adults with cancer. This includes key outcomes to be considered for inclusion within undergraduate and postgraduate curricula.

Background: Formal education of oncology is lacking in many undergraduate medical curricula. Mentoring schemes can expose participants to specific areas of medicine and may address the shortfalls in oncology education. Few mentoring schemes have been designed within the United Kingdom, especially within oncology. There is a need to understand reasons for mentor and mentee participation in such schemes and to identify ways to minimize barriers to engagement. Objective: This study identifies motivations for participation in an oncology mentoring scheme and its benefits and limitations to both the mentee and the mentor. Methods: The British Oncology Network for Undergraduate Societies launched a National Oncology Mentorship Scheme (NOMS) on September 1, 2021. Mentees (medical student or foundation doctor) were paired with mentors (specialty registrar or consultant), for 6 months of mentoring. In total, 86 mentors and 112 mentees were recruited to the scheme. The mentees and mentors were asked to meet at least 3 times during this period and suggestions were provided on the content of mentoring. Mentees and mentors were invited to complete a prescheme questionnaire, exploring motivations for involvement in the scheme, current experiences within oncology, and knowledge and interests in the field. At the end of the scheme, mentors and mentees were asked to complete a postscheme questionnaire exploring experiences and benefits or limitations of participation. Paired analysis was performed using the Wilcoxon signed-rank test. For free text data, content analysis was applied to summarize the main themes in the data. Results: Of the 66 (59%) mentees who completed the prescheme questionnaire, 41 (62%) were clinical, 21 (32%) preclinical medical students, and the remainder were junior doctors. For mentees, networking was the primary reason for joining the scheme (n=25, 38%). Mentees ranked experience of oncology at medical school at 3 on 10 (IQR 2-5). In this, 46 (53%) mentors completed the prescheme questionnaire, 35 (76%) were registrar level, and the remainder were consultant level (n=11). The most common reason for mentor participation was to increase awareness and interest in the field (n=29, 63%). Of those who completed the prescheme questionnaire, 23 (35%) mentees and 25 (54%) mentors completed the postscheme questionnaire. Knowledge in all areas of oncology assessed significantly increased during the scheme (P<.001). Most mentees (n=21, 91%) and mentors (n=18, 72%) felt they had benefited from the scheme. Mentees cited gaining insights into oncology as most beneficial; and mentors, opportunities to develop professionally. Whilst mentees did not report any barriers to participating in the scheme, mentors stated lack of time as the greatest barrier to mentoring. Conclusions: British Oncology Network for Undergraduate Societies’ NOMS is expanding and is beneficial for mentees through increasing knowledge, providing exposure, and career advice in oncology. Mentors benefit from improving their mentoring skills and personal satisfaction.

BACKGROUND Formal education of oncology is lacking in many undergraduate medical curricula. Mentoring schemes can expose participants to specific areas of medicine and may address the shortfalls in oncology education. Few mentoring schemes have been designed within the United Kingdom, especially within oncology. There is a need to understand reasons for mentor and mentee participation in such schemes and to identify ways to minimize barriers to engagement. OBJECTIVE This study identifies motivations for participation in an oncology mentoring scheme and its benefits and limitations to both the mentee and the mentor. METHODS The British Oncology Network for Undergraduate Societies launched a National Oncology Mentorship Scheme (NOMS) on September 1, 2021. Mentees (medical student or foundation doctor) were paired with mentors (specialty registrar or consultant), for 6 months of mentoring. In total, 86 mentors and 112 mentees were recruited to the scheme. The mentees and mentors were asked to meet at least 3 times during this period and suggestions were provided on the content of mentoring. Mentees and mentors were invited to complete a prescheme questionnaire, exploring motivations for involvement in the scheme, current experiences within oncology, and knowledge and interests in the field. At the end of the scheme, mentors and mentees were asked to complete a postscheme questionnaire exploring experiences and benefits or limitations of participation. Paired analysis was performed using the Wilcoxon signed-rank test. For free text data, content analysis was applied to summarize the main themes in the data. RESULTS Of the 66 (59%) mentees who completed the prescheme questionnaire, 41 (62%) were clinical, 21 (32%) preclinical medical students, and the remainder were junior doctors. For mentees, networking was the primary reason for joining the scheme (n=25, 38%). Mentees ranked experience of oncology at medical school at 3 on 10 (IQR 2-5). In this, 46 (53%) mentors completed the prescheme questionnaire, 35 (76%) were registrar level, and the remainder were consultant level (n=11). The most common reason for mentor participation was to increase awareness and interest in the field (n=29, 63%). Of those who completed the prescheme questionnaire, 23 (35%) mentees and 25 (54%) mentors completed the postscheme questionnaire. Knowledge in all areas of oncology assessed significantly increased during the scheme (P<.001). Most mentees (n=21, 91%) and mentors (n=18, 72%) felt they had benefited from the scheme. Mentees cited gaining insights into oncology as most beneficial; and mentors, opportunities to develop professionally. Whilst mentees did not report any barriers to participating in the scheme, mentors stated lack of time as the greatest barrier to mentoring. CONCLUSIONS British Oncology Network for Undergraduate Societies’ NOMS is expanding and is beneficial for mentees through increasing knowledge, providing exposure, and career advice in oncology. Mentors benefit from improving their mentoring skills and personal satisfaction. CLINICALTRIAL

Cylindroma is a benign adnexal tumour that occurs as a solitary pink–red coloured nodule and is usually found on the scalp or neck. There have been few cases reported of these lesions being found on the genitalia. They can be found in single or in multiple form, with the latter usually inherited in an autosomal dominant pattern. CYLD lysine 63 deubiquitinase (CYLD) cutaneous syndrome, also known as Brooke-Spiegler syndrome, is a genetic condition characterized by the growth of multiple benign adnexal skin tumours. The most common tumours are cylindromas, spiradenomas and trichoepitheliomas. The cause of this syndrome can be attributed to mutations in the CYLD tumour suppressor gene. If both copies of this gene are mutated, the cell undergoes uncontrolled cell proliferation and division resulting in the formation of a tumour. Here, we present an unusual case of a female patient presenting with a large cylindroma over the mons pubis.

Background: SARS-CoV-2 have been shown to be associated with more severe disease and death in cancer patient. A systematic review and meta-analysis was conducted to determine the risk by age, tumour type and treatment of infection with SARS-CoV-2 in cancer patients. Methods: Systematic review by searching PubMed, Web of Science, and Scopus for articles published in English up to June 14, 2021 of SARS-CoV-2 infection in >10 patients with malignant disease. Outcomes included factors in patients with malignant disease that may predict a poor outcome from COVID-19 compared to patients without malignant disease, including patient demographics, tumour subtype and cancer treatments. A meta-analysis was performed using random effects model. Results: 81 studies were included, totalling 61,532 cancer patients. Haematological malignancies comprised 22.1% (9,672 of 43,676) of cases. Relative risk (RR) of mortality when age and sex matched was 1.69 (95% CI, 1.46-1.95; p2 =51%). RR of mortality, versus non-cancer patients, was associated with decreasing age (exp(b)0.96; 95% CI, 0.922–0.994; p=0.028) but not male sex (exp(b)1.89; 95% CI, 0.222–6.366; p=0.83). RR of mortality in those with haematological malignancies versus non-cancer control was 1.81 (95% CI, 1.53-2.95; I ² =0.0%). Compared to other cancers, increased risk of death was seen for lung (RR 1.68, 95% CI, 1.45-1.94; p2 =86.97%) and endocrine therapy the lowest at 11% (95% CI, 6-16%; I ² =70.7%). Conclusions: Cancer patients, particularly younger cancer patients, appear at increased risk of mortality from COVID-19 compared to non-cancer patients. Differences in outcomes were seen based on tumour types and treatment. Highlights: - To our knowledge this is the largest review and meta-analysis of COVID-19 in cancer patients with insights into tumour types and therapies. - In unadjusted analysis cancer doubles the risk of COVID-19 related mortality. This decreased when adjusted for age and sex. - Younger cancer patients have the highest risk of mortality when compared to non-cancer COVID-19 patient of a similar age. - Patients with lung, genitourinary and haematological malignancies are at increased risk of mortality, breast and gynaecological cancers are at lower risk. - Patients on chemotherapy have the highest pooled mortality risk with those on endocrine therapy the lowest.