Sue Hartup

Background: In recent years, telemedicine use in cancer care has grown rapidly to support long-term cancer survivorship care needs. While remote care offers many benefits such as reduced travel burden for patients and increased clinic capacity for those with complex needs, challenges with adoption remain. Existing systematic reviews on telemedicine focus on barriers and facilitators of implementation. This systematic review will use the RE-AIM framework to evaluate telemedicine in cancer follow-up, aiming to identify components for sustainable implementation. It will also explore nurse-led care delivery and Patient-Reported Outcome Measures in these interventions. Methods: Electronic databases will be systematically searched for publications in English that describe telemedicine interventions in cancer follow-up care of at least 1 year. The database searches [MEDLINE (Ovid), CINAHL (EBESCO), Web of Science, Embase (Ovid), PsycINFO (Ovid), Cochrane Central Register of Controlled Trials, and IEEE Xplore] will be supplemented by searching the reference lists of relevant full texts. Title and abstract screening will be conducted by two independent reviewers and discrepancies resolved through discussion with senior authors. Data extraction and narrative synthesis will be guided by the five dimensions of the RE-AIM framework: Reach, Effectiveness, Adoption, Implementation, and Maintenance. Discussion: This systematic review aims to collate the evidence regarding telemedicine interventions in cancer follow-up care. Findings will contribute to the development of a toolkit for a new, nurse-led model of germ cell cancer follow-up. Systematic review registration: PROSPERO CRD42024589524

Background: Adherence to the World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR) cancer prevention guidelines is linked to lower cancer incidence and improved outcomes. However, the relationship between these guidelines and chemotherapy response, particularly in Triple Negative Breast Cancer, is not well understood. TNBC has the poorest survival rates among breast cancer subtypes, with only 32% of patients achieving pathological complete response after neoadjuvant chemotherapy. Predicting which patients will respond and gain survival benefits remains a challenge and identifying patients unlikely to respond would help provide more effective treatment options and reduce side-effects and hospital admissions. This study assesses the feasibility of collecting data for a clinical trial aimed at identifying factors that predict chemoresponse with particular attention on diet, nutrition, physical activity, adherence to WCRF/AICR recommendations, and tumour and circulating biomarkers. Methods: This prospective, non-randomised feasibility study will recruit, over 24 months, between 15-20 triple negative breast cancer patients undergoing neoadjuvant chemotherapy. The data collected are: body mass index, chemotherapy details, surgery type, gene expression analysis in diagnostic tumour cores, serum and plasma samples for lipid and vitamin analysis, tumour response by magnetic resonance imaging during and after treatment and pathological response after treatment. Participants will complete patient-reported outcome measures, food and physical activity questionnaires, at the start and end of treatment. Discussion: This study aims to explore the impact of dietary patterns on chemotherapy responses in TNBC patients, a subtype with poor prognosis and high relapse risk. Adherence to the WCRF/AICR cancer prevention guidelines is linked to reduced cancer incidence and better outcomes. However, the role of diet in predicting chemotherapy response remains unclear. The study seeks to gather data for a future clinical trial examining these connections, aligning with research priorities to prevent cancer relapse and provide evidence-based dietary advice. This feasibility study will inform patient recruitment, data collection, and trial design. Trial registration: This trial was prospectively registered on 12 ^th December 2022 ( ISRCTN20130557 ).

Purpose of the review: Chronic post-treatment pain in breast cancer affects a high proportion of patients. Symptom burden and financial costs are increasingly impacting patients and healthcare systems because of improved treatments and survival rates. Supporting long-term breast cancer symptoms using novel methodology has been examined, yet few have explored the opportunity to utilise these interventions for prevention. This review aims to explore the need for, range of, and effectiveness of such interventions. Recent findings: Three papers describe risk factors for chronic pain, with six recent papers describing the use of interventions for acute pain in the surgical setting. The evidence for the effectiveness of these interventions to improve pain management in this setting is limited but tentatively positive. The results have to take into account the variation between systems and limited testing. Summary: Multiple types of intervention emerged and appear well accepted by patients. Most assessed short-term impact and did not evaluate for reduction in chronic pain. Such interventions require rigorous effectiveness testing to meet the growing needs of post-treatment pain in breast cancer. A detailed understanding of components of web-based interventions and their individual impact on acute pain and chronic pain is needed within future optimisation trials. Their effectiveness as preventative tools are yet to be decided.

Background: Despite a UK 5-year breast cancer survival rate of 86.6%, patients may develop breast cancer recurrence within the same breast after breast conserving surgery, as well as in the remaining skin or chest wall after mastectomy or in the ipsilateral lymph glands. These recurrences, collectively termed locoregional recurrence (LRR), occur in around 8% of patients within 10 years of their original diagnosis. Currently, there is a lack of robust information on the presentation and prevalence of LRR with no UK-specific clinical guidelines available for the optimal management of this patient group. Additionally, there is a need to identify patterns of LRR presentation and their progression, which will enable prognostic factors to be determined. This will subsequently enable the tailoring of treatment and improve patient outcome. Methods: The MARECA study is a prospective, multicentre cohort study recruiting patients diagnosed with breast cancer LRR +/- associated distant metastases. Over 50 UK breast units are participating in the study with the aim of recruiting at least 500 patients over a recruitment period of 24 months. The data collected will detail the tumour pathology, imaging results, surgical treatment, radiotherapy and systemic therapy of the primary and recurrent breast cancer. Study follow-up will be for up to 5 years following LRR diagnosis to determine subsequent oncological outcomes and evaluate potential prognostic factors. Discussion: This study will address the current knowledge gap and identify subgroups of patients who have less successful treatment outcomes. The results will determine the current management of LRR and the prognosis of patients diagnosed with breast cancer LRR +/- distant metastases in the UK, with the aim of establishing best practice and informing future national guidelines. The results will direct future research and inform the design of additional interventional trials and translational studies.