Feasibility, reliability and satisfaction of (automated) capillary carcinoembryonic antigen measurements for future home-based blood sampling: the prospective CASA-I study.

AIM: Follow-up for colorectal cancer (CRC) necessitates regular monitoring of carcinoembryonic antigen (CEA) at the hospital. Capillary home-based blood collection, including minimally invasive techniques such as lancet sampling or an automated upper arm device (TAP-II), has the potential to replace a significant portion of hospital-based blood sampling, thereby enhancing self-reliance and quality of life. The objectives of this study were to assess the feasibility, reliability and preference for CEA blood collection. METHODS: Baseline venous and capillary (by lancet and TAP-II) blood samples were collected from 102 participants, including 20 CRC patients with elevated CEA levels, 60 CRC patients undergoing postoperative outpatient monitoring and 20 healthy volunteers. The second group performed capillary blood collections at home on two consecutive follow-up appointments and subsequently sent them to the hospital. Satisfaction was assessed via patient reported outcome measures on pain, burden, ease of use and preference. RESULTS: The Pearson's correlation test of all usable samples resulted in a linear coefficient of 0.998 (95% CI 0.997-0.998) for the TAP-II method and 0.997 (95% CI 0.996-0.998) for the lancet method, both compared to venipuncture. Following the initial blood collection, 86% of the participants (n = 102) favoured the TAP-II, rating it as the least painful and burdensome option. After two home-based blood samples, the preference for the TAP-II method persisted, with 64% of the patients endorsing its use. CONCLUSION: This study demonstrated the feasibility of home-based capillary sampling of CEA. The TAP-II blood collection is the most reliable method and is preferred by patients over venipuncture and lancet sampling.

Prognostic value of total tumor volume in patients with colorectal liver metastases: A secondary analysis of the randomized CAIRO5 trial with external cohort validation.

BACKGROUND: This study aimed to assess the prognostic value of total tumor volume (TTV) for early recurrence (within 6 months) and overall survival (OS) in patients with colorectal liver metastases (CRLM), treated with induction systemic therapy followed by complete local treatment. METHODS: Patients with initially unresectable CRLM from the multicenter randomized phase 3 CAIRO5 trial (NCT02162563) who received induction systemic therapy followed by local treatment were included. Baseline TTV and change in TTV as response to systemic therapy were calculated using the CT scan before and the first after systemic treatment, and were assessed for their added prognostic value. The findings were validated in an external cohort of patients treated at a tertiary center. RESULTS: In total, 215 CAIRO5 patients were included. Baseline TTV and absolute change in TTV were significantly associated with early recurrence (P = 0.005 and P = 0.040, respectively) and OS in multivariable analyses (P = 0.024 and P = 0.006, respectively), whereas RECIST1.1 was not prognostic for early recurrence (P = 0.88) and OS (P = 0.35). In the validation cohort (n = 85), baseline TTV and absolute change in TTV remained prognostic for early recurrence (P = 0.041 and P = 0.021, respectively) and OS in multivariable analyses (P < 0.0001 and P = 0.012, respectively), and showed added prognostic value over conventional clinicopathological variables (increase C-statistic, 0.06; 95 % CI, 0.02 to 0.14; P = 0.008). CONCLUSION: Total tumor volume is strongly prognostic for early recurrence and OS in patients who underwent complete local treatment of initially unresectable CRLM, both in the CAIRO5 trial and the validation cohort. In contrast, RECIST1.1 did not show prognostic value for neither early recurrence nor OS.

Assessing patients' needs in the follow-up after treatment for colorectal cancer-a mixed-method study.

PURPOSE: The accessibility of cancer care faces challenges due to the rising prevalence of colorectal cancer (CRC) coupled with a shrinkage of healthcare professionals-known as the double aging phenomenon. To ensure sustainable and patient-centred care, innovative solutions are needed. This study aims to assess the needs of CRC patients regarding their follow-up care. METHODS: This study uses a mixed-method approach divided in three phases. The initial phase involved focus group sessions, followed by semi-structured interviews to identify patients' needs during follow-up. Open analysis was done to define main themes and needs for patients. In the subsequent quantitative phase, a CRC follow-up needs questionnaire was distributed to patients in the follow-up. RESULTS: After two focus groups (n = 14) and interviews (n = 5), this study identified six main themes. Findings underscore the importance of providing assistance in managing both physical and mental challenges associated with cancer. Participants emphasised the need of a designated contact person and an increased focus on addressing psychological distress. Furthermore, patients desire individualised feedback on quality of life questionnaires, and obtaining tailored information. The subsequent questionnaire (n = 96) revealed the priority of different needs, with the highest priority being the need for simplified radiology results. A possible approach to address a part of the diverse needs could be the implementation of a platform; nearly 70% of patients expressed interest in the proposed platform. CONCLUSIONS: CRC patients perceive substantial room for improvement of their follow-up care. Findings can help to develop a platform fulfilling the distinct demands of CRC patients during follow-up.

Association of modified textbook outcome and overall survival after surgery for colorectal liver metastases: A nationwide analysis.

BACKGROUND: Textbook outcome (TO) represents a multidimensional quality measurement, encompassing the desirable short-term outcomes following surgery. This study aimed to investigate whether achieving TO after resection of colorectal liver metastases (CRLM) surgery is related to better overall survival (OS) in a national cohort. METHOD: Data was retrieved from the Dutch Hepato Biliary Audit. A modified definition of TO (mTO) was used because readmissions were only recorded from 2019. mTO was achieved when no severe postoperative complications, mortality, prolonged length of hospital stay, occurred and when adequate surgical resection margins were obtained. To compare outcomes of patients with and without mTO and reduce baseline differences between both groups propensity score matching (PSM) was used for patients operated on between 2014 and 2018. RESULTS: Out of 6525 eligible patients, 81 % achieved mTO. For the cohort between 2014 and 2018, those achieving mTO had a 5-year OS of 46.7 % (CI 44.8-48.6) while non-mTO patients had a 5-year OS of 33.7 % (CI 29.8-38.2), p < 0.001. Not achieving mTO was associated with a worse OS (aHR 1.34 (95 % CI 1.17-1.53), p < 0.001. Median follow-up was 76 months., PSM assigned 519 patients to each group. In the PSM cohort patients achieving mTO, 5-year OS was 43.6 % (95 % CI 39.2-48.5) compared to 36.4 % (95 % CI 31.9-41.2) in patients who did not achieve mTO, p = 0.006. CONCLUSION: Achieving mTO is associated with improved long-term survival. This emphasizes the importance of optimising perioperative care and reducing postoperative complications in surgical treatment of CRLM.

Reliable capillary sampling of carcinoembryonic antigen at home: the CASA feasibility study.

AIM: Follow-up after colorectal cancer requires frequent surveillance of the tumour marker carcinoembryonic antigen (CEA). Home-based blood sampling could be beneficial in terms of patients' well-being and societal cost-effectiveness. Blood sampling by venepuncture is unsuitable for home-based sampling. The aim of this feasibility study is to evaluate the long-term whole-blood stability of CEA. METHOD: In this prospective feasibility study capillary blood withdrawal was collected in a Hem-Col® microtube containing a patented stabilization buffer using an internal lithium standard to correct for dilution. Long-term whole-blood stability was considered adequate if the relative bias in CEA concentration between delayed analysis of capillary samples and directly processed venepuncture is within the total error margin of CEA. RESULTS: Twenty two colorectal cancer patients were included to determine the stability of CEA in capillary sampling compared with directly processed (i.e. within 2 h) venepuncture sampling. The median time between venous sampling and CEA analysis and capillary sampling and CEA analysis was 2 h (interquartile range 1-4 h) and 76 h (interquartile range 74-95 h), respectively. A Bland-Altman difference plot excluding outliers showed an overall relative bias of -1.23%. The two capillary samples in our outlier analysis also showed the highest lithium concentrations. CONCLUSION: Home-based capillary sampling with the use of the Hem-Col® buffer is a feasible method for CEA determination when analysed within 4 days after blood withdrawal, allowing monitoring for colorectal cancer patients from home. High lithium concentrations due to insufficient filling of the Hem-Col® tube suggest less reliable CEA measurements.

Oncological surgery follow-up and quality of life: meta-analysis.

BACKGROUND: Previous trials found that more intensive postoperative surveillance schedules did not improve survival. Oncological follow-up also provides an opportunity to address psychological issues (for example anxiety, depression, and fear of recurrence). This systematic review assessed the impact of a less intensive surveillance strategy on health-related quality of life (HRQoL), emotional well-being, and patient satisfaction. METHODS: A systematic search was conducted in PubMed/MEDLINE, Embase, Web of Science, Cochrane database, PsycINFO, and Google Scholar to identify studies comparing different follow-up strategies after oncological surgery and their effect on HRQoL and patient satisfaction, published before 4 May 2022. A meta-analysis was conducted on the most relevant European Organisation for Research and Treatment of Cancer QLQ-C30 and Hospital Anxiety and Depression Scale subscales. RESULTS: Thirty-five studies were identified, focusing on melanoma (4), colorectal (10), breast (7), prostate (4), upper gastrointestinal (4), gynaecological (3), lung (2), and head and neck (1) cancers. Twenty-two studies were considered to have a low risk of bias, of which 14 showed no significant difference in HRQoL between follow-up approaches. Five studies with a low risk of bias showed improved HRQoL or emotional well-being with a less intensive follow-up approach and three with an intensive approach. Meta-analysis of HRQoL outcomes revealed no negative effects for patients receiving less intensive follow-up. CONCLUSION: Low-intensity follow-up does not diminish HRQoL, emotional well-being, or patient satisfaction.

Male-Female Differences in Ascending Aortic Aneurysm Surgery: 25-Year Single Center Results.

The aim of this study was to improve insight into male-female differences in patients undergoing ascending aortic aneurysm surgery. Consecutive patients that underwent ascending aortic aneurysm surgery between January 1991-December 2016 were retrospectively analyzed. Patient and procedural characteristics, 30-day mortality, and survival were compared between male and female patients. Multivariable Cox-regression analysis was performed to explore differences in factors associated with long-term mortality. Of 631 included patients, 36% were female patients. They were older (66 (55.9-72.9) vs 56 (44.1-67.3) years, p < 0.001), had a higher logistic EuroSCORE (12 (8-17) vs 8 (5-12), p < 0.001), and underwent concomitant arch surgery more often (74% vs 54%, p < 0.001). Aortic diameter (5.5 (5.0.6.5) vs 5.5 (5.0-6.0) cm, p = 0.025) and Aortic Size Index (3.15 (2.80-3.65) vs 2.70 (2.42-3.00) cm/m2, p < 0.001) were larger in female patients. Early mortality was 0.9% in female patients and 2.0% in male patients (p = 0.51). Adjusted 15-year survival was comparable between male and female patients. Multivariable Cox-regression did not identify an independent association between female sex and mortality. In males a larger aortic diameter (HR1.38 per centimeter increase, 95%-CI 1.03-1.85, p = 0.003) was an independent factor associated with mortality, and in female patients a larger BSA (HR0.08 per 1kg/m2 increase, 95%-CI 0.01-0.49, p = 0.007) was an independent risk-reducing factor. Female patients presented at older age and with more advanced disease. Increased awareness for ascending aortic pathology and timely referral may result in better preoperative profiles in female patients. This may improve outcomes after ascending aortic aneurysm surgery.

The prevalence of pulmonary arterial hypertension before and after atrial septal defect closure at adult age: A systematic review.

BACKGROUND: The development or persistence of pulmonary arterial hypertension (PAH) after atrial septal defect (ASD) closure at adult age is associated with a poor prognosis. The objective of this review was to investigate the prevalence of PAH before and after ASD closure and to identify factors that are associated with PAH. METHODS: EMBASE and MEDLINE databases were searched for publications until March 2017. All studies reporting the prevalence of PAH or data on pulmonary artery pressures both before and after surgical or percutaneous ASD closure in an adult population (≥16 years of age) were included. Papers were methodologically checked and data was visualized in tables, bar charts and plots. RESULTS: A total of 30 papers were included. The prevalence of PAH ranged from 29% to 73% before ASD closure and from 5% to 50% after closure; being highest in older studies, small study cohorts, and studies with high rates of loss to follow-up. The pooled systolic pulmonary artery pressure (PAP) was 43±13 before ASD closure and 32±10 after closure. The overall mean PAP was 34±10 before closure and 28±8 after closure. Studies with a higher mean PAP before closure and a higher mean age of the study cohort reported greater PAP reductions. CONCLUSIONS: The prevalence of PAH and mean pulmonary pressures decreased in all studies, regardless of the mean age or pulmonary pressures of the cohort. The reported prevalence of PAH after ASD closure is substantial, although widely varying (5%-50%), which is likely affected by selection of the study cohort.