Background: PRIMETIME is a UK-led prospective biomarker-directed cohort study aiming to identify ... more Background: PRIMETIME is a UK-led prospective biomarker-directed cohort study aiming to identify a group of breast cancer patients who can safely avoid radiotherapy following breast conserving surgery. This group is deemed to be at such a low risk of local relapse that the potential benefits of radiotherapy are unlikely to outweigh the risks. The uncertainty patients face regarding healthcare decisions is known as decisional conflict. Patient decision aids (PDA) are interventions which help patients to weigh up the risks and benefits of treatments. Evidence suggests PDA reduce decisional conflict. A study within a trial (SWAT) concept which enables trialists to conduct research embedded within a larger trial was used to investigate if the introduction of a PDA video reduces decisional conflict within PRIMETIME. Methods: The PDA video was designed to be used in addition to the standard written information and developed in close collaboration with PRIMETIME patient advocates. The PRIM...
IntroductionSystemic anticancer therapy is given to selected patients with early breast cancer (E... more IntroductionSystemic anticancer therapy is given to selected patients with early breast cancer (EBC) before or after surgery with the aim of eradicating micrometastatic spread and reducing the risk of cancer recurrence. Chemotherapy treatment is most effective when patients receive the optimum dose, on time and without delays or reductions in their treatment doses. Most chemotherapy drugs are dosed according to body surface area calculated from a patient’s height and weight. These calculations were however designed based on data from normal weight patients. This has resulted in uncertainty as to the optimal dosing for patients with different amounts of blood, muscle and fatty tissue (body composition). This study uses segmental bioelectrical impedance analysis (using the Seca mBCA 515) to determine whether differences in the measures of resistance and reactance, and derived estimates of body composition, are predictive of chemotherapy toxicity in the treatment of EBC.Methods and ana...
Additional file 1: Appendix figure 1. Questionnaire given to patients in the standard group. Appe... more Additional file 1: Appendix figure 1. Questionnaire given to patients in the standard group. Appendix figure 2. Questionnaire given to patients in the enhanced group. Appendix figure 3. Summary of the risk of recurrence in very low risk patients. Appendix figure 4. Summary of change in breast appearance in women treated with radiotherapy. Appendix table 1. Summary of script structure. Appendix table 2. Summary of association of age and education level with decisional conflict. Appendix table 3. Summary of decisional conflict subscales results.
Background: PRIMETIME is a UK-led prospective biomarker directed cohort study aiming to identify ... more Background: PRIMETIME is a UK-led prospective biomarker directed cohort study aiming to identify a group of breast cancer patients who can safely avoid radiotherapy following breast conserving surgery. This group is deemed to be at such a low risk of local relapse that the potential benefits of radiotherapy are unlikely to outweigh the risks. The uncertainty patients face regarding healthcare decisions is known as ‘decisional conflict’ which may increase when a component of standard of care is removed. Patient decision aids (PDA) are interventions which help patients to weigh up the risks and benefits of treatments. Evidence suggests PDA reduce decisional conflict. The study within a trial (SWAT) concept enables trialists to conduct research embedded within a larger trial in an economic and efficient manner. A SWAT testing whether the introduction of a PDA video reduces decisional conflict was conducted within the PRIMETIME study. The method development of the PRIMETIME SWAT is desc...
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, Jan 28, 2018
To develop a decision support tool for young women with breast cancer considering genetic testing... more To develop a decision support tool for young women with breast cancer considering genetic testing for BRCA1/2 mutations soon after cancer diagnosis. A four-stage iterative development process was employed; stage 1, literature review exploring the availability and efficacy of empirically tested decision support tools; stage 2, in-depth interviews with 29 young women (< 50 years) recently diagnosed with breast cancer, exploring information requirements and experiences of genetic testing decision making; stage 3, three focus groups (N = 21) exploring preferences for information presentation and prioritisation of content; stage 4, think-aloud interviews to refine the prototype (N = 16). Participants wanted information regarding the pros and cons of testing, the testing process and implications for their family, presented in a way that allowed them to choose the level of detail they required. They preferred the term 'altered gene', valued a medical word definition function and...
Women who have been treated for breast cancer may identify vasomotor symptoms, such as hot flushe... more Women who have been treated for breast cancer may identify vasomotor symptoms, such as hot flushes and night sweats (HFNS), as a serious problem. HFNS are unpleasant to experience and can have a significant impact on daily life, potentially leading to reduced adherence to life saving adjuvant hormonal therapy. It is known that Cognitive Behavioural Therapy (CBT) is effective for the alleviation of hot flushes in both well women and women who have had breast cancer. Most women with breast cancer will see a breast care nurse and there is evidence that nurses can be trained to deliver psychological treatments to a satisfactory level, whilst also maintaining treatment fidelity. The research team will assess whether breast care nurses can effectively deliver a CBT intervention to alleviate hot flushes in women with breast cancer. This study is a multi-centre phase III individually randomised controlled trial of group CBT versus usual care to reduce the impact of hot flushes in women with...
The Breast Cancer Campaign Tissue Bank (BCCTB) was initiated in 2010 after the charity Breast Can... more The Breast Cancer Campaign Tissue Bank (BCCTB) was initiated in 2010 after the charity Breast Cancer Campaign heard from breast cancer experts that insufficient high quality breast cancer tissue was preventing research which would impact people with breast cancer1. The charity decided to involve patient advocates in the development of the BCCTB from the beginning. Two advocates reviewed the initial applications to form the BCCTB. These included both single and multi-centre applications so they suggested that, rather than choosing one centre to form the Bank, the charity consider a collaboration of centres. Throughout the development of the BCCTB, the patient advocates asked the ‘elephant in the room’ questions and brought a different perspective. They also helped to design the Bank9s processes, including the consent process and asking that all tissue applicants produce a lay summary of their research. There are now two advocates on the Board which provides strategic direction to the BCCTB. The advocates have equal status to other Board members. There are also three advocates on the Tissue Access Committee which controls the use of tissue in the Bank. Lay summaries of projects have to be approved by all advocates before an application can proceed. This means that no precious tissue is released without the approval of a lay person, who can ensure maximum patient benefit will be achieved from any research. The Bank9s data return policy was also driven by the patient advocates who were keen that the tissues donated were used to their maximum benefit. This has resulted in the first publication from BCCTB 2 Patient advocates have been involved in promoting the use of tissue from the bank presenting at conferences and at BCCTB road shows. Patient advocates have also been involved in asking potential donors to consent to donate to the tissue bank. The involvement of patient advocates in the development and oversight of the BCCTB has shown researchers that patient and public involvement works. The advocates can also help promote the Bank and the benefits of tissue donation to both professionals and lay groups. The patient advocates involved in the Breast Cancer Campaign Tissue Bank are members of the charity Independent Cancer Patients’ Voice 1. Thompson P, Brennan K, Cox A, Gee J, Harcourt D, Harris A, Harvie M, Holen I, Howell A, Nicholson R, Steel M, Streuli C. Evaluation of the current knowledge limitations in breast cancer research: a gap analysis. Breast Cancer Res 2008: 10(2); R26. 2. Speirs V, Morgan A. Investment biobanking – increased returns on tissue samples. Nat Rev Clin Onc 2013; 10:128-129. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-10-01.
Background For patients with early breast cancer considered at very-low risk of local relapse, ri... more Background For patients with early breast cancer considered at very-low risk of local relapse, risks of radiotherapy may outweigh the benefits. Decisions regarding treatment omission can lead to patient uncertainty (decisional conflict), which may be lessened with patient decision aids (PDA). PRIMETIME (ISRCTN 41579286) is a UK-led biomarker-directed study evaluating omission of adjuvant radiotherapy in breast cancer; an embedded Study Within A Trial (SWAT) investigated whether PDA reduces decisional conflict using a cluster stepped-wedge trial design. Methods PDA diagrams and a video explaining risks and benefits of radiotherapy were developed in close collaboration between patient advocates and PRIMETIME trialists. The SWAT used a cluster stepped-wedge trial design, where each cluster represented the radiotherapy centre and referring peripheral centres. All clusters began in the standard information group (patient information and diagrams) and were randomised to cross-over to the ...
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, Jan 7, 2015
Cancer-related fatigue (CRF) is a frequent and distressing symptom experienced after cancer treat... more Cancer-related fatigue (CRF) is a frequent and distressing symptom experienced after cancer treatment. RESTORE is the first web-based resource designed to enhance self-efficacy to manage CRF following curative-intent treatment. The aim of this study is to test the proof of concept and inform the design of an effectiveness trial. A multi-centre parallel-group two-armed (1:1) exploratory randomised controlled trial (RCT) with qualitative process evaluation was employed in the study. Participants (≥18 years; ≤5 years post treatment with moderate to severe fatigue) were recruited and randomly assigned to RESTORE or a leaflet. Feasibility and acceptability were measured by recruitment, attrition, intervention adherence, completion of outcome measures and process evaluation. Change in self-efficacy to manage CRF was also explored. Outcome measures were completed at baseline (T0), 6 weeks (T1) and 12 weeks (T2). Data were analysed using mixed-effects linear regression and directed content ...
Background: PRIMETIME is a UK-led prospective biomarker-directed cohort study aiming to identify ... more Background: PRIMETIME is a UK-led prospective biomarker-directed cohort study aiming to identify a group of breast cancer patients who can safely avoid radiotherapy following breast conserving surgery. This group is deemed to be at such a low risk of local relapse that the potential benefits of radiotherapy are unlikely to outweigh the risks. The uncertainty patients face regarding healthcare decisions is known as decisional conflict. Patient decision aids (PDA) are interventions which help patients to weigh up the risks and benefits of treatments. Evidence suggests PDA reduce decisional conflict. A study within a trial (SWAT) concept which enables trialists to conduct research embedded within a larger trial was used to investigate if the introduction of a PDA video reduces decisional conflict within PRIMETIME. Methods: The PDA video was designed to be used in addition to the standard written information and developed in close collaboration with PRIMETIME patient advocates. The PRIM...
IntroductionSystemic anticancer therapy is given to selected patients with early breast cancer (E... more IntroductionSystemic anticancer therapy is given to selected patients with early breast cancer (EBC) before or after surgery with the aim of eradicating micrometastatic spread and reducing the risk of cancer recurrence. Chemotherapy treatment is most effective when patients receive the optimum dose, on time and without delays or reductions in their treatment doses. Most chemotherapy drugs are dosed according to body surface area calculated from a patient’s height and weight. These calculations were however designed based on data from normal weight patients. This has resulted in uncertainty as to the optimal dosing for patients with different amounts of blood, muscle and fatty tissue (body composition). This study uses segmental bioelectrical impedance analysis (using the Seca mBCA 515) to determine whether differences in the measures of resistance and reactance, and derived estimates of body composition, are predictive of chemotherapy toxicity in the treatment of EBC.Methods and ana...
Additional file 1: Appendix figure 1. Questionnaire given to patients in the standard group. Appe... more Additional file 1: Appendix figure 1. Questionnaire given to patients in the standard group. Appendix figure 2. Questionnaire given to patients in the enhanced group. Appendix figure 3. Summary of the risk of recurrence in very low risk patients. Appendix figure 4. Summary of change in breast appearance in women treated with radiotherapy. Appendix table 1. Summary of script structure. Appendix table 2. Summary of association of age and education level with decisional conflict. Appendix table 3. Summary of decisional conflict subscales results.
Background: PRIMETIME is a UK-led prospective biomarker directed cohort study aiming to identify ... more Background: PRIMETIME is a UK-led prospective biomarker directed cohort study aiming to identify a group of breast cancer patients who can safely avoid radiotherapy following breast conserving surgery. This group is deemed to be at such a low risk of local relapse that the potential benefits of radiotherapy are unlikely to outweigh the risks. The uncertainty patients face regarding healthcare decisions is known as ‘decisional conflict’ which may increase when a component of standard of care is removed. Patient decision aids (PDA) are interventions which help patients to weigh up the risks and benefits of treatments. Evidence suggests PDA reduce decisional conflict. The study within a trial (SWAT) concept enables trialists to conduct research embedded within a larger trial in an economic and efficient manner. A SWAT testing whether the introduction of a PDA video reduces decisional conflict was conducted within the PRIMETIME study. The method development of the PRIMETIME SWAT is desc...
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, Jan 28, 2018
To develop a decision support tool for young women with breast cancer considering genetic testing... more To develop a decision support tool for young women with breast cancer considering genetic testing for BRCA1/2 mutations soon after cancer diagnosis. A four-stage iterative development process was employed; stage 1, literature review exploring the availability and efficacy of empirically tested decision support tools; stage 2, in-depth interviews with 29 young women (< 50 years) recently diagnosed with breast cancer, exploring information requirements and experiences of genetic testing decision making; stage 3, three focus groups (N = 21) exploring preferences for information presentation and prioritisation of content; stage 4, think-aloud interviews to refine the prototype (N = 16). Participants wanted information regarding the pros and cons of testing, the testing process and implications for their family, presented in a way that allowed them to choose the level of detail they required. They preferred the term 'altered gene', valued a medical word definition function and...
Women who have been treated for breast cancer may identify vasomotor symptoms, such as hot flushe... more Women who have been treated for breast cancer may identify vasomotor symptoms, such as hot flushes and night sweats (HFNS), as a serious problem. HFNS are unpleasant to experience and can have a significant impact on daily life, potentially leading to reduced adherence to life saving adjuvant hormonal therapy. It is known that Cognitive Behavioural Therapy (CBT) is effective for the alleviation of hot flushes in both well women and women who have had breast cancer. Most women with breast cancer will see a breast care nurse and there is evidence that nurses can be trained to deliver psychological treatments to a satisfactory level, whilst also maintaining treatment fidelity. The research team will assess whether breast care nurses can effectively deliver a CBT intervention to alleviate hot flushes in women with breast cancer. This study is a multi-centre phase III individually randomised controlled trial of group CBT versus usual care to reduce the impact of hot flushes in women with...
The Breast Cancer Campaign Tissue Bank (BCCTB) was initiated in 2010 after the charity Breast Can... more The Breast Cancer Campaign Tissue Bank (BCCTB) was initiated in 2010 after the charity Breast Cancer Campaign heard from breast cancer experts that insufficient high quality breast cancer tissue was preventing research which would impact people with breast cancer1. The charity decided to involve patient advocates in the development of the BCCTB from the beginning. Two advocates reviewed the initial applications to form the BCCTB. These included both single and multi-centre applications so they suggested that, rather than choosing one centre to form the Bank, the charity consider a collaboration of centres. Throughout the development of the BCCTB, the patient advocates asked the ‘elephant in the room’ questions and brought a different perspective. They also helped to design the Bank9s processes, including the consent process and asking that all tissue applicants produce a lay summary of their research. There are now two advocates on the Board which provides strategic direction to the BCCTB. The advocates have equal status to other Board members. There are also three advocates on the Tissue Access Committee which controls the use of tissue in the Bank. Lay summaries of projects have to be approved by all advocates before an application can proceed. This means that no precious tissue is released without the approval of a lay person, who can ensure maximum patient benefit will be achieved from any research. The Bank9s data return policy was also driven by the patient advocates who were keen that the tissues donated were used to their maximum benefit. This has resulted in the first publication from BCCTB 2 Patient advocates have been involved in promoting the use of tissue from the bank presenting at conferences and at BCCTB road shows. Patient advocates have also been involved in asking potential donors to consent to donate to the tissue bank. The involvement of patient advocates in the development and oversight of the BCCTB has shown researchers that patient and public involvement works. The advocates can also help promote the Bank and the benefits of tissue donation to both professionals and lay groups. The patient advocates involved in the Breast Cancer Campaign Tissue Bank are members of the charity Independent Cancer Patients’ Voice 1. Thompson P, Brennan K, Cox A, Gee J, Harcourt D, Harris A, Harvie M, Holen I, Howell A, Nicholson R, Steel M, Streuli C. Evaluation of the current knowledge limitations in breast cancer research: a gap analysis. Breast Cancer Res 2008: 10(2); R26. 2. Speirs V, Morgan A. Investment biobanking – increased returns on tissue samples. Nat Rev Clin Onc 2013; 10:128-129. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-10-01.
Background For patients with early breast cancer considered at very-low risk of local relapse, ri... more Background For patients with early breast cancer considered at very-low risk of local relapse, risks of radiotherapy may outweigh the benefits. Decisions regarding treatment omission can lead to patient uncertainty (decisional conflict), which may be lessened with patient decision aids (PDA). PRIMETIME (ISRCTN 41579286) is a UK-led biomarker-directed study evaluating omission of adjuvant radiotherapy in breast cancer; an embedded Study Within A Trial (SWAT) investigated whether PDA reduces decisional conflict using a cluster stepped-wedge trial design. Methods PDA diagrams and a video explaining risks and benefits of radiotherapy were developed in close collaboration between patient advocates and PRIMETIME trialists. The SWAT used a cluster stepped-wedge trial design, where each cluster represented the radiotherapy centre and referring peripheral centres. All clusters began in the standard information group (patient information and diagrams) and were randomised to cross-over to the ...
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, Jan 7, 2015
Cancer-related fatigue (CRF) is a frequent and distressing symptom experienced after cancer treat... more Cancer-related fatigue (CRF) is a frequent and distressing symptom experienced after cancer treatment. RESTORE is the first web-based resource designed to enhance self-efficacy to manage CRF following curative-intent treatment. The aim of this study is to test the proof of concept and inform the design of an effectiveness trial. A multi-centre parallel-group two-armed (1:1) exploratory randomised controlled trial (RCT) with qualitative process evaluation was employed in the study. Participants (≥18 years; ≤5 years post treatment with moderate to severe fatigue) were recruited and randomly assigned to RESTORE or a leaflet. Feasibility and acceptability were measured by recruitment, attrition, intervention adherence, completion of outcome measures and process evaluation. Change in self-efficacy to manage CRF was also explored. Outcome measures were completed at baseline (T0), 6 weeks (T1) and 12 weeks (T2). Data were analysed using mixed-effects linear regression and directed content ...
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Papers by Lesley Turner