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Objectives To determine the incidence and risk factors for thromboembolic events (TE) and febrile neutropenia (FN) in patients receiving systemic chemotherapy for early breast cancer (EBC). Methods 325 patients received FEC 75 , FEC 100 -T or ECaP for EBC in 2013. Results TE occurred in 7.4% and FN in 19.1% of patients. Risk factors for TE were: central venous catheter (p = 0.011). Risk factors for FN were: FEC 100 -T treatment versus FEC 75 and ECaP (p ≤ 0.001); lower pre-treatment neutrophil count (p = 0.009) and poorer performance status (p = 0.012). Two patients died from treatment-related toxicities. Conclusion In real-world experience, the majority of patients completed adequate treatment, despite significant complications.

Introduction: Corneal transplantations are surgeries performed for irreparable corneal diseases and damage. However, there is a gap between the number of potential recipients and the number of donor corneas available. The main aim of the study was to determine the awareness and attitudes towards corneal transplants among applicants and staff of DVLA, Kumasi-Ghana. Materials and Methods: A descriptive cross-sectional study was conducted. 100 participants were selected using convenient sampling method. A structured questionnaire was used to elicit responses from participants concerning awareness and attitudes toward corneal transplant. Results: The mean ± SD age of the participants was 32.05 ± 11.48years and age range, 18-67years. Males were 66% whilst females constituted 34%. 32.7% of the participants were aware of corneal transplant. Majority of the participants were Christians (83.1%) and Singles (63%). Television was the source of information with the highest preponderance (49.4%). 67.3% were willing to donate their corneas after death. 63.9% were willing to indicate their donor statuses on drivers’ license form which had a significant association with willingness to donate cornea after death (pConclusion: There is a poor level of awareness (32.7%) of transplant donation amongst the study population but and a good level of willingness to donate organs (67%). Consent via driving license would seem to be a good potential mode of obtaining consent to supplement the harvesting of adequate tissues for transplant if adequate awareness is created. Keywords: Knowledge, Willingness, Unwillingness, Cornea, DVLA

Background/Aim: Cisplatin-based radical chemoradiotherapy (CRT) is utilised in oesophagogastric (OG) cancer but the toxicity profile of cisplatin limits its use. This study aimed to evaluate the clinical characteristics and outcomes of patients treated with either cisplatin or carboplatin based CRT at our institution. Materials and Methods: This is a retrospective analysis of patients with localised OG cancer undergoing CRT with cisplatin/fluoropyrimidine (CX/F) or carboplatin/fluoropyrimidine (CarboX/F) between January 2001 and December 2014. Results: A total of 91 eligible patients were included. Median age was 65 years (IQR=57-75) for CX/F and 77 years (IQR=69-80) for CarboX/F. Adenocarcinoma histology and Charlson comorbidity index were higher in the CarboX/F group. Endoscopic complete response (CR) was achieved in 64% of CX/F group and 48% of CarboX/F group (p=0.19). The median PFS for CX/F was 31.0 months (95%CI=18.2-NE) vs. 18.7 months for CarboX/F (95%CI=13.5-30.4; HR=1.49, p=0.21). Conclusion: Despite significant differences in baseline clinical characteristics, patients treated with carboplatin CRT demonstrated no significant difference in PFS or endoscopic CR rate, compared to those treated with cisplatin.

Background Patients with oesophago-gastric (OG) cancer may be at risk of malnutrition, troublesome gastrointestinal symptoms (GI) and reduced dietary intake in view of the tumour location and multimodality curative treatment approach. Longitudinal research is lacking. The present study aimed to assess (i) nutritional status and how it evolved over the first year; (ii) the association between nutritional status scores and GI symptom scores; and (iii) the nutrient and food group intake pattern. Methods This was a prospective, observational study of patients with an OG lesion planned for radical treatment, with assessment at diagnosis, 3 months and 12 months after the start of treatment. Nutritional assessment was performed using the Patient-Generated Subjective Global Assessment, GI symptoms measured using the modified Gastrointestinal Symptom Rating Scale and dietary intake assessed using a semi-quantitative food frequency approach. Results Eighty patients (61 males, 19 females; aged 46-89 years) were recruited. At baseline, 3 (n = 68) and 12 months (n = 57), 61%, 62% and 60%, respectively, were moderately/severely malnourished. Higher symptom burden was associated with poorer nutritional status at baseline (r = 0.55, P < 0.001), 3 months (r = 0.51, P < 0.001) and 12 months (r = 0.42, P = 0.001). At each respective time point, 37%, 38% and 42% were meeting their estimated average requirement for energy. No change in mean (SD) intake of energy, fibre, nutrient and food groups was observed over time. Conclusions Patients with OG cancer have progressive weight loss, with malnutrition present over the majority of the 12-month study period. Optimising nutritional status and symptom management throughout the treatment pathway should be a clinical priority.

Background Society of Surgical Oncology and American Society for Radiation Oncology guidelines define clear margins in breast-conserving therapy (BCT) as 'no ink on tumour', in contrast to the attainment of margins of at least 1 mm widely practised in the UK. The primary aim of this study was to explore clinical, surgical and tumour-related factors associated with local recurrence after BCT, with a secondary aim of assessing the impact of margin re-excision on the risk of local recurrence. Methods Patient demographics, surgical details, tumour characteristics and local recurrence were recorded for consecutive women with BCT undergoing surgery between January 1997 and January 2007. Margins were defined as clear (greater than 1 mm), close (less than 1 mm but no ink on tumour), reaches (ink on tumour) and clear after re-excision. Results A total of 1045 women of median age 54 (range 18-86) years were studied. Median follow-up was 89 (range 4-196) months. Local recurrence occurred in 52 patients (5·0 per cent). Ink on tumour was associated with local recurrence (hazard ratio (HR) 4·86, 95 per cent c.i. 1·49 to 15·79; P = 0·009). Risk of local recurrence was the same for close and clear margins (HR 1·03, 0·40 to 2·62; P = 0·954). In women with involved margins, re-excision was still associated with an increased local recurrence risk (HR 2·50, 1·32 to 4·72; P = 0·005). Oestrogen receptor negativity increased risk (HR 2·28, 1·28 to 4·06; P = 0·005). Conclusion Adequately excised margins, even when under 1 mm, provide equivalent outcomes to wider margins in BCT. Achieving complete excision at primary surgery achieves the lowest rates of local recurrence.

Background Ado-trastuzumab emtansine (T-DM1) is standard of care for patients with advanced HER2+ breast cancer who relapse within 6 months of adjuvant trastuzumab or progress on anti-HER2 therapy. Hepatotoxicity on T-DM1 requires careful monitoring especially on long-term treatment. We evaluated its safety and efficacy in our real-world population, with particular attention to liver toxicity. Methods We identified patients on T-DM1 from 01/01/2014 to 12/03/2018 from our electronic records. Patients’ and tumour characteristics were recorded, along with safety and efficacy outcomes. Chi-squared/Fishers exact test and Kaplan-Meier statistical methods were utilised. Results 128 patients treated with T-DM1 were included in the analysis with a median age of 55 years (26-85). 115 (89.8%) had ECOG PS 0-1 and 95 (74.2%) were postmenopausal. 27 (21.1%) had de novo metastatic, 74 (57.8%) ER-positive disease. Metastatic spread involved bones in 82 patients (64.1%), liver in 71 (55.5%), lung in 62 (48.4%), nodes in 78 (60.9%), chest wall in 26 (20.3%) and central nervous system in 49 (38.3%). All patients had received prior trastuzumab and 39 (30.5%) pertuzumab. Neutropenia occurred in 29 patients (22.7% - G3-4 in 1 [3.5%]), anemia in 51 (39.2% - G3-4 in 8 [15.7%] and thrombocytopenia in 56 (43.8% - G3-4 in 6 [12.8%]). 88 patients (68.8%) had deranged liver function (G3-4 in 25 [28.4%]), 5 (3.9%) spider naevi and 12 (9.4%) bleeding. 7 patients (5.5%) experienced diarrhoea, 33 (25.8%) nausea, 82 (64.1%) fatigue, 10 (7.8%) skin rash. Cardiotoxicity occurred in 5 patients (3.9%), lung toxicity in 1 (0.8%). 46 (35.9%) required dose reductions, mostly due to neuropathy (30.4%), fatigue (23.9%), thrombocytopenia (17.4%), liver toxicity (17.4%). T-DM1 was stopped due to toxicity in 14 patients (12.6%). Responses were seen in 77 patients (64.1%). Median PFS was 7 months (95% CI 5-8) and OS 15 months (95% CI 12-17). No significant differences were seen based on prior pertuzumab use. Conclusions The safety of T-DM1 in this population is overall similar to those reported in literature, although we observed slightly higher rates of thrombocytopenia and deranged liver function. Responses were higher but more short-lived. Legal entity responsible for the study The Royal Marsden NHS Foundation Trust. Funding Has not received any funding. Disclosure N.M.L. Battisti: Travel / Accommodation / Expenses: Genomic Health; Speaker Bureau / Expert testimony: Pfizer. A. Ring: Advisory / Consultancy, Speaker Bureau / Expert testimony: Novartis; Advisory / Consultancy, Speaker Bureau / Expert testimony: Pfizer; Advisory / Consultancy: Lilly. All other authors have declared no conflicts of interest.

Background ATR inhibition (ATRi) exploits high levels of replication stress and G1/S cell cycle checkpoint dysfunction frequently seen in cancers, increasing DNA damage and inducing mitotic crisis. ATRi may also potentiate DNA-damaging anticancer therapies to improve clinical activity. Methods We present results from the monotherapy phase of a study of AZD6738, an oral ATRi in patients with advanced solid tumours (NCT02223923). Endpoints were MTD, safety, tolerability, pharmacokinetics (PK) and preliminary efficacy. MTD and PK were previously presented. Results Forty-six patients enrolled and received at least 1 dose AZD6738 to February 2019, 24 completed ≥1 cycle (28 days) of treatment in the dose-escalation phase, 20 commenced treatment in expansion phase, testing 2 different schedules at MTD (160 mg BD). The median number of cycles was 3 (range 2-12) in dose-escalation phase and 4 (1-12) in the dose-expansion cohort. 17/26 (65%) patients in dose escalation and 7/20 (35%) in dose-expansion had G ≥ 3 treatment-related adverse events (TRAEs). An intermittent schedule (2-week-on, 2-week-off) was better tolerated than continuous dosing, with G ≥ 3 TRAEs in 4/6 (67%) receiving continuous and 3/15 (20%) with intermittent dosing. The most common TRAEs were fatigue, anaemia, nausea and thrombocytopenia; 20 (77%) of patients in dose escalation and 16 (80%) in expansion discontinued AZD6738 due to progressive disease (PD). 5 (19%) patients in dose-escalation and 1 (5%) in dose-expansion discontinued due to toxicity. Best overall response was confirmed partial response (PR) in 3 (7%) participants, unconfirmed PR in 1 (2%), stable disease (SD) in 22 (48%) and PD in 12 (26%). Early clinical PD or toxicity prevented radiological assessment in 8 (17%). 5/24 (21%) participants in dose-escalation and 5/20 (25%) in dose-expansion had SD of ≥ 4 cycles (16 weeks) duration. Conclusions AZD6738 is well tolerated at 160 mg BD on a 2-week-on, 2-week-off schedule. ATRi monotherapy resulted in confirmed PR and a high proportion of prolonged SD. Future cohorts will enrich for DNA damage response-deficient tumours. A parallel dose-escalation study of AZD6738 combined with palliative radiotherapy is underway. Funding: CRUKD/14/007. Clinical trial identification NCT02223923; EudraCT: 2013-003994-84. Legal entity responsible for the study Royal Marsden NHS Foundation Trust and The Institute of Cancer Research: Royal Cancer Hospital. Funding Cancer Research UK, ECMC Combinations Alliance, AstraZeneca. Disclosure S.A. Smith: Shareholder / Stockholder / Stock options, Full / Part-time employment: AstraZeneca. E. Dean: Full / Part-time employment: AstraZeneca. J. Spicer: Honoraria (self), Advisory / Consultancy, Travel / Accommodation / Expenses: Boehringer Ingelheim; Honoraria (self): Lilly; Honoraria (self): Lytix Biopharma; Honoraria (self): Pierre Fabre; Honoraria (self): Roche; Honoraria (self), Advisory / Consultancy: Shionogi; Research grant / Funding (self): GlaxoSmithKline; Research grant / Funding (self): Quintiles; Travel / Accommodation / Expenses: Merck; Advisory / Consultancy: Clovis Oncology; Advisory / Consultancy: AstraZeneca. M.D. Forster: Advisory / Consultancy: AstraZeneca; Advisory / Consultancy: Boehringer Ingelheim; Advisory / Consultancy: Merck; Advisory / Consultancy: Novartis; Advisory / Consultancy, Travel / Accommodation / Expenses: Pfizer; Advisory / Consultancy, Travel / Accommodation / Expenses: Merck Sharpe & Dohme; Travel / Accommodation / Expenses: Roche; Advisory / Consultancy: Clovis Oncology; Advisory / Consultancy, Travel / Accommodation / Expenses: Lilly. K.J. Harrington: Advisory / Consultancy: Amgen; Advisory / Consultancy: AstraZeneca-Medimmune; Advisory / Consultancy: Bristol-Myers Squibb; Advisory / Consultancy: Lytix Biopharma; Advisory / Consultancy, Research grant / Funding (self): Merck Sharp & Dohme; Advisory / Consultancy: Merck; Advisory / Consultancy: Oncos Therapeutics; Advisory / Consultancy: Pfizer; Advisory / Consultancy, Research grant / Funding (self): Viralytics; Research grant / Funding (self): Oncolytics Biotech. All other authors have declared no conflicts of interest.

Background Surgical resection remains the best option for long-term survival in many solid tumors. Surgery can, however, lead to tumor cell release into the circulation. Data have suggested differential effects of anesthetic agents on cancer cell growth. This retrospective analysis investigated the association of anesthetic technique with long-term survival in patients presenting for elective surgery in a comprehensive cancer center over 3 yr. Methods All patients undergoing elective surgery between June 2010 and May 2013 were included. Patients were grouped according to whether they had received volatile inhalational (INHA) or total IV anesthesia (TIVA). After excluding those who received both forms of anesthesia during the study period, Kaplan–Meier survival curves were constructed from the date of surgery to death. After propensity matching, univariate and multivariable regression models were used to compare hazard ratios for death. Results A total of 11,395 anesthetics using INHA or TIVA were delivered in the study period. After exclusions, 3,316 patients (796 deaths, 24%) remained in the INHA group and 3,714 (504 deaths, 13.5%) in the TIVA group. After propensity matching, 2,607 patients remained in each group (597 deaths, 22.8%, in INHA group vs. 407, 15.6%, in TIVA group). Volatile inhalational anesthesia was associated with a hazard ratio of 1.59 (1.30 to 1.95) for death on univariate analysis and 1.46 (1.29 to 1.66) after multivariable analysis of known confounders in the matched group. Conclusions This retrospective analysis demonstrates an association between type of anesthetic delivered and survival. This analysis alongside biological plausibility should lead to urgent prospective work exploring the effect of anesthetic technique on survival.

Background Trastuzumab has changed the natural history of metastatic HER2 positive breast cancer. Some patients remain well and in remission for many years. There is currently no established duration after which trastuzumab in the advanced setting can be safely discontinued. This study aims to evaluate long-term efficacy and cardiac safety of trastuzumab when used as first-line treatment for patients with metastatic HER2 positive breast cancer. Patient and methods We retrospectively identified 215 patients with HER2 positive, locally advanced or metastatic breast cancer who commenced first line trastuzumab-containing therapy for metastatic disease between 2001 and 2010 at The Royal Marsden Hospital. Results The median progression free survival for all patients was 12 months (95%CI: 10.3–14.6 months); 103 (48%) patients remained in remission beyond one year, 59 (27%) beyond two years and 25 (12%) beyond five years. The median overall survival was 2.6 years (95% confidence interval (CI): 2.2–3.3). The objective response rate (ORR) was 65% with 17 (8%) complete responses and 120 (57%) partial responses. Trastuzumab was well tolerated. Twenty eight (13%) patients recorded any grade of left ventricular dysfunction. There was no significant difference in cardiac toxicity between those patients on less than or more than one year of trastuzumab. Conclusion Trastuzumab is associated with long-term remissions in a significant proportion of patients with metastatic HER2 positive disease when used in the first-line advanced setting.

Plant architecture is an important factor for crop production. Some members of microRNA156 (miR156) and their target genes SQUAMOSA Promoter‐Binding Protein‐Like (SPL) were identified to play essential roles in the establishment of plant architecture. However, the roles and regulation of miR156 is not well understood yet. Here, we identified a T‐DNA insertion mutant Osmtd1 (Oryza sativa multi‐tillering and dwarf mutant). Osmtd1 produced more tillers and displayed short stature phenotype. We determined that the dramatic morphological changes were caused by a single T‐DNA insertion in Osmtd1. Further analysis revealed that the T‐DNA insertion was located in the gene Os08g34258 encoding a putative inhibitor I family protein. Os08g34258 was knocked out and OsmiR156f was significantly upregulated in Osmtd1. Overexpression of Os08g34258 in Osmtd1 complemented the defects of the mutant architecture, while overexpression of OsmiR156f in wild‐type rice phenocopied Osmtd1. We showed that the expression of OsSPL3, OsSPL12, and OsSPL14 were significantly downregulated in Osmtd1 or OsmiR156f overexpressed lines, indicating that OsSPL3, OsSPL12, and OsSPL14 were possibly direct target genes of OsmiR156f. Our results suggested that OsmiR156f controlled plant architecture by mediating plant stature and tiller outgrowth and may be regulated by an unknown protease inhibitor I family protein.

Background Prognosis is worse for advanced triple-negative breast cancer (aTNBC) compared to other disease subtypes. Trials describe treatment outcomes in single specified lines of therapy; but few data describe treatment outcomes across the whole treatment pathway, which is critical in determining when patients should be referred for trials and to inform discussion. We evaluated treatment outcomes for aTNBC (overall response rate [ORR], median progression-free survival [mPFS] and median overall survival [mOS]) in patients treated largely outside of clinical trials. Methods We retrospectively identified 268 patients diagnosed with aTNBC from 01/12/2011 to 30/11/2016 from our electronic records and recorded patients' and tumour characteristics and treatment outcomes. Chi-squared/Fishers exact test and Kaplan-Meier statistical methods were utilised. Results 186 patients treated with ≥1 line of systemic treatment were eligible and had median age of 55 (range 26–91). 53.8% had ECOG Performance Status 0 and 69.9% visceral involvement. 38.6% had disease-free interval (DFI)≤12 months following surgery or adjuvant chemotherapy completion and 14.0% had de-novo advanced disease. 11.4% carried a BRCA mutation. 64.5% received two lines of therapy, 37.6% three and 21.5% four. ORR and mPFS were 43.9% and 3.7 months for first-line therapy, 40.2% and 3.5 months for second-line, 28.8% and 2.5 months for third-line and 25.0% and 2.1 months for fourth-line. In first line, DFI>12 months was associated with higher ORR and longer PFS compared DFI ≤12 months. Conclusions The observed response rates are consistent with literature. However, PFS is short, and early consideration of clinical trials can be justified in these patients.

Summary Background Chronic gastrointestinal symptoms after pelvic radiotherapy are common, multifactorial in cause, and affect patients' quality of life. We assessed whether such patients could be helped if a practitioner followed an investigative and management algorithm, and whether outcomes differed by whether a nurse or a gastroenterologist led this algorithm-based care. Methods For this three-arm randomised controlled trial we recruited patients (aged ≥18 years) from clinics in London, UK, with new-onset gastrointestinal symptoms persisting 6 months after pelvic radiotherapy. Using a computer-generated randomisation sequence, we randomly allocated patients to one of three groups (1:1:1; stratified by tumour site [urological, gynaecological, or gastrointestinal], and degree of bowel dysfunction [IBDQ-B score vs 60–70]): usual care (a detailed self-help booklet), gastroenterologist-led algorithm-based treatment, or nurse-led algorithm-based treatment. The primary endpoint was change in Inflammatory Bowel Disease Questionnaire–Bowel subset score (IBDQ-B) at 6 months, analysed by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00737230. Findings Between Nov 26, 2007, and Dec 12, 2011, we enrolled and randomly allocated 218 patients to treatment: 80 to the nurse group, 70 to the gastroenterologist group, and 68 to the booklet group (figure). Most had a baseline IBDQ-B score indicating moderate-to-severe symptoms. We recorded the following pair-wise mean difference in change in IBDQ-B score between groups: nurse versus booklet 4·12 (95% CI 0·04–8·19; p=0·04), gastroenterologist versus booklet 5·47 (1·14–9·81; p=0·01). Outcomes in the nurse group were not inferior to outcomes in the gastroenterologist group (mean difference 1·36, one sided 95% CI −1·48). Interpretation Patients given targeted intervention following a detailed clinical algorithm had better improvements in radiotherapy-induced gastrointestinal symptoms than did patients given usual care. Our findings suggest that, for most patients, this algorithm-based care can be given by a trained nurse. Funding The National Institute for Health Research.

Background Active surveillance (AS) aims to allow men with favourable-risk, localised prostate cancer to avoid unnecessary treatment. Objective To describe the clinical outcomes of a prospective study of AS. Design, setting, and participants A single-centre, prospective cohort study. Eligibility criteria included histologically proven prostate adenocarcinoma, age 50–80 yr, stage T1/T2, prostate-specific antigen level (PSA) 65 yr), and percent positive biopsy cores (PPC) ≤50%. Intervention Patients were assessed by serum PSA level, and digital rectal examination at 3-mo intervals in year 1, 4-mo intervals in year 2, and at 6-mo intervals thereafter. Transrectal ultrasound-guided prostate biopsy was performed after 18–24 mo and every 2 yr thereafter. Treatment was recommended for PSA velocity (PSAV) >1 ng/ml per year or adverse histology, defined as GS ≥4+3 or PPC >50%. Outcome measurements and statistical analysis Outcomes described, using Kaplan-Meier methods, were rate of adverse histology on repeat biopsy, freedom from treatment, biochemical control after deferred treatment, and overall survival. Analyses using Cox regression were performed to determine predictors of deferred treatment and adverse histology. Results and limitations The study enrolled 471 eligible patients from 2002 to 2011. Median age was 66 yr and median initial PSA value was 6.4 ng/ml. Eighty-eight percent of patients had T1 disease and 93% had GS ≤3+3. At median follow-up of 5.7 yr, the 5-yr rate of adverse histology and treatment-free probability was 22% (95% confidence interval [CI], 16–29%) and 70% (95% CI, 65–75%), respectively. There were two deaths from prostate cancer. Predictors of time to adverse histology were GS 7, PSAV >1 ng/ml per year, low ratio of free PSA to total PSA, and PPC >25%. Longer follow-up is needed to confirm the safety of this strategy. Conclusions This study demonstrates satisfactory medium-term outcomes for AS in selected men with localised prostate cancer.

We examine the impact of firm, corporate governance and managerial characteristics on the corporate social responsibility (CSR) activities of Vietnamese listed firms. Our results show that export-oriented firms engage in more CSR activities. As for corporate governance factors, we observe that foreign ownership and board diversity positively influence CSR. Among the managerial characteristics, we find that CEO education has a positive impact on CSR. The interaction coefficients of foreign ownership with firm’s export-orientation, board diversity and CEO education are significantly positive. The results of the study help us in understanding the key drivers of observed CSR practices of firms from an emerging country.

Background: Therapeutic radiotherapy is an important treatment of pelvic cancers. Historically, low-fiber diets have been recommended despite a lack of evidence and potentially beneficial mechanisms of fiber. Objective: This randomized controlled trial compared low-, habitual-, and high-fiber diets for the prevention of gastrointestinal toxicity in patients undergoing pelvic radiotherapy. Design: Patients were randomly assigned to low-fiber [≤10 g nonstarch polysaccharide (NSP)/d], habitual-fiber (control), or high-fiber (≥18 g NSP/d) diets and received individualized counseling at the start of radiotherapy to achieve these targets. The primary endpoint was the difference between groups in the change in the Inflammatory Bowel Disease Questionnaire–Bowel Subset (IBDQ-B) score between the starting and nadir (worst) score during treatment. Other measures included macronutrient intake, stool diaries, and fecal short-chain fatty acid concentrations. Results: Patients were randomly assigned to low-fiber (n = 55), habitual-fiber (n = 55), or high-fiber (n = 56) dietary advice. Fiber intakes were significantly different between groups (P < 0.001). The difference between groups in the change in IBDQ-B scores between the start and nadir was not significant (P = 0.093). However, the change in score between the start and end of radiotherapy was smaller in the high-fiber group (mean ± SD: −3.7 ± 12.8) than in the habitual-fiber group (−10.8 ± 13.5; P = 0.011). At 1-y postradiotherapy (n = 126) the difference in IBDQ-B scores between the high-fiber (+0.1 ± 14.5) and the habitual-fiber (−8.4 ± 13.3) groups was significant (P = 0.004). No significant differences were observed in stool frequency or form or in short-chain fatty acid concentrations. Significant reductions in energy, protein, and fat intake occurred in the low- and habitual-fiber groups only. Conclusions: Dietary advice to follow a high-fiber diet during pelvic radiotherapy resulted in reduced gastrointestinal toxicity both acutely and at 1 y compared with habitual-fiber intake. Restrictive, non–evidence-based advice to reduce fiber intake in this setting should be abandoned. This trial was registered at clinicaltrials.gov as NCT 01170299.

The randomized, double-blinded Royal Marsden Tamoxifen Breast Cancer Prevention Trial in healthy high-risk women started in 1986 and is still blinded. Eligible participants (

Multiple myeloma (MM) is a molecularly and clinically heterogeneous disease, making it challenging to control. Despite the impact of novel agents, including the immunomodulatory drugs (IMiDs) thali...

The theoretical as well as empirical relationships between corporate social responsibility and corporate financial performance are not without controversy. Yet, CSR activities are increasingly undertaken by a large number of firms, not only in developed countries but also in emerging countries. Using a multiple theory framework, we analyze a sample of Vietnamese listed firms and find that corporate social responsibility activities affect their financial performance positively. We also find that corporate governance feature like foreign ownership strengthens the positive relationship between CSR and financial performance. However, the moderating impact of state ownership is not always clear.

Objective The study aimed to evaluate Problem-Focussed Interactive Telephone Therapy, an individual psychological therapy based on cognitive-behavioural therapy adapted for telephone delivery to cancer patients with high psychological needs. Methods A non-randomised, within-group prospective design was used. Outcome measures pre-therapy and post-therapy included were as follows: Hospital Anxiety and Depression Scale, Mental Adjustment to Cancer Scale: helpless/hopeless sub-scale only, Checklist of Cancer Concerns, Cancer Coping Questionnaire and EQ-5D quality of life. A study-specific Service Evaluation Questionnaire was included. Eligible patients were either (i) offered out-patient screening for anxiety/depression/helplessness (n = 649) or (ii) referred for psychological care by oncology clinicians (n = 160). Results Thirty two percent (36/114) of screen-identified cases and 22% (35/160) of referred patients participated, and 42 were available for analysis. There were significant post-therapy improvements in Hospital Anxiety and Depression Scale anxiety (p = 0.002) and depression (p = 0.003), Mental Adjustment to Cancer Scale helpless/hopeless (p = 0.036), cancer concerns (p = 0.005) and overall quality of life (p = 0.048). Overall, 81% (34/42) of participants were defined as clinical cases at baseline and 32% were no longer cases post-therapy. There were significant improvements in coping consistent with the therapy method. Conclusions A minority of symptomatic patients opt for telephone psychological therapy; however, where they do, there are significant improvements indicating that telephone-delivered therapy is feasible in patients with high needs. Findings are discussed in relation to current issues on the implementation of distress screening and psychological therapy provision within clinical settings. Copyright © 2012 John Wiley & Sons, Ltd.