Danish Research Center for Cancer Surgery | ACROBATIC
Research Collaboration Across Surgical Oncology for Better Patient Care
ACROBATIC Research Projects
Granted applications
Fall 2024 call
Four ACROBATIC members received a grant to support their work described in their Work Packages for the Fall 2024 application round. The following ACROBATIC Research Projects were granted.
Due to colorectal cancer, ~3000 colorectal resections are performed annually in Denmark. The procedure is often complicated by anastomosis leakage (AL) and postoperative ileus (POI), leading to increased patient morbidity. Recent research suggests that active treatment with gastric pacing could reduce the POI burden, and clinical trials are currently pending.
Literature shows that POI increases the risk of anastomotic leakage (AL), an association that could be mediated through decreased microcirculation leading to impaired anastomosis healing. Nevertheless, this has never previously been investigated. Moreover, an objective tool for perioperative evaluation of the microcirculation has until now been unavailable; Currently, the evaluation of the intestinal microcirculation is done by subjective assessment of the tissue color, bleeding, and arterial pulsation by the surgeon. However, Laser Speckle Contrast Imaging (LSCI) is an emerging new tool for objective measurement of the microcirculation, which could support the surgeon’s perioperative evaluation of the microcirculation, and thus healing potential, in an anastomosis.
Therefore, the scope of this project is to investigate microcirculation with LSCI and promote the transfer of LSCI into the clinic. We will do this by combining porcine studies with a clinical human trial. The results will contribute to the knowledge of microcirculation around anastomosis in colorectal surgery, with especial focus on complications as POI and AL. Further, results will show whether it is feasible to implement laparoscopic LSCI measurements in a clinical setting to support the surgeon’s evaluation of the intestinal microcirculation. In time, such a support tool could improve patient healing after onco-surgery.
Awarded to: Mai-Britt Worm Ørntoft (Gødstrup Hospital) – CFA2
Awarded grant to suport VIP personnel.
Sarcomas are rare and aggressive tumors accounting for 1% of all adult malignancies and 10% of pediatric malignancies. The management of sarcomas in orthopedic oncology is challenging, discerning tumor from healthy tissue intraoperatively difficult, and positive margin rates following primary surgery are high despite highly specialized treatment. Positive margins have been shown to be associated with increased local recurrence but the role of positive margins as an independent risk factor in survival is less clear. Fluorescence-guided surgery is a well-established technology that has been used in other surgical specialties for tumor identification, but also mapping of the lymphatic system and angiography. The technique involves intravenously injecting a dye that fluoresces which can then be detected intraoperatively through an imaging system. This project aims to assess whether fluorescence-guided surgery can be repurposed to improve intraoperative attainment of negative margins in sarcoma surgery in a national multicenter trial using indocyanine green (ICG) – a fluorescent dye that has been shown to accumulate in sarcomas. Additionally, we aim to assess the role of positive margins on local recurrence and survival through a retrospective cohort study based on the national Danish Sarcoma Registry.
If margins of sarcomas could be accurately determined intraoperatively through fluorescence-guided surgery, this would immediately reduce reoperations based on positive margins, most likely reduce local recurrence and may improve survival while sparing as much healthy tissue as possible.
Awarded to: Thomas Baad-Hansen (Aarhus University Hospital) – CFA2
Awarded grant to support VIP personnel.
Lymphedema, encompassing accumulation of lymphatic fluid in the extremities, often results from cancer treatments such as lymph node biopsy, dissection, or radiotherapy(1). Lymphedema substantially reduces patients’ mental and physical health and overall well-being(2). Additionally, it imposes a notable economic burden on both patients and society (3). Lower limb lymphedema (LLL) is most likely more common than upper limb lymphedema, as the risk of developing lymphedema following the same procedures such as lymph node dissections (axillary/inguinal) is more than double for the lower limbs(4). Moreover, the range of cancers that can lead to lymphedema due to treatment is broader for the lower extremities (cervix, ovarian, prostate, melanoma a.o.) compared to the upper extremities (breast, melanoma).
Inventive and potentially curative LLL treatments are being explored. Among these, lymphovenous anastomoses (LVA) have internationally been implemented. LVA aims to circumvent impaired lymphatic vessels by establishing connections with neighboring veins through anastomoses under a microscope, facilitating direct drainage of lymphatic fluid into the venous system(5). Some centers report promising outcomes from LVA for treating lymphedema while other reports are less positive (6-8); in addition, negative studies are prone to publication bias.
Results of LVA range from miraculous (removing lymphedema completely) to no improvement or even deterioration (8, 9). Our department has been the sole provider of LVA in Denmark until recently with mixed results. Heterogeneity in patient selection including varying lymphedema severity, patient demographics, and comorbidities influence the efficacy of LVA. Secondly, lack of validated and standardized evaluation of LVA’s effectiveness can lead to significantly differing results(10) and a randomized study of LVA’s effect along with exploration of the best measurement methods is much needed.
Awarded to: Lisbet Rosenkrantz Hölmich (Herlev and Gentofte Hospital) – CFA2
Awarded grant to support VIP personnel.
The Danish Health and Medicines Authority explicitly described that the aim of follow up beyond cancer treatment is to detect and manage both cancer recurrence and long-term sequelae (1). The patient perspective using patient reported outcome measures (PROMs) is pivotal in the follow-up program for assessment of QOL and late adverse effects and has gained widespread use in both medical and surgical oncology (2). During the recent decade, our research group has developed a series of Patient Reported Outcome Measures (PROMs) covering pelvic organ functions, including gastrointestinal-, bladder- and sexual dysfunction, stoma function, and pain (3-6). The Low Anterior Resection Score (LARS score) was the first developed by our group at Aarhus University Hospital (7). It is now validated and translated into more than 30 languages and used in a large number of trials worldwide (8). Items included in the scores and the weight of each item are determined by their impact on quality of life. Thereby, the scores are not only simple and easy to use, they also very much reflect the patient perspective of symptoms and impact on QOL.
ePROMs are acceptable to both patients and staff, save much time and add value from the patient perspective, and have proven to be an effective and reliable data source on national level within the Danish Cancer Society National Research Centres for late adverse effect following pelvic organ cancers (9). Since 2019, more than 3760 colorectal cancer patients have been screened and enrolled in the prospective database, now holding 9821 sets of PROMs. Proof-of-concept from these dedicated centres has significantly impacted the understanding and management strategies with a patient centred approach for late adverse effects following colorectal cancer (10).
We want an even better focus on the most clinically important domains and specific questions related to late effects within the comprehensive lists of PROMS used in the current database. Identifying key indicators for late effects and downsizing the database will be mandatory to make the database sustainable implementing PROMs and ease the use in clinical practice.
Awarded to:Peter Christensen (Aarhus University Hospital) – CFA3
Awarded grant to support VIP personnel.
Winter 2024 call
Five ACROBATIC members received a grant to support their work described in their Work Packages for the Winter 2024 application round. The following ACROBATIC Research Projects were granted.
We will investigate how incorporating artificial intelligence (AI) based risk prediction model into the decision-making process for perioperative treatment stratification can help minimize the rate of complications in the postoperative course for newly diagnosed colorectal cancer (CRC) patients undergoing elective curative-intent surgery. Seven centers across all five Danish regions will utilize a software platform designed to facilitate the randomization process. Patients will be stratified to one of four risk profiles (Low (<1%), moderate (1-5%), high (5-15%), or very high (>15%) risk of 1-year mortality) based on either an artificial intelligence (AI)-
augmented approach (intervention arm) or an expert physician-based (control arm) risk stratification. The randomization process will ensure that the allocation of patients to the different risk groups is balanced and unbiased between the intervention and control arms. The assigned risk group will then determine the individualized treatment trajectories for each patient, regardless of whether they are in the intervention or control arm. The treatment pathways include preoperative, intraoperative, and postoperative interdisciplinary optimization led by surgeons, anesthesiologists, physiotherapists, geriatricians, and dietitians to optimize the perioperative course of the patient according to the risk prediction.
Awarded to: Ismail Gögenur (Center for Surgical Science) – CFA1
Awarded grant to support VIP personnel.
Annually 3000 breast cancer (BC) patients are treated with breast conserving therapy (BCT), comprising of breast conserving surgery and radiotherapy. The goal of BCT is to achieve cure while preserving a good cosmetic outcome (CO). In clinical trials, CO is assessed by comparing the treated breast with the other breast and is scored as excellent/good/fair/poor. One in five patients scores CO as fair or poor, and these patients have a lower body image score, find themselves less sexually attractive, and score lower on overall quality of life compared to patients with an excellent or good score. For the 95% of patients treated outside of clinical trials, there is no systematic assessment of CO.
Currently, national effort is put to implement patient reported outcome measures (PROMs), where BC patients can systematically report on their health condition during treatment and follow-up. What is unclear, is how PROMs can be utilized in a clinical setting where there is less time for patient consultations. We envision that we need an additional objective self-assessment tool. By combining objective and subjective CO scoring, we can track CO over time, and provide a foundation to select the right patients who need additional consultations, better addressing their personal needs.
In this study we will develop an objective CO scoring tool using data of 3 large Danish randomized trials. We will subsequently co-develop the photo-app with BC patients. Finally, we will determine the usability of the photo-app, and pilot the potential clinical value in five workshops organized throughout the country.
Awarded to: Jasper Nijkamp (Aarhus University Hospital) – CFA3
Awarded grant to support VIP personnel.
The upsurge in squamous cell carcinoma ( of the oropharynx during the past deca des is primarily
attributed to the Human Papilloma Virus ( far surpassing tobacco induced SCCOP as the leading cause
of the disease. HPV associated SCCOP differs markedly from tobacco induced SCCOP regarding disease
survival, and demographic and socio economic composition. Afflicted individuals are typically younger and
possess higher levels of education and generally survive the disease, in contrast to tobacco induced SCCOP
which is associated with a poorer survival, mainly affecting social and economi cally marginalized males in
their sixties and seventies.
The
escalation of SCCOP combined with a changing demographic profile and improved survival is likely to have substantial socioeconomic implications.
Herein, we aim to delineate health expenditures a nd socioeconomic consequences associated with diagnosis, treatment and survival of SCCOP in an era where HPV driven disease has been a significant game changer.
Our aim is to:
1. To estimate the direct medical costs of the diagnostic work up of SCCOP and evaluate the consequences of delays in initiation of treatment on health related expenditures
2. To evaluate differences in cost effectiveness between transoral robotic surgery (and radiation
therapy (in early stage SCCOP).
3. To estimate the direct medical costs associated with SCCOP and describe changes of these costs over time.
Our results may provide information on consequences of delays to cancer treatment, present unique data on cost effectiveness and the cost utility of modern interventions for SCCOP, and reveal information on
medical costs and socioeconomic effects associated with SCCOP.
Awarded to: Thomas Kjærgaard (Aarhus University Hospital) – CFA2
Awarded grant to support TAP personnel.
Epithelial ovarian cancer (EOC) is diagnosed in older comorbid women. Potential curative treatment is a combination of extensive surgery and chemotherapy, either as primary debulking surgery (PDS) followed by chemotherapy or as neoadjuvant chemotherapy (NACT) with interval debulking surgery (IDS). However, 43% of EOC patients aged > 70 are not referred to surgery. Several organizations recommend a comprehensive geriatric assessment (CGA) and derived interventions before and during the oncological treatment to guide decision-making. Likewise, a combination of aerobic and resistance training is recommended during and after oncological treatment, as it has been proved to reduce complications in other cancer types. Screening tools to identify frail patients have been developed, but neither CGA, exercise therapy or the screening tools have been validated in EOC.
Aims: To examine whether CGA and physical training can increase the number of patients referred to IDS, completion of chemotherapy treatment, and its impact ontreatment outcomes and quality of life. Additionally, to examine the performance of three screening tools to identify deficiencies in CGA.
Methods: Patients diagnosed with EOC > 70 are included and screened for frailty. Patients selected for NACT are r andomized 1:1 to CGA and derived interventions along with exercise therapy or standard of care . Patients referred to PDS or palliative care will be followed in an observational cohort.
Perspectives: Systematic frailty screening and optimization of older EOC patients will result in a better selection of patients before treatment, more patients undergoing surgery and complete chemotherapy,
prevent complications and ultimately improving quality of life.
Awarded to: Tine Henrichsen Schnack (Odense University Hospital) – CFA1
Awarded grant to support VIP personnel.
Breast cancer treatment has become increasingly more effective over the last decades with improved survival. This has led to an increased focus on aesthetic outcomes and quality of life, while maintaining oncological safety. Accordingly, there is a growing interest in the use of nipple-sparing mastectomy (NSM) and skin-sparing mastectomy (SSM) with immediate reconstruction as an alternative to traditional mastectomy and subsequent reconstruction of the breast (2). In SSM the skin envelope is preserved, but breast tissue and nipple areola complex (NAC) is removed. NSM removes breast tissue while retaining the entire skin envelope and NAC. Preserving the NAC in NSM leaves a small amount of breast tissue behind the nipple, potentially increasing the risk of local recurrence and raising doubts about its oncological safety, despite studies reporting improved aesthetics and quality of life. (2,4,5,6)
The aim of this study is to investigate the oncological safety of NSM compared to SSM, regarding cancer recurrence and survival, and to investigate the accuracy of nipple to lesion distance on mammography in surgery planning. The study is planned as a national register study based on data from the DBCG database and on original imaging files.
The results have the potential to be used in shared decision making when patients are guided in choosing the right type of mastectomy, enhance the quality of life, while preserving their body image and self-esteem.
Awarded to: Tove Filtenborg Tvedskov (Herlev-Gentofte Hospital) – CFA3
Awarded grant to support VIP personnel.
Fall 2023 call
One ACROBATIC member received a conditional grant, and two received a grant to support their work described in their Work Packages for the Fall 2023 application round. The following ACROBATIC Research Projects were granted.
Timely identification and treatment of venous thromboembolism (VTE), particularly pulmonary embolism, in lung cancer patients is challenging and crucial for prevention, early detection, treatment, and prognosis. VTE in lung cancer patients results increases morbidity and premature death. There is no reliable risk assessment tool for predicting VTE risk in lung cancer. The overlapping symptoms of VTE and lung cancer complicate timely diagnosis and treatment. Health care professionals’ (HCP) communication regarding VTE is generally inadequate.
This project aims to explore the experience of VTE symptoms in the context of lung cancer. Specifically, we will explore and characterize the experience and perception of symptoms and signs of VTE in relation to lung cancer symptoms. In a co-creation process involving workshops with patients and HCPs, we will develop, implement, and evaluate the effectiveness of an information video integrated into a digital care guide. The video will account for the symptomatic profile of pulmonary embolism in lung cancer. We will collaborate with patients and HCPs to identify relevant endpoints for measuring the video’s effectiveness covering aspects such as awareness, symptom, morbidity, mortality, health care resource utilization, quality of life, and satisfaction.
The video will be implemented in clinical practice in an existing digital care guide. With a pre-post design, the study will compare outcomes in lung cancer patients with VTE before and after implementation. Ultimately, this project aims to facilitate effective, personalized treatment decisions to reduce adverse events and healthcare costs, with potential for national implementation and adaption to other cancer populations.
Awarded to: Thomas Decker Christensen (Aarhus Universitetshospital) – CFA3
Awarded grant to support VIP and TAP personnel.
Patients diagnosed with pancreatic cancer (PC) have a dismal prognosis with a 5-year overall survival (OS) of only 10%. Less than 20% of patients with PC are eligible for curative resection, and around 80% of resected patients experience relapse within the first few years after surgery. Circulating tumor DNA (ctDNA) and extrachromosomal circular DNA (eccDNA) in blood are emerging new tools for monitoring disease progression and recurrence.
To explore the utility of ctDNA/eccDNA in PC, we have initiated CIRCPAC, a national multidisciplinary translational study.
We will include 700 patients with suspected PC and explore whether ctDNA/eccDNA are prognostic markers for OS. Of those, 410 will additionally be included in a randomized controlled trial, where the intervention is a new intensive follow-up program, with longitudinal ctDNA measurement, endoscopic ultrasound, and CT imaging. The endpoints, in terms of time to recurrence, OS, quality of life, and health economic costs, will be compared to standard-of-care after three years follow-up. The study includes all four Danish PC centers. Inclusion started in January 2023 and will expectedly run for three years.
We foresee that ctDNA/eccDNA biomarkers will reveal much needed diagnostic and predictive discriminatory abilities, that can be used to identify high-risk patients suspected of PC in the daily clinical practice. Further we hope that an intensive follow-up strategy will improve recurrence treatment, and thereby OS, as well as quality of life for patients with PC.
Awarded to: Claus Lindbjerg Andersen (MOMA) – CFA3
Awarded grant to support VIP and TAP personnel.
Pelvic exenteration (PE) is the only curable treatment option in patients with locally advanced or recurrent cancer, of various origins, invading surrounding organs or structures in the pelvis. The main indication for PE is the ability to achieve oncological radicality with tumour-free resection margins (R0). Especially, the improvement in reconstruction has made it possible to remove more tissue if necessary.
The mortality after pelvic exenteration is low; 0.5% to 2%. However, despite marked modifications in the surgical techniques, improved technology, and improvements in the perioperative care, the 30-day morbidity is still reported high, ranging from 31.2% to 45.1% for rectal cancer.
While the indication for PE with curative intent is clear, there is no clear indications in cases where symptom alleviation may be the primary goal. For instance, if the symptom burden may be so heavy that PE should be considered, even though non-radical or in case of metastases that are either non-resectable or multiple.
The objective of this study is to evaluate the QoL before and after PE performed to alleviate symptoms as the main indication.
Further, to identify potential preoperative parameters predicting improved QoL to support the selection of future patients for PE on the indication to alleviate symptoms.
Additionally, to perform an economic evaluation of an alleviating pelvic exenteration.
The study will, thus, provide new and comprehensive knowledge regarding the decision-making on when to perform an alleviating PE as well as provide information on health economical evaluation related to alleviating PE and the patient’s QoL.
Awarded to: Jonas Amstrup Funder (vejle Sygehus) – CFA2
Awarded grant to support TAP personnel.
Winter 2023 call
Four ACROBATIC members received a grant to support their work described in their Work Packages for the Winter 2023 application round. The following ACROBATIC Research Projects were granted.
Surgical treatment for breast cancer may be performed as breast conserving therapy, mastectomy with or without reconstruction, axillary lymph node dissection (sentinel node or relevant axillary dissection). These treatments have increased the overall survival for women treated for BC. However, BC treatment modalities may leave the patient with a missing breast (distorted body-image) and as a late-effect in addition lymphedema, in some patients significantly decreases their quality of life. Indocyanine green angiography has been shown to optimize breast reconstructive procedures. In addition, Indocyanine green lymphangiography has become the mainstay of identification of lymphatic drainage pathway. Thus, applying these two techniques may significantly improve the breast reconstruction with autologous tissue and alleviate one of the late effects of breast cancer treatment i.e., lymphedema.
The study will assess the use of indocyanine-green-imaging in breast reconstruction after mastectomy as well as surgical treatment of lymphedema, when conservative treatment fails. The patient reported outcome measures and quality of life will be assessed using the validated Breast-Q and Lymph-Q questionnaires.
Should the results of this observational study yield favorable results for breast-cancer-related lymphedema and breast reconstruction, we may consider implementing VLNT+/- LVA and indocyanine green imaging as standard of care for the Danish patients. Moreover, the results from the present study – if favorable – may potentially also benefit patients suffering from lymphedema caused by treatment of other types of cancers than BC. Finally, this study represents repurposing of the ICG-technique.
Awarded to: Jens Ahm Sørensen (Odense Universitets Hospital) – CFA2
Awarded grant to support VIP personnel.
Introduction: Sentinel node (SN) mapping is a safe staging method in patients with Vulva Cancer (VC) with tumors < 4 cm. In patients with larger tumors, inguinofemoral lymphadenectomy (IL) is the standard procedure. IL causes severe short- and long-term morbidity. The aim of this study is to evaluate the accuracy of SN mapping in patients with primary vulvar cancer and tumors ≥ 4cm, multi-focal or recurrent disease. Methodology: Patients with primary VC, tumor ≥ 4cm, multi-focal, or recurrent disease are included in this prospective observational national study. The study is conducted at the two national departments that undertake the treatment of patients with VC in Denmark (Rigshospitalet and Aarhus University Hospital). The primary outcome is the sensitivity and the negative predictive value of SN mapping. The secondary endpoints are self-reported quality of life and lymphedema. Procedure: All women will undergo SN mapping with ICG followed by IL. All removed SNs will undergo ultra-staging according to a national pathological protocol. Perspectives: An extension of the SN mapping for patients with tumors ≥ 4 cm, multi-focal, or recurrent disease is likely to reduce short- and long-time morbidity. The present study is exploratory due to the rarity of the disease but will provide high-quality population-based data of great international value. Status: A feasibility study of ICG as a combined tracer with Technetium (Tc) has been performed at RH. The study is VEK approved. Both centers (AUH and RH) have acquired an optic camera for the use in the study and pilot testing.
Awarded to: Ligita Paskeviciute Frøding (Rigshospitalet) – CFA2
Awarded grant to support VIP and TAP personnel.
With the introduction of robotic-assisted surgery, a vast amount of digital data (i.e., movements of the robotic arms and surgical tools, endoscope video, time of execution, etc.) is generated during operations. This data can potentially be used to describe and improve best practices in new and improved surgical learning curricula. However, robotic data is not currently saved systematically anywhere in the world.
This project will develop a prototype system to collect data from robot-assisted minimally invasive surgical (RMIS) procedures in Danish hospitals. Recorded data will be anonymized and subsequently transferred securely to a national data vault from where it can be extracted and analyzed. The focus of this project is the technical development of the data collection system, although part of it will also be determining which data are feasible or beneficial to collect.
We expect the gathered data will yield new information on how particular surgical procedures are performed by cancer surgeons in different hospitals. This information can be used to improve surgical standards, benefiting both clinical staff and patients.
Awarded to: Thiusius Rajeeth Savarimthu – CFA2
Awarded grant to support VIP personnel.
Sarcomas are rare and aggressive tumors. The management of sarcomas in orthopedic oncology is challenging, discerning tumor from healthy tissue intraoperatively difficult, and positive margin rates following primary surgery are high despite highly specialized treatment. Positive margins have been shown to be associated with increased local recurrence but the role of positive margins as an independent risk factor in survival is less clear. Fluorescence-guided surgery is a well-established technology that has been used in other surgical specialties for tumor identification, but also mapping of the lymphatic system and angiography. The technique involves injecting a dye that fluoresces which can then be detected intraoperatively through an imaging system. This project aims to assess whether fluorescence-guided surgery can be repurposed to improve intraoperative attainment of negative margins in soft-tissue sarcoma surgery in a national multicenter randomized controlled trial using indocyanine green – a fluorescent dye that has been shown to accumulate in sarcomas – and near-infrared imaging. To our knowledge, no randomized controlled trial exploring this modality has been performed. Additionally, we aim to assess the role of positive margins on local recurrence and survival through a retrospective cohort study based on the national Danish Sarcoma Registry.
If margins of sarcomas could be accurately determined intraoperatively through fluorescence-guided surgery, this would immediately reduce reoperations based on positive margins, most likely reduce local recurrence and may improve survival while sparing as much healthy tissue as possible.
Awarded to: Tine Engberg Damsgaard (Rigshospitalet) – CFA2
Awarded grant to support VIP personnel.
Fall 2022 call
Two ACROBATIC members received a grant to support their work described in their Work Packages for the Fall 2022 application round. The following ACROBATIC Research Projects were granted.
The primary aim of the project is to implement the use of the validated patient reported outcome tools “Functional Assessment of Cancer Therapy – Melanoma” in the daily clinical work at the Department of Plastic Surgery at Herlev and Gentofte Hospital. The questionnaires include questions regarding sequelae after melanoma treatment and quality of life. By systematic collection of such information, we will be able to provide targeted, more effective treatment of adverse effects for the individual patient and hopefully improve stratification for different treatment modalities as well as quality of life. Secondarily, we also aim to implement the prospective PRO data collection in the Danish Melanoma Database on a nationwide basis to be able to monitor how this affects the quality of treatment.
Awarded to: Lisbet Rosenkrantz Hölmlich (Herlev-Gentofte Hospital) – CFA3
Awarded grant to support TAP personnel.
Patients diagnosed with Lung Cancer (LC) and Head and Neck Cancer (HNC) have a lower socioeconomic position and often experience severe physical and psychological symptoms, such as decreased exercise capacity, muscle weakness, compromised health-related quality of life (HRQOL) and increased anxiety and depression levels. More than 30% of eligible patients for surgery with LC and HNC have insufficient spirometry, are evaluated with a poor performance status score (>2) or have another reason to be excluded from surgery. The aim of this study is to test the safety and feasibility of an exercise based intervention for patients with LC and HNC evaluated ineligible for surgery.
Awarded to: Morten Quist (Rigshospitalet) – CFA1
Awarded grant to support VIP personnel.
Spring 2022 call
Five ACROBATIC members received a grant to support their work described in their Work Packages for the Spring 2022 application round. The following ACROBATIC Research Projects were granted.
The aim of the study is to examine the effect of a perioperative Comprehensive geriatric assessment (CGA), tailored interventions, and implementation of an inter- and multidisciplinary collaboration in older, frail patients with muscle invasive bladder cancer (MIBC) and scheduled for radical cystectomy.
Patients with MIBC are often older, multimorbid, and possible frail, thus in increased risk of perioperative mortality and morbidity. Frailty can potentially be modified. CGA identifies patient-specific problems and initiate relevant interventions to optimize health status and improve treatment tolerability. Limited evidence exists in relation to surgical cancer treatment.
In total, 140 patients ≥65 years and considered frail by the G8 frailty screening tool, will be included in this nationwide randomised controlled trial. Patients will be randomised 1:1 to either control group with “standard care” or intervention with preoperative CGA followed by tailored interventions, and postoperative geriatric ward rounds. Primary outcome will be Days Alive Out of Hospital 90 days postoperatively. Secondary outcomes will be complications (Clavien-Dindo Grade III-V and Comprehensive Comorbidity Index (CCI)) 30 and 90 days, mortality, hospital readmissions, Length of stay (LOS), Quality of Life (EQ-ED-5L and EORTC C30). Finally, we will also evaluate the cost-effectiveness. Older frail patients are often excluded in studies, but as numbers of older people are expected to increase remarkably in the next 30 years, further knowledge on this fragile group is essential.
Results could have a significant positive impact on cancer treatment and health-related quality of life for each patient.
Awarded to: Jørgen Bjerggard Jensen (AUH) – CFA1
Awarded grant to support TAP personnel.
Epithelial ovarian cancer (EOC) is often diagnosed in older comorbid women. Extensive surgery (primary debulking surgery (PDS) or neoadjuvant chemotherapy (NACT) with interval debulking surgery (IDS)) with no residual disease is the most important prognostic factor. However, 40% of patients ≥70 years are not operated due to extent of disease, frailty, or fear of complications. Frailty screening and a Comprehensive Geriatric Assessment (CGA) are recommended in oncologic geriatrics. However, known frailty screening tools are inaccurate and CGA is time-consuming and expensive. Their impact has never been assessed in EOC patients.
Awarded to: Tine Schnack Henrichsen (SDU) – CFA1
Awarded grant to support TAP personnel.
Bone sarcomas are rare neoplasms and represent less than 1% of all cancers. Regrettably, sarcomas are resistant to both chemo- and radiation therapy. Therefore, the cornerstone in sarcoma management is surgery. Basically, the surgical treatment consists of two parts, tumor removal and reconstruction of the affected region. Often biological reconstructions utilize the patient’s own bone stock (structural autographs). Traditionally the bone is cut with saws and while mechanical tools only cut straight or slightly curved lines, robot-guided laser osteotome can create custom geometries. As a result, bone segments can slot together like puzzle pieces, making the use of metal plate and screws systems superfluous. Also, the larger contact surface can facilitate the healing process. A shift from conventional surgery to computer-assisted patient-specific interventions will allow a faster recovery, enabling MRI follow up due to the lack of metal implants allowing detection of local recurrence.
An important tool in personalized surgery is the use of operating robots. While robot surgery is still in its infancy in orthopedic oncology, it is widely implemented in, e.g., general surgery. The key question to be answered by this project is how we can adapt and develop new treatment options based on robotic surgery for the benefit of this group of patients. The project has the potential to reduce time-to-treatment, re-surgery, increased quality of life, and improve overall survival.
Awarded to: Thomas Baad-Hansen (AUH) – CFA2
Awarded grant to support VIP personnel.
In many countries, first line treatment of oropharyngeal squamous cell carcinoma (OPSCC) is radiation therapy (RT). However, minimal invasive surgery by transoral robotic surgery (TORS) is emerging as a surgical alternative, especially in early stages of the disease. There is a lack of data on cost-effectiveness and the cost-utility of modern interventions for OPSCC and a paucity in studies comparing the treatment effects of TORS and RT in a societal perspective. We will perform an economic evaluation alongside a nationwide multicenter randomized phase II trial comparing TORS to RT in the treatment of early stage OPSCC.
The economic evaluation will include both a cost-effectiveness and cost-utility analysis. Cost-effectiveness is calculated as the ratio of the costs of the intervention to the effect of the intervention. The cost-utility analysis is evaluated as quality adjusted life years which represents the product of time and health effects. All relevant costs will be measured, valued and analyzed i.e., cost of the interventions, costs of other health care utilization, and costs of productivity loss. A micro-costing approach is used to calculate costs of interventions. Our project will provide reliable data on cost-effectiveness and the cost-utility of modern interventions for OPSCC, a disease which is in a significant increase in the western world. Such information may be of great value to institutions, senior health care providers and the authorities and aid in decision making and prioritizing health services.
Awarded to: Thomas Kjærgaard – CFA2
Awarded grant to support TAP personnel.
Surgery is a key element in the treatment of melanoma, and naturally linked with an inflammatory response and recruitment of innate immune cells. Although surgery has a favorable intent, surgery-induced inflammation, neutrophils in particular, may accelerating growth of local and systemic micrometastases. Thus, improving cancer surgery and modulating the microenvironment in ways that benefit the patients is crucial. Our preliminary data from zebrafish studies suggest that the plasminogen pathway is up-regulated in melanoma progression and that this pathway can be inhibited by Tranexamic Acid, subsequently reducing recruitment of neutrophils to a wound. By a randomized clinical trial we are aiming to reduce the early relapses and postoperative complications for the patients, and from peri-operative blood- and tissue samples and collaborative zebrafish experiments, understanding the prognostic and treatment-related impact of the plasminogen pathway in relation to melanoma surgery.
Awarded to: Marie Louise Bønnelykke-Behrndtz (AUH) – CFA2
Awarded grant to support TAP personnel.
Focus
Acrobatic Research