Three WP leaders receives grants from DCCC’s extraordinary 2023 call
Research to improve and target cancer folllow-up
Three of ACROBATICs affiliated projects received a grant from DCCCs extraordinary call in 2023 that supported projects contributing to create a more focused cancer follow-up. You can read more about the projects below.
WP 3.8 – WP leader Pernille Tine Jensen (Main applicant: PhD student Louise Krog) – AUH
Project title: The value of patient reported outcome measure assessment and circulating tumor DNA to detect early relapse during surveillance in women with vulva cancer.
Abstract: Vulva cancer, i.e. cancer of the female external genitalia, is a rare disease that has not previously received much research attention. The treatment, which most often consists of surgery and possibly adjuvant radiation chemotherapy, entails a high risk of late sequelae, and is also associated with a high risk of recurrence. The current standardized follow-up program consists of interview and gynecological examination. Today, the detection of lymph node metastases and occurrence of the skin disease lichen sclerosus and consequent precancer dVIN (differentiated vulvar intraepithelial neoplasia) are the only known clinical biomarkers of recurrence. Allocation to postoperative radiation-chemotherapy occurs in the presence of lymph node metastases, and the follow-up is the same for all patients. The project, for which DCCC provides support, aims to optimize the current follow-up program by investigating whether specific warning symptoms can predict a relapse of the disease, or answering questionnaires, combined with algorithm-determined telephone contact in the follow-up process, can contribute to early detection of recurrence and early identification of patient-reported late effects. Furthermore, the project will investigate whether relevant circulating tumor DNA (ctDNA) can be identified in blood samples from patients with vulvar cancer, so ctDNA, in the future, can be used for improved allocation of patients for adjuvant treatment and for earlier recurrence detection in the follow-up process.
WP 3.15 – WP leader Jasper Nijkamp – AUH
Project title: Empowering breast cancer patients to assess and address their breast costmetic outcome after breast conserving therapy.
Abstract: Annually, 3,500 women receive breast-conserving surgery in Denmark. The aim of the treatment, which in addition to surgery often also involves radiation therapy, is to control the disease while preserving the breast with a good cosmetic result. In clinical trials, cosmetic outcome assessment (CO) is made using a 4-point scale. Here, the treated breast is compared with the other breast. It turns out that patients with the two lowest scores in CO (respectively ‘fair’ and ‘poor’) also more often have a lower bodily self-esteem, find themselves less sexually attractive and generally have a lower quality of life than those with a high score. However, nine out of ten patients are treated outside of clinical trials, and today there is no systematic attention to the cosmetic result assessment. At the same time, the healthcare system these years is experiencing pressure, which results in fewer follow-up meetings, and thus limited attention to cosmetic result assessment and the patient-reported outcome (PROMs) for this patient group. The Danish Breast Cancer Group (DBCG) has addressed this by developing an electronic PROMs tool that allows patients to report regularly on their physical and mental health from home. There is also a dedicated PROMs questionnaire (BREAST-Q) for CO, and this is to be implemented nationally – in this regard, DBCG expects that one in five patients will report a fair or poor CO. The project, which the DCCC provides support for, has two goals: First, the project aims to improve objective CO assessment by applying artificial intelligence to a large number of photos from Danish randomized trials. Secondly, the aim is to develop a photo-tool where the patients themselves can carry out an objective assessment of their cosmetic result. This combines subjective BREAST-Q data with objective assessments and categorizes the patients into four groups. The goal is to improve follow-up care and thus be able to refer patients for further treatment based on their specific needs.
WP 3.17 – WP leader Peter Christensen – AUH
Project title: RESPONSE: Follow-up of colon cancer patients – now digital and need-based. A national intervention study for stage I and II patients.
Abstract: Today, patients who have undergone surgery for stage I and II colon and rectal cancer, follow a standardized follow-up program where they are offered CT scans 12 and 36 months after surgery. The program focuses unilaterally on detection of relapse, which only a few in the patient group get. The majority of patients thus do not benefit from the follow-up program today. On the other hand, up to half of all patients experience moderate to severe psychological and/or physical late effects, and there is no standardized program to track down and treat these. It is the ambition of the RESPONSE project to change this. In a researcher-initiated intervention study, information from serial blood samples measuring the level of ctDNA, is used to identify the minority of patients who actually benefit from CT scans. ctDNA has been shown to be an effective biomarker for predicting relapse with high sensitivity and specificity, and it is thus expected that this change will not impair the chances of finding relapse, quite the opposite. The change means that resources are freed up, which can be used for ongoing monitoring and treatment of physical and psychological late effects. Physical late effects will be treated in specialized late effects clinics and psychological late effects will be addressed with specialized therapeutic efforts. The new follow-up program will be supported by a digital care guide in the form of an existing app (Emento), which increases patient autonomy. After 3 years of follow-up, the project will compare quality of life and late sequelae between the patients in the new program and the existing program. Here, it is expected that a holistic, patient-led follow-up program will improve the quality of life, without reducing survival or increasing costs.