Richard Simcock

• MBBS MRCPI FRCR
• Consultant at University Hospitals Sussex

A qualitative study interviewing oncologists and people living with cancer about their experience of using remote communication(telephone and video call) during the COVID pandemic. The work showed broad acceptance of the technology by both people with cancer and clinicians but highlighted areas for improvement

Oncologists should recognise the need to move beyond the Eastern Cooperative Oncology Group Performance Status (ECOG PS) score. ECOG PS is a longstanding and ubiquitous feature of oncology. It was evolved 40 years ago as an adaption of the 70-year-old Karnofsky performance score. It is short, easily understood and part of the global language of onc...

An editorial discussing the use of the CARG tool in triage for older people with cancer receiving chemotherapy

Purpose: The welcome development of new systemic anticancer therapies (SACT) has improved the clinical outcomes for people affected by breast cancer [1,2]. At present, 78% of cancer drug appraisal recommendations by NICE are positive [3]. We have reviewed how these changes have impacted visits to our SACT delivery units in the Sussex Cancer Network...

A life is changed by a diagnosis of cancer. The moment of a cancer diagnosis is seismic for the person affected. At that point the person becomes a citizen of what Susan Sontag described as the "Kingdom of the Sick" (1). The transition of this unwanted citizenship is undoubtedly a trauma. The US-based oncologist and pancreatic cancer survivor, Mark...

Frailty is defined as “A medical syndrome with multiple causes and contributors that is characterised by diminished strength, endurance, and reduced physiologic function that increases an individual’s vulnerability….” Frailty is common in patients with cancer. Patients with frailty are vulnerable to higher rates of treatment toxicity and surgical...

European wide survey of people affected by cancer demonstrating low levels of understanding of genomic testing. Study indicated a need for greater information and education for both heathcare professionals and people affected by cancer

The normal ageing process brings with it changes in physiology and organ function, the accumulation of co-morbidities and progression of frailty. In this context, patient-centred decision making in breast cancer becomes more complex as these multiple factors need to be balanced to achieve best outcomes. Increasing medical complexity in older patien...

Purpose/Objective(s) For radiation oncology (RO), Twitter is a favored communication platform. Hashtags enable user-enhanced discussions and specific post-hoc analysis. As such, the first structured set of RO hashtags was introduced in 2019, in order to organize social media use. Our aim is to analyze the pattern of subsequent structured set use an...

Purpose For radiation oncology, social media is a favored communication platform, but it uses non-structured hashtags, which limits communication. In this work, we created a set of structured hashtags with key opinion leaders in radiation oncology, and we report on their use after two years post-deployment. Materials/Methods Hashtags were created,...

Background In breast cancer management, age-related practice variation is widespread, with older women having lower rates of surgery and chemotherapy than younger women, based on the premise of reduced treatment tolerance and benefit. This may contribute to inferior outcomes. There are currently no age- and fitness-stratified guidelines on which to...

Purpose: The management of older adults with cancer is rapidly becoming a significant challenge in radiation oncology (RO) practice. The education of future radiation oncologists in geriatric oncology is fundamental to ensuring that older adults receive high quality care. Currently RO trainees receive little training and education in geriatric onc...

In 2021 NICE introduced guidelines on Shared Decision Making - central to that was sharing information with patients. We looked at how often Oncology correspondence was shared with patients and whether it was written in a way that patients could understand. We used a modified version of the SAIL instrument of letter quality. We found that letters w...

Purpose/Objective(s) Oncology was founded on scientific inquiry. Data for our decision making has increased exponentially. However, behavior is not changing at scale. This stresses a need for smarter, faster, and more adaptive ways to develop, deliver, and improve on our education and information. With increasing emphasis on social media for health...

Introduction Geriatric assessment (GA) has been recommended to form part of treatment decision making for older adults with cancer. However despite consensus guidelines from various organizations, GA does not appear to be a part of routine practice in radiation oncology. The aim of the current study was to explore the implementation of GA in radiat...

Background Breast cancer incidence increases with age and real-world data is essential to guide prescribing practices in the older population. The aim of this study was to collect large scale real-world data on tolerability and efficacy of palbociclib + AI in the first line treatment of ER+/HER2-advanced breast cancer in those aged ≥75 years. Meth...

Introduction: Social media connects people globally and may enhance access to radiation oncology information. We characterized the global growth of the radiation oncology Twitter community using the hashtag #radonc. Materials and Methods: We analyzed all public tweets bearing the hashtag #radonc from 2014 to 2019 using Symplur Signals. We collect...

Background Management of prostate cancer after surgery is controversial. Past studies on adjuvant radiotherapy (aRT) for higher-risk features have had conflicting results. Through the collaborative conversations of the global radiation oncology Twitter-based journal club (#RadOnc #JC), we explored this complex topic to share recent advances, better...

Background Radiotherapy reduces in-breast recurrence risk in early breast cancer (EBC) in older women. This benefit may be small and should be balanced against treatment effect and holistic patient assessment. This study described treatment patterns according to fitness and impact on health-related quality-of-life (HRQoL). Methods A multicentre, o...

Background Chemotherapy improves outcomes for high risk early breast cancer (EBC) patients but is infrequently offered to older individuals. This study determined if there are fit older patients with high-risk disease who may benefit from chemotherapy. Methods A multicentre, prospective, observational study was performed to determine chemotherapy...

Objectives Approximately 20% of UK women aged 70+ with early breast cancer receive primary endocrine therapy (PET) instead of surgery. PET reduces surgical morbidity but with some survival decrement. To complement and utilize a treatment dependent prognostic model, we investigated the cost-effectiveness of surgery plus adjuvant therapies versus PET...

Background Primary endocrine therapy may be an alternative treatment for less fit women with oestrogen receptor (ER)-positive breast cancer. This study compared quality-of-life (QoL) outcomes in older women treated with surgery or primary endocrine therapy. Methods This was a multicentre, prospective, observational cohort study of surgery or prima...

Background Rates of surgery and adjuvant therapy for breast cancer vary widely between breast units. This may contribute to differences in survival. This cluster RCT evaluated the impact of decision support interventions (DESIs) for older women with breast cancer, to ascertain whether DESIs influenced quality of life, survival, decision quality, an...

Introduction Older patients with early breast cancer (EBC) derive modest survival benefit from chemotherapy but have increased toxicity risk. Data on the impact of chemotherapy for EBC on quality of life in older patients are limited, but this is a key determinant of treatment acceptance. We aimed to investigate its effect on quality of life in old...

Background Age-related breast cancer treatment variance is widespread with many older women having primary endocrine therapy (PET), which may contribute to inferior survival and local control. This propensity-matched study determined if a subgroup of older women may safely be offered PET. Methods Multicentre, prospective, UK, observational cohort...

An introduction to a Special Edition highlighting the issues related to the care of older adults in radiotherapy

Background: In the UK there is variation in the treatment of older women with breast cancer, with up to 40% receiving primary endocrine therapy (PET), which is associated with inferior survival. Case mix and patient choice may explain some variation in practice but clinician preference may also be important. Methods: A multicentre prospective co...

The ageing population poses new challenges globally. Cancer care for older patients is one of these challenges, and it has a significant impact on societies. In the United Kingdom (UK), as the number of older cancer patients increases, the management of this group has become part of daily practice for most oncology teams in every geographical area....

As the global COVID-19 pandemic escalates there is a need within radiation oncology to work to support our patients in the best way possible. Measures are required to reduce infection spread between patients and within the workforce. Departments need contingency planning to create capacity and continue essential treatments despite a reduced workfor...

In 2002 we surveyed patients attending our cancer centre on their access and use of the Internet. We were interested to know how they used the web and other resources for information around their cancer. We repeated the survey 15 years later by asking 100 consecutive attendees at our breast clinic to complete an anonymised survey on a computer in a...

Holistic Needs Assessment (HNA) is a key component of the Recovery Package endorsed by NHS England. Macmillan’s eHNA is completed electronically via touchscreen tablet and information is then sent through a secure website to support care planning. Anonymous eHNA data can be used to look at the overall needs of different groups of people. We present...

Purpose/Objective(s) Hashtags are metadata used on multiple social media websites. Through structured use they can categorize online content for patients and physicians. We hypothesize that hashtags can enhance online communication in the international radiation oncology community. Our aim was to develop an English-based structured set of hashtags...

Dr Anthony Cunliffe and Dr Richard Simcock share 10 top tips for primary care on the diagnosis and management of patients with lung cancer Read this article to learn more about: why early diagnosis is vital what conventional and new treatments are available and their side-effects how to support patients to reduce their risk of lung cancer through...

More and more people are living with the consequences of cancer and its treatment (living with and beyond cancer), yet the level of relevant research is low compared to other types of cancer research in the UK. NCRI aims to increase the level of research in this area and to ultimately improve the lives of those affected by cancer. Undefined researc...

More and more people are living with the consequences of cancer and its treatment (living with and beyond cancer), yet the level of relevant research is low compared to other types of cancer research in the UK. NCRI aims to increase the level of research in this area and to ultimately improve the lives of those affected by cancer. Undefined researc...

Background: Adjuvant trastuzumab significantly improves outcomes for patients with HER2-positive early breast cancer. The standard treatment duration is 12 months but shorter treatment could provide similar efficacy while reducing toxicities and cost. We aimed to investigate whether 6-month adjuvant trastuzumab treatment is non-inferior to the sta...

e12503 Background: The oncological management of HER2+ mBC is complicated by the development of resistance to HER2-directed therapies (HER2-DTs). This project analyses real-world clinical data to determine disease response patterns that may guide treatment sequencing decisions. Methods: This collaborative project analysed HER2+ mBC datasets held by...

Purpose: Trials of novel drugs used in advanced disease often show only progression-free survival or modest overall survival benefits. Hypothetical studies suggest that stabilisation of metastatic disease and/or symptom burden are worth treatment-related side effects. We examined this premise contemporaneously using qualitative and quantitative me...

A correspondence about the opportunities presented by free open access medical education (FOAMed) in Oncology

As part of our Radiation Nation #radonc Journal Clubs on Twitter we discussed the important PORTEC-3 trial. This correspondence summarises some of the key questions emerging from that journal club discussion

Objectives: To estimate the total costs of treating head and neck cancers, specifically oropharyngeal, laryngeal and oral cavity cancer, in secondary care facilities in England during the period 2006/2007 to 2010/2011. Design: Patient records were extracted from an English hospital database to estimate the number of patients treated for orophary...

e12002 Background: Endopredict is a multigene test including tumor size and nodal status; it predicts low or high risk of distant recurrence in patients (pts) with ER+ve, HER2–ve breast cancer treated with adjuvant endocrine therapy alone. We compared adj chemotherapy decisions pre and post Endopredict test results, pts’ anxiety, decisional conflic...

PurposeThe use of novel and often expensive drugs offering limited survival benefit in advanced disease is controversial. Treatment recommendations are influenced by patient characteristics and trial data showing overall response rates (ORR), progression-free survival (PFS) and overall survival (OS). PFS is frequently the primary outcome in licenci...

In this article we discuss risk factors and presentation of breast cancer in primary care and treatment of early disease Dr Anthony Cunliffe Macmillan GPA Dr Richard Simcock Consultant Clinical Oncologist Breast cancer is the most common cancer in women in the UK with over 50,000 new cases diagnosed each year. For women at average risk in the UK, t...

Treatments for head and neck cancer are improving, yet they remain toxic and challenging. The incidence of some forms of head and neck cancer (e.g. oropharyngeal) is rising. This creates an enlarging cohort of survivors with complex needs. These needs may be overlooked and undertreated. This overview presents evidence for the unmet survivorship nee...

Pulmonary lymphangitic carcinomatosis (PLC) secondary to mucosal head and neck squamous cell carcinoma (HNSCC) is extremely rare, difficult to diagnose in the pre-symptomatic phase, and is rapidly fatal. We describe two cases of fatal PLC secondary to squamous cell carcinoma in whom a review of pre-treatment imaging (computed tomography of the ches...

Aim: To quantify active healthcare professional (HCP) time and costs associated with subcutaneous (SC) and intravenous (IV) infusion administration of trastuzumab (Herceptin) in the treatment of patients with HER2-positive early breast cancer within the adjuvant PrefHer trial; secondly, to measure patient time in the care unit and patient chair tim...

Aim: Firstly, to quantify active healthcare professional (HCP) time and costs associated with subcutaneous (SC) admini-stration of trastuzumab (Herceptin ®) compared with the standard intravenous infusion (IV) in the treatment of patients with HER2-positive early breast cancer within the adjuvant PrefHer trial setting; secondly, to measure patient...

Background Radiation treatment of head and neck cancer can cause chronic xerostomia which impairs patients' quality of life. The study reported here examined the efficacy of acupuncture in alleviating xerostomia symptoms especially dry mouth.Patients and methodsA total of 145 patients with chronic radiation-induced xerostomia >18 months after treat...

Objective: To investigate the presenting features of cases of laryngeal carcinoma to a large tertiary head and neck center over a 4-year period. Method: A retrospective cohort study was carried out on laryngeal cancer patients presenting to our head and neck center between 2007 and 2011. Information on sex, age, smoking status, presenting symptoms,...

Objective: 1) To report the process of management and 2-year disease-free survival statistics for laryngeal cancer cases presenting to a United Kingdom tertiary cancer center. 2) To investigate which modality of treatment is the most appropriate for specific stages of laryngeal cancer. Method: A retrospective cohort study was carried out on larynge...

To see evidence that multidisciplinary teams are effective in cancer is a relief, given the effort required to implement them.1 Whether their efficacy derives from surgical specialisation or the addition of members such as oncologists to the team is not clear. Introducing multidisciplinary teams has come at huge organisational cost, particularly w...

5527 Background: Radiation induced xerostomia impairs quality of life of in head and neck cancer survivors. Prior small non-randomised studies suggest that acupuncture may alleviate symptoms. We report the first large randomised trial comparing 8 weeks of group acupuncture with oral care sessions as a control. Methods: 145 patients with radiation i...

Background : A randomised study to investigate whether bilateral arm abduction is superior to unilateral abduction with respect to stability using shifts on treatment as the main outcome measure. Material and Methods : 50 consecutive female patients were randomised to ipsilateral or bilateral arm abduction. Central lung depth (CLD) and cranial caud...

There is continuing concern that patient information leaflets, tailored to current regulatory requirements, fail to meet patients' needs. Provision of comprehensible information is vital if patients are to provide valid informed consent. The design of the ARIX (acupuncture for radiation induced xerostomia) trial provided an opportunity to deliver r...

The association between squamous cell carcinoma of the head and neck (HNSCC) and infection with human papilloma viruses (HPV) has created considerable interest. Rates of primary oropharyngeal cancers have shown increasing incidence and declining age at presentation over the last decade, believed to relate to infection with oncogenic or high-risk su...

This article discusses oncology evidence for a neoadjuvant strategy in breast cancer and chal-lenges a common view that a mid-point imaging assessment can usefully influence management. Chemotherapy in early breast cancer Adjuvant chemotherapy following surgery has contributed significantly to the improved survival seen in breast cancer over the la...