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Article ; Online: Ask every job candidate about care.

Holcombe, Chris

2015 Volume 350, Page(s) h1759

MeSH term(s)	Delivery of Health Care/standards ; Empathy ; Humans ; State Medicine/standards ; United Kingdom
Language	English
Publishing date	2015-04-16
Publishing country	England
Document type	Journal Article
ZDB-ID	1362901-3
ISSN	1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
ISSN (online)	1756-1833
ISSN	0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
DOI	10.1136/bmj.h1759
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Article ; Online: Overall survival after mastectomy versus breast-conserving surgery with adjuvant radiotherapy for early-stage breast cancer: meta-analysis.

Rajan, Kiran K / Fairhurst, Katherine / Birkbeck, Beth / Novintan, Shonnelly / Wilson, Rebecca / Savović, Jelena / Holcombe, Chris / Potter, Shelley

BJS open

2024 Volume 8, Issue 3

Abstract: Background: Breast-conserving surgery with adjuvant radiotherapy and mastectomy are currently offered as equivalent surgical options for early-stage breast cancer based on RCTs from the 1970s and 1980s. However, the treatment of breast cancer has ... ...

Abstract	Background: Breast-conserving surgery with adjuvant radiotherapy and mastectomy are currently offered as equivalent surgical options for early-stage breast cancer based on RCTs from the 1970s and 1980s. However, the treatment of breast cancer has evolved and recent observational studies suggest a survival advantage for breast-conserving surgery with adjuvant radiotherapy. A systematic review and meta-analysis was undertaken to summarize the contemporary evidence regarding survival after breast-conserving surgery with adjuvant radiotherapy versus mastectomy for women with early-stage breast cancer. Methods: A systematic search of MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), and Embase that identified studies published between 1 January 2000 and 18 December 2023 comparing overall survival after breast-conserving surgery with adjuvant radiotherapy versus mastectomy for patients with unilateral stage 1-3 breast cancer was undertaken. The main exclusion criteria were studies evaluating neoadjuvant chemotherapy, rare breast cancer subtypes, and specific breast cancer populations. The ROBINS-I tool was used to assess risk of bias, with the overall certainty of evidence assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool. Studies without critical risk of bias were included in a quantitative meta-analysis. Results: From 11 750 abstracts, 108 eligible articles were identified, with one article including two studies; 29 studies were excluded from the meta-analysis due to an overall critical risk of bias, 42 studies were excluded due to overlapping study populations, and three studies were excluded due to reporting incompatible results. A total of 35 observational studies reported survival outcomes for 909 077 patients (362 390 patients undergoing mastectomy and 546 687 patients undergoing breast-conserving surgery with adjuvant radiotherapy). The pooled HR was 0.72 (95% c.i. 0.68 to 0.75, P < 0.001), demonstrating improved overall survival for patients undergoing breast-conserving surgery with adjuvant radiotherapy. The overall certainty of the evidence was very low. Conclusion: This meta-analysis provides evidence suggesting a survival advantage for women undergoing breast-conserving surgery with adjuvant radiotherapy for early-stage breast cancer compared with mastectomy. Although these results should be interpreted with caution, they should be shared with patients to support informed surgical decision-making.
MeSH term(s)	Humans ; Radiotherapy, Adjuvant ; Female ; Mastectomy, Segmental ; Breast Neoplasms/radiotherapy ; Breast Neoplasms/mortality ; Breast Neoplasms/surgery ; Breast Neoplasms/pathology ; Neoplasm Staging ; Mastectomy
Language	English
Publishing date	2024-05-17
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ISSN	2474-9842
ISSN (online)	2474-9842
DOI	10.1093/bjsopen/zrae040
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Article ; Online: Perceived barriers to randomised controlled trials in breast reconstruction: obstacle to trial initiation or opportunity to resolve? A qualitative study.

Davies, Gareth / Mills, Nicola / Holcombe, Chris / Potter, Shelley

Trials

2020 Volume 21, Issue 1, Page(s) 316

Abstract: Background: Implant-based breast reconstruction (IBBR) is the most commonly performed breast reconstruction technique worldwide but the technique is evolving rapidly. High-quality evidence is needed to support practice. Randomised controlled trials ( ... ...

Abstract	Background: Implant-based breast reconstruction (IBBR) is the most commonly performed breast reconstruction technique worldwide but the technique is evolving rapidly. High-quality evidence is needed to support practice. Randomised controlled trials (RCTs) provide the best evidence but can be challenging to conduct. iBRA is a four-phased study which aimed to inform the feasibility, design and conduct of an RCT in IBBR. In phase 3, the randomisation acceptability study, an electronic survey and qualitative interviews were conducted to explore professionals' perceptions of future trials in IBBR. Findings from the interviews are presented here. Methods: Semi-structured qualitative interviews were undertaken with a purposive sample of 31 health professionals (HPs) who completed the survey to explore their attitudes to the feasibility of potential RCTs in more detail. All interviews were transcribed verbatim and data were analysed thematically using constant comparative techniques. Sampling, data collection and analysis were undertaken iteratively and concurrently until data saturation was achieved. Results: Almost all HPs acknowledged the need for better evidence to support the practice of IBBR and most identified RCTs as generating the highest-quality evidence. Despite highlighting potential challenges, most participants supported the need for an RCT in IBBR. A minority, however, were strongly opposed to a future trial. The opposition and challenges identified centred around three key themes; (i) limited understanding of pragmatic study design and the value of randomisation in minimising bias; (ii) clinician and patient equipoise and (iii) aspects of surgical culture and training that were not supportive of RCTs. Conclusion: There is a need for well-designed, large-scale RCTs to support the current practice of IBBR but barriers to their acceptability are evident. The perceived barriers to RCTs in breast reconstruction identified in this study are not insurmountable and have previously been overcome in other similar surgical trials. This may represent an opportunity, not only to establish the evidence base for IBBR, but also to improve engagement in RCTs in breast surgery in general to ultimately improve outcomes for patients. Trial registration: International Standard Randomised Controlled Trial Number ISRCTN37664281.
MeSH term(s)	Attitude of Health Personnel ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Interviews as Topic ; Male ; Mammaplasty/methods ; Patient Selection ; Practice Patterns, Physicians' ; Qualitative Research ; Randomized Controlled Trials as Topic/methods ; Surveys and Questionnaires
Language	English
Publishing date	2020-04-06
Publishing country	England
Document type	Journal Article
ZDB-ID	2040523-6
ISSN	1745-6215 ; 1468-6694 ; 1468-6708
ISSN (online)	1745-6215 ; 1468-6694
ISSN	1468-6708
DOI	10.1186/s13063-020-4227-1
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Article ; Online: Wire- and radiofrequency identification tag-guided localization of impalpable breast lesions: iBRA-NET localization study.

Harvey, James / Morgan, Jenna / Lowes, Simon / Milligan, Robert / Barrett, Emma / Carmichael, Amtul / Elgammal, Suzanne / Masudi, Tahir / Holcombe, Chris / Masannat, Yazan / Potter, Shelley / Dave, Rajiv V

The British journal of surgery

2024 Volume 111, Issue 2

MeSH term(s)	Humans ; Female ; Breast ; Breast Neoplasms/surgery
Language	English
Publishing date	2024-02-07
Publishing country	England
Document type	Journal Article
ZDB-ID	2985-3
ISSN	1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
ISSN (online)	1365-2168
ISSN	0263-1202 ; 0007-1323 ; 1355-7688
DOI	10.1093/bjs/znae007
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Article ; Online: The BRASS (BReast Angiosarcoma Surveillance Study): Protocol for a retrospective multicentre cohort study to evaluate the management and outcomes of angiosarcoma of the breast and chest wall.

Banks, Jenny / Ives, Charlotte / Potter, Shelley / Holcombe, Chris

International journal of surgery protocols

2017 Volume 5, Page(s) 5–10

Abstract: Multicentre retrospective study involving breast and plastic units across the UK.•Will produce valuable data regarding management and outcomes.•Will inform decision making and help shape a future definitive study. ...

Abstract	•Multicentre retrospective study involving breast and plastic units across the UK.•Will produce valuable data regarding management and outcomes.•Will inform decision making and help shape a future definitive study.
Language	English
Publishing date	2017-05-22
Publishing country	England
Document type	Journal Article
ISSN	2468-3574
ISSN (online)	2468-3574
DOI	10.1016/j.isjp.2017.05.001
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Article ; Online: Impact of procedure type on revisional surgery and secondary reconstruction after immediate breast reconstruction in a population-based cohort.

Johnson, Leigh / White, Paul / Holcombe, Chris / O'Donoghue, Joe / Jeevan, Ranjeet / Browne, John / Fairbrother, Patricia / MacKenzie, Mairead / Gulliver-Clarke, Carmel / Mohiuddin, Syed / Hollingworth, Will / Potter, Shelley

The British journal of surgery

2023 Volume 110, Issue 6, Page(s) 666–675

Abstract: Background: Women considering immediate breast reconstruction require high-quality information about the likely need for secondary reconstruction and the long-term risk of revisional surgery to make fully informed decisions about different ... ...

Abstract	Background: Women considering immediate breast reconstruction require high-quality information about the likely need for secondary reconstruction and the long-term risk of revisional surgery to make fully informed decisions about different reconstructive options. Such data are currently lacking. This study aimed to explore the impact of reconstruction type on the number of revisions and secondary reconstructions performed 3, 5, and 8 years after immediate breast reconstruction in a large population-based cohort. Methods: Women undergoing unilateral mastectomy and immediate breast reconstruction for breast cancer or ductal carcinoma in situ in England between 1 April 2009 and 31 March 2015 were identified from National Health Service Hospital Episode Statistics. Numbers of revisions and secondary reconstructions in women undergoing primary definitive immediate breast reconstruction were compared by procedure type at 3, 5, and 8 years after index surgery. Results: Some 16 897 women underwent immediate breast reconstruction with at least 3 years' follow-up. Of these, 14 069 had a definitive reconstruction with an implant only (5193), latissimus dorsi flap with (3110) or without (2373) an implant, or abdominal free flap (3393). Women undergoing implant-only reconstruction were more likely to require revision, with 69.5 per cent (747 of 1075) undergoing at least one revision by 8 years compared with 49.3 per cent (1568 of 3180) in other reconstruction groups. They were also more likely to undergo secondary reconstruction, with the proportion of women having further reconstructive procedures increasing over time: 12.8 per cent (663 of 5193) at 3 years, 14.3 per cent (535 of 3752) at 5 years, and 17.6 per cent (189 of 1075) at 8 years. Conclusion: Long-term rates of revisions and secondary reconstructions were considerably higher after primary implant-based reconstruction than autologous procedures. These results should be shared with patients to support informed decision-making.
MeSH term(s)	Humans ; Female ; Breast Neoplasms/surgery ; Breast Neoplasms/pathology ; Mastectomy ; State Medicine ; Mammaplasty/methods ; Surgical Flaps/pathology ; Surgical Flaps/surgery ; Breast Implants ; Retrospective Studies
Language	English
Publishing date	2023-06-28
Publishing country	England
Document type	Journal Article
ZDB-ID	2985-3
ISSN	1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
ISSN (online)	1365-2168
ISSN	0263-1202 ; 0007-1323 ; 1355-7688
DOI	10.1093/bjs/znad050
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Article ; Online: Long-term patient-reported outcomes of immediate breast reconstruction after mastectomy for breast cancer: population-based cohort study.

Johnson, Leigh / White, Paul / Jeevan, Ranjeet / Browne, John / Gulliver-Clarke, Carmel / O'Donoghue, Joe / Mohiuddin, Syed / Hollingworth, William / Fairbrother, Patricia / MacKenzie, Mairead / Holcombe, Chris / Potter, Shelley

The British journal of surgery

2023 Volume 110, Issue 12, Page(s) 1815–1823

Abstract: Background: Breast reconstruction is offered to improve quality of life for women after mastectomy for breast cancer, but information regarding the long-term patient-reported outcomes of different reconstruction procedures is currently lacking. The ... ...

Abstract	Background: Breast reconstruction is offered to improve quality of life for women after mastectomy for breast cancer, but information regarding the long-term patient-reported outcomes of different reconstruction procedures is currently lacking. The Brighter study aimed to evaluate long-term patient-reported outcomes after immediate breast reconstruction (IBR) in a population-based cohort. Methods: Women who underwent mastectomy with IBR for breast cancer in England between 1 January 2008 and 31 March 2009 were identified from National Health Service Hospital Episode Statistics. Surviving women were invited to complete the BREAST-Q, EQ-5D-5L™, and ICECAP-A at least 12 years after the index procedure. Questionnaires were scored according to developers' instructions and compared by IBR type. Results: Some 1236 women underwent IBR; 343 (27.8 per cent) had 2-stage expander/implant, 630 (51.0 per cent) latissimus dorsi, and 263 (21.3 per cent) abdominal flap reconstructions, with a mean(s.d.) follow-up of 13.3(0.5) years. Women who underwent abdominal flap reconstruction reported higher scores in all BREAST-Q domains than those who had other procedures. These differences remained statistically significant and clinically meaningful after adjusting for age, ethnicity, geographical region, socioeconomic status, smoking, BMI, and complications. The greatest difference was seen in scores for satisfaction with breasts; women who had abdominal flap reconstructions reported scores that were 13.17 (95 per cent c.i. 9.48 to 16.87) points; P < 0.001) higher than those among women who had two-stage expander/implant procedures. Women who underwent latissimus dorsi reconstruction reported significantly more pain/discomfort on the EQ-5D-5L™, but no other differences between procedures were seen. Conclusion: Long-term patient-reported outcomes are significantly better following abdominal flap reconstruction than other traditional procedure types. These findings should be shared with women considering IBR to help them make informed decisions about their surgical options.
MeSH term(s)	Female ; Humans ; Mastectomy/methods ; Breast Neoplasms/surgery ; Cohort Studies ; Quality of Life ; State Medicine ; Treatment Outcome ; Mammaplasty/methods ; Retrospective Studies
Language	English
Publishing date	2023-09-28
Publishing country	England
Document type	Journal Article
ZDB-ID	2985-3
ISSN	1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
ISSN (online)	1365-2168
ISSN	0263-1202 ; 0007-1323 ; 1355-7688
DOI	10.1093/bjs/znad276
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Article ; Online: Quality of life after breast reconstruction-the BRIOS study.

Potter, Shelley / Cutress, Ramsey I / Conroy, Elizabeth J / Holcombe, Chris

The Lancet. Oncology

2018 Volume 19, Issue 11, Page(s) e577

MeSH term(s)	Acellular Dermis ; Humans ; Mammaplasty ; Mastectomy ; Patient Satisfaction ; Quality of Life
Language	English
Publishing date	2018-11-01
Publishing country	England
Document type	Letter ; Research Support, Non-U.S. Gov't ; Comment
ZDB-ID	2049730-1
ISSN	1474-5488 ; 1470-2045
ISSN (online)	1474-5488
ISSN	1470-2045
DOI	10.1016/S1470-2045(18)30694-6
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Article ; Online: Clinico-pathologic relationships with Ki67 and its change with short-term aromatase inhibitor treatment in primary ER + breast cancer: further results from the POETIC trial (CRUK/07/015).

Bliss, Judith M / Tovey, Holly / Evans, Abigail / Holcombe, Chris / Horgan, Kieran / Mallon, Elizabeth / Vidya, Raghavan / Skene, Anthony / Dodson, Andrew / Hills, Margaret / Detre, Simone / Zabaglo, Lila / Banerji, Jane / Kilburn, Lucy / Morden, James P / Robertson, John F R / Smith, Ian / Dowsett, Mitch

Breast cancer research : BCR

2023 Volume 25, Issue 1, Page(s) 39

Abstract: Purpose: Ki67 assessed at diagnosis (Ki67: Patients and methods: In POETIC 4480 postmenopausal patients with primary ER and/or PgR + breast cancer were randomised 2:1 to 2 weeks' presurgical AI (anastrozole or letrozole) or no presurgical treatment ( ... ...

Abstract	Purpose: Ki67 assessed at diagnosis (Ki67 Patients and methods: In POETIC 4480 postmenopausal patients with primary ER and/or PgR + breast cancer were randomised 2:1 to 2 weeks' presurgical AI (anastrozole or letrozole) or no presurgical treatment (control). Ki67 was measured centrally in core-cut biopsies taken prior to AI and in core-cuts or the excision biopsy at surgery. Relationships between the Ki67 and biologic factors were explored using linear regression. Results: Established associations of Ki67 Conclusions: The magnitude of this study allowed characterisation of relationships between Ki67
MeSH term(s)	Female ; Humans ; Aromatase Inhibitors/therapeutic use ; Breast Neoplasms/pathology ; Ki-67 Antigen/genetics ; Letrozole/therapeutic use ; Receptor, ErbB-2/genetics ; Receptors, Progesterone
Chemical Substances	Aromatase Inhibitors ; Ki-67 Antigen ; Letrozole (7LKK855W8I) ; Receptor, ErbB-2 (EC 2.7.10.1) ; Receptors, Progesterone ; MKI67 protein, human
Language	English
Publishing date	2023-04-12
Publishing country	England
Document type	Randomized Controlled Trial ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2015059-3
ISSN	1465-542X ; 1465-5411
ISSN (online)	1465-542X
ISSN	1465-5411
DOI	10.1186/s13058-023-01626-3
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Article ; Online: Outcomes of complex oncoplastic breast surgery in older women. Analysis of data from the Age Gap cohort study.

Quddus, Ratul / Banks, Jessica / Morgan, Jenna L / Martin, Charlene / Reed, Malcolm Wr / Walters, Stephen / Cheung, Kwok Leung / Todd, Annaliza / Audisio, Riccardo / Green, Tracy / Revell, Deirdre / Gath, Jacqui / Horgan, Kieran / Holcombe, Chris / Parmeshwar, Rishi / Thompson, Alastair / Wyld, L

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

2023 Volume 49, Issue 11, Page(s) 107075

Abstract: Key words: Breast cancer, mastectomy, breast conserving surgery, post-mastectomy reconstruction, older women, quality of life. ...

Abstract	Key words: Breast cancer, mastectomy, breast conserving surgery, post-mastectomy reconstruction, older women, quality of life.
MeSH term(s)	Female ; Humans ; Aged ; Mastectomy ; Breast Neoplasms/surgery ; Cohort Studies ; Mammaplasty ; Quality of Life ; Mastectomy, Segmental
Language	English
Publishing date	2023-09-23
Publishing country	England
Document type	Journal Article
ZDB-ID	632519-1
ISSN	1532-2157 ; 0748-7983
ISSN (online)	1532-2157
ISSN	0748-7983
DOI	10.1016/j.ejso.2023.107075
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