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    • Blood pressure targets for the very elderly: preventing strokes and heart attacks in the over 80s
    • Brighton Waste House
    • Cannibalism in early humans: the calorific significance of human cannibalism in the Palaeolithic era
    • Childhood asthma and eczema treatment: a personalised approach
    • Coexistence with carnivores: how do we better understand inter-relationships between humans and wild carnivores?
    • Communities of Practice and Value Creation Frameworks: how do we learn from each other?
    • Crowd safety: revolutionising crowd management through a better understanding of the psychology of crowds
    • Delayed umbilical cord clamping: research into the health benefits to babies
    • Design history research: how we help to develop a greater understanding of our global cultural heritage
    • Diabetes patient care: providing life-saving therapy and improved quality of life
    • Faecal-borne diseases: research provides life-saving advances in disease control
    • Food recycling: waste solutions through city-scale food recycling policy are developed and tested in China
    • Football4Peace...Rugby4Peace: how sport is bringing intercultural cooperation to communities in conflict
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    • PrefHER: putting patient choice and preferences at the forefront of breast cancer management
    • Research impact
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    • Stonehenge, where were the stones from? Geochemical fingerprinting research reveals origins of the sarsen stones
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    • Can stress cause cancer? Research examines the relationship between stress and cancer
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  • PrefHER: putting patient choice and preferences at the forefront of breast cancer management

PrefHER: putting patient choice and preferences at the forefront of breast cancer management

Approximately one in five patients diagnosed with breast cancer worldwide will have HER2-positive (HER2+) breast cancer, a particularly aggressive form of the disease. HER2+ breast cancer patients require treatment via the targeted anti-HER2 monoclonal antibody agent, trastuzumab following surgery, chemotherapy and radiotherapy.  

This demands hospital attendance for intravenous administration via a cannula, an in situ port, or line, 3 times weekly for 12 months. Intravenous administration is inconvenient and can take several hours exerting a considerable physical and emotional burden, limiting patients’ ability to resume normal life. In 2013 NICE approved a new subcutaneous formulation of trastuzumab with similar efficacy and safety as its intravenous counterpart, but with an administration time of just five minutes. In the wider clinical context patient preference is a key factor when drugs or administration methods have similar efficacy and safety properties. Taking patient preference into account helps to ensure optimal treatment adherence and improves the patient experience and satisfaction with treatment.  

Find out more about the work of Professor Dame Lesley Fallowfield

Measuring patient preference for subcutaneous or intravenous HER2 positive breast cancer treatment

Professor Dame Lesley Fallowfield and colleagues at the Sussex Health Outcomes Research and Education in Cancer Centre (SHORE-C) have pioneered a body of research on Psycho-Oncology with a particular focus on patient preference and health professionals’ communication skills with patients, especially those with cancer. The team is also leading the field in assessing patients’ quality of life in cancer trials including the MRC/NIHR funded UK Collaborative Trial of Ovarian Cancer Screening.

Brighton and Sussex Medical School (BSMS) researchers, led by Professor Dame Lesley Fallowfield, designed, conducted and analysed study-specific patient interview schedules used in the international clinical trial, PrefHER, to measure patient preference for subcutaneous or intravenous HER2+ breast cancer treatment. The findings of the PrefHER study were pivotal to the regulatory approval of trastuzumab subcutaneous by the Australian Therapeutic Goods Administration in 2015 and the US Federal Drug Administration in 2019, thus opening the route to market in these countries.

For the trials, patients had the trastuzumab administered first subcutaneously and then switched to intravenous, or vice-versa. Fallowfield and colleagues at SHORE-C led the development, optimisation and implementation of the study-specific patient interviews in each participating country. Two sets of interviews were carried out, one before patient randomization, and one after the treatment cycles. The PrefHER study was global and yet, irrespective of culture, the primary outcome was the same, with patients expressing a strong and compelling preference for subcutaneous delivery. 

Patient preference studies such as PrefHER can serve as a powerful tool to engage patients and their communities. Moreover, it can quantify the patient voice across different stages of clinical drug development, drug regulatory approval and care management to support patient-centric, healthcare decision-making. By revealing an overwhelming preference for its subcutaneous route of administration. This finding contributed to the market approval of trastuzumab subcutaneous by the US Food and Drug Administration (FDA) and its Australian counterpart. In practice, it also provided the research evidence to support the delivery of cancer treatments closer to the patient’s home– a central tenet of the NHS Five Year Forward plan for improvement in outcomes for cancer patients.  

As part of its multi-disciplinary review and evaluation of the application, the FDA commented on the robustness of the SHORE-C led interview methods and approved product labelling that refers to the PrefHER trial data to support the Patient Experience.

 

Further examples of research excellence at the University of Brighton

  • Can stress cause cancer? Research examines the relationship between stress and cancer

    Can stress cause cancer? Research examines the relationship between stress and cancer

  • Childhood asthma and eczema treatment: a personalised approach

    Childhood asthma and eczema treatment: a personalised approach

  • Liver disease research: medical device innovation and commercialisation to combat liver disease

    Liver disease research: medical device innovation and commercialisation to combat liver disease

  • Faecal-borne diseases: research provides life-saving advances in disease control

    Faecal-borne diseases: research provides life-saving advances in disease control

  • Blood pressure targets for the very elderly: preventing strokes and heart attacks in the over 80s

    Blood pressure targets for the very elderly: preventing strokes and heart attacks in the over 80s

  • Sexual health research: understanding HIV and improving health among men who have sex with men

    Sexual health research: understanding HIV and improving health among men who have sex with men

  • Communities of Practice and Value Creation Frameworks: how do we learn from each other?

    Communities of Practice and Value Creation Frameworks: how do we learn from each other?

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