1521 Background: Older adults have a higher risk of developing chemotherapy (CTx) related toxicity. The Cancer Aging Research Group (CARG) score was developed and validated in the USA to predict risk of severe CTx induced toxicity in older adults; subsequent validation studies have had varying results. The TOASTIE study sought to evaluate the CARG score prospectively in a United Kingdom (UK) population. Methods: This multicentre, prospective, observational study recruited patients aged ≥65 years commencing first-line neo-adjuvant, adjuvant or palliative CTx for any solid organ malignancy. Those receiving non-CTx agents were excluded. Baseline demographics and established frailty measures were recorded, including Eastern Cooperative Oncology Group performance status (ECOG PS), Rockwood Clinical Frailty Scale (CFS), Geriatric-8 (G8) score and Charlson Co-morbidity Index (CCI). CARG score was calculated after initial Oncology consultation. Follow-up data including CTCAEv5 toxicity and hospital admissions were collected retrospectively. Results: 19 centres recruited 330 patients between Nov 2019 - Dec 2022. Median age was 73 years (range 65-92) and 51.9% were male. 54.9% had a primary tumour of gastrointestinal origin, 48.7% received CTx with palliative intent and 70.8% received doublet therapy. At baseline, 85% patients had an ECOG PS 0 or 1, with median CFS 3 (range 0-8), G8 score 12 (range 6-16) and CCI 6 (range 2-12). Follow-up data was available for 314 (92.6%) patients; the median CTx cycles received was 4 (range 1-16) with 124 (39%) patients dose reduced at cycle one. Treatment delays occurred in 83 (26.4%) patients and 123 (39.2%) stopped treatment early, with 60 (48.8%) cases due to treatment-related toxicity. 69(22.3%) patients experienced a CTCAE grade ≥3 toxicity and 84 (27%) requiring hospital admission. CARG score was available for 313 patients; 107 (34.2%) low risk, 167 (53.4%) medium risk and 39 (12.5%) high risk. Increasing CARG risk groups had increased toxicity rates (low 19.6%, medium 22.2%, high 28.2%) however this was non-significant with no evidence of robust predictive performance (Table). The performance of CFS and ECOG PS was superior to CARG. Conclusions: In this UK older patient population, baseline frailty was prevalent. CARG score was unable to robustly discriminate or predict risk of high-grade toxicity. ECOG showed superior, albeit limited, ability to predict and discriminate toxicity risk. This study highlights the need for development of further tools predictive of toxicity in this population. [Table: see text]

Contrary to Pemetrexed-containing chemo-immunotherapy studies, Atezolizumab, Bevacizumab, Carboplatin, and Paclitaxel (ABCP) treatment has consistently shown clinical benefit in prospective studies in patients with lung cancer and actionable mutations, where intracranial metastases are common. Here, we aimed to describe the real-life population of patients fit to receive ABCP after targeted therapy and quantify its clinical effect in patients with brain metastases. Patients treated in Cheshire and Merseyside between 2019 and 2022 were identified. Data were collected retrospectively. A total of 34 patients with actionable EGFR or ALK alterations had treatment with a median age of 59 years (range 32–77). The disease control rate was 100% in patients with PDL1 ≥ 1% (n = 10). In total, 19 patients (56%) had brain metastases before starting ABCP, 17 (50%) had untreated CNS disease, and 4 (22%) had PDL1 ≥ 1%. The median time to symptom improvement was 12.5 days (range 4–21 days), with 74% intracranial disease control rates and 89.5% synchronous intracranial (IC) and extracranial (EC) responses. IC median Progression Free Survival (mPFS) was 6.48 months, EC mPFS was 10.75 months, and median Overall Survival 11.47 months. ABCP in real-life patients with brain metastases (treated or untreated) was feasible and showed similar efficacy to that described in patients without actionable mutations treated with upfront chemo-immunotherapy.

Background Enhanced Supportive Care (ESC) promotes the earlier implementation of supportive care within cancer care (Bakitas, Tosteson, Li, et al. J Clin Oncol. 2015;33(13):1438–1445; Bandieri, Banchelli, Artioli, et al. BMJ Support Palliat Care. 2020;10(4):e32; Monnery, Benson, Griffiths, et al. Int J Palliat Nurs. 2018; 24(10):510–514). Integration of care between Oncology and Palliative Care can improve patient outcomes and is increasingly recommended (Benson, Wong, Olsson-Brown, et al. Int J Palliat Nurs. 2023; 29(3):129–136; Monnery, Tredgett, Hooper, et al. Clin Oncol. 2023; 35(6):395–403). The Clatterbridge Cancer Centre has introduced an integrated ESC model within the mutation driven non-small cell lung cancer (NSCLC) clinic. This is a collaborative clinic between the Oncology and Palliative Care teams. Aims To evaluate an integrated ESC model within lung cancer care. To assess the impact on patient outcomes and identify patient needs. Methods 38 patients with NSCLC were supported by integrated ESC delivery in the first six months of the clinic. These patients had an IPOS score completed at initial review and at follow up. Data was collected retrospectively. This was used to assess longitudinal changes in Integrated Palliative Care Outcome Scale (IPOS) scores as indicators of quality of life (Cicely Saunders Institute. Integrated Palliative Care Outcome Score. 2012; Basch, Deal, Dueck, et al. JAMA. 2017; 318(2):197–198). A retrospective case control analysis was used to review other outcomes. Results Patients seen by the ESC team experienced less severe symptoms over time. There were statistically significant improvements seen in dyspnoea, pain and the information needs of patients who were seen in the joint clinic. Conclusion An integrated ESC model can be effective in improving outcomes for patients with NSCLC. This is a developing service and continued data collection will allow the ongoing impact on patient outcomes to be assessed.

Tivozanib is a licensed as first-line treatment for metastatic renal cell carcinoma (mRCC). To evaluate the outcomes from tivozanib in a real-world mRCC population. Patients with mRCC commencing first-line tivozanib between March 2017 and May 2019 were identified across four specialist cancer centres in the UK. Data relating to response, overall survival (OS), progression-free survival (PFS) and adverse events (AEs) were collected retrospectively with censoring on 31 December 2020. A total of 113 patients were identified: median age was 69 years; 78

Abstract AIMS Brain metastases (BMs) are common in lung cancer and carry adverse prognostic significance. Such occurrences should be reviewed through a regional specialist neuro-oncology MDT. Our aim is to highlight which aspects of the pathway could be contributing to delays in the treatment of lung cancer patients with BMs. METHOD All lung cancer patients discussed at the Neuro-Oncology MDT in 2020 were identified. Details of the patient journey through the pathway from diagnosis to death were obtained from the Orion System, regional PACS system, regional neuro-oncology MDT notes and electronic case notes from Clatterbridge. RESULTS Full datasets were available for 100 patients discussed at the Neuro-Oncology MDT. 49 of these were patients presenting with BMs and lung cancer synchronously. Only 5 out of 13 (38%) of synchronous patients recommended for SRS received this treatment. 7 of 13 patients received a suboptimal treatment (best supportive care or whole-brain radiotherapy). Length of time from neuro-oncology MDT discussion to receiving SRS in the synchronous cohort was 47 versus 20.3 days in the asynchronous group. A review of all 13 cases found that 4 of the 7 cases of CNS-specific deterioration were potentially preventable. Further analysis of these cases revealed common themes of lengthy delays in histological sampling (9), delayed referral or discussion in the appropriate MDT (8) and not jointly referring to neuro-oncology and respiratory oncology (7). CONCLUSION Lung cancer patients with synchronous BMs receive SRS after full staging and biopsy. There is potential evidence of suboptimal outcomes due to inflexible MDT systems and delays for histology.

Abstract AIMS The aim of this project was to review the outcomes of patients referred via our regional neuro-oncology pathway who received neurosurgery, SRS, whole brain radiotherapy (WBRT), chemotherapy (SACT) or best supportive care (BSC). METHOD All lung cancer patients discussed at our Neuro-Oncology MDT in 2020 were identified. Patient characteristics and outcomes were obtained from the regional lung and neuro-oncology MDT notes and electronic case notes from Clatterbridge Cancer Centre. Overall survival (OS) was calculated from the date of diagnostic scan to death. The date of data cut-off was 15/10/2021. RESULTS Full datasets were available for 100 patients discussed at the Neuro-Oncology MDT. 65 were adenocarcinomas, 4 had ALK or EGFR mutations and 49 were synchronously presenting with brain metastases and lung cancer. At data cut-off 84 deaths had occurred. The median OS in days was calculated for surgery (207), SRS (360), surgery and cavity boost (298), SACT (249), WBRT (102) and BSC (60). A grouped comparison of SRS and surgery versus other interventions or best supportive care found a statistically significant advantage favouring SRS or surgery (Median OS 360 days, p=0.001). When comparing the synchronous versus asynchronous setting, the combined median OS of the neurosurgical, SRS or SACT cohorts was 276 versus 170 days but there was no difference in WBRT or BSC. CONCLUSION This real-world data details the number of lung cancer patients referred to and receiving neurosurgery or SRS via the Merseyside neuro-oncology MDT. This data supports pre-existing evidence that those who receive SRS or neurosurgery have a superior OS.

335 Background: The TIVO-1 study demonstrated improved PFS in mRCC patients (pts) undergoing 1L treatment with T compared with sorafenib. We previously presented outcomes of our experience of T in 4 cancer centres in NWE. Here we present updated outcomes with longer follow-up (FU). Methods: mRCC pts commencing 1L T March 2017- May 2019 were identified. Outcomes of interest included overall response rate (ORR), survival (OS, PFS) and toxicity. Data cut off for this update was 30/11/2020. Results: 113 pts were identified with characteristics as in the table. Median FU was 25.9 mo (18.3-44.7mo), 18% pts remain on treatment at data cut-off. 88.5% commenced T at full dose, of which 67% maintained dose intensity. 11.5% commenced T with dose reduction due to prior TKI toxicities or comorbidities. Median number of cycles was 7 (1-33). In terms of efficacy, ORR was 29% (CR 0%, PR29%, SD39%, PD26%, NE 6%) and median PFS was 9.0 months (95% C.I. 6.0-12.1mo). Median PFS by IMDC risk group was: F= 23.0 months (95% C.I. 7.6-38.4mo); I= 10.0 months (95% C.I. 6.3-13.7mo); P= 3.0 months (95% C.I. 1.5.- 4.5mo), p value<0.0001. Median OS was 25.0 months (95% C.I. 15.4-34.6mo). Median OS by IMDC risk group was: F= NR with 72% alive at data cut-off; I= 26.0 months (95% C.I. 17.9-34.1mo); P= 7.0 months (95% C.I. 4.4-9.6mo), p value<0.0001. Adverse events (AEs) of any grade occurred in 77% (≥G3 13%) including fatigue 42% (≥G3 0%), diarrhoea 19% (≥G3 < 1%), mucositis 24% ( ≥G3 2%), anorexia 12% (≥G3 < 1%); and hypertension 7% (≥G3 2%). Notable ≥G3 events included abnormal liver function 3%; vascular events 2% and seizure < 1%. 18% of patients discontinued treatment due to toxicity with no treatment-related deaths. Conclusions: Our real world experience of 1L T suggests comparable activity with randomized data and other TKIs, particularly in F and I IMDC risk groups. The low incidence of serious AEs makes it an attractive option if unsuitable for combination therapies. [Table: see text]

2522 Background: Pre-existing autoimmune disease (AID) potentially increases the propensity for the development of immune related adverse events (irAE) in response to oncological immune checkpoint inhibitors (ICIs) is biologically plausible and clinically observed. However, due to consistent clinical trial exclusion of those with pre-existing AID, the impact on the frequency and severity of irAEs is uncertain. Here we analyse this relationship in a large, real-world, UK multi-centre cohort. Methods: A retrospective analysis of 2049 patients treated with ICIs over a two year period was undertaken across 12 National Health Service centres by the UK National Oncology Trainees Collaborative for Healthcare Research (NOTCH). Patients received ICIs as standard of care for malignant melanoma, non-small cell lung cancer and renal cell carcinoma. The presence of pre-existing AIDs was assessed and classified as either autoantibody driven or autoinflammatory then correlated with clinically significant irAEs (i.e. ≥grade 2 or all-grade endocrinopathies). Statistical analyses included T-test, Mann-Whitney and Chi-squared. For overall survival (OS) Kaplan-Meier and log-rank tests were utilised. Results: Pre-existing AID were present in 13% (n = 257) of the overall cohort. Pre-existing endocrinopathies (30%; n = 76) were most common followed by rheumatological AIDs (18%; n = 46). In the pre-existing AID cohort there was a female predominance (48% vs 39%; p = 0.006) but no difference in smoking history (p = 0.074) or ethnicity (p = 0.12). There was no difference in ICI treatment between those with and without pre-existing AID (p = 0.2800). IrAEs occurred in 45% (n = 117) patients with pre-existing AID vs 33% (n = 583) without (p£0.001). The median time to onset of irAEs was similar. IrAEs with an increased incidence in the pre-existing AID cohort were colitis (p = < 0.001), arthralgia (p = 0.008) and dermatological irAEs (p = 0.014). There was no difference in the incidence of irAEs in patients with autoantibody driven vs autoinflammatory pre-existing AID (44.0 % vs 44.8%, p = 0.905). In the overall cohort, those with pre-existing AIDs had a median OS of 20.4 months (95% CI: 19.4-21.7) vs 14.1 months (95% CI: 12.8-16.3) in those without pre-existing AID (p = 0.004). Conclusions: This large multi-centre ICI-treated cohort demonstrates that pre-existing AID is a predisposing factor for the development of irAEs, however the incidence is lower than previously quoted. The pathological basis of pre-existing AID did not differentially affect irAE manifestation. Patients with pre-existing AID had improved OS compared to those without which has not been observed in previously reported studies. ICI treatment should be considered in those with pre-existing AID but further studies are needed to determine how best to optimise outcomes whilst mitigating the impact of irAEs.

12026 Background: Immune checkpoint inhibitor (ICI) therapy is now commonly used in a range of tumours and settings. Most data relating to outcomes and rates of immune-related adverse events (irAE) is derived from clinical trial or registry populations and small case series. Limited data exist for patients aged > 75 years. Here we present a multi-centre, real-world analysis of the outcomes and incidence of irAEs in older adults managed within a single comprehensive public health service. We also compare these outcomes to younger patients in the same cohort. Methods: A retrospective analysis of 2049 patients treated with ICIs was undertaken across 12 centres. All patients were managed within the UK National Health Service outside of a trial setting between June 2016 and September 2018. Patients received either ICI monotherapy (MT) or duel combination ICI therapy (CT) for malignant melanoma (MM), non-small cell lung cancer (NSCLC) or renal cell cancer (RCC). Data were collected using a standardised, collection tool. IrAEs ≥ grade 2 or all-grade endocrinopathies were recorded as per the Common Terminology Criteria for Adverse Events (V5) (CTCAE). Statistical analyses were performed using T-tests, Mann-Whitney and Chi-squared. Kaplan-Meier analysis and log-rank test were used for overall survival (OS) analysis. Results: 409 (20%) of patients were aged > 75 years(a), 1413 (69%) aged 50-75(b) and 227 (11.1%) aged < 50(c). There was no difference in sex, ethnicity or PD-L1 status (in the NSCLC cohort) between groups. Older patients were less likely to receive combination therapy (3%(a) v 13%(b) v 34%(c), p < 0.001). There was no difference in median OS across age groups in the cohort as a whole (p = 0.822) or for the individual tumour groups when treated with single agent ICI. Across the total cohort patients aged > 75 had no increased risk of any irAE (35%(a) v 33%(b) v 41%(c),p = 0.074). However there was an increase in irAEs in older patients treated with MT (36%(a) v 26(b) v 25%(c), p = 0.011) However there was no difference in the > 75s with regard to severe (G3/4) toxicity, toxicity type, admission or discontinuation due to toxicity in the aPD-1 group. In the overall cohort younger patients were more likely to develop irAEs and be admitted. Conclusions: Patients aged > 75 years treated with anti-PD1 therapy in the standard of care setting derive similar survival benefit to younger patients. There was no increase in ≥G3 toxicity. Our data support the safety of single agent aPD-1 ICI therapy in older adults and provide reassurance relating to the impact of toxicity.[Table: see text]

Aims Immune checkpoint blockade (ICB) is the mainstay of treatment for metastatic melanoma and lung adenocarcinoma, and their use is growing in cancer. Immune checkpoint blockade induced colitis (ICB colitis) presents a management challenge and its mechanisms remain poorly elucidated. Methods We performed next generation single-cell RNA sequencing of immune cells from patients given ICB. We validated findings using confocal microscopy, drawing comparisons bioinformatically with ulcerative colitis. In parallel, we conducted a review of 1,074 patients given checkpoint inhibitors across two tertiary centres between 2011–2018 to discover patterns in incidence and predictors of clinical outcome. Results Using single-cell RNA sequencing, we discovered excessive local CD8 T cell proliferation was a key feature of ICB colitis, and we were able to visualise higher numbers of replicating CD8 T cells in gut tissue sections of patients with colitis than those without ICB colitis. The degree of replication was greater than seen in ulcerative colitis by bioinformatic analysis. From our clinical review, age, gender and smoking status did not alter the risk of developing colitis, whereas type of immunotherapy did (incidence 9% in PD-1 Monotherapy vs 32% Combination Therapy). Having prior IBD did not guarantee the development of ICB Colitis. Systemic markers of inflammation (C-Reactive Protein, Albumin) did not predict outcome, whereas local markers of inflammation (endoscopic UCEIS scoring, histological Nancy Index) did. Conclusions We putatively link novel insights from bench science to clinical trends. ICB colitis may be driven more by a gut localised inflammation response in comparison to ulcerative colitis. As we also demonstrate, this may explain why endoscopic and histological scoring may have better prognostic value than systemic measures of inflammation.

Background: Clostridioides difficile infection (CDI) is one of the most common health care associated infection.To reduce the recurrent CDI (rCDI), monoclonal antibodies against CD toxin A (actoxumab) and toxin B (bezlotoxumab) were developed.In the present study, we performed a systematic review and meta-analysis to assess their efficacy and safety.Methods: Electronic database were searched for relevant randomized controlled trials (RCTs) or observational studies assessing bezlotoxumab and/or actoxumab.Outcomes included rate of rCDI and adverse events including cardiovascular and gastrointestinal events.Results: Four RCTs comparing anti-toxin antibodies (n = 1916) versus placebo (n = 889) were identified.rCDI was significantly reduced by bezlotoxumab plus actoxumab (risk ratio (RR) = 0.54, 95% CI = 0.41-0.70,P < 0.001) and bezlotoxumab monotherapy (RR = 0.62, 95% CI = 0.51-0.76,P < 0.001) compared with placebo (Figure 1).Subgroup analysis showed that bezlotoxumab plus actoxumab was remarkably preventive for patients with the following high-risk features: inpatients, vancomycin treatment, and BI/NAP/027 strain.Regarding the safety, there was no difference in cardiovascular and gastrointestinal events as well as allcause mortality between bezlotoxumab-treated patients and placebo.On the other hand, 4 observational studies with a total of 150 patients with CDI treated with bezlotoxumab were identified.The proportion of patients requiring hospitalization, those with prior episodes of CDI, and those with severe CDI were 41-61%, 45-100%, and 31-40%, respectively.The S-535AGA Abstracts pooled frequency of rCDI event and serious adverse events were 22.2% (95% CI = 16.2-29.6)and 2.9% (95% CI = 0.6-13.2),respectively (Figure 2).Conclusions: The results of our meta-analysis demonstrated the effectiveness and safety of bezlotoxumab for the prevention of rCDI.Bezlotoxumab may be a good therapeutic option for severe CDI rather than mild cases. Su1185

Abstract Background Immune checkpoint inhibitors (ICI) have revolutionised oncological care but cause immune-related adverse events (irAE). Inflammation of the gastrointestinal tract (enterocolitis) is the most frequent cause of significant morbidity and cessation of ICI. We sought to determine whether Common Terminology Criteria for Adverse Events (CTCAE) classification of colitis, inflammatory bowel disease (IBD) biomarkers, endoscopic scores and histology scores correlate with disease outcome. Methods A retrospective study was performed on patients receiving ICI for metastatic melanoma, non-small cell lung cancer and urothelial cancer from 2012 to 2018 at two UK centres by reviewing the electronic patient records and oncology prescribing databases to identify patients who had irAE colitis. irAE colitis was defined as diarrhoea requiring steroid/infliximab therapy for resolution and/or with endoscopic/histological confirmation. Demographics, clinical data, endoscopic findings, histopathology reports and treatment outcomes were obtained. Patients were divided into three categories: (1) Mild-moderate disease where diarrhoea settled rapidly following a course of steroids ≤60 days; (2) Refractory or moderate–severe colitis requiring steroids >60 days; and (3) Severe colitis requiring infliximab ‘rescue therapy’. Endoscopies were re-analysed with image scoring using Mayo and ulcerative colitis Endoscopic Index of Severity (UCEIS) scores by two independent endoscopists. Histology was scored using the Nancy Index by two expert GI histopathologists. Results 1074 patients were analysed. Twelve per cent (134) developed irAE colitis. Median patient age was 66, 59% were male. Age, sex, smoking status and prior IBD or autoimmune disease were not associated with risk of developing irAE colitis. CTCAE grading did not correlate with steroid duration (p = 0.92) or infliximab requirement (p = 0.18) (Figure 1). CRP, albumin and haemoglobin didn’t correlate with severity of irAE colitis (Figure 2). 22% of patients received rescue therapy with infliximab either as single or multiple doses, with 3 undergoing a colectomy (2.3%; two had ipilimumab and one had combination). The UCEIS (p = 0.008) and Mayo (p = 0.016) scores correlated with disease severity and infliximab requirement. Patients with higher Nancy scores (3/4) were more likely to require infliximab (p = 0.03) (Figure 3). Conclusion Clinical assessment with CTCAE does not accurately reflect immunotherapy-colitis severity thus negatively impacting timely treatment decisions. Our data support endoscopic scoring of colitis severity, and demonstrate the potential prognostic utility of objective histologic scoring. we suggest that clinical guidelines are changed to incorporate new algorithms for the investigation and management of irAE colitis.

BACKGROUND:Immune checkpoint inhibitors (ICI) improve survival but cause immune-related adverse events (irAE). We sought to determine if CTCAE classification, IBD biomarkers/endoscopic/histological scores correlate with irAE colitis outcomes. METHODS:A dual-centre retrospective study was performed on patients receiving ICI for melanoma, NSCLC or urothelial cancer from 2012 to 2018. Demographics, clinical data, endoscopies (reanalysed using Mayo/Ulcerative Colitis Endoscopic Index of Severity (UCEIS) scores), histology (scored with Nancy Index) and treatment outcomes were analysed. RESULTS:In all, 1074 patients were analysed. Twelve percent (134) developed irAE colitis. Median patient age was 66, 59% were male. CTCAE diarrhoea grade does not correlate with steroid/ infliximab use. G3/4 colitis patients are more likely to need infliximab (p < 0.0001) but colitis grade does not correlate with steroid duration. CRP, albumin and haemoglobin do not correlate with severity. The UCEIS (p = 0.008) and Mayo (p = 0.016) scores correlate with severity/infliximab requirement. Patients with higher Nancy indices (3/4) are more likely to require infliximab (p = 0.03). CONCLUSIONS:CTCAE assessment does not accurately reflect colitis severity and our data do not support its use in isolation, as this may negatively impact timely management. Our data support utilising endoscopic scoring for patients with >grade 1 CTCAE disease, and demonstrate the potential prognostic utility of objective histologic scoring.

Background The Apnoea–Hypopnoea index (AHI) is regarded as a gold standard diagnostic marker of Obstructive Sleep Apnoea Syndrome (OSAS). However, a number of patients present with excessive daytime sleepiness (EDS), yet exhibit a raised Respiratory Disturbance Index (RDI), comprising of flow limited breaths in the presence of a normal AHI (<5 events/hr). We sought to evaluate the benefits of CPAP in this “Flow Limitation” cohort compared to a matched population of OSAS subjects. Results 27 subjects (Mean age 47 (SD 8) years; ESS 17(4); 48% male; BMI 35.60 (8.12)) presented to our Sleep Service with EDS and undertook a cardio-respiratory polysomnograph, demonstrating an RDI >15 and AHI <5 (Mean RDI 16 (4); AHI 3(2); ODI 5(3)) 25 subjects were subsequently treated with CPAP. At “6-week compliance” visits, 20 (80%) were deemed compliant with CPAP (mean nightly usage 6.03 (1.47) hrs; pre-CPAP ESS 18(3) falling to 9 (4) following CPAP. Within the Flow Limitation cohort, statistically significant associations were observed between CPAP compliance and Female gender (100 v 55%), higher BMI (36.61 v 31.56), higher pre-CPAP ESS (18 v13) and lower Pulse Transit Time PTT (300.90 v 316 ms). This “Flow Limitation” cohort was compared with an age/gender matched “OSAS “cohort (ESS 15(5); BMI 38.33 (7.80) AHI 58.16 (25.79) ODI 48 (23)). 26 OSAS subjects were treated with CPAP with 19 (70%) deemed compliant (nightly usage 5.25 (3.55) hrs; pre-CPAP ESS 16 (5) falling to 10(5) following CPAP. Whilst the mean PTT of the OSAS cohort was lower than the “Flow Limitation” cohort, this did not reach statistical significance (298.85(15.04) v 306.44 (18.36) ms; ANOVA; p = 0.1) yet the PTT Deceleration Index (DI), a surrogate of physiological arousal, was significantly higher in the OSAS cohort (59.05(29.33) v 36.32(23.69)/hour; ANOVA; p = 0.003). Conclusion “Sleepy” subjects exhibiting an elevated Flow Limitation Index in the presence of a normal AHI appear to demonstrate a response to CPAP therapy comparable to that observed in OSAS. Female gender and a higher BMI appear to predict compliance with therapy, whilst the utility of Pulse Transit Time in guiding decision making in “sleepy” subjects with a normal AHI merits further study.

Clinical OtolaryngologyVolume 40, Issue 5 p. 486-490 Correspondence: Our Experience Do mandatory nasal interventions after epistaxis just delay discharge? – Our experience in 90 adults A.S. Lau, Corresponding Author A.S. Lau orcid.org/0000-0002-6489-204X Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool, UKCorrespondence: A. Lau, Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool L9 7AL, UK. Tel.: +44 151 525 5980; Fax: +44 151 529 5237; e-mail: andrew.lau@liverpool.ac.ukSearch for more papers by this authorK. Smith, K. Smith Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool, UKSearch for more papers by this authorL. Mealey, L. Mealey Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool, UKSearch for more papers by this authorJ. Rylands, J. Rylands Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool, UKSearch for more papers by this authorJ. Heseltine, J. Heseltine Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool, UKSearch for more papers by this authorS.P. Williams, S.P. Williams Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool, UKSearch for more papers by this authorA.C. Swift, A.C. Swift Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool, UKSearch for more papers by this author A.S. Lau, Corresponding Author A.S. Lau orcid.org/0000-0002-6489-204X Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool, UKCorrespondence: A. Lau, Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool L9 7AL, UK. Tel.: +44 151 525 5980; Fax: +44 151 529 5237; e-mail: andrew.lau@liverpool.ac.ukSearch for more papers by this authorK. Smith, K. Smith Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool, UKSearch for more papers by this authorL. Mealey, L. Mealey Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool, UKSearch for more papers by this authorJ. Rylands, J. Rylands Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool, UKSearch for more papers by this authorJ. Heseltine, J. Heseltine Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool, UKSearch for more papers by this authorS.P. Williams, S.P. Williams Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool, UKSearch for more papers by this authorA.C. Swift, A.C. Swift Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool, UKSearch for more papers by this author First published: 09 March 2015 https://doi.org/10.1111/coa.12411Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume40, Issue5October 2015Pages 486-490 RelatedInformation

PURPOSE:The patient concerns inventory (PCI) was developed to help patients raise issues/concerns during routine follow-up and to indicate team members they want to see. This paper reports the use of the PCI across various H&N Cancer sub-sites (oral, oropharyngeal and laryngeal) and stages of disease (early and late) and describes the main concerns that patients want to discuss using a cross-sectional survey comprising the PCI with the University of Washington Quality of Life questionnaire. Patients treated for primary H&N squamous cell carcinoma, 1998-2009, were identified from the University Hospital Aintree H&N Cancer database. 447/775 (58 %) patients responded. Fear of recurrence concerns was common to all clinical groups (range 32-67 %). Speech issues were more common with laryngeal tumours, and saliva issues with oropharyngeal tumours (32 % early, 48 % late). Apart from early-stage laryngeal tumours, patients consistently reported issues concerning dental health/teeth and chewing. The median (IQR) number of concerns overall was 4 (2-7), with significant variation (p < 0.001) between clinical groups ranging from 2 (1-6) for early-stage oral to 6 (2-10) for late-stage oropharyngeal and 7 (5-9) late-stage laryngeal. The results indicated that PCI can be readily incorporated into managing HNC patients and supports a holistic multidisciplinary approach to clinic consultations. It accommodates difficult issues such as fear of recurrence and intimacy. Completion of the PCI by patients before consultation can highlight problems and concerns that doctors can target for discussion, thereby streamlining consultations, and ensuring that patient needs are better met, thus creating a more effective service.