Maidstone Hospital

Primary mucinous adenocarcinoma (PMAC) of the urethra is an exceptionally rare subtype of primary urethral carcinoma, with limited published data to guide diagnosis or treatment. Most literature consists of isolated case reports, and the non-specific presentation often delays diagnosis. This report presents two further cases and a review of the literature with a view to expand current understanding. We report two cases of PMAC. The first involves a 67-year-old male with progressive lower urinary tract symptoms initially treated as benign prostatic hyperplasia. Histology following a transurethral resection of the prostate revealed invasive mucinous adenocarcinoma with enteric features. He underwent radical prostatectomy, chemotherapy and radiotherapy for metastatic disease. The second case is a 52-year-old female with chronic urinary symptoms and a urethral mass initially misattributed to being from gynaecological origin. However, a biopsy later confirmed mucinous adenocarcinoma of the urethra. She underwent chemotherapy and radiotherapy, with partial response, but later developed further metastatic spread and is now undergoing palliative chemotherapy. PMAC is aggressive, often presents with non-specific urinary symptoms and lacks standardised diagnostic or treatment protocols. These cases highlight the importance of early detection through biopsies, immunohistochemical analysis and a multidisciplinary approach. Broader awareness and further reporting of cases are essential to develop evidence-based diagnostic and treatment guidelines for this rare malignancy.

We thank Dr [...].

Fire and rescue services in England routinely carry out Home Fire Safety Visits which aim to reduce risk of fire, support independent living and improve quality of life. The visits include a person-centred assessment and providing general advice on health-related topics such as preventing falls. To assess the effectiveness and cost-effectiveness of Home Fire Safety Visits (also known as Safe and Well Visits) to reduce falls and improve quality of life in older adults living in the community. We designed a multicentre, randomised controlled trial with economic and qualitative evaluations, involving two fire and rescue services in England, to recruit 1156 community-dwelling adults aged 65 years and over. All participants could continue to access routine care from healthcare professionals and were provided with a falls prevention leaflet as part of the trial. The intervention group were additionally offered a Home Fire Safety Visit. The usual care group were offered a visit after they had completed the trial. Blinding was not possible. Participants were randomised 1 : 1 using a secure web-based system. The primary outcomes were (1) the number of falls per participant and (2) health-related quality of life (EuroQol-5 Dimensions, five-level version) over 12 months from randomisation. Secondary outcomes included fire risk-taking behaviours, loneliness, fear of falling and time to first fall. The planned economic evaluation comprised cost-utility and cost-effectiveness analyses. The qualitative study was designed to examine intervention fidelity and acceptability. It proved impossible to conduct the trial as planned in the current research landscape. We faced significant delays in setting up and starting recruitment, in large part due to this coinciding with the start of the COVID-19 pandemic. Obtaining regulatory approval took longer than anticipated. Additionally, we were unable to access general practitioner registration data to identify participants as planned and so we had to use Consumer Classification Platform data to identify potential households to send study invitations to. This resulted in a less targeted and non-personalised mail-out as this is not patient-level data so the householder names were unavailable. Ultimately, recruitment was much lower than expected. In total, 237 participants were assessed for eligibility and 63 randomised (intervention, n = 32; usual care, n = 31). The Home Fire Safety Visits were delivered as planned to both groups; however, the planned statistical and health economic analyses could not be conducted due to the limited data. Data from the qualitative evaluation indicated the intervention was largely acceptable to staff and service users. Conducting trials in this setting is currently extremely challenging. To facilitate future research, we recommend an urgent review of research governance issues related to the types of personal data that can be accessed and used for research. This review should aim to provide support and avoid creating additional obstacles to research in this area. The evidence for the effectiveness and cost-effectiveness of Home Fire Safety Visits remains inconclusive. Research governance in local authorities needs urgent review. This trial is registered as Current Controlled Trials NCT04717258. This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: NIHR128341) and is published in full in Public Health Research; Vol. 13, No. 7. See the NIHR Funding and Awards website for further award information.

PurposeThere are multiple contemporary systemic therapy options for patients with HER2-positive advanced breast cancer. However, there are few longitudinal data regarding what proportion of patients go on to receive later lines of therapy, real-world outcomes and the impact of brain metastases. We therefore conducted a prospective, multicentre non-interventional study to describe the anti-cancer treatment regimens used and clinical outcomes in patients with HER2-positive advanced breast cancer across multiple lines of therapy undergoing treatment in routine clinical care.MethodsAdult patients diagnosed with HER2-positive advanced breast cancer were recruited to a prospective, multicentre non-interventional study to observe treatment patterns and outcomes.ResultsThree hundred and eleven patients were recruited with median age 57 years. Of those patients initiating first, second-, and third-line treatment, 72 (23.2%), 59 (41.3%), and 20 (35%), respectively had passed away without advancing on to subsequent lines of therapy. The median progression-free survival in the first line was 25.8 months and overall survival 56.7 months. Over the course of the study 107 (34.4%) of participants were diagnosed with CNS metastases. Median overall survival from diagnosis of brain metastases was 15.4 months.ConclusionsMany patients treated in routine practice may not get to benefit from contemporary second and later line treatments, where brain metastases become increasingly common. These findings have implications for selection of optimal systemic therapy sequencing in advanced HER2-positive breast cancer.Clinical Trial RegistrationThis study was approved by Nottingham Research Ethics Committee on 29th December 2014. Clinical Trial Registration: NCT02393924.

89 Background: Darolutamide has authorisation for treatment of metastatic hormone sensitive prostate cancer (MHSPC) in combination with docetaxel chemotherapy and androgen deprivation therapy (triplet therapy) based on ARASENS trial results. The RECOMMEND study is a prospective real-world evaluation (RWE) of clinical outcomes in patients with MHSPC treated with this regimen in the UK. Methods: 318 patients were enrolled from 21 UK centres over 20 months from November 2022. Data cut-off was 14 August 2024. Disease characteristics were evaluated. Descriptive statistics have been used for patient demographics and PSA changes with treatment were analysed. Results: Patients on the study had a median age of 67 (range 38-84) years. Majority of the patients were de novo metastatic (91.2%). 68.2% have a Gleason score ≥8. 76 patients (23.9%) had next generation imaging (NGI) at diagnosis. Performance score was 0 (62.7%) or 1 (37.3%). The distribution of metastases (%) were: bone (84.9), nodal (60.4), lung (12.6) and liver (2.5). The median PSA level was 134 (range 1 to 5628) ng/mL at diagnosis. At the end of docetaxel chemotherapy median PSA was 0.35 ng/mL. PSA response see in the 226 patients who had completed 6 cycles of docetaxel chemotherapy at the data cut-off, PSA 50 was seen in 87.6% (198/226) and PSA 90 in 53.2%. PSA responses in those who only completed 4/5 cycles of docetaxel (n=14) did not significantly differ compared to those who completed all 6 cycles (PSA 50 p=0.445 and PSA 90 p-0.664). At 6 months from darolutamide initiation, quality of life (QoL) data is currently available for 173 patients, of these 88.4% reported either stable or improved QoL and 11.6% had a decline in QoL at the end of chemotherapy. Conclusions: The tolerability and efficacy profile of treatment with ADT+Darolutamide+Docetaxel in MHSPC in the RECOmMEnD study is similar to that reported in the ARASENS trial. The QoL data available for 173 patients to date reports either stable or improved QoL at 6 months for 88.4% cases. This provides important prospective RWE data, enabling patients and clinical teams to make informed choices in this setting.

Shared housing for adults with intellectual disabilities with staff support, is a common housing model internationally. We explored an overlooked aspect of group homes, namely the extent to which they enable a sense of 'feeling at home' for residents. A diverse group of 19 housemates participated in a photovoice study. Participants took photos in their homes and discussed them in individual interviews and in groups. Data was analysed using reflexive thematic analysis. Residents' experience of home was multi-dimensional. 'Feeling at home' related to home as a site of identity cultivation (personal home); physical comfort or 'misfitting' (physical home) and home as the locus of key relationships (social home). Achieving a sense of 'feeling at home' requires engagement in practices of home-making. Many of our participants required support from staff to engage in these practices. For some housemates their experience of home was conditional and precarious.