Clive Peedell Profile picture
Mar 21, 2020 9 tweets 7 min read Read on X
THREAD: Should we continue to offer concurrent ChemoRT and Durvalumab in selected stage III NSCLC patients during the #COVID19 outbreak?
I think yes, and this thread explains why #radonc #medonc #lcsm
Chemo added sequentially to RT gives ~5% absolute Overall Survival (OS) benefit to RT alone at 5 years. ChemoRT given concurrently adds a further 4.5% absolute OS benefit at 5 years (Auperin meta-analysis). #lcsm #radonc #medonc #covid19 Image
We now know that addition of Durvalumab after concurrent ChemoRT improves absolute 3 year OS from 43.5% to 57% (PACIFIC trial). The curves are not coming together, with both curves flattening, suggesting 5yr absolute OS benefit will be maintained ie at least 10%
#radonc #medonc
In summary concurrent CRT plus Durva likely to add 20%+ absolute survival benefit at 5 years versus giving RT alone.
*BUT*, we now have to factor in the mortality *risk* of giving chemo and IO during the #COVID19 outbreak....
Computer modeling from Imperial College, London has suggested giving chemo during #COVID19 outbreak could have a mortality rate of >5%. (Commonest age range for giving ChemoRT is 60-70). We know less about IO, but risk is also likely to be higher medrxiv.org/content/10.110… ImageImage
There are clearly a lot of uncertainties here, and multiple visits to hospital will increase chance of being infected. On balance though, I think the 20%+ absolute OS benefit versus RT alone is worth the risk at this stage. These patients are generally fitter & younger too
We use the SOCCAR regimen. Cis/Vin concurrent with with 55Gy in 20 fractions. We are going to drop the 2 neoadjuvant cycles we normally give and go straight into concurrent. It’s a tough regimen, so for fit PS0-1 only & younger patients (<70yrs). ejcancer.com/article/S0959-…
There is also the issue of giving a year (26 cycles) of adjuvant durvalumab. I just think we need to be as cautious as possible and take all the necessary infection control measures to reduce infection risk. #covid19 #lcsm #medonc #radonc
We are clearly in a very rapidly changing situation and we may come to the point that offering any cytotoxic treatment that increases hospital admission risk will have to stop. Let’s hope and pray we never get to that point. Keep safe all #radonc #medonc #covid19 #lcsm

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More from @cpeedell

Dec 17, 2023
The #NHS is actually quite easy to improve. This is how you do it:
1. Vote out the Tories
2. Focus on the social determinants of health. Wealth inequality causes health inequality. Tax unearned wealth (rentier billionaires & tax evaders)
3. Invest and promote public health
4. Understand that health spending has a fiscal multiplier effect and promotes economic growth
5. Invest in social care services
6. Use monopsony (dominant buyer in healthcare market) power of NHS for procurement of drugs and medical technology
7. Abolish purchaser-provider split
8. Invest in General Practice and community services. GPs & community nurses play an incredibly important “gatekeeper” role.
9. Promote role of community pharmacists in managing common and mild illness eg viral infections
10. Ensure clinician involvement in all major IT projects
Read 4 tweets
Jul 19, 2023
THREAD on #Consultants #Strike:
As a consultant oncologist, this is how I am going to support the strike:
I will work tomorrow because I have 2 MDTs, which can’t be cancelled because it would delay cancer treatment decisions by a week for about 80 patients. 1/
On Friday I have cancelled my radiotherapy planning clinic and my afternoon follow up clinic. I will enjoy a long weekend. However, all the patients will get seen tomorrow instead, with an extra ad hoc clinic and remote radiotherapy planning. 2/
I will lose a day’s pay on Friday, but I am going to claim BMA rates for my extra ad hoc clinic work, which will be paid at 3-4x my normal hourly rate. Hence cancer patients will not experience any delay or harm, and I will be financially better off!! 3/
Read 4 tweets
Aug 8, 2021
THREAD: A tribute to Simon Stevens, outgoing #NHS CEO.
When I first heard Simon Stevens was going to be CEO of the NHS, I was convinced he was going to accelerate the privatisation of the NHS, as he was appointed by a Tory Government, and was formerly CEO of UnitedHealth 1/11
Over time, he has proved me wrong. In fact, I now believe he did an enormous amount of work to slow down #NHS privatisation, despite the concerted efforts of Lansley and Hunt to drive forward a Tory market driven agenda 2/11
He effectively ignored large swathes of Lansley’s Health and Social Care Act legislation, and broadly favoured NHS collaboration over competition & marketisation. He listened to the concerns of clinical leaders over and above his political masters 3/11
Read 11 tweets
Jan 9, 2021
THREAD: We were a few hundred thousand votes away from the most powerful and militarized nation on earth becoming an authoritarian dictatorship. We must understand why we got so this close to this disaster. /1
In my opinion this is a direct result of neoliberal ideology, which has resulted in gross wealth inequality. The gap between rich & poor is higher than ever, leading to a large proportion of the population being left behind with poor prospects & enduring very difficult lives. /2
This leads to resentment, social unrest and distrust of Government. The appetite for scapegoats and blame is then ripe for manipulation by conspiracy theory and disinformation. The ideal environment to fuel right wing nationalism. /3
Read 11 tweets
Oct 11, 2020
I disagree with the Barrington declaration for the following reasons:
1 We don’t know enough about natural history of #COVID19 eg what are long term complications? risks of re-infection? severity of re-infection?
2 Spread can occur via asymptomatic cases, increasing transmission
3. You can’t effectively cocoon the elderly population. Younger people live with, work with, and look after older people
4. Infection spreads like wildfire through care homes and nursing homes. It’s devastating
5. If R number gets out of control, the health system will collapse
6. High numbers of infections will also increase sickness absence from work, with damaging economic costs
7. #COVID19 disproportionately affects the poorest regions in the country
Read 4 tweets
Oct 6, 2020
As a cancer specialist I think it’s important to respond to the #HealthSecretary’s comments about cancer treatment not being available if #COVID19 gets out of control. Firstly, it’s important to state that #Hancock and his own Government’s failures have contributed to the problem
Secondly, I think it’s unlikely that those in most need will miss out. We have learnt an enormous amount about managing cancer in a #COVID19 environment and are now much better prepared. At present we are managing generally very well, although surgical waiting lists are a problem
Non surgical cancer treatment like chemotherapy and radiotherapy is mainly outpatient based and we should be able to cope. Initial concerns about risks to patients on chemo have not turned out to be as serious as we first thought.
Read 8 tweets

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