Esther Moss

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Papers by Esther Moss

Awareness of and attitudes towards cervical cancer prevention among migrant Eastern European women in England

Journal of Medical Screening, Sep 12, 2019

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Knowledge, attitudes and awareness of the human papillomavirus among health professionals in New Zealand

PLOS ONE, Dec 31, 2018

Human papillomavirus (HPV) is a common sexually transmitted infection that is implicated in 99.7%... more Human papillomavirus (HPV) is a common sexually transmitted infection that is implicated in 99.7% of cervical cancers and several other cancers that affect both men and women. Despite the role that HPV plays in an estimated 5% of all cancers and the evolving role of HPV vaccination and testing in protecting the public against these cancers, preliminary research in New Zealand health professionals suggest knowledge about HPV may not be sufficient. A total of 230 practice nurses, smear takers and other clinical and laboratory staff who attended a range of training events completed a cross-sectional survey between April 2016 and July 2017. The survey explored four broad areas: demographics and level of experience, HPV knowledge (general HPV knowledge, HPV triage and test of cure (TOC) knowledge and HPV vaccine knowledge), attitudes towards the HPV vaccine and self-perceived adequacy of HPV knowledge. The mean score on the general HPV knowledge questions was 13.2 out of 15, with only 25.2% of respondents scoring 100%. In response to an additional question, 12.7% thought (or were unsure) that HPV causes HIV/AIDS. The mean score on the HPV Triage and TOC knowledge questions was 7.4 out of 10, with only 9.1% scoring 100%. The mean score on the HPV vaccine knowledge questions was 6.0 out of 7 and 44.3% scored 100%. Only 63.7% of respondents agreed or strongly agreed that they were adequately informed about HPV, although 73.3% agreed or strongly agreed that they could confidently answer HPVrelated questions asked by patients. Multivariate analyses revealed that knowledge in each

format_quote96.5% of respondents indicated intention to recommend HPV vaccination, yet 63.7% felt adequately informed about HPV.format_quote

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Economic evaluation of different routes of surgery for the management of endometrial cancer: a retrospective cohort study

BMJ Open, May 1, 2021

Objectives The benefits of minimally invasive surgery (MIS) for endometrial carcinoma (EC) are we... more Objectives The benefits of minimally invasive surgery (MIS) for endometrial carcinoma (EC) are well established although the financial impact of roboticassisted hysterectomy (RH) compared with laparoscopic hysterectomy (LH) is disputed. Design Retrospective cohort study. Setting English National Health Service hospitals 2011-2017/2018. Participants 35 304 women having a hysterectomy for EC identified from Hospital Episode Statistics. Primary and secondary outcome measures The primary outcome was the association between route of surgery on cost at intervention, 30, 90 and 365 days for women undergoing an open hysterectomy (OH) or MIS (LH/ RH) for EC in England. The average marginal effect was calculated to compare RH versus OH and RH versus LH which adjusted for any differences in the characteristics of the surgical approaches. Secondary outcomes were to analyse costing data for each surgical approach by age, Charlson Comorbidity Index (CCI) and hospital MIS rate classification. Results A total of 35 304 procedures were performed, 20 405 (57.8%) were MIS (LH: 18 604 and RH: 1801), 14 291 (40.5%) OH. Mean cost for LH was significantly less than RH, whereas RH was significantly less than OH at intervention, 30, 90 and 365 days (p<0.001). Over time, patients who underwent RH had increasing CCI scores and by the 2015/2016 year had a higher average CCI than LH. Comparing the cost of LH and RH against CCI score identified that the costs closely reflected the patients' CCI. Increasing disparity was also seen between the MIS and OH costs with rising age. When exploring the association between provider volume, MIS rate and surgical costs, there was an association with the higher the MIS rate the lower the average cost. Conclusions Further research is needed to investigate costs in matched patient cohorts to determine the optimum surgical modality in different populations.

format_quoteDespite clinical benefits, RH use is questioned due to high capital and consumable costs compared to LH and OH.format_quote

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Increasing physical activity levels following treatment for cervical cancer: an intervention mapping approach

Journal of Cancer Survivorship, 2021

Purpose The purpose of this study was to utilise the intervention mapping (IM) protocol as a fram... more Purpose The purpose of this study was to utilise the intervention mapping (IM) protocol as a framework with which to develop an intervention underpinned by relevant behaviour change theory to promote physical activity (PA) following treatment for cervical cancer. Methods The six steps of the IM protocol were followed. A qualitative semi-structured interview study and a rapid review of the literature were conducted along with the development of a logic model of the problem and a logic model of change to inform intervention development. Results An intervention was developed which aims to increase PA levels following treatment for cervical cancer, tailored to address key findings from the IM needs assessment. These include embedding behavioural and social strategies that help participants to overcome perceived barriers to PA participation; goal setting strategies to gradually increase PA levels with a view of reaching relevant PA guidelines for cancer survivors and feedback to encourag...

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Patient acceptability of circulating tumour DNA testing in endometrial cancer follow‐up

European Journal of Cancer Care, 2021

The identification of circulating tumour DNA (ctDNA) is hailed as introducing a paradigm shift in... more The identification of circulating tumour DNA (ctDNA) is hailed as introducing a paradigm shift in cancer management, enabling a more personalised approach to treatment. One of the reported advantages of ctDNA is its high sensitivity and specificity in identifying patients who will experience disease relapse, often many months, or even years, before clinical signs/symptoms or detection on imaging . Monitoring ctDNA levels to identify cancer recurrence before it is clinically or radiologically detectable has the potential to dramatically impact patient management by being used as the basis of remote monitoring schemes, as compared to the current standard management for most tumour sites of clinician-led hospital follow-up (HFU).

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Patient acceptability of ctDNA testing in endometrial cancer follow-up

ABSTRACTObjectiveCirculating tumour DNA (ctDNA) is emerging as a potential option to detect disea... more ABSTRACTObjectiveCirculating tumour DNA (ctDNA) is emerging as a potential option to detect disease recurrence in many cancer types however, ensuring patient acceptability of changing clinical practice and the introduction of new technology is paramount. This study aimed to explore women’s opinions on the acceptability of ctDNA to monitor for endometrial cancer (EC) recurrence.MethodsWomen enrolled on a non-intervention cohort study determining the ability of ctDNA to detect recurrent endometrial cancer were invited to participate in a semi-structured interview. Data was analysed using Template Analysis.ResultsEighteen women were interviewed. Participants represented a mix of cases, including early stage high-risk EC, metastatic disease at diagnosis and EC recurrence, to ensure a wide range of participant experiences were captured. A ctDNA blood test was viewed by participants as more physically and psychologically acceptable than clinical examination to monitor for EC recurrence. I...

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Comparing Characteristics of Endometrial Cancer in Women of South Asian and White Ethnicity in England

Cancers, 2021

Differences in patient demographic and tumour characteristics between patients of South Asian and... more Differences in patient demographic and tumour characteristics between patients of South Asian and White ethnicity diagnosed with an endometrial cancer (EC) and currently living in England are not well described. We undertook a retrospective study of EC cases diagnosed at the University Hospitals of Leicester, UK. A total of 1884 cases were included, with 13% of the patients being of South Asian ethnicity. South Asian women were diagnosed at a significantly younger age (mean age of 60.3 years) compared to women of White ethnicity (mean age of 66.9 years) with a mean difference of 6.6 years (95% CI 5.1 to 8.1, p < 0.001). Rising body mass index (BMI) in the White patient group was significantly correlated with younger age at diagnosis (p < 0.001); however, this association was not seen in South Asian patients. A linear regression that adjusted for diabetes status, BMI, and the interaction terms of diabetes status with BMI and ethnicity with BMI, highlighted a younger age of diag...

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305 Surgical complexity and intra-operative fluid management influence duration of ICU care following cytoreductive surgery

The Poster, 2020

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Surgical trends, outcomes and disparities in minimal invasive surgery for patients with endometrial cancer in England: a retrospective cohort study

BMJ Open, 2020

ObjectiveTo examine surgical outcomes and trends in the implementation of minimally invasive surg... more ObjectiveTo examine surgical outcomes and trends in the implementation of minimally invasive surgery (MIS) use for endometrial cancer (EC).DesignRetrospective cohort study.SettingEnglish National Health Service hospitals 2011–2017/2018.Population35 304 patients having a hysterectomy for EC identified from Hospital Episode Statistics.MethodsUnivariate and multivariate analyses compared MIS to open hysterectomy (OH) by assessing the association between demographic, clinical and hospital characteristics by using logistic regression. A propensity score was created, to control for confounding factors including demographics, clinical and hospital characteristics, from a logistic regression which enabled the inverse probability weighting of treatment to be applied in order to compare outcomes of treatment.Main outcome measuresThe association between route of surgery on perioperative morbidity and mortality.ResultsThe MIS rate rose from 40.3% in 2011 to 68.7% in 2017/2018, however, there wa...

format_quoteMIS procedures rose from 40.3% to 68.7% (p<0.001) from 2011 to 2017; open surgery rates fell significantly (p<0.001).format_quote

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428 Comparing characteristics of endometrial cancer in South Asian and White ethnicity women in England

Endometrial cancer, 2021

According to our findings, abnormal uterine bleeding is considered the guiding symptom for the di... more According to our findings, abnormal uterine bleeding is considered the guiding symptom for the diagnosis of this oncological pathology, being to one of the most frequent reasons to demand a gynecological evaluation. Endometrial polyps are the main observed lesions in our cohort, in both ultrasound exam and hysteroscopy.

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Development of a patient-derived explant model for prediction of drug responses in endometrial cancer

Gynecologic Oncology, 2021

To undertake a pilot study to develop a novel Patient-Derived-Explant (PDE) model system for use ... more To undertake a pilot study to develop a novel Patient-Derived-Explant (PDE) model system for use in endometrial cancer (EC) that is capable of monitoring differential drug responses in a pre-clinical setting. Fresh tumour was obtained post-hysterectomy from 27 patients with EC. Tumours were cut into 1-3 mm 3 explants that were cultured at the air-liquid interface for 16-24 hours in culture media. Explants were cultured in different media conditions to optimise viability. Explants were also treated with carboplatin/paclitaxel or pembrolizumab for 24 hours and processed into histology slides. Multiplexed immunofluorescence for Ki67 (proliferation marker), cPARP (apoptosis marker) and CAM 5.2 (tumour mask) was performed followed by image analysis and quantitation of biomarker expression. EC samples are amenable to PDE culture with preserved histological architecture and PDE viability for up to 48 hours, with the addition of autologous serum in culture media facilitating EC-PDE viability. Our PDE platform provides evidence of differential drugresponse to conventional chemotherapeutics and immune checkpoint inhibition, and these responses can be assessed in the context of a preserved tumour microenvironment. Our PDE platform represents a rapid, low-cost pre-clinical model which can be easily integrated into drug development pipelines. PDE culture preserves original tumour architecture and enables evaluation of spatial relationships in the tumour microenvironment. PDE culture has the potential for personalised drug-testing in a pre-clinical setting which is increasingly important in an era of personalised medicine in the treatment of EC.

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Patient-initiated follow-up for low-risk endometrial cancer: a cost-analysis evaluation

International Journal of Gynecologic Cancer, 2020

ObjectiveRisk stratification has resulted in patient-initiated follow-up being introduced for low... more ObjectiveRisk stratification has resulted in patient-initiated follow-up being introduced for low-risk endometrial cancer in place of routine hospital follow-up. The financial benefit to the patient and the healthcare economy of patient-initiated follow-up, as compared with hospital follow-up, has yet to be explored. In this study, we explored the potential impact for both the healthcare economy and patients of patient-initiated follow-up.MethodsWomen diagnosed with low-risk endometrial cancer enrolled on a patient-initiated follow-up scheme between November 2014 and September 2018 were included. Data on the number of telephone calls to the nurse specialists and clinic appointments attended were collected prospectively. The number of clinic appointments that would have taken place if the patient had continued on hospital follow-up, rather than starting on patient-initiated follow-up, was calculated and costs determined using standard National Health Service (NHS) reference costs. Th...

Utility of circulating tumor DNA for detection and monitoring of endometrial cancer recurrence and progression

ABSTRACTDespite the increasing incidence of endometrial cancer (EC) worldwide and the poor overal... more ABSTRACTDespite the increasing incidence of endometrial cancer (EC) worldwide and the poor overall survival of patients who recur, no reliable biomarker exists for detecting and monitoring EC recurrence and progression during routine follow-up. Circulating tumor DNA (ctDNA) is a sensitive method for monitoring cancer activity and stratifying patients that are likely to respond to therapy. As a pilot study, we investigated the utility of ctDNA for detecting and monitoring EC recurrence and progression in 13 patients using targeted next-generation sequencing (tNGS) and personalized ctDNA assays. Using tNGS, at least 1 somatic mutation at a variant allele frequency (VAF) >20% was detected in 69% (9/13) of patient tumors. The four patients with no detectable tumor mutations at >20% VAF were whole exome sequenced, with all four harboring mutations in genes not analyzed by tNGS. Analysis of matched and longitudinal plasma DNA revealed earlier detection of EC recurrence and progressi...

format_quotectDNA identified recurrence in 100% of patients with early-stage diagnosis, outperforming traditional imaging by up to 10 months in lead time.format_quote

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EP610 Investigation of patient acceptability of ctDNA in endometrial cancer follow-up

ePoster, 2019

Introduction/Background Circulating tumour DNA (ctDNA) is emerging as a potential option to detec... more Introduction/Background Circulating tumour DNA (ctDNA) is emerging as a potential option to detect disease recurrence in women undergoing follow-up for endometrial cancer (EC). However, ensuring patient acceptability of changing clinical practice and the introduction of new technology is paramount. Methodology The aim of this study was to explore women’s opinions on the acceptability of ctDNA and their experiences of the ctDNA study. Women undergoing follow-up and participating in a cohort study investigating the utility of ctDNA to detect/monitor recurrent/progressive EC were invited to participate. Semi-structured interviews were conducted by a psychology student (independent from the clinical research team) and analysed through template analysis. Participants were also asked on their views as to the potential role for ctDNA in clinical practice, either in combination with hospital follow-up or as remote monitoring with a patient-initiated follow-up (PIFU) scheme. Results Women expressed that their motivations behind participating in the study were primarily due to altruism and a desire to help others, including protecting others from having pelvic examinations. Participants spoke about their dislike of the pelvic examinations, which were deemed unpleasant, and shared their desires to ‘find a better way’, and a blood test was viewed as a welcome alternative. The ctDNA blood test was viewed as more physically and psychologically acceptable than the current clinical examination. Participants expressed a wish to know if their ctDNA level was raised, even if a recurrence wasn’t detectable on imaging, because it was felt that they would have more certainty in their likelihood of recurrence. Conclusion This study provides in-depth insights into patient views on the acceptability of ctDNA for monitoring of EC, with women stating an overwhelming preference for a blood test over pelvic examination. Participant insights also revealed that PIFU in conjunction with ctDNA, appears to be an acceptable new approach to EC follow-up. Disclosure Nothing to disclose.

Barriers and motivators for uptake of cervical cancer prevention strategies in Eastern Europe: the perspective from Latvia

Acta Dermatovenerologica Alpina Pannonica et Adriatica, 2019

The incidence of cervical cancer (CC) in eastern European countries is high; however, uptake of a... more The incidence of cervical cancer (CC) in eastern European countries is high; however, uptake of available prevention strategies is suboptimal. We explored knowledge, behaviors, and attitudes toward CC prevention strategies in Latvian women. Methods: A mixed-methods study of Latvian women, consisting of surveys and semi-structured interviews, was conducted in Riga, Latvia in September and October 2015. Results: Altogether, 158 surveys were completed and 10 interviews were conducted. In total, 87% (n = 135) had previously had a smear test, and 67% (n = 105) correctly identified that cervical cytology was performed to identify precancerous changes. The practice of annual gynecological checkups was prevalent, and many believed it to be synonymous with cervical screening. Detailed knowledge of human papillomavirus (HPV) infection and the HPV vaccine was deficient, although 73% (n = 115) and 70% (n = 90), respectively, claimed to have heard of them. Negative attitudes existed regarding the HPV vaccine due to fear of potential side effects. On learning that HPV was transmitted through sexual contact, the notion of testing positive for HPV was met with shame and embarrassment. Conclusions: A small proportion of Latvian women are over-screened, whereas many women remain unscreened. The main contributing factor for this was their poor understanding of the roles that cervical screening and HPV vaccination play in preventing CC.

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298 Multidisciplinary maximum effort cyto-reductive surgery (MES) for advanced ovarian cancer in leicester: outcomes

E-Poster viewings, 2019

Median 3-year OS increased from 56% (95% CI, 45.9-65%) to 77% (95% CI 70.2-82%), p<0.001. OS was ... more Median 3-year OS increased from 56% (95% CI, 45.9-65%) to 77% (95% CI 70.2-82%), p<0.001. OS was similar among patients who underwent UAS by a consultant versus a GO (p=0.308). Conclusions GOs who attain the learning curve perform UAS with maximal cytoreduction, with a success rate similar to that of intraoperative consultants. Including UAS in the surgical armamentarium contributes to increased rates of CGR.

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Iatrogenic Menopause After Treatment for Cervical Cancer

Clinical Oncology, 2016

The ever-improving prognosis of women diagnosed with cervical cancer has meant that survivorship ... more The ever-improving prognosis of women diagnosed with cervical cancer has meant that survivorship and treatment-related sequelae are being brought more into the spotlight in an attempt to try reduce morbidity and improve women's long-term health. There are many issues however surrounding an iatrogenic menopause in cervical cancer, a variety of potential management options and barriers to treatment. Women who have become menopausal under the age of 45 years as a result of cervical cancer are significantly less likely to start HRT or continue it long term as compared to those who have undergone a surgical menopause for a benign reason. High profile media reports raising concerns about the safety of HRT use have left many women reluctant to consider HRT as a therapeutic option for menopausal symptoms and many are seeking to use complementary/alternative medicine, including non-pharmacological interventions, to alleviate symptoms. The benefits of HRT in this population have been shown to reduce these effects although adherence to treatment regimens is a challenge due to poor compliance, which is in part due to fear of a second malignancy. The development of non-HRT based interventions to ameliorate menopausal symptoms and reduce the long-term health consequences are needed for women who chose not to take HRT.

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Gender differences in understanding and acceptance of robot-assisted surgery

Journal of Robotic Surgery, 2019

Robot-assisted surgery has numerous patient benefits compared to open surgery including smaller i... more Robot-assisted surgery has numerous patient benefits compared to open surgery including smaller incisions, lower risk of infection, less post-operative pain, shorter hospital stays and a quicker return to the workforce. As such, it has become the first-choice surgical modality for several surgical procedures with the most common being prostatectomy and hysterectomy. However, research has identified that the perceptions of robot-assisted surgery among surgical patients and medical staff often do not accurately reflect the real-world situation. This study aimed to understand male and female perceptions of robot-assisted surgery with the objective of identifying the factors that might inhibit or facilitate the acceptance of robotic surgery. Semi-structured interviews were undertaken with 25 men/women from diverse social/ethnic backgrounds. The interviews were transcribed and analysed using thematic analysis. The majority of female participants expressed concerns in relation to the safety and perception of new technology in surgery, whereas many male participants appeared to be unfazed by the notion of robotic surgery. There were clear differences in how males and females understood and conceptualised the robot-assisted surgical process. Whilst male participants tended to humanise the process, female participants saw it as dehumanising. There is still a discrepancy between the public perceptions of robotic surgery and the clinical reality perceived by healthcare professionals. The findings will educate medical staff and support the development of current informative techniques given to patients prior to surgery.

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Acceptability and utilisation of patient-initiated follow-up for endometrial cancer amongst women from diverse ethnic and social backgrounds: A mixed methods study

European Journal of Cancer Care, 2019

A shift in focus towards risk stratification and survivorship in early stage endometrial cancer (... more A shift in focus towards risk stratification and survivorship in early stage endometrial cancer (EC) has led to the replacement of hospital follow-up (HFU) with patient-initiated follow-up (PIFU) schemes. A mixed-methods study was undertaken prospectively to investigate utility and patient satisfaction with a newly introduced PIFU scheme. 228 women were enrolled onto PIFU in the first 18 months, median age 65 years (range 42-90 years). Twenty-four (10.5%) women were non British-White ethnicity. Forty-five women contacted the Clinical Nurse Specialist (CNS) at least once (19.7%), the primary reason being vaginal bleeding/discharge (42%). Contact was greater in first six months on the scheme compared to the second six months, and women who made contact were significantly younger than those who did not (57 years versus 65 years, p<0.001). PIFU appears to be well received by the majority of women. Although many of the CNS contacts were due to physical symptoms, a number were for psychological support or reassurance. Younger women had greater CNS contact indicating that they may benefit from a greater level support. Patient feedback of the PIFU scheme was positive, with many women reporting that it enabled them to have more control over their own health.

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Knowledge, attitudes and awareness of the human papillomavirus amongst primary care practice nurses: an evaluation of current training in England

Journal of public health (Oxford, England), Sep 13, 2016

The incorporation of Human papillomavirus (HPV) testing into the English cervical screening progr... more The incorporation of Human papillomavirus (HPV) testing into the English cervical screening programme has been met with fear and anxiety. Healthcare professionals need to be adequately informed about HPV to help alleviate patient concerns.The aim of this study was to evaluate the HPV training provided to practice nurses (PNs) and determine their level of HPV knowledge. A web-based survey was distributed to 147 General Practice surgeries in the Leicester, Leicestershire and Rutland regions, between May and July 2015. The survey explored four broad areas; demographics/level of experience, HPV knowledge, attitudes towards the HPV vaccine and self-perceived adequacy of HPV knowledge. A total of 128 surveys were completed, with 94 complete responses. Overall awareness of basic HPV facts was adequate; however, detailed, and in some cases basic, knowledge was lacking. 9.6% failed to identify that HPV can cause cervical cancer and 62.8% believed that HPV requires treatment. Not all PNs felt...

format_quote128 PN completed the survey; median age was 50 years, with 53.2% last trained over a year ago, impacting knowledge retention.format_quote

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