South East London Research Articles

The impact of national non-pharmaceutical interventions (‘lockdowns’) on the presentation of cancer patients

One of the most ignored aspects of the COVID-19 pandemic has been the impact of public health measures by governments on wider health and welfare. From March 2020, hospitals in the UK saw a dramatic reduction in patients with cancer presenting due to multifactorial reasons. The impact of the pandemic on patients with cancer in the South East London Cancer Alliance was studied. The specific aims were (1) to examine the reduction in cancer diagnoses during the first wave of the pandemic and (2) to examine the stage of diagnosis of patients with cancer presenting during the pandemic compared with that of patients presenting before the pandemic.There was an 18.2% reduction in new cancer diagnoses (an estimate of 987 cancers), when compared with 2019. This fall in cancer diagnoses was most marked in patients with prostate (51.4%), gynaecological (29.7%), breast (29.5%) and lung (23.4%) cancers. There was an overall 3.9% increase in advanced stage presentation (Stages 3 and 4), with an overall 6.8% increase in Stage 4 cancers during this period. The greatest shifts were seen in lung (increase of 6.3%, with an 11.2% increase in Stage 4 cancer alone) and colorectal (5.4%) cancers. For prostate cancer, there was an increase in 3.8% in those presenting with Stage 4 disease. For breast cancer, there was an 8% reduction in patients diagnosed with Stage 1 cancer with commensurate increases in the proportion of those with Stage 2 disease.The experiences in cancer are a salient warning that pandemic control measures and policy need to balance all health and welfare. Alternative strategies need to be adopted during further waves of the current and any future pandemic to ensure that patients with cancer are prioritised for diagnosis and treatment to prevent late-stage presentation and an increase in avoidable deaths.

Hospital admissions for dental disorders in patients with severe mental illness in Southeast London: A register-based cohort study.

In people with mental disorders, adverse general health is well recognized but dental diseases remain underinvestigated. The objective of this study was to investigate risk factors for hospital admissions for dental disorders in patients with severe mental illness (SMI) and/or depressive disorder. De‐identified electronic mental health records from the South London and Maudsley NHS Foundation Trust (SLaM) were linked to national Hospital Episode Statistics (HES) data for analysis. Data were extracted for adults with a diagnosis of SMI (schizophrenia, schizoaffective disorder, bipolar disorder) and/or depression, who had received care at SLaM between 1 January 2010 and 31 March 2017. In the cohort of 18,999 patients thus obtained, the following factors were independently associated with hospital admission for dental disorders: female gender [odds ratio (OR) = 1.48, 95% CI: 1.31–1.68)], Health of the Nation Outcome Scales (HoNOS) problem drinking/drug taking (OR = 1.12, 95% CI: 1.05–1.19), HoNOS physical illness/disability (OR = 1.18, 95% CI: 1.12–.25), diabetes (OR = 1.24, 95% CI: 1.06–1.43), recorded current/past smoking (OR = 1.35, 95% CI: 1.06–1.43), treatment with antidepressant medication (OR = 1.48, 95% CI: 1.31–1.68), and depressive disorder (OR = 1.36, 95% CI: 1.11–1.68). Building on previous research in this population, which indicated a relatively high risk of acute care hospitalizations with dental disorders as discharge diagnoses, a number of demographic and clinical characteristics were found to be independent predictors over a 7‐yr period. Further research into these predictors would facilitate a better understanding of how adverse dental outcomes might be prevented.

Privilege, Precarity and the Epistemic and Political Challenge of COVID-19

Much of my initial shock at lockdown was the result of a loss of privilege. As a middle class professional working mother and a transnational scholar, I have constructed a life based on movement and freedom. Yes, I have ties that bind me: I am a single parent and a recent migrant to London, meaning my support network is somewhat limited. But with money I have been able to secure childcare and my career has allowed me to live simultaneously across three countries on three continents. So suddenly being locked in a small flat in London with restricted movement and full-time working and caring responsibilities was unsurprisingly an intensely traumatizing experience (reflected in my blog piece for the Feminist Review – https://femrev.wordpress.com/2020/05/26/resisting-the-violence-of-common-sense/). As the weeks have turned into months, my points of focus have shifted. On the one hand it has become much clearer to me that it was losing the illusion of constantly ‘moving forward’ that I was mourning: of not being able to escape, feel a sense of momentum and freedom, of planning and anticipating future adventures. On the other, as the world began to reopen slowly, I also became much more conscious of how being ‘locked down’ had actually been a privilege in itself. Not everyone had that luxury. Both in my local setting of south east London and in my research ‘fieldsite’ of Sri Lanka, it became clear that many had not been able to secure themselves at home – ordering food (and anything else they desired!) delivered to their door, avoiding all forms of public transport, working from home, doing home renovation, youtube workouts and taking up new hobbies. Reflecting on the question of privilege from these two angles, I wonder how the COVID-19 pandemic may provide an important moment to return to questions of solidarity, resistance and progressive politics. For many elites we see ourselves as the vanguard of struggles. Yet our impatience with the present (let alone the past!), reliance (conscious or not) on ideas of progress and experience of constant movement makes us ill-equipped to sit in an uncomfortable present and uncertain future. Do we have the necessary skills, tools and imagination to respond to this time? Meanwhile the realities of extremely disadvantaged and marginalised people are that they have never had the luxury of relying on a social, political and economic system to support them. As a result, while they have often been terribly affected, they have not been shocked that they would be affected. Instead they have found (sometimes subversive) ways to survive and organize, developed informal networks of support and creative forms of resilience.
 
 With this in mind, how might we rethink which agents and whose knowledge might be most valuable in this moment when trying to articulate responsive and transformative politics and practices? How might this allow for a richer understanding of not only the experience but also the possible responses to the precarity that has become a dominant contemporary reality? And how might new epistemic and political practices emerge that are not only more ethical but also more productive, radical and disruptive of the existing order?

Motor signs in Alzheimer's disease and vascular dementia: Detection through natural language processing, co-morbid features and relationship to adverse outcomes.

Motor signs in patients with dementia are associated with a higher risk of cognitive decline, institutionalisation, death and increased health care costs, but prevalences differ between studies. The aims of this study were to employ a natural language processing pipeline to detect motor signs in a patient cohort in routine care; to explore which other difficulties occur co-morbid to motor signs; and whether these, as a group and individually, predict adverse outcomes. A cohort of 11,106 patients with dementia in Alzheimer's disease, vascular dementia or a combination was assembled from a large dementia care health records database in Southeast London. A natural language processing algorithm was devised in order to establish the presence of motor signs (bradykinesia, Parkinsonian gait, rigidity, tremor) recorded around the time of dementia diagnosis. We examined the co-morbidity profile of patients with these symptoms and used Cox regression models to analyse associations with survival and hospitalisation, adjusting for twenty-four potential confounders. Less than 10% of patients were recorded to display any motor sign, and tremor was most frequently detected. Presence of motor signs was associated with younger age at diagnosis, neuropsychiatric symptoms, poor physical health and higher prescribing of psychotropics. Rigidity was independently associated with a 23% increased mortality risk after adjustment for confounders (p=0.014). A non-significant trend for a 15% higher risk of hospitalisation was detected in those with a recorded Parkinsonian gait (p=0.094). With the exception of tremor, motor signs appear to be under-recorded in routine care. They are part of a complex clinical picture and often accompanied by neuropsychiatric and functional difficulties, and thereby associated with adverse outcomes. This underlines the need to establish structured examinations in routine clinical practice via easy-to-use tools.

Obstetric near misses among women with serious mental illness: data linkage cohort study.

Investigating obstetric near misses (life-threatening obstetric complications) provides crucial information to prevent maternal mortality and morbidity. To investigate the rate and type of obstetric near misses among women with serious mental illness (SMI). We conducted a historical cohort study, using de-identified electronic mental health records linked with maternity data from Hospital Episode Statistics. The English Maternal Morbidity Outcome Indicator was used to identify obstetric near misses at the time of delivery in two cohorts: (1) exposed cohort - all women with a live or still birth in 2007-2016, and a history of secondary mental healthcare before delivery in south-east London (n = 13 570); (2) unexposed cohort - all women with a live or still birth in 2007-2016, resident within south-east London, with no history of mental healthcare before delivery (n = 223 274). The rate of obstetric near misses was 884.3/100 000 (95% CI 733.2-1057.4) maternities in the exposed group compared with 575.1/100 000 (95% CI 544.0-607.4) maternities in the unexposed group (adjusted odds ratio 1.6, 95% CI 1.3-2.0, P < 0.001). Highest risks were for acute renal failure (adjusted odds ratio 2.1, 95% CI 1.1-3.8, P = 0.022); cardiac arrest, failure or infarction (adjusted odds ratio 2.3, 95% CI 1.1-4.8, P = 0.028); and obstetric embolism (adjusted odds ratio 3.1, 95% CI 1.6-5.8, P < 0.001). Findings emphasise the importance of integrated physical and mental healthcare before and during pregnancy for women with SMI.

Reconsidering the reasons for heightened inflammation in major depressive disorder

BackgroundIncreased circulating pro-inflammatory markers have repeatedly been associated with major depressive disorder (MDD). However, it remains unclear whether inflammation represents a causal mechanism for MDD, or whether the association is influenced by confounding factors such as body mass index (BMI). MethodsTo better understand this complex relationship, we generated polygenic risk scores (PRS) for MDD and BMI in a population cohort and attempted to isolate the impact these potential risk factors have on adulthood inflammation. Peripheral blood samples were collected as part of the South East London Community Health study, where we generated individualized PRS for MDD and BMI and quantified inflammatory markers using multiplex ELISA-based technology. We performed linear regressions to investigate the effects of PRS for MDD and BMI on inflammatory marker levels. ResultsOut of 35 inflammatory markers, we found a nominal effect of PRS for MDD on interleukin-10. We also found a significant positive effect of BMI on nine inflammatory markers, of which the two most strongly affected markers, interleukin-6 (IL-6) and C-reactive protein (CRP), were also nominally predicted by BMI PRS. LimitationsThe study utilized a cross-sectional design with a moderately sized sample. ConclusionsOur findings suggest there may not be a shared genetic mechanism contributing to MDD and higher inflammatory marker levels. However, there may be shared genetic etiology between BMI and adulthood levels of CRP and IL-6. Therefore, polygenic risk scores for BMI may represent a useful indicator for heightened levels of inflammation in adulthood.

Penetrating maxillofacial trauma – a three year review of epidemiology and injury at a level 1 trauma centre

Introduction: King's College Hospital is a Level 1 trauma centre serving an inner-city area with a high incidence of knife and gun violence. The hospital also forms the hub for the SELKAM (South East London, Kent and Medway) trauma network. A total of 15,023 knife crime offences were recorded in London in the year to June 2019 – the highest on record.

Mental health consequences of urban air pollution: prospective population-based longitudinal survey

PurposeThe World Health Organisation (WHO) recently ranked air pollution as the major environmental cause of premature death. However, the significant potential health and societal costs of poor mental health in relation to air quality are not represented in the WHO report due to limited evidence. We aimed to test the hypothesis that long-term exposure to air pollution is associated with poor mental health.MethodsA prospective longitudinal population-based mental health survey was conducted of 1698 adults living in 1075 households in South East London, from 2008 to 2013. High-resolution quarterly average air pollution concentrations of nitrogen dioxide (NO2) and oxides (NOx), ozone (O3), particulate matter with an aerodynamic diameter < 10 μm (PM10) and < 2.5 μm (PM2.5) were linked to the home addresses of the study participants. Associations with mental health were analysed with the use of multilevel generalised linear models, after adjusting for large number of confounders, including the individuals’ socioeconomic position and exposure to road-traffic noise.ResultsWe found robust evidence for interquartile range increases in PM2.5, NOx and NO2 to be associated with 18–39% increased odds of common mental disorders, 19–30% increased odds of poor physical symptoms and 33% of psychotic experiences only for PM10. These longitudinal associations were more pronounced in the subset of non-movers for NO2 and NOx.ConclusionsThe findings suggest that traffic-related air pollution is adversely affecting mental health. Whilst causation cannot be proved, this work suggests substantial morbidity from mental disorders could be avoided with improved air quality.

Re-empowering into voice: experiments in organic community co-production

Abstract This article explores and extrapolates an emerging concept within community practice: namely that of organic community co-production. The concept is influenced by previous uses of the term ‘organic’, specifically as applied by Tönnies in relation to certain types of community, and Gramsci in respect of a concept of leadership. Our development of the term has been generated within the context of reflective practitioner experience, located in a community-led action campaign Voice4Deptford, in South East London. The case study explores the interdisciplinary roots of this form of co-production. It highlights the way that these pre-existing principles and methods have been adapted, reflected upon and improvised in the light of 30 years’ grassroots engagement by Green to evolve a bespoke approach that we are proposing to call ‘organic community coproduction’. The case study outlines several original dimensions or modalities of community organic co-production including; stepping aside; the academic as a non-expert and giving voice. It unpacks the different elements of impact and transformation, that are consequent upon organic community co-production. These include; evidence of change; working together and community reflective time. The article concludes with a discussion of the issues involved in reframing of local power, the campaigns early successes and its continuing challenges.

Cohort profile: King\u2019s Health Partners bladder cancer biobank

BackgroundBladder cancer (BC) is the 9th most common cancer worldwide, but little progress has been made in improving patient outcomes over the last 25 years. The King’s Health Partners (KHP) BC biobank was established to study unanswered, clinically relevant BC research questions.Donors are recruited from the Urology or Oncology departments of Guy’s Hospital (UK) and can be approached for consent at any point during their treatment pathway.At present, patients with bladder cancer are approached to provide their consent to provide blood, urine and bladder tissue. They also give access to medical records and linkage of relevant clinical and pathological data across the course of their disease. Between June 2017 and June 2019, 531 out of 997 BC patients (53.3%) gave consent to donate samples and data to the Biobank. During this period, the Biobank collected fresh frozen tumour samples from 90/178 surgical procedures (of which 73 were biopsies) and had access to fixed, paraffin embedded samples from all patients who gave consent. Blood and urine samples have been collected from 38 patients, all of which were processed into component derivatives within 1 to 2 h of collection. This equates to 193 peripheral blood mononuclear cell vials; 238 plasma vials, 224 serum vials, 414 urine supernatant vials and 104 urine cell pellets. This biobank population is demographically and clinically representative of the KHP catchment area.ConclusionThe King’s Health Partners BC Biobank has assembled a rich data and tissue repository which is clinically and demographically representative of the local South East London BC population, making it a valuable resource for future BC research.

Abstract PO-028: One piece of the jigsaw for the cancer recovery strategy: Prevalence of COVID-19 in patients with cancer

Abstract Background: COVID-19 has forced governments to make drastic changes to the health care system. While these may have reduced COVID-19 morbidity/mortality, there have been unintended consequences on society and non-COVID-19 health issues. Although initial data start to inform us how to care for cancer patients during COVID-19, there is as yet no long-term follow-up. To start making informed decisions about cancer care, it is crucial to understand the scale of COVID-19 infection in cancer patients. Therefore, we introduced swab testing for patients visiting Guy’s Cancer Centre. Methods: Our Centre in South-East London treats approximately 8,800 patients annually (including 4,500 new diagnoses) and is one of the largest Comprehensive Cancer Centres in the UK at the epicenter of the UK COVID-19 epidemic. The first COVID-19-positive cancer patient was reported on 29 February, 2020. Until 30 April, 2020, a COVID-19 swab was ordered for cancer patients with symptoms necessitating hospitalization or if they were scheduled to undergo a cancer-related treatment. From 1 May, 2020, COVID-19 testing was introduced as standard of care, with about 25% of patients being swabbed daily depending upon staff and testing kit availability. We analyzed data from 7-15 May, 2020 for COVID-19 test results in all cancer patients at our Centre. Results: 2,647 patients attended for outpatient, chemotherapy, or radiotherapy appointments from across South East London (and England). Of these, 654 were swabbed for COVID-19 (25%). Over 57% of patients filled out a symptom assessment, and 97% were asymptomatic. Of the patients tested, nine were positive for COVID-19 (1.38%) of whom seven were asymptomatic. Based on data from the Office for National Statistics, between 28 April-10 May, 2020, 0.27% of the community population had COVID-19 (95%CI: 0.17-0.41). However, for those working in patient-facing health care or resident-facing social care roles, this was estimated at 1.33% (95CI%: 0.39-3.28). Nevertheless, London has been the region hardest hit by COVID-19, so the rate of 1.38% among asymptomatic cancer patients, the majority of whom will have been shielding, is likely to be more representative of the local situation. However, this “snapshot” of prevalence is not enough for an evolving situation. Conclusion: Cancer service providers will need to understand their local cancer population prevalence and keep this under regular review. The absolute priority is that cancer patients have the confidence to attend hospitals and be reassured that they will be treated in a COVID-19-managed environment. Citation Format: Charlotte Moss, Beth Russell, Mary Lei, Sharmista Ghosh, Sophie Papa, Richard Sullivan, Mieke Van Hemelrijck, Anne Rigg, Guy's Cancer Real World Evidence Programme. One piece of the jigsaw for the cancer recovery strategy: Prevalence of COVID-19 in patients with cancer [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-028.

How do users of a ‘digital-only’ contraceptive service provide biometric measurements and what does this teach us about safe and effective online care? A qualitative interview study

ObjectivesTo describe user experience of obtaining and uploading biometric measurements to a ‘digital-only’ contraceptive service prior to a prescription for the combined oral contraceptive (COC). To analyse this experience to...

Racial burdens, translations, and chance

Racial burdens, translations, and chance

The influence of 2020 coronavirus lockdown on presentation of oral and maxillofacial trauma to a central London hospital

The novel coronavirus COVID-19 was first identified in China in December 2019. Its spread resulted in a pandemic, with the United Kingdom entering a period of national lockdown on 23 March 2020 to reduce disease burden on the National Health Service (NHS). King’s College Hospital is a Major Trauma Centre serving an inner-city population of 700,000 with 120,000 patients attending the emergency department (ED) annually. We aimed to determine the effect of lockdown on OMFS trauma presentations and lessons learned from emergency service provision during a pandemic. All referrals to the oral and maxillofacial surgical (OMFS) team from ED during the first six weeks of the lockdown period – 23 March 2020 - 3 May 2020 – were compared with the same six-week period in 2019. A total of 111 referrals were made to OMFS during the first six weeks of the lockdown period in 2020 compared with 380 referrals in 2019. Of these, 50.5%, (n=192) were related to facial trauma in 2019 vs (63.1%, n=70) in 2020. Fewer patients were admitted under OMFS: 17.4% (n=35) in 2019 vs 2.9% (n=2) in 2020, and a greater number of patients were discharged from OMFS care directly from the ED: 63.2% (n=127) in 2019 vs 82.9% (n=58) in 2020. There was profound effect of the lockdown on referrals to OMFS from the ED, in number and type of diagnosis. This is potentially reflective of the increased availability of acute/emergency dental services in South-East London during the lockdown period. This gives us valuable insight for service planning in the event of further restrictions.

Dementia in People from Ethnic Minority Backgrounds: Disability, Functioning, and Pharmacotherapy at the Time of Diagnosis

ObjectivesIncreasingly, older populations in the United Kingdom and other well-resourced settings are ethnically diverse. Despite a concern that the prevalence of dementia is expected to rise, very little is known about the association of ethnicity and dementia among aging older adults. The current study aimed to compare ethnic group differences in symptom profile, functioning and pharmacotherapy at dementia diagnosis. DesignCross-sectional study of patient characteristics at the point of dementia diagnosis. Setting and ParticipantsIn total, 12,154 patients aged 65 years or older diagnosed with dementia in Southeast London between 2007 and 2015. MethodsData were extracted from the Clinical Record Interactive Search system, which provides anonymized access to the electronic health records of a large mental healthcare provider in Southeast London. Patients from ethnic minority backgrounds were compared with white British individuals on mental and physical well-being, functional scales and medications prescribed at dementia diagnosis, as well as subtype of dementia documented anywhere in the record. ResultsCompared with white British patients, Black African and Black Caribbean patients were more likely to present with psychotic symptoms and were less likely to have an antidepressant prescribed; white Irish patients had higher rates of substance/alcohol use and depressive symptoms were more prevalent in South Asian patients; all ethnic minority groups had higher odds of polypharmacy; and vascular dementia diagnoses were more common in Black and Irish ethnic minority groups. Conclusions and ImplicationsAt dementia diagnosis, there are substantial differences in noncognitive mental health symptoms and pharmacotherapy across ethnic minority groups and compared with the white British majority population. Some of these differences might reflect access/treatment inequalities or implicit unconscious bias related to ethnicity, influencing both. They need to be taken into consideration to optimize pathways into care and personalize assessment and management.

Capoeira: An exploration of animism and the representation of the spirit through ethnographic animation

This study investigates the relationships between ethnographic study and animation practice, focusing on the Brazilian martial art, capoeira, often referred to as a dance, fight and game. This approach was adopted to explore the ways animation can be placed in relation to both historical and more recent critical theory. A local capoeira community group based in South East London participated in the study for a period of twelve months. The respondents were a combination of teachers and learners, and semi-structured interviews in the form of a conversational style were conducted with several participants. The Capoeira music was composed remotely in collaboration with a capoeira practitioner and a professional berimbau instrumentalist, based in Rio de Janeiro, Brazil. Additional music was recorded in a studio in London by main subject of this study, Professor Saruê. Practice-based investigations are currently in development, consisting of footage recorded on 16 mm black-and-white negative film. Direct animation and scratch film were created using 16 mm black leader and 35 mm film, forming a series of animated experiments. The ethnographic methods later revealed a strong connection between capoeira and the Brazilian religion of Candomblé, and attempts to determine how animation can be used to represent the phenomenon of the spirit. Evaluation and reflection of animation practice revealed a strong relationship between ethnography and animation, a relatively new area with promising developments and scope for further research within visual anthropology. Further research is needed to identify other factors that could strengthen the effectiveness of this methodology. The practice-based components of the overall study revealed the potential for in depth fieldwork, overseas travel and longitudinal study spanning the space of one to two years. This would expand a relatively small yet emerging area of academic research.

Inequalities in referral pathways for young people accessing secondary mental health services in south east London

Differences in health service use between ethnic groups have been well documented, but little research has been conducted on inequalities in access to mental health services among young people. This study examines inequalities in pathways into care by ethnicity and migration status in 12–29 years old accessing health services in south east London. This study analyses anonymized electronic patient record data for patients aged 12–29 referred to a south east London mental health trust between 2008 and 2016 for an anxiety or non-psychotic depressive disorder (n = 18,931). Multinomial regression was used to examine associations between ethnicity, migration status, and both referral source and destination, stratified by age group. Young people in the Black African ethnic group were more likely to be referred from secondary health or social/criminal justice services compared to those in the White British ethnic group; the effect was most pronounced for those aged 16–17 years. Young people in the Black African ethnic group were also significantly more likely to be referred to inpatient and emergency services compared to those in the White British ethnic group. Black individuals living in south east London, particularly those who identify as Black African, are referred to mental health services via more adverse pathways than White individuals. Our findings suggest that inequalities in referral destination may be perpetuated by inequalities generated at the point of access.

Planetary health in practice: sensing air pollution and transforming urban environments

Often, health is seen to be a matter of attending to individuals and their behaviour, or of studying populations in order to manage disease. However, pollution is a problem of the health of environments, as much as it is a problem of the health of bodies. To understand health and pollution, it is necessary to examine energy-intensive infrastructures and developed environments that produce air pollutants and impair ecosystems. In other words, air pollution requires approaches to health that are planetary in scope and that account for the socio-environmental processes and relations that make health possible. Planetary health is often approached as a broad analysis of earth systems. However, diverse and situated environmental practices also contribute to the formation of planetary health. This article asks how citizen-sensing practices tune into the problem of air pollution in Southeast London, and in so doing differently configure pollution and planetary health. While many sensing technologies promise to make citizens into more capable political actors through the collection of data, this research investigates how communities use sensors in distinct ways to support, activate or extend community-led projects in urban environments. Rather than citizen-sensing practices contributing to improved air quality through the abstract circulation of data, we found that environmental monitoring became enmeshed in ongoing and broader struggles to improve the health of urban environments. These practices not only challenge the official scripts of sensing devices, they also remake the usual ways of demarcating health in relation to air pollution by shifting away from individual behaviour and toward collective environmental actions. This article then asks how community proposals for urban design and action conjoin with citizen-sensing practices to generate strategies for reworking and reconstituting health toward more planetary compositions.

Hope’s Work

AbstractThis article, given as the Antipode RGS‐IBG Lecture on 28 August 2019, argues that hope can be found through training an attentiveness to the social world in troubled times. Hope then is an empirical question and a matter of documenting hopeful possibilities that often otherwise remain unremarked upon. In this sense “worldly hope” draws possibilities that are manifested in the social world and stands in contrast to cruel forms of optimism or an unrealistic faith in future progress. An argument for such an approach to hope and trouble is developed through two examples drawn from contemporary London life, namely, the silent walks at Grenfell Tower in West London and a community arts project in Bellingham, South East London.

Pathological Complete Response Rate (pCR) in Patients with Triple Negative Breast Cancer (TNBC) who Received Either Platinum and Taxane Containing Regimen or Taxane Containing Regimen Alone, Along with Anthracyclines: Real Life Results from South East London Accountable Cancer Network

Purpose: To determine the pCR in patients with TNBC according to the neoadjuvant chemotherapy (NACT) they received; taxane-based chemotherapy alone and anthracyclines or taxane-based chemotherapy together with carboplatin and antracyclines.