Funded Travel Grants

Title: Employing skin self-examination and fear of cancer recurrence management in early-stage melanoma follow-up: Evaluation of the MELACARE intervention in a randomised controlled trial

Conference:
11th World Congress of Melanoma (WCM) and 21st EADO Congress 2025, 3rd to 5th of April, Athens, Greece (poster presentation).

Purpose: 
The MELACARE intervention aimed to evaluate a nurse-led follow-up program incorporating SSE education and psychosocial support to address fear of cancer recurrence (FCR) and promote patient empowerment in early-stage melanoma survivors. This study assessed MELACARE’s impact on FCR, psychological well-being, SSE performance, and healthcare usage compared to standard physician-led follow-up.

Methods: 
A two-group randomised controlled trial was conducted at Herlev and Gentofte Hospital, Denmark with 153 melanoma patients (stages IA–IIA). Patients were randomised to either the MELACARE intervention (n=78) or standard physician-led follow-up (n=75). The intervention involved nurse-led sessions focusing on SSE techniques and metacognitive strategies. Key outcomes included FCR, distress, anxiety, depression, health-related quality of life (HRQoL), workability, patient activation, and SSE confidence at six months.

Results: 
At six months, FCR and psychological symptoms decreased in the intervention group, but the differences were not statistically significant. However, patients in the MELACARE group reported significantly improved HRQoL (p=0.02) and patient activation (p=0.003). Confidence in SSE was higher, with most patients performing SSE at recommended intervals.

Conclusions: 
The MELACARE intervention improves HRQoL and patient activation, though it did not significantly reduce FCR or psychological symptoms. The study highlights the potential of structured SSE education and psychosocial support to empower melanoma survivors. Further long-term follow-ups (two and five years) will provide more insights into its lasting impact.

Title: Why Are Patients With Non-Small Cell Lung Cancer in Stage I-IIIA Considered Inoperable? A Registry Study from Denmark.

Conference:
IASLC World Conference on Lung Cancer (WCLC), 06th to 09th of September, 2025, Barcelona, Spain (Poster presentation).

Introduction: 
Surgical resection is the first-line treatment for patients with stage I-IIIA non-small cell lung cancer (NSCLC) when feasible, offering the best chance for long-term survival. However, a significant proportion of patients are deemed inoperable despite technically resectable tumors. The decision to withhold surgery is influenced by multiple factors, including tumor burden, mediastinal lymph node involvement, and patient-specific factors, necessitating a multidisciplinary team (MDT) evaluation to determine the most appropriate strategy.

Methods: 
This retrospective registry-based cohort study included patients diagnosed with NSCLC in stage I-IIIA in the Capital Region of Denmark between January and December 2022. Patients were stratified into "Surgery" and "No Surgery" groups based on treatment records. Data on demographic variables, comorbidities, pulmonary function, performance status, and MDT decisions were extracted from the Danish Lung Cancer Registry and medical records. Logistic regression analyses identified predictors of non-surgical management. The one-year overall survival (OS) rate was estimated using the Kaplan-Meier method. Additionally, preoperative exercise testing was documented.

Results: 
Among 524 patients with NSCLC in stage I-IIIA, 178 (34%) did not undergo surgery. Advanced age (≥ 80 years, OR 1.298), poor performance status (ECOG-PS ≥ 2, OR 1.443), comorbidities (OR 1.116), and stage IIIA disease (OR 1.181) were significantly associated with non-surgical management. The primary reasons for non-operative management in MDT decisions were low pulmonary function or poor performance status (29.2%) and comorbidities (18.0%). Notably, in 19.7% of cases, no justification for "No Surgery" was recorded. Furthermore, preoperative exercise testing was not documented for any patient. One-year OS was 95.7% in the "Surgery" group versus 82.0% in the "No Surgery" group.

Conclusions: 
The findings of this study align with previous research, indicating that patients with stage I-IIIA NSCLC are often deemed inoperable due to comorbidities, poor performance status, or advanced age. A novel insight from this study is its documentation of the rationale for non-operative treatment, as recorded in the MDT decision-making process. Additionally, our findings indicate that exercise testing is not utilized in the assessment process, despite being recommended in current guidelines. The study also suggests a difference in overall survival between operative and non-operative treatment; however, these results should be interpreted with caution due to study limitations. Further research is needed to explore the underlying reasons for treatment decisions. Moreover, future studies could examine whether the implementation of exercise testing, as recommended, may improve the assessment of patients with lung cancer and their surgical eligibility.

Title: Prophylactic Laparoscopic Hyperthermic Intraperitoneal Chemotherapy in locally Advanced Gastric Cancer. Randomized controlled feasibility study: the ProPEC-I Trial.

Conference:
44th Congress of the European Society of Surgical Oncology (ESSO), 15th to 17th of October, 2025, Göteborg, Sweden (Oral and poster presentation).

Introduction: 
The prognosis for advanced gastric cancer (GC) remains poor, only approx. 1/3 of patients are offered curative treatment. Early progression in the peritoneum during preoperative chemotherapy causes a dropout from curative treatment. With peritoneal metastasis (PM) median overall survival is merely 3 months, chemotherapy extends survival, but long-term outcomes remain dismal.
HIPEC shows promise in preventing PM in GC after resective surgery, improving survival. This study is the first prospective, randomized study to investigate the feasibility of laparoscopic HIPEC (LS-HIPEC) in Denmark, and the first in the world to investigate the safety of LS-HIPEC administered before preoperative chemotherapy in GC patients, paving way to investigate the role of LS-HIPEC as prophylaxis against early peritoneal progression.

Methods: 
This randomized feasibility phase I/II study included 14 patients assigned 1:1 to HIPEC or no-HIPEC. The No-HIPEC group received standard treatment with pre- and postoperative chemotherapy and standard D1+ gastrectomy. The HIPEC arm received the ProPEC-I regimen: one cycle of LS-HIPEC with 100 mg/m2 cisplatin at 40°- 41°C administered intraoperatively during evaluating diagnostic laparoscopic exploration, followed by standard treatment. Endpoints included toxicity, morbidity, and Quality of Life. Survival data will be monitored for five years.

Results: 
LS-HIPEC was technically feasible and well tolerated. In the treatment arm, one serious adverse event was reported, though unrelated to the HIPEC procedure. No patients were dropped from curative treatment due to early progression.

Conclusions: 
LS-HIPEC is feasible and safe without delaying treatment. Larger trials are needed to evaluate its impact on survival.

Title: Peri-operative treatment with tranexamic acid (TXA); prognostic and treatment related impact of the plasmin(ogen) pathway in melanoma.

Conference:
Nordic Melanoma Meeting 2025, 10th to 12th of November 2025, Tromsø, Norway (Oral presentation).

Aims:
As a novel approach, we are repurposing tranexamic acid as a perioperative anti-carcinogenic drug, currently investigating its clinical impact on relapse and postoperative complication rates for patients with melanoma.

Materials and Methods: 
The PRIME trial (Perioperative treatment with tranexamic acid in melanoma) is a national randomized controlled trial, within the Danish Melanoma Group. Over an estimated period of three years (2023-2026), we include adults (n=1204) diagnosed with cutaneous melanoma (tumor grade≥T2b) and eligible for sentinel node dissection, to receive either perioperative treatment with tranexamic acid or placebo.
In PRIME-Translational, we conduct a comprehensive analysis of a proportion of these participants (n=250) exploring how melanoma surgery affects molecular pathways of fibrinolysis, inflammation, and the gut microbiome and how perioperative treatment with tranexamic acid impacts prognostic and treatment-related outcomes, aiming to provide a rationale for novel and early targets of therapy for patients with melanoma.
Blood samples are assessed at baseline, 2 hours-, 12 days-, 3, 12, and 24 months or post-surgery or at first relapse, analyzing markers of fibrinolysis (SuPAR, fibrinogen, fibrin D-dimer, t-PA, PAI-1, and fibrinolytic capacity) and inflammation (hs-CRP, differential count, macrophage markers and a wide range and panels of inflammatory cells and cytokines). In addition, we assess fecal samples at baseline, 12 days, 3, and 24 months post-surgery or at first relapse exploring the composition of intestinal microbiome and metabolites.
The markers are associated with known prognostic markers of melanoma (Breslow thickness, presence of ulceration, mitosis), clinical stage (presence of micrometastases), and relapse (local, regional, or systemic).

Perspectives:
In PRIME-translational we will explore the impact of perioperative changes in markers of inflammation, fibrinolysis and the gut microbiome, as well as the underlying mechanisms driving the inflammatory effects of TXA.
The goal is to identify novel and early targets of therapy, ultimately improving current treatments regimens for patients with melanoma.

Title: Optimizing Preoperative Planning for Lymphovenous Anastomosis in Breast Cancer-Related Lymphedema.

Conference:
International Lymphedema Framework Conference 2025 , 23rd to 25th of October, 2025, Niagra Falls (Oral presentation).

Introduction: 
Lymphovenous anastomosis (LVA) is an advanced supermicrosurgical technique that offers a minimally invasive approach to treating breast cancer-related lymphedema (BCRL). The procedure relies on the precise identification of lymphatic vessels and venules for successful anastomosis. Failure to locate suitable structures can compromise patency and reduce surgical success.
While indocyanine green lymphography (ICG-L) has been widely used for lymphatic vessel visualization, it does not provide details on recipient vessels. Ultra-high frequency ultrasound (UHFUS) with a 70 MHz probe and color Doppler presents a potential advancement in preoperative mapping by offering highresolution imaging of small anatomical structures, including subdermal venules. This enhanced visualization may improve surgical precision and overall outcomes.

Aim of the study:
The aim of this study was to assess the feasibility and efficacy of targeted preoperative planning using ICG-L and UHFUS for identifying lymphatic vessels and venules for LVA surgery. Additionally, surgical success was evaluated by comparing the number of planned and performed anastomoses. Secondary outcomes included arm volume, L-Dex score, LVA patency, and health-related quality of life.

Methods: 
This is a prospective pilot study including ten patients undergoing LVA at the Department of Plastic Surgery at Odense University Hospital. Preoperative planning was conducted using ICG-L and UHFUS to identify lymphatic vessels and venules. Patient assessments were conducted at baseline, three-, six-, nine- and twelve months.

Results: 
All ten patients underwent preoperative planning and LVA surgery successfully. On average, 2.2 (±1.03) lymphatic vessels were identified preoperatively, with a 94.2% rediscovery rate during surgery. Similarly, 2.1 (±0.99) venules were planned, and 82.5% were identified intraoperatively. A mean of 2.0 (±0.82) anastomoses were planned, with 81.7% successfully performed. Secondary outcomes are being collected and will be available by April 2025.

Conclusions: 
Optimized preoperative planning using ICG-L and UHFUS has proven to be a feasible and efficient approach, offering high precision with minimal risk or discomfort for patients. This method has also facilitated the transition from general to local anesthesia in our department. By allowing for a precise and targeted approach, this advancement not only improves the safety of the patient but also contributes to a successful and efficient surgical procedure.

Title:
ICG-BREAST-LYMPH (IBL) – Breast cancer related lymphedema (BCRL) and breast reconstruction. An Inter-Regional Observational Study

Conference:
Barcelona Breast Meeting, 20th to 22nd og March 2024, Barcelona, Spain (Oral presentation).

Background:
Surgical treatments are increasingly adopted and gaining popularity for lymphedema treatment. However, challenges persist in selecting appropriate treatment modalities targeted for individual patients and achieving consensus on choice of treatment as well as outcomes.(1–3) The systematic review aimed to address these issues by developing a treatment algorithm based on current scientific evidence. We evaluated and synthesized the evidence on the effectiveness of three surgical treatments for breast cancer-related lymphedema (BCRL): lymphovenous anastomosis (LVA), vascularized lymph node transfer (VLNT), and liposuction.

Method:
We conducted a systematic search of electronic databases on 18 June 2023, including Medline, Embase, Cochrane Library, Google Scholar, and ClinicalTrials.org. Eligible studies were randomized controlled trials, non-randomized comparative studies, and observational studies that assessed the outcomes of LVA, VLNT, or liposuction in managing BCRL. The primary outcome of interest were changes in arm volume, lymphatic flow, and quality of life. Two independent reviewers performed the study selection and data extraction. Following this, we systematically reviewed and conducted a risk of bias assessment. Results were qualitatively presented and a treatment algorithm was developed based on the available data.

Results:
We identified 16,593 papers, after removal of duplicates. Following assessment of studies, 73 articles met the inclusion criteria. We were not able to conduct a meta-analysis due to considerable heterogeneity. Liposuction appears effective for patients presenting with non-pitting lymphedema. LVA indicate variable success rate, with some evidence indicating a reduction in limb volume and symptomatic relief amongst early stages of lymphedema. VLNT showed promising results for limb volume reduction and symptom improvement in patients presenting with mild and moderate lymphedema.

Conclusion:
Liposuction, LVA and VLNT seems to be effective treatments for BCRL, when targeted for the appropriate patient. Well-conducted high evidence clinical studies in the field are still lacking to uncover the efficacy of surgical treatment for BCRL.

Title:
Melacare: nurse-led follow-up after early-stage melanoma – feasibility study

Conference:
SCAPLAS Congress, 12th to14th og June, Helsingfors, Finland (Oral presentation)

Introduction:
We developed the Melacare nurse-led intervention combining management of fear of cancer recurrence (FCR) and skin self-examination (SSE) as a resource-conscious method to detect recurrence in patients with melanoma.

Aims:
This study aims to evaluate the feasibility of the Melacare intervention before a later RCT.

Methods:
In this intervention-only feasibility study, the included patients attended the first 2 nurse sessions of the intervention and were provided an educational booklet. The patients completed patient-reported outcome questionnaires at baseline and before each nurse session. After the intervention had ended, the patients completed a study-specific feedback questionnaire. Feasibility was evaluated in terms of recruitment, adherence, and attendance. The effect of the intervention was also evaluated.

Results:
Fourteen patients were included in the feasibility study, 9 stage IA and 5 stage IB. The attendance and recruitment rates were both 100 % and adherence in terms of completed questionnaires (98 % completion rate) and booklet use (100 % read at least half) was very good. The effect of the intervention showed that all patients felt better at coping with FCR and knew how to perform SSE. Conclusion: This feasibility study demonstrated that the Melacare intervention was feasible and accepted by patients with early-stage melanoma, but it also highlighted some minor issues that we needed to adjust before the commencement of the RCT e.g., the method of recruitment and making both face-to-face consultations and telephone/video consultations an option.

Title:
Free vascularized Fibular Grafting for Reconstruction After Sarcoma in Denmark

Conference:
36th Annual Meeting of the European Musculo-Sceletal Oncology Society 24th EMSOS Nurse and Allied Professions Group Meeting, 12th to 14th of June, Stettin, Poland (Poster presentation).

Background and Objective:
Vascularized fibula grafting following tumor resection is an important component in limb salvage surgery. The purpose of this study was to determine both surgical and oncological outcomes of patients treated in Denmark between 2009 and 2023.

Materials and methods:
We describe a retrospective review of 27 consecutively treated patients who underwent surgery between January 1st, 2009, and November 1st, 2023, at Aarhus or Copenhagen University Hospitals. Patients were identified from the national Danish Sarcoma Database. There were 12 cases of osteosarcoma, 13 cases of Ewing’s sarcoma and 2 cases of giant cell tumor. Mean age at the time of surgery was 15.1 years (range: 2.4-38.9). Mean follow-up was 74.8 months (range: 12-138). Patients were analyzed overall and stratified on basis of tumor location in an upper and a lower extremity group.

Results:
During the follow-up period, 18 patients attained graft union (66.7 %) with a mean time to union of 13.9 months (range: 7-28.5). 6 patients developed nonunion (22.2 %) and 20 patients (74.1 %) had to undergo one or more reoperations in relation to the primary surgery. Patients in the upper extremity group were more likely to attain graft union (91.7 % vs. 46.7 %, RR=5.5, 95 % CI=1.3-31.5, p=0.02) and less likely to undergo multiple reoperations (16.7 % vs 60 %, RR=0.3, 95 % CI:0.1-0.9, p=0.047) compared to patients in the lower extremity group. 6 patients died during follow-up. 5- year overall survival was 81.2 % (95 % CI: 60.5-91.7). 8 patients (29.6 %) experienced relapse with distant metastases. Among these patients, 5 also developed local recurrence (18.5 %). Mean time to metastasis was 10.3 months (range: 1-18) while mean time to local recurrence was 13.2 months (range: 7-17).

Conclusion:
Biological reconstruction with vascularized fibula graft following tumor resection remains a viable option, despite the low rate of graft union and the need for multiple reoperations, particularly in lower extremity cases.

Title:
In-house 3D printed porous implants: in-vivo study of oaaeointegration

Conference:
36th Annual Meeting of the European Musculo-Sceletal Oncology Society 24th EMSOS Nurse and Allied Professions Group Meeting, 12th to 14th of June, Stettin, Poland (Oral presentation).

Introduction:
A collaboration between a 3DP centre in Aarhus University Hospital (AUH)
and the Danish Technological Institute (DTI), allow us to manufacture custom-made 3D metal implant in house. Aim of this study was to assess the osseointegration of 3D-printed titanium implants through a validated randomized animal study.

Methods:
20 stable, non-weight-loaded, 6*10 mm cylindrical implants were 3D printed by
DTI: 10 with a rough and 10 with a smooth surface. Implants were randomized and implanted into the left humerus of 20 skeletally mature sheep. After 4 weeks of observation all sheep were euthanized. The specimens were collected and cut into blokes, each containing an implant and surrounding tissue. Each block was then cut into a 3 mm block for mechanical test, closest to the surgical entry site, and a 6 mm block for future histomorphometrical evaluation. Biomechanical testing was performed as failure by push-out test on an Instron Universal Test Machine.

Results:
Implants with a smooth surface demonstrate complete absence of osseointegration,
as they fall out of the bone during sample preparation. Testing was therefore not possible. Porous implants showed macroscopic integration and breaking point at implant´s surface. We measured a median Ultimate Shear Strength of 0,06 MPa (IQR:1,14), a median Apparent Shear Stiffness of 0,16 MPa/mm (IQR:0,48) and a median Energy Absorption of 19,98 J/m2 (IQR:25,80).

Conclusion:
Our study shows superior osseointegration in 3DP implants with a porous surface.

Title:
RESPONSE: coloRectal cancEr Survivors’ follow-uP care – nOw digital and Need-baSEd. A national interventional trial for stage I and II patients

Conference:
European Survivorship and Rehabilitation Symposium 2024, 9th to 10th of September, Copenhagen, Denmark (Poster presentation).

Introduction:
Due to colorectal cancer (CRC) screening, the number of early stage I-II CRC survivors increases. Their risk of recurrence is low (5-10%), whereas their risk of moderate to severe ‘late adverse effects’ (LAEs) after treatment is much higher (30-50%), including poor health-related quality of life (HRQoL). This is not addressed in the current ‘one-size-fits-all’ follow-up program, which solely focus on recurrence detection. Thus for 90-95% of stage I-II CRC survivors, today’s program is irrelevant. To balance their low recurrence risk against their need for support due to LAEs, we aim to develop an improved follow-up program and compare it to standard-of-care.

Methodology:
The RESPONSE follow-up program includes 1) circulating tumor DNA guided recurrence detection; 2) identification of LAEs with digital assessment of Patient Reported Outcomes (PROs); 3) standardised treatment of LAEs; and 4) a smartphone app to guide the patient through the program. The new program will be compared to standard-of-care in a national multicentre two-armed intervention effectiveness trial, including 200 survivors in each arm. All stage I-II CRC patients >18 years, who have received curative surgery, are eligible. The primary outcome is difference in EORTC-QLQ-C30 global scores 3-years post-surgery. Secondary outcomes include differences in fear-of-cancer-recurrence, severity of LAEs, overall survival, and health care costs measured in QUALY.

Results:
Circulating tumor DNA markers for recurrence detection have been developed and validated. A smartphone app to guide follow-up is currently evaluated in a pilot study. RESPONSE inclusion begins 01-06-24.

Conclusion:
The results from RESPONSE will be used to qualify the future follow-up program for patients with stage I-II CRC in Denmark. We expect our study to facilitate a shift in survivorship care from recurrence monitoring only to an increased awareness of LAEs, which we hypothesize will improve HRQoL, without compromising overall survival or increasing health care costs.