Patient engagement in designing and publishing research in prostate cancer: a scoping review

Abstract

Patients with cancer have the unique ability of being able to offer valuable insights into how cancer therapeutics may impact the overall patient experience and improve clinical outcomes. Patient engagement could therefore contribute to tailoring treatment strategies and research design according to patient needs. This study evaluated patient engagement in prostate cancer research by identifying patient input in the prostate cancer literature. We performed a keyword cluster analysis of articles from multiple databases and congresses in which patients provided input on disease management or were involved in study design, manuscript authorship or presentation of results (patient voice). In total, 112 studies were included. Patients were involved in the design of 11 studies and were credited as authors in four studies. This review suggests a lack of meaningful patient involvement in prostate cancer research and publications.

Plain language summary

Patients with cancer have first-hand knowledge of what does and does not work for their care. Therefore, their voice is valuable to help improve treatment and guide research. Our goal was to find prostate cancer articles with patient input. We searched databases using keywords related to patient voice. We looked for articles involving patients in designing, writing or presenting the study. Only four out of the 112 articles we identified were published in journals focused on involving patients. Eleven articles involved patients in designing the study. Four articles involved patients in writing the published work. Overall, we did not find many articles where patients had a meaningful role in the study. Prostate cancer treatment and research will likely benefit from more patient input.

Executive summary

Background

• Prostate cancer patients have first-hand experience with their disease and various prostate cancer treatments.

• Therefore, they have a unique perspective and a valuable voice to help guide clinical cancer research.

• Objective: To conduct a scoping review in which keywords related to patient voice (i.e., input from patients on their prostate cancer treatment and management) were used to identify studies in which prostate cancer patients were involved in study design, manuscript authorship or presentation of results.

Methods

• The scoping review included studies that:

  • focused on patients with any stage of prostate cancer

  • were published in English

  • were related to input from patients on their prostate cancer treatment

• Animal studies and articles published before 2016 were excluded.

• The scoping review included studies from the following sources:

  • Embase

  • MEDLINE

  • Cochrane Library

• Search criteria

  • Search strings contained combinations of free text and MeSH terms related to prostate cancer.

  • The search was performed on 11 November 2021.

• Keyword cluster analysis and random selection

  • Out of 2224 relevant articles retrieved, 500 articles were randomly selected for search against eligibility criteria.

• Supplementary searches

  • Multiple congresses were searched.

  • Search dates: January 2019 to March 2022

    • American Society of Clinical Oncology

    • ASCO Genitourinary Cancers

    • American Urological Association

    • European Association of Urology

    • European Society for Medical Oncology

    • European Urology Oncology

    • Journal of the Advanced Practitioner in Oncology

    • Oncology Nursing Society

    • Society of Urologic Nurses and Associates

• The following information was extracted from each eligible article:

  • Authors

  • Title

  • Year of publication

  • Type of article

  • Study objectives and methods

  • Study outcomes

  • Patient involvement in prostate cancer research

  • Treatment and management

Results

• Following full-text review and supplementary searches, 112 relevant articles were identified for further review (76 from the main searches after randomization and 36 from supplementary searches).

• 52 were published papers, 55 were congress abstracts and five were oral presentations.

• Only 11 studies included patients involved in study design.

• Only four studies included patients as authors.

• Thirteen studies focused on racial differences in prostate cancer treatment.

Discussion

• This scoping review provides an overview of the literature between 2016 and 2021 on patient involvement in prostate cancer research.

• Our findings indicate a lack of involvement of patients in study design and authorship during this time period, and highlight an unmet need for increased patient participation in prostate cancer research.

Keywords: :

• patient-reported outcomes
• patient authorship
• patient engagement
• patient involvement
• patient participation
• prostate cancer
• prostate neoplasm

Shared decision-making between patients and their healthcare providers has the potential to improve clinical outcomes [1] by enabling patients to communicate experiences that have significantly impacted their healthcare journey. People with cancer generally want to be involved in decisions about their healthcare [^2-5], and their engagement with treatment decision-making can improve healthcare outcomes and treatment satisfaction [6,7]. In a wider context, patient engagement contributes to research through patient reports of the perceived advantages and disadvantages linked to different treatments. Patient engagement in research is being encouraged by medical journals and this is empowering patients through their involvement and opportunity to author medical articles. Most importantly, patient involvement ensures that research is directly pertinent to patients' needs and concerns, thereby bringing tailored changes to research design and improving the translation of research findings to clinical practice [8].

In an effort to facilitate patient engagement with published research, there has been an increasing demand from publishers and the clinical community for communications that describe research findings in a way that is understandable to nonspecialist audiences (e.g., plain language summaries, infographics and video abstracts) [4]. Several journals now specify an interest in patient centricity within their aims and scope, with some encouraging greater involvement of patients as authors and peer reviewers [9,10]. In addition, the fourth iteration of the Good Publication Practice (GPP 2022) highlights the importance of patient involvement in publication planning and authoring [11].

Prostate cancer is the second most frequently diagnosed malignancy in men worldwide, after lung cancer [12]. Prostate cancer and its treatment can have a life-changing effect on health-related quality of life, including, but not limited to, urinary and sexual dysfunction, depleted energy/vitality, increased anxiety and depression and impaired performance in physical and social tasks [13,14]. The impact of prostate cancer depends not only on the stage of disease but also on patient-related factors such as race, age and family/social support. As such, input from patients on research relating to their treatment is expected to provide a useful contribution to the prostate cancer research landscape. Despite the importance and potential benefits of patient involvement in prostate cancer research, little is known about the nature and extent of their engagement in this field, particularly in relation to their treatment, research study design, manuscript authorship or presentation of results. To the best of our knowledge, this has not yet been methodically assessed or reviewed.

The aim of the present review was to identify studies in which prostate cancer patients or patient advocacy groups were involved in study design, manuscript authorship or presentation of results by conducting a scoping review [15] using keywords related to patient voice. We focused on study design and involvement in manuscript preparation since these stages represent the beginning and the end of the timeline of clinical knowledge generation, respectively, while manuscript authorship is reflected across all points on the continuum.

Methods

Scoping review process

We analyzed occurrences of publication keywords provided by authors (a keyword cluster analysis) to visualize intersections in keyword occurrences across different published articles, and thereby identify themes in patient-centered prostate cancer research (Figure 1). Given the lack of standard keywords and Medical Subject Heading (MeSH) terms relating to patient-centered prostate cancer research, a keyword cluster analysis broadened our search for literature documenting patient engagement. We then conducted a literature review of a randomly selected shortlist of 500 articles according to the main themes identified in the keyword cluster analysis using the randomization function in Microsoft Excel. This allowed for a more manageable number of papers to be analyzed. The review was performed in accordance with the 2018 Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) adaptation for scoping reviews (PRISMA-ScR) [16].

Figure 1. Scoping review process.

Eligibility criteria

Included studies focused on patients with any stage of prostate cancer and were not restricted by intervention, comparator(s) or country. English language publications of research articles, narrative reviews and systematic reviews were included. Animal studies and studies published in full before 2016 were excluded to provide a contemporary analysis reflecting current practice and the evolving nature of patient involvement within the literature. The outcomes of interest were any data relating to input from patients on their prostate cancer treatment and management (defined as ‘the patient voice’ for this analysis), and data relating to whether and how patients were engaged in study design, manuscript authorship or presentation of results, as ascertained by the reviewer. Patient authorship was identified where explicitly stated in the article. Articles without patient involvement in authorship or study design, and articles that did not report or discuss patients' input regarding their treatment, were excluded as irrelevant.

Publications were identified by electronic searches of Embase, MEDLINE (In-Process and Other Non-Indexed Citations; Ovid MEDLINE) and Cochrane Library (Cochrane Database of Systematic Reviews; Database of Abstracts of Reviews of Effects; Cochrane Central Register of Controlled Trials; Cochrane Methodology Register; NHS Economic Evaluations Database; Health Technology Assessment Database; American College of Physicians Journal Club). Search strings were combinations of free text and MeSH terms relating to prostate cancer, combined with terms relating to patient involvement (see supplementary information for search strings; Supplementary Tables 1–3). Electronic searches were run on 11 November 2021, downloaded into Endnote (Clarivate Analytics, PA, USA), and deduplicated before eligibility screening.

Keyword cluster analysis & random selection

The titles of all articles identified in the electronic searches were screened by a single reviewer to exclude all irrelevant articles from the keyword cluster analysis. Article keywords and terminology co-occurrences were assessed to identify keyword clusters. Findings from the cluster analysis were used to inform the process of randomization and selection of 500 articles for full-text review against the eligibility criteria.

Supplementary searches

The electronic database searches were supplemented with searches of the following congresses from January 2019 to March 2022: American Society of Clinical Oncology (ASCO), American Urological Association (AUA), ASCO Genitourinary Cancers, European Association of Urology (EAU), European Society for Medical Oncology (ESMO), European Urology Oncology, Journal of the Advanced Practitioner in Oncology, Oncology Nursing Society and Society of Urologic Nurses and Associates. We also conducted searches of the bibliography sections of identified studies for further relevant articles. Articles identified by supplementary search strategies were added to the shortlist of eligible publications for data extraction.

Data extraction

Articles identified as relevant following the main and supplementary searches were included for data extraction. Data were extracted into a tailored data extraction table in Microsoft Excel. The following information was extracted from each eligible article: authors, title, year of publication, type of article, study objectives and methods, study characteristics, patient characteristics, reported outcomes, patient involvement in prostate cancer research and treatment and management.

Results

Included studies

Initial searches of electronic databases returned a total of 5706 articles published between January 2016 and November 2021, with 3482 irrelevant articles excluded by title screening (Figure 2). The remaining 2224 articles were included for keyword cluster analysis. We observed five major themes (clusters) in the literature landscape: patient perspectives of prostate cancer treatment, current and historical surgical treatment options, radiotherapy-related outcomes, prostate cancer treatment patterns and patient demographics and prognoses in prostate cancer (Figure 3).

Figure 2. Flow chart illustrating the process of identification and shortlisting of articles.

Figure 3. Keyword cluster analysis.

Assessment of keyword co-occurrences in the cluster analysis showed that keywords in the patient demographics and prognoses cluster were less connected to those in the remaining clusters. Additionally, unlike the other clusters, studies in this cluster were not focused on prostate cancer treatment or treatment outcomes and were least likely to focus on patients' engagement in their treatment journey. Consequently, the patient demographics and prognoses cluster was thought to be the least relevant for the scoping review and excluded from further analysis. Therefore, 125 articles were randomly selected from each of the remaining clusters using the randomization function in Microsoft Excel, resulting in a total of 500 articles for full-text review. This was deemed a manageable number of articles to analyze that would at the same time yield meaningful conclusions.

Following full-text review and supplementary searches, we identified 112 relevant articles (76 from the main searches after randomization and 36 from supplementary searches) for further review (Figure 2).

Study characteristics

Of the 112 included studies: 52 were published manuscripts, 55 were congress abstracts and five were oral presentations (Supplementary Table 4). With regard to study location, 42 were from the USA, ten from Canada, nine from the UK, six from Australia, six from Germany, five from the Netherlands, three from Japan, three from Sweden, two from Denmark and one each from Norway, South Africa, South Korea, Spain and Switzerland; ten articles reported results from multiple countries and 11 did not report a study location (Figure 4). Overall, 58 of the identified studies were observational, 37 were cross sectional, six were randomized controlled trials and three were systematic reviews. The remaining eight studies were an epidemiological study, a case study, a peer support program, a feasibility assessment and randomized controlled trial, a Delphi consensus and randomized controlled trial, a patient survey and literature review, an iterative design process and a presentation by a cancer survivor and patient advocate (Supplementary Table 4).

Figure 4. Study locations.

^†11 articles did not report a study location. The study locations map is based on the 500 articles randomly selected from the list of eligible studies and may not capture all of the countries producing research with patient involvement.

All included articles covered various topics relating to the patient voice in prostate cancer treatment and management. Most of the identified studies were published in oncology-focused (n = 57) or urology-focused (n = 33) journals; four studies were published in journals that focus on patient education or participation (three in Patient Education and Counselling and one in Health Expectations). Of the full-text publications, 36 were published in open-access journals and 45 were published in journals with an impact factor of three or higher, suggesting high citation rates within the patient-centric prostate cancer research publication landscape (Supplementary Table 4).

Only 11 studies engaged patients in study design (Table 1) [^17-27]. Of these, four were abstracts presented at AUA 2019, ESMO 2020 and EAU 2021, two were oral presentations by patients at the EAU 2021 congress and one was an abstract published in the Journal of Urology. Of the remaining five full-text publications, two were published in the American Journal of Men's Health, which is associated with the Men's Health Network, and one was published in the Journal of Medical Internet Research, which focuses on patient-centered approaches in cancer care. The other two full-text publications with patients involved in study design were published in BMC Health Services Research and IEEE Transactions on Visualisation and Computer Graphics, neither of which include patient centricity in their aims and scope.

Table 1. Patient involvement in study design.

Study (year)	Patient involvement details as ascertained by reviewer	Ref.
Chhatre et al. (2020)	Prostate cancer patients provided input on the treatments that they found most useful and would be most likely to share with other patients making treatment decisions	[17]
Clarke et al. (2019)	The authors thanked the patient representatives who participated in data analysis	[18]
Deschamps et al. (2020)	Europa Uomo, the patient organization for men with prostate cancer in Europe, initiated a unique patient-driven QoL study with the aim of providing a patient-driven prognosis after treatment	[19]
Griesser et al. (2021)	Peer support training program coordinated with patients, who took a leading role with supporting/engaging conversations and training of volunteers	[20]
Hakone et al. (2017)	Personalized health risk communication tool (PROgnosis Assessment for Conservative Treatment) designed in consultation with prostate cancer survivors	[21]
McCaughan et al. (2020)	Prostate cancer patients provided input on the usefulness of a tablet-based Engagement, Assessment, Support and Sign-Posting (EASSi) tool with the aim of addressing barriers to sexual well-being discussions with healthcare providers	[22]
Morgans et al. (2022)	Survey of prostate cancer patient experiences, expectations and attitudes conducted in collaboration with patient organizations	[23]
Nakayama et al. (2018)	Draft questionnaire reviewed and modified by ten patients and five physicians. A qualitative pre-study test run was then performed by 25 patients to check the quality of the draft questionnaire	[24]
Nayak et al. (2018)	Patient focus groups provided input on syntax and formatting of draft patient-centered pathology reports	[25]
Sammon et al. (2019)	Treatment decision aid designed with patient input	[26]
Venderbos et al. (2021)	Europa Uomo initiated a unique patient-driven QoL study with the aim of providing a patient-driven prognosis after treatment	[27]

QoL: Quality of life.

Patients met authorship eligibility criteria in only four studies (Table 2) [17,^28-30]. One study engaged patients in both study design and authorship [17]. All the articles authored or co-authored by patients were published after 2020. In the four articles with patient authors, three were full-text articles and one was an oral presentation by a patient describing how patients can support empirical data and strengthen cancer research. Of the three full-text articles, one was published in the American Journal of Men's Health and assessed factors affecting information-seeking activities by patients with localized prostate cancer. Another was published in Oncology and Therapy and included the perspectives of the patient, the physician and the clinical nurse specialists with accompanying digital content (including a summary slide to facilitate understanding of the article). The third full-text article, a plain language patient perspective of a randomized controlled trial, was published in Future Oncology.

Table 2. Patient involvement in authorship.

Study (years)	Patient involvement details as ascertained by reviewer	Ref.
Chhatre et al. (2020)	Prostate cancer patients were interviewed, and their responses were transcribed and used verbatim	[17]
Collier et al. (2020)	Article co-authored by a patient with metastatic hormone-sensitive prostate cancer who is receiving abiraterone and androgen deprivation therapy in Manchester, UK	[28]
Fizazi et al. (2021)	Plain language summary co-authored by two patients who had participated in study, complementary to main publication of the RCT	[29]
Geissler et al. (2021)	An oral presentation by a cancer survivor and patient advocate	[30]

RCT: Randomized controlled trial.

In total, 16 journals, in which 30 of the identified studies were published, report an interest in patient-centric research in their aims and scope. Despite this, only six of the 30 studies involved patients in study design (n = 3) or authorship (n = 3). Additionally, only three journals (European Urology, Future Oncology and Oncology and Therapy), in which seven articles identified in this review were published, included plain language summaries or digital content alongside the published articles. Only one of these articles included a patient author and none involved patients in study design.

The patient voice in prostate cancer treatment & management

Topics relating to the patient voice in prostate cancer treatment and management were categorized into the following groups: treatment decision-making (how patients were involved in key decisions about their treatment, n = 40); patient preferences when facing different treatment options (n = 31); unmet needs of patients and their caregivers (n = 16); and patient experiences with their disease and treatment journey (n = 37).

In total, 48 of the 112 included studies covered ‘other topics’ including health literacy, patient financial needs, active surveillance informational needs, patient-perceived causes of their prostate cancer, perceptions about prostate cancer risk and opportunistic screening and patient perspectives on virtual oncology appointments during the COVID-19 pandemic.

Overall, 13 of the included studies focused on the patient voice in relation to racial differences in prostate cancer treatment; 11 of which were conducted in the USA, one in South Africa and one across the USA and the UK (Supplementary Table 5). None of these articles engaged patients in research study design or authorship. Five articles covered the patient voice in treatment decision-making, five discussed patient preferences, four covered unmet needs and six reported on the patient experience with their disease and treatment journey.

‘Other topics’ also included discussion of an initiative to improve the recruitment of Black men with prostate cancer in clinical trials, a comparison of community health worker- and physician-led educational sessions for prostate cancer screening, patient perceptions about prostate cancer screening, racial differences in access to prostate cancer care and racial differences in the perceptions of feasibility and value of an electronic patient-reported outcome tool.

Patient involvement in prostate cancer study design, authorship & presentation of results

Of 11 studies in which patients participated in the study design, two reported data from a patient-driven quality of life study supported by Europa Uomo, a patient organization for men with prostate cancer in Europe (Table 1) [^17-27]. In another study, which looked at the implementation of a prostate cancer-specific holistic needs assessment, patient representatives participated in data analysis. Among the remaining studies, patients were usually involved in design, review and modification of surveys and questionnaires.

Among the four studies with patient authors, one case study related a patient's personal experiences with diagnosis and treatment of prostate cancer, and the physical, emotional and psychosexual impacts of prostate cancer on his life. In the other publications with patient authors: a patient and a physician described how qualitative empirical data from patients can strengthen cancer research in a presentation at ESMO 2021; patients summarized the results of a randomized controlled trial in collaboration with a physician who was involved in the trial; and one study was supported by the Patient-Centered Outcomes Research Institute (PCORI; an independent research organization that facilitates patient engagement by including patients throughout the research process).

Notably, 17 of the congress abstracts and oral presentations that were identified in our original search have subsequently been published as articles (Supplementary Table 6).

Discussion

Following review of 500 articles randomly selected from publications identified in electronic database searches and supplementary searches, 112 studies were found to cover various issues related to the patient voice, across five main themes: patient involvement in decision-making, patient experiences, patient preferences, unmet needs and other topics. We found no clear trends in patient-centric studies over the 5 years studied in the current analysis (2016–2021), during a time of rapid evolution in the prostate cancer treatment space and role of the patient voice. However, most articles were open access (freely available for download) and published in journals with a high impact factor, suggesting that patient-centric research is commonly published in highly cited journals. Despite generally being available to the public via open access publication, only three journals (European Urology, Future Oncology and Oncology and Therapy), in which five of the identified articles were published, include plain language summaries or digital content alongside published articles to aid nonspecialist readers. This finding may reflect the relative infancy of patient centricity in medical research. Future studies in this area may show an increase in the proportion of publications with plain language summaries. Notably, only eleven studies engaged patients in study design and only four met patient authorship eligibility criteria, highlighting the limited level of patient involvement in prostate cancer research.

In the USA, the US FDA has prioritized patient engagement, including patient involvement in clinical trial design during product development, patient input into decisions about marketing approval and perspectives on whether safety signals justify restrictive action [31]. Additionally, the Prostate Cancer Research Program (PCRP; the prostate cancer-focused arm of the Congressionally Directed Medical Research Programs) now requires the involvement of patient advocates throughout the research process as a prerequisite for grant approval [32]. In the UK, a government report about the response of the NHS to safety concerns emphasized the need for patient engagement throughout the regulatory lifecycle of medicinal products and devices [33]. Despite the importance of patient involvement in medical research being acknowledged at the governmental level, our study is one of the first to review the literature landscape relating to the nature of patient involvement in prostate cancer research.

The findings of this review regarding the lack of patient involvement in prostate cancer research are consistent with a previous study which found only three articles, out of 344 included for full evaluation, in which there was patient involvement in design and execution of urological research [34]. Although patients may lack the scientific knowledge required to design or review a study, they can provide valuable insights as they have first-hand experience of living with the disease or condition. Despite this, the appetite for patient authorship appears to be lacking in the scientific community; a survey of 112 editors-in-chief of English-language medical journals carried out in 2021 showed that almost a third thought that it was ‘not appropriate’ for patients to be authors or co-authors on published research articles [35]. The reasons given for this response were various and suggested a lack of understanding of patient partnership in research [35]. This survey also found that only 4% of journals have a policy in place that discusses patient author eligibility criteria [35]. Although this survey was not specific to cancer research, the findings are in accordance with the results of this scoping review. To address this issue, the Workgroup of European Cancer Patient Advocacy Networks has developed a course to help patients to assess, plan and publish research in peer-reviewed journals [36].

Owing to the large volume of prostate cancer research and the lack of MeSH terms for patient involvement, this scoping review took a nonsystematic approach to shortlisting articles for full-text review. Following title screening and a keyword cluster analysis, we randomly selected 125 articles from each of four identified clusters to allow for a more manageable number of papers to be analyzed. As such, relevant studies may have been missed during this process. This limitation was partly addressed by a robust supplementary search of relevant congresses from January 2019 to March 2022 which would not have been captured by search strings due to the limitations of MeSH terms and by searches of the bibliography sections of identified studies. Overall, this scoping review provides a snapshot of the literature landscape in this area as opposed to a robust systematic appraisal.

There remains an unmet need for patient involvement in prostate cancer research, which has been acknowledged by the FDA's prioritization of patient engagement and is being addressed by initiatives from organizations such as PCORI and the PCRP. Of note, both initiatives are based in the USA, in line with our finding that most patient-centric prostate cancer research is currently conducted in the USA.

In the USA, prostate cancer mortality is twice as high and has a 60% higher incidence in Black men compared with White men [37]. Despite this, prostate cancer clinical trials have historically consisted of predominantly White patients [38]. Of the 13 identified articles that focused on ethnic or racial differences among patient participants in prostate cancer research, 12 were based in the USA, suggesting that efforts are being made to address racial disparities in this area (Supplementary Table 5). However, inclusion of Black men with prostate cancer in research design and data dissemination remains lacking.

In addition to improving patient engagement in prostate cancer research, guidelines for how patient involvement is reported in associated publications will ensure transparency. We identified a lack of patient authorship in publications of prostate cancer research, which is partly being addressed by recent initiatives by congresses to include patient-led sessions dedicated to patient-centric research, such as the EAU and AUA Patient Poster Sessions.

With the patient voice in research becoming increasingly important, it would be helpful if search engines included keywords and MeSH headings for patient involvement in research design and authorship. This would allow for the use of more robust systematic review methodologies to investigate this topic.

With numerous studies showing that patient engagement with their treatment can improve health outcomes [6,7], and with passive involvement in treatment decision-making leading to unmet expectations and decisional regret [39,40], our scoping review suggests that patient engagement with prostate cancer healthcare and research is insufficient. In addition to a lack of patient authors and involvement in study design, plain language summaries of prostate cancer research articles appear an area of increasing interest but are still not widely offered. Overall, this review suggests that ongoing efforts to engage patients in prostate cancer healthcare and publications should be enhanced.

Conclusion & future perspective

Focused efforts will hopefully lead to increased patient participation in study design and authorship in prostate cancer research. These efforts will likely improve health outcomes in two ways: by more directly immersing patients in learning about their own disease and treatment and by bringing the unique patient voice and perspective to the clinical research endeavor. The rationale for empowering patients to participate in shared decision-making and provide insights into medical care is based on their direct experience with the disease and various treatments. With more patient input, clinical trials will also become more tailored to patient needs. However, the benefits of patient input depend on the drive to include patients in research. In this regard, our study provides an important first step by bringing attention to the lack of patient participation in prostate cancer research over the past several years and highlighting this deficiency as an unmet need.

Author contributions

J Ghith contributed to the conception of the study. All authors contributed to the design of the study and to interpretation of the results. All authors contributed to the drafting of the paper and/or to revising it critically for intellectual content. All authors gave final approval of the version to be published and agree to be accountable for all aspects of the work.

Financial disclosure

T Bognanno received funding from Pfizer Inc. for participation in patient advisory steering groups. O Evuarherhe received funding from Pfizer Inc. for medical writing support for this publication. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Writing disclosure

Medical writing support was provided by G Carter of Oxford PharmaGenesis, Oxford, UK and P Gray and A Anazim of Onyx (a division of Prime, London UK). Editorial support was provided by R Henderson of Onyx. Funding was provided by Pfizer.

Acknowledgments

The authors thank G Carter of Oxford PharmaGenesis, Oxford, UK and P Gray and A Anazim of Onyx (a division of Prime, London, UK) for providing medical writing support, funded by Pfizer.

Competing interests disclosure

J Ghith and G Rodriguez are full-time employees of Pfizer Inc. O Evuarherhe is a full-time employee of Oxford PharmaGenesis. A Morgans has received consultancy honoraria from AAA, Astellas Pharma Inc., AstraZeneca, Bayer, Dendreon, Exelixis, Lantheus, Janssen, Myovant, Myriad Genetics, Novartis, Pfizer Inc., Sanofi and Telix, and research funding from Astellas Pharma Inc., Bayer, Myovant, Pfizer Inc. and Sanofi. L Sutton, M Labriola, S Moneer and L Moore have nothing to disclose. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

J Ghith and G Rodriguez are full-time employees of Pfizer Inc. O Evuarherhe is a full-time employee of Oxford PharmaGenesis. A Morgans has received consultancy honoraria from AAA, Astellas Pharma Inc., AstraZeneca, Bayer, Dendreon, Exelixis, Lantheus, Janssen, Myovant, Myriad Genetics, Novartis, Pfizer Inc., Sanofi and Telix, and research funding from Astellas Pharma Inc., Bayer, Myovant, Pfizer Inc. and Sanofi. L Sutton, M Labriola, S Moneer and L Moore have nothing to disclose.