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BMJ Open Is Committed to Open Peer Review. As Part of This Commitment We Make the Peer Review History of Every Article We Publish Publicly Available BMJ Open: first published as 10.1136/bmjopen-2020-044854 on 7 April 2021. Downloaded from BMJ Open is committed to open peer review. As part of this commitment we make the peer review history of every article we publish publicly available. When an article is published we post the peer reviewers’ comments and the authors’ responses online. We also post the versions of the paper that were used during peer review. These are the versions that the peer review comments apply to. The versions of the paper that follow are the versions that were submitted during the peer review process. They are not the versions of record or the final published versions. They should not be cited or distributed as the published version of this manuscript. BMJ Open is an open access journal and the full, final, typeset and author-corrected version of record of the manuscript is available on our site with no access controls, subscription charges or pay-per-view fees (http://bmjopen.bmj.com). If you have any questions on BMJ Open’s open peer review process please email [email protected] http://bmjopen.bmj.com/ on October 1, 2021 by guest. Protected copyright. BMJ Open BMJ Open: first published as 10.1136/bmjopen-2020-044854 on 7 April 2021. Downloaded from Processes of care and survival associated with treatment in specialist teenage and young adult cancer centres: results from the BRIGHTLIGHT cohort study ForJournal: peerBMJ Open review only Manuscript ID bmjopen-2020-044854 Article Type: Original research Date Submitted by the 16-Sep-2020 Author: Complete List of Authors: Fern, Lorna; University College London Hospitals NHS Foundation Trust, Oncology Taylor, Rachel; University College London Hospitals NHS Foundation Trust, Centre for Nurse, Midwife and AHP Led Research (CNMAR) Barber, Julie; University College London, Department of Statistical Science Alvarez-Galvez, Javier; University of Cadiz, Department of Biomedicine, Biotechnology and Public Health Feltbower, Richard; University of Leeds, Lea, Sarah; University College London Hospitals NHS Foundation Trust Martins, Ana; University College London Hospitals NHS Foundation Trust, Cancer Clinical Trials Morris, Stephen; University of Cambridge, Primary Care Unit http://bmjopen.bmj.com/ Hooker, Louise; University Hospital Southampton NHS Foundation Trust, Wessex Teenage and Young Adult Cancer Service, Gibson, Faith; University of Surrey, Faculty of Health and Medical Sciences; Great Ormond Street Hospital For Children NHS Foundation Trust, Raine, Rosalind; University College London, Institute of Epidemiology & Health Stark, Dan; University of Leeds, Leeds Insitute of Molecular Medicine Whelan, Jeremy; University College London Hospitals NHS Foundation on October 1, 2021 by guest. Protected copyright. Trust, Organisational development < HEALTH SERVICES ADMINISTRATION & Keywords: MANAGEMENT, Quality in health care < HEALTH SERVICES ADMINISTRATION & MANAGEMENT, ONCOLOGY For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 1 of 25 BMJ Open 1 2 3 4 5 BMJ Open: first published as 10.1136/bmjopen-2020-044854 on 7 April 2021. Downloaded from 6 7 8 9 I, the Submitting Author has the right to grant and does grant on behalf of all authors of the Work (as defined 10 in the below author licence), an exclusive licence and/or a non-exclusive licence for contributions from authors 11 who are: i) UK Crown employees; ii) where BMJ has agreed a CC-BY licence shall apply, and/or iii) in accordance 12 with the terms applicable for US Federal Government officers or employees acting as part of their official 13 duties; on a worldwide, perpetual, irrevocable, royalty-free basis to BMJ Publishing Group Ltd (“BMJ”) its 14 licensees and where the relevant Journal is co-owned by BMJ to the co-owners of the Journal, to publish the 15 Work in this journal and any other BMJ products and to exploit all rights, as set out in our licence. 16 17 The Submitting Author accepts and understands that any supply made under these terms is made by BMJ to 18 the Submitting Author Forunless you peer are acting as review an employee on behalf only of your employer or a postgraduate 19 student of an affiliated institution which is paying any applicable article publishing charge (“APC”) for Open 20 Access articles. Where the Submitting Author wishes to make the Work available on an Open Access basis (and 21 intends to pay the relevant APC), the terms of reuse of such Open Access shall be governed by a Creative 22 Commons licence – details of these licences and which Creative Commons licence will apply to this Work are set 23 out in our licence referred to above. 24 25 Other than as permitted in any relevant BMJ Author’s Self Archiving Policies, I confirm this Work has not been 26 accepted for publication elsewhere, is not being considered for publication elsewhere and does not duplicate 27 material already published. I confirm all authors consent to publication of this Work and authorise the granting 28 of this licence. 29 30 31 32 33 34 35 36 37 http://bmjopen.bmj.com/ 38 39 40 41 42 43 44 45 on October 1, 2021 by guest. Protected copyright. 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 2 of 25 1 2 3 Processes of care and survival associated with treatment in specialist teenage and young 4 adult cancer centres: results from the BRIGHTLIGHT cohort study 5 BMJ Open: first published as 10.1136/bmjopen-2020-044854 on 7 April 2021. Downloaded from 6 7 Lorna A Fern PhD, Rachel M Taylor PhD, Julie A Barber PhD, Javier Alvarez Galvez PhD, 8 Richard Feltbower PhD, Sarah Lea PhD, Ana Martins PhD, Steve Morris PhD, Louise Hooker 9 MSc, Faith Gibson PhD, Rosalind Raine PhD, Dan P Stark MD, Jeremy S Whelan MD 10 11 12 13 Lorna Fern, Teenage and Young Adult Cancer Researcher and Patient/Public Involvement 14 Lead, Cancer Division, University College London Hospitals NHS Foundation Trust, London 15 NW1 2PG 16 17 18 Rachel Taylor, DirectorFor of the peer CNMAR, Centrereview for Nurse, Midwifeonly and AHP Led Research 19 (CNMAR), University College London Hospitals NHS Foundation Trust, London NW1 2PG 20 21 Julie Barber, Associate Professor in Medical Statistics, Department of Statistical Science, 22 23 University College, London WC1E 6BT 24 25 Javier Alvarez-Galvez, Research Fellow, Department of Biomedicine, Biotechnology and 26 Public Health, University of Cadiz, Avda. Ana de Viya, 52, 11009 Cádiz, Spain 27 28 Richard Feltbower, Senior Lecturer in Epidemiology, Leeds Institute for Data Analytics, 29 30 School of Medicine, University of Leeds, Leeds, LS2 9JT. 31 32 Sarah Lea, Research Facilitator, Cancer Division, University College London Hospitals NHS 33 Foundation Trust, London NW1 2PG 34 35 36 Ana Martins, Research Associate, Cancer Division, University College London Hospitals 37 NHS Foundation Trust, London NW1 2PG http://bmjopen.bmj.com/ 38 39 Steve Morris, Professor of Health Economics, Primary Care Unit, Department of Public 40 41 Health and Primary Care, University of Cambridge, United Kingdom 42 43 Louise Hooker, teenage Cancer Trust Lead Nurse, Wessex Teenage and Young Adult 44 Cancer Service, University Hospital Southampton, Southampton, SO16 5YA 45 on October 1, 2021 by guest. Protected copyright. 46 47 Faith Gibson, Professor of Child Health and Cancer Care, School of Health Sciences, 48 Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey GU2 7XH 49 and Centre for Outcomes and Experience Research in Children’s Health, Illness and 50 Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, 51 London WCIN3JH 52 53 54 Rosalind Raine, Professor of Health Services research, Department of Applied Health 55 Research, Director, NIHR CLAHRC North Thames, NIHR Senior Investigator, University 56 College London, London WC1E 7HB 57 58 59 Dan Stark, Professor of Teenage and Young Adult Cancer Research and Consultant 60 Medical Oncologist, Leeds Institute of Medical Research at St James's, Leeds LS9 7TF 1 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 3 of 25 BMJ Open 1 2 3 4 Jeremy Whelan, Professor of Cancer Medicine, Cancer Division, University College London 5 BMJ Open: first published as 10.1136/bmjopen-2020-044854 on 7 April 2021. Downloaded from 6 Hospitals NHS Foundation Trust, London NW1 2PG 7 8 Correspondence: Dr Rachel Taylor, [email protected] 9 10 Keywords: BRIGHTLIGHT, teenagers and young adults, cancer, observational research, 11 12 cohort, outcome, survival 13 14 Abstract = 297/300 15 Word count = 3,536 16 17 Number of Tables = 6 18 Number of Figures For= 1 peer review only 19 20 21 ABSTRACT 22 23 24 Objective: Survival gains in teenagers and young adults (TYA) are reported to be lower than 25 children and adults for some cancers. Place of care is implicated, influencing access to 26 specialist TYA professionals and research. Consequently, age-appropriate specialist cancer 27 28 care is advocated for TYA although systematic investigation of associated outcomes is 29 lacking. In England, age-appropriate care is delivered through 13 Principal Treatment 30 Centres (TYA-PTC). BRIGHTLIGHT is the national evaluation of TYA cancer services to 31 examine outcomes associated with differing places and levels of care. We aimed to examine 32 the association between exposure to TYA-PTC care, survival and documentation of clinical 33 34 processes of care. 35 36 Design: Prospective cohort study 37 http://bmjopen.bmj.com/ 38 Setting: 109 National Health Service (NHS) hospitals across England 39 40 41 Participants: 1,114 TYA, aged 13-24, newly diagnosed with cancer between 2012-2014 42 43 Intervention: Participants were assigned a TYA-PTC category dependent on the proportion 44 45 of care delivered in a TYA-PTC in the first year after diagnosis: all care in a TYA-PTC (ALL- on October 1, 2021 by guest.
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