Journal articles on the topic 'Cancer Treatment Victoria'
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Shih, S., R. Carter, S. Heward, and C. Sinclair. "Costs Related to Skin Cancer Prevention in Victoria and Australia." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 9s. http://dx.doi.org/10.1200/jgo.18.10800.
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Background: The aim of this presentation is to provide an update on the economic evaluation of the Australian SunSmart program as well as outline the cost of skin cancer treatment to the Victorian public hospital system. This follows the publication of two recently released published economic evaluations that discusses the potential effects of skin cancer prevention inventions. Aim: 1. To highlight the cost effectiveness of skin cancer prevention in Australia 2. To highlight the costs of skin cancer treatment in the Victorian public hospital system 3. To provide strong evidence to inform governments of the value of skin cancer prevention to reduce the costs of treatment in future years. Methods: Program cost was compared with cost savings to determine the investment return of the program. In a separate study, a prevalence-based cost approach was undertaken in public hospitals in Victoria. Costs were estimated for inpatient admissions, using state service statistics, and outpatient services based on attendance at three hospitals in 2012-13. Cost-effectiveness for prevention was estimated from 'observed vs expected' analysis, together with program expenditure data. Results: With additional $AUD 0.16 ($USD 0.12) per capita investment into skin cancer prevention across Australia from 2011 to 2030, an upgraded SunSmart Program would prevent 45,000 melanoma and 95,000 NMSC cases. Potential savings in future healthcare costs were estimated at $200 million, while productivity gains were significant. A future upgraded SunSmart Program was predicted to be cost-saving from the funder perspective, with an investment return of $3.20 for every additional dollar the Australian governments/funding bodies invested into the program. In relation to the costs to the Victorian public hospital system, total annual costs were $48 million to $56 million. Skin cancer treatment in public hospitals ($9.20∼$10.39 per head/year) was 30-times current public funding in skin cancer prevention ($0.37 per head/year). Conclusion: The study demonstrates the strong economic credentials of the SunSmart Program, with a strong economic rationale for increased investment. Increased funding for skin cancer prevention must be kept high on the public health agenda. This would also have the dual benefit of enabling hospitals to redirect resources to nonpreventable conditions.
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Hurley, Susan F., Patricia M. Livingston, Damien J. Jolley, and Stewart A. Hart. "PATTERNS OF SURGICAL TREATMENT OF BREAST CANCER IN VICTORIA." ANZ Journal of Surgery 60, no. 11 (November 1990): 871–78. http://dx.doi.org/10.1111/j.1445-2197.1990.tb07491.x.
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Vedsted, Peter, David Weller, Alina Zalounina Falborg, Henry Jensen, Jatinderpal Kalsi, David Brewster, Yulan Lin, et al. "Diagnostic pathways for breast cancer in 10 International Cancer Benchmarking Partnership (ICBP) jurisdictions: an international comparative cohort study based on questionnaire and registry data." BMJ Open 12, no. 12 (December 2022): e059669. http://dx.doi.org/10.1136/bmjopen-2021-059669.
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ObjectivesA growing body of evidence suggests longer time between symptom onset and start of treatment affects breast cancer prognosis. To explore this association, the International Cancer Benchmarking Partnership Module 4 examined differences in breast cancer diagnostic pathways in 10 jurisdictions across Australia, Canada, Denmark, Norway, Sweden and the UK.SettingPrimary care in 10 jurisdictions.ParticipantData were collated from 3471 women aged >40 diagnosed for the first time with breast cancer and surveyed between 2013 and 2015. Data were supplemented by feedback from their primary care physicians (PCPs), cancer treatment specialists and available registry data.Primary and secondary outcome measuresPatient, primary care, diagnostic and treatment intervals.ResultsOverall, 56% of women reported symptoms to primary care, with 66% first noticing lumps or breast changes. PCPs reported 77% presented with symptoms, of whom 81% were urgently referred with suspicion of cancer (ranging from 62% to 92%; Norway and Victoria). Ranges for median patient, primary care and diagnostic intervals (days) for symptomatic patients were 3–29 (Denmark and Sweden), 0–20 (seven jurisdictions and Ontario) and 8–29 (Denmark and Wales). Ranges for median treatment and total intervals (days) for all patients were 15–39 (Norway, Victoria and Manitoba) and 4–78 days (Sweden, Victoria and Ontario). The 10% longest waits ranged between 101 and 209 days (Sweden and Ontario).ConclusionsLarge international differences in breast cancer diagnostic pathways exist, suggesting some jurisdictions develop more effective strategies to optimise pathways and reduce time intervals. Targeted awareness interventions could also facilitate more timely diagnosis of breast cancer.
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Mitchell, Anne E., Deborah L. Scarcella, Gemma L. Rigutto, David M. Ashley, Vicky J. Thursfield, Graham G. Giles, and Maree Sexton. "Cancer in adolescents and young adults: treatment and outcome in Victoria." Medical Journal of Australia 180, no. 2 (January 2004): 59–62. http://dx.doi.org/10.5694/j.1326-5377.2004.tb05799.x.
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White, Les, Jane Ewing, Anne M. Senner, Madeleine King, and Belinda Goodenough. "Cancer in adolescents and young adults: treatment and outcome in Victoria." Medical Journal of Australia 180, no. 12 (June 2004): 653–54. http://dx.doi.org/10.5694/j.1326-5377.2004.tb06138.x.
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Yoong, Jaclyn, Michael Franco, Leeroy William, and Peter Poon. "Perspectives of cancer treatment providers regarding voluntary assisted dying in Victoria." Internal Medicine Journal 48, no. 7 (July 2018): 770–73. http://dx.doi.org/10.1111/imj.13939.
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Bergin, R., J. Emery, R. Bollard, A. Falborg, H. Jensen, D. Weller, U. Menon, et al. "Rural-Urban Variation in Time to Diagnosis and Treatment of Colorectal or Breast Cancer in Victoria, Australia." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 47s. http://dx.doi.org/10.1200/jgo.18.10700.
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Background: Rural-urban disparities in cancer outcomes are found in many countries, though these vary by cancer type. In Victoria, Australia, survival is poorer for rural patients with colorectal cancer, but not breast cancer. Delayed diagnosis and treatment may contribute to disparities, but previous studies have not compared the timeliness of rural and urban pathways to treatment of these common cancers. Aim: We investigated whether time to diagnosis and treatment differed for rural and urban patients with colorectal or breast cancer in Victoria, Australia. Methods: Population-based, cross-sectional surveys examining events and dates on the pathway to treatment completed by patients aged ≥ 40 and approached within six months of diagnosis, their general practitioner (GP) and specialist. Data were collected from 2013 to 2014 as part of the International Cancer Benchmarking Partnership, Module 4. Six intervals were explored: patient (symptom to presentation), primary care (presentation to referral), diagnostic (presentation/screening to diagnosis), treatment (diagnosis to treatment), health system (presentation to treatment) and total intervals (symptom/screening to treatment). Rural-urban differences were examined for each cancer using quantile regression (50th, 75th and 90th percentiles) models including age, gender, health insurance and socioeconomic status. Results: 433 colorectal (48% rural) and 489 breast (42% rural) patients, 621 GPs and 370 specialists completed surveys. Compared with urban patients, symptomatic colorectal cancer patients from rural areas had a significantly longer total interval at all percentiles: 50th (18 days longer, 95% confidence interval (CI): 9-27), 75th (53, 95% CI: 47-59) 90th (44, 95% CI: 40-48). These patients also had longer health system intervals, ranging 7-85 days longer. This appeared mostly due to longer diagnostic intervals (range: 6-54 days longer). Results were similar when including screen-detected cases. In contrast, breast cancer intervals were similar for rural and urban patients, except the patient interval, which was shorter for rural patients. Conclusion: Consistent with variation in survival, we found longer total and diagnostic intervals for rural compared with urban patients with colorectal cancer, but not breast cancer. The lack of rural-urban differences observed for breast cancer suggest that inequities in the timeliness of colorectal cancer pathways can be ameliorated, and may improve clinical outcomes. Indeed, based on previous research, delays observed in this study could result in stage progression and hence reduced survival. From our results, interventions targeting the time from presentation to colorectal cancer diagnosis in rural populations should be pursued. Countries seeking to understand cancer disparities in their local context may also consider using a pathways approach to identify possible targets for policy intervention.
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Adamson, E., N. Yussf, and E. Schreiber. "Using Liver Cancer Prevention Messages to Scale up the Diagnosis and Treatment of People Living With Hepatitis B." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 132s. http://dx.doi.org/10.1200/jgo.18.32800.
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Background and context: Chronic hepatitis B (CHB) is a major public health issue in Australia, affecting an estimated 238,000 people. If not appropriately managed, chronic hepatitis B infection can cause cirrhosis and liver cancer. Liver cancer has the fastest increasing incidence rate of all cancers in Australia, and its survival is among the lowest. To reduce the burden of liver cancer, more people with CHB need to be diagnosed and treated. The majority of people living in Australia with CHB (61%) were born overseas, and research indicates people have low levels of understanding about hepatitis B, and its link to liver cancer. Cancer Council Victoria developed several communication campaigns to increase testing and diagnosis for hepatitis B in the Vietnamese and south Sudanese communities living in Victoria. Aim: •To raise awareness about hepatitis B and the link to liver cancer in the Vietnamese and south Sudanese community •To increase understanding about diagnosis, vaccination and management •To mobilize the community to talk to their trusted GP about hepatitis and to be tested. Strategy/Tactics: The campaign strategy was designed to address the knowledge barriers to testing for these two communities. To inform the strategy, qualitative focus groups and community interviews were used to identify perceptions of hepatitis B and liver cancer, as well as the barriers and motivators to testing. Both communities identified their local doctor as a trusted source of health information. Two media campaigns were developed featuring a known doctor from each community. An additional campaign was tailored specifically for young south Sudanese people using hip hop music as method of disseminating key messages about liver cancer prevention. Program/Policy process: The campaigns were designed by the Screening, Early Detection and Immunization Team at Cancer in Council Victoria, Australia. Outcomes: Digital metrics and face to face interviews with community members, nurses and doctors were used to assess the impact of the campaigns. Evaluation results also indicated people did visit their doctor to talk about hepatitis B. The success in motivating people to see their doctor was attributed to the campaigns featuring a message about liver cancer being caused by hepatitis B, and it being led by a known and respected doctor from their own community. What was learned: Cancer organizations can target liver cancer prevention efforts to · increase awareness about liver cancer and hepatitis B in at risk communities; · motivate at risk people to visit their doctor for hepatitis B testing, vaccination and treatment by linking the prevention of liver cancer to hepatitis treatment; · tailor communications to the specific needs of different culturally diverse communities; · collaborate closely with communities from culturally diverse backgrounds to ensure campaign messages and calls to action are culturally appropriate.
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Pilgrim, Charles H. C., Luc te Marvelde, Ella Stuart, Dan Croagh, David Deutscher, Mehrdad Nikfarjam, Belinda Lee, and Christopher Christophi. "Population‐based analysis of treatment patterns and outcomes for pancreas cancer in Victoria." ANZ Journal of Surgery 90, no. 9 (April 29, 2020): 1677–82. http://dx.doi.org/10.1111/ans.15721.
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COOK, JANET T. "The Treatment of Patients with Persisting Cancer at the Austin Hospital, Heidelberg, Victoria." Australian Occupational Therapy Journal 14, no. 2 (August 27, 2010): 5–11. http://dx.doi.org/10.1111/j.1440-1630.1967.tb00197.x.
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Rosenthal, M., K. Drummond, M. Dally, M. Murphy, L. Cher, D. Ashley, V. Thursfield, and G. Giles. "Glioma patterns of care in Victoria from 1998–2000." Journal of Clinical Oncology 24, no. 18_suppl (June 20, 2006): 11521. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.11521.
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11521 Background: The management of Gliomas is complex and requires a multidisciplinary approach. The care of such patients (pts) may be variable. The State of Victoria has a population of approximately 4 million people and over 300 new glioma cases diagnosed annually. Methods: This was a retrospective cohort study conducted by surveying doctors involved in managing incident adult glioma cases identified from the population based Victorian Cancer Registry during 1998–2000. The survey was conducted in 2004–5 obtaining at least four years follow-up data on all pts. Results: 828 pts were considered eligible for this study. 264 pts (32%) were aged over 70 years and 92 (11%) were aged over 80 years. 105 (13%) did not have a histologic diagnosis and 473 (57%) had glioblastoma multiforme (GBM). Complete macroscopic resection was performed in 209 pts (25%). Of all pts with a glioma, 612 (74%) and 326 (54%) were referred at initial diagnosis for consideration of radiotherapy and chemotherapy respectively. In 473 pts with GBM, 406 (86%) and 147 (31%) pts were initially referred for consideration of radiotherapy and chemotherapy respectively. Only 39 pts(5%) were enrolled on a clinical trial. The median survival for pts with a GBM was 7.4 months with a 3% five-year survival. Conclusions: This is one of the largest ever-reported glioma management surveys. Much of the patient demographics and approach to treatment were expected and represent a reasonable “standard of care”. Importantly, this study emphasises the elderly nature of this patient population and identifies areas of concern including: absence of histologic diagnosis, lack of multi-disciplinary care and low clinical trial enrolment. No significant financial relationships to disclose.
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Rodríguez, María Angeles Prieto, Astrid Suess, Joan Carles March Cerdá, María Escudero Carretero, and Alina Danet. "Opinions and Expectations of Women in the Treatment of Cervical and Uterine Cancer in Spain." Women's Health 7, no. 6 (November 2011): 709–18. http://dx.doi.org/10.2217/whe.11.50.
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Aim: To know the experiences, needs and expectations of women in the treatment of cervical and uterine cancer in the Andalusian Health Service. Methods: Focus groups and in-depth interviews with women being treated for cervical–uterine cancer within the Andalusian Health Service. Analysis with Nudist Vivo 1.0 (QSR International Pty Ltd, Doncaster, Victoria, Australia). Results: The needs and expectations detected were: coherence in the promotion strategies and the presence of a proactive approach by health professionals, availability of comprehensive information and understanding, possibility of expressing to health professionals one's doubts and fears, and of participation in decision-making, technical quality, humane treatment and continuity of care and attention to psychosocial aspects. Conclusion: The knowledge of women in the treatment of cancer of the cervix and uterus plays a crucial part in improving the delivery of these services.
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Tissera, S., B. Billah, N. Karim, M. Brand, S. Smith, J. Zalcberg, and R. Stirling. "OA01.03 Lung Cancer in Victoria: Association Between Stage-Specific Receipt of Guideline-Concordant Treatment and Survival." Journal of Thoracic Oncology 17, no. 9 (September 2022): S3—S4. http://dx.doi.org/10.1016/j.jtho.2022.07.015.
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Patabendi Bandarage, Varuni Ransika Kumari, Baki Billah, Jeremy L. Millar, and Sue Evans. "Prospective evaluation of patient-reported quality of life outcomes after external beam radiation treatment for prostate cancer in Victoria: A cohort study by the Victorian Prostate Cancer Registry." Journal of Medical Imaging and Radiation Oncology 60, no. 3 (January 13, 2016): 420–27. http://dx.doi.org/10.1111/1754-9485.12433.
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Oyebola, F. O. "Communication Issues and Challenges of Information Sharing, Care Plans and Treatment Modalities for Cancer Patients and Families Accessing Hospice and Palliative Care Services in Nigeria and South Africa." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 106s. http://dx.doi.org/10.1200/jgo.18.24600.
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Background: The recent upsurge in the prevalence of cancer cases in Nigeria and other African countries is fast becoming a great challenge for the clinicians and urgently required holistic interventions. Most patients (60%–70%) usually present at an advanced incurable stage. Communication issues such as breaking bad news, discussions around treatment options, prognosis and advance care plans are often neglected. Cancer diagnosis is often synonymous to a death sentence and inadequate knowledge about disease trajectories and information sharing with patients and their families is often responsible for patients' frustration. A supportive palliative oncology teams play a critical role in facilitating and communicating between clinicians, patients and their families to bridge the gap and ensure effective therapeutic communication. Aim: In preparation for the forthcoming UICC African Cancer fellowship visit to the Life Abundant Palliative Care, Victoria Hospital in Wynberg, South Africa, a preliminary study will be made to identify relevant challenging issues and data among cancer patients at the Federal Medical Center Abeokuta Nigeria. Methods: A retrospective and prospective study will be performed of diagnosed cancer patients referred to the Pain and Palliative Medicine Department of the Federal Medical Centre Abeokuta, Nigeria between 2016 and 2017. Their diagnosis, treatment options, treatment compliance and defaults, offer of advance care plans, extent of interdisciplinary team and family involvement will be evaluated using the patients' case-notes. For surviving patients attending the pain and supportive palliative oncology clinic, their knowledge of the disease, treatment challenges, prognostication and family support will be identified and documented. Results: The observational gaps in the retrieved information and data about the treatment outcomes and interdisciplinary team support and challenges will form the basis or rather the prestudy platform for the planned fellowship visit on to the Life Abundant Palliative Care, Victoria Hospital in Wynberg, South Africa. The identified knowledge and skills gap would be used to design the final study in South Africa in August 2018. Conclusion: It is expected that the two studies will reflect communication issues and the approach to cancer patients' management in two different African clinical settings. The acquired lessons or experience during the second phase studies in the South Africa clinical setting would be translated to Nigeria practice and also shared at the 2018 UICC World Congress.
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Rauw, Jennifer Marie, Sunil Parimi, Helen Anderson, Pamela Hinada, Bethina Abrahams, and Katie Hennessy. "Improving management of hypersensitivity reactions: A BC Cancer-Victoria quality improvement initiative." Journal of Clinical Oncology 39, no. 28_suppl (October 1, 2021): 230. http://dx.doi.org/10.1200/jco.2020.39.28_suppl.230.
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230 Background: Hypersensitivity reactions (HSR) are a documented, predictable side effect of multiple chemotherapy agents. Reactions negatively affect the patient experience, increase the amount of chair time, nursing and physician resources, may result in the omission of a potentially effective cancer management tool from a patient’s treatment plan and could potentially result in death. BC Cancer is a Health Care Organization with 6 cancer centres across British Columbia, Canada. Guideline(GL)s have been developed at BC Cancer to support clinicians to manage reactions acutely and reduce the risk of reactions with subsequent cycles. A recent audit identified that the GLs were not always being followed at the Victoria Centre. Our goal was to encourage physician and nursing staff to follow GLs, which we hypothesized would result in decreased rates of HSR. Methods: Our aim was to decrease HSR to < 5% of doses delivered within 1 year at BC Cancer-Victoria. We engaged stakeholders (nursing, physicians, pharmacy, clerical staff and administration). Our change ideas improved adherence to GLs by focusing on: physician attendance and documentation, written orders for rescue medication, and rate of infusion of the chemotherapy drug rechallenge. Our interventions included: two physician-education sessions, one nursing education session, daily huddles, pre-printed order development for management of the reaction (PPOA) and prophylaxis for subsequent cycles (PPOB), and a modified clinic flow. All interventions were introduced and underwent modifications through PDSA cycles. Our family of measures were: Outcome: number of reactions, percent of reactions per dose given. Process: percent of PPO use per reaction, physician attendance and notes dictated per reaction. Balancing: physician and nursing satisfaction. We analyzed the data using quality improvement run charts and control charts. Results: After the start of our initiative, our total number of reactions displayed special cause variation, and a shift in the baseline from a mean of 11.27 HSR per month to 7.526. This change was reflected in the percentage of reactions per doses given which fell from 3.1% to 1.9%. Average percentage of dictated notes per reaction increased from 55% to 64%. Physician attendance per reaction also showed special cause variation with the average increasing from 57% to 90%. PPOA and PPOB use both increased over time. Nursing and Physician satisfaction data will also be presented. Conclusions: Our successful initiative has resulted in HSR management which more closely reflects GLs, including increased physician attendance and notes, and clear consistent written orders detailed on PPO A and B. This has led to decreased HSRs at our site, resulting in decreased resource use and increased patient safety and quality. This has provincial implications as there is the potential to spread this initiative to other BC Cancer sites.
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Ong, Wee Loon, Farshad Foroudi, and Jeremy Laurence Millar. "Australian population-based study of single- versus multi-fraction palliative radiotherapy for bone metastases." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): 6568. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.6568.
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6568 Background: Single fraction palliative radiotherapy (SFRT) has been shown to be equivalent to multi-fraction radiotherapy (MFRT) for bone metastases symptom management. Remuneration for radiotherapy (RT) in Australia are largely determined by fractions delivered. We aim to determine the use of SFRT for bone metastases in Australia. Methods: We did a population-based linkage study of multiple administrative healthcare databases in Victoria, Australia: the Victorian Radiotherapy Minimum Data Set (VRMDS), the Victorian Cancer Registry (VCR), and the Birth, Death and Marriage registry (BDM). All patients with solid tumour (excluding primary bone cancer) who received palliative radiotherapy for bone metastases between 2012 and 2017 were included. The primary outcome was use of SFRT. The Cochrane-Armitage test for trend was used to evaluate SFRT use over time. Multivariable logistic regression was used to identify factors associated with SFRT use. Results: A total of 15,668 courses of RT for bone metastases were delivered to 10,351 patients. The overall proportion of SFRT was 18% (2,746/ 15,668). There was no significant change in SFRT use over time, from 18% in 2012 to 20% in 2017 (P = 0.06). Older patients were more likely to have SFRT (mean age 69.4 vs. 68.2, P < 0.001). Patients who had lung cancer (21%) and prostate cancer (19%) were more likely to have SFRT compared to other tumour types (P < 0.001). Spine RT was associated with lower use of SFRT compared to other treatment sites (14% vs. 22%, P < 0.001). Patients from remote area were more likely to have SFRT compared to patients from major cities (22% vs. 17%, P < 0.001). Patients treated in private institutions were less likely to have SFRT compared to those treated in public institutions (10% vs. 22%, P < 0.001). In multivariate analyses, patients’ age, tumour type, area of residence, and treatment institutions were independently associated with SFRT use. Conclusions: This is the largest Australian population-based cohort treated with RT for bone metastases, with low utilisation of SFRT over time. There is large variation in SFRT use depending on patient-, tumour-, geographical and institutional factors. Further work is needed to increase uptake, and reduce unwarranted variation, in SFRT use.
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Mitchell, Paul, Jennifer Soon, Joanne Kenny, and Katherine Simons. "What do doctors value about attending multi-disciplinary cancer case discussions?" Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e18324-e18324. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e18324.
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e18324 Background: Discussion of cancer cases at multi-disciplinary meetings (MDMs) for treatment planning is expected standard care in Australia. There has been rapid uptake of MDMs in the last 10 - 15 years and in the state of Victoria approximately 70% of cancer cases are discussed. MDMs have strong support from medical staff and we investigated their motivation in attending MDMs. Methods: Over 12 months, Austin Health in Melbourne, Victoria, hosted 452 cancer MDMs discussing 5943 patients. MDMs covered 15 tumour areas: 11 solid tumour, one lymphoma and three haematological. Over a 4-week period, medical staff attending MDMs were surveyed and asked to rank what they valued most about cancer MDMs, over and above the benefits for patients. Results: Responses were received from 84% of the 285 medical staff surveyed, which included consultants as well as trainees (registrars and fellows). For 75% of respondents the highest ranking was given to multi-disciplinary communication, 9% gave the highest ranking to quality assurance and governance, 5% ongoing learning for consultants, 5% collegiate relationships, 2% learning and teaching for non-consultant staff, 2% peer support 1% job satisfaction and 1% clinical trials engagement. Similar results were obtained for consultant staff and for registrars / fellows. For consultant medical staff, if multidisciplinary communication was excluded, 44% of respondents gave the highest ranking to quality assurance and governance, 23% to collegiate relationships, 20% ongoing learning for consultants, 10% peer support and 3% clinical trials engagement. Conclusions: When we asked doctors what they valued most about attending cancer MDMs, besides the benefits for patients, communication between disciplines was clearly the most valued aspect. The benefits for quality and governance was the next most valued, then collegiate relationships and peer support, and ongoing learning.
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Perry, Alison R., and Margaret A. Shaw. "Evaluation of functional outcomes (speech, swallowing and voice) in patients attending speech pathology after head and neck cancer treatment(s): development of a multi-centre database." Journal of Laryngology & Otology 114, no. 8 (August 2000): 605–15. http://dx.doi.org/10.1258/0022215001906516.
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Since April 1997, in Melbourne, Australia, speech pathologists have collaborated to establish a prospective database of functional outcomes of speech, swallowing and voice for patients undergoing head and neck cancer treatments.Staff at eight acute care hospitals, all of which offer speech pathology for head and neck cancer services in Victoria, are contributing data, collated centrally, in an agreed pro forma.Early results are given (after 12 months’ data collection). The implications for clinically-based research, and the future potential for benchmarking outcomes – by expansion of the rehabilitation database beyond the current participating sites – is discussed.This paper outlines the rationale of establishing the database is multicentred, and explores some of the complexities involved, including the challenges inherent in long-term accurate data collection in the head and neck cancer patient population. This work represents the development of an appropriate, usable tool for data collection on functional outcomes.
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Milch, Vivienne, Cleola Anderiesz, Debra Hector, Scott Turnbull, Melissa Austen, Rhona Wang, Carolyn Der Vartanian, and Dorothy Mary Kate Keefe. "Cancer care in the time of COVID-19: A conceptual framework to improve cancer outcomes during a pandemic." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): e18628-e18628. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e18628.
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e18628 Background: At the start of the COVID-19 pandemic, a plan for cancer management during a pandemic did not exist. It soon became clear that without proper planning, cancer outcomes would worsen. Cancer patients are at increased risk of COVID-19 infection, morbidity, and mortality. Health sectors internationally reduced or paused non-urgent cancer care to protect cancer patients from COVID-19. However, disproportionate delays in screening, diagnosis, and treatment can unduly impact cancer outcomes, and backlogs can further burden a strained health system. Tailored approaches to cancer management are required which balance health resource availability along with the risks of exposure and benefits of treatment. Australia’s relatively low COVID-19 case numbers afforded Cancer Australia an opportunity to proactively plan for optimal cancer management during this, and future, pandemics. Methods: Cancer Australia’s Cancer care in the time of COVID-19: A conceptual framework for the management of cancer during a pandemic (the framework) maps evidence-based cancer care considerations in relation to a health system’s capacity across acute and recovery pandemic phases, in relation to steps of the cancer care pathway. The framework promotes infection control and resource prioritisation in the context of innovative care models, triaging approaches and individualised treatment plans, underpinned by effective communication and shared decision-making. Results: The framework supports health system planning and risk-stratified approaches to guide decision-making and improve cancer outcomes. Many aspects of cancer care are recommended to continue (to varying degrees) in most pandemic phases, with modifications or pauses in some aspects of care as the pandemic curve approaches or exceeds health system capacity. Principles of the framework were employed during the second wave of COVID-19 in the Australian state of Victoria, with continuation of cancer screening programs, diagnostic investigations, and treatments wherever it was safe to do so. This resulted in reductions in cancer services and treatment being relatively smaller than in the first wave. Conclusions: Cancer management in a pandemic is not a one-size-fits-all. Countries and jurisdictions need to tailor cancer care according to the risk of the health system becoming overwhelmed. The framework guides optimal cancer care to improve outcomes for people with cancer, while minimising COVID-19 infection. As further evidence becomes available from this pandemic or in future pandemics, this framework can be refined to inform ongoing and future pandemic health system planning.
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Largey, Geraldine, Eli Ristevski, Helen Chambers, Heather Davis, and Peter Briggs. "Lung cancer interval times from point of referral to the acute health sector to the start of first treatment." Australian Health Review 40, no. 6 (2016): 649. http://dx.doi.org/10.1071/ah15220.
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Objective The aim of the present study was to compare lung cancer diagnostic and treatment intervals with agreed target measures across three large public health services in Victoria and assess any differences in interval times by treatment type and health service. Methods A retrospective medical record audit of 78 patients admitted with a new diagnosis of lung cancer was conducted. Interval times from referral to diagnosis, diagnosis to first treatment and referral to first treatment were recorded in three treatment types: surgery, chemotherapy and radiotherapy. Results There was a significant difference in the mean number of days from referral to diagnosis by treatment type. Patients who underwent surgery waited significantly longer (mean (± s.d.) 41.6 ± 38.4 days) to obtain a diagnosis than those who received radiotherapy (15.1 ± 18.6 days). Only 47% of surgical patients obtained a diagnosis within the recommended 28 days. Moreover, only 45% and 44% of patients, respectively, met the diagnosis-to-treatment target of 14 days and referral-to-treatment target of 42 days. Conclusion The present study highlights the effect of treatment type on lung cancer referral interval times. It demonstrates the benefits of using evidenced-based interval target times to benchmark and compare performance outcomes in lung cancer. What is known about the topic? Lung cancer is the leading cause of cancer mortality in Australia and has the lowest 5-year survival rate of all cancer types. Delays in the diagnosis of lung cancer can change the prognosis from potentially curable to incurable, particularly in faster-growing tumours. What does this paper add? This study reveals treatment type was a greater factor in explaining variations in diagnosis and treatment than health service. Surgical patients were consistently lower in meeting the recommended interval targets across referral to diagnosis, diagnosis to treatment and referral to treatment. What are the implications for practitioners? This study demonstrates the value of using evidenced-based interval target times to benchmark and compare performance outcomes in lung cancer. Such measures may further improve prognostic outcomes in lung cancer by reducing unwanted delays.
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Rauw, Jennifer Marie, Sunil Parimi, Nikita Ivanov, Jessica Noble, Eugenia Wu, Monita Sundar, Jennifer Goulart, and Celestia S. Higano. "The evolution of the education module for men with metastatic prostate cancer (mPC) in the prostate cancer supportive care (PCSC) program." Journal of Clinical Oncology 39, no. 28_suppl (October 1, 2021): 279. http://dx.doi.org/10.1200/jco.2020.39.28_suppl.279.
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279 Background: The PCSC Program was initiated in 2013 at the Vancouver Prostate Centre to provide a comprehensive program for patients and partners with prostate cancer. This program provides educational sessions (ES) and clinical services, including decision-making for primary therapy, sexual health, pelvic floor physiotherapy, hormone therapy, counseling, exercise, and nutrition for patients in BC, Canada. In 2016, the PCSC Program expanded to BC Cancer Victoria and in 2017 to other BC Cancer sites. In 2018, medical oncologists (MDs) in Victoria (JR, SP) developed an Education Module addressing treatment options for men with metastatic hormone sensitive (mHSPC) and metastatic castration resistant (mCRPC) disease. MDs delivered in-person ES in Victoria in 2018 and, in 2019, added a virtual platform (VP) option. From 3-5/2020, the ESs were on hold due to the COVID pandemic and parental leaves. In 6/2020, the ESs resumed only on VP, and the PCSC Oncology Nurse Practitioner (NP), NI, gave the presentations for the MDs on leave. In 10/2020, due to a changing standard of care for mHSPC, the PCSC team consolidated the two ESs into one. We report on the evolution of this Education Module in response to both the changing standard of care and the COVID pandemic. Methods: We prospectively collected attendance and patient characteristic metrics from all ES for men with mPC. We tracked presenter type (MD vs. NP) and prospectively collected anonymous patient satisfaction questionnaires. Results: From 1/2018 to 1/2021, 100 men registered for 27 ES; 81 men, 41 partners, and 2 family members actually attended. 48/75 (64%) men were white, 39/75 (52%) retired, and 56/75 (74.7%) married. 47 men attended 12 mHSPC ES, 13 men attended ten mCRPC ES, and 17 attended four consolidated ES. MDs presented 15 ES, and the NP presented 12 ES. Responses to questions on 70 satisfaction surveys were similar for MD vs. NP presenters. 9 responders to the recently added VP-specific questions said they agreed (4) or strongly agreed (5) that it was beneficial to watch the ES at home on a computer. The Table below shows attendance per site per year. Conclusions: The ESs for men with mPC were well-received. Although there was a VP option before COVID, attendance increased significantly after the lockdown as patients and providers became more familiar with VPs. Satisfaction surveys confirmed that an NP could deliver the ES rather than MD. Consolidation of the mHSPC and mCRPC ES reflected the changing standard of care and resulted in more efficient use of presenter time. Virtual delivery of the sessions provided greater access to those living in distant or remote areas of the province and those in lockdown during the COVID pandemic. [Table: see text]
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Millar, Jeremy L., Susan M. Evans, Mark Frydenberg, Declan G. Murphy, Damien M. Bolton, Graham G. Giles, and Ian D. Davis. "Quality-of-life outcomes for prostate cancer treatment in Australia." Journal of Clinical Oncology 31, no. 6_suppl (February 20, 2013): 143. http://dx.doi.org/10.1200/jco.2013.31.6_suppl.143.
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143 Background: We aimed to use a population based quality registry established in Australia, to review patient-reported health-related QOL after the diagnosis of Prostate Cancer (PCa). Methods: Prospective registry of men with PCa from statutory notifications to the canonical population-based cancer registry in Victoria. An "opt-off" mechanism used. Coverage expanded from 30%-80% of State population over time. Demographics and disease features, management, and outcomes from medical record; men phoned at 12 and 24 months (m), interviewed with script including SF12 and items from standard form (UCLA PCI) for specific QOL outcomes. Urinary, rectal, and sexual function bother (UB, RB, and SB) scores where analysed by univariate and multivariable modelling for relationship of these with presentation or management factors, adjusting for risk. Results: Men from 8/2008 - 2/2011; 1.9% of eligible opted out. Followed 1172 to 12 & 24 m. Median diagnosis age 65 yr; median PSA 6.8 ng/mL; 97.3% clinically localised with 47.7% having NCCN intermediate risk. 520 had treatment with Radical Prostatectomy (RP) (89 also with external beam-EBRT), 171 had EBRT (with or without HDR brachy), and 211 seed implant (SI). 226 had no treatment (NT) in the first 12 m. 52.5% managed in public hospitals, rest private. Univariate analysis: UB associated with management type, and hospital type, and RB and SB associated with these factors, as well as age and disease stage. On multivariate regression SB at 12 m was associated with increasing age (p=0.002) and radical treatment types (RP and EBRT/HDR, p<0.001 and 0.003 respectively)—except SI—compared to NT; RB was associated with SI (0.02) and EBRT/HDR (0.007) and treatment in a public hospital (0.006); and UB was associated with public hospital (<0.001). All associations at 12 m remained significant at 24 m. SF12 physical score had a positive association with RP vs NT (0.014), hospital type (0.001) and younger age. SF12 mental health also showed associations. Conclusions: A large scale registry in Australia assessing patient-reported quality of life outcomes after prostate cancer treatment shows patterns similar to that seen in North American reports.
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Bell, Robin J., Pamela Fradkin, Nishanthinie Parathithasan, Penelope J. Robinson, Max Schwarz, and Susan R. Davis. "Pregnancy-associated breast cancer and pregnancy following treatment for breast cancer, in a cohort of women from Victoria, Australia, with a first diagnosis of invasive breast cancer." Breast 22, no. 5 (October 2013): 980–85. http://dx.doi.org/10.1016/j.breast.2013.05.013.
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Fleming, Julia Ann, and Bradley David O’Connor. "Use of Lidocaine Patches for Neuropathic Pain in a Comprehensive Cancer Centre." Pain Research and Management 14, no. 5 (2009): 381–88. http://dx.doi.org/10.1155/2009/723179.
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BACKGROUND: There are few reports of the use of the lidocaine 5% patch (L5%P) for neuropathic pain (NP) in the cancer patient. Within a comprehensive cancer centre, L5%P has been prescribed by the Pain and Palliative Care Service (Peter McCallum Cancer Centre, East Melbourne, Victoria, Australia) for selected patients with NP since 2001.OBJECTIVE: To retrospectively audit the use of L5%P within a comprehensive cancer centre.METHODS: All L5%P prescriptions up to January 2009 were listed and patient medical records were searched to determine neuropathic pain syndromes treated, the presence of allodynia, previous analgesic medications, treatment duration and outcome.RESULTS: L5%P was prescribed for 97 patients, most frequently for persistent postsurgical NP (n=26), postherpetic neuralgia (n=24) and cancer-related NP (n=18). Six patients had no history of cancer and two patients never applied L5%P. Reviewers classed L5%P analgesic efficacy as ‘potent’ in 38% of patients with postherpetic neuralgia, 35% of patients with postsurgical pain, 27% of patients with NP after other treatments for cancer and 12% of patients with NP attributed to cancer alone. Allodynia featured in at least 60% of patients. Where allodynia was present, the efficacy of L5%P was assessed as ‘potent’ in 38% and ‘partial’ in 24%, but ‘ineffective’ in 26%, and ‘causing worse pain’ in 3.4% of patients. Treatment duration extended longer than one month in 52 patients, longer than two months in 29 patients and longer than one year in 13 patients. Therapy was ceased due to skin irritation in seven patients. The outcomes in relation to other reports are discussed.CONCLUSION: The present data support trials of L5%P for cancer patients with NP syndromes associated with allodynia.
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Ristevski, Eli, Sharyn Thompson, Sharon Kingaby, Claire Nightingale, and Mahesh Iddawela. "Understanding Aboriginal Peoples’ Cultural and Family Connections Can Help Inform the Development of Culturally Appropriate Cancer Survivorship Models of Care." JCO Global Oncology, no. 6 (September 2020): 124–32. http://dx.doi.org/10.1200/jgo.19.00109.
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PURPOSE To explore the cancer diagnosis, treatment, and survivorship experiences of Aboriginal people in the Gippsland region, Victoria, Australia, and identify factors critical to the development of a culturally appropriate cancer survivorship model of care. PATIENTS AND METHODS Yarning circles were used to capture the stories of 15 people diagnosed with cancer and/or those of family members. Yarning circles were conducted in two locations in the Gippsland region. Sessions were facilitated by an Aboriginal Elder, audio recorded, and transcribed verbatim. Thematic analysis of the data were triangulated among three researchers and incorporated researcher reflexivity. RESULTS Cultural connections and family were critical supports on the cancer journey. Putting the needs of the family first and caring for sick family members were more important than an individual’s own health. There was “no time to grieve” for one’s own cancer diagnosis and look after oneself. Cancer was a private experience; however, the constancy of deaths highlighted the importance of raising family awareness. Health professionals did not always understand the importance of people’s cultural and family supports in their treatment and recovery. There were negatives attitudes in hospitals when family come to visit, seeing family as too large and overstaying visiting times. Health professionals did not seek family assistance with communication of information to family members whose literacy level was low, nor did they include family in treatment decision-making. Access to services depended on family support with transport, finances, and family responsibilities, often resulting in lapses in treatment and follow-up services. CONCLUSION Understanding the importance of Aboriginal peoples’ cultural and family connections can help to inform the development of culturally safe cancer survivorship models of care.
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Koo, Kendrick, Nathan Papa, Melanie Evans, Michael Jefford, Maarten J. IJzerman, and Jeremy Laurence Millar. "Mapping geographical disparities in population-level patient-reported quality of life following prostate cancer management." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): e18531-e18531. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e18531.
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e18531 Background: Prostate cancer patients generally have good survival outcomes, but some survivors have poor functional outcomes with persisting symptoms and poor quality of life (QoL). Socio-economic status (SES), access to specialist care and place of residence (including rural, remote areas) are associated with poor survival. These variables may also impact survivorship outcomes, including QoL. This study aimed to identify and visualise geographical disparities in QoL outcomes for prostate cancer survivors. Methods: We extracted complete data for 7690 patients, including patient-reported EPIC-26 QoL questionnaire results (12 months post-treatment), from the Prostate Cancer Outcomes Registry–Victoria (PCOR-VIC), a population-based clinical quality outcomes registry. Patient-matched geographic coordinates were obtained through the Victorian Cancer Registry. Scores from each of the 5 EPIC-26 functional domains were visualised using geospatial maps and correlated to the Index of Relative Socio-economic Advantage and Disadvantage (IRSAD) and geographical remoteness. A composite score condensing all 5 domains into a single number (range 5 – 20) was created for succinct visualisation of functional outcomes. We analysed hotspots using the Getis-Ord Gi* statistic. Results: Scores in all 5 functional domains were positively correlated to IRSAD, which remained an independent predictor of low functional score when controlling for age, disease stage, treatment modality and geographical remoteness (p < 0.001 for all). Geographical remoteness predicted low functional score in all domains (p < 0.05) except Urinary Irritative but was not statistically significant when adjusted for IRSAD. The constructed composite score was significantly correlated to IRSAD and remoteness in a univariate model (p < 0.001). In a multivariate model, remoteness was not an independent predictor of outcome, but the composite score rose by 0.13 for each IRSAD decile (p < 0.001), with patients in the bottom decile of IRSAD more likely to have composite scores below median ( < 14) than those in the top decile (OR 1.8 CI 1.4-2.2 p < 0.001). The composite score allowed visualisation of functional outcomes in a single figure and identification of geographic hotspots with poor outcome. Conclusions: Systematic collection of long-term patient-reported outcomes is feasible. Geographical disparities in QoL outcome following prostate cancer treatment correlated with SES and remoteness, and we note the relative importance of SES over remoteness. A single composite score for EPIC-26 showed face-validity. Our results will allow targeted efforts to further understand the drivers of these findings and improve equity in survivorship outcomes for prostate cancer survivors. The methods developed in this study can be extended and re-deployed to evaluate outcomes in other jurisdictions and cancer types.
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Conway, Paul, Michael Leach, Neetu Tejani, Amanda Robinson, Yachna Shethia, and Ilana Solo. "Oesophageal cancer treatment patterns, timeliness of care and outcomes in the Loddon Mallee region of Victoria: A retrospective cohort study." Journal of Medical Imaging and Radiation Oncology 65, no. 2 (February 26, 2021): 242–50. http://dx.doi.org/10.1111/1754-9485.13167.
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Menon, Usha, Peter Vedsted, Alina Zalounina Falborg, Henry Jensen, Samantha Harrison, Irene Reguilon, Andriana Barisic, et al. "Time intervals and routes to diagnosis for lung cancer in 10 jurisdictions: cross-sectional study findings from the International Cancer Benchmarking Partnership (ICBP)." BMJ Open 9, no. 11 (November 2019): e025895. http://dx.doi.org/10.1136/bmjopen-2018-025895.
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ObjectiveDifferences in time intervals to diagnosis and treatment between jurisdictions may contribute to previously reported differences in stage at diagnosis and survival. The International Cancer Benchmarking Partnership Module 4 reports the first international comparison of routes to diagnosis and time intervals from symptom onset until treatment start for patients with lung cancer.DesignNewly diagnosed patients with lung cancer, their primary care physicians (PCPs) and cancer treatment specialists (CTSs) were surveyed in Victoria (Australia), Manitoba and Ontario (Canada), Northern Ireland, England, Scotland and Wales (UK), Denmark, Norway and Sweden. Using Wales as the reference jurisdiction, the 50th, 75th and 90th percentiles for intervals were compared using quantile regression adjusted for age, gender and comorbidity.ParticipantsConsecutive newly diagnosed patients with lung cancer, aged ≥40 years, diagnosed between October 2012 and March 2015 were identified through cancer registries. Of 10 203 eligible symptomatic patients contacted, 2631 (27.5%) responded and 2143 (21.0%) were included in the analysis. Data were also available from 1211 (56.6%) of their PCPs and 643 (37.0%) of their CTS.Primary and secondary outcome measuresInterval lengths (days; primary), routes to diagnosis and symptoms (secondary).ResultsWith the exception of Denmark (−49 days), in all other jurisdictions, the median adjusted total interval from symptom onset to treatment, for respondents diagnosed in 2012–2015, was similar to that of Wales (116 days). Denmark had shorter median adjusted primary care interval (−11 days) than Wales (20 days); Sweden had shorter (−20) and Manitoba longer (+40) median adjusted diagnostic intervals compared with Wales (45 days). Denmark (−13), Manitoba (−11), England (−9) and Northern Ireland (−4) had shorter median adjusted treatment intervals than Wales (43 days). The differences were greater for the 10% of patients who waited the longest. Based on overall trends, jurisdictions could be grouped into those with trends of reduced, longer and similar intervals to Wales. The proportion of patients diagnosed following presentation to the PCP ranged from 35% to 75%.ConclusionThere are differences between jurisdictions in interval to treatment, which are magnified in patients with lung cancer who wait the longest. The data could help jurisdictions develop more focused lung cancer policy and targeted clinical initiatives. Future analysis will explore if these differences in intervals impact on stage or survival.
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Biondi, Christine, Vivienne Milch, Van Nguyen, Regina Ryan, David Roder, Alan Woods, Kristie Cooper, Rhona Wang, Cleola Anderiesz, and Dorothy Mary Kate Keefe. "The COVID-19 pandemic led to a reduction in cancer services in Australia." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): e18812-e18812. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e18812.
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e18812 Background: Australian oncologists reported dramatic decreases in cancer referrals during the pandemic. As real time data were difficult to acquire, Cancer Australia used surrogate measures to infer where reductions in medical services occurred. We analysed data available through the Medicare Benefits Schedule (MBS), a list of the medical services and professional attendances subsidised by the Australian Government, for the five highest incidence cancers: breast, colorectal, lung, prostate, and skin cancers. Methods: We identified over 500 MBS item codes for diagnostic and treatment procedures for malignancies and pre-cancerous conditions. Item codes were categorised into analysis groups based on cancer type and/or similarities in type of service. Data were examined at national and jurisdictional levels for 2020 to determine reductions during the initial COVID-19 period and to monitor subsequent recovery. Data were compared to 2019 to account for normal seasonal variation. Results: Australia’s first wave of the pandemic ran from March to May, and a second wave in the state of Victoria alone ran from July to September 2020. We observed notable reductions across all diagnostic and surgical procedure groups examined, with initial reductions observed between March and April for diagnostic procedures, and a one-month delay for surgical procedures, between April and May. Some services showed an initial recovery in May, with many showing partial or full recovery by June. For some groups, analyses showed sustained reductions over the 12-month period. While COVID-19 case numbers were greater during the second wave, the impact on services was less pronounced, likely owing to more refined policy approaches to managing health system and workforce capacity. There was further recovery by September for some but not all services. Similar patterns of change were observed across all Australian states and territories, with some variation by jurisdiction. Conclusions: The pandemic has impacted the delivery of cancer care. Any potential delays in diagnoses and treatment due to these reductions in services may lead to more advanced cancer stage at diagnosis and poorer patient outcomes including recurrence and survival. Impact of COVID-19 on selected cancer services in Australia in 2020.[Table: see text]
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Fisher, M., F. McRae, M. Pitcher, I. Hornung, and J. Spence. "Bridge of Support: A Collaborative Approach to a Peer Support Program." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 169s. http://dx.doi.org/10.1200/jgo.18.74600.
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Background and context: The Bridge of Support Program (BOS) is adapting a successful community based model of peer support to an acute setting, at the Sunshine Hospital Breast Clinic, to meet the cultural and socioeconomic diverse needs of women with breast cancer. This two year project was funded by LUCRF Community Partnership Trust. Aim: To improve the experience of women undergoing treatment of breast cancer at Western Health. To improve access to psych-social, emotional and practical support for women by extending the reach of CounterPart- a state-wide service of women´s Health Victoria, funded by the Victorian Department of Health and Human Services to provide peer support and information to people affected by breast or a gynecologic cancer. Program/Policy process: Peer support volunteers actively guided women to current and credible evidence-based information, support decision making and provide emotional support. Peer support volunteers are rostered once a week at Sunshine Hospital to coincide with breast clinic and include access to the day oncology unit and radiotherapy center. Detailed contact information is recorded and women receive follow-up contact (with consent) from the peer support volunteers at the CounterPart Resource Centre in Melbourne. A CounterPart staff member oversees the project and provides direct support and supervision to the volunteers on site at the hospital. Women can self refer. Outcomes: Between February and December 2016 the BOS program had 159 separate contacts with patients and their families. 82 contacts were with men and women who were new to CounterPart and 77 were follow-up contacts. 90 individuals treated for breast cancer at Western Health accessed the program, which represent 53% of the women seen by the breast service. 48% of the contacts were follow-up contacts with the CounterPart volunteers indicating that once engaged with the service many men and women continue to make contact. 38% of contacts were with women diagnosed with metastatic disease, a group who often have higher levels of unmet or more complex needs. 49% were born in a nonmain English speaking country (compared with the overall state of Victoria average of 19.6%) thus reflecting an accessible service to the non-English speaking community. What was learned: At a time when peer support is being increasingly recognized as a key part of effective supportive care in cancer services, the BOS program offers a model of integrated peer support that is respected, reliable, well supported and safe within the acute setting. This acute-community sector partnership demonstrates how the medical and social models of health care can work together to provide a connected and quality service for men and women diagnosed with breast cancer. An active research approach is enabling the project to be responsive to issues and challenges as they arise including the ongoing recruitment of women as volunteers from the local community to work within the acute setting.
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Perry, Alison R., Margaret A. Shaw, and Susan Cotton. "An evaluation of functional outcomes (speech, swallowing) in patients attending speech pathology after head and neck cancer treatment(s): results and analysis at 12 months post-intervention." Journal of Laryngology & Otology 117, no. 5 (May 2003): 368–81. http://dx.doi.org/10.1258/002221503321626410.
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We have earlier reported establishing a computerized database to audit functional outcomes in patients who underwent head and neck cancer treatment in Victoria, Australiaand attended speech pathology services from April 1997–April 1999. This paper presents the statistical analyses and results from this study.Speech pathologists collected, prospectively, functional outcome data on 293 patients who underwent head and neck cancer treatment, and sent these for analysis to La Trobe University. Clinician and patient assessments of outcomes: speech, swallowing, activity, pain, employment, health, QOL status were made.Initial data on 293 patients were collected and data on mortality and morbidity were compiled at three, six and 12 months post-treatment. Within twelve months, 74 patients had died. Three, six and/or 12-month follow-up data was available on 219 patients, with both clinician and patient assessments of status completed. The status forms are presented as appendices to this paper. Complete status forms on 179 patients at 12 months were obtained.This clinical audit of functional outcomes represents the first study of this kind, collecting data from speech pathologists and patients in a multi-centre study of patients with head and neck cancer. We present data to demonstrate optimal recovery of function at six months, such that this may represent a good reference point for reporting and comparison of functional outcomes.
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Largey, Geraldine, Samantha Chakraborty, Tracey Tobias, Peter Briggs, and Danielle Mazza. "Audit of referral pathways in the diagnosis of lung cancer: a pilot study." Australian Journal of Primary Health 21, no. 1 (2015): 106. http://dx.doi.org/10.1071/py13043.
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This pilot study sought to describe the diagnostic pathways for patients with lung cancer and explore the feasibility of a medical record audit for this purpose. An audit of 25 medical records of patients with a confirmed diagnosis of lung cancer was conducted, at a single outer metropolitan hospital in Victoria. Patients were presented to secondary care from general practice (n = 17, 68%), the emergency department (n = 3, 12%) or specialist rooms (n = 1, 4%). Those who journeyed through general practice experienced the longest median intervals to diagnosis (20 days, interquartile range 7–47). The majority of patients (n = 15, 60%) were referred by a specialist to a multidisciplinary team after a diagnosis had been confirmed but before treatment commenced. These patients waited a median of 20 days from their first specialist appointment to a multidisciplinary team appointment. This research illustrated that a variety of pathways to diagnosis exist. Critically, it requires patient data and additional auditing of primary, public and private health sector records to determine generalisability of findings and the effectiveness of a medical record audit as a data collection tool.
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Gates, Priscilla, Karla Gough, Haryana Dhillon, Carlene Wilson, Eliza Hawkes, Vincent Dore, Yuliya Perchyonok, et al. "Longitudinal exploration of cancer-related cognitive impairment in patients with newly diagnosed aggressive lymphoma: protocol for a feasibility study." BMJ Open 10, no. 9 (September 2020): e038312. http://dx.doi.org/10.1136/bmjopen-2020-038312.
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IntroductionCancer-related cognitive impairment (CRCI) is a distressing and disabling side-effect of cancer treatments affecting up to 75% of patients. For some patients, their cognitive impairment may be transient, but for a subgroup, these symptoms can be long-standing and have a major impact on the quality of life. This paper describes the protocol for a study: (1) to assess the feasibility of collecting longitudinal data on cognition via self-report, neuropsychological testing, peripheral markers of inflammation and neuroimaging and (2) to explore and describe patterns of cancer-related cognitive impairment over the course of treatment and recovery in patients with newly diagnosed, aggressive lymphoma undergoing standard therapy with curative intent.Methods and analysisThis is a prospective, longitudinal, feasibility study in which 30 newly diagnosed, treatment-naive patients with aggressive lymphoma will be recruited over a 12-month period. Patients will complete comprehensive assessments at three time points: baseline (time 1, pre-treatment) and two post-baseline follow-up assessments (time 2, mid-treatment and time 3, 6–8 weeks post-treatment completion). All patients will be assessed for self-reported cognitive difficulties and objective cognitive function using Stroop Colour and Word, Trail Making Test Part A and B, Hopkins Verbal Learning Test-Revised, Controlled Oral Word Association and Digit Span. Blood cell-based inflammatory markers and neuroimaging including a positron emission tomography (PET) with 18F-labelled fluoro-2-deoxyglucose (18F-FDG) and CT (18F-FDG-PET/CT) and a MRI will explore potential inflammatory and neuroanatomical or functional mechanisms and biomarkers related to CRCI. The primary intent of analysis will be to assess the feasibility of collecting longitudinal data on cognition using subjective reports and objective tasks from patients during treatment and recovery for lymphoma. These data will inform the design of a larger-scale investigation into the patterns of cognitive change over the course of treatment and recovery, adding to an underexplored area of cancer survivorship research.Ethics and disseminationEthical approval has been granted by Austin Health Human Rights Ethics Committee (HREC) in Victoria Australia. Peer reviewed publications and conference presentations will report the findings of this novel study.Trial registration numberAustralian New Zealand Clinical Trials Registry (ACTRN12619001649101).
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Seymour, John F. "Ovarian tissue cryopreservation for cancer patients: who is appropriate?" Reproduction, Fertility and Development 13, no. 1 (2001): 81. http://dx.doi.org/10.1071/rd00075.
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In recent decades there has been parallel progress in the fields of cancer chemotherapy and reproductive medicine technology, which has led to increasing numbers of women surviving their malignancies, often with significant reproductive impairment, and a range of choices for the potential preservation of fertility, including storage of embryos, mature oocytes, immature oocytes or ovarian tissue. Although each of these procedures has specific relative advantages and disadvantages, there are no clear guidelines for selection of patients for such interventions. There are six distinct issues that should be considered before making any recommendations regarding the appropriateness of any of the range of measures aimed at enhancing the future reproductive capacity of the patient: (1) the risk of sterility with the proposed treatment program; (2) the overall prognosis for the patient; (3) the potential risks of delaying chemotherapy; (4) the impact of any future pregnancy upon the risk of tumour recurrence; (5) the impact of any required hormonal manipulation on the tumour itself; and (6) the possibility of tumour contamination of the harvested tissue. For illustrative purposes, it is reasonable to assume that the preservation of future fertility is likely to be a priority for women under the age of 40 years. Within this group in 1996 in the Australian State of Victoria (total population, ˜4.6 million), there were 837 cases of cancer diagnosed (annual incidence rate, ˜60 per 100 000 population). Of those afflicted, it is estimated that 10% were pre-pubertal, 38% were treated by potentially curative surgery alone, 15% had cancers of the reproductive tract, and 5% were treated with palliative intent. Thus the remaining 32% of patients with invasive cancer in this age group (267 per year) are potentially curable, and require initial treatment, including chemotherapy. These tumours comprise predominantly breast cancer (161 cases or 19%), sarcomas of bone and soft-tissue (32 cases or 4%), and the haematologic malignancies (Hodgkin’s disease, non-Hodgkin’s lymphomas, and the leukaemias, each approximately 25 cases or 3%). Consideration of procedures that may preserve future fertility would be appropriate in this group of patients. Current data relating to the six issues noted earlier using contemporary treatment programmes will be presented and discussed as they apply to each of these categories of patient. An understanding of the relative importance of each of these factors to patients with a range of malignancies will facilitate the safe and appropriate application of the available methods to maintain the possibility of future child-bearing.
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Barry, Lucinda, Leanne Storer, and Meron Pitcher. "The impact of a breast cancer diagnosis on women’s work status." Journal of Clinical Oncology 36, no. 7_suppl (March 1, 2018): 23. http://dx.doi.org/10.1200/jco.2018.36.7_suppl.23.
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23 Background: The diagnosis and treatment of cancer often causes financial stress, partly by impacting on the ability to continue in paid employment. Our aim was to identify changes in work status 12 months after a diagnosis of breast cancer. Methods: An audit of the medical records of women who presented to the Western Health (Victoria, Australia) nurse led breast cancer Survivorship Clinic (SC) between October 2015 and October 2016 was performed to identify employment status at diagnosis and at their review at SC 12 months later. Results: 111 records were reviewed. The mean age was 55 (range 28-82yrs). 84 of these women (76%) were 65 years of younger at the time of diagnosis. 46 of the 84 women ≤65 years were in paid employment at diagnosis (55%), and 38 (83%) were still working in some capacity at review in the SC. Of the 38 still working, 28 were working in the same capacity, 8 were working reduced hours, and 2 were working increased hours. Women who had axillary dissections were most likely to have changed work status. Financial stress was reported by 8/19 of women who stopped working or had changed work hours, including 9 no longer in paid employment and 10 with changed hours. 2/28 women working in the same capacity reported financial stress. 65% of those who reported financial stress (11/17) had chemotherapy as part of their treatment. Conclusions: A breast cancer diagnosis has the ability to influence a woman's work status one year after diagnosis. Health professionals should appreciate the potential work concerns and financial stresses continuing to affect their patients.
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Drosdowsky, A., K. Gough, M. Grewal, A. Dabscheck, N. Tebbutt, J. Philip, O. Spruyt, M. Michael, and M. Krishnasamy. "Does Care for Australians With Pancreatic Cancer Compare Favourably to a Consensus-Based Standard of Optimal Care?" Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 82s. http://dx.doi.org/10.1200/jgo.18.58800.
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Background: Pancreatic cancer has one of the lowest survival rates of all cancer types, with an incidence to mortality ratio approaching one. People with pancreatic cancer experience a rapid decline in health characterized by pain, nausea, fatigue and weight loss. For most people, the disease is detected at an advanced stage and the focus of treatment is palliative. In Victoria, Australia, knowledge regarding patterns of care for people with pancreatic cancer is out-of-date, but central to quality improvement initiatives targeting unwarranted variations in care and improvement in supports that are consistent with patient preferences. Aim: Our aim was to compare care received by patients with pancreatic cancer with a consensus-based standard representing optimal care to identify deviations from best practice and highlight processes that may improve the quality and safety of care provided. Methods: Eligible patients included those with pancreatic cancer, first treated in 2015, at one of three tertiary hospitals in Victoria, Australia. Once identified, dates and details of events indicated by the optimal care pathway were extracted from the medical record of each patient. Data were summarized using descriptive statistics and process maps: a visualization method that illuminates gaps, duplication, deviations from best practice and processes that may be amenable to improvement. Results: Thirty-two of 165 care pathways have been mapped to date. The nature and timing of care received appears highly variable. Only nine of 32 patients (28%) received all of their cancer care at a single institution; the remainder (n=23, 72%) received care in multiple tertiary and community facilities. Apart from four (13%) emergency presentations, referrals for specialist care came from general/primary practitioners (n=26, 81%). The timeframe for general/primary practitioner investigations ranged from one to 57 days. Once referred to a tertiary setting, most patients (n=23, 72%) were discussed at a multidisciplinary team meeting and received standard therapies. Only four had resectable disease. Nineteen patients (60%) had documented referrals to hospital- or community-based palliative care services. Where observed, deviations from the consensus-based standard tended to be related to the difficult nature of diagnosing pancreatic cancer, and determining appropriate care for patients with an advanced cancer with nonspecific symptoms. Conclusion: Process mapping provided a useful and efficient means of comparing care received with a consensus-based standard; however, the assessment of adherence to optimal timeframes and specific care events was complicated by missing data. Implications for quality improvement activities will be considered in the context of study limitations. We will also emphasize the importance of engaging patients and carers in setting improvement priorities.
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Pagadala, Meghana, Victoria Wu, Eva Pérez-Guijarro, Hyo Kim, Andrea Castro, James Talwar, Cristian Gonzalez-Colin, et al. "Abstract 3825: Germline modifiers of the tumor immune microenvironment reveal drivers of immunotherapy response." Cancer Research 82, no. 12_Supplement (June 15, 2022): 3825. http://dx.doi.org/10.1158/1538-7445.am2022-3825.
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Abstract With the continued promise of immunotherapy as an avenue for treating cancer, understanding how host genetics contributes to the tumor immune microenvironment (TIME) is essential to tailoring cancer risk screening and treatment strategies. Using genotypes from over 8,000 European individuals in The Cancer Genome Atlas and 137 heritable tumor immune phenotype components (IP components), we identified and investigated 532 TIME-SNPs. Focusing on 77 variants that were relevant to cancer risk, survival, or treatment response, we explored their potential to reveal novel targets for immunotherapy. Many variants overlapped regions with histone marks indicating active transcription, and influenced gene activities in specific immune cell subsets, such as macrophages and dendritic cells. TIME-SNPs implicated genes such as LAIR1, TREX1, CTSS, CTSW and LILRB2 were differentially expressed between responders and non-responders to immune-checkpoint blockade (ICB) in preclinical studies. Of these, LILRB2 and LAIR1 have already been identified as putative targets for immunotherapy. Here we found that inhibition of CTSS led to better tumor control and survival in murine models, alone or in combination with anti-PD-1. Collectively we show that through an integrative approach, it is possible to link host genetics to TIME characteristics, informing novel biomarkers for cancer risk and target identification in immunotherapy. Citation Format: Meghana Pagadala, Victoria Wu, Eva Pérez-Guijarro, Hyo Kim, Andrea Castro, James Talwar, Cristian Gonzalez-Colin, Steven Cao, Benjamin J. Schmiedel, Timothy Sears, Shervin Goudarzi, Divya Kirani, Rany M. Salem, Gerald P. Morris, Olivier Harismendy, Sandip P. Patel, Jill P. Mesirov, Maurizio Zanetti, Chi-Ping Day, Chun C. Fan, Wesley K. Thompson, Glenn Merlino, J. Silvio Gutkind, Pandurangan Vijayanand, Hannah Carter. Germline modifiers of the tumor immune microenvironment reveal drivers of immunotherapy response [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3825.
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Bibi, Rabia, Mishal Liaqat, Kalsoom Bibi, Iram Liaqat, and Yasmeen Akhtar. "Rare Periampullary Carcinoma: A Case Report." Pakistan Journal of Medical and Health Sciences 16, no. 5 (May 26, 2022): 210–11. http://dx.doi.org/10.53350/pjmhs22165210.
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Periampullary carcinoma is usually used to define a heterogeneous group of neoplasms raised on the head of the pancreas, duodenum, and distal common bile duct. Most of the periampullary growths are adenocarcinomas. Timely diagnosis and successful surgical treatment are dependent on the first physician. A 60 years old male patient was presented to medical outpatients of Bahawal Victoria Hospital Bahawalpur in October 2019 with a rare etiology of unexpected vomiting, nausea, fatigue, weight loss, and abdominal cramps for 12 days continuously. Abdominal ultrasound revealed a hypo-echoic mass with a measurement of 2.6x2.7cm on the head of the pancreasobstructingthe distal common bile duct with mild intrahepatic cholestasis. Based on physical examination signs& symptoms and lab investigations patient was considered of having periampullary cancer and a prompt Whipple plan was prepared. The vigilance of the physician and support of the patient’s family helped to make an early decision of pancreatoduodenectomy of the patient before the multi nodulation of the tumor hence, increased the life expectancy. Keywords: Periampullary, Whipple Plan, Pancreatoduodenectomy, Pancreatic Cancer.
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Alekseeva, T. V., and M. A. Alekseeva. "COMPARATIVE EFFECTIVENESS OF HEPATOPROTECTIVE AGENTS IN TREATMENT OF HEPATOSIS IN DOG." Scientific Life 15, no. 11 (2020): 1527–33. http://dx.doi.org/10.35679/1991-9476-2020-15-11-1527-1533.
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The article presents the results of testing twelve promising hybrids (six combinations) in nurseries of competitive testing (1 and 2 years) in the conditions of Central Yakutia, conducted in 2018–2019. (the characteristics of weather conditions are presented). All of them belong to the group of early maturing and mid-early (55-70 days): 216 (Dachny × 128-6), 239-1, 239-2, 239-3 (Ladoga × Rosalind), 233, 233-2 (Slavyanka × Rosalind ), 237, 237-1 (Northern × Dubrava), 232 (Aurora × Bonus), 234 (Scarlet Sail × Victoria). The evaluation showed that the studied hybrids correspond to the model of the variety in terms of economically valuable traits: they have a high yield, good biochemical parameters, the appearance of the tubers meets the requirements of consumers (small superficial eyes, medium-deep stolon footprint), high keeping quality during storage, tasting assessment of tubers - 4 0 points. The studied samples of hybrids had a yield of 26.0 - 42.0 t / ha, marketability of 92–97%, which makes them economically valuable. The samples differed in the content of dry matter (18.4–22.1%) and starch (9.5–13.4%). The nitrate content in tubers did not exceed the permissible concentration. The studied samples are resistant to the most common diseases of the zone: viral (common mosaic, leaf twisting, curliness, wrinkled mosaic, etc.), macrosporiosis, rhizoctonia, common scab. Based on the results of the studies, potato hybrids 232 (Aurora × Bonus), 233 (Slavyanka × Rosalind) and 239-2 (Ladozhsky x Razolind) were selected for further study and transferred for resistance to the causative agent of cancer and nematodes.
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Ong, Wee Loon, Farshad Foroudi, Susan M. Evans, and Jeremy Laurence Millar. "Management of low-risk prostate cancer in a population-based cohort of Australian men between 2008 and 2016." Journal of Clinical Oncology 37, no. 7_suppl (March 1, 2019): 13. http://dx.doi.org/10.1200/jco.2019.37.7_suppl.13.
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13 Background: The aim of this study is to evaluate the practice pattern of management of NCCN low-risk prostate cancer (LRPC) in a population-based cohort of Australian men. Methods: This is prospective cohort of men captured in Prostate Cancer Outcomes Registry Victoria (PCOR-Vic), who were diagnosed with LRPC between Aug 2008 and Dec 2016. Conservative management was defined as no active treatment (surgery, radiotherapy, or other local therapy) within 12-month of LRPC diagnosis. Chi-squared test for trend was used to evaluate change in practice over time. Multivariate logistics regressions were used to patient-, tumour- and institutional factors influencing the likelihood of conservative management for LRPC. Results: A total of 3238 men with LRPC were identified in the PCOR-Vic database. The median age was 62.6 (range:37-94). The median PSA level was 5.1ng/mL (range: 0.01-9.96). Overall, 1934 (60%) had conservative management, of which 1668 (86%) were documented as being on active surveillance. Of the 1304 (40%) men who active treatment within 12-month of diagnosis, 977 (30%) had surgeries, 289 (9%) had radiotherapy, and 38 (1%) had other local treatment. Overall, there is increasing trend in conservative management for LRPC from 52% in 2009 to 73% in 2016 (P<0.001). In multivariate analyses, age, PSA, clinical stage, institutions and year of diagnosis were all independently associated with conservative management. Men diagnosed in private and regional centres were 26% (95%CI=0.63-0.88, P=0.001) and 40% (95% CI=0.51-0.72, P<0.001) less likely to have conservative management for LRPC. Conclusions: This is the largest Australian series on management of LRPC to date. We observe increasing use of conservative management for LRPC over time, however, there is large institutional variations in care with men diagnosed in private and regional centres more likely to have active local management for LRPC.
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Ruíz, Sofía, Bella Pajares, Maria-Jose Bermejo-Perez, Cristina Roldán Jiménez, Antonio Cuesta Vargas, and Emilio Alba Conejo. "Effect of tailored and supervised therapeutic exercise in metastatic breast cancer patients: A prospective study." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e13075-e13075. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e13075.
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e13075 Background: The safety, feasibility and benefit of physical activity is robust in adjuvant breast cancer, but as far as we know, there is little information on the feasibility and benefit of exercise in women with advanced breast cancer. The objective of our study is to analyze the feasibility and impact on fatigue, quality of life and functionality of an individualized, prospective and supervised exercise program in a group of patients with metastatic breast cancer. Methods: A prospective study on 30 metastatic breast cancer patients who were recruited as volunteers between February 2018 and April 2019 by Medical Oncologists from the Medical Oncology Unit at University Clinical Hospital Virgen de la Victoria (Malaga, Spain). Participants included in this study were patients aged between 34 and 71 years old and all had metastatic breast cancer, not amenable to curative treatment. The intervention was a twelve-week Therapeutic Exercise and Education Programme delivered by a physiotherapist. The intervention was preceded by a physical assessment of the musculoskeletal system. The outcomes were cancer-related fatigue, quality of life and functional outcomes (patient- reported and other measured by investigators). Results: Of the 30 patients initially recruited, only 11 of them completed the program with an attendance greater or equal to 17 sessions (75% of assistance). Most of patients who dropped (19), did it because of personal matters, not related to disease progression. Regarding patients who completed the completion of physical activity program (n = 11), the majority were treated on first line of treatment with hormonal receptors positive tumors and bone metastasis. After the intervention, no major changes were observed in cancer-related fatigue, quality of life and several patients-reported outcomes, although an improvement in functionality was observed, in investigator-measured parameters (30-STS and adapted burpees). Conclusions: Our study shows that a supervised and individualized tailored physical activity program in metastatic breast cancer patients is safe and feasible, although more studies are needed to analyse its impact on improving functional parameters, fatigue and quality of life.
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Tangen-Steffins, Kristin, Nelson Leong, Sally Hodgson, Elizabeth Wambolt, Catherine Hildebrand, Chantalle Willie, Khurram Siddiqui, et al. "Development and evaluation of the TrueNTH-Prostate Cancer Canada electronic Library for Improved (urinary and bowel) Function post Treatment (TrueNTH-PCC-eLIFT)." Journal of Clinical Oncology 34, no. 3_suppl (January 20, 2016): 161. http://dx.doi.org/10.1200/jco.2016.34.3_suppl.161.
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161 Background: The TrueNTH program is a Movember-funded, pan Canadian effort to develop a comprehensive patient-centered online portal in English and French that will cover a full spectrum of prostate cancer survivor needs. Through the support of Prostate Cancer Canada, the TrueNTH-PCC-eLIFT resource, as part of the TrueNTH program, is being developed by a multi-disciplinary team of urologists, radiation oncologists, gastroenterologists, researchers, nurses and survivors at pilot sites in Victoria, BC and London, ON. eLIFT will address urinary and bowel side effects that may be experienced after curative intent treatment by External Beam Radiation Therapy (EBRT), Brachytherapy (BT), combined EBRT + BT or Radical Prostatectomy (RP). Methods: eLIFT includes a didactic electronic library, symptom assessment tool and content tailored to treatment or symptoms experienced. A sequential prospective cohort study is underway to evaluate the impact of the resource. A baseline cohort of eighty patients per site receiving standard of care is currently open. A second cohort of eighty patients per site will be accrued to receive the eLIFT intervention. The study measurespatient self-efficacy, knowledge, Health Related Quality of Life (HRQoL), urinary and bowel function, health resource usage and satisfaction. Results: eLIFT content, with a total of 22 video modules is complete and in production. Preliminary results from the first cohort of patients, receiving standard care, confirm a need for a reliable, online resource in Canada. Patients note that the oral information provided by their oncologist at their preliminary consultation, while informative, is not easily retained. Information that was provided as print varied and was often outdated. Further, patients deem websites outside of Canada as the most reliable and helpful, which may not reflect Canadian recommendations. Conclusions: eLIFT will provide a unique and scalable centralized resource that will allow for expansion to a National level and increase access to a scientifically-sound library of information with the goal of improving the quality of care for prostate cancer patients across Canada.
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Goldstein, David, Ming Sze, Melanie Bell, Madeleine King, Michael Jefford, Maurice Eisenbruch, Afaf Girgis, Lisa Vaccaro, and Phyllis Noemi Butow. "Disparities in quality-of-life outcomes in immigrant cancer patients." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): e16507-e16507. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.e16507.
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e16507 Background: Immigration is increasing world-wide. We explored disparities in quality of life outcomes for immigrant (IM) versus Anglo-Australian (AA) cancer patients having anti-cancer treatment. Methods: In a cross-sectional design, cancer patients were recruited through outpatient Oncology clinics in New South Wales, Victoria, and the Northern Territory in Australia. IM participants, their parents and grand parents were born in a country where Chinese, Greek, or Arabic is spoken and spoke one of those languages. AAs were born in Australia and spoke English. All were diagnosed with cancer < 1 year previously. Questionnaires (completed in preferred language) included the Hospital Anxiety and Depression Scale (anxiety/depression), FACT-G (quality of life) and the Supportive Care Needs Survey (unmet needs). Adjusted regression models comparing AA and IM groups included age, gender, socio-economic status, education, marital status, religion, time since diagnosis, and cancer type (colorectal, breast, lung, other). Results: There were 910 participants (response rate 57%). IM were similar to AA, except that IM were more likely to be married (76 vs 67 %, p = 0.01) and in the low and the highly educated groups (p < 0.0001). In adjusted analyses, IMs had clinically significant higher anxiety, greater unmet information and physical needs and lower quality of life than AAs (see table). The possible ranges are 0-21 for anxiety and depression, and 0-100 otherwise. Conclusions: In this hospital-based study with a high rate of advanced disease, immigrants with cancer experienced poorer quality of life outcomes, even after adjusting for socio-economic, demographic, and disease variables. Interventions are required to improve their experience of cancer care. Results highlight areas of unmet need that might be better addressed by the health system (particularly with regards to provision of information and meeting support and physical needs). [Table: see text]
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Facey, Caroline O., Victoria O. Hunsu, Brian T. Osmond, Lynn M. Opdenaker, and Bruce M. Boman. "Abstract 6068: Restoring the balance between WNT and retinoic acid signaling to promote differentiation of cancer stem cells in treatment of colorectal cancer." Cancer Research 82, no. 12_Supplement (June 15, 2022): 6068. http://dx.doi.org/10.1158/1538-7445.am2022-6068.
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Abstract Given that the stem cell (SC) marker ALDH is a key component of the retinoic acid (RA) signaling pathway and since APC mutation leads to increased WNT signaling and overpopulation of ALDH+ SCs in colorectal cancer (CRC), we hypothesized that human CRC evolves due to an imbalance between dysregulated RA and WNT signaling. Herein, we investigated how to target the link between these two pathways to restore proper WNT and RA signaling, and promote differentiation of CSCs along the neuroendocrine cell (NEC) lineage. Accordingly, we conducted in vitro experiments to determine if restoring wt-APC in APC-mutant CRC cells reduces Wnt/β-catenin signaling, increases sensitivity to retinoids, reduces cell proliferation, reduces expression of stem cell markers, reduces the number of ALDH+ cells, and enhances NEC maturation. We utilized Nanostring profiling, TCF reporter assay, western blot, and fluorescence activated cell sorting analyses to ascertain the effects of restoring WNT in HT29 CRC cells. We found that induction of wt-APC expression decreased WNT/β-catenin signaling and reduced protein expression of WNT-target genes. Notably, inducing wt-APC decreased ATRA-induced expression of the WNT target gene CYP26A1 (by 50%), which is predicted to increase RA signaling by lowering the degradation of RA. Indeed, wt-APC increased sensitivity of CRC cells to ATRA-induced inhibition of cell proliferation in a dose-dependent manner. Expression of ALDH1A1 decreased 3-fold by ATRA treatment and inducing wt-APC furthered the decrease by an additional 2-fold. Furthermore, we found an increase in the protein expression of several NEC markers including CHGA, GLP2R, NSE (ENO2), and SSTR1, and an increased number of GLP2R+ NECs upon inducing wt-APC. Thus, the link between WNT and RA signaling at the level of CYP26A1, provides a mechanism that can explain how mutant APC leads to decreased maturation of ALDH+ SCs along the NEC lineage and an increased number of ALDH+ SCs. Therefore, discovering ways to increase differentiation of SCs along the NEC lineage in vivo might lead to new more effective treatment strategies involving retinoids for CRC patients. Citation Format: Caroline O. Facey, Victoria O. Hunsu, Brian T. Osmond, Lynn M. Opdenaker, Bruce M. Boman. Restoring the balance between WNT and retinoic acid signaling to promote differentiation of cancer stem cells in treatment of colorectal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 6068.
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Ruíz, Sofía, Bella Pajares, Marcos Iglesias Campos, Cristina Roldán Jiménez, Antonio Cuesta Vargas, and Emilio Alba Conejo. "Analysis of the fatigue benefit, functionality, and body composition of a program of therapeutic exercise and healthy lifestyle habits in patients breast cancer operated." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e12533-e12533. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e12533.
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e12533 Background: Numerous studies support the benefit of physical exercise in breast cancer, with a lower rate of fatigue, lower risk of recurrence and greater survival. In addition, it prevents cardiovascular diseases, diabetes and obesity. The objective of this work is to analyze the effect of a program of physical exercise and habits of healthy life on fatigue, functionality and body composition in breast cancer patients of the Medical Oncology Unit of the Hospital Virgen de la Victoria, Malaga. Methods: Prospective study on 97 patients with breast cancer after completing locoregional treatment and systemic chemotherapy. Treatment with hormone therapy and trastuzumab was allowed. All patients were without disease, without cardiovascular history that contraindicated the program and have signed the relevant informed consent. The duration of the program was 3 months and the parameter measurement was performed before and after. The main objective was analyze cancer-related fatigue and secondary functional parameters, anthropometric and adherence to Mediterranean diet. Fatigue, parameters functional and adherence to Mediterranean diet were evaluated by tests specific and anthropometric by different measurements including use of Tanita TBF-300A. Results: 97 patients were recruited, with a median age of 52 years (32 and 69), 60% had received neo/adjuvant chemotherapy, 84% hormonal therapy and 12% trastuzumab. Most patients underwent conservative surgery. (76%). After 3 months of intervention, women improved significantly cancer-related fatigue (p = 0.000), levels of diet adherence Mediterranean (p = 0.000), as well as functional parameters. One was observed statistically significant improvement in limb functionality/mobility upper, lower limb and general functionality (p = 0.005, p = 0.013 and 0.000, respectively). No differences were observed in terms of mass index body, fat mass or lean mass. Conclusions: This study shows the benefit in functionality and fatigue of an exercise program therapeutic and healthy lifestyle habits in breast cancer operated patients. Despite a significant increase in adherence to the Mediterranean diet, it is not they observed differences in anthropometric parameters.
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Iglesias Campos, Marcos, Bella Pajares, Cristina Roldán Jiménez, Maria-Jose Bermejo-Perez, Emilio Alba, and Antonio Cuesta Vargas. "Functional status of patients suffering from ovarian cancer: A cross-sectional study." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): e17556-e17556. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e17556.
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e17556 Background: Physical activity displays multiple benefits in oncology patients, with the strongest evidence related to breast cancer. But there is little information about patient with ovarian cancer, even less in those who are metastatic. The main objective of this study was to assess and describe the performance´s in patients suffering from ovarian cancer in terms of function and cancer-related fatigue (CRF). Methods: Patients willing to join therapeutic exercise program (TEP) were at the Medical Oncology Unit of the Hospital Virgen de la Victoria, Malaga. A physiotherapist carried out an interview and a baseline assessment. The following outcomes were recorded: number of repetitions (n) performed in 30 seconds sit-to-stand test (30-STS), handgrip strength (Kg), cancer related fatigue (CRF) measured by Piper Fatigue Scale (0-10), upper and lower limb function measured by Upper Limb Functional Index (ULFI) and Lower Upper Limb Functional Index (LLFI), respectively (%). Results: Patients recruited had a diagnosed of an advanced ovarian cancer receiving or not active treatment. All participants had a good performance status (PS) and signed informed consent. 8 women were included, with a mean age of 52.66 (9.53) years and a mean BMI of 27.22 (4.56) kg/m2. Women performed 22 (4.24) repetitions of 30-STS test. Handgrip strength was 22 (2.7) Kg and CRF 5.43 (2.91) points. Patients reported 64.81% (34.65) and 66.83% (37.91) in ULFI and LLFI questionnaires, respectively. Conclusions: At the light of these preliminary results, ovarian cancer patients present a good level of function measured by 30-STS and a good grip strength. However, they report a moderate level of CRF and affected upper and lower limbs function. In additions, patients measured had function enough to participate in a therapeutic exercise program. Given the heterogeneity of the sample and its low number of participants, future studies with a wider sample should be carried out.
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Ioannou, Liane J., Jonathan Serpell, Joanne Dean, Cino Bendinelli, Jenny Gough, Dean Lisewski, Julie A. Miller, et al. "Development of a binational thyroid cancer clinical quality registry: a protocol paper." BMJ Open 9, no. 1 (January 2019): e023723. http://dx.doi.org/10.1136/bmjopen-2018-023723.
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IntroductionThe occurrence of thyroid cancer is increasing throughout the developed world and since the 1990s has become the fastest increasing malignancy. In 2014, a total of 2693 Australians and 302 New Zealanders were diagnosed with thyroid cancer, with this number projected to rise to 3650 in 2018. The purpose of this protocol is to establish a binational population-based clinical quality registry with the aim of monitoring and improving the quality of care provided to patients diagnosed with thyroid cancer in Australia and New Zealand.Methods and analysisThe Australian and New Zealand Thyroid Cancer Registry (ANZTCR) aims to capture clinical data for all patients over the age of 16 years with thyroid cancer, confirmed by histopathology report, who have been diagnosed, assessed or treated at a contributing hospital. A multidisciplinary steering committee was formed which, with operational support from Monash University, established the ANZTCR in early 2017. The pilot phase of the registry is currently operating in Victoria, New South Wales, Queensland, Western Australia and South Australia, with over 20 sites expected to come on board across Australia in 2018. A modified Delphi process was undertaken to determine the clinical quality indicators to be reported by the registry, and a minimum data set was developed comprising information regarding thyroid cancer diagnosis, pathology, surgery and 90-day follow-up.Future plansThe establishment of the ANZTCR provides the opportunity for Australia and New Zealand to further understand current practice in the treatment of thyroid cancer and identify variation in outcomes. The engagement of endocrine surgeons in supporting this initiative is crucial. While the pilot registry has a focus on early clinical outcomes, it is anticipated that future collection of longer term outcome data particularly for patients with poor prognostic disease will add significant further value to the registry.
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Devitt, Bianca Alix, Jennifer Philip, Madhu Sudan Singh, Linda R. Mileshkin, and Sue-Anne McLachlan. "Patients’ and health professionals’ perspectives on the outcomes, conduct, and medico-legal implications of multidisciplinary cancer meetings (MDMs)." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): e16562-e16562. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.e16562.
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e16562 Background: Multidisciplinary cancer meetings (MDMs) are a fundamental component of multidisciplinary cancer care. Guidelines relating to their conduct are largely based on expert opinion rather than empirical evidence. We examined patients and health professionals’ (HPs) attitudes to the outcomes, conduct and medico-legal implications of MDMs. Methods: Two study-specific questionnaires were developed based on qualitative research, published literature and guidelines, for health professionals who attend MDMs and patients with a current or previous diagnosis of cancer. The questionnaires were administered at 4 health services encompassing tertiary and regional centres in Victoria, Australia. Results: 170 HPs (response rate 62%) and 110 patients (response rate 83%) completed the questionnaire. 92% of patients want their case discussed at an MDM. HPs believe the focus of MDMs is to consider different treatment modalities (99%) and ensure patients receive evidence-based care (83%) rather than address psychosocial issues (52%). Similarly, patients allocated 71% of MDM discussion time to discussing possible treatment options, 15% to relevant social issues and 14% to psychological issues. More than 70% of patients and HPs thought no formal patient consent was required prior to discussion at MDM. 75% of HPs agreed MDMs provided them with increased medico-legal protection. 93% of HPs thought MDM discussions should result in a consensus on the proposed management plan. Patients would prefer to discuss the outcomes of the MDM personally with their treating doctor (81%) and 75% also desired written documentation. Conclusions: Patients and HPs agree the focus of MDMs is predominately medical with emphasis on treatment planning rather than the psychosocial needs of patients. Both groups believe MDM discussion forms part of standard care and formal consent is not required. HPs aim to develop an individualized, evidence-based management plan, agreed to by consensus. Strategies to improve communication of this plan to patients should be developed. This is the first empirical evidence on MDMs’ conduct and should help inform the development of future guidelines.
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Taha, Hania M., Alexander N. Slade, Betty Schwartz, and Anna E. Arthur. "A Case–Control Study Examining the Association of Fiber, Fruit, and Vegetable Intake and the Risk of Colorectal Cancer in a Palestinian Population." International Journal of Environmental Research and Public Health 19, no. 12 (June 11, 2022): 7181. http://dx.doi.org/10.3390/ijerph19127181.
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While there is an association between Western diets and the incidence of colorectal cancer (CRC), this dietary association has remained unexplored in Palestine. The aim of this study was to examine how fiber and fruit and vegetable (FV) intakes are associated with CRC risk among Palestinian adults. We recruited 528 Palestinians between 2014 and 2016. We identified 118 patients who received CRC treatment at Augusta Victoria Hospital, East Jerusalem. We additionally identified 410 controls who consisted of community-based Palestinians without cancer. All participants completed a survey on demographics and a validated dietary intake food screener. Multivariable logistic regression models tested associations between fiber and FV intakes (categorized into quartiles) with CRC risk. After adjusting for significant covariates (age, sex, education, physical activity, smoking status, BMI, IBD, and family history of CRC), as fibers increased across increasing quartiles, the CRC risk significantly decreased (OR = 0.36, 95% CI: 0.15–0.86, p-trend = 0.02). After adjusting for age and sex, as FV intake increased, the CRC risk significantly decreased (OR = 0.34, 95% CI: 0.15–0.75, p-trend = 0.009). Consumption of fiber-rich foods was inversely associated with CRC risk. Understanding this relationship among Palestinians is essential in order to develop targeted, culturally relevant strategies that may potentially alleviate the burden of CRC.