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Egeler MD, van Leeuwen M, Lai-Kwon J, Eriksson H, Bartula I, Elashwah S, Fox L, Van Hemelrijck M, Jefford M, Lijnsvelt J, Bagge ASL, Morag O, Ny L, Bagge RO, Rogiers A, Saw RPM, Serpentini S, Iannopollo L, Thompson J, Stiller HT, Vanlaer N, van Akkooi ACJ, van de Poll-Franse LV. Understanding quality of life issues in patients with advanced melanoma: Phase 1 and 2 in the development of the EORTC advanced melanoma module. Eur J Cancer 2024; 207:114176. [PMID: 38875843 DOI: 10.1016/j.ejca.2024.114176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 06/05/2024] [Indexed: 06/16/2024]
Abstract
AIMS We aimed to develop a European Organization for Research and Treatment of Cancer (EORTC) Quality of Life (QoL) module tailored for patients with advanced (resectable or unresectable stage III/IV) melanoma receiving immune checkpoint inhibitors or targeted therapy. METHODS Following the EORTC QoL Group module development guidelines, we conducted phases 1 and 2 of the development process. In phase 1, we generated a list of health-related (HR)QoL issues through a systematic literature review and semi-structured interviews with healthcare professionals (HCPs) and patients with advanced melanoma. In phase 2, these issues were converted into questionnaire items to create the preliminary module. RESULTS Phase 1: we retrieved 8006 articles for the literature review, of which 35 were deemed relevant, resulting in 84 HRQoL issues being extracted to create the initial issue list. Semi-structured interviews with 18 HCPs and 28 patients with advanced melanoma resulted in 28 issues being added to the initial issue list. Following EORTC module development criteria, 26 issues were removed, and two issues were added after review by patient advocates. Phase 2: To ensure uniformity and avoid duplication, 16 issues were consolidated into eight items. Additionally, an independent expert contributed one new item, resulting in a preliminary module comprising 80 HRQoL items. CONCLUSION We identified a range of HRQoL issues (dry skin, xerostomia, and arthralgia) relevant to patients with stage III/IV melanoma. Future module development phases will refine the questionnaire. Once completed, this module will enable standardized assessment of HRQoL in patients with (locally) advanced melanoma.
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Affiliation(s)
- M D Egeler
- Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - M van Leeuwen
- Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - J Lai-Kwon
- Department of Medical Oncology and Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - H Eriksson
- Theme Cancer, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology-Pathology, Karolinska Institutet, Sweden
| | - I Bartula
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - S Elashwah
- Medical Oncology Unit, Oncology Center, Mansoura University (OCMU), Egypt
| | - L Fox
- King's College London, London, United Kingdom
| | | | - M Jefford
- Department of Medical Oncology and Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - J Lijnsvelt
- Netherlands Cancer Institute, Department of Medical Oncology, Amsterdam, the Netherlands
| | - A-S Lindqvist Bagge
- Sahlgrenska Center for Cancer Research, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - O Morag
- Sheba Medical Center, The Jusjdman Cancer Center, Ramat-gan, Israel
| | - L Ny
- Sahlgrenska Center for Cancer Research, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - R Olofsson Bagge
- Sahlgrenska Center for Cancer Research, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - A Rogiers
- Department of Medical Oncology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - R P M Saw
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | | | | | - J Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | | | - N Vanlaer
- Sheba Medical Center, The Jusjdman Cancer Center, Ramat-gan, Israel
| | - A C J van Akkooi
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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Ng CA, Luckett T, Mulhern B, Kee D, Lai-Kwon J, Joshua AM. What matters most to people with metastatic uveal melanoma? A qualitative study to inform future measurement of health-related quality of life. Melanoma Res 2024; 34:248-257. [PMID: 38469755 PMCID: PMC11045555 DOI: 10.1097/cmr.0000000000000961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/10/2024] [Indexed: 03/13/2024]
Abstract
Metastatic uveal melanoma (mUM) is a rare cancer with poor prognosis, but novel treatments are emerging. Currently, there are no mUM-specific health-related quality of life (HRQL) questionnaires available for clinical research. We aimed to explore how mUM and its treatment affect HRQL and assess the content validity of existing questionnaires. Participants were patients with mUM and healthcare professionals involved in their care. Qualitative data were collected using semi-structured interviews and focus groups. Data collection and analysis used an integrative approach involving inductive questions/coding to elicit new concepts and deductive questions/coding based on domains of existing HRQL questionnaires. Initial interviews/focus groups focussed on HRQL questionnaires designed for patients with uveal melanoma or liver metastases. As new concepts were elicited, domains and items from other questionnaires were subsequently added. Seventeen patients and 16 clinicians participated. HRQL concerns assessed by uveal melanoma-specific questionnaires were largely resolved by the time of metastasis. The Functional Assessment of Cancer Therapy - Immunotherapy Module (FACT-ICM) adequately captured most immunotherapy-related side effects during initial treatment cycles. However, most patients emphasised emotional impacts over physical ones, focussing on the existential threat posed by disease amidst uncertainty about treatment accessibility and effectiveness. Patients were also concerned with treatment burden, including time commitment, travel, need for hospitalisation, and expenses. The relative importance of HRQL issues varied over time and across treatment modalities, with no single questionnaire being sufficient. Pending further development and psychometric testing, clinical researchers may need to take a modular approach to measuring the HRQL impacts of mUM.
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Affiliation(s)
- Carrie-Anne Ng
- Centre for Health Economics Research and Evaluation (CHERE), Faculty of Health, University of Technology Sydney
| | - Tim Luckett
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, NSW
| | - Brendan Mulhern
- Centre for Health Economics Research and Evaluation (CHERE), Faculty of Health, University of Technology Sydney
| | - Damien Kee
- Department of Medical Oncology, Austin Health
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria
| | - Julia Lai-Kwon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria
- Melanoma Institute Australia, The University of Sydney
| | - Anthony M. Joshua
- Melanoma Institute Australia, The University of Sydney
- The Kinghorn Cancer Centre, Saint Vincent’s Hospital, Darlinghurst, NSW, Australia
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Thompson JR, Fu H, Saw RPM, Sherman KA, Beedle V, Atkinson V, Boyle F, O'Sullivan NA, Martin LK, Bartula I. Supportive care needs in Australian melanoma patients and caregivers: results from a quantitative cross-sectional survey. Qual Life Res 2023; 32:3531-3545. [PMID: 37522941 PMCID: PMC10624748 DOI: 10.1007/s11136-023-03492-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE This study aimed to investigate the supportive care needs of Australian melanoma patients and their caregivers to form the basis for improving services. METHODS General and melanoma-related supportive care needs in melanoma patients were measured using the SCNS-SF34 and SCNS-M12 respectively, whereas caregivers completed the SCNS-P&C. Patients also completed the MCQ-28 and FCRI-9, with all participants completing the QLQ-C30, DASS-21, and questions measuring utilisation and preference for supportive health services. Multivariable stepwise logistic regression was used to identify variables associated with unmet needs in melanoma patients. RESULTS A total of 56 early-stage patients, 100 advanced-stage patients, and 37 caregivers participated. At least three-quarters ([Formula: see text] 75%) of each participant group reported at least one unmet need. Of the ten most reported unmet needs in each participant group, at least six ([Formula: see text] 60%) were related to psychological and emotional well-being, with access to a psychologist the most desired service (> 25%). Fear of cancer recurrence was equally prevalent in both patient groups at a level indicative of need for intervention. Advanced-stage patients reported significantly (p < 0.05) more unmet psychological, physical and daily living, and sexuality needs, and significantly (p < 0.05) worse functioning than early-stage patients. CONCLUSION Australian melanoma patients and caregivers report substantial unmet supportive care needs, particularly regarding their psychological and emotional well-being. Psychological and emotional well-being services, such as access to a clinical psychologist or implementation of patient-reported outcome measures, should be incorporated into routine melanoma care to address unmet patient and caregiver needs and improve well-being.
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Affiliation(s)
- Jake R Thompson
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
- Melanoma Institute Australia, The University of Sydney, 40 Rocklands Road, Wollstonecraft, Sydney, NSW, 2065, Australia.
| | - Hong Fu
- Department of Cancer Services, Princess Alexandra Hospital, University of Queensland, Woolloongabba, QLD, Australia
| | - Robyn P M Saw
- Melanoma Institute Australia, The University of Sydney, 40 Rocklands Road, Wollstonecraft, Sydney, NSW, 2065, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Kerry A Sherman
- School of Psychological Sciences, Macquarie University, Macquarie Park, NSW, Australia
| | | | - Victoria Atkinson
- Department of Cancer Services, Princess Alexandra Hospital, University of Queensland, Woolloongabba, QLD, Australia
| | - Frances Boyle
- Melanoma Institute Australia, The University of Sydney, 40 Rocklands Road, Wollstonecraft, Sydney, NSW, 2065, Australia
- Patricia Ritchie Centre for Cancer Care and Research, Mater Hospital, North Sydney, NSW, Australia
| | - Niamh A O'Sullivan
- Melanoma Institute Australia, The University of Sydney, 40 Rocklands Road, Wollstonecraft, Sydney, NSW, 2065, Australia
| | - Linda K Martin
- Melanoma Institute Australia, The University of Sydney, 40 Rocklands Road, Wollstonecraft, Sydney, NSW, 2065, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Iris Bartula
- Melanoma Institute Australia, The University of Sydney, 40 Rocklands Road, Wollstonecraft, Sydney, NSW, 2065, Australia
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Al‐Rikaby A, Sulaiman A, Thompson JR, Saw RPM, Boyle F, Taylor N, Carlino MS, Morton RL, Nieweg OE, Thompson JF, Bartula I. Telehealth follow-up consultations for melanoma patients during the COVID-19 pandemic: Patient and clinician satisfaction. Cancer Med 2023; 12:21373-21388. [PMID: 37930181 PMCID: PMC10726917 DOI: 10.1002/cam4.6679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 10/05/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic caused rapid implementation of telehealth for melanoma follow-up care in Australia. This study explores Australian melanoma patients and clinicians' level of satisfaction with telehealth. METHODS A cross-sectional study was conducted across three specialist melanoma centres in Sydney, Australia. Melanoma patients (all stages) and clinicians completed mixed methods surveys seeking socio-demographic and clinical information and questionnaires to assess satisfaction with telehealth. Additionally, patients completed measures of quality of life, fear of cancer recurrence and trust in their oncologist. Patients and clinicians provided open-ended responses to qualitative questions about their perceptions of telehealth. RESULTS One hundred and fifteen patients and 13 clinicians responded to surveys. Telephone was used by 109 (95%) patients and 11 (85%) clinicians. Fifty-seven (50%) patients and nine (69%) clinicians preferred face-to-face consultations, 38 (33%) patients and 3 (23%) clinicians preferred a combination of face-to-face and telehealth consultations. Five (4%) patients and nil clinicians preferred telehealth consultations. Patients diagnosed with early-stage melanoma, using telehealth for the first time, who have lower trust in their oncologist, and having higher care delivery, communication and supportive care concerns were likely to report lower satisfaction with telehealth. Open-ended responses were consistent between patients and clinicians, who reported safety, convenience and improved access to care as major benefits, while identifying personal, interpersonal, clinical and system-related disadvantages. DISCUSSION While telehealth has been widely implemented during COVID-19, the benefits identified by patients and clinicians may extend past the pandemic. Telehealth may be considered for use in conjunction with face-to-face consultations to provide melanoma follow-up care.
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Affiliation(s)
- Ali Al‐Rikaby
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Ahmad Sulaiman
- Melanoma Institute AustraliaThe University of SydneyNorth SydneyNew South WalesAustralia
| | - Jake R. Thompson
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Melanoma Institute AustraliaThe University of SydneyNorth SydneyNew South WalesAustralia
| | - Robyn P. M. Saw
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Melanoma Institute AustraliaThe University of SydneyNorth SydneyNew South WalesAustralia
- Department of Melanoma and Surgical OncologyRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
| | - Frances Boyle
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Melanoma Institute AustraliaThe University of SydneyNorth SydneyNew South WalesAustralia
- Patricia Ritchie Centre for Cancer Care and ResearchMater HospitalNorth SydneyNew South WalesAustralia
| | - Nicole Taylor
- Department of Medical OncologyWestmead and Blacktown HospitalsSydneyNew South WalesAustralia
| | - Matteo S. Carlino
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Melanoma Institute AustraliaThe University of SydneyNorth SydneyNew South WalesAustralia
- Department of Medical OncologyWestmead and Blacktown HospitalsSydneyNew South WalesAustralia
| | - Rachael L. Morton
- Melanoma Institute AustraliaThe University of SydneyNorth SydneyNew South WalesAustralia
- NHMRC Clinical Trials Centre, Faculty of Medicine and HealthThe University of SydneyCamperdown, SydneyNew South WalesAustralia
| | - Omgo E. Nieweg
- Melanoma Institute AustraliaThe University of SydneyNorth SydneyNew South WalesAustralia
- Department of Melanoma and Surgical OncologyRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
| | - John F. Thompson
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Melanoma Institute AustraliaThe University of SydneyNorth SydneyNew South WalesAustralia
- Department of Melanoma and Surgical OncologyRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
| | - Iris Bartula
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Melanoma Institute AustraliaThe University of SydneyNorth SydneyNew South WalesAustralia
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Assessment of the perceived burden associated with Malignant Melanoma with Pictorial Representation of Illness and Self Measure (PRISM) and Melanoma Concerns Questionnaire (MCQ-28). Support Care Cancer 2022; 30:3643-3653. [PMID: 35032200 PMCID: PMC8857156 DOI: 10.1007/s00520-021-06760-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/13/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE The impact of malignant melanoma (MM) on patients' psychophysical well-being has been poorly addressed. We aimed to assess the perceived burden in patients with a diagnosis of MM, using two different tools, one generic and one specific for MM, such as Pictorial Representation of Illness and Self Measure (PRISM) and Melanoma Concerns Questionnaire (MCQ-28), respectively. The correlation between PRISM and MCQ-28 subscales and the relevance of disease and patient-related variables were also investigated. METHODS This single-centre, cross-sectional study included all adult consecutive MM patients who attended our Dermatology Unit from December 2020 to June 2021. Demographics and disease-related data were recorded. PRISM and MCQ-28 were administered. RESULTS One hundred and seventy-one patients were included (mean age: 59.5 ±14.9 years.; 48.0% males). Median time from MM diagnosis to inclusion was 36 months. Nearly 80% of the patients had in situ or stage I MM. Overall, 22.2% of the patients reported a PRISM score <100mm and similar percentages provided scores indicating impaired quality of life, as assessed with MCQ-28 subscales. A weak, albeit significant, correlation was found between PRISM scores and ACP, CON and SOC2 subscales. The most relevant association found was that between lower PRISM scores and higher-stage MM. CONCLUSIONS In the study population, mostly affected with superficial MM, their perception of the burden associated with MM did not appear either particularly dramatic or disabling. PRISM seems a reliable system for capturing and quantifying the domains correlated with the emotive dimension of MM, especially MM-related concerns and willingness to face life.
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Blood Z, Tran A, Caleo L, Saw R, Dieng M, Shackleton M, Soyer HP, Arnold C, Mann GJ, Morton RL. Implementation of patient-reported outcome measures and patient-reported experience measures in melanoma clinical quality registries: a systematic review. BMJ Open 2021; 11:e040751. [PMID: 33574144 PMCID: PMC7880114 DOI: 10.1136/bmjopen-2020-040751] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To identify patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) in clinical quality registries, for people with cutaneous melanoma, to inform a new Australian Melanoma Clinical Outcomes Registry; and describe opportunities and challenges of routine PROM/PREM collection, especially in primary care. DESIGN Systematic review. PRIMARY AND SECONDARY OUTCOME MEASURES Which PROMs and PREMs are used in clinical quality registries for people with cutaneous melanoma, how they are collected, frequency of collection, participant recruitment methods and funding models for each registry. RESULTS 1134 studies were identified from MEDLINE, PreMEDLINE, Embase, PsychInfo, Cochrane Database of Abstracts of Reviews of Effects databases and TUFTS Cost-Effectiveness Analysis Registry, alongside grey literature, from database inception to 5th February 2020. Following screening, 14 studies were included, identifying four relevant registries: Dutch Melanoma Registry, Adelphi Real-World Disease-Specific Programme (Melanoma), Patient-Reported Outcomes Following Initial treatment and Long-term Evaluation of Survivorship Registry, and Cancer Experience Registry. These used seven PROMs: EuroQol-5 Dimensions, Functional Assessment of Cancer-General (FACT-G) and FACT-Melanoma (FACT-M), European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Cancer 30 (EORTC QLQ-C30), Fatigue Assessment Scale Hospital Anxiety and Depression Scale, Patient-Reported Outcome Measures Information System-29 and one PREM; EORTC QLQ-Information Module 26. PROMs/PREMs in registries were reported to improve transparency of care; facilitate clinical auditing for quality assessment; enable cost-effectiveness analyses and create large-scale research platforms. Challenges included resource burden for data entry and potential collection bias toward younger, more affluent respondents. Feedback from patients with melanoma highlighted the relevance of PROMs/PREMs in assessing patient outcomes and patient experiences. CONCLUSIONS Clinical registries indicate PROMs/PREMs for melanoma care can be incorporated and address important gaps, however cost and collection bias may limit generalisability. PROSPERO REGISTRATION NUMBER CRD42018086737.
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Affiliation(s)
- Zachary Blood
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Anh Tran
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Lauren Caleo
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Robyn Saw
- Melanoma Institute Australia, North Sydney, New South Wales, Australia
| | - Mbathio Dieng
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Shackleton
- Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - H Peter Soyer
- The University of Queensland Diamantina Institute, Dermatology Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Chris Arnold
- Skin Health Institute, Melbourne, Victoria, Australia
- BioGrid Australia, Parkville, Victoria, Australia
| | - Graham J Mann
- Western Clinical School, Westmead Millennium Institute, The University of Sydney, Sydney, New South Wales, Australia
- John Curtin School of Medical Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
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