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Karnchanachari N, Milton S, Muhlen-Schulte T, Scarborough R, Holland JF, Walter FM, Zalcberg J, Emery J. The SYMPTOM-upper gastrointestinal study: A mixed methods study exploring symptom appraisal and help-seeking in Australian upper gastrointestinal cancer patients. Eur J Cancer Care (Engl) 2022; 31:e13605. [PMID: 35523160 PMCID: PMC9542126 DOI: 10.1111/ecc.13605] [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: 09/16/2021] [Revised: 01/20/2022] [Accepted: 04/18/2022] [Indexed: 11/29/2022]
Abstract
Objective There is limited evidence on the development of pancreatic and oesophagogastric cancer, how patients decide to seek help and the factors impacting help‐seeking. Our study, the first in Australia, aimed to explore symptom appraisal and diagnostic pathways in these patients. A secondary aim was to examine the potential to recruit cancer patients through a cancer quality registry. Methods Patients diagnosed with pancreatic or oesophagogastric cancer were recruited through Monash University's Upper‐Gastrointestinal Cancer Registry. Data collected through general practitioners (GP) and patient questionnaires included symptoms and their onset, whereas patient interviews focused on the patient's decision‐making in seeking help from healthcare pracitioners. Data collection and analysis was informed by the Aarhus statement. Coding was inductive, and themes were mapped onto the Model of Pathways to Treatment. Results Between November 2018 and March 2020, 27 patient questionnaires and 13 phone interviews were completed. Prior to diagnosis, patients lacked awareness of pancreatic and oesophagogastric cancer symptoms, leading to the normalisation, dismissal and misattribution of the symptoms. Patients initially self‐managed symptoms, but worsening of symptoms and jaundice triggered help‐seeking. Competing priorities, beliefs about illnesses and difficulties accessing healthcare delayed help‐seeking. Conclusion Increased awareness of insidious pancreatic and oesophagogastric cancer symptoms in patients and general practitioners may prompt more urgent investigations and lead to earlier diagnosis.
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Affiliation(s)
- Napin Karnchanachari
- Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
| | - Shakira Milton
- Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
| | - Tjuntu Muhlen-Schulte
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Riati Scarborough
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia.,Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Jennifer F Holland
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Fiona M Walter
- Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia.,The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - John Zalcberg
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jon Emery
- Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
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2
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Martins T, Walter FM, Penfold C, Abel G, Hamilton W. Primary care use by men with symptoms of possible prostate cancer: A multi-method study with an ethnically diverse sample in London. Eur J Cancer Care (Engl) 2021; 30:e13482. [PMID: 34152656 DOI: 10.1111/ecc.13482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/15/2021] [Accepted: 05/31/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study is to investigate primary care use by men with recent onset of lower urinary tract symptoms (LUTS) to identify differences in presentation and investigation that may explain ethnic inequality in prostate cancer outcomes. METHODS This is a multi-method study of men presenting LUTS to primary care. Two hundred seventy-four men completed a self-administered questionnaire, and 23 participated in face-to-face interviews. Regression analyses investigated ethnic differences in (a) the period between symptom onset and first primary care presentation (patient interval) and (b) the interval between first primary care presentation and investigation with prostate-specific antigen (PSA) and digital rectal examination (DRE). Interview data were analysed using thematic analysis. RESULTS Half (144, 53%) reported a solitary first symptom, although multiple first symptoms were also common, particularly in Asian and Black men. There was no difference between ethnicities in patient interval or time from presentation to investigation. However, Asian men were offered less PSA testing (odds ratio 0.39; 95% confidence interval 0.17-0.92; p = 0.03). Qualitative data revealed ethnic differences in general practitioners' offer of DRE and PSA testing and highlighted limitations in doctor-patient communication and safety netting. CONCLUSION Our study showed only small differences in primary care experiences, insufficient to explain ethnic inequalities in prostate cancer outcomes.
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Affiliation(s)
- Tanimola Martins
- College of Medicine and Health, University of Exeter-College House St Luke's Campus, Exeter, UK
| | - Fiona M Walter
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Clarissa Penfold
- Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute of Palliative Care, London, UK
| | - Gary Abel
- College of Medicine and Health, University of Exeter-College House St Luke's Campus, Exeter, UK
| | - William Hamilton
- College of Medicine and Health, University of Exeter-College House St Luke's Campus, Exeter, UK
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3
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Muthusamy A, Long D, Underhill CR. Improving recruitment to clinical trials for regional and rural cancer patients through a regionally based clinical trials network. Med J Aust 2021; 214:453-454.e1. [PMID: 33990964 DOI: 10.5694/mja2.51078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Donna Long
- Regional Trials Network Victoria, Albury, NSW
| | - Craig R Underhill
- Border Medical Oncology, Albury, NSW.,Rural Clinical School, UNSW, Albury, NSW
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4
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Clark JM, Boffa DJ, Meguid RA, Brown LM, Cooke DT. Regionalization of esophagectomy: where are we now? J Thorac Dis 2019; 11:S1633-S1642. [PMID: 31489231 DOI: 10.21037/jtd.2019.07.88] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The morbidity and mortality benefits of performing high-risk operations in high-volume centers by high-volume surgeons are evident. Regionalization is a proposed strategy to leverage high-volume centers for esophagectomy to improve quality outcomes. Internationally, regionalization occurs under national mandates. Those mandates do not exist in the United States and spontaneous regionalization of esophagectomy has only modestly occurred in the U.S. Regionalization must strike a careful balance and not limit access to optimal oncologic care to our most vulnerable cancer patient populations in rural and disadvantaged socioeconomic areas. We reviewed the recent literature highlighting: the justification of hospital and surgeon annual esophagectomy volumes for regionalization; how safety performance metrics could influence regionalization; whether regionalization is occurring in the US; what impact regionalization may have on esophagectomy costs; and barriers to patients traveling to receive oncologic treatment at regionalized centers of excellence.
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Affiliation(s)
- James M Clark
- Section of General Thoracic Surgery, Department of Surgery, University of California, Davis Health, Sacramento, CA, USA
| | - Daniel J Boffa
- Section of Thoracic Surgery, Department of Surgery, Yale New Haven Hospital, New Haven, CT, USA
| | - Robert A Meguid
- Division of Thoracic Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lisa M Brown
- Section of General Thoracic Surgery, Department of Surgery, University of California, Davis Health, Sacramento, CA, USA
| | - David T Cooke
- Section of General Thoracic Surgery, Department of Surgery, University of California, Davis Health, Sacramento, CA, USA
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5
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Ritter AJ, Goldstein JS, Ayers AA, Flowers CR. Rural and urban patients with diffuse large B-cell and follicular lymphoma experience reduced overall survival: a National Cancer DataBase study. Leuk Lymphoma 2019; 60:1656-1667. [PMID: 30632824 PMCID: PMC6594869 DOI: 10.1080/10428194.2018.1546855] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 10/31/2018] [Indexed: 12/27/2022]
Abstract
We examined 83,108 patients with diffuse large B-cell lymphoma (DLBCL) and 43,393 patients with follicular lymphoma (FL) to investigate disparities related to geographic population density, stratified as rural, urban, or metropolitan. We found that urban and rural patients less commonly had private insurance and high socioeconomic status. Urban and rural DLBCL patients were more likely to receive treatment within 14 days of diagnosis (OR 0.93, 95% confidence interval [CI] 0.89-0.98; and OR 0.81, 95% CI 0.72-0.91) while urban FL patients were more likely to have treatment >14 days after diagnosis (OR 1.08, 95% CI 1.01-1.16). Multivariable analyses demonstrated that rural and urban patients had worse overall survival with DLBCL (hazard ratio [HR] 1.09; 95% CI 1-1.19 and HR 1.08; 95% CI 1.04-1.11) and FL (HR 1.11; 95% CI 1.04-1.18 and HR 1.2; 95% CI 1.02-1.41), respectively, suggesting needs for focused study and interventions for these populations.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Cities
- Databases, Factual
- Female
- Follow-Up Studies
- Georgia/epidemiology
- Humans
- Lymphoma, Follicular/epidemiology
- Lymphoma, Follicular/mortality
- Lymphoma, Follicular/pathology
- Lymphoma, Large B-Cell, Diffuse/epidemiology
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Prognosis
- Retrospective Studies
- Rural Population/statistics & numerical data
- Social Class
- Survival Rate
- Urban Population/statistics & numerical data
- Young Adult
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Affiliation(s)
| | | | - Amy A Ayers
- b Winship Cancer Institute , Atlanta , GA , USA
| | - Christopher R Flowers
- b Winship Cancer Institute , Atlanta , GA , USA
- c Department of Hematology and Medical Oncology , Emory University School of Medicine , Atlanta , GA , USA
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6
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Availability and use of cancer decision-support tools: a cross-sectional survey of UK primary care. Br J Gen Pract 2019; 69:e437-e443. [PMID: 31064743 PMCID: PMC6592323 DOI: 10.3399/bjgp19x703745] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 11/26/2018] [Indexed: 12/13/2022] Open
Abstract
Background Decision-support tools quantify the risk of undiagnosed cancer in symptomatic patients, and may help GPs when making referrals. Aim To quantify the availability and use of cancer decision-support tools (QCancer® and risk assessment tools) and to explore the association between tool availability and 2-week-wait (2WW) referrals for suspected cancer. Design and setting A cross-sectional postal survey in UK primary care. Methods Out of 975 UK randomly selected general practices, 4600 GPs and registrars were invited to participate. Outcome measures included the proportions of UK general practices where cancer decision-support tools are available and at least one GP uses the tool. Weighted least-squares linear regression with robust errors tested the association between tool availability and number of 2WW referrals, adjusting for practice size, sex, age, and Index of Multiple Deprivation. Results In total, 476 GPs in 227 practices responded (response rates: practitioner, 10.3%; practice, 23.3%). At the practice level, 83/227 (36.6%, 95% confidence interval [CI] = 30.3 to 43.1) practices had at least one GP or registrar with access to cancer decision-support tools. Tools were available and likely to be used in 38/227 (16.7%, 95% CI = 12.1 to 22.2) practices. In subgroup analyses of 172 English practices, there was no difference in mean 2WW referral rate between practices with tools and those without (mean adjusted difference in referrals per 100 000: 3.1, 95% CI = −5.5 to 11.7). Conclusion This is the first survey of cancer decision-support tool availability and use. It suggests that the tools are an underused resource in the UK. Given the cost of cancer investigation, a randomised controlled trial of such clinical decision-support aids would be appropriate.
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Philip PM, Kannan S, Parambil NA. Community-based interventions for health promotion and disease prevention in noncommunicable diseases: A narrative review. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2018; 7:141. [PMID: 30596113 PMCID: PMC6282482 DOI: 10.4103/jehp.jehp_145_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/04/2018] [Indexed: 06/07/2023]
Abstract
PURPOSE Noncommunicable disease (NCD) prevention is emerging as a public health priority in developing countries. For better health outcome in these countries, it is necessary to understand the different community-based interventions developed and implemented across the world. OBJECTIVE The objective of the current review is to identify the best strategies used in community-based health intervention (CBHI) programs across the world. MATERIALS AND METHODS For review, we searched in PubMed and Google Scholar with the keywords "community based," "health interventions," "health promotions," "primary prevention," chronic diseases," "lifestyle-related diseases," and "NCD." Data were extracted using predesigned data extraction form. CBHI studies detailing their intervention strategies only were included in the review. RESULTS Out of 35 articles reviewed, 14 (40%) were randomized control trials, while 18 (51.4%) were quasi-experimental design. Individual level (n = 14), group level (n = 5), community level (n = 6), and policy level (n = 4) intervention strategies were identified. Twenty-three (64%) studies were based on interventions for 1 year and above. Twenty-eight (80%) studies were intervened among specific populations such as Latinos and so on. CONCLUSION Successful programs advocate for a package or a chain of interventions than a single intervention. The type of interventions at different levels, namely individual, group, community, and policy levels vary across studies, but individual, and group level interventions are more frequently used.
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Affiliation(s)
- Phinse Mappalakayil Philip
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Srinivasan Kannan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Neetu Ambali Parambil
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Telehealth in radiation oncology at the Townsville Cancer Centre: Service evaluation and patient satisfaction. Clin Transl Radiat Oncol 2018; 15:20-25. [PMID: 30582017 PMCID: PMC6293044 DOI: 10.1016/j.ctro.2018.11.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 11/16/2018] [Accepted: 11/17/2018] [Indexed: 12/14/2022] Open
Abstract
Telehealth serviced a range of ages, cancer diagnoses and treatment intents. Tele-radiation oncology consultations reduced travel and time burden for patients. Patients reported an overall high level of satisfaction with telehealth consultation.
Purpose Telehealth (TH) in Radiation Oncology at Townsville Cancer Centre (TCC) was implemented in July 2011 to provide cancer care closer to home to the regional and rural population. The aim of this study was to describe the service use and patient satisfaction. Materials and methods A retrospective audit of records was conducted for patients treated at TCC between July 2011 and December 2015. Data included patient demographics, diagnosis and treatment. Results of a patient satisfaction survey were summarised through descriptive statistics. Results A total of 1530 TH consultations were provided to 833 patients. 311 patient charts were audited (615 TH, 650 in-person, 151 phone consultations). Median distance from TCC to satellites was 327.3 km (21.6 to 1130.1). 71% were male and median age was 65 (23–94 years). Cancer diagnoses included prostate (32%), breast (12%) and head and neck (10%). 60% of patients underwent radiation therapy for curative intent, 22% palliative and 18% did not undergo treatment. 106 patients participated in the satisfaction survey (231 patients invited, response rate of 46%), with the overall positive response mainly attributed to advantages in travel and time savings. 54.7% of patients selected TH as their preference for future consultations, 34.9% indicated a mix of TH and in-person consultations, and only 1 patient (0.9%) indicating in-person only. Conclusion TH enables the delivery of radiation oncology consultations to rural and regional patients, with an overall high level of patient satisfaction. Patients welcomed the model for benefits of travel and time savings. Future directions include engaging with specialist, rural medical staff and patients to maximize access.
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9
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Pathways to Lung Cancer Diagnosis: A Qualitative Study of Patients and General Practitioners about Diagnostic and Pretreatment Intervals. Ann Am Thorac Soc 2018; 14:742-753. [PMID: 28222271 DOI: 10.1513/annalsats.201610-817oc] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
RATIONALE Pathways to lung cancer diagnosis and treatment are complex. International evidence shows significant variations in pathways. Qualitative research investigating pathways to lung cancer diagnosis rarely considers both patient and general practitioner views simultaneously. OBJECTIVES To describe the lung cancer diagnostic pathway, focusing on the perspective of patients and general practitioners about diagnostic and pretreatment intervals. METHODS This qualitative study of patients with lung cancer and general practitioners in Australia used qualitative interviews or a focus group in which participants responded to a semistructured questionnaire designed to explore experiences of the diagnostic pathway. The Model of Pathways to Treatment (the Model) was used as a framework for analysis, with data organized into (1) events, (2) processes, and (3) contributing factors for variations in diagnostic and pretreatment intervals. RESULTS Thirty participants (19 patients with lung cancer and 11 general practitioners) took part. Nine themes were identified during analysis. For the diagnostic interval, these were: (1) taking patient concerns seriously, (2) a sense of urgency, (3) advocacy that is doctor-driven or self-motivated, and (4) referral: "knowing who to refer to." For the pretreatment interval, themes were: (5) uncertainty, (6) psychosocial support for the patient and family before treatment, and (7) communication among the multidisciplinary team and general practitioners. Two cross-cutting themes were: (8) coordination of care and "handing over" the patient, and (9) general practitioner knowledge about lung cancer. Events were perceived as complex, with diagnosis often being revealed over time, rather than as a single event. Contributing factors at patient, system, and disease levels are described for both intervals. CONCLUSIONS Patients and general practitioners expressed similar themes across the diagnostic and pretreatment intervals. Significant improvements could be made to health systems to facilitate better patient and general practitioner experiences of the diagnostic pathway. This novel presentation of patient and general practitioner perspectives indicates that systemic interventions have a role in timely and appropriate referrals to specialist care and coordination of investigations. Systemic interventions may alleviate concerns about urgency of diagnostic workup, communication, and coordination of care as patients transition from primary to specialist care.
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10
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Croager EJ, Gray V, Pratt IS, Slevin T, Pettigrew S, Holman CD, Bulsara M, Emery J. Find Cancer Early: Evaluation of a Community Education Campaign to Increase Awareness of Cancer Signs and Symptoms in People in Regional Western Australians. Front Public Health 2018; 6:22. [PMID: 29473031 PMCID: PMC5809399 DOI: 10.3389/fpubh.2018.00022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 01/22/2018] [Indexed: 12/13/2022] Open
Abstract
Introduction Cancer outcomes for people living in rural and remote areas are worse than for those living in urban areas. Although access to and quality of cancer treatment are important determinants of outcomes, delayed presentation has been observed in rural patients. Methods Formative research with people from rural Western Australia (WA) led to the Find Cancer Early campaign. Find Cancer Early was delivered in three regions of WA, with two other regions acting as controls. Staff delivered the campaign using a community engagement approach, including promotion in local media. Television communications were not used to minimize contamination in the control regions. The campaign evaluation was undertaken at 20 months via a computer-assisted telephone interview (CATI) survey comparing campaign and control regions. The primary outcome variable was knowledge of cancer signs and symptoms. Results Recognition and recall of Find Cancer Early and symptom knowledge were higher in the campaign regions. More than a quarter of those who were aware of the campaign reported seeing the GP as a result of their exposure. Conclusion Despite limited use of mass media, Find Cancer Early successfully improved knowledge of cancer symptoms and possibly led to changes in behavior. Social marketing campaigns using community development can raise awareness and knowledge of a health issue in the absence of television advertising.
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Affiliation(s)
| | - Victoria Gray
- University of Western Australia, Perth, WA, Australia
| | - Iain Stephen Pratt
- Cancer Council Western Australia, Subiaco, WA, Australia.,Western Australian Cancer Prevention Research Unit, Curtin University, Perth, WA, Australia
| | - Terry Slevin
- Cancer Council Western Australia, Subiaco, WA, Australia.,Western Australian Cancer Prevention Research Unit, Curtin University, Perth, WA, Australia
| | - Simone Pettigrew
- Western Australian Cancer Prevention Research Unit, Curtin University, Perth, WA, Australia
| | | | - Max Bulsara
- University of Notre Dame Australia, Fremantle, WA, Australia
| | - Jon Emery
- University of Melbourne, Melbourne, VIC, Australia
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11
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Emery JD, Gray V, Walter FM, Cheetham S, Croager EJ, Slevin T, Saunders C, Threlfall T, Auret K, Nowak AK, Geelhoed E, Bulsara M, Holman CDJ. The Improving Rural Cancer Outcomes Trial: a cluster-randomised controlled trial of a complex intervention to reduce time to diagnosis in rural cancer patients in Western Australia. Br J Cancer 2017; 117:1459-1469. [PMID: 28926528 PMCID: PMC5680459 DOI: 10.1038/bjc.2017.310] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 07/19/2017] [Accepted: 08/14/2017] [Indexed: 11/28/2022] Open
Abstract
Background: Rural Australians have poorer survival for most common cancers, due partially to later diagnosis. Internationally, several initiatives to improve cancer outcomes have focused on earlier presentation to healthcare and timely diagnosis. We aimed to measure the effect of community-based symptom awareness and general practice-based educational interventions on the time to diagnosis in rural patients presenting with breast, prostate, colorectal or lung cancer in Western Australia. Methods: 2 × 2 factorial cluster randomised controlled trial. Community Intervention: cancer symptom awareness campaign tailored for rural Australians. GP intervention: resource card with symptom risk assessment charts and local cancer referral pathways implemented through multiple academic detailing visits. Trial Area A received the community symptom awareness and Trial Area B acted as the community campaign control region. Within both Trial Areas general practices were randomised to the GP intervention or control. Primary outcome: total diagnostic interval (TDI). Results: 1358 people with incident breast, prostate, colorectal or lung cancer were recruited. There were no significant differences in the median or ln mean TDI at either intervention level (community intervention vs control: median TDI 107.5 vs 92 days; ln mean difference 0.08 95% CI −0.06–0.23 P=0.27; GP intervention vs control: median TDI 97 vs 96.5 days; ln mean difference 0.004 95% CI −0.18–0.19 P=0.99). There were no significant differences in the TDI when analysed by factorial design, tumour group or sub-intervals of the TDI. Conclusions: This is the largest trial to test the effect of community campaign or GP interventions on timeliness of cancer diagnosis. We found no effect of either intervention. This may reflect limited dose of the interventions, or the limited duration of follow-up. Alternatively, these interventions do not have a measurable effect on time to cancer diagnosis.
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Affiliation(s)
- Jon D Emery
- Department of General Practice and The Centre for Cancer Research, The University of Melbourne, Melbourne, VIC, Australia.,School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, Crawley, WA, Australia.,The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Victoria Gray
- School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, Crawley, WA, Australia.,School of Population Health, The University of Western Australia, Crawley, WA, Australia.,Education and Research Division, Cancer Council Western Australia, Subiaco, WA, Australia
| | - Fiona M Walter
- School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, Crawley, WA, Australia.,The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK.,General Practice and Primary Health Care Academic Centre, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
| | - Shelley Cheetham
- School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, Crawley, WA, Australia.,School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, Australia
| | - Emma J Croager
- Education & Research Division, Cancer Council Western Australia; School of Psychology and Speech Pathology, Curtin University, Bentley, WA, Australia
| | - Terry Slevin
- Education & Research Division, Cancer Council Western Australia; School of Psychology and Speech Pathology, Curtin University, Bentley, WA, Australia
| | - Christobel Saunders
- School of Surgery, The University of Western Australia, Crawley, WA, Australia
| | - Timothy Threlfall
- Western Australia Cancer Registry, The Department of Health of Western Australia, Perth, WA, Australia
| | - Kirsten Auret
- Rural Clinical School of Western Australia, The University of Western Australia, Albany, WA, Australia
| | - Anna K Nowak
- School of Medicine, The University of Western Australia, Crawley, WA, Australia.,Department of Medical Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Elizabeth Geelhoed
- School of Population Health, The University of Western Australia, Crawley, WA, Australia
| | - Max Bulsara
- Institute for Health Research, University of Notre Dame, Freemantle, WA, Australia
| | - C D'Arcy J Holman
- School of Population Health, The University of Western Australia, Crawley, WA, Australia
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12
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Abstract
Much time, effort and investment goes into the diagnosis of symptomatic cancer, with the expectation that this approach brings clinical benefits. This investment of resources has been particularly noticeable in the UK, which has, for several years, appeared near the bottom of international league tables for cancer survival in economically developed countries. In this Review, we examine expedited diagnosis of cancer from four perspectives. The first relates to the potential for clinical benefits of expedited diagnosis of symptomatic cancer. Limited evidence from clinical trials is available, but the considerable observational evidence suggests benefits can be obtained from this approach. The second perspective considers how expedited diagnosis can be achieved. We concentrate on data from the UK, where extensive awareness campaigns have been conducted, and initiatives in the primary-care setting, including clinical decision support, have all occurred during a period of considerable national policy change. The third section considers the most appropriate patients for cancer investigations, and the possible community settings for identification of such patients; UK national guidance for selection of patients for investigation is discussed. Finally, the health economics of expedited diagnosis are reviewed, although few studies provide definitive evidence on this topic.
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Affiliation(s)
- Willie Hamilton
- University of Exeter, College House, St Luke's Campus, Exeter EX2 4TE, UK
| | - Fiona M Walter
- Department of Public Health &Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
| | - Greg Rubin
- School of Medicine, Pharmacy and Health, Wolfson Building, Queen's Campus, University of Durham, Stockton-on-Tees TS17 6BH, UK
| | - Richard D Neal
- North Wales Centre for Primary Care Research, Bangor University, Gwenfro Unit 5, Wrexham Technology Park, Wrexham LL13 7YP, UK
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13
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Rankin N, McGregor D, Stone E, Butow P, Young J, White K, Shaw T. Evidence-practice gaps in lung cancer: A scoping review. Eur J Cancer Care (Engl) 2016; 27:e12588. [DOI: 10.1111/ecc.12588] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2016] [Indexed: 12/24/2022]
Affiliation(s)
- N.M. Rankin
- Sydney Catalyst Translational Cancer Research Center; University of Sydney; Camperdown NSW Australia
| | - D. McGregor
- Sydney Catalyst Translational Cancer Research Center; University of Sydney; Camperdown NSW Australia
- Research in Implementation Science and eHealth (RISe); Faculty of Health Sciences; University of Sydney; Sydney NSW Australia
| | - E. Stone
- Sydney Catalyst Translational Cancer Research Center; University of Sydney; Camperdown NSW Australia
- Department of Thoracic Medicine; St Vincent's Hospital; Darlinghurst NSW Australia
| | - P.N. Butow
- Sydney Catalyst Translational Cancer Research Center; University of Sydney; Camperdown NSW Australia
- Psycho-Oncology Co-operative Research Group; School of Psychology; University of Sydney; Sydney NSW Australia
- Centre for Medical Psychology & Evidence-based Decision-Making; University of Sydney; Sydney NSW Australia
| | - J.M. Young
- Sydney Catalyst Translational Cancer Research Center; University of Sydney; Camperdown NSW Australia
- Royal Prince Alfred Institute of Academic Surgery; Sydney Local Health District; Camperdown NSW Australia
- School of Public Health; University of Sydney; Sydney NSW Australia
| | - K. White
- Sydney Catalyst Translational Cancer Research Center; University of Sydney; Camperdown NSW Australia
- Cancer Nursing Research Unit; University of Sydney; Sydney NSW Australia
| | - T. Shaw
- Sydney Catalyst Translational Cancer Research Center; University of Sydney; Camperdown NSW Australia
- Research in Implementation Science and eHealth (RISe); Faculty of Health Sciences; University of Sydney; Sydney NSW Australia
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McGregor D, Rankin N, Butow P, York S, White K, Phillips J, Stone E, Barnes D, Jones R, Shaw T. Closing evidence-practice gaps in lung cancer: Results from multi-methods priority setting in the clinical context. Asia Pac J Clin Oncol 2016; 13:28-36. [DOI: 10.1111/ajco.12499] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/02/2016] [Accepted: 04/05/2016] [Indexed: 12/24/2022]
Affiliation(s)
- Deborah McGregor
- RISE Faculty of Health Sciences; University of Sydney; New South Wales Australia
| | - Nicole Rankin
- Sydney Catalyst Translational Cancer Centre; University of Sydney; New South Wales Australia
| | - Phyllis Butow
- Psycho-oncology Co-operative Research Group (PoCoG), and School of Psychology; University of Sydney; New South Wales Australia
| | - Sarah York
- Sydney Catalyst Translational Cancer Centre; University of Sydney; New South Wales Australia
| | - Kate White
- Cancer Nursing Research Unit; University of Sydney, and Sydney Local Health District; New South Wales Australia
| | - Jane Phillips
- Centre for Cardiovascular and Chronic Care; University of Technology Sydney; New South Wales Australia
| | - Emily Stone
- Department of Thoracic Medicine; St Vincent's Hospital; Darlinghurst New South Wales Australia
| | - David Barnes
- Department of Respiratory and Sleep Medicine; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Ruth Jones
- Western New South Wales Local Health District; Dubbo New South Wales Australia
| | - Tim Shaw
- RISE Faculty of Health Sciences; University of Sydney; New South Wales Australia
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15
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Emery JD. The challenges of early diagnosis of cancer in general practice. Med J Aust 2016; 203:391-3. [PMID: 26561897 DOI: 10.5694/mja15.00527] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 08/25/2015] [Indexed: 11/17/2022]
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16
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Clark JM, Heifetz LJ, Palmer D, Brown LM, Cooke DT, David EA. TELEHEALTH ALLOWS FOR CLINICAL TRIAL PARTICIPATION AND MULTIMODALITY THERAPY IN A RURAL PATIENT WITH STAGE 4 NON-SMALL CELL LUNG CANCER. Cancer Treat Res Commun 2016; 9:139-142. [PMID: 28580436 DOI: 10.1016/j.ctarc.2016.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Oligometastatic non-small cell lung cancer (NSCLC) has a poor prognosis for rural patients with traditional therapies. Implementation of multi-modality systemic therapy in conjunction with surgical resection can dramatically improve overall survival, leading to clinical complete remission. The currently accepted indications for resection in oligometastatic NSCLC include brain and adrenal metastases. Rural populations are known to have disparities in care of complex malignancies and the use of telehealth has been shown to improve outcomes. We present a case of a rural patient with stage IV NSCLC, who was able to participate in two clinical trials, undergo trimodality therapy, and remain disease-free for 18 months, whose care was facilitated via telehealth video conferencing with a tertiary care center.
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Affiliation(s)
- James M Clark
- Section of General Thoracic Surgery, Department of Surgery, UC Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA 95817, USA
| | - Laurence J Heifetz
- Department of Medical Oncology, Tahoe Forest Cancer Center, 10121 Pine Ave, Truckee, CA 96161, USA
| | - Daphne Palmer
- Department of Radiation Oncology, Tahoe Forest Cancer Center, 10121 Pine Ave, Truckee, CA 96161, USA
| | - Lisa M Brown
- Section of General Thoracic Surgery, Department of Surgery, UC Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA 95817, USA
| | - David T Cooke
- Section of General Thoracic Surgery, Department of Surgery, UC Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA 95817, USA
| | - Elizabeth A David
- Section of General Thoracic Surgery, Department of Surgery, UC Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA 95817, USA.,Heart Lung Vascular Center, David Grant Medical Center, Travis AFB, 101 Bodin Cir, Fairfield CA 94533, USA
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