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Kim GY, Conduit C, O'Haire S, Chong CY, Baenziger O, Lewin J, Thomas B, Lawrentschuk N, Stockler MR, Olver I, Grimison P, Tran B. Association between low total serum testosterone and body mass index in Australian survivors of testicular cancer: a retrospective analysis. Basic Clin Androl 2024; 34:14. [PMID: 39223491 PMCID: PMC11369996 DOI: 10.1186/s12610-024-00230-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 07/01/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Primary hypogonadism is a recognised complication in survivors of testicular cancer. However, secondary hypogonadism can result from other causes that suppress the hypothalamic-pituitary axis, including obesity, high dose glucocorticoids, chronic end organ failure, and diabetes. The aim of this study was to explore low total serum testosterone in Australian survivors of testicular cancer and examine associations with body mass index, age, and prior chemotherapy use. METHODS Clinical data including height, weight, diagnosis, treatment, and hormonal evaluations during follow-up were extracted from the Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group Chemocog study (2007-2012), accompanied by data from two Australian, high-volume testicular cancer centres included in the iTestis testicular cancer registry (2012-2019). Low testosterone was defined by a serum concentration of testosterone (T) < 10 nmol/L, and was classified as primary by a serum concentration of luteinising hormone (LH) > 8 IU/L, otherwise as secondary. RESULTS Two hundred eighty-five individuals with either stage 1 or advanced testicular cancer were included. Of these, 105 (37%) were treated with orchidectomy and chemotherapy. Forty-nine (17%) met criteria for low testosterone during follow-up: 21 (43%) had primary and 27 (55%) had secondary low testosterone. Survivors of testicular cancer with higher body mass index were more likely to display low testosterone, both primary (p = 0.032) and secondary (p = 0.028). Our data did not show evidence of an association between older age or chemotherapy use and low testosterone in our cohort. CONCLUSIONS Low total serum testosterone was common in survivors of testicular cancer, and associated with a higher body mass index prior to orchidectomy, suggesting that elevated body mass index may contribute to low testosterone in this population, and that body weight, diet, and exercise should be addressed in testicular cancer follow-up.
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Affiliation(s)
- Grace Y Kim
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.
| | - Ciara Conduit
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
| | - Sophie O'Haire
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - Chia Yuen Chong
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Olivia Baenziger
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - Jeremy Lewin
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
- ONTrac at Peter Mac Victorian Adolescent & Young Adult Cancer Service, Parkville, VIC, Australia
| | - Benjamin Thomas
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Nathan Lawrentschuk
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Epworth Freemasons Hospital, Melbourne, VIC, Australia
| | - Martin R Stockler
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
- Concord Repatriation General Hospital, Sydney, NSW, Australia
- Chris O'Brien Lifehouse, Sydney, NSW, Australia
| | - Ian Olver
- Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Barangaroo, NSW, Australia
| | - Peter Grimison
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
- Chris O'Brien Lifehouse, Sydney, NSW, Australia
| | - Ben Tran
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
- Epworth Freemasons Hospital, Melbourne, VIC, Australia
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Narasimhan P, Levy AR, Rogers SN, Schache AG, Patterson JM, Williams NH, Brooker RC, Midgley AW. A protocol for the longitudinal investigation of cancer related fatigue in head and neck cancer with an emphasis on the role of physical activity. PLoS One 2024; 19:e0308400. [PMID: 39141642 PMCID: PMC11324130 DOI: 10.1371/journal.pone.0308400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/24/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND AND AIM Cancer related fatigue significantly impairs the ability to undertake sustained physical activity across the domains of daily living, work and recreation. The purpose of this study is to monitor cancer related fatigue and the factors affected or caused by it for 12 months in head and neck cancer patients following their diagnosis. Their perceptions of how fatigue might affect their activity levels in addition to identifying avenues to improve engagement with physical activity will be also explored. METHODS A single centre longitudinal mixed-methods study will be conducted. Forty head and neck cancer patients will be recruited over 6 months following the confirmation of their treatment plan, after which fatigue and physical activity will be assessed at four time points over 12 months. Additionally, other factors which influence fatigue such as body composition, blood counts, systemic inflammation levels, haemoglobin concentration, thyroid function, sleep quality, cardiorespiratory fitness and upper and lower extremity strength will be measured to understand how the multifactorial problem of fatigue may evolve over time and influence physical activity levels. Semi-structured interviews will be conducted after treatment completion and at end of twelve months which will analyse the participants fatigue experiences, understand how their perceived fatigue may have impacted physical activity and report the factors which may improve engagement with physical activity during cancer. Quantitative data will be analysed and reported using standard descriptive statistics and post-hoc pairwise comparisons. The changes in outcome measures across time will be analysed using the MIXED procedure in SPSS software. Statistical significance will be accepted at p<0.05. Qualitative data will be analysed using the Interpretative Phenomenological Approach using the NVivo software. DISCUSSION The results from this study may help inform the planning and delivery of appropriately timed interventions for the management of cancer related fatigue.
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Affiliation(s)
- Prahalad Narasimhan
- Department of Sport and Physical Activity, Edge Hill University, Ormskirk, United Kingdom
| | - Andrew R. Levy
- Health Research Institute, Edge Hill University, Ormskirk, United Kingdom
- Department of Psychology, Edge Hill University, Ormskirk, United Kingdom
| | - Simon N. Rogers
- Wirral University Teaching Hospital, Wirral, United Kingdom
- Faculty of Health and Social Care, Edge Hill University, Ormskirk, United Kingdom
| | - Andrew G. Schache
- Liverpool Head and Neck Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Joanne M. Patterson
- Liverpool Head and Neck Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Nefyn H. Williams
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Rachel C. Brooker
- Liverpool Head and Neck Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
- The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Adrian W. Midgley
- Department of Sport and Physical Activity, Edge Hill University, Ormskirk, United Kingdom
- Health Research Institute, Edge Hill University, Ormskirk, United Kingdom
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Khan I, Taylor SJC, Robinson C, Moschopoulou E, McCrone P, Bourke L, Thaha M, Bhui K, Rosario D, Ridge D, Donovan S, Korszun A, Little P, Morgan A, Quentin O, Roylance R, White P, Chalder T. Study protocol for a pragmatic randomised controlled trial of comparing enhanced acceptance and commitment therapy plus (+) added to usual aftercare versus usual aftercare only, in patients living with or beyond cancer: SUrvivors' Rehabilitation Evaluation after CANcer (SURECAN) trial. Trials 2024; 25:228. [PMID: 38566197 PMCID: PMC10985882 DOI: 10.1186/s13063-024-08062-4] [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: 12/12/2023] [Accepted: 03/18/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Two million people in the UK are living with or beyond cancer and a third of them report poor quality of life (QoL) due to problems such as fatigue, fear of cancer recurrence, and concerns about returning to work. We aimed to develop and evaluate an intervention based on acceptance and commitment therapy (ACT), suited to address the concerns of cancer survivors and in improving their QoL. We also recognise the importance of exercise and vocational activity on QoL and therefore will integrate options for physical activity and return to work/vocational support, thus ACT Plus (+). METHODS We will conduct a multi-centre, pragmatic, theory driven, randomised controlled trial. We will assess whether ACT+ including usual aftercare (intervention) is more effective and cost-effective than usual aftercare alone (control). The primary outcome is QoL of participants living with or beyond cancer measured using the Functional Assessment of Cancer Therapy: General scale (FACT-G) at 52 weeks. We will recruit 344 participants identified from secondary care sites who have completed hospital-based treatment for cancer with curative intent, with low QoL (determined by the FACT-G) and randomise with an allocation ratio of 1:1 to the intervention or control. The intervention (ACT+) will be delivered by NHS Talking Therapies, specialist services, and cancer charities. The intervention consists of up to eight sessions at weekly or fortnightly intervals using different modalities of delivery to suit individual needs, i.e. face-to-face sessions, over the phone or skype. DISCUSSION To date, there have been no robust trials reporting both clinical and cost-effectiveness of an ACT based intervention for people with low QoL after curative cancer treatment in the UK. We will provide high quality evidence of the effectiveness and cost-effectiveness of adding ACT+ to usual aftercare provided by the NHS. If shown to be effective and cost-effective then commissioners, providers and cancer charities will know how to improve QoL in cancer survivors and their families. TRIAL REGISTRATION ISRCTN: ISRCTN67900293 . Registered on 09 December 2019. All items from the World Health Organization Trial Registration Data Set for this protocol can be found in Additional file 2 Table S1.
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Affiliation(s)
- Imran Khan
- Barts and the London Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
| | - Stephanie J C Taylor
- Barts and the London Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
| | - Clare Robinson
- Barts and the London Pragmatic Clinical Trials Unit, Centre for Evaluation and Methods, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Elisavet Moschopoulou
- Barts and the London Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Paul McCrone
- Institute for Lifecourse Development, University of Greenwich, London, UK
| | - Liam Bourke
- Dept. Allied Health Professionals, Sheffield Hallam University, Sheffield, UK
| | - Mohamed Thaha
- Blizard Institute, Queen Mary University of London, London, UK
| | - Kamaldeep Bhui
- Nuffield Department of Primary Care Health Sciences, Wadham College, University of Oxford, Oxford, UK
| | - Derek Rosario
- The Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Damien Ridge
- School of Social Sciences, University of Westminster, New Cavendish St, London, UK
| | - Sheila Donovan
- Barts and the London Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Ania Korszun
- The Barts and the London Unit for Psychological Medicine, Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Paul Little
- Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Adrienne Morgan
- Independent Cancer Patient's Voice (ICPV), 17 Woodbridge Street, London, UK
| | - Olivier Quentin
- Barts and the London Pragmatic Clinical Trials Unit, Centre for Evaluation and Methods, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Rebecca Roylance
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Peter White
- The Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Trudie Chalder
- Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, DeCrespigny Park, London, UK
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Amiri A, Chovanec M, Oliva V, Sedliak M, Mego M, Ukropec J, Ukropcová B. Chemotherapy-induced toxicity in patients with testicular germ cell tumors: The impact of physical fitness and regular exercise. Andrology 2021; 9:1879-1892. [PMID: 34245663 DOI: 10.1111/andr.13078] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/04/2021] [Accepted: 07/07/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Testicular germ cell tumors (TGCTs) represent ∼95% of testicular malignancies and are the most common type of malignancy in young male adults. While the incidence of TGCTs has increased during the last decades, the advances in treatment, namely introducing cisplatin into the chemotherapy regimen, have made TGCTs highly curable with the 10-year survival rate exceeding 95%. However, in parallel with increased cure rates, survivors may experience acute and late adverse effects of treatment, which increase morbidity, reduce the quality of life, and can be potentially life-threatening. Chemotherapy-related toxicities include cardiovascular and metabolic diseases, secondary cancer, avascular necrosis, cognitive impairment, cancer-related fatigue, poor mental health-related quality of life, nephrotoxicity, hypogonadism, neurotoxicity, pulmonary toxicity, anxiety, and depression. These treatment-related adverse effects have emerged as important survivorship dilemmas in TGCT cancer survivors. Recently, regular physical exercise has increasingly attracted research and clinical attention as an adjunct therapy for cancer patients. PURPOSE Herein, we review the most common chemotherapy-related adverse effects in TGCT survivors and clinical relevance of exercise and increased cardio-respiratory fitness in modulating chemotherapy-related toxicity and quality of life in this population. RESULTS AND CONCLUSION Exercise has positive effects on a spectrum of physical and psychosocial outcomes during and after cancer treatment, and current guidelines on exercise prescription in chronic diseases define the recommended dose (volume and intensity) of regular exercise for cancer survivors, highlighting regular, sufficiently intensive physical activity as an essential part of patients' care.
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Affiliation(s)
- Ali Amiri
- Department of Metabolic Disease Research & Center of Physical Activity Research, Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Michal Chovanec
- 2nd, Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia
| | - Viktor Oliva
- Faculty of Physical Education and Sports, Comenius University, Bratislava, Slovakia
| | - Milan Sedliak
- Faculty of Physical Education and Sports, Comenius University, Bratislava, Slovakia
| | - Michal Mego
- 2nd, Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia
| | - Jozef Ukropec
- Department of Metabolic Disease Research & Center of Physical Activity Research, Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Barbara Ukropcová
- Department of Metabolic Disease Research & Center of Physical Activity Research, Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia.,Institute of Pathophysiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
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5
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Neves RL, Cardoso DT, Rêgo FD, Gontijo CMF, Barbosa DS, Soares RP. A follow-up study (2007-2018) on American Tegumentary Leishmaniasis in the municipality of Caratinga, Minas Gerais State, Brazil: Spatial analyses and sand fly collection. PLoS Negl Trop Dis 2021; 15:e0009429. [PMID: 34003866 PMCID: PMC8162678 DOI: 10.1371/journal.pntd.0009429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 05/28/2021] [Accepted: 04/30/2021] [Indexed: 11/17/2022] Open
Abstract
Background The municipality of Caratinga is an important endemic area for American Tegumentary Leishmaniasis (ATL) and no epidemiological studies were performed during the past two decades. Here, we analyzed the epidemiological situation and the geographical distribution of ATL cases in the municipality of Caratinga from 2007 to 2018 using geographic information systems (GIS). Also, we evaluated the impact of several demographic parameters in ATL distribution and the sand flies incriminated in its transmission. Methods All demographic information (gender, age, educational level, clinical form, diagnostic criteria and case evolution) used in this study was retrieved from the public health archives and confirmed in the State Health Services databases. All cases were analyzed using GIS software based on ATL distribution. Also, non-systematic sand fly collections and molecular detection of Leishmania were performed in the hotspots. Results and conclusions During the period, ATL cases continued and increased especially in the past years (2016–2018). Hotspots included urban Caratinga areas and the districts of Patrocínio de Caratinga and Sapucaia. The species Nyssomyia whitmani, Nyssomyia intermedia, Migonemyia migonei and Evandromyia cortelezzii complex were captured. However, ITS1-PCR did not detect Leishmania DNA in those insects. Based on our analyses, urbanization of ATL in Caratinga has occurred in the past years. Due to the increase in the number of cases and vectors presence, it is recommended that health authorities focus on control measures in the most affected areas (Patrocínio of Caratinga and Sapucaia districts and urban Caratinga). Leishmaniasis is an important health problem in Latin American countries and worldwide. In some places, notification is limited and underreported hindering correct assessment of existing data. In Brazil, ATL is mainly caused by Leishmania (Viannia) braziliensis. It is transmitted by sand fly vectors Nyssomyia whitmani and Nyssomyia intermedia. ATL comprises different clinical manifestations including cutaneous leishmaniasis, muco-cutaneous leishmaniasis and atypical leishmaniasis. The objective is to present the spatial distribution of cases of ATL notified by the Public Health System of Caratinga between the period of 2007 and 2018. This city is one of the most important endemic areas in the State of Minas Gerais and compose the panel of knowledge on epidemiological aspects of cutaneous leishmaniasis caused by L. braziliensis. This information will be important for developing strategies for ATL control in the affected areas. There is strong evidence that supports ATL urbanization in the city of Caratinga and increase of cases in two rural districts (Sapucaia and Patrocínio de Caratinga).
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Affiliation(s)
- Rafael L Neves
- René Rachou Institute, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil
| | - Diogo T Cardoso
- Parasitology Department, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Felipe D Rêgo
- René Rachou Institute, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil
| | - Célia M F Gontijo
- René Rachou Institute, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil
| | - David S Barbosa
- Parasitology Department, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rodrigo P Soares
- René Rachou Institute, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil
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Duncan M, Korszun A, White P, Eva G. Qualitative analysis of feasibility of recruitment and retention in a planned randomised controlled trial of a psychosocial cancer intervention within the NHS. Trials 2018; 19:327. [PMID: 29929536 PMCID: PMC6013879 DOI: 10.1186/s13063-018-2728-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 06/07/2018] [Indexed: 11/25/2022] Open
Abstract
Background The randomised control trial (RCT) is the most rigorous method of evaluating interventions. Recruitment is often slower and more challenging than expected. The aim of the current paper is to understand the feasibility of recruitment within the NHS and the barriers and motivators to recruitment from the perspective of patients and healthcare professionals (HCPs). Methods NHS HCPs were surveyed to establish their willingness to participate. Twenty HCPs were interviewed to establish barriers and motivators to recruitment. Eleven patients were interviewed to understand their willingness to participate. Interviews were analysed using thematic analysis. Results HCP interviews identified key barriers to recruitment: practical barriers included workload and time; clinical barriers included terminology and concern that the trial implied criticism of their current practice; and patient barriers included gender and cultural factors. Motivators to recruitment included: regular communication between research and clinical teams; feedback on findings; and patient and individual benefits for clinicians. Patient interviews suggested that participation in a trial of a psychosocial intervention would strengthen existing coping skills and develop mechanisms for those who were struggling. Conclusions Survey results demonstrated that recruitment to an RCT of a psychosocial intervention for people living with and beyond cancer would be feasible within the NHS if specific barriers are addressed. From a clinician point of view, barriers should be addressed to improve recruitment, particularly training and education of clinicians and clear communication. From a patient perspective, interventions and RCT should be tailored to target those not routinely represented in RCTs.
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Affiliation(s)
- M Duncan
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, EC1M 6BQ, UK
| | - A Korszun
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, EC1M 6BQ, UK
| | - P White
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, EC1M 6BQ, UK
| | - G Eva
- Department of Clinical Sciences, Brunel University London, Uxbridge, UB8 3PH, UK.
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McEwen SE, Dunphy C, Rios JN, Davis AM, Jones J, Martino R, Poon I, Ringash J. Evaluation of a rehabilitation planning consult for survivors of head and neck cancer. Head Neck 2018; 40:1415-1424. [DOI: 10.1002/hed.25113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 11/03/2017] [Accepted: 01/23/2018] [Indexed: 12/14/2022] Open
Affiliation(s)
- Sara E. McEwen
- Sunnybrook Research Institute, St. John's Rehab Research Program; Toronto Ontario Canada
- Department of Physical Therapy; University of Toronto; Toronto Ontario Canada
- Rehabilitation Sciences Institute; University of Toronto; Toronto Ontario Canada
| | - Colleen Dunphy
- University Health Network, Cancer Survivorship Program; Toronto Ontario Canada
| | - Jorge N. Rios
- Sunnybrook Research Institute, St. John's Rehab Research Program; Toronto Ontario Canada
| | - Aileen M. Davis
- Rehabilitation Sciences Institute; University of Toronto; Toronto Ontario Canada
- Krembil Research Institute; Toronto Ontario Canada
- Department of Management and Evaluation; University of Toronto, Institute of Health Policy; Toronto Ontario Canada
| | - Jennifer Jones
- University Health Network, Cancer Survivorship Program; Toronto Ontario Canada
- University of Toronto, Dalla Lana School of Public Health; Toronto Ontario Canada
| | - Rosemary Martino
- Rehabilitation Sciences Institute; University of Toronto; Toronto Ontario Canada
- Krembil Research Institute; Toronto Ontario Canada
- Department of Speech-Language Pathology; University of Toronto; Toronto Ontario Canada
- Department of Otolaryngology - Head and Neck Surgery; University of Toronto; Toronto ON Canada
| | - Ian Poon
- Department of Radiation Oncology; Sunnybrook Health Sciences Centre; Toronto Ontario Canada
- University of Toronto, Faculty of Medicine; Toronto Ontario Canada
| | - Jolie Ringash
- University of Toronto, Faculty of Medicine; Toronto Ontario Canada
- Department of Radiation Oncology; Princess Margaret Cancer Centre; Toronto Ontario Canada
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