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Noya F, Carr S, Thompson S. Social accountability in a medical school: is it sufficient? A regional medical school curriculum and approaches to equip graduates for rural and remote medical services. BMC MEDICAL EDUCATION 2024; 24:526. [PMID: 38734593 PMCID: PMC11088763 DOI: 10.1186/s12909-024-05522-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 05/06/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Social accountability is increasingly integral to medical education, aligning health systems with community needs. Universitas Pattimura's Faculty of Medicine (FMUP) enhances this through a curriculum that prepares graduates for rural and remote (RR) medical practice, exceeding national standards. The impact of this curriculum on graduate readiness in actual work settings remains unassessed. OBJECTIVE This study was conducted to capture the perspectives of FMUP medical graduates in a rural-centric curriculum, focusing on the teaching and learning opportunities afforded to them during their medical education. These insights are crucial for evaluating the accountability of regional medical schools in delivering quality service, particularly in underserved areas. METHODS Semistructured interviews were conducted with nine FMUP graduates employed in the RR areas of Maluku Province. A qualitative analysis was employed to examine graduates' views on the curriculum concerning medical school accountability. RESULTS The FMUP curriculum, informed by social accountability principles, partially prepares graduates to work under Maluku's RR conditions. However, it was reported by participants that their skills and preparedness often fall short in the face of substandard working environments. CONCLUSIONS The FMUP curriculum supports the government's aim to develop an RR medical workforce. However, the curriculum's social accountability and rural emphasis fall short of addressing community health needs amid inadequate practice conditions. Political investment in standardizing medical facilities and equipment is essential for enhancing graduates' effectiveness and health outcomes in RR communities.
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Affiliation(s)
- Farah Noya
- Department of Medical Education, Faculty of Medicine Universitas Pattimura, Jl. Ir. M. Putuhena Poka, Ambon, Maluku, 97233, Indonesia.
| | - Sandra Carr
- Division of Health Professions Education, School of Allied Health, The University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA, 6009, Australia
| | - Sandra Thompson
- Western Australian Centre for Rural Health, The University of Western Australia, 167 Fitzgerald Street, Geraldton, WA, 6530, Australia
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Noya FC, Carr SE, Thompson SC. Expert consensus on the attributes and competencies required for rural and remote junior physicians to work effectively in isolated indonesian communities. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:587-609. [PMID: 37556029 PMCID: PMC11078787 DOI: 10.1007/s10459-023-10275-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 08/06/2023] [Indexed: 08/10/2023]
Abstract
Indonesian physicians working in rural and remote areas must be equipped not only with generic competencies but also with the attributes and skills necessary to provide health care services without compromising quality. This study sought to reach a consensus on the attributes and competencies that are viewed as essential and important for working effectively as an early career doctor in rural and remote practice in Indonesia. A two-round Delphi study was conducted by reference to 27 consenting physicians working in rural and remote Indonesia. Forty-three items covering 9 attributes and 34 competencies were sent to these physicians to be rated on a Likert scale ranging from 1 to 5 in terms of their importance for effective rural and remote practice. Nine attributes and 29 competencies progressed to Round 2. All nine attributes and 29 competencies were identified as essential or important for junior physicians' ability to be effective in their practice. The essential attributes included professional quality related to prioritising the rural community. The essential competencies included medical skills, professional behaviour, interprofessional skills, health promotion and connection to the rural community. The consensus thus reached on these essential and important attributes and competencies can inform curriculum development for the undergraduate and postgraduate training of junior rural and remote physicians.
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Affiliation(s)
- Farah C Noya
- Division of Health Professions Education, School of Allied Health, The University of Western Australia, Perth, Australia.
- Medical Education Unit, Faculty of Medicine, Universitas Pattimura, Ambon, Indonesia.
| | - Sandra E Carr
- Division of Health Professions Education, School of Allied Health, The University of Western Australia, Perth, Australia
| | - Sandra C Thompson
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, Australia
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Chen HMN, Anzela A, Hetherington E, Buddle N, Vignarajah D, Hogan D, Fowler A, Forstner D, Chua B, Gowda R, Min M. A proposed framework for the implementation of head and neck cancer treatment at a new cancer center from a radiation oncology perspective. Asia Pac J Clin Oncol 2024; 20:168-179. [PMID: 37186498 DOI: 10.1111/ajco.13963] [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: 11/01/2022] [Revised: 03/18/2023] [Accepted: 03/29/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Establishing a new head and neck cancer (HNC) treatment center requires multidisciplinary team management and expertise. To our knowledge, there are no clear recommendations or guidelines in the literature for the commencement of HNC radiation therapy (RT) at a new cancer center. We propose a novel framework outlining the necessary components required to set-up a new radiation therapy HNC treatment. METHODS We reviewed the infrastructure and methodology in the commencement of HNC radiation therapy in our cancer care center and invited several external, experienced metropolitan head and neck radiation oncologists to develop a novel consensus guideline that may be used by new RT centers to treat HNC. Recommendations were presented to our internal and external staff specialists using a survey questionnaire with ratings utilized to determine consensus using pre-defined thresholds as per the American Society of Clinical Oncology Guidelines Methodology Manual. CONCLUSION This consensus recommendation aims to improve RT utilization whilst advocating for optimal patient outcomes by presenting a framework for new radiation therapy centers ready to step up and manage the treatment of head and neck cancer patients. We propose these evidence-based consensus guidelines endorsed by external HNC radiation oncologists.
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Affiliation(s)
- Hon Ming N Chen
- Illawarra Cancer Care Centre, Wollongong Hospital, Wollongong, Australia
| | - Anzela Anzela
- Central Coast Cancer Centre, Gosford Hospital, Gosford, Australia
| | - Ebony Hetherington
- Adem Crosby Cancer Centre, Sunshine Coast University Hospital, Sunshine Coast, Australia
| | - Nicole Buddle
- Adem Crosby Cancer Centre, Sunshine Coast University Hospital, Sunshine Coast, Australia
- School of Medicine, Griffith University, Brisbane, Australia
| | - Dinesh Vignarajah
- Adem Crosby Cancer Centre, Sunshine Coast University Hospital, Sunshine Coast, Australia
- School of Medicine, Griffith University, Brisbane, Australia
| | - David Hogan
- Adem Crosby Cancer Centre, Sunshine Coast University Hospital, Sunshine Coast, Australia
| | - Allan Fowler
- Liverpool Cancer Therapy Centre, Liverpool Hospital, Liverpool, Australia
| | - Dion Forstner
- GenesisCare, St Vincents Hospital, Sydney, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Benjamin Chua
- Cancer Care Services, Royal Brisbane & Women's Hospital, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Raghu Gowda
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, Australia
| | - Myo Min
- Adem Crosby Cancer Centre, Sunshine Coast University Hospital, Sunshine Coast, Australia
- School of Medicine, Griffith University, Brisbane, Australia
- School of Health, University of Sunshine Coast, Sunshine Coast, Australia
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Guan TL, Kutzko JH, Lunn DP, Dunn NA, Burmeister BH, Dadwal P, Tran N, Holt TR. Utility of 30-day mortality as a quality metric for palliative radiation treatment: A population-based analysis from Queensland, Australia. J Med Imaging Radiat Oncol 2024; 68:316-324. [PMID: 38500454 DOI: 10.1111/1754-9485.13633] [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: 10/04/2023] [Accepted: 02/23/2024] [Indexed: 03/20/2024]
Abstract
INTRODUCTION Palliative radiotherapy (PRT) is frequently used to treat symptoms of advanced cancer, however benefits are questionable when life expectancy is limited. The 30-day mortality rate after PRT is a potential quality indicator, and results from a recent meta-analysis suggest a benchmark of 16% as an upper limit. In this population-based study from Queensland, Australia, we examined 30-day mortality rates following PRT and factors associated with decreased life expectancy. METHODS Retrospective population data from Queensland Oncology Repository was used. Study population data included 22,501 patients diagnosed with an invasive cancer who died from any cause between 2008 and 2017 and had received PRT. Thirty-day mortality rates were determined from the date of last PRT fraction to date of death. Cox proportional hazards models were used to identify factors independently associated with risk of death within 30 days of PRT. RESULTS Overall 30-day mortality after PRT was 22.2% with decreasing trend in more recent years (P = 0.001). Male (HR = 1.20, 95% CI = 1.13-1.27); receiving 5 or less radiotherapy fractions (HR = 2.97, 95% CI = 2.74-3.22 and HR = 2.17, 95% CI = 2.03-2.32, respectively) and receiving PRT in a private compared to public facility (HR = 1.61, 95% CI = 1.51-1.71) was associated with decreased survival. CONCLUSION The 30-day mortality rate in Queensland following PRT is higher than expected and there is scope to reduce unnecessarily protracted treatment schedules. We encourage other Australian and New Zealand centres to examine and report their own 30-day mortality rate following PRT and would support collaboration for 30-day mortality to become a national and international quality metric for radiation oncology centres.
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Affiliation(s)
- Tracey L Guan
- Cancer Alliance Queensland, Brisbane, Queensland, Australia
| | - Justin H Kutzko
- Queensland Cancer Control Safety and Quality Partnership, Radiation Oncology Sub-Committee, Brisbane, Queensland, Australia
- William Osler Health System, Brampton, Ontario, Canada
- University of Queensland, Brisbane, Queensland, Australia
| | - Dominic P Lunn
- Queensland Cancer Control Safety and Quality Partnership, Radiation Oncology Sub-Committee, Brisbane, Queensland, Australia
- ICON, Gold Coast University Hospital, Brisbane, Queensland, Australia
- ICON, Greenslopes Hospital, Brisbane, Queensland, Australia
| | - Nathan Am Dunn
- Cancer Alliance Queensland, Brisbane, Queensland, Australia
| | - Bryan H Burmeister
- Queensland Cancer Control Safety and Quality Partnership, Radiation Oncology Sub-Committee, Brisbane, Queensland, Australia
- GenesisCare, St Stephen's Hospital (Oncology), Hervey Bay, Queensland, Australia
- University of Queensland Rural Clinical School, Hervey Bay, Queensland, Australia
| | - Parvati Dadwal
- Cairns Hospital, Cairns, Queensland, Australia
- James Cook University, Townsville, Queensland, Australia
| | - Nancy Tran
- Cancer Alliance Queensland, Brisbane, Queensland, Australia
| | - Tanya R Holt
- Queensland Cancer Control Safety and Quality Partnership, Radiation Oncology Sub-Committee, Brisbane, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
- ICON, Greenslopes Hospital, Brisbane, Queensland, Australia
- Princess Alexandra Hospital - ROPART, Brisbane, Queensland, Australia
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Chen E, Deshane A, Damico N, Kharouta M, Kim U, Kemmann M, Kyasaram R, Wu AK, Biswas T, Dorth J, Mansur D, Choi S, Bhatt A. An Analysis of Cancer Center-Provided Rideshare Utilization for Radiation Therapy. J Am Coll Radiol 2023; 20:40-50. [PMID: 36581084 DOI: 10.1016/j.jacr.2022.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/08/2022] [Accepted: 12/20/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The potential of rideshare services to facilitate timely radiation therapy (RT), especially for resource-limited patients, is understudied. METHODS Patients (n = 63) who received 73 courses of RT (1,513 fractions) and utilized free hospital-provided rideshare service (537 rides) were included in this retrospective study. A multidimensional analysis was conducted including a comparison of demographic, disease characteristics, and treatment completion data; a revenue analysis to evaluate the financial impact of rideshare services; and a geospatial analysis to evaluate community-level characteristics of patients. RESULTS Median age was 59; most were female (56%) and self-identified as Black or African American (56%), not working (91%), not partnered (83%), high school educated or less (78%), and insured with Medicaid (51%). Geospatial analysis revealed that patients lived in communities with significantly higher rates of resource deprivation. Median rideshare distance was 6.4 miles (interquartile range 3.4-11.2) with a median cost of $13.04 per rideshare (interquartile range 9-19). Of the rideshare-facilitated treatments, 100% were completed, with an overall course completion rate of 97.3% compared with 85.4% for those who did not use rideshare (P = .001); two patients discontinued RT for reasons unrelated to transportation. High rideshare utilization (n = 32), defined as utilization ≥ 45% of the treatment course, was associated with significantly shorter treatment courses and lower radiation doses compared with low rideshare utilization (P = .04). Total rideshare cost for high utilizers and whole cohort was $11,589 and $16,895, facilitating an estimated revenue of $401,952 and $1,175,119, respectively. CONCLUSIONS Free hospital-provided rideshare service is economically feasible and associated with high RT completion rates. It may help enhance quality radiation care for those who come from resource-limited communities.
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Affiliation(s)
- Eric Chen
- Resident, Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio
| | - Alok Deshane
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio; and Medical Student, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Nicholas Damico
- Resident, Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio
| | - Michael Kharouta
- Resident, Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio
| | - Uriel Kim
- Medical Student, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Matthew Kemmann
- Director, Strategic Planning and Analytics, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Ravi Kyasaram
- Cancer Informatics Senior Data Architect, Cancer Informatics, University Hospitals Seidman Cancer Center, Cleveland, Ohio
| | - Anna K Wu
- Medical Student, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Tithi Biswas
- Thoracic Section Leader, Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio; and Professor, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jennifer Dorth
- Head and Neck Section Leader, Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio; and Associate Professor, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - David Mansur
- Pediatric Section Leader, Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio; and Professor, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Serah Choi
- CNS Section Leader, and Vice Chair of Laboratory Research, Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio; and Assistant Professor, Case Western Reserve University School of Medicine, Cleveland, Ohio.
| | - Aashish Bhatt
- Professor, Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio; and Associate Professor, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Improving Access to Cancer Treatment Services in Australia’s Northern Territory—History and Progress. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137705. [PMID: 35805361 PMCID: PMC9265828 DOI: 10.3390/ijerph19137705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/14/2022] [Accepted: 06/21/2022] [Indexed: 12/28/2022]
Abstract
Cancer is the leading cause of death in the Northern Territory (NT), Australia’s most sparsely populated jurisdiction with the highest proportion of Aboriginal people. Providing cancer care to the NT’s diverse population has significant challenges, particularly related to large distances, limited resources and cultural differences. This paper describes the developments to improve cancer treatment services, screening and end-of-life care in the NT over the past two decades, with a particular focus on what this means for the NT’s Indigenous peoples. This overview of NT cancer services was collated from peer-reviewed literature, government reports, cabinet papers and personal communication with health service providers. The establishment of the Alan Walker Cancer Care Centre (AWCCC), which provides radiotherapy, chemotherapy and other specialist cancer services at Royal Darwin Hospital, and recent investment in a PET Scanner have reduced patients’ need to travel interstate for cancer diagnosis and treatment. The new chemotherapy day units at Alice Springs Hospital and Katherine Hospital and the rapid expansion of tele-oncology have also reduced patient travel within the NT. Access to palliative care facilities has also improved, with end-of-life care now available in Darwin, Alice Springs and Katherine. However, future efforts in the NT should focus on increasing and improving travel assistance and support and increasing the availability of appropriate accommodation; ongoing implementation of strategies to improve recruitment and retention of health professionals working in cancer care, particularly Indigenous health professionals; and expanding the use of telehealth as a means of delivering cancer care and treatment.
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Nguyen VT, Winterman S, Playe M, Benbara A, Zelek L, Pamoukdjian F, Bousquet G. Dose-Intense Cisplatin-Based Neoadjuvant Chemotherapy Increases Survival in Advanced Cervical Cancer: An Up-to-Date Meta-Analysis. Cancers (Basel) 2022; 14:cancers14030842. [PMID: 35159111 PMCID: PMC8834199 DOI: 10.3390/cancers14030842] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Although neoadjuvant chemotherapy has become standard care for many locally advanced cancer sites, the benefit of neoadjuvant chemotherapy remains unclear for the treatment of locally advanced cervical cancer. With this meta-analysis, we set out to demonstrate the benefit of using dose-intense cisplatin-based neoadjuvant chemotherapy in terms of overall survival and progression-free survival. Dose-intense cisplatin-based neoadjuvant chemotherapy followed by local therapy was significantly associated with a survival benefit in the treatment of locally advanced cervical carcinoma. Even though radiotherapy combined with weekly cisplatin-based chemotherapy remains standard of care for the treatment of locally advanced cervical cancer, our meta-analysis makes it possible to consider the use of dose-intense cisplatin-based neoadjuvant chemotherapy when local treatment is suboptimal and opens perspectives for designing new clinical trials in this setting. Abstract Purpose: We set out to demonstrate the benefit of using dose-intense cisplatin-based neoadjuvant chemotherapy in terms of overall survival and progression-free survival. Methods: We searched through MEDLINE and Cochrane Library databases up to May 2021 to identify randomized clinical trials comparing the benefit of using cisplatin-based neoadjuvant chemotherapy followed by local treatment with local treatment alone for the treatment of locally advanced cervical cancer. The PRISMA statement was applied. Results: Twenty-two randomized clinical trials were retrieved between 1991 and 2019, corresponding to 3632 women with FIGO stages IB2-IVA cervical cancer. More than 50% of the randomized clinical trials were assessed as having a low risk of bias. There was no benefit of neoadjuvant chemotherapy on overall survival, but there was significant heterogeneity across studies (I2 = 45%, p = 0.01). In contrast, dose-intense cisplatin at over 72.5 mg/m2/3 weeks was significantly associated with increased overall survival (RR = 0.87, p < 0.05) with no heterogeneity across the pooled studies (I2 = 36%, p = 0.11). The survival benefit was even greater when cisplatin was administered at a dose over 105 mg/m2/3 weeks (RR = 0.79, p < 0.05). Conclusion: Even though radiotherapy combined with weekly cisplatin-based chemotherapy remains standard of care for the treatment of locally advanced cervical cancer, our meta-analysis makes it possible to consider the use of dose-intense cisplatin-based neoadjuvant chemotherapy when local treatment is suboptimal and opens perspectives for designing new clinical trials in this setting. Neoadjuvant chemotherapy could be proposed when surgery is local treatment instead of standard chemoradiotherapy for the treatment of locally advanced cervical cancer.
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Affiliation(s)
- Van Tai Nguyen
- National Cancer Hospital, Department of Medical Oncology 1, Hanoi 10000, Vietnam;
- Assistance Publique Hôpitaux de Paris, Hôpital Avicenne, Service d’Oncologie Médicale, 93000 Bobigny, France; (S.W.); (L.Z.)
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMR_S942, Université de Paris-Université Sorbonne Paris Nord, 93000 Bobigny, France;
| | - Sabine Winterman
- Assistance Publique Hôpitaux de Paris, Hôpital Avicenne, Service d’Oncologie Médicale, 93000 Bobigny, France; (S.W.); (L.Z.)
| | - Margot Playe
- Assistance Publique Hôpitaux de Paris, Hôpital Avicenne, Service de Médecine Nucléaire, 93000 Bobigny, France;
| | - Amélie Benbara
- Assistance Publique Hôpitaux de Paris, Hôpital Jean Verdier, Service de Gynécologie—Obstétrique, 93140 Bondy, France;
| | - Laurent Zelek
- Assistance Publique Hôpitaux de Paris, Hôpital Avicenne, Service d’Oncologie Médicale, 93000 Bobigny, France; (S.W.); (L.Z.)
- Université Sorbonne Paris Nord, 9 Avenue Jean Baptiste Clément, 93439 Villetaneuse, France
| | - Frédéric Pamoukdjian
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMR_S942, Université de Paris-Université Sorbonne Paris Nord, 93000 Bobigny, France;
- Assistance Publique Hôpitaux de Paris, Hôpital Avicenne, Service de Médecine Gériatrique, 93000 Bobigny, France
| | - Guilhem Bousquet
- Assistance Publique Hôpitaux de Paris, Hôpital Avicenne, Service d’Oncologie Médicale, 93000 Bobigny, France; (S.W.); (L.Z.)
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMR_S942, Université de Paris-Université Sorbonne Paris Nord, 93000 Bobigny, France;
- Université Sorbonne Paris Nord, 9 Avenue Jean Baptiste Clément, 93439 Villetaneuse, France
- Correspondence:
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Sigurdson S, Harrison M, Pearce A, Richardson H, Zaza K, Brundage M. One Fraction Size Does Not Fit All: Patient Preferences for Hypofractionated Radiation Therapy From a Discrete Choice Experiment. Pract Radiat Oncol 2022; 12:e24-e33. [PMID: 34991857 DOI: 10.1016/j.prro.2021.08.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/29/2021] [Accepted: 08/16/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Hypofractionated external beam radiation therapy (EBRT) is a standard of care option for localized prostate cancer. To inform clinical practice we quantified patients' preferences for convenience, efficacy, and toxicity risks, of conventional, moderate hypofractionation, and stereotactic radiation therapy regimens. METHODS AND MATERIALS We used a discrete choice experiment with a voluntary sample consisting of patients treated with EBRT for localized prostate cancer at our academic cancer center. In 2019, 58 participants, mean (SD) age of 72.9 (7.1) years, agreed to complete an in-person 1:1 discrete choice experiment. Each participant made 12 choices between 2 unique EBRT scenarios, each described by 5 attributes: (1) treatment time; (2) fiducial markers; and risk of (3) prostate specific antigen recurrence; (4) acute and (5) late GI or GU toxicity. Patient preferences were estimated using mixed multinomial logistic regression, and prespecified subgroups with conditional logistic regression. RESULTS All attributes were statistically significant, thus influenced participants' choices. Risks of prostate specific antigen recurrence (β = -2.581), late (β = -1.854), and acute (β = -1.005) toxicity were most important to participants (P < .001 for each), followed by EBRT length (β = -0.728; P = .017) and fiducial marker implantation (β = -0.563; P = .004). Older (β = -0.063; 95% confidence interval, -0.12, -0.01) and rural (β = -0.083; 95% CI -0.14, -0.02) participants significantly preferred shorter EBRT and were less willing-to-extend treatment to reduce toxicity risk. CONCLUSIONS Patients with prostate cancer place importance on EBRT attributes, and some are willing to trade-off increased risk of toxicity for improved convenience. Our findings promote shared clinical decision-making because patients are interested in learning about the trade-offs involved.
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Affiliation(s)
- Samantha Sigurdson
- Department of Radiation Oncology, Cancer Centre of Southeastern Ontario, Kingston, Ontario, Canada; Department of Public Health Sciences, Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada.
| | - Mark Harrison
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Alison Pearce
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia; Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Harriet Richardson
- Department of Public Health Sciences, Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada
| | - Khaled Zaza
- Department of Radiation Oncology, Cancer Centre of Southeastern Ontario, Kingston, Ontario, Canada
| | - Michael Brundage
- Department of Radiation Oncology, Cancer Centre of Southeastern Ontario, Kingston, Ontario, Canada; Department of Public Health Sciences, Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada
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Kelly T, Surjan Y, Rinks M, Warren‐Forward H. A radiation therapist's guide to health literacy: A narrative review. J Med Radiat Sci 2021; 68:465-474. [PMID: 34137186 PMCID: PMC8656194 DOI: 10.1002/jmrs.520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 05/15/2021] [Accepted: 05/22/2021] [Indexed: 11/09/2022] Open
Abstract
Radiation therapist (RT) communication plays an essential part of patient-centred care in achieving better patient outcomes within radiation oncology. Patients present from a range of social circumstances, education levels and cultural backgrounds, all of which may significantly impact their level of health literacy (HL). Using literature sourced from databases such as EMCare Nursing & Allied Health Database, MEDLINE(R) and APA PsycInfo, this narrative review explores HL definitions, international comparison rates and indications of individual low HL. It also reviews HL assessments as well as exploring enablers and barriers to HL from the RT perspective. Strategies from both the individual or organisational perspective are provided for RTs to begin or continue their HL interest. By educating the radiation therapy profession about health literacy and making small changes in interpersonal interactions, there is the opportunity to impact patients' experiences and outcomes significantly.
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Affiliation(s)
- Toni Kelly
- School of Health SciencesUniversity of NewcastleAustralia
- Illawarra Shoalhaven Local Health DistrictAustralia
| | - Yolanda Surjan
- School of Health SciencesUniversity of NewcastleAustralia
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Noya F, Carr S, Thompson S, Clifford R, Playford D. Factors associated with the rural and remote practice of medical workforce in Maluku Islands of Indonesia: a cross-sectional study. HUMAN RESOURCES FOR HEALTH 2021; 19:126. [PMID: 34627282 PMCID: PMC8502290 DOI: 10.1186/s12960-021-00667-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/28/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Many factors contribute to engagement in rural and remote (RR) medical practice, but little is known about the factors associated with rural and remote medical practice in such remote locations as the Maluku Province of Indonesia. This study describes factors associated with actual RR practice, preferred RR practice, and intention to remain practice in Maluku Province. METHODS An online survey of work-related experience and intentions for future rural work was administered to 410 doctors working in the Maluku province of Indonesia. Participant characteristics were described using descriptive statistics, associations between the independent variables with the location of the workforce, intention to remain practice in Maluku, preference for future RR practice in Maluku were analysed using Chi-square tests and logistic regression. RESULTS A total of 324 responses (79% response rate) were recorded, comprising 70% females and 30% Pattimura University graduates of doctors employed in Maluku. Doctors working in RR areas were more likely to be a GP (OR 3.49, CI 1.03-11.8), have a monthly salary of more than IDR 6 million (OR 11.5, CI 4.24-31.1), and have no additional practice (OR 2.78, CI 1.34-5.78). Doctors intended to stay practice in Maluku were more likely to be born in Maluku (OR 7.77, CI 3.42-17.7) and have graduated from Pattimura University (OR 3.06, CI 1.09-8.54), and less likely to be a temporary employee (OR 0.24, CI 0.10-0.57). Doctors who prefer future RR practice in Maluku were more likely to experience rural living (OR 2.05 CI 1.05-3.99), have a positive indication of the impact of community exposure during medical schools on their current practice (OR 2.08, CI 1.06-4.09), currently practising in RR Maluku (OR 8.23, CI 3.27-20.8); and less likely to have bigger take-home pay (OR 0.30, CI 0.13-0.70). CONCLUSION This study indicates that special attention should be given to recruiting doctors with a rural background and ongoing support through attractive opportunities to build a sustainable RR workforce. Since a regional medical school helps supply doctors to the RR areas in its region, a sustained collaboration between medical schools and local government implementing relevant strategies are needed to widen participation and improve the recruitment and retention of RR doctors.
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Affiliation(s)
- Farah Noya
- Division of Health Professions Education, School of Allied Health, University of Western Australia, Perth, Australia
- Medical Education Unit, Faculty of Medicine, Pattimura University, Ambon, Indonesia
- Health Professions Education Building, The University of Western Australia, Crawley Avenue (off Mounts Bay Road-next to CAR PARK 25), Nedlands, WA 6009 Australia
| | - Sandra Carr
- Division of Health Professions Education, School of Allied Health, University of Western Australia, Perth, Australia
| | - Sandra Thompson
- Western Australian Centre for Rural Health, The University of Western Australia, Perth, Australia
| | - Rhonda Clifford
- School of Allied Health, University of Western Australia, Perth, Australia
| | - Denese Playford
- The Rural Clinical School of WA, School of Medicine, The University of Western Australia, Perth, Australia
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11
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Slavova-Azmanova NS, Newton JC, Johnson CE, Hohnen H, Ives A, McKiernan S, Platt V, Bulsara M, Saunders C. A cross-sectional analysis of out-of-pocket expenses for people living with a cancer in rural and outer metropolitan Western Australia. AUST HEALTH REV 2021; 45:148-156. [PMID: 33587885 DOI: 10.1071/ah19265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 06/15/2020] [Indexed: 11/23/2022]
Abstract
Objective To determine the extent of medical and non-medical out-of-pocket expenses (OOPE) among regional/rural and outer metropolitan Western Australian patients diagnosed with cancer, and the factors associated with higher costs. Methods Cross-sectional data were collected from adult patients living in four regional/rural areas and two outer metropolitan regions in Western Australia who had been diagnosed with breast, prostate, colorectal or lung cancer. Consenting participants were mailed demographic and financial questionnaires, and requested to report all OOPE related to their cancer treatment. Results The median total OOPE reported by 308 regional/rural participants and 119 outer metropolitan participants were A$1518 (interquartile range (IQR): A$581-A$3769) and A$2855 (IQR: A$958-A$7142) respectively. Participants most likely to experience higher total OOPE were younger than 65 years of age, male, resided in the outer metropolitan area, worked prior to diagnosis, had private health insurance, were in a relationship, and underwent surgery. Multivariate analysis of regional/rural participants revealed that receiving care at a rural cancer centre was associated with significantly lower non-medical OOPE (estimated mean A$805, 95% confidence interval (CI): A$735-A$875, P=0.038; compared with other rural participants (A$1347, 95% CI: A$743-A$1951, P<0.001)). Conclusion The cancer patients who participated in this study experienced variation in OOPE, with outer metropolitan participants reporting higher OOPE compared with their regional/rural counterparts. There is a need for cost transparency and access to care close to home, so that patients can make informed choices about where to receive their care. What is known about the topic? In recent years, OOPE for health care in general and cancer in particular have been widely debated by consumers and not-for-profit organisations; the topic has attracted much political attention because it affects both equity and access to care and has wider financial implications for the community. Research studies and reports from both consumer organisations and a Ministerial Advisory Committee found that cancer patients can face exorbitant out-of-pocket costs, and that individuals with private health insurance and those with prostate and breast cancer reported higher costs. In Western Australia, a cancer centre providing comprehensive cancer care was established in the second most populous region to ameliorate the high costs for travel and accommodation that regional cancer patients are known to experience. What does this paper add? This study is unique because it collected detailed cost information from patients and reports on the OOPE of regional/rural and outer metropolitan Western Australian patients receiving care for one of the four most common cancers; it therefore offers novel insight into the experiences of these groups. This study demonstrates that outer metropolitan cancer patients are experiencing much higher OOPE compared with regional/rural cancer patients. Additionally, regional/rural study participants who accessed a Regional Cancer Centre experienced significantly lower non-medical OOPE, compared with regional/rural study participants receiving care elsewhere. What are the implications for practitioners? First, there is a need for improved communication of OOPE to minimise costs to the patient, for example, by facilitating access to local cancer care. Health service providers and insurance companies can improve cost transparency for cancer patients by making this information more readily available, allowing patients to make informed financial choices about where to seek care. Second, the needs of working patients deserve specific attention. These patients face significant work uncertainty and additional distress following a cancer diagnosis.
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Affiliation(s)
- Neli S Slavova-Azmanova
- UWA Medical School, The University of Western Australia, 35 Stirling Highway, Perth, WA 6099, Australia. ; ; ; ; and Corresponding author.
| | - Jade C Newton
- UWA Medical School, The University of Western Australia, 35 Stirling Highway, Perth, WA 6099, Australia. ; ; ;
| | - Claire E Johnson
- UWA Medical School, The University of Western Australia, 35 Stirling Highway, Perth, WA 6099, Australia. ; ; ; ; and School of Nursing and Midwifery, Monash University, Wellington Road, Clayton, Vic. 3800, Australia; and Eastern Health, 5 Arnold Street, Box Hill, Vic. 3128, Australia.
| | - Harry Hohnen
- UWA Medical School, The University of Western Australia, 35 Stirling Highway, Perth, WA 6099, Australia. ; ; ;
| | - Angela Ives
- UWA Medical School, The University of Western Australia, 35 Stirling Highway, Perth, WA 6099, Australia. ; ; ;
| | - Sandy McKiernan
- Cancer Council Western Australia, Perth, WA 6008, Australia.
| | - Violet Platt
- WA Cancer and Palliative Care Network, North Metropolitan Health Service, 4th Floor A Block, Verdun Street, Nedlands, WA 6009, Australia.
| | - Max Bulsara
- Institute for Health Research, University of Notre Dame, 32 Mouat Street, Fremantle, WA 6959, Australia.
| | - Christobel Saunders
- UWA Medical School, The University of Western Australia, 35 Stirling Highway, Perth, WA 6099, Australia. ; ; ;
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12
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Conway P, Leach M, Tejani N, Robinson A, Shethia Y, Solo I. Oesophageal cancer treatment patterns, timeliness of care and outcomes in the Loddon Mallee region of Victoria: A retrospective cohort study. J Med Imaging Radiat Oncol 2021; 65:242-250. [PMID: 33634598 DOI: 10.1111/1754-9485.13167] [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: 04/07/2020] [Revised: 10/16/2020] [Accepted: 02/03/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Few studies have investigated oesophageal cancer care in regional areas. This study aimed to describe treatment patterns for oesophageal cancer in a regional area, and to identify factors associated with radiotherapy utilisation, timeliness of care, and death. METHODS In a retrospective cohort study, medical records were reviewed to source data on all patients diagnosed with and/or treated for oesophageal cancer at two regional Victorian hospitals over July 2015-June 2018. Cox proportional hazards regression was employed to identify factors associated with time from diagnosis to death while binary logistic regression was used to identify factors associated with radiotherapy utilisation and treatment within 28 days of diagnosis - a time frame derived from the relevant optimal care pathway. RESULTS Of 95 patients, 72% had radiotherapy, 32% received any treatment within 28 days, and 78% died over a median time of nine months. Odds of not receiving radiotherapy were decreased (odds ratio [OR] = 0.26, 95% confidence interval [CI] = 0.08-0.87) for histology other than adenocarcinoma. Odds of timely care were increased for any palliative radiotherapy (OR = 3.47, 95% CI = 1.15-10.5) and decreased for older age (OR = 0.95, 95% CI = 0.91.0.999). Hazard of death was elevated for stage IV disease (hazard ratio [HR] = 2.73, 95% CI = 1.64-4.54) and reduced for radical intent (HR = 0.27, 95% CI = 0.15-0.48). CONCLUSION Nearly three-quarters of regional oesophageal cancer patients had radiotherapy while approximately one-third received any treatment within the recommended 28 days. Any palliative radiotherapy and younger age were associated with timely treatment. Future studies could further investigate factors related to timely oesophageal cancer care.
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Affiliation(s)
- Paul Conway
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Michael Leach
- Loddon Mallee Integrated Cancer Service, Bendigo, Victoria, Australia.,School of Rural Health, Monash University, Bendigo, Victoria, Australia
| | - Neetu Tejani
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Amanda Robinson
- Loddon Mallee Integrated Cancer Service, Bendigo, Victoria, Australia
| | - Yachna Shethia
- Loddon Mallee Integrated Cancer Service, Bendigo, Victoria, Australia
| | - Ilana Solo
- Loddon Mallee Integrated Cancer Service, Bendigo, Victoria, Australia
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13
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Slavova-Azmanova NS, Newton JC, Saunders C, Johnson CE. 'Biggest factors in having cancer were costs and no entitlement to compensation'-The determinants of out-of-pocket costs for cancer care through the lenses of rural and outer metropolitan Western Australians. Aust J Rural Health 2021; 28:588-602. [PMID: 33382474 DOI: 10.1111/ajr.12686] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The aim of this qualitative analysis was to determine patients' perceptions of the impact of cancer-related costs. DESIGN A qualitative inductive content analysis of the comment sections of surveys completed by participants in a cross-sectional study of cancer-related expenses. SETTING Residents of 4 regional/rural and 2 outer metropolitan areas in Western Australia. PARTICIPANTS Adults diagnosed with breast, prostate, colorectal or lung cancer participated in the study between 1 April 2014 and 31 April 2017. MAIN OUTCOME MEASURES This study identified the key factors contributing to the cost experiences reported by the participants. RESULTS Participant comments were organised into 4 main categories perceived to incorporate the key factors contributing to the cost experiences reported by 300 participants: 1) health care system factors (access to care in the public or private sector, availability of services close to home, gap payments, cost of travel) 2) financial factors (impact of cancer on employment, ability to work, and career; and strategies for improving financial difficulties) 3) social and community support provided by the government and not-for-profit organisations and 4) understanding of the health care system. CONCLUSION There is a need for cost transparency, initiatives for no- or low-fee billing providers, access to care close to home, development of financial assistance schemes and return to work programs to alleviate the financial hardship experienced by cancer patients and their families.
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Affiliation(s)
| | - Jade C Newton
- UWA Medical School, The University of Western Australia, Perth, WA, Australia
| | - Christobel Saunders
- UWA Medical School, The University of Western Australia, Perth, WA, Australia
| | - Claire E Johnson
- UWA Medical School, The University of Western Australia, Perth, WA, Australia.,Monash Nursing and Midwifery, Monash University, Melbourne, Vic., Australia.,Eastern Health, Melbourne, Vic., Australia
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14
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Reconceptualising Rural Cancer Inequalities: Time for a New Research Agenda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041455. [PMID: 32102462 PMCID: PMC7068553 DOI: 10.3390/ijerph17041455] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/18/2020] [Accepted: 02/18/2020] [Indexed: 12/13/2022]
Abstract
Evidence has shown for over 20 years that patients residing in rural areas face poorer outcomes for cancer. The inequalities in survival that rural cancer patients face are observed throughout the developed world, yet this issue remains under-examined and unexplained. There is evidence to suggest that rural patients are more likely to be diagnosed as a result of an emergency presentation and that rural patients may take longer to seek help for symptoms. However, research to date has been predominantly epidemiological, providing us with an understanding of what is occurring in these populations, yet failing to explain why. In this paper we outline the problems inherent in current research approaches to rural cancer inequalities, namely how ‘cancer symptoms’ are conceived of and examined, and the propensity towards a reductionist approach to rural environments and populations, which fails to account for their heterogeneity. We advocate for a revised rural cancer inequalities research agenda, built upon in-depth, community-based examinations of rural patients’ experiences across the cancer pathway, which takes into account both the micro and macro factors which exert influence on these experiences, in order to develop meaningful interventions to improve cancer outcomes for rural populations.
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15
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Chan J, Polo A, Zubizarreta E, Bourque JM, Hanna TP, Gaudet M, Dennis K, Brundage M, Slotman B, Abdel-Wahab M. Access to radiotherapy and its association with cancer outcomes in a high-income country: Addressing the inequity in Canada. Radiother Oncol 2019; 141:48-55. [PMID: 31575428 DOI: 10.1016/j.radonc.2019.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 08/03/2019] [Accepted: 09/07/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND PURPOSE Canada is a high-income country with universal healthcare. In international comparisons, its overall level of access to radiotherapy appears sufficient. However, challenges exist due to Canada's large geographic area and small population density. The association between access and cancer outcomes nationally has not yet been described. MATERIALS AND METHODS We quantified geographic accessibility for 2012 using the linear distance from each Canadian health region centroid to the nearest radiotherapy center. We used geospatial analytic techniques to detect clusters of age-standardized all-cancer mortality-to-incidence ratios (MIRs) across health regions, from 2010-2012. Global ordinary least squares (OLS) and geographically-weighted regression (GWR) were conducted to examine relationships between distance and MIR, adjusting for sociodemographic factors. RESULTS Median distance from health region centroid to nearest radiotherapy center was 101.73 km (range 1.14-2095.12). One cluster of worse outcomes (MIR range 0.45-0.88) involved most of northern Canada, with a second cluster of better outcomes (MIR range 0.40-0.41) in southern British Columbia. In both regression models, regions with longer distance to radiotherapy center (ß = 0.0001), increased smoking (ß = 0.002), and poorer food security (ß = -0.003) were significantly associated with worse outcomes (OLS R2 = 0.70, GWR R2 = 0.74). Distance remained independently associated with MIR for lung and colorectal cancer subgroups, but not breast and prostate. CONCLUSIONS A clear north-south discordance in cancer outcomes exists in Canada, with poorer outcomes in the north, while radiotherapy centers are concentrated along the south. Increased distance to radiotherapy, along with other sociodemographic and health-system factors, are associated with poorer cancer outcomes. Our study could be replicated, particularly in other high-income countries, to help identify national patterns and regional disparities in access and outcomes.
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Affiliation(s)
- Jessica Chan
- Division of Radiation Oncology, The Ottawa Hospital and the University of Ottawa, Canada; Division of Human Health, International Atomic Energy Agency, Vienna, Austria; Department of Radiation Oncology, Amsterdam UMC - Vrije University Medical Center, The Netherlands.
| | - Alfredo Polo
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Eduardo Zubizarreta
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Jean-Marc Bourque
- Division of Radiation Oncology, The Ottawa Hospital and the University of Ottawa, Canada; Division of Human Health, International Atomic Energy Agency, Vienna, Austria; Institute of Cancer Policy, Kings College London, United Kingdom
| | - Timothy P Hanna
- Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston, Canada
| | - Marc Gaudet
- Division of Radiation Oncology, The Ottawa Hospital and the University of Ottawa, Canada
| | - Kristopher Dennis
- Division of Radiation Oncology, The Ottawa Hospital and the University of Ottawa, Canada
| | - Michael Brundage
- Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston, Canada
| | - Ben Slotman
- Department of Radiation Oncology, Amsterdam UMC - Vrije University Medical Center, The Netherlands
| | - May Abdel-Wahab
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
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16
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Hunter J, Smith C, Delaney GP, Templeman K, Grant S, Ussher JM. Coverage of cancer services in Australia and providers' views on service gaps: findings from a national cross-sectional survey. BMC Cancer 2019; 19:570. [PMID: 31185937 PMCID: PMC6560726 DOI: 10.1186/s12885-019-5649-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 04/26/2019] [Indexed: 01/02/2023] Open
Abstract
Background In response to the increasing cancer prevalence and the evolving health service landscape across the public and private health sectors in Australia, this study aimed to map cancer services and identify factors associated with service provision and important service gaps. Methods A prospective, cross-sectional survey was conducted throughout 2016. Extensive search strategies identified Government or privately-owned, hospital or community-based healthcare organisations with dedicated cancer services. One nominated staff member from each organisation answered a purpose specific online/paper questionnaire. Descriptive statistics, standardised rates, and single level and multilevel multinomial logistic regression were used to analyse the data. Analysis was augmented with a qualitative descriptive analysis of open-ended questions. Results From the 295 eligible organisations with a cancer service in Australia, 93.2% participated in the survey. After adjusting for remoteness, for-profit companies were significantly more likely than Government operated services to provide only one or two types of cancer services (e.g. radiotherapy) in a limited range of settings (e.g. day hospital with no in-patient or home care) (p < 0.001) and less likely to provide comprehensive cancer services (p < 0.001). After adjusting for ownership and the respondent’s role in the organisation, respondents located in remote regions of Australia were more likely to identify cancer services that are dependent upon specialist medical practitioners as the most important service gaps in their region (p = 0.003). Despite 76.0% of organisations across Australia offering some type of supportive care or survivorship services, providers identified this group of services as the most pressing service gaps in major cities, rural and remote regions alike (standardised rate: 47.9% (95%CI: 43.6–57.4%); p < .000). This included the need for improved integration, outreach and affordability. Conclusions The broad range of cancer services, settings and ownership identified by this survey highlights the complexity of the Australian healthcare system that cancer survivors must navigate and the challenges of providing comprehensive cancer care particularly in rural and remote regions. Whilst the significant role of supportive care and survivorship services are increasingly being recognised, the findings from this survey support calls for innovative service models and funding mechanisms that expand the focus from preventing and treating cancer to supporting cancer survivors throughout the cancer continuum and promoting the delivery of integrated and equitable cancer care across the public and private sectors. Electronic supplementary material The online version of this article (10.1186/s12885-019-5649-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jennifer Hunter
- NICM Health Research Institute, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia. .,Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
| | - Caroline Smith
- NICM Health Research Institute, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Geoff P Delaney
- South-Western Sydney Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,Cancer Services, South Western Sydney Local Health District, Sydney, NSW, Australia.,Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Kate Templeman
- NICM Health Research Institute, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Suzanne Grant
- NICM Health Research Institute, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Jane M Ussher
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW, Australia
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17
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Haigh MM, Baxi S, Lyford M, Cheetham S, Thompson SC. Cancer support services: Are they meeting the needs of rural radiotherapy patients? Eur J Cancer Care (Engl) 2018; 28:e12904. [PMID: 30084525 DOI: 10.1111/ecc.12904] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 06/17/2018] [Accepted: 07/09/2018] [Indexed: 12/30/2022]
Abstract
This paper examines the supportive care in place to meet the needs of patients receiving radiotherapy at a regional oncology service in Bunbury, Western Australia. Semi-structured in-depth interviews with 21 service providers and 17 adults diagnosed with cancer who underwent radiotherapy at the Service were recorded, transcribed and analysed thematically. Key themes relevant were co-operation and collaboration of interdisciplinary team members; support from organisations to assist with accommodation, transport, emotional support and provision of practical assistance, as well as barriers to accessing support. Most participants were positive about the support available, recognising the needs of rural radiotherapy patients for assistance with travel, accommodation and psychosocial support to help deal with the stressors they face. Collaboration between the various service providers maximised the support available to patients but the drop off in psychosocial support once the intensity of treatment was completed was identified as a weakness in the support available. The support system, established around a regional radiotherapy service, was enhanced by the collaborative professional relationships developed among service providers. The service extends beyond clinical service delivery by recognising financial, logistical and psychosocial support needs, factors to be considered to ensure rural radiotherapy patients are provided with holistic care.
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Affiliation(s)
- Margaret M Haigh
- Western Australian Centre for Rural Health, The University of Western Australia, Perth, Western Australia, Australia.,School of Nursing and Midwifery, The University of Dublin Trinity College, Dublin 2, Ireland
| | - Siddhartha Baxi
- Western Australian Centre for Rural Health, The University of Western Australia, Perth, Western Australia, Australia.,Radiation Oncology, South West Radiation Oncology Service, South West Health Campus, Corner of Bussell Hwy & Robertson Drive, Bunbury, Western Australia, Australia
| | - Marilyn Lyford
- Western Australian Centre for Rural Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Shelley Cheetham
- Western Australian Centre for Rural Health, The University of Western Australia, Perth, Western Australia, Australia.,School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Sandra C Thompson
- Western Australian Centre for Rural Health, The University of Western Australia, Perth, Western Australia, Australia
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18
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Donkor A, Luckett T, Aranda S, Phillips J. Barriers and facilitators to implementation of cancer treatment and palliative care strategies in low- and middle-income countries: systematic review. Int J Public Health 2018; 63:1047-1057. [PMID: 29974131 DOI: 10.1007/s00038-018-1142-2] [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] [Received: 02/22/2018] [Revised: 06/21/2018] [Accepted: 06/26/2018] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To appraise improvement strategies adopted by low- and middle-income countries to increase access to cancer treatments and palliative care; and identify the facilitators and barriers to implementation. METHODS A systematic review was conducted and reported in accordance with PRISMA statement. MEDLINE, CINAHL, and the Cochrane Library databases were searched. Bias was assessed using the Standards for Quality Improvement Reporting Excellence, and evidence graded using the Australian National Health and Medical Research Council system. RESULTS Of 3069 articles identified, 18 studied were included. These studies involved less than a tenth (n = 12, 8.6%) of all low- and middle-income countries. Most were case reports (58%), and the majority focused on palliative care (n = 11, 61%). Facilitators included: stakeholder engagement, financial support, supportive learning environment, and community networks. Barriers included: lack of human resources, financial constraints, and limited infrastructure. CONCLUSIONS There is limited evidence on sustainable strategies for increasing access to cancer treatments and palliative care in low- and middle-income countries. Future strategies should be externally evaluated and be tailored to address service delivery; workforce; information; medical products, vaccines, and technologies; financing; and leadership and governance.
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Affiliation(s)
- Andrew Donkor
- Faculty of Health, IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), University of Technology Sydney, Sydney, NSW, 2007, Australia. .,National Centre for Radiotherapy, Korle-Bu Teaching Hospital, Accra, Ghana.
| | - Tim Luckett
- Faculty of Health, IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), University of Technology Sydney, Sydney, NSW, 2007, Australia
| | - Sanchia Aranda
- Faculty of Health, IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), University of Technology Sydney, Sydney, NSW, 2007, Australia.,Cancer Council Australia, Sydney, NSW, Australia
| | - Jane Phillips
- Faculty of Health, IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), University of Technology Sydney, Sydney, NSW, 2007, Australia
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