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Bierbaum M, Rapport F, Arnolda G, Tran Y, Nic Giolla Easpaig B, Ludlow K, Clay-Williams R, Austin E, Laginha B, Lo CY, Churruca K, van Baar L, Hutchinson K, Chittajallu R, Owais SS, Nullwala R, Hibbert P, Fajardo Pulido D, Braithwaite J. Rates of adherence to cancer treatment guidelines in Australia and the factors associated with adherence: A systematic review. Asia Pac J Clin Oncol 2023; 19:618-644. [PMID: 36881529 DOI: 10.1111/ajco.13948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 03/08/2023]
Abstract
Adherence to cancer treatment clinical practice guidelines (CPGs) varies enormously across Australia, despite being associated with improved patient outcomes. This systematic review aims to characterize adherence rates to active-cancer treatment CPGs in Australia and related factors to inform future implementation strategies. Five databases were systematically searched, abstracts were screened for eligibility, a full-text review and critical appraisal of eligible studies performed, and data extracted. A narrative synthesis of factors associated with adherence was conducted, and the median adherence rates within cancer streams calculated. A total of 21,031 abstracts were identified. After duplicates were removed, abstracts screened, and full texts reviewed, 20 studies focused on adherence to active-cancer treatment CPGs were included. Overall adherence rates ranged from 29% to 100%. Receipt of guideline recommended treatments was higher for patients who were younger (diffuse large B-cell lymphoma [DLBCL], colorectal, lung, and breast cancer); female (breast and lung cancer), and male (DLBCL and colorectal cancer); never smokers (DLBCL and lung cancer); non-Indigenous Australians (cervical and lung cancer); with less advanced stage disease (colorectal, lung, and cervical cancer), without comorbidities (DLBCL, colorectal, and lung cancer); with good-excellent Eastern Cooperative Oncology Group performance status (lung cancer); living in moderately accessible places (colon cancer); and; treated in metropolitan facilities (DLBLC, breast and colon cancer). This review characterized active-cancer treatment CPG adherence rates and associated factors in Australia. Future targeted CPG implementation strategies should account for these factors, to redress unwarranted variation particularly in vulnerable populations, and improve patient outcomes (Prospero number: CRD42020222962).
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Affiliation(s)
- Mia Bierbaum
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
- Centre for Research Excellence in Implementation Science in Oncology, AIHI, Macquarie University, Sydney, Australia
| | - Yvonne Tran
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
- Centre for Research Excellence in Implementation Science in Oncology, AIHI, Macquarie University, Sydney, Australia
| | - Brona Nic Giolla Easpaig
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
- Centre for Research Excellence in Implementation Science in Oncology, AIHI, Macquarie University, Sydney, Australia
| | - Kristiana Ludlow
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Elizabeth Austin
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Bela Laginha
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Chi Yhun Lo
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Lieke van Baar
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Karen Hutchinson
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Renuka Chittajallu
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
- Riverina Cancer Care Centre, Wagga Wagga, New South Wales, Australia
- GenesisCare, Kingswood, New South Wales, Australia
| | - Syeda Somyyah Owais
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Ruqaiya Nullwala
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
- North Eastern Public Health Unit, Eastern Health, Melbourne, Victoria, Australia
| | - Peter Hibbert
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
- South Australian Health & Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Diana Fajardo Pulido
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
- Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
- Centre for Research Excellence in Implementation Science in Oncology, AIHI, Macquarie University, Sydney, Australia
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Bierbaum M, Rapport F, Arnolda G, Delaney GP, Liauw W, Olver I, Braithwaite J. Clinical practice guideline adherence in oncology: A qualitative study of insights from clinicians in Australia. PLoS One 2022; 17:e0279116. [PMID: 36525435 PMCID: PMC9757567 DOI: 10.1371/journal.pone.0279116] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The burden of cancer is large in Australia, and rates of cancer Clinical Practice Guideline (CPG) adherence is suboptimal across various cancers. METHODS The objective of this study is to characterise clinician-perceived barriers and facilitators to cancer CPG adherence in Australia. Semi-structured interviews were conducted to collect data from 33 oncology-focused clinicians (surgeons, radiation oncologists, medical oncologists and haematologists). Clinicians were recruited in 2019 and 2020 through purposive and snowball sampling from 7 hospitals across Sydney, Australia, and interviewed either face-to-face in hospitals or by phone. Audio recordings were transcribed verbatim, and qualitative thematic analysis of the interview data was undertaken. Human research ethics committee approval and governance approval was granted (2019/ETH11722, #52019568810127). RESULTS Five broad themes and subthemes of key barriers and facilitators to cancer treatment CPG adherence were identified: Theme 1: CPG content; Theme 2: Individual clinician and patient factors; Theme 3: Access to, awareness of and availability of CPGs; Theme 4: Organisational and cultural factors; and Theme 5: Development and implementation factors. The most frequently reported barriers to adherence were CPGs not catering for patient complexities, being slow to be updated, patient treatment preferences, geographical challenges for patients who travel large distances to access cancer services and limited funding of CPG recommended drugs. The most frequently reported facilitators to adherence were easy accessibility, peer review, multidisciplinary engagement or MDT attendance, and transparent CPG development by trusted, multidisciplinary experts. CPGs provide a reassuring framework for clinicians to check their treatment plans against. Clinicians want cancer CPGs to be frequently updated utilising a wiki-like process, and easily accessible online via a comprehensive database, coordinated by a well-trusted development body. CONCLUSION Future implementation strategies of cancer CPGs in Australia should be tailored to consider these context-specific barriers and facilitators, taking into account both the content of CPGs and the communication of that content. The establishment of a centralised, comprehensive, online database, with living wiki-style cancer CPGs, coordinated by a well-funded development body, along with incorporation of recommendations into point-of-care decision support would potentially address many of the issues identified.
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Affiliation(s)
- Mia Bierbaum
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- * E-mail:
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Centre for Research Excellence in Implementation Science in Oncology, Sydney, Australia
| | - Geoff P. Delaney
- Centre for Research Excellence in Implementation Science in Oncology, Sydney, Australia
- SWSLHD Cancer Services, Liverpool, Australia
| | - Winston Liauw
- Centre for Research Excellence in Implementation Science in Oncology, Sydney, Australia
- SESLHD Cancer Service, Kogarah, Australia
| | - Ian Olver
- School of Psychology, University of Adelaide, Adelaide, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Centre for Research Excellence in Implementation Science in Oncology, Sydney, Australia
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Bierbaum M, Rapport F, Arnolda G, Tran Y, Nic Giolla Easpaig B, Ludlow K, Braithwaite J. Adherence to clinical practice guidelines (CPGs) for the treatment of cancers in Australia and the factors associated with adherence: a systematic review protocol. BMJ Open 2021; 11:e050912. [PMID: 34548359 PMCID: PMC8458325 DOI: 10.1136/bmjopen-2021-050912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Clinical practice guidelines (CPGs) synthesise the latest evidence to support clinical and patient decision-making. CPG adherent care is associated with improved patient survival outcomes; however, adherence rates are low across some cancer streams in Australia. Greater understanding of specific barriers to cancer treatment CPG adherence is warranted to inform future implementation strategies.This paper presents the protocol for a systematic review that aims to determine cancer treatment CPG adherence rates in Australia across a variety of common cancers, and to identify any factors associated with adherence to those CPGs, as well as any associations between CPG adherence and patient outcomes. METHODS AND ANALYSIS Five databases will be searched, Ovid Medline, PsychInfo, Embase, Scopus and Web of Science, for eligible studies evaluating adherence rates to cancer treatment CPGs in Australia. A team of reviewers will screen the abstracts in pairs according to predetermined inclusion criteria and then review the full text of eligible studies. All included studies will be assessed for quality and risk of bias. Data will be extracted using a predefined data extraction template. The frequency or rate of adherence to CPGs, factors associated with adherence to those CPGs and any reported patient outcome rates (eg, relative risk ratios or 5-year survival rates) associated with adherence to CPGs will be described. If applicable, a pooled estimate of the rate of adherence will be calculated by conducting a random-effects meta-analysis. The systematic review will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. ETHICS AND DISSEMINATION Ethics approval will not be required, as this review will present anonymised data from other published studies. Results from this study will form part of a doctoral dissertation (MB), will be published in a journal, presented at conferences, and other academic presentations. PROSPERO REGISTRATION NUMBER CRD42020222962.
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Affiliation(s)
- Mia Bierbaum
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Yvonne Tran
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Macquarie University Hearing, Sydney, New South Wales, Australia
| | - Bróna Nic Giolla Easpaig
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Kristiana Ludlow
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- The University of Queensland, School of Psychology, Saint Lucia, Queensland, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Lu PW, McCarty JC, Fields AC, Azzeh M, Goldberg JE, Irani J, Bleday R, Melnitchouk N. The Distribution of Colorectal Surgeons in the United States. J Surg Res 2020; 251:71-77. [DOI: 10.1016/j.jss.2020.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/14/2020] [Accepted: 01/25/2020] [Indexed: 11/30/2022]
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A systematic scoping review of determinants of multidisciplinary cancer team access and decision-making in the management of older patients diagnosed with colorectal cancer. J Geriatr Oncol 2020; 11:909-916. [DOI: 10.1016/j.jgo.2019.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 08/06/2019] [Accepted: 11/04/2019] [Indexed: 12/24/2022]
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Feletto E, Lew JB, Worthington J, He E, Caruana M, Butler K, Hui H, Taylor N, Banks E, Barclay K, Broun K, Butt A, Carter R, Cuff J, Dessaix A, Ee H, Emery J, Frayling IM, Grogan P, Holden C, Horn C, Jenkins MA, Kench JG, Laaksonen MA, Leggett B, Mitchell G, Morris S, Parkinson B, St John DJ, Taoube L, Tucker K, Wakefield MA, Ward RL, Win AK, Worthley DL, Armstrong BK, Macrae FA, Canfell K. Pathways to a cancer-free future: a protocol for modelled evaluations to minimise the future burden of colorectal cancer in Australia. BMJ Open 2020; 10:e036475. [PMID: 32565470 PMCID: PMC7307542 DOI: 10.1136/bmjopen-2019-036475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION With almost 50% of cases preventable and the Australian National Bowel Cancer Screening Program in place, colorectal cancer (CRC) is a prime candidate for investment to reduce the cancer burden. The challenge is determining effective ways to reduce morbidity and mortality and their implementation through policy and practice. Pathways-Bowel is a multistage programme that aims to identify best-value investment in CRC control by integrating expert and end-user engagement; relevant evidence; modelled interventions to guide future investment; and policy-driven implementation of interventions using evidence-based methods. METHODS AND ANALYSIS: Pathways-Bowel is an iterative work programme incorporating a calibrated and validated CRC natural history model for Australia (Policy1-Bowel) and assessing the health and cost outcomes and resource use of targeted interventions. Experts help identify and prioritise modelled evaluations of changing trends and interventions and critically assess results to advise on their real-world applicability. Where appropriate the results are used to support public policy change and make the case for optimal investment in specific CRC control interventions. Fourteen high-priority evaluations have been modelled or planned, including evaluations of CRC outcomes from the changing prevalence of modifiable exposures, including smoking and body fatness; potential benefits of daily aspirin intake as chemoprevention; increasing CRC incidence in people aged <50 years; increasing screening participation in the general and Aboriginal and Torres Strait Islander populations; alternative screening technologies and modalities; and changes to follow-up surveillance protocols. Pathways-Bowel is a unique, comprehensive approach to evaluating CRC control; no prior body of work has assessed the relative benefits of a variety of interventions across CRC development and progression to produce a list of best-value investments. ETHICS AND DISSEMINATION Ethics approval was not required as human participants were not involved. Findings are reported in a series of papers in peer-reviewed journals and presented at fora to engage the community and policymakers.
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Affiliation(s)
- Eleonora Feletto
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, New South Wales, Australia
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jie-Bin Lew
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, New South Wales, Australia
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Joachim Worthington
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, New South Wales, Australia
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Emily He
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, New South Wales, Australia
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Michael Caruana
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, New South Wales, Australia
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Katherine Butler
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, New South Wales, Australia
| | - Harriet Hui
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, New South Wales, Australia
| | - Natalie Taylor
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Emily Banks
- ANU College of Medicine, Biology and Environment, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Karen Barclay
- Northern Clinical School, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kate Broun
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Alison Butt
- Research Strategy Office, University of New South Wales, Sydney, New South Wales, Australia
| | - Rob Carter
- Deakin Institute for Health Research, Deakin University, Melbourne, Victoria, Australia
| | - Jeff Cuff
- Faculty of Science Biotech and Biomolecular Science, University of New South Wales, Sydney, New South Wales, Australia
- Research Advocate, Sydney, New South Wales, Australia
| | - Anita Dessaix
- Cancer Prevention and Advocacy, Cancer Council NSW, Woolloomooloo, New South Wales, Australia
| | - Hooi Ee
- Department of Gastroenterology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Jon Emery
- General Practice and Primary Care Academic Centre, University of Melbourne, Carlton, Victoria, Australia
| | - Ian M Frayling
- Inherited Tumour Syndromes Research Group, Division of Cancer & Genetics, Cardiff University, Cardiff, UK
| | - Paul Grogan
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, New South Wales, Australia
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Carol Holden
- No Australians Dying of Bowel Cancer Initiative, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Christopher Horn
- Cancer Institute New South Wales, Eveleigh, New South Wales, Australia
| | - Mark A Jenkins
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, Victoria, Australia
| | - James G Kench
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Tissue Pathology & Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Maarit A Laaksonen
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Barbara Leggett
- Conjoint Gastroenterology, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
- School of Medicine, University of Queensland, Herston, Queensland, Australia
- Gastroenterology & Hepatology Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Gillian Mitchell
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Susan Morris
- Research Advocate, Sydney, New South Wales, Australia
- Lynch Syndrome Australia, Brisbane, Queensland, Australia
| | - Bonny Parkinson
- Macquarie University Centre for the Health Economy, Macquarie University, Sydney, New South Wales, Australia
| | - D James St John
- Cancer Council Victoria, Melbourne, Victoria, Australia
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Linda Taoube
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Katherine Tucker
- Hereditary Cancer Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Melanie A Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Robyn L Ward
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Aung Ko Win
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, Victoria, Australia
- Precision Prevention and Early Detection, University of Melbourne Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
| | - Daniel L Worthley
- No Australians Dying of Bowel Cancer Initiative, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Bruce K Armstrong
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Finlay A Macrae
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Genetic Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, New South Wales, Australia
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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Steele SR, Bilchik A, Johnson EK, Nissan A, Peoples GE, Eberhardt JS, Kalina P, Petersen B, BrüCher B, Protic M, Avital I, Stojadinovic A. Time-dependent Estimates of Recurrence and Survival in Colon Cancer: Clinical Decision Support System Tool Development for Adjuvant Therapy and Oncological Outcome Assessment. Am Surg 2020. [DOI: 10.1177/000313481408000514] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Unanswered questions remain in determining which high-risk node-negative colon cancer (CC) cohorts benefit from adjuvant therapy and how it may differ in an equal access population. Machine-learned Bayesian Belief Networks (ml-BBNs) accurately estimate outcomes in CC, providing clinicians with Clinical Decision Support System (CDSS) tools to facilitate treatment planning. We evaluated ml-BBNs ability to estimate survival and recurrence in CC. We performed a retrospective analysis of registry data of patients with CC to train–test–crossvalidate ml-BBNs using the Department of Defense Automated Central Tumor Registry (January 1993 to December 2004). Cases with events or follow-up that passed quality control were stratified into 1-, 2-, 3-, and 5-year survival cohorts. ml-BBNs were trained using machine-learning algorithms and k-fold crossvalidation and receiver operating characteristic curve analysis used for validation. BBNs were comprised of 5301 patients and areas under the curve ranged from 0.85 to 0.90. Positive predictive values for recurrence and mortality ranged from 78 to 84 per cent and negative predictive values from 74 to 90 per cent by survival cohort. In the 12-month model alone, 1,132,462,080 unique rule sets allow physicians to predict individual recurrence/mortality estimates. Patients with Stage II (N0M0) CC benefit from chemotherapy at different rates. At one year, all patients older than 73 years of age with T2–4 tumors and abnormal carcinoembryonic antigen levels benefited, whereas at five years, all had relative reduction in mortality with the largest benefit amongst elderly, highest T-stage patients. ml-BBN can readily predict which high-risk patients benefit from adjuvant therapy. CDSS tools yield individualized, clinically relevant estimates of outcomes to assist clinicians in treatment planning.
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Affiliation(s)
- Scott R. Steele
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland; the
- Department of Surgery, Madigan Army Medical Center, Tacoma, Washington; the
| | - Anton Bilchik
- U.S. Military Cancer Institute, Clinical Trials Group, Washington, DC; the
- John Wayne Cancer Institute, Santa Monica, California, and the California Oncology Research Institute, Los Angeles, California; the
- INCORE, International Consortium of Research Excellence of the Theodor-Billroth-Academy, Munich, Germany; the
| | - Eric K. Johnson
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland; the
- U.S. Military Cancer Institute, Clinical Trials Group, Washington, DC; the
- Department of Surgery, Madigan Army Medical Center, Tacoma, Washington; the
| | - Aviram Nissan
- U.S. Military Cancer Institute, Clinical Trials Group, Washington, DC; the
- Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; the
- INCORE, International Consortium of Research Excellence of the Theodor-Billroth-Academy, Munich, Germany; the
| | - George E. Peoples
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland; the
- U.S. Military Cancer Institute, Clinical Trials Group, Washington, DC; the
- Department of Surgery, Brooke Army Medical Center, San Antonio, Texas
| | | | | | | | - BjöRn BrüCher
- U.S. Military Cancer Institute, Clinical Trials Group, Washington, DC; the
- Bon Secours Cancer Institute, Richmond, Virginia
- INCORE, International Consortium of Research Excellence of the Theodor-Billroth-Academy, Munich, Germany; the
| | - Mladjan Protic
- U.S. Military Cancer Institute, Clinical Trials Group, Washington, DC; the
- INCORE, International Consortium of Research Excellence of the Theodor-Billroth-Academy, Munich, Germany; the
- Clinic of Abdominal, Endocrine, and Transplantation Surgery, Clinical Center of Vojvodina, Novi Sad, Serbia
- University of Novi Sad–Medical Faculty, Novi Sad, Serbia
| | - Itzhak Avital
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland; the
- U.S. Military Cancer Institute, Clinical Trials Group, Washington, DC; the
- Bon Secours Cancer Institute, Richmond, Virginia
- INCORE, International Consortium of Research Excellence of the Theodor-Billroth-Academy, Munich, Germany; the
| | - Alexander Stojadinovic
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland; the
- U.S. Military Cancer Institute, Clinical Trials Group, Washington, DC; the
- Department of Surgery, Division of Surgical Oncology, Walter Reed Army Medical Center, Washington, DC; the
- INCORE, International Consortium of Research Excellence of the Theodor-Billroth-Academy, Munich, Germany; the
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Bergin RJ, Thomas RJS, Whitfield K, White V. Concordance between Optimal Care Pathways and colorectal cancer care: Identifying opportunities to improve quality and reduce disparities. J Eval Clin Pract 2020; 26:918-926. [PMID: 31287616 DOI: 10.1111/jep.13231] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/24/2019] [Accepted: 06/27/2019] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Care pathway policies for cancer aim to reduce variation and improve the quality of patient care, and there is increasing evidence that adherence to such pathways is associated with improved survival and lower health care costs. Australia is implementing Optimal Care Pathways (OCPs) for several cancers, including colorectal cancer, but studies evaluating how well care conforms to OCP recommendations are rare. This study examined concordance between OCP recommendations and colorectal cancer care prior to policy rollout and disparities for vulnerable populations. METHOD Cross-sectional survey (2012-2014) of cancer registry-identified colorectal cancer patients aged ≥40 approached within 6 months of diagnosis (n = 433), their general practitioner (GP, n = 290), and specialist (n = 144) in Victoria, Australia. We measured concordance with 10 OCP recommendations and variation by geography, socio-economic, and health insurance status using age- and sex-adjusted logistic regression models. RESULTS Use of recommended GP investigations varied from 66% for colonoscopy to 13% for digital rectal exam. Recommended waiting times to receive a colonoscopy, see a specialist after referral, and begin adjuvant chemotherapy were exceeded for around a third of patients. Twenty-eight percent of specialists reported a pretreatment multidisciplinary meeting. Most patients received surgery in a hospital with an intensive care unit (92%) and chemotherapy for high risk disease (84%). In general, care was similar across sociodemographic groups. However, receipt of GP investigations tended to be higher and waiting times longer for rural, low socio-economic, and non-privately insured patients. For example, receiving a colonoscopy within 4 weeks was significantly less likely for rural (51%) than urban (78%) patients (odds ratio = 0.30; 95% confidence interval, 0.11-0.79). CONCLUSION Prior to implementation, a significant proportion of colorectal cancer patients received care that did not meet OCP recommendations. Low concordance and inequities for rural and disadvantaged populations highlight components of the pathway to target during policy implementation.
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Affiliation(s)
- Rebecca J Bergin
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia.,Department of General Practice/Centre for Cancer Research, University of Melbourne, Melbourne, Australia
| | - Robert J S Thomas
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Kathryn Whitfield
- Department of Health and Human Services Victoria, Victorian Government, Melbourne, Australia
| | - Victoria White
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia.,School of Psychology, Deakin University, Melbourne, Australia
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Abstract
The use of data from the real world to address clinical and policy-relevant questions that cannot be answered using data from clinical trials is garnering increased interest. Indeed, data from cancer registries and linked treatment records can provide unique insights into patients, treatments and outcomes in routine oncology practice. In this Review, we explore the quality of real-world data (RWD), provide a framework for the use of RWD and draw attention to the methodological pitfalls inherent to using RWD in studies of comparative effectiveness. Randomized controlled trials and RWD remain complementary forms of medical evidence; studies using RWD should not be used as substitutes for clinical trials. The comparison of outcomes between nonrandomized groups of patients who have received different treatments in routine practice remains problematic. Accordingly, comparative effectiveness studies need to be designed and interpreted very carefully. With due diligence, RWD can be used to identify and close gaps in health care, offering the potential for short-term improvement in health-care systems by enabling them to achieve the achievable.
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10
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Crawford-Williams F, March S, Ireland MJ, Rowe A, Goodwin B, Hyde MK, Chambers SK, Aitken JF, Dunn J. Geographical Variations in the Clinical Management of Colorectal Cancer in Australia: A Systematic Review. Front Oncol 2018; 8:116. [PMID: 29868464 PMCID: PMC5965390 DOI: 10.3389/fonc.2018.00116] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 03/29/2018] [Indexed: 12/17/2022] Open
Abstract
Background In Australia, cancer survival is significantly lower in non-metropolitan compared to metropolitan areas. Our objective was to evaluate the evidence on geographical variations in the clinical management and treatment of colorectal cancer (CRC). Methods A systematic review of published and gray literature was conducted. Five databases (CINAHL, PubMed, Embase, ProQuest, and Informit) were searched for articles published in English from 1990 to 2018. Studies were included if they assessed differences in clinical management according to geographical location; focused on CRC patients; and were conducted in Australia. Included studies were critically appraised using a modified Newcastle–Ottawa Scale. PRISMA systematic review reporting methods were applied. Results 17 articles met inclusion criteria. All were of high (53%) or moderate (47%) quality. The evidence available may suggest that patients in non-metropolitan areas are more likely to experience delays in surgery and are less likely to receive chemotherapy for stage III colon cancer and adjuvant radiotherapy for rectal cancer. Conclusion The present review found limited information on clinical management across geographic regions in Australia and the synthesis highlights significant issues both for data collection and reporting at the population level, and for future research in the area of geographic variation. Where geographical disparities exist, these may be due to a combination of patient and system factors reflective of location. It is recommended that population-level data regarding clinical management of CRC be routinely collected to better understand geographical variations and inform future guidelines and policy.
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Affiliation(s)
- Fiona Crawford-Williams
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, Australia.,School of Psychology and Counselling, University of Southern Queensland, Springfield Central, QLD, Australia
| | - Sonja March
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, Australia.,School of Psychology and Counselling, University of Southern Queensland, Springfield Central, QLD, Australia
| | - Michael J Ireland
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, Australia.,School of Psychology and Counselling, University of Southern Queensland, Springfield Central, QLD, Australia
| | - Arlen Rowe
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, Australia.,School of Psychology and Counselling, University of Southern Queensland, Springfield Central, QLD, Australia
| | - Belinda Goodwin
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, Australia.,School of Psychology and Counselling, University of Southern Queensland, Springfield Central, QLD, Australia
| | - Melissa K Hyde
- Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
| | - Suzanne K Chambers
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, Australia.,Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia.,Prostate Cancer Foundation of Australia, St Leonards, NSW, Australia.,Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia
| | - Joanne F Aitken
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, Australia.,Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Jeff Dunn
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, Australia.,Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, QLD, Australia.,School of Social Science, University of Queensland, Brisbane, QLD, Australia.,School of Medicine, Griffith University, Brisbane, QLD, Australia
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11
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Adelson P, Fusco K, Karapetis C, Wattchow D, Joshi R, Price T, Sharplin G, Roder D. Use of guideline-recommended adjuvant therapies and survival outcomes for people with colorectal cancer at tertiary referral hospitals in South Australia. J Eval Clin Pract 2018; 24:135-144. [PMID: 28474459 DOI: 10.1111/jep.12757] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 03/14/2017] [Accepted: 03/14/2017] [Indexed: 12/12/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Adjuvant care for colorectal cancer (CRC) has increased over the past 3 decades in South Australia (SA) in accordance with national treatment guidelines. This study explores the (1) receipt of adjuvant therapy for CRC in SA as related to national guideline recommendations, with a focus on stage C colon and stage B and C rectal cancer; (2) timing of these adjuvant therapies in relation to surgery; and (3) comparative survival outcomes. METHODS Data from the SA Clinical Cancer Registry from 4 tertiary referral hospitals for 2000 to 2010 were examined. Patterns of care were compared with treatment guidelines using multivariable logistic regression. Disease-specific survivals were calculated by treatment pathway. RESULTS Four hundred forty-three (60%) patients with stage C colon cancer and 363 (46%) with stage B and C rectal cancer received guideline-recommended care. While an overall increase in proportion receiving adjuvant care was not evident across the study period, the proportion having neoadjuvant care increased substantially. Older age was an independent predictor of not receiving adjuvant care. Patients with stage C colon cancer who received recommended adjuvant care had a higher 5-year survival than those not receiving this care, ie, 71.2% vs 53.2%. Similarly adjuvant therapy was associated with better outcomes for stage C rectal cancers. The median time for receiving adjuvant care was 8 weeks. CONCLUSIONS Survival was better for stage C CRC treated according to guidelines. Adjuvant care should be provided except where clear contraindications present. Other possible contributors to guideline adherence warranting additional investigation include co-morbidity status, multidisciplinary team involvement, and choice.
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Affiliation(s)
- Pamela Adelson
- Cancer Council South Australia, Adelaide, South Australia, Australia.,Rosemary Bryant Research Centre, School of Nursing and Midwifery, University of South Australia, Adelaide, Australia
| | - Kellie Fusco
- South Australia Clinical Cancer Registry, University of South Australia, Adelaide, South Australia, Australia
| | - Christos Karapetis
- Flinders Centre for Innovation in Cancer, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - David Wattchow
- Department of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Rohit Joshi
- Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Timothy Price
- Medical Oncology, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Greg Sharplin
- Cancer Council South Australia, Adelaide, South Australia, Australia
| | - David Roder
- Cancer Epidemiology & Population Health, University of South Australia, Adelaide, South Australia, Australia
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12
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Goldsbury D, Weber M, Yap S, Banks E, O'Connell DL, Canfell K. Identifying incident colorectal and lung cancer cases in health service utilisation databases in Australia: a validation study. BMC Med Inform Decis Mak 2017; 17:23. [PMID: 28241763 PMCID: PMC5327557 DOI: 10.1186/s12911-017-0417-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 02/10/2017] [Indexed: 11/16/2022] Open
Abstract
Background Data from centralised, population-based statutory cancer registries are generally considered the 'gold standard' for confirming incident cases of cancer. When these are not available, or more current information is needed, hospital or other routinely collected population-level data may be feasible alternative sources. We aimed to determine the validity of various methods using routinely collected administrative health data for ascertaining incident cases of colorectal or lung cancer in participants from the 45 and Up Study in New South Wales (NSW), Australia. Methods For 266,844 participants in the 45 and Up Study (recruited 2006–2009) ascertainment of incident colorectal or lung cancers was assessed using diagnosis and treatment records in linked administrative health datasets (hospital, emergency department, Medicare and pharmaceutical claims, death records). This was compared with ascertainment via the NSW Cancer Registry (NSWCR, the 'gold standard') for a period for which both data sources were available for participants. Results A total of 2253 colorectal and 1019 lung cancers were recorded for study participants in the NSWCR over the period 2006–2010. A diagnosis of primary cancer recorded in the statewide Admitted Patient Data Collection identified the majority of NSWCR colorectal and lung cancers, with sensitivities and positive predictive values (PPV) of 95% and 91% for colorectal cancer and 81% and 85% for lung cancer, respectively. Using additional information on lung cancer deaths from death records increased sensitivity to 84% (PPV 83%) for lung cancer, but did not improve ascertainment of colorectal cancers. Hospital procedure codes for colorectal cancer surgery identified cases with sensitivity 81% and PPV 54%. No other individual indicator had sensitivity >50% or PPV >65% for either cancer type and no combination of indicators increased both the sensitivity and PPV above that achieved using the hospital cancer diagnosis data. All specificities were close to 100%; 95% confidence intervals for sensitivity and PPV were generally +/−2%. Conclusions In NSW, identifying new cases of colorectal and lung cancer from administrative health datasets, such as hospital records, is a feasible alternative when cancer registry data are not available. However, the strengths and limitations of the different data sources should be borne in mind. Electronic supplementary material The online version of this article (doi:10.1186/s12911-017-0417-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David Goldsbury
- Cancer Research Division, Cancer Council New South Wales, Sydney, Australia.
| | - Marianne Weber
- Cancer Research Division, Cancer Council New South Wales, Sydney, Australia
| | - Sarsha Yap
- Cancer Research Division, Cancer Council New South Wales, Sydney, Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Dianne L O'Connell
- Cancer Research Division, Cancer Council New South Wales, Sydney, Australia.,Sydney School of Public Health, University of Sydney, Sydney, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Karen Canfell
- Cancer Research Division, Cancer Council New South Wales, Sydney, Australia.,Sydney School of Public Health, University of Sydney, Sydney, Australia.,Prince of Wales Clinical School, UNSW, Sydney, Australia
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13
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Ireland MJ, March S, Crawford-Williams F, Cassimatis M, Aitken JF, Hyde MK, Chambers SK, Sun J, Dunn J. A systematic review of geographical differences in management and outcomes for colorectal cancer in Australia. BMC Cancer 2017; 17:95. [PMID: 28152983 PMCID: PMC5290650 DOI: 10.1186/s12885-017-3067-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 01/18/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Australia and New Zealand have the highest incidence of colorectal cancer (CRC) in the world, presenting considerable health, economic, and societal burden. Over a third of the Australian population live in regional areas and research has shown they experience a range of health disadvantages that result in a higher disease burden and lower life expectancy. The extent to which geographical disparities exist in CRC management and outcomes has not been systematically explored. The present review aims to identify the nature of geographical disparities in CRC survival, clinical management, and psychosocial outcomes. METHODS The review followed PRISMA guidelines and searches were undertaken using seven databases covering articles between 1 January 1990 and 20 April 2016 in an Australian setting. Inclusion criteria stipulated studies had to be peer-reviewed, in English, reporting data from Australia on CRC patients and relevant to one of fourteen questions examining geographical variations in a) survival outcomes, b) patient and cancer characteristics, c) diagnostic and treatment characteristics and d) psychosocial and quality of life outcomes. RESULTS Thirty-eight quantitative, two qualitative, and three mixed-methods studies met review criteria. Twenty-seven studies were of high quality, sixteen studies were of moderate quality, and no studies were found to be low quality. Individuals with CRC living in regional, rural, and remote areas of Australia showed poorer survival and experienced less optimal clinical management. However, this effect is likely moderated by a range of other factors (e.g., SES, age, gender) and did appear to vary linearly with increasing distance from metropolitan centres. No studies examined differences in use of stoma, or support with stomas, by geographic location. CONCLUSIONS Overall, despite evidence of disparity in CRC survival and clinical management across geographic locations, the evidence was limited and at times inconsistent. Further, access to treatment and services may not be the main driver of disparities, with individual patient characteristics and type of region also playing an important role. A better understanding of factors driving ongoing and significant geographical disparities in cancer related outcomes is required to inform the development of effective interventions to improve the health and welfare of regional Australians.
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Affiliation(s)
- Michael J. Ireland
- Institute of Resilient Regions, University of Southern Queensland, Springfield Central, Australia
- School of Psychology and Counselling, University of Southern Queensland, Springfield Central, Australia
| | - Sonja March
- Institute of Resilient Regions, University of Southern Queensland, Springfield Central, Australia
- School of Psychology and Counselling, University of Southern Queensland, Springfield Central, Australia
| | - Fiona Crawford-Williams
- Institute of Resilient Regions, University of Southern Queensland, Springfield Central, Australia
- School of Psychology and Counselling, University of Southern Queensland, Springfield Central, Australia
| | - Mandy Cassimatis
- Non-communicable Disease Control Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC Australia
| | - Joanne F. Aitken
- Institute of Resilient Regions, University of Southern Queensland, Springfield Central, Australia
- Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, 4006 QLD Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, QLD Australia
| | - Melissa K. Hyde
- Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, 4006 QLD Australia
- Menzies Health Institute Queensland, Griffith University, Southport, QLD Australia
| | - Suzanne K. Chambers
- Institute of Resilient Regions, University of Southern Queensland, Springfield Central, Australia
- Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, 4006 QLD Australia
- Menzies Health Institute Queensland, Griffith University, Southport, QLD Australia
- Prostate Cancer Foundation of Australia, St Leonards, NSW Australia
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA Australia
| | - Jiandong Sun
- Institute of Resilient Regions, University of Southern Queensland, Springfield Central, Australia
| | - Jeff Dunn
- Institute of Resilient Regions, University of Southern Queensland, Springfield Central, Australia
- Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, 4006 QLD Australia
- School of Social Science, University of Queensland, Brisbane, Australia
- School of Medicine, Griffith University, Brisbane, QLD Australia
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14
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A Guide to Implementing Enhanced Recovery After Surgery Protocols: Creating, Scaling, and Managing a Perioperative Consult Service. Int Anesthesiol Clin 2017; 55:101-115. [DOI: 10.1097/aia.0000000000000163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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15
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Beckmann KR, Bennett A, Young GP, Cole SR, Joshi R, Adams J, Singhal N, Karapetis C, Wattchow D, Roder D. Sociodemographic disparities in survival from colorectal cancer in South Australia: a population-wide data linkage study. BMC Health Serv Res 2016; 16:24. [PMID: 26792195 PMCID: PMC4721049 DOI: 10.1186/s12913-016-1263-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 01/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inequalities in survival from colorectal cancer (CRC) across socioeconomic groups and by area of residence have been described in various health care settings. Few population-wide datasets which include clinical and treatment information are available in Australia to investigate disparities. This study examines socio-demographic differences in survival for CRC patients in South Australia (SA), using a population-wide database derived via linkage of administrative and surveillance datasets. METHODS The study population comprised all cases of CRC diagnosed in 2003-2008 among SA residents aged 50-79 yrs in the SA Central Cancer Registry. Measures of socioeconomic status (area level), geographical remoteness, clinical characteristics, comorbid conditions, treatments and outcomes were derived through record linkage of central cancer registry, hospital-based clinical registries, hospital separations, and radiotherapy services data sources. Socio-demographic disparities in CRC survival were examined using competing risk regression analysis. RESULTS Four thousand six hundred and forty one eligible cases were followed for an average of 4.7 yrs, during which time 1525 died from CRC and 416 died from other causes. Results of competing risk regression indicated higher risk of CRC death with higher grade (HR high v low =2.25, 95% CI 1.32-3.84), later stage (HR C v A = 7.74, 95% CI 5.75-10.4), severe comorbidity (HR severe v none =1.21, 95% CI 1.02-1.44) and receiving radiotherapy (HR = 1.41, 95% CI 1.18-1.68). Patients from the most socioeconomically advantaged areas had significantly better outcomes than those from the least advantaged areas (HR =0.75, 95% 0.62-0.91). Patients residing in remote locations had significantly worse outcomes than metropolitan residents, though this was only evident for stages A-C (HR = 1.35, 95 % CI 1.01-1.80). These disparities were not explained by differences in stage at diagnosis between socioeconomic groups or area of residence. Nor were they explained by differences in patient factors, other tumour characteristics, comorbidity, or treatment modalities. CONCLUSIONS Socio-economic and regional disparities in survival following CRC are evident in SA, despite having a universal health care system. Of particular concern is the poorer survival for patients from remote areas with potentially curable CRC. Reasons for these disparities require further exploration to identify factors that can be addressed to improve outcomes.
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Affiliation(s)
- Kerri R. Beckmann
- Centre for Population Health Research, University of South Australia, GPO Box 2471, Adelaide, SA 5001 Australia
| | - Alice Bennett
- Flinders Medical Centre, Flinders Drive, Bedford Park, SA 5042 Australia
| | - Graeme P. Young
- Flinders Centre for Innovation in Cancer, Flinders University, Flinders Drive, Bedford Park, SA 5042 Australia
| | - Stephen R. Cole
- Flinders Centre for Innovation in Cancer, Flinders University, Flinders Drive, Bedford Park, SA 5042 Australia
| | - Rohit Joshi
- Lyell McEwin Hospital, Elizabeth Vale, SA 5112 Australia
| | - Jacqui Adams
- Country Health SA, Adelaide, SA 5000 Australia
- Lyell McEwin Hospital, Elizabeth Vale, SA 5112 Australia
| | - Nimit Singhal
- Medical Oncologist, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA 5001 Australia
| | - Christos Karapetis
- Flinders Centre for Innovation in Cancer, Flinders University, Flinders Drive, Bedford Park, SA 5042 Australia
- South Adelaide Health Network, Medical Oncology, Flinders Medical Centre, Flinders Drive, Bedford Park, SA 5042 Australia
| | - David Wattchow
- Flinders University, Flinders Medical Centre, Bedford Park, SA 5042 Australia
| | - David Roder
- Centre for Population Health Research, University of South Australia, GPO Box 2471, Adelaide, SA 5001 Australia
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16
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Beckmann KR, Bennett A, Young GP, Roder DM. Treatment patterns among colorectal cancer patients in South Australia: a demonstration of the utility of population-based data linkage. J Eval Clin Pract 2014; 20:467-77. [PMID: 24851796 DOI: 10.1111/jep.12183] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2014] [Indexed: 12/18/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Population level data on colorectal cancer (CRC) management in Australia are lacking. This study assessed broad level patterns of care and concordance with guidelines for CRC management at the population level using linked administrative data from both the private and public health sectors across South Australia. Disparities in CRC treatment were also explored. METHOD Linking information from the South Australian Cancer Registry, hospital separations, radiotherapy services and hospital-based cancer registry systems provided data on the socio-demographic, clinical and treatment characteristics for 4641 CRC patients, aged 50-79 years, diagnosed from 2003 to 2008. Factors associated with receiving site/stage-specific treatments (surgery, chemotherapy and radiotherapy) and overall concordance with treatment guidelines were identified using Poisson regression analysis. RESULTS About 83% of colon and 56% of rectal cancer patients received recommended treatment. Provision of neo-adjuvant/adjuvant therapies may be less than optimal. Radiotherapy was less likely among older patients (prevalence ratio 0.7, 95% confidence interval 0.5-0.8). Chemotherapy was less likely among older patients (0.7, 0.6-0.8), those with severe or multiple co-morbidities (0.8, 0.7-0.9), and those from rural areas (0.9, 0.8-1.0). Overall discordance with treatment guidelines was more likely among rectal cancer patients (3.0, 2.7-3.3), older patients (1.6, 1.4-1.8), those with multiple co-morbid conditions (1.3, 1.1-1.4), and those living in rural areas (1.2, 1.0-1.3). CONCLUSIONS Greater emphasis should be given to ensure CRC patients who may benefit from neo-adjuvant/adjuvant therapies have access to these treatments.
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Affiliation(s)
- Kerri R Beckmann
- School of Population Health, Facility of Health Sciences, University of Adelaide, Adelaide, Australia
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17
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Brown B(B, Young J, Smith DP, Kneebone AB, Brooks AJ, Xhilaga M, Dominello A, O’Connell DL, Haines M. Clinician-led improvement in cancer care (CLICC)--testing a multifaceted implementation strategy to increase evidence-based prostate cancer care: phased randomised controlled trial--study protocol. Implement Sci 2014; 9:64. [PMID: 24884877 PMCID: PMC4048539 DOI: 10.1186/1748-5908-9-64] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 05/22/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Clinical practice guidelines have been widely developed and disseminated with the aim of improving healthcare processes and patient outcomes but the uptake of evidence-based practice remains haphazard. There is a need to develop effective implementation methods to achieve large-scale adoption of proven innovations and recommended care. Clinical networks are increasingly being viewed as a vehicle through which evidence-based care can be embedded into healthcare systems using a collegial approach to agree on and implement a range of strategies within hospitals. In Australia, the provision of evidence-based care for men with prostate cancer has been identified as a high priority. Clinical audits have shown that fewer than 10% of patients in New South Wales (NSW) Australia at high risk of recurrence after radical prostatectomy receive guideline recommended radiation treatment following surgery. This trial will test a clinical network-based intervention to improve uptake of guideline recommended care for men with high-risk prostate cancer. METHODS/DESIGN In Phase I, a phased randomised cluster trial will test a multifaceted intervention that harnesses the NSW Agency for Clinical Innovation (ACI) Urology Clinical Network to increase evidence-based care for men with high-risk prostate cancer following surgery. The intervention will be introduced in nine NSW hospitals over 10 months using a stepped wedge design. Outcome data (referral to radiation oncology for discussion of adjuvant radiotherapy in line with guideline recommended care or referral to a clinical trial of adjuvant versus salvage radiotherapy) will be collected through review of patient medical records. In Phase II, mixed methods will be used to identify mechanisms of provider and organisational change. Clinicians' knowledge and attitudes will be assessed through surveys. Process outcome measures will be assessed through document review. Semi-structured interviews will be conducted to elucidate mechanisms of change. DISCUSSION The study will be one of the first randomised controlled trials to test the effectiveness of clinical networks to lead changes in clinical practice in hospitals treating patients with high-risk cancer. It will additionally provide direction regarding implementation strategies that can be effectively employed to encourage widespread adoption of clinical practice guidelines. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12611001251910.
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Affiliation(s)
- Bernadette (Bea) Brown
- Sax Institute, Haymarket, Australia
- School of Public Health, University of Sydney, Camperdown, Australia
| | - Jane Young
- School of Public Health, University of Sydney, Camperdown, Australia
| | - David P Smith
- Cancer Research Division, Cancer Council NSW, Sydney, Australia
- Griffith Health Institute, Griffith University, Gold Coast, QLD, Australia
| | - Andrew B Kneebone
- Department of Radiation Oncology, Royal North Shore Hospital, Sydney, Australia
- Northern Clinical School, University of Sydney, Camperdown, Australia
| | - Andrew J Brooks
- NSW Agency for Clinical Innovation, Sydney, Australia
- Westmead Private Hospital, Westmead, Australia
- Westmead Clinical School, University of Sydney, Camperdown, Australia
| | - Miranda Xhilaga
- Prostate Cancer Foundation of Australia, Melbourne, Australia
| | | | - Dianne L O’Connell
- School of Public Health, University of Sydney, Camperdown, Australia
- Cancer Research Division, Cancer Council NSW, Sydney, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Mary Haines
- Sax Institute, Haymarket, Australia
- School of Public Health, University of Sydney, Camperdown, Australia
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18
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Goldstein D, Bell ML, Butow P, Sze M, Vaccaro L, Dong S, Liauw W, Hui R, Tattersall M, Ng W, Asghari R, Steer C, Vardy J, Parente P, Harris M, Karanth NV, King M, Girgis A, Eisenbruch M, Jefford M. Immigrants' perceptions of the quality of their cancer care: an Australian comparative study, identifying potentially modifiable factors. Ann Oncol 2014; 25:1643-9. [PMID: 24827124 DOI: 10.1093/annonc/mdu182] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Recent data show a falling cancer mortality in the general population without a similar shift in immigrant outcomes, leading to a greater cancer burden and mortality for immigrants. Our aims were to compare perceived patterns of care in immigrants and native-born cancer patients. PATIENTS AND METHODS This was a hospital-based sample of first-generation immigrants and Australian-born Anglo patients in the first year following diagnosis. It was restricted to Chinese, Arabic, or Greek speakers. Eligible participants, recruited via 16 oncology clinics, were over 18, with cancer (any type or stage), and having commenced treatment at least 1 month previously. Five hundred and seventy-one CALD patients (comprising 145 Arabic, 248 Chinese, and 178 Greek) and a control group of 274 Anglo-Australian patients participated. RESULTS Immigrants had difficulty communicating with the doctor (73% versus 29%) and understanding the health system (38% versus 10%). Differences were found in 'difficulty knowing who to see' (P = 0.0002), 'length of time to confirm diagnosis' (P = 0.04), wanting more choice about a specialist and hospital (P < 0.0001); being offered the opportunity to see a counselor (P < 0.0001); and actually seeing one (P < 0.0001). There were no significant self-reported differences regarding how cancer was detected, time to see a health professional, or type first seen; however, immigrants reported difficulty knowing who to see. Previous studies showed differences in patterns of care according to socioeconomic status (SES) and educational level. Despite adjusting for age, sex, education, marital status, SES, time since diagnosis, and type of cancer, we did not find significant differences. Instead, we found that understanding of the health system and confidence understanding English were important factors. CONCLUSIONS This study confirmed that immigrants with cancer perceive an inferior quality of cancer care. We highlight potentially modifiable factors including assistance in navigating the health system, translated information, and cultural competency training for health professionals.
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Affiliation(s)
- D Goldstein
- Department of Medical Oncology, Prince of Wales Hospital, Sydney
| | - M L Bell
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney
| | - P Butow
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney Centre of Medical Psychology and Evidence-based Decision-making (CeMPED), University of Sydney, Sydney
| | - M Sze
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney
| | - L Vaccaro
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney
| | - S Dong
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney
| | - W Liauw
- Cancer Care Centre, St George Hospital, Sydney
| | - R Hui
- Department of Medical Oncology, Westmead Hospital and Blacktown Oncology Unit, Blacktown Hospital Sydney, Sydney
| | - M Tattersall
- Department of Cancer Medicine, University of Sydney, Sydney Department of Medical Oncology, Royal Prince Alfred Hospital, Sydney
| | - W Ng
- Department of Medical Oncology, Liverpool Hospital, Sydney
| | - R Asghari
- Bankstown Cancer Care Centre, Bankstown Lidcombe Hospital, Sydney
| | - C Steer
- Border Medical Oncology, Wodonga
| | - J Vardy
- Centre of Medical Psychology and Evidence-based Decision-making (CeMPED), University of Sydney, Sydney
| | - P Parente
- Department of Clinical Haematology and Medical Oncology, Box Hill Hospital, Victoria
| | - M Harris
- Department of Medical Oncology, Monash Medical Centre, Victoria
| | - N V Karanth
- Department of Medical Oncology, Royal Darwin Hospital, Northern Territory
| | - M King
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney
| | - A Girgis
- Translational Cancer Research Unit, Ingham Institute for Applied Medical Research, and University of NSW, Sydney
| | - M Eisenbruch
- School of Psych, Psychiatry and Psych Medicine, Monash University, Victoria
| | - M Jefford
- Sir Peter MacCallum Department of Oncology and Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria Division of Medicine, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
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19
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Jorgensen ML, Young JM, Dobbins TA, Solomon MJ. Predictors of variation in colorectal cancer care and outcomes in New South Wales: a population‐based health data linkage study. Med J Aust 2014; 200:403-7. [DOI: 10.5694/mja13.10710] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 12/08/2013] [Indexed: 11/17/2022]
Affiliation(s)
- Mikaela L Jorgensen
- Cancer Epidemiology and Services Research, Sydney School of Public Health, University of Sydney, Sydney, NSW
| | - Jane M Young
- Cancer Epidemiology and Services Research, Sydney School of Public Health, University of Sydney, Sydney, NSW
| | - Timothy A Dobbins
- Cancer Epidemiology and Services Research, Sydney School of Public Health, University of Sydney, Sydney, NSW
| | - Michael J Solomon
- Surgical Outcomes Research Centre, Sydney Local Health District and University of Sydney, Sydney, NSW
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Does patient age still affect receipt of adjuvant therapy for colorectal cancer in New South Wales, Australia? J Geriatr Oncol 2014; 5:323-30. [PMID: 24656735 DOI: 10.1016/j.jgo.2014.02.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 01/14/2014] [Accepted: 02/26/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To investigate the effect of patient age on receipt of stage-appropriate adjuvant therapy for colorectal cancer in New South Wales, Australia. MATERIALS AND METHODS A linked population-based dataset was used to examine the records of 580 people with lymph node-positive colon cancer and 498 people with high-risk rectal cancer who underwent surgery following diagnosis in 2007/2008. Multilevel logistic regression models were used to determine whether age remained an independent predictor of adjuvant therapy utilisation after accounting for significant patient, surgeon and hospital characteristics. RESULTS Overall, 65-73% of eligible patients received chemotherapy and 42-53% received radiotherapy. Increasing age was strongly associated with decreasing likelihood of receiving chemotherapy for lymph node-positive colon cancer (p<0.001) and radiotherapy for high-risk rectal cancer (p=0.003), even after adjusting for confounders such as Charlson comorbidity score and ASA health status. People aged over 70years for chemotherapy and over 75years for radiotherapy were significantly less likely to receive treatment than those aged less than 65. Emergency resection, intensive care admission, and not having a current partner also independently predicted chemotherapy nonreceipt. Other predictors of radiotherapy nonreceipt included being female, not being discussed at multidisciplinary meeting, and lower T stage. Adjuvant therapy rates varied widely between hospitals where surgery was performed. CONCLUSION There are continuing age disparities in adjuvant therapy utilisation in NSW that are not explained by patients' comorbidities or health status. Further exploration of these complex treatment decisions is needed. Variation by hospital and patient characteristics indicates opportunities to improve patient care and outcomes.
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Chawla N, Butler EN, Lund J, Warren JL, Harlan LC, Yabroff KR. Patterns of colorectal cancer care in Europe, Australia, and New Zealand. J Natl Cancer Inst Monogr 2014; 2013:36-61. [PMID: 23962509 DOI: 10.1093/jncimonographs/lgt009] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Colorectal cancer is the second most common cancer in women and the third most common in men worldwide. In this study, we used MEDLINE to conduct a systematic review of existing literature published in English between 2000 and 2010 on patterns of colorectal cancer care. Specifically, this review examined 66 studies conducted in Europe, Australia, and New Zealand to assess patterns of initial care, post-diagnostic surveillance, and end-of-life care for colorectal cancer. The majority of studies in this review reported rates of initial care, and limited research examined either post-diagnostic surveillance or end-of-life care for colorectal cancer. Older colorectal cancer patients and individuals with comorbidities generally received less surgery, chemotherapy, or radiotherapy. Patients with lower socioeconomic status were less likely to receive treatment, and variations in patterns of care were observed by patient demographic and clinical characteristics, geographical location, and hospital setting. However, there was wide variability in data collection and measures, health-care systems, patient populations, and population representativeness, making direct comparisons challenging. Future research and policy efforts should emphasize increased comparability of data systems, promote data standardization, and encourage collaboration between and within European cancer registries and administrative databases.
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Affiliation(s)
- Neetu Chawla
- Health Services and Economics Branch/Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Dr, Room 3E346, Rockville, MD 20852, USA
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22
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Baade PD, Dasgupta P, Aitken JF, Turrell G. Geographic remoteness, area-level socioeconomic disadvantage and inequalities in colorectal cancer survival in Queensland: a multilevel analysis. BMC Cancer 2013; 13:493. [PMID: 24152961 PMCID: PMC3871027 DOI: 10.1186/1471-2407-13-493] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 10/16/2013] [Indexed: 11/10/2022] Open
Abstract
Background To explore the impact of geographical remoteness and area-level socioeconomic disadvantage on colorectal cancer (CRC) survival. Methods Multilevel logistic regression and Markov chain Monte Carlo simulations were used to analyze geographical variations in five-year all-cause and CRC-specific survival across 478 regions in Queensland Australia for 22,727 CRC cases aged 20–84 years diagnosed from 1997–2007. Results Area-level disadvantage and geographic remoteness were independently associated with CRC survival. After full multivariate adjustment (both levels), patients from remote (odds Ratio [OR]: 1.24, 95%CrI: 1.07-1.42) and more disadvantaged quintiles (OR = 1.12, 1.15, 1.20, 1.23 for Quintiles 4, 3, 2 and 1 respectively) had lower CRC-specific survival than major cities and least disadvantaged areas. Similar associations were found for all-cause survival. Area disadvantage accounted for a substantial amount of the all-cause variation between areas. Conclusions We have demonstrated that the area-level inequalities in survival of colorectal cancer patients cannot be explained by the measured individual-level characteristics of the patients or their cancer and remain after adjusting for cancer stage. Further research is urgently needed to clarify the factors that underlie the survival differences, including the importance of geographical differences in clinical management of CRC.
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23
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Yu XQ, Clements M, O’Connell D. Projections of cancer prevalence by phase of care: a potential tool for planning future health service needs. J Cancer Surviv 2013; 7:641-51. [DOI: 10.1007/s11764-013-0303-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 07/22/2013] [Indexed: 10/26/2022]
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24
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Goldsbury D, Harris M, Pascoe S, Barton M, Olver I, Spigelman A, Beilby J, Veitch C, Weller D, O'Connell DL. The varying role of the GP in the pathway between colonoscopy and surgery for colorectal cancer: a retrospective cohort study. BMJ Open 2013; 3:bmjopen-2012-002325. [PMID: 23471608 PMCID: PMC3612745 DOI: 10.1136/bmjopen-2012-002325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To describe general practitioner (GP) involvement in the treatment referral pathway for colorectal cancer (CRC) patients. DESIGN A retrospective cohort analysis of linked data. SETTING A population-based sample of CRC patients diagnosed from August 2004 to December 2007 in New South Wales, Australia, using the 45 and Up Study, cancer registry diagnosis records, inpatient hospital records and Medicare claims records. PARTICIPANTS 407 CRC patients who had a colonoscopy followed by surgery. PRIMARY OUTCOME MEASURES Patterns of GP consultations between colonoscopy and surgery (ie, between diagnosis and treatment). We investigated whether consulting a GP presurgery was associated with time to surgery, postsurgical GP consultations or rectal cancer cases having surgery in a centre with radiotherapy facilities. RESULTS Of the 407 patients, 43% (n=175) had at least one GP consultation between colonoscopy and surgery. The median time from colonoscopy to surgery was 27 days for those with an intervening GP consultation and 15 days for those without the consultation. 55% (n=223) had a GP consultation up to 30 days postsurgery; it was more common in cases of patients who consulted a GP presurgery than for those who did not (65% and 47%, respectively, adjusted OR 2.71, 95% CI 1.50 to 4.89, p=0.001). Of the 142 rectal cancer cases, 23% (n=33) had their surgery in a centre with radiotherapy facilities, with no difference between those who did and did not consult a GP presurgery (21% and 25% respectively, adjusted OR 0.84, 95% CI 0.27 to 2.63, p=0.76). CONCLUSIONS Consulting a GP between colonoscopy and surgery was associated with a longer interval between diagnosis and treatment, and with further GP consultations postsurgery, but for rectal cancer cases it was not associated with treatment in a centre with radiotherapy facilities. GPs might require a more defined and systematic approach to CRC management.
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Affiliation(s)
- David Goldsbury
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
| | - Mark Harris
- UNSW Research Centre for Primary Health Care and Equity, Sydney, New South Wales, Australia
| | - Shane Pascoe
- UNSW Research Centre for Primary Health Care and Equity, Sydney, New South Wales, Australia
| | - Michael Barton
- Liverpool Health Service, Collaboration for Cancer Outcomes Research & Evaluation, Sydney, New South Wales, Australia
| | - Ian Olver
- Cancer Council Australia, Sydney, New South Wales, Australia
| | - Allan Spigelman
- UNSW St Vincent's Clinical School, Sydney, New South Wales, Australia
| | - Justin Beilby
- Faculty of Health Sciences, University of Adelaide, Adelaide, New South Wales, Australia
| | - Craig Veitch
- Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - David Weller
- Centre for Population Health Services, University of Edinburgh,Edinburgh, Scotland
| | - Dianne L O'Connell
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
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Dasgupta P, Youlden DR, Baade PD. An analysis of competing mortality risks among colorectal cancer survivors in Queensland, 1996–2009. Cancer Causes Control 2013; 24:897-909. [DOI: 10.1007/s10552-013-0166-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 02/02/2013] [Indexed: 11/28/2022]
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26
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van der Geest LG, Krijnen P, Wouters MW, Erkelens WG, Marinelli AW, Nortier HJ, Tollenaar RA, Struikmans H. Improved guideline compliance after a 3-year audit of multidisciplinary colorectal cancer care in the western part of the Netherlands. J Surg Oncol 2012; 106:1-9. [DOI: 10.1002/jso.23038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 12/18/2011] [Indexed: 01/03/2023]
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Siddins MT, Wong VV, Fitzgerald JT, Bamberg LJ. Challenges in non-muscle invasive bladder cancer: lessons from a regional review. ANZ J Surg 2011; 81:889-94. [DOI: 10.1111/j.1445-2197.2011.05894.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Jorgensen ML, Young JM, Solomon MJ. Older patients and adjuvant therapy for colorectal cancer: surgeon knowledge, opinions, and practice. Dis Colon Rectum 2011; 54:335-41. [PMID: 21304306 DOI: 10.1007/dcr.0b013e3181ff43d6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Increasing patient age independently predicts nonreferral and nonreceipt of adjuvant therapy among patients with colorectal cancer. OBJECTIVE This study aimed to identify factors affecting surgeons' decisions to refer older patients for adjuvant therapy. DESIGN/SETTINGS/PARTICIPANTS A self-administered survey was sent to all Australian and New Zealand colorectal surgeons (n = 146). MAIN OUTCOME MEASURES The survey consisted of 3 sections: 1) knowledge of research evidence, 2) opinions on evidence and adjuvant therapy in older patients, and 3) self-reported practice, or likelihood of patient referral in different scenarios. Demographic information was also obtained. RESULTS Seventy percent of surgeons responded. Surgeons were significantly less likely to refer older patients than younger patients for adjuvant therapy in all scenarios (P < .001). The difference in referral recommendations was greatest when patients lived a long way from treatment, had a comorbid condition, or had little social support. There was greater variation in referral recommendations for older patients, and marked disagreement between surgeons in knowledge and opinion questions. Surgeon age was the only significant predictor of survey responses. Greater knowledge and more positive opinions predicted similar referral recommendations for older and younger patients (P = .02, P = .01). LIMITATIONS Although decreased referral and receipt of adjuvant therapy among older patients is most likely multifactorial, this survey focused on the views of one physician group and a number of specific scenarios. CONCLUSIONS Chronological age alone appears to impact colorectal surgeons' decisions to refer patients for adjuvant therapy. Sociodemographic and physiological factors further decrease the likelihood of referral of older patients. A lack of consensus among surgeons suggests that more research is needed both to predict how older patients with cancer will react to treatment, and to determine how information from emerging evidence can be best used to assist physicians' treatment decisions.
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Muhammed O, Teubner D, Jones DN, Slavotinek JP. Retrospective audit of the investigation of patients with suspected acute subarachnoid haemorrhage. J Med Imaging Radiat Oncol 2010; 54:339-46. [PMID: 20718914 DOI: 10.1111/j.1754-9485.2010.02180.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Recommended investigational care (RIC) of emergency department (ED) patients with suspected subarachnoid haemorrhage comprises lumbar puncture (LP) to detect xanthochromia if the preceding CT scan is negative. METHODS Retrospective audit of the investigational care of 100 consecutive ED patients presenting with possible subarachnoid haemorrhage. RESULTS Of the 100 patients, 91 had negative CT, and 36 (39.6%) of these patients had an LP performed to detect xanthochromia (i.e. RIC). Fifty-five of 91 (60.4%) patients did not receive RIC. Of the 55 patients who did not receive RIC, 25 (45.5%) had a documented senior clinical decision not to perform an LP; 15 (27.3%) had no documented reason; five (9.1%) refused consent; two (3.6%) had an LP but no xanthochromia requested, one patient did not have an LP because of technical issues, six patients underwent CT angiography (CTA), and one patient underwent magnetic resonance angiography (MRA), in the absence of a LP, following a negative CT. Two patients underwent CTA following a negative xanthochromia result. Patients admitted to the emergency extended care unit had 6.85 times the odds of receiving RIC (95% CI 2.20-21.4). CONCLUSIONS Fifty-five (55) of 91 (60%) ED patients did not receive RIC. Fifteen of the 55 did not have any documented justification for not performing an LP with xanthochromia testing. Admission to an emergency extended care unit was a predictor of receiving RIC. Inappropriate use of CTA and MRA was identified. These findings have important implications for patient safety. Multifaceted strategies are required to close this evidence-practice gap.
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Affiliation(s)
- O Muhammed
- Flinders Medical Centre, Adelaide Health Service, Adelaide, Australia
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Habib MR, Solomon MJ, Young JM, Armstrong BK, O'Connell D, Armstrong K. Evidence-based and clinical outcome scores to facilitate audit and feedback for colorectal cancer care. Dis Colon Rectum 2009; 52:616-22; discussion 622-3. [PMID: 19404063 DOI: 10.1007/dcr.0b013e31819edb7d] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE To describe a methodology for surgical audit and feedback based on hospital-level indicators of the quality of colorectal cancer care. METHODS Process and outcome indicators were identified from a population-based database (N = 3095 patients treated by 258 surgeons at 130 hospitals across New South Wales between February 1, 2000 and January 31, 2001). Hospitals were ranked on each indicator, with those in the lowest 20th percentile receiving a score of 0 and the remainder receiving a score of 1. Scores for individual indicators were then summed for each hospital and divided by the number of relevant indicators to provide an evidence-based score (EBS) and a clinical outcome score. RESULTS Ten process and six clinical outcome indicators were identified. Hospital-level summary scores ranged from 0.14 to 1.0 for evidence-based processes and from 0.17 to 1.0 for clinical outcomes. Evidence-based score and clinical outcome score were independent (r = 0.12, P = 0.32). There was a small positive association between evidence-based score and caseload (r = 0.33, P = 0.005) but clinical outcome score and caseload were unrelated (r = 0.11, P = 0.36). CONCLUSIONS Evidence-based score and clinical outcome score address different aspects of quality of care. The wide variability of hospitals' outcome scores and an association of evidence-based score and caseload indicate that simple scores may be useful in audit and feedback.
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Affiliation(s)
- Miriam R Habib
- Surgical Outcomes Research Centre, University of Sydney, Royal Prince Alfred Hospital, Sydney, Australia
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Gagliardi AR, Wright FC, Davis D, McLeod RS, Urbach DR. Challenges in multidisciplinary cancer care among general surgeons in Canada. BMC Med Inform Decis Mak 2008; 8:59. [PMID: 19102761 PMCID: PMC2631026 DOI: 10.1186/1472-6947-8-59] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Accepted: 12/22/2008] [Indexed: 12/04/2022] Open
Abstract
Background While many factors can influence the way that cancer care is delivered, including the way that evidence is packaged and disseminated, little research has evaluated how health care professionals who manage cancer patients seek and use this information to identify whether and how this could be supported. Through interviews we identified that general surgeons experience challenges in coordinating care for complex cancer patients whose management is not easily addressed by guidelines, and conducted a population-based survey of general surgeon information needs and information seeking practices to extend these findings. Methods General surgeons with privileges at acute care hospitals in Ontario, Canada were mailed a questionnaire to solicit information needs (task, importance), information seeking (source, frequency of and reasons for use), key challenges and suggested solutions. Non-responders received up to three reminder packages. Significant differences among sub-groups (age, setting) were examined statistically (Kruskal Wallis, Mann Whitney, Chi Square). Standard qualitative methods were used to thematically analyze open-ended responses. Results The response rate was 44.2% (170/385) representing all 14 health regions. System resource constraints (60.4%), comorbidities (56.4%) and physiologic factors (51.8%) were top-ranked issues creating information needs. Local surgical colleagues (84.6%), other local colleagues (82.2%) and the Internet (81.1%) were top-ranked sources of information, primarily due to familiarity and speed of access. No resources were considered to be highly applicable to patient care. Challenges were related to limitations in diagnostics and staging, operative resources, and systems to support multidisciplinary care, together accounting for 76.0% of all reported issues. Findings did not differ significantly by surgeon age or setting of care. Conclusion General surgeons appear to use a wide range of information resources but they may not address the complex needs of many cancer patients. Decision-making is challenged by informational and logistical issues related to the coordination of multidisciplinary care. This suggests that limitations in system capacity may, in part, contribute to variable guideline compliance. Further research is required to evaluate the appropriateness of information seeking, and both concurrent and consecutive mechanisms by which to achieve multidisciplinary care.
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Abstract
BACKGROUND The transfer of evidence from research into clinical practice is made almost impossible by enormous volume of literature on any topic. Consolidated evidence into guidelines is not very helpful as there are usually 50 guidelines existing on common clinical topics. Clinicians need assistance in identifying the best available evidence. This paper describes two strategies to transfer research evidence into clinical practice. METHODS The Guideline Advisory Committee (GAC) in Ontario has assessed all available guidelines on 70 clinical topics using a validated and transparent process involving community-based physicians as assessors. A single best guideline is selected and a summary of its evidence-based recommendations are produced for easy use by practitioners (http://www.gacguidelines.ca). The Critically Appraised Practice Reflection Exercise (CAPRE) programme takes the best available evidence on 40 common practice problems, presents a summary for clinician and patient, has a strategy for physician and patient to find common ground in applying the evidence and has the practitioner to carry out a reflection exercise to gain continuing education credits (http://www.capre.ca). Distribution of these strategies in practice-based research networks is a further step in making research more relevant to practice. RESULTS The GAC website has more than 100,000 'hits' per month and 4500 identified regular users from Canada and the world. The numbers are steadily increasing. The CAPRE programme has not been formally evaluated but over 150 clinicians have used the programme with patients. With a national launch, the programme there between 60,000 and 80,000 hits per week with 100 physicians completing the programme for continuing medical education (CME) credits in the first month. Physicians report that their patients are very pleased with their physician using the latest evidence to address their problem. This is true even if the patient does not agree to follow the evidence-based recommendations. Using these programmes in practice-based research, networks should further promote making research more relevant to practice. CONCLUSIONS Transferring research-based evidence into clinical practice has many challenges. Two programmes developed to address these challenges are described. Although not fully evaluated, there is some evidence of success.
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Affiliation(s)
- Walter Rosser
- Department of Family Medicine, Queen's University, 220 Bagot Street, Kingston, Ontario K7L5E9, Canada.
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Frontiers of cancer care in Asia-Pacific region: cancer care in Australia. Biomed Imaging Interv J 2008; 4:e30. [PMID: 21611000 PMCID: PMC3097737 DOI: 10.2349/biij.4.3.e30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Accepted: 05/31/2008] [Indexed: 11/17/2022] Open
Abstract
Cancer has a significant impact on the Australian community. One in three men and one in four women will develop cancer by the age of 75. The estimated annual health expenditure due to cancer in 2000-1 in Australia was $2.7 billion, representing 5.5% of the country’s total healthcare expenditure. An historical overview of the national cancer control strategies in Australia is provided. In males, the five most common cancers in order of decreasing incidence are: prostate cancer, colorectal cancer, lung cancer, melanoma and lymphoma, while for Australian women, breast cancer is the most common cancer. Key epidemiologic information about these common cancers, current management issues and comprehensive national clinical practice guidelines (where available) are highlighted. Aspects of skin cancer, a particularly common cancer in the Australian environment – with a focus on melanoma – are also included. Cancer outcomes in Australia, measured by selected outcomes, are among the best in the world. However, there is still evidence of health inequalities, especially among patients residing in regional and remote areas, the indigenous population and people from lower socio-economic classes. Limitations of current cancer care practices in Australia, including provision of oncology services, resources and other access issues, as well as suggested improvements for future cancer care, are summarised. Ongoing implementation of national and state cancer control plans and evaluation of their effectiveness will be needed to pursue the goal of optimal cancer care in Australia.
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