1
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Stout NL, Santa Mina D, Lyons KD, Robb K, Silver JK. A systematic review of rehabilitation and exercise recommendations in oncology guidelines. CA Cancer J Clin 2021; 71:149-175. [PMID: 33107982 PMCID: PMC7988887 DOI: 10.3322/caac.21639] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 12/18/2022] Open
Abstract
Guidelines promote high quality cancer care. Rehabilitation recommendations in oncology guidelines have not been characterized and may provide insight to improve integration of rehabilitation into oncology care. This report was developed as a part of the World Health Organization (WHO) Rehabilitation 2030 initiative to identify rehabilitation-specific recommendations in guidelines for oncology care. A systematic review of guidelines was conducted. Only guidelines published in English, for adults with cancer, providing recommendations for rehabilitation referral and assessment or interventions between 2009 and 2019 were included. 13840 articles were identified. After duplicates and applied filters, 4897 articles were screened. 69 guidelines were identified with rehabilitation-specific recommendations. Thirty-seven of the 69 guidelines endorsed referral to rehabilitation services but provided no specific recommendations regarding assessment or interventions. Thirty-two of the 69 guidelines met the full inclusion criteria and were assessed using the AGREE II tool. Twenty-one of these guidelines achieved an AGREE II quality score of ≥ 45 and were fully extracted. Guidelines exclusive to pharmacologic interventions and complementary and alternative interventions were excluded. Findings identify guidelines that recommend rehabilitation services across many cancer types and for various consequences of cancer treatment signifying that rehabilitation is a recognized component of oncology care. However, these findings are at odds with clinical reports of low rehabilitation utilization rates suggesting that guideline recommendations may be overlooked. Considering that functional morbidity negatively affects a majority of cancer survivors, improving guideline concordant rehabilitative care could have substantial impact on function and quality of life among cancer survivors.
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Affiliation(s)
- Nicole L Stout
- Department of Hematology/Oncology Cancer Prevention and Control, West Virginia University Cancer Institute, Morgantown, West Virginia
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, Maryland
| | - Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Kathleen D Lyons
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
- Norris Cotton Cancer Center, Geisel School of Medicine, Hanover, New Hampshire
| | - Karen Robb
- North East London Cancer Alliance, London, United Kingdom
- Transforming Cancer Services Team for London, Healthy London Partnership, London, United Kingdom
| | - Julie K Silver
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Boston, Massachusetts
- Massachusetts General Hospital, Boston, Massachusetts
- Brigham and Women's Hospital, Boston, Massachusetts
- Spaulding Rehabilitation Hospital, Boston, Massachusetts
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2
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Payne TJ, Hart JL, Giachello AL, Walker KL, Wang W, Groom A, Sims M, Sears CG, Lee AS, Tompkins LK, Kesh A, Robb K, Robertson RM. Tobacco perceptions and practices: User groups and demographic characteristics, Mississippi, USA. Popul Med 2020; 2. [PMID: 33521651 DOI: 10.18332/popmed/127236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Despite decreases in the overall US smoking rate, tobacco use remains more common in some areas and by some groups. Deeper understanding of group differences is needed in order to tailor public health campaigns to the interests, perceptions and experiences of targeted audiences. Although some differences have been identified across African American and Caucasian smokers in the United States, additional insight is needed regarding factors that differentiate these groups. This study examined tobacco-related perceptions and practices, with an emphasis on identifying differences across African American and Caucasian smokers. Toward this goal, we examined key demographic variables of race and age, and tobacco use characteristics. METHODS The sample consisted of 284 people from the Jackson, Mississippi area who participated in focus groups and completed surveys addressing a variety of tobacco-related topics, including knowledge and perceptions of products as well as use and health information seeking behavior. The selection criteria and recruitment approach ensured a balance across race (black, white), age (18-34, >35 years), sex, and cigarette smoking status (current, former, never). Statistical analyses were performed using SAS (v.9.4). RESULTS Differences were observed across demographic subgroups regarding type and pattern of tobacco products used (e.g. mentholated, markers of nicotine dependence, hookah). Differences in preferred sources of health information based on age as well as perceptions of risk as a function of age, smoking status and race were also noted. Exposure to secondhand smoke and perceptions of its risks, quitting efforts and cessation methods differed by race. CONCLUSIONS Study findings suggest key differences across important subgroups. Knowledge of such differences has the potential to improve strategic public health messaging, allowing health campaigns to more effectively prevent tobacco product uptake as well as promote interest in quitting tobacco.
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Affiliation(s)
- Thomas J Payne
- Department of Otolaryngology-Head and Neck Surgery, University of Mississippi Medical Center, Jackson, United States.,American Heart Association Tobacco Center for Regulatory Science, Dallas, United States
| | - Joy L Hart
- American Heart Association Tobacco Center for Regulatory Science, Dallas, United States.,Department of Communication, University of Louisville, Louisville, United States
| | - Aida L Giachello
- American Heart Association Tobacco Center for Regulatory Science, Dallas, United States.,Department of Preventative Medicine, Northwestern University, Chicago, United States
| | - Kandi L Walker
- American Heart Association Tobacco Center for Regulatory Science, Dallas, United States.,Department of Communication, University of Louisville, Louisville, United States
| | - Wei Wang
- U.S. Food and Drug Administration, Silver Spring, United States
| | - Allison Groom
- American Heart Association Tobacco Center for Regulatory Science, Dallas, United States.,Customer and Marketing Research, American Heart Association, Dallas, United States
| | - Mario Sims
- American Heart Association Tobacco Center for Regulatory Science, Dallas, United States.,Department of Medicine, University of Mississippi Medical Center, Jackson, United States
| | - Clara G Sears
- American Heart Association Tobacco Center for Regulatory Science, Dallas, United States.,Department of Communication, University of Louisville, Louisville, United States
| | - Alexander S Lee
- American Heart Association Tobacco Center for Regulatory Science, Dallas, United States.,Department of Communication, University of Louisville, Louisville, United States
| | - Lindsay K Tompkins
- American Heart Association Tobacco Center for Regulatory Science, Dallas, United States.,Department of Communication, University of Louisville, Louisville, United States
| | - Anshula Kesh
- American Heart Association Tobacco Center for Regulatory Science, Dallas, United States.,Office of Science Operations, American Heart Association, Dallas, United States
| | - Karen Robb
- American Heart Association Tobacco Center for Regulatory Science, Dallas, United States.,Customer and Marketing Research, American Heart Association, Dallas, United States
| | - Rose M Robertson
- American Heart Association Tobacco Center for Regulatory Science, Dallas, United States.,Science and Medicine Office, American Heart Association, Dallas, United States
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3
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Li F, Morgan A, McCullagh A, Johnson A, Giles C, Greenfield D, Crawford G, Gath J, Lyons J, Andreyev J, Tobutt J, Tugwell J, Robb K, Cove-Smith L, Bennister L, Doyle N, Lee N, Nash R, Simcock R, Stephens R, Best S, Moug S, Staley K, Regan S, Ellis P, Griffiths S, Lewis I. Abstract 3348: Top 10 living with and beyond cancer research priorities. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-3348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
More and more people are living with the consequences of cancer and its treatment (living with and beyond cancer), yet the level of relevant research is low compared to other types of cancer research in the UK. NCRI aims to increase the level of research in this area and to ultimately improve the lives of those affected by cancer. Undefined research priorities in this broad area has been a barrier to research. The 2015 NHS Independent Cancer Taskforce report also recommends defining research priorities and to enable this research to happen. To address this barrier the NCRI has undertaken a James Lind Alliance Priority Setting Partnership (PSP) to identify priorities that matter most to people affected by cancer and the health and social care professionals.A PSP consists of patients and carers, health and social care professionals. PSPs have several stages and begin with a UK-wide survey to gather questions about uncertainties in living with and beyond cancer. Once the results were analysed, an interim exercise takes place to further prioritise the uncertainties. The last stage is a final workshop where partners debate and finally arrive at a top 10 list of shared uncertainties.The living with and beyond cancer PSP received 3500 questions submitted by people affected by cancer and healthcare professionals. Through a 18-month established rigorous process, the questions are prioritised down to the Top 10 living with and beyond cancer priorities for research in June 2018. This is the first time that clear research priorities have been identified in this area. They are the most impactful research questions that will help improve the lives of people affected by cancer. The Top 10 uncertainties will be publicised widely to ensure that researchers and those who fund research really understand what matters to people affected by cancer. The top uncertainties will be promoted to many research organizations and relevant funders in the UK. We anticipate they will directly influence future research.
Citation Format: Feng Li, Adrienne Morgan, Angela McCullagh, Anne Johnson, Ceinwen Giles, Diana Greenfield, Graeme Crawford, Jacqui Gath, Jane Lyons, Jervoise Andreyev, Jonathan Tobutt, Julia Tugwell, Karen Robb, Laura Cove-Smith, Lindsey Bennister, Natalie Doyle, Nicolas Lee, Rebecca Nash, Richard Simcock, Richard Stephens, Sabine Best, Susan Moug, Kristina Staley, Sandra Regan, Patricia Ellis, Stuart Griffiths, Ian Lewis. Top 10 living with and beyond cancer research priorities [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3348.
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Affiliation(s)
- Feng Li
- 1National Cancer Research Institute, London, United Kingdom
| | | | - Angela McCullagh
- 3National Cancer Research Institute Consumer Forum, London, United Kingdom
| | | | | | - Diana Greenfield
- 6Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Graeme Crawford
- 7Bangor Health Centre, Northern Ireland, Bangor, United Kingdom
| | - Jacqui Gath
- 2Independent Cancer Patients' Voice, London, United Kingdom
| | | | - Jervoise Andreyev
- 9United Lincolnshire Hospitals NHS Trust, Lincolnshire, United Kingdom
| | | | - Julia Tugwell
- 3National Cancer Research Institute Consumer Forum, London, United Kingdom
| | - Karen Robb
- 11Transforming Cancer Services Team in London, London, United Kingdom
| | | | | | - Natalie Doyle
- 14The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Nicolas Lee
- 15Macmillan Cancer Support, London, United Kingdom
| | - Rebecca Nash
- 15Macmillan Cancer Support, London, United Kingdom
| | - Richard Simcock
- 16Brighton and Sussex University Hospital Trust, Brighton, United Kingdom
| | - Richard Stephens
- 3National Cancer Research Institute Consumer Forum, London, United Kingdom
| | | | - Susan Moug
- 18Royal Alexandra Hospital Paisley, Glasgow, United Kingdom
| | | | - Sandra Regan
- 20NIHR Oxford Health Biomedical Research Centre, Oxford, United Kingdom
| | | | | | - Ian Lewis
- 1National Cancer Research Institute, London, United Kingdom
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4
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Robb K, Gómez-Aristizábal A, Gandhi R, Viswanathan S. Culture enhanced mesenchymal stromal cells with increased potency. Cytotherapy 2019. [DOI: 10.1016/j.jcyt.2019.03.532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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5
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Farmer MT, Bunt R, Corradini M, Ellison P, Francis M, Gabor J, Gauntt R, Henry C, Linthicum R, Luangdilok W, Lutz R, Paik C, Plys M, Rabiti C, Rempe J, Robb K, Wachowiak R. Reactor Safety Gap Evaluation of Accident-Tolerant Components and Severe Accident Analysis. NUCL SCI ENG 2017. [DOI: 10.13182/nse16-13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | - R. Bunt
- Southern Nuclear, Birmingham, Alabama
| | | | | | - M. Francis
- Oak Ridge National Laboratory, Oak Ridge, Tennessee
| | - J. Gabor
- Jensen Hughes, Baltimore, Maryland
| | - R. Gauntt
- Sandia National Laboratories, Albuquerque, New Mexico
| | - C. Henry
- Fauske and Associates, Burr Ridge, Illinois
| | | | | | - R. Lutz
- Lutz Consulting, Hendersonville, North Carolina
| | - C. Paik
- Fauske and Associates, Burr Ridge, Illinois
| | - M. Plys
- Fauske and Associates, Burr Ridge, Illinois
| | - C. Rabiti
- Idaho National Laboratory, Idaho Falls, Idaho
| | - J. Rempe
- Rempe and Associates, LLC, Idaho Falls, Idaho
| | - K. Robb
- Oak Ridge National Laboratory, Oak Ridge, Tennessee
| | - R. Wachowiak
- Electric Power Research Institute, Palo Alto, California
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6
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Ayala C, Tong X, Neeley E, Lane R, Robb K, Loustalot F. Home blood pressure monitoring among adults-American Heart Association Cardiovascular Health Consumer Survey, 2012. J Clin Hypertens (Greenwich) 2017; 19:584-591. [PMID: 28371252 DOI: 10.1111/jch.12983] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 12/20/2016] [Accepted: 12/25/2016] [Indexed: 01/13/2023]
Abstract
Home blood pressure monitoring (HBPM) among hypertensive adults was assessed using the 2012 American Heart Association Cardiovascular Health Consumer Survey. The prevalence of hypertension was 25.5% and 53.8% of those reported HBPM. Approximately 63% of hypertensive adults 65 years and older reported HBPM followed by 51% and 34.6% (35-64 and 18-34 years, respectively; P=.001). Those who had seen a healthcare professional within a year reported HBPM compared with those who had not (54.8% vs 32.8%, P=.047). Those who believed that lowering blood pressure can reduce risk of heart attack and stroke had a higher percentage of HBPM compared with those who did not (55.5% vs 33.1%, P=.01). Age and the belief that lowering blood pressure could reduce cardiovascular disease risk were significant factors associated with HBPM. Half of the adult hypertensive patients reported HBPM and its use was greater among those who reported a positive attitude toward lowering blood pressure to reduce cardiovascular disease risk.
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Affiliation(s)
- Carma Ayala
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA
| | - Xin Tong
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA
| | - Eunice Neeley
- University of California at San Francisco Medical School, San Francisco, GA, USA
| | - Rashon Lane
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA
| | - Karen Robb
- American Heart Association/American Stroke Association, Dallas, TX, USA
| | - Fleetwood Loustalot
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA
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7
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Shamley D, Robb K. An early warning surveillance programme for detecting upper limb deterioration after treatment for breast cancer: A novel technology supported system. BMC Cancer 2015. [PMID: 26370571 DOI: 10.1186/s12885‐015‐1636‐8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Upper limb morbidity is a well-recognised consequence of treatment for breast cancer that can develop for up to 6 years after treatment. However, the capacity to fully integrate evidence-based rehabilitation pathways into routine care for all patients is questionable due to limited resources. A long term surveillance programme must therefore be accessible to all patients, should identify those at risk of developing morbidity and target the interventions at the high risk population of patients. The proposed model uses a surrogate marker for assessing risk of morbidity, incorporated into an Early Warning System (EWS), to produce a technology-lead, prospective surveillance programme.
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Affiliation(s)
- Delva Shamley
- Clinical Research Centre, Faculty of Health Sciences, University of Cape Town, Anzio Rd, Observatory, 7925, Cape Town, South Africa.
| | - Karen Robb
- Macmillan Cancer Care, Consequences of Cancer Treatment Collaborative, England, UK.
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8
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Shamley D, Robb K. An early warning surveillance programme for detecting upper limb deterioration after treatment for breast cancer: A novel technology supported system. BMC Cancer 2015; 15:635. [PMID: 26370571 PMCID: PMC4570230 DOI: 10.1186/s12885-015-1636-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 09/01/2015] [Indexed: 11/17/2022] Open
Abstract
Upper limb morbidity is a well-recognised consequence of treatment for breast cancer that can develop for up to 6 years after treatment. However, the capacity to fully integrate evidence-based rehabilitation pathways into routine care for all patients is questionable due to limited resources. A long term surveillance programme must therefore be accessible to all patients, should identify those at risk of developing morbidity and target the interventions at the high risk population of patients. The proposed model uses a surrogate marker for assessing risk of morbidity, incorporated into an Early Warning System (EWS), to produce a technology-lead, prospective surveillance programme.
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Affiliation(s)
- Delva Shamley
- Clinical Research Centre, Faculty of Health Sciences, University of Cape Town, Anzio Rd, Observatory, 7925, Cape Town, South Africa.
| | - Karen Robb
- Macmillan Cancer Care, Consequences of Cancer Treatment Collaborative, England, UK.
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9
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Harris J, Tsianakas V, Ream E, Van Hemelrijck M, Purushotham A, Mucci L, Green JS, Robb K, Fewster J, Armes J. CanWalk: study protocol for a randomized feasibility trial of a walking intervention for people with recurrent or metastatic cancer. Pilot Feasibility Stud 2015; 1:7. [PMID: 27965787 PMCID: PMC5153811 DOI: 10.1186/s40814-015-0003-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 02/11/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Increasing numbers of people in the UK are living with recurrent or metastatic cancer, many of whom experience reduced quality of life resulting from the physical and psychosocial consequences of cancer and its treatment. While drug treatments are important at alleviating some symptoms, there is increasing evidence of the benefits of exercise in enhancing quality of life and health outcomes. Walking is an inexpensive and accessible form of exercise. To our knowledge, no studies have investigated whether a walking intervention is sufficient to enhance quality of life and alleviate symptoms in people with recurrent or metastatic cancer across a range of tumor types. This paper describes the CanWalk study protocol, which aims to assess the feasibility and acceptability of undertaking a randomized controlled trial of a community-based walking program to enhance quality of life and well-being in people with recurrent or metastatic cancer. METHODS A mixed methods feasibility study includes an exploratory two-center randomized controlled trial and qualitative interviews. A minimum of 60 participants will be recruited from two London NHS Trusts and randomized 1:1 between the walking intervention and standard care using minimization. The walking intervention consists of the initial provision of written/online information followed by a short motivational interview. Participants are instructed to walk for 30 min on alternate days and attend an organized volunteer-led walk once a week. Half of all participants will be asked to use a pedometer. Postal questionnaires will be completed at baseline (pre-randomization) and at 6, 12 and 24 weeks. A subsample of participants and stakeholders will be interviewed at the end of the study. RESULTS Primary outcomes will be the acceptability and feasibility of the intervention and trial. A range of secondary outcome assessments needed to design a main study, including estimates of recruitment, adherence and variability in quality of life, will be evaluated. CONCLUSIONS Data from this study will be used to refine the walking intervention, investigate the acceptability of the intervention and study design, and determine the most appropriate outcome measures thereby providing estimates of the factors needed to design the main study. TRIAL REGISTRATION ISRCTN42072606.
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Affiliation(s)
- Jenny Harris
- Kings College London, Kings Health Partners, Florence Nightingale Faculty of Nursing and Midwifery, London, UK
| | - Vicki Tsianakas
- Kings College London, Kings Health Partners, Florence Nightingale Faculty of Nursing and Midwifery, London, UK
| | - Emma Ream
- University of Surrey, School of Health Sciences, Faculty of Health and Medical Sciences, Guildford, UK
| | - Mieke Van Hemelrijck
- King's College London, Kings Health Partners, Division of Cancer Studies, London, UK
| | - Arnie Purushotham
- King's College London, Kings Health Partners, Division of Cancer Studies, London, UK
| | - Lorelei Mucci
- Department of Epidemiology, Harvard School of Public Health, Boston, USA
| | - James Sa Green
- Department of Urology and North London East Regional Urological Cancer Centre, Whipps Cross Hospital, London, UK ; Department of Health and Social Care, London South Bank University, London, UK
| | | | | | - Jo Armes
- Kings College London, Kings Health Partners, Florence Nightingale Faculty of Nursing and Midwifery, London, UK
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10
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Robb K. Survivorship, palliative care and quality of life. Eur J Cancer Care (Engl) 2014; 23:583-4. [PMID: 25142284 DOI: 10.1111/ecc.12229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- K Robb
- Consultant Physiotherapist & Member of Macmillan Consequences of Cancer Treatment Collaborative, London, UK
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11
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Fenlon D, Faithfull S, Greenfield D, Knowles G, Robb K, Roberts K, Taylor G, Wells M, White I, Wiseman T. 3052 POSTER Ten Top Tips for Cancer Survivorship: a Prompt for Cancer Patients at the End of Their Primary Treatment. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71125-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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12
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Macdonell RA, Triggs WJ, Leikauskas J, Bourque M, Robb K, Day BJ, Shahani BT. Functional electrical stimulation to the affected lower limb and recovery after cerebral infarction. J Stroke Cerebrovasc Dis 2010; 4:155-60. [PMID: 26486052 DOI: 10.1016/s1052-3057(10)80178-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Functional electrical stimulation (FES) may improve recovery after stroke. We studied its effects in 38 postcerebral infarct patients. Twenty were randomly assigned to receive FES producing ankle dorsiflexion on the affected side and physical therapy. The remaining 18 received physical therapy only. Subjects were evaluated prior to commencing therapy, at its completion after 4 weeks, and again 4 weeks later using functional and electrophysiological measures. Functional deficit in most patients improved (p < 0.01). Although no significant differences were observed when those treated with FES and those not treated were compared at 4 and 8 weeks, there was significant improvement in the rate of recovery using an ambulation score (p < 0.05), and there was a similar trend in the Barthel Index for FES-treated patients (p < 0.1). Our results indicate that FES may confer additional benefit in acute stroke rehabilitation. Further studies are needed to delineate how best to use it.
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Affiliation(s)
- R A Macdonell
- From the Department of Neurology, Austin Hospital, Heidelberg 3084, Australia
| | - W J Triggs
- Department of Neurology, University of Florida, Gainesville, FL, U.S.A
| | - J Leikauskas
- Spaulding Rehabilitation Hospital, Boston, MA, U.S.A
| | - M Bourque
- Spaulding Rehabilitation Hospital, Boston, MA, U.S.A
| | - K Robb
- Spaulding Rehabilitation Hospital, Boston, MA, U.S.A
| | - B J Day
- Department of Neurology, Alfred Hospital, Prahran 3181, Australia
| | - B T Shahani
- Department of Physical Medicine and Rehabilitation, University of Illinois, Chicago, IL, U.S.A
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13
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Raphael J, Ahmedzai S, Hester J, Urch C, Barrie J, Williams J, Farquhar-Smith P, Fallon M, Hoskin P, Robb K, Bennett MI, Haines R, Johnson M, Bhaskar A, Chong S, Duarte R, Sparkes E. Cancer Pain: Part 1: Pathophysiology; Oncological, Pharmacological, and Psychological Treatments: A Perspective from the British Pain Society Endorsed by the UK Association of Palliative Medicine and the Royal College of General Practitioners. Pain Med 2010; 11:742-64. [DOI: 10.1111/j.1526-4637.2010.00840.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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14
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Raphael J, Hester J, Ahmedzai S, Barrie J, Farqhuar-Smith P, Williams J, Urch C, Bennett MI, Robb K, Simpson B, Pittler M, Wider B, Ewer-Smith C, DeCourcy J, Young A, Liossi C, McCullough R, Rajapakse D, Johnson M, Duarte R, Sparkes E. Cancer pain: part 2: physical, interventional and complimentary therapies; management in the community; acute, treatment-related and complex cancer pain: a perspective from the British Pain Society endorsed by the UK Association of Palliative Medicine and the Royal College of General Practitioners. Pain Med 2010; 11:872-96. [PMID: 20456069 DOI: 10.1111/j.1526-4637.2010.00841.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This discussion document about the management of cancer pain is written from the pain specialists' perspective in order to provoke thought and interest in a multimodal approach to the management of cancer pain, not just towards the end of life, but pain at diagnosis, as a consequence of cancer therapies, and in cancer survivors. It relates the science of pain to the clinical setting and explains the role of psychological, physical, interventional and complementary therapies in cancer pain. METHODS This document has been produced by a consensus group of relevant healthcare professionals in the United Kingdom and patients' representatives making reference to the current body of evidence relating to cancer pain. In the second of two parts, physical, invasive and complementary cancer pain therapies; treatment in the community; acute, treatment-related and complex cancer pain are considered. CONCLUSIONS It is recognized that the World Health Organization (WHO) analgesic ladder, whilst providing relief of cancer pain towards the end of life for many sufferers world-wide, may have limitations in the context of longer survival and increasing disease complexity. To complement this, it is suggested that a more comprehensive model of managing cancer pain is needed that is mechanism-based and multimodal, using combination therapies including interventions where appropriate, tailored to the needs of an individual, with the aim to optimize pain relief with minimization of adverse effects.
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Affiliation(s)
- Jon Raphael
- Faculty of Health, Birmingham City University, Birmingham, UK.
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15
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Robb K, Stubbings S, Ramirez A, Macleod U, Austoker J, Waller J, Hiom S, Wardle J. Public awareness of cancer in Britain: a population-based survey of adults. Br J Cancer 2010; 101 Suppl 2:S18-23. [PMID: 19956158 PMCID: PMC2790705 DOI: 10.1038/sj.bjc.6605386] [Citation(s) in RCA: 227] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective: To assess public awareness of cancer warning signs, anticipated delay and perceived barriers to seeking medical advice in the British population. Methods: We carried out a population-based survey using face-to-face, computer-assisted interviews to administer the cancer awareness measure (CAM), a newly developed, validated measure of cancer awareness. The sample included 2216 adults (970 males and 1246 females) recruited as part of the Office for National Statistics Opinions Survey using stratified probability sampling. Results: Awareness of cancer warning signs was low when open-ended (recall) questions were used and higher with closed (recognition) questions; but on either measure, awareness was lower in those who were male, younger, and from lower socio-economic status (SES) groups or ethnic minorities. The most commonly endorsed barriers to help seeking were difficulty making an appointment, worry about wasting the doctor's time and worry about what would be found. Emotional barriers were more prominent in lower SES groups and practical barriers (e.g. too busy) more prominent in higher SES groups. Anticipated delay was lower in ethnic minority and lower SES groups. In multivariate analysis, higher symptom awareness was associated with lower anticipated delay, and more barriers with greater anticipated delay. Conclusions: A combination of public education about symptoms and empowerment to seek medical advice, as well as support at primary care level, could enhance early presentation and improve cancer outcomes.
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Affiliation(s)
- K Robb
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, UCL, Gower Street, London, UK
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Robb K, Oxberry SG, Bennett MI, Johnson MI, Simpson KH, Searle RD. A cochrane systematic review of transcutaneous electrical nerve stimulation for cancer pain. J Pain Symptom Manage 2009; 37:746-53. [PMID: 18790600 DOI: 10.1016/j.jpainsymman.2008.03.022] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2008] [Revised: 03/13/2008] [Accepted: 04/03/2008] [Indexed: 11/30/2022]
Abstract
Cancer-related pain is complex and multi-dimensional; yet, the mainstay of cancer pain management has been the biomedical approach. There is a need for nonpharmacological and innovative pain management strategies. Transcutaneous electrical nerve stimulation (TENS) may have a role. The aim of this systematic review was to determine the effectiveness of TENS for cancer-related pain in adults. The Cochrane Library, MEDLINE, EMBASE, CINAHL, PsychINFO, AMED, and PEDro databases were searched for randomized controlled trials (RCTs) investigating the use of TENS for the management of cancer-related pain in adults. Once relevant studies were identified, two pairs of reviewers assessed eligibility for inclusion in the review based on a study eligibility form and using the 5-point Oxford Quality Scale. Two RCTs met the study eligibility criteria (these involved 64 patients). These studies were heterogeneous with respect to study population, methodology, and outcome measures. This prevented meta-analysis. In one RCT, there were no significant differences between TENS and placebo in women with chronic pain secondary to breast cancer treatment. In the other RCT, there were no significant differences between acupuncture-like TENS (AL-TENS) and sham in palliative care patients; this study was significantly underpowered. There is insufficient available evidence to determine the effectiveness of TENS in treating cancer-related pain. Further research is needed to help guide clinical practice, and large multi-center RCTs are required to assess the value of TENS in the management of cancer-related pain in adults.
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Affiliation(s)
- Karen Robb
- St. Bartholomew's Hospital, London, United Kingdom
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Abstract
STUDY OBJECTIVE To examine the completion rate, internal reliability, and external validity of a home affluence scale based on adolescents' reports of material circumstances in the home as a measure of family socioeconomic status. DESIGN Cross sectional survey. SETTING Data were collected from a school based study in seven schools in the north of England Cheshire over a five month period from September 1999 to January 2000. PARTICIPANTS 1824 students (1248 girls, 567 boys) aged 13-15 years who were attending normal classes in Years 9 and 10 in 7 schools on the days of data collection. MAIN RESULTS Comparatively poor completion rates were found for questions on parental education and occupation while material deprivation items had much higher completion rates. There was evidence that students with poorer material circumstances were less able to report parental education and occupation whereas material based questions showed less bias. A home affluence scale composed of material items was found to have adequate internal reliability and good external validity. CONCLUSIONS A home affluence scale based on material markers provides a useful alternative in assessing family affluence in adolescents. Additionally, it prevents exclusion of those less materially well off adolescents who fail to complete conventional socioeconomic status items.
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Affiliation(s)
- J Wardle
- ICRF Health Behaviour Unit, University College London, UK.
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Robb K. The Whole Woman. J Midwifery Womens Health 2001. [DOI: 10.1016/s1526-9523(00)00101-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Etchells E, Bell C, Robb K. Does this patient have an abnormal systolic murmur? JAMA 1997; 277:564-71. [PMID: 9032164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Our objective was to review the available evidence of the precision and accuracy of the clinical examination for abnormal systolic murmurs. We conducted a MEDLINE search, manually reviewed all reference lists, and contacted authors of published studies. Each study was independently reviewed by 2 observers and graded for methodologic quality. We found that most studies were conducted using cardiologist examiners. In the clinical setting, the reliability of detecting systolic murmurs was fair (kappa, 0.30-0.48). The most useful findings for ruling in aortic stenosis are a slow rate of rise of the carotid pulse (positive likelihood ratio, 2.8-130), mid to late peak intensity of the murmur (positive likelihood ratio, 8.0-101), and decreased intensity of the second heart sound (positive likelihood ratio, 3.1-50). The most useful finding for ruling out aortic stenosis is the absence of murmur radiation to the right carotid artery (negative likelihood ratio, 0.05-0.10). Smaller, lower-quality studies indicate that cardiologists can accurately rule in and rule out mitral regurgitation, tricuspid regurgitation, hypertrophic cardiomyopathy, and echocardiographic mitral valve prolapse. We conclude that the clinical examination by cardiologists is accurate for detecting various causes of abnormal systolic murmurs. Studies of the clinical examination by noncardiologists are needed.
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Affiliation(s)
- E Etchells
- Division of General Internal Medicine and Clinical Epidemiology, University of Toronto, Ontario.
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Abstract
The alien hand syndrome has been associated with different descriptions of abnormal motor behavior. We report on two patients with transient left hemiparesis who remained with limb apraxia and were particularly impaired by a variety of involuntary skilled movements of their apractic limb. After the report and a review of the literature, we discuss the presence of one type of abnormal movement observed in this syndrome. These movements resemble the mirror movements seen in the normal development of motor control and in some pathologic conditions later. Their appearance in the alien hand syndrome seems to demand both intrahemispheric and interhemispheric motor pathway damage.
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Affiliation(s)
- D Gottlieb
- Spaulding Rehabilitation Hospital, Boston, Massachusetts
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