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Yeganeh L, Willey S, Wan CS, Bahri Khomami M, Chehrazi M, Cook O, Webber K. The effects of lifestyle and behavioural interventions on cancer recurrence, overall survival and quality of life in breast cancer survivors: A systematic review and network meta-analysis. Maturitas 2024; 185:107977. [PMID: 38574414 DOI: 10.1016/j.maturitas.2024.107977] [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] [Received: 01/13/2024] [Revised: 03/08/2024] [Accepted: 03/20/2024] [Indexed: 04/06/2024]
Abstract
Lifestyle/behavioural interventions may improve breast cancer outcomes and quality of life (QoL); however, uncertainty remains about the most effective interventions due to limited evidence. This study aimed to assess and compare the effects of lifestyle/behavioural interventions on cancer recurrence, survival and QoL in breast cancer survivors. Electronic databases including Medline, EMBASE, PsycINFO, CINAHL and EBM Reviews were searched for relevant literature. Randomized controlled trials (RCTs) and quasi-RCTs comparing a lifestyle/behavioural intervention with a control condition in breast cancer survivors were included. Outcomes included cancer recurrence, overall survival and QoL. A network meta-analysis synthesized intervention effect. Studies not included in the analysis were reported narratively. Of 6251 identified articles, 38 studies met the selection criteria. Limited evidence exists on the impacts of lifestyle/behavioural interventions on breast cancer recurrence/survival. Exercise was identified as the most effective intervention in improving overall survival (HR 0.50, 95 % CI 0.36, 0.68). Lifestyle/behavioural interventions may improve QoL; psychosocial interventions (SMD 1.28, 95 % CI 0.80, 1.77) and aerobic-resistance exercise (SMD 0.33, 95 % CI -0.03, 0.69) were the most effective interventions to enhance QoL. This review highlights potential post-breast cancer benefits from lifestyle/behavioural interventions, notably exercise and psychosocial support for QoL and exercise for overall survival. Thus, encouraging active lifestyle, stress management and coping skills programs during and after cancer treatment may enhance physical wellbeing and QoL. However, the findings should be interpreted with caution due to the small number and sample sizes of studies. Future longer-term RCTs are required for conclusive recommendations.
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Affiliation(s)
- Ladan Yeganeh
- Monash Nursing and Midwifery, Monash University, Clayton, VIC, Australia; Monash Centre for Health Research and Implementation, Monash University, VIC, Australia.
| | - Suzanne Willey
- Monash Nursing and Midwifery, Monash University, Peninsula Campus, VIC, Australia
| | - Ching Shan Wan
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Melbourne, VIC, Australia
| | - Mahnaz Bahri Khomami
- Monash Centre for Health Research and Implementation, Monash University, VIC, Australia
| | - Mohammad Chehrazi
- Department of Biostatistics and Epidemiology, School of Public Health, Babol University of Medical Sciences, Babol, Iran
| | - Olivia Cook
- Monash Nursing and Midwifery, Monash University, Clayton, VIC, Australia; McGrath Foundation, North Sydney, NSW, Australia
| | - Kate Webber
- Oncology Department, Monash Health, Clayton, VIC, Australia; School of Clinical Sciences, Monash University, Clayton, VIC, Australia
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Hill RE, Mercieca‐Bebber R, Fardell JE, Wakefield CE, Signorelli C, Webber K, Cohn RJ. Relationship between survivorship care plans and unmet information needs, quality of life, satisfaction with care, and propensity to engage with, and attend, follow-up care. Cancer 2023; 129:3820-3832. [PMID: 37566341 PMCID: PMC10952368 DOI: 10.1002/cncr.34984] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 06/29/2023] [Accepted: 07/15/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND The impact of survivorship care plans (SCPs) on the proximal and distal outcomes of adult and childhood cancer survivors, and parent proxies, is unclear. This study aimed to determine the relationship between SCP receipt and these outcomes. METHODS A cross-sectional survey of adult and childhood cancer survivors (and parent proxies for survivors aged younger than 16 years) across Australia and New Zealand was conducted. Multivariate regression models were fitted to measure the impact of SCP receipt on proximal (unmet information needs and propensity to engage with, and attend, cancer-related follow-up care) and distal outcomes (quality of life and satisfaction with cancer-related follow-up care) with control for cancer history and sociodemographic factors. RESULTS Of 1123 respondents, 499 were adult cancer survivors and 624 were childhood cancer survivors (including 222 parent proxies). We found that SCP receipt was predictive of greater attendance at, and awareness of, cancer-related follow-up care (adult: odds ratio [OR], 2.46; 95% CI, 1.18-5.12; OR, 2.38; 95% CI, 1.07-5.29; child/parent: OR, 2.61; 95% CI, 1.63-4.17; OR, 1.63; 95% CI, 1.06-2.50; respectively). SCP receipt also predicted fewer unmet information needs related to "follow-up care required" and "possible late effects" (adult: OR, 0.44; 95% CI, 0.20-0.96; OR, 0.29; 95% CI, 0.13-0.64; child/parent: OR, 0.46; 95% CI, 0.30-0.72; OR, 0.57; 95% CI, 0.38-0.85; respectively). In terms of distal outcomes, SCP receipt predicted a better global quality of life for adult cancer survivors (β, 0.08; 95% CI, -0.01-7.93), proxy-reported health-related quality of life (β, 0.15; 95% CI, 0.44-7.12), and satisfaction with follow-up care for childhood cancer survivors (OR, 2.93; 95% CI, 1.64-5.23). CONCLUSIONS Previous studies have shown little impact of SCPs on distal end points. Results suggest that SCPs may be beneficial to cancer survivors' proximal and distal outcomes.
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Affiliation(s)
- Rebecca E. Hill
- Discipline of Paediatrics & Child HealthSchool of Clinical MedicineUniversity of New South Wales (UNSW) Medicine and HealthUNSW SydneyRandwickNew South WalesAustralia
- Behavioural Sciences UnitKids Cancer CentreSydney Children’s HospitalSydneyNew South WalesAustralia
| | - Rebecca Mercieca‐Bebber
- National Health and Medical Research Council Clinical Trials CentreThe University of SydneySydneyNew South WalesAustralia
| | - Joanna E. Fardell
- Discipline of Paediatrics & Child HealthSchool of Clinical MedicineUniversity of New South Wales (UNSW) Medicine and HealthUNSW SydneyRandwickNew South WalesAustralia
- Behavioural Sciences UnitKids Cancer CentreSydney Children’s HospitalSydneyNew South WalesAustralia
| | - Claire E. Wakefield
- Discipline of Paediatrics & Child HealthSchool of Clinical MedicineUniversity of New South Wales (UNSW) Medicine and HealthUNSW SydneyRandwickNew South WalesAustralia
- Behavioural Sciences UnitKids Cancer CentreSydney Children’s HospitalSydneyNew South WalesAustralia
| | - Christina Signorelli
- Discipline of Paediatrics & Child HealthSchool of Clinical MedicineUniversity of New South Wales (UNSW) Medicine and HealthUNSW SydneyRandwickNew South WalesAustralia
- Behavioural Sciences UnitKids Cancer CentreSydney Children’s HospitalSydneyNew South WalesAustralia
| | - Kate Webber
- School of Clinical Sciences at Monash HealthFaculty of MedicineMonash UniversityClaytonVictoriaAustralia
| | - Richard J. Cohn
- Discipline of Paediatrics & Child HealthSchool of Clinical MedicineUniversity of New South Wales (UNSW) Medicine and HealthUNSW SydneyRandwickNew South WalesAustralia
- Behavioural Sciences UnitKids Cancer CentreSydney Children’s HospitalSydneyNew South WalesAustralia
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Chung H, Hyatt A, Kosmider S, Webber K, Krishnasamy M. Availability and accessibility of services to address financial toxicity described by Australian lung cancer patients and healthcare professionals. Support Care Cancer 2023; 31:554. [PMID: 37659009 PMCID: PMC10474978 DOI: 10.1007/s00520-023-08019-4] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/25/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE Although the financial burden and impact of a cancer diagnosis has been widely described in international literature, less understood is the availability and accessibility of services to ameliorate this need. This study reports the experiences of Australian lung cancer patients and health professionals delivering care, regarding factors that exacerbate and mitigate financial stress, and availability and accessibility of services to support people following a cancer diagnosis. METHODS Qualitative semi-structured interviews with twenty-three lung cancer patients attending two metropolitan tertiary health services and eleven health professionals delivering care were undertaken during July-August 2021. RESULTS Neither health service systematically screened for financial toxicity nor routinely provided information regarding potential financial impacts during consultations. Patients experienced lengthy delays in accessing welfare supports, provoking financial stress and worry. Health professionals reported limited resources and referral services to support patients with financial need; this was especially problematic for patients with lung cancer. They described its psychological impact on patients and their family members or carers and warned of its impact on ability to adhere to treatment. CONCLUSION Available and accessibility of services addressing financial toxicity in Australian lung cancer patients is inadequate. Although financial stress is a common, distressing problem, health professionals feel hampered in their ability to help due to limited service availability. Left unaddressed, financial toxicity can impact treatment adherence, directly influencing health outcomes, and increase risk of poverty, amplifying social inequities. Findings highlight opportunity for actionable interventions like financial consent and routine screening and discussion of financial toxicity across care pathways.
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Affiliation(s)
- Holly Chung
- Academic Nursing Unit, Peter MacCallum Cancer Centre, 305 Grattan Street Parkville, Melbourne, Victoria, 3000, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, 305 Grattan Street Parkville, Melbourne, Victoria, 3000, Australia
| | - Amelia Hyatt
- Department of Health Services Research, Peter MacCallum Cancer Centre, 305 Grattan Street Parkville, Melbourne, Victoria, 3000, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, 3010, Australia
- Department of Nursing, University of Melbourne, Melbourne, Victoria, 3010, Australia
| | - Suzanne Kosmider
- Cancer Services, Sunshine Hospital, Western Health, St Albans, Victoria, 3021, Australia
| | - Kate Webber
- Oncology Department, Monash Health, Clayton, Victoria, 3168, Australia
- School of Clinical Sciences, Monash University, Clayton, Victoria, 3800, Australia
| | - Meinir Krishnasamy
- Academic Nursing Unit, Peter MacCallum Cancer Centre, 305 Grattan Street Parkville, Melbourne, Victoria, 3000, Australia.
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, 3010, Australia.
- Department of Nursing, University of Melbourne, Melbourne, Victoria, 3010, Australia.
- Victorian Comprehensive Cancer Centre Alliance, Melbourne, Victoria, 3000, Australia.
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Nguyen M, Bain N, Grech L, Kwok A, Hamad N, Tognela A, Chan B, Nott L, Harris S, Chau N, Underhill C, Day D, McCartney A, Webber K, Segelov E. 1614P Influence of cancer on COVID-19 vaccine beliefs, attitudes and uptake. Ann Oncol 2022. [PMCID: PMC9472538 DOI: 10.1016/j.annonc.2022.07.1707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Bain N, Nguyen M, Grech L, Day D, McCartney A, Webber K, Kwok A, Harris S, Chau H, Chan B, Nott L, Hamad N, Tognela A, Underhill C, Loe BS, Freeman D, Segelov E. COVID-19 Vaccine Hesitancy in Australian Patients with Solid Organ Cancers. Vaccines (Basel) 2022; 10:vaccines10091373. [PMID: 36146450 PMCID: PMC9503648 DOI: 10.3390/vaccines10091373] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 07/22/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 02/07/2023] Open
Abstract
Background: Vaccination is the cornerstone of the global public health response to the COVID-19 pandemic. Excess morbidity and mortality of COVID-19 infection is seen in people with cancer. COVID-19 vaccine hesitancy has been observed in this medically vulnerable population, although associated attitudes and beliefs remain poorly understood. Methods: An online cross-sectional survey of people with solid organ cancers was conducted through nine health services across Australia. Demographics, cancer-related characteristics and vaccine uptake were collected. Perceptions and beliefs regarding COVID-19 vaccination were assessed using the Oxford COVID-19 Vaccine Hesitancy Scale, the Oxford COVID-19 Vaccine Confidence and Complacency Scale and the Disease Influenced Vaccine Acceptance Scale-6. Results: Between June and October 2021, 2691 people with solid organ cancers completed the survey. The median age was 62.5 years (SD = 11.8; range 19–95), 40.9% were male, 71.3% lived in metropolitan areas and 90.3% spoke English as their first language. The commonest cancer diagnoses were breast (36.6%), genitourinary (18.6%) and gastrointestinal (18.3%); 59.2% had localized disease and 56.0% were receiving anti-cancer therapy. Most participants (79.7%) had at least one COVID-19 vaccine dose. Vaccine uptake was higher in people who were older, male, metropolitan, spoke English as a first language and had a cancer diagnosis for more than six months. Vaccine hesitancy was higher in people who were younger, female, spoke English as a non-dominant language and lived in a regional location, and lower in people with genitourinary cancer. Vaccinated respondents were more concerned about being infected with COVID-19 and less concerned about vaccine safety and efficacy. Conclusions: People with cancer have concerns about acquiring COVID-19, which they balance against vaccine-related concerns about the potential impact on their disease progress and/or treatment. Detailed exploration of concerns in cancer patients provides valuable insights, both for discussions with individual patients and public health messaging for this vulnerable population.
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Affiliation(s)
- Nathan Bain
- Department of Oncology, Monash Health, Clayton, VIC 3168, Australia
| | - Mike Nguyen
- Department of Oncology, Monash Health, Clayton, VIC 3168, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, VIC 3168, Australia
- Correspondence: ; Tel.: +61-3-8572-2392
| | - Lisa Grech
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, VIC 3168, Australia
| | - Daphne Day
- Department of Oncology, Monash Health, Clayton, VIC 3168, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, VIC 3168, Australia
| | - Amelia McCartney
- Department of Oncology, Monash Health, Clayton, VIC 3168, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, VIC 3168, Australia
| | - Kate Webber
- Department of Oncology, Monash Health, Clayton, VIC 3168, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, VIC 3168, Australia
| | - Alastair Kwok
- Department of Oncology, Monash Health, Clayton, VIC 3168, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, VIC 3168, Australia
| | - Sam Harris
- Department of Medical Oncology, Bendigo Health, Bendigo, VIC 3550, Australia
| | - Hieu Chau
- Department of Oncology, Latrobe Regional Hospital, Traralgon, VIC 3844, Australia
| | - Bryan Chan
- Department of Oncology, Sunshine Coast Hospital and Health Service, Birtinya, QLD 4575, Australia
- School of Medicine, Griffith University, Birtinya, QLD 4575, Australia
| | - Louise Nott
- Icon Cancer Centre Hobart, Hobart, TAS 7000, Australia
| | - Nada Hamad
- Department of Hematology, St Vincent’s Hospital Sydney, Darlinghurst, NSW 2010, Australia
- School of Clinical Medicine, Medicine & Health, University of New South Wales, Kensington, NSW 2052, Australia
- School of Medicine, University of Notre Dame Australia, Chippendale, NSW 2007, Australia
| | - Annette Tognela
- Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown, NSW 2560, Australia
| | - Craig Underhill
- Border Medical Oncology Research Unit, Albury, NSW 2640, Australia
- Rural Medical School, University of New South Wales, Albury, NSW 2640, Australia
| | - Bao Sheng Loe
- The Psychometrics Centre, University of Cambridge, Cambridge CB2 1AG, UK
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK
- Oxford Health National Health Service Foundation Trust, Oxford OX3 7JX, UK
| | - Eva Segelov
- Department of Oncology, Monash Health, Clayton, VIC 3168, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, VIC 3168, Australia
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Day D, Grech L, Nguyen M, Bain N, Kwok A, Harris S, Chau H, Chan B, Blennerhassett R, Nott L, Hamad N, Tognela A, Hoffman D, McCartney A, Webber K, Wong J, Underhill C, Sillars B, Winkel A, Savage M, Loe BS, Freeman D, Segelov E. Serious Underlying Medical Conditions and COVID-19 Vaccine Hesitancy: A Large Cross-Sectional Analysis from Australia. Vaccines (Basel) 2022; 10:vaccines10060851. [PMID: 35746458 PMCID: PMC9230066 DOI: 10.3390/vaccines10060851] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 05/10/2022] [Revised: 05/23/2022] [Accepted: 05/23/2022] [Indexed: 01/27/2023] Open
Abstract
As COVID-19 vaccinations became available and were proven effective in preventing serious infection, uptake amongst individuals varied, including in medically vulnerable populations. This cross-sectional multi-site study examined vaccine uptake, hesitancy, and explanatory factors amongst people with serious and/or chronic health conditions, including the impact of underlying disease on attitudes to vaccination. A 42-item survey was distributed to people with cancer, diabetes, or multiple sclerosis across ten Australian health services from 30 June to 5 October 2021. The survey evaluated sociodemographic and disease-related characteristics and incorporated three validated scales measuring vaccine hesitancy and vaccine-related beliefs generally and specific to their disease: the Oxford COVID-19 Vaccine Hesitancy Scale, the Oxford COVID-19 Vaccine Confidence and Complacency Scale and the Disease Influenced Vaccine Acceptance Scale-Six. Among 4683 participants (2548 [54.4%] female, 2108 [45.0%] male, 27 [0.6%] other; mean [SD] age, 60.6 [13.3] years; 3560 [76.0%] cancer, 842 [18.0%] diabetes, and 281 [6.0%] multiple sclerosis), 3813 (81.5%) self-reported having at least one COVID-19 vaccine. Unvaccinated status was associated with younger age, female sex, lower education and income, English as a second language, and residence in regional areas. Unvaccinated participants were more likely to report greater vaccine hesitancy and more negative perceptions toward vaccines. Disease-related vaccine concerns were associated with unvaccinated status and hesitancy, including greater complacency about COVID-19 infection, and concerns relating to vaccine efficacy and impact on their disease and/or treatment. This highlights the need to develop targeted strategies and education about COVID-19 vaccination to support medically vulnerable populations and health professionals.
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Affiliation(s)
- Daphne Day
- Department of Oncology, Monash Health, Clayton, VIC 3168, Australia; (M.N.); (N.B.); (A.K.); (A.M.); (K.W.); (E.S.)
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC 3168, Australia; (L.G.); (J.W.)
- Correspondence: ; Tel.: +61-3-8572-2392
| | - Lisa Grech
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC 3168, Australia; (L.G.); (J.W.)
| | - Mike Nguyen
- Department of Oncology, Monash Health, Clayton, VIC 3168, Australia; (M.N.); (N.B.); (A.K.); (A.M.); (K.W.); (E.S.)
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC 3168, Australia; (L.G.); (J.W.)
| | - Nathan Bain
- Department of Oncology, Monash Health, Clayton, VIC 3168, Australia; (M.N.); (N.B.); (A.K.); (A.M.); (K.W.); (E.S.)
| | - Alastair Kwok
- Department of Oncology, Monash Health, Clayton, VIC 3168, Australia; (M.N.); (N.B.); (A.K.); (A.M.); (K.W.); (E.S.)
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC 3168, Australia; (L.G.); (J.W.)
| | - Sam Harris
- Department of Medical Oncology, Bendigo Health, Bendigo, VIC 3550, Australia;
| | - Hieu Chau
- Department of Oncology, Latrobe Regional Hospital, Traralgon, VIC 3844, Australia;
| | - Bryan Chan
- Department of Oncology, Sunshine Coast Hospital and Health Service, Birtinya, QLD 4575, Australia;
- School of Medicine, Griffith University, Birtinya, QLD 4575, Australia;
| | - Richard Blennerhassett
- Central Coast Haematology, North Gosford, NSW 2250, Australia;
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia
| | - Louise Nott
- Icon Cancer Centre Hobart, Hobart, TAS 7000, Australia;
| | - Nada Hamad
- Department of Haematology, St Vincent’s Hospital Sydney, Darlinghurst, NSW 2010, Australia;
- School of Clinical Medicine, Faculty of Medicine & Health, University of New South Wales, Kensington, NSW 2052, Australia
- School of Medicine, University of Notre Dame Australia, Chippendale, NSW 2007, Australia
| | - Annette Tognela
- Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown, NSW 2560, Australia;
| | | | - Amelia McCartney
- Department of Oncology, Monash Health, Clayton, VIC 3168, Australia; (M.N.); (N.B.); (A.K.); (A.M.); (K.W.); (E.S.)
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC 3168, Australia; (L.G.); (J.W.)
| | - Kate Webber
- Department of Oncology, Monash Health, Clayton, VIC 3168, Australia; (M.N.); (N.B.); (A.K.); (A.M.); (K.W.); (E.S.)
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC 3168, Australia; (L.G.); (J.W.)
| | - Jennifer Wong
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC 3168, Australia; (L.G.); (J.W.)
- Monash Diabetes, Monash Health, Clayton, VIC 3168, Australia
| | - Craig Underhill
- Border Medical Oncology, Albury, NSW 2640, Australia;
- Rural Medical School, University of New South Wales, Albury, NSW 2640, Australia
| | - Brett Sillars
- Department of Endocrinology, Sunshine Coast Hospital and Health Service, Birtinya, QLD 4575, Australia;
| | - Antony Winkel
- School of Medicine, Griffith University, Birtinya, QLD 4575, Australia;
- Department of Neurology, Sunshine Coast Hospital and Health Service, Birtinya, QLD 4575, Australia
| | - Mark Savage
- Department of Endocrinology, Bendigo Health, Bendigo, VIC 3550, Australia;
| | - Bao Sheng Loe
- The Psychometrics Centre, University of Cambridge, Cambridge CB2 1AG, UK;
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK;
- Oxford Health National Health Service Foundation Trust, Oxford OX3 7JX, UK
| | - Eva Segelov
- Department of Oncology, Monash Health, Clayton, VIC 3168, Australia; (M.N.); (N.B.); (A.K.); (A.M.); (K.W.); (E.S.)
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC 3168, Australia; (L.G.); (J.W.)
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Sivakumaran T, Krasovitsky M, Freimund A, Lee YC, Webber K, So J, Norris C, Friedlander M, Mileshkin L, Au-Yeung G. Treatment patterns after poly-ADP ribose polymerase (PARP) inhibitors in epithelial ovarian cancer patients. Int J Gynecol Cancer 2022; 32:906-912. [PMID: 35321889 DOI: 10.1136/ijgc-2021-003009] [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: 11/04/2022] Open
Abstract
OBJECTIVES The primary objective of this study was to describe treatment patterns after poly-ADP ribose polymerase (PARP) inhibitor in patients with epithelial ovarian cancer. Secondary objectives were to evaluate duration of response, time to first subsequent therapy, progression-free survival and overall survival. METHODS This was a retrospective analysis of patients with epithelial ovarian cancer treated with PARP inhibitor therapy at six Australian gynecological oncology centers. Eligible patients were identified via clinics, trial databases and pharmacy dispensing logs between January 2005 and September 2019. Information regarding clinico-pathological characteristics and treatment outcomes were collated from medical records. RESULTS A total of 85 patients with epithelial ovarian cancer were identified. Of these, 61% had germline BRCA1/2 mutations, 9% had somatic BRCA1/2 mutations, 5% had confirmed homologous recombination deficiency and 25% were BRCA1/2 wildtype mutations. A total of seventy-seven (91%) patients received chemotherapy after PARP inhibitor, with fifty-six (72.7%) of these patients receiving platinum-based chemotherapy. Four patients (5%) had a complete response, 15 (20%) a partial response, 15 (20%) stable disease and 41 (55%) progressive disease. Median duration of response to chemotherapy was 7.0 months (range 0.2-20.4). Median time to first subsequent therapy was 17.6 and 15.1 months in patients who received a PARP inhibitor as maintenance therapy and treatment, respectively. Median progression-free survival of first line treatment after PARP inhibitor was 9.6, 3.5 and 4.6 months for platinum doublet, single agent platinum and non-platinum chemotherapy, respectively. Adjusting for age and FIGO (Federation of Gynecological Oncologists classification) stage progression-free survival did not differ between treatment groups (p=0.14). Median overall survival for the cohort was 69 months, and patients with platinum sensitive ovarian cancer had improved survival compared with those with platinum refractory or resistant disease. CONCLUSION Platinum doublet chemotherapy resulted in non-significant improved progression-free survival compared with other regimens, suggesting potential independent mechanisms of resistance between PARP inhibitor and platinum compounds.
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Affiliation(s)
- Tharani Sivakumaran
- Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Krasovitsky
- Department of Medical Oncology, Prince of Wales Hospital and Royal Hospital for Women, Randwick, New South Wales, Australia.,University of New South Wales Prince of Wales Clinical School, Randwick, New South Wales, Australia
| | - Alison Freimund
- Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Yeh Chen Lee
- Department of Medical Oncology, Prince of Wales Hospital and Royal Hospital for Women, Randwick, New South Wales, Australia.,University of New South Wales Prince of Wales Clinical School, Randwick, New South Wales, Australia
| | - Kate Webber
- Department of Medical Oncology, Monash Health, Clayton, Victoria, Australia.,School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Jane So
- Department of Medical Oncology, Monash Health, Clayton, Victoria, Australia
| | - Christie Norris
- Department of Medical Oncology, Prince of Wales Hospital and Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Michael Friedlander
- Department of Medical Oncology, Prince of Wales Hospital and Royal Hospital for Women, Randwick, New South Wales, Australia.,University of New South Wales Prince of Wales Clinical School, Randwick, New South Wales, Australia
| | - Linda Mileshkin
- Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Gynaecological Oncology, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - George Au-Yeung
- Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia .,Oncology and Dysplasia, The Royal Women's Hospital, Parkville, Victoria, Australia
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Mazariego C, Jefford M, Chan RJ, Roberts N, Millar L, Anazodo A, Hayes S, Brown B, Saunders C, Webber K, Vardy J, Girgis A, Koczwara B. Priority recommendations for the implementation of patient-reported outcomes in clinical cancer care: a Delphi study. J Cancer Surviv 2022; 16:33-43. [PMID: 35107792 PMCID: PMC8881271 DOI: 10.1007/s11764-021-01135-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/06/2021] [Indexed: 12/13/2022]
Abstract
Purpose The aim of this study was to develop priority recommendations for the service level implementation of patient-reported outcomes (PROs) into clinical cancer care. Methods Development of draft guidance statements was informed by a literature review, the Knowledge to Action (KTA) implementation framework, and discussion with PRO experts and cancer survivors. A two-round modified Delphi survey with key stakeholders including cancer survivors, clinical and research experts, and Information Technology specialists was undertaken. Round 1 rated the importance of the statements and round 2 ranked statements in order of priority. Results Round 1 was completed by 70 participants with round 2 completed by 45 participants. Forty-seven statements were rated in round 2. In round 1, the highest agreement items (>90% agreement) included those that focused on the formation of strong stakeholder partnerships, ensuring ongoing communication within these partnerships, and the use of PROs for improvement and guidance in clinical care. Items ranked as the highest priorities in round 2 included assessment of current staff capabilities and service requirements, mapping of workflows and processes to enable collection, and using collected PROs to guide improved health outcomes. Conclusions This stakeholder consultation process has identified key priorities in PRO implementation into clinical cancer care that include clinical relevance, stakeholder engagement, communication, and integration within the existing processes and capabilities. Implication for Cancer Survivors Routine adoption of PRO collection by clinical cancer services requires multiple implementation steps; of highest priority is strong engagement and communication with key stakeholders including cancer survivors. Supplementary Information The online version contains supplementary material available at 10.1007/s11764-021-01135-2.
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Affiliation(s)
- C Mazariego
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, 153 Dowling street, Woolloomooloo, NSW, 2011, Australia.
| | - M Jefford
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - R J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - N Roberts
- Metro North Health Service, Herston, QLD, Australia.,University of Queensland Centre for Clinical Research, Herston, QLD, Australia
| | - L Millar
- Medical School, University of Western Australia, Perth, WA, Australia
| | - A Anazodo
- School of Women's and Children's Health, University of New South Wales, Randwick, Sydney, Australia.,Kids Cancer Centre, Sydney, Sydney Children's Hospital, Randwick, Sydney, Australia.,Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, Australia
| | - S Hayes
- Consumer representative, Patients First: The Continuous Improvement in Care-Cancer Project, Perth, Australia
| | - B Brown
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Brisbane, Australia
| | - C Saunders
- Medical School, University of Western Australia, Perth, WA, Australia
| | - K Webber
- School of Medical Sciences, Monash University, Clayton, Vic, Australia.,Oncology Department, Monash Health, Clayton, Vic, Australia
| | - J Vardy
- Sydney Medical School, University of Sydney, Camperdown, Australia.,Concord Cancer Centre, Concord Hospital, Concord, NSW, Australia
| | - A Girgis
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
| | - B Koczwara
- Department of Clinical Oncology, Flinders Medical Centre, Adelaide, SA, Australia.,Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
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9
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Nguyen M, Bain N, Grech L, Hamad N, Chan BA, Blennerhassett R, Nott LM, Harris SJ, Chau NMH, Underhill C, Williams J, Kwok A, McCartney A, Webber K, Day D, Segelov E. Lower COVID-19 vaccination rates amongst Australians with gastrointestinal (GI) compared to other cancers. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.648] [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: 11/20/2022] Open
Abstract
648 Background: People with cancer are at higher risk of serious illness and death from COVID-19 infection. We investigated the differences in COVID-19 vaccine uptake and attitudes in people with various solid organ and hematological malignancies. Methods: An online survey of adult patients with cancer attending eight health services across four states in Australia, was conducted from June to September 2021. Demographics, cancer history and vaccination status were recorded. Only completed surveys were analysed. Variables were compared with chi-squared and multivariable analysis using logistic regression. Vaccine hesitancy was assessed using the Oxford COVID-19 Vaccine Hesitancy Scale, the Oxford Vaccine Confidence and Complacency Scale, and the Monash Disease Vaccine Acceptance Scale. T-test analysis was used to examine relationships between the scales and groups. Results: There were 2997 evaluable responses; 53.2% female, 61.8% from metropolitan areas, 27.5% with metastatic solid organ disease and 50.6% on current anti-cancer treatment. Patients with GI cancers comprised 13.5% (n = 405), compared with hematological 28.4%, breast 24.6%, genitourinary 14.1% and other cancer types 19.4%. Vaccination rates were significantly lower for respondents with GI cancers compared to other cancer types (71.6% v 79.3%; p< 0.001). Significant differences in the GI cancer population compared to all others were: more males ( p < 0.001), lower level of education ( p= 0.001), fewer reporting English as first language ( p = 0.02) and shorter time since cancer diagnosis ( p < 0.001). These remained significant after logistic regression. Among GI cancer respondents, factors associated with being vaccinated compared to unvaccinated included: older age ( p < 0.001), higher education level ( p = 0.03) and English as first language ( p = 0.01). There was no significant difference in the scales measuring vaccine hesitancy, confidence and complacency, for the GI cancer population compared to other cancers. As expected, there were significant differences in all scales comparing vaccinated to unvaccinated respondents with GI cancers. Conclusions: In our large, contemporary survey, Australians with GI cancers report lower COVID-19 vaccine uptake compared with patients with other cancer types. We identified demographic and disease related characteristics that contribute to these differences. Interventions and targeted communication are required for people with GI cancers to maximise vaccination uptake in this medically vulnerable group.
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Affiliation(s)
| | | | | | - Nada Hamad
- St Vincent’s Hospital Sydney, Darlinghurst, Australia
| | | | | | | | - Samuel J. Harris
- Department of Medical Oncology, Bendigo Health, Bendigo, Australia
| | | | | | - Janne Williams
- Southern Melbourne Integrated Cancer Service, Melbourne, Australia
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10
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Nguyen M, Bain N, Grech L, Choi T, Harris S, Chau H, Freeman D, Kwok A, Williams J, McCartney A, Webber K, Day D, Segelov E. COVID-19 vaccination rates, intent, and hesitancy in patients with solid organ and blood cancers: A multicenter study. Asia Pac J Clin Oncol 2022; 18:570-577. [PMID: 35043559 DOI: 10.1111/ajco.13754] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/13/2021] [Indexed: 12/21/2022]
Abstract
INTRODUCTION People with cancer are at higher risk of serious illness and death from COVID-19 infection. We investigated COVID-19 vaccine uptake among patients with solid organ and blood cancers and explored factors related to hesitancy. METHODS Cross-sectional online survey of adults with a history of cancer at three health services across metropolitan and regional Victoria. Vaccine hesitancy was measured by the validated Oxford COVID-19 vaccine hesitancy scale. RESULTS There were 1073 respondents: 56% female; median age 62 years (range 23 - 91). Commonest tumor types included breast 29%, gastrointestinal 19%, hematological 15%, genitourinary 15%, and lung 8%. Thirty-six percent had metastatic disease, and 54% were receiving active anticancer treatment. Eighty-four percent of respondents indicated positive intent toward COVID-19 vaccination, 10% were undecided, and 6% indicated negative attitudes. At least one vaccine dose had been received by 65% of respondents, leaving 35% unvaccinated. Fifty-eight percent of unvaccinated patients answered that they would "definitely" or "probably" take a vaccine. Higher vaccine uptake was significantly associated with older age, male gender, English as first language, longer time since cancer diagnosis, and not being on current anticancer treatment. Concerns regarding vaccine side effects, particularly thrombosis, and the desire for clear medical advice were prominent among unvaccinated respondents. CONCLUSION Despite being eligible for COVID-19 vaccination since March 2021, a substantial minority of patients with cancer remained unvaccinated as of August 2021. Targeted communication and educational resources addressing vaccine safety in the context of cancer are key to promoting vaccine uptake in this vulnerable population.
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Affiliation(s)
- Mike Nguyen
- Oncology Department, Monash Health, Clayton, Victoria, Australia.,School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Nathan Bain
- Oncology Department, Monash Health, Clayton, Victoria, Australia
| | - Lisa Grech
- School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Tammie Choi
- Department of Nutrition, Dietetics and Food, Monash University, Clayton, Victoria, Australia
| | - Sam Harris
- Bendigo Health, Bendigo, Victoria, Australia
| | - Hieu Chau
- Latrobe Regional Hospital, Traralgon, Victoria, Australia
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Alastair Kwok
- Oncology Department, Monash Health, Clayton, Victoria, Australia
| | - Janne Williams
- Southern Melbourne Integrated Cancer Service, Melbourne, Victoria, Australia
| | - Amelia McCartney
- Oncology Department, Monash Health, Clayton, Victoria, Australia.,School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Kate Webber
- Oncology Department, Monash Health, Clayton, Victoria, Australia.,School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Daphne Day
- Oncology Department, Monash Health, Clayton, Victoria, Australia.,School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Eva Segelov
- Oncology Department, Monash Health, Clayton, Victoria, Australia.,School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
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11
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White VM, Lisy K, Ward A, Ristevski E, Clode M, Webber K, Emery J, Ijzerman MJ, Afshar N, Millar J, Gibbs P, Evans S, Jefford M. Disparities in quality of life, social distress and employment outcomes in Australian cancer survivors. Support Care Cancer 2022; 30:5299-5309. [PMID: 35279769 PMCID: PMC9046289 DOI: 10.1007/s00520-022-06914-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 02/12/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To examine how socio-demographic, comorbidities and information needs influence quality of life (QoL) outcomes of survivors of breast, colorectal, or prostate cancer, non-Hodgkin lymphoma or melanoma. METHODS Cross-sectional postal survey with eligible participants identified through a population-based cancer registry. QoL outcomes were assessed by EQ-5D-5L, social difficulties index (SDI) and, for those employed at diagnosis, current employment. Regression analyses explored associations between outcome variables and cancer type, age, time since diagnosis, residential location, socio-economic disadvantage, comorbidities and unmet information needs. Mediation analyses examined whether comorbidities and information needs explained relationships between outcome variables and socio-economic disadvantage. RESULTS 2115 survivors participated. Mean EQ-5D-5L scores (mean = 0.84) were similar to population averages and SDI scores were low for the entire sample (mean = 3.80). In multivariate analyses, being aged over 80, greater socio-economic disadvantage, comorbidities and unmet information needs decreased EQ-5D-5L scores. Higher SDI scores were associated with socio-economic disadvantage, comorbidities and unmet information needs. Not being employed was associated with being aged over 50, more comorbidities and socio-economic disadvantage. Comorbidities but not information needs partially mediated the impact of socio-economic disadvantage on EQ-5D-5L and SDI accounting for 17% and 14% of the total effect of socio-economic disadvantage respectively. Neither comorbidities nor information needs mediated the association between socio-economic disadvantage and employment outcomes. CONCLUSIONS To improve quality of life, survivorship care should be better tailored to address the needs of individuals given their overall health and impact of comorbidities, their age and type of cancer and not simply time since diagnosis.
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Affiliation(s)
- Victoria M. White
- grid.1021.20000 0001 0526 7079School of Psychology, Faculty of Health, Deakin University, Geelong, VIC Australia ,grid.3263.40000 0001 1482 3639Cancer Council Victoria, Melbourne, VIC Australia
| | - Karolina Lisy
- grid.1055.10000000403978434Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC Australia ,grid.1055.10000000403978434Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC Australia ,grid.1008.90000 0001 2179 088XSir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC Australia
| | - Andrew Ward
- The Social Research Centre, Melbourne, VIC Australia
| | - Eli Ristevski
- grid.1002.30000 0004 1936 7857Monash Rural Health, Monash University, Warragul, VIC Australia
| | - Melanie Clode
- grid.1055.10000000403978434Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC Australia
| | - Kate Webber
- grid.1002.30000 0004 1936 7857School of Clinical Sciences, Monash University, Clayton, VIC Australia ,grid.419789.a0000 0000 9295 3933Department of Oncology, Monash Health, Clayton, VIC Australia
| | - Jon Emery
- grid.1008.90000 0001 2179 088XDepartment of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, Australia
| | - Maarten J. Ijzerman
- grid.1008.90000 0001 2179 088XSir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC Australia
| | - Nina Afshar
- grid.3263.40000 0001 1482 3639Cancer Council Victoria, Melbourne, VIC Australia ,grid.1008.90000 0001 2179 088XCentre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Jeremy Millar
- grid.267362.40000 0004 0432 5259Alfred Health Radiation Oncology, Alfred and LaTrobe Regional Hospital, Melbourne, VIC 3004 Australia ,grid.1002.30000 0004 1936 7857School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004 Australia
| | - Peter Gibbs
- Department of Medical Oncology, Western Health, St. Albans, Victoria, Australia ,grid.1042.70000 0004 0432 4889Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC Australia
| | - Sue Evans
- grid.3263.40000 0001 1482 3639Cancer Council Victoria, Melbourne, VIC Australia ,grid.1002.30000 0004 1936 7857School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004 Australia
| | - Michael Jefford
- grid.1055.10000000403978434Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC Australia ,grid.1055.10000000403978434Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC Australia ,grid.1008.90000 0001 2179 088XSir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC Australia
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12
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Merrick B, Noronha M, Batra R, Douthwaite S, Nebbia G, Snell L, Pickering S, Galao R, Whitfield J, Jahangeer A, Gunawardena R, Godfrey T, Laifa R, Webber K, Cliff P, Cunningham E, Neil S, Gettings H, Edgeworth J, Harrison H. Real-world deployment of lateral flow SARS-CoV-2 antigen detection in the emergency department to provide rapid, accurate and safe diagnosis of COVID-19. Infect Prev Pract 2021; 3:100186. [PMID: 34812417 PMCID: PMC8598289 DOI: 10.1016/j.infpip.2021.100186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/10/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Point-of-care (POC) SARS-CoV-2 lateral-flow antigen detection (LFD) testing in the emergency department (ED) could inform rapid infection control decisions but requirements for safe deployment have not been fully defined. METHODS Review of LFD test results, laboratory and POC-RT-PCR results and ED-performance metrics during a two-week high SARS-CoV-2 prevalence period followed by several months of falling prevalence. AIM Determine whether LFD testing can be safely deployed in ED to provide an effective universal SARS-CoV-2 testing capability. FINDINGS 93% (345/371) of COVID-19 patients left ED with a virological diagnosis during the 2-week universal LFD evaluation period compared to 77% with targeted POC-RT-PCR deployment alone, on background of approximately one-third having an NHS Track and Trace RT-PCR test-result at presentation. LFD sensitivity and specificity was 70.7% and 99.1% respectively providing a PPV of 97.7% and NPV of 86.4% with disease prevalence of 34.7%. ED discharge-delays (breaches) attributable to COVID-19 fell to 33/3532 (0.94%) compared with the preceding POC-RT-PCR period (107/4114 (2.6%); p=<0.0001). Importantly, LFD testing identified 1 or 2 clinically-unsuspected COVID-19 patients/day. Three clinically-confirmed LFD false positive patients were appropriately triaged based on LFD action-card flowchart, and only 5 of 95 false-negative LFD results were inappropriately admitted to non-COVID-19 areas where no onward-transmission was identified. LFD testing was restricted to asymptomatic patients when disease prevalence fell below 5% and detected 1-3 cases/week. CONCLUSION Universal SARS-CoV-2 LFD testing can be safely and effectively deployed in ED alongside POC-RT-PCR testing during periods of high and low disease prevalence.
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Affiliation(s)
- B. Merrick
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, UK
- Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M. Noronha
- Emergency Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - R. Batra
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, UK
- Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - S. Douthwaite
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, UK
- Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - G. Nebbia
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, UK
- Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - L.B. Snell
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, UK
- Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - S. Pickering
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, UK
| | - R.P. Galao
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, UK
| | - J. Whitfield
- Guy's King's and Thomas' School of Medicine, King's College London, UK
| | - A. Jahangeer
- Guy's King's and Thomas' School of Medicine, King's College London, UK
| | - R. Gunawardena
- Guy's King's and Thomas' School of Medicine, King's College London, UK
| | - T. Godfrey
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, UK
| | - R. Laifa
- Emergency Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | | | | | - S.J.D. Neil
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, UK
| | - H. Gettings
- Emergency Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - J.D. Edgeworth
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, UK
- Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - H.L. Harrison
- Emergency Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
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13
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Webber K, Cook O, White M, Kwok A, Segelov E. The impact of the COVID-19 pandemic on patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) in an Australian outpatient oncology setting. J Clin Oncol 2021. [DOI: 10.1200/jco.2020.39.28_suppl.195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
195 Background: PROMs and PREMs may be useful tools to reflect the impact of the COVID-19 pandemic on cancer patients’ wellbeing and care. This analysis compares baseline self-reported quality of life (QoL), symptoms and supportive care needs between two independent patient groups based on when and how they attended their oncology appointment: 1) in person, prior to the global declaration of the COVID-19 pandemic and; 2) via telehealth, during the pandemic. Methods: Patients were invited to complete a suite of PROMs and PREMs including the EQ-5D-5L, modified Edmonton Symptom Assessment System-Revised (ESAS-R) and the modified Supportive Care Needs Survey Short-Form (SCNS-SF34) on an iPad in the waiting room before each appointment (pre-COVID-19 pandemic phase, December 2019 to March 2020) or online prior to a telehealth appointment (COVID-19 pandemic phase, October 2020 to April 2021). Descriptive statistics were reported for clinical and demographic factors and the PROMs and PREMs. Baseline scores from pre-COVID-19 and COVID-19 cohorts were compared using t-tests and chi-square tests. Results: In the pre-COVID-19 phase, 100 patients (99 females, 60.7 years old) participated compared with 129 patients (128 females, 59.7 years old) in the COVID-19 phase. Primary cancer diagnoses were breast (pre-COVID-19 68%, COVID-19 71%), gynaecological (pre-COVID-19 31%, COVID-19 37%) and lung (pre-COVID-19 1%) cancers. Mean age, gender, relationship status, language spoken, cancer diagnoses, and staging were similar, all p > 0.05. Median self-rated health (EQ-VAS score) was also similar between the pre-COVID-19 phase (74, IQR 33) and the COVID-19 phase (75, IQR 34), p = 0.51. Median ESAS-R swelling/lymphoedema score was higher for the COVID-19 phase (1, IQR 3) than the pre-COVID-19 phase (0, IQR 3), p = 0.03. Median SCNS standardised psychological domain score was lower for the COVID-19 phase (35, IQR 40) compared with the pre-COVID-19 phase (45, IQR 42), p = 0.03. No other significant differences in symptoms or unmet needs were noted (all p > 0.05). The top three symptoms concerns (ESAS-R score ≥7) were: 1) tiredness (pre-COVID-19 33%, COVID-19 22.7%); 2) sleep problems (pre-COVID-19 24.5%, COVID-19 21.9%); 3) drowsiness (pre-COVID-19 21.2%) and concentration and memory (COVID-19 19.5%). Conclusions: Despite the COVID-19 pandemic, these data reflect the symptoms and concerns impacting on the QoL among Australian oncology patients have remained largely stable. Although Australian COVID-19 case numbers have remained low, PROMs and PREMs are crucial tools for continuing to support oncology patients with QoL and supportive needs in the pandemic era. Clinical trial information: ACTRN12619001470189.
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Affiliation(s)
| | | | | | | | - Eva Segelov
- Monash University/ Monash Health, Clayton, VIC, Australia
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14
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Cameron B, Webber K, Li H, Bennett B, Boyle F, de Souza P, Wilcken N, Lynch J, Friedlander M, Goldstein D, Lloyd A. Genetic associations of fatigue and other symptoms following breast cancer treatment: A prospective study. Brain Behav Immun Health 2021; 10:100189. [PMID: 34589724 PMCID: PMC8474532 DOI: 10.1016/j.bbih.2020.100189] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 10/29/2020] [Revised: 12/04/2020] [Accepted: 12/06/2020] [Indexed: 12/30/2022] Open
Abstract
Background Cancer-related fatigue, mood disturbances, pain and cognitive disturbance are common after adjuvant cancer therapy, but vary considerably between individuals despite common disease features and treatment exposures. A genetic basis for this variability was explored in a prospective cohort. Methods Physical and psychological health of women were assessed prospectively following therapy for early stage breast cancer with self-report questionnaires. Participation in a genetic association sub-study was offered. Indices for the key symptom domains of fatigue, pain, depression, anxiety, and neurocognitive difficulties were empirically derived by principal components analysis from end-treatment questionnaires, and then applied longitudinally. Genetic associations were sought with functional single nucleotide polymorphisms (SNPs) in pro- and anti-inflammatory cytokine genes - tumour necrosis factor (TNF)-α (−308 GG), interferon (IFN)-ɣ (+874 TA), interleukin (IL)-10 (1082 GA and −592 CA), IL-6 (−174 GC), IL-1β (−511 GA). Results Questionnaire data was available for 210 participants, of whom 111 participated in the genetic sub-study. As expected, symptom domain scores generally improved over several months following treatment completion. Tumour and adjuvant treatment related factors were unassociated with either severity or duration of the individual symptom domains, but severity of symptoms at end-treatment was strongly associated with duration for each domain (all p < 0.05). In multivariable analyses, risk genotypes were independently associated with: fatigue with IL-6 -174 GG/GC and IL-10 -1082 GG; depression and anxiety with IL-10 -1082 AA; neurocognitive disturbance: TNF-α −308 GG; depression IL-1β (all p < 0.05). The identified SNPs also had cumulative effects in prolonging the time to recovery from the associated symptom domain. Conclusions Genetic factors contribute to the severity and duration of common symptom domains after cancer therapy. Common symptoms following breast cancer treatment can be grouped into symptom domains. Symptom domains are useful to describe patterns and trajectories of symptoms following breast cancer treatment. Cytokine gene polymorphisms are associated with the severity and duration of symptom domains following cancer treatment. The symptom severity at final treatment predicts the duration of symptoms.
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Affiliation(s)
- B. Cameron
- The Kirby Institute, UNSW, Sydney, Australia
- Corresponding author. The Kirby Institute, University of New South Wales, Sydney, Australia.
| | - K. Webber
- Prince of Wales Hospital Clinical School, Sydney, Australia
| | - H. Li
- The Kirby Institute, UNSW, Sydney, Australia
| | - B.K. Bennett
- Prince of Wales Hospital Clinical School, Sydney, Australia
| | - F. Boyle
- Patricia Ritchie Cancer Care Centre, Mater Hospital, Sydney, Australia
| | - P. de Souza
- Southside Cancer Care Centre, St George Hospital, Sydney, Australia
| | - N. Wilcken
- Westmead Hospital Cancer Care Centre, Sydney, Australia
| | - J. Lynch
- St George Hospital, Sydney, Australia
| | - M. Friedlander
- Prince of Wales Hospital Cancer Centre, Sydney, Australia
| | - D. Goldstein
- The Kirby Institute, UNSW, Sydney, Australia
- Prince of Wales Hospital Clinical School, Sydney, Australia
| | - A.R. Lloyd
- The Kirby Institute, UNSW, Sydney, Australia
- Prince of Wales Hospital Clinical School, Sydney, Australia
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15
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Davies A, Lum C, Raju R, Ansell E, Webber K, Segelov E. Anti-cancer therapy made easier: a 25-year update. Intern Med J 2021; 51:473-480. [PMID: 32362017 PMCID: PMC8251731 DOI: 10.1111/imj.14878] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/22/2020] [Accepted: 03/27/2020] [Indexed: 12/12/2022]
Abstract
In 1993, the Internal Medicine Journal published ‘Chemotherapy made easier’, outlining developments in supportive care of patients undergoing chemotherapy. This described the contemporary state of anti‐emetics, colony stimulating factors, cardiac toxicity, neurotoxicity, development of drug analogues and venous access devices. Twenty‐five years later, we update the measures that improve the tolerability of the plethora of new anti‐cancer therapies, which have extended well beyond traditional chemotherapy agents to include immunotherapy and targeted therapies. Optimisation of supportive care is paramount to allow safe delivery with the least possible impact on quality of life of these new treatments, many of which have resulted dramatically improved outcomes across multiple cancer types. This state of the art update summarises advances in supportive care therapies relating to improving the patient experience during and after anti‐cancer treatment, including new anti‐emetics, hair preservation techniques, bone marrow support and improved venous access devices; the ongoing challenge of neurotoxicity; and the advent of multidisciplinary sub‐specialised fields such as cardio‐oncology and oncofertility. Supportive care medications for immuno‐oncology therapies is a new section; these highly effective (although not universally so) agents were a mere illusion in 1993.
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Affiliation(s)
- Amy Davies
- Department of Oncology, Monash Health, Melbourne, Victoria, Australia
| | - Caroline Lum
- Department of Oncology, Monash Health, Melbourne, Victoria, Australia
| | - Rachel Raju
- Department of Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Evan Ansell
- Department of Oncology, Monash Health, Melbourne, Victoria, Australia
| | - Kate Webber
- Department of Oncology, Monash Health, Melbourne, Victoria, Australia.,School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Eva Segelov
- Department of Oncology, Monash Health, Melbourne, Victoria, Australia.,School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
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16
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Koczwara B, Bonnamy J, Briggs P, Brown B, Butow PN, Chan RJ, Cohn RJ, Girgis A, Jefford M, Jl Joske D, Licqurish S, Mackay G, Saunders CM, Webber K. Patient-reported outcomes and personalised cancer care. Med J Aust 2020; 214:406-408.e1. [PMID: 34046907 DOI: 10.5694/mja2.50893] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | - Bogda Koczwara
- Flinders Medical Centre, Adelaide, SA.,Flinders University, Adelaide, SA
| | | | | | - Bena Brown
- Menzies School of Health Research, Brisbane, QLD
| | - Phyllis N Butow
- Centre for Medical Psychology and Evidence-based Decision Making, University of Sydney, Sydney, NSW
| | - Raymond J Chan
- Queensland University of Technology, Brisbane, QLD.,Princess Alexandra Hospital, Brisbane, QLD
| | - Richard J Cohn
- Long Term Follow-up Program, Sydney Children's Hospital Randwick, Sydney, NSW.,UNSW Sydney, Sydney, NSW
| | - Afaf Girgis
- Ingham Institute for Applied Medical Research, University of New South Wales, Sydney, NSW
| | | | - David Jl Joske
- Sir Charles Gairdner Hospital, Perth, WA.,University of Western Australia, Perth, WA
| | | | | | | | - Kate Webber
- Monash University, Melbourne, VIC.,Monash Health, Melbourne, VIC
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17
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Vuong K, Uebel K, Agaliotis M, Jun S, Taggart J, Suchy S, Liauw W, Chin M, Webber K, Harris M. Assessing suitability for long-term colorectal cancer shared care: a scenario-based qualitative study. BMC Fam Pract 2020; 21:240. [PMID: 33220715 PMCID: PMC7680065 DOI: 10.1186/s12875-020-01311-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/10/2020] [Indexed: 11/10/2022]
Abstract
Background Shared care is the preferred model for long-term survivorship care by cancer survivors, general practitioners and specialists. However, survivorship care remains specialist-led. A risk-stratified approach has been proposed to select suitable patients for long-term shared care after survivors have completed adjuvant cancer treatment. This study aims to use patient scenarios to explore views on patient suitability for long-term colorectal cancer shared care across the risk spectrum from survivors, general practitioners and specialists. Methods Participants completed a brief questionnaire assessing demographics and clinical issues before a semi-structured in-depth interview. The interviews focused on the participant’s view on suitability for long term cancer shared care, challenges and facilitators in delivering it and resources that would be helpful. We conducted thematic analysis using an inductive approach to discover new concepts and themes. Results Interviews were conducted with 10 cancer survivors, 6 general practitioners and 9 cancer specialists. The main themes that emerged were patient-centredness, team resilience underlined by mutual trust and stronger system supports by way of cancer-specific training, survivorship care protocols, shared information systems, care coordination and navigational supports. Conclusions Decisions on the appropriateness of this model for patients need to be made collaboratively with cancer survivors, considering their trust and relationship with their general practitioners and the support they need. Further research on improving mutual trust and operationalising support systems would assist in the integration of shared survivorship care. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-020-01311-w.
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Affiliation(s)
- Kylie Vuong
- School of Population Health, University of New South Wales, Sydney, Australia.
| | - Kerry Uebel
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Maria Agaliotis
- Australian Institute of Health Service Management, University of Tasmania, Sydney, Australia
| | - Stella Jun
- Translational Cancer Research Network, University of New South Wales, Sydney, Australia
| | - Jane Taggart
- School of Population Health, University of New South Wales, Sydney, Australia.,Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Sue Suchy
- Translational Cancer Research Network, University of New South Wales, Sydney, Australia
| | - Winston Liauw
- Saint George and Sutherland Clinical School, University of New South Wales, Sydney, Australia
| | - Melvin Chin
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Kate Webber
- School of Clinical Sciences, Monash University, Clayton, Australia.,Department of Medical Oncology, Monash Health, Clayton, Australia
| | - Mark Harris
- School of Population Health, University of New South Wales, Sydney, Australia.,Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
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18
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Cook O, Daiyan Y, Yeganeh L, Davies AG, Kwok A, Webber K, Segelov E. Exploration of the use and impact of patient-reported experience measures (PREMs) in oncology settings: A systematic review. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.29_suppl.166] [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: 11/20/2022] Open
Abstract
166 Background: In addition to patient-reported outcome measures, the use of patient-reported experience measures (PREMs) is also developing as a patient-centred method for evaluating health performance. PREMs are tools that measure patients’ experience of health care including accessibility, the physical environment of services, and their interactions with health service providers and clinicians. This systematic review aimed to explore the use and impact of PREMs in the clinical care of cancer patients and survivors. Methods: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. An a priori protocol was established and systematic searches of major databases (CINAHL, Medline, PsycINFO, Ovid Emcare and Scopus) were conducted between 2009 and 2019. Quantitative studies of adult or paediatric populations were eligible for inclusion. Articles reporting patient satisfaction only were excluded. Quality appraisal was conducted using the Johanna Briggs Institute Critical Appraisal Tools. A narrative synthesis of findings was conducted. Results: A total of 3246 articles were screened for eligibility with 45 studies included in the systematic review. The majority of included studies (n=37) were cross-sectional in design with a variety of PREMs used, most commonly the National Cancer Patient Experience Survey. Most studies were assessed as ‘moderate’ to ‘high’ for quality. Studies were categorised according to the use of the PREM with the majority (n=40) utilising a PREM to evaluate cancer services at the service or national level, and five using a PREM to evaluate a specific clinical intervention. Various gaps in care were identified across studies highlighting areas for improvement such as time to diagnosis and information provision. Few studies reported the barriers or enablers to PREM collection or discussed service improvement initiatives arising from them. Conclusions: Whilst PREM collection is becoming more common in oncology settings, the use and impact of this valuable data is not well reported. Patients willingly share their experiences of oncology care, yet planned or complete actions resulting from the data to improve care are seldom reported. The collection of PREMs should be met with a commitment to service improvement and longitudinal collection of PREMs is recommended to evaluate quality improvement initiatives.
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Affiliation(s)
| | | | | | | | | | | | - Eva Segelov
- Department of Medical Oncology, Monash Health, Melbourne, VIC, Australia
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19
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Beesley VL, Webber K, Nagle CM, DeFazio A, Obermair A, Williams M, Friedlander M, Webb PM. When will I feel normal again? Trajectories and predictors of persistent symptoms and poor wellbeing after primary chemotherapy for ovarian cancer. Gynecol Oncol 2020; 159:179-186. [DOI: 10.1016/j.ygyno.2020.07.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/19/2020] [Indexed: 12/31/2022]
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20
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Van Leeuwen MT, Luu S, Gurney H, Brown MR, Pearson SA, Webber K, Hunt L, Hong S, Delaney GP, Vajdic CM. Cardiovascular Toxicity of Targeted Therapies for Cancer: An Overview of Systematic Reviews. JNCI Cancer Spectr 2020; 4:pkaa076. [PMID: 33392444 PMCID: PMC7768929 DOI: 10.1093/jncics/pkaa076] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 03/26/2020] [Revised: 07/01/2020] [Accepted: 08/18/2020] [Indexed: 12/16/2022] Open
Abstract
Background Several targeted therapies for cancer have been associated with cardiovascular toxicity. The evidence for this association has not been synthesized systematically nor has the quality of evidence been considered. We synthesized systematic review evidence of cardiovascular toxicity of individual targeted agents. Methods We searched MEDLINE, Embase, and the Cochrane Database of Systematic Reviews for systematic reviews with meta-analyses of cardiovascular outcomes for individual agents published to May 2020. We selected reviews according to prespecified eligibility criteria (International Prospective Register of Systematic Reviews CRD42017080014). We classified evidence of cardiovascular toxicity as sufficient, probable, possible, or indeterminate for specific cardiovascular outcomes based on statistical significance, study quality, and size. Results From 113 systematic reviews, we found at least probable systematic review evidence of cardiovascular toxicity for 18 agents, including high- and all-grade hypertension for bevacizumab, ramucirumab, axitinib, cediranib, pazopanib, sorafenib, sunitinib, vandetanib, aflibercept, abiraterone, and enzalutamide, and all-grade hypertension for nintedanib; high- and all-grade arterial thromboembolism (includes cardiac and/or cerebral events) for bevacizumab and abiraterone, high-grade arterial thromboembolism for trastuzumab, and all-grade arterial thromboembolism for sorafenib and tamoxifen; high- and all-grade venous thromboembolism (VTE) for lenalidomide and thalidomide, high-grade VTE for cetuximab and panitumumab, and all-grade VTE for bevacizumab; high- and all-grade left ventricular ejection fraction decline or congestive heart failure for bevacizumab and trastuzumab, and all-grade left ventricular ejection fraction decline/congestive heart failure for pazopanib and sunitinib; and all-grade corrected QT interval prolongation for vandetanib. Conclusions Our review provides an accessible summary of the cardiovascular toxicity of targeted therapy to assist clinicians and patients when managing cardiovascular health.
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Affiliation(s)
- Marina T Van Leeuwen
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Steven Luu
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Howard Gurney
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Martin R Brown
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Kate Webber
- Department of Oncology, Monash Health, Clayton, Victoria, Australia.,School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Lee Hunt
- Cancer Voices NSW, Milsons Point, New South Wales, Australia
| | - Soojung Hong
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia.,Division of Oncology-Haematology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Geoffrey P Delaney
- Liverpool Cancer Therapy Centre, Liverpool, New South Wales, Australia.,Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
| | - Claire M Vajdic
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
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21
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Tran B, Vajdic CM, Webber K, Laaksonen MA, Stavrou EP, Tiller K, Suchy S, Bosco AM, Harris MF, Lloyd AR, Goldstein D. Self-reported health, lifestyle and social circumstances of Australian adult cancer survivors: A propensity score weighted cross-sectional study. Cancer Epidemiol 2020; 67:101773. [PMID: 32615538 DOI: 10.1016/j.canep.2020.101773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/19/2020] [Accepted: 06/21/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND With the prevalence of cancer survivors increasing, their unique needs must be better understood. We examined the health, lifestyles and social circumstances of adults with and without a history of cancer. METHODS We performed a cross-sectional study, using exposure and outcome data from the baseline survey (2006-2009) of participants in the 45 and Up Study, a prospective cohort study in New South Wales, Australia. We compared 20,811 cancer registry-verified adult cancer survivors with 207,148 participants without a history of cancer using propensity score weighting and accounting for multiple testing. The propensity weighting included age, sociodemographic factors and number of self-reported co-morbidities. RESULTS Cancer survivors were more likely to report poorer physical and psychological health and quality of life compared to those without a cancer history, with most deficits still evident more than 10 years after cancer diagnosis. Cancer survivors were more likely to have a higher body mass index, but were less likely to smoke. Cancer survivors had greater functional limitations, including sexual, and were less likely to work full time, volunteer and spend time outdoors. Their social connectedness was, however, similar. Those with haematological cancer, lung cancer, or distant metastases, and those diagnosed at an older age, had the greatest health deficits and functional limitations. CONCLUSIONS A history of cancer is associated with poorer health and less paid and unpaid work. Our findings reinforce the importance of routine long-term, integrated multidisciplinary care for cancer survivors and indicate the subgroups with the greatest unmet needs.
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Affiliation(s)
- Bich Tran
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Claire M Vajdic
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia.
| | - Kate Webber
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia; Department of Oncology, Monash Health, Melbourne, Australia; School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Maarit A Laaksonen
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Efty P Stavrou
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | | | - Sue Suchy
- Consumer Advisory Panel, Translational Cancer Research Network, Sydney, Australia
| | - Ann Marie Bosco
- Prince of Wales Hospital, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Andrew R Lloyd
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - David Goldstein
- Department of Medical Oncology, Nelune Cancer Centre, Prince of Wales Hospital, Sydney, Australia
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22
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Webber K, Carolus E, Mileshkin L, Sommeijer D, McAlpine J, Bladgen S, Coleman RL, Herzog TJ, Sehouli J, Nasser S, Inci G, Friedlander M. OVQUEST – Life after the diagnosis and treatment of ovarian cancer - An international survey of symptoms and concerns in ovarian cancer survivors. Gynecol Oncol 2019; 155:126-134. [DOI: 10.1016/j.ygyno.2019.08.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 07/29/2019] [Accepted: 08/04/2019] [Indexed: 10/26/2022]
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23
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van Leeuwen MT, Luu S, Gurney H, Brown MR, Webber K, Pearson SA, Hunt L, Vajdic CM. Cardiovascular toxicity of targeted therapies for cancer: a protocol for an overview of systematic reviews. BMJ Open 2018; 8:e021064. [PMID: 29950466 PMCID: PMC6042572 DOI: 10.1136/bmjopen-2017-021064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The introduction of targeted therapies for cancer has contributed to dramatic improvements in patient survival. Nevertheless, several targeted therapies have been associated with 'off-target' adverse effects, based on varying levels of evidence. To date, this evidence has not been systematically synthesised. We will synthesise published systematic review evidence of cardiovascular toxicity associated with targeted cancer therapies. METHODS AND ANALYSIS We will include systematic reviews of randomised controlled trials and observational studies that report on cardiovascular outcomes for individual agents. We will identify systematic reviews by applying predeveloped, standardised search strategies within Embase, Medline and Cochrane Central. Two independent reviewers will identify reviews published up to 31 December 2016 using predefined eligibility criteria. They will resolve ambiguous cases through consensus, arbitrated by a third reviewer if required. The reviewers will extract and report data according to methodological guidelines for overviews provided by the Cochrane Collaboration, Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. They will assess the quality of included reviews by applying the Assessment of Multiple Systematic Reviews tool. They will judge the quality of evidence in included reviews based on their assessment of bias and incorporation into the interpretation of findings. In synthesising the evidence, we will classify agents based on systematic review evidence of toxicity (sufficient, probable, possible or indeterminate) for specific cardiovascular outcomes (congestive heart failure, myocardial infarction, ischaemic heart disease, left ventricular ejection fraction decline, cerebrovascular disease, pulmonary embolism, thrombosis and hypertension). This will provide clinicians and patients with an accessible synthesis based on robust methodology. ETHICS AND DISSEMINATION Ethics approval is not required for overviews. We will conduct the study in collaboration with consumer representatives. We will submit results for peer-review publication, and disseminate them through established clinical and consumer networks. PROSPERO REGISTRATION NUMBER CRD42017080014.
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Affiliation(s)
- Marina T van Leeuwen
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Steven Luu
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Howard Gurney
- Faculty of Medicine and Health Science, Macquarie University, Sydney, New South Wales, Australia
| | - Martin R Brown
- Faculty of Medicine and Health Science, Macquarie University, Sydney, New South Wales, Australia
| | - Kate Webber
- Department of Medical Oncology, Prince of Wales Hospital and Royal Hospital for Women, Randwick, New South Wales, Australia
- Prince of Wales Clinical School, University of New South Wales, UNSW, New South Wales, Australia
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Lee Hunt
- Cancer Voices NSW, Sydney, New South Wales, Australia
| | - Claire M Vajdic
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
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24
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Signorelli C, Wakefield CE, Johnston KA, Fardell JE, Brierley MEE, Thornton-Benko E, Foreman T, Webber K, Wallace WH, Cohn RJ. 'Re-engage' pilot study protocol: a nurse-led eHealth intervention to re-engage, educate and empower childhood cancer survivors. BMJ Open 2018; 8:e022269. [PMID: 29654052 PMCID: PMC5898358 DOI: 10.1136/bmjopen-2018-022269] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Many childhood cancer survivors are disengaged from cancer-related follow-up care despite being at high risk of treatment-related late effects. Innovative models of long-term follow-up (LTFU) care to manage ongoing treatment-related complications are needed. 'Re-engage' is a nurse-led eHealth intervention designed to improve survivors' health-related self-efficacy, targeted at survivors disengaged from follow-up. Re-engage aims to overcome survivor- and parent-reported barriers to care and ensure survivors receive the care most appropriate to their risk level. METHODS AND ANALYSIS This study will recruit 30 Australian childhood cancer survivors who are not receiving any cancer-related care. Participation involves two online/telephone consultations with a survivorship nurse for medical assessment, a case review, risk stratification and creation of a care plan by a multidisciplinary team of specialists. We will assess the feasibility of implementing 'Re-engage' and its acceptability to participants and health professionals involved. The primary outcome will be survivors' health-related self-efficacy, measured at baseline and 1 and 6 months postintervention. Secondary outcomes will include the effect of 'Re-engage' on survivors' health behaviours and beliefs, engagement in healthcare, information needs and emotional well-being. We will also document the cost per patient to deliver 'Re-engage'. If Re-engage is acceptable, feasible and demonstrates early efficacy, it may have the potential to empower survivors in coordinating their complex care, improving survivors' long-term engagement and satisfaction with care. Ideally, it will be implemented into clinical practice to recall survivors lost to follow-up and reduce the ongoing burden of treatment for childhood cancer. ETHICS AND DISSEMINATION The study protocol has been approved by the South Eastern Sydney Local Health District Human Research Ethics Committee (reference number: 16/366). The results will be disseminated in peer-reviewed journals and at scientific conferences. A lay summary will be published on the Behavioural Sciences Unit website. TRIAL REGISTRATION NUMBER ACTRN12618000194268.
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Affiliation(s)
- Christina Signorelli
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Claire E Wakefield
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Karen A Johnston
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Joanna E Fardell
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Mary-Ellen E Brierley
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Elysia Thornton-Benko
- Bondi Road Doctors, Sydney, New South Wales, Australia
- Wellac Lifestyle: Wellness After, And during Cancer, Eastgardens, New South Wales, Australia
| | - Tali Foreman
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Kate Webber
- Department of Medical Oncology, Prince of Wales Hospital, Randwick, New South Wales, Australia
- National Centre for Cancer Survivorship, University of New South Wales, Kensington, New South Wales, Australia
| | - W Hamish Wallace
- Department of Hematology/Oncology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Richard J Cohn
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
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25
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Abstract
Cancer survivors are increasing as improvements in cancer diagnosis and treatment translate to improved outcomes. As cancer survivors in their reproductive years contemplate pregnancy, it is important to understand the impact of cancer and its treatment on fertility and pregnancy outcomes. Cancer treatments such as chemotherapy and radiotherapy can affect patients' fertility, and strategies are available to help preserve the future fertility of survivors. The potential impact of previous cancer diagnoses and treatments on pregnancy and maternal and fetal outcomes needs to be assessed and discussed with survivors, with support from materno-fetal medicine specialists and high-risk antenatal services as needed.
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Affiliation(s)
- Monica Tang
- Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Kate Webber
- Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW, Australia
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26
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Musgrave KM, Webber K, Murphy P, Avery P, Biss TT. Evaluation of the age-dependent dosing recommendations for the administration of daily tinzaparin in children with thrombosis. J Thromb Haemost 2017; 15:2361-2366. [PMID: 28976613 DOI: 10.1111/jth.13856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Indexed: 11/26/2022]
Abstract
Essentials The once-daily dosing of tinzaparin provides an advantage over other low molecular weight heparins. The recommended age-dependent doses of tinzaparin in children have not previously been validated. Once-daily administration of tinzaparin is a safe and effective treatment of childhood thrombosis. Recommended doses are appropriate but monitoring may be required due to inter-individual variation. SUMMARY Background The recommended starting doses of tinzaparin for the treatment of thrombosis in children have not previously been validated. There are few data to support the efficacy and safety of once-daily tinzaparin dosing in children with thrombosis. Objectives To investigate the use of tinzaparin for the treatment of childhood thrombosis, and to evaluate the age-dependent dosing recommendations and define outcomes in terms of efficacy and safety. Methods This was a retrospective cohort study of children aged 0 to < 16 years treated for thrombosis at a large teaching hospital in the UK between 2008 and 2015. Medical records were reviewed to evaluate tinzaparin dosing, anti-activated factor X (FXa) levels, and patient outcomes. Results Seventy-nine children were identified as having received tinzaparin. Dosing information was available for 57. Younger children required higher doses to reach a therapeutic level. The therapeutic dose requirement varied within age groups, supporting the use of anti-FXa monitoring. Over a median follow-up of 35 months, there were 13 (16%) bleeding episodes (two major; seven clinically relevant but non-major; and four minor). There were two (3%) recurrent episodes of thrombosis. Children were treated for a median duration of 3 months, and the majority (86%) remained on tinzaparin for the duration of their anticoagulant therapy. Conclusion Once-daily tinzaparin is a safe and effective treatment for childhood thrombosis, with rates of recurrence and bleeding similar to those for other anticoagulants used in children. The recommended starting doses are appropriate, but anti-FXa monitoring may be required, owing to interindividual variability in the therapeutic dose requirement.
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Affiliation(s)
- K M Musgrave
- Department of Haematology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - K Webber
- Newcastle University Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - P Murphy
- Blood Sciences Laboratory, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - P Avery
- School of Mathematics and Statistics, Newcastle University, Newcastle upon Tyne, UK
| | - T T Biss
- Department of Haematology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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27
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Sandler CX, Goldstein D, Horsfield S, Bennett BK, Friedlander M, Bastick PA, Lewis CR, Segelov E, Boyle FM, Chin MTM, Webber K, Barry BK, Lloyd AR. Randomized Evaluation of Cognitive-Behavioral Therapy and Graded Exercise Therapy for Post-Cancer Fatigue. J Pain Symptom Manage 2017; 54:74-84. [PMID: 28502786 DOI: 10.1016/j.jpainsymman.2017.03.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 02/24/2017] [Accepted: 03/22/2017] [Indexed: 12/13/2022]
Abstract
CONTEXT Cancer-related fatigue is prevalent and disabling. When persistent and unexplained, it is termed post-cancer fatigue (PCF). Cognitive behavioral therapy (CBT) and graded exercise therapy (GET) may improve symptoms and functional outcomes. OBJECTIVES To evaluate the outcomes of a randomized controlled trial, which assigned patients with post-cancer fatigue to education, or 12 weeks of integrated cognitive-behavioral therapy (CBT) and graded exercise therapy (GET). METHODS Three months after treatment for breast or colon cancer, eligible patients had clinically significant fatigue, no comorbid medical or psychiatric conditions that explained the fatigue, and no evidence of recurrence. The CBT/GET arm included individually tailored consultations at approximately two weekly intervals. The education arm included a single visit with clinicians describing the principles of CBT/GET and a booklet. The primary outcome was clinically significant improvement in self-reported fatigue (Somatic and Psychological HEalth REport 0-12), designated a priori as greater than one SD of improvement in fatigue score. The secondary outcome was associated improvement in function (role limitation due to physical health problems-36-Item Short Form Health Survey 0-100) comparing baseline, end treatment (12 weeks), and follow-up (24 weeks). RESULTS There were 46 patients enrolled, including 43 women (94%), with a mean age of 51 years. Fatigue severity improved in all subjects from a mean of 5.2 (±3.1) at baseline to 3.9 (±2.8) at 12 weeks, suggesting a natural history of improvement. Clinically significant improvement was observed in 7 of 22 subjects in the intervention group compared with 2 of 24 in the education group (P < 0.05, χ2). These subjects also had improvement in functional status compared with nonresponders (P < 0.01, t-test). CONCLUSION Combined CBT/GET improves fatigue and functional outcomes for a subset of patients with post-cancer fatigue. Further studies to improve the response rate and the magnitude of the benefit are warranted.
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Affiliation(s)
- Carolina X Sandler
- National Centre for Cancer Survivorship, The University of New South Wales, Sydney, Australia; Fatigue Clinic, Lifestyle Clinic, School of Medical Sciences, The University of New South Wales, Sydney, Australia
| | - David Goldstein
- National Centre for Cancer Survivorship, The University of New South Wales, Sydney, Australia; The Prince of Wales Hospital, Sydney, Australia
| | - Sarah Horsfield
- Fatigue Clinic, Lifestyle Clinic, School of Medical Sciences, The University of New South Wales, Sydney, Australia
| | - Barbara K Bennett
- National Centre for Cancer Survivorship, The University of New South Wales, Sydney, Australia
| | | | | | | | - Eva Segelov
- Monash University and Monash Health, Victoria, Australia
| | - Frances M Boyle
- The University of Sydney, Australia; Mater Hospital, North Sydney, Australia
| | | | - Kate Webber
- National Centre for Cancer Survivorship, The University of New South Wales, Sydney, Australia
| | - Benjamin K Barry
- Fatigue Clinic, Lifestyle Clinic, School of Medical Sciences, The University of New South Wales, Sydney, Australia; Neuroscience Research Australia, The University of New South Wales, Sydney, Australia
| | - Andrew R Lloyd
- National Centre for Cancer Survivorship, The University of New South Wales, Sydney, Australia; Fatigue Clinic, Lifestyle Clinic, School of Medical Sciences, The University of New South Wales, Sydney, Australia; Viral Immunology Systems Program (VISP), The Kirby Institute, The University of New South Wales, Sydney, Australia.
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Abstract
Chemotherapy plays a key role in the management of women with epithelial ovarian, fallopian tube and primary peritoneal cancer (EOC). Platinum- and taxane-based regimens are the standard of care for adjuvant treatment in early-stage EOC and first-line therapy for advanced stage disease. Efforts to define the optimal scheduling, timing and route of administration are ongoing. The majority of women with EOC will develop recurrent disease, and treatment options for these women are depend on the time that has elapsed from first-line therapy. Platinum-based doublet chemotherapy is preferred for women with platinum-sensitive recurrent cancer. In platinum-resistant relapsed EOC, options are much more limited, and careful consideration of symptoms, performance status, anticipated toxicity and quality of life is essential when recommending chemotherapy for these women.
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Affiliation(s)
- Kate Webber
- Department of Medical Oncology, Prince of Wales Hospital and Royal Hospital for Women, Randwick, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.
| | - Michael Friedlander
- Department of Medical Oncology, Prince of Wales Hospital and Royal Hospital for Women, Randwick, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
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Webber K, Friedlander M. Chemotherapy for epithelial ovarian, fallopian tube and primary peritoneal cancer. Best Pract Res Clin Obstet Gynaecol 2016; 41:126-138. [PMID: 28027849 DOI: 10.1016/j.bpobgyn.2016.11.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 11/03/2016] [Accepted: 11/11/2016] [Indexed: 01/01/2023]
Abstract
Chemotherapy plays a key role in the management of women with epithelial ovarian, fallopian tube and primary peritoneal cancer (EOC). Platinum- and taxane-based regimens are the standard of care for adjuvant treatment in early-stage EOC and first-line therapy for advanced stage disease. Efforts to define the optimal scheduling, timing and route of administration are ongoing. The majority of women with EOC will develop recurrent disease, and treatment options for these women are depend on the time that has elapsed from first-line therapy. Platinum-based doublet chemotherapy is preferred for women with platinum-sensitive recurrent cancer. In platinum-resistant relapsed EOC, options are much more limited, and careful consideration of symptoms, performance status, anticipated toxicity and quality of life is essential when recommending chemotherapy for these women.
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Affiliation(s)
- Kate Webber
- Department of Medical Oncology, Prince of Wales Hospital and Royal Hospital for Women, Randwick, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.
| | - Michael Friedlander
- Department of Medical Oncology, Prince of Wales Hospital and Royal Hospital for Women, Randwick, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
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Sandler C, Goldstein D, Horsfield S, Bennett BK, Friedlander M, Bastick PA, Lewis CR, Segelov E, Boyle FM, Chin MT, Barry BK, Webber K, Lloyd AR. TOPS: A randomised controlled trial of a multidisciplinary intervention for post-cancer fatigue. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.9571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Carolina Sandler
- University of New South Wales, NSW Cancer Survivors Centre, Sydney, Australia
| | - David Goldstein
- Prince of Wales Hospital, University of New South Wales, Cancer Survivors Centre, Sydney, Australia
| | - Sarah Horsfield
- University of New South Wales, NSW Cancer Survivors Centre, Sydney, Australia
| | | | | | | | | | - Eva Segelov
- St. Vincent's Clinic, University of New South Wales, Sydney, Australia
| | - Frances M. Boyle
- University of Sydney and Mater Hospital, North Sydney, Australia
| | | | - Benjamin K Barry
- University of New South Wales, Neuroscience Research Australia, Sydney, Australia
| | - Kate Webber
- Prince of Wales Hospital, University of New South Wales, NSW Cancer Survivors Centre, Sydney, Australia
| | - Andrew R. Lloyd
- University of New South Wales, NSW Cancer Survivors Centre, Sydney, Australia
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Webber K, Bennett BK, Goldstein D, Lloyd AR. Genetic associations of fatigue and other symptom domains after breast cancer treatment: Results from a prospective cohort study. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.9537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kate Webber
- University of New South Wales, Sydney, Australia
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Webber K, Girgis A, Bennett BK, Bonaventura A, Boyle FM, Koh ES, Friedlander M, Segelov E, Goldstein D. The unmet needs of cancer survivors and their preferences for discussing them with oncologists and general practitioners (GPs). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.9602] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9602 Background: Cancer survivors experience a range of post-treatment issues which are not well met by current services. This study explores the unmet needs of adult cancer survivors and their levels of comfort in addressing issues with oncologists and GPs. Methods: A cross-sectional survey was mailed to adult cancer survivors 4 years from diagnosis from 6 oncology units. Self-report data were obtained ranking physical, psychological and practical areas of importance to survivors; unmet needs in these areas; and the providers with whom they were happy to discuss each issue. Descriptive statistics were obtained regarding needs and preferences. Univariate and multivariate logistic regression analyses assessed demographic and clinical variables associated with 4 or more unmet care needs. Results: 228 surveys were returned (response rate 50.5%). Respondents had a mean age of 59.3 years (range 32-87), 71.5% were female, with most common primary cancers being breast (71.5%), colorectal (13.9%), prostate (4.5%) and ovarian (2.2%). The most commonly reported unmet needs were information about late effects (50.3%), managing fatigue (41.7 %), genetic risk to family (34.7%), reassurance (32.0 %) and diet (31.4 %). The median number of unmet needs was 4 (range 0-23). On univariate analysis, female gender, younger age and tertiary education were associated with greater unmet needs (p<0.001, p=0.01 and p=0.02). On multivariate analysis higher education (p=0.04) remained independently associated. Conclusions: Cancer survivors report significant unmet care needs, and their comfort levels for discussing them varies between providers. Some key issues are not entrusted to either oncologists or GPs. Models of care for survivors must address these potential deficits in care. [Table: see text]
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Affiliation(s)
- Kate Webber
- University of New South Wales, Sydney, Australia
| | - Afaf Girgis
- University of New South Wales, Sydney, Australia
| | | | | | | | | | | | - Eva Segelov
- University of New South Wales, Sydney, Australia
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Goldstein D, Bennett BK, Webber K, Lloyd AR. Reply to A. Giacalone et al. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.45.6269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- David Goldstein
- Prince of Wales Hospital; University of New South Wales, Sydney Australia
| | - Barbara K. Bennett
- Prince of Wales Hospital; University of New South Wales, Sydney Australia
| | - Kate Webber
- Prince of Wales Hospital; University of New South Wales, Sydney Australia
| | - Andrew R. Lloyd
- Prince of Wales Hospital; University of New South Wales, Sydney Australia
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Abstract
BACKGROUND Metastatic renal cell cancer is associated with poor prognosis and survival and is resistant to conventional chemotherapy. Therapeutic targeting of molecular pathways for tumour angiogenesis and other specific activation mechanisms offers improved tumour response and prolonged survival. AIMS To conduct a retrospective audit of metastatic renal cell carcinoma patients treated with targeted therapies. METHODS Data were extracted from clinical records of patients undergoing targeted treatment between 2005 and 2009 at two hospital sites. Data collected included pathology, systemic therapy class, toxicity and survival. Univariate and multivariate survival analyses were performed. RESULTS Sixty-one patients were treated with 102 lines of therapy with a median overall survival (OS) of 23 months, median time to failure of first-line treatment (TTF1) of 10 months and median time to failure of second-line treatment (TTF2) of 5.2 months. Time from first diagnosis to treatment >12 months was significantly associated with improved OS, longer TTF1, TTF2 and response to first-line anti-vascular endothelial growth factor receptor tyrosine kinase inhibitors (anti-VEGF TKI) therapy. Variables associated with tumour biology, natural history and the systemic inflammatory response were associated with improved OS and TTF1. Development of hypertension was predictive of anti-VEGF TKI outcome. Toxicities were as expected for each drug class. CONCLUSIONS Survival and toxicity outcomes from two Australian sites are comparable to published data. The adverse event profile differs to conventional chemotherapy. Clinicians caring for patients with metastatic renal cancer will need to become familiar with these toxicities and their management as these agents enter widespread use.
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Affiliation(s)
- K Webber
- Department of Medical Oncology, Prince of Wales Hospital, University of New South Wales, Sydney, Australia.
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Abstract
9044 Background: Because a cancer diagnosis may be regarded as a potentially traumatic event with untoward consequences, much research has focussed on negative aspects of cancer diagnosis and treatment, emphasising psychological outcomes. A recent paradigm shift recognises that such a psycho-pathological approach discounts the human capacity for resilience "the ability to maintain relatively stable functioning following an aversive life event" (Bonanno GA Curr Direct in Psychol Science 2005 14(3) 135). Predictors of resilience in women who recovered uneventfully from surgical and adjuvant treatment for early stage breast cancer were investigated in a prospective study. Methods: Validated self-report measures of mood, somatic symptoms, temperament, illness attitudes, and social support were completed post-surgery. Clinical, tumor and treatment details were recorded. At end treatment and subsequently at 1, 3, 6, 9 and 12 months, self-report measures of mood and somatic symptoms were completed. Resilience was defined as: no evidence of protracted psychological or somatic distress in the 12 months following treatment completion. Identified resilient and non-resilient groups were compared and predictors sought by logistic regression. Results: Of 218 women evaluated, 106 (49%) were classified as "resilient." They either reported no clinically significant psychological or other distress post-surgery (34%) and 12months following adjuvant treatment or recovered promptly (15%) and remained well. There were no significant differences in age (52 years); marital status; tumor size; treatment; treatment toxicity (nadir hemoglobin and neutrophil count) or mortality at 5 years post treatment (8 confirmed deaths in each group). Logistic regression identified low neuroticism (temperament or personality trait) as the most significant predictor of resilience. Conclusions: These findings suggest that without any intervention almost half the women treated for breast cancer adapt well to diagnosis and treatment. These outcomes warrant further research, to provide further insight into how individuals cope with major illness and to facilitate development of programs to aid those in whom outcomes are protracted.
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Goldstein D, Bennett BK, Webber K, Boyle F, de Souza PL, Wilcken NRC, Scott EM, Toppler R, Murie P, O'Malley L, McCourt J, Friedlander M, Hickie IB, Lloyd AR. Cancer-related fatigue in women with breast cancer: outcomes of a 5-year prospective cohort study. J Clin Oncol 2012; 30:1805-12. [PMID: 22508807 DOI: 10.1200/jco.2011.34.6148] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Prolonged and disabling fatigue is prevalent after cancer treatment, but the early natural history of cancer-related fatigue (CRF) has not been systematically examined to document consistent presence of symptoms. Hence, relationships to cancer, surgery, and adjuvant therapy are unclear. PATIENTS AND METHODS A prospective cohort study of women receiving adjuvant treatment for early-stage breast cancer was conducted. Women (n = 218) were enrolled after surgery and observed at end treatment and at 1, 3, 6, 9, and 12 months as well as 5 years. Structured interviews and self-report questionnaires were used to record physical and psychologic health as well as disability and health care utilization. Patients with CRF persisting for 6 months were assessed to exclude alternative medical and psychiatric causes of fatigue. Predictors of persistent fatigue, mood disturbance, and health care utilization were sought by logistic regression. RESULTS The case rate for CRF was 24% (n = 51) postsurgery and 31% (n = 69) at end of treatment; it became persistent in 11% (n = 24) at 6 months and 6% (n = 12) at 12 months. At each time point, approximately one third of the patients had comorbid mood disturbance. Persistent CRF was predicted by tumor size but not demographic, psychologic, surgical, or hematologic parameters. CRF was associated with significant disability and health care utilization. CONCLUSION CRF is common but generally runs a self-limiting course. Much of the previously reported high rates of persistent CRF may be attributable to factors unrelated to the cancer or its treatment.
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Webber K, Mok K, Bennett B, Lloyd AR, Friedlander M, Juraskova I, Goldstein D. If I am in the mood, I enjoy it: an exploration of cancer-related fatigue and sexual functioning in women with breast cancer. Oncologist 2011; 16:1333-44. [PMID: 21835897 DOI: 10.1634/theoncologist.2011-0100] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND We recently reported that cancer-related fatigue (CRF) after adjuvant breast cancer therapy was prevalent and disabling, but largely self-limiting within 12 months. The current paper describes sexual functioning (SF) and its relationship to CRF, mood disorder, and quality of life (QOL) over the first year after completion of adjuvant therapy. METHODS Women were recruited after surgery, but prior to commencing adjuvant treatment, for early-stage breast cancer. Self-reported validated questionnaires assessed SF, CRF, mood, menopausal symptoms, disability, and QOL at baseline, completion of therapy, and at 6 months and 12 months after treatment. RESULTS Of the 218 participants, 92 (42%) completed the SF measure (mean age, 50 years). They were significantly younger, more likely to be partnered, and less likely to be postmenopausal than nonresponders. At baseline, 40% reported problems with sexual interest and 60% reported problems with physical sexual function. SF scores declined across all domains at the end of treatment, then improved but remained below baseline at 12 months, with a significant temporal effect in the physical SF subscale and a trend for overall satisfaction. There were significant correlations between the SF and QOL domains (physical and emotional health, social functioning, and general health) as well as overall QOL. The presence of mood disorder, but not fatigue, demographic, or treatment variables, independently predicted worse overall sexual satisfaction. CONCLUSIONS Sexual dysfunction is common after breast cancer therapy and impacts QOL. Interventions should include identification and treatment of concomitant mood disorder.
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Affiliation(s)
- Kate Webber
- Department of Medical Oncology, Prince of Wales Hospital, High Street, Randwick, New South Wales 2031, Australia.
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38
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Webber K, Mok K, Bennett BK, Juraskova I, Goldstein D, Friedlander M, Lloyd AR. Cancer-related fatigue and sexual functioning in women with early breast cancer: Is there a link? J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.9072] [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: 11/20/2022] Open
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Webber K, Goldstein D, Bennett BK, Boyle FM, De Souza PL, Wilcken N, Friedlander M, Lloyd AR. Influence of fatigue after breast cancer adjuvant therapy on health care utilization and perceived needs. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.9047] [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: 11/20/2022] Open
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Slocum DW, Conway B, Hodgman M, Kuchel K, Moronsk M, Noble R, Webber K, Duraj S, Siegel A, Owen DA. The Potential of π-Bonded Organometallic Polymers in Catalyst Design. ACTA ACUST UNITED AC 2007. [DOI: 10.1080/00222338108082056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- D. W. Slocum
- a Neckers Laboratory Southern Illinois University , Carbondale , IL , 62901
| | - B. Conway
- a Neckers Laboratory Southern Illinois University , Carbondale , IL , 62901
| | - M. Hodgman
- a Neckers Laboratory Southern Illinois University , Carbondale , IL , 62901
| | - K. Kuchel
- a Neckers Laboratory Southern Illinois University , Carbondale , IL , 62901
| | - M. Moronsk
- a Neckers Laboratory Southern Illinois University , Carbondale , IL , 62901
| | - R. Noble
- a Neckers Laboratory Southern Illinois University , Carbondale , IL , 62901
| | - K. Webber
- a Neckers Laboratory Southern Illinois University , Carbondale , IL , 62901
| | - S. Duraj
- a Neckers Laboratory Southern Illinois University , Carbondale , IL , 62901
| | - A. Siegel
- b Department of Chemistry , Indiana State University Terre , Haute , IN , 47809
| | - D. A. Owen
- c Department of Chemistry , Murray State University , Murray , KY , 42071
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Lee HG, Zhu X, O'Neill MJ, Webber K, Casadesus G, Marlatt M, Raina AK, Perry G, Smith MA. The role of metabotropic glutamate receptors in Alzheimer's disease. Acta Neurobiol Exp (Wars) 2004; 64:89-98. [PMID: 15190683 DOI: 10.55782/ane-2004-1494] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2023]
Abstract
While glutamatergic transmission is severely altered by early degeneration of cortico-cortical connections and hippocampal projections in Alzheimer's disease (AD), the role of glutamate receptors in the pathogenesis of AD is not yet defined clearly. Nonetheless, as reviewed here, the topographical distribution of different types of receptors likely contributes to the regional selective nature of neuronal degeneration. In particular, metabotropic glutamate receptors (mGluR) may contribute the pathogenesis of many neurological conditions and also regulate neuronal vulnerability against cytotoxic stress. Thus, we here discuss the possible role of mGluR in the pathogenesis of AD based on the results from other neurodegenerative diseases that may give us clues to solve the mysterious selective neurodegeneration evident in AD.
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Affiliation(s)
- Hyoung-Gon Lee
- Institute of Pathology, Case Western Reserve University, 2085 Adelbert Road, Cleveland, Ohio 44106, USA
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Thompson T, Webber K, Montgomery I. Performance and persistence of worriers and non-worriers following success and failure feedback. Personality and Individual Differences 2002. [DOI: 10.1016/s0191-8869(01)00076-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Pai-Scherf LH, Carrasquillo JA, Paik C, Gansow O, Whatley M, Pearson D, Webber K, Hamilton M, Allegra C, Brechbiel M, Willingham MC, Pastan I. Imaging and phase I study of 111In- and 90Y-labeled anti-LewisY monoclonal antibody B3. Clin Cancer Res 2000; 6:1720-30. [PMID: 10815890] [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] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
B3 is a murine monoclonal antibody (mAb) that recognizes a LewisY carbohydrate antigen present on the surface of many carcinomas. An imaging and Phase I trial was performed to study the ability of 111In-mAb B3 to image known metastasis and determine the maximum tolerated dose (MTD), dose-limiting toxicity (DLT), kinetics, and biodistribution of 90Y-mAb B3. Patients (n = 26) with advanced epithelial tumors that express the LewisY antigen were entered. All patients received 5 mCi of 111In-mAb B3 for imaging. 90Y-mAb B3 doses were escalated from 5 to 25 mCi in 5-mCi increments. 111In-mAb B3 and 90Y-mAb B3 were coadministered over a 1-h infusion. Definite tumor imaging was observed in 20 of 26 patients. Sites imaged included lung, liver, bone, and soft tissues. The MTD of 90Y-mAb B3 was determined to be 20 mCi. The DLTs were neutropenia and thrombocytopenia. Tumor doses ranged from 7.7 to 65.1 rad/mCi. 111In- and 90Y-mAb B3 serum pharmacokinetics (n = 23) were found to be similar. The amount of B3 administered (5, 10, and 50 mg) did not alter the pharmacokinetics. Bone marrow biopsies (n = 23) showed 0.0038+/-0.0016% of injected dose/gram for 111In-mAb B3 compared to 0.0046+/-0.0017% of injected dose/gram for 90Y-mAb B3 (P = 0.009). When given to patients with carcinomas that express the LewisY antigen, 111In-mAb B3 demonstrated good tumor localization. The MTD of 90Y-mAb B3 is 20 mCi, with myelosuppression as the DLT. Higher doses of radioactivity need to be delivered to achieve an antitumor effect. Humanized mAb B3 is being developed for evaluation in radioimmunotherapy. A clinical trial to explore the use of higher doses of 90Y-mAb B3 with autologous stem cell support is planned.
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Affiliation(s)
- L H Pai-Scherf
- Laboratory of Molecular Biology, National Cancer Institute, NIH, Bethesda, Maryland 20892-4255, USA
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Matthews K, Webber K, McKim E, Banoub-Baddour S, Laryea M. Maternal infant-feeding decisions: reasons and influences. Can J Nurs Res 1998; 30:177-98. [PMID: 9807295] [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] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
The purpose of this prospective longitudinal study was to determine the reasons for and influences on mothers' infant-feeding decisions over the 6 months post-birth. The breastfeeding initiation rate of 41.7% had declined to 11.4% at 6 months. The major reasons for not choosing breastfeeding were embarrassment and discomfort with the idea. Younger, less-educated mothers with lower incomes were less likely to start breastfeeding, more likely to discontinue breastfeeding early, and more likely to feed their babies cheaper evaporated milks. Mothers gave up breastfeeding early because it was too difficult or because they were returning to work. Reasons given by both breastfeeding and bottle-feeding mothers for switching milks were that the baby was "not satisfied" on the milk or that it was "not agreeing with" the baby. Generally, the social network, rather then health professionals, had greater influence on mothers' decisions.
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Affiliation(s)
- K Matthews
- School of Nursing, Memorial University of Newfoundland, St. John's
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Brinkmann U, Webber K, Di Carlo A, Beers R, Chowdhury P, Chang K, Chaudhary V, Gallo M, Pastan I. Cloning and expression of the recombinant FAb fragment of monoclonal antibody K1 that reacts with mesothelin present on mesotheliomas and ovarian cancers. Int J Cancer 1997; 71:638-44. [PMID: 9178820 DOI: 10.1002/(sici)1097-0215(19970516)71:4<638::aid-ijc21>3.0.co;2-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The monoclonal antibody (MAb) K1 recognizes an approximate 40 kDa glycoprotein, mesothelin, that is present on the surface of human mesothelial cells, mesotheliomas and ovarian cancers. We have cloned the cDNAs encoding the variable regions of MAb K1 and constructed plasmids for expression of recombinant K1(FAb). Recombinant FAb was produced in Escherichia coli in inclusion bodies that were solubilized and refolded to active protein. Binding of K1 MAb and FAb was compared by radioactive binding and competition assays and by surface plasmon resonance (BIAcore). Recombinant K1(FAb) binds to cells expressing K1-antigen with a similar affinity as papain derived FAb from K1(IgG) and with a 4- to 10-fold reduced affinity compared with bivalent IgG. The cloned FAb can be used to make higher affinity antibodies and immunoconjugates that could be useful for various types of immunotherapies.
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Affiliation(s)
- U Brinkmann
- Laboratory of Molecular Biology, NCI, NIH, Bethesda, MD 20892-4255, USA
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Matthews MK, Webber K, McKim E, Banoub-Baddour S, Laryea M. Infant feeding practices in Newfoundland and Labrador. Can J Public Health 1995; 86:296-300. [PMID: 8556673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- M K Matthews
- School of Nursing, Memorial University of Newfoundland, St. John's
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Segatore M, Miller M, Webber K. Medication out of control? Can Nurse 1994; 90:35-39. [PMID: 7923035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Jackson T, Murray S, Webber K. Meeting the challenge of critical care nursing. Dimens Health Serv 1981; 58:20-1. [PMID: 7286478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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