Showing papers by "Haryana M. Dhillon published in 2018"
TL;DR: Self-reported cognitive function and its associations with neuropsychological tests and patient-reported outcomes in adult cancer patients who received chemotherapy treatment for a solid cancer is evaluated.
Abstract: Cognitive symptoms are common in cancer patients, with up to 70% reporting cognitive symptoms following chemotherapy. These symptoms can have a major impact on how an individual functions in all aspects of their lives. This review evaluates self-reported cognitive function and its associations with neuropsychological tests and patient-reported outcomes in adult cancer patients who received chemotherapy treatment for a solid cancer. A search of multiple databases (Medline, Ovid at Nursing, PsycINFO, Allied and Complementary Medicine) from 1936 to 2017 was conducted, identifying 1563 unique articles, of which 101 met inclusion criteria. Of the 101 included studies, 48 (47%) were cross-sectional and 38 (38%) longitudinal in design, with 12 (12%) randomised controlled trials. A minority (26%) incorporated a healthy control arm in the study design, whilst the majority (79%) were in women with breast cancer. There was diversity in the assessment of self-reported cognitive symptoms. A total of 43 of 44 studies that sought an association between self-reported cognitive function and patient-reported outcomes found a moderate to strong association. Overall, 31 studies showed a lack of association between self-reported cognitive symptoms and neuropsychological results, whilst 14 studies reported a significant association between the two, but the association was often restricted to limited cognitive domains. The review found widespread heterogeneity in the assessment of self-reported cognitive symptoms and consistently absent or weak association with neuropsychological test scores. This research highlights the need for a standardised approach to measurement of self-reported cognitive symptoms in cancer patients.
96 citations
TL;DR: Clinical recommendations for how to engage men in psychological treatments including paying attention to tapping the strengths of multiple masculinities coexisting within and across men are presented.
Abstract: Tailoring psychological treatments to men's specific needs has been a topic of concern for decades given evidence that many men are reticent to seek professional health care. However, existing literature providing clinical recommendations for engaging men in psychological treatments is diffuse. The aim of this scoping review was to provide a comprehensive summary of recommendations for how to engage men in psychological treatment. Four electronic databases (MEDLINE, PubMed, CINAHL, PsycINFO) were searched for articles published between 2000 and 2017. Titles and abstracts were reviewed; data extracted and synthesized thematically. Of 3,627 citations identified, 46 met the inclusion criteria. Thirty articles (65%) were reviews or commentaries; 23 (50%) provided broad recommendations for working with all men. Findings indicate providing male-appropriate psychological treatment requires clinicians to consider the impact of masculine socialization on their client and themselves, and how gender norms may impact clinical engagement and outcomes. Existing literature also emphasized specific process micro-skills (e.g., self-disclosure, normalizing), language adaption (e.g., male-oriented metaphors) and treatment styles most engaging for men (e.g., collaborative, transparent, action-oriented, goal-focused). Presented are clinical recommendations for how to engage men in psychological treatments including paying attention to tapping the strengths of multiple masculinities coexisting within and across men. Our review suggests more empirically informed tailored interventions are needed, along with formal program evaluations to advance the evidence base.
90 citations
TL;DR: In the wake of government-funded campaigns across many Western nations that have sought to address this, not all men are reticent in seeking help for mental health concerns as mentioned in this paper, and it is well understood that men tend to be reticent to seek help.
Abstract: It is well understood that men are reticent in seeking help for mental health concerns. In the wake of government-funded campaigns across many Western nations that have sought to address this, noti...
80 citations
TL;DR: The authors explored Australian men's experiences with treatment for major depressive disorder and found that many men are reticent to seek and sustain psychotherapy, while the prevalence of depression continues to rise.
Abstract: While the prevalence of major depressive disorder continues to rise, many men are reticent to seek and sustain psychotherapy. The current study explored Australian men's experiences with treatment ...
69 citations
TL;DR: A scoping review of literature from MEDLINE, Embase, Scopus and hand searches found no effect of fast-track interventions on reducing time intervals, and explored barriers and facilitators to timely care.
Abstract: Earlier access to lung cancer specialist (LCS) care improves survival, highlighting the need for streamlined patient referral. International guidelines recommend 14-day maximum time intervals from general practitioner (GP) referral to first LCS appointment (“GP–LCS interval”), and diagnosis to treatment (“treatment interval”). We compared time intervals in lung cancer care against timeframe benchmarks, and explored barriers and facilitators to timely care. We conducted a scoping review of literature from MEDLINE, Embase, Scopus and hand searches. Primary end-points were GP–LCS and treatment intervals. Performance against guidelines and factors responsible for delays were explored. We used descriptive statistics and nonparametric Wilcoxon rank sum tests to compare intervals in studies reporting fast-track interventions. Of 1343 identified studies, 128 full-text articles were eligible. Only 33 (26%) studies reported GP–LCS intervals, with an overall median of 7 days and distributions largely meeting guidelines. Overall, 52 (41%) studies reported treatment intervals, with a median of 27 days, and distributions of times falling short of guidelines. There was no effect of fast-track interventions on reducing time intervals. Lack of symptoms and multiple procedures or specialist visits were suggested causes for delay. Although most patients with lung cancer see a specialist within a reasonable timeframe, treatment commencement is often delayed. There is regional variation in establishing timeliness of care.
50 citations
TL;DR: Efficacious, timely and acceptable psychological interventions are a necessary component of comprehensive cancer care and there is some way to go before the evidence conclusively points towards which interventions work for which cancer groups and for which specific outcomes.
Abstract: Purpose of review Psychological distress and mental health comorbidity are common in cancer. Various therapeutic frameworks have been used for interventions to improve psychological wellbeing and quality of life in cancer patients with mixed results. This article reviews contributions to that literature published since January 2017. Recent findings The majority of new psychological intervention research in cancer has used cognitive behavioural therapy (CBT) or mindfulness-based interventions. CBT has been considered a gold-standard intervention and recent evidence justifies continuation of this. Recent reviews call into question the validity of evidence for mindfulness-based interventions. A smaller number of trials using acceptance and commitment therapy, meta-cognitive therapy, dignity therapy and coaching have emerged, and whereas findings are promising, additional fully powered trials are required. Weaker evidence exists for counselling, support-based and narrative therapy interventions. Summary Efficacious, timely and acceptable psychological interventions are a necessary component of comprehensive cancer care. There is some way to go before the evidence conclusively points towards which interventions work for which cancer groups and for which specific outcomes. Methodological limitations must be addressed in future trials; at the forefront remains the need for fully powered, head-to-head comparison trials.
48 citations
TL;DR: Cognitive symptoms were greatest in those who received chemotherapy, with no significant difference between the non-chemotherapy survivors and healthy controls, and a weak-moderate association was found between PCA and attention/executive function and visual memory.
Abstract: Cognitive symptoms are common after cancer, but poorly associated with neuropsychological results. We previously reported colorectal cancer (CRC) patients had more cognitive impairment than controls. Here, we explore relationships between cognitive symptoms and neuropsychological domains. Subjects with CRC (N = 362) and 72 healthy controls completed neuropsychological assessments and Functional Assessment of Cancer Therapy-Cognition (FACT-COG) at baseline (pre-chemotherapy) and 6, 12, and 24 months. Associations between neuropsychological and FACT-COG scores were explored: perceived cognitive impairment (PCI), perceived cognitive ability (PCA), impact of PCI on quality of life (CogQOL). Of 362 CRC subjects, 289 had loco-regional disease and 173 received chemotherapy (CTh+). At baseline, groups did not differ on total FACT-COG, PCI, or PCA scores. All scores, except PCA, were worse at 6 months in CTh+. CRC patients not receiving chemotherapy did not differ from controls on FACT-COG domains. PCA associated weakly (r = 0.28–0.34) with attention/executive function, visual memory, and global deficit score. There was no association between PCI and neuropsychological domains. Fatigue, anxiety/depression, and poorer quality of life were associated with PCI and CogQOL (r = 0.44–0.51) in CRC patients. No association was seen between total FACT-COG or PCI, and neuropsychological domains. A weak-moderate association was found between PCA and attention/executive function and visual memory. The study was registered with clinicaltrials.gov
(trial registration: NCT00188331). Cognitive symptoms are associated with fatigue, anxiety/depression, and poorer quality of life, and do not appear to be related to actual cognitive performance. Rates were lower than that reported in breast cancer survivors. Cognitive symptoms were greatest in those who received chemotherapy, with no significant difference between the non-chemotherapy survivors and healthy controls.
40 citations
TL;DR: This is the first cluster randomised trial to establish optimal levels of implementation effort and associated costs to achieve successful uptake of a clinical pathway within cancer care and compares the clinical and cost effectiveness of two implementation strategies.
Abstract: Health service change is difficult to achieve. One strategy to facilitate such change is the clinical pathway, a guide for clinicians containing a defined set of evidence-based interventions for a specific condition. However, optimal strategies for implementing clinical pathways are not well understood. Building on a strong evidence-base, the Psycho-Oncology Co-operative Research Group (PoCoG) in Australia developed an evidence and consensus-based clinical pathway for screening, assessing and managing cancer-related anxiety and depression (ADAPT CP) and web-based resources to support it - staff training, patient education, cognitive-behavioural therapy and a management system (ADAPT Portal). The ADAPT Portal manages patient screening and prompts staff to follow the recommendations of the ADAPT CP. This study compares the clinical and cost effectiveness of two implementation strategies (varying in resource intensiveness), designed to encourage adherence to the ADAPT CP over a 12-month period. This cluster randomised controlled trial will recruit 12 cancer service sites, stratified by size (large versus small), and randomised at site level to a standard (Core) versus supported (Enhanced) implementation strategy. After a 3-month period of site engagement, staff training and site tailoring of the ADAPT CP and Portal, each site will “Go-live”, implementing the ADAPT CP for 12 months. During the implementation phase, all eligible patients will be introduced to the ADAPT CP as routine care. Patient participants will be registered on the ADAPT Portal to complete screening for anxiety and depression. Staff will be responsible for responding to prompts to follow the ADAPT CP. The primary outcome will be adherence to the ADAPT CP. Secondary outcomes include staff attitudes to and experiences of following the ADAPT CP, using the ADAPT Portal and being exposed to ADAPT implementation strategies, collected using quantitative and qualitative methods. Data will be collected at T0 (baseline, after site engagement), T1 (6 months post Go-live) and T2 (12 months post Go-live). This will be the first cluster randomised trial to establish optimal levels of implementation effort and associated costs to achieve successful uptake of a clinical pathway within cancer care. The study was registered prospectively with the ANZCTR on 22/3/2017. Trial ID ACTRN12617000411347
30 citations
TL;DR: Empirical cumulative distribution functions of change in FACT-Cog demonstrating possible MCTs showed that anchor change of none, minimally better and much better were well separated and can help in the design, analysis and interpretation of self-reported cognitive function in cancer patients and survivors.
Abstract: We estimated clinically important, group-level differences in self-reported cognitive function for the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) instrument. We also investigated individual level change that could be considered meaningful for cancer survivors affected by cognitive impairment following chemotherapy, and that could be used for responder analyses. We used data from a multi-site randomized controlled trial in 242 participants that evaluated a web-based intervention for improving self-reported cognitive functioning in adult cancer survivors who reported cognitive impairment and who had adjuvant chemotherapy in the previous 6–60 months. We used anchor and distribution methods to estimate a range of clinically important differences (CIDs) and investigated meaningful change thresholds (MCTs) for the FACT-Cog and the Perceived Cognitive Impairments (PCI) subscale, post-intervention and at six-month follow-up with empirical cumulative distribution functions. Our primary anchor was the patient reported cognitive function subscale of the European Organization for Research and Treatment of Cancer Quality of Life-Cognitive Functioning Scale (EORTC-CF). Most participants were female (95%) breast cancer survivors (89%). Correlation of changes in the FACT-Cog and the EORTC-CF were 0.55 post-intervention and 0.61 at follow-up. Anchor-based CID estimates for the FACT-Cog using our primary anchor were 11.3 points (post) and 8.8 (follow-up), which corresponds to a standardized effect size of 0.49 and 0.38; 8.6% and 6.6% of the total scale’s range. Anchor-based CID estimates for the FACT-Cog PCI subscale were 7.4 (post) and 4.6 points (follow-up), which corresponds to a standardized effect size of 0.50 and 0.31; 10.3% and 6.4% of the PCI range). Empirical cumulative distribution functions of change in FACT-Cog demonstrating possible MCTs showed that anchor change of none, minimally better and much better were well separated. The CID and MCT estimates from this manuscript can help in the design, analysis and interpretation of self-reported cognitive function in cancer patients and survivors.
29 citations
TL;DR: Oral treatment with low-dose aspirin completely blocked tumor-induced memory impairment without affecting tumor- induced sickness or tumor growth, demonstrating a causal role for inflammation in cognitive impairment and suggesting that anti-inflammatories may be a safe and readily translatable strategy that could be used to prevent cancer-associated cognitive impairment in patients.
Abstract: Cancer patients with non-central nervous system tumors often suffer from cognitive impairment. While chemotherapy has long been attributed as the cause of these memory, learning and concentration difficulties, we recently observed cognitive impairment in cancer patients prior to treatment. This suggests the cancer alone may be sufficient to induce cognitive impairment, however the mechanisms are unknown. Here, we show that we can experimentally replicate the clinical phenomenon of cancer-associated cognitive impairment and we identify inflammation as a causal mechanism. We demonstrate that a peripheral tumor is sufficient to induce memory loss. Using an othotopic mouse model of breast cancer, we found that mice with 4T1.2 or EO771 mammary tumors had significantly poorer memory than mice without tumors. Memory impairment was independent of cancer-induced sickness behavior, which was only observed during the later stage of cancer progression in mice with high metastatic burden. Tumor-secreted factors were sufficient to induce memory impairment and pro-inflammatory cytokines were elevated in the plasma of tumor-bearing mice. Oral treatment with low-dose aspirin completely blocked tumor-induced memory impairment without affecting tumor-induced sickness or tumor growth, demonstrating a causal role for inflammation in cognitive impairment. These findings suggest that anti-inflammatories may be a safe and readily translatable strategy that could be used to prevent cancer-associated cognitive impairment in patients.
29 citations
TL;DR: The FACT-Cog can be used in populations other than cancer patients, with modifications to the scoring system, and it is worth considering scoring specific cognitive domains separately.
TL;DR: This study adds to existing evidence that health is an engaging topic for adult learners, and health literacy can be successfully implemented in an adult basic learning curriculum to empower learners to better manage their health.
Abstract: Adults with low literacy are less empowered to take care of their health, have poorer health outcomes and higher healthcare costs We facilitated partnerships between adult literacy teachers and community health providers to deliver a health literacy training program in adult basic education classrooms Following course completion we interviewed 19 adult education teachers (15 delivering the health literacy program; 4 delivering standard literacy classes) and four community health providers (CHPs) about their experiences, and analysed transcripts using Framework analysis Written feedback from eight teachers on specific course content was added to the Framework Health literacy teachers reported a noticeable improvement in their student's health behaviours, confidence, vocabulary to communicate about health, understanding of the health system and language, literacy and numeracy skills CHP participation was perceived by teachers and CHPs as very successful, with teachers and CHPs reporting they complemented each other's skills The logistics of coordinating CHPs within the constraints of the adult education setting was a significant obstacle to CHP participation This study adds to existing evidence that health is an engaging topic for adult learners, and health literacy can be successfully implemented in an adult basic learning curriculum to empower learners to better manage their health Health workers can deliver targeted health messages in this environment, and introduce local health services Investment in adult literacy programs teaching health content has potential both to meet the goals of adult language and literacy programs and deliver health benefit in vulnerable populations
TL;DR: Use of GEEs are demonstrated to analyze PROs with missing data in randomized trials with assessments at fixed time points in Psycho‐oncology researchers.
Abstract: OBJECTIVE Patient reported outcomes (PROs) are important in oncology research; however, missing data can pose a threat to the validity of results. Psycho-oncology researchers should be aware of the statistical options for handling missing data robustly. One rarely used set of methods, which includes extensions for handling missing data, is generalized estimating equations (GEEs). Our objective was to demonstrate use of GEEs to analyze PROs with missing data in randomized trials with assessments at fixed time points. METHODS We introduce GEEs and show, with a worked example, how to use GEEs that account for missing data: inverse probability weighted GEEs and multiple imputation with GEE. We use data from an RCT evaluating a web-based brain training for cancer survivors reporting cognitive symptoms after chemotherapy treatment. The primary outcome for this demonstration is the binary outcome of cognitive impairment. Several methods are used, and results are compared. RESULTS We demonstrate that estimates can vary depending on the choice of analytical approach, with odds ratios for no cognitive impairment ranging from 2.04 to 5.74. While most of these estimates were statistically significant (P < 0.05), a few were not. CONCLUSIONS Researchers using PROs should use statistical methods that handle missing data in a way as to result in unbiased estimates. GEE extensions are analytic options for handling dropouts in longitudinal RCTs, particularly if the outcome is not continuous.
Journal Article•
TL;DR: In this paper, the authors reviewed the evidence for the putative mechanisms of CRCI by examining clinical and preclinical models, primarily those associated with chemotherapy and discussed pharmacologic and nonpharmacologic options for treating CRCI based on the best evidence available.
Abstract: Up to 70% of survivors of adult-onset, non-central nervous system (CNS) solid tumors report cognitive symptoms, and approximately 30% have impairment on formal neuropsychological testing. The etiology of the impairment is unknown. There is a lack of robust evidence on how to prevent or treat cancer-related cognitive impairment (CRCI). Here, we review the evidence for the putative mechanisms of CRCI by examining clinical and preclinical models, primarily those associated with chemotherapy. Pharmacologic and nonpharmacologic options for treating CRCI are discussed based on the best evidence available. Practical clinical advice for health professionals managing patients with CRCI is also provided.
TL;DR: The aim of this review was to critically appraise mindfulness intervention reporting and study methodology.
Abstract: Objectives While mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) have demonstrated efficacy in clinical populations, the potential therapeutic benefit of mindfulness in the context of cancer is less clear. The aim of this review was to critically appraise mindfulness intervention reporting and study methodology. Methods Studies using randomized control trial design and/or a control arm were included. PubMed, Medline, PsycINFO, CINAHL, and Embase databases between January 1999 and April 2017 were searched. Studies were assessed on (1) reported theoretical framework, (2) intervention description, and (3) justification of modifications to standardized MBSR/MBCT. The overall quality of study design and research methodology were also assessed. Results Of 30 studies identified, none adhered to MBSR. Modified versions of MBSR were reported in 19 studies. Five studies reported variants of MBCT, 1 used a combination of MBSR/MBCT, and 5 inadequately documented the intervention/ theoretical framework. Overall, component and timeline modifications were poorly documented and justified. Mean intervention contact time was less than standardized MBSR/MBCT protocols. Target outcomes were poorly justified, and 12 studies failed to identify a primary aim, reporting multiple outcomes. Only 9 of 15 studies recruiting clinical populations included clinical cutoffs, and an active therapeutic control was included in 4 studies. Conclusions Mindfulness is increasingly considered a standard therapy in psycho-oncology. While many studies proclaim benefits, considerable variability, modification to standardized protocols, and claims of benefit often reflect decreases in sub-clinical supportive care symptomology rather than therapeutic relief of clinically significant psychological disorders.
TL;DR: HNC patients who are either tertiary educated or female are more likely to prefer active involvement in decision-making, and psychological distress is more likely in patients actively involved in decision making, younger patients, and in females.
21 Dec 2018
TL;DR: The portal developed to support patients with cancer to increase daily physical activity levels was feasible for use by people with a history of cancer and was found to be acceptable by participants.
Abstract: Background: Physical activity levels typically decline during cancer treatment and often do not return to prediagnosis or minimum recommended levels. Interventions to promote physical activity are needed. Support through the use of digital health tools may be helpful in this situation. Objective: The goal of the research was to evaluate the feasibility, usability, and acceptability of an interactive Web portal developed to support patients with cancer to increase daily physical activity levels. Methods: A Web portal for supportive cancer care which was developed to act as a patient-clinician information and coaching tool focused on integrating wearable device data and remote symptom reporting. Patients currently receiving or who had completed intensive anticancer therapy were recruited to 3 cohorts. All cohorts were given access to the Web portal and an activity monitor over a 10-week period. Cohort 2 received additional summative messaging, and cohort 3 received personalized coaching messaging. Qualitative semistructured interviews were completed following the intervention. The primary outcome was feasibility of the use of the portal assessed as both the number of log-ins to the portal to record symptoms and the completion of post-program questionnaires. Results: Of the 49 people were recruited, 40 completed the intervention. Engagement increased with more health professional contact and was highest in cohort 3. The intervention was found to be acceptable by participants. Conclusions: The portal was feasible for use by people with a history of cancer. Further research is needed to determine optimal coaching methods.
01 Feb 2018
TL;DR: None of the a priori selected markers of inflammation, fatigue or cognitive function was associated with OS or DFS in this cohort of patients.
Abstract: Background Inflammation promotes the development of malignancy, while a variety of systemic markers of inflammation predict for worse cancer outcomes including recurrence and survival. Here, we evaluate the prognostic impact of cytokine concentrations, full blood count (FBC) differential ratios, cognitive function and fatigue on survival in patients with localised colorectal cancer (CRC). Patients and methods Data are from a prospective longitudinal study comparing cognitive function and fatigue in patients with CRC who did (n=173) and did not (n=116) receive adjuvant/neoadjuvant chemotherapy. Baseline blood results (prior to any chemotherapy) included cytokines and FBC from which neutrophil lymphocyte ratio, lymphocyte monocyte ratio, platelet lymphocyte ratio and platelet monocyte ratio were derived. Fatigue was measured with the Functional Assessment of Cancer Therapy-Fatigue subscale and cognitive function by a neuropsychological test battery. Kaplan-Meier methods were used to estimate disease-free survival (DFS) and overall survival (OS). Univariable and multivariable Cox regression analyses were performed to evaluate factors potentially prognostic of outcomes. Results At a median follow-up of 91.2 months, 227 subjects (79%) are still alive, and 212 (73%) have no evidence of a recurrence. Five-year OS and DFS are 86% (95% CI 81% to 90%) and 77% (95% CI 71% to 82%), respectively. None of the cytokines (interleukin (IL-6), IL-1 and tumour necrosis factor) or differential ratios of blood components, fatigue or cognitive function was statistically related to DFS or OS. Patient educational status (P=0.018), stage of disease (P=0.032), alanine transaminase (P=0.003), lactate dehydrogenase (P=0.008) and carcinoembryonic antigen (P=0.002) were significant as prognostic covariates of OS in univariable analyses, with similar results for DFS. Conclusion None of the a priori selected markers of inflammation, fatigue or cognitive function was associated with OS or DFS in this cohort of patients. Trial registration number NCT00188331, Post-results.
TL;DR: Preclinical research has confirmed that a number of chemotherapy agents are toxic to neural progenitor cells and oligodendrocytes, indicating that potential for neural recovery may be diminished.
Abstract: Ahles and Hurria's excellent review elucidates the problem of cognitive impairment associatedwith cancer and its importance for cancer patients, their families, clinicians, and the broader community. Studies suggest that up to 70% of early stage breast cancer patients experience cognitive symptoms during treatment, often persisting months to years after cancer treatment ends. In formal clinical neuropsychological testing, rates of cognitive impairment vary, but most studies report impairment rates of approximately 30%. Incidence of impairment varies depending on tumor type, treatment modalities received (including chemotherapy regimen and dose intensity), time from diagnosis, study design, type of cognitive assessment, definition of cognitive impairment, and analytical methods used. Formost patients, impairments are subtle, with executive functioning, memory, and processing speed commonly affected. With the original studies being cross‐sectional in design in patients who had previously received chemotherapy, and patients receiving chemotherapy treatment reporting cognitive changes to their treating doctors, it was hypothesized that cognitive impairment was a direct toxicity of chemotherapy. In support of this hypothesis, animal models have shown that a number of common chemotherapy agents cause cognitive impairment in rodents and that the cognitive domains affected are the same as seen in clinical studies. Preclinical research has confirmed that a number of chemotherapy agents are toxic to neural progenitor cells and oligodendrocytes, indicating that potential for neural recovery may be diminished. Numerous studies have shown greater cognitive decline over time in cancer patients who received chemotherapy compared with those who did not. Neuroimaging studies have confirmed changes in gray matter volume, white matter integrity, and functional connectivity in breast cancer survivors who received chemotherapy compared with those who did not or compared with noncancer controls.
TL;DR: Rural and metropolitan NSW patients face comparable time lines to diagnosis and treatment of lung cancer, but transition through Secondary Care and addressing patient expectations could be improved.
Abstract: Introduction:Earlier access to lung cancer specialist (LCS) care improves survival. We examined times to diagnosis and treatment of patients with lung cancer in rural and metropolitan New South Wal...
TL;DR: Radiation therapists have daily contact with patients and can provide daily psychosocial support to reduce patient anxiety, fear and loneliness, however, RTs vary in their values, skills, training, knowledge and involvement in providing psychossocial support.
Abstract: Introduction Up to one third of radiation therapy patients are reported to have unmet psychosocial needs. Radiation therapists (RTs) have daily contact with patients and can provide daily psychosocial support to reduce patient anxiety, fear and loneliness. However, RTs vary in their values, skills, training, knowledge and involvement in providing psychosocial support. The aims of this study were to: (1) develop an online survey instrument to explore RT values, skills, training and knowledge regarding patient anxiety and psychosocial support, and (2) pilot the instrument with RT professionals to assess content validity, functionality and length. Method An online cross-sectional survey, titled 'Radiation therapists and psychosocial support' was developed. Items included patient vignettes, embedded items from RT research, and the Professional Quality of Life Scale (ProQOL5). Four radiation oncology departments volunteered to pilot the survey; each nominated four RT staff to participate. Survey data were analysed descriptively and qualitative feedback grouped and coded to determine whether the survey needed to be refined. Results Thirteen of sixteen RTs completed the pilot survey and feedback form. Median time to completion was 35 mins, with 54% of respondents stating this was too long. Respondents reported content, questions and response options were relevant and appropriate. Feedback was used to: refine the survey instrument, minimise responder burden and drop out and improve functionality and quality of data collection. Conclusion This pilot of the 'Radiation therapists and psychosocial support' survey instrument demonstrated content validity and usability. The main survey will be circulated to a representative sample of RTs for completion.
TL;DR: In this article, a 21-item survey of Australian healthcare professionals evaluating patient waiting times to diagnosis and treatment of lung cancer was distributed through two Australian conferences, a national multidisciplinary team directory and email, with a total of 135 responses obtained from HCP working in secondary healthcare who had recent clinical experience treating lung cancer patients.
Abstract: Background Streamlined referral to specialist care impacts lung cancer outcomes. Aim To examine Australian healthcare professionals' (HCP) perceptions of the timeliness of pathways to diagnosis and treatment for people with lung cancer, compared against timeframe guidelines. Methods A 21-item survey of HCP evaluating patient waiting times to diagnosis and treatment of lung cancer was distributed through two Australian conferences, a national Multidisciplinary Team directory and email. Main outcome measures were HCP estimates of actual and acceptable waiting times in their practice and factors contributing to perceived delays. Results A total of 135 responses was obtained from HCP working in secondary healthcare who had recent clinical experience treating lung cancer patients. While 79% believed a diagnosis of lung cancer should be obtained within 14 days of first clinical suspicion, only 56% estimated that this occurred in their practice due mainly to delays in primary care. Most HCP (81%) estimated that patients receive treatment within 28 days of seeing a specialist, but 28% believed a wait of >14 days to treatment was a 'delay', generally due to resource limitations. In general, most HCP estimates of time spent in primary care were longer than those in the literature, while estimates for secondary care were shorter. Conclusions Australian HCP treating lung cancer patients perceive a mismatch between acceptable and estimated waiting times to diagnosis and treatment of lung cancer due to patient, provider and system factors. If perceived delays are justified, it is unclear whether HCP overestimate times spent by patients in primary care or underestimate delays in secondary care. Variations in HCP expectations need to be addressed.
TL;DR: The Web portal evaluated in this study will provide a system to monitor physical activity and sleep, for use by both clinician and patient, along with symptom and health-related quality of life tracking capabilities.
Abstract: Background: Significant benefits accrue from increasing physical activity levels in people with a history of cancer. Physical activity levels can be increased using behavioral change interventions in this population. Access to Web portals and provision of activity monitors to provide feedback may support behavior change by encouraging patient engagement in physical therapy. The Web portal evaluated in this study will provide a system to monitor physical activity and sleep, for use by both clinician and patient, along with symptom and health-related quality of life tracking capabilities. Objective: The aim of this study was to outline a protocol for a feasibility study focused on a Web-based portal that provides activity monitoring and personalized messaging to increase physical activity in people with cancer. Methods: Using a longitudinal cohort design, people with cancer will be serially allocated to 3 intervention cohorts of 20 participants each and followed for 10 weeks. Cohort 1 will be provided a wearable activity monitor and access to a Web-based portal. Cohort 2 will receive the same content as Cohort 1 and in addition will receive a weekly activity summary message. Cohort 3 will receive the same content as Cohorts 1 and 2 and in addition will receive a personalized weekly coaching message. Feasibility of the use of the portal is the primary outcome. Results: Results are expected in early 2018. Outcome measures will include goal attainment and completion rate. Conclusions: This study will provide information about the feasibility of investigating eHealth initiatives to promote physical activity in people with cancer. Registered Report Identifier: RR1-10.2196/9586
TL;DR: Australian clinicians’ perceptions of currently used HNC information resources were determined and it was found that patients with head and neck cancer believe that appropriate educational resources should be provided to them.
Abstract: Background Providing appropriate educational resources to patients with head and neck cancer (HNC) is important but challenging. The aim of this study was to determine Australian clinicians' perceptions of currently used HNC information resources. Methods A purpose-designed questionnaire was disseminated electronically to clinician members of the Australian and New Zealand Head and Neck Cancer Society (ANZHNCS) and The Australian Society of Otolaryngology Head and Neck Surgery (ASOHNS). Results Of the 648 clinicians invited, 112 responded to the survey (17.3% response rate). Overall, 85% utilized written information as their primary mode of patient education and 49% received information on treatment details. Areas for improvement include information provision, pain management, emerging risk factors, survivorship and side effects. The majority (66%) of clinicians had a preference for internet patient education materials. Conclusions Clinicians predominantly utilized written HNC information rather than multimedia or interactive resources. However, they expressed the desire to be able to deliver HNC information resources via an internet-based platform covering the psychosocial effects of treatment.