Using Single Patient Trials To Determine The Effectiveness Of Psychostimulants In Fatigue In Advanced Cancer Patients
Funder
National Health and Medical Research Council
Funding Amount
$162,563.00
Summary
The lack of good evidence in palliative care (PC) is widely acknowledged but research in PC is difficult. Methodological barriers include: difficulties in recruitment, high rates of attrition, problems with maintaining distinct and sustainable intervention strategies, poorly chosen outcomes and opposition to randomization. Organizational barriers include: lack of research infrastructure, few trained clinical researchers, prioritisation of clinical responsibilities and funding difficulties. The h ....The lack of good evidence in palliative care (PC) is widely acknowledged but research in PC is difficult. Methodological barriers include: difficulties in recruitment, high rates of attrition, problems with maintaining distinct and sustainable intervention strategies, poorly chosen outcomes and opposition to randomization. Organizational barriers include: lack of research infrastructure, few trained clinical researchers, prioritisation of clinical responsibilities and funding difficulties. The hierarchy of evidence rates RCTs as the gold standard. An alternative is the n-of-1 trial: a randomized, double-blind cross-over comparison of active drug with placebo or another drug. The patient is in effect their own control. N-of-1 trials provide an objective means of testing the effectiveness of medicines in individual patients, providing evidence stronger than RCT evidence for the efficacy of that drug in that particular individual. If multiple n-of-1 trials are conducted, the resultant data amounts to RCT evidence for that treatment in a population. We propose n-of-1 trials as a workable option for researching the benefit of drugs and other therapies in PC patients. If successful, this model could be accepted internationally as the gold standard for research in this difficult population group. This would be a world first and of great national and international significance. In advanced cancer, the prevalence of fatigue is very high at 60-90% and can be related to the treatment or the disease itself. The impact of fatigue on function (physical, mental, social and spiritual) and hence quality of life (QOL) is very significant for many palliative patients as well as their families-carers. The role of pyschostimulants in the management of fatigue in patients with advanced cancer and life limiting disease needs to be defined. We will conduct n-of-1 trials of psychostimulants (i.e. methylphenidate) for fatigue in a group of 40 patients, recruited from 5 sites around Australia through a national clinical trial network recently set up for palliative care research. Managing fatigue with treatment supported by the best possible evidence for individual patients and producing any improvement in fatigue will improve patients� functional status, and will greatly improve QOL for patients and carers.Read moreRead less
Evidence For Psychological And-or Educational Interventions For Cancer-related Fatigue: A Systematic Review
Funder
National Health and Medical Research Council
Funding Amount
$28,283.00
Summary
Potential benefits to the community: Fatigue is one of the most common and distressing symptoms experienced by people with cancer and can exacerbate the experience of other symptoms, negatively affect mood, and impact on function and quality of life. Understanding which interventions are effective in helping people cope with cancer-related fatigue is important to inform decision-making by consumers, clinicians working in palliative care and policy makers. Objectives: This study aims to systemati ....Potential benefits to the community: Fatigue is one of the most common and distressing symptoms experienced by people with cancer and can exacerbate the experience of other symptoms, negatively affect mood, and impact on function and quality of life. Understanding which interventions are effective in helping people cope with cancer-related fatigue is important to inform decision-making by consumers, clinicians working in palliative care and policy makers. Objectives: This study aims to systematically review the evidence for psychological and-or educational interventions for managing cancer-related fatigue. Methods: This study will use the Cochrane Collaboration’s methodology to search, critically appraise, and analyse randomised controlled trials of psychological and-or educational interventions. This will involve collaboration with consumers and with the Cochrane Pain, Palliative Care, and Supportive Care Collaborative Review Group. This review will inform decision-making at all levels, assist in research translation and identify further gaps in the research regarding this distressing symptom.Read moreRead less
Informing The Development Of A Model Of Care For Patients With End Stage COPD: What Are Their Needs And And They Being Met
Funder
National Health and Medical Research Council
Funding Amount
$49,425.00
Summary
Currently there is no specific model of care for people with end stage chronic obstructive pulmonary disease (COPD), despite growing evidence of the specific symptoms and issues of this patient group. Interviews with end stage COPD patients and their carers will be undertaken to explore the services currently being accessed, and how well patients’ needs are being met by these services. This project will conduct an audit of available services in South Australia and then examine how hospital, spec ....Currently there is no specific model of care for people with end stage chronic obstructive pulmonary disease (COPD), despite growing evidence of the specific symptoms and issues of this patient group. Interviews with end stage COPD patients and their carers will be undertaken to explore the services currently being accessed, and how well patients’ needs are being met by these services. This project will conduct an audit of available services in South Australia and then examine how hospital, specialist palliative care units and primary care services (including general practice) can interface to meet these identified patient and carer needs. The results from this study will be used to inform development of a distinct model (or models) of care that addresses the needs of patients with end stage COPD.Read moreRead less
Supporting The Pathways To Palliative Care For People Diagnosed With Chronic Kidney Disease
Funder
National Health and Medical Research Council
Funding Amount
$43,575.00
Summary
Palliative care is highly relevant to the care of people with chronic kidney disease (CKD). As the person’s kidneys fail, dialysis or transplant will be required to prolong life. Palliative care is another option should patients choose not to have treatment. The health care team plays an important role in offering and supporting this choice but the planned patient care pathway often does not include palliative care as an option until the patient’s prognosis is very poor. Health professionals’ ow ....Palliative care is highly relevant to the care of people with chronic kidney disease (CKD). As the person’s kidneys fail, dialysis or transplant will be required to prolong life. Palliative care is another option should patients choose not to have treatment. The health care team plays an important role in offering and supporting this choice but the planned patient care pathway often does not include palliative care as an option until the patient’s prognosis is very poor. Health professionals’ own beliefs, values and knowledge about palliative care, death and dying, impact upon their decision to offer and support a palliative care option. This research which will be conducted in Northern Tasmania and will explore how palliative care is currently integrated into the care of patients with CKD and the perceptions that health professionals have about palliative care that may influence their decision making. From this information the research team and participating staff will develop the foundational protocols, resources and education and support program needed to introduce a multidisciplinary care pathway that integrates palliative care for all CKD patients.Read moreRead less
A Type II Diabetes Adn Obesity Prevention Program For Primary School Aged Rural Indigenous Children
Funder
National Health and Medical Research Council
Funding Amount
$1,497,369.00
Summary
This project aims to develop and evaluate the impact of an innovative multi-component community and school-based program for type II diabetes and obesity prevention program for Indigenous and non-Indigenous rural children.
An Evaluation Of The Validity Of Measureing Salivary Oxycodone Concentrations For Pharmacokinetic Studies In Patients
Funder
National Health and Medical Research Council
Funding Amount
$49,135.00
Summary
In many countries, oxycodone is replacing morphine as the opioid of first choice for the treatment of moderate to severe pain. Despite this, very little is known about how the drug is processed in the body or how its ability to control pain is affected by such factors as other drugs, age or organ function. Studies to determine this usually require multiple blood tests from individual patients over set time periods. Our team is able to measure drug levels in saliva and has shown this to be a vali ....In many countries, oxycodone is replacing morphine as the opioid of first choice for the treatment of moderate to severe pain. Despite this, very little is known about how the drug is processed in the body or how its ability to control pain is affected by such factors as other drugs, age or organ function. Studies to determine this usually require multiple blood tests from individual patients over set time periods. Our team is able to measure drug levels in saliva and has shown this to be a valid substitute for the measurement of drug levels in blood. Furthermore, one of us has developed a computer modelling system that shows how drugs are handled in the body using only a few samples from each patient. Palliative care patients are generally frail and unwell. We are reluctant to expose them to invasive tests such as repeated blood sampling. If we can prove that saliva sampling is as good as blood sampling, we will have identified a simple non-invasive means of greatly increasing our knowledge of oxycodone and how it behaves in individual patients. This in turn may allow us to tailor drug doses according to the unique characteristics of each patient and to optimise their pain control.Read moreRead less
CAM Use Among Mid-age Women: A National Mixed-methods Study Across The Urban-rural Divide
Funder
National Health and Medical Research Council
Funding Amount
$452,251.00
Summary
The aim of this project is to understand and explain why higher proportions of mid-age women in regional areas use complementary and alternative medicine (CAM) than those in urban areas of Australia. Such work will provide an evidence-base for policy and practice on this topic and the project findings will help develop CAM initiatives and programs for women’s health that are sensitive to geographical variations in community health, health practice and provision. Women are significantly more like ....The aim of this project is to understand and explain why higher proportions of mid-age women in regional areas use complementary and alternative medicine (CAM) than those in urban areas of Australia. Such work will provide an evidence-base for policy and practice on this topic and the project findings will help develop CAM initiatives and programs for women’s health that are sensitive to geographical variations in community health, health practice and provision. Women are significantly more likely to utilise CAM treatments than males and mid-age women have been found to be the highest CAM user group amongst Australian women. Researchers and practitioners have identified treatments from within CAM as potentially well-suited to dealing with a range of health problems and associated symptoms prevalent amongst mid-age women including the onset of cancer, arthritis, diabetes and asthma as well as menopause. Our previous pilot work found that mid-age women in regional areas are significantly more likely to use CAM than those in urban areas. A number of explanations as to why this is so can be or have been proposed. These include: limited access to conventional health care services in regional areas; closer working ties between non-urban general practitioners and CAM provision; dissatisfaction with conventional health care services in regional areas and stronger informal community networks in nonurban areas. Our proposed project, drawing upon a national representative sample of mid-age women will test such hypotheses and will provide findings of benefit and interest to policy makers, practitioners, consumers and all involved in women’s health and health care across urban and regional Australia.Read moreRead less