ORCID Profile
0000-0002-1829-396X
Current Organisations
South Western Sydney Local Health District & UNSW
,
UNSW Sydney
,
Western Sydney University
,
Cancer Institute NSW
,
Liverpool Hospital
,
MSG Sphere
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Publications
Barriers and Facilitators to Integrative Oncology Services in Australia: A Changed Mind Set Required.
Publisher: Mary Ann Liebert Inc
Date: 03-2021
A pilot randomised comparison of dexamethasone 96 mg vs 16 mg per day for malignant spinal-cord compression treated by radiotherapy: TROG 01.05 Superdex study.
Publisher: Elsevier BV
Date: 02-2006
Refinement of the basic treatment equivalent model to reflect radiotherapy treatment throughput using Australasian data.
Publisher: Wiley
Date: 11-1999
DOI: 10.1046/J.1440-1673.1999.00747.X
Abstract: A model of radiotherapy linear accelerator throughput has been developed and shown to be a more sensitive measure of throughput than current measures of throughput. The present study aims to develop a more sensitive basic treatment equivalent (BTE) model that still measures linear accelerator throughput and considers some of the shortcomings of the previous model. All radiation oncology departments in Australia and New Zealand were invited to participate. Departments were asked to time with a stopwatch all episodes of radiotherapy treatment over a 4-week period. Data collected for each treatment fraction included treatment intent, tumour site, patient age, Eastern Cooperative Oncology Group (ECOG) performance status, number of fields used, number of wedges used, number of junctions, number of shielding blocks used, whether the treatment was the first fraction, the use of general anaesthesia and whether port films or electronic portal imaging was used. Twenty-six departments of radiation oncology (70%) participated in this trial. A total of 7929 fractions of treatment, administered to 2424 patients, were timed. The factors found to most significantly impact on treatment duration on multivariate analysis were the type of fraction (first fraction was longer than subsequent fractions), type of beam (electrons were quicker than photons, which were quicker than mixed), number of fields, number of shields, number of junctions, number of port films and performance status (ECOG 2). The age of the patient, number of compensators and the sex of the patient were not significant. The relationships between factors were assessed, and models of measuring linear accelerator throughput which consider complexity corrections were derived. It is possible to show that linear accelerator throughput is poorly measured by just considering numbers of patients or fields treated per unit time and that other factors that impact on treatment duration must be considered. A more sensitive model of patient throughput is suggested but even when a large number of factors are considered, some insensitivity still remains in the model.
Impact of radiotherapy underutilisation measured by survival shortfall, years of potential life lost and disability-adjusted life years lost in New South Wales, Australia.
Publisher: Elsevier BV
Date: 11-2018
DAta Linkage to Enhance Cancer Care (DaLECC): Protocol of a Large Australian Data Linkage Study
Publisher: MDPI AG
Date: 29-05-2023
Abstract: Cancer is a leading cause of global morbidity and mortality, accounting for 250 Disability-Adjusted Life Years and 10 million deaths in 2019. Minimising unwarranted variation and ensuring appropriate cost-effective treatment across primary and tertiary care to improve health outcomes is a key health priority. There are few studies that have used linked data to explore healthcare utilisation prior to diagnosis in addition to post-diagnosis patterns of care. This protocol outlines the aims of the DaLECC project and key methodological features of the linked dataset. The primary aim of this project is to explore predictors of variations in pre- and post-cancer diagnosis care, and to explore the economic and health impact of any variation. The cohort of patients includes all South Australian residents diagnosed with cancer between 2011 and 2020, who were recorded on the South Australian Cancer Registry. These cancer registry records are being linked with state and national healthcare databases to capture health service utilisation and costs for a minimum of one-year prior to diagnosis and to a maximum of 10 years post-diagnosis. Healthcare utilisation includes state databases for inpatient separations and emergency department presentations and national databases for Medicare services and pharmaceuticals. Our results will identify barriers to timely receipt of care, estimate the impact of variations in the use of health care, and provide evidence to support interventions to improve health outcomes to inform national and local decisions to enhance the access and uptake of health care services.
Estimating the optimal utilization rates of radiotherapy for hematologic malignancies from a review of the evidence: part II-leukemia and myeloma.
Publisher: Wiley
Date: 05-01-2005
DOI: 10.1002/CNCR.20755
Abstract: The objective of this study was to estimate the ideal proportion of new patients with leukemia and myeloma who should receive radiotherapy at some time during the course of their illness based on the best evidence. Available evidence of the efficacy of radiotherapy in most clinical situations for leukemia and myeloma was identified through extensive literature reviews and treatment guideline searches. Epidemiologic data concerning the distribution of types, disease stages, and other factors that influence the use of radiotherapy were identified. Decision trees were constructed to merge the evidence-based recommendations with the epidemiological data to calculate the optimal proportion of patients who should receive radiotherapy according to the best available evidence. Actual radiotherapy utilization rates also were identified. The proportion of patients diagnosed with myeloma in Australia who should receive radiotherapy based on the evidence was 38%. There was wide variation in the proportion of patients who actually received radiotherapy for myeloma from 24% up to 55%. The recommended proportion of patients diagnosed with myeloma in Australia who, according to the best available evidence, should receive at least a single course of radiotherapy was 38%. The proportion of patients diagnosed in Australia with leukemia who should receive radiotherapy at some point in their management, according to the best available evidence, was calculated at 4%, which corresponded with actual practice. Further research will be required to determine why more patients who are diagnosed with myeloma are not treated with radiotherapy.
Estimation of an optimal chemotherapy utilisation rate for lung cancer: An evidence-based benchmark for cancer care
Publisher: Elsevier BV
Date: 09-2010
DOI: 10.1016/J.LUNGCAN.2009.11.017
Abstract: Optimal chemotherapy utilisation rates can serve as benchmarks to assess the quality of cancer service delivery. This study aims to determine the optimal proportion of patients with lung cancer that should receive chemotherapy at least once during the course of their illness, based on the best available evidence. An optimal chemotherapy utilisation tree was constructed using indications for chemotherapy identified from evidence-based treatment guidelines. Data on the proportion of patient and tumour-related attributes for which chemotherapy was indicated were obtained and merged with the treatment indications to calculate an optimal chemotherapy utilisation rate. This optimal rate was compared with reported actual rates of chemotherapy utilisation. Chemotherapy is recommended at least once in 73% of all patients with lung cancer (93% of small cell lung cancer (SCLC) patients and 69% of non-small cell lung cancer (NSCLC) patients). Comparison of these benchmark rates with international reported actual chemotherapy utilisation rates reveals under-utilisation of chemotherapy in all newly diagnosed lung cancer patients, regardless of histological type and stage, with the exception of stage I NSCLC. The optimal chemotherapy utilisation rate can serve as a feasible, evidence-based measure of the quality of cancer care. Chemotherapy may be under-utilised in the initial management of lung cancer.
Estimating the optimal utilization rates of radiotherapy for hematologic malignancies from a review of the evidence: part I-lymphoma.
Publisher: Wiley
Date: 05-01-2005
DOI: 10.1002/CNCR.20754
Abstract: The objective of this study was to estimate the ideal proportion of new patients with lymphoma who should receive radiotherapy at some time during the course of their illness, based on the best evidence. Available evidence of the efficacy of radiotherapy in most clinical situations for lymphoma were identified through extensive literature reviews and treatment guideline searches. Epidemiologic data concerning the distribution of histologic type, disease stage, and other factors that influence the use of radiotherapy were identified. Decision trees were constructed to merge the evidence-based recommendations with the epidemiologic data to calculate the optimal proportion of patients who should receive radiotherapy according to the best available evidence. Actual radiotherapy utilization rates also were identified. The proportion of patients with lymphoma in Australia that should receive radiotherapy at some point in their management, according to the best available evidence, was calculated at 65.0%. Multivariate analysis with a Monte Carlo simulation yielded a radiotherapy utilization rate of 64.4%. The actual utilization rates of radiotherapy for lymphoma reported in clinical practice were 22-29%, substantially lower than the optimal rate calculated in this project. Further research will be required to identify why more patients who are diagnosed with lymphoma are not treated with radiotherapy.
The effect of imaging modality (magnetic resonance imaging vs. computed tomography) and patient position (supine vs. prone) on target and organ at risk doses in partial breast irradiation
Publisher: Wiley
Date: 07-12-2021
DOI: 10.1002/JMRS.453
Abstract: Conventionally computed tomography (CT) has been used to delineate target volumes in radiotherapy however, magnetic resonance imaging (MRI) is being continually integrated into clinical practice therefore, the investigation into targets derived from MRI is warranted. The purpose of this study was to evaluate the impact of imaging modality (MRI vs. CT) and patient positioning (supine vs. prone) on planning target volumes (PTVs) and organs at risk (OARs) for partial breast irradiation (PBI). A retrospective data set, of 35 patients, was accessed where each patient had undergone MRI and CT imaging for tangential whole breast radiotherapy in both the supine and prone position. PTVs were defined from seroma cavity (SC) volumes delineated on each respective image, resulting in 4 PTVs per patient. PBI plans were generated with 6MV external beam radiotherapy (EBRT) using the TROG 06.02 protocol guidelines. A prescription of 38.5Gy in 10 fractions was used for all cases. The impact analysis of imaging modality and patient positioning included dose to PTVs, and OARs based on agreed criteria. Statistical analysis was conducted though Mann–Whitey U, Fisher’s exact and chi‐squared testing ( P 0.005). Twenty‐four patients were eligible for imaging analysis. However, positioning analysis could only be investigated on 19 of these data sets. No statistically significant difference was found in OAR doses based on imaging modality. Supine patient position resulted in lower contralateral breast dose (0.10Gy ± 0.35 vs. 0.33Gy ± 0.78, p = 0.011). Prone positioning resulted in a lower dose to ipsilateral lung volumes (10.85Gy ± 11.37 vs. 3.41Gy ± 3.93, P = .001). PBI plans with PTVs derived from MRI exhibited no clinically significant differences when compared to plans created from CT in relation to plan compliance and OAR dose. Patient position requires careful consideration regardless of imaging modality chosen. Although there was no proven superiority of MRI derived target volumes, it indicates that MRI could be considered for PBI target delineation.
Estimation of an optimal chemotherapy utilisation rate for head and neck carcinoma: setting an evidence-based benchmark for the best-quality cancer care.
Publisher: Elsevier BV
Date: 08-2009
Interobserver Variability in Clinical Target Volume Delineation in Tangential Breast Irradiation: a Comparison between Radiation Oncologists and Radiation Therapists
Publisher: Elsevier BV
Date: 03-2011
DOI: 10.1016/J.CLON.2010.10.004
Abstract: The delineation of target volumes has been radiation oncologist led. If radiation therapists were to undertake this task, work processes may be more efficient and the skills set of radiation therapy staff broadened. This study was undertaken to quantify interobserver variability of breast target volumes between radiation oncologists and radiation therapists. The planning computed tomography datasets of 30 patients undergoing tangential breast radiotherapy were utilised. Four radiation oncologists and four radiation therapists independently contoured the clinical target volume (CTV) of the breast on planning computed tomography using a written protocol. The mean CTV volumes and the mean distance between centres of volume (COV) were determined for both groups to determine intergroup variation. Each of the radiation oncologists' readings in turn has been used as the gold standard and compared with that of the radiation therapists. The concordance index for each patient's CTV was determined relative to the gold standard for each group. A paired t-test was used for statistical comparison between the groups. An intraclass correlation coefficient was calculated to measure the agreement between the radiation oncologist and radiation therapist groups. The mean concordance index was 0.81 for radiation oncologists and 0.84 for radiation therapists. The intraclass correlation coefficient for the mean volume was 0.995 (95% confidence interval 0.981-0.998) between radiation oncologist- and radiation therapist-contoured volumes. The intraclass correlation for the mean difference between radiation oncologists' and radiation therapists' COV was 0.999 (95% confidence interval 0.999-1.000). Interobserver variability between radiation oncologists and radiation therapists was found to be low. Radiation therapists could potentially assume the role of CTV voluming for breast radiotherapy provided a standardised contouring protocol is in place.
The role of radiotherapy in cancer treatment: estimating optimal utilization from a review of evidence-based clinical guidelines.
Publisher: Wiley
Date: 03-08-2005
DOI: 10.1002/CNCR.21324
Variations in breast cancer histology and treatment patterns between the major ethnic groups of South West Sydney.
Publisher: Hindawi Limited
Date: 19-12-2017
DOI: 10.1111/TBJ.12973
Feasibility of multi-atlas cardiac segmentation from thoracic planning CT in a probabilistic framework
Publisher: IOP Publishing
Date: 08-04-2019
Abstract: Toxicity to cardiac and coronary structures is an important late morbidity for patients undergoing left-sided breast radiotherapy. Many current studies have relied on estimates of cardiac doses assuming standardised anatomy, with a calculated increase in relative risk of 7.4% per Gy (mean heart dose). To provide in idualised estimates for dose, delineation of various cardiac structures on patient images is required. Automatic multi-atlas based segmentation can provide a consistent, robust solution, however there are challenges to this method. We are aiming to develop and validate a cardiac atlas and segmentation framework, with a focus on the limitations and uncertainties in the process. We present a probabilistic approach to segmentation, which provides a simple method to incorporate inter-observer variation, as well as a useful tool for evaluating the accuracy and sources of error in segmentation. A dataset consisting of 20 planning computed tomography (CT) images of Australian breast cancer patients with delineations of 17 structures (including whole heart, four chambers, coronary arteries and valves) was manually contoured by three independent observers, following a protocol based on a published reference atlas, with verification by a cardiologist. To develop and validate the segmentation framework a leave-one-out cross-validation strategy was implemented. Performance of the automatic segmentations was evaluated relative to inter-observer variability in manually-derived contours measures of volume and surface accuracy (Dice similarity coefficient (DSC) and mean absolute surface distance (MASD), respectively) were used to compare automatic segmentation to the consensus segmentation from manual contours. For the whole heart, the resulting segmentation achieved a DSC of [Formula: see text], with a MASD of [Formula: see text] mm. Quantitative results, together with the analysis of probabilistic labelling, indicate the feasibility of accurate and consistent segmentation of larger structures, whereas this is not the case for many smaller structures, where a major limitation in segmentation accuracy is the inter-observer variability in manual contouring.
No improvement in lung cancer care: The management of lung cancer in 1996 and 2002 in New South Wales
Publisher: Wiley
Date: 07-2009
DOI: 10.1111/J.1445-5994.2008.01788.X
Abstract: Patterns-of-care studies emphasize significant variation in the management of lung cancer. The aim of the study was to compare the patterns of care for patients diagnosed with lung cancer in 1996 and 2002 within three health areas in New South Wales. Treatment data were collected from medical records and treating doctors for the calendar year 1996 and between 1 November 2001 and 31 December 2002. Patients were residents of either south-western Sydney, Hunter or Northern Sydney health areas at the time of diagnosis. chi(2)-tests were used to investigate changes in treatment patterns between the two time periods. An adjusted odds ratio for treatment in 2002 relative to 1996 was calculated using logistic regression. Data were available for 738 and 567 cases in 1996 and 2002, respectively. Cancer-specific therapy was given within 6 months of diagnosis to 62 and 64% of patients, respectively. Adjusting for health area, age, sex, pathology and performance status, the odds ratio (OR) of treatment in 2002 relative to 1996 was 1.03 (95% confidence interval (CI) 0.78-1.35). When stage was included, the odds of treatment in 2002 relative to 1996 for non-small-cell lung cancer (n = 950) was 1.21 (95%CI 0.87-1.68). After adjustment for potential confounders, patients diagnosed with small-cell lung cancer (n = 176) were substantially less likely to receive treatment in 2002 compared with patients diagnosed in 1996 (OR = 0.11 95%CI 0.04-0.34). The odds of receiving treatment in 2002 and 1996 were similar. However, patients diagnosed with small-cell lung cancer in 2002 were significantly less likely to receive treatment. Overall, this study suggests there has been no change in lung cancer care in New South Wales. Further work is required to determine what proportion of persons with lung cancer should receive cancer-specific treatment so that clinical practices can be judged appropriately.
Patterns of care study of brachytherapy in New South Wales: cervical cancer treatment quality depends on caseload.
Publisher: Termedia Sp. z.o.o.
Date: 2014
The population benefit of radiotherapy for cervical cancer: local control and survival estimates for optimally utilized radiotherapy and chemoradiation.
Publisher: Elsevier BV
Date: 03-2015
Digital photography as source documentation of skin toxicity: an analysis from the Trans Tasman Radiation Oncology Group (TROG) 04.01 post-mastectomy radiation skin care trial.
Publisher: Wiley
Date: 25-05-2012
Estimation of an optimal chemotherapy utilisation rate for breast cancer: setting an evidence-based benchmark for the best-quality cancer care.
Publisher: Elsevier BV
Date: 03-2010
Lower trial participation by culturally and linguistically diverse (CALD) cancer patients is largely due to language barriers.
Publisher: Wiley
Date: 30-10-2017
DOI: 10.1111/AJCO.12818
Interpreting and Acting on the PRO Scores From the Patient-reported Outcomes for Personalized Treatment and Care (PROMPT-Care) eHealth System.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2019
DOI: 10.1097/MLR.0000000000001094
Abstract: Patient-reported Outcomes for Personalized Treatment and Care (PROMPT-Care) is the first eHealth system in Australia that is fully electronically integrated into hospital oncology information systems, enabling real-time, routine collection of patient-reported outcomes (PROs) to support and enable cancer patients to achieve and maintain improved health, well-being, and cancer outcomes. Five previously published papers detail the impetus for developing this eHealth system, its development, and testing of its acceptability and feasibility, the development of algorithms to standardize the cancer care pathways which underpin patient care, and the protocol for evaluating the efficacy of PROMPT-Care. This manuscript provides “how-to” guidance to inform future system development, focusing on selecting relevant PROs and measuring them in cancer patients, score interpretation, and determining recommended care in response to scores which are above the predetermined threshold. Electronic PRO systems are increasingly used in cancer clinical care settings, with the potential to support timely patient-centered care when implemented appropriately. PRO selection should consider patient response burden, and prioritizing PROs that are amenable to clinical intervention. Having clear, evidence-based, care pathways, and actionable recommendations in response to above-threshold PRO scores facilitate PRO integration into the clinical workflow. Centers should determine thresholds for clinical action for each PRO which provide an acceptable balance between false positives and false negatives and develop care pathway recommendations which consider the availability of local services and resources, are feasible in the clinical setting, clear, concise, manageable, based on evidence-based guidelines, and adaptable to local environments.
Analysis of Cardiac Substructure Dose in a Large, Multi-Centre Danish Breast Cancer Cohort (the DBCG HYPO trial): Trends and Predictive Modelling.
Publisher: Elsevier BV
Date: 12-2020
Guidance for establishing an integrative oncology service in the Australian healthcare setting-a discussion paper.
Publisher: Springer Science and Business Media LLC
Date: 09-2017
DOI: 10.1007/S00520-017-3851-0
Abstract: There is an obvious mismatch between the high reported rates of use of traditional and complementary medicines (T&CM) by Australian cancer patients and cancer survivors and the low numbers of Australian cancer services integrating T&CM. An estimated 65% of Australian cancer patients use at least one form of T&CM. Over half use T&CM in conjunction with conventional cancer therapy. Yet, less than 20% of Australian hospital cancer care facilities provide access to T&CM. This compares to around 70% of UK cancer care facilities offering at least one T&CM therapy. Barriers to developing integrative oncology services include determining an appropriate service model and revenue structure concerns with ethical and legal issues such as regulations and credentialing and inadequate high-quality scientific evidence demonstrating safety and effectiveness, including concerns about the possibility of adversely affecting chemotherapy or radiotherapy treatment. This paper aims to provide general guidance and practical strategies for those seeking to develop integrative oncology services in Australian cancer care facilities.
Risks and benefits of reducing target volume margins in breast tangent radiotherapy
Publisher: Springer Science and Business Media LLC
Date: 27-02-2017
DOI: 10.1007/S13246-017-0529-3
Abstract: This study investigates the potential benefits of planning target volume (PTV) margin reduction for whole breast radiotherapy in relation to dose received by organs at risk (OARs), as well as reductions in radiation-induced secondary cancer risk. Such benefits were compared to the increased radiation-induced secondary cancer risk attributed from increased ionizing radiation imaging doses. Ten retrospective patients' computed tomography datasets were considered. Three computerized treatment plans with varied PTV margins (0, 5 and 10 mm) were created for each patient complying with the Radiation Therapy Oncology Group (RTOG) 1005 protocol requirements. The BEIR VII lifetime attributable risk (LAR) model was used to estimate secondary cancer risk to OARs. The LAR was assessed for all treatment plans considering (a) doses from PTV margin variation and (b) doses from two (daily and weekly) kilovoltage cone beam computed tomography (kV CBCT) imaging protocols during the course of treatment. We found PTV margins from largest to smallest resulted in a mean OAR relative dose reduction of 31% (heart), 28% (lung) and 23% (contralateral breast) and the risk of radiation-induced secondary cancer by a relative 23% (contralateral breast) and 22% (contralateral lung). Daily image-guidance using kV CBCT increased the risk of radiation induced secondary cancer to the contralateral breast and contralateral lung by a relative 1.6-1.9% and 1.9-2.5% respectively. Despite the additional dose from kV CBCT for the two considered imaging protocols, smaller PTV margins would still result in an overall reduction in secondary cancer risk.
Comparison of setup accuracy of three different image assessment methods for tangential breast radiotherapy.
Publisher: Wiley
Date: 31-05-2016
DOI: 10.1002/JMRS.180
Do multidisciplinary meetings follow guideline-based care?
Publisher: American Society of Clinical Oncology (ASCO)
Date: 11-2010
Abstract: Multidisciplinary meeting recommendations are largely concordant with guidelines in the treatment of lung cancer.
Coverage of cancer services in Australia and providers' views on service gaps: findings from a national cross-sectional survey.
Publisher: Springer Science and Business Media LLC
Date: 11-06-2019
An assessment of basic treatment equivalent at Cookridge Hospital.
Publisher: Elsevier BV
Date: 10-2002
Abstract: The Australian model of Basic Treatment Equivalent (BTE) for measuring radiotherapy treatment productivity was developed for and tested within a busy UK radiotherapy centre and the results assessed against three other BTE models. The department's productivity was compared for three different models of treatment machine. Treatment fraction durations were timed for 362 consecutive treatment episodes on three treatment machines at Cookridge Hospital. Leeds. The treatment factors found to have a statistically significant impact on fraction duration were: initial fraction patient mobility number of fields treatment intent and the type of treatment machine. In comparison with the Australasian study, shorter mean fraction times were shown for a number of types of treatment, carried out on one particular linac type, which had multileaf collimation (MLC). The average non-operational time was 17% at Cookridge (31% in Australasia) with overall productivity gains. This efficiency may have been achieved partly by a higher number of staff per machine (five rather than four) and the presence of newer technology such as MLC. A BTE model was derived for Cookridge using the significant treatment factors and compared to other published models. The Cookridge model was most sensitive in predicting productivity. BTE models developed by other groups were also excellent in predicting treatment duration. The development of a BTE model is potentially applicable in the U.K. radiotherapy community at a time when optimizing activity per radiographer is key to minimizing waiting times.
Web-Based Patient-Reported Outcome Measures for Personalized Treatment and Care (PROMPT-Care): Multicenter Pragmatic Nonrandomized Trial
Publisher: JMIR Publications Inc.
Date: 29-10-2020
DOI: 10.2196/19685
Abstract: Despite the acceptability and efficacy of e–patient-reported outcome (ePRO) systems, implementation in routine clinical care remains challenging. This pragmatic trial implemented the PROMPT-Care (Patient Reported Outcome Measures for Personalized Treatment and Care) web-based system into existing clinical workflows and evaluated its effectiveness among a erse population of patients with cancer. Adult patients with solid tumors receiving active treatment or follow-up care in four cancer centers were enrolled. The PROMPT-Care intervention supported patient management through (1) monthly off-site electronic PRO physical symptom and psychosocial well-being assessments, (2) automated electronic clinical alerts notifying the care team of unresolved clinical issues following two consecutive assessments, and (3) tailored online patient self-management resources. Propensity score matching was used to match controls with intervention patients in a 4:1 ratio for patient age, sex, and treatment status. The primary outcome was a reduction in emergency department presentations. Secondary outcomes were time spent on chemotherapy and the number of allied health service referrals. From April 2016 to October 2018, 328 patients from four public hospitals received the intervention. Matched controls (n=1312) comprised the general population of patients with cancer, seen at the participating hospitals during the study period. Emergency department visits were significantly reduced by 33% (P=.02) among patients receiving the intervention compared with patients in the matched controls. No significant associations were found in allied health referrals or time to end of chemotherapy. At baseline, the most common patient reported outcomes (above-threshold) were fatigue (39%), tiredness (38.4%), worry (32.9%), general wellbeing (32.9%), and sleep (24.1%), aligning with the most frequently accessed self-management domain pages of physical well-being (36%) and emotional well-being (23%). The majority of clinical feedback reports were reviewed by nursing staff (729/893, 82%), largely in response to the automated clinical alerts (n=877). Algorithm-supported web-based systems utilizing patient reported outcomes in clinical practice reduced emergency department presentations among a erse population of patients with cancer. This study also highlighted the importance of (1) automated triggers for reviewing above-threshold results in patient reports, rather than passive manual review of patient records (2) the instrumental role nurses play in managing alerts and (3) providing patients with resources to support guided self-management, where appropriate. Together, these factors will inform the integration of web-based PRO systems into future models of routine cancer care. Australian New Zealand Clinical Trials Registry ACTRN12616000615482 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370633 RR2-10.1186/s12885-018-4729-3
Great expectations or waiting for Godot? Time for development of a near real‐time national reporting system of radiotherapy utilisation
Publisher: Wiley
Date: 24-05-2022
Clinicians' attitudes and perceived barriers and facilitators to cancer treatment clinical practice guideline adherence: A systematic review of qualitative and quantitative literature
Publisher: Springer Science and Business Media LLC
Date: 27-05-2020
DOI: 10.1186/S13012-020-00991-3
Abstract: Clinical Practice Guidelines (CPGs) synthesize the best available evidence to guide clinician and patient decision making. There are a multitude of barriers and facilitators to clinicians adhering to CPGs however, little is known about active cancer treatment CPG adherence specifically. This systematic review sought to identify clinician attitudes, and perceived barriers and facilitators to active cancer treatment CPG adherence. A systematic search was undertaken of five databases Ovid Medline, PsychInfo, Embase, Scopus, CINAHL, and PROQUEST. The retrieved abstracts were screened for eligibility against inclusion criteria, and a full text review was conducted of all eligible studies. Data were extracted, and a quality assessment was conducted of all included studies. The qualitative papers were thematically analyzed. Attitudes, barriers, and facilitating factors extracted from the quantitative papers were categorized within the qualitative thematic framework. The search resulted in the identification of 9676 titles. After duplicates were removed, abstracts screened, and full texts reviewed, 15 studies were included. Four themes were identified which related to negative clinician attitudes and barriers to active cancer treatment CPG adherence: (1) concern over CPG content and currency of CPGs (2) concern about the evidence underpinning CPGs (3) clinician uncertainty and negative perceptions of CPGs and (4) organizational and patient factors. The review also identified four themes related to positive attitudes and facilitators to active cancer treatment CPG adherence: (5) CPG accessibility and ease of use (6) endorsement and dissemination of CPGs and adequate access to treatment facilities and resources (7) awareness of CPGs and belief in their relevance and (8) belief that CPGs support decision making, improve patient care, reduce clinical variation, and reduce costs. These results highlight that adherence to active cancer treatment CPG recommendations by oncology clinicians is influenced by multiple factors such as attitudes, practices, and access to resources. The review has also revealed many similarities and differences in the factors associated with general CPG, and active cancer treatment CPG, adherence. These findings will inform tailored implementation strategies to increase adherence to cancer treatment CPGs. PROSPERO (2019) CRD42019125748 .
Factors affecting radiotherapy utilisation in geriatric oncology patients in NSW, Australia
Publisher: Elsevier BV
Date: 12-2020
Lung cancer in patients aged 50 years and younger: clinical characteristics, treatment details and outcome.
Publisher: Wiley
Date: 08-1999
DOI: 10.1046/J.1440-1673.1999.433666.X
Abstract: Younger patients (< or = 50 years of age) develop lung cancer. Many series report 5-10% of all cases occurring in younger patients. Outcome, inspite of treatment, is universally poor. Females and adenocarcinomas are over-represented and the aetiology for such an early-age presentation is unclear. The aims of this retrospective study were to review the clinical characteristics, treatment details and outcome of patients aged 50 years or younger diagnosed with lung cancer (small cell and non-small cell). Over a period of 34 months, 497 lung cancer patients were treated at the Liverpool Hospital Cancer Therapy Centre. Thirty-seven (7.4%) patients aged less than or equal to 50 years were identified. The median age at diagnosis was 44 years (range 32-49 years) in 20 females and 17 males. Adenocarcinoma was the predominant histological subtype (32%). No referred patient had stage I/II disease. Almost 90% of patients were smokers. Median survival following diagnosis was 12 months (range, 9 days-68 months) with 70% having died by the close of study. The clinical characteristics and outcome of young patients in our study were comparable to other similar series.
Variable structure methods in hydraulic servo systems control
Publisher: Elsevier BV
Date: 04-2001
Radiotherapy underutilisation and its impact on local control and survival in New South Wales, Australia.
Publisher: Elsevier BV
Date: 12-2019
Development of an age- and comorbidity adjusted- optimal radiotherapy utilisation rate for women with breast cancer.
Publisher: Elsevier BV
Date: 07-2022
Waiting times for radiotherapy—a survey of patients' attitudes
Publisher: Elsevier BV
Date: 03-2004
Radiation dose and contralateral breast cancer risk associated with megavoltage cone-beam computed tomographic image verification in breast radiation therapy.
Publisher: Elsevier BV
Date: 04-2013
Patterns of palliative radiotherapy fractionation for brain metastases patients in New South Wales, Australia
Publisher: Elsevier BV
Date: 03-2021
A comparison of systemic breast cancer therapy utilization in Canada (British Columbia), Scotland (Dundee), and Australia (Western Australia) with models of optimal therapy.
Publisher: Elsevier BV
Date: 08-2012
Estimation of the optimal utilisation rates of radical prostatectomy, external beam radiotherapy and brachytherapy in the treatment of prostate cancer by a review of clinical practice guidelines.
Publisher: Elsevier BV
Date: 2016
Comparison of face-to-face and videoconferenced multidisciplinary clinical meetings.
Publisher: Wiley
Date: 12-2004
DOI: 10.1111/J.1440-1673.2004.01349.X
Abstract: A trial of videoconferencing of multidisciplinary breast cancer clinical meetings between three public hospitals was conducted in an attempt to increase attendance by medical staff at the meetings, and thus facilitate multidisciplinary care for breast cancer patients. The videoconferences were compared with the previously existing face-to-face clinical meetings through questionnaires, attendance, number of cases discussed and anthropological analysis. Although more people attended the videoconferences than the face-to-face meetings, most of the participants in the trial preferred the face-to-face meetings to the videoconferences. The mean number of cases discussed at the videoconferences was significantly less than the mean number of cases presented at the face-to-face clinical meetings. The face-to-face meetings were informal, spontaneous and conducive to open discussion. In contrast, the videoconferences were formal and regimented. Multidisciplinary case discussion can be facilitated by videoconferencing. Some of the negative experiences we encountered could be overcome with changes in meeting format. Our experience may help others in setting up a successful multidisciplinary team via videoconference.
eHealth System for Collecting and Utilizing Patient Reported Outcome Measures for Personalized Treatment and Care (PROMPT-Care) Among Cancer Patients: Mixed Methods Approach to Evaluate Feasibility and Acceptability
Publisher: JMIR Publications Inc.
Date: 02-10-2017
DOI: 10.2196/JMIR.8360
Regional Nodal Irradiation in Early-Stage Breast Cancer
Publisher: Massachusetts Medical Society
Date: 23-07-2015
Estimation of an optimal radiotherapy utilization rate for breast carcinoma: a review of the evidence.
Publisher: Wiley
Date: 22-10-2003
DOI: 10.1002/CNCR.11740
Abstract: Radiotherapy utilization rates for breast carcinoma vary widely, both within and between countries. Current estimates of the proportion of patients with carcinoma who optimally should receive radiotherapy are based either on expert opinion or on the measurement of actual utilization rates, and not on the best scientific evidence. To develop an evidence-based benchmark for radiotherapy utilization in patients with breast carcinoma, the authors undertook a systematic review of treatment guidelines on the use of radiotherapy for breast carcinoma. A decision tree was constructed, and the proportions of patients with clinical features that lead to a decision for radiotherapy were obtained from epidemiological data. This ideal utilization rate was compared with the utilization rates of radiotherapy over the last decade for breast carcinoma in Australia and internationally. The proportion of patients with breast carcinoma in whom radiotherapy would be recommended according to the best available evidence was calculated at 83% (95% confidence interval, 82-85%) of all patients with breast carcinoma. A review of actual radiotherapy utilization rates for breast carcinoma revealed that, in clinical practice, actual utilization rates varied between 24% and 71%. A substantial difference was found between the recommended optimal utilization of radiotherapy based on evidence and the actual rates reported in clinical practice. The reasons for these differences need to be examined, and a plan for addressing the suboptimal use of radiotherapy needs to be implemented. Cancer 2003.
Patterns of retreatment by radiotherapy.
Publisher: Elsevier BV
Date: 02-2011
Lung cancer patterns of care in south western Sydney, Australia
Publisher: BMJ
Date: 08-2003
Abstract: Lung cancer is the leading cause of cancer deaths in New South Wales (NSW). There is a significantly higher incidence of lung cancer in the South Western Sydney Area Health Service (SWSAHS) than the NSW average. The aim of this study was to document patterns of lung cancer care for SWSAHS residents. SWSAHS residents diagnosed with lung cancer in 1993 and 1996 were identified from the NSW Central Cancer Registry and their medical records reviewed. The study population comprised 527 patients of median age 68 years. 12% did not see a lung cancer specialist, 9% did not have a pathological diagnosis, and 28% did not receive any active treatment throughout the course of their illness. The median survival was 6.7 months and the 5 year overall survival was 8% (95% CI 6 to 10). The rates of pathological diagnosis, specialist referral, and treatment decreased with older age and poorer performance status. The management of lung cancer patients in SWSAHS is suboptimal. A significant proportion of patients are not receiving treatment. To improve patient care and outcomes, all lung cancer patients should be referred to a specialist for management, ideally in a multidisciplinary setting. Both consumers and general practitioners need to be educated about options available for the management of lung cancers and ageist and nihilistic attitudes need to be overcome.
Assessment of dose variation for accelerated partial-breast irradiation using rigid and deformable image registrations.
Publisher: Elsevier BV
Date: 2016
Assessment of MRI image quality for various setup positions used in breast radiotherapy planning.
Publisher: Elsevier BV
Date: 04-2016
DOI: 10.1016/J.RADONC.2016.02.024
Abstract: This study investigates breast magnetic resonance imaging (MRI) image quality for 3 different breast radiotherapy positions (prone, supine flat and supine inclined) and associated choice of breast coils. Supine breast MRI has comparable image quality to prone breast MRI for the purposes of radiotherapy delineation for T2-weighted sequences.
Why a breast boost should remain a controversial aspect of routine breast conservation management in Australia and New Zealand in 2002
Publisher: Wiley
Date: 06-02-2003
DOI: 10.1046/J.1440-1673.2003.01128.X
Abstract: Two randomized trials have recently shown a statistically significant improvement in local control when a boost is employed in the conservative treatment of early breast cancer. However, unresolved issues of cost effectiveness, potentially increased toxicity and the inability to automatically generalize these results to Australian and New Zealand practice remain. In view of these unresolved controversies, the St George and Wollongong hospitals breast boost trial (SGW trial) will continue to recruit.
Changes in practice of breast cancer radiotherapy 1998–2002: An Australasian survey
Publisher: Wiley
Date: 02-2005
DOI: 10.1111/J.1440-1673.2005.01393.X
Abstract: In order to assess the impact on radiation oncology practice of the publication of evidence-based guidelines for technical aspects of therapeutic radiation for breast cancer, the Radiation Oncology Expert Advisory Group of the National Breast Cancer Centre conducted two postal surveys of radiation oncologists practising in Australia and New Zealand. Results from a survey conducted in 1998, prior to distribution of the guidelines, have been published previously. This article reports on results from a survey undertaken in 2002 and contains data from 102 respondents who manage women with breast cancer. The results show several important changes in practice since 1998, including increased use of CT scanning in breast cancer treatment planning and increased use of immobilization devices for patient treatment. There is also evidence of increased attention to technical aspects of treatment planning that reduce the potential risk of treatment toxicity. The influence of the guidelines, the wider availability of modern equipment and results from landmark clinical trials on change in radiation therapy practice is discussed.
Cancer,chronic conditions and social disadvantage: The perfect storm
Publisher: Springer Singapore
Date: 2016
Performance of different radiotherapy workload models.
Publisher: Elsevier BV
Date: 03-2003
DOI: 10.1016/S0360-3016(02)04400-0
Abstract: The purpose of this study was to evaluate the performance of different radiotherapy workload models using a prospectively collected dataset of patient and treatment information from a single center. Information about all in idual radiotherapy treatments was collected for 2 weeks from the three linear accelerators (linacs) in our department. This information included diagnosis code, treatment site, treatment unit, treatment time, fields per fraction, technique, beam type, blocks, wedges, junctions, port films, and Eastern Cooperative Oncology Group (ECOG) performance status. We evaluated the accuracy and precision of the original and revised basic treatment equivalent (BTE) model, the simple and complex Addenbrooke models, the equivalent simple treatment visit (ESTV) model, fields per hour, and two local standards of workload measurement. Data were collected for 2 weeks in June 2001. During this time, 151 patients were treated with 857 fractions. The revised BTE model performed better than the other models with a mean [observed -predicted] of 2.62 (2.44-2.80). It estimated 88.0% of treatment times within 5 min, which is similar to the previously reported accuracy of the model. The revised BTE model had similar accuracy and precision for data collected in our center as it did for the original dataset and performed the best of the models assessed. This model would have uses for patient scheduling, and describing workloads and case complexity.
Acupuncture for Cancer Related Pain: Protocol for a Pragmatic Randomised Wait-List Controlled Trial.
Publisher: SAGE Publications
Date: 2020
Abstract: Acupuncture has been proved effective for cancer related pain (CRP) in China, America and some other countries. However, there is relative lack of evidence to support the use of acupuncture for CRP in Australia. To assess the effectiveness and safety of acupuncture for management of CRP in a real-world setting and to understand cancer patients’ experience of undergoing acupuncture for CRP. A pragmatic randomised controlled trial will be conducted in South Western Sydney Local Health District (SWSLHD) in NSW, Australia. Adults with cancer related pain (n = 106) will be randomised in a 1:1 ratio to receive the acupuncture intervention up front versus after a wait list period of 4 weeks. Pain level (by Numerical Rating Scale), analgesic use, auricular acupressure frequency and adverse events will be assessed at baseline, mid-treatment and post-treatment. Expectancy on trial outcome (by Credibility and Expectancy questionnaire) will be assessed at baseline. The perspective of the participants (by an interview) will be recorded after the last intervention. We hypothesise that acupuncture will relieve cancer related pain at mid-treatment and post-treatment. We also hypothesise that few adverse events will be provoked by acupuncture. Australia New-Zealand Clinical Trial Registry (ACTRN12620000325909).
The impact of cancer and chronic conditions on caregivers and family members
Publisher: Springer Singapore
Date: 2016
Study protocol for a controlled trial of an eHealth system utilising patient reported outcome measures for personalised treatment and care: PROMPT-Care 2.0.
Publisher: Springer Science and Business Media LLC
Date: 23-08-2018
Estimation of optimal brachytherapy utilization rate in the treatment of malignancies of the uterine corpus by a review of clinical practice guidelines and the primary evidence.
Publisher: Elsevier BV
Date: 11-2008
Rapid learning in practice: a lung cancer survival decision support system in routine patient care data.
Publisher: Elsevier BV
Date: 10-2014
Validation of a new open-source method for automatic delineation and dose assessment of the heart and LADCA in breast radiotherapy with simultaneous uncertainty estimation.
Publisher: IOP Publishing
Date: 25-01-2021
Abstract: Radiotherapy has been shown to increase risks of cardiotoxicities for breast cancer patients. Automated delineation approaches are necessary for consistent and efficient assessment of cardiac doses in large, retrospective datasets, while patient-specific estimation of the uncertainty in these doses provides valuable additional data for modelling and understanding risks. In this work, we aim to validate the consistency of our previously described open-source software model for automatic cardiac delineation in the context of dose assessment, relative to manual contouring. We also extend our software to introduce a novel method to automatically quantify the uncertainty in cardiac doses based on expected inter-observer variability (IOV) in contouring. This method was applied to a cohort of 15 left-sided breast cancer patients treated in Denmark using modern tangential radiotherapy techniques. On each image set, the whole heart and left anterior descending coronary artery (LADCA) were contoured by nine independent experts the range of doses to these nine volumes provided a reference for the dose uncertainties generated from the automatic method. Local and external atlas sets were used to test the method. Results give confidence in the consistency of automatic segmentations, with mean whole heart dose differences for local and external atlas sets of −0.20 ± 0.17 and −0.10 ± 0.14 Gy, respectively. Automatic estimates of uncertainties in doses are similar to those from IOV for both the whole heart and LADCA. Overall, this study confirms that our automated approach can be used to accurately assess cardiac doses, and the proposed method can provide a useful tool in estimating dose uncertainties.
Persistent reduction in global longitudinal strain in the longer term after radiation therapy in patients with breast cancer.
Publisher: Elsevier BV
Date: 03-2018
Support of large breasts during tangential irradiation using a micro-shell and minimizing the skin dose--a pilot study.
Publisher: Elsevier BV
Date: 03-2005
DOI: 10.1016/J.MEDDOS.2004.10.006
Abstract: Tangential radiotherapy delivered to women with large breasts can be problematic due to the excessive skin folds and the way that the breast falls into the axilla. This may necessitate excessive lung irradiation to cover the posterior part of the breast volume adequately. Conventional breast rings used to move the breast anteriorly can be very difficult to reproduce and may substantially increase the skin dose and hence skin toxicity due to the bolus effect. An in-house designed microshell device was constructed to improve setup reproducibility and minimize skin dose. Dose comparisons using a phantom were made between this device and 2 other commonly used devices. The microshell successfully reduced the surface dose compared to the other breast rings tested. This device was then investigated on 8 patients under clinical conditions. Skin doses measured on the trial patients were within acceptable limits. During this small pilot study, no patients suffered excessive skin toxicity or required treatment breaks. Due to the microshell's expandable nature, ease of application, which increases patient comfort compared to other breast rings, and the lower surface dose, the microshell is the preferred breast stabilization device for this department when treating patients with large pendulous breasts. We encourage other departments to consider their current method of breast stabilization and compare them to our results.
Estimation of the optimal number of radiotherapy fractions for breast cancer: A review of the evidence.
Publisher: Elsevier BV
Date: 08-2015
Imaging dose in breast radiotherapy: does breast size affect the dose to the organs at risk and the risk of secondary cancer to the contralateral breast?
Publisher: Wiley
Date: 07-01-2015
DOI: 10.1002/JMRS.91
What are the attitudes of health professionals regarding patient reported outcome measures (PROMs) in oncology practice? A mixed-method synthesis of the qualitative evidence
Publisher: Springer Science and Business Media LLC
Date: 10-02-2020
DOI: 10.1186/S12913-020-4939-7
Abstract: The adoption of Patient Reported Outcome Measures (PROMs) in cancer care has been widely advocated, but little is known about the evidence for the implementation of PROMs in practice. Qualitative research captures the perspectives of health professionals as end-users of PROMs and can be used to inform adoption efforts. This paper presents a systematic review and synthesis of qualitative research conducted to address the question: What are the attitudes of health professionals towards PROMs in oncology, including any barriers and facilitators to the adoption of PROMS, reported in qualitative evidence? Systematic searches of qualitative evidence were undertaken in four databases and reviewed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies published in English between 1998 and 2018, which reported qualitative findings about the attitudes of health professionals working in oncology towards PROMs were eligible. Studies were assessed using the Critical Appraisal Skills Programme’s Qualitative Research Checklist. A sentiment analysis was conducted on primary text to examine the polarity (neutral, positive or negative) of health professionals’ views of PROMs. Qualitative meta-synthesis was conducted using a constant comparative analysis. From 1227 articles after duplicates were removed, with 1014 excluded against the screening criteria, 213 full text articles remained and were assessed 34 studies met the inclusion criteria and were included. The majority of studies were of good quality. Sentiment analysis on primary text demonstrated an overall positive polarity from the expressed opinions of health professionals. The meta-synthesis showed health professionals’ attitudes in four domains: identifying patient issues and needs using PROMs managing and addressing patient issues the care experience and the integration of PROMs into clinical practice. From the accounts of health professionals, the fit of PROMs with existing practice, how PROMs are valued, capacity to respond to PROMs and the supports in place, formed the key factors which may impede or promote adoption of PROMs in routine practice. To assist policy-makers and services involved in implementing these initiatives, further evidence is required about the relationship between PROMs data collection and corresponding clinical actions. International Prospective Register of Systematic Reviews (PROSPERO) CRD42019119447 , 6th March, 2019.
Medical Error – the Perspective of the Clinician and the Director of a Department Involved in an Error
Publisher: Elsevier BV
Date: 09-2017
Basic Treatment Equivalent (BTE): a new measure of linear accelerator workload.
Publisher: Elsevier BV
Date: 1997
DOI: 10.1016/S0936-6555(97)80007-6
Abstract: The measurement of linear accelerator workload in radiation oncology departments is usually based on the number of fields treated per unit time. However, this approach ignores variations in treatment complexity. This prospective study, was designed to measure treatment workload directly, taking into account the variations in complexity of different treatment techniques. From this, a model was to be developed, which would be simple to apply and reproducible, both within and between radiation oncology departments in Australasia. It would provide a realistic basis for assessing treatment costs and enable the comparison of patient throughput between departments. This paper describes the derivation of the model. Over a 4-week period in the Radiation Oncology Department of Westmead Hospital, all fractions of radiotherapy were timed. The data collected included: tumour site treatment intent number of fields number of wedges, compensators and shielding blocks fraction number patient age performance status and need for general anaesthesia. Multivariate modelling was performed to identify factors that significantly affected fraction duration, so that these could be used to develop a model of resource utilization. The durations of 2371 fractions were measured in 219 patients. Seventy-five per cent of fractions were given with radical intent. The factors found to influence fraction duration on multivariate modelling were: number of fields number of shielding blocks first treatment fraction need for anaesthesia and performance status. The number of wedges and compensators were also found to be significant but were not included in the model in order to maintain simplicity. This was felt to be necessary if the model is to be applied to the widest possible variety of machines. A model of resources utilization called 'Basic Treatment Equivalent' (BTE) was derived, which incorporated these factors. When tested at Westmead Hospital, this model accurately reflected the predicted BTE value over a further 1-week study period. This model of linear accelerator use, which incorporates complexity has been derived and evaluated in one radiation oncology department. This requires further prospective testing before its widespread use. The model appears to reflect linear accelerator workload better than previous measures. An Australasian study to validate the model further will be undertaken. If adopted, this model has implications for comparative workload reports, diagnostic-related groups, waiting list calculations, and patient scheduling.
The impact of imaging modality (CT vs MRI) and patient position (supine vs prone) on tangential whole breast radiation therapy planning.
Publisher: Elsevier BV
Date: 05-2017
The development of a model of outpatient chemotherapy delivery--chemotherapy basic treatment equivalent (CBTE).
Publisher: Elsevier BV
Date: 10-2002
Abstract: The aims of this study were to study the patient-, tumour- and treatment-related factors that significantly impact on treatment episode duration for outpatient chemotherapy treatment delivery, and to develop a new measure of outpatient chemotherapy throughput that considers variations in treatment duration compared with the older measures of patients treated per day. A pilot study in our institution randomly measured the duration of outpatient chemotherapy delivery for 266 occasions of service. Patient, tumour and treatment factors were collected and assessed for their impact on treatment duration using multivariate analysis. A new model of outpatient chemotherapy was developed using various modeling processes. Median treatment duration was 90 min. Significant factors that impacted on treatment duration were the chemotherapy regimen, type of infusion, patient age and whether the patients required a community nurse to be organized. A measure was developed (Chemotherapy Basic Treatment Equivalent or CBTE) that considers the variations in treatment duration and showed that although the daily number of patients treated in our department each day remained stable, there were wide fluctuations in workload when variations in treatment duration were considered. A new measure of chemotherapy workload has therefore been proposed although further testing across departments is required. If broadly implemented this could substantially improve resource planning, resource use and patient satisfaction as it considers variations in treatment duration, which is not previously considered in chemotherapy throughput statistics.
Estimation of an optimal radiotherapy utilization rate for gynecologic carcinoma: part II--carcinoma of the endometrium.
Publisher: Wiley
Date: 02-08-2004
DOI: 10.1002/CNCR.20445
Abstract: Radiotherapy utilization rates for cancer vary widely, both within and between countries. Current estimates of the proportion of cancer patients who should optimally receive radiotherapy are based either on expert opinion or on the measurement of actual utilization rates, rather than on the best scientific evidence. Evidence-based treatment guidelines regarding endometrial carcinoma were reviewed to develop an evidence-based benchmark for radiotherapy utilization. An optimal radiotherapy utilization tree was constructed and the proportions of endometrial carcinoma patients with clinical indications for radiotherapy were obtained from epidemiologic data. The ideal utilization rates were compared with actual radiotherapy utilization rates for endometrial carcinoma both in Australia and internationally. According to the best available evidence, radiotherapy is indicated at least once in 46% of all patients with endometrial carcinoma. A review of the limited data available concerning actual radiotherapy utilization rates revealed that the actual rates are approximately 10% lower than the optimal rates. Further research into the patterns of actual treatment and the development of optimal chemotherapy and surgery utilization rates for endometrial carcinoma is recommended. The difference between the optimal and the actual utilization rates warrants investigation into the reasons for the low radiotherapy utilization rates encountered in clinical practice.
Do cancer follow-up consultations create anxiety?
Publisher: Informa UK Limited
Date: 2008
Estimation of an optimal radiotherapy utilization rate for gynecologic carcinoma: part I--malignancies of the cervix, ovary, vagina and vulva.
Publisher: Wiley
Date: 02-08-2004
DOI: 10.1002/CNCR.20444
Abstract: Radiotherapy usage rates exhibit wide variations both within and between countries. Current estimates of the proportion of cancer patients who should optimally receive radiotherapy are based either on expert opinion or on the measurement of actual usage rates rather than on the best available scientific evidence. With the goal of developing an evidence-based benchmark for radiotherapy use in the treatment of malignancies of the cervix, vagina, vulva, and ovary (endometrial malignancies are covered in a separate article), the authors reviewed international evidence-based treatment guidelines. Optimal radiotherapy usage trees were constructed, and proportions of patients with clinical indications for radiotherapy were obtained from epidemiologic data. These ideal usage rates were compared with actual radiotherapy utilization rates recorded in Australia and elsewhere. According to the best available evidence, radiotherapy is indicated at least once for 58% of patients with cervical carcinoma, 4% of patients with ovarian carcinoma, 100% of patients with vaginal carcinoma, and 34% of patients with vulvar carcinoma. A review of the limited data available suggests that actual radiotherapy usage rates for patients with gynecologic malignancies are comparable to optimal usage rates. Actual practice appears to approximate the authors' model of optimal radiotherapy use. This finding reflects the high level of agreement among treatment guidelines as well as the existence of high-quality evidence related to the management of gynecologic malignancies, and it may also be indicative of the fact that a large proportion of patients are treated in specialist units. The management of gynecologic malignancies may serve as a good ex le in the development of management strategies for other types of cancer.
Estimation of an optimal radiotherapy utilization rate for gastrointestinal carcinoma: a review of the evidence.
Publisher: Wiley
Date: 02-08-2004
DOI: 10.1002/CNCR.20443
Abstract: Radiotherapy utilization rates for cancer vary widely, both within and between countries. The optimal proportion of patients with gastrointestinal malignancies who should receive at least one course of radiotherapy at some time during their illness is an important benchmark. The authors studied treatment guidelines and treatment reviews to identify the indications for radiotherapy for patients with gastrointestinal malignancies. Optimal radiotherapy utilization trees were constructed to show the clinical attributes of patients with gastrointestinal carcinomas who will benefit from radiotherapy. Epidemiologic incidence data for each of these clinical attributes were obtained to calculate the optimal proportion of all patients with gastrointestinal malignancies for whom radiotherapy was considered appropriate. Optimal rates of radiotherapy use were compared with actual rates in population-based studies to assess any discrepancies between actual and optimal radiotherapy utilization rates. Radiotherapy was indicated in 80% of patients with esophageal carcinoma, 68% of patients with gastric carcinoma, 57% of patients with pancreatic carcinoma, 13% of patients with carcinoma of the gallbladder, 0% of patients with hepatic carcinoma, 14% of patients with colon carcinoma, and 61% of patients with rectal carcinoma. The actual radiotherapy utilization rates for most of these gastrointestinal malignancies fell well short of optimal rates, which were derived from evidence-based treatment guidelines. It is possible to model optimal radiotherapy utilization using published treatment guidelines and existing incidence data. There was a discrepancy between the optimal and actual rates of radiotherapy utilization for patients with carcinomas of the esophagus, stomach, pancreas, and rectum. Strategies to implement evidence-based clinical guidelines are recommended.
A review of the management of ductal carcinoma in situ following breast conserving surgery.
Publisher: Elsevier BV
Date: 12-2013
Variations in breast tangent radiotherapy: a survey of practice in New South Wales and the Australian Capital Territory.
Publisher: Wiley
Date: 08-1999
DOI: 10.1046/J.1440-1673.1999.433667.X
Abstract: The breast is a complex anatomical structure where achieving a homogeneous dose distribution with radiation treatment is difficult. Despite obvious similarities in the approach to such treatment (using tangents) there is variation in the process of simulation, planning and treatment between radiation oncologists. Previous Australasian studies in the treatment of lung cancer, prostate cancer and Hodgkin's disease highlighted considerable variation in many areas of treatment. As part of a multicentre breast phantom study involving 10 radiation oncology departments throughout New South Wales (NSW) and the Australian Capital Territory (ACT), a 22-question survey was distributed. The aim of the survey was to assess the extent of variation in the approach to the simulation, planning and treatment of early breast cancer using tangents. Responses from 10 different radiation oncology departments revealed variation in most areas of the survey. There is no reason to assume similar variations do not occur Australasia wide. Studies involving overseas radiation oncologists also reveal a wide variation in treating early breast cancer. The consequences of such variations remain unclear.
Prostate brachytherapy in New South Wales: patterns of care study and impact of caseload on treatment quality.
Publisher: Termedia Sp. z.o.o.
Date: 2015
The Pattern of Use of Hypofractionated Radiation Therapy for Early-Stage Breast Cancer in New South Wales, Australia, 2008 to 2012.
Publisher: Elsevier BV
Date: 10-2016
The population benefit of radiotherapy for gynaecological cancer: Local control and survival estimates.
Publisher: Elsevier BV
Date: 09-2016
DOI: 10.1016/J.RADONC.2016.04.008
Abstract: The population benefit of radiotherapy for gynaecological cancer (GC) if evidence-based guidelines were routinely followed is not known. This study's aim was to address this. Decision trees were utilised to estimate benefit. Radiotherapy alone (RT) benefit was the absolute proportional benefit of radiotherapy over no radiotherapy for radical indications, and over surgery alone for adjuvant indications. Chemoradiotherapy (CRT) benefit was the absolute incremental benefit of concurrent chemotherapy and RT over RT alone. Citation databases were systematically queried for the highest level of evidence defining 5-year Local Control (LC), and 2-year and 5-year Overall Survival (OS) benefit. Meta-analysis was performed if there were multiple sources of the same evidence level. Deterministic and probabilistic sensitivity analysis was performed. Guidelines supported 22 radiotherapy indications, of which 8 were for CRT. 21% of all GC had an adjuvant or curative radiotherapy indication. The absolute estimated population-based 5-year LC and OS benefits of RT, if all patients were treated according to guidelines, were: endometrial cancer LC 5.7% (95% CI (3.5%,8.2%)), OS 2.3% (1.2%,3.4%), ovarian cancer (nil), vulval cancer LC 10.0% (1.6%,18.2%), OS 8.5% (0.5%,15.9%). Combined with prior estimates for cervical cancer, RT benefits for all GC were LC 9.0% (7.8%,10.3%), OS 4.6% (3.8%,5.4%). The incremental benefit of CRT for all GC was LC 0.7% (0.4%,0.9%), OS 0.5% (0.2%,0.8%). Benefits were distinct from the contribution of other modalities. The model was robust in sensitivity analysis. Most radiotherapy benefit was irreplaceable by other modalities. Radiotherapy provides important and irreplaceable LC and OS benefits for GC when optimally utilised. The population model provided a robust means for estimating this benefit.
An evidence-based estimation of local control and survival benefit of radiotherapy for breast cancer.
Publisher: Elsevier BV
Date: 07-2007
Effect of oral sucralfate on late rectal injury associated with radiotherapy for prostate cancer: A double-blind, randomized trial.
Publisher: Elsevier BV
Date: 11-2004
DOI: 10.1016/J.IJROBP.2004.04.033
Abstract: To assess whether oral sucralfate is effective in preventing late rectal injury in prostate cancer patients treated with radiotherapy. A double-blind, placebo-controlled, randomized trial was conducted across four institutions in Australia. Patients receiving definitive radiotherapy for prostate cancer were randomized to receive either 3 g of oral sucralfate suspension or placebo twice daily. Data on patients' symptoms were collected for 2 years, and flexible sigmoidoscopy was scheduled at 12 months after treatment. A total of 338 patients were randomized, of whom 298 had adequate follow-up data available for an analysis of late symptoms. Of the 298 patients, 143 were randomized to receive sucralfate and 155 placebo. The cumulative incidence of Radiation Therapy Oncology Group Grade 2 or worse late rectal toxicity at 2 years was 28% for placebo and 22% for the sucralfate arm (p = 0.23 95% confidence interval for the difference -3% to 16%). Seventeen percent of patients in the sucralfate group had significant bleeding (Grade 2 or worse) compared with 23% in the placebo group (p = 0.18, 95% confidence interval -15% to 3%). No statistically significant difference was found between the two groups with respect to bowel frequency (p = 0.99), mucus discharge (p = 0.64), or fecal incontinence (p = 0.90). Sigmoidoscopy findings showed a nonstatistically significant reduction in Grade 2 or worse rectal changes from 32% with placebo to 27% in the sucralfate group (p = 0.25). This trial demonstrated no statistically significant reduction in the incidence of late rectal toxicity in patients randomized to receive sucralfate. However, this result was considered inconclusive, because the trial was unable to exclude clinically important differences in the late toxicity rates.
The importance of quality and safety in radiotherapy delivery.
Publisher: Elsevier BV
Date: 06-2020
Cancer Care Team’s Management of Clinical Alerts Generated by Electronically Collected Patient Reported Outcomes: We Could Do Better
Publisher: MDPI AG
Date: 21-01-2012
Abstract: Electronically administered patient-reported outcome measures (ePROMs) are effective digital health tools for informing clinicians about cancer patients’ symptoms and facilitating timely patient-centred care. This paper describes the delivery of healthcare activities supported by the PROMPT-Care model, including ePROMs generated clinical alerts, cancer care team (CCT) response to alerts, and patients’ perceptions of the CCT response and ePROMs system. This mixed-methods study includes cancer patients from four cancer therapy centres in New South Wales, Australia. Quantitative and qualitative data were collected regarding clinical alert activity, CCT response, and patient perceptions of the CCT responses and ePROMs system. Qualitative data were thematically analysed. Of the 328 participants whose care was informed by the digital health tool, 70.8% (n = 233) generated at least one alert during the trial period, with 877 alerts generated in total. Although 43.7% (n = 383) were actioned by the CCT, at least 80% of participants found follow-up CCT phone calls beneficial, with multiple benefits confirmed in interviews. The cancer care delivery arm of the PROMPT-Care trial involving clinical alerts to the CCT was positively perceived by most participants, resulting in a erse range of benefits. However, further work is required, informed by implementation science, to improve the percentage of actioned clinical alerts.
Strain Imaging Detects Dose-Dependent Segmental Cardiac Dysfunction in the Acute Phase After Breast Irradiation.
Publisher: Elsevier BV
Date: 09-2017
DOI: 10.1016/J.IJROBP.2017.05.030
Abstract: We examined the utility of echocardiographic 2-dimensional speckle tracking strain imaging (SI) for the evaluation of segmental myocardial dysfunction before and after radiation therapy (RT) and the relationship to dose exposure. We prospectively recruited 40 women with left-sided breast cancer, undergoing only adjuvant RT to the left chest. Comparisons of traditional echocardiographic parameters and SI parameters at baseline and 6 weeks after RT were analyzed. Regional strain and strain rate (SR) parameters were obtained from all 18 left ventricular segments. The correlation of change in strain parameters with segmental radiation dose was examined. We observed a significant reduction in global and segmental systolic strain parameters at 6 weeks after RT compared with baseline, with the largest decrement in the apical segments this corresponded with the segments receiving the highest radiation dose exposure (apical peak systolic strain of -21.21% ± 3.49% before RT vs -18.69% ± 3.34% after RT, percentage change of 11.88%, P=.002 apical peak systolic SR of -1.17 ± 0.24 s Two-dimensional SI detected dose-related regional myocardial dysfunction in the acute phase after RT in chemotherapy-naive left-sided breast cancer patients. Although the long-term effects remain unknown, this imaging modality may have a potential role in the evaluation of irradiation-related cardiotoxicity.
Clinical audit of a new radiation oncology department in the first 20 months of establishment.
Publisher: Wiley
Date: 02-1999
DOI: 10.1046/J.1440-1673.1999.00608.X
Abstract: This audit was carried out to examine the workload statistics of the Radiation Oncology Department at Liverpool Hospital in its first 20 months of operation, and their implications for the delivery of radiation oncology services in the Southwestern Sydney Area Health Service (SWSAHS). Data on patient demographics, primary diagnosis and radiotherapy treatment details from April 1995 to December 1996 were analysed. In this time period, 1329 new patients were seen 90.6% of them lived in the local area health service and approximately 30% came from a non-English-speaking background. The most common primary tumour sites were breast (25%), prostate (17%) and lung (15%). Nine hundred and ninety-eight of the new patients (74%) proceeded to have radiotherapy. Fifty-seven per cent were treated radically with curative or adjuvant intent, the remainder were treated palliatively for symptom control or local control. The most commonly used fractionation schedules were 31-35 fractions for radical treatment and 1-5 fractions for palliative treatment. Forty patients (4%) did not complete the treatment course as planned. Eighty-nine patients (9%) were retreated in the same time period. These workload statistics were helpful in determining ongoing workload and planning future expansion.
Parental feeding practices to manage snack food intake: Associations with energy intake regulation in young children
Publisher: Elsevier BV
Date: 04-2018
DOI: 10.1016/J.APPET.2017.12.024
Abstract: Little attention has been directed to understanding the relationship between restriction and regulation of snack food intake in toddlers. The aim of this study was to examine the effects of parental restriction of toddlers' eating of snacks in the absence of hunger (EAH) and to examine the impact of three contextual factors snack food access, frequency of snack food consumption, and attraction to snack food. 64 parents and toddlers (aged 22-36 months) took part in a protocol to measure EAH (defined as kJ of energy-dense snack foods consumed). Mean EAH was 199 kJ (SD = 299), with 43 children consuming at least some snacks. Restriction was measured with the Child Feeding Questionnaire Restriction subscale. Snack food access was measured with Allow Access from the Toddler Snack Food Feeding Questionnaire (TSFFQ), snack food consumption was measured with a short snack food frequency questionnaire, and attraction to snack foods was measured with Child's Attraction from the TSFFQ. Moderated regression analyses tested interactions between Restriction and contextual factors in predicting EAH. EAH was associated with Restriction (r = 0.25, p = .05, 95% CI 0.004 - 0.47). There was an interaction between Restriction and accessibility of snack foods (R These finding have practical relevance and reinforce the importance of the home food environment for managing young children's snack food intake.
Sucralfate cream in the management of moist desquamation during radiotherapy.
Publisher: Wiley
Date: 08-1997
DOI: 10.1111/J.1440-1673.1997.TB00672.X
Abstract: Randomized trials have shown that sucralfate is effective in the management of acute radiation reactions such as oesophagitis, mucositis and proctitis. However, at the time of commencement of the present trial, it had never been used in the management of moist desquamation of the skin. The purpose of the present study was to assess the value of sucralfate cream in the management of moist desquamation during radiotherapy. Patients who developed moist desquamation during radiation were eligible. Patients were stratified by site of radiotherapy into three groups: (i) the head and neck (ii) the breast and (iii) other sites. Patients were randomized to receive 10% sucralfate in sorbolene cream or sorbolene alone. Patients' pain and skin healing were assessed by using linear analogue self-assessment (LASA) scales and by serial measurement of the desquamated area. Due to poor patient accrual, the trial was terminated after 2 years and 39 patients. No statistically significant difference was found between the two arms in either time from randomization to healing or improvement in pain score. Twenty patients in the sucralfate arm took a geometric mean of 14.8 days to heal whereas 19 patients receiving sorbolene alone took a geometric mean of 14.2 days. The ratio of mean times of healing, 1.043, is not statistically different from 1 (P = 0.86 95% CI = 0.65, 1.67). A total of 75% of the patients reported pain relief on application of either cream. Mean LASA scores for pain for each day after randomization were compared by treatment arm and there was no statistically significant difference (P = 0.32). The present trial was unable to show a difference in terms of time to healing or pain relief in the treatment of moist desquamation. The small number of patients in the trial gave a wide confidence interval for treatment difference, implying that an important effect of sucralfate has not been excluded. Given the poor accrual in the present, single-institution study, future studies may need to be multi-institutional and we encourage other centres to perform randomized trials in the management of moist desquamation.
The impact of breast cosmetic and functional outcomes on quality of life: long-term results from the St. George and Wollongong randomized breast boost trial.
Publisher: Springer Science and Business Media LLC
Date: 12-04-2013
Stepping into the real world: a mixed-methods evaluation of the implementation of electronic patient reported outcomes in routine lung cancer care.
Publisher: Springer Science and Business Media LLC
Date: 16-02-2026
DOI: 10.1186/S41687-022-00475-6
Abstract: To realize the broader benefits of electronic patient-reported outcome measures (ePROMs) in routine care, we used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to inform the translation of a clinically effective ePROM system (hereafter referred to as the PRM system) into practice. The study aimed to evaluate the processes and success of implementing the PRM system in the routine care of patients diagnosed with lung cancer. A controlled before-and-after mixed-methods study was undertaken. Data sources included a self-report questionnaire and interviews with healthcare providers, electronic health record data for PRMs patients and historical controls, and field notes. Descriptive statistics, logistic regression modelling, negative binomial models, generalized estimating equations and repeated measures ANOVA were used to analyze quantitative data. Qualitative data was thematically analyzed. A total of 48/79 eligible people diagnosed with lung cancer completed 90 assessments during the 5-month implementation period (RE-AIM reach ). Every assessment breached the pre-defined threshold and care coordinators reviewed and actioned 95.6% of breaches, resulting in 146 referrals to allied health services, most frequently for social work (25.3%), dietetics (18.5%), physiotherapy (18.5%) and occupational therapy (17.1%). PRMs patients had significantly fewer visits to the cancer assessment unit for problematic symptoms (M = 0.23 vs. M = 0.43 p = 0.035), and were significantly more likely to be offered referrals (71% vs. 29%, p 0.0001) than historical controls (RE-AIM effect ). The levels of ‘organizational readiness for implementing change’ (ORIC) did not show much differences between baseline and follow-up, though this was already high at baseline but significantly more staff reported improved confidence when asking patients to complete assessments (64.7% at baseline vs. 88.2% at follow-up, p = 0.0046), and when describing the assessment tool to patients (64.7% at baseline vs. 76.47% at follow-up, p = 0.0018) (RE-AIM adoption ). A total of 78 staff received PRM system training, and 95.6% of the PRM system alerts were actioned (RE-AIM implementation ) and all lung cancer care coordinators were engaged with the PRM system beyond the end of the study period (RE-AIM maintenance ). This study demonstrates the potential of the PRM system in enhancing the routine care of lung cancer patients, through leveraging the capabilities of automated web-based care options. Research has shown the clear benefits of using electronically collected patient-reported outcome measures (ePROMs) for cancer patients and health services. However, we need to better understand how to implement ePROMs as part of routine care. This study evaluated the processes and outcomes of implementing an ePROMs system in the routine care of patients diagnosed with lung cancer. Key findings included: (a) a majority of eligible patients completed the scheduled assessments (b) patient concerns were identified in every assessment, and care coordinators reviewed and actioned almost all of these, including making significantly more referrals to allied health services (c) patients completing assessments regularly were less likely to present to the cancer assessment unit with problematic symptoms, suggesting that ePROMs identified patient concerns early and this led to a timely response to concerns (d) staff training and engagement was high, and staff reporting increased confidence when asking patients to complete assessments and when describing the assessment tool to patients at the end of the implementation period. This study shows that implementing ePROMs in routine care is feasible and can lead to improvements in patient care.
The use of categorized time-trend reporting of radiation oncology incidents: a proactive analytical approach to improving quality and safety over time.
Publisher: Elsevier BV
Date: 12-2010
The effect of oral sucralfate on the acute proctitis associated with prostate radiotherapy: a double-blind, randomized trial.
Publisher: Elsevier BV
Date: 11-2001
DOI: 10.1016/S0360-3016(01)01660-1
Abstract: Acute rectal complications occur in the majority of patients receiving external-beam radiotherapy for carcinoma of the prostate. Sucralfate has been proposed to reduce radiation-induced mucosal injury by forming a protective barrier on ulcer bases, binding local growth factors, and stimulating angiogenesis. However, there is conflicting clinical evidence as to whether sucralfate, taken prophylactically during radiotherapy, can ameliorate the symptoms of acute radiation proctitis. A double-blind randomized trial was conducted at four Radiation Oncology Departments in Sydney, Australia, between February 1995 and June 1997. A total of 338 patients with clinically localized prostate cancer receiving small volume radiotherapy, of whom 335 were evaluable, were randomized to receive either 3 g of oral sucralfate suspension or placebo twice a day during radiotherapy. Patients kept a daily record of their bowel symptoms and were graded according to the RTOG/EORTC acute toxicity criteria. One hundred sixty-four patients received sucralfate and 171 received placebo. Both groups were well balanced with regard to patient, tumor, treatment factors, and baseline symptoms, except that the placebo group had a significantly more liquid baseline stool consistency score (p = 0.004). Patients kept a daily diary of symptoms during radiotherapy. After adjusting for baseline values, there was no significant difference between the two groups with regard to stool frequency (p = 0.41), consistency (p = 0.20), flatus (p = 0.25), mucus (p = 0.54), and pain (p = 0.73). However, there was more bleeding in the sucralfate group, with 64% of patients noticing rectal bleeding, compared with 47% in the placebo group (p = 0.001). There was no significant difference between the two groups with respect to RTOG/EORTC acute toxicity (p = 0.88 sucralfate 13%, 44%, 43% and placebo 15%, 44%, 40% for grade 0, 1, and 2, respectively). This study suggests that oral sucralfate taken prophylactically during radiotherapy does not ameliorate the symptoms of acute radiation proctitis and may increase acute bleeding. The cause of the increased bleeding in the sucralfate group is unclear. As the pathogenesis of acute and late reactions are different, late follow-up, which includes sigmoidoscopic evaluation, is currently being performed on this cohort of patients.
Trends in the use of short-course radiation therapy for rectal cancer in New South Wales, Australia.
Publisher: Wiley
Date: 03-12-2021
Abstract: Trends in the use of short‐course radiation therapy (RT) for rectal cancer in Australia are unknown. The purpose of this study was to compare short‐course RT and long‐course chemoradiation (CRT) utilisation in the neoadjuvant treatment of rectal cancer in New South Wales (NSW). Patients who received neoadjuvant RT (2009–2014) for rectal cancer were identified from the NSW Central Cancer Registry. Univariate and multivariable analyses were performed to investigate factors associated with receipt of short‐course RT. A total of 1196 (81%) patients received long‐course CRT, and 274 (19%) patients received short‐course RT. Receipt of short‐course RT was associated with older age: 54% in patients ≥80 years, and 11% in patients years ( P 0.0001). Patients with T2 disease (30%) were more likely to receive short‐course RT, compared with T3 (19%) or T4 (8%) disease ( P = 0.002). Patients with N0 (23%) disease were more likely to be treated with short‐course RT, compared with N+ (16%) ( P = 0.03). The proportion of short‐course RT delivered to patients with Charlson Comorbidity Index (CCI) ≥ 2 (28%) was higher than patients with CCI = 0 (17%) ( P = 0.002). There was wide variation in the proportion of short‐course RT used across residence local health districts (5–29%) ( P 0.0001). In rectal cancer patients treated with neoadjuvant RT in NSW, 19% received short‐course RT. The use of short‐course RT was associated with older age, comorbidities and less advanced disease. Wide variation across NSW was identified and future research investigating factors for the variation will be useful.
The equivalent simple treatment visit (ESTV) model does not measure radiation oncology productivity under Australian conditions.
Publisher: Elsevier BV
Date: 1997
DOI: 10.1016/S0936-6555(97)80009-X
Abstract: The measurement of workload in radiation oncology departments has been based on the number of patients treated per linear accelerator per unit time, or on the number of fields treated per linear accelerator per unit time. The Equivalent Simple Treatment Visit (ESTV) model was proposed to allow for the incorporation of a factor for complexity of treatment techniques, to permit more detailed comparisons than those offered by previous measures. This prospective study was designed to assess the suitability of the ESTV model as a measure of radiation oncology productivity within an Australian radiation oncology department. A calculated ESTV value was assigned to all treatment fractions delivered in our department over a 4-week period. Treatment fractions were then timed using a stopwatch, and average treatment times for simple, intermediate and complex techniques were calculated and analysed by multiple t-tests for statistical significance. Average treatment times were 8.1 minutes (standard deviation (SD) = 4.2) for 'simple' techniques, 14.1 minutes (SD = 4.4) for 'intermediate' techniques, and 11.8 minutes (SD = 5.6) for 'complex' techniques. These times were significantly different from each other (P < 0.05). Although ESTV attempts to allow for the incorporation of a complexity factor into productivity reporting, a revision of the model is necessary, given the inconsistency by which a 'complex' technique takes significantly less time than an 'intermediate' technique.
Socio-economic status and patterns of care in lung cancer.
Publisher: Elsevier BV
Date: 08-2005
DOI: 10.1111/J.1467-842X.2005.TB00209.X
Abstract: This retrospective study aims to explore the associations between socio-economic factors and lung cancer management and outcomes in the Australian setting. The study population consisted of patients who were living in the Northern Sydney Area Health Service (NSAHS) or South Western Sydney Area Health Service (SWSAHS) at the time of their lung cancer diagnosis in 1996. Data on patient demographics, tumour characteristics, management details, recurrence and survival were collected and compared between the two areas. Socio-economic status indicators of the two Area Health Services were obtained from the Australian Bureau of Statistics. There were 270 and 256 new cases of lung cancer identified in NSAHS and SWSAHS respectively. Patients in NSAHS were slightly older and there were more women. Based on the 1996 Census data, the population of NSAHS is more affluent, better educated and more likely to be employed compared with SWSAHS. The stage distributions and performance status of the two areas were similar. The utilisation rates of different treatment modalities in the two areas were similar except for chemotherapy. The five-year overall survival rate was 10.5% in NSAHS and 7.2% in SWSAHS (p=0.08). Comparison based on the SEIFA Index of Relative Socio-economic Disadvantage did not reveal significant differences. Patients with lung cancer had similar patterns of care and survival despite differences in socio-economic profiles between the two Area Health Services. There seems to be equity of access to lung cancer services between the two Area Health Services.
Australian integrative oncology services: a mixed-method study exploring the views of cancer survivors
Publisher: Springer Science and Business Media LLC
Date: 09-05-2018
Ten-year Mortality, Disease Progression, and Treatment-related Side Effects in Men with Localised Prostate Cancer from the ProtecT Randomised Controlled Trial According to Treatment Received.
Publisher: Elsevier BV
Date: 03-2019
Survey of image-guided radiotherapy use in Australia.
Publisher: Wiley
Date: 09-11-2016
Infrastructure platform for privacy-preserving distributed machine learning development of computer-assisted theragnostics in cancer
Publisher: Elsevier BV
Date: 10-2022
The potential for an enhanced role for MRI in radiation-therapy treatment planning.
Publisher: SAGE Publications
Date: 10-2013
Abstract: The exquisite soft-tissue contrast of magnetic resonance imaging (MRI) has meant that the technique is having an increasing role in contouring the gross tumor volume (GTV) and organs at risk (OAR) in radiation therapy treatment planning systems (TPS). MRI-planning scans from diagnostic MRI scanners are currently incorporated into the planning process by being registered to CT data. The soft-tissue data from the MRI provides target outline guidance and the CT provides a solid geometric and electron density map for accurate dose calculation on the TPS computer. There is increasing interest in MRI machine placement in radiotherapy clinics as an adjunct to CT simulators. Most vendors now offer 70 cm bores with flat couch inserts and specialised RF coil designs. We would refer to these devices as MR-simulators. There is also research into the future application of MR-simulators independent of CT and as in-room image-guidance devices. It is within the background of this increased interest in the utility of MRI in radiotherapy treatment planning that this paper is couched. The paper outlines publications that deal with standard MRI sequences used in current clinical practice. It then discusses the potential for using processed functional diffusion maps (fDM) derived from diffusion weighted image sequences in tracking tumor activity and tumor recurrence. Next, this paper reviews publications that describe the use of MRI in patient-management applications that may, in turn, be relevant to radiotherapy treatment planning. The review briefly discusses the concepts behind functional techniques such as dynamic contrast enhanced (DCE), diffusion-weighted (DW) MRI sequences and magnetic resonance spectroscopic imaging (MRSI). Significant applications of MR are discussed in terms of the following treatment sites: brain, head and neck, breast, lung, prostate and cervix. While not yet routine, the use of apparent diffusion coefficient (ADC) map analysis indicates an exciting future application for functional MRI. Although DW-MRI has not yet been routinely used in boost adaptive techniques, it is being assessed in cohort studies for sub-volume boosting in prostate tumors.
Estimation of the optimal brachytherapy utilization rate in the treatment of carcinoma of the uterine cervix: review of clinical practice guidelines and primary evidence.
Publisher: Wiley
Date: 2006
DOI: 10.1002/CNCR.22337
Absence of adverse early quality of life outcomes of radiation therapy in breast conservation therapy for early breast cancer
Publisher: Wiley
Date: 02-2005
DOI: 10.1111/J.1440-1673.2005.01392.X
Abstract: The New South Wales Breast Radiation Oncology Group has completed a prospective multicentre study of the impact of radiation therapy (RT) on acute toxicity and quality of life (QoL) in women with early breast cancer treated with breast conservation therapy. The patient group received adjuvant breast tangential RT after wide local excision of breast cancer. Acute toxicity and cosmesis was assessed quantitatively and qualitatively. European Organization of Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-30) and Perceived Adjustment to Chronic Illness Scale (PACIS) were the QoL instruments used. Of 175 women, 34.3% described lethargy leading to a significant disruption to normal activity during RT. At week 6, this had reduced to 7.5% reporting significant lethargy. No negative effects on QoL were noted over the time period of RT EORTC demonstrated no difference (P = 0.79). PACIS recorded a significant improvement in functioning (P < 0.001) from baseline to week 6. Univariate analysis on potential predictive patient, tumour and treatment factors demonstrated an association of baseline pre-RT breast discomfort with worse lethargy (P = 0.03), EORTC (P < 0.01) and PACIS (P < 0.01) measures. This study confirms the minimal impact of RT on patient functioning at 6 weeks post-treatment.
Hospital policies on complementary medicine: a cross-sectional survey of Australian cancer services.
Publisher: AMPCo
Date: 12-08-2020
DOI: 10.5694/MJA2.50731
Variations in breast cancer histology and treatment patterns between the major ethnic groups of South West Sydney.
Publisher: Hindawi Limited
Date: 19-12-2017
DOI: 10.1111/TBJ.12973
A comparison of surgical and radiotherapy breast cancer therapy utilization in Canada (British Columbia), Scotland (Dundee), and Australia (Western Australia) with models of optimal therapy.
Publisher: Elsevier BV
Date: 08-2012
Underutilization of radiotherapy for lung cancer in New South Wales, Australia
Publisher: Wiley
Date: 02-12-2010
DOI: 10.1002/CNCR.24762
Abstract: Lung cancer is the leading cause of cancer death in most developed countries. Radiotherapy is important in its treatment, with an estimated optimal utilization rate between 45% and 68% at initial diagnosis. The objective of this study was to describe radiotherapy practice for lung cancer in New South Wales (NSW), Australia. Patients with lung cancer were identified prospectively from the NSW Central Cancer Registry (CCR) from November 1, 2001 to December 31, 2002. Questionnaires were mailed to diagnosing and treating clinicians to obtain detailed information on diagnosis, staging, referrals, and treatment. The authors describe referral for and receipt of radiotherapy treatment. Of 1812 patients with lung cancer patients who were identified, 943 patients (52%) were referred for radiotherapy, 846 patients (47%) received a radiotherapy questionnaire, and 727 patients (40%) received radiotherapy. Compared with optimal radiotherapy, there was less curative radiotherapy to the primary site (20% actual vs 50% optimal), and there was more palliative radiotherapy to metastatic sites (36% actual vs 11% optimal). The greatest shortfall in radiotherapy use was observed in patients who had limited stage small cell lung cancer (46% actual vs 94% optimal). The use of combined-modality treatment for stage III nonsmall cell lung cancer and for limited stage small cell lung cancer was uncommon. There is underutilization of radiotherapy for lung cancer in NSW, especially in small cell lung cancer. The use of combined-modality treatment for potentially curable lung cancers is suboptimal. These issues have to be addressed to improve survival and quality of life for patients with lung cancer.
Testing criterion-based benchmarking for the appropriate use of radiotherapy.
Publisher: Elsevier BV
Date: 09-2018
DOI: 10.1016/J.RADONC.2018.05.023
Abstract: Planning for radiotherapy (RT) services requires information on the proportion of patients who should be given radiotherapy. Criterion-Based Benchmark (CBB) has been proposed in Canada to estimate the proportion of cancer patients who should be treated with radiotherapy. The aim of this study was to assess CBB in a health system outside of Canada. Radiotherapy data for all new cases of cancer in New South Wales (NSW), and the Australian Capital Territory (ACT) Australia in 2004-06 and were linked to Central Cancer Registry records. Road distances between patient residence and the nearest RT centre were calculated. Local Government Areas (LGAs) with public radiotherapy departments were selected as CBB LGAs if they met the following criteria: 1. Patients make no direct payment for radiotherapy. 2. All RT is provided by site-specialised radiation oncologists in multi-disciplinary centres. 3. Radiation oncologists receive salary for their service. 4. More than 75% of patients live within 30 km from the nearest RT, and 5. Patients' waiting times were <4 weeks. 25,383 (26%) out of 98,000 eligible patients in NSW and ACT received radiotherapy in the study period as part of their initial treatment. An average of 31% of patients in the CBB LGAs received radiotherapy compared to an average of 26% in all LGAs during the study period. NSW-ACT RT utilisation for selected tumour sites was 7-16% higher in the CBB LGAs than in all LGAs, but was still 30-65% below the estimated optimal radiotherapy utilisation rates and differed significantly from Canadian CBBs. CBB is based on the assumption that there is perfect service delivery in some parts of the health service that can be used to benchmark the whole service. It may be applicable in well-resourced publicly-funded services in Canada, but the CBB approach may not be reproducible in other jurisdictions.
Breast radiotherapy: an Australasian survey of current treatment techniques.
Publisher: Wiley
Date: 17-05-2001
DOI: 10.1046/J.1440-1673.2001.00898.X
Abstract: Prior to the dissemination of evidence-based quality assurance guidelines, the Australian National Breast Cancer Centre Radiation Oncology Group conducted a process survey of breast radiotherapy treatment delivery throughout Australia. A process survey was conducted in August/September 1998. This survey comprised questions enquiring about treatment positioning, immobilization devices used, planning strategies, simulation and dose computation methods, treatment prescribing and quality assurance. The survey was sent to 123 Australian fellows of the Royal Australian and New Zealand College of Radiologists (RANZCR) and to the six directors of New Zealand radiation oncology departments. Fifty-eight questionnaires were returned of which 38 were received from in iduals and 20 represented a reply from a department with a routine breast radiotherapy protocol (representing an average of 4.5 radiation oncologists per reply). The study identified great consistency between departments with respect to dose and fractionation for breast tangents. The study also identified some areas of treatment planning and delivery that varied between in iduals or departments. These mainly reflected a lack of evidence in some areas of radiotherapy treatment delivery. The circulation of quality assurance guidelines will perhaps improve consistency of radiotherapy techniques in which studies have identified that technique changes improve outcome. This study identified that these areas include the taking of simulation and port films and the use of off-axis dosimetry. Further studies are required for areas of radiotherapy treatment delivery that have little evidence for or against their implementation.
Prediction of outcome of early ER+ breast cancer is improved using a biomarker panel, which includes Ki-67 and p53.
Publisher: Springer Science and Business Media LLC
Date: 28-06-2011
DOI: 10.1038/BJC.2011.228
Development of Health Pathways to Standardize Cancer Care Pathways Informed by Patient-Reported Outcomes and Clinical Practice Guidelines.
Publisher: American Society of Clinical Oncology (ASCO)
Date: 12-2018
DOI: 10.1200/CCI.18.00024
Abstract: High-quality symptom management and supportive care are essential components of comprehensive cancer care. We aimed to describe the development of an evidence-based automated decisional algorithm for patients with cancer that had specific, actionable, clinical, evidence-based recommendations to improve patient care, communication, and management. We reviewed existing literature and clinical practice guidelines to identify priority domains of patient care and potential clinical recommendations. Two multidisciplinary clinical advisory groups used a two-stage consensus decision-making approach to determine domains of care and patient-reported outcome (PRO) measures and subsequently developed automated algorithms with clear clinical recommendations amendable to intervention in clinical settings. Algorithms were developed to inform management of patient symptoms, distress, and unmet needs. Three PRO measures were chosen: Distress Thermometer and problem checklist, Edmonton Symptom Assessment Scale, and the Supportive Care Needs Survey–Screening Tool 9. PRO items were mapped to five domains of patient well-being: physical, emotional, practical, social and family, and maintenance of well-being. A total of 15 actionable clinical recommendations tailored to specific issues of concern were established. Using automated algorithms and clinical recommendations provides a platform for streamlining and systematizing the use of PROs to inform risk-stratified guideline-informed care. The series of algorithms, which set out systematized care pathways for the clinical care of patients with cancer, can be used to potentially inform patient-centered care.
An assessment of the Basic Treatment Equivalent (BTE) model as measure of radiotherapy workload.
Publisher: Elsevier BV
Date: 1997
DOI: 10.1016/S0936-6555(97)80008-8
Abstract: Current methods of linear accelerator workload analysis in radiation oncology use patients per hour or fields per hour as the basic unit of measurement but fail to take account of the variations in complexity of different treatment techniques. The Basic Treatment Equivalent (BTE) model of productivity assessment has been derived as a potentially better measure of workload because it includes a complexity factor. This model has now been tested prospectively in ten radiation oncology departments in New South Wales and compared with the numbers of fields and patients per hour. Over a 4-week period there were 50,115 fields administrated in 18,466 fractions in 441 hours of machine time in ten radiation oncology departments. The average productivity results for all departments were 4.18 patients, 11.25 fields and 5.66 BTE per hour. When compared with patients per hour and fields per hour, there was less variability of BTE per patient per hour in all departments, suggesting that most departments deliver radiation therapy in a consistent way, which is not appropriately reflected in the numbers of fields or patients per hour. Departments that were able to treat a high number of patients or fields per hour were able to do so because they used less complicated techniques or had a less complicated casemix of patients. The BTE model allows for variations in the complexity of treatment techniques, is simple to apply, and is reproducible under different conditions in different departments. Following revision of the model, an Australasian study is now proposed. The confirmation of our findings will have significant implications for resource utilization comparisons, patient time allocations, waiting list estimates and cost-benefit analysis.
Evaluation of traditional and novel echocardiographic methods of cardiac diastolic dysfunction post radiotherapy in breast cancer.
Publisher: Elsevier BV
Date: 09-2017
DOI: 10.1016/J.IJCARD.2017.05.007
Abstract: To investigate alterations in left ventricular (LV) diastolic function using traditional and novel echocardiographic parameters, following radiation therapy (RT) in breast cancer patients in the acute setting. 40 chemotherapy-naïve women with left-sided breast cancer undergoing RT were prospectively recruited. A comprehensive transthoracic echocardiogram (TTE) was performed at baseline, during RT and 6weeks post-RT. Traditional echocardiographic diastolic parameters and diastolic strain rate were measured and analysed. The relationship between alterations in diastolic parameters, changes in global longitudinal systolic strain (GLS) and radiation dose were investigated. Traditional diastolic parameters remained largely unchanged however diastolic strain parameters, E-Sr and A-Sr were significantly reduced 6weeks post-RT [Longitudinal E-Sr (s Diastolic dysfunction was only evident acutely, post-RT with the use of newer methods like strain analysis. A significant reduction in diastolic function was seen in the patient subgroup with ≥10% reduction in systolic function, enhancing the notion of diastolic function as a potential indicator for systolic dysfunction. Future longitudinal studies are required to determine the specific prognostic value of these observations.
Variation in the use of radiotherapy fractionation for breast cancer: Survival outcome and cost implications.
Publisher: Elsevier BV
Date: 11-2020
Quality of life after breast-conserving therapy and adjuvant radiotherapy for non-low-risk ductal carcinoma in situ (BIG 3-07/TROG 07.01): 2-year results of a randomised, controlled, phase 3 trial
Publisher: Elsevier BV
Date: 05-2020
Estimating the optimal external-beam radiotherapy utilization rate for genitourinary malignancies.
Publisher: Wiley
Date: 2005
DOI: 10.1002/CNCR.20789
Abstract: Benchmark radiotherapy utilization rates for genitourinary malignancies are largely unknown, despite the finding that genitourinary cancers comprise approximately 19% of all registered malignancies in Australia. To develop an evidence-based benchmark of the optimal proportion of patients with genitourinary malignancies who should receive at least one course of radiotherapy at some time during their illness, the authors studied treatment guidelines and treatment reviews regarding genitourinary malignancies. Optimal radiotherapy utilization trees were constructed to show the clinical attributes that indicated possible benefit from radiotherapy based on evidence. Epidemiologic incidence data for each of these clinical attributes were obtained to calculate the optimal proportion of all patients with genitourinary cancer for whom radiotherapy was considered appropriate. The proportion of patients with genitourinary malignancies for whom radiotherapy was indicated at some point in their illness, according to the best available evidence, was estimated to be 27% of patients with renal cancer, 58% of patients with bladder cancer, 60% of patients with prostate cancer, and 49% of patients with testicular cancer. The occurrence of ureteric and penile cancers among patients was too rare, and, therefore, these patients were not included in the current study. There was a large discrepancy between actual radiotherapy utilization and the evidence-based optimal rate. The authors recommended strategies to implement the evidence-based guidelines. Evidence-based benchmarks for radiotherapy utilization rates such as the ones described in the current study were important in the evaluation of the appropriate use of radiotherapy.
Estimation of an evidence-based benchmark for the optimal endocrine therapy utilization rate in breast cancer.
Publisher: Elsevier BV
Date: 10-2010
Prediction of local recurrence, distant metastases, and death after breast-conserving therapy in early-stage invasive breast cancer using a five-biomarker panel
Publisher: American Society of Clinical Oncology (ASCO)
Date: 10-2009
Abstract: To determine the clinical utility of intrinsic molecular phenotype after breast-conserving therapy (BCT) with lumpectomy and whole-breast irradiation with or without a cavity boost. Four hundred ninety-eight patients with invasive breast cancer were enrolled into a randomized trial of BCT with or without a tumor bed radiation boost. Tumors were classified by intrinsic molecular phenotype as luminal A or B, HER-2, basal-like, or unclassified using a five-biomarker panel: estrogen receptor, progesterone receptor, HER-2, CK5/6, and epidermal growth factor receptor. Kaplan-Meier and Cox proportional hazards methodology were used to ascertain relationships to ipsilateral breast tumor recurrence (IBTR), locoregional recurrence (LRR), distant disease-free survival (DDFS), and death from breast cancer. Median follow-up was 84 months. Three hundred ninety-four patients were classified as luminal A, 23 were luminal B, 52 were basal, 13 were HER-2, and 16 were unclassified. There were 24 IBTR (4.8%), 35 LRR (7%), 47 distant metastases (9.4%), and 37 breast cancer deaths (7.4%). The overall 5-year disease-free rates for the whole cohort were: IBTR 97.4%, LRR 95.6%, DDFS 92.9%, and breast cancer–specific death 96.3%. A significant difference was observed for survival between subtypes for LRR (P = .012), DDFS (P = .0035), and breast cancer–specific death (P = .0482), but not for IBTR (P = .346). The 5-year and 10-year survival rates varied according to molecular subtype. Although this approach provides additional information to predict time to IBTR, LRR, DDFS, and death from breast cancer, its predictive power is less than that of traditional pathologic indices. This information may be useful in discussing outcomes and planning management with patients after BCT.
Surgical and radiotherapy patterns of care in the management of breast cancer in NSW and ACT Australia.
Publisher: Wiley
Date: 30-11-2021
Abstract: This study aims to report on the surgical and radiotherapy patterns of breast cancer care in New South Wales (NSW) and Australian Capital Territory (ACT) in Australia, to identify factors that impact on utilisation of evidence‐based treatment and to report on the overall survival (OS) rate and the influencing factors on OS. Cancer registry data linked to hospital records for all patients with breast cancer diagnosis in NSW and ACT between 2009 and 2014 were used to calculate rates of breast conserving surgery (BCS), mastectomy, sentinel lymph node biopsy (SLNB), axillary lymph node dissection (ALND) and radiotherapy. Multivariate analysis used to identify factors that led to variations in care. 5‐year OS was calculated and cox regression model assessed factors that influenced survival. Data for 30,337 patients were analysed. BCS and mastectomy rates were 64% and 36%, respectively. The SLNB, ALND and ALND after SLNB rates were 61.5%, 32.1% and 6.4%, respectively. Radiotherapy was utilised in 63%. Younger age, socio‐economic disadvantage, longer distance to a radiotherapy facility and overseas place of birth were factors that predicted for increased rates of mastectomy and ALND. Radiotherapy was more likely to be utilised in later years of diagnosis, patients between 40‐69 years old, and those who lived in major cities and closer to a radiotherapy facility. 5‐year OS was 80.5%. Older patients, the socioeconomically disadvantaged and those advanced tumours had worse survival. Variations in breast cancer care continue to exist in certain patient groups that we identified. Targeted strategic planning and further research to identify other drivers of existing disparities remain a priority.
Providing outpatient cancer care for CALD patients: a qualitative study.
Publisher: Springer Science and Business Media LLC
Date: 09-08-2021
DOI: 10.1186/S13104-021-05724-3
Abstract: There have been few descriptions of how outpatient cancer care is provided to patients from culturally and linguistically erse (CALD) communities. As populations who experience disparities in cancer care access and outcomes, deeper understanding is needed to help identify those factors which can shape the receipt of multidisciplinary care in ambulatory settings. This paper reports on data collected and analysed as part of a multicentre characterisation of care in Australian public hospital cancer outpatient clinics (OPCs). Analysis of data from our ethnographic study of four OPCs identified three themes: “Identifying CALD patient language-related needs” “Capacity and resources to meet CALD patient needs”, and “Making it work for CALD communities.” The care team comprises not only clinicians but also families and non-clinical staff OPCs serve as “touchpoints” facilitating access to a range of therapeutic services. The findings highlight the potential challenges oncology professionals negotiate in providing care to CALD communities and the ways in which clinicians adapt their practices, formulate strategies and use available resources to support care delivery.
Experimental evaluation of position control methods for hydraulic systems
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 11-2002
A model for decision making for the use of radiotherapy in lung cancer
Publisher: Elsevier BV
Date: 02-2003
DOI: 10.1016/S1470-2045(03)00984-7
Abstract: To develop an evidence-based benchmark for the use of radiotherapy in lung cancer, we did a systematic review of treatment guidelines on radiotherapy for lung cancer. We then constructed an optimum use of radiotherapy "tree" from epidemiological data, which shows the proportion of patients with clinical attributes indicating that they would benefit from radiotherapy. We calculated that the proportion of patients with lung cancer in whom radiotherapy is indicated (according to the best available evidence) is 76%. We then compared this ideal rate with the actual rates of use of radiotherapy for lung cancer in Australia, and internationally, in the past decade. A substantial discrepancy was found between the evidence-based recommended rate of use and the actual rates reported in clinical practice. We hope this model will be used to plan efficient and cost-effective radiotherapy services.
Estimation of an optimal chemotherapy utilisation rate for colon cancer: an evidence-based benchmark for cancer care.
Publisher: Elsevier BV
Date: 09-2009
Clinical trials knowledge and attitudes of Vietnamese- and Anglo-Australian cancer patients: A cross-sectional study.
Publisher: Wiley
Date: 10-08-2020
DOI: 10.1111/AJCO.13388
Three-dimensional dose distribution of tangential breast irradiation: results of a multicentre phantom dosimetry study
Publisher: Elsevier BV
Date: 10-2000
DOI: 10.1016/S0167-8140(00)00262-0
Abstract: One aspect of good radiotherapeutic practice is to achieve dose homogeneity. Dose inhomogeneities occur with breast tangent irradiation, particularly in women with large breasts. Ten Australian radiation oncology centres agreed to participate in this multicentre phantom dosimetry study. An Alderson radiation therapy anthropomorphic phantom with attachable breasts of two different cup sizes (B and DD) was used. The entire phantom was capable of having thermoluminescent dosimeters (TLD) material inserted at various locations. Nine TLD positions were distributed throughout the left breast phantom including the superior and inferior planes. The ten centres were asked to simulate, plan and treat (with a prescription of 100 cGy) the breast phantoms according to their standard practice. Point doses from resultant computer plans were calculated for each TLD position. Measured and calculated (planning computer) doses were compared. The dose planning predictability between departments did not appear to be significantly different for both the small and large breast phantoms. The median dose deviation (calculated dose minus measured dose) for all centres ranged from 2. 3 to 5.3 cGy on the central axis and from 2.1 to 7.5 cGy for the off-axis planes. The highest absolute dose was measured in the inferior plane of the large breast (128.7 cGy). The greatest dose inhomogeneity occurred in the small breast phantom volume (median range 93.2-105 cGy) compared with the large breast phantom volume (median range, 100.1-107.7 cGy). There was considerable variation in the use (or not) of wedges to obtain optimized dosimetry. No department used 3D compensators. The results highlight areas of potential improvement in the delivery of breast tangent radiotherapy. Despite reasonable dose predictability, the greatest dose deviation and highest measured doses occurred in the inferior aspects of both the small and large breast phantoms.
Hypofractionated versus conventionally fractionated radiotherapy for ductal carcinoma in situ (DCIS) of the breast
Publisher: Wiley
Date: 05-01-2016
Abstract: Hypofractionated radiotherapy (RT) in the setting of early invasive breast cancer has been shown to have similar local control rates and cosmetic outcomes as conventionally fractionated RT. This study compares ipsilateral recurrence rates between hypofractionated and conventional RT, with and without a boost. The effect of hypofractionated RT and chest wall separation (CWS) on cosmetic outcome was also assessed. All patients with ductal carcinoma in situ (DCIS) treated between 1998 and 2012 across two sites of a single cancer institution were retrospectively studied. Patients were analysed according to those receiving conventional RT (≤2 Gy per fraction) and those receiving hypofractionated RT (>2 Gy per fraction), as well as the presence or absence of a tumour bed boost. Data were collected through electronic medical records and local cancer registry. Cosmetic outcome was scored by physicians on a four-point scale during clinical follow-up appointments. One hundred and ninety-seven patients were treated for DCIS during the study period. One hundred and forty-one were treated with conventional RT, and 56 with hypofractionated RT. After a median follow up of 4.4 years, there were 12 ipsilateral recurrences, of which seven were invasive disease and five DCIS. Ten recurrences occurred in patients who received conventional RT (7.1% recurrence rate) and two in those who received hypofractionated RT (3.6% recurrence rate) (P = 0.48). Cosmetic outcomes were not significantly different between conventional and hypofractionated RT (P = 0.06). Hypofractionation represents a suitable alternative for treating DCIS in the absence of randomised data.
Patterns of care study of brachytherapy in New South Wales: malignancies of the uterine corpus.
Publisher: Termedia Sp. z.o.o.
Date: 2015
Web-Based Patient-Reported Outcome Measures for Personalized Treatment and Care (PROMPT-Care): Multicenter Pragmatic Nonrandomized Trial (Preprint)
Publisher: JMIR Publications Inc.
Date: 28-04-2020
Abstract: espite the acceptability and efficacy of e–patient-reported outcome (ePRO) systems, implementation in routine clinical care remains challenging. his pragmatic trial implemented the PROMPT-Care (Patient Reported Outcome Measures for Personalized Treatment and Care) web-based system into existing clinical workflows and evaluated its effectiveness among a erse population of patients with cancer. dult patients with solid tumors receiving active treatment or follow-up care in four cancer centers were enrolled. The PROMPT-Care intervention supported patient management through (1) monthly off-site electronic PRO physical symptom and psychosocial well-being assessments, (2) automated electronic clinical alerts notifying the care team of unresolved clinical issues following two consecutive assessments, and (3) tailored online patient self-management resources. Propensity score matching was used to match controls with intervention patients in a 4:1 ratio for patient age, sex, and treatment status. The primary outcome was a reduction in emergency department presentations. Secondary outcomes were time spent on chemotherapy and the number of allied health service referrals. rom April 2016 to October 2018, 328 patients from four public hospitals received the intervention. Matched controls (n=1312) comprised the general population of patients with cancer, seen at the participating hospitals during the study period. Emergency department visits were significantly reduced by 33% ( i P /i =.02) among patients receiving the intervention compared with patients in the matched controls. No significant associations were found in allied health referrals or time to end of chemotherapy. At baseline, the most common patient reported outcomes (above-threshold) were fatigue (39%), tiredness (38.4%), worry (32.9%), general wellbeing (32.9%), and sleep (24.1%), aligning with the most frequently accessed self-management domain pages of physical well-being (36%) and emotional well-being (23%). The majority of clinical feedback reports were reviewed by nursing staff (729/893, 82%), largely in response to the automated clinical alerts (n=877). lgorithm-supported web-based systems utilizing patient reported outcomes in clinical practice reduced emergency department presentations among a erse population of patients with cancer. This study also highlighted the importance of (1) automated triggers for reviewing above-threshold results in patient reports, rather than passive manual review of patient records (2) the instrumental role nurses play in managing alerts and (3) providing patients with resources to support guided self-management, where appropriate. Together, these factors will inform the integration of web-based PRO systems into future models of routine cancer care. ustralian New Zealand Clinical Trials Registry ACTRN12616000615482 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370633 R2-10.1186/s12885-018-4729-3
The development of a new basic treatment equivalent model to assess linear accelerator throughput.
Publisher: Elsevier BV
Date: 08-2005
DOI: 10.1016/J.CLON.2005.02.016
Abstract: The basic treatment equivalent (BTE) model was developed in 1996 in an attempt to improve the measurement of linear accelerator throughput in radiotherapy. This study aimed to assess the effect of treatment set-up and patient characteristics on fraction duration, to update the BTE model and to determine the better throughput measure between fields per hour and BTE per hour. Stopwatch measurements of the duration of each radiotherapy treatment fraction delivered on each linear accelerator in participating New South Wales radiation oncology departments over a 5-day period in 2003 were undertaken. Patient, equipment and staff data were collected to assess the effect of these variables on fraction duration. A new BTE equation was derived, including the most significant variables. Statistical comparison of fields and BTE per unit time was made to assess the better predictor of fraction duration. Data collected on 27 linear accelerators in 13 departments included a total of 135 days of linear accelerator operation, 4316 fractions and 12 892 treatment fields. Seventeen factors significantly influenced fraction duration (P < 0.01). These accounted for 46% of the total variance in the models. The eight most influential predictors of prolonged fraction duration were included in the BTE model. These were as follows: high number of fields, high number of port films/electronic portal imaging, absence of automatic field-sequencing and multi-leaf collimation, high number of junctions, use of bolus and first fraction of a treatment course. The BTE per hour was shown to be a better predictor of throughput than fields per hour. The BTE model is a better measure of linear accelerator throughput. It incorporates weightings for treatment and patient factors that significantly influenced fraction duration. This measure could be routinely collected by the radiation oncology departments and included in the electronic radiotherapy information systems.
Cilazapril and dietary gamma-linolenic acid prevent the deficit in sciatic nerve conduction velocity in the streptozotocin diabetic rat
Publisher: Elsevier BV
Date: 03-1998
DOI: 10.1016/S1056-8727(97)00072-X
Abstract: Young adult male Hooded Wistar rats were rendered diabetic by administration of streptozotocin and maintained for 5 weeks on a diet containing either 6% olive oil as the total source of fat (OO diet), or purified gamma-linolenic acid (GLA) at a concentration of 0.5% with the remaining 5.5% provided by olive oil (GLA diet). Rats were treated with the angiotensin converting inhibitor, cilazapril, administered in the drinking water at a dose of 20 mg kg-1 body weight day-1. For the OO diet groups, sciatic nerve conduction velocity (NCV) in diabetic rats was reduced by 32% (p < 0.01) in comparison with nondiabetic (vehicle-treated) rats and 27.5% (p < 0.05) in comparison with diabetic rats treated with cilazapril. Diabetic, cilazapril-treated rats showed no reduction in NCV. For the nondiabetic, diabetic, and diabetic plus cilazapril groups fed GLA, the NCV was not significantly different, indicating that dietary GLA also prevented the deficit in the NCV induced by the diabetic state. Analysis of the sciatic nerve endoneurial phospholipid fatty acids revealed a significant reduction in the proportion of GLA and an elevation in the proportion of linoleic acid in the diabetic groups compared with the nondiabetic groups and this was independent of the cilazapril treatment or the dietary lipid supplement. Sciatic nerve myo-inositol content was unaltered while mannose, fructose, glucose, and sorbitol levels were elevated in the diabetic groups and these changes were independent of the cilazapril treatment or the dietary lipid supplement. These results indicate that in the rat, cilazapril treatment or dietary GLA, at the doses tested, are effective in preventing the deficit in the NCV induced by diabetes.
International comparison of cosmetic outcomes of breast conserving surgery and radiation therapy for women with ductal carcinoma in situ of the breast.
Publisher: Elsevier BV
Date: 2019
Establishing treatment benchmarks for mammography-screened breast cancer population based on a review of evidence-based clinical guidelines.
Publisher: Wiley
Date: 21-04-2008
DOI: 10.1002/CNCR.23384
What is multidisciplinary cancer care like in practice? a protocol for a mixed-method study to characterise ambulatory oncology services in the Australian public sector
Publisher: BMJ
Date: 10-2019
DOI: 10.1136/BMJOPEN-2019-031179
Abstract: An understanding of the real-world provision of oncology outpatient services can help maintain service quality in the face of escalating demand and tight budgets, by informing the design of interventions that improve the effectiveness or efficiency of provision. The aims of this study are threefold. First, to develop an understanding of cancer services in outpatient clinics by characterising the organisation and practice of multidisciplinary care (MDC). Second, to explore the key areas of: (a) clinical decision-making and (b) engagement with patients’ supportive needs. Third, to identify barriers to, and facilitators of, the delivery of quality care in these settings. A suite of mixed-methods studies will be implemented at six hospitals providing cancer outpatient clinics, with a staged roll-out. In Stage One, we will examine policies, use unstructured observations and undertake interviews with key health professionals to characterise the organisation and delivery of MDC. In Stage Two, observations of practice will continue, to deepen our understanding, and to inform two focused studies. The first will explore decision-making practices and the second will examine how staff engage with patients’ needs both studies involve interviews, to complement observation. As part of the study of supportive care, we will examine the implications of an introduction of patient-reported measures (PRMs) into care, adding surveys to interviews before and after PRMs roll-out. Data analysis will account for site-specific and cross-site issues using an adapted Qualitative Rapid Appraisal, Rigorous Analysis approach. Quantitative data from clinician surveys will be statistically analysed and triangulated with the related qualitative study findings. Ethical approval was granted by South Eastern Sydney Local Health District Human Research Ethics Committee (no. 18/207). Findings will be shared with participating hospitals and widely disseminated through publications and presentations.
Estimating the demand for radiotherapy from the evidence: a review of changes from 2003 to 2012.
Publisher: Elsevier BV
Date: 07-2014
Quality management in radiation therapy: A 15 year review of incident reporting in two integrated cancer centres.
Publisher: Elsevier BV
Date: 06-2020
Gaps in optimal care for lung cancer.
Publisher: Elsevier BV
Date: 08-2008
Technology enhancements and changes in radiotherapy throughput in New South Wales.
Publisher: Elsevier BV
Date: 08-2005
DOI: 10.1016/J.CLON.2005.02.011
Abstract: To assess the effect that the age of linear accelerators and recent changes in technology have had on linear accelerator throughput in New South Wales, Australia. Duration was measured (time of patient entry into the treatment room to time of exit) of each radiotherapy treatment fraction delivered on each linear accelerator over a 5-day period. Patient-, treatment- and equipment-based variables were collected for all treatment fractions, and assessed for their effect on fraction duration. Comparisons were made between these data and similar productivity data collected from a study carried out in 1996. Since the s le sizes for both the study periods were large enough, the distributions of the means were assumed normal (Central Limit Theorem). Specific analyses were carried out to assess the affect that new technologies, such as automatic field-sequencing (AFS) and multi-leaf collimator (MLC), have had on fraction duration. A total of 12 892 treatment fields and 4316 treatment fractions were delivered on 27 linear accelerators over 135 days. Comparison between the 2003 and 1996 productivity data showed an increase in the mean number of patients treated per hour by 11% and fields treated per hour by 31%. The mean number of fields treated per fraction increased by 15%. The mean fraction duration was reduced by 13% for linear accelerators of less than the median age of 7 years that were equipped with MLC/AFS, or both, compared with older linear accelerators without AFS and MLC. This reduction was more obvious for complex techniques, such as four-field breast treatments (27% decrease in fraction duration). The mean number of fields treated per hour was 43% more on the newer machines equipped with AFS and MLC. An increase in productivity has been observed between the 1996 and 2003 study periods, as measured by patients or fields per hour, despite an increase in treatment complexity as measured by fields per fraction. The application of AFS and MLC, and the use of newer linear accelerators, significantly shortened the mean duration per fraction for the common treatment techniques.
Integrative oncology and complementary medicine cancer services in Australia: findings from a national cross-sectional survey
Publisher: Springer Science and Business Media LLC
Date: 29-10-2018
Patterns of retreatment by radiotherapy.
Publisher: Elsevier BV
Date: 10-2014
Estimation of an optimal chemotherapy utilisation rate for upper gastrointestinal cancers: setting an evidence-based benchmark for the best-quality cancer care.
Publisher: Hindawi Limited
Date: 2015
DOI: 10.1155/2015/753480
Abstract: Aims . The proportion of patients with upper gastrointestinal cancers that received chemotherapy varies widely in Australia and internationally, indicating a need for a benchmark rate of chemotherapy utilisation. We developed evidence-based models for upper gastrointestinal cancers to estimate the optimal chemotherapy utilisation rates that can serve as useful benchmarks for measuring and improving the quality of care. Materials and Methods . Optimal chemotherapy utilisation models for cancers of the oesophagus, stomach, pancreas, gallbladder, and primary liver were constructed using indications for chemotherapy identified from evidence-based guidelines. Results . Based on the best available evidence, the optimal proportion of upper gastrointestinal cancers that should receive chemotherapy at least once during the course of the patients’ illness was estimated to be 79% for oesophageal cancer, 83% for gastric cancer, 35% for pancreatic cancer, 80% for gallbladder cancer, and 27% for primary liver cancer. Conclusions . The reported chemotherapy utilisation rates for upper gastrointestinal cancers (with the exception of primary liver cancer) appear to be substantially lower than the estimated optimal rates suggesting that chemotherapy may be underutilised. Further studies to elucidate the reasons for the potential underutilisation of chemotherapy in upper gastrointestinal tumours are required to bridge the gap between the ideal and actual practice identified.
Estimation of an optimal external beam radiotherapy utilization rate for head and neck carcinoma.
Publisher: Wiley
Date: 2005
DOI: 10.1002/CNCR.21084
Abstract: Radiotherapy is used commonly in the treatment of patients with head and neck carcinoma. The benchmark radiotherapy utilization rates for head and neck carcinoma largely are unknown. The objective of the current study was to determine the optimal radiotherapy utilization rate for patients with head and neck carcinoma and to compare this optimal rate with actual utilization rates where actual utilization data were available. An optimal radiotherapy utilization tree was constructed that depicted all patients with head and neck carcinoma in whom radiotherapy was indicated according to evidence-based treatment guidelines. The proportions of patients with clinical attributes that indicated possible benefit from radiotherapy were obtained from epidemiological data and were inserted into the utilization tree. The optimal proportion of patients with carcinoma of the head and neck who should receive radiotherapy was calculated by merging the evidence-based recommendations with the epidemiological data in the tree. Optimal rates of radiotherapy utilization were compared with actual rates obtained from population-based studies. Radiotherapy was indicated at some point during their illness in 74% of all patients with head and neck carcinoma. By subsite, the optimal radiotherapy utilization rates were oral cavity, 74% lip, 20% larynx, 100% oropharynx, 100% salivary gland, 87% hypopharynx, 100% nasopharynx, 100% paranasal sinuses, 100% and unknown squamous cell carcinoma of the head and neck, 90%. All treatment recommendations were based on Level III or IV evidence. Assessment of actual radiotherapy utilization rates indicated an increased use of radiotherapy over time for head and neck carcinoma. However, there also were some decreases in the use of radiotherapy for some carcinoma subsites over the past 20 years, despite the lower actual rates compared with the optimal rates. The reasons for these reductions in use were not identified. The actual radiotherapy utilization rate for patients with head and neck carcinoma corresponded reasonably closely to the optimal rate for some populations but also identified some shortfalls for other patient groups. The results of this study provide a way of assessing shortfalls in radiotherapy.
Subclinical cardiac dysfunction detected by strain imaging during breast irradiation with persistent changes 6 weeks after treatment.
Publisher: Elsevier BV
Date: 06-2015
Minimally invasive techniques for medically inoperable stage 1 non small cell lung cancer: radiotherapy is still the gold standard.
Publisher: Wiley
Date: 02-2014
The complexities, coordination, culture and capacities that characterise the delivery of oncology services in the common areas of ambulatory settings.
Publisher: Springer Science and Business Media LLC
Date: 12-02-2022
DOI: 10.1186/S12913-022-07593-3
Abstract: Relatively little is understood about real-world provision of oncology care in ambulatory outpatient clinics (OPCs). This study aimed to: 1) develop an understanding of behaviours and practices inherent in the delivery of cancer services in OPC common areas by characterising the organisation and implementation of this care and 2) identify barriers to, and facilitators of, the delivery of this care in OPC common areas. A purpose-designed ethnographic study was employed in four public hospital OPCs. Informal field scoping activities were followed by in-situ observations, key informant interviews and document review. A view of OPCs as complex adaptive systems was used as a scaffold for the data collection and interpretation, with the intent of understanding ‘work as done’. Data were analysed using an adapted “Qualitative Rapid Appraisal, Rigorous Analysis” approach. Field observations were conducted over 135 h, interviews over 6.5 h and documents were reviewed. Analysis found six themes. Staff working in OPCs see themselves as part of small local teams and as part of a broader multidisciplinary care team. Professional role boundaries could be unclear in practice, as duties expanded to meet demand or to stop patients “falling through the cracks.” Formal care processes in OPCs were supported by relationships, social capital and informal, but invaluable, institutional expertise. Features of the clinic layout, such as the proximity of departments, affected professional interactions. Staff were aware of inter- and intra-service communication difficulties and employed strategies to minimise negative impacts on patients. We found that complexity, coordination, culture and capacity underpin the themes that characterise this care provision. The study advances understanding of how multidisciplinary care is delivered in ambulatory settings and the factors which promote or inhibit effective care practice. Time pressures, communication challenges and competing priorities can pose barriers to care delivery. OPC care is facilitated by: self-organisation of participants professional acumen institutional knowledge social ties and relationships between and within professional groups and commitment to patient-centred care. An understanding of the realities of ‘work-as-done’ may help OPCs to sustain high-quality care in the face of escalating service demand.
Estimation of an optimal chemotherapy utilisation rate for primary malignant brain tumours: an evidence-based benchmark for cancer care.
Publisher: Elsevier BV
Date: 02-2011
Outcomes of Ethnic Minority Groups with Node-Positive, Non-Metastatic Breast Cancer in Two Tertiary Referral Canters in Sydney, Australia
Publisher: Public Library of Science (PLoS)
Date: 21-04-2014
The Reactions of Adolescents, Parents and Clinicians to Participating in Qualitative Research Interviews Regarding Adolescents Bereaved by Suicide and Other Traumatic Death
Publisher: MDPI AG
Date: 2022
Abstract: There are concerns that involving adolescents bereaved by suicide and other traumatic death in research may cause distress and harm. However, no study has investigated such bereaved adolescents’ research experiences. In addition, no study has looked at the experiences of parents and clinicians as participants in adolescent suicide and traumatic death bereavement research. This study aimed to explore the short-term impact of research participation experienced by adolescents, parents, and clinicians. A total of 61 participants (adolescents, n = 17 parents, n = 12 clinicians, n = 32) filled out a short survey within two weeks of having taken part in a qualitative interview study. Data were analyzed descriptively. Most participants had experienced no distress while participating and no negative effects of participating rather, participation was experienced as helpful for them and they would highly recommend participating in a study like this to others. A few adolescents and parents reported some distress, related to anxiety about participation and the unpleasantness of grief memories. The study clearly indicates that bereaved adolescents, parents and clinicians can safely participate in research interviews regarding their experiences of grief and help after suicide, generally valuing the opportunity to share their experience. To prevent and mitigate potential distress, training of research staff and implementation of appropriate participant distress protocols are imperative. Future studies could include longitudinal follow-up of participants to assess any longer-term consequences.
A decade of investment in radiotherapy in New South Wales: why does the gap between optimal and actual persist?
Publisher: Wiley
Date: 08-2011
Can the Aviation Industry be Useful in Teaching Oncology about Safety?
Publisher: Elsevier BV
Date: 10-2017
DOI: 10.1016/J.CLON.2017.06.007
Abstract: Healthcare practitioners have long considered aviation as a domain from which much can be learned about safety. Over the past 30 years, attempts have been made to apply aviation safety-related concepts to healthcare. Although some applications have been successful, a few decades later, many healthcare safety experts have learned that the appeal of the aviation-healthcare analogy is an illusion. Both domains are so basically dissimilar that simple adoption of aviation concepts will not be successful. However, what has succeeded is healthcare's adaptation of specific aviation safety concepts. Three concepts, investment in safety, human factors and safety management systems, are described and ex les are given of adapted applications to healthcare/clinical oncology. Finally, there is a need to ensure that these concepts are applied systematically throughout healthcare rather than sporadically and without a centralised mandate, to help ensure success and improved patient and provider safety.
A Double-Filter Provision for Expanded Red Flag Laws: A Proposal for Balancing Rights and Risks in Preventing Gun Violence.
Publisher: Cambridge University Press (CUP)
Date: 2020
Abstract: In response to the continued expansion of “red flag” laws allowing broader classes of people to petition a court for the removal of firearms from in iduals who exhibit dangerous conduct, this paper argues that state laws should adopt a double-filter provision that balances in idual rights and government public safety interests. The main component of such a provision is a special statutory category — “reporting party” — that enables a broader social network, such as co-workers or school administrators, to request that a law enforcement officer file a petition for an Extreme Risk Protection Order (ERPO). A double-filter provision would not give reporting parties a right to file a court petition directly. Instead, parties would file a request for petition with law enforcement officers (first filter), who must seek an ERPO from the court if they find the reporting party's information credible. That information is then transmitted to the court (second filter) as a sworn affidavit of the reporting party. The goal is to facilitate a balanced policy model that (1) widens the reporting circle in order to feed more potentially life-saving information into the system, (2) mitigates the risk of erroneous deprivation of constitutionally protected due process and Second Amendment rights.
Do variations in hospital mortality patterns after weekend admission reflect reduced quality of care or different patient cohorts? A population-based study.
Publisher: BMJ
Date: 25-10-2014
Rhinophyma treated with kilovoltage photons.
Publisher: Wiley
Date: 13-04-2005
DOI: 10.1111/J.1440-0960.2005.00148.X
Abstract: A 72-year-old retired truck driver presented with a 10-year history of rhinophyma and was successfully treated with 90-kV photons to a total dose of 40 Gy in 20 daily fractions. A brief discussion of radiotherapy in the treatment of rhinophyma follows.
Safety in Radiotherapy mini-series
Publisher: Elsevier BV
Date: 09-2017
A review of setup error in supine breast radiotherapy using cone-beam computed tomography.
Publisher: Elsevier BV
Date: 2016
Quantification of cardiac subvolume dosimetry using a 17 segment model of the left ventricle in breast cancer patients receiving tangential beam radiotherapy
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.RADONC.2018.09.021
Abstract: Subacute changes following breast radiotherapy have been demonstrated in discrete areas of the left ventricle (LV), with recent guidelines being developed to help determine dose to subvolumes of the LV. This study aims to determine doses to the 17 segments of the LV as per the American Heart Association (AHA) and other cardiac subvolumes, and to correlate mean heart (MHD) dose with various subvolume dosimetric indices. These results may direct focus to specific left ventricular segments in studies of radiation-related heart disease incorporating surveillance imaging, help to determine more precise dose response relationships, and potentially aid prediction of late radiation effects. The heart and cardiac subvolumes of 29 patients treated with tangential radiotherapy for left breast cancer were contoured. Delineation of cardiac subvolumes (cardiac chambers, cardiac valves and the 17 segments of the LV) was undertaken using a novel contouring method on planning CT data reformatted into the cardiac axis. In idual segments were then combined to determine doses to the basal, mid and apical left ventricular regions, and the anterior, septal, inferior and lateral ventricular walls. Radiotherapy doses (including maximum, mean, D1cc, V25) were determined. Correlation analyses were performed between MHD and various substructure dosimetric indices. Twenty five patients received tangential breast free breathing radiotherapy alone, and four patients received regional nodal irradiation including the internal mammary chain with deep inspiration breath hold (DIBH). For patients receiving breast only radiation, the median mean heart radiation dose was 2.62 Gy (range 1.52-3.90 Gy), and a heterogeneous dose distribution to the LV was noted, with the apical region receiving the highest median mean dose (14.99 Gy) compared with the mid and basal regions (3.10 Gy and 1.51 Gy respectively). The anterior LV wall received the highest median mean dose (9.21 Gy) with the remaining walls receiving similar mean doses (range 1.79-3.05 Gy). The anterior LV apical segment (segment 13) and apex (segment 17) received the highest in idual median mean segment doses (26.73 Gy and 30.02 Gy respectively). Apical segments received the highest median mean doses (segments 13, 14, 15, 16), followed by the mid anterior (segment 7) and anteroseptal (segment 8) segments. Segments receiving the highest doses remained unchanged between the DIBH cohort and free breathing cohort. MHD showed a high correlation with the anterior wall r = 0.71, p < 0.05 and entire left ventricle r = 0.82, p < 0.05, but correlations varied from weak to high when MHD was correlated with segments receiving highest doses (range r = 0.43-0.76), p < 0.05. In the setting of breast cancer radiotherapy, there are substantial RT dose variations within specific LV segments, with mid and apical anterior ventricular segments (segments 7, 13) and the apical region of the LV (segments 13, 14, 15, 16, 17) being consistently exposed to the highest radiation doses. Determining segmental and regional RT doses to the left ventricle may help guide focus in diagnostic cardiology in the post radiotherapy setting.
Clinicians’ attitudes to oncology clinical practice guidelines and the barriers and facilitators to adherence: a mixed methods study protocol
Publisher: BMJ
Date: 03-2020
DOI: 10.1136/BMJOPEN-2019-035448
Abstract: Clinical practice guidelines (CPGs) are designed to reduce inappropriate clinical variation and improve the quality of care. Barriers to CPGs include a lack of awareness of CPGs, access to them, time pressures and concerns regarding the evidence underpinning CPG development, implementation and dissemination. The objectives of this study are to assess clinicians’ attitudes to CPGs for cancer treatment and the perceived barriers to and facilitators of CPG adherence in order to inform the implementation of cancer treatment CPGs. A mixed methods study will be conducted using a three-phase, sequential design, with each phase informing the next. In phase 1, a qualitative study using recorded interviews will investigate clinicians’ attitudes to CPGs for cancer treatment and perceptions of barriers and facilitators to CPG adherence (n=30) interview transcripts will be analysed thematically. In phase 2, a survey will quantify the frequency of attitudes, barriers and facilitators identified in phase 1, in a broader clinical s le (n=200). In phase 3, a workshop forum will be held to facilitate discussions examining the implications of phase 1 and 2 findings for cancer CPG implementation strategies (n=40) leading to recommendations for improvements to practice. The workshop discussion will be recorded, and the transcript will be analysed thematically. This study has received ethics approval in New South Wales, Australia (2019/ETH11722, #52019568810127). Study findings will be published in peer-reviewed journals and will form part of a doctoral thesis and be presented at national and international conferences.
Split-course accelerated therapy in head and neck cancer: an analysis of toxicity.
Publisher: Elsevier BV
Date: 06-1995
Estimating the optimal radiotherapy utilization for carcinoma of the central nervous system, thyroid carcinoma, and carcinoma of unknown primary origin from evidence-based clinical guidelines.
Publisher: Wiley
Date: 14-12-2006
DOI: 10.1002/CNCR.21596
Implementing patient-reported outcomes into routine care: an audit of cancer patients from two local health districts in New South Wales to understand their capabilities and preferences.
Publisher: CSIRO Publishing
Date: 12-05-2022
DOI: 10.1071/AH21270
Abstract: Objective It has been established that the implementation of patient-reported outcome measures (PROMs) in routine care provides significant benefits to patients, providers and health services. However, there are patient-level barriers that must be identified and addressed for the successful implementation of PROMs. This study aimed to understand the capabilities and preferences of our cancer patient population prior to implementation of electronically collected PROMs (ePROMs). Specifically, we conducted a clinic audit to determine the proportion of patients in clinics with access to out-of-clinic internet those preferring to complete PROMs on paper or via an electronic device those capable of completing PROMs in English and those anticipating requiring assistance to complete PROMs. Methods Patients receiving cancer treatment or follow-up care at two Local Health Districts (LHDs) in New South Wales, Australia, completed a questionnaire (audit form) with items about internet and mobile access, communication preferences and assistance needed to complete PROMs. Participant demographic and treatment information were extracted from their electronic medical records. Results Across both LHDs, 637 of 1668 participants (38%) completed the audit forms. Mean participant age was 65 years (range = 23–98), 53% were female, and 92% were outpatients. Patients in the two LHDs differed in their levels of internet and email access, and ability to complete PROMs independently in English, suggesting that some LHD-specific tailoring of implementation strategies is necessary to optimise ePROMs uptake. Conclusion This study highlights the importance of understanding the specific local contexts and patient populations, including potential technology and language barriers, which can influence patient ability to complete ePROMs.
Development and Feasibility Testing of PROMPT-Care, an eHealth System for Collection and Use of Patient-Reported Outcome Measures for Personalized Treatment and Care: A Study Protocol
Publisher: JMIR Publications Inc.
Date: 24-11-2016
DOI: 10.2196/RESPROT.6459
The Benefits of Providing External Beam Radiotherapy in Low- and Middle-income Countries.
Publisher: Elsevier BV
Date: 02-2016
Visual Motion Estimation for an Autonomous Underwater Reef Monitoring Robot
Publisher: Springer Berlin Heidelberg
Date: 2006
A Standard Set of Value-Based Patient-Centered Outcomes for Breast Cancer
Publisher: American Medical Association (AMA)
Date: 05-2017
DOI: 10.1001/JAMAONCOL.2016.4851
Abstract: A major challenge in value-based health care is the lack of standardized health outcomes measurements, hindering optimal monitoring and comparison of the quality of health care across different settings globally. The International Consortium for Health Outcomes Measurement (ICHOM) assembled a multidisciplinary international working group, comprised of 26 health care providers and patient advocates, to develop a standard set of value-based patient-centered outcomes for breast cancer (BC). The working group convened via 8 teleconferences and completed a follow-up survey after each meeting. A modified 2-round Delphi method was used to achieve consensus on the outcomes and case-mix variables to be included. Patient focus group meetings (8 early or metastatic BC patients) and online anonymized surveys of 1225 multinational BC patients and survivors were also conducted to obtain patients' input. The standard set encompasses survival and cancer control, and disutility of care (eg, acute treatment complications) outcomes, to be collected through administrative data and/or clinical records. A combination of multiple patient-reported outcomes measurement (PROM) tools is recommended to capture long-term degree of health outcomes. Selected case-mix factors were recommended to be collected at baseline. The ICHOM will endeavor to achieve wide buy-in of this set and facilitate its implementation in routine clinical practice in various settings and institutions worldwide.
Autonomous Excavation Using a Rope Shovel
Publisher: Springer Berlin Heidelberg
Date: 2006
Estimating the need for radiotherapy for patients with prostate, breast, and lung cancers: verification of model estimates of need with radiotherapy utilization data from British Columbia.
Publisher: Elsevier BV
Date: 04-2011
Safety and efficacy of progressive resistance training in breast cancer: a systematic review and meta-analysis.
Publisher: Springer Science and Business Media LLC
Date: 17-10-2014
The challenge of putting principles into practice: Resource tensions and real-world constraints in multidisciplinary oncology team meetings.
Publisher: Wiley
Date: 21-05-2019
DOI: 10.1111/AJCO.13166
A Basic Treatment Equivalent for High-Dose-Rate Gynaecological Brachytherapy–A Pilot Study
Publisher: Elsevier BV
Date: 10-2002
Abstract: The aims of this pilot study were to assess the factors that were predictive of high-dose-rate (HDR) gynaecological brachytherapy duration and to model them using previously described Basic Treatment Equivalent (BTE) methodology. This was a prospective single arm pilot study that aimed to enrol 20 patients from two centres. Patient, tumour and treatment factors were recorded. The duration of each component of brachytherapy was recorded. Univariate and bivariate analyses were conducted to identify factors that predicted overall brachytherapy duration. The generalized estimating equations method was used to derive an equation that predicted the duration of brachytherapy. Data were collected for 20 patients who underwent 53 episodes of brachytherapy, either as part of definitive radiotherapy (tandem and ovoids) or post-operatively (vaginal cylinder). Factors that were predictive of overall duration were technique (tandem and ovoids vs vaginal cylinder, P = 0.0007), treatment intention (definitive vs post-operative, P = 0.0001), type of plan (in idual vs standard, P = 0.0001), hospital (1 vs 2, P = 0.0001) and body mass index (P = 0.0001). This study demonstrates the feasibility of examining factors that influence the duration of gynaecological brachytherapy using BTE methodology. To develop a reliable model, a larger multicentre study is needed. Such a model will allow comparisons of efficiency and more accurate assessment of treatment capacity between centres.
A paired, double-blind, randomized comparison of a moisturizing durable barrier cream to 10% glycerine cream in the prophylactic management of postmastectomy irradiation skin care: trans Tasman Radiation Oncology Group (TROG) 04.01.
Publisher: Elsevier BV
Date: 05-2013
Herbal Medicine for Hot Flushes Induced by Endocrine Therapy in Women with Breast Cancer: A Systematic Review and Meta-Analysis.
Publisher: Hindawi Limited
Date: 2016
DOI: 10.1155/2016/1327251
Abstract: Objective. This systematic review was conducted to evaluate the clinical effectiveness and safety of herbal medicine (HM) as an alternative management for hot flushes induced by endocrine therapy in breast cancer patients. Methods. Key English and Chinese language databases were searched from inception to July 2015. Randomized Controlled Trials (RCTs) evaluating the effects of HM on hot flushes induced by endocrine therapy in women with breast cancer were retrieved. We conducted data collection and analysis in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. Statistical analysis was performed with the software (Review Manager 5.3). Results. 19 articles were selected from the articles retrieved, and 5 articles met the inclusion criteria for analysis. Some included in idual studies showed that HM can relieve hot flushes as well as other menopausal symptoms induced by endocrine therapy among women with breast cancer and improve the quality of life. There are minor side effects related to HM which are well tolerated. Conclusion. Given the small number of included studies and relatively poor methodological quality, there is insufficient evidence to draw positive conclusions regarding the objective benefit of HM. Additional high quality studies are needed with more rigorous methodological approach to answer this question.
Magnetic resonance imaging (MRI) guided proton therapy: A review of the clinical challenges, potential benefits and pathway to implementation.
Publisher: Elsevier BV
Date: 05-2022
An e-health strategy to facilitate care of breast cancer survivors: A pilot study.
Publisher: Wiley
Date: 03-03-2016
DOI: 10.1111/AJCO.12475
Abstract: Innovative e-health strategies are emerging, to tailor and provide convenient, systematic and high-quality survivorship care for an expanding cancer survivor population. This pilot study tests the application of an e-health platform, "Healthy.me," in a breast cancer survivor cohort at Liverpool and Macarthur Cancer Therapy Centres, New South Wales, Australia. Fifty breast cancer patients were recruited to use the Healthy.me website, designed by the Centre of Health Informatics at the University of New South Wales, over a 4-month period. Telephone and online questionnaires were used at 1 and 4 months and a face-to-face feedback at study completion, to gather qualitative and quantitative data regarding feasibility of Healthy.me. Healthy.me was reported to be a useful online resource by most users. Usage declined from 76% at 1 month to 48% at 4 months. Breast cancer survivors enjoyed a variety of tailored information regarding health and life-style issues. Positive aspects of Healthy.me were the convenient access to trusted information, and interaction with their peers and healthcare professionals. Barriers to usage contributing to usage decline were lack of reported patient time to re-access information, limited content updates and technical factors. This pilot study suggested the potential of an e-health strategy such as Healthy.me in addressing the needs of a growing breast cancer survivor population. Ongoing development of a more robust e-health resource and integration with primary care models is warranted.
Patterns of use of palliative radiotherapy fractionation for bone metastases and 30-day mortality
Publisher: Elsevier BV
Date: 2021
Segmental Cardiac Radiation Dose Determines Magnitude of Regional Cardiac Dysfunction
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-04-2021
Abstract: Subclinical left ventricular dysfunction detected by 2‐dimensional global longitudinal strain post breast radiotherapy has been described in patients with breast cancer. We hypothesized that left ventricular dysfunction postradiotherapy may be site specific, based on differential segmental radiotherapy dose received. Transthoracic echocardiograms were performed at baseline, 6 weeks, and 12 months postradiotherapy on 61 chemotherapy‐naïve women with left‐sided breast cancer undergoing tangential breast radiotherapy. Radiation received within basal, mid, and apical regions for the 6 left ventricular walls was quantified from the radiotherapy treatment planning system. Anterior, anteroseptal, and anterolateral walls received the highest radiation doses, while inferolateral and inferior walls received the lowest. There was a progressive increase in the radiation dose received from basal to apical regions. At 6 weeks, the most significant percentage deterioration in strain was seen in the apical region, with greatest reductions in the anterior wall followed by the anteroseptal and anterolateral walls, with a similar pattern persisting at 12 months. There was a within‐patient dose–response association between the segment‐specific percentage deterioration in strain at 6 weeks and 12 months and the radiation dose received. Radiotherapy for left‐sided breast cancer causes differential segmental dysfunction, with myocardial segments that receive the highest radiation dose demonstrating greatest strain impairment. Percentage deterioration in strain observed 6 weeks postradiotherapy persisted at 12 months and demonstrated a dose–response relationship with radiotherapy dose received. Radiotherapy‐induced subclinical cardiac dysfunction is of importance because it could be additive to chemotherapy‐related cardiotoxicity in patients with breast cancer. Long‐term outcomes in patients with asymptomatic strain reduction require further investigation.
Estimation of an optimal utilisation rate for palliative radiotherapy in newly diagnosed cancer patients.
Publisher: Elsevier BV
Date: 02-2010
Chemotherapy in rectal cancer: variation in utilization and development of an evidence-based benchmark rate of optimal chemotherapy utilization.
Publisher: Elsevier BV
Date: 06-2011
Estimation of the optimal brachytherapy utilization rate in the treatment of gynecological cancers and comparison with patterns of care.
Publisher: Elsevier BV
Date: 02-2013
Quantification of Cardiac Subvolume Dosimetry in Breast Cancer Patients Receiving Tangential Beam Radiation Therapy
Publisher: Elsevier BV
Date: 10-2017
Estimation of an optimal radiotherapy utilization rate for melanoma: a review of the evidence.
Publisher: Wiley
Date: 15-03-2004
DOI: 10.1002/CNCR.20092
Abstract: Radiotherapy is not used commonly in the treatment of patients with malignant melanoma. The benchmark optimal radiotherapy utilization rates for melanoma are largely unknown, despite the fact that melanoma is a very common cancer. To develop an evidence-based benchmark for the optimal proportion of patients with melanoma who should receive radiotherapy, the authors reviewed major treatment guidelines for melanoma. A radiotherapy decision tree was constructed showing the clinical features of melanoma patients for whom radiotherapy was indicated based on evidence. The proportions of melanoma patients with indications for radiotherapy were obtained from epidemiologic data and were used to calculate the optimal proportion of melanoma patients who should receive radiotherapy. The proportion of patients with melanoma for whom radiotherapy is indicated at some point in their illness, according to the best available evidence, was calculated at 23% of all melanoma patients. The utilization rates of radiotherapy for melanoma recorded in actual practice were 13% in New South Wales, 6% in data from the American College of Surgeons, and 1% according to Surveillance, Epidemiology, and End Results data. Strategies for implementing the evidence-based guidelines are recommended to overcome the shortfall in the use of radiotherapy in the treatment of patients with melanoma.
Adapting an integrated care pathway for implementing electronic patient reported outcomes assessment in routine oncology care: Lessons learned from a case study.
Publisher: Wiley
Date: 25-04-2022
DOI: 10.1111/JEP.13688
Abstract: Details of the development and implementation of integrated care pathways (ICPs) in the context of electronic collection of patient reported outcomes (ePROs) for cancer patients are largely lacking in the literature. This study describes what, why and how decisions were made to adapt and implement an ePROs ICP for patients with lung cancer. A consensus process was utilized, with the implementation advisory group including multidisciplinary representation from three participating hospitals, to identify local ch ions and adapt and incorporate the ePRO ICP into the local contexts. Engagement meetings were documented via meeting transcripts, and detailed notes from October 2019 to November 2020 were content‐analysed to identify decision‐making themes based on the Consolidated Framework for Implementation Research workflows and process maps were reviewed and modified to integrate ePROs. In total, 55 engagement activities were held (24 meetings, 20 workshops 11 educational sessions), with n = 96 staff from multiple disciplines participating in the ePROs implementation through advisory meetings, process mapping, change management and staff education. Decisions were made regarding eligible patient cohorts to include, the process for onboarding patients onto the ePRO system, and follow‐up and referral pathways. Rationales for decisions included alignment with existing workflows, utilizing available staff, minimizing staff and patient burden and maximizing patient engagement. Existing resources, staff input and technical and logistical reasons often guided the ICP decisions, highlighting the need for in‐depth engagement across all stakeholders for optimal implementation of ePRO ICPs. The ePRO implementation required substantial dialogue and systematic resolution to reach agreement on the final processes. Adapting the local ICP through rigorous engagement facilitated the successful implementation of ePROs as business‐as‐usual at all three cancer centres. Involving all relevant stakeholders is critical to the successful adaptation of ICPs before their introduction into routine care.
The population benefit of evidence-based radiotherapy: 5-Year local control and overall survival benefits.
Publisher: Elsevier BV
Date: 02-2017
Why Do Some Lung Cancer Patients Receive No Anticancer Treatment?
Publisher: Elsevier BV
Date: 07-2010
Optimal uptake rates for initial treatments for cervical cancer in concordance with guidelines in Australia and Canada: Results from two large cancer facilities.
Publisher: Elsevier BV
Date: 08-2015
Assessing outcomes of cancer care: lessons to be learned from a retrospective review of the management of small cell lung cancer at the Cancer Therapy Centre, Liverpool Hospital, January 1996-July 2000.
Publisher: Wiley
Date: 09-2004
An Australasian assessment of the basic treatment equivalent model derived from New South Wales data.
Publisher: Wiley
Date: 11-1999
DOI: 10.1046/J.1440-1673.1999.00746.X
Abstract: The current method of assessment of radiation oncology linear accelerator throughput is either by patients per unit time or fields per unit time. This, however, does not take into consideration the complexity of different treatment techniques or of casemix. A model has been developed in an earlier study, called 'basic treatment equivalent' (BTE), to measure patient throughput of a linear accelerator, which includes consideration of the complexity of treatment techniques. The present study compared the BTE model with the current best measure of patient throughput of fields per hour. All 37 departments in Australia and New Zealand were invited to participate in testing the model, and 36 agreed to participate. The study period for each department was a consecutive 4 weeks between August and December, 1996. The prospective data collected were the total BTE units treated per linear accelerator per day, the total number of patients and fields treated per linear accelerator per day, and the total linear accelerator hours of operation per day excluding calibration time and significant breaks of linear accelerator time such as planned meal breaks. The treatment breaks between consecutive treatment fractions were not excluded from the linear accelerator treatment time. The throughput data for 36 departments (92 linear accelerators) were collected over the 4-week study period. The average throughput for the departments was 10.8 fields per hour and 4.2 patients per hour. The average BTE per department was 5.7 BTE per hour. The average BTE per episode per department was 1.38. The BTE model was found to be a more sensitive measure of productivity compared with fields per hour (P < 0.001). Some treatment techniques were thought to be not well represented by the BTE formula, particularly those techniques where junctions were present. The BTE model is a more sensitive measure than fields per hour and better reflects the variations in complexity in techniques. Despite this result there is further refinement to be performed to make the model even more sensitive.
Estimation of the optimal brachytherapy utilisation rate in the treatment of vaginal cancer and comparison with patterns of care.
Publisher: Wiley
Date: 28-05-2012
Evidence-based optimal number of radiotherapy fractions for cancer: A useful tool to estimate radiotherapy demand.
Publisher: Elsevier BV
Date: 04-2015
Related Organisations
South Western Sydney Local Health District & UNSW
Location: Australia
University Of New South Wales School Of Medical Sciences
Location: Australia
Royal Australasian And New Zealand College Of Radiologists
Location: Australia
Royal Australasian College And New Zealand College Of Radiologists
Location: Australia
Royal Australiasian And New Zealand College Of Radiologists
Location: Australia
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