ORCID Profile
0000-0002-3055-8502
Current Organisations
UNSW Sydney
,
Liverpool Hospital
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Publisher: Elsevier BV
Date: 11-2018
Publisher: Wiley
Date: 25-09-2021
DOI: 10.1111/AJCO.13437
Abstract: Pacific Island Countries and Territories (PICTs) have experienced an increase in cancer burden in the recent years. There is need for major investments in the cancer treatment facilities including radiotherapy (RT). This study aimed to provide a quantitative estimation of the effect of establishing new RT facilities on patient access through Geographic Information System (GIS) modelling of population density and service availability to assess the best location for a new RT centre when there are multiple competing locations. Methods involved cancer epidemiological data collection and assessing RT demand (proportion needing RT) in 2040, assessment of current RT facilities meeting the demand, GIS‐based assessment of minimal travel distance in relation to RT demand and scenario‐based location planning with adoption of the principles of efficiency, availability and equity for establishment of suitability of new RT facilities. In 2040, three highest new cancer case projections are for Papua New Guinea (PNG) (22662), Fiji (2058) and New Caledonia (2037). Twenty‐nine megavoltage machines (MVMs) are needed to meet adequate RT demand with three existing in New Caledonia, Guam and French Polynesia meeting 2–6% demand. PNG with highest RT demand of 68% and Fiji with second highest (6%) demand are found as the choice venues for maximum accessibility of cancer population within the PICTs. The travel distance‐based GIS modelling estimation of establishment of new RT facilities will provide useful information for planning of RT services in the PICTS with improved patient outcome.
Publisher: Elsevier BV
Date: 03-2015
Publisher: Elsevier BV
Date: 08-2012
Publisher: Wiley
Date: 26-04-2011
DOI: 10.1002/CNCR.26149
Abstract: There is limited evidence regarding the effectiveness of multidisciplinary team (MDT) meetings in lung cancer. The objective of this study was to compare the patterns of care for patients with newly diagnosed lung cancer who were presented at a lung cancer MDT meeting with the patterns of care for patients who were not presented. All patients who had lung cancer newly diagnosed in South West Sydney (SWS) between December 1, 2005, and December 31, 2008, were identified from the local Clinical Cancer Registry. Patient and tumor characteristics and treatment receipt were compared between patients who were and were not presented at MDT meetings. A logistic regression model was constructed to determine predictors for receiving treatment and survival. In total, there were 988 patients, including 504 patients who were presented at MDT meetings and 484 who were not presented at MDT meetings. The median patient age was 69 years and 73 years in the MDT group and the non-MDT group, respectively (P < .01). There was no pathologic diagnosis for 13% of non-MDT patients compared with 4% of MDT patients (P < .01). Treatment receipt for MDT patients versus non-MDT patients was 12% versus 13%, respectively, for surgery (P value nonsignificant) 66% versus 33%, respectively, for radiotherapy (P < .001) 46% versus 29%, respectively, for chemotherapy (P < .001) and 66% versus 53%, respectively, for palliative care (P < .001). In patients with good performance status, the MDT group had significantly better receipt of radiotherapy among patients with stage I through IV nonsmall cell lung cancer (NSCLC) and had significantly better receipt of chemotherapy among patients with stage IV NSCLC. MDT discussion was an independent predictor of receiving radiotherapy, chemotherapy, and referral to palliative care but did not influence survival. MDT discussion was associated with better treatment receipt, which potentially may improve quality of life for patients with lung cancer. However, it did not improve survival.
Publisher: Wiley
Date: 06-2010
DOI: 10.1111/J.1754-9485.2010.02170.X
Abstract: Acute skin toxicity occurs in the majority of the patients undergoing radical radiotherapy. While a variety of topical agents and dressing are used to ameliorate side effects, there is minimal evidence to support their use. The aims of this study were to systematically review evidence on acute skin toxicity management and to assess the current practices in ANZ. A systematic review of the literature was conducted on studies published between 1980 and 2008. A meta-analysis was performed on articles on clinical trials reporting grade II or greater toxicity. Analyses were ided into breast (the most common site) and other sites. A survey of Radiation Oncology departments across ANZ was conducted to identify patterns of practices and compare these with the published evidence. Twenty-nine articles were reviewed. Only seven articles demonstrated statistically significant results for management of side-effects. These were for topical corticosteroids, hyaluronic acid, sucralfate, calendula, Cavilon cream (3M, St Paul, Minnesota, USA) and silver leaf dressing. Meta-analysis demonstrated statistical significance for the prophylactic use of topical agents in the management acute toxicity. The survey of departments had a low response rate but demonstrated variation in skin care practices across ANZ. A considerable number of these practices were based only on anecdotal evidence. Lack of evidence in the literature for the care of radiation skin reactions was associated with variation in practice. Only a limited number of studies have demonstrated a significant benefit of specific topical agents. There is a need for objective and prospective recording of skin toxicity to collect meaningful comparative data on which to base recommendations for practice.
Publisher: Wiley
Date: 04-2010
DOI: 10.1111/J.1754-9485.2010.02155.X
Abstract: Summary The aim of this study was to assess the impact of F-18 fluorodeoxyglucose-positron emission tomography (FDG-PET) CT on radiotherapy planning parameters for patients treated curatively with radiotherapy for non-small-cell lung cancer (NSCLC). Five patients with stages I-III NSCLC underwent a diagnostic FDG-PET CT (dPET CT), planning FDG-PET CT (pPET CT) and a simulation CT (RTP CT). For each patient, three radiation oncologists delineated a gross tumour volume based on RTP CT alone, and fused with dPET CT and pPET CT. Standard expansions were used to generate PTVs, and a 3D conformal plan was created. Normal tissue doses were compared between plans. Coverage of pPET CT PTV by the plans based on RTP CT and dPET CT was assessed, and tumour control probabilities were calculated. Mean PTV was similar between RTP CT, dPET CT and pPET CT, although there were significant inter-observer differences in four patients. The plans, however, showed no significant differences in doses to lung, oesophagus, heart or spinal cord. The RTP CT plan and dPET CT plan significantly underdosed the pPET PTV in two patients with minimum doses ranging from 12 to 63% of prescribed dose. Coverage by the 95% isodose was suboptimal in these patients, but this did not translate into poorer tumour control probability. The effect of fused FDG-PET varied between observers. The addition of dPET and pPET did not significantly change the radiotherapy planning parameters. Although FDG-PET is of benefit in tumour delineation, its effect on normal tissue complication probability and tumour control probability cannot be predicted.
Publisher: Elsevier BV
Date: 11-2020
Publisher: Elsevier BV
Date: 02-2016
Publisher: Elsevier BV
Date: 07-2006
Publisher: Elsevier BV
Date: 09-2009
DOI: 10.1016/J.EJCA.2009.05.024
Abstract: The objective of this study was to examine the agreement between health care professionals' (HCPs) and patients' evaluation of health-related quality of life (HRQOL) issues for cancer patients with bone metastases. A total of 413 patients and 152 HCPs were interviewed across five centres worldwide. Mean scores were almost always higher for HCPs than for patients. Patients and HCPs agreed that four issues affect HRQOL of bone metastases patients profoundly: 'long-term (chronic) pain', 'difficulty in carrying out usual daily tasks', 'able to perform self-care' and 'able to perform role functioning'. A substantial difference was found with respect to the perceived importance of psychosocial and somatic issues. Patients emphasised psychosocial issues with a particular focus on 'worry' about loss of mobility, dependence on others and disease progression, HCPs however rated 'symptom' issues as more important, specifically those related to 'pain'. In conclusion, patients and HCPs agreed that pain and physical/role functioning are important to the HRQOL of cancer patients with bone metastases, but patients also emphasized the importance of psychosocial issues to HRQOL. This information has been an important component in the development of a health-related quality of life questionnaire for patients with bone metastases (EORTC QLQ-BM 22).
Publisher: Wiley
Date: 13-02-2019
DOI: 10.1111/AJCO.13127
Abstract: To describe patterns of follow-up care for non-small cell lung cancer patients treated with curative radiotherapy and to evaluate the role of routine imaging. We retrospectively analyzed follow-up care of patients with stage I-III non-small cell lung cancer treated with curative radiotherapy (minimum dose of 50 Gy) between 2007 and 2011 at three Sydney institutions. Patient demographics, tumor characteristics and treatment factors were collected from oncology and hospital records. Follow-up visits were recorded until an event (recurrence or new primary) was diagnosed or censor date was reached (December 31, 2016). Univariate and multivariate analyses were performed to identify factors associated with subsequent curative treatment and survival. Two-hundred and eighty-three patients were identified with a median age of 72 (36-91) years. Median number of follow-up visits was 6, and median time to first event was 10.8 months. Follow-up visits were by routine appointment in 74%, and symptomatic presentation in 26%. Variation in follow-up was seen across the three institutions in terms of imaging conducted and specialist seen. Recurrences were diagnosed in 175 patients of whom 85 were symptomatic and 90 diagnosed on routine imaging. New primaries were diagnosed in 23 patients, 18 with symptoms and 5 on routine imaging. Subsequent treatment was curative in 17 (10%) patients with recurrent disease and 18 (78%) with new primaries. On multivariable analysis, symptomatic diagnosis (P = 0.006) was associated with subsequent curative treatment but not with overall survival (P > 0.05). The follow-up of patients showed considerable variation between institutions. Routine imaging was not associated with subsequent curative treatment of events or improved overall survival.
Publisher: Elsevier BV
Date: 05-2009
DOI: 10.1016/J.EJCA.2008.11.013
Abstract: The aim of this study was to develop a bone metastases module to supplement the European Organisation for Research and Treatment of Cancer Core Questionnaire (EORTC QLQ-C30) or the EORTC QLQ-C15-PAL for patients with bone metastases. Phases 1-2 of module development were conducted in Canada, Australia and Germany according to EORTC QOL group guidelines. Phase 3 was conducted in nine countries in seven languages. Sixty-one health-related quality of life (HRQOL) issues were generated from health care professionals (n=152) and patients (n=413). This resulted in a 22-item provisional module. Further testing in 170 patients from nine countries resulted in the EORTC QLQ-BM22 module, containing 22 items, conceptualised into both symptom scales, with five painful sites and three pain characteristics, and also functional scales, with eight functional interference and six psychosocial aspects. This study provides a provisional comprehensive HRQOL measurement tool for future trials, which will continue to undergo further validation.
Publisher: Elsevier BV
Date: 2021
Publisher: Elsevier BV
Date: 07-2007
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.
Publisher: Elsevier BV
Date: 02-2015
DOI: 10.1016/J.CLON.2014.10.011
Abstract: The measurement of population benefits is important for priority setting, economic evaluation and quality improvement. It also informs advocacy. In this article, the use of demand models to estimate the achievable benefit of cancer therapy is reviewed. Achievable benefit refers to the treatment benefit achievable under optimal conditions. The population benefit of radiotherapy has been used as an ex le. Demand models provide a means of estimating the optimal proportion of patients with treatment indications when guidelines are followed. They may be used to estimate achievable benefit. The choice of end point should reflect the range of benefits associated with the treatment of interest. In some cases, further model development is needed if a pre-existing demand model is used. The benefit of treatment for each indication is estimated using a systematic review process. The highest level of evidence is used to define the benefit for each indication. In cases where multiple sources of the same level and quality of evidence exist, a meta-analysis is carried out. Population-based effectiveness data sources are considered, but three major challenges to their use are: (i) generalisability of the observed outcomes, (ii) data resolution and (iii) confounding and bias. The population benefit determined from this process describes the population proportion achieving a benefit due to the use of guideline-based treatment, compared with no use of that treatment. Sensitivity analysis provides a means for modelling the effect of model uncertainties. The predominant uncertainty is most often due to uncertainty in indication proportion. Preference-sensitive treatment decisions are a common ex le. The described approach to estimating the achievable benefit of cancer therapy is robust to model uncertainties, rapidly adaptable and is transparent. However, estimates rely on the quality of model data sources and may be affected by model assumptions. Models should be developed for a broader range of modalities of cancer therapy and relevant end points.
Publisher: Wiley
Date: 21-04-2008
DOI: 10.1002/CNCR.23384
Publisher: Elsevier BV
Date: 02-2017
Publisher: Elsevier BV
Date: 07-2014
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.
Publisher: Elsevier BV
Date: 03-2021
Publisher: Elsevier BV
Date: 09-2006
Publisher: Elsevier BV
Date: 08-2012
Publisher: Elsevier BV
Date: 07-2009
DOI: 10.1016/J.RADONC.2009.03.007
Abstract: Errors from radiotherapy machine or software malfunction usually are well documented as they affect hundreds of patients, whereas random errors affecting in idual patients are more difficult to be discovered and prevented. Although major clinical radiotherapy incidents have been reported, many more have remained unrecognised or have not been reported. The literature in this field is limited as it is mostly published as a result of investigation of major errors. We present a review of radiotherapy incidents internationally with the aim of identifying the domains where most errors occur through extensive review and synthesis of published reports, unpublished 'Grey literature' and departmental incident data. Our review of radiotherapy-related events in the last three decades (1976-2007) identified more than seven thousand (N=7741) incidents and near misses. Three thousand one hundred and twenty-five incidents reported patient harm of variable intensity ranging from underdose increasing the risk of recurrence, to overdose causing toxicity, and even death for 1% (N=38) 4616 events were near misses with no recognisable patient harm. Based on our review, a radiotherapy risk profile has been published by the WHO World Alliance for Patient Safety that highlights the role of communication, training and strict adherence to guidelines rotocols in improving the safety of radiotherapy process.
Publisher: Elsevier BV
Date: 2016
Publisher: Elsevier BV
Date: 09-2009
Abstract: Appropriately timed cessation of chemotherapy is integral to patient's quality of life. We evaluate the use of and associated factors with chemotherapy at the end of life. A review of deceased oncology patients treated with palliative intent from April 2005 over 2 years at two cancer centres was carried out. Chi-square tests of patient demographics, cancer and chemotherapy variables were carried out to determine associations with commencing chemotherapy and continuation within 2 and 4 weeks of death. Multivariate analyses were carried out with significant factors to determine their independent effect. Seven hundred and forty-seven patients died during this period median age 67 years (range 20-96) female 44%. Three hundred and ninety-eight (53%) received chemotherapy: 18% and 8% within 4 and 2 weeks of death, respectively. Younger age (P < 0.01), cancer type (P < 0.01) and chemosensitivity of the tumour (P < 0.01) were predictors for commencing chemotherapy in multivariate analysis. Treating doctor predicted for chemotherapy in the 4 weeks before death (<0.05), but none of the variables predicted for chemotherapy in the last 2 weeks of life. Younger age, tumour type and chemosensitivity are important predictors of patients receiving palliative chemotherapy. In idual clinician was the only predictor for continuing chemotherapy in the last 4 weeks of life.
No related grants have been discovered for Jesmin Shafiq.