Monika Janda

Elderly patients with stage III or IV ovarian cancer: Should they receive standard care?

Publisher: BMJ

Date: 2008

DOI: 10.1111/J.1525-1438.2007.01122.X

Abstract: Due to the higher risk of morbidity and perioperative mortality compared to younger patients, elderly patients with advanced ovarian cancer are challenging to treat. A population-based analysis was performed to predict treatment outcomes and establish risk factors for early death of elderly patients with advanced ovarian cancer using a cohort of 3994 women diagnosed with stage III or IV ovarian cancer between 1992 and 1999, registered with the Surveillance, Epidemiology and End Results Cancer Registries. A multivariate accelerated failure time model allowed estimation of a risk factor model for overall survival. Patient's age, stage at presentation, presence of comorbidities, and oncology treatment facility were independently associated with overall survival at 12 months from diagnosis. Patients were assigned to low (0–7 points), moderate (8–14 points) or high (≥15 points) risk groups according to accumulation of risk factors, which showed good ability to predict 12-month mortality (receiver–operator characteristics curve [ROC] derivation cohort = 0.763 ROC validation cohort = 0.756). Across all three risk groups, patients who received both surgery and chemotherapy showed significantly improved survival as compared to patients who received only surgery or chemotherapy. For patients 80 years and over who had upfront surgery, perioperative mortality was significantly greater in the high-risk group (21% 95% CI = 16–26%) compared to patients within the moderate (8% 95% CI = 5–12%) and low-risk groups (0% 95% CI = 0–11%). The risk factor profile established could be helpful to plan future clinical trials to establish optimal treatment for elderly patients with advanced stage ovarian cancer

Digital Technology in Skin Cancer Prevention and Early Detection

Publisher: JMIR Publications Inc.

Date: 14-02-2022

DOI: 10.2196/36908

Abstract: Mobile teledermatology is increasingly being used in clinical practice and offers the opportunity to counsel the general public about sun protection and skin cancer early detection. Growing evidence suggests that SMS text messaging interventions are an effective way to reach a large number of people and promote sun protection behaviors. Many medical practices already have SMS text message systems in place to communicate with patients, especially for appointment reminders and information. However, could we use these systems for even better outcomes? If so, how? This presentation will outline the results of the SunText study, a theory-based SMS text messaging intervention designed to evaluate how often and in what way we could communicate with people at risk of skin cancer to have a beneficial effect on sun protection behaviors, sunburn, and participant engagement. The SunText study was conducted between February-July 2019 in Queensland, Australia. Volunteer participants aged 18 to 40 years were randomized to 4 different intervention schedules using a Latin square design. The schedules included personalized or interactive messages with constant frequency and personalized and interactive messages with either increasing or decreasing frequency. Outcomes measured were reduction in sunburn and engagement with interactive messages, defined as responding to messages by return text. Compared to baseline, the self-reported sun protection habits index was significantly higher in all 4 interventions (P .01). Overall, sunburn rates decreased from baseline to the end of the intervention (40.3% to 7.0%), and remained significantly below baseline levels (23.5%) at the 6-month follow-up (P .01). All 4 interventions achieved reductions in sunburn rates (18%-48% reduction) during the intervention period. The overall engagement rate with interactive messages was 71%. The intervention involving interactive messages with constant frequency achieved the highest engagement rate. The intervention with personalized and interactive messages with increasing frequency had the lowest engagement rate. This study adds to the evidence that text messages targeting sun protection are effective in improving sun protection behaviors and reducing sunburn. Results also suggest higher engagement with constant or decreasing message frequency. Although many clinics already use SMS text messaging for scheduling, this presentation may encourage its extended use to raise awareness of sun protection. Interactive messages could also be integrated into sun protection mobile health apps, and provide an opportunity for engaging in health promotion content. This study was funded by a research grant from the Harry J Lloyd Charitable Trust. HPS is a shareholder of MoleMap NZ Limited and e-derm consult GmbH, and undertakes regular teledermatological reporting for both companies. HPS is a Medical Consultant for Canfield Scientific Inc, MoleMap Australia Pty Ltd, Blaze Bioscience Inc, Revenio Research Oy and a Medical Advisor for First Derm. All other authors declare no conflicts of interest.

Anxiety, depression and quality of life in people with pancreatic cancer and their carers

Publisher: Elsevier BV

Date: 03-2017

DOI: 10.1016/J.PAN.2017.01.008

Abstract: People with pancreatic cancer have high levels of anxiety and depression and reduced quality of life (QoL), but few studies have assessed these outcomes for patient-carer dyads. We therefore investigated these issues in an Australian population-based study. Patients with pancreatic cancer (n = 136) and many of their carers (n = 84) completed the Hospital Anxiety and Depression Scale (HADS) and Functional Assessment of Cancer Therapy QoL questionnaire at a median of three months after diagnosis. Overall QoL and well-being subscales (physical, social, emotional, functional) were compared with general population norms. Intraclass correlation coefficients were used to compare anxiety, depression and QoL scores of patients and their respective carers. Fifteen percent of patients and 39% of carers had HADS scores indicative of anxiety and 15% of patients and 14% of carers of depression, respectively. Overall, 70% of patients and 58% of carers had QoL scores below the Queensland population average. Patients' anxiety, depression, overall QoL, social, emotional and functional wellbeing scores were significantly related to those scores in their carers. Among patients and carers, accessing psychological help was associated with elevated anxiety. Not receiving chemotherapy was associated with elevated depression among patients and younger age was associated with poorer outcomes in carers. More carers had symptoms of anxiety than patients with pancreatic cancer, but symptoms of depression were similarly common in patients and carers. Further research is needed to assess whether interventions to reduce patients' distress could also improve QoL among carers, or whether carer-focussed interventions are required.

Using Social Media to Determine the Affective and Cognitive Components of Tweets about Sunburn

Publisher: S. Karger AG

Date: 2020

DOI: 10.1159/000506102

Abstract: b i Background: /i /b The relationship between social media usage and the public’s expressions of sunburn remains unexplored. This study is a content analysis of Twitter that was performed to identify the public’s expressions, perceptions, and attitudes towards sunburn. b i Methods: /i /b Qualitative content analysis was conducted on tweets by Australian Twitter users during January 2007 and January 2016. Out of 2,000 tweets available, in-depth content analysis of 200 random tweets was performed. b i Results: /i /b Tweets in this study were categorised into 10 distinct themes, three of which were cognitive (fact based) and seven affective (emotional), while one was miscellaneous. Results reveal that tweets about sunburn overwhelmingly contained affective as opposed to cognitive components. In addition, the sentiments contained in the affective tweets were frequently positively (68.9%) rather than negatively valanced (31.1%). While humour was the most common theme ( i n /i = 68 tweets), many tweets also expressed a link between Australian national identity and sunburn ( i n /i = 25 tweets). b i Conclusion: /i /b Many of the tweets analysed contained positive affective sentiments such as joy, rather than worry or concern, suggesting an avenue for further health promotion research.

Health-related quality of life among Indigenous Australians diagnosed with cancer

Publisher: Springer Science and Business Media LLC

Date: 02-2016

DOI: 10.1007/S11136-016-1233-6

Abstract: Health-related quality of life (HRQoL) and associated factors were assessed among 155 Indigenous Australian adult cancer patients 6 months post-diagnosis. The Assessment of Quality of Life-4D Questionnaire was used to assess HRQoL. Differences in the median utility score among subgroups of interest were examined using nonparametric tests. Factors associated with excellent HRQoL were assessed through logistic regression. Participants' mean age was 52 years (range 20-78), and the majority were female (60 %), unemployed (72 %), and recruited from outpatients clinics (64 %). Breast cancer (27 %) was the most common diagnosis. The median HRQoL score was 0.62 14 % of participants reported excellent HRQoL (>0.90). After adjusting for age, admission status, and treatment, excellent HRQoL was more likely among participants of Torres Strait Islander origin [adjusted odds ratio (AOR) 3.68 95 % CI 1.23-11.01], those living in regional areas (AOR 5.59 95 % CI 1.42-22.06), and those whose main language spoken at home was not English (AOR 3.60 95 % CI 1.08-11.99) and less likely among those reporting less contact with Indigenous people (AOR 0.23 95 % CI 0.68-0.81). Assessing HRQoL is important to identifying and improving the length and quality of cancer survivorship, especially in groups that have significantly poorer cancer outcomes, such as Indigenous Australians. Acknowledging the study's observational nature, we found HRQoL was lower than reported for other Australians, and we identified some socio-demographic factors that were associated with excellent HRQoL. Such assessments are an important component of identifying and evaluating appropriate interventions to improve the health and well-being of Indigenous cancer patients.

The iPROMOS protocol: a stepped-wedge study to implement routine patient-reported outcomes in a medical oncology outpatient setting

Publisher: BMJ

Date: 02-2019

DOI: 10.1136/BMJOPEN-2018-027046

Abstract: Patient-reported outcome measures (PROMs) are data capture tools that collect information directly from patients. Several large research studies provide evidence that the use of PROMs in routine care provides benefits to mortality and morbidity outcomes in medical oncology patients. Despite this, implementation of PROMs in daily clinical routine is slow and challenging. This study will use a stepped-wedge design to assess the implementation of a PROM intervention in highly frequented medical oncology outpatient clinics. During a lead-in period of 4 weeks, control data will be collected. The intervention will then be implemented for 4 weeks in Clinic 1 initially, then in Clinic 2 for another 4 weeks. 500 patient encounters will be measured over the 12 weeks in total. The process of implementation will be informed and evaluated using the Medical Research Council Guidelines for Implementing Complex Interventions. The study will be guided by the Promoting Action Research in Health Services framework approach for implementation. The intervention and implementation outcomes will be measured using qualitative and quantitative data. Ethical approval has been obtained, approval number HREC/16/QRBW/100 by the Royal Brisbane and Women’s Hospital Human Research Ethics Committee. Results will be disseminated in peer-reviewed journals and at scientific meetings. ACTRN12618000398202. Trial Status: Opened on 25 March 2018 and will continue until 12 months after the last PROMs reporting encounter.

Factors associated with quality of care for patients with pancreatic cancer in Australia

Publisher: AMPCo

Date: 11-2016

DOI: 10.5694/MJA16.00567

Abstract: To develop a composite score for the quality of care for patients with pancreatic cancer in Australia to determine whether it was affected by patient and health service-related factors to assess whether the score and survival were correlated. We reviewed medical records of patients diagnosed with pancreatic cancer during July 2009 - June 2011 and notified to the Queensland and New South Wales cancer registries. Participants were allocated proportional quality of care scores based on indicators derived from a Delphi process, ranging from 0 (lowest) to 1 (highest quality care). Associations between patient and health service-related factors and the score were tested by linear regression, and associations between the score and survival with Kaplan-Meier and Cox proportional hazards methods. Proportional quality of care scores were assigned to 1571 patients. Scores for patients living in rural areas were significantly lower than for those in major cities (adjusted difference, 11% 95% CI, 8-13%) they were higher for patients in the least socio-economically disadvantaged areas (v most disadvantaged areas: 8% higher 95% CI, 6-11%), who were younger, had better Eastern Cooperative Oncology Group performance status, or who first presented to a hospital with a high pancreatic case volume. Higher scores were associated with improved survival after adjusting for patient-related factors, each 10 percentage point increase in the score reduced the risk of dying by 6% (hazard ratio, 0.94 95% CI, 0.91-0.97). Geographic category of residence may influence the quality of care received by patients with pancreatic cancer, and survival could be improved if they received optimal care.

The functional assessment of cancer-vulvar: Reliability and validity

Publisher: Elsevier BV

Date: 05-2005

DOI: 10.1016/J.YGYNO.2005.01.047

Abstract: To assess the reliability and validity of the Functional Assessment of Cancer Therapy-Vulvar (FACT-V). Seventy-seven patients treated between January 1996 and January 2001 for cancer of the vulva completed the FACT-V, the Eastern Cooperative Oncology Group Performance Status Rating (ECOG-PSR) and the Hospital Anxiety and Depression Scale (HADS) once, 20 consecutive patients treated between February 2001 and October 2001 completed the questionnaires twice, once before surgery and at 2 months follow-up. The FACT-V scores were compared by patients' performance status, FIGO stage, recurrence, and age, and correlated to the HADS scores. Changes in the FACT-V from baseline to 2 months follow-up were evaluated to establish FACT-V's responsiveness to change. The FACT-V's internal consistency was adequate (Chronbach's alpha range, 0.75 to 0.92). Patients with lower performance status, higher FIGO-stage or recurrent disease received lower FACT-V scores, indicating discriminant validity. The correlation between the FACT-V and the HADS were in the expected direction, indicating convergent and ergent validity. From pre- to post-surgery, scores in nine out of fifteen items of the vulvar cancer-specific subscale improved, while those of five items declined, indicating sensitivity of the vulvar cancer specific items to changes in patients' well-being. The newly developed FACT-V provides a reliable and valid assessment of the quality of life of women with vulvar cancer. It can be used as a short measure of quality of life within research studies, and to facilitate communication about quality of life issues in clinical practice.

Prevalence, predictors, and correlates of supportive care needs among women 3-5 years after a diagnosis of endometrial cancer

Publisher: Springer Science and Business Media LLC

Date: 12-10-2015

DOI: 10.1007/S00520-014-2456-0

Abstract: The purpose of this study is to examine the prevalence, sociodemographic and clinical predictors, and physical and psychosocial correlates of unmet needs among women 3-5 years following treatment for endometrial cancer. Women with endometrial cancer completed a survey around the time of diagnosis and again 3-5 years later. The follow-up survey asked women about their physical and psychosocial functioning and supportive care needs (CaSUN). Multivariable-adjusted logistic regression identified the predictors and correlates of women's unmet needs 3-5 years after diagnosis. Of the 629 women who completed the cancer survivors' unmet needs measure (CaSUN), 24 % (n = 153) women reported one or more unmet supportive care needs in the last month. Unmet needs at 3-5 years post-diagnosis were predicted by younger age (OR = 4.47 95 % CI: 2.09-9.56) and advanced disease stage at diagnosis (OR = 2.47 95 % CI: 1.38-4.45) and correlated with greater cancer symptoms (OR = 1.78 95 % CI: 1.05-3.02), lower limb swelling (OR = 2.50 95 % CI: 1.51-4.15), symptoms of anxiety (OR = 2.21 95 % CI: 1.31-3.72), and less availability of social support (OR = 3.42 95 % CI: 1.92-6.11). Women with a history of comorbidities (OR = 0.47 95 % CI: 0.27-0.82) and those living in a rural area at the time of diagnosis (OR = 0.56 95 % CI: 0.34-0.92) were less likely to report unmet needs. Sociodemographic, health, and psychosocial factors seem important for identifying women who will or will not have unmet needs several years following endometrial cancer. Longitudinal assessments of people's needs over the course of their cancer trajectory may be an effective way to identify areas that should receive further attention by health providers.

Factors associated with recall of media reports about vitamin D and sun protection

Publisher: Elsevier BV

Date: 04-2011

DOI: 10.1111/J.1753-6405.2011.00686.X

Abstract: To assess the recall of media reports about vitamin D and associated factors. Analysis of cross-sectional telephone interview data (2,001 Queensland adults, 18-70 years) on vitamin D and personal sun protection, recall of media reports and participant characteristics. 83.7% of participants had heard of vitamin D, 47.5% through the media. Only 513 (25.6%) participants recalled the media content within four main themes: vitamin D is beneficial/comes from the sun (47.0%) some people aren't getting enough vitamin D, need more sun (27.9%) need to balance sun exposure and skin protection (11.5%) or other (13.6%). Only 65 of the 950 participants (6.8%) reported a change to their behaviour(s) due to the media report. Although the media were the main source of information about vitamin D for almost 50% of participants, recall of the content and direct effect on behaviour was low. Only a small minority recalled a balanced media report of beneficial and harmful aspects of sun exposure. Health professionals often supply media with background information. To achieve best public health practice for sun protection and vitamin D, information to foster balanced media reports should be provided.

Exercise during CHemotherapy for Ovarian cancer (ECHO) trial: design and implementation of a randomised controlled trial

Publisher: BMJ

Date: 04-2023

DOI: 10.1136/BMJOPEN-2022-067925

Abstract: Epidemiological evidence supports an association between higher levels of physical activity and improved cancer survival. Trial evidence is now needed to demonstrate the effect of exercise in a clinical setting. The E xercise during CH emotherapy for O varian cancer (ECHO) trial is a phase III, randomised controlled trial, designed to determine the effect of exercise on progression-free survival and physical well-being for patients receiving first-line chemotherapy for ovarian cancer. Participants (target s le size: n=500) include women with newly diagnosed primary ovarian cancer, scheduled to receive first-line chemotherapy. Consenting participants are randomly allocated (1:1) to either the exercise intervention (plus usual care) or usual care alone, with stratification for recruitment site, age, stage of disease and chemotherapy delivery (neoadjuvant vs adjuvant). The exercise intervention involves in idualised exercise prescription with a weekly target of 150 minutes of moderate-intensity, mixed-mode exercise (equivalent to 450 metabolic equivalent minutes per week), delivered for the duration of first-line chemotherapy through weekly telephone sessions with a trial-trained exercise professional. The primary outcomes are progression-free survival and physical well-being. Secondary outcomes include overall survival, physical function, body composition, quality of life, fatigue, sleep, lymphoedema, anxiety, depression, chemotherapy completion rate, chemotherapy-related adverse events, physical activity levels and healthcare usage. Ethics approval for the ECHO trial (2019/ETH08923) was granted by the Sydney Local Health District Ethics Review Committee (Royal Prince Alfred Zone) on 21 November 2014. Subsequent approvals were granted for an additional 11 sites across Queensland, New South Wales, Victoria and the Australian Capital Territory. Findings from the ECHO trial are planned to be disseminated via peer-reviewed publications and international exercise and oncology conferences. Australian New Zealand Clinical Trial Registry (ANZCTRN12614001311640 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367123& isReview=true ).

Serum HE4 as a prognostic marker in endometrial cancer - A population based study

Publisher: Elsevier BV

Date: 2014

DOI: 10.1016/J.YGYNO.2013.10.036

Can clinical decision making be enhanced by artificial intelligence?

Publisher: Oxford University Press (OUP)

Date: 02-2019

DOI: 10.1111/BJD.17110

Vitamin D and sun protection: The impact of mixed public health messages in Australia

Publisher: Wiley

Date: 12-02-2009

DOI: 10.1002/IJC.24154

Abstract: Exposure of the skin to sunlight can cause skin cancer and is also necessary for cutaneous Vitamin D production. Media reports have highlighted the purported health benefits of Vitamin D. Our aim was to examine attitudes and behaviours related to sun protection and Vitamin D. A cross-sectional study of 2,001 residents in Queensland, Australia, aged 20-70 years was undertaken. Information collected included the following: skin cancer risk factors perceptions about levels of sun exposure required to maintain Vitamin D belief that sun protection increases risk of Vitamin D deficiency intention, and actual change in sun protection practices for adults and children. Multivariate models examined predictors of attitudinal and behavioural change. One-third (32%) believed a fair-skinned adult, and 31% thought a child required at least 30 min/day in summer sun to maintain Vitamin D levels. Reductions in sun protection were reported by 21% of adults and 14% of children. Factors associated with the belief that sun protection may result in not obtaining enough Vitamin D included age of >or=60 years (OR = 1.35, 95% CI 1.09-1.66) and having skin that tanned easily (OR = 1.96, 95% CI 1.38-2.78). Participants from low-income households, and those who frequently used sun-protective clothing were more likely to have reduced sun protection practices (OR = 1.33, 95% CI 1.10-1.73 and OR = 1.73, 95% CI 1.36-2.20, respectively). This study provides evidence of reductions in sun protection practices in a population living in a high UV environment. There is an urgent need to refocus messages regarding sun exposure and for continued sun protection practices.

A pilot trial of mobile, patient-performed teledermoscopy

Publisher: Oxford University Press (OUP)

Date: 04-03-2015

DOI: 10.1111/BJD.13550

Abstract: Early detection by skin self-examination (SSE) could improve outcomes for melanoma. Mobile teledermoscopy may aid this process. To establish the clinical accuracy of SSE plus mobile teledermoscopy vs. clinical skin examination (CSE) and to test whether providing people with detailed SSE instructions improves accuracy. Men and women aged 50-64 years (n = 58) performed SSE plus mobile teledermoscopy in their homes between May and November 2013 and were given technical instructions plus detailed SSE instructions (intervention) or technical instructions only (control). Within 3 months, they underwent a CSE. Outcome measures included (i) body sites examined, lesions photographed, and missed (ii) sensitivity of SSE plus mobile teledermoscopy vs. in-person CSE using either patients or lesions as denominator and (iii) concordance of telediagnosis with CSE. Overall 49 of 58 randomized participants completed the study, and submitted 309 lesions to the teledermatologist. Intervention-group participants were more likely to submit lesions from their legs compared with controls (P = 0·03), with no other differences. Eleven participants (22%) did not photograph 14 pigmented lesions that the dermatologist considered worthwhile photographing or monitoring. The sensitivity of SSE plus mobile teledermoscopy was 82% using the patient as denominator and 42% using the lesion as denominator. There was substantial agreement between telediagnosis and CSE (κ = 0·90), accounting for differential diagnoses. SSE plus mobile teledermoscopy is promising for surveillance of particular lesions even without detailed SSE instructions. However, in the format tested in this study, consumers may overlook lesions and send many nonpigmented lesions. This investigation demonstrates that high-quality dermoscopic images can be taken by patients at home with high accuracy.

Nomogram to Predict the Probability of Relapse in Patients Diagnosed With Borderline Ovarian Tumors

Publisher: BMJ

Date: 02-2013

DOI: 10.1097/IGC.0B013E31827B8844

Lesion Selection by Melanoma High-Risk Consumers During Skin Self-examination Using Mobile Teledermoscopy

Publisher: American Medical Association (AMA)

Date: 06-2014

DOI: 10.1001/JAMADERMATOL.2013.7743

Body Site Distribution of Acquired Melanocytic Naevi and Associated Characteristics in the General Population of Caucasian Adults: A Scoping Review

Publisher: Springer Science and Business Media LLC

Date: 30-09-2022

DOI: 10.1007/S13555-022-00806-X

A Mobile Technology Intervention With Ultraviolet Radiation Dosimeters and Smartphone Apps for Skin Cancer Prevention in Young Adults: Randomized Controlled Trial (Preprint)

Publisher: JMIR Publications Inc.

Date: 21-02-2018

DOI: 10.2196/PREPRINTS.9854

Abstract: kin cancer is the most prevalent and most preventable cancer in Australia. Despite Australia’s long-running public health c aigns, young Australian adults continue to report high levels of ultraviolet radiation (UVR) exposure and frequent sunburns. Young people are now increasingly turning away from traditional media, such as newspapers and TV, favoring Web-based streaming, which is challenging the health care sector to develop new ways to reach this group with targeted, personalized health promotion messages. Advances in technology have enabled delivery of time- and context-relevant health interventions. he primary aim of this randomized controlled trial was to test the effect of UVR feedback from a smartphone app or a UVR dosimeter feedback device on sun protection habits, sun exposure behaviors, sunburn, and physical activity levels in young adults. oung adults aged 18-35 years (n=124) were recruited from Queensland, Australia, between September 2015 and April 2016, via social or traditional media c aigns and outreach activities in the local community. Participants were randomized into 3 groups for a 4-week intervention: (1) no intervention control group (2) UVR monitor group, who were asked to wear a UVR dosimeter feedback device set to their skin type and (3) a SunSmart app group, who were asked to download and use the SunSmart phone app. Data were self-assessed through Web-based surveys at baseline and 1 week and 3 months postintervention. omplete data were available for 86.2% (107/124) of participants (control group, n=36 UVR monitor group, n=36 and SunSmart app group, n=35). Intervention uptake in the UVR monitor group was high, with 94% (34/36) of participants using the device all or some of the time when outdoors. All SunSmart app group participants downloaded the app on their smartphone. There was no significant difference in the change in the sun protection habits (SPH) index (main outcome measure) across the 3 groups. However, compared with the control group, a significantly greater proportion of the participants in the UVR monitor group reduced their time unprotected and exposed to UVR on weekends during the intervention compared with the baseline (odds ratio [OR]: 2.706, 95% CI 1.047-6.992, P=.04). This significant effect was sustained with greater reductions observed up to 3 months postintervention (OR: 3.130, 95% CI 1.196-8.190, P=.02). There were no significant differences between the groups in weekday sun exposure, sunscreen use, sunburn, suntan, or physical activity. sing technology such as apps and personal UVR monitoring devices may improve some sun exposure behaviors among young adults, but as the SPH index did not increase in this study, further research is required to achieve consistent uptake of sun protection in young people. he Australian and New Zealand Clinical Trials register ACTRN12615001296527 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368458 (Archived by WebCite at 31somROx)

The Additive Value of 3D Total Body Imaging for Sequential Monitoring of Skin Lesions: A Case Series

Publisher: S. Karger AG

Date: 11-08-2021

DOI: 10.1159/000517900

Abstract: b i Background: /i /b Timely diagnosis is the cornerstone of melanoma morbidity and mortality reduction. 2D total body photography and dermoscopy are routinely used to assist with early detection of skin malignancies. Polarized 3D total body photography is a novel technique that enables fast image acquisition of almost the entire skin surface. We aimed to determine the added value of 3D total body photography alongside dermoscopy for monitoring cutaneous lesions. b i Methods: /i /b Lesion images from high-risk in iduals were assessed for long-term substantial changes via dermoscopy and 3D total body photography. Three case studies are presented demonstrating how 3D total body photography may enhance lesion analysis alongside traditional dermoscopy. b i Results: /i /b 3D total body photography can assist clinicians by presenting cutaneous lesions in their skin ecosystem, thereby providing additional clinical context and enabling a more holistic assessment to aid dermoscopy interpretation. For lesion cases where previous dermoscopy is unavailable, corresponding 3D images can substitute for baseline dermoscopy. Additionally, 3D total body photography is not susceptible to artificial stretch artefacts. b i Conclusion: /i /b 3D total body photography is valuable alongside dermoscopy for monitoring cutaneous lesions. Furthermore, it is capable of surveilling almost the entire skin surface, including areas not traditionally monitored by sequential imaging.

Comparability of skin screening histories obtained by telephone interviews and mailed questionnaires: A randomized crossover study

Publisher: Oxford University Press (OUP)

Date: 15-09-2004

DOI: 10.1093/AJE/KWH263

Toward Incorporating Health-Related Quality of Life as Coprimary End Points in Clinical Trials: Time to Achieve Clinical Important Differences and QoL Profiles

Publisher: American Society of Clinical Oncology (ASCO)

Date: 20-07-2022

DOI: 10.1200/JCO.21.02750

Abstract: Besides morbidity and mortality, quality of life (QoL) is a key outcome of cancer treatments. Trials on the basis of clinical outcomes have expectations that QoL outcomes can be either tolerated or improved. Simultaneously considering QoL and clinical outcomes is challenging with lack of suitable metrics allowing incorporation of QoL as coprimary end points in clinical trial design and utilization of hierarchical hypothesis testing. We propose combining time to achieving a minimal clinically important difference (MCID) and probabilities of a MCID occurring in each QoL domain to provide QoL metrics analogous to those used for clinical end points. For QoL domains of interest, these yield QoL profiles, time to MCID, and number needed to treat. Incorporation of QoL as coprimary end points in clinical trial designs through hierarchical hypothesis testing can easily be achieved. The noninferiority designed Laparoscopic Approach to Carcinoma of the Endometrium trial, evaluating laparoscopic versus open abdominal surgery for endometrial cancer with Functional Assessment of Cancer Therapy–General QoL domains, is used to illustrate the usefulness of these metrics. This analysis revealed that laparoscopic surgery had a significant shorter time to MCID for physical and functional well-being QoL domains (physical mean: 1.5 months, 95% CI, 0.5 to 2.6 P = .002 and functional mean: 1.4 months 95% CI, 0.4 to 2.4 P = .003) than abdominal surgery, but little difference between the two approaches for psychologic social and emotion well-being. Probability profile plots show a consistent 2-fold higher chance of attaining a MCID for physical and functional well-being over time for laparoscopic compared with abdominal surgery. This analysis reinforces the potential value of novel MCID metrics and their usefulness in raising the profile of QoL outcomes to complement clinical end points. The methods will allow health professionals to counsel patients about QoL outcomes and clinical outcomes simultaneously.

Validity of self-reported skin screening histories

Publisher: Oxford University Press (OUP)

Date: 06-2004

DOI: 10.1093/AJE/KWH143

Medical cost-offsets from psychosocial care in breast cancer

Publisher: Springer Science and Business Media LLC

Date: 20-09-2007

DOI: 10.1007/S10549-007-9750-1

What is needed by staff to implement PROMs into routine oncology care? A qualitative study with the multi‐disciplinary team

Publisher: Hindawi Limited

Date: 11-2019

DOI: 10.1111/ECC.13167

Abstract: The aim of this study was to identify strategies to implement patient-reported outcome measures (PROMs) into routine oncology outpatients' clinical care. Qualitative focus groups were conducted with staff from multiple disciplines using a semistructured interview guide, with supporting data collected in field notes. Data were analysed using a Directed Content Analysis guided by an implementation science framework. The synthesis of the extracted data aimed to identify key requirements which correspond to intrinsic enablers and barriers for implementation. 52 staff members from the multi-disciplinary team participated. Data extracted showed five key themes and three key requirements regarding implementation of PROMs. Staff would consider using PROMs if there was strong research evidence that demonstrates benefits for patient outcomes, if PROM data was relevant to current clinical practice, and if applied appropriately in the specific setting. These findings add pragmatic detail and new knowledge to the current evidence on pathways to PROM implementation. This data can be used to inform implementation of PROMs into health services. Staff have valuable tacit knowledge of what works in practice that offers a unique opportunity to increase successful implementation of a PROM intervention for patient symptom reporting.

Identification of doctors at risk of recurrent complaints: a national study of healthcare complaints in Australia

Publisher: BMJ

Date: 19-08-2013

DOI: 10.1136/BMJQS-2013-002209

Changes in outdoor workers' sun-related attitudes, beliefs, and behaviors: A pre-post workplace intervention

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 09-2014

DOI: 10.1097/JOM.0000000000000244

Incidence, risk factors and estimates of a woman's risk of developing secondary lower limb lymphedema and lymphedema-specific supportive care needs in women treated for endometrial cancer

Publisher: Elsevier BV

Date: 2015

DOI: 10.1016/J.YGYNO.2014.11.006

Abstract: Few studies have assessed the risk and impact of lymphedema among women treated for endometrial cancer. We aimed to quantify cumulative incidence of, and risk factors for developing lymphedema following treatment for endometrial cancer and estimate absolute risk for in iduals. Further, we report unmet needs for help with lymphedema-specific issues. Women treated for endometrial cancer (n = 1243) were followed-up 3-5 years after diagnosis a subset of 643 completed a follow-up survey that asked about lymphedema and lymphedema-related support needs. We identified a diagnosis of secondary lymphedema from medical records or self-report. Multivariable logistic regression was used to evaluate risk factors and estimates. Overall, 13% of women developed lymphedema. Risk varied markedly with the number of lymph nodes removed and, to a lesser extent, receipt of adjuvant radiation or chemotherapy treatment, and use of nonsteroidal anti-inflammatory drugs (pre-diagnosis). The absolute risk of developing lymphedema was >50% for women with 15+ nodes removed and 2-3 additional risk factors, 30-41% for those with 15+ nodes removed plus 0-1 risk factors or 6-14 nodes removed plus 3 risk factors, but ≤ 8% for women with no nodes removed or 1-5 nodes but no additional risk factors. Over half (55%) of those who developed lymphedema reported unmet need(s), particularly with lymphedema-related costs and pain. Lymphedema is common experienced by one in eight women following endometrial cancer. Women who have undergone lymphadenectomy have very high risks of lymphedema and should be informed how to self-monitor for symptoms. Affected women need greater levels of support.

Factors associated with human papillomavirus (HPV) test acceptability in primary screening for cervical cancer: A mixed methods research synthesis

Publisher: Elsevier BV

Date: 11-2018

DOI: 10.1016/J.YPMED.2018.08.034

Abstract: Primary screening for cervical cancer is transitioning from the longstanding Pap smear towards implementation of an HPV-DNA test, which is more sensitive than Pap cytology in detecting high-risk lesions and offers greater protection against invasive cervical carcinomas. Based on these results, many countries are recommending and implementing HPV testing-based screening programs. Understanding what factors (e.g., knowledge, attitudes) will impact on HPV test acceptability by women is crucial for ensuring adequate public health practices to optimize cervical screening uptake. We used mixed methods research synthesis to provide a categorization of the relevant factors related to HPV primary screening for cervical cancer and describe their influence on women's acceptability of HPV testing. We searched Medline, Embase, PsycINFO, CINAHL, Global Health and Web of Science for journal articles between January 1, 1980 and October 31, 2017 and retained 22 empirical articles. Our results show that while most factors associated with HPV test acceptability are included in the Health Belief Model and/or Theory of Planned Behavior (e.g., attitudes, knowledge), other important factors are not encompassed by these theoretical frameworks (e.g., health behaviors, negative emotional reactions related to HPV testing). The direction of influence of psychosocial factors on HPV test acceptability was synthesized based on 14 quantitative studies as: facilitators (e.g., high perceived HPV test benefits), barriers (e.g., negative attitudes towards increased screening intervals), contradictory evidence (e.g., sexual history) and no impact (e.g., high perceived severity of HPV infection). Further population-based studies are needed to confirm the impact of these factors on HPV-based screening acceptability.

Primary Prevention of Skin Cancer

Publisher: Wiley

Date: 06-06-2014

DOI: 10.1002/9781118357606.CH30

Perspectives and Experiences of Patient-Led Melanoma Surveillance Using Digital Technologies From Clinicians Involved in the MEL-SELF Pilot Randomized Controlled Trial: Qualitative Interview Study

Publisher: JMIR Publications Inc.

Date: 20-12-2022

DOI: 10.2196/40623

Abstract: The growing number of melanoma patients who need long-term surveillance increasingly exceeds the capacity of the dermatology workforce, particularly outside of metropolitan areas. Digital technologies that enable patients to perform skin self-examination and send dermoscopic images of lesions of concern to a dermatologist (mobile teledermoscopy) are a potential solution. If these technologies and the remote delivery of melanoma surveillance are to be incorporated into routine clinical practice, they need to be accepted by clinicians providing melanoma care, such as dermatologists and general practitioners (GPs). This study aimed to explore perceptions of potential benefits and harms of mobile teledermoscopy, as well as experiences with this technology, among clinicians participating in a pilot randomized controlled trial (RCT) of patient-led melanoma surveillance. This qualitative study was nested within a pilot RCT conducted at dermatologist and skin specialist GP–led melanoma clinics in New South Wales, Australia. We conducted semistructured interviews with 8 of the total 11 clinicians who were involved in the trial, including 4 dermatologists (3 provided teledermatology, 2 were treating clinicians), 1 surgical oncologist, and 3 GPs with qualifications in skin cancer screening (the remaining 3 GPs declined an interview). Thematic analysis was used to analyze the data with reference to the concepts of “medical overuse” and “high-value care.” Clinicians identified several potential benefits, including increased access to dermatology services, earlier detection of melanomas, reassurance for patients between scheduled visits, and a reduction in unnecessary clinic visits. However, they also identified some potential concerns regarding the use of the technology and remote monitoring that could result in diagnostic uncertainty. These included poor image quality, difficulty making assessments from a 2D digital image (even if good quality), insufficient clinical history provided, and concern that suspicious lesions may have been missed by the patient. Clinicians thought that uncertainty arising from these concerns, together with perceived potential medicolegal consequences from missing a diagnosis, might lead to increases in unnecessary clinic visits and procedures. Strategies suggested for achieving high-value care included managing clinical uncertainty to decrease the potential for medical overuse and ensuring optimal placement of patient-led teledermoscopy within existing clinical care pathways to increase the potential for benefits. Clinicians were enthusiastic about the potential and experienced benefits of mobile teledermoscopy however, managing clinical uncertainty will be necessary to achieve these benefits in clinical care outside of trial contexts and minimize potential harms from medical overuse. Australian and New Zealand Clinical Trials Registry ACTRN12616001716459 anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371865

Differences in epidural and analgesic use in patients with apparent stage i endometrial cancer treated by open versus laparoscopic surgery: Results from the randomised LACE trial

Publisher: Hindawi Limited

Date: 2013

DOI: 10.1155/2013/764329

Abstract: Objectives . We compared postoperative analgesic requirements between women with early stage endometrial cancer treated by total abdominal hysterectomy (TAH) or total laparoscopic hysterectomy (TLH). Methods . 760 patients with apparent stage I endometrial cancer were treated in the international, multicentre, prospective randomised trial (LACE) by TAH ( n = 353 ) or TLH ( n = 407 ) (2005–2010). Epidural, opioid, and nonopioid analgesic requirements were collected until ten months after surgery. Results . Baseline demographics and analgesic use were comparable between treatment arms. TAH patients were more likely to receive epidural analgesia than TLH patients (33% versus 0.5%, P 0.001 ) during the early postoperative phase. Although opioid use was comparable in the TAH versus TLH groups during postoperative 0–2 days (99.7% versus 98.5%, P = 0.09 ), a significantly higher proportion of TAH patients required opioids 3–5 days (70% versus 22%, P 0.0001 ), 6–14 days (35% versus 15%, P 0.0001 ), and 15–60 days (15% versus 9%, P = 0.02 ) after surgery. Mean pain scores were significantly higher in the TAH versus TLH group one (2.48 versus 1.62, P 0.0001 ) and four weeks (0.89 versus 0.63, P = 0.01 ) following surgery. Conclusion . Treatment of early stage endometrial cancer with TLH is associated with less frequent use of epidural, lower post-operative opioid requirements, and better pain scores than TAH.

Consumer Acceptance and Expectations of a Mobile Health Application to Photograph Skin Lesions for Early Detection of Melanoma

Publisher: S. Karger AG

Date: 07-11-2018

DOI: 10.1159/000493728

Abstract: b i Background: /i /b Mobile teledermoscopy may facilitate skin self-examinations (SSEs) and further improve monitoring and detection of melanoma. b i Objective: /i /b To assess consumer acceptability and expectations of a mobile health app used to: (i) instruct SSE and (ii) conduct consumer-performed mobile teledermoscopy. b i Methods: /i /b People aged 18 years and above were invited to participate in either (i) an online survey or (ii) focus group in Brisbane, Australia. Participants were asked about their SSE practices, mobile teledermoscopy acceptance, and app design and functionality. The online survey responses and focus group discussions were coded by two researchers who conducted thematic analysis. b i Results: /i /b Four focus groups were held with a total of 28 participants 88 participants completed the online survey. The mean ages of participants in the focus group and online survey were 46 and 38 years, respectively. There were more males in the focus groups (61%, 17/28) compared to the online survey (19%, 17/88). Regular SSEs were conducted by 56 (64%) of the online survey participants. Barriers to SSE were forgetfulness (44%), low self-perceived risk of melanoma (25%) and low confidence in conducting SSEs (25%). The large majority of online survey participants (95%) would consider sending photos of their skin lesions to a medical practitioner via an app. Focus group participants reported that they would accept using mobile teledermoscopy however, they would prefer to use it to monitor lesions between face-to-face consultations. b i Conclusions: /i /b Overall, participants had positive views on using mobile teledermoscopy to send images of skin lesions to a dermatologist or other medical practitioner.

Weight and weight control behaviors during long‐term endometrial cancer survivorship: Results of the Laparoscopic Approach to Cancer of the Endometrium long‐term follow‐up study

Publisher: Wiley

Date: 18-06-2021

DOI: 10.1002/CAM4.4032

Abstract: Overweight or obesity is common in endometrial cancer (EC). This study aimed to examine sociodemographic, clinical, and psychosocial characteristics associated with being discontent with current weight and use of weight control methods among long‐term EC survivors. Women diagnosed with early‐stage EC who participated in the Laparoscopic Approach to Cancer of the Endometrium (LACE) trial ( n = 516) were invited to complete a long‐term follow‐up survey at least 4.5 years after treatment. Chi‐square test and multivariate logistic regression models adjusted for time since surgery were used to determine factors associated with being discontent with current weight. On average 9 years after surgery, 190/259 (73%) of participants were currently discontent with their weight, and 146 (56%) had used one or more weight loss methods during the past 12 months. Women who were discontent with their weight were more likely to be younger than 70 years ( p 0.000), and used one or more weight loss methods ever or during the past 12 months ( p 0.000). Among the weight loss methods used, exercise (40.1%), meal reductions (52.7%), or fat/sugar reductions (48.5%) were much more commonly reported than fasting (2.6%) or designated weight loss programs (2.3%). Our study provides evidence that the majority of long‐term EC survivors in this clinical trial population are discontent with their weight and over half continue to use multiple methods to lose weight each year. These data indicate that health professionals and lifestyle educators need to assess weight issues, and develop a tailored plan to address the specific needs of long‐term survivors to assist them become content with their weight after treatment for EC.

Redesigning Skin Cancer Early Detection and Care Using a New Mobile Health Application: Protocol of the SKIN Research Project, a Randomised Controlled Trial

Publisher: S. Karger AG

Date: 07-11-2018

DOI: 10.1159/000493729

Abstract: Patients often detect melanoma themselves therefore, regular skin self-examinations (SSEs) play an important role in the early detection and prompt treatment of melanoma. Mobile teledermoscopy is a technology that may facilitate consumer SSEs and rapid communication with a dermatologist. This paper describes the planned randomised controlled trial of an intervention to determine whether mobile technologies can help improve the precision of SSE in consumers. A randomised controlled trial will be conducted to evaluate mobile teledermoscopy-enhanced SSE versus naked-eye SSE. Participants in each group will conduct three home whole-body SSEs at baseline, 1 and 2 months, then present for a clinical skin examination (CSE) by a doctor after the 2-month SSE. Specifically, participants will identify skin lesions that meet the AC (asymmetry and colour) rule for detecting a suspicious skin spot. The primary outcomes are sensitivity and specificity of the skin lesions selected by the participants as needing attention by a doctor, compared to the clinical diagnosis by the dermatologist that will serve as the reference standard for this analysis. For the mobile teledermoscopy-enhanced SSE group, researchers will assess the number, location and type of lesions (1) sent by the participant via mobile teledermoscopy, (2) found at CSE or (3) missed by the participant. For the naked-eye SSE group, researchers will assess the number, location and type of lesions (1) recorded on their body chart by the participant, (2) found at CSE or (3) missed by the participant. Secondary outcomes are based on participants’ self-reported data via online questionnaires.

Skin Cancer Prevention Queensland: towards a future of reduced skin cancer burden for Queenslanders

Publisher: The University of Queensland

Date: 24-01-2023

DOI: 10.14264/2753BD0

Do centralised skin screening clinics increase participation in melanoma screening (Australia)?

Publisher: Springer Science and Business Media LLC

Date: 03-2006

DOI: 10.1007/S10552-005-0419-Y

Abstract: To compare during the first 12 months of a 3-year randomised community-based trial of population screening for melanoma three methods of screening delivery: skin screening within day-to-day primary care (Group A) screening in dedicated skin screening clinics either organised privately by local physicians (Group B) or organised centrally with participants referred back to their physicians for definitive diagnosis and management (Group C). The trial involved 18 regional communities in Queensland, Australia. Of the nine communities randomised to the intervention group, three communities were allocated to each of the Groups A, B or C. All intervention communities received a community education programme and an education and support programme for primary care physicians. The self-reported prevalence of clinical skin examination was assessed by surveying 3,110 residents (66.9% participation rate) aged > or = 30 years by telephone at baseline, and 14,060 residents (70.9% participation rate) by self-administered mailed questionnaire at 12-month follow-up. At baseline the prevalence of skin screening did not differ between intervention and control communities. At 12-month follow-up, participants within intervention communities reported skin screening significantly more frequently (20.9% versus 10.9% p < 0.001). Within intervention communities, the prevalence of clinical skin examinations in Group A was similar to that of control communities (12.6% and 10.9% p = 0.33). Communities in Group B (16.5% p = 0.001) and Group C (27.1% p < 0.001) reported significantly higher prevalence of clinical examinations than the control group. The provision of centrally organised skin screening clinics significantly increases skin screening rates and may have relevance for future melanoma control programmes.

Lymphedema Following Breast Cancer

Publisher: American Society of Clinical Oncology (ASCO)

Date: 10-06-2009

DOI: 10.1200/JCO.2009.22.3388

What Can Twitter Tell Us about Skin Cancer Communication and Prevention on Social Media?

Publisher: S. Karger AG

Date: 2020

DOI: 10.1159/000506458

Abstract: b i Background: /i /b Skin cancer places a substantial burden on the health system in Australia. The modernisation of skin cancer prevention interventions by using social media may enhance their contemporary reach and relevance, especially among the youth. This study aimed to analyse Twitter posts in Australia to establish a baseline of skin cancer and sun-related communication trends. b i Methods: /i /b Tweets posted over the summer of 2018/2019 relating to relevant keywords and hashtags such as “slipslopslap” and “sunscreen” were analysed using quantitative and qualitative methods. The number of tweets, related communication patterns, and possible factors for sudden changes in tweet volume were studied. b i Results: /i /b Results showed that Australians are using Twitter to communicate about their sun-related and skin cancer experiences and to share advice and information on this matter. Overall, Australians use Twitter more frequently to talk about sunscreen (number of tweets between December 2018 and February 2019 = 5,842) and/or skin cancer ( i n /i = 3,936), but not so often to communicate about other sun-protective behaviours ( i n /i = 1,972) or skin cancer prevention c aigns ( i n /i = 108). The number of tweets is greatly affected by the increase in temperature. Celebrities, non-health-related organisations with a high number of followers, and in iduals sharing their own skin cancer experiences achieve a substantial number of likes and retweets and thus influence on Twitter regarding skin cancer-related communication. b i Conclusions: /i /b The results allow deeper understanding of important determinants for effective social media use for health promotion and public health messaging in the future. Linking tweets with temperature, sharing by celebrities or non-health-related organisations and in iduals with a high following can all contribute to greater spread of skin cancer and sun-related messages.

ACEMID cohort study: protocol of a prospective cohort study using 3D total body photography for melanoma imaging and diagnosis

Publisher: BMJ

Date: 09-2023

DOI: 10.1136/BMJOPEN-2023-072788

Evaluating healthcare practitioners’ views on store-and-forward teledermoscopy services for the diagnosis of skin cancer

Publisher: SAGE Publications

Date: 2019

DOI: 10.1177/2055207619828225

Abstract: The aim of the study is to evaluate healthcare practitioners’ views on and satisfaction with (i) digital image acquisition and storage and (ii) store-and-forward teledermoscopy services for the diagnosis of skin cancer in their clinical practice. An online survey was conducted among 59 healthcare practitioners (GPs ( n=17), dermatologists ( n=22), dermatology registrars ( n=18), a dermatology research fellow ( n=1) and a plastic surgeon ( n=1)) to assess usability of digital image acquisition and storage for when the imaging process is conducted by the healthcare practitioners themselves, or by their patients. The study identifies the enablers and barriers of this emerging mode of medical practice. A thematic analysis was used to extract key themes from open-ended responses, which involved identifying themes and patterns within and across participants. Thirty-four healthcare practitioners (58%) had previously used a mobile dermatoscope within their practice. Participants most appreciated its use in their practice for lesion monitoring (59%) and record keeping (39%). Challenges reported were the increased time to support the additional workload (45%), technical issues (33%) and cost of equipment (27%). Practitioners were unsure (36%) or did not advocate teledermoscopy for direct-to-consumer use (41%). Only 23% supported the use of direct-to-consumer teledermoscopy. While most practitioners are receptive to mobile teledermoscopy, there was less support for patient-initiated use, whereby the patient controls the imaging process. As technology improves rapidly it is important to evaluate practitioners’ acceptance and satisfaction of evolving telehealth services, moving forward with models of practice where healthcare practitioners and other healthcare providers will feel comfortable engaging in telehealth services.

Anemia before and during concurrent chemoradiotherapy in patients with cervical carcinoma: Effect on progression-free survival

Publisher: BMJ

Date: 09-2003

DOI: 10.1046/J.1525-1438.2003.13395.X

Abstract: To determine the impact of anemia before and during chemoradiation in patients with cervical cancer, we collected data on hemoglobin (Hb) levels before and during treatment from 60 unselected patients with cervical carcinoma. All patients had FIGO stage IB to IVA disease and were treated with concurrent chemoradiation for the aim of cure. Patients with an Hb value below or equal to the lower 25th quartile were considered anemic. Progression-free survival (PFS) was evaluated by univariate and multivariate analyses. After a median follow-up of 26.3 months, 20 patients developed disease progression. The lowest Hb during chemoradiation (nadir Hb), the stage of disease, and parametrial involvement were correlated significantly with PFS. On multivariate analysis, the nadir Hb (relative risk [RR] 0.29) and tumor stage (RR 3.4) remained the only prognostically relevant factors predicting PFS. At 60 months the PFS was 39.1% for anemic patients and 48.0% for nonanemic patients (P < 0.0002). In patients undergoing chemoradiation for cervical carcinoma, a low nadir Hb is highly predictive of shortened PFS, whereas the Hb before treatment is prognostically not significant.

Clinical outcomes from skin screening clinics within a community-based melanoma screening program

Publisher: Elsevier BV

Date: 2006

DOI: 10.1016/J.JAAD.2005.08.072

Abstract: Within a randomized trial of population screening for melanoma, primary care physicians conducted whole-body skin examinations and referred all patients with suspect lesions to their own doctor for further treatment. Our aim was to describe characteristics of skin screening participants, clinical screening diagnoses, management following referral, and specificity and yield of screening examinations. Information collected from consent forms, referral forms, and histopathological reports of lesions that had been excised or undergone biopsy was analyzed by means of descriptive statistics. A total of 16,383 whole-body skin examinations resulted in 2302 referrals (14.1% overall 15.5% men, 18.2% > or = 50 years of age) for 4129 suspect lesions (including 222 suspected melanoma, 1101 suspected basal cell carcinomas [BCCs], 265 suspected squamous cell carcinomas [SCCs]). Histopathologic results were available for 94.8% of 1417 lesions excised and confirmed 33 melanomas (23 in men 24 in participants > or = 50 years of age), 259 BCCs, and 97 SCCs. The probability of detecting skin cancer of any type within the program was 2.4%. The estimated specificity of whole-body skin examinations for melanoma was 86.1% (95% confidence interval = 85.6-86.6). The positive predictive value (number of confirmed/number of lesions excised or biopsied x 100) for melanoma was 2.5%, 19.3% for BCC, and 7.2% for SCC (overall positive predictive value for skin cancer, 28.9%). Follow-up of participants with a negative screening examination has not been conducted for the present investigation. The rate of skin cancer detected per 100 patients screened was higher than previously reported and men and attendees older than 50 years more frequently received a referral and diagnosis of melanoma. The specificity for detection of melanoma through whole-body skin examination by a primary care physician was comparable to that of other screening tests, including mammography.

Challenges and controversies in the conservative management of uterine and ovarian cancer

Publisher: Elsevier BV

Date: 02-2019

DOI: 10.1016/J.BPOBGYN.2018.08.004

Abstract: Uterine cancer is the fifth most common cancer in women worldwide with an estimated 320,000 annual diagnoses. Its most common form, endometrioid adenocarcinoma of the endometrium (endometrial adenocarcinoma [EAC]), is thought to develop through excessive proliferation of endometrial glands, and then increasing steadily in incidence. The current standard treatment for EAC is hysterectomy, which is often curative. However, it may be unacceptably expensive for women with severe medical comorbidities, those who are at risk of intra- and postoperative adverse events and those who desire fertility. Ovarian cancer is the most malignant of all gynaecological cancers, but patients with disease limited to one ovary and patients with non-epithelial tumours may expect a good prognosis. A selected group of young patients who desire fertility may be well treated with conservative surgery. This chapter reviews patient selection, diagnosis, pre-treatment evaluation, treatment options, surveillance and risk of relapse.

Reproducible Naevus Counts Using 3D Total Body Photography and Convolutional Neural Networks

Publisher: S. Karger AG

Date: 08-07-2022

DOI: 10.1159/000517218

Abstract: b i Background: /i /b The number of naevi on a person is the strongest risk factor for melanoma however, naevus counting is highly variable due to lack of consistent methodology and lack of inter-rater agreement. Machine learning has been shown to be a valuable tool for image classification in dermatology. b i Objectives: /i /b To test whether automated, reproducible naevus counts are possible through the combination of convolutional neural networks (CNN) and three-dimensional (3D) total body imaging. b i Methods: /i /b Total body images from a study of naevi in the general population were used for the training (82 subjects, 57,742 lesions) and testing (10 subjects 4,868 lesions) datasets for the development of a CNN. Lesions were labelled as naevi, or not (“non-naevi”), by a senior dermatologist as the gold standard. Performance of the CNN was assessed using sensitivity, specificity, and Cohen’s kappa, and evaluated at the lesion level and person level. b i Results: /i /b Lesion-level analysis comparing the automated counts to the gold standard showed a sensitivity and specificity of 79% (76–83%) and 91% (90–92%), respectively, for lesions ≥2 mm, and 84% (75–91%) and 91% (88–94%) for lesions ≥5 mm. Cohen’s kappa was 0.56 (0.53–0.59) indicating moderate agreement for naevi ≥2 mm, and substantial agreement (0.72, 0.63–0.80) for naevi ≥5 mm. For the 10 in iduals in the test set, person-level agreement was assessed as categories with 70% agreement between the automated and gold standard counts. Agreement was lower in subjects with numerous seborrhoeic keratoses. b i Conclusion: /i /b Automated naevus counts with reasonable agreement to those of an expert clinician are possible through the combination of 3D total body photography and CNNs. Such an algorithm may provide a faster, reproducible method over the traditional in person total body naevus counts.

Variations in supportive care needs of patients after diagnosis of localised cutaneous melanoma: a 2-year follow-up study

Publisher: Springer Science and Business Media LLC

Date: 25-08-2017

DOI: 10.1007/S00520-016-3378-9

Abstract: We aimed to describe variations in unmet supportive care needs of patients diagnosed with localised melanoma at high risk of recurrence and factors associated with initial and persisting moderate-to-high needs. We ascertained 386 patients diagnosed with clinical stage IB-II melanoma and administered surveys every 6 months for 2 years. The proportion experiencing at least one moderate-to-high need was assessed among salient subgroups: 306 patients with no previous melanoma and 80 with previous melanoma at enrolment, 30 who experienced disease recurrence during follow-up and 31 who developed another primary. Baseline factors associated with (a) needs at enrolment and (b) persistent needs over 2 years (or as long as disease-free) were identified by logistic regression analyses. The proportion of patients with needs substantially declined over the first 6 months (if no previous melanoma, from 48 to 22 %, p < 0.001 previous melanoma, 35 to 17 %, p = 0.007), and in those remaining disease-free, needs declined further by 24 months (to 14 and 6 % respectively). By contrast, 50 % of those experiencing recurrence, and 39 % of those who developed another primary, reported needs. Stressful life events and anxiety were associated with needs at enrolment. At least one need, mainly fear of recurrence, persisted in 22 % of disease-free participants. Persistent needs were predicted by age, depression, anxiety and other stressful life events. Melanoma patients' needs peak when first diagnosed and if disease recurs. Younger people or those experiencing additional stressful events, anxiety or depression are more likely to experience persistent needs and may benefit from tailored support.

Fertility-sparing treatment in early endometrial cancer: current state and future strategies.

Publisher: Korean Society of Obstetrics and Gynecology

Date: 15-07-2020

DOI: 10.5468/OGS.19169

Do hand‐addressed envelopes improve community response rates for a longitudinal study?

Publisher: Wiley

Date: 21-09-2017

DOI: 10.1111/JEP.12816

Safety, feasibility and effects of an individualised walking intervention for women undergoing chemotherapy for ovarian cancer: a pilot study

Publisher: Springer Science and Business Media LLC

Date: 08-09-2011

DOI: 10.1186/1471-2407-11-389

Systematic Review of Interventions to Improve the Provision of Information for Adults with Primary Brain Tumors and Their Caregivers

Publisher: Frontiers Media SA

Date: 23-01-2015

DOI: 10.3389/FONC.2015.00001

Can people take high‐quality images using mobile dermatoscopes at home on easy‐to‐see and difficult‐to‐see body areas?

Publisher: Wiley

Date: 13-10-2022

DOI: 10.1111/JDV.18633

Clinical trials, culture and language: More than meets the eye?

Publisher: Wiley

Date: 24-01-2018

DOI: 10.1111/AJCO.12842

Factors in Randomized Controlled Trials Reported to Impact the Implementation of Patient-Reported Outcome Measures Into Routine Care: Protocol for a Systematic Review

Publisher: JMIR Publications Inc.

Date: 26-11-2019

DOI: 10.2196/14579

Abstract: Patient-reported outcome measures (PROMs) are tools that enable patients to directly report their own assessments of well-being, or symptoms, in a structured and consistent way. Despite the usefulness of PROMs in optimizing health outcomes, their use in clinical practice is not routine. PROMs are complex to integrate into the clinical setting, with many elements potentially impacting on the success of implementation. For this reason, a protocol has been developed to guide a systematic review to collate information on implementation as presented in the randomized controlled trials (RCTs) to date. The primary objective of this systematic review is to identify and synthesize factors available from RCT data about the fidelity of PROM interventions in clinical practice. The secondary objective will be an assessment of how implementation factors impact fidelity outcomes. Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting standards will be followed. MEDLINE, EMBASE, and the Cumulative Index to Nursing and Allied Health Literature via OvidSP will be accessed using a defined search strategy. Grey literature and ClinicalTrials.gov will be reviewed for unpublished studies. Data extraction will be done to identify fidelity and factors impacting implementation, summarized using a narrative synthesis. An evidence-based implementation science framework will assist in identifying potential elements of importance and their effect on the process and outcomes of implementation. A meta-analysis to assess the impact of implementation factors will be attempted. A Cochrane risk of bias tool will be used. This protocol has received funding, and searches of databases will commence at the end of May 2019. It is planned that this systematic review will be finalized for publication in (December) 2019. Applying an implementation science evidence-based framework to the published literature may identify factors present in the data that impact on the implementation of PROMs into routine clinical care. This systematic review aims to improve understanding of how these factors impact the fidelity of this intervention, so that PROMs can be more effectively used in the care of patients. This systematic review can also offer more detailed information about the process and outcomes of successful implementation of PROMs. PRR1-10.2196/14579

Development of a Checklist Tool to Assess the Quality of Skin Lesion Images Acquired by Consumers Using Sequential Mobile Teledermoscopy

Publisher: S. Karger AG

Date: 13-04-2021

DOI: 10.1159/000515158

Abstract: b i Background: /i /b Mobile teledermoscopy is an emerging technology that involves imaging and digitally sending dermoscopic images of skin lesions to a clinician for assessment. High-quality, consistent images are required for accurate telediagnoses when monitoring lesions over time. To date there are no tools to assess the quality of sequential images taken by consumers using mobile teledermoscopy. The purpose of this study was to develop a tool to assess the quality of images acquired by consumers. b i Methods: /i /b Participants imaged skin lesions that they felt were concerning at baseline, 1-, and 2-months. A checklist to assess the quality of consumer sequential imaging of skin lesions was developed based on the International Skin Imaging Collaboration guidelines. A scale was implemented to grade the quality of the images: 0 (low) to 18 (very high). Intra- and inter-reliability of the checklist was assessed using Bland-Altman analysis. Using this checklist, the consistency with which 85 sets of images were scored by 2 evaluators were compared using Kappa statistics. Items with a low Kappa value & #x3c .4 were removed. b i Results: /i /b After reliability testing, 5 of the items were removed due to low Kappa values (& #x3c .4) and the final checklist included 13 items surveying: lesion selection image orientation lighting field of view focus and depth of view. Participants had a mean age of 41 years (range 19–73), and 67% were female. Most participants (84%, i n /i = 71/85) were able to select and image the correct lesion over time for both the dermoscopic and overview images. Younger participants (& #x3c years old) scored significantly higher (8.1 ± 2.1) on the imaging checklist compared to older participants (7.1 ± 2.4 i /i = 0.037). Participants had most difficulty with consistent image orientation. b i Conclusions: /i /b This checklist could be used as a triage tool to filter images acquired by consumers prior to telediagnosis evaluation, which would improve the efficiency and accuracy of teledermatology and teledermoscopy processes. It may also be used to provide feedback to the consumers to improve image acquisition over time.

Malnutrition among gynaecological cancer patients

Publisher: Springer Science and Business Media LLC

Date: 04-10-2007

DOI: 10.1038/SJ.EJCN.1602540

Abstract: To assess the nutritional status of patients with gynaecological cancer. A prospective study assessing the nutritional status of gynaecological patients with suspected or proven gynaecological cancer. Queensland Centre for Gynaecological Cancer, Brisbane, Australia a tertiary referral centre for gynaecological cancer. One hundred forty-five patients with suspected or proven gynaecological cancer aged 20-91 years. Scored patient-generated subjective global assessment (PG-SGA) and serum albumin before treatment. One hundred and sixteen (80%) patients were categorized as PG-SGA class A, 29 (20%) patients were PG-SGA B and none of the patients were PG-SGA C. Ovarian cancer patients had significantly lower serum albumin levels (P=0.003) and higher PG-SGA scores (P<0.001) than patients with other types of cancer and benign conditions. Sixty-seven per cent of patients with ovarian cancer were classified as PG-SGA B. After adjusting for patient's age, body mass index and albumin level, ovarian cancer patients were 19 times more likely to be categorized as PG-SGA class B compared to patients with benign conditions (95% confidence interval: 3.03-129.8 P=0.002). Malnutrition in gynaecological cancer patients is a significant problem, especially among those patients diagnosed with ovarian cancer.

The utility of serum CA-125 in predicting extra-uterine disease in apparent early-stage endometrial cancer

Publisher: Wiley

Date: 19-11-2012

DOI: 10.1002/IJC.26433

Abstract: Surgical staging in early-stage uterine cancer is controversial. Preoperative serum CA-125 may be of clinical value in predicting the presence of extra-uterine disease in patients with apparent early-stage endometrial cancer. Between October 6, 2005, and June 17, 2010, 760 patients were enrolled in an international, multicentre, prospective randomized trial (LACE) comparing laparotomy with laparoscopy in the management of endometrial cancer apparently confined to the uterus. Of these, 657 patients with endometrial adenocarcinoma had a preoperative serum CA-125 value recorded. Multiple cross-validation analysis was undertaken to correlate preoperative serum CA-125 with stage of disease (Stage I vs. Stage II+) after surgery. Patients' median preoperative serum CA-125 was 14 U/ml. A cutoff point of 30 U/ml was associated with the smallest misclassification error, and using this cutoff, 98 patients (14.9%) had elevated CA-125 levels. Of those, 36 (36.7%) had evidence of extra-uterine disease. Of the 116 patients (17.7%) with evidence of extra-uterine disease, 31.0% had an elevated CA-125 level. On univariate and multivariable logistic regression analysis, only preoperative CA-125 level, but no other preoperative clinical characteristics were found to be associated with extra-uterine spread of disease. Utilizing a cutoff point of 30 U/ml achieved a sensitivity, specificity, positive predictive value and negative predictive value of 31.0, 88.5, 36.7 and 85.7%, respectively. Elevated CA-125 above 30 U/ml in patients with apparent early-stage disease is a risk factor for the presence of extra-uterine disease and may assist clinicians in the management of patients with clinical Stage I endometrial cancer.

Review of educational tools for skin self‐examination: A qualitative analysis of laypeople’s preferences

Publisher: Wiley

Date: 29-06-2021

DOI: 10.1002/HPJA.509

Abstract: Skin self‐examination (SSE) empowers in iduals to be aware of their skin and to identify and present to a doctor with any suspicious lesions however evidence‐based, clear guidance for SSE is lacking. A new acronym entitled SCAN (Sore, Changing, Abnormal, New) was compiled to help laypeople recognise early signs of skin cancer. This study undertook a qualitative investigation on how well laypeople understand SCAN and other commonly used educational tools (ABCDE, AC, and “ugly duckling”), whether they have a preferred SSE tool, and whether pictorial presentations enhance their understanding. Seven focus groups were conducted with 28 participants (age range 19‐78 years), including 6 participants with a previous melanoma diagnosis. Among all the educational tools presented, SCAN was commonly described as the favoured to guide SSE. SCAN was perceived as patient‐oriented due to its simplicity and use of easily understood words, while other tools, although perceived as positive in some aspects, were often identified as complex, difficult to understand and aimed towards clinician use. Pictorial presentations were desired as part of an educational tool however, many also raised their potential disadvantages. This was the first study to determine the patient perspective of SCAN and established a erse range of potential quality indicators for SSE educational tools. The findings of this study suggest that current widely used SSE tools may not be the most effective to promote SSE. SCAN may be preferred, as it simplifies SSE by using lay language and is applicable to all skin cancers.

Qpersonalised electronic messages to improve sun protection in young adults

Publisher: SAGE Publications

Date: 02-02-2012

DOI: 10.1258/JTT.2011.111101

Abstract: We studied the acceptability and feasibility of delivering sun protection messages via electronic media such as short message services (SMS) to people aged 18–40 years. An online survey was conducted using a pre-established panel of volunteers. We compared the characteristics of those who indicated that they would like to be alerted to the UV index, with those who would not, using bivariate logistic regression. Characteristics found to be associated with a desire to receive such advice were entered into a multivariate logistic regression analysis. The median age of the 141 participants was 34 years. Overall, 80% of participants agreed that they would like to receive some form of sun protection advice. Of these, 20% preferred to receive it via SMS and 42% via email. Willingness to receive electronic messages about the UV index was associated with being unsure about whether a suntanned person would look healthy and greater use of sun protection in the past. Careful attention to message framing and timing of message delivery, and focus on the short-term effects of sun exposure such as sunburn and skin ageing should increase the acceptability of such messages to young people. Sun protection messages delivered to young adults via electronic media appear to be feasible and acceptable.

How to train practising gynaecologists in total laparoscopic hysterectomy: protocol for the stepped-wedge IMAGINE trial

Publisher: BMJ

Date: 05-2019

DOI: 10.1136/BMJOPEN-2018-027155

Abstract: Hysterectomy is the most common major gynaecological procedure in women and minimally invasive approaches should be used wherever possible total laparoscopic hysterectomy (TLH) is one such surgical approach which allows removal of the uterus entirely laparoscopically. However, lack of surgical training opportunities is impeding its increased adoption. This study will formally test a surgical outreach training model to equip surgeons with the skills to provide TLH as an alternative to total abdominal hysterectomy (TAH). Stepped wedge implementation trial of a surgical training programme for practising obstetrician gynaecologist specialists in four hospitals. Change in the proportion of hysterectomies performed by TAH, measured between preintervention and postintervention we aim to reduce TAH by at least 30% in 75% of the trainees. (1) Number of hospitals screened, eligible, agree to training and complete the training (2) number of surgeons screened for eligibility, eligible, agree to training, who complete training and achieve proficiency (3) proportion of trainees achieving proficiency in correct theatre setup, vascular exposure, mobilisation and surgery closure change in proportion proficient over time (4) adverse events (conversion from TLH to TAH, anaesthetic incident, intraoperative visceral injury, red cell transfusions, hospital stay days, incidental finding of malignancy, unplanned readmission, admission to intensive care, return to theatre, postoperative pulmonary embolism or deep vein thrombosis, development of a fistula, vault haematoma, vaginal vault dehiscence or pelvic infection) (5) hospital length-of-stay (6) cost-effectiveness and (7) trainee surgeon proficiency with TLH. The study has been approved by the Royal Brisbane and Women’s Hospital Human Research Ethics Committee and has received site-specific approval from all participating hospitals. Results will be submitted for publication in a peer-reviewed journal. NCT03617354 Pre-results.

Long-term deaths from melanoma according to tumor thickness at diagnosis

Publisher: Wiley

Date: 28-02-2020

DOI: 10.1002/IJC.32930

Primary fallopian tube carcinoma: the Queensland experience

Publisher: BMJ

Date: 26-01-2001

DOI: 10.1046/J.1525-1438.2001.011001069.X

Abstract: The purpose of this study was to review the experience with fallopian tube carcinoma in Queensland and to compare it with previously published data. Thirty-six patients with primary fallopian tube carcinoma treated at the Queensland Gynaecological Cancer Center from 1988 to 1999 were reviewed in a retrospective clinicopathologic study. All patients had primary surgery and 31/36 received chemotherapy postoperatively. Abnormal vaginal bleeding (15/36) and abdominal pain (14/36) were the most common presenting symptoms at the time of diagnosis. Median follow-up was 70.3 months and the median overall survival was 68.1 months. Surgical stage I disease (P = 0.02) and the absence of residual tumor after operation (P = 0.03) were the only factors associated with improved survival. Twenty of the 36 patients (55%) presented with stage I disease and survival was 62.7% at 5 years. No patient with postoperative residual tumor survived. The majority of the patients with fallopian tube carcinoma present with stage I disease at diagnosis, but their survival probability is low compared with that of other early stage gynecological malignancies. If primary surgical debulking cannot achieve macroscopic tumor clearence, the chance of survival is extremely low.

Effect of solar ultraviolet radiation exposure on serum 25(OH)D concentration: a pilot randomised controlled trial

Publisher: Springer Science and Business Media LLC

Date: 05-2018

DOI: 10.1039/C7PP00378A

Abstract: Sunlight generates vitamin D, but there are scant human data from randomised trials on which to base health policy advice about how much sun exposure is necessary to change 25(OH)D concentrations. The purpose of the study was to evaluate the feasibility of using solar ultraviolet (UV) radiation exposure to generate a change in 25(OH)D concentration in a randomised controlled trial (RCT). The intervention tested in this RCT was supervised exposure to one standard erythemal dose (SED 100 J m-2) of solar UV radiation three days per week for three weeks with approximately 35% of the body surface area not covered by clothing. Thirty-six fair-skinned (skin type II and III) indoor workers from Brisbane, Australia were randomised into either the intervention group (n = 16) or the control group (n = 20) the latter did not receive any supervised sun exposure. We asked both groups to use sunscreen and to minimise time outdoors during the study period. We collected blood s les at baseline, once per week during the three week intervention period, and four weeks after the intervention finished. The cumulative UV radiation exposure over the intervention period measured using polysulphone badges was higher in the intervention group than in the control group (median 8 vs. 4 SEDs, p = 0.14). After three weeks, the mean serum 25(OH)D concentration increased from 60 to 65 nmol l-1 in the intervention group and from 55 to 57 nmol l-1 in the control group. After adjustment for baseline 25(OH)D, the mean change per week during the intervention phase was non-significantly higher in the intervention than in the control group (0.7 vs. 0.3 p = 0.35). This difference was not sustained during the follow-up period. Large field trials are needed to inform policy about how much natural sun exposure is required to raise 25(OH)D concentrations. This pilot identified key issues that need to be considered in the design of such a trial.

Advances in skin cancer early detection and diagnosis

Publisher: Elsevier BV

Date: 08-2013

DOI: 10.1016/J.SONCN.2013.06.003

Abstract: To provide an overview of 1) traditional methods of skin cancer early detection, 2) current technologies for skin cancer detection, and 3) evolving practice models of early detection. Peer-reviewed databased articles and reviews, scholarly texts, and Web-based resources. Early detection of skin cancer through established methods or newer technologies is critical for reducing both skin cancer mortality and the overall skin cancer burden. A basic knowledge of recommended skin examination guidelines and risk factors for skin cancer, traditional methods to further examine lesions that are suspicious for skin cancer and evolving detection technologies can guide patient education and skin inspection decisions.

Quality of life of women with lower limb swelling or lymphedema 3-5 years following endometrial cancer

Publisher: Elsevier BV

Date: 05-2014

DOI: 10.1016/J.YGYNO.2014.03.003

Abstract: To quantitatively assess and compare the quality of life (QoL) of women with a self-reported diagnosis of lower limb lymphedema (LLL), to women with lower limb swelling (LLS), and to women without LLL or LLS following treatment for endometrial cancer. 1399 participants in the Australian National Endometrial Cancer Study were sent a follow-up questionnaire 3-5 years after diagnosis. Women were asked if they had experienced swelling in the lower limbs and, if so, whether they had received a diagnosis of lymphedema by a health professional. The 639 women who responded were categorized as: Women with LLL (n=68), women with LLS (n=177) and women without LLL or LLS (n=394). Multivariable-adjusted generalized linear models were used to compare women's physical and mental QoL by LLL status. On average, women were 65 years of age and 4 years after diagnosis. Women with LLL had clinically lower physical QoL (M=41.8, SE=1.4) than women without LLL or LLS (M=45.1, SE=0.8, p=.07), however, their mental QoL was within the normative range (M=49.6 SE=1.1 p=1.0). Women with LLS had significantly lower physical (M=41.0, SE=1.0, p=.003) and mental QoL (M=46.8 SE=0.8, p<.0001) than women without LLL or LLS (Mental QoL: M=50.6, SE=0.8). Although LLL was associated with reductions in physical QoL, LLS was related to reductions in both physical and mental QoL 3-5 years after cancer treatment. Early referral to evidence-based lymphedema programs may prevent long-term impairments to women's QoL.

UV detection stickers can assist people to reapply sunscreen

Publisher: Elsevier BV

Date: 07-2019

DOI: 10.1016/J.YPMED.2019.05.005

Abstract: Sunscreen when applied at the recommended concentration (2 mg/cm

Patterns, correlates, and prognostic significance of quality of life following breast cancer

Publisher: Wiley

Date: 27-09-2011

DOI: 10.1002/PON.1816

Abstract: To describe quality of life (QOL) over a 12-month period among women with breast cancer, consider the association between QOL and overall survival (OS), and explore characteristics associated with QOL declines. A population-based s le of Australian women (n=287) with invasive, unilateral breast cancer (Stage I+) was observed prospectively for a median of 6.6 years. QOL was assessed at 6, 12, and 18 months post-diagnosis, using the Functional Assessment of Cancer Therapy, Breast (FACT-B+4) questionnaire. Raw scores for the FACT-B+4 and subscales were computed and in iduals were categorized according to whether QOL declined, remained stable or improved between 6 and 18 months. Kaplan-Meier and Cox proportional hazards survival methods were used to estimate OS and its associations with QOL. Logistic regression models identified factors associated with QOL decline. Within FACT-B+4 subscales, between 10% and 23% of women showed declines in QOL. Following adjustment for established prognostic factors, emotional well-being and FACT-B+4 scores at 6 months post-diagnosis were associated with OS (p<0.05). Declines in physical (p<0.01) or functional (p=0.02) well-being between 6 and 18 months post-diagnosis were also associated significantly with OS. Receiving multiple forms of adjuvant treatment, a perception of not handling stress well and reporting one or more other major life events at 6 months post-diagnosis were factors associated with declines in QOL in multivariable analyses. Interventions targeted at preventing QOL declines may ultimately improve quantity as well as quality of life following breast cancer.

Can skin cancer prevention and early detection be improved via mobile phone text messaging? A randomised, attention control trial

Publisher: Elsevier BV

Date: 02-2015

DOI: 10.1016/J.YPMED.2014.12.009

Abstract: To test the impact of a theory-based, SMS (text message)-delivered behavioural intervention (Healthy Text) targeting sun protection or skin self-examination behaviours compared to attention control. Overall, 546 participants aged 18-42 years were randomised using a computer-generated number list to the skin self-examination (N=176), sun protection (N=187), or attention control (N=183) text messages group. Each group received 21 text messages about their assigned topic over 12 months (12 weekly messages for 3 months, then monthly messages for the next 9 months). Data were collected via telephone survey at baseline, 3, and 12 months across Queensland from January 2012 to August 2013. One year after baseline, the sun protection (mean change 0.12 P=0.030) and skin self-examination groups (mean change 0.12 P=0.035) had significantly greater improvement in their sun protection habits (SPH) index compared to the attention control group (reference mean change 0.02). The increase in the proportion of participants who reported any skin self-examination from baseline to 12 months was significantly greater in the skin self-examination intervention group (103/163 63% P<0.001) than the sun protection (83/173 48%) or attention control (65/165 36%) groups. There was no significant effect of the intervention for participants' self-reported whole-body skin self-examination, sun tanning, or sunburn behaviours. The Healthy Text intervention was effective in inducing significant improvements in sun protection and any type of skin self-examination behaviours. The Australian and New Zealand Clinical Trials register (ACTRN12612000577819). Cancer Australia 1011999.

Impact of videotaped information on frequency and confidence of breast self-examination

Publisher: Springer Science and Business Media LLC

Date: 05-2002

DOI: 10.1023/A:1015264103561

Abstract: Videotaped education materials to teach breast self-examination (BSE) are used worldwide. However, evaluation of videotaped BSE instructions is lacking. Premenopausal women (mean age 33.4+/-11.2 years) without history of breast cancer were approached to participate in this experimental study and randomly assigned to a video intervention group (VG n = 130: length of the video = 15 min) or non-video comparison group (NVG n = 121). All participants answered a questionnaire on BSE behavior and health beliefs. No additional training was given. The total duration of the session including completion of the questionnaire was 15 min for the NVG and 30 min for the VG. Three months later, changes in BSE behavior were compared in the two groups. The influence of health beliefs on actual BSE behavior was investigated as well. Women of both the VG and NVG performed BSE significantly more frequently at follow-up than at baseline. Analysis of covariance, using the baseline BSE-frequency as co-variate and the follow-up BSE frequency as the dependent variable, revealed that women in the VG (adjusted mean = 7.9 times per year, 95%CI = 6.5-9.4) performed BSE more frequently than women of the NVG (adjusted mean = 6.1 times per year, 95%CI = 4.6-7.5) (F = 4.2, df= 2, p = 0.02). Among motivational predictors, having an ex le of a role model (modeling) was shown by regression analysis to explain the greatest amount of variance (13%) in BSE frequency. Use of an educational videotape increased the frequency of BSE among premenopausal women.

Possible Genetic Predisposition to Lymphedema after Breast Cancer

Publisher: Mary Ann Liebert Inc

Date: 03-2012

DOI: 10.1089/LRB.2011.0024

Quality and Readability of Information Materials for People with Brain Tumours and Their Families

Publisher: Springer Science and Business Media LLC

Date: 25-08-2012

DOI: 10.1007/S13187-012-0401-9

Abstract: Written information is commonly used to inform patients about their disease and treatment but must be evidence-based and understandable to be useful. This study assessed the quality of the content and the readability of information brochures for people affected by brain tumours. We randomly selected 18 publicly available brochures. Brochures were assessed by criteria to assess the quality of content using the DISCERN instrument. Readability was tested using three commonly used formulas, which yield the reading grade level required to comprehend the brochure (sixth grade level recommended). The mean overall DISCERN score was 3.17 out of a maximum of 5 (moderate quality) only one achieved a rating greater than 4 (high quality). Only one brochure met the sixth grade readability criteria. Although brochures may have accurate content, few satisfied all of the recommended criteria to evaluate their content. Existing brochures need to be critically reviewed and simplified and consumer-focused brochures, produced.

Lymphedema After Breast or Gynecological Cancer: Use and Effectiveness of Mainstream and Complementary Therapies

Publisher: Mary Ann Liebert Inc

Date: 09-2011

DOI: 10.1089/ACM.2010.0456

Abstract: The purpose of this study was to describe the use, as well as perceived effectiveness, of mainstream and complementary and alternative medicine (CAM) therapies in the treatment of lymphedema following breast or gynecological cancer. Further, the study assessed the relationship between the characteristics of lymphedema (including type, severity, stability, and duration), and the use of CAM and/or mainstream treatment. This was a cross-sectional study using a convenience s le of women with lymphedema following breast and gynecological cancers. A self-administered questionnaire was sent to 247 potentially eligible women. Of those returned (50%), 23 were ineligible and 6 were excluded due to level of missing data. In the previous 12 months, the majority of women (90%) had used mainstream treatments to treat their lymphedema, with massage being the most commonly used (86%). One (1) in 2 women had used CAM to treat their lymphedema, and 98% of those using CAM were also using mainstream treatments. Over 27 types of CAM were reported, with use of a chi machine, vitamin E supplements, yoga, and meditation being the most commonly reported forms. The perceived effectiveness ratings (1-7 with 7=completely effective) of mainstream (mean±standard deviation (SD): 5.3±1.5) and CAM therapies (mean±SD: 5.2+1.6) were considered high. These results demonstrate that mainstream and CAM treatment use is common, varied, and considered to be effective among women with lymphedema following breast or gynecological cancer. Furthermore, it highlights the immediate need for larger prospective studies assessing the inter-relationship between the use of mainstream and CAM therapies for treatment success.

A phase III randomized clinical trial comparing sentinel node biopsy with no retroperitoneal node dissection in apparent early-stage endometrial cancer – ENDO-3: ANZGOG trial 1911/2020

Publisher: BMJ

Date: 02-11-2021

DOI: 10.1136/IJGC-2021-003029

Abstract: Sentinel node biopsy is a surgical technique to explore lymph nodes for surgical staging of endometrial cancer, which has replaced full retroperitoneal lymph node dissection. However, the effectiveness of sentinel node biopsy, its value to patients, and potential harms compared with no-node dissection have never been shown in a randomized trial. Stage 1 will test recovery from surgery. Stage 2 will compare disease-free survival at 4.5 years between patients randomized to sentinel node biopsy versus no retroperitoneal node dissection. The primary hypothesis for stage 1 is that treatment with sentinel node biopsy will not cause detriment to patient outcomes (lymphedema, morbidity, loss of quality of life) and will not increase treatment-related morbidity or health services costs compared with patients treated without a retroperitoneal node dissection at 12 months after surgery. The primary hypothesis for stage 2 is that disease-free survival at 4.5 years after surgery in patients without retroperitoneal node dissection is not inferior to those receiving sentinel node biopsy. This phase III, open-label, two-arm, multistage, randomized non-inferiority trial (ENDO-3) will determine the value of sentinel node biopsy for surgical management of endometrial cancer. Patients with endometrial cancer are randomized to receive: (1) laparoscopic/robotic hysterectomy, bilateral salpingo-oophorectomy with sentinel node biopsy or (2) laparoscopic/robotic hysterectomy, bilateral salpingo-oophorectomy without retroperitoneal node dissection. In stage 1, 444 patients will be enrolled to demonstrate feasibility and quality of life. If this is demonstrated, we will enroll another 316 patients in stage 2. Inclusion criteria include women aged 18 years or older with histologically confirmed endometrial cancer clinical stage 1, who meet the criteria for laparoscopic or robotic total hysterectomy and bilateral salpingo-oophorectomy. Patients with uterine mesenchymal tumors are excluded. The endpoint for stage 1 is surgical recovery, with the proportion of patients returning to usual daily activities at 3 months post-surgery as measured with the EQ-5D. Stage 2 is disease-free survival at 4.5 years. 760 participants (both stages). Stage 1 commenced in January 2021 and is planned to be completed in December 2024 when 444 participants have completed 12 months' follow-up. Stage 2 will enroll a further 316 participants for a total of 760 patients. NCT04073706 .

Mobile medical applications for melanoma risk assessment: False assurance or valuable tool?

Publisher: IEEE

Date: 2014

DOI: 10.1109/HICSS.2014.337

Describing the Skin Surface Ecosystem Using 3D Total Body Photography

Publisher: S. Karger AG

Date: 30-07-2021

DOI: 10.1159/000515147

The effect of an educational programme to improve the skills of general practitioners in diagnosing melanocytic/pigmented lesions

Publisher: Oxford University Press (OUP)

Date: 07-2007

DOI: 10.1111/J.1365-2230.2007.02414.X

Abstract: Skin cancer is a major public health issue in fair-skinned populations, and general practitioners (GPs) play an important role in the diagnosis and management of this disease. To evaluate a self-instructional education module with audit and feedback, designed to increase the skills of GPs in diagnosing melanocytic lesions and skin cancer. This study, conducted in Queensland, Australia, included 16 GPs who participated in an 18-month programme, comprising a 6-month baseline audit of skin excisions, a 6-month educational programme and a 6-month posteducation audit. The overall diagnostic accuracy of malignant lesions was 63.2% (95% CI 60.0-66.3) during baseline and 64.5% (95% CI 61.1-67.7) posteducation. Significant improvements were seen posteducation in the proportion of melanocytic lesions confirmed as malignant (6.1% baseline and 13.5% posteducation, chi(2) = 6.6, P = 0.01). GPs with /= 25 years of practice (P = 0.001). There were no differences in diagnostic skill posteducation according to years of practice. The education programme improved the malignant : benign ratio of melanocytic lesions, resulting in a doubling in the number of melanomas diagnosed. We found that GPs with less experience benefited most from the programme, indicating that tailoring of programmes to in idual skills and years of practice might be beneficial.

Efficacy of smartphone applications in high‐risk pigmented lesions

Publisher: Wiley

Date: 27-02-2017

DOI: 10.1111/AJD.12599

Abstract: Melanoma apps are smartphone applications that assess risk of pigmented lesions using a smartphone camera and underlying algorithm. We aimed to assess the capability of melanoma smartphone applications (apps) in making clinical decisions about risk, compared with lesion assessment by specialist trained dermatologists. A prospective study of 3 melanoma apps was conducted between 2015 and 2016, recruiting 30 patients with 57 pigmented lesions. Risk categories assigned by the apps were compared with the clinical decisions of two consultant dermatologists classifying lesions as 'suspicious' or 'benign'. Of the 42 lesions deemed clinically suspicious to a dermatologist, from 9 to 26 were classified as suspicious by the apps of the 15 clinically benign lesions 3 to 15 were correctly classified as benign by the apps. The apps' sensitivity and specificity ranged from 21 to 72% and 27 to 100.0%, respectively, when compared with the specialists' decisions. Two apps were unable to analyse 14 and 18% of lesions submitted, respectively. Interrater agreement between dermatologists and apps was poor (κ = -0.01 SE = 0.16 P = 0.97) to slight (κ = 0.16 SE = 0.09 P = 0.12). None of the melanoma apps tested had high enough agreement with the dermatologist's clinical opinion to be considered to provide additional benefit to patients in assessing their skin for high-risk pigmented lesions. The low sensitivity in detecting lesions that are suspicious to a trained specialist may mean false reassurance is being given to patients. Development of highly sensitive and specific melanoma apps remains a work in progress.

What determines the health-related quality of life among regional and rural breast cancer survivors?

Publisher: Elsevier BV

Date: 12-2009

DOI: 10.1111/J.1753-6405.2009.00449.X

Abstract: To assess the health-related quality of life (HRQoL) of regional and rural breast cancer survivors at 12 months post-diagnosis and to identify correlates of HRQoL. In 2006/07, 323 (202 regional and 121 rural) Queensland women diagnosed with unilateral breast cancer participated in a population-based, cross-sectional study. HRQoL was measured using the Functional Assessment of Cancer Therapy, Breast plus arm morbidity (FACT-B+4) self-administered questionnaire. In age-adjusted analyses, mean HRQoL scores of regional breast cancer survivors were comparable to their rural counterparts 12 months post-diagnosis (122.9, 95% CI: 119.8, 126.0 vs. 123.7, 95% CI: 119.7, 127.8 p>0.05). Irrespective of residence, younger (<50 years) women reported lower HRQoL than older (50+ years) women (113.5, 95% CI: 109.3, 117.8 vs. 128.2, 95%CI: 125.1, 131.2 p<0.05). Those women who received chemotherapy, reported two complications post-surgery, had poorer upper-body function than most, reported more stress, reduced coping, who were socially isolated, had no confidante for social-emotional support, had unmet health care needs, and low health self-efficacy reported lower HRQoL scores. The results underscore the importance of supporting and promoting regional and rural breast cancer programs that are designed to improve physical functioning, reduce stress and provide psychosocial support following diagnosis. Further, the information can be used by general practitioners and other allied health professionals for identifying women at risk of poorer HRQoL.

Consumer acceptance of patient-performed mobile teledermoscopy for the early detection of melanoma

Publisher: Oxford University Press (OUP)

Date: 02-09-2016

DOI: 10.1111/BJD.14630

Abstract: Mobile teledermoscopy allows consumers to send images of skin lesions to a teledermatologist for remote diagnosis. Currently, technology acceptance of mobile teledermoscopy by people at high risk of melanoma is unknown. We aimed to determine the acceptance of mobile teledermoscopy by consumers based on perceived usefulness, ease of use, compatibility, attitude/intention, subjective norms, facilitators and trust before use. Consumer satisfaction was explored after use. Consumers aged 50-64 years at high risk of melanoma (fair skin or previous skin cancer) were recruited from a population-based cohort study and via media announcements in Brisbane, Australia in 2013. The participants completed a 27-item questionnaire preteledermoscopy modified from a technology acceptance model. The first 49 participants with a suitable smartphone then conducted mobile teledermoscopy in their homes for early detection of melanoma and were asked to rate their satisfaction. The preteledermoscopy questionnaire was completed by 228 participants. Most participants (87%) agreed that mobile teledermoscopy would improve their skin self-examination performance and 91% agreed that it would be in their best interest to use mobile teledermoscopy. However, nearly half of participants (45%) were unsure about whether they had complete trust in the telediagnosis. The participants who conducted mobile teledermoscopy (n = 49) reported that the dermatoscope was easy to use (94%) and motivated them to examine their skin more often (86%). However, 18% could not take photographs in hard-to-see areas and 35% required help to submit the photograph to the teledermatologist. Mobile teledermoscopy consumer acceptance appears to be favourable. This new technology warrants further assessment for its utility in the early detection of melanoma or follow-up.

Chemotherapy in patients with unresected pancreatic cancer in Australia: A population‐based study of uptake and survival

Publisher: Wiley

Date: 23-03-2018

DOI: 10.1111/AJCO.12862

Abstract: Palliative chemotherapy improves symptom control and prolongs survival in patients with unresectable pancreatic cancer, but there is a paucity of data describing its use and effectiveness in everyday practice. We explored patterns of chemotherapy use in patients with unresected pancreatic cancer in Australia and the impact of use on survival. We reviewed the medical records of residents of New South Wales or Queensland, Australia, diagnosed with unresectable pancreatic adenocarcinoma between July 2009 and June 2011. Associations between receipt of chemotherapy and sociodemographic, clinical and health service factors were evaluated using logistic regression. We used Cox proportional hazards models to analyze associations between chemotherapy use and survival. Data were collected for 1173 eligible patients. Chemotherapy was received by 44% (n = 184/414) of patients with localized pancreatic cancer and 53% (n = 406/759) of patients with metastases. Chemotherapy receipt depended on clinical factors, such as performance status and comorbidity burden, and nonclinical factors, such as age, place of residence, multidisciplinary team review and the type of specialist first encountered. Consultation with an oncologist mitigated most of the sociodemographic and service-related disparities in chemotherapy use. The receipt of chemotherapy was associated with prolonged survival in patients with inoperable pancreatic cancer, including after adjusting for common prognostic factors. These findings highlight the need to establish referral pathways to ensure that all patients have the opportunity to discuss treatment options with a medical oncologist. This is particularly relevant for health care systems covering areas with a geographically dispersed population.

Disease-free survival after vaginal vault brachytherapy versus observation for patients with node-negative intermediate-risk endometrial adenocarcinoma

Publisher: Elsevier BV

Date: 09-2008

DOI: 10.1016/J.YGYNO.2008.05.028

Abstract: To compare the disease-free survival (DFS) of patients with surgical stage 1, intermediate-risk endometrial adenocarcinoma (EAC) treated with primary surgery with or without adjuvant vaginal vault brachytherapy (VVBT). A retrospective chart review identified 575 patients with stage 1B, 1C or 2A endometrial cancer who had surgery between 1990 and 2004. All patients were surgically staged and 259 patients received postoperative VVBT. The date and site of first recurrence were considered the primary statistical endpoints and were analysed by univariate and multivariate Cox models. Subgroups of patients stratified by substage and grade were created and Log-rank tests using vaginal recurrence as the endpoint were calculated within these groups. After a mean follow-up period of 72 months (95%-confidence interval (CI): 68 to 75 months) a total of 43 (7.5%) patients developed recurrence. Multivariate analysis demonstrated that increasing patient's age at diagnosis and stage 1C or 2A disease were independent risk factors for recurrence whereas the grade of differentiation and the type of treatment (surgery alone vs. surgery followed by postoperative VVBT) were not associated with a change in DFS. Analysis within the subgroups stratified by substage and grade did not even reveal a trend towards improved local control with VVBT. Postoperative VVBT was not associated with a measurable reduction in the risk of recurrence in surgical stage 1, intermediate-risk endometrial cancer.

Estimating Skin Cancer Risk: Evaluating Mobile Computer-Adaptive Testing

Publisher: JMIR Publications Inc.

Date: 22-01-2016

DOI: 10.2196/JMIR.4736

Unmet supportive care needs and interest in services among patients with a brain tumour and their carers

Publisher: Elsevier BV

Date: 05-2008

DOI: 10.1016/J.PEC.2008.01.020

Abstract: To assess the supportive care needs and interest in related services among brain tumour patients and their carers and to compare the level of unmet needs to other cancer populations. A cross-sectional survey was posted to 363 households who were subscribed to the Queensland Cancer Fund Brain Tumour Support Service in 2005. Overall, 75 patients and 70 carers (response rate 29.8%) returned completed questionnaires. Measures were the Supportive Care Needs Survey (SCNS-34) and a brain tumour specific subscale for patients and carers, as well as the Hospital Anxiety and Depression Scale (HADS). Patients most frequently reported requiring support to overcome fatigue, uncertainty about the future and not being able to do the things they used to do. Carers wanted help dealing with fears about the patients mental or physical deterioration, with the impact caring had on their own life, and with reducing stress in the patient's life. Among patients, 30% reported anxious mood and 17% depressed mood on the HADS, while corresponding numbers for carers were 40% and 10%, respectively. Patients and/or carers with higher than average supportive care needs expressed greater interest in support services, such as those to improve physical activity, using community services more effectively and to manage stress. Greater emotional distress predicted higher supportive care needs (e.g. odds ratio depressed patients=2.11 (95% confidence interval 1.10-4.03), while no association was detected between patients' or carers' demographic characteristics, or patients' self-reported medical status and higher than average supportive care needs. The level of unmet supportive care needs observed among patients with a brain tumour and their carers is similar to that observed among cancer populations with metastatic disease. Interventions for this group should integrate lifestyle, coping support, and neuropsychological rehabilitation.

Accuracy of mobile digital teledermoscopy for skin self-examinations in adults at high risk of skin cancer: an open-label, randomised controlled trial

Publisher: Elsevier BV

Date: 03-2020

DOI: 10.1016/S2589-7500(20)30001-7

Development and piloting of a brain tumour-specific question prompt list

Publisher: Hindawi Limited

Date: 06-02-2012

DOI: 10.1111/J.1365-2354.2012.01328.X

Abstract: The objective of this research was to develop a question prompt list aimed at increasing question asking and reducing the unmet information needs of adults with primary brain tumours, and to pilot the question prompt list to determine its suitability for the intended population. Thematic analysis of existing resources was used to create a draft which was refined via interviews with 12 brain tumour patients and six relatives, readability testing and review by health professionals. A non-randomised before-after pilot study with 20 brain tumour patients was used to assess the acceptability and usefulness of the question prompt list, compared with a 'standard brochure', and the feasibility of evaluation strategies. The question prompt list developed covered seven main topics (diagnosis, prognosis, symptoms and changes, treatment, support, after treatment finishes and the health professional team). Pilot study participants provided with the question prompt list agreed that it was helpful (7/7), contained questions that were useful to them (7/7) and prompted them to ask their medical oncologist questions (5/7). The question prompt list is acceptable to patients and contains questions relevant to them. Research is now needed to assess its effectiveness in increasing question asking and reducing unmet information needs.

Laparoscopy or laparotomy for early endometrial cancer? – Authors' reply

Publisher: Elsevier BV

Date: 11-2010

DOI: 10.1016/S1470-2045(10)70219-9

Quality of life after early enteral feeding versus standard care for proven or suspected advanced epithelial ovarian cancer: Results from a randomised trial

Publisher: Elsevier BV

Date: 06-2015

DOI: 10.1016/J.YGYNO.2015.03.048

Abstract: Malnutrition is common in patients with advanced epithelial ovarian cancer (EOC), and is associated with impaired quality of life (QoL), longer hospital stay and higher risk of treatment-related adverse events. This phase III multi-centre randomised clinical trial tested early enteral feeding versus standard care on postoperative QoL. From 2009 to 2013, 109 patients requiring surgery for suspected advanced EOC, moderately to severely malnourished were enrolled at five sites across Queensland and randomised to intervention (n=53) or control (n=56) groups. Intervention involved intraoperative nasojejunal tube placement and enteral feeding until adequate oral intake could be maintained. Despite being randomised to intervention, 20 patients did not receive feeds (13 did not receive the feeding tube 7 had it removed early). Control involved postoperative diet as tolerated. QoL was measured at baseline, 6weeks postoperatively and 30days after the third cycle of chemotherapy. The primary outcome measure was the difference in QoL between the intervention and the control group. Secondary endpoints included treatment-related adverse event occurrence, length of stay, postoperative services use, and nutritional status. Baseline characteristics were comparable between treatment groups. No significant difference in QoL was found between the groups at any time point. There was a trend towards better nutritional status in patients who received the intervention but the differences did not reach statistical significance except for the intention-to-treat analysis at 7days postoperatively (11.8 intervention vs. 13.8 control, p 0.04). Early enteral feeding did not significantly improve patients' QoL compared to standard of care but may improve nutritional status.

Health professionals' perspectives on information provision for patients with brain tumours and their families

Publisher: Hindawi Limited

Date: 19-09-2013

DOI: 10.1111/ECC.12011

Abstract: A significant number of patients diagnosed with primary brain tumours report unmet information needs. Using concept mapping methodology, this study aimed to identify strategies for improving information provision, and to describe factors that health professionals understood to influence their provision of information to patients with brain tumours and their families. Concept mapping is a mixed-methods approach that uses statistical methods to represent participants' perceived relationships between elements as conceptual maps. These maps, and results of associated data collection and analyses, are used to extract concepts involved in information provision to these patients. Thirty health professionals working across a range of neuro-oncology roles and settings participated in the concept mapping process. Participants rated a care coordinator as the most important strategy for improving brain tumour care, with psychological support as a whole rated as the most important element of care. Five major themes were identified as facilitating information provision: health professionals' communication skills, style and attitudes patients' needs and preferences perceptions of patients' need for protection and initiative rapport and continuity between patients and health professionals and the nature of the healthcare system. Overall, health professionals conceptualised information provision as 'in idualised', dependent on these interconnected personal and environmental factors.

The view from two sides: A qualitative study of community and medical perspectives on screening for colorectal cancer using FOBT

Publisher: Elsevier BV

Date: 09-2004

DOI: 10.1016/J.YPMED.2004.05.015

Epidural analgesia is associated with an increased incidence of postoperative complications in patients requiring an abdominal hysterectomy for early stage endometrial cancer

Publisher: Elsevier BV

Date: 11-2013

DOI: 10.1016/J.YGYNO.2013.08.027

Abstract: Analgesia and early quality of recovery may be improved by epidural analgesia. We aimed to assess the effect of receiving epidural analgesia on surgical adverse events and quality of life after laparotomy for endometrial cancer. Patients were enrolled in an international, multicentre, prospective randomised trial of outcomes for laparoscopic versus open surgical treatment for the management of apparent stage I endometrial cancer (LACE trial). The current analysis focussed on patients who received an open abdominal hysterectomy via vertical midline incision only (n=257), examining outcomes in patients who did (n=108) and did not (n=149) receive epidural analgesia. Baseline characteristics were comparable between patients with or without epidural analgesia. More patients without epidural (34%) ceased opioid analgesia 3-5 days after surgery compared to patients who had an epidural (7% p<0.01). Postoperative complications (any grade) occurred in 86% of patients with and in 66% of patients without an epidural (p<0.01) but there was no difference in serious adverse events (p=0.19). Epidural analgesia was associated with increased length of stay (up to 48 days compared to up to 34 days in the non-epidural group). There was no difference in postoperative quality of life up to six months after surgery. Epidural analgesia was associated with an increase in any, but not serious, postoperative complications and length of stay after abdominal hysterectomy. Randomised controlled trials are needed to examine the effect of epidural analgesia on surgical adverse events, especially as the present data do not support a quality of life benefit with epidural analgesia.

Position statement: balancing the harms and benefits of sun exposure

Publisher: The University of Queensland

Date: 21-07-2023

DOI: 10.14264/17C76BD

Self-reported naevus density may lead to misclassification of melanoma risk

Publisher: Oxford University Press (OUP)

Date: 20-01-2020

DOI: 10.1111/BJD.18802

Lower preoperative quality of life increases postoperative risk of adverse events in women with endometrial cancer: Results from the LACE trial

Publisher: Elsevier BV

Date: 04-2015

DOI: 10.1016/J.YGYNO.2015.02.008

Abstract: To examine the association between preoperative quality of life (QoL) and postoperative adverse events in women treated for endometrial cancer. 760 women with apparent Stage I endometrial cancer were randomised into a clinical trial evaluating laparoscopic versus open surgery. This analysis includes women with preoperative QoL measurements, from the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire, and who were followed up for at least 6 weeks after surgery (n=684). The outcomes for this study were defined as (1) the occurrence of moderate to severe adverse events within 6 months (Common Toxicology Criteria (CTC) grade≥3) and (2) any serious adverse event (SAE). The association between preoperative QoL and the occurrence of AE was examined, after controlling for baseline comorbidity and other factors. After adjusting for other factors, odds of occurrence of AE of CTC grade≥3 were significantly increased with each unit decrease in baseline FACT-G score (OR=1.02, 95% CI 1.00-1.03, p=0.030), which was driven by physical well-being (PWB) (OR=1.09, 95% CI 1.04-1.13, p=0.0002) and functional well-being subscales (FWB) (OR=1.04, 95% CI 1.00-1.07, p=0.035). Similarly, odds of SAE occurrence were significantly increased with each unit decrease in baseline FACT-G score (OR=1.02, 95% CI 1.01-1.04, p=0.011), baseline PWB (OR=1.11, 95% CI 1.06-1.16, p<0.0001) or baseline FWB subscales (OR=1.05, 95% CI 1.01-1.10, p=0.0077). Women with early endometrial cancer presenting with lower QoL prior to surgery are at higher risk of developing a serious adverse event following surgery. Cancer Council Queensland, Cancer Council New South Wales, Cancer Council Victoria, Cancer Council, Western Australia NHMRC project grant 456110 Cancer Australia project grant 631523 The Women and Infants Research Foundation, Western Australia Royal Brisbane and Women's Hospital Foundation Wesley Research Institute Gallipoli Research Foundation Gynetech TYCO Healthcare, Australia Johnson and Johnson Medical, Australia Hunter New England Centre for Gynaecological Cancer Genesis Oncology Trust and Smart Health Research Grant QLD Health.

Perspectives and experiences of patient-led melanoma surveillance using digital technologies from clinicians involved in the MEL-SELF pilot randomised controlled trial: Qualitative Interview Study (Pr

Publisher: JMIR Publications Inc.

Date: 30-06-2022

DOI: 10.2196/PREPRINTS.40623

Abstract: he large and growing number of melanoma patients who need long term surveillance increasingly exceeds capacity of the dermatology workforce, particularly outside of metropolitan areas. Digital technologies that enable patients to do skin self-examination and send dermoscopic images of lesions of concern to a dermatologist (mobile teledermoscopy) are one potential solution. If these technologies and the remote delivery of melanoma surveillance are to be incorporated into routine clinical practice, they need to be accepted by clinicians providing melanoma care (e.g., dermatologists and general practitioners (GPs)). o explore perceptions of potential benefits and harms of mobile teledermoscopy, and experiences with this technology, among clinicians participating in a pilot randomised controlled trial (RCT) of patient-led melanoma surveillance. his qualitative study was nested within a pilot RCT conducted at dermatologist- and skin specialist GP-led melanoma clinics in New South Wales, Australia. We conducted semi-structured interviews with 8 of the total 11 clinicians who were involved in the trial: 4 dermatologists (3 provided teledermatology, 2 were treating clinicians), 1 surgical oncologist, and 3 GPs with qualifications in skin cancer screening (the remaining 3 GPs declined interview). Thematic analysis was used to analyse the data with reference to concepts ‘medical overuse’ and ‘high-value care’. linicians identified several potential benefits, including increased access to dermatology services, earlier detection of melanomas, reassurance for patients between scheduled visits, and a reduction in unnecessary clinic visits. However, they also identified some potential concerns around use of the technology and remote monitoring that could result in diagnostic uncertainty. These included poor image quality, difficulty making assessments from a 2D digital image (even if good quality), insufficient clinical history provided, and concern that suspicious lesions may have been missed by the patient. Clinicians thought that uncertainty arising from these concerns, together with perceived potential medico-legal consequences from missing a diagnosis, might lead to increases in unnecessary clinic visits and procedures. Strategies suggested for achieving high-value care included managing clinical uncertainty in order to decrease the potential for medical overuse, and by ensuring optimal placement of patient-led teledermoscopy within existing clinical care pathways to increase the potential for benefits. linicians were enthusiastic about the potential and experienced benefits of mobile teledermoscopy however, managing clinical uncertainty will be necessary to achieve these benefits in clinical care outside of trial contexts, and to minimise potential harms from medical overuse.

Are psychological interventions effective on anxiety in cancer patients? A systematic review and meta‐analyses

Publisher: Wiley

Date: 16-07-2018

DOI: 10.1002/PON.4794

Abstract: The aims of this meta-analysis were to estimate the overall effect size (ES) of psychological interventions on anxiety in patients with cancer and extract s le and intervention characteristics that influence effectiveness. PubMed, Scopus, PsycINFO, Embase, Medline, and CINAHL were searched using Medical Subject Heading keywords 'cancer' AND 'anxiety' AND 'psychological intervention' AND 'counselling' AND 'psycho*' AND 'psychotherapy' AND 'psychosocial' AND 'therapy' between January 1993 and June 2017. Seventy-one studies were eligible for the systematic review among them, 51 studies were included in the meta-analysis calculations. The overall ES was -0.21 (95% confidence interval -0.30 to -0.13) in favour of the intervention. From subgroup analyses, studies conducted in Asia, enrolling inpatients, focussing on relaxation, of <6-week intervention duration, <30-minute intervention dose per session, and <4 hours of total time of intervention showed moderate ESs ranging from -0.40 to -0.55. Only 2 studies restricted enrolment to prescreened patients with clinically elevated level of anxiety and showed moderate ES of -0.58. Low psychological distress at baseline and nonevidence-based interventions were the main factors identified for low effectiveness. Screening and assessment to determine clinical levels of anxiety in patients with cancer should be considered in future trials as an inclusion criterion before providing psychological interventions. Systematic review registration: PROSPERO: International Prospective Register of Systematic Reviews: CRD42017056132.

Pretreatment malnutrition and quality of life - association with prolonged length of hospital stay among patients with gynecological cancer: A cohort study

Publisher: Springer Science and Business Media LLC

Date: 25-05-2010

DOI: 10.1186/1471-2407-10-232

Abstract: Length of hospital stay (LOS) is a surrogate marker for patients' well-being during hospital treatment and is associated with health care costs. Identifying pretreatment factors associated with LOS in surgical patients may enable early intervention in order to reduce postoperative LOS. This cohort study enrolled 157 patients with suspected or proven gynecological cancer at a tertiary cancer centre (2004-2006). Before commencing treatment, the scored Patient Generated - Subjective Global Assessment (PG-SGA) measuring nutritional status and the Functional Assessment of Cancer Therapy-General (FACT-G) scale measuring quality of life (QOL) were completed. Clinical and demographic patient characteristics were prospectively obtained. Patients were grouped into those with prolonged LOS if their hospital stay was greater than the median LOS and those with average or below average LOS. Patients' mean age was 58 years (SD 14 years). Preoperatively, 81 (52%) patients presented with suspected benign disease elvic mass, 23 (15%) with suspected advanced ovarian cancer, 36 (23%) patients with suspected endometrial and 17 (11%) with cervical cancer, respectively. In univariate models prolonged LOS was associated with low serum albumin or hemoglobin, malnutrition (PG-SGA score and PG-SGA group B or C), low pretreatment FACT-G score, and suspected diagnosis of cancer. In multivariable models, PG-SGA group B or C, FACT-G score and suspected diagnosis of advanced ovarian cancer independently predicted LOS. Malnutrition, low quality of life scores and being diagnosed with advanced ovarian cancer are the major determinants of prolonged LOS amongst gynecological cancer patients. Interventions addressing malnutrition and poor QOL may decrease LOS in gynecological cancer patients.

Body-site distribution of skin cancer, pre-malignant and common benign pigmented lesions excised in general practice

Publisher: Oxford University Press (OUP)

Date: 26-05-2011

DOI: 10.1111/J.1365-2133.2011.10337.X

Abstract: Concern about skin cancer is a common reason for people from predominantly fair-skinned populations to present to primary care doctors. To examine the frequency and body-site distribution of malignant, pre-malignant and benign pigmented skin lesions excised in primary care. This prospective study conducted in Queensland, Australia, included 154 primary care doctors. For all excised or biopsied lesions, doctors recorded the patient's age and sex, body site, level of patient pressure to excise, and the clinical diagnosis. Histological confirmation was obtained through pathology laboratories. Of 9650 skin lesions, 57·7% were excised in males and 75·0% excised in patients ≥ 50 years. The most common diagnoses were basal cell carcinoma (BCC) (35·1%) and squamous cell carcinoma (SCC) (19·7%). Compared with the whole body, the highest densities for SCC, BCC and actinic keratoses were observed on chronically sun-exposed areas of the body including the face in males and females, the scalp and ears in males, and the hands in females. The density of BCC was also high on intermittently or rarely exposed body sites. Females, younger patients and patients with melanocytic naevi were significantly more likely to exert moderate/high levels of pressure on the doctor to excise. More than half the excised lesions were skin cancer, which mostly occurred on the more chronically sun-exposed areas of the body. Information on the type and body-site distribution of skin lesions can aid in the diagnosis and planned management of skin cancer and other skin lesions commonly presented in primary care.

Early detection of melanoma: a consensus report from the Australian Skin and Skin Cancer Research Centre Melanoma Screening Summit

Publisher: Elsevier BV

Date: 04-2020

DOI: 10.1111/1753-6405.12972

Acceptability and feasibility of a community-based screening programme for melanoma in Australia

Publisher: Oxford University Press (OUP)

Date: 09-11-2004

DOI: 10.1093/HEAPRO/DAH405

Abstract: The evaluation of a community-based screening programme for melanoma (SkinWatch) in 18 regional communities (total adult population >30 years 63 035) in Queensland, Australia is described. The aim of the SkinWatch programme was to promote whole-body skin screening for melanoma by primary care physicians. The programme included community education, education and support for local medical practitioners and open-access skin screening clinics. Programme delivery was achieved through assistance of local volunteers. All programme activities and resources were recorded for process evaluation. A baseline telephone survey (n = 3110) and a telephone survey four months after programme launch (n = 680) assessed community awareness of the SkinWatch programme and, 37 face-to-face interviews with community members, doctors and community leaders were conducted to assess satisfaction with the programme. A s le of 1043 of 16,383 residents who attended the skin screening clinics provided as part of the programme were interviewed to assess reasons for attending, and positive and negative aspects of SkinWatch programme. Community awareness of the SkinWatch programme increased by over 30% (p < 0.001) within four months of the start of the programme. Interview participants described the SkinWatch programme as a useful service for the communities and 90% stated they would revisit the clinics. A total of 43% of all attendees were over 50 years old, and nearly 50% were men. These findings demonstrate the acceptability and feasibility of a community-based screening programme for melanoma in rural areas. Volunteers were instrumental in increasing community ownership of and involvement in the SkinWatch programme.

Voluntary whole-blood donors, and compensated platelet donors and plasma donors: Motivation to donate, altruism and aggression

Publisher: Elsevier BV

Date: 10-2005

DOI: 10.1016/J.TRANSCI.2005.03.011

Abstract: To establish if voluntary whole-blood donors and compensated platelet donors and plasma donors may differ in their motivation to donate, altruism, aggression and autoaggression. Whole-blood (n=51), platelet (n=52) and plasma donors (n=48) completed a battery of validated questionnaires while waiting to donate. Bivariate and multivariate analyses of variance and t-tests were performed to detect differences between groups as noted. Altruism (mean=40.2) was slightly higher in whole-blood donors than in platelet (mean=38.3) and plasma donors (mean=39.1) (p=0.07). Blood donors (mean=2.8) scored lower in the spontaneous aggression measure than platelet (mean=4.1) and plasma donors (mean=4.4) (p=0.01). Plasma donors (mean=4.9) had higher auto-aggression than whole-blood donors and platelet donors (mean for both groups=3.4) (p=0.01). Differences between the three groups were mediated by sociodemographic variables (MANCOVA). Whole-blood donors donated to help others, platelet and plasma donors mostly to receive the compensation. However, those platelet and plasma donors, who would continue to donate without compensation were similar in altruism and aggression to whole-blood donors. While most platelet donors and plasma donors were motivated by the compensation, those who stated that they would continue to donate without compensation had altruism and aggression scores similar to voluntary whole-blood donors.

Vulvar cancer patients' quality of life: A qualitative assessment

Publisher: BMJ

Date: 09-2004

DOI: 10.1111/J.1048-891X.2004.14524.X

Genomic Risk Score for Melanoma in a Prospective Study of Older Individuals

Publisher: Oxford University Press (OUP)

Date: 10-04-2021

DOI: 10.1093/JNCI/DJAB076

Abstract: Recent genome-wide association meta-analysis for melanoma doubled the number of previously identified variants. We assessed the performance of an updated polygenic risk score (PRS) in a population of older in iduals, where melanoma incidence and cumulative ultraviolet radiation exposure is greatest. We assessed a PRS for cutaneous melanoma comprising 55 variants in a prospective study of 12 712 in iduals in the ASPirin in Reducing Events in the Elderly Trial. We evaluated incident melanomas diagnosed during the trial and prevalent melanomas diagnosed preenrolment (self-reported). Multivariable models examined associations between PRS as a continuous variable (per SD) and categorical (low-risk [0%-20%], medium-risk [21%-80%], high-risk [81%-100%] groups) with incident melanoma. Logistic regression examined the association between PRS and prevalent melanoma. At baseline, mean participant age was 75 years 55.0% were female, and 528 (4.2%) had prevalent melanomas. During follow-up (median = 4.7 years), 120 (1.0%) incident cutaneous melanomas occurred, 98 of which were in participants with no history. PRS was associated with incident melanoma (hazard ratio = 1.46 per SD, 95% confidence interval [CI] = 1.20 to 1.77) and prevalent melanoma (odds ratio [OR] = 1.55 per SD, 95% CI = 1.42 to 1.69). Participants in the highest-risk PRS group had increased risk compared with the low-risk group for incident melanoma (OR = 2.51, 95% CI = 1.28 to 4.92) and prevalent melanoma (OR = 3.66, 95% CI = 2.69 to 5.05). When stratifying by sex, only males had an association between the PRS and incident melanoma, whereas both sexes had an association between the PRS and prevalent melanoma. A genomic risk score is associated with melanoma risk in older in iduals and may contribute to targeted surveillance.

Evaluation of a skin self examination attitude scale using an item response theory model approach

Publisher: Springer Science and Business Media LLC

Date: 12-2014

DOI: 10.1186/S12955-014-0189-X

What motivates men age ≥50 years to participate in a screening program for melanoma?

Publisher: Wiley

Date: 10-08-2006

DOI: 10.1002/CNCR.22051

Abstract: The screening behavior and screening outcomes of men age > or =50 years was investigated within a randomized controlled trial of a community-based intervention of screening for melanoma, consisting of a community education program, an education program for medical practitioners, and the provision of dedicated skin-screening clinics. Data from cross-sectional telephone surveys before (559 completed interviews), at the end (591 completed interview), and at 2 years after the intervention (445 completed interviews) were analyzed. In addition, the authors analyzed data from skin-screening clinics within the intervention program (3355 men age > or =50 years participated). During the intervention period men age > or =50 years increased both their screening behavior and intention to screen. Those men age > or =50 years who reported a past history of removal of a mole as well as other risk factors for skin cancer and positive attitudes toward screening were more likely to participate in skin screening across time. Men age > or =50 years accounted for 20.5% of all skin-screening clinic attendees, 31.3% of those referred for a suspicious lesion, 48.5% of melanomas, and 45% of all keratinocyte carcinomas diagnosed within the screening program, respectively. The intervention program successfully motivated men age > or =50 years to attend screening for skin cancer, resulting in the highest yield of skin cancer within this subgroup of the population. Messages addressing skin cancer risk factors and attitudes toward skin cancer and screening could be used to target a screening program for melanoma toward men age > or =50 years.

Association between single-nucleotide polymorphisms in growth factor genes and quality of life in men with prostate cancer and the general population

Publisher: Springer Science and Business Media LLC

Date: 28-02-2015

DOI: 10.1007/S11136-015-0950-6

Abstract: Improved survival for men with prostate cancer has led to increased attention to factors influencing quality of life (QOL). As protein levels of vascular endothelial growth factor (VEGF) and insulin-like growth factor 1 (IGF-1) have been reported to be associated with QOL in people with cancer, we sought to identify whether single-nucleotide polymorphisms (SNPs) of these genes were associated with QOL in men with prostate cancer. Multiple linear regression of two data sets (including approximately 750 men newly diagnosed with prostate cancer and 550 men from the general population) was used to investigate SNPs of VEGF and IGF-1 (10 SNPs in total) for associations with QOL (measured by the SF-36v2 health survey). Men with prostate cancer who carried the minor 'T' allele for IGF-1 SNP rs35767 had higher mean Role-Physical scale scores (≥0.3 SD) compared to non-carriers (p < 0.05). While this association was not identified in men from the general population, one IGF-1 SNP rs7965399 was associated with higher mean Bodily Pain scale scores in men from the general population that was not found in men with prostate cancer. Men from the general population who carried the rare 'C' allele had higher mean Bodily Pain scale scores (≥0.3 SD) than non-carriers (p < 0.05). Through identifying SNPs that are associated with QOL in men with prostate cancer and men from the general population, this study adds to the mapping of complex interrelationships that influence QOL and suggests a role for IGF-I in physical QOL outcomes. Future research may identify biomarkers associated with increased risk of poor QOL that could assist in the provision of pre-emptive support for those identified at risk.

Self-Reported Changes in Sun-Protection Behaviors at Different Latitudes in Australia

Publisher: Wiley

Date: 22-03-2016

DOI: 10.1111/PHP.12582

Abstract: Sun exposure is the most important source of vitamin D, but is also a risk factor for skin cancer. This study investigated attitudes toward vitamin D, and changes in sun-exposure behavior due to concern about adequate vitamin D. Participants (n = 1002) were recruited from four regions of Australia and completed self- and interviewer-administered surveys. Chi-square tests were used to assess associations between participants' latitude of residence, vitamin D-related attitudes and changes in sun-exposure behaviors during the last summer. Multivariate logistic regression analyses were used to model the association between attitudes and behaviors. Overall, people who worried about their vitamin D status were more likely to have altered sun protection and spent more time in the sun people not concerned about vitamin D. Concern about vitamin D was also more common with increasing latitude. Use of novel item response theory analysis highlighted the potential impact of self-reported behavior change on skin cancer predisposition due concern to vitamin. This cross-sectional study shows that the strongest determinants of self-reported sun-protection behavior changes due to concerns about vitamin D were attitudes and location, with people at higher latitudes worrying more.

Review of smartphone mobile applications for skin cancer detection: what are the changes in availability, functionality, and costs to users over time?

Publisher: Wiley

Date: 02-09-2020

DOI: 10.1111/IJD.15132

Abstract: Smartphone applications (apps) are available to consumers for skin cancer prevention and early detection. This study aims to review changes over time in the skin cancer apps available to consumers as well as their functionality and costs. Apps for the prevention of skin cancer were searched on two major smartphone app stores (Android and iOS) in June 2019. The number, functionality, ratings, and price of the apps were described and compared to similar reviews of the skin cancer app market from 2014 to 2017. Overall, the June 2019 search identified 66 apps. Of 39 apps found in 2014, 30 were no longer available in 2019 representing an attrition rate of 77% of 43 apps available in 2017, attrition was 46.5%. In 2019, 63.6% ( n = 42/66) of apps were free to download compared to 53.5% ( n = 23/43) in 2017. Input from clinician rofessional bodies was evident for 47.0% ( n = 31/66) of the apps in 2019 compared to 34.9% (15/43) in 2017. The most common app functionality offered in 2019 was monitoring/tracking of lesions at 48.5% ( n = 32/66). Since 2014, there has been a steady increase in the number of apps available for the general public to support the prevention or early detection of skin cancers. There continues to be a high turnover of apps, and many apps still appear to lack clinician input and/or evidence for their safety and value.

Using Mobile Health Technology and Social Media for the Prevention and Early Detection of Skin Cancer

Publisher: S. Karger AG

Date: 2020

DOI: 10.1159/000505150

Quality of life of women with lower-limb lymphedema following gynecological cancer

Publisher: Informa UK Limited

Date: 06-2011

DOI: 10.1586/ERP.11.30

Abstract: Secondary lower-limb lymphedema can develop following treatment for gynecological cancers, and has debilitating effects on quality of life (QoL). Lymphedema can limit mobility and ability to perform daily activities, and have adverse effects on psychological and social wellbeing. When assessing the effect of lymphedema treatment methods, the focus is on change in clinically measured lymphedema status, rather than QoL outcomes. Considering that treatment for lymphedema involves a significant and ongoing commitment from patients, it is essential to determine whether the benefits to patients outweigh the burden associated with treatment. This article summarizes the results of studies assessing the impact of lower-limb lymphedema on QoL in women with gynecological cancer, evaluates their methodologies and discusses limitations and priorities for future research.

Practice guidelines for teledermatology in Australia

Publisher: Wiley

Date: 03-05-2020

DOI: 10.1111/AJD.13301

Experiences of Patient-Led Surveillance, Including Patient-Performed Teledermoscopy, in the MEL-SELF Pilot Randomized Controlled Trial: Qualitative Interview Study

Publisher: JMIR Publications Inc.

Date: 07-2022

DOI: 10.2196/35916

Abstract: Current clinician-led melanoma surveillance models require frequent routinely scheduled clinic visits, with associated travel, cost, and time burden for patients. Patient-led surveillance is a new model of follow-up care that could reduce health care use such as clinic visits and medical procedures and their associated costs, increase access to care, and promote early diagnosis of a subsequent new melanoma after treatment of a primary melanoma. Understanding patient experiences may allow improvements in implementation. This study aims to explore patients’ experiences and perceptions of patient-led surveillance during the 6 months of participation in the MEL-SELF pilot randomized controlled trial. Patient-led surveillance comprised regular skin self-examination, use of a mobile dermatoscope to image lesions of concern, and a smartphone app to track and send images to a teledermatologist for review, in addition to usual care. Semistructured interviews were conducted with patients previously treated for melanoma localized to the skin in New South Wales, Australia, who were randomized to the patient-led surveillance (intervention group) in the trial. Thematic analysis was used to analyze the data with reference to the technology acceptance model. We interviewed 20 patients (n=8, 40% women and n=12, 60% men median age 62 years). Patients who were more adherent experienced benefits such as increased awareness of their skin and improved skin self-examination practice, early detection of melanomas, and opportunities to be proactive in managing their clinical follow-up. Most participants experienced difficulty in obtaining clear images and technical problems with the app. These barriers were overcome or persevered by participants with previous experience with digital technology and with effective help from a skin check partner (such as a spouse, sibling, or friend). Having too many or too few moles decreased perceived usefulness. Patients with melanoma are receptive to and experience benefits from patient-led surveillance using teledermoscopy. Increased provision of training and technical support to patients and their skin check partners may help to realize the full potential benefits of this new model of melanoma surveillance.

Chronic condition self-management support for aboriginal people: Adapting tools and training

Publisher: Wiley

Date: 22-04-2018

DOI: 10.1111/AJR.12413

Abstract: Chronic conditions are major health problems for Australian Aboriginal people. Self-management programs can improve health outcomes. However, few health workers are skilled in self-management support and existing programs are not always appropriate in Australian Aboriginal contexts. The goal was to increase the capacity of the Australian health workforce to support Australian Aboriginal people to self-manage their chronic conditions by adapting the Flinders Program of chronic condition self-management support for Australian Aboriginal clients and develop and deliver training for health professionals to implement the program. Feedback from health professionals highlighted that the Flinders Program assessment and care planning tools needed to be adapted to suit Australian Aboriginal contexts. Through consultation with Australian Aboriginal Elders and other experts, the tools were condensed into an illustrated booklet called 'My Health Story'. Associated training courses and resources focusing on cultural safety and effective engagement were developed. A total of 825 health professionals across Australia was trained and 61 people qualified as accredited trainers in the program, ensuring sustainability. The capacity and skills of the Australian health workforce to engage with and support Australian Aboriginal people to self-manage their chronic health problems significantly increased as a result of this project. The adapted tools and training were popular and appreciated by the health care organisations, health professionals and clients involved. The adapted tools have widespread appeal for cultures that do not have Western models of health care and where there are health literacy challenges. My Health Story has already been used internationally.

Quality of life changes during conformal radiation therapy for prostate carcinoma

Publisher: Wiley

Date: 15-09-2000

DOI: 10.1002/1097-0142(20000915)89:6<1322::AID-CNCR18>3.0.CO;2-D

Abstract: The objective of this study was to describe prospectively quality of life (QOL) before and after radiotherapy for patients with prostate carcinoma. Forty-three patients with T1-T3 prostate carcinoma who underwent conformal external beam radiation therapy were randomized either to the complete European Organization for Research and Treatment of Cancer (EORTC) QOL questionnaire (EORTC QLQ-C30) or the Medical Outcomes Study Group Short Form Health Survey (SF-36) at baseline, at 3 weeks and 6 weeks after initial treatment, and at 6 weeks and 5 months after the completion of radiotherapy. The measures were self-reported patient QOL, and values are given as the mean +/- standard error of the mean. Changes in QOL are described from baseline to the end of treatment in both questionnaire groups. Emotional role functioning, as measured with the SF-36 questionnaire, significantly improved from 68.2 +/- 9.9 at baseline to 93.3 +/- 5.2 at the end of therapy (P = 0.02). The EORTC QLQ-C30 questionnaire revealed consistent values of emotional functioning during treatment (72.7 +/- 5.9 at baseline) but showed a significant improvement 6 weeks after therapy (89.0 +/- 4.4 P = 0.01). Role functioning deteriorated from 80.1 +/- 6.5 at baseline to 62.5 +/- 8.8 at the end of radiotherapy (P = 0.02). Symptoms of fatigue were shown to increase significantly from 26.9 +/- 6.0 at baseline to 37.7 +/- 7.6 at the end of therapy (P = 0.02). No significant changes in the other dimensions were observed in either questionnaire. After radiotherapy for prostate carcinoma, patients experience a temporary deterioration of fatigue and role functioning, as measured with the EORTC QLQ-C-30. Despite physical deterioration, the authors observed an improvement in emotional functioning scores with both questionnaires. This may have been due to psychological adaptation and coping.

Time and treatments: It is what you make of it that counts

Publisher: Wiley

Date: 14-11-2017

DOI: 10.1111/AJCO.12763

A Randomized Trial on the Effect of Exercise Mode on Breast Cancer–Related Lymphedema

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 10-2016

DOI: 10.1249/MSS.0000000000000988

Recruiting older adults to health research studies: A systematic review

Publisher: Wiley

Date: 30-08-2009

DOI: 10.1111/J.1741-6612.2009.00362.X

Abstract: To provide a systematic review of papers comparing the effectiveness of different strategies to recruit older adults (aged 50 years and over) to participate in health research studies, to guide successful recruitment in future research. Four major databases were searched for papers published between 1995 and 2008 with: target group aged 50 years or over participants allocated to receive one of two or more recruitment strategies and an outcome measure of response rate or enrolment in study. Twelve papers were included in the review. For postal questionnaires, recruitment strategies used with older adults had comparable outcomes to those used to recruit from the general population. For other types of studies, strategies involving face-to-face contact may be more effective than indirect methods, but this needs to be balanced against feasibility. Overall, little evidence on the topic exists and more rigorous investigation is necessary.

Sun protection and low levels of vitamin D: Are people concerned?

Publisher: Springer Science and Business Media LLC

Date: 20-07-2007

DOI: 10.1007/S10552-007-9042-4

Abstract: Recent reports on the association between low serum vitamin D and increased risk of cancer raised concerns about possible adverse effects of primary prevention strategies for skin cancer. To evaluate if these reports may influence peoples' sun protective behavior, knowledge, and attitudes to the impact of sun protection on vitamin D. Within a population-based survey in Queensland, Australia (5,611 participants, mean age 50.7 years (range 20-75) 48.2% men), agreement with the statement that sun protection may result in not having enough vitamin D as well as factors associated with agreement were assessed. Overall, 837 (15.0%) participants agreed that sun protection may result in not having enough vitamin D, 2,163 (38.7%) neither agreed nor disagreed, and 2,591 (46.3%) disagreed with this statement. Factors associated with agreement included older age, darker skin color, and attempt to develop a suntan within the past year. These results suggest that future sun protection c aigns may need to address the issue of vitamin D and present ways to achieve sufficient vitamin D levels without increasing sun exposure at least in countries with high UV radiation throughout the year.

Skin cancer excisions and histopathology outcomes when following a contemporary population‐based cohort longitudinally with 3D total‐body photography

Publisher: Wiley

Date: 22-01-2023

DOI: 10.1002/SKI2.216

Abstract: Skin cancer represents a significant health burden across the globe and early detection is critical to improve health outcomes. Three‐dimensional (3D) total‐body photography is a new and emerging technology which can support clinicians when they monitor people's skin over time. The aim of this study was to improve our understanding of the epidemiology and natural history of melanocytic naevi in adults, and their relationship with melanoma and other skin cancers. Mind Your Moles was a 3‐year prospective, population‐based cohort study which ran from December 2016 to February 2020. Participants visited the Princess Alexandra Hospital every 6 months for 3 years to undergo both a clinical skin examination and 3D total‐body photography. A total of 1213 skin screening imaging sessions were completed. Fifty‐six percent of participants ( n = 108/193) received a referral to their own doctor for 250 lesions of concern, 101/108 (94%) for an excision/biopsy. Of those, 86 people (85%) visited their doctor and received an excision/biopsy for 138 lesions. Histopathology of these lesions found 39 non‐melanoma skin cancers (across 32 participants) and six in situ melanomas (across four participants). 3D total‐body imaging results in diagnosis of a high number of keratinocyte cancers (KCs) and their precursors in the general population.

Consumer Preference and Willingness to Pay for Direct-to-Consumer Mobile Teledermoscopy Services in Australia

Publisher: S. Karger AG

Date: 13-08-2021

DOI: 10.1159/000517257

Abstract: b i Objective: /i /b To investigate consumer preference and willingness to pay for mobile teledermoscopy services in Australia. b i Methods: /i /b Consumers who were taking part in a randomised controlled trial comparing mobile teledermoscopy and skin self-examination were asked to complete a survey which incorporated a discrete choice experiment (DCE) and a contingent valuation question. Responses were used to determine their willingness to pay for mobile teledermoscopy services in Australia and their overall service preferences. b i Results: /i /b The 199 consumers who responded were 71% female and had a mean age of 42 years (range, 18–73). The DCE results showed that consumers prefer a trained medical professional to be involved in their skin cancer screening. Consumers were willing to pay AUD 41 to change from a general practitioner reviewing their lesions in-person to having a dermatologist reviewing the teledermoscopy images. Additionally, they were willing to pay for services that had shorter waiting times, that reduced the time away from their usual activities, and that have higher accuracy and lower likelihood of unnecessary excision of a skin lesion. When asked directly about their willingness to pay for a teledermoscopy service using a contingent valuation question, the majority (73%) of consumers selected the lowest two value brackets of AUD 1–20 or AUD 21–40. b i Conclusion: /i /b Consumers are willing to pay out of pocket to access services with attributes such as a dermatologist review, improved accuracy, and fewer excisions.

Quality of life among patients with a brain tumor and their carers

Publisher: Elsevier BV

Date: 12-2007

DOI: 10.1016/J.JPSYCHORES.2007.06.018

Abstract: This study assessed the quality of life and psychosocial well-being of brain tumor patients and their carers. A cross-sectional postal survey was completed by 75 patients and 70 carers (response rate=29.8%) who were listed in a community-based brain tumor support group database. Measures used were the Functional Assessment of Cancer Therapy-General (FACT-G) and the Hospital Anxiety and Depression Scale (HADS). Queensland population-based norms for the FACT-G were used for comparison. On average, as compared with population norms, the FACT-G summary scores of the patients (mean=74.6, S.D.=18.6) and carers (mean=76.7, S.D.=17.7) were between 0.5 and 1 S.D. lower, representing a clinically significant reduction in their quality of life. Among patients and carers, 30% and 40%, respectively, reported anxious moods and 17% and 10%, respectively, reported depressed moods on the HADS. Significant correlations were observed between the FACT-G and HADS subscales, particularly emotional well-being and anxiety, as well as physical and functional well-being and depression, and between patients' and their carers' quality of life. Among the patients, predictors of lower quality of life were older age and female sex, whereas for the carers, there was a trend for lower quality of life among those looking after a patient with a high-grade disease. The degree of detriment to quality of life by a brain tumor for patients and that for their carers are similar and clinically significant. The association between the FACT-G subscales and the HADS indicates that improvements could be achieved by alleviating emotional distress and improving functional well-being.

The Children and Sunscreen Study

Publisher: American Medical Association (AMA)

Date: 05-2012

DOI: 10.1001/ARCHDERMATOL.2011.2586

Abstract: To measure the thickness at which primary schoolchildren apply sunscreen on school day mornings and to compare it with the thickness (2.00 mg/cm(2)) at which sunscreen is tested during product development, as well as to investigate how application thickness was influenced by age of the child (school grades 1-7) and by dispenser type (500-mL pump, 125-mL squeeze bottle, or 50-mL roll-on). A crossover quasiexperimental study design comparing 3 sunscreen dispenser types. Children aged 5 to 12 years from public primary schools (grades 1-7) in Queensland, Australia. Children (n=87) and their parents randomly recruited from the enrollment lists of 7 primary schools. Each child provided up to 3 observations (n=258). Children applied sunscreen during 3 consecutive school weeks (Monday through Friday) for the first application of the day using a different dispenser each week. Thickness of sunscreen application (in milligrams per square centimeter). The dispensers were weighed before and after use to calculate the weight of sunscreen applied. This was ided by the coverage area of application (in square centimeters), which was calculated by multiplying the children's body surface area by the percentage of the body covered with sunscreen. Children applied their sunscreen at a median thickness of 0.48 mg/cm(2). Children applied significantly more sunscreen when using the pump (0.75 mg/cm(2)) and the squeeze bottle (0.57 mg/cm(2)) compared with the roll-on (0.22 mg/cm(2)) (P<.001 for both). Regardless of age, primary schoolchildren apply sunscreen at substantially less than 1.00 mg/cm(2), similar to what has been observed among adults. Some sunscreen dispensers seem to facilitate thicker application than others.

'Mind your Moles' study: protocol of a prospective cohort study of melanocytic naevi.

Publisher: BMJ

Date: 09-2018

DOI: 10.1136/BMJOPEN-2018-025857

Abstract: Having many melanocytic naevi or ‘moles’ on the skin is the strongest predictor of melanoma thus, much can be learnt from investigating naevi in the general population. We aim to improve the understanding of the epidemiology and biology of naevi by conducting a 3-year prospective study of melanocytic naevi in adults. This is a population-based cohort study of melanocytic naevi in 200 adults aged 20–69 years recruited via the Australian electoral roll. At baseline, participants will complete a questionnaire on their sun behaviour and health and undergo a clinical examination. Three-dimensional (3D) total-body photography will be used to record the images of skin lesions. Pigmented naevi will be analysed in terms of number, diameter, colour and border irregularity using automated analysis software (excluding scalp, beneath underwear and soles of feet). All naevi ≥5 mm will be recorded using the integrated dermoscopy photographic system. A saliva s le will be obtained at baseline for genomic DNA analysis of pigmentation, naevus and melanoma-associated genes using the Illumina HumanCoreExome platform. The sun behaviour and health follow-up questionnaire, clinical examination and 3D total-body photography will be repeated every 6 months for 3 years. The first 50 participants will also undergo manual counts of naevi ≥2 mm and ≥5 mm at baseline, 6-month and 12-month follow-ups. Microbiopsy and excision of naevi of research interest is planned to commence at the 18-month time point among those who agree to donate s les for detailed histopathological and molecular assessment. This study was approved by the Metro South Health Human Research Ethics Committee in April 2016 (approval number: HREC/16/QPAH/125). The findings will be disseminated through peer-reviewed and non-peer-reviewed publications and presentations at conferences.

Teledermatology: Its Use in the Detection and Management of Actinic Keratosis

Publisher: S. Karger AG

Date: 18-12-2014

DOI: 10.1159/000366545

Abstract: Teledermatology can profoundly improve access to medical services for those who may have limited access to dermatology due to workforce shortages or limitations in their mobility or who are located far from providers. Two common methods of teledermatology are synchronous live methods, where the patient and doctor directly communicate, and asynchronous store-and-forward methods, where the patient and doctor independently provide and assess the medical information. Teledermatology has been tested for its safety, feasibility and accuracy for a number of dermatological conditions, including the early detection of skin cancer, and is considered safe, feasible and accurate. Studies have reported somewhat better results for synchronous than asynchronous methods, possibly due to the loss of information if no direct patient doctor contact was feasible. However, asynchronous methods are easier to organise, require less-sophisticated technology and are more widely accessible and convenient for both patients and doctors. No study to date has focused solely on teledermatology for actinic keratosis, but such lesions are typically found during teledermatology examinations for other main target lesions. In studies where such results were reported, actinic keratoses seemed to be readily identifiable for teledermatologists, and adequate management and treatment can be suggested within remote consultations.

Multidisciplinary cancer care in Australia

Publisher: Wiley

Date: 11-07-2019

DOI: 10.1111/AJCO.13164

Factors in Randomized Controlled Trials Reported to Impact the Implementation of Patient-Reported Outcome Measures Into Routine Care: Protocol for a Systematic Review (Preprint)

Publisher: JMIR Publications Inc.

Date: 03-05-2019

DOI: 10.2196/PREPRINTS.14579

Abstract: atient-reported outcome measures (PROMs) are tools that enable patients to directly report their own assessments of well-being, or symptoms, in a structured and consistent way. Despite the usefulness of PROMs in optimizing health outcomes, their use in clinical practice is not routine. PROMs are complex to integrate into the clinical setting, with many elements potentially impacting on the success of implementation. For this reason, a protocol has been developed to guide a systematic review to collate information on implementation as presented in the randomized controlled trials (RCTs) to date. he primary objective of this systematic review is to identify and synthesize factors available from RCT data about the fidelity of PROM interventions in clinical practice. The secondary objective will be an assessment of how implementation factors impact fidelity outcomes. referred Reporting Items for Systematic Reviews and Meta-Analyses reporting standards will be followed. MEDLINE, EMBASE, and the Cumulative Index to Nursing and Allied Health Literature via OvidSP will be accessed using a defined search strategy. Grey literature and ClinicalTrials.gov will be reviewed for unpublished studies. Data extraction will be done to identify fidelity and factors impacting implementation, summarized using a narrative synthesis. An evidence-based implementation science framework will assist in identifying potential elements of importance and their effect on the process and outcomes of implementation. A meta-analysis to assess the impact of implementation factors will be attempted. A Cochrane risk of bias tool will be used. his protocol has received funding, and searches of databases will commence at the end of May 2019. It is planned that this systematic review will be finalized for publication in (December) 2019. pplying an implementation science evidence-based framework to the published literature may identify factors present in the data that impact on the implementation of PROMs into routine clinical care. This systematic review aims to improve understanding of how these factors impact the fidelity of this intervention, so that PROMs can be more effectively used in the care of patients. This systematic review can also offer more detailed information about the process and outcomes of successful implementation of PROMs.

Consumer views of melanoma early detection using 3D total‐body photography: cross‐sectional survey

Publisher: Wiley

Date: 27-01-2023

DOI: 10.1111/IJD.16578

Abstract: Three‐dimensional (3D) total‐body photography is a recent advance in melanoma early detection that can aid in monitoring and identifying new and changing skin lesions over time. A cross‐sectional survey of adults living in metropolitan and rural areas of Australia was conducted to assess perceptions of 3D total‐body photography. Participants completed a survey detailing their previous use of skin cancer photography, personal skin checking history, perceptions of 3D total‐body photography, and willingness to pay. Participants were also asked to describe the potential barriers and facilitators of 3D total‐body photography in their own words. A total of 1056 participants completed the survey, with 739 (70%) from metropolitan areas of Australia and 317 (30%) from rural areas. Most participants (95%, n = 1004/1056) indicated they would consider using 3D total‐body photography if it became commercially available at their regular medical practice. Most participants indicated 3D total‐body photography would be effective to identify suspicious skin spots (94%, n = 995/1056), monitor lesion changes (94%, n = 997/1056), and reduce skin cancer related anxiety (90%, n = 950/1055). In open‐ended feedback, participants (87%, n = 918/1056) identified perceived benefits, including more comprehensive screenings, earlier detection, and less human error. Participants (84%, n = 889/1056) also identified potential barriers to 3D total‐body photography, including cost, accessibility and availability, trust in the technology, and digital security concerns. Participant feedback indicated a high level of acceptance and confidence in the technology. To facilitate clinical translation, addressing consumer‐identified barriers to 3D total‐body photography will be vital.

Unintended sunburn after sunscreen application: An exploratory study of sun protection

Publisher: Wiley

Date: 04-11-2019

DOI: 10.1002/HPJA.301

Abstract: This study explores the experiences of adults aged 18 years and older who received an unintended sunburn while wearing sunscreen and examines why the application of sunscreen as a sun protection measure did not work as intended. Qualitative content analysis was conducted on 11 interviews with people living in Australia who had received an unintended sunburn. Data were collected from July 2017 to January 2018. Twelve participants took part in in idual semi-structured interviews either face-to-face or over the telephone, and 11 participants met the eligibility criteria and were included for analysis. The themes that emerged included experience of disbelief after sunburn sunburn after water-based activity inaccurate sunscreen application sunscreen acceptability and trust discomfort in application, opportunistic sun exposure aesthetically motivated behaviour normative beliefs and lack of awareness of recent sun safety c aigns. Participants perceived themselves as well protected from sun exposure and were surprised they received a sunburn. We found that participants did not reapply sunscreen often enough, especially before and during water activities and overestimated the amount of time they could be safely exposed to the sun. SO WHAT?: The findings of this study suggest a greater need for sun protection education on how to effectively use and apply sunscreen to avoid sunburn and skin cancer. This study explores the experiences of adults aged 18 years and older who received an unintended sunburn while wearing sunscreen and examines why the application of sunscreen as a sun protection measure did not work as intended. Qualitative content analysis was conducted on 11 interviews with people living in Australia who had received an unintended sunburn.

Pelvic floor functional outcomes after total abdominal vs total laparoscopic hysterectomy for endometrial cancer

Publisher: Elsevier BV

Date: 04-2018

DOI: 10.1016/J.AJOG.2017.12.233

Abstract: Pelvic floor functioning is an important concern for women requiring a hysterectomy for endometrial cancer. The incidence of pelvic floor symptoms has not been reported in women who have undergone a hysterectomy for early-stage endometrial cancer. We sought to evaluate pelvic floor function in women who have had surgical treatment for early-stage endometrial cancer as part of the multinational Laparoscopic Approach to Cancer of the Endometrium trial and to compare patients' outcomes who had total abdominal vs total laparoscopic hysterectomy. A multinational, phase III, randomized noninferiority trial compared disease-free survival of patients who had total abdominal hysterectomy vs total laparoscopic hysterectomy. This substudy analyzes the results from a self-administered validated questionnaire on pelvic floor symptoms (Pelvic Floor Distress Inventory) administered preoperatively, and at follow-up visits 6, 18, 30, 42, and 54 months postoperatively. Overall, 381 patients with endometrial cancer were included in the analysis (total abdominal hysterectomy, n = 195 total laparoscopic hysterectomy, n = 186). At 6 months postsurgery both groups experienced an improvement in Pelvic Floor Distress Inventory scores compared to presurgical pelvic floor well-being (total abdominal hysterectomy: mean change -11.17 95% confidence interval, -17.11 to -5.24 total laparoscopic hysterectomy: mean change -10.25 95% confidence interval, -16.31 to -4.19). The magnitude of change from baseline in pelvic floor symptoms did not differ between both treatment groups up to 54 months postsurgery. These findings suggest that pelvic floor function in terms of urinary, bowel, and prolapse symptoms are unlikely to deteriorate following abdominal or laparoscopic hysterectomy and are reassuring for women undergoing hysterectomy for early-stage endometrial cancer.

Risk factors for current and future unmet supportive care needs of people with pancreatic cancer. A longitudinal study

Publisher: Springer Science and Business Media LLC

Date: 16-04-2016

DOI: 10.1007/S00520-016-3212-4

Abstract: This study aims to determine if the supportive care needs of people with pancreatic cancer change over time and identify the factors associated with current and future unmet needs. Australian pancreatic cancer patients completed a self-administered survey at 0-6 months post-diagnosis (n = 116) then follow-up surveys 2 (n = 82) and 4 months (n = 50) later. The validated survey measured 34 needs across five domains. Weighted generalised estimating equations were used to identify factors associated with having ≥1 current or future moderate-to-high unmet need. The overall proportion of patients reporting ≥1 moderate-or-high-level need did not significantly change over time (baseline = 70 % to 4 months = 75 %), although there was a non-significant reduction in needs for patients who had a complete resection (71 to 63 %) and an increase in patients with locally advanced (73 to 85 %) or metastatic (66 to 88 %) disease. Higher levels of pain (OR 6.1, CI 2.4-15.3), anxiety (OR 3.3, CI 1.5-7.3) and depression (OR 3.2, CI 1.7-6.0) were significantly associated with current needs. People with pain (OR 4.9, CI 1.5-15.4), metastatic disease (OR 2.7, CI 0.7-10.0) or anxiety (OR 2.5, CI 0.7-8.6) had substantially higher odds of reporting needs at their next survey. The prevalence of needs was highest in the physical/daily living and psychological domains (both 53 % at baseline). Pain and anxiety had respectively the strongest associations with these domains. Careful and continued attention to pain control and psychological morbidity is paramount in addressing significant unmet needs, particularly for people with metastatic disease. Research on how best to coordinate this is crucial.

Do breast cancer survivors benefit from prophylactic removal of uterus and ovaries? A population-based data linkage replication study

Publisher: Wiley

Date: 27-05-2017

DOI: 10.1111/AJCO.12508

Abstract: Our previous population-based research found prophylactic surgery (hysterectomy and bilateral salpingo-oophorectomy [BSO]) halved the mortality risk for premenopausal breast cancer patients. Here we aim to replicate findings in a Western Australia dataset. Data from the Western Australia Cancer Registry of 15 395 women 20-79 years diagnosed with primary breast cancer (1997-2011) was categorized into four groups: neither hysterectomy nor BSO, hysterectomy only, BSO only, or hysterectomy + BSO. We fitted flexible parametric breast cancer-specific and overall survival models with 95% confidence intervals (also known as Royston-Parmar models) to assess the impact of prophylactic surgery. A total of 12 630 (82.0%) patients had no surgery, 1799 (11.7%) had a hysterectomy only, 337 (2.2%) had BSO only and 629 (4.1%) had both a hysterectomy and BSO. For all-causes mortality, unadjusted 10-year survival was highest for women who had either a hysterectomy + BSO (84.7%) or a hysterectomy only (84.2%). After adjusting for covariates, the survival advantage compared to women without any surgery remained significant for the hysterectomy only group (hazard ratio [HR] = 0.89 95% confidence interval [CI], 0.81-0.98 P = 0.02). A similar pattern emerged in breast cancer-specific survival with significantly improved survival for women who had a hysterectomy only (HR = 0.83 95% CI, 0.74-0.94 P = 0.003). However, for non-breast cancer-related survival, having a BSO alone increased risk of death (HR = 1.83 95% CI, 1.14-2.93 P = 0.01). We observed significantly improved overall and breast cancer-specific survival among women who had a hysterectomy only, but increased non-breast cancer-related risk after BSO only. Breast cancer patients must weigh up pros and cons of prophylactic surgery.

The Living Well after Breast Cancer™ Pilot Trial: a weight loss intervention for women following treatment for breast cancer

Publisher: Wiley

Date: 10-11-2016

DOI: 10.1111/AJCO.12629

Abstract: Obesity is associated with poor prognosis and risk of treatment side-effects in breast cancer survivors. This pilot study assessed the feasibility, acceptability, safety and efficacy of a telephone-delivered weight loss intervention, among women (BMI 25-40 kg/m Ninety women (mean ± SD age: 55.3 ± 8.7years BMI: 31.0 ± 4.3 kg/m Oncologists provided consent to contact 82.6% of patients, with 84.1% of those women contacted and eligible consenting to participate. Compared with usual care, mean weight loss was significantly greater in the intervention arm (-3.1 kg [95% CI, -5.4 to -0.7] -3.7% baseline weight [95% CI, -6.6 to -0.9]), as were reductions in fat mass (-2.1 kg [95% CI, -4.2 to -0.1]) and waist circumference (-4.0 cm [95% CI, -6.6 to -1.3]). No other statistically significant intervention effects were observed. Participants were highly satisfied with the intervention overall and it is timing in relation to diagnosis/treatment. One reported adverse event (musculoskeletal injury) was attributable to the intervention. This weight loss intervention was feasible, acceptable, safe and effective for women 1-2 years after a breast cancer diagnosis. The effect of weight loss on quality of life and treatment-related side-effects should be examined further in fully-powered studies.

The use of CAM products, practices, and practitioners by long-term endometrial cancer survivors in Australia

Publisher: Springer Science and Business Media LLC

Date: 13-03-2020

DOI: 10.1007/S00520-020-05404-1

Treatment for upper-limb and lower-limb lymphedema by professionals specializing in lymphedema care

Publisher: Hindawi Limited

Date: 09-2008

DOI: 10.1111/J.1365-2354.2007.00878.X

Abstract: Up to 60% of patients with cancer of the vulva, and between 20 and 30% of patients with breast or abdominal cancers may develop lymphedema following treatment. The aims of this study were to assess health professionals' knowledge about treatment, diagnostic procedures, advice and confidence in treatment of patients with either upper-limb (ULL) or lower-limb lymphoedema (LLL), and whether these differed by health professionals' background or for patients with ULL compared with LLL. A cross-sectional telephone interview was undertaken in 2006, of 63 health professionals (response rate 92.6%) known to treat lymphedema. Sixty-three per cent of the health professionals were physiotherapists the majority were university-trained, with 20 years' experience or more. Ninety-five per cent of health professionals used circumferential measurements to establish lymphedema status, and most health professionals advised avoiding scratches and cuts (100%), insect bites (98.4%), sunburn (98.4%) and excessive exercise (65.1%) on the affected limb. Health professionals reported that compared with patients with LLL, patients with ULL were more likely to present within the first 3 months of being symptomatic (P < 0.01). Patients with LLL were more likely to present with swelling (P = 0.001), heaviness (P = 0.003), tightness (P = 0.007) and skin problems (P < 0.001) compared with patients with ULL. Treatment and advice differed according to health professionals' background, but not location of lymphedema (ULL vs. LLL). Assessment, treatment and advice for lymphedema vary across professional groups. Our results suggest that improvements should be attempted in the early detection of lymphedema, in particular of LLL among cancer patients.

High variability in anatomic patterns of cutaneous photodamage: a population-based study

Publisher: Wiley

Date: 09-06-2021

DOI: 10.1111/JDV.17352

Abstract: Skin cancer is strongly associated with photodamaged skin, but body sites are often referred to as ‘exposed’ or ‘unexposed’ to sun without recognizing extent of site‐specific variation. To assess whole‐body patterns of photodamage in an Australian population. A random s le of adult residents of Queensland underwent imaging across 10 body sites. Photodamage was graded from images using an ordinal photonumeric scale. We used cluster analysis to identify whole‐body photodamage patterns and prevalence proportion ratios (PPRs) to assess associated factors. Of 190 adults (median age 52 58% males), 58% showed severe or moderate‐to‐severe photodamage on most body sites. A higher proportion of woman had severe photodamage on the arms (upper: P = 0.002, lower: P = 0.034). A higher proportion of men had moderate or severe photodamage on the lower back ( P = 0.004). We identified four photodamage patterns: ‘severe general’ ( n = 24, 13%), ‘moderate‐severe general’ ( n = 86, 45%), ‘moderate‐severe v‐neck’ ( n = 40, 21%) and ‘mild‐moderate upper body’ ( n = 12, 6%). All participants with ‘severe‐general’ photodamage were years and more likely to have past skin cancer (PPR: 2.54, 95% CI: 1.44–4.49) than those with 'moderate‐severe v‐neck' photodamage. Those with ‘moderate‐severe general’ photodamage showed similar associations and were more likely female (PPR: 1.33, 95% CI: 1.04–1.69). Past or current smoking was associated with having higher levels of photodamage, with no smokers in those with ‘mild‐moderate upper body’ photodamage. Moderate‐to‐severe photodamage across much of the body is common in Queensland adults and associated with age, sex, past skin cancer and smoking. Assuming a universal pattern of site‐specific sun exposure could lead to spurious correlations, while accurate and objective assessment of site‐specific photodamage can add to understanding of the development of sun‐associated skin cancers, in particular site‐specific skin carcinogenesis. Additionally, degree of site‐specific photodamage has the potential to assist skin cancer screening.

Nutrition interventions in patients with gynecological cancers requiring surgery

Publisher: Elsevier BV

Date: 04-2016

DOI: 10.1016/J.YGYNO.2017.01.028

Abstract: Including developing countries, between 20 and 88% of gynecological oncology patients may present with at least mild malnutrition at diagnosis. Significant morbidity and mortality is attributed to malnutrition. Here we reviewed randomized clinical trials of nutritional interventions used to achieve early return to oral diet, enhance recovery from surgery and reduce adverse events in gynecological cancer patients undergoing surgery. Ebscohost (CINAHL+Medline+PsycINFO), Cochrane, Embase, PubMed and Scopus databases were searched for articles published from 2000 onwards. Potentially eligible articles were screened by two reviewers. Length of hospital stay (LOS), postoperative complications, recovery of intestinal function, quality of life (QOL), hematological and immunological parameters were outcome measures of the nutritional interventions. Seven randomized clinical trials were included in the review. Early clear liquid diet, semiliquid diet, regular diet or immune-enhanced enteral diets were all found to be safe as nutritional interventions. In five of the seven trials significantly better outcomes were observed in the intervention group compared to usual care for one of more of the outcomes intestinal recovery time, LOS, postoperative complications and immunological parameters. However, the nutritional interventions varied greatly between the trials, making it difficult to directly compare their findings. Trial quality was low to moderate. Recommended malnutrition screening and assessment tools and guidelines for treatment are reviewed. From the limited findings it would appear that nutritional interventions of early oral feeding and enteral feeding are safe. Receiving nutritional interventions seems to reduce LOS, intestinal recovery time and postoperative complications for some patients. Increasing use of neoadjuvant treatment may reduce the prevalence of patients presenting malnourished for surgery in the future.

Does quality of life among breast cancer survivors one year after diagnosis differ depending on urban and non-urban residence? A comparative study

Publisher: Springer Science and Business Media LLC

Date: 2010

DOI: 10.1186/1477-7525-8-3

The skin awareness study: Promoting thorough skin self-examination for skin cancer among men 50 years or older

Publisher: Elsevier BV

Date: 2010

DOI: 10.1016/J.CCT.2009.11.003

Abstract: Incidence and mortality from skin cancers including melanoma are highest among men 50 years or older. Thorough skin self-examination may be beneficial to improve skin cancer outcomes. To develop and conduct a randomized-controlled trial of a video-based intervention to improve skin self-examination behavior among men 50 years or older. Pilot work ascertained appropriate targeting of the 12-minute intervention video towards men 50 years or older. Overall, 968 men were recruited and 929 completed baseline telephone assessment. Baseline analysis assessed randomization balance and demographic, skin cancer risk and attitudinal factors associated with conducting a whole-body skin self-examination or receiving a whole-body clinical skin examination by a doctor during the past 12 months. Randomization resulted in well-balanced intervention and control groups. Overall 13% of men reported conducting a thorough skin self-examination using a mirror or the help of another person to check difficult to see areas, while 39% reported having received a whole-body skin examination by a doctor within the past 12 months. Confidence in finding time for and receiving advice or instructions by a doctor to perform a skin self-examination were among the factors associated with thorough skin self-examination at baseline. Men 50 years or older can successfully be recruited to a video-based intervention trial with the aim to reduce their burden through skin cancer. Randomization by computer generated randomization list resulted in good balance between control and intervention group and baseline analysis determined factors associated with skin cancer early detection behavior.

Efficacy of oral or intrauterine device-delivered progestin in patients with complex endometrial hyperplasia with atypia or early endometrial adenocarcinoma: A meta-analysis and systematic review of the literature

Publisher: Elsevier BV

Date: 04-2012

DOI: 10.1016/J.YGYNO.2011.11.043

Abstract: To investigate the efficacy of progestin treatment to achieve pathological complete response (pCR) in patients with complex atypical endometrial hyperplasia (CAH) or early endometrial adenocarcinoma (EC). A systematic search identified 3245 potentially relevant citations. Studies containing less than ten eligible CAH or EC patients in either oral or intrauterine treatment arm were excluded. Only information from patients receiving six or more months of treatment and not receiving other treatments was included. Weighted proportions of patients achieving pCR were calculated using R software. Twelve studies met the selection criteria. Eleven studies reported treatment of patients with oral (219 patients, 117 with CAH, 102 with grade 1 Stage I EC) and one reported treatment of patients with intrauterine progestin (11 patients with grade 1 Stage IEC). Overall, 74% (95% confidence interval [CI] 65-81%) of patients with CAH and 72% (95% CI 62-80%) of patients with grade 1 Stage I EC achieved a pCR to oral progestin. Disease progression whilst on oral treatment was reported for 6/219 (2.7%), and relapse after initial complete response for 32/159 (20.1%) patients. The weighted mean pCR rate of patients with grade 1 Stage I EC treated with intrauterine progestin from one prospective pilot study and an unpublished retrospective case series from the Queensland Centre of Gynaecologic Oncology (QCGC) was 68% (95% CI 45-86%). There is a lack of high quality evidence for the efficacy of progestin in CAH or EC. The available evidence however suggests that treatment with oral or intrauterine progestin is similarly effective. The risk of progression during treatment is small but longer follow-up is required. Evidence from prospective controlled clinical trials is warranted to establish how the efficacy of progestin for the treatment of CAH and EC can be improved further.

Predicting positive and negative impacts of cancer among long-term endometrial cancer survivors

Publisher: Wiley

Date: 12-12-2013

DOI: 10.1002/PON.3236

Abstract: Although the survival outcomes among women diagnosed with endometrial cancer are very favorable, little is known about the long-term impact of their cancer experience. This study identifies the extent of positive and negative impacts of cancer and factors associated with this, amongst long-term survivors of endometrial cancer. Australian women diagnosed with endometrial cancer (N=632) were sent questionnaires at the time of diagnosis and 3-5 years later. Hierarchical multiple regression models were used to examine whether a range of variables at diagnosis/treatment predicted subsequent scores on the Impact of Cancer Scale, which examines positive (e.g. health awareness) and negative (e.g. appearance concerns) impacts amongst cancer survivors. Overall, women had a higher mean score for the positive than negative impact scales (M=3.5 versus M=2.5, respectively). An intermediate grade of endometrial cancer, a prior diagnosis of cancer and lower levels of education were significant, but weak, predictors of higher scores on the positive impact scale. Higher scores on the negative impact scale were predicted by a higher grade of cancer, poor physical and mental health, a younger age, being single or having lower levels of education. The study demonstrates that factors that predict positive impact in cancer survivors differ to those that predict negative impact, suggesting that interventions to optimize cancer survivors' quality of life will need to be multi-dimensional, and this supports the need for tailored intervention.

Digital Technology in Skin Cancer Prevention and Early Detection (Preprint)

Publisher: JMIR Publications Inc.

Date: 28-01-2022

DOI: 10.2196/PREPRINTS.36908

Abstract: obile teledermatology is increasingly being used in clinical practice and offers the opportunity to counsel the general public about sun protection and skin cancer early detection. Growing evidence suggests that SMS text messaging interventions are an effective way to reach a large number of people and promote sun protection behaviors. Many medical practices already have SMS text message systems in place to communicate with patients, especially for appointment reminders and information. However, could we use these systems for even better outcomes? If so, how? his presentation will outline the results of the SunText study, a theory-based SMS text messaging intervention designed to evaluate how often and in what way we could communicate with people at risk of skin cancer to have a beneficial effect on sun protection behaviors, sunburn, and participant engagement. he SunText study was conducted between February-July 2019 in Queensland, Australia. Volunteer participants aged 18 to 40 years were randomized to 4 different intervention schedules using a Latin square design. The schedules included personalized or interactive messages with constant frequency and personalized and interactive messages with either increasing or decreasing frequency. Outcomes measured were reduction in sunburn and engagement with interactive messages, defined as responding to messages by return text. ompared to baseline, the self-reported sun protection habits index was significantly higher in all 4 interventions ( i P /i & .01). Overall, sunburn rates decreased from baseline to the end of the intervention (40.3% to 7.0%), and remained significantly below baseline levels (23.5%) at the 6-month follow-up ( i P /i & .01). All 4 interventions achieved reductions in sunburn rates (18%-48% reduction) during the intervention period. The overall engagement rate with interactive messages was 71%. The intervention involving interactive messages with constant frequency achieved the highest engagement rate. The intervention with personalized and interactive messages with increasing frequency had the lowest engagement rate. his study adds to the evidence that text messages targeting sun protection are effective in improving sun protection behaviors and reducing sunburn. Results also suggest higher engagement with constant or decreasing message frequency. Although many clinics already use SMS text messaging for scheduling, this presentation may encourage its extended use to raise awareness of sun protection. Interactive messages could also be integrated into sun protection mobile health apps, and provide an opportunity for engaging in health promotion content.

Cost-Effectiveness Analysis of a Skin Awareness Intervention for Early Detection of Skin Cancer Targeting Men Older Than 50 Years

Publisher: Elsevier BV

Date: 04-2017

DOI: 10.1016/J.JVAL.2016.12.017

Abstract: To assess the cost-effectiveness of an educational intervention encouraging self-skin examinations for early detection of skin cancers among men older than 50 years. A lifetime Markov model was constructed to combine data from the Skin Awareness Trial and other published sources. The model incorporated a health system perspective and the cost and health outcomes for melanoma, squamous and basal cell carcinomas, and benign skin lesions. Key model outcomes included Australian costs (2015), quality-adjusted life-years (QALYs), life-years, and counts of skin cancers. Univariate and probabilistic sensitivity analyses were undertaken to address parameter uncertainty. The mean cost of the intervention was A$5,298 compared with A$4,684 for usual care, whereas mean QALYs were 7.58 for the intervention group and 7.77 for the usual care group. The intervention was thus inferior to usual care. When only survival gain is considered, the model predicted the intervention would cost A$1,059 per life-year saved. The likelihood that the intervention was cost-effective up to A$50,000 per QALY gained was 43.9%. The model was stable to most data estimates nevertheless, it relies on the specificity of clinical diagnosis of skin cancers and is subject to limited health utility data for people with skin lesions. Although the intervention improved skin checking behaviors and encouraged men to seek medical advice about suspicious lesions, the overall costs and effects from also detecting more squamous and basal cell carcinomas and benign lesions outweighed the positive health gains from detecting more thin melanomas.

Changes in cancer preventive behaviours, screening and diagnosis during COVID‐19

Publisher: Wiley

Date: 27-10-2020

DOI: 10.1002/PON.5575

Study protocol for The GOAL Trial: comprehensive geriatric assessment for frail older people with chronic kidney disease to increase attainment of patient-identified goals—a cluster randomised controlled trial

Publisher: Springer Science and Business Media LLC

Date: 30-05-2023

DOI: 10.1186/S13063-023-07363-4

Abstract: An increasing number of older people are living with chronic kidney disease (CKD). Many have complex healthcare needs and are at risk of deteriorating health and functional status, which can adversely affect their quality of life. Comprehensive geriatric assessment (CGA) is an effective intervention to improve survival and independence of older people, but its clinical utility and cost-effectiveness in frail older people living with CKD is unknown. The GOAL Trial is a pragmatic, multi-centre, open-label, superiority, cluster randomised controlled trial developed by consumers, clinicians, and researchers. It has a two-arm design, CGA compared with standard care, with 1:1 allocation of a total of 16 clusters. Within each cluster, study participants ≥ 65 years of age (or ≥ 55 years if Aboriginal or Torres Strait Islander (First Nations Australians)) with CKD stage 3–5/5D who are frail, measured by a Frailty Index (FI) of 0.25, are recruited. Participants in intervention clusters receive a CGA by a geriatrician to identify medical, social, and functional needs, optimise medication prescribing, and arrange multidisciplinary referral if required. Those in standard care clusters receive usual care. The primary outcome is attainment of self-identified goals assessed by standardised Goal Attainment Scaling (GAS) at 3 months. Secondary outcomes include GAS at 6 and 12 months, quality of life (EQ-5D-5L), frailty (Frailty Index – Short Form), transfer to residential aged care facilities, cost-effectiveness, and safety (cause-specific hospitalisations, mortality). A process evaluation will be conducted in parallel with the trial including whether the intervention was delivered as intended, any issue or local barriers to intervention delivery, and perceptions of the intervention by participants. The trial has 90% power to detect a clinically meaningful mean difference in GAS of 10 units. This trial addresses patient-prioritised outcomes. It will be conducted, disseminated and implemented by clinicians and researchers in partnership with consumers. If CGA is found to have clinical and cost-effectiveness for frail older people with CKD, the intervention framework could be embedded into routine clinical practice. The implementation of the trial’s findings will be supported by presentations at conferences and forums with clinicians and consumers at specifically convened workshops, to enable rapid adoption into practice and policy for both nephrology and geriatric disciplines. It has potential to materially advance patient-centred care and improve clinical and patient-reported outcomes (including quality of life) for frail older people living with CKD. ClinicalTrials.gov NCT04538157. Registered on 3 September 2020.

Can skin cancer prevention be improved through mobile technology interventions? A systematic review

Publisher: Elsevier BV

Date: 09-2016

DOI: 10.1016/J.YPMED.2016.06.037

Abstract: Print-based health promotion interventions are being phased out to bring forth more appealing and assessable new technology applications. This review aimed to evaluate the current literature on the use of mobile text messaging and similar electronic technology interventions in the area of skin cancer prevention. A search of studies guided by Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) was conducted on mobile technology interventions for improving skin cancer prevention in the electronic databases PubMed, MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO. Overall, 136 articles were screened for eligibility between 2001 (earliest relevant article found) and November 2015. Eight studies fulfilled the inclusion criteria and were reviewed according to the PRISMA guidelines. Of these, five were randomised controlled trials (RCTs), two were controlled clinical trials, and one was a cohort study. Five studies used text messages as an intervention, two used mobile phone applications, and another used electronic messages via email. All studies resulted in self-reported behaviour change in at least one of their outcome measures (e.g., sunscreen application, seeking shade). While the behaviour change outcomes are promising, the lack of change in more objective measures such as sunburn indicates a need to further improve mobile phone technology-delivered interventions in order to have a greater impact on skin cancer prevention. Future studies may consider the use of objective outcome measures (e.g., sunscreen weight), electronic diaries, or behavioural outcomes in social networks.

Repeat participation in colorectal cancer screening utilizing fecal occult blood testing: A community‐based project in a rural setting

Publisher: Wiley

Date: 07-06-2010

DOI: 10.1111/J.1440-1746.2010.06405.X

Abstract: To investigate participation in a second round of colorectal cancer screening using a fecal occult blood test (FOBT) in an Australian rural community, and to assess the demographic characteristics and in idual perspectives associated with repeat screening. Potential participants from round 1 (50-74 years of age) were sent an intervention package and asked to return a completed FOBT (n = 3406). Doctors of participants testing positive referred to colonoscopy as appropriate. Following screening, 119 participants completed qualitative telephone interviews. Multivariable logistic regression models evaluated the association between round-2 participation and other variables. Round-2 participation was 34.7% the strongest predictor was participation in round 1. Repeat participants were more likely to be female inconsistent screeners were more likely to be younger (aged 50-59 years). The proportion of positive FOBT was 12.7%, that of colonoscopy compliance was 98.6%, and the positive predictive value for cancer or adenoma of advanced pathology was 23.9%. Reasons for participation included testing as a precautionary measure or having family history/friends with colorectal cancer reasons for non-participation included apathy or doctors' advice against screening. Participation was relatively low and consistent across rounds. Unless suitable strategies are identified to overcome behavioral trends and/or to screen out ineligible participants, little change in overall participation rates can be expected across rounds.

Patient Portals Facilitating Engagement With Inpatient Electronic Medical Records: A Systematic Review

Publisher: JMIR Publications Inc.

Date: 11-04-2019

DOI: 10.2196/12779

All-cause death in young women with endometrial cancer who receive progesterone therapy

Publisher: Elsevier BV

Date: 07-2018

DOI: 10.1016/J.AJOG.2018.03.009

Primary prevention of skin cancer: a review of sun protection in Australia and internationally

Publisher: Oxford University Press (OUP)

Date: 09-2004

DOI: 10.1093/HEAPRO/DAH310

Gynecological cancer survivors and community support services: Referral, awareness, utilization and satisfaction

Publisher: Wiley

Date: 2010

DOI: 10.1002/PON.1528

Abstract: To quantify gynecological cancer survivors' referral to, awareness of, utilization of and satisfaction with community support services, as well as the factors associated with service use. In 2004, 802 gynecological cancer survivors, 3 months-5 years post-diagnosis, completed a postal questionnaire (56% response rate). Descriptive statistics summarized outcome prevalences. Logistic regression models identified correlates of service utilization. Substantial proportions of women were aware of the main cancer support organization, Cancer Council Queensland (72%), and of information booklets (74%), helplines (66%), support groups (56%) and internet information (50%). Less than half were aware of other services. The most commonly used resources and services were information booklets (37%), the internet (23%), and helplines (20%). More broadly, 43% utilized information/internet support, 30% utilized psychosocial services and 27% utilized functional ractical services. Approximately one-fifth (19%) used more than one support types. Having a health-care provider referral, being diagnosed with lymphedema or living in northern Queensland were associated with higher odds of service use in all three of the support types. While most (86%) of those referred used a service, only a few women received referrals. Among users, satisfaction with services was high. While gynecological cancer survivors accessed a variety of support, there is a need to ensure women are aware of services. Given the low prevalence of referrals and that referral was a key influence on service use, clinician education may be necessary to improve service referral. Organizations should also consider strategies to keep services high on clinicians' radars.

Prospective, non-randomized phase 2 clinical trial of carboplatin plus paclitaxel with sequential radical pelvic radiotherapy for uterine papillary serous carcinoma

Publisher: Elsevier BV

Date: 02-2011

DOI: 10.1016/J.YGYNO.2010.10.039

Abstract: Uterine Papillary Serous Carcinoma (UPSC) is uncommon and accounts for less than 5% of all uterine cancers. Therefore the majority of evidence about the benefits of adjuvant treatment comes from retrospective case series. We conducted a prospective multi-centre non-randomized phase 2 clinical trial using four cycles of adjuvant paclitaxel plus carboplatin chemotherapy followed by pelvic radiotherapy, in order to evaluate the tolerability and safety of this approach. This trial enrolled patients with newly diagnosed, previously untreated patients with stage 1b-4 (FIGO-1988) UPSC with a papillary serous component of at least 30%. Paclitaxel (175 mg/m(2)) and carboplatin (AUC 6) were administered on day 1 of each 3-week cycle for 4 cycles. Chemotherapy was followed by external beam radiotherapy to the whole pelvis (50.4 Gy over 5.5 weeks). Completion and toxicity of treatment (Common Toxicity Criteria, CTC) and quality of life measures were the primary outcome indicators. Twenty-nine of 31 patients completed treatment as planned. Dose reduction was needed in 9 patients (29%), treatment delay in 7 (23%), and treatment cessation in 2 patients (6.5%). Hematologic toxicity, grade 3 or 4 occurred in 19% (6/31) of patients. Patients' self-reported quality of life remained stable throughout treatment. Thirteen of the 29 patients with stages 1-3 disease (44.8%) recurred (average follow-up 28.1 months, range 8-60 months). This multimodal treatment is feasible, safe and tolerated reasonably well and would be suitable for use in multi-institutional prospective randomized clinical trials incorporating novel therapies in patients with UPSC.

Reasons behind Low Cervical Screening Uptake among South Asian Immigrant Women: A Qualitative Exploration

Publisher: MDPI AG

Date: 28-01-2022

DOI: 10.3390/IJERPH19031527

Abstract: Despite advancements in prevention strategies, cervical cancer remains a leading cause of death among underprivileged women. Although Australia has low age-standardized cervical cancer incidence rates compared with other countries, disparities exist in cervical screening uptake among certain population subgroups, especially those from culturally and linguistically erse (CALD) backgrounds. South Asian immigrant women have been reported to have lower cervical screening uptake than Australian-born women and those from other immigrant backgrounds. The objective of this study was to gain insight into the reasons and barriers for low cervical screening participation among South Asian immigrant women, through qualitative exploration. Semi-structured, in-depth interviews were conducted with 20 women, aged 26–50 years, living in Queensland, Australia, who were recruited via purposive s ling. After translation and transcription of recorded interviews, data was analysed via inductive thematic approach. Resulting themes, illustrating barriers towards screening, included: lack of cervical cancer and screening knowledge, especially of the changes in the revised screening program effect of preventive, health-seeking behaviours health care system factors role of practical constraints and influence of sociocultural beliefs. Results suggest that culturally informed interventions, that involve relevant information provision and behavioural change strategies, to clarify women’s misconceptions, are required.

A qualitative analysis of the needs and wishes of people with type 2 diabetes and healthcare professionals for optimal diabetes care

Publisher: Wiley

Date: 23-06-2022

DOI: 10.1111/DME.14886

Abstract: Globally, type 2 diabetes care is often fragmented and still organised in a provider‐centred way, resulting in suboptimal care for many in iduals. As healthcare systems seek to implement digital care innovations, it is timely to reassess stakeholders' priorities to guide the redesign of diabetes care. This study aimed to identify the needs and wishes of people with type 2 diabetes, and specialist and primary care teams regarding optimal diabetes care to explore how to better support people with diabetes in a metropolitan healthcare service in Australia. Our project was guided by a Participatory Design approach and this paper reports part of the first step, identification of needs. We conducted four focus groups and 16 interviews (November 2019 – January 2020) with 17 adults with type 2 diabetes and seven specialist clinicians from a diabetes outpatient clinic in Brisbane, Australia, and seven primary care professionals from different clinics in Brisbane. Data were analysed using reflexive thematic analysis, building on the Capability, Opportunity, Motivation and Behaviour model. People with diabetes expressed the wish to be equipped, supported and recognised for their efforts in a holistic way, receive personalised care at the right time and improved access to connected services. Healthcare professionals agreed and expressed their own burden regarding their challenging work. Overall, both groups desired holistic, personalised, supportive, proactive and coordinated care pathways. We conclude that there is an alignment of the perceived needs and wishes for improved diabetes care among key stakeholders, however, important gaps remain in the healthcare system.

The Experience of 3D Total-Body Photography to Monitor Nevi: Results From an Australian General Population-Based Cohort Study

Publisher: JMIR Publications Inc.

Date: 20-06-2022

DOI: 10.2196/37034

Abstract: Digital 3D total-body photography of the skin surface is an emerging imaging modality that can facilitate the identification of new and changing nevi. We aimed to describe the experiences of study participants drawn from the general population who were provided 3D total-body photography and dermoscopy for the monitoring of nevi. A population-based prospective study of adults aged 20-70 years from South East Queensland, Australia was conducted. Participants underwent 3D total-body photography and dermoscopy every 6 months over a 3-year period. Participants were asked to provide closed and open-ended feedback on their 3D total-body photography and dermoscopy experience (eg, comfort, trust, intended future use, and willingness to pay) at the halfway study time point (18 months) and final study time point (36 months). We assessed changes in participants’ reported experience of 3D total-body photography, and patient characteristics associated with patient experience at the end of the study (36 months) were analyzed. A total of 149 participants completed the surveys at both the 18- and 36-month time points (median age 55, range 23-70 years n=94, 63.1% were male). At the 18-month time point, most participants (n=103, 69.1%) stated they completely trusted 3D total-body imaging for the diagnosis and monitoring of their nevi, and this did not change at the 36-month (n=104, 69.8%) time point. The majority of participants reported that they were very comfortable or comfortable with the technology at both the 18- (n=138, 92.6%) and 36-month (n=140, 94%) time points, respectively albeit, the number of participants reporting that they were very comfortable reduced significantly between the 18- and 36-month time points, from 71.1% (n=106) to 61.1% (n=91 P=.01). Almost all participants (n=140, 94%) would consider using this technology if it were to become commercially available, and this did not change during the two study time points. Half of the participants (n=74) cited barriers to participating in 3D total-body photography, including trust in the ability of this technology to detect and monitor suspicious lesions, digital privacy, cost, and travel requirements. The majority of participants expressed positive attitudes toward 3D total-body photography for the monitoring of their moles. Half of the participants identified potential barriers to uptake.

Knowledge about health benefits of vitamin D in Queensland Australia

Publisher: Elsevier BV

Date: 04-2010

DOI: 10.1016/J.YPMED.2010.02.004

User preferences for text message-delivered skin cancer prevention and early detection

Publisher: SAGE Publications

Date: 19-02-2015

DOI: 10.1177/1357633X15571652

Abstract: Evidence is needed for the acceptability and user preferences of receiving skin cancer-related text messages. We prepared 27 questions to evaluate attitudes, satisfaction with program characteristics such as timing and spacing, and overall satisfaction with the Healthy Text program in young adults. Within this randomised controlled trial (age 18–42 years), 546 participants were assigned to one of three Healthy Text message groups sun protection, skin self-examination, or attention-control. Over a 12-month period, 21 behaviour-specific text messages were sent to each group. Participants’ preferences were compared between the two interventions and control group at the 12-month follow-up telephone interview. In all three groups, participants reported the messages were easy to understand (98%), provided good suggestions or ideas (88%), and were encouraging (86%) and informative (85%) with little difference between the groups. The timing of the texts was received positively (92%) however, some suggestions for frequency or time of day the messages were received from 8% of participants. Participants in the two intervention groups found their messages more informative, and triggering behaviour change compared to control. Text messages about skin cancer prevention and early detection are novel and acceptable to induce behaviour change in young adults.

Virtual melanoma checks during a pandemic

Publisher: Oxford University Press (OUP)

Date: 13-07-2020

DOI: 10.1111/BJD.19255

Psychological distress among Indigenous Australian cancer survivors

Publisher: Springer Science and Business Media LLC

Date: 14-12-2017

DOI: 10.1007/S00520-017-3995-Y

Abstract: The purpose of this study is to identify the level of and factors associated with distress in 155 Indigenous Australian cancer survivors approximately 6 months post-diagnosis. The distress thermometer (DT) was used to assess clinically significant distress (defined as having a DT score ≥ 4). Logistic regression was used to identify sociodemographic and clinical factors associated with clinically significant distress. The mean distress score was 2.7 (SD 2.9), with about one in three Indigenous cancer survivors reporting clinically significant distress (35% n = 54). After adjusting for age and sex, clinically significant distress was more likely among those who were separated/ orced/widowed than those who were married (odds ratio (OR) = 2.99, 95% confidence intervals (95% CI) 1.21-7.35, p = 0.017) and less likely among those residing in remote areas than those in major cities (OR = 0.23, 95% CI 0.08-0.71, p = 0.001) and in those receiving non-surgical treatment only compared with surgery only (OR = 0.24, 95% CI 0.08-0.68, p = 0.008). Despite increased screening for distress in cancer care, this is, to our knowledge, the first published assessment of distress among Indigenous Australian cancer survivors. The characteristics of Indigenous cancer survivors associated with greater likelihood of clinically significant distress indicate at-risk subgroups who would benefit from screening and early intervention. Further research is required to identify the specific aetiologies of distress. Our findings indicate a need to identify psychological distress and for survivorship care to include culturally sensitive and tailored psychological support for Indigenous cancer survivors.

Real‐world surgical outcomes of a gelatin‐hemostatic matrix in women requiring a hysterectomy: a matched case–control study

Publisher: Wiley

Date: 10-06-2016

DOI: 10.1111/AOGS.12924

Abstract: The aim of this study was to compare adverse events and surgical outcomes of hysterectomy with or without use of a gelatin-hemostatic matrix (SURGIFLO(®) ). Prospective case-control study (Canadian Task Force classification II2) of total hysterectomy (Piver Type 1) provided by surgeons in Australia between November 2005 and May 2015. Data were collected via SurgicalPerformance, a web-based data project which aims to provide confidential feedback to surgeons about their surgical outcomes. Of 2440 records of women who received a hysterectomy, 1351 were eligible for these analyses 107 received SURGIFLO(®) hemostatic matrix to prevent postoperative blood loss and 1244 did not. Patients with or without SURGIFLO(®) differed in age, Charlson comorbidity index, and American Society of Anesthesiologists physical status classification system score (ASA), and also differed in clinical outcomes. After matching for patient's age and ASA at surgery, patients with and without SURGIFLO(®) had comparable baseline characteristics. Matched patients with and without SURGIFLO(®) had comparable clinical outcomes including risk of developing vault hematoma, return to the operating room, transfusion of red cells, surgical site infection (pelvis), readmission within 30 days and unplanned ICU admission. In a s le matched by age and ASA, SURGIFLO(®) neither prevented nor caused additional adverse events in women undergoing hysterectomy. Surgeons used SURGIFLO(®) more commonly among women who were older, had more comorbidities and a higher ASA score. This indicates that it may be most useful in complicated surgery or cases.

Capturing Ultraviolet Radiation Exposure and Physical Activity: Feasibility Study and Comparison Between Self-Reports, Mobile Apps, Dosimeters, and Accelerometers (Preprint)

Publisher: JMIR Publications Inc.

Date: 19-12-2017

DOI: 10.2196/PREPRINTS.9695

Abstract: kin cancer is the most prevalent cancer in Australia. Skin cancer prevention programs aim to reduce sun exposure and increase sun protection behaviors. Effectiveness is usually assessed through self-report. t was the aim of this study to test the acceptance and validity of a newly developed ultraviolet radiation (UVR) exposure app, designed to reduce the data collection burden to research participants. Physical activity data was collected because a strong focus on sun avoidance may result in unhealthy reductions in physical activity. This paper provides lessons learned from collecting data from participants using paper diaries, a mobile app, dosimeters, and accelerometers for measuring end-points of UVR exposure and physical activity. wo participant groups were recruited through social and traditional media c aigns 1) Group A—UVR Diaries and 2) Group B—Physical Activity. In Group A, nineteen participants wore an UVR dosimeter wristwatch (University of Canterbury, New Zealand) when outside for 7 days. They also recorded their sun exposure and physical activity levels using both 1) the UVR diary app and 2) a paper UVR diary. In Group B, 55 participants wore an accelerometer (Actigraph, Pensacola, FL, USA) for 14 days and completed the UVR diary app. Data from the UVR diary app were compared with UVR dosimeter wristwatch, accelerometer, and paper UVR diary data. Cohen kappa coefficient score was used to determine if there was agreement between categorical variables for different UVR data collection methods and Spearman rank correlation coefficient was used to determine agreement between continuous accelerometer data and app-collected self-report physical activity. he mean age of participants in Groups A (n=19) and B (n=55) was 29.3 and 25.4 years, and 63% (12/19) and 75% (41/55) were females, respectively. Self-reported sun exposure data in the UVR app correlated highly with UVR dosimetry (κ=0.83, 95% CI 0.64-1.00, P .001). Correlation between self-reported UVR app and accelerometer-collected moderate to vigorous physical activity data was low (ρ=0.23, P=.10), while agreement for low-intensity physical activity was significantly different (ρ=-0.49, P .001). Seventy-nine percent of participants preferred the app over the paper diary for daily self-report of UVR exposure and physical activity. his feasibility study highlights self-report using an UVR app can reliably collect personal UVR exposure, but further improvements are required before the app can also be used to collect physical activity data.

The validity and reliability of remote diabetic foot ulcer assessment using mobile phone images

Publisher: Springer Science and Business Media LLC

Date: 25-08-2017

DOI: 10.1038/S41598-017-09828-4

Abstract: Despite their potential for telemedicine in diabetic foot ulcer treatment, diagnostic accuracy of assessment of diabetic foot ulcers using mobile phone images is unknown. Our aim was to determine the validity and reliability of remote diabetic foot ulcer assessment using mobile phone images. Fifty diabetic foot ulcers were assessed live and photographed. Five independent observers remotely assessed the mobile phone images twice for presence of nine clinical characteristics and three treatment decisions. Positive likelihood (LLR+) and negative likelihood (LLR−) ratios were calculated for validity. Multirater Randolph’s and bi-rater Bennet kappa values were calculated for reliability. LLR+ ranged from 1.3–4.2 LLR− ranged from 0.13–0.88 the treatment decision ‘peri-wound debridement’ was the only item with ‘strong diagnostic evidence’. Inter-observer reliability kappa ranged from 0.09–0.71 test-retest reliability from 0.45–0.86 the treatment decision ‘peri-wound debridement’ was the only item with ‘adequate agreement’. In conclusion, mobile phone images had low validity and reliability for remote assessment of diabetic foot ulcers and should not be used as a stand-alone diagnostic instrument. Clinicians who use mobile phone images in clinical practice should obtain as much additional information as possible when making treatment decisions based on these images, and be cautious of the low diagnostic accuracy.

Experience from an outright ban of commercial sunbeds in the Australian context

Publisher: Oxford University Press (OUP)

Date: 04-05-2022

DOI: 10.1111/BJD.21582

Sun Exposure Summit position statement

Publisher: The University of Queensland

Date: 06-03-2023

DOI: 10.14264/F9E3744

Skin cancer detection by one click - Are we any closer?

Publisher: AMPCo

Date: 12-2013

DOI: 10.5694/MJA13.11338

Is there a role for digital technology in measuring the value of skin self‐examination?

Publisher: Oxford University Press (OUP)

Date: 06-2019

DOI: 10.1111/BJD.17883

What is a Bayes factor?

Publisher: American Psychological Association (APA)

Date: 06-2023

DOI: 10.1037/MET0000421

Why a randomized melanoma screening trial may be a good idea

Publisher: Oxford University Press (OUP)

Date: 20-09-2018

DOI: 10.1111/BJD.17089

Experiences of Patient-Led Surveillance, Including Patient-Performed Teledermoscopy, in the MEL-SELF Pilot Randomized Controlled Trial: Qualitative Interview Study (Preprint)

Publisher: JMIR Publications Inc.

Date: 23-12-0018

DOI: 10.2196/PREPRINTS.35916

Abstract: urrent clinician-led melanoma surveillance models require frequent routinely scheduled clinic visits, with associated travel, cost, and time burden for patients. Patient-led surveillance is a new model of follow-up care that could reduce health care use such as clinic visits and medical procedures and their associated costs, increase access to care, and promote early diagnosis of a subsequent new melanoma after treatment of a primary melanoma. Understanding patient experiences may allow improvements in implementation. his study aims to explore patients’ experiences and perceptions of patient-led surveillance during the 6 months of participation in the MEL-SELF pilot randomized controlled trial. Patient-led surveillance comprised regular skin self-examination, use of a mobile dermatoscope to image lesions of concern, and a smartphone app to track and send images to a teledermatologist for review, in addition to usual care. emistructured interviews were conducted with patients previously treated for melanoma localized to the skin in New South Wales, Australia, who were randomized to the patient-led surveillance (intervention group) in the trial. Thematic analysis was used to analyze the data with reference to the technology acceptance model. e interviewed 20 patients (n=8, 40% women and n=12, 60% men median age 62 years). Patients who were more adherent experienced benefits such as increased awareness of their skin and improved skin self-examination practice, early detection of melanomas, and opportunities to be proactive in managing their clinical follow-up. Most participants experienced difficulty in obtaining clear images and technical problems with the app. These barriers were overcome or persevered by participants with previous experience with digital technology and with effective help from a skin check partner (such as a spouse, sibling, or friend). Having too many or too few moles decreased perceived usefulness. atients with melanoma are receptive to and experience benefits from patient-led surveillance using teledermoscopy. Increased provision of training and technical support to patients and their skin check partners may help to realize the full potential benefits of this new model of melanoma surveillance.

Reply

Publisher: Elsevier BV

Date: 09-2006

DOI: 10.1016/J.JAAD.2006.04.071

Women with self-reported lower limb lymphedema after treatment for gynecological cancers: Are they more likely to self-report psychosocial symptoms and less likely to use services?

Publisher: Frontline Medical Communications, Inc.

Date: 02-2015

DOI: 10.12788/JCSO.0109

Abstract: Survivorship for gynecological cancers has increased because of improved screening and treatment. Use of supportive care services after treatment is important to improve patient quality of life. To assess self-reported lower-limb lymphedema (LLL), depression, anxiety, quality of life, unmet supportive care needs, and service use among gynecological cancer survivors. In 2010, a population-based, cross-sectional mail survey was conducted among 160 gynecological cancer survivors 5-30 months after their diagnoses (response rate, 53%). Overall, 30% of women self-reported symptoms of LLL, 21% and 24% self-reported symptoms of depression or anxiety, respectively. Women with LLL were more likely to also report symptoms of depression or anxiety, and had higher unmet supportive care needs. Services needed but not used by 10%-15% of women with LLL, anxiety, or depression were those of a lymphedema specialist, pain specialist, and physiotherapist for LLL, and a psychiatrist, psychologist, and pain specialist for anxiety and depression. Small s le size, self-reported data, limited generalization to other countries, underrepresentation of older women (age >70 years) and women from non-Caucasian backgrounds. Women with LLL or high distress were less likely to use services they needed.

In Vitro Model of Vitamin D Synthesis by UV Radiation in an Australian Urban Environment

Publisher: Wiley

Date: 22-12-2010

DOI: 10.1111/J.1751-1097.2010.00865.X

Abstract: Vitamin D, an important constituent of human health, is produced through the exposure of human skin to short wave (280-315 nm) ultraviolet radiation (UV). We aimed to establish whether an urbanized environment with tall buildings in close proximity (an "urban canyon") significantly reduced the capacity of sunlight to synthesize vitamin D, when compared with a typical suburban area (∼2.5 km away) and to investigate the association of UV and vitamin D production with pollution, temperature, and humidity. Measurements of ambient UV (295-400 nm) (using a portable photometer/radiometer and detector) and synthesized vitamin D (from an in vitro model) were taken regularly at urban and control sites over 3 months in Brisbane, Australia. During a typical 20 min measurement, urban and control sites received 0.26 and 1.03 W m(-2) mean total UV respectively (P < 0.001), and produced 0.12 and 0.53 μg mL(-1) mean vitamin D (P < 0.001). Pollution, temperature and humidity were not associated with UV or vitamin D production. This demonstrates a large difference in vitamin D synthesis between an urban canyon and a nearby control site. Although the results cannot be directly applied to humans, they emphasize the need for further study of human vitamin D production in urban environments.

Living well after breast cancer randomized controlled trial protocol: evaluating a telephone-delivered weight loss intervention versus usual care in women following treatment for breast cancer

Publisher: Springer Science and Business Media LLC

Date: 28-10-2016

DOI: 10.1186/S12885-016-2858-0

The healthytexts study: A randomized controlled trial to improve skin cancer prevention behaviors among young people

Publisher: Elsevier BV

Date: 05-2013

DOI: 10.1016/J.CCT.2013.03.009

Abstract: Several randomized trials have found behavior change programs delivered via text messaging to be efficacious to improve preventive health behaviors such as physical activity and stopping smoking however few have assessed its value in skin cancer prevention or early detection. The HealthyTexts study enrolled 678 participants 18-42 years, and assigned them to receive 21 text messages about skin cancer prevention, skin self-examination or physical activity (attention control) over the course of one year. Baseline data have been collected and outcomes will be assessed at three months and twelve months post-intervention. The trial aims to increase the mean overall sun protection habits index score from 2.3 to 2.7 with a standard deviation of 0.5 (effect size of 0.5) and the proportion of people who conduct a whole-body skin self-examination by an absolute 10%. This paper describes the study design and participants' baseline characteristics. In addition, participants' goals for their health, and strategies they apply to achieve those goals are summarized.

Anatomic Distribution of Cherry Angiomas in the General Population

Publisher: S. Karger AG

Date: 22-07-2021

DOI: 10.1159/000517172

Abstract: b i Background: /i /b Cherry angiomas are common benign vascular skin lesions of unknown aetiology, found largely on the trunk. However, their exact anatomic distribution besides their truncal predisposition, and how they manifest in the general population, has not been characterised. b i Methods: /i /b Three-dimensional (3D) total body imaging was obtained from 163 adult participants of a general population cohort study in Brisbane, Australia. Demographic, phenotypic, and sun behaviour characteristics were collected using a standard questionnaire along with history of melanoma and keratinocyte cancers. Cherry angiomas were identified using an automated classification algorithm with a sensitivity of 87% and a specificity of 99%, developed specifically for this study population. b i Results: /i /b The 3D total body images of 163 participants were analysed. Participants had a median age of 57 years and 61% were male. On average, males had more angiomas than females (median of 16 vs. 12) and the number and size of cherry angiomas increased with age. In addition to male sex and age, an increase in angiomas was associated with Caucasian ancestry other than British/Irish only, fair skin colour opposed to medium/olive, having green/hazel eyes compared to blue/grey, and personal history of melanoma. The most common site for cherry angiomas was the front trunk, followed by the back. Interestingly, although males had more angiomas overall, females had more angiomas on the legs. b i Conclusion: /i /b Describing the distribution of cherry angiomas by body site is an important step towards further understanding of the aetiology of angiomas. While personal history of melanoma is associated with an increased number of cherry angiomas, whether this association is prognostic, co-occurs with development of melanoma, or is merely fortuitous requires further investigation.

Psychometric properties of an Australian supportive care needs assessment tool for Indigenous patients with cancer

Publisher: Wiley

Date: 06-05-2015

DOI: 10.1002/CNCR.29433

Abstract: There are significant disparities in cancer outcomes between Indigenous and non-Indigenous Australians. Identifying the unmet supportive care needs of Indigenous Australians with cancer is imperative to improve their cancer care. The purpose of the current study was to test the psychometric properties of a supportive cancer care needs assessment tool for Indigenous people (SCNAT-IP) with cancer. The SCNAT-IP was administered to 248 Indigenous Australians diagnosed with a range of cancer types and stages, and who received treatment in 1 of 4 Queensland hospitals. All 39 items were assessed for ceiling and floor effects and were analyzed using exploratory factor analysis to determine construct validity. Identified factors were assessed for internal consistency and convergent validity to validated psychosocial tools. Exploratory factor analysis revealed a 4-factor structure (physical and psychological, hospital care, information and communication, and practical and cultural needs) explaining 51% of the variance. Internal consistency of the 4 subscales was good, with Cronbach alpha reliability coefficients ranging from .70 to .89. Convergent validity was supported by significant correlations between the SCNAT-IP with the National Comprehensive Cancer Network Distress Thermometer (correlation coefficient [r] = 0.60 P<.001) and the Cancer Worry Chart (r = 0.58 P<.001) and a moderately strong negative correlation with the Assessment of Quality of Life questionnaire (r = -0.56 P<.001). These data provide initial support for the SCNAT-IP, a measure of multiple supportive care needs domains specific to Indigenous Australian patients with cancer undergoing treatment.

Measurement of Quality of Life in Head and Neck Cancer Patients Utilizing the Quality of Life Radiation Therapy Questionnaire

Publisher: Springer Science and Business Media LLC

Date: 03-2002

DOI: 10.1007/S00066-002-0902-2

Abstract: Quality of life (QOL) measures give patients the possibility to express subjective changes in wellbeing. We aimed to translate the radiation specific quality of life questionnaire (QOL-RTI) and the companion head and neck module (H&N) questionnaire into German and to test its reliability, validity and sensitivity. After translation and final revisions based on qualitative interviews with ten patients, 97 head and neck cancer patients were screened for eligibility. Patients answered the 38 items questionnaire at baseline and twice in week 4 of radiotherapy for test-retest reliability. Internal consistency was calculated using Chronbach's alpha. Patients also completed the functional assessment of cancer tool plus head and neck (FACT-G plus H&N) for concurrent validity. Item analyses were performed to test the sensitivity. Chronbach's alpha yielded alpha = 0.85 for the QOL-RTI and alpha = 0.80 for the H&N module, test-retest reliability scores were r = 0.87 and r = 0.83, respectively. The correlation of the QOL-RTI plus H&N and the FACT plus H&N was r = 0.79. Questionnaire sensitivity was supported by significant changes in the mean score of 45.8% of the QOL-RTI items and 78.6% of the H&N items between baseline and week 4 of radiotherapy. The German version of the QOL-RTI was shown to be a reliable, valid and sensitive tool to assess the quality of life of patients undergoing radiotherapy. The H&N module is useful for patients undergoing treatment for head and neck cancer.

The Queensland cancer risk study: General population norms for the Functional Assessment of Cancer Therapy-General (FACT-G)

Publisher: Wiley

Date: 06-2009

DOI: 10.1002/PON.1428

Abstract: To derive Australian normative scores for the Functional Assessment of Cancer Therapy-General Population (FACT-GP) and to confirm its factor structure. Quality of life (QoL) data (as measured by the FACT-GP) were collected within the Queensland Cancer Risk Study (QCRS) in 2004. The QCRS explored cancer screening and cancer risk behaviours among 9419 English-speaking residents of Queensland aged 20-75 years. Information was collected through computer-assisted telephone interviews and augmented by mailed, Self-Administered Questionnaires (SAQ). A total of 2727 participants largely comparable to the general population of Queensland self-completed the FACT-GP however, participants were somewhat higher educated, more likely to have had cancer and less likely to be of indigenous heritage. The Queensland population reported a FACT-GP summary score of 85.9 (SD=15.1), with subscale scores (range: 19.2 for social well-being to 25.1 for physical well-being (PWB)). In this study, men and women within different age groups reported similar QoL. QoL was clinically and significantly lower among participants not married, with a body mass index (BMI) deviating from normal weight and with one or more self-reported morbidities. A four-factor solution was confirmed with good goodness-of-fit indices (RSMEA<0.05 for all three age groups). The reference values from the general population reported here can be used for comparison with the QoL measured in populations of cancer patients, providing a benchmark against which clinicians can evaluate the impact of the disease and/or the treatments on QoL.

Supportive care needs of people with brain tumours and their carers

Publisher: Springer Science and Business Media LLC

Date: 19-05-2006

DOI: 10.1007/S00520-006-0074-1

Abstract: The diagnosis and treatment of a brain tumour may result in long-term changes in a patient's functional and social abilities and/or in a greatly reduced life span. A qualitative investigation was conducted to examine the supportive care needs of patients with brain tumour and their carers. Overall, 18 patients and 18 carers participated in focus groups or telephone interviews, following a structured interview guide to elicit supportive care services of importance to these patients and carers. Six major themes were identified using the framework analysis method, including needs for information and coping with uncertainty, practical support, support to return to pretreatment responsibilities or prepare for long-term care, support to deal with social isolation and organize respite care, support to overcome stigma/discrimination and support to discuss potentially reduced life expectancy. Five recommendations to improve service delivery include: assignment of a dedicated member of the care team or case manager proactive dissemination of information, education and psychosocial support access to objective assessment of neuropsychological functioning facilitating easier access to welfare payments and services facilitating communication about difficult illness-related topics. Provision of services along these recommendations could improve supportive care of brain tumour patients and their carers.

The Importance of Incorporating Human Factors in the Design and Implementation of Artificial Intelligence for Skin Cancer Diagnosis in the Real World

Publisher: Springer Science and Business Media LLC

Date: 22-12-2021

DOI: 10.1007/S40257-020-00574-4

Abstract: Artificial intelligence (AI) algorithms have been shown to diagnose skin lesions with impressive accuracy in experimental settings. The majority of the literature to date has compared AI and dermatologists as opponents in skin cancer diagnosis. However, in the real-world clinical setting, the clinician will work in collaboration with AI. Existing evidence regarding the integration of such AI diagnostic tools into clinical practice is limited. Human factors, such as cognitive style, personality, experience, preferences, and attitudes may influence clinicians' use of AI. In this review, we consider these human factors and the potential cognitive errors, biases, and unintended consequences that could arise when using an AI skin cancer diagnostic tool in the real world. Integrating this knowledge in the design and implementation of AI technology will assist in ensuring that the end product can be used effectively. Dermatologist leadership in the development of these tools will further improve their clinical relevance and safety.

Feasibility and safety of a surgical training program in total laparoscopic hysterectomy: Results of a pilot trial

Publisher: Wiley

Date: 24-07-2023

DOI: 10.1111/AJO.13740

Abstract: It is widely accepted total laparoscopic hysterectomy (TLH) and vaginal hysterectomy are less invasive procedures compared to total abdominal hysterectomy (TAH). However, rates of TAH remain unreasonably high. To pilot‐test a model of training for practising obstetricians and gynaecologists (O& Gs) in TLH. Training of participating O& Gs was conducted across four hospitals in Queensland, Australia, while other O& Gs were observed as contemporary controls. Type of hysterectomy, details of the surgery, including adverse events, were collected from hospital medical records. Eleven O& Gs completed the pre‐intervention and intervention training periods, and nine completed the post‐intervention follow‐up. TLH rates increased from 24% prior to 75% during and 68% after intervention. Overall, the uptake rate of TLH showed a two‐fold increase during the intervention period (2.08, 95% CI: 1.16–8.56, P 0.001) and a 12% increase was retained during the follow‐up period (1.12, 95% CI: 0.54–4.02, P = 0.427). Pre‐intervention, across all sites, 24% of hysterectomies were performed via TAH by the participating specialist trainees, which decreased to 13% during the intervention and 14% during follow‐up. The rate of adverse events decreased from 13.5% at pre‐intervention, to 6.4% during and 4.2% post‐intervention. By comparison, no change in surgical approach or rate of adverse events was observed in the control group. The implementation of a formal and structured surgical training program teaching TLH resulted in important benefits to trainees, patients and society in the four trial hospitals.

Consumer Preferences for Skin Cancer Screening Using Mobile Teledermoscopy: A Qualitative Study

Publisher: S. Karger AG

Date: 2020

DOI: 10.1159/000505620

Abstract: b i Background: /i /b Mobile teledermoscopy is a rapidly advancing technology that promotes early detection and management of skin cancers. Whilst the use of teledermoscopy has proven to be effective and has a role in the detection of skin cancers, patients’ attitudes towards the multiple ways in which this technology can be utilised has not been explored. b i Methods: /i /b Data were obtained from a large randomised controlled trial comparing mobile teledermoscopy-enhanced skin self-examinations (SSEs) with naked-eye SSE. A semi-structured interview guide was developed by the investigators with questions focusing on people’s previous skin screening behaviours and 2 of the major pathways which can be utilised in mobile teledermoscopy: (i) direct-to-consumer and (ii) doctor-to-doctor. All interviews were tape-recorded and transcribed verbatim. Thematic analysis was undertaken by 2 independent researchers. b i Results: /i /b Twenty-eight participants were interviewed. Eighty-six percent of participants ( i n /i = 24/28) had previously had a clinical skin examination. Only 18% of participants ( i n /i = 5/28) visited the same doctor for each clinical skin examination. Five main themes were identified in the interviews that affected how people felt about the integration of mobile teledermoscopy into skin screening pathways: history of clinical skin examinations, continuity of the doctor-patient relationship, convenience of the direct-to-consumer teledermoscopy, expedited review enhancing the doctor-to-doctor setting and mobile teledermoscopy as a partner-assisted task. b i Conclusions: /i /b Overall mobile teledermoscopy was viewed positively for both direct-to-consumer and doctor-to-doctor interaction. Continuity of care in the doctor-patient relationship was not found to be a priority for clinical skin examination with most participants visiting several doctors throughout their clinical skin examination history.

Impaired Quality of Life in Patients Commencing Radiotherapy for Cancer

Publisher: Springer Science and Business Media LLC

Date: 02-2004

DOI: 10.1007/S00066-004-1160-2

Abstract: This study tested a three-item questionnaire to measure global quality of life (QOL) and pain in patients commencing radiotherapy, based on items from the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 instrument. In a pretest, the EORTC QLQ-C30 and the three-item short questionnaire were administered to 100 patients, yielding similar global QOL and pain scores. After the pretest, the three-item questionnaire was administered to 1,837 patients prior to first radiotherapy treatment. 254 (13.8%) patients with impaired QOL were identified. These patients had a mean global QOL score of 32.6 compared to 72.4 (p < 0.001) found in patients with satisfactory QOL. Patients with impaired QOL were also more likely < 60 years and treated for lung, gastrointestinal or head and neck cancer or advanced, metastatic cancer. This brief questionnaire addresses important aspects of QOL, is feasible to use in a clinical setting and therefore represents a potentially useful tool for detecting those patients who may benefit from further evaluation and/or psychosocial support.

Depression, anxiety and body image after treatment for invasive stage one epithelial ovarian cancer

Publisher: Wiley

Date: 12-2009

DOI: 10.1111/J.1479-828X.2009.01074.X

Is Teledermoscopy Ready to Replace Face-to-Face Examinations for the Early Detection of Skin Cancer? Consumer Views, Technology Acceptance, and Satisfaction with Care

Publisher: S. Karger AG

Date: 2020

DOI: 10.1159/000506154

Abstract: b i Background: /i /b Previous cross-sectional research indicates high acceptance of mobile teledermoscopy-enhanced skin self-examination (SSE) by consumers based on the technology acceptance model (TAM) domains: perceived usefulness, ease of use, compatibility, attitude and intention, subjective norms, facilitator, and trust. However, no study has assessed this outcome longitudinally among people who actually used the technology in their own homes. b i Methods: /i /b Participants were living in Brisbane, Australia, aged 18 years or older, and at high risk of skin cancer. Participants randomly assigned to the intervention group ( i n /i = 98) completed a self-administered questionnaire on mobile teledermoscopy acceptance for skin cancer detection both before use and after performing mobile teledermoscopy-enhanced SSE in their homes. The survey included a 25-item scale assessing seven TAM domains. Item scores ranged from 5 (strongly agree) to 1 (strongly disagree). Participants also answered survey questions on satisfaction with use of teledermoscopy, and a 9-item “thoughts about melanoma” scale that measures cancer worry. b i Results: /i /b Participants were 19–73 years old, had high skin cancer risk, blue or grey eyes (53.1%), fair or very fair skin (88.8%), and previous skin cancer treatments (61.2%). Participants were more accepting of mobile teledermoscopy at baseline: mean TAM score of 4.15 (SE 0.05) their level of acceptance decreased significantly after teledermoscopy use: mean score 3.94 (SE 0.05 i /i = 0.001). In linear regression analysis, the decrease in TAM scores was similar across demographic and skin cancer risk categories. Ninety-two percent ( i n /i = 90) of participants agreed that mobile teledermoscopy was easy to use. The mean score of the “thoughts about melanoma” scale did not change significantly from baseline to follow-up. b i Conclusion: /i /b Consumers had high TAM scores before they used mobile teledermoscopy within a randomised control trial. At the end of the intervention period, TAM scores decreased, although participants’ average score still indicated “agreement” that mobile teledermoscopy was acceptable.

Determinants of Uptake of Whole-Body Skin Self-Examination in Older Men

Publisher: Informa UK Limited

Date: 04-2013

DOI: 10.1080/08964289.2013.782851

Abstract: Early detection through whole-body Skin Self-Examination (wbSSE) may decrease mortality from melanoma. Using the Health Action Process Approach (HAPA) or Health Belief Model (HBM) we aimed to assess determinants of uptake of wbSSE in 410 men 50 years of older who participated in the control group of a randomized trial. Overall, the HAPA was a significantly better predictor of wbSSE compared to the HBM (p < .001). The construct of self-efficacy in the HBM was a significant predictor of future wbSSE (p = .001), while neither perceived threat (p = .584) nor outcome expectations (p = .220) were. In contrast, self-efficacy, perceived threat, and outcome expectations predicted intention to perform SSE, which predicted behavior (p = .015). The HAPA construct volitional self-efficacy was also associated with wbSSE (p = .046). The use of the HAPA model for future SSE interventions for this population is warranted.

Acute Side Effects during 3-D-Planned Conformal Radiotherapy of Prostate Cancer

Publisher: Springer Science and Business Media LLC

Date: 05-2003

DOI: 10.1007/S00066-003-1029-9

Abstract: Radiotherapy-induced side effects are often scored retrospectively according to the EORTC/RTOG scores for organs at risk by reviewing the medical records. Some studies could prove an over- or underestimation of side effects as assessed by the medical professionals. The aim of this study was to prospectively evaluate differences in side effects as described by the doctors and the patients. 47 patients with prostate cancer were questioned about their side effects by a radiotherapist and asked to fill in a questionnaire at the start, in the middle and at the end of radiotherapy. The data of this questionnaire and the doctor's report were scored according to the German version of the EORTC/RTOG scores for gastrointestinal (GI) and genitourinary (GU) side effects and subsequently compared. We distinguished between "moderate" disagreement (better/worse by one grade, assessed by the doctor) and "pronounced" disagreement (better/worse by two grades, assessed by the doctor). The number of GI and GU side effects increased during radiotherapy both according to data obtained from the doctor and the patient questionnaire. Comparing doctors' reports with patients' questionnaires, for GI side effects an agreement was found in 22/47 patients, "moderately better" scores by the doctor's report were found in 13/47 patients, and "moderately worse" scores in 9/47 patients on average. "Pronouncedly better and worse" scores were found in 2/47 patients. For GU side effects an agreement was seen in 22/47 patients, "moderately better" scores in 17/47 patients and "moderately worse" scores in 3/47 patients. Regarding GU side effects, only pronouncedly better scores, as assessed by the doctor, were found in a mean of 4/47 patients. If the EORTC/RTOG score is used in its original English version, a difference is found, particularly in the assessment of GU side effects, resulting in an higher amount of agreement concerning GU side effects and a minor amount of "pronounced disagreement". In order to evaluate radiation-induced side effects, a patient's self-reported questionnaire should be included in the analysis of morbidity, above all for grade 0, 1, and 2 side effects. The validity of data seems to be questionable, particularly in the assessment of grade 0, 1 and 2 side effects, if only data from the doctors' reports are taken into account. The German version of the EORTC/RTOG score--not including the pretreatment status--leads to different results, particularly in the assessment of grade 0, 1, and 2 urinary side effects, which asks for a revision.

Sun protection behavior after diagnosis of high-risk primary melanoma and risk of a subsequent primary

Publisher: Elsevier BV

Date: 2019

DOI: 10.1016/J.JAAD.2018.06.068

Abstract: Melanoma survivors are at high risk of further primary melanomas. To assess sun behavior after melanoma diagnosis and in relation to further primary melanomas. We applied repeated measures latent class analysis to reported primary prevention behavior at time of diagnosis and every 6 months for 2 years after diagnosis in patients with clinical stage IB or II melanoma. Correlates of behavior trajectories and risk of subsequent primaries were determined by using multivariable logistic and Cox regression analyses, respectively. Among the 448 male and 341 female patients, sunscreen use fell into 3 trajectories: stable never-use (26% of males and 12% of females), stable sometimes-use (35% of males and 29% of females), and increased to often-use (39% of males and 59% of females). Most reduced their weekend sun exposure, but in 82% of males and 69% of females it remained increased. Males, smokers, the less educated, those who tanned, and those not self-checking their skin were more likely to have trajectories of inadequate protection. Patients with a history of melanoma before the study doubled their risk of another primary melanoma in the next 2 years if sunscreen use in that time was inadequate (hazard ratio, 2.45 95% confidence interval, 1.00-6.06). Patient-reported data are susceptible to recall bias. Our results may assist clinicians in identifying patients not using adequate sun protection and providing information for patient counseling.

Prevention versus early detection for long-term control of melanoma and keratinocyte carcinomas: a cost-effectiveness modelling study

Publisher: BMJ

Date: 02-2020

DOI: 10.1136/BMJOPEN-2019-034388

Abstract: To compare the long-term economic impact of melanoma prevention by sun protection, with the corresponding impact of early detection of melanoma to decrease melanoma deaths. Cost-effectiveness analysis using Markov cohort model. Data were primarily from two population-based randomised controlled trials, epidemiological and costing reports, and included flow-on effects for keratinocyte cancers (previously non-melanoma skin cancers) and actinic keratoses. Queensland, Australia. Men and women with a mean age 50 years modelled for 30 years. Daily sunscreen use (prevention) compared with annual clinical skin examinations (early detection) and comparing these in turn with the status quo. Costs, counts of melanoma, melanoma deaths, keratinocyte cancers, life years and quality-adjusted life years. Per 100 000 in iduals, for early detection, primary prevention and without intervention, there were 2446, 1364 and 2419 new melanomas, 556, 341 and 567 melanoma deaths, 64 452, 47 682 and 64 659 keratinocyte cancers and £493.5, £386.4 and £406.1 million in economic costs, respectively. There were small differences between prevention and early detection in life years saved (0.09%) and quality-adjusted life years gained (0.10%). Compared with early detection of melanoma, systematic sunscreen use at a population level will prevent substantial numbers of new skin tumours, melanoma deaths and save healthcare costs. Primary prevention through daily use of sunscreen is a priority for investment in the control of melanoma.

Total laparoscopic versus open surgery for stage 1 endometrial cancer: The LACE randomized controlled trial

Publisher: Elsevier BV

Date: 08-2006

DOI: 10.1016/J.CCT.2006.03.004

Abstract: Endometrial cancer is the most common gynaecological malignancy in Australia and the US. Current standard treatment involves open surgery to remove the uterus, and both tubes and ovaries (TAH). The Laparoscopic Approach to Cancer of the Endometrium (LACE) trial was designed to assess equivalence of performing this in a total laparoscopic approach (TLH). Patient recruitment was designed to proceed along two stages to accommodate for a potential increase in patient requests of laparoscopic surgery. During the first stage, patients are randomised in a 2:1 allocation to receive TLH or TAH, with the primary endpoint quality of life (QoL) at 6 month post-surgery, requiring 180 patients to be enrolled to have 80% power at alpha=0.05 to detect a clinically significant difference of 8 points on the Functional Assessment of Cancer General (FACT-G) QoL instrument. If additional recruitment of patients seems impossible after accrual of 180 patients, this cohort will be followed for 4 years, and disease free survival (DFS) of patients treated by TLH will be compared to DFS within the endometrial cancer population. During the second stage, recruitment will be extended to a total of 590 patients in a 1:1 TLH:TAH allocation, to assess the equivalence with respect to DFS with 80% power and alpha=0.05. Equivalence will be assumed if the difference in DFS does not exceed 7% at 4 years. Secondary outcomes include treatment related morbidity costs and cost-effectiveness patterns of recurrence and overall survival. All data from this multicentre study will be entered using online electronic case report forms (e-CRF), allowing real time assessment of data completeness and patient follow-up. The LACE trial will establish the equivalence of a TLH approach for patients with stage 1 endometrial cancer following a two stage protocol to accommodate potential threats to patient recruitment through requests for laparoscopic surgery.

Lymphedema After Breast Cancer: Incidence, Risk Factors, and Effect on Upper Body Function

Publisher: American Society of Clinical Oncology (ASCO)

Date: 20-07-2008

DOI: 10.1200/JCO.2007.14.4899

Abstract: Secondary lymphedema is associated with adverse physical and psychosocial consequences among women with breast cancer (BC). This article describes the prevalence and incidence of lymphedema between 6 and 18 months after BC treatment personal, treatment, and behavioral correlates of lymphedema status and the presence of other upper-body symptoms (UBS) and function (UBF). A population-based s le of Australian women (n = 287) with recently diagnosed, invasive BC were evaluated on five occasions using bioimpedance spectroscopy. Lymphedema was diagnosed when the ratio of impedance values, comparing treated and untreated sides, was three standard deviations more than normative data. UBF was assessed using the validated Disability of the Arm, Shoulder, and Hand questionnaire. From 6 to 18 months after surgery, 33% (n = 62) of the s le were classified as having lymphedema of these, 40% had long-term lymphedema. Although older age, more extensive surgery or axillary node dissection, and experiencing one or more treatment-related complication(s) or symptom(s) at baseline were associated with increased odds, lower socioeconomic status, having a partner, greater child care responsibilities, being treated on the dominant side, participation in regular activity, and having good UBF were associated with decreased odds of lymphedema. Not surprisingly, lymphedema leads to reduced UBF however, BC survivors report high prevalences of other UBS (34% to 62%), irrespective of their lymphedema status. Lymphedema is a public health issue deserving greater attention. More systematic surveillance for earlier detection and the potential benefits of physical activity to prevent lymphedema and mitigate symptoms warrant further clinical integration and research.

Mediation of improvements in sun protective and skin self-examination behaviours: Results from the healthy text study

Publisher: Wiley

Date: 11-11-2016

DOI: 10.1002/PON.4007

Abstract: Melanoma is on the rise, especially in Caucasian populations exposed to high ultraviolet radiation such as in Australia. This paper examined the psychological components facilitating change in skin cancer prevention or early detection behaviours following a text message intervention. The Queensland-based participants were 18 to 42 years old, from the Healthy Text study (N = 546). Overall, 512 (94%) participants completed the 12-month follow-up questionnaires. Following the social cognitive model, potential mediators of skin self-examination (SSE) and sun protection behaviour change were examined using stepwise logistic regression models. At 12-month follow-up, odds of performing an SSE in the past 12 months were mediated by baseline confidence in finding time to check skin (an outcome expectation), with a change in odds ratio of 11.9% in the SSE group versus the control group when including the mediator. Odds of greater than average sun protective habits index at 12-month follow-up were mediated by (a) an attempt to get a suntan at baseline (an outcome expectation) and (b) baseline sun protective habits index, with a change in odds ratio of 10.0% and 11.8%, respectively in the SSE group versus the control group. Few of the suspected mediation pathways were confirmed with the exception of outcome expectations and past behaviours. Future intervention programmes could use alternative theoretical models to elucidate how improvements in health behaviours can optimally be facilitated.

Clinical skin examination outcomes after a video-based behavioral intervention analysis from a randomized clinical trial

Publisher: American Medical Association (AMA)

Date: 04-2014

DOI: 10.1001/JAMADERMATOL.2013.9313

Abstract: Older men are at risk of dying of melanoma. To assess attendance at and clinical outcomes of clinical skin examinations (CSEs) in older men exposed to a video-based behavioral intervention. This was a behavioral randomized clinical trial of a video-based intervention in men aged at least 50 years. Between June 1 and August 31, 2008, men were recruited, completed baseline telephone interviews, and were than randomized to receive either a video-based intervention (n = 469) or brochures only (n = 461 overall response rate, 37.1%) and were again interviewed 7 months later (n = 870 93.5% retention). Video on skin self-examination and skin awareness and written informational materials. The control group received written materials only. Participants who reported a CSE were asked for the type of CSE (skin spot, partial body, or whole body), who initiated it, whether the physician noted any suspicious lesions, and, if so, how lesions were managed. Physicians completed a case report form that included the type of CSE, who initiated it, the number of suspicious lesions detected, how lesions were managed (excision, nonsurgical treatment, monitoring, or referral), and pathology reports after lesion excision or biopsy. Overall, 540 of 870 men (62.1%) self-reported a CSE since receiving intervention materials, and 321 of 540 (59.4%) consented for their physician to provide medical information (received for 266 of 321 [82.9%]). Attendance of any CSE was similar between groups (intervention group, 246 of 436 [56.4%] control group, 229 of 434 [52.8%]), but men in the intervention group were more likely to self-report a whole-body CSE (154 of 436 [35.3%] vs 118 of 434 [27.2%] for control group P = .01). Two melanomas, 29 squamous cell carcinomas, and 38 basal cell carcinomas were diagnosed, with a higher proportion of malignant lesions in the intervention group (60.0% vs 40.0% for controls P = .03). Baseline attitudes, behaviors, and skin cancer history were associated with higher odds of CSE and skin cancer diagnosis. A video-based intervention may increase whole-body CSE and skin cancer diagnosis in older men. anzctr.org.au Identifier: ACTRN12608000384358.

What is a Bayes Factor?

Publisher: Center for Open Science

Date: 14-09-2020

DOI: 10.31219/OSF.IO/VGQBT

Abstract: The use of Bayes Factors is becoming increasingly common in psychological sciences. Thus, it is important that researchers understand the logic behind the Bayes Factor in order to correctly interpret it, and the strengths of weaknesses of the Bayesian approach. As education for psychological scientists focuses on Frequentist statistics, resources are needed for researchers and students who want to learn more about this alternative approach. The aim of the current article is to provide such an overview to a psychological researcher. We cover the general logic behind Bayesian statistics, explain how the Bayes Factor is calculated, how to set the priors in popular software packages, to reflect the prior beliefs of the researcher, and finally provide a set of recommendations and caveats for interpreting Bayes Factors.

Multifocal outer retinopathy in a patient with multifocal inner choroidopathy.

Publisher: Wiley

Date: 04-04-2011

DOI: 10.1111/J.1442-9071.2011.02525.X

Using Advances in Skin Imaging Technology and Genomics for the Early Detection and Prevention of Melanoma

Publisher: S. Karger AG

Date: 25-09-2018

DOI: 10.1159/000493260

A systematic review and meta‐analysis of prescribing practices of antidepressants in cancer patients

Publisher: Wiley

Date: 17-01-2016

DOI: 10.1002/PON.4048

Abstract: Antidepressants are commonly used for the pharmacological treatment of depression. We aimed to summarise the prevalence of antidepressant prescription to cancer patients, and differences by study or patient characteristics. PubMed, Embase, Web of Science, Scopus and psychINFO were searched using keywords 'psychotropic', 'antidepressants', 'prescription' and 'cancer'. Prevalence of antidepressants, type, dose and follow-up of antidepressants and prescriber details were extracted. Overall, 1537 articles between 1979 and February 2015 were found, 38 met the inclusion criteria and were reviewed according to PRISMA guidelines. The prevalence rate of prescribing antidepressants to cancer patients was 15.6% (95% CI = 13.3-18.3). Prescription was significantly less common in studies from Asia (7.4% 95% CI = 4.3-12.5), more common in female (22.6% 95% CI = 16.0-31.0) or breast cancer patients (22.6% 95% CI = 16.0-30.9). Selective serotonin reuptake inhibitors were the most frequently prescribed antidepressants. General practitioners and psychiatrists, followed by oncologists, were identified as the major providers of antidepressant prescriptions to cancer patients. Few studies reported the exact dose, length of time drugs were prescribed for or follow-up regimens. There is considerable variation in the prescribing patterns of antidepressants across the world, with few studies reporting robust data on exact dose or follow-up regimens. Prospective studies that monitor antidepressant prescribing, including details of reasons for prescribing and the healthcare providers involved, dose, change in dose or type of medication and follow-up are needed to ascertain whether patients are being treated optimally and if side effects or drug-drug interactions are identified and managed. Copyright © 2016 John Wiley & Sons, Ltd.

Interventions to decrease skin cancer risk in outdoor workers: update to a 2007 systematic review

Publisher: Springer Science and Business Media LLC

Date: 07-01-2014

DOI: 10.1186/1756-0500-7-10

Abstract: Outdoor workers are at high risk of harmful ultraviolet radiation exposure and are identified as an at risk group for the development of skin cancer. This systematic evidence based review provides an update to a previous review published in 2007 about interventions for the prevention of skin cancer in outdoor workers. This review includes interventions published between 2007-2012 and presents findings about sun protection behaviours and/or objective measures of skin cancer risk. Six papers met inclusion criteria and were included in the review. Large studies with extended follow-up times demonstrated the efficacy of educational and multi-component interventions to increase sun protection, with some higher use of personal protective equipment such as sunscreen. However, there is less evidence for the effectiveness of policy or specific intervention components. Further research aimed at improving overall attitudes towards sun protection in outdoor workers is needed to provide an overarching framework.

Spatial Randomness in the Distribution of Acquired Melanocytic Nevi of the Back in a Population-Based Sample

Publisher: Elsevier BV

Date: 06-2023

DOI: 10.1016/J.JID.2022.11.013

Factors influencing participants’ engagement with an interactive text-message intervention to improve sun protection behaviors: “SunText” randomized controlled trial

Publisher: Oxford University Press (OUP)

Date: 08-11-2021

DOI: 10.1093/TBM/IBAB135

Abstract: There is growing evidence suggesting that text-message-based interventions are effective to promote sun protection behaviors. However, it is still unclear how engagement and adherence with the intervention messages can be optimized through intervention design. This study evaluated the effect of different combinations of personalized and two-way interactive messages on participant engagement with a theory-based skin cancer prevention intervention. In the SunText study conducted in February–July 2019 in Queensland, Australia participants 18–40 years were randomized to four different text message schedules using a Latin square design. This study analyzed if the order and intensity in which the schedules were received were associated with participants’ level of engagement, and if this differed by demographic factors. Out of the 389 participants enrolled in the study, 375 completed the intervention period and remained for analysis. The overall intervention engagement rate was 71% and decreased from the beginning to the end of the study (82.2%–61.4%). The group starting with personalized, but not interactive messaging showed the lowest engagement rate. The intervention involving interactive messages three times a week for 4 weeks achieved the highest engagement rate. The intervention with increasing frequency (personalized and interactive three times a week for 2 weeks then daily for 2 weeks) had lower engagement than intervention with constant or decreasing frequency. Engagement with two-way interactive messages was high across all intervention groups. Results suggest enhanced engagement with constant or decreasing message frequency compared to increasing frequency.

Incidence, risk factors, and estimates of a woman's risk for developing secondary lower limb lymphedema and lymphedema-specific supportive care needs in women treated for endometrial cancer: Editorial comment

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 03-2015

DOI: 10.1097/OGX.0000000000000167

Views of supervisors of colonoscopy training on quality issues for the national bowel cancer screening program in Australia

Publisher: Wiley

Date: 22-01-2009

DOI: 10.1111/J.1440-1746.2008.05603.X

Abstract: To describe the views of supervisors of colonoscopy training in regard to colonoscopy training capacity and quality in Australia. Anonymous postal surveys from March to May 2007 were posted to 127 colonoscopy training supervisors (30.2% estimated response rate). The surveys queried colonoscopy training capacity and quality, supervisors' views and opinions on innovative approaches to colonoscopy training, number of colonoscopies and time required by trainees to gain competence in colonoscopy. Approximately 50% of trainers agreed and 27% disagreed that current numbers of training places were adequate to maintain a skilled colonoscopy workforce in preparation for the National Bowel Cancer Screening Program (NBCSP). A collaborative approach with the private sector was seen as beneficial by 65%. Non-gastroenterologists (non-GEs) were more likely than gastroenterologists (GEs) to be of the opinion that simulators are beneficial for colonoscopy training (chi(2)-test = 5.55, P = 0.026). The majority of trainers did not support training either nurses (73%) or general practitioners (GPs) in colonoscopy (71%). Approximately 60% of trainers considered that the current requirements for recognition of training in colonoscopy could be insufficient for trainees to gain competence and 80% of those indicated that > or = 200 colonoscopies were needed. Colonoscopy training in Australia has traditionally followed the apprenticeship model. Projected increases in demand for colonoscopy with the introduction of the NBCSP may require additional training places and new and innovative approaches to training in order to ensure the provision of high-quality colonoscopy services under the NBCSP.

Consumer perceptions on privacy and confidentiality in dermatology for 3D total‐body imaging

Publisher: Wiley

Date: 08-11-2022

DOI: 10.1111/AJD.13952

Abstract: As 3D total‐body photography for the early detection of melanoma is not yet widely used in clinical practice, we do not have a full understanding of patient's concerns about use, privacy and confidentiality, and if their concerns differ depending on the use‐case. We conducted a virtual consumer forum to assess patients concerns about privacy and confidentiality in dermatology imaging for research, artificial intelligence development and for their own clinical care.

Fighting Melanoma with Smartphones: A Snapshot of Where We are a Decade after App Stores Opened Their Doors

Publisher: Elsevier BV

Date: 10-2018

DOI: 10.1016/J.IJMEDINF.2018.08.004

Abstract: Smartphone applications ("apps") exist for primary and secondary prevention of melanoma. Our aim was to review currently available apps for community, patient and generalist clinician users. Prospective study, April 2017 - May 2017. Appropriate apps available to Android and Apple smartphones were assessed in regards to app specific information (target user, cost, store rating, last update), functions offered and clinician, professional or scientific input and or peer review. Comparison was made with a similar 2014 review of the app market. 43 apps meeting inclusion criteria were found. Compared to 2014, 24 of 43 (55.8%) were new, and apps performing automated image analysis declined from 46.1% to 23.3% market share. 23 of 43 (53.4%) were free to download, 48.8% (n = 20) required payments of some form. The most common functionality was monitoring/tracking with 24 of 43 (55.8%) apps performing this. 15 of 43 apps (34.9%) reported clinician, professional or scientific input in 2014 it was only 4 of 39 (10.3%). 2 of 43 apps (5%) mentioned peer-reviewed evidence along with professional input. Not all apps had ratings. On Android 20 of 22 apps had ratings average app rating was 3.5, range 1.6 to 4.6. On Apple, 13 of 13 had ratings average rating was 3.5 range 1- 5. Since 2014 there have been an expanding and changing landscape of apps targeting melanoma diagnosis. There remains a lack of evidence backing their efficacy. This is concerning given their public availability and the gravity of their subject matter.

Characteristics of men aged 50 years or older who do not take up skin self-examination following an educational intervention

Publisher: Elsevier BV

Date: 07-2012

DOI: 10.1016/J.JAAD.2011.10.019

Patient Portals Facilitating Engagement With Inpatient Electronic Medical Records: A Systematic Review (Preprint)

Publisher: JMIR Publications Inc.

Date: 18-11-2018

DOI: 10.2196/PREPRINTS.12779

Abstract: ngaging patients in the delivery of health care has the potential to improve health outcomes and patient satisfaction. Patient portals may enhance patient engagement by enabling patients to access their electronic medical records (EMRs) and facilitating secure patient-provider communication. he aim of this study was to review literature describing patient portals tethered to an EMR in inpatient settings, their role in patient engagement, and their impact on health care delivery in order to identify factors and best practices for successful implementation of this technology and areas that require further research. systematic search for articles in the PubMed, CINAHL, and Embase databases was conducted using keywords associated with patient engagement, electronic health records, and patient portals and their respective subject headings in each database. Articles for inclusion were evaluated for quality using A Measurement Tool to Assess Systematic Reviews (AMSTAR) for systematic review articles and the Quality Assessment Tool for Studies with Diverse Designs for empirical studies. Included studies were categorized by their focus on input factors (eg, portal design), process factors (eg, portal use), and output factors (eg, benefits) and by the valence of their findings regarding patient portals (ie, positive, negative, or mixed). he systematic search identified 58 articles for inclusion. The inputs category was addressed by 40 articles, while the processes and outputs categories were addressed by 36 and 46 articles, respectively: 47 articles addressed multiple themes across the three categories, and 11 addressed only a single theme. Nineteen articles had high- to very high-quality, 21 had medium quality, and 18 had low- to very low-quality. Findings in the inputs category showed wide-ranging portal designs patients’ privacy concerns and lack of encouragement from providers were among portal adoption barriers while information access and patient-provider communication were among facilitators. Several methods were used to train portal users with varying success. In the processes category, sociodemographic characteristics and medical conditions of patients were predictors of portal use some patients wanted unlimited access to their EMRs, personalized health education, and nonclinical information and patients were keen to use portals for communicating with their health care teams. In the outputs category, some but not all studies found patient portals improved patient engagement patients perceived some portal functions as inadequate but others as useful patients and staff thought portals may improve patient care but could cause anxiety in some patients and portals improved patient safety, adherence to medications, and patient-provider communication but had no impact on objective health outcomes. hile the evidence is currently immature, patient portals have demonstrated benefit by enabling the discovery of medical errors, improving adherence to medications, and providing patient-provider communication, etc. High-quality studies are needed to fully understand, improve, and evaluate their impact.

How people construct their experience of living with secondary lymphoedema in the context of their everyday lives in Australia

Publisher: Springer Science and Business Media LLC

Date: 18-07-2012

DOI: 10.1007/S00520-012-1534-4

Abstract: The purpose of this work was to explore how men and women construct their experiences living with lymphoedema following treatment for any cancer in the context of everyday life. The design and conduct of this qualitative study was guided by Charmaz' social constructivist grounded theory. To collect data, focus groups and telephone interviews were conducted. Audiotapes were transcribed verbatim and imported into NVivo8 to organize data and codes. Data were analyzed using key grounded theory principles of constant comparison, data saturation, and initial, focused, and theoretical coding. Participants were 3 men and 26 women who had developed upper- or lower-limb lymphoedema following cancer treatment. Three conceptual categories were developed during data analysis and were labeled "accidental journey," "altered normalcy," and "ebb and flow of control." "Altered normalcy" reflects the physical and psychosocial consequences of lymphoedema and its relationship to everyday life. "Accidental journey" explains the participants' experiences with the health care system, including the prevention, treatment, and management of their lymphoedema. "Ebb and flow of control" draws upon a range of in idual and social elements that influenced the participants' perceived control over lymphoedema. These conceptual categories were interrelated and contributed to the core category of "sense of self," which describes their perceptions of their identity and roles. Results highlight the need for greater clinical and public awareness of lymphoedema as a chronic condition requiring prevention and treatment, and one that has far-reaching effects on physical and psychosocial well-being as well as overall quality of life.

Skin Cancer Prevention Queensland: Sunscreen Industry Forum Report

Publisher: Skin Cancer Prevention Queensland and The University of Queensland

Date: 08-2023

DOI: 10.14264/3D35DC1

Using a Delphi process to determine optimal care for patients with pancreatic cancer

Publisher: Wiley

Date: 21-01-2016

DOI: 10.1111/AJCO.12450

Abstract: Overall 5-year survival for pancreatic cancer is ∼5%. Optimizing the care that pancreatic cancer patients receive may be one way of improving outcomes. The objective of this study was to establish components of care which Australian health professionals believe important to optimally manage patients with pancreatic cancer. Using a Delphi process, a multidisciplinary panel of 250 health professionals were invited to provide a list of factors they considered important for optimal care of pancreatic cancer patients. They were then asked to score and then rescore (from one [no importance/disagree] to 10 [very important/agree]) the factors. The mean and coefficient of variation scores were calculated and categorized into three levels of importance. Overall, 63 (66% of those sent the final questionnaire 25% of those initially invited) health professionals from nine disciplines completed the final scoring of 55 statements/factors encompassing themes of presentation/staging, surgery and biliary obstruction, multidisciplinary team details and oncology. Mean scores ranged from 3.7 to 9.7 with the highest related to communication and patient assessment. There was substantial intra- and interdisciplinary variation in views about MDT membership and roles. Overall, the opinions of Australian health professionals reflect international guideline recommended care however, they identified a number of additional factors focusing on where patients should be treated, the importance of clear communication and the need for multidisciplinary care which were not included in current clinical practice guidelines. Differences in priorities between specialty groups were also identified.

Women’s Perceptions of Their Lifestyle and Quality of Life Several Years After a Diagnosis of Endometrial Cancer

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 2015

DOI: 10.1097/NCC.0000000000000129

Impact of hemoglobin levels before and during concurrent chemoradiotherapy on the response of treatment in patients with cervical carcinoma - Preliminary results

Publisher: Wiley

Date: 2001

DOI: 10.1002/1097-0142(20010815)92:4<903::AID-CNCR1399>3.0.CO;2-2

Abstract: In patients undergoing radiation for cervical carcinoma, there is evidence that anemia is associated with an impaired outcome. For patients undergoing chemoradiation, there are no data available. The objective of this retrospective study was to examine the impact of anemia before and during chemoradiation in patients with cervical carcinoma. The authors collected data on hemoglobin (Hb) levels before and during treatment from 57 patients with cervical carcinoma. The stage of disease ranged between Stage IB and Stage IVA. All patients were treated with concurrent chemoradiation. Response to chemoradiation was evaluated by univariate and multivariate analyses. The mean Hb level at the time of presentation was 12.9 +/- 1.6 g/dL in patients with a complete clinical response (CCR) and 12.1 +/- 1.4 g/dL in those with persistent disease (P = 0.126). In patients with a CCR, the mean nadir Hb level was 11.1 +/- 1.3 g/dL, and in patients with treatment failure, it was 9.8 +/- 1.8 g/dL (P = 0.008). A univariate logistic regression model demonstrated that the nadir Hb level was the most predictive factor for treatment failure (relative risk, 1.92 P = 0.015) followed by disease stage (relative risk, 0.51 P = 0.074). In a multivariate model, the nadir Hb level remained the only prognostically relevant factor predicting the response to chemoradiation. Only patients with nadir Hb values > 11 g/dL throughout chemoradiation had a more than 90% chance of achieving a CCR. In patients undergoing chemoradiation for cervical carcinoma, the nadir Hb level is highly predictive of response to treatment, whereas the Hb level at the time of presentation is prognostically not significant.

Greater Precision in Melanoma Prevention

Publisher: American Medical Association (AMA)

Date: 2017

DOI: 10.1001/JAMADERMATOL.2016.3472

The cost-effectiveness of total laparoscopic hysterectomy compared to total abdominal hysterectomy for the treatment of early stage endometrial cancer

Publisher: BMJ

Date: 2013

DOI: 10.1136/BMJOPEN-2012-001884

Diagnosis and management costs of suspicious skin lesions from a population-based melanoma screening programme

Publisher: SAGE Publications

Date: 06-2007

DOI: 10.1258/096914107781261963

Abstract: Background: Recently, massive increases in health-care costs for the diagnosis and management of skin lesions have been observed (2000–05). The aim of this study was to describe the health system costs attributed to the diagnosis and management of suspicious skin lesions detected during a trial of a population melanoma screening programme (1998–2001). Setting: Queensland, Australia. Methods: Data from the trial and Medicare Australia were used to categorize and cost all suspicious skin lesions arising from the trial, which included general practitioner consultations, diagnosis/management and pathology. Comparisons were made with other screened and unscreened populations. Results: Overall, 2982 lesions were treated within the trial producing a mean cost of Aus& dollar per lesion. Excisions for benign lesions contributed the greatest proportion of total costs (45%). The total cost burden was approximately 10% higher for men than women, and 63% of overall costs were for persons aged & ge years. For diagnosis and management procedures, the estimated average cost per 1000 in iduals was Aus& dollar ,560 for men aged & ge years from the skin cancer screening trial, compared with Aus& dollar ,967 for BreastScreen Australia and Aus& dollar for the National Cervical Screening Program. Conclusions: The proportion of costs for benign skin lesions and biopsies arising from the screening programme were no higher than in the two-year period outside the trial. While comparisons are difficult, it appears that diagnostic and management costs for skin cancer as a result of screening may be comparable with those for BreastScreen Australia, if screening is targeted at men aged ≥50 years.

Enhanced Skin Self-examination: A Novel Approach to Skin Cancer Monitoring and Follow-up

Publisher: American Medical Association (AMA)

Date: 02-2013

DOI: 10.1001/JAMADERMATOL.2013.1218

Informing a position statement on the use of artificial intelligence in dermatology in Australia

Publisher: Wiley

Date: 15-11-2023

DOI: 10.1111/AJD.13946

Abstract: Artificial Intelligence (AI) is the ability for computers to simulate human intelligence. In dermatology, there is substantial interest in using AI to identify skin lesions from images. Due to increasing research and interest in the use of AI, the Australasian College of Dermatologists has developed a position statement to inform its members of appropriate use of AI. This article presents the ACD Position Statement on the use of AI in dermatology, and provides explanatory information that was used to inform the development of this statement.

Health-related quality of life 18 months after breast cancer: Comparison with the general population of Queensland, Australia

Publisher: Springer Science and Business Media LLC

Date: 16-01-2008

DOI: 10.1007/S00520-007-0392-Y

Abstract: Health-related quality of life (HRQoL) was compared between urban breast cancer survivors (BCS) and the general female population in urban Queensland, and correlates were identified. HRQoL data were collected at 6, 12, and 18 months post-diagnosis from a population-based s le of 287 women, aged 74 years or younger, diagnosed with breast cancer in 2002. The urban comparison group was drawn from a population-based survey conducted in 2004 and included 675 women aged 30-74 years with no prior history of breast cancer. The Functional Assessment of Cancer Therapy-General questionnaire was used to measure HRQoL in both groups. Younger (<50 years) BCS reported lower HRQoL at 6 months (mean, 80.2 vs 86.8) but were comparable to the general population by 12 months post-diagnosis (mean = 87.3). In contrast, HRQoL of older (50+ years) BCS at 6 months (mean = 87.1) was comparable to their general population peers (mean = 86.0) and was clinically better 18 months post-diagnosis (mean = 91.0). Compared with the general population, physical and emotional well-being among younger BCS was impaired at 6 months post-diagnosis (mean, 24.9 vs 21.0 and 21.0 vs 18.0, respectively) and did not improve over time for emotional well-being (mean = 18.8). These results persisted after adjustment for treatment-related factors, although receiving chemotherapy was an important correlate of HRQoL among younger BCS at 6 months post-diagnosis (-14.9). This study not only shows that the HRQoL of BCS improves between 6 and 18 months post-diagnosis but also suggests that emotional well-being among younger BCS may benefit from targeted intervention.

Cost-effectiveness of store-and-forward teledermatology: A systematic review

Publisher: American Medical Association (AMA)

Date: 06-2016

DOI: 10.1001/JAMADERMATOL.2016.0525

Review of the Evidence of Lymphedema Treatment Effect

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 06-2015

DOI: 10.1097/PHM.0000000000000246

Gynecological cancer survivors’ health behaviors and their associations with quality of life

Publisher: Springer Science and Business Media LLC

Date: 06-03-2008

DOI: 10.1007/S10552-008-9140-Y

Abstract: To evaluate health behaviors (smoking, physical activity, fruit and vegetable intake) and body mass index of gynecological cancer survivors and their association with quality of life. We collected cross-sectional mail survey data from 802 gynecological cancer survivors (56% response rate) The questionnaire included validated measures of health behaviors, quality of life, clinical status, and demographics. Depending on gynecological cancer subtype, 61-68% were insufficiently active or sedentary, 19-44% were obese, 31-41% had less than two daily serves of fruit, 82-89% had less than five serves of vegetables and 6-21% smoked. Significantly more endometrial than other cancer survivors were obese (44% 95% CI 41-47%) smoking was more prevalent among cervical cancer survivors (21% 95% CI 19-23%). Using general linear modeling we identified a positive linear trend of physical activity level with quality of life (p = 0.039). Being insufficiently active or sedentary was also associated with not meeting the guidelines for fruit and vegetable consumption, with smoking and with overweight/obesity. This research demonstrates the importance of integrating physical activity into follow-up of gynecological cancer survivors. Interventions to improve physical activity and test the causal effect of exercise on quality of life are a future research priority.

Quality of life following minimally invasive hysterectomy compared to abdominal hysterectomy: A metanalysis

Publisher: Elsevier BV

Date: 09-2020

DOI: 10.1016/J.EJOGRB.2020.06.055

Attitudes and intentions in relation to skin checks for early signs of skin cancer

Publisher: Elsevier BV

Date: 07-2004

DOI: 10.1016/J.YPMED.2004.02.019

Obesity in total laparoscopic hysterectomy for early stage endometrial cancer: health gain and inpatient resource use

Publisher: Oxford University Press (OUP)

Date: 27-07-2018

DOI: 10.1093/INTQHC/MZY162

Abstract: To explore relationships between BMI (morbid/severe obesity BMI ≥ 35 kg/m2 vs. non morbid/severe obesity BMI < 35 kg/m2), postoperative health gain and hospital resource use for women who receive a Total Laparoscopic Hysterectomy (TLH) for early stage endometrial cancer. Secondary analysis of RCT data (LACE Study Total Abdominal Hysterectomy vs. TLH). 20 tertiary gynaecological cancer centres in Australia, New Zealand and Hong Kong. About 404 women who received TLH to treat early stage endometrial cancer. For women with BMI < 35 vs. BMI ≥ 35 kg/m2, we compared (i) postoperative health gain, using utility scores derived from responses to the EQ-5D-3L health-related quality of life instrument, and (ii) inpatient hospital resource use, using adverse events, surgery duration and postoperative length of stay as indicators, to 6 months post-surgery. Health gain, resource use. Mean postoperative health gain was 0.07 units, and did not vary by BMI. Women with a BMI ≥ 35 had an increased rate of severe postoperative AEs (BMI ≥ 35 RR = 1.95, P = 0.02), and the surgery took on average 9.6 min longer (BMI < 35 kg/m2 122.5 min 95% CI 117.4-127.8 BMI ≥ 35 kg/m2 132.1 min 95% CI 126.3-138.2 P = 0.02). While postoperative health gain for women with BMI ≥ 35 was similar to that of women with lower BMI, the gain was achieved at the expense of greater resource use. Further work could definitively quantify the excess cost of TLH for obese patients with endometrial cancer, and investigate the potential for non-surgical treatment options, at least for those women at high risk of postoperative AEs.

How many patients enter endometrial cancer surgery with psychotropic medication prescriptions, and how many receive a new prescription perioperatively?

Publisher: Elsevier BV

Date: 02-2019

DOI: 10.1016/J.YGYNO.2018.11.018

Abstract: Psychotropic medications including antidepressants and anxiolytics are used to treat anxiety and depression in cancer patients however, little is known about the prescription practices in endometrial cancer. This study aimed to determine the prevalence, type, dose, frequency and timing of psychotropic medications prescribed to endometrial cancer patients. A secondary aim was to study sociodemographic and clinical characteristics associated with receiving a psychotropic medication prescription. Secondary data analysis of an international, multicentre, prospective randomised controlled trial was conducted. Patients aged >18 years diagnosed with Stage I endometrial cancer were included. Logistic regression models were fitted to estimate the association of receiving psychotropic medications with patient's socio-demographic and clinical characteristics. The overall prevalence of patients prescribed one or more psychotropic medications was 16.8% (n = 121/719) comprising antidepressants (12.6%, n = 91/719) and anxiolytics (5.8%, n = 42/719). The majority of patients (78.1%, n = 71/91) were already receiving antidepressants before cancer diagnosis, the remaining medications were newly prescribed perioperatively (21.9%, n = 20/91). Patients of younger age (18-50 years, OR (Odds Ratio): 2.61), who had hypertension (OR: 0.61), history of a previous cancer (OR: 1.96), and ≥2 comorbidities (2-3, OR: 2.97 4-5, OR: 7.85 ≥6, OR: 9.13) were significantly (p < 0.05) more likely to receive a prescription of psychotropic medications. While one in eight patients already had psychotropic medications prescribed before surgery for early stage endometrial cancer, only few women received a new prescription after surgery. The overall prescription rates were similar to other patients with cancer, but higher than those observed in the general population, likely reflecting the comorbidity burden of patients who develop endometrial cancer. Qualitative data could be used in future research to explore the psychological and quality of life impacts of endometrial cancer.

An Instrument to Measure Adherence to Weight Loss Programs: The Compliance Praxis Survey-Diet (COMPASS-Diet)

Publisher: MDPI AG

Date: 26-09-2013

DOI: 10.3390/NU5103828

The impact on health outcomes of implementing electronic health records to support the care of older people in residential aged care: A scoping review

Publisher: Elsevier BV

Date: 07-2021

DOI: 10.1016/J.IJMEDINF.2021.104471

Exercise barriers self-efficacy: development and validation of a subcale for individuals with cancer-related lymphedema

Publisher: Springer Science and Business Media LLC

Date: 2015

DOI: 10.1186/S12955-015-0223-7

The impact of risk-reducing hysterectomy and bilateral salpingo- oophorectomy on survival in patients with a history of breast cancer - A population-based data linkage study

Publisher: Wiley

Date: 31-10-2014

DOI: 10.1002/IJC.28537

Abstract: Prophylactic surgery including hysterectomy and bilateral salpingo-oophorectomy (BSO) is recommended in breast cancer susceptibility gene (BRCA)-positive women, whereas in women from the general population, hysterectomy plus BSO may increase the risk of overall mortality. The effect of hysterectomy plus BSO on women previously diagnosed with breast cancer is unknown. We used data from a population-base data linkage study of all women diagnosed with primary breast cancer in Queensland, Australia between 1997 and 2008 (n = 21,067). We fitted flexible parametric breast cancer-specific and overall survival models with 95% confidence intervals (also known as Royston-Parmar models) to assess the impact of risk-reducing surgery (removal of uterus, one or both ovaries). We also stratified analyses by age 20-49 and 50-79 years, respectively. Overall, 1,426 women (7%) underwent risk-reducing surgery (13% of premenopausal women and 3% of postmenopausal women). No women who had risk-reducing surgery compared to 171 who did not have risk-reducing surgery developed a gynaecological cancer. Overall, 3,165 (15%) women died, including 2,195 (10%) from breast cancer. Hysterectomy plus BSO was associated with significantly reduced risk of death overall [adjusted hazard ration (HR), 0.69 95% confidence interval (CI), 0.53-0.89 p = 0.005]. Risk reduction was greater among premenopausal women, whose risk of death halved (HR, 0.45 95% CI, 0.25-0.79 p < 0.006). This was largely driven by reduction in breast cancer-specific mortality (HR, 0.43 95% CI, 0.24-0.79 p < 0.006). This population-based study found that risk-reducing surgery halved the mortality risk for premenopausal breast cancer patients. Replication of our results in independent cohorts and subsequently randomised trials are needed to confirm these findings.

Prevalence, correlates, and supportive care needs

Publisher: Wiley

Date: 15-06-2007

DOI: 10.1002/CNCR.22684

Abstract: Few studies have evaluated lymphedema after gynecological cancer treatment. The aim of this research was to establish prevalence, correlates, and supportive care needs of gynecological cancer survivors who develop lymphedema. In 2004, a population-based cross-sectional mail survey (56% response rate) was completed by 802 gynecological cancer survivors. The questionnaire included demographic questions, a validated, generic supportive care needs measure, and a supplementary, newly developed, lymphedema needs module. Ten percent (95% confidence interval [CI], 8%-12%) of participants reported being diagnosed with lymphedema, and a further 15% (95% CI, 13%-17%) reported undiagnosed "symptomatic" lower limb swelling. Diagnosed lymphedema was more prevalent (36%) amongst vulvar cancer survivors. For cervical cancer survivors, those who had radiotherapy or who had lymph nodes removed had higher odds of developing swelling. For uterine and ovarian cancer survivors, those who had lymph nodes removed or who were overweight or obese had higher odds of developing swelling. Gynecological cancer survivors with lymphedema had higher supportive care needs in the information and symptom management domains compared with those who had no swelling. This population-based study provided evidence that lymphedema is a morbidity experienced by a significant proportion of gynecological cancer survivors and that there are considerable levels of associated unmet needs. Women at risk of lymphedema would benefit from instructions about early signs and symptoms and provision of referral information.

A tsunami of unmet needs: pancreatic and ampullary cancer patients' supportive care needs and use of community and allied health services

Publisher: Wiley

Date: 29-06-2015

DOI: 10.1002/PON.3887

Abstract: People diagnosed with pancreatic cancer have the worst survival prognosis of any cancer. No previous research has documented the supportive care needs of this population. Our objective was to describe people's needs and use of support services and to examine whether these differed according to whether or not patients had undergone surgical resection. Queensland pancreatic or ullary cancer patients (n = 136, 54% of those eligible) completed a survey, which assessed 34 needs across five domains (Supportive Care Needs Survey-Short Form) and use of health services. Differences by resection were compared with Chi-squared tests. Overall, 96% of participants reported having some needs. More than half reported moderate-to-high unmet physical (54%) or psychological (52%) needs, whereas health system/information (32%), patient care (21%) and sexuality needs (16%) were described less frequently. The three most frequently reported moderate-to-high needs included 'not being able to do things they used to do' (41%), 'concerns about the worries of those close' (37%) and 'uncertainty about the future' (30%). Patients with non-resectable disease reported greater in idual information needs, but their needs were otherwise similar to patients with resectable disease. Self-reported use of support was low only 35% accessed information, 28%, 18% and 15% consulted a dietician, complementary medicine practitioner or mental health practitioner, respectively. Palliative care access was greater (59% vs 27%) among those with non-resectable disease. Very high levels of needs were reported by people with pancreatic or ullary cancer. Future work needs to elucidate why uptake of appropriate supportive care is low and which services are required.

A Mobile Technology Intervention With Ultraviolet Radiation Dosimeters and Smartphone Apps for Skin Cancer Prevention in Young Adults: Randomized Controlled Trial

Publisher: JMIR Publications Inc.

Date: 28-11-2018

DOI: 10.2196/MHEALTH.9854

Factors associated with the number of lesions excised for each skin cancer: A study of primary care physicians in Queensland, Australia

Publisher: American Medical Association (AMA)

Date: 11-2008

DOI: 10.1001/ARCHDERM.144.11.1468

Abstract: To assess physician, patient, and skin lesion characteristics that affect the number of benign skin lesions excised by primary care physicians for each skin cancer. Prospective study collecting clinical, patient, and histopathologic details of excisions or biopsies of skin lesions by random s les of primary care physicians. Southeast Queensland involving traditional family medicine physicians (n = 104 response rate, 53.9%) and family medicine physicians working in 27 primary care skin cancer clinics (n = 50 response rate, 75.0%). Of 28 755 skin examinations recorded during the study, 11 403 skin lesions were excised or biopsied 97.5% of the excised lesions had clinical and histologic diagnoses recorded. Number of lesions needed to excise or biopsy (NNE) for 1 melanoma (pigmented lesions only) and NNE for 1 nonmelanoma skin cancer (nonpigmented lesions only). The NNE for nonpigmented lesions (n = 8139) was 1.5 (95% confidence interval, 1.4-1.6) and for pigmented lesions (n = 2977) was 19.6 (16.2-22.9). The NNE estimates were up to 8 times lower if the physician thought the lesion was likely to be malignant and up to 2.5 times higher if there was strong patient pressure to excise. The NNE estimates varied by other physician-, patient-, and lesion-related variables. Clinical impressions of excised skin lesions were strongly associated with NNE estimates. By focusing on pigmented skin lesions and by addressing the physician- and patient-specific factors identified, the effectiveness of future training for primary care physicians in the clinical management of skin cancer could be improved.

Who attends skin cancer clinics within a randomized melanoma screening program?

Publisher: Elsevier BV

Date: 2006

DOI: 10.1016/J.CDP.2005.10.003

Abstract: Screening may reduce morbidity and mortality associated with melanoma, although in the absence of randomized-controlled trials, this remains unproven. As part of a randomized community-based trial of melanoma screening in Queensland, Australia, sociodemographic characteristics, skin cancer risk factors and attitudes towards skin cancer associated with attendance at screening clinics and reasons for attendance or non-attendance were examined. A telephone survey was conducted among 743 attendees and 298 non-attendees. After adjustment, the following factors were associated with clinic attendance: age 40-49 years, having fair skin, a personal history of skin cancer or melanoma or concern about a specific spot or mole, and no recent whole-body skin examination by a doctor. The main reasons for attendance were "to see if I have melanoma", "to have a suspicious mole checked" or "to have a whole-body skin examination". The main reasons for non-attendance were lack of knowledge about the clinics, no time or being away while the clinics were held and having had a skin check in the recent past. Overall, 77% of non-attendees compared to 65% of attendees stated they planned to participate in future screening. The results suggest that we were able to attract both men and women equally to a skin screening clinic, along with those at all levels of education and indicate the importance of using well-designed promotional materials to attract community members to skin screening clinics. Future work should test strategies to remove barriers to participation in skin screening identified in this study.

Determinants of Outcomes Following Resection for Pancreatic Cancer—a Population-Based Study

Publisher: Springer Science and Business Media LLC

Date: 16-05-2016

DOI: 10.1007/S11605-016-3157-4

Abstract: Patient and health system determinants of outcomes following pancreatic cancer resection, particularly the relative importance of hospital and surgeon volume, are unclear. Our objective was to identify patient, tumour and health service factors related to mortality and survival amongst a cohort of patients who underwent completed resection for pancreatic cancer. Eligible patients were diagnosed with pancreatic adenocarcinoma between July 2009 and June 2011 and had a completed resection performed in Queensland or New South Wales, Australia, with either tumour-free (R0) or microscopically involved margins (R1) (n = 270). Associations were examined using logistic regression (for binary outcomes) and Cox proportional hazards or stratified Cox models (for time-to-event outcomes). Patients treated by surgeons who performed <4 resections/year were more likely to die from a surgical complication (versus ≥4 resections/year, P = 0.04), had higher 1-year mortality (P = 0.03), and worse overall survival up to 1.5 years after surgery (adjusted hazard ratio 1.58, 95 % confidence interval 1.07-2.34). Amongst patients who had ≥1 complication within 30 days of surgery, those aged ≥70 years had higher 1-year mortality compared to patients aged <60 years. Adjuvant chemotherapy treatment improved recurrence-free survival (P = 0.01). There were no significant associations between hospital volume and mortality or survival. Systems should be implemented to ensure that surgeons are completing a sufficient number of resections to optimize patient outcomes. These findings may be particularly relevant for countries with a relatively small and geographically dispersed population.

Clinical utility of skin cancer and melanoma risk scores for population screening: TRoPICS study

Publisher: Wiley

Date: 27-12-2021

DOI: 10.1111/JDV.17062

Abstract: Screening for skin cancer can be cost‐effective if focused on high‐risk groups. Risk prediction tools have been developed for keratinocyte cancers and melanoma to optimize advice and management. However, few have been validated in a clinical setting over the past few years. To assess the clinical utility of risk assessment tools to identify in iduals with prevalent skin cancers in a volunteer‐based screening clinic. Participants were adults presenting for a skin check at a volunteer‐based skin cancer screening facility. We used previously published tools, based on questionnaire responses, to predict melanoma and keratinocyte cancers [KCs basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)] and classified each participant into one of five risk categories. Participants subsequently underwent a full skin examination by a dermatologist. All suspicious lesions were biopsied, and all cancers were histopathologically confirmed. Of 789 people who presented to the clinic, 507 (64%) consented to the study. Twenty‐two BCCs, 19 SCCs and eight melanomas were diagnosed. The proportion of keratinocyte cancers diagnosed increased according to risk category from % in the lowest to 24% in the highest risk category ( P 0.001). Subtype analysis revealed similar proportionate increases in BCC or SCC prevalence according to risk category. However, a similar proportion of melanoma cases were detected in the low‐risk and high‐risk groups. The risk prediction model for keratinocyte cancers can reliably identify in iduals with a significant skin cancer burden prior to a skin examination in the community setting. The prediction tool for melanoma needs to be tested in a larger s le exposed to a wider range of environmental risk factors.

The dynamic nature of naevi in adulthood: prospective population-based study using three-dimensional total-body photography

Publisher: Oxford University Press (OUP)

Date: 17-11-2023

DOI: 10.1093/BJD/LJAC095

Beyond survivorship? A discursive analysis of how people with pancreatic cancer negotiate identity transitions in their health

Publisher: SAGE Publications

Date: 10-07-2016

DOI: 10.1177/1359105315592050

Abstract: We explored how people negotiate, and respond to, identity transitions following a diagnosis of pancreatic cancer. Interviews with 19 people with pancreatic cancer were analysed using thematic discourse analysis. While discursively negotiating two transitions, ‘moving from healthy to ill’ and ‘moving from active treatment to end-of-life care’, participants positioned themselves as ‘in control’, ‘optimistic’ and managing their health and illness. In the absence of other discourses or models of life post-cancer, many people draw on the promise of survival. Moving away from ‘survivorship’ may assist people with advanced cancer to make sense of their lives in a short timeframe.

Redefining Dermatologists' Role in Skin Cancer Early Detection and Follow-up Care

Publisher: American Medical Association (AMA)

Date: 05-2015

DOI: 10.1001/JAMADERMATOL.2014.3875

Seasonal Variation in Measured Solar Ultraviolet Radiation Exposure of Adults in Subtropical Australia

Publisher: Wiley

Date: 03-2010

DOI: 10.1111/J.1751-1097.2009.00686.X

Abstract: Generating accurate population-specific public health messages regarding sun protection requires knowledge about seasonal variation in sun exposure in different environments. To address this issue for a subtropical area of Australia, we used polysulphone badges to measure UVR for the township of Nambour (26 degrees latitude) and personal UVR exposure among Nambour residents who were taking part in a skin cancer prevention trial. Badges were worn by participants for two winter and two summer days. The ambient UVR was approximately three times as high in summer as in winter. However, participants received more than twice the proportion of available UVR in winter as in summer (6.5%vs 2.7%, P < 0.05), resulting in an average ratio of summer to winter personal UVR exposure of 1.35. The average absolute difference in daily dose between summer and winter was only one-seventh of a minimal erythemal dose. Extrapolating from our data, we estimate that ca. 42% of the total exposure received in the 6 months of winter (June-August) and summer (December-February) is received during the three winter months. Our data show that in Queensland a substantial proportion of people's annual UVR dose is obtained in winter, underscoring the need for dissemination of sun protection messages throughout the year in subtropical and tropical climates.

Consumer preferences for teledermoscopy screening to detect melanoma early

Publisher: SAGE Publications

Date: 29-05-2016

DOI: 10.1177/1357633X15586701

Abstract: ‘Store and forward’ teledermoscopy is a technology with potential advantages for melanoma screening. Any large-scale implementation of this technology is dependent on consumer acceptance. To investigate preferences for melanoma screening options compared with skin self-examination in adults considered to be at increased risk of developing skin cancer. A discrete choice experiment was completed by 35 consumers, all of whom had prior experience with the use of teledermoscopy, in Queensland, Australia. Participants made 12 choices between screening alternatives described by seven attributes including monetary cost. A mixed logit model was used to estimate the relative weights that consumers place on different aspects of screening, along with the marginal willingness to pay for teledermoscopy as opposed to screening at a clinic. Overall, participants preferred screening/diagnosis by a health professional rather than skin self-examination. Key drivers of screening choice were for results to be reviewed by a dermatologist a higher detection rate fewer non-cancerous moles being removed in relation to every skin cancer detected and less time spent away from usual activities. On average, participants were willing to pay AUD110 to have teledermoscopy with dermatologist review available to them as a screening option. Consumers preferentially value aspects of care that are more feasible with a teledermoscopy screening model, as compared with other skin cancer screening and diagnosis options. This study adds to previous literature in the area which has relied on the use of consumer satisfaction scales to assess the acceptability of teledermoscopy.

Improving treatment for obese women with early stage cancer of the uterus: Rationale and design of the levonorgestrel intrauterine device +/- Metformin +/- weight loss in endometrial cancer (feMME) trial

Publisher: Elsevier BV

Date: 09-2014

DOI: 10.1016/J.CCT.2014.06.014

Abstract: Endometrial adenocarcinoma (EC) is the most common gynaecologic cancer. Up to 90% of EC patients are obese which poses a health threat to patients post-treatment. Standard treatment for EC includes hysterectomy, although this has significant side effects for obese women at high risk of surgical complications and for women of childbearing age. This trial investigates the effectiveness of non-surgical or conservative treatment options for obese women with early stage EC. The primary aim is to determine the efficacy of: levonorgestrel intrauterine device (LNG-IUD) with or without metformin (an antidiabetic drug) and with or without a weight loss intervention to achieve a pathological complete response (pCR) in EC at six months from study treatment initiation. The secondary aim is to enhance understanding of the molecular processes and to predict a treatment response by investigating EC biomarkers. An open label, three-armed, randomised, phase-II, multi-centre trial of LNG-IUD ± metformin ± weight loss intervention. 165 participants from 28 centres are randomly assigned in a 3:3:5 ratio to the treatment arms. Clinical, quality of life and health behavioural data will be collected at baseline, six weeks, three and six months. EC biomarkers will be assessed at baseline, three and six months. There is limited prospective evidence for conservative treatment for EC. Trial results could benefit patients and reduce health system costs through a reduction in hospitalisations and through lower incidence of adverse events currently observed with standard treatment.

Prevalence of whole-body skin self-examination in a population at high risk for skin cancer (Australia)

Publisher: Springer Science and Business Media LLC

Date: 06-2004

DOI: 10.1023/B:CACO.0000036451.39128.F6

Patient-Reported Experiences After Hysterectomy: A Cross-Sectional Study of the Views of Over 2300 Women

Publisher: SAGE Publications

Date: 25-04-2020

DOI: 10.1177/2374373519840076

Abstract: To evaluate women’s experiences after hysterectomy and predictors of their contentment and regret with the surgical approaches. Cross-sectional, Patient-Reported Experience Measures survey in 2319 Australian women aged 21 to 90 years (median age of 52 years) who had received hysterectomy in the preceding 2 years. Overall, the vast majority of women ( %) did not regret having had the hysterectomy. Women who received an open abdominal hysterectomy reported slower recovery with about 7% of women still not fully recovered after 12 months compared to those whose surgery was through a less invasive approach. Women who reported no adverse events, having been given a choice of type of hysterectomy, women who received an alternative to open abdominal hysterectomy, and women who felt prepared for discharge from hospital were significantly more likely to be content with their hysterectomy and report positive patient experiences. Compared with those who received a less invasive approach to hysterectomy, women who received open surgery were more likely to express negative experiences relating to their hospital stay and recovery from surgery. The results inform future improvements of care for women planning a hysterectomy.

Evaluation of the efficacy of 3D total-body photography with sequential digital dermoscopy in a high-risk melanoma cohort: Protocol for a randomised controlled trial

Publisher: BMJ

Date: 11-2019

DOI: 10.1136/BMJOPEN-2019-032969

Abstract: Melanoma is Australia’s fourth most common cancer. Early detection is fundamental in maximising health outcomes and minimising treatment costs. To date, population-based screening programmes have not been justified in health economic studies. However, a skin surveillance approach targeting high-risk in iduals could improve the cost-benefit ratio. This paper describes a 2-year longitudinal randomised controlled trial (RCT) to compare routine clinical care (control) with an intensive skin surveillance programme (intervention) consisting of novel three-dimensional (3D) total-body photography (TBP), sequential digital dermoscopy and melanoma-risk stratification, in a high-risk melanoma cohort. Primary outcomes will evaluate clinical, economic and consumer impact of the intervention. Clinical outcomes will evaluate differences in the rate of lesion excisions/biopsies per person, benign to malignant ratio for excisions and thickness of melanomas diagnosed. A health economic analysis using government data repositories will capture healthcare utilisation and costs relating to skin surveillance. Consumer questionnaires will examine intervention acceptability, the psychological impact, and attitudes towards melanoma risk and sun protective behaviour. Secondary outcomes include the development of a holistic risk algorithm incorporating clinical, phenotypic and genetic factors to facilitate the identification of those most likely to benefit from this surveillance approach. Furthermore, the feasibility of integrating the intervention with teledermatology to enhance specialist care in remote locations will be evaluated. This will be the first RCT to compare a targeted surveillance programme utilising new 3D TBP technology against current routine clinical care for in iduals at high risk of melanoma. This study has received Human Research Ethics Committee (HREC) approval from both Metro South Health HREC (HREC/17/QPAH/816) and The University of Queensland HREC (2018000074). ANZCTR12618000267257 Pre-results.

The Experience of 3D Total-Body Photography to Monitor Nevi: Results From an Australian General Population-Based Cohort Study (Preprint)

Publisher: JMIR Publications Inc.

Date: 17-02-2022

DOI: 10.2196/PREPRINTS.37034

Abstract: igital 3D total-body photography of the skin surface is an emerging imaging modality that can facilitate the identification of new and changing nevi. e aimed to describe the experiences of study participants drawn from the general population who were provided 3D total-body photography and dermoscopy for the monitoring of nevi. population-based prospective study of adults aged 20-70 years from South East Queensland, Australia was conducted. Participants underwent 3D total-body photography and dermoscopy every 6 months over a 3-year period. Participants were asked to provide closed and open-ended feedback on their 3D total-body photography and dermoscopy experience (eg, comfort, trust, intended future use, and willingness to pay) at the halfway study time point (18 months) and final study time point (36 months). We assessed changes in participants’ reported experience of 3D total-body photography, and patient characteristics associated with patient experience at the end of the study (36 months) were analyzed. total of 149 participants completed the surveys at both the 18- and 36-month time points (median age 55, range 23-70 years n=94, 63.1% were male). At the 18-month time point, most participants (n=103, 69.1%) stated they completely trusted 3D total-body imaging for the diagnosis and monitoring of their nevi, and this did not change at the 36-month (n=104, 69.8%) time point. The majority of participants reported that they were very comfortable or comfortable with the technology at both the 18- (n=138, 92.6%) and 36-month (n=140, 94%) time points, respectively albeit, the number of participants reporting that they were very comfortable reduced significantly between the 18- and 36-month time points, from 71.1% (n=106) to 61.1% (n=91 i P /i =.01). Almost all participants (n=140, 94%) would consider using this technology if it were to become commercially available, and this did not change during the two study time points. Half of the participants (n=74) cited barriers to participating in 3D total-body photography, including trust in the ability of this technology to detect and monitor suspicious lesions, digital privacy, cost, and travel requirements. he majority of participants expressed positive attitudes toward 3D total-body photography for the monitoring of their moles. Half of the participants identified potential barriers to uptake.

Impact of a Video-Based Intervention to Improve the Prevalence of Skin Self-examination in Men 50 Years or Older

Publisher: American Medical Association (AMA)

Date: 07-2011

DOI: 10.1001/ARCHDERMATOL.2011.48

Abstract: To improve the proportion of men 50 years or older who conduct a thorough whole-body skin self-examination (SSE), because these men are at increased risk of being diagnosed as having thick melanomas and dying of melanoma. Randomized trial of a video-based intervention to increase whole-body SSE compared with brochures-only control. Men from an Australian population register. The study included 930 men 50 years or older. The men were randomly assigned to receive either written materials only (control) or written materials along with a DVD or video and 2 postcard reminders (intervention). Telephone interviews were conducted at baseline and at 7 and 13 months. The proportion of men who conducted a whole-body SSE with the help of 2 mirrors and/or a person to assist with difficult-to-see areas. Compared with baseline (10%), by 13 months both groups had increased their whole-body SSE behaviors similarly (36% intervention and 31% control) (P = .85). At 7 months, the intervention group was significantly more likely to examine at least 1 part of their back (P < .001) and to examine a greater number of body sites (P < .001). At 7 months, the proportion of men conducting any SSE increased by 28% in the intervention group compared with 13% in the control group (P < .001), but at 13 months, the prevalence of any self-examination (83% vs 80%) was again similar. While men 50 years or older are responsive to appropriately targeted intervention materials to increase their SSE behaviors, the addition of a video or DVD to written materials had only a transient advantage for optimal SSE practices. anzctr.org.au Identifier: 12608000384358.

Capturing Ultraviolet Radiation Exposure and Physical Activity: Feasibility Study and Comparison Between Self-Reports, Mobile Apps, Dosimeters, and Accelerometers

Publisher: JMIR Publications Inc.

Date: 17-04-2018

DOI: 10.2196/RESPROT.9695

Determinants of survival and attempted resection in patients with non-metastatic pancreatic cancer: An Australian population-based study

Publisher: Elsevier BV

Date: 09-2016

DOI: 10.1016/J.PAN.2016.06.010

Abstract: There are indications that pancreatic cancer survival may differ according to sociodemographic factors, such as residential location. This may be due to differential access to curative resection. Understanding factors associated with the decision to offer a resection might enable strategies to increase the proportion of patients undergoing potentially curative surgery. Data were extracted from medical records and cancer registries for patients diagnosed with pancreatic cancer between July 2009 and June 2011, living in one of two Australian states. Among patients clinically staged with non-metastatic disease we examined factors associated with survival using Cox proportional hazards models. To investigate survival differences we examined determinants of: 1) attempted surgical resection overall 2) whether patients with locally advanced disease were classified as having resectable disease and 3) attempted resection among those considered resectable. Data were collected for 786 eligible patients. Disease was considered locally advanced for 561 (71%) patients, 510 (65%) were classified as having potentially resectable disease and 365 (72%) of these had an attempted resection. Along with age, comorbidities and tumour stage, increasing remoteness of residence was associated with poorer survival. Remoteness of residence and review by a hepatobiliary surgeon were factors influencing the decision to offer surgery. This study indicated disparity in survival dependent on patients' residential location and access to a specialist hepatobiliary surgeon. Accurate clinical staging is a critical element in assessing surgical resectability and it is therefore crucial that all patients have access to specialised clinical services.

Uptake of skin self-examination and clinical examination behavior by outdoor workers ashley

Publisher: Informa UK Limited

Date: 05-02-2014

DOI: 10.1080/19338244.2013.771247

Abstract: This study investigated the association between outdoor work and response to a behavioral skin cancer early detection intervention among men 50 years or older. Overall, 495 men currently working in outdoor, mixed, or indoor occupations were randomized to a video-based intervention or control group. At 7 months post intervention, indoor workers reported the lowest proportion of whole-body skin self-examination (wbSSE 20%). However, at 13 months mixed workers engaged more commonly in wbSSE (36%) compared with indoor (31%) and outdoor (32%) workers. In adjusted analysis, the uptake of early detection behaviors during the trial did not differ between men working in different settings. Outdoor workers compared with men in indoor or mixed work settings were similar in their response to an intervention encouraging uptake of secondary skin cancer prevention behaviors during this intervention trial.

Increase in skin cancer screening during a community-based randomized intervention trial

Publisher: Wiley

Date: 13-12-2006

DOI: 10.1002/IJC.21455

Abstract: Survival from cutaneous melanoma is mainly dependent on the thickness of the lesion at diagnosis. Skin screening may increase detection of thin lesions and hence improve survival. Within a community-based randomized controlled trial of a population screening program for melanoma in Queensland, Australia, 9 communities were randomly assigned to the 3-year intervention and 9 communities to the control group. Skin screening prevalence was monitored by cross-sectional surveys at baseline, 1, 2 and 3 years into the intervention and 2 years later. At baseline, prevalence of whole-body clinical skin examination was similar in intervention and control communities. In intervention communities, the prevalence of whole-body skin examinations increased to 29.2%, an absolute difference of 18% from baseline, with a peak of 34.8% 2 years after baseline, and began to decline again at the end of the intervention period. The largest increases were seen in men and women > or =50 years. Uptake of screening did not differ according to melanoma risk factors however, the decline in screening was less in participants who reported a number of melanoma risk factors. The prevalence of skin self-examination remained stable during the intervention program. No changes were observed in the control communities. These results indicate that the intervention program significantly increased the prevalence of whole-body clinical skin examinations in intervention communities. Once the intervention program ceased, and particularly after skin clinics ceased, levels of skin screening began to decline. The provision of specialized skin screening clinics may be needed to achieve sufficient screening rates should population based screening for skin cancer be considered.

A review of literature supporting the development of practice guidelines for teledermatology in Australia

Publisher: Wiley

Date: 30-03-2020

DOI: 10.1111/AJD.13249

Aalborg University

Location: Denmark

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University Of Queensland

Location: Australia

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Universidad Nacional De Entre Ríos

Location: Argentina

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National University Of Entre Ríos

Location: Argentina

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Universitas Negeri Malang

Location: No location found

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National Scientific And Technical Research Council

Location: Argentina

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Cancer Council Queensland

Location: No location found

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Queensland University Of Technology

Location: Australia

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Cancer Council Queensland

Location: Australia

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University Of Vienna

Location: Austria

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Sun And Health

Start Date: 2010

End Date: 2015

Funder: National Health and Medical Research Council

Supporting People With Cancer Grant

Start Date: Start date not available

End Date: 2019

Funder: Cancer Australia

The ECHO Trial: Exercise During Chemotherapy For Ovarian Cancer.

Start Date: Start date not available

End Date: 2019

Funder: Cancer Australia

ACEMID

Start Date: Start date not available

End Date: 2018

Funder: Australian Cancer Research Foundation

Can Patient-led Surveillance Detect Recurrent Or New Primary Melanoma & Reduce Need For Routinely Scheduled Follow-up? A Randomised Controlled Trial.

Start Date: Start date not available

End Date: 2019

Funder: National Health and Medical Research Council

The Implementation Of Minimally Invasive Hysterectomy (IMAGINE) Trial

Start Date: Start date not available

End Date: 2017

Funder: National Health and Medical Research Council

Evaluating And Disseminating The Implementation Success Of A Surgical Training Program

Start Date: Start date not available

End Date: 2018

Funder: National Health and Medical Research Council

Discovery Indigenous Researchers Development - Grant ID: DI0989086

Start Date: 2009

End Date: 12-2010

Amount: $185,000.00

Funder: Australian Research Council