ORCID Profile
0000-0002-5739-5790
Current Organisation
Royal Australasian College of Physicians
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Publisher: Springer Science and Business Media LLC
Date: 27-10-2017
DOI: 10.1007/S11764-017-0656-6
Abstract: Cognitive symptoms are common after cancer, but poorly associated with neuropsychological results. We previously reported colorectal cancer (CRC) patients had more cognitive impairment than controls. Here, we explore relationships between cognitive symptoms and neuropsychological domains. Subjects with CRC (N = 362) and 72 healthy controls completed neuropsychological assessments and Functional Assessment of Cancer Therapy-Cognition (FACT-COG) at baseline (pre-chemotherapy) and 6, 12, and 24 months. Associations between neuropsychological and FACT-COG scores were explored: perceived cognitive impairment (PCI), perceived cognitive ability (PCA), impact of PCI on quality of life (CogQOL). Of 362 CRC subjects, 289 had loco-regional disease and 173 received chemotherapy (CTh+). At baseline, groups did not differ on total FACT-COG, PCI, or PCA scores. All scores, except PCA, were worse at 6 months in CTh+. CRC patients not receiving chemotherapy did not differ from controls on FACT-COG domains. PCA associated weakly (r = 0.28-0.34) with attention/executive function, visual memory, and global deficit score. There was no association between PCI and neuropsychological domains. Fatigue, anxiety/depression, and poorer quality of life were associated with PCI and CogQOL (r = 0.44-0.51) in CRC patients. No association was seen between total FACT-COG or PCI, and neuropsychological domains. A weak-moderate association was found between PCA and attention/executive function and visual memory. The study was registered with clinicaltrials.gov (trial registration: NCT00188331). Cognitive symptoms are associated with fatigue, anxiety/depression, and poorer quality of life, and do not appear to be related to actual cognitive performance. Rates were lower than that reported in breast cancer survivors. Cognitive symptoms were greatest in those who received chemotherapy, with no significant difference between the non-chemotherapy survivors and healthy controls.
Publisher: Elsevier BV
Date: 06-2011
Publisher: Informa UK Limited
Date: 21-10-2016
DOI: 10.1080/17474124.2016.1244003
Abstract: Colon cancer is common and can be considered a disease of older adults with more than half of cases diagnosed in patients aged over 70 years. Decision-making about treatment with chemotherapy for older adults may be complicated by age-related physiological changes, impaired functional status, limited social supports, concerns regarding the occurrence of and ability to tolerate treatment toxicity, and the presence of comorbidities. This is compounded by a lack of high quality evidence guiding cancer treatment decisions for older adults. Areas covered: This narrative review evaluates the evidence for adjuvant and palliative systemic therapy in older adults with colon cancer. The value of an adequate assessment prior to making a treatment decision is addressed, with emphasis on the geriatric assessment. Guidance in making a treatment decision is provided. Expert commentary: Treatment decisions should consider goals of care, a patient's treatment preferences, and weigh up relative benefits and harms.
Publisher: Elsevier BV
Date: 04-2013
DOI: 10.1016/J.PEC.2012.11.004
Abstract: The Trust in Oncologist Scale (TiOS) was recently developed and validated in The Netherlands to assess cancer patients' trust in their oncologist. In this study, we translated and further validated the scale amongst English-speaking Australian cancer patients, to establish cross-cultural validity. The translated 18-item scale was administered to cancer patients (n = 175) from three Sydney hospitals. In addition to trust, we assessed patients' satisfaction, trust in health care, and background characteristics. Dimensionality, internal consistency, and construct validity of the translated scale were assessed. Psychometric properties of all items were acceptable. Trust scores were very high. Factor analyses indicated one-dimensionality of the scale. Internal consistency was strong. Moderate to high correlations were found between trust (TiOS) and its known correlates, i.e., satisfaction, number of previous consultations with the oncologist, and trust in health care, indicating good construct validity. Trust is highly coherent, suggesting that cancer patients do not distinguish between separate dimensions of trust. Future research could clarify if trust is equally strong and one-dimensional among specific groups of cancer patients. Both the English and the Dutch Trust in Oncologist Scales appear suitable for assessing cancer patients' trust reliably and validly.
Publisher: Elsevier BV
Date: 05-2012
Abstract: The selection criteria for phase III trials are often stringent. We aimed to determine how many advanced non-small-cell lung cancer (NSCLC) patients would have been eligible for phase III targeted therapy trials and the proportion receiving anticancer treatment. From March 2007 to May 2008, all advanced NSCLC patients presented at our lung cancer multidisciplinary team meeting were included to assess eligibility for the targeted therapy trials: ECOG-4599, AVAiL, FLEX, TALENT, INTACT-1, INTACT-2, ESCAPE, NEXUS and MONET1. Medical records were examined to determine treatment utilisation and overall survival. A total of 62 patients were registered: 63% male median age 71 years 61% stage IIIB disease. Percentages that met criteria were: ECOG-4599 31%, AVAiL 24%, FLEX 69%, TALENT 27%, INTACT-1 50%, INTACT-2 42%, ESCAPE 39%, NEXUS 63% and MONET1 34%. Common reasons for ineligibility were insufficient life expectancy, poor performance status, abnormal bloods, proteinuria and associated cancer problems. Systemic therapies were received by 66% of patients and median survival was 10.3 months. Only 24%-69% were eligible for targeted therapy trials but 66% received anticancer treatment. Clinical trials in patients with advanced NSCLC need to be more representative of the majority of patients.
Publisher: Elsevier BV
Date: 08-2013
DOI: 10.1016/J.PEC.2013.03.006
Abstract: Poor prognosis is difficult to impart, particularly across a cultural ide. This study compared prognostic communication with immigrants (with and without interpreters) versus native-born patients in audio-taped oncology consultations. Ten oncologists, 78 patients (31 Australian-born, 47 immigrants) and 115 family members participated. The first two consultations after diagnosis of incurable disease were audiotaped, transcribed and coded. 142 consultations were included in the analysis. Fifty percent of doctor and 59% of patient prognostic speech units were not interpreted or interpreted non-equivalently when an interpreter was present. Immigrant status predicted few prognostic facts, and oncologist characteristics no prognostic facts, disclosed. Oncologists were significantly less likely to convey hope to immigrants (p=0.0004), and more likely to use medical jargon (p=0.009) than with Australian-born patients. Incurable disease status and a limited life span were commonly acknowledged, generally with no timeframe provided. Physical issues were discussed more commonly than emotional aspects. While culture did not appear to influence doctor speech, interpreters filtered or blocked much prognostic communication. Initiatives to empower all patients to attain needed information, optimise communication when an interpreter is present and train cancer health professionals in culturally appropriate care, are urgently required.
Publisher: MDPI AG
Date: 18-08-2020
DOI: 10.3390/JCM9082664
Abstract: Background: Bevacizumab, a vascular endothelial growth factor (VEGF) monoclonal antibody commonly used for the treatment of various cancers, is often associated with adverse cardiovascular effects such as hypertension, cardiac and cerebral ischemia, thrombosis, and bleeding events. Factors associated with increased risks of adverse cardiovascular effects with bevacizumab have not been intensively studied. In this study, we determined factors associated with hospital admissions due to cardiovascular complications in patients who received bevacizumab for cancer treatment. Methods and Results: We retrospectively collected data for all patients treated with bevacizumab between the 1st January 2016 and the 31st December 2017 at the Hunter New England Local Health District. Patients’ characteristics and their medical history were obtained from hospital electronic medical records. Outcome data were sourced from the Institutional Cardiac and Stroke Outcomes Unit database. A total of n = 230 patients (mean age 65, males n = 124 (53.9%)) were treated with bevacizumab during the study period. N = 28 patients were admitted to hospital for a major cardiovascular-related event. Higher total treatment dose (p 0.05), concomitant hypertension (p = 0.005), diabetes (p = 0.04), atrial fibrillation (p = 0.03), and lack of use of statin therapy (p = 0.03) were key contributors to hospital admission. Conclusions: Results of our study highlight the fact that patients with concomitant baseline cardiovascular disease/risk factors are at an increased risk of cardiovascular hospitalization related to bevacizumab treatment. Careful baseline cardiovascular assessment may be an essential step to minimize cardiovascular complications.
Publisher: BMJ
Date: 05-2017
Publisher: Springer Science and Business Media LLC
Date: 17-12-2023
Publisher: Springer Science and Business Media LLC
Date: 06-01-2010
Publisher: MDPI AG
Date: 12-02-2022
Abstract: Endocrine therapy forms the backbone of systemic therapy for the majority of persons with early and late-stage breast cancer. However, the side effects can negatively affect quality of life, and impact treatment adherence and overall oncological outcomes. Adverse effects on cognition are common, underreported and challenging to manage. We aim to describe the nature, incidence, risk factors and underlying mechanisms of endocrine therapy-induced cognitive dysfunction. We conducted a comprehensive literature review of the studies reporting on cognitive dysfunction associated with endocrine therapies for breast cancer. We also summarise prevention and treatment strategies, and ongoing research. Given that patients are taking endocrine therapies for longer durations than ever before, it is essential that these side effects are managed pro-actively within a multi-disciplinary team in order to promote adherence to endocrine therapy and improve patients' quality of life.
Publisher: Wiley
Date: 10-11-2015
DOI: 10.1111/AJCO.12306
Abstract: Chemotherapy with cisplatin and pemetrexed has been shown to provide a survival benefit and improvement in quality of life in patients with malignant pleural mesothelioma (MPM). The reported chemotherapy utilization rates range from 18% to 61%. This study aimed to estimate the proportion of MPM patients that should receive chemotherapy based on best available evidence. An optimal chemotherapy utilization model for MPM was constructed using indications for chemotherapy identified from evidence-based MPM treatment guidelines. Epidemiological data on the proportion of patients and their tumor-related attributes were combined with the chemotherapy indications to estimate the optimal chemotherapy utilization rate using decision analysis software (TreeAge Pro 2007). Sensitivity analyses were performed to assess the impact of major variations in the epidemiological data on the optimal chemotherapy utilization rate. The optimal rate was compared with the actual rate reported in the literature. Chemotherapy is recommended at least once during the disease trajectory in 65% of MPM patients. Sensitivity analyses indicate an optimal utilization rate ranging from 50% to 65%. This optimal rate is relatively comparable to the rates mentioned in contemporary reports from Canada (61% between 2003 and 2005) and Australia (54% between 2007 and 2009) and high when compared with data from the Netherlands (36% during 2005-2006). An evidence-based model provided an optimal chemotherapy utilization rate of 65% for patients with MPM. Chemotherapy for MPM may be underutilized and barriers are likely multifactorial.
Publisher: Springer Science and Business Media LLC
Date: 06-09-2012
DOI: 10.1007/S10549-012-2205-3
Abstract: Uncertainty remains about the optimal anti-emetic regimen for control of delayed nausea and vomiting after adjuvant chemotherapy for breast cancer. Many patients receive dexamethasone but complain of insomnia, anxiety/agitation, and indigestion. The aim was to determine if patients receiving chemotherapy for breast cancer prefer treatment with dexamethasone or placebo for prophylaxis against delayed nausea and vomiting, and to compare quality of life (QOL) between the two treatments. In this randomized, double-blind, cross-over trial, we compared oral dexamethasone (4 mg twice daily for 2 days) versus placebo for chemotherapy-naïve patients with breast cancer. All patients received intravenous granisetron and dexamethasone pre-chemotherapy and oral granisetron on day 2. Primary endpoints were: (i) patient preference (ii) difference between cycles in change of QOL from days 1 to 8. Median age of the 94 women was 51 years (range 27-76): 79 received fluorouracil/epirubicin/cyclophosphamide and 15 received doxorubicin/cyclophosphamide. Thirteen withdrew pre-cycle 2 with no differences between arms. Of 80 patients stating a preference, 31 preferred placebo (39 %, 95 % CI: 28-50 %) and 37 (46 %, 95 % CI: 35-58 %) preferred dexamethasone 12 had no preference. There were no differences in intensity of vomiting, nausea, or time to onset of vomiting. There was greater decrease in global QOL (p = 0.06) when patients received dexamethasone. No other symptom/QOL domains differed significantly. In conclusion, no significant difference was found in patient preference, QOL, or symptoms regardless of whether dexamethasone or placebo was used after adjuvant chemotherapy.
Publisher: American Society of Clinical Oncology (ASCO)
Date: 10-07-2011
Abstract: Immigrants with cancer often have professional and/or family interpreters to overcome challenges communicating with their health team. This study explored the rate and consequences of nonequivalent interpretation in medical oncology consultations. Consecutive immigrant patients with newly diagnosed with incurable cancer, who spoke Arabic, Cantonese, Mandarin, or Greek, were recruited from the practices of 10 medical oncologists in nine hospitals. Their first two consultations were audio taped, transcribed, translated into English and coded. Thirty-two of 78 participants had an interpreter at 49 consultations 43% of interpreters were family, 35% professional, 18% both a professional and family, and 4% a health professional. Sixty-five percent of professional interpretations were equivalent to the original speech versus 50% for family interpreters (P= .02). Seventy percent of nonequivalent interpretations were inconsequential or positive however, 10% could result in misunderstanding, in 5% the tone was more authoritarian than originally intended, and in 3% more certainty was conveyed. There were no significant differences in interpreter type for equivalency of interpretations. Nonequivalent interpretation is common, and not always innocuous. Our study suggests that there may remain a role for family or telephone versus face-to-face professional interpreters. Practice implications: careful communication between oncologists and interpreters is required to ensure optimal communication with the patient.
Publisher: Springer Science and Business Media LLC
Date: 21-08-2016
DOI: 10.1007/S00520-015-2897-0
Abstract: In brain tumours, brain metastases or advanced cancer treatment with corticosteroids, side effects can add to symptoms. These are best assessed by patients, complementing clinical assessment. We assessed the feasibility and validity of the Dexamethasone Symptom Questionnaire-Chronic (DSQ-Chronic), patient and caregiver versions. A longitudinal cohort study was conducted, collecting clinician-rated toxicity, performance status, dexamethasone dose and DSQ-Chronic (patient and caregiver versions) at baseline, then 2, 4 and 8 weeks later. Patients had a primary malignant brain tumour, brain metastases, or advanced cancer Karnofsky Performance Status ≥40 and predicted survival ≥8 weeks. Analysis included questionnaire completion rates, frequency and severity of dexamethasone-attributable side effects, agreement between patient and caregiver ratings, comparison with clinician-rated toxicity and correlation with performance status. Sixty-six patients were recruited (mean age 60 years), with their caregivers. Completion of questionnaires was over 90% for the dyad at baseline but dropped over time, with caregiver completion rates higher at all timepoints. Agreement between patients and proxies was fair to moderate, and while proxies systematically overestimated symptom severity on DSQ-chronic total scores, the bias was less than 10 points. Patient and clinician agreement was higher for more objective symptoms. The DSQ-Chronic is feasible when the patient is relatively well. As capacity to complete the DSQ-Chronic diminishes, caregivers can be proxy-raters. Clinicians capture corticosteroid toxicities, which may not be obvious to the patient. The DSQ-Chronic, patient and caregiver versions, are useful tools to be used with clinician assessment.
Publisher: Springer Science and Business Media LLC
Date: 15-04-2023
DOI: 10.1007/S00520-023-07710-W
Abstract: We report on prevalence of anxiety, depression, and concentration difficulties and their associations in survivors of cancer in a nationally representative s le up to 25 years after diagnosis. Using the National Health and Nutrition Examination Survey (NHANES) data from 2015 to 2018, participants between the ages of 18 and 79 self-reported on cancer history, symptoms of anxiety, depression, and difficulties with concentration. Of 10,337 participants, 691 (6.7%) reported a previous diagnosis of cancer the median time since diagnosis was 8 years. Prevalence was similar between those with and without cancer for anxiety (45.8% versus 46.9%) and depression (19.7% versus 20.0%). Concentration difficulties were more common (11.3% versus 9.0%) for those with a history of cancer compared to those without (adjusted OR = 1.38, 95% CI: 1.00–1.90). Prevalence of mental health symptoms was not related to time since diagnosis. Anxiety and depression were highly correlated ( r = 0.81, 95% CI: 0.74–0.86) and moderately correlated with difficulty with concentration ( r = 0.52, 95%CI: 0.40–0.64 and r = 0.64, 95% CI: 0.53–0.74 respectively). Difficulty with concentration was more commonly reported by participants with than without a cancer history. Report of anxiety and depression was no different between participants with and without a history of cancer. Anxiety, depression, and difficulties with concentration were strongly related. Further research is needed to explore if there is a causal association, and if so, the direction of these correlations, so that interventions may be appropriately targeted.
Publisher: Elsevier BV
Date: 11-2015
Abstract: We sought to determine whether the substantial benefits of topical nitroglycerin with first-line, platinum-based, doublet chemotherapy in advanced nonsmall-cell lung cancer (NSCLC) seen in a phase II trial could be corroborated in a rigorous, multicenter, phase III trial. Patients starting one of five, prespecified, platinum-based doublets as first-line chemotherapy for advanced NSCLC were randomly allocated treatment with or without nitroglycerin 25 mg patches for 2 days before, the day of, and 2 days after, each chemotherapy infusion. Progression-free survival (PFS) was the primary end point. Accrual was stopped after the first interim analysis of 270 events. Chemotherapy was predominantly with carboplatin and gemcitabine (79%) or carboplatin and paclitaxel (18%). The final analysis included 345 events in 372 participants with a median follow-up of 33 months. Topical nitroglycerin had no demonstrable effect on PFS [median 5.0 versus 4.8 months, hazard ratio (HR) = 1.07, 95% confidence interval (CI) 0.86-1.32, P = 0.55], overall survival (median 11.0 versus 10.3 months, HR = 0.99, 95% CI 0.79-1.24, P = 0.94), or objective tumor response (31% versus 30%, relative risk = 1.03, 95% CI 0.82-1.29, P = 0.81). Headache, hypotension, syncope, diarrhea, dizziness, and anorexia were more frequent in those allocated nitroglycerin. The addition of topical nitroglycerin to carboplatin-based, doublet chemotherapy in NSCLC had no demonstrable benefit and should not be used or pursued further. Australian New Zealand Clinical Trials Registry Number ACTRN12608000588392.
Publisher: Elsevier BV
Date: 10-2007
Publisher: Elsevier BV
Date: 09-2007
DOI: 10.1016/J.CRITREVONC.2007.06.001
Abstract: Evidence is emerging that some cancer survivors suffer cognitive impairment after chemotherapy the cause is unknown. Here we review studies evaluating cognitive impairment in adult cancer survivors and discuss methodological challenges associated with this research. We evaluate evidence for cognitive impairment in cancer patients, the incidence of self-reported impairment, and identify potential mechanisms and confounders. Most studies of cognitive function are cross-sectional and report impairment in 15-45% of subjects. Longitudinal studies suggest that some impairment is present prior to receiving chemotherapy, and that this worsens in some patients. The aetiology is unknown. A larger number of subjects self-report changes in cognitive function after chemotherapy this does not correlate with objective testing. Cognitive impairment occurs in a subset of cancer survivors and is generally subtle. Most evidence suggests an association with chemotherapy although other factors associated with the diagnosis and treatment of cancer may contribute.
Publisher: JMIR Publications Inc.
Date: 15-07-2022
Abstract: urgery remains the standard curative treatment for early-stage colorectal and upper gastrointestinal cancer. Reduced preoperative functional capacity, nutritional status, and psychological well-being are associated with poor postoperative outcomes. Prehabilitation aims to improve preoperative functional reserves through physical, nutritional, and psychological interventions. Yet, how it transitions from a trial setting to being integrated into a real-world health setting is unknown. he primary aim is to evaluate the implementation of a multimodal (supervised exercise, nutrition, and nursing support) prehabilitation program into standard care for patients with gastrointestinal cancer (colorectal and upper gastrointestinal cancer) scheduled for curative intent surgery. The secondary aim is to determine the impact of a multimodal prehabilitation program on functional capacity, nutritional and psychological status, and surgical outcomes. his is an implementation study that will investigate a multimodal prehabilitation intervention, in a nonblinded, nonrandomized, single-group, pre-post design. Patients diagnosed with colorectal and upper gastrointestinal cancer scheduled for potentially curative intent surgery at Concord Repatriation General Hospital, with ≥14 intervention days prior to surgery and are medically cleared to exercise will be eligible. The study will be evaluated using the Reach, Effectiveness, Adoption, Implementation, and Maintenance Evaluation Framework. he protocol was approved in December 2019 by the Concord Repatriation General Hospital Human Research Ethics Committee (reference number 2019/PID13679). Recruitment commenced in January 2020. In response to the COVID-19 pandemic, recruitment was paused in March 2020 and reopened in August 2020 with remote or telehealth intervention adaptations. Recruitment ended on December 31, 2021. Over the 16-month recruitment period, a total of 77 participants were recruited. rehabilitation represents an opportunity to maximize functional capacity and improve surgical outcomes. The study will provide guidance and contribute to the evidence on the integration of prehabilitation into standard care using adaptive models of health care delivery including telehealth. ustralian and New Zealand Clinical Trials Registry ACTR 12620000409976 anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378974& isReview=true R1-10.2196/41101
Publisher: Springer Science and Business Media LLC
Date: 18-01-2023
DOI: 10.1007/S11764-021-01155-Y
Abstract: Colorectal cancer (CRC) is the third most common cancer worldwide. After curative intent treatment, international guidelines recommend surveillance protocols which include annual CT chest, abdomen and pelvis (CAP) and serum carcinoembryonic antigen (CEA) monitoring which aim to improve overall survival by early detection of recurrence. Despite the widespread recommendations, robust evidence of an overall survival benefit is lacking. Our study aimed to quantify the utility of annual CT CAP as a surveillance modality in comparison to the rate of potentially harmful false-positive and incidental findings. High-risk stage II and stage III CRC patients were retrospectively identified from the Sydney Cancer Survivorship Centre database. Findings on surveillance CT were classified into confirmed recurrence or the potentially harmful findings of (a) false-positive or (b) clinically significant incidental finding. A total of 376 surveillance CT CAPs were performed in 174 survivors between 12 September 2013 and 30 June 2020. The recurrence rate during the study period was 23/174 (13.2%) with the majority of recurrences detected by abnormal CEA (14/23, 60.9%) versus surveillance CT (4/23, 17.4%), with the remainder identified on non-surveillance CT (5/23, 21.7%). Curative intent surgery was performed in 12/23 people with CRC recurrence. Surveillance CT was shown to result in high levels of false-positive (31/174, 17.8% of patients) or clinically significant incidental findings (30/174, 17.2% of patients). The risk of identifying these potentially harmful findings was ongoing with each year of surveillance CT. Surveillance CT was associated with low detection rates and high rates of potentially harmful findings bringing this surveillance modality under further scrutiny. An increased emphasis should be placed on educating survivors on the benefits of surveillance CT weighed against the risk of potentially harmful findings.
Publisher: Springer Science and Business Media LLC
Date: 04-09-2014
DOI: 10.1038/BJC.2014.478
Publisher: Elsevier BV
Date: 02-2012
DOI: 10.1016/J.BBR.2011.11.005
Abstract: Recent evidence has shown that erse chemotherapy agents can induce cognitive impairments and neurotoxic damage to the central nervous system. Oxaliplatin (OXP), a platinum compound, has been linked with acute and chronic peripheral neuropathies. This study explored the cognitive impacts of OXP in the rat with a fear conditioning procedure. 10 days prior to conditioning and testing, rats received an intraperitoneal injection of OXP (12 mg/kg). On the first day of conditioning, the rats were conditioned to two CSs (CS-ren and CS-ext) in one set of chambers (context A). They then received three tests on separate days. First, the rats were assessed for contextual fear conditioning in context A. Next, the CSs were presented 20 times in a new context (B) until fear conditioning had extinguished. Finally, one of the CSs (CS-ext) was tested again in the extinction context (B), and the other (CS-ren) presented in a new context (C). Results showed that OXP had no effect on the ability of rats to express fear to the conditioning context (A), or on the expression and extinction of conditioned fear to either CS when presented in a second context (B). However, the administration of OXP did impair the ability of rats to renew levels of conditioned fear to CS-ren when this CS was presented in a novel context (C) following extinction. This profile of impairment is consistent with hippoc al damage, and may also involve frontal cortical, amygdalar and thalamic regions important for context discrimination and the contextual modulation of behaviour.
Publisher: Wiley
Date: 23-02-2011
DOI: 10.1002/PON.1923
Abstract: Migrant patients comprise a significant proportion of Western oncologists' clientele. Although previous research has found that barriers exist in the communication between ethnically erse patients and health professionals, little is known about their personal preferences for communication and information, or the concordance of views held between patients and family members. Seventy-three patients (31 Anglo-Australians, and 20 Chinese, 11 Arabic and 11 Greek migrants) and 65 relatives (25 Anglo-Australians, and 23 Chinese, 11 Arabic and 7 Greek migrants) were recruited through nine Sydney oncology clinics. Following prognostic consultations, participants were interviewed in their preferred language about their experiences and ideals regarding information and communication with oncologists. Interviews were audio-taped, translated and transcribed, and then thematically analysed using N-Vivo software. Consistency was found in patient preferences, regardless of ethnicity, in that almost all patients preferred prognostic information to be delivered in a caring and personalised manner from an authoritative oncologist. Contrary to previous research, migrant patients often expressed a desire for prognostic disclosure. Discordance was found between migrant patients and their families. These families displayed traditional non-Western preferences of non-disclosure of prognosis and wanted to actively influence consultations by meeting with oncologists separately beforehand and directing the oncologists on what and how information should be conveyed to patients. Many of the communication issues facing patients in the metastatic cancer setting are shared amongst Anglo-Australian and migrant patients alike. Understanding the dynamics within migrant families is also an important component in providing culturally sensitive communication. Future directions for research are provided.
Publisher: American Society of Clinical Oncology (ASCO)
Date: 12-2017
Publisher: No publisher found
Date: 2013
DOI: 10.1016/J.LFS.2013.05.006
Abstract: Previous animal studies have examined the potential for cytostatic drugs to induce learning and memory deficits in laboratory animals but, to date, there is no pre-clinical evidence that taxanes have the potential to cause cognitive impairment. Therefore our aim was to explore the short- and long-term cognitive effects of different dosing schedules of the taxane docetaxel (DTX) on laboratory rodents. Healthy male hooded Wistar rats were treated with DTX (6 mg/kg, 10mg/kg) or physiological saline (control), once a week for 3 weeks (Experiment 1) or once only (10mg/kg Experiment 2). Cognitive function was assessed using the novel object recognition (NOR) task and spatial water maze (WM) task 1 to 3 weeks after treatment and again 4 months after treatment. Shortly after DTX treatment, rats perform poorly on NOR regardless of treatment regimen. Treatment with a single injection of 10mg/kg DTX does not appear to induce sustained deficits in object recognition or peripheral neuropathy. Overall these findings show that treatment with the taxane DTX in the absence of cancer and other anti-cancer treatments causes cognitive impairment in healthy rodents.
Publisher: Springer Science and Business Media LLC
Date: 12-2012
Abstract: People with lung cancer have substantial symptom burden and more unmet needs than the general cancer population. Physical activity (PA) has been shown to positively influence quality of life (QOL), fatigue and daily functioning in the curative treatment of people with breast and colorectal cancers and lung diseases, as well as in palliative settings. A randomised controlled trial (RCT) is needed to determine if lung cancer patients benefit from structured PA intervention. The P hysical A ctivity in L ung Cancer ( PAL ) trial is designed to evaluate the impact of a 2-month PA intervention on fatigue and QOL in patients with non-resectable lung cancer. Biological mechanisms will also be studied. A multi-centre RCT with patients randomised to usual care or a 2-month PA programme, involving supervised PA sessions including a behavioural change component and home-based PA. QOL questionnaires, disease and functional status and body composition will be assessed at baseline, 2, 4 and 6 months follow-up. The primary endpoint is comparative levels of fatigue between the 2 arms. Secondary endpoints include: QOL, functional abilities and physical function. Exploratory endpoints include: anxiety, depression, distress, dyspnoea, PA behaviour, fitness, hospitalisations, survival, cytokines and insulin-like growth factor levels. This study will provide high-level evidence of the effect of PA programmes on cancer-related fatigue and QOL in patients with advanced lung cancer. If positive, the study has the potential to change care for people with cancer using a simple, inexpensive intervention to improve their QOL and help them maintain independent function for as long as possible. Australian New Zealand Clinical Trials Registry No. ACTRN12609000971235
Publisher: Public Library of Science (PLoS)
Date: 26-09-2014
Publisher: Elsevier BV
Date: 12-2013
DOI: 10.1016/J.CLGC.2013.04.020
Abstract: The modified Glasgow Prognostic Score (mGPS), derived from C-reactive protein (CRP) and albumin levels, and the neutrophil-lymphocyte ratio (NLR) have demonstrated prognostic significance in a number of malignancies. Baseline mGPS and NLR were calculated in a prospective cohort of chemotherapy-naive patients with metastatic castration-resistant prostate cancer (mCRPC) (AT-101-CS-205 trial) who received docetaxel and prednisone ± AT101. Cox proportional hazards regression models estimated their effects on overall survival (OS). Of 220 eligible patients, mGPS and neutrophil and lymphocyte counts were available for 184, 193, and 112 patients, respectively. Albumin (hazard ratio [HR], 0.28 95% confidence interval [CI]: 0.14-0.56 P < .001) and CRP (HR, 1.22 95% CI, 1.00-1.48 P = .048) were independently prognostic for OS. An association between mGPS and OS was found (HR, 1.87 95% CI, 1.35-2.59 P < .001 median survival, 23.5 months at mGPS 0 vs. 9.8 months at mGPS 2). mGPS was significant after controlling for 3 previously published nomograms or NLR (P ≤ .001). NLR was not prognostic for OS (HR, 0.98 P = .91), and no association between mGPS and toxicity was noted. Our results demonstrate the prognostic role of the mGPS in mCRPC over variables previously identified. mGPS is inexpensive, easily measured, and could be incorporated into routine clinical testing if our results are confirmed in a subsequent validation study. The utility of the NLR in mCRPC remains uncertain despite evidence in other malignancies.
Publisher: Springer Science and Business Media LLC
Date: 19-09-2020
Publisher: Elsevier BV
Date: 11-2011
Publisher: Oxford University Press (OUP)
Date: 26-08-2019
DOI: 10.1093/JNCI/DJZ168
Abstract: A paradigm shift is occurring in cancer therapy, where instead of targeting tumor cells, immunotherapy agents (IA) target the immune system to overcome cancer tolerance and to stimulate an antitumor immune response. IA using immune checkpoint inhibitors (CPI) or chimeric antigen receptor T-cells have emerged as the most encouraging approaches to treat cancer patients. CPI are reported to induce moderate-to-severe neurologic immune-related adverse events in less than 1% of patients, whereas chimeric antigen receptor T-cell therapy is associated with frequent neurological toxicities that can be severe or even fatal. Cognitive difficulties have been described following chemotherapy and targeted therapy, but not specifically explored in patients receiving IA. The aim of this review is to establish a picture of the first published studies suggesting some biological and physiopathological effects of IA on cognitive functions among cancer patients. The first results originate from a preclinical study evaluating the role of CPI associated with peripheral radiation on cognitive dysfunction and the recent discovery of the central nervous lymphatic system allowing leukocytes to penetrate the central nervous system. Evaluating possible side effects of IA on cognitive function will be an important challenge for future clinical trials and for better understanding the underlying mechanisms through preclinical animal models.
Publisher: Elsevier BV
Date: 08-2017
Abstract: Physical activity (PA) improves fatigue and quality of life (QOL) in cancer survivors. Our aim was to assess whether a 2-month PA intervention improves fatigue and QOL for people with advanced lung cancer. Participants with advanced lung cancer, Eastern Cooperative Oncology Group performance status (PS) ≤2, >6 months life expectancy, and ability to complete six-min walk test, were stratified (disease stage, PS 0-1 versus 2, centre) and randomized (1:1) in an open-label study to usual care (UC) (nutrition and PA education materials) or experimental intervention (EX): UC plus 2-month supervised weekly PA and behaviour change sessions. Assessments occurred at baseline, 2, 4, and 6 months. The primary endpoint was fatigue [Functional Assessment of Cancer Therapy-Fatigue (FACT-F) questionnaire] at 2 months. The study was designed to detect a difference in mean FACT-F subscale score of 6. Analysis was intention-to-treat using linear mixed models. We recruited 112 patients: 56 (50.4%) were randomized to EX, 55(49.5%) to UC 1 ineligible. Male 55% median age 64 years (34-80) 106 (96%) non-small cell lung cancer 106 (95.5%) stage IV. At 2, 4 and 6 months, 90, 73 and 62 participants were assessed, respectively, with no difference in attrition between groups. There were no significant differences in fatigue between the groups at 2, 4 or 6 months: mean scores at 2 months EX 37.5, UC 36.4 (difference 1.2, 95% CI - 3.5, 5.8, P = 0.62). There were no significant differences in QOL, symptoms, physical or functional status, or survival. Adherence to the intervention was good but the intervention group did not increase their PA enough compared to the control group, and no difference was seen in fatigue or QOL. Australian New Zealand Clinical Trials Registry No. ACTRN12609000971235.
Publisher: Massachusetts Medical Society
Date: 22-10-2015
Publisher: Springer Science and Business Media LLC
Date: 02-05-2017
DOI: 10.1007/S11682-017-9728-5
Abstract: Some women report cognitive impairment after adjuvant chemotherapy (CTh) for breast cancer. Here we explore cognitive function, and underlying mechanisms with blood tests and functional magnetic resonance imaging (fMRI). Women treated for early breast cancer were recruited to three groups based on self-reported cognitive symptoms (CS) using FACT-Cog scores. CTh + CS+ (n = 44) had received chemotherapy and self-reported cognitive symptoms CTh + CS- (n = 52) had chemotherapy but did not report cognitive problems CTh- (n = 30) had not received chemotherapy. Clinical and computer-based neuropsychological tests were performed. Blood tests included 10 cytokines, sex hormones, coagulation factors, and apolipoprotein-E genotype. fMRI (n = 101) was performed while subjects performed an n-back memory task. Participants had median age 50 (range: 29-60) years and were a median of 17 months post-diagnosis. On clinical neuropsychological tests 19% had cognitive impairment using Global Deficit Score, and 36% using International Cancer and Cognition Task Force criteria with no significant differences in cognitive impairment rates between groups. CTh + CS+ had significantly more fatigue, anxiety/depression and poorer quality-of-life than other groups. There was no association between FACT-Cog and neuropsychological scores. There were significant differences in frontal and parietal regions on fMRI scans: CTh- showed hyperactivation compared to chemotherapy-treated groups, CTh + CS+ had more frontal activation than CTh + CS-. Elevated IL-1, IL-2 were associated weakly and IL-8 more strongly with neuropsychological impairment (rho > 0.20). There were no differences in global cognitive impairment between groups. Cognitive symptoms were associated with fatigue and anxiety/depression, but not with objective cognitive impairment. fMRI scans differed among the three groups.
Publisher: American Society of Clinical Oncology (ASCO)
Date: 10-01-2017
Abstract: Cognitive impairment is reported frequently by cancer survivors. There are no proven treatments. We evaluated a cognitive rehabilitation program (Insight) and compared it with standard care in cancer survivors self-reporting cognitive symptoms. We recruited adult cancer survivors with a primary malignancy (excluding central nervous system malignancies) who had completed three or more cycles of adjuvant chemotherapy in the previous 6 to 60 months and reported persistent cognitive symptoms. All participants received a 30-minute telephone consultation and were then randomly assigned to the 15-week, home-based intervention or to standard care. Primary outcome was self-reported cognitive function (Functional Assessment of Cancer Therapy Cognitive Function [FACT-COG] perceived cognitive impairment [PCI] subscale): difference between groups after intervention (T2) and 6 months later (T3). A total of 242 participants were randomly assigned: median age, 53 years 95% female. The primary outcome of difference in FACT-COG PCI was significant, with less PCI in the intervention group at T2 ( P .001). This difference was sustained at T3 ( P .001). At T2, there was a significant difference in all FACT-COG subscales, favoring the intervention. Neuropsychological results were not significantly different between the groups at T2 or T3. There were significantly lower levels of anxiety/depression and fatigue in the intervention group at T2. There were significant improvements in stress in the intervention group at both time points. There was no significant difference in quality of life between the groups at T2, but the intervention group had better quality of life at T3. The intervention, Insight, led to improvements in cognitive symptoms compared with standard care. To our knowledge, this is the first large randomized controlled trial showing an improvement in self-reported cognitive function in cancer survivors, indicating that this intervention is a feasible treatment.
Publisher: Springer Science and Business Media LLC
Date: 27-10-2022
DOI: 10.1007/S00520-021-06636-5
Abstract: The transitioning of cancer survivors from active treatment to surveillance care has been described as uncoordinated, with lack of communication between healthcare professionals. Survivorship care plans (SCP) are recommended to bridge this transitioning period and help improve coordination of care. SCP contain in idualized information about a survivor's cancer diagnosis, treatment, and recommendations for managing treatment-related side effects and improving lifestyle risk factors for cancer recurrence and chronic disease. The aims of the study were to assess the delivery, usefulness, and compliance with SCP of survivors attending a multidisciplinary survivorship clinic and to determine patient suggestions regarding how to improve SCP. A total of 110 survivors were interviewed in-person or by phone regarding their SCP following a script with formalized questions. Data were analyzed quantitatively using descriptive statistics. Overall, 65% of participants (72/110) acknowledged having received a SCP and 86% found them useful. Only 11% of survivors (8/72) showed their SCP to other health professionals and about half (33/72) showed it to family/friends. Ninety percent of survivors (65/72) reported following at least one recommendation in their SCP. Survivors found SCP helpful but did not share them with other healthcare providers, which questions their usefulness in coordinating care. There were challenges with SCP delivery. Survivors reported they were compliant with SCP lifestyle recommendations. Further research is required to address the utility of SCP to other stakeholders, such as general practitioners, to determine whether they receive the SCP, if they find them helpful, and their expectations regarding SCP.
Publisher: Springer Science and Business Media LLC
Date: 29-04-2009
Publisher: Springer Science and Business Media LLC
Date: 07-2023
DOI: 10.1007/S00520-023-07889-Y
Abstract: This study asked consumers (patients, carers) and healthcare professionals (HCPs) to identify the most important symptoms for adults with cancer and potential treatment interventions. A modified Delphi study was conducted involving two rounds of electronic surveys based on prevalent cancer symptoms identified from the literature. Round 1 gathered information on participant demographics, opinions and/or experience on cancer symptom frequency and impact, and suggestions for interventions and/or service delivery models for further research to improve management of cancer symptoms. In Round 2, respondents ranked the importance of the top ten interventions identified in Round 1. In Round 3, separate expert panels of consumers and healthcare professionals (HCPs) attempted to reach consensus on the symptoms and interventions previously identified. Consensus was reached for six symptoms across both groups: fatigue, constipation, diarrhoea, incontinence, and difficulty with urination. Notably, fatigue was the only symptom to reach consensus across both groups in Round 1. Similarly, consensus was reached for six interventions across both groups. These were the following: medicinal cannabis, physical activity, psychological therapies, non-opioid interventions for pain, opioids for breathlessness and cough, and other pharmacological interventions. Consumers and HCPs prioritise differently however, the symptoms and interventions that reached consensus provide a basis for future research. Fatigue should be considered a high priority given its prevalence and its influence on other symptoms. The lack of consumer consensus indicates the uniqueness of their experience and the need for a patient-centred approach. Understanding in idual consumer experience is important when planning research into better symptom management.
Publisher: Wiley
Date: 21-11-2013
DOI: 10.1111/AJCO.12043
Abstract: The accurate diagnosis of malignant pleural mesothelioma (MPM) is essential for therapeutic and legal reasons. In 2006 the International Mesothelioma Panel advocated the use of a panel, including two mesothelial and two non-mesothelial immunohistochemical (IHC) markers. We assessed the changing use of IHC for the diagnosis of MPM in Australia over two decades in the context of current best practice. Patients with a confirmed clinico-pathological diagnosis of MPM who underwent extrapleural pneumonectomy or pleurectomy and/or decortication between 1988 and 2006 were identified from the cardiothoracic database at Royal Prince Alfred Hospital and combined with consecutive patients reviewed by the Dust Diseases Board between March 2007 and March 2009. Initial diagnostic pathology reports were reviewed. A total of 289 patients were identified. A median of six IHC stains per s le was performed (range 0-18): two (range 0-5) mesothelial markers, two (0-6) carcinoma markers and two epithelial markers. A trend to the higher usage of antibodies in epithelioid tumors versus biphasic and sarcomatoid tumors was noted (P = 0.148 and 0.389, respectively). Testing increased from a median of three stains per s le (1988-1997) to seven (2006-2009). Labeling specimens with > 2 mesothelial markers and > 2 carcinoma markers increased to 72 and 67 percent, respectively, after 2006. Reflecting the acceptance of diagnostic panels and increased availability of antibodies, an increase in the use of IHC stains for MPM diagnosis has occurred over the past two decades although uncertainty persists as to the optimal panel composition.
Publisher: Elsevier BV
Date: 02-2011
Publisher: Springer Science and Business Media LLC
Date: 14-12-2022
Publisher: Springer Science and Business Media LLC
Date: 19-06-2012
DOI: 10.1007/S00520-011-1209-6
Abstract: Cancer patients often experience diminished cognitive function (CF) and quality of life (QOL) due to the side effects of treatment and the disease symptoms. This study evaluates the effects of medical Qigong (MQ combination of gentle exercise and meditation) on CF, QOL, and inflammation in cancer patients. Eighty-one cancer patients recruited between October 2007 and May 2008 were randomly assigned to two groups: a control group (n = 44) who received the usual health care and an intervention group (n = 37) who participated in a 10-week MQ program. Self-reported CF was measured by the European Organization for Research and Treatment of Cancer (EORTC-CF) and the Functional Assessment of Cancer Therapy-Cognitive (FACT-Cog). The Functional Assessment of Cancer Therapy-General (FACT-G) was used to measure QOL. C-reactive protein (CRP) was assessed as a biomarker of inflammation. The MQ group self-reported significantly improved CF (mean difference (MD) = 7.78, t (51) = -2.532, p = 0.014) in the EORTC-CF and all the FACT-Cog subscales [perceived cognitive impairment (MD = 4.70, t (43) = -2.254, p = 0.029), impact of perceived cognitive impairment on QOL (MD = 1.64, t (45) = -2.377, p = 0.024), and perceived cognitive abilities (MD = 3.61, t (45) = -2.229, p = 0.031)] compared to controls. The MQ group also reported significantly improved QOL (MD = 12.66, t (45) = -5.715, p < 0.001) and had reduced CRP levels (MD = -0.72, t (45) = 2.092, p = 0.042) compared to controls. Results suggest that MQ benefits cancer patients' self-reported CF, QOL, and inflammation. A larger randomized controlled trial including an objective assessment of CF is planned.
Publisher: Springer Science and Business Media LLC
Date: 06-09-2011
DOI: 10.1007/S00213-011-2466-2
Abstract: Studies in women with breast cancer, and in animal models, have demonstrated that chemotherapy can have a negative impact on cognitive function. Which chemotherapy agents cause problems with cognition and the aetiology of the impairment is unknown. Furthermore, there is no proven treatment. This study aimed to evaluate the effects of 5-fluorouracil (5FU) and oxaliplatin (OX) chemotherapy agents commonly used to treat colorectal cancer on cognition in laboratory rodents. Furthermore, we assessed physical activity as a potential remedy for the observed chemotherapy-induced cognitive deficits. In rodents, treatment with 5FU and OX alone impairs memory as measured by novel object recognition. But combined treatment appears to have greater detrimental effects on hippoc al-dependent tasks, contextual fear recall and spatial reference memory (water maze), yet had no effect on cued fear recall, a non-hippoc al task. These impairments were prevented by 4 weeks of wheel running overnight after 5FU/OX treatment. We found a significant interaction between chemotherapy and exercise: rats receiving both 5FU/OX and exercise had improved cognition relative to non-exercising 5FU/OX rats on novel object recognition and spatial reference memory. The combination 5FU/OX had a significant impact on cognition. However, rats treated with 5FU/OX that exercised post chemotherapy had improved cognition relative to non-exercising rats. This suggests that physical activity may prove useful in ameliorating the cognitive impairments induced by 5FU/OX.
Publisher: Springer Science and Business Media LLC
Date: 17-04-2011
Abstract: Cerebral metastases are a common cause of death in patients with melanoma. Systemic drug treatment of these metastases is rarely effective, and where possible surgical resection and/or stereotactic radiosurgery (SRS) are the preferred treatment options. Treatment with adjuvant whole brain radiotherapy (WBRT) following neurosurgery and/or SRS is controversial. Proponents of WBRT report prolongation of intracranial control with reduced neurological events and better palliation. Opponents state melanoma is radioresistant that WBRT yields no survival benefit and may impair neurocognitive function. These opinions are based largely on studies in other tumour types in which assessment of neurocognitive function has been incomplete. This trial is an international, prospective multi-centre, open-label, phase III randomised controlled trial comparing WBRT to observation following local treatment of intracranial melanoma metastases with surgery and/or SRS. Patients aged 18 years or older with 1-3 brain metastases excised and/or stereotactically irradiated and an ECOG status of 0-2 are eligible. Patients with leptomeningeal disease, or who have had previous WBRT or localised treatment for brain metastases are ineligible. WBRT prescription is at least 30 Gy in 10 fractions commenced within 8 weeks of surgery and/or SRS. Randomisation is stratified by the number of cerebral metastases, presence or absence of extracranial disease, treatment centre, sex, radiotherapy dose and patient age. The primary endpoint is the proportion of patients with distant intracranial failure as determined by MRI assessment at 12 months. Secondary end points include: survival, quality of life, performance status and neurocognitive function. Accrual to previous trials for patients with brain metastases has been difficult, mainly due to referral bias for or against WBRT. This trial should provide the evidence that is currently lacking in treatment decision-making for patients with melanoma brain metastases. The trial is conducted by the Australia and New Zealand Melanoma Trials Group (ANZMTG-study 01-07), and the Trans Tasman Radiation Oncology Group (TROG) but international participation is encouraged. Twelve sites are open to date with 43 patients randomised as of the 31st March 2011. The target accrual is 200 patients. Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12607000512426
Publisher: Elsevier BV
Date: 08-2014
Abstract: Recent data show a falling cancer mortality in the general population without a similar shift in immigrant outcomes, leading to a greater cancer burden and mortality for immigrants. Our aims were to compare perceived patterns of care in immigrants and native-born cancer patients. This was a hospital-based s le of first-generation immigrants and Australian-born Anglo patients in the first year following diagnosis. It was restricted to Chinese, Arabic, or Greek speakers. Eligible participants, recruited via 16 oncology clinics, were over 18, with cancer (any type or stage), and having commenced treatment at least 1 month previously. Five hundred and seventy-one CALD patients (comprising 145 Arabic, 248 Chinese, and 178 Greek) and a control group of 274 Anglo-Australian patients participated. Immigrants had difficulty communicating with the doctor (73% versus 29%) and understanding the health system (38% versus 10%). Differences were found in 'difficulty knowing who to see' (P = 0.0002), 'length of time to confirm diagnosis' (P = 0.04), wanting more choice about a specialist and hospital (P < 0.0001) being offered the opportunity to see a counselor (P < 0.0001) and actually seeing one (P < 0.0001). There were no significant self-reported differences regarding how cancer was detected, time to see a health professional, or type first seen however, immigrants reported difficulty knowing who to see. Previous studies showed differences in patterns of care according to socioeconomic status (SES) and educational level. Despite adjusting for age, sex, education, marital status, SES, time since diagnosis, and type of cancer, we did not find significant differences. Instead, we found that understanding of the health system and confidence understanding English were important factors. This study confirmed that immigrants with cancer perceive an inferior quality of cancer care. We highlight potentially modifiable factors including assistance in navigating the health system, translated information, and cultural competency training for health professionals.
Publisher: Future Medicine Ltd
Date: 04-2017
Publisher: American Society of Clinical Oncology (ASCO)
Date: 10-06-2007
Abstract: There is evidence that some cancer survivors suffer cognitive impairment after chemotherapy. Determining if a patient has cognitive impairment is challenging, especially because impairment is usually subtle. We assessed the design of studies evaluating cognitive function during or after chemotherapy in adult patients with solid tumors. We also reviewed methods used to evaluate cognitive function in subjects with other diseases and make recommendations for future studies. We identified 22 studies that met our criteria: 82% included women with breast cancer. Eight studies were longitudinal, 12 were cross-sectional, and two were follow-ups of cross-sectional studies. Sixteen studies used a battery of neuropsychological (NP) tests to assess subjects, and 13 included a control group. Ten studies (45%) had no explicit definition of cognitive impairment most others used z scores or T scores and defined impairment based on standard deviations below the mean, but there was no consistency in for the cutoff point used or the number of tests required. There is no consistency in defining cognitive impairment, in the NP batteries used, or in statistical methods in studies of cognitive function of cancer patients. We suggest guidelines to define criteria for cognitive impairment. Use of summary scores and control groups is recommended. Practice effect should be adjusted for in longitudinal studies. A balance is needed between comprehensive batteries and briefer tests, which still need to be sensitive to mild impairment.
Publisher: Springer Science and Business Media LLC
Date: 19-08-2021
DOI: 10.1007/S00520-021-06502-4
Abstract: Chemotherapy-induced peripheral neuropathy (CIPN) is the most common dose-limiting side effect of oxaliplatin. It often persists and can adversely affect quality of life of colorectal cancer (CRC) survivors. This systematic review explored the proportions of patients with persistent CIPN and the reporting methods used. MEDLINE, EMBASE, Web of Science and CINAHL were searched up to March 2021 for publications reporting CIPN outcomes following adjuvant oxaliplatin-containing chemotherapy at prespecified timepoints in participants with CRC. Secondary outcomes assessed the tools used to measure CIPN. Two authors reviewed full text publications for eligibility, data extraction and appraisal. Meta-analysis was performed where Common Terminology Criteria for Adverse Events (any grade) was reported at the most frequent timepoints. From 7895 citations identified, 27 studies met the eligibility criteria: six were randomised control trials, and 21 were non-randomised studies. Pooled prevalence of CIPN at 6, 12, 24 and 36 months after chemotherapy were 58%, 45%, 32% and 24% respectively. The average prevalence of CIPN decreased by 26% per year after chemotherapy (pooled RR = 0.74 95% CI 0.72-0.75). Across all studies, ten separate tools were used as the primary measure of CIPN. Quality appraisal identified open-label design and inadequate reporting of participants lost to follow-up as the main methodological limitations. Our summary of reported rates of persistent CIPN indicates substantial long-term toxicity affecting CRC survivors, and will help clinicians estimate CIPN risk and its change over time. The heterogeneity of CIPN measures identified in the review highlights the need for a standardised CIPN assessment.
Publisher: Elsevier BV
Date: 09-2015
DOI: 10.1016/J.BBR.2015.04.038
Abstract: Chemotherapy treatment is associated with cognitive dysfunction in cancer survivors after treatment completion. The duration of these impairments is unclear. Therefore this paper aims to evaluate the lasting impact of varying doses of the chemotherapy oxaliplatin (OX) on cognition and peripheral neuropathy. In Experiment 1 rats were treated once a week for 3 weeks with either physiological saline (control) or 6 mg/kg OX i.p. and were assessed for peripheral neuropathy, using von Frey filaments, and cognitive function, using novel object and location recognition, up to 2 weeks after treatment completion. For Experiment 2 rats received 3 weekly i.p. injections of either physiological saline (control), 0.6 mg/kg, 2mg/kg or 6 mg/kg OX and assessed for peripheral neuropathy and cognitive function up to 11 months after treatment completion. Systemic OX treatment induced lasting effects on cognitive function at 11 months after treatment, and peripheral neuropathy at 1 month after treatment and these were dose dependent higher doses of OX resulted in worse cognitive outcomes and more severe peripheral neuropathy.
Publisher: Springer Science and Business Media LLC
Date: 25-01-2019
DOI: 10.1007/S00520-019-4648-0
Abstract: Malignant pleural mesothelioma (MPM) has a poor prognosis and heavy symptom burden. Here, we investigate health professionals' attitudes to management and decision-making in people with MPM. Survey questions were based on previous interviews with health professionals, MPM patients, and caregivers. Surveys were sent to specialist doctors and nurses who treat MPM. Surveys were completed by 107 doctors and 19 nurses from January-September 2014. Most doctors were respiratory physicians (50%) or medical oncologists (35%). Overall, 90% of doctors estimated > 10% of eligible MPM patients did not receive chemotherapy 43% estimated the rate was > 20%. Doctors believed clinical barriers to chemotherapy were clinician nihilism (70%) non-referral to medical oncology (49%) and lack of specialists in rural/regional areas (44%). Nurses perceived barriers as follows: delayed diagnosis (74%) non-referral to medical oncology (63%) lack of clinician knowledge (58%). Patient-related barriers were negative perception of chemotherapy (83%) and belief survival benefit not worthwhile (63%). Doctors' preference in decision-making was for the patient to make the decision while strongly considering the doctor's opinion (33%) equally with the doctor (29%) and using knowledge gained (23%). Nurses described their roles as providing patient support (100%) information (95%) intermediary (74%) and link to palliative care (74%). Overall, 95% believed they enabled better resource allocation and provided patients with holistic care (95%) clearer communication (89%) more time (89%) additional information (89%) timely referrals (89%). Caring for patients with MPM is challenging and complex. Health care professionals believe under-utilisation of chemotherapy is occurring, primarily due to clinician nihilism and lack of medical oncology referral.
Publisher: Elsevier BV
Date: 12-2007
Abstract: Measures reflecting quality of life (QoL) or symptom control should be included as major endpoints in most phase III trials for patients with advanced cancer. Here we review the use of such endpoints. We evaluated methodological aspects relating to QoL or symptom control in randomized controlled trials (RCTs) that included >or=150 patients, published from 1994 to 2004, using a 10-point checklist. Of 112 RCTs that met our criteria, few were rated as high quality: 22% defined QoL or symptom control as a primary endpoint 19% established an a priori hypothesis relevant to palliation and 21% defined minimal differences in QoL or symptom scores that were clinically meaningful. Most trials (81%) analyzed differences between mean or median scores across groups and only 21% defined the proportion of in idual patients who met criteria for palliative response. Only 15% of the studies met more than 5/10 criteria from our checklist. There was improvement over time in methodology and reporting. Current standards for analyzing QoL and symptom control in RCTs are poor. Definition of a palliative endpoint, with an a priori hypothesis, is essential defining the proportion of patients with palliative response is preferred. The proposed checklist could raise standards of reporting in future RCTs.
Publisher: Elsevier BV
Date: 09-2006
DOI: 10.1016/J.PBB.2006.07.010
Abstract: There is evidence that standard-dose chemotherapy may impact cognitive function in cancer patients. The present study evaluated the effects of a combination of two anti-cancer drugs, methotrexate (37.5 mg/kg) and 5-fluorouracil (5FU, 75 mg/kg) on cognitive function in a mouse model. Drug-induced deficits were observed in adult BALB/C mice on tests of spatial memory, non-matching-to-s le (NMTS) learning and in a delayed-NMTS test of non-spatial memory. There were no group differences on tests of cued memory or discrimination learning. Performance-related variables were ruled out as possible explanations of the observed impairments. The impaired performance of the drug group, which was consistent with cognitive deficits observed in human cancer patients treated with similar types of chemotherapy, was attributed to functional changes in specific brain regions, including the frontal lobes and hippoc us.
Publisher: Informa UK Limited
Date: 21-02-2014
Analytical approaches and estimands to take account of missing patient-reported data in longitudinal studies
Publisher: Informa UK Limited
Date: 04-2019
DOI: 10.2147/PROM.S178963
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2002
DOI: 10.1097/00001813-200203000-00015
Abstract: Dermatomyositis is associated with malignancy in approximately 20-25% of cases. The most common associated cancers are ovarian, lung, pancreatic, stomach, colon and non-Hodgkin's lymphoma. Nasopharyngeal cancer is not common in the Caucasian population however, there is a much higher incidence in Asian patients. Radiotherapy is the mainstay of treatment for early nasopharyngeal cancer, but combination chemoradiotherapy is becoming more common for patients with advanced disease since the Intergroup trial 0099 demonstrated improved progression-free survival and overall survival for chemoradiotherapy. Increasingly, the cytotoxic agent amifostine is being used prior to radiotherapy in an attempt to decrease associated morbidities. Amifostine has been found to significantly decrease acute and chronic xerostomia but not mucositis. It appears to be selectively protective to salivary glands and kidneys without being tumor protective. The most common side effects associated with amifostine are nausea, vomiting, hypotension, hypocalcemia and allergic reactions. We describe the case of a man with dermatomyositis and stage IV nasopharyngeal cancer treated with chemoradiotherapy and s.c. amifostine. The patient suffered a life-threatening anaphylactoid reaction to amifostine.
Publisher: Elsevier BV
Date: 03-2013
DOI: 10.1016/J.CLLC.2012.09.003
Abstract: We hypothesized that in patients with malignant pleural mesothelioma (MPM) undergoing extrapleural pneumonectomy (EPP), high expression of excision repair cross complementation group 1 (ERCC1) and low expression of thymidylate synthase (TS) are associated with prolonged survival. Consecutive patients undergoing EPP at our institutions were reviewed. Tissue microarrays were constructed using five 1-mm cores per patient. TS and ERCC1 protein expression was evaluated by immunohistochemical techniques. The average percentage scores from evaluable cores were assessed and the median score was used to ide the group. Overall survival (OS) from the time of surgery was determined by the Kaplan-Meier method and results were compared by the log-rank test. Eighty patients were included: median age, 58 years 79% men 76% epithelial and 24% biphasic subtypes 25% and pathologic stage I/II and 73% stage III/IV. The median OS was 18.2 months (80% deceased at the censor date). Nineteen patients received neoadjuvant chemotherapy 2 patients received chemotherapy with adjuvant intent and 28 patients received palliative chemotherapy. The median score was 10.2% for TS and 35% for ERCC1. There was no correlation between TS expression and OS (13.7 vs. 21.6 months for low and high levels, respectively P = .32). There was a trend between high ERCC1 expression and longer OS (27.6 vs. 10.3 months P = .06). In this series of patients with MPM undergoing EPP, TS expression was not associated with prolonged survival, but there was a trend for longer survival in patients with high ERCC1 expression.
Publisher: Springer Science and Business Media LLC
Date: 15-10-2023
DOI: 10.1007/S11764-022-01261-5
Abstract: Up to 70% of survivors report cognitive symptoms after chemotherapy. We compared two cognitive rehabilitation programs to a control group in cancer survivors. Study population were adult cancer survivors with cognitive symptoms 6–60 months after adjuvant chemotherapy. Participants randomised to: Attention Process Training (APT), Compensatory Strategy Training (CST), or control group. Active interventions comprised 6–week, 2–h/week small group sessions. Assessments: pre- and post-intervention, 6- and 12-months later. Primary outcome was change in cognitive symptoms (FACT-COG-PCI subscale) between baseline and post-intervention. Secondary endpoints included objective neuropsychological performance, Functional Impact Assessment (FIA), patient-reported outcome measures, and associations. Analyses were on an intention-to-treat basis. Analysis of covariance mixed models were used for continuous outcomes. Sixty-five participants were randomised (APT n = 21 CST n = 24 controls n = 20): 94% breast cancer, median age 54. Median time since chemotherapy 20.7 months. FACT-COG-PCI, clinical neuropsychological T -scores, and FIA improved in all groups over time, but no significant differences between arms. On mean neuropsychological T -scores 19/65 (29%) were impaired at baseline post-intervention impairment controls 31.3%, CST 16.7%, APT 20.0%. On FIA at baseline, nine were impaired this decreased to three post-intervention (one/group). FACT-COG-PCI was weakly associated with neuropsychological tests (rho = 0.24, p = 0.051) at baseline, and had no association with FIA. Neuropsychological total mean T -score was moderately positively associated with FIA (rho = 0.37, p = 0.003). There were no significant differences between intervention groups and controls using linear mixed models adjusted for baseline scores. Cognitive symptoms and neuropsychological test scores improve over time.
Publisher: Elsevier BV
Date: 08-2017
Publisher: Hindawi Limited
Date: 20-06-2022
DOI: 10.1111/ECC.13627
Abstract: To explore the experience of family caregivers of people with mesothelioma with focus on end-of-life issues. A qualitative sub-study using semi-structured interviews and thematic analysis. Fourteen caregivers were interviewed 11 were bereaved. The overarching theme was the impact of patients' diagnosis, treatment and death on caregivers and families. Three main themes were identified: (i) information provision and decision-making (ii) grief and bereavement and (iii) involvement and timing of palliative care. Caregivers initially had minimal knowledge of mesothelioma and wanted more information. Prognostic uncertainty caused distress. Grief and bereavement sub-themes were (i) coping and personal priorities (ii) reflections on dying and (iii) reflections on care. Caregivers highlighted the importance of creating meaningful events, having hope, 'doing something' and support from family and external sources. Reflections on dying contrasted regret after a 'bad', often unexpected death, with 'good' deaths. Care was made difficult by challenges navigating the health system and perceived gaps. Caregivers reported late referral to palliative care. Lack of information caused challenges for caregivers. Grief and bereavement outcomes varied and may have been adversely impacted by lack of engagement with palliative care. Integrated care with lung cancer coordinators and improved palliative care access may reduce caregiver burden.
Publisher: Springer Science and Business Media LLC
Date: 21-03-2006
Publisher: Wiley
Date: 19-01-2023
DOI: 10.1111/AJCO.13914
Abstract: Response to the substantial and long‐term impacts that a cancer diagnosis and treatment has on the growing population of cancer survivors, requires priority‐driven, impactful research. This study aimed to map Australian cancer survivorship research activities to identify gaps and opportunities for improvement and compare activities against identified survivorship research priorities. An online survey was completed by Australian researchers regarding their cancer survivorship research, and the barriers they identified to conducting such research. Current research activity was compared to recently established Australian survivorship research priorities. Overall, 178 participants completed the online survey. The majority of the research undertaken utilized survey or qualitative designs and focused on breast cancer, adult populations, and those in early survivorship ( years post‐treatment). Barriers to conducting survivorship research included funding, collaboration and networking, mentoring, and time constraints. There was moderate alignment with existing research priorities. Investigating models of care and health service delivery were the most frequently researched priorities. Research priorities that were less commonly investigated included patient navigation, patient‐reported outcomes, multimorbidity, fear of cancer recurrence, and economic issues. This study provides the first snapshot of Australian survivorship research activity. Comparison to established priorities demonstrates health services research is receiving attention and highlights areas for potential pursuits, such as rare cancers or multimorbidity. Findings indicate the need for improved funding and infrastructure to support researchers in advancing the survivorship research agenda.
Publisher: Oxford University Press (OUP)
Date: 03-2023
Publisher: Elsevier BV
Date: 09-2016
Publisher: Oxford University Press (OUP)
Date: 13-07-2021
DOI: 10.1093/JNCI/DJAB134
Publisher: Springer Science and Business Media LLC
Date: 12-2015
Publisher: Springer Science and Business Media LLC
Date: 23-10-2014
DOI: 10.1007/S00520-014-2469-8
Abstract: We performed a systematic review and meta-analysis to explore the clinical application of Chinese herbal medicine (CHM) for chemotherapy-induced leucopenia and to evaluate its effectiveness and safety. We included randomized clinical trials (RCTs) with no limitation of publication type or language. Participants were cancer patients undergoing chemotherapy. Trial designs included comparisons of CHM with granulocyte colony-stimulating factor, supportive treatments for leucopenia, and/or placebo. Main outcomes were white blood cell count and incidence of leucopenia. Screening, data extraction, and analysis were conducted according to the PRISMA guidelines. Eighty-three RCTs (n = 8,012) met the inclusion criteria. Fifteen Chinese patent medicines and 47 different modified formulas were used as prophylaxis for chemotherapy-induced leucopenia. Compared with no treatment, CHMs were shown to decrease the incidence of leucopenia (odds ratio (OR) -0.23 [-0.20, -0.27]), P < 0.00001), with the number needed to treat (NNT) -3.45 [-3.13, -3.85]. Subgroup analysis suggested a prophylactic benefit for white blood cell counts with Fufang E-jiao Jiang, Diyu Shengbai Pian, combination Huangqi and Shengmai Zhusheye, and Fuzhong Shengbai Fang for patients undergoing chemotherapy. No serious adverse events were reported. Only three articles (3/83, 4 %) were rated as having adequate methodological quality with a low level of bias. Funnel plots were asymmetrical. Some CHMs may be efficacious in the treatment of chemotherapy-induced leucopenia, but the majority of reviewed studies were of poor quality. Results need to be confirmed in rigorously conducted high-quality trials, including pharmacokinetic studies to ensure that there are no interactions between the CHM agent and chemotherapy.
Publisher: Springer Science and Business Media LLC
Date: 08-07-2021
Publisher: Oxford University Press (OUP)
Date: 07-2022
Publisher: Wiley
Date: 20-10-2020
DOI: 10.1111/AJCO.13434
Abstract: To define the prevalence and severity of fear of cancer recurrence and identify factors associated with fear of cancer recurrence in breast cancer and colorectal cancer survivors attending the Sydney Cancer Survivorship Clinic. A cross‐sectional study was performed using prospectively collected data. Survivors completed questionnaires assessing quality of life (Functional Assessment of Cancer Therapy‐General and symptoms (Distress Thermometer, Patient's Disease and Treatment Assessment Form)). Survivors were assessed by a clinical psychologist for the presence of fear of cancer recurrence. Clinical and quality of life variables were evaluated for associations with fear of cancer recurrence. Overall, 315 survivors (181 breast cancer, 134 colorectal cancer) were included. In total, 201 survivors (64%) had fear of cancer recurrence according to psychology assessment, and of the 118 that had fear of cancer recurrence severity recorded, 64 (54%) were rated as moderate‐severe. On univariate analysis, fear of cancer recurrence was associated with younger age ( P 0.001), higher distress thermometer score ( P = 0.001) and poorer overall wellbeing ( P 0.001). On multivariate analysis, younger age ( P = 0.043), being bothered by side effects of treatment ( P = 0.023), feeling sad ( P = 0.020) and greater worry that their condition will get worse ( P = 0.017) were independently associated with fear of cancer recurrence. Fear of cancer recurrence is common in breast and colorectal cancer survivors, and moderate‐severe in over half. Fear of cancer recurrence was independently associated with younger age, feeling sad, being more bothered by side effects.
Publisher: Springer Science and Business Media LLC
Date: 22-03-2013
Abstract: Women receiving treatment for breast cancer commonly ingest herbal medicines. Little is known about the potential for herb-drug interactions in this population. The aim of this study is to investigate the effect of ginkgo biloba co-administration on the pharmacokinetics of tamoxifen, anastrozole and letrozole. This was a prospective open-label cross-over study in 60 women with early stage breast cancer taking either tamoxifen, anastrozole or letrozole (n=20/group). Participants received ginkgo biloba (EGb 761) for 3 weeks (120 mg twice daily). Trough concentrations of drugs were measured before and after ginkgo biloba treatment using LC-MS/MS. Toxicities were graded according to National Cancer Institute Common Terminology Criteria for Adverse Events. Trough concentrations before and after treatment with ginkgo biloba were not significantly different for tamoxifen (93.5 ± 29.0, 86.5 ± 25.3 ng/mL p=0.16), letrozole (91.1 ± 50.4, 89.6 ± 52.14 ng/mL p=0.60) or anastrozole (29.1 ± 8.6, 29.1 ± 7.6 ng/mL p=0.97). Ginkgo biloba was well tolerated, with no difference in toxicity during ginkgo biloba. Co-administration of ginkgo biloba does not significantly affect the pharmacokinetics of tamoxifen, anastrozole or letrozole. There was no difference in the toxicity profile of hormone therapy with ginkgo biloba use in women with early stage breast cancer.
Publisher: Wiley
Date: 14-09-2022
DOI: 10.1111/IMJ.15861
Abstract: Chemotherapy‐induced peripheral neuropathy (CIPN) is a common dose‐limiting toxicity for people treated for cancer. Impaired balance and falls are functional consequences of CIPN. Virtual reality (VR) technology may be able to assess balance and identify patients at risk of falls. To assess the impact of potentially neurotoxic chemotherapy on balance using VR, and explore associations between VR balance assessment, falls and CIPN. This prospective, repeated measures longitudinal study was conducted at two Australian cancer centres. Eligible participants were commencing adjuvant chemotherapy containing a taxane for breast cancer, or oxaliplatin for colorectal cancer (CRC), per institutional guidelines. Balance assessments using VR were conducted at baseline, end of chemotherapy and 3 and 6 months after completion of chemotherapy. Participants also completed a comprehensive CIPN assessment comprising clinical and patient‐reported outcomes, and recorded falls or near falls. Out of 34 participants consented, 24 (71%) had breast cancer and 10 (29%) had CRC. Compared to baseline, balance threshold was reduced in 10/28 (36%) evaluable participants assessed at the end of chemotherapy, and persistent in 7/22 (32%) at 6 months. CIPN was identified in 86% at end of chemotherapy and persisted to 6 months after chemotherapy completion in 73%. Falls or near falls were reported by 12/34 (35%) participants, and were associated with impaired VR balance threshold ( P = 0.002). While VR balance assessment was no better at identifying CIPN than existing measures, it is a potential surrogate method to assess patients at risk of falls from CIPN.
Publisher: Elsevier BV
Date: 10-2014
DOI: 10.1016/J.CLGC.2014.03.005
Abstract: We retrospectively evaluated the prognostic impact of neutrophil-lymphocyte ratio (NLR) as a marker for inflammatory and immune state in men with progressive metastatic castration resistant prostate cancer (mCRPC) following docetaxel. The SUN-1120 phase III trial comparing prednisone combined with sunitinib (n = 584) or placebo (n = 289) for mCRPC following docetaxel-based chemotherapy was evaluated. The arms were combined for analysis, since no difference was observed in the primary endpoint of overall survival (OS). A logarithmic transformation was applied to non-normal factors. The Kaplan-Meier method was used for OS estimation. To identify an optimal prognostic model for survival, we used a Cox proportional hazards regression method with forward stepwise selection, stratifying for ECOG PS, progression type (prostate specific antigen [PSA] or radiographic) and treatment group. Patients were categorized into risk groups. Complete data was evaluable for 784 men. The factors used in the model that remained in idually significant for OS in multivariable analysis were: log-lactate dehydrogenase level (LDH) level (HR 2.86 [95% CI = 2.29, 3.56], P < .001), hemoglobin (0.80 [0.74, 0.85], P 1 organ involved by metastatic disease (1.49 [1.21, 1.84], P < .001), log-alkaline phosphatase (1.13 [0.99, 1.28], P = .074), log-number of prior cycles of docetaxel (0.84 [0.71, 0.98], P = .031), progression on docetaxel (1.35 [1.00, 1.81], P = .049), log-PSA (1.06 [1.00, 1.12], P = .075) and log-NLR (1.55 [1.32, 1.83], P < .001). NLR increased the c-statistic of the prognostic model from 0.703 to 0.715. High NLR may be associated with an independent poor prognostic impact in post-docetaxel patients with mCRPC. These data warrant external validation.
Publisher: Wiley
Date: 27-01-2011
DOI: 10.1002/PON.1727
Abstract: There is little information about the accuracy of patient perceptions of their life expectancy. Here, we compare patient perceptions of their outlook and their oncologist's estimates of life expectancy to actual survival. The Unmet Needs Study recruited patients with metastatic cancer. Oncologists were asked to estimate patient survival as: (1) weeks (2) months (3) <1 year (4) 2 years. Patients were asked to estimate their outlook on a numerical scale from 1-7. Patient and oncologist estimates were compared with actual survival. Complete survival data were available for 50 patients: median age 63.5 years 48% male tumor types: 32% colorectal, 24% lung, 10% upper gastrointestinal cancer, 12% unknown primary and median survival 6.8 months. The oncologists were 32% accurate in predicting survival and overestimated survival 42% of the time (weighted kappa=0.34). The correlation between self-reported patient outlook and survival was modest (Spearman's rho=0.36, p=0.01). The median survival for categories of outlook of 1-3, 4-5, and 6-7 were 4.4, 5.4, and 14.8 months, respectively (p=0.01). Overseas-born patient was the only independent predictor for the oncologists' accurate estimates (p=0.01). Oncologists were relatively poor at predicting survival and tended to be optimistic in their prognostication. The probability of survival significantly decreased with worse self-reported patient outlook.
Publisher: Wiley
Date: 30-03-2022
DOI: 10.1002/PON.5928
Abstract: Cognitive symptoms are commonly reported among cancer patients and survivors, yet guidance on when self‐reported cognitive symptoms warrant follow‐up is lacking. We sought to establish cut‐off scores for identifying patients with perceived low cognitive functioning on widely used self‐report measures of cognition and a novel single item Cognitive Change Score. Adult patients diagnosed with invasive cancer who had completed at least one cycle of chemotherapy completed a questionnaire containing the EORTC‐Cognitive Function (CF) subscale, Functional Assessment of Cancer Therapy‐Cognitive Function (FACT‐COG) Perceived Cognitive Impairment (PCI) and our Cognitive Change Score (CCS). We used receiver operating characteristic analyses to establish the discriminative ability of these measures against the Patient's Assessment of Own Functioning Inventory (PAOFI) as our reference standard. We chose cut‐off scores on each measure that maximised both sensitivity and specificity for identifying patients with self‐reported low CF. We recruited 294 participants (55.8% women, mean age 56.6 years) with mixed cancer diagnoses (25.5 months since diagnosis). On the CCS, 77.6% reported some cognitive change since starting chemotherapy. On the PAOFI 36% had low CF. The following cut‐off scores identified cases of low CF: ≥28.5 on the CCS (75.5% sensitivity, 67.6% specificity) ≤75.0 on the European Organisation for Research and Treatment of Cancer, QLQ‐C30 Cognitive Functioning scale (90.9% sensitivity, 57.1% specificity) ≤55.1 on the FACT‐COG PCI‐18 (84.8% sensitivity, 76.2% specificity), and ≤59.5 on the FACT‐COG PCI‐20 (78.8% sensitivity, 84.1% specificity). We found a single item question asking about cognitive change has acceptable discrimination between patients with self‐reported normal and low CF when compared to other more comprehensive self‐report measures of cognitive symptoms. Further validation work is required.
Publisher: JMIR Publications Inc.
Date: 27-03-2023
DOI: 10.2196/41101
Abstract: Surgery remains the standard curative treatment for early-stage colorectal and upper gastrointestinal cancer. Reduced preoperative functional capacity, nutritional status, and psychological well-being are associated with poor postoperative outcomes. Prehabilitation aims to improve preoperative functional reserves through physical, nutritional, and psychological interventions. Yet, how it transitions from a trial setting to being integrated into a real-world health setting is unknown. The primary aim is to evaluate the implementation of a multimodal (supervised exercise, nutrition, and nursing support) prehabilitation program into standard care for patients with gastrointestinal cancer (colorectal and upper gastrointestinal cancer) scheduled for curative intent surgery. The secondary aim is to determine the impact of a multimodal prehabilitation program on functional capacity, nutritional and psychological status, and surgical outcomes. This is an implementation study that will investigate a multimodal prehabilitation intervention, in a nonblinded, nonrandomized, single-group, pre-post design. Patients diagnosed with colorectal and upper gastrointestinal cancer scheduled for potentially curative intent surgery at Concord Repatriation General Hospital, with ≥14 intervention days prior to surgery and are medically cleared to exercise will be eligible. The study will be evaluated using the Reach, Effectiveness, Adoption, Implementation, and Maintenance Evaluation Framework. The protocol was approved in December 2019 by the Concord Repatriation General Hospital Human Research Ethics Committee (reference number 2019/PID13679). Recruitment commenced in January 2020. In response to the COVID-19 pandemic, recruitment was paused in March 2020 and reopened in August 2020 with remote or telehealth intervention adaptations. Recruitment ended on December 31, 2021. Over the 16-month recruitment period, a total of 77 participants were recruited. Prehabilitation represents an opportunity to maximize functional capacity and improve surgical outcomes. The study will provide guidance and contribute to the evidence on the integration of prehabilitation into standard care using adaptive models of health care delivery including telehealth. Australian and New Zealand Clinical Trials Registry ACTR 12620000409976 anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378974& isReview=true RR1-10.2196/41101
Publisher: Elsevier BV
Date: 04-2008
Abstract: A subset of survivors has cognitive impairment after cancer treatment. This is generally subtle, but may be sustained. In October 2006, the second international cognitive workshop was held in Venice. The workshop included neuropsychologists, clinical and experimental psychologists, medical oncologists, imaging experts, and patient advocates. The main developments since the first Cognitive Workshop in 2003 have been the following. (i) studies evaluating cognitive function in patients receiving chemotherapy for cancers other than breast cancer, and in patients receiving hormonal therapy for cancer. (ii) The publication of longitudinal prospective studies which have shown that some patients already exhibit cognitive impairment on neuropsychological testing before receiving chemotherapy, and some patients have deterioration in cognitive functioning from pre- to postchemotherapy. (iii) Studies of the underlying mechanisms of cognitive impairment both in patients and in animal models. (iv) Use of structural and functional imaging techniques to study changes in brain morphology and activation patterns associated with chemotherapy. (v) At present cognitive research in cancer is limited by methodological challenges and the lack of standardization in neuropsychological studies. The current workshop addressed many of these issues and established an international task force to provide guidelines for future research and information on how best to manage these symptoms.
Publisher: Springer Science and Business Media LLC
Date: 08-05-2015
Publisher: BMJ
Date: 09-2020
DOI: 10.1136/BMJOPEN-2020-038312
Abstract: Cancer-related cognitive impairment (CRCI) is a distressing and disabling side-effect of cancer treatments affecting up to 75% of patients. For some patients, their cognitive impairment may be transient, but for a subgroup, these symptoms can be long-standing and have a major impact on the quality of life. This paper describes the protocol for a study: (1) to assess the feasibility of collecting longitudinal data on cognition via self-report, neuropsychological testing, peripheral markers of inflammation and neuroimaging and (2) to explore and describe patterns of cancer-related cognitive impairment over the course of treatment and recovery in patients with newly diagnosed, aggressive lymphoma undergoing standard therapy with curative intent. This is a prospective, longitudinal, feasibility study in which 30 newly diagnosed, treatment-naive patients with aggressive lymphoma will be recruited over a 12-month period. Patients will complete comprehensive assessments at three time points: baseline (time 1, pre-treatment) and two post-baseline follow-up assessments (time 2, mid-treatment and time 3, 6–8 weeks post-treatment completion). All patients will be assessed for self-reported cognitive difficulties and objective cognitive function using Stroop Colour and Word, Trail Making Test Part A and B, Hopkins Verbal Learning Test-Revised, Controlled Oral Word Association and Digit Span. Blood cell-based inflammatory markers and neuroimaging including a positron emission tomography (PET) with 18 F-labelled fluoro-2-deoxyglucose ( 18 F-FDG) and CT ( 18 F-FDG-PET/CT) and a MRI will explore potential inflammatory and neuroanatomical or functional mechanisms and biomarkers related to CRCI. The primary intent of analysis will be to assess the feasibility of collecting longitudinal data on cognition using subjective reports and objective tasks from patients during treatment and recovery for lymphoma. These data will inform the design of a larger-scale investigation into the patterns of cognitive change over the course of treatment and recovery, adding to an underexplored area of cancer survivorship research. Ethical approval has been granted by Austin Health Human Rights Ethics Committee (HREC) in Victoria Australia. Peer reviewed publications and conference presentations will report the findings of this novel study. Australian New Zealand Clinical Trials Registry (ACTRN12619001649101).
Publisher: American Society of Clinical Oncology (ASCO)
Date: 15-08-2004
Abstract: To determine whether adding regular acetaminophen (paracetamol) could improve pain and well-being in people with advanced cancer and pain despite strong opioids. Participants took acetaminophen for 48 hours and placebo for 48 hours. The order (acetaminophen or placebo first) was randomly allocated. Pain was the primary outcome. Preferences, number of opioid breakthrough doses, overall well-being, nausea and vomiting, drowsiness, constipation, and cold sweats were secondary outcomes. Patients rated themselves daily with visual analog scales (VAS) and a verbal numeric scale (VNS) for pain, all scaled from 0 to 10. Thirty patients completed the trial. The oral opioid was morphine in 23 patients and hydromorphone in seven patients. The median daily opioid dose in oral morphine equivalents was 200 mg (range, 20 to 2,100 mg). Nonsteroidal anti-inflammatory drugs, corticosteroids, or both were used by 16 patients. Pain and overall well-being were better for patients receiving acetaminophen than for those receiving placebo. The mean difference was 0.4 (95% CI, 0.1 to 0.8 P = .03) in VNS for pain, 0.6 (95% CI, −0.1 to 1.3 P = .09) in VAS for pain, and 0.7 (95% CI, 0.0 to 1.4 P = .05) in VAS for overall well-being. More patients preferred the period they took acetaminophen (n = 14) than the period they took placebo (n = 8), but many had no preference (n = 8). There were no differences in the other outcomes. Acetaminophen improved pain and well-being without major side effects in patients with cancer and persistent pain despite a strong opioid regimen. Its addition is worth considering in all such patients.
Publisher: Wiley
Date: 11-2010
DOI: 10.1111/J.1445-5994.2010.02223.X
Abstract: Malignant mesothelioma (MM) is an aggressive tumour that commonly affects the mesothelial surfaces of the pleural and peritoneal cavities, and occasionally, the tunica vaginalis and the pericardium. Formerly a rare tumour, MM is increasing in incidence in Australia due to the heavy nationwide use of asbestos from 1940 until the 1980s. The incidence is expected to peak in Australia in the next decade, mirroring the long latency period between asbestos exposure and development of MM. Diagnosis of MM can be difficult. Definitive pathological diagnosis is required and it often requires an experienced pathologist to differentiate MM from other benign or malignant processes. Treatment of MM requires a multidisciplinary approach, regardless of palliative or curative intent. Treatment options, such as surgery, chemotherapy, radiotherapy and active symptom control or a combination of these, may be used. Further research is needed to advance the therapeutic options for MM, and strategies to realize personalisation of therapy through discovery of predictive markers. In the Australian society where asbestos contamination of the built environment is very high, education and stringent public health measures are required to prevent a second wave of increased MM incidence.
Publisher: BMJ
Date: 13-06-2014
Publisher: MDPI AG
Date: 25-03-2019
DOI: 10.3390/GERIATRICS4010031
Abstract: Nicotinamide (vitamin B3) has photoprotective effects and reduces skin cancer incidence in high risk patients. Nicotinamide also improves cognition in animal models. As part of the ONTRAC (Oral Nicotinamide To Reduce Actinic Cancer) phase III placebo-controlled, randomized trial to assess nicotinamide’s efficacy in skin cancer prevention, we included clinical neurocognitive function and patient-reported quality of life assessments at baseline and after 12 months of intervention in in iduals with previous skin cancer in order to assess any effect of oral nicotinamide (500 mg po twice daily) on cognitive function and quality of life. In our s le of 310 participants who completed neurocognitive function testing at baseline and at 12 months, we were not able to detect any significant effect of oral nicotinamide on cognitive function nor on quality of life. Further studies of nicotinamide’s effects on cognition in humans might include in iduals with pre-existing mild cognitive impairment, and it may be that higher doses of nicotinamide are required to significantly influence cognitive function compared to doses required to reduce skin cancer.
Publisher: Elsevier BV
Date: 2018
Publisher: Elsevier BV
Date: 2013
DOI: 10.1016/J.CLLC.2012.03.011
Abstract: We aimed to examine the prognostic values of established risk factors and to validate the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) in an independent series of patients with malignant pleural mesothelioma (MPM). A total of 148 patients who applied for compensation at the Dust Diseases Board from 2007 to 2009 were included in this study. Overall survival was determined by the Kaplan-Meier method, and NLR was defined as the absolute neutrophil ided by the lymphocyte count. The prognostic value of the variables was examined by using Cox regression analysis, and all factors were entered into a multivariate model to determine their independent effect. The patient characteristics were median age of 73 years 93% men 59% epithelial subtype median NLR of 3.5 at diagnosis (n = 79) median overall survival of 10.6 months. The following variables were predictive of longer overall survival in univariate analysis: younger age, epithelial subtype, lower tumor stage, low white cell count, low platelet count, low hemoglobin level, and low NLR. Multivariate analysis confirmed that nonepithelial vs. epithelial subtype (hazard ratio [HR], 3.0 P < .001), tumor stage (HR, 1.6 P < .001), hemoglobin level difference ≥10 vs. <10 (HR, 2.0 P = .03), no chemotherapy vs. use of chemotherapy (HR, 2.4 P < .001), and NLR ≥3 vs. <3 (HR, 2.2 P < .01) were independently associated with prognosis. Apart from previously recognized factors, such as histosubtype, tumor stage, and hemoglobin level difference, NLR, an index of systemic inflammation bears prognostic significance that shows that a snapshot of immune status is able to convey important prognostic information.
Publisher: Springer Science and Business Media LLC
Date: 15-03-2006
DOI: 10.1007/S00520-006-0037-6
Abstract: Some patients with cancer suffer cognitive impairment after chemotherapy. A brief, sensitive instrument is required to screen patients for cognitive impairment. In this study, we compare three possible screening instruments. Cancer patients (n=31) who had received adjuvant chemotherapy within 2 years underwent cognitive evaluation on three occasions. Fluent English speakers (n=20) completed the High Sensitivity Cognitive Screen (HSCS), the computer-based Headminder and CogHealth, and the Functional Assessment of Cancer Therapy-cognitive function (FACT-COG) questionnaire. Patients not fluent in English (NESB) (n=11) performed CogHealth and Headminder. The patients were aged 31-65 years, and 94% were women with breast cancer. At baseline, 6 of 20 (30%) had moderate-severe cognitive impairment on HSCS, 17 of 31 (55%) had scores greater than one standard deviation (SD) below the mean for normative data in one to two of three domains on Headminder, and on CogHealth, 8 of 31 (26%) were greater than one SD below the mean in at least two of six domains. A large practice effect was seen for the HSCS, with moderate-severe cognitive impairment decreasing from 30 to 5% between the first and second assessment. On FACT-COG, 9 of 19 patients (47%) rated their cognition as greater than one SD below that of a pre-chemotherapy breast cancer control group, with impact on quality of life greater than one SD below for 10 of 19 (53%) patients. No correlation was seen between objective cognitive testing and the FACT-COG. CogHealth and Headminder were suitable for NESB patients. The HSCS is not recommended for longitudinal studies with short intervals between testing due to practice effect. There is poor correlation between the patients' perception of their cognitive impairment and the objective tests.
Publisher: Wiley
Date: 04-2013
DOI: 10.1111/J.1445-5994.2012.02925.X
Abstract: The silent epidemic of mesothelioma in Australia is steadily increasing, and 30% of cases occur in New South Wales (NSW). To describe the patterns of care and outcomes of patients with malignant pleural mesothelioma (MPM) in NSW. MPM patients in NSW applying for compensation at the NSW Dust Diseases Board from 2007 to 2009 were included. Survival from time of diagnosis was determined by the Kaplan-Meier method. The Chi-squared test was used to determine if there was an association between utilisation of treatment and geographical location. A total of 138 patients was included: median age was 72.5 91.3% male 60.1% epithelial subtype and 65.2% lived in major cities. All patients had at least one chest X-ray and computed tomography scan, and 21% had a positron emission tomography scan 93.5% and 4.3% had histological or cytological confirmation respectively. Thoracoscopy (59.4%) was the most commonly used diagnostic procedure. Treatment utilisation: 53.6% chemotherapy 35.5% radiotherapy 9.4% extrapleural pneumonectomy (EPP) and 72.5% had palliative care involvement. There were no major differences in treatment utilisation between patients living in major cities and those in regional NSW (chemotherapy P = 0.42 radiotherapy P = 0.13 and palliative care P = 0.60), except for a higher rate of EPP in regional patients (16.7% vs 5.6% P = 0.03). Median survival was 9.7 versus 12.3 months for city and regional patients respectively (P = 0.22). Survival and treatment utilisation was not significantly different between MPM patients living in major cities and regional NSW, except for a higher rate of EPP in patients in regional NSW.
Publisher: MDPI AG
Date: 04-12-2008
DOI: 10.3747/CO.V15I6.378
Publisher: Elsevier BV
Date: 07-2011
Publisher: Springer Science and Business Media LLC
Date: 03-04-2019
DOI: 10.1007/S00520-019-04760-X
Abstract: Malignant pleural mesothelioma (MPM) is a rare cancer with poor prognosis. As there is little information on the lived experience of MPM, our aim was to document the experience of MPM patients and their caregivers. Surveys for MPM patients and caregivers were developed from previous interviews with patients, caregivers, and health professionals, about treatments and decision-making. Participants were recruited from two hospitals, government compensation body, and support groups. Survey responses were received from 78 MPM patients and 106 caregivers from January to September 2014. 85% male, median age 69 years, median time since diagnosis 15 months. Caregivers: median age 68, 91% female, 90% spouse of MPM patient, 95% bereaved. Most participants felt informed about treatment options but only 69% thought all treatment options were discussed. Chemotherapy was discussed most frequently (92-95%) ~80% had sufficient information for decision-making. Decision regarding chemotherapy was made by patient considering doctor's opinion (24%), doctor and patient equally (18%), and doctor (17%). Participants 'agreed'/'strongly agreed' that they made the right decision about chemotherapy (patients 81%, caregivers 60%), but 5% and 16%, respectively, regretted the decision. Most participants received 'sufficient' support (71%). A quarter reported seeing cancer nurse specialists. Palliative care referral: 31% patients, 85% caregivers. Caregivers would have liked to talk to someone by themselves (41%), more time with doctors (30%), psychological support (29%), and clearer information (31%). Bereaved caregivers requested grief counselling (39%) and post-death consultation with specialists (23-25%). Satisfaction with treatment was high, but participants identified need for improved communication and quality information, discussion about all treatments, end-of-life assistance, and caregiver support after the patient's death.
Publisher: American Association for Cancer Research (AACR)
Date: 31-05-2016
DOI: 10.1158/1055-9965.EPI-15-1267
Abstract: Background: There is strong interest in testing lifestyle interventions to improve cancer outcomes however, the optimal methods for achieving behavior change in large-scale pragmatic trials are unknown. Here, we report the 1-year feasibility results for exercise behavior change in the Canadian Cancer Trials Group CO.21 (CHALLENGE) Trial. Methods: Between 2009 and 2014, 273 high-risk stage II and III colon cancer survivors from 42 centers in Canada and Australia were randomized to a structured exercise program (SEP n = 136) or health education materials (HEM n = 137). The primary feasibility outcome in a prespecified interim analysis was a difference between randomized groups of ≥5 metabolic equivalent task (MET)-hours/week in self-reported recreational physical activity (PA) after at least 250 participants reached the 1-year follow-up. Secondary outcomes included health-related fitness. Results: The SEP group reported an increase in recreational PA of 15.6 MET-hours/week compared with 5.1 MET-hours/week in the HEM group [mean difference = +10.5 95% confidence interval (CI) = +3.1–+17.9 P = 0.002]. The SEP group also improved relative to the HEM group in predicted VO2max (P = 0.068), 6-minute walk (P & 0.001), 30-second chair stand (P & 0.001), 8-foot up-and-go (P = 0.004), and sit-and-reach (P = 0.08). Conclusions: The behavior change intervention in the CHALLENGE Trial produced a substantial increase in self-reported recreational PA that met the feasibility criterion for trial continuation, resulted in objective fitness improvements, and is consistent with the amount of PA associated with improved colon cancer outcomes in observational studies. Impact: The CHALLENGE Trial is poised to determine the causal effects of PA on colon cancer outcomes. Cancer Epidemiol Biomarkers Prev 25(6) 969–77. ©2016 AACR.
Publisher: Springer Science and Business Media LLC
Date: 18-10-2023
Publisher: Oxford University Press (OUP)
Date: 29-10-2022
Publisher: Springer Science and Business Media LLC
Date: 14-02-2013
DOI: 10.1007/S00520-013-1753-3
Abstract: Malignant pleural mesothelioma (MPM) is considered a treatment-resistant disease. We determined the proportion of patients who received treatment in the last month of life and potential factors associated with use of chemotherapy at the end of life. Consenting MPM patients compensated by the Dust Diseases Board (DDB) were included. Patient, treatment and outcome details were obtained through the DDB, treating physicians and Medicare Australia. The association between potential factors (age, gender, geographical location, disease stage, histological subtype, palliative care referral, length of first line chemotherapy and lines of treatment) and chemotherapy use in the last month of life was determined. A total of 147 MPM patients were included in the analysis: 78 received chemotherapy, 50 had radiotherapy and 116 had surgery (77 received more than one treatment modality whilst 56 received one treatment modality). Twenty-one patients received treatment in their last month of life: nine received chemotherapy six, radiotherapy and six had surgery. Those who were treated with second or subsequent lines of chemotherapy were more at risk of receiving chemotherapy until the end of life (six of 19 patients, i.e., 32 %) compared to those who were only treated with first-line therapy (three of 59 patients, i.e., 5 % p < 0.01). Patients who received chemotherapy at the end of life had shorter survival compared to those who did not receive chemotherapy at the end of life (5.3 vs. 12.5 months, respectively p = 0.01). Chemotherapy utilisation in the last month of life is not uncommon in this series of MPM patients. Patients who failed previous chemotherapy were more likely to receive chemotherapy near the end of life. More careful consideration of when to cease chemotherapy needs to be made as patients who received chemotherapy at the end of life had poorer survival outcome.
Publisher: Springer Science and Business Media LLC
Date: 31-08-2013
DOI: 10.1007/S00520-012-1569-6
Abstract: Malignant pleural mesothelioma (MPM) is a highly aggressive and symptomatic disease. We examined the relationship between health-related quality of life (HRQoL) and inflammatory markers, and the prognostic role of HRQoL in MPM patients. MPM patients from two parallel phase II studies (thalidomide alone or thalidomide with chemotherapy) were included. HRQoL was assessed at baseline using the modified Lung Cancer Symptom Scale (LCSS). Baseline inflammatory markers and cytokines were measured. Spearman correlation was used to examine the relationship between inflammatory markers and HRQoL measures. The prognostic value of the HRQoL domains was examined using Cox proportional hazard model. Sixty-three patients were included: median age 61 years (range 44-79) 82% male 77% Eastern Cooperative Oncology Group (ECOG) performance status 0-1 44% epithelial histology subtype. Baseline systemic symptoms of anorexia and fatigue, the summation symptoms of overall symptomatic distress, interference with normal activity and global QoL and the aggregate score of total LCSS score were all associated with elevated neutrophil-to-lymphocyte ratio, C-reactive protein and vascular endothelial growth factor levels at baseline (rho ≥ 0.25 p < 0.05). Baseline anorexia, fatigue, cough, dyspnoea, pain, overall symptomatic distress, interference with normal activity, global QoL and total LCSS score were all significantly related to survival (p < 0.05) after adjusting for established prognostic factors (age, gender, histological subtype and performance status) and treatment effect. In conclusion, HRQoL seems to relate to a patient's systemic inflammatory status and is associated with survival in MPM patients.
Publisher: Elsevier BV
Date: 04-2018
DOI: 10.1016/J.JPAINSYMMAN.2017.12.486
Abstract: The Functional Assessment of Cancer Therapy-Cognitive (FACT-Cog) version 3 questionnaire is designed to assess perceived cognitive function and impact on quality of life in cancer patients. We examined the factor structure of the FACT-Cog version 3 in s les of cancer patients, older adults, and students. Data from three populations were sourced. Cancer patient data (N = 158) came from two studies, one evaluating a web-based cognitive training program, and the other evaluating symptoms in patients receiving chemotherapy. The older adult s le (N = 477) was commercial brain training users in the general population. The student s le (N = 154) came from a study examining the relation between cognitive test performance and perceived cognitive function. The patient s le conformed to the traditional four-factor structure (impairments, abilities, noticeability, and quality of life), with some support for separating the broad impairment/ability factors into specific cognitive domains. The older adult s le was best described using both impairments/abilities and specific cognitive domains. The student s le suggested two impairment/ability factors but separation of concentration/acuity and memory/verbal impairment items. The FACT-Cog can be used in populations other than cancer patients, with modifications to the scoring system. Even when used with cancer patients, it is worth considering scoring specific cognitive domains separately.
Publisher: American Association for Cancer Research (AACR)
Date: 12-2010
DOI: 10.1158/1078-0432.CCR-10-2245
Abstract: Purpose: Asbestos-induced chronic inflammation is implicated in the pathogenesis of malignant mesothelioma (MM). We have investigated blood neutrophil-to-lymphocyte ratio (NLR), an index of systemic inflammation, as a prognostic factor in MM patients. Experimental Design: Patients with MM who had systemic therapy at participating institutes were studied. Potential prognostic factors such as age, gender, performance status, histologic subtype, and baseline laboratory parameters, including NLR, were analyzed. Overall survival from commencement of therapy was determined by the Kaplan–Meier method. Multivariate analyses using Cox Regression model were performed with significant factors (P ≤ 0.05) to determine their independent effect. Results: A total of 173 MM patients undergoing systemic therapy including 119 patients receiving first-line therapy and 54 patients receiving second- or third-line therapy were included in this retrospective evaluation. Forty-two percent of patients had an elevated NLR at baseline. The following variables were predictive of survival: female gender (P = 0.044), epithelioid histologic subtype (P & 0.001), baseline white blood cell count less than 8.3 × 109/L (P = 0.008), baseline platelet count 400 × 109/L or less (P = 0.05), and NLR of 5 or less (P & 0.001). After multivariate analysis, histologic epithelioid subtype [hazard ratio (HR) = 2.0 95% confidence interval (CI) = 1.3–2.9 P = 0.001], and NLR less than 5 (HR = 2.7 95% CI = 1.8–3.9 P & 0.001) remained independent predictors. The 1-year survival rate was 60% versus 26%, whereas the 2-year survival rate was 34% versus 10% for NLR less than 5 and 5 or greater, respectively. In the separate analyses of chemotherapy-naive and previously treated patient groups, NLR was an independent predictor of survival in both groups. Conclusion: Our results indicate that NLR is an independent predictor of survival for patients with MM undergoing systemic therapy. Clin Cancer Res 16(23) 5805–13. ©2010 AACR.
Publisher: Oxford University Press (OUP)
Date: 09-04-2015
Publisher: Springer Science and Business Media LLC
Date: 11-01-2022
DOI: 10.1007/S00520-022-06804-1
Abstract: Studies in 1983 and 1993 identified and ranked symptoms experienced by cancer patients receiving chemotherapy. We repeated the studies to obtain updated information on patient perceptions of chemotherapy-associated symptoms. A cross-sectional interview and patient-reported outcome questionnaires were administered to out-patients receiving chemotherapy. Patients selected from 124 cards to identify and rank the severity of physical and non-physical symptoms they had experienced and attributed to chemotherapy (primary endpoint). The patient’s medical oncologist and primary chemotherapy nurse were invited to rank the five symptoms they believed the patient would rank as their most severe. We analysed the association of symptoms and their severity with patient demographics, chemotherapy regimen, and patient-reported outcomes. Results were compared to the earlier studies. Overall, 302 patients completed the interview: median age 58 years (range 17–85) 56% female main tumour types colorectal 81 (27%), breast 67 (22%), lung 49 (16%) 45% treated with curative intent. Most common symptoms (reported by %) were: alopecia, general weakness, effects on family artner, loss of taste, nausea, fatigue, difficulty sleeping, effects on work/home duties, and having to put life on hold. The most severe symptoms (ranked by % in top five) were: concern about effects on family artner, nausea, fear of the future, fatigue, not knowing what will happen, putting my life on hold, and general weakness. Perceptions of doctors and nurses of patients’ symptom severity closely matched patients’ rankings. Compared to earlier studies, there was an increase in non-physical concerns such as effects on family and future, and a decrease in physical symptoms, particularly vomiting, but nausea, fatigue and general weakness remained bothersome. • Symptoms related to chemotherapy have changed over time, likely due to less toxic regimens and improvements in supportive care. • Effects on family artner, fear of the future, not knowing what will happen, and “life on hold” were major issues for patients. • Vomiting has decreased but nausea, fatigue and general weakness remain common symptoms for chemotherapy patients.
Publisher: Springer Science and Business Media LLC
Date: 02-2019
DOI: 10.1007/S00520-019-04664-W
Abstract: Cancer survivors experience significant health concerns compared to the general population. Sydney Survivorship Clinic (SSC) is a multi-disciplinary clinic aiming to help survivors treated with curative intent manage side effects, and establish a healthy lifestyle. Here, we determine the health concerns of survivors post-primary treatment. Survivors completed questionnaires assessing symptoms, quality of life (QOL), distress, diet, and exercise before attending SSC, and a satisfaction survey after. Body mass index (BMI), clinical findings and recommendations were reviewed. Descriptive statistical methods were used. Overall, 410 new patients attended SSC between September 2013 and April 2018, with 385 survivors included in analysis: median age 57 years (range 18-86) 69% female 43% breast, 31% colorectal and 19% haematological cancers. Median time from diagnosis, 12 months. Common symptoms of at least moderate severity: fatigue (45%), insomnia (37%), pain (34%), anxiety (31%) and with 56% having > 5 moderate-severe symptoms. Overall, 45% scored distress ≥ 4/10 and 62% were rated by clinical psychologist as having 'fear of cancer recurrence'. Compared to population mean of 50, mean global QOL T-score was 47.2, with physical and emotional well-being domains most affected. Average BMI was 28.2 kg/m Distress, fear of cancer recurrence, fatigue, obesity and sedentary lifestyle are common in cancer survivors attending SSC and may best be addressed in a multi-disciplinary Survivorship Clinic to minimise longer-term effects. This model is well-rated by survivors.
Publisher: Wiley
Date: 11-02-2008
Publisher: Mary Ann Liebert Inc
Date: 2017
Abstract: Integrative medicine (IM) has been recognized and introduced into Western healthcare systems over the past two decades. Limited information on IM models is available to guide development of an optimal healthcare service. A scoping review was carried out to evaluate IM models in the extant literature, including the distinctive features of each model, to gain an understanding of the core requirements needed to develop models of IM that best meet the needs of patients. Directed content analysis was used to classify the IM models into systems based on coding schema developed from theoretical models and to identify the key concepts of each system. From 1374 articles identified, 45 studies were included. Models were categorized as theoretical and practical and were sub ided into five main models: coexistence, cooptative, cooperative, collaborative, and patient-centered care. They were then ided into three systems-independent, dependent, and integrative-on the basis of the level of involvement of general practitioners and complementary and alternative medicine (CAM) practitioners. The theoretical coexistence and cooptative models have distinct roles for different health care professionals, whereas practical models tend to be ad hoc market-driven services, dependent on patient demand. The cooperative and collaborative models were team-based, with formalized interaction between the two medical paradigms of conventional medicine and CAM, with the practical models focusing on facilitating communication, behaviors, and relationships. The patient-centered care model recognized the philosophy of CAM and required collaboration between disciplines based around patient needs. The focus of IM models has transferred from providers to patients with the independent and integrative systems. This may require a philosophical shift for IM. Further research is required to best understand how to practice patient-centered care in IM services.
Publisher: American Society of Clinical Oncology (ASCO)
Date: 02-2005
Publisher: Oxford University Press (OUP)
Date: 10-08-2016
DOI: 10.1111/BJD.14662
Publisher: Wiley
Date: 31-10-2017
DOI: 10.1002/OBY.22015
Publisher: Wiley
Date: 26-10-2016
DOI: 10.1111/AJCO.12591
Abstract: The main aim of this research was to describe the availability and integration of supportive care programs (SCPs), particularly complementary and alternative medicine (CAM) services, for adults in Australian oncology treatment centers. We systematically searched 124 Australian hospitals listed as having an oncology department out of a total of 1157 hospitals listed in the Australian Hospitals and Aged Care Databases (2014), and assessed their website and relevant leaflets. Direct contact was made with a relevant staff member in each hospital. Data were collected regarding the range of SCP and CAM services available. Of the 124 hospitals, 89 (72%) provide nonspecific guidance to SCP or a staff member (e.g. social worker or care coordinator) who directs patients, advising them about SCP 35 hospitals (28%) provide active referral to SCP, of which 24 of 35 (69%) include CAM in their service, with in idual variation in how it is incorporated. Only 11 (46%) of these 24 CAM incorporated oncology centers in Australia provided systematically integrated CAM programs. The majority of Australian oncology departments do not have CAM incorporated into their services. In those that do, less than half had systemically integrated CAM. The types of CAM available, how they are accessed and how they are integrated varied across hospitals. Further research is required to understand how to successfully and systematically integrate cancer-specific supportive care such as CAM into Australian cancer services.
Publisher: Mary Ann Liebert Inc
Date: 12-2017
Abstract: This study explored the models of services and experiences of coordinators and directors engaged in providing complementary and alternative medicine (CAM) or integrative medicine (IM) in oncology centers throughout Australia. Fourteen leaders of IM programs from ten systematically selected Australian oncology centers were interviewed. Participants described their center's service model. Interview transcripts were thematically analyzed to identify underlying themes. Results were merged using the matrix technique for triangulation. Ten oncology centers were reviewed. IM was perceived in the context of supportive care and wellness. IM program types provided included the following: body-mind programs (56%) body-energy programs (23%), and body programs (21%). All programs were outpatient focused, generally did not require a doctors' referral, were freely accessible to cancer patients and carers at no or minimal cost, were centralized by coordinators, and involved volunteers, nurses, allied health practitioners, third parties, and patients in their treatment planning. Interaction between medical and CAM/IM teams was limited and tended to be informal. The underlying structure comprised four main themes: cultural context, human components, systematic components, and resource availability. Human components and resources were considered important in influencing cultural context and systematic components in the IM structure. Australian integrative oncology models are based on the concept of wellness and in idualized care, focused on patient empowerment and engagement. IM models are generally independent of conventional medical care. Building relationships and trust between stakeholders and open collaboration with conventional medical care will be important to integrate IM into the hospital system. Systemic changes to deliver patient centered care in the provision of IM healthcare will facilitate the incorporation of CAM and IM into cancer services in hospital settings.
Publisher: Springer Science and Business Media LLC
Date: 25-01-2017
DOI: 10.1007/S00520-017-3590-2
Abstract: Integrative medicine (IM) has received increasing attention since the 1990s, but few studies have explored the key factors of the IM model in health care. This study aimed to describe the IM model in leading centers operating in the USA and Germany. A 28-item structured survey and semi-structured interviews were conducted in six centers providing integrative medicine in the USA and Germany, and were analyzed using a convergent mixed-method approach. The elements in common across all six centers were the following: (1) involvement of general physicians (GP) in delivering complementary and alternative medicine (CAM) services (2) requirement for GP or medical referral or recommendation to CAM services (3) involvement of an integrative physician (IP) as a "gatekeeper" (4) focus on research, education, and clinical practice and (5) ongoing academic activities. The key elements differentiating the two countries were the following: (1) level of requirements for GP referral to CAM services (2) differences in IM service delivery, including treatment modalities used (3) accessibility of CAM services to patients (4) interaction between team members and patients (5) perception of CAM/IM and (6) perception of patient-centered care. Themes underpinning these elements are the following: cultural aspects in conceptualizing IM health care communication within IM programs and resource availability for delivering IM services, which impacts patient engagement and team collaboration in the IM framework. Delivering IM health care requires a model of care that encourages interaction between all stakeholders. Developing a comprehensive conceptual framework to support IM practice is required to facilitate efficient and safe patient care.
Publisher: Elsevier BV
Date: 12-2010
DOI: 10.1016/J.PBB.2010.08.019
Abstract: Clinical studies have suggested that cognitive impairment due to chemotherapy persists long after treatment cessation. While animal studies have similarly found impairments in cognition due to chemotherapy, these studies are limited as they only assess the acute or extremely short-term effects of chemotherapy on cognition (e.g. within 1month of treatment). Male hooded Wistar rats (N=22) received either a high dose of methotrexate (MTX: 250mg/kg i.p.) or physiological saline. Cognitive performance was evaluated acutely at 2weeks, and up to 8months post injection using the Morris water maze, Novel object recognition task, and an instrumental go/no-go task to assess discrimination learning. MTX-treated rats displayed impaired novel object recognition compared to controls at 11, 95, and 255days after treatment. MTX rats were able to learn the hidden spatial location of a platform 22days after treatment. When tested again after a 95-day retention interval, MTX rats showed impaired spatial memory compared to controls, but were subsequently able to re-learn the task. Finally, MTX-treated rats showed considerable difficulty learning to inhibit their behaviour in an instrumental discrimination task. These results show that chemotherapy produces persistent but subtle cognitive deficits in laboratory rodents that vary with time post treatment.
Publisher: American Society of Clinical Oncology (ASCO)
Date: 12-2015
Abstract: Cognitive dysfunction is reported in people with cancer. Therefore, we evaluated longitudinal changes in cognitive function and underlying mechanisms in people with colorectal cancer (CRC) and healthy controls (HCs). Participants completed cognitive assessments and questionnaires reporting cognitive symptoms, fatigue, quality of life, and anxiety/depression at baseline (before chemotherapy, if given) and 6, 12, and 24 months. Blood tests included cytokines, clotting factors, apolipoprotein E genotype, and sex hormones. Primary end point was overall cognitive function measured by the Global Deficit Score at 12 months. We recruited 289 patients with localized CRC (173 received chemotherapy median age, 59 years 63% male), 73 patients with limited metastatic/recurrent CRC, and 72 HCs. Cognitive impairment was more frequent in patients with localized CRC than HCs at baseline (43% v 15%, respectively P .001) and 12 months (46% v 13%, respectively P .001), with no significant effect of chemotherapy. Attention/working memory, verbal learning/memory, and complex processing speed were most affected. Cognitive impairment was similar in patients with localized and metastatic CRC. Cytokine levels were elevated in patients with CRC compared with HCs. There was no association between overall cognitive function and fatigue, quality of life, anxiety/depression, or any blood test. Cognitive symptoms at 12 months were reported in 25% of patients with localized CRC versus 17% of HCs (P = .19). More participants who received chemotherapy had cognitive symptoms at 6 months (32%) versus those who did not (16% P = .007), with no significant difference at 12 months (29% v 21%, respectively P = .19). Objective cognitive function was only weakly associated with cognitive symptoms. Patients with CRC had substantially more cognitive impairment at every assessment than HCs, with no significant added effect of chemotherapy. Mechanisms of cognitive impairment remain unknown.
Publisher: Wiley
Date: 14-04-2021
DOI: 10.1111/AJCO.13564
Abstract: Evaluate feasibility and outcomes of a multimodal prehabiliation program in patients with stage I‐III colorectal cancer (CRC) awaiting surgery. Patients scheduled for elective CRC resection at Concord Repatriation General Hospital were recruited from pre‐admission clinic between January and November 2018. Participants received a 2‐4 week prehabilitation program consisting of supervised exercise sessions, nurse‐led phone support, and written nutritional information. Participants were assessed at baseline, pre‐surgery, and 4 weeks post‐surgery. Twenty‐two patients participated in the program: 55% male median age 73 (56‐86) years. Six (28%) required an interpreter. At baseline, 19 of 22 (86%) had at least one comorbidity. Median intervention length was 11.5 days (range 7‐29). Participants attended 79% of scheduled exercise sessions (range 33‐100%, mean 3.5 sessions) and 66% of nurse support calls (range 0‐100%, mean 2.6 sessions). Between baseline and pre‐surgery, participants reported increasing mean unsupervised moderate‐intensity aerobic exercise from 17 (range 0‐210) to 73 minutes/week (range 0–276) and mean vigorous‐intensity aerobic exercise from 0 to 24 minutes/week (range 0‐300). Resistance exercise sessions increased from 0.6 to 2.6 times/week. Mean 6‐minute walk test distance increased by 48 meters (435‐483 m) and 30‐second "sit to stand" by 1.6 repetitions. Small improvements were seen in global quality of life and fatigue. Nutritional status and body composition remained unchanged. All participants were satisfied/strongly satisfied with the program and would recommend it to others. Our multimodal prehabilitation program was feasible in CRC patients inclusive of those from non‐English speaking backgrounds, with improvement in functional capacity before CRC surgery.
Publisher: MDPI AG
Date: 24-10-2023
Publisher: Elsevier BV
Date: 03-2011
Publisher: Elsevier BV
Date: 06-2009
Publisher: Wiley
Date: 14-10-2012
DOI: 10.1111/ADJ.12000
Abstract: Why oral health status outside capital cities is poorer than that in capital cities has not been satisfactorily explained. The aim of this study was to determine if the reason was poorer access to dental care. Data were obtained from the Australian National Survey of Adult Oral Health (2004-06). Oral health status was measured by DMFT Index, and numbers of decayed, missing and filled teeth. A two-step analysis was undertaken: comparing the dependent variables by location, socio-demographic confounders and preventive dental behaviours, and then including six access to dental care variables. Of the 14 123 people interviewed, 5505 were examined, and 4170 completed the questionnaire. With socio-economic parameters in the first regression model, non-capital city people had higher DMFT (regression coefficient = 1.15, p < 0.01), more decayed (0.42, p < 0.01) and missing teeth (0.85, p < 0.01), but not filled teeth (-0.11, p = 0.71), than capital city based people. In the second step analysis, non-capital city people still had a greater DMFT (1.01, p < 0.01), more decayed (0.27, p = 0.03) and missing teeth (0.74, p < 0.01), but not filled teeth (0.00, p = 0.99) than capital city based people. Access to dental care was not the only reason why people outside capital cities have poorer oral health than people living in capital cities.
Publisher: Springer Science and Business Media LLC
Date: 20-06-2016
DOI: 10.1007/S00520-016-3315-Y
Abstract: Cancer-related cognitive changes (CRCC) can have a profound impact on a cancer survivor's quality of life. However, cancer survivors frequently report receiving limited information about their experience of CRCC from their oncology specialists. This qualitative study aimed to explore the perceptions of oncology specialists regarding CRCC and the potential for their views to influence their decisions about patient care. Thirteen medical oncologists and five radiation oncologists currently practising in Australia participated in this study. Data collection involved in idual semi-structured interviews via telephone. Data were audio-recorded, transcribed verbatim and analysed using a thematic approach. Four key themes emerged: (1) beliefs about the impact of priming on cancer survivors' perceived cognitive function, (2) perceptions of who is more likely to raise concerns of cognitive change, (3) uncertainty of how to best manage CRCC, and (4) the perceived role of oncologists in the management of CRCC. CRCC and its impact on the cancer survivor's journey have been under-addressed by oncology specialists, and they are uncertain of potential management strategies. With cancer survival rates increasing, there is a need for specific interventions and management guidelines addressing CRCC and their effects on cancer survivors. Future exploration should focus on the survivor as central to their care and holistic approaches to CRCC management involving all members of the multidisciplinary team.
Publisher: Springer Science and Business Media LLC
Date: 14-04-2022
DOI: 10.1007/S00520-022-07008-3
Abstract: Our longitudinal study reported cognitive impairment in 43% of people following diagnosis of localised colorectal cancer (CRC) versus 15% in healthy controls ( p 0.001) and 50% versus 13% 1–2 years later ( p 0.001). Here we evaluate cognitive function and neuroimaging in a subgroup at long-term follow-up. Cancer-free Australian participants in the study, and controls, completed cognitive and functional assessments. Neuroimaging was optional. Blood tests included inflammatory markers, clotting factors, sex hormones and apolipoprotein E genotype. The primary endpoint was demographically and practice effect-corrected cognitive scores comparing CRC survivors with controls over time examined using a linear mixed model, adjusted for baseline performance. Secondary endpoints included cognitive impairment rate using the Global Deficit Score [GDS 0.5], Functional Deficit Score, blood results and neuroimaging. The study included 25 CRC survivors (60% men, median age 72) at mean 9 years after baseline (9 received adjuvant chemotherapy) and 25 controls (44% men, median age 68) at mean 6 years after baseline. There were no significant differences in cognitive scores or proportion with cognitive impairment (16 vs. 8%) between survivors and controls and no evidence of accelerated ageing in CRC survivors. Baseline cognitive performance predicted for subsequent cognitive function. There were no differences in functional tests or blood tests between groups. In 18 participants undergoing neuroimaging, 10 CRC survivors had higher myoinositol levels than 8 controls, and lower volume in the right amygdala and caudate and left hippoc al regions. There was no difference in cognitive capacity and function between CRC survivors and controls 6–12 years after diagnosis. Differences in neuroimaging require confirmation in a larger s le. • No evidence of long term cognitive impairment in colorectal cancer survivors compared to controls 6–12 years after diagnosis • No evidence of accelerated cognitive ageing in colorectal cancer survivors • No evidence of long-term functional impairment in colorectal cancer survivors
Publisher: Elsevier BV
Date: 11-2012
DOI: 10.1016/J.CRITREVONC.2012.03.001
Abstract: The relationship between asbestos exposure and malignant mesothelioma (MM) has been well established. Despite bans on asbestos use in an increasing number of nations, the prolonged latency from exposure to diagnosis, and the ongoing presence and use of these dangerous fibres, have led to the increasing prevalence of this deadly disease worldwide. Whilst occupational contact has been implicated in the bulk of diagnosed cases over the past 50 years, a significant proportion of disease has been linked to para-occupational, domestic and environmental exposure. In this review, we will provide an update on the impact of historical and ongoing asbestos contact in both occupational and non-occupational settings. Furthermore, we will address the unresolved controversies surrounding the use of chrysotile asbestos, the effect of gender and genetics on development of this disease, childhood mesothelioma and co-aetiological factors including SV40 exposure.
Publisher: American Society of Clinical Oncology (ASCO)
Date: 06-2014
Abstract: The WHO analgesic ladder for the treatment of cancer pain provides a three-step sequential approach for analgesic administration based on pain severity that has global applicability. Nonopioids were recommended for mild pain, with the addition of mild opioids for moderate pain and strong opioids for severe pain. Here, we review the evidence for the use of nonopioid analgesic agents in patients with cancer and describe the mode of action of the main drug classes. Evidence supports the use of anti-inflammatory drugs such as acetaminophen aracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) for mild cancer pain. Adding an NSAID to an opioid for stronger cancer pain is efficacious, but the risk of long-term adverse effects has not been quantified. There is limited evidence to support using acetaminophen with stronger opioids. Corticosteroids have a specific role in spinal cord compression and brain metastases, where improved analgesia is a secondary benefit. There is limited evidence for adding corticosteroids to stronger opioids when pain control is the primary objective. Systematic reviews suggest a role for antidepressant and anticonvulsant medications for neuropathic pain, but there are methodologic issues with the available studies. Bisphosphonates improve pain in patients with bony metastases in some tumor types. Denosumab may delay worsening of pain compared with bisphosphonates. Larger studies of longer duration are required to address outstanding questions concerning the use of nonopioid analgesia for stronger cancer pain.
Publisher: Springer Science and Business Media LLC
Date: 08-10-2013
DOI: 10.1007/S00213-013-3301-8
Abstract: A subset of cancer survivors demonstrates impairments in cognition long after chemotherapy completion. At present, it is unclear whether these changes are due to direct neurotoxic effects of chemotherapy. This study examined the impact of variable docetaxel (DTX) chemotherapy dosing on brain DTX exposure via analyses of neural morphology and changes in cognition. Male CD-1 mice were treated with DTX either intermittently (8 mg/kg i.p. weekly) or via a sustained delivery system (DTX-PoLigel), which continuously releases DTX. Both groups received total DTX doses of 32 mg/kg. Mice were assessed on the novel object recognition (NOR) task and the Morris water maze (MWM) shortly after treatment. Post-treatment behavioral testing demonstrated impaired NOR in mice treated with either dosing schedule relative to controls. No differences were observed between groups in MWM training and initial testing, though control mice performed better than chance while DTX-treated mice did not. Appreciable amounts of DTX were found in the brain after both treatment regimens. DTX treatment did not significantly increase levels of apoptosis within the CNS. However, some elevation in neural autophagy was observed following DTX treatment. Analysis of astrocytic activation demonstrated that intermittent DTX treatment resulted in an elevation of GFAP-positive astrocytes for 48 h after administration. Sustained chemotherapy demonstrated prolonged but lower levels of astrocyte activation over 9 days following implantation. DTX treatment induced cognitive impairment shortly after treatment. Further, these findings suggest an association between DTX dosing, neurotoxicity, and cognitive effects.
Publisher: Springer US
Date: 2009
Publisher: Springer Science and Business Media LLC
Date: 27-10-2021
Publisher: Springer Science and Business Media LLC
Date: 03-08-2011
Abstract: Chemotherapy has improved survival rates in patients with many of the common cancers. However, there is reliable evidence that, as a result of treatment, a subset of cancer survivors experience cognitive problems that can last for many years after the completion of chemotherapy. The etiology of this phenomenon is largely unknown, and currently there are no proven treatments. This article explores the clinical and preclinical literature on potential therapies for chemotherapy-induced cognitive impairments. Emerging results suggest that both pharmacological and behavioral approaches may offer patients some benefits. However, research in this area has been limited and is sometimes fraught with methodological flaws. As a result, it is difficult to draw definite conclusions regarding treatment efficacy. These issues, along with predictors of cognitive decline, are discussed in the light of possible interventions.
Publisher: Elsevier BV
Date: 09-2009
Abstract: Appropriately timed cessation of chemotherapy is integral to patient's quality of life. We evaluate the use of and associated factors with chemotherapy at the end of life. A review of deceased oncology patients treated with palliative intent from April 2005 over 2 years at two cancer centres was carried out. Chi-square tests of patient demographics, cancer and chemotherapy variables were carried out to determine associations with commencing chemotherapy and continuation within 2 and 4 weeks of death. Multivariate analyses were carried out with significant factors to determine their independent effect. Seven hundred and forty-seven patients died during this period median age 67 years (range 20-96) female 44%. Three hundred and ninety-eight (53%) received chemotherapy: 18% and 8% within 4 and 2 weeks of death, respectively. Younger age (P < 0.01), cancer type (P < 0.01) and chemosensitivity of the tumour (P < 0.01) were predictors for commencing chemotherapy in multivariate analysis. Treating doctor predicted for chemotherapy in the 4 weeks before death (<0.05), but none of the variables predicted for chemotherapy in the last 2 weeks of life. Younger age, tumour type and chemosensitivity are important predictors of patients receiving palliative chemotherapy. In idual clinician was the only predictor for continuing chemotherapy in the last 4 weeks of life.
Publisher: Springer Science and Business Media LLC
Date: 14-07-2020
No related grants have been discovered for Janette Vardy.