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Shu DH, Ho WJ, Kagohara LT, Girgis A, Shin SM, Danilova L, Lee JW, Sidiropoulos DN, Mitchell S, Munjal K, Howe K, Bendinelli KJ, Qi H, Mo G, Montagne J, Leatherman JM, Lopez-Vidal TY, Zhu Q, Huff AL, Yuan X, Hernandez A, Coyne EM, Zaidi N, Zabransky DJ, Engle LL, Ogurtsova A, Baretti M, Laheru D, Durham JN, Wang H, Anders R, Jaffee EM, Fertig EJ, Yarchoan M. Immune landscape of tertiary lymphoid structures in hepatocellular carcinoma (HCC) treated with neoadjuvant immune checkpoint blockade. bioRxiv 2023:2023.10.16.562104. [PMID: 37904980 PMCID: PMC10614819 DOI: 10.1101/2023.10.16.562104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Neoadjuvant immunotherapy is thought to produce long-term remissions through induction of antitumor immune responses before removal of the primary tumor. Tertiary lymphoid structures (TLS), germinal center-like structures that can arise within tumors, may contribute to the establishment of immunological memory in this setting, but understanding of their role remains limited. Here, we investigated the contribution of TLS to antitumor immunity in hepatocellular carcinoma (HCC) treated with neoadjuvant immunotherapy. We found that neoadjuvant immunotherapy induced the formation of TLS, which were associated with superior pathologic response, improved relapse free survival, and expansion of the intratumoral T and B cell repertoire. While TLS in viable tumor displayed a highly active mature morphology, in areas of tumor regression we identified an involuted TLS morphology, which was characterized by dispersion of the B cell follicle and persistence of a T cell zone enriched for ongoing antigen presentation and T cell-mature dendritic cell interactions. Involuted TLS showed increased expression of T cell memory markers and expansion of CD8+ cytotoxic and tissue resident memory clonotypes. Collectively, these data reveal the circumstances of TLS dissolution and suggest a functional role for late-stage TLS as sites of T cell memory formation after elimination of viable tumor.
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Affiliation(s)
- Daniel H. Shu
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Convergence Institute, Johns Hopkins University, Baltimore, Maryland
| | - Won Jin Ho
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Convergence Institute, Johns Hopkins University, Baltimore, Maryland
| | - Luciane T. Kagohara
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Convergence Institute, Johns Hopkins University, Baltimore, Maryland
| | - Alexander Girgis
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Convergence Institute, Johns Hopkins University, Baltimore, Maryland
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sarah M. Shin
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ludmila Danilova
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jae W. Lee
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Dimitrios N. Sidiropoulos
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Convergence Institute, Johns Hopkins University, Baltimore, Maryland
| | - Sarah Mitchell
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kabeer Munjal
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kathryn Howe
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kayla J. Bendinelli
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hanfei Qi
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Guanglan Mo
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Janelle Montagne
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Convergence Institute, Johns Hopkins University, Baltimore, Maryland
| | - James M. Leatherman
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tamara Y. Lopez-Vidal
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Convergence Institute, Johns Hopkins University, Baltimore, Maryland
| | - Qingfeng Zhu
- Convergence Institute, Johns Hopkins University, Baltimore, Maryland
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Amanda L. Huff
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Convergence Institute, Johns Hopkins University, Baltimore, Maryland
| | - Xuan Yuan
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alexei Hernandez
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Erin M. Coyne
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Neeha Zaidi
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Convergence Institute, Johns Hopkins University, Baltimore, Maryland
| | - Daniel J. Zabransky
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Convergence Institute, Johns Hopkins University, Baltimore, Maryland
| | - Logan L. Engle
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- The Mark Foundation Center for Advanced Genomics and Imaging, Johns Hopkins University, Baltimore, Maryland
- Bloomberg∼Kimmel Institute for Cancer Immunotherapy and Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Aleksandra Ogurtsova
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- The Mark Foundation Center for Advanced Genomics and Imaging, Johns Hopkins University, Baltimore, Maryland
- Bloomberg∼Kimmel Institute for Cancer Immunotherapy and Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Marina Baretti
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel Laheru
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Convergence Institute, Johns Hopkins University, Baltimore, Maryland
| | - Jennifer N. Durham
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hao Wang
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert Anders
- Convergence Institute, Johns Hopkins University, Baltimore, Maryland
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Elizabeth M. Jaffee
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Convergence Institute, Johns Hopkins University, Baltimore, Maryland
- Bloomberg∼Kimmel Institute for Cancer Immunotherapy and Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Elana J. Fertig
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Convergence Institute, Johns Hopkins University, Baltimore, Maryland
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Applied Mathematics and Statistics, Johns Hopkins University Whiting School of Engineering, Baltimore, Maryland
| | - Mark Yarchoan
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Convergence Institute, Johns Hopkins University, Baltimore, Maryland
- Bloomberg∼Kimmel Institute for Cancer Immunotherapy and Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
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Girgis A, Bamgboje-Ayodele A, Rincones O, Vinod S, Avery S, Descallar J, Arnold B, Arnold A, Bray V, Durcinoska I, Rankin N, Delaney G. EP04.01-025 Implementation of Electronic Patient Reported Outcomes in Routine Cancer Care. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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3
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Mazariego C, Jefford M, Chan RJ, Roberts N, Millar L, Anazodo A, Hayes S, Brown B, Saunders C, Webber K, Vardy J, Girgis A, Koczwara B. Priority recommendations for the implementation of patient-reported outcomes in clinical cancer care: a Delphi study. J Cancer Surviv 2022; 16:33-43. [PMID: 35107792 PMCID: PMC8881271 DOI: 10.1007/s11764-021-01135-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/06/2021] [Indexed: 12/13/2022]
Abstract
Purpose The aim of this study was to develop priority recommendations for the service level implementation of patient-reported outcomes (PROs) into clinical cancer care. Methods Development of draft guidance statements was informed by a literature review, the Knowledge to Action (KTA) implementation framework, and discussion with PRO experts and cancer survivors. A two-round modified Delphi survey with key stakeholders including cancer survivors, clinical and research experts, and Information Technology specialists was undertaken. Round 1 rated the importance of the statements and round 2 ranked statements in order of priority. Results Round 1 was completed by 70 participants with round 2 completed by 45 participants. Forty-seven statements were rated in round 2. In round 1, the highest agreement items (>90% agreement) included those that focused on the formation of strong stakeholder partnerships, ensuring ongoing communication within these partnerships, and the use of PROs for improvement and guidance in clinical care. Items ranked as the highest priorities in round 2 included assessment of current staff capabilities and service requirements, mapping of workflows and processes to enable collection, and using collected PROs to guide improved health outcomes. Conclusions This stakeholder consultation process has identified key priorities in PRO implementation into clinical cancer care that include clinical relevance, stakeholder engagement, communication, and integration within the existing processes and capabilities. Implication for Cancer Survivors Routine adoption of PRO collection by clinical cancer services requires multiple implementation steps; of highest priority is strong engagement and communication with key stakeholders including cancer survivors. Supplementary Information The online version contains supplementary material available at 10.1007/s11764-021-01135-2.
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Affiliation(s)
- C Mazariego
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, 153 Dowling street, Woolloomooloo, NSW, 2011, Australia.
| | - M Jefford
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - R J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - N Roberts
- Metro North Health Service, Herston, QLD, Australia.,University of Queensland Centre for Clinical Research, Herston, QLD, Australia
| | - L Millar
- Medical School, University of Western Australia, Perth, WA, Australia
| | - A Anazodo
- School of Women's and Children's Health, University of New South Wales, Randwick, Sydney, Australia.,Kids Cancer Centre, Sydney, Sydney Children's Hospital, Randwick, Sydney, Australia.,Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, Australia
| | - S Hayes
- Consumer representative, Patients First: The Continuous Improvement in Care-Cancer Project, Perth, Australia
| | - B Brown
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Brisbane, Australia
| | - C Saunders
- Medical School, University of Western Australia, Perth, WA, Australia
| | - K Webber
- School of Medical Sciences, Monash University, Clayton, Vic, Australia.,Oncology Department, Monash Health, Clayton, Vic, Australia
| | - J Vardy
- Sydney Medical School, University of Sydney, Camperdown, Australia.,Concord Cancer Centre, Concord Hospital, Concord, NSW, Australia
| | - A Girgis
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
| | - B Koczwara
- Department of Clinical Oncology, Flinders Medical Centre, Adelaide, SA, Australia.,Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
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Perusina Lanfranca M, Zhang Y, Girgis A, Kasselman S, Lazarus J, Kryczek I, Delrosario L, Rhim A, Koneva L, Sartor M, Sun L, Halbrook C, Nathan H, Shi J, Crawford HC, Pasca di Magliano M, Zou W, Frankel TL. Interleukin 22 Signaling Regulates Acinar Cell Plasticity to Promote Pancreatic Tumor Development in Mice. Gastroenterology 2020; 158:1417-1432.e11. [PMID: 31843590 PMCID: PMC7197347 DOI: 10.1053/j.gastro.2019.12.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 12/02/2019] [Accepted: 12/04/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy that invades surrounding structures and metastasizes rapidly. Although inflammation is associated with tumor formation and progression, little is known about the mechanisms of this connection. We investigate the effects of interleukin (IL) 22 in the development of pancreatic tumors in mice. METHODS We performed studies with Pdx1-Cre;LSL-KrasG12D;Trp53+/-;Rosa26EYFP/+ (PKCY) mice, which develop pancreatic tumors, and PKCY mice with disruption of IL22 (PKCY Il22-/-mice). Pancreata were collected at different stages of tumor development and analyzed by immunohistochemistry, immunoblotting, real-time polymerase chain reaction, and flow cytometry. Some mice were given cerulean to induce pancreatitis. Pancreatic cancer cell lines (PD2560) were orthotopically injected into C57BL/6 mice or Il22-/-mice, and tumor development was monitored. Pancreatic cells were injected into the tail veins of mice, and lung metastases were quantified. Acini were collected from C57BL/6 mice and resected human pancreata and were cultured. Cell lines and acini cultures were incubated with IL22 and pharmacologic inhibitors, and protein levels were knocked down with small hairpin RNAs. We performed immunohistochemical analyses of 26 PDACs and 5 nonneoplastic pancreas specimens. RESULTS We observed increased expression of IL22 and the IL22 receptor (IL22R) in the pancreas compared with other tissues in mice; IL22 increased with pancreatitis and tumorigenesis. Flow cytometry indicated that the IL22 was produced primarily by T-helper 22 cells. PKCY Il22-/-mice did not develop precancerous lesions or pancreatic tumors. The addition of IL22 to cultured acinar cells increased their expression of markers of ductal metaplasia; these effects of IL22 were prevented with inhibitors of Janus kinase signaling to signal transducer and activator of transcription (STAT) (ruxolitinib) or mitogen-activated protein kinase kinase (MEK) (trametinib) and with STAT3 knockdown. Pancreatic cells injected into Il22-/- mice formed smaller tumors than those injected into C57BL/6. Incubation of IL22R-expressing PDAC cells with IL22 promoted spheroid formation and invasive activity, resulting in increased expression of stem-associated transcription factors (GATA4, SOX2, SOX17, and NANOG), and increased markers of the epithelial-mesenchymal transition (CDH1, SNAI2, TWIST1, and beta catenin); ruxolitinib blocked these effects. Human PDAC tissues had higher levels of IL22, phosphorylated STAT3, and markers of the epithelial-mesenchymal transition than nonneoplastic tissues. An increased level of STAT3 in IL22R-positive cells was associated with shorter survival times of patients. CONCLUSIONS We found levels of IL22 to be increased during pancreatitis and pancreatic tumor development and to be required for tumor development and progression in mice. IL22 promotes acinar to ductal metaplasia, stem cell features, and increased expression of markers of the epithelial-mesenchymal transition; inhibitors of STAT3 block these effects. Increased expression of IL22 by PDACs is associated with reduced survival times.
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MESH Headings
- Acinar Cells/immunology
- Acinar Cells/pathology
- Animals
- Carcinoma, Pancreatic Ductal/genetics
- Carcinoma, Pancreatic Ductal/immunology
- Carcinoma, Pancreatic Ductal/mortality
- Carcinoma, Pancreatic Ductal/pathology
- Cell Line, Tumor/transplantation
- Cell Plasticity/drug effects
- Cell Plasticity/immunology
- Cell Transformation, Neoplastic/drug effects
- Cell Transformation, Neoplastic/immunology
- Disease Models, Animal
- Epithelial-Mesenchymal Transition/drug effects
- Epithelial-Mesenchymal Transition/immunology
- Female
- HEK293 Cells
- Humans
- Interleukins/immunology
- Interleukins/metabolism
- Janus Kinases/antagonists & inhibitors
- Janus Kinases/metabolism
- Male
- Metaplasia/immunology
- Metaplasia/pathology
- Mice
- Mice, Knockout
- Nitriles
- Pancreas/cytology
- Pancreas/immunology
- Pancreas/pathology
- Pancreatic Neoplasms/genetics
- Pancreatic Neoplasms/immunology
- Pancreatic Neoplasms/mortality
- Pancreatic Neoplasms/pathology
- Pancreatitis/immunology
- Pancreatitis/pathology
- Pyrazoles/pharmacology
- Pyridones/pharmacology
- Pyrimidines
- Pyrimidinones/pharmacology
- RNA, Small Interfering/metabolism
- Receptors, Interleukin/metabolism
- STAT3 Transcription Factor/antagonists & inhibitors
- STAT3 Transcription Factor/metabolism
- Signal Transduction/drug effects
- Signal Transduction/immunology
- Survival Analysis
- Interleukin-22
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Affiliation(s)
| | - Yaqing Zhang
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Alexander Girgis
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | | | - Jenny Lazarus
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Illona Kryczek
- Department of Surgery, University of Michigan, Ann Arbor, Michigan; Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | | | - Andrew Rhim
- Department of Gastroenterology, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Lada Koneva
- Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, Michigan
| | - Maureen Sartor
- Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, Michigan
| | - Lei Sun
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Christopher Halbrook
- Molecular and Integrative Physiology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Hari Nathan
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Jiaqi Shi
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Howard C Crawford
- Molecular and Integrative Physiology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Marina Pasca di Magliano
- Department of Surgery, University of Michigan, Ann Arbor, Michigan; Molecular and Integrative Physiology, University of Michigan Medical School, Ann Arbor, Michigan; Department of Cell and Developmental Biology, University of Michigan, Ann Arbor, Michigan; Program in Cellular and Molecular Biology, University of Michigan, Ann Arbor, Michigan; Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Weiping Zou
- Department of Surgery, University of Michigan, Ann Arbor, Michigan; Department of Pathology, University of Michigan, Ann Arbor, Michigan; Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan; Graduate Programs in Immunology and Tumor Biology, University of Michigan, Ann Arbor, Michigan
| | - Timothy L Frankel
- Department of Surgery, University of Michigan, Ann Arbor, Michigan; Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan.
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Sharpe L, Turner J, Fardell JE, Thewes B, Smith AB, Gilchrist J, Beith J, Girgis A, Tesson S, Day S, Grunewald K, Butow P. Psychological intervention (ConquerFear) for treating fear of cancer recurrence: mediators and moderators of treatment efficacy. J Cancer Surviv 2019; 13:695-702. [PMID: 31347010 DOI: 10.1007/s11764-019-00788-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 07/05/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE ConquerFear is an efficacious intervention for fear of cancer recurrence (FCR) that demonstrated greater improvements than an attention control (relaxation training) in a randomized controlled trial. This study aimed to determine mediators and moderators of the relative treatment efficacy of ConquerFear versus relaxation. METHODS One hundred and fifty-two cancer survivors completed 5 therapy sessions and outcome measures before and after intervention and at 6 months' follow-up. We examined theoretically relevant variables as potential mediators and moderators of treatment outcome. We hypothesized that metacognitions and intrusions would moderate and mediate the relationship between treatment group and FCR level at follow-up. RESULTS Only total FCR score at baseline moderated treatment outcome. Participants with higher levels of FCR benefited more from ConquerFear relative to relaxation on the primary outcome. Changes in metacognitions and intrusive thoughts about cancer during treatment partially mediated the relationship between treatment group and FCR. CONCLUSIONS These results show that ConquerFear is relatively more effective than relaxation for those with overall higher levels of FCR. The mediation analyses confirmed that the most likely mechanism of treatment efficacy was the reduction in unhelpful metacognitions and intrusive thoughts during treatment, consistent with the theoretical framework underpinning ConquerFear. IMPLICATIONS FOR CANCER SURVIVORS ConquerFear is a brief, effective treatment for FCR in cancer survivors with early-stage disease. The treatment works by reducing intrusive thoughts about cancer and changing beliefs about worry and is particularly helpful for people with moderate to severe FCR.
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Affiliation(s)
- Louise Sharpe
- School of Psychology, University of Sydney, Brennan MacCallum (A18), Camperdown, NSW, 2006, Australia.
| | - J Turner
- Mental Health Centre, Faculty of Medicine, University of Queensland, Saint Lucia, Australia
| | - J E Fardell
- Kids Cancer Centre, Sydney Children's Hospital and School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Saint Lucia, Australia
| | - B Thewes
- School of Psychology, University of Sydney, Brennan MacCallum (A18), Camperdown, NSW, 2006, Australia.,Department Medical Psychology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - A B Smith
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - J Gilchrist
- Crown Princess Mary Cancer Centre, Breast Cancer Institute, Westmead Hospital, Westmead, Australia
| | - J Beith
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Camperdown, Australia.,Department of Medical Oncology, Chris O'Brien Lifehouse, Missenden Rd., Camperdown, Australia
| | - A Girgis
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - S Tesson
- School of Psychology, University of Sydney, Brennan MacCallum (A18), Camperdown, NSW, 2006, Australia
| | - S Day
- School of Psychology, University of Sydney, Brennan MacCallum (A18), Camperdown, NSW, 2006, Australia
| | - K Grunewald
- School of Psychology, University of Sydney, Brennan MacCallum (A18), Camperdown, NSW, 2006, Australia
| | - P Butow
- School of Psychology, University of Sydney, Brennan MacCallum (A18), Camperdown, NSW, 2006, Australia.,Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Camperdown, Australia
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6
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Lazarus J, Maj T, Smith JJ, Perusina Lanfranca M, Rao A, D'Angelica MI, Delrosario L, Girgis A, Schukow C, Shia J, Kryczek I, Shi J, Wasserman I, Crawford H, Nathan H, Pasca Di Magliano M, Zou W, Frankel TL. Spatial and phenotypic immune profiling of metastatic colon cancer. JCI Insight 2018; 3:121932. [PMID: 30429368 DOI: 10.1172/jci.insight.121932] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 10/11/2018] [Indexed: 12/14/2022] Open
Abstract
Paramount to the efficacy of immune checkpoint inhibitors is proper selection of patients with adequate tumor immunogenicity and a robust but suppressed immune infiltrate. In colon cancer, immune-based therapies are approved for patients with DNA mismatch repair (MMR) deficiencies, in whom accumulation of genetic mutations results in increased neoantigen expression, triggering an immune response that is suppressed by the PD-L1/PD-1 pathway. Here, we report that characterization of the microenvironment of MMR-deficient metastatic colorectal cancer using multiplex fluorescent immunohistochemistry (mfIHC) identified increased infiltration of cytotoxic T lymphocytes (CTLs), which were more often engaged with epithelial cells (ECs) and improved overall survival. A subset of patients with intact MMR but a similar immune microenvironment to MMR-deficient patients was identified and found to universally express high levels of PD-L1, suggesting that they may represent a currently untreated, checkpoint inhibitor-responsive population. Further, PD-L1 expression on antigen-presenting cells (APCs) in the tumor microenvironment (TME) resulted in impaired CTL/EC engagement and enhanced infiltration and engagement of Tregs. Characterization of the TME by mfIHC highlights the interconnection between immunity and immunosuppression in metastatic colon cancer and may better stratify patients for receipt of immunotherapies.
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Affiliation(s)
- Jenny Lazarus
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Tomasz Maj
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - J Joshua Smith
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Arvind Rao
- Department of Computational Medicine & Bioinformatics, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael I D'Angelica
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Alexander Girgis
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Casey Schukow
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Jinru Shia
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ilona Kryczek
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Isaac Wasserman
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Howard Crawford
- Department of Molecular and Cellular Physiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Hari Nathan
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Weiping Zou
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.,Department of Pathology and
| | - Timothy L Frankel
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
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7
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Watts KJ, Meiser B, Zilliacus E, Kaur R, Taouk M, Girgis A, Butow P, Kissane DW, Hale S, Perry A, Aranda SK, Goldstein D. Perspectives of oncology nurses and oncologists regarding barriers to working with patients from a minority background: Systemic issues and working with interpreters. Eur J Cancer Care (Engl) 2017; 27:e12758. [PMID: 28892208 DOI: 10.1111/ecc.12758] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2017] [Indexed: 11/29/2022]
Abstract
This study aimed to ascertain the systemic barriers encountered by oncology health professionals (HPs) working with patients from ethnic minorities to guide the development of a communication skills training programme. Twelve medical and five radiation oncologists and 21 oncology nurses were invited to participate in this qualitative study. Participants were interviewed individually or in a focus group about their experiences working with people from minority backgrounds. All interviews were transcribed verbatim and analysed thematically. HPs encountered language and communication barriers in their interactions with patients and their families, which were perceived to impact negatively on the quality and amount of information and support provided. There was a shortage of, and poor processes for engaging, interpreters and some HPs were concerned about the accuracy of interpretation. HPs expressed a need for training in cultural awareness and communication skills with a preference for face-to-face delivery. A lack of funding, a culture of "learning on the job", and time constraints were systemic barriers to training. Oncologists and oncology nurses encounter complex challenges in clinical interactions with minority patients and their families, including difficulties working with interpreters. Formal training programmes targeted to the development of culturally competent communication skills are required.
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Affiliation(s)
- K J Watts
- Prince of Wales Clinical School, The University of New South Wales, Sydney, Australia
| | - B Meiser
- Prince of Wales Clinical School, The University of New South Wales, Sydney, Australia
| | - E Zilliacus
- Prince of Wales Clinical School, The University of New South Wales, Sydney, Australia
| | - R Kaur
- Prince of Wales Clinical School, The University of New South Wales, Sydney, Australia
| | - M Taouk
- Prince of Wales Clinical School, The University of New South Wales, Sydney, Australia
| | - A Girgis
- Prince of Wales Clinical School, The University of New South Wales, Sydney, Australia.,Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - P Butow
- Psycho-Oncology Co-operative Research Group, Centre for Medical Psychology and Evidence-based Decision-Making, The University of Sydney, Sydney, Australia
| | - D W Kissane
- Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - S Hale
- Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia
| | - A Perry
- Multicultural Health Service, South Eastern Sydney Local Health District, Sydney, Australia
| | - S K Aranda
- School of Health Sciences, University of Melbourne, Melbourne, VIC, Australia.,Cancer Council Australia, Sydney, Australia
| | - D Goldstein
- Prince of Wales Clinical School, The University of New South Wales, Sydney, Australia.,Department of Medical Oncology, Prince of Wales Hospital, Sydney, NSW, Australia
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Lanfranca MP, Kryczek I, Rhim A, Girgis A, Lazarus J, Di Magliano MP, Zou W, Frankel T. IL-22 Promotes Pancreatic Cancer Tumorigenesis through Induction of Stemness and Epithelial to Mesenchymal Transition. The Journal of Immunology 2017. [DOI: 10.4049/jimmunol.198.supp.66.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Elevated levels of Interleukin 22 (IL-22) and its receptor (IL-22R) are associated with poor prognosis in pancreatic ductal adenocarcinoma (PDAC) and the underlying mechanism is currently unknown. Our aim is to investigate the role of the IL-22 axis in PDAC initiation and progression.
Impact of IL-22 on tumor initiation was assayed by subcutaneous and intravenous inoculation of PDAC cells into wild-type and IL-22−/− mice. The PKCY (Pdx1-Cre; KrasG12D; p53fl/+; RosaYFP) model of pancreas cancer was used to study the in-vivo presence and significance of IL-22 in spontaneous tumors. Results were confirmed in human specimens of surgically resected pancreas cancer.
IL-22R was present in all tested PDAC lines and IL-22 treatment led to STAT3 phosphorylation and subsequent increased expression of EMT (Epithelial to Mesenchymal Transition) transcription factors. Cells transitioned to a mesenchymal phenotype and robust tumor sphere formation was observed. While tumors readily formed in wild-type mice, initiation, establishment and growth were impaired in IL-22−/− mice and PKCY-IL-22−/− mice. Increased levels of IL-22 were found in both spontaneous murine tumors and surgical specimens compared to control tissue. IHC of tumors showed diffuse IL-22R staining with increasing intensity of pSTAT3 and EMT markers as tumors progressed to invasive cancer. FACS analysis identified type 3 innate lymphoid cells and TH22 cells as the source of IL-22 in both human and murine PDAC.
Our data suggests that IL-22 is integral in the initiation, progression and establishment of pancreatic cancer, positioning it as an attractive target for cancer therapy.
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Thewes B, Davis E, Girgis A, Valery PC, Giam K, Hocking A, Jackson J, He VY, Yip D, Garvey G. Routine screening of Indigenous cancer patients' unmet support needs: a qualitative study of patient and clinician attitudes. Int J Equity Health 2016; 15:90. [PMID: 27286811 PMCID: PMC4902957 DOI: 10.1186/s12939-016-0380-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 06/06/2016] [Indexed: 12/18/2022] Open
Abstract
Background Indigenous Australians have poorer cancer outcomes in terms of incidence mortality and survival compared with non-Indigenous Australians. The factors contributing to this disparity are complex. Identifying and addressing the psychosocial factors and support needs of Indigenous cancer patients may help reduce this disparity. The Supportive Care Needs Assessment Tool for Indigenous People (SCNAT-IP) is a validated 26-item questionnaire developed to assess their unmet supportive care needs. This qualitative study reports on patient and clinician attitudes towards feasibility and acceptability of SCNAT-IP in routine care. Methods Forty-four in-depth semi-structured interviews were conducted with 10 clinical staff and 34 Indigenous cancer patients with heterogeneous tumours. Participants were recruited from four geographically diverse Australian cancer clinics. Transcripts were imported into qualitative analysis software (NVivo 10 Software), coded and thematic analysis performed. Results Indigenous patients (mean age 54.4 years) found the SCNAT-IP beneficial and easy to understand and they felt valued and heard. Clinical staff reported multiple benefits of using the SCNAT-IP. They particularly appreciated its comprehensive and systematic nature as well as the associated opportunities for early intervention. Some staff described improvements in team communication, while both staff and patients reported that new referrals to support services were directly triggered by completion of the SCNAT-IP. There were also inter-cultural benefits, with a positive and bi-directional exchange of information and cultural knowledge reported when using the SCNAT-IP. Although staff identified some potential barriers to using the SCNAT-IP, including the time required, the response format and comprehension difficulties amongst some participants with low English fluency, these were outweighed by the benefits. Some areas for scaled improvement were also identified by staff. Conclusions Staff and patients found the SCNAT-IP to be an acceptable tool and supported universal screening for Indigenous cancer patients. The SCNAT-IP has the potential to help reduce the inequalities in cancer care experienced by Indigenous Australians by identifying and subsequently addressing their unmet support needs. Further research is needed to explore the validity of the SCNAT-IP for Indigenous people from other nations.
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Affiliation(s)
- B Thewes
- Menzies School of Health Research, Charles Darwin University, Adelaide Street, PO Box 10639, Brisbane, QLD, 4000, Australia
| | - E Davis
- Menzies School of Health Research, Charles Darwin University, Adelaide Street, PO Box 10639, Brisbane, QLD, 4000, Australia
| | - A Girgis
- South Western Sydney Clinical School, UNSW, Sydney, Australia
| | - P C Valery
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - K Giam
- Alan Walker Cancer Care Centre, Royal Darwin Hospital, Darwin, Australia
| | - A Hocking
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - J Jackson
- Southern NSW Local Health District, New South Wales, Australia
| | - V Yf He
- Menzies School of Health Research, Charles Darwin University, Adelaide Street, PO Box 10639, Brisbane, QLD, 4000, Australia
| | - D Yip
- ANU Medical School, Australian National University, Canberra, Australia
| | - G Garvey
- Menzies School of Health Research, Charles Darwin University, Adelaide Street, PO Box 10639, Brisbane, QLD, 4000, Australia.
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10
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James EL, Stacey FG, Chapman K, Boyes AW, Burrows T, Girgis A, Asprey G, Bisquera A, Lubans DR. Impact of a nutrition and physical activity intervention (ENRICH: Exercise and Nutrition Routine Improving Cancer Health) on health behaviors of cancer survivors and carers: a pragmatic randomized controlled trial. BMC Cancer 2015; 15:710. [PMID: 26471791 PMCID: PMC4608129 DOI: 10.1186/s12885-015-1775-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 10/10/2015] [Indexed: 12/19/2022] Open
Abstract
Background Physical activity and consuming a healthy diet have clear benefits to the physical and psychosocial health of cancer survivors, with guidelines recognising the importance of these behaviors for cancer survivors. Interventions to promote physical activity and improve dietary behaviors among cancer survivors and carers are needed. The aim of this study was to determine the effects of a group-based, face-to-face multiple health behavior change intervention on behavioral outcomes among cancer survivors of mixed diagnoses and carers. Methods The Exercise and Nutrition Routine Improving Cancer Health (ENRICH) intervention was evaluated using a two-group pragmatic randomized controlled trial. Cancer survivors and carers (n = 174) were randomly allocated to the face-to-face, group-based intervention (six, theory-based two-hour sessions delivered over 8 weeks targeting healthy eating and physical activity [PA]) or wait-list control (after completion of 20-week data collection). Assessment of the primary outcome (pedometer-assessed mean daily step counts) and secondary outcomes (diet and alcohol intake [Food Frequency Questionnaire], self-reported PA, weight, body mass index, and waist circumference) were assessed at baseline, 8-and 20-weeks. Results There was a significant difference between the change over time in the intervention group and the control group. At 20 weeks, the intervention group had increased by 478 steps, and the control group had decreased by 1282 steps; this represented an adjusted mean difference of 1761 steps (184 to 3337; P = 0.0028). Significant intervention effects for secondary outcomes, included a half serving increase in vegetable intake (difference 39 g/day; 95 % CI: 12 to 67; P = 0.02), weight loss (kg) (difference -1.5 kg; 95 % CI, -2.6 to -0.3; P = 0.014) and change in body mass index (kg/m2) (difference -0.55 kg/m2; 95 % CI, -0.97 to -0.13; P = 0.012). No significant intervention effects were found for self-reported PA, total sitting time, waist circumference, fruit, energy, fibre, alcohol, meat, or fat consumption. Conclusions The ENRICH intervention was effective for improving PA, weight, body mass index, and vegetable consumption even with the inclusion of multiple cancer types and carers. As an example of successful research translation, the Cancer Council NSW has subsequently adopted ENRICH as a state-wide program. Trial registration Australian New Zealand Clinical Trials Register identifier: ANZCTRN1260901086257.
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Affiliation(s)
- E L James
- School of Medicine and Public Health, Priority Research Centre for Health Behavior, Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - F G Stacey
- School of Medicine and Public Health, Priority Research Centre for Health Behavior, Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW, Australia. .,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
| | - K Chapman
- Cancer Council New South Wales, Woolloomooloo, NSW, Australia
| | - A W Boyes
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Priority Research Centre for Health Behavior, School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
| | - T Burrows
- School of Health Sciences, Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW, Australia
| | - A Girgis
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, UNSW Medicine, Liverpool, NSW, Australia
| | - G Asprey
- Cancer Council New South Wales, Woolloomooloo, NSW, Australia
| | - A Bisquera
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - D R Lubans
- School of Education, Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW, Australia
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11
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Garvey G, Thewes B, He VFY, Davis E, Girgis A, Valery PC, Giam K, Hocking A, Jackson J, Jones V, Yip D. Indigenous cancer patient and staff attitudes towards unmet needs screening using the SCNAT-IP. Support Care Cancer 2015; 24:215-223. [PMID: 26003424 DOI: 10.1007/s00520-015-2770-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 05/12/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Indigenous Australians have a higher cancer incidence, worse mortality and are less likely to receive optimal cancer treatment compared with non-Indigenous Australians. Culturally appropriate supportive care helps ensure that Indigenous patients engage in and receive optimal care. However, many existing supportive care needs tools lack cultural relevance for Indigenous people, and their feasibility with Indigenous people has not been demonstrated. The Supportive Care Needs Assessment Tool for Indigenous People (SCNAT-IP) assesses the unmet supportive care needs of Indigenous cancer patients. PURPOSE This descriptive study evaluates the clinical implementation of the SCNAT-IP in routine care. METHODS Two large tertiary cancer treatment centres and two regional oncology clinics participated. Participants included 10 clinical staff and 36 adult Indigenous cancer patients (mean age 54 years). Patients and clinicians completed brief, purpose-designed questionnaires and interviews. RESULTS Patients reported high ratings (means >8/10) for acceptability, helpfulness and timing items. The majority (≥80%) of staff agreed that the SCNAT-IP was useful to clinical practice, should be used in routine care and was acceptable to their patients. CONCLUSIONS The study provides empirical support for the feasibility and acceptability of the SCNAT-IP in routine cancer care with Indigenous Australians. Routine screening with the SCNAT-IP has the potential to improve cancer care for Indigenous people with cancer.
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Affiliation(s)
- G Garvey
- Menzies School of Health Research, PO Box 10639, Adelaide Street, Brisbane, QLD, 4000, Australia.
| | - B Thewes
- Menzies School of Health Research, PO Box 10639, Adelaide Street, Brisbane, QLD, 4000, Australia
| | - V F Y He
- Menzies School of Health Research, PO Box 10639, Adelaide Street, Brisbane, QLD, 4000, Australia
| | - E Davis
- Menzies School of Health Research, PO Box 10639, Adelaide Street, Brisbane, QLD, 4000, Australia
| | - A Girgis
- South Western Sydney Clinical School, UNSW, Sydney, Australia
| | - P C Valery
- Menzies School of Health Research, PO Box 10639, Adelaide Street, Brisbane, QLD, 4000, Australia
| | - K Giam
- Alan Walker Cancer Care Centre, Royal Darwin Hospital, Darwin, Australia
| | - A Hocking
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - J Jackson
- Southern NSW Local Health District, Queanbeyan, NSW, Australia
| | - V Jones
- Southern NSW Local Health District, Queanbeyan, NSW, Australia
| | - D Yip
- ANU Medical School, Australian National University, Canberra, Australia
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Sklenarova H, Haun M, Krümpelmann A, Friederich HC, Huber J, Thomas M, Winkler E, Girgis A, Dinkel A, Herzog W, Hartmann M. Psychometric evaluation of the German Version of the Supportive Care Needs Survey for Partners and Caregivers (SCNS-P&C-G) of cancer patients. Eur J Cancer Care (Engl) 2015; 24:884-97. [DOI: 10.1111/ecc.12325] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2015] [Indexed: 11/27/2022]
Affiliation(s)
- H. Sklenarova
- Department of General Internal Medicine & Psychosomatics; Heidelberg University Hospital; D-69120 Heidelberg Germany
| | - M.W. Haun
- Department of General Internal Medicine & Psychosomatics; Heidelberg University Hospital; D-69120 Heidelberg Germany
| | - A. Krümpelmann
- Department of General Internal Medicine & Psychosomatics; Heidelberg University Hospital; D-69120 Heidelberg Germany
| | - H.-C. Friederich
- Department of General Internal Medicine & Psychosomatics; Heidelberg University Hospital; D-69120 Heidelberg Germany
| | - J. Huber
- Department of Urology; University Hospital Carl Gustav Carus; Technical University of Dresden; Dresden 01307 Germany
| | - M. Thomas
- Thoraxklinik-Heidelberg gGmbH; Heidelberg University Hospital; 69126 Heidelberg Germany
| | - E.C. Winkler
- Heidelberg University Hospital; National Center for Tumor Diseases Heidelberg; 69120 Heidelberg Germany
| | - A. Girgis
- Ingham Institute for Applied Medical Research; The University of New South Wales; Liverpool BC NSW 1871 Australia
| | - A. Dinkel
- Department of Psychosomatic Medicine and Psychotherapy; Klinikum rechts der Isar der TU München; 81675 München Germany
| | - W. Herzog
- Department of General Internal Medicine & Psychosomatics; Heidelberg University Hospital; D-69120 Heidelberg Germany
| | - M. Hartmann
- Department of General Internal Medicine & Psychosomatics; Heidelberg University Hospital; D-69120 Heidelberg Germany
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13
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Goldstein D, Bell ML, Butow P, Sze M, Vaccaro L, Dong S, Liauw W, Hui R, Tattersall M, Ng W, Asghari R, Steer C, Vardy J, Parente P, Harris M, Karanth NV, King M, Girgis A, Eisenbruch M, Jefford M. Immigrants' perceptions of the quality of their cancer care: an Australian comparative study, identifying potentially modifiable factors. Ann Oncol 2014; 25:1643-9. [PMID: 24827124 DOI: 10.1093/annonc/mdu182] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND 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. PATIENTS AND METHODS This was a hospital-based sample 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- D Goldstein
- Department of Medical Oncology, Prince of Wales Hospital, Sydney
| | - M L Bell
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney
| | - P Butow
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney Centre of Medical Psychology and Evidence-based Decision-making (CeMPED), University of Sydney, Sydney
| | - M Sze
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney
| | - L Vaccaro
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney
| | - S Dong
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney
| | - W Liauw
- Cancer Care Centre, St George Hospital, Sydney
| | - R Hui
- Department of Medical Oncology, Westmead Hospital and Blacktown Oncology Unit, Blacktown Hospital Sydney, Sydney
| | - M Tattersall
- Department of Cancer Medicine, University of Sydney, Sydney Department of Medical Oncology, Royal Prince Alfred Hospital, Sydney
| | - W Ng
- Department of Medical Oncology, Liverpool Hospital, Sydney
| | - R Asghari
- Bankstown Cancer Care Centre, Bankstown Lidcombe Hospital, Sydney
| | - C Steer
- Border Medical Oncology, Wodonga
| | - J Vardy
- Centre of Medical Psychology and Evidence-based Decision-making (CeMPED), University of Sydney, Sydney
| | - P Parente
- Department of Clinical Haematology and Medical Oncology, Box Hill Hospital, Victoria
| | - M Harris
- Department of Medical Oncology, Monash Medical Centre, Victoria
| | - N V Karanth
- Department of Medical Oncology, Royal Darwin Hospital, Northern Territory
| | - M King
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney
| | - A Girgis
- Translational Cancer Research Unit, Ingham Institute for Applied Medical Research, and University of NSW, Sydney
| | - M Eisenbruch
- School of Psych, Psychiatry and Psych Medicine, Monash University, Victoria
| | - M Jefford
- Sir Peter MacCallum Department of Oncology and Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria Division of Medicine, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
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15
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Mitchell GK, Girgis A, Jiwa M, Sibbritt D, Burridge LH. A tool to assess lay cancer carers' changing needs in general practice. BMJ Support Palliat Care 2011. [DOI: 10.1136/bmjspcare-2011-000020.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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16
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Au A, Lam WWT, Kwong A, Suen D, Tsang J, Yeo W, Suen J, Ho WM, Yau TK, Soong I, Wong KY, Sze WK, Ng A, Girgis A, Fielding R. Validation of the Chinese version of the Short-form Supportive Care Needs Survey Questionnaire (SCNS-SF34-C). Psychooncology 2010; 20:1292-300. [DOI: 10.1002/pon.1851] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Revised: 08/13/2010] [Accepted: 08/16/2010] [Indexed: 11/08/2022]
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Alvarez LW, Anderson JA, Bedwei FE, Burkhard J, Fakhry A, Girgis A, Goneid A, Hassan F, Iverson D, Lynch G, Miligy Z, Moussa AH, Sharkawi M, Yazolino L. Search for hidden chambers in the pyramids. Science 2010; 167:832-9. [PMID: 17742609 DOI: 10.1126/science.167.3919.832] [Citation(s) in RCA: 285] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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18
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Short C, James E, Girgis A. Tailoring to promote physical activity and broken sedentary time amongst chronic disease populations. J Sci Med Sport 2010. [DOI: 10.1016/j.jsams.2009.10.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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19
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Girgis A, Bonevski B, Perkins J, Sanson-Fisher R. Self-reported cervical screening practices and beliefs of women from urban, rural and remote regions. J OBSTET GYNAECOL 2009; 19:172-9. [PMID: 15512264 DOI: 10.1080/01443619965543] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This survey aimed to explore women's perceptions of a number of issues relating to the availability and utilisation of cervical cancer screening services in the rural, remote and urban regions of New South Wales (NSW) Australia. The survey involved urban, rural and remote regions of NSW determined by the definition of the Department of Community Services and Health. This was a cross-sectional telephone survey. Of the 339 eligible urban households, 265 (78%) completed interviews; of the 286 eligible rural households, 238 (83%) completed interviews; of the 285 eligible remote households, 230 (81%) completed interviews. Telephone contact was made with randomly selected households in each region. Women in the households were asked to complete a computer-assisted telephone interview. The survey addressed a number of issues relating to cervical screening: cervical cancer risk status; provider of Pap smear service; distance travelled to have a Pap smear; perceived barriers and facilitators to cervical screening. There was no statistically significant difference in the proportions of women from urban (74%), rural (76%), and remote (71%) regions who reported having a Pap smear in the 2 years preceding the survey. General practitioners provided the majority (more than 70%) of tests irrespective of region. Compared with women from urban areas, women from rural and remote areas were almost twice as likely to have had their last Pap smear from a male general practitioner. A greater proportion of women from remote regions had to travel for 60 minutes or more to access providers of Pap smear services. Few differences in the top three reported barriers to, and facilitators for screening were evident between regions and between those women who had and had not been adequately screened. Issues of distance, isolation and access to alternative service providers are a concern to women in rural and remote regions and should be considered by those involved in the implementation of cervical cancer screening services.
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Affiliation(s)
- A Girgis
- NSW Cancer Council, Cancer Education Research Program, Newcastle, Australia
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20
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Bonevski B, Sanson-Fisher R, Girgis A, Perkins J. Women's experiences of having a colposcopic examination: self-reported satisfaction with care, perceived needs and consequences. J OBSTET GYNAECOL 2009; 18:462-70. [PMID: 15512145 DOI: 10.1080/01443619866804] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study was conducted in seven gynaecological clinics in New South Wales (NSW), Australia. The study aimed to assess the level of satisfaction with care, unmet needs and consequences following the procedure reported by women having a colposcopic examination. Of the 161 eligible women attending colposcopy clinics who were approached to take part, 156 (97%) gave written consent to participate and 138 (86%) completed interviews. Consenting women were telephoned within 1 week of their clinic visit to complete a computer-assisted telephone interview (CATI). The survey addressed a number of issues relating to the care they received during their colposcopic examination: satisfaction with care, satisfaction with the waiting time to have a colposcopy, preferences for provider gender, information and health care needs while waiting for the colposcopy, information and health care needs during the colposcopy, short-term physical consequences and shortterm psychosocial consequences of the procedure. Results indicate that satisfaction with care among women ranged from 69% to 96%. The highest expressed needs while waiting for the colposcopy were for information about risks of cancer (91%), reasons for needing a colposcopy (86%), and the colposcopy procedure (86%). Women reported that outcomes such as anxiety and disinterest in sex had further worsened or not been improved following the colposcopy. The results indicate that interventions to address specific concerns would need to be designed, implemented and evaluated.
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Affiliation(s)
- B Bonevski
- NSW Cancer Council Cancer Education Research Program (CERP), Newcastle, Australia
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Waller A, Girgis A, Currow D, Lecathelinais C. Development of the palliative care needs assessment tool (PC-NAT) for use by multi-disciplinary health professionals. Palliat Med 2008; 22:956-64. [PMID: 18952754 DOI: 10.1177/0269216308098797] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Needs assessment strategies can facilitate prioritisation of resources. To develop a needs assessment tool for use with advanced cancer patients and caregivers, to prompt early intervation. A convenience sample of 103 health professionals viewed three videotaped consultations involving a simulated patient, his/her caregiver and a health professional, completed the Palliative Care Needs Assessment Tool (PC-NAT) and provided feedback on clarity, content and acceptability of the PC-NAT. Face and content validity, acceptability and feasibility of the PC-NAT were confirmed. Kappa scores indicated adequate inter-rater reliability for the majority of domains; the patient spirituality domain and the caregiver physical and family and relationship domains had low reliability. The PC-NAT can be used by health professionals with a range of clinical expertise to identify individuals' needs, thereby enabling early intervention. Further psychometric testing and an evaluation to assess the impact of the systematic use of the PC-NAT on quality of life, unmet needs and service utilisation of patients and caregivers are underway.
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Affiliation(s)
- A Waller
- Centre for Health Research & Psycho-oncology, School of Medicine & Public Health, The Cancer Council NSW, University of Newcastle & Hunter Medical Research Institute, Newcastle, NSW, Australia.
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Abstract
PURPOSE Cancer specialists can facilitate timely and appropriate access to specialized palliative care (SPC) services. To better match patients' needs with access to SPC services, we must understand factors associated with referral. This study aimed to investigate cancer specialists' referral practices, perceptions of, barriers to and triggers for referral of people with advanced cancer to SPC services. METHOD A self-report questionnaire was mailed to all oncologists, clinical haematologists, respiratory physicians and colorectal surgeons in Australia (N = 1713). RESULTS Out of 699 specialists who participated, 48% reported referring >60% of patients to SPC services. Most frequent reasons for referral were: the future need for symptom control, the presence of a terminal illness or uncontrolled physical symptoms. Psychosocial issues rarely triggered referral. Main reasons reported for not referring included: ability to manage patients' symptoms; the absence of symptoms or rapid deterioration. Significant predictors of referral (P < 0.05) included: being female; >10 years of practice in the speciality; agreeing all people with advanced cancer need referral, referral for the purpose of multidisciplinary management and having SPC services available. CONCLUSIONS Specialists mainly refer people with advanced cancer for symptom-related reasons. Measures are needed to encourage ongoing needs-based assessments, especially of emotional, cultural and spiritual issues.
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Affiliation(s)
- C E Johnson
- Centre for Health Research and Psycho-oncology (CHeRP), The Cancer Council NSW, University of Newcastle and Hunter Medical Research Institute, Newcastle.
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23
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Boyes A, Newell S, Girgis A, McElduff P, Sanson-Fisher R. Does routine assessment and real-time feedback improve cancer patients' psychosocial well-being? Eur J Cancer Care (Engl) 2006; 15:163-71. [PMID: 16643264 DOI: 10.1111/j.1365-2354.2005.00633.x] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study examined the effectiveness of giving medical oncologists immediate feedback about cancer patients' self-reported psychosocial well-being in reducing those patients' levels of anxiety, depression, perceived needs and physical symptoms. Cancer patients attending one cancer centre for their first visit were allocated to intervention (n = 42) or control (n = 38) groups. All patients completed a computerized survey assessing their psychosocial well-being while waiting to see the oncologist. Intervention patients' responses were immediately scored and summary reports were placed in each patient's file for follow-up. A total of 48 participants (25 intervention and 23 control) completed the survey four times. Intervention patients who reported a debilitating physical symptom at visit 2 were significantly less likely to report a debilitating physical symptom at visit 3 compared with control patients (OR = 2.8, P = 0.04). Reductions in levels of anxiety, depression and perceived needs among intervention patients were not significantly different to control patients. Repeated collection and immediate feedback of patient-reported health information to oncologists has potential to improve patients' symptom control, but has little impact upon emotional well-being, including those at high risk. Future research should consider providing the feedback to other health professionals and patients, and monitor the impact on the process of individual patient care.
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Affiliation(s)
- A Boyes
- Centre for Health Research and Psycho-oncology (CHeRP), Hunter Medical Research Institute, The University of Newcastle and The Cancer Council NSW, Wallsend, Australia.
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Paul CL, Stacey F, Girgis A, Brozek I, Baird H, Hughes J. Solaria compliance in an unregulated environment: the Australian experience. Eur J Cancer 2005; 41:1178-84. [PMID: 15911242 DOI: 10.1016/j.ejca.2005.01.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2004] [Revised: 12/10/2004] [Accepted: 01/31/2005] [Indexed: 11/26/2022]
Abstract
This study aimed to explore compliance with international recommendations on solaria use in a unregulated setting. Simulated customers visited 176 solaria operating in Australia and two face-to-face visits and one telephone contact were made for each establishment. From the survey, establishments compliant with the recommendations ranged from: 1.1% refusing access to the customer with skin type I; 9.7% recommending to the customer with skin type I against solaria use and up to 87.5% assessing skin type and recommending eye protection. Few (15.9%) were compliant with more than 10 of the 13 recommendations. Establishment type and number of sunbeds were significantly associated with compliance. This study has shown that a much higher level of compliance with recommendations, particularly those excluding higher-risk groups, is required to reduce the harm associated with use of solaria. While new legislation may be useful, other harm minimisation strategies including mandatory staff training and taxation should be considered.
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Affiliation(s)
- C L Paul
- Centre for Health Research and Psycho-oncology (CHeRP), The Cancer Council NSW, University of Newcastle, Locked Bag No. 10, Wallsend, NSW 2287, Australia.
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Ryan H, Schofield P, Cockburn J, Butow P, Tattersall M, Turner J, Girgis A, Bandaranayake D, Bowman D. How to recognize and manage psychological distress in cancer patients. Eur J Cancer Care (Engl) 2005; 14:7-15. [PMID: 15698382 DOI: 10.1111/j.1365-2354.2005.00482.x] [Citation(s) in RCA: 169] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Psychological distress is common in cancer patients, however, it is often unrecognized and untreated. We aimed to identify barriers to cancer patients expressing their psychological concerns, and to recommend strategies to assist oncologists to elicit, recognize, and manage psychological distress in their patients. Medline, Psychlit, and the Cochrane databases were searched for articles relating to the detection of emotional distress in patients. Patients can provide verbal and non-verbal information about their emotional state. However, many patients may not reveal emotional issues as they believe it is not a doctor's role to help with their emotional concerns. Moreover, patients may normalize or somatize their feelings. Anxiety and depression can mimic physical symptoms of cancer or treatments, and consequently emotional distress may not be detected. Techniques such as active listening, using open questions and emotional words, responding appropriately to patients' emotional cues, and a patient-centred consulting style can assist in detection. Screening tools for psychological distress and patient question prompt sheets administered prior to the consultation can also be useful. In conclusion, the application of basic communication techniques enhances detection of patients' emotional concerns. Training oncologists in these techniques should improve the psychosocial care of cancer patients.
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Affiliation(s)
- H Ryan
- Centre for Health Research & Psycho-oncology, University of Newcastle, Newcastle, UK
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26
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Abstract
AIMS Few smokers currently make use of available and effective cessation strategies, despite their expressed desire to quit and reported interest in cessation support. This study aimed to explore the feasibility of a telephone-based direct-marketing approach to delivering cessation strategies. DESIGN, SETTING, MEASUREMENTS AND PARTICIPANTS: A community survey was conducted to explore the views of current adult smokers regarding the acceptability, likely uptake and barriers to uptake of smoking cessation services offered by direct telephone marketing. FINDINGS Three quarters (73.8%) of smokers contacted agreed to be surveyed. Of the 194 study participants, 75.3% reported that they would utilize vouchers for discount nicotine replacement therapy (NRT), 66.5% would use a mailed self-help booklet, 57.2% would take up the offer of regular mailings of personalized letters and self-help materials and 46.4% would utilize a 'we-call-you' telephone counselling service. The characteristics of those indicating likely uptake of these services were also explored. The two major barriers to uptake of services were preferring to quit without help and a belief that a particular service would not help the participant. CONCLUSIONS The data suggest strong support for the direct marketing of smoking cessation strategies; they also highlight the need for further study of the cost-effectiveness of telephone-based direct marketing of smoking cessation strategies as a population-based strategy for reducing the prevalence of smoking in the community.
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Affiliation(s)
- C L Paul
- Centre for Health Research and Psycho-oncology, Cancer Council of New South Wales, NSW, Australia.
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27
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Thewes B, Butow P, Girgis A, Pendlebury S. The psychosocial needs of breast cancer survivors; A qualitative study of the shared and unique needs of younger versus older survivors. Psychooncology 2004; 13:177-89. [PMID: 15022153 DOI: 10.1002/pon.710] [Citation(s) in RCA: 217] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Due to improvements in medical treatment and survival following breast cancer, researchers have turned their attention to investigating the needs of breast cancer survivors. There is disagreement about the extent to which survivors continue to experience psychological morbidity after treatment ends. Whilst the majority of women adjust well to breast cancer, some may have continued psychosocial needs. Available research suggests that younger pre-menopausal women are at increased risk of psychological morbidity following breast cancer. The present study aimed to gather preliminary qualitative data on the psychosocial needs of breast cancer survivors and to identify the shared and unique needs of younger versus older survivors. A qualitative methodology was chosen as this was a relatively unexplored area of enquiry. Patients treated for early-stage breast cancer who had completed their hospital-based treatment 6-24 months prior to participation were recruited. Sampling was discontinued when informational redundancy was achieved. Eighteen telephone interviews were conducted. A wide variety of on-going psychosocial and information needs were reported by breast cancer survivors including support needs, psychological needs, practical needs, physical needs and information needs. Younger women reported more needs than their older counterparts. Several needs reported by younger women were directly related to being of younger age or pre-menopausal at the time of diagnosis. Clinical implications are discussed.
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Affiliation(s)
- B Thewes
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, Australia.
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28
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Newell S, Girgis A, Sanson-Fisher R, Ireland M. Accuracy of Patients' Recall of Pap and Cholesterol Screening. J Low Genit Tract Dis 2001. [DOI: 10.1046/j.1526-0976.2001.52011-7.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Hancock L, Sanson-Fisher R, Perkins J, Girgis A, Howley P, Schofield M. The effect of a community action intervention on adolescent smoking rates in rural australian towns: the CART project. Cancer Action in Rural Towns. Prev Med 2001; 32:332-40. [PMID: 11304094 DOI: 10.1006/pmed.2000.0823] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND This paper describes one outcome of a randomized controlled trial of community action for cancer prevention, Cancer Action in Rural Towns. The aims are to [1] explore the effectiveness of community action in decreasing adolescent smoking in rural Australian towns; and [2] describe the relationship between adolescent smoking rates and demographic variables. METHODS In 1992, 20 rural Australian towns were selected. Community action involved formation of community committees and utilization of access-point networks to initiate and maintain intervention strategies. Cross-sectional surveys of smoking behaviors for all Year 9 and Year 10 students (13-16 years) in each town were conducted pre- and posttest. The main outcome measure was self-reported smoking in the past 4 weeks. SUDAAN software was used to look at differences between treatment. RESULTS The results showed strong secular trends toward increased adolescent smoking, regardless of treatment group, particularly for females. There was no significant intervention effect. CONCLUSIONS Increasing adolescent smoking rates found in this and other studies highlight that the definitive strategy to stem the adolescent smoking epidemic has not been found. Hope may remain for recent legislative strategies, but rigorous evaluation is essential, and compliance with legislation should be carefully monitored.
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Affiliation(s)
- L Hancock
- Hunter Centre for Health Advancement, Newcastle, Wallsend, New South Wales, 2287, Australia.
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30
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Girgis A, Sanson-Fisher RW, Walsh RA. Preventive and other interactional skills of general practitioners, surgeons, and physicians: perceived competence and endorsement of postgraduate training. Prev Med 2001; 32:73-81. [PMID: 11162329 DOI: 10.1006/pmed.2000.0781] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Perceived competencies and support for formal postgraduate training across a range of preventive and other interactional skills were examined in three medical groups. METHODS All eligible final year students and recent graduates of the three major Australian medical colleges (n = 767) were mailed a questionnaire examining communication skills in four domains: preventive, educational, therapeutic, and general. RESULTS Overall consent rate was 45%. For most items, at least one-third of each group reported low competence. On preventive items, low competence ratings ranged from 5 to 39% in general practice, 38 to 67% in surgery, and 33 to 51% in the speciality physician group. Significant intergroup differences occurred on eight competence items. Agreement with training on preventive topics ranged from 80 to 91% in general practice, 48 to 69% in surgery, and 72 to 82% in the specialty physician group. On all 11 training items where significant differences occurred, the general practice group reported the highest level and the surgeon group the lowest level of endorsement for formal training and assessment. CONCLUSIONS Substantial proportions in the general practice, surgery, and the physician specialty report lack of competence in common interactional skills. There were high levels of support for formal training in preventive and other interactional skills. The strong endorsement supports the development of effective, tailored interactional skills training programs.
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Affiliation(s)
- A Girgis
- New South Wales Cancer Council, Cancer Education Research Program (CERP), Newcastle, Australia.
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31
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Abstract
OBJECTIVES This study was undertaken in mid-1994 and assessed how accurately patients recall the recency and result of their most recent cholesterol and Papanicolaou (Pap) tests. METHODS A cross-sectional, door-to-door community survey was used to gather self-report and, subsequently, pathology laboratory data for 195 individuals. RESULTS In regard to cholesterol screening, 30% of individuals who reported being adequately screened were actually inadequately screened, 45% who reported normal cholesterol levels actually had elevated levels, and 21% of inadequately screened individuals and 56% of individuals with elevated levels were not identified by self-report. In terms of Pap screening, 28% of women who reported being adequately screened were actually inadequately screened, 11% of patients who reported a normal Pap test actually had abnormal or inadequate results, and 55% of inadequately screened individuals and 53% of individuals with abnormal or inadequate results were not identified by self-report. CONCLUSIONS This study revealed self-report to be a less-than-adequate measure of individuals' recall of cholesterol and Pap screening. Relying exclusively on self-report surveys as indicators of screening coverage is likely to result in significant underestimations of the proportion of people who are inadequately screened or whose results indicate a need for intervention.
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Affiliation(s)
- S Newell
- Faculty of Medicine and Health Sciences, University of Newcastle, Australia
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Rankin N, Newell S, Sanson-Fisher R, Girgis A. Consumer participation in the development of psychosocial clinical practice guidelines: opinions of women with breast cancer. Eur J Cancer Care (Engl) 2000; 9:97-104. [PMID: 11261017 DOI: 10.1046/j.1365-2354.2000.00198.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Clinical practice guidelines are playing an increasingly important role in defining quality care and consumers have a considerable interest in participating in the development of guidelines. The objective of this study was to explore consumer's perceptions of guideline items relating to psychosocial care of women with breast cancer, developed by Australia's National Health and Medical Research Council National Breast Cancer Centre. Women diagnosed with breast cancer in the previous 2 years (n = 313) received a letter about the study via their radiation oncologist. Consenting women were contacted by the researchers to complete a telephone survey. The survey asked women to rate the importance of draft guidelines items, including discussing prognosis, providing information and choice, doctor-patient communication, preparation for surgery, providing emotional support, providing social support, dealing with practical and cultural issues and continuity of care. One hundred and forty women (45%) completed the survey. The results indicated that at least 50% of respondents rated 28 of the 52 items as 'essential' components, with respondents identifying providing information and choice, and doctor-patient communication as the most important aspects of psychosocial care. The findings suggest the guidelines adequately reflect consumer opinions and identify priority areas for clinicians to address in providing psychosocial support to women with breast cancer.
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Affiliation(s)
- N Rankin
- NSW Cancer Council Cancer Education Research Program (CERP), Locked Mail Bag 10, Wallsend, NSW 2287, Australia
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34
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Abstract
OBJECTIVE To assess the prevalence and predictors of perceived unmet needs among women diagnosed with breast cancer, with a particular focus on the impact of location (rural/urban). METHOD A random sample of women in NSW diagnosed with breast cancer was surveyed during 1995-96. The Breast Cancer Patients' Needs Questionnaire (BR-CPNQ) explores patients' perceived needs across five domains: psychological, health information, physical/daily living, patient care/support and interpersonal communication. Items assessing breast cancer specific needs and access to services and resources were included. Of 235 eligible rural women, 134 (57%) consented to participate and 129 (55%) returned completed surveys. Of 196 eligible urban women, 102 (52%) consented to participate and 100 (51%) returned completed surveys. RESULTS For 12 of the 52 items, at least one-third of the sample reported ever having a moderate/high need for help. Of the 15 highest moderate or high unmet needs, 10 related to health information and three to psychological needs. There were few differences in the prevalence of needs reported by rural and urban women. Only in the physical/daily living domain were rural women more likely than urban women to report some need for help (OR = 2.59, 95% CI 1.21-5.52). CONCLUSIONS Unmet needs, particularly in the information and psycho-social domains, are reported by both rural and urban women with breast cancer, with sub-groups experiencing different types of needs. IMPLICATIONS There is a need to develop and trial targeted and innovative strategies to meet the health information and psychological needs of women with breast cancer, and the physical/daily living needs of rural women diagnosed with breast cancer.
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Abstract
BACKGROUND This study aimed to assess the face, content, and construct validity and the internal reliability of a tool for assessing the generic needs of patients with cancer (the Supportive Care Needs Survey). METHODS A total of 1,492 consecutive patients attending the surgical, radiation, or medical oncology departments of 9 cancer treatment centers in New South Wales, Australia, were asked to participate. Of the 1,370 eligible patients, 1,354 (99%) consented to participate and 888 (65%) completed the survey. Eligible consenting patients were given a Supportive Care Needs Survey to complete at home and return by mail within 7 days. RESULTS In the assessment of construct validity, the principal components method of factor analysis identified 5 factors with eigenvalues greater than 1, which together accounted for 64% of the total variance (patients' needs in the domains of psychologic, health system and information, physical and daily living, patient care and support, and sexuality). Face and content validity were found to be high following pilot tests and tests of reading ease. Internal reliability coefficients (Cronbach alpha) of all 5 factor-based scales were found to be substantial, ranging from 0.87 to 0.97. CONCLUSIONS These findings suggest that the Supportive Care Needs Survey provides a reliable and valid index of the global needs of oncology patients. The standardized and widespread application of this instrument is recommended following further refinement and evaluation.
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Affiliation(s)
- B Bonevski
- NSW Cancer Council Cancer Education Research Program, Wallsend NSW, Australia
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36
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Abstract
BACKGROUND The aim of this study was to determine the prevalence and predictors of the perceived unmet needs of cancer patients undergoing treatment for their disease at public treatment centers. METHODS A total of 1,492 consecutive patients attending the surgical, radiation, or medical oncology departments of 9 major public cancer treatment centers in New South Wales, Australia, were asked to participate. Of the 1,370 eligible patients, 1,354 (99%) consented to participate and 888 (65%) returned completed surveys. Eligible consenting patients were given a Supportive Care Needs Survey to complete at home and return by mail within 7 days. RESULTS Patients' perceived needs were assessed across the following five areas: psychologic, health system and information, physical and daily living, patient care and support, and sexuality. Patients' perceived needs were highest in the psychologic, health system and information, and physical and daily living domains. Logistic regression modeling revealed subgroups of patients with different types of needs. The significant predictors of reporting some unmet need for help varied according to the domain examined. CONCLUSIONS This statewide study shows that cancer patients experience high levels of unmet needs across the range of domains examined. The study provides information that may be valuable in identifying areas where interventions could be tested and evaluated in an attempt to address the unmet needs of people living with cancer.
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Affiliation(s)
- R Sanson-Fisher
- NSW Cancer Council Cancer Education Research Program, Wallsend NSW, Australia
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Newell SA, Girgis A, Sanson-Fisher RW, Savolainen NJ. The accuracy of self-reported health behaviors and risk factors relating to cancer and cardiovascular disease in the general population: a critical review. Am J Prev Med 1999; 17:211-29. [PMID: 10987638 DOI: 10.1016/s0749-3797(99)00069-0] [Citation(s) in RCA: 251] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To critically review the literature concerning the accuracy of self-reported health behaviors and risk factors relating to cancer and cardiovascular disease among the general population. METHOD A literature search was conducted on three major health research databases: MEDLINE, HealthPLAN, and PsychLit. The bibliographies of located articles were also checked for additional relevant references. Studies meeting the following five inclusion criteria were included in the review: They were investigating the accuracy of self-report among the general population, as opposed to among clinical populations. They employed an adequate and appropriate gold standard. At least 70% of respondents consented to validation, where validation imposed minimal demands on the respondent; and 60% consent to validation was considered acceptable where validation imposed a greater burden. They had a sample size capable of estimating sensitivity and specificity rates with 95% confidence intervals of width +/-10%. The time lag between collection of the self-report and validation data for physical measures did not exceed one month. RESULTS Twenty-four of 66 identified studies met all the inclusion criteria described above. In the vast majority, self-report data consistently underestimated the proportion of individuals considered "at-risk." Similarly, community prevalences of risk factors were considerably higher according to gold standard data sources than they were according to self-report data. CONCLUSIONS This review casts serious doubts on the wisdom of relying exclusively on self-reported health information. It suggests that caution should be exercised both when trying to identify at-risk individuals and when estimating the prevalence of risk factors among the general population. The review also suggests a number of ways in which the accuracy of individuals' self-reported health information can be maximized.
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Affiliation(s)
- S A Newell
- New South Wales Cancer Council Cancer Education Research Program, Wallsend, Australia
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Abstract
Eighty-four breast cancer patients, 64 oncologists, and 140 oncology nurses rated the importance of 15 general principles and 12 recommended steps to guide clinicians in breaking bad news to patients. At least 70% of the three samples rated 7 of the 15 principles and 6 of the 12 steps as essential. All three groups agreed that patients have a legal and moral right to accurate and reliable information and that patients should be given the diagnosis and prognosis honestly and in simple language, though not bluntly. The groups differed on the relative importance of other items, with less variation about the steps than about the principles. Patients' perceptions of the importance of various guideline steps and principles are probably most important, given that patients receive the troubling news and that research indicates that how the news is delivered is associated with important patient outcomes. Recommendations for further research are discussed.
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Affiliation(s)
- A Girgis
- New South Wales Cancer Council, Cancer Education Research Program (CERP), University of Newcastle, Australia
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Newell S, Sanson-Fisher RW, Girgis A, Ackland S. The physical and psycho-social experiences of patients attending an outpatient medical oncology department: a cross-sectional study. Eur J Cancer Care (Engl) 1999; 8:73-82. [PMID: 10476109 DOI: 10.1046/j.1365-2354.1999.00125.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of this study was to assess the prevalence and predictors of physical symptoms, anxiety, depression and perceived needs among patients receiving treatment at an outpatient medical oncology department using a cross-sectional survey. It was carried out at the outpatient clinic of an academic medical oncology department, which sees around 150-180 outpatients each week; 201 patients were selected. These patients answered questions to assess their levels of anxiety and depression (Hospital Anxiety and Depression Scale), perceived needs (Cancer Needs Questionnaire) and the frequency and severity of 15 physical symptoms. Fatigue, nausea, appetite loss and vomiting were the most commonly experienced and most debilitating physical symptoms. Approximately 25% of participants had borderline or clinical levels of anxiety and depression. Although relatively low levels of perceived needs were reported, physical and psychological needs were the most common. Levels of each outcome measure tended to be predictive of each other. Medical oncology outpatients experience a wide range of physical and psycho-social problems which appear, to some extent, interrelated.
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Affiliation(s)
- S Newell
- New South Wales Cancer Council Cancer Education Research Programme, Australia
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40
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Newell S, Sanson-Fisher RW, Girgis A, Bonaventura A. How well do medical oncologists' perceptions reflect their patients' reported physical and psychosocial problems? Data from a survey of five oncologists. Cancer 1998; 83:1640-51. [PMID: 9781960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Modern cancer treatments can cure or prolong patients' lives. However, the associated physical and psychosocial problems can detrimentally affect patients' compliance with treatment and, ultimately, their outcomes. Therefore, oncologists need to recognize the problems experienced by their patients and, when possible, help resolve these problems. METHODS The authors conducted a cross-sectional survey of physical symptoms, anxiety, depression, and perceived needs among 204 consenting patients visiting an outpatient medical oncology department. Immediately following consultations with consenting patients, medical oncologists and registrars also completed a survey in which they indicated their perception of each patient's level of each problem. These two data sets were then compared. RESULTS Five oncologists' perceptions of patients' levels of the major physical symptoms cited in the survey (fatigue, nausea, vomiting, and hair loss) demonstrated the highest levels of awareness, with sensitivity rates up to 80%. Although sensitivity was less than 50% for all other physical symptoms, specificity was greater than 78% for all symptoms except fatigue. Only 17% of patients classified as clinically anxious and 6% of those classified as clinically depressed were perceived as such by their oncologists. However, the oncologists perceived much higher levels of perceived needs than patients reported, resulting in high sensitivity but low specificity rates. Oncologists' knowledge of and rapport with their patients and the pressure of their workloads were associated with their awareness of their patients' reported problems. CONCLUSIONS Medical oncologists' perceptions may not accurately reflect their patients' reported physical and psychosocial experiences. Further interventions should be developed to assist oncologists in detecting such problems, especially psychosocial ones.
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Affiliation(s)
- S Newell
- New South Wales Cancer Council Cancer Education Research Program, Newcastle, Australia
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41
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Abstract
Literature related to breaking bad news to medical patients was reviewed. An analysis of citations appearing between 1994 and August 1997 updated earlier work and indicated that a minority (24%) of the studies on the subject were designed to collect original data. Ten randomized controlled trials (RCTs) evaluating communication strategies with cancer patients in the diagnostic phase have been published since 1980. These RCTs were analyzed for methodological adequacy and their clinical implications. The sampling methods of the RCTs presented particular problems. Although patients liked the experimental interventions, there was little evidence of any effect on the patients' psychological adjustment; the effects on patients' knowledge and satisfaction levels were inconsistent. Healthcare consequences of issues concerned with patient selection, cultural factors, medical-legal requirements, and intervention costs are outlined and specific suggestions offered for future research testing the effects of different approaches to breaking bad news.
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Affiliation(s)
- R A Walsh
- New South Wales Cancer Council Cancer Education Research Program (CERP), Newcastle, Australia
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42
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Abstract
Reviews of the literature on how to convey bad news to patients with serious diseases have identified a paucity of empirically based information to guide clinicians in undertaking this difficult task. In 1994, consensus guidelines for clinicians that incorporated the views of medical oncologists, general practitioners, surgeons, nurse consultants, social workers, clergy, human-rights representatives, cancer patients, hospital interns, and clinical directors of medical schools were developed in Australia. Since then, the guidelines have been published widely and incorporated into other documents outlining recommendations for the best practices. The most recent version of the guidelines on breaking bad news is reported in this article. Revisions based on feedback from key groups, including medical schools and clinicians, and on comparisons of the views of breast cancer patients with their providers' views on the importance of each recommendation in the guidelines are included, and suggestions for future research are detailed.
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Affiliation(s)
- A Girgis
- New South Wales Cancer Council Cancer Education Research Program (CERP), Newcastle, Australia
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43
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Abstract
The purpose of this study was to assess the needs of rural women travelling to the city for breast cancer treatment. Participants included 80 women aged between 34 and 80 years living in rural NSW and South Australia who travelled for breast cancer treatment. After completing treatment, participants completed a brief telephone survey on the needs of rural women travelling for treatment. Findings revealed that more than 90% of women travelled for treatment due to the lack of available treatment centres closer to home and on average they spent 6.79 weeks (SD = 4.73) away from their home and family. Findings also showed that 89% identified specific problems for rural women, with social and practical support being primary concerns. Although the majority of women were provided with some type of social support, only 39% of women received financial assistance and 19% of these women had trouble claiming money for which they were eligible. Recommendations of appropriate interventions to ensure equity in the availability and access to breast cancer treatment for all women are discussed.
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Affiliation(s)
- C Davis
- National Health and Medical Research Council, National Breast Cancer Centre, New South Wales.
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Abstract
BACKGROUND Adolescence has been identified as a critical period in the etiology of subsequent melanoma and nonmelanocytic skin cancer. This study examines the prevalence and predictors of solar protection use among adolescents. METHODS A total of 3,642 adolescents between the ages of 11 and 16 years were recruited from a random sample of 27 schools in an Australian state. The participants completed a validated survey that provided information on a range of demographic, knowledge, attitudinal, and behavioral factors. Sun protection practices adopted during the preceding weekend were assessed using a validated self-report diary. A formula that quantifies protection status was then employed to categorize adolescents into those who were using adequate versus low levels of solar protection. RESULTS Overall 54% of males and 44% of females were classified as adequately protected during the preceding weekend. Logistic regression analyses identified the following as significant predictors of having an adequate level of sun protection--gender (males more likely to be protected), age (11 to 13 year olds more likely to be protected than 14 to 16 years olds), ownership of a broad-brimmed hat or cap, attitudes relating to the discomfort associated with wearing a hat, image to peers, "hassle" associated with the use of sun protective measures, school attended, and sun protective policies of the school. CONCLUSIONS Implications of these findings for future preventive strategies are discussed and include improved targeting of sun protection programs to non-adopters, modification of attitudes relating to suntans and image to peers, reducing the level of perceived difficulty associated with utilizing sunscreen, and the potential role that schools may play in fostering sun protection.
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Affiliation(s)
- T Lower
- New South Wales Cancer Council Cancer Education Research Program, Newcastle, Australia
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45
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Abstract
BACKGROUND The accurate assessment of sun protective behaviors can assist in the effective targeting of preventive strategies. METHODS This study explored the validity of self-report by adolescents in relation to parental/guardian reports using a scale to determine whether adolescents were accurately classified as adequately protected or not during the preceding weekend. The study sample was drawn from a school population and provided 53 matched adolescent and parental/guardian responses from 115 subjects (consent rate 46%). The validity of self-reports in relation to the level of protection afforded to a range of body parts (face, neck, shoulders, torso, etc.) was calculated. Calculations of sensitivity, which represented the proportion of cases in which the body part was classified as adequately protected by both the criterion reference and the self-report, and specificity, in which inadequate protection was confirmed by both the criterion reference and the self-report, were completed. In instances in which fewer than five observations fell into a cell, thereby limiting the accuracy of results, no measures were calculated. RESULTS Measures of sensitivity for the use of sun protection were legs (59%), neck (79%), feet (79%), face (92%), and shoulders, torso, and upper arms (98%). In contrast measures of specificity were face (61%), legs (80%), and neck (87%). CONCLUSIONS Although further studies of self-report methodologies with larger samples are required to verify these findings, the results suggest that adolescent self-report of solar protection is relatively valid and has the potential to be utilized with a degree of confidence to assess behavior.
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Affiliation(s)
- T Lower
- New South Wales Cancer Council Cancer Education Research Program, Newcastle, Australia
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46
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Abstract
This research aimed to determine whether, between 1990 and 1993, there were any changes in the government revenue gained from sale of cigarettes to minors and the proportion of this revenue spent on attempting to prevent the uptake of this habit by adolescents. The methodology is consistent with the 1990 study, although some revisions have been necessary. From our analysis, it is estimated that state revenue from under-age smoking increased 97% from $9.37 million in 1990 to $18.45 million in 1993. State expenditure on anti-smoking campaigns (for the entire population) increased 24% from $9.47 million in 1990 to an estimated $11.75 million in 1993. When this expenditure is converted to a relative amount, relative state expenditure per under-age smoker fell an estimated 10%, from $4.40 in 1990 to $3.98 in 1993. This is equivalent to approximately 7.7% and 5.1%, in 1990 and 1993 respectively, of state revenue from cigarette smoking by those under the legal purchase age being spent on discouraging adolescents from taking up this habit. These results suggest a growing inequity in the expenditure on anti-smoking activities compared to revenues received from sales to minors.
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Affiliation(s)
- C M Doran
- NSW Cancer Council Cancer Education Research Program, New South Wales
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47
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Abstract
BACKGROUND This study assessed surgeons' current perceived level of competence in a number of interactional skills, their perceptions of the need for training and assessment in interactional skills, and their perceptions of the appropriateness of the format and content of two existing communication skills training packages. METHODS Of 267 surgeons who were sent the survey, 63% (n = 143) of eligible respondents completed and returned it. RESULTS More than three-quarters of the sample identified the following skills as being important or very important in being a good surgeon: breaking bad news; preparing patients for surgical procedures; educating patients about their diagnosis and treatment, and increasing the likelihood that they will remember what they have been told; detecting anxiety and depression in patients, encouraging patients to express these and listening to their anxieties. More than half the sample felt at least competent at seven of the 10 interactional skills, but almost one-third of the sample reported being 'not or not at all competent' at increasing patients' ability to remember what they have been told and at encouraging patients to express anxieties about their condition, and a further 13.3% reported a lack of competence at breaking bad news to patients about their diagnosis/prognosis. A higher proportion reported a lack of competence in providing bereavement counselling (59.6%), and gaining consent for organ donation (56.6%) and for autopsy (48.9%). The majority rated different aspects of the two communication skills training packages as either 'good' or 'excellent'. CONCLUSIONS The survey identified a number of communication skills which are perceived by surgeons to be important and to require formal training and assessment.
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Affiliation(s)
- A Girgis
- NSW Cancer Council Cancer Education Research Program, Newcastle, New South Wales, Australia
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48
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Hancock L, Sanson-Fisher RW, Redman S, Burton R, Burton L, Butler J, Girgis A, Gibberd R, Hensley M, McClintock A, Reid A, Schofield M, Tripodi T, Walsh R. Community action for health promotion: a review of methods and outcomes 1990-1995. Am J Prev Med 1997; 13:229-39. [PMID: 9236957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Our objective was to explore the effectiveness of community action as a strategy for health promotion, through a critical review of five years of community action evaluation literature. METHODS Community action was defined as a health promotion, program that involved the community in implementation and control of the process of the program. Criteria for scientific evaluation of programs were proposed for sampling and control procedures, reliability and validity of instruments, analysis techniques, and specification of details of the intervention. A critical review of the literature, located by an on-line and related reference search, was undertaken for community action aimed at reducing cancer and cardiovascular disease, between January 1990 and May 1995. RESULTS None of seven community action studies (17 articles) that examined cancer risk factors fulfilled all the criteria for rigorous scientific evaluation. The most methodologically adequate cancer study, the COMMIT intervention, had only a moderate degree of success in reducing community smoking rates. Similarly, none of the six studies (25 articles) on cardiovascular disease fulfilled all the criteria. The results for the most methodologically adequate study, the Minnesota Heart Health Program, were disappointing, with strong secular trends preventing adequate assessment of the intervention effect. CONCLUSIONS The finding that none of the reviewed studies met all evaluation criteria was due to several factors, including political considerations, feasibility, and the continued evolution of the science of evaluation in health promotion. Some important questions are posed for researchers by the failure of methodologically superior projects, such as COMMIT, to show major gains in reducing health risk behaviors.
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Affiliation(s)
- L Hancock
- Faculty of Medicine, University of Newcastle, NSW, Australia.
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49
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Girgis A, Sanson-Fisher R. Community based health education: general practitioners' perceptions of their role and willingness to participate. Aust N Z J Public Health 1996; 20:381-5. [PMID: 8908761 DOI: 10.1111/j.1467-842x.1996.tb01050.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
This study aimed to: 1. determine general practitioners' perceptions of their appropriateness to conduct community based health education; 2. assess the proportion of general practitioners who had undertaken group health education in the previous 12 months, and identify the factors that discourage and encourage this activity; and 3. identify appropriate health areas and the community groups that general practitioners would be prepared to address if provided with educational packages on the topic. A random sample of 181 general practitioners (66.5 per cent response rate) completed a mailed questionnaire. General practitioners rated health promotion officers (32.6 per cent) and general practitioners (30.9 per cent) as the most appropriate health care providers to undertake community based health education activities. Of the general practitioners, 38 per cent had undertaken community health education in the previous 12 months, with lack of time, lack of earnings while away from the practice, and lack of confidence in public speaking being the main reasons for not undertaking this activity. Being specifically invited to address groups, being provided with an information package on the topic, and being paid for their time were the three factors most likely to encourage this activity. Skin, cervical and breast cancer, blood pressure and cholesterol, and asthma were the topics general practitioners were most willing to speak on. Although this survey suggests that general practitioners would be willing to undertake this community health education, research is needed on whether they are the most appropriate and effective group for this.
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Affiliation(s)
- A Girgis
- NSW Cancer Council Cancer Education Research Program (CERP), Newcastle
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50
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Abstract
BACKGROUND AND DESIGN - Australia has the highest rates of skin cancer in the world, and the incidence is estimated to be doubling every 10 years. Despite advances in the early detection and treatment of melanoma about 800 people still die nationally of the disease each year. A possible strategy for further reducing the mortality from melanoma is an organised programme of population screening for unsuspected lesions in asymptomatic people. Arguments against introducing melanoma screening have been based on cost and the lack of reliable data on the efficacy of any screening tests. To date, however, there has been no systematic economic assessment of the cost effectiveness of melanoma screening. The purpose of this research was to determine whether screening may be potentially cost effective and, therefore, warrants further investigation. A computer was used to simulate the effects of a hypothetical melanoma screening programme that was in operation for 20 years, using cohorts of Australians aged 50 at the start of the programme. Based on this simulation, cost-effectiveness estimates of melanoma screening were calculated. RESULTS - Under the standard assumptions used in the model, and setting the sensitivity of the screening test (visual inspection of the skin) at 60%, cost effectiveness ranged from Aust$6853 per life year saved for men if screening was undertaken five yearly to $12 137 if screening was two yearly. For women, it ranged from $11 102 for five yearly screening to $20 877 for two yearly screening. CONCLUSION - The analysis suggests that a melanoma screening programme could be cost effective, particularly if five yearly screening is implemented by family practitioners for men over the age of 50.
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Affiliation(s)
- A Girgis
- NSW Cancer Council, Cancer Education Research Program (CERP), Newcastle, Australia
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