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Background: Randomised controlled trials (RCTs) are considered the gold standard design to determine the effectiveness of an intervention, as the only method of decreasing section bias and minimising random error. However, participant recruitment to randomised controlled trials is a major challenge, with many trials failing to recruit the targeted sample size accordingly to the planned protocol. Thus, the aim of this review is to detail the recruitment challenges of preoperative exercise clinical trials. Methods: A comprehensive search was performed on MEDLINE, Embase, The Cochrane Library, CINAHL, AMED and PsycINFO from inception to July 2021. Randomised controlled trials investigating the effectiveness of preoperative exercise on postoperative complication and/or length of hospital stay in adult cancer patients were included. Main outcomes included recruitment rate, retention rate, number of days needed to screen and recruit one patient and trial recruitment duration. Descriptive statistics were used to summarise outcomes of interest. Results: A total of 27 trials were identified, including 3656 patients screened (N = 21) and 1414 randomised (median recruitment rate (interquartile range) = 53.6% (25.2%–67.6%), N = 21). The sample size of the included trials ranged from 19 to 270 (median = 48.0; interquartile range = 40.0–85.0) and the duration of trial recruitment ranged from 3 to 50 months (median = 19.0 months; interquartile range = 10.5–34.0). Overall, a median of 3.6 days was needed to screen one patient, whereas 13.7 days were needed to randomise one participant. Over the trials duration, the median dropout rate was 7.9%. Variations in recruitment outcomes were observed across trials of different cancer types but were not statistically significant. Conclusion: The recruitment of participants to preoperative exercise randomised controlled trials is challenging, but patient retention appears to be less of a problem. Future trials investigating the effectiveness of a preoperative exercise programme following cancer surgery should consider the time taken to recruit patients. Strategies associated with improved recruitment should be investigated in future studies. [ABSTRACT FROM AUTHOR]

Objective: Lung cancer patients from ethnic minorities have poorer outcomes than their Caucasian counterparts. We compared lung cancer intervals between culturally and linguistically diverse (CALD) and Anglo‐Australian patients to identify ethnic disparities. Methods: This was a prospective, observational cohort study comprising a patient survey and reviews of patients' hospital and general practice records. Across three states, 577 (407 Anglo‐Australian and 170 CALD) patients were recruited and their hospital records reviewed. The survey was returned by 189 (135 Anglo‐Australian and 54 CALD) patients, and a review was completed by general practitioners (GPs) of 99 (76 Anglo‐Australian and 23 CALD) patients. Survival and Cox regression analyses were conducted. Results: CALD patients had longer hospital diagnostic interval [median 30 days, 95% confidence interval (CI) 26–34] than Anglo‐Australian patients (median 17, 95% CI 14–20), p = 0.005, hazard ratio (HR) = 1.32 (95% CI 1.09–1.60). This difference persisted after relevant factors were taken into consideration, adjusted HR = 1.26 (95% CI 1.03–1.54, p = 0.022). CALD patients also reported longer prehospital intervals; however, these differences were not statistically significant. Conclusion: Target interventions need to be developed to address ethnic disparity in hospital diagnostic interval. [ABSTRACT FROM AUTHOR]

Abstract Background There is uncertainty about the role of preoperative physical activity (PA) level and its influence on postoperative outcomes, especially for patients undergoing cancer surgery. Aim: To investigate if the level of preoperative PA in patients undergoing cancer surgery is associated with postoperative complication rates, length of hospital stay (LOS) and quality of life (QOL). Methods An electronic search was performed from inception to 26th November 2017 in MEDLINE, Embase, AMED and CINAHL. Studies investigating the association between objective or subjective level of PA and postoperative complication rates, LOS and QOL were included. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. When possible, summary odds ratios (OR) and 95% confidence intervals (CI) were calculated using random-effect models. Results 13 studies (5523 unique patients) were included. Overall, most studies were rated as having low or moderate risk of bias. Higher preoperative level of PA was not significantly associated with absence of postoperative complications (OR = 2.60; 95%CI = 0.59 to 11.37) but was significantly associated with shorter LOS (OR = 3.66; 95%CI = 1.38 to 9.6) and postoperative QOL (OR = 1.29; 95%CI = 1.11 to 1.49). Conclusions The available literature suggests higher levels of preoperative PA in patients undergoing cancer surgery may be associated with better postoperative outcomes, particularly shorter LOS and better QOL. There is a need for high-quality studies investigating the association between preoperative PA and postoperative outcomes. Systematic review registration PROSPERO 2017 CRD42017082334. Available from: http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017082334. [ABSTRACT FROM AUTHOR]

Introduction. Colorectal cancer (CRC) and its treatments can cause distressing sequelae. We conducted a multicenter randomized controlled trial aiming to improve psychological distress, supportive care needs (SCNs), and quality of life (QOL) of patients with CRC. The intervention, called SurvivorCare (SC), comprised educational materials, needs assessment, survivorship care plan, end-of-treatment session, and three follow-up telephone calls. Methods. At the end of treatment for stage I-III CRC, eligible patients were randomized 1:1 to usual care (UC) or to UC plus SC. Distress (Brief Symptom Inventory 18), SCNs (Cancer Survivors' Unmet Needs measure), and QOL (European Organization for Research and Treatment of Cancer [EORTC] QOL questionnaires C30 and EORTC CRC module CR29) were assessed at baseline and at 2 and 6 months (follow-up 1 [FU1] and FU2, respectively). The primary hypothesis was that SC would have a beneficial effect on distress at FU1. The secondary hypotheses were that SC would have a beneficial effect on (a) SCN and QOL at FU1 and on (b) distress, SCNs, and QOL at FU2. A total of 15 items assessed experience of care. Results. Of 221 patients randomly assigned, 4 were ineligible for the study and 1 was lost to FU, leaving 110 in the UC group and 106 in the SC group. Patients' characteristics included the following: median age, 64 years; men, 52%; colon cancer, 56%; rectal cancer, 35%; overlapping sites of disease, 10%; stage I disease, 7%; stage II, 22%; stage III, 71%. Baseline distress and QOL scores were similar to population norms. Between-group differences in distress at FU1 (primary outcome) and at FU2, and SCNs and QOLat FU1 and FU2 were small and nonsignificant. Patients in the SC group were more satisfied with survivorship care than those in the UC group (significant differences on 10 of 15 items). Conclusion. The addition of SC to UC did not have a beneficial effect on distress, SCNs, or QOL outcomes, but patients in the SC group were more satisfied with care. [ABSTRACT FROM AUTHOR]

The article presents information on a study for identifying predictors of variation in colorectal cancer care as well as outcomes in New South Wales. The study was conducted on data from 6890 people. It has been suggested to include patient characteristics in risk-adjustment models for comparing the outcomes.

Objective To investigate the associations of a range of personal and clinical variables with bladder cancer survival in men and women in NSW to see if we could explain why bladder cancer survival is consistently poorer in women than in men., Patients and Methods All 6880 cases of bladder cancers diagnosed in NSW between 2000 and 2008 were linked to hospital separation data and to deaths., Separate Cox proportional hazards regression models of hazard of bladder cancer death were constructed for those who did or did not undergo cystectomy., Results A total of 16% of patients with bladder cancer underwent cystectomy (16% of men and 15% of women). Women who underwent cystectomy were 26% more likely to die than men (hazard ratio [ HR] 1.26, 95% confidence interval [ CI] 1.00-1.59) after adjustment for age, stage, time from diagnosis to cystectomy, distance from treatment facility and country of birth., None of the above covariates had a material effect on the difference in hazard between women and men; however, when stratified by a history of cystitis, the adjusted hazard was 55% higher in women ( HR 1.55, 95% CI 1.15-2.10) than in men with a history of cystitis while, in the absence of this history, there was no difference in the hazard between men and women ( HR 0.99, 95% CI 0.57-1.70)., This apparent modification of the effect of sex on bladder cancer outcome was not seen in patients treated only by resection: the adjusted HRs in women relative to men were 1.10 (95% CI 0.92-1.31) in those with a history of cystitis and 1.21 (95% CI 0.98-1.50) in those without., A history of haematuria did not modify appreciably the association of sex with bladder cancer outcome., Conclusion Women's poorer survival from bladder cancer compared with that of men remains unexplained; however, the possibility that some factor associated with a history of cystitis may contribute to or explain the poorer outcome in women merits further investigation. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Telephone-based supportive care presents a potentially highly accessible means of addressing unmet supportive care needs for people with cancer. Identification of behaviours that facilitate communication is essential for development of training for telephone-based supportive care. The aim of this study was to describe communication behaviours within supportive care telephone calls in two contexts (1) a telephone outreach intervention and (2) cancer helpline calls, to identify potential areas for further training. Methods: 50 recorded calls were analysed using two standardised coding systems: the RIAS and Verona-CoDES-C. Results: Mean call length was 21min (304 utterances) for nurse-outreach calls and 23min (355 utterances) for helpline calls. Closed questioning, verbal attentiveness and giving information/counselling were the most common communication behaviours identified. Emotional cues were most commonly responded to through non-explicit back-channelling, exploration of content or provision of reassurance or advice. Conclusions: This study confirmed the need to address the manner in which questions are framed to maximise patient disclosure. Responding to patent emotional cues was highlighted as an area for future training focus. Practice implications: Communication skills training that addresses each of these tasks is likely to improve the effectiveness of telephone-based delivery of supportive care. [Copyright &y& Elsevier]

Background: Colorectal cancer (CRC) is the most common cancer affecting both men and women in Australia. The illness and related treatments can cause distressing adverse effects, impact on emotional and psychological well-being, and adversely affect social, occupational and relationship functioning for many years after the end of treatment or, in fact, lifelong. Current models of follow-up fail to address the complex needs arising after treatment completion. Strategies to better prepare and support survivors are urgently required. We previously developed a nurse-led supportive care program (SurvivorCare) and tested it in a pilot study involving 10 CRC survivors. The intervention was found to be highly acceptable, appropriate, relevant and useful.Methods/design: This study is a multisite, randomised controlled trial, designed to assess the impact of the addition of the SurvivorCare intervention to usual post-treatment care, for people with potentially cured CRC. SurvivorCare comprises the provision of survivorship educational materials, a tailored survivorship care plan, an individually tailored nurse-led, face-to-face end of treatment consultation and three subsequent telephone calls. Eligible patients have completed treatment for potentially cured CRC. Other eligibility criteria include stage I to III disease, age greater than 18 years and adequate understanding of English. All consenting patients complete questionnaires at three time points over a six-month period (baseline, two and six months). Measures assess psychological distress, unmet needs and quality of life.Discussion: This supportive care package has the potential to significantly reduce individual suffering, whilst reducing the burden of follow-up on acute cancer services through enhanced engagement with and utilisation of general practitioners and community based services. If the intervention is successful in achieving the expected health benefits, it could be disseminated readily. All training and supporting materials have been developed and standardised. Furthermore, the intervention could easily be adapted to other cancer or chronic disease settings.Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12610000207011. [ABSTRACT FROM AUTHOR]

The article discusses the challenges involved in prognosis and end-of-life care. It states that misunderstanding one's prognosis add to bad decision making. An expert panel used a question prompt list to study this. Patients with advanced cancer and health professionals participated. Analysis identified themes including reinforcement of known benefits of question prompt list, appraisal of content and suggestions for further development, and contrast feedbacks in Australian and U. S. patients.

Purpose: Australia has one of the most culturally diverse populations in the world. Immigrant cancer patients' poorer outcomes compared to English-speaking patients confirm the need for culturally sensitive supportive care interventions. The aims of this study were (1) to identify cultural sensitivities that are important to the acceptability of a telephone-based supportive care intervention and (2) to identify cultural barriers and facilitators to intervention participation. Methods: Patients and carers attending Chinese or Arabic cancer support groups were recruited. Two focus groups comprising 12 patients and 4 carers, and two telephone interviews were conducted in the participants' own language. A semi-structured interview format was utilised to determine potential cultural sensitivities that may influence the intervention delivery format as well as patients' willingness to participate in telephone-based supportive care interventions. Content analysis confirmed similar themes across groups. Results: The intervention was viewed favourably as a means of providing information and support in the patient's language. Cultural considerations included assurances of confidentiality, as cancer is not openly discussed within communities. An initial face-to-face contact was highlighted as the most important factor facilitating participation. Participants also recommended the inclusion of patient-initiated calls as part of the intervention. Conclusions: This study provides cultural insights relevant to the development of a culturally sensitive telephone-based supportive care intervention for Arabic- and Chinese-speaking cancer patients. Participants highlighted the need for face-to-face contact and inclusion of patient-initiated calls as important methodological considerations. [ABSTRACT FROM AUTHOR]

Purpose: Cancer is primarily a disease of ageing, yet the unmet supportive care needs of older cancer patients are not well understood. This study aims to explore how unmet needs differ by age over the 3 months following colorectal cancer surgery. Methods: Control groups from pilot phases of an ongoing randomised trial completed the Supportive Care Needs Survey-Short Form 34 (SCNS-SF34) at 1 and 3 months following hospital discharge ( n = 57). Multiple regression was used to investigate whether age was an independent predictor of unmet needs in each of the five SCNS-SF34 domains. The proportion of patients with unmet needs and the pattern of item responses were compared between patients aged <65 and ≥65 years at both time points. Results: Older age independently predicted significantly lower levels of unmet need than younger age in nearly all SCNS-SF34 domains. However, more than half of all older patients had unmet needs at both time points (56% and 65%), and age differences in unmet needs were less apparent by 3 months. Older patients were less likely than younger patients to report 'satisfied' needs, as older patients were significantly more likely to report items were 'not applicable' at both 1 month (mean difference 29%, p < 0.001) and 3 months (mean difference 23%, p = 0.01). Conclusions: While older patients reported lower levels of unmet need than younger patients, the high prevalence of unmet needs and age differences in item response patterns indicate that further research is needed to determine whether older patients' needs are being accurately captured. [ABSTRACT FROM AUTHOR]

Goals of work This study aims to describe a pilot study of the feasibility, acceptability and likely impact of a nurse-delivered, telephone intervention to reduce unmet need and improve quality of life for surgical patients with colorectal cancer. Materials and methods The CONNECT intervention comprises five standardised calls over 6 months commencing on day 3 post-discharge. A prospective non-randomised control trial with patients who had surgery for colorectal cancer at Royal Prince Alfred Hospital, Sydney between July and December 2006 was conducted. Patients completed a telephone interview with an independent researcher at 1, 3 and 6 months to assess study outcomes, including unmet need (Supportive Care Needs Survey), psychological distress and quality of life (FACT-C). Patients' views of the intervention were ascertained. Main results Forty-one patients participated, 20 in the intervention period. Intervention calls were successfully completed with 85% or more of patients at each of the five time points. Mean call duration ranged from 14-19 min with the highest number of needs (27 for 20 patients) identified on day 3. Patients indicated that the timing of the calls was appropriate and the majority (85%) felt the number of calls was sufficient. There were promising trends in outcomes. For both patient groups, there were clinically meaningful improvements in FACT-C scores over time, with a larger improvement in the intervention group (20.4 points) than the control group (11.7). Conclusions The CONNECT intervention was found to be feasible and acceptable to patients. A larger randomised trial is underway to establish its effectiveness to improve patient outcomes. [ABSTRACT FROM AUTHOR]

The article focuses on the findings of a survey on the perception of health professionals and consumers on involving breast cancer patients in the multidisciplinary discussion (MD) of their disease and treatment plan in Australia. The survey found that the majority of the respondents support shared decision-making. It cites that the common reasons for advocating patient involvement included providing patients with more information and an opportunity to ask questions. Patient advocates support the inclusion of women in the MD meeting.

Re: Pre-treatment wait time for head and neck cancer patients in Western Australia: description of a new metric and examination of predictive factors Increasing complexity of surgical and radiotherapy treatment planning may partly explain this observation, but it is likely due to several interacting patient and system factors. Metrics such as "treatment package time" for patients with head and neck cancer undergoing surgery and post-operative radiotherapy may also be warranted given evidence it independently predicts survival.[3]. [Extracted from the article]

Objectives: To investigate differences between quality of life (QoL) scores obtained preoperatively or recalled in the early postoperative period amongst patients undergoing major cancer surgery. Results: Of the 283 patients included, 133 completed their baseline QoL questionnaire preoperatively and 150 postoperatively. Patient groups were broadly comparable in terms of age however the preoperative group had a lower proportion of patients from non-English speaking backgrounds. There were important and statistically significant differences between mean scores for physical health (overall physical health, physical functioning and role physical domains) and mental health (overall mental health and mental health domains) between pre- and postoperative groups. There were no differences for other domain-specific scores (bodily pain, general health, vitality, social functioning and role emotional). [ABSTRACT FROM AUTHOR]

Background Patients are often not given the information needed to understand their prognosis and make informed treatment choices, with many consequently experiencing less than optimal care and quality-of-life at end-of-life. Objectives To evaluate the efficacy of a nurse-facilitated communication support program for patients with advanced, incurable cancer to assist them in discussing prognosis and end-of-life care. Design A parallel-group randomised controlled trial design was used. Settings This trial was conducted at six cancer treatment centres affiliated with major hospitals in Sydney, Australia. Participants 110 patients with advanced, incurable cancer participated. Methods The communication support program included guided exploration of a question prompt list, communication challenges, patient values and concerns and the value of discussing end-of-life care early, with oncologists cued to endorse question-asking and question prompt list use. Patients were randomised after baseline measure completion, a regular oncology consultation was audio-recorded and a follow-up questionnaire was completed one month later. Communication, health-related quality-of-life and satisfaction measures and a manualised consultation-coding scheme were used. Descriptive, Mixed Modelling and Generalised Linear Mixed Modelling analyses were conducted using SPSS version 22. Results Communication support program recipients gave significantly more cues for discussion of prognosis, end-of-life care, future care options and general issues not targeted by the intervention during recorded consultations, but did not ask more questions about these issues or overall. Oncologists’ question prompt list and question asking endorsement was inconsistent. Communication support program recipients’ self-efficacy in knowing what questions to ask their doctor significantly improved at follow-up while control arm patients’ self-efficacy declined. The communication support program did not impact patients’ health-related quality-of-life or the likelihood that their health information or shared decision-making preferences would be met. Satisfaction with the communication support program was high. Conclusions Given the importance of clarifying prognostic expectations and end-of-life care wishes in the advanced cancer context, the communication support program appears to be an effective and well-received solution to encourage early information seeking related to these issues though, its long-term impact remains unclear. The manualised nature of the intervention, designed with existing clinical staff in mind, may make it suited for implementation in a clinical setting, though additional work is needed to identify why question asking was unaffected and establish its impact later in the illness trajectory. [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to provide insight into how advanced cancer patients and their caregivers use a Question Prompt List (QPL) during a consultation and for preparation for future consultations. Methods Audiotaped consultations and follow-up phone calls of 28 advanced cancer patients were coded and content analyzed. Questions asked and concerns expressed in consultations were coded for initiator, content, inclusion in the QPL and exact wording. Patients’ reported and future use of the QPL were coded from the phone calls. Results The majority of patients reported that they used the QPL. Questions asked by patients and caregivers predominately coincided with questions from the prognosis section of the QPL. Questions were rarely asked literally from the QPL, instead questions were tailored to patients’ own circumstances. Conclusion QPLs are useful to stimulate discussion on prognosis among advanced cancer patients and caregivers. Patients tailored questions from the QPL to their own circumstances which may suggest high involvement and engagement. The development of more specific tailored communication interventions for advanced cancer patients is warranted. Practice implications Implementation of QPLs in the advanced cancer setting may be beneficial for patients, caregivers and healthcare providers to facilitate discussion of topics such as prognosis. [ABSTRACT FROM AUTHOR]