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Breast cancer patients' utilisation of supportive care has been understudied. In this paper, results from a population-based survey are used to assess the role of physicians and nurses in providing supportive care to women. Participants for this study were women with histologically confirmed invasive breast cancer diagnosed 23-36 months prior to contact about the study, who were randomly selected from the Ontario Cancer Registry. Patients for whom a physician approved contact were sent a survey questionnaire. There were two follow-up mailings. The survey included items related to patients' perceptions of supportive care involvement of oncologists, surgeons, family physicians and nurses. Among 1,119 eligible patients, 65% returned completed questionnaires. A total of 72% of these women reported having talked with an oncologist about one or more supportive care issues; 78% with a surgeon; 73% with a family physician; and 45% with a nurse. Factors linked to seeking supportive care from physicians and/or nurses included: younger age, working status, higher education, additional health insurance beyond that provided by government, higher household income, and receiving chemotherapy. Results indicate that physicians and nurses were providing important supportive care to most women with breast cancer. In a health care context where specialised supportive care services (e.g. help from dietitians, psychologists, social workers) are often unavailable or difficult to access, supportive care remains largely a responsibility of medical and nursing professionals. Even brief interventions may make an important difference to how patients deal with their illness over time.

Our primary objective was to determine the content and format that is most suitable for educational events targeting patients and carers who are living with advanced cancer. Secondary objectives included examining the differences in information needs between patients and their carers, and providing an estimate of the rate of participation in educational events targeting such patients and carers. Out-patients receiving palliative radiotherapy at Toronto Sunnybrook Regional Cancer Center and their carers were invited to complete the Advanced Cancer Information Needs Survey. One hundred forty-four respondents participated in the survey. The participants identified the management of pain, fatigue, and home palliative care resources as the areas in which information was most needed. Carers displayed greater interest, and the range of topics in which they continue to seek additional information is wider. Thirty-one percent of respondents said they would participate in an educational event. A 'one-on-one' interview approach and short written materials were the preferred sources of information. Our study examined potential content areas and preferred format for proposed educational events targeting patients and carers living with advanced cancer. We also highlighted the reasons for, and potential limitations of this approach. The investment of future effort in evaluating the impact of 1 on 1 interviews and 'short written materials' on the informational needs of patients and carers living with advanced cancer is warranted.

For patients with advanced incurable cancer, radiotherapy provides effective palliation and improved quality of life. At the Toronto-Sunnybrook Regional Cancer Centre, the Rapid Response Radiotherapy Programme, a pilot programme in Ontario, was started in 1996 to provide timely palliative radiotherapy. Over 200 patients have been seen annually since 1996. Of the patients referred to the clinic, 90% were treated by palliative radiotherapy. Of those requiring radiotherapy, 80% received treatment on the day of their initial visits, and 90% of the irradiated patients received one to five treatments. The programme has been warmly welcomed by many community medical oncologists and palliative care consultants. Other centres in Canada have followed our example and set up similar clinics. We sent out a survey to all referring physicians to explore the strengths and weaknesses of our programme so as to improve our services. There has been an increase in the utilization of palliative radiotherapy because of the availability of our programme. As a result of this survey we corrected some of our deficiencies. We plan to survey our patients' needs and satisfaction to further improve our programme, since the patients are the ultimate consumers of the service.