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1. 'I'm a Survivor': Aboriginal and Torres Strait Islander Cancer Survivors' Perspectives of Cancer Survivorship.

Author

Meiklejohn, JA, Bailie, R, Adams, J, Garvey, G, Bernardes, CM, Williamson, D, Marcusson, B, Arley, B, Martin, JH, Walpole, ET, Valery, PC, Meiklejohn, JA, Bailie, R, Adams, J, Garvey, G, Bernardes, CM, Williamson, D, Marcusson, B, Arley, B, Martin, JH, Walpole, ET, and Valery, PC

Abstract

BACKGROUND:Disparity in outcomes between Indigenous and non-Indigenous people after cancer diagnosis is multifactorial, including lower cancer screening participation, later diagnosis, reduced access and uptake of cancer treatment, higher rate of comorbidities, and barriers accessing the health system. Little is known about cancer survivorship experiences. OBJECTIVE:The aim of this study was to explore Indigenous Australian cancer survivor's perspectives of cancer survivorship. METHODS:Indigenous people who completed cancer treatment 6 months to 5 years before fieldwork were recruited from a tertiary hospital and remote primary health service for this qualitative study. Data collection was guided by yarning methods, a culturally appropriate method emphasizing storytelling. Data were interpreted using a social constructionist framework. RESULTS:Thirteen women and 6 men were interviewed. Participants' past experiences contributed to their specific identity as survivors. Participants described factors affecting a positive transition from cancer patient to cancer survivor and the importance of ongoing family support in helping to manage survivorship. Finally, participants described a range of community support they received and provided to others and how this improved their cancer survivorship. CONCLUSION:Although a range of experiences are presented, this study provides evidence that the survivorship perspectives of Indigenous cancer survivors may be, in part, shared by non-Indigenous cancer survivors. IMPLICATIONS FOR PRACTICE:Acknowledging Indigenous cancer survivors' past experiences and how these influence their overall well-being is important for providing patient-centered and culturally appropriate care. Nurses and other healthcare professionals may use this knowledge to foster a range of coping strategies to assist Indigenous cancer survivors to live well.

Published
2020

2. Community-identified recommendations to enhance cancer survivorship for Aboriginal and Torres Strait Islander people

Author

Meiklejohn, JA, Arley, B, Bailie, R, Adams, J, Garvey, G, Martin, JH, Walpole, ET, Valery, PC, Meiklejohn, JA, Arley, B, Bailie, R, Adams, J, Garvey, G, Martin, JH, Walpole, ET, and Valery, PC

Abstract

© La Trobe University 2018. Indigenous Australians diagnosed with cancer experience higher mortality and lower survival rates compared to non-Indigenous Australians. Reasons are multifaceted and complex. Knowledge about Indigenous cancer survivors' perspectives of positive cancer survivorship is a gap in research evidence. The study explored cancer survivorship perspectives of Indigenous cancer survivors, their support people and healthcare workers with a view to developing recommendations for cancer survivorship. Indigenous Australians who completed cancer treatment in the previous 6 months to 5 years, their support people and primary healthcare workers were recruited from primary healthcare centres and a large tertiary Queensland hospital. Semi-structured interviews and focus groups were conducted with written and informed consent obtained prior. Participants emphasised key action areas and recommendations to enhance cancer survivorship, namely: establishing a community cancer advocate and peer support program, availability and use of a cancer-specific Indigenous primary healthcare worker and hospital-based Indigenous patient navigator, as well as adoption of question prompt lists and cancer survivorship care plans. Existing research suggests significant benefits from implementing the key recommendations identified in this study. Greater support and commitment across health sectors and funding bodies is needed to promote institutional change and health system development.

Published
2018

3. Identification of Australian Aboriginal and Torres Strait Islander Cancer Patients in the Primary Health Care Setting

Author

de Witt, A, Cunningham, FC, Bailie, R, Bernardes, CM, Matthews, V, Arley, B, Meiklejohn, JA, Garvey, G, Adams, J, Martin, JH, Walpole, ET, Williamson, D, Valery, PC, de Witt, A, Cunningham, FC, Bailie, R, Bernardes, CM, Matthews, V, Arley, B, Meiklejohn, JA, Garvey, G, Adams, J, Martin, JH, Walpole, ET, Williamson, D, and Valery, PC

Abstract

BACKGROUND: Aboriginal and Torres Strait Islander Australians have poorer cancer outcomes and experience 30% higher mortality rates compared to non-Indigenous Australians. Primary health care (PHC) services are increasingly being recognized as pivotal in improving Indigenous cancer patient outcomes. It is currently unknown whether patient information systems and practices in PHC settings accurately record Indigenous and cancer status. Being able to identify Indigenous cancer patients accessing services in PHC settings is the first step in improving outcomes. METHODS: Aboriginal Medical Centres, mainstream (non-Indigenous specific), and government-operated centers in Queensland were contacted and data were collected by telephone during the period from 2014 to 2016. Participants were asked to (i) identify the number of patients diagnosed with cancer attending the service in the previous year; (ii) identify the Indigenous status of these patients and if this information was available; and (iii) advise how this information was obtained. RESULTS: Ten primary health care centers (PHCCs) across Queensland participated in this study. Four centers were located in regional areas, three in remote areas and three in major cities. All participating centers reported ability to identify Indigenous cancer patients attending their service and utilizing electronic Patient Care Information Systems (PCIS) to manage their records; however, not all centers were able to identify Indigenous cancer patients in this way. Indigenous cancer patients were identified by PHCCs using PCIS (n = 8), searching paper records (n = 1), and combination of PCIS and staff recall (n = 1). Six different types of PCIS were being utilized by participating centers. There was no standardized way to identify Indigenous cancer patients across centers. Health service information systems, search functions and capacities of systems, and staff skill in extracting data using PCIS varied between centers. CONCLUSION: It

Published
2017

4. The role of the GP in follow-up cancer care: a systematic literature review

Author

Meiklejohn, JA, Mimery, A, Martin, JH, Bailie, R, Garvey, G, Walpole, ET, Adams, J, Williamson, D, and Valery, PC

Subjects
Male, General Practitioners, Neoplasms, Humans, Aftercare, Female, Oncology & Carcinogenesis, Survivors
Abstract

© 2016, Springer Science+Business Media New York. Purpose: The purpose of the present study is to explore the role of the general practitioners, family physicians and primary care physicians (GP) in the provision of follow-up cancer care. Methods: PubMed, MEDLINE and CINAHL were systematically searched for primary research focussing on the role of the GP from the perspective of GPs and patients. Data were extracted using a standardised form and synthesised using a qualitative descriptive approach. Results: The initial search generated 6487 articles: 25 quantitative and 33 qualitative articles were included. Articles focused on patients’ and GPs’ perspectives of the GP role in follow-up cancer care. Some studies reported on the current role of the GP, barriers and enablers to GP involvement from the perspective of the GP and suggestions for future GP roles. Variations in guidelines and practice of follow-up cancer care in the primary health care sector exist. However, GPs and patients across the included studies supported a greater GP role in follow-up cancer care. This included greater support for care coordination, screening, diagnosis and management of physical and psychological effects of cancer and its treatment, symptom and pain relief, health promotion, palliative care and continuing normal general health care provision. Conclusion: While there are variations in guidelines and practice of follow-up cancer care in the primary health care sector, GPs and patients across the reviewed studies supported a greater role by the GP. Implications for Cancer Survivors: Greater GP role in cancer care could improve the quality of patient care for cancer survivors. Better communication between the tertiary sector and GP across the cancer phases would enable clear delineation of roles.

Published
2016

5. Health professional's perspectives of the barriers and enablers to cancer care for Indigenous Australians

Author

Meiklejohn, JA, Adams, J, Valery, PC, Walpole, ET, Martin, JH, Williams, HM, and Garvey, G

Subjects
Adult, Male, Oncologists, Attitude of Health Personnel, Allied Health Personnel, Australia, Radiation Oncologists, Nurses, Middle Aged, Oceanic Ancestry Group, Neoplasms, Humans, Female, Oncology & Carcinogenesis, Delivery of Health Care, Qualitative Research
Abstract

© 2016 John Wiley & Sons Ltd. To investigate health professionals' perspectives about factors that impede or facilitate cancer care for Indigenous people. Semi-structured interviews with 22 health professionals involved in Indigenous cancer care. Data were interpreted using an inductive thematic analysis approach. Participants presented their perspectives on a number of barriers and enablers to Indigenous cancer care. Barriers were related to challenges with communication, the health system and coordination of care, issues around individual and community priorities and views of cancer treatment and health professional judgement. Enablers to cancer care were related to the importance of trust and rapport as well as health care system and support factors. The findings highlighted the need for recording of Indigenous status in medical records and a coordinated approach to the provision of evidence-based and culturally appropriate cancer care. This could go some way to improving Indigenous patient's engagement with tertiary cancer care services.

Published
2016

6. Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial

Author

Nordlinger, B, Sorbye, H, Glimelius, B, Poston, Gj, Schlag, Pm, Rougier, P, Bechstein, Wo, Primrose, Jn, Walpole, Et, FINCH JONES, M, Jaeck, D, Mirza, D, Parks, Rw, Collette, L, Praet, M, Bethe, U, VAN CUTSEM, E, Scheithauer, W, Gruenberger, T, Hohenberger, W, Iveson, T, Karner, J, Levi, J, Hugh, T, DE GREVE, J, Chan, A, Davidson, B, Lindner, P, Peeters, M, Stein, B, Diamond, T, Ducreux, M, Lasser, P, Graeven, U, Paillot, B, Doran, J, Gouillat, C, Iesalnieks, I, Jauch, Kw, JAGOT LACOUSSIERE, P, Jansen, Rl, Koehne, H, Konopke, R, Otto, F, Sherlock, D, VAN HAZEL, G, Ackland, S, Bedenne, L, Bories, E, CLAVERO FABRI MC, Conroy, T, KAMINSKY FORRETT MC, Husseini, F, Karapetis, C, Mãœller, L, Price, T, Rosenberg, R, Schott, J, Tschmelitsch, J, VAN LAETHEM JL, Wals, J, Weimann, A, Arnaud, Jp, Arsene, D, Auby, D, Bhattacharya, S, Cebon, E, Cherqui, D, Confente, C, Dousset, B, Frickhofen, N, Frilling, A, Evan, P, Ganju, V, Hã–ffken, K, Lazorthes, F, Letoublon, C, Madroszyk, A, Nitti, Donato, Orr, B, Pariente, Ea, Pector, Jc, Raoul, Jl, Rees, M, Ridwelski, K, Rouanet, P, Toogood, Gj, Vergauwe, P, Wilke, Hj, Kaplan, R, Horiot, Jc, Littbrand, B, Awada, A, Stenning, S, Lejeune, F., Haukeland University Hospital, University of Bergen (UiB), Uppsala Universitet [Uppsala], Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Centre de Chirurgie Viscérale, Hépatique et de Transplantation Multiorganes, Université Louis Pasteur - Strasbourg I, European Organisation for Research and Treatment of Cancer [Bruxelles] (EORTC), European Cancer Organisation [Bruxelles] (ECCO), University Hospitals Leuven [Leuven], Centre Énergétique et Procédés (CEP), MINES ParisTech - École nationale supérieure des mines de Paris, Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL), Hémodynamique, Interaction Fibrose et Invasivité tumorales Hépatiques (HIFIH), and Université d'Angers (UA)

Subjects
Adult, Male, medicine.medical_specialty, Organoplatinum Compounds, Colorectal cancer, [SDV]Life Sciences [q-bio], 030230 surgery, Perioperative Care, 03 medical and health sciences, 0302 clinical medicine, Hepatic arterial infusion, Antineoplastic Combined Chemotherapy Protocols, medicine, Humans, Aged, business.industry, Liver Neoplasms, Hazard ratio, Cancer, General Medicine, Perioperative, Middle Aged, medicine.disease, Combined Modality Therapy, 3. Good health, Surgery, Oxaliplatin, Clinical trial, 030220 oncology & carcinogenesis, Female, Fluorouracil, Colorectal Neoplasms, Liver cancer, business, medicine.drug
Abstract

Summary Background Surgical resection alone is regarded as the standard of care for patients with liver metastases from colorectal cancer, but relapse is common. We assessed the combination of perioperative chemotherapy and surgery compared with surgery alone for patients with initially resectable liver metastases from colorectal cancer. Methods This parallel-group study reports the trial's final data for progression-free survival for a protocol unspecified interim time-point, while overall survival is still being monitored. 364 patients with histologically proven colorectal cancer and up to four liver metastases were randomly assigned to either six cycles of FOLFOX4 before and six cycles after surgery or to surgery alone (182 in perioperative chemotherapy group vs 182 in surgery group). Patients were centrally randomised by minimisation, adjusting for centre and risk score. The primary objective was to detect a hazard ratio (HR) of 0·71 or less for progression-free survival. Primary analysis was by intention to treat. Analyses were repeated for all eligible (171 vs 171) and resected patients (151 vs 152). This trial is registered with ClinicalTrials.gov, number NCT00006479. Findings In the perioperative chemotherapy group, 151 (83%) patients were resected after a median of six (range 1–6) preoperative cycles and 115 (63%) patients received a median six (1–8) postoperative cycles. 152 (84%) patients were resected in the surgery group. The absolute increase in rate of progression-free survival at 3 years was 7·3% (from 28·1% [95·66% CI 21·3–35·5] to 35·4% [28·1–42·7]; HR 0·79 [0·62–1·02]; p=0·058) in randomised patients; 8·1% (from 28·1% [21·2–36·6] to 36·2% [28·7–43·8]; HR 0·77 [0·60–1·00]; p=0·041) in eligible patients; and 9·2% (from 33·2% [25·3–41·2] to 42·4% [34·0–50·5]; HR 0·73 [0·55–0·97]; p=0·025) in patients undergoing resection. 139 patients died (64 in perioperative chemotherapy group vs 75 in surgery group). Reversible postoperative complications occurred more often after chemotherapy than after surgery (40/159 [25%] vs 27/170 [16%]; p=0·04). After surgery we recorded two deaths in the surgery alone group and one in the perioperative chemotherapy group. Interpretation Perioperative chemotherapy with FOLFOX4 is compatible with major liver surgery and reduces the risk of events of progression-free survival in eligible and resected patients. Funding Swedish Cancer Society, Cancer Research UK, Ligue Nationale Contre le Cancer, US National Cancer Institute, Sanofi-Aventis.

Published
2008

7. Preoperative cisplatin, fluorouracil, and docetaxel with or without radiotherapy after poor early response to cisplatin and fluorouracil for resectable oesophageal adenocarcinoma (AGITG DOCTOR): results from a multicentre, randomised controlled phase II trial.

Author

Barbour AP, Walpole ET, Mai GT, Barnes EH, Watson DI, Ackland SP, Martin JM, Burge M, Finch R, Karapetis CS, Shannon J, Nott LM, Varma S, Marx G, Falk GL, Gebski V, Oostendorp M, Wilson K, Thomas J, Lampe G, Zalcberg JR, Simes J, and Smithers BM

Subjects
Antineoplastic Combined Chemotherapy Protocols therapeutic use, Cisplatin therapeutic use, Docetaxel therapeutic use, Fluorouracil therapeutic use, Humans, Neoplasm Recurrence, Local, Positron Emission Tomography Computed Tomography, Treatment Outcome, Adenocarcinoma drug therapy, Adenocarcinoma radiotherapy, Esophageal Neoplasms drug therapy
Abstract

Background: Patients with oesophageal/gastro-oesophageal junction adenocarcinoma (EAC) not showing early metabolic response (EMR) to chemotherapy have poorer survival and histological response rates <5%. We investigated whether tailoring neoadjuvant therapy can improve outcomes in these patients., Patients and Methods: Patients with resectable EAC were enrolled and randomised into two single-arm, multicentre phase II trials. After induction cisplatin and 5-fluorouracil (CF), all were assessed by day 15 positron emission tomography (PET). Patients with an EMR [maximum standardised uptake values (SUVmax) ≥35% reduction from baseline to day 15 PET] received a second CF cycle then oesophagectomy. Non-responders were randomised 1 : 1 to two cycles of CF and docetaxel (DCF, n = 31) or DCF + 45 Gy radiotherapy (DCFRT, n = 35) then oesophagectomy. The primary end point was major histological response (<10% residual tumour) in the oesophagectomy specimen; secondary end points were overall survival (OS), progression-free survival (PFS), and locoregional recurrence (LR)., Results: Of 124 patients recruited, major histological response was achieved in 3/45 (7%) with EMR, 6/30 (20%) DCF, and 22/35 (63%) DCFRT patients. Grade 3/4 toxicities occurred in 12/45 (27%) EMR (CF), 13/31 (42%) DCF, and 25/35 (71%) DCFRT patients. No treatment-related deaths occurred. LR by 3 years was seen in 5/45 (11%) EMR, 10/31 (32%) DCF, and 4/35 (11%) DCFRT patients. PFS [95% confidence interval (CI)] at 36 months was 47% (31% to 61%) for EMR, 29% (15% to 45%) for DCF, and 46% (29% to 61%) for DCFRT patients. OS (95% CI) at 60 months was 53% (37% to 67%) for EMR, 31% (16% to 48%) for DCF, and 46% (29% to 61%) for DCFRT patients., Conclusions: EMR is associated with favourable OS, PFS, and low LR. For non-responders, the addition of docetaxel augmented histological response rates, but OS, PFS, and LR remained inferior compared with responders. DCFRT improved histological response and PFS/LR outcomes, matching the EMR group. Early PET/CT has the potential to tailor therapy for patients not showing an early response to chemotherapy., Trial Registration: ACTRN12609000665235., (Crown Copyright © 2019. Published by Elsevier Ltd. All rights reserved.)

Published
2020
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8. Development and Implementation of a Cancer Quality Index in Queensland, Australia: A Tool for Monitoring Cancer Care.

Author

Walpole ET, Theile DE, Philpot S, and Youl PH

Subjects
Delivery of Health Care, Humans, Queensland, Neoplasms therapy, Quality of Health Care
Abstract

Purpose: Many cancer-specific assessment tools to measure health care performance have been developed. However, reporting on quality indicators at a population level is uncommon. We describe the development and implementation of a Cancer Quality Index (CQI) and examine the sensitivity of the index to detect change over time., Methods: In developing the CQI, we reviewed existing indices, guidelines, and cancer care pathways. Our choice of indicators was additionally guided by the availability of population-wide data. A series of pilot indicators underwent trial use and were evaluated, and outcomes were discussed before a final set of indicators was established. The process was overseen by a clinician-led quality assurance committee that included hospital administrators and data custodians., Results: The CQI includes five quality dimensions and 16 indicators for public and private cancer services using population-wide information. The following are the five indicators: Effective, Efficient, Safe, Accessible, and Equitable. We demonstrated the sensitivity of the CQI to measure change over time by examining outcomes such as time to first treatment and 30-day surgical mortality, using linked cancer registry and health administrative data for 99,728 patients with cancer diagnosed between 2005 and 2009 and 2010 and 2014., Conclusion: The CQI is a valuable tool to track progress in delivering safe, quality cancer care within health care services. Critical to its development and implementation has been the involvement of clinicians from several disciplines and the availability of population-based data. We found the CQI to be a sensitive tool able to detect changes over time.

Published
2019
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9. Identification of Australian Aboriginal and Torres Strait Islander Cancer Patients in the Primary Health Care Setting.

Author

de Witt A, Cunningham FC, Bailie R, Bernardes CM, Matthews V, Arley B, Meiklejohn JA, Garvey G, Adams J, Martin JH, Walpole ET, Williamson D, and Valery PC

Abstract

Background: Aboriginal and Torres Strait Islander Australians have poorer cancer outcomes and experience 30% higher mortality rates compared to non-Indigenous Australians. Primary health care (PHC) services are increasingly being recognized as pivotal in improving Indigenous cancer patient outcomes. It is currently unknown whether patient information systems and practices in PHC settings accurately record Indigenous and cancer status. Being able to identify Indigenous cancer patients accessing services in PHC settings is the first step in improving outcomes., Methods: Aboriginal Medical Centres, mainstream (non-Indigenous specific), and government-operated centers in Queensland were contacted and data were collected by telephone during the period from 2014 to 2016. Participants were asked to (i) identify the number of patients diagnosed with cancer attending the service in the previous year; (ii) identify the Indigenous status of these patients and if this information was available; and (iii) advise how this information was obtained., Results: Ten primary health care centers (PHCCs) across Queensland participated in this study. Four centers were located in regional areas, three in remote areas and three in major cities. All participating centers reported ability to identify Indigenous cancer patients attending their service and utilizing electronic Patient Care Information Systems (PCIS) to manage their records; however, not all centers were able to identify Indigenous cancer patients in this way. Indigenous cancer patients were identified by PHCCs using PCIS ( n  = 8), searching paper records ( n  = 1), and combination of PCIS and staff recall ( n  = 1). Six different types of PCIS were being utilized by participating centers. There was no standardized way to identify Indigenous cancer patients across centers. Health service information systems, search functions and capacities of systems, and staff skill in extracting data using PCIS varied between centers., Conclusion: It is crucial to be able to easily identify Indigenous cancer patients accessing health services in the PHC setting to monitor progress, improve and evaluate care, and ultimately improve Indigenous cancer outcomes. It is also important for PHC staff to receive adequate training and support to utilize PCISs efficiently and effectively.

Published
2017
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