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Electronically administered patient-reported outcome measures (ePROMs) are effective digital health tools for informing clinicians about cancer patients' symptoms and facilitating timely patient-centred care. This paper describes the delivery of healthcare activities supported by the PROMPT-Care model, including ePROMs generated clinical alerts, cancer care team (CCT) response to alerts, and patients' perceptions of the CCT response and ePROMs system. This mixed-methods study includes cancer patients from four cancer therapy centres in New South Wales, Australia. Quantitative and qualitative data were collected regarding clinical alert activity, CCT response, and patient perceptions of the CCT responses and ePROMs system. Qualitative data were thematically analysed. Of the 328 participants whose care was informed by the digital health tool, 70.8% ( n = 233) generated at least one alert during the trial period, with 877 alerts generated in total. Although 43.7% ( n = 383) were actioned by the CCT, at least 80% of participants found follow-up CCT phone calls beneficial, with multiple benefits confirmed in interviews. The cancer care delivery arm of the PROMPT-Care trial involving clinical alerts to the CCT was positively perceived by most participants, resulting in a diverse range of benefits. However, further work is required, informed by implementation science, to improve the percentage of actioned clinical alerts.

Background: The burden of cancer is large in Australia, and rates of cancer Clinical Practice Guideline (CPG) adherence is suboptimal across various cancers., Methods: The objective of this study is to characterise clinician-perceived barriers and facilitators to cancer CPG adherence in Australia. Semi-structured interviews were conducted to collect data from 33 oncology-focused clinicians (surgeons, radiation oncologists, medical oncologists and haematologists). Clinicians were recruited in 2019 and 2020 through purposive and snowball sampling from 7 hospitals across Sydney, Australia, and interviewed either face-to-face in hospitals or by phone. Audio recordings were transcribed verbatim, and qualitative thematic analysis of the interview data was undertaken. Human research ethics committee approval and governance approval was granted (2019/ETH11722, #52019568810127)., Results: Five broad themes and subthemes of key barriers and facilitators to cancer treatment CPG adherence were identified: Theme 1: CPG content; Theme 2: Individual clinician and patient factors; Theme 3: Access to, awareness of and availability of CPGs; Theme 4: Organisational and cultural factors; and Theme 5: Development and implementation factors. The most frequently reported barriers to adherence were CPGs not catering for patient complexities, being slow to be updated, patient treatment preferences, geographical challenges for patients who travel large distances to access cancer services and limited funding of CPG recommended drugs. The most frequently reported facilitators to adherence were easy accessibility, peer review, multidisciplinary engagement or MDT attendance, and transparent CPG development by trusted, multidisciplinary experts. CPGs provide a reassuring framework for clinicians to check their treatment plans against. Clinicians want cancer CPGs to be frequently updated utilising a wiki-like process, and easily accessible online via a comprehensive database, coordinated by a well-trusted development body., Conclusion: Future implementation strategies of cancer CPGs in Australia should be tailored to consider these context-specific barriers and facilitators, taking into account both the content of CPGs and the communication of that content. The establishment of a centralised, comprehensive, online database, with living wiki-style cancer CPGs, coordinated by a well-funded development body, along with incorporation of recommendations into point-of-care decision support would potentially address many of the issues identified., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Bierbaum et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Rationale, Aims and Objective: Details of the development and implementation of integrated care pathways (ICPs) in the context of electronic collection of patient reported outcomes (ePROs) for cancer patients are largely lacking in the literature. This study describes what, why and how decisions were made to adapt and implement an ePROs ICP for patients with lung cancer., Methods: A consensus process was utilized, with the implementation advisory group including multidisciplinary representation from three participating hospitals, to identify local champions and adapt and incorporate the ePRO ICP into the local contexts. Engagement meetings were documented via meeting transcripts, and detailed notes from October 2019 to November 2020 were content-analysed to identify decision-making themes based on the Consolidated Framework for Implementation Research; workflows and process maps were reviewed and modified to integrate ePROs., Results: In total, 55 engagement activities were held (24 meetings, 20 workshops 11 educational sessions), with n = 96 staff from multiple disciplines participating in the ePROs implementation through advisory meetings, process mapping, change management and staff education. Decisions were made regarding eligible patient cohorts to include, the process for onboarding patients onto the ePRO system, and follow-up and referral pathways. Rationales for decisions included alignment with existing workflows, utilizing available staff, minimizing staff and patient burden and maximizing patient engagement., Conclusion: Existing resources, staff input and technical and logistical reasons often guided the ICP decisions, highlighting the need for in-depth engagement across all stakeholders for optimal implementation of ePRO ICPs. The ePRO implementation required substantial dialogue and systematic resolution to reach agreement on the final processes. Adapting the local ICP through rigorous engagement facilitated the successful implementation of ePROs as business-as-usual at all three cancer centres. Involving all relevant stakeholders is critical to the successful adaptation of ICPs before their introduction into routine care., (© 2022 John Wiley & Sons Ltd.)

Objective It has been established that the implementation of patient-reported outcome measures (PROMs) in routine care provides significant benefits to patients, providers and health services. However, there are patient-level barriers that must be identified and addressed for the successful implementation of PROMs. This study aimed to understand the capabilities and preferences of our cancer patient population prior to implementation of electronically collected PROMs (ePROMs). Specifically, we conducted a clinic audit to determine the proportion of patients in clinics with access to out-of-clinic internet; those preferring to complete PROMs on paper or via an electronic device; those capable of completing PROMs in English; and those anticipating requiring assistance to complete PROMs. Methods Patients receiving cancer treatment or follow-up care at two Local Health Districts (LHDs) in New South Wales, Australia, completed a questionnaire (audit form) with items about internet and mobile access, communication preferences and assistance needed to complete PROMs. Participant demographic and treatment information were extracted from their electronic medical records. Results Across both LHDs, 637 of 1668 participants (38%) completed the audit forms. Mean participant age was 65 years (range = 23-98), 53% were female, and 92% were outpatients. Patients in the two LHDs differed in their levels of internet and email access, and ability to complete PROMs independently in English, suggesting that some LHD-specific tailoring of implementation strategies is necessary to optimise ePROMs uptake. Conclusion This study highlights the importance of understanding the specific local contexts and patient populations, including potential technology and language barriers, which can influence patient ability to complete ePROMs.

Proton therapy and MRI-Linacs are two of the most exciting and fast growing technologies in radiation oncology. With over 100 MRI-Linacs and 100 proton therapy centres either in operation or under construction, an integrated approach that brings together the excellent soft tissue imaging of MRI with the superior dose conformity of proton therapy is compelling. The promise of MRI-guided proton therapy has prompted multiple research studies and the building of two pre-clinical experimental systems, taking us closer to realisation of this technology. Patients who would benefit most are those whose cancers have substantial tumour motion or anatomical variation, and those who are currently unable to receive safe dose-escalation due to nearby critical structures. MRI-guided proton therapy could allow more patients with pancreatic cancer, central lung cancer and oligo-metastatic cancers in the upper abdomen (e.g. liver and adrenal) to safely receive escalated curative doses. Head and neck, lung, brain and cervix cancers, where treatment accuracy is affected by inter-fraction tumour changes such as tumour regression or changing oedema, or normal anatomy variations, would also benefit from MRI-guidance. There will be new options to improve cure by functional MRI-guided biologically adapted proton therapy. This review focuses on the clinical aspects of MRI-guided proton therapy. We describe the clinical challenges in proton therapy and the clinical benefits from the addition of MRI-guidance. We provide updates on the design and beam modelling of in-line and perpendicular MRI-guided proton therapy systems, and a roadmap to clinical implementation., (Crown Copyright © 2022. Published by Elsevier B.V. All rights reserved.)

Objective: There have been few descriptions of how outpatient cancer care is provided to patients from culturally and linguistically diverse (CALD) communities. As populations who experience disparities in cancer care access and outcomes, deeper understanding is needed to help identify those factors which can shape the receipt of multidisciplinary care in ambulatory settings. This paper reports on data collected and analysed as part of a multicentre characterisation of care in Australian public hospital cancer outpatient clinics (OPCs)., Results: Analysis of data from our ethnographic study of four OPCs identified three themes: "Identifying CALD patient language-related needs"; "Capacity and resources to meet CALD patient needs", and "Making it work for CALD communities." The care team comprises not only clinicians but also families and non-clinical staff; OPCs serve as "touchpoints" facilitating access to a range of therapeutic services. The findings highlight the potential challenges oncology professionals negotiate in providing care to CALD communities and the ways in which clinicians adapt their practices, formulate strategies and use available resources to support care delivery., (© 2021. The Author(s).)

Aim: Low participation in cancer clinical trials by culturally and linguistically diverse (CALD) patients limits access to cutting-edge treatments and generalizability of results. This is the first study exploring trials knowledge/attitudes and their association with trial participation in Vietnamese- and Anglo-Australian cancer patients., Methods: Eligible patients diagnosed with cancer in the past 10 years were invited to complete a self-report questionnaire comprising validated measures of: trials knowledge and attitudes, preferred information amount, preferred decision-making involvement, health literacy, and past and future (i.e. hypothetical) trial participation. Multivariable linear regression evaluated correlates of trials knowledge/attitudes. Multinomial logistic regression estimated the relationship between trials knowledge/attitudes and possible future trial participation., Results: Vietnamese-Australian participants (n = 50) had more negative attitudes regarding trials than Anglo-Australians (n = 100; B = -9.28; 95% confidence interval [CI], -17.60 to -0.97; P = 0.029), but similar knowledge (B = -0.91; 95% CI, -2.27 to 0.44; P = 0.18). Future trial participation was associated with positive attitudes (odds ratio [OR] = 1.08; 95% CI, 1.04-1.12; P < 0.001) and greater knowledge (OR = 1.30; 95% CI, 1.04-1.62; P = 0.02), but not Vietnamese background (OR = 0.95; 95% CI, 0.27-3.32; P = 0.93)., Conclusion: Despite poorer attitudes regarding trials in Vietnamese-Australians, Vietnamese background was not associated with less likely future trial participation, suggesting low trial participation by CALD patients may be more due to opportunity barriers. Improving knowledge and attitudes may increase trial participation generally., (© 2020 John Wiley & Sons Australia, Ltd.)

Background: Clinical Practice Guidelines (CPGs) synthesize the best available evidence to guide clinician and patient decision making. There are a multitude of barriers and facilitators to clinicians adhering to CPGs; however, little is known about active cancer treatment CPG adherence specifically. This systematic review sought to identify clinician attitudes, and perceived barriers and facilitators to active cancer treatment CPG adherence., Methods: A systematic search was undertaken of five databases; Ovid Medline, PsychInfo, Embase, Scopus, CINAHL, and PROQUEST. The retrieved abstracts were screened for eligibility against inclusion criteria, and a full text review was conducted of all eligible studies. Data were extracted, and a quality assessment was conducted of all included studies. The qualitative papers were thematically analyzed. Attitudes, barriers, and facilitating factors extracted from the quantitative papers were categorized within the qualitative thematic framework., Results: The search resulted in the identification of 9676 titles. After duplicates were removed, abstracts screened, and full texts reviewed, 15 studies were included. Four themes were identified which related to negative clinician attitudes and barriers to active cancer treatment CPG adherence: (1) concern over CPG content and currency of CPGs; (2) concern about the evidence underpinning CPGs; (3) clinician uncertainty and negative perceptions of CPGs; and (4) organizational and patient factors. The review also identified four themes related to positive attitudes and facilitators to active cancer treatment CPG adherence: (5) CPG accessibility and ease of use; (6) endorsement and dissemination of CPGs and adequate access to treatment facilities and resources; (7) awareness of CPGs and belief in their relevance; and (8) belief that CPGs support decision making, improve patient care, reduce clinical variation, and reduce costs., Conclusion: These results highlight that adherence to active cancer treatment CPG recommendations by oncology clinicians is influenced by multiple factors such as attitudes, practices, and access to resources. The review has also revealed many similarities and differences in the factors associated with general CPG, and active cancer treatment CPG, adherence. These findings will inform tailored implementation strategies to increase adherence to cancer treatment CPGs., Trial Registration: PROSPERO (2019) CRD42019125748.

Background: Acupuncture has been proved effective for cancer related pain (CRP) in China, America and some other countries. However, there is relative lack of evidence to support the use of acupuncture for CRP in Australia., Objectives: To assess the effectiveness and safety of acupuncture for management of CRP in a real-world setting and to understand cancer patients' experience of undergoing acupuncture for CRP., Methods: A pragmatic randomised controlled trial will be conducted in South Western Sydney Local Health District (SWSLHD) in NSW, Australia. Adults with cancer related pain (n = 106) will be randomised in a 1:1 ratio to receive the acupuncture intervention up front versus after a wait list period of 4 weeks. Pain level (by Numerical Rating Scale), analgesic use, auricular acupressure frequency and adverse events will be assessed at baseline, mid-treatment and post-treatment. Expectancy on trial outcome (by Credibility and Expectancy questionnaire) will be assessed at baseline. The perspective of the participants (by an interview) will be recorded after the last intervention., Expected Outcomes: We hypothesise that acupuncture will relieve cancer related pain at mid-treatment and post-treatment. We also hypothesise that few adverse events will be provoked by acupuncture., Trial Registration: Australia New-Zealand Clinical Trial Registry (ACTRN12620000325909).

Background and Purpose: This study aimed to identify the actual radiotherapy utilisation rate (A-RUR) in New South Wales (NSW) Australia for 2009-2011 and compare that to the published evidence-based optimal radiotherapy utilisation rate (O-RUR) and to previously reported A-RUR in NSW in 2004-2006. It also aimed to estimate the effect of underutilisation on 5-year local control (LC) and overall survival (OS) and identify factors that predict for underutilisation., Materials and Methods: All cases of registered cancer diagnosed in NSW between 2009 and 2011 were identified from the NSW Central Cancer Registry and linked with data from all radiotherapy departments. The A-RUR was calculated and compared with O-RURs for all cancers. The difference for each indication was used to estimate 5-year OS and LC shortfall. Univariate and multivariate analyses were performed to identify factors that correlated with reduced radiotherapy utilisation., Results: 110,645 cancer cases were identified. 25% received radiotherapy within one year of diagnosis compared to an estimated optimal rate of 45%. This has marginally improved from previously reported rate of 22% in NSW in 2004-2006. We estimated that 5-year OS and LC were compromised in 1162 and 5062 patients respectively. Factors that predicted for underuse of radiotherapy were older age, male gender, lower socioeconomic status, increasing distance to nearest radiotherapy centre and localised disease., Conclusion: The identified deficit in radiotherapy use has a significant negative impact on patient outcomes. Strategies to overcome such shortfalls need to be developed to improve radiotherapy use and patient outcomes., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Multidisciplinary oncology team meetings are crucial hubs for integrated, patient-centered diagnosis and treatment planning. Team meetings are designed to enact the best practice principles of multidisciplinary care. Yet surveys of clinicians and allied health providers who are members of multidisciplinary teams (MDTs) identify real-world constraints on putting principles into practice. We review the guidelines for multidisciplinary care set out by Cancer Australia and scope the real-world constraints in enacting each of these guidelines, focusing on the crucial MDT meeting component of multidisciplinary care. We discuss resources and strategies required for compliance., (© 2019 John Wiley & Sons Australia, Ltd.)

Background and Purpose: Escalating health care costs have led to greater efforts directed at measuring the cost and benefits of medical treatments. The aim of this study was to estimate the costs of 5-year local control and overall survival benefits of radiotherapy for the cancer population in Australia., Materials and Methods: The local control and overall survival benefits of radiotherapy at 5-years and optimal number of fractions per course have been estimated for 26 tumour sites for which radiotherapy is indicated. For this study, a hybrid approach that merges features from activity based costing (ABC) and relative value units costing (RVU) were used to provide cost estimates. ABC methodology was used to allocate costs to all radiotherapy activities associated with each patient's treatment course, while the RVUs represent the cost of each radiotherapy activity relative to the average cost of all activities and were used to achieve a weighted cost allocation. A patient's journey for the financial year was constructed by consolidating all the radiotherapy activities and their associated costs, and the average cost per activity (fraction) was determined. The cost of radiotherapy per 5-year overall survival and local control was then estimated., Results: The estimated population 5-year local control and overall survival benefits of radiotherapy for all cancer were 23% and 6%, respectively. The optimal number of fractions per treatment course if guidelines were followed was 19.4 fractions. The average cost per fraction for all cancer was AU$276. The estimated cost of radiotherapy was AU$23,585 per 5-year local control and AU$86,480 per 5-year overall survival (equivalent to 5 life years) for all cancer., Conclusion: The cost of AU$86,480 per 5-year overall survival would translate to AU$17,296 1-year overall survival. Therefore, the cost of radiotherapy is inexpensive if delivered optimally. Policy implications from this study include knowledge about cost to deliver radiotherapy to allow one to quantify the expected benefit at a population level., (Crown Copyright © 2019. Published by Elsevier B.V. All rights reserved.)

Background: In response to the increasing cancer prevalence and the evolving health service landscape across the public and private health sectors in Australia, this study aimed to map cancer services and identify factors associated with service provision and important service gaps., Methods: A prospective, cross-sectional survey was conducted throughout 2016. Extensive search strategies identified Government or privately-owned, hospital or community-based healthcare organisations with dedicated cancer services. One nominated staff member from each organisation answered a purpose specific online/paper questionnaire. Descriptive statistics, standardised rates, and single level and multilevel multinomial logistic regression were used to analyse the data. Analysis was augmented with a qualitative descriptive analysis of open-ended questions., Results: From the 295 eligible organisations with a cancer service in Australia, 93.2% participated in the survey. After adjusting for remoteness, for-profit companies were significantly more likely than Government operated services to provide only one or two types of cancer services (e.g. radiotherapy) in a limited range of settings (e.g. day hospital with no in-patient or home care) (p < 0.001) and less likely to provide comprehensive cancer services (p < 0.001). After adjusting for ownership and the respondent's role in the organisation, respondents located in remote regions of Australia were more likely to identify cancer services that are dependent upon specialist medical practitioners as the most important service gaps in their region (p = 0.003). Despite 76.0% of organisations across Australia offering some type of supportive care or survivorship services, providers identified this group of services as the most pressing service gaps in major cities, rural and remote regions alike (standardised rate: 47.9% (95%CI: 43.6-57.4%); p < .000). This included the need for improved integration, outreach and affordability., Conclusions: The broad range of cancer services, settings and ownership identified by this survey highlights the complexity of the Australian healthcare system that cancer survivors must navigate and the challenges of providing comprehensive cancer care particularly in rural and remote regions. Whilst the significant role of supportive care and survivorship services are increasingly being recognised, the findings from this survey support calls for innovative service models and funding mechanisms that expand the focus from preventing and treating cancer to supporting cancer survivors throughout the cancer continuum and promoting the delivery of integrated and equitable cancer care across the public and private sectors.

Introduction: Patient-reported Outcomes for Personalized Treatment and Care (PROMPT-Care) is the first eHealth system in Australia that is fully electronically integrated into hospital oncology information systems, enabling real-time, routine collection of patient-reported outcomes (PROs) to support and enable cancer patients to achieve and maintain improved health, well-being, and cancer outcomes. Five previously published papers detail the impetus for developing this eHealth system, its development, and testing of its acceptability and feasibility, the development of algorithms to standardize the cancer care pathways which underpin patient care, and the protocol for evaluating the efficacy of PROMPT-Care., Methods: This manuscript provides "how-to" guidance to inform future system development, focusing on selecting relevant PROs and measuring them in cancer patients, score interpretation, and determining recommended care in response to scores which are above the predetermined threshold., Discussion: Electronic PRO systems are increasingly used in cancer clinical care settings, with the potential to support timely patient-centered care when implemented appropriately., Key Points: PRO selection should consider patient response burden, and prioritizing PROs that are amenable to clinical intervention. Having clear, evidence-based, care pathways, and actionable recommendations in response to above-threshold PRO scores facilitate PRO integration into the clinical workflow. Centers should determine thresholds for clinical action for each PRO which provide an acceptable balance between false positives and false negatives; and develop care pathway recommendations which consider the availability of local services and resources, are feasible in the clinical setting, clear, concise, manageable, based on evidence-based guidelines, and adaptable to local environments.

Background and Purpose: Despite evidence of the benefits of radiotherapy (RT) in the treatment of cancer patients, its underutilisation has been reported for various tumour sites. The aim of this study was to estimate survival shortfall, 'years of potential life lost' (YPLL) and 'disability-adjusted life years lost' (DALY) to demonstrate the impact of radiotherapy underutilisation in Australia., Materials and Methods: Optimal and actual RT utilisation (RTU) was compared to assess RT underutilisation to estimate 5-year overall survival shortfall using 2006 data from New South Wales (NSW) for 26 common tumour sites. 5-year overall survival shortfall is defined as number of people not surviving for 5-years due to RT underutilisation [=benefit proportion × shortfall [(optimal-actual RTU)/optimal RTU] proportion × No. of new cases]. YPLL = survival shortfall × estimated years of life lost per person (overall life expectancy - median age at death for specific cancer). DALY = (Years lived with disability + Years of life lost) × survival shortfall., Results: The total number of new cases with cancer in 2006 in NSW was 20,741. Optimal RTU was 48% while actual RTU was 26%, resulting in estimated of 411 deaths due to underutilisation. Each death resulted in an average of 10.4 YPLL and 17.5 DALY. It was estimated RT underutilisation resulted in a total of 4,289 YPLL and 7,192 DALY overall., Conclusion: This study illustrates the value of considering different mortality statistics, which include measures of the burden of cancer deaths on both the population and patients., (Crown Copyright © 2018. Published by Elsevier B.V. All rights reserved.)

Background: Individuals living with and beyond a cancer diagnosis are increasingly using complementary therapies and medicines (CM) to enhance the effectiveness of cancer treatment, manage treatment-related side effects, improve quality-of-life, and promote self-efficacy. In response to the increasing use and demand for CM by cancer patients, interest in the implementation of Integrative Oncology (IO) services that provide CM alongside conventional cancer care in Australia and abroad has developed. The extent that cancer services in Australia are integrating CM is uncertain. Thus, the aim of this study was to identify IO services in Australia and explore barriers and facilitators to IO service provision., Methods: A national, cross-sectional survey of healthcare organisations was conducted in 2016. Organisations in the public and private sectors, including not-for-profit organisations that provided cancer care in hospital or community setting, were included., Results: A response rate of 93.2% was achieved (n = 275/295). Seventy-one organisations (25.8%) across all states/territories, except the Northern Territory, offered IO albeit in a limited amount by many. Most common IO services included massage, psychological-wellbeing, and movement modalities in hospital outpatient or inpatient settings. There were only a few instances where biological-based complementary medicine (CM) therapies were prescribed. Funding was often mixed, including patient contributions, philanthropy, funding by the organisation, and volunteer practitioners. Of the 204 non-IO providers, 80.9% had never provided any IO service. Overwhelmingly, the most common barrier to IO was a lack of funding, followed by uncertainty about patient demand, choice of services, and establishing such services. Less-common barriers were a lack of evidence, and support from oncologists or management. More funding, education and training, and building the evidence-base for CM were the most commonly suggested solutions., Conclusion: IO is increasingly being provided in Australia, although service provision remains limited or non-existent in many areas. Mismatches appear to exist between low IO service provision, CM evidence, and high CM use by cancer patients. Greater strategic planning and policy guidance is indicated to ensure the appropriate provision of, and equitable access to IO services for all Australian cancer survivors.

Background: Routine assessment and clinical utilisation of patient-reported outcome (PRO) measures can lead to improved patient outcomes. The PROMPT-Care eHealth system facilitates PRO data capture from cancer patients, data linkage and retrieval to support clinical decisions, patient self-management, and shared care. Pilot testing demonstrated acceptability and feasibility of PROMPT-Care Version 1.0. This study aims to implement PROMPT-Care Version 2.0 and determine its efficacy in reducing emergency department (ED) presentations, and improving chemotherapy delivery and health service referrals, compared to usual care., Methods: Groups eligible to participate in the intervention arm of this controlled trial are patients receiving cancer care (including follow-up). PROMPT-Care patients will complete monthly assessments (distress, symptoms, unmet needs) until voluntary withdrawal or death. In Version 1.0, the care team accessed patients' clinical feedback reports in 'real time' to guide their care, and patients received links to support their self-management, tailored to their PRO responses. Version 2.0 was extended to include: i) an additional alert system notifying the care team of ongoing unresolved clinical issues, ii) patient self-management resources, and iii) an auto-populated Treatment Summary and Survivorship Care Plan (SCP). The control population will be patients extracted from hospital databases of the general cancer patient population who were seen at the participating cancer therapy centres during the study period, with a ratio of 1:4 of intervention to control patients. A minimum sample size of 1760 (352 intervention and 1408 control) patients will detect a 14% reduction in the number of ED presentations (primary outcome) in the PROMPT-Care group compared with the control group. Intervention patients will provide feedback on system usability and value of the self-management materials; oncology staff will provide feedback on usefulness of PROMPT-Care reports, response to clinical alerts, impact on routine care, and usefulness of the SCPs; and GPs will provide feedback on the usefulness of the SCPs and attitudes towards shared-care models of survivorship care planning., Discussion: This study will inform the PROMPT-Care system's impact on healthcare utilisation and utility as an alternative model for ongoing supportive care., Trial Registration: Australian New Zealand Clinical Trials Registry ( ACTRN12616000615482 ) on 12th May 2016 ( www.anzctr.org.au ).

There is an obvious mismatch between the high reported rates of use of traditional and complementary medicines (T&CM) by Australian cancer patients and cancer survivors and the low numbers of Australian cancer services integrating T&CM. An estimated 65% of Australian cancer patients use at least one form of T&CM. Over half use T&CM in conjunction with conventional cancer therapy. Yet, less than 20% of Australian hospital cancer care facilities provide access to T&CM. This compares to around 70% of UK cancer care facilities offering at least one T&CM therapy. Barriers to developing integrative oncology services include determining an appropriate service model and revenue structure; concerns with ethical and legal issues such as regulations and credentialing; and inadequate high-quality scientific evidence demonstrating safety and effectiveness, including concerns about the possibility of adversely affecting chemotherapy or radiotherapy treatment. This paper aims to provide general guidance and practical strategies for those seeking to develop integrative oncology services in Australian cancer care facilities.

Background and Purpose: The recently updated optimal radiotherapy utilisation model estimated that 48.3% of all cancer patients should receive external beam radiotherapy at least once during their disease course. Adapting this model, we constructed an evidence-based model to estimate the optimal number of fractions for notifiable cancers in Australia to determine equipment and workload implications., Materials and Methods: The optimal number of fractions was calculated based on the frequency of specific clinical conditions where radiotherapy is indicated and the evidence-based recommended number of fractions for each condition. Sensitivity analysis was performed to assess the impact of variables on the model., Results: Of the 27 cancer sites, the optimal number of fractions for the first course of radiotherapy ranged from 0 to 23.3 per cancer patient, and 1.5 to 29.1 per treatment course. Brain, prostate and head and neck cancers had the highest average number of fractions per course. Overall, the optimal number of fractions was 9.4 per cancer patient (range 8.7-10.0) and 19.4 per course (range 18.0-20.7)., Conclusions: These results provide valuable data for radiotherapy services planning and comparison with actual practice. The model can be easily adapted by inserting population-specific epidemiological data thus making it applicable to other jurisdictions., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Background: It has been estimated that half of all cancer patients should receive radiotherapy during the course of the disease. Actual Radiotherapy Utilization (RTU) rates are usually lower than the optimal rates., Methods: Data were collected from all radiotherapy departments (RTD) in New South Wales (NSW) and the Australian Capital Territory (ACT) for the period 2004-06 and were linked to Central Cancer Registries. Geographic Information System (GIS) software was used to calculate road distance between patient residence and the closest RTD. Patients were excluded from the study if their nearest RTD was outside NSW., Results: The overall RTU rate was 26%. The RTU rates decreased with increasing travel distance from patient residence to the nearest RTD (p<0.0001). Multivariate logistic regression shows that male gender, younger age and shorter travel distance were significantly associated with receiving radiotherapy. Patients were 10% less likely to receive radiotherapy for each additional 100 km distance from the nearest RTD (p<0.001)., Conclusions: There was a statistically significant reduction in radiotherapy access with longer road distance between patient residence and radiotherapy department., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Background and Purpose: In 2003 we estimated that 52.3% of new cases of cancer in Australia had an indication for external beam radiotherapy at least once at some time during the course of their illness. This update reviews the contemporary evidence to define the optimal proportion of new cancers that would benefit from radiotherapy as part of their treatment and estimates the changes to the optimal radiotherapy utilisation rate from 2003 to 2012., Materials and Methods: National and international guidelines were reviewed for external beam radiotherapy indications in the management of cancers. Epidemiological data on the proportion of new cases of cancer with each indication for radiotherapy were identified. Indications and epidemiological data were merged to develop an optimal radiotherapy utilisation tree. Univariate and Monte Carlo simulations were used in sensitivity analysis., Results: The overall optimal radiotherapy utilisation rate (external beam radiotherapy) for all registered cancers in Australia changed from 52.3% in 2003 to 48.3% in 2012. Overall 8.9% of all cancer patients in Australia have at least one indication for concurrent chemo-radiotherapy during the course of their illness., Conclusions: The reduction in the radiotherapy utilisation rate was due to changes in epidemiological data, changes to radiotherapy indications and refinements of the model structure., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Background: There is a gap between optimal and actual radiotherapy utilization (RTU) rates in New South Wales (NSW). It is uncertain if this is because these investments have been insufficient to meet demand, or demand has been over-estimated. In this study we assess trends in infrastructure, staffing and productivity in NSW over the last 10 years., Methods: The NSW Radiotherapy Management Information System reports annually on activity including new patients, new courses, retreatments, attendances, radiotherapy fields and Area Health Service (AHS) of residence. Data are obtained from interstate radiotherapy departments that treat NSW residents. A census of equipment and staffing is reported. RTU was defined as the number of new cases in a year treated by radiotherapy divided by the number of new cases of cancer in that year., Results: From 1999 to 2008, 115,941 NSW residents received at least one course of radiotherapy. During this time period there were 325,965 new diagnoses of cancer reported by the Central Cancer Registry. RTU was 38% in 1999 and in 2008. The number of linear accelerators increased from 34 to 42 between 1999 and 2008 but the number of accelerators per 1000 new cases of cancer remained static at 1.2. For AHSs, there was a significant relationship between more linear accelerators per 1000 patients and higher RTU (P = 0.0023)., Conclusion: Radiotherapy utilization in NSW has remained at 38% for the period 1999 to 2008 because investment in new facilities only just kept pace with the increase in the number of new cases of cancer with an indication for radiotherapy. Some regional AHS have shown significant increases in RTU with new facilities., (© 2011 The Authors. Journal of Medical Imaging and Radiation Oncology © 2011 The Royal Australian and New Zealand College of Radiologists.)