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The availability of hospital‐based dental services across Australia varies with a number of hospitals disestablishing dental departments due to rising costs. However, the perceived costs are difficult to quantify as funding models used to capture activity are not uniform across health facilities. To investigate this the predicted funding generated using current models of activity‐based funding in the provision of specialist dentistry in Australian public hospitals was examined. Using data from Fiona Stanley Hospital regarding the dental treatment for head and neck cancer patients as part of their work‐up for cancer management, expected funding was estimated using the existing fee‐for‐service and capped‐fee models currently in use. Funding estimates were based on the Department of Veterans' Affairs Fee Schedule of Dental Services and the Independent Hospital Pricing Authority's Australian Non‐Admitted Care Classification. A total of 127 patients received dental treatment over 209 appointments including 17 patients who had all their remaining teeth removed. Analysis revealed the fee‐for‐service model generated more expected funding than the current capped‐fee model, or an average of AUD$458 (USD$356) per patient. Differences in how activity was recorded resulted in 81.7% uncaptured funding between the two models. This study shows that fee‐for‐service models capture activity more accurately. However, this model is not used in public hospitals despite it being standard practice in stand‐alone public dental clinics. As a result, hospital‐based dental clinics appear to be unproductive. Further research can include developing a model that better captures both the activity undertaken as well as patient complexity. Key points: Dental clinics in Australian hospitals are perceived to be costly and inefficient; however, they may do so as a result of discrepancies and biases inherent in medical funding models.Current funding models do not accurately capture the complexity of patients presenting for specialist dental care.Governments should develop a model that captures the activity of hospital‐based dental clinics in managing patients with complex health‐care needs. [ABSTRACT FROM AUTHOR]

Patients with cancer and diabetes face unique challenges. Limited data are available on diabetes management in patients undergoing concurrent chemoradiotherapy (CCRT), a curative intent anticancer therapy commonly associated with glucocorticoid administration, weight fluctuations and enteral feeds. This retrospective case–control study examined the real-world incidence of acute diabetes-related complications in patients with head and neck cancer receiving CCRT, along with the impact of diabetes on CCRT tolerance and outcomes. Methods: Consecutive patients with head and neck squamous cell or nasopharyngeal cancer who underwent definitive or adjuvant CCRT between 2010 and 2019 at two large cancer centers in Australia were included. Clinicopathological characteristics, treatment complications and outcomes were collected from medical records. Results: Of 282 patients who received CCRT, 29 (10.3%) had pre-existing type 2 diabetes. None had type 1 diabetes. The majority (74.5%) required enteral feeding. A higher proportion of patients with diabetes required admission to a high-dependency or intensive care unit (17.2 versus 4.0%, p = 0.003). This difference was driven by the group who required insulin at baseline (n = 5), of which four (80.0%) were admitted to a high-dependency unit with diabetes-related complications, and three (60.0%) required omission of at least one cycle of chemotherapy. Conclusions: Patients with diabetes requiring insulin have a high risk of acute life-threatening diabetes-related complications while receiving CCRT. We recommend multidisciplinary management involving a diabetes specialist, educator, dietitian, and pharmacist, in collaboration with the cancer care team, to better avoid these complications. [ABSTRACT FROM AUTHOR]

Introduction: Globally, the research community is coming to realise the need for diversity, equity and inclusion (DEI) amongst research teams and leadership. Diverse teams reduce homogeneous 'group think', propagate innovation, propound support for broader more representative research and facilitate the recruitment of patients from diverse backgrounds. Given the above, this study aims to retrospectively examine the characteristics of chief investigators (CI) and principal investigators (PI) in past and present Australian and New Zealand radiation oncology clinical trials. Methods: Data on CI and PI characteristics were attained from the Trans Tasman Radiation Oncology Group (TROG) website as well as archived master database files provided by the TROG Scientific Committee. Data included CI and PI discipline, clinical trial activation date, institution type (private vs. public) and geographical location if in Australia. Australian and New Zealand health practitioner registration agency websites were used to determine the registered sex of the CIs and PIs and their years of experience. Results: One hundred and twenty TROG clinical trials have been initiated by 134 CIs from 1989 to 2022 and 463 TROG clinical trials have been opened by 465 PIs at their respective institutions from 2000 to 2022. Most TROG trial investigators have been radiation oncologists and those with over 10 years of experience. Only one in five trials and one in three trials have been led by female PIs and CIs, respectively. Investigators have largely been affiliated with public institutions, with only one in 100 CIs and one in eight PIs being affiliated with the private sector. TROG members from regional and rural areas in Australia have not been engaged as investigators, with all CIs and most PIs affiliated with metropolitan institutions. Conclusion: This study highlights the gaps in diversity amongst CIs and PIs in TROG clinical trials. Further unpacking and understanding of issues related to CI and PI diversity are important to inform initiatives to improve researcher, leadership and patient diversity in future TROG clinical trials. [ABSTRACT FROM AUTHOR]

Introduction: Patient-reported outcomes (PROs) are direct reports from patients about their health status. Patient-reported outcome measures (PROMs) are validated tools assessing PROs and completed by patients. Though commonly used in research, implementing PROMs into routine clinical care has been challenging. We aimed to examine health professionals' (HPs') perceptions of barriers and facilitators to PRO and PROM use in the routine care of head and neck cancer (HNC) patients.Methods: A custom survey was created, pilot-tested and disseminated to all HPs involved in the care of HNC patients in Western Sydney Local Health District, Australia. Participants were asked to rate the degree to which they believed the survey items were barriers or facilitators to routine PRO use by answering 'not at all', 'very little', 'quite a bit' and 'very much'.Results: Of 129 HPs, 86% had never routinely used PROs. Key barriers perceived were low workplace awareness of PROs (73%), HPs' lack of knowledge on PRO use (63%) and lack of PROMs in patient preferred languages (63%). Insufficient time, staff and infrastructure to support routine PRO collection and non-integrated PROMs in patient electronic medical records were also highlighted. Top facilitators were time for PRO administration and interpretation (86%), clear definition of staff roles (84%) and automatic scoring and interpretation of PROMs (81%).Conclusions: This study highlighted key barriers and facilitators to PRO use in routine HNC patient care as perceived by HPs. The findings will be useful in guiding the successful and sustainable implementation of routine PRO collection in clinical settings. [ABSTRACT FROM AUTHOR]

Introduction: The global COVID-19 pandemic forced the cancellation of the TROG 2020 face to face Annual Scientific Meeting (ASM). It was instead delivered as a live virtual meeting with 6 days of planning. Here, we report the participants' experience of this live virtual meeting.Method: Participants were invited to complete custom-developed, pre- and post-meeting surveys to assess their expectations of and satisfaction with the live virtual format. Speakers and moderators were also invited to complete a custom-developed satisfaction survey. The working parties of TROG (head/neck/skin, genitourinary, breast and lung) were also sampled.Results: In total, 188/273 (69%) registered participants logged in to the live virtual meeting. The online engagement for each of the oral sessions ranged from 53 to 66%. There were 102 and 57 responders to the online pre- and post-meeting surveys, respectively. The majority of pre-meeting responders indicated a significant level of employer support to attend the virtual meeting. Post-meeting satisfaction exceeded pre-meeting expectations ('very much' and 'quite a bit'; 86% vs. 54%; P < 0.0001). The majority indicated they would be 'quite a bit' or 'very much' interested in future live virtual meetings.Conclusion: The TROG 2020 ASM was conducted as a live virtual meeting. Participant satisfaction and future interest in a live virtual meeting was high, indicating this is a viable platform for other CCTG's faced with the decision to deliver virtual content at times of global public health threats. [ABSTRACT FROM AUTHOR]

Objective: Head and neck cancer (HNC) patients commonly undergo radiation therapy requiring immobilisation by a mask. Some find the mask distressing, and this can disrupt treatment sessions. This study aimed to explore the patient experience of immobilisation masks in the Australian and New Zealand (ANZ) context, to guide possible intervention. Methods: Semi‐structured interviews were conducted with HNC patients who had completed radiation therapy, recruited via hospitals and social media. Interviews continued until data saturation; then, three further interviews were conducted for member‐checking purposes. Qualitative methodology with thematic analysis was used to identify themes in the data. Results: Twenty HNC survivors participated in interviews, and seven themes were identified: information received by participants, potential predictors of mask anxiety, participant reactions to the mask, trajectories of mask anxiety, supportive behaviour and communication of health professionals, coping with the mask, and thoughts and feelings about the mask. Conclusions: Participant experiences of the immobilisation mask were diverse. The findings fit with Lazarus and Folkman's (Stress, appraisal, and coping. New York, NY: Springer Pub. Co) transactional model of stress and coping, as participants appeared to make cognitive appraisals of the mask and their coping abilities throughout treatment, resulting in varied levels of mask‐related distress. Complex intervention is recommended to reduce mask anxiety in HNC patients across ANZ. [ABSTRACT FROM AUTHOR]

Aims Radiation therapy (RT) is an essential and cost-effective cancer treatment, but it is underutilized in Australia. We aimed to quantify consumers' perceptions of factors that influence RT decisions. Methods A cross-sectional, survey-based study was conducted in March-August 2012. Potential participants were invited to complete an electronic survey disseminated through multiple patient support and advocacy groups throughout New South Wales (NSW), Australia. Study invitations were also placed in local newspapers across NSW with hard copy surveys mailed to respondents. Current or past cancer patients (and carers) who had been offered RT were eligible to participate regardless of their RT decision. Results Of the 1191 participants (electronic, n = 1153; hard copy, n = 38), 91% were female, most (88%) were current or past patients, and 78% had accepted RT. Issues commonly perceived to be moderate to strong influencers of RT decisions were: concern about acute and long-term side effects; management of side effects; fear and anxiety regarding RT; lack of awareness of RT; lack of local availability of RT; and lack of RT information resources. Those who declined RT were significantly more likely to highlight practical difficulties with receiving RT. Conclusions Although availability of RT is well recognized, other issues such as fear and anxiety about RT and perceived side effects appear to feature prominently in consumers' decisions. Perceived practical difficulties with receiving RT may have influenced those who declined RT. There may be a need for information resources, support services and interventions to increase awareness of RT. [ABSTRACT FROM AUTHOR]

Objective The study aimed to determine factors related to ICU mortality in critically ill patients transferred by Adult Retrieval Victoria ( ARV) medical staff. Patients who died in ICU after interhospital transfer were compared against those who survived. Methods This was a retrospective cohort study of ARV cases between 1 January 2009 and 30 June 2010. Retrieval data were linked with data from the ANZICS CORE APD ( Australia and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation Adult Patient Database). Victoria Data Linkage ( VDL) performed linkage of data. Data included demographic and clinical data obtained during transfer and clinical data recorded in ICU. Results Of the 601 cases transferred by ARV during the study period, 549 cases were eligible for linkage to 25 543 ANZICS APD case records for the same period. VDL matched 460 of these cases (83.8%). Mortality rate in the matched sample was 13.9%. Variables associated with mortality were: advanced age (odds ratios [ OR] 1.02, 95% confidence interval [ CI] 1.00-1.04, P = 0.02), principal referral problem cardiac ( OR 1.84, 95% CI 1.02-3.32, P = 0.04), lower mean arterial blood pressure ( OR 0.97, 95% CI 0.95-0.99, P = 0.005) and tachycardia ( OR 1.02, 95% CI 1.00-1.03, P = 0.008) on arrival at destination hospital. Conclusions Advanced age, lower mean arterial blood pressure and tachycardia towards the completion of transfer were associated with increased ICU mortality in this population. Clinicians should be aware of the additional risk for cardiac patients. [ABSTRACT FROM AUTHOR]

Abstract: Aims: Merkel cell carcinoma (MCC) is a radiosensitive tumour. Radiotherapy has an important role in its treatment, including definitive management. This study aimed to determine the in-field control achieved with definitive radiotherapy or chemoradiotherapy (CRT) and to examine patterns of relapse. Materials and methods: Patients treated with definitive radiotherapy or CRT for biopsy-confirmed MCC were identified from records of the Royal Prince Alfred Hospital and Melanoma Institute Australia. Definitive treatment was defined as treatment delivered to macroscopic or residual microscopic disease at the primary site or in regional nodes. Patients with distant metastatic disease at presentation and those treated electively or adjuvantly (i.e. after microscopically clear excision) were excluded. Results: Of 26 patients treated with definitive radiotherapy (n = 18) or CRT (n = 8), 20 were disease free at last follow-up (median follow-up 23.5 months). Five of the six patients who recurred did so at distant sites, with two experiencing simultaneous in-field failure at treated nodal sites where there had been macroscopic disease at presentation. Eighty-nine per cent of all patients and 85% of those with macroscopic disease were free of in-field recurrence at 2 years. Conclusion: Definitive radiotherapy or CRT produces excellent in-field disease control in the treatment of primary and regionally metastatic MCC. [Copyright &y& Elsevier]

Purpose: Radiation Oncology (RO) societies which provide research grants from membership dues or charitable donations owe it to their funders to assess value for money, yet very little has been published on the outcomes of such grants. A previous Royal Australian and New Zealand College of Radiologists (RANZCR) survey confirmed significant academic impact from their RO grants. The purpose of this work was to update and broaden the survey using, to our knowledge for the first time in the RO literature, the "Payback Framework", a model employed extensively elsewhere in health research.Methods and Materials: Between funding years 2010 and 2020, 58 grants were awarded to 41 individuals, median 1 per individual (range 1-4), median AUD $20,000 (US $14,000) per grant (range AUD $5,000-$26,000). Five recipients of failed projects were excluded. The remaining 36 individuals, receiving 51 grants totaling US $660,000, were eligible for a voluntary on-line survey (SurveyMonkey) assessing project outcomes. Data collection and checking extended to 31 January 2022.Results: The survey response rate was 100% (36/36). Objective academic outcomes attributable, at least in part, to the grants included 103 conference presentations, 59 publications, 21 prizes and 18 higher degrees. 27 consequential grants totaled US $4.5M, a 6.8-fold return on investment. Broader impacts included perceived contributions to guideline development (53% of recipients), changes in clinical decision making (72%) or radiotherapy techniques (61%), enabling of subsequent research (56%), development of novel research tools (19%) and recruitment of research assistant(s) (19%). The three most important factors reported to contribute to project success were the RO grant (83%), networking (81%) and local infrastructure (81%). The grant program was rated very positively.Conclusions: This updated RANZCR survey has confirmed continuing significant academic output from its RO research grants but has also revealed broader benefits using the Payback Framework. We would encourage other RO societies to report their grant outcomes using a similar framework. [ABSTRACT FROM AUTHOR]

Objective: Is there a relationship between decision-making preferences and psychological distress?Methods: Patients who had received treatment for head and neck cancer (HNC) at four institutions within NSW, Australia were invited to complete a single questionnaire.Results: Five hundred and ninety-seven patients completed the questionnaire. The majority of patients (308, 54%) preferred shared decision making. Significant predictors of a preference towards active decision making were education level (OR 2.1 for tertiary, p < 0.001), primary cancer site (OR 1.9 for thyroid compared to salivary gland, p = 0.024) and gender (OR 1.4 for female, p = 0.028). Mean psychological distress score on Kessler 6 (K6) was 9 (Range: 0-28). Significant predictors of psychological distress were age (p < 0.001), gender (p < 0.001), primary site (p < 0.01), and decision preference (p < 0.01).Conclusion: HNC patients who are either tertiary educated or female are more likely to prefer active involvement in decision-making. Psychological distress is more likely in patients actively involved in decision making, younger patients, and in females.Practice Implications: Patients experienced paternalistic decision-making, but most preferred active or a shared approached. Clinicians need to be aware of potential for psychological distress in active decision-makers and refer patients for psychosocial support. [ABSTRACT FROM AUTHOR]