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Objective: To investigate the effectiveness of the Melanoma Care Programme when implemented into routine clinical practice coupled with fear of cancer recurrence (FCR) screening and a stepped‐care model of intervention delivery. Methods: Using a Type‐I hybrid effectiveness‐implementation design, individuals with stage 0‐II melanoma and a Fear of Cancer Recurrence Inventory FCR severity score of ≥ 13 were offered the Melanoma Care Programme. The programme included a psychoeducational booklet and 3 to 5 psychotherapeutic telehealth sessions with a clinical psychologist, timed around routine dermatological appointments. Multivariable linear mixed modelling was used to analyse the effect of the intervention at 1‐week post‐intervention on patient‐reported outcomes, including FCR severity (primary outcome), symptoms of depression, anxiety, and stress, melanoma‐related knowledge, and health‐related quality of life. Results: One hundred and twelve participants completed the intervention from 146 participants screened for FCR. Adjusted multivariable linear mixed modelling demonstrated that participants who received the intervention reported a reduced FCR severity at 1‐week post‐intervention (mean change: −3.81 [95% CI: −4.67, −2.95], p < 0.001) compared to baseline. Participants also reported improvements in melanoma‐related knowledge (mean change: 0.64 [95% CI: 0.13, 1.15], p = 0.014), depressive symptoms (mean change: −1.41 [95% CI: −1.92, −0.90], p < 0.001), anxiety (mean change: −1.05 [95% CI: −1.48, −0.61], p < 0.001), stress (mean change: −1.58 [95% CI: −2.22, −0.93], p < 0.001), and health‐related quality of life (mean change: 4.05 [95% CI: 2.84, 5.26], p < 0.001). Conclusions: The Melanoma Care Programme maintained effectiveness when implemented into routine clinical practice with the addition of FCR screening and a stepped care model of delivery. Trial Registration: This study is registered with the Australia and New Zealand Clinical Trials Register (ACTRN12621000145808) [ABSTRACT FROM AUTHOR]

Population‐wide skin cancer screening is not currently recommended in most countries. Instead, most clinical guidelines incorporate risk‐based recommendations for skin checks, despite limited evidence around implementation and adherence to recommendations in practice. We aimed to determine adherence to personal risk‐tailored melanoma skin check schedules and explore reasons influencing adherence. Patients (with/without a previous melanoma) attending tertiary dermatology clinics at the Melanoma Institute Australia, Sydney, Australia, were invited to complete a melanoma risk assessment questionnaire via iPad and provided with personal risk information alongside a risk‐tailored skin check schedule. Data were collected from the risk tool, clinician‐recorded data on schedule deviations, and appointment booking system. Post‐consultation, we conducted semi‐structured interviews with patients and clinic staff. We used a convergent segregated mixed methods approach for analysis. Interviews were audio recorded, transcribed and data were analysed thematically. Participant data were analysed from clinic records (n = 247) and interviews (n = 29 patients, 11 staff). Overall, there was 62% adherence to risk‐tailored skin check schedules. In cases of non‐adherence, skin checks tended to occur more frequently than recommended. Decisions to deviate were similarly influenced by patients (44%) and clinicians (56%). Themes driving non‐adherence among patients included anxiety and wanting autonomy around decision‐making, and among clinicians included concerns around specific lesions and risk estimate accuracy. There was moderate adherence to a clinical service program of personal risk‐tailored skin check recommendations. Further adherence may be gained by incorporating strategies to identify and assist patients with high levels of anxiety and supporting clinicians to communicate risk‐based recommendations with patients. [ABSTRACT FROM AUTHOR]

Invasive alien species (IAS) cause major environmental and economic damage worldwide, and also threaten human food security and health. The impacts of IAS are expected to rise with continued globalization, land use modification, and climate change. Developing effective strategies to deal with IAS requires a collaborative, interdisciplinary approach, in which scientists work co-operatively with social scientists and policy-makers. Higher education can contribute to this process by training professionals to balance the ecological, economic, and social dimensions of the IAS problem. We examined the extent of such training in Canada by reviewing undergraduate and graduate university curricula at all 94 member institutions of the Association of Universities and Colleges of Canada for IAS content. We found that degree and diploma programs focusing on IAS issues are lacking at Canadian post-secondary institutions. Furthermore, few courses are devoted solely to IAS, and those that are typically adopt an ecological perspective. We argue that the absence of interdisciplinary university curricula on IAS in Canada negatively affects our ability to respond to this growing global challenge. We present several international educational programs on IAS as case studies on how to better integrate training on invasive species into university curricula in Canada. (Contains 1 table.)

Background: We investigated differences in cumulative incidence of first distant recurrence (DR) following non-metastatic breast cancer over a time period when new adjuvant therapies became available in Australia. Methods: We conducted a health record linkage study of females with localized (T1-3N0) or regional (T4 or N+) breast cancer in the New South Wales Cancer Registry in 2001 to 2002 and 2006 to 2007. We linked cancer registry records with administrative records from hospitals, dispensed medicines, radiotherapy services, and death registrations to estimate the 9-year cumulative incidence of DR and describe use of adjuvant treatment. Results: The study included 13,170 women (2001-2002 n = 6,338, 2006-2007 n = 6,832). The 9-year cumulative incidence of DR was 3.6% [95% confidence interval (CI), 2.3%-4.9%] lower for 2006-2007 diagnoses (15.0%) than 2001-2002 (18.6%). Differences in the annual hazard of DR between cohorts were largest in year two. DR incidence declined for localized and regional disease. Decline was largest for ages <40 years (absolute difference, 14.4%; 95% CI, 8.3%-20.6%), whereas their use of adjuvant chemotherapy (2001-2002 49%, 2006-2007 75%) and HER2-targeted therapy (2001-2002 0%, 2006-2007 16%) increased. DR did not decline for ages =70 years (absolute difference, 0.9%; 95% CI, -3.6%-1.8%) who had low use of adjuvant chemotherapy and HER2-targeted therapy. Conclusions: This whole-of-population study suggests that DR incidence declined over time. Decline was largest for younger ages, coinciding with changes to adjuvant breast cancer therapy. [ABSTRACT FROM AUTHOR]

Skin cancer is a growing global problem and a significant health and economic burden. Despite the practical necessity for skin cancer to be managed in primary care settings, little is known about how quality of care is or should be measured in this setting. This scoping review aimed to capture the breadth and range of contemporary evidence related to the measurement of quality in skin cancer management in primary care settings. Six databases were searched for relevant texts reporting on quality measurement in primary care skin cancer management. Data from 46 texts published since 2011 were extracted, and quality measures were catalogued according to the three domains of the Donabedian model of healthcare quality (structure, process and outcome). Quality measures within each domain were inductively analysed into 13 key emergent groups. These represented what were deemed to be the most relevant components of skin cancer management as related to structure, process or outcomes measurement. Four groups related to the structural elements of care provision (e.g. diagnostic tools and equipment), five related to the process of care delivery (e.g. diagnostic processes) and four related to the outcomes of care (e.g. poor treatment outcomes). A broad range of quality measures have been documented, based predominantly on articles using retrospective cohort designs; systematic reviews and randomised controlled trials were limited. [ABSTRACT FROM AUTHOR]