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Background: The impact of patient-reported outcome measures on patient outcomes in longitudinal clinical studies is poorly understood. This observational study explored longitudinal changes in distress and problems reported by cancer patients screened and managed in accordance with a clinical pathway for anxiety and depression (ADAPT CP), implemented over 12 months. Methods: Patients reported distress using the Distress Thermometer and indicated reasons for distress using the 39-item Problem List across five domains: practical, social, emotional, spiritual/religious, and physical. Repeat screening occurred on average 3 monthly (quarterly). Results: Six hundred sixty patients from 10 participating services completed 1,256 screening events over 12 months, reporting 8,645 problems. On average, more emotional (27–34%) and physical (19–22%) issues were reported across all quarters than practical (7–9%) and social (8–9%) issues. Distress and emotional, physical, practical, and social problems reduced from initial to follow-up screens, although the decrease in emotional problems over time was not significantly different than that of the other problems. Worry, fatigue, sleep difficulties, health of family members, and insurance/finances were more persistent problems. Conclusions: Although distress and the change in the number of emotional concerns over time did not differ from other problems, rescreening is recommended within oncology settings to allow patients to indicate new or persistent problems and hospital staff to monitor and assess needs. Emotional concerns are high in oncology patients, suggesting the need for the prioritization of psychosocial care. These problems can persist over time due to their clinically challenging nature or because access to, or implementation of, evidence-based interventions are not yet widespread.

PURPOSE: To assess the literature on men's preferences and perceptions regarding prostate cancer radiation therapy. METHODS: A scoping review was undertaken as per JBI guidelines. Searches were conducted in PubMed, CINAHL, Scopus and Science Direct with search terms including "prostate cancer," "radiotherapy," "radiation therapy," "radiation oncology," "patient preferences," "patient perceptions" and "patient experience." The resultant studies were mapped and grouped according to the emergent themes and pathway stages. RESULTS: A total of 779 titles and abstracts were screened by two independent reviewers. Fifty-two full-text studies were reviewed, with 27 eligible for inclusion. There were 4 pre-treatment, 13 during treatment and 10 post-treatment studies covering broad themes of information needs (n = 3), preferences and decisions (n = 6), general experiences (n = 8), side effects (n = 6), and support (n = 4). There were a mix of methodologies, including 11 qualitative, 14 quantitative (including four preference studies), one mixed methods and one narrative review. CONCLUSION: There were only four preference studies, with the remaining 23 reporting on perceptions. Overall, there is a paucity of literature regarding patient preferences and perceptions of prostate cancer radiation therapy, particularly when considering how many clinical and technical studies are published in the area. This highlights opportunities for future research.

BACKGROUND Approximately 2000 people are diagnosed with brain cancer in Australia each year Compared to glioblastoma patients the IDH mutated high grade glioma IDHmHGG is a more favourable diagnosis better prognosis and survival outcomes Coupled with improved treatments the IDHmHGG cohort is living longer which means treatment side effects eg fatigue cognitive deficits physical limitations etc can significantly impact their quality of life in the survivorship years Hence there is a need to identify and determine the survivorship issues most pertinent for the IDHmHGG cohort MATERIAL AND METHODS A mixed METHODS cross sectional study was conducted to investigate the relationship between socio demographic clinical factors and quality of life in the IDHmHGG cohort Qualitative data collection consisted of a neuro oncology clinician focus group n 11 regarding survivorship issues and was contrasted with semi structured patient interviews n 27 Quantitative data collection n 41 involved socio demographic questions the Functional Assessment of Cancer Therapy Brain FACT Br tool and The Hospital Anxiety and Depression Scale HADS RESULTS The results indicate that marital status employment status and treatment complications are strongly associated with quality of life in IDHmHGG patients Being single and unemployed is associated with lower quality of life p 0 05 Similarly our findings show that psychological distress specifically the presence of anxiety and depressive symptoms is a major factor that can negatively impact the QoL in an IDHmHGG cohort The order of ranking between clinician and patient identified issues only matched for physical limitations ranked 3rd Although not matched in ranking both groups identified cognitive function employment social function isolation and mental health as commonly experienced in the survivorship years CONCLUSION This study highlights the importance of considering socio demographic and clinical factors in the care and support of brai

PurposeH3K27M and H3G34R mutant gliomas are recently classified subgroups of high grade gliomas HGGs affecting younger adults This study aimed to describe patterns of infiltration and failure and the volumetric response of these tumours to radiotherapy MethodsPatients with histone mutant gliomas aged 16 50 years managed from 2009 to 2021 were identified and clinical radiological and histopathological characteristics collected Tumour volume was assessed on MRI at diagnosis pre radiotherapy month 1 3 and 5 post radiation and at relapse ResultsOf 538 IDH1 2 wild type HGGs 18 15 had a histone alteration Eleven were H3K27M and 7 H3G34R mutant respectively Median age at diagnosis was 20 years range17 48 years Median overall survival was 20 months 95 CI 14 29 months Both H3K27M and H3G34R mutant tumours exhibited extensive T2F infiltration involving a median of 4 neuroanatomical subsites at diagnosis Median volume of disease pre radiotherapy on T1gd and T2F respectively was 0 5cm3 IQR 0 1 7cm3 and 11 9 cm3 IQR 7 5 29 6cm3 for H3K27M and 0 9cm3 IQR 0 8 4cm3 and 43 8cm3 IQR 25 2 86 6 cm3 for H3G34R tumours T2F volume reduction 50 was observed 3 months post IMRT in 7 64 patients with H3K27M and 1 14 with H3G34R tumours Fourteen patients had relapsed Relapse was local only distant only and both in 4 44 3 33 and 2 22 H3K27M mutant and 1 20 2 40 and 2 40 H3G34R mutant tumours On last scan before death leptomeningeal spread was present in 4 8 50 and 1 5 20 and subependymal spread in 4 8 50 and 0 5 H3K27M and G34R mutant cases respectively ConclusionH3K27M mutant gliomas are highly responsive to radiotherapy but exhibit high propensity for subsequent leptomeningeal and subependymal spread H3G34R mutant tumours exhibit lesser early volumetric response to radiotherapy and propensity for distant in brain failure

Background Glioblastoma GBM is the most aggressive type of brain cancer with a 5 year survival rate of 5 and most tumours recurring locally within months of first line treatment Hypoxia is associated with worse clinical outcomes in GBM as it leads to localized resistance to radiotherapy and subsequent tumour recurrence Current standard of care treatment does not account for tumour hypoxia due to the challenges of mapping tumour hypoxia in routine clinical practice In this clinical study we aim to investigate the role of oxygen enhanced OE and blood oxygen level dependent BOLD MRI as non invasive imaging biomarkers of hypoxia in GBM and to evaluate their potential role in dose painting radiotherapy planning and treatment response assessment Methods The primary endpoint is to evaluate the quantitative and spatial correlation between OE and BOLD MRI measurements and sup 18 sup F MISO values of uptake in the tumour The secondary endpoints are to evaluate the repeatability of MRI biomarkers of hypoxia in a test retest study to estimate the potential clinical benefits of using MRI biomarkers of hypoxia to guide dose painting radiotherapy and to evaluate the ability of MRI biomarkers of hypoxia to assess treatment response Twenty newly diagnosed GBM patients will be enrolled in this study Patients will undergo standard of care treatment while receiving additional OE BOLD MRI and sup 18 sup F MISO PET scans at several timepoints during treatment The ability of OE BOLD MRI to map hypoxic tumour regions will be evaluated by assessing spatial and quantitative correlations with areas of hypoxic tumour identified via sup 18 sup F MISO PET imaging Discussion MANGO Magnetic resonance imaging of hypoxia for radiation treatment guidance in glioblastoma multiforme is a diagnostic prognostic study investigating the role of imaging biomarkers of hypoxia in GBM management The study will generate a large amount of longitudinal multimodal MRI and PET imaging data that could be used to unv

Introduction. The use of biopolymers in effluents treatment allows to control the environmental impact associated with agroindustrial wastewater discharge. Objective. To evaluate the effectiveness of chitosan as a natural coagulant in the treatment of palm oil production effluents. Materials and methods. The following parameters were determined: Chemical Oxygen Demand (COD), total suspended solids (TSS) and volatile solids (TVS), turbidity and fats and oils (GYA) in wastewater associated with palm oil production from the municipality of Agustín Codazzi in the department of Cesar (Colombia), by the jar test assay. Chitosan was applied in doses of: 100, 200, 300, 400, and 0 mg L-1 at three pH levels 4, 5, and 6 of the water. A completely randomized, two-way, fixed effects experimental was implemented. A multivariate analysis of the physical-chemical parameters of industrial effluent was used for data analysis. The study was conducted in 2012. Results. Chitosan allowed a reduction of more than 87 % turbidity, COD, TSS, TVS and fats and oils in all coagulant doses. While the control (0 mg L-1) was statistically different (p<0.05) to all the treatments. In the multivariate analysis of the data, the principal component 1 (PC1) explained 79.3 % of the total variance of the variables. Conclusion. Doses of 100, 200, 300, and 400 mg L-1 of chitosan evaluated as a natural coagulant in water treatment, decreased the concentration of pollutants in effluents associated with palm oil production., Introducción. El uso de biopolímeros en el tratamiento de efluentes permite controlar el impacto ambiental asociado a la descarga de aguas residuales agroindustriales. Objetivo. Evaluar la efectividad del quitosano como coagulante natural en el tratamiento de efluentes de producción de aceite de palma. Materiales y métodos. Se determinaron los parámetros: demanda química de oxígeno (DQO), los sólidos suspendidos totales (SST) y volátiles (SSV), turbidez y grasas y aceites (GYA) sobre en el agua residual asociada a la producción de aceite de palma proveniente del municipio de Agustín Codazzi en el departamento del Cesar (Colombia), por el ensayo de pruebas de jarras. Se aplicó quitosano en dosis de: 100, 200, 300, 400 y 0 mg L-1 a tres niveles de pH 4, 5 y 6 del agua. Se implementó un diseño experimental completamente aleatorizado, de dos vías, con efectos fijos. Para el análisis de datos se utilizó un análisis multivariado de los parámetros fisicoquímicos del efluente industrial. El estudio se realizó en el año 2012. Resultados. El quitosano permitió reducir más del 87 % de turbidez, DQO, SST, SSV y grasas y aceites en todas las dosis del coagulante, mientras que el control (0 mg L-1) fue diferente estadísticamente (p<0,05) a todos los tratamientos. En el análisis multivariado de los datos, el componente principal 1 (PC1) explicó el 79,3 % de la varianza total de las variables. Conclusión. Dosis de 100, 200, 300 y 400 mg L-1 de quitosano evaluado como coagulante natural en el tratamiento de aguas, disminuyeron la concentración de contaminantes en efluentes asociados a la producción de aceite de palma.

Understanding preferences of key stakeholders including patients, clinicians and policymakers can inform clinical practice, workforce and policy. It also allows health services to evaluate existing clinical practices, policies and procedures. This commentary aims to introduce medical radiation professionals to health preference research by describing commonly used preference methodologies, with a particular focus on discrete choice experiments. Relevant examples of health preference research will be highlighted to demonstrate the application of health preference research in medical radiation sciences.

Aims: Translation of evidence-based psycho-oncology interventions into routine care can significantly improve patient outcomes, yet effective implementation remains challenging due to numerous real-world barriers. A key factor that may influence implementation is organisational readiness for change. This mixed method study sought to identify factors associated with organisational readiness for implementing the Australian clinical pathway for the screening, assessment and management of anxiety and depression in adult cancer patients (ADAPT CP). Methods: We collected data from multidisciplinary staff across six Australian cancer services who were preparing to implement the ADAPT CP. Services were categorised as having ‘high’ versus ‘mid-range’ organisational readiness based on a median split on the Organizational Readiness for Implementing Change (ORIC) questionnaire (score range = 12–60). Qualitative data from the semi-structured interviews based on the Promoting Action Research in Health Services (PARiHS) framework were analysed thematically and compared for services with high- versus mid-range organisational readiness. Results: Three services with high- (mean ORIC range, 52.25–56.88), and three with mid-range (range, 38.75–46.39) organisational readiness scores were identified. Staff at services reporting higher readiness described a more collaborative and proactive service culture, strong communication processes and greater role flexibility. They also reported greater confidence in overcoming anticipated barriers and clearer strategies for addressing issues. Conclusions: Levels of organisational readiness were related to distinct qualitative themes. Targeting these issues in services where readiness is mid-range or low prior to full-scale roll-out may improve staff levels of confidence and efficacy in implementing psycho-oncology-focused interventions.

BACKGROUND: Before integrating prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) into routine care, it is important to assess if the benefits justify the differences in resource use. OBJECTIVE: To determine the cost-effectiveness of PSMA-PET/CT when compared with conventional imaging. DESIGN, SETTING, AND PARTICIPANTS: A cost-effectiveness analysis was developed using data from the proPSMA study. proPSMA included patients with high-risk prostate cancer assigned to conventional imaging or 68Ga-PSMA-11 PET/CT with planned health economics data collected. The cost-effectiveness analysis was conducted from an Australian societal perspective. INTERVENTION: 68Ga-PSMA-11 PET/CT compared with conventional imaging (CT and bone scan). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary outcome from proPSMA was diagnostic accuracy (nodal and distant metastases). This informed a decision tree analysis of the cost per accurate diagnosis. RESULTS AND LIMITATIONS: The estimated cost per scan for PSMA PET/CT was AUD$1203, which was less than the conventional imaging cost at AUD$1412. PSMA PET/CT was thus dominant, having both better accuracy and a lower cost. This resulted in a cost of AUD$959 saved per additional accurate detection of nodal disease, and AUD$1412 saved for additional accurate detection of distant metastases. The results were most sensitive to variations in the number of men scanned for each 68Ga-PSMA-11 production run. Subsequent research is required to assess the long-term costs and benefits of PSMA PET/CT-directed care. CONCLUSIONS: PSMA PET/CT has lower direct comparative costs and greater accuracy compared to conventional imaging for initial staging of men with high-risk prostate cancer. This provides a compelling case for adopting PSMA PET/CT into clinical practice. PATIENT SUMMARY: The proPSMA study demonstrated that prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomogra

BACKGROUND: Anxiety and depression have a higher prevalence in cancer survivors than in the general population and are associated with lower quality of life, poorer survival and an increased risk of suicide. Anxiety and depression are also highly comorbid among cancer survivors and associated with increased health service use. As such, it is important to consider both anxiety and depression and health service use in cancer survivors. OBJECTIVE: Our objective was to explore the association between anxiety and depression and health service utilisation, both cancer-specific and general doctor visits, in cancer survivors. METHODS: Data from a Dutch cancer registry were analysed to determine the association between anxiety and depression (measured using the Hospital Anxiety and Depression Scale) and health service use. Negative binomial regression models, controlling for patient demographics, comorbidities and cancer-related variables were estimated. RESULTS: Cancer survivors (n = 2538), with a mean age of 61.1 years and between 0.7 and 10.9 years since diagnosis, were included in the analysis. Increasing levels of anxiety and depression were associated with increased health service use. Having severe levels of anxiety was associated with more frequent visits to the general practitioner (p < 0.001). Severe depression in cancer survivors was associated with more frequent visits to the specialist (p < 0.001). CONCLUSION: Anxiety and depression in cancer survivors, particularly severe anxiety and depression, were associated with increased health service use. Treatment of anxiety and depression in cancer survivors has the potential to reduce overall health service use and associated costs and improve health outcomes for cancer survivors.