Cost-Outcome of Radiotherapy for Local Control and Overall Survival Outcomes for Selected Cancers.

Introduction: Optimal radiotherapy (RT) use in cancer patients results in substantial 5-year local control (LC) and overall survival (OS) benefits at the population level. This study aimed to estimate the average per capita cost of the first course of RT treatment and the associated cost per LC and OS outcomes, both overall and by cancer stage.

Methods: Data on RT activities from 2017 to 2020 for lung, rectum, cervix, prostate, brain and head and neck (H&N) cancers were extracted from South-Western Sydney Local Health District electronic oncology information system MOSAIQ (Elekta, version 2.

Radiation Therapy Utilization for Primary Cutaneous T-Cell Lymphoma Is Lowest Among Patients Living in the Most Geographically Accessible Areas: An Australian Study.

Purpose: Cutaneous T-cell lymphomas (CTCL) are rare with increasing incidence. Most patients have skin-confined mycosis fungoides: a typically indolent, highly morbid, incurable disease requiring multi-lined treatment. For these patients, radiation therapy (RT) is efficacious, well-tolerated, and cost-effective; total skin electron beam therapy (TSEBT) is a specialized technique with proven quality-of-life benefits.

It is never too late to stop smoking. Applying working estimates of smoking cessation on five-year overall survival gains after a cancer diagnosis.

Background: Detailed data on five-year overall survival (5Y-OS) in relation to smoking cessation after a cancer diagnosis are sparse. Implementation of smoking cessation in cancer treatment centres is also sub-optimal. The aim is to provide working, numeric estimates of 5Y-OS outcomes in relation to quitting smoking to help inform patients with cancer.

Overview of cardiac toxicity from radiation therapy.

Radiotherapy is an essential part of treatment for many patients with thoracic cancers. However, proximity of the heart to tumour targets can lead to cardiac side effects, with studies demonstrating link between cardiac radiation dose and adverse outcomes. Although reducing cardiac dose can reduce associated risks, most cardiac constraint recommendations in clinical use are generally based on dose to the whole heart, as dose assessment at cardiac substructure levels on individual patients has been limited historically.

Multidisciplinary team meeting Chairs' attitudes and perceived facilitators, barriers and ideal improvements to meeting functionality: A qualitative study.

Aim: Oncology care provision by multidisciplinary teams (MDTs) is widely acknowledged as best practice. Formal team meetings, led by chairpersons, coordinate decisions on diagnosis, staging, treatment planning, and review. This study addresses a gap in meeting Chairs' perspectives on factors affecting functionality across the meeting cycle, from pre-meeting patient list triage to post-meeting dissemination of recommendations.

Age-related experiences of colorectal cancer diagnosis: a secondary analysis of the English National Cancer Patient Experience Survey.

Objective: The incidence of colorectal cancer (CRC) in people aged <50 years has been increasing dramatically in the past three decades and such patients are known to face difficulties in diagnosis. The objective of this study was to better understand the diagnostic experiences of patients with CRC and explore age-related differences in the proportion with positive experiences.

Method: A secondary analysis of the English National Cancer Patient Experience Survey (CPES) 2017 was conducted on the responses of patients with CRC, restricted to those likely to have been diagnosed in the preceding 12 months via pathways other than routine screening.

Open-source, fully-automated hybrid cardiac substructure segmentation: development and optimisation.

Radiotherapy for thoracic and breast tumours is associated with a range of cardiotoxicities. Emerging evidence suggests cardiac substructure doses may be more predictive of specific outcomes, however, quantitative data necessary to develop clinical planning constraints is lacking. Retrospective analysis of patient data is required, which relies on accurate segmentation of cardiac substructures.

Cancer Care Team's Management of Clinical Alerts Generated by Electronically Collected Patient Reported Outcomes: We Could Do Better.

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.

Clinical practice guideline adherence in oncology: A qualitative study of insights from clinicians in Australia.

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).

Infrastructure platform for privacy-preserving distributed machine learning development of computer-assisted theragnostics in cancer.

Introduction: Emerging evidence suggests that data-driven support tools have found their way into clinical decision-making in a number of areas, including cancer care. Improving them and widening their scope of availability in various differing clinical scenarios, including for prognostic models derived from retrospective data, requires co-ordinated data sharing between clinical centres, secondary analyses of large multi-institutional clinical trial data, or distributed (federated) learning infrastructures. A systematic approach to utilizing routinely collected data across cancer care clinics remains a significant challenge due to privacy, administrative and political barriers.

Patterns of curative treatment for non-small cell lung cancer in New South Wales, Australia.

Introduction: There is a lack of large population-based studies examining patterns of curative treatment for non-small cell lung cancer (NSCLC) in Australia. This study aimed to evaluate the utilization of curative treatment for NCSLC at a population level and identify factors associated with its use in New South Wales (NSW), Australia.

Methods: Patients diagnosed with localized or locoregional NSCLC between 2009 and 2014 were identified from the NSW Central Cancer Registry.

Stepping into the real world: a mixed-methods evaluation of the implementation of electronic patient reported outcomes in routine lung cancer care.

Background: To realize the broader benefits of electronic patient-reported outcome measures (ePROMs) in routine care, we used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to inform the translation of a clinically effective ePROM system (hereafter referred to as the PRM system) into practice. The study aimed to evaluate the processes and success of implementing the PRM system in the routine care of patients diagnosed with lung cancer.

Method: A controlled before-and-after mixed-methods study was undertaken.

Implementing patient-reported outcomes into routine care: an audit of cancer patients from two local health districts in New South Wales to understand their capabilities and preferences.

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).

Adapting an integrated care pathway for implementing electronic patient reported outcomes assessment in routine oncology care: Lessons learned from a case study.

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.

Supporting cancer patients to self-manage: Extent of use and perceptions of "trusted" online self-management resources.

Objectives: Online resources can support patient self-management practices, but are not systematically used in routine clinical practice. We evaluated cancer patients' satisfaction with, and use of, tailored online resources.

Methods: Patients completed monthly validated electronic patient reported outcome measures (ePROMs) of distress, unmet needs and symptoms.

Magnetic resonance imaging (MRI) guided proton therapy: A review of the clinical challenges, potential benefits and pathway to implementation.

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.

The complexities, coordination, culture and capacities that characterise the delivery of oncology services in the common areas of ambulatory settings.

Background: Relatively little is understood about real-world provision of oncology care in ambulatory outpatient clinics (OPCs). This study aimed to: 1) develop an understanding of behaviours and practices inherent in the delivery of cancer services in OPC common areas by characterising the organisation and implementation of this care; and 2) identify barriers to, and facilitators of, the delivery of this care in OPC common areas.

Methods: A purpose-designed ethnographic study was employed in four public hospital OPCs.

Trends in the use of short-course radiation therapy for rectal cancer in New South Wales, Australia.

Introduction: Trends in the use of short-course radiation therapy (RT) for rectal cancer in Australia are unknown. The purpose of this study was to compare short-course RT and long-course chemoradiation (CRT) utilisation in the neoadjuvant treatment of rectal cancer in New South Wales (NSW).

Methods: Patients who received neoadjuvant RT (2009-2014) for rectal cancer were identified from the NSW Central Cancer Registry.

Surgical and radiotherapy patterns of care in the management of breast cancer in NSW and ACT Australia.

Introduction: This study aims to report on the surgical and radiotherapy patterns of breast cancer care in New South Wales (NSW) and Australian Capital Territory (ACT) in Australia, to identify factors that impact on utilisation of evidence-based treatment and to report on the overall survival (OS) rate and the influencing factors on OS.

Methods: Cancer registry data linked to hospital records for all patients with breast cancer diagnosis in NSW and ACT between 2009 and 2014 were used to calculate rates of breast conserving surgery (BCS), mastectomy, sentinel lymph node biopsy (SLNB), axillary lymph node dissection (ALND) and radiotherapy. Multivariate analysis used to identify factors that led to variations in care.

Providing outpatient cancer care for CALD patients: a qualitative study.

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).

Barriers and Facilitators to Integrative Oncology Services in Australia: A Changed Mind Set Required.

This study aimed to explore barriers and facilitators to integrative oncology (IO) service provision and access in Australia. The study design was mixed method with two substudies: a cross-sectional national cancer service survey of public and private sectors; and focus group interviews and an online survey of cancer survivors. Triangulation analysis of qualitative and quantitative data was used to identify and interrogate meta-themes.