Publications by authors named "Victoria White"

130 Publications

Tumor Treating Fields for Ovarian Carcinoma: A Modeling Study.

Adv Radiat Oncol 2021 Jul-Aug;6(4):100716. Epub 2021 May 17.

Brain Tumor Center & Neuro-Oncology Unit, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

Purpose: Since the inception of tumor treating fields (TTFields) therapy as a Food and Drug Administration-approved treatment with known clinical efficacy against recurrent and newly diagnosed glioblastoma, various in silico modeling studies have been performed in an effort to better understand the distribution of applied electric fields throughout the human body for various malignancies or metastases.

Methods And Materials: Postacquisition attenuation-corrected positron emission tomography-computed tomography image data sets from 2 patients with ovarian carcinoma were used to fully segment various intrapelvic and intra-abdominal gross anatomic structures. A 3-dimensional finite element mesh model was generated and then solved for the distribution of applied electric fields, rate of energy deposition, and current density at the clinical target volumes (CTVs) and other intrapelvic and intra-abdominal structures. Electric field-volume histograms, specific absorption rate-volume histograms, and current density-volume histograms were generated, by which plan quality metrics were derived from and used to evaluate relative differences in field coverage between models under various conditions.

Results: TTFields therapy distribution throughout the pelvis and abdomen was largely heterogeneous, where specifically the field intensity at the CTV was heavily influenced by surrounding anatomic structures as well as its shape and location. The electric conductivity of the CTV had a direct effect on the field strength within itself, as did the position of the arrays on the surface of the pelvis and/or abdomen.

Conclusion: The combined use of electric field-volume histograms, specific absorption rate-volume histograms, current density-volume histograms, and plan quality metrics enables a personalized method to dosimetrically evaluate patients receiving TTFields therapy for ovarian carcinoma when certain patient- and tumor-specific factors are integrated with the treatment plan.
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http://dx.doi.org/10.1016/j.adro.2021.100716DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8361065PMC
May 2021

Understanding women's perspectives and information needs about shared follow-up care for early breast cancer: a qualitative study.

Fam Pract 2021 Jul 22. Epub 2021 Jul 22.

School of Nursing, Deakin University, Burwood Victoria, Australia.

Background: Shared breast cancer follow-up care involving a breast cancer specialist and a general practitioner (GP) has been demonstrated to be effective, yet barriers to participation in this model by women remain. This study explores the responses of women who recently finished active treatment for early breast cancer (EBC) to a proposed model of shared follow-up care to understand the type of information needed to support participation.

Methods: Qualitative study based on focus groups with women with EBC in the early stage of follow-up care from across metropolitan, regional and rural settings in Australia. Discussions were transcribed and thematic analysis is undertaken.

Results: Four focus groups were conducted, involving 31 women aged between 32 and 78 years. The discussion focused on two topics. In the first topic 'Current experiences of follow-up care', two themes emerged: (i) follow-up as a continuation of active treatment; (ii) GPs involvement in care during active treatment influence attitudes to shared follow-up care. In the second topic area 'Perceptions of shared follow-up care' four themes emerged: (i) a need for evidence regarding model effectiveness; (ii) choice; (iii) concerns regarding capacity and capability of GPs to deliver care and (iv) the need for clear communication between GPs, specialists and women.

Conclusions: Women need information regarding the evidence for the effectiveness of shared follow-up care to assure them it does not pose a risk to their health outcomes. Clear descriptions of GP and specialist roles and the opportunity to jointly decide participation is essential for the model to be adopted.
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http://dx.doi.org/10.1093/fampra/cmab048DOI Listing
July 2021

Factors Explaining Socio-Economic Inequalities in Survival from Colon Cancer: A Causal Mediation Analysis.

Cancer Epidemiol Biomarkers Prev 2021 Jul 16. Epub 2021 Jul 16.

Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.

Background: Socio-economic inequalities in colon cancer survival exist in high-income countries, but the reasons are unclear. We assessed the mediating effects of stage at diagnosis, comorbidities, and treatment (surgery and intravenous chemotherapy) on survival from colon cancer.

Methods: We identified 2,203 people aged 15 to 79 years with first primary colon cancer diagnosed in Victoria, Australia, between 2008 and 2011. Colon cancer cases were identified through the Victorian Cancer Registry (VCR), and clinical information was obtained from hospital records. Deaths till December 31, 2016 ( = 807), were identified from Victorian and national death registries. Socio-economic disadvantage was based on residential address at diagnosis. For stage III disease, we decomposed its total effect into direct and indirect effects using interventional mediation analysis.

Results: Socio-economic inequalities in colon cancer survival were not explained by stage and were greater for men than women. For men with stage III disease, there were 161 [95% confidence interval (CI), 67-256] additional deaths per 1,000 cases in the 5 years following diagnosis for the most disadvantaged compared with the least disadvantaged. The indirect effects through comorbidities and intravenous chemotherapy explained 6 (95% CI, -10-21) and 15 (95% CI, -14-44) per 1,000 of these additional deaths, respectively. Surgery did not explain the observed gap in survival.

Conclusions: Disadvantaged men have lower survival from stage III colon cancer that is only modestly explained by having comorbidities or not receiving chemotherapy after surgery.

Impact: Future studies should investigate the potential mediating role of factors occurring beyond the first year following diagnosis, such as compliance with surveillance for recurrence and supportive care services.
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http://dx.doi.org/10.1158/1055-9965.EPI-21-0222DOI Listing
July 2021

Improving access to cancer information and supportive care services: A systematic review of mechanisms applied to link people with cancer to psychosocial supportive care services.

Psychooncology 2021 Jun 7. Epub 2021 Jun 7.

Olivia Newton-John Cancer Wellness & Research Centre, Austin Health, Heidelberg, VIC, Australia.

Objective: Previous research has described the low uptake of psychosocial support services in people living with cancer. While characteristics of individuals using services have been examined, mechanisms applied to link individuals to support services are less frequently considered. This review aims to identify the mechanisms used to link people with cancer to support services and assess their impact.

Methods: Systematic searches of Pubmed, CINAHL, EMBASE and PsycINFO were conducted up to May 2020. Studies reporting service use associated with mechanisms to link adults with cancer to support services targeting emotional, informational, practical or social support needs were eligible. Eligible study designs included controlled trials, pre-post designs and observational studies. Study quality was assessed and a narrative synthesis of findings undertaken.

Results: A total of 10 papers (from 8,037 unique titles) were eligible. Testing the feasibility of the linkage mechanism was the primary aim in five (50%) studies. Three linkage mechanisms were identified: (a) outreach from the support service; (b) clinician recommendation/referral; (c) mailed invitation. Outreach was the most successful in connecting people with cancer to services (52%-90% use); clinician recommendation/referral was least successful (3%-28%). The impact of different linkage mechanisms for different demographic groups was not assessed.

Conclusions: Outreach from services shows the most potential for increasing access to support services. However, the limited number of studies and limitations in the types of support services people with cancer were linked to, demonstrated the need for further work in this area. Identifying mechanisms that are effective for underserved, high-needs patient groups is also needed.
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http://dx.doi.org/10.1002/pon.5744DOI Listing
June 2021

Public Perceptions of Harm for Nine Popular Gambling Products.

J Gambl Stud 2021 Feb 26. Epub 2021 Feb 26.

The George Institute for Global Health, 1 King St, Newtown, NSW, 2042, Australia.

Gambling causes significant levels of harm globally and is recognised as a serious public health issue. To reduce gambling-related harm, various strategies and policies have been recommended, including decreasing the availability of gambling products, restricting gambling advertising, and implementing public education campaigns. Government willingness to implement such strategies will be influenced by levels of public support, which in turn will be dependent on public perceptions of the harm caused by gambling products. The aim of the present study was to assess public perceptions of the harm associated with individual gambling products to inform future gambling reform. A sample of 2112 Australian adults provided perceived harm ratings for nine popular gambling products that are known to be associated with gambling-related harm: electronic gambling machines, casino table games, sports betting, bingo, scratch tickets, private betting, horse/dog races, keno, and the lottery. Binary logistic regressions were used to identify factors associated with harm perceptions. Only electronic gambling machines (70%), casino table games (64%), betting on horse/dog races (59%), and sports betting (53%) were perceived by a majority of respondents as being harmful. Less frequent gambling and experiencing greater levels of gambling-related harm were associated with higher harm perceptions. Many potentially harmful gambling products may not be recognised as such by the public, which is likely to reduce support for recommended harm-reduction strategies and policies. Efforts are needed to ensure Australians in general and gamblers in particular understand the levels of harm associated with popular gambling products.
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http://dx.doi.org/10.1007/s10899-021-10014-5DOI Listing
February 2021

Anaesthesia practices for Caesarean section amongst non-physician anaesthesia providers at an Ethiopian referral hospital.

Trop Doct 2021 Jan 28;51(1):29-33. Epub 2020 Nov 28.

Senior Clinical Lecturer, School of Medicine, Medical Sciences and Nutrition, 1019University of Aberdeen, Aberdeen, UK.

Sub-Saharan Africa faces high rates of maternal mortality and there is an urgent need to reduce this. Shortfalls in access to safe surgery and anaesthetic care result in avoidable maternal death. Providing quality training to anaesthesia providers is of key importance to reduce mortality. This mixed-methods prospective study incorporated workplace observations of anaesthesia for Caesarean section, a paper-based questionnaire and semi-structured, face-to-face interviews in Felege Hiwot Referral Hospital in Ethiopia.A total of 67 Caesarean section cases under spinal anaesthesia provided by 12 non-physician anaesthetists were observed and a 92% ( = 11) response rate to questionnaires obtained. Deficiencies were observed in communication, pre-operative assessment, spinal height evaluation and application of lateral tilt, while interviews revealed anaesthesia provider perceptions of hierarchy within the surgical team and deficiency in anticipation of potential complications. This study suggests that focusing on communication and anticipation of complications could aid providers in preventing and preparing for complications.
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http://dx.doi.org/10.1177/0049475520974991DOI Listing
January 2021

Transcaval approach to treat a type II endoleak.

J Vasc Surg 2020 12;72(6):2166

Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia.

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http://dx.doi.org/10.1016/j.jvs.2020.06.111DOI Listing
December 2020

Non-hydrolytic synthesis of caprylate capped cobalt ferrite nanoparticles and their application against Erwinia carotovora and Stenotrophomonas maltophilia.

J Mater Chem B 2020 12 12;8(47):10845-10853. Epub 2020 Nov 12.

Department of Chemistry, Sam Houston State University, Huntsville, Texas 77340, USA.

Magnetic cobalt Ferrite nanoparticles capped with caprylate groups, CH(CH)CO, have been synthesized using a novel non-hydrolytic coprecipitation method under inert conditions. Particle diameter was characterized using dynamic light scattering (DLS) and transmission electron microscopy (TEM). The spinel ferrite crystal phase was verified using X-ray diffraction (XRD), and the presence of the capping agent was confirmed using Fourier Transform Infrared spectroscopy (FTIR). Bactericidal effects of the particles were tested against broth cultures of Erwinia carotovora and Stenotrophomonas maltophilia. The final particles had an average diameter of 3.81 nm and readily responded to a neodymium magnet. The particles did have a significant effect on the OD600 of both broth cultures.
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http://dx.doi.org/10.1039/d0tb02283gDOI Listing
December 2020

Treatment and Outcomes for Central Nervous System Tumors in Australian Adolescents and Young Adults: A Population-Based National Study.

J Adolesc Young Adult Oncol 2021 04 26;10(2):202-208. Epub 2020 Aug 26.

Oncology Services Group, Queensland Children's Hospital, Queensland, Australia.

While central nervous system (CNS) tumors account for only 10% of adolescent and young adult (AYA) cancers, they are the leading cause of cancer death in this age group. Using national data for Australia, we describe the presentation, treatment, and survival for AYAs diagnosed with CNS tumors. A population-based study of 15-24 year-olds diagnosed with CNS tumors (low- and high-grade glioma [LGG, HGG], medulloblastoma [MB], primitive neuroectodermal tumors [PNET], ependymoma [EP]) or other (e.g., low-grade neuronal tumor) between 2007 and 2012. Clinical details were extracted from hospital medical records for each patient. Treatment centers were classified as pediatric or adult services. Two hundred seventy-five patients (129 LGG, 77 HGG, 23 MB, 10 PNET, 19 EP, 17 other) were identified, with 17% treated at pediatric hospitals. Symptoms (headache [53%], nausea [31%]) were present for a median of 3 weeks before consulting a health professional. Of LGG patients, 15% had radiotherapy (RT) and 12% chemotherapy (CT). Of HGG patients, 81% had RT and 75% CT. All MB and PNET were managed with surgery, and 74% of MB and 80% of PNET had both RT and CT. Treatment did not differ by treatment center type. Five-year survival for LGG and EP was over 80%, but was 42% for HGG and 20% for PNET. This national, population-based study indicates similar treatment for AYA patients with CNS tumors between pediatric and adult services. Poor outcomes for HGG and PNET patients highlight the need for clinical trials of novel approaches for these tumors.
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http://dx.doi.org/10.1089/jayao.2020.0074DOI Listing
April 2021

Smoking behaviours and other substance use among Indigenous and non-Indigenous Australian secondary students, 2017.

Drug Alcohol Rev 2021 01 11;40(1):58-67. Epub 2020 Aug 11.

Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia.

Introduction And Aims: Smoking is a major cause of preventable illness for Indigenous peoples. As most regular smoking is established during adolescence when other substances are often first used, effective tobacco prevention requires an understanding of the patterns of related substance use for Indigenous youth.

Design And Methods: We reviewed smoking among Indigenous students through cross-sectional analyses of the 2017 Australian Secondary Students' Alcohol and Drug survey and compared findings to non-Indigenous participants. We used logistic regression to evaluate differences in prevalence of tobacco, alcohol and cannabis use, and how smoking and other substance use were related.

Results: Past month smoking was strongly associated with alcohol and cannabis use for both Indigenous and non-Indigenous students. The association between tobacco and cannabis use did not differ by Indigenous status, but the tobacco and alcohol use association was weaker for Indigenous students (P = 0.004). However, the prevalence of tobacco [odds ratio (OR) 1.91 (95% confidence interval; CI 1.55, 2.36)], alcohol [OR 1.44 (1.25, 1.66)] and cannabis [OR 1.97 (1.56, 2.48)] use in the past month was significantly higher in Indigenous than non-Indigenous students. Even within the most socially advantaged sub-group, Indigenous students were more likely to smoke than non-Indigenous students [OR 3.37 (2.23, 5.09)].

Discussion And Conclusions: Cannabis and alcohol use are important predictors of smoking for all students. Tobacco policies and community programs must address common determinants of tobacco and other substance use, including resilience and social influence skills as well as broader family and community factors that may be different for Indigenous students.
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http://dx.doi.org/10.1111/dar.13130DOI Listing
January 2021

The decline of smoking initiation among Aboriginal and Torres Strait Islander secondary students: implications for future policy.

Aust N Z J Public Health 2020 Oct 10;44(5):397-403. Epub 2020 Aug 10.

Centre for Behavioural Research in Cancer, Cancer Council Victoria, Victoria.

Objective: Smoking is a major cause of preventable illness for Aboriginal and Torres Strait Islander people, with most commencing in adolescence. Understanding trends in youth tobacco use can inform prevention policies and programs.

Methods: Logistic regression models examined smoking trends among Aboriginal and Torres Strait Islander and all students aged 12-17 years, in five nationally representative triennial surveys, 2005-2017. Outcomes measured lifetime, past month, past week tobacco use and number of cigarettes smoked daily (smoking intensity).

Results: Aboriginal and Torres Strait Islander students' never smoking increased (2005: 49%, 2017: 70%) with corresponding declines in past month and week smoking. Smoking intensity reduced among current smokers (low intensity increased 2005: 67%, 2017: 77%). Trends over time were similar for Aboriginal and Torres Strait Islander students as for all students (8-10% annual increase in never smoking).

Conclusions: Most Aboriginal and Torres Strait Islander students are now never smokers. Comparable declines indicate similar policy impact for Aboriginal and Torres Strait Islander and all students. Implications for Public Health: Comprehensive population-based tobacco control policies can impact all students. Continued investment, including in communities, is needed to maintain and accelerate reductions among Aboriginal and Torres Strait Islander students to achieve equivalent prevalence rates and reduce health inequities.
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http://dx.doi.org/10.1111/1753-6405.13022DOI Listing
October 2020

Distress and problem assessment among people living with cancer from Culturally and Linguistically Diverse backgrounds.

Psychooncology 2020 10 28;29(10):1662-1669. Epub 2020 Aug 28.

School of Psychology & Public Health, La Trobe University, Melbourne, Australia.

Objective: To examine whether routine assessment of distress, recommended as part of comprehensive cancer care, is utilised equally with culturally and linguistically diverse (CALD) vs non-CALD people living with cancer.

Methods: A medical records review of all patients attending cancer-specific treatment units at a single tertiary hospital in Melbourne, Australia between 2015-2018. Recording of administration of the Distress Thermometer and Problem Checklist (DT and PC) was extracted for all patients. Details regarding how the DT and PC (used together) was administered were extracted for a random sub-sample of 294 CALD patients and 294 matched non-CALD patients.

Results: A total of 6977 patients were identified (12.0% CALD). Just over half of the CALD (54.7%) and non-CALD (58.2%) patients had a recorded DT and PC (P > 0.05). For the sub-sample analysis, CALD patients were less likely to complete the form themselves (14.8% vs 75.9% non-CALD) and were more likely to have a family member complete the form (55.1% vs 15.1% non-CALD). CALD patients reported a similar level of distress to non-CALD patients. Distress scores for CALD and non-CALD patients were higher when family members completed the form. Provision of discussion, written information, referral offers and rates of referral acceptance were similar between CALD and non-CALD patients.

Conclusions: Assessment of distress and associated problems, and the process following assessment, were similar for CALD and non-CALD patients. However, differences in how the form was completed highlight the need for further improvements to ensure that CALD patients are actively involved in their care.
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http://dx.doi.org/10.1002/pon.5503DOI Listing
October 2020

Unmet information needs predict anxiety in early survivorship in young women with breast cancer.

J Cancer Surviv 2020 12 8;14(6):826-833. Epub 2020 Jun 8.

School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.

Purpose: To examine variations in anxiety and longitudinal associations between unmet supportive care needs and elevated anxiety in young women (< 50 years) within 13 months of their breast cancer diagnosis.

Methods: Two hundred and nine women recruited through Victorian Cancer Registry completed questionnaires at study entry (T1) (average 7 months post-diagnosis) then 3 (T2) and 6 months later (T3). Women completed the Hospital Anxiety and Depression Scale (HADS) and Supportive Care Needs Survey-Breast Cancer (SCNS-Breast) at each time point. Primary outcome was anxiety with six domains of SCNS-Breast (physical daily living, information, psychological, health system information, peer support, patient care and miscellaneous needs) the key predictors. Generalised estimating equations examined longitudinal associations.

Results: Over the 6 months, the proportion of young women with elevated anxiety decreased (T1, 41% to T3, 35%; p = .06) as did the proportion with any moderate or high unmet needs (T1, 88%; T3, 74%; p < .01). While psychological needs and peer needs were positively associated with anxiety levels in multivariable cross-sectional analyses, in multivariable longitudinal analysis, only informational needs were associated with higher levels of anxiety (p < .001) with this association holding after adjusting for baseline anxiety levels.

Conclusions: While reducing over time, a third of young women treated for breast cancer enter early survivorship with elevated anxiety and unmet supportive care needs.

Implications For Cancer Survivors: As informational needs were positively associated with future levels of anxiety, addressing needs in this domain may decrease the risk of anxiety in younger women with breast cancer.
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http://dx.doi.org/10.1007/s11764-020-00895-7DOI Listing
December 2020

Gambling-related harms attributable to lotteries products.

Addict Behav 2020 10 19;109:106472. Epub 2020 May 19.

The George Institute for Global Health, 1 King St, Newtown, NSW 2042, Australia. Electronic address:

Lotteries products (lottery tickets and scratch tickets) are the most popular forms of gambling worldwide, however little research has investigated whether these products are associated with gambling-related harm. The limited available research suggests these products are linked to problematic gambling behaviors and a range of resulting negative outcomes, with certain sub-groups appearing to be more vulnerable to experiencing harms. The present study examined risk of gambling-related harm (measured by the Problem Gambling Severity Index) from lotteries products use in an Australian sample of lotteries-only gamblers (n = 540). Additionally, the study investigated whether risk varied according to a range of sociodemographic and behavioral characteristics (age, gender, household income, location (rural vs. metropolitan), employment status, alcohol consumption, smoking status, frequency of e-cigarette use, frequency of scratch ticket use, frequency of lottery ticket use, expenditure on scratch tickets, and expenditure on lottery tickets). Almost one-third of the sample was found to be at some level of gambling-related risk due to their use of lotteries products. Younger respondents, males, current smokers, e-cigarette users, and those who purchase scratch tickets more frequently were more likely to report problematic use of lotteries products. Policy makers should enact strategies to prevent and reduce harms resulting from lotteries products, especially among the identified at-risk groups.
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http://dx.doi.org/10.1016/j.addbeh.2020.106472DOI Listing
October 2020

Comparing Pathways to Diagnosis and Treatment for Rural and Urban Patients With Colorectal or Breast Cancer: A Qualitative Study.

J Rural Health 2020 09 2;36(4):517-535. Epub 2020 Jun 2.

School of Psychology, Deakin University, Burwood, Australia.

Purpose: Colorectal cancer patients living in rural areas have poorer outcomes than urban counterparts, but such disparities are not found for breast cancer. Although time to care may contribute to rural-urban disparities, few studies examine patient experiences to understand how and why delays may occur. We compared rural and urban patient experiences of pathways to colorectal or breast cancer diagnosis and treatment in Victoria, Australia.

Methods: Semistructured telephone interviews were conducted with 43 patients (49% colorectal; 60% rural, median 7 months postdiagnosis). A framework analysis was applied using the Model of Pathways to Treatment.

Findings: Rural and urban patients expressed similar attitudes and reasons for prolonged symptom appraisal and help-seeking triggers. However, some rural patients reported long waiting times to see a Primary Care Practitioner (PCP) and perceived greater gatekeeping to diagnostic services. Patient perceptions of the urgency of PCP referral could impact behavior, such as waiting longer to book appointments. Colorectal cancer patients reported more variable types of symptoms, interpretation, and coping strategies, as well as diverse presentation routes and reduced sense of urgency, compared to breast cancer patients. Waiting time for colonoscopy could be long, particularly in the public health system, but mammograms were quickly arranged.

Conclusions: Pathway variation was more evident by cancer type than residential location. However, access to primary care and diagnostic services for rural patients with colorectal cancer may be important policy targets. Future research should investigate the impact of diagnostic service accessibility on PCP referral behavior to further understand rural-urban disparities.
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http://dx.doi.org/10.1111/jrh.12437DOI Listing
September 2020

A Simple Clinical Tool for Stratifying Risk of Clinically Significant CKD after Nephrectomy: Development and Multinational Validation.

J Am Soc Nephrol 2020 05 1;31(5):1107-1117. Epub 2020 Apr 1.

Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.

Background: Clinically significant CKD following surgery for kidney cancer is associated with increased morbidity and mortality, but identifying patients at increased CKD risk remains difficult. Simple methods to stratify risk of clinically significant CKD after nephrectomy are needed.

Methods: To develop a tool for stratifying patients' risk of CKD arising after surgery for kidney cancer, we tested models in a population-based cohort of 699 patients with kidney cancer in Queensland, Australia (2012-2013). We validated these models in a population-based cohort of 423 patients from Victoria, Australia, and in patient cohorts from single centers in Queensland, Scotland, and England. Eligible patients had two functioning kidneys and a preoperative eGFR ≥60 ml/min per 1.73 m. The main outcome was incident eGFR <45 ml/min per 1.73 m at 12 months postnephrectomy. We used prespecified predictors-age ≥65 years old, diabetes mellitus, preoperative eGFR, and nephrectomy type (partial/radical)-to fit logistic regression models and grouped patients according to degree of risk of clinically significant CKD (negligible, low, moderate, or high risk).

Results: Absolute risks of stage 3b or higher CKD were <2%, 3% to 14%, 21% to 26%, and 46% to 69% across the four strata of negligible, low, moderate, and high risk, respectively. The negative predictive value of the negligible risk category was 98.9% for clinically significant CKD. The statistic for this score ranged from 0.84 to 0.88 across derivation and validation cohorts.

Conclusions: Our simple scoring system can reproducibly stratify postnephrectomy CKD risk on the basis of readily available parameters. This clinical tool's quantitative assessment of CKD risk may be weighed against other considerations when planning management of kidney tumors and help inform shared decision making between clinicians and patients.
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http://dx.doi.org/10.1681/ASN.2019121328DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7217412PMC
May 2020

Finite element analysis of Tumor Treating Fields in a patient with posterior fossa glioblastoma.

J Neurooncol 2020 Mar 27;147(1):125-133. Epub 2020 Jan 27.

Brain Tumor Center & Neuro-Oncology Unit, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA.

Introduction: Tumor Treating Fields (TTFields) are alternating electric fields at 200 kHz that disrupt tumor cells as they undergo mitosis. Patient survival benefit has been demonstrated in randomized clinical trials but much of the data are available only for supratentorial glioblastomas. We investigated a series of alternative array configurations for the posterior fossa to determine the electric field coverage of a cerebellar glioblastoma.

Methods: Semi-automated segmentation of neuro-anatomical structures was performed while the gross tumor volume (GTV) was manually delineated. A three-dimensional finite-element mesh was generated and then solved for field distribution.

Results: Compared to the supratentorial array configuration, the alternative array configurations consist of posterior displacement the 2 lateral opposing arrays and inferior displacement of the posteroanterior array, resulting in an average increase of 46.6% electric field coverage of the GTV as measured by the area under the curve of the electric field-volume histogram (E). Hotspots, or regions of interest with the highest 5% of TTFields intensity (E), had an average increase of 95.6%. Of the 6 posterior fossa configurations modeled, the PA arrangement provided the greatest field coverage at the GTV when the posteroanterior array was placed centrally along the patient's posterior neck and horizontally parallel, along the longer axis, to the coronal plane of the patient's head. Varying the arrays also produced hotspots proportional to TTFields coverage.

Conclusions: Our finite element modeling showed that the alternative array configurations offer an improved TTFields coverage to the cerebellar tumor compared to the conventional supratentorial configuration.
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http://dx.doi.org/10.1007/s11060-020-03406-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7076058PMC
March 2020

The test accuracy of antenatal ultrasound definitions of fetal macrosomia to predict birth injury: A systematic review.

Eur J Obstet Gynecol Reprod Biol 2020 Mar 16;246:79-85. Epub 2020 Jan 16.

Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, United Kingdom.

Objectives: To determine which ultrasound measurement for predicted fetal macrosomia most accurately predicts adverse delivery and neonatal outcomes.

Study Design: Four biomedical databases searched for studies published after 1966. Randomised trials or observational studies of women with singleton pregnancies, resulting in a term birth who have undergone an index test of interest measured and recorded as predicted fetal macrosomia ≥28 weeks. Adverse outcomes of interest included shoulder dystocia, brachial plexus injury (BPI) and Caesarean section.

Results: Twenty-five observational studies (13,285 participants) were included. For BPI, the only significant positive association was found for Abdominal Circumference (AC) to Head Circumference (HC) difference > 50 mm (OR 7.2, 95 % CI 1.8-29). Shoulder dystocia was significantly associated with abdominal diameter (AD) minus biparietal diameter (BPD) ≥ 2.6 cm (OR 4.2, 95 % CI 2.3-7.5, PPV 11 %) and AC > 90th centile (OR 2.3, 95 % CI 1.3-4.0, PPV 8.6 %) and an estimated fetal weight (EFW) > 4000 g (OR 2.1 95 %CI 1.0-4.1, PPV 7.2 %).

Conclusions: Estimated fetal weight is the most widely used ultrasound marker to predict fetal macrosomia in the UK. This study suggests other markers have a higher positive predictive value for adverse outcomes associated with fetal macrosomia.
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http://dx.doi.org/10.1016/j.ejogrb.2020.01.019DOI Listing
March 2020

Time intervals and routes to diagnosis for lung cancer in 10 jurisdictions: cross-sectional study findings from the International Cancer Benchmarking Partnership (ICBP).

BMJ Open 2019 11 27;9(11):e025895. Epub 2019 Nov 27.

Centre for Population Health Sciences, Edinburgh University, Edinburgh, UK.

Objective: Differences in time intervals to diagnosis and treatment between jurisdictions may contribute to previously reported differences in stage at diagnosis and survival. The International Cancer Benchmarking Partnership Module 4 reports the first international comparison of routes to diagnosis and time intervals from symptom onset until treatment start for patients with lung cancer.

Design: Newly diagnosed patients with lung cancer, their primary care physicians (PCPs) and cancer treatment specialists (CTSs) were surveyed in Victoria (Australia), Manitoba and Ontario (Canada), Northern Ireland, England, Scotland and Wales (UK), Denmark, Norway and Sweden. Using Wales as the reference jurisdiction, the 50th, 75th and 90th percentiles for intervals were compared using quantile regression adjusted for age, gender and comorbidity.

Participants: Consecutive newly diagnosed patients with lung cancer, aged ≥40 years, diagnosed between October 2012 and March 2015 were identified through cancer registries. Of 10 203 eligible symptomatic patients contacted, 2631 (27.5%) responded and 2143 (21.0%) were included in the analysis. Data were also available from 1211 (56.6%) of their PCPs and 643 (37.0%) of their CTS.

Primary And Secondary Outcome Measures: Interval lengths (days; primary), routes to diagnosis and symptoms (secondary).

Results: With the exception of Denmark (-49 days), in all other jurisdictions, the median adjusted total interval from symptom onset to treatment, for respondents diagnosed in 2012-2015, was similar to that of Wales (116 days). Denmark had shorter median adjusted primary care interval (-11 days) than Wales (20 days); Sweden had shorter (-20) and Manitoba longer (+40) median adjusted diagnostic intervals compared with Wales (45 days). Denmark (-13), Manitoba (-11), England (-9) and Northern Ireland (-4) had shorter median adjusted treatment intervals than Wales (43 days). The differences were greater for the 10% of patients who waited the longest. Based on overall trends, jurisdictions could be grouped into those with trends of reduced, longer and similar intervals to Wales. The proportion of patients diagnosed following presentation to the PCP ranged from 35% to 75%.

Conclusion: There are differences between jurisdictions in interval to treatment, which are magnified in patients with lung cancer who wait the longest. The data could help jurisdictions develop more focused lung cancer policy and targeted clinical initiatives. Future analysis will explore if these differences in intervals impact on stage or survival.
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http://dx.doi.org/10.1136/bmjopen-2018-025895DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6886977PMC
November 2019

Social connectedness and mortality after prostate cancer diagnosis: A prospective cohort study.

Int J Cancer 2020 08 2;147(3):766-776. Epub 2019 Dec 2.

Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia.

Men with prostate cancer experience side effects for which a supportive social environment may be beneficial. We examined the association between four measures of social connectedness and mortality after a prostate cancer diagnosis. Male participants in the Melbourne Collaborative Cohort Study in 1990-1994, who developed incident prostate cancer and attended follow-up in 2003-2007, were eligible for the study. Information on social connectedness, collected at follow-up, included (i) living arrangement; (ii) frequency of visits to friends/relatives and (iii) from friends/relatives; (iv) weekly hours of social activities. A total of 1,421 prostate cancer cases was observed (338 all-cause deaths, 113 from prostate cancer), including 867 after follow-up (150 all-cause deaths, 55 from prostate cancer) and 554 before follow-up (188 all-cause deaths, 58 from prostate cancer). Cox models stratified by tumour Gleason score and stage, and sequentially adjusted for socioeconomic, health- and lifestyle-related confounders, were used to calculate hazard ratios (HR) and 95% confidence intervals (95% CI) for the association between social connectedness and all-cause mortality after prostate cancer. Men who reported living alone before diagnosis had higher overall mortality (HR = 1.6, 95% CI: 1.0-2.5), after adjustment for socioeconomic, health and lifestyle confounders. Lower mortality was observed for men with more social activities (p-trend = 0.07), but not in comprehensively adjusted models. Consistent with these findings, men living alone after prostate cancer diagnosis had higher mortality (HR = 1.3, 95% CI: 0.9-1.9). Lower mortality was observed with increasing socializing hours in the age-adjusted model (p-trend = 0.06) but not after more comprehensive adjustment. Our findings suggest that living with someone, but not other aspects of social connectedness, may be associated with decreased mortality for men with prostate cancer.
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http://dx.doi.org/10.1002/ijc.32786DOI Listing
August 2020

The pathway to diagnosis and treatment for surgically managed lung cancer patients.

Fam Pract 2020 03;37(2):234-241

Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom.

Background: Most lung cancer is diagnosed at an advanced stage, resulting in poor survival. This study examined diagnostic pathways for patients with operable lung cancer to identify factors contributing to early diagnosis.

Methods: Surgically treated lung cancer patients (aged ≥40, within 6 months of diagnosis), approached via the population-based Cancer Registry, with their primary care physicians (PCPs) and specialists completed cross-sectional surveys assessing symptoms, diagnostic route (symptomatic or 'investigation' of other problem), tests, key event dates and treatment. Time intervals to diagnosis and treatment were determined, and quantile regression examined differences between the two diagnostic routes. Cox proportional hazard regression analyses examined associations between survival and diagnostic route adjusting for stage, sex and age.

Results: One hundred and ninety-two patients (36% response rate), 107 PCPs and 55 specialists participated. Fifty-eight per cent of patients had a symptomatic diagnostic route reporting an average of 1.6 symptoms, most commonly cough, fatigue or haemoptysis. Symptomatic patients had longer median primary care interval than 'investigation' patients (12 versus 9 days, P < 0.05) and were more likely to report their PCP first-ordered imaging tests. Secondary care interval was shorter for symptomatic (median = 43 days) than investigation (median = 62 days, P < 0.05) patients. However, 56% of all patients waited longer than national recommendations (6 weeks). While survival estimates were better for investigation than symptomatic patients, these differences were not significant.

Conclusion: Many operable lung cancer patients are diagnosed incidentally, highlighting the difficulty of symptom-based approaches to diagnosing early stage disease. Longer than recommended secondary care interval suggests the need for improvements in care pathways.
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http://dx.doi.org/10.1093/fampra/cmz064DOI Listing
March 2020

Long-term impact of plain packaging of cigarettes with larger graphic health warnings: findings from cross-sectional surveys of Australian adolescents between 2011 and 2017.

Tob Control 2019 08 20;28(e1):e77-e84. Epub 2019 Aug 20.

Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia.

Objective: To assess the long-term impact of plain packaging (PP) of cigarettes with larger graphic health warnings (HW) introduced in December 2012 on adolescents' relevant tobacco-related perceptions.

Methods: Cross-sectional school-based surveys of 12 to 17 year olds in 2011 (n=4413), 2013 (n=4423), 2014 (n=4576) and 2017 (n=4266). Students rated the character of four popular cigarette brands, indicated their agreement regarding brand differences in smoking ease, quitting, addictiveness, harmfulness and pack attractiveness and positive/negative perceptions of pack image. The frequency of students reading, attending to, thinking and talking about HW was assessed. Responses of students seeing cigarette packs in the previous 6 months (2011: 63%; 2013: 67%, 2014: 56%, 2017: 56%) were examined.

Results: Smoking prevalence declined from 2011 to 2017. Among students who had recently seen packs, cigarette packs were rated less positively and more negatively in 2017 than in 2011 (p<0.001) with ratings similar between 2013 and 2017. Positive character ratings for each brand reduced between 2011 and 2013 (ps<0.05) with further reductions between 2013 and 2017 (ps<0.05). Fewer students agreed, and more were uncertain, that brands differed in their smoking ease, addictiveness, harmfulness and pack attractiveness in 2017 than 2011. The frequency of students reading, attending, talking or thinking about HW did not change between 2011 and 2017.

Conclusions: PP's initial impact in reducing adolescent's positive perceptions of cigarette packs and brand differences continued in the following years with tobacco packaging less appealing to young people in 2017 than 2011 and students more uncertain about brand differences.
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http://dx.doi.org/10.1136/tobaccocontrol-2019-054988DOI Listing
August 2019

Concordance between Optimal Care Pathways and colorectal cancer care: Identifying opportunities to improve quality and reduce disparities.

J Eval Clin Pract 2020 Jun 9;26(3):918-926. Epub 2019 Jul 9.

Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia.

Rationale, Aims, And Objectives: Care pathway policies for cancer aim to reduce variation and improve the quality of patient care, and there is increasing evidence that adherence to such pathways is associated with improved survival and lower health care costs. Australia is implementing Optimal Care Pathways (OCPs) for several cancers, including colorectal cancer, but studies evaluating how well care conforms to OCP recommendations are rare. This study examined concordance between OCP recommendations and colorectal cancer care prior to policy rollout and disparities for vulnerable populations.

Method: Cross-sectional survey (2012-2014) of cancer registry-identified colorectal cancer patients aged ≥40 approached within 6 months of diagnosis (n = 433), their general practitioner (GP, n = 290), and specialist (n = 144) in Victoria, Australia. We measured concordance with 10 OCP recommendations and variation by geography, socio-economic, and health insurance status using age- and sex-adjusted logistic regression models.

Results: Use of recommended GP investigations varied from 66% for colonoscopy to 13% for digital rectal exam. Recommended waiting times to receive a colonoscopy, see a specialist after referral, and begin adjuvant chemotherapy were exceeded for around a third of patients. Twenty-eight percent of specialists reported a pretreatment multidisciplinary meeting. Most patients received surgery in a hospital with an intensive care unit (92%) and chemotherapy for high risk disease (84%). In general, care was similar across sociodemographic groups. However, receipt of GP investigations tended to be higher and waiting times longer for rural, low socio-economic, and non-privately insured patients. For example, receiving a colonoscopy within 4 weeks was significantly less likely for rural (51%) than urban (78%) patients (odds ratio = 0.30; 95% confidence interval, 0.11-0.79).

Conclusion: Prior to implementation, a significant proportion of colorectal cancer patients received care that did not meet OCP recommendations. Low concordance and inequities for rural and disadvantaged populations highlight components of the pathway to target during policy implementation.
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http://dx.doi.org/10.1111/jep.13231DOI Listing
June 2020

The Use of Optimal Treatment for DLBCL Is Improving in All Age Groups and Is a Key Factor in Overall Survival, but Non-Clinical Factors Influence Treatment.

Cancers (Basel) 2019 Jul 2;11(7). Epub 2019 Jul 2.

Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria 3004, Australia.

Introduction: Diffuse large B cell lymphoma (DLBCL) is an aggressive form of non-Hodgkin lymphoma for which a cure is usually the therapeutic goal of optimal treatment. Using a large population-based cohort we sought to examine the factors associated with optimal DLBCL treatment and survival.

Methods: DLBCL cases were identified through the population-based Victorian Cancer Registry, capturing new diagnoses for two time periods: 2008-2009 and 2012-2013. Treatment was pre-emptively classified as 'optimal' or 'suboptimal', according to compliance with current treatment guidelines. Univariable and multivariable logistic regression models were fitted to determine factors associated with treatment and survival.

Results: Altogether, 1442 DLBCL cases were included. Based on multivariable analysis, delivery of optimal treatment was less likely for those aged ≥80 years (p < 0.001), women (p = 0.012), those with medical comorbidity (p < 0.001), those treated in a non-metropolitan hospital (p = 0.02) and those who were ex-smokers (p = 0.02). Delivery of optimal treatment increased between 2008-2009 and the 2012-2013 (from 60% to 79%, p < 0.001). Delivery of optimal treatment was independently associated with a lower risk of death (hazard ratio (HR) = 0.60 (95% confidence interval (CI) 0.45-0.81), p = 0.001).

Conclusion: Delivery of optimal treatment for DLBCL is associated with hospital location and category, highlighting possible demographic variation in treatment patterns. Together with an increase in the proportion of patients receiving optimal treatment in the more recent time period, this suggests that treatment decisions in DLBCL may be subject to non-clinical influences, which may have implications when evaluating equity of treatment access. The positive association with survival emphasizes the importance of delivering optimal treatment in DLBCL.
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http://dx.doi.org/10.3390/cancers11070928DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6678990PMC
July 2019

Tumor size and postoperative kidney function following radical nephrectomy.

Clin Epidemiol 2019 6;11:333-348. Epub 2019 May 6.

Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.

Chronic kidney disease (CKD) following nephrectomy for kidney tumors is common, and both patient and tumor characteristics may affect postoperative kidney function. Several studies have reported that surgery for large tumors is associated with a lower likelihood of postoperative CKD, but others have reported CKD to be more common before surgery in patients with large tumors. The aim of this study was to clarify inconsistencies in the literature regarding the prognostic significance of tumor size for postoperative kidney function. We analyzed data from 944 kidney cancer patients managed with radical nephrectomy between January 2012 and December 2013, and 242 living kidney donors who underwent surgery between January 2011 and December 2014 in the Australian states of Queensland and Victoria. Multivariable logistic regression was used to assess the primary outcome of CKD upstaging. Structural equation modeling was used to evaluate causal models, to delineate the influence of patient and tumor characteristics on postoperative kidney function. We determined that a significant interaction between age and tumor size (=0.03) led to the observed inverse association between large tumor size and CKD upstaging, and was accentuated by other forms of selection bias. Subgrouping patients by age and tumor size demonstrated that all patients aged ≥65 years were at increased risk of CKD upstaging, regardless of tumor size. Risk of CKD upstaging was comparable between age-matched living donors and kidney cancer patients. Larger tumors are unlikely to confer a protective effect with respect to postoperative kidney function. The reason for the previously reported inconsistency is likely a combination of the analytical approach and selection bias.
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http://dx.doi.org/10.2147/CLEP.S197968DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6511655PMC
May 2019

Research evidence supports cancer policymaking but is insufficient for change: Findings of key informant interviews from five countries.

Health Policy 2019 06 13;123(6):572-581. Epub 2019 Apr 13.

Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Rd, Melbourne, 3004, Australia; School of Psychology, Deakin University, 221 Burwood Hwy, Burwood, 3125, Australia.

Evidence-based policymaking values the use of research in the process of developing, implementing and evaluating policy. However, there is limited research attempting to understand how cancer policymaking occurs and the role of evidence in this process. Our study aimed to provide a deeper understanding of levers and challenges to the development and implementation of large-scale, health service policies or programs in cancer care. Within a realist framework, we conducted a thematic analysis of interviews with 13 key informants from five countries: Australia, Canada, Scotland, Denmark and New Zealand. Results identified a complex array of program mechanisms and contextual factors influencing cancer health-service policymaking. Research evidence was important and could form a rationale for change, such as by identifying unwarranted variation in cancer outcomes across or within countries. However, other factors were equally important in driving policy change, including advocacy, leadership, stakeholder collaboration, program adaptability, clinician and consumer involvement, and the influential role of context. These findings resonate with political science theories and health service reform literature, while offering novel insight into specific factors that influence policymaking in cancer care, namely clinical engagement, consumer input and policy context. Although research evidence supports policymaking, the complex ways in which cancer policies are developed and implemented requires recognition and should be considered when designing new programs and promoting the use of evidence in policymaking.
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http://dx.doi.org/10.1016/j.healthpol.2019.04.003DOI Listing
June 2019

Incident Chronic Kidney Disease After Radical Nephrectomy for Renal Cell Carcinoma.

Clin Genitourin Cancer 2019 06 15;17(3):e581-e591. Epub 2019 Mar 15.

QIMR Berghofer Medical Research Institute, Brisbane, Australia; University of Queensland, Brisbane, Australia.

Background: Chronic kidney disease (CKD) after surgery for kidney cancer is common, and is associated with increased morbidity and mortality. This study aimed to identify factors associated with incident CKD in patients managed with radical nephrectomy.

Patients And Methods: All patients diagnosed with renal cell carcinoma between January 2012 and December 2013 were ascertained from state-based cancer registries in Queensland and Victoria. Information on patient, tumor, and health service characteristics was obtained via chart review. Multivariable logistic regression was used to evaluate exposures associated with incident CKD (estimated glomerular filtration rate [eGFR] <60 mL per minute per 1.73 m) at 12 months after nephrectomy.

Results: Older age (adjusted odds ratio [aOR] per 5-year increase, 1.5; 95% confidence interval [CI], 1.4-1.6), male sex (aOR, 1.4; 95% CI, 1.0-2.0), obese compared with not obese (aOR, 1.8; 95% CI, 1.2-2.7), rural compared with urban place of residence (aOR, 1.8; 95% CI, 1.1-3.0) were associated with a higher risk of incident CKD. Lower preoperative eGFR was also associated with a higher risk of incident CKD. Management in private compared with public hospitals was also associated with a higher risk of CKD (aOR, 1.6; 95% CI, 1.2-2.2). Factors related to tumor size and cancer severity were also associated with worse postoperative kidney function, although it is likely this was a consequence of selection bias.

Conclusion: Patient characteristics have the strongest associations with incident CKD after radical nephrectomy. Potential risk factors were reasonably similar to recognized CKD risk factors for the general population. Patients who undergo nephrectomy who have CKD risk factors might benefit from ongoing postoperative screening for deterioration of kidney function.
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http://dx.doi.org/10.1016/j.clgc.2019.02.011DOI Listing
June 2019

Trials of antenatal corticosteroids for preterm fetal lung maturity: a review of the potential for selective outcome reporting.

Eur J Obstet Gynecol Reprod Biol 2019 May 11;236:58-68. Epub 2019 Mar 11.

Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham City Hospital, NG5 1PB, United Kingdom.

Objective: To measure the extent to which the evidence underpinning prenatal corticosteroids for preterm fetal lung maturity is at risk of bias due to selective outcome reporting.

Study Design: Five biomedical databases (Medline, ClinicalTrials.gov, Embase, OVID and HMIC) were searched for trials published between February 2016 and September 2017. Randomised trials of prenatal steroids for women at risk of preterm birth were identified. For each, we recorded the registration status and timing, and whether the registered primary outcome had been reported. For unregistered trials, we estimated the potential for selective outcome reporting indirectly by tabulating all reported outcomes and by comparing the first outcome reported in the methods to the first in the results section.

Results: Twenty seven trials were identified. Only three (11%) trials had been registered. All three reported their pre-specified primary outcome. Among the unregistered trials, thirteen (54%) had different first reported outcomes in the methods and results sections, and among all trials many different outcomes were reported suggesting considerable potential for selective reporting. However, the single outcome of respiratory distress syndrome, albeit defined in different ways, was reported in all but two trials. This is reassuring evidence that the beneficial effect of steroids on this outcome has not been exaggerated by selective outcome reporting.

Conclusion: We conclude that the evidence that steroids reduce respiratory distress syndrome is secure.
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http://dx.doi.org/10.1016/j.ejogrb.2019.02.031DOI Listing
May 2019

Management of Sarcoma in Adolescents and Young Adults: An Australian Population-Based Study.

J Adolesc Young Adult Oncol 2019 06 1;8(3):272-280. Epub 2019 Mar 1.

12 Kids Cancer Center, Sydney Children's Hospital, Sydney, Australia.

While overall survival (OS) for cancer in adolescents and young adults (AYA) has improved, there has been little change in AYA survival for several types of sarcomas. Using national data for Australia we describe (1) the treatment centers caring for AYA sarcoma, (2) treatments provided, and (3) survival outcomes. National population-based study assessing treatment of 15-24 year-olds diagnosed with soft tissue sarcoma (STS), bone sarcoma (BS), and Ewing family tumors (ET) between 2007 and 2012. Treatment details were abstracted from hospital medical records. Treatment centers were classified as pediatric or adult specialist AYA/sarcoma center, or other adult. Cox proportional hazard regression analyses examined associations between type of treatment center and OS. Sixty-one hospitals delivered treatment to 318 patients (135 STS; 91 BS, 92 ET), with 9%, 22%, and 17% of STS, BS, and ET, respectively, treated at pediatric and 62%, 59%, and 71% at adult specialist hospitals. Of 18-24 year-olds, 82% of BS, 90% of ET, and 73% of rhabdomyosarcomas at adult specialist centers were on a trial or standard protocol, compared with 42%, 89%, and 100%, respectively, at nonspecialist adult hospitals. After adjusting for disease and patient characteristics, survival was not associated with treatment center type for any disease type. However, ET survival was poorer for patients not receiving a standard chemotherapy protocol. Around 10% of AYA sarcoma patients attending adult hospitals were not on a standard protocol. Poorer survival for ET patients not on a standard protocol highlights the importance of ensuring all patients receive optimal care.
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http://dx.doi.org/10.1089/jayao.2018.0136DOI Listing
June 2019
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