Aplikasi Smartphone sebagai Sarana Promosi Kesehatan Kanker dengan Terapi Radiasi

This study aims to determine the benefits of using smartphone applications in the health sector in increasing the knowledge of patients or survivors about cancer health, prevention, early detection and screening of cancer, especially treatment with radiation modalities. The method used is PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) on several electronic databases through screening titles about cancer education or health promotion with radiation therapy. The results showed that many smartphone applications in the field of cancer services were used in patients receiving radiation therapy. This application is very useful for cancer patients during treatment and for post-therapy survivors. The m-Health application is also able to increase patient knowledge about cancer and can encourage changes in healthy living behavior. In conclusion, health promotion and intervention through smartphone applications can have a positive impact on improving health quality, both physically and psychologically, socially, increasing health literacy and being economically more cost-effective. Keywords: Applications, Education, Cancer, Radiotherapy, Smartphon

Cochleotoxicity and vestibulotoxicity monitoring in patients receiving chemotherapy in South Africa

Platinum-based agents can cause ototoxicity, an adverse reaction affecting the inner ear. The ototoxicity is characterised by cochleotoxicity and vestibulotoxicity. Although ototoxic medications play an essential role in modern medicine, they have the capability to cause harm and can have a significant effect on health-related quality of life (HRQoL). Ototoxicity surveillance is vital for possible treatment modifications, early identification and rehabilitation of hearing and vestibular function. Although many ototoxicity monitoring protocols exist and have proved to be effective in identification of ototoxicity, their success of implementation is questionable. One of the major factors affecting current monitoring protocols is the incapacitated state of the cancer patients. Reliable and efficient monitoring protocols that are less labour intensive and time consuming are required. Shortened protocols that target sensitive frequencies for ototoxicity and allow testing outside of traditional settings are required. Technologies need to be validated in order to decentralise services from the traditional models and ensure access for cancer patients at their treatment venue. There is limited knowledge about the current status of ototoxicity monitoring in oncology units in South Africa. This information could guide future practices of ototoxicity monitoring in South Africa. This project investigated (i) the status of ototoxicity monitoring in South Africa, (ii) the role of innovative technology to support decentralised ototoxicity monitoring, and, lastly, (iii) potential monitoring of vestibulotoxicity in cancer patients. Study I investigated (i) the national status of ototoxicity monitoring implemented in private and public cancer facilities, (ii) the knowledge and ototoxicity monitoring approaches implemented, and (iii) reported challenges. A descriptive quantitative survey was conducted in public and private oncology units and audiology referral clinics. Provinces included were Gauteng, Free State, Mpumalanga, Limpopo, North West, Western Cape, Northern Cape, Eastern Cape and KwaZulu-Natal. Private (60%) and public (43%) oncology units that provide platinum-based chemotherapy in South Africa and 54% of audiology referral units were (1) surveyed telephonically to determine if ototoxicity monitoring takes place, and (2) a self-administered survey was sent to qualifying oncology units and audiology referral clinics. All public oncology units reported that ototoxicity monitoring only occurred on referral and was not standard practice. All private oncology units indicated that monitoring was on a patient self-referral basis when symptoms occurred. Poor awareness of ototoxicity monitoring best practice guidelines was reported by all oncology units and 14% of audiology referral clinics. Audiology referral clinics reported adequate knowledge of ototoxicity protocols although they were not widely used, with only 43% following best practice guidelines. The most prominent challenges reported by participants were referral system (67% oncology units; 57% audiology referral clinics), environmental noise (83% oncology units; 86% audiology referral clinics) and the compromised status of cancer patients (67% oncology units; 57% audiology referral clinics). There is significant discrepancy in the manner in which ototoxicity monitoring is conducted across South Africa in both the private and public sector. Effective scheduling and test location are key to a successful monitoring programme. Ototoxic monitoring programmes need to become standard for the care of all patients receiving treatment with ototoxic chemotherapy. Study II investigated mHealth-enabled surveillance in ototoxicity. A longitudinal study of 32 participants receiving chemotherapy was conducted. Baseline and exit audiograms that included conventional and extended high-frequency (EHF) audiometry were recorded at the patient’s treatment venue using a validated mobile health (mHealth) audiometer. Average hearing thresholds at baseline were within the normal range (81.2% left; 93.8% right), reducing at exit testing (71.9% left; 78.1% right). Half (50%) of participants presented with a threshold shift according to ototoxicity monitoring criteria. Frequencies affected most were between 4000 and 16000 Hz, with left ears significantly (p < 0.05) more affected than right ears. During threshold determination, noise levels exceeded the maximum permissible ambient noise levels in up to 43.8% of thresholds determined in low frequencies between 250 and 1000 Hz. Ototoxicity surveillance that included mHealth audiometry and EHF for cancer patients receiving platinum-based chemotherapy proved to be valuable, and testing could take place at the treatment venue. Baseline and exit testing performed could track changes in hearing. Shortened monitoring protocols focusing on high frequencies and EHF may be more efficient, and address the possibility of noise interference in the lower frequencies during testing. Study III investigated the changes in vestibular and cochlear function in patients receiving platinum-based chemotherapy. A longitudinal study of 32 participants (10-70 years) receiving chemotherapy was conducted. Baseline and exit vestibular and hearing assessments that included video head impulse (VHIT) testing, cervical and ocular vestibular evoked myogenic potentials (VEMP), bedside dynamic visual acuity (DVA) and pure-tone audiometry were performed at the patient’s treatment venue. Half (50%) of the participants showed cochleotoxicity from baseline to exit testing according to ototoxicity criteria, with left ears significantly (p 60 years, VEMP may not be practical as a vestibulotoxicity monitoring tool for older cancer patients. As patients did not report vestibular symptoms that had a functional impact on daily life, patient self-report of symptoms may be sufficient to monitor vestibulotoxicity in the treatment venue for patients who are ill and incapacitated. The results from the three studies demonstrated that ototoxicity monitoring was not routinely implemented across oncology units in South Africa. Multidisciplinary teamwork and a decentralised approach to ototoxicity monitoring may improve hearing outcomes for cancer patients. mHealth-supported audiometry proved to be a valuable tool for ototoxicity monitoring at the treatment venue. Changes in hearing sensitivity over time could be tracked, improving surveillance in patients with full treatment schedules and compromised health status. VHIT proved to be a useful measure of changes in vestibular function secondary to ototoxicity. Future investigations should determine vestibulotoxicity criteria and optimal protocols for sensitivity and efficiency in monitoring vestibular functioning during chemotherapy treatment at the patient’s treatment venue or hospital ward. This project highlighted that ototoxicity monitoring as standard practice at the patient’s treatment venue would relieve the over-burdened treatment schedule of cancer patients. This would ensure that HRQoL is preserved and an opportunity for early intervention and aural rehabilitation is provided.Thesis (PhD (Audiology))--University of Pretoria, 2021.Sefako Makgatho Health Sciences University Research Development Grant (D200).Speech-Language Pathology and AudiologyPhD (Audiology)Unrestricte

“Is there anything else you would like to tell us?” – A thematic analysis of free-text comments from a self-management questionnaire with people affected by cancer

Background: Researchers are frequently using open-ended questions at the end of questionnaires that invite respondents to add, in their own words, further information about issues covered in the questionnaire. The aim of this study was to present the qualitative findings from the further information section at the end of a questionnaire that was designed to collect data on aspects of self-management in people affected by cancer. Methods: Respondents were asked: ‘Thinking about how you manage your health and health care, if there is anything else you would like to tell us about your experience, please write in the box below.’ Free-text responses were analysed thematically. Results: 128 participants completed the free-text response at the end of the questionnaire. The main overarching theme was the concept of the participants “moving on” from cancer and developing a meaningful life for themselves following diagnosis and treatment. For most, this incorporated making adjustments to their physical, social, psychological, spiritual and emotional wellbeing. “Luck” was another overwhelming theme where many participants stated they were “glad to still be alive” and “consider myself very lucky.” Participants reported adjustments made to health behaviours such as leading an active lifestyle and making changes to their diet and nutrition. The final theme incorporates the participants identifying their main sources of support, both clinical and non-clinical, some of which they stated “could not have done it without them.” Conclusions: The findings highlight the valuable insight that free-text comments can add as a data source at the end of self-completion questionnaires with people affected by cancer