Experiences of colorectal cancer survivors in returning to primary coordinated healthcare following treatment

Background. Advances in screening and treatments for colorectal cancer (CRC) have improved survival rates, leading to a large population of CRC survivors. Treatment for CRC can cause longterm side-effects and functioning impairments. General practitioners (GPs) have a role in meeting survivorship care needs of this group of survivors. We explored CRC survivors’ experiences of managing the consequences of treatment in the community and their perspective on the GP’s role in post-treatment care. Methods. This was a qualitative study using an interpretive descriptive approach. Adult participants no longer actively receiving treatment for CRC were asked about: side-effects post-treatment; experiences of GP-coordinated care; perceived care gaps; and perceived GP role in post-treatment care. Thematic analysis was used for data analysis. Results. A total of 19 interviews were conducted. Participants experienced side-effects that significantly impacted their lives; many they felt ill-prepared for. Disappointment and frustration was expressed with the healthcare system when expectations about preparation for posttreatment effects were not met. The GP was considered vital in survivorship care. Participants' unmet needs led to self-management, self-directed information seeking and sourcing referral options, leaving them feeling like their own care coordinator. Disparities in post-treatment care between metropolitan and rural participants were observed. Conclusion. There is a need for improved discharge preparation and information for GPs, and earlier recognition of concerns following CRC treatment to ensure timely management and access to services in the community, supported by system-level initiatives and appropriate interventions

The Devil\u27s Tic Tac\u27s - Understanding the adverse events of steroid therapy associated with the treatment of multiple myeloma

Background: The goals of treatment for multiple myeloma (MM) are to induce remission, prolong survival and maintain quality of life. Corticosteroids ( steroids ) are an important component of treatment regimens but cause a number of significant, poorly understood adverse effects (AEs) which profoundly affect quality of life (QoL). Greater understanding of the experience of these AEs and their management can enhance patient education and supportive care measures. Aims: 1) Examine the experience of AEs of high dose steroids of MM patients and their carers, including AE profile, severity and overall impact, and 2) Describe clinicians\u27 perspectives of the AE profile for and clinical management of steroids. Aim 1 is the focus of this abstract. Method: A two-phase study with a mixed method design was employed. Phase one (qualitative), Focus group and individual interviews with current MM patients and carers to examine the experience of AEs, information and support needs. Data was analysed with content analysis. Phase Two (mixed) Prospective collection using a tailored patient diary recorded over 2 month period to capture subjective assessment of AE, type, frequency, severity and impact. Symptom Assessment Scale and questions prompts with scales and open-ended questions were included. Participants also participated in individual interviews pre and post diary data collection. Results: 47 participants participated in the focus group interviews and 22 participants took part in in-depth individual interviews and diaries. Major themes identified included learning & knowing, adapting & accommodating, taking ownership and negotiating. Tracking tools were utilised to help manage AEs. 110 weekly journals were completed. Most commonly reported AEs include mood changes, insomnia, facial flushing and let down effect. The overt nature of mood changes have an adverse impact and adaptive behaviours such as isolating self from others were utilised to manage this AE. Mood and energy changes are common reasons for dose adjustment, and dose reductions due to AEs are frequent. Conclusions: Themes identified in the interview and journaling confirm that steroids cause a range of AEs and that dose reductions are often applied to minimise the impact. Patients use experience and tracking tools to learn how best to accommodate steroids effects. Results from this study will inform part 2 of the study and identify ways to improve clinical management of AEs associated with steroid therapy