Clinical management of financial toxicity - identifying opportunities through experiential insights of cancer survivors, caregivers, and social workers

Perspectives of cancer survivors, caregivers, and social workers as key stakeholders on the clinical management of financial toxicity (FT) are critical to identify opportunities for better FT management. Semi-structured interviews (cancer survivors, caregivers) and a focus group (social workers) were undertaken using purposive sampling at a quaternary public hospital in Australia. People with any cancer diagnosis attending the hospital were eligible. Data were analysed using inductive-deductive content analysis techniques. Twenty-two stakeholders (n = 10 cancer survivors of mixed-cancer types, n = 5 caregivers, and n = 7 social workers) participated. Key findings included: (i) genuine concern for FT of cancer survivors and caregivers shown through practical support by health care and social workers; (ii) need for clarity of role and services; (iii) importance of timely information flow; and (iv) proactive navigation as a priority. While cancer survivors and caregivers received financial assistance and support from the hospital, the lack of synchronised, shared understanding of roles and services in relation to finance between cancer survivors, caregivers, and health professionals undermined the effectiveness and consistency of these services. A proactive approach to anticipate cancer survivors’ and caregivers’ needs is recommended. Future research may develop and evaluate initiatives to manage cancer survivors and families FT experiences and outcomes

The sustainability of changes in agricultural technology:The carbon, economic and labour implications of mechanisation and synthetic fertiliser use

New agricultural technologies bring multiple impacts which are hard to predict. Two changes taking place in Indian agriculture are a transition from bullocks to tractors and an associated replacement of manure with synthetic fertilisers. This paper uses primary data to model social, environmental and economic impacts of these transitions in South India. It compares ploughing by bullocks or tractors and the provision of nitrogen from manure or synthetic urea for irrigated rice from the greenhouse gas (GHG), economic and labour perspective. Tractors plough nine times faster than bullocks, use substantially less labour, with no significant difference in GHG emissions. Tractors are twice as costly as bullocks yet remain more popular to hire. The GHG emissions from manure-N paddy are 30 % higher than for urea-N, largely due to the organic matter in manure driving methane emissions. Labour use is significantly higher for manure, and the gender balance is more equal. Manure is substantially more expensive as a source of nutrients compared to synthetic nutrients, yet remains popular when available. This paper demonstrates the need to take a broad approach to analysing the sustainability impacts of new technologies, as trade-offs between different metrics are common

Topical opioids and antimicrobials for the management of pain, infection, and infection-related odors in malignant wounds:A systematic review

Problem Identification Patients with malignant wounds report pain, distress from odour and exudate, decreased self-esteem and poor quality of life. This systematic review explores topical opioids, antimicrobials and odour-reducing agents for preventing or managing malignant wound pain, infection and odour. Literature Search CINAHL, CENTRAL, Medline, PsychINFO and reference lists were searched to identify relevant studies. Data evaluation Eligible study designs included interventions with pre- and post-intervention data. Data extraction and risk of bias assessments were conducted using the Cochrane approach. Synthesis No studies evaluated opioid use. Five studies (four RCTs) evaluated topical antimicrobials for infection and odour. All studies reported clinically (although generally not statistically) significant improvements in outcomes. Conclusion While not as prevalent as formerly, 5-10% of tumours, especially in breast cancer, sarcoma and melanoma, are expected to fungate. Gaps in the literature pertain to topical opioids and antimicrobials for managing pain, odour and infection control in malignant wounds. Implications for Practice or Research Current recommendations for topical control of malignant wounds are based on case reports and observational studies in breast cancer patients. Robust, controlled trials of topical opioid and antimicrobial use are warranted in patients with melanoma, breast or head and neck cancer

Ovarian response in Indonesian Peranakan Ongle cows to a roughage diet supplemented with a mix of shrub legume leaves

The Peranakan Ongole (PO), a Bos indicus breed, makes up a significant proportion of the total cattle population of East Java; the Province of Indonesia that supplies most of that country’s beef. (Komarudin-Ma’sum and Teleni, 1991) The PO cows have been recorded as having a poor reproductive performance (Yusran et al., 1998) probably due to poor nutritional status. This study was undertaken to examine the effect of supplementing the basal diet of PO cows, post-partum, with shrub/tree legumes

Cancer cachexia: an overview of diagnostic criteria and therapeutic approaches for the accredited practicing dietitian

Background: Cancer cachexia (CC) is a multifactorial syndrome characterised by ongoing skeletal muscle loss that leads to progressive functional impairment driven by reduced food intake and abnormal metabolism. Despite the traditional use of non-volitional weight loss as the primary marker of CC, there is no consensus on how to diagnose and manage CC. Methods: The aim of this narrative review was to describe and discuss diagnostic criteria and therapeutic approaches for the accredited practicing dietitian with respect to identifying and managing CC. Results: Available diagnostic criteria for cachexia include the cancer-specific (Fearon and Cachexia Score) and general criteria (Evans and Global Leadership Initiative on Malnutrition). These include phenotypic criteria [weight loss, body mass index, (objective) muscle mass assessments, quality of life] and aetiological criteria (disease burden, inflammation, energy expenditure, anorexia and inadequate food intake) and can be incorporated into the nutrition care process (NCP). This informs the nutrition diagnosis of 'chronic disease- or condition-related malnutrition (undernutrition) as related to increased nutrient needs, anorexia or diminished intake due to CC'. Optimal nutrition care and management of CC is multidisciplinary, corrects for increased energy expenditure (via immunonutrition/eicosapentaenoic acid), suboptimal protein/energy intake and poor nutrition quality of life, and includes a physical exercise intervention. Monitoring of intervention efficacy should focus on maintaining or slowing the loss of muscle mass, with weight change as an alternative gross indicator. Conclusions: Dietitians and the NCP can play an essential role with respect to identifying and managing CC, focusing on aspects of nutrition screening, assessment and intervention

Cancer cachexia: an overview of diagnostic criteria and therapeutic approaches for the accredited practicing dietitian

Cancer cachexia (CC) is a multifactorial syndrome characterised by ongoing skeletal muscle loss that leads to progressive functional impairment driven by reduced food intake and abnormal metabolism. Despite the traditional use of non-volitional weight loss as the primary marker of CC, there is no consensus on how to diagnose and manage CC.The aim of this narrative review was to describe and discuss diagnostic criteria and therapeutic approaches for the accredited practicing dietitian with respect to identifying and managing CC.Available diagnostic criteria for cachexia include the cancer-specific (Fearon and Cachexia Score) and general criteria (Evans and Global Leadership Initiative on Malnutrition). These include phenotypic criteria [weight loss, body mass index, (objective) muscle mass assessments, quality of life] and aetiological criteria (disease burden, inflammation, energy expenditure, anorexia and inadequate food intake) and can be incorporated into the nutrition care process (NCP). This informs the nutrition diagnosis of 'chronic disease- or condition-related malnutrition (undernutrition) as related to increased nutrient needs, anorexia or diminished intake due to CC'. Optimal nutrition care and management of CC is multidisciplinary, corrects for increased energy expenditure (via immunonutrition/eicosapentaenoic acid), suboptimal protein/energy intake and poor nutrition quality of life, and includes a physical exercise intervention. Monitoring of intervention efficacy should focus on maintaining or slowing the loss of muscle mass, with weight change as an alternative gross indicator.Dietitians and the NCP can play an essential role with respect to identifying and managing CC, focusing on aspects of nutrition screening, assessment and intervention

Cancer cachexia: an overview of diagnostic criteria and therapeutic approaches for the accredited practicing dietitian

Background: Cancer cachexia (CC) is a multifactorial syndrome characterised by ongoing skeletal muscle loss that leads to progressive functional impairment driven by reduced food intake and abnormal metabolism. Despite the traditional use of non-volitional weight loss as the primary marker of CC, there is no consensus on how to diagnose and manage CC. Methods: The aim of this narrative review was to describe and discuss diagnostic criteria and therapeutic approaches for the accredited practicing dietitian with respect to identifying and managing CC. Results: Available diagnostic criteria for cachexia include the cancer-specific (Fearon and Cachexia Score) and general criteria (Evans and Global Leadership Initiative on Malnutrition). These include phenotypic criteria [weight loss, body mass index, (objective) muscle mass assessments, quality of life] and aetiological criteria (disease burden, inflammation, energy expenditure, anorexia and inadequate food intake) and can be incorporated into the nutrition care process (NCP). This informs the nutrition diagnosis of 'chronic disease- or condition-related malnutrition (undernutrition) as related to increased nutrient needs, anorexia or diminished intake due to CC'. Optimal nutrition care and management of CC is multidisciplinary, corrects for increased energy expenditure (via immunonutrition/eicosapentaenoic acid), suboptimal protein/energy intake and poor nutrition quality of life, and includes a physical exercise intervention. Monitoring of intervention efficacy should focus on maintaining or slowing the loss of muscle mass, with weight change as an alternative gross indicator. Conclusions: Dietitians and the NCP can play an essential role with respect to identifying and managing CC, focusing on aspects of nutrition screening, assessment and intervention

Patient-generated subjective global assessment short form (PG-SGA SF) is a valid screening tool in chemotherapy outpatients

Purpose: In the oncology population where malnutrition prevalence is high, more descriptive screening tools can provide further information to assist triaging and capture acute change. The Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) is a component of a nutritional assessment tool which could be used for descriptive nutrition screening. The purpose of this study was to conduct a secondary analysis of nutrition screening and assessment data to identify the most relevant information contributing to the PG-SGA SF to identify malnutrition risk with high sensitivity and specificity. Methods: This was an observational, cross-sectional study of 300 consecutive adult patients receiving ambulatory anti-cancer treatment at an Australian tertiary hospital. Anthropometric and patient descriptive data were collected. The scored PG-SGA generated a score for nutritional risk (PG-SGA SF) and a global rating for nutrition status. Receiver operating characteristic curves (ROC) were generated to determine optimal cut-off scores for combinations of the PG-SGA SF boxes with the greatest sensitivity and specificity for predicting malnutrition according to scored PG-SGA global rating. Results: The additive scores of boxes 1–3 had the highest sensitivity (90.2\ua0%) while maintaining satisfactory specificity (67.5\ua0%) and demonstrating high diagnostic value (AUC\ua0=\ua00.85, 95\ua0% CI\ua0=\ua00.81–0.89). The inclusion of box 4 (PG-SGA SF) did not add further value as a screening tool (AUC\ua0=\ua00.85, 95\ua0% CI\ua0=\ua00.80–0.89; sensitivity 80.4\ua0%; specificity 72.3\ua0%). Conclusions: The validity of the PG-SGA SF in chemotherapy outpatients was confirmed. The present study however demonstrated that the functional capacity question (box 4) does not improve the overall discriminatory value of the PG-SGA SF