A randomised controlled trial of a tele-based lifestyle intervention for colorectal cancer survivors ('CanChange'): study protocol

Background Colorectal cancer survivors may suffer from a range of ongoing psychosocial and physical problems that negatively impact on quality of life. This paper presents the study protocol for a novel telephone-delivered intervention to improve lifestyle factors and health outcomes for colorectal cancer survivors. Methods/Design Approximately 350 recently diagnosed colorectal cancer survivors will be recruited through the Queensland Cancer Registry and randomised to the intervention or control condition. The intervention focuses on symptom management, lifestyle and psychosocial support to assist participants to make improvements in lifestyle factors (physical activity, healthy diet, weight management, and smoking cessation) and health outcomes. Participants will receive up to 11 telephone-delivered sessions over a 6 month period from a qualified health professional or 'health coach'. Data collection will occur at baseline (Time 1), post-intervention or six months follow-up (Time 2), and at 12 months follow-up for longer term effects (Time 3). Primary outcome measures will include physical activity, cancer-related fatigue and quality of life. A cost-effective analysis of the costs and outcomes for survivors in the intervention and control conditions will be conducted from the perspective of health care costs to the government. Discussion The study will provide valuable information about an innovative intervention to improve lifestyle factors and health outcomes for colorectal cancer survivors

Oncology Nurses' Perceptions of their Supportive Care for Parents with Advanced Cancer: Challenges and Educational Needs

Despite the emotional impact for children with a parent with advanced cancer, most families receive limited information and support to assist them. A project is underway to determine the acceptability and effectiveness of a supportive and educational intervention for parents with advanced cancer to be delivered by specially trained oncology nurses. To assess the perceptions of oncology nurses about this role, explore potential challenges, and understand their educational needs, oncology nurses were recruited from three metropolitan hospitals to participate in focus groups. This data was supplemented with data from individual interviews conducted with rurally based nurses unable to participate in focus groups held in a metropolitan location. Four focus groups were held, with 24 participants. Individual telephone interviews were conducted with five nurses. Nurses identified the emotional burden of the supportive care role as a key challenge, along with health care systems which were not attuned to the needs of families. Attention to self-care and professional confidence, and access to role-models emerged as key elements required in education, along with information about the impact of parental cancer on children and their developmental stages, and ways to promote more open parental communicate with children

Treatment and survival from breast cancer: The experience of patients at South Australian teaching hospitals between 1977 and 2003

Rationale: Treatment guidelines recommend a more conservative surgical approach than mastectomy for early stage breast cancer and a stronger emphasis on adjuvant therapy. Registry data at South Australian teaching hospitals have been used to monitor survivals and treatment in relation to these guidelines. Aims and objectives: To use registry data to: (1) investigate trends in survival and treatment; and (2) compare treatment with guidelines. Methods: Registry data from three teaching hospitals were used to analyse trends in primary courses of treatment of breast cancers during 1977–2003 (n = 4671), using univariate analyses and multiple logistic regression. Disease-specific survivals were analysed using Kaplan–Meier product limit estimates and multivariable Cox proportional hazards regression. Results: The 5-year survival was 79.9%, but with a secular increase, reaching 83.6% in 1997–2003. The relative risk of death (95% confidence limits) was 0.74 (0.62, 0.88) for 1997–2003, compared with previous diagnoses, after adjusting for tumour node metastasis stage, grade, age and place of residence. Treatment changes included an increase in conservative surgery (as opposed to mastectomy) from 51.7% in 1977–1990 to 76.8% in 1997–2003 for stage I (P < 0.001) and from 31.1% to 52.2% across these periods for stage II (P < 0.001). Adjuvant radiotherapy also became more common (P < 0.001), with 20.6% of patients receiving this treatment in 1977–1990 compared with 60.7% in 1997–2003. Radiotherapy generally was more prevalent when conservative surgery was provided, although also relatively common in mastectomy patients when tumour diameters exceeded 50 mm or when there were four or more involved nodes. The proportion of patients receiving chemotherapy increased (P < 0.001), from 19.6% in 1977–1990 to 36.9% in 1997–2003, and the proportion having hormone therapy also increased (P < 0.001), from 34.3% to 59.4% between these periods. Conclusions: Survivals appear to be increasing and treatment trends are broadly consistent with guideline directions, and the earlier research on which these recommendations were based.Colin Luke, Grantley Gill, Stephen Birrell, Vlad Humeniuk, Martin Borg, Christos Karapetis, Bogda Koczwara, Ian Olver, Michael Penniment, Ken Pittman, Tim Price, David Walsh, Eng Kiat (Eric) Yeoh and David Rode

A telephone-delivered lifestyle intervention for colorectal cancer survivors 'CanChange': a pilot study

Objective: To investigate the feasibility and short-term effectiveness of a lifestyle intervention for colorectal cancer (CRC) survivors.\ud \ud Methods: CanChange was telephone-delivered to 20 CRC survivors by health coaches over 6 weeks supported by an interactive participant handbook. We assessed program feasibility (program retention and satisfaction) and health outcomes [CRC-specific symptoms (fatigue, nausea, diarrhoea), quality of life (QOL), and lifestyle variables (physical activity, dietary intake, alcohol intake, smoking, body mass index (BMI))] at baseline and post-intervention.\ud \ud Results: Post-intervention, 76% of participants rated the program as excellent, 100% rated the health coach as excellent, and 75% rated the handbook as excellent. In addition, 80% said that CanChange addressed their issues, 72% said that CanChange helped them deal more effectively with their problems, and 100% said that CanChange made them more motivated to make positive life changes. Finally, all participants said that they would recommend CanChange to other CRC survivors. From baseline to post-intervention we observed: non-significant improvements in all CRC-specific symptoms and QOL; a significant decrease in processed meat intake [median (interquartile range): 1.0 (3.0) vs 0.0 (1.0), p=0.01]; as well as non-significant improvements in sedentary behaviour, and the proportion of participants meeting the national guidelines for fruit and vegetable intake. We observed no change in smoking status, while the results for alcohol intake, physical activity, and BMI were variable.\ud \ud Conclusions: CanChange was a feasible and potentially effective lifestyle intervention to improve health outcomes for CRC survivors. A large randomised controlled trial will follow to test the longer-term effects of this approac

Is government action out-of-step with public opinion on tobacco control?: results of a New South Wales population survey

Objective: To assess community attitudes towards smoking bans, tobacco availability, promotion and product regulation, tobacco industry donations to political parties, and government spending on tobacco control activities. To compare public preferences on these issues with policies of the NSW and Commonwealth governments. Method: Anonymous, computer assisted telephone interviews of adults from randomly selected households in the NSW Electronic White Pages conducted in 2004. All subjects completed a core question set and subsequently, one of three sub-sets. Results: Overall 49.1% of eligible subjects consented. Data from two sub-samples containing 1,191 and 1,158 subjects are reported. Majority support existed for smoking bans in all six settings assessed: children's playgrounds (89%), sports stadia (77%), licensed premises (72%), outdoor dining (69%), beaches (55%) and motor vehicles carrying children (55%). Respondents nominated vastly higher tobacco control budgets than current levels of government expenditure. On a scale assessing support for tobacco control (maximum score = 13), the mean scores of both non-smokers (10.4) and smokers (8.0) were high. Of seven variables tested, only two: living with a smoker and personal smoking status were independent predictors of having a high pro-tobacco control score. Conclusion: There is strong community support for additional government regulation mandating smoke-free provision and other counter tobacco measures. Implications: Continued advocacy campaigns are required to align government tobacco control agenda more closely with public preferences