Body weight management in overweight and obese breast cancer survivors

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of different body weight management approaches in breast cancer survivors who are overweight or obese

Incidence and prevalence of falls in adults living with an intellectual disability living in the community: A systematic review

Review question/objective: The objective of this review is to synthesize the best available evidence to determine the incidence and prevalence of falls in adults with intellectual disability living in the community

Systematic review and meta-analysis of patient reported outcomes for nurse-led models of survivorship care for adult cancer patients

Purpose: This systematic review aimed to determine the effectiveness of nurse-led cancer survivorship care, compared with existing models of care, on patient reported outcomes for cancer survivors. Methods: Randomised and non-randomised controlled trials and controlled before-after studies published in English between 1 January 2007 and 28 July 2017 were identified in bibliographic databases including Medline, Pubmed and PsychINFO. Included studies described nurse-led cancer care after treatment to adults (age ≥18 years) \u3c2 years post treatment completion. Risk of bias was assessed using Joanna Briggs Institute’s tools and meta-analysis was undertaken. Results: Twenty one publications were included describing 15 tumour-specific trials involving 3278 survivors of breast (n = 5), gynecological (n = 3), head and neck (n = 2), colorectal (n = 2), upper gastrointestinal (n = 2) and prostate (n = 1) cancers. Seven trials reported quality of life (QoL) using the EORTC QLQ-C30; participants receiving nurse-led care (4–6 months) had better cognitive (4 trials, 463 participants; mean difference [MD] = 4.04 [95% CI, 0.59–7.50]; p = 0.02) and social functioning (4 trials, 463 participants; MD = 3.06 [0.14–5.97]; p = 0.04) but worse appetite loss (3 trials, 354 participants; MD = 4.43 [0.08–8.78]; p = 0.05). After intervention completion, intervention participants had reduced fatigue (4 trials, 647 participants; MD = −4.45 [−7.93 to −0.97]; p = 0.01). Conclusion: This systematic review synthesised outcomes of models of nurse-led survivorship care and contributes a meta-analysis of patient QoL to survivorship evidence. This review was limited by the risk of bias in many included studies for blinding of treatment personnel and outcome assessors. Nurse-led care appears beneficial for cancer survivors for some QoL domains

Optimizing patient risk stratification for colonoscopy screening and surveillance of colorectal cancer: The role for linked data

No abstract available for this article

Care After Lymphoma (CALy) trial: A phase II pilot pragmatic randomised controlled trial of a nurse-led model of survivorship care

Purpose: Post-treatment follow-up for lymphoma potentially fails to address the supportive care needs of survivors. A nurse-led lymphoma survivorship model of care was developed and tested in a phase II pilot pragmatic randomised controlled trial (RCT). The intervention comprised three face-to-face appointments, delivery of tailored resources and an individualised survivorship care plan and treatment summary (SCPTS), shared with the general practitioner (GP). Method: Three months’ post-treatment completion, eligible lymphoma patients were randomised 1:1 to usual care (control) or usual care plus intervention. Survivorship unmet needs (Short-Form Survivor Unmet Needs Survey), distress (Depression Anxiety Stress Scale 21), adjustment to cancer (Mini-Mental Adjustment to Cancer scale) and self-empowerment (Patient Empowerment Scale) were assessed at baseline, three and six months. Univariate and multivariate analyses examined changes within and between groups at the three time points. A GP evaluation survey sought information on the perceived utility of the SCPTS. Results: Statistical significance was set at 0.05 (2-tailed). Although not statistically significant, by study completion, intervention participants (n = 30), reported less unmet needs (M = 21.41 vs M = 25.72, p = .506), less distress ((M = 13.03 vs M = 15.14, p = .558) and an increase in empowerment (M = 50.21 vs M = 47.21, p = .056) compared with control participants (n = 30). The SCPTS was rated good to very good by a majority of GPs (n = 13, 81%). Conclusions: The nurse-led lymphoma survivorship model of care may be a helpful intervention for lymphoma patients who had completed treatment. Survivors require individualised and tailored support and resources. A tailored SCPTS may promote survivor self-management and increase GP engagement

Test-retest reliability of the short-form survivor unmet needs survey

Objective: Reliable and valid needs assessment measures are important assessment tools in cancer survivorship care. A new 30-item short-form version of the Survivor Unmet Needs Survey (SF-SUNS) was developed and validated with cancer survivors, including hematology cancer survivors; however, test-retest reliability has not been established. The objective of this study was to assess the test-retest reliability of the SF-SUNS with a cohort of lymphoma survivors (n = 40). Methods: Test-retest reliability of the SF-SUNS was conducted at two time points: baseline (time 1) and 5 days later (time 2). Test-retest data were collected from lymphoma cancer survivors (n = 40) in a large tertiary cancer center in Western Australia. Intraclass correlation analyses compared data at time 1 (baseline) and time 2 (5 days later). Cronbach\u27s alpha analyses were performed to assess the internal consistency at both time points. Results: The majority (23/30, 77%) of items achieved test-retest reliability scores 0.45-0.74 (fair to good). A high degree of overall internal consistency was demonstrated (time 1 = 0.92, time 2 = 0.95), with scores 0.65-0.94 across subscales for both time points. Conclusions: Mixed test-retest reliability of the SF-SUNS was established. Our results indicate the SF-SUNS is responsive to the changing needs of lymphoma cancer survivors. Routine use of cancer survivorship specific needs-based assessments is required in oncology care today. Nurses are well placed to administer these assessments and provide tailored information and resources. Further assessment of test-retest reliability in hematology and other cancer cohorts is warranted

Incidence and prevalence of falls in adults with intellectual disability living in the community: a systematic review.

OBJECTIVE: The objective of the review was too synthesize the best available evidence on the incidence and prevalence of falls among adults with intellectual disability (ID). INTRODUCTION: Falls among adults with ID frequently cause physical injury and may negatively impact on their quality of life. Studies investigating falls among people with ID have used differing methods and populations, making it difficult to determine the scope and extent of this problem. INCLUSION CRITERIA: This review considered all studies that included adults with ID aged 18 years and over and which reported percentage/numbers of individuals who fell, and the total number of falls and injurious falls sustained from a fall. Studies were included if they were conducted within community or residential settings. Studies that were conducted in hospitals were excluded. Cohort studies, case-control and cross-sectional studies were included. Studies that used an experimental design, both randomized controlled and quasi experimental design, were also included. METHODS: A three-step search strategy was undertaken for published and unpublished literature in English from 1990 to 2017. An initial search of MEDLINE and CINAHL was undertaken before a more extensive search was conducted using keywords and index terms across 11 electronic databases. Two independent reviewers assessed the methodological quality of the included studies using the Joanna Briggs Institute standardized critical appraisal instrument for prevalence studies (Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data).Data was extracted using the Joanna Briggs Institute's standardized extraction tool. Data that directly reported or could be used to calculate the incidence and prevalence of falls were extracted. Quantitative data for the number (proportion) of people who fell were pooled in statistical meta-analysis using STATA version 14 (Stata Corp LLC, Texas, USA). Data measuring incidence of falls (rate of falls for the duration of the study) and incidence of injurious falls (rate of falls resulting in one or more injuries for the duration of the study) could not be pooled in meta-analysis, hence results have been presented in a narrative form including tables. Standard GRADE (Grading of Recommendations Assessment, Development and Evaluation) evidence assessment of outcomes is also reported. RESULTS: Nine studies were eligible for inclusion in this review. Eight articles were observational cohort studies which reported on the incidence/prevalence of falls as outcome measures, and one article was a quasi-experimental study design. Overall the methodological quality of the included studies was considered moderate. The pooled proportion of people with ID who fell (four studies, 854 participants) was 39% (95% CI [0.35%-0.43%], very low GRADE evidence). The rate of falls (eight studies, 782 participants) ranged from 0.54 to 6.29 per person year (very low GRADE evidence). The rate of injurious falls (two studies, 352 participants) ranged from 0.33 to 0.68 per person year (very low GRADE evidence). CONCLUSIONS: Synthesized findings demonstrate that people with ID, who live in community or residential settings, may fall more frequently, and at a younger age, compared to general community populations. Studies should take a consistent approach to measuring and reporting falls outcomes. Further research is recommended to identify the impact of falls on health related outcomes for people with ID and subsequently evaluate falls interventions for their efficacy

Health economics of targeted intraoperative radiotherapy (TARGIT-IORT) for early breast cancer: a cost-effectiveness analysis in the United Kingdom

Objective: The clinical effectiveness of targeted intraoperative radiotherapy (TARGIT-IORT) has been confirmed in the randomised TARGIT-A (targeted intraoperative radiotherapy-alone) trial to be similar to a several weeks’ course of whole-breast external-beam radiation therapy (EBRT) in patients with early breast cancer. This study aims to determine the cost effectiveness of TARGIT-IORT to inform policy decisions about its wider implementation. Setting TARGIT-A randomised clinical trial (ISRCTN34086741) which compared TARGIT with traditional EBRT and found similar breast cancer control, particularly when TARGIT was given simultaneously with lumpectomy. Methods: Cost-utility analysis using decision analytic modelling by a Markov model. A cost-effectiveness Markov model was developed using TreeAge Pro V.2015. The decision analytic model compared two strategies of radiotherapy for breast cancer in a hypothetical cohort of patients with early breast cancer based on the published health state transition probability data from the TARGIT-A trial. Analysis was performed for UK setting and National Health Service (NHS) healthcare payer’s perspective using NHS cost data and treatment outcomes were simulated for both strategies for a time horizon of 10 years. Model health state utilities were drawn from the published literature. Future costs and effects were discounted at the rate of 3.5%. To address uncertainty, one-way and probabilistic sensitivity analyses were performed. Main outcome measures: Quality-adjusted life-years (QALYs). Results: In the base case analysis, TARGIT-IORT was a highly cost-effective strategy yielding health gain at a lower cost than its comparator EBRT. Discounted TARGITIORT and EBRT costs for the time horizon of 10 years were £12 455 and £13 280, respectively. TARGIT-IORT gained 0.18 incremental QALY as the discounted QALYs gained by TARGIT-IORT were 8.15 and by EBRT were 7.97 showing TARGIT-IORT as a dominant strategy over EBRT. Model outputs were robust to one-way and probabilistic sensitivity analyses. Conclusions: TARGIT-IORT is a dominant strategy over EBRT, being less costly and producing higher QALY gain

The relationship between destination proximity, destination mix and physical activity behaviors

Background. The presence and mix of destinations is an important aspect of the built environment that may encourage or discourage physical activity. This study examined the association between the proximity and mix of neighbourhood destinations and physical activity. Methods. Secondary analysis was undertaken on physical activity data from Western Australian adults (n=1394). These data were linked with geographical information systems (GIS) data including the presence and the mix of destinations located within 400 and 1500 m from respondents' homes. Associations with walking for transport and recreation and vigorous physical activity were examined. Results. Access to post boxes, bus stops, convenience stores, newsagencies, shopping malls, and transit stations within 400 m (OR 1.63–5.00) and schools, transit stations, newsagencies, convenience stores and shopping malls within 1500 m (OR 1.75–2.38) was associated with participation in regular transport-related walking. A dose–response relationship between the mix of destinations and walking for transport was also found. Each additional destination within 400 and 1500 m resulted in an additional 12 and 11 min/fortnight spent walking for transport, respectively. Conclusion. Proximity and mix of destinations appears strongly associated with walking for transport, but not walking for recreation or vigorous activity. Increasing the diversity of destinations may contribute to adults doing more transport-related walking and achieving recommended levels of physical activity

Patient preferences for adjuvant radiotherapy in early breast cancer are strongly influenced by treatment received through random assignment

Objective: TARGIT‐A randomised women with early breast cancer to receive external beam radiotherapy (EBRT) or intraoperative radiotherapy (TARGIT‐IORT). This study aimed to identify what extra risk of recurrence patients would accept for per‐ ceived benefits and risks of different radiotherapy treatments. Methods: Patient preferences were determined by self‐rated trade‐off question‐ naires in two studies: Stage (1) 209 TARGIT‐A participants (TARGIT‐IORT n = 108, EBRT n = 101); Stage (2) 123 non‐trial patients yet to receive radiotherapy (pre‐treat‐ ment group), with 85 also surveyed post‐radiotherapy. Patients traded‐off risks of local recurrence in preference selection between TARGIT‐IORT and EBRT. Results: TARGIT‐IORT patients were more accepting of IORT than EBRT patients with 60% accepting the highest increased risk presented (4%–6%) compared to 12% of EBRT patients, and 2% not accepting IORT at all compared to 43% of EBRT pa‐ tients. Pre‐treatment patients were more accepting of IORT than post‐treatment pa‐ tients with 23% accepting the highest increased risk presented compared to 15% of post‐treatment patients, and 15% not accepting IORT at all compared to 41% of pre‐ treatment patients. Conclusions: Breast cancer patients yet to receive radiotherapy accept a higher recurrence risk than the actual risk found in TARGIT‐A. Measured patient preferences are highly influenced by experience of treatment received. This finding challenges the validity of post‐treatment preference studies