Discussion of costs and financial burden in clinical practice: A survey of medical oncologists in Australia.
Abstract Background: A diagnosis of cancer is associated with significant physical, psychological and financial burden. Including costs of cancer is an important component of shared decision making. Doctors bear a responsibility towards educating patients about the financial aspects of care. Multiple organisations have advocated for price transparency and implementing Informed Financial Consent in the clinic. However, few studies have evaluated the perspectives of oncologists on the current state of this discussion. Aims: The aim of this study is to determine the views and perspectives of medical oncologists regarding communication of costs and financial burden in patients with cancer. Methods: We conducted a [...]
Exploring the Integration of Environmental Impacts in the Cost Analysis of the Pilot MEL-SELF Trial of Patient-Led Melanoma Surveillance.
Abstract Aims: Human health is intrinsically linked with planetary health. But planetary resources are currently being degraded and this poses an existential threat to human health and the sustainability of our healthcare systems. The aims of this study were to (1) describe an approach to integrate environmental impacts in a cost analysis; and (2) demonstrate this approach by estimating select environmental impacts alongside traditional health system and other costs using the example of the pilot MEL-SELF randomised controlled trial of patient-led melanoma surveillance. Methods: Economic costs were calculated alongside a randomised trial using standard cost analysis methodology from a [...]
Developing an Australian Melanoma Clinical Outcomes Registry (MelCOR): a protocol paper.
Abstract Introduction: Australia has the highest incidence of melanoma in the world with variable care provided by a diverse range of clinicians. Clinical quality registries aim to identify these variations in care and provide anonymised, benchmarked feedback to clinicians and institutions to improve patient outcomes. The Australian Melanoma Clinical Outcomes Registry (MelCOR) aims to collect population-wide, clinical-level data for the early management of cutaneous melanoma and provide anonymised feedback to healthcare providers. Methods and analysis: A modified Delphi process will be undertaken to identify key clinical quality indicators for inclusion in the MelCOR pilot. MelCOR will prospectively collect data [...]
Estimating loss in capability wellbeing in the first year of the COVID-19 pandemic: a cross-sectional study of the general adult population in the UK, Australia and the Netherlands.
Abstract Objectives: To estimate capability wellbeing lost from the general adult populations in the UK, Australia and the Netherlands in the first year of the COVID-19 pandemic and the associated social restrictions, including lockdowns. Design: Cross-sectional with recalled timepoints. Setting: Online panels in the UK, Australia and the Netherlands conducted in February 2021 (data collected 26 January-2 March 2021). Participants: Representative general adult (≥ 18 years old) population samples in the UK (n = 1,017), Australia (n = 1,011) and the Netherlands (n = 1,017) MAIN OUTCOME MEASURE: Participants completed the ICECAP-A capability wellbeing measure in February 2021, and for two recalled timepoints [...]
Patient-reported outcome measures (PROMs) to guide clinical care: recommendations and challenges.
No abstract available. Read Full Paper
Barriers and facilitators to nurse-led advance care planning and palliative care practice change in primary healthcare: a qualitative study.
Abstract Primary care settings are ideal for initiating advance care planning (ACP) conversations and assessing palliative and supportive care needs. However, time constraints and a lack of confidence to sensitively and efficiently initiate such discussions are noted barriers. The Advance Project implemented a national multicomponent training package to support Australian general practice nurses (GPNs) to work with GPs to initiate ACP and palliative care conversations in their practice. This paper reports on semistructured interviews conducted with 20 GPNs to explore barriers and facilitators to implementing the Advance Project model. Participants identified a range of factors that affected implementation, including [...]
Melanoma and Quality of Life
Abstract Melanoma is a skin cancer affecting mostly people of fair skinned ancestry. Treatment of melanoma at each stage of disease is very different, and therefore results in distinct physical and subsequently psychological and quality of life (QoL) issues. Surgery is the main treatment for primary melanoma and nodal metastases. The advent of new drug therapy (immune therapy and targeted therapy) for more advanced disease has significantly improved survival outcomes, albeit with side effects of treatment and therefore changed the QoL issues experienced by survivors of disease. This chapter aims to summarise these issues. Read Full Paper [...]
Cost-Effectiveness of PET/CT Surveillance Schedules to Detect Distant Recurrence of Resected Stage III Melanoma
Abstract Objective: To estimate the cost-effectiveness of three surveillance imaging strategies using whole-body positron emission tomography (PET) with computed tomography (CT) (PET/CT) in a follow-up program for adults with resected stage III melanoma. Methods: An analytic decision model was constructed to estimate the costs and benefits of PET/CT surveillance imaging performed 3-monthly, 6-monthly, or 12-monthly compared with no surveillance imaging. Results: At 5 years, 3-monthly PET/CT surveillance imaging incurred a total cost of AUD 88,387 per patient, versus AUD 77,998 for 6-monthly, AUD 52,560 for 12-monthly imaging, and AUD 51,149 for no surveillance imaging. When compared with no surveillance imaging, 12-monthly PET/CT [...]
The Impact of Surveillance Imaging Frequency on the Detection of Distant Disease for Patients with Resected Stage III Melanoma
Abstract Background: It is not known whether there is a survival benefit associated with more frequent surveillance imaging in patients with resected American Joint Committee on Cancer stage III melanoma. Objective: The aim of this study was to investigate distant disease-free survival (DDFS), melanoma-specific survival (MSS), post distant recurrence MSS (dMSS), and overall survival for patients with resected stage III melanoma undergoing regular computed tomography (CT) or positron emission tomography (PET)/CT surveillance imaging at different intervals. Patients and methods: A closely followed longitudinal cohort of patients with resected stage IIIA-D disease treated at a tertiary referral center underwent 3- to 4-monthly, 6-monthly, [...]