David Currow is Professor of Palliative Medicine at IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney. He is Associate Director (Research) for the Wolfson Institute, Hull York Medical School, University of Hull. Research track record includes: better understanding and treating chronic breathlessness; phase II, III and IV clinical trials; population-based planning for palliative care; and codifying the evidence base underpinning palliative care.
He is the principal investigator for the Palliative Care Clinical Studies Collaborative (PaCCSC) which has randomised more than 1800 palliative care patients across 23 sites to adequately powered and rigorously designed phase III symptom control studies. He is a foundation partner in the Australian Palliative Care Outcomes Collaborative (PCOC), an initiative to improve systematically clinical outcomes in palliative care. Competitive funding has included the National Health and Medical Research Council (NHMRC) and the National Institutes of Health (NIH).
David has published more than 460 peer-reviewed articles, editorials and books. He is an editor on the 5th edition of the Oxford Textbook of Palliative Medicine. He is senior associate editor of Journal of Palliative Medicine and on the editorial boards of Journal of Pain and Symptom Management, BMJ Supportive and Palliative Care and the Journal of Oncology Practice. David is a former president of Palliative Care Australia and the Clinical Oncological Society of Australia.
Awarded, 2016 British Medical Association (BMA) Medical Textbook of the year. ‘Oxford Textbook of Palliative Medicine.’ (5th Edition). Nathan Cherny, Stein Kaasa, Russell Portenoy, Marie Fallon, David Currow (Editors) Oxford University Press. (March, 2015)
Tom Reeve Award for Outstanding Contribution to Cancer Care from the Clinical Oncological Society of Australia 2015
For a significant contribution to cancer care through research and clinical leadership
American Academy of Hospice and Palliative Care (AAHPM) 2015 Award for Excellence in Scientific Research in Palliative Care. The Award recognizes meaningful, exemplary research contributions to the field of hospice and palliative care. February, 2015 at the annual Academy meeting.
Palliative Care Council of South Australia Lifetime Achievement Award. 2013. The Lifetime Achievement Award recognizes excellence in mentorship, support, passion for their field of work, commitment to working in partnerships, respect for others, teamwork, persistence and pioneering developments/
University of Newcastle 2012 Alumni Medal (joint winner) Awarded annually to a graduate with an outstanding track record of professional excellence in leadership, knowledge and professional practice.
Royal College of Physicians and Surgeons of Canada, 2013 Balfour M. Mount Visiting Professorship in Palliative Medicine
National winner 2012 - Team Award – Postgraduate education Australian Learning and Teaching Centre
Flinders Offshore Palliative Care Program. In conjunction with the Lien Foundation (Singapore) and the Asia Pacific Hospice and Palliative Care Network, this was a program to provide Graduate Certificate post-graduate qualifications for health professionals in palliative care for resource challenged countries in South East Asia. More than 100 students have graduated to date.
Can supervise: YES
David is the Principal Investigator on the Australian government funded Palliative Care Clinical Studies Collaborative – the world’s largest clinical trials group in palliative care. He is also a co-founder of the Australian Palliative Care Outcomes Collaborative, the world’s largest point-of-care quality improvement program in palliative care.
- Palliative care
© Oxford University Press, 2012. All rights reserved. Respiratory symptoms such as breathlessness and cough are common in patients with advancing and incurable disease. For example, cancer, chronic cardiac and pulmonary disease, progressive neuromuscular disorders, and degenerative disorders all give rise to varying degrees of respiratory distress which adversely affects the patient's quality of life. In recent years, there has been significant growth into the palliation of respiratory symptoms leading to practical ways of giving relief in hospices, hospitals, and at home. The second edition of this title in the Supportive Care series includes non-malignant respiratory diseases such as tuberculosis in AIDS patients, cystic fibrosis and ventilator-dependent patients, and focuses on aetiology and diagnosis and management, emphasizing symptoms, quality of life, and psychosocial support. The underlying theme of the book is the application of modern research-based knowledge, in a humane way, for patients with advancing disease.
© Oxford University Press 2005. All rights reserved. This book provides a practical, evidence-based overview of the supportive care of patients with urological failure, focusing on chronic symptoms such as chronic prostatitis. It begins by looking at quality of life measurements, self-help strategies, the role of the interdisciplinary team, and psychological and social support. It then moves on to clinical chapters which cover issues such as patients who present with hematuria, urinary retention, urinary incontinence, neurological disease affecting the urinary tract, chronic prostatitis, and infertility; ending with a chapter on supportive care for the urology patient and family in the future. The book places a special emphasis on symptomatic interventions, particularly in the setting where the course of the illness cannot be modified.
Baddeley, E, Bravington, A, Johnson, M, Currow, DC, Murtagh, FE, Boland, E, Obita, G, Nelson, A, Seddon, K, Oliver, A, Noble, S & Boland, J 2020, 'Development of a core outcome set to use in the research and assessment of malignant bowel obstruction: protocol for the RAMBO study.', BMJ open, vol. 10, no. 6, pp. e039154-e039154.View/Download from: Publisher's site
INTRODUCTION:Studies regarding the management of malignant bowel obstruction (MBO) report conflicting findings. This is partly due to different outcome measures being used to evaluate severity of MBO and the response to treatments. Furthermore, current outcome measures focus mainly on measurable physiological parameters which may not correlate strongly with patient-defined quality of life. The development of core outcome sets allows a consistent approach to evaluating clinical conditions taking into consideration patient, healthcare professional and researcher viewpoints. It follows an internationally recognised standard methodology. We present a protocol for the development of a core outcome set for Research and Assessment of MBO (RAMBO). METHODS:RAMBO is a multicentre study, comprising of four phases: a systematic review to examine current scope of outcome measures associated with MBO (phase I). Interviews with patients, companions and healthcare professionals will explore priorities and preferences for care and outcomes (phase II). An expert panel meeting will collate the findings into a set of outcomes (phase III), refined by consensus through a Delphi survey with key stakeholders (phase IV). The final set of outcomes will be ratified at a consensus meeting. Each step will actively include patient partners. Thematic analysis and descriptive statistics will be used to analyse qualitative and quantitative data, respectively. ETHICS AND DISSEMINATION:Ethical approval was obtained (Wales REC 5, REF: 19/LO/1876). Study participants and relevant stakeholders will be updated with newsletters and a lay summary at the end of the study. Abstracts will be submitted to national and international conferences, result papers will be submitted to peer-reviewed, open access journals. TRIAL AND PROSPERO REGISTRATION NUMBERS:Core Outcome Measures in Effectiveness Trials (1402); Systematic Literature Review (CRD42019150648); Rapid Review (CRD42020176393).
Bajwah, S, Wilcock, A, Towers, R, Costantini, M, Bausewein, C, Simon, ST, Bendstrup, E, Prentice, W, Johnson, MJ, Currow, DC, Kreuter, M, Wells, AU, Birring, SS, Edmonds, P & Higginson, IJ 2020, 'Managing the supportive care needs of those affected by COVID-19.', The European respiratory journal, vol. 55, no. 4.View/Download from: Publisher's site
Clark, K & Currow, DC 2020, 'Response to Davies A, Leach C, Caponero R, Dickman A, Fuchs D, Paice J, Emmanuel A (2020) MASCC recommendations on the management of constipation in patients with advanced cancer. Support Care Cancer 28:23.', Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, vol. 28, no. 5, pp. 2041-2042.View/Download from: Publisher's site
Cornelius, T, Schwartz, JE, Balte, P, Bhatt, SP, Cassano, PA, Currow, D, Jacobs, DR, Johnson, M, Kalhan, R, Kronmal, R, Loehr, L, O'Connor, GT, Smith, B, White, WB, Yende, S & Oelsner, EC 2020, 'A Dyadic Growth Modeling Approach to Examine Associations Between Weight Gain and Lung Function Decline: The NHLBI Pooled Cohorts Study.', American journal of epidemiology.View/Download from: Publisher's site
The relationship between body weight and lung function is complex. Using a dyadic multilevel linear modeling approach, treating body mass index (BMI) and lung function as paired, within-person outcomes, we test the hypothesis that individuals with more rapid increase in BMI exhibit more rapid decline in lung function: forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and their ratio (FEV1/FVC). Models included random intercepts and slopes and were adjusted for socio-demographic and smoking-related factors. A sample of 9,115 adults with paired measurements of BMI and lung function at ≥3 visits were selected from a pooled set of 5 US population-based cohorts (1983 - 2018; mean age at baseline, 46 years; median follow-up, 19 years). At age 46, average annual rates-of-change in BMI, FEV1, FVC, and FEV1/FVC were 0.22 kg/m2/year, -25.50 mL/year, -21.99 mL/year, and -0.24 percent/year, respectively. Individuals with steeper BMI increases had faster declines in FEV1 (r=-0.16) and FVC (r=-0.26), and slower declines in FEV1/FVC (r=0.11) (all P<0.0001). Results were similar in subgroup analyses. Residual correlations were negative (P<.0001), suggesting additional interdependence between BMI and lung function. Results show that greater rates of weight gain are associated with greater rates of lung function loss.
Creighton, N, Torvonen, HE, Zhao, GW & Currow, DC 2020, 'Capture of systemic anticancer medicines in Pharmaceutical Benefits Scheme (PBS) data likely higher than previously reported - Authors' reply.', Public health research & practice, vol. 30, no. 2.View/Download from: Publisher's site
Currow, D, Louw, S & McCloud, P 2020, 'Regular, sustained-release morphine for chronic breathlessness: a multicentre, double-blind, randomised, placebo-controlled trial (vol 75, pg 50, 2020)', THORAX, vol. 75, no. 7, pp. E5-E5.View/Download from: Publisher's site
Currow, DC, Chang, S, Grande, ED, Ferreira, DH, Kochovska, S, Kinchin, I, Johnson, MJ & Ekstrom, M 2020, 'Quality of life changes with duration of chronic breathlessness: a random sample of community-dwelling people', Journal of Pain and Symptom Management.View/Download from: Publisher's site
Currow, DC, Chang, S, Reddel, HK, Kochovska, S, Ferreira, D, Kinchin, I, Johnson, M & Ekstrom, M 2020, 'Breathlessness, Anxiety, Depression, and Function-The BAD-F Study: A Cross-Sectional and Population Prevalence Study in Adults.', Journal of Pain and Symptom Management, vol. 59, no. 2, pp. 197-205.View/Download from: Publisher's site
CONTEXT:Breathlessness is associated with depression, but its relationship to anxiety or impaired function is less clear. OBJECTIVES:This study evaluated associations between chronic breathlessness and anxiety, depression, and functional status in the general population. METHODS:This cross-sectional study of consenting adults (18 years and older) used an online survey. Quota sampling (n = 3000) was used reflecting the 2016 national census for sex, age, and place of residence. Other data included Four-Item Patient Health Questionnaire for depression and anxiety, the modified Medical Research Council (mMRC) Breathlessness Scale, and the Australia-modified Karnofsky Performance Scale. Multinomial logistic regression assessed predictors. RESULTS:About 2977 respondents had all relevant scores (female 51.2%; median age 45.0 [range 18-92]). Prevalence of breathlessness (mMRC ≥2) was 2.4%, anxiety 6.0%, depression 2.7%, coexisting anxiety/depression 6.1%, and poorer functional status (Australia-modified Karnofsky Performance Scale ≤60) 1.6%. In multinomial regression, depression, anxiety, and coexisting anxiety/depression were predicted by younger age, longer duration of breathlessness, and poorer functional status. The highest proportions of people with breathlessness were found in the coexisting anxiety/depression group (10.6%) and depression only group (8.8%). Poorest function was in the coexisting anxiety/depression group with 11.6%. The relationship between poorer functional status and coexisting anxiety/depression was significant (odds ratio 0.90; 95% CI 0.89, 0.92). Adjusted odds ratio for breathlessness and depression only was 3.0 (95% CI 1.2, 7.8). CONCLUSION:Clinically important breathlessness (mMRC ≥2) was associated with depression, anxiety, and coexisting anxiety/depression. Poorer function that is associated with psychological morbidity in the general population requires further research.
Currow, DC, Clark, K, Louw, S, Fazekas, B, Greene, A & Sanderson, CR 2020, 'A randomized, double-blind, crossover, dose ranging study to determine the optimal dose of oral opioid to treat breakthrough pain for patients with advanced cancer already established on regular opioids.', European journal of pain (London, England), vol. 24, no. 5, pp. 983-991.View/Download from: Publisher's site
BACKGROUND:Pain in people with advanced cancer is prevalent. When a stable dose of opioids is established, people still experience episodic breakthrough pain for which dosing of an immediate release opioid is usually a proportion of the total daily dose. METHODS:This multi-site, double blind, randomized trial tested three dose proportions (1/6, 1/8, 1/12 of total daily dose) in two blocks, each block with three dose proportions in random order (6 numbered bottles in total). When participants required opioid breakthrough doses and it was their first breakthrough dose for that study day, they took the next numbered bottle rather than their usual breakthrough dose. (Subsequent doses on that day reverted to their usual dose.) RESULTS: Eighty-five people were randomized in this study of whom 81 took at least one dose and 73 (90%) took at least block one (one of each dose proportion). No dose was found to be optimal at 30 min with approximately one-third of participants showing maximal reduction with each dose proportion. Median time to pain relief was 120 min. There were no differences in harms: drowsiness, confusion, nausea or vomiting at 30, 60 or 120 min. CONCLUSIONS:This adequately powered study did not show any difference with three dose proportions for reduction in pain intensity, time to pain relief, pain control on the subsequent day nor any difference in harms. From first principles, this suggests 1/12 the 24 hourly dose should be used as the lowest dose that delivers benefit. Future studies should include a placebo arm. SIGNIFICANCE:Despite the widespread use of immediate release morphine solution for breakthrough cancer pain, the ideal dose derived from background dose has not been determined in an adequately powered randomized, double-blind, crossover, dose ranging study. This study tested three dose levels in people with advanced cancer. Given no differences in time to onset, level of analgesia achieved, nor side effects, the lowest dose tested (1/12th of...
Currow, DC, Johnson, MJ, Pollack, A, Ferreira, DH, Kochovska, S, Ekstrom, M & Harrison, C 2020, 'Breathlessness and opioid prescribing in COPD in general practice: a cross-sectional, observational study.', ERJ open research, vol. 6, no. 2.View/Download from: Publisher's site
Chronic breathlessness is a disabling syndrome, prevalent in people with advanced chronic obstructive pulmonary disease (COPD). Regular, low-dose, oral sustained-release morphine is approved in Australia to reduce symptomatic chronic breathlessness. We aimed to determine the current prescribing patterns of opioids for chronic breathlessness in COPD in Australian general practice and to define any associated patient and practitioner characteristics. Five years (2011 to 2016) of the Bettering the Evaluation and Care of Health database, an Australian national, continual, cross-sectional study of clinical care in general practice were used. The database included 100 consecutive clinical encounters from almost 1000 general practitioners annually (n=488 100 encounters). Descriptive analyses with subsequent regression models were generated. Breathlessness as a patient-defined reason for encounter was identified in 621 of 4522 encounters where COPD was managed. Opioids were prescribed in 309 of 4522 encounters where COPD was managed (6.8%; (95% CI) 6.1-7.6), of which only 17 were prescribed for breathlessness, and the rest for other conditions almost entirely related to pain. Patient age (45-64 years versus age 80+ years, OR 1.68; 1.19-2.36), Commonwealth Concession Card holders (OR 1.70; 1.23-2.34) and socioeconomic disadvantage (OR 1.30; 1.01-1.68) were associated with increased likelihood of opioid prescription at COPD encounters. The rate of opioid prescriptions rose over the 5 years of study. In primary care encounters for COPD, opioids were prescribed in 6.8% of cases, but almost never for breathlessness. These data create a baseline against which to compare changes in prescribing as the treatment of chronic breathlessness evolves.
Currow, DC, Kochovska, S, Ferreira, D & Johnson, M 2020, 'Morphine for the symptomatic reduction of chronic breathlessness: the case for controlled release', Current opinion in supportive and palliative care, vol. 14, no. 3, pp. 177-181.View/Download from: Publisher's site
PURPOSE OF REVIEW: Clinicians who seek to reduce the symptomatic burden of chronic breathlessness by initiating regular low-dose morphine has the choice of immediate or sustained-release formulations - which will be better for this often frail population, and which has the more robust evidence to inform its prescription? Both formulations can be used. RECENT FINDINGS: For chronic breathlessness, three factors consistently favour the use of regular, low-dose, sustained-release morphine over immediate-release formulations: SUMMARY: As the evidence base expands for the symptomatic reduction of chronic breathlessness, pharmacological interventions will play a part. Using the best available evidence underpins patient-centred approaches that seek to predictably maximize the net effect.As such, the weight of evidence in patient-centred clinical care favours the use of regular, low-dose sustained-release morphine for the symptomatic reduction of chronic breathlessness.
Easpaig, BNG, Tran, Y, Bierbaum, M, Arnolda, G, Delaney, GP, Liauw, W, Ward, RL, Olver, I, Currow, D, Girgis, A, Durcinoska, I & Braithwaite, J 2020, 'What are the attitudes of health professionals regarding patient reported outcome measures (PROMs) in oncology practice? A mixed-method synthesis of the qualitative evidence', BMC HEALTH SERVICES RESEARCH, vol. 20, no. 1.View/Download from: Publisher's site
Ekström, M, Johnson, MJ, Huang, C & Currow, DC 2020, 'Minimal clinically important differences in average, best, worst and current intensity and unpleasantness of chronic breathlessness', European Respiratory Journal, vol. 56, no. 2.View/Download from: Publisher's site
Copyright © ERS 2020 Background: Chronic breathlessness has devastating consequences. The minimal clinically important difference (MCID) for current intensity has been estimated as 9 mm on a 100-mm visual analogue scale (VAS). We aimed to determine MCIDs for commonly used dimensions and recall periods: the current unpleasantness and current, average, best and worst intensity of the past 24 h for chronic breathlessness. Methods: This was a secondary analysis of a randomised controlled trial of morphine versus placebo over 7 days in people with chronic breathlessness from severe disease. The breathlessness scores were self-reported using a diary each evening on 100-mm VAS. The MCID for improvement in each score was estimated using anchor-based and distribution-based methods. Results: 283 participants (mean age 74.2 years; 63% male; 58% COPD; 87.0% modified Medical Research Council (mMRC) score 3-4) were included. Anchor-based MCIDs for breathlessness scores ranged from −13.9 mm to −9.5 mm. The MCIDs were similar when using different anchors and across all participants, and participants with more severe breathlessness (mMRC 3-4). Distribution-based effect sizes were classed as small (−4.7−6.3 mm), moderate (−9.4−12.5 mm) and large (−15.0−20.0 mm) effect. Sample sizes for trials using the different scores were proposed. MCIDs of absolute change were more stable than using relative change from baseline. Conclusion: An improvement of ∼10 mm on a 100-mm VAS is likely to be clinically meaningful across commonly used measures of chronic breathlessness (current intensity, unpleasantness, and average, best and worst intensity over the past 24 h) to evaluate clinical benefit and effects in therapeutic trials.
Ekstrom, M, Palmqvist, S, Currow, DC, Sjøgren, P, Kurita, GP, Jakobsen, G, Kaasa, S & Hjermstad, M 2020, 'Mild to Moderate Cognitive Impairment Does Not Affect the Ability to Self-Report Important Symptoms in Patients With Cancer: A Prospective Longitudinal Multinational Study (EPCCS).', Journal of pain and symptom management, vol. 60, no. 2, pp. 346-354.e2.View/Download from: Publisher's site
CONTEXT:Patients with advanced cancer commonly suffer from both distressing symptoms and cognitive impairment, but the effect of cognitive impairment on the reliability and validity of symptom self-report is unknown. OBJECTIVES:To evaluate the reliability and validity of symptom self-report in cancer outpatients with and without mild to moderate cognitive impairment. METHODS:This was an analysis of the longitudinal European Palliative Care Cancer Symptom study of adults with incurable cancer in specialized palliative care (30 centers across 12 countries). Patients who could not comply with the study because of severe cognitive impairment were excluded. Cognitive status on the Mini-Mental State Examination short version and nine symptoms (pain, tiredness, drowsiness, nausea, appetite, breathlessness, depression, anxiety, and well-being) using the revised Edmonton Symptom Assessment System were self-reported at baseline and one-month follow-up. Reliability was analyzed using intraclass correlation coefficients and validity using regression of each symptom with health-related quality of life (HrQoL) measured with European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 for Palliative Care. RESULTS:A total of 1047 patients were included: mean age of 62.9 years; 54.4% women; main cancer types were of digestive organs (26.6%), breast (21.6%), and lungs (21.2%). Cognitive impairment was present in 181 (17.3%) at baseline and associated with worse self-reported tiredness, drowsiness, appetite, and depression. Reliability (intraclass correlation coefficient) and validity (associations with HrQoL) were similar between people with/without cognitive impairment across the nine symptoms, except breathlessness, which showed a weaker relation to HrQoL in patients with cognitive impairment. Findings were robust in sensitivity analyses and after controlling for potential confounders. CONCLUSION:In advanced cancer, self-report of nine major s...
Fitzadam, S, Lin, E, Creighton, N & Currow, DC 2020, 'Lung, breast, and bowel cancer treatment for Aboriginal people in New South Wales: a population-based cohort study.', Internal medicine journal.View/Download from: Publisher's site
BACKGROUND:Aboriginal Australians have higher cancer mortality than non-Aboriginal Australians. Lower rates of cancer treatment among Aboriginal people can contribute to this. AIMS:To investigate demographic, clinical and access factors associated with lung, breast, and bowel cancer treatment for Aboriginal people compared with non-Aboriginal people in New South Wales, Australia. METHODS:Population-based cohort study using linked routinely-collected datasets, including all diagnoses of primary lung, breast, or bowel cancer from January 2009-June 2012. Treatment (surgery, radiotherapy, or chemotherapy) within six months from diagnosis was measured. Access was measured using minimum distance to radiotherapy or hospital with a cancer-specific multidisciplinary team, visit to a specialist, and possession of private health insurance. Logistic regression modelling was employed. RESULTS:There were 587 Aboriginal and 34 015 non-Aboriginal people diagnosed with cancer. For lung cancer, significantly fewer Aboriginal than non-Aboriginal people received surgery (odds ratio (OR) 0.46 (95% confidence interval (CI) 0.29-0.73, p < 0.001)) or any treatment (surgery, chemotherapy or radiotherapy; OR 0.64, 95% CI 0.47-0.88, p = 0.006) after adjusting for sex, age, disease extent and comorbidities. They were less likely to have an attendance with a surgeon (27.0%, 62/230 v 33.3%, 2865/8597, p = 0.04) compared with non-Aboriginal people. There were no significant differences in cancer treatment for Aboriginal people compared with non-Aboriginal people for breast or bowel cancers after adjusting for patient sex, age, disease extent and comorbidities. CONCLUSION:Aboriginal people were significantly less likely to receive surgery for lung cancer than non-Aboriginal people and had fewer attendances with a surgeon, suggesting a need to strengthen referral pathways. This article is protected by copyright. All rights reserved.
Higginson, IJ, Wilcock, A, Johnson, MJ, Bajwah, S, Lovell, N, Yi, D, Hart, SP, Crosby, V, Poad, H, Currow, D, Best, E, Brown, S & BETTER-B Feasibility Trial Group 2020, 'Randomised, double-blind, multicentre, mixed-methods, dose-escalation feasibility trial of mirtazapine for better treatment of severe breathlessness in advanced lung disease (BETTER-B feasibility).', Thorax, vol. 75, no. 2, pp. 176-179.View/Download from: Publisher's site
New treatments are required for severe breathlessness in advanced disease. We conducted a randomised feasibility trial of mirtazapine over 28 days in adults with a modified medical research council breathlessness scale score ≥3. Sixty-four patients were randomised (409 screened), achieving our primary feasibility endpoint of recruitment. Most patients had COPD or interstitial lung disease; 52 (81%) completed the trial. There were no differences between placebo and mirtazapine in tolerability or safety, and blinding was maintained. Worst breathlessness ratings at day 28 (primary clinical activity endpoint) were, 7.1 (SD 2.3, placebo) and 6.3 (SD 1.8, mirtazapine). A phase III trial of mirtazapine is indicated. Trial registration: ISRCTN 32236160; European Clinical Trials Database (EudraCT no: 2015-004064-11).
Huang, C, Kochovska, S & Currow, DC 2020, 'Letter in Response to Grobler AC, Lee K. Intention-To-Treat Analyses for Randomized Controlled Trials in Hospice/Palliative Care Enhanced by Principled Methods to Handle Missing Data.', Journal of pain and symptom management, vol. 60, no. 4, pp. e30-e31.View/Download from: Publisher's site
Janssen, DJA, Ekström, M, Currow, DC, Johnson, MJ, Maddocks, M, Simonds, AK, Tonia, T & Marsaa, K 2020, 'COVID-19: guidance on palliative care from a European Respiratory Society international task force.', The European respiratory journal, vol. 56, no. 3.View/Download from: Publisher's site
BACKGROUND:Many people are dying from coronavirus disease 2019 (COVID-19), but consensus guidance on palliative care in COVID-19 is lacking. This new life-threatening disease has put healthcare systems under pressure, with the increased need of palliative care provided to many patients by clinicians who have limited prior experience in this field. Therefore, we aimed to make consensus recommendations for palliative care for patients with COVID-19 using the Convergence of Opinion on Recommendations and Evidence (CORE) process. METHODS:We invited 90 international experts to complete an online survey including stating their agreement, or not, with 14 potential recommendations. At least 70% agreement on directionality was needed to provide consensus recommendations. If consensus was not achieved on the first round, a second round was conducted. RESULTS:68 (75.6%) experts responded in the first round. Most participants were experts in palliative care, respiratory medicine or critical care medicine. In the first round, consensus was achieved on 13 recommendations based upon indirect evidence and clinical experience. In the second round, 58 (85.3%) out of 68 of the first-round experts responded, resulting in consensus for the 14th recommendation. CONCLUSION:This multi-national task force provides consensus recommendations for palliative care for patients with COVID-19 concerning: advance care planning; (pharmacological) palliative treatment of breathlessness; clinician-patient communication; remote clinician-family communication; palliative care involvement in patients with serious COVID-19; spiritual care; psychosocial care; and bereavement care. Future studies are needed to generate empirical evidence for these recommendations.
Chronic breathlessness is a disabling and distressing condition for which there is a growing evidence base for a range of interventions. Non-pharmacological interventions are the mainstay of management and should be optimised prior to use of opioid medication. Opioids are being implemented variably in practice for chronic breathlessness. This narrative review summarises the evidence defining current opioids for breathlessness best practice and identifies remaining research gaps. There is level 1a evidence to support the use of opioids for breathlessness. The best evidence is for 10-30 mg daily de novo low-dose oral sustained-release morphine in opioid-naïve patients. This should be considered the current standard of care following independent, regulatory scrutiny by one of the world's therapeutics regulatory bodies. Optimal benefits are seen in steady state; however, there are few published data about longer term benefits or harms. Morphine-related adverse events are common but mostly mild and self-limiting on withdrawal of drug. Early and meticulous management of constipation, nausea and vomiting is needed particularly in the first week of administration. Serious adverse events are no more common than placebo in clinical studies. Observational studies in severe chronic lung disease do not show excess mortality or hospital admission in those taking opioids. We have no long-term data on immune or endocrine function. There are promising data regarding prophylaxis for exertion-related breathlessness, but given the risks associated with transmucosal fentanyl, caution is needed with regard to clinical use pending longer term, robust safety data.
Johnston, A, Creighton, N, Parkinson, J, Koh, E-S, Wheeler, H, Hovey, E, Rodriguez, M & Currow, DC 2020, 'Ongoing improvements in postoperative survival of glioblastoma in the temozolomide era: a population-based data linkage study.', Neuro-oncology practice, vol. 7, no. 1, pp. 22-30.View/Download from: Publisher's site
Background:Translating outcomes achieved by clinical trials into routine care is crucial to improving outcomes of glioblastoma (GBM). This study examines the extent to which an advance in treatment for GBM has translated into meaningful, population-level survival benefits in New South Wales (NSW), Australia. Methods:This retrospective cohort study used linked population-based cancer registry, admitted patient, and mortality datasets. The cohort (n = 2604) included NSW residents aged ≥18 years with a histologically confirmed GBM and a surgical resection between July 2001 and December 2012. The study outcome was all-cause survival, examined using multivariable proportional hazard models. The main study factor was period of surgery, categorized into 4 periods corresponding to different eras in temozolomide (TMZ) use. Survival was examined over time by age (≤70 and >70 years) and for a subcohort selected to approximate the seminal European Organisation for Research and Treatment of Cancer (Stupp) protocol trial cohort. TMZ use was estimated using aggregate prescription claims data. Results:Median survival in 2001-2003, 2004-2006, 2007-2009, and 2010-2012 was 7.4, 9.0, 9.8, and 10.6 months, and risk-adjusted 2-year survival was 8.2%, 13.8%, 15.5%, and 18.3%, respectively. Survival improved for those aged ≤70 years and those aged >70 years. In the proxy trial subcohort, median and 2-year survival were 14.3 months and 27.3%, respectively. The volume of TMZ prescribed annually increased rapidly from 2005. Conclusions:Introduction of TMZ into standard care in 2005 coincided with improvements in survival and a rapid increase in TMZ prescribing. Optimization of care has continued to improve survival of people with GBM in subsequent years.
Kamal, AH, Bausewein, C, Casarett, DJ, Currow, DC, Dudgeon, DJ & Higginson, IJ 2020, 'Standards, guidelines, and quality measures for successful specialty palliative care integration into oncology: Current approaches and future directions', Journal of Clinical Oncology, vol. 38, no. 9, pp. 987-994.View/Download from: Publisher's site
© 2020 by American Society of Clinical Oncology Although robust evidence demonstrates that specialty palliative care integrated into oncology care improves patient and health system outcomes, few clinicians are familiar with the standards, guidelines, and quality measures related to integration. These types of guidance outline principles of best practice and provide a framework for assessing the fidelity of their implementation. Significant advances in the understanding of effective methods and procedures to guide integration of specialty palliative care into oncology have led to a proliferation of guidance documents around the world, with several areas of commonality but also some key differences. Commonalities originate from a shared vision for integration; differences arise from diverse roles of palliative care specialists within cancer care globally. In this review we discuss three of the most cited standards/ guidelines, as well as quality measures related to integrated palliative and oncology care. We also recommend changes to the quality measurement framework for palliative care and a new way to match palliative care services to patients with advanced cancer on the basis of care complexity and patient needs, irrespective of prognosis.
Kleinig, PA, Woodman, RJ & Currow, DC 2020, 'The Association between Glycemic Control in People with Diabetes and Symptoms at the End of Life: A Prospective Observational Consecutive Cohort Study.', Journal of Palliative Medicine, vol. 23, no. 3, pp. 406-410.View/Download from: Publisher's site
Background: Diabetes is increasingly prevalent globally, including in palliative care. Guidelines vary as to the ideal glycemic goals for patients near the end of life. The relationship between hyperglycemia and attributable symptoms late in life remains ill defined. Objective: To pilot the association between blood glucose level (BGL) and symptoms (nausea, fatigue, pain, and appetite) and mortality in palliative care patients with diabetes. Design: This prospective observational consecutive cohort study consisted of 17 patients with diabetes admitted to an inpatient palliative care unit. Repeat measures of BGL and symptom distress scores using the patient-reported Symptom Assessment Scale (SAS) were recorded during a five-month period as was patient mortality. The association between BGL and SAS domains was assessed using negative binomial regression and the association between mortality and high versus low BGL was determined using log-rank statistics and Kaplan-Meier curves. Results: All patients had malignancy: 15 had type 2 diabetes and 2 had steroid-induced diabetes. A total of 121 patient observation days were included in the analysis. BGL was inversely associated with patient-reported SAS for nausea (incidence rate ratio [IRR] = 0.83, 95% confidence interval [CI] = 0.70-0.99, p = 0.04), but not other symptoms. Insulin usage was also associated with decreased nausea (IRR = 0.24, 95% CI = 0.09-0.60, p = 0.002). Survival did not differ between low- and high-BGL groups. Conclusion: These findings warrant a larger multisite consecutive cohort study and a re-exploration of current clinical practice. Ultimately, interventional trials comparing strict versus more liberal glycemic control on symptom management and survival are the ideal design to better understand differing levels of glycemic control at the end of life.
Li, M, Holliday, L, Roder, D, Tervonen, H, Anazodo, A, Dallapozza, L, Hesketh, E & Currow, D 2020, 'Degree of Cancer Spread at Presentation and Survival Among Adolescents and Young Adults in New South Wales, Australia', JOURNAL OF ADOLESCENT AND YOUNG ADULT ONCOLOGY.View/Download from: Publisher's site
Li, M, Roder, D, D'Onise, K, Walters, D, Farshid, G, Buckley, E, Karapetis, C, Joshi, R, Price, T, Townsend, A, Miller, CL, Currow, D, Powell, K, Buranyi-Trevarton, D & Olver, I 2020, 'Monitoring TNM stage of female breast cancer and survival across the South Australian population, with national and international TNM benchmarking: A population-based cohort study.', BMJ open, vol. 10, no. 6.View/Download from: Publisher's site
OBJECTIVE:Using linked cancer registry and administrative data to monitor, tumour, node and metastases (TNM) stage and survival from female breast cancer in Australia. METHOD:Analysis of 2000-2014 diagnoses with linked population-based data to investigate: (1) sociodemographic predictors of advanced stage (stages III and IV), using unadjusted and adjusted logistic regression; and (2) sociodemographic factors and stage as predictors of breast cancer survival using competing risk regression. DESIGN:Population-based registry cohort. SETTING AND PARTICIPANTS:14 759 South Australian women diagnosed in 2000-2014. PRIMARY AND SECONDARY OUTCOME MEASURES:Stage and survival. RESULTS:At diagnosis, 46% of women were classified as stage I, 39% as stage II, 12% as stage III and 4% as stage IV. After adjusting for sociodemographic factors, advanced stage was more common: (1) for ages <50 years; and although not statistically significant, for ages 80+ years; and (2) in women from socioeconomically disadvantaged areas. Compared with 2000-2004 diagnoses, stage and sociodemographic adjusted risks (sub-HRs (SHRs)) of breast cancer death were lower in 2005-2009 (SHR 0.75, 95% CI 0.67 to 0.83) and 2010-2015 (SHR 0.57, 95% CI 0.48 to 0.67). Compared with stage I, the SHR was 3.87 (95% CI 3.32 to 4.53) for stage II, 10.87 (95% CI 9.22 to 12.81) for stage III, and 41.97 (95% CI 34.78 to 50.65) for stage IV. Women aged 70+ years at diagnosis and those living in the most socioeconomically disadvantaged areas were at elevated risk of breast cancer death, independent of stage and sociodemographic factors. CONCLUSIONS:Stage varied by age, diagnostic period and socioeconomic status, and was a stronger predictor of survival than other statistically significant sociodemographic predictors. Achieving earlier diagnosis outside the original BreastScreen target of 50-69 years (as applying <2014) and in residents of socioeconomically disadvantaged areas likely would increase cancer survival at a popu...
Li, M, Warner-Smith, M, McGill, S, Roder, D & Currow, D 2020, 'History of screening by BreastScreen New South Wales of women with invasive breast cancer.', Cancer epidemiology, vol. 64.View/Download from: Publisher's site
BACKGROUND:The principal target age for Australian BreastScreen services was 50-69 years in 1991-2013 and 50-74 years from 2014. History of BreastScreen NSW screening participation of NSW women diagnosed with breast cancer in 2005-2014 was examined using linked BreastScreen and Cancer Registry data. METHODS:Differences in BreastScreen participation were investigated by sociodemographic and tumour characteristics, and diagnostic period, using the Pearson Chi-square test, or Fisher's Exact test when numbers were small, and by multivariate logistic regression. RESULTS:At breast cancer diagnosis, a history of BreastScreen participation varied by age from 23 % for 40-49 years to 68 % for 50-59 years, 72 % for 70-74 years and 78 % for 60-69 years. Among women experiencing breast cancer at age 50-69 years, 60 % had participated in BreastScreen <24 months of diagnosis. Higher odds of BreastScreen participation applied to residents of inner regional and remote compared with major city areas and for women with localized compared with more distant cancer spread. BreastScreen participation was lower in Indigenous than non-Indigenous women. Differences in participation existed by country of birth and residential location, but they were not pronounced. CONCLUSION:The history of BreastScreen NSW participation of 60 % <24 months for women aged 50-69 years at breast-cancer diagnosis is less than the 70 % target for biennial screening coverage at a population level, but this target has never been reached by an Australian jurisdiction. Qualitative research of screening barriers and opportunities may provide a useful guide for reducing barriers across the population.
Lucey, M, O'Reilly, M, Currow, D, Eagar, K, Walsh, D, Conroy, M, Twomey, F, O'Reilly, V, Doherty, M, Coffey, S, Sheridan, J & Moran, S 2020, 'Is Inpatient Hospice Care Clinically Effective? Using Phase of Illness to Evaluate Care Outcomes for Patients Admitted to a Specialist Palliative Care Unit in Ireland.', Journal of palliative medicine, vol. 23, no. 4, pp. 535-541.View/Download from: Publisher's site
Background: In health care, clinical effectiveness involves evaluating the degree to which clinical interventions achieve beneficial patient and caregiver outcomes. Objective: To evaluate the clinical effectiveness of care in a specialist palliative care unit (SPCU) in Ireland, including an analysis of the temporal relationship among admission, Phase of Illness and patient and family distress. Design/Measurements: A consecutive case series with prospectively collected admission data (n = 400). Using a casemix tool (Phase of Illness), pain, other symptoms, psychological and family distress, and performance status were documented on admission and then daily by medical staff. Results: Three hundred forty-two (85%) patients had complete data recorded on day 1. After admission, there were linear correlations between days since admission and progressive improvements in pain (Cramer's V = 0.131, p < 0.001), other symptoms (V = 0.206, p < 0.001), psychological distress (V = 0.101, p < 0.001), and family distress (V = 0.124, p < 0.001). Forty-three percent were in an unstable phase on admission. Nearly two thirds (60.7%) of these unstable patients converted to a stable phase within 48 hours of admission. Over the first 72 hours, 70.7% of unstable patients converted to a stable phase. There was also a significant correlation between phase stabilization and pain and symptom control (p = 0.007). Stable phase over the first 4 days and first 14 days was associated with significantly higher performance status. Conclusion: This study demonstrates the significant clinical effectiveness of SPCU admission across the different aspects of patient and family care.
Merrett, N, Richardson, A, Lam, V, Walton, R & Currow, D 2020, 'Pancreaticoduodenectomy outcomes in Australia.', ANZ journal of surgery, vol. 90, no. 5, pp. 938-939.View/Download from: Publisher's site
Mitchell, GK, Willmott, L, White, BP, Piper, D, Currow, DC & Yates, PM 2020, 'A perfect storm: fear of litigation for end of life care.', The Medical journal of Australia.View/Download from: Publisher's site
Morgan, DD, Brown, A, Cerdor, PA & Currow, DC 2020, 'Does Resource Utilization Group-Activities of Daily Living Help Us Better Interpret Australian Karnofsky-Modified Performance Scale?', Journal of palliative medicine, vol. 23, no. 9, pp. 1153-1154.View/Download from: Publisher's site
Mori, M, Yamaguchi, T, Matsuda, Y, Suzuki, K, Watanabe, H, Matsunuma, R, Kako, J, Imai, K, Usui, Y, Matsumoto, Y, Hui, D, Currow, D & Morita, T 2020, 'Unanswered questions and future direction in the management of terminal breathlessness in patients with cancer', ESMO OPEN, vol. 5.View/Download from: Publisher's site
Sobanski, PZ, Alt-Epping, B, Currow, DC, Goodlin, SJ, Grodzicki, T, Hogg, K, Janssen, DJA, Johnson, MJ, Krajnik, M, Leget, C, Martínez-Sellés, M, Moroni, M, Mueller, PS, Ryder, M, Simon, ST, Stowe, E & Larkin, PJ 2020, 'Palliative Care for people living with heart failure - European Association for Palliative Care Task Force expert position statement.', Cardiovascular Research, vol. 116, no. 1, pp. 12-27.View/Download from: Publisher's site
Contrary to common perception, modern palliative care (PC) is applicable to all people with an incurable disease, not only cancer. PC is appropriate at every stage of disease progression, when PC needs emerge. These needs can be of physical, emotional, social or spiritual nature. This document encourages the use of validated assessment tools to recognise such needs and ascertain efficacy of management. PC interventions should be provided alongside cardiologic management. Treating breathlessness is more effective, when cardiologic management is supported by PC interventions. Treating other symptoms like pain or depression requires predominantly PC interventions. Advance Care Planning aims to ensure that the future treatment and care the person receives is concordant with their personal values and goals, even after losing decision-making capacity. It should include also disease specific aspects, such as modification of implantable device activity at the end of life. The Whole Person Care concept describes the inseparability of the physical, emotional and spiritual dimensions of the human being. Addressing psychological and spiritual needs, together with medical treatment, maintains personal integrity and promotes emotional healing. Most PC concerns can be addressed by the usual care team, supported by a PC specialist if needed. During dying, the persons' needs may change dynamically and intensive PC is often required. Following the death of a person, bereavement services benefit loved ones. The authors conclude that the inclusion of PC within the regular clinical framework for people with heart failure results in a substantial improvement in quality of life as well as comfort and dignity whilst dying.
Tait, P, Cuthbertson, E & Currow, DC 2020, 'What Are the Factors Identifying Caregivers Who Need Help in Managing Medications for Palliative Care Patients at Home? A Population Survey', JOURNAL OF PALLIATIVE MEDICINE, vol. 23, no. 8, pp. 1084-1089.View/Download from: Publisher's site
Tervonen, HE, Creighton, N, Zhao, GW, Ng, M & Currow, DC 2020, 'Capture of systemic anticancer therapy use by routinely collected health datasets.', Public health research & practice, vol. 30, no. 1, pp. 1-4.View/Download from: Publisher's site
White, KM, Walton, RJ, Zhao, GW, Creighton, N, Farrell, R, Saidi, S, Herbst, U, Hogg, R & Currow, DC 2020, 'Patterns of surgical care for women with ovarian cancer in New South Wales.', The Australian & New Zealand journal of obstetrics & gynaecology, vol. 60, no. 4, pp. 592-597.View/Download from: Publisher's site
BACKGROUND:Little is known about the delivery of surgical services and outcomes for women with ovarian cancer across New South Wales (NSW). AIM:The study objective was to provide a descriptive analysis of the proportion of women who had surgery for ovarian cancer in NSW in specialist gynaecological oncology hospitals and compare outcomes for women attending specialist and non-specialist services in NSW. MATERIALS AND METHODS:This study is a retrospective analysis of women with primary ovarian, fallopian tube or peritoneal cancer from 2009 to 2012. Data were analysed from the NSW Cancer Registry, NSW Admitted Patient Data Collection and Register of Births Deaths and Marriages. Treating hospitals were characterised as public specialist, public non-specialist and private. Morbidity and mortality outcomes are reported. RESULTS:The study included 1106 women. Fifty-seven hospitals performed surgery: seven public specialist, 27 private and 23 public non-specialist hospitals. The highest proportion of surgery was performed in public specialist hospitals (61%). There was considerable variation in the utilisation of public specialist hospitals between local health districts. There was no significant difference in outcomes related to the type of hospital where surgery was performed. CONCLUSIONS:Although the majority of women are having surgery in a specialist gynaecological oncology public hospital across NSW, many are not. Women living in regional and remote NSW were less likely to have their surgery in a specialist hospital. This is the first step in understanding where women in NSW are currently receiving their surgical care, as well as the outcomes related to this.
Willmott, L, White, B, Yates, P, Mitchell, G, Currow, DC, Gerber, K & Piper, D 2020, 'Nurses' knowledge of law at the end of life and implications for practice: A qualitative study.', Palliative medicine, vol. 34, no. 4, pp. 524-532.View/Download from: Publisher's site
BACKGROUND:Some patients do not receive adequate pain and symptom relief at the end of life, causing distress to patients, families and healthcare professionals. It is unclear whether undertreatment of symptoms occurs, in part, because of nurses' concerns about legal and/or disciplinary repercussions if the patient dies after medication is administered. AIM:The aim was to explore nurses' experiences and knowledge of the law relating to the provision of end-of-life pain and symptom relief. DESIGN:Semi-structured interviews with nurses were assessed using a six-stage hybrid thematic analysis technique. SETTING/PARTICIPANTS:Four face-to-face and 21 telephone interviews were conducted with nurses who routinely prescribed and/or administered pain and symptom relief to patients approaching the end of their lives in Queensland and New South Wales, Australia. RESULTS:While many nurses had no personal experiences with legal or professional repercussions after a patient had died, the fear of hastening death and being held accountable was frequently discussed and regarded as relevant to the provision of inadequate pain and symptom relief. Concerns included potential civil or criminal liability and losing one's job, registration or reputation. Two-thirds of participants believed that pain relief was sometimes withheld because of these legal concerns. Less than half of the interviewed nurses demonstrated knowledge of the doctrine of double effect, the legal protection for health professionals who provide end-of-life pain and symptom relief. CONCLUSION:Education is urgently required to strengthen nurses' knowledge of the legal protections supporting the provision of appropriate palliative medication, thereby improving their clinical practice with end-of-life patients.
Kochovska, S, Chang, S, Morgan, DD, Ferreira, D, Sidhu, M, Saleh Moussa, R, Johnson, MJ, Ekström, M & Currow, DC 2020, 'Activities Forgone because of Chronic Breathlessness: A Cross-Sectional Population Prevalence Study', Palliative Medicine Reports, vol. 1, no. 1, pp. 166-170.View/Download from: Publisher's site
Clark, K, Byrne, PG, Hunt, J, Brown, L, Rowett, D, Watts, G, Lovell, M & Currow, DC 2020, 'Pharmacovigilance in Hospice/Palliative Care: De-Prescribing Combination Controlled Release Oxycodone-Naloxone.', Journal of palliative medicine, vol. 23, no. 5, pp. 656-661.View/Download from: Publisher's site
Background: Pharmacovigilance studies in hospice/palliative care provide extra information to improve medication safety. Combination controlled release oxycodone-naloxone offers an alternative opioid with less risk of opioid-induced constipation. Objective: To examine why palliative care clinicians chose to cease oxycodone-naloxone and to explore immediate and short-term benefits and harms of this medication change. Design: A consecutive cohort study. Setting: 112 adults from 13 palliative care centers. Measurements: Reasons for ceasing medication and the harms and benefits that followed this 24 and 72 hours later. Symptom burdens were summarised by the National Cancer Institute Common Terminology Criteria for Adverse Events Toxicity Gradings. Results: Combination medication was most commonly ceased because of poor pain control or impaired hepatic function. The last median oral morphine equivalent oxycodone dose before the switch was 45 mg (range 7.5-240 mg) with 76 switched to an alternative long-acting opioid (initial median oral morphine equivalent dose being 45 mg [range 5-210 mg]). Subgroup analysis of those switched because of clinicians' concerns about hepatic dysfunction demonstrated this group were receiving significantly lower opioid doses pre-cessation compared to those switched because of other reasons( p = 0.007). Regardless of why the medication was changed, improvements in pain and constipation scores were seen, the latter associated with an attendant increase in laxatives. Conclusions: This preliminary work suggests that despite theoretical concerns regarding the effect of the naloxone on opioid doses, most people were switched safely to very similar opioid doses with attendant improvements in pain control.
Currow, DC & Agar, MR 2020, 'Benzodiazepine Prescribing in People with Chronic Obstructive Pulmonary Disease: Clinical Considerations', DRUGS & AGING, vol. 37, no. 4, pp. 263-270.View/Download from: Publisher's site
Ferreira, DH, Louw, S, McCloud, P, Fazekas, B, McDonald, CF, Agar, M, Clark, K, McCaffrey, N, Ekstrom, M, Currow, DC & Australian national Palliative Care Clinical Studies Collaborative (PaCCSC) 2020, 'Controlled-release oxycodone versus placebo in the treatment of chronic breathlessness - a multi-site randomised placebo controlled trial.', Journal of Pain and Symptom Management, vol. 59, no. 3, pp. 581-589.View/Download from: Publisher's site
CONTEXT:Chronic breathlessness is a clinical syndrome that results in significant distress and disability. Morphine can reduce chronic breathlessness when the contributing aetiologies are optimally treated. OBJECTIVE:Does oxycodone reduce chronic breathlessness compared with placebo? METHODS:A multi-site, randomised, placebo-controlled, double-blind, parallel-arm, fixed-dose trial of oral controlled-release oxycodone 15mg (5 mg 8 hourly) or placebo (ACTRN12609000806268 at www.anzctr.org.au). 'As needed' immediate-release morphine (2.5mg per dose; ≤6 doses/day) was available for both arms as required by one ethics committee overseeing the trial.Recruitment occurred from 2010 to 2014 in 14 inpatient and outpatient respiratory, cardiology and palliative care services across Australia. Participants were adults, with chronic breathlessness (modified Medical Research Council Scale 3 or 4), who were opioid naïve. The primary endpoint was the proportion of people with >15% reduction from baseline in the intensity of breathlessness now (0-100 mm visual analogue scale) comparing arms days 5-7. Secondary endpoints were 'average' and 'worst' breathlessness; quality of life; function; and harms. RESULTS:Of 157 participants randomised, 155 were included (74 oxycodone, 81 placebo), but the study did not reach target recruitment. There was no difference between groups for the primary outcome (p=0.489) nor any of the pre-specified secondary outcomes. Placebo participants used more 'as needed' morphine (mean 7.0 versus 4.2 doses; p≤0.001). Oxycodone participants reported more nausea (p<0.001). CONCLUSIONS:There was no signal of benefit from oxycodone over placebo. Future research should focus on investigating the existence of an opioid class effect on the reduction of chronic breathlessness.
Johnson, MJ, Sbizzera, I, Fairhurst, C, Fazekas, B, Agar, M, Ekstrom, M & Currow, DC 2020, 'No excess harms from sustained-release morphine: a randomised placebo-controlled trial in chronic breathlessness.', BMJ Supportive and Palliative Care.View/Download from: Publisher's site
OBJECTIVES:We aimed to identify and evaluate: (1) treatment-emergent adverse events (TEAE (worse or new since baseline)) and the subgroup of severe TEAEs in a placebo-controlled 7-day randomised trial of regular, low-dose, sustained-release oral morphine for chronic breathlessness and (2) clinical characteristics associated with TEAE. METHODS:Safety analysis of trial data. Adults with chronic breathlessness (modified Medical Research Council breathlessness score ≥2) due to heart or lung disease, or cancer, not on regular opioids were eligible. Symptoms associated with opioids (TEAE of special interest) were systematically sought using Common Terminology Criteria for Adverse Events (CTCAE) grading. Other harms could be reported at any time. The relationship between characteristics and presence of ≥1 TEAE of special interest was explored using univariable logistic regression analyses. RESULTS:1449/5624 (26%) Adverse Events from 279 participants were TEAE of which 150/1449 (10%) were severe (CTCAE grades 3-5). 1086/5624 (75%) were events of special interest of which 41/1086 (4%) were severe. Compared with placebo, morphine was not associated with more TEAE or severe TEAE of special interest (TEAE: OR 0.53, 95% CI 0.21 to 1.38, p=0.20; severe TEAE: OR 0.96, 95% CI 0.27 to 3.41, p=0.95) nor with CTCAE severity grade (χ2=4.39, p=0.50). Among the 26/150 (17%) with severe TEAEs, study withdrawal was more common in the morphine arm (18/26 (69%) morphine arm; 8/26 (30%) placebo arm). None of the severe TEAEs was a respiratory harm. CONCLUSIONS:Severe morphine-associated toxicity was uncommon and not associated with study arm. Clinical consequences were minor and self-limiting. TRIAL REGISTRATION NUMBER:ACTRN126000806268.
King, MT, Agar, M, Currow, DC, Hardy, J, Fazekas, B & McCaffrey, N 2020, 'Assessing quality of life in palliative care settings: head-to-head comparison of four patient-reported outcome measures (EORTC QLQ-C15-PAL, FACT-Pal, FACT-Pal-14, FACT-G7).', Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, vol. 28, no. 1, pp. 141-153.View/Download from: Publisher's site
PURPOSE:Head-to-head comparison of reliability, validity and responsiveness of four patient-reported outcome measures (PROMS) suitable for assessing health-related quality of life (HRQOL) in palliative care settings: EORTC QLQ-C15-PAL, FACT-G7, FACIT-Pal and short-form FACIT-Pal-14. METHODS:Secondary analysis of two phase III randomised trials: ketamine for chronic cancer pain, octreotide for vomiting in inoperable malignant bowel obstruction. Sub-groups were defined by Australia-modified Karnofsky performance status (AKPS) and participants' global impression of change (GIC). Two aspects of reliability were assessed: internal consistency (Cronbach alpha, α); test-retest reliability (intra-class correlation coefficient (ICC)) of patients with stable AKPS and those who self-reported 'no change' on GIC. Construct validity was assessed via pre-determined hypotheses about sensitivity of PROM scores to AKPS groups and responsiveness of PROM change scores to GIC groups using analysis of variance. RESULTS:FACIT-Pal had better internal consistency (α ranged 0.59-0.80, 15/18 ≥ 0.70) than QLQ-C15-PAL (0.51-0.85, 4/8 ≥ 0.70) and FACT-G7 (0.54-0.64, 0/2 ≥ 0.70). FACIT scales had better test-retest reliability (FACIT-Pal 11/27 ICCs ≥ 0.70, FACT-G7 2/3 ICCs ≥ 0.70) than QLQ-C15-PAL (2/30 ICCs ≥ 0.70, 18/30 ≤ 0.5). Four scales demonstrated sensitivity to AKPS: QLQ-PAL-15 Physical Functioning and Global QOL, FACT-G Functional Wellbeing and FACIT-Pal Trial Outcome Index (TOI). Nine scales demonstrated responsiveness: three in the ketamine trial population (QLQ-C15-PAL Pain, FACIT-Pal-14, FACT-G7), six in the octreotide trial population (QLQ-C15-PAL Fatigue; FACIT-Pal PalCare, TOI, Total; FACT-G Physical Wellbeing and Total). CONCLUSIONS:No PROM was clearly superior, confirming that choosing the best PROM requires careful consideration of the research goals, patient population and the domains of HRQOL targeted by the intervention being investigated.
Kochovska, S, Huang, C, Johnson, MJ, Agar, MR, Fallon, MT, Kaasa, S, Hussain, JA, Portenoy, RK, Higginson, IJ & Currow, DC 2020, 'Intention-to-Treat Analyses for Randomized Controlled Trials in Hospice/Palliative Care: The Case for Analyses to be of People Exposed to the Intervention.', Journal of Pain and Symptom Management, vol. 59, no. 3, pp. 637-645.View/Download from: Publisher's site
CONTEXT:Minimizing bias in randomized controlled trials (RCTs) includes intention-to-treat analyses. Hospice/palliative care RCTs are constrained by high attrition unpredictable when consenting, including withdrawals between randomization and first exposure to the intervention. Such withdrawals may systematically bias findings away from the new intervention being evaluated if they are considered nonresponders. OBJECTIVES:This study aimed to quantify the impact within intention-to-treat principles. METHODS:A theoretical model was developed to assess the impact of withdrawals between randomization and first exposure on study power and effect sizes. Ten reported hospice/palliative care studies had power recalculated accounting for such withdrawal. RESULTS:In the theoretical model, when 5% of withdrawals occurred between randomization and first exposure to the intervention, change in power was demonstrated in binary outcomes (2.0%-2.2%), continuous outcomes (0.8%-2.0%), and time-to-event outcomes (1.6%-2.0%), and odds ratios were changed by 0.06-0.17. Greater power loss was observed with larger effect sizes. Withdrawal rates were 0.9%-10% in the 10 reported RCTs, corresponding to power losses of 0.1%-2.2%. For studies with binary outcomes, withdrawal rates were 0.3%-1.2% changing odds ratios by 0.01-0.22. CONCLUSION:If blinding is maintained and all interventions are available simultaneously, our model suggests that excluding data from withdrawals between randomization and first exposure to the intervention minimizes one bias. This is the safety population as defined by the International Committee on Harmonization. When planning for future trials, minimizing the time between randomization and first exposure to the intervention will minimize the problem. Power should be calculated on people who receive the intervention.
To, THM, Collier, A, Agar, MR, Rowett, D & Currow, DC 2020, 'Symptomatic Events in a Community Palliative Care Population: A Prospective Pilot Study.', Journal of palliative medicine, vol. 23, no. 9, pp. 1223-1226.View/Download from: Publisher's site
Background: The palliative care population is prescribed a large number of drugs, increasing as patients deteriorate. The cumulative effects of these medications combined with underlying symptom burden can result in significant morbidity. There is an urgent need to describe possible symptomatic events that could be exacerbated by commonly prescribed drugs in palliative care and their impact. Objectives: To trial the feasibility and acceptability of determining baseline symptomatic event rates for community palliative care patients from which a composite measure of symptomatic events can be developed. Design: This prospective pilot study of patient-reported symptomatic events recruited a convenience cohort of 27 community palliative care patients in a metropolitan specialist palliative care service in Australia. Results: This study has demonstrated a high prevalence rate of symptomatic events (total crude event/participant day rate 0.87) in the study population. Conclusion: Data collection of patient-centered symptomatic events was acceptable and feasible to participants. This pilot supports a fully powered study.
Lee, W, Pulbrook, M, Sheehan, C, Kochovska, S, Chang, S, Hosie, A, Lobb, E, Parker, D, Draper, B, Agar, MR & Currow, DC 2020, 'Clinically Significant Depressive Symptoms Are Prevalent in People With Extremely Short Prognoses—A Systematic Review', Journal of Pain and Symptom Management.View/Download from: Publisher's site
© 2020 American Academy of Hospice and Palliative Medicine Context: Currently, systematic evidence of the prevalence of clinically significant depressive symptoms in people with extremely short prognoses is not available to inform its global burden, assessment, and management. Objectives: To determine the prevalence of clinically significant depressive symptoms in people with advanced life-limiting illnesses and extremely short prognoses (range of days to weeks). Methods: A systematic review and meta-analysis (random-effects model) were performed (PROSPERO: CRD42019125119). MEDLINE, Embase, PsycINFO, CINAHL, and CareSearch were searched for studies (1994–2019). Data were screened for the prevalence of clinically significant depressive symptoms (assessed using validated depression-specific screening tools or diagnostic criteria) of adults with advanced life-limiting illnesses and extremely short prognoses (defined by survival or functional status). Quality assessment was performed using the Joanna Briggs Institute Systematic Reviews Checklist for Prevalence Studies for individual studies and Grading of Recommendations Assessment, Development and Evaluation (GRADE) across studies. Results: Thirteen studies were included. The overall pooled prevalence of clinically significant depressive symptoms in adults with extremely short prognoses (n = 10 studies; extremely short prognoses: N = 905) using depression-specific screening tools was 50% (95% CI: 29%–70%; I2 = 97.6%). Prevalence of major and minor depression was 10% (95% CI: 4%–16%) and 5% (95% CI: 2%–8%), respectively. Major limitations included high heterogeneity, selection bias, and small sample sizes in individual studies. Conclusions: Clinically, significant depressive symptoms were prevalent in people with advanced life-limiting illnesses and extremely short prognoses. Clinicians need to be proactive in the recognition and assessment of these symptoms to allow for timely intervention.
Asano, R, Mathai, SC, Macdonald, PS, Newton, PJ, Currow, DC, Phillips, J, Yeung, W-F & Davidson, PM 2020, 'Oxygen use in chronic heart failure to relieve breathlessness: A systematic review.', Heart Failure Reviews, vol. 25, no. 2, pp. 195-205.View/Download from: Publisher's site
To appraise published studies on the use of supplemental oxygen in chronic heart failure. Chronic breathlessness is a characterizing symptom of symptomatic heart failure resulting in substantial disability and healthcare utilization and is the primary reason for emergency room visits and hospitalizations. In spite of the variable evidence, oxygen therapy is commonly administered both acutely and chronically. Moreover, the role of oxygen therapy to relieve chronic breathlessness in heart failure is not well described, particularly in normoxemic or mild or intermittent hypoxemic states. In fact, several studies have shown the detrimental effects of oxygen therapy with normal oxygen saturation levels. A systematic review using PRISMA guidelines. Four databases PubMed, Embase, CINAHL, and Web of Science were systematically searched from January 2001 to January 2019 investigating the use of oxygen in heart failure. Duplicate articles were removed from the review. Titles and abstracts were screened for inclusion and exclusion criteria. The remaining full-text articles were reviewed and hand-searched for additional references. The quality of the full-text articles was assessed using standardized critical appraisal instruments by the Joanna Briggs Institute. A total of 11 studies, including three intervention and eight non-interventions studies, were included in this review from 1072 non-duplicated records retrieved. Sample size ranged from 4 to 5862. In spite of common usage, this review suggests that there are scant data available to justify the use of oxygen in individuals with non-hypoxemic chronic heart failure and chronic breathlessness.
Asano, R, Newton, PJ, Currow, DC, Macdonald, PS, Leung, D, Phillips, JL, Perrin, N & Davidson, PM 2020, 'Rationale for targeted self-management strategies for breathlessness in heart failure.', Heart failure reviews.View/Download from: Publisher's site
To provide a conceptual rationale for targeted self-management strategies for breathlessness in chronic heart failure. Breathlessness is a defining symptom of chronic heart failure and is the primary cause for hospital readmissions and emergency room visits, resulting in extensive health care utilization. Chronic breathlessness, punctuated by acute physiological decompensation, is a sentinel symptom of the heart failure syndrome and often intensifies towards the end of life. Drawing upon evidence-based guidelines, physiological mechanisms and existing conceptual models for the management of breathlessness is proposed. Key elements of this model include adherence to evidence-based approaches (pharmacological and non-pharmacological management to optimize heart failure treatment), self-monitoring of symptoms, identification of modifiable factors (such as fluid overload), and targeted strategies for breathlessness including distraction and gas flow. Self-management is an essential component in heart failure management which could positively influences health outcomes and quality of life. Refining programs to focus on breathlessness may have the potential to reduce symptom burden and improve quality of life.
Asano, R, Newton, PJ, Currow, DC, Macdonald, PS, Leung, D, Phillips, JL, Perrin, N & Davidson, PM 2020, 'Reply to Kako, Kajiwara, Kobayashi, and Oosono letter to the editor response.', Heart failure reviews, vol. 25, no. 5, pp. 893-893.View/Download from: Publisher's site
Currow, DC, Agar, MR & Phillips, JL 2020, 'Role of Hospice Care at the End of Life for People With Cancer', JOURNAL OF CLINICAL ONCOLOGY, vol. 38, no. 9, pp. 937-+.View/Download from: Publisher's site
Ferreira, DH, Boland, JW, Kochovska, S, Honson, A, Phillips, JL & Currow, DC 2020, 'Patients' and caregivers' experiences of driving with chronic breathlessness before and after regular low-dose sustained-release morphine: A qualitative study.', Palliative medicine, vol. 34, no. 8, pp. 1078-1087.View/Download from: Publisher's site
BACKGROUND:Chronic breathlessness is a disabling syndrome that profoundly impacts patients' and caregivers' lives. Driving is important for most people, including those with advanced disease. Regular, low-dose, sustained-release morphine safely reduces breathlessness, but little is known about its impact on driving. AIM:To understand patients' and caregivers' (1) perspectives and experiences of driving with chronic breathlessness; and (2) perceived impact of regular, low-dose, sustained-release morphine on driving. DESIGN:A qualitative study embedded in a pragmatic, phase III, randomised, placebo-controlled trial of low-dose, sustained-release morphine (⩽32 mg/24 h) for chronic breathlessness. Semi-structured interviews were conducted immediately after participants withdrew or completed the randomised, placebo-controlled trial. Informed by grounded theory, a constant comparative approach to analysis was adopted. SETTING/PARTICIPANTS:Participants were recruited from an outpatients palliative care service in Adelaide, Australia. Participants included patients (n = 13) with severe breathlessness associated with chronic obstructive pulmonary disease and their caregivers (n = 9). RESULTS:Participants were interviewed at home. Eleven received morphine 8-32 mg. Three themes emerged: (1) independence; (2) breathlessness' impact on driving; and (3) driving while taking regular, low-dose, sustained-release morphine. CONCLUSION:Driving contributed to a sense of identity and independence. Being able to drive increased the physical and social space available to patients and caregivers, their social engagement and well-being. Patients reported breathlessness at rest may impair driving skills, while the introduction of sustained-release morphine seemed to have no self-reported impact on driving. Investigating this last perception objectively, especially in terms of safety, is the subject of ongoing work.
Ferreira, DH, Kochovska, S, Honson, A, Phillips, JL & Currow, DC 2020, 'Two faces of the same coin: a qualitative study of patients' and carers' coexistence with chronic breathlessness associated with chronic obstructive pulmonary disease (COPD)', BMC PALLIATIVE CARE, vol. 19, no. 1.View/Download from: Publisher's site
Kochovska, S, Ferreira, DH, Luckett, T, Phillips, JL & Currow, DC 2020, 'Earlier multidisciplinary palliative care intervention for people with lung cancer: a systematic review and meta-analysis.', Translational lung cancer research, vol. 9, no. 4, pp. 1699-1709.View/Download from: Publisher's site
Lung cancer is the most common cancer and leading cause of cancer mortality globally. Lung cancer is associated with significant morbidity, with symptoms often being poorly managed, causing significant symptom burden for both patients and their family caregivers. In people with life-limiting illnesses including advanced cancer, palliative care has been effective in improving symptom control, physical and mental wellbeing, quality of life, and survivorship; with benefits extending to caregivers while in the role and subsequently. Earlier integration of palliative care within oncology may be associated with improved patient outcomes, and has been supported by two Lancet commissions and national guidelines. The evidence for its effectiveness, however, has been mixed across the cancer spectrum. The aim of this review was to evaluate the current evidence for the effectiveness of early integrated palliative care in improving outcomes for people with lung cancer and their caregivers. Meta-analyses were performed where studies used the same measure. Otherwise, synthesis used a narrative approach. Similar to other types of advanced cancer, this review reveals mixed evidence for the effectiveness of early referral to palliative care and for the effectiveness of individual palliative interventions for people with lung cancer and their caregivers. Evidence that on-demand palliative care is equally, if not more effective than palliative care that is routinely provided, raises the question whether initiation and provision of palliative care as part of multidisciplinary lung cancer care ought to be guided by an early referral or need-based referral. Better understanding of what constitutes palliative care when delivered to people with lung cancer and their caregivers will help delineate the correlation with reported outcomes for these populations.
Luckett, T, San Martin, A, Currow, DC, Johnson, MJ, Barnes-Harris, MMM & Phillips, JL 2020, 'A systematic review and meta-analysis of studies comparing burden from lung cancer and chronic obstructive pulmonary disease', PALLIATIVE MEDICINE.View/Download from: Publisher's site
Stone, E, Rankin, N, Currow, D, Fong, KM, Phillips, JL & Shaw, T 2020, 'Optimizing lung cancer MDT data for maximum clinical impact-a scoping literature review.', Translational lung cancer research, vol. 9, no. 4, pp. 1629-1638.View/Download from: Publisher's site
Multidisciplinary care in is widely recommended as best practice for lung cancer in many countries and jurisdictions. A number of studies suggest multidisciplinary care benefits patient outcomes, with analyses based on a range of data sources including national, state and local registries as well as multidisciplinary team meeting (MDT)-based data collections, often focused on different questions depending on data sources. MDT data collection and linkage are not standardized and not routine although data collection and feedback are specifically recommended by at least one statutory body. We performed a scoping review of current evidence for lung cancer MDT data collection and analysis, to identify discrete strategies through illustrative examples and to make recommendations for future approaches. Thirteen studies were identified that presented lung cancer MDT-related clinical outcomes, three included MDTs from multiple tumour streams while 10 studies focussed on lung cancer MDT meetings. Eleven studies measured the effect of MDT discussion on clinical outcomes of which eight were positive. Data sources included MDT records (3 studies), medical or hospital records (3 studies), institutional registries (5 studies) and state or national administrative datasets (6 studies), with some overlap. Examples of studies based on different data sources (local MDT, institutional registry, national registry) exemplified the different types of clinical research questions appropriate for each data source. While MDT data collection is not well-defined, the importance of clinical audit and data feedback and the potential for real-time analysis to improve outcomes deserve further investigation. Optimized datasets and linkage strategies are likely to maximize benefits for patients.
Stone, E, Rankin, NM, Vinod, SK, Nagarajah, M, Donnelly, C, Currow, DC, Fong, KM, Phillips, JL & Shaw, T 2020, 'Clinical impact of data feedback at lung cancer multidisciplinary team meetings: A mixed methods study.', Asia-Pacific journal of clinical oncology, vol. 16, no. 1, pp. 45-55.View/Download from: Publisher's site
AIM:Multidisciplinary team (MDT) meetings can facilitate optimal lung cancer care, yet details of structured data collection and feedback remain sparse. This study aimed to investigate data collection and the impact of feedback to lung cancer MDTs. METHODS:A mixed-methods study using pre and post-test surveys, semistructured interviews, and observation to evaluate data collection and response to modeled data feedback in three Australian lung cancer MDTs at different locations and development stage (site A: outer metropolitan, established; site B, outer metropolitan, new; and site C, inner metropolitan, established). RESULTS:MDT attendees (range 13-25) discussed 5-8 cases per meeting. All sites collected data prospectively (80% prepopulated) into local oncology medical information systems. The pretest survey had 17 respondents in total (88% clinicians). At sites A and C, 100% of respondents noted regular data audits, occasional at site B. Regular audit data included number of cases, stage, final diagnosis, and time to diagnosis and treatment. The post-test survey had 25 respondents in total, all clinicians. The majority (88-96%) of respondents found modeled data easy to interpret, relevant to clinical practice and the MDT, and welcomed future regular data presentations (as rated on a 5-point Likert scale mean weighted average 4.5 where > 4 demonstrates agreement). Semistructured interviews identified five major themes for MDTs: current practice, attitudes, enablers, barriers, and benefits for the MDT. CONCLUSIONS:MDT teams exhibited positive responses to modeled data feedback. Key characteristics of MDT data were identified and may assist with future team research and development.
Disler, RT, Spiliopoulos, N, Inglis, SC, Currow, DC & Davidson, PM 2020, 'Cognitive screening in chronic obstructive pulmonary disease: patient's perspectives.', Disability and rehabilitation, vol. 42, no. 9, pp. 1233-1239.View/Download from: Publisher's site
Purpose: Cognitive impairment is highly prevalent (61%) in chronic obstructive pulmonary disease (COPD). International guidelines recommend providing self-management education through resource-intensive, pulmonary rehabilitation programs, yet screening for deficits likely to interfere with learning have received insufficient attention. Concerns over cognitive testing as confronting are described by health professionals as a barrier to screening, but with minimal empiric data. This study explored views on cognitive impairment and screening in patients with COPD.Design: Qualitative study, focus groups.Methods: Participants with COPD were recruited from a respiratory service at a regional hospital. Conversations were recorded, transcribed verbatim, and analyzed using thematic analysis.Results: Focus groups were undertaken between February and May 2014. Fifteen patients, with a diagnosis of COPD and mean age of 73, participated. Thematic analysis resulted in four overall themes: (1) limited awareness of the connection between cognitive change and COPD; (2) cognitive change as part of normal ageing; (3) current strategies for self-management activities and cognition functioning; and (4) attitudes to cognitive testing.Conclusions: This study identified that participants were open to discussing issues of cognitive function suggesting that normalizing discussion around cognitive change presents an opportunity to introduce screening within routine assessments. Identifying cognitive impairment provides opportunity to tailor rehabilitation for those at risk of sub-optimal self-management.Implications for RehabilitationChanges in cognition are recognized as a barrier to optimal self-management and rehabilitation efficacy in chronic disease.This study identified that participants were open to discussing issues of cognitive function suggesting that normalizing discussion around cognitive change presents an opportunity to introduce screening within routine assessments.Identifyi...
Currow, DC, Ekström, M, Louw, S, Hill, J, Fazekas, B, Clark, K, Davidson, PM, McDonald, C, Sajkov, D, McCaffrey, N, Doogue, M, Abernethy, AP & Agar, M 2019, 'Sertraline in symptomatic chronic breathlessness: a double blind, randomised trial.', European Respiratory Journal, vol. 53, no. 1.View/Download from: Publisher's site
Does sertraline provide symptomatic relief for chronic breathlessness in people with advanced disease whose underlying cause(s) are optimally treated?223 participants with chronic breathlessness (modified Medical Research Council breathlessness scale ≥2) who had optimal treatment of underlying cause(s) were randomised 1:1 to sertraline 25-100 mg (titrated upwards over 9 days) or placebo for 4 weeks. The primary outcome was the proportion who had an improvement in intensity of current breathlessness >15% from baseline on a 100-mm visual analogue scale.The proportion of people responding to sertraline was similar to placebo for current breathlessness on days 26-28 (OR 1.00, 95% CI 0.71-1.40) and for other measures of breathlessness. Quality of life in the sertraline arm had a higher likelihood of improving than in the placebo arm over the 4 weeks (OR 0.21, 95% CI 0.01-0.41; p=0.044). No differences in performance status, anxiety and depression, or survival were observed. Adverse event rates were similar between arms.Sertraline does not appear to provide any benefit over placebo in the symptomatic relief of chronic breathlessness in this patient population.
Arnold, M, Rutherford, MJ, Bardot, A, Ferlay, J, Andersson, TM-L, Myklebust, TA, Tervonen, H, Thursfield, V, Ransom, D, Shack, L, Woods, RR, Turner, D, Leonfellner, S, Ryan, S, Saint-Jacques, N, De, P, McClure, C, Ramanakumar, AV, Stuart-Panko, H, Engholm, G, Walsh, PM, Jackson, C, Vernon, S, Morgan, E, Gavin, A, Morrison, DS, Huws, DW, Porter, G, Butler, J, Bryant, H, Currow, DC, Hiom, S, Parkin, DM, Sasieni, P, Lambert, PC, Moller, B, Soerjomataram, I & Bray, F 2019, 'Progress in cancer survival, mortality, and incidence in seven high-income countries 1995-2014 (ICBP SURVMARK-2): a population-based study', LANCET ONCOLOGY, vol. 20, no. 11, pp. 1493-1505.View/Download from: Publisher's site
Boland, JW, Currow, D & Johnson, M 2019, 'Response to "Hyoscine Butylbromide for the Management of Death Rattle: Sooner Rather Than Later"', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 57, no. 3, pp. E12-E13.View/Download from: Publisher's site
Brożek, B, Damps-Konstańska, I, Pierzchała, W, Barczyk, A, Currow, DC, Jassem, E & Krajnik, M 2019, 'End-of-life care for patients with advanced lung cancer and chronic obstructive pulmonary disease: survey among Polish pulmonologists.', Polish archives of internal medicine, vol. 129, no. 4, pp. 242-252.View/Download from: Publisher's site
INTRODUCTION There is evidence that people with nonmalignant disease receive poorer end‑of‑life (EOL) care compared with people with cancer. OBJECTIVES The aim of the study was to assess the selected aspects of symptomatic treatment and communication between physicians and patients diagnosed with either advanced chronic obstructive pulmonary disease (COPD) or lung cancer. METHODS A questionnaire survey was conducted online among members of the Polish Respiratory Society. RESULTS Properly completed questionnaires were returned by 174 respondents (27.2% of those proved to be contacted by email). In COPD, 32% of respondents always or often used opioids in chronic breathlessness and 18.3% always or often referred patients to a palliative care (PC) specialist. Nearly 80% of the respondents claimed that bedside discussions on EOL issues with people with COPD are essential, although only 20% would always or often initiate them. In people with lung cancer, opioids were routinely used for relief of chronic breathlessness by 80% of physicians; 81.7% referred patients to a PC specialist. More than half of the respondents always or often discussed EOL issues only with the patient's caregivers or relatives. Younger physicians, those at an earlier stage of their career, those caring for higher numbers of patients with lung cancer, and those who were better acquainted with Polish Respiratory Society recommendations for PC in chronic lung diseases seemed to provide better EOL care for COPD patients. CONCLUSIONS Patients with COPD, as compared with patients with lung cancer, were less frequently treated with opioids to relieve chronic breathlessness or referred for a PC consultation. Discussing the EOL issues with a patient was generally found challenging by physicians, and most often pursued with caregivers instead. The COPD recommendations on PC may prove helpful in providing better EOL care by pulmonologists.
Clark, J, Amoakwa, E, Blenkinsopp, J, Currow, D, Farrin, A, Foy, R, Macleod, U, Meads, D, Wright-Hughes, A & Johnson, M 2019, 'Cluster randomised feasibility trial to test the routine use of the Needs Assessment Tool: Cancer (NAT:-C) in primary care to reduce unmet patient and carer needs and determine the feasibility of a definitive trial', British Journal of General Practice, vol. 69, no. suppl 1, pp. bjgp19X702857-bjgp19X702857.View/Download from: Publisher's site
BackgroundPeople with cancer commonly have unidentified palliative care needs. The NAT-C is a validated tool to identify and triage unmet needs.AimTo assess the feasibility and acceptability of a primary care cRCT of the NAT-C: 1) recruiting four GP-practices and 40–60 patients, 2) uptake of NAT-C, 3) questionnaire completion 4) acceptability of measures.MethodA non-blinded cRCT with process evaluation. Patients with active cancer were identified through cancer registries or opportunistically. Carers were nominated by patient-participant. Participants completed measures at baseline, 1, 3, and 6 months. Patients booked a 20-minute GP-assessment post-baseline. Patients, carers, and GP practice staff participated in interviews and focus groups.ResultsFive GP practices were approached, four recruited and trained in the use of the NAT-C. Practices were randomised (1:1) to provide a consultation with a known NAT-C trained clinician, or a clinician as usual. Forty-seven patients and 17 carers were recruited. Process evaluation informed refinement of study invitations. Recruitment rate showed a trial was feasible. Forty-three (94%) patients received a study appointment, 42/43 (95%) attended and 32/43 (76%) a NAT-guided consultation. The proposed primary outcome measure (Supportive Care Needs Survey) was completed by 43 (91%) at 1 month and the proportion with ≥1 moderate–severe unmet need fell from 72% (baseline) to 45%. Fifteen patient interviews and four focus groups with GP practices were conducted. Participants supported the definitive trial and found measures acceptable.ConclusionA definitive cRCT is feasible based on the recruitment rate, intervention uptake, and data collect...
Currow, DC, Hunt, T, Louw, S, Eckert, D, Allcroft, P, To, THM, Greene, A, Krajnik, M, Mahler, D & Ekström, M 2019, 'Isolating peripheral effects of endogenous opioids in modulating exertional breathlessness in people with moderate or severe COPD: a randomised controlled trial.', ERJ open research, vol. 5, no. 4.View/Download from: Publisher's site
Question addressed by the study:Endogenous opioids (endorphins) have been reported to modulate exercise-induced breathlessness, but the relative contribution of peripheral opioid receptors has not been tested. Materials participants and methods:This was a double-blind, randomised, three-arm, cross-over trial in outpatients with spirometry-verified moderate to severe chronic obstructive pulmonary disease. Participants undertook an incremental symptom-limited treadmill test followed by five endurance treadmill tests at 75% of their maximal work rate; two tests for familiarisation and three tests 30 min after intravenous injection of either methylnaltrexone 0.3 mg·kg-1 (blocking peripheral opioid receptors only) or naloxone 0.1 mg·kg-1 (blocking both central and peripheral opioid receptors) or normal saline, in randomised order. The primary end-point was the regression slope between breathlessness intensity (0-10 numerical rating scale) and oxygen consumption (V'O2 ) during the walk tests, comparing methylnaltrexone and placebo using a paired t-test. Results:17 participants completed the trial: median (range) 66 (55-82) years; 15 males; mean±sd forced expiratory volume (FEV1) 53.8±17.6% predicted; FEV1/forced vital capacity ratio 0.55±15.9. There was no statistically or clinically significant difference in the primary end-point (regression slope of breathlessness intensity and V'O2 ) for methylnaltrexone (p=0.498) or naloxone (p=0.804), compared to placebo. Secondary outcomes were similar between the three treatment groups, including peak and mean breathlessness intensity and unpleasantness, exercise capacity, endurance time and leg fatigue. Answer to the question:Blocking peripheral opioid receptors (methylnaltrexone) or peripheral and central opioid receptors (naloxone) did not appear to modulate breathlessness intensity nor exercise capacity when compared with placebo (no blockade).
Ekstrom, M, Chang, S, Johnson, MJ, Fazekas, B, Kochovska, S, Huang, C & Currow, DC 2019, 'Low agreement between mMRC rated by patients and clinicians: implications for practice', EUROPEAN RESPIRATORY JOURNAL, vol. 54, no. 6.View/Download from: Publisher's site
Ekström, M, Williams, M, Johnson, MJ, Huang, C & Currow, DC 2019, 'Agreement Between Breathlessness Severity and Unpleasantness in People With Chronic Breathlessness: A Longitudinal Clinical Study.', Journal of pain and symptom management, vol. 57, no. 4, pp. 715-723.View/Download from: Publisher's site
CONTEXT:Chronic breathlessness is a cardinal symptom in cardiopulmonary disease where both overall intensity or severity (S) and unpleasantness (U) are commonly quantified. OBJECTIVE:We aimed to evaluate agreement between breathlessness severity and unpleasantness over eight days in patients with chronic breathlessness. METHODS:Longitudinal analysis of 265 patients with chronic breathlessness who rated current overall breathlessness severity and unpleasantness on a 0-100 mm visual analogue scale (VAS) in the morning and evening over eight days. A total of 3630 paired overall severity-unpleasantness (S-U) differences were analyzed; median 15 (IQR 13-16) per patient. Agreement was evaluated using Bland-Altman plots. Associations of the difference between severity and unpleasantness (S-U difference) with clinical factors and perceived quality of life were analyzed using multilevel linear regression adjusted for confounders. RESULTS:Over eight days, severity and unpleasantness scores were highly correlated, had similar variability, and varied more between patients than within patients. The mean S-U difference was small at 2.1 mm. Agreement between overall severity and unpleasantness was similar or higher than expected from the variability in individual scores. The S-U difference was similar across evaluated factors including age, sex, diagnosis, morning/evening assessment, modified Medical Research Council breathlessness score, morphine treatment, and presence of different sensory qualities of breathlessness. Higher overall severity and unpleasantness associated with worse perceived quality of life in a similar way. CONCLUSION:In patients with chronic breathlessness over eight days, overall severity and unpleasantness of breathlessness were comparable and associated to other clinical factors in a similar manner.
Hardy, JR, Skerman, H, Philip, J, Good, P, Currow, DC, Mitchell, G & Yates, P 2019, 'Methotrimeprazine versus haloperidol in palliative care patients with cancer-related nausea: a randomised, double-blind controlled trial.', BMJ open, vol. 9, no. 9.View/Download from: Publisher's site
OBJECTIVES:Methotrimeprazine is commonly used for the management of nausea but never tested formally against other drugs used in this setting. The aim was to demonstrate superior antiemetic efficacy. DESIGN:Double-blind, randomised, controlled trial of methotrimeprazine versus haloperidol. SETTING:11 palliative care sites in Australia. PARTICIPANTS:Participants were >18 years, had cancer, an average nausea score of ≥3/10 and able to tolerate oral medications. Ineligible patients had acute nausea related to treatment, nausea for which a specific antiemetic was indicated, were about to undergo a procedure or had received either of the study drugs or a change in glucocorticoid dose within the previous 48 hours. INTERVENTIONS:Based on previous studies, haloperidol was used as the control. Participants were randomised to encapsulated methotrimeprazine 6·25 mg or haloperidol 1·5 mg one time or two times per day and assessed every 24 hours for 72 hours. MAIN OUTCOME MEASURES:A ≥two-point reduction in nausea score at 72 hours from baseline. Secondary outcome measures were as follows: complete response at 72 hours (end nausea score less than 3), response at 24 and 48 hours, vomiting episodes, use of rescue antiemetics, harms and global impression of change. RESULTS:Response to treatment at 72 hours was 75% (44/59) in the haloperidol (H) arm and 63% (36/57) in the methotrimeprazine (M) arm with no difference between groups (intention-to-treat analysis). Complete response rates were 56% (H) and 51% (M). In the per protocol analysis, there was no difference in response rates: (85% (44/52) (H) and 74% (36/49) (M). Complete per protocol response rates were 64% (H) and 59% (M). Toxicity worse than baseline was minimal with a trend towards greater sedation in the methotrimeprazine arm. CONCLUSION:This study did not demonstrate any difference in response rate between methotrimeprazine and haloperidol in the control of nausea. TRIAL REGISTRATION NUMBER:ACTRN 12615000177550.
Hochman, MJ, Kamal, AH, Wolf, SP, Samsa, GP, Currow, DC, Abernethy, AP & LeBlanc, TW 2019, 'Erratum to 'Anticholinergic Drug Burden in Noncancer Versus Cancer Patients Near the End of Life [Journal of Pain and Symptom Management 52 (2016) 737-743]', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 57, no. 5, pp. E9-E10.View/Download from: Publisher's site
Hodiamont, F, Allgar, V, Currow, DC & Johnson, MJ 2019, 'Mental wellbeing in bereaved carers: A Health Survey for England population study', BMJ Supportive and Palliative Care.View/Download from: Publisher's site
© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ. Objectives: The experience of caregiving may affect carers' well-being into bereavement. We explored associations between mental well-being and previous experience of bereavement of, and caring for, someone close at the end-of-life. Methods: An end-of-life set of questions was included in population-based household survey administered to adults (age 16 years and above). We used univariable regression to explore the cross-sectional relationship between our primary outcome (Warwick-Edinburgh Mental Well-being Scale (WEMWBS)) and possible explanatory variables: sociodemographic; death and bereavement including ability to continue with their life; disease and carer characteristics; service use and caregiving experience. Results: The analysis dataset included 7606 of whom 5849 (77%) were not bereaved, 1174 (15%) were bereaved but provided no care and 583 (8%) were bereaved carers. WEMWBS was lower in the oldest age class (85 years and above) in both bereaved groups compared with not bereaved (p<0.001). The worst WEMWBS scores were seen in the €bereaved but no care' group who had bad/very bad health self-assessed general health (39.8 (10.1)) vs 41.6 (9.5)) in those not bereaved and 46.4 (10.7) in bereaved carers. Among the bereaved groups, those who would not be willing to care again had lower WEMWBS scores than those who would (48.3 (8.3) vs 51.4 (8.4), p=0.024). Conclusion: Mental well-being in bereavement was worse in people with self-reported poor/very poor general health and those with a worse caregiving experience. Although causality cannot be assumed, interventions to help people with worse mental and physical health to care, so that their experience is as positive as possible, should be explored prospectively.
Hutchinson, A, Johnson, MJ & Currow, D 2019, 'Acute-on-Chronic Breathlessness: Recognition and Response.', Journal of pain and symptom management, vol. 57, no. 5, pp. e4-e5.View/Download from: Publisher's site
Janssen, DJ, Boyne, J, Currow, DC, Schols, JM, Johnson, MJ & La Rocca, H-PB 2019, 'Timely recognition of palliative care needs of patients with advanced chronic heart failure: a pilot study of a Dutch translation of the Needs Assessment Tool: Progressive Disease - Heart Failure (NAT:PD-HF).', European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology, vol. 18, no. 5, pp. 375-388.View/Download from: Publisher's site
BACKGROUND:The Needs Assessment Tool: Progressive Disease - Heart Failure (NAT:PD-HF) was developed to identify and triage palliative care needs in patients with chronic heart failure. A Dutch version is currently lacking. AIMS:The aim of this study was to investigate the feasibility and acceptability of a Dutch NAT:PD-HF in chronic heart failure outpatients; and to gain preliminary data regarding the effect of the NAT:PD-HF on palliative care referral, symptoms, health status, care dependency, caregiver burden and advance directives. METHODS:A mixed methods study including 23 outpatients with advanced chronic heart failure and 20 family caregivers was performed. Nurses conducted patient consultations using a Dutch translation of the NAT:PD-HF and rated acceptability. Before this visit and 4 months later, symptoms, health status, performance status, care dependency, caregiver burden and recorded advance directives were assessed. A focus group with participating nurses discussed barriers and facilitators towards palliative care needs assessment. RESULTS:Acceptability was rated as 7 (interquartile range 6-7 points) on a 10-point scale. All patients had palliative care needs. In 48% actions were taken, including two patients referred to palliative care. Symptoms, performance status, care dependency, caregiver burden and advance directives were unchanged at 4 months, while health status deteriorated in patients completing follow-up ( n=17). Barriers towards palliative care needs assessment included feeling uncomfortable to initiate discussions and concerns about the ability to address palliative care needs. CONCLUSIONS:The NAT:PD-HF identified palliative care needs in all participants, and triggered action to address these in half. However, training in palliative care communication skills as well as palliative care interventions should accompany the introduction of a palliative care needs assessment tool. NETHERLANDS NATIONAL TRIAL REGISTER (NTR):5616. http://www.tri...
Janssen, DJA, Rechberger, S, Wouters, EFM, Schols, JMGA, Johnson, MJ, Currow, DC, Curtis, JR & Spruit, MA 2019, 'Clustering of 27,525,663 Death Records from the United States Based on Health Conditions Associated with Death: An Example of big Health Data Exploration.', Journal of clinical medicine, vol. 8, no. 7.View/Download from: Publisher's site
BACKGROUND:Insight into health conditions associated with death can inform healthcare policy. We aimed to cluster 27,525,663 deceased people based on the health conditions associated with death to study the associations between the health condition clusters, demographics, the recorded underlying cause and place of death. METHODS:Data from all deaths in the United States registered between 2006 and 2016 from the National Vital Statistics System of the National Center for Health Statistics were analyzed. A self-organizing map (SOM) was used to create an ordered representation of the mortality data. RESULTS:16 clusters based on the health conditions associated with death were found showing significant differences in socio-demographics, place, and cause of death. Most people died at old age (73.1 (18.0) years) and had multiple health conditions. Chronic ischemic heart disease was the main cause of death. Most people died in the hospital or at home. CONCLUSIONS:The prevalence of multiple health conditions at death requires a shift from disease-oriented towards person-centred palliative care at the end of life, including timely advance care planning. Understanding differences in population-based patterns and clusters of end-of-life experiences is an important step toward developing a strategy for implementing population-based palliative care.
Johnson, M, Amoakwa, E, Allgar, V, Blenkinsopp, J, Currow, D, Farrin, A, Foy, R, MacLeod, U, Meads, D, Wright-Hughes, A & Clark, J 2019, '146 A cluster randomised feasibility trial (cRCT) to test the routine use of the needs assessment tool: cancer (NAT:C) in primary care to reduce unmet patient and carer needs and determine the feasibility of a definitive trial', Poster presentations.View/Download from: Publisher's site
Johnson, MJ, Cockayne, S, Currow, DC, Bell, K, Hicks, K, Fairhurst, C, Gabe, R, Torgerson, D, Jefferson, L, Oxberry, S, Ghosh, J, Hogg, KJ, Murphy, J, Allgar, V, Cleland, JGF & Clark, AL 2019, 'Oral modified release morphine for breathlessness in chronic heart failure: a randomized placebo-controlled trial', ESC HEART FAILURE, vol. 6, no. 6, pp. 1149-1160.View/Download from: Publisher's site
Jones, TA, Olds, TS, Currow, DC & Williams, MT 2019, 'Use of time in people with a life-limiting illness: A longitudinal cohort feasibility pilot study', PALLIATIVE MEDICINE, vol. 33, no. 10, pp. 1319-1324.View/Download from: Publisher's site
Kochovska, S, Fazekas, B, Hensley, M, Wheatley, J, Allcroft, P & Currow, DC 2019, 'A Randomized, Double-Blind, Multisite, Pilot, Placebo-Controlled Trial of Regular, Low-Dose Morphine on Outcomes of Pulmonary Rehabilitation in COPD', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 58, no. 5, pp. E7-E9.View/Download from: Publisher's site
Krajnik, M, Currow, DC & Sobański, P 2019, 'Appropriate pharmacotherapy at the end of life: prescribing safely and only what is needed as part of whole-person care.', Polish archives of internal medicine, vol. 129, no. 10, pp. 654-656.View/Download from: Publisher's site
Krajnik, M, Currow, DC, Brożek, B, Damps-Konstańska, I, Pierzchała, W, Barczyk, A & Jassem, E 2019, 'End-of-life care for patients with advanced lung cancer and chronic obstructive pulmonary disease. Authors' reply.', Polish archives of internal medicine, vol. 129, no. 6, pp. 436-437.View/Download from: Publisher's site
Lin, E, Chen, T, Little, A, Holliday, L, Roach, P, Butler, P, Hosking, E, Bailey, E, Elison, B & Currow, D 2019, 'Safety and outcomes of Lu-177-DOTATATE for neuroendocrine tumours: experience in New South Wales, Australia', INTERNAL MEDICINE JOURNAL, vol. 49, no. 10, pp. 1268-1277.View/Download from: Publisher's site
Mitchell, GK, Willmott, L, White, BP, Piper, D, Currow, DC & Yates, PM 2019, 'A perfect storm: fear of litigation for end of life care.', The Medical journal of Australia, vol. 210, no. 10, pp. 441-441.e1.View/Download from: Publisher's site
Morgan, DD, Tieman, JJ, Allingham, SF, Ekström, MP, Connolly, A & Currow, DC 2019, 'The trajectory of functional decline over the last 4 months of life in a palliative care population: A prospective, consecutive cohort study.', Palliative medicine, vol. 33, no. 6, pp. 693-703.View/Download from: Publisher's site
BACKGROUND:Understanding current patterns of functional decline will inform patient care and has health service and resource implications. AIM:This prospective consecutive cohort study aims to map the shape of functional decline trajectories at the end of life by diagnosis. DESIGN:Changes in functional status were measured using the Australia-modified Karnofsky Performance Status Scale. Segmented regression was used to identify time points prior to death associated with significant changes in the slope of functional decline for each diagnostic cohort. Sensitivity analyses explored the impact of severe symptoms and late referrals, age and sex. SETTING/PARTICIPANTS:In all, 115 specialist palliative care services submit prospectively collected patient data to the national Palliative Care Outcomes Collaboration across Australia. Data on 55,954 patients who died in the care of these services between 1 January 2013 and 31 December 2015 were included. RESULTS:Two simplified functional decline trajectories were identified in the last 4 months of life. Trajectory 1 has an almost uniform slow decline until the last 14 days of life when function declines more rapidly. Trajectory 2 has a flatter more stable trajectory with greater functional impairment at 120 days before death, followed by a more rapid decline in the last 2 weeks of life. The most rapid rate of decline occurs in the last 2 weeks of life for all cohorts. CONCLUSIONS:Two simplified trajectories of functional decline in the last 4 months of life were identified for five patient cohorts. Both trajectories present opportunities to plan for responsive healthcare that will support patients and families.
Nic Giolla Easpaig, B, Arnolda, G, Tran, Y, Bierbaum, M, Lamprell, K, Delaney, GP, Liauw, W, Chittajallu, R, Winata, T, Ward, RL, Currow, DC, Olver, I, Karnon, J, Westbrook, J & Braithwaite, J 2019, 'What is multidisciplinary cancer care like in practice? a protocol for a mixed-method study to characterise ambulatory oncology services in the Australian public sector.', BMJ open, vol. 9, no. 10, pp. e031179-e031179.View/Download from: Publisher's site
INTRODUCTION:An understanding of the real-world provision of oncology outpatient services can help maintain service quality in the face of escalating demand and tight budgets, by informing the design of interventions that improve the effectiveness or efficiency of provision. The aims of this study are threefold. First, to develop an understanding of cancer services in outpatient clinics by characterising the organisation and practice of multidisciplinary care (MDC). Second, to explore the key areas of: (a) clinical decision-making and (b) engagement with patients' supportive needs. Third, to identify barriers to, and facilitators of, the delivery of quality care in these settings. METHODS AND ANALYSIS:A suite of mixed-methods studies will be implemented at six hospitals providing cancer outpatient clinics, with a staged roll-out. In Stage One, we will examine policies, use unstructured observations and undertake interviews with key health professionals to characterise the organisation and delivery of MDC. In Stage Two, observations of practice will continue, to deepen our understanding, and to inform two focused studies. The first will explore decision-making practices and the second will examine how staff engage with patients' needs; both studies involve interviews, to complement observation. As part of the study of supportive care, we will examine the implications of an introduction of patient-reported measures (PRMs) into care, adding surveys to interviews before and after PRMs roll-out. Data analysis will account for site-specific and cross-site issues using an adapted Qualitative Rapid Appraisal, Rigorous Analysis approach. Quantitative data from clinician surveys will be statistically analysed and triangulated with the related qualitative study findings. ETHICS AND DISSEMINATION:Ethical approval was granted by South Eastern Sydney Local Health District Human Research Ethics Committee (no. 18/207). Findings will be shared with participating hospitals and wid...
Purdie, S, Creighton, N, White, KM, Baker, D, Ewald, D, Lee, CK, Lyon, A, Man, J, Michail, D, Miller, AA, Tan, L, Currow, D & Young, JM 2019, 'Pathways to diagnosis of non-small cell lung cancer: a descriptive cohort study.', NPJ primary care respiratory medicine, vol. 29, no. 1.View/Download from: Publisher's site
Little has been published on the diagnostic and referral pathway for lung cancer in Australia. This study set out to quantify general practitioner (GP) and lung specialist attendance and diagnostic imaging in the lead-up to a diagnosis of non-small cell lung cancer (NSCLC) and identify common pathways to diagnosis in New South Wales (NSW), Australia. We used linked health data for participants of the 45 and Up Study (a NSW population-based cohort study) diagnosed with NSCLC between 2006 and 2012. Our main outcome measures were GP and specialist attendances, X-rays and computed tomography (CT) scans of the chest and lung cancer-related hospital admissions. Among our study cohort (N = 894), 60% (n = 536) had ≥4 GP attendances in the 3 months prior to diagnosis of NSCLC, 56% (n = 505) had GP-ordered imaging (chest X-ray or CT scan), 39% (N = 349) attended a respiratory physician and 11% (N = 102) attended a cardiothoracic surgeon. The two most common pathways to diagnosis, accounting for one in three people, included GP and lung specialist (respiratory physician or cardiothoracic surgeon) involvement. Overall, 25% of people (n = 223) had an emergency hospital admission. For 14% of people (N = 129), an emergency hospital admission was the only event identified on the pathway to diagnosis. We found little effect of remoteness of residence on access to services. This study identified a substantial proportion of people with NSCLC being diagnosed in an emergency setting. Further research is needed to establish whether there were barriers to the timely diagnosis of these cases.
Sandberg, J, Lansing, R, Anderberg, P, Currow, D, Sundh, J, Ahmadi, Z, Palmqvist, S & Ekström, M 2019, 'Relating Experienced To Recalled breathlessness Observational (RETRO) study: a prospective study using a mobile phone application.', BMJ Open Respiratory Research, vol. 6, no. 1, pp. e000370-e000370.View/Download from: Publisher's site
Background:Breathlessness, the subjective sensation of breathing discomfort, is common and appears in the daily life of people with cardiorespiratory diseases. Physicians often rely on patient's history based on symptom recall. The relation between recalled and experienced breathlessness is still poorly understood. This paper presents the protocol for a study primarily aimed at evaluating the relationship between experienced breathlessness and (1) recalled breathlessness and (2) predicted future breathlessness. Methods:A mobile phone application will be used to collect data during daily life. Medically stable participants, ≥18 years of age with mean daily breathlessness of Numerical Rating Scale (NRS) 3/10 and able to use a mobile phone with internet will rate their breathlessness intensity on a 0-10 NRS prompted the user several times daily for 1 week. Participants will recall their breathlessness each day and week. Multivariable random effects regression models will be used for statistical analyses. Results:Results of the study will be submitted for publication in peer-reviewed journals and presented at relevant conferences. Discussion:This protocol describes a study aimed at investigating previously unknown areas of the experience and recall of breathlessness using a new method of data collection. Registration details:Prospectively registered with ClinicalTrials.gov (Nr: NCT03468205). Ethics and dissemination:The study has received ethical approval from the Regional Ethical Review Board Lund (DNr 2017/149). After a general study information including that participation is entirely voluntary, participants will answer the eligibility criteria and be asked to consent to participate before entering the study questions. Written informed consent to participate will be obtained for participants in the clinical sub-cohort. Participation can be discontinued at the discretion of the participant in which case no further data will be collected.
Sara, G, Arumuganathan, M, Chen, W, Wu, F, Currow, D, Large, M, Mulder, C, Ramanuj, PP & Burgess, PM 2019, 'Cohort profile: Mental Health Living Longer: a population-wide data linkage to understand and reduce premature mortality in mental health service users in New South Wales, Australia.', BMJ open, vol. 9, no. 11.View/Download from: Publisher's site
PURPOSE:Health systems must move from recognition to action if we are to address premature mortality in people with mental illness. Population data registers are an essential tool for planning and monitoring improvement efforts. The Mental Health Living Longer (MHLL) programme establishes a population-wide data linkage to support research translation and service reform in New South Wales (NSW), Australia. PARTICIPANTS:A total of 8.6 million people who have had contact with NSW public and private health services between July 2001 and June 2018 are currently included in the study. Data include more than 120 million linked records from NSW data collections covering public and private hospital care, emergency departments, ambulance, community mental health services, cancer notifications and care, and death registrations. Linkage is occurring with population-wide breast and cervical cancer screening programmes. Data will be updated 6 monthly. FINDINGS TO DATE:The cohort includes 970 145 people who have received mental healthcare: 79% have received community mental healthcare, 35% a general hospital admission with a primary mental health diagnosis and 25% have received specialist mental health inpatient care. The most frequent pattern of care is receipt of community mental healthcare only (50%). The median age of the mental health cohort is 34 years, and three-quarters are younger than 53 years. Eleven per cent of the mental health cohort had died during the observation period. Their median age at death was 69 years, which was younger than the median age at death for people accessing other health services. FUTURE PLANS:The MHLL programme will examine (i) all-cause mortality, (ii) suicide, (iii) cancer mortality and (iv) medical mortality. Within each theme, the programme will quantify the problem in mental health service users compared with the NSW population, describe the people most affected, describe the care received, identify predictors of premature mortality, and...
Smallwood, N, Currow, D, Booth, S, Spathis, A, Irving, L & Philip, J 2019, 'Approaches to palliative oxygen therapy in chronic obstructive pulmonary disease: a multi-national survey of specialists.', Internal medicine journal, vol. 49, no. 2, pp. 252-256.View/Download from: Publisher's site
As palliative oxygen therapy (POT) is beneficial only to a minority of patients with chronic breathlessness, it is no longer routinely recommended. This multi-national, online survey of respiratory and palliative medicine specialists, with 440 participants, identified that prescription of POT has decreased over the past decade; however a sizeable proportion of doctors, particularly within palliative care, still support and recommend POT. Further education and research regarding the optimal management of chronic breathlessness are required.
Sundh, J, Bornefalk-Hermansson, A, Ahmadi, Z, Blomberg, A, Janson, C, Currow, DC, McDonald, CF, McCaffrey, N & Ekström, M 2019, 'REgistry-based randomized controlled trial of treatment and Duration and mortality in long-term OXygen therapy (REDOX) study protocol.', BMC pulmonary medicine, vol. 19, no. 1.View/Download from: Publisher's site
OBJECTIVE:Long-term oxygen therapy (LTOT) during 15 h/day or more prolongs survival in patients with chronic obstructive pulmonary disease (COPD) and severe hypoxemia. No randomized controlled trial has evaluated the net effects (benefits or harms) from LTOT 24 h/day compared with 15 h/day or the effect in conditions other than COPD. We describe a multicenter, national, phase IV, non-superiority, registry-based, randomized controlled trial (R-RCT) of LTOT prescribed 24 h/day compared with 15 h/day. The primary endpoint is all-cause-mortality at 1 year. Secondary endpoints include cause-specific mortality, hospitalizations, health-related quality of life, symptoms, and outcomes in interstitial lung disease. METHODS/DESIGN:Patients qualifying for LTOT are randomized to LTOT 24 h/day versus 15 h/day during 12 months using the Swedish Register for Respiratory Failure (Swedevox). Planned sample size in this pragmatic study is 2126 randomized patients. Clinical follow-up and concurrent treatments are according to routine clinical practice. Mortality, hospitalizations, and incident diseases are assessed using national Swedish registries with expected complete follow-up. Patient-reported outcomes are assessed using postal questionnaire at 3 and 12 months. DISCUSSION:The R-RCT approach combines the advantages of a prospective randomized trial and large clinical national registries for enrollment, allocation, and data collection, with the aim of improving the evidence-based use of LTOT. TRIAL REGISTRATION:Clinical Trial registered with www.clinicaltrials.gov , Title: REgistry-based Treatment Duration and Mortality in Long-term OXygen Therapy (REDOX); ID: NCT03441204.
Tervonen, HE, Chen, TYT, Lin, E, Boyle, FM, Moylan, EJ, Della-Fiorentina, SA, Beith, J, Johnston, A & Currow, DC 2019, 'Risk of emergency hospitalisation and survival outcomes following adjuvant chemotherapy for early breast cancer in New South Wales, Australia', EUROPEAN JOURNAL OF CANCER CARE, vol. 28, no. 5.View/Download from: Publisher's site
Tervonen, HE, Morrell, S, Roder, D, You, H & Currow, DC 2019, 'Differences in cancer incidence by age at diagnosis between Aboriginal and non-Aboriginal people for cancer types included in Australian national screening programs.', Cancer epidemiology, vol. 60, pp. 102-105.View/Download from: Publisher's site
BACKGROUND:This study examined age distributions and age-specific incidence of screened cancers by Aboriginal status in New South Wales (NSW) to consider the appropriateness of screening target age ranges. METHODS:The NSW Cancer Registry identified invasive (female) breast, cervical and bowel cancers in people diagnosed in 2001-2014. RESULTS:Aboriginal people were younger at diagnosis with higher proportions of breast and bowel cancers diagnosed before the screening target age range (<50 years) compared with non-Aboriginal people (30.6% vs. 22.8%, and 17.3% vs. 7.3%, respectively). Age-specific incidence rate ratios (IRRs) were lower/similar for breast and bowel cancers in younger and higher in older Aboriginal than non-Aboriginal people. All age-specific cervical cancer IRRs were higher for Aboriginal compared with non-Aboriginal people. CONCLUSION:Although higher proportions of breast and colorectal cancers were diagnosed before screening commencement age in Aboriginal people, this does not necessarily indicate a need for earlier screening commencement. Other aspects needing consideration include benefits, harms and cost-effectiveness.
To, THM, Currow, DC, Swetenham, K, Morgan, DD & Tieman, J 2019, 'How Can Activity Monitors Be Used in Palliative Care Patients?', Journal of palliative medicine, vol. 22, no. 7, pp. 830-832.View/Download from: Publisher's site
Background: Physical activity in palliative care patients is closely linked to independence, function, carer burden, prognosis, and quality of life. Changes in physical activity can also be related to service provision needs, including requirements for support and prognosis. However, the objective measurement of physical activity is challenging, with options, including self-report, invasive and intensive measures such as calorimetry, or newer options such as pedometers and accelerometers. This latter option is also becoming more viable with the advent of consumer technology driven by the health and exercise industry. Objective: In this article, we highlight our experiences of activity monitoring in palliative care patients as part of telehealth trial. We also highlight the strengths and limitations of activity monitoring in the palliative care population and potential applications. Conclusions: Although the advent of consumer technology for activity measurement makes their use seem attractive in clinical settings for palliative care patients, there are a number of issues that must be considered, in particular the reason for the activity monitoring and associated limitations in the technology.
Eastman, P, Currow, DC, Fazekas, B, Brown, L & Le, B 2019, 'Oral dexamethasone in the management of cancer-related pain: A feasibility study.', Palliative Medicine, vol. 33, no. 4, pp. 477-478.View/Download from: Publisher's site
Currow, DC, Agar, M & Ekstroem, M 2019, 'Sertraline or placebo in chronic breathlessness? Lessons from placebo research', EUROPEAN RESPIRATORY JOURNAL, vol. 53, no. 1.View/Download from: Publisher's site
Currow, DC, Ekstrom, M, Louw, S, Hill, J, Fazekas, B, Clark, K, Davidson, P, McDonald, C, Sajkov, D, McCaffrey, N, Doogue, M, Abernethy, AP & Agar, M 2019, 'Sertraline in symptomatic chronic breathlessness: a double blind, randomised trial', European Respiratory Journal, vol. 53, no. 1.View/Download from: Publisher's site
Jeon, MS, Dhillon, HM, Descallar, J, Lam, L, Allingham, S, Koh, ES, Currow, DC & Agar, MR 2019, 'Prevalence and severity of sleep difficulty in patients with a CNS cancer receiving palliative care in Australia', Neuro-Oncology Practice, vol. 6, no. 6, pp. 499-507.View/Download from: Publisher's site
© The Author(s) 2019. Background. The literature describing the incidence of sleep difficulty in CNS cancers is very limited, with exploration of a sleep difficulty symptom trajectory particularly sparse in people with advanced disease. We aimed to establish the prevalence and longitudinal trajectory of sleep difficulty in populations with CNS cancers receiving palliative care nationally, and to identify clinically modifiable predictors of sleep difficulty. Methods. A consecutive cohort of 2406 patients with CNS cancers receiving palliative care from sites participating in the Australian national Palliative Care Outcomes Collaboration were evaluated longitudinally on patientreported sleep difficulty from point-of-care data collection, comorbid symptoms, and clinician-rated problems. Multilevel models were used to analyze patient-reported sleep difficulty. Results. Reporting of mild to severe sleep difficulties ranged from 10% to 43%. Sleep scores fluctuated greatly over the course of palliative care. While improvement in patients' clinical status was associated with less sleep difficulty, the relationship was not clear when patients deteriorated. Worsening of sleep difficulty was associated with higher psychological distress (P < .0001), greater breathing problems (P < .05) and pain (P < .05), and higher functional status (P < .001) at the beginning of care. Conclusions. Sleep difficulty is prevalent but fluctuates widely in patients with CNS cancers receiving palliative care. A better-tailored sleep symptom assessment may be needed for this patient population. Early interventions targeting psychological distress, breathing symptoms, and pain for more functional patients should be explored to see whether it reduces sleep difficulties late in life.
Matsuoka, H, Agar, M, Vandersman, Z, Good, P, Fazekas, B, Brown, L, Hardy, J, Weil, J & Currow, DC 2019, 'Harms From Haloperidol for Symptom Management in Palliative Care-a Post Hoc Pooled Analysis of Three Randomized Controlled Studies and Two Consecutive Cohort Studies.', Journal of Pain and Symptom Management, vol. 58, no. 3, pp. e6-e8.View/Download from: Publisher's site
Matsuoka, H, Allingham, S, Fazekas, B, Brown, L, Vandersman, Z, Clark, K, Agar, MR & Currow, DC 2019, 'Comparability of the Australian National Cancer Symptom Trials (CST) Group's Study Populations to National Referrals to Non-CST Specialist Palliative Care Services Participating in the Palliative Care Outcomes Collaboration.', Journal of Pain and Symptom Management, vol. 57, no. 1, pp. e9-e14.View/Download from: Publisher's site
McCaffrey, N, Flint, T, Kaambwa, B, Fazekas, B, Rowett, D, Currow, DC, Hardy, J, Agar, MR, Quinn, S & Eckermann, S 2019, 'Economic evaluation of the randomised, double-blind, placebo-controlled study of subcutaneous ketamine in the management of chronic cancer pain.', Palliative medicine, vol. 33, no. 1, pp. 74-81.View/Download from: Publisher's site
White, KM, Agar, MR & Currow, DC 2019, 'Assessing the exertion required to induce breathlessness in a population with advanced cancer: matching measures to the level of physical function.', BMC palliative care, vol. 18, no. 1.View/Download from: Publisher's site
BACKGROUND:The aim of the study was to assess four evidence-based assessments utilising exercise challenges that induce breathlessness, each with progressively less demanding levels of exertion, which can be tailored to people with a range of functional capabilities in the setting of advanced cancer for research studies. Functional cut off points for these assessments have not previously been defined. METHODS:A cross sectional study of four exercise tests attempted by all participants: 6 min walk test (6MWT); (derived) 2 min walk test (2MWT); arm exercises; and reading numbers aloud. Performance status (Australia-modified Karnofsky Performance Status (AKPS)), baseline breathlessness using the modified Medical Research Council (mMRC) breathlessness scale, and a visual analogue scale of intensity and unpleasantness of breathlessness were measured. Co-morbidity was codified using the Charlson Co-morbidity Index. Percentage of people completing each test by AKPS level of function and baseline mMRC breathlessness scores were quantified. RESULTS:In the 68 participants, poorer function decreased the proportion of people able to complete the exercise tests. For completion rates ≥80%, of 6MWT and 2MWT, only people with an AKPS 70-90 had completion. For arm exercises, this included people with an AKPS as low as ≥50; and for reading numbers, it included people with an AKPS of 40 but not below. CONCLUSIONS:Walking tests have poor utility in people with high levels of functional impairment. For people with high levels of dependence, reading numbers should be used in evaluating exercise-induced breathlessness in research studies. These data also suggest that people's exertional limitations have been under-estimated as cancer progresses.
Barbetta, C, Allgar, V, Maddocks, M, Ribeiro, C, Wilcock, A, Currow, DC, Phillips, J & Johnson, MJ 2019, 'Australia-modified Karnofsky Performance Scale and physical activity in COPD and lung cancer: An exploratory pooled data analysis', BMJ Supportive and Palliative Care.View/Download from: Publisher's site
© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ. Objectives: Patient-relevant measures of functional status are required in chronic obstructive pulmonary disease (COPD) and lung cancer in clinical practice and research. We explored the relationship between the Australia-modified Karnofsky Performance Scale (AKPS) and measures of functional capacity and physical activity in these patient groups. Methods: Pooled clinical trial data were analysed to explore the relationship between AKPS and average daily steps (ADS), 6 min walk distance (6MWD), and body mass index, airflow obstruction, dyspnoea and exercise score (COPD group). Receiver operator characteristic curves were produced to compare sensitivity and specificity of cut-offs (no dependency >70, high dependency <60) and area under the curve (AUC). Results: Seven clinical trials included people with COPD (n=79) and lung cancer (n=150). To detect an AKPS of >70, the optimal ADS cut-points were COPD, 3342 steps (AUC 0.88, 95% CI 0.79 to 0.97, sensitivity 82%, specificity 76%), and lung cancer, 3380 steps (AUC 0.72, 95% CI 0.64 to 0.81, sensitivity 61%, specificity 74%), and for 6MWD (COPD only) 242 m (AUC 0.72, 95% CI 0.63 to 0.81, sensitivity 73%, specificity 34%). Conclusions: An AKPS score is strongly related to ADS in people with COPD and lung cancer. The AKPS may be useful in clinical practice and research to indicate levels of physical activity where ADS and 6 min walk test are not possible. Longitudinal data are needed to confirm these findings.
Barnes-Harris, M, Allgar, V, Booth, S, Currow, D, Hart, S, Phillips, J, Swan, F & Johnson, MJ 2019, 'Battery operated fan and chronic breathlessness: does it help?', BMJ SUPPORTIVE & PALLIATIVE CARE, vol. 9, no. 4, pp. 478-481.View/Download from: Publisher's site
Breaden, K, Collier, A, Litster, C, Allcroft, P, Currow, DC & Phillips, JL 2019, 'Stigma and the in(visible) perspectives and expectations of home oxygen therapy among people with chronic breathlessness syndrome: A qualitative study.', Palliative medicine, vol. 33, no. 1, pp. 82-90.View/Download from: Publisher's site
BACKGROUND:Chronic breathlessness syndrome in the context of advancing disease is distressing for all concerned. Oxygen is commonly prescribed in this setting; however, little is known about the perspectives of breathless people who either are on oxygen or are yet to have it prescribed. AIM:To understand and describe the perspectives and experiences of breathless people towards oxygen use at home. DESIGN:This qualitative study utilised an interpretive description approach using semi-structured interviews and thematic analysis. SETTING/PARTICIPANTS:A total of 19 people with chronic breathlessness syndrome living in South Australia participated in semi-structured interviews. Participants were divided into sub-groups according to whether they were chronically breathless and (1) not using home oxygen ( n = 6), (2) using funded home oxygen for severe hypoxaemia ( n = 7) and (3) using home oxygen for palliation outside of funding guidelines ( n = 6). RESULTS:Three main themes were identified: (1) managing distress and living with chronic breathlessness syndrome, with or without oxygen, requires a range of self-management strategies; (2) expectations of oxygen use: 'Not as good as I thought it would be'; and (3) the stigma of using oxygen: the visible and invisible. CONCLUSION:People living with chronic breathlessness struggle daily with both the progression of the underlying disease and the distressing nature of the syndrome. While oxygen does provide benefit for some people, its use and the perceptions of its use are often associated with both the visible and invisible manifestations of stigma. Clinicians need to promote self-management strategies and give careful thought to the prescribing of home oxygen, especially outside the current funding guidelines.
Clark, K, Allingham, S, Phillips, JL, Brown, L & Currow, DC 2019, 'A Response to: Challenges in Recruiting Patients to a Controlled Feasibility Study of a Drug for Opioid-Induced Constipation: Lessons From the Population With Advanced Cancer.', Journal of Pain and Symptom Management, vol. 58, no. 3, pp. e1-e2.View/Download from: Publisher's site
Luckett, T, Phillips, J, Currow, DC, Agar, M & Molassiotis, A 2019, 'Cough in lung cancer: A survey of current practice among Australian health professionals', Collegian, vol. 26, no. 6, pp. 629-633.View/Download from: Publisher's site
© 2019 Australian College of Nursing Ltd Background: Systematic reviews and guidelines are available to guide management of cough in lung cancer, but evidence for intervention efficacy is limited, and little research has yet described current practice. Aim: To canvass the experiences and perspectives of Australian health professionals with regard to the clinical importance and current management of cough in people with lung cancer. Methods: An open, online, cross-sectional survey was conducted in 2018. Health professionals of all disciplines were eligible, and recruitment was by direct approach to lung cancer multidisciplinary teams, professional listservs and conferences. Findings: Fifty-eight people completed the survey, of whom 26 (45%) were medical practitioners, 21 (36%) registered nurses, and 10 (17%) allied health practitioners. Nearly all (>90%) considered cough to be of clinical concern and welcomed efforts to improve management. In most services, ≤25% of patients with clinically concerning cough receive management. Opiates were perceived to be the most consistently effective pharmacological strategy, with ≥50% participants indicating minimal or variable effectiveness for all others. The few participants who had experience of non-pharmacological strategies perceived these to be only somewhat or variably effective. Discussion: Results from this study identified variability in the management of cough associated with lung cancer, and suggest this problem may be under-treated in most services. Unmet needs identified by this study are likely under-estimated due to the volunteer effect associated with open surveys. Conclusion: Further efforts are needed to raise awareness about the importance of managing cough and provide evidence-based strategies for this population.
Phillips, JL, Lobb, EA, Bellemore, F, Hays, T & Currow, DC 2019, ''Through the eyes of the dying'—Identifying who may benefit from bereavement follow-up: A qualitative study', Collegian, vol. 26, no. 6, pp. 615-620.View/Download from: Publisher's site
© 2019 Introduction: Bereavement support is an integral element of palliative care. Emerging evidence stipulates that bereavement support should be reserved for those most at risk of poor outcomes. While this evidence makes identifying those at risk of experiencing a complex bereavement a necessary first step, it has been difficult to arrive at a consensus as to whom that should be. Aim: To explore whether palliative care in-patients with advanced disease are concerned about the bereavement needs of others and, if so, is it their next-of-kin. Design: A qualitative study using semi-structured interviews, and thematic analysis using a constant comparative method. Setting/participants: Patients identified by their physicians as being aware of their limited prognosis (n = 19) in a specialist palliative care service in Sydney, Australia. Findings: Three key themes emerged: 1) Families considered close and supportive may not require bereavement follow-up; 2) Families with previous significant losses or who have more complex lives are perceived by patients as having greater risk; and 3) Asking palliative care patients about whom they are most concerned in their network after their death is difficult but possible. Conclusions: There are potentially people in the palliative patients' networks who may be in need of bereavement support, but who are unlikely to be informed about available bereavement services. New strategies are needed to identify people who may benefit from bereavement support.
Yee, J, Davis, GM, Hackett, D, Beith, JM, Wilcken, N, Currow, D, Emery, J, Phillips, J, Martin, A, Hui, R, Harrison, M, Segelov, E & Kilbreath, SL 2019, 'Physical Activity for Symptom Management in Women With Metastatic Breast Cancer: A Randomized Feasibility Trial on Physical Activity and Breast Metastases', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 58, no. 6, pp. 929-939.View/Download from: Publisher's site
Disler, RT, Inglis, SC, Newton, P, Currow, DC, Macdonald, PS, Glanville, AR, Donesky, D, Carrieri-Kohlman, V & Davidson, PM 2019, 'Older Patients' Perspectives of Online Health Approaches in Chronic Obstructive Pulmonary Disease.', Telemedicine Journal and e-Health, vol. 25, no. 9.View/Download from: Publisher's site
BACKGROUND:Chronic obstructive pulmonary disease (COPD) is a complex, chronic condition. Patients commonly have limited access to face-to-face support due to decreased mobility, symptom burden, and availability of services. Online health care approaches provide the potential for increased access to self-management education and support. This study sought to understand older patients with COPD's perspectives of online approaches to health care. MATERIALS AND METHODS:Participants older than 65 years were recruited from a respiratory service at an academic medical center. Qualitative, focus groups were used and recorded, transcribed verbatim, and analyzed using thematic analysis to identify key and repeated emergent themes. RESULTS:Focus groups were undertaken between January and May 2014. Thematic analysis resulted in five overall themes: (1) concern over risks in the online environment; (2) multimedia and technology use as part of everyday life; (3) online resources as an opportunity for revision of forgotten knowledge; (5) potential for facilitation of decision-making support across geographical and physical barriers; and (4) perceived benefits of online peer support for people with COPD. CONCLUSIONS:Overall, these older participants with COPD had positive views of online health information, but did raise the need for guidance to ensure valid and reliable online sources. The capacity for online sources to increase access to decision support and up-to-date information was viewed positively, as was the ability to interact with peers who had similar experiences. Telecommunication tools and approaches are already being utilized in health care interactions. Further research is required into the most appropriate, feasible, and sustainable online health approaches to support patients with chronic illnesses such as COPD.
Ahmadi, Z, Sandberg, J, Shannon-Honson, A, Vandersman, Z, Currow, DC & Ekstroem, M 2018, 'Is chronic breathlessness less recognised and treated compared with chronic pain? A case-based randomised controlled trial', EUROPEAN RESPIRATORY JOURNAL, vol. 52, no. 3.View/Download from: Publisher's site
Allemani, C, Matsuda, T, Di Carlo, V, Harewood, R, Matz, M, Nikšić, M, Bonaventure, A, Valkov, M, Johnson, CJ, Estève, J, Ogunbiyi, OJ, Azevedo e Silva, G, Chen, WQ, Eser, S, Engholm, G, Stiller, CA, Monnereau, A, Woods, RR, Visser, O, Lim, GH, Aitken, J, Weir, HK, Coleman, MP, Bouzbid, S, Hamdi-Chérif, M, Zaidi, Z, Meguenni, K, Regagba, D, Bayo, S, Cheick Bougadari, T, Manraj, SS, Bendahhou, K, Fabowale, A, Bradshaw, D, Somdyala, NIM, Kumcher, I, Moreno, F, Calabrano, GH, Espinola, SB, Carballo Quintero, B, Fita, R, Diumenjo, MC, Laspada, WD, Ibañez, SG, Lima, CA, De Souza, PCF, Del Pino, K, Laporte, C, Curado, MP, de Oliveira, JC, Veneziano, CLA, Veneziano, DB, Latorre, MRDO, Tanaka, LF, Rebelo, MS, Santos, MO, Galaz, JC, Aparicio Aravena, M, Sanhueza Monsalve, J, Herrmann, DA, Vargas, S, Herrera, VM, Uribe, CJ, Bravo, LE, Garcia, LS, Arias-Ortiz, NE, Morantes, D, Jurado, DM, Yépez Chamorro, MC, Delgado, S, Ramirez, M, Galán Alvarez, YH, Torres, P, Martínez-Reyes, F, Jaramillo, L, Quinto, R, Castillo, J, Mendoza, M, Cueva, P, Yépez, JG, Bhakkan, B, Deloumeaux, J, Joachim, C, Macni, J, Carrillo, R, Shalkow Klincovstein, J, Rivera Gomez, R, Poquioma, E, Tortolero-Luna, G, Zavala, D, Alonso, R, Barrios, E, Eckstrand, A, Nikiforuk, C, Noonan, G, Turner, D, Kumar, E, Zhang, B, McCrate, FR & Ryan, S 2018, 'Global surveillance of trends in cancer survival 2000–14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries', The Lancet, vol. 391, no. 10125, pp. 1023-1075.View/Download from: Publisher's site
© 2018 Elsevier Ltd Background: In 2015, the second cycle of the CONCORD programme established global surveillance of cancer survival as a metric of the effectiveness of health systems and to inform global policy on cancer control. CONCORD-3 updates the worldwide surveillance of cancer survival to 2014. Methods: CONCORD-3 includes individual records for 37·5 million patients diagnosed with cancer during the 15-year period 2000–14. Data were provided by 322 population-based cancer registries in 71 countries and territories, 47 of which provided data with 100% population coverage. The study includes 18 cancers or groups of cancers: oesophagus, stomach, colon, rectum, liver, pancreas, lung, breast (women), cervix, ovary, prostate, and melanoma of the skin in adults, and brain tumours, leukaemias, and lymphomas in both adults and children. Standardised quality control procedures were applied; errors were rectified by the registry concerned. We estimated 5-year net survival. Estimates were age-standardised with the International Cancer Survival Standard weights. Findings: For most cancers, 5-year net survival remains among the highest in the world in the USA and Canada, in Australia and New Zealand, and in Finland, Iceland, Norway, and Sweden. For many cancers, Denmark is closing the survival gap with the other Nordic countries. Survival trends are generally increasing, even for some of the more lethal cancers: in some countries, survival has increased by up to 5% for cancers of the liver, pancreas, and lung. For women diagnosed during 2010–14, 5-year survival for breast cancer is now 89·5% in Australia and 90·2% in the USA, but international differences remain very wide, with levels as low as 66·1% in India. For gastrointestinal cancers, the highest levels of 5-year survival are seen in southeast Asia: in South Korea for cancers of the stomach (68·9%), colon (71·8%), and rectum (71·1%); in Japan for oesophageal cancer (36·0%); and in Taiwan for liver cancer (27·9%). ...
Allgar, VL, Chen, H, Richfield, E, Currow, D, Macleod, U & Johnson, MJ 2018, 'Psychometric Properties of the Needs Assessment Tool-Progressive Disease Cancer in UK Primary Care', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 56, no. 4, pp. 602-612.View/Download from: Publisher's site
Bajwah, S, Davies, JM, Tanash, H, Currow, DC, Oluyase, AO & Ekström, M 2018, 'Safety of benzodiazepines and opioids in interstitial lung disease: A national prospective study.', European Respiratory Journal, vol. 52, no. 6.View/Download from: Publisher's site
Safety concerns are a barrier to prescribing benzodiazepines (BDZ) and opioids in Interstitial Lung Disease (ILD). We therefore examined association of BDZ and opioids on risk of admission to hospital and death.We conducted a population based longitudinal cohort study of fibrotic ILD patients starting Long Term Oxygen Therapy in Sweden 2005-2014. Effects of BDZ and opioids on rates of admission to hospital and mortality were analysed using Fine-Gray and Cox regression whilst adjusting for potential confounders.We included 1603 patients (61% women). BDZ were used by 196 (12%), opioids by 254 (15%). There was no association between BDZ and increased admission. Treatment with higher versus lower dose BDZ was associated with increased mortality: (SHR 1·46, 95% CI 1·08-1·98) versus (SHR 1·13, 95% CI 0·92-1·38). Opioids showed no association with increased admission. Neither low dose opioids (<30 mg·day-1 morphine equivalent) (SHR 1·18 (95% CI 0.96-1·45) nor high dose opioids (>30 mg·day-1 morphine equivalent) (SHR 1·11 (95% CI 0·89-1·39) showed association with increased mortality.This first ever study to examine associations between BDZ and opioid use and harm in ILD supports the use of opioids and low dose BDZ in severely ill patients with respiratory compromise.
Burns, E, Prigerson, HG, Quinn, SJ, Abernethy, AP & Currow, DC 2018, 'Moving on: Factors associated with caregivers' bereavement adjustment using a random population-based face-to-face survey.', Palliative Medicine, vol. 32, no. 1, pp. 257-267.View/Download from: Publisher's site
Providing care at end of life has consequences for caregivers' bereavement experience. 'Difficulty moving on with life' is an informative and unbiased symptom of prolonged grief disorder. Predictors of bereaved caregivers' ability to 'move on' have not been examined across the population.To identify the characteristics of bereaved hands-on caregivers who were, and were not, able to 'move on' 13-60 months after the 'expected' death of someone close.The South Australian Health Omnibus is an annual, random, cross-sectional community survey. From 2000 to 2007, respondents were asked about providing care for someone terminally ill and their subsequent ability to 'move on'. Multivariable logistic regression models explored the characteristics moving on and not moving on.Respondents were aged ⩾15 years and lived in households within South Australia. They had provided care to someone who had died of terminal illness in the preceding 5 years.A total of 922 people provided hands-on care. In all, 80% of caregivers (745) had been able to 'move on'. Closeness of relationship to the deceased, increasing caregiver age, caregiver report of needs met, increasing time since loss, sex and English-speaking background were significantly associated with 'moving on'. A closer relationship to the deceased, socioeconomic disadvantage and being male were significantly associated with not 'moving on'.These results support the relevance of 'moving on' as an indicator of caregivers' bereavement adjustment. Following the outcomes of bereaved caregivers longitudinally is essential if effective interventions are to be developed to minimise the risk of prolonged grief disorder.
Clark, K, Sheehan, C & Currow, DC 2018, 'Letter to the Editor Re: "Hyoscine Butylbromide for the Management of Death Rattle: Sooner Rather Than Later".', Journal of Pain and Symptom Management.View/Download from: Publisher's site
Currow, DC & Clark, J 2018, 'Why Smart Emerging Economies Will Invest in Excellent Palliative Care, if Palliative Care Services Do Their Part.', Journal of Palliative Medicine, vol. 21, no. 3, pp. 276-277.View/Download from: Publisher's site
Currow, DC & Krajnik, M 2018, 'Relieving chronic breathlessness is a human right', Palliative Medicine in Practice, vol. 12, no. 1, pp. 8-10.
Copyright © Via Medica. Chronic breathlessness, defined as breathlessness that persists despite optimising the treatment of underlying causes, is recognised by recent international consensus as a distinct clinical syndrome. Across our communities, population-based studies of chronic breathlessness expose an enormous burden from this. Among the palliative care population, one in four people die with severe breathlessness despite treatment from a palliative care service. Recently, the relief of breathlessness was claimed to be a human right, particularly when there are treatments available to alleviate the unnecessary suffering caused by chronic breathlessness. The timely recognition of, and response to chronic breathlessness is a crucial clinical skill.
Currow, DC & LeBlanc, TW 2018, 'It is time to rethink weight loss in cancer.', Annals of oncology : official journal of the European Society for Medical Oncology, vol. 29, no. 5, pp. 1091-1092.View/Download from: Publisher's site
Currow, DC, Ekstrom, M & Johnson, MJ 2018, 'The strength of evidence: low dose morphine for chronic breathlessness', INTERNAL MEDICINE JOURNAL, vol. 48, no. 1, pp. 102-103.View/Download from: Publisher's site
Currow, DC, Johnson, MJ & Ekstrom, M 2018, 'Ensuring caregivers are part of palliative care service delivery', PALLIATIVE & SUPPORTIVE CARE, vol. 16, no. 5, pp. 639-640.View/Download from: Publisher's site
Currow, DC, Maddocks, M, Cella, D & Muscaritoli, M 2018, 'Efficacy of Anamorelin, a Novel Non-Peptide Ghrelin Analogue, in Patients with Advanced Non-Small Cell Lung Cancer (NSCLC) and Cachexia-Review and Expert Opinion', INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES, vol. 19, no. 11.View/Download from: Publisher's site
Currow, DC, Smith, JM, Chansriwong, P, Noble, SIR, Nikolaidou, T, Ferreira, D, Johnson, MJ & Ekstrom, M 2018, 'Missed opportunity? Worsening breathlessness as a harbinger of death: a cohort study', EUROPEAN RESPIRATORY JOURNAL, vol. 52, no. 3.View/Download from: Publisher's site
Ekström, M, Bajwah, S, Bland, JM, Currow, DC, Hussain, J & Johnson, MJ 2018, 'One evidence base; three stories: do opioids relieve chronic breathlessness?', Thorax, vol. 73, no. 1, pp. 88-90.View/Download from: Publisher's site
The efficacy of low-dose systemic opioids for chronic breathlessness was questioned by the recent Cochrane review by Barnes et al We examined the reasons for this conflicting finding and re-evaluated the efficacy of systemic opioids. Compared with previous meta-analyses, Barnes et al reported a smaller effect and lower precision, but did not account for matched data of crossover trials (11/12 included trials) and added a risk-of-bias criterion (sample size). When re-analysed to account for crossover data, opioids decreased breathlessness (standardised mean differences -0.32; -0.18 to -0.47; I2=44.8%) representing a clinically meaningful reduction of 0.8 points (0-10 numerical rating scale), consistent across meta-analyses.
Ekström, M, Bornefalk-Hermansson, A, Wysham, N, Currow, DC & MacIntyre, N 2018, 'Spirometric Volumes and Breathlessness Across Levels of Airflow Limitation: The COPDGene Study.', American journal of respiratory and critical care medicine, vol. 198, no. 5, pp. 678-680.View/Download from: Publisher's site
Ekstrom, M, Johnson, MJ & Currow, DC 2018, 'Statistical compared to clinical significance and the risk of misattribution', EUROPEAN RESPIRATORY JOURNAL, vol. 52, no. 5.View/Download from: Publisher's site
Ekstrom, M, Johnson, MJ, Taylor, B, Luszcz, M, Wohland, P, Ferreira, DH & Currow, DC 2018, 'Breathlessness and sexual activity in older adults: the Australian Longitudinal Study of Ageing', NPJ PRIMARY CARE RESPIRATORY MEDICINE, vol. 28.View/Download from: Publisher's site
Ferreira, DH, Ekstrom, M, Sajkov, D, Vandersman, Z, Eckert, DJ & Currow, DC 2018, 'Extended-Release Morphine for Chronic Breathlessness in Pulmonary Arterial Hypertension-A Randomized, Double-Blind, Placebo-Controlled, Crossover Study', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 56, no. 4, pp. 483-492.View/Download from: Publisher's site
Gisev, N, Pearson, S-A, Dobbins, T, Currow, DC, Blyth, F, Larney, S, Dunlop, A, Mattick, RP, Wilson, A & Degenhardt, L 2018, 'Combating escalating harms associated with pharmaceutical opioid use in Australia: the POPPY II study protocol', BMJ OPEN, vol. 8, no. 12.View/Download from: Publisher's site
Hanchanale, S, Kerr, M, Ashwood, P, Curran, E, Ekstrom, M, Allen, S, Currow, D & Johnson, MJ 2018, 'Conference presentation in palliative medicine: predictors of subsequent publication.', BMJ Supportive and Palliative Care, vol. 8, no. 1, pp. 73-77.View/Download from: Publisher's site
Concerns have been raised about poor-quality palliative care research and low publication rate from conference abstracts. The study objectives: to estimate the publication rate for European Association for Palliative Care research conference abstracts (2008) and explore associated characteristics and to understand reasons for non-publication.Full published papers were searched to March 2015 (Medline; Pubmed; Google Scholar) and data extracted: country of origin, study design/population/topic. Multivariate logistic regression was used to identify predictors of publication.Members of two different palliative care associations were surveyed to understand reasons for non-publication. χ2 statistic was used to explore associations with publication.Overall publication rate of the 445 proffered abstracts was 57%. In the final model, publication was more likely for oral presentations (OR 2.13; 95% CI 1.28 to 3.55; P=0.003), those from Europe (3.24; 1.09 to 9.56; P=0.033) and much less likely for non-cancer topics (0.21; 0.07 to 0.64; P=0.006). Funding status, academic unit or study design were not associated with publication.407/1546 (26.3%) physicians responded of whom 254 (62%) had submitted a conference abstract. Full publication was associated with: oral presentation (P<0.001), international conference abstracts (P=0.01) and academic clinicians versus clinicians (P<0.001). Reasons for non-publication included: low priority for workload (53%) and time constraints (43%).The publication rate was similar to 2005 clinical conference. Probable quality markers were associated with publication: oral presentations selected by conference committee, international conference abstracts and abstracts from those with an academic appointment. Publication was given a low priority among clinical time pressures.
Hardy, J, Skerman, H, Glare, P, Philip, J, Hudson, P, Mitchell, G, Martin, P, Spruyt, O, Currow, D & Yates, P 2018, 'A randomized open-label study of guideline-driven antiemetic therapy versus single agent antiemetic therapy in patients with advanced cancer and nausea not related to anticancer treatment.', BMC cancer, vol. 18, no. 1, pp. 510-510.View/Download from: Publisher's site
BACKGROUNDNausea/vomiting (N/V) not related to anti-cancer treatment is common in patients with advanced cancer. The standard approach to management is to define a dominant cause, and treat with an antiemetic selected through pathophysiologic knowledge of emetic pathways. High rates of N/V control have been reported using both etiology-based guideline-driven antiemetic regimens and an empiric approach using single agents in uncontrolled studies. These different approaches had never been formally compared.METHODSThis randomized, prospective, open label, dose-escalating study used readily available antiemetics in accordance with etiology-based guidelines or single agent therapy with haloperidol. Participants had a baseline average nausea score of ≥3/10. Response was defined as a ≥ 2/10 point reduction on a numerical rating scale of average nausea score with a final score < 3/10 at 72 h.RESULTSNausea scores and distress from nausea improved over time in the majority of the 185 patients randomized. For those who completed each treatment day, a greater response rate was seen in the guideline arm than the single agent arm at 24 h (49% vs 32%; p = 0.02), but not at 48 or 72 h. Response rates at 72 h in the intention to treat analysis were 49 and 53% respectively, with no significant difference between arms (0·04; 95% CI: -0·11, 0·19; p = 0·59). Over 80% of all participants reported an improved global impression of change. There were few adverse events worse than baseline in either arm.CONCLUSIONAn etiology-based, guideline-directed approach to antiemetic therapy may offer more rapid benefit, but is no better than single agent treatment with haloperidol at 72 h.CLINICAL TRIAL REGISTRATIONAustralian New Zealand Clinical Trials Registry: ANZCTRN12610000481077 .
Hatano, Y, Matsuoka, H, Lam, L & Currow, DC 2018, 'Side effects of corticosteroids in patients with advanced cancer: a systematic review', SUPPORTIVE CARE IN CANCER, vol. 26, no. 12, pp. 3979-3983.View/Download from: Publisher's site
Johnson, MJ, Allgar, V, Chen, H, Dunn, L, Macleod, U & Currow, DC 2018, 'The complex relationship between household income of family caregivers, access to palliative care services and place of death: A national household population survey.', Palliative Medicine, vol. 32, no. 2, pp. 357-365.View/Download from: Publisher's site
Previous work shows that more affluent patients with cancer are more likely to die at home, whereas those dying from non-cancer conditions are more likely to die in hospital. Family caregivers are an important factor in determining place of death.To investigate associations between family caregivers' household income, patients' access to specialist palliative care and place of patients' death, by level of personal end-of-life care.A cross-sectional community household population survey.Respondents to the Household Survey for England.One-third of 1265 bereaved respondents had provided personal end-of-life care (caregivers) (30%). Just over half (55%) of decedents accessed palliative care services and 15% died in a hospice. Place of death and access to palliative care were strongly related ( p < 0.001). Palliative care services reduced the proportion of deaths in hospital ( p < 0.001), and decedents accessing palliative care were more likely to die at home than those who did not ( p < 0.001). Respondents' income was not associated with palliative care access ( p = 0.233). Overall, respondents' income and home death were not related ( p = 0.106), but decedents with caregivers in the highest income group were least likely to die at home ( p = 0.069).For people who had someone close to them die, decedents' access to palliative care services was associated with fewer deaths in hospital and more home deaths. Respondents' income was unrelated to care recipients' place of death when adjusted for palliative care access. When only caregivers were considered, decedents with caregivers from higher income quartiles were the least likely to die at home. Family caregivers from higher income brackets are likely to be powerful patient advocates. Caregiver information needs must be addressed especially with regard to stage of disease, aim of care and appropriate interventions at the end of life.
Johnson, MJ, Jamali, A, Ross, J, Fairhurst, C, Boland, J, Reigada, C, Hart, SP, Grande, G, Currow, DC, Wells, AU, Bajwah, S, Papadopoulos, T, Bland, JM & Yorke, J 2018, 'Psychometric validation of the needs assessment tool: progressive disease in interstitial lung disease.', Thorax, pp. 1-5.View/Download from: Publisher's site
The inter-rater/test-retest reliability and construct validity of a palliative care needs assessment tool in interstitial lung disease (NAT:PD-ILD) were tested using NAT:PD-ILD-guided video-recorded consultations, and NAT:PD-ILD-guided consultations, and patient and carer-report outcomes (St George's Respiratory Questionnaire (SGRQ)-ILD, Carer Strain Index (CSI)/Carer Support Needs Assessment Tool (CSNAT)). 11/16 items reached at least fair inter-rater agreement; 5 items reached at least moderate test-retest agreement. 4/6 patient constructs demonstrated agreement with SGRQ-I scores (Kendall's tau-b, 0.24-20.36; P<0.05). 4/7 carer constructs agreed with the CSI/CSNAT items (kappa, 0.23-20.53). The NAT:PD-ILD is reliable and valid. Clinical effectiveness and implementation are to be evaluated.
Johnson, MJ, Yorke, J, Hansen-Flaschen, J, Ekstrom, M & Currow, DC 2018, 'Chronic breathlessness: re-thinking the symptom', EUROPEAN RESPIRATORY JOURNAL, vol. 51, no. 4.View/Download from: Publisher's site
Johnson, MJ, Yorke, J, Hansen-Flaschen, J, Lansing, R, Ekstrom, M & Currow, DC 2018, 'Chronic breathlessness: re-thinking the symptom', EUROPEAN RESPIRATORY JOURNAL, vol. 51, no. 1.
Johnson, MJ, Yorke, J, Hansen-Flaschen, J, Lansing, R, Ekstrom, M & Currow, DC 2018, 'Chronic breathlessness: re-thinking the symptom'', EUROPEAN RESPIRATORY JOURNAL, vol. 51, no. 1.View/Download from: Publisher's site
Kaasa, S, Loge, JH, Aapro, M, Albreht, T, Anderson, R, Bruera, E, Brunelli, C, Caraceni, A, Cervantes, A, Currow, DC, Deliens, L, Fallon, M, Gómez-Batiste, X, Grotmol, KS, Hannon, B, Haugen, DF, Higginson, IJ, Hjermstad, MJ, Hui, D, Jordan, K, Kurita, GP, Larkin, PJ, Miccinesi, G, Nauck, F, Pribakovic, R, Rodin, G, Sjøgren, P, Stone, P, Zimmermann, C & Lundeby, T 2018, 'Integration of oncology and palliative care: a Lancet Oncology Commission.', The Lancet Oncology, vol. 19, pp. 588-653.View/Download from: Publisher's site
Full integration of oncology and palliative care relies on the specific knowledge and skills of two modes of care: the tumour-directed approach, the main focus of which is on treating the disease; and the host-directed approach, which focuses on the patient with the disease. This Commission addresses how to combine these two paradigms to achieve the best outcome of patient care. Randomised clinical trials on integration of oncology and palliative care point to health gains: improved survival and symptom control, less anxiety and depression, reduced use of futile chemotherapy at the end of life, improved family satisfaction and quality of life, and improved use of health-care resources. Early delivery of patient-directed care by specialist palliative care teams alongside tumour-directed treatment promotes patient-centred care. Systematic assessment and use of patient-reported outcomes and active patient involvement in the decisions about cancer care result in better symptom control, improved physical and mental health, and better use of health-care resources. The absence of international agreements on the content and standards of the organisation, education, and research of palliative care in oncology are major barriers to successful integration. Other barriers include the common misconception that palliative care is end-of-life care only, stigmatisation of death and dying, and insufficient infrastructure and funding. The absence of established priorities might also hinder integration more widely. This Commission proposes the use of standardised care pathways and multidisciplinary teams to promote integration of oncology and palliative care, and calls for changes at the system level to coordinate the activities of professionals, and for the development and implementation of new and improved education programmes, with the overall goal of improving patient care. Integration raises new research questions, all of which contribute to improved clinical care. When and ho...
Li, M, Morrell, S, Creighton, N, Tervonen, H, You, H, Roder, D & Currow, D 2018, 'Has cancer survival improved for older people as for younger people? New South Wales, 1980-2012', CANCER EPIDEMIOLOGY, vol. 55, pp. 23-29.View/Download from: Publisher's site
Miller, J, Wells, L, Nwulu, U, Currow, D, Johnson, MJ & Skipworth, RJE 2018, 'Validated screening tools for the assessment of cachexia, sarcopenia, and malnutrition: a systematic review', AMERICAN JOURNAL OF CLINICAL NUTRITION, vol. 108, no. 6, pp. 1196-1208.View/Download from: Publisher's site
Morgan, DD, Marston, C, Garner, J & Currow, DC 2018, 'Subacute Rehabilitation Does Have Benefits for Patients With Advanced Cancer.', Journal of Pain and Symptom Management, vol. 55, no. 1, pp. e1-e2.View/Download from: Publisher's site
Nag, N, Millar, J, Davis, ID, Costello, S, Duthie, JB, Mark, S, Delprado, W, Smith, D, Pryor, D, Galvin, D, Sullivan, F, Murphy, Á, Roder, D, Elsaleh, H, Currow, D, White, C, Skala, M, Moretti, KL, Walker, T, De Ieso, P, Brooks, A, Heathcote, P, Frydenberg, M, Thavaseelan, J & Evans, SM 2018, 'Development of Indicators to Assess Quality of Care for Prostate Cancer', European urology focus, vol. 4, no. 1, pp. 57-63.View/Download from: Publisher's site
BACKGROUND: The development, monitoring, and reporting of indicator measures that describe standard of care provide the gold standard for assessing quality of care and patient outcomes. Although indicator measures have been reported, little evidence of their use in measuring and benchmarking performance is available. A standard set, defining numerator, denominator, and risk adjustments, will enable global benchmarking of quality of care. OBJECTIVE: To develop a set of indicators to enable assessment and reporting of quality of care for men with localised prostate cancer (PCa). DESIGN, SETTING, AND PARTICIPANTS: Candidate indicators were identified from the literature. An international panel was invited to participate in a modified Delphi process. Teleconferences were held before and after each voting round to provide instruction and to review results. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Panellists were asked to rate each proposed indicator on a Likert scale of 1-9 in a two-round iterative process. Calculations required to report on the endorsed indicators were evaluated and modified to reflect the data capture of the Prostate Cancer Outcomes Registry-Australia and New Zealand (PCOR-ANZ). RESULTS AND LIMITATIONS: A total of 97 candidate indicators were identified, of which 12 were endorsed. The set includes indicators covering pre-, intra-, and post-treatment of PCa care, within the limits of the data captured by PCOR-ANZ. CONCLUSIONS: The 12 endorsed quality measures enable international benchmarking on the quality of care of men with localised PCa. Reporting on these indicators enhances safety and efficacy of treatment, reduces variation in care, and can improve patient outcomes. PATIENT SUMMARY: PCa has the highest incidence of all cancers in men. Early diagnosis and relatively high survival rates mean issues of quality of care and best possible health outcomes for patients are important. This paper identifies 12 important measurable quality indicato...
Pidgeon, TM, Johnson, CE, Lester, L, Currow, D, Yates, P, Allingham, SF, Bird, S & Eagar, K 2018, 'Perceptions of the care received from Australian palliative care services: A caregiver perspective.', Palliative and Supportive Care, vol. 16, no. 2, pp. 198-208.View/Download from: Publisher's site
BACKGROUND: Caregiver satisfaction and experience surveys help health professionals to understand, measure, and improve the quality of care provided for patients and their families. OBJECTIVE: Our aim was to explore caregiver perceptions of the care received from Australian specialist palliative care services. METHOD: Caregivers of patients receiving palliative care in services registered with Australia's Palliative Care Outcomes Collaboration were invited to participate in a caregiver survey. The survey included the FAMCARE-2 and four items from the Ongoing Needs Identification: Caregiver Profile questionnaire. RESULTS: Surveys were completed by 1,592 caregivers from 49 services. Most respondents reported high satisfaction and positive experiences. Caregivers receiving care from community-based palliative care teams were less satisfied with the management of physical symptoms and comfort (odds ratio [OR] = 0.29; 95% confidence interval [CI 95%] = 0.14, 0.59), with patient psychological care (OR = 0.56; CI 95% = 0.32, 0.98), and with family support (OR = 0.52; CI 95% = 0.35, 0.77) than caregivers of patients in an inpatient setting. If aged over 60 years, caregivers were less likely to have their information needs met regarding available support services (OR = 0.98; CI 95% = 0.97, 0.98) and carer payments (OR = 0.99; CI 95% = 0.98, 1.00). Also, caregivers were less likely to receive adequate information about carer payments if located in an outer regional area (OR = 0.41; CI 95% = 0.25, 0.64). With practical training, caregivers receiving care from community services reported inadequate information provision to support them in caring for patients (OR = 0.60; CI 95% = 0.45, 0.81). SIGNIFICANCE OF RESULTS: While our study identified caregivers as having positive and satisfactory experiences across all domains of care, there is room for improvement in the delivery of palliative care across symptom management, as well as patient and caregiver support, especially in c...
Sandberg, J, Johnson, MJ, Currow, DC & Ekström, M 2018, 'Validation of the Dyspnea Exertion Scale of Breathlessness in People With Life-Limiting Illness.', Journal of pain and symptom management, vol. 56, no. 3, pp. 430-435.e2.View/Download from: Publisher's site
Although chronic breathlessness is common in life-limiting illnesses, validated feasible instruments to measure functional impact of the symptom in this population are scarce. We aimed to validate the Dyspnea Exertion Scale (DES) compared with the modified Medical Research Council (mMRC) breathlessness scale for test-retest reliability, concurrent validity, and responsiveness in people with life-limiting illness.A total of 188 participants, 66% males, with chronic breathlessness, mostly (70%) because of chronic pulmonary disease (chronic obstructive pulmonary disease) self-reported evening scores of mMRC, DES, Numerical Rating Scale (NRS), and Eastern Cooperative Oncology Group during nine days.About 44% (n = 81) scored the highest score on mMRC indicating a ceiling effect not seen with DES. Both scales had moderate-to-good test-retest agreement (89% DES; 84% mMRC; P < 0.001 for both). Analyses for concurrent validity showed that higher DES and mMRC scores were correlated with higher NRS breathlessness intensity scores and Eastern Cooperative Oncology Group scores throughout the nine days. In longitudinal analyses, DES (r = 0.30; P < 0.001) was more responsive to change in NRS score during nine days than the mMRC (r = 0.16; P = 0.03).Compared with mMRC, DES had comparable or better measurement properties in terms of test-retest reliability and concurrent validity and could be used as a discriminative tool in this population, but both scales are too insensitive to change to be used as an outcome in clinical trials.
Sanderson, CR & Currow, DC 2018, 'Palliative care meets immunotherapy: what happens as cancer paradigms change?', BMJ SUPPORTIVE & PALLIATIVE CARE, vol. 8, no. 4, pp. 431-432.View/Download from: Publisher's site
Shaw, T, York, S, White, K, McGregor, D, Rankin, N, Hawkey, A, Aranda, S, Rushton, S & Currow, D 2018, 'Defining success factors to describe coordinated care in cancer', TRANSLATIONAL BEHAVIORAL MEDICINE, vol. 8, no. 3, pp. 357-365.View/Download from: Publisher's site
Smallwood, N, Currow, D, Booth, S, Spathis, A, Irving, L & Philip, J 2018, 'Attitudes to specialist palliative care and advance care planning in people with COPD: a multi-national survey of palliative and respiratory medicine specialists', BMC PALLIATIVE CARE, vol. 17.View/Download from: Publisher's site
Smallwood, N, Currow, D, Booth, S, Spathis, A, Irving, L & Philip, J 2018, 'Differing Approaches to Managing the Chronic Breathlessness Syndrome in Advanced COPD: A Multi-National Survey of Specialists.', COPD: Journal of Chronic Obstructive Pulmonary Disease, vol. 15, no. 3, pp. 294-302.View/Download from: Publisher's site
This study explored the approaches of respiratory and palliative medicine specialists to managing the chronic breathlessness syndrome in patients with severe chronic obstructive pulmonary disease. A voluntary, online survey was emailed to all specialists and trainees in respiratory medicine in Australia and New Zealand (ANZ), and to all palliative medicine specialists and trainees in ANZ and the United Kingdom (UK). Five hundred and seventy-seven (33.0%) responses were received from 1,749 specialists, with 440 (25.2%) complete questionnaires included from 177 respiratory and 263 palliative medicine doctors. Palliative medicine doctors in ANZ and the UK had similar approaches to managing chronic breathlessness, whereas respiratory and palliative medicine doctors had significantly different approaches (p < 0.0001). Both specialties most commonly recommended a combination of non-pharmacological and pharmacological breathlessness management strategies. Respiratory doctors focussed more on pulmonary rehabilitation, whereas palliative medicine doctors recommended breathing techniques, anxiety management and the handheld fan. Palliative medicine doctors (197 (74.9%)) recommended short acting oral morphine for breathlessness, as compared with 73 (41.2%) respiratory doctors (p < 0.0001). Respiratory doctors cited opioid concerns related to respiratory depression and lack of knowledge. Nineteen (10.7%) respiratory doctors made no specific recommendations for managing chronic breathlessness. Both specialties reported actively managing chronic breathlessness, albeit with differing approaches. Integrated services, which combine the complementary knowledge and approaches of both specialities, may overcome current gaps in care and improve the management of distressing, chronic breathlessness.
Tervonen, HE, Chen, TYT, Lin, E, Boyle, FM, Moylan, EJ, Della-Fiorentina, SA, Beith, JM & Currow, DC 2018, 'Balancing the risk and benefit of adjuvant chemotherapy for early breast cancer: A retrospective cohort study in New South Wales (NSW), Australia', JOURNAL OF CLINICAL ONCOLOGY, vol. 36, no. 15.View/Download from: Publisher's site
Willmott, L, White, B, Piper, D, Yates, P, Mitchell, G & Currow, D 2018, 'Providing Palliative Care at the End of Life: Should Health Professionals Fear Regulation?', Journal of law and medicine, vol. 26, no. 1, pp. 214-245.
Anecdotal evidence from Australia and abroad suggests that health professionals may fear potential legal and/or professional repercussions if their patient dies after receiving pain relieving medication at the end of life. As a result, patients may be under-medicated and their pain and other symptoms not adequately relieved. The regulatory repercussions from inappropriate administration of medications are potentially broad and include criminal charges, civil negligence claims, coronial investigations and disciplinary proceedings. But despite these potentially serious repercussions, a review of publicly available cases in Australia reveals there has been comparatively little judicial or quasi-judicial scrutiny where over-medication is alleged to have resulted in a patient's death. In this article, we describe the regulatory framework that governs this field of medical practice and analyse the extent to which the actions of health professionals have been scrutinised, and the consequences of that scrutiny. We identify a number of themes arising from this analysis and conclude that fears of legal or professional repercussions are largely unfounded, and that existing laws and other forms of regulation should not inhibit the prescription and administration of adequate pain and other symptom relief to people at the end of life.
Campbell, R, McCaffrey, N, Brown, L, Agar, MR, Clark, K & Currow, DC 2018, 'Clinician-reported changes in octreotide prescribing for malignant bowel obstruction as a result of an adequately powered phase III study: A transnational, online survey', PALLIATIVE MEDICINE, vol. 32, no. 8, pp. 1363-1368.View/Download from: Publisher's site
Digges, M, Hussein, A, Wilcock, A, Crawford, GB, Boland, JW, Agar, MR, Sinnarajah, A, Currow, DC & Johnson, MJ 2018, 'Pharmacovigilance in Hospice/Palliative Care: Net Effect of Haloperidol for Nausea or Vomiting.', Journal of Palliative Medicine, vol. 21, no. 1, pp. 37-43.View/Download from: Publisher's site
Haloperidol is widely prescribed as an antiemetic in patients receiving palliative care, but there is limited evidence to support and refine its use.To explore the immediate and short-term net clinical effects of haloperidol when treating nausea and/or vomiting in palliative care patients.A prospective, multicenter, consecutive case series.Twenty-two sites, five countries: consultative, ambulatory, and inpatient services.When haloperidol was started in routine care as an antiemetic, data were collected at three time points: baseline; 48 hours (benefits); day seven (harms). Clinical effects were assessed using the National Cancer Institute's Common Terminology Criteria for Adverse Events (NCI CTCAE).Data were collected (May 2014-March 2016) from 150 patients: 61% male; 86% with cancer; mean age 72 (standard deviation 11) years and median Australian-modified Karnofsky Performance Scale 50 (range 10-90). At baseline, nausea was moderate (88; 62%) or severe (11; 8%); 145 patients reported vomiting, with a baseline NCI CTCAE vomiting score of 1.0. The median (range) dose of haloperidol was 1.5 mg/24 hours (0.5-5 mg/24 hours) given orally or parenterally. Five patients (3%) died before further data collection. At 48 hours, 114 patients (79%) had complete resolution of their nausea and vomiting, with greater benefit seen in the resolution of nausea than vomiting. At day seven, 37 (26%) patients had a total of 62 mild/moderate harms including constipation 25 (40%); dry mouth 13 (21%); and somnolence 12 (19%).Haloperidol as an antiemetic provided rapid net clinical benefit with low-grade, short-term harms.
Clark, K, Lam, L, Talley, NJ, Watts, G, Phillips, JL, Byfieldt, NJ & Currow, DC 2018, 'A pragmatic comparative study of palliative care clinician's reports of the degree of shadowing visible on plain abdominal radiographs.', Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, vol. 26.View/Download from: Publisher's site
The assessment of constipation symptoms is based on history and physical examination. However, the experience is highly subjective perhaps explaining why palliative medicine doctors continue to use plain abdominal radiographs as part of routine assessment of constipation. Previous studies have demonstrated poor agreement between clinicians with this work in palliative care, limited further by disparity of clinicians' experience and training. The aim of this work was to explore whether there was less variation in the assessments of faecal shadowing made by more experienced clinicians compared to their less experienced colleagues. This pragmatic study was conducted across six palliative care services in Sydney (NSW, Australia). Doctors of varying clinical experience were asked to independently report their opinions of the amount of shadowing seen on 10 plain abdominal radiographs all taken from cancer patients who self-identified themselves as constipated. There were 46 doctors of varying clinical experience who participated including qualified specialists, doctors in specialist training and lastly, doctors in their second- and third post-graduate years. Poor agreement was seen between the faecal shadowing scores allocated by doctors of similar experience and training (Fleiss's kappa (FK): RMO 0.05; registrar 0.06; specialist 0.11). Further, when the levels of agreement between groups were considered, no statistically significant differences were observed. Although the doctors did not agree on the appearance of the film, the majority felt they were able to extrapolate patients' experiences from the radiograph's appearance. As it remains challenging in palliative care to objectively assess and diagnose constipation by history and imaging, uniform and objective assessment and diagnostic criteria are required. It is likely that any agreed criteria will include a combination of imaging and history. The results suggest the use of radiographs alone to diagnose and assess...
Ferreira, DH, Boland, JW, Phillips, JL, Lam, L & Currow, DC 2018, 'The impact of therapeutic opioid agonists on driving-related psychomotor skills assessed by a driving simulator or an on-road driving task: A systematic review.', Palliative Medicine, vol. 32, no. 4, pp. 786-803.View/Download from: Publisher's site
Driving cessation is associated with poor health-related outcomes. People with chronic diseases are often prescribed long-term opioid agonists that have the potential to impair driving. Studies evaluating the impact of opioids on driving-related psychomotor skills report contradictory results likely due to heterogeneous designs, assessment tools and study populations. A better understanding of the effects of regular therapeutic opioid agonists on driving can help to inform the balance between individual's independence and community safety.To identify the literature assessing the impact of regular therapeutic opioid agonists on driving-related psychomotor skills for people with chronic pain or chronic breathlessness.Systematic review reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis statement; PROSPERO Registration CRD42017055909.Six electronic databases and grey literature were systematically searched up to January, 2017. Inclusion criteria were as follows: (1) empirical studies reporting data on driving simulation, on-the-road driving tasks or driving outcomes; (2) people with chronic pain or chronic breathlessness; and (3) taking regular therapeutic opioid agonists. Critical appraisal used the National Institutes of Health's quality assessment tools.From 3809 records screened, three studies matched the inclusion criteria. All reported data on people with chronic non-malignant pain. No significant impact of regular therapeutic opioid agonists on people's driving-related psychomotor skills was reported. One study reported more intense pain significantly worsened driving performance.This systematic review does not identify impaired simulated driving performance when people take regular therapeutic opioid agonists for symptom control, although more prospective studies are needed.
Luckett, T, Phillips, J, Agar, M, Lam, L, Davidson, PM, McCaffrey, N, Boyle, F, Shaw, T, Currow, DC, Read, A, Hosie, A & Lovell, M 2018, 'Protocol for a phase III pragmatic stepped wedge cluster randomised controlled trial comparing the effectiveness and cost-effectiveness of screening and guidelines with, versus without, implementation strategies for improving pain in adults with cancer attending outpatient oncology and palliative care services: the Stop Cancer PAIN trial', BMC HEALTH SERVICES RESEARCH, vol. 18.View/Download from: Publisher's site
Phillips, JL, Lobb, E, Mohacsi, P, Heneka, N & Currow, D 2018, 'Identifying systems barriers that may prevent bereavement service access to bereaved carers: A report from an Australian specialist palliative care service', Collegian, vol. 25, no. 1, pp. 39-43.View/Download from: Publisher's site
© 2017 Australian College of Nursing Ltd. Background: Bereavement follow up is an integral element of palliative care. However, little is known about the systems that link bereavement services with bereaved carers. Aim: To map how effectively a specialist palliative care service linked bereavement service to bereaved carers. Methodology: A retrospective medical audit, using process mapping was undertaken within one Australian specialist palliative care service to identify the systems that linked bereavement services to a consecutive cohort of palliative care decedents (n=60) next of kin. Results: Bereavement records were located for 80% of decedents. Nearly all (98%) had a nominated next of kin, with just over half (54%) of those nominated contacted by bereavement services. Incomplete or missing contact details was the main reason (75%) that the bereavement service was unable to contact the decedents' next of kin. Conclusion: Having access to a designated bereavement service can ensure that bereaved next of kin are contract routinely and in a timely way. However the effectiveness of this type of service is dependent upon the bereavement service having access to all relevant contact information. There are numerous opportunities to refine and strengthen the recording of palliative care next of kin details to optimize follow up.
Stone, E, Rankin, N, Kerr, S, Fong, K, Currow, DC, Phillips, J, Connon, T, Zhang, L & Shaw, T 2018, 'Does presentation at multidisciplinary team meetings improve lung cancer survival? Findings from a consecutive cohort study', LUNG CANCER, vol. 124, pp. 199-204.View/Download from: Publisher's site
Stone, E, Rankin, N, Phillips, J, Fong, K, Currow, DC, Miller, A, Largey, G, Zielinski, R, Flynn, P & Shaw, T 2018, 'Consensus minimum data set for lung cancer multidisciplinary teams: Results of a Delphi process', RESPIROLOGY, vol. 23, no. 10, pp. 927-934.View/Download from: Publisher's site
Cancer-related fatigue is serious and complex, as well as one of the most common symptoms experienced by patients with colorectal cancer, with the potential to compromise quality of life, activities of daily living, and ultimately survival. There is a lack of consensus about the definition of cancer-related fatigue; however, definitions have been put forward by the European Association for Palliative Care (EAPC) and the National Comprehensive Cancer Network (NCCN). Numerous cancer- and treatment-related factors can contribute to fatigue, including disease progression, comorbidities, medical complications such as anemia, side effects of other medications, and a number of physical and psychologic factors. This underlines the importance of tackling factors that may contribute to fatigue before reducing the dose of treatment. NCCN guidelines and the EAPC have proposed approaches to managing fatigue in cancer patients; however, relatively few therapeutic agents have been demonstrated to reduce fatigue in randomized controlled trials. It is recognized that physical activity produces many beneficial physiologic modifications to markers of physical performance that can help to counteract various causes of fatigue. In appropriately managed and monitored patients with colorectal cancer, emerging evidence indicates that exercise programs may have a favorable influence on cancer-related fatigue, quality of life, and clinical outcomes, and therefore may help patients tolerate chemotherapy. This review assesses fatigue in patients with colorectal cancer and proposes updates to a treatment algorithm that may help clinicians manage this common problem.
Ahmadi, Z, Currow, DC & Ekstrom, M 2017, 'The need for greater opioid pharmacovigilance in COPD Reply', International Journal of Chronic Obstructive Pulmonary Disease, vol. 12, pp. 190-192.
Ahmadi, Z, Currow, DC & Ekström, M 2017, 'Authors' reply', International Journal of COPD, vol. 12, pp. 191-192.
Ahmadi, Z, Currow, DC & Ekström, M 2017, 'Palliative oxygen for chronic breathlessness: what new evidence?', Current Opinion in Supportive and Palliative Care, vol. 11, no. 3, pp. 159-164.View/Download from: Publisher's site
Supplemental oxygen improves survival in patients with chronic obstructive pulmonary disease (COPD) and severe hypoxaemia, but the effect of oxygen therapy in mild or moderate hypoxaemia to reduce symptomatic chronic breathlessness remains unclear. This review provides an overview of recent evidence about the role of oxygen therapy for the relief of chronic breathlessness in advanced illness.In COPD, a recent Cochrane review strengthens earlier findings regarding the positive effect of supplemental oxygen compared with air during exercise test in the training setting. The novel analysis of effect of oxygen therapy on quality of life (QoL) showed no clear effect. Short-burst oxygen therapy given before exercise had no effect and should not be used.Supplemental oxygen during exercise has been shown to reduce breathlessness in patients with COPD who have no or mild hypoxaemia, but it is not clear whether the reduction in breathlessness shown in the laboratory setting translates into a clinically important benefit. Further studies are needed to establish this.
Barbetta, C, Currow, DC & Johnson, MJ 2017, 'Non-opioid medications for the relief of chronic breathlessness: current evidence.', Expert Review of Respiratory Medicine, vol. 11, no. 4, pp. 333-341.View/Download from: Publisher's site
To evaluate systematically randomised clinical trials investigating non-opioid medications for the management and treatment of chronic breathlessness. Areas covered: The evidence for the role of benzodiazepines, anxiolytics, selective serotonin re-uptake inhibitors (SSRIs), tricyclic antidepressants, antihistamines, cannabinoids, nebulized furosemide and herbal-based treatments were critically reviewed. Search of the Clinical Trials Registry (Clinicaltrial.gov) identified ongoing studies expected to generate new data in the near future in several classes of non-opioid medications for their net effect on chronic breathlessness. Expert commentary: Morphine still has the best level of evidence for the symptomatic treatment of chronic breathlessness. Non-opioid treatments for chronic breathlessness are less studied than morphine and morphine-related medications although evidence is emerging in relation to some options. Currently, there is insufficient evidence to recommend non-opioids in the routine treatment of chronic breathlessness. There is a need to find agents, new as well as re-purposed, that can be used as alternative therapies to opioids for chronic breathlessness for people who are unable to tolerate morphine.
Bonaventure, A, Harewood, R, Stiller, CA, Gatta, G, Clavel, J, Stefan, DC, Carreira, H, Spika, D, Marcos-Gragera, R, Peris-Bonet, R, Piñeros, M, Sant, M, Kuehni, CE, Murphy, MFG, Coleman, MP, Allemani, C, Bouzbid, S, Hamdi-Chérif, M, Zaidi, Z, Bah, E, Swaminathan, R, Nortje, SH, El Mistiri, MM, Bayo, S, Malle, B, Manraj, SS, Sewpaul-Sungkur, R, Fabowale, Ogunbiyi, OJ, Bradshaw, D, Somdyala, NIM, Stefan, DC, Abdel-Rahman, M, Jaidane, L, Mokni, M, Kumcher, I, Moreno, F, González, MS, Laura, EA, Espinola, SB, Calabrano, GH, Carballo Quintero, B, Fita, R, Garcilazo, DA, Giacciani, PL, Diumenjo, MC, Laspada, WD, Green, MA, Lanza, MF, Ibañez, SG, Lima, CA, de Oliveira, EL, Daniel, C, Scandiuzzi, C, De Souza, PCF, Melo, CD, Del Pino, K, Laporte, C, Curado, MP, de Oliveira, JC, Veneziano, CLA, Veneziano, DB, Alexandre, TS, Verdugo, AS, Azevedo e Silva, G, Galaz, JC, Moya, JA, Herrmann, DA, Vargas, S, Herrera, VM, Uribe, CJ, Bravo, LE, Arias-Ortiz, NE, Jurado, DM, Yépez, MC, Galán, YH, Torres, P, Martínez-Reyes, F, Pérez-Meza, ML, Jaramillo, L, Quinto, R, Cueva, P, Yépez, JG, Torres-Cintrón, CR, Tortolero-Luna, G, Alonso, R, Barrios, E, Nikiforuk, C, Shack, L, Coldman, AJ, Woods, RR, Noonan, G, Turner, D, Kumar, E, Zhang, B, McCrate, FR, Ryan, S, Hannah, H, Dewar, RAD & MacIntyre, M 2017, 'Worldwide comparison of survival from childhood leukaemia for 1995–2009, by subtype, age, and sex (CONCORD-2): a population-based study of individual data for 89 828 children from 198 registries in 53 countries', The Lancet Haematology, vol. 4, no. 5, pp. e202-e217.View/Download from: Publisher's site
© 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license Background Global inequalities in access to health care are reflected in differences in cancer survival. The CONCORD programme was designed to assess worldwide differences and trends in population-based cancer survival. In this population-based study, we aimed to estimate survival inequalities globally for several subtypes of childhood leukaemia. Methods Cancer registries participating in CONCORD were asked to submit tumour registrations for all children aged 0–14 years who were diagnosed with leukaemia between Jan 1, 1995, and Dec 31, 2009, and followed up until Dec 31, 2009. Haematological malignancies were defined by morphology codes in the International Classification of Diseases for Oncology, third revision. We excluded data from registries from which the data were judged to be less reliable, or included only lymphomas, and data from countries in which data for fewer than ten children were available for analysis. We also excluded records because of a missing date of birth, diagnosis, or last known vital status. We estimated 5-year net survival (ie, the probability of surviving at least 5 years after diagnosis, after controlling for deaths from other causes [background mortality]) for children by calendar period of diagnosis (1995–99, 2000–04, and 2005–09), sex, and age at diagnosis ( < 1, 1–4, 5–9, and 10–14 years, inclusive) using appropriate life tables. We estimated age-standardised net survival for international comparison of survival trends for precursor-cell acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML). Findings We analysed data from 89 828 children from 198 registries in 53 countries. During 1995–99, 5-year age-standardised net survival for all lymphoid leukaemias combined ranged from 10·6% (95% CI 3·1–18·2) in the Chinese registries to 86·8% (81·6–92·0) in Austria. International differences in 5-year survival for childhood ...
Creighton, N, Walton, R, Roder, DM, Aranda, S, Richardson, AJ, Merrett, N & Currow, D 2017, 'Pancreatectomy is underused in NSW regions with low institutional surgical volumes: a population data linkage study.', Medical Journal of Australia, vol. 206, no. 1, pp. 23-29.View/Download from: Publisher's site
OBJECTIVE: To examine differences in the proportions of people diagnosed with pancreatic cancer who underwent pancreatectomy, post-operative outcomes and 5-year survival in different New South Wales administrative health regions of residence. DESIGN, SETTING AND PARTICIPANTS: Retrospective analysis of NSW data on pancreatic cancer incidence and surgery, 2005-2013. MAIN OUTCOME MEASURES: The proportion of newly diagnosed patients with pancreatic cancer who were resected in each region; 90-day post-operative mortality; one-year post-operative survival; 5-year post-diagnosis survival. RESULTS: 14% of people diagnosed with pancreatic cancer during 2010-2013 (431 of 3064) underwent pancreatectomy, an average of 108 resections per year. After adjusting for age, sex and comorbidities, the proportion that underwent resection varied significantly between regions, ranging between 8% and 21% (P<0.001). Higher resection rates were not associated with higher post-operative 90-day mortality or lower one-year survival (unadjusted and risk-adjusted analyses). Higher resection rates were associated with higher 5-year post-diagnosis survival: the mean survival in regions with resection rates below 10% was 3.4%, compared with 7.2% in regions with rates greater than 15% (unadjusted and adjusted survival analyses; P<0.001). There was a positive association between regional resection rate and the pancreatectomy volume of hospitals during 2005-2009. An additional 32 people would be resected annually if resection rates in low rate regions were increased to the 80th percentile regional resection rate (18%). CONCLUSION: There is significant geographic variation in the proportion of people with pancreatic cancer undergoing pancreatectomy, and the 5-year survival rate is higher in regions where this proportion is higher.
Currow, D, Temel, J, Abernethy, A, Friend, J & Fearon, K 2017, 'P1.06-003 Anamorelin in Cachectic Patients with Advanced NSCLC, a Post-Hoc Pooled Efficacy Data Analysis of Two Phase 3 Trials', Journal of Thoracic Oncology, vol. 12, no. 1, pp. S665-S666.View/Download from: Publisher's site
Currow, D, Temel, JS, Abernethy, A, Milanowski, J, Friend, J & Fearon, KC 2017, 'ROMANA 3: a phase 3 safety extension study of anamorelin in advanced non-small-cell lung cancer (NSCLC) patients with cachexia.', Annals of Oncology, vol. 28, no. 8, pp. 1949-1956.View/Download from: Publisher's site
Cancer anorexia-cachexia is a debilitating condition frequently observed in NSCLC patients, characterized by decreased body weight, reduced food intake, and impaired quality of life. Anamorelin, a novel selective ghrelin receptor agonist, has anabolic and appetite-enhancing activities.ROMANA 3 was a safety extension study of two phase 3, double-blind studies that assessed safety and efficacy of anamorelin in advanced NSCLC patients with cachexia. Patients with preserved Eastern Cooperative Oncology Group ≤2 after completing 12 weeks (w) on the ROMANA 1 or ROMANA 2 trials (0-12 weeks) could enroll in ROMANA 3 and continue to receive anamorelin 100 mg or placebo once daily for an additional 12w (12-24 weeks). The primary endpoint of ROMANA 3 was anamorelin safety/tolerability (12-24 weeks). Secondary endpoints included changes in body weight, handgrip strength (HGS), and symptom burden (0-24 weeks).Of the 703 patients who completed ROMANA 1 and ROMANA 2, 513 patients entered ROMANA 3 (anamorelin, N = 345, mean age 62.0 years; placebo, N = 168; mean age 62.2 years). During ROMANA 3, anamorelin and placebo groups had similar incidences of treatment-emergent adverse events (TEAEs; 52.2% versus 55.7%), grade ≥3 TEAEs (22.4% versus 21.6%), and serious TEAEs (12.8% versus 12.6%). There were 36 (10.5%) and 23 (13.8%) deaths in the anamorelin and placebo groups, respectively; none were drug-related. Improvements in body weight and anorexia-cachexia symptoms observed in the original trials were consistently maintained over 12-24 weeks. Anamorelin, versus placebo, significantly increased body weight from baseline of original trials at all time points (P < 0.0001) and improved anorexia-cachexia symptoms at weeks 3, 6, 9, 12, and 16 (P < 0.05). No significant improvement in HGS was seen in either group.During the 12-24 weeks ROMANA 3 trial, anamorelin continued to be well tolerated. Over the entire 0-24w treatment period, body weight and symptom burden were improved with anamo...
Currow, DC & Skipworth, RJ 2017, 'The emerging role of anamorelin hydrochloride in the management of patients with cancer anorexia-cachexia.', Future Oncology, vol. 13, no. 20, pp. 1767-1783.View/Download from: Publisher's site
Cancer cachexia affects many patients with advanced cancer. This multifactorial syndrome, which involves loss of muscle mass and body weight, profoundly affects patients' physical functioning and quality of life. Pharmacologic interventions that target weight loss and also improve patient-reported measures are required. Anamorelin hydrochloride is an oral ghrelin receptor agonist for the treatment of cancer anorexia-cachexia that stimulates release of growth hormone and insulin-like growth factor 1, and improves food intake and body weight. Phase II and III trials have demonstrated that anamorelin increases body muscle and fat composition, and improves patient-reported appetite and quality of life. Anamorelin shows promise as an anabolic agent with benefits maintained over time, without the virilizing side effects of other anabolic medications.
Currow, DC, Abernethy, AP, Fallon, M & Portenoy, RK 2017, 'Repurposing Medications for Hospice/Palliative Care Symptom Control Is No Longer Sufficient: A Manifesto for Change.', Journal of Pain and Symptom Management, vol. 53, no. 3, pp. 533-539.View/Download from: Publisher's site
The World Health Organization essential medications list for hospice/palliative care reflects that, with the judicious use of currently available medications, the majority of symptoms can be lessened, and some controlled completely. Even with optimal use of current medications, symptom control is still unacceptable for many people. Currently available medications offer great benefit to a minority of patients, some benefit to an additional group, and no benefit or harms to others. In symptom control, development of new drugs is advancing at a glacial pace, contrasting to the rapid advances seen in many other disciplines. Specialists in palliative care should agree on several principles consequently: 1) Access to symptom-control drugs codified in the World Health Organization Essential Medicines list deserves the strongest support from national policies and professional guidelines, especially in resource-challenged countries. 2) The optimal use of currently available symptom-control drugs cannot yield acceptably high rates of net benefits. 3) There is a compelling need to identify patient subgroups that are likely to benefit from available medications and provide rigorous empirical support for indications, dosing, and route of administration for clinical practice. 4) New therapies are needed requiring an accelerated effort to investigate further the pathophysiology, neurobiology, and pharmacogenetics of distressing symptoms, and factors contributing to variations in drug response. This development requires a lengthy lead time. 5) Smarter ways to promote new knowledge into practice are needed as no drug will be suitable for all patients. We need to improve clinical characterization and biomarker technology to bring the best drugs to the right patients every time.
Currow, DC, Dal Grande, E, Ferreira, D, Johnson, MJ, McCaffrey, N & Ekström, M 2017, 'Chronic breathlessness associated with poorer physical and mental health-related quality of life (SF-12) across all adult age groups.', Thorax, vol. 72, no. 12, pp. 1151-1153.View/Download from: Publisher's site
Little is known about the impact of chronic breathlessness (modified Medical Research Council (mMRC) score ≥2 for most days, at least three of the last six months) on health-related quality of life (Short Form-12 (SF-12)). 3005 adults from randomly selected households were interviewed face-to-face in South Australia. mMRC ≥2 community prevalence was 2.9%. Adjusted analyses showed clinically meaningful and statistically significant decrements of physical and mental components of SF-12 (mean SF-12 summary scores in physical (-13.0 (-16.0 to -10.2)) and mental (-10.7 (-13.7 to -7.8)) components compared with people with mMRC=0) as chronic breathlessness severity increased, across five age groupings.
Currow, DC, Dal Grande, E, Sidhu, C, Ekstrom, M & Johnson, MJ 2017, 'The independent association of overweight and obesity with breathlessness in adults: a cross-sectional, population-based study', EUROPEAN RESPIRATORY JOURNAL, vol. 50, no. 3.View/Download from: Publisher's site
Currow, DC, Ekström, M & Johnson, MJ 2017, 'Overdosing on immediate-release morphine solution has predictable adverse effects.', The European respiratory journal, vol. 50, no. 3.View/Download from: Publisher's site
Currow, DC, Temel, JS, Abernethy, AP, Friend, J & Giorgino, R 2017, 'Body weight response with anamorelin in advanced non-small cell lung cancer (NSCLC) patients with anorexia/cachexia: Pooled analysis of two phase III trials.', JOURNAL OF CLINICAL ONCOLOGY, vol. 35.View/Download from: Publisher's site
Anorexia/cachexia commonly occurs in patients with advanced NSCLC and is associated with increased morbidity and mortality. In two randomized, double-blind, placebo-controlled phase 3 trials in NSCLC patients with cachexia, the ghrelin receptor agonist anamorelin was well tolerated and significantly increased body weight, lean and fat mass, and anorexia/cachexia symptom burden over 12 weeks compared to placebo (Temel J. Lancet Oncol. 2016). Since an involuntary weight loss of ≥ 5% is an established diagnostic criterion for cancer anorexia/cachexia, an analysis was conducted to assess the proportion of patients with ≥ 5% increase in body weight. Methods: NSCLC patients [ROMANA 1 (NCT01387269; N = 484) and ROMANA 2 (NCT01387282; N = 495)] with stage III/IV disease and cachexia (BMI < 20 kg/m2 or ≥ 5% weight loss during prior 6 months) were randomized 2:1 to receive 100 mg once daily oral anamorelin or placebo up to 12 weeks. A pooled analysis was conducted post-hoc in the modified intent-to-treat population (N = 829) to measure the proportion of patients with ≥ 5% increase in body weight at the end of study (or last observation carried forward since week 6 or 9). Results: The percentage of patients with ≥ 5% increase in body weight at the end of study was significantly higher in the anamorelin arm (N = 188/552, 34.1%) compared to placebo (N = 37/277; 13.4%). Among patients with BMI < 20kg/m2 at baseline (N = 182), 47.3% (N = 53/112) of anamorelin patients had a weight increase of ≥ 5% compared to 17.4% (N = 12/69) in the placebo arm. In both cases the nominal p-value was lower than 0.0001. Conclusions: Data from two published large pivotal studies in advanced NSCLC patients with anorexia/cachexia suggest that anamorelin treatment effect size on body weight is clinically relevant, as shown by the higher response rate achieved when the stringent cut-off of ≥ 5% weight gain was applied. The proportion of patients with BMI < 20kg/m2 that benefited from anamorelin treat...
Dunlop, S, Perez, D, Dessaix, A & Currow, D 2017, 'Australia's plain tobacco packs: anticipated and actual responses among adolescents and young adults 2010-2013.', Tobacco control.View/Download from: Publisher's site
In December 2012, Australia introduced world-first legislation mandating plain packaging for all tobacco products. To date, there is very little evidence on youth responses to the changed packs.To assess attitudes towards, and responses to, tobacco plain packs preimplementation and postimplementation.The Tobacco Promotion Impact Study (TPIS) was a yearly cross-sectional telephone survey of adolescents and young adults (12-24 years) from the states of New South Wales (NSW) and Queensland, conducted at three time points preimplementation (June 2010; June 2011; June 2012) and one time point postimplementation (June 2013; total n=8820).There were significant increases in support for plain packaging from preimplementation to postimplementation for: never smokers (56% in 2012 vs 63% in 2013; OR=0.77, 95% CI 0.65 to 0.90, p=0.001), experimenters/ex-smokers (55% in 2012 vs 72% in 2013; OR=0.51, 95% CI 0.38 to 0.68, p<0.001) and current smokers (35% in 2012 vs 55% in 2013; OR=0.49, 95% CI 0.32 to 0.75, p=0.001). At postimplementation, 16% of never smokers reported that plain packaging made them less likely to try smoking and 18% of experimenters/ex-smokers reported that plain packaging made them less likely to smoke again. Youth were significantly less likely to have anticipated these responses preimplementation (never smokers: 8% in 2011; OR=0.43, 95% CI 0.28 to 0.65, p<0.00; experimenters/ex-smokers: 11%; OR=0.65, 95% CI 0.52 to 0.82, p<0.001). At postimplementation, 34% of smokers reported a quitting-related response to plain packaging (tried to quit or thought about quitting); the proportion who anticipated such a response preimplementation was significantly less (14% in 2011; OR=0.33, 95% CI 0.20 to 0.53, p<0.001). 28% of smokers reported a social denormalisation response at postimplementation (hid their pack from view, used a case to cover their pack, felt embarrassed); the proportion who anticipated such a response preimplementation was significantly less (9% in 20...
Grotmol, KS, Lie, HC, Hjermstad, MJ, Aass, N, Currow, D, Kaasa, S, Moum, TÅ, Pigni, A, Loge, JH & European Palliative Care Research Collaborative (EPCRC) 2017, 'Depression-A Major Contributor to Poor Quality of Life in Patients With Advanced Cancer.', Journal of Pain and Symptom Management, vol. 54, no. 6, pp. 889-897.View/Download from: Publisher's site
Quality of life (QoL) and depression are important patient-reported outcomes in cancer care. However, the relative importance of depression severity in predicting QoL remains unclear because of few methodologically sound studies.To examine whether depression contributes to impairment of QoL irrespective of prognostic factors and symptom burden.A total of 563 patients were included from the European Palliative Care Research Collaborative-Computerized Symptom Assessment Study, an international, multi-center, cross-sectional study. The relative importance of prognostic factors (systemic inflammation [modified Glasgow Prognostic Score-mGPS]), co-morbidities and physical performance (Karnofsky Performance Status), symptom burden (loss of appetite, breathlessness, nausea [Edmonton Symptom Assessment Scale], and pain [Brief Pain Inventory]), and depression severity (Patient Health Questionnaire 9) in predicting Global Health/QoL (European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire [EORTC-QLQ-C30]) were assessed using hierarchical multiple regression models.Fifty-five percent were women, median age was 64 years, 87% had metastatic disease, median Karnofsky Performance Status was 70, and mean global QoL was 50.5 (SD = 23.3). Worse QoL was associated with increased systemic inflammation (mGPS = 1 β = -0.12, P = 0.003; mGPS = 2 β = -0.09, P = 0.023), lower physical performance (β = 0.17, P < 0.001), reduced appetite (β = -0.15, P < 0.001), breathlessness (β = -0.11, P = 0.004), pain (β = -0.14, P = 0.002), and higher depression severity (β = -0.27, P < 0.001). The full model accounted for 29% of the observed variance in QoL scores. The strongest predictor was depression severity, accounting for 5.8% of the variance.Depression severity was the strongest single predictor of poorer QoL in this sample of patients with advanced cancer, after accounting for a wide range of clinically relevant variables. Future studies should investigate t...
Hussain, JA, Bland, M, Langan, D, Johnson, MJ, Currow, DC & White, IR 2017, 'Quality of missing data reporting and handling in palliative care trials demonstrates that further development of the CONSORT statement is required: a systematic review.', Journal of Clinical Epidemiology, vol. 88, pp. 81-91.View/Download from: Publisher's site
Assess (i) the quality of reporting and handling of missing data (MD) in palliative care trials, (ii) whether there are differences in the reporting of criteria specified by the Consolidated Standards of Reporting Trials (CONSORT) 2010 statement compared with those not specified, and (iii) the association of the reporting of MD with journal impact factor and CONSORT endorsement status.Systematic review of palliative care randomized controlled trials. CENTRAL, MEDLINE, and EMBASE (2009-2014) were searched.One hundred and eight trials (15,560 participants) were included. MD was incompletely reported and not handled in accordance with current guidance. Reporting criteria specified by the CONSORT statement were better reported than those not specified (participant flow, 69%; number of participants not included in the primary outcome analysis, 94%; and the reason for MD, 71%). However, MD in items contributing to scale summaries (10%) and secondary outcomes (9%) were poorly reported, so the proportion of MD stated is likely to be an underestimate. The reason for MD provided was unclear for 54% of participants and only 16% of trials with MD reported a MD sensitivity analysis. The odds of reporting most of the MD and other risk of bias reporting criteria were increased as the journal impact factor increased and in journals that endorsed the CONSORT statement.Further development of the CONSORT MD reporting guidance is likely to improve the quality of reporting. Reporting recommendations are provided.
Janowiak, P, Krajnik, M, Podolec, Z, Bandurski, T, Damps-Konstańska, I, Sobański, P, Currow, DC & Jassem, E 2017, 'Dosimetrically administered nebulized morphine for breathlessness in very severe chronic obstructive pulmonary disease: a randomized, controlled trial.', BMC Pulmonary Medicine, vol. 17, no. 1, pp. 1-8.View/Download from: Publisher's site
Systemic morphine has evidence to support its use for reducing breathlessness in patients with severe chronic obstructive pulmonary disease (COPD). The effectiveness of the nebulized route, however, has not yet been confirmed. Recent studies have shown that opioid receptors are localized within epithelium of human trachea and large bronchi, a target site for a dosimetric nebulizer. The aim of this study was to compare any clinical or statistical differences in breathlessness intensity between nebulized 2.0% morphine and 0,9% NaCl in patients with very severe COPD.The study was a double-blind, controlled, cross-over trial. Participants received morphine or NaCl during two 4-day periods. Sequence of periods was randomized. The primary outcome measure was reduction of breathlessness intensity now by ≥20 mm using a 100 mm visual analogue scale (VAS) at baseline, 15, 30, 60, 120, 180 and 240 min after daily administration, during normal activities.Ten of 11 patients included completed the study protocol. All patients experienced clinically and statistically significant (p < 0.0001) breathlessness reduction during morphine nebulization. Mean VAS changes for morphine and 0.9% NaCl periods were 25.4 mm (standard deviation (SD): 9.0; median: 23,0; range: 14.0 to 41,5; confidence interval (CI): 95%) and 6.3 mm (SD: 7.8; median: 6.8; range: -11,5 to 19,5; CI: 95%), respectively. No treatment emergent adverse effects were noted.Our study showed superiority of dosimetrically administered nebulized morphine compared to NaCl in reducing breathlessness. This may have been achieved through morphine's direct action on receptors in large airways, although a systemic effect from absorption through the lungs cannot be excluded.Retrospectively registered (07.03.2017), ISRCTN14865597.
Johnson, MJ, Yorke, J, Hansen-Flaschen, J, Lansing, R, Ekström, M & Currow, DC 2017, 'Breathlessness despite optimal pathophysiological treatment: on the relevance of being chronic.', The European respiratory journal, vol. 50, no. 3.View/Download from: Publisher's site
Johnson, MJ, Yorke, J, Hansen-Flaschen, J, Lansing, R, Ekstrom, M, Similowski, T & Currow, DC 2017, 'Towards an expert consensus to delineate a clinical syndrome of chronic breathlessness', EUROPEAN RESPIRATORY JOURNAL, vol. 49, no. 5.View/Download from: Publisher's site
Jones, TA, Olds, TS, Currow, DC & Williams, MT 2017, 'Feasibility and Pilot Studies in Palliative Care Research: A Systematic Review', Journal of Pain and Symptom Management, vol. 54, no. 1, pp. 139-151.View/Download from: Publisher's site
© 2017 American Academy of Hospice and Palliative Medicine. Context: Feasibility and pilot study designs are common in palliative care research. Finding standard guidelines on the structure and reporting of these study types is difficult. Objectives: In feasibility and pilot studies in palliative care research, to determine 1) how commonly a priori feasibility are criteria reported and whether results are subsequently reported against these criteria? and 2) how commonly are participants' views on acceptability of burden of the study protocol assessed? Methods: Four databases (OVID Medline, EMBASE, CINAHL, and PubMed via caresearch.com.au.) were searched. Search terms included palliative care, terminal care, advance care planning, hospice, pilot, feasibility, with a publication date between January 1, 2012 and December 31, 2013. Articles were selected and appraised by two independent reviewers. Results: Fifty-six feasibility and/or pilot studies were included in this review. Only three studies had clear a priori criteria to measure success. Sixteen studies reported participant acceptability or burden with measures. Forty-eight studies concluded feasibility. Conclusion: The terms "feasibility" and "pilot" are used synonymously in palliative care research when describing studies that test for feasibility. Few studies in palliative care research outline clear criteria for success. The assessment of participant acceptability and burden is uncommon. A gold standard for feasibility study design in palliative care research that includes both clear criteria for success and testing of the study protocol for participant acceptability and burden is needed. Such a standard would assist with consistency in the design, conduct and reporting of feasibility and pilot studies.
Kaasa, S, Laird, B, Fallon, M, McMillan, D, Skipworth, R, Currow, D & Giorgino, R 2017, 'Efficacy of anamorelin in advanced non-small cell lung cancer (NSCLC) patients with anorexia/cachexia and modified Glasgow Prognostic Score (mGPS) of 2: Pooled analysis of two phase 3 trials', Annals of Oncology, vol. 28, pp. v498-v498.View/Download from: Publisher's site
Laird, B, McMillan, D, Kaasa, S, Fallon, M, Skipworth, R, Currow, D & Giorgino, R 2017, 'Characterization of cachectic patients with non-small cell lung cancer (NSCLC) according to their modified Glasgow Prognostic Score (mGPS)', Annals of Oncology, vol. 28, pp. v499-v499.View/Download from: Publisher's site
Li, Z, Frost, HR, Tosteson, TD, Zhao, L, Liu, L, Lyons, K, Chen, H, Cole, B, Currow, D & Bakitas, M 2017, 'A semiparametric joint model for terminal trend of quality of life and survival in palliative care research.', Statistics in Medicine, vol. 36, no. 29, pp. 4692-4704.View/Download from: Publisher's site
Palliative medicine is an interdisciplinary specialty focusing on improving quality of life (QOL) for patients with serious illness and their families. Palliative care programs are available or under development at over 80% of large US hospitals (300+ beds). Palliative care clinical trials present unique analytic challenges relative to evaluating the palliative care treatment efficacy which is to improve patients' diminishing QOL as disease progresses towards end of life (EOL). A unique feature of palliative care clinical trials is that patients will experience decreasing QOL during the trial despite potentially beneficial treatment. Often longitudinal QOL and survival data are highly correlated which, in the face of censoring, makes it challenging to properly analyze and interpret terminal QOL trend. To address these issues, we propose a novel semiparametric statistical approach to jointly model the terminal trend of QOL and survival data. There are two sub-models in our approach: a semiparametric mixed effects model for longitudinal QOL and a Cox model for survival. We use regression splines method to estimate the nonparametric curves and AIC to select knots. We assess the model performance through simulation to establish a novel modeling approach that could be used in future palliative care research trials. Application of our approach in a recently completed palliative care clinical trial is also presented.
Matz, M, Coleman, MP, Carreira, H, Salmerón, D, Chirlaque, MD, Allemani, C & CONCORD Working Group 2017, 'Worldwide comparison of ovarian cancer survival: Histological group and stage at diagnosis (CONCORD-2).', Gynecologic Oncology, vol. 144, no. 2, pp. 396-404.View/Download from: Publisher's site
Ovarian cancer comprises several histological groups with widely differing levels of survival. We aimed to explore international variation in survival for each group to help interpret international differences in survival from all ovarian cancers combined. We also examined differences in stage-specific survival.The CONCORD programme is the largest population-based study of global trends in cancer survival, including data from 60 countries for 695,932 women (aged 15-99years) diagnosed with ovarian cancer during 1995-2009. We defined six histological groups: type I epithelial, type II epithelial, germ cell, sex cord-stromal, other specific non-epithelial and non-specific morphology, and estimated age-standardised 5-year net survival for each country by histological group. We also analysed data from 67 cancer registries for 233,659 women diagnosed from 2001 to 2009, for whom information on stage at diagnosis was available. We estimated age-standardised 5-year net survival by stage at diagnosis (localised or advanced).Survival from type I epithelial ovarian tumours for women diagnosed during 2005-09 ranged from 40 to 70%. Survival from type II epithelial tumours was much lower (20-45%). Survival from germ cell tumours was higher than that of type II epithelial tumours, but also varied widely between countries. Survival for sex-cord stromal tumours was higher than for the five other groups. Survival from localised tumours was much higher than for advanced disease (80% vs. 30%).There is wide variation in survival between histological groups, and stage at diagnosis remains an important factor in ovarian cancer survival. International comparisons of ovarian cancer survival should incorporate histology.
Matz, M, Coleman, MP, Carreira, H, Salmerón, D, Chirlaque, MD, Allemani, C, Bouzbid, S, Hamdi-Chérif, M, Zaidi, Z, Bah, E, Swaminathan, R, Nortje, SH, El Mistiri, MM, Bayo, S, Malle, B, Manraj, SS, Sewpaul-Sungkur, R, Fabowale, A, Ogunbiyi, OJ, Bradshaw, D, Somdyala, NIM, Stefan, DC, Abdel-Rahman, M, Jaidane, L, Mokni, M, Kumcher, I, Moreno, F, González, MS, Laura, EA, Espinola, SB, Calabrano, GH, Carballo Quintero, B, Fita, R, Garcilazo, DA, Giacciani, PL, Diumenjo, MC, Laspada, WD, Green, MA, Lanza, MF, Ibañez, SG, Lima, CA, Lobo de Oliveira, E, Daniel, C, Scandiuzzi, C, De Souza, PCF, Melo, CD, Del Pino, K, Laporte, C, Curado, MP, de Oliveira, JC, Veneziano, CLA, Veneziano, DB, Latorre, MRDO, Tanaka, LF, Azevedo e Silva, G, Galaz, JC, Moya, JA, Herrmann, DA, Vargas, S, Herrera, VM, Uribe, CJ, Bravo, LE, Arias-Ortiz, NE, Jurado, DM, Yépez, MC, Galán, YH, Torres, P, Martínez-Reyes, F, Pérez-Meza, ML, Jaramillo, L, Quinto, R, Cueva, P, Yépez, JG, Torres-Cintrón, CR, Tortolero-Luna, G, Alonso, R, Barrios, E, Nikiforuk, C, Shack, L, Coldman, AJ, Woods, RR, Noonan, G, Turner, D, Kumar, E, Zhang, B, McCrate, FR, Ryan, S, Hannah, H, Dewar, RAD, MacIntyre, M, Lalany, A, Ruta, M, Marrett, L, Nishri, DE, McClure, C, Vriends, KA, Bertrand, C, Louchini, R, Robb, KI & Stuart-Panko, H 2017, 'Erratum to "Worldwide comparison of ovarian cancer survival: Histological group and stage at diagnosis (CONCORD-2)" [Gynecol. Oncol. 144 (2017) 396–404](S009082581631575X)(10.1016/j.ygyno.2016.11.019)', Gynecologic Oncology, vol. 147, no. 3, p. 725.View/Download from: Publisher's site
© 2017 Elsevier Inc. Unfortunately, the original publication of the article includes errors in the author list for the CONCORD Working Group members (pages 402–403). The CONCORD Working Group members for the Registro de Câncer de São Paulo (Brazil) should read MRDO Latorre, LF Tanaka; the correct affiliation for DC Stefan is Umtata University (South Africa); the correct affiliation for N Bhoo-Pathy is University of Malaya (Malaysia); the correct affiliation for O Chimedsuren is Mongolian National University of Medical Sciences – MNUMS (Mongolia); the affiliation for G Gatta and M Sant should read Fondazione IRCCS Istituto Nazionale dei Tumori (Italy); and for the United Kingdom, correct initials for C Stiller should read CA Stiller. Due to a miscommunication during the process of transferring this manuscript from our editorial team to Production, the CONCORD Working Group authors were not properly indexed in PubMed. This has now been corrected online. The publisher would like to apologise for any inconvenience caused.
Matz, M, Coleman, MP, Sant, M, Chirlaque, MD, Visser, O, Gore, M, Allemani, C & CONCORD Working Group 2017, 'The histology of ovarian cancer: worldwide distribution and implications for international survival comparisons (CONCORD-2).', Gynecologic Oncology, vol. 144, no. 2, pp. 405-413.View/Download from: Publisher's site
Ovarian cancers comprise several histologically distinct tumour groups with widely different prognosis. We aimed to describe the worldwide distribution of ovarian cancer histology and to understand what role this may play in international variation in survival.The CONCORD programme is the largest population-based study of global trends in cancer survival. Data on 681,759 women diagnosed during 1995-2009 with cancer of the ovary, fallopian tube, peritoneum and retroperitonum in 51 countries were included. We categorised ovarian tumours into six histological groups, and explored the worldwide distribution of histology.During 2005-2009, type II epithelial tumours were the most common. The proportion was much higher in Oceania (73.1%), North America (73.0%) and Europe (72.6%) than in Central and South America (65.7%) and Asia (56.1%). By contrast, type I epithelial tumours were more common in Asia (32.5%), compared with only 19.4% in North America. From 1995 to 2009, the proportion of type II epithelial tumours increased from 68.6% to 71.1%, while the proportion of type I epithelial tumours fell from 23.8% to 21.2%. The proportions of germ cell tumours, sex cord-stromal tumours, other specific non-epithelial tumours and tumours of non-specific morphology all remained stable over time.The distribution of ovarian cancer histology varies widely worldwide. Type I epithelial, germ cell and sex cord-stromal tumours are generally associated with higher survival than type II tumours, so the proportion of these tumours may influence survival estimates for all ovarian cancers combined. The distribution of histological groups should be considered when comparing survival between countries and regions.
Matz, M, Coleman, MP, Sant, M, Chirlaque, MD, Visser, O, Gore, M, Allemani, C, Bouzbid, S, Hamdi-Chérif, M, Zaidi, Z, Bah, E, Swaminathan, R, Nortje, SH, El Mistiri, MM, Bayo, S, Malle, B, Manraj, SS, Sewpaul-Sungkur, R, Fabowale, A, Ogunbiyi, OJ, Bradshaw, D, Somdyala, NIM, Stefan, DC, Abdel-Rahman, M, Jaidane, L, Mokni, M, Kumcher, I, Moreno, F, González, MS, Laura, EA, Espinola, SB, Calabrano, GH, Carballo Quintero, B, Fita, R, Garcilazo, DA, Giacciani, PL, Diumenjo, MC, Laspada, WD, Green, MA, Lanza, MF, Ibañez, SG, Lima, CA, Lobo de Oliveira, E, Daniel, C, Scandiuzzi, C, De Souza, PCF, Melo, CD, Del Pino, K, Laporte, C, Curado, MP, de Oliveira, JC, Veneziano, CLA, Veneziano, DB, Latorre, MRDO, Tanaka, LF, Azevedo e Silva, G, Galaz, JC, Moya, JA, Herrmann, DA, Vargas, S, Herrera, VM, Uribe, CJ, Bravo, LE, Arias-Ortiz, NE, Jurado, DM, Yépez, MC, Galán, YH, Torres, P, Martínez-Reyes, F, Pérez-Meza, ML, Jaramillo, L, Quinto, R, Cueva, P, Yépez, JG, Torres-Cintrón, CR, Tortolero-Luna, G, Alonso, R, Barrios, E, Nikiforuk, C, Shack, L, Coldman, AJ, Woods, RR, Noonan, G, Turner, D, Kumar, E, Zhang, B, McCrate, FR, Ryan, S, Hannah, H, Dewar, RAD, MacIntyre, M, Lalany, A, Ruta, M, Marrett, L, Nishri, DE, McClure, C, Vriends, KA, Bertrand, C, Louchini, R & Robb, KI 2017, 'Erratum to "The histology of ovarian cancer: Worldwide distribution and implications for international survival comparisons (CONCORD-2)" [Gynecol. Oncol. 144 (2017) 405–413](S0090825816314974)(10.1016/j.ygyno.2016.10.019)', Gynecologic Oncology, vol. 147, no. 3, p. 726.View/Download from: Publisher's site
© 2017 Unfortunately, the original publication of the article includes errors in the author list for the CONCORD Working Group members (pages 411–412). The CONCORD Working Group members for the Registro de Câncer de São Paulo (Brazil) should read MRDO Latorre, LF Tanaka; the correct affiliation for DC Stefan is Umtata University (South Africa); the correct affiliation for N Bhoo-Pathy is University of Malaya (Malaysia); the correct affiliation for O Chimedsuren is Mongolian National University of Medical Sciences – MNUMS (Mongolia); the affiliation for G Gatta and M Sant should read Fondazione IRCCS Istituto Nazionale dei Tumori (Italy); and for the United Kingdom, correct initials for C Stiller should read CA Stiller. Due to a miscommunication during the process of transferring this manuscript from our editorial team to Production, the CONCORD Working Group authors were not properly indexed in PubMed. This has now been corrected online. The publisher would like to apologise for any inconvenience caused.
Morgan, DD, Currow, DC, Denehy, L & Aranda, SA 2017, 'Living actively in the face of impending death: constantly adjusting to bodily decline at the end-of-life.', BMJ Supportive and Palliative Care, vol. 7, no. 2, pp. 179-188.View/Download from: Publisher's site
People with advanced cancer experience bodily change resulting in debilitating functional decline. Although inability to participate in everyday activities (occupation) contributes to profound suffering, limited research has examined the relationship between altered bodily experience (embodiment) and functional ability.The purpose of this study was to better understand the lived experience of functional decline for people with advanced cancer living at home.Indepth interviews were conducted with 10 community dwelling people with advanced cancer about their bodily experiences of functional decline. This study employed a pragmatic qualitative approach, informed by hermeneutic phenomenology.People described living with rapidly disintegrating bodies and how this affected their ability to participate in everyday activities. Analysis identified themes which were evaluated against conceptual frameworks of 'occupation' and 'embodiment'. People experienced a shifting sense of self. They had to continuously reinterpret changing bodies. Previously automatic movements became disjointed and effortful. Simple actions like standing or getting out of bed required increasing concentration. Relentless bodily breakdown disrupted peoples' relationship with time, hindering their ability, but not their desire, to participate in everyday activities. Contending with this deterioration is the work of adaptation to functional decline at the end-of-life.This study highlights the role active participation in everyday activities plays in mediating adjustment to functional decline. These findings challenge us to look beyond palliation of physical symptoms and psychospiritual care as ends in themselves. Symptom control and palliation should be viewed as mechanisms to optimise active participation in essential and valued activities.
Morgan, DD, Swetenham, K, To, THM, Currow, DC & Tieman, JJ 2017, 'Telemonitoring via Self-Report and Video Review in Community Palliative Care: A Case Report.', Healthcare, vol. 5, no. 3.View/Download from: Publisher's site
Continuous monitoring and management of a person's symptoms and performance status are critical for the delivery of effective palliative care. This monitoring occurs routinely in inpatient settings; however, such close evaluation in the community has remained elusive. Patient self-reporting using telehealth offers opportunities to identify symptom escalation and functional decline in real time, and facilitate timely proactive management. We report the case of a 57-year-old man with advanced non-small cell lung cancer who participated in a telehealth trial run by a community palliative care service. This gentleman was able to complete self-reporting of function and symptoms via iPad although at times he was reticent to do so. Self-reporting was perceived as a means to communicate his clinical needs without being a bother to the community palliative care team. He also participated in a videoconference with clinical staff from the community palliative care service and his General Practitioner. Videoconferencing with the nurse and GP was highly valued as an effective way to communicate and also because it eliminated the need for travel. This case report provides important information about the feasibility and acceptability of palliative care telehealth as a way to better manage clinical care in a community setting.
Reigada, C, Papadopoulos, A, Boland, JW, Yorke, J, Ross, J, Currow, DC, Hart, S, Bajwah, S, Grande, G, Wells, A & Johnson, MJ 2017, 'Implementation of the Needs Assessment Tool for patients with interstitial lung disease (NAT:ILD): facilitators and barriers.', Thorax, vol. 72, no. 11, pp. 1049-1051.View/Download from: Publisher's site
A Needs Assessment Tool (NAT) was developed previously to help clinicians identify the supportive/palliative needs of people with interstitial lung disease (ILD) (NAT:ILD). This letter presents barriers and facilitators to clinical implementation. Data from (1) a focus group of respiratory clinicians and (2) an expert consensus group (respiratory and palliative clinicians, academics, patients, carers) were analysed using Framework Analysis. Barriers related to resources and service reconfiguration, and facilitators to clinical need, structure, objectiveness, flexibility and benefits of an 'aide-memoire'. Identified training needs included communication skills and local service knowledge. The NAT:ILD was seen as useful, necessary and practical in everyday practice.
Tervonen, HE, Aranda, S, Roder, D, You, H, Walton, R, Morrell, S, Baker, D & Currow, DC 2017, 'Cancer survival disparities worsening by socio-economic disadvantage over the last 3 decades in new South Wales, Australia.', BMC Public Health, vol. 17, no. 1, pp. 1-11.View/Download from: Publisher's site
Public concerns are commonly expressed about widening health gaps. This cohort study examines variations and trends in cancer survival by socio-economic disadvantage, geographical remoteness and country of birth in an Australian population over a 30-year period.Data for cases diagnosed in New South Wales (NSW) in 1980-2008 (n = 651,245) were extracted from the population-based NSW Cancer Registry. Competing risk regression models, using the Fine & Gray method, were used for comparative analyses to estimate sub-hazard ratios (SHR) with 95% confidence intervals (CI) among people diagnosed with cancer.Increased risk of cancer death was associated with living in the most socio-economically disadvantaged areas compared with the least disadvantaged areas (SHR 1.15, 95% CI 1.13-1.17), and in outer regional/remote areas compared with major cities (SHR 1.05, 95% CI 1.03-1.06). People born outside Australia had a similar or lower risk of cancer death than Australian-born (SHR 0.99, 95% CI 0.98-1.01 and SHR 0.91, 95% CI 0.90-0.92 for people born in other English and non-English speaking countries, respectively). An increasing comparative risk of cancer death was observed over time when comparing the most with the least socio-economically disadvantaged areas (SHR 1.07, 95% CI 1.04-1.10 for 1980-1989; SHR 1.14, 95% CI 1.12-1.17 for 1990-1999; and SHR 1.24, 95% CI 1.21-1.27 for 2000-2008; p < 0.001 for interaction between disadvantage quintile and year of diagnosis).There is a widening gap in comparative risk of cancer death by level of socio-economic disadvantage that warrants a policy response and further examination of reasons behind these disparities.
Tervonen, HE, Morrell, S, Aranda, S, Roder, D, You, H, Niyonsenga, T, Walton, R, Baker, D & Currow, D 2017, 'The impact of geographic unit of analysis on socioeconomic inequalities in cancer survival and distant summary stage - a population-based study.', Australian and New Zealand Journal of Public Health, vol. 41, no. 2, pp. 130-136.View/Download from: Publisher's site
OBJECTIVE: When using area-level disadvantage measures, size of geographic unit can have major effects on recorded socioeconomic cancer disparities. This study examined the extent of changes in recorded socioeconomic inequalities in cancer survival and distant stage when the measure of socioeconomic disadvantage was based on smaller Census Collection Districts (CDs) instead of Statistical Local Areas (SLAs). METHODS: Population-based New South Wales Cancer Registry data were used to identify cases diagnosed with primary invasive cancer in 2000-2008 (n=264,236). Logistic regression and competing risk regression modelling were performed to examine socioeconomic differences in odds of distant stage and hazard of cancer death for all sites combined and separately for breast, prostate, colorectal and lung cancers. RESULTS: For all sites collectively, associations between socioeconomic disadvantage and cancer survival and distant stage were stronger when the CD-based socioeconomic disadvantage measure was used compared with the SLA-based measure. The CD-based measure showed a more consistent socioeconomic gradient with a linear upward trend of risk of cancer death/distant stage with increasing socioeconomic disadvantage. Site-specific analyses provided similar findings for the risk of death but less consistent results for the likelihood of distant stage. CONCLUSIONS: The use of socioeconomic disadvantage measure based on the smallest available spatial unit should be encouraged in the future. Implications for Public Health: Disadvantage measures based on small spatial units can more accurately identify socioeconomic cancer disparities to inform priority settings in service planning.
Tervonen, HE, Roder, D, Morrell, S, You, H & Currow, DC 2017, 'Does exclusion of cancers registered only from death-certificate information diminish socio-demographic disparities in recorded survival?', Cancer Epidemiology, vol. 48, pp. 70-77.View/Download from: Publisher's site
Death Certificate Only (DCO) cancer cases are commonly excluded from survival analyses due to unknown survival time. This study examines whether socio-demographic factors are associated with DCO diagnosis, and the potential effects of excluding DCO cases on socio-demographic cancer survival disparities in NSW, Australia.NSW Cancer Registry data for cases diagnosed in 2000-2008 were used in this study. Logistic regression was used to estimate the odds of DCO registration by socio-demographic sub-group (socio-economic disadvantage, residential remoteness, country of birth, age at diagnosis). Cox proportional hazard regression was used to estimate the probability of death from cancer by socio-demographic subgroup when DCO cases were included and excluded from analyses.DCO cases consisted of 1.5% (n=4336) of all cases (n=299,651). DCO diagnosis was associated with living in socio-economically disadvantaged areas (most disadvantaged compared with least disadvantaged quintile: odds ratio OR 1.25, 95%CI 1.12-1.40), living in inner regional (OR 1.16, 95%CI 1.08-1.25) or remote areas (OR 1.48, 95%CI 1.01-2.19), having an unknown country of birth (OR 1.63, 95%CI 1.47-1.81) and older age. Including or excluding DCO cases had no significant impact on hazard ratios for cancer death by socio-economic disadvantage quintile or remoteness category, and only a minor impact on hazard ratios by age.Socio-demographic factors were associated with DCO diagnosis in NSW. However, socio-demographic cancer survival disparities remained unchanged or varied only slightly irrespective of including/excluding DCO cases. Further research could examine the upper limits of DCO proportions that significantly alter estimated cancer survival differentials if DCOs are excluded.
Tervonen, HE, Walton, R, You, H, Baker, D, Roder, D, Currow, D & Aranda, S 2017, 'After accounting for competing causes of death and more advanced stage, do Aboriginal and Torres Strait Islander peoples with cancer still have worse survival? A population-based cohort study in New South Wales.', BMC Cancer, vol. 17, no. 1, pp. 398-398.View/Download from: Publisher's site
BACKGROUND: Aboriginal and Torres Strait Islander peoples in Australia have been found to have poorer cancer survival than non-Aboriginal people. However, use of conventional relative survival analyses is limited due to a lack of life tables. This cohort study examined whether poorer survival persist after accounting for competing risks of death from other causes and disparities in cancer stage at diagnosis, for all cancers collectively and by cancer site. METHODS: People diagnosed in 2000-2008 were extracted from the population-based New South Wales Cancer Registry. Aboriginal status was multiply imputed for people with missing information (12.9%). Logistic regression models were used to compute odds ratios (ORs) with 95% confidence intervals (CIs) for 'advanced stage' at diagnosis (separately for distant and distant/regional stage). Survival was examined using competing risk regression to compute subhazard ratios (SHRs) with 95%CIs. RESULTS: Of the 301,356 cases, 2517 (0.84%) identified as Aboriginal (0.94% after imputation). After adjusting for age, sex, year of diagnosis, socio-economic status, remoteness, and cancer site Aboriginal peoples were more likely to be diagnosed with distant (OR 1.30, 95%CI 1.17-1.44) or distant/regional stage (OR 1.29, 95%CI 1.18-1.40) for all cancers collectively. This applied to cancers of the female breast, uterus, prostate, kidney, others (those not included in other categories) and cervix (when analyses were restricted to cases with known stages/known Aboriginal status). Aboriginal peoples had a higher hazard of death than non-Aboriginal people after accounting for competing risks from other causes of death, socio-demographic factors, stage and cancer site (SHR 1.40, 95%CI 1.31-1.50 for all cancers collectively). Consistent results applied to colorectal, lung, breast, prostate and other cancers. CONCLUSIONS: Aboriginal peoples with cancer have an elevated hazard of cancer death compared with non-Aboriginal people, after accou...
To, THM, Tait, P, Morgan, DD, Tieman, JJ, Crawford, G, Michelmore, A, Currow, DC & Swetenham, K 2017, 'Case conferencing for palliative care patients - a survey of South Australian general practitioners', AUSTRALIAN JOURNAL OF PRIMARY HEALTH, vol. 23, no. 5, pp. 458-463.View/Download from: Publisher's site
Agar, M, Lawlor, P, Quinn, S, Draper, B, Caplan, G, Rowett, D, Sanderson, C, Hardy, J, Le, B, Eckermann, S, McCaffrey, N, Devilee, L, Fazekas, B, Hill, M & Currow, D 2017, 'Efficacy of Oral Risperidone, Haloperidol, or Placebo for Symptoms of Delirium Among Patients in Palliative Care A Randomized Clinical Trial', JAMA Internal Medicine, vol. 177, no. 1, pp. 34-42.View/Download from: Publisher's site
Importance: Antipsychotics are widely used for distressing symptoms of delirium, but efficacy has not been established in placebo-controlled trials in palliative care.
Objective: To determine efficacy of risperidone or haloperidol relative to placebo in relieving target symptoms of delirium associated with distress among patients receiving palliative care.
Design, Setting, and Participants: A double-blind, parallel-arm, dose-titrated randomized clinical trial was conducted at 11 Australian inpatient hospice or hospital palliative care services between August 13, 2008, and April 2, 2014, among participants with life-limiting illness, delirium, and a delirium symptoms score (sum of Nursing Delirium Screening Scale behavioral, communication, and perceptual items) of 1 or more.
Interventions: Age-adjusted titrated doses of oral risperidone, haloperidol, or placebo solution were administered every 12 hours for 72 hours, based on symptoms of delirium. Patients also received supportive care, individualized treatment of delirium precipitants, and subcutaneous midazolam hydrochloride as required for severe distress or safety.
Main Outcome and Measures: Improvement in mean group difference of delirium symptom score (severity range, 0-6) between baseline and day 3. Five a priori secondary outcomes: delirium severity, midazolam use, extrapyramidal effects, sedation, and survival.
Results: Two hundred forty-seven participants (mean [SD] age, 74.9 [9.8] years; 85 women [34.4%]; 218 with cancer [88.3%]) were included in intention-to-treat analysis (82 receiving risperidone, 81 receiving haloperidol, and 84 receiving placebo). In the primary intention-to-treat analysis, participants in the risperidone arm had delirium symptom scores that were significantly higher than those among participants in the placebo arm (on average 0.48 Units higher; 95% CI, 0.09-0.86; P = .02) at study end. Similarly, for those in the haloperidol arm, delirium symptom scores were on average 0.24 Units h...
Boland, JW, Allgar, V, Boland, EG, Oviasu, O, Agar, M, Currow, DC & Johnson, MJ 2017, 'Effect of Opioids and Benzodiazepines on Clinical Outcomes in Patients Receiving Palliative Care: An Exploratory Analysis.', Journal of Palliative Medicine.View/Download from: Publisher's site
BACKGROUND: Medications for symptom management in palliative care have associated, but poorly understood, harms. Drug-related harms have important clinical implications, may impact on patients' compliance and contribute to symptoms. OBJECTIVE: To explore the longitudinal relationship between oral morphine equivalent daily dose (MEDD) and oral diazepam equivalent daily dose (DEDD) with functional, cognitive, and symptom outcomes in patients receiving palliative care. DESIGN: Secondary longitudinal analysis of cancer decedents (n = 235) was carried out from a palliative care randomized controlled trial with multiple outcome measures. At each time point, MEDD and DEDD were calculated. Multilevel modeling was used to investigate independent associations between MEDD and DEDD, and cognitive and gastrointestinal symptoms, quality of life (QoL), performance status, and survival. SETTING/SUBJECTS: Participants were recruited from a specialist palliative care program in southern Adelaide, were expected to live ≥48 hours, had pain in the previous 3 months, and a baseline Folstein Mini-Mental Status Examination score ≥25. RESULTS: Cognitive and gastrointestinal symptoms, performance status, and QoL worsened over time. In the adjusted multilevel analysis, statistically significant relationships remained between MEDD/DEDD and worsening performance status (p = 0.001), DEDD and gastrointestinal effects (p < 0.001), MEDD and QoL (p < 0.022). CONCLUSIONS: Commonly used palliative medications were associated with deteriorating performance status. The lack of association between MEDD with gastrointestinal or cognitive symptoms underlines that these associations are not inevitable with close attention. This analysis highlights the importance of including other medications as confounders when exploring medication-related harms. An understanding of the risk-benefit balance of medications is needed to maximize net benefits for patients.
Boland, JW, Allgar, V, Boland, EG, Oviasu, O, Agar, M, Currow, DC & Johnson, MJ 2017, 'O-3 Opioids, benzodiazepines, anti-cholinergic load and clinical outcomes in patients with advanced cancer', BMJ Supportive & Palliative Care, vol. 7, no. Suppl 1, pp. A1.3-A2.View/Download from: Publisher's site
Currow, D, Watts, GJ, Johnson, M, McDonald, CF, Miners, JO, Somogyi, AA, Denehy, L, McCaffrey, N, Eckert, DJ, McCloud, P, Louw, S, Lam, L, Greene, A, Fazekas, B, Clark, KC, Fong, K, Agar, MR, Joshi, R, Kilbreath, S, Ferreira, D, Ekström, M & Australian national Palliative Care Clinical Studies Collaborative (PaCCSC) 2017, 'A pragmatic, phase III, multisite, double-blind, placebo-controlled, parallel-arm, dose increment randomised trial of regular, low-dose extended-release morphine for chronic breathlessness: Breathlessness, Exertion And Morphine Sulfate (BEAMS) study protocol.', BMJ Open, vol. 7, no. 7, pp. 1-19.View/Download from: Publisher's site
INTRODUCTION: Chronic breathlessness is highly prevalent and distressing to patients and families. No medication is registered for its symptomatic reduction. The strongest evidence is for regular, low-dose, extended- release (ER) oral morphine. A recent large phase III study suggests the subgroup most likely to benefit have chronic obstructive pulmonary disease (COPD) and modified Medical Research Council breathlessness scores of 3 or 4. This protocol is for an adequately powered, parallel-arm, placebo-controlled, multisite, factorial, block-randomised study evaluating regular ER morphine for chronic breathlessness in people with COPD. METHODS AND ANALYSIS: The primary question is what effect regular ER morphine has on worst breathlessness, measured daily on a 0-10 numerical rating scale. Uniquely, the coprimary outcome will use a FitBit to measure habitual physical activity. Secondary questions include safety and, whether upward titration after initial benefit delivers greater net symptom reduction. Substudies include longitudinal driving simulation, sleep, caregiver, health economic and pharmacogenetic studies. Seventeen centres will recruit 171 participants from respiratory and palliative care. The study has five phases including three randomisation phases to increasing doses of ER morphine. All participants will receive placebo or active laxatives as appropriate. Appropriate statistical analysis of primary and secondary outcomes will be used. ETHICS AND DISSEMINATION: Ethics approval has been obtained. Results of the study will be submitted for publication in peer-reviewed journals, findings presented at relevant conferences and potentially used to inform registration of ER morphine for chronic breathlessness. TRIAL REGISTRATION NUMBER: NCT02720822; Pre-results.
To, THM, LeBlanc, TW, Eastman, P, Neoh, K, Agar, MR, To, LB, Rowett, D, Vandersman, Z & Currow, DC 2017, 'The Prospective Evaluation of the Net Effect of Red Blood Cell Transfusions in Routine Provision of Palliative Care.', Journal of Palliative Medicine, vol. 20, no. 10, pp. 1152-1157.View/Download from: Publisher's site
Red Blood Cell (RBC) transfusions are commonly used in palliative care. RBCs are a finite resource, transfusions carry risks, and the net effect (benefits and harms) is poorly defined for people with life-limiting illnesses.To examine the indications and effects of RBC transfusion in palliative care patients.This international, multisite, prospective consecutive cohort study.Palliative care patients undergoing RBC transfusion.Target symptoms (fatigue, breathlessness, generalized weakness, or dizziness) were assessed before transfusion and at day 7 by treating clinicians, using National Cancer Center Institute Common Terminology Criteria for Adverse Events. Assessment of harms was made at day 2.One hundred and one transfusions with day 7 follow-up were collected. Median age was 72.0 (interquartile range 61.5-83.0) years, 58% men, and mean Australia-modified Karnofsky Performance Status (AKPS) of 48 (standard deviation [SD] 17). A mean 2.1 (SD 0.6) unit was tranfused. The target symptoms were fatigue (61%), breathlessness (16%), generalized weakness (12%), dizziness (6%), or other (5%). Forty-nine percent of transfusions improved the primary target symptom, and 78% of transfusions improved at least one of the target symptoms. Harms were infrequent and mild. An AKPS of 40%-50% was associated with higher chances of symptomatic benefit in the target symptom; however, no other predictors of response were identified.In the largest prospective consecutive case series to date, clinicians generally reported benefit, with minimal harms. Ongoing work is required to define the optimal patient- and clinician-reported hematological and functional outcome measures to optimize the use of donor blood and to minimize transfusion-associated risk.
Clark, K, Lam, LT, Talley, NJ, Phillips, JL & Currow, DC 2017, 'Identifying Factors That Predict Worse Constipation Symptoms in Palliative Care Patients: A Secondary Analysis.', Journal of Palliative Medicine, vol. 20, no. 5, pp. 528-532.View/Download from: Publisher's site
OBJECTIVE: The aim of this work was to investigate whether variables identified as likely to impact the experience of constipation in other clinical settings similarly affected the experiences of constipated palliative care patients. BACKGROUND: The majority of palliative care patients with cancer are likely to be bothered by constipation symptoms at some point in their disease trajectory. Despite this, it remains unclear as to which factors predict more severe problems. METHODS: This study was conducted in a sample of 94 constipated palliative care patients who were asked to voluntarily complete a series of questions regarding their demographic and other characteristics, including whether they had chronic constipation symptoms, that is, constipation symptoms for 12 months. Other variables included age, body mass index, sex, performance status, and regular opioids and their doses. At the same time, they were asked to complete the Patient Assessment of Constipation Symptoms (PAC-SYM) and Patient Assessment of Constipation Quality of Life (PAC-QOL) questionnaires. RESULTS: Descriptive statistics summarized baseline data. Unadjusted associations between the selected variables on PAC-SYM were examined by using bi-variate analyses. Significant variables identified on bi-variate analyses were included in a multivariate analysis. The final results identified that only the chronicity of constipation symptoms predicted more severe symptoms. This relationship persisted when this single variable was retained in the final model, illustrating that PAC-SYM scores are 0.41 higher in patients with chronic constipation compared with those without it (p = 0.02). In contrast, regular opioid use was not identified as a significant factor (p = 0.56). DISCUSSION: This study suggests that the factor most likely to predict worse constipation symptoms was the duration that people had experienced problems. Further, those who perceived their constipation symptoms to be more severe had a po...
Collier, A, Breaden, K, Phillips, JL, Agar, M, Litster, C & Currow, DC 2017, 'Caregivers' Perspectives on the Use of Long-Term Oxygen Therapy for the Treatment of Refractory Breathlessness: A Qualitative Study.', Journal of Pain and Symptom Management, vol. 53, no. 1, pp. 33-39.View/Download from: Publisher's site
CONTEXT: Despite limited clinical evidence, long-term oxygen therapy (LTOT) is used for the management of refractory breathlessness in people with life-limiting illnesses who are not necessarily hypoxemic. OBJECTIVES: The aim of this study was to understand caregiver factors associated with caring for someone with LTOT from the perspectives and experiences of caregivers themselves. METHODS: The qualitative study used semistructured interviews. The study was conducted in two states in Australia. Participants (n = 20) were self-nominated caregivers of people receiving LTOT for refractory breathlessness in the palliative setting. RESULTS: Data analyses established one overarching theme titled: "Oxygen giveth (something to help caregivers relieve breathlessness) and oxygen taketh away (from patients who lose some autonomy)." The theme captured caregivers' feelings of extreme distress in response to witnessing refractory breathlessness, and oxygen fulfilling several critical and beneficial roles in this context. In parallel, caregivers also explicitly and implicitly articulated several downsides to the use of LTOT. CONCLUSION: Caregivers find caring for someone with refractory breathlessness extremely distressing. The benefits of LTOT are often overestimated, whereas its potential harms are underestimated. As significant stakeholders of people receiving LTOT, caregivers should be provided with opportunities to collaborate with clinicians in evidence-based decision making, efforts should be made to provide them with information and education about the most effective pharmacological and nonpharmacological strategies to manage refractory breathlessness in a palliative care setting including the appropriate use of LTOT to enable them to do so.
Currow, DC, Phillips, J & Agar, M 2017, 'Population-based models of planning for palliative care in older people.', Current Opinion in Supportive and Palliative Care, vol. 11, no. 4, pp. 310-314.View/Download from: Publisher's site
Health service planning requires demographic, clinical, and health systems data and is unique to each health system. Planning for palliative care in older people must include patients and their carers. This review explores literature from the last 24 months.The proportion of people living in skilled nursing facilities is increasing and many residents require quality palliative care. Simultaneously, the complexity of care for older people is also increasing. Systematic approaches to improving palliative care in these facilities have shown benefits that are cost-effective.Although advance care planning is widely promoted, a randomized controlled trial failed to show the benefits seen in nonrandomized trials. This requires a reconceptualization of current programs that seek to increase uptake.Caregivers take on complex decision-making which can be stressful. By contrast, patients are often very confident that the people who are close to them will make good decisions on their behalf.Specific subgroups considered in this review include carers (and the challenges they face), the 'oldest old' and people with dementia.Excellent research is being done to improve the care of older people with palliative care needs. Ultimately, how can key findings be incorporated into clinical care?
DiGiacomo, M, Hatano, Y, Phillips, J, Lewis, J, Abernathy, A & Currow, D 2017, 'Caregiver characteristics and bereavement needs: findings from a population study', Palliative Medicine, vol. 31, no. 5, pp. 465-474.View/Download from: Publisher's site
Background: Globally, the majority of care for people with life-limiting illnesses is provided by informal caregivers. Identifying characteristics of caregivers that may have unmet needs and negative outcomes can enable provision of better support to facilitate their adjustment.
Aim: We compared characteristics, expressed unmet needs, and outcomes for spousal caregivers, with other caregivers at the end of life, by gender and age.
Design: The South Australian Health Omnibus is an annual, random, face-to-face, cross-sectional survey wherein respondents are asked about end-of-life care.
Setting/Participants: Participants were aged over 15, resided in households in South Australia, and had someone close to them die from a terminal illness in the last five years.
Results: Of the 1,540 respondents who provided hands-on care for someone close at the end of life, 155 were widows/widowers. Bereaved spousal caregivers were more likely to: be older, female, better educated, have lower incomes, less full-time work, English as second language, sought help with grief, and provided more day-to-day care for longer periods. Spousal caregivers were less likely to be willing to take on caregiving again, less able to 'move on' with life, and needed greater emotional support and more information about the illness and services. The only difference between widows and widowers was older age of spouse in women. Younger spousal caregivers perceived greater unmet emotional needs and were significantly less likely to be able to 'move on'.
Conclusions: Spousal caregivers are different from other caregivers, with more intense needs that are not fully met. These have implications for bereavement, health, and social services.
Luckett, T, Phillips, J, Johnson, M, Garcia, M, Bhattarai, P, Carrieri-Kohlman, V, Hutchinson, A, Disler, RT, Currow, D, Agar, M, Ivynian, S, Chye, R, Newton, PJ & Davidson, PM 2017, 'Insights from Australians with respiratory disease living in the community with experience of self-managing through an emergency department 'near miss' for breathlessness: a strengths-based qualitative study.', BMJ Open, vol. 7, no. 12, pp. 1-11.View/Download from: Publisher's site
Breathlessness 'crises' in people with chronic respiratory conditions are a common precipitant for emergency department (ED) presentations, many of which might be avoided through improved self-management and support. This study sought insights from people with experience of ED 'near misses' where they considered going to the ED but successfully self-managed instead.A qualitative approach was used with a phenomenological orientation. Participants were eligible if they reported breathlessness on most days from a diagnosed respiratory condition and experience of ≥1 ED near miss. Recruitment was through respiratory support groups and pulmonary rehabilitation clinics. Semistructured interviews were conducted with each participant via telephone or face-to-face. Questions focused on ED-related decision-making, information finding, breathlessness management and support. This analysis used an integrative approach and independent coding by two researchers. Lazarus and Cohen's Transactional Model of Stress and Coping informed interpretive themes.Interviews were conducted with 20 participants, 15 of whom had chronic obstructive pulmonary disease. Nineteen interviews were conducted via telephone. Analysis identified important factors in avoiding ED presentation to include perceived control over breathlessness, self-efficacy in coping with a crisis and desire not to be hospitalised. Effective coping strategies included: taking a project management approach that involved goal setting, monitoring and risk management; managing the affective dimension of breathlessness separately from the sensory perceptual and building three-way partnerships with primary care and respiratory services.In addition to teaching non-pharmacological and pharmacological management of breathlessness, interventions should aim to develop patients' generic self-management skills. Interventions to improve self-efficacy should ensure this is substantiated by transfer of skills and support, including knowledge...
Phillips, JL & Currow, DC 2017, 'Would reframing aged care facilities as a 'hospice' instead of a 'home' enable older people to get the care they need?', Collegian, vol. 24, no. 1, pp. 1-2.View/Download from: Publisher's site
Stone, E, Rankin, N, Phillips, J, Fong, K, Miller, A, Largey, G, Zielinski, R, Flynn, P, Currow, D & Shaw, T 2017, 'P3.07-019 AMDAT Lung, An Ideal Lung Cancer MDT Dataset', Journal of Thoracic Oncology, vol. 12, no. 1, pp. S1442-S1442.View/Download from: Publisher's site
Ahmadi, Z, Bernelid, E, Currow, DC & Ekstrom, M 2016, 'Prescription of opioids for breathlessness in end-stage COPD: a national population-based study', INTERNATIONAL JOURNAL OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE, vol. 11, pp. 2651-2657.View/Download from: Publisher's site
Ahmadi, Z, Wysham, NG, Lundstrom, S, Janson, C, Currow, DC & Ekstrom, M 2016, 'End-of-life care in oxygen-dependent ILD compared with lung cancer: a national population-based study', THORAX, vol. 71, no. 6, pp. 510-516.View/Download from: Publisher's site
Allen, SA, Dal Grande, E, Abernethy, AP & Currow, DC 2016, 'Two colliding epidemics - obesity is independently associated with chronic pain interfering with activities of daily living in adults 18 years and over; a cross-sectional, population-based study', BMC Public Health, vol. 16, no. 1, pp. 1-9.View/Download from: Publisher's site
© 2016 The Author(s). Background: Chronic pain interfering with activities of daily living is highly prevalent in the community. More than 600 million people worldwide are obese. The aim of this paper is to assess if such chronic pain is associated independently with obesity across the adult population, having controlled for other key factors. Methods: The South Australian Health Omnibus is an annual, population-based, cross-sectional study. Data on 2616 participants were analysed for episodes of daily pain for three of the preceding six months. Obesity was derived from self-reported height and weight. Multivariable logistic regression analysed the associations between chronic pain interfering with activities of daily living, body mass index (BMI) and key socio-demographic factors. Results: Chronic pain interfering with activities of daily living peaks in people ≥75 years of age while obesity peaks in the 45-54 age group. Pain and obesity together peak in the 55-74 year age group. In the adjusted multinominal logistic regression model, compared to those with no pain, there was a strong association between obesity and pain that interfered moderately or extremely with day-to-day activities (OR 2.25; 95 % CI 1.57-3.23; p < 0.001) having controlled for respondents' age, gender, rurality, country of birth and highest educational attainment. People over 65 years of age and those with lower educational levels were more likely to experience such chronic pain related to obesity. Conclusion: This study demonstrates a strong association between chronic pain and obesity/morbid obesity in the South Australian population. Prospective, longitudinal data are needed to understand the dynamic interaction between these two prevalent conditions.
Bausewein, C, Daveson, BA, Currow, DC, Downing, J, Deliens, L, Radbruch, L, Defilippi, K, Lopes Ferreira, P, Costantini, M, Harding, R & Higginson, IJ 2016, 'EAPC White Paper on outcome measurement in palliative care: Improving practice, attaining outcomes and delivering quality services - Recommendations from the European Association for Palliative Care (EAPC) Task Force on Outcome Measurement', PALLIATIVE MEDICINE, vol. 30, no. 1, pp. 6-22.View/Download from: Publisher's site
Boland, JW, Reigada, C, Yorke, J, Hart, SP, Bajwah, S, Ross, J, Wells, A, Papadopoulos, A, Currow, DC, Grande, G, Macleod, U & Johnson, MJ 2016, 'The Adaptation, Face, and Content Validation of a Needs Assessment Tool: Progressive Disease for People with Interstitial Lung Disease', JOURNAL OF PALLIATIVE MEDICINE, vol. 19, no. 5, pp. 549-555.View/Download from: Publisher's site
Clark, K, Connolly, A, Clapham, S, Quinsey, K & Currow, D 2016, 'The Prevalence and Intensity of People's Physical Symptoms at the Time That Dying Was Diagnosed: A Prospective Cohort Study', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 52, no. 6, pp. E17-E17.View/Download from: Publisher's site
Clark, K, Connolly, A, Clapham, S, Quinsey, K, Eagar, K & Currow, DC 2016, 'Physical Symptoms at the Time of Dying Was Diagnosed: A Consecutive Cohort Study To Describe the Prevalence and Intensity of Problems Experienced by Imminently Dying Palliative Care Patients by Diagnosis and Place of Care', JOURNAL OF PALLIATIVE MEDICINE, vol. 19, no. 12, pp. 1288-1295.View/Download from: Publisher's site
Clark, K, Eagar, K & Currow, DC 2016, 'Embedding Objective Measurements of Quality into Routine Practice in Hospice/Palliative Care', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 52, no. 3, pp. E5-E7.View/Download from: Publisher's site
Clark, K, Lam, LT, Talley, NJ, Quinn, J, Blight, A, Byfieldt, N & Currow, DC 2016, 'Assessing the Presence and Severity of Constipation with Plain Radiographs in Constipated Palliative Care Patients', JOURNAL OF PALLIATIVE MEDICINE, vol. 19, no. 6, pp. 617-621.View/Download from: Publisher's site
Collier, A, Morgan, DD, Swetenham, K, To, THM, Currow, DC & Tieman, JJ 2016, 'Implementation of a pilot telehealth programme in community palliative care: A qualitative study of clinicians' perspectives', PALLIATIVE MEDICINE, vol. 30, no. 4, pp. 409-417.View/Download from: Publisher's site
Collins, A, Burchell, J, Ritchie, D, Le, B, Sundararajan, V, Hudson, P, McLachlan, S-A, Krishnasamy, M, Millar, J, Currow, D, Mileshkin, L & Philip, J 2016, 'Exploring the Landscape of Palliative Care for People with Non-Hodgkin's Lymphoma: Do They Receive Quality End-of-Life Care?', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 52, no. 6, pp. E151-E152.View/Download from: Publisher's site
Collins, A, Burchell, J, Sundararajan, V, Millar, J, Le, B, Currow, D, Hudson, P, McLachlan, S-A, Mileshkin, L & Krishnasamy, M 2016, 'Transition to Palliative Care for Patients with Metastatic Prostate Cancer: How Well Have We Integrated?', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 52, no. 6, pp. E150-E151.View/Download from: Publisher's site
Crane, M, Scott, N, O'Hara, BJ, Aranda, S, Lafontaine, M, Stacey, I, Varlow, M & Currow, D 2016, 'Knowledge of the signs and symptoms and risk factors of lung cancer in Australia: mixed methods study', BMC PUBLIC HEALTH, vol. 16.View/Download from: Publisher's site
Creighton, N, Walton, R, Roder, D, Aranda, S & Currow, D 2016, 'Validation of administrative hospital data for identifying incident pancreatic and periampullary cancer cases: a population-based study using linked cancer registry and administrative hospital data in New South Wales, Australia', BMJ OPEN, vol. 6, no. 7.View/Download from: Publisher's site
Currow, D, Temel, J, Abernethy, A, Friend, J, Giorgino, R & Fearon, KC 2016, 'Anamorelin in cachectic patients with non-small cell lung cancer (NSCLC) and acute phase protein reaction (APPR): Pooled analysis of two phase 3 trials (ROMANA 1 and ROMANA 2)', ANNALS OF ONCOLOGY, vol. 27.View/Download from: Publisher's site
Currow, DC, Davidson, PM & Higginson, IJ 2016, '"Outcomes" Is Not an Oxymoron in Hospice/Palliative Care', JOURNAL OF PALLIATIVE MEDICINE, vol. 19, no. 11, pp. 1128-1129.View/Download from: Publisher's site
Currow, DC, Ekstroem, M & Johnson, MJ 2016, 'Opioids in chronic obstructive pulmonary disease: the whole picture using all available evidence', BRITISH JOURNAL OF CLINICAL PHARMACOLOGY, vol. 81, no. 4, pp. 795-796.View/Download from: Publisher's site
Delaney, GP, Gandhidasan, S, Walton, R, Terlich, F, Baker, D & Currow, D 2016, 'The Pattern of Use of Hypofractionated Radiation Therapy for Early-Stage Breast Cancer in New South Wales, Australia, 2008 to 2012', INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, vol. 96, no. 2, pp. 266-272.View/Download from: Publisher's site
Dessaix, A, Maag, A, McKenzie, J & Currow, DC 2016, 'Factors influencing reductions in smoking among Australian adolescents.', Public Health Research and Practice, vol. 26, no. 1, pp. 1-4.View/Download from: Publisher's site
A continued increase in the proportion of adolescents who never smoke, as well as an understanding of factors that influence reductions in smoking among this susceptible population, is crucial. The World Health Organization Framework Convention on Tobacco Control provides an appropriate structure to briefly examine Australian and New South Wales policies and programs that are influencing reductions in smoking among adolescents in Australia. This paper provides an overview of price and recent tax measures to reduce the demand for tobacco, the evolution of smoke-free environment policies, changes to tobacco labelling and packaging, public education campaigns, and restrictions to curb tobacco advertising. It also discusses supplyreduction measures that limit adolescents' access to tobacco products. Consideration is given to emerging priorities to achieve continued declines in smoking by Australian adolescents.
Dunlop, S, Dessaix, A & Currow, D 2016, 'How are tobacco smokers using e-cigarettes? Patterns of use, reasons for use and places of purchase in New South Wales REPLY', MEDICAL JOURNAL OF AUSTRALIA, vol. 205, no. 7, pp. 336-336.View/Download from: Publisher's site
Dunlop, S, Lyons, C, Dessaix, A & Currow, D 2016, 'How are tobacco smokers using e-cigarettes? Patterns of use, reasons for use and places of purchase in New South Wales', The Medical journal of Australia, vol. 204, no. 9, pp. 355e1-355e7.View/Download from: Publisher's site
OBJECTIVES: To explore how and why tobacco smokers and recent quitters in NSW use e-cigarettes, as well as common places of purchase. DESIGN: The Cancer Institute Tobacco Tracking Survey is a serial cross-sectional telephone survey, with 40 interviews in NSW each week. PARTICIPANTS: 2966 tobacco smokers and recent quitters (in the past 12 months) interviewed January 2014 - June 2015. MEASURES: Current e-cigarette use; reasons for using; places of purchase. RESULTS: 9% of the sample reported currently using e-cigarettes; the rate was highest among 18-29-year-old people (16%). Infrequent use (less than weekly; 57%) was more common than frequent use (at least weekly; 43%). Frequent use was more likely among older adults (55 years and older v 18-29 years: adjusted odds ratio [aOR], 4.43; P = 0.002) and less likely among current tobacco smokers (v recent quitters: aOR, 0.38, P = 0.020). The most commo n reasons for using e-cigarettes by those over 30 years of age was "to help me quit" (42%) and to "cut down" smoking (35%); for younger adults it was "because they are not as bad for your health as cigarettes" (25%). Common places of purchase were the internet (29%) and tobacconists (27%). CONCLUSIONS: Although use of e-cigarettes by tobacco smokers in NSW remains low, some are using e-cigarettes in attempts to reduce tobacco-related harm. Physicians and public health campaigners should inform smokers about the risks associated with dual e-cigarette and tobacco use, advise interested quitters that e-cigarettes are currently unregulated as cessation aids, and continue to provide evidence-based recommendations and cessation services to smokers wanting to quit.
Dunlop, S, Lyons, C, Dessaix, A & Currow, D 2016, 'How are tobacco smokers using e-cigarettes? Patterns of use, reasons for use and places of purchase in New South Wales', MEDICAL JOURNAL OF AUSTRALIA, vol. 204, no. 9, pp. 355-355.View/Download from: Publisher's site
Ekstrom, M, Ahmadi, Z, Bornefalk-Hermansson, A, Abernethy, A & Currow, D 2016, 'Oxygen for breathlessness in patients with chronic obstructive pulmonary disease who do not qualify for home oxygen therapy', COCHRANE DATABASE OF SYSTEMATIC REVIEWS, no. 11.View/Download from: Publisher's site
Ekstrom, M, Allingham, SF, Eagar, K, Yates, P, Johnson, C & Currow, DC 2016, 'Breathlessness During the Last Week of Life in Palliative Care: An Australian Prospective, Longitudinal Study', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 51, no. 5, pp. 816-823.View/Download from: Publisher's site
Ekstrom, M, Johnson, MJ, Schioler, L, Kaasa, S, Hjermstad, MJ & Currow, DC 2016, 'Who experiences higher and increasing breathlessness in advanced cancer? The longitudinal EPCCS Study', SUPPORTIVE CARE IN CANCER, vol. 24, no. 9, pp. 3803-3811.View/Download from: Publisher's site
Ekstrom, M, Vergo, MT, Ahmadi, Z & Currow, DC 2016, 'Prevalence of Sudden Death in Palliative Care: Data From the Australian Palliative Care Outcomes Collaboration', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 52, no. 2, pp. 221-227.View/Download from: Publisher's site
Fearon, K, Currow, D, Temel, J, Giorgino, R, Friend, J & Abernethy, A 2016, 'OR45: Body Composition in Non-Small Cell Lung Cancer (Nsclc) Patients with Cachexia and Improved Anorexia-Cachexia Symptoms: Anamorelin Phase 3 Trials Pooled Analysis', Clinical Nutrition, vol. 35, pp. S18-S19.View/Download from: Publisher's site
Ferreira, DH, Silva, JP, Quinn, S, Abernethy, AP, Johnson, MJ, Oxberry, SG & Currow, DC 2016, 'Blinded Patient Preference for Morphine Compared to Placebo in the Setting of Chronic Refractory Breathlessness-An Exploratory Study', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 51, no. 2, pp. 247-254.View/Download from: Publisher's site
Hochman, MJ, Kamal, AH, Wolf, SP, Samsa, GP, Currow, DC, Abernethy, AP & LeBlanc, TW 2016, 'Anticholinergic Drug Burden in Noncancer Versus Cancer Patients Near the End of Life', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 52, no. 5, pp. 737-+.View/Download from: Publisher's site
Hui, D, Bansal, S, Strasser, F, Morita, T, Caraceni, A, Davis, M, Cherny, N, Kaasa, S, Currow, D, Abernethy, A, Nekolaichuk, C & Bruera, E 2016, 'Reply to the letter to the editor 'Integration between oncology and palliative care: does one size fit all?' by Verna et al.', ANNALS OF ONCOLOGY, vol. 27, no. 3, pp. 549-550.View/Download from: Publisher's site
Hussain, JA, White, IR, Langan, D, Johnson, MJ, Currow, DC, Torgerson, DJ & Bland, M 2016, 'Missing data in randomized controlled trials testing palliative interventions pose a significant risk of bias and loss of power: a systematic review and meta-analyses', JOURNAL OF CLINICAL EPIDEMIOLOGY, vol. 74, pp. 57-65.View/Download from: Publisher's site
Johnson, MJ & Currow, DC 2016, 'Treating breathlessness in lung cancer patients: the potential of breathing training', EXPERT REVIEW OF RESPIRATORY MEDICINE, vol. 10, no. 3, pp. 241-243.View/Download from: Publisher's site
Johnson, MJ, Allgar, V, Macleod, U, Jones, A, Oliver, S & Currow, D 2016, 'Family Caregivers Who Would Be Unwilling to Provide Care at the End of Life Again: Findings from the Health Survey for England Population Survey', PLOS ONE, vol. 11, no. 1.View/Download from: Publisher's site
Johnson, MJ, Bland, JM, Gahbauer, EA, Ekstroem, M, Sinnarajah, A, Gill, TM & Currow, DC 2016, 'Breathlessness in Elderly Adults During the Last Year of Life Sufficient to Restrict Activity: Prevalence, Pattern, and Associated Factors', JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, vol. 64, no. 1, pp. 73-80.View/Download from: Publisher's site
Johnson, MJ, Hui, D & Currow, DC 2016, 'Opioids, Exertion, and Dyspnea: A Review of the Evidence', AMERICAN JOURNAL OF HOSPICE & PALLIATIVE MEDICINE, vol. 33, no. 2, pp. 194-200.View/Download from: Publisher's site
Johnston, AK, Creighton, N & Currow, D 2016, 'Breast reconstruction following mastectomy in NSW, 2008-2011', Asia-Pacific Journal of Clinical Oncology, vol. 12, pp. 111-111.
Kirby, S, Barlow, V, Saurman, E, Lyle, D, Passey, M & Currow, D 2016, 'Are rural and remote patients, families and caregivers needs in life-limiting illness different from those of urban dwellers? A narrative synthesis of the evidence', AUSTRALIAN JOURNAL OF RURAL HEALTH, vol. 24, no. 5, pp. 289-299.View/Download from: Publisher's site
Martins, RT, Currow, DC, Abernethy, AP, Johnson, MJ, Toson, B & Eckert, DJ 2016, 'Effects of low-dose morphine on perceived sleep quality in patients with refractory breathlessness: A hypothesis generating study', RESPIROLOGY, vol. 21, no. 2, pp. 386-391.View/Download from: Publisher's site
Masso, M, Allingham, SF, Johnson, CE, Pidgeon, T, Yates, P, Currow, D & Eagar, K 2016, 'Palliative Care Problem Severity Score: Reliability and acceptability in a national study', PALLIATIVE MEDICINE, vol. 30, no. 5, pp. 479-485.View/Download from: Publisher's site
McCaffrey, N, Al-Janabi, H, Currow, D, Hoefman, R & Ratcliffe, J 2016, 'Protocol for a systematic review of preference-based instruments for measuring care-related outcomes and their suitability for the palliative care setting', BMJ OPEN, vol. 6, no. 9.View/Download from: Publisher's site
McCaffrey, N, Bradley, S, Ratcliffe, J & Currow, DC 2016, 'What Aspects of Quality of Life Are Important From Palliative Care Patients' Perspectives? A Systematic Review of Qualitative Research.', Journal of Pain and Symptom Management, vol. 52, no. 2, pp. 318-328.e5.View/Download from: Publisher's site
CONTEXT: Despite the availability of numerous tools professing to measure quality of life (QOL) in the palliative care setting, no single instrument includes all patient-valued domains. OBJECTIVES: To identify which aspects of QOL are important from palliative care patients' perspectives, aiding coverage, and content validity evaluation of available tools. METHODS: A systematic review and synthesis of qualitative research was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. ASSIA, CINAHL, Cochrane library, Embase, Medline, PsycINFO, and PubMed were searched from database inception to December 31, 2015. Published, peer-reviewed, English-language articles reporting primary qualitative data investigating QOL domains in adults with a progressive, life-limiting illness were included. Studies a priori exploring a chosen aspect of QOL were not included. Articles scoring ≤2 on reporting quality were excluded. Framework synthesis was used to identify key themes across the studies. RESULTS: Overall, 3589 articles were screened and 24 studies were included. Eight important aspects of QOL were identified: physical; personal autonomy; emotional; social; spiritual; cognitive; healthcare; and preparatory. All but one study discussed spiritual aspects, whereas only six studies mentioned cognitive aspects. CONCLUSION: A broad range of domains are important to the QOL of people with life-limiting illnesses receiving palliation. Refinement of measures is needed to help ensure services address issues valued by patients such as preparation for death and aspects of health care provision, elements which are seldom included in currently available preference-based measures used to inform value for money decisions in palliative care.
McCaffrey, N, Fazekas, B, Cutri, N & Currow, DC 2016, 'How Accurately Do Consecutive Cohort Audits Predict Phase III Multisite Clinical Trial Recruitment in Palliative Care?', Journal of Pain and Symptom Management, vol. 51, no. 4, pp. 748-755.View/Download from: Publisher's site
CONTEXT: Audits have been proposed for estimating possible recruitment rates to randomized controlled trials (RCTs), but few studies have compared audit data with subsequent recruitment rates. OBJECTIVES: To compare the accuracy of estimates of potential recruitment from a retrospective consecutive cohort audit of actual participating sites and recruitment to four Phase III multisite clinical RCTs. METHODS: The proportion of potentially eligible study participants estimated from an inpatient chart review of people with life-limiting illnesses referred to six Australian specialist palliative care services was compared with recruitment data extracted from study prescreening information from three sites that participated fully in four Palliative Care Clinical Studies Collaborative RCTs. The predominant reasons for ineligibility in the audit and RCTs were analyzed. RESULTS: The audit overestimated the proportion of people referred to the palliative care services who could participate in the RCTs (pain 17.7% vs. 1.2%, delirium 5.8% vs. 0.6%, anorexia 5.1% vs. 0.8%, and bowel obstruction 2.8% vs. 0.5%). Approximately 2% of the referral base was potentially eligible for these effectiveness studies. Ineligibility for general criteria (language, cognition, and geographic proximity) varied between studies, whereas the reasons for exclusion were similar between the audit and pain and anorexia studies but not for delirium or bowel obstruction. CONCLUSION: The retrospective consecutive case note audit in participating sites did not predict realistic recruitment rates, mostly underestimating the impact of study-specific inclusion criteria. These findings have implications for the applicability of the results of RCTs. Prospective pilot studies are more likely to predict actual recruitment.
McCaffrey, N, Kaambwa, B, Currow, DC & Ratcliffe, J 2016, 'Health-related quality of life measured using the EQ-5D-5L: South Australian population norms.', Health and Quality of Life Outcomes, vol. 14, no. 1, pp. 1-12.View/Download from: Publisher's site
BACKGROUND: Although a five level version of the widely-used EuroQol 5 dimensions (EQ-5D) instrument has been developed, population norms are not yet available for Australia to inform the future valuation of health in economic evaluations. The aim of this study was to estimate HrQOL normative values for the EQ-5D-5L preference-based measure in a large, randomly selected, community sample in South Australia. METHODS: The EQ-5D-5L instrument was included in the 2013 South Australian Health Omnibus Survey, an interviewer-administered, face-to-face, cross-sectional survey. Respondents rated their level of impairment across dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) and global health rating on a visual analogue scale (EQ-VAS). Utility scores were derived using the newly-developed UK general population-based algorithm and relationships between utility and EQ-VAS scores and socio-demographic factors were also explored using multivariate regression analyses. RESULTS: Ultimately, 2,908 adults participated in the survey (63.4 % participation rate). The mean utility and EQ-VAS scores were 0.91 (95 CI 0.90, 0.91) and 78.55 (95 % CI 77.95, 79.15), respectively. Almost half of respondents reported no problems across all dimensions (42.8 %), whereas only 7.2 % rated their health >90 on the EQ-VAS (100 = the best health you can imagine). Younger age, male gender, longer duration of education, higher annual household income, employment and marriage/de facto relationships were all independent, statistically significant predictors of better health status (p < 0.01) measured with the EQ-VAS. Only age and employment status were associated with higher utility scores, indicating fundamental differences between these measures of health status. CONCLUSIONS: This is the first Australian study to apply the EQ-5D-5L in a large, community sample. Overall, findings are consistent with EQ-5D-5L utility and VAS scores reported for other countries...
Muircroft, W & Currow, D 2016, 'Palliative care in advanced pancreatic cancer', Cancer Forum, vol. 40, no. 1, pp. 62-65.
The management of patients with advanced pancreatic cancer often requires a multi-disciplinary approach with individualised therapy. Addressing the underlying causes of several of the troublesome symptoms that are relatively unique to the pathophysiology of pancreatic cancer is crucial in order to optimise the function and comfort of people diagnosed with this poor prognosis cancer. Early recognition and response is likely to improve outcomes later in the course of the disease, but more work needs to be done to compare expectant and reactive approaches to the most troublesome symptoms in advanced pancreatic cancer. Given such a poor outlook, referral to a palliative care service that has an active, team-based approach that includes dietetics, gastroenterology, interventional pain expertise and liaison psychiatry is likely to deliver the best possible outcomes. Such programs need to be in centres with sufficient caseload to ensure that meaningful outcomes can be measured prospectively and these teams are also best placed to incorporate new knowledge and approaches as the evidence base continues to evolve.
Muircroft, W, Gooden, H, Collier, A, Carey, S, Gott, M & Currow, D 2016, 'A qualitative exploration of patient and carer perspectives on pancreatic exocrine insufficiency due to pancreatic cancer', BMJ Supportive & Palliative Care, vol. 6, no. 3, pp. 400.1-400.View/Download from: Publisher's site
Nikles, J, Mitchell, GK, Hardy, J, Senior, H, Carmont, S-A, Schluter, PJ, Vora, R, Currow, D & Yelland, M 2016, 'Single-patient multiple crossover studies to determine the effectiveness of paracetamol in relieving pain suffered by patients with advanced cancer taking regular opioids: A pilot study', PALLIATIVE MEDICINE, vol. 30, no. 8, pp. 800-802.View/Download from: Publisher's site
Obita, GP, Boland, EG, Currow, DC, Johnson, MJ & Boland, JW 2016, 'Somatostatin Analogues Compared With Placebo and Other Pharmacologic Agents in the Management of Symptoms of Inoperable Malignant Bowel Obstruction: A Systematic Review', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 52, no. 6, pp. 901-+.View/Download from: Publisher's site
Philip, J, Collins, A, Burchell, J, Krishnasamy, M, Mileshkin, L, McLachlan, S-A, Le, B, Millar, J, Currow, D, Hudson, P & Sundararajan, V 2016, 'Integration of Palliative Care for Patients with Metastatic Breast Cancer: Have We Achieved Quality End-of-Life Care?', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 52, no. 6, pp. E152-E152.View/Download from: Publisher's site
Pidgeon, T, Johnson, CE, Currow, D, Yates, P, Banfield, M, Lester, L, Allingham, SF, Bird, S & Eagar, K 2016, 'A survey of patients' experience of pain and other symptoms while receiving care from palliative care services', BMJ SUPPORTIVE & PALLIATIVE CARE, vol. 6, no. 3, pp. 315-322.View/Download from: Publisher's site
Reigada, C, Fairhurst, C, Yorke, J, Ross, J, Boland, J, Hart, S, Currow, D, Grande, G, Bajwah, S, Wells, A, Macleod, U, Bland, M & Johnson, M 2016, 'Construct validity of the needs assessment tool progressive diseases for interstitial lung disease (nat: pd-ild) patients', Thorax, vol. 71, pp. A266-A266.View/Download from: Publisher's site
Smith, AK, Currow, DC, Abernethy, AP, Johnson, MJ, Miao, Y, Boscardin, WJ & Ritchie, CS 2016, 'Prevalence and Outcomes of Breathlessness in Older Adults: A National Population Study', JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, vol. 64, no. 10, pp. 2035-2041.View/Download from: Publisher's site
Soeberg, MJ, Creighton, N, Currow, DC, Young, JM & van Zandwijk, N 2016, 'Patterns in the incidence, mortality and survival of malignant pleural and peritoneal mesothelioma, New South Wales, 1972-2009', AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, vol. 40, no. 3, pp. 255-262.View/Download from: Publisher's site
Taylor, A, Morris, G, Tieman, J, Currow, D, Kidd, M & Carati, C 2016, 'Can Video Conferencing Be as Easy as Telephoning?—A Home Healthcare Case Study', E-Health Telecommunication Systems and Networks, vol. 05, no. 01, pp. 8-18.View/Download from: Publisher's site
Temel, JS, Abernethy, AP, Currow, DC, Friend, J, Duus, EM, Yan, Y & Fearon, KC 2016, 'Anamorelin in patients with non-small-cell lung cancer and cachexia (ROMANA 1 and ROMANA 2): results from two randomised, double-blind, phase 3 trials', LANCET ONCOLOGY, vol. 17, no. 4, pp. 519-531.View/Download from: Publisher's site
Tervonen, HE, Aranda, S, Roder, D, Walton, R, Baker, D, You, H & Currow, D 2016, 'Differences in impact of Aboriginal and Torres Strait Islander status on cancer stage and survival by level of socio-economic disadvantage and remoteness of residence-A population-based cohort study in Australia', CANCER EPIDEMIOLOGY, vol. 41, pp. 132-138.View/Download from: Publisher's site
Tieman, JJ, Swetenham, K, Morgan, DD, To, TH & Currow, DC 2016, 'Using telehealth to support end of life care in the community: a feasibility study.', BMC Palliative Care, vol. 15, no. 1, pp. 94-94.View/Download from: Publisher's site
BACKGROUND: Telehealth is being used increasingly in providing care to patients in the community setting. Telehealth enhanced service delivery could offer new ways of managing load and care prioritisation for palliative care patients living in the community. The study assesses the feasibility of a telehealth-based model of service provision for community based palliative care patients, carers and clinicians. METHODS: This study was a prospective cohort study of a telehealth-based intervention for community based patients of a specialist palliative care service living in Southern Adelaide, South Australia. Participants were 43 community living patients enrolled in the Southern Adelaide Palliative Service. To be eligible patients needed to be over 18 years and have an Australian modified Karnofksy Performance Score > 40. Exclusion criteria included a demonstrated inability to manage the hardware or technology (unless living with a carer who could manage the technology) or non-English speaking without a suitable carer/proxy. Participants received video-based conferences between service staff and the patient/carer; virtual case conferences with the patient/carer, service staff and patient's general practitioner (GP); self-report assessment tools for patient and carer; and remote activity monitoring (ACTRN12613000733774). RESULTS: The average age of patients was 71.6 years (range: 49 to 91 years). All 43 patients managed to enter data using the telehealth system. Self-reported data entered by patients and carers did identify changes in performance status leading to changes in care. Over 4000 alerts were generated. Staff reported that videocalls were similar (22.3%) or better/much better (65.2%) than phone calls and similar (63.1%) or better/much better (27.1%) than face-to-face. Issues with the volume of alerts generated, technical support required and the impact of service change were identified. CONCLUSIONS: The trial showed that patients and carers could manage the...
To, THM, To, LB & Currow, DC 2016, 'Can We Detect Transfusion Benefits in Palliative Care Patients?', JOURNAL OF PALLIATIVE MEDICINE, vol. 19, no. 10, pp. 1110-1113.View/Download from: Publisher's site
Wysham, NG, Nipp, RD, Leblanc, TW, Wolf, SP, Ekstrom, MP & Currow, DC 2016, 'A practical measurement of thoracic sarcopenia: Correlation with clinical parameters and outcomes in advanced lung cancer', ERJ Open Research, vol. 2, no. 2, pp. 1-3.View/Download from: Publisher's site
To the Editor:
Sarcopenia, the loss of skeletal muscle mass, is common in chronic disease, and has been hypothesised to
contribute to fatigue and breathlessness [1, 2]. The research gold standard for assessing sarcopenia relies
on whole-body, cross-sectional imaging, an impractical approach in routine care . A more practical
alternative measures lumbar skeletal muscle density at L3 using computed tomography (CT) normalised
for height, termed the skeletal muscle index (SMI) . While evidence suggests that reduced lumbar SMI
correlates with adverse clinical outcomes, such as mortality in lung or colorectal cancers , little research
has explored how this measure of sarcopenia relates to breathlessness or exercise tolerance.
Bush, SH, Lacaze-Masmonteil, N, McNamara-Kilian, MT, MacDonald, AR, Tierney, S, Momoli, F, Agar, M, Currow, DC & Lawlor, PG 2016, 'The preventative role of exogenous melatonin administration to patients with advanced cancer who are at risk of delirium: study protocol for a randomized controlled trial', TRIALS, vol. 17.View/Download from: Publisher's site
Hatano, Y, Moroni, M, Wilcock, A, Quinn, S, Csikos, A, Allan, SG, Agar, M, Clark, K, Clayton, JM & Currow, DC 2016, 'Pharmacovigilance in hospice/palliative care: the net immediate and short-term effects of dexamethasone for anorexia', BMJ SUPPORTIVE & PALLIATIVE CARE, vol. 6, no. 3, pp. 331-337.View/Download from: Publisher's site
McCaffrey, N, Hardy, J, Fazekas, B, Agar, M, Devilee, L, Rowett, D & Currow, D 2016, 'Potential economic impact on hospitalisations of the Palliative Care Clinical Studies Collaborative (PaCCSC) ketamine randomised controlled trial', AUSTRALIAN HEALTH REVIEW, vol. 40, no. 1, pp. 100-105.View/Download from: Publisher's site
Sanderson, C, Quinn, SJ, Agar, M, Chye, R, Clark, K, Doogue, M, Fazekas, B, Lee, J, Lovell, MR, Rowett, D, Spruyt, O & Currow, DC 2016, 'Pharmacovigilance in hospice/palliative care: net effect of pregabalin for neuropathic pain.', BMJ Supportive and Palliative Care, vol. 6, pp. 323-330.View/Download from: Publisher's site
Real-world effectiveness of many medications has been poorly researched, including in hospice/palliative care. Directly extrapolating findings from other clinical settings may not yield robust clinical advice. Pharmacovigilance studies provide an opportunity to understand better the net impact of medications. The study aimed to examine immediate and short-term benefits and harms of pregabalin in routine practice for neuropathic pain in hospice/palliative care.A consecutive cohort of 155 patients from 62 centres in 5 countries was started on pregabalin and studied prospectively. Data were collected at three time points: baseline; day 7 (immediate, short-term harms); ad hoc reports of any harms ≤21 days; and day 21 (short-term benefits).Median dose for 155 patients at day 21 was 150 mg/24 h. Benefits were reported by 61 patients (39%), of whom 11 (7%) experienced complete pain resolution. Harms were reported by 51 (35%) patients at or before 7 days, the most frequent of which were somnolence, fatigue, cognitive disturbance and dizziness. 10 patients (6%) ceased pregabalin due to harms, but 82 patients (53%) were being treated at 21 days. In regression modelling, people with worse baseline pain derived more benefit (OR=8.5 (95% CI 2.5 to 28.68).Pregabalin delivered benefit to many patients, with 4 of 10 experiencing pain reductions by 21 days. Harms, occurring in 1 in 3 patients, may be difficult to detect in clinical practice, as they mostly involve worsening of symptoms prevalent at baseline.
Watts, GJ, Clark, K, Agar, M, Davidson, PM, McDonald, C, Lam, LT, Sajkov, D, McCaffrey, N, Doogue, M, Abernethy, AP & Currow, DC 2016, 'Study protocol: a phase III randomised, double-blind, parallel arm, stratified, block randomised, placebo-controlled trial investigating the clinical effect and cost-effectiveness of sertraline for the palliative relief of breathlessness in people with chronic breathlessness', BMJ OPEN, vol. 6, no. 11.View/Download from: Publisher's site
Langton, J, Reeve, R, Srasuebkul, P, Haas, M, Viney, R, Currow, D & Pearson, S-A 2016, 'Health service use and costs in the last six months of life in elderly decedents with a history of cancer: A comprehensive analysis from a health payer perspective', British Journal of Cancer, vol. 114, no. 11, pp. 1293-1302.View/Download from: Publisher's site
Agar, MR, Quinn, SJ, Crawford, GB, Ritchie, CS, Phillips, JL, Collier, A & Currow, DC 2016, 'Predictors of Mortality for Delirium in Palliative Care', JOURNAL OF PALLIATIVE MEDICINE, vol. 19, no. 11, pp. 1205-1209.View/Download from: Publisher's site
Currow, DC, Abernethy, AP, Allcroft, P, Banzett, RB, Bausewein, C, Booth, S, Carrieri-Kohlman, V, Davidson, P, Disler, R, Donesky, D, Dudgeon, D, Ekstrom, M, Farquhar, M, Higginson, I, Janssen, D, Jensen, D, Jolley, C, Krajnik, M, Laveneziana, P, McDonald, C, Maddocks, M, Morelot-Panzini, C, Moxham, J, Mularski, RA, Noble, S, O'Donnell, D, Parshall, MB, Pattinson, K, Phillips, J, Ross, J, Schwartzstein, RM, Similowski, T, Simon, ST, Smith, T, Wells, A, Yates, P, Yorke, J & Johnson, MJ 2016, 'The need to research refractory breathlessness', EUROPEAN RESPIRATORY JOURNAL, vol. 47, no. 1, pp. 342-+.View/Download from: Publisher's site
Currow, DC, Phillips, J & Clark, K 2016, 'Using opioids in general practice for chronic non-cancer pain: an overview of current evidence', MEDICAL JOURNAL OF AUSTRALIA, vol. 204, no. 8, pp. 305-+.View/Download from: Publisher's site
Currow, DC, Phillips, J & Clark, K 2016, 'Using opioids in general practice for chronic non-cancer pain: an overview of current evidence REPLY', MEDICAL JOURNAL OF AUSTRALIA, vol. 205, no. 7, pp. 334-335.View/Download from: Publisher's site
Davidson, PM, Phillips, JL, Dennison-Himmelfarb, C, Thompson, SC, Luckett, T & Currow, DC 2016, 'Providing palliative care for cardiovascular disease from a perspective of sociocultural diversity: a global view', CURRENT OPINION IN SUPPORTIVE AND PALLIATIVE CARE, vol. 10, no. 1, pp. 11-17.View/Download from: Publisher's site
Johnson, MJ, Booth, S, Currow, DC, Lam, LT & Phillips, JL 2016, 'A Mixed-Methods, Randomized, Controlled Feasibility Trial to Inform the Design of a Phase III Trial to Test the Effect of the Handheld Fan on Physical Activity and Carer Anxiety in Patients With Refractory Breathlessness', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 51, no. 5, pp. 807-815.View/Download from: Publisher's site
Luckett, T, Disler, R, Hosie, A, Johnson, M, Davidson, P, Currow, D, Sumah, A & Phillips, J 2016, 'Content and quality of websites supporting self-management of chronic breathlessness in advanced illness: a systematic review', NPJ PRIMARY CARE RESPIRATORY MEDICINE, vol. 26.View/Download from: Publisher's site
Luckett, TR, Phillips, J, Lintzeris, N, Allsop, D, Lee, J, Solowij, N, Martin, J, Lam, L, Aggarwal, R, McCaffrey, N, Currow, D, Chye, R, Lovell, M, McGregor, I & Agar, M 2016, 'Clinical trials of medicinal cannabis for appetite-related symptoms from advanced cancer: A survey of preferences, attitudes and beliefs among patients willing to consider participation', Internal Medicine Journal, vol. 46, no. 11, pp. 1269-1275.View/Download from: Publisher's site
Abernethy, A, Fearon, K, Friend, J, Yan, Y, Duus, E & Currow, D 2015, 'Results From Phase III Trials of Anamorelin in Advanced Non-Small Cell Lung Cancer Patients with Cachexia: ROMANA 1 and 2', JOURNAL OF THORACIC ONCOLOGY, vol. 10, no. 9, pp. S791-S792.
Ahmadi, Z, Lundstrom, S, Janson, C, Strang, P, Emtner, M, Currow, DC & Ekstrom, M 2015, 'End-of-life care in oxygen-dependent COPD and cancer: a national population-based study', EUROPEAN RESPIRATORY JOURNAL, vol. 46, no. 4, pp. 1190-1193.View/Download from: Publisher's site
Allemani, C, Weir, HK, Carreira, H, Harewood, R, Spika, D, Wang, X-S, Bannon, F, Ahn, JV, Johnson, CJ, Bonaventure, A, Marcos-Gragera, R, Stiller, C, Azevedo e Silva, G, Chen, W-Q, Ogunbiyi, OJ, Rachet, B, Soeberg, MJ, You, H, Matsuda, T, Bielska-Lasota, M, Storm, H, Tucker, TC & Coleman, MP 2015, 'Global surveillance of cancer survival 1995-2009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2).', Lancet, vol. 385, no. 9972, pp. 977-1010.View/Download from: Publisher's site
Worldwide data for cancer survival are scarce. We aimed to initiate worldwide surveillance of cancer survival by central analysis of population-based registry data, as a metric of the effectiveness of health systems, and to inform global policy on cancer control.Individual tumour records were submitted by 279 population-based cancer registries in 67 countries for 25·7 million adults (age 15-99 years) and 75,000 children (age 0-14 years) diagnosed with cancer during 1995-2009 and followed up to Dec 31, 2009, or later. We looked at cancers of the stomach, colon, rectum, liver, lung, breast (women), cervix, ovary, and prostate in adults, and adult and childhood leukaemia. Standardised quality control procedures were applied; errors were corrected by the registry concerned. We estimated 5-year net survival, adjusted for background mortality in every country or region by age (single year), sex, and calendar year, and by race or ethnic origin in some countries. Estimates were age-standardised with the International Cancer Survival Standard weights.5-year survival from colon, rectal, and breast cancers has increased steadily in most developed countries. For patients diagnosed during 2005-09, survival for colon and rectal cancer reached 60% or more in 22 countries around the world; for breast cancer, 5-year survival rose to 85% or higher in 17 countries worldwide. Liver and lung cancer remain lethal in all nations: for both cancers, 5-year survival is below 20% everywhere in Europe, in the range 15-19% in North America, and as low as 7-9% in Mongolia and Thailand. Striking rises in 5-year survival from prostate cancer have occurred in many countries: survival rose by 10-20% between 1995-99 and 2005-09 in 22 countries in South America, Asia, and Europe, but survival still varies widely around the world, from less than 60% in Bulgaria and Thailand to 95% or more in Brazil, Puerto Rico, and the USA. For cervical cancer, national estimates of 5-year survival range from less ...
Boland, J, Currow, DC, Wilcock, A, Tieman, J, Hussain, JA, Pitsillides, C, Abernethy, AP & Johnson, MJ 2015, 'A Systematic Review of Strategies Used to Increase Recruitment of People With Cancer or Organ Failure Into Clinical Trials: Implications for Palliative Care Research', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 49, no. 4, pp. 762-+.View/Download from: Publisher's site
Brewer, C, Abernethy, A, Currow, D, Fearon, K, Friend, J & Temel, J 2015, 'EVALUATION OF ANOREXIA-CACHEXIA SYMPTOMS/CONCERNS FROM ROMANA 2, A PHASE III TRIAL OF ANAMORELIN IN NON-SMALL CELL LUNG CANCER PATIENTS WITH CACHEXIA.', ONCOLOGY NURSING FORUM, vol. 42, no. 2, pp. E229-E229.
Burns, CM, Dal Grande, E, Tieman, J, Abernethy, AP & Currow, DC 2015, 'Who provides care for people dying of cancer? A comparison of a rural and metropolitan cohort in a South Australian bereaved population study.', Aust J Rural Health, vol. 23, no. 1, pp. 24-31.View/Download from: Publisher's site
OBJECTIVE: To examine and compare urban and rural palliative care service availability and patterns of care from randomised, population-based surveys of caregivers of people at the end of life. DESIGN, SETTING & PARTICIPANTS: Survey responses on the death of 'someone close' from 23,588 interviews of South Australians conducted between 2001 and 2007 are analysed. INTERVENTIONS: A randomised population survey. MAIN OUTCOME MEASURES: Explored palliative care service availability, caregiving provided, and characteristics of the deceased and their caregivers. RESULTS: There was no difference in reported rates of accessing specialist palliative care services between rural and urban respondents (in unadjusted and adjusted analyses) nor did the proportion of people for whom cancer was their life-limiting illness. There was greater reliance on friends than first degree relatives in hands-on care provided at the end of life in rural settings. The rates of reported need for more support did not differ between urban and rural respondents for caregivers of people at the end of life. CONCLUSION: Use of palliative care services was similar for rural and urban caregivers for someone close at the end of life with similar levels of met and unmet needs.
Burns, EJ, Quinn, SJ, Abernethy, AP & Currow, DC 2015, 'Caregiver Expectations: Predictors of a Worse Than Expected Caregiving Experience at the End of Life', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 50, no. 4, pp. 453-461.View/Download from: Publisher's site
Chen, TYT, Morrell, S, Thomson, W, Baker, DF, Walton, R, Aranda, S & Currow, DC 2015, 'Survival from breast, colon, lung, ovarian and rectal cancer by geographical remoteness in New South Wales, Australia, 2000-2008', AUSTRALIAN JOURNAL OF RURAL HEALTH, vol. 23, no. 1, pp. 49-56.View/Download from: Publisher's site
Chin, C, Butcher, HH, Spathis, A, Ryan, R, Johnson, M, Pattinson, K, Currow, D, Banzett, R, Yorke, J, Clayson, H, Macnaughton, J, Penfold, C, Farquhar, M & Booth, S 2015, 'What's trending in Breathlessness research? Proceedings from the 8th Annual Meeting of the Breathlessness Research Interest Group', Progress in Palliative Care, vol. 23, no. 6, pp. 326-330.View/Download from: Publisher's site
© W. S. Maney & Son Ltd 2015. Breathlessness remains a challenging symptom, common to a multitude of malignant and non-malignant diseases, for which there are limited effective therapies once disease control is optimized. The American Thoracic Society (ATS) statement on dyspnoea reports that: (i) progress in dyspnoea management has not matched progress in elucidating underlying mechanisms; (ii) there is a critical need for interdisciplinary translational research to connect dyspnoea mechanisms with treatments; and (iii) there is a need to validate dyspnoea measures as patient-reported outcomes for clinical trials. Research into the many dimensions of breathlessness and its significance to patients and their carers has increased in recent years. This meeting is convened yearly to bring together researchers across various disciplines including respiratory medicine, anaesthetics, medical humanities, engineering, and palliative care, t further understanding of the symptom, discuss new techniques and advances in research, and pave the way forward for future studies and interventions. The presentations generated much vibrant discussion amongst the multidisciplinary attendees and highlighted areas where care for breathless patients could be improved. This is a positive time for breathlessness research, with several ATS research priorities being addressed and it is clear that further studies and ensuing interventions are on the horizon.
Clark, K, Collier, A & Currow, DC 2015, 'Dying in Australian hospitals: will a separate national clinical standard improve the delivery of quality care?', AUSTRALIAN HEALTH REVIEW, vol. 39, no. 2, pp. 202-204.View/Download from: Publisher's site
Clark, K, Quinn, SJ, Doogue, M, Sanderson, C, Lovell, M & Currow, DC 2015, 'Routine prescribing of gabapentin or pregabalin in supportive and palliative care: what are the comparative performances of the medications in a palliative care population?', Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, vol. 23, no. 9, pp. 2517-2520.View/Download from: Publisher's site
Neuropathic pain is a prevalent and distressing problem faced by people with life-limiting illness that is often difficult to palliate. Gabapentin and pregabalin are widely prescribed as part of the routine approach to palliating neuropathic pain. Although they are often viewed as interchangeable agents, very little comparative data of their benefits and harms exists in clinical practice. Two previously reported pharmacovigilance studies that had used the same methodology for gabapentin and pregabalin were compared. These studies examined the benefits and harms of gabapentin and pregabalin after the medications had been routinely prescribed by clinicians working in a network of palliative care services using the same data collection tools with the same definitions and the same time points. Data were collected over 21 days from 282 patients prescribed either gabapentin or pregabalin for pain. Items included medication doses, pain scores, and adverse effects. In order to compare the medication responses, the final doses of pregabalin were converted to gabapentin does equivalents using previously published recommendations. The final pain scores were similar for both groups, and the reduction in pain were similar (OR = 11.2; 95 % CI 3.9, 32.7, p < 0.001). However, this was achieved at lower doses of gabapentin compared to pregabalin. Those receiving gabapentin were more likely to experience harms (OR = 3.5; 95 % CI 1.4, 9.1, p = 0.009) with the reported harms including somnolence, ataxia, nausea, tremor and nystagmus This hypothesis-generating work strongly supports the need for further trials to best delineate clinical differences in the GABA analogues.
Collier, A, Rowett, D, Allcroft, P, Greene, A & Currow, DC 2015, 'Academic detailing of general practitioners by a respiratory physician for diagnosis and management of refractory breathlessness: a randomised pilot study', BMC HEALTH SERVICES RESEARCH, vol. 15.View/Download from: Publisher's site
Currow, D, Temel, J, Fearon, K, Friend, J, Yan, Y & Abernethy, A 2015, 'ROMANA 3: A safety extension study of anamorelin in advanced non-small cell lung cancer (NSCLC) patients with cachexia', EUROPEAN JOURNAL OF CANCER, vol. 51, pp. S239-S239.View/Download from: Publisher's site
Currow, DC & Aranda, S 2015, 'Cancer control is not beyond us ... but could be if we don't invest wisely.', Medical Journal of Australia, vol. 202, no. 2, pp. 63-63.View/Download from: Publisher's site
Currow, DC, Allingham, S, Yates, P, Johnson, C, Clark, K & Eagar, K 2015, 'Improving national hospice/palliative care service symptom outcomes systematically through point-of-care data collection, structured feedback and benchmarking.', Support Care Cancer, vol. 23, no. 2, pp. 307-315.View/Download from: Publisher's site
PURPOSE: Every health care sector including hospice/palliative care needs to systematically improve services using patient-defined outcomes. Data from the national Australian Palliative Care Outcomes Collaboration aims to define whether hospice/palliative care patients' outcomes and the consistency of these outcomes have improved in the last 3 years. METHODS: Data were analysed by clinical phase (stable, unstable, deteriorating, terminal). Patient-level data included the Symptom Assessment Scale and the Palliative Care Problem Severity Score. Nationally collected point-of-care data were anchored for the period July-December 2008 and subsequently compared to this baseline in six 6-month reporting cycles for all services that submitted data in every time period (n = 30) using individual longitudinal multi-level random coefficient models. RESULTS: Data were analysed for 19,747 patients (46 % female; 85 % cancer; 27,928 episodes of care; 65,463 phases). There were significant improvements across all domains (symptom control, family care, psychological and spiritual care) except pain. Simultaneously, the interquartile ranges decreased, jointly indicating that better and more consistent patient outcomes were being achieved. CONCLUSION: These are the first national hospice/palliative care symptom control performance data to demonstrate improvements in clinical outcomes at a service level as a result of routine data collection and systematic feedback.
Currow, DC, Hutchinson, A & Johnson, MJ 2015, 'Re: Asia, Australia and New Zealand Dyspnoea in Emergency Departments (AANZDEM) study: Rationale, design and analysis.', Emergency Medicine Australasia, vol. 27, no. 5, pp. 498-499.View/Download from: Publisher's site
Currow, DC, Quinn, S, Ekstrom, M, Kaasa, S, Johnson, MJ, Somogyi, AA & Klepstad, P 2015, 'Can variability in the effect of opioids on refractory breathlessness be explained by genetic factors?', BMJ OPEN, vol. 5, no. 5.View/Download from: Publisher's site
Currow, DC, Temel, JS, Fearon, K, Yan, Y, Friend, J & Abernethy, AP 2015, 'A safety extension study of anamorelin in advanced non-small cell lung cancer patients with cachexia: ROMANA 3.', Journal of Clinical Oncology, vol. 33, no. 15_suppl, pp. e20715-e20715.View/Download from: Publisher's site
Davis, GM, Yee, J, Abell, B, Ward, LC, Currow, D & Kilbreath, SL 2015, 'Validation of Three Physical Activity Monitors for Assessment of Energy Expenditure in Older Women', Medicine & Science in Sports & Exercise, vol. 47, pp. 246-246.View/Download from: Publisher's site
Dobbins, TA, Badgery-Parker, T, Currow, DC & Young, JM 2015, 'Assessing measures of comorbidity and functional status for risk adjustment to compare hospital performance for colorectal cancer surgery: a retrospective data-linkage study.', BMC Medical Informatics and Decision Making, vol. 15, pp. 1-7.View/Download from: Publisher's site
BACKGROUND: Comparing outcomes between hospitals requires consideration of patient factors that could account for any observed differences. Adjusting for comorbid conditions is common when studying outcomes following cancer surgery, and a commonly used measure is the Charlson comorbidity index. Other measures of patient health include the ECOG performance status and the ASA physical status score. This study aimed to ascertain how frequently ECOG and ASA scores are recorded in population-based administrative data collections in New South Wales, Australia and to assess the contribution each makes in addition to the Charlson comorbidity index in risk adjustment models for comparative assessment of colorectal cancer surgery outcomes between hospitals. METHODS: We used linked administrative data to identify 6964 patients receiving surgery for colorectal cancer in 2007 and 2008. We summarised the frequency of missing data for Charlson comorbidity index, ECOG and ASA scores, and compared patient characteristics between those with and without these measures. The performance of ASA and ECOG in risk adjustment models that also included Charlson index was assessed for three binary outcomes: 12-month mortality, extended length of stay and 28-day readmission. Patient outcomes were compared between hospital peer groups using multilevel logistic regression analysis. RESULTS: The Charlson comorbidity index could be derived for all patients, ASA score was recorded for 78 % of patients and ECOG performance status recorded for only 24 % of eligible patients. Including ASA or ECOG improved the predictive ability of models, but there was no consistently best combination. The addition of ASA or ECOG did not substantially change parameter estimates for hospital peer group after adjusting for Charlson comorbidity index. CONCLUSIONS: While predictive ability of regression models is maximised by inclusion of one or both of ASA score and ECOG performance status, there is little to be gaine...
Dobbins, TA, Creighton, N, Currow, DC & Young, JM 2015, 'Look back for the Charlson Index did not improve risk adjustment of cancer surgical outcomes.', J Clin Epidemiol, vol. 68, no. 4, pp. 379-386.View/Download from: Publisher's site
OBJECTIVES: The Charlson score is a commonly used measure of comorbidity; however, there is little empirical research into the optimal implementation when studying cancer surgery outcomes using administrative data. We compared four alternative Charlson score implementations, including and excluding metastatic cancer and varying the look-back periods. STUDY DESIGN AND SETTING: Nine years of linked administrative data were used to identify patients undergoing surgery for cancer of the colon, rectum, or lung in New South Wales, Australia. Four binary outcomes of 30- and 365-day mortality, length of stay greater than 21 days, and emergency readmission within 28 days were compared between groups of similar hospitals. Hospital risk adjustment models were compared for alternative Charlson score implementations. RESULTS: Excluding metastatic cancer from the Charlson score improved model performance for short-term outcomes, but there was no implementation that was consistently optimal. Incorporating a look-back period reduced the number of patients for analysis but did not improve hospital risk adjustment. CONCLUSION: Charlson scores for hospital risk adjustment of short-term outcomes of cancer surgery should be calculated excluding metastatic cancer as a separate comorbidity. We found no clear best performing implementation and found no benefit in incorporating any look-back period.
Dunlop, S, Kite, J, Grunseit, AC, Rissel, C, Perez, DA, Dessaix, A, Cotter, T, Bauman, A, Young, J & Currow, D 2015, 'Out of Sight and Out of Mind? Evaluating the Impact of Point-of-Sale Tobacco Display Bans on Smoking-Related Beliefs and Behaviors in a Sample of Australian Adolescents and Young Adults.', Nicotine and Tobacco Research, vol. 17, no. 7, pp. 761-768.View/Download from: Publisher's site
The Australian states of New South Wales (NSW) and Queensland implemented bans on tobacco pack displays at point-of-sale (PoS) in July 2010 and November 2011, respectively. This study evaluated the medium-term impact of the bans on youth.Data were drawn from the Tobacco Promotion Impact Study, a repeated cross-sectional survey of youth (12-24 years) in NSW and Queensland conducted yearly 2010-2012 (n = 6,014). Regression analyses examined differences in youth's recall of PoS tobacco displays, smoking-related beliefs, and smoking behaviors in relation to the timing of the PoS display bans.Recall of PoS tobacco displays was significantly less likely for youth interviewed after the bans versus before (OR = 0.45, 95% CI = 0.39, 0.52, p < .01). They were also less likely to report tobacco brand awareness (OR = 0.76, 95% CI = 0.62, 0.92, p < .01), to over-estimate peer smoking (OR = 0.84, 95% CI = 0.74, 0.96, p < .01), or be current smokers (OR = 0.73, 95% CI = 0.55, 0.96, p < .05). Stratified analyses showed that these differences were primarily apparent in the group of youth most likely to be affected by tobacco PoS displays: those who visit tobacco retailers most frequently. After the bans, smokers were less likely to report that they think about smoking as a result of seeing PoS tobacco displays (OR = 0.60, 95% CI = 0.37, 0.97, p < .039).Our findings suggest an immediate impact of display bans on youth's exposure to tobacco pack displays, and likely impacts on smoking-related outcomes. These results suggest that removing tobacco displays from retail environments can positively contribute to the denormalization of smoking among youth.
Ekstroem, M, Currow, DC & Johnson, MJ 2015, 'Outcome measurement of refractory breathlessness: endpoints and important differences', CURRENT OPINION IN SUPPORTIVE AND PALLIATIVE CARE, vol. 9, no. 3, pp. 238-243.View/Download from: Publisher's site
Ekström, M, Bornefalk-Hermansson, A, Abernethy, A & Currow, D 2015, 'Low-dose opioids should be considered for symptom relief also in advanced chronic obstructive pulmonary disease (COPD)', Evidence-Based Medicine, vol. 20, no. 1, p. 39.View/Download from: Publisher's site
Ekström, M, Nilsson, F, Abernethy, AA & Currow, DC 2015, 'Effects of opioids on breathlessness and exercise capacity in chronic obstructive pulmonary disease. A systematic review.', Annals of the American Thoracic Society, vol. 12, no. 7, pp. 1079-1092.View/Download from: Publisher's site
Patients with chronic obstructive pulmonary disease (COPD) commonly suffer from breathlessness, deconditioning, and reduced health-related quality of life (HRQL) despite best medical management. Opioids may relieve breathlessness at rest and on exertion in COPD.We aimed to estimate the efficacy and safety of opioids on refractory breathlessness, exercise capacity, and HRQL in COPD.This was a systematic review and metaanalysis using Cochrane methodology. We searched Cochrane Central Register of Controlled Trials, MEDLINE, and Embase up to 8 September, 2014 for randomized, double-blind, placebo-controlled trials of any opioid for breathlessness, exercise capacity, or HRQL that included at least one participant with COPD. Effects were analyzed as standardized mean differences (SMDs) with 95% confidence intervals (CIs) using random effect models.A total of 16 studies (15 crossover trials and 1 parallel-group study, 271 participants, 95% with severe COPD) were included. There were no serious adverse effects. Breathlessness was reduced by opioids overall: SMD, -0.35 (95% CI, -0.53 to -0.17; I(2), 48.9%), by systemic opioids (eight studies, 118 participants): SMD, -0.34 (95% CI, -0.58 to -0.10; I(2), 0%), and less consistently by nebulized opioids (four studies, 82 participants): SMD, -0.39 (95% CI, -0.71 to -0.07; I(2), 78.9%). The quality of evidence was moderate for systemic opioids and low for nebulized opioids on breathlessness. Opioids did not affect exercise capacity (13 studies, 149 participants): SMD, 0.06 (95% CI, -0.15 to 0.28; I(2), 70.7%). HRQL could not be analyzed. Findings were robust in sensitivity analyses. Risk of study bias was low or unclear.Opioids improved breathlessness but not exercise capacity in severe COPD.
Ekström, MP, Abernethy, AP & Currow, DC 2015, 'The management of chronic breathlessness in patients with advanced and terminal illness.', BMJ, vol. 349, pp. g7617-g7617.
Girgis, A, Abernethy, AP & Currow, DC 2015, 'Caring at the end of life: do cancer caregivers differ from other caregivers?', BMJ Support Palliat Care, vol. 5, no. 5, pp. 513-517.View/Download from: Publisher's site
OBJECTIVE: Cancer is one of the most common health conditions in receipt of informal caregiving. This study compares key characteristics of caregivers who cared for someone with cancer until death with caregivers of people with other life-limiting illnesses and their care recipients irrespective of health service utilisation. METHOD: Data were analysed from annual state-wide South Australian Health Omnibus Surveys (2000-2007) involving 14,624 respondents, regarding end of life care. Descriptive and comparative data are presented. RESULTS: Almost a third of respondents (32%; participation rate 72%) had someone close to them die from an 'expected' death in the preceding 5 years. One in 10 (10%) respondents reported providing hands-on care predominantly for someone with cancer. Compared with non-cancer caregivers, cancer caregivers cared for someone who was significantly younger (mean age 66 (95% CI 64 to 67) years vs 74 (95% CI 72 to 77) years; one-way analysis of variance p<0.0001) and were more likely to report having a hospice/palliative care service involved in the care of the deceased (65% (95% CI 63 to 67) compared with 39% (95% CI 37 to 42). In the Australian context, this may mean contact with inpatient, outpatient and community-based services.There were no differences between the needs which caregivers perceived to be unmet or the perceptions that no additional supports were required between the two groups. CONCLUSIONS: Informal caregivers perform a critical social and economic role in care provision. Cancer caregivers are a proportionally larger cohort than non-cancer caregivers. With the increasing incidence of cancer, the sustainability of a voluntary cancer caregiving workforce will be reliant upon minimising the burden of care.
Hoefman, R, Al-Janabi, H, McCaffrey, N, Currow, D & Ratcliffe, J 2015, 'Measuring caregiver outcomes in palliative care: a construct validation study of two instruments for use in economic evaluations.', Quality of Life Research, vol. 24, no. 5, pp. 1255-1273.View/Download from: Publisher's site
PURPOSE: Providing care to patients nearing the end of life can place a considerable burden on caregivers. Hence, policy decisions on interventions in palliative care should be guided by information on this burden. This study investigates construct validation of two preference-based caregiver outcome instruments suitable for economic evaluations: the Carer Experience Scale (CES) and the Care-related Quality of Life (CarerQol) instrument. Moreover, this study reports caregiver experiences in end-of-life care. METHODS: Data were collected with written questionnaires among caregivers of patients receiving palliative care services in the Southern metropolitan area of Adelaide, South Australia (n = 97). The effect of caregiving on caregivers was measured with the CES, CarerQol, Process Utility (PU) and Caregiver Strain Index (CSI). Convergent, discriminative and clinical validity were studied. RESULTS: As hypothesized, higher negative effect of caregiving measured on the CES was associated with higher negative effect on the CarerQol. Both the CES and CarerQol were associated in the expected positive direction with less strain from caregiving (CSI), more positive care experiences and more PU from caring. Caregivers' and care recipients' health status and duration of caregiving were negatively associated with caring experiences. CONCLUSIONS: Our findings suggest that the CES and CarerQol validly assess the effect of caregiving on caregivers in end-of-life care. Economic evaluations in end-of-life care should attempt to incorporate such instruments to provide a more holistic assessment of the true impact of interventions, especially where family and friends are heavily involved in caregiving.
Holloway, K, Toye, C, McConigley, R, Tieman, J, Currow, D & Hegarty, M 2015, 'National consultation informing development of guidelines for a palliative approach for aged care in the community setting.', Australasian Journal on Ageing, vol. 34, no. 1, pp. 21-26.View/Download from: Publisher's site
This study aimed to obtain perspectives from key stakeholders to inform the development of Australian national guidelines for a palliative approach to aged care in the community setting.A descriptive, exploratory qualitative design was used. Sampling was purposive. Data were collected during audiotaped, semistructured, individual and focus group interviews that addressed the need for the guidelines and aimed to identify practice areas for inclusion. Thematic analysis was undertaken.Interviews were conducted across Australia and included 172 participants: health-care providers, consumers, volunteers and researchers/educators. Themes emerging from the data were: Provision of a Palliative Approach in Community Aged Care, Carer Support, Advance Care Planning, Physical and Psychological Symptom Assessment and Management, Psychosocial Support, Spiritual Support, Issues for Aboriginal or Torres Strait Islander People, Older People from Diverse Cultural and Language Groups, and Clients with Special Needs.Findings underpinned development of new guideline documents.
Hui, D, Bansal, S, Strasser, F, Morita, T, Caraceni, A, Davis, M, Cherny, N, Kaasa, S, Currow, D, Abernethy, A, Nekolaichuk, C & Bruera, E 2015, 'Indicators of integration of oncology and palliative care programs: an international consensus', ANNALS OF ONCOLOGY, vol. 26, no. 9, pp. 1953-1959.View/Download from: Publisher's site
Hutchinson, A, Booth, S, Currow, D, Higginson, I & Johnson, M 2015, 'Invisible suffering: breathlessness in and beyond the clinic-a reply', LANCET RESPIRATORY MEDICINE, vol. 3, no. 8, pp. E29-E29.View/Download from: Publisher's site
Johnson, MJ & Currow, DC 2015, 'Chronic refractory breathlessness is a distinct clinical syndrome', CURRENT OPINION IN SUPPORTIVE AND PALLIATIVE CARE, vol. 9, no. 3, pp. 203-205.View/Download from: Publisher's site
Johnson, MJ, Simpson, MIG, Currow, DC, Millman, RE, Hart, SP & Green, G 2015, 'Magnetoencephalography to investigate central perception of exercise-induced breathlessness in people with chronic lung disease: a feasibility pilot', BMJ OPEN, vol. 5, no. 6.View/Download from: Publisher's site
Kutner, JS, Blatchford, PJ, Taylor, DH, Ritchie, CS, Bull, JH, Fairclough, DL, Hanson, LC, LeBlanc, TW, Samsa, GP, Wolf, S, Aziz, NM, Currow, DC, Ferrell, B, Wagner-Johnston, N, Zafar, SY, Cleary, JF, Dev, S, Goode, PS, Kamal, AH, Kassner, C, Kvale, EA, McCallum, JG, Ogunseitan, AB, Pantilat, SZ, Portenoy, RK, Prince-Paul, M, Sloan, JA, Swetz, KM, Von Gunten, CF & Abernethy, AP 2015, 'Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: a randomized clinical trial.', JAMA Intern Med, vol. 175, no. 5, pp. 691-700.View/Download from: Publisher's site
IMPORTANCE: For patients with limited prognosis, some medication risks may outweigh the benefits, particularly when benefits take years to accrue; statins are one example. Data are lacking regarding the risks and benefits of discontinuing statin therapy for patients with limited life expectancy. OBJECTIVE: To evaluate the safety, clinical, and cost impact of discontinuing statin medications for patients in the palliative care setting. DESIGN, SETTING, AND PARTICIPANTS: This was a multicenter, parallel-group, unblinded, pragmatic clinical trial. Eligibility included adults with an estimated life expectancy of between 1 month and 1 year, statin therapy for 3 months or more for primary or secondary prevention of cardiovascular disease, recent deterioration in functional status, and no recent active cardiovascular disease. Participants were randomized to either discontinue or continue statin therapy and were monitored monthly for up to 1 year. The study was conducted from June 3, 2011, to May 2, 2013. All analyses were performed using an intent-to-treat approach. INTERVENTIONS: Statin therapy was withdrawn from eligible patients who were randomized to the discontinuation group. Patients in the continuation group continued to receive statins. MAIN OUTCOMES AND MEASURES: Outcomes included death within 60 days (primary outcome), survival, cardiovascular events, performance status, quality of life (QOL), symptoms, number of nonstatin medications, and cost savings. RESULTS: A total of 381 patients were enrolled; 189 of these were randomized to discontinue statins, and 192 were randomized to continue therapy. Mean (SD) age was 74.1 (11.6) years, 22.0% of the participants were cognitively impaired, and 48.8% had cancer. The proportion of participants in the discontinuation vs continuation groups who died within 60 days was not significantly different (23.8% vs 20.3%; 90% CI, -3.5% to 10.5%; P=.36) and did not meet the noninferiority end point. Total QOL was better for the g...
LeBlanc, TW, McNeil, MJ, Kamal, AH, Currow, DC & Abernethy, AP 2015, 'Polypharmacy in patients with advanced cancer and the role of medication discontinuation.', Lancet Oncol, vol. 16, no. 7, pp. e333-e341.View/Download from: Publisher's site
Polypharmacy is a well known problem in elderly patients in general, but its prevalence and effects in patients with cancer are less clear, particularly in end-of-life settings. This Review examines the existing literature on polypharmacy in advanced cancer and end-of-life settings by reviewing evidence-based approaches to reduce polypharmacy, and outlining the potential benefits of decreasing the number of drugs that patients with cancer can take, with emphasis on the need for thoughtful discontinuation initiatives in the context of life-limiting malignant disease. In view of the apparent burden of polypharmacy in patients with advanced cancer, we expect that greater attention to polypharmacy could lead to improvements in adverse drug events, cost, and possibly quality of life. However, few data for specific interventions in the advanced cancer population are available, and thus more research is warranted.
LeBlanc, TW, Smith, JM & Currow, DC 2015, 'Symptom burden of haematological malignancies as death approaches in a community palliative care service: a retrospective cohort study of a consecutive case series', LANCET HAEMATOLOGY, vol. 2, no. 8, pp. E334-E338.View/Download from: Publisher's site
Li, Y, Jackson, KA, Slon, B, Hardy, JR, Franco, M, William, L, Poon, P, Coller, JK, Hutchinson, MR, Currow, DC & Somogyi, AA 2015, 'CYP2B6*6 allele and age substantially reduce steady-state ketamine clearance in chronic pain patients: impact on adverse effects', BRITISH JOURNAL OF CLINICAL PHARMACOLOGY, vol. 80, no. 2, pp. 276-284.View/Download from: Publisher's site
McConigley, R, Shelby-James, T & Currow, DC 2015, 'Promoting the consumer voice in palliative care: exploring the possibility of using consumer impact statements', HEALTH EXPECTATIONS, vol. 18, no. 5, pp. 653-660.View/Download from: Publisher's site
McLoughlin, K, Rhatigan, J, McGilloway, S, Callinan, J, Wright, M, Kellehear, A, Lucey, M, Conroy, M, Twomey, F, Kumar, S, Herrera-Mollina, E, Furlong, M, Watson, M, Currow, D & Bailey, C 2015, 'WA40 The good neighbour partnership: why do we need it? who is going to do it? how on earth are we going to evaluate it?', BMJ supportive & palliative care, vol. 5 Suppl 1, p. A13.View/Download from: Publisher's site
: This one-hour symposium considers Milford Care Centre's Compassionate Communities Good Neighbour Partnership and it's evaluation by an international team, led by Maynooth University and funded by the All Ireland Institute of Hospice and Palliative Care, The Irish Cancer Society, The Irish Hospice Foundation and Milford Care Centre. The symposium will be divided into three sections: 1. The Good Neighbour Partnership: Why do we need it? In this section we will describe the findings from a recent scoping study to determine the social and practical needs of community dwelling adults (and their families) living with advanced life limiting illness at home. We will consider the rationale for specialist palliative care services, working with community groups, to lead the development of a volunteer-based social model of care to address unmet need. 2. The Good Neighbour Partnership: How do we recruit and train volunteers? We will share our process and experience of recruiting and training 15 Compassionate Communities Volunteers to assess unmet social and practical need, and to mobile the person's circle of community to meet those needs. An understanding of the motivating factors of volunteers will be shared. 3. The Good Neighbour Partnership: How on earth are we going to evaluate it? Here we describe the INSPIRE study - Investigating Social and Practical Supports at the End of life. An exploratory delayed intervention randomised controlled trial (framed by the MRC Framework for Complex Interventions) to assess the feasibility, acceptability and potential effectiveness of the Good Neighbour Partnership.
McLoughlin, K, Rhatigan, J, McGilloway, S, Kellehear, A, Lucey, M, Twomey, F, Conroy, M, Herrera-Molina, E, Kumar, S, Furlong, M, Callinan, J, Watson, M, Currow, D & Bailey, C 2015, 'INSPIRE (INvestigating Social and PractIcal suppoRts at the End of life): Pilot randomised trial of a community social and practical support intervention for adults with life-limiting illness', BMC PALLIATIVE CARE, vol. 14.View/Download from: Publisher's site
Mitchell, GK, Hardy, JR, Nikles, CJ, Carmont, S-AS, Senior, HE, Schluter, PJ, Good, P & Currow, DC 2015, 'The Effect of Methylphenidate on Fatigue in Advanced Cancer: An Aggregated N-of-1 Trial.', J Pain Symptom Manage, vol. 50, no. 3, pp. 289-296.View/Download from: Publisher's site
CONTEXT: Fatigue is common in life-limiting cancer. Methylphenidate (MPH), a psychostimulant, may be a useful therapy. Gathering evidence in patients with advanced cancer can be challenging. OBJECTIVES: To determine if MPH improves cancer-related fatigue in people with advanced cancer. METHODS: N-of-1 trials are multicycle, double-blind, randomized, controlled crossover trials using standardized measures of effect in individuals. They are normally used to assess treatment effects in individuals. Aggregated N-of-1 trials from participants with end-stage cancer suffering fatigue were used to assess the group effect of MPH, producing an estimate of equivalent power to a parallel-group randomized controlled trial (RCT) but requiring less than half of the sample size. Up to three cycles of MPH 5 mg twice daily (three days) vs. identical placebo (three days) capsules were offered to participants. Primary outcome was improvement in fatigue as measured by the Functional Assessment of Chronic Illness Therapy-Fatigue Scale and the Wu Cancer Fatigue Scale. Analysis used Bayesian statistical methods using intention-to-treat principles. RESULTS: Forty-three participants completed 84 cycles of MPH and placebo in random order, exceeding sample size estimates. Overall, MPH did not improve fatigue (mean difference 3.2; 95% credible interval -2.0, 9.0; posterior probability of favorable effect 0.890). Eight participants showed important improvement, and one participant showed important worsening of fatigue on MPH. There were no features that distinguished participants whose fatigue responded to MPH compared with those who did not. CONCLUSION: MPH does not improve fatigue in the population of patients with end-stage cancer. Aggregated N-of-1 trial methodology is feasible and produces population-based sample estimates with less than half the sample size required for the equivalent parallel-group RCT. It also identified individuals who did and did not respond to MPH, which is a featu...
Nipp, RD, Currow, DC, Cherny, NI, Strasser, F, Abernethy, AP & Zafar, SY 2015, 'Best supportive care in clinical trials: review of the inconsistency in control arm design', BRITISH JOURNAL OF CANCER, vol. 113, no. 1, pp. 6-11.View/Download from: Publisher's site
Reigada, C, Bajwah, S, Ross, J, Boland, J, Wells, A, Yorke, J, Grande, G, Hart, S, Currow, D, Papadopoulos, T, Macleod, U & Johnson, M 2015, 'Adaptation, face and content validation of a palliative care needs assessment tool for people with interstitial lung disease.', BMJ supportive & palliative care, vol. 5, no. 1, pp. 111-112.View/Download from: Publisher's site
INTRODUCTION: Interstitial lung disease (ILD) is a non-malignant progressive disease which causes breathlessness, cough, fatigue, psycho-social, financial and spiritual distress; difficult for patients and their family carers. The Needs Assessment Tool: Progressive Disease (NAT:PD-C) was developed as an "aide-memoire" to help clinicians identify a range of palliative care needs in people with cancer, and their carers, in daily practice. We have adapted this tool for people with ILD. AIMS AND METHODS: Our aim was to adapt, and then test face and content validity of the adapted version. The NAT:PD-C was adapted for people with ILD using data from a systematic review of the literature and previously completed qualitative interviews. Focus groups were held (patients [N=7], carers [N=3], clinicians [N=8] followed by an Expert Consensus Group to discuss face and content validity of the NAT:PD-ILD. The Expert Group also discussed issues regarding implementation in practice. The discussion was audio and video-recorded, and cognitive mapping was used. Data was analysed following the principles of inductive theory building. Further validation and reliability testing is ongoing. We present the preliminary results of the face/content validation. RESULTS: All sections ("red flags" for high risk patients; priority referral; patient wellbeing; ability of carer to provide care; carer wellbeing) of the tool were felt to be important. Some symptoms (voice, mucous and mobility) were added by patients. Clinicians identified training needs about "Spiritual or existential concerns". Carers highlighted the need for support for themselves. CONCLUSIONS: The NAT:PD-ILD appears to have face and content validity and the content and structure reflected the experience of all groups. *This research was funding by Marie Curie Care Cancer Research UK.
Roder, D, Creighton, N, Baker, D, Walton, R, Aranda, S & Currow, D 2015, 'Changing roles of population-based cancer registries in Australia', AUSTRALIAN HEALTH REVIEW, vol. 39, no. 4, pp. 425-428.View/Download from: Publisher's site
Scott, N, Crane, M, Lafontaine, M, Seale, H & Currow, D 2015, 'Stigma as a barrier to diagnosis of lung cancer: patient and general practitioner perspectives', PRIMARY HEALTH CARE RESEARCH AND DEVELOPMENT, vol. 16, no. 6, pp. 618-622.View/Download from: Publisher's site
Smallwood, N, Le, B, Currow, D, Irving, L & Philip, J 2015, 'Management of refractory breathlessness with morphine in patients with chronic obstructive pulmonary disease', INTERNAL MEDICINE JOURNAL, vol. 45, no. 9, pp. 898-904.View/Download from: Publisher's site
Soeberg, MJ, Rogers, K, Currow, DC & Young, JM 2015, 'Trends in incidence and survival for anal cancer in New South Wales, Australia, 1972-2009.', Cancer Epidemiol, vol. 39, no. 6, pp. 842-847.View/Download from: Publisher's site
INTRODUCTION: Little is known about the incidence and survival of anal cancer in New South Wales (NSW), Australia, as anal cancer cases are often grouped together with other colorectal cancers in descriptive epidemiological analyses. METHODS: We studied patterns and trends in the incidence and survival of people diagnosed with anal cancer in NSW, Australia, 1972-2009 (n=2724). We also predicted anal cancer incidence in NSW during 2010-2032. Given the human papilloma virus-associated aetiology for most anal cancers, we quantified these changes over time in incidence and survival by histological subtype: anal squamous cell carcinoma (ASCC); and anal adenocarcinoma (AAC). RESULTS: There was a linear increase in incident anal cancer cases in NSW with an average annual percentage change (AAPC) of 1.6 (95% CI 1.1-2.0) such that, in combination with age-period-cohort modelling, we predict there will be 198 cases of anal cancer in the 2032 calendar year (95% CI 169-236). Almost all of these anal cancer cases are projected to be ASCC (94%). Survival improved over time regardless of histological subtype. However, five-year relative survival was substantially higher for people with ASCC (70% (95% CI 66-74%)) compared to AAC (51% (95% CI 43-59%)), a 37% difference. Survival was also greater for women (69% (95% CI 64-73%)) with ASCC compared to men (55% (95% CI 50-60%)). It was not possible to estimate survival by stage at diagnosis particularly given that 8% of all cases were recorded as having distant stage and 22% had missing stage data. INTERPRETATION: Aetiological explanations, namely exposure to oncogenic types of human papillomavirus, along with demographic changes most likely explain the actual and projected increase in ASCC case numbers. Survival differences by gender and histological subtype point to areas where further research is warranted to improve treatment and outcomes for all anal cancer patients.
Swetenham, K, Tieman, J, Butow, P & Currow, D 2015, 'Communication differences when patients and caregivers are seen separately or together', INTERNATIONAL JOURNAL OF PALLIATIVE NURSING, vol. 21, no. 11, pp. 557-563.View/Download from: Publisher's site
Taylor, A, Morris, G, Tieman, J, Currow, D, Kidd, M & Carati, C 2015, 'Building an Architectural Component Model for a Telehealth Service', E-Health Telecommunication Systems and Networks, vol. 04, no. 03, pp. 35-44.View/Download from: Publisher's site
Temel, JS, Currow, DC, Fearon, K, Yan, Y, Friend, J & Abernethy, AP 2015, 'Anamorelin in patients with advanced non-small cell lung cancer and cachexia: Results from the phase III studies ROMANA 1 and 2', JOURNAL OF CLINICAL ONCOLOGY, vol. 33, no. 29.View/Download from: Publisher's site
Temel, JS, Currow, DC, Fearon, K, Yan, Y, Friend, J & Abernethy, AP 2015, 'Phase III trials of anamorelin in patients with advanced non-small cell lung cancer (NSCLC) and cachexia (ROMANA 1 and 2).', Journal of Clinical Oncology, vol. 33, no. 15_suppl, pp. 9500-9500.View/Download from: Publisher's site
Tervonen, H, Aranda, S, Walton, R, Baker, D, Currow, D, Morrell, S, You, H & Roder, D 2015, 'HOW CAN WE BETTER MEASURE AND ADDRESS SOCIO-DEMOGRAPHIC DISADVANTAGE IN CANCER OUTCOMES?', Asia-Pacific Journal of Clinical Oncology, vol. 11, pp. 65-65.
Uronis, HE, Ekström, MP, Currow, DC, McCrory, DC, Samsa, GP & Abernethy, AP 2015, 'Oxygen for relief of dyspnoea in people with chronic obstructive pulmonary disease who would not qualify for home oxygen: a systematic review and meta-analysis.', Thorax, vol. 70, no. 5, pp. 492-494.View/Download from: Publisher's site
We searched MEDLINE, EMBASE and the Cochrane Controlled Trials Register to determine whether oxygen relieves dyspnoea in mildly or non-hypoxemic COPD and included 18 randomised controlled trials (431 participants) in the meta-analysis using Cochrane methodology. Oxygen therapy reduced dyspnoea when compared with medical air; standardised mean difference -0.37 (95% CI -0.50 to -0.24; I(2)=14%). In a priori subgroup and sensitivity analyses, dyspnoea was reduced by continuous oxygen during exertion but not short-burst oxygen therapy. Continuous exertional oxygen can relieve dyspnoea in mildly or non-hypoxemic COPD, but evidence from larger clinical trials is needed.
Wysham, NG, Miriovsky, BJ, Currow, DC, Herndon, JE, Samsa, GP, Wilcock, A & Abernethy, AP 2015, 'Practical Dyspnea Assessment: Relationship Between the 0-10 Numerical Rating Scale and the Four-Level Categorical Verbal Descriptor Scale of Dyspnea Intensity', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 50, no. 4, pp. 480-487.View/Download from: Publisher's site
Young, J, Badgery-Parker, T, Dobbins, T, Jorgensen, M, Gibbs, P, Faragher, I, Jones, I & Currow, D 2015, 'Comparison of ECOG/WHO performance status and ASA score as a measure of functional status.', Journal of Pain and Symptom Management, vol. 49, no. 2, pp. 258-264.View/Download from: Publisher's site
CONTEXT: The Eastern Cooperative Oncology Group/World Health Organization Performance Status (ECOG/WHO PS) is a prognostic factor. It should be used in analyzing health outcomes such as risk-adjusted hospital performance models in cancer populations. Performance status is rarely recorded in surgery, often the place where cancer is first diagnosed. Could a universally collected preoperative measure be substituted for ECOG/WHO PS? OBJECTIVES: The aim of this study was to assess whether the American Society of Anesthesiologists (ASA) score could be used as a proxy for ECOG/WHO PS in risk adjustment models predicting extended length of stay (LOS) after cancer surgery. METHODS: Data were obtained from the BioGrid Colorectal Cancer Database for 2540 treatment episodes (2528 patients) at five hospitals in Victoria and Tasmania, Australia, from 2003 to 2012. Using extended LOS as the index outcome measure, a risk adjustment model was developed using patient demographic and clinical variables. The ECOG/WHO PS and ASA score were added to this model, and the relative percentage change in hospital coefficients were examined. Model fit was compared using Akaike's information criterion (AIC) and concordance statistic (c). RESULTS: Adding ECOG/WHO PS or ASA score to the model resulted in relative changes in the hospital coefficients of up to 27%. The ECOG/WHO PS and ASA score performed similarly, with addition of either improving the AIC from 988.2 to 976.3. Inclusion of both measures further improved AIC to 972.4. CONCLUSION: The ASA score can be used as a proxy for ECOG/WHO PS in risk adjustment models predicting cancer surgery. Further studies should assess its broader application for other outcomes and in other settings.
Young, JM, O'Halloran, A, McAulay, C, Pirotta, M, Forsdike, K, Stacey, I & Currow, D 2015, 'Unconditional and conditional incentives differentially improved general practitioners' participation in an online survey: randomized controlled trial.', Journal of Clinical Epidemiology, vol. 68, no. 6, pp. 693-697.View/Download from: Publisher's site
OBJECTIVES: To compare the impact of unconditional and conditional financial incentives on response rates among Australian general practitioners invited by mail to participate in an online survey about cancer care and to investigate possible differential response bias between incentive groups. STUDY DESIGN AND SETTING: Australian general practitioners were randomly allocated to unconditional incentive (book voucher mailed with letter of invitation), conditional incentive (book voucher mailed on completion of the online survey), or control (no incentive). Nonresponders were asked to complete a small subset of questions from the online survey. RESULTS: Among 3,334 eligible general practitioners, significantly higher response rates were achieved in the unconditional group (167 of 1,101, 15%) compared with the conditional group (118 of 1,111, 11%) (P = 0.0014), and both were significantly higher than the control group (74 of 1,122, 7%; both P < 0.001). Although more positive opinions about cancer care were expressed by online responders compared with nonresponders, there was no evidence that the magnitude of difference varied by the incentive group. The incremental cost for each additional 1% increase above the control group response rate was substantially higher for the unconditional incentive group compared with the conditional incentive group. CONCLUSION: Both unconditional and conditional financial incentives significantly increased response with no evidence of differential response bias. Although unconditional incentives had the largest effect, the conditional approach was more cost-effective.
Agar, M, Lawlor, P, Quinn, S, Caplan, G, Draper, B, Rowett, D, Devilee, L, Fazekas, B, Sanderson, C, McCaffery, N, Hardy, J, Le, B, Eckermann, S, Hill, M & Currow, D 2015, 'Phase III randomised double-blind controlled trial of oral risperidone, haloperidol or placebo with rescue subcutaneous midazolam for delirium management in palliative care', AUSTRALASIAN JOURNAL ON AGEING, vol. 34, no. S1, pp. 33-33.
Guidelines recommend targeted use of antipsychotics indelirium for speciﬁc symptoms however this approach has notbeen evaluated in randomised trials. To compare the efﬁcacyof risperidone relative to placebo in the control of speciﬁcdelirium symptoms in palliative care patients (communica-tion, behaviour and/or perceptual disturbances on NursingDelirium Screening Scale) at 72 hours after study commence-ment. Secondary aims were to compare haloperidol andplacebo; and risperidone and haloperidol
Currow, DC, Quinn, S, Agar, M, Fazekas, B, Hardy, J, McCaffrey, N, Eckermann, S, Abernethy, AP & Clark, K 2015, 'Double-Blind, Placebo-Controlled, Randomized Trial of Octreotide in Malignant Bowel Obstruction', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 49, no. 5, pp. 814-821.View/Download from: Publisher's site
McCaffrey, N, Agar, M, Harlum, J, Karnon, J, Currow, D & Eckermann, S 2015, 'Better Informing Decision Making with Multiple Outcomes Cost-Effectiveness Analysis under Uncertainty in Cost-Disutility Space', PLOS ONE, vol. 10, no. 3.View/Download from: Publisher's site
Nikles, J, Mitchell, GK, Hardy, J, Agar, M, Senior, H, Carmont, S-A, Schluter, PJ, Good, P, Vora, R & Currow, D 2015, 'Testing pilocarpine drops for dry mouth in advanced cancer using n-of-1 trials: A feasibility study', PALLIATIVE MEDICINE, vol. 29, no. 10, pp. 967-974.View/Download from: Publisher's site
Sanderson, C, Quinn, SJ, Agar, M, Chye, R, Clark, K, Doogue, M, Fazekas, B, Lee, J, Lovell, MR, Rowett, D, Spruyt, O & Currow, DC 2015, 'Pharmacovigilance in hospice/palliative care: net effect of gabapentin for neuropathic pain', BMJ SUPPORTIVE & PALLIATIVE CARE, vol. 5, no. 3, pp. 273-280.View/Download from: Publisher's site
Hudson, PL, Girgis, A, Mitchell, GK, Philip, J, Parker, D, Currow, D, Liew, D, Thomas, K, Le, B, Moran, J & Brand, C 2015, 'Benefits and resource implications of family meetings for hospitalized palliative care patients: research protocol', BMC PALLIATIVE CARE, vol. 14.View/Download from: Publisher's site
Currow, DC, Clark, K, Kamal, A, Collier, A, Agar, MR, Lovell, MR, Phillips, JL & Ritchie, C 2015, 'The Population Burden of Chronic Symptoms that Substantially Predate the Diagnosis of a Life-Limiting Illness', JOURNAL OF PALLIATIVE MEDICINE, vol. 18, no. 6, pp. 480-485.View/Download from: Publisher's site
Luckett, T, Bhattarai, P, Phillips, J, Agar, M, Currow, D, Krastev, Y & Davidson, PM 2015, 'Advance care planning in 21st century Australia: a systematic review and appraisal of online advance care directive templates against national framework criteria', AUSTRALIAN HEALTH REVIEW, vol. 39, no. 5, pp. 552-560.View/Download from: Publisher's site
Phillips, J, Dal Grande, E, Ritchie, C, Abernethy, AP & Currow, DC 2015, 'A population-based cross-sectional study that defined normative population data for the Life-Space Mobility Assessment-composite score.', Journal of pain and symptom management, vol. 49, no. 5, pp. 885-893.View/Download from: Publisher's site
Mobility is linked to health status and quality of life. Life-Space Mobility Assessment (LSMA; range 0-120) measures the spatial extent of people's excursion and physical support needs over the preceding month.The aim of this study was to generate normative population data for an LSMA-Composite (LSMA-C) score, irrespective of age or health service contact and explore the LSM of people with diabetes, current asthma, arthritis, and osteoporosis.LSMA questions were included in the 2011 South Australian Health Omnibus Survey, a multistage, systematic, and clustered sample of household face-to-face interviews. Sociodemographic and clinical variables were explored in relation to LSMA scores using descriptive, univariable, and multivariable analyses and receiver operator curves.For the 3032 respondents, the mean LSMA score was 98.3 (SD 20.3; median 100; interquartile range 34 [86-120]; range 6-120). Five percent of respondents scored <60, 11% scored between ≥ 60 and 79, 27% scored between ≥ 80 and 99, and the remainder scored between 100 and 120. After 55 years of age, LSMA-C scores declined, more so in females. In multivariable analysis, declining scores were associated with being female, being older, living in rural areas, lower educational attainment, not working, lower household income, and higher numbers of chronic conditions (R(2) = 0.35, P < 0.001). The receiver operator curve demonstrated a highly specific but relatively insensitive measure.Having controlled for known confounders, the male/female difference cannot be easily explained. These data will help to contextualize studies in the future that use the LSMA-C score.
Integrating a palliative approach with active management can help identify and address the significant needs of patients with advanced heart failure.
Introducing a palliative approach to care of patients with heart failure while still attempting to modify the disease course through treatment can improve patients' quality of life.
Patients who would benefit from a palliative approach can be better identified by tools that assess needs rather than prognosis.
Optimal palliative care of patients with heart failure integrates ongoing active management with specific interventions to manage symptoms such as breathlessness and oedema.
A plan for deactivation of implantable cardioverter defibrillators at the end of life should be devised and discussed with patients.
Patients should be given the opportunity to reflect on and communicate their preferences for end-of-life care early in the disease process.
Disler, R, Inglis, S, Newton, P, Currow, D, Macdonald, P, Glanville, A, Donesky, D, Carrieri-Kohlman, V & Davidson, P 2015, 'ATTITUDES TO ONLINE DELIVERY OF HEALTH INFORMATION AND CHRONIC DISEASE MANAGEMENT IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE: FOCUS GROUP STUDY', Respirology, vol. 20, pp. 105-105.
Disler, R, Inglis, S, Newton, P, Currow, D, Macdonald, P, Glanville, A, Donesky, D, Carrieri-Kohlman, V & Davidson, P 2015, 'USE OF TECHNOLOGY IN CARDIOPULMONARY PATIENTS', Respirology, vol. 20, pp. 13-13.
Disler, R, Spiliopoulos, N, Inglis, S, Currow, D & Davidson, P 2015, 'INDIVIDUALS ATTITUDES TO COGNITIVE IMPAIRMENT AND IMPACT IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE: FOCUS GROUP STUDY', RESPIROLOGY, vol. 20, pp. 105-105.
Disler, RT, Inglis, SC, Newton, PJ, Currow, DC, Macdonald, PS, Glanville, AR, Donesky, D, Carrieri-Kohlman, V & Davidson, PM 2015, 'Patterns of Technology Use in Patients Attending a Cardiopulmonary Outpatient Clinic: A Self-Report Survey', Interactive Journal of Medical Research, vol. 4, no. 1, pp. 1-14.View/Download from: Publisher's site
Background: Self-management education for cardiopulmonary diseases is primarily provided through time-limited, face-to-face programs, with access limited to a small percentage of patients. Telecommunication tools will increasingly be an important component of future health care delivery.
Objective: The purpose of this study was to describe the patterns of technology use in patients attending a cardiopulmonary clinic in an academic medical center.
Methods: A prevalence survey was developed to collect data on participant demographics (age in years, sex, and socioeconomic status); access to computers, Internet, and mobile phones; and use of current online health support sites or programs. Surveys were offered by reception staff to all patients attending the outpatient clinic.
Results: A total of 123 surveys were collected between March and April 2014. Technological devices were a pervasive part of everyday life with respondents engaged in regular computer (102/123, 82.9%), mobile telephone (115/117, 98.3%), and Internet (104/121, 86.0%) use. Emailing (101/121, 83.4%), researching and reading news articles (93/121, 76.9%), social media (71/121, 58.7%), and day-to-day activities (65/121, 53.7%) were the most common telecommunication activities. The majority of respondents reported that access to health support programs and assistance through the Internet (82/111, 73.9%) would be of use, with benefits reported as better understanding of health information (16/111, 22.5%), avoidance of difficult travel requirements and time-consuming face-to-face appointments (13/111, 18.3%), convenient and easily accessible help and information (12/111, 16.9%), and access to peer support and sharing (9/111, 12.7%). The majority of patients did not have concerns over participating in the online environment (87/111, 78.4%); the few concerns noted related to privacy and security (10/15), information accuracy (2/15), and computer literacy and access (2/15).
Conclusions: Chronic disease bur...
Disler, RT, Inglis, SC, Newton, PJ, Currow, DC, Macdonald, PS, Glanville, AR, Donesky, D, Carrieri-Kohlman, V & Davidson, PM 2015, 'Patterns of Technology Use in Patients Attending a Cardiopulmonary Outpatient Clinic: A Self-Report Survey', JOURNAL OF MEDICAL INTERNET RESEARCH, vol. 17, no. 3.
Spiliopoulos, N, Inglis, SC, Currow, DC, Davidson, PM & Disler, RT 2015, 'Attitudes To Cognitive Impairment And Testing In Patients With Chronic Obstructive Pulmonary Disease: Focus Group Study', Am J Respir Crit Care Med, vol. 191, pp. A5291-A5291.
Abernethy, AP, Currow, DC, Gleich, LL, Yan, Y, Friend, J & Temel, JS 2014, 'Subgroup analysis of ECOG2 patients from ROMANA 2: A phase III study of anamorelin in NSCLC patients with cachexia.', Journal of Clinical Oncology, vol. 32, no. 31_suppl, pp. 6-6.View/Download from: Publisher's site
6 Background: Cancer anorexia-cachexia syndrome (CACS), often observed in NSCLC patients, is characterized by decreased body weight, mainly lean body mass (LBM), and is associated with worse morbidity and survival. Anamorelin HCl (ANAM), a novel selective ghrelin receptor agonist with appetite-enhancing and anabolic activity, is in development as a treatment of NSCLC CACS. Methods: ROMANA 2 was one of two global, double-blind, Phase III trials assessing ANAM efficacy and safety in NSCLC. Patients with unresectable stage III/IV NSCLC, ECOG 0-2 and cachexia (≥5% weight loss within prior 6 months or BMI <20 kg/m2), were randomized (2:1) to 100 mg ANAM or placebo, given daily orally for 12 weeks. Co-primary endpoints were change from baseline over 12 weeks in LBM (measured by DXA) and in handgrip strength (HGS). Secondary endpoints included change in patient symptoms/concerns regarding anorexia-cachexia and fatigue (via Functional Assessment of Anorexia/Cachexia Treatment [FAACT] and Functional Assessment of Chronic Illness Therapy – Fatigue [FACIT-F]). Safety assessments included lab values and adverse events (AEs). This pre-specified analysis focused on ECOG2 patients. Results: ROMANA 2 (N=495) enrolled 130 ECOG2 patients (N=41 placebo; N=89 ANAM). Subgroup demographics were balanced: median age= 64 yr, male (81.5%), metastatic (74.6%), and prior weight loss >10% (61.5%). In the overall trial, ANAM significantly increased LBM vs placebo (0.75 vs -0.96 kg; p<0.0001) and improved FAACT over 12 weeks (3.48±0.9 vs 1.34±1.0; p=0.0016); change in HGS was not statistically different. In the ECOG2 subgroup, ANAM also significantly increased LBM (0.45 vs -2.66 kg; p=0.0004); there was a trend towards improvement in FAACT and FACIT-F but this was not statistically significant. In the ANAM arm of the ECOG2 subgroup, the most frequent drug-related AE was hyperglycemia (4.5%), with few (1.1%) drug-related Grade ≥ 3 AEs. C...
Bischoff, K, Currow, DC, Corvera, C & Pantilat, SZ 2014, 'Unanswered Questions in Malignant Bowel Obstruction', JOURNAL OF PALLIATIVE CARE, vol. 30, no. 4, pp. 265-270.View/Download from: Publisher's site
Clark, K & Currow, DC 2014, 'Advancing research into symptoms of constipation at the end of life', International Journal of Palliative Nursing, vol. 20, no. 8, pp. 370-372.View/Download from: Publisher's site
Creighton, N, Smith, RC & Currow, DC 2014, 'Survival, mortality and morbidity outcomes after oesophagogastric cancer surgery in New South Wales, 2001-2008 REPLY', MEDICAL JOURNAL OF AUSTRALIA, vol. 201, no. 8, pp. 447-447.View/Download from: Publisher's site
Creighton, N, Walton, R, Aranda, S & Currow, D 2014, 'USING DATA TO INFORM AND SUPPORT SYSTEM IMPROVEMENT - OVERCOMING CHALLENGES IN A LOW-VOLUME ENVIRONMENT', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, vol. 10, pp. 248-248.
Currow, D 2014, 'ACHIEVING SYSTEMS CHANGE - CHALLENGE OF THE REAL WORLD', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, vol. 10, pp. 123-123.
Currow, DC & Abernethy, AP 2014, 'Anamorelin hydrochloride in the treatment of cancer anorexia-cachexia syndrome.', Future oncology (London, England), vol. 10, no. 5, pp. 789-802.View/Download from: Publisher's site
Anamorelin hydrochloride is an orally active ghrelin receptor agonist in development by Helsinn, for the treatment of non-small-cell lung cancer (NSCLC) cachexia. In preclinical and clinical studies, the potent affinity of anamorelin for the ghrelin receptor is associated with significant appetite-enhancing activity and resultant improvements in body weight, lean body mass, and handgrip strength compared with placebo. The accompanying stimulatory effects on growth hormone and IGF-1 are not associated with tumor growth, and overall survival in patients with cancer is not compromised. Anamorelin is well tolerated with no dose-limiting toxicities identified to date. The findings of ongoing Phase III studies are needed to confirm the significant potential of anamorelin to treat NSCLC cachexia.
Currow, DC & Abernethy, AP 2014, 'The science of breathlessness: '... as we come onto the home straight, Science is catching Clinical Practice. Just two lengths between them'.', Curr Opin Support Palliat Care, vol. 8, no. 3, pp. 189-190.View/Download from: Publisher's site
Currow, DC & Sansom, LN 2014, 'Uptake of medicines and prescribing patterns in the palliative care schedule of the Pharmaceutical Benefits Scheme', MEDICAL JOURNAL OF AUSTRALIA, vol. 200, no. 10, pp. 560-561.View/Download from: Publisher's site
Currow, DC, Abernethy, AP & Ko, DN 2014, 'The active identification and management of chronic refractory breathlessness is a human right', THORAX, vol. 69, no. 4, pp. 393-394.View/Download from: Publisher's site
Currow, DC, You, H, Aranda, S, McCaughan, BC, Morrell, S, Baker, DF, Walton, R & Roder, DM 2014, 'What factors are predictive of surgical resection and survival from localised non-small cell lung cancer?', MEDICAL JOURNAL OF AUSTRALIA, vol. 201, no. 8, pp. 475-480.View/Download from: Publisher's site
Dunlop, S, Dobbins, T, Young, J, Perez, D & Currow, D 2014, 'SHORT-TERM IMPACT OF AUSTRALIA'S NEW TOBACCO PLAIN PACKS ON ADULT SMOKERS' PACK-RELATED PERCEPTIONS AND RESPONSES: RESULTS FROM A CONTINUOUS TRACKING SURVEY', Asia-Pacific Journal of Clinical Oncology, vol. 10, no. Supp. 9, pp. 1-264.
Background: Given that the introduction of the tobacco plain packaginglegislation in Australia is the first of its kind, research on its real-worldimpact is crucial for policy decision-making in other jurisdictions.Aim: To investigate the impact of Australia's plain tobacco packaging policyon two stated purposes of the legislation – increasing the impact of healthwarnings and decreasing the promotional appeal of packaging – amongadult smokers.Methods: Serial cross-sectional study with weekly telephone surveys ofadult smokers (April 2006 to May 2013, n = 15,745). Interrupted time-series analyses using ARIMA modelling and logistic regression analyses wereused to investigate intervention effects.Results: Adjusting for background trends, seasonality, and variations inanti-smoking advertising activity and cigarette costliness, results fromARIMA modelling showed that, two to three months after the introductionof the new packs there was a significant increase in the proportion ofsmokers having strong cognitive (B = 0.098, SE = 0.034, p = 0.005), emo-tional (B = 0.086, SE = 0.035, p = 0.01) and avoidant (B = 0.098,SE = 0.028, p = 0.0005) responses to on-pack health warnings. Threemonths following the introduction of the new packs, there was a significantincrease in the proportion of smokers strongly disagreeing that the look oftheir cigarette pack is attractive (B = 0.596, SE = 0.098, p < 0.0001), sayssomething good about them (B = 0.539, SE = 0.089, p < 0.0001), influencesthe brand they buy (B = 0.423, SE = 0.091, p < 0.0001), makes their packstand out (B = 0.546, SE = 0.108, p < 0.0001), is fashionable (B = 0.454,SE = 0.084, p < 0.0001), and matches their style (B = 0.470, SE = 0.086,p < 0.0001). Logistic regression analyses, controlling for demographic andsmoking characteristics, confirmed these effects. Changes in these outcomeswere maintained six months post-intervention.Conclusions: The introductory effects are consistent with the specific objec-tives of the plain ...
Dunlop, SM, Dobbins, T, Young, JM, Perez, D & Currow, DC 2014, 'Impact of Australia's introduction of tobacco plain packs on adult smokers' pack-related perceptions and responses: results from a continuous tracking survey', BMJ OPEN, vol. 4, no. 12.View/Download from: Publisher's site
Ekstrom, MP, Bornefalk-Hermansson, A, Abernethy, A & Currow, DC 2014, 'Safety Of Benzodiazepines And Opioids In Very Severe COPD: A National Prospective Study', AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, vol. 189.
Ekstrom, MP, Bornefalk-Hermansson, A, Abernethy, AP & Currow, DC 2014, 'Safety of benzodiazepines and opioids in very severe respiratory disease: national prospective study', BMJ-BRITISH MEDICAL JOURNAL, vol. 348.View/Download from: Publisher's site
Hardy, JR, Spruyt, O, Quinn, SJ, Devilee, LR & Currow, DC 2014, 'Implementing practice change in chronic cancer pain management: clinician response to a phase III study of ketamine.', Internal Medicine Journal, vol. 44, no. 6, pp. 586-591.View/Download from: Publisher's site
BACKGROUND: An adequately powered, double-blind, multisite, randomised controlled trial has shown no net clinical benefit for subcutaneous ketamine over placebo in the management of cancer pain refractory to combination opioid and co-analgesic therapy. The results of the trial were disseminated widely both nationally and internationally. AIM: To determine whether the trial had impacted on clinical practice in Australasia. METHODS: Members of the Australia and New Zealand Society of Palliative Medicine were sent an online ketamine utilisation survey. RESULTS: A total of 123/392 clinicians responded (31% response rate). The majority of respondents had practised for more than 10 years in a metropolitan hospital setting. Ketamine had been prescribed by 91% of respondents, and 92% were aware of the trial. As a result, 65% of respondents had changed practice (17% no longer prescribed ketamine, 46% used less and 2% more). Thirty-five per cent had not changed practice. Reasons for change included belief in the results of the study, concerns over the toxicity reported or because there were alternatives for pain control. Of those who prescribed less, over 80% were more selective and would now only use the drug in certain clinical situations or pain types, or when all other medications had failed. CONCLUSIONS: Although two-thirds of respondents reported practice change as a result of the randomised controlled trial, a minority remained convinced of the benefit of the drug from their own observations and would require additional evidence.
Johnson, C, Rushton, S, Tieman, J, Currow, D & Aranda, S 2014, 'Reclaiming the midnight hours: up-to-date evidence in just one click.', European Journal of Cancer Care, vol. 23, no. 6, pp. 760-761.View/Download from: Publisher's site
Johnson, MJ, Bland, JM, Davidson, PM, Newton, PJ, Oxberry, SG, Abernethy, AP & Currow, DC 2014, 'The Relationship Between Two Performance Scales: New York Heart Association Classification and Karnofsky Performance Status Scale', Journal of Pain and Symptom Management, vol. 47, no. 3, pp. 652-658.View/Download from: Publisher's site
Johnson, MJ, Bland, JM, Oxberry, SG, Abernethy, AP & Currow, DC 2014, 'Measuring improvement in dyspnoea: should absolute or relative values be used?', EUROPEAN RESPIRATORY JOURNAL, vol. 44, no. 6, pp. 1700-1703.View/Download from: Publisher's site
Johnson, MJ, Currow, DC & Booth, S 2014, 'Prevalence and assessment of breathlessness in the clinical setting', EXPERT REVIEW OF RESPIRATORY MEDICINE, vol. 8, no. 2, pp. 151-161.View/Download from: Publisher's site
LeBlanc, TW, Currow, DC & Abernethy, AP 2014, 'On Goldilocks, care coordination, and palliative care: making it 'just right'', PRIMARY CARE RESPIRATORY JOURNAL, vol. 23, no. 1, pp. 8-10.View/Download from: Publisher's site
McCaffrey, N, Skuza, P, Breaden, K, Eckermann, S, Hardy, J, Oaten, S, Briffa, M & Currow, D 2014, 'Preliminary development and validation of a new end-of-life patient-reported outcome measure assessing the ability of patients to finalise their affairs at the end of life.', PLoS ONE, vol. 9, no. 4, pp. 1-10.View/Download from: Publisher's site
INTRODUCTION: The ability of patients to finalise their affairs at the end of life is an often neglected aspect of quality of life (QOL) measurement in palliative care effectiveness research despite compelling evidence of the high value patients place on this domain. OBJECTIVE: This paper describes the preliminary development and evaluation of a new, single-item, end-of-life patient-reported outcome measure (EOLPRO) designed to capture changes in the ability of patients to finalise their affairs at the end of life. METHODS: Cognitive interviews with purposively sampled Australian palliative care patients (N = 9) were analysed thematically to explore content validity. Simultaneously, secondary analysis of data from a randomised controlled trial comparing ketamine and placebo for the management of cancer pain (N = 185) evaluated: construct validity; test-retest reliability; and responsiveness. RESULTS: Preliminary findings suggest patients interpret the new measure consistently. The EOLPRO captures the ability to complete physical tasks and finalise practical matters although it is unclear whether emotional tasks or resolution of relationship issues are considered. Personal and financial affairs should be separated to allow for differences in ability for these two types of affairs. The significant correlation between performance status and EOLPRO scores (r = 0.41, p<0.01, n = 137) and expected relationships between EOLPRO and proximity to death and constipation demonstrated construct validity. Pre- and post-treatment EOLPRO scores moderately agreed (n = 14, κ = 0.52 [95% CI 0.19, 0.84]) supporting reliability. The measure's apparent lack of sensitivity to discriminate between treatment responders and non-responders may be confounded. CONCLUSION: Based on the preliminary findings, the EOLPRO should be separated into 'personal' and 'financial' affairs with further testing suggested, particularly to verify coverage and responsiveness. Initial evaluation suggests that ...
McConigley, R, Kristjanson, LJ, Aoun, SM, Oldham, L, Currow, DC, O'Connor, M & Holloway, K 2014, 'Staying just one step ahead: providing care for patients with motor neurone disease', BMJ SUPPORTIVE & PALLIATIVE CARE, vol. 4, no. 1, pp. 38-42.View/Download from: Publisher's site
Pinkawa, M, Djukic, V, Klotz, J, Petz, D, Piroth, MD, Holy, R & Eble, MJ 2014, 'Hematologic changes during prostate cancer radiation therapy are dependent on the treatment volume.', Future oncology (London, England), vol. 10, no. 5, pp. 835-843.View/Download from: Publisher's site
AIM: To assess hematologic changes of modern prostate radiation therapy (RT) comparing different target volumes. PATIENTS & METHODS: Blood samples were evaluated before (T1), during (T2-T4) and 6-8 weeks after (T5) RT in a group of 113 patients. Whole-pelvic RT up to 46 Gy was applied in 27 cases. The total dose to the prostatic fossa (n = 46)/prostate (n = 67) was 66/76 Gy. RESULTS: Erythrocyte, leukocyte and platelet levels decreased significantly relative to baseline levels at T2-T5. Neoadjuvant hormonal therapy had an impact on hemoglobin levels before and during RT. The cumulative incidence of grade 2 leukopenia was 15 versus 2% (p = 0.02) and grade 2 anemia 8 versus 0% (p = 0.03) with versus without whole-pelvic RT, respectively. Lymphocyte decrease was larger at times T2-T5 (36 vs 3% grade 3 toxicity; p < 0.01). CONCLUSION: Prostate RT has a small but significant and longer effect on the blood count. Lower lymphocyte levels need to be considered when larger volumes are treated.
© 2014 Australian Government Publishing Service. All rights reserved. Patients receiving palliative care are at high risk of adverse effects from drugs. As these effects can be difficult to distinguish from the symptoms of the terminal illness, harm from medicines is often not recognised.Adverse effects can contribute to the burden of symptoms, at a time when good control of symptoms is paramount. Adding another drug to treat the adverse effects can compound the problem.Patients should be asked about their symptoms as they may not volunteer the information or recognise the link with their medicines. Reviewing their treatment may prompt a change in dose, drug or lead to some treatments being stopped.
Russell, BJ, Rowett, D & Currow, DC 2014, 'Pro Re Nata Prescribing in a Population Receiving Palliative Care: A Prospective Consecutive Case Note Review', JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, vol. 62, no. 9, pp. 1736-1740.View/Download from: Publisher's site
Russell, BJ, Rowett, D, Abernethy, AP & Currow, DC 2014, 'Prescribing for comorbid disease in a palliative population: focus on the use of lipid-lowering medications.', Internal Medicine Journal, vol. 44, no. 2, pp. 177-184.View/Download from: Publisher's site
BACKGROUND: The balance of benefit versus burden of ongoing treatments for comorbid disease in palliative populations as death approaches needs careful consideration given their particular susceptibility to adverse drug effects. AIM: To provide descriptive data regarding the medications being prescribed to patients who have a life-limiting illness at the time of referral to a palliative care service in regional Australia, with particular focus on lipid-lowering medications. METHODS: A prospective case note review of 203 patients reporting the number of medications prescribed and, for lipid-lowering medications, the indication and level of prevention sought (primary, secondary, tertiary). Rates were compared by performance status, disease phase and comorbidity burden. RESULTS: Mean number of regular medications prescribed was 7.2, with higher rates observed in those patients with a non-malignant primary diagnosis (rate ratio 1.28, confidence interval (CI) 1.11-1.50) or poorer performance status (rate ratio 1.37, CI 1.11-1.69) and lower rates for those in the terminal phase of disease (rate ratio 0.48, CI 0.30-0.76). Over one fifth of patients were prescribed a lipid-lowering medication, and two fifths of these prescriptions were for primary prevention of cardiovascular disease. Patients in the highest quartile of Charlson Comorbidity Index score were 4.6 (CI 2.06-10.09) times more likely to be prescribed a lipid-lowering medication than those in the lowest quartile. CONCLUSIONS: Polypharmacy is prevalent for this group of patients, placing them at high risk of drug-drug and drug-host interactions. Prescribing may be driven by risk factors and disease guidelines rather than a rational, patient-centred approach.
Scott, N, Donato-Hunt, C, Crane, M, Lafontaine, M, Varlow, M, Seale, H & Currow, D 2014, 'Knowledge, attitudes and beliefs about lung cancer in three culturally and linguistically diverse communities living in Australia: a qualitative study.', Health Promotion Journal of Australia, vol. 25, no. 1, pp. 46-51.View/Download from: Publisher's site
ISSUE ADDRESSED: Knowledge, attitudes and beliefs about lung cancer among Chinese, Vietnamese and Arabic-speaking communities in Sydney, New South Wales (NSW) are explored. METHODS: Seven focus groups were completed with a total of 51 participants (smokers and non-smokers) from three culturally and linguistically diverse communities (CALD). Five topics were discussed and translated summaries from focus groups were thematically analysed. RESULTS: There were variations in perceived susceptibility to lung cancer between the CALD groups and between smokers and non-smokers. Fatalistic views towards lung cancer were apparent across all three CALD communities. There were low levels of awareness of lung cancer signs and symptoms, with the exception of haemoptysis. Differences in help-seeking behaviour and levels of trust of general practitioners (GP) were apparent. CONCLUSION: Limited awareness of the signs and symptoms of lung cancer, combined with cultural perceptions about cancer, impacted on attitudes towards help-seeking behaviour in these three CALD communities. So what? The prevalence of smoking among Chinese men, Vietnamese men and Arabic-speaking communities in NSW puts them at increased risk of lung cancer. Health promotion initiatives for lung cancer should be tailored for CALD communities and could focus on increasing knowledge of key symptoms, awareness that ex-smokers are at risk and awareness of the diagnostic pathway including the importance of avoiding delays in help-seeking.
Smith, RC, Creighton, N, Lord, RV, Merrett, ND, Keogh, GW, Liauw, WS & Currow, DC 2014, 'Survival, mortality and morbidity outcomes after oesophagogastric cancer surgery in New South Wales, 2001-2008', MEDICAL JOURNAL OF AUSTRALIA, vol. 200, no. 7, pp. 408-413.View/Download from: Publisher's site
Swetenham, K, Tieman, J & Currow, D 2014, 'Do patients and carers find separate palliative care clinic consultations acceptable? A pilot study.', International Journal of Palliative Nursing, vol. 20, no. 6, pp. 301-305.View/Download from: Publisher's site
BACKGROUND: As differing patient and carer information needs have been reported, and in light of changing health-system priorities and issues identified in a self-assessment study, a specialist palliative care service established an interdisciplinary psychosocial assessment clinic to separately assess patient and carer needs. AIM: To determine the acceptability of the separate assessment to patients and carers. METHOD: Patients with a high functional score and who were deemed well enough to manage an appointment were invited to attend the clinic. Consent to follow-up was obtained. Patient and carer satisfaction surveys were developed based on existing tools. Questionnaires were posted out with a pre-paid reply envelope to patients and carers. Data from completed surveys was entered into a data management system and frequency analysis completed. A secondary analysis of the comments was undertaken. FINDINGS: The clinic was attended by 41 patients and 37 carers between September 2011 and the end of February 2012. There was a 46% response rate, with 24 questionnaires returned from both the patient and their carer, 6 from patients only, and 6 from carers only (2 of whom were bereaved). The opportunity for privacy to discuss their own fears and concerns related to the illness was appreciated by 94% of the patients and 83% of the carers. CONCLUSION: This initial pilot data shows patient and carer satisfaction with this clinic model. Further qualitative data would provide more information on the patient and carer experiences of the clinic.
Temel, J, Currow, D, Fearon, K, Gleich, L, Yan, Y, Friend, J & Abernethy, A 2014, 'Anamorelin for the Treatment of Cancer Anorexia-Cachexia in Nsclc: Results from the Phase 3 Studies Romana 1 and 2', Annals of Oncology, vol. 25, pp. v1-v1.View/Download from: Publisher's site
Tieman, JJ, Morgan, DD, Swetenham, K, To, THM & Currow, DC 2014, 'Designing clinically valuable telehealth resources: processes to develop a community-based palliative care prototype.', JMIR Research Protocols, vol. 3, no. 3, pp. 1-8.View/Download from: Publisher's site
BACKGROUND: Changing population demography and patterns of disease are increasing demands on the health system. Telehealth is seen as providing a mechanism to support community-based care, thus reducing pressure on hospital services and supporting consumer preferences for care in the home. OBJECTIVE: This study examined the processes involved in developing a prototype telehealth intervention to support palliative care patients involved with a palliative care service living in the community. METHODS: The challenges and considerations in developing the palliative care telehealth prototype were reviewed against the Center for eHealth Research (CeHRes) framework, a telehealth development model. The project activities to develop the prototype were specifically mapped against the model's first four phases: multidisciplinary project management, contextual inquiry, value specification, and design. This project has been developed as part of the Telehealth in the Home: Aged and Palliative Care in South Australia initiative. RESULTS: Significant issues were identified and subsequently addressed during concept and prototype development. The CeHRes approach highlighted the implicit diversity in views and opinions among participants and stakeholders and enabled issues to be considered, resolved, and incorporated during design through continuous engagement. CONCLUSIONS: The CeHRes model provided a mechanism that facilitated "better" solutions in the development of the palliative care prototype by addressing the inherent but potentially unrecognized differences in values and beliefs of participants. This collaboration enabled greater interaction and exchange among participants resulting in a more useful and clinically valuable telehealth prototype.
Tracey, E, Watt, H, Currow, D, Young, J & Armstrong, B 2014, 'Investigation of poorer bladder cancer survival in women in NSW, Australia: a data linkage study.', BJU International, vol. 113, no. 3, pp. 437-448.View/Download from: Publisher's site
OBJECTIVE: To investigate the associations of a range of personal and clinical variables with bladder cancer survival in men and women in NSW to see if we could explain why bladder cancer survival is consistently poorer in women than in men. PATIENTS AND METHODS: All 6880 cases of bladder cancers diagnosed in NSW between 2000 and 2008 were linked to hospital separation data and to deaths. Separate Cox proportional hazards regression models of hazard of bladder cancer death were constructed for those who did or did not undergo cystectomy. RESULTS: A total of 16% of patients with bladder cancer underwent cystectomy (16% of men and 15% of women). Women who underwent cystectomy were 26% more likely to die than men (hazard ratio [HR] 1.26, 95% confidence interval [CI] 1.00-1.59) after adjustment for age, stage, time from diagnosis to cystectomy, distance from treatment facility and country of birth. None of the above covariates had a material effect on the difference in hazard between women and men; however, when stratified by a history of cystitis, the adjusted hazard was 55% higher in women (HR 1.55, 95% CI 1.15-2.10) than in men with a history of cystitis while, in the absence of this history, there was no difference in the hazard between men and women (HR 0.99, 95% CI 0.57-1.70). This apparent modification of the effect of sex on bladder cancer outcome was not seen in patients treated only by resection: the adjusted HRs in women relative to men were 1.10 (95% CI 0.92-1.31) in those with a history of cystitis and 1.21 (95% CI 0.98-1.50) in those without. A history of haematuria did not modify appreciably the association of sex with bladder cancer outcome. CONCLUSION: Women's poorer survival from bladder cancer compared with that of men remains unexplained; however, the possibility that some factor associated with a history of cystitis may contribute to or explain the poorer outcome in women merits further investigation.
Young, JM, Currow, D & Dunlop, S 2014, 'The association between tobacco plain packaging and Quitline calls.', The Medical journal of Australia, vol. 200, no. 6, pp. 314-315.View/Download from: Publisher's site
In reply: We thank Magnusson for placing our study1 in the broader context of government involvement in public health initiatives. A key point that deserves further exploration is the role of governments around the world when novel legislative initiatives are introduced to improve the health of the population. Each government that introduces novel laws or regulations must also ensure that it has adequate resources to measure the impact of these measures. If this is not done, there is the risk of failing to fully quantify the impact of the new initiatives.
The three studies published to date that evaluate aspects of the impact of introducing plain tobacco packaging were not funded by the jurisdiction that introduced the legislation.1,2,3 It is notable that our study would not have been possible without ongoing investment in long-term longitudinal data collection that enabled the comparisons between different initiatives (the introduction of graphic health warnings and the introduction of plain packaging) to be undertaken.
Young, JM, Stacey, I, Dobbins, TA, Dunlop, S, Dessaix, AL & Currow, DC 2014, 'Association between tobacco plain packaging and Quitline calls: a population-based, interrupted time-series analysis.', The Medical journal of Australia, vol. 200, no. 1, pp. 29-32.View/Download from: Publisher's site
OBJECTIVES: To investigate whether the introduction of tobacco plain packaging in Australia from 1 October 2012 was associated with a change in the number of calls to the smoking cessation helpline, Quitline, and to compare this with the impact of the introduction of graphic health warnings from 1 March 2006. DESIGN AND SETTING: Whole-of-population interrupted time-series analysis in New South Wales and the Australian Capital Territory between 1 March 2005 and October 2006 for the comparator, graphic health warnings, and October 2011 and April 2013 for the intervention of interest, tobacco plain packaging. MAIN OUTCOME MEASURE: Weekly number of calls to the Quitline, after adjusting for seasonal trends, anti-tobacco advertising, cigarette costliness and the number of smokers in the community. RESULTS: There was a 78% increase in the number of calls to the Quitline associated with the introduction of plain packaging (baseline, 363/week; peak, 651/week [95% CI, 523-780/week; P < 0.001]). This peak occurred 4 weeks after the initial appearance of plain packaging and has been prolonged. The 2006 introduction of graphic health warnings had the same relative increase in calls (84%; baseline, 910/week; peak, 1673/week [95% CI, 1383-1963/week; P < 0.001]) but the impact of plain packaging has continued for longer. CONCLUSIONS: There has been a sustained increase in calls to the Quitline after the introduction of tobacco plain packaging. This increase is not attributable to anti-tobacco advertising activity, cigarette price increases nor other identifiable causes. This is an important incremental step in comprehensive tobacco control.
Bush, SH, Bruera, E, Lawlor, PG, Kanji, S, Davis, DHJ, Agar, M, Wright, DK, Hartwick, M, Currow, DC, Gagnon, B, Simon, J & Pereira, JL 2014, 'Clinical practice guidelines for delirium management: potential application in palliative care.', Journal of Pain and Symptom Management, vol. 48, no. 2, pp. 249-258.View/Download from: Publisher's site
CONTEXT: Delirium occurs in patients across a wide array of health care settings. The extent to which formal management guidelines exist or are adaptable to palliative care is unclear. OBJECTIVES: This review aims to 1) source published delirium management guidelines with potential relevance to palliative care settings, 2) discuss the process of guideline development, 3) appraise their clinical utility, and 4) outline the processes of their implementation and evaluation and make recommendations for future guideline development. METHODS: We searched PubMed (1990-2013), Scopus, U.S. National Guideline Clearinghouse, Google, and relevant reference lists to identify published guidelines for the management of delirium. This was supplemented with multidisciplinary input from delirium researchers and other relevant stakeholders at an international delirium study planning meeting. RESULTS: There is a paucity of high-level evidence for pharmacological and non-pharmacological interventions in the management of delirium in palliative care. However, multiple delirium guidelines for clinical practice have been developed, with recommendations derived from "expert opinion" for areas where research evidence is lacking. In addition to their potential benefits, limitations of clinical guidelines warrant consideration. Guidelines should be appraised and then adapted for use in a particular setting before implementation. Further research is needed on the evaluation of guidelines, as disseminated and implemented in a clinical setting, focusing on measurable outcomes in addition to their impact on quality of care. CONCLUSION: Delirium clinical guidelines are available but the level of evidence is limited. More robust evidence is required for future guideline development.
Bush, SH, Kanji, S, Pereira, JL, Davis, DHJ, Currow, DC, Meagher, DJ, Rabheru, K, Wright, DK, Bruera, E, Agar, M, Hartwick, M, Gagnon, PR, Gagnon, B, Breitbart, W, Regnier, L & Lawlor, PG 2014, 'Treating an established episode of delirium in palliative care: expert opinion and review of the current evidence base with recommendations for future development.', Journal of Pain and Symptom Management, vol. 48, no. 2, pp. 231-248.View/Download from: Publisher's site
CONTEXT: Delirium is a highly prevalent complication in patients in palliative care settings, especially in the end-of-life context. OBJECTIVES: To review the current evidence base for treating episodes of delirium in palliative care settings and propose a framework for future development. METHODS: We combined multidisciplinary input from delirium researchers and other purposely selected stakeholders at an international delirium study planning meeting. This was supplemented by a literature search of multiple databases and relevant reference lists to identify studies regarding therapeutic interventions for delirium. RESULTS: The context of delirium management in palliative care is highly variable. The standard management of a delirium episode includes the investigation of precipitating and aggravating factors followed by symptomatic treatment with drug therapy. However, the intensity of this management depends on illness trajectory and goals of care in addition to the local availability of both investigative modalities and therapeutic interventions. Pharmacologically, haloperidol remains the practice standard by consensus for symptomatic control. Dosing schedules are derived from expert opinion and various clinical practice guidelines as evidence-based data from palliative care settings are limited. The commonly used pharmacologic interventions for delirium in this population warrant evaluation in clinical trials to examine dosing and titration regimens, different routes of administration, and safety and efficacy compared with placebo. CONCLUSION: Delirium treatment is multidimensional and includes the identification of precipitating and aggravating factors. For symptomatic management, haloperidol remains the practice standard. Further high-quality collaborative research investigating the appropriate treatment of this complex syndrome is needed.
Bush, SH, Leonard, MM, Agar, M, Spiller, JA, Hosie, A, Wright, DK, Meagher, DJ, Currow, DC, Bruera, E & Lawlor, PG 2014, 'End-of-life delirium: issues regarding recognition, optimal management, and the role of sedation in the dying phase.', Journal of Pain and Symptom Management, vol. 48, no. 2, pp. 215-230.View/Download from: Publisher's site
CONTEXT: In end-of-life care, delirium is often not recognized and poses unique management challenges, especially in the case of refractory delirium in the terminal phase. OBJECTIVES: To review delirium in the terminal phase context, specifically in relation to recognition issues; the decision-making processes and management strategies regarding its reversibility; the potential refractoriness of delirium to symptomatic treatment; and the role of sedation in refractory delirium. METHODS: We combined multidisciplinary input from delirium researchers and knowledge users at an international delirium study planning meeting and relevant electronic database literature searches (Ovid Medline, Embase, PsycINFO, and CINAHL) to inform this narrative review. RESULTS: The overall management strategy for delirium at the end of life is directed by the patient's prognosis in association with the patient's goals of care. As symptoms of delirium are often refractory in the terminal phase, especially in the case of agitated delirium, the judicious use of palliative sedation is frequently required. However, there remains a lack of high-level evidence for the management of delirium in the terminal phase, including the role of antipsychotics and optimal sedation strategies. For the family and health-care staff, clear communication, education, and emotional support are vital components to assist with decision making and direct the treatment care plan. CONCLUSION: Further research on the effectiveness of delirium management strategies in the terminal phase for patients and their families is required. Further validation of assessment tools for diagnostic screening and severity measurement is needed in this patient population.
Clark, K, Lam, L, Currow, DC & Agar, M 2014, 'A Prospective Study to Investigate Contributory Factors That Lead to Constipation in Palliative Care Patients', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 47, no. 6, pp. E1-E4.View/Download from: Publisher's site
Hegarty, M, Breaden, K, Agar, M, Devery, K, Goh, C, Shaw, R, Swetenham, K & Currow, DC 2014, 'Asia Pacific Palliative Care Development Through Education', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 47, no. 2, pp. E7-E9.View/Download from: Publisher's site
Lawlor, PG, Davis, DHJ, Ansari, M, Hosie, A, Kanji, S, Momoli, F, Bush, SH, Watanabe, S, Currow, DC, Gagnon, B, Agar, M, Bruera, E, Meagher, DJ, de Rooij, SEJA, Adamis, D, Caraceni, A, Marchington, K & Stewart, DJ 2014, 'An analytical framework for delirium research in palliative care settings: integrated epidemiologic, clinician-researcher, and knowledge user perspectives.', Journal of Pain and Symptom Management, vol. 48, no. 2, pp. 159-175.View/Download from: Publisher's site
CONTEXT: Delirium often presents difficult management challenges in the context of goals of care in palliative care settings. OBJECTIVES: The aim was to formulate an analytical framework for further research on delirium in palliative care settings, prioritize the associated research questions, discuss the inherent methodological challenges associated with relevant studies, and outline the next steps in a program of delirium research. METHODS: We combined multidisciplinary input from delirium researchers and knowledge users at an international delirium study planning meeting, relevant literature searches, focused input of epidemiologic expertise, and a meeting participant and coauthor survey to formulate a conceptual research framework and prioritize research questions. RESULTS: Our proposed framework incorporates three main groups of research questions: the first was predominantly epidemiologic, such as delirium occurrence rates, risk factor evaluation, screening, and diagnosis; the second covers pragmatic management questions; and the third relates to the development of predictive models for delirium outcomes. Based on aggregated survey responses to each research question or domain, the combined modal ratings of "very" or "extremely" important confirmed their priority. CONCLUSION: Using an analytical framework to represent the full clinical care pathway of delirium in palliative care settings, we identified multiple knowledge gaps in relation to the occurrence rates, assessment, management, and outcome prediction of delirium in this population. The knowledge synthesis generated from adequately powered, multicenter studies to answer the framework's research questions will inform decision making and policy development regarding delirium detection and management and thus help to achieve better outcomes for patients in palliative care settings.
Sweet, L, Adamis, D, Meagher, DJ, Davis, D, Currow, DC, Bush, SH, Barnes, C, Hartwick, M, Agar, M, Simon, J, Breitbart, W, MacDonald, N & Lawlor, PG 2014, 'Ethical challenges and solutions regarding delirium studies in palliative care.', Journal of Pain and Symptom Management, vol. 48, no. 2, pp. 259-271.View/Download from: Publisher's site
CONTEXT: Delirium occurs commonly in settings of palliative care (PC), in which patient vulnerability in the unique context of end-of-life care and delirium-associated impairment of decision-making capacity may together present many ethical challenges. OBJECTIVES: Based on deliberations at the Studies to Understand Delirium in Palliative Care Settings (SUNDIPS) meeting and an associated literature review, this article discusses ethical issues central to the conduct of research on delirious PC patients. METHODS: Together with an analysis of the ethical deliberations at the SUNDIPS meeting, we conducted a narrative literature review by key words searching of relevant databases and a subsequent hand search of initially identified articles. We also reviewed statements of relevance to delirium research in major national and international ethics guidelines. RESULTS: Key issues identified include the inclusion of PC patients in delirium research, capacity determination, and the mandate to respect patient autonomy and ensure maintenance of patient dignity. Proposed solutions include designing informed consent statements that are clear, concise, and free of complex phraseology; use of concise, yet accurate, capacity assessment instruments with a minimally burdensome schedule; and use of PC friendly consent models, such as facilitated, deferred, experienced, advance, and proxy models. CONCLUSION: Delirium research in PC patients must meet the common standards for such research in any setting. Certain features unique to PC establish a need for extra diligence in meeting these standards and the employment of assessments, consent procedures, and patient-family interactions that are clearly grounded on the tenets of PC.
To, THM, Agar, M, Yates, P & Currow, DC 2014, 'Prescribing for nausea in palliative care: a cross-sectional national survey of Australian palliative medicine doctors.', Journal of Palliative Medicine, vol. 17, no. 9, pp. 1032-1036.View/Download from: Publisher's site
BACKGROUND: Nausea can be a debilitating symptom for patients with a life-limiting illness. While addressing reversible components, nonpharmacological strategies and antiemetics are the main therapeutic option. The choice of medication, dose, and route of administration remain highly variable. OBJECTIVE: The aim of this study was to codify the current clinical approaches and quantify any variation found nationally. METHODS: A cross-sectional study utilizing a survey of palliative medicine clinicians examined prescribing preferences for nausea using a clinical vignette. Respondent characteristics, the use of nonpharmacological interventions, first- and second-line antiemetic choices, commencing and maximal dose, and time to review were collected. RESULTS: Responding clinicians were predominantly working in palliative medicine across a range of settings with a 49% response rate (105/213). The main nonpharmacological recommendation was "small, frequent snacks." Metoclopramide was the predominant first-line agent (69%), followed by haloperidol (26%), while second-line haloperidol was the predominant agent (47%), with wide variation in other nominated agents. Respondents favoring metoclopramide as first-line tended to use haloperidol second-line (65%), but not vice versa. Maximal doses for an individual antiemetic varied up to tenfold. CONCLUSION: For nausea, a commonly encountered symptom in palliative care, clinicians' favored metoclopramide and haloperidol; however, after these choices, there was large variation in antiemetic selection. While most clinicians recommended modifying meal size and frequency, use of other nonpharmacological therapies was limited.
Chan, RJ, Webster, J, Phillips, J & Currow, DC 2014, 'The withdrawal of the Liverpool Care Pathway in the United Kingdom: what are the implications for Australia?', The Medical journal of Australia, vol. 200, no. 10, pp. 573-573.View/Download from: Publisher's site
Integrated care pathways are documents that outline the essential steps of multidisciplinary care in dealing with a specific clinical problem.1 They can be used to introduce best clinical practice, to ensure that the most appropriate management occurs at the most appropriate time, and that it is provided by the most appropriate health professional. By providing clear instructions, decision support and a framework for clinician–patient interactions, care pathways guide the systematic provision of best evidence-based care. The Liverpool Care Pathway for the Dying Patient (LCP) is an example of an integrated care pathway — it was designed in the United Kingdom in the 1990s to guide care for people with cancer who were in their last days of life and expected to die in hospital.2,3 This pathway evolved out of a recognised local need to better support non-specialist palliative care providers to care for patients dying of cancer in their inpatient units. Historically, despite the many people in acute care settings whose treatment intent was palliative,4 dying patients in these settings tended to receive insufficient attention from senior medical and nursing staff.5 As the quality of end-of-life care was considered inadequate, much could be learned from the way patients were cared for by palliative care services.5 The LCP was a strategy to improve this end-of-life care and was based on the care received by those dying in the palliative care setting.2,3
Phillips, JL, Lam, L, Luckett, T, Agar, M & Currow, D 2014, 'Is the Life Space Assessment applicable to a palliative care population? : A brief methodological report on its relationship to measures of performance and quality of life. Brief Methodological Report.', Journal of Pain and Symptom Management, vol. 47, no. 6, pp. 1121-1127.View/Download from: Publisher's site
The spatial environments that palliative care patients frequent for business and leisure constrict as their disease progresses and their physical functioning deteriorates. Measuring a persons movement within his or her own environment is a clinically relevant and patient-centered outcome because it measures function in a way that reflects actual and not theoretical participation.
Yee, J, Davis, GM, Beith, JM, Wilcken, N, Currow, D, Emery, J, Phillips, J, Martin, A, Hui, R, Harrison, M, Segelov, E & Kilbreath, SL 2014, 'Physical activity and fitness in women with metastatic breast cancer.', Journal of Cancer Survivorship, vol. 8, no. 4, pp. 647-656.View/Download from: Publisher's site
PURPOSE: This study aimed to explore differences in physical activity and fitness between women with metastatic breast cancer compared to healthy controls and factors associated with their physical activity levels. METHODS: Seventy-one women with metastatic breast cancer, aged (mean (SD)) 57.7 (9.5) and 2.9 (3.1) years after the onset of metastatic disease, and 71 healthy controls aged 55.0 (9.4) years participated. Of those with metastatic disease, 27% had bone-only metastases, 35% visceral-only metastases and 38% bone and visceral metastases. Patient-reported outcomes and physical measures of muscle strength and aerobic fitness assessments were obtained. Participants wore a SenseWear® physical activity monitor over 7 days, and the average steps/day and the time spent in moderate-to-vigorous intensity physical activity were determined. RESULTS: Women with metastases were significantly (i) less aerobically fit than the control group (25.3 (5.4) vs. 31.9 (6.1) mL • kg(-1) • min(-1); P < 0.001); (ii) weaker (e.g. lower limb strength for the metastatic and control groups was 53.5 (23.7) vs. 76.0 (27.4) kg, respectively; P < 0.001); (iii) less active, with the metastatic group attaining only 56% of the mean daily step counts of the healthy women; and (iv) more symptomatic, reporting higher levels of fatigue and dyspnoea (P < 0.001). CONCLUSION: Women living in the community with metastatic breast cancer possessed lower aerobic fitness, reduced muscular strength and less daily physical activity compared to healthy counterparts. They also experienced poorer functioning and higher symptom burden. IMPLICATIONS FOR CANCER SURVIVORS: Women living with metastatic breast cancer may benefit from a physical activity programme to address their physical impairments.
Disler, RT, Green, AR, Luckett, T, Newton, PJ, Inglis, S, Currow, D & Davidson, PM 2014, 'Experience of advanced chronic obstructive pulmonary disease: Metasynthesis of qualitative data.', Journal of Pain and Symptom Management, vol. 48, no. 6, pp. 1182-1199.View/Download from: Publisher's site
Context. Chronic obstructive pulmonary disease (COPD) is a life-limiting illness. Despite best available treatments, individuals continue to experience symptom burden and have high health-care utilization. Objectives. To increase understanding of the experience and ongoing needs of individuals living with COPD.
Lewis, J, DiGiacomo, M, Currow, DC & Davidson, PM 2014, 'Social capital in a lower socioeconomic palliative care population: a qualitative investigation of individual, community and civic networks and relations', BMC Palliative Care, vol. 13, no. 30, pp. 1-9.View/Download from: Publisher's site
The article reports findings from a qualitative investigation of the needs and experiences of palliative care patients and caregivers who are experiencing financial hardship or disadvantage. This article highlights the individual, community and civic networks and relations relevant to these experiences.
Abernethy, AP, Currow, DC, Shelby-James, T, Rowett, D, May, F, Samsa, GP, Hunt, R, Williams, H, Esterman, A & Phillips, PA 2013, 'Delivery Strategies to Optimize Resource Utilization and Performance Status for Patients With Advanced Life-Limiting Illness: Results From the "Palliative Care Trial" [ISRCTN 81117481]', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 45, no. 3, pp. 488-505.View/Download from: Publisher's site
Abernethy, AP, Nipp, RD, Currow, D, Cherny, N, Strasser, F & Zafar, Y 2013, 'Best supportive care (BSC) in published clinical trials.', Journal of Clinical Oncology, vol. 31, no. 15_suppl, pp. 9560-9560.View/Download from: Publisher's site
9560 Background: BSC as a control arm in clinical trials is poorly defined. A systematic review was conducted to evaluate clinical trial concordance with published, consensus-based framework for BSC delivery in trials. Methods: A consensus-based Delphi panel previously identified 4 key domains of BSC delivery in trials: multidisciplinary care; supportive care documentation; symptom assessment at least as often as the intervention arm; and guideline-based symptom management. A systematic review of trials including BSC control arms assessed BSC concordance to the consensus-based domains. Databases were searched from 2002-2012 using search strings: "cancer"; "best supportive care"; "randomized" or "random allocation"; and "supportive" or "palliative." Exclusion criteria were: no BSC arm, non-human trial, not randomized, not English, not advanced cancer, or not including anticancer therapy. Data were independently extracted by 2 reviewers and scored by 4 reviewers for conformance with consensus-based BSC framework. Results: 373 articles were retrieved, 17 retained after applying exclusion criteria. Overall, trials conformed to <18% of the consensus-based BSC standards. 35% of articles offered a detailed description of BSC. 65% reported baseline and regular symptom assessment, and 47% reported using validated symptom assessment measures. 35% reported symptom assessment at identical intervals in both experimental and BSC arms. None listed an evidence-based guideline for symptom management. None of the multicenter trials reported standardization of BSC across sites. No studies reported educating patients on symptom management or goals of anti-cancer therapy. No studies reported offering access to palliative care specialists, social workers, financial or spiritual counseling. Conclusions: Reporting of BSC in trials is incomplete, resulting in uncertain internal and external validity. Such poorly defined interventions and variation between si...
Abernethy, AP, Temel, JS, Currow, D, Gleich, LL & Friend, J 2013, 'Phase III clinical trials with anamorelin HCl, a novel oral treatment for NSCLC cachexia.', Journal of Clinical Oncology, vol. 31, no. 15_suppl, pp. TPS9649-TPS9649.View/Download from: Publisher's site
TPS9649 Background: Cancer anorexia/cachexia is a debilitating and life-threatening complication of an underlying malignancy that may develop in up to 80% of terminally ill cancer patients. Cancer cachexia has a multifactorial pathogenesis and is manifested by accelerated losses of skeletal muscle and disproportionate losses of lean body mass (LBM). Anamorelin HCl is a ghrelin receptor agonist that has demonstrated significant increases in LBM, physical strength, and body weight in Phase II trials in patients with cancer cachexia. Through its ghrelin and growth hormone secretagogue activity, it displays both anabolic and appetite stimulating properties – two aspects vital to treating cancer anorexia/cachexia. Methods: HT-ANAM-301 (NCT01387269) and HT-ANAM-302 (NCT01387282), also known as ROMANA 1 and ROMANA 2, are double-blind, placebo-controlled, randomized (2:1 anamorelin HCl vs. placebo) Phase III trials in patients with non-small cell lung cancer (NSCLC) cachexia. Eligible patients must have unresectable Stage III or IV NSCLC and cachexia (weight loss of ≥5% body weight within prior 6 months or BMI <20 kg/m2). Patients receive once daily oral doses of anamorelin HCl (100 mg) or placebo for 12 weeks. Co-primary endpoints are the change from baseline in LBM as measured by DXA and in muscle strength as measured by handgrip strength. Secondary endpoints include change in body weight, overall survival, and quality of life (FACIT-F and FAACT questionnaires). For HT-ANAM-301 only, blood samples are collected at Week 6 for population pharmacokinetics. After 12 weeks of treatment, patients may continue in a separate 12-week safety extension study (HT-ANAM-303 [ROMANA 3] NCT01395914). At their last meeting (August 2012), the Independent Data Monitoring Committee suggested no safety issue and allowed the trials to continue as planned. Clinical trial information: NCT01387269, NCT01387282, NCT01395914.
Burns, CM, Abernethy, AP, Dal Grande, E & Currow, DC 2013, 'Uncovering an invisible network of direct caregivers at the end of life: A population study', PALLIATIVE MEDICINE, vol. 27, no. 7, pp. 608-615.View/Download from: Publisher's site
Clark, K & Currow, DC 2013, 'A Pilot Study To Assess the Feasibility of Measuring the Prevalence of Slow Colon Transit or Evacuation Disorder in Palliative Care', JOURNAL OF PALLIATIVE MEDICINE, vol. 16, no. 5, pp. 542-545.View/Download from: Publisher's site
Clark, K & Currow, DC 2013, 'Constipation in Palliative Care: What Do We Use as Definitions and Outcome Measures?', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 45, no. 4, pp. 753-762.View/Download from: Publisher's site
Clark, K, Rowett, D, Robinson, M & Currow, DC 2013, 'Uptake of methylnaltrexone in Australian patients with opioid-induced constipation: a review of the number of prescriptions presented in the first 12 months of subsidisation.', BMJ Supportive and Palliative Care, vol. 3, no. 1, pp. 98-102.View/Download from: Publisher's site
BACKGROUND: Disturbed bowel habits are very common in palliative care patients, most commonly thought to be due to opioid use. The peripheral opioid-antagonist methylnaltrexone has been subsidised in Australia to ensure that palliative care patients have timely and equitable access to this medication. The aim of this paper is to describe the use of methylnaltrexone in the first year after it was subsidised for palliative care, in particular focusing on the actual use of this medication compared with predicted need. METHODS: The predicted need for methylnaltrexone was calculated using an epidemiological approach based on data collected by the Australian Institute of Health and Welfare to determine the number of Australian deaths annually. A single source of data was used to determine the number of patients who die while under the care of palliative services in Australia (National Census of Palliative Care Services, 1999). These figures allowed the number of people likely to be receiving opioids to be estimated and therefore the number who could potentially benefit from methylnaltrexone. RESULTS: The number of patients who might benefit was calculated to be 5000, which contrasts with the 261 actual prescriptions written for methylnaltrexone. Even more striking was the disparity between initial prescriptions and the 93 requests for ongoing use. CONCLUSIONS: These data highlight much lower use of methylnaltrexone than predicted and raise a number of questions including the fact that the palliative care literature emphasises opioids as the dominant cause of constipation in palliative care patients given little ongoing use of methylnaltrexone.
Clark, K, Sheehan, C & Currow, DC 2013, 'Letter to the Editor re "Four Essential Drugs Needed for Quality Care of the Dying: A Delphi-Study Based International Expert Consensus Opinion"', JOURNAL OF PALLIATIVE MEDICINE, vol. 16, no. 7, pp. 721-722.View/Download from: Publisher's site
Crane, M, Aranda, S, Stacey, I, Lafontaine, M, Scott, N, O'Hara, B & Currow, D 2013, 'AWARENESS ABOUT THE SIGNS AND SYMPTOMS OF LUNG CANCER IN AUSTRALIA, A MIXED METHODS STUDY', JOURNAL OF THORACIC ONCOLOGY, vol. 8, pp. S250-S251.
Homo sapiens probably reached Ulm in southern Germany
around 40 000 years ago, when the area offered plenty of good
mammoth hunting on the steppe between the Alpine ice mass
immediately to the south and the endless glacier that covered
Europe from about Hamburg northwards. The human population
of Ulm has changed a great deal since then, but one ancient
feature remains—Ulmians, like most people in Europe, are bad
at making vitamin D. In a study of 1418 older people living in
southern Germany, researchers investigated the seasonal
differences in vitamin D levels (Age and Ageing 2013; doi:10.
1093/ageing/aft042). They found that proportions of vitamin D
deficiency, insufficiency, and sufficiency were 78.8%, 19.2%,
and 1.9% in March 2009, respectively. Corresponding
proportions in August 2009 were 16.1%, 63.4%, and 20.5%,
respectively. Now that their supply of mammoth liver has dried
up, the people of Ulm may need to look to other sources to
remedy their lack of vitamin D
Currow, D & Temel, J 2013, 'ANAMORELIN HCL FOR THE TREATMENT OF ANOREXIA-CACHEXIA IN NSCLC: BASELINE CHARACTERISTICS OF PATIENTS IN THE PHASE III CLINICAL TRIAL ROMANA 2 (HT-ANAM-302)', JOURNAL OF THORACIC ONCOLOGY, vol. 8, pp. S1314-S1314.
Currow, D, Johnson, M, White, P & Abernethy, A 2013, 'Evidence-based intervention for chronic refractory breathlessness: practical therapies that make a difference', BRITISH JOURNAL OF GENERAL PRACTICE, vol. 63, no. 616, pp. 609-610.View/Download from: Publisher's site
Currow, DC 2013, 'Prescribing at the end of life', AUSTRALASIAN JOURNAL ON AGEING, vol. 32, pp. 6-6.
Currow, DC 2013, 'Symptom management in palliative care', AUSTRALASIAN JOURNAL ON AGEING, vol. 32, pp. 34-34.
Currow, DC & Abernethy, AP 2013, 'Five Years' Time and the Next Five Things for the List of Choosing Wisely', JOURNAL OF PALLIATIVE MEDICINE, vol. 16, no. 6, pp. 594-595.View/Download from: Publisher's site
Currow, DC, Clark, K, Mitchell, GK, Johnson, MJ & Abernethy, AP 2013, 'Prospectively Collected Characteristics of Adult Patients, Their Consultations and Outcomes as They Report Breathlessness When Presenting to General Practice in Australia', PLOS ONE, vol. 8, no. 9.View/Download from: Publisher's site
Currow, DC, Higginson, IJ & Johnson, MJ 2013, 'Breathlessness - current and emerging mechanisms, measurement and management: A discussion from an European Association of Palliative Care workshop', PALLIATIVE MEDICINE, vol. 27, no. 10, pp. 932-938.View/Download from: Publisher's site
Currow, DC, Quinn, S, Greene, A, Bull, J, Johnson, MJ & Abernethy, AP 2013, 'The Longitudinal Pattern of Response When Morphine Is Used To Treat Chronic Refractory Dyspnea', JOURNAL OF PALLIATIVE MEDICINE, vol. 16, no. 8, pp. 881-886.View/Download from: Publisher's site
Davidson, PM, Abernethy, AP, Newton, PJ, Clark, K & Currow, DC 2013, 'The caregiving perspective in heart failure: a population based study', BMC Health Services Research, vol. 13, no. 342.View/Download from: Publisher's site
Fazekas, B, Cutri, N & Currow, D 2013, 'AUDIT VERSUS ACTUAL RECRUITMENT IN PALLIATIVE CARE CLINICAL TRIALS', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, vol. 9, pp. 117-118.
Fazekas, B, Cutri, N, Devilee, L, Litster, C & Currow, D 2013, 'MONITORING CLINICAL STUDIES - IMPROVING QUALITY', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, vol. 9, pp. 109-109.
Girgis, A, Lambert, S, Johnson, C, Waller, A & Currow, D 2013, 'Physical, Psychosocial, Relationship, and Economic Burden of Caring for People With Cancer: A Review', JOURNAL OF ONCOLOGY PRACTICE, vol. 9, no. 4, pp. 197-202.View/Download from: Publisher's site
Johnson, MJ, Abernethy, AP & Currow, DC 2013, 'The Evidence Base for Oxygen for Chronic Refractory Breathlessness: Issues, Gaps, and a Future Work Plan', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 45, no. 4, pp. 763-775.View/Download from: Publisher's site
Johnson, MJ, Bland, JM, Oxberry, SG, Abernethy, AP & Currow, DC 2013, 'Clinically Important Differences in the Intensity of Chronic Refractory Breathlessness', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 46, no. 6, pp. 957-963.View/Download from: Publisher's site
Johnson, MJ, Bland, JM, Oxberry, SG, Abernethy, AP & Currow, DC 2013, 'Opioids for chronic refractory breathlessness: patient predictors of beneficial response', EUROPEAN RESPIRATORY JOURNAL, vol. 42, no. 3, pp. 758-766.View/Download from: Publisher's site
Kamal, AH, Currow, DC, Ritchie, CS, Bull, J & Abernethy, AP 2013, 'Community-Based Palliative Care: The Natural Evolution for Palliative Care Delivery in the US', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 46, no. 2, pp. 254-264.View/Download from: Publisher's site
Lafontaine, M, Crane, M, Scott, N, Kite, J, Dessaix, A & Currow, D 2013, 'PROMPTING EARLIER DIAGNOSIS OF LUNG CANCER: EVALUATION OF A PUBLIC EDUCATION CAMPAIGN IN NSW TO RAISE AWARENESS OF LUNG CANCER SYMPTOMS', JOURNAL OF THORACIC ONCOLOGY, vol. 8, pp. S1277-S1278.
LeBlanc, TW, Abernethy, AP, Currow, DC & Kutner, JS 2013, 'Considerations in reporting palliative care clinical trials: standardizing information reported and authorship practices (vol 6, pg 494, 2012)', CURRENT OPINION IN SUPPORTIVE AND PALLIATIVE CARE, vol. 7, no. 1, pp. 129-129.
LeBlanc, TW, Lodato, JE, Currow, DC & Abernethy, AP 2013, 'Overcoming Recruitment Challenges in Palliative Care Clinical Trials', JOURNAL OF ONCOLOGY PRACTICE, vol. 9, no. 6, pp. 277-282.View/Download from: Publisher's site
McNamara, BA, Rosenwax, LK, Murray, K & Currow, DC 2013, 'Early Admission to Community-Based Palliative Care Reduces Use of Emergency Departments in the Ninety Days before Death', JOURNAL OF PALLIATIVE MEDICINE, vol. 16, no. 7, pp. 774-779.View/Download from: Publisher's site
Nekolaichuk, CL, Fainsinger, RL, Aass, N, Hjermstad, MJ, Knudsen, AK, Klepstad, P, Currow, DC & Kaasa, S 2013, 'The Edmonton Classification System for Cancer Pain: Comparison of Pain Classification Features and Pain Intensity Across Diverse Palliative Care Settings in Eight Countries', JOURNAL OF PALLIATIVE MEDICINE, vol. 16, no. 5, pp. 516-523.View/Download from: Publisher's site
Ritchie, CS, Currow, DC, Abernethy, AP & Kutner, JS 2013, 'Multisite Studies Offer a Solution to Recruitment Challenges in Palliative Care Studies', JOURNAL OF PALLIATIVE MEDICINE, vol. 16, no. 3, pp. 225-225.View/Download from: Publisher's site
Sanderson, C, Hardy, J, Spruyt, O & Currow, DC 2013, 'Placebo and Nocebo Effects in Randomized Controlled Trials: The Implications for Research and Practice', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 46, no. 5, pp. 722-730.View/Download from: Publisher's site
Soeberg, M, You, H, Allemani, C, Bannon, F, Carreira, H, Harewood, R, Wang, X-S, Ahn, J, Currow, D & Coleman, M 2013, 'AUSTRALIAN DATA IN GLOBAL SURVEILLANCE OF POPULATION-BASED CANCER SURVIVAL (THE CONCORD PROGRAMME)', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, vol. 9, pp. 134-134.
Tait, PA, Gray, J, Hakendorf, P, Morris, B, Currow, DC & Rowett, DS 2013, 'Community pharmacists: a forgotten resource for palliative care', BMJ SUPPORTIVE & PALLIATIVE CARE, vol. 3, no. 4, pp. 436-443.View/Download from: Publisher's site
Tieman, J, Damarell, R, Sladek, R & Currow, D 2013, 'EFFECTIVE SEARCHING: EVIDENCE BASED SOLUTIONS', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, vol. 9, pp. 71-71.
van Zandwijk, N, Clarke, C, Henderson, D, Musk, AW, Fong, K, Nowak, A, Loneragan, R, McCaughan, B, Boyer, M, Feigen, M, Currow, D, Schofield, P, Ivimey, B, Pavlakis, N, McLean, J, Marshall, H, Leong, S, Keena, V & Penman, A 2013, 'Guidelines for the diagnosis and treatment of malignant pleural mesothelioma', JOURNAL OF THORACIC DISEASE, vol. 5, no. 6, pp. E254-E307.View/Download from: Publisher's site
Waller, A, Girgis, A, Davidson, PM, Newton, PJ, Lecathelinais, C, Macdonald, P, Hayward, C & Currow, D 2013, 'Facilitating needs-based support and palliative care for people with chronic heart failure: preliminary evidence for the acceptability, inter-rater reliability and validity of a needs assessment tool', Journal of Pain and Symptom Management, vol. 45, no. 5, pp. 912-925.View/Download from: Publisher's site
Context. Understanding the types and extent of need is critical to informing needs-based care for people with chronic heart failure (CHF). Objectives. To explore the psychometric quality of a newly developed rapid screening measure to assess the supportive and palliative care needs of people with CHF.
Wiseman, R, Rowett, D, Allcroft, P, Abernethy, A & Currow, D 2013, 'Chronic refractory dyspnoea Evidence based management', AUSTRALIAN FAMILY PHYSICIAN, vol. 42, no. 3, pp. 137-139.
Agar, M, Ko, DN, Sheehan, C, Chapman, M & Currow, DC 2013, 'Informed Consent in Palliative Care Clinical Trials: Challenging but Possible', JOURNAL OF PALLIATIVE MEDICINE, vol. 16, no. 5, pp. 485-491.View/Download from: Publisher's site
Agar, M, White, K & Currow, D 2013, 'FEASIBILITY OF MEASUREMENT OF FUNCTION IN ADVANCED CANCER: COMPARISON OF THE 6-MINUTE WALK TEST, 2-MINUTE WALK TEST, ISOMETRIC ARM EXERCISES AND READING NUMBERS ALOUD', JOURNAL OF THORACIC ONCOLOGY, vol. 8, pp. S423-S423.
Allcroft, P, Currow, D, Margitinovic, V, Greene, A, Agar, M, Clark, K & Abernethy, A 2013, 'THE ROLE OF BENZODIAZEPINES IN BREATHLESSNESS: A SINGLE-SITE, OPEN-LABEL, PILOT OF OPIOID SPARING ABILITY', RESPIROLOGY, vol. 18, pp. 57-57.
Allcroft, P, Margitanovic, V, Greene, A, Agar, MR, Clark, K, Abernethy, AP & Currow, DC 2013, 'The Role of Benzodiazepines in Breathlessness: A Single Site, Open Label Pilot of Sustained Release Morphine Together with Clonazepam', JOURNAL OF PALLIATIVE MEDICINE, vol. 16, no. 7, pp. 741-744.View/Download from: Publisher's site
Clark, K, Agar, MR & Currow, D 2013, 'Metoclopramide for chronic nausea in adult palliative care patients with advanced cancer', Cochrane Database of Systematic Reviews, vol. 2013, no. 11.View/Download from: Publisher's site
© 2013 The Cochrane Collaboration. This is the protocol for a review and there is no abstract. The objectives are as follows: To determine the efficacy of metoclopramide administered by any route to control the chronic nausea of cancer which is advanced as defined by the fact the cancer is no longer amenable to cure. Additionally, if the data permit: to identify which adverse reactions to the medication were documented, the doses at which they occurred and the characteristics of the affected people; the frequency with which adverse events occur; the duration of therapeutic response that could be expected.
Hardy, J, Quinn, S, Fazekas, B, Agar, M & Currow, D 2013, 'Can the LANSS scale be used to classify pain in chronic cancer pain trials?', SUPPORTIVE CARE IN CANCER, vol. 21, no. 12, pp. 3387-3391.View/Download from: Publisher's site
Hardy, J, Quinn, S, Fazekas, B, Eckermann, S, Agar, MR, Spruyt, O, Rowett, D & Currow, D 2013, 'Ketamine in the Management of Cancer Pain Reply', JOURNAL OF CLINICAL ONCOLOGY, vol. 31, no. 10, pp. 1375-1376.View/Download from: Publisher's site
McCaffrey, N, Agar, M, Harlum, J, Karnon, J, Currow, D & Eckermann, S 2013, 'Is home-based palliative care cost-effective? An economic evaluation of the Palliative Care Extended Packages at Home (PEACH) pilot', BMJ SUPPORTIVE & PALLIATIVE CARE, vol. 3, no. 4, pp. 431-435.View/Download from: Publisher's site
Nikles, J, Mitchell, GK, Hardy, J, Agar, M, Senior, H, Carmont, S-A, Schluter, PJ, Good, P, Vora, R & Currow, D 2013, 'Do pilocarpine drops help dry mouth in palliative care patients: a protocol for an aggregated series of n-of-1 trials', BMC PALLIATIVE CARE, vol. 12.View/Download from: Publisher's site
Senior, HE, Mitchell, GK, Nikles, J, Carmont, S-A, Schluter, PJ, Currow, DC, Vora, R, Yelland, MJ, Agar, M, Good, PD & Hardy, JR 2013, 'Using aggregated single patient (N-of-1) trials to determine the effectiveness of psychostimulants to reduce fatigue in advanced cancer patients: a rationale and protocol.', BMC palliative care, vol. 12, no. 1, pp. 17-17.View/Download from: Publisher's site
BACKGROUND: It is estimated that 29% of deaths in Australia are caused by malignant disease each year and can be expected to increase with population ageing. In advanced cancer, the prevalence of fatigue is high at 70-90%, and can be related to the disease and/or the treatment. The negative impact of fatigue on function (physical, mental, social and spiritual) and quality of life is substantial for many palliative patients as well as their families/carers. METHOD/DESIGN: This paper describes the design of single patient trials (n-of-1 s or SPTs) of a psychostimulant, methylphenidate hydrochloride (MPH) (5 mg bd), compared to placebo as a treatment for fatigue, with a population estimate of the benefit by the aggregation of multiple SPTs. Forty patients who have advanced cancer will be enrolled through specialist palliative care services in Australia. Patients will complete up to 3 cycles of treatment. Each cycle is 6 days long and has 3 days treatment and 3 days placebo. The order of treatment and placebo is randomly allocated for each cycle. The primary outcome is a reduction in fatigue severity as measured by the Functional Assessment of Cancer Therapy-fatigue subscale (FACIT-F). Secondary outcomes include adverse events, quality of life, additional fatigue assessments, depression and Australian Karnovsky Performance Scale. DISCUSSION: This study will provide high-level evidence using a novel methodological approach about the effectiveness of psychostimulants for cancer-related fatigue. If effective, the findings will guide clinical practice in reducing this prevalent condition to improve function and quality of life. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12609000794202.
To, THM, Agar, M, Shelby-James, T, Abernethy, AP, Doogue, M, Rowett, D, Ko, D & Currow, DC 2013, 'Off-label prescribing in palliative care - a cross-sectional national survey of Palliative Medicine doctors', PALLIATIVE MEDICINE, vol. 27, no. 4, pp. 320-328.View/Download from: Publisher's site
Breaden, K, Phillips, JL, Agar, M, Grbich, C, Abernethy, A & Currow, D 2013, 'The clinical and social dimension of prescribing home oxygen for the relief of refractory dyspnea', Journal Of Palliative Medicine, vol. 16, no. 3, pp. 268-273.View/Download from: Publisher's site
Background: Chronic breathlessness is a significant problem in palliative care and oxygen is often prescribed in an attempt to ameliorate it. Often, this prescription falls outside the current funding guidelines for long-term home oxygen use. The aim of this qualitative study was to understand the factors that most influence Australian specialist palliative care nurses' initiation of home oxygen for their patients. Methods: A series of focus groups were held across three states in Australia in 2011 involving specialist palliative care nurses. The invitation to the nurses was sent by e-mail through their national association. Recorded and transcribed data were coded for themes and subthemes. A summary, which included quotes, was provided to participants to confirm. Results: Fifty-one experienced palliative care nurses participated in seven focus groups held in three capital cities. Two major themes were identified: 1) logistic/health service issues (not reported in this paper as specific to the Australian context) involving the local context of prescribing and, 2) clinical care issues that involved assessing the patient's need for home oxygen and ongoing monitoring concerns. Palliative care nurses involved in initiating or prescribing oxygen often reported using oxygen as a second-line treatment after other interventions had been trialed and these had not provided sufficient symptomatic benefit. Safety issues were a universal concern and a person living alone did not emerge as a specific issue among the nurses interviewed. Conclusion: The role of oxygen is currently seen as a second-line therapy in refractory dyspnea by specialist palliative care nurses.
Crawford, G, Agar, M, Quinn, S, Phillips, JL, Litster, C, Michael, N, Doogue, M, Rowett, D & Currow, D 2013, 'Pharmacovigilance in hospice/palliative care. Net effect of haloperidol for delirium', Journal Of Palliative Medicine, vol. 16, no. 11, pp. 1335-1341.View/Download from: Publisher's site
Prescribing practice in hospice/palliative care is largely extrapolated from other areas of clinical practice, with few studies of net medication effects (benefits and harms) in hospice/palliative care to guide prescribing decisions. Hospice/palliative care patients differ in multiple ways from better studied participant groups, hence the applicability of studies in other participant groups is uncertain. Haloperidol, a butyrophenone derivative and dopamine antagonist, is commonly prescribed for nausea, vomiting, and delirium in hospice/palliative care. Its frequent use in delirium occurs despite little evidence of the effect of antipsychotics on the untreated course of delirium. The aim of this study was to examine the immediate and short-term clinical benefits and harms of haloperidol for delirium in hospice/palliative care patients. METHOD: A consecutive cohort of participants from 14 centers across four countries who had haloperidol commenced for delirium were recruited. Data were collected at three time points: baseline, 48 hours (clinical benefits), and day 10 (clinical harms). Investigators were also able to report clinical harms at any time up to 14 days after it was commenced. RESULTS: Of the 119 participants included, the average dose was 2.1?mg per 24 hours; 42 of 106 (35.2%) reported benefit at 48 hours. Harm was reported in 14 of 119 (12%) at 10 days, the most frequent being somnolence (n=11) and urinary retention (n=6). Seven participants had their medication ceased due to harms (2 for somnolence and 2 for rigidity). Approximately half (55/119) were still being treated with haloperidol after 10 days. CONCLUSION: Overall, 1 in 3 participants gained net clinical benefit at 10 days.
In parallel with the rapid development of oncology in Australia, palliative and supportive care has evolved rapidly. The sponsorship for such development was largely generated by oncology services in response to unmet needs that were encountered daily. Development of state, territory and national strategies has mirrored the professional development in service delivery, education (of existing practitioners and tomorrows clinicians) and research. More recently, national programs are delivering better outcomes for palliative care patients and their families, world-leading clinical research, improved access to essential medications in the community and the ability to access quality evidence to inform practice and policy. These initiatives provide a valuable foundation for continuing to improve access to high quality clinical care wherever people live.
Davis, GM, Beith, JM, Wilcken, N, Hui, R, Harrison, ML, Currow, D, Emery, J, Phillips, J, Martin, A, Segelov, E & Kilbreath, SL 2013, 'Physical activity and fitness in women with metastatic breast cancer.', J Clin Oncol, vol. 31, no. 26_suppl, p. 136.View/Download from: Publisher's site
136 Background: Women with metastatic breast cancer may survive for many years after disease onset, and there is little published evidence on their habitual levels of physical activity. The aim of this study was to investigate differences in physical activity levels and physical fitness between women with and without metastatic breast cancer. METHODS: Seventy-one women with metastatic breast cancer (METS) aged 57.7 ± 9.5 y and 2.9 ± 3.1 y after disease onset, and 71 healthy controls (CONTROLS) aged 55.0 ± 9.4 y participated. Of those with metastatic disease, 27% had metastases in bone only, 35% in viscera only and 38% in both bone and viscera. Strength was measured using hand and leg dynamometry, aerobic fitness using the Modified Canadian Aerobic Fitness Test, and fatigue with the FACT-Fatigue questionnaire. Participants wore a SenseWear physical activity armband over 6 days, and the average steps taken per day over 5 of these days, where there was a minimum wear time of 8 hours per day, was derived. RESULTS: METS possessed lower aerobic fitness than CONTROLS (25.3 ± 5.4 versus 31.9 ± 6.1 ml·kg·min(-1) respectively; p<0.01). METS were significantly weaker than CONTROLS. Lower limb strength for the METS and CONTROLS was 53.8 ± 23.7 versus 76.0 ± 27.4 kg and handgrip strength was 26.6 ± 6.0 versus 30.2 ± 6.4 kg. METS were also significantly less active, attaining only 57% of the daily step counts of CONTROLS. Fatigue was significantly higher in women with metastatic cancer compared to their healthy counterparts (38.0 ± 9.8 versus 46.3 ± 4.6; p<0.01). Correlation between fatigue with average steps per day (r=0.46), handgrip strength (r=0.29) and leg strength (r=0.26) was low in the METS group. CONCLUSIONS: Women living in the community with metastatic breast cancer are weaker, have lower aerobic fitness, and are relatively inactive compared to their healthy counterparts. Increased fatigue in these women is poorly associated with their decreased physical activity le...
Luckett, T, Davidson, PM, Lam, L, Phillips, JL, Currow, D & Agar, M 2013, 'Do Community Specialist Palliative Care Services That Provide Home Nursing Increase Rates of Home Death for People with Life-Limiting Illnesses? A Systematic Review and Meta-Analysis of Comparative Studies', Journal of Pain and Symptom Management, vol. 45, no. 2, pp. 279-297.View/Download from: Publisher's site
Context. Systematic reviews and meta-analyses suggest that community specialist palliative care services (SPCSs) can avoid hospitalizations and enable home deaths. But more information is needed regarding the relative efficacies of different models. Family caregivers highlight home nursing as the most important service, but it is also likely the most costly.
Lewis, J, DiGiacomo, M, Luckett, T, Davidson, PM & Currow, D 2013, 'A Social Capital Framework for Palliative Care: Supporting Health and Well-Being for People With Life-Limiting Illness and Their Carers Through Social Relations and Networks', Journal of Pain and Symptom Management, vol. 45, no. 1, pp. 92-103.View/Download from: Publisher's site
This paper summarizes the literature on social capital, well-being, and quality of life for key outcomes to inform a model of social capital in palliative care.
Clark, K & Currow, DC 2012, 'Re: Oral Docusate in the Management of Constipation in Hospice Patients', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 44, no. 6, pp. E6-E7.View/Download from: Publisher's site
Clark, K & Currow, DC 2012, 'Response to "A cross-sectional study of constipation and laxative use in advanced cancer patients: insights for revision of current practise"', SUPPORTIVE CARE IN CANCER, vol. 20, no. 12, pp. 3027-3028.View/Download from: Publisher's site
Clark, K, Byfieldt, N, Dawe, M & Currow, DC 2012, 'Treating Constipation in Palliative Care: The Impact of Other Factors Aside From Opioids', AMERICAN JOURNAL OF HOSPICE & PALLIATIVE MEDICINE, vol. 29, no. 2, pp. 122-125.View/Download from: Publisher's site
Clark, K, Smith, J, Lovell, M & Currow, DC 2012, 'Longitudinal Pain Reports in a Palliative Care Population', JOURNAL OF PALLIATIVE MEDICINE, vol. 15, no. 12, pp. 1335-1341.View/Download from: Publisher's site
Clark, K, Smith, JM & Currow, DC 2012, 'The Prevalence of Bowel Problems Reported in a Palliative Care Population', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 43, no. 6, pp. 993-1000.View/Download from: Publisher's site
Currow, DC & Abernethy, AP 2012, 'Breathlessness in an age of noncommunicable diseases', CURRENT OPINION IN SUPPORTIVE AND PALLIATIVE CARE, vol. 6, no. 2, pp. 127-128.View/Download from: Publisher's site
Currow, DC & Abernethy, AP 2012, 'The importance of publishing studies with negative results in palliative care', European Journal of Palliative Care, vol. 19, no. 4, pp. 186-190.
The minimisation of bias is the underpinning of rigorous research; the goal is to most closely approximate 'truth' in a reliable and reproducible way while simultaneously optimising the resources needed to reach the conclusion.
Currow, DC, Kutner, JS & Abernethy, AP 2012, 'Management of polypharmacy: can we safely discontinue medications?', AUSTRALIAN PRESCRIBER, vol. 35, no. 3, pp. 75-76.View/Download from: Publisher's site
Currow, DC, Plummer, JL, Kutner, JS, Samsa, GP & Abernethy, AP 2012, 'Analyzing Phase III Studies in Hospice/Palliative Care. A Solution That Sits Between Intention-to-Treat and Per Protocol Analyses: The Palliative-Modified ITT Analysis', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 44, no. 4, pp. 595-603.View/Download from: Publisher's site
Currow, DC, Rowett, D, Doogue, M, To, THM & Abernethy, AP 2012, 'An International Initiative To Create a Collaborative for Pharmacovigilance in Hospice and Palliative Care Clinical Practice', JOURNAL OF PALLIATIVE MEDICINE, vol. 15, no. 3, pp. 282-286.View/Download from: Publisher's site
Currow, DC, Samsa, GP & Abernethy, AP 2012, 'Understanding the Impact of Withdrawing From Phase III Studies in Palliative Care: Reply to Johnson et al.', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 44, no. 6, pp. E2-E4.View/Download from: Publisher's site
Currow, DC, Spruyt, O & Hardy, J 2012, 'Defining Refractory Pain in Cancer for Clinicians and Researchers', JOURNAL OF PALLIATIVE MEDICINE, vol. 15, no. 1, pp. 5-6.View/Download from: Publisher's site
Currow, DC, Tieman, JJ, Greene, A, Zafar, SY, Wheeler, JL & Abernethy, AP 2012, 'Refining a Checklist for Reporting Patient Populations and Service Characteristics in Hospice and Palliative Care Research', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 43, no. 5, pp. 902-910.View/Download from: Publisher's site
Currow, DC, Vella-Brincat, J, Fazekas, B, Clark, K, Doogue, M & Rowett, D 2012, 'Pharmacovigilance in Hospice/Palliative Care: Rapid Report of Net Clinical Effect of Metoclopramide', JOURNAL OF PALLIATIVE MEDICINE, vol. 15, no. 10, pp. 1071-1075.View/Download from: Publisher's site
Dear, RF, Barratt, AL, Askie, LM, Butow, PN, McGeechan, K, Crossing, S, Currow, DC & Tattersall, MHN 2012, 'Impact of a cancer clinical trials web site on discussions about trial participation: a cluster randomized trial', ANNALS OF ONCOLOGY, vol. 23, no. 7, pp. 1912-1918.View/Download from: Publisher's site
Girgis, A, Abernethy, AP & Currow, DC 2012, 'Caring for people at the end of life: How do cancer caregivers differ from other caregivers?', Journal of Clinical Oncology, vol. 30, no. 15_suppl, pp. 9128-9128.View/Download from: Publisher's site
9128 Background: The size of the population in receipt of cancer care is growing as the population ages and grows, with many receiving outpatient care, living for longer and wishing to be cared for at home. Hence, cancer is now one of the most common health conditions in receipt of informal care giving. Methods: The South Australian Health Omnibus is an annual, face-to-face, cross-sectional, whole-of-population, multi-stage, systematic area sampling survey which seeks a minimum of 3,000 respondents each year state-wide. From 2000-2007, questions about end of life were asked. This study compares people who cared for someone with cancer until death (cancer caregivers) with caregivers of people with other life limiting illnesses (non-cancer caregivers). Results: 4,665/14,624 (31.9%; participation rate 71.6%) had someone close to them die from an "expected" death in the 5 years prior to being surveyed. One in 10 (10%; 1,504/14,624) provided hands-on (day-to-day or intermittent) care; the majority (79.5%) having cared for someone with cancer. Compared to non-cancer caregivers, cancer caregivers cared for someone who was significantly younger (mean age 66 vs 74 years; p<0.0001), and to have had a palliative care service involved in the care of that person (64.9% vs 39%; p=0.000). Whilst not statistically significant, cancer caregivers were somewhat less likely to be the spouse of the person they cared for (11.8% vs 16.8%); more likely to be of non-English speaking background (11% vs 7.5%); more likely to report that the deceased was comfortable in the last 2 weeks of life (44.1% vs 31.7%); and prepared to care again for someone with a life-limiting illness (81.3% vs 71.4%). Conclusions: Caring for someone with cancer at the end of life appears to be fundamentally different to other caregiver populations, particularly in relation to age of, and relationship to, the patient, which may contribute to their substantially greater utilisation of ...
Girgis, A, Lambert, SD, Johnson, C & Currow, D 2012, 'APPLYING AN EVIDENCE-BASED APPROACH TO DEVELOPMENT AND EVALUATION OF RESOURCES FOR FAMILIES FACING ADVANCED CANCER: LESSONS LEARNED FROM THE 'CONSUMER TOOLKIT'', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, vol. 8, pp. 232-232.
Greene, A, Aranda, S, Tieman, JJ, Fazekas, B & Currow, DC 2012, 'Can assessing caregiver needs and activating community networks improve caregiver-defined outcomes? A single-blind, quasi-experimental pilot study: Community facilitator pilot', PALLIATIVE MEDICINE, vol. 26, no. 7, pp. 917-923.View/Download from: Publisher's site
Harrington, A, Mitchell, P, Jones, J, Swetenham, K & Currow, D 2012, 'Transition to an in-patient palliative care unit: carers share their experiences.', International Journal of Palliative Nursing, vol. 18, no. 11, pp. 548-552.View/Download from: Publisher's site
BACKGROUND: For a carer, transitioning the care of a person who is dying to others may be a challenging experience. At this time, more than any other, carers' experiences need to be understood. The emotional impact of care transitions may have clinical significance for both carers and those they care for. AIM: To explore carers experiences of the transition of the person they were caring for to in-patient care. METHOD: Carers reflected on their. experiences through an explorative/descriptive research methodology. RESULTS: Feelings of guilt and relief figured prominently in the participants' discourses. CONCLUSIONS: Prominent feelings of guilt and relief overshadowed the participants' experiences of transitioning care. This finding needs to be considered by care providers.
Hjermstad, MJ, Lie, HC, Caraceni, A, Currow, DC, Fainsinger, RL, Gundersen, OE, Haugen, DF, Heitzer, E, Radbruch, L, Stone, PC, Strasser, F, Kaasa, S & Loge, JH 2012, 'Computer-Based Symptom Assessment Is Feasible in Patients With Advanced Cancer: Results From an International Multicenter Study, the EPCRC-CSA', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 44, no. 5, pp. 639-654.View/Download from: Publisher's site
Johnson, MJ, Abernethy, AP & Currow, DC 2012, 'Gaps in the Evidence Base of Opioids for Refractory Breathlessness. A Future Work Plan?', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 43, no. 3, pp. 614-624.View/Download from: Publisher's site
Johnson, MJ, Bowden, JA, Abernethy, AP & Currow, DC 2012, 'To What Causes Do People Attribute Their Chronic Breathlessness? A Population Survey', JOURNAL OF PALLIATIVE MEDICINE, vol. 15, no. 7, pp. 744-750.View/Download from: Publisher's site
Kamal, AH, Miriovsky, BJ, Currow, DC & Abernethy, AP 2012, 'Improving the management of dyspnea in the community using rapid learning approaches', CHRONIC RESPIRATORY DISEASE, vol. 9, no. 1, pp. 51-61.View/Download from: Publisher's site
LeBlanc, TW, Abernethy, AP, Currow, DC & Kutner, JS 2012, 'Considerations in reporting palliative care clinical trials: standardizing information reported and authorship practices', CURRENT OPINION IN SUPPORTIVE AND PALLIATIVE CARE, vol. 6, no. 4, pp. 494-499.View/Download from: Publisher's site
McConigley, R, Aoun, S, Kristjanson, L, Colyer, S, Deas, K, O'Connor, M, Harris, R, Currow, D & Yates, P 2012, 'Implementation and evaluation of an education program to guide palliative care for people with motor neurone disease', PALLIATIVE MEDICINE, vol. 26, no. 8, pp. 994-1000.View/Download from: Publisher's site
Rowett, DS, Clark, K, Robinson, MK & Currow, DC 2012, 'Subsidised use of methylnaltrexone in Australia for palliative care', MEDICAL JOURNAL OF AUSTRALIA, vol. 197, no. 9, pp. 492-492.View/Download from: Publisher's site
Shelby-James, TM, Butow, P, Davison, G & Currow, DC 2012, 'Case conferences in palliative care A substudy of a cluster randomised controlled trial', AUSTRALIAN FAMILY PHYSICIAN, vol. 41, no. 8, pp. 608-612.
To, THM, Clark, K, Lam, L, Shelby-James, T & Currow, DC 2012, 'The Role of Ondansetron in the Management of Cholestatic or Uremic Pruritusd-A Systematic Review', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 44, no. 5, pp. 725-730.View/Download from: Publisher's site
To, THM, Ong, WY, Rawlings, D, Greene, A & Currow, DC 2012, 'The Disparity between Patient and Nurse Symptom Rating in a Hospice Population', JOURNAL OF PALLIATIVE MEDICINE, vol. 15, no. 5, pp. 542-547.View/Download from: Publisher's site
Toye, C, Abbey, J, Currow, D, Hegarty, M, Holloway, K & Tieman, J 2012, 'Community aged care: guidelines for a palliative approach', AUSTRALASIAN JOURNAL ON AGEING, vol. 31, pp. 67-67.
Toye, C, Blackwell, S, Maher, S, Currow, DC, Holloway, K, Tieman, J & Hegarty, M 2012, 'Guidelines for a palliative approach for aged care in the community setting: A suite of resources', Australasian Medical Journal, vol. 5, no. 11, pp. 569-574.View/Download from: Publisher's site
In Australia, many people ageing in their own homes are becoming increasingly frail and unwell, approaching the end of life. A palliative approach, which adheres to palliative care principles, is often appropriate. These principles provide a framework for proactive and holistic care in which quality of life and of dying is prioritised, as is support for families. A palliative approach can be delivered by the general practitioner working with the community aged care team, in collaboration with family carers. Support from specialist palliative care services is available if necessary. The Guidelines for a Palliative Approach for Aged Care in the Community Setting were published by the Australian Government Department of Health and Ageing to inform practice in this area. There are three resource documents. The main document provides practical evidence based guidelines, good practice points, tools, and links to resources. This document is written for general practitioners, nurses, social workers, therapists, pastoral care workers, and other health professionals and responded to needs identified during national consultation. Evidence based guidelines were underpinned by systematic reviews of the research literature. Good practice points were developed from literature reviews and expert opinion. Two 'plain English' booklets were developed in a process involving consumer consultation; one is for older people and their families, the other for care workers. The resources are intended to facilitate home care that acknowledges and plans for the client's deteriorating functional trajectory and inevitable death. At a time when hospitals and residential aged care facilities are under enormous pressure as the population ages, such a planned approach makes sense for the health system as a whole. The approach also makes sense for older people who wish to die in their own homes. Family needs are recognised and addressed. Unnecessary hospitalisations or residential placements and cl...
Tracey, EA, Roder, DM & Currow, DC 2012, 'What factors affect the odds of NSW cancer patients presenting with localised as opposed to more advanced cancer?', CANCER CAUSES & CONTROL, vol. 23, no. 2, pp. 255-262.View/Download from: Publisher's site
Uronis, HE, Shelby, RA, Currow, DC, Ahmedzai, SH, Bosworth, HB, Coan, A & Abernethy, AP 2012, 'Assessment of the Psychometric Properties of an English Version of the Cancer Dyspnea Scale in People With Advanced Lung Cancer', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 44, no. 5, pp. 741-749.View/Download from: Publisher's site
Wheeler, JL, Greene, A, Tieman, JJ, Abernethy, AP & Currow, DC 2012, 'Key Characteristics of Palliative Care Studies Reported in the Specialized Literature', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 43, no. 6, pp. 987-992.View/Download from: Publisher's site
Zafar, SY, Currow, DC, Cherny, N, Strasser, F, Fowler, R & Abernethy, AP 2012, 'Consensus-based standards for best supportive care in clinical trials in advanced cancer.', Lancet Oncology, vol. 13, no. 2, pp. e77-e82.View/Download from: Publisher's site
Best supportive care is poorly defined in clinical trials, and a standard framework for delivery of such care is needed, using best available evidence and allowing replication of studies. We convened a panel of 36 experts to develop consensus statements via the Delphi method. The first round included open-ended questions; subsequent rounds sought to develop consensus-based standards. Consensus was assessed by use of a 5-point Likert agreement scale; more than 70% of panellists had to give a score of 5 to meet a-priori levels of consensus. The panel identified four key domains of best supportive care in clinical trials: multidisciplinary care; supportive care documentation; symptom assessment; and symptom management. Consensus was reached on 11 statements within these four domains. For example, 24 (96%) panellists recommended that the intervals between symptom assessments should be identical for control and experimental groups. Availability of resources was cited as a challenge to implementation of best supportive care standards.
Waller, A, Girgis, A, Johnson, C, Lecathelinais, C, Sibbritt, D, Forstner, D, Liauw, W & Currow, DC 2012, 'Improving Outcomes for People With Progressive Cancer: Interrupted Time Series Trial of a Needs Assessment Intervention', Journal of Pain and Symptom Management, vol. 43, no. 3, pp. 569-581.View/Download from: Publisher's site
Waller, A, Girgis, A, Johnson, C, Lecathelinais, C, Sibbritt, D, Seldon, M, Bonaventura, T, Currow, D & Palliative Care Research Program Team 2012, 'Implications of a needs assessment intervention for people with progressive cancer: Impact on clinical assessment, response and service utlisation.', Psycho-oncology, vol. 21, no. 5, pp. 550-557.View/Download from: Publisher's site
To assess the impact of the systematic use of the Palliative Care Needs Assessment Guidelines and Needs Assessment Tool: Progressive Disease - Cancer (NAT: PD-C) on clinical assessment, response and service utilisation.
Currow, DC, Clark, K, Cartmill, J, Pather, S, Plummer, J, Eckermann, S, Abernethy, AP, Agar, M & Quinn, S 2012, 'A multi-site, fixed dose, parallel arm, double-blind, placebo controlled, block randomised trial of the addition of infusional octreotide or placebo to regular ranitidine and dexamethasone for the evaluation of vomiting associated with bowel obstruction at the end of life.', Journal of Clinical Oncology, vol. 30, no. 15_suppl, pp. TPS9153-TPS9153.View/Download from: Publisher's site
TPS9153 Background: Bowel obstruction due to advanced cancer that is surgically inoperable is a major management problem. Studies to date have either been underpowered or have used comparators that may not draw on the best available evidence. Methods: This double-blind, block randomised, placebo controlled, set dose, parallel arm study was conducted across 12 sites in Australia. Eligibility included inoperable bowel obstruction secondary to cancer or its treatments. The intervention was the addition of infusional octreotide or placebo in addition to 200mg ranitidine per 24 hours parenterally and 4mg per 24 hours parenterally of dexamethasone. The primary outcome measure was the numbers of days free of vomiting up to 72 hours after all medications were administered the first time. Participants were also administered between 10-20mls per hour of subcutaneous isotonic fluid over the 72 hour period. Results: This study will close to recruitment in March 2012. To date 89 of 92 required participants have been randomised. Conclusions: This adequately powered study will define the additional net clinical benefit derived from octreotide over placebo in people who have an anti-secretary agent (ranitidine) and glucocorticoids (dexamethasone).
Currow, DC, Hardy, J, Quinn, S, Fazekas, B, Plummer, J, Eckermann, S, Agar, M, Spruyt, O & Debra, R 2012, 'A randomized, double-blind, placebo-controlled study to assess the efficacy and toxicity of subcutaneous ketamine in the management of cancer pain.', Journal of Clinical Oncology, vol. 30, no. 15_suppl, pp. 2604-2604.View/Download from: Publisher's site
2604 Background: The dissociative anaesthetic ketamine is widely used for cancer related pain. A Cochrane review concluded that insufficient evidence was available to support its use in this setting. Methods: This phase III, multisite, double-blind, dose escalation, placebo, randomised controlled study aimed to determine whether ketamine, delivered subcutaneously over three to five days is more effective than placebo, when used in conjunction with adjuvant therapy in the management of chronic uncontrolled cancer pain. Ketamine would be considered to be of net benefit if it provided a reduction in average pain scores by ≥2/10 points from baseline, with limited breakthrough analgesia and acceptable toxicity. Results: For the 185 participants, there was no significant difference between the proportion of positive outcomes (0.04 (-0.10, 0.18) p=0.55) in the placebo and intervention arms (response rates 27% (25/92) and 31% (29/93)). Pain type (nociceptive versus neuropathic) was not a predictor of response. There was almost twice the incidence of adverse events worse than baseline in the ketamine group after day 1 (IRR = 1.95 (1.46, 2.61), p<0.001) and throughout the study. Those receiving ketamine were more likely to experience a more severe grade of adverse event/day (OR=1.09 (1.00, 1.18), p=0.039). The number needed to treat for one additional patient to get a positive outcome from ketamine was 25 (6, ∞). The number needed to harm, because of toxicity-related withdrawal was 6 (4, 13). Conclusions: Ketamine does not have net clinical benefit when used as an adjunct to opioids and standard co-analgesics in cancer pain.
Hardy, J, Quinn, S, Fazekas, B, Plummer, J, Eckermann, S, Agar, M, Spruyt, O, Rowett, D & Currow, D 2012, 'A Randomized, Double-Blind, Placebo-Controlled Study to Assess the Efficacy and Toxicity of Subcutaneous Ketamine in the Management of Cancer Pain', JOURNAL OF PALLIATIVE CARE, vol. 28, no. 3, pp. 202-202.
Hardy, J, Quinn, S, Fazekas, B, Plummer, J, Eckermann, S, Agar, M, Spruyt, O, Rowett, D & Currow, DC 2012, 'Randomized, Double-Blind, Placebo-Controlled Study to Assess the Efficacy and Toxicity of Subcutaneous Ketamine in the Management of Cancer Pain', JOURNAL OF CLINICAL ONCOLOGY, vol. 30, no. 29, pp. 3611-3617.View/Download from: Publisher's site
Sheehan, C, Agar, M & Currow, DC 2012, 'End-of-Life Research: Do We Need To Build Proxy Consent into All Clinical Trial Protocols Studying the Terminal Phase?', JOURNAL OF PALLIATIVE MEDICINE, vol. 15, no. 9, pp. 962-962.View/Download from: Publisher's site
Thm, T, Agar, M, Shelby-James, T, Abernethy, A, Doogue, M, Rowett, D & Currow, DC 2012, 'Off-Label Prescribing in Palliative Care: A Cross-sectional National Survey of Australian Palliative Medicine Doctors', JOURNAL OF PALLIATIVE CARE, vol. 28, no. 3, pp. 189-190.
White, K, Agar, M & Currow, D 2012, 'FEASIBILITY OF MEASUREMENT OF FUNCTION IN ADVANCED CANCER: COMPARISON OF THE 6-MINUTE WALK TEST, 2-MINUTE WALK TEST, ISOMETRIC ARM EXERCISES AND READING NUMBERS ALOUD', JOURNAL OF THORACIC ONCOLOGY, vol. 7, no. 9, pp. S187-S188.
Kamal, AH, Maguire, JM, Wheeler, JL, Currow, DC & Abernethy, AP 2012, 'Dyspnea Review for the Palliative Care Professional: Treatment Goals and Therapeutic Options', JOURNAL OF PALLIATIVE MEDICINE, vol. 15, no. 1, pp. 106-114.View/Download from: Publisher's site
Shelby-James, TM, Hardy, J, Agar, M, Yates, P, Mitchell, G, Sanderson, C, Luckett, T, Abernethy, AP & Currow, DC 2012, 'Designing and conducting randomized controlled trials in palliative care: A summary of discussions from the 2010 clinical research forum of the Australian Palliative Care Clinical Studies Collaborative', PALLIATIVE MEDICINE, vol. 26, no. 8, pp. 1042-1047.View/Download from: Publisher's site
Agar, M, Draper, B, Phillips, JL, Collier, A, Harlum, J, Currow, D & Phillips, PA 2012, 'Making decisions about delirium: a qualitative comparison of decision making between nurses working in palliative care, aged care, aged care psychiatry, and oncology.', Palliative Medicine, vol. 26, no. 7, pp. 887-896.View/Download from: Publisher's site
Background: Delirium has a significant impact on nursing practice from diagnosis and management, with under-detection and variable management of delirium being international problems. This study aimed to explore nurses' assessment and management of delirium when caring for people with cancer, the elderly or older people requiring psychiatric care in the inpatient setting. Methods: Participants in this qualitative study were nurses working in Australian public hospital inpatient dedicated units in palliative care, aged care (geriatrics), aged care (geriatric) psychiatry and oncology. Semi-structured interviews were used to explore nurses' views about specific areas of delirium assessment and management. Purposive sampling was used and interviews conducted until thematic saturation reached. A thematic content analysis was performed from a grounded theory perspective. Results: A total of 40 participants were included in the study. The analysis revealed four broad analytical themes: (1) superficial recognition and understanding of the operational definition of delirium or recognition of delirium as a syndrome; (2) nursing assessment: investigative versus a problem solving approach; (3) management: maintaining dignity and minimizing chaos; and (4) distress and the effect on others. Discussion: Nurses have limited knowledge of the features of delirium regardless of their specialty discipline. Delirium was uniformly identified as a highly distressing experience for patients, families and staff alike. The majority of nurses had a superficial understanding of delirium management, and adopted a task-orientated approach aimed at addressing the more noticeable problems. These findings have implications for both education and knowledge translation. Innovative approaches are needed to align health professional behaviours with best evidence delirium care.
Disler, RT, Currow, DC, Phillips, JL, Davidson, PM, Johnson, MJ & Smith, T 2012, 'Interventions to support a palliative care approach in patients with chronic obstructive pulmonary disease: An integrative review.', International Journal of Nursing Studies, vol. 49, no. 11, pp. 1443-1458.View/Download from: Publisher's site
End-stage chronic obstructive pulmonary disease (COPD) is a debilitating, life-limiting condition. A palliative approach is appropriate for individuals with end-stage COPD, yet currently few interventions embrace this holistic, multidisciplinary and inclusive perspective.
Disler, R, Inglis, SC, Currow, DC & Davidson, PM 2012, 'Palliative and Supportive Care in Chronic Obstructive Pulmonary Disease: Research Priorities to Decrease Suffering', Open Access Scientific Reports, vol. 1, no. 6, pp. 1-3.View/Download from: Publisher's site
Chronic obstructive pulmonary disease (COPD) affects 80 million people worldwide, is the fourth most prevalent
cause of death globally and accounts for 3.5% of total years lost due to disability. Despite the similarities with
malignant disease, many individuals suffer unnecessarily and continue to have limited access to palliative and endof-life
care. Changing this will require a shift in focus and approach as well as support for clinical decision making.
Lack of communication regarding care plans and prognosis and coordination across care settings has been identified
as barriers to end-of-life care. Research specifically should focus on improving the use of comprehensive and
collaborative approaches to end-stage COPD care such as those illustrated in the Chronic Care Model which has
demonstrated improved outcomes for chronic conditions. Revision of funding models and workforce organisation,
aided by clinical pathways may improve end of life care for COPD.
Disler, RT, Green, AR, Luckett, T, Newton, PJ, Inglis, S, Currow, D & Davidson, PM 2012, 'Unmet needs in chronic obstructive pulmonary disease: a metasynthesis protocol', International Journal of Research in Nursing, vol. 3, no. 1, pp. 15-20.View/Download from: Publisher's site
Abstract: Problem statement: Chronic obstructive pulmonary disease is a chronic progressive illness. Despite the high burden experienced by individuals in the advanced stages of illness, individuals with advanced COPD continue to have unmet needs and limited access to palliative care. This Metasynthesis seeks to describe: the barriers and facilitators care access and provision; the unmet needs of individuals with advanced COPD, their families and carers; and the experiences of health professionals. Data sources: Medline, PsychINFO, AMED, CINAHL and Sociological Abstracts were searched for articles published between 1990 and December 31st 2011. Medical Subject Headings (MeSH) and key words will be used to guide the search. The strategy will be reviewed by the CareSearch palliative knowledge network and a health informatics expert. Approach: Metasyntheses are increasingly used to gain new insights and understandings of complex research questions through the amalgamation of data from individual qualitative studies. The principles of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and thematic synthesis will be used to achieve consistent reporting and transparency of methods. Results: Inclusion of studies, quality assessment and allocation of free codes into EPPI-Reviewer 4 software will be carried out by two independent investigators. Auditing of random cases will be undertaken and disagreements resolved through group discussion of an expert panel. Descriptive and analytical themes will be developed through thematic synthesis and expert panel discussion. Conclusion: Qualitative data provide useful information in understanding the individual's unique experience. Combining discrete qualitative studies provides an important opportunity to provide a voice to patients, their families and professional careers in managing advanced COPD.
Currow, D, Allingham, S, Bird, S, Yates, P, Lewis, J, Dawber, J & Eagar, K 2012, 'Referral patterns and proximity to palliative care inpatient services by level of socio-economic disadvantage. A national study using spatial analysis', BMC Health Services Research, vol. 12, no. 424, pp. 1-14.View/Download from: Publisher's site
A range of health outcomes at a population level are related to differences in levels of social disadvantage. Understanding the impact of any such differences in palliative care is important. The aim of this study was to assess, by level of socio-economic disadvantage, referral patterns to specialist palliative care and proximity to inpatient services. This study examined all inpatient and community palliative care services nationally were geocoded (using postcode) to one nationally standardised measure of socio-economic deprivation Socio-Economic Index for Areas (SEIFA; 2006 census data). Referral to palliative care services and characteristics of referrals were described through data collected routinely at clinical encounters. Inpatient location was measured from each person's home postcode, and stratified by socio-economic disadvantage. This study covered July-December 2009 with data from 10,064 patients. People from the highest SEIFA group (least disadvantaged) were significantly less likely to be referred to a specialist palliative care service, likely to be referred closer to death and to have more episodes of inpatient care for longer time. Physical proximity of a persons home to inpatient care showed a gradient with increasing distance by decreasing levels of socio-economic advantage. These data suggest that a simple relationship of low socioeconomic status and poor access to a referral-based specialty such as palliative care does not exist. Different patterns of referral and hence different patterns of care emerge.
Abernethy, AP & Currow, DC 2011, 'Patient self-reporting in palliative care using information technology: Yes, there is hope!', Palliat Med, vol. 25, no. 7, pp. 673-674.View/Download from: Publisher's site
Abernethy, AP, Currow, D, Cherny, N, Strasser, F, Fowler, R & Zafar, Y 2011, 'Consensus-based standards for best supportive care in cancer clinical trials.', Journal of Clinical Oncology, vol. 29, no. 15_suppl, pp. e19507-e19507.View/Download from: Publisher's site
Burns, CM, Abernethy, AP, Leblanc, TW & Currow, DC 2011, 'What is the role of friends when contributing care at the end of life? Findings from an Australian population study.', Psychooncology, vol. 20, no. 2, pp. 203-212.View/Download from: Publisher's site
PURPOSE: To examine the role of friends as caregivers of people with terminal illness. METHOD: Piloted questions were included in the 2001-2007 random face-to-face annual health surveys of 23588 South Australians on the death of a loved one, caregiving provided, and characteristics of the caregiver and deceased individual. The survey was representative of the population by age, gender, and region of residence. Analyses focused on friends of the deceased loved one, providing daily or intermittent 'hands on' care. Logistic regression assessed predictors of home death. RESULTS: Daily 'hands on' carers were much more likely to be female and aged between 55 and 64; there was also a younger (12 months. Home deaths were more frequent (32%, p=0.014) when friends were carers, and the rate of palliative care use was higher than when family/others provided care (70 vs 61%). Regression analyses confirmed friends as caregivers as a predictor of home death (OR 1.73: 95%, CI 1.15-2.87). CONCLUSION: Friends contribute their caregiving: A cohort of younger caregivers may reflect changing social mores as the extended family shrinks and people turn to friendship networks for care and support at the end of life.
Clark, K & Currow, DC 2011, 'Plain Abdominal Radiographs to Diagnose Constipation Patients with Advanced Progressive Illness?', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 41, no. 4, pp. E2-E4.View/Download from: Publisher's site
Clark, K, Girgis, A & Currow, DC 2011, 'Palliative care of people with oesophageal cancer', Cancer Forum, vol. 35, no. 3, pp. 175-179.
Palliative management of patients with incurable oesophageal cancer necessitates a broad spectrum of measures to relieve symptoms. Symptoms include those generated by the direct effects of disease (dysphagia due to local tumour burden) and the systemic effects of advanced cancer. Aggressive surgical treatments are rarely indicated for locally advanced disease because of the high associated morbidity and mortality. Interventions are aimed at eliminating dysphagia with options including stenting and tumour-specific treatments. Likewise, systemic disease responds in a limited way to aggressive therapy. The aim of all therapy (disease-modifying or direct symptom measures) is to optimise levels of function and comfort in the face of advancing disease. The choice of interventions depends upon the symptoms experienced, the overall functional status of the person, the estimated prognosis of the person, the sites of disease spread and the patient's preference. Palliative management requires a multidisciplinary approach including the active engagement of the patient's general practitioner.
Clark, K, Lam, L & Currow, D 2011, 'Exploring the Relationship Between the Frequency of Documented Bowel Movements and Prescribed Laxatives in Hospitalized Palliative Care Patients', AMERICAN JOURNAL OF HOSPICE & PALLIATIVE MEDICINE, vol. 28, no. 4, pp. 258-263.View/Download from: Publisher's site
Coleman, MP, Forman, D, Bryant, H, Butler, J, Rachet, B, Maringe, C, Nur, U, Tracey, E, Coory, M, Hatcher, J, McGahan, CE, Turner, D, Marrett, L, Gjerstorff, ML, Johannesen, TB, Adolfsson, J, Lambe, M, Lawrence, G, Meechan, D, Morris, EJ, Middleton, R, Steward, J, Richards, MA & ICBP Module 1 Working Group 2011, 'Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995-2007 (the International Cancer Benchmarking Partnership): an analysis of population-based cancer registry data.', Lancet, vol. 377, no. 9760, pp. 127-138.View/Download from: Publisher's site
BACKGROUND: Cancer survival is a key measure of the effectiveness of health-care systems. Persistent regional and international differences in survival represent many avoidable deaths. Differences in survival have prompted or guided cancer control strategies. This is the first study in a programme to investigate international survival disparities, with the aim of informing health policy to raise standards and reduce inequalities in survival. METHODS: Data from population-based cancer registries in 12 jurisdictions in six countries were provided for 2·4 million adults diagnosed with primary colorectal, lung, breast (women), or ovarian cancer during 1995-2007, with follow-up to Dec 31, 2007. Data quality control and analyses were done centrally with a common protocol, overseen by external experts. We estimated 1-year and 5-year relative survival, constructing 252 complete life tables to control for background mortality by age, sex, and calendar year. We report age-specific and age-standardised relative survival at 1 and 5 years, and 5-year survival conditional on survival to the first anniversary of diagnosis. We also examined incidence and mortality trends during 1985-2005. FINDINGS: Relative survival improved during 1995-2007 for all four cancers in all jurisdictions. Survival was persistently higher in Australia, Canada, and Sweden, intermediate in Norway, and lower in Denmark, England, Northern Ireland, and Wales, particularly in the first year after diagnosis and for patients aged 65 years and older. International differences narrowed at all ages for breast cancer, from about 9% to 5% at 1 year and from about 14% to 8% at 5 years, but less or not at all for the other cancers. For colorectal cancer, the international range narrowed only for patients aged 65 years and older, by 2-6% at 1 year and by 2-3% at 5 years. INTERPRETATION: Up-to-date survival trends show increases but persistent differences between countries. Trends in cancer incidence and mortality are...
Currow, D 2011, 'SCIENTIFIC BASIS FOR THE MANAGEMENT OF DYSPNEA', JOURNAL OF THORACIC ONCOLOGY, vol. 6, no. 6, pp. S79-S80.
Currow, D 2011, 'SYMPTOMATIC MANAGEMENT OF COPD', INTERNAL MEDICINE JOURNAL, vol. 41, pp. 6-6.
Currow, DC 2011, 'The PRISMA Symposium 3: lessons from beyond Europe. why invest in research and service development in palliative care? An Australian perspective.', J Pain Symptom Manage, vol. 42, no. 4, pp. 505-510.View/Download from: Publisher's site
Hospice and palliative care services need to be able to compete with finite health care resources. To compete for such funding, the sector needs to continuously improve the evidence base that demonstrates improved outcomes, or else funding will continue to be at the level of a "social good" rather than as services that deliver improved health outcomes. Three questions need to be answered for policy makers and health funders: 1) Why invest health care spending in hospice and palliative care?, 2) Why invest research monies in hospice and palliative care clinical research and health service development?, and 3) How can emerging evidence be more effectively implemented to improve patient outcomes? No single measure captures the net benefit of hospice and palliative care services. By patient-defined parameters, hospice and palliative care services have demonstrated benefits, including physical symptom control. To meet patients' concerns, greater emphasis needs to be placed on maintaining physical independence for a longer period of time. Targeted investment of research funding can deliver further improvements in patient outcomes and models of service delivery. Rigorous studies are feasible and necessary if each patient is going to receive the best possible support. Benchmarking and service development strategies can deliver improved patient outcomes. With routine point-of-care data collection and feedback loops to individual services, patient-valued outcomes and resourcing can be improved in hospice and palliative care. Public-good investments in hospice and palliative care research are vital to building the evidence base for improving the quality of care offered.
Currow, DC & Abernethy, AP 2011, 'Therapeutic nihilism: the next hurdle in improving the treatment of breathlessness.', Curr Opin Support Palliat Care, vol. 5, no. 2, pp. 69-70.View/Download from: Publisher's site
Currow, DC & Dessaix, A 2011, 'Plain packaging for tobacco products.', BMJ, vol. 343, pp. d5693-d5693.
Currow, DC, Abernethy, AP, Bausewein, C, Johnson, M, Harding, R & Higginson, I 2011, 'Measuring the net benefits of hospice and palliative care: a composite measure for multiple audiences-palliative net benefit.', J Palliat Med, vol. 14, no. 3, pp. 264-265.View/Download from: Publisher's site
Currow, DC, Farquhar, M, Ward, AM, Crawford, GB & Abernethy, AP 2011, 'Caregivers' perceived adequacy of support in end-stage lung disease: results of a population survey', BMC PULMONARY MEDICINE, vol. 11.View/Download from: Publisher's site
Currow, DC, Foley, K, Zafar, SY, Wheeler, JL & Abernethy, AP 2011, 'The need for a re-evaluation of best supportive care studies reported to date', BRITISH JOURNAL OF CANCER, vol. 104, no. 3, pp. 390-391.View/Download from: Publisher's site
Currow, DC, McDonald, C, Oaten, S, Kenny, B, Allcroft, P, Frith, P, Briffa, M, Johnson, MJ & Abernethy, AP 2011, 'Once-daily opioids for chronic dyspnea: a dose increment and pharmacovigilance study.', J Pain Symptom Manage, vol. 42, no. 3, pp. 388-399.View/Download from: Publisher's site
CONTEXT: Randomized controlled trials can answer questions of efficacy, but long-term pharmacovigilance studies generate complementary safety data. OBJECTIVES: Level I evidence supports short-term efficacy of opioids in reducing chronic refractory dyspnea. This study aimed to determine the minimum effective once-daily dose of sustained-release morphine, and whether net clinical benefits are sustained safely. METHODS: In a Phase II dose increment study, 10mg daily of sustained-release morphine was administered, and increased in nonresponders by 10mg daily each week to a maximum of 30 mg daily. The participant was withdrawn if there were unacceptable side effects or no response to maximum dose. If participants had a 10% improvement in dyspnea over their own baseline, they joined a long-term Phase IV effectiveness/safety study at that dose. Complying with Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines, response and side effects are described, with demographic and clinical characteristics of responders. RESULTS: Eighty-three participants (53 males, mean age 75 years, 54% with chronic obstructive pulmonary disease) provided more than 30 patient-years of data. Fifty-two participants derived ≥ 10% benefit (on average 35% improvement over baseline), giving a response rate of 62% (number needed to treat of 1.6: number needed to harm 4.6); for 70%, this dose was 10mg/24h. Benefit was maintained at three months for 28 (33%) people. Ranking of breathlessness was reduced significantly (P<0.001), but constipation increased (P<0.001) despite laxatives. There were no episodes of respiratory depression or hospitalizations as a result of the sustained-release morphine. Overall, one in three people continued to derive benefit at three months. CONCLUSION: Ten milligrams of sustained-release oral morphine once daily is safe and effective for most people who respond.
Du, H, Newton, PJ, Zecchin, R, Denniss, AR, Salamonson, Y, Everett, B, Currow, D, Macdonald, P & Davidson, PM 2011, 'An intervention to promote physical activity and self-management in people with stable chronic heart failure The Home-Heart-Walk study: study protocol for a randomized controlled trial', Trials, vol. 12, no. 63.View/Download from: Publisher's site
Background: Chronic heart failure (CHF) is a chronic debilitating condition with economic consequences, mostly because of frequent hospitalisations. Physical activity and adequate self-management capacity are important risk reduction strategies in the management of CHF. The Home-Heart-Walk is a self-monitoring intervention. This model of intervention has adapted the 6-minute walk test as a home-based activity that is self-administered and can be used for monitoring physical functional capacity in people with CHF. The aim of the Home-Heart-Walk program is to promote adherence to physical activity recommendations and improving self-management in people with CHF. Methods/Design: A randomised controlled trial is being conducted in English speaking people with CHF in four hospitals in Sydney, Australia. Individuals diagnosed with CHF, in New York Heart Association Functional Class II or III, with a previous admission to hospital for CHF are eligible to participate. Based on a previous CHF study and a loss to follow-up of 10%, 166 participants are required to be able to detect a 12-point difference in the study primary endpoint (SF-36 physical function domain). All enrolled participant receive an information session with a cardiovascular nurse. This information session covers key self-management components of CHF: daily weight; diet (salt reduction); medication adherence; and physical activity. Participants are randomised to either intervention or control group through the study randomisation centre after baseline questionnaires and assessment are completed. For people in the intervention group, the research nurse also explains the weekly Home-Heart-Walk protocol. All participants receive monthly phone calls from a research coordinator for six months, and outcome measures are conducted at one, three and six months.
Hegarty, MM, Abernethy, AP, Olver, I & Currow, DC 2011, 'Former palliative caregivers who identify that additional spiritual support would have been helpful in a population survey', PALLIATIVE MEDICINE, vol. 25, no. 3, pp. 266-277.View/Download from: Publisher's site
Johnson, CE, Girgis, A, Paul, CL & Currow, DC 2011, 'Palliative care referral practices and perceptions: the divide between metropolitan and non-metropolitan general practitioners.', Palliat Support Care, vol. 9, no. 2, pp. 181-189.View/Download from: Publisher's site
OBJECTIVE: Late or non-referral of patients to specialist palliative care (SPC) services may affect patients' and their carers' quality of care. General practitioners (GPs) are key professionals in linking people with SPC. The aim of this article is to assess GPs' perceptions and SPC referrals for their patients with advanced cancer and differences between metropolitan (M GPs) and non-metropolitan GPs (NM GPs). METHOD: Self-report survey mailed to a stratified random sample of 1,680 Australian GPs was used. RESULTS: Thirty-one percent (469) of eligible GPs returned surveys. More M GPs than NM GPs reported referring >60% of their patients for SPC (p = 0.014); and that a more comprehensive range of SPC services was available. The most frequently reported referral prompts were: presence of terminal illness (M GPs, 71%, NM GPs, 66%, ns (not significant)); future need for symptom control (69% vs. 59%, ns) and uncontrolled physical symptoms (63% vs. 54%, ns). Reasons for not referring were: doctor's ability to manage symptoms (62% vs. 68%, ns) and the absence of symptoms (29% vs. 18%, p = 0.025). Higher referral was associated with: having a palliative care physician or consultative service available; agreeing that all patients with advanced cancer should be referred, and agreeing that with SPC, the needs of the family are better met. SIGNIFICANCE OF RESULTS: Referrals for SPC were primarily disease-related rather than for psychological and emotional concerns. Measures are needed to encourage referrals based upon psychosocial needs as well as for physical concerns, and to support GPs caring for people with advanced cancer in areas with fewer comprehensive SPC services.
Kamal, AH, Currow, DC, Ritchie, C, Bull, J, Wheeler, JL & Abernethy, AP 2011, 'The Value of Data Collection within a Palliative Care Program', CURRENT ONCOLOGY REPORTS, vol. 13, no. 4, pp. 308-315.View/Download from: Publisher's site
Nadimi, F & Currow, DC 2011, 'As death approaches: a retrospective survey of the care of adults dying in Alice Springs Hospital.', Aust J Rural Health, vol. 19, no. 1, pp. 4-8.View/Download from: Publisher's site
OBJECTIVE: Australians are more likely to die in a hospital than anywhere else, and most of these deaths are 'expected'. The aims of this survey were to identify if specific end-of-life issues were documented in clinical records of a regional hospital serving remote Australia. DESIGN: A retrospective consecutive case-note audit covering 18 months from 1 January 2006. SETTING: Alice Springs Hospital. PARTICIPANTS: Adult deaths in Alice Springs Hospital. During this period there were 128 deaths. OUTCOME MEASURES: Demographic, process (diagnosis of dying documented, 'not for resuscitation' documentation, intensive care unit (ICU) admission, social worker referral and specialised palliative care service referral) and outcome data ('comfort at end of life') were surveyed. RESULTS: Of the 128 admissions, 55 cases were excluded: 10 were children under 18, 33 died in < 48 hours, nine were coroner's cases and three files could no't be found. Of the 73 deaths surveyed (33 men), 47 (64%) were Aboriginal. A diagnosis of dying was made in 84%, 88% had an 'not for resuscitation' order, 48% were admitted to ICU during their last admission, 66% were referred to social workers, 68% were referred to palliative care and 85% of people were documented to be 'comfortable' during the dying process with no differential outcomes for Aboriginal and non-Aboriginal decedents except age (P < 0.0001). CONCLUSION: This survey highlights the continuing need to diagnose dying, understand optimal use of intensive care and improve comfort care at the end of life.
Nikles, J, Mitchell, GK, Schluter, P, Good, P, Hardy, J, Rowett, D, Shelby-James, T, Vohra, S & Currow, D 2011, 'Aggregating single patient (n-of-1) trials in populations where recruitment and retention was difficult: The case of palliative care', JOURNAL OF CLINICAL EPIDEMIOLOGY, vol. 64, no. 5, pp. 471-480.View/Download from: Publisher's site
Rosenwax, LK, McNamara, BA, Murray, K, McCabe, RJ, Aoun, SM & Currow, DC 2011, 'Hospital and emergency department use in the last year of life: a baseline for future modifications to end‐of‐life care', Medical Journal of Australia, vol. 195, no. 2, pp. 104-104.View/Download from: Publisher's site
Rosenwax, LK, McNamara, BA, Murray, K, McCabe, RJ, Aoun, SM & Currow, DC 2011, 'Hospital and emergency department use in the last year of life: a baseline for future modifications to end-of-life care.', Med J Aust, vol. 194, no. 11, pp. 570-573.
OBJECTIVES: To describe hospital and emergency department use in the last year of life by people for whom death from cancer or one of another nine conditions was an expected outcome. DESIGN, PARTICIPANTS AND SETTING: Retrospective cross-sectional study based on death registrations and morbidity data for 1071 Western Australians who died between 1 August 2005 and 30 June 2006. Decedents had an informal primary carer, did not live in residential aged care and died of a condition amenable to palliative care. MAIN OUTCOME MEASURES: Total number of hospital admissions; emergency presentations (with and without hospital admission); days spent in hospital by age group at death, sex, metropolitan or rural place of residence and cancer versus non-cancer diagnosis; proportion in hospital on any day in the last 365 days of life; time points of change in the last 365 days of life at which there was an increasing proportion of hospital admissions for those with cancer and non-cancer conditions. RESULTS: All but 4% of the decedents spent time in hospital with a marked increase in hospitalisations in the last 108 days of life for people who died of cancer and the last 83 days of life for people who died of non-cancer conditions. Those with cancer spent less time in hospital than those with other diagnoses. Seventy per cent of the cohort had at least one emergency presentation. On the last day of life, 61.5% of people were in hospital and 4.0% had been seen in emergency departments. CONCLUSIONS: Western Australian hospitals currently provide extensive and progressively greater care at the end of life. Identifying patterns of emergency and inpatient use for various disease trajectories will assist in the planning of appropriate services for people where death is an expected outcome.
Rowett, D & Currow, D 2011, 'PRESCRIBING AT THE END OF LIFE, PHARMACOVIGILANCE AND CLINICAL TRIALS', INTERNAL MEDICINE JOURNAL, vol. 41, pp. 6-6.
Uronis, H, McCrory, DC, Samsa, G, Currow, D & Abernethy, A 2011, 'Symptomatic oxygen for non-hypoxaemic chronic obstructive pulmonary disease', Cochrane Database of Systematic Reviews, no. 6.View/Download from: Publisher's site
Dyspnoea is a common symptom in chronic obstructive pulmonary disease (COPD). People who are hypoxaemic may be given long-term oxygen relief therapy (LTOT) to improve their life expectancy and quality of life. However, the symptomatic benefit of home oxygen therapy in mildly or non-hypoxaemic people with COPD with dyspnoea who do not meet international funding criteria for LTOT (PaO(2)< 55 mmHg or other special cases) is unknown.
To determine the efficacy of oxygen versus medical air for relief of subjective dyspnoea in mildly or non-hypoxaemic people with COPD who would not otherwise qualify for home oxygen therapy. The main outcome was patient-reported dyspnoea and secondary outcome was exercise tolerance.
We searched the Cochrane Airways Group Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE, to November 2009, to identify randomised controlled trials. We handsearched reference lists of included articles.
We only included randomised controlled trials of oxygen versus medical air in mildly or non-hypoxaemic people with COPD. Two review authors independently assessed articles for inclusion.
DATA COLLECTION AND ANALYSIS:
One review author completed data extraction and methodological quality assessment. A second review author then over-read evidence tables to assess for accuracy.
Twenty-eight trials on 702 patients met the criteria for inclusion; 18 trials (431 participants) were included in the meta-analysis. Oxygen reduced dyspnoea with a standardised mean difference (SMD) of -0.37 (95% confidence interval (CI) -0.50 to -0.24, P < 0.00001). We observed significant heterogeneity.
Oxygen can relieve dyspnoea in mildly and non-hypoxaemic people with COPD who would not otherwise qualify for home oxygen therapy. Given the significant heterogeneity among the included studies, clinicians should continue to evaluate patients on a...
Waller, A, Girgis, A, Davidson, P, Newton, P, Lecathelinais, C, Macdonald, P, Hayward, C & Currow, D 2011, 'Facilitating Needs Based Care for People with Chronic Heart Failure: Inter-rater Reliability, Validity and Acceptability of a Needs Assessment Tool', Heart, Lung and Circulation, vol. 20, pp. S65-S66.View/Download from: Publisher's site
Dear, R, Barratt, A, Askie, L, McGeechan, K, Arora, S, Crossing, S, Currow, D & Tattersall, M 2011, 'Adding value to clinical trial registries: insights from Australian Cancer Trials Online, a website for consumers', CLINICAL TRIALS, vol. 8, no. 1, pp. 70-76.View/Download from: Publisher's site
There is an ethical imperative to provide the best quality of care for all people, including people at the end of life. In order to provide such care, each intervention used in clinical practice must be tested objectively for net clinical benefit (response and toxicity). For pharmacological and non-pharmacological interventions, the gold standard of evidence remains a phase III randomized, controlled study. In palliative care, there is a gradually emerging evidence base for clinical practice derived from rigorously designed and conducted interventional studies. Such studies can effectively recruit, even in this clinical setting, to completion.There are design and implantation challenges in all controlled clinical trials. Some issues are highly likely in palliative care and will influence trial design and analysis including expected attrition unrelated to the intervention, wide variation in the diagnosis and timing of referral to individual palliative care services and responsible reporting of serious adverse events. Factors that are not unique to palliative care but are often magnified in such studies include concerns by referrers and participants about randomization and blinding, how and when to measure endpoints that are clinically relevant, how to minimize the burden of data collection, ensuring studies are adequately powered and how best to deal with primary outcomes that are subjective. Many studies in the palliative care population have successfully overcome these challenges by thoughtful study design. Factors associated with successful (palliative care) study completion include (i) a shared vision about what the research is designed to achieve; (ii) governance structures independent of the researchers; (iii) ways of defining standard practice for the control arm using best available evidence and consensus; (iv) face-to-face meetings especially for protocol development; (v) adequate funding given estimates that four to six palliative care patients will be s...
Currow, DC, Agar, MR, To, THM, Rowett, D, Greene, A & Abernethy, AP 2011, 'Adverse Events in Hospice and Palliative Care: A Pilot Study to Determine Feasibility of Collection and Baseline Rates', JOURNAL OF PALLIATIVE MEDICINE, vol. 14, no. 3, pp. 309-314.View/Download from: Publisher's site
Lobb, EA, Swetenham, K, Agar, M & Currow, DC 2011, 'A Collateral Benefit of Research in Palliative Care', JOURNAL OF PALLIATIVE MEDICINE, vol. 14, no. 9, pp. 986-987.View/Download from: Publisher's site
To, THM, Greene, AG, Agar, MR & Currow, DC 2011, 'A point prevalence survey of hospital inpatients to define the proportion with palliation as the primary goal of care and the need for specialist palliative care', INTERNAL MEDICINE JOURNAL, vol. 41, no. 5, pp. 430-433.View/Download from: Publisher's site
Kamal, AH, Maguire, JM, Wheeler, JL, Currow, DC & Abernethy, AP 2011, 'Dyspnea Review for the Palliative Care Professional: Assessment, Burdens, and Etiologies', JOURNAL OF PALLIATIVE MEDICINE, vol. 14, no. 10, pp. 1167-1172.View/Download from: Publisher's site
Johnson, C, Girgis, A, Paul, C, Currow, D, Adams, J & Aranda, S 2011, 'Australian Palliative Care Providers Perceptions And Experiences Of The Barriers And Facilitators To Palliative Care Provision', Supportive Care in Cancer, vol. 19, no. 3, pp. 343-351.View/Download from: Publisher's site
People with advanced cancer who may benefit from specialised palliative care (SPC) do not necessarily access such services. To obtain a deeper understanding of issues affecting access to SPC, five focus groups were undertaken with nurses (35), physicians
Johnson, C, Paul, C, Girgis, A, Adams, J & Currow, D 2011, 'Australian General Practitioners And Oncology Specialists Perceptions Of Barriers And Facilitators Of Access To Specialist Palliative Care Services', Journal Of Palliative Medicine, vol. 14, no. 4, pp. 429-435.View/Download from: Publisher's site
Purpose: Doctors in Australia play an important role in facilitating access to specialist palliative care (SPC) services for people with advanced cancer. This study aimed to describe doctors perceptions of barriers to referring patients for SPC, and to i
Currow, D, Burns, C, Agar, M, Phillips, JL, McCaffrey, N & Abernethy, A 2011, 'Palliative caregivers who would not take on the role again', Journal of Pain and Symptom Management, vol. 41, no. 4, pp. 661-672.View/Download from: Publisher's site
Abstract Context Health and social services rely heavily on family and friends for caregiving at the end of life. Objectives This study sought to determine the prevalence and factors associated with an unwillingness to take on the caregiving role again by interviewing former caregivers of palliative care patients. Methods The setting for this study was South Australia, with a population of 1.6 million people (7% of the Australian population) and used the South Australian Health Omnibus, an annual, face-to-face, cross-sectional, whole-of-population, multistage, systematic area sampling survey, which seeks a minimum of 3000 respondents each year statewide. One interview was conducted per household with the person over the age of 15 who most recently had a birthday. Using two years of data (n = 8377; 65.4% participation rate), comparisons between those who definitely would care again and those who would not was undertaken.
Davidson, PM, Jiwa, M, Goldsmith, AJ, McGrath, S, DiGiacomo, M, Phillips, JL, Agar, M, Newton, PJ & Currow, D 2011, 'Decisions for lung cancer chemotherapy: the influence of physician and patient factors', Supportive Care in Cancer, vol. 19, no. 8, pp. 1261-1266.View/Download from: Publisher's site
Purpose The purpose of this study is to review the literature examining how the beliefs and behaviours of physicians and patients influence clinical communication, doctor-patient interaction and treatment decisions for lung cancer treatment. Methods Literature was obtained via electronic database searches and hand searching of journals from 1990 to 2011. Results Wide variability in perceptions of the value of chemotherapy in lung cancer is present among both physicians and patients. There is a mismatch in the degree patients and physicians weigh survival, such that patients value survival benefits highly whilst physicians strongly emphasize toxicity and associated symptoms. This lack of congruence between patients and clinicians is influenced by a range of factors and has implications for treatment decisions, long-term survival and quality of life in people affected by lung cancer. Conclusion The divergence of treatment priorities indicates a need for improved communication strategies addressing the needs and concerns of both patients and clinicians. Patients should understand the benefits and risks of treatment options, while clinicians can gain a greater awareness of factors influencing patients' decisions on treatments. Reflecting these perspectives and patient preferences for lung cancer treatment in clinical guidelines may improve clinician awareness.
Lewis, J, DiGiacomo, M, Currow, D & Davidson, PM 2011, 'Dying in the margins: understanding palliative care and socioeconomic deprivation in the developed world', Journal of Pain and Symptom Management, vol. 42, no. 1, pp. 105-118.View/Download from: Publisher's site
Individuals from low socioeconomic (SE) groups have less resources and poorer health outcomes. Understanding the nature of access to appropriate end-of-life care services for this group is important. This article evaluated the literature in the developed world for barriers to access for low SE groups. Electronic databases searched in the review included MEDLINE (1996â2010), CINAHL (1996â2010), PsychINFO (2000â2010), Cochrane Library (2010), and EMBASE (1996â2010). Publications were searched for key terms âsocioeconomic disadvantage,â âsocioeconomic,â âpoverty,â âpoorâ paired with âend-of-life care,â âpalliative care,â âdying,â and âterminal Illness.â Articles were analyzed using existing descriptions for dimensions of access to health services, which include availability, affordability, acceptability, and geographical access. A total of 67 articles were identified for the literature review. Literature describing end-of-life care and low SE status was limited. Findings from the review were summarized under the headings for dimensions of access. Low SE groups experience barriers to access in palliative care services. Identification and evaluation of interventions aimed at reducing this disparity is required.
Abermann, J, Fischer, A, Lambrecht, A & Geist, T 2010, 'On the potential of very high-resolution repeat DEMs in glacial and periglacial environments', CRYOSPHERE, vol. 4, no. 1, pp. 53-65.View/Download from: Publisher's site
Abernethy, AP & Currow, DC 2010, 'Need for mechanistically focused research of global systemic interventions in palliative care', Journal of Pain and Symptom Management, vol. 40, no. 3.View/Download from: Publisher's site
Abernethy, AP, Aziz, NM, Basch, E, Bull, J, Cleeland, CS, Currow, DC, Fairclough, D, Hanson, L, Hauser, J, Ko, D, Lloyd, L, Morrison, RS, Otis-Green, S, Pantilat, S, Portenoy, RK, Ritchie, C, Rocker, G, Wheeler, JL, Zafar, SY & Kutner, JS 2010, 'A Strategy To Advance the Evidence Base in Palliative Medicine: Formation of a Palliative Care Research Cooperative Group', JOURNAL OF PALLIATIVE MEDICINE, vol. 13, no. 12, pp. 1407-1413.View/Download from: Publisher's site
Abernethy, AP, Clark, K & Currow, DC 2010, 'How Should We Conduct and Interpret Phase III Clinical Trials in Palliative Care?', Journal of Pain and Symptom Management, vol. 39, no. 1.View/Download from: Publisher's site
Abernethy, AP, Currow, DC, Wurzelmann, J, Janning, SW, Bull, J, Norris, JF, Baringtang, DC, Pierce, A & Snidow, J 2010, 'Enhancing enrollment in palliative care trials: Key insights from a randomized, placebo-controlled study', Journal of Supportive Oncology, vol. 8, no. 3, pp. 139-144.
Abernethy, AP, McDonald, CF, Frith, PA, Clark, K, Herndon, JE, Marcello, J, Young, IH, Bull, J, Wilcock, A, Booth, S, Wheeler, JL, Tulsky, JA, Crockett, AJ & Currow, DC 2010, 'Effect of palliative oxygen versus room air in relief of breathlessness in patients with refractory dyspnoea: a double-blind, randomised controlled trial', LANCET, vol. 376, no. 9743, pp. 784-793.View/Download from: Publisher's site
Abernethy, AP, Wheeler, JL & Currow, DC 2010, 'Editorial comment: Common approaches to dyspnoea management in advanced life-limiting illness', Current Opinion in Supportive and Palliative Care, vol. 4, no. 2, pp. 53-55.View/Download from: Publisher's site
Abernethy, AP, Wheeler, JL & Currow, DC 2010, 'Utility and Use of Palliative Care Screening Tools in Routine Oncology Practice', CANCER JOURNAL, vol. 16, no. 5, pp. 444-460.View/Download from: Publisher's site
Aoun, S, Bird, S, Kristjanson, LJ & Currow, D 2010, 'Reliability testing of the FAMCARE-2 scale: measuring family carer satisfaction with palliative care', PALLIATIVE MEDICINE, vol. 24, no. 7, pp. 674-681.View/Download from: Publisher's site
Aoun, S, McConigley, R, Abernethy, A & Currow, DC 2010, 'Caregivers of People with Neurodegenerative Diseases: Profile and Unmet Needs from a Population-Based Survey in South Australia', JOURNAL OF PALLIATIVE MEDICINE, vol. 13, no. 6, pp. 653-661.View/Download from: Publisher's site
Burns, CM, Abernethy, A & Currow, D 2010, 'Caregiving networks at the end of life - Findings from SA Population Study', AUSTRALASIAN JOURNAL ON AGEING, vol. 29, pp. 6-6.
Burns, CM, LeBlanc, TW, Abernethy, A & Currow, D 2010, 'Young Caregivers in the End-of-Life Setting: A Population-Based Profile of an Emerging Group', JOURNAL OF PALLIATIVE MEDICINE, vol. 13, no. 10, pp. 1225-1235.View/Download from: Publisher's site
Clark, K, Currow, DC & Talley, NJ 2010, 'The Use of Digital Rectal Examinations in Palliative Care Inpatients', JOURNAL OF PALLIATIVE MEDICINE, vol. 13, no. 7, pp. 797-797.View/Download from: Publisher's site
Clark, K, Urban, K & Currow, DC 2010, 'Current Approaches to Diagnosing and Managing Constipation in Advanced Cancer and Palliative Care', JOURNAL OF PALLIATIVE MEDICINE, vol. 13, no. 4, pp. 473-476.View/Download from: Publisher's site
Currow, D & Davis, C 2010, 'How quick are palliative care doctors to adopt new evidence?', European Journal of Palliative Care, vol. 17, no. 5, p. 213.
Currow, DC 2010, 'Why Don't We Do More Rigorous Clinical Research So That We Can Stop Experimenting on Patients?', JOURNAL OF PALLIATIVE MEDICINE, vol. 13, no. 6, pp. 636-637.View/Download from: Publisher's site
Currow, DC & Abernethy, AP 2010, 'Potential Opioid-Sparing Effect of Regular Benzodiazepines in Dyspnea Longer Duration of Studies Needed', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 40, no. 5, pp. E1-E2.View/Download from: Publisher's site
Breathlessness is a common and distressing symptom in both malignant and non-malignant conditions. Both pharmacological and non-pharmacological strategies are necessary to minimise symptom burden and distress. Assessing the individualâs needs and clarifying the goals of treatment is an important first step in determining an effective treatment plan. Although the evidence supporting the use of some of these therapies is variable, there is an increasing evidence base to inform clinical decision making and treatment plans. Pharmacotherapy with opioids is a common and effective strategy for managing breathlessness, yet requires judicious titration and management. The adverse effects of opioid therapy, including constipation and drowsiness, can be anticipated and managed with adjunctive therapies. The use of oxygen in people who are hypoxaemic is supported, but is of limited value in people who are not hypoxaemic. Individualised strategies and advance care planning is important to avoid unnecessary hospitalisations and futile treatments at the end of life. There is a clear mismatch between the prevalence and burden of this problem and data to inform evidence-based guidelines. Refractory breathlessness is a fertile area for ongoing research and requires increased attention to address the burden of this highly prevalent symptom.
Background: Chronic heart failure is common, particularly in older individuals, and comorbidities are frequent. Patients with end stage heart failure can be highly symptomatic and require careful monitoring and treatment adjustment to improve symptoms.
BACKGROUND: Chronic heart failure is common, particularly in older individuals, and comorbidities are frequent. Patients with end stage heart failure can be highly symptomatic and require careful monitoring and treatment adjustment to improve symptoms. OBJECTIVE: This article summarises the fundamentals of implementing palliative care in general practice and provides guidelines on caring for chronic heart failure patients at the end of life. DISCUSSION: The high mortality in chronic heart failure underscores the importance of effective communication, symptom management and advanced care planning. The unpredictability and uncertainty around the timing of death mean that individuals, and their families, may be less likely to have an understanding of their prognosis or have access to supportive and palliative care. Ideally, patients with symptomatic chronic heart failure should be managed in collaboration with a multidisciplinary heart failure program. Symptom management can be achieved by additive therapies and access to specialist palliative care services should be considered when the symptom burden is high.
Eagar, K, Watters, P, Currow, DC, Aoun, SM & Yates, P 2010, 'The Australian Palliative Care Outcomes Collaboration (PCOC) - measuring the quality and outcomes of palliative care on a routine basis', AUSTRALIAN HEALTH REVIEW, vol. 34, no. 2, pp. 186-192.View/Download from: Publisher's site
Hardy, J, Shelby-James, T & Currow, DC 2010, 'Research in palliative care: is death always an adverse event?', INTERNAL MEDICINE JOURNAL, vol. 40, no. 1, pp. 89-90.View/Download from: Publisher's site
Horton, R, Rocker, G & Currow, D 2010, 'The dyspnea target: Can we zero in on opioid responsiveness in advanced chronic obstructive pulmonary disease?', Current Opinion in Supportive and Palliative Care, vol. 4, no. 2, pp. 92-96.View/Download from: Publisher's site
The 'dyspnea target' or similar conceptual models that attempt to predict how specific aspects of dyspnea may affect response to treatments offer clinicians the potential to more effectively target interventions. The model is presented in its theoretical stage in order to stimulate further discussion and research in an area of current interest. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Sladek, RM, Tieman, J & Currow, DC 2010, 'Searchers be aware: limiting PubMed searches to 'humans' loses more than you think', INTERNAL MEDICINE JOURNAL, vol. 40, no. 1, pp. 88-89.View/Download from: Publisher's site
Tieman, JJ, Abernethy, A & Currow, DC 2010, 'Not Published, Not Indexed: Issues in Generating and Finding Hospice and Palliative Care Literature', JOURNAL OF PALLIATIVE MEDICINE, vol. 13, no. 6, pp. 669-675.View/Download from: Publisher's site
Zafar, SY, Currow, DC, Daugherty, CK & Abernethy, AP 2010, 'Standards for Palliative Care Delivery in Oncology Settings', CANCER JOURNAL, vol. 16, no. 5, pp. 436-443.View/Download from: Publisher's site
Waller, A, Girgis, A, Johnson, C, Mitchell, G, Yates, P, Kristjanson, L, Tattersall, M, Lecathelinais, C, Sibbritt, D, Kelly, B, Gorton, E & Currow, D 2010, 'Facilitating needs based cancer care for people with a chronic disease: Evaluation of an intervention using a multi-centre interrupted time series design.', BMC Palliative Care, vol. 9, p. 2.View/Download from: Publisher's site
BACKGROUND: Palliative care should be provided according to the individual needs of the patient, caregiver and family, so that the type and level of care provided, as well as the setting in which it is delivered, are dependent on the complexity and severity of individual needs, rather than prognosis or diagnosis . This paper presents a study designed to assess the feasibility and efficacy of an intervention to assist in the allocation of palliative care resources according to need, within the context of a population of people with advanced cancer. METHODS/DESIGN: People with advanced cancer and their caregivers completed bi-monthly telephone interviews over a period of up to 18 months to assess unmet needs, anxiety and depression, quality of life, satisfaction with care and service utilisation. The intervention, introduced after at least two baseline phone interviews, involved a) training medical, nursing and allied health professionals at each recruitment site on the use of the Palliative Care Needs Assessment Guidelines and the Needs Assessment Tool: Progressive Disease - Cancer (NAT: PD-C); b) health professionals completing the NAT: PD-C with participating patients approximately monthly for the rest of the study period. Changes in outcomes will be compared pre-and post-intervention. DISCUSSION: The study will determine whether the routine, systematic and regular use of the Guidelines and NAT: PD-C in a range of clinical settings is a feasible and effective strategy for facilitating the timely provision of needs based care. TRIALS REGISTRATION: ISRCTN21699701.
Waller, A, Girgis, A, Johnson, C, Mitchell, G, Yates, P, Kristjanson, L, Tattersall, M, Lecathelinais, C, Sibbritt, D, Kelly, B, Gorton, E & Currow, D 2010, 'Facilitating needs based cancer care for people with a chronic disease: Evaluation of an intervention using a multi-centre interrupted timeseries design', BMC Palliative Care, vol. 9, no. 2, pp. 1-6.
Background: Palliative care should be provided according to the individual needs of the patient, caregiver and family, so that the type and level of care provided, as well as the setting in which it is delivered, are dependent on the complexity and severity of individual needs, rather than prognosis or diagnosis . This paper presents a study designed to assess the feasibility and efficacy of an intervention to assist in the allocation of palliative care resources according to need, within the context of a population of people with advanced cancer.
Waller, A, Girgis, A, Lecathelinais, C, Scott, W, Foot, L, Sibbritt, D & Currow, D 2010, 'Validity, reliability and clinical feasibility of a Needs Assessment Tool for people with progressive cancer', Psycho-oncology, vol. 19, pp. 726-733.View/Download from: Publisher's site
Background: Needs assessment is a valuable approach for determining the way health and social services allocate resources to people with cancer and their caregivers. Aim: To assess the reliability, validity and acceptability of a Needs Assessment Tool (NAT) in a palliative care clinical setting.
Agar, M, To, T, Plummer, J, Abernethy, A & Currow, D 2010, 'Anti-Cholinergic Load, Health Care Utilization, and Survival in People with Advanced Cancer: A Pilot Study', JOURNAL OF PALLIATIVE MEDICINE, vol. 13, no. 6, pp. 745-752.View/Download from: Publisher's site
Clark, K, Lam, LT, Agar, M, Chye, R & Currow, DC 2010, 'The impact of opioids, anticholinergic medications and disease progression on the prescription of laxatives in hospitalized palliative care patients: a retrospective analysis', PALLIATIVE MEDICINE, vol. 24, no. 4, pp. 410-418.View/Download from: Publisher's site
Currow, D & Agar, M 2010, 'The Necessary Work Program for Safe Delivery of Combinations of Injectable Medications', JOURNAL OF PALLIATIVE MEDICINE, vol. 13, no. 9, pp. 1052-1052.View/Download from: Publisher's site
Currow, D, Smith, J, Davidson, PM, Newton, PJ, Agar, M, Care, MP & Abernethy, A 2010, 'Do the Trajectories of Dyspnea Differ in Prevalence and Intensity By Diagnosis at the End of Life? A Consecutive Cohort Study', Journal of Pain and Symptom Management, vol. 39, no. 4, pp. 680-690.
Context. Breathlessness reportedly worsens as death approaches for many people, but the differences in intensity and time course between underlying causes are not well described. Objectives. To determine differences in the intensity of breathlessness by diagnosis over time as death approaches in a consecutive cohort seen by a specialist palliative care service. Methods. Patients referred to Silver Chain Hospice Care Service over a period of four years (January 2004 to December 2007) had dyspnea evaluated at every clinical encounter until death. A numeric rating scale (NRS) was used to measure the intensity. Patients were categorized into five clusters (lung cancer, secondary cancer to lung, heart failure, end-stage pulmonary disease, and no identifiable cardiorespiratory cause) at three time points (60e53 [T3], 30e23 [T2], and 7e0 [T1] days before death [T0]). Group differences were assessed using analysis of variance. Joinpoint regression models defined significant changes in mean breathlessness intensity.
Currow, DC, Agar, M, Plummer, JL, Blyth, FM & Abernethy, AP 2010, 'Chronic pain in South Australia - population levels that interfere extremely with activities of daily living', AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, vol. 34, no. 3, pp. 232-239.View/Download from: Publisher's site
Currow, DC, Shelby-James, TM, Agar, M, Plummer, J, Rowett, D, Glare, P, Spruyt, O & Hardy, J 2010, 'Planning phase III multi-site clinical trials in palliative care: the role of consecutive cohort audits to identify potential participant populations', SUPPORTIVE CARE IN CANCER, vol. 18, no. 12, pp. 1571-1579.View/Download from: Publisher's site
Shelby-James, T, Agar, MR & Currow, DC 2010, 'A case study evaluation of ethics review systems for multicentre clinical trials', MEDICAL JOURNAL OF AUSTRALIA, vol. 192, no. 5, pp. 292-292.View/Download from: Publisher's site
Background Over the past two decades the number of people living with cancer has increased. Many cancer survivors end up with long term disabilities requiring ongoing care and support. For many people, cancer survival now means living with a chronic and complex condition. Aim The purpose of this paper is to provide an overview of the long term management issues for cancer survivors and strategies to enhance their care. Discussion Cancer survivors require ongoing support in four key areas: prevention; surveillance; intervention for consequences of cancer and its treatment; and coordination between specialist and generalist providers. Conclusion Cancer survivors experience significant physical and psychological morbidity which makes minimising their burden of disability and distress an important priority. Survivors require ongoing care that is well co-ordinated, focuses on prevention, provides going surveillance whilst minimising and managing the long term effects of treatment and other co-morbidities.
Abernethy, A, Burns, C, Wheeler, J & Currow, D 2009, 'Defining distinct caregiver subpopulations by intensity of end-of-life care provided', PALLIATIVE MEDICINE, vol. 23, no. 1, pp. 66-79.View/Download from: Publisher's site
Abernethy, AP, Uronis, HE, Wheeler, JL & Currow, DC 2009, 'Management of dyspnea in patients with chronic obstructive pulmonary disease', Wiener Medizinische Wochenschrift, vol. 159, no. 23-24, pp. 583-590.View/Download from: Publisher's site
A progressive and debilitating illness, chronic obstructive pulmonary disease (COPD) has major worldwide impact. In addition to the care for underlying causes of disease, COPD treatment involves palliative intervention to address associated symptoms; in later stages of disease, when the underlying disease has been maximally treated, symptom management assumes primacy as the goal of care. Dyspnea is the most distressing symptom experienced by COPD patients. When dyspnea cannot be relieved by traditional COPD management strategies (i.e., "refractory dyspnea"), the goal of care shifts from prolonged survival to minimized symptoms, improved function, and enhanced quality of life. Numerous pharmacologic and non-pharmacologic interventions are available to achieve these goals, but supporting evidence is variable. This review summarizes options for managing refractory dyspnea in COPD patients, referring to the available evidence and highlighting areas for further investigation. Topics include oxygen, opioids, psychotropic drugs, inhaled frusemide, Heliox28, nutrition, psychosocial support, and breathing techniques. © 2009 Springer-Verlag.
Cherny, NI, Abernethy, AP, Strasser, F, Sapir, R, Currow, D & Zafar, SY 2009, 'Improving the Methodologic and Ethical Validity of Best Supportive Care Studies in Oncology: Lessons From a Systematic Review', JOURNAL OF CLINICAL ONCOLOGY, vol. 27, no. 32, pp. 5476-5486.View/Download from: Publisher's site
Clark, K, Lam, L & Currow, D 2009, 'Reducing gastric secretions-a role for histamine 2 antagonists or proton pump inhibitors in malignant bowel obstruction?', SUPPORTIVE CARE IN CANCER, vol. 17, no. 12, pp. 1463-1468.View/Download from: Publisher's site
Clark, K, Lam, LT, Gibson, S & Currow, D 2009, 'The effect of ranitidine versus proton pump inhibitors on gastric secretions: a meta-analysis of randomised control trials', ANAESTHESIA, vol. 64, no. 6, pp. 652-657.View/Download from: Publisher's site
Currow, DC & Abernethy, A 2009, 'Current Opinion in Supportive and Palliative Care: Editorial introductions', Current Opinion in Supportive and Palliative Care, vol. 3, no. 2.View/Download from: Publisher's site
Currow, DC & Rowett, DS 2009, 'Cancer pain - progress and ongoing issues in Australia', PAIN RESEARCH & MANAGEMENT, vol. 14, no. 5, pp. 351-352.
Currow, DC, Plummer, JL, Crockett, A, Cert, G & Abernethy, AP 2009, 'A Community Population Survey of Prevalence and Severity of Dyspnea in Adults', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 38, no. 4, pp. 533-545.View/Download from: Publisher's site
Currow, DC, To, THM & Abernethy, AP 2009, 'PRESCRIBING AT TIMES OF CLINICAL TRANSITION IN CHRONIC OR PROGRESSIVE DISEASES', INTERNATIONAL JOURNAL OF GERONTOLOGY, vol. 3, no. 1, pp. 1-8.View/Download from: Publisher's site
Currow, DC, Ward, AM & Abernethy, AP 2009, 'Advances in the pharmacological management of breathlessness', Current Opinion in Supportive and Palliative Care, vol. 3, no. 2, pp. 103-106.View/Download from: Publisher's site
Opioids prescribed regularly can help to predictably and safely reduce breathlessness for people with a range of end-stage illnesses. © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Currow, DC, Wheeler, JL, Glare, PA, Kaasa, S & Abernethy, AP 2009, 'A Framework for Generalizability in Palliative Care', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 37, no. 3, pp. 373-386.View/Download from: Publisher's site
Dorman, S, Jolley, C, Abernethy, A, Currow, D, Johnson, M, Farquhar, M, Griffiths, G, Peel, T, Moosavi, S, Byrne, A, Wilcock, A, Alloway, L, Bausewein, C, Higginson, I & Booth, S 2009, 'Researching breathlessness in palliative care: consensus statement of the National Cancer Research Institute Palliative Care Breathlessness Subgroup', PALLIATIVE MEDICINE, vol. 23, no. 3, pp. 213-227.View/Download from: Publisher's site
Ferris, FD, Bruera, E, Cherny, N, Cummings, C, Currow, D, Dudgeon, D, JanJan, N, Strasser, F, von Gunten, CF & Von Roenn, JH 2009, 'Palliative Cancer Care a Decade Later: Accomplishments, the Need, Next Steps-From the American Society of Clinical Oncology', JOURNAL OF CLINICAL ONCOLOGY, vol. 27, no. 18, pp. 3052-3058.View/Download from: Publisher's site
Gordon, R, Eagar, K, Currow, D & Green, J 2009, 'Current Funding and Financing Issues in the Australian Hospice and Palliative Care Sector', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 38, no. 1, pp. 68-74.View/Download from: Publisher's site
McCaffrey, N, Currow, DC & Eckermann, S 2009, 'Measuring Impacts of Value to Patients Is Crucial When Evaluating Palliative Care', Journal of Pain and Symptom Management, vol. 37, no. 6, p. e7.View/Download from: Publisher's site
Nikles, J, Mitchell, G, Walters, J, Hardy, J, Good, P, Rowett, D, Shelby-James, T & Currow, D 2009, 'Prioritising drugs for single patient (n-of-1) trials in palliative care', PALLIATIVE MEDICINE, vol. 23, no. 7, pp. 623-634.View/Download from: Publisher's site
Rocker, G, Horton, R, Currow, D, Goodridge, D, Young, J & Booth, S 2009, 'Palliation of dyspnoea in advanced COPD: revisiting a role for opioids', THORAX, vol. 64, no. 10, pp. 910-915.View/Download from: Publisher's site
Roder, D & Currow, D 2009, 'Cancer in Aboriginal and Torres Strait Islander People of Australia', ASIAN PACIFIC JOURNAL OF CANCER PREVENTION, vol. 10, no. 5, pp. 729-733.
Rose, M & Currow, DC 2009, 'The need for chemical compatibility studies of subcutaneous medication combinations used in palliative care', Journal of Pain and Palliative Care Pharmacotherapy, vol. 23, no. 3, pp. 223-230.View/Download from: Publisher's site
When a person with a life-limiting illness is unable to swallow, the subcutaneous route of administration is a widely used way of administering many medications, either as repeated bolus injections or by continuous infusions to complement transdermal, sublingual, or rectal routes of administration. To optimize symptom control as changes are made from other routes of administration to subcutaneous delivery, basic principles for ensuring optimal net clinical benefit (therapeutic benefit and minimizing side effects) must be understood as fully as science will allow. Despite the widespread use of combinations of injectable medications in this clinical setting and the availability of the technology to do the studies, the limited work done suggests that there may be significant drug loss with some combinations of medications without any visual or physical changes apparent. Work needs to be done urgently to evaluate a wide range of medication combinations used extensively in hospice and palliative care for chemical compatibility, while ensuring the work that has been done in other areas (anesthetics, chronic pain) is adopted into practice as results become available. Almost all of these medications are off-patent and there is therefore no financial incentive for the pharmaceutical industry to do the studies on medications now produced generically. Other sources of funding need to be identified. At best, it is likely that optimal symptom control is at times compromised in palliative care without chemical compatibility data for combinations of injectable medications and, at worst, toxicity is generated unknowingly.
Rowett, D, Ravenscroft, PJ, Hardy, J & Currow, DC 2009, 'Using National Health Policies to Improve Access to Palliative Care Medications in the Community', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 37, no. 3, pp. 395-402.View/Download from: Publisher's site
Zafar, SY, Abernethy, AP & Currow, D 2009, 'Other Problems With Phase III Best Supportive Care Studies IN REPLY', JOURNAL OF CLINICAL ONCOLOGY, vol. 27, no. 5, pp. 829-829.View/Download from: Publisher's site
Agar, M, Currow, D, Plummer, J, Seidel, R, Carnahan, R & Abernethy, AP 2009, 'Changes in anticholinergic load from regular prescribed medications in palliative care as death approaches', PALLIATIVE MEDICINE, vol. 23, no. 3, pp. 257-265.View/Download from: Publisher's site
Agar, M, Currow, D, Plummer, J, Seidel, R, Carnahan, R & Abernethy, AP 2009, 'Changes in Anticholinergic Load From Regular Prescribed Medications in Palliative Care as Death Approaches Editorial Comment', JOURNAL OF UROLOGY, vol. 182, no. 6, pp. 2840-2840.
Currow, DC, Agar, M, Smith, J & Abernethy, AP 2009, 'Does palliative home oxygen improve dyspnoea? A consecutive cohort study', PALLIATIVE MEDICINE, vol. 23, no. 4, pp. 309-316.View/Download from: Publisher's site
Abernethy, AP & Currow, DC 2008, 'Culture and financing influence palliative care services, study populations, and generalizability of research findings', JOURNAL OF PALLIATIVE MEDICINE, vol. 11, no. 2, pp. 146-146.View/Download from: Publisher's site
Abernethy, AP, Currow, DC, Fazekas, BS, Luszcz, MA, Wheeler, JL & Kuchibhatla, M 2008, 'Specialized palliative care services are associated with improved short- and long-term caregiver outcomes', SUPPORTIVE CARE IN CANCER, vol. 16, no. 6, pp. 585-597.View/Download from: Publisher's site
Abernethy, AP, Uronis, HE, Wheeler, JL & Currow, DC 2008, 'Pharmacological management of breathlessness in advanced disease', Progress in Palliative Care, vol. 16, no. 1, pp. 15-20.View/Download from: Publisher's site
Dyspnoea is one of the most distressing symptoms experienced by patients with life-limiting illnesses; when not relieved by disease management strategies it is termed 'refractory dyspnoea' and global palliative approaches are required. The focus of care shifts from prolonging survival to reducing symptoms, increasing function, and improving quality of life. Numerous pharmacological and non-pharmacological interventions can achieve these goals, though the level of evidence supporting their use varies. This narrative review provides a summary of pharmacological options for the management of refractory breathlessness, with a focus on those options with adequate supporting data; oxygen therapy is also considered as a potentially viable palliative measure. Currently available evidence is provided, highlighting areas for further investigation of selected approaches. The agents with adequate current evidence warranting inclusion as current 'best practices' are: oxygen, opioids, psychotropic drugs, inhaled frusemide, and Heliox 28. © 2008 W.S. Maney & Son Ltd.
Aoun, S, Kristjanson, LJ, Oldham, L & Currow, D 2008, 'A qualitative investigation of the palliative care needs of terminally ill people who live alone', COLLEGIAN, vol. 15, no. 1, pp. 3-9.View/Download from: Publisher's site
Boyle, P, Anderson, BO, Andersson, LC, Ariyaratne, Y, Auleley, G-R, Barbacid, M, Bartelink, H, Baselga, J, Behbehani, K, Belardelli, F, Berns, A, Bishop, J, Brawley, O, Burns, H, Clanton, M, Cox, B, Currow, D, Dangou, J-M, de Valeriola, D, Dinshaw, K, Eggermont, A, Fitzpatrick, J, Forstmane, M, Garaci, E, Gavin, AT, Kakizoe, T, Kasler, M, Keita, N, Kerr, D, Khayat, D, Khleif, S, Khuhaprema, T, Knezevic, T, Kubinova, R, Mallath, M, Martin-Moreno, J, McCance, D, McVie, JG, Merriman, A, Ngoma, T, Nowacki, M, Orgelbrand, J, Park, J-G, Pierotti, M, Ashton, LP, Puska, P, Escobar, CVR, Rajan, B, Rajkumar, T, Ringborg, U, Robertson, C, Rodger, A, Roovali, L, Santini, LA, Sarhan, M, Seffrin, J, Semiglazov, V, Shrestha, BM, Soo, KC, Stamenic, V, Tamblyn, C, Thomas, R, Tuncer, M, Tursz, T, Vaitkiene, R, Vallejos, C, Veronesi, U, Wojtyla, A, Yach, D, Yoo, K-Y, Zatonski, W, Zaridze, D, Zeng, Y-X, Zhao, P & Zheng, T 2008, 'Need for global action for cancer control', ANNALS OF ONCOLOGY, vol. 19, no. 9, pp. 1519-1521.View/Download from: Publisher's site
Clayton, JM, Hancock, K, Parker, S, Butow, PN, Walder, S, Carrick, S, Currow, D, Ghersi, D, Glare, P, Hagerty, R, Olver, IN & Tattersall, MHN 2008, 'Sustaining hope when communicating with terminally ill patients and their families: a systematic review', PSYCHO-ONCOLOGY, vol. 17, no. 7, pp. 641-659.View/Download from: Publisher's site
Currow, DC, Allen, K, Plummer, J, Aoun, S, Hegarty, M & Abernethy, AP 2008, 'Bereavement help-seeking following an 'expected' death: a cross-sectional randomised face-to-face population survey', BMC Palliative Care, vol. 7, no. 1.View/Download from: Publisher's site
Currow, DC, Burns, CM & Abernethy, AR 2008, 'Place of death for people with noncancer and cancer illness in South Australia: A population-based survey', JOURNAL OF PALLIATIVE CARE, vol. 24, no. 3, pp. 144-150.View/Download from: Publisher's site
Currow, DC, Christou, T, Smith, J, Carmody, S, Lewin, G, Aoun, S & Abernethy, AP 2008, 'Do Terminally Ill People who Live Alone Miss Out on Home Oxygen Treatment? An Hypothesis Generating Study', JOURNAL OF PALLIATIVE MEDICINE, vol. 11, no. 7, pp. 1015-1022.View/Download from: Publisher's site
Currow, DC, Christou, T, Smith, J, Carmody, S, Lewin, G, Aoun, S & Abernethy, AP 2008, 'Do Terminally Ill People Who Live Alone Miss Out on Home Oxygen Treatment? An Hypothesis Generating Study (vol 11, pg 1015, 2008)', JOURNAL OF PALLIATIVE MEDICINE, vol. 11, no. 9, pp. 1285-1285.View/Download from: Publisher's site
Currow, DC, Eagar, K, Aoun, S, Fildes, D, Yates, P & Kristjanson, LJ 2008, 'Is it feasible and desirable to collect voluntarily quality and outcome data nationally in palliative oncology care?', JOURNAL OF CLINICAL ONCOLOGY, vol. 26, no. 23, pp. 3853-3859.View/Download from: Publisher's site
Currow, DC, Ward, A, Clark, K, Burns, CM & Abernethy, AP 2008, 'Caregivers for people with end-stage lung disease: Characteristics and unmet needs in the whole population', International Journal of COPD, vol. 3, no. 4, pp. 753-762.
Introduction: End-stage lung disease (ESLD) (predominantly caused by chronic obstructive pulmonary disease and restrictive lung disease) is a significant cause of death. Little is known about community care for people with ESLD especially in the period leading to death. This paper describes demographic characteristics of caregivers, and key characteristics of the deceased irrespective of specialist service utilization. Methods: The South Australian Health Omnibus is an annual, random, face-to-face, cross-sectional survey conducted statewide. For the last eight years questions about end of life have been asked of 3000 respondents annually (participation rate 77.9%). Directly standardized to the whole population, this study describes people who cared for someone with ESLD until death. Results: One third (6370/18267) had someone die in the last five years from a terminal illness, 644 from ESLD (3.5% of respondents; 10.2% of deaths). One in five (20.8%) provided physical care: 43 respondents provided day-to-day and 63 provided intermittent hands-on care for an average of 40.1 months (SD 56.9). Caregivers were on average 51.2 years old (range 17-85; SD 16.5) and one in five was a spouse. Additional support to provide physical care was an unmet need by 17% of caregivers. The deceased were an average of 73.9 years old (range 47-92; SD 10.4). Only 31.1% were assessed as 'comfortable' or 'very comfortable' in the last fortnight of life. Discussion: Given the health consequences of caregiving, caregivers of people with ESLD would benefit from prospectively defining their needs given the time for which intense caregiving is provided. © 2008 Currow et al, publisher and licensee Dove Medical Press Ltd.
Currow, DC, Ward, AM, Plummer, JL, Bruera, E & Abernethy, AP 2008, 'Comfort in the last 2 weeks of life: relationship to accessing palliative care services', SUPPORTIVE CARE IN CANCER, vol. 16, no. 11, pp. 1255-1263.View/Download from: Publisher's site
Dupont, A, Abernethy, A, Bums, CM, Wheeler, J & Currow, D 2008, 'Defining distinct Caregiver sub-populations by intensity of end-of-life care provided', PSYCHO-ONCOLOGY, vol. 17, pp. S122-S122.
Grbich, C, Abernethy, AR, Shelby-James, T, Fazekas, B & Currow, DC 2008, 'Creating a research culture in a palliative care service environment: a qualitative study of the evolution of staff attitudes to research during a large longitudinal controlled trial (ISRCTN81117481)', JOURNAL OF PALLIATIVE CARE, vol. 24, no. 2, pp. 100-109.View/Download from: Publisher's site
Greene, AG, Kenny, B & Currow, DC 2008, 'Reducing the paperwork for residential aged-care facility waiting lists', MEDICAL JOURNAL OF AUSTRALIA, vol. 189, no. 1, pp. 50-50.View/Download from: Publisher's site
Johnson, CE, Girgis, A, Paul, CL & Currow, DC 2008, 'Cancer specialists' palliative care referral practices and perceptions: results of a national survey', PALLIATIVE MEDICINE, vol. 22, no. 1, pp. 51-57.View/Download from: Publisher's site
Tieman, J, Sladek, R & Currow, D 2008, 'Changes in the Quantity and Level of Evidence of Palliative and Hospice Care Literature: The Last Century', JOURNAL OF CLINICAL ONCOLOGY, vol. 26, no. 35, pp. 5679-5683.View/Download from: Publisher's site
Uronis, HE, Currow, DC, McCrory, DC, Samsa, GP & Abernethy, AP 2008, 'Oxygen for relief of dyspnoea in mildly- or non-hypoxaemic patients with cancer: a systematic review and meta-analysis', BRITISH JOURNAL OF CANCER, vol. 98, no. 2, pp. 294-299.View/Download from: Publisher's site
Waller, A, Girgis, A, Currow, D & Lecathelinais, C 2008, 'Development of the Palliative Care Needs Assessment Tool (PC-NAT) for use by multi-disciplinary health professionals', PALLIATIVE MEDICINE, vol. 22, no. 8, pp. 956-964.View/Download from: Publisher's site
Agar, M, Currow, DC, Plummer, J, Chye, R & Draper, B 2008, 'Differing management of people with advanced cancer and delirium by four sub-specialties', PALLIATIVE MEDICINE, vol. 22, no. 5, pp. 633-640.View/Download from: Publisher's site
Agar, M, Currow, DC, Shelby-James, TM, Plummer, J, Sanderson, C & Abernethy, AP 2008, 'Preference for place of care and place of death in palliative care: are these different questions?', PALLIATIVE MEDICINE, vol. 22, no. 7, pp. 787-795.View/Download from: Publisher's site
Clark, K, Currow, DC, Agar, M, Fazekas, BS & Abernethy, AP 2008, 'A pilot phase II randomized, cross-over, double-blinded, controlled efficacy study of octreotide versus hyoscine hydrobromide for control of noisy breathing at the end-of-life', Journal of Pain and Palliative Care Pharmacotherapy, vol. 22, no. 2, pp. 131-138.View/Download from: Publisher's site
Noisy breathing at the end of life (noisy breathing (NB) occurs in up to 90% of people. Interventions have not been systematically evaluated. There has been clinical observation coupled with a proposed mechanism of effect that supports a role for octreotide in management of NB. The aim of this phase II study was to assess ten completed participants for the feasibility of an adequately powered phase III study. This randomized, double-blind, crossover pilot trial recruited participants from an inpatient palliative unit. Participants while well and their proxies simultaneously provided written informed consent. If NB were encountered, people were randomized to 200 mcg octreotide or 400 mcg hyoscine hydrobromide subcutaneously. If subsequent treatment was needed, the other medication was administered. A five point categorical scale documented the nurses' assessment of secretions over six hours. Eighty participants were consented of whom 10 (3 females, 7 males; median age 79, all with advanced cancer) received medication, five in each arm. There was no difference in the median time to administration of the second medication (3 hours). Two participants in each arm had a 2 category reduction of intensity after the second medication. Although feasible to consent and study this population in a way that respects autonomy and dignity even in the terminal hours of life, this pilot study suggests reconsideration of the pharmacological interventions (choice of agents, dosing, timing of dosing and pharmacokinetic profiles), standardizing of non-pharmacological care; and ways to measure directly family distress before further randomized studies for this symptom. © 2008 by Informa Healthcare USA, Inc. All rights reserved.
Currow, DC, Agar, M, Sanderson, C & Abernethy, AP 2008, 'Populations who die without specialist palliative care: does lower uptake equate with unmet need?', PALLIATIVE MEDICINE, vol. 22, no. 1, pp. 43-50.View/Download from: Publisher's site
Currow, DC, Agar, M, Tientan, J & Abernethy, AP 2008, 'Multi-site research allows adequately powered palliative care trials; web-based data management makes it achievable today', PALLIATIVE MEDICINE, vol. 22, no. 1, pp. 91-92.View/Download from: Publisher's site
Jeyasingam, L, Agar, M, Soares, M, Plummer, J & Currow, D 2008, 'A prospective study of unmet activity of daily living needs in palliative care inpatients', AUSTRALIAN OCCUPATIONAL THERAPY JOURNAL, vol. 55, no. 4, pp. 266-272.View/Download from: Publisher's site
Aoun, S, Kristjanson, LJ, Currow, D, Skett, K, Oldham, L & Yates, P 2007, 'Terminally-ill people living alone without a caregiver: an Australian national scoping study of palliative care needs', PALLIATIVE MEDICINE, vol. 21, no. 1, pp. 29-34.View/Download from: Publisher's site
Clayton, JM, Butow, PN, Tattersall, MHN, Devine, RJ, Simpson, JM, Aggarwal, G, Clark, KJ, Currow, DC, Elliott, LM, Lacey, J, Lee, PG & Noel, MA 2007, 'Randomized controlled trial of a prompt list to help advanced cancer patients and their caregivers to ask questions about prognosis and end-of-life care', JOURNAL OF CLINICAL ONCOLOGY, vol. 25, no. 6, pp. 715-723.View/Download from: Publisher's site
Clayton, JM, Hancock, KM, Butow, PN, Tattersall, MHN & Currow, DC 2007, 'Clinical practice guidelines for communicating prognosis and end-of-life issues with adults in the advanced stages of a life-limiting illness, and their caregivers - Reply', MEDICAL JOURNAL OF AUSTRALIA, vol. 187, no. 8, pp. 478-478.View/Download from: Publisher's site
Clayton, JM, Hancock, KM, Butow, PN, Tattersall, MHN, Currow, DC, Adler, J, Aranda, S, Auret, K, Boyle, F, Britton, A, Chye, R, Clark, K, Davidson, P, Davis, JM, Girgis, A, Graham, S, Hardy, J, Introna, K, Kearsley, J, Kerridge, I, Kristjanson, L, Martin, P, McBride, A, Meller, A, Mitchell, G, Moore, A, Noble, B, Olver, I, Parker, S, Peters, M, Saul, P, Stewart, C, Swinburne, L, Tobin, B, Tuckwell, K & Yates, P 2007, 'Clinical practice guidelines for communicating prognosis and end-of-life issues with adults in the advanced stages of a life-limiting illness, and their caregivers.', The Medical journal of Australia, vol. 186, no. 12 Suppl.View/Download from: Publisher's site
PURPOSE OF REVIEW: This paper reviews the current evidence for the pharmacological treatment of refractory symptomatic breathlessness in people with advanced life-limiting illnesses. The paper does not explore changes in function. RECENT FINDINGS: Oral and parenteral opioids reduce dyspnoea, and data continue to add to this indication for these drugs. Optimal dosing of opioids is being refined. Interest in other medications continues to be explored - benzodiazepines, nebulised frusemide, and selective serotonin reuptake inhibitors - but their role in day-to-day clinical practice is not defined. SUMMARY: Low-dose regular opioids, especially sustained-release preparations, have a key role in the pharmacological management of dyspnoea when titrated for effect, and may be used regularly across a range of underlying pathophysiologies. Key research questions for all the current symptomatic pharmacological agents used in refractory dyspnoea remain.
Currow, DC, Fazekas, B & Abernethy, AP 2007, 'Oxygen use-patients define symptomatic benefit discerningly', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 34, no. 2, pp. 113-114.View/Download from: Publisher's site
Currow, DC, Plummer, J, Frith, P & Abernethy, AP 2007, 'Can we predict which patients with refractory Dyspnea will respond to opioids?', JOURNAL OF PALLIATIVE MEDICINE, vol. 10, no. 5, pp. 1031-1036.View/Download from: Publisher's site
Currow, DC, Plummer, JL, Cooney, NJ, Gorman, D & Glare, PA 2007, 'A randomized, double-blind, multi-site, crossover, placebo-controlled equivalence study of morning versus evening once-daily sustained-release morphine sulfate in people with pain from advanced cancer', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 34, no. 1, pp. 17-23.View/Download from: Publisher's site
Currow, DC, Stevenson, JP, Abernethy, AP, Plummer, J & Shelby-James, TM 2007, 'Prescribing in palliative care as death approaches', JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, vol. 55, no. 4, pp. 590-595.View/Download from: Publisher's site
Hancock, K, Clayton, JM, Parker, SM, Walder, S, Blttow, PN, Carrick, S, Currow, D, Ghersi, D, Glare, P, Hagerty, R & Tattersall, MHN 2007, 'Discrepant perceptions about end-of-life communication: A systematic review', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 34, no. 2, pp. 190-200.View/Download from: Publisher's site
Hancock, K, Clayton, JM, Parker, SM, Wall der, S, Butow, PN, Carrick, S, Currow, D, Ghersi, D, Glare, P, Hagerty, R & Tattersall, MHN 2007, 'Truth-telling in discussing prognosis in advanced life-limiting illnesses: a systematic review', PALLIATIVE MEDICINE, vol. 21, no. 6, pp. 507-517.View/Download from: Publisher's site
Hegarty, M & Currow, DC 2007, 'Palliative aged care: Collaborative partnerships between gerontology, geriatrics and palliative care', INTERNATIONAL JOURNAL OF GERONTOLOGY, vol. 1, no. 3, pp. 112-117.View/Download from: Publisher's site
Parker, SM, Clayton, JM, Hancock, K, Walder, S, Butow, PN, Carrick, S, Currow, D, Ghersi, D, Glare, P, Eth, A, Hagerty, R & Tattersall, MHN 2007, 'A systematic review of Prognostic/End-of-Life communication with adults in the advanced stages of a life-limiting illness: Patient/caregiver preferences for the content, style, and timing of information', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 34, no. 1, pp. 81-93.View/Download from: Publisher's site
Parker, SM, Clayton, JM, Hancock, K, Walder, S, Butow, PN, Carrick, S, Currow, D, Ghersi, D, Glare, P, Hagerty, R & Tattersall, MHN 2007, 'A Systematic Review of Prognostic/End-of-Life Communication with Adults in the Advanced Stages of a Life-Limiting Illness: Patient/Caregiver Preferences for the Content, Style, and Timing of Information', Journal of Pain and Symptom Management, vol. 34, no. 1, pp. 81-93.View/Download from: Publisher's site
Evidence-based recommendations concerning how to discuss dying, life expectancy, and likely future symptoms with patients with a limited life expectancy and their families are lacking. The aim of this systematic review was to review studies regarding prognostic/end-of-life communication with adult patients in the advanced stages of a life-limiting illness and their caregivers. Relevant studies meeting the inclusion criteria were identified by searching computerized databases up to November 2004. One hundred twenty-three studies met the criteria for the full review, and 46 articles reported on patient/caregiver preferences for content, style, and timing of information. The majority of the research was descriptive. Although there were individual differences, patients/caregivers in general had high levels of information need at all stages of the disease process regarding the illness itself, likely future symptoms and their management, and life expectancy and information about clinical treatment options. Patient and caregiver information needs showed a tendency to diverge as the illness progressed, with caregivers needing more and patients wanting less information. Patients and caregivers preferred a trusted health professional who showed empathy and honesty, encouraged questions, and clarified each individual's information needs and level of understanding. In general, most patients/caregivers wanted at least some discussion of these topics at the time of diagnosis of an advanced, progressive, life-limiting illness, or shortly after. However, they wanted to negotiate the content and extent of this information. © 2007 U.S. Cancer Pain Relief Committee.
Sanderson, CR, Koczwara, B & Currow, DC 2007, 'The "therapeutic footprint" of medical, complementary and alternative therapies and a doctor's duty of care - Reply', MEDICAL JOURNAL OF AUSTRALIA, vol. 186, no. 4, pp. 214-215.View/Download from: Publisher's site
Shelby-James, TM, Currow, DC, Phillips, PA, Williams, H & Abernethy, AP 2007, 'Promoting patient centred palliative care though case conferencing', AUSTRALIAN FAMILY PHYSICIAN, vol. 36, no. 11, pp. 961-964.
Sladek, RM, Tieman, J & Currow, DC 2007, 'Improving search filter development: a study of palliative care literature', BMC MEDICAL INFORMATICS AND DECISION MAKING, vol. 7.View/Download from: Publisher's site
Stevenson, JP, Currow, DC & Abernethy, AP 2007, 'Frameworks for prescribing in comorbid illness', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 34, no. 2, pp. 117-118.View/Download from: Publisher's site
Stevenson, JP, Currow, DC & Abernethy, AP 2007, 'The broader implications of managing statins at the end of life', JOURNAL OF PALLIATIVE CARE, vol. 23, no. 3, pp. 188-189.View/Download from: Publisher's site
Tieman, J, Mitchell, G, Shelby-James, T, Currow, D, Fazekas, B, O'Doherty, L, Hegarty, M, Eriksson, L, Brown, R & Reid-Orr, D 2007, 'Integration, coordination and multidisciplinary care: What can these approaches offer to Australian primary health care?', AUSTRALIAN JOURNAL OF PRIMARY HEALTH, vol. 13, no. 2, pp. 56-65.View/Download from: Publisher's site
Uronis, HE, McCrory, DC, Samsa, GP, Currow, DC & Abernethy, A 2007, 'Palliative oxygen for non-hypoxaemic chronic obstructive pulmonary disease', Cochrane Database of Systematic Reviews, no. 2.View/Download from: Publisher's site
Abernethy, AP, Currow, DC, Hunt, R, Williams, H, Roder-Allen, G, Rowett, D, Shelby-James, T, Esterman, A, May, F & Phillips, PA 2006, 'A pragmatic 2x2x2 factorial cluster randomized controlled trial of educational outreach visiting and case conferencing in palliative care - methodology of the Palliative Care Trial [ISRCTN 81117481]', CONTEMPORARY CLINICAL TRIALS, vol. 27, no. 1, pp. 83-100.View/Download from: Publisher's site
Abernethy, AP, Currow, DC, Shelby-James, T, Williams, H, Roder-Allen, G, Hunt, R, Rowett, D, Esterman, A, May, F & Phillips, PA 2006, 'Improving palliative care: A 2x2x2 factorial cluster randomized controlled trial of case conferencing and educational outreach visiting', Journal of Clinical Oncology, vol. 24, no. 18_suppl, pp. 8517-8517.View/Download from: Publisher's site
8517 Background: Evidence-based palliative care service delivery models are needed. General practitioner (GP) and patient-centered case conferences may increase multidisciplinary interaction and enhance patient care. Educational outreach visiting in pain management may empower learners and improve care. Methods: Three interventions were tested against a routine care control in a 2×2×2 cluster factorial randomized controlled trial. Interventions were case conferencing, educational visiting for GPs, and educational visiting for patients. Subjects were adult patients referred to palliative care services in southern Adelaide, Australia, with any pain in the preceding 3 months. Participants were followed longitudinally until death. Main outcomes included performance status (Australian-modified Karnofsky Performance Status (AKPS)) and hospitalization rates. Longitudinal intention-to-treat analyses using cluster-specific methods were conducted. The sample goal was 460. Results: 461 participants were enrolled from 4/02–6/04. Mean age was 71 yrs, 50% were male, 91% had cancer. Mean and median survival was 146 and 87 days; median baseline AKPS was 60%. When participants had AKPS <70 (i.e. required a caregiver) at referral, those randomized to case conferencing or patient education had higher mean performance status than routine care (case conferencing: average daily AKPS, 54.9% vs 46.3%, p=0.0106; patient education: 54.7% vs 46.4%, p=0.0120). GP education did not improve performance status. Both case conferencing and patient education significantly decreased hospitalization rates compared to routine care (case conferencing: least-squares mean number of hospitalizations, 1.4 (standard error (SE) 0.1) vs 1.9 (SE 0.1), p=0.0002; patient education: 1.4 (SE 0.1) vs 1.8 (SE 0.1), p=0.0078). The addition of both interventions decreased hospitalizations to 1.2 (SE 0.1). Conclusion: At a time when declining function and higher healthcare utilization is...
Allen, K, Swetenham, K, Currow, D, Hegarty, M & Abernthy, A 2006, 'Bereavement help-seeking following a palliative death-a cross-sectional randomised population survey', PSYCHO-ONCOLOGY, vol. 15, no. 2, pp. S425-S426.
Care of people at the end of life is a challenge for the person with a life-limiting illness, their family and friends, and their professional carers. Clinicians, including pastoral care workers, nurses, doctors, and allied health professionals, find themselves at the bedside of the dying. At times, the professional's sense of self is challenged both by the suffering that they witness (physical, emotional, existential, social, sexual, or financial) and a sense of helplessness to relieve not only the patient's suffering but also that of the people to whom the dying person is close. What framework can help us to deal with the suffering that we cannot help but encounter? Ultimately people connecting in a real and meaningful way with other people is probably the only way that each of us can confront suffering and not have it destroy us. Creating an environment where people can begin to, or continue to connect with others at a level that is meaningful for all concerned is a pivotal starting point in dealing with suffering in any encounter with people at the bedside. Copyright © by The Haworth Press, Inc. All rights reserved.
Currow, D, Hegarty, M, Allen, K, Swetenham, K & Abernethy, A 2006, 'Bereavement help-seeking following a palliative death', JOURNAL OF PALLIATIVE CARE, vol. 22, no. 3, pp. 192-192.
Currow, D, Shelby-James, T, Plummer, J, Stevenson, J & Abernethy, A 2006, 'Polypharmacy worsens as death approaches', JOURNAL OF PALLIATIVE CARE, vol. 22, no. 3, pp. 214-214.
Currow, DC & Abernethy, AP 2006, 'Reader questions benefit of nebulized opioids', ONCOLOGY NURSING FORUM, vol. 33, no. 3, pp. 513-513.
Currow, DC & Hegarty, M 2006, 'Residential aged-care facility palliative care guidelines: improving care.', International journal of palliative nursing, vol. 12, no. 5, pp. 231-233.View/Download from: Publisher's site
The Guidelines for a Palliative Approach in Residential Aged Care (Australian Government Department of Health and Ageing, 2004) are the result of the synthesis of evidence from three disciplines: geriatrics, gerontology and palliative care. Each paradigm challenges and informs the others, together developing a balanced and enriched understanding of palliative aged care. The guidelines address the challenges of the clinical and service delivery contexts of palliative care in residential aged care facilities, including the impact of complex, co-morbid illnesses with unpredictable trajectories; shorter, more dependent inpatient stays; and an evolving accreditation process.
Currow, DC, Abernethy, AP, Shelby-James, TM & Phillips, PA 2006, 'The impact of conducting a regional palliative care clinical study', PALLIATIVE MEDICINE, vol. 20, no. 8, pp. 735-743.View/Download from: Publisher's site
Girgis, A, Currow, DC, Johnson, CE, Waller, AE & Kristjanson, LJ 2006, 'Overview of a research program to improve needs based palliative care in Australia', PSYCHO-ONCOLOGY, vol. 15, no. 2, pp. S251-S251.
Girgis, A, Johnson, C, Aoun, S & Currow, D 2006, 'Challenges experienced by informal caregivers in cancer', Cancer Forum, vol. 30, no. 1, pp. 21-25.
Evidence from the literature highlights the significant negative impact of care giving on the physical, mental and financial aspects of caregivers' lives. It also reinforces the importance of reducing the barriers to meeting the unmet needs of caregivers and that research priorities in intervention development need to focus on reducing the negative aspects of care giving. Increased assistance to caregivers needs to ensure that they have the knowledge, skills, income security, job protection and other supports to provide care, while maintaining their own health and well-being throughout the dying and grieving process. This is particularly important in light of the predicted shortfall in the number in caregivers and especially as caregivers are increasingly replacing skilled health workers in the delivery of unfamiliar, complex cancer care at home.
Good, PD, Cavenagh, JD, Currow, DC, Woods, DA, Tuffin, PH & Ravenscroft, PJ 2006, 'What are the essential medications in pallative care? - a survey of Australian palliative care doctors.', Australian family physician., vol. 35, no. 4, pp. 261-264.
BACKGROUND: There is a disparity of availability and cost of drugs in the community for palliative care patients through the Pharmaceutical Benefits Scheme (PBS) compared to those available to inpatients in public hospitals. METHODS: The Joint Therapeutics Committee of the Australian and New Zealand Society of Palliative Medicine, Palliative Care Australia and the Clinical Oncological Society of Australia surveyed palliative care practitioners in Australia to compile a list of drugs they considered essential. RESULTS: Drugs nominated generally had good levels of evidence for use in palliative care, although many practitioners still used some without evidence of benefit. DISCUSSION: We are now working with the Commonwealth Department of Health and Ageing to agree on a list of drugs for specific palliative care indications. As a result, the first ever section in the PBS for a specific patient population has been created. There is a need for high quality studies in palliative care to determine the best drugs to add to the list.
Hegarty, MM, Devery, K, Breaden, K & Currow, DC 2006, 'The impact of refractory suffering: Educating clinicians in awareness and capacity building through an online multidisciplinary postgraduate programme', PSYCHO-ONCOLOGY, vol. 15, no. 2, pp. S263-S264.
Martin, M, Currow, DC & Abernethy, AP 2006, 'Breadth of prescribing in palliative care, a prospective cohort study', JOURNAL OF GENERAL INTERNAL MEDICINE, vol. 21, pp. 22-22.
Sanderson, CR, Koczwara, B & Currow, DC 2006, 'The "therapeutic footprint" of medical, complementary and alternative therapies and a doctor's duty of care', MEDICAL JOURNAL OF AUSTRALIA, vol. 185, no. 7, pp. 373-376.View/Download from: Publisher's site
Seidel, R, Sanderson, C, Mitchell, G & Currow, DC 2006, 'Until the chemist opens - palliation from the doctor's bag.', Australian family physician., vol. 35, no. 4, pp. 225-231.
BACKGROUND: People with a life limiting illness may have unpredictable exacerbations of their symptoms requiring after hours care by general practitioners using medications that are readily accessible. All doctors are provided with injectable 'doctor's bag' emergency drugs for use in such a crisis. OBJECTIVE: This article aims to: identify which medications from the doctor's bag can be used in the palliative care crises that are most frequently encountered, present the best possible evidence for these indications, and to provide GPs caring for palliative care patients after hours with management strategies so, whenever appropriate, they can continue to be managed at home. DISCUSSION: The clinical context, including disease trajectory and patient and caregivers' wishes, must be assessed in palliative care crises. Having excluded reversible problems, symptoms can be treated using doctor's bag medications. Attention must be given to route of administration, duration of effect, and appropriate doses for effective palliation.
Shelby-James, T, Abernethy, AP & Currow, DC 2006, 'Evidence in palliative care research: how should it be gathered?', MEDICAL JOURNAL OF AUSTRALIA, vol. 184, no. 4, pp. 196-197.View/Download from: Publisher's site
Sladek, R, Tieman, J, Fazekas, BS, Abernethy, AR & Currow, DC 2006, 'Development of a subject search filter to find information relevant to palliative care in the general medical literature', JOURNAL OF THE MEDICAL LIBRARY ASSOCIATION, vol. 94, no. 4, pp. 394-401.
Tieman, J & Currow, DC 2006, 'Evidence in palliative care research: how should it be gathered?', MEDICAL JOURNAL OF AUSTRALIA, vol. 184, no. 4, pp. 197-198.
Uronis, HE, Currow, DC & Abernethy, AP 2006, 'Palliative management of refractory dyspnea in COPD.', International journal of chronic obstructive pulmonary disease, vol. 1, no. 3, pp. 289-304.View/Download from: Publisher's site
COPD is a progressive illness with worldwide impact. Patients invariably reach a point at which they require palliative interventions. Dyspnea is the most distressing symptom experienced by these patients; when not relieved by traditional COPD management strategies it is termed "refractory dyspnea" and palliative approaches are required. The focus of care shifts from prolonging survival to reducing symptoms, increasing function, and improving quality of life. Numerous pharmacological and non-pharmacological interventions can achieve these goals, though evidence supporting their use is variable. This review provides a summary of the options for the management of refractory dyspnea in COPD, outlining currently available evidence and highlighting areas for further investigation. Topics include oxygen, opioids, psychotropic drugs, inhaled furosemide, Heliox, rehabilitation, nutrition, psychosocial support, breathing techniques, and breathlessness clinics.
Agar, M, Chye, R, Currow, D & Draper, B 2006, 'Survey of current practice: Management of delirium by palliative care, psychogeriatric, geriatric, and oncology specialists in Australia and New Zealand', JOURNAL OF PALLIATIVE CARE, vol. 22, no. 3, pp. 209-210.
Abernethy, AP, Currow, DC, Frith, P & Fazekas, BS 2005, 'Prescribing palliative oxygen: a clinician survey of expected benefit and patterns of use', PALLIATIVE MEDICINE, vol. 19, no. 2, pp. 168-170.View/Download from: Publisher's site
Abernethy, AP, Shelby-James, T, Fazekas, BS, Woods, D & Currow, DC 2005, 'The Australia-modified Karnofsky Performance Status (AKPS) scale: A revised scale for contemporary palliative care clinical practice [ISRCTN81117481]', BMC Palliative Care, vol. 4.View/Download from: Publisher's site
Background: The Karnofsky Performance Status (KPS) is a gold standard scale. The Thornemodified KPS (TKPS) focuses on community-based care and has been shown to be more relevant to palliative care settings than the original KPS. The Australia-modified KPS (AKPS) blends KPS and TKPS to accommodate any setting of care. Methods: Performance status was measured using all three scales for palliative care patients enrolled in a randomized controlled trial in South Australia. Care occurred in a range of settings. Survival was defined from enrollment to death. Results: Ratings were collected at 1600 timepoints for 306 participants. The median score on all scales was 60. KPS and AKPS agreed in 87% of ratings; 79% of disagreements occurred within 1 level on the 11-level scales. KPS and TKPS agreed in 76% of ratings; 85% of disagreements occurred within one level. AKPS and TKPS agreed in 85% of ratings; 87% of disagreements were within one level. Strongest agreement occurred at the highest levels (70-90), with greatest disagreement at lower levels (≤40). Kappa coefficients for agreement were KPS-TKPS 0.71, KPS-AKPS 0.84, and AKPS-TKPS 0.82 (all p < 0.001). Spearman correlations with survival were KPS 0.26, TKPS 0.27 and AKPS 0.26 (all p < 0.001). AKPS was most predictive of survival at the lower range of the scale. All had longitudinal test-retest validity. Face validity was greatest for the AKPS. Conclusion: The AKPS is a useful modification of the KPS that is more appropriate for clinical settings that include multiple venues of care such as palliative care. © 2005 Abernethy et al; licensee BioMed Central Ltd.
Aoun, SM, Kristjanson, LJ, Hudson, PL, Currow, DC & Rosenberg, JP 2005, 'The experience of supporting a dying relative: Reflections of caregivers', Progress in Palliative Care, vol. 13, no. 6, pp. 319-325.View/Download from: Publisher's site
This article describes family caregivers' responses to a National Inquiry into the Social Impact of Caregiving for Terminally Ill, initiated by Palliative Care Australia, which aimed to influence policy and practice to support caregivers. Caregivers recounted their experiences of supporting a dying relative and reported their unmet needs and the impact that the caregiving role had on their financial, physical and psychosocial well-being. The issues raised by caregivers were consistent with data obtained from a wide cross-section of service providers and a number of findings were congruent with empirical literature related to family caregiving. Caregivers' reports confirm that, to maintain their health and well-being, they need adequate resources, fairer remuneration, quality respite care, education about the role, equipment, psychosocial support, home-help, improved access to the paid workforce and to gain community recognition. Such collected evidence reinforced the importance of policy responses and resource allocations that are focused on helping caregivers perform a vital role into the future.
Currow, DC & Abernethy, AP 2005, 'Quality palliative care: Practitioners' needs for dynamic lifelong learning', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 29, no. 4, pp. 332-334.View/Download from: Publisher's site
Currow, DC, Easterbrook, S & Mattes, R 2005, 'Improving choices for community palliative care: A prospective 2-year pilot of a live-in support person', Progress in Palliative Care, vol. 13, no. 5, pp. 257-262.View/Download from: Publisher's site
Introduction: This prospective pilot evaluates a free-to-client, live-in support person (LISP) for community palliative care. People who needed additional support to be at home rather than in hospital/hospice were included. A LISP from 0900 Monday to 1600 Friday was offered to palliative clients for an initial 2-week placement. Patients and methods: Over 24 months, a sequential cohort was evaluated. Hospital admissions avoided and discharges facilitated, costs and potential uptake rates were gathered. Caregivers provided feedback 3 months after the placement. Results: The LISP had 49 long-term placements with 44 clients saving 409 bed days. Median placement was short (5 days; range, 2-33 days). Only 8 clients used the LISP around-the-clock. Net potential savings (allowing for caregiver costs) were AU$11,379 annually. Qualitatively, caregivers appreciated the re-assurance offered. Discussion: This pilot study supports the need for a randomised controlled trial to evaluate further the role of the free-to-client, LISP for community palliative care. Evaluating new models of service delivery for patients and caregivers is imperative in palliative care. The LISP improves choices for people in a cost-neutral way if existing services can be substituted.
Tieman, JJ, Abernethy, AP, Fazekas, BS & Currow, DC 2005, 'CareSearch: Finding and evaluating Australia's missing palliative care literature', BMC Palliative Care, vol. 4.View/Download from: Publisher's site
Background: Palliative care is an evolving specialty with a growing evidence base. However, evidence is less accessible than it could be with a lower than average conversion of conference abstracts to articles in peer-reviewed journals and the need for more accessible tools to support evidence-based practice (EBP) in palliative care. The CareSearch project involved identifying, collecting and evaluating Australia's "grey" palliative care literature and identifying international published literature missing from the electronic indexing systems. The literature was then catalogued and made publicly available through the CareSearch website. Results: To date over 2,500 items have been included in the CareSearch database and can be accessed and searched through a publicly available website. Nearly 2,000 items are conference abstracts and 178 are theses or government, organisational and planning documents. A further 410 items relate to articles from palliative journals that are not indexed on a major bibliographic database. The website also provides tools and facilities to support palliative care practice and research. Conclusion: CareSearch is a new evidence resource for palliative practitioners, educators and researchers. The palliative community now has access to a more comprehensive literature base as well as a resource that supports the integration of knowledge into practice. This specialised data repository enables users to access information on the body of work that has shaped palliative care development and prevents the potential loss or duplication of research work. It also provides a template for other emerging disciplines to use in capturing their literature and evidence. © 2005 Tieman et al; licensee BioMed Central Ltd.
Currow, D, Andrews, G & Lawrence, J 2004, 'Palliative care in aged care - a key initiative for the aged care sector', AUSTRALASIAN JOURNAL ON AGEING, vol. 23, pp. A51-A52.
Currow, DC, Abernethy, AP & Fazekas, BS 2004, 'Specialist palliative care needs of whole populations: a feasibility study using a novel approach', PALLIATIVE MEDICINE, vol. 18, no. 3, pp. 239-247.View/Download from: Publisher's site
Stevenson, J, Abernethy, AP, Miller, C & Currow, DC 2004, 'Managing comorbidities in patients at the end of life', BMJ-BRITISH MEDICAL JOURNAL, vol. 329, no. 7471, pp. 909-912.View/Download from: Publisher's site
Toye, C, Kristjanson, L, White, K, Sullivan, K, Currow, D, Cordingley, S, Oldham, L, Hearn, L, Leavesley, S, Cook, P, Taylor, A, Shiels, W, Harris, P, Schaper, F & Walton, J 2004, 'The Volunteering in Palliative Residential Aged Care Project', AUSTRALASIAN JOURNAL ON AGEING, vol. 23, pp. A3-A3.
Abernethy, AP, Currow, DC, Frith, P, Fazekas, BS, McHugh, A & Bui, C 2003, 'Randomised, double blind, placebo controlled crossover trial of sustained release morphine for the management of refractory dyspnoea', BRITISH MEDICAL JOURNAL, vol. 327, no. 7414, pp. 523-526.View/Download from: Publisher's site
Berrill, JW & Linnasne, SJ 2003, 'Morphine for management of refractory dyspnoea - Opiates should be used with caution', BMJ-BRITISH MEDICAL JOURNAL, vol. 327, no. 7426, pp. 1288-1288.View/Download from: Publisher's site
Currow, DC & Nightingale, EM 2003, '"A planning guide": developing a consensus document for palliative care service provision', MEDICAL JOURNAL OF AUSTRALIA, vol. 179, no. 6, pp. S23-S25.
Currow, DC & Nightingale, EM 2003, '"A planning guide": Developing a consensus document for palliative care service provision', Medical Journal of Australia, vol. 179, no. 6 SUPPL..View/Download from: Publisher's site
Over the past 30 years, palliative care services have developed in an ad-hoc way in Australia and around the world. Community expectations for palliative care have grown in recent years. As palliative care has evolved, the World Health Organization definition of palliative care has changed substantially. The changes challenge those who are involved in planning, funding and provision of services to meet new expectations. Many services have not attracted adequate nursing, medical and allied health resources to provide interdisciplinary palliative care. A national consensus document ("a planning guide") has been developed in consultation with key stakeholders and organisations. It outlines the minimum needs for service provision, independent of fundholders and models of service delivery.
Currow, DC, Abernethy, AP & Frith, P 2003, 'Morphine for management of refractory dyspnoea - Reply', BMJ-BRITISH MEDICAL JOURNAL, vol. 327, no. 7426, pp. 1288-1289.View/Download from: Publisher's site
Currow, DC, Noel, MA & Sullivan, KA 2003, 'Place of death. What is the measure of Success? ', Irish Medical Journal, vol. 96, no. 4, pp. 120-121.
Hordern, AJ & Currow, DC 2003, 'A patient-centred approach to sexuality in the face of life-limiting illness', Medical Journal of Australia, vol. 179, no. 6 SUPPL..View/Download from: Publisher's site
Sexuality is intrinsic to a person's sense of self and can be an intimate form of communication that helps relieve suffering and lessens the threat to personhood in the face of life-limiting illness. Health professionals struggle to accept that people with life-limiting illness, especially older people, continue to be sexual beings. People facing life-limiting illness may appreciate the opportunity to discuss issues of sexuality and intimacy with a trusted health professional. Practical strategies to assist health professionals to communicate effectively about sexuality and intimacy include creating a conducive atmosphere, initiating the topic, using open-ended questions and a non-judgemental approach, and avoiding medical jargon.
Hordern, AJ & Currow, DC 2003, 'A patient-centred approach to sexuality in the face of life-limiting illness', MEDICAL JOURNAL OF AUSTRALIA, vol. 179, no. 6, pp. S8-S11.
Taylor, K & Currow, D 2003, 'A prospective study of patient identified unmet activity of daily living needs among cancer patients at a comprehensive cancer care centre', Australian Occupational Therapy Journal, vol. 50, no. 2, pp. 79-85.View/Download from: Publisher's site
Cancer, as a chronic illness, demands a new focus in physical and emotional support. Thus, an assessment of activities of daily living needs among cancer patients was completed. A 1-week, cross-sectional survey of patients was undertaken, by using the Modified Barthel Index, the Eastern Co-operative Oncology Group performance status, a Modified Instrumental Activities of Daily Living Scale and a screening tool. As functional status declined, the number of unmet needs per patient increased. At least one-third of patients who would benefit from assessment were not referred. Without simple screening tools, the needs of this population are not always being recognised or met. Patient identified needs, when analysed by functional level and treatment intent, challenge existing assumptions of service provision. In conclusion, there is an unmet need in this cancer population. By using the Screening Tool on referral, and with each change in level of function (as measured by the Eastern Co-operative Oncology Group), it would help identify patients who may benefit more from occupational therapy assessment.
Currow, DC 2002, 'Integrating cancer and supportive services: The progress and the challenges', Cancer Forum, vol. 26, no. 1, pp. 3-4.
Mitchell, G & Currow, D 2002, 'Chemotherapy and radiotherapy. When to call it quits.', Australian family physician, vol. 31, no. 2, pp. 129-133.
BACKGROUND: Patients diagnosed with cancer are often treated with chemotherapy and radiotherapy with curative intent. The transition from curative to palliative intent involves re-evaluation of treatment, and has to take into account the attitudes, beliefs and life aims of the patient. OBJECTIVE: To discuss the difficulties in determining when to cease chemotherapy and radiotherapy in patients with advanced cancer. DISCUSSION: The concept of treatment evaluation using a 'burden versus benefit' paradigm is discussed. Treatment aims must be in concordance with those of the patient, which are often couched in functional terms or linked to future significant life events. Chemotherapy and radiotherapy can offer patients in the palliative phase of cancer illness, benefits in terms of relief of symptoms and meaningful prolongation of life, and should be considered in appropriate circumstances.
Abernethy, A, Phillips, P & Currow, D 2001, 'Applying the evidence to improve the quality of our system of cancer care: What do the words mean?', Cancer Forum, vol. 25, no. 2, pp. 109-111.
Translation of the medical literature into real programs that will improve the quality of cancer care in Australia requires assessment of the validity of the research plus application of the data. In order to assess the results readers must understand fundamental differences about the presentation of research data. What is the difference between efficacy and effectiveness? How do I assess the applicability of a study? What are the different types of synthesized presentations, such as a systematic review, clinical decision analysis, and economic analysis? How do I interpret various economic analyses? This paper answers these questions within the framework of cancer care in Australia.
Barton, MB, Dawson, R, Jacob, S, Currow, D, Stevens, G & Morgan, G 2001, 'Palliative radiotherapy of bone metastases: an evaluation of outcome measures', JOURNAL OF EVALUATION IN CLINICAL PRACTICE, vol. 7, no. 1, pp. 47-64.View/Download from: Publisher's site
Stuart-Harris, R, Joel, SP, McDonald, P, Currow, D & Slevin, ML 2000, 'The pharmacokinetics of morphine and morphine glucuronide metabolites after subcutaneous bolus injection and subcutaneous infusion of morphine', BRITISH JOURNAL OF CLINICAL PHARMACOLOGY, vol. 49, no. 3, pp. 207-214.View/Download from: Publisher's site
Bui, CDH, Martin, CJ & Currow, DC 1999, 'Effective community palliation of intractable malignant ascites with a permanently implanted abdominal drain', Journal of Palliative Medicine, vol. 2, no. 3, pp. 319-321.View/Download from: Publisher's site
A patient with intractable malignant ascites from metastatic lobular breast carcinoma underwent insertion of a Tenckhoff catheter in July 1997. Seventeen months later the patient continues to have excellent symptomatic relief, without complications, by self-drainage of ascites at home. Tenckhoff catheter can be useful in the management of intractable malignant ascites.
Dawson, R, Currow, D, Stevens, G, Morgan, G & Barton, MB 1999, 'Radiotherapy for bone metastases: A critical appraisal of outcome measures', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 17, no. 3, pp. 208-218.View/Download from: Publisher's site
Currow, DC, Coughlan, M, Fardell, B & Cooney, NJ 1997, 'Use of ondansetron in palliative medicine', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 13, no. 5, pp. 302-307.View/Download from: Publisher's site
Currow, DC, Findlay, M, Cox, K & Harnett, PR 1996, 'Elevated germ cell markers in carcinoma of uncertain primary site do not predict response to platinum based chemotherapy', EUROPEAN JOURNAL OF CANCER, vol. 32A, no. 13, pp. 2357-2359.View/Download from: Publisher's site
Objective: To establish guidelines for use of ondansetron. Data sources: MEDLINE computer search (to July 1993) and information from the manufacturer. Data extraction: We circulated a position paper based on our literature review for comment by clinicians and directors of pharmacy in major teaching hospitals in New South Wales who had an interest in ondansetron. Data synthesis: Ondansetron is effective in the control of nausea and vomiting occurring 24-48 hours after highly emetogenic chemotherapy and after radiotherapy. There are no data to support its use in delayed emesis. Combination with dexamethasone may improve emetic control. The most commonly reported adverse effects are headache and constipation. Optimal dose, frequency of dosing and route of administration have not been established. The cost for each inpatient treated successfully is about 3% more than conventional antiemetic therapy. Conclusions: Ondansetron shows clinical benefit in the management of acute nausea and vomiting in patients receiving highly emetogenic chemotherapy, those who have responded poorly to other antiemetics after moderately emetogenic chemotherapy, those who have intolerable side effects with conventional antiemetic agents and those receiving radiotherapy to the upper abdomen. It is also marketed for the prevention and treatment of postoperative nausea and vomiting.
Currow, D & Cooney, N 1994, 'Comparison of metal Versus Vialon® subcutaneous catheters in a palliative care setting', Palliative Medicine, vol. 8, no. 4, pp. 333-336.View/Download from: Publisher's site
In 63 evaluable palliative care patients requiring intermittent bolus subcutaneous administration of medication, who were randomly assigned either a standard metal subcutaneous needle or a PTFE (Vialon®) catheter, there was a significantly greater incidence of local reactions at the insertion site with the metal needles (9/30) compared with the PTFE catheters (2/33). Despite this, there was no significant difference between the two in functional survival. Volume of medication injected per day was the best predictor of total time that the subcutaneous lines remained in situ. © 1994, Edward Arnold. All rights reserved.
KEREIAKES, D, FERGUSON, JJ, POPMA, JJ, SHAW, RE, TCHENG, JE, WEISMAN, H, LINCOFF, AM, BREZINA, K & AGUIRRE, F 1994, 'UNTITLED', JOURNAL OF INVASIVE CARDIOLOGY, vol. 6, pp. A43-A56.
Clark, JD, Johnson, M, Fabowale, B, Farrelly, M & Currow, D, 'Does the International Narcotics Control Board (INCB) sufficiently prioritise enablement of access to therapeutic opioids? A systematic critical analysis of six INCB annual reports, 1968-2018', Journal of Global Health Reports.View/Download from: Publisher's site
Roder, D, You, H, Baker, D, Walton, R, McCaughan, B, Sranda, S & Currow, D, 'Using Linked Lung Cancer Registry and Hospital Data for Guiding Health Service Improvement', Asia Pacific Journal of Health Management, vol. 11, no. 1, pp. 65-75.View/Download from: Publisher's site
Objective: To use linked NSW Cancer Registry and hospital lung cancer (LC) data for raising discussion points on how to improve outcomes.
Design: Historical cohort – cases diagnosed in 2003-2007.
Setting: New South Wales, Australia
Outcome Measures: Relative odds (OR) of localised disease and resection of non-small cases (NSCLC) using multiple logistic regression. Comparisons of risk of NSCLC death using competing risk regression.
Findings: (1) Older patients have fewer resections of localised NSCLC [adjusted OR 95% CLs; 80+Vs <60 years; 0.20 (0.14, 0.28)]. Cases with co-morbidity have fewer resections [adjusted OR, 0.74 (0.61, 0.90)] and have more conservative resections. Question: Is there the best balance between resection and avoiding surgery to accommodate frailty and co-morbidity? (2) Compared with public patients, the health insured: have higher odds of localised LC [adjusted OR, 1.23 (1.12, 1.35] and resection for localised NSCLC [adjusted OR, 2.08 (1.70, 2.54)]; are more likely to have lobectomies than wedge/segmental resections (p<0.001); and have a lower risk of LC death [adjusted SHR, 0.89 (0.85, 0.93)]. Question: Are there opportunities for improving publicpatient outcomes? (3) Patients born in non-English speaking countries have lower odds of localised disease [adjusted OR, 0.88 (0.79, 0.99)]. – Question: Could this difference be decreased by reducing cultural and language barriers? (4) Cancers of pulmonary lobes rather than the main bronchus pose lower risks of LC death. Question: Could outcomes for main bronchus cancers be improved by up-skilling or referral to higher-volume centres? (5) Greater extent of disease is strongly predictive of case fatality – Question: Could LC deaths be reduced by earlier treatment? (6) Use of lobectomies varies – Question: Could survival be increased through greater use of lobectomies for localised NSCLC?
Conclusions: Linked cancer registry and hospital data can increase sy...
Phillips, JL & Currow, D 2019, 'Challenges and Future Directions of Palliative Care' in Textbook of Palliative Care, Springer International Publishing, pp. 111-130.View/Download from: Publisher's site
Currow, D & Ekström, M 2018, 'Management of Respiratory Symptoms in People with Cancer' in The MASCC Textbook of Cancer Supportive Care and Survivorship, Springer International Publishing, pp. 217-229.View/Download from: Publisher's site
© ERS 2016. Breathlessness is the cardinal symptom of cardiorespiratory disease. It increases with disease severity and is often associated with other chronic and debilitating symptoms. This chapter reviews the prevalence and consequences of breathlessness in advanced disease and the affected (older) population, associated symptoms, and risk factors for experiencing more severe symptoms, particularly focusing on changes in breathlessness and associated symptoms over time in patients with advanced disease and nearing death.
The majority of people diagnosed with cancer are older and therefore are
likely to have co-morbidities at the time it is diagnosed and if the cancer progresses
to advanced disease. Guidance in the process of managing long-term co-morbidities
at the end of life requires clarity about the goals of care for the person's cancer, and
for each of his/her co-morbidities. Why was a particular therapy started in the first
place? What risk is the therapy mitigating, and does it need to be continued? Very
few studies help to inform the process of ceasing medications. For example, with
cachexia and its associated weight loss, frequently encountered in advanced cancer,
the management of two of the most frequent conditions—hypertension and diabetes
—will change. The need for anti-hypertensives will decrease or the person will risk
postural symptoms and the need for lower doses of hypoglycaemic agents and
liberalised diets will be hallmarks of managing diabetes in order to avoid hypoglycaemia.
Mostly, this care is in the setting of multiple co-morbidities, making
review a complex and continuing process. Changes in co-morbidities can also
directly influence the anti-cancer therapies that are available to patients, because of
characteristics of the drug itself or changes in metabolism or elimination. Adjusting
chemotherapy in advanced disease also requires careful evaluation of the goals of
palliative treatment—are there symptoms that can best be addressed by disease
modifying treatments or are there other more direct, better tolerated symptom
control therapies available? Not only will there be a need for active management of
long-term co-morbidities, but people will need to adjust psychologically to these
changes. Modifying the goals of treatment is often the most overt signal to people
that their disease is progressing and therefore can be particularly confronting. Such
changes will often precipitate, or are an opportunity for, much wider conversations
about life, dying and dea...
Luckett, TR & Reid, K 2015, 'Speech and language therapy in palliative care' in Cherny, N, Fallon, M, Kaasa, S, Portenoy, R & Currow, D (eds), The Oxford textbook of palliative medicine, Oxford University Press, Oxford UK, pp. 202-209.
Currow, D & Phillips, JL 2015, 'Policies on palliative care for older people in Australia' in Palliative care for older people A public health perspective, Oxford University Press.View/Download from: Publisher's site
The book begins by outlining the range of policies towards palliative care for older people that are found worldwide.
© 2014 Springer-Verlag Berlin Heidelberg. All rights reserved. The goal of clinical medicine is to improve or maintain the best possible health and well-being. An intervention is palliative when the primary aim is to optimise function or comfort without an expectation that the course of the illness will be changed. The philosophy of surgery is predicated on a localised, biomechanical intervention at a single point in time, often with an optimism focusing on what could be achieved. Conditions with potential surgical interventions that develop in advanced disease have widely varying manifestations and progression, making studies difficult, leading to greater reliance on clinical intuition for decision-making. The person's premorbid level of function, and the likelihood that any intervention will help them to return to, or maintain, better function, becomes the measures for decisions when considering palliative interventions. Principles include: Do no harm as surgery is trauma and, in someone with progressive, irreversible cachexia, anything that accelerates his/her deterioration is likely to compound disease progression even when minimally invasive. Just because something could be done does not mean that it should be done.
Abernethy, AP, Kamal, A & Currow, DC 2013, 'When Should Nonsteroidal Antiinflammatory Drugs Be Used to Manage Pain?' in Evidence-Based Practice of Palliative Medicine, Elsevier BV, The Netherlands, pp. 49-53.View/Download from: Publisher's site
Abernethy, AP, Kamal, A, Maguire, JM & Currow, DC 2013, 'What Interventions Are Effective for Managing Dyspnea in Cancer?' in Evidence-Based Practice of Palliative Medicine, Elsevier BV, pp. 103-110.View/Download from: Publisher's site
Abernethy, AP, Wheeler, JL, Kamal, A & Currow, DC 2013, 'When Should Corticosteroids Be Used to Manage Pain?' in Evidence-Based Practice of Palliative Medicine, Elsevier, The Netherlands, pp. 44-48.View/Download from: Publisher's site
Currow, DC & Abernethy, AP 2013, 'Palliative care clinical trials: Generalizability and applicability in hospice and palliative care practice' in Handbook of Pain and Palliative Care: Biobehavioral Approaches for the Life Course, Springer, Germany, pp. 109-119.View/Download from: Publisher's site
Clinical practice in hospice and palliative care is underpinned by a strong evidence base which continues to develop rapidly. High quality clinical studies are being done that can, and should, directly inform practice.
An additional challenge to uptake of new evidence into practice in hospice and palliative care is the wide variation in service delivery models and the populations which are referred to those services. Approximately one in two people in resource-rich countries will be referred to hospice and palliative care but which one in two varies widely even within countries. This chapter sets out some key parameters for considering how to help researchers to describe their research in hospice and palliative care so that the reader can more easily apply the findings to their clinical practice. If this is done more systematically, it is hoped that this will aid the more timely uptake of evidence into practice in order to continue to improve patient outcomes. Such a process requires service and population descriptors for both the researchers and the person applying the research.
Kamal, A, Maguire, JM, Currow, DC & Abernethy, AP 2013, 'Should Bisphosphonates Be Used Routinely to Manage Pain and Skeletal Complications in Cancer?' in Evidence-Based Practice in Palliative Medicine, Elsevier, pp. 59-64.View/Download from: Publisher's site
Maguire, JM, Kamal, A, Currow, DC & Abernethy, AP 2013, 'Should Bisphosphonates Be Used Routinely to Manage Pain and Skeletal Complications in Other Conditions?' in Evidence-Based Practice of Palliative Medicine, Elsevier BV, Germany, pp. 65-69.View/Download from: Publisher's site
Bone loss not related to age, referred to as secondary
osteoporosis, presents a significant potential
for morbidity and mortality in patients with chronic
or life-threatening illnesses. Increasingly, as palliative
care aims to evaluate and treat patients with
serious illness earlier in the course of their illness,
when disease-directed therapies are still ongoing,
palliative medicine professionals may encounter
patients who are potential candidates for bonedirected
therapies. The goal remains prevention;
dramatic consequences of untreated bone loss are
often fracture, pain, accelerated and ultimately irreversible
debility, hospitalization, rehabilitation, and
Secondary osteoporosis accounts for almost half
ofall cases of bone loss in the United States. 1 Bone
loss may result from chronic medications, diseases
that directly impair bone integrity or cause an imbalance
between bone production and resorption,
or a combination of both. Medications used long
term that may cause bone loss include corticosteroids
(technically glucocorticoids), heparin, anticonvulsants,
and immunosuppressants. Medical
conditions that may cause decreased bone density
include endocrine dysfunction (e.g., h