Bogda Koczwara

Validity of the malnutrition screening tool as an effective predictor of nutritional risk in oncology outpatients receiving chemotherapy

Goals of workTo determine the relative validity of the Malnutrition Screening Tool (MST) compared with a full nutrition assessment by the scored Patient Generated-Subjective Global Assessment (PG-SGA) and to assess MST inter-rater reliability in patients receiving chemotherapy.Patients and methodsAn observational, cross-sectional study was conducted at an Australian public hospital in 50 oncology outpatients receiving chemotherapy. Inter-rater reliability was assessed in a subsample of 20 patients.Main resultsAccording to PG-SGA global rating, the prevalence of malnutrition was 26%. The MST was a strong predictor of nutritional risk relative to the PG-SGA (100% sensitivity, 92% specificity, 0.8 positive predictive value, 1.0 negative predictive value). MST inter-rater reliability was acceptable with agreement by administration staff/nursing staff/patient and the dietitian in 18/20 cases (kappa=0.83; p0.001).ConclusionThe MST has acceptable relative validity, inter-rater reliability, sensitivity, and specificity to identify chemotherapy outpatients at risk of malnutrition and, hence, is an acceptable nutrition screening tool in this patient population.

High rate of complications associated with peripherally inserted central venous catheters in patients with solid tumours

Abstract

The psychosocial concerns and needs of women recently diagnosed with breast cancer: a qualitative study of patient, nurse and volunteer perspectives

Objective  To qualitatively identify the concerns and needs of Australian women recently diagnosed with breast cancer.

The impact of comorbidity on cancer and its treatment

Answer questions and earn CME/CNE

Left and right ventricular effects of anthracycline and trastuzumab chemotherapy: A prospective study using novel cardiac imaging and biochemical markers

This article appeared in a journal published by Elsevier. Under Elseviers copyright, mandated authors are not permitted to make work available in an institutional repository.

'I'm living with a chronic illness, not . . . dying with cancer': a qualitative study of Australian women's self-identified concerns and needs following primary treatment for breast cancer.

This study aimed to identify the current concerns and needs of Australian women who had recently completed primary treatment for breast cancer in order to develop a workbook-journal for this population. Focus groups were utilized to allow women to use their own frames of reference, and to identify and verbalize the topics that were important to them following treatment. All focus groups were conducted in a patient education and relaxation room, familiar to the women to assist them to feel more at ease. Ten women aged 36-68 years who had recently completed treatment for early-stage breast cancer at a South Australian public hospital took part in one of three focus groups. Topics covered included current physical, emotional and social needs. Participants reported a sense of apprehension about the future at the completion of primary treatment. In addition to this, five specific areas of concern were identified including physical sequelae of treatment, intimacy issues, fear of recurrence, benefit finding, and optimism versus pessimism about the future. Means of addressing post-treatment concerns were also discussed. Following the presentation of these findings, suggestions to aid health-care professionals in their clinical practice are provided.

Nutritional status and information needs of medical oncology patients receiving treatment at an Australian public hospital

This study aimed to identify 1) the prevalence of malnutrition according to the scored Patient Generated-Subjective Global Assessment (PG-SGA), 2) utilization of available nutrition resources, 3) patient nutrition information needs, and 4) external sources of nutrition information. An observational, cross-sectional study was undertaken at an Australian public hospital on 191 patients receiving oncology services. According to PG-SGA, 49% of patients were malnourished, and 46% required improved symptom management and/or nutrition intervention. Commonly reported nutrition-impact symptoms included peculiar tastes (31%), no appetite (24%), and nausea (24%). External sources of nutrition information were accessed by 37%, with popular choices being media/Internet ( n = 19) and family/friends ( n = 13). In a subsample ( n = 65), 32 patients were aware of the available nutrition resources, 23 thought the information sufficient, and 19 patients had actually read them. Additional information on supplements and modifying side effects was requested by 26 patients. Malnutrition is common in oncology patients receiving treatment at an Australian public hospital, and almost half require improved symptom management and/or nutrition intervention. Patients who read the available nutrition information found it useful; however, awareness of these nutrition resources and the provision of information on supplementation and managing symptoms requires attention.

Breaking Bad News: Learning Through Experience

She sits in bed, propped up by two pillows, wearing a white hospital gown, staring out of the window. Her fingers pick at something—is it a tissue? —listlessly, distractedly. I’ve been told to see her and “get a history.” I’m nervous—she doesn’t look well and certainly is in no cheerful mood to talk. But I do as I’m told, and approach her with a smile: “Hello, I’m a medical student; do you mind chatting to me about why you’re in the hospital?” She turns and wearily looks me up and down— was my cheerfulness too forced? “Oh, I suppose so, if you must. Not much else for me to do, is there?” So I pull up a chair and we get started. Dianne tells me that she noticed a lump on her neck some weeks ago, and dismissed it at first, thinking, “must have knocked myself on something,” but when it didn’t go away, she visited her local doctor. Before she knew it, he ordered some tests, and had her admitted to the hospital overnight for a lymph node biopsy. And here she was—it was midmorning—anxiously awaiting her test results. “They said it could be lymphoma,” she told me, “which is a death sentence, isn’t it? My friend’s mother had a blood cancer a couple of years ago, and it was horrible—all her hair fell out, she was so sick. Those last few months. . .she was in so much pain.” And then she burst into tears. “I’m going to die of cancer,” Dianne sobbed, “I’m so young, I have two children. What is my husband going to do? And what about work—I can’t afford to take time off!” Desperately, I offered up the box of tissues by her bed— wanting to get out of the room and feeling completely helpless. “Time out! Let’s leave it there for a minute. Tell me, Dianne, how are you feeling?” Our moderator cut in. “And you, Stephanie, what do you think about the way you approached this patient?” I was in a simulation. Dianne no longer had a lump and had wiped away her tears, revealing the actor beneath. “I felt blocked,” said the actor. “Your offering me a tissue was an indication that you didn’t want to listen to my problems, you just wanted me to stop crying!” I agreed, but for different reasons—I had no idea how to help a very distressed patient deal with terribly bad news and was actually very upset myself. WHY IS BREAKING BAD NEWS SO DIFFICULT?

The shortage of medical oncologists: the Australian Medical Oncologist Workforce Study

Objective: To determine current and projected supply, demand and shortfall of medical oncologists (MOs) and the Australian chemotherapy utilisation rate.

Gemcitabine and carboplatin in carcinoma of unknown primary site: a phase 2 Adelaide Cancer Trials and Education Collaborative study

Cancer of unknown primary site (CUP) represents up to 5% of all cancer diagnoses and is associated with poor survival. We have performed a prospective multicentre phase 2 trial to evaluate efficacy and toxicity of the combination of gemcitabine (G) and carboplatin (C) for patients with CUP. Patients with histologically confirmed metastatic carcinoma in which the primary site of cancer was not evident after prospectively designated investigation and who had ECOG performance status 0–2 were treated with G 1000 mg m−2 intravenously (i.v.) days 1 and 8, and C AUC 5 i.v. on day 8 every 3 weeks to a maximum of nine cycles. The primary end points were response rate, and toxicity, with secondary end points of progression-free survival and overall survival. Fifty-one (23 male, 27 female) patients were enrolled (one patient ineligible), with a median age of 69 years (range 41–83 years). Fifty patients were evaluable for toxicity and 46 patients were evaluable for efficacy. The overall response rate to the GC regimen was 30.5%. With a median follow-up of 24 months, the median progression-free survival was 18 weeks (4.2 months) and the median overall survival was 34 weeks (7.8 months). The frequency of grade 3 or 4 toxicity was low. Nausea/vomiting was the most common side effect, but was usually only mild in severity. Uncomplicated neutropenia (14%), thrombocytopenia (10%) and anaemia (8%) were the most common causes of grade 3–4 toxicity. The regimen was very well tolerated, particularly in the elderly. The GC regimen is an active regimen in CUP with excellent tolerability and should be considered particularly for elderly patients with CUP.