Townsville Cancer Centre Research Articles

Perception and knowledge of clinical trials and factors affecting participation of regional and rural cancer patients of North Queensland

e17558 Background: The best treatment option for most cancers is participation in clinical trials. Participation in trials is generally low and among rural patients it is likely to be even lower. The aim of this study was to assess knowledge about and attitudes towards clinical trials among rural and regional cancer patients of North Queensland. Methods: A questionnaire-based survey was conducted in outpatient clinics at the Townsville Cancer Centre on all types of cancer patients. Results: The mean age of the 178 participants was 56 years and 45.4% lived in rural or remote areas. Median distance to the trial centre (Townsville) for rural participants was 180 km (range 80 - 1300 km). Being asked whether they would take part in a RCT, 13.2% of participants said no, 56.3% said yes, and 30.5% were unsure. There were no significant relationships between willingness to participate and rurality (p = 0.896) or education level (p = 0.943). For the majority of patients, the number of clinic visits and blood tests required did not matter. Cost of travel (41.1% rural/remote; 23.5% regional; p < 0.001) and the need for family or friends to accompany (38.9% rural/remote; 24.1% regional; p = 0.021) were more important for rural/remote than regional patients as factors affecting participation. Only 16.4% of participants were aware of early studies. After education, percentage of patients willing to participate in phase I and II studies were 57% and 84%, respectively. Rural patients were less willing to participate in phase I studies than regional patients (33.9% vs 52.6%, p = 0.029). Conclusions: Rural patients are as interested in participating in clinical trials as urban patients except for phase 1 trials and should not be excluded because of rurality. Knowledge of trials is poor and there is a need for education early. Cost of travel seems more important for rural patients and as such budgets should include cost of travel to encourage participation of rural patients. No significant financial relationships to disclose.

Video linked medical oncology clinics: A novel way to improve patients’ access to medical oncology services in rural Australia

e17573 Background: To improve the access of Mt Isa patients to medical oncologists, Townsville Cancer Centre runs weekly medical oncology clinics via videolink. Aim of this study was to assess patient satisfaction, safety of chemotherapy delivery, and cost effectiveness of such technology. Methods: Between 2006 and 2008, 42 patients were seen. A questionnaire based survey was conducted by telephone to assess patient's level of satisfaction and quality of communication. Safety of chemotherapy delivery was evaluated by retrospective chart audit. Results: 25 patients completed the questionnaire. Six were new patients and the rest were for review leading to more than 90 encounters. Satisfaction: 100% of those interviewed were satisfied with the care given by the Townsville Cancer Centre. Of these 88% felt they developed a friendly relationship with the specialist. 90% felt medication could be taken without any concerns after videolink. 27% of patients interviewed felt examination was needed by the specialist, but 92% of the patients would rather see the specialist via videolink than travel to Townsville. Overall 96% felt it saved time, money and was convenient. Responses, apart from the question about the need for physical examination by the specialist, were more than 80% in agreement. Safety: 32 patients received active therapy. 60% were treated with palliative intent and the rest adjuvant. The median number of cycles was 5 (1–8). A total of 4 patients were admitted for complications- 2 for febrile neutropenia and 2 for emesis.There were no treatment related deaths. Cost effectiveness: Factors for consideration were cost of patient and specialist travel and accommodation,cost of interruption of routine clinics at specialists’ home, cost of video link apparatus and maintenance and cost of disturbance of quality of life for patients and doctors resulting from travel. Conclusions: Satisfaction with video linked clinics is high. It saves travel time for the patients and specialists and seems to be cost effective. It is safe to supervise chemotherapy administration using this technology. Therefore, this method of service delivery could be adopted by medical oncology departments to improve services to the rural and remote areas. No significant financial relationships to disclose.

A descriptive study comparing health attitudes of urban and rural oncology patients

Rural patients have poor outcomes in cancer management. Previous studies have shown different health beliefs and values in rural populations with high levels of stoicism and fatalism, leading to later presentation and diagnosis, with subsequent poorer prognosis and survival. This study explores the relationship between urban or rural background and health attitudes of newly diagnosed oncology patients, attending one oncology unit in north Queensland, during a 5 month period. This study is a forerunner to a planned larger project to explore the research question: do oncology patients from rural backgrounds differ in their health attitudes and hope levels compared with those from urban backgrounds? The aim of this study was to determine the utility of the selected validated instruments, newly diagnosed patients' willingness and ability to complete the composite survey instrument, and to identify likely issues for inclusion and/or greater focus in the larger project. As pilot studies are also used to develop or refine research questions and hypotheses, this article also considers some research questions for the planned large scale study. Self-administered questionnaire survey of 47 patients newly referred to the Medical Oncology Department in The Townsville Cancer Centre. Scales used were: the EORTC QLQ-C30 to assess symptom burden and quality of life; the Duke UNS Functional Social Support Questionnaire to assess social support; the Herth Hope Index to assess hope; and the Multi-Dimensional Health Locus of Control to assess health beliefs. Data were collated and transformed according to the various scales' scoring manuals. Rurality was ascertained using the RRMA classification and patient self-assessment. Uni-variate analyses were conducted as small numbers precluded multi-variate analysis. Non-parametric Mann-Whitney U and Kruskal-Wallis tests were used where data were skewed, or categorical. Monte-Carlo estimations of p-values were generated. In all, 28 of 47 patients classified as rural, 27 were suitable for curative treatment, and 31 were male. Median age was 56 years. Some respondents (17%) identified as 'rural', although they had an urban residence, and vice versa. Health attitude scores were not affected by global health scores or by intent of treatment (palliative/curative). Males scored significantly higher for belief in chance. Rural patients scored significantly higher for internal belief and belief in chance. No statistically significant differences were evident between rural/urban patients by gender, nor social support scores. Hope levels were generally high with no significant difference between urban and rural patients, regardless of treatment intent. The study does reveal differences in health attitudes between urban and rural populations; however, there are several confounding factors which may contribute to this, especially gender. In this study women were under-represented. People with fatalistic beliefs (high belief in chance) tend to have poor initiative in health matters which may cause delay in seeking treatment, or poor compliance with treatment. Analysis is limited by small numbers of patients. This study is a pilot to a larger project to investigate health attitudes and decisions by oncology patients in northern Queensland. The questionnaire was well received by patients, but the need for a dedicated recruitment person was evident. There is a need to determine how patients identify in terms of rurality over and above their actual place of residence.