Treatment Outcomes Profile Research Articles

Proton pencil-beam scanning radiotherapy in the treatment of nasopharyngeal cancer: dosimetric parameters and 2-year results.

Patients with nasopharyngeal cancer are candidates for proton radiotherapy due to large and comprehensive target volumes, and the necessity for sparing of healthy tissues.The aim of this work is to evaluate treatment outcome and toxicity profile of patients treated with proton pencil-beam scanning radiotherapy. Between Jan 2013 and June 2018, 40 patients were treated for nasopharyngeal cancer (NPC) with IMPT (proton radiotherapy with modulated intensity). Median age was 47years and the majority of patients had locally advanced tumors (stage 2-8 patients. (20%); stage 3-18 patients (45%); stage 4A-10 patients. (25%); stage 4B-4 patients. (10%). Median of total dose was 74 GyE (70-76 GyE) in 37 fractions (35-38). Bilateral neck irradiation was used in all cases. Concomitant chemotherapy was applied in 34 cases. (85%). Median follow-up time was 24 (1.5-62) months. Two-year overall survival (OS), disease-free survival (DFS), and local control (LC) were 80%, 75%, and 84%, respectively. Acute toxicity was generally mild despite large target volumes and concurrent application of chemotherapy with skin toxicity and dysphagia reported as the most frequent acute side effects. The insertion of a percutaneous endoscopic gastrectomy (PEG) was necessary in four cases (10%). Serious late toxicity (G > 3. RTOG) was observed in two patients (5%) (dysphagia and brain necrosis). IMPT for nasopharyngeal cancer patients is feasible with mild acute toxicity. Treatment outcomes are promising despite the high percentage of advanced disease in this group.

Survey methods and characteristics of a sample of Aboriginal and Torres Strait Islander and non-Indigenous people who have recently used methamphetamine: the NIMAC survey.

There is a need for detailed information on methamphetamine use in Aboriginal and Torres Strait Islander communities. We describe a national survey on methamphetamine use among Aboriginal and Torres Strait Islander people and non-Indigenous people. Participants aged 16 years or older who reported using methamphetamine in the past year were recruited for a cross-sectional survey through 10 Aboriginal Community Controlled Organisations. Surveys were completed anonymously on electronic tablets. Measures included the Australian Treatment Outcomes Profile, the Severity of Dependence Scale, subscales from Opiate Treatment Index and the Kessler 10. A Chronic Stress Scale was used to assess culturally situated chronic stress factors. Of the 734 participants, 416 (59%) were Aboriginal or Torres Strait Islander and 331 (45%) were female. In the previous year, most participants reported smoking (48.7%) or injecting (34%) methamphetamine and 17.4% reported daily use. Aboriginal and Torres Strait Islander people did not differ significantly from non-Indigenous participants on methamphetamine use patterns (age at first use, frequency of use, main mode of use, injecting risk, poly drug use). Aboriginal and Torres Strait Islander participants felt less able to access health care (32% vs. 48%, P < 0.001), including mental health services (19% vs. 29%, P < 0.002), were less likely to report a mental health diagnosis (50% vs. 60%, P < 0.002) and were more likely to turn to family for support (52% vs. 34%, P < 0.001). We recruited and surveyed a large sample of Aboriginal and Torres Strait Islander people from which we can derive detailed comparative data on methamphetamine use and related health service needs for Aboriginal and Torres Strait Islander and non-Indigenous Australians.

Assessing the validity of the Australian Treatment Outcomes Profile for telephone administration in drug health treatment populations.

The Australian Treatment Outcomes Profile (ATOP) is a brief clinical tool measuring recent substance use, health and wellbeing among clients attending alcohol and other drug (AOD) treatment services. It has previously been assessed for concurrent validity and inter-rater reliability. In this study we examine whether it is suitable for administration over the telephone. We recruited a sample of 107 AOD clients across public sector specialist AOD treatment services in New South Wales, Australia between 2016 and 2018. Participants had a mean age of 47 years and 46% were female. Participants completed a face-to-face ATOP and a phone ATOP with a researcher within 5 days. Comparisons between the two administration modes were undertaken using Spearman's rank correlation coefficient for continuous or ordinal variables, and Cohen's Kappa for nominal variables. Among 107 participants, 59% were attending for alcohol treatment and 41% for opioid treatment. Most ATOP items (76%) reached above 0.7 (good) or 0.9 (excellent) agreement between face-to-face and telephone use. Our findings suggest that the ATOP is a suitable instrument for telephone monitoring of recent substance use, health and social functioning among AOD clients. Its validation for remote use over the telephone will support staff to monitor clients' risks and outcomes-of particular relevance in response to the COVID-19 pandemic in which services are increasingly relying on telework approaches to client monitoring.

Validation of the Australian Treatment Outcomes Profile for use in clients with cannabis dependence

The Australian Treatment Outcomes Profile (ATOP) was developed as a clinical tool for monitoring the substance use, health and wellbeing of clients in alcohol and other drug treatment. This is the first psychometric validation of the ATOP in a cannabis-dependent treatment population. A total of 128 individuals with cannabis dependence enrolled in an outpatient randomised controlled trial were administered the ATOP and gold-standard health and wellbeing questionnaires once by clinicians and once by researchers at baseline. Concurrent validity was assessed by testing ATOP Psychological Health, Physical Health and Quality of Life questions against concurrently administered gold-standard questionnaires: the Short Form 36 Health Survey (SF-36), the 21-item Depression, Anxiety and Stress Scale (DASS-21) and the Sheehan Disability Scale (SDS). Interrater reliability was tested by comparing clinician-administered ATOP items at the medical screening interview to the same ATOP items administered by researchers at baseline. ATOP Psychological Health showed moderate to strong correlations with SF-36 Mental Components, SF-36 Mental Health and DASS-21 scores (r = 0.40-0.52) and ATOP Physical Health with SF-36 Physical Components and SF-36 General Health scores (r = 0.36-0.67). The ATOP Quality of Life scale showed moderate agreement with the SDS and six-dimensional health state short form scales (r = 0.38-0.40). ATOP substance use, employment, education and child care items showed good to excellent interrater reliability (Krippendorff's α = 0.62-0.81), and tobacco use, Psychological Health, Physical Health and Quality of Life showed fair to moderate interrater reliability (Krippendorff's α = 0.42-0.53). The ATOP appears to be valid and reliable when tested in a population with cannabis-dependence, justifying its widespread use in clinical settings.

Factors associated with concurrent illicit use of opiates and crack/cocaine among opiate-users in treatment: implications for treatment services in England

Background: The aim of this study was to identify factors associated with concurrent illicit drug use of opiates and crack/cocaine use among individuals receiving of opioid medication-assisted treatment (MAT) in one English rural/urban County Council area.Methods: 776 opiate users in treatment were assessed using the Addiction Dimensions for Assessment and Personalised Treatment (ADAPT) assessment tool. The tool encompasses three domains and 14 subdomains covering addiction severity, recovery strengths and coexisting health and social needs. Data were opportunistically matched to the National Drug Treatment Monitoring System (NDTMS) and the Treatment Outcome Profile (TOP). Two backward stepwise logistic regression models were run to discern the nature of concurrent illicit drug use.Results: Addiction severity (Odds Ratio [OR] 12.55, Confidence interval [CI] 6.49–24.27), low recovery strengths (OR 2.30, CI 1.30–4.07) and no ‘urge/control’ (OR 27.45, 13.18–57.16) were strongly associated with concurrent use. Individuals with moderate psychological needs were more likely to be abstinent (OR 2.97, CI 1.67–5.29) compared to those with no need. Abstaining from injecting (OR 2.38, CI 1.15–4.93), alcohol consumption (OR 1.55, CI 1.05–2.30), increasing age (OR 1.03, CI 1.01-1.06) and increased quality-of-life (OR 1.05, CI 1.00–1.10) were associated with abstinence from concurrent use.Conclusion: Practitioner assessments with self-report data offer unique perspectives on service users’ holistic needs. Interventions addressing concurrent use during MAT should consider managing urges and control of illicit Class A use, injecting and alcohol consumption within a stepped-care approach. Packages for developing recovery strengths supporting psychological need and enhancing quality-of-life is recommended.

Going green - treatment outcome and safety profile of chronic central serous chorioretinopathy treated with subthreshold green laser.

AimSubthreshold lasers have gained popularity in the treatment of chorioretinopathy central serous chorioretinopathy (CSCR) and yellow (577 nm) lasers have completely revolutionized the treatment. However, there is very little literature regarding the use of a more common and conventional – green (532 nm) subthreshold laser for the treatment of chronic CSCR. We report the use of green (532 nm) laser for the treatment of chronic CSCR and its outcome.MethodsEyes with nonresolving CSCR were treated with green subthreshold laser and evaluated at the end of 5 months. Visual acuity, central macular thickness (CMT), and macular volume (MV) at baseline and at 5 months following treatment were evaluated.ResultsThirteen eyes with chronic CSCR were treated with green laser in SP-Mode™. The mean duration of CSCR was 7.64±3.77 months at the time of treatment. The median age of the patients was 41 (35–57) years. The baseline mean best-corrected visual acuity (BCVA) was 0.96 logMAR ± 0.17, with mean baseline CMT of 503.8 μm ± 181.9 and MV of 12.8 mm3 ± 3.81. The mean CMT at 5 months was 211 μm ± 31.7 and mean MV was 9.65 mm3 ± 0.60, correlating to a mean decrease of 292 μm ± 79 in CMT and mean decrease of 3.18 mm3 ± 1.87 in the MV from baseline (P<0.05). The mean BCVA after treatment was 0.18 logMAR±0.09 (P<0.05). Two cases of CSCR with pigment epithelial detachment (PED) also had complete resolution of both at 5 months.ConclusionSubthreshold green laser (532 nm) is a safe and effective modality for the treatment of chronic CSCR with very good and stable outcomes. It may also be beneficial in the treatment of PEDs.

Effectiveness and Cost-Effectiveness of Adjunctive Personalised Psychosocial Intervention in Treatment-Resistant Opioid Agonist Therapy: A Pragmatic, Open-Label, Randomised Controlled Trial

BACKGROUND: Opioid use disorder (OUD) is a debilitating, chronic and costly disorder, and is increasingly prevalent in many countries. Maintenance opioid agonist therapy (OAT) with oral methadone or oral buprenorphine is the first-line, empirically-supported treatment. However, many patients do not stop taking illicit drugs during OAT. We developed a personalised psychosocial intervention (PSI) to select behaviour change methods tailored to patient need and preference. The aim was to determine if this PSI adjunctive to on-going OAT can help treatment-resistant patients achieve abstinence. METHODS: This was a pragmatic, open-label, randomised controlled trial at a specialist NHS community addictions clinic. We recruited adults meeting Diagnostic and Statistical Manual of Mental Disorders IV criteria for opioid and/or cocaine dependence, enrolled in OAT for a median of 26 weeks (IQR 10-88), voluntarily seeking continued OAT, who were treatmentresistant. Treatment resistance was defined as using illicit or nonmedical opioids and/or cocaine on one or more days in the past 28 days at screening, verified by urine drug screen. Participants were allocated (1:1) by a Clinical Trials Unit managed, webaccessed, password-protected, randomisation sequence (stratified by OAT medication, cocaine use, and drug injecting) to receive continued OAT and standard case management (treatment-as-usual, TAU) or OAT TAU and a psychology assistant-delivered personalised PSI. Treatment was provided open-label. Outcome data were collected by independent research assistants. The primary outcome was treatment response at 18 weeks, defined as abstinence from illicit and non-prescribed opioids and cocaine in the past 28 days recorded by Treatment Outcomes Profile and negative urine drug screen. Taking a societal cost perspective, the evaluation of cost-effectiveness was done by taking a wide range of values of willingness-to-pay (WTP) for a unit improvement in the probability of treatment response, and EQ-5D-3L derived quality adjusted life years (QALYs). The planned analysis was intention-to-treat (ITT), including all those who were randomly allocated. This trial is registered with the ISRCTN registry, number ISRCTN69313751. FINDINGS: Between June 7, 2013 and December 21, 2015, we randomly allocated 136 patients (50%) to the PSI group and 137 patients (51%) to the TAU group. The trial database was locked for analysis on April 19, 2017. In error, we re-randomised three participants. These cases were excluded from all analysis. Due to this error, the analysis is classified as a modified ITT (mITT). All other randomised participants were included. PSI was superior to TAU. In the mITT analysis, there were 22 responders (16·3%) among the 135 participants in the PSI group, and 9 responders (6·7%) among the 135 participants in the TAU group (adjusted log odds 1·20; 95% CI 0·01 to 2·37; p-value=0·005). PSI had a higher probability of being cost-effective than TAU. There was a probability range of 47% to 87% for WTP thresholds of £0 to £1,000. QALYs were higher in the PSI group than the TAU (mean difference 0·048 [95% CI 0·016 to 0·080]; p-value=0·004), with a 60% and 67% probability of cost-effectiveness at the NICE willingness to pay thresholds of £20,000 and £30,000 per QALY, respectively. In the TAU group, one participant (1%) died (hospitalised with acute sepsis) and another (1%) had a serious adverse event (hospitalised with head injury). In the PSI group, one participant (1%) had a serious adverse event (hospitalised with panic attack). None of these events was judged to be trial-related. INTERPRETATION: We found a personalised PSI for OAT-resistant patients, delivered by psychology assistants, was effective and had a higher probability of being cost-effective compared to TAU. Treatment-resistant patients should be offered personalised PSI. Trial Registration Number: This trial is registered with the ISRCTN registry, number ISRCTN69313751. Funding: Unrestricted research grant to Action on Addiction from Indivior. Declaration of Interest: JM is supported by research grants from the Department of Health, Institute for Health Research (NIHR), and the NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Mental Health Foundation Trust (SLaM). He has part-time employment as Senior Academic Advisor for the Alcohol, Drugs, Tobacco and Justice Division, Health and Wellbeing Directorate, Public Health England. He declares an unrestricted research grant funding at IoPPN and SLaM to Action on Addiction from Indivior for the present study, and grant support from NIHR for a trial of oral and extended-release naltrexone. JM has received honoraria from PCM Scientific in relation to the Improving Outcomes in Treatment of Opioid Dependence conference (2015-2018). He holds no stocks in any company. JH was supported by a National Institute for Health Research (NIHR) doctoral fellowship. MK, GS and LM declare unrestricted research grant funding at IoPPN and SLaM to Action on Addiction from Indivior for the present study. Ethical Approval: Ethical approval for the study was granted by the UK National Health Service (London-Bromley Research Ethics Committee: 13/LO/0640). Details of the study protocol and PSI have been published.

Reliability and validity of the Treatment Outcome Profile among patients attending methadone maintenance treatment programs in Kunming, China

Background & objectiveSubstance misuse has been a major health and social issue worldwide and has become an important public health issue in China over the past two decades. Methadone maintenance treatment (MMT) has been proved worldwide by large bodies of research to be one of the most effective practices for illicit drug users. The Treatment Outcome Profile (TOP) was developed in 2007 by the UK National Treatment Agency (NTA). It has been proved to be a reliable instrument for outcome measure. This study aim to develop the Chinese version of the Treatment Outcome Profile (TOP), and to assess whether TOP is a reliable outcome measure that can be recommended for use in Chinese MMT program. MethodsThe Chinese version of TOP was translated and revised based on the English version of TOP. Psychometric properties of TOP were evaluated through face-to-face interviews in 197 patients who had been attending methadone maintenance treatment clinics in Kunming city, Yunnan Institute for Drug Abuse, for less than three months. Patients were interviewed by 3 trained interviewers. Reliability and validity of the instrument were analyzed by measures including test-retest and inter-rater reliability, concurrent validity and change sensitivity. Concurrent validity was assessed by comparing the scores from TOP with scores obtained from validated clinometric instruments. Self-reported opiate use was compared with results of urine analysis. Change sensitivity was judged by t-tests and chi-square tests. Results & conclusionsAbout 67% of the 197 interviewers were male and 33% were female. Test-retest reliability of TOP scores (after 10 days interval) were good (K=0.65 to 0.95), inter-rater correlations (ICC) ranged from 0.7 to 0.9, and the criterion validity ranged from 0.72 to 0.88. TOP covers a large scope of problems encountered by drug users needed for treatment. The Chinese version of TOP is a reliable and valid assessment tool.

Cognition and adaptive functioning in older people attending drug and alcohol services.

Substance use disorders in older adults are expected to increase dramatically in the coming years. Given the increased susceptibility to cognitive deficits in older substance users (defined here as aged 50+ years due to the accelerated health decline observed in this population), it is important to consider the functional correlates of cognitive impairment in these older adults. This study details the cognitive status of older individuals attending outpatient drug and alcohol (D&A) treatment services and seeks to determine of the association of cognitive impairment to self-reported daily functioning. Ninety nine clients aged 50 years or over attending outpatient D&A treatment services in Sydney, Australia participated. Cognition was assessed using the Addenbrooke's Cognitive Examination - Revised (ACE-R). Recent substance use (Australian Treatment Outcome Profile), physical and mental health (SF12, Geriatric Depression Scale), social isolation (Lubben Social Network Scale), and activities of daily living (Bayer ADL Scale) were also assessed. Nearly two-thirds of participants screened positive for cognitive impairment on the ACE-R; 41% and 65% of clients met the cut-off scores for mild cognitive impairment (MCI) and more severe cognitive impairment, respectively. Self-reported seizure history was a predictor of cognitive impairment. The results suggest that cognitive impairment in this group is common. The assessment of cognitive status for this older group of patients should not only include the identification of cognitive impairment but also encompass mental health and social functioning. A greater understanding of the needs of this cohort will also enable better co-ordination with other health and welfare services tailored to this population.

Respiratory health screening for opiate misusers in a specialist community clinic: a mixed-methods pilot study, with integrated staff and service user feedback

ObjectivesIncreased rates of illicit drug inhalation are thought to expose opiate misusers (OMUs) to an enhanced risk of respiratory health problems. This pilot study aimed to determine the feasibility of...

“Check in, check up”: an evaluation of the impact of post-treatment follow-ups on substance users’ recovery

Aims: Post-discharge telephone check-ins were piloted in Change, grow, live (CGL), a leading UK-based social care and health charity, to measure substance misuse clients’ recovery through the use of the Treatment Outcomes Profile (TOP). The aims were to examine the effectiveness of these check-ins on re-presentation rates and to determine whether a case can be made for extending these check-ins across CGL.Methods: The cohort consisted of 1145 adult clients classified across four main drug groups: any opiate; alcohol only; non-opiate and alcohol; non-opiate only. The cohort clients had to have had a planned discharge from CGL services, been out of treatment for at least six months, and had a post-exit TOP within this 6 month period.Findings: Over the six months from discharge, there was a considerable reduction in the re-presentation rates for those clients who were checked in with, relative to CGL national averages and to PHE averages.Conclusion: Further research is required to verify the relationship between the post-exit check-ins and a reduction in re-presentations.

Measuring Health and Broader Well-Being Benefits in the Context of Opiate Dependence: The Psychometric Performance of the ICECAP-A and the EQ-5D-5L

BackgroundMeasuring outcomes in economic evaluations of social care interventions is challenging because both health and well-being benefits are evident. The ICEpop CAPability instrument for adults (ICECAP-A) and the five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) are measures potentially suitable for the economic evaluation of treatments for substance use disorders. Evidence for their validity in this context is, however, lacking. ObjectivesTo assess the construct validity of the ICECAP-A and the EQ-5D-5L in terms of convergent and discriminative validity and sensitivity to change on the basis of standard clinical measures (Clinical Outcomes in Routine Evaluation-Outcome Measure, Treatment Outcomes Profile, Interpersonal Support Evaluation List, Leeds Dependence Questionnaire, and Social Satisfaction Questionnaire). MethodsA secondary analysis of pilot trial data for heroin users in opiate substitution treatment was conducted. Baseline convergence with clinical measures was assessed using the Pearson correlation coefficient. Discriminative validity was assessed using one-way analysis of variance and stepwise regressions. Sensitivity to changes in clinical indicators was assessed at 3 and 12 months using the standardized response mean statistic and parametric and nonparametric testing. ResultsBoth measures had the same level of construct validity, except for clinical indicators of well-being, for which the ICECAP-A performed better. The ICECAP-A was sensitive to changes in both health and well-being indicators. The EQ-5D-5L had lower levels of sensitivity to change, and a ceiling effect (27%), particularly evident in the dimensions of self-care (89%), mobility (75%), and usual activities (72%). ConclusionsThe findings support the construct validity of both measures, but the ICECAP-A gives more attention to broader impacts and is more sensitive to change. The ICECAP-A shows promise in evaluating treatments for substance use disorders for which recovery is the desired outcome.

The Australian Treatment Outcomes Profile instrument as a clinical tool for older alcohol and other drug clients: A validation study.

The Australian Treatment Outcomes Profile (ATOP) is a brief instrument that assesses a range of substance use, health and well-being measures over the past 28 days. Previously, it has been validated in general adult Australian alcohol and other drug (AOD) treatment populations. However, the increasing number of older-aged clients attending AOD treatment warrants the instrument to be validated for this population. The aim of this study was to validate the ATOP for use in older AOD populations, by comparing it with validated 'gold standard' measures used in older populations. A convenience sample of 99 participants aged ≥50 attending specialist AOD services in Sydney, Australia were administered the ATOP by a researcher, along with alcohol use (AUDIT) and health questionnaires [Physical Health Questionnaire-15, 12-item short-form Health Survey (SF-12) and Geriatric Depression Scale]. The ATOP items had strong agreement with the comparison instruments. The highest correlation was between the 28 days alcohol use and the AUDIT. ATOP psychological health scores highly correlated with the SF-12 mental health subscale and the Geriatric Depression Scale, and ATOP physical health scores significantly correlated with the SF-12 physical health subscale and the Physical Health Questionnaire-15. The ATOP Quality of Life score significantly correlated with all health measures. Discussion and Conclusions The ATOP has good concurrent validity with other validated substance use and health measures in an older population. Comparison with general older populations demonstrated the poorer health of this group of older AOD clients in particular.[Lintzeris N, Monds L A, Rivas G, Leung S, Withall A, Draper B. The Australian Treatment Outcomes Profile instrument as a clinical tool for older alcohol and other drug clients: A validation study. Drug Alcohol Rev 2016;35:673-677].

Association between patient's personality traits and outcome of hospital treatment of opioid addiction

IntroductionDespite different treatment approaches many drug addicted patients continue to use drugs during and after treatment.ObjectivesPersonality traits are considered risk factors for drug use, and, in turn, the psychoactive substances impact individuals’ traits.AimsTo describe the sample of 186 opioid addicted patients entered hospital treatment and assessing the differences in personality traits between abstinent and non-abstinent after one year.MethodsA cohort of 186 patients consecutively admitted to the detoxification unit was investigated. The research interview, the Big Five Inventory (BFI), the Treatment Outcomes Profile (TOP) were administered during the first week of admission to the detoxification unit. Urine test was administered on the day of admission and at each follow-up point in combination with the TOP (after three, six and twelve months). Illicit drugs abstinence during one year after intake was selected as a treatment outcome measure.ResultsTwelve months after admission 82 (44.9%) patients abstained completely. Agreeable patients remain in treatment longer (r = 0.20, P = 0.07). Extraversion and openness are negatively correlated with abstinence after six and twelve months (r = –0.15, P = 0.041; r = –0.15, P = 0.044). Neuroticism is in negative correlation with duration of treatment (r = –0.20, P = 0.006). Patients who are less open to new experiences are more likely to abstain from drugs 6 months after admission (r = –0.17, P = 0.021).ConclusionPersonality measured with BFI correlates with treatment outcome poorly. At the same time personality could have an important role in responding to treatment, but personality traits could be at the same time protective as well as risk factors.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Combining Systemic Therapies with Radiation in Non small Cell Lung Cancer.

Radiotherapy has been the mainstay of treatment of stage III nonsmall cell lung cancer patients. In the early 90s, combined treatment with chemotherapy was introduced. In 1995, a meta-analysis showed improved treatment outcome of the sequential use of cisplatin-based chemotherapy and radiotherapy compared to radiotherapy alone. Subsequent randomized studies and two meta-analyses demonstrated that concurrent radiochemotherapy is superior (local control and overall survival) to sequential usage of both method. However, several questions remain unanswered concerning the optimal chemotherapy regimen and radiotherapy doses and techniques in terms of treatment outcome and toxicity profile. Targeted therapies represent a new class of drugs, which interfere with specific molecular targets (typically proteins) playing critical roles in tumor growth and progression. Some combinations appear to be too toxic, such as the vascular epithelial growth factor antibody bevacizumab. The feasibility of adding the epidermal growth factor receptor inhibitor cetuximab has been recently reported for nonsmall cell lung cancer patients. Strategies to incorporate safely novel antiangiogenic agents into combined- modality therapy in lung cancer are needed. Hopefully, rapid development of molecular oncology will contribute to better patient selection to particular strategies and to treatment optimization. Increasing radiotherapy doses applied according to up -to -date techniques and combinations with new biologicals might lead to further treatment improvements.

Adaptation and Validation of the Instrument Treatment Outcomes Profile to the Chilean Population

This study aims to psychometrically validate the Chilean version of the treatment outcomes profile (TOP), an instrument that can be used by treatment centers to monitor the results of drug and alcohol treatments. Specifically, this study is interested in evaluating the inter-rater reliability, concurrent validity, change sensitivity and discriminant and construct validity of this instrument. The TOP was modified to reflect the Chilean context and then applied in three successive stages: an initial application at the beginning of treatment, a retest after 1week, and a follow up after a month. The sample was composed of 411 users of different types of drugs who were in treatment centers in the three largest regions of the country. The TOP reliability was greater than .75 for most items. Regarding concurrent validity, all the coefficients were in the expected direction and statistically significant. Change over time, as measured by Cohen's d statistic and the Reliable Change Index, was significant for most items. Users in treatment for less than 3months showed higher alcohol consumption (odds ratio [OR]=1.07; 95% confidence interval [95% CI]: 1.01–1.13), poorer psychological health (OR=0.94; 95% CI: 0.87–1.00), fewer days worked (0.56; 0.95–0.99) and poorer housing conditions (OR=2.76; 95% CI: 1.22–6.23) than did their counterparts who had more than 3months of treatment. Researchers extracted six components with eigenvalues greater than one, accounting for 69.0% of the total variance. In general, the Chilean TOP is a reliable and valid mechanism to monitor outcomes of people treated for problems with drug and alcohol abuse in Chile, but further validation work is required in some dimensions.

Contraceptive use and pregnancy outcomes among opioid drug-using women: a retrospective cohort study.

ObjectiveThe contraceptive needs of illicit opioid users differ from non-drug users but are poorly understood. The aim of this study was to describe contraceptive use and pregnancy outcomes in opioid-using women, and to examine their association with a range of risk factors.MethodThis retrospective cohort study used UK general practice records, Treatment Outcomes Profile and National Drug Treatment Monitoring System data, and a nested data validation exercise. A cohort of 376 women aged 20–61 years were in active treatment for opioid addiction in October 2010 at two specialised primary care practices in North-East England. Outcomes were age-adjusted prevalence estimates for contraceptive use and pregnancy outcomes in users of illicit opioids. The association between lifestyle-related risk factors and contraception was explored.ResultsDrug-using women made lower use of planned (non-condom) contraception (24% vs 50%, p<0.001), had more frequent pregnancy terminations (0.46 vs. 0.025, p = 0.004) and higher annual incidence of chlamydia (1.1% vs. 0.33%, p<0.001), when compared with age-matched population data. Specifically, there was low use of oral contraceptives (4% vs. 25%, p<0.001), IUCD (1% vs. 6%, p<0.001), and sterilisation (7% vs. 6%, p = 0.053), but higher rates of injectable contraceptives (6% vs. 3%, p = 0.003). A total of 64% of children aged <16 years born to this group did not live with their mother. No individual risk factor (such as sex-working) significantly explained the lower use or type of non-condom contraception.ConclusionsThis is the first study to describe planned contraceptive use among drug-users, as well as the association with a range of risk factors and pregnancy outcomes. The low uptake of planned contraception, set against high rates of terminations and sexually transmitted disease demonstrates the urgent clinical need to improve contraceptive services, informed by qualitative work to explore the values and beliefs influencing low contraceptive uptake.

A retrospective outcomes evaluation of cannabis use at an addictions center

Purpose – The purpose of this paper is to retrospectively evaluate outcomes measured for patients attending the Leeds Addiction Unit (LAU) for cannabis use disorders. Design/methodology/approach – The authors performed a retrospective evaluation of data for clients referred to LAU for cannabis use disorders. These clients are routinely allocated to a programme of social behaviour and network therapy (SBNT), and methods of monitoring treatment include four questionnaires completed by clients, and the collection of treatment outcomes profile (TOP) data. Data were compared using non-parametric statistical methods. Findings – Of 158 clients included in the study, 20 completed the four questionnaires at assessment and follow-up. A statistically significant improvement was found for the outcome measuring level of dependence (p=0.013). TOP data showed significant reduction in the average number of days of cannabis use over the past four weeks (p&lt;0.001) and improved median scores for the client's rating of overall quality of life (p&lt;0.001). Practical implications – These findings suggest that treatment using SBNT can result in clinical improvement in cannabis use disorders. The promising results of the UK Alcohol Treatment Trial naturally raised the question as to whether SBNT can be adapted to treat substance use disorders other than alcoholism. This study aims to add to the body of evidence for this proposal. Originality/value – This is the first evaluation of the service to measure outcomes for the treatment of cannabis misuse. This study is especially relevant given the recent changes made to the Diagnostic and Statistical Manual of Mental Disorders regarding cannabis use disorders, and has triggered another evaluation of cannabis treatment at LAU looking into specific pharmacotherapy.

Combining Systemic Therapies with Radiation in Non-Small Cell Lung Cancer

Radiotherapy has been the mainstay of the treatment of stage III non-small cell lung cancer (NSCLC) patients. In the early nineties, combined treatment with chemotherapy was introduced. In 1995, a meta-analysis showed improved treatment outcome of the sequential use of cisplatin-based chemotherapy and radiotherapy (RCT) compared to radiotherapy alone. Subsequent randomized studies and the two meta-analyses demonstrated that concurrent radiochemotherapy (RCT) is superior (local control and overall survival) to sequential used both method. However, several questions remain unanswered concerning the optimal chemotherapy regimen and radiotherapy doses and techniques in terms of treatment outcome and toxicity profile. Targeted therapies represent a new class of drugs which interfere with specific molecular targets (typically proteins) playing critical roles in tumor growth and progression. Some combinations appear to be too toxic like the vascular epithelial growth factor antibody bevacizumab. The feasibility of adding the epidermal growth factor receptor inhibitor cetuximab has been recently reported for NSCLC patients. Strategies to safely incorporate novel antiangiogenic agents into combined-modality therapy in lung cancer are needed. The rapid development of molecular oncology will hopefully contribute to a better patient selection to particular strategies and to treatment optimization. Increasing radiotherapy doses applied according to up-to-date techniques and combinations with new biologicals might lead to further treatment improvements.

Development of the Addiction Dimensions for Assessment and Personalised Treatment (ADAPT)

BackgroundConvergent research reveals heterogeneity in substance use disorders (SUD). The Addiction Dimensions for Assessment and Personalised Treatment (ADAPT) is designed to help clinicians tailor therapies. MethodsMulticentre study in 21 SUD clinics in London, Birmingham (England) and Adelaide (Australia). 132 clinicians rated their caseload on a beta version with 16 ordinal indicators of addiction severity, health and social problem complexity, and recovery strengths constructs. In Birmingham, two in-treatment outcomes were recorded after 15-months: 28-day drug use (Treatment Outcome Profile; n=703) and Global Assessment of Functioning (GAF; DSM-IV Axis V; n=695). Following item-level screening (inter-rater reliability [IRR]; n=388), exploratory structural equation models (ESEM), latent profile analysis (LPA), and mixed-effects regression evaluated construct, concurrent and predictive validity characteristics, respectively. Results2467 patients rated (majority opioid or stimulant dependent, enrolled in opioid medication assisted or psychological treatment). IRR-screening removed two items and ESEM models identified and recalibrated remaining indicators (root mean square error of approximation 0.066 [90% confidence interval 0.055–0.064]). Following minor re-specification and satisfactory measurement invariance evaluation, ADAPT factor scores discriminated patients by sample, addiction therapy and drug use. LPA identified three patient sub-types: Class 1 (moderate severity, moderate complexity, high strengths profile; 46.9%); Class 2 (low severity, low complexity, high strengths; 25.4%) and Class 3 (high severity, high complexity, low strengths; 27.7%). Class 2 had higher GAF (z=4.30). Class 3 predicted follow-up drug use (z=2.02) and lower GAF (z=3.51). ConclusionThe ADAPT is a valid instrument for SUD treatment planning, clinical review and outcome evaluation. Scoring and application are discussed.