Prognostic factors and the impact of frontline therapy in peripheral T-cell lymphoma: 10 years of 'real-world' experience from Western Australia.

We present an analysis of 98 consecutive patients with peripheral T-cell lymphoma (PTCL) treated over a 10-year period within Western Australia. The most common frontline therapies were CHO(E)P (47%), HyperCVAD (21%), and reduced intensity therapy or supportive care alone (19%). Median and 4-year overall survival (OS) for the whole cohort were 1.59 years and 34%. Amongst CHO(E)P and HyperCVAD-treated patients, elevated LDH, advanced stage, IPI >1, and non-ALK + ALCL histology predicted inferior progression-free survival (PFS). Inferior OS was predicted by elevated LDH, age >60, IPI >1, and non-ALK + ALCL histology. Response rates and PFS were not significantly different between patients treated with CHO(E)P or HyperCVAD. OS was longer in the HyperCVAD group, however this was not significant on multivariable analysis and appears to relate to the younger age and more aggressive therapy at relapse in this group. Our data confirmed the prognostic utility of the IPI in patients with PTCL and do not demonstrate a clear benefit of HyperCVAD.

Clostridium difficile Infections amongst Patients with Haematological Malignancies: A Data Linkage Study.

OBJECTIVES: Identify risk factors for Clostridium difficile infection (CDI) and assess CDI outcomes among Australian patients with a haematological malignancy. METHODS: A retrospective cohort study involving all patients admitted to hospitals in Western Australia with a haematological malignancy from July 2011 to June 2012. Hospital admission data were linked with all hospital investigated CDI case data. Potential risk factors were assessed by logistic regression. The risk of death within 60 and 90 days of CDI was assessed by Cox Proportional Hazards regression. RESULTS: There were 2085 patients of whom 65 had at least one CDI. Twenty percent of CDI cases were either community-acquired, indeterminate source or had only single-day admissions in the 28 days prior to CDI. Using logistic regression, having acute lymphocytic leukaemia, neutropenia and having had bacterial pneumonia or another bacterial infection were associated with CDI. CDI was associated with an increased risk of death within 60 and 90 days post CDI, but only two deaths had CDI recorded as an antecedent factor. Ribotyping information was available for 33 of the 65 CDIs. There were 19 different ribotypes identified. CONCLUSIONS: Neutropenia was strongly associated with CDI. While having CDI is a risk factor for death, in many cases it may not be a direct contributor to death but may reflect patients having higher morbidity. A wide variety of C. difficile ribotypes were found and community-acquired infection may be under-estimated in these patients.

A randomised controlled trial comparing the effects of a 12-week supervised exercise versus usual care on outcomes in haematological cancer patients.

PURPOSE: Following treatment, haematological cancer (HEM) patients exhibit significant physical deconditioning and psychological distress. Exercise has been shown as a clinically effective and safe intervention for cancer patients, with the potential to reverse the deleterious effects following treatment. Our aim was to investigate the efficacy of a 12-week exercise rehabilitation on cancer-related fatigue (CRF) and associated outcomes in HEM patients post-treatment. METHODS: Patients with a HEM were recruited to participate in a 12-week exercise rehabilitation intervention post-treatment. Pre-, post- and follow-up assessments were conducted on outcome measures including CRF, quality of life (QoL), psychological distress, cardiovascular fitness, muscle strength (MS) and body composition. Patients were given tailored exercise programmes comprising aerobic and resistance exercises, carried out three times per week for 12 weeks in local gyms and clinics. Usual-care participants were offered a delayed, tailored 12-week exercise intervention after the initial study period. RESULTS: Thirty-seven patients (49 % recruitment rate) were randomly assigned to the 12-week exercise rehabilitation (n = 18) or usual care (n = 19) with a 91 % adherence to the exercise intervention. Following the exercise programme, significant improvements were seen in CRF (p = 0.01), cardiovascular fitness (p ≤ 0.001), QoL (p ≤ 0.001), MS (p ≤ 0.001) and body composition (p = 0.001), with moderate to large effects for all primary outcomes. Patient follow-up at 24 weeks demonstrated outcome maintenance in the exercise rehabilitation group and significant improvements in outcomes in usual-care patients following participation in a delayed exercise programme. There were no adverse reactions or study withdrawals. CONCLUSIONS: A 12-week exercise rehabilitation programme resulted in significant statistical (p ≤ 0.05) and clinical improvements in CRF and additional outcomes in HEM patients following treatment. Additionally, a 12-week delayed exercise programme showed similar significant improvements in patient outcomes. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12609000450213.

Randomized Controlled Trial of Shared Care for Patients With Cancer Involving General Practitioners and Cancer Specialists.

PURPOSE: We aimed to determine whether a shared care model (SCM) during chemotherapy treatment improved emotional well-being, empowerment, and prevalence of symptoms for people being treated for cancer. METHODS: People receiving chemotherapy for hematologic, breast, ovarian, or colorectal malignancies at two cancer centers were randomly assigned to receive SCM or standard care. The SCM involved a patient-held record, a project coordinator, routine contact between the patient and general practitioner/primary care physician, and primary care physician education. Participants completed the Hospital Anxiety and Depression Scale, the Mini-Mental Adjustment to Cancer, and an empowerment questionnaire before, in the middle of, and on completion of chemotherapy. The presence and severity of adverse effects of chemotherapy were recorded by patients in a symptom diary. RESULTS: Ninety-seven eligible participants were randomly allocated, less than half the intended recruitment. There were no significant differences between the groups for empowerment, symptom prevalence, or Mini-Mental Adjustment to Cancer scores. The proportion with clinical anxiety (Hospital Anxiety and Depression Scale anxiety score of ≥ 11) decreased over time in both groups (P = .013) but decreased more in the intervention group (P = .002). Depression was unchanged over time. CONCLUSION: Our study was limited by low recruitment and predominance of patients with breast cancer, and was underpowered for the main analyses. Results should therefore be interpreted with caution. Little benefit was seen for SCM in the majority of domains including empowerment, symptom prevalence, and psychological adjustment to cancer. The SCM showed efficacy in clinically anxious patients. Such interventions may be better implemented by using a targeted approach to identify at-need subgroups.

Positive patient experiences in an Australian integrative oncology centre.

BACKGROUND: The purpose of this study was to explore the experiences of cancer patients' utilising complementary and integrative therapies (CIT) within integrative oncology centres across Western Australia. METHODS: Across four locations 135 patients accessed CIT services whilst undergoing outpatient medical treatment for cancer. Of the 135 patients, 66 (61±12 y; female n=45; male n=21) agreed to complete a personal accounts questionnaire consisting of open-ended questions designed to explore patients' perceptions of CIT. All results were transcribed into nVivo (v9) and using thematic analysis, key themes were identified. RESULTS: Of the 66 participants, 100% indicated they would "recommend complementary therapies to other patients" and 92% stated "CIT would play a significant role in their future lifestyle". A mean score of 8±1 indicated an improvement in participants' perception of wellbeing following a CIT session. Three central themes were identified: empowerment, support and relaxation. Fourteen sub-themes were identified, with all themes clustered into a framework of multifaceted views held by cancer patients in relation to wellbeing, role of significant others and control. CONCLUSIONS: Exploration of patients' experiences reveals uniformly positive results. One of the key merits of the environment created within the centres is patients are able to work through their cancer journey with an increased sense of empowerment, without placing them in opposition to conventional medical treatment. In order to effectively target integrative support services it is crucial to explore the experiences of patients in their own words and use those forms of expression to drive service delivery.

An oasis in the hospital: the perceived benefits of a cancer support center in a hospital setting offering complementary therapies.

AIMS: The aim of this study was to explore and describe the experiences of persons attending a cancer support center, providing emotional support to cancer patients through self-selected complementary therapies offered free of charge through qualified volunteer therapists. A grounded theory methodology was used. Sources of data were 16 semistructured interviews with persons attending the center. Interviews were digitally recorded and transcribed verbatim. Analysis was conducted using the constant comparative method. FINDINGS: The overarching theme that emerged in this study was the benefits attributed to attendance at the cancer support center. The center was described as an "oasis" in the hospital, and three aspects relating to this were identified: (a) facilitating comfort, (b) increasing personal control, and (c) helping make sense of the cancer experience. CONCLUSION: A drop-in center offering complementary therapies appeared to enable coping with the diagnosis and treatment of cancer by facilitating comfort and increasing perceptions of personal control. The center also helped some participants to make sense of their experience with cancer. This research has provided a unique insight into the ongoing emotional needs of cancer patients, and directions for further development and research into the provision of holistic care for patients within a hospital setting.

Characteristics and quality of life of patients presenting to cancer support centres: patient rated outcomes and use of complementary therapies.

BACKGROUND: In order to effectively target and provide individualised patient support strategies it is crucial to have a comprehensive picture of those presenting for services. The purpose of this study was to determine the characteristics and patient rated outcomes of individuals presenting to SolarisCare cancer support centres and their choices regarding complementary and integrated therapies (CIT). METHODS: A cohort with a current or previous cancer diagnosis aged 18 - 87 years presenting to a SolarisCare centre during a 5-day period completed a questionnaire. Four SolarisCare centres participated in the trial including regional and metropolitan locations. Outcomes included medical and demographic characteristics, CIT variables and patient rated outcomes (PROs) including quality of life (QoL). RESULTS: Of the 95 participants (70.3%) who completed the survey, the mean age was 60.5 years with 62% currently receiving treatment. Eighty percent of the sample had at least one other comorbid condition, with the most popular CIT being relaxation massage. Of the PROs, QoL was significantly lower than norms for the Australian population and other mixed cancer populations. No notable differences were seen between genders, however significantly poorer outcomes were found for the younger age group. Fifty percent of the population did not meet physical activity recommendations, and musculoskeletal symptoms explained between 25-27% of variance in QoL. CONCLUSIONS: A greater understanding of the health profiles of patients presenting to supportive care centres and their use of CIT, provides Western Australian health professionals with key information to ensure the safety of supportive care practices, as well as fosters optimal patient outcomes and enhances the integration of supportive care strategies within mainstream medical care.

Test-retest reliability of the aerobic power index submaximal exercise test in cancer patients.

The purpose of this study was to investigate the reliability of the Aerobic Power Index (API) submaximal cardiorespiratory exercise test, as well as associated variables of oxygen uptake (ml·kg(-1)·min(-1)) and ratings of perceived exertion (RPE) in cancer patients who are generally unable to complete maximal or lengthy aerobic fitness tests. Twenty male and female participants (11 male; 9 female) aged between 18 and 70 y (mean = 53.28 ± 11. 82 y) were recruited with medical consent within 4 weeks of completing chemotherapy treatment for a lymphohaematopoietic cancer (LHC). Of the twenty recruited participants' 2 were excluded from analysis due to disease relapse or complications unrelated to testing occurring within the month following testing. Intra-class correlation coefficient (ICC) scores for power output (W·kg(-1)) and oxygen uptake (ml·kg(-1)·min(-1)) were highly reliable (R1 = 0.96 and 0.96, respectively) and the ICC for RPE was moderately reliable (R1 = 0.83). Technical error of measurement results for power output (W·kg(-1)), oxygen uptake (ml·kg(-1)·min(-1)) and RPE were 0.11W·kg(-1), 1.18 ml·kg(-1)·min(-1) and 1.0 respectively. A Pearson's product-moment correlation demonstrated a strong relationship between power output (W·kg(-1)) and oxygen uptake (ml·kg(-1)·min(-1)) for both trials (r = 0.93 and 0.89, respectively). Results demonstrate that the API test is a highly reliable protocol for use with a LHC population and can be considered a clinically feasible, safe and tolerable exercise test.

Chronic myeloid leukaemia: the evolution of gene-targeted therapy.

Chronic myeloid leukaemia (CML) was the first human cancer linked to an acquired chromosomal abnormality, subsequently shown to be a reciprocal translocation between chromosomes 9 and 22. The resulting fusion gene product, BCR-ABL, was shown to be the causative agent of the disease. CML has an incidence of around 1-2 cases per 100,000; in Australia, there are probably more than 200 new cases per year and more than 1300 prevalent cases. Treatment of CML with imatinib has been a powerful vindication of the concept of rational, gene-targeted drug design. Five-year published experience with imatinib at 400 mg orally daily demonstrates 89% overall survival and an estimated 93% freedom from disease progression. Adverse effects are mostly mild and transient. Higher doses of imatinib may be more efficacious and will be studied in upcoming clinical trials in Australia; however, imatinib is almost certainly not curative. Up to 28% of patients may have to stop imatinib because of intolerance or disease resistance, mostly due to point mutations of BCR-ABL. In this situation, many patients will respond to second- and third-generation tyrosine kinase inhibitors. Management of CML patients should involve close monitoring, especially in the first 2 years, with regular cytogenetics and quantitative polymerase chain reaction to optimise response and identify suboptimal responders as early as possible. Bone marrow transplantation remains the only known cure, but is reserved for patients whose kinase inhibitor therapy has failed, or who have advanced disease (accelerated phase or blastic transformation).

Plasma glutamine responses to high-intensity exercise before and after endurance training.

Glutamine responses to strenuous interval exercise were examined before and after 6 weeks of endurance training. Glutamine measures were obtained before and after the interval exercise sessions and training in untrained males assigned to training (T; n = 10) or control (C; n = 10) groups. Before training, C and T group glutamine progressively decreased (p < 0.05) by 18% and 16%, respectively, by 150-min postinterval exercise. Over the training period C group glutamine did not change, while T group values increased (p < 0.05) by 14%. After training, glutamine again decreased (p < 0.05) by similar percentages (C = 16% and T = 15%) by 150-min postinterval exercise, but the T group recorded higher (p < 0.05) resting and postexercise glutamine concentrations than the C group. Training induced increases in glutamine may prevent the decline in glutamine levels following strenuous exercise falling below a threshold where immune function might be acutely compromised.