ABSTRACT
Introduction: The Sydney Cancer Survivorship Centre (SCSC) runs a face-to-face multi-disciplinary team (MDT) visit for each new patient. This enables patients to be assessed by each member of the MDT. In March 2020 the clinic rapidly transitioned to telehealth delivery in response to the COVID-19 pandemic. Aim(s): To explore the experiences of delivering survivorship care via telehealth. Method(s): Using an interpretive descriptive qualitative methodology, we conducted focus groups (FG) and individual interviews with MDT members from SCSC. One FG was conducted in person, all others via the zoom platform. Discussions were audio-recorded and transcribed for analysis. Result(s): Thirteen people participated in three FG or two individual interviews. Four key themes were identified: What is lost;Relationships;Logistical issues;and, Telehealth skills. Within 'Relationships' there were impacts on team relationships which became more fragmented without in person contact. With patients, telehealth was easier where relationships had already been established. Establishing rapport with new patients was more difficult. 'What is lost' identified the limited ability to garner visual cues, vital signs, and conduct physical examinations. While patient reported outcome measures assisted in overcoming some issues, without visual cues, assessment was more challenging. 'Logistical issues' were both positive and negative, with positive outcomes for patients: reduced travel time, time off work, parking, and costs. Whereas, time required to prepare patients for the clinic was greater, engaging with interpreters challenging, and technical issues commonly compromised interactions. Participants noted telehealth requires specific skills from both staff and patients. Determining patients able to manage telehealth was challenging. Staff noted developing skills in telehealth, particularly how to detect more subtle cues or communicate effectively. Conclusion(s): The SCSC clinic transitioned successfully to telehealth. However, there is a need to improve telehealth platforms, skills of staff to communicate and assess patients, and management of patient flow through the clinic.
ABSTRACT
Aims: To determine the efficacy of physical activity (PA) in reducing disease recurrence in patients with localised colon cancer. Our primary hypothesis is that a PA program will improve disease-free survival (DFS) in patients with resected stage II (high risk) and III colon cancer who have completed adjuvant therapy. In addition, we hypothesise that exercise can improve fatigue, quality of life (QOL), physical functioning and body composition. Methods : An international multi-centre phase 3 RCT primarily between Australia and Canada. Subjects are randomised to PA program or standard care. Primary objective compares DFS between patients in PA and control arms. Key secondary objectives are to compare: 1. fatigue, QOL, depression, anxiety, sleep, body composition, exercise behaviour and fitness;2. overall survival (OS);3. association of cytokines, and insulin axis levels with PA, fatigue, and DFS;4. Health economic evaluation of the PA intervention. The study intervention is a 36-month PA programme aiming to achieve > 10 metabolic equivalent rates/week above baseline. Study assessments include: Disease status, fitness, body composition, QOL questionnaires at 0/6/12/18/24/30/36 months. Then annual patient reported outcomes and disease status until study closure. Interim analysis (n = 273 with 12 months follow up) showed good intervention adherence, significant difference in PA with 10.5 MET hours/week difference between groups, and objective fitness improvements in PA group. Adaptations due to COVID: In 2020, rapid amendments were made in response to COVID-19 to provide alternative modes for intervention delivery (via phone or virtual) and assessments conducted virtually where possible, with option of electronic completion of patient-reported outcomes. Current Status: Number of randomisations = 792 (82% of planned sample size);270 from Australia (from 24 sites). Five sites continue recruitment in Australia: Concord, Royal Brisbane and Women's, Tamworth, Newcastle Private, and Northern Cancer Institute.