Telehealth cancer care consultations during the COVID-19 pandemic: a qualitative study of the experiences of Australians affected by cancer.

BACKGROUND: In response to the onset of the COVID-19 pandemic, telehealth was rapidly rolled out in health services across Australia including those delivering cancer care. This study aimed to understand people with cancer and carers' experiences with telehealth for cancer care during the COVID-19 pandemic and associated restrictions. METHOD: Semi-structured interviews conducted with people with cancer and carers via telephone or online video link between December 2020 and May 2021. Participants were recruited through cancer networks and social media. Interviews were transcribed and thematic analysis undertaken. RESULTS: Twenty-three patients and 5 carers were interviewed. Telephone-based appointments were most common. Responses to telehealth were influenced by existing relationships with doctors, treatment/cancer stage and type of appointment. Four themes were derived: (i) benefits, (ii) quality of care concerns, (iii) involving carers, and (iv) optimising use of telehealth. Benefits included efficiency and reduced travel. Quality of care concerns identified subthemes: transactional feel to appointments; difficulties for rapport; suitability for appointment type and adequacy for monitoring. Both patients and carers noted a lack of opportunity for carers to participate in telephone-based appointments. Aligning appointment mode (i.e. telehealth or in person) with appointment purpose and ensuring telehealth was the patient's choice were seen as essential for its ongoing use. DISCUSSION AND CONCLUSIONS: While telehealth has benefits, its potential to reduce the quality of interactions with clinicians made it less attractive for cancer patients. Patient-centred guidelines that ensure patient choice, quality communication, and alignment with appointment purpose may help to increase telehealth's utility for people affected by cancer.

The evolutionary dynamics of the lion Panthera leo revealed by host and viral population genomics.

The lion Panthera leo is one of the world's most charismatic carnivores and is one of Africa's key predators. Here, we used a large dataset from 357 lions comprehending 1.13 megabases of sequence data and genotypes from 22 microsatellite loci to characterize its recent evolutionary history. Patterns of molecular genetic variation in multiple maternal (mtDNA), paternal (Y-chromosome), and biparental nuclear (nDNA) genetic markers were compared with patterns of sequence and subtype variation of the lion feline immunodeficiency virus (FIV(Ple)), a lentivirus analogous to human immunodeficiency virus (HIV). In spite of the ability of lions to disperse long distances, patterns of lion genetic diversity suggest substantial population subdivision (mtDNA Phi(ST) = 0.92; nDNA F(ST) = 0.18), and reduced gene flow, which, along with large differences in sero-prevalence of six distinct FIV(Ple) subtypes among lion populations, refute the hypothesis that African lions consist of a single panmictic population. Our results suggest that extant lion populations derive from several Pleistocene refugia in East and Southern Africa ( approximately 324,000-169,000 years ago), which expanded during the Late Pleistocene ( approximately 100,000 years ago) into Central and North Africa and into Asia. During the Pleistocene/Holocene transition ( approximately 14,000-7,000 years), another expansion occurred from southern refugia northwards towards East Africa, causing population interbreeding. In particular, lion and FIV(Ple) variation affirms that the large, well-studied lion population occupying the greater Serengeti Ecosystem is derived from three distinct populations that admixed recently.