AN INVESTIGATION ON ROUTINE FOLLOW-UP CARE FOR HEAD AND NECK CANCER

BACKGROUND: Follow-up care aims to provide surveillance with early detection of recurring cancers and to address treatment complications and other health issues in survivorship. It is assumed that follow-up care fulfills these aims, however little evidence supports routine surveillance detecting curable disease early enough to improve survival. Cancer survivors are a diverse patient population, suggesting that a single follow-up regimen may not meet all patients’ follow-up needs. Little is known about what effective follow-up care should include for head and neck cancer patients in a Canadian setting. Identification of subgroups of patients with specific needs and current practices would allow for hypotheses to be generated for enhancing follow-up care. OBJECTIVES: 1a) To describe the follow-up needs and preferences of head and neck cancer patients, 1b) to identify which patient characteristics predict needs and preferences, 1c) to evaluate how needs and preferences change over time, 2a) to describe follow-up care practices by physician visits and imaging tests, and 2b) to identify factors associated to the delivered follow-up care. METHODS: 1) 175 patients who completed treatment between 2012 and 2013 in Kingston and London, Ontario were recruited to participate in a prospective survey study on patients’ needs and preferences in follow-up care. Bivariate and multivariate analyses were employed to describe patient survey responses and to identify patient characteristics that predicted needs and preferences. 2) A retrospective cohort study of 3975 patients on routine follow-up from 2007 to 2015 was carried out using data linkages across registry and administrative databases to describe follow-up practices in Ontario by visits and tests. Multivariate regression analyses assessed factors related to follow-up care. RESULTS: 1) Patients’ needs and preferences were wide-ranging with several characteristics predicting needs and preferences (ORECOG=2.69 and ORAnxiety=1.13). Needs and preferences declined as patients transitioned into their second year of follow-up (p<0.05). 2) Wide variation in practices was found, with marked differences compared to existing consensus guidelines. Multiple factors were associated with follow-up practices (RRTumor site=0.73 and RRLHIN=1.47). CONCLUSIONS: Patient characteristics can be used to personalize care and guidelines are not informing practice. Future research should evaluate individualized approaches to follow-up care.

Correlating Additives to Deterioration and Assessing the Effectiveness of Acrylic Coatings for the Protection of Rubber

Conservators have long been aware of the problems associated with the preservation of rubber objects due to inherent instability that can be attributed, in part, to the presence of additives. Inorganic additives, such as fillers, accelerators, stabilizers, and special ingredients are necessary in manufacturing to alter the properties of natural rubber. These materials all have different interactions with the rubber, and each other, and differing effects on the ageing process. To date, the most effective and accepted methods to preserve rubber are cold, dark storage of objects, or the use of low oxygen environments. While these methods are effective, they greatly limit access. The application of coatings to the surface of rubber objects can slow deterioration and greatly increase the ability of an institution to handle and display rubber objects. While numerous coatings for preventive and interventive treatment have been tested, none have been so successful to warrant routine use. The first section of this research highlighted the relationship between the inclusion of certain additives in natural rubber objects and the accelerated or slowed down overall degradation. In the second part of this research, the acrylic varnishes Golden Polymer Varnish with UVLS, Lascaux Acrylic Transparent Varnish-UV, Sennelier Matte Lacquer with UV Protection, and Liquitex Soluvar Varnish containing ultraviolet light absorbers or stabilizers were tested as a preventative coating for rubber. Through testing the visual and physical properties of the samples, as well as compound analysis the results of this research suggest that acrylic varnishes do provide protection, each to varying degrees. The results also provided insight into the behavior of rubber and these varnishes with continuing light exposure.