Patterns, correlates, and prognostic significance of quality of life following breast cancer

Objective To describe quality of life (QOL) over a 12-month period among women with breast cancer, consider the association between QOL and overall survival (OS), and explore characteristics associated with QOL declines. Methods A population-based sample of Australian women (n=287) with invasive, unilateral breast cancer (Stage I+), was observed prospectively for a median of 6.6 years. QOL was assessed at six, 12 and 18 months post-diagnosis, using the Functional Assessment of Cancer Therapy, Breast (FACT-B+4) questionnaire. Raw scores for the FACT-B+4 and subscales were computed and individuals were categorized according to whether QOL declined, remained stable or improved between six and 18 months. Kaplan-Meier and Cox proportional hazards survival methods were used to estimate OS and its associations with QOL. Logistic regression models identified factors associated with QOL decline. Results Within FACT-B+4 sub-scales, between 10% and 23% of women showed declines in QOL. Following adjustment for established prognostic factors, emotional wellbeing and FACT-B+4 scores at six months post-diagnosis were associated with OS (p<0.05). Declines in physical (p<0.01) or functional (p=0.02) well-being between six and 18 months post-diagnosis were also associated significantly with OS. Receiving multiple forms of adjuvant treatment, a perception of not handling stress well and reporting one or more other major life events at six months post-diagnosis were factors associated with declines in QOL in multivariable analyses. Conclusions Interventions targeted at preventing QOL declines may ultimately improve quantity as well as quality of life following breast cancer.

The National Aboriginal and Torres Strait Islander Women's Health Strategy on Talkin with Tiga Bayles, 98.9 AM National Indigenous Radio Service (NIRS), Wednesday 21 July 2010. (9.00 - 10.00am).

Radio Program. Talkin with Tiga Bayles, 98.9 AM National Indigenous Radio Service (NIRS), 9.00-10.00am, Wednesday 21 July 2010. (1 hour program).----- Bronwyn Fredericks discssed the National Aboriginal and Torres Strait Islander Women’s Health Strategy was launched at the Australian Women’s Health Network (AWHN) National Conference in Hobart on the 19 May 2010. Within this radio interview the background of the Strategy is discussed, funding, who did the consultations and the writing. In the interview Bronwyn Fredericks outlines the process of the Strategy’s development and its uses for the future.----- It is important to note that this Strategy does not replace other national or State and Territory documents which identify priorities and needs. The aim is to supplement existing work.

Image acquisition and manipulation protocols for CT-PET fusion to improve the accuracy of gross tumour volume localisation for 3D conformal radiotherapy for lung cancer

Aims: To develop clinical protocols for acquiring PET images, performing CT-PET registration and tumour volume definition based on the PET image data, for radiotherapy for lung cancer patients and then to test these protocols with respect to levels of accuracy and reproducibility. Method: A phantom-based quality assurance study of the processes associated with using registered CT and PET scans for tumour volume definition was conducted to: (1) investigate image acquisition and manipulation techniques for registering and contouring CT and PET images in a radiotherapy treatment planning system, and (2) determine technology-based errors in the registration and contouring processes. The outcomes of the phantom image based quality assurance study were used to determine clinical protocols. Protocols were developed for (1) acquiring patient PET image data for incorporation into the 3DCRT process, particularly for ensuring that the patient is positioned in their treatment position; (2) CT-PET image registration techniques and (3) GTV definition using the PET image data. The developed clinical protocols were tested using retrospective clinical trials to assess levels of inter-user variability which may be attributed to the use of these protocols. A Siemens Somatom Open Sensation 20 slice CT scanner and a Philips Allegro stand-alone PET scanner were used to acquire the images for this research. The Philips Pinnacle3 treatment planning system was used to perform the image registration and contouring of the CT and PET images. Results: Both the attenuation-corrected and transmission images obtained from standard whole-body PET staging clinical scanning protocols were acquired and imported into the treatment planning system for the phantom-based quality assurance study. Protocols for manipulating the PET images in the treatment planning system, particularly for quantifying uptake in volumes of interest and window levels for accurate geometric visualisation were determined. The automatic registration algorithms were found to have sub-voxel levels of accuracy, with transmission scan-based CT-PET registration more accurate than emission scan-based registration of the phantom images. Respiration induced image artifacts were not found to influence registration accuracy while inadequate pre-registration over-lap of the CT and PET images was found to result in large registration errors. A threshold value based on a percentage of the maximum uptake within a volume of interest was found to accurately contour the different features of the phantom despite the lower spatial resolution of the PET images. Appropriate selection of the threshold value is dependant on target-to-background ratios and the presence of respiratory motion. The results from the phantom-based study were used to design, implement and test clinical CT-PET fusion protocols. The patient PET image acquisition protocols enabled patients to be successfully identified and positioned in their radiotherapy treatment position during the acquisition of their whole-body PET staging scan. While automatic registration techniques were found to reduce inter-user variation compared to manual techniques, there was no significant difference in the registration outcomes for transmission or emission scan-based registration of the patient images, using the protocol. Tumour volumes contoured on registered patient CT-PET images using the tested threshold values and viewing windows determined from the phantom study, demonstrated less inter-user variation for the primary tumour volume contours than those contoured using only the patient’s planning CT scans. Conclusions: The developed clinical protocols allow a patient’s whole-body PET staging scan to be incorporated, manipulated and quantified in the treatment planning process to improve the accuracy of gross tumour volume localisation in 3D conformal radiotherapy for lung cancer. Image registration protocols which factor in potential software-based errors combined with adequate user training are recommended to increase the accuracy and reproducibility of registration outcomes. A semi-automated adaptive threshold contouring technique incorporating a PET windowing protocol, accurately defines the geometric edge of a tumour volume using PET image data from a stand alone PET scanner, including 4D target volumes.

Alternative analytical methods for the identification of cancer-related symptom clusters

Advances in symptom management strategies through a better understanding of cancer symptom clusters depend on the identification of symptom clusters that are valid and reliable. The purpose of this exploratory research was to investigate alternative analytical approaches to identify symptom clusters for patients with cancer, using readily accessible statistical methods, and to justify which methods of identification may be appropriate for this context. Three studies were undertaken: (1) a systematic review of the literature, to identify analytical methods commonly used for symptom cluster identification for cancer patients; (2) a secondary data analysis to identify symptom clusters and compare alternative methods, as a guide to best practice approaches in cross-sectional studies; and (3) a secondary data analysis to investigate the stability of symptom clusters over time. The systematic literature review identified, in 10 years prior to March 2007, 13 cross-sectional studies implementing multivariate methods to identify cancer related symptom clusters. The methods commonly used to group symptoms were exploratory factor analysis, hierarchical cluster analysis and principal components analysis. Common factor analysis methods were recommended as the best practice cross-sectional methods for cancer symptom cluster identification. A comparison of alternative common factor analysis methods was conducted, in a secondary analysis of a sample of 219 ambulatory cancer patients with mixed diagnoses, assessed within one month of commencing chemotherapy treatment. Principal axis factoring, unweighted least squares and image factor analysis identified five consistent symptom clusters, based on patient self-reported distress ratings of 42 physical symptoms. Extraction of an additional cluster was necessary when using alpha factor analysis to determine clinically relevant symptom clusters. The recommended approaches for symptom cluster identification using nonmultivariate normal data were: principal axis factoring or unweighted least squares for factor extraction, followed by oblique rotation; and use of the scree plot and Minimum Average Partial procedure to determine the number of factors. In contrast to other studies which typically interpret pattern coefficients alone, in these studies symptom clusters were determined on the basis of structure coefficients. This approach was adopted for the stability of the results as structure coefficients are correlations between factors and symptoms unaffected by the correlations between factors. Symptoms could be associated with multiple clusters as a foundation for investigating potential interventions. The stability of these five symptom clusters was investigated in separate common factor analyses, 6 and 12 months after chemotherapy commenced. Five qualitatively consistent symptom clusters were identified over time (Musculoskeletal-discomforts/lethargy, Oral-discomforts, Gastrointestinaldiscomforts, Vasomotor-symptoms, Gastrointestinal-toxicities), but at 12 months two additional clusters were determined (Lethargy and Gastrointestinal/digestive symptoms). Future studies should include physical, psychological, and cognitive symptoms. Further investigation of the identified symptom clusters is required for validation, to examine causality, and potentially to suggest interventions for symptom management. Future studies should use longitudinal analyses to investigate change in symptom clusters, the influence of patient related factors, and the impact on outcomes (e.g., daily functioning) over time.

The Queensland Cancer Physics Collaborative and the Quantitative Biomedical Imaging & Characterisation (Q-BIC) Research Group

a presentation about immersive visualised simulation systems, image analysis and GPGPU Techonology

A life jacket with holes- : a case study of 'temporary engagement' : a strategy used by Education Queensland to employ beginning secondary teachers

This research investigated the impact of Education Queensland's employment policy and practices for beginning secondary teachers appointed on temporary engagement. The context was the public secondary school sector within the state of Queensland, Australia. The study was set within a context of the changing nature of work from full-time permanent employment towards casual, fixed-term contracts, temporary and part-time employment, a trend reflected in the employment patterns for teachers within Australia. Two broad categories of literature relating to the research problem of this thesis were reviewed, namely the beginning teacher and permanency or tenure. The focus in the research literature on beginning teachers was the professional experiences of teachers within the classroom and school. There was a paucity of research that considered the working and industrial conditions of temporary employment for beginning teachers or the personal and professional implications of this form of employment. The review of the context and literature was conceptualised as a Beginning Temporary Teacher Theoretical Framework which served to inform the study. Using a qualitative case study methodology, the research techniques employed for the thesis were semi-structured interview and document analysis. A simultaneously conducted research project in which the researcher participated entitled 'Winning the Lottery? Beginning Teachers on Temporary Engagement' foregrounded this thesis in terms of refining the research question, contributing to the literature and in the selection of the participants. For this case study the perspectives of four distinct yet inter-related categories of professionals were sought. These included four beginning secondary teachers, three school administrators, a Senior Personnel Officer with Education Queensland, and a representative from the Queensland Teachers' Union. The research findings indicated that none of the beginning teachers or other professionals viewed starting a career in teaching on temporary engagement as the ideal. The negative features identified were the differential treatment received and the high level of uncertainty associated with temporary employment. Differential treatment tended to indicate 'less' entitlements, in terms of access to induction and professional development, recreational and sick leave, acceptance by and expectations of other colleagues, and avenues of redress in grievance cases. Moreover, interviews indicated a high level of uncertainty in terms of starting within the teaching profession, commencing at a new school, and a regular income. In addition, frequent changes in schools and/or cohorts of students exacerbated levels of uncertainty. The beginning teachers reported significantly decreased motivation, self-esteem and sense of belonging, and increased stress levels. There was an even more marked negative impact on those beginning teachers who had experienced a higher number of temporary engagements and schools in their first year of teaching. Conversely, strong staff support and a reasonable length of time in the one school improved the quality of the beginning teachers' experiences. The overall impact of being on temporary engagement resulted in delayed permanent position appointments, decreased commitment to particular schools and to Education Queensland as the employing authority, and for two of the beginning teachers, it produced a desire to seek alternative employment. The implementation of Education Queensland's policies relating to working conditions and entitlements for these temporary beginning teachers at the school level was revealed to be less than satisfactory. There was a tendency towards 'just-in- time' management of the beginning teacher on temporary engagement. The beginning teachers received 'less-than-messages' about access to and use of departmental documentation, support through induction and professional development, and their transition from temporary to permanent employment. To ensure a more systematic, supportive and inclusive process for managing the temporary beginning teacher, a conceptual framework entitled 'Continuums of Tension' was developed. The four continuums included permanent employment - temporary employment; system perspective - individual perspective; teaching as a profession - teaching as a job; and the permanent beginning teacher - university graduate. The general principles of the human resource policies of Education Queensland were based on a commitment to permanent employment, a system's perspective, viewing teaching as a profession and a homogeneous group of permanent beginning teachers. Contrasting with this, the beginning teacher on temporary engagement tended to operate from the position of temporary employment and a perspective that was individually based. Their priorities therefore included the 'occupational' aspects of being a temporary teacher striving to become permanent. Thus there existed a tension or contradiction between the general principles of human resource policies within Education Queensland and the employment experiences of beginning teachers on temporary engagement. The study proposed three actions for resolution to address the aforementioned tensions. The actions included: (a) the effective provision and targeted communication of information; (b) support, induction and professional development; and (c) a coordinated approach between Education Queensland, Queensland Teachers' Union, the Universities and the beginning teacher. These actions are fm1her refined to include: (a) an induction kit to suppm1 the individual through the pre-employment to permanent employee phases, (b) an extrapolation of the roles and responsibilities of Education Queensland personnel charged with supporting the beginning temporary teacher, and (c) a series of recommendations to effect a coordinated approach amongst the key stakeholders. The theoretical and conceptual frameworks have provided a means of addressing the identified needs of the beginning teacher on temporary engagement. As such, this study has contributed to the research literature on teacher employment and professionalism and aims to provide a beginning temporary teacher with managed professional and occupational support.