Are radiation oncologists aware of health literacy among people with cancer treated with radiotherapy?

Health literacy skills are important for people affected by cancer as they are exposed to complex treatment and follow‐up care information. This study aimed to (1) explore radiation oncologists' understandings and awareness of health literacy among patients with a reasonable command of English; (2) gain insight into oncologists' views regarding health literacy; and (3) identify techniques oncologists employ to communicate to different literacy populations. We conducted semi‐structured interviews with 26 radiation oncologists. Four key themes were identified: (1) identifying a patient's literacy level; (2) perceived impact of literacy; (3) challenges and strategies to communicating concepts and supporting decision‐making; and (4) suggested improvements to the health system. Participants described subjectively assessing a person's literacy level by monitoring the types of questions asked; analysing the language used; examining non‐verbal behaviour, and considering a person's socio‐economic situation. Participants reported the challenges of discussing the subtleties of cancer treatments with lower literacy groups such as the benefits and risks of treatment options and clinical trials, and tended to provide the basic facts to facilitate understanding. Radiation oncologists acknowledged the importance of health literacy in oncology, and employed a number of techniques to tailor their communication to different literacy populations. Further research is needed to address the challenges faced by oncologists when interacting with different literacy groups.     

Readability of health care literature

Abstract A sample of health care literature produced for parents was analysed, using the Flesch method, for readability and human interest. As a comparison, the readability and human interest scores were also calculated for Sydney daily newspapers. It was found that the pamphlets produced by government agencies were more readable than those produced by non-government agencies. Those pamphlets written with input from parents were the most readable of all. Similar results were found for the human interest level of the pamphlets. The readability and the human interest scores of the government-produced pamphlets were similar to those of the larger circulation daily newspapers. Health care literature for parents needs to be of good quality and easily understood. The involvement of parents in their production may improve the effectiveness of these leaflets.     

Mapping the clinical care pathways for advanced stage non-small cell lung cancer patients in Victoria: A retrospective cohort study of supportive and palliative care

The lung cancer Optimal Care Pathway recommends supportive care and palliative care integration throughout its various steps, with early referral to appropriate services improving the quality of life in advanced stage non-small cell lung cancer patients. Using Victorian Lung Cancer Registry data and linked administrative datasets, this retrospective cohort study mapped clinical care pathways of 525 Stage III–IV non-small cell lung cancer patients in Victoria to 11 recommendations in the Optimal Care Pathway, identifying unwarranted variations in clinical care. Supportive care and palliative care delivery were further examined to understand the involvement and timing of specialist care teams. Our findings showed that palliative care utilization is highest at the time of treatment, despite recommendations that it should be provided early after diagnosis to improve patient outcomes and satisfaction. Early supportive care screening was observed in half the cohort and almost three-quarters of the patients had been presented at a multidisciplinary meeting. Multidisciplinary meeting presentations and supportive care provide an opportunity to improve communication about palliative care needs and integration into routine clinical practice, such as at the time of treatment planning.     

The Effects of Danazol After Endometrial Resection: Results of a randomized, placebo-controlled, double-blind study

Summary: We report the results of a controlled, randomized, prospective, 'double blind' evaluation of the effect of danazol treatment in 120 patients after hysteroscopic endometrial resection. After endometrial resection, the women were allocated to 1 of 3 groups: Group A—placebo; Group B—high-dose danazol (600 mg daily); Group C—low-dose danazol (200 mg daily) plus placebo tablets. Tablets were specifically manufactured for the study, were identical in appearance, and were supplied in individual prepackaged boxes. The duration of treatment was 3 months and patients' compliance was noted. Amenorrhoea, dysmenorrhoea and premenstrual tension symptoms were assessed for each group by 1 or 2 independent gynaecologists at follow-up intervals of 6 weeks, 3, 6 and 12 months. A statistically-significant increased rate of amenorrhoea was found in patients who received treatment with the higher-dose danazol (600 mg day) following endometrial resection. While not statistically significant, the same trend was noted with the low-dose danazol. This result should influence our clinical management of women with menorrhagia, and the long-term results on the same cohort of patients are awaited with interest.     

Randomized Prospective Intervention Study of Human Cervical Wart Virus Infection

Summary: Between February, 1988, and January, 1991,222 women with histologically proven cervical wart virus infection without dysplasia were randomized to be managed by 1 of 4 protocols. Group 1 acted as control, Group 2 were asked to use condoms for 6 months, Group 3 underwent local ablative therapy and Group 4 were asked to use condoms after ablative therapy. Assessment at 2 and 3 years of follow-up showed no statistically significant superiority for treatment over observation. Defaulters from follow-up were over 50% by the completion of the study.     

Trends in Invasive Cancer of the Cervix Uteri in New South Wales, 1973–1982

Summary: Data from the New South Wales (NSW) Central Cancer Registry comprising all new cases of, and deaths from, invasive cancer of the cervix uteri registered in persons aged 15 years and over for the 10-year period 1973 to 1982 were examined using log-linear regression to determine whether incidence and mortality had been changing in NSW. Allowing for the estimated fraction of women who had undergone hysterectomy, this cancer had decreased significantly in incidence (- 1.3% per year) as well as mortality (-3.6%). There were no significant trends in relation to age at diagnosis, stage at diagnosis or histological type. Overall, younger age at diagnosis was associated with an earlier stage at presentation and there was no evidence for a trend towards more severe disease in young women during the 10-year period. No evidence was found for an increasing incidence of adenocarcinoma. By 1982 the age-standardized incidence rate was 10.4 per 100,000 (12.5 per 100,000 after adjustment for the hysterectomy fraction). Cancer of the cervix uteri was more common in Inner and Western Sydney and less common in the Northern Metropolitan region of Sydney and rural New South Wales.