Dr Hiren Mandaliya

Background: The COVID-19 pandemic has challenged cancer care globally, introducing resource limitations and competing risks into clinical practice. Aims: To describe the COVID-19 impact on medical oncology care provision in an Australian setting. Methods: Calvary Mater Newcastle and Newcastle Private Hospital medical oncology data from 1 February to 31 April 2019 versus 2020 were retrospectively analysed. Results: Three hundred and sixty-four inpatient admissions occurred in 2020, 21% less than in 2019. Total inpatient days decreased by 22% (2842 vs 2203). April was most impacted (36% and 44% fewer admissions and inpatient days respectively). Mean length of stay remained unchanged (6.4 vs 6.2 days, P = 0.7). In all, 5072 outpatient consultations were conducted, including 417 new-patient consultations (4% and 6% increase on 2019 respectively). Telephone consultations (0 vs 1380) replaced one-quarter of face-to-face consultations (4859 vs 3623, -25%), with minimal telehealth use (6 vs 69). Day Treatment Centre encounters remained stable (3751 vs 3444, -8%). The proportion of new patients planned for palliative treatment decreased (35% vs 28%, P = 0.04), observation increased (16% vs 23%, P¿=¿0.04) and curative intent treatment was unchanged (both 41%). Recruiting clinical trials decreased by one-third (45 vs 30), two trials were activated (vs 5 in 2019) and 45% fewer patients consented to trial participation (62 vs 34). Conclusion: Our medical oncology teams adapted rapidly to COVID-19 with significant changes to care provision, including fewer hospital admissions, a notable transition to telephone-based outpatient clinics and reduced clinical trial activity. The continuum of care was largely defended despite pandemic considerations and growing service volumes.

Aim: Patients with cancer have varied preferences for involvement in decision-making. We sought older adults' preferred and perceived roles in decision-making about palliative chemotherapy; priorities; and information received and desired. Methods: Patients =65y who had made a decision about palliative chemotherapy with an oncologist completed a written questionnaire. Preferred and perceived decision-making roles were assessed by the Control Preferences Scale. Wilcoxon rank-sum tests evaluated associations with preferred role. Factors important in decision-making were rated and ranked, and receipt of, and desire for information was described. Results: Characteristics of the 179 respondents: median age 74y, male (64%), having chemotherapy (83%), vulnerable (Vulnerable Elders Survey-13 score = 3) (52%). Preferred decision-making roles (n = 173) were active in 39%, collaborative in 27%, and passive in 35%. Perceived decision-making roles (n = 172) were active in 42%, collaborative in 22%, and passive in 36% and matched the preferred role for 63% of patients. Associated with preference for an active role: being single/widowed (p = .004, OR = 1.49), having declined chemotherapy (p = .02, OR = 2.00). Ranked most important (n = 159) were ¿doing everything possible¿ (30%), ¿my doctor's recommendation¿ (26%), ¿my quality of life¿ (20%), and ¿living longer¿ (15%). A minority expected chemotherapy to cure their cancer (14%). Most had discussed expectations of cure (70%), side effects (88%) and benefits (82%) of chemotherapy. Fewer had received quantitative prognostic information (49%) than desired this information (67%). Conclusion: Older adults exhibited a range of preferences for involvement in decision-making about palliative chemotherapy. Oncologists should seek patients' decision-making preferences, priorities, and information needs when discussing palliative chemotherapy.

Background: Currently, there is no single validated biomarker which can prognosticate survival in patients with stage IV non-small cell lung cancer (NSCLC). This study examines the prognostic significance of four biomarkers: neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), platelet to lymphocyte ratio (PLR) and advanced lung cancer inflammation index (ALI) in patients with stage IV NSCLC. Methods: This study aimed to establish the relationship between NLR, LMR, PLR, ALI and overall survival (OS) at baseline and post first cycle of treatment using Cox univariate PH models. We also studied these biomarkers in the elderly (age =70 years). Clinical data was sourced from Calvary Mater Newcastle between 2010 and 2015. Results: Baseline NLR, PLR, LMR and ALI showed strong association with OS. Five unit increase in NLR and PLR was associated with an 11% and 0.5% increase in the hazard of death respectively while 1 unit increase in ALI resulted in 4% increase in hazard of death. Five unit increase in LMR was associated with a 50% reduction in hazard of death. Post-treatment NLR and low ALI correlated with shorter OS but no statistically significant relationship could be demonstrated for PLR nor LMR. Similar prognostic trends were noted for elderly. Conclusions: High NLR, high PLR, low LMR and low ALI at baseline are significantly associated with poor OS. High NLR and low ALI are significantly associated with poor OS post treatment. Findings are similar regardless of age.

Background: Cancer treatments can have long-term physical, psychological, financial, sexual and cognitive effects that may influence the quality of life. These can vary from urban to rural areas, survival period and according to the type of cancer. We here aimed to describe demographics and psychosocial analysis of cancer survivors three to five years post-treatment in rural Australia and also assess relationships with financial stress and quality of life domains. Materials and Methods: In this cross-sectional study, 65 participants visiting the outpatient oncology clinic were given a self-administered questionnaire. The inclusion criteria included three to five years post-treatment. Three domains were investigated using standardised and validated tools such as the Standard Quality of Life in Adult Cancer Survivors Scale (QLACS) and the Personal and Household Finances (HILDA) survey. Included were demographic parameters, quality of life, treatment information and well-being. Results: There was no evidence of associations between any demographic variable and either financial stress or cancer-specific quality of life domains. Financial stress was however significantly associated with the cancerspecific quality of life domains of appearance-related concerns, family related distress, and distress related to recurrence. Conclusions: This unique study effectively points to psychosocial aspects of cancer survivors in rural regions of Australia. Although the majority of demographic characteristics were not been found to be associated with financial stress, this latter itself is significantly associated with distress related to family and cancer recurrence. This finding may be of assistance in future studies and also considering plans to fulfil unmet needs.