Dr Nick Zdenkowski

Dr Nick Zdenkowski

Conjoint Lecturer

School of Medicine and Public Health (Medicine)

Career Summary

Biography

Dr Nick Zdenkowski is a clinician researcher with an interest in breast cancer. He would like to see research more embedded in routine clinical practice, to enable rapid and efficient translation of research into patient care. Application of the principles of implementation research gives more patient the chance to benefit from advances in seen in clinical trials.

Following completion of his medical degree (BMed, Newcastle) and basic physician training, Nick trained as a medical oncologist (FRACP), recognising the great need for improvements in outcomes for cancer patients. This sparked an interest in the potential for research to impact upon patient's lives on a greater scale. He has maintained his clinical practice, providing patients with care based on best available evidence. He currently practices at Calvary Mater Hospital, Waratah, and The Breast and Endocrine Centre, Gateshead. He works as a Medical Adviser with Breast Cancer Trials, a collaborative breast cancer clinical trials group based in Newcastle.

His research includes supporting patient decision-making, supportive care in cancer, and implementation of research findings into routine practice. He is interested in the decisions around giving pre-operative systemic therapy for women with operable breast cancer. This takes into account patient, clinician and system factors. His PhD thesis explores these issues. This thesis also describes the development of a patient decision aid that was successfully integrated into the patient care pathway.

Nick has also completed a Graduate Diploma in Clinical Epidemiology (Newcastle), and a Clinical Diploma in Palliative Care (RACP). He has accumulated expertise in the development, conduct and reporting of clinical trials during a fellowship with Breast Cancer Trials (formerly known as the Australia and New Zealand Breast Cancer Trials Group). He is an early career researcher, with a Web of Science h-index of 5, 23 peer reviewed publications and 24 abstracts presented at national and international scientific meetings since 2013.

He is the principal investigator on several clinical trials, and is the Australian coordinating investigator on the international PALLAS study, for which he also serves on the international steering committee. He sits on the Breast Cancer Trials Scientific Advisory Committee, and the Hunter Cancer Research Alliance Implementation Flagship Steering Committee.


Qualifications

  • Fellow - Royal Australasian College of Physicians, Royal Australasian College of Physicians

Keywords

  • Breast Cancer
  • Chemotherapy
  • Endocrine therapy
  • Neoadjuvant systemic therapy
  • Decision-making
  • Clinical trials

Languages

  • English (Mother)

Fields of Research

Code Description Percentage
110399 Clinical Sciences not elsewhere classified 80
170199 Psychology not elsewhere classified 10
111205 Chemotherapy 10

Professional Experience

Academic appointment

Dates Title Organisation / Department
18/01/2016 -  Clinical Research Fellow Hunter New England Health LHD, NSW Health
Australia
19/01/2015 -  Conjoint Lecturer Faculty of Health and Medicine, University of Newcastle
School of Medicine and Public Health
Australia

Professional appointment

Dates Title Organisation / Department
21/01/2013 - 15/01/2016 Clinical Research Fellow

This role provided high level experience in the development, conduct and reporting of national and international clinical trials in breast cancer.

Breast Cancer Trials
Trials Coordination
Australia
19/01/2010 - 18/01/2013 Advanced Trainee in Medical Oncology

In this role I completed training to become an independent medical oncologist.

Calvary Mater Newcastle
Department of Medical Oncology
Australia
21/01/2008 - 15/01/2010 Basic Physician Trainee Northern Sydney Central Coast Area Health Service (NSCCAHS)
Medicine
Australia

Awards

Award

Year Award
2017 High Value Healthcare - Patients as Partners
Hunter New England Health LHD, NSW Health

Invitations

Speaker

Year Title / Rationale
2017 Neoadjuvant Systemic Therapy for Breast Cancer: Patient, Practice and Research Considerations
Edit

Publications

For publications that are currently unpublished or in-press, details are shown in italics.


Journal article (28 outputs)

Year Citation Altmetrics Link
2018 Herrmann A, Hall A, Zdenkowski N, 'Women's Experiences with Deciding on Neoadjuvant Systemic Therapy for Operable Breast Cancer: A Qualitative Study.', Asia-Pacific journal of oncology nursing, 5 68-76 (2018) [C1]
DOI 10.4103/apjon.apjon_60_17
2018 Waller A, Hall A, Sanson-Fisher R, Zdenkowski N, Douglas C, Walsh J, 'Do medical oncology patients and their support persons agree about end-of-life issues?', Internal Medicine Journal, 48 60-66 (2018) [C1]

© 2017 Royal Australasian College of Physicians. Background: The perceptions of those called on to make decisions on behalf of patients who lack capacity at the end of life must a... [more]

© 2017 Royal Australasian College of Physicians. Background: The perceptions of those called on to make decisions on behalf of patients who lack capacity at the end of life must accurately reflect patient preferences. Aims: To establish the extent to which the views of medical oncology outpatients are understood by their support persons, specifically with regards to (i) preferred type and location of end-of-life care, (ii) preferred level of involvement in end-of-life decision-making and (iii) whether the patient has completed an advance care plan or appointed an enduring guardian. Methods: Adults with a confirmed cancer diagnosis and their nominated support persons were approached between September 2015 and January 2016 in the waiting room of an Australian tertiary referral clinic. Consenting participants completed a pen-and-paper survey. Nominated support persons answered the same questions from the patient¿s perspective. Results: In total, 208 participants (39% of eligible dyads) participated. Observed agreement across the five outcomes ranged from 54% to 84%. Kappa values for concordance between patient¿support person responses were fair to moderate (0.24¿0.47) for enduring guardian, decision-making, advance care plan and care location outcomes. A slight level of concordance (k = 0.15; 95% confidence interval: -0.02, 0.32) was found for the type of care outcome. Conclusion: Relying on support persons¿ views does not guarantee that patients¿ actual preferences will be followed. Strategies that make patient preferences known to healthcare providers and support persons while they still have the capacity to do so is a critical next step in improving quality cancer care.

DOI 10.1111/imj.13626
Citations Scopus - 2Web of Science - 1
Co-authors Charles Douglas, Amy Waller, Rob Sanson-Fisher
2018 Herrmann A, Boyle F, Butow P, Hall AE, Zdenkowski N, 'Exploring women's experiences with a decision aid for neoadjuvant systemic therapy for operable breast cancer', Health Science Reports, 1 (2018) [C1]
DOI 10.1002/hsr2.13
2018 Herrmann A, Sanson-Fisher R, Hall A, Wall L, Zdenkowski N, Waller A, 'Support persons' preferences for the type of consultation and the format of information provided when making a cancer treatment decision', BMC Research Notes, 11 1-6 (2018) [C1]
DOI 10.1186/s13104-018-3552-x
Co-authors Amy Waller, Rob Sanson-Fisher
2018 Waller A, Douglas C, Sanson-Fisher R, Zdenkowski N, Pearce A, Evans T, Walsh J, 'Dances with denial: Have medical oncology outpatients conveyed their end-of-life wishes and do they want to?', JNCCN Journal of the National Comprehensive Cancer Network, 16 498-505 (2018) [C1]

© JNCCN-Journal of the National Comprehensive Cancer Network. Objectives: This study surveyed a sample of medical oncology outpatients to determine (1) the proportion who have alr... [more]

© JNCCN-Journal of the National Comprehensive Cancer Network. Objectives: This study surveyed a sample of medical oncology outpatients to determine (1) the proportion who have already discussed and documented their end-of-life (EOL) wishes; (2) when and with whom they would prefer to convey their EOL wishes; (3) the EOL issues they would want to discuss; and (4) the association between perceived cancer status and advance care planning (ACP) participation. Methods: Adult medical oncology outpatients were approached in the waiting room of an Australian tertiary treatment center. Consenting participants completed a pen-and-paper survey assessing participation in ACP, preferences for conveying EOL wishes, timing of EOL discussions, and EOL issues they want to be asked about. Results: A total of 203 patients returned the survey (47% of eligible). EOL discussions occurred more frequently with support persons (47%) than with doctors (7%). Only 14% had recorded their wishes, and 45% had appointed an enduring guardian. Those who perceived their cancer as incurable were more likely to have participated in ACP. If facing EOL, patients indicated that they would want family involved in discussions (85%), to be able to write down EOL wishes (82%), and to appoint enduring guardians (91%). Many (45%) preferred the first discussion to happen when their disease became incurable. Slightly less than one-third thought discussions regarding EOL should be patient-initiated. Most agreed doctors should ask about preferred decision-making involvement (92%), how important it is that pain is managed well (95%), and how important it is to remain conscious (82%). Fewer (55%) wanted to be asked about the importance of care extending life. Conclusions: Many patients would like to have discussions regarding EOL care with their doctor and involve their support persons in this process. Only a small percentage of respondents had discussed EOL care with their doctors, recorded their wishes, or appointed an enduring guardian. The first step requires clinicians to ask whether an individual patient wishes to discuss EOL issues, in what format, and at what level of detail.

DOI 10.6004/jnccn.2017.7054
Co-authors Rob Sanson-Fisher, Amy Waller, Charles Douglas
2018 Zdenkowski N, Butow P, Spillane A, Douglas C, Snook K, Jones M, et al., 'Single-arm longitudinal study to evaluate a decision aid for women offered Neoadjuvant systemic therapy for operable breast cancer', JNCCN Journal of the National Comprehensive Cancer Network, 16 378-385 (2018) [C1]

© JNCCN-Journal of the National Comprehensive Cancer Network Background: Neoadjuvant systemic therapy (NAST) is an increasingly used treatment option for women with large operable... [more]

© JNCCN-Journal of the National Comprehensive Cancer Network Background: Neoadjuvant systemic therapy (NAST) is an increasingly used treatment option for women with large operable or highly proliferative breast cancer. With equivalent survival outcomes between NAST and up-front surgery, the situation-specific preference-sensitive nature of the decision makes it suitable for a decision aid (DA). This study aimed to develop and evaluate a DA for this population. Methods: A DA booklet was developed according to international standards, including information about adjuvant and neoadjuvant treatment, outcome probabilities, and a values clarification exercise. Eligible women, considered by investigators as candidates for NAST, were enrolled in a multi-institutional, single-arm, longitudinal study. Patient-reported outcome measure questionnaires were completed pre- and post-DA, between chemotherapy and surgery, and at 12 months. Outcomes were feasibility (percentage of eligible patients accessing the DA); acceptability to patients (percentage who would recommend it to others) and clinicians (percentage who would use the DA in routine practice); and decision-related outcomes. Results: From 77 eligible women, 59 were enrolled, of whom 47 (79.7%; 95% CI, 69.4-89.9) reported having read the DA; 51 completed the first post-DA questionnaire. Of these 51, 41 participants (80.4%; 95% CI, 69.5-91.3) found the DA useful for their decision about NAST. Of 18 responding investigators, 16 (88.9%; 95% CI, 74.4-103.4) indicated they would continue to use the DA in routine practice. Post-DA, decisional conflict decreased significantly (P<.01); anxiety and distress decreased significantly; and 86.3% (95% CI, 73.7-94.3) achieved at least as much decisional control as they desired. Conclusions: This DA was feasible and acceptable to patients and clinicians, and improvement in decision-related outcomes was demonstrated when used in combination with clinical consultations. This DA could safely be implemented into routine practice for women considering NAST for operable breast cancer.

DOI 10.6004/jnccn.2017.7063
Co-authors Charles Douglas, Christopher Oldmeadow
2018 Ager B, Jansen J, Porter D, Phillips KA, Glassey R, Butow P, 'Development and pilot testing of a Decision Aid (DA) for women with early-stage breast cancer considering contralateral prophylactic mastectomy', BREAST, 40 156-164 (2018)
DOI 10.1016/j.breast.2018.05.009
2018 Herrmann A, Hall A, Sanson-Fisher R, Zdenkowski N, Watson R, Turon H, 'Not asking cancer patients about their preferences does make a difference. A cross-sectional study examining cancer patients' preferred and perceived role in decision-making regarding their last important cancer treatment.', Eur J Cancer Care (Engl), e12871 (2018)
DOI 10.1111/ecc.12871
Co-authors Rob Sanson-Fisher
2018 Waller A, Sanson-Fisher R, Zdenkowski N, Douglas C, Hall A, Walsh J, 'The right place at the right time: Medical oncology outpatients' perceptions of location of end-of-life care', JNCCN Journal of the National Comprehensive Cancer Network, 16 35-41 (2018) [C1]

© 2018 JNCCN-Journal of the National Comprehensive Cancer Network. Background: Helping people achieve their preferred location of care is an important indicator of quality end-of-... [more]

© 2018 JNCCN-Journal of the National Comprehensive Cancer Network. Background: Helping people achieve their preferred location of care is an important indicator of quality end-of-life (EOL) care. Using a sample of Australian medical oncology outpatients, this study examined (1) their preferred location of EOL care; (2) their perceived benefits and worries of receiving care in that location; (3) the percentage who had discussed preferences with their doctor and/or support person; and (4) whether they wanted their doctor to ask them where they wanted to die. Methods: Adults with a confirmed diagnosis of cancer were approached between September 2015 and January 2016 in the waiting room of an Australian oncology outpatient clinic. Consenting participants completed a home-based pen-and-paper survey indicating preferred location of care, perceived benefits and worries of that location, whether they had discussed preferences with their doctors, and whether they were willing to be asked about their preferences. Results: A total of 203 patients returned the survey (47% of those eligible). Less than half preferred to be cared for at home (47%), 34% preferred a hospice/palliative care unit, and 19% preferred the hospital. Common benefits and worries associated with locations included perceived burden on others, familiarity of environment, availability of expert medical care, symptom management, and likelihood of having wishes respected. More patients had discussed preferences with their support persons (41%) than doctors (7%). Most wanted a doctor to ask them about preferred location of care (87%) and thought it was important to die in the location of their choice (93%). Conclusions: Patients were willing to have clinicians to ask them where they wanted to die, although few had discussed their preferences with doctors. Although home was the most preferred location for many patients, the overall variation suggests that clinicians should adopt a systematic approach to eliciting patient preferences.

DOI 10.6004/jnccn.2017.7025
Citations Scopus - 2Web of Science - 1
Co-authors Amy Waller, Charles Douglas, Rob Sanson-Fisher
2018 Herrmann A, Sanson-Fisher R, Hall A, Wall L, Zdenkowski N, Waller A, 'A discrete choice experiment to assess cancer patients¿ preferences for when and how to make treatment decisions', Supportive Care in Cancer, 26 1215-1220 (2018) [C1]

© 2017, Springer-Verlag GmbH Germany. Purpose: Cancer patients can be overwhelmed when being confronted with their diagnosis and treatment options. Such information is often provi... [more]

© 2017, Springer-Verlag GmbH Germany. Purpose: Cancer patients can be overwhelmed when being confronted with their diagnosis and treatment options. Such information is often provided during one consultation between the patient and treating clinician. In order to achieve optimal cancer care, there may be justification for alternative consultation styles. We assessed, in a sample of adult medical oncology patients, their preferences for (i) attending one 40-min consultation or two 20-min consultations and (ii) receiving written only or both written and online information, when making a cancer treatment decision. Methods: This was a cross-sectional survey using a discrete choice design of 159 adult medical oncology patients presenting for their second or subsequent outpatient consultation. Participants were presented with a set of hypothetical scenarios and asked to indicate their most and least preferred scenario. The scenarios contained a caveat explaining that there would be no difference between the available treatment options in terms of when treatment would be initiated and the impact it would have on patients¿ life expectancy. Results: One hundred forty-seven patients completed the DCE. Of these, 70% (n¿=¿103) preferred being provided with written and online information rather than just written information. This preference was statistically significant (p¿<¿0.01). Fifty-nine percent (n¿=¿86) of patients preferred two 20-min consultations over one 40-min consultation when making a treatment decision. Significantly, more patients preferred two shorter consultations rather than one longer consultation when this was combined with written and online information (p¿<¿0.01). Conclusion: When making a cancer treatment decision, clinicians should consider offering patients written and online information, combined with two shorter consultations.

DOI 10.1007/s00520-017-3944-9
Citations Scopus - 1
Co-authors Rob Sanson-Fisher, Amy Waller
2017 Zdenkowski N, Radvan G, Pugliese L, Charlton J, Oldmeadow C, Fraser A, Bonaventura A, 'Treatment of pancreatic insufficiency using pancreatic extract in patients with advanced pancreatic cancer: a pilot study (PICNIC)', Supportive Care in Cancer, 25 1963-1971 (2017) [C1]
DOI 10.1007/s00520-017-3602-2
Co-authors Christopher Oldmeadow
2017 Rutherford C, Zdenkowski N, 'Strategies to support shared decision making in breast cancer', Cancer Forum, 41 1-9 (2017) [C1]
Citations Scopus - 1
2016 Zdenkowski N, Forbes JF, Boyle FM, Kannourakis G, Gill PG, Bayliss E, et al., 'Observation versus late reintroduction of letrozole as adjuvant endocrine therapy for hormone receptorpositive breast cancer (ANZ0501 LATER): An open-label randomised, controlled trial', Annals of Oncology, 27 806-812 (2016) [C1]

© The Author 2016. Background: Despite the effectiveness of adjuvant endocrine therapy in preventing breast cancer recurrence, breast cancer events continue at a high rate for at ... [more]

© The Author 2016. Background: Despite the effectiveness of adjuvant endocrine therapy in preventing breast cancer recurrence, breast cancer events continue at a high rate for at least 10 years after completion of therapy. Patients and methods: This randomised open label phase III trial recruited postmenopausal women from 29 Australian and New Zealand sites, with hormone receptor-positive early breast cancer, who had completed =4 years of endocrine therapy [aromatase inhibitor (AI), tamoxifen, ovarian suppression, or sequential combination] =1 year prior, to oral letrozole 2.5 mg daily for 5 years, or observation. Treatment allocation was by central computerised randomisation, stratified by institution, axillary node status and prior endocrine therapy. The primary outcome was invasive breast cancer events (new invasive primary, local, regional or distant recurrence, or contralateral breast cancer), analysed by intention to treat. The secondary outcomes were disease-free survival (DFS), overall survival, and safety. Results: Between 16 May 2007 and 14 March 2012, 181 patients were randomised to letrozole and 179 to observation (median age 64.3 years). Endocrine therapy was completed at a median of 2.6 years before randomisation, and 47.5% had tumours of >2 cm and/or node positive. At 3.9 years median follow-up (interquartile range 3.1- 4.8), 2 patients assigned letrozole (1.1%) and 17 patients assigned observation (9.5%) had experienced an invasive breast cancer event (difference 8.4%, 95% confidence interval 3.8% to 13.0%, log-rank test P = 0.0004). Twenty-four patients (13.4%) in the observation and 14 (7.7%) in the letrozole arm experienced a DFS event (log-rank P = 0.067). Adverse events linked to oestrogen depletion, but not serious adverse events, were more common with letrozole. Conclusion: These results should be considered exploratory, but lend weight to emerging data supporting longer duration endocrine therapy for hormone receptor-positive breast cancer, and offer insight into reintroduction of AI therapy.

DOI 10.1093/annonc/mdw055
Citations Scopus - 3Web of Science - 3
Co-authors John Forbes
2016 Zdenkowski N, Butow P, Hutchings E, Douglas C, Coll JR, Boyle FM, 'A Decision Aid for Women Considering Neoadjuvant Systemic Therapy for Operable Invasive Breast Cancer: Development and Protocol of a Phase II Evaluation Study (ANZ1301 DOMINO)', JMIR RESEARCH PROTOCOLS, 5 (2016)
DOI 10.2196/resprot.5641
Citations Web of Science - 2
Co-authors Charles Douglas
2016 Lombard JM, Zdenkowski N, Wells K, Beckmore C, Reaby L, Forbes JF, Chirgwin J, 'Aromatase inhibitor induced musculoskeletal syndrome: a significant problem with limited treatment options', Supportive Care in Cancer, 24 2139-2146 (2016) [C1]

© 2015, Springer-Verlag Berlin Heidelberg. Background: Aromatase inhibitor induced musculoskeletal syndrome is experienced by approximately half of women taking aromatase inhibito... [more]

© 2015, Springer-Verlag Berlin Heidelberg. Background: Aromatase inhibitor induced musculoskeletal syndrome is experienced by approximately half of women taking aromatase inhibitors, impairing quality of life and leading some to discontinue treatment. Evidence for effective treatments is lacking. We aimed to understand the manifestations and impact of this syndrome in the Australian breast cancer community, and strategies used for its management. Methods: A survey invitation was sent to 2390 members of the Breast Cancer Network Australia Review and Survey Group in April 2014. The online questionnaire included 45 questions covering demographics, aromatase inhibitor use, clinical manifestations and risk factors for the aromatase inhibitor musculoskeletal syndrome, reasons for treatment discontinuation and efficacy of interventions used. Results: Aromatase inhibitor induced musculoskeletal syndrome was reported by 302 (82¿%) of 370 respondents. Twenty-seven percent had discontinued treatment for any reason and of these, 68¿% discontinued because of the musculoskeletal syndrome. Eighty-one percent had used at least one intervention from the following three categories to manage the syndrome: doctor prescribed medications, over-the-counter/complementary medicines or alternative/non-drug therapies. Anti-inflammatories, paracetamol (acetaminophen) and yoga were most successful in relieving symptoms in each of the respective categories. Almost a third of respondents reported that one or more interventions helped prevent aromatase inhibitor discontinuation. However, approximately 20¿% of respondents found no intervention effective in any category. Conclusion: We conclude that aromatase inhibitor induced musculoskeletal syndrome is a significant issue for Australian women and is an important reason for treatment discontinuation. Women use a variety of interventions to manage this syndrome; however, their efficacy appears limited.

DOI 10.1007/s00520-015-3001-5
Citations Scopus - 11Web of Science - 9
Co-authors John Forbes
2016 Zdenkowski N, Butow P, Mann GB, Fewster S, Beckmore C, Isaacs R, et al., 'A survey of Australian and New Zealand clinical practice with neoadjuvant systemic therapy for breast cancer', Internal Medicine Journal, 46 677-683 (2016) [C1]

© 2016 Royal Australasian College of Physicians. Background: Neoadjuvant systemic therapy (NAST) has become an established treatment option for women with operable breast cancer. ... [more]

© 2016 Royal Australasian College of Physicians. Background: Neoadjuvant systemic therapy (NAST) has become an established treatment option for women with operable breast cancer. Aim: We aimed to better understand NAST treatment patterns, barriers and facilitators in Australia and New Zealand. Methods: We undertook a cross-sectional survey of the current clinical practice of Australian and New Zealand breast cancer specialists. Questions included referral patterns for NAST, patient selection, logistics, decision making and barriers. Results: Of 207 respondents, 162 (78%) reported routinely offering NAST to selected patients with operable breast cancer (median 9% of patients offered NAST). Specialty, location, practice type, gender or years of experience did not predict for offering NAST. In all, 45 and 58% wanted to increase the number of patients who receive NAST in routine care and in clinical trials respectively. Facilitators included the multidisciplinary team meeting and access to NAST clinical trials. Specialist-reported patient barriers included: patient desire for immediate surgery (63% rated as important/very important); lack of awareness of NAST (50%); concern about progression (43%) and disinterest in downstaging (32%). Forty-three per cent of participants experienced system-related barriers to the use of NAST, including other clinicians' lack of interest (27%); lack of clinical trials (24%) and unacceptable wait for a medical oncology appointment (37%). Conclusion: This group of Australian and New Zealand clinicians are interested in NAST for operable breast cancer in routine care and clinical trials. Patient- and system-related barriers that prevent the optimal uptake of this treatment approach will need to be systematically addressed if NAST is to become a more common approach.

DOI 10.1111/imj.13049
Citations Scopus - 1Web of Science - 2
Co-authors Charles Douglas
2016 Zdenkowski N, Butow P, Tesson S, Boyle F, 'A systematic review of decision aids for patients making a decision about treatment for early breast cancer', BREAST, 26 31-45 (2016)
DOI 10.1016/j.breast.2015.12.007
Citations Scopus - 16Web of Science - 19
2016 Zdenkowski N, Tesson S, Lombard J, Lovell M, Hayes S, Francis PA, et al., 'Supportive care of women with breast cancer: key concerns and practical solutions.', Med J Aust, 205 471-475 (2016) [C1]
Citations Scopus - 5Web of Science - 5
2016 Herrmann A, Mansfield E, Hall AE, Sanson-Fisher R, Zdenkowski N, 'Wilfully out of sight? A literature review on the effectiveness of cancer-related decision aids and implementation strategies', BMC Medical Informatics and Decision Making, 16 (2016) [C1]

© 2016 Herrmann et al. Background: There is evidence to suggest that decision aids improve a number of patient outcomes. However, little is known about the progression of research... [more]

© 2016 Herrmann et al. Background: There is evidence to suggest that decision aids improve a number of patient outcomes. However, little is known about the progression of research effort in this area over time. This literature review examined the volume of research published in 2000, 2007 and 2014 which tested the effectiveness of decision aids in improving cancer patient outcomes, coded by cancer site and decision type being targeted. These numbers were compared with the volume of research examining the effectiveness of strategies to increase the adoption of decision aids by healthcare providers. Methods: A literature review of intervention studies was undertaken. Medline, Embase, PsychInfo and Cochrane Database of Systematic Reviews were searched. The search was limited to human studies published in English, French, or German. Abstracts were assessed against eligibility criteria by one reviewer and a random sample of 20 % checked by a second. Eligible intervention studies in the three time periods were categorised by: i) whether they tested the effectiveness of decision aids, coded by cancer site and decision type, and ii) whether they tested strategies to increase healthcare provider adoption of decision aids. Results: Over the three time points assessed, increasing research effort has been directed towards testing the effectiveness of decision aids in improving patient outcomes (p < 0.0001). The number of studies on decision aids for cancer screening or prevention increased statistically significantly (p < 0.0001) whereas the number of studies on cancer treatment did not (p = 1.00). The majority of studies examined the effectiveness of decision aids for prostate (n = 10), breast (n = 9) or colon cancer (n = 7). Only two studies assessed the effectiveness of implementation strategies to increase healthcare provider adoption of decision aids. Conclusions: While the number of studies testing the effectiveness of decision aids has increased, the majority of research has focused on screening and prevention decision aids for only a few cancer sites. This neglects a number of cancer populations, as well as other areas of cancer care such as treatment decisions. Also, given the apparent effectiveness of decision aids, more effort needs to be made to implement this evidence into meaningful benefits for patients.

DOI 10.1186/s12911-016-0273-8
Citations Scopus - 6Web of Science - 6
Co-authors Elise Mansfield, Rob Sanson-Fisher
2016 Zdenkowski N, Butow P, Fewster S, Beckmore C, Wells K, Forbes JF, Boyle F, 'Exploring Decision-Making about Neo-adjuvant Chemotherapy for Breast Cancer', BREAST JOURNAL, 22 133-134 (2016)
DOI 10.1111/tbj.12537
Citations Web of Science - 4
Co-authors John Forbes
2016 Ager B, Butow P, Jansen J, Phillips KA, Porter D, Rankin N, et al., 'Contralateral prophylactic mastectomy (CPM): A systematic review of patient reported factors and psychological predictors influencing choice and satisfaction', Breast, 28 107-120 (2016) [C1]

© 2016 Elsevier Ltd. Objective: Conduct a systematic review of quantitative and qualitative studies exploring patient reported factors and psychological variables influencing the ... [more]

© 2016 Elsevier Ltd. Objective: Conduct a systematic review of quantitative and qualitative studies exploring patient reported factors and psychological variables influencing the decision to have contralateral prophylactic mastectomy (CPM), and satisfaction with CPM, in women with early stage breast cancer. Methods: Studies were identified via databases: Medline, CINAHL, Embase and PsycINFO. Data were extracted by one author and crosschecked by two additional authors for accuracy. The quality of included articles was assessed using standardised criteria by three authors. Results: Of the 1346 unique citations identified, 17 were studies that met the inclusion criteria. Studies included were primarily cross-sectional and retrospective. No study utilised a theoretical framework to guide research and few studies considered psychological predictors of CPM. Fear of breast cancer was the most commonly cited reason for CPM, followed by cosmetic reasons such as desire for symmetry. Overall, women appeared satisfied with CPM, however, adverse/diminished body image, poor cosmetic result, complications, diminished sense of sexuality, emotional issues and perceived lack of education regarding alternative surveillance/CPM efficacy were cited as reasons for dissatisfaction. Conclusion: Current literature has begun to identify patient-reported reasons for CPM; however, the relative importance of different factors and how these factors relate to the process underlying the decision to have CPM are unknown. Of women who considered CPM, limited information is available regarding differences between those who proceed with or ultimately decline CPM.

DOI 10.1016/j.breast.2016.04.005
Citations Scopus - 10
2015 Zdenkowski N, Butow P, Mann B, Fewster S, Douglas C, Boyle FM, 'Decisions about neoadjuvant systemic therapy for breast cancer: A survey of Australian and New Zealand specialists', ANZ Journal of Surgery, 85 797-798 (2015) [C3]
DOI 10.1111/ans.13266
Citations Scopus - 1Web of Science - 3
Co-authors Charles Douglas
2014 McCarthy N, Boyle F, Zdenkowski N, Bull J, Leong E, Simpson A, et al., 'Neoadjuvant chemotherapy with sequential anthracycline-docetaxel with gemcitabine for large operable or locally advanced breast cancer: ANZ 0502 (NeoGem)', BREAST, 23 142-151 (2014) [C1]
DOI 10.1016/j.breast.2013.12.001
Citations Scopus - 4Web of Science - 5
Co-authors John Forbes
2014 De Boer R, Beith J, Chirgwin J, Chua S, Colosimo M, Francis P, et al., 'Systemic treatment of HER2+metastatic breast cancer: Clinical conundrums and future perspectives', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, 10 15-25 (2014) [C1]
DOI 10.1111/ajco.12207
Citations Scopus - 1Web of Science - 1
2014 Wilcken N, Zdenkowski N, White M, Snyder R, Pittman K, Mainwaring P, et al., 'Systemic treatment of HER2-positive metastatic breast cancer: A systematic review', Asia-Pacific Journal of Clinical Oncology, 10 1-14 (2014) [C1]

Aim: We aimed to systematically review and summarize data from the available clinical trials that examined the treatment of HER2-positive metastatic breast cancer. Methods: We rev... [more]

Aim: We aimed to systematically review and summarize data from the available clinical trials that examined the treatment of HER2-positive metastatic breast cancer. Methods: We reviewed phase 2 and 3 studies in which an anti-HER2 agent was used in one or both arms of the study. While formal meta-analysis was not possible for such a heterogeneous group of trials, resulting forest plots outline some generalizable findings. Results: There is strong evidence that the addition of an anti-HER2 agent to standard chemo- or endocrine therapy improves clinically relevant measurable outcomes. There is also consistent evidence that initial treatment with trastuzumab alone (and subsequent use of a cytotoxic) is inferior to the initial combination of trastuzumab plus chemotherapy, and that either T-DM1 or dual anti-HER2 agents are superior to single anti-HER2 agent regimens. There is no strong evidence that the use of more than one cytotoxic agent together with an anti-HER2 agent confers any benefit over a single cytotoxic, anti-HER2 combination. Conclusion: This review provides a strong evidence base for current clinical practice with a discussion of treatment in the Australian setting. © 2014 Wiley Publishing Asia Pty Ltd.

DOI 10.1111/ajco.12206
Citations Scopus - 7Web of Science - 6
2014 Zdenkowski N, McCarthy N, 'Neoadjuvant chemotherapy: what does it take to tAnGo?', Translational Cancer Research, 3 547-551 (2014) [C1]
DOI 10.3978/j.issn.2218-676X.2014.06.11
2013 Zdenkowski N, Cavenagh J, Ku YC, Bisquera A, Bonaventura A, 'Administration of chemotherapy with palliative intent in the last 30 days of life: the balance between palliation and chemotherapy', INTERNAL MEDICINE JOURNAL, 43 1191-1198 (2013) [C1]
DOI 10.1111/imj.12245
Citations Scopus - 17Web of Science - 17
2012 Zdenkowski N, Chen S, Van Der Westhuizen A, Ackland S, 'Curative strategies for liver metastases from colorectal cancer: A review', Oncologist, 17 201-211 (2012) [C1]
Citations Scopus - 16Web of Science - 16
Co-authors Stephen Ackland
Show 25 more journal articles

Conference (27 outputs)

Year Citation Altmetrics Link
2018 Friedlander M, Scott CL, Lindeman GJ, Gibbs E, Badger HD, Paterson RJ, et al., 'A Phase 1 Trial of Olaparib and Oral Metronomic. Cyclophosphamide in Patients with Metastatic BRCA-Associated Breast/Ovarian Cancers or Non-BRCA Associated Triple-Negative Breast Cancer/High Grade Serous Ovarian Cancers', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY (2018)
2018 Zdenkowski N, Loi S, Francis P, Gebski V, Badger H, Boyle F, 'BCT1702 CHARIOT: Checkpoint Therapy in Triple Negative Breast Cancer - Trial in Progress', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY (2018)
2018 Zdenkowski N, Loi S, Francis P, Gebski V, Hay T, Hui R, 'BCT1703 DIAMOND: Double Immune Activation in Advanced HER2-Positive Breast Cancer - Trial in Progress', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY (2018)
2017 Zdenkowski N, Lynam J, Wall L, Brown S, Sproule V, 'Results of a Survey Investigating Cancer Patients' Willingness to Travel to Participate in a Clinical Trial', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY (2017)
2017 Zdenkowski N, Butow P, Boyle F, 'Primary Results of a Study to Evaluate a Decision Aid For Women-Offered Neoadjuvant Systemic Therapy for Breast Cancer', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY (2017)
2017 Zdenkowski N, Butow P, Spillane AJ, Douglas C, Beckmore C, Jones M, Boyle FM, 'Primary results of a study to evaluate a decision aid for women offered neoadjuvant systemic therapy for breast cancer', ANNALS OF ONCOLOGY, Madrid, SPAIN (2017)
Co-authors Charles Douglas
2017 Zdenkowski N, Lynam JF, Wall L, Brown S, Wells K, Sproule V, 'Breast cancer patients' willingness to travel to participate in a clinical trial.', Journal of Clinical Oncology (2017)
DOI 10.1200/JCO.2017.35.15_suppl.e14031
Co-authors Scott Brown
2017 Zdenkowski N, Butow P, Boyle FM, 'Patient-Reported Outcome Results from the ANZ1301 Domino Neoadjuvant Breast Cancer Decision AID Study', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY (2017)
2017 Waller A, Sanson-Fisher R, Zdenkowski N, Douglas C, Walsh J, Hall A, 'Are older and seriously ill Australians planning for their future medical care?', PSYCHO-ONCOLOGY (2017)
Co-authors Rob Sanson-Fisher, Charles Douglas, Amy Waller
2017 Zdenkowski N, Herrmann A, Hall A, Boyle FM, Butow P, 'Women's experiences with a decision aid for neoadjuvant systemic therapy for operable breast cancer', CANCER RESEARCH, San Antonio, TX (2017)
DOI 10.1158/1538-7445.SABCS16-P3-11-02
2016 Lynam J, Hall A, Ayoola A, Sridharan S, Henskens F, Smith A, et al., 'DECISION-MAKING PREFERENCES AND SATISFACTION OF STAGE ONE TESTICULAR CANCER PATIENTS', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY (2016)
Co-authors Frans Henskens, Bree Hobden
2016 Herrmann A, Hall A, Zdenkowski N, 'Exploring how women make decisions on neoadjuvant systemic therapy (NAST) for operable breast cancer', BREAST, Lugano, Switzerland (2016)
2016 Hall A, Lynam J, Ayoola A, Sridharan S, Henskens F, Smith A, et al., 'ASSESSING THE INFORMATION NEEDS OF STAGE ONE TESTICULAR CANCER PATIENTS AND THEIR CARERS', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, Newcastle, Australia (2016)
Co-authors Bree Hobden, Frans Henskens
2016 Herrmann A, Mansfield E, Hall A, Sanson-Fisher R, Zdenkowski N, 'EXAMINING WHERE RESEARCH EFFORTS ON CANCER-RELATED DECISION AIDS HAVE BEEN MADE', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, Newcastle, Australia (2016)
Co-authors Rob Sanson-Fisher, Elise Mansfield
2016 Zdenkowski N, 'DEVELOPMENT AND TESTING OF A DECISION AID FOR WOMEN CONTEMPLATING NEOADJUVANT SYSTEMIC THERAPY FOR OPERABLE BREAST CANCER', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, Gold Coast, QLD (2016)
2016 Zdenkowski N, 'DECISION AIDS, PATIENT VIEWS AND BARRIERS', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, Gold Coast, QLD (2016)
2015 Zdenkowski N, Green M, Boyle FM, Kannourakis G, Gill PG, Bayliss E, et al., 'Final analysis of a randomized comparison of letrozole (Let) vs observation (Obs) as late reintroduction of adjuvant endocrine therapy (AET) for postmenopausal women with hormone receptor positive (HR plus ) breast cancer (BC) after completion of prior AET: ANZBCTG 0501 (LATER).', JOURNAL OF CLINICAL ONCOLOGY, Chicago, IL (2015) [E3]
Co-authors John Forbes
2015 Zdenkowski N, Butow P, Mann GB, Fewster S, Beckmore C, Isaacs R, Boyle FM, 'Neoadjuvant systemic therapy for breast cancer: a survey of Australian and New Zealand specialists', BREAST (2015) [E3]
DOI 10.1016/S0960-9776(15)70233-X
2015 Lombard JM, Zdenkowski N, Wells K, Grant N, Reaby L, Forbes JF, Chirgwin J, 'Aromatase inhibitor induced musculoskeletal syndrome (AIMSS) in Australian women with early breast cancer: An Australia and New Zealand Breast Cancer Trials Group (ANZBCTG) survey of members of the Breast Cancer Network Australia (BCNA)', Cancer Research, San Antonio, TX, USA (2015) [E3]
Co-authors John Forbes
2015 Zdenkowski N, Butow P, Mann GB, Fewster S, Beckmore C, Isaacs R, Boyle FM, 'A SURVEY OF AUSTRALIAN AND NEW ZEALAND (ANZ) SPECIALISTS' USE OF NEOADJUVANT SYSTEMIC THERAPY (NAST) FOR WOMEN WITH BREAST CANCER', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY (2015) [E3]
2015 Zdenkowski N, Plowman L, Hall S, Jones D, Ackland S, 'MIDKINE (MK) AS A PREDICTIVE BIOMARKER IN METASTATIC COLORECTAL CANCER (mCRC)', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY (2015) [E3]
Co-authors Sharron Hall, Stephen Ackland
2015 Zdenkowski N, Sproule V, Hutchings E, Butow P, Boyle F, 'DEVELOPMENT AND TESTING OF A DECISION AID FOR WOMEN CONSIDERING NEOADJUVANT SYSTEMIC THERAPY FOR OPERABLE BREAST CANCER (STUDY IN PROGRESS)', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY (2015) [E3]
2014 Zdenkowski N, Butow PN, Fewster S, Beckmore C, Wells K, Forbes JF, Boyle FM, 'Exploring decision making about neoadjuvant chemotherapy for early breast cancer.', JOURNAL OF CLINICAL ONCOLOGY, Chicago, IL (2014)
Co-authors John Forbes
2014 Zdenkowski N, Butow P, Fewster S, Beckmore C, Wells K, Forbes JF, Boyle F, 'EXPLORING DECISION MAKING ABOUT NEOADJUVANT CHEMOTHERAPY FOR EARLY BREAST CANCER', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY (2014) [E3]
Citations Scopus - 3
Co-authors John Forbes
2014 Ackland SP, Zdenkowski N, Adler K, Hall S, Jones D, 'MIDKINE AS A PREDICTIVE MARKER IN METASTATIC COLORECTAL CANCER', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY (2014) [E3]
Co-authors Sharron Hall, Stephen Ackland
2014 Zdenkowski N, Radvan G, Oldmeadow C, Bonaventura A, 'PICNIC: TREATMENT OF PANCREATIC ENZYME INSUFFICIENCY IN PATIENTS WITH PANCREATIC CANCER (TRIAL IN PROGRESS)', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY (2014) [E3]
Co-authors Christopher Oldmeadow
2012 Zdenkowski N, Bonaventura A, Ku Y, 'Patterns of palliative chemotherapy administration in the last 30 days of life', Asia-Pacific Journal of Clinical Oncology: Special Issue: Abstracts of the Joint Meeting of the COSA 39th Annual Scientific Meeting and IPOS 14th World Congress of Psycho-Oncology, Brisbane, Qld (2012) [E3]
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Grants and Funding

Summary

Number of grants 4
Total funding $535,058

Click on a grant title below to expand the full details for that specific grant.


20152 grants / $193,436

Development and evaluation of a decision aid for women considering neoadjuvant systemic therapy for operable breast cancer$191,936

Funding body: HCF Health and Medical Research Foundation

Funding body HCF Health and Medical Research Foundation
Project Team

Zdenkowski N, Butow P, Boyle FM, Forbes J, Wilcken N, Reaby L, Gebski V, Mann GB

Scheme Research Grant
Role Lead
Funding Start 2015
Funding Finish 2017
GNo
Type Of Funding Grant - Aust Non Government
Category 3AFG
UON N

American Society of Clinical Oncology Annual Meeting 2015, Chicago USA, 29/5/15-2/6/15 $1,500

Funding body: University of Newcastle - Faculty of Health and Medicine

Funding body University of Newcastle - Faculty of Health and Medicine
Project Team Doctor Nick Zdenkowski
Scheme Travel Grant
Role Lead
Funding Start 2015
Funding Finish 2016
GNo G1500526
Type Of Funding Internal
Category INTE
UON Y

20141 grants / $260,564

Who decides and at what cost? Comparing patient, surrogate and oncologist perspectives on end of life care$260,564

Funding body: NHMRC (National Health & Medical Research Council)

Funding body NHMRC (National Health & Medical Research Council)
Project Team Laureate Professor Robert Sanson-Fisher, Emeritus Professor Neil Rees, Ms Gill Batt, Doctor Charles Douglas, Professor Ian Olver, Doctor Nick Zdenkowski, Conjoint Associate Professor Frans Henskens
Scheme Partnership Projects
Role Investigator
Funding Start 2014
Funding Finish 2017
GNo G1300011
Type Of Funding Aust Competitive - Commonwealth
Category 1CS
UON Y

20131 grants / $81,058

Who decides and at what cost? Comparing patient, surrogate and oncologist perspectives on end of life care$81,058

Funding body: Cancer Council NSW

Funding body Cancer Council NSW
Project Team Laureate Professor Robert Sanson-Fisher, Emeritus Professor Neil Rees, Ms Gill Batt, Doctor Charles Douglas, Professor Ian Olver, Doctor Nick Zdenkowski, Doctor Scott Twaddell, Conjoint Associate Professor Frans Henskens
Scheme Partnership Projects Partner Funding
Role Investigator
Funding Start 2013
Funding Finish 2015
GNo G1300851
Type Of Funding Grant - Aust Non Government
Category 3AFG
UON Y
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Research Supervision

Number of supervisions

Completed1
Current0

Past Supervision

Year Level of Study Research Title Program Supervisor Type
2018 PhD Working Towards Patient-Centred Decision Making in Cancer Care PhD (Behavioural Science), Faculty of Health and Medicine, The University of Newcastle Co-Supervisor
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Research Collaborations

The map is a representation of a researchers co-authorship with collaborators across the globe. The map displays the number of publications against a country, where there is at least one co-author based in that country. Data is sourced from the University of Newcastle research publication management system (NURO) and may not fully represent the authors complete body of work.

Country Count of Publications
Australia 52
New Zealand 8
United Kingdom 1
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Dr Nick Zdenkowski

Position

Conjoint Lecturer
School of Medicine and Public Health
Faculty of Health and Medicine

Focus area

Medicine

Contact Details

Email nick.zdenkowski@newcastle.edu.au
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