4 research outputs found
Time to act : The challenges of working during and after cancer, initiatives in research and practice
No full textPeer reviewe
Strategies to improve recruitment to randomised trials
No full textBackground
Recruiting participants to trials can be extremely difficult. Identifying strategies that improve trial recruitment would benefit both trialists and health research.
Objectives
To quantify the effects of strategies for improving recruitment of participants to randomised trials. A secondary objective is to assess the evidence for the effect of the research setting (e.g. primary care versus secondary care) on recruitment.
Search methods
We searched the Cochrane Methodology Review Group Specialised Register (CMR) in the Cochrane Library (July 2012, searched 11 February 2015); MEDLINE and MEDLINE In Process (OVID) (1946 to 10 February 2015); Embase (OVID) (1996 to 2015 Week 06); Science Citation Index & Social Science Citation Index (ISI) (2009 to 11 February 2015) and ERIC (EBSCO) (2009 to 11 February 2015).
Selection criteria
Randomised and quasi-randomised trials of methods to increase recruitment to randomised trials. This includes non-healthcare studies and studies recruiting to hypothetical trials. We excluded studies aiming to increase response rates to questionnaires or trial retention and those evaluating incentives and disincentives for clinicians to recruit participants.
Data collection and analysis
We extracted data on: the method evaluated; country in which the study was carried out; nature of the population; nature of the study setting; nature of the study to be recruited into; randomisation or quasi-randomisation method; and numbers and proportions in each intervention group. We used a risk difference to estimate the absolute improvement and the 95% confidence interval (CI) to describe the effect in individual trials. We assessed heterogeneity between trial results. We used GRADE to judge the certainty we had in the evidence coming from each comparison.
Main results
We identified 68 eligible trials (24 new to this update) with more than 74,000 participants. There were 63 studies involving interventions aimed directly at trial participants, while five evaluated interventions aimed at people recruiting participants. All studies were in health care.
We found 72 comparisons, but just three are supported by high-certainty evidence according to GRADE.
1. Open trials rather than blinded, placebo trials. The absolute improvement was 10% (95% CI 7% to 13%).
2. Telephone reminders to people who do not respond to a postal invitation. The absolute improvement was 6% (95% CI 3% to 9%). This result applies to trials that have low underlying recruitment. We are less certain for trials that start out with moderately good recruitment (i.e. over 10%).
3. Using a particular, bespoke, user-testing approach to develop participant information leaflets. This method involved spending a lot of time working with the target population for recruitment to decide on the content, format and appearance of the participant information leaflet. This made little or no difference to recruitment: absolute improvement was 1% (95% CI −1% to 3%).
We had moderate-certainty evidence for eight other comparisons; our confidence was reduced for most of these because the results came from a single study. Three of the methods were changes to trial management, three were changes to how potential participants received information, one was aimed at recruiters, and the last was a test of financial incentives. All of these comparisons would benefit from other researchers replicating the evaluation. There were no evaluations in paediatric trials.
We had much less confidence in the other 61 comparisons because the studies had design flaws, were single studies, had very uncertain results or were hypothetical (mock) trials rather than real ones.
Authors' conclusions
The literature on interventions to improve recruitment to trials has plenty of variety but little depth. Only 3 of 72 comparisons are supported by high-certainty evidence according to GRADE: having an open trial and using telephone reminders to non-responders to postal interventions both increase recruitment; a specialised way of developing participant information leaflets had little or no effect. The methodology research community should improve the evidence base by replicating evaluations of existing strategies, rather than developing and testing new ones
Interventions to enhance return-to-work for cancer patients
No full textCancer patients are 1.4 times more likely to be unemployed than healthy people. Therefore it is important to provide cancer patients with programmes to support the return-to-work (RTW) process. This is an update of a Cochrane review first published in 2011. To evaluate the effectiveness of interventions aimed at enhancing RTW in cancer patients compared to alternative programmes including usual care or no intervention. We searched the Cochrane Central Register of Controlled Trials (CENTRAL, in the Cochrane Library Issue 3, 2014), MEDLINE (January 1966 to March 2014), EMBASE (January 1947 to March 2014), CINAHL (January 1983 to March, 2014), OSH-ROM and OSH Update (January 1960 to March, 2014), PsycINFO (January 1806 to 25 March 2014), DARE (January 1995 to March, 2014), ClinicalTrials.gov, Trialregister.nl and Controlled-trials.com up to 25 March 2014. We also examined the reference lists of included studies and selected reviews, and contacted authors of relevant studies. We included randomised controlled trials (RCTs) of the effectiveness of psycho-educational, vocational, physical, medical or multidisciplinary interventions enhancing RTW in cancer patients. The primary outcome was RTW measured as either RTW rate or sick leave duration measured at 12 months' follow-up. The secondary outcome was quality of life. Two review authors independently assessed trials for inclusion, assessed the risk of bias and extracted data. We pooled study results we judged to be clinically homogeneous in different comparisons reporting risk ratios (RRs) with 95% confidence intervals (CIs). We assessed the overall quality of the evidence for each comparison using the GRADE approach. Fifteen RCTs including 1835 cancer patients met the inclusion criteria and because of multiple arms studies we included 19 evaluations. We judged six studies to have a high risk of bias and nine to have a low risk of bias. All included studies were conducted in high income countries and most studies were aimed at breast cancer patients (seven trials) or prostate cancer patients (two trials).Two studies involved psycho-educational interventions including patient education and teaching self-care behaviours. Results indicated low quality evidence of similar RTW rates for psycho-educational interventions compared to care as usual (RR 1.09, 95% CI 0.88 to 1.35, n = 260 patients) and low quality evidence that there is no difference in the effect of psycho-educational interventions compared to care as usual on quality of life (standardised mean difference (SMD) 0.05, 95% CI -0.2 to 0.3, n = 260 patients). We did not find any studies on vocational interventions. In one study breast cancer patients were offered a physical training programme. Low quality evidence suggested that physical training was not more effective than care as usual in improving RTW (RR 1.20, 95% CI 0.32 to 4.54, n = 28 patients) or quality of life (SMD -0.37, 95% CI -0.99 to 0.25, n = 41 patients).Seven RCTs assessed the effects of a medical intervention on RTW. In all studies a less radical or functioning conserving medical intervention was compared with a more radical treatment. We found low quality evidence that less radical, functioning conserving approaches had similar RTW rates as more radical treatments (RR 1.04, 95% CI 0.96 to 1.09, n = 1097 patients) and moderate quality evidence of no differences in quality of life outcomes (SMD 0.10, 95% CI -0.04 to 0.23, n = 1028 patients).Five RCTs involved multidisciplinary interventions in which vocational counselling was combined with patient education, patient counselling, and biofeedback-assisted behavioral training or physical exercises. Moderate quality evidence showed that multidisciplinary interventions involving physical, psycho-educational and vocational components led to higher RTW rates than care as usual (RR 1.11, 95% CI 1.03 to 1.16, n = 450 patients). We found no differences in the effect of multidisciplinary interventions compared to care as usual on quality of life outcomes (SMD 0.03, 95% CI -0.20 to 0.25, n = 316 patients). We found moderate quality evidence that multidisciplinary interventions enhance the RTW of patients with cance
Rehabilitation and socio-medical assessment of performance in gastric cancer
No full textGastric cancer has been decreasing in the last decades continuously. For patients affected the disease causes changes by altering the patient's lifestyle habits, time-schedule and work life. Advances in the therapeutic procedures led to improved survival times especially for younger patients. Overall, about 25% of the patients with gastric cancer are under the age of 65 yrs. (still working). In a society growing older this percentage is going to increase. Rehabilitation and integration into work life is therefore of growing concern for patients with gastric cancer. This publication deals with rehabilitation and assessment of secondary disorders and restrictions with regard to the patient's further professional activity (socio-medical assessment).Die Häufigkeit des Magenkarzinoms hat sich in den letzten Jahrzehnten immer weiter verringert. Das Magenkarzinom hat für den jeweiligen Betroffenen erhebliche Auswirkungen dadurch, dass sich dessen Lebensumstände, Lebensgewohnheiten, zeitliche Abläufe und häufig auch die Berufstätigkeit durch die Erkrankung verändern. Behandlungsfortschritte in der jüngeren Vergangenheit führten zu verbesserten Überlebenszeiten, insbesondere bei jüngeren Patienten. Die Wiederherstellung der Gesundheit und Wiedereingliederung in den Arbeitsprozess sind daher für Patienten nach Behandlung eines Magenkarzinoms von hoher Bedeutung. Allerdings ist eine Rückkehr in die bisher ausgeübte Berufstätigkeit nach Abschluss der Primärbehandlung häufig nicht mehr möglich, insbesondere wenn die bisherige Tätigkeit mit körperlichen Belastungen oder unregelmäßigen Arbeitszeiten verbunden war. Ca. 25% der Patienten mit Magenkarzinom stehen noch im Erwerbsleben. Durch die zunehmende Überalterung der Gesellschaft mit ansteigendem Renteneintritt ist die Rückkehr in das Erwerbsleben daher von steigender Bedeutung. Die vorliegende Publikation beschäftigt sich mit der Rehabilitation, Bewertung und Beurteilung von Folgestörungen und Beeinträchtigungen nach Behandlung eines Magenkarzinoms und die hiermit verbundenen Auswirkungen auf die berufliche Reintegration (sozialmedizinische Beurteilung)
