Project staff:
- Michael King, Robert Blizard. Department of Mental Health Sciences, UCL
- Louise Jones, Adrian Tookman. Edenhall Hospice and Marie Curie Palliative Care Research Unit
- Irwin Nazareth, Alison Jones. Royal Free and University College Medical School
- Alison Richardson. King's College London
- Christina Mason. St Joseph's Hospice
- Current research staff:
- Mary Rogers, Ona McCarthy. Department of Mental Health Sciences, UCL.
Funders
NHS Service Delivery and Organisation (SDO); part of the NHS SDO continuity of care in chronic disease programme.
Start/Finish date
Part one: 38 months, completed November 2005; final report published online, available at http://www.sdo.lshtm.ac.uk/sdo13e2001.html.
Part two: commenced July/August 2006, to end Jan/Feb 2008. Development and exploratory trial of an intervention to improve continuity of care in cancer.
Aims
To identify key elements of continuity of care and assess when continuity might be at risk; to develop an intervention to improve continuity.
Methods
The study uses the MRC framework for the development of complex interventions and, in part 2, is piloting a patient led intervention to improve continuity of care. Once fully developed, the intervention will be tested in an exploratory randomised controlled trial across the North Central London cancer network.
Progress
Interviews with patients and clinicians formed the final format of the intervention, consisting of two components: 1) a reliability-tested 17-item questionnaire and 2) clinician response to the patients’ completed questionnaire.
The three-armed feasibility trial is currently underway, which will include 60 randomised patients.
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Project staff:
- Bridget Candy, Clare Miles, Louise Jones, Rachael Williams, Adrian Tookman. Marie Curie Palliative Care Research Unit
- Michael King. Department of Mental Health Sciences, UCL
Start/finish date
June 2005 - August 2007
Background
Our department has an interest in and has published earlier work on the role of sexuality in cancer patients. Treatments for many cancers have ongoing effects on sexual function which may significantly affect patients' quality of life. Little is known about the effectiveness of interventions that have been attempted to address these issues.
Objectives
- To evaluate the effectiveness of interventions (psychological, pharmacological, mechanical or complementary) for sexual dysfunction following treatments for cancer.
- To assess adverse events associated with therapy.
Method
This is a systematic literature review. In accordance with the defined inclusion criteria, studies will be assessed independently by two of the reviewers to judge which articles are suitable for inclusion. Justification for excluding studies at this stage will be documented.
The effectiveness of the interventions for sexual dysfunction will be assessed with analyses of specific sub-groups undertaken as follows:
- by type of cancer and intervention
- by study quality
Progress
The study protocol (project plan) has been registered with the Cochrane Collaboration – http://www.thecochranelibrary.com. The final report of the review is due to be available on the Cochrane website in late 2007.
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Project staff:
- Bridget Candy, Louise Jones, Rachael Williams, Adrian Tookman. Marie Curie Palliative Care Research Unit
- Michael King. Department of Mental Health Sciences, UCL
Start/finish date
June 2006 - May 2008
Background
Depression is common in cancer patients. Psycho-stimulants can be used to treat moderate to severe depression. Their advantages in comparison with anti-depressants are that they are fast acting and may be better tolerated. Individual studies that have evaluated their effectiveness have had mixed results, with some finding a benefit and others not.
Objectives
- To evaluate the effectiveness of psycho-stimulants for depression
- To assess adverse events associated with therapy
Method
This is a systematic literature review. In accordance with the defined inclusion criteria, studies will be assessed independently by two of the reviewers to judge which articles are suitable for inclusion. Justification for excluding studies at this stage will be documented.
The effectiveness of psycho-stimulants will be assessed with analyses of specific sub-groups undertaken as follows:
- by type of psycho-stimulant
- by population group
- by study quality
Progress
The study protocol (project plan) has been registered with the Cochrane Collaboration. It will be accessible from the Cochrane Library in Issue 3, 2007, available at: http://www.thecochranelibrary.com. We aim to submit the complete review to the Cochrane Collaboration in Autumn 2007.
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Project staff:
- Bridget Candy, Louise Jones, Adrian Tookman. Marie Curie Palliative Care Research Unit
- Jane Neerkin. Marie Curie Hospice, Hampstead
Start/finish date
May 2007 - August 2008
Background
As cancer patients now survive for longer periods, this may result in long term opioid therapy, particularly in men and women with metastatic cancer where it is the main stay of chronic pain management. Quality of life issues such as sexual function are recognised as important in palliative care. However, opioids may have a potentially significant effect on levels of sex hormones, prolactin, cortisol and gonadotrophins.
Objectives
In men and women with metastatic cancer who are receiving specialist palliative care and who are not receiving hormone therapy, what is the prevalence of SD and its associations with:
- Opioid dose
- Serum levels of sex hormones, gonadotrophins, prolactin, cortisol and IGF1
- Psychological status
Method
We will recruit patients on the point of referral to specialist palliative care. Patients recruited will complete a questionnaire and will have blood taken.
We aim to assess the associations between opioid use, hormonal levels, sexual and psychological functioning. This will be assessed as appropriate using multivariate and regression analysis.
Progress
The study has started to recruit patients.
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Project staff:
- Michael King. Department of Mental Health Sciences, UCL
- Louise Jones, Adrian Tookman, Kelly Barnes, Cate Barlow, Rachael Williams. Marie Curie Palliative Care Research Unit
- Dr David Chao. Royal Free Hospital, Hampstead
Funders
Dimbleby Cancer Care
Start/Finish date
October 2006 - September 2008
Background
Patients facing life-threatening illness may have many concerns about their future needs and care, and there is little evidence that health care professionals are willing or able to confront these issues. Enabling a discussion of advance care planning might facilitate an increase in openness between patients, their families and professionals.
Aims
To determine the acceptability and feasibility of an intervention of end-of-life care and to determine what outcomes are appropriate and measurable for this intervention.
Methods
Clinicians will introduce the study to patients who have undergone the primary course of treatment but still have clinically detectable, progressive, active disease. Those interested will be approached by a researcher who will give patients written information, explain the study in detail and answer any questions. We shall use simple, clear descriptions of what advance care planning discussions entail and what will happen if the patient is randomised into the usual care arm to ensure that patients can make informed choices based on their preferences. After valid informed consent, patients will be recruited to the study and asked to express their preference to undertaking an advance care planning discussion, the intervention. The need for and process of randomisation will be clearly explained. A separate decision will be made by potential participants about whether to enter the randomised or preference cohort of the trial. Strong preferences do not always mean that patients will not consider accepting randomisation and vice versa.
Progress
Eighteen patients have consented to take part in the study so far (February - July 2007). Of these, seven have been randomised to either receive the intervention or usual care. Eleven have been put into the strong preference arm.
Having received a referral from the clinician, the researcher is now approaching patients directly to explain the study and consent those patients who are interested in taking part.
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Project staff:
- Michael King, Shahed Murad. Department of Mental Health Sciences, UCL
- Louise Jones, Adrian Tookman, Kelly Barnes, Rachael Williams. Marie Curie Palliative Care Research Unit
- Gerard Leavey. Enfield & Haringey Mental Health NHS Trust
- Peter Speck. Department of Palliative Care & Policy, King’s College
- Eve Garrard. Centre for Professional Ethics, Keele University
- Lallita Carballo. North London Cancer Network
- Ruth Sack. User Group Member
Researchers:
- Faye Owen (Research Fellow), Abigail Taylor (Research Administrator). Marie Curie Palliative Care Research Unit.
- Junior Researcher to be appointed.
Funders
Cancer Research UK
Start/Finish date
April 2007 – September 2009
Background
Our group has been conducting research into concepts of spirituality in health and disease for several years. Building on this work, we shall use our Beliefs and Values Scale (King et al, 2006) to explore the relationship between spiritual beliefs and psychological status over time, in patients receiving specialist palliative care.
The study responds to NICE guidance on supportive and palliative care for adults with cancer (2004). It will provide evidence of the nature and impact of spiritual beliefs and inform strategies to assess and support patients and families.
Aims
Our questions are:
- Does strength of spiritual belief change as disease progresses towards the end of life?
- Do people with stronger spiritual beliefs experience less psychological distress?
- Are there associations between spiritual belief, psychological status & the use of prescribed drugs, including analgesic and psychotropic drugs?
Methods
We shall conduct a prospective cohort quantitative study over ten weeks. We shall be recruiting cancer patients living in the North London Cancer Network who are receiving specialist palliative care at home.
Progress
The study commenced in June 2007.
References
King M, Jones L, Barnes K, Low J, Walker C, Wilkinson S, Mason C, Sutherland J, Tookman A (2006) Measuring spiritual belief: development and standardisation of a Beliefs and Values Scale.
Psychological Medicine. 36: 417-426.
National Institute for Clinical excellence (2004) Improving Supportive and Palliative Care for Adults with Cancer.
London: NICE.
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