David Goldstein

Publications (191) View all

• Article: Informatively missing quality of life and unmet needs sex data for immigrant and Anglo-Australian cancer patients and survivors.

  Melanie L Bell, Phyllis N Butow, David Goldstein
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  ABSTRACT: PURPOSE: Although cancer can seriously affect peoples' sexual well-being, survivors and patients may be reluctant to answer questions about sex. This reluctance may be stronger for immigrants. This study aimed to investigate missing sex data rates and predictors of missingness in two large studies on immigrants and Anglo-Australian controls with cancer and to investigate whether those with missing sex data may have worse sexual outcomes than those with complete data. METHODS: We carried out two studies aimed at describing the quality of life (QoL) and unmet needs amongst Arabic, Chinese and Greek immigrants versus Anglo-Australians cancer survivors (n = 596, recruited from cancer registries) and patients (n = 845). Logistic regression was used to model the probability of having missing sex data in either of the questionnaires. We compared the mean of the unmet sex needs responses of those who had missing QoL sex data (but not needs) to those who had completed both, and vice versa. RESULTS: Missing sex data rates were as high as 65 %, with immigrants more likely to skip sex items than Anglo-Australians (p = 0.02 for registry study, p < 0.0001 for hospital study). Women, older participants and participants with more advanced disease had increased odds of missingness. There was evidence that data were informatively missing. Additionally, the questionnaire which stated that the sex questions are optional had higher missing data rates. CONCLUSION: High missing data rates and informatively missing data can lead to biased results. Using the questionnaires that state that they may skip sex items may lead to an underestimation of sexual problems or an overestimation of quality of life.
  Quality of Life Research 04/2013; · 2.30 Impact Factor
• Article: Should culture affect practice? A comparison of prognostic discussions in consultations with immigrant versus native-born cancer patients.

  Phyllis N Butow, Ming Sze, Maurice Eisenbruch, Melaine L Bell, Lynley J Aldridge, Sarah Abdo, Michelle Tanious, Skye Dong, Rick Iedema, Janette Vardy, Rina Hui, Francis Boyle, Winston Liauw, David Goldstein
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  ABSTRACT: OBJECTIVE: Poor prognosis is difficult to impart, particularly across a cultural divide. This study compared prognostic communication with immigrants (with and without interpreters) versus native-born patients in audio-taped oncology consultations. METHODS: Ten oncologists, 78 patients (31 Australian-born, 47 immigrants) and 115 family members participated. The first two consultations after diagnosis of incurable disease were audiotaped, transcribed and coded. 142 consultations were included in the analysis. RESULTS: Fifty percent of doctor and 59% of patient prognostic speech units were not interpreted or interpreted non-equivalently when an interpreter was present. Immigrant status predicted few prognostic facts, and oncologist characteristics no prognostic facts, disclosed. Oncologists were significantly less likely to convey hope to immigrants (p=0.0004), and more likely to use medical jargon (p=0.009) than with Australian-born patients. Incurable disease status and a limited life span were commonly acknowledged, generally with no timeframe provided. Physical issues were discussed more commonly than emotional aspects. CONCLUSIONS: While culture did not appear to influence doctor speech, interpreters filtered or blocked much prognostic communication. PRACTICE IMPLICATIONS: Initiatives to empower all patients to attain needed information, optimise communication when an interpreter is present and train cancer health professionals in culturally appropriate care, are urgently required.
  Patient Education and Counseling 03/2013; · 2.31 Impact Factor
• Article: Reducing disparity in outcomes for immigrants with cancer: a qualitative assessment of the feasibility and acceptability of a culturally targeted telephone-based supportive care intervention.

  Joanne Shaw, Phyllis Butow, Ming Sze, Jane Young, David Goldstein
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  ABSTRACT: PURPOSE: Australia has one of the most culturally diverse populations in the world. Immigrant cancer patients' poorer outcomes compared to English-speaking patients confirm the need for culturally sensitive supportive care interventions. The aims of this study were (1) to identify cultural sensitivities that are important to the acceptability of a telephone-based supportive care intervention and (2) to identify cultural barriers and facilitators to intervention participation. METHODS: Patients and carers attending Chinese or Arabic cancer support groups were recruited. Two focus groups comprising 12 patients and 4 carers, and two telephone interviews were conducted in the participants' own language. A semi-structured interview format was utilised to determine potential cultural sensitivities that may influence the intervention delivery format as well as patients' willingness to participate in telephone-based supportive care interventions. Content analysis confirmed similar themes across groups. RESULTS: The intervention was viewed favourably as a means of providing information and support in the patient's language. Cultural considerations included assurances of confidentiality, as cancer is not openly discussed within communities. An initial face-to-face contact was highlighted as the most important factor facilitating participation. Participants also recommended the inclusion of patient-initiated calls as part of the intervention. CONCLUSIONS: This study provides cultural insights relevant to the development of a culturally sensitive telephone-based supportive care intervention for Arabic- and Chinese-speaking cancer patients. Participants highlighted the need for face-to-face contact and inclusion of patient-initiated calls as important methodological considerations.
  Supportive Care in Cancer 03/2013; · 2.09 Impact Factor
• Article: Inferior health-related quality of life and psychological well-being in immigrant cancer survivors: A population-based study.

  Phyllis N Butow, Lynley Aldridge, Melanie L Bell, Ming Sze, Maurice Eisenbruch, Michael Jefford, Penelope Schofield, Afaf Girgis, Madeleine King, Priya Duggal-Beri, Joshua McGrane, David Goldstein
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  ABSTRACT: This study compared health-related quality of life (QOL) and psychological morbidity in a population-based sample of first generation immigrant and Anglo-Australian cancer survivors. Eligible participants, recruited via three State Cancer Registries, included those: with a new diagnosis of one of 12 most incident cancers (all stages) 1-6years earlier; aged 18-80 at diagnosis; born in a Chinese, Arabic, or Greek speaking country and able to speak one of these languages. A random sample of English-speaking Anglo-Australian-born controls frequency matched for cancer diagnosis was recruited. 596 patients (277 of whom were immigrants) participated (a 26% response rate). In multiple linear regression models adjusted for age, sex, education, marital status, socio-economic status, time since diagnosis and type of cancer, immigrants had clinically significantly worse QOL (5.4-8.5 points on Functional Assessment of Cancer Therapy - General (FACT-G), P<0·0001), higher depression (P<0·0001) and higher incidence of clinical depression (P<0·01) than Anglo-Australians. Understanding the health system partially mediated this relationship for depression (P=0·0004) and QOL (P=0·001). Immigrant survivors of cancer have worse psychological and QOL outcomes than Anglo-Australians. Potential targets for intervention include assistance in navigating the health system, translated information and cultural competency training for health professionals.
  European journal of cancer (Oxford, England: 1990) 02/2013; · 4.12 Impact Factor
• Article: Randomized Trial of Short-Course Radiotherapy Versus Long-Course Chemoradiation Comparing Rates of Local Recurrence in Patients With T3 Rectal Cancer: Trans-Tasman Radiation Oncology Group Trial 01.04.

  Samuel Y Ngan, Bryan Burmeister, Richard J Fisher, Michael Solomon, David Goldstein, David Joseph, Stephen P Ackland, David Schache, Bev McClure, Sue-Anne McLachlan, Joseph McKendrick, Trevor Leong, Cris Hartopeanu, John Zalcberg, John Mackay
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  ABSTRACT: PURPOSETo compare the local recurrence (LR) rate between short-course (SC) and long-course (LC) neoadjuvant radiotherapy for rectal cancer. PATIENTS AND METHODS Eligible patients had ultrasound- or magnetic resonance imaging-staged T3N0-2M0 rectal adenocarcinoma within 12 cm from anal verge. SC consisted of pelvic radiotherapy 5 × 5 Gy in 1 week, early surgery, and six courses of adjuvant chemotherapy. LC was 50.4 Gy, 1.8 Gy/fraction, in 5.5 weeks, with continuous infusional fluorouracil 225 mg/m(2) per day, surgery in 4 to 6 weeks, and four courses of chemotherapy. RESULTS: SC, 1.04; 95% CI, 0.69 to 1.56). Overall survival rates at 5 years were 74% for SC and 70% for LC (log-rank P = 0.62; HR, 1.12; 95% CI, 0.76 to 1.67). Late toxicity rates were not substantially different (Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer G3-4: SC, 5.8%; LC, 8.2%; P = .53). CONCLUSION Three-year LR rates between SC and LC were not statistically significantly different; the CI for the difference is consistent with either no clinically important difference or differences in favor of LC. LC may be more effective in reducing LR for distal tumors. No differences in rates of distant recurrence, relapse-free survival, overall survival, or late toxicity were detected.
  Journal of Clinical Oncology 09/2012; · 18.37 Impact Factor