A sequential multiple assignment randomised trial (SMART) of nursing interventions to reduce pain associated with chemotherapy induced peripheral neuropathy
Funding / Grants
- NHMRC Project Grant (APP 1129532): $713,418 (2017 – 2021)
Chemotherapy-induced peripheral neuropathy (CIN) is the most prevalent neurologic complication from the most commonly used cytotoxic agents in cancer treatment– the taxanes and plantinums. CIN is a dysfunction in peripheral neurons that results in a variable set of signs and symptoms. These symptoms occur predominantly in the extremities and include pain, numbness, tingling, and burning; gait and balance disturbances; difficulty with fine motor skills; reduced vibratory sense, touch, and proprioception; and progressive loss of deep tendon reflexes. Importantly, CIN is a dose-limiting toxicity of chemotherapy. It can cause treatment delays or cessation which in turn can lead to disease progression and reduced survival.
For patients with persistent, post-treatment CIN, the objectives of this study are to:
- compare the effectiveness of the initial and adaptive non-pharmacological interventions;
- identify the best adaptive non-pharmacological interventions embedded within the SMART design; and
- evaluate the cost-effictiveness of each of the non-pharmacological intervention approaches for CIN in the respective trial arms.
This study uses a sequential multiple assignment randomised trial (SMART), to build optimal adaptive interventions aimed at decreasing the sensory, motor and autonomic impairments associated with CIN and improving mood and quality of life. Through evaluation of sequential non-pharmacological interventions, this novel study design enables comparison of separate interventions (heat therapy, massage, standard care), while allowing the intervention approach to be adapted according to patient response. For more information, please contact the lead PI – Professor Patsy Yates.
QCCS Team Members
QCCS Co-Chair and Professor of Cancer Nursing
Doctor of Philosophy (Queensland University of Technology), Master of Applied Science (Research) (Queensland University of Technology), Bachelor of Nursing (Queensland University of Technology)
Dr Raymond Chan is Professor of Cancer Nursing, Princess Alexandra Hospital and Queensland University of Technology. To date, he has attracted over 8.5 million (AUD) of research project grants as a chief investigator (> $2 Million as CIA) to undertake research in supportive cancer care. Dr Chan is a chief investigator for 4 current/past NHMRC project grants and 1 NHMRC Fellowship, and has published 97 peer-reviewed articles. Ray is currently the Chair for the Survivorship Group, Multinational Association for Supportive Care in Cancer (MASCC), and the Board Director (Knowledge Development and Dissemination) for the International Society of Nurses in Cancer Care (ISNCC). He is a past President for the Cancer Nurses Society of Australia (CNSA), the peak professional body representing cancer nurses across Australia.
Recent funded project highlights include:
- (2019-2020): ImplEMenting a nurse-coordinated, INtegrated, shared-care model involving specialists and general practitioners in breast cancer post-treatmENT follow-up: a Phase II randomised controlled trial (The EMINENT Trial). Metro South Health (CIA)
- (2017-2020): A sequential multiple assignment randomised trial (SMART) of nursing interventions to reduce pain associated with chemotherapy induced peripheral neuropathy. NHMRC (CID)
- (2016-2019): Peripherally InSerted Central catheter Securement: the PISCES Trial. NHMRC (CIC)
- (2014-2017): Development and evaluation of a nurse-led, tailored self-management behavioural intervention for managing distressing symptoms in patients with advanced cancer (The SM2 Study). RBWH Foundation and NHMRC (CIA)
- (2014-2015): Younger women’s wellness after cancer program. RBWH Foundation (CID)
- (2014): Central venous Access device SeCurement And Dressing Effectiveness in Cancer Care: The CASCADE Trial. RBWH Foundation (CIA)
- (2013-2016): Improving quality of life in high-risk cancer populations: a randomised trial of a structured intervention for head and neck cancer survivors. NHMRC (CIJ)
- (2012-2013): A double-blind randomised controlled trial of Moogoo Udder Cream® versus aqueous cream for managing radiation-induced skin reactions in patients with cancer. RBWH Foundation; Office of Health and Medical Research; Cancer Nurses Society of Australia; Moogoo Skincare
- (2011-2014): The RSVP Trial: Replacement of Intravascular device administration sets after Standard Versus Prolonged use. NHMRC and RBWH Foundation (CIG)
- (2010): Self-management associated with fatigue in patients with advanced cancer. RBWH Foundation, Queensland Nursing Council, Royal College of Nursing Australia (CIA)
Recent QCCS Project
- The effects of bundled interventions on clinical practice for fertility preservation amongst young cancer patients
A/Prof David Wyld
Director, Department of Medical Oncology, RBWH
Qualifications: MBBS (Hons), University of Qld, 1987; RACP Advanced Training in Medical Oncology, 1996; Fellowship of Royal Australian College of Physicians (FRACP), 1996.
– Associate Professor, School of Medicine, University of Queensland (UQ)
– Adjunct Associate Professor, Faculty of Health, Queensland University of Technology (QUT)
– Affiliate, QIMR Berghofer Medical Research Institute
Assoc Prof Wyld is a Medical Oncologist who has practiced as a staff specialist (currently Eminent status) at Royal Brisbane and Women’s Hospital (RBWH) for over 20 years, after having undertaken an ICRF Cancer Research Fellowship in Leeds, UK, in 1996-97. He has been the Director of Medical Oncology at RBWH for 20 years, during which time he has overseen the development of the large, highly regarded Medical Oncology clinical trials unit at RBWH, and has managed the unit continuously for almost 20 years. Over the last 20 years as a full-time practicing cancer clinician at RBWH, Assoc Prof Wyld has maintained an active research focus, predominantly in the area of clinical research, including a major focus on clinical trials (see below). Assoc Prof Wyld’s research involvement over 20 years has been broad, but with a particular focus on gastrointestinal cancers, gynaecologic malignancies and qualitative patient-focused research. His current major research interests are in the area of neuroendocrine tumours (NETs), pancreatic cancer, colorectal cancer and the area of supportive care, survivorship and qualitative patient focused research. He also has a long history of mentoring staff in clinical research and a proven track record of research collaboration.
Head, School of Nursing at Queensland University of Technology and Director for Queensland Health’s statewide Centre for Palliative Care Research and Education (CPCRE)
Distinguished Professor Yates is jointly appointed as Head, School of Nursing at Queensland University of Technology and Director for Queensland Health’s statewide Centre for Palliative Care Research and Education (CPCRE). She leads a range of research and service improvement programs focused on developing workforce capacity in cancer and palliative care, advancing the management of cancer related symptoms and treatment side effects, and strengthening the nexus between research, policy and practice in cancer care. Patsy has served as member of the Executive Committee of the Clinical Oncological Society of Australia and is currently President of Palliative Care Australia. She was a member of the Executive Committee for the International Society of Nurses in Cancer Care from 2004-2012. Patsy has also been a member of the Nursing and Midwifery Board of Queensland since 2008. She is regularly invited to provide expert advice to professional groups and government bodies, and has held ministerial appointments on a number of Boards and Committees for Federal and State Governments. Patsy has received awards in recognition of her research, teaching and service, including being awarded the Tom Reeve Oration Award for Outstanding Contribution to Cancer Care and Life Membership from the Cancer Nurses Society of Australia as well as the Clinical Oncological Society of Australia. In 2010, she was awarded a Citation from the Australian Learning and Teaching Council for Outstanding Contribution to Student Learning. Patsy is a fellow of the American Academy of Nursing and has recently been inducted into the Sigma Theta Tau International Nurse Researcher Hall of Fame.
2015-2017: The changing landscapes of survivorship: A sociological study of life with cancer. Australian Research Council Discovery Grant.
2014-2019: Chronic Kidney Disease Centre for Research Excellence. National Health and Medical Research Council.
2014-2015: Younger Women’s Wellness after Cancer Program: Pilot Study. Royal Brisbane and Women’s Hospital Research Foundation.
2014-2015: Pre-post determination of effect of oncogeriatric assessment and intervention on chemotherapy outcomes in solid cancer patients aged 70 years and over. PA Research Foundation.
2013-2018: Centre for Research Excellence in End of Life Care. National Health and Medical Research Council.
2013-2015: The Women’s Wellness after Cancer Program: a national multisite randomized clinical trial of an e-health enabled lifestyle modification intervention to improve the health and wellness of women after cancer treatment. National Health and Medical Research Council.
2013-2015: Finding My Way: A randomized controlled trial evaluating an internet self-help program for cancer-related distress. National Health and Medical Research Council.
2013-2015: Improving quality of life in high-risk cancer populations: a randomized trial of a structured intervention for head and neck cancer survivors. National Health and Medical Research Council.
2012-2015: Pathways to and through palliative care: a sociological study of patient, carer and clinician experiences at the end-of-life. Australian Research Council.
Industry Research Activities
2013-2015: National Advisory Service for Palliative Care and Advance Care Planning. Australian Government, Department of Health and Ageing.
2012-2014: Evaluation of the role of the Prostate Specialist Nurse: A National PCFA Pilot Project. Prostate Cancer Foundation of Australia.
2011-2014: National Coordination and Management of the Program of Experience in the Palliative Approach (Phase 4). Australian Government, Department of Health and Ageing.
2011-2014: Palliative Care Curriculum for Undergraduates (PCC4U). Australian Government, Department of Health and Ageing.
Patsy Yates’s full profile, contact information and publications are available on:
A/Prof Kim Alexander
Assoc. Professor Alexander is as an Associate Professor for the School of Nursing, Queensland University of Technology and Chair of Research for Holy Spirit Northside Private Hospital (HSNPH). She is a registered nurse with cross-disciplinary research experience in nursing, epidemiology, genetics, patient outcomes (i.e. disease risk, symptom experience and quality of life) and personalised health care.
Assoc. Professor Alexander is the Chair of the Cancer Nursing Society of Australia Research Committee and the St Vincent’s Health and Aged Care Human Research Ethics Committee. She is also the Subject Area Coordinator for Cancer Nursing within the School and teaches the coursework component of the postgraduate and undergraduate cancer curriculum and supervises 10 quantitative Masters and Doctoral students in the field. Assoc. Professor Alexander has over 10 years experience in oncology as a Registered Nurse, Clinical Trials Nurse, Nurse Researcher and Epidemiologist. Her qualifications include a double degree in Nursing and Public Health and she was awarded her PhD in 2011. More recently she graduated with a graduate certificate in Academic Practice and a Masters of Education (Higher Education).
Assoc. Professor Alexander’s research focuses on enabling personalised approaches to precision health through understanding the genetic underpinnings to subjective patient experiences (i.e., symptoms and quality of life). Her research into chronic and complex illness such as cancer, chronic wounds and chlamydia with collaborations across several groups have resulted in numerous successes including over 17 peer reviewed journal articles, funding for research totalling over $900,000, eight invited speaker invitations, and five peer-reviewed presentations. Assoc. Professor Alexander’s role in this project will be to guide data collection protocols and in combined analysis and interpretation of clinical and biological data.