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Papers by Maurice Stevens

Australian Journal of Rural Health, Jun 6, 2023

ObjectiveLiving in regional/rural areas can impact outcomes for people with head and neck cancer ... more ObjectiveLiving in regional/rural areas can impact outcomes for people with head and neck cancer (HNC). Using a comprehensive state‐wide dataset, the impact of remoteness on key service parameters and outcomes for people with HNC was examined.MethodsRetrospective quantitative analysis of routinely collected data held within the Queensland Oncology Repository.DesignQuantitative methods (descriptive statistics, multivariable logistic regression and geospatial analysis).SettingAll people diagnosed with HNC in Queensland, Australia.ParticipantsThe impact of remoteness was examined in 1991 people (1171 metropolitan, 485 inner‐regional, 335 rural) with HNC cancer diagnosed between 2013 and 2015.Main Outcome MeasuresThis paper reports key demographics and tumour characteristics (age, gender, socioeconomic status, First Nations status, co‐morbidities, primary tumour site and staging), service use/uptake (treatment rates, attendance at multidisciplinary team review and timing to treatment) and post‐acute outcomes (readmission rates, causes of readmission and 2‐year survival). In addition to this, the distribution of people with HNC across QLD, distances travelled and patterns of readmission were also analysed.ResultsRegression analysis revealed remoteness significantly (p < 0.001) impacted access to MDT review, receiving treatment, and time to treatment commencement, but not readmission or 2‐year survival. Reasons for readmission did not differ by remoteness, with dysphagia, nutritional inadequacies, gastrointestinal disorders and fluid imbalance indicated in the majority of readmissions. Rural people were significantly (p < 0.0001) more likely to travel to care and to readmit to a different facility than provided primary treatment.ConclusionsThis study provides new insights into the health care disparities for people with HNC residing in regional/rural areas.

Head & neck, Mar 23, 2022

BackgroundPeople with head and neck cancer (HNC) have complex health care needs; however, limited... more BackgroundPeople with head and neck cancer (HNC) have complex health care needs; however, limited evidence exists regarding the nature or patterns of service access and use. This study explored the post‐discharge health care needs and experiences of individuals with HNC from metropolitan and rural areas.MethodsHealth care appointments and services accessed by people with HNC were collated for 6‐month post‐treatment. Data analysis of the whole cohort examined patterns of access while journey mapping integrated participants' experiences of recovery.ResultsThe 6‐month service access journey was mapped for 11 people. Rural participants attended a significantly greater number of appointments (p = 0.012), higher canceled/missed appointments (p = 0.013), and saw more professionals (p = 0.007). Rural participants reported higher stress and burden due to service access barriers and unmet needs.ConclusionsMultiple challenges and inequities exist for rural people with HNC. Findings inform opportunities to enhance the post‐treatment recovery of people with HNC in rural areas.

PubMed, Aug 1, 2002

Background: The vast majority of cases of epistaxis can be managed successfully within general pr... more Background: The vast majority of cases of epistaxis can be managed successfully within general practice. Objective: To describe a range of clinical interventions in the management of epistaxis appropriate to general practice. Discussion: A number of relatively simple treatments and procedures may provide relief for anterior nasal bleeding, which is the site for over 80% of cases of epistaxis. Where more procedural interventions are necessary, adequate preparation and appropriate tools are required to perform these processes safely. Initial identification of the site of bleeding before commencement of treatment may be difficult but allows the correct treatment to be applied with minimal discomfort to the patient. More copious bleeding which constitutes less than 5-10% of cases, is usually the result of posterior nasal bleeding and is best treated in a facility well set up to handle such an eventuality. In cases of chronic epistaxis, a number of interventions, medical and surgical have been trialled with variable success, and should be used with caution in general practice.

Australian Journal of Rural Health

Archives of Otolaryngology–Head & Neck Surgery, 2005

Objective: To determine whether isotretinoin (or 13cis-retinoic acid) decreases the risk of secon... more Objective: To determine whether isotretinoin (or 13cis-retinoic acid) decreases the risk of second primary cancers in patients previously treated for cure of head and neck squamous cell carcinoma. Design: Randomized, double-blind, placebocontrolled trial. Setting: Two head and neck multidisciplinary cancer clinics in university teaching hospitals taking cases from 4 to 5 million people in Queensland, Australia, combined to enter appropriate patients into this trial. Patients: One hundred fifty-one patients with their first head and neck squamous cell carcinoma treated with high expectation for cure and living close by. They were randomized into 3 arms to receive 3 years of treatment. Interventions: Patients took isotretinoin at a high dose (1.0 mg/kg per day) or a moderate dose (0.5 mg/kg per day) or placebo. Group 1 took the high dose for 1 year and then the moderate dose for 2 years. Group 2 took the moderate dose for 3 years. Group 3 took placebo for 3 years. Main Outcome Measures: The diagnosis of a second primary malignancy of the head and neck, lung, or bladder was regarded as the end point signifying failure of therapy. Issues of drug adverse effect profile and impact on survival were measured. Results: There was no significant difference in the occurrence of second primary disease (P = .90), the recurrence of primary disease (P = .70), or disease-free time (P=.80) between the treatment and nontreatment arms. Numbers were too small to find differences in survival. Conclusion: With evidence that retinoid treatment adversely affects survival of lung cancer and with this drug not significantly decreasing the incidence of second primary tumors of head and neck squamous cell carcinoma, the use of this drug in head and neck cancer patients for second cancer prophylaxis is not indicated.

Australian family physician, 2002

BACKGROUND The vast majority of cases of epistaxis can be managed successfully within general pra... more BACKGROUND The vast majority of cases of epistaxis can be managed successfully within general practice. OBJECTIVE To describe a range of clinical interventions in the management of epistaxis appropriate to general practice. DISCUSSION A number of relatively simple treatments and procedures may provide relief for anterior nasal bleeding, which is the site for over 80% of cases of epistaxis. Where more procedural interventions are necessary, adequate preparation and appropriate tools are required to perform these processes safely. Initial identification of the site of bleeding before commencement of treatment may be difficult but allows the correct treatment to be applied with minimal discomfort to the patient. More copious bleeding which constitutes less than 5-10% of cases, is usually the result of posterior nasal bleeding and is best treated in a facility well set up to handle such an eventuality. In cases of chronic epistaxis, a number of interventions, medical and surgical have b...

Australian family physician, 2002

The vast majority of cases of epistaxis can be managed successfully within general practice. To d... more The vast majority of cases of epistaxis can be managed successfully within general practice. To describe a range of clinical interventions in the management of epistaxis appropriate to general practice. A number of relatively simple treatments and procedures may provide relief for anterior nasal bleeding, which is the site for over 80% of cases of epistaxis. Where more procedural interventions are necessary, adequate preparation and appropriate tools are required to perform these processes safely. Initial identification of the site of bleeding before commencement of treatment may be difficult but allows the correct treatment to be applied with minimal discomfort to the patient. More copious bleeding which constitutes less than 5-10% of cases, is usually the result of posterior nasal bleeding and is best treated in a facility well set up to handle such an eventuality. In cases of chronic epistaxis, a number of interventions, medical and surgical have been trialled with variable succe...

Australian family physician, 2002

The vast majority of cases of epistaxis can be managed successfully within general practice. To d... more The vast majority of cases of epistaxis can be managed successfully within general practice. To describe a range of clinical interventions in the management of epistaxis appropriate to general practice. A number of relatively simple treatments and procedures may provide relief for anterior nasal bleeding, which is the site for over 80% of cases of epistaxis. Where more procedural interventions are necessary, adequate preparation and appropriate tools are required to perform these processes safely. Initial identification of the site of bleeding before commencement of treatment may be difficult but allows the correct treatment to be applied with minimal discomfort to the patient. More copious bleeding which constitutes less than 5-10% of cases, is usually the result of posterior nasal bleeding and is best treated in a facility well set up to handle such an eventuality. In cases of chronic epistaxis, a number of interventions, medical and surgical have been trialled with variable succe...

Australian family physician, 2002

The vast majority of cases of epistaxis can be managed successfully within general practice. To d... more The vast majority of cases of epistaxis can be managed successfully within general practice. To describe a range of clinical interventions in the management of epistaxis appropriate to general practice. A number of relatively simple treatments and procedures may provide relief for anterior nasal bleeding, which is the site for over 80% of cases of epistaxis. Where more procedural interventions are necessary, adequate preparation and appropriate tools are required to perform these processes safely. Initial identification of the site of bleeding before commencement of treatment may be difficult but allows the correct treatment to be applied with minimal discomfort to the patient. More copious bleeding which constitutes less than 5-10% of cases, is usually the result of posterior nasal bleeding and is best treated in a facility well set up to handle such an eventuality. In cases of chronic epistaxis, a number of interventions, medical and surgical have been trialled with variable succe...

Archives of Otolaryngology–Head & Neck Surgery, 2005

To determine whether isotretinoin (or 13-cis-retinoic acid) decreases the risk of second primary ... more To determine whether isotretinoin (or 13-cis-retinoic acid) decreases the risk of second primary cancers in patients previously treated for cure of head and neck squamous cell carcinoma. Randomized, double-blind, placebo-controlled trial. Two head and neck multidisciplinary cancer clinics in university teaching hospitals taking cases from 4 to 5 million people in Queensland, Australia, combined to enter appropriate patients into this trial. One hundred fifty-one patients with their first head and neck squamous cell carcinoma treated with high expectation for cure and living close by. They were randomized into 3 arms to receive 3 years of treatment. Patients took isotretinoin at a high dose (1.0 mg/kg per day) or a moderate dose (0.5 mg/kg per day) or placebo. Group 1 took the high dose for 1 year and then the moderate dose for 2 years. Group 2 took the moderate dose for 3 years. Group 3 took placebo for 3 years. The diagnosis of a second primary malignancy of the head and neck, lung, or bladder was regarded as the end point signifying failure of therapy. Issues of drug adverse effect profile and impact on survival were measured. There was no significant difference in the occurrence of second primary disease (P = .90), the recurrence of primary disease (P = .70), or disease-free time (P = .80) between the treatment and nontreatment arms. Numbers were too small to find differences in survival. With evidence that retinoid treatment adversely affects survival of lung cancer and with this drug not significantly decreasing the incidence of second primary tumors of head and neck squamous cell carcinoma, the use of this drug in head and neck cancer patients for second cancer prophylaxis is not indicated.

Australian Journal of Rural Health, Jun 6, 2023

ObjectiveLiving in regional/rural areas can impact outcomes for people with head and neck cancer ... more ObjectiveLiving in regional/rural areas can impact outcomes for people with head and neck cancer (HNC). Using a comprehensive state‐wide dataset, the impact of remoteness on key service parameters and outcomes for people with HNC was examined.MethodsRetrospective quantitative analysis of routinely collected data held within the Queensland Oncology Repository.DesignQuantitative methods (descriptive statistics, multivariable logistic regression and geospatial analysis).SettingAll people diagnosed with HNC in Queensland, Australia.ParticipantsThe impact of remoteness was examined in 1991 people (1171 metropolitan, 485 inner‐regional, 335 rural) with HNC cancer diagnosed between 2013 and 2015.Main Outcome MeasuresThis paper reports key demographics and tumour characteristics (age, gender, socioeconomic status, First Nations status, co‐morbidities, primary tumour site and staging), service use/uptake (treatment rates, attendance at multidisciplinary team review and timing to treatment) and post‐acute outcomes (readmission rates, causes of readmission and 2‐year survival). In addition to this, the distribution of people with HNC across QLD, distances travelled and patterns of readmission were also analysed.ResultsRegression analysis revealed remoteness significantly (p < 0.001) impacted access to MDT review, receiving treatment, and time to treatment commencement, but not readmission or 2‐year survival. Reasons for readmission did not differ by remoteness, with dysphagia, nutritional inadequacies, gastrointestinal disorders and fluid imbalance indicated in the majority of readmissions. Rural people were significantly (p < 0.0001) more likely to travel to care and to readmit to a different facility than provided primary treatment.ConclusionsThis study provides new insights into the health care disparities for people with HNC residing in regional/rural areas.

Head & neck, Mar 23, 2022

BackgroundPeople with head and neck cancer (HNC) have complex health care needs; however, limited... more BackgroundPeople with head and neck cancer (HNC) have complex health care needs; however, limited evidence exists regarding the nature or patterns of service access and use. This study explored the post‐discharge health care needs and experiences of individuals with HNC from metropolitan and rural areas.MethodsHealth care appointments and services accessed by people with HNC were collated for 6‐month post‐treatment. Data analysis of the whole cohort examined patterns of access while journey mapping integrated participants' experiences of recovery.ResultsThe 6‐month service access journey was mapped for 11 people. Rural participants attended a significantly greater number of appointments (p = 0.012), higher canceled/missed appointments (p = 0.013), and saw more professionals (p = 0.007). Rural participants reported higher stress and burden due to service access barriers and unmet needs.ConclusionsMultiple challenges and inequities exist for rural people with HNC. Findings inform opportunities to enhance the post‐treatment recovery of people with HNC in rural areas.

PubMed, Aug 1, 2002

Background: The vast majority of cases of epistaxis can be managed successfully within general pr... more Background: The vast majority of cases of epistaxis can be managed successfully within general practice. Objective: To describe a range of clinical interventions in the management of epistaxis appropriate to general practice. Discussion: A number of relatively simple treatments and procedures may provide relief for anterior nasal bleeding, which is the site for over 80% of cases of epistaxis. Where more procedural interventions are necessary, adequate preparation and appropriate tools are required to perform these processes safely. Initial identification of the site of bleeding before commencement of treatment may be difficult but allows the correct treatment to be applied with minimal discomfort to the patient. More copious bleeding which constitutes less than 5-10% of cases, is usually the result of posterior nasal bleeding and is best treated in a facility well set up to handle such an eventuality. In cases of chronic epistaxis, a number of interventions, medical and surgical have been trialled with variable success, and should be used with caution in general practice.

Australian Journal of Rural Health

Archives of Otolaryngology–Head & Neck Surgery, 2005

Objective: To determine whether isotretinoin (or 13cis-retinoic acid) decreases the risk of secon... more Objective: To determine whether isotretinoin (or 13cis-retinoic acid) decreases the risk of second primary cancers in patients previously treated for cure of head and neck squamous cell carcinoma. Design: Randomized, double-blind, placebocontrolled trial. Setting: Two head and neck multidisciplinary cancer clinics in university teaching hospitals taking cases from 4 to 5 million people in Queensland, Australia, combined to enter appropriate patients into this trial. Patients: One hundred fifty-one patients with their first head and neck squamous cell carcinoma treated with high expectation for cure and living close by. They were randomized into 3 arms to receive 3 years of treatment. Interventions: Patients took isotretinoin at a high dose (1.0 mg/kg per day) or a moderate dose (0.5 mg/kg per day) or placebo. Group 1 took the high dose for 1 year and then the moderate dose for 2 years. Group 2 took the moderate dose for 3 years. Group 3 took placebo for 3 years. Main Outcome Measures: The diagnosis of a second primary malignancy of the head and neck, lung, or bladder was regarded as the end point signifying failure of therapy. Issues of drug adverse effect profile and impact on survival were measured. Results: There was no significant difference in the occurrence of second primary disease (P = .90), the recurrence of primary disease (P = .70), or disease-free time (P=.80) between the treatment and nontreatment arms. Numbers were too small to find differences in survival. Conclusion: With evidence that retinoid treatment adversely affects survival of lung cancer and with this drug not significantly decreasing the incidence of second primary tumors of head and neck squamous cell carcinoma, the use of this drug in head and neck cancer patients for second cancer prophylaxis is not indicated.

Australian family physician, 2002

BACKGROUND The vast majority of cases of epistaxis can be managed successfully within general pra... more BACKGROUND The vast majority of cases of epistaxis can be managed successfully within general practice. OBJECTIVE To describe a range of clinical interventions in the management of epistaxis appropriate to general practice. DISCUSSION A number of relatively simple treatments and procedures may provide relief for anterior nasal bleeding, which is the site for over 80% of cases of epistaxis. Where more procedural interventions are necessary, adequate preparation and appropriate tools are required to perform these processes safely. Initial identification of the site of bleeding before commencement of treatment may be difficult but allows the correct treatment to be applied with minimal discomfort to the patient. More copious bleeding which constitutes less than 5-10% of cases, is usually the result of posterior nasal bleeding and is best treated in a facility well set up to handle such an eventuality. In cases of chronic epistaxis, a number of interventions, medical and surgical have b...

Australian family physician, 2002

The vast majority of cases of epistaxis can be managed successfully within general practice. To d... more The vast majority of cases of epistaxis can be managed successfully within general practice. To describe a range of clinical interventions in the management of epistaxis appropriate to general practice. A number of relatively simple treatments and procedures may provide relief for anterior nasal bleeding, which is the site for over 80% of cases of epistaxis. Where more procedural interventions are necessary, adequate preparation and appropriate tools are required to perform these processes safely. Initial identification of the site of bleeding before commencement of treatment may be difficult but allows the correct treatment to be applied with minimal discomfort to the patient. More copious bleeding which constitutes less than 5-10% of cases, is usually the result of posterior nasal bleeding and is best treated in a facility well set up to handle such an eventuality. In cases of chronic epistaxis, a number of interventions, medical and surgical have been trialled with variable succe...

Australian family physician, 2002

The vast majority of cases of epistaxis can be managed successfully within general practice. To d... more The vast majority of cases of epistaxis can be managed successfully within general practice. To describe a range of clinical interventions in the management of epistaxis appropriate to general practice. A number of relatively simple treatments and procedures may provide relief for anterior nasal bleeding, which is the site for over 80% of cases of epistaxis. Where more procedural interventions are necessary, adequate preparation and appropriate tools are required to perform these processes safely. Initial identification of the site of bleeding before commencement of treatment may be difficult but allows the correct treatment to be applied with minimal discomfort to the patient. More copious bleeding which constitutes less than 5-10% of cases, is usually the result of posterior nasal bleeding and is best treated in a facility well set up to handle such an eventuality. In cases of chronic epistaxis, a number of interventions, medical and surgical have been trialled with variable succe...

Australian family physician, 2002

The vast majority of cases of epistaxis can be managed successfully within general practice. To d... more The vast majority of cases of epistaxis can be managed successfully within general practice. To describe a range of clinical interventions in the management of epistaxis appropriate to general practice. A number of relatively simple treatments and procedures may provide relief for anterior nasal bleeding, which is the site for over 80% of cases of epistaxis. Where more procedural interventions are necessary, adequate preparation and appropriate tools are required to perform these processes safely. Initial identification of the site of bleeding before commencement of treatment may be difficult but allows the correct treatment to be applied with minimal discomfort to the patient. More copious bleeding which constitutes less than 5-10% of cases, is usually the result of posterior nasal bleeding and is best treated in a facility well set up to handle such an eventuality. In cases of chronic epistaxis, a number of interventions, medical and surgical have been trialled with variable succe...

Archives of Otolaryngology–Head & Neck Surgery, 2005

To determine whether isotretinoin (or 13-cis-retinoic acid) decreases the risk of second primary ... more To determine whether isotretinoin (or 13-cis-retinoic acid) decreases the risk of second primary cancers in patients previously treated for cure of head and neck squamous cell carcinoma. Randomized, double-blind, placebo-controlled trial. Two head and neck multidisciplinary cancer clinics in university teaching hospitals taking cases from 4 to 5 million people in Queensland, Australia, combined to enter appropriate patients into this trial. One hundred fifty-one patients with their first head and neck squamous cell carcinoma treated with high expectation for cure and living close by. They were randomized into 3 arms to receive 3 years of treatment. Patients took isotretinoin at a high dose (1.0 mg/kg per day) or a moderate dose (0.5 mg/kg per day) or placebo. Group 1 took the high dose for 1 year and then the moderate dose for 2 years. Group 2 took the moderate dose for 3 years. Group 3 took placebo for 3 years. The diagnosis of a second primary malignancy of the head and neck, lung, or bladder was regarded as the end point signifying failure of therapy. Issues of drug adverse effect profile and impact on survival were measured. There was no significant difference in the occurrence of second primary disease (P = .90), the recurrence of primary disease (P = .70), or disease-free time (P = .80) between the treatment and nontreatment arms. Numbers were too small to find differences in survival. With evidence that retinoid treatment adversely affects survival of lung cancer and with this drug not significantly decreasing the incidence of second primary tumors of head and neck squamous cell carcinoma, the use of this drug in head and neck cancer patients for second cancer prophylaxis is not indicated.