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Home   Researchers   Our researchers
Prof Janet Hardy

Prof Janet Hardy

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    Prof Janet Hardy

    Professor Janet Hardy is a Senior Researcher, a co-lead of the Cancer Biology and Care Program and leads the Palliative Care Research Group at Mater Research, in addition to being the Medical Director of the Mater Cancer Care Centre, the Director of Palliative Care and the Acting Medical Lead of the Cancer Care Stream at Mater. Janet also holds an honorary chair with the School of Medicine at the University of Queensland.

    Janet has been an author on over 130 scientific publications and many text book chapters, and has also received more than $4.5 million in competitive funding.

    Janet came to Mater in 2003 and has had a very successful career which has allowed her to pursue her varied research interests. Her research group’s major interests are research methodology in palliative care, opioids in pain management and the use and abuse of corticosteroids. At Mater, Janet has developed a wide portfolio of clinical trials; ranging from electro-acupuncture to relieve nausea and the effect of steroids on sleep quality in oncology and palliative care patients, to the use of intraperitoneal injection of bevacizumab to prevent the re-accumulation of malignant ascites (the accumulation of fluid in the abdominal cavity). Janet has been instrumental in ensuring a bench to bedside approach in research and activity collaborates with her biomedical colleagues.

    Janet is a specialty editor for the Internal Medicine Journal and frequently performs manuscript reviews for high quality journals, both national and international. She has served as an external assessor and project committee member for the National Health and Medical Research Council (NHMRC). Janet is the Chair and a founding member of the Queensland Palliative Care Research Group (QPCRG), has been a key player and chair of the Trials Management Committee for the Palliative Care Clinical Studies Collaborative (PaCCSCa national palliative care research collaborative, and has served on the council of the Australia and New Zealand Palliative Care Society (ANZSPM) amongst many other scientific committees.

    “My interest in research came from my time at the Royal Marsden Hospital in London, an international centre of excellence for cancer research. I built up a palliative care research program there which has now been translated to the Australian environment. I strongly believe that the care of patients with life limiting disease should be based on research evidence that is just as strong as that which underpins the care of those patients with potentially curable disease.”

    Research Programs and Groups

    • Cancer Biology and Care - Palliative Care Research

    Research Interests

    • Oncology and Carcinogenesis not elsewhere classified - Oncology and Carcinogenesis

    Funding

    • 2016 - Brisbane Diamantina Health Partners (Strategic Initiative Grant Scheme) - $45,000.00
      Funded ProjectThe Queensland Gynaecological Cancer Initiative

    Publications

    A pilot study of intraperitoneal bevacizumab for the palliation of malignant ascites
    2016 - Journal Article - DOI: 10.1111/ajco.12578
    Jones, Joanna M., Hardy, Janet R., Munster, David J. and Shannon, Catherine M.

    no abstract available


    A randomised, double-blind controlled trial of intranasal midazolam for the palliation of dyspnoea in patients with life-limiting disease
    2016 - Journal Article - DOI: 10.1007/s00520-016-3125-2
    Hardy, Janet, Randall, Clare, Pinkerton, Eve, Flatley, Christopher, Gibbons, Kristen and Allan, Simon

    Read Abstract

    Purpose
    Anxiety is a major component of breathlessness and is often palliated with benzodiazepines. Midazolam is a short-acting water-soluble benzodiazepine with a rapid onset of action and short half-life. Intranasal midazolam had been shown to be of marked clinical benefit in an uncontrolled pilot study for the control of dyspnoea. A blinded randomised controlled study was therefore undertaken across four Australasian palliative care services.

    Methods
    All participants received six numbered study nasal spray (SNS) bottles, three of which contained midazolam and three placebo. They were instructed to use one SNS bottle on each day they were breathless, for 6 days within 2 weeks. Dyspnoea scores were recorded before and at set time intervals following the first use of each SNS bottle.

    Results
    Across all SNS bottles, the maximum change of 2.1 on an 11-point numerical rating scale was seen at 60 min. There was no difference in dyspnoea score between the two arms. Approximately 50 % of participants in each arm had a positive response (i.e. ≥2 point change in dyspnoea score from baseline). Anxiety scores at baseline were low. The most common adverse event was local nasal reactions.

    Conclusion
    Intranasal midazolam had no clinical benefit over intranasal placebo for the control of dyspnoea. The low level of anxiety at baseline and dose of active drug delivered may have been important factors. Many participants found the SNS bottles to be a challenging mode of drug delivery. This study confirms the importance of placebo-controlled trials for defining best clinical practise.


    An open-label pilot study of oral vitamin C as an opioid-sparing agent in patients with chronic pain secondary to cancer
    2016 - Journal Article - DOI: 10.1007/s00520-016-3472-z
    Pinkerton, E., Good, P., Gibbons, K. and Hardy, J.

    Read Abstract

    Purpose: The purpose of this study is to assess the efficacy of oral Vitamin C as an opioid-sparing agent when used in conjunction with opioids and standard adjuvant therapy in the management of chronic cancer pain.

    Methods: An open-label pilot study of patients ≥18 years of age with chronic pain secondary to cancer and/or its treatment and a Brief Pain Inventory average pain score of ≥3/10. In addition to opioid analgesia, patients received 1 g of vitamin C twice daily over 3 days (total daily dose of 2 g). Patients’ usual medications, including breakthrough medications, were continued throughout the study period. The primary endpoint was total daily opioid use during vitamin C administration compared with that immediately prior to study.

    Results: Thirty-four patients were enrolled in the study. Seven failed to complete the trial. Across the 17 evaluable patients, the median daily opioid consumption was 360 mg oral morphine equivalents (OME) on the days prior to vitamin C and 390 mg when administered with vitamin C.

    Conclusion: This study failed to demonstrate any clinically significant benefit from vitamin C in conjunction with opioids in cancer-related pain and does not provide support for embarking on a larger randomised trial to determine efficacy.


    Interventional options for the management of refractory cancer pain-what is the evidence?
    2016 - Journal Article - DOI: 10.1007/s00520-015-3047-4
    Vayne-Bossert, Petra, Afsharimani, Banafsheh, Good, Phillip, Gray, Paul and Hardy, Janet

    Read Abstract

    Purpose Pain is the most common symptom in cancer patients. Standard pain treatment according to the WHO three-step analgesic ladder provides effective pain management in approximately 70–90 % of cancer patients. Refractory pain is defined as not responding to “standard” treatments. Interventional analgesic techniques can be used in an attempt to control refractory pain in patients in whom conventional analgesic strategies fail to provide effective pain relief or are intolerable due to severe adverse effects. This systematic review aims to provide the latest evidence on interventional refractory pain management in cancer patients.
    Methods Systematic literature search in Cochrane, EMBASE and PubMed including reviews and randomised controlled trials (RCTs) and non-randomised controlled trials in the absence of reviews.
    Results Neuraxial analgesia may play a role in refractory cancer pain management. Paravertebral blocks decrease the incidence of persistent post-surgical pain after breast cancer. Coeliac plexus blocks improve pain scores in refractory pancreatic cancer pain for up to 4 weeks after the intervention with fewer burdensome side effects as compared to opioids. Cordotomy has mainly been studied in mesothelioma, and the case series suggest possible benefit for pain at the expense of a relatively high risk of side effects.
    Conclusions Overall, very few RCTs have been conducted on interventional pain techniques. In reality, it is very difficult to undertake large controlled trials for a number of reasons. Therefore, today’s best evidence for practice may be from large case series of comparable patients with careful response and toxicity evaluation and follow-up.


    Pining for the fjords
    2016 - Journal Article - DOI: 10.1111/imj.13105
    Hardy, J. R. and Douglas, C. M.

    no abstract available


    Potential economic impact on hospitalisations of the Palliative Care Clinical Studies Collaborative (PaCCSC) ketamine randomised controlled trial
    2016 - Journal Article - DOI: 10.1071/ah15012
    McCaffrey, Nikki, Hardy, Janet, Fazekas, Belinda, Agar, Meera, Devilee, Linda, Rowett, Debra and Currow, David

    Read Abstract

    Objective The aim of the present study was to estimate the potential healthcare cost savings associated with reduced prescribing of subcutaneous ketamine for the treatment of chronic cancer pain after publication of the Palliative Care Clinical Studies Collaborative (PaCCSC) ketamine randomised controlled trial (RCT), to provide further reasons to modify ketamine prescribing practice in this setting.

    Methods Potential cost savings in this setting were estimated from a health system perspective using a 1-year impact model. The model was populated with estimates derived using an epidemiological approach informed by morbidity and prevalence data, the PaCCSC feasibility study, ketamine RCT and national ketamine utilisation survey results, as well as clinical opinion.

    Results The total estimated annual hospitalisation costs associated with subcutaneous ketamine prescribing were A$3 899 600 (2605 bed-days). A 17% reduction in ketamine prescribing lowered hospitalisation costs to A$3 236 668 (2162 bed-days), a reduction of A$662 932 (443 bed-days) because of reduced in-patient stays associated with ketamine toxicity and prescribing process.

    Conclusions The findings from the modelled impact analysis suggest that dissemination of the PaCCSC ketamine RCT results may have saved the Australian healthcare system approximately A$663 000 in annual hospitalisation costs and freed up 443 in-patient bed-days, although there was high uncertainty within the study. Wider dissemination over time and targeted, local de-adoption strategies could result in further savings.


    Quantitative determination of the enantiomers of methadone in human plasma and saliva by chiral column chromatography coupled with mass spectrometric detection
    2016 - Journal Article - DOI: 10.1016/j.talanta.2015.11.044
    George, Rani, Lobb, Michael, Haywood, Alison, Khan, Sohil, Hardy, Janet, Good, Phillip, Hennig, Stefanie and Norris, Ross

    no abstract available


    Single patient multiple cross-over studies to determine the effectiveness of paracetamol in relieving pain suffered by patients with advanced cancer taking regular opioids: a pilot study.
    2016 - Journal Article - DOI: 10.1177/0269216316635012
    Nikles, Jane, Mitchell, Geoffrey K., Hardy, Janet, Senior, Hugh, Carmont, Sue-Ann, Schluter, Philip J., Vora, Rohan, Currow, David and Yelland, Michael

    no abstract available


    Corticosteroids for adult patients with advanced cancer who have nausea and vomiting (not related to chemo- or radiotherapy, or surgery)(Protocol)
    2015 - Journal Article - DOI: 10.1002/14651858.cd012002
    Vayne-Bossert, Petra, Haywood, Alison, Good, Phillip, Khan, Sohil, Rickett, Kirsty, Jenkins-Marsh, Sue and Hardy, Janet R

    Read Abstract

    This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of corticosteroids on nausea and vomiting not related to chemotherapy, radiotherapy, or surgery in adult cancer patients.


    Corticosteroids for the management of cancer-related pain in adults (Review)
    2015 - Journal Article - DOI: 10.1002/14651858.cd010756.pub2
    Haywood, Alison, Good, Phillip, Khan, Sohil, Leupp, Aurelia, Jenkins-Marsh, Sue, Rickett, Kirsty and Hardy, Janet R.

    Read Abstract

    Background
    One of the most feared symptoms associated with cancer is pain. Opioids remain the mainstay of pain treatment but corticosteroids are often used concurrently as co- or adjuvant analgesics. Due to their anti-inflammatory mechanism of action, corticosteroids are said to provide effective analgesia for pain associated with inflammation and in the management of cancer-related complications such as brain metastasis and spinal cord compression. However, corticosteroids have a wide range of adverse effects that are dose and time dependent.

    Objectives
    To evaluate the efficacy of corticosteroids in treating cancer-related pain in adults.  Search methods
    We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2014, Issue 4),MEDLINE (OVID) (1966 to 29 September 2014), EMBASE (OVID) (1970 to 29 September 2014), CINAHL (1982 to 29 September 2014), Science Citation Index (Web of Science) (1899 to 29 September 2014) and Conference Proceedings Citation Index - Science (Web of Science) (1990 to 29 September 2014).

    Selection criteria
    Any randomised or prospective controlled trial that included patients over 18 years with cancer-related pain were eligible for the review. Corticosteroids were compared to placebo or usual treatment and/or supportive care. Data collection and analysis All review authors independently assessed trial quality and extracted data. We used arithmetic means and standard deviations for each outcome to report the mean difference (MD) with 95% confidence interval (CI).

    Main results
    Fifteen studies met the inclusion criteria, enrolling 1926 participants. The trial size varied from 20 to 598 patients. Most studies compared corticosteroids, particularly dexamethasone, to standard therapy. We included six studies with data at one week in the metaanalysis for pain intensity; no data were available at that time point for the remaining studies. Corticosteroid therapy resulted in less pain (measured on a scale of 0 to 10 with a lower score indicating less pain) compared to control at one week (MD 0.84 lower pain, 95% CI 1.38 to 0.30 lower; low quality evidence). Adverse events were poorly documented. Factors limiting statistical analysis included the lack of standardised measurements of pain and the use of different agents, dosages, comparisons and routes of drug delivery. Subgroup analysis according to type of cancer was not possible. The quality of this evidence was limited by the risk of bias of the studies and small sample size. The results were also compromised by attrition, with data missing for the enrolled patients.

    Authors’ conclusions
    The evidence for the efficacy of corticosteroids for pain control in cancer patients is weak. Significant pain relief was noted in some studies, albeit only for a short period of time. This could be important for patients with poor clinical status. Further trials, with increased numbers of participants, are needed to evaluate the safety and effectiveness of corticosteroids for the management cancer pain in adults, and to establish an ideal dose, duration of therapy and route of administration.

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