About 125,000 people are diagnosed with cancer in Australia each year. With population growth and aging this is set to rise to 150,000 new cases each year by 2020.1 in 2 Australian men and 1 in 3 Australian women will be diagnosed with cancer by the age of 85. Cancer is a leading cause of death in Australia. (Source: Cancer Council Australia)
New South Wales
Latest Research Publications
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Latest Research Publications
Feasibility, acceptability and efficacy of a text message-enhanced clinical exercise rehabilitation intervention for increasing 'whole-of-day' activity in people living with and beyond cancer.
BMC Public Health. 2019; 19(Suppl 2):542 [PubMed] Free Access to Full Article Related Publications
METHODS: Participants (n = 36; mean ± SD age 64.8 ± 9.6 years; 44.1 ± 30.8 months since treatment) were randomized 1:1 to receive the text message-enhanced clinical exercise rehabilitation program, or the standard clinical exercise rehabilitation program alone. Activity was assessed at baseline, 4-weeks (end of the standard program) and 12-weeks (end of enhanced program) using both device (activPAL accelerometer; sitting, standing, light-stepping, moderate-stepping) and self-report [Multimedia Activity Recall for Children and Adults (MARCA); sedentary, light, moderate-to-vigorous physical activity (MVPA)] methods. The MARCA also assessed time use domains to provide context to activity changes. Changes and intervention effects were evaluated using linear mixed models, adjusting for baseline values and potential confounders.
RESULTS: The study had high retention (86%) and participants reported high levels of satisfaction [4.3/5 (±0.8)] with the intervention. Over the first 4 weeks, MARCA-assessed MVPA increased [+ 53.2 (95%CI: 2.9, 103.5) min/d] between groups, favoring the text message-enhanced program, but there were no significant intervention effects on sedentary behavior. By 12 weeks, relative to the standard group, participants in the text message-enhanced group sat less [activPAL overall sitting: - 48.2 (- 89.9, - 5.6) min/16 h awake; MARCA: -80.1 (- 156.5, - 3.8) min/d] and were participating in more physical activity [activPAL light stepping: + 7.0 (0.4, 13.6: min/16 h awake; MARCA MVPA: + 67.3 (24.0, 110.6) min/d]. The time-use domains of Quiet Time [- 63.3 (- 110.5, - 16.0) min/d] and Screen Time [- 62.0 (- 109.7, - 14.2) min/d] differed significantly between groups.
CONCLUSIONS: Results demonstrate feasibility, acceptability and efficacy of a novel, text message-enhanced clinical exercise rehabilitation program to support changes in whole-of-day activity, including both physical activity and sedentary behavior. Changes were largely seen at 12-week follow-up, indicating potential for the intervention to result in continued improvement and maintenance of behavior change following a supervised exercise intervention.
TRIAL REGISTRATION: This trial is registered with the Australian New Zealand Clinical Trials Registry ( ACTRN12616000641493 ; date registered 17/5/16).
Management of patients with follicular lymphoma treated first line with obinutuzumab.
Asia Pac J Clin Oncol. 2019; 15 Suppl 3:3-11 [PubMed] Related Publications
The trials and tribulations of conducting an m-health pilot randomized controlled trial to improve oral cancer therapy adherence: recommendations for future multisite, non-drug clinical trials.
BMC Res Notes. 2019; 12(1):226 [PubMed] Free Access to Full Article Related Publications
RESULTS: Eighteen patients were recruited to the study; eight were randomly allocated to the intervention arm. Intervention participants responded to their daily medication-reminder text messages, indicating that medication had been taken or not, and nurses were able to organize their calls around their workload. The trial closed prematurely primarily due to inadequate numbers of eligible patients; however, other potentially resolvable feasibility issues were identified. These included lack of infrastructure at study sites, poor screening data acquisition and management processes, and inexperience in conducting supportive care trials at participating sites. M-health intervention trials are designed to inform implementation of best supportive care practice. Adequate skills and infrastructure are research prerequisites that require careful consideration and sufficient investment for the successful execution of multi-site supportive care trials. Trial registration Australian and New Zealand Clinical Trials Register: ACTRN12612000635864.
Factors contributing to low readiness and capacity of culturally diverse participants to use the Australian national bowel screening kit.
Public Health Res Pract. 2019; 29(1) [PubMed] Related Publications
METHODS: Thirty-three people (aged 50-79 years) from Serbian and Macedonian communities in the Illawarra region in New South Wales, Australia, participated in one of five interactive focus group sessions. Sessions used innovative 'customer journey' techniques to understand participants' experience of each step of the faecal occult blood test process. Participants discussed knowledge of bowel cancer and attitudes to screening, and participated in a collective mock use of a test kit. Sessions were audio recorded, transcribed and thematically analysed by two researchers in collaboration with bicultural health workers.
RESULTS: Multiple factors contributed to low readiness and capacity to use the kit, including limited promotion of the program in community languages, complicated and poorly sequenced kit instructions, and confusion around the order and labelling of kit components. Participants suggested several ways to improve kits to improve uptake by CALD communities.
CONCLUSION: Simplified and targeted promotion of bowel screening programs in community languages, and improved kit design, may support participation of CALD populations in screening programs.
Lifetime recreational physical activity and the risk of prostate cancer.
Cancer Causes Control. 2019; 30(6):617-625 [PubMed] Related Publications
METHODS: A population-based case-control study was conducted in Western Australia in 2001-2002. Data were collected on lifetime recreational physical activity from a self-reported questionnaire. The estimated effects of recreational physical activity on prostate cancer risk were analyzed using logistic regression, adjusting for demographic and lifestyle factors. This analysis included 569 incident cases and 443 controls.
RESULTS: There was a significant, inverse dose-response relationship between vigorous-intensity recreational physical activity between the ages 19 and 34 years and the risk of prostate cancer (p
CONCLUSIONS: A high level of vigorous recreational physical activity in early adulthood may be required to reduce the risk of prostate cancer.
Increasing incidence and mortality related to liver cancer in Australia: time to turn the tide.
Aust N Z J Public Health. 2019; 43(3):267-273 [PubMed] Related Publications
METHODS: Analysis of Australian Cancer Incidence and Mortality data published in 2017 by the AIHW. Age-standardised rates (ASR) for 1982 to 2014/2015. Piecewise linear regression was used to assess temporal trends. For the purposes of comparison, data were also extracted for all cancers with greater burdens of disease (lung, colorectal, breast, prostate, pancreatic, and brain cancers and melanoma of the skin).
RESULTS: Since 1982, the average annual percentage change (AAPC) for ASR incidence of liver cancer was 4.858% (95%CI 4.558-5.563). This marked a 306% increase from 1.822/100,000 persons (95%CI 1.586-2.058) in 1982 to 7.396/100,000 persons (95%CI 7.069-7.723) in 2014. AAPC for ASR mortality was 3.013% (95%CI 2.448-3.521): an increase of 184% from 2.323/100,000 persons (95%CI 2.052-2.594) in 1982 to 6.593/100,000 (95%CI 6.290-6.896) in 2015. ASR incidence and mortality were highest in the NT (12.607/100,000 persons), VIC (8.229/100,000) and NSW (7.798/100,000). In comparison to the other selected cancers, higher AAPC for both incidence and mortality of liver cancer were observed.
CONCLUSION: Incidence and mortality associated with liver cancer have increased substantially in the past three decades, in contrast to the improved outcomes observed for many other cancers. Jurisdictional incidence rates reflect higher prevalence of hepatitis B and C. Implications for public health: In the context of Australian cancer prevention and care programs, liver cancer is an outlier. Strategies to mitigate risk factors and improve surveillance of liver health for at-risk groups are urgently required.
Evaluation of the accuracy and availability of cancer-related physical activity and sedentary behaviour information on English-language websites.
J Psychosoc Oncol. 2018 Nov-Dec; 36(6):754-767 [PubMed] Related Publications
DESIGN: The study used a cross-sectional design.
SAMPLE: A list of major cancer websites (N = 11) was generated from countries that speak English primarily (e.g., Canada, Australia).
METHODS: These websites were assessed for quality and accuracy based on a detailed coding framework (e.g., PA guidelines, PA and cancer prevention). Frequencies and descriptive statistics were derived for website characteristics of interest.
FINDINGS: All sites reviewed within this study offered PA information for cancer prevention and cancer survivorship. However, while 81% of the sites presented information for SB and cancer prevention, very little information was presented for SB and cancer survivorship, with only 18.2% of the information being offered.
CONCLUSIONS: The quality and accuracy of cancer-related PA and SB information presented on leading cancer websites is variable. Further information is warranted in the areas of SB, resistance training, and behaviour change strategies.
IMPLICATIONS: Websites have considerable value as knowledge translation tools and, therefore, presenting evidence-based information that is easy to understand may positively impact the health and behaviours of cancer populations, as well as the general population.
The preventable burden of endometrial and ovarian cancers in Australia: A pooled cohort study.
Gynecol Oncol. 2019; 153(3):580-588 [PubMed] Related Publications
METHODS: We linked pooled data from six Australian cohort studies to national cancer and death registries, and quantified exposure-cancer associations using adjusted proportional hazards models. We estimated exposure prevalence from representative health surveys. We then calculated Population Attributable Fractions (PAFs) with 95% confidence intervals (CIs), accounting for competing risk of death, and compared PAFs for population subgroups.
RESULTS: During a median 4.9 years follow-up, 510 incident endometrial and 303 ovarian cancers were diagnosed. Overweight and obesity explained 41.9% (95% CI 32.3-50.1) of the endometrial cancer burden and obesity alone 34.5% (95% CI 27.5-40.9). This translates to 12,800 and 10,500 endometrial cancers in Australia in the next 10 years, respectively. The body fatness-related endometrial cancer burden was highest (49-87%) among women with diabetes, living remotely, of older age, lower socio-economic status or educational attainment and born in Australia. Never use of oral contraceptives (OCs) explained 8.1% (95% CI 1.8-14.1) or 2500 endometrial cancers. A higher BMI and current long-term MHT use increased, and long-term OC use decreased, the risk of ovarian cancer, but the burden attributable to overweight, obesity or exogenous hormonal factors was not statistically significant.
CONCLUSIONS: Excess body fatness, a trait that is of high and increasing prevalence globally, is responsible for a large proportion of the endometrial cancer burden, indicating the need for effective strategies to reduce adiposity.
Breast Cancer Diagnostic Efficacy in a Developing South-East Asian Country
Asian Pac J Cancer Prev. 2019; 20(3):727-731 [PubMed] Related Publications
Is Vitamin D Level at Melanoma Diagnosis Associated With Stage Of Tumor? An Observational Study of Melanoma Patients Living in a High Ultraviolet Radiation Environment.
Mil Med. 2019; 184(Suppl 1):506-510 [PubMed] Related Publications
METHODS: We aim to recruit 600 recently diagnosed melanoma patients from Queensland, Australia, a high UVR location with one of the world's highest melanoma incidence rates. Patients are recruited through general practitioner, skin cancer specialist, dermatological and hospital-based practices. As close as possible to diagnosis, participants provide a blood sample for vitamin D analysis and have their sun exposure/sun protection behavior, melanoma risk factors and dietary vitamin D intake assessed by questionnaire and phone interview. Details of tumor pathology, including tumor level, thickness, and ulceration, are abstracted from cancer registry records. Here, we describe the study methods and present preliminary findings from early participants.
RESULTS: As of December 2017, we have recruited 128 participants (48% male, mean age 60.2 years, mean Breslow thickness 0.63 mm).
CONCLUSIONS: When complete, this study will give insights into the association between vitamin D at diagnosis and melanoma tumor characteristics whilst adjusting for recent sun exposure and sun protection use. This study may impact military sun exposure and nutrition policies as vitamin D may play a role in melanomagenesis.
Process evaluation of a behaviour change approach to improving clinical practice for detecting hereditary cancer.
BMC Health Serv Res. 2019; 19(1):180 [PubMed] Free Access to Full Article Related Publications
METHODS: Semi-structured interviews explored participants' perceptions of the TDFI approach and Health services researchers wrote structured reflections. Interview transcripts and reflections were coded initially against implementation outcomes for the various TDFI approach activities: acceptability, appropriateness, feasibility, value for time cost, and adoption. On a second pass, themes were coded around challenges to the approach.
RESULTS: Interviews were held with nine key project participants including pathologists, oncologists, surgeons, genetic counsellors and an administrative officer. Two health services researchers wrote structured reflections. The first of two major themes was 'Theory-related challenges', with subthemes of accessibility of theory underpinning the TDFI, commitment to that theory-based approach, and the problem of complexity. The second theme was 'Practical challenges' with subthemes of stakeholder management, navigating the system, and perceptions of the problem. Health services researchers reflected on the benefits of bridging professional divides and facilitating collective learning and problem solving, but noted frustrations around clinicians' time constraints that led to sparse interactions with the team, and lack of authority to effect change themselves.
CONCLUSIONS: Mixed success of adoption as an outcome was attributed to the complexity and highly nuanced nature of the setting. This made identifying the target behaviour, a key step in the TDFI approach, challenging. Introduced changes in the screening process led to new, unexpected issues yet to be addressed. Strategies to address challenges are presented, including using an internal facilitator with a focus on applying a theory-based implementation approach.
Pathways to a cancer-free future: A protocol for modelled evaluations to maximize the future impact of interventions on cervical cancer in Australia.
Gynecol Oncol. 2019; 152(3):465-471 [PubMed] Related Publications
METHODS: Based on evidence from literature reviews and guidance from a multi-disciplinary Scientific Advisory Committee (SAC), the most relevant evaluations for prevention, diagnosis and treatment were identified.
RESULTS: Priority evaluations agreed by the SAC included: increasing/decreasing and retaining vaccination uptake at the current level; vaccinating older women; increasing screening participation; methods for triaging HPV-positive women; improving the diagnosis of cervical intraepithelial neoplasia (CIN) and cancer; treating cervical abnormalities and cancer; and vaccinating women treated for CIN2/3 to prevent recurrence. Evaluations will be performed using a simulation model, Policy1-Cervix previously used to perform policy evaluations in Australia. Exploratory modelling of interventions using idealised scenarios will initially be conducted in single birth cohorts. If these have a significant impact on findings then evaluations with more realistic assumptions will be conducted. Promising strategies will be investigated further by multi-cohort simulations predicting health outcomes, resource use and cost outcomes.
CONCLUSIONS: Pathways-Cervix will assess the relative benefits of strategies and treatment options in a systematic and health economic framework, producing a list of 'best buys' for future decision-making in cervical cancer control.
Prognostic models for breast cancer: a systematic review.
BMC Cancer. 2019; 19(1):230 [PubMed] Free Access to Full Article Related Publications
METHODS: We conducted a systematic search in four electronic databases and some oncology websites, and a manual search in the bibliographies of the included studies. We identified original studies that were published prior to 1st January 2017, and presented the development and/or validation of models based mainly on clinico-pathological factors to predict mortality and/or recurrence in female breast cancer patients.
RESULTS: From the 96 articles selected from 4095 citations found, we identified 58 models, which predicted mortality (n = 28), recurrence (n = 23), or both (n = 7). The most frequently used predictors were nodal status (n = 49), tumour size (n = 42), tumour grade (n = 29), age at diagnosis (n = 24), and oestrogen receptor status (n = 21). Models were developed in Europe (n = 25), Asia (n = 13), North America (n = 12), and Australia (n = 1) between 1982 and 2016. Models were validated in the development cohorts (n = 43) and/or independent populations (n = 17), by comparing the predicted outcomes with the observed outcomes (n = 55) and/or with the outcomes estimated by other models (n = 32), or the outcomes estimated by individual prognostic factors (n = 8). The most commonly used methods were: Cox proportional hazards regression for model development (n = 32); the absolute differences between the predicted and observed outcomes (n = 30) for calibration; and C-index/AUC (n = 44) for discrimination. Overall, the models performed well in the development cohorts but less accurately in some independent populations, particularly in patients with high risk and young and elderly patients. An exception is the Nottingham Prognostic Index, which retains its predicting ability in most independent populations.
CONCLUSIONS: Many prognostic models have been developed for breast cancer, but only a few have been validated widely in different settings. Importantly, their performance was suboptimal in independent populations, particularly in patients with high risk and in young and elderly patients.
Patterns of care for stage III non-small cell lung cancer in Australia.
Asia Pac J Clin Oncol. 2019; 15(3):93-100 [PubMed] Related Publications
Evaluation of the efficacy and toxicity of upper extremity isolated limb infusion chemotherapy for melanoma: An Australian multi-center study.
Eur J Surg Oncol. 2019; 45(5):832-837 [PubMed] Related Publications
PATIENTS AND METHODS: 316 ILI procedures for melanoma performed between 1992 and 2008 in five Australian institutions were analyzed. In all institutions melphalan (±actinomycin D) was circulated in the isolated limb for 20-30 min.
RESULTS: Baseline patient characteristics for UL-ILI (n = 27) and LL-ILI (n = 289) were similar, except that more men underwent UL-ILI (66% vs. 38%; p = 0.007) and disease in LL-ILI was mostly located on the distal limb (p = 0.02). Median tourniquet times were shorter for UL-ILI (38 vs. 48 min; p = 0.04) and UL-ILI patients experienced less limb toxicity (Grade III/IV in 24% vs. 31%; p = 0.01). Complete response (CR) rates were similar: 33% after LL-ILI (p = 0.70), 30% after UL-ILI, while overall response (OR) rates were higher after LL-ILI: (76%) than UL-ILI (59%; p = 0.05). No difference in survival was seen.
CONCLUSIONS: UL-ILI is safe to perform and effective, resulting in low limb toxicity. CR rates were similar to those for LL-ILI, but OR rates were lower for UL-ILI. It may be possible to improve OR rates achieved by UL-ILI by optimizing perioperative factors, while maintaining low toxicity.
NTHL1-associate polyposis: first Australian case report.
Fam Cancer. 2019; 18(2):179-182 [PubMed] Related Publications
Australasian Gastrointestinal Pathology Society (AGPS) consensus guidelines for universal defective mismatch repair testing in colorectal carcinoma.
Pathology. 2019; 51(3):233-239 [PubMed] Related Publications
A longitudinal investigation of Western Australian families impacted by parental cancer with adolescent and young adult offspring.
Aust N Z J Public Health. 2019; 43(3):261-266 [PubMed] Related Publications
METHODS: A retrospective cohort study was conducted using data from the Western Australia Data Linkage System, which provided results generalisable at a national level.
RESULTS: Between 1982 and 2015, 57,708 offspring were impacted by 34,600 parents' incident malignant cancer diagnoses. The most common diagnosis was breast cancer. Of the 36.4% of parents who died, this was mostly a result of cancer. Most families resided in regional areas and were of high or middle socioeconomic status. Significant predictors of earlier parent death included low socioeconomic status, remoteness, age, having more children and having older children.
CONCLUSION: A considerable number of adolescent and young adult offspring are impacted by parental cancer at a potentially vulnerable age. This research provides knowledge to better understand who is affected by parental cancer in Australia. Implications for public health: These results may be useful for planning and implementation of Australian supportive services.
The distribution and determinants of mammographic density measures in Western Australian aboriginal women.
Breast Cancer Res. 2019; 21(1):33 [PubMed] Free Access to Full Article Related Publications
METHODS: Epidemiological data and mammographic images were obtained from 628 Aboriginal women and 624 age-, year of screen-, and screening location-matched non-Aboriginal women randomly selected from the BreastScreen Western Australia database. Women were cancer free at the time of their mammogram between 1989 and 2014. MD was measured using the Cumulus software. Kolmogorov-Smirnov tests were used to compare distributions of absolute dense area (DA), precent dense area (PDA), non-dense area (NDA) and total breast area between Aboriginal and non-Aboriginal women. General linear regression was used to estimate the determinants of MD, adjusting for age, NDA, hormone therapy use, family history, measures of socio-economic status and remoteness of residence for Aboriginal and non-Aboriginal women separately.
RESULTS: Aboriginal women were found to have lower DA and PDA and higher NDA than non-Aboriginal women. Age (p < 0.001) was negatively associated and several socio-economic indices (p < 0.001) were positively associated with DA and PDA in Aboriginal and non-Aboriginal women. Remoteness of residence was associated with both mammographic measures but for non-Aboriginal women only.
CONCLUSIONS: Aboriginal women have, on average, less MD than non-Aboriginal women but the factors associated with MD are similar for both sample populations. Since reduced MD is associated with improved sensitivity of mammography, this study suggests that mammographic screening is a particularly good test for Australian Indigenous women, a population that suffers from high breast cancer mortality.
Barriers of Access to Breast Reconstruction: A Systematic Review.
Plast Reconstr Surg. 2019; 143(3):465e-476e [PubMed] Related Publications
METHODS: The authors performed a systematic review that focused on (1) breast reconstruction, (2) barriers, and (3) breast cancer. Eight databases (i.e., EMBASE, MEDLINE, PsycINFO, CINHAL, ePub MEDLINE, ProQuest, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials) were searched. English peer-reviewed articles published between 1996 and 2016 were included.
RESULTS: The authors' search retrieved 4282 unique articles. Two independent reviewers screened texts, selecting 99 articles for inclusion. All studies were observational and qualitative in nature. The availability of breast reconstruction was highest in teaching hospitals, private hospitals, and national cancer institutions. Accessibility affected access, with lower likelihood of breast reconstruction in rural geographic locations. Affordability also impacted access; high costs of the procedure or poor reimbursement by insurance companies negatively influenced access to breast reconstruction. Acceptability of the procedure was not universal, with unfavorable physician attitudes toward breast reconstruction and specific patient and tumor characteristics correlating with lower rates of breast reconstruction. Lastly, lack of patient awareness of breast reconstruction reduced the receipt of breast reconstruction.
CONCLUSIONS: Using the access-to-care framework by Penchansky and Thomas, the authors found that barriers to breast reconstruction existed in all six domains and interplayed at many levels. The authors' systematic review analyzed this complex relationship and suggested multiprong interventions aimed at targeting breast reconstruction barriers, with the goal of promoting equitable access to breast reconstruction for all breast cancer patients.
Rare mimic of recurrent anaphylaxis.
BMJ Case Rep. 2019; 12(2) [PubMed] Related Publications
Pathological process has a crucial role in sentinel node biopsy for vulvar cancer.
Gynecol Oncol. 2019; 153(2):292-296 [PubMed] Related Publications
METHODS: A prospective multi-center study in 8 participating centers. Eligible patients had squamous cell carcinomas clinically restricted to the vulva <4 cm in diameter. SN procedures and pathological assessment were to be performed in accordance with the methods published by the GROINSS-V collaboration .
RESULTS: 130 women with apparent early stage vulvar cancer were enrolled. Seventeen women subsequently did not meet the eligibility criteria and were excluded. SNs were identified in 111/113 of the remaining women. Twenty-two women had positive nodes. Sixteen of these women had at least 12 months follow up and 7 (44%) had recurrent disease. Eighty-nine women had only negative nodes. Seventy-four of these women had at least 12 months follow up and 6 (8%) had recurrent disease (including 2 [2.7%] with recurrence in the groin). On subsequent review of the two women with negative SNs who had groin recurrences, it was found that the recommended pathology protocol had not been followed. In both cases, SN metastases were identified following serial sectioning of the nodes.
CONCLUSIONS: SN biopsy is feasible in routine clinical practice. However, undetected metastases in a removed SN may be associated with groin recurrence. To ensure patient safety, strict adherence to the pathology protocol is an essential component in the utilization of the sentinel lymph node technique in vulvar cancer.
The Epidemiology of Breast Implant-Associated Anaplastic Large Cell Lymphoma in Australia and New Zealand Confirms the Highest Risk for Grade 4 Surface Breast Implants.
Plast Reconstr Surg. 2019; 143(5):1285-1292 [PubMed] Related Publications
METHODS: New cases in Australia and New Zealand were identified and analyzed. Updated sales data from three leading breast implant manufacturers (i.e., Mentor, Allergan, and Silimed) were secured to estimate implant-specific risk.
RESULTS: A total of 26 new cases of BIA-ALCL were diagnosed between January of 2017 and April of 2018, increasing the total number of confirmed cases in Australia and New Zealand to 81. This represents a 47 percent increase in the number of reported cases over this period. The mean age and time to development remain unchanged. The implant-specific risk has increased for Silimed polyurethane (23.4 times higher) compared with Biocell, which has remained relatively static (16.5 times higher) compared with Siltex implants.
CONCLUSIONS: The number of confirmed cases of BIA-ALCL in Australia and New Zealand continues to rise. The implant-specific risk has now changed to reflect a strong link to implant surface area/roughness as a major association with this cancer.
Long-term out of pocket expenditure of people with cancer: comparing health service cost and use for indigenous and non-indigenous people with cancer in Australia.
Int J Equity Health. 2019; 18(1):32 [PubMed] Free Access to Full Article Related Publications
METHODS: We used CancerCostMod, a model using linked administrative data. The base population was all persons diagnosed with cancer in Queensland, Australia (01JUL2011 to 30JUN2012) (n = 25,553). Each individual record was then linked to their Admitted Patient Data Collection, Emergency Data Information System, Medicare Benefits Schedule (MBS), and Pharmaceutical Benefits Scheme (PBS) records (01JUL2011 to 30JUN2015). We then weighted the population to be representative of the Australian population (approximately 123,900 Australians, 1.7% Indigenous Australians). The patient co-payment charged for each MBS service and PBS prescription was summed for each month from date of diagnosis to 36-months post-diagnosis. We then limited our model to MBS items to identify the quantity and type of healthcare services accessed during the first three-years.
RESULTS: On average Indigenous people with cancer had less than half the out-of-pocket expenditure for each 12-month period (0-12 months: mean $401 Indigenous vs $1074 non-Indigenous; 13-24 months: mean $200 vs $484; and 25-36 months: mean $181 vs $441). A stepwise generalised linear model of out-of-pocket expenditure found that Indigenous status was a significant predictor of out of pocket expenditure. We found that Indigenous people with cancer on average accessed 236 services per person, however, this would increase to 309 services per person if Indigenous people had the same rate of service use as non-Indigenous people.
CONCLUSIONS: Indigenous people with cancer had lower out-of-pocket expenditure, but also accessed fewer Medicare services compared to their non-Indigenous counterparts. Indigenous people with cancer were less likely to access specialist attendances, pathology tests, and diagnostic imaging through MBS, and more likely to access primary health care, such as services provided by general practitioners.
A feasibility study of the Nativis Voyager
CNS Oncol. 2019; 8(1):CNS31 [PubMed] Free Access to Full Article Related Publications
MATERIALS & METHODS: A total of 15 patients with rGBM were treated with one of two Voyager ultra-low radio frequency energy cognates: A1A or A2HU. Safety and clinical utility were assessed every 2-4 months.
RESULTS: Median overall survival was 8.04 months in the A1A arm and 6.89 months in the A2HU arm. No serious adverse events associated with Voyager were reported. No clinically relevant trends were noted in clinical laboratory parameters or physical exams.
CONCLUSION: The data suggest that the Voyager is safe and feasible for the treatment of rGBM.
Malignant otitis externa in Australian Aboriginal patients: A 9-year retrospective analysis from the Northern Territory.
Aust J Rural Health. 2019; 27(1):78-82 [PubMed] Related Publications
DESIGN: Retrospective case series.
SETTING: Otolaryngology unit in a tertiary referral hospital in Northern Territory, Australia.
PARTICIPANTS: Patients admitted with malignant otitis externa between January 2007 and October 2016 were identified by reviewing case notes. Patients diagnosed with malignant otitis externa based on results from clinical, microbiological and radiological criteria were included.
MAIN OUTCOME MEASURES: Complications rates, duration of hospital stay and parenteral antibiotics, age of onset and causative organisms.
RESULTS: Nine patients were included. Six were Australian Aboriginal - all from regional centres. The most common causative organism was Pseudomonas aeruginosa. There was a higher-than-expected occurrence of fungal malignant otitis externa (33% of Australian Aboriginal patients), who tended to be younger at diagnosis, had longer hospital stays and had a higher disease-specific mortality. Over half of the patients did not receive follow-up gallium bone scans to monitor disease resolution, reflecting the limitations of rural health care.
CONCLUSION: Malignant otitis externa in the Australian Aboriginal population is a challenging disease with high complication and mortality rates. Their rural and remote distribution is a significant barrier to specialist investigation and care. Providing effective care for this disease requires improved access to high-quality primary health care and tertiary specialist services.
Home to health care to hospital: Evaluation of a cancer care team based in Australian Aboriginal primary care.
Aust J Rural Health. 2019; 27(1):88-92 [PubMed] Related Publications
DESIGN: The cancer care team consisted of an Australian Aboriginal health worker, counsellor and enrolled nurse employed for 2 days a week, supported by a general practitioner. The cancer care team supported patients from prediagnosis while investigations were being undertaken, at diagnosis and through treatment, such as surgery, chemotherapy and radiotherapy, and follow-up, including to palliative care and grief support where these were required. They coordinated preventive programs, such as cervical smear and mammogram recall registers, and coordinated health promotion activities to promote prevention and early detection of other cancers, such as bowel cancer, skin cancer, liver cancer and prostate cancer. The program was evaluated qualitatively using semistructured interviews with current clients of the cancer care team and stakeholders, using grounded theory to analyse emerging themes.
SETTING: An Australian Aboriginal community-controlled health service in New South Wales.
PARTICIPANTS: The cancer care team provided care for 79 clients.
MAIN OUTCOME MEASURES: Acceptability and accessibility of cancer care services.
RESULTS: The evaluation involved recruitment of eight Australian Aboriginal clients of the cancer care team and eight stakeholders. The main themes to emerge included improved accessibility of cancer care services, including availability of home visits, transport and accompaniment to tertiary settings. The service was viewed as being culturally safe.
CONCLUSION: A primary care-based cancer care team in an Australian Aboriginal medical service provided a culturally safe and accessible service for clients.
Timing of palliative care referral and aggressive cancer care toward the end-of-life in pancreatic cancer: a retrospective, single-center observational study.
BMC Palliat Care. 2019; 18(1):13 [PubMed] Free Access to Full Article Related Publications
METHOD: A retrospective cohort analysis of end-of-life (EOL) care outcomes of patients with pancreatic cancer who died between 2012 and 2016. Key indicators of aggressive cancer care in the last 30 days of life used were: ≥1 emergency department (ED) presentations, acute inpatient/intensive care unit (ICU) admission, and chemotherapy use. We examined time from PCR to death and place of death. Early and late PCR were defined as > 90 and ≤ 90 days before death respectively.
RESULTS: Out of the 278 eligible deaths, 187 (67.3%) were categorized as receiving a late PCR and 91 (32.7%) an early PCR. The median time between referral and death was 48 days. Compared to those receiving early PCR, those with late PCR had: 18.1% (95% CI 6.8-29.4%) more ED presentations; 12.5% (95% CI 1.7-24.8%) more acute hospital admissions; with no differences in ICU admissions. Pain and complications of cancer accounted for the majority of overall ED presentations. Of the 166 patients who received chemotherapy within 30 days of death, 23 (24.5%) had a late PCR and 12 (16.7%) an early PCR, with no association of PCR status either unadjusted or adjusted for age or gender. The majority of patients (55.8%) died at the inpatient palliative care unit.
CONCLUSION: Our findings reaffirm the benefits of early PCR for pancreatic cancer patients to avoid inappropriate care toward the EOL. We suggest that in modern cancer care, there can sometimes be a need to reconsider the use of the term 'aggressive cancer care' at the EOL when the care is appropriately based on an individual patient's presenting physical and psychosocial needs. Pancreatic cancer patients warrant early PCR but the debate must thus continue as to how we best achieve and benchmark outcomes that are compatible with patient and family needs and healthcare priorities.
The significance of the small adenoma: a longitudinal study of surveillance colonoscopy in an Australian population.
Eur J Gastroenterol Hepatol. 2019; 31(5):563-569 [PubMed] Related Publications
PATIENTS AND METHODS: A retrospective audit was undertaken of patients enrolled in a CRC surveillance program, wherein regular colonoscopies and screening with faecal immunochemical test (FIT) were provided. Patients diagnosed with either small or advanced adenoma followed by at least one surveillance colonoscopy were included. Advanced adenoma included adenomas with features of villous change, size of at least 10 mm, high-grade dysplasia, three or more small tubular adenomas and traditional and sessile serrated adenomas. Subdistribution hazard ratios were calculated for advanced neoplasia (CRC or advanced adenoma).
RESULTS: Overall, 378 patients (62.6±11.2 years, 57.9% male) were included, with 44.2% diagnosed with small adenoma and 55.5% with advanced adenoma at baseline. The crude cumulative incidence of advanced neoplasia at first surveillance was 13.2 and 18.5% after small and advanced adenoma (P=0.16) (at 45.9 and 35.6 months, respectively), which became significant for advanced adenoma after adjustment (subdistribution hazard ratio=2.55, 95% confidence interval=1.49-4.35, P<001). A positive FIT was the only independent predictor of advanced neoplasia after a small adenoma at baseline colonoscopy (odds ratio=5.05, 95% confidence interval=1.27-20.02, P=0.02).
CONCLUSIONS: The risk of advanced neoplasia following a small adenoma was lower than that following an advanced adenoma, but was strongly predicted by a positive FIT. Reducing frequency of colonoscopy while providing regular FIT might be a more efficient use of resources for this population.
Early specialist palliative care on quality of life for malignant pleural mesothelioma: a randomised controlled trial.
Thorax. 2019; 74(4):354-361 [PubMed] Related Publications
METHODS: We performed a multicentre, randomised, parallel group controlled trial comparing early referral to SPC versus standard care across 19 hospital sites in the UK and one large site in Western Australia. Participants had newly diagnosed MPM; main carers were additionally recruited.
INTERVENTION: review by SPC within 3 weeks of allocation and every 4 weeks throughout the study. HRQoL was assessed at baseline and every 4 weeks with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30.
PRIMARY OUTCOME: change in EORTC C30 Global Health Status 12 weeks after randomisation.
RESULTS: Between April 2014 and October 2016, 174 participants were randomised. There was no significant between group difference in HRQoL score at 12 weeks (mean difference 1.8 (95% CI -4.9 to 8.5; p=0.59)). HRQoL did not differ at 24 weeks (mean difference -2.0 (95% CI -8.6 to 4.6; p=0.54)). There was no difference in depression/anxiety scores at 12 weeks or 24 weeks. In carers, there was no difference in HRQoL or mood at 12 weeks or 24 weeks, although there was a consistent preference for care, favouring the intervention arm.
CONCLUSION: There is no role for routine referral to SPC soon after diagnosis of MPM for patients who are cared for in centres with good access to SPC when required.
TRIAL REGISTRATION NUMBER: ISRCTN18955704.