The Daffodil Centre

Potential inequities in availability of care from breast care nurses: a qualitative study reporting the experiences and perspectives of women with metastatic breast cancer in Australia.

Sat, 01 Jan 2022 00:00:00 GMT

Potential inequities in availability of care from breast care nurses: a qualitative study reporting the experiences and perspectives of women with metastatic breast cancer in Australia. Smith, Andrea; Boyle, Fran; Lewis, Sophie Abstract Background: International consensus guidelines recommend patients with metastatic breast cancer have access to a nurse experienced in the treatment of metastatic breast cancer. This study aimed to explore women’s experiences of supportive care from breast care nurses, including their perspectives on the role breast care nurses currently play in providing support to people with metastatic breast cancer. Methods: Multiple semi-structured qualitative interviews with 38 women with metastatic breast cancer in Australia. Data relating to nursing care were extracted and analysed using thematic analysis. Results: Three themes were identifed: (1) feeling that supportive care needs are unrecognised; (2) confusion about role and relevance of breast care nurse to those with metastatic breast cancer; (3) care from metastatic breast care nurses (when available) was appreciated, valued and benefcial. Participants’ experiences difered in relation to ease of access to, amount of contact with, and level of care provided by breast care nurses. Contact and care ranged from little or none to comprehensive and ongoing. A key system-level challenge was that the diversity of diagnostic and treatment pathways for metastatic breast cancer meant that no systematic means existed to support routine or regular contact between breast care nurses and participants. Participants who did report having access to a specialised metastatic breast care nurse placed considerable value on the care received. For these participants, care from the breast care nurse extended and complemented care from the oncologist and included much needed psychosocial and practical support. For these participants, the breast care nurse assumed the role of key contact and care coordinator and was valued for their availability, accessibility and responsiveness. High levels of trust developed between patient and breast care nurse. Conclusions: Findings indicate that there may be gaps and inequities in supportive care in Australia for people diagnosed with metastatic breast cancer, a finding that supports earlier reports of limited access to breast care nurses for people with metastatic breast cancer in Australia. The specialised metastatic breast care nurse could potentially play a key role in addressing the high level of unmet supportive care needs and improve continuity of care for these patients.

Conclusion: the road ahead: where should we go now to improve healthcare quality in acute settings?

Conclusion: the road ahead: where should we go now to improve healthcare quality in acute settings? Braithwaite J; Taylor N; Clay-Williams R; Ting H; Arnolda G This final article in our 12-part series articulating a suite of quality improvement studies completes our report on the Deepening our Understanding of Quality in Australia (DUQuA) program of work. Here, we bring the Supplement’s key findings and contributions together, tying up loose ends. Traversing the DUQuA articles, we first argued the case for the research, conducted so that an in-depth analysis of one country’s health system, completed 5 years after the landmark Deepening our Understanding of Quality Improvement in Europe (DUQuE), was available. We now provide a digest of the learning from each article. Essentially, we have contributed an understanding of quality and safety activities in 32 of the largest acute settings in Australia, developed a series of scales and tools for use within Australia, modifiable for other purposes elsewhere, and provided a platform for future studies of this kind. Our main message is, despite the value of publishing an intense study of quality activities in 32 hospitals in one country, there is no gold standard, one-size-fits-all methodology or guarantee of success in quality improvement activities, whether the initiatives are conducted at departmental, organization-wide or whole-of-systems levels. Notwithstanding this, armed with the tools, scales and lessons from DUQuA, we hope we have provided many more options and opportunities for others going about strengthening their quality improvement activities, but we do not claim to have solved all problems or provided a definitive approach. In our view, quality improvement initiatives are perennially challenging, and progress hard-won. Effective measurement, evaluating progress over time, selecting a useful suite of quality methods and having the persistence to climb the improvement gradient over time, using all the expertise and tools available, is at the core of the work of quality improvement and will continue to be so.

Colorectal cancer metastatic disease progression in Australia: a population-based analysis

Sun, 01 Jan 2017 00:00:00 GMT

Colorectal cancer metastatic disease progression in Australia: a population-based analysis Luo Q; O'Connell DL; Kahn C; Yu XQ No previous Australian population-based studies have described or quantified the progression of colorectal cancer (CRC) to metastatic disease. We describe patterns of progression to metastatic disease for an Australian cohort diagnosed with localised or regional CRC.All localised and regional CRC cases in the New South Wales Cancer Registry diagnosed during 2000-2007 were followed to December 2011 for subsequent metastases (identified by subsequent disease episode notifications) or CRC death. Cox regression was used to identify factors associated with metastatic progression.After a median 5.3 years follow-up, 26.4% of the 12757 cases initially diagnosed with localised or regional colon cancer had developed metastatic disease, as had 29.5% of the 7154 rectal cancer cases. For both cancer sites, risk of metastatic progression was significantly higher for those initially diagnosed with regional disease (adjusted hazard ratio [aHR] 3.49 for colon, 2.66 for rectal cancer), and for older cases (e.g. aHR for >79years vs <60years: 1.38 for colon, 1.69 for rectal cancer). Risk of disease progression was significantly lower for females, and varied by histology type. For colon cancer, the risk of disease progression decreased over time. For rectal cancer, risk of metastatic progression was significantly higher for those living in more socioeconomically disadvantaged areas compared with those in the least disadvantaged area.An understanding of the variation in risk of metastatic progression is useful for planning health service requirements, and can help inform decisions about treatment and follow-up for colorectal cancer patients.

Estimating the Cost-Effectiveness of Lung Cancer Screening with Low-Dose Computed Tomography for High-Risk Smokers in Australia

Mon, 01 Jan 2018 00:00:00 GMT

Estimating the Cost-Effectiveness of Lung Cancer Screening with Low-Dose Computed Tomography for High-Risk Smokers in Australia Wade S; Weber MF; Caruana M; Kang YJ; Marshall H; Manser R; Vinod S; Rankin N; Fong K; Canfell K Introduction Health economic evaluations of lung cancer screening with low-dose computed tomography (LDCT) that are underpinned by clinical outcomes are relatively few. Methods We assessed the cost-effectiveness of LDCT lung screening in Australia by applying Australian cost and survival data to the outcomes observed in the U.S. National Lung Screening Trial (NLST), in which a 20% lung cancer mortality benefit was demonstrated for three rounds of annual screening among high-risk smokers age 55 to 74 years. Screening-related costs were estimated from Medicare Benefits Schedule reimbursement rates (2015), lung cancer diagnosis and treatment costs from a 2012 Australian hospital–based study, lung cancer survival rates from the New South Wales Cancer Registry (2005–2009), and other-cause mortality from Australian life tables weighted by smoking status. The health utility outcomes, screening participation rates, and lung cancer rates were those observed in the NLST. Incremental cost effectiveness ratios (ICER) were calculated for a 10-year time horizon. Results The cost-effectiveness of LDCT lung screening was estimated at AU$138,000 (80% confidence interval: AU$84,700–AU$353,000)/life-year gained and AU$233,000 (80% confidence interval: AU$128,000–AU$1,110,000)/quality-adjusted life year (QALY) gained. The ICER was more favorable when LDCT screening impact on all-cause mortality was considered, even when the costs of incidental findings were also estimated in sensitivity analyses: AU$157,000/QALY gained. This can be compared to an indicative willingness-to-pay threshold in Australia of AU$30,000 to AU$50,000/QALY. Conclusions LDCT lung screening using NLST selection and implementation criteria is unlikely to be cost-effective in Australia. Future economic evaluations should consider alternative screening eligibility criteria, intervals, nodule management, the impact and cost of new therapies, investigations of incidental findings, and incorporation of smoking cessation interventions.

Impact of the National Cervical Screening Programme in New Zealand by age: analysis of cervical cancer trends 1985-2013 in all women and in Māori women

Sun, 01 Jan 2017 00:00:00 GMT

Impact of the National Cervical Screening Programme in New Zealand by age: analysis of cervical cancer trends 1985-2013 in all women and in Māori women Smith MA; Edwards S; Canfell K Background New Zealand is an example of a country with a well-established cytology-based screening program. New Zealand’s National Cervical Screening Programme (NCSP) commenced in 1990, and recommends three-yearly cytology-based screening for women aged 20–69 years. In 2018, the NCSP will transition to five-yearly HPV-based screening for women aged 25–69 years. The aim of this study was to assess the impact of the program to date in different groups, to provide a benchmark for the new program. Methods Analysis of cervical cancer trends in New Zealand by age and ethnicity over the period 1985–2013, and by morphology over the period 1997–2013, using data from the New Zealand Cancer Registry was conducted. Results The overall incidence of cervical cancer was 56% (95% CI 51–60%) lower in 2009–2013 than in 1985–1989, and significant reductions were observed in women aged 25–49, 50–69, and 70 + years. Relative reductions in cervical cancer were very similar for Māori and non-Māori women aged 25–49 (50% in Māori; 52% in non-Māori) and 50–69 years (65% in Māori; 69% in non-Māori). In contrast, incidence appeared to increase after around 1996 in women aged 20–24. The increasing trend was significant for women aged 20–24 overall and for non-Māori women (p < 0.01 in both cases). Conclusion There have been substantial reductions in cervical cancer among women aged 25 + years in New Zealand since the inception of the NCSP, and these reductions are similar in Māori and non-Māori women. Cervical cancer incidence among women 20–24 years has not declined since the NCSP began, and appears to be increasing.

How will transitioning from cytology to HPV testing change the balance between the benefits and harms of cervical cancer screening? Estimates of the impact on cervical cancer, treatment rates and adverse obstetric outcomes in Australia, a high vaccination coverage country

Sun, 01 Jan 2017 00:00:00 GMT

How will transitioning from cytology to HPV testing change the balance between the benefits and harms of cervical cancer screening? Estimates of the impact on cervical cancer, treatment rates and adverse obstetric outcomes in Australia, a high vaccination coverage country Velentzis LS; Caruana M; Simms KT; Lew JB; Shi JF; Saville M; Canfell K; Smith MA; Lord SJ; Tan J; Bateson D; Quinn M Primary HPV screening enables earlier diagnosis of cervical lesions compared to cytology, however, its effect on the risk of treatment and adverse obstetric outcomes has not been extensively investigated. We estimated the cumulative lifetime risk (CLR) of cervical cancer and excisional treatment, and change in adverse obstetric outcomes in HPV unvaccinated women and cohorts offered vaccination (>70% coverage in 12-13 years) for the Australian cervical screening program. Two-yearly cytology screening (ages 18-69 years) was compared to 5-yearly primary HPV screening with partial genotyping for HPV16/18 (ages 25-74 years). A dynamic model of HPV transmission, vaccination, cervical screening and treatment for precancerous lesions was coupled with an individual-based simulation of obstetric complications. For cytology screening, the CLR of cervical cancer diagnosis, death and treatment was estimated to be 0.649%, 0.198% and 13.4% without vaccination and 0.182%, 0.056% and 6.8%, in vaccinated women, respectively. For HPV screening, relative reductions of 33% and 22% in cancer risk for unvaccinated and vaccinated women are predicted, respectively, compared to cytology. Without the implementation of vaccination, a 4% increase in treatment risk for HPV versus cytology screening would have been expected, implying a possible increase in pre-term delivery (PTD) and low birth weight (LBW) events of 19 to 35 and 14 to 37, respectively, per 100,000 unvaccinated women. However, in vaccinated women, treatment risk will decrease by 13%, potentially leading to 4 to 41 fewer PTD events and from 2 more to 52 fewer LBW events per 100,000 vaccinated women. In unvaccinated women in cohorts offered vaccination as 12-13 year olds, no change to lifetime treatment risk is expected with HPV screening. In unvaccinated women in cohorts offered vaccination as 12-13 year olds, no change to lifetime treatment risk is expected with HPV screening. HPV screening starting at age 25 in populations with high vaccination coverage, is therefore expected to both improve the benefits (further decrease risk of cervical cancer) and reduce the harms (reduce treatments and possible obstetric complications) associated with cervical cancer screening.

Patterns of care and emergency presentations for people with non-small cell lung cancer in New South Wales, Australia: A population-based study

Mon, 01 Jan 2018 00:00:00 GMT

Patterns of care and emergency presentations for people with non-small cell lung cancer in New South Wales, Australia: A population-based study Yap S; Goldsbury DE; Yap ML; Yuill S; Rankin N; Weber MF; Canfell K; O'Connell DL Introduction Little is known about population-wide emergency presentations and patterns of care for people diagnosed with non-small cell lung cancer (NSCLC) in Australia. We examined patients’ characteristics associated with presenting to an emergency department around the time of diagnosis (“emergency presenters”), and receiving anti-cancer treatment within 12 months of diagnosis. Materials and Methods Participants in the 45 and Up Study who were newly diagnosed with NSCLC during 2006–2010 were included. We used linked data from population-wide health databases including Medicare and pharmaceutical claims, inpatient hospitalisations and emergency department presentations to follow participants to June 2014. Patients’ characteristics associated with being an emergency presenter and receiving any anti-cancer treatment were examined. Results A total of 647 NSCLC cases were included (58.6% male, median age 73 years). Emergency presenters (34.5% of cases) were more likely to have a high Charlson comorbidity index score, be an ex-smoker who had quit in the past 15 years and to be diagnosed with distant metastases. Almost all patients had visited their general practitioner ≥3 times in the 6 months prior to diagnosis. Nearly one-third (29.5%) of patients did not receive any anti-cancer treatment, however, there were no differences between emergency and non-emergency presenters in the likelihood of receiving treatment. Those less likely to be treated were older, had no private health insurance, and had unknown stage disease recorded. Conclusion Our results indicate the difficulties in diagnosing lung cancer at an early stage and inequities in NSCLC treatment. Future research should address opportunities to diagnose lung cancer earlier and to optimise treatment pathways.

Quantifying the impact of dissimilar HPV vaccination uptake among Manitoban school girls by ethnicity using a transmission dynamic model

Tue, 01 Jan 2013 00:00:00 GMT

Quantifying the impact of dissimilar HPV vaccination uptake among Manitoban school girls by ethnicity using a transmission dynamic model Shafer LA; Jeffrey I; Elias B; Shearer B; Canfell K; Kliewer E BACKGROUND: Gardasil, a human papillomavirus (HPV) vaccine, began among grade 6 girls in Manitoba, Canada in 2008. In Manitoba, there is evidence that First Nations, Metis, and Inuit women (FNMI) have higher HPV prevalence, lower invasive cervical cancer (ICC) screening, and higher ICC incidence than all other Manitoban (AOM) women. We developed a mathematical model to assess the plausible impact of unequal vaccination coverage among school girls on future cervical cancer incidence. METHODS: We fit model estimated HPV prevalence and ICC incidence to corresponding empirical estimates. We used the fitted model to evaluate the impact of varying levels of vaccination uptake by FNMI status on future ICC incidence, assuming cervical screening uptake among FNMI and AOM women remained unchanged. RESULTS: Depending on vaccination coverage, estimated ICC incidence by 2059 ranged from 15% to 68% lower than if there were no vaccination. The level of cross-ethnic sexual mixing influenced the impact that vaccination rates among FNMI has on ICC incidence among AOM, and vice versa. The same level of AOM vaccination could result in ICC incidence that differs by up to 10%, depending on the level of FNMI vaccination. Similarly, the same level of FNMI vaccination could result in ICC incidence that differs by almost 40%, depending on the level of AOM vaccination. CONCLUSIONS: If we are unable to equalize vaccination uptake among all school girls, policy makers should prepare for higher levels of cervical cancer than would occur under equal vaccination uptake

Letter to the Editor: Inaccurate and fundamentally flawed analysis risks undermining confidence in cervical screening programs

Mon, 01 Jan 2018 00:00:00 GMT

Letter to the Editor: Inaccurate and fundamentally flawed analysis risks undermining confidence in cervical screening programs Smith MA; Brotherton JML; Hammond IG; Anderson L; Simms KT; Saville M; Canfell K

A revision of sexual mixing matrices in models of sexually transmitted infection

Sun, 01 Jan 2012 00:00:00 GMT

A revision of sexual mixing matrices in models of sexually transmitted infection Walker R; Nickson C; Lew JB; Smith MA; Canfell K Two sexual mixing matrices previously used in models of sexually transmitted infections (STIs) are intended to calculate the probability of sexual interaction between age groups and sexual behaviour subgroups. When these matrices are used to specify multiple criteria for how people select sexual partners (such as age group and sexual behaviour class), their conditional probability structure means that they have in practice been prone to misuse. We constructed revised mixing matrices that incorporate a corrected conditional probability structure and then used one of them to examine the effect of this revision on population modelling of STIs. Using a dynamic model of human papillomavirus (HPV) transmission as an example, we examined changes to estimates of HPV prevalence and the relative reduction in age-standardised HPV incidence after the commencement of publicly funded HPV vaccination in Australia. When all other model specifications were left unchanged, the revised mixing matrix initially led to estimates of age-specific oncogenic HPV prevalence that were up to 11% higher than our previous models at certain ages. After re-calibrating the model by modifying unobservable parameters characterising HPV natural history, the revised mixing matrix yielded similar estimates to our previous models, predicting that vaccination would lead to relative HPV incidence reductions of 43% and 85% by 2010 and 2050, respectively, compared with 43% and 86% using the unrevised mixing matrix formulation. Our revised mixing matrix offers a rigorous alternative to commonly used mixing matrices, which can be used to reliably and explicitly accommodate conditional probabilities, with appropriate re-calibration of unobservable model parameters

Synoptic reporting improves histopathological assessment of pancreatic resection specimens

Thu, 01 Jan 2009 00:00:00 GMT

Synoptic reporting improves histopathological assessment of pancreatic resection specimens Gill AJ; Biankin AV; Kench JG; for the NSW Pancreatic Network (incl Sitas F); Johns AL; Eckstein R; Samra JS; Kaufman A; Chang DK; Merrett ND; Cosman PH; Smith RC AIM: We examined whether introduction of a standardised pancreatic cancer minimum data set improved the reporting of key pathological features across multiple institutions. METHODS: From seven different pathology departments that are members of the New South Wales Pancreatic Cancer Network, 109 free text reports and 68 synoptic reports were compared. RESULTS: AJCC stage could not be inferred from 44% of free text reports, whereas stage was reported in all 68 synoptic reports. In the free text reports 28 different names were used to designate margins. All margins were reported in only 12 (11%) of the free text reports compared with 64 (94%) of the synoptic reports (p = 0.0011). The presence or absence of lymphovascular or perineural invasion was reported in 72 (66%) and 92 (84%) of free text reports, respectively. In contrast, lymphovascular space and perineural invasion were reported in all synoptic reports (p = 0.0011 and p = 0.0058). CONCLUSION: We conclude that synoptic reporting of pancreatic resections without any other intervention increases the information contained within histopathology reports. Therefore, the introduction of minimal data set synoptic reports is a simple and feasible mechanism to immediately improve reporting for pancreatectomy specimens

Cancer Screening among immigrants living in urban and regional Australia: results from the 45 and up study.

Wed, 01 Jan 2014 00:00:00 GMT

Cancer Screening among immigrants living in urban and regional Australia: results from the 45 and up study. Weber MF; Chiew M; Feletto E; Kahn C; Sitas F; Webster L Over 25% of the Australian population are immigrants, and are less active participants in cancer screening programmes. Most immigrants live in urban areas of Australia, but a significant proportion (~20%), live in regional areas. This study explored differences in cancer screening participation by place of birth and residence. Self-reported use of mammogram, faecal occult blood test (FOBT), and/or prostate specific antigen (PSA) tests was obtained from 48,642 immigrants and 141,275 Australian-born participants aged 50 years or older in the 45 and Up Study (New South Wales, Australia 2006–2010). Poisson regression was used to estimate relative risks of test use, adjusting for key socio-demographic characteristics. Overall, immigrants from Asia and Europe were less likely to have had any of the tests in the previous two years than Australian-born participants. Regional Australian-born participants were more likely to have had any of the tests than those living in urban areas. Regional immigrant participants were more likely to have had an FOBT or PSA test than those living in urban areas, but there were no differences in mammograms. This report identifies key immigrant groups in urban and regional areas that policymakers and healthcare providers should target with culturally appropriate information to promote cancer screening

Cancer in South Africa 1996-1997

Tue, 01 Jan 2002 00:00:00 GMT

Cancer in South Africa 1996-1997 Mqoqi N; Sitas F; Madhoo J; Wessie J; Kellet P; Urban M; Stein L; Ratshikhopha ME; Wojcicki JM; Malope I

Cancer in New South Wales Incidence and Mortality 1997

Fri, 01 Jan 1999 00:00:00 GMT

Cancer in New South Wales Incidence and Mortality 1997 Coates M; Tracey E

Integrated Care project. First Evaluation Report. Report to the Pharmaceutical Alliance.

Sat, 01 Jan 2000 00:00:00 GMT

Integrated Care project. First Evaluation Report. Report to the Pharmaceutical Alliance. Hill S; Henderson K; O'Connell DL; Fryer J; Henry D

Cervical cancer screening in Australia: modelled evaluation of the impact of changing the recommended interval from two to three years

Fri, 01 Jan 2010 00:00:00 GMT

Cervical cancer screening in Australia: modelled evaluation of the impact of changing the recommended interval from two to three years Creighton P; Lew JB; Clements M; Smith MA; Howard K; Dyer S; Lord S; Canfell K ABSTRACT: BACKGROUND: The National Cervical Screening Program in Australia currently recommends that sexually active women between the ages of 18-70 years attend routine screening every 2 years. The publically funded National HPV Vaccination Program commenced in 2007, with catch-up in females aged 12-26 years conducted until 2009; and this may prompt consideration of whether the screening interval and other aspects of the organized screening program could be reviewed. The aim of the current evaluation was to assess the epidemiologic outcomes and cost implications of changing the recommended screening interval in Australia to 3 years. METHODS: We used a modelling approach to evaluate the effects of moving to a 3-yearly recommended screening interval. We used data from the Victorian Cervical Cytology Registry over the period 1997-2007 to model compliance with routine screening under current practice, and registry data from other countries with 3-yearly recommendations to inform assumptions about future screening behaviour under two alternative systems for screening organisation - retention of a reminder-based system (as in New Zealand), or a move to a call-and-recall system (as in England). RESULTS: A 3-yearly recommendation is predicted to be of similar effectiveness to the current 2-yearly recommendation, resulting in no substantial change to the total number of incident cervical cancer cases or cancer deaths, or to the estimated 0.68% average cumulative lifetime risk of cervical cancer in unvaccinated Australian women. However, a 3-yearly screening policy would be associated with decreases in the annual number of colposcopy and biopsy procedures performed (by 4-10%) and decreases in the number of treatments for pre-invasive lesions (by 2-4%). The magnitude of the decrease in the number of diagnostic procedures and treatments would depend on the method of screening organization, with call-and-recall screening associated with the highest reductions. The cost savings are predicted to be of the order of A$10-18M annually, equivalent to 6-11% of the total cost of the current program (excluding overheads), with call-and-recall being associated with the greatest savings. CONCLUSIONS: Lengthening the recommended screening interval to 3 years in Australia is not predicted to result in increases in rates of cervical cancer and is predicted to decrease the number of women undergoing diagnostic and treatment procedures. These findings are consistent with a large body of international evidence showing that screening more frequently than every three years with cervical cytology does not result in substantial gains in screening effectiveness

Pathology reporting of resected colorectal cancers in New South Wales in 2000

Tue, 01 Jan 2008 00:00:00 GMT

Pathology reporting of resected colorectal cancers in New South Wales in 2000 Chapuis PH; Chan C; Lin BP; Armstrong K; Armstrong B; Spigelman AD; O'Connell DL; Leong D; Dent OF BACKGROUND: The aim of this study was to determine the extent to which pathology reporting of colorectal cancers notified to the New South Wales Central Cancer Registry during 2000 conformed to guidelines promulgated by the National Health and Medical Research Council. METHODS: De-identified reports for 2233 resected specimens of primary invasive colorectal carcinoma were coded according to a standardized system to compile information on 28 clinical and pathology features. An overall score for each report was calculated by computing the number out of 13 essential features specified in the guidelines for which data had been recorded explicitly and unambiguously in the report. RESULTS: The overall score ranged from 3 to 13 features with a mean of 9. No more than 7 features were reported explicitly in just less than one quarter of the reports and no more than 10 in three quarters. There were only 110 reports (4.9%) that included all features. Information on direct spread and nodal metastasis was well reported; resection margins less so. Many reports lacked information on metastases beyond the operative field, the involvement of deep or circumferential resection margins and tumour stage. CONCLUSION: In some respects pathology reports of resected colorectal cancer specimens displayed a high level of completeness. Some important features, however, were poorly described. Reporting could be improved if surgeons were to use a standardized form to convey clinical information to the pathologist and if pathologists were to report in a structured or synoptic format, explicitly recording the presence or absence of each feature in a standard list

Randomised controlled trial of effect of feedback on general practitioners' prescribing in Australia

Fri, 01 Jan 1999 00:00:00 GMT

Randomised controlled trial of effect of feedback on general practitioners' prescribing in Australia O'Connell DL; Henry D; Tomlins R OBJECTIVE: To evaluate the effect on general practitioners' prescribing of feedback on their levels of prescribing. DESIGN: Randomised controlled trial. SETTING: General practice in rural Australia. PARTICIPANTS: 2440 full time recognised general practitioners practising in non-urban areas. INTERVENTION: Two sets of graphical displays (6 months apart) of their prescribing rates for 2 years, relative to those of their peers, were posted to participants. Data were provided for five main drug groups and were accompanied by educational newsletters. The control group received no information on their prescribing. MAIN OUTCOME MEASURES: Prescribing rates in the intervention and control groups for the five main drug groups, total prescribing and potential substitute prescribing and ordering before and after the interventions. RESULTS: The intervention and control groups had similar baseline characteristics (age, sex, patient mix, practices). Median prescribing rates for the two groups were almost identical before and after the interventions. Any changes in prescribing observed in the intervention group were also seen in the control group. There was no evidence that feedback reduced the variability in prescribing nor did it differentially affect the very high or very low prescribers. CONCLUSIONS: The form of feedback evaluated here-mailed, unsolicited, centralised, government sponsored, and based on aggregate data-had no impact on the prescribing levels of general practitioners

To sell or not to sell: cigarette sales in alcohol-licenced premises

Mon, 01 Jan 2018 00:00:00 GMT

To sell or not to sell: cigarette sales in alcohol-licenced premises Burton S; Ludbrooke M; Williams K; Walsberger S; Egger S Objective To obtain insight into tobacco retailing by alcohol-licenced premises, in order to understand the financial importance of tobacco sales for such retailers. Method Data were collected by a telephone survey of 1042 clubs, hotels and packaged liquor outlets in New South Wales, Australia. The response rate was 86.1%. Qualitative and quantitative data were obtained. Logistic and linear regression were used to determine factors associated with the probability of selling and stopping selling and the importance of cigarette sales. Results More than a third (36.4%) of premises contacted did not sell cigarettes. 147 (an estimated 18.1% of those who had ever sold) had stopped selling. There were significant differences in the probability of selling, in the reported importance of cigarette sales and in the probability of stopping selling, between different outlet types and other outlet characteristics (number of gaming machines, proximity of nearest alternative tobacco retailer and remoteness). Outlets where alcohol can be consumed were more likely to rate cigarette sales as ‘not important’ than ‘important’. Conclusions Despite claims by tobacco companies that tobacco sales are important for many Australian retailers, tobacco sales appear to be of limited importance for alcohol-licenced premises. This means that opposition to stopping tobacco sales where alcohol is consumed and/or sold may be less than expected.

Optimal Management Strategies for Primary HPV Testing for Cervical Screening: Cost-Effectiveness Evaluation for the National Cervical Screening Program in Australia

Sun, 01 Jan 2017 00:00:00 GMT

Optimal Management Strategies for Primary HPV Testing for Cervical Screening: Cost-Effectiveness Evaluation for the National Cervical Screening Program in Australia Simms KT; Hall M; Smith MA; Lew JB; Hughes S; Yuill S; Hammond I; Saville M; Canfell K Background Several countries are implementing a transition to HPV testing for cervical screening in response to the introduction of HPV vaccination and evidence indicating that HPV screening is more effective than cytology. In Australia, a 2017 transition from 2-yearly conventional cytology in 18–20 to 69 years to 5-yearly primary HPV screening in 25 to 74 years will involve partial genotyping for HPV 16/18 with direct referral to colposcopy for this higher risk group. The objective of this study was to determine the optimal management of women positive for other high-risk HPV types (not 16/18) ('OHR HPV'). Methods We used a dynamic model of HPV transmission, vaccination, natural history and cervical screening to determine the optimal management of women positive for OHR HPV. We assumed cytology triage testing was used to inform management in this group and that those with high-grade cytology would be referred to colposcopy and those with negative cytology would receive 12-month surveillance. For those with OHR HPV and low-grade cytology (considered to be a single low-grade category in Australia incorporating ASC-US and LSIL), we evaluated (1) the 20-year risk of invasive cervical cancer assuming this group are referred for 12-month follow-up vs. colposcopy, and compared this to the risk in women with low-grade cytology under the current program (i.e. an accepted benchmark risk for 12-month follow-up in Australia); (2) the population-level impact of the whole program, assuming this group are referred to 12-month surveillance vs. colposcopy; and (3) the cost-effectiveness of immediate colposcopy compared to 12-month follow-up. Evaluation was performed both for HPV-unvaccinated cohorts and cohorts offered vaccination (coverage ~72%). Findings The estimated 20-year risk of cervical cancer is ≤1.0% at all ages if this group are referred to colposcopy vs. ≤1.2% if followed-up in 12 months, both of which are lower than the ≤2.6% benchmark risk in women with low-grade cytology in the current program (who are returned for 12-month follow-up). At the population level, immediate colposcopy referral provides an incremental 1–3% reduction in cervical cancer incidence and mortality compared with 12-month follow-up, but this is in the context of a predicted 24–36% reduction associated with the new HPV screening program compared to the current cytology-based program. Furthermore, immediate colposcopy substantially increases the predicted number of colposcopies, with >650 additional colposcopies required to avert each additional case of cervical cancer compared to 12-month follow-up. Compared to 12-month follow-up, immediate colposcopy has an incremental cost-effectiveness ratio (ICER) of A$104,600/LYS (95%CrI:A$100,100–109,100) in unvaccinated women and A$117,100/LYS (95%CrI:A$112,300–122,000) in cohorts offered vaccination [Indicative willingness-to-pay threshold: A$50,000/LYS]. Conclusions In primary HPV screening programs, partial genotyping for HPV16/18 or high-grade triage cytology in OHR HPV positive women can be used to refer the highest risk group to colposcopy, but 12-month follow-up for women with OHR HPV and low-grade cytology is associated with a low risk of developing cervical cancer. Direct referral to colposcopy for this group would be associated with a substantial increase in colposcopy referrals and the associated harms, and is also cost-ineffective; thus, 12-month surveillance for women with OHR HPV and low-grade cytology provides the best balance between benefits, harms and cost-effectiveness.

Response to Letter Regarding Article, “Frequent Physical Activity May Not Reduce Vascular Disease Risk as Much as Moderate Activity: Large Prospective Study of Women in the United Kingdom”

Thu, 01 Jan 2015 00:00:00 GMT

Response to Letter Regarding Article, “Frequent Physical Activity May Not Reduce Vascular Disease Risk as Much as Moderate Activity: Large Prospective Study of Women in the United Kingdom” Green J; Reeves GK; Beral V; Cairns BJ; for the Million Women Study Collaborators (incl. Canfell K); Armstrong M We thank Lin and colleagues for drawing attention to hypotheses about the possible role of heavy manual work and work-related stress in vascular disease. We previously reported associations between coronary heart disease, cerebrovascular disease, and venous thromboembolism risk and the frequency of strenuous activity and of any activity.1 We also assessed the associations between these diseases and walking, gardening, cycling, housework, and strenuous activity, which were reported for the first time ≈3 years after recruitment.1 At that time, women were asked about whether or not they were in paid work: about half (53%) reported that they were not in paid work. Findings for women not in paid work cannot be confounded by heavy manual work or stress at work. We therefore conducted further analyses for vascular disease risk associated with physical activity, restricted to the 376 732 women who reported not being in paid work, using the date at which they reported their employment status as the start of follow-up. Similar to our previous findings for all women,1 we again observed that the lowest risks were among women with a moderate frequency of physical activity, suggesting that these associations are not attributable to heavy manual work or stress at work. (There may, of course, be residual confounding with other factors, as discussed in our original article.) The results for the frequency of strenuous physical activity among women who reported not being in paid work are presented here, for comparison with our findings for all women. For coronary heart disease risk (20 861 cases), in comparison with inactive women, the women who were active at most once per week had a relative risk (RR) of 0.85 (95% confidence interval [CI], 0.82–0.87), women active 2 to 3 times per week had an RR of 0.80 (95% CI, 0.77–0.84), women active 4 to 6 times per week had an RR of 0.74 (95% CI, 0.67–0.81), and those active daily had an RR of 0.91 (95% CI, 0.84– 0.99). For cerebrovascular disease (7638 cases), the corresponding RRs and 95% CIs were 0.83 (0.78–0.88), 0.84 (0.78–0.90), 0.84 (0.74–0.97), and 0.92 (0.80–1.05), and for venous thromboembolism (5999 cases), the corresponding RRs and 95% CIs were 0.85 (0.80– 0.90), 0.82 (0.76–0.89), 0.86 (0.73–1.00), and 0.98 (0.84–1.13). The P values for heterogeneity across activity levels were significant (P<0.001) for each vascular disease. Similar to our previous findings for all women,1 we again observed that the lowest risks were among women with a moderate frequency of physical activity, suggesting that these associations are not attributable to heavy manual work or stress at work. (There may, of course, be residual confounding with other factors, as discussed in our original article.) In summary, about half the women in this study were not in paid work, and results restricted to them still support our main conclusion that moderate physical activity is associated with lower risks than inactivity for coronary heart disease, stroke, and venous thromboembolism and that, among active women, there is little evidence to suggest greater benefits with increasing the frequency of activity.

Optimal uptake rates for initial treatments for cervical cancer in concordance with guidelines in Australia and Canada: Results from two large cancer facilities

Thu, 01 Jan 2015 00:00:00 GMT

Optimal uptake rates for initial treatments for cervical cancer in concordance with guidelines in Australia and Canada: Results from two large cancer facilities Kang YJ; O'Connell DL; Tan J; Lew JB; Demers A; Lotocki R; Kliewer EV; Hacker NF; Jackson M; Delaney GP; Barton M; Canfell K BACKGROUND: Prior work estimating optimal treatment utilisation rates for cervical cancer has focused on radiotherapy or chemotherapy, using proportions of patients with clinical indications for specific treatment strategies which were obtained from the published literature. OBJECTIVES: To estimate optimal uptake rates for surgery, radiotherapy, chemotherapy and chemo-radiotherapy for cervical cancer treatment in Australia and Canada, and to quantify the differences in the optimal and the observed treatment utilisation rates in a large cancer facility from each country. METHODS: A decision tree was constructed to reflect treatments according to guidelines and current practice (in 1999-2008) in each setting. Detailed patterns of care data from a large cancer facility in each country were obtained, and the observed stage distribution and proportions of patients with each clinical indication were used as inputs. RESULTS: The estimated overall optimal treatment rates for cervical cancer in Australia and Canada differed, largely due to the difference in the stage distribution at diagnosis in the two settings; 72% vs 54% with FIGO IA-IIA disease, respectively. The estimated optimal rates for surgery, radiotherapy, chemotherapy and chemo-radiotherapy in Australia were 63% (95% credible interval: 61-64%), 52% (53-56%), 36% (35-38%) and 36% (35-38%), respectively. The corresponding rates in Canada were 38% (36-39%), 68% (68-71%), 51% (49-52%) and 50% (49-51%), respectively. The absolute differences between the optimal and the observed rates were similar between the two settings; the absolute differences for chemotherapy and chemo-radiotherapy uptake were more pronounced (9-15% less than optimal) than those for surgery and radiotherapy uptake (within 5% of optimal). CONCLUSIONS: This is the first study to use detailed patterns of care data in multiple settings to compare optimal and observed rates for all cervical cancer treatment modalities. We found optimal treatment rates were largely dependent on the overall stage distribution. In Australia and Canada, observed surgery rates, as measured in the two large cancer facilities, were similar to the estimated optimal rates, whereas radiotherapy, chemotherapy and chemo-radiotherapy appeared to be under-utilised.

Breast cancer in New South Wales in 1972-1995: tumor size and the impact of mammographic screening

Fri, 01 Jan 1999 00:00:00 GMT

Breast cancer in New South Wales in 1972-1995: tumor size and the impact of mammographic screening Kricker A; Farac K; Smith DP; Sweeny A; McCredie M; Armstrong BK To examine the use of mammographic screening in women in New South Wales (NSW), we measured uptake of initial mammograms and estimated the proportions of breast cancers that were screen detected. To see if mammographic screening has been associated with reductions in advanced breast cancers and mortality from breast cancer, we analyzed trends in age-specific and age-standardized breast cancer incidence and mortality from 1972 to 1995 and tumor size in 1986, 1989, 1992 and April to September 1995. Between 1984 and the end of 1995, an estimated 72% of NSW women in their 50s and 67% in their 60s had had at least 1 mammogram and, in 1995, an estimated 39% of invasive breast cancers in women in these age groups were detected by mammography. Before 1989, breast cancer incidence increased only slightly (+1.3% annually) but then, from 1990 to 1995, increased more rapidly (+3.1% annually). Between 1986 and 1995, rates of small cancers (< 1 cm) increased steeply by 2.7 times in women 40-49 years of age and 5.6 times in women 50-69 years of age. The incidence of large breast cancers (3+ cm), after little apparent change to 1992, fell by 17% in women 40-49 years of age and 20% in those 50-69 years of age to 1995. Breast cancer mortality increased slightly between 1972 and 1989 (+0.5% annually) but then fell (-2.3% annually) from 1990 to 1995. We concluded that breast cancer rates had been influenced in expected directions by the introduction of mammographic screening in women resident in NSW. We expect that recent falls in incidence of larger breast cancers and breast cancer mortality will become steeper as screening coverage increases in the second half of the 1990s

Children's exposure to food advertising; an anlysis of the effectiveness of self-regulatory codes in Australia

Wed, 01 Jan 2014 00:00:00 GMT

Children's exposure to food advertising; an anlysis of the effectiveness of self-regulatory codes in Australia Roberts M; Pettigrew S; Chapman K; Quester P; Miller C Aim: The aim of this study was to update knowledge about children's exposure to televised food advertising in Australia, providing a more comprehensive examination of children's exposure since the introduction of self-regulatory codes. Methods: Two months of food advertisement data from four free-to-air television stations (SBS, Seven Network, Nine Network and Ten Network) in the five largest Australian cities (Sydney, Melbourne, Brisbane, Adelaide and Perth) were purchased and analysed. A content analysis was performed to classify the advertised products into food groups according to the Australian Guide to Healthy Eating and whether they were scheduled in children's popular viewing times (CPVT) according to audience viewing data from OzTam. They were also assessed as to whether they included a premium offer (free incentive). The 2 months of data covered September and October 2010 and included 43 weekdays, 18 weekend days and 15 days of school holidays. Results: In total, 93?284 food advertisements, including repeat airings, were analysed from 1464 hours of continuous programming. The majority (63%) included non-core foods. During CPVT, this figure was significantly higher at 65% versus 61% outside CPVT. Within CPVT, the percentage of advertisements was higher for quick-service restaurants (30% vs 26%) and unhealthy beverages (3% vs 2%). Fifteen?per?cent of all advertisements were for sugar-sweetened soft drinks. Premiums were still apparent (10% vs 8%) despite being restricted by the codes. Conclusions: Australian children continue to be exposed to a large amount of advertising for non-core foods, despite the introduction of voluntary codes.

Patterns of surgical care for prostate cancer in NSW, 1993-2002: rural/urban and socio-economic variation

Mon, 01 Jan 2007 00:00:00 GMT

Patterns of surgical care for prostate cancer in NSW, 1993-2002: rural/urban and socio-economic variation Hayen A; Smith DP; Patel MI; O'Connell DL OBJECTIVES: Prostate cancer is the most commonly registered cancer in Australian men, yet there is a lack of information about its management. We described the patterns and trends in the surgical treatment of men with prostate cancer in New South Wales (NSW). METHOD: We used probabilistic record linkage to link cancer registry data with hospital admissions. All NSW men diagnosed with prostate cancer between 1993 and 2002 were eligible for the study. Rates of radical prostatectomy, bilateral orchidectomy and transurethral resection of the prostate were calculated. Factors affecting the probability of undergoing these procedures were examined using log-binomial regression. RESULTS: Between January 1993 and December 2002, 38,712 men were diagnosed with prostate cancer in NSW. Of these, 33,200 (85.8%) cancer registry records were linked to at least one hospital admission record. Men resident in rural areas at diagnosis (RR = 0.69, 95% Cl 0.65-0.73) and men resident in more socio-economically disadvantaged areas (RR =0.83, 95% Cl 0.78-0.89 for most disadvantaged) were significantly less likely to undergo a radical prostatectomy after adjusting for age and disease stage. While orchidectomy rates fell significantly during the period, rates were significantly higher in rural and lower socio-economic areas after adjusting for age and stage. CONCLUSION AND IMPLICATIONS: Further investigation is needed to understand the reasons for the variation in the surgical patterns of care for prostate cancer so that interventions can be implemented to ensure appropriate access for all men

Lung cancer treatment and mortality for Aboriginal people in New South Wales, Australia: results from a population-based record linkage study and medical record audit

Fri, 01 Jan 2016 00:00:00 GMT

Lung cancer treatment and mortality for Aboriginal people in New South Wales, Australia: results from a population-based record linkage study and medical record audit Gibberd A; Supramaniam R; Dillon A; Armstrong BK; O'Connell DL Background The aim of this study was to compare surgical treatment received by Aboriginal and non-Aboriginal people with non-small cell lung cancer (NSCLC) in New South Wales (NSW), Australia and to examine whether patient and disease characteristics are associated with any disparities found. An additional objective was to describe the adjuvant treatments received by Aboriginal people diagnosed with NSCLC in NSW. Finally, we compared the risk of death from NSCLC for Aboriginal and non-Aboriginal people. Methods We used logistic regression and competing risks regression to analyse population-based cancer registry records for people diagnosed with NSCLC in NSW, 2001–2007, linked to hospital inpatient episodes and deaths. We also analysed treatment patterns from a medical record audit for 170 Aboriginal people diagnosed with NSCLC in NSW, 2000–2010. Results Of 20,154 people diagnosed with primary lung cancer, 341 (1.7 %) were Aboriginal. Larger proportions of Aboriginal people were younger, female, living outside major cities or in areas of greater socioeconomic disadvantage, smoking at the time of diagnosis and had comorbidities. Although Aboriginal people were, on average, younger at diagnosis with non-metastatic NSCLC than non-Aboriginal people, only 30.8 % of Aboriginal people received surgery, compared with 39.5 % of non-Aboriginal people. Further, Aboriginal people who were not receiving surgery, at the time of diagnosis, were more likely to be younger, live in major cities and have no comorbidities. The observed risk of death from NSCLC 5 years after diagnosis was higher for 266 Aboriginal people (83.3 % 95 % CI 77.5–87.7) than for 15,491 non-Aboriginal people (77.6 % 95 % CI 76.9–78.3) and the adjusted subhazard ratio was 1.32 (95 % CI 1.14–1.52). From the medical record audit, 29 % of Aboriginal people with NSCLC had potentially curative treatment, 45 % had palliative radiotherapy/chemotherapy and 26 % had no active treatment. Conclusions There are disparities in NSCLC surgical treatment and mortality for Aboriginal people compared with non-Aboriginal people in NSW. It is imperative that Aboriginal people are offered active lung cancer treatment, particularly those who are younger and without comorbidities and are therefore most likely to benefit, and are provided with assistance to access it if required.

How has COVID-19 impacted cancer screening? Adaptation of services and the future outlook in Australia

Wed, 01 Jan 2020 00:00:00 GMT

How has COVID-19 impacted cancer screening? Adaptation of services and the future outlook in Australia Feletto, E; Grogan, P; Dickson, C; Smith, MA; Canfell, K The coronavirus disease 2019 (COVID-19) pandemic has caused major disruptions to many aspects of life in Australia and globally. This includes actual and potential future impacts on Australia’s three national screening programs for breast, bowel and cervical cancer. These programs aim to improve cancer outcomes through an organised approach to the early detection of cancer and precancer in asymptomatic populations. The design of each program varies according to biological differences in the three cancers, the available screening technology, the target population, and variations in their administration of Australia’s federal, state and territory jurisdictions. The observed and potential impacts of COVID-19 on these programs, and on related activities such as the current national enquiry into lung cancer screening feasibility, therefore vary significantly. This article focuses on observed short-term impacts, adaptations and the longer-term outlook for cancer screening in relation to COVID-19. It summarises potential responses to minimise the harms of disruptions caused by COVID-19, and highlights research and policy opportunities in the pandemic response and recovery which could inform and accelerate optimisation of cancer screening in the long term.

National Cervical Screening Programme Monitoring Report 45 1 January to 30 June 2016

Sun, 01 Jan 2017 00:00:00 GMT

National Cervical Screening Programme Monitoring Report 45 1 January to 30 June 2016 Smith MA; Rumlee L; Canfell K This report provides data on performance indicators of the National Cervical Screening Programme (NCSP) for the period National Cervical Screening Programme Monitoring Report 45 1 January to 30 June 2016.

Identifying positively deviant elderly medical wards using routinely collected NHS Safety Thermometer data: an observational study

Mon, 01 Jan 2018 00:00:00 GMT

Identifying positively deviant elderly medical wards using routinely collected NHS Safety Thermometer data: an observational study Baxter R; Taylor N; Kellar I; Mohammed M; Pye V; Lawton R Objective The positive deviance approach seeks to identify and learn from exceptional performers. Although a framework exists to apply positive deviance within healthcare organisations, there is limited guidance to support its implementation. The approach has also rarely explored exceptional performance on broad outcomes, been implemented at ward level, or applied within the UK. This study develops and critically appraises a pragmatic method for identifying positively deviant wards using a routinely collected, broad measure of patient safety. Design A two-phased observational study was conducted. During phase 1, cross-sectional and temporal analyses of Safety Thermometer data were conducted to identify a discrete group of positively deviant wards that consistently demonstrated exceptional levels of safety. A group of matched comparison wards with above average performances were also identified. During phase 2, multidisciplinary staff and patients on the positively deviant and comparison wards completed surveys to explore whether their perceptions of safety supported the identification of positively deviant wards. Setting 34 elderly medical wards within a northern region of England, UK. Participants Multidisciplinary staff (n=161) and patients (n=188) clustered within nine positively deviant and comparison wards. Results Phase 1: A combination of analyses identified five positively deviant wards that performed best in the region, outperformed their organisation and performed consistently well over 12 months. Five above average matched comparator wards were also identified. Phase 2: Staff and patient perceptions of safety generally supported the identification of positively deviant wards using Safety Thermometer data, although patient perceptions of safety were less concordant with the routinely collected data. Conclusions This study tentatively supports a pragmatic method of using routinely collected data to identify positively deviant elderly medical wards; however, it also highlights the various challenges that are faced when conducting the first stage of the positive deviance approach

BRCA2 mutations in a population-based series of patients with ocular melanoma

Tue, 01 Jan 2002 00:00:00 GMT

BRCA2 mutations in a population-based series of patients with ocular melanoma Scott RJ; Vajdic CM; Armstrong BK; Ainsworth CJ; Meldrum CJ; Aitken JF; Kricker A We studied the BRCA2 gene for germline mutations in 71 of 99 patients (72%) with ocular melanoma who were diagnosed consecutively in Australia in 1997 and 1998. Patients considered for our study fulfilled one of the following critiera: (i) were 50 years of age or less at diagnosis; (ii) had bilateral disease (2 patients); (iii) reported a family history of ocular melanoma (4 patients). Mutation detection was performed using the protein truncation test and denaturing high-performance liquid chromatography with primers designed to include intron-exon boundaries. Six DNA changes were found of which 2 were exonic, in exons 14 (A>C in nucleotide 7244 leading to His>Arg) and 27 (base pair substitution in nucleotide 9976 leading to a stop codon). One exonic change has been reported previously. None of the intronic mutations were deemed to affect splicing efficiency. Neither exonic mutation was in a person with bilateral ocular melanoma or a family history of cutaneous melanoma. We estimated the prevalence of possible loss of function changes in BRCA2 in patients with ocular melanoma at 3% (95% CI 0-10%). This figure was similar to previous estimates of 2.8% and 2% in nonrepresentative samples of patients with ocular melanoma and 2.1% in a representative sample of young women with breast cancer

Psychometric Evaluation of a Patient-Reported Symptom Index for Nonmuscle Invasive Bladder Cancer: Field Testing Protocol

Sun, 01 Jan 2017 00:00:00 GMT

Psychometric Evaluation of a Patient-Reported Symptom Index for Nonmuscle Invasive Bladder Cancer: Field Testing Protocol Rutherford C; King M; Smith DP; Costa D; Tait M; Patel M; NMIBC-SI Working Group Background: Nonmuscle invasive bladder cancer (NMIBC) is a chronic condition requiring intensive follow-up, repeated endoscopic examinations, tumor resections, and intravesical treatments that can occur every 3 months for life. In this clinical context, patient-reported outcomes (PROs) are a critical concern for patients and their managing clinicians. PROs have enormous potential to be integral to treatment assessment and recommendations for NMIBC; however, current PRO measures are inadequate for NMIBC because they lack key NMIBC-specific symptoms and side effects associated with contemporary treatments. Objective: The overarching aim of this study was to develop and evaluate a patient-reported symptom index (SI) for individuals with NMIBC (the NMIBC-SI) that is acceptable to patients; reliable, valid, and responsive to differences between contemporary treatments for NMIBC; and fit for purpose as an endpoint in clinical trials. Methods: The NMIBC-SI will be evaluated in 2 field tests across a total of 3 years. Field test 1 is a cross-sectional study design involving 225 adult NMIBC patients recruited while undergoing active treatment or those who completed final treatment within the past week. Data collected include patient demographics, clinical features of the tumor, risk category, treatment type, comorbidity, and PROs. Field test 2 is a prospective longitudinal study involving 225 newly diagnosed NMIBC-SI patients. Clinical data and patient-completed questionnaires will be collected at 4 time points during treatment: before tumor resection, 1 week after resection, end-of-induction intravesical therapy, and 1-year follow-up. Standard psychometric tests will be performed to assess the reliability, validity, responsiveness, and clinical utility of the NMIBC-SI. Results: Participant recruitment to field test 1 commenced in February 2017. Recruitment for field test 2 is planned to commence in January 2018. Final results are expected to be published in 2019. The NMIBC-SI will be freely available for use via registration. Conclusions: This study protocol contains detailed methods that will be used across multiple international sites. Phase 2 in the development of the NMIBC-SI will enable a comprehensive evaluation of its reliability, validity, and responsiveness to ensure that the NMIBC-SI is fit for purpose in clinical research and provides an evidence base for the ongoing improvement of future therapies for NMIBC.

Phase of care prevalence for prostate cancer in New South Wales, Australia: A population-based modelling study.

Sun, 01 Jan 2017 00:00:00 GMT

Phase of care prevalence for prostate cancer in New South Wales, Australia: A population-based modelling study. Yu XQ; Luo Q; Smith DP; Clements MS; Patel MI; O'Connell DL To develop a method for estimating the future numbers of prostate cancer survivors requiring different levels of care. DESIGN, SETTING AND PARTICIPANTS: Analysis of population-based cancer registry data for prostate cancer cases (aged 18-84 years) diagnosed in 1996-2007, and a linked dataset with hospital admission data for men with prostate cancer diagnosed during 2005-2007 in New South Wales (NSW), Australia. METHODS: Cancer registry data (1996-2007) were used to project complete prostate cancer prevalence in NSW, Australia for 2008-2017, and treatment information from hospital records (2005-2007) was used to estimate the inpatient care needs during the first year after diagnosis. The projected complete prevalence was divided into care needs-based groups. We first divided the cohort into two groups based on patient's age (<75 and 75-84 years). The younger cohort was further divided into initial care and monitoring phases. Cause of death data were used as a proxy for patients requiring last year of life prostate cancer care. Finally, episode data were used to estimate the future number of cases with metastatic progression. RESULTS: Of the estimated total of 60,910 men with a previous diagnosis of prostate cancer in 2017, the largest groups will be older patients (52.0%) and younger men who require monitoring (42.5%). If current treatment patterns continue, in the first year post-diagnosis 41% (1380) of patients (<75 years) will have a radical prostatectomy, and 52.6% (1752) will be likely to have either active surveillance, external beam radiotherapy or androgen deprivation therapy. About 3% will require care for subsequent metastases, and 1288 men with prostate cancer are likely to die from the disease in 2017. CONCLUSIONS: This method extends the application of routinely collected population-based data, and can contribute much to the knowledge of the number of men with prostate cancer and their health care requirements. This could be of significant use in planning future cancer care services and facilities in Australia.

Resilience of a FIT screening programme against screening fatigue: a modelling study

Fri, 01 Jan 2016 00:00:00 GMT

Resilience of a FIT screening programme against screening fatigue: a modelling study Greuter MJ; Berkhof J; Canfell K; Lew JB; Dekker E; Coupé VM BACKGROUND: Repeated participation is important in faecal immunochemical testing (FIT) screening for colorectal cancer (CRC). However, a large number of screening invitations over time may lead to screening fatigue and consequently, decreased participation rates. We evaluated the impact of screening fatigue on overall screening programme effectiveness. METHODS: Using the ASCCA model, we simulated the Dutch CRC screening programme consisting of biennial FIT screening in individuals aged 55-75. We studied the resilience of the programme against heterogeneity in screening attendance and decrease in participation rate due to screening fatigue. Outcomes were reductions in CRC incidence and mortality compared to no screening. RESULTS: Assuming a homogenous 63 % participation, i.e., each round each individual was equally likely to attend screening, 30 years of screening reduced CRC incidence and mortality by 39 and 53 %, respectively, compared to no screening. When assuming clustered participation, i.e., three subgroups of individuals with a high (95 %), moderate (65 %) and low (5 %) participation rate, screening was less effective; reductions were 33 % for CRC incidence and 43 % for CRC mortality. Screening fatigue considerably reduced screening effectiveness; if individuals refrained from screening after three negative screens, model-predicted incidence reductions decreased to 25 and 18 % under homogenous and clustered participation, respectively. Figures were 34 and 25 % for mortality reduction. CONCLUSIONS: Screening will substantially decrease CRC incidence and mortality. However, screening effectiveness can be seriously compromised if screening fatigue occurs. This warrants careful monitoring of individual screening behaviour and consideration of targeted invitation systems in individuals who have (repeatedly) missed screening rounds.

Prohibitin 3' untranslated region polymorphism and breast cancer risk in Australian women

Tue, 01 Jan 2002 00:00:00 GMT

Prohibitin 3' untranslated region polymorphism and breast cancer risk in Australian women Spurdle AB; Hopper JL; Chen X; McCredie MR; Giles GG; Newman B; Chenevix-Trench G A C to T transition within the 3' untranslated region of the prohibitin gene alters mRNA function, and an association between the T allele and an increased risk of breast cancer has been reported in North American women, specifically in those aged under 50 years with a first-degree family history of breast cancer. We did a population-based case-control study to assess whether this association existed in Australian women. We did not note such an association in our sample of 1446 patients and 786 controls (odds ratio 0.96, 95% CI 0.80-1.16; p=0.7), or in subgroups defined by age or family history, or both. Hence, our results do not lend support to the hypothesis that this polymorphism contributes to risk of breast cancer

Cancer incidence and mortality in people aged less than 75 years: changes in Australia over the period 1987-2007

Tue, 01 Jan 2013 00:00:00 GMT

Cancer incidence and mortality in people aged less than 75 years: changes in Australia over the period 1987-2007 Sitas F; O'Connell DL; Smith MA; Armstrong K; Yu XQ; Canfell K; Robotin M; Feletto E; Penman A; Gibberd A; Kahn C; Weber MF; Chiew M; Supramaniam R; Velentzis L; Nickson C; Smith DP BACKGROUND: Australia has one of the highest rates of cancer incidence worldwide and, despite improving survival, cancer continues to be a major public health problem. Our aim was to provide simple summary measures of changes in cancer mortality and incidence in Australia so that progress and areas for improvement in cancer control can be identified. METHODS: We used national data on cancer deaths and newly registered cancer cases and compared expected and observed numbers of deaths and cases diagnosed in 2007. The expected numbers were obtained by applying 1987 age-sex specific rates (average of 1986-1988) directly to the 2007 population. The observed numbers of deaths and incident cases were calculated for 2007 (average of 2006-2008). We limited the analyses to people aged less than 75 years. RESULTS: There was a 28% fall in cancer mortality (7827 fewer deaths in 2007 vs. 1987) and a 21% increase in new cancer diagnoses (13,012 more diagnosed cases in 2007). The greatest reductions in deaths were for cancers of the lung in males (-2259), bowel (-1797), breast (-773) and stomach (-577). Other notable falls were for cancers of the prostate (-295), cervix (-242) and non-Hodgkin lymphoma (-240). Only small or no changes occurred in mortality for cancers of the lung (female only), pancreas, brain and related, oesophagus and thyroid, with an increase in liver cancer (267). Cancer types that showed the greatest increase in incident cases were cancers of the prostate (10,245), breast (2736), other cancers (1353), melanoma (1138) and thyroid (1107), while falls were seen for cancers of the lung (-1705), bladder (-1110) and unknown primary (-904). CONCLUSIONS: The reduction in mortality indicates that prevention strategies, improvements in cancer treatment, and screening programmes have made significant contributions to cancer control in Australia since 1987. The rise in incidence is partly due to diagnoses being brought forward by technological improvements and increased coverage of screening and early diagnostic testing

Obesity, physical activity and cancer risks: Results from the Cancer, Lifestyle and Evaluation of Risk Study (CLEAR)

Sun, 01 Jan 2017 00:00:00 GMT

Obesity, physical activity and cancer risks: Results from the Cancer, Lifestyle and Evaluation of Risk Study (CLEAR) Nunez C; Bauman A; Egger S; Sitas F; Nair-Shalliker V Introduction Physical activity (PA) has been associated with lower risk of cardiovascular diseases, but the evidence linking PA with lower cancer risk is inconclusive. We examined the independent and interactive effects of PA and obesity using body mass index (BMI) as a proxy for obesity, on the risk of developing prostate (PC), postmenopausal breast (BC), colorectal (CRC), ovarian (OC) and uterine (UC) cancers. Methods We estimated odds ratios (OR) and 95% confidence intervals (CI), adjusting for cancer specific confounders, in 6831 self-reported cancer cases and 1992 self-reported cancer-free controls from the Cancer Lifestyle and Evaluation of Risk Study, using unconditional logistic regression. Results For women, BMI was positively associated with UC risk; specifically, obese women (BMI ≥30 kg/m2) had nearly twice the risk of developing UC compared to women with healthy-BMI-range (<25 kg/m2) (OR = 1.99;CI:1.31–3.03). For men, BMI was also positively associated with the risk of developing any cancer type, CRC and PC. In particular, obese men had 37% (OR = 1.37;CI:1.11–1.70), 113% (OR = 2.13;CI:1.55–2.91) and 51% (OR = 1.51;CI:1.17-1.94) higher risks of developing any cancer, CRC and PC respectively, when compared to men with healthy-BMI-range (BMI<25 kg/m2). Among women, PA was inversely associated with the risks of CRC, UC and BC. In particular, the highest level of PA (versus nil activity) was associated with reduced risks of CRC (OR = 0.60;CI:0.44–0.84) and UC (OR = 0.47;CI:0.27–0.80). Reduced risks of BC were associated with low (OR = 0.66;CI:0.51–0.86) and moderate (OR = 0.72;CI:0.57–0.91) levels of PA. There was no association between PA levels and cancer risks for men. We found no evidence of an interaction between BMI and PA in the CLEAR study. Conclusion These findings suggest that PA and obesity are independent cancer risk factors.

Physical activity, obesity and sedentary behaviour and the risks of colon and rectal cancers in the 45 and up study

Mon, 01 Jan 2018 00:00:00 GMT

Physical activity, obesity and sedentary behaviour and the risks of colon and rectal cancers in the 45 and up study Nunez C; Nair-Shalliker V; Egger S; Sitas F; Bauman A Background Obesity and physical activity (PA) are predictors of colon (CC) and rectal (RC) cancers. Prolonged sitting is also emerging as a potential predictor for these cancers. Little knowledge exists about the interactive effects of obesity, PA and prolonged sitting on cancer risk. This analysis assessed independent and interactive effects of PA, body mass index (BMI) and sitting time on CC and RC risks. Methods This analysis used data from a prospective study of 226,584 participants aged 45 years and over in New South Wales (NSW), Australia, who joined the 45 and Up study between 2006 and 2009. Baseline data were linked with data relating to mortality, cancer registration, hospital admission and Department of Human Services to December 2010. Multivariable Cox regression was used to estimate adjusted hazard ratios (referred to as relative risks, RRs) and 95% confidence intervals (Cis). Statistical significance was defined as p < 0.05. Results There were 846 and 369 ascertained cases of CC and RC. BMI was positively associated with CC risk (p = 0.003, P-trend = 0.0006) but not with RC. CC risk was increased in participants in the highest BMI quartile (≥29.4-≤50 kg/m2) compared to the lowest (15- < 23.6 kg/m2), (RR = 1.32, 95% CI:1.08–1.63). PA was associated with CC risk (p = 0.02) but not with RC. Specifically, CC risk was lower in individuals partaking in any amount of vigorous activity (time/week) compared to participants with no engagement (RR = 0.78, 95% CI:0.65–0.93). Sitting time was not associated with CC or RC. We found no evidence of interactive effects of PA, BMI and prolonged sitting on cancer risk. Conclusion This evidence suggests that a healthy weight and vigorous activity are essential to reduce CC risk since these factors may be independent of each other.

Smoking questions on the Australian death notification form: adopting international best practice?

Thu, 01 Jan 2009 00:00:00 GMT

Smoking questions on the Australian death notification form: adopting international best practice? Sitas F; O'Connell DL; Jamrozik K; Lopez AD Australia's achievement in tobacco control has been remarkable, but relies on indirect estimates of tobacco-attributed mortality, and on using relative risks from Western countries to calculate tobacco's impact. To accelerate the decline in smoking, more precise measures of tobacco's relative importance among different population subgroups are required. We propose that more direct and accurate measures of tobacco-attributed mortality are needed, which could be achieved by adding a small set of voluntary questions about the smoking status of the deceased to a revised death notification form. Ideally, this form should also record the smoking status of the next-of-kin or family informant, as this would help establish a living control group. Such information will provide data on tobacco-attributed deaths with incomparable precision, allowing accurate monitoring of the current state of the smoking epidemic, and its evolution over time. This is particularly pertinent for sections of the population in which tobacco control measures have been less successful. A number of practical concerns have been raised, but we do not believe these are insurmountable

Prevalence and correlates of current smoking among medical oncology outpatients.

Thu, 01 Jan 2015 00:00:00 GMT

Prevalence and correlates of current smoking among medical oncology outpatients. Regan T; Carey M; Bryant J; Waller A; Mansfield F; Sitas F; Tracey E Continued smoking following a cancer diagnosis has adverse impacts on cancer treatment and puts individuals at risk of secondary cancers. Data on the prevalence and correlates of smoking among cancer patients are critical for successfully targeting smoking cessation interventions.

Factors associated with the use of complementary and alternative medicines for prostate cancer by long-term survivors

Mon, 01 Jan 2018 00:00:00 GMT

Factors associated with the use of complementary and alternative medicines for prostate cancer by long-term survivors Egger S; Hughes S; Smith DP; Chambers S; Kahn C; Moxey A; O'Connell DL Objective To assess whether the use of complementary and alternative medicines therapies (CAMs) for prostate cancer and/or its treatment side effects by long-term survivors is associated with selected socio-demographic, clinical, health-related quality-of-life (HRQOL) and/or psychological factors. Design, setting and participants The Prostate Cancer Care and Outcomes Study (PCOS) is a population-based cohort study of men with prostate cancer who were aged less than 70 years at diagnosis in New South Wales, Australia. Included in these analyses were men who returned a 10-year follow-up questionnaire, which included questions about CAM use. Methods Validated instruments assessed patient’s HRQOL and psychological well-being. Poisson regression with robust variance estimation was used to estimate the adjusted relative risks of current CAM use for prostate cancer according to socio-demographic, clinical, HRQOL and psychological factors. Results 996 of 1634 (61%) living PCOS participants completed the 10-year questionnaire. Of these 996 men, 168 (17%) were using CAMs for prostate cancer and 525 (53%) were using CAMs for any reason (including prostate cancer). Those using CAM for prostate cancer were more likely to be regular or occasional support group participants (vs. no participation RR = 2.02; 95%CI 1.41–2.88), born in another country (vs. Australian born RR = 1.59; 95%CI 1.17–2.16), have received androgen deprivation treatment (ADT) since diagnosis (RR = 1.60; 95%CI 1.12–2.28) or in the past two years (RR = 2.34; 95%CI 1.56–3.52). CAM use was associated with greater fear of recurrence (RR = 1.29; 95%CI 1.12–1.48), cancer-specific distress (RR = 1.15; 95%CI 1.01–1.30), cancer-specific hyperarousal (RR = 1.17; 95%CI 1.04–1.31), cancer locus of control (RR = 1.16; 95%CI 1.01–1.34) and less satisfaction with medical treatments (RR = 0.86; 95%CI 0.76–0.97), but not with intrusive thinking, cognitive avoidance, depression, anxiety or any HRQOL domains. Conclusions In this study, about one in six long term prostate cancer survivors used CAMs for their prostate cancer with use centred around ADT, country of birth, distress, cancer control, fear of recurrence and active help seeking.

Part I: Cancer in Indigenous Africans--burden, distribution, and trends

Tue, 01 Jan 2008 00:00:00 GMT

Part I: Cancer in Indigenous Africans--burden, distribution, and trends Parkin DM; Sitas F; Chirenje M; Stein L; Abratt R; Wabinga H Cancer is an under-emphasised issue in Africa, partly because of the overwhelming burden of communicable diseases. However cancer is a common disease in Africa with 650 000 people, of a population of 965 million, diagnosed annually. Furthermore, the lifetime risk in females (between 0 and 64 years) of cancer is about 10%, which is only about 30% lower than the risk in developed countries. In females, the lifetime risk of dying from cancer in Africa is almost double the risk in developed countries. This Review is the first of two papers and focuses on the current knowledge of the distribution and trends of the most common cancers in Africa. The cancers with the highest incidence are cervical, breast, and now HIV-associated Kaposi's sarcoma. The top five cancers in males--Kaposi's sarcoma (constituting 12.9% of all cancers in males) and cancer of the liver (14.8%), prostate (9.5%), bladder (6.1%), and non-Hodgkin lymphoma (5.7%)--and in females--cancer of the cervix (constituting 23.3% of all cancers in females) and breast (19.2%), Kaposi's sarcoma (5.1%), cancer of the liver (5.0%), and non-Hodgkin lymphoma (3.7%)--are discussed in detail. The second paper will focus on the causes and control of cancer in Africa. The cancer burden in Africa is likely to increase as a result of increases in HIV-associated cancers, changes in lifestyles associated with economic development, and the increasing age of the population (despite AIDS). Although the knowledge of cancer in this region is improving, better surveillance of cancer incidence, mortality, and prevalence of risk factors is urgently needed to monitor the development of the cancer epidemic, formulate appropriate cancer-control strategies, and assess the outcomes of these strategies

Prevention of cervical cancer in rural China: evaluation of HPV vaccination and primary HPV screening strategies

Sat, 01 Jan 2011 00:00:00 GMT

Prevention of cervical cancer in rural China: evaluation of HPV vaccination and primary HPV screening strategies Canfell K; Nickson C; Qiao YL; Shi JF; Lew JB; Walker R; Zhao FH; Simonella L; Chen JF; Legood R; Smith MA Comprehensive evaluation of the cost-effectiveness of HPV vaccination in China has not previously been performed. The objective of this study was to evaluate vaccination as an alternative or addition to primary HPV screening with careHPV (Qiagen, Gaithersburg, USA), and to assess the threshold total cost per vaccinated girl (CVG) at which strategies involving vaccination would become viable compared to screening-only strategies in rural China. We used data from field studies in Shanxi Province to support modelling of HPV vaccination and screening, including local information on sexual behaviour, HPV prevalence, test accuracy, treatment protocols and costs. We evaluated several strategies involving screening once or twice per lifetime or at regular 5-yearly intervals, with or without vaccination of young females at age 15 years, assuming 70% coverage for both screening and vaccination. We also predicted cross-sectional cancer incidence each year to the year 2050 for a range of strategies. We found that strategies involving vaccination would be cost-effective at CVGs of US$50-54 or less, but at CVGs >$54, screening-only strategies would be more cost-effective. If vaccination of young cohorts is combined with two rounds of careHPV screening for women aged 30-59 years in 2012 and 2027, a predicted indicative 33% reduction in cervical cancer incidence by 2030 would be sustained until 2050, with incidence rates decreasing thereafter. In conclusion, taking into account estimated vaccine delivery costs (for 3 doses), a per-dose HPV vaccine cost of approximately <$9-14 would be required for strategies involving vaccination to be cost-effective. Overall, combined screening and vaccination approaches are required to maximise outcomes in rural China

Prostate cancer screening for men aged 75 to 84 years in New South Wales

Tue, 01 Jan 2013 00:00:00 GMT

Prostate cancer screening for men aged 75 to 84 years in New South Wales Carmichael LK; Goldsbury DE; O'Connell DL

Health in South Africa: changes and challenges since 2009

Sun, 01 Jan 2012 00:00:00 GMT

Health in South Africa: changes and challenges since 2009 Mayosi BM; Lawn JE; van Niekerk A; Bradshaw D; Abdool Karim SS; Coovadia HM; for The Lancet South Africa Team (incl. Sitas F) Since the 2009 Lancet Health in South Africa Series, important changes have occurred in the country, resulting in an increase in life expectancy to 60 years. Historical injustices together with the disastrous health policies of the previous administration are being transformed. The change in leadership of the Ministry of Health has been key, but new momentum is inhibited by stasis within the health management bureaucracy. Specific policy and programme changes are evident for all four of the so-called colliding epidemics: HIV and tuberculosis; chronic illness and mental health; injury and violence; and maternal, neonatal, and child health. South Africa now has the world's largest programme of antiretroviral therapy, and some advances have been made in implementation of new tuberculosis diagnostics and treatment scale-up and integration. HIV prevention has received increased attention. Child mortality has benefited from progress in addressing HIV. However, more attention to postnatal feeding support is needed. Many risk factors for non-communicable diseases have increased substantially during the past two decades, but an ambitious government policy to address lifestyle risks such as consumption of salt and alcohol provide real potential for change. Although mortality due to injuries seems to be decreasing, high levels of interpersonal violence and accidents persist. An integrated strategic framework for prevention of injury and violence is in progress but its successful implementation will need high-level commitment, support for evidence-led prevention interventions, investment in surveillance systems and research, and improved human-resources and management capacities. A radical system of national health insurance and re-engineering of primary health care will be phased in for 14 years to enable universal, equitable, and affordable health-care coverage. Finally, national consensus has been reached about seven priorities for health research with a commitment to increase the health research budget to 2.0% of national health spending. However, large racial differentials exist in social determinants of health, especially housing and sanitation for the poor and inequity between the sexes, although progress has been made in access to basic education, electricity, piped water, and social protection. Integration of the private and public sectors and of services for HIV, tuberculosis, and non-communicable diseases needs to improve, as do surveillance and information systems. Additionally, successful interventions need to be delivered widely. Transformation of the health system into a national institution that is based on equity and merit and is built on an effective human-resources system could still place South Africa on track to achieve Millennium Development Goals 4, 5, and 6 and would enhance the lives of its citizens

Increased exposure to community-based education and 'below the line' social marketing results in increased fruit and vegetable consumption

Sun, 01 Jan 2012 00:00:00 GMT

Increased exposure to community-based education and 'below the line' social marketing results in increased fruit and vegetable consumption Glasson C; Chapman K; Wilson T; Gander K; Hughes C; Hudson N; James E OBJECTIVE: To determine if localised programmes that are successful in engaging the community can add value to larger fruit and vegetable mass-media campaigns by evaluating the results of the Eat It To Beat It programme. DESIGN: The Eat It To Beat It programme is a multi-strategy intervention that uses community-based education and 'below the line' social marketing to increase fruit and vegetable consumption in parents. This programme was evaluated by a controlled before-and-after study with repeat cross-sectional data collected via computer-assisted telephone interviews with 1403 parents before the intervention (2008) and 1401 following intervention delivery (2011). SETTING: The intervention area was the Hunter region and the control area was the New England region of New South Wales, Australia. SUBJECTS: Parents of primary school-aged children (Kindergarten to Year 6). RESULTS: The programme achieved improvements in knowledge of recommended intakes for fruit and vegetables and some positive changes in knowledge of serving size for vegetables. Exposure to the programme resulted in a net increase of 0.5 servings of fruit and vegetables daily for those who recalled the programme compared with those who did not (P = 0.004). Increased intake of fruit and vegetables was significantly associated with increasing exposure to programme strategies. CONCLUSIONS: The Eat It To Beat It programme demonstrates that an increase in consumption of fruit and vegetables can be achieved by programmes that build on the successes of larger mass-media and social-marketing campaigns.This suggests that funding for localised, community-based programmes should be increased

Impact of deprivation on breast cancer survival among women eligible for mammographic screening in the West Midlands (UK) and New South Wales (Australia): Women diagnosed 1997-2006

Fri, 01 Jan 2016 00:00:00 GMT

Impact of deprivation on breast cancer survival among women eligible for mammographic screening in the West Midlands (UK) and New South Wales (Australia): Women diagnosed 1997-2006 Woods LM; Rachet B; O'Connell DL; Lawrence G; Coleman MP Women diagnosed with breast cancer in the UK display marked differences in survival between categories defined by socio-economic deprivation. Timeliness of diagnosis is one of the possible explanations for these patterns. Women whose cancer is screen-detected are more likely to be diagnosed at an earlier stage. We examined deprivation and screening-specific survival in order to evaluate the role of early diagnosis upon deprivation-specific survival differences in the West Midlands (England) and New South Wales (Australia). We estimated net survival for women aged 50-65 years at diagnosis and whom had been continuously eligible for screening from the age of 50. Records for 5,628 women in West Midlands (98.5% of those eligible, mean age at diagnosis 53.7 years) and 6,396 women in New South Wales (99.9% of those eligible, mean age at diagnosis 53.8 years). In New South Wales, survival was similar amongst affluent and deprived women, regardless of whether their cancer was or was not screen-detected. In the West Midlands, there were large and persistent differences in survival between affluent and deprived women. Deprivation differences were similar between the screen-detected and non-screen detected groups. These differences are unlikely to be solely explained by artefact, or by patient or tumour factors. Further investigations into the timeliness and appropriateness of the treatments received by women with breast cancer across the social spectrum in the UK are warranted.

How does sun exposure cause skin cancer - epidemiological perspective

Thu, 01 Jan 2004 00:00:00 GMT

How does sun exposure cause skin cancer - epidemiological perspective Armstrong B

Urologists' referral and radiation oncologists' treatment patterns regarding high-risk prostate cancer patients receiving radiotherapy within 6 months after radical prostatectomy: A prospective cohort analysis

Wed, 01 Jan 2020 00:00:00 GMT

Urologists' referral and radiation oncologists' treatment patterns regarding high-risk prostate cancer patients receiving radiotherapy within 6 months after radical prostatectomy: A prospective cohort analysis Egger S; Smith D; Brown B; Kneebone A; Dominello A; Brooks A; Young J; Xhilaga M; Haines M; O'Connell D Introduction: Previous studies have observed low rates of adjuvant radiotherapy after radical prostatectomy (RP) for high-risk prostate cancer patients. However, it is not clear the extent to which these low rates are driven by urologists' referral and radiation oncologists' treatment patterns. Method: The Clinician-Led Improvement in Cancer Care (CLICC) implementation trial was conducted in nine public hospitals in New South Wales, Australia. Men who underwent RP for prostate cancer during 2013-2015 and had at least one high-risk pathological feature of extracapsular extension, seminal vesicle invasion and/or positive surgical margins were included in these analyses. Outcomes were as follows: (i) referral to a radiation oncologist within 4 months after RP ('referred'); (ii) commencement of radiotherapy within 6 months after RP among those who consulted a radiation oncologist ('radiotherapy after consultation'). Results: Three hundred and twenty-five (30%) of 1071 patients were 'referred', and 74 (61%) of 121 patients received 'radiotherapy after consultation'. Overall, the probability of receiving radiotherapy within 6 months after RP was 15%. The probability of being 'referred' increased according to higher 5-year risk of cancer-recurrence (P < 0.001). Conclusion: Only 30% of patients with high-risk features are referred to a radiation oncologist with the likelihood of referral being influenced by the perceived risk of cancer-recurrence as well as the urologist's institutional/personal preference. When patients are seen by a radiation oncologist, 61% receive radiotherapy within 6 months after RP with the likelihood of receiving radiotherapy not being heavily influenced by increasing risk of recurrence. This suggests many suitable patients would receive radiotherapy if referred and seen by a radiation oncologist.

Antibodies against six human herpesviruses in relation to seven cancers in black South Africans: a case control study

Sun, 01 Jan 2006 00:00:00 GMT

Antibodies against six human herpesviruses in relation to seven cancers in black South Africans: a case control study Berrington de GA; Beral V; Urban MI; Sitas F; Blackburn N; Hale M; Patel M; Ruff P; Sur R; Newton R BACKGROUND: Infections with certain human herpesviruses have been established as risk factors for some cancer types. For example, Epstein-Barr Virus is considered a cause of Burkitt's lymphoma and other immunosuppression related lymphomas, Hodgkin lymphoma, and nasopharyngeal cancer. Several other human herpesviruses have been linked to cancers but the totality of evidence is inconclusive. METHODS: We conducted a systematic sub-study from within an ongoing case control study of adult black South Africans to investigate the relationship between antibodies to six human herpesviruses and seven cancer groups that may be caused by infectious agents. Subjects had incident cancers of the oral cavity (n = 88), the cervix (n = 53), the prostate (n = 66), Hodgkin lymphoma (n = 83), non-Hodgkin lymphoma (n = 80), multiple myeloma (n = 94) or leukaemia (n = 203). For comparison, patients with other cancers (n = 95) or cardiovascular disease (n = 101) were randomly selected from within the study. Patients were interviewed and their blood was tested for IgG antibodies against HSV-1, HSV-2, VZV, EBV-EBNA, CMV and HHV-6 using enzyme linked immunosorbent assays. Because these viruses are highly prevalent in this population, optical density results from the assays were used as an indirect, quantitative measure of antibody level. RESULTS: There was significant variation in the mean log antibody measures for HSV-2, VZV, CMV and HHV-6 between the disease groups. However, none of the specific cancer groups had significantly higher mean log antibody measures for any of the viruses compared to either control group. In a more detailed examination of seven associations between cancers and herpesviruses for which there had been prior reports, two statistically significant associations were found: a decreasing risk of myeloid leukaemia and an increasing risk of oral cancer with increasing tertiles of antibodies against HHV-6 compared to all other patients (p-trend = 0.03 and 0.02, respectively). Odds ratios for the top tertile compared to the bottom tertile were 0.58 (95%CI 0.3-1.0) for myeloid leukaemia and 2.21 (95% CI 1.1-4.3) for oral cancer. CONCLUSION: In this population, using these tests for IgG, neither mean antibody measure nor high antibody measure against human herpesviruses 1-6 was strongly associated with any of the seven cancer groups. However, we may not have had sufficient power to detect weak associations or associations with a sub-type of cancer if they were present

Reaching the hard-to-reach: a systematic review of strategies for improving health and medical research with socially disadvantaged groups

Tue, 01 Jan 2013 00:00:00 GMT

Reaching the hard-to-reach: a systematic review of strategies for improving health and medical research with socially disadvantaged groups Bonevski B; Randell M; Paul C; Chapman K; Twyman L; Bryant J; Brozek I; Hughes C BACKGROUND: This study aims to review the literature regarding the barriers to sampling, recruitment, participation, and retention of members of socioeconomically disadvantaged groups in health research and strategies for increasing the amount of health research conducted with socially disadvantaged groups. METHODS: A systematic review with narrative synthesis was conducted. Searches of electronic databases Medline, PsychInfo, EMBASE, Social Science Index via Web of Knowledge and CINHAL were conducted for English language articles published up to May 2013. Qualitative and quantitative studies as well as literature reviews were included. Articles were included if they reported attempts to increase disadvantaged group participation in research, or the barriers to research with disadvantaged groups. Groups of interest were those described as socially, culturally or financially disadvantaged compared to the majority of society. Eligible articles were categorised according to five phases of research: 1) sampling, 2) recruitment and gaining consent, 3) data collection and measurement, 4) intervention delivery and uptake, and 5) retention and attrition. RESULTS: In total, 116 papers from 115 studies met inclusion criteria and 31 previous literature reviews were included. A comprehensive summation of the major barriers to working with various disadvantaged groups is provided, along with proposed strategies for addressing each of the identified types of barriers. Most studies of strategies to address the barriers were of a descriptive nature and only nine studies reported the results of randomised trials. CONCLUSIONS: To tackle the challenges of research with socially disadvantaged groups, and increase their representation in health and medical research, researchers and research institutions need to acknowledge extended timeframes, plan for higher resourcing costs and operate via community partnerships