Value Of Androgen Deprivation And Bisphosphonate Therapy In Patients Treated By Radiotherapy For Limited Prostate Cancer
Funder
National Health and Medical Research Council
Funding Amount
$1,757,375.00
Summary
Prostate cancer depends for its growth on the male hormone, testosterone, which circulates in the blood. As a result treatment which reduces testosterone level ('androgen deprivation'[AD] therapy) can produce clinically important shrinkage of prostate cancer. Each year approximately 4000 men in Australia and New Zealand develop prostate cancer which has not spread widely and which is amenable to attempted cure by surgery or radiation. Results from recent trials, including a large trial run in Au ....Prostate cancer depends for its growth on the male hormone, testosterone, which circulates in the blood. As a result treatment which reduces testosterone level ('androgen deprivation'[AD] therapy) can produce clinically important shrinkage of prostate cancer. Each year approximately 4000 men in Australia and New Zealand develop prostate cancer which has not spread widely and which is amenable to attempted cure by surgery or radiation. Results from recent trials, including a large trial run in Australia and New Zealand by the Trans-Tasman Radiation Oncology Group (TROG) between 1996 and 2000, suggest that 6 months AD will benefit many of these men if administered in conjunction with radiotherapy.The aim of this project is to run a further trial to find out whether 12 months of AD, after radiotherapy will prevent the need for further treatment and prolong more lives than only 6 months AD. Bisphosphonate treatment also offers important benefits to prostate cancer patients because it can increase bony stregth by increasing its density and can also arrest cancerous growth in bones. A further aim of the trial therefore is to determine whether 18 months of bisphosphonate therapy (BP) will prevent bone loss (osteoporosis) caused by AD, and also further reduce the risk of secondary bone cancer developing. This trial will involve recruitment of 1000 men across Australia and New Zealand over a 5 year period. When complete the trial will determine whether further treatment can be delayed and life prolonged in up to half of all men in whom treatment presently fails. This grant will support collection of patient data and the necessary quality checks to ensure that reliable conclusions can be drawn.Read moreRead less
Preparing Cancer Patients For Clinical Decision Making: A Randomised Trial Of Preconsultation Preparation Packages.
Funder
National Health and Medical Research Council
Funding Amount
$228,427.00
Summary
Most cancer patients in Australia now expect and are told their cancer diagnosis. There is considerable variation in the extent to which patients are informed about treatment options and are involved in treatment decisions. It can be argued that a treatment decision should be based on the oncologist's knowledge and the patient's preference. Two possible models can achieve this optimal outcome: the oncologist decides treatment on the basis of information passed on to him-her from the patient (the ....Most cancer patients in Australia now expect and are told their cancer diagnosis. There is considerable variation in the extent to which patients are informed about treatment options and are involved in treatment decisions. It can be argued that a treatment decision should be based on the oncologist's knowledge and the patient's preference. Two possible models can achieve this optimal outcome: the oncologist decides treatment on the basis of information passed on to him-her from the patient (the enabled doctor), and the patient chooses treatment based on informaton provided by the doctor (the empowered patient). We have developed a booklet on 'how treatment decisions are made'. In a randomised trial, patients seeing an oncologist for the first time are given the booklet and shown a video of ' their' oncologist interviewing an actor patient. The subsequent consultation is audiotaped to study the effect of these interventions on patient and doctor behaviour. The results of this trial will inform the development of our new patient educational materials. We now plan to develop consultation preparation packages. Patients will be sent information at least 48 hours before their first appointment with an oncologist with the goal of helping patients to achieve their preferred involvement in the consultation. The complete package will contain four components : a booklet on how treatment decisions are made including an outline of the two treatment decision models, a question prompt sheet and recommendation to prepare a list of questions, a booklet on Patient Rights, and an introduction to the Cancer Centre. The effects of the total package, and of just the Cancer Centre component on patient preferences for information and involvement in medical decisions, their consultation behaviour, and patient and doctor satisfaction with decision making will be studied in a randomised trial with control patients receiving no preparatory materials.Read moreRead less
A Comparison Of Arthroscopic Synovial Biopsy Based Targeted Biologic Therapy Versus Conventional Therapy In Rheumatoid Arthritis
Funder
National Health and Medical Research Council
Funding Amount
$133,351.00
Summary
This proposed study will investigate if treatment of rheumatoid arthritis (RA) based on biopsy of affected joints’ lining is better than standard therapy (not based on the results of biopsy). Current strategies to treat RA not infrequently result in incomplete disease suppression with potentially resultant joint damage, in part because of lack of definite guidelines to individualise treatment. We propose that therapy on the basis of the analysis of biopsy of joint lining will lead to better dise ....This proposed study will investigate if treatment of rheumatoid arthritis (RA) based on biopsy of affected joints’ lining is better than standard therapy (not based on the results of biopsy). Current strategies to treat RA not infrequently result in incomplete disease suppression with potentially resultant joint damage, in part because of lack of definite guidelines to individualise treatment. We propose that therapy on the basis of the analysis of biopsy of joint lining will lead to better disease control than the currently prevalent approach.Read moreRead less
Novel Therapeutic Strategy Against Multidrug-resistant Gram-negative Bacteria
Funder
National Health and Medical Research Council
Funding Amount
$349,823.00
Summary
In the past two decades, there has been a marked decline in discovery and development of new antibiotics while there has been a remarkable increase in resistance to the currently available antibiotics. The growth in the number of resistant bacteria and lack of antibiotics available for treatment is very significant with gram-negative bacteria, such as Pseudomonas aeruginosa, Acinetobacter baumannii and Stenotrophomonas maltophilia. Colistin, an old antibiotic that has been used little over the l ....In the past two decades, there has been a marked decline in discovery and development of new antibiotics while there has been a remarkable increase in resistance to the currently available antibiotics. The growth in the number of resistant bacteria and lack of antibiotics available for treatment is very significant with gram-negative bacteria, such as Pseudomonas aeruginosa, Acinetobacter baumannii and Stenotrophomonas maltophilia. Colistin, an old antibiotic that has been used little over the last 40-50 years, has been 'taken off the shelf' and is now being used as a last line of defence to treat people with infections caused by these bacteria. Clearly, doctors and their infected patients will be in an even more precarious position than currently exists if resistance to colistin increases. We have discovered a novel therapeutic strategy that is able to reverse colistin resistance in P. aeruginosa. The studies proposed in this project will investigate this novel strategy across a range of multidrug-resistant bacteria and provide the information essential for rational use in patients. We propose that such a novel therapeutic strategy will provide a powerful weapon for the war on these 'superbugs'.Read moreRead less
Microbial Restoriation In Crohn's Disease: A Randomised Trial Of Faecal Microbial Transplanatation In Crohn's Disease
Funder
National Health and Medical Research Council
Funding Amount
$487,123.00
Summary
Crohn's disease causes inflammation and damage to the digestive tract. Compelling evidence suggests that the bacteria in the gut play an important role in the onset of disease. Changing the gut bacteria through the administration of healthy stool to a patient, faecal microbiota transplantation (FMT), is safe and may be effective. This placebo controlled trial will determine whether FMT (delivered via capsule) can control inflammation in Crohn's. Results will change current treatment paradigms.
A La CaRT: Australasian Laparoscopic Cancer Of The Rectum Trial. A Phase III Prospective Randomised Trial Comparing Laparoscopic-assisted Resection Versus Open Resection For Rectal Cancer
Funder
National Health and Medical Research Council
Funding Amount
$599,054.00
Summary
The major treatment for rectal cancer is surgical removal of tumour with a large cut through the abdomen. There is a newer, less invasive procedure known as laparoscopic resection which enables the same surgery to be performed using a scope inserted in the abdomen and another smaller incision for removal of the tumour. This study is being conducted to determine whether the newer procedure is as safe and effective as the current procedure. Patients on the trial will be given either laparoscopi
Towards Optimising Dosing Of The 'old' Antibiotic Colistin Methanesulphonate: Enhancing Efficacy And Reducing Resistance
Funder
National Health and Medical Research Council
Funding Amount
$266,500.00
Summary
The global problem of multidrug-resistant bacteria is a major clinical challenge. In cystic fibrosis (CF) patients, the bacteria pseudomonas shows significantly high resistance to the commonly used antibiotics and is a major cause of death. As a consequence, interest in an old antibiotic, colistin, has been rekindled after 40 years on the shelf. The safety of intravenous colistin has been demonstrated in several clinical trials. However, based on our preliminary studies in CF patients, the curre ....The global problem of multidrug-resistant bacteria is a major clinical challenge. In cystic fibrosis (CF) patients, the bacteria pseudomonas shows significantly high resistance to the commonly used antibiotics and is a major cause of death. As a consequence, interest in an old antibiotic, colistin, has been rekindled after 40 years on the shelf. The safety of intravenous colistin has been demonstrated in several clinical trials. However, based on our preliminary studies in CF patients, the current dosage regimen where colistin is given three times a day does not achieve high enough concentrations to kill the bacteria. The studies proposed in this project will address the safety, effectivenss and impact on development of resistance of larger doses of intravenous colistin given once or twice daily. We propose that such dosing strategies will yield more effective usage of this promising 'old' antibiotic.Read moreRead less
Improving Outcomes For People With Depression In Community Settings: A Cluster RCT
Funder
National Health and Medical Research Council
Funding Amount
$803,554.00
Summary
Depression affects 350 million people worldwide. Given the pivotal role of primary care in the management of depression, effective strategies are needed to assist GPs in the delivery of patient-centred depression care. This study will test the effectiveness of providing GPs with education; as well as feedback about patients’ self-reported depressive scores using a standardised instrument and perceived need and preferences for help. This cluster RCT will be the first Australian trial of its kind.