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Health System Performance And Outcomes For Indigenous Australians With Cancer: A National Study.
Funder
National Health and Medical Research Council
Funding Amount
$412,354.00
Summary
Cancer has only recently been recognised as a significant Indigenous health issue, partly because no national information has been available on the impact of cancer on Indigenous people or on health system performance for Indigenous cancer patients. Recent research in the Northern Territory has demonstrated large deficiencies in diagnosis, treatment and survival for Indigenous compared to other cancer patients. Despite imperfect data on Indigenous status, important information can be obtained ab ....Cancer has only recently been recognised as a significant Indigenous health issue, partly because no national information has been available on the impact of cancer on Indigenous people or on health system performance for Indigenous cancer patients. Recent research in the Northern Territory has demonstrated large deficiencies in diagnosis, treatment and survival for Indigenous compared to other cancer patients. Despite imperfect data on Indigenous status, important information can be obtained about health system performance for Indigenous Australians from national administrative databases and registers. This project will assess health system performance and outcome for Indigenous people with cancer at a national level for the first time. It will compare Indigenous with non-Indigenous cancer survival rates for Australia as a whole, including regional (urban-rural-remote) variations and time trends. For those states where data on stage at diagnosis and hospital treatment are available, it will also investigate the performance of diagnostic and treatment services for Indigenous cancer patients by comparing their stage at diagnosis and surgical treatment with that for non-Indigenous patients. Time trends for each of these issues will be examined using data from those states with data of adequate quality and consistency over the past 10-15 years. This project will provide the methodological basis for regular reporting of Indigenous cancer survival and related statistics in the national cancer reporting system and demonstrate that national monitoring of the acute care system for Indigenous people is possible for other conditions. The results of this research will directly inform acute care policy and practice for Indigenous people with cancer (particularly the relative need for improvement in primary health or acute care services), and have implications for the performance of the acute care system system more generally for Indigenous Australians.Read moreRead less
COX-2 Inhibitors And The Development Of Unstable Angina And Myocardial Infarction
Funder
National Health and Medical Research Council
Funding Amount
$171,450.00
Summary
Anti-inflammatory drugs (sometimes called NSAIDs) are widely used in the treatment of arthritis and also as general purpose pain killers. Up to 10 million prescriptions are written each year for these drugs in Australia. Some of the older versions of these drugs like ibuprofen (eg Brufen) and naproxen (trade name Naproxen) cause side effects which can be serious. Damage to the stomach is a particular problem and this can lead to serious bleeding or perforation of ulcers. Less well recognized are ....Anti-inflammatory drugs (sometimes called NSAIDs) are widely used in the treatment of arthritis and also as general purpose pain killers. Up to 10 million prescriptions are written each year for these drugs in Australia. Some of the older versions of these drugs like ibuprofen (eg Brufen) and naproxen (trade name Naproxen) cause side effects which can be serious. Damage to the stomach is a particular problem and this can lead to serious bleeding or perforation of ulcers. Less well recognized are the adverse effects of these drugs on the heart and the kidneys. The older fashioned members of this class of drug are rapidly being replaced by newer agents known as COX-2 inhibitors. Popular examples in Australia are celecoxib (trade name Celebrex) and rofecoxib (trade name Vioxx). These drugs are heavily promoted as being safer than the older NSAIDs. In the case of the stomach, this claim seems to be correct. However, the effects of the new COX-2 inhibitors on the circulation have not been fully assessed. Recently, claims have been made that these drugs may increase the risk of heart attacks. If this were true, it would be an effect that was unique to COX-2 inhibitors as it has not been reported with the older NSAIDs. We plan to carry out a 3 year study in Newcastle hospitals in which we compare the use of COX-2 inhibitors in a group of patients admitted to hospital with a heart attack or unstable angina with that of a control group of patients who were admitted to hospital around the same time, but not for heart problems. We are interested in whether COX-2 inhibitors are associated with an increased risk of heart attacks and whether use of small doses of aspirin protects against this effect. Depending on the results we may be able to improve the safety of these drugs in patients at risk of heart attacks.Read moreRead less
This Study aims to answer the question: When is the best time for adults with kidney disease to start dialysis? This question is currently a subject of intense international debate. It has been suggested that patients who commence dialysis relatively early, when they still have a high level of remaining kidney function, have fewer complications, maintain a better level of function in the community and are less likely to die as a result of their kidney disease. However, this has not been determin ....This Study aims to answer the question: When is the best time for adults with kidney disease to start dialysis? This question is currently a subject of intense international debate. It has been suggested that patients who commence dialysis relatively early, when they still have a high level of remaining kidney function, have fewer complications, maintain a better level of function in the community and are less likely to die as a result of their kidney disease. However, this has not been determined in a rigorous scientific manner. In fact starting dialysis earlier may expose the person to the risks associated with the use of dialysis and may also impact on their quality of life. Many international kidney societies have formulated guidelines recommending that dialysis should be commenced early - when the remaining kidney function drops to a level of approximately 10-15% of normal kidney function. Recent practice in Australia and New Zealand has been to commence dialysis when the remaining kidney function is between 6 and 9% of normal. Hence, the adoption of these guidelines recommending an earlier dialysis start time will have a significant impact on health costs; therefore a net benefit to the patient and the community, needs to be demonstrated. To answer this important question, we have designed and instituted a multi-center trial, that was commenced in 2000. The trial has been scientifically designed (randomised controlled trial) to compare the effect of early start dialysis (remaining kidney function between 10-14%) versus late start dialysis (remaining kidney function between 5-7%) on survival, disease and dialysis complications and subsequent hospitalization. To date 748 of the required 800 patients have been entered into the trial and will be followed for a minimum of 3 years. We are confident the results of this trial will impact at a local, national and international level, delineating best practice management of dialysis in people with kidney failure.Read moreRead less
COX-2 INHIBITORS AS A CAUSE OF HEART AND RENAL FAILURE
Funder
National Health and Medical Research Council
Funding Amount
$271,610.00
Summary
Non-steroid anti-inflammatory drugs (NSAIDs) have pain-killing and anti-inflammatory properties. For many years Australia had a higher use of these drugs than other countries. The drugs are quite toxic, and in susceptible individuals may cause ulceration and bleeding from the stomach and duodenum, kidney damage and fluid congestion leading to heart failure. Each of these conditions carries a high morbidity, particularly in the elderly. Because of concerns about toxicity, the use of NSAIDs in Aus ....Non-steroid anti-inflammatory drugs (NSAIDs) have pain-killing and anti-inflammatory properties. For many years Australia had a higher use of these drugs than other countries. The drugs are quite toxic, and in susceptible individuals may cause ulceration and bleeding from the stomach and duodenum, kidney damage and fluid congestion leading to heart failure. Each of these conditions carries a high morbidity, particularly in the elderly. Because of concerns about toxicity, the use of NSAIDs in Australia fell during the 1990s by around 40%. Newer allegedly safer forms of NSAIDs called COX-2 inhibitors have been introduced into the Australian market. The first 2 drugs to be marketed are called Celebrex and Vioxx. These drugs appear to be safer for the stomach and duodenum, but the true effects on the kidney and heart are as yet unclear. COX-2 inhibitors have been very widely used with over 1.7 million prescriptions issued since their listing on the Pharmaceutical Benefits Scheme in August 2000. Most of this use appears to be in addition to prescribing of the older NSAIDs rather than as a replacement for them. The purpose of this study is to compare the safety of the new COX-2 inhibitors with that of the older NSAIDs. We are interested in how often they cause renal failure and heart failure. The investigators will use well-established research methods to estimate the risk of heart failure and kidney failure with these drugs in the Australian community. Data from the study will form the basis of clinical practice guidelines for the safe use of these drugs in Australia.Read moreRead less
Optimal Duration Of Neoadjuvant Androgen Deprivation Therapy In Localised Prostate Cancer
Funder
National Health and Medical Research Council
Funding Amount
$275,000.00
Summary
Each year approximately 8000 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. 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 shrinkage of prostate cancer. In fact AD has caused temporary but valued relief to millions of men with cancer ....Each year approximately 8000 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. 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 shrinkage of prostate cancer. In fact AD has caused temporary but valued relief to millions of men with cancer of the prostate that has spread throughout the body for the last five decades, worldwide. It remains uncertain however whether AD administered before surgery or radiation will benefit any of the 8000 men each year who develop localised cancer by shrinking the cancer first. In 1996 a trial involving 800 men across Australia and New Zealand commenced under the auspices of the Trans-Tasman Radiation Oncology Group (TROG) to answer the questions: 1 - Does either 3 or 6 months AD prior to radiotherapy reduce the chances of recurrence of the cancer after radiotherapy? 2 - Does such therapy reduce the volume of tissue requiring radiotherapy and hence the chances of long term side effects after radiotherapy? This grant will support collection of follow-up information from the trial and hence answers to the questions asked.Read moreRead less
Methylation As A Risk And Prognostic Factor For Breast Cancer
Funder
National Health and Medical Research Council
Funding Amount
$594,913.00
Summary
DNA methylation is a process playing critical roles throughout life by altering the expression of genes. This study aims to investigate the potential use of methylation as marker of risk and early diagnosis of breast cancer in women with no clinical evidence of disease and marker of prognosis and response to treatment in breast cancer cases.
This proposal is designed to test the protein leverage hypothesis (PLH) in humans: the idea that the level of food consumption in humans, like other animals, is adjusted to maintain a target protein intake. As the prevalence of overweight and obesity increases, with its attendant health problems, the need to identify which dietary components limit rather than exacerbate energy intake is imperative. According to the PLH, the consumption of a diet low in % protein and high in % fat and carbohydrat ....This proposal is designed to test the protein leverage hypothesis (PLH) in humans: the idea that the level of food consumption in humans, like other animals, is adjusted to maintain a target protein intake. As the prevalence of overweight and obesity increases, with its attendant health problems, the need to identify which dietary components limit rather than exacerbate energy intake is imperative. According to the PLH, the consumption of a diet low in % protein and high in % fat and carbohydrate, typical of many Western countries, inevitably requires the ingestion of additional energy to maintain protein intake constant, thus driving weight gain. Conversely, the consumption of a diet that is relatively high in % protein requires the ingestion of lower levels of energy, creating the potential for weight loss. Preliminary experimental and population-level nutritional survey data support the PLH, as does the finding that protein is more satiating than other macronutrients. If, as predicted, small changes in the proportion of protein in diets described in the current study are found to impact on total energy intake there will be significant implications for weight control strategies. Thus, if the PLH is confirmed, public health dietary recommendations and government policy settings for the food industry will need to change. Large-scale intervention studies aimed at demonstrating the longer term impact on body weight will also be required.Read moreRead less