ORCID Profile
0000-0003-2354-1857
Current Organisations
University of New South Wales
,
Royal Australasian College of Physicians
,
Liverpool Hospital
,
Western Sydney University - Campbelltown Campus
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Publications
Estimation of an optimal chemotherapy utilisation rate for lung cancer: An evidence-based benchmark for cancer care
Publisher: Elsevier BV
Date: 09-2010
DOI: 10.1016/J.LUNGCAN.2009.11.017
Abstract: Optimal chemotherapy utilisation rates can serve as benchmarks to assess the quality of cancer service delivery. This study aims to determine the optimal proportion of patients with lung cancer that should receive chemotherapy at least once during the course of their illness, based on the best available evidence. An optimal chemotherapy utilisation tree was constructed using indications for chemotherapy identified from evidence-based treatment guidelines. Data on the proportion of patient and tumour-related attributes for which chemotherapy was indicated were obtained and merged with the treatment indications to calculate an optimal chemotherapy utilisation rate. This optimal rate was compared with reported actual rates of chemotherapy utilisation. Chemotherapy is recommended at least once in 73% of all patients with lung cancer (93% of small cell lung cancer (SCLC) patients and 69% of non-small cell lung cancer (NSCLC) patients). Comparison of these benchmark rates with international reported actual chemotherapy utilisation rates reveals under-utilisation of chemotherapy in all newly diagnosed lung cancer patients, regardless of histological type and stage, with the exception of stage I NSCLC. The optimal chemotherapy utilisation rate can serve as a feasible, evidence-based measure of the quality of cancer care. Chemotherapy may be under-utilised in the initial management of lung cancer.
Psychological morbidity and quality of life of ethnic minority patients with cancer: a systematic review and meta-analysis
Publisher: Elsevier BV
Date: 12-2011
Estimation of an optimal chemotherapy utilisation rate for primary malignant brain tumours: an evidence-based benchmark for cancer care.
Publisher: Elsevier BV
Date: 02-2011
The value of first‐line chemotherapy and targeted therapy in the treatment of breast cancer
Publisher: Hindawi Limited
Date: 04-11-2020
DOI: 10.1111/ECC.13352
Estimation of an optimal chemotherapy utilisation rate for head and neck carcinoma: setting an evidence-based benchmark for the best-quality cancer care.
Publisher: Elsevier BV
Date: 08-2009
Metabolic information on staging FDG-PET-CT as a prognostic tool in the evaluation of 97 patients with gastric cancer
Publisher: Springer Science and Business Media LLC
Date: 03-12-2014
DOI: 10.1007/S12149-013-0791-8
Abstract: Gastric cancer remains a leading cause of malignancy-related mortality. Many patients with locally advanced disease succumb despite peri-operative chemotherapy and the survival benefit of chemotherapy for advanced disease is modest, suggesting that current staging is imperfect. The role of fluorine-18-2-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) in the staging of gastric cancer remains to be determined. This study aimed to determine, and compare with computerized tomography (CT), the association between FDG-PET uptake in the primary tumour and regional lymph nodes, and overall survival in patients with all stage gastric cancer. Patients with histologically confirmed gastric cancer (any stage) who, at diagnosis, had received a staging FDG-PET-CT at our institution between 2006 and 2011 were included. Records were retrospectively analysed. Patients with >50 % of tumour above the gastro-oesophageal junction or an active second malignancy were excluded. 97 patients were included in the analysis. Surgery with curative intent was performed in 68 patients. In univariate analysis, an association with overall survival was seen in patients who had FDG-PET-positive primary tumours (hazard ratio (HR) for death 3.33, 95 % confidence interval (95 % CI) 1.63-6.80, p = 0.001). FDG-PET lymph node positive (vs node negativity) was associated with inferior overall survival (HR 8.66, 95 % CI 4.59-16.37, p < 0.0001), and remained an independent predictor in the multivariate analysis. In contrast, positive lymphadenopathy identified on CT was not associated with overall survival (HR 1.34, 95 % CI 0.79-2.29, p = 0.82). FDG-PET-positive tumours are associated with an inferior overall survival. In contrast to CT, FDG-PET-positive lymphadenopathy is associated with a decreased overall survival.
Nutritional status, management and clinical outcomes in patients with esophageal and gastro-oesophageal cancers: A descriptive study
Publisher: Wiley
Date: 19-09-2017
Abstract: The aims of this study were to investigate the nutritional management practice and nutritional status of patients with oesophageal and gastro-oesophageal cancers, and to propose strategies for improving their nutritional and clinical outcomes. All patients diagnosed with oesophageal and gastro-oesophageal cancers and treated with chemotherapy and/or radiotherapy at the Liverpool Cancer Therapy Centre (between August 2010 and February 2014) were included in this retrospective study. Patient and tumour characteristics, nutritional status and management were compared to clinical outcomes. A total of 69 patients met the inclusion criteria. The median weight loss prior to treatment commencement was 10.5% (Interquartile Range (IQR) = 6.6-15.4). A decline in nutritional status continued throughout the treatment course. The median percentage of weight loss during treatment was 3.53% (IQR = 0.00-6.84). Seven and 19 patients required nutrition intervention using a feeding tube or stent insertion to manage dysphagia, respectively. In patients treated with a curative intent, radiotherapy was completed in 100% of those with a nasogastric tube insertion as compared to 80% who had a stent insertion. There was a higher percentage of patients from culturally and linguistically erse (CALD) background, experiencing significant weight loss when compared with their non-CALD counterparts (P = 0.04). Patients with oesophageal and gastro-oesophageal cancers commonly present with significant weight loss and this continues during the course of their anti-cancer treatment. A standardised protocol of nutrition management for these cancer patients is recommended, focusing on assisting patients from CALD backgrounds.
Estimation of an optimal chemotherapy utilization rate for malignant pleural mesothelioma: An evidence-based benchmark for cancer care
Publisher: Wiley
Date: 10-11-2015
DOI: 10.1111/AJCO.12306
Abstract: Chemotherapy with cisplatin and pemetrexed has been shown to provide a survival benefit and improvement in quality of life in patients with malignant pleural mesothelioma (MPM). The reported chemotherapy utilization rates range from 18% to 61%. This study aimed to estimate the proportion of MPM patients that should receive chemotherapy based on best available evidence. An optimal chemotherapy utilization model for MPM was constructed using indications for chemotherapy identified from evidence-based MPM treatment guidelines. Epidemiological data on the proportion of patients and their tumor-related attributes were combined with the chemotherapy indications to estimate the optimal chemotherapy utilization rate using decision analysis software (TreeAge Pro 2007). Sensitivity analyses were performed to assess the impact of major variations in the epidemiological data on the optimal chemotherapy utilization rate. The optimal rate was compared with the actual rate reported in the literature. Chemotherapy is recommended at least once during the disease trajectory in 65% of MPM patients. Sensitivity analyses indicate an optimal utilization rate ranging from 50% to 65%. This optimal rate is relatively comparable to the rates mentioned in contemporary reports from Canada (61% between 2003 and 2005) and Australia (54% between 2007 and 2009) and high when compared with data from the Netherlands (36% during 2005-2006). An evidence-based model provided an optimal chemotherapy utilization rate of 65% for patients with MPM. Chemotherapy for MPM may be underutilized and barriers are likely multifactorial.
A comparison of surgical and radiotherapy breast cancer therapy utilization in Canada (British Columbia), Scotland (Dundee), and Australia (Western Australia) with models of optimal therapy.
Publisher: Elsevier BV
Date: 08-2012
Immigrants' perceptions of the quality of their cancer care: An Australian comparative study, identifying potentially modifiable factors
Publisher: Elsevier BV
Date: 08-2014
Abstract: Recent data show a falling cancer mortality in the general population without a similar shift in immigrant outcomes, leading to a greater cancer burden and mortality for immigrants. Our aims were to compare perceived patterns of care in immigrants and native-born cancer patients. This was a hospital-based s le of first-generation immigrants and Australian-born Anglo patients in the first year following diagnosis. It was restricted to Chinese, Arabic, or Greek speakers. Eligible participants, recruited via 16 oncology clinics, were over 18, with cancer (any type or stage), and having commenced treatment at least 1 month previously. Five hundred and seventy-one CALD patients (comprising 145 Arabic, 248 Chinese, and 178 Greek) and a control group of 274 Anglo-Australian patients participated. Immigrants had difficulty communicating with the doctor (73% versus 29%) and understanding the health system (38% versus 10%). Differences were found in 'difficulty knowing who to see' (P = 0.0002), 'length of time to confirm diagnosis' (P = 0.04), wanting more choice about a specialist and hospital (P < 0.0001) being offered the opportunity to see a counselor (P < 0.0001) and actually seeing one (P < 0.0001). There were no significant self-reported differences regarding how cancer was detected, time to see a health professional, or type first seen however, immigrants reported difficulty knowing who to see. Previous studies showed differences in patterns of care according to socioeconomic status (SES) and educational level. Despite adjusting for age, sex, education, marital status, SES, time since diagnosis, and type of cancer, we did not find significant differences. Instead, we found that understanding of the health system and confidence understanding English were important factors. This study confirmed that immigrants with cancer perceive an inferior quality of cancer care. We highlight potentially modifiable factors including assistance in navigating the health system, translated information, and cultural competency training for health professionals.
MRE11 and ATM Expression Levels Predict Rectal Cancer Survival and Their Association with Radiotherapy Response
Publisher: Public Library of Science (PLoS)
Date: 08-12-2016
Estimation of an optimal chemotherapy utilisation rate for breast cancer: setting an evidence-based benchmark for the best-quality cancer care.
Publisher: Elsevier BV
Date: 03-2010
Study protocol for a controlled trial of an eHealth system utilising patient reported outcome measures for personalised treatment and care: PROMPT-Care 2.0.
Publisher: Springer Science and Business Media LLC
Date: 23-08-2018
Health-Related Quality of Life during Chemoradiation in Locally Advanced Rectal Cancer: Impacts and Ethnic Disparities
Publisher: MDPI AG
Date: 28-08-2019
Abstract: Aims: There is limited data on health-related quality of life (HRQoL) in locally advanced rectal cancer. We assessed HRQoL before, during and after neoadjuvant chemoradiation, correlated this to corresponding clinician-reported adverse events (CR-AEs) and explored disparities between patients of Asian ethnicity versus Caucasians. Correlation between HRQoL and treatment response was also assessed. Methods: A consecutive s le of patients was recruited. HRQoL was assessed with the EORTC QLQ-C30 before chemoradiation, week three of chemoradiation and one-week pre-surgery. Clinical variables including CR-AEs were recorded at these time-points. Patients self-reported socio-demographic variables. Treatment response was assessed by the tumour regression grade. HRQoL data were analysed with multilevel models. Results: Fifty-one patients were recruited. HRQoL completion rates were ≥86%. Cognitive and role functioning worsened significantly during treatment. Emotional, role and social functioning improved significantly at pre-surgery. Fatigue and nausea/vomiting worsened during treatment while fatigue, appetite loss, diarrhoea and financial difficulties improved from treatment to pre-surgery. Almost 30% of the cohort were Asian ethnicity. Differences were found in multiple HRQoL domains between Asians and Caucasians, with Asians faring worse. Significant differences were evident in physical, role and cognitive functioning, and in seven out of the 8 symptom scales. The correlation between patient-reported outcomes and clinician-reported outcomes was weak, with diarrhoea having the strongest correlation (r = 0.58). Vomiting during treatment correlated with poor response, whilst baseline constipation correlated with good response. Conclusion: Chemoradiation for locally advanced rectal cancer affects multiple HRQoL domains. Our findings highlight the importance of psychological aspects of treatment. Significant differences were identified between the Asian and Caucasian populations, with Asians consistently performing worse. Poor correlations between patient and clinician reporting strongly support the inclusion of patient-reported outcomes in clinical studies. HRQoL domains of vomiting and constipation are potential biomarkers of treatment response.
Upregulated polo-like kinase 1 expression correlates with inferior survival outcomes in rectal cancer
Publisher: Public Library of Science (PLoS)
Date: 05-06-2015
Predictive and prognostic biomarkers for neoadjuvant chemoradiotherapy in locally advanced rectal cancer
Publisher: Elsevier BV
Date: 10-2015
DOI: 10.1016/J.CRITREVONC.2015.05.003
Abstract: Locally advanced rectal cancer is regularly treated with trimodality therapy consisting of neoadjuvant chemoradiation, surgery and adjuvant chemotherapy. There is a need for biomarkers to assess treatment response, and aid in stratification of patient risk to adapt and personalise components of the therapy. Currently, pathological stage and tumour regression grade are used to assess response. Experimental markers include proteins involved in cell proliferation, apoptosis, angiogenesis, the epithelial to mesenchymal transition and microsatellite instability. As yet, no single marker is sufficiently robust to have clinical utility. Microarrays that screen a tumour for multiple promising candidate markers, gene expression and microRNA profiling will likely have higher yield and it is expected that a combination or panel of markers would prove most useful. Moving forward, utilising serial s les of circulating tumour cells or circulating nucleic acids can potentially allow us to demonstrate tumour heterogeneity, document mutational changes and subsequently measure treatment response.
A Cohort Study to Examine the Use of Chinese Herbal Medicine in Combination With Conventional Therapies for Patients With Hepatocellular Carcinoma in China
Publisher: SAGE Publications
Date: 18-05-2018
Abstract: Background. Hepatocellular carcinoma (HCC) is one of the major malignancies associated with high mortality rates. Chinese herbal medicine (CHM) alone, or in combination with conventional therapies (CT), has been widely used for patients with HCC in China. This study aims to explore how integrative therapy (IT) through the combination of CHM and CT affects the survival of patients with intermediate-advanced HCC. Methods. A retrospective cohort study was performed at the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China. Data of consecutive patients diagnosed with intermediate-advanced HCC and a specific traditional Chinese medicine diagnostic pattern between January 2006 and December 2013 were retrieved from the electronic medical record system at the hospital. Patients were ided into 3 groups based on the therapies used, that is, IT, CHM alone, and CT alone, and the survival times of these patients was compared. Results. A total of 328 patients were included in this study. Median follow-up period was 26.4 months (95% confidence interval [CI] = 22.7-38.9). Median overall survival was 11.0 months for IT, 8.6 months for CHM, and 9.4 months for CT groups ( P .001). The adjusted hazard ratio (HR) of death for the IT group was 0.55 (95% CI = 0.38-0.79, P = .001) relative to the CT group and 0.68 (95% CI = 0.52-0.90, P = .007) relative to the CHM group, after adjusting for the factors that impact prognosis. Stratified analysis shows that IT can significantly lower the risk of death, especially for patients with good performance status (PS) and Child-Pugh class A. Conclusions. It was indicated that the integrative approach with combination of CHM and CT might improve survival for patients with intermediate-advanced HCC, especially for patients with good PS and Child-Pugh class A. However, a randomized controlled trial is warranted for a conclusive statement.
Development of Health Pathways to Standardize Cancer Care Pathways Informed by Patient-Reported Outcomes and Clinical Practice Guidelines.
Publisher: American Society of Clinical Oncology (ASCO)
Date: 12-2018
DOI: 10.1200/CCI.18.00024
Abstract: High-quality symptom management and supportive care are essential components of comprehensive cancer care. We aimed to describe the development of an evidence-based automated decisional algorithm for patients with cancer that had specific, actionable, clinical, evidence-based recommendations to improve patient care, communication, and management. We reviewed existing literature and clinical practice guidelines to identify priority domains of patient care and potential clinical recommendations. Two multidisciplinary clinical advisory groups used a two-stage consensus decision-making approach to determine domains of care and patient-reported outcome (PRO) measures and subsequently developed automated algorithms with clear clinical recommendations amendable to intervention in clinical settings. Algorithms were developed to inform management of patient symptoms, distress, and unmet needs. Three PRO measures were chosen: Distress Thermometer and problem checklist, Edmonton Symptom Assessment Scale, and the Supportive Care Needs Survey–Screening Tool 9. PRO items were mapped to five domains of patient well-being: physical, emotional, practical, social and family, and maintenance of well-being. A total of 15 actionable clinical recommendations tailored to specific issues of concern were established. Using automated algorithms and clinical recommendations provides a platform for streamlining and systematizing the use of PROs to inform risk-stratified guideline-informed care. The series of algorithms, which set out systematized care pathways for the clinical care of patients with cancer, can be used to potentially inform patient-centered care.
Development and Feasibility Testing of PROMPT-Care, an eHealth System for Collection and Use of Patient-Reported Outcome Measures for Personalized Treatment and Care: A Study Protocol
Publisher: JMIR Publications Inc.
Date: 24-11-2016
DOI: 10.2196/RESPROT.6459
Sidedness is prognostic in locoregional colon cancer: an analysis of 9509 Australian patients
Publisher: Springer Science and Business Media LLC
Date: 08-04-2017
Estimation of an evidence-based benchmark for the optimal endocrine therapy utilization rate in breast cancer.
Publisher: Elsevier BV
Date: 10-2010
Positron emission tomography and colorectal cancer
Publisher: Elsevier BV
Date: 2011
DOI: 10.1016/J.CRITREVONC.2010.04.011
Abstract: Colorectal cancer (CRC) is a major cause of cancer-related morbidity and mortality. Molecular imaging using positron emission tomography (PET) is now an integral part of multidisciplinary cancer care. In this review, we discuss the role of PET in CRC including well established indications in the assessment of recurrent disease and emerging applications such as initial staging, monitoring therapy efficacy and using PET for radiotherapy planning. With rapid advancement in imaging technology, we also discuss the future potential of combining PET and magnetic resonance imaging and the use of novel radiotracers.
Early Postoperative Low Expression of RAD50 in Rectal Cancer Patients Associates with Disease-Free Survival
Publisher: MDPI AG
Date: 30-11-2017
Web-Based Patient-Reported Outcome Measures for Personalized Treatment and Care (PROMPT-Care): Multicenter Pragmatic Nonrandomized Trial
Publisher: JMIR Publications Inc.
Date: 29-10-2020
DOI: 10.2196/19685
Abstract: Despite the acceptability and efficacy of e–patient-reported outcome (ePRO) systems, implementation in routine clinical care remains challenging. This pragmatic trial implemented the PROMPT-Care (Patient Reported Outcome Measures for Personalized Treatment and Care) web-based system into existing clinical workflows and evaluated its effectiveness among a erse population of patients with cancer. Adult patients with solid tumors receiving active treatment or follow-up care in four cancer centers were enrolled. The PROMPT-Care intervention supported patient management through (1) monthly off-site electronic PRO physical symptom and psychosocial well-being assessments, (2) automated electronic clinical alerts notifying the care team of unresolved clinical issues following two consecutive assessments, and (3) tailored online patient self-management resources. Propensity score matching was used to match controls with intervention patients in a 4:1 ratio for patient age, sex, and treatment status. The primary outcome was a reduction in emergency department presentations. Secondary outcomes were time spent on chemotherapy and the number of allied health service referrals. From April 2016 to October 2018, 328 patients from four public hospitals received the intervention. Matched controls (n=1312) comprised the general population of patients with cancer, seen at the participating hospitals during the study period. Emergency department visits were significantly reduced by 33% (P=.02) among patients receiving the intervention compared with patients in the matched controls. No significant associations were found in allied health referrals or time to end of chemotherapy. At baseline, the most common patient reported outcomes (above-threshold) were fatigue (39%), tiredness (38.4%), worry (32.9%), general wellbeing (32.9%), and sleep (24.1%), aligning with the most frequently accessed self-management domain pages of physical well-being (36%) and emotional well-being (23%). The majority of clinical feedback reports were reviewed by nursing staff (729/893, 82%), largely in response to the automated clinical alerts (n=877). Algorithm-supported web-based systems utilizing patient reported outcomes in clinical practice reduced emergency department presentations among a erse population of patients with cancer. This study also highlighted the importance of (1) automated triggers for reviewing above-threshold results in patient reports, rather than passive manual review of patient records (2) the instrumental role nurses play in managing alerts and (3) providing patients with resources to support guided self-management, where appropriate. Together, these factors will inform the integration of web-based PRO systems into future models of routine cancer care. Australian New Zealand Clinical Trials Registry ACTRN12616000615482 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370633 RR2-10.1186/s12885-018-4729-3
Overexpression of the MRE11-RAD50-NBS1 (MRN) complex in rectal cancer correlates with poor response to neoadjuvant radiotherapy and prognosis
Publisher: Springer Science and Business Media LLC
Date: 03-09-2018
Estimation of an optimal chemotherapy utilisation rate for colon cancer: an evidence-based benchmark for cancer care.
Publisher: Elsevier BV
Date: 09-2009
Web-Based Patient-Reported Outcome Measures for Personalized Treatment and Care (PROMPT-Care): Multicenter Pragmatic Nonrandomized Trial (Preprint)
Publisher: JMIR Publications Inc.
Date: 28-04-2020
Abstract: espite the acceptability and efficacy of e–patient-reported outcome (ePRO) systems, implementation in routine clinical care remains challenging. his pragmatic trial implemented the PROMPT-Care (Patient Reported Outcome Measures for Personalized Treatment and Care) web-based system into existing clinical workflows and evaluated its effectiveness among a erse population of patients with cancer. dult patients with solid tumors receiving active treatment or follow-up care in four cancer centers were enrolled. The PROMPT-Care intervention supported patient management through (1) monthly off-site electronic PRO physical symptom and psychosocial well-being assessments, (2) automated electronic clinical alerts notifying the care team of unresolved clinical issues following two consecutive assessments, and (3) tailored online patient self-management resources. Propensity score matching was used to match controls with intervention patients in a 4:1 ratio for patient age, sex, and treatment status. The primary outcome was a reduction in emergency department presentations. Secondary outcomes were time spent on chemotherapy and the number of allied health service referrals. rom April 2016 to October 2018, 328 patients from four public hospitals received the intervention. Matched controls (n=1312) comprised the general population of patients with cancer, seen at the participating hospitals during the study period. Emergency department visits were significantly reduced by 33% ( i P /i =.02) among patients receiving the intervention compared with patients in the matched controls. No significant associations were found in allied health referrals or time to end of chemotherapy. At baseline, the most common patient reported outcomes (above-threshold) were fatigue (39%), tiredness (38.4%), worry (32.9%), general wellbeing (32.9%), and sleep (24.1%), aligning with the most frequently accessed self-management domain pages of physical well-being (36%) and emotional well-being (23%). The majority of clinical feedback reports were reviewed by nursing staff (729/893, 82%), largely in response to the automated clinical alerts (n=877). lgorithm-supported web-based systems utilizing patient reported outcomes in clinical practice reduced emergency department presentations among a erse population of patients with cancer. This study also highlighted the importance of (1) automated triggers for reviewing above-threshold results in patient reports, rather than passive manual review of patient records (2) the instrumental role nurses play in managing alerts and (3) providing patients with resources to support guided self-management, where appropriate. Together, these factors will inform the integration of web-based PRO systems into future models of routine cancer care. ustralian New Zealand Clinical Trials Registry ACTRN12616000615482 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370633 R2-10.1186/s12885-018-4729-3
Migrant health in cancer: Outcome disparities and the determinant role of migrant-specific variables
Publisher: Oxford University Press (OUP)
Date: 23-03-2015
DOI: 10.1634/THEONCOLOGIST.2014-0274
Abstract: Multiethnic societies face challenges in delivering evidence-based culturally competent health care. This study compared health-related quality of life and psychological morbidity in a hospital-based s le of first-generation migrants and Australian-born Anglo cancer patients, controlling for potential confounders related to migrant status. Further, it explored the relative contribution of ethnicity versus migrant-related variables. Eligible participants, recruited via 16 oncology clinics in Australia, included those over the age of 18, diagnosed with cancer (any type or stage) within the previous 12 months and having commenced treatment at least 1 month previously. In total, 571 migrant patients (comprising 145 Arabic, 248 Chinese, and 178 Greek) and a control group of 274 Anglo-Australian patients participated. In multiple linear regression models adjusted for age, sex, education, marital status, socioeconomic status, time since diagnosis, and type of cancer, migrants had clinically significantly worse health-related quality of life (HRQL 3.6–7.3 points on FACT-G, p & .0001), higher depression and anxiety (both p & .0001), and higher incidence of clinical depression (p & .0001) and anxiety (p = .003) than Anglo-Australians. Understanding the health system (p & .0001 for each outcome) and difficulty communicating with the doctor (p = .04 to .0001) partially mediated the impact of migrancy. In migrant-only analyses, migrant-related variables (language difficulty and poor understanding of the health system), not ethnicity, predicted outcomes. Migrants who develop cancer have worse psychological and HRQL outcomes than Anglo-Australians. Potential targets for intervention include assistance in navigating the health system, translated information, and cultural competency training for health professionals.
Chemotherapy in rectal cancer: variation in utilization and development of an evidence-based benchmark rate of optimal chemotherapy utilization.
Publisher: Elsevier BV
Date: 06-2011
Circulating tumour cells and circulating free nucleic acid as prognostic and predictive biomarkers in colorectal cancer
Publisher: Elsevier BV
Date: 04-2014
DOI: 10.1016/J.CANLET.2013.12.019
Abstract: The detection of circulating tumour cells or circulating free tumour nucleic acids can potentially guide treatment and inform prognosis in colorectal cancer using minimally invasive "liquid biopsies". Current literature supports the notion that high circulating tumour cell counts or presence of tumour nucleic acid correlate with inferior clinical outcomes for patients, but they are not yet part of routine clinical care. Future research evolves around the examination of the molecular phenotype of circulating tumour cells. The key unanswered areas include differentiating between circulating tumour cell presence and their proliferative capacity and dormancy, identifying tumour heterogeneity and understanding the epithelial-mesenchymal transition.
Circulating tumour cells and the epithelial mesenchymal transition in colorectal cancer
Publisher: BMJ
Date: 09-07-2014
DOI: 10.1136/JCLINPATH-2014-202499
Abstract: Circulating tumour cells (CTCs) hold great potential as liquid biopsies to prognosticate disease and guide treatment in colorectal cancer. However, their emerging role in determining the molecular phenotype of tumour metastasis carries even more promising clinical use in the provision of comprehensive biomarker detection for targeted therapies and determination of drug resistance. The isolation of CTCs is technology dependent, and in the case of epithelial cell adhesion molecule-based platforms, the ability to detect cells that have undergone the epithelial to mesenchymal transition (EMT) is ineffective. CTCs displaying a mesenchymal phenotype are believed to have an increased metastatic potential. The rarity of CTCs provides another challenge in the enumeration of these cells. The future will likely involve the analysis of in idual CTCs at any stage of the EMT in order to provide real-time phenotypic and molecular snapshots capable of tracking the dynamic evolution of tumour progression over time.
Gastrointestinal perforation in metastatic colorectal cancer patients with peritoneal metastases receiving bevacizumab
Publisher: Baishideng Publishing Group Inc.
Date: 2015
Aberrant Expression of RAD52, Its Prognostic Impact in Rectal Cancer and Association with Poor Survival of Patients
Publisher: MDPI AG
Date: 04-03-2020
DOI: 10.3390/IJMS21051768
Abstract: The DNA damage response enables cells to survive and maintain genome integrity. RAD52 is a DNA-binding protein involved in the homologous recombination in DNA repair, and is important for the maintenance of tumour genome integrity. We investigated possible correlations between RAD52 expression and cancer survival and response to preoperative radiotherapy. RAD52 expression was examined in tumour s les from 179 patients who underwent surgery for rectal cancer, including a sub-cohort of 40 patients who were treated with neoadjuvant therapy. A high score for RAD52 expression in the tumour centre was significantly associated with worse disease-free survival (DFS p = 0.045). In contrast, reduced RAD52 expression in tumour centre s les from patients treated with neoadjuvant therapy (n = 40) significantly correlated with poor DFS (p = 0.025) and overall survival (OS p = 0.048). Our results suggested that RAD52 may have clinical value as a prognostic marker of tumour response to neoadjuvant radiation and both disease-free status and overall survival in patients with rectal cancer.
The Potential Value of Immunotherapy in Colorectal Cancers: Review of the Evidence for Programmed Death-1 Inhibitor Therapy
Publisher: Elsevier BV
Date: 12-2016
DOI: 10.1016/J.CLCC.2016.07.007
Abstract: Colorectal cancers (CRCs) have been identified as potential targets for immunotherapy with programmed cell death (PD)-1 inhibitors. English-language publications from MedLine and Embase that evaluated PD-1/PD ligand 1 (PD-L1) in the CRC tumor microenvironment and clinical trials that assessed PD-1 inhibitors were included. Sixteen abstracts were screened. Fifteen met the inclusion criteria. After review of the full texts, this resulted in a final reference list of 8 studies eligible for review. Five studies that assessed PD-1/PD-L1 in CRC and 3 trials that assessed PD-1 inhibitors were included. PD-1-positive (PD-1
A comparison of systemic breast cancer therapy utilization in Canada (British Columbia), Scotland (Dundee), and Australia (Western Australia) with models of optimal therapy.
Publisher: Elsevier BV
Date: 08-2012
The efficacy of oral ondansetron and dexamethasone for the prevention of acute chemotherapy-induced nausea and vomiting associated with moderately emetogenic chemotherapy - a retrospective audit
Publisher: Hindawi Limited
Date: 05-2010
DOI: 10.1111/J.1365-2354.2009.01068.X
Abstract: The optimal dose of oral ondansetron for the prevention of acute chemotherapy-induced nausea and vomiting (CINV) resulting from moderately emetogenic chemotherapy (MEC) is unknown. This retrospective audit was conducted to determine the efficacy of 8 mg oral ondansetron plus 8 mg oral dexamethasone as pre-chemotherapy anti-emetic regimen for patients receiving MEC. The efficacy outcomes analysed were the proportion of patients with no acute vomiting, proportion of patients with no acute nausea and the incidence of grade 3 or 4 CINV. A total of 81 patients were identified. The most frequent chemotherapy regimens received in the study population were anthracycline- (48%) and carboplatin-based (28%). No acute vomiting and nausea rates in the study population were 75% and 44% respectively. The incidence of grade 3 CINV was 1%. Patients who received anthracycline-based regimens had a significantly higher incidence of acute emesis (P= 0.001) and nausea (P < 0.0001) when compared with patients who received non-anthracycline-based regimens. In this study, the use of 8 mg oral ondansetron plus 8 mg oral dexamethasone achieved control of acute emesis in 75% of all patients receiving MEC which is comparable to previously reported rates of 70-80%. The benefits of using oral pre-chemotherapy anti-emetics include reduction in the costs of drugs and nursing administration time.
Estimation of an optimal chemotherapy utilisation rate for upper gastrointestinal cancers: setting an evidence-based benchmark for the best-quality cancer care.
Publisher: Hindawi Limited
Date: 2015
DOI: 10.1155/2015/753480
Abstract: Aims . The proportion of patients with upper gastrointestinal cancers that received chemotherapy varies widely in Australia and internationally, indicating a need for a benchmark rate of chemotherapy utilisation. We developed evidence-based models for upper gastrointestinal cancers to estimate the optimal chemotherapy utilisation rates that can serve as useful benchmarks for measuring and improving the quality of care. Materials and Methods . Optimal chemotherapy utilisation models for cancers of the oesophagus, stomach, pancreas, gallbladder, and primary liver were constructed using indications for chemotherapy identified from evidence-based guidelines. Results . Based on the best available evidence, the optimal proportion of upper gastrointestinal cancers that should receive chemotherapy at least once during the course of the patients’ illness was estimated to be 79% for oesophageal cancer, 83% for gastric cancer, 35% for pancreatic cancer, 80% for gallbladder cancer, and 27% for primary liver cancer. Conclusions . The reported chemotherapy utilisation rates for upper gastrointestinal cancers (with the exception of primary liver cancer) appear to be substantially lower than the estimated optimal rates suggesting that chemotherapy may be underutilised. Further studies to elucidate the reasons for the potential underutilisation of chemotherapy in upper gastrointestinal tumours are required to bridge the gap between the ideal and actual practice identified.
MRI rectal cancer in Australia and New Zealand: an audit from the PETACC-6 trial
Publisher: Wiley
Date: 11-07-2017
Abstract: An MRI audit substudy was conducted in patients who underwent an MRI prior to treatment in Australia and New Zealand as part of the PETACC-6 trial in locally advanced rectal cancer. A total of 82 patients from 15 centres had rectal MRI scans reviewed for technique, data included in reports and comparison of reports with blinded central reporting by two experienced radiologists. In total, 82% performed minimum T2 sagittal and T2 axial oblique sequences. The high-resolution T2 sequence parameters varied significantly with only 33% obtaining a voxel size of <1.3 mm There is significant variation in scan quality and low rates of including all relevant findings in rectal MRI reports in the audit. The authors recommend adoption of routine sequences and template reports in both trial settings and routine practice to improve scan technique and adequacy of reports in rectal cancer MRI staging scans across Australia and New Zealand.
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