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Bierbaum M, Rapport F, Arnolda G, Tran Y, Nic Giolla Easpaig B, Ludlow K, Clay-Williams R, Austin E, Laginha B, Lo CY, Churruca K, van Baar L, Hutchinson K, Chittajallu R, Owais SS, Nullwala R, Hibbert P, Fajardo Pulido D, Braithwaite J. Rates of adherence to cancer treatment guidelines in Australia and the factors associated with adherence: A systematic review. Asia Pac J Clin Oncol 2023; 19:618-644. [PMID: 36881529 DOI: 10.1111/ajco.13948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 03/08/2023]
Abstract
Adherence to cancer treatment clinical practice guidelines (CPGs) varies enormously across Australia, despite being associated with improved patient outcomes. This systematic review aims to characterize adherence rates to active-cancer treatment CPGs in Australia and related factors to inform future implementation strategies. Five databases were systematically searched, abstracts were screened for eligibility, a full-text review and critical appraisal of eligible studies performed, and data extracted. A narrative synthesis of factors associated with adherence was conducted, and the median adherence rates within cancer streams calculated. A total of 21,031 abstracts were identified. After duplicates were removed, abstracts screened, and full texts reviewed, 20 studies focused on adherence to active-cancer treatment CPGs were included. Overall adherence rates ranged from 29% to 100%. Receipt of guideline recommended treatments was higher for patients who were younger (diffuse large B-cell lymphoma [DLBCL], colorectal, lung, and breast cancer); female (breast and lung cancer), and male (DLBCL and colorectal cancer); never smokers (DLBCL and lung cancer); non-Indigenous Australians (cervical and lung cancer); with less advanced stage disease (colorectal, lung, and cervical cancer), without comorbidities (DLBCL, colorectal, and lung cancer); with good-excellent Eastern Cooperative Oncology Group performance status (lung cancer); living in moderately accessible places (colon cancer); and; treated in metropolitan facilities (DLBLC, breast and colon cancer). This review characterized active-cancer treatment CPG adherence rates and associated factors in Australia. Future targeted CPG implementation strategies should account for these factors, to redress unwarranted variation particularly in vulnerable populations, and improve patient outcomes (Prospero number: CRD42020222962).
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Affiliation(s)
- Mia Bierbaum
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
- Centre for Research Excellence in Implementation Science in Oncology, AIHI, Macquarie University, Sydney, Australia
| | - Yvonne Tran
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
- Centre for Research Excellence in Implementation Science in Oncology, AIHI, Macquarie University, Sydney, Australia
| | - Brona Nic Giolla Easpaig
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
- Centre for Research Excellence in Implementation Science in Oncology, AIHI, Macquarie University, Sydney, Australia
| | - Kristiana Ludlow
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Elizabeth Austin
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Bela Laginha
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Chi Yhun Lo
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Lieke van Baar
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Karen Hutchinson
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Renuka Chittajallu
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
- Riverina Cancer Care Centre, Wagga Wagga, New South Wales, Australia
- GenesisCare, Kingswood, New South Wales, Australia
| | - Syeda Somyyah Owais
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Ruqaiya Nullwala
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
- North Eastern Public Health Unit, Eastern Health, Melbourne, Victoria, Australia
| | - Peter Hibbert
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
- South Australian Health & Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Diana Fajardo Pulido
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
- Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
- Centre for Research Excellence in Implementation Science in Oncology, AIHI, Macquarie University, Sydney, Australia
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Chong K, Maida J, Ong HI, Proud D, Lin J, Burgess A, Heriot A, Smart P, Mohan H. Cancer incidence and outcomes registries in an Australian context: a systematic review. ANZ J Surg 2023; 93:2314-2336. [PMID: 37668278 DOI: 10.1111/ans.18678] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Multiple cancer registries in Australia are used to track the incidence of cancer and the outcomes of their treatment. These registries can be broadly classed into a few types with an increasing number of registries comes a greater potential for collaboration and linkage. This article aims to critically review cancer registry types in Australia and evaluate the Australian Cancer registry landscape to identify these areas. METHODS A systematic review was performed through MEDLINE, EMBASE and Cochrane Library, updated to September 2022 using a predefined search strategy. Inclusion criteria were those that only analysed Australian and/or New Zealand based cancer registries, appraised the utility of cancer outcomes and/or incidence registries, and explored the utility of linked databases using cancer outcomes and/or incidence registries. The grey literature was searched for all operating cancer registries in Australia. Details of registry infrastructure was extracted for analysis and comparison. RESULTS Three thousand two hundred and sixteen articles identified from the three databases. Twelve met the inclusion criteria. Twenty-eight registries were identified using the grey literature. Strengths and weaknesses of Cancer Outcome Registries(COR) and Cancer Incidence Registries(CIR) were compared. Data linkage between registries or with other healthcare databases show great benefits in improving evidence for cancer research but are challenging to implement. Both registry types utilize differing modes of administration, influencing their accuracy and completeness. CONCLUSION Outcome registries provide detailed data but their weakness lies in incomplete data coverage. Incidence registries record a large dataset which contain inaccuracies. Improving coverage of quality outcome registries, and quality assurance of data in incidence registries is required to ensure collection of accurate, meaningful data. Areas for collaboration identified included establishment of defined definitions and outcomes, data linkage between registry types or with healthcare databases, and collaboration in logistical planning to improve clinical utility of cancer registries.
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Affiliation(s)
- Kit Chong
- Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Jack Maida
- Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Hwa Ian Ong
- Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia
| | - David Proud
- Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia
| | - James Lin
- Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Adele Burgess
- Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Alexander Heriot
- Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
- Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Philip Smart
- Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Helen Mohan
- Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia
- Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Edney LC, Roseleur J, Bright T, Watson DI, Arnolda G, Braithwaite J, Delaney GP, Liauw W, Mitchell R, Karnon J. DAta Linkage to Enhance Cancer Care (DaLECC): Protocol of a Large Australian Data Linkage Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5987. [PMID: 37297591 PMCID: PMC10252629 DOI: 10.3390/ijerph20115987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/17/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023]
Abstract
Cancer is a leading cause of global morbidity and mortality, accounting for 250 Disability-Adjusted Life Years and 10 million deaths in 2019. Minimising unwarranted variation and ensuring appropriate cost-effective treatment across primary and tertiary care to improve health outcomes is a key health priority. There are few studies that have used linked data to explore healthcare utilisation prior to diagnosis in addition to post-diagnosis patterns of care. This protocol outlines the aims of the DaLECC project and key methodological features of the linked dataset. The primary aim of this project is to explore predictors of variations in pre- and post-cancer diagnosis care, and to explore the economic and health impact of any variation. The cohort of patients includes all South Australian residents diagnosed with cancer between 2011 and 2020, who were recorded on the South Australian Cancer Registry. These cancer registry records are being linked with state and national healthcare databases to capture health service utilisation and costs for a minimum of one-year prior to diagnosis and to a maximum of 10 years post-diagnosis. Healthcare utilisation includes state databases for inpatient separations and emergency department presentations and national databases for Medicare services and pharmaceuticals. Our results will identify barriers to timely receipt of care, estimate the impact of variations in the use of health care, and provide evidence to support interventions to improve health outcomes to inform national and local decisions to enhance the access and uptake of health care services.
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Affiliation(s)
- Laura C. Edney
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA 5042, Australia
| | - Jackie Roseleur
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA 5042, Australia
| | - Tim Bright
- Oesophagogastric Surgery Unit, Flinders Medical Centre, Bedford Park, SA 5042, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia
| | - David I. Watson
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA 5042, Australia
- Oesophagogastric Surgery Unit, Flinders Medical Centre, Bedford Park, SA 5042, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW 2109, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW 2109, Australia
| | - Geoffrey P. Delaney
- Liverpool Cancer Therapy Centre, Liverpool, NSW 2170, Australia
- South Western Sydney Clinical School, University of New South Wales, Liverpool, NSW 2170, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
| | - Winston Liauw
- St. George Cancer Care Centre, St. George Hospital, Kogarah, NSW 2217, Australia
- St. George Hospital Clinical School, University of New South Wales, Sydney, NSW 2217, Australia
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW 2109, Australia
| | - Jonathan Karnon
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA 5042, Australia
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Variations in Patterns of Care of Rectal Cancer Patients in South Australia According to Sociodemographic Characteristics:A Registry Study. Eur J Cancer Care (Engl) 2023. [DOI: 10.1155/2023/7974059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Objective. To explore variations in patterns of care over three decades for a subgroup of rectal cancer patients in South Australia according to sociodemographic characteristics. Methods. This study evaluated three decades of retrospective data from the South Australian Clinical Cancer Registry. A total of 4,131 patients diagnosed with rectal cancer between 1982 and 2015 and treated in South Australian public hospitals were included. Study outcomes were age at diagnosis, area of primary residence, cancer stage, and primary treatment (surgery, chemotherapy, or radiotherapy). Results. There was a significantly lower likelihood of conventional therapy for the elderly. Adjusted odds of receiving surgery or radiotherapy decreased by 70% and those of receiving chemotherapy by 90% in the 80+ age group, compared to the 50–59 age group. No significant variation was detected according to area-level socioeconomic status or remoteness. Conclusion. Socioeconomic factors showed little impact on the receipt of therapies for rectal cancer patients in South Australia. Variation in treatment by age, irrespective of disease stage or period of diagnosis, requires further investigation.
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Cancer Treatment Patterns and Factors Affecting Receipt of Treatment in Older Adults: Results from the ASPREE Cancer Treatment Substudy (ACTS). Cancers (Basel) 2023; 15:cancers15041017. [PMID: 36831362 PMCID: PMC9953887 DOI: 10.3390/cancers15041017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/19/2023] [Accepted: 02/02/2023] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Cancer treatment planning in older adults is complex and requires careful balancing of survival, quality of life benefits, and risk of treatment-related morbidity and toxicity. As a result, treatment selection in this cohort tends to differ from that for younger patients. However, there are very few studies describing cancer treatment patterns in older cohorts. METHODS We used data from the ASPirin in Reducing Events in the Elderly (ASPREE) trial and the ASPREE Cancer Treatment Substudy (ACTS) to describe cancer treatment patterns in older adults. We used a multivariate logistic regression model to identify factors affecting receipt of treatment. RESULTS Of 1893 eligible Australian and United States (US) participants with incident cancer, 1569 (81%) received some form of cancer treatment. Non-metastatic breast cancers most frequently received treatment (98%), while haematological malignancy received the lowest rates of treatment (60%). Factors associated with not receiving treatment were older age (OR 0.94, 95% CI 0.91-0.96), residence in the US (OR 0.34, 95% CI 0.22-0.54), smoking (OR 0.57, 95% CI 0.40-0.81), and diabetes (OR 0.56, 95% CI 0.39-0.80). After adjustment for treatment patterns in sex-specific cancers, sex did not impact receipt of treatment. CONCLUSIONS This study is one of the first describing cancer treatment patterns and factors affecting receipt of treatment across common cancer types in older adults. We found that most older adults with cancer received some form of cancer treatment, typically surgery or systemic therapy, although this varied by factors such as cancer type, age, sex, and country of residence.
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Yap S, He E, Egger S, Goldsbury DE, Lew JB, Ngo PJ, Worthington J, Rillstone H, Zalcberg JR, Cuff J, Ward RL, Canfell K, Feletto E, Steinberg J. Colon and rectal cancer treatment patterns and their associations with clinical, sociodemographic and lifestyle characteristics: analysis of the Australian 45 and Up Study cohort. BMC Cancer 2023; 23:60. [PMID: 36650482 PMCID: PMC9845101 DOI: 10.1186/s12885-023-10528-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/09/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Colorectal cancer is the third most diagnosed cancer globally and the second leading cause of cancer death. We examined colon and rectal cancer treatment patterns in Australia. METHODS From cancer registry records, we identified 1,236 and 542 people with incident colon and rectal cancer, respectively, diagnosed during 2006-2013 in the 45 and Up Study cohort (267,357 participants). Cancer treatment and deaths were determined via linkage to routinely collected data, including hospital and medical services records. For colon cancer, we examined treatment categories of "surgery only", "surgery plus chemotherapy", "other treatment" (i.e. other combinations of surgery/chemotherapy/radiotherapy), "no record of cancer-related treatment, died"; and, for rectal cancer, "surgery only", "surgery plus chemotherapy and/or radiotherapy", "other treatment", and "no record of cancer-related treatment, died". We analysed survival, time to first treatment, and characteristics associated with treatment receipt using competing risks regression. RESULTS 86.4% and 86.5% of people with colon and rectal cancer, respectively, had a record of receiving any treatment ≤2 years post-diagnosis. Of those treated, 93.2% and 90.8% started treatment ≤2 months post-diagnosis, respectively. Characteristics significantly associated with treatment receipt were similar for colon and rectal cancer, with strongest associations for spread of disease and age at diagnosis (p<0.003). For colon cancer, the rate of "no record of cancer-related treatment, died" was higher for people with distant spread of disease (versus localised, subdistribution hazard ratio (SHR)=13.6, 95% confidence interval (CI):5.5-33.9), age ≥75 years (versus age 45-74, SHR=3.6, 95%CI:1.8-7.1), and visiting an emergency department ≤1 month pre-diagnosis (SHR=2.9, 95%CI:1.6-5.2). For rectal cancer, the rate of "surgery plus chemotherapy and/or radiotherapy" was higher for people with regional spread of disease (versus localised, SHR=5.2, 95%CI:3.6-7.7) and lower for people with poorer physical functioning (SHR=0.5, 95%CI:0.3-0.8) or no private health insurance (SHR=0.7, 95%CI:0.5-0.9). CONCLUSION Before the COVID-19 pandemic, most people with colon or rectal cancer received treatment ≤2 months post-diagnosis, however, treatment patterns varied by spread of disease and age. This work can be used to inform future healthcare requirements, to estimate the impact of cancer control interventions to improve prevention and early diagnosis, and serve as a benchmark to assess treatment delays/disruptions during the pandemic. Future work should examine associations with clinical factors (e.g. performance status at diagnosis) and interdependencies between characteristics such as age, comorbidities, and emergency department visits.
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Affiliation(s)
- Sarsha Yap
- grid.1013.30000 0004 1936 834XThe Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, 153 Dowling St, Woolloomooloo, Sydney, New South Wales 2011 Australia
| | - Emily He
- grid.1013.30000 0004 1936 834XThe Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, 153 Dowling St, Woolloomooloo, Sydney, New South Wales 2011 Australia
| | - Sam Egger
- grid.1013.30000 0004 1936 834XThe Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, 153 Dowling St, Woolloomooloo, Sydney, New South Wales 2011 Australia
| | - David E Goldsbury
- grid.1013.30000 0004 1936 834XThe Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, 153 Dowling St, Woolloomooloo, Sydney, New South Wales 2011 Australia
| | - Jie-Bin Lew
- grid.1013.30000 0004 1936 834XThe Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, 153 Dowling St, Woolloomooloo, Sydney, New South Wales 2011 Australia
| | - Preston J Ngo
- grid.1013.30000 0004 1936 834XThe Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, 153 Dowling St, Woolloomooloo, Sydney, New South Wales 2011 Australia
| | - Joachim Worthington
- grid.1013.30000 0004 1936 834XThe Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, 153 Dowling St, Woolloomooloo, Sydney, New South Wales 2011 Australia
| | - Hannah Rillstone
- grid.420082.c0000 0001 2166 6280Cancer Policy and Advocacy, Cancer Council NSW, Woolloomooloo, Sydney, New South Wales Australia
| | - John R Zalcberg
- grid.1002.30000 0004 1936 7857School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria Australia ,grid.267362.40000 0004 0432 5259Department of Medical Oncology, Alfred Health, Melbourne, Victoria Australia
| | - Jeff Cuff
- grid.1005.40000 0004 4902 0432Faculty of Science Biotech and Biomolecular Science, University of New South Wales, Sydney, New South Wales Australia ,Research Advocate, The Daffodil Centre, Sydney, New South Wales Australia
| | - Robyn L Ward
- grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, University of Sydney, Sydney, New South Wales Australia
| | - Karen Canfell
- grid.1013.30000 0004 1936 834XThe Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, 153 Dowling St, Woolloomooloo, Sydney, New South Wales 2011 Australia
| | - Eleonora Feletto
- grid.1013.30000 0004 1936 834XThe Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, 153 Dowling St, Woolloomooloo, Sydney, New South Wales 2011 Australia
| | - Julia Steinberg
- grid.1013.30000 0004 1936 834XThe Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, 153 Dowling St, Woolloomooloo, Sydney, New South Wales 2011 Australia
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Bierbaum M, Rapport F, Arnolda G, Delaney GP, Liauw W, Olver I, Braithwaite J. Clinical practice guideline adherence in oncology: A qualitative study of insights from clinicians in Australia. PLoS One 2022; 17:e0279116. [PMID: 36525435 PMCID: PMC9757567 DOI: 10.1371/journal.pone.0279116] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The burden of cancer is large in Australia, and rates of cancer Clinical Practice Guideline (CPG) adherence is suboptimal across various cancers. METHODS The objective of this study is to characterise clinician-perceived barriers and facilitators to cancer CPG adherence in Australia. Semi-structured interviews were conducted to collect data from 33 oncology-focused clinicians (surgeons, radiation oncologists, medical oncologists and haematologists). Clinicians were recruited in 2019 and 2020 through purposive and snowball sampling from 7 hospitals across Sydney, Australia, and interviewed either face-to-face in hospitals or by phone. Audio recordings were transcribed verbatim, and qualitative thematic analysis of the interview data was undertaken. Human research ethics committee approval and governance approval was granted (2019/ETH11722, #52019568810127). RESULTS Five broad themes and subthemes of key barriers and facilitators to cancer treatment CPG adherence were identified: Theme 1: CPG content; Theme 2: Individual clinician and patient factors; Theme 3: Access to, awareness of and availability of CPGs; Theme 4: Organisational and cultural factors; and Theme 5: Development and implementation factors. The most frequently reported barriers to adherence were CPGs not catering for patient complexities, being slow to be updated, patient treatment preferences, geographical challenges for patients who travel large distances to access cancer services and limited funding of CPG recommended drugs. The most frequently reported facilitators to adherence were easy accessibility, peer review, multidisciplinary engagement or MDT attendance, and transparent CPG development by trusted, multidisciplinary experts. CPGs provide a reassuring framework for clinicians to check their treatment plans against. Clinicians want cancer CPGs to be frequently updated utilising a wiki-like process, and easily accessible online via a comprehensive database, coordinated by a well-trusted development body. CONCLUSION Future implementation strategies of cancer CPGs in Australia should be tailored to consider these context-specific barriers and facilitators, taking into account both the content of CPGs and the communication of that content. The establishment of a centralised, comprehensive, online database, with living wiki-style cancer CPGs, coordinated by a well-funded development body, along with incorporation of recommendations into point-of-care decision support would potentially address many of the issues identified.
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Affiliation(s)
- Mia Bierbaum
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- * E-mail:
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Centre for Research Excellence in Implementation Science in Oncology, Sydney, Australia
| | - Geoff P. Delaney
- Centre for Research Excellence in Implementation Science in Oncology, Sydney, Australia
- SWSLHD Cancer Services, Liverpool, Australia
| | - Winston Liauw
- Centre for Research Excellence in Implementation Science in Oncology, Sydney, Australia
- SESLHD Cancer Service, Kogarah, Australia
| | - Ian Olver
- School of Psychology, University of Adelaide, Adelaide, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Centre for Research Excellence in Implementation Science in Oncology, Sydney, Australia
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8
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Gugusheff J, White K, Fitzadam S, Creighton N, Engel A, Lee M, Thompson SR, Chantrill L, Young J, Currow D. Population-level utilisation of neoadjuvant radiotherapy for the treatment of rectal cancer. J Surg Oncol 2022; 126:322-329. [PMID: 35362557 DOI: 10.1002/jso.26872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/13/2022] [Indexed: 11/12/2022]
Abstract
PURPOSE International clinical guidelines recommend long- or short-course neoadjuvant radiotherapy for locally advanced rectal cancer. This study aims to examine variation in the use of neoadjuvant radiotherapy for rectal cancer and identify patient and hospital factors that underpin this variation. METHODS AND MATERIALS We conducted a retrospective, consecutive cohort study using statewide hospitalisation and radiotherapy data from New South Wales, Australia, 2013-2018. Included participants had a primary rectal adenocarcinoma and underwent surgical resection. Factors associated with the use or not of any neoadjuvant radiotherapy, and short versus long-course were explored using multilevel logistic regression models. RESULTS Of the 2912 people included in the study, 43% received neoadjuvant radiotherapy. There was significant variation in the use of neoadjuvant radiotherapy depending on geographic location. Abdominoperineal excision (odds ratio [OR] = 1.87, 95% confidence interval [CI] = 1.53-2.28) and having surgery in a public hospital (OR = 2.34, 95% CI = 1.92-2.87) were both predictors of use. Among those receiving neoadjuvant radiotherapy, 17% received short-course therapy, with short-course declining over the study period. CONCLUSIONS The use of neoadjuvant radiotherapy for rectal cancer is highly variable, with differences only partially explained by assessable patient-or hospital-level factors. Understanding neoadjuvant radiotherapy utilisation patterns may assist in identifying barriers and opportunities to improve adherence to clinical guidelines.
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Affiliation(s)
| | - Kahren White
- Cancer Institute NSW, St Leonards, New South Wales, Australia
| | | | | | - Alexander Engel
- Royal North Shore Hospital, St Leonards, New South Wales, Australia.,School of Medicine, University of Sydney, Sydney, Australia
| | - Mark Lee
- School of Medicine, University of New South Wales, Kensington, Australia.,Department of Radiation Oncology, Liverpool Hospital, New South Wales, Australia
| | - Stephen R Thompson
- School of Medicine, University of New South Wales, Kensington, Australia.,Department of Radiation Oncology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Lorraine Chantrill
- School of Medicine, University of New South Wales, Kensington, Australia.,Illawarra Shoalhaven Local Health District, New South Wales, Australia
| | - Jane Young
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - David Currow
- Cancer Institute NSW, St Leonards, New South Wales, Australia
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9
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Tham N, Skandarajah A, Hayes IP. Colorectal cancer databases and registries in Australia: what data is available? ANZ J Surg 2021; 92:27-33. [PMID: 34569698 DOI: 10.1111/ans.17221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 08/29/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND There are multiple data sources relating to colorectal cancer (CRC) nationwide. Prospective clinical cancer databases, population-based registries and linked administrative data are powerful tools in clinical outcomes research and provide real-world perspective on cancer treatments. This study aims to review the different Australian data sources for CRC from the perspective of conducting comparative research studies using a PICO (patient, intervention, comparison, outcome) framework. METHODS Data dictionaries from the different data sources were evaluated for the types of exposure and outcome variables contained to highlight their differing research utility. RESULTS State or territory-based cancer registries contain limited histology, cancer staging and treatment detail. They enable investigation of population-level patterns in overall survival (OS) of cancer patients with different demographics. Prospective clinical cancer databases contain more detail, especially surgical. Their strength is in auditing short-term surgical outcomes. They vary in the amount of data collected for other cancer treatments and completion of follow up data. Linked administrative databases have broad population coverage but less surgical detail. They provide population-level data on treatment patterns, short-term outcome measures and OS, as well as long-term surgical outcomes such as identifying patients who did not undergo stoma reversal. These databases cannot assess disease-free survival. CONCLUSION Of the various CRC data sources within Australia, linked administrative databases have the potential to provide the widest population coverage combined with the broadest range of exposures and outcomes, and arguably the most research utility.
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Affiliation(s)
- Nicole Tham
- Colorectal Surgical Unit, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anita Skandarajah
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ian P Hayes
- Colorectal Surgical Unit, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
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10
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Scheepers ERM, Schiphorst AH, van Huis-Tanja LH, Emmelot-Vonk MH, Hamaker ME. Treatment patterns and primary reasons for adjusted treatment in older and younger patients with stage II or III colorectal cancer. Eur J Surg Oncol 2021; 47:1675-1682. [PMID: 33563486 DOI: 10.1016/j.ejso.2021.01.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 01/10/2021] [Accepted: 01/29/2021] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE This study aims to assess age-related treatment patterns and primary reasons for adjusted treatment in patients with colorectal cancer. METHODS Patients with colorectal cancer stage II or III diagnosed between 2015 and 2018 in the Netherlands were eligible for this study. Data were provided by the Netherlands Cancer Registry and included socio-demographics, clinical characteristics, treatment patterns and primary reasons for adjusted treatment. Treatment patterns and reasons for adjusted treatment were analysed according to age groups. RESULTS Of all 29,620 patients, 30% were aged <65 years (n = 8994), 34% between 65 and 75 years (n = 10,173), 27% between 75 and 85 years (n = 8102) and 8% were ≥85 years (n = 2349). Irrespective of cancer location or stage, older patients received less frequently a combination of surgery and (neo)adjuvant therapy compared to younger patients (decreasing from 55% to 1% in colon cancer patients, and from 71% to 23% in rectal cancer patients aged <65 years and ≥85 years respectively). Omission of surgical treatment increased with age in both patients with colon cancer (ranging from 1% in patients aged <65 years to 16% in those ≥85 years) and rectal cancer (ranging from 12% in patients aged <65 years to 56% in those ≥85 years). The most common reasons for adjusted treatment were patient preference (27%) and functional status (20%), both reasons increased with advancing age. CONCLUSIONS Guideline non-adherence increased with advancing age and omission of standard treatment was mainly based on patient preference and functional status. These findings provides insight in the treatment decision-making process in patients with colorectal cancer. Future research is necessary to further assess patient's role in the treatment decision-making process.
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Affiliation(s)
- E R M Scheepers
- Department of Internal Medicine, Diakonessenhuis, Utrecht, the Netherlands.
| | - A H Schiphorst
- Department of Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - L H van Huis-Tanja
- Department of Internal Medicine, Diakonessenhuis, Utrecht, the Netherlands
| | - M H Emmelot-Vonk
- Department of Geriatric Medicine, University Medical Centre Utrecht, the Netherlands
| | - M E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis, Utrecht, the Netherlands
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11
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Pule L, Buckley E, Niyonsenga T, Roder D. Optimizing the measurement of comorbidity for a South Australian colorectal cancer population using administrative data. J Eval Clin Pract 2020; 26:1250-1258. [PMID: 31721394 DOI: 10.1111/jep.13305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 09/11/2019] [Accepted: 10/08/2019] [Indexed: 12/23/2022]
Abstract
RATIONALE AND OBJECTIVES In epidemiological research, it is essential to account for the confounding effects of factors such as age, stage, and comorbidity for accurate prediction of cancer outcomes. There are several internationally developed and commonly used comorbidity indices. However, none are regarded as the gold-standard method. This study will assess and compare the predictive validity of established indices for use in a South Australian (SA) colorectal cancer (CRC) population against a local index. Furthermore, the prognostic influence of comorbidity on survival is investigated. METHODS A population-based study of patients diagnosed with CRC from 2003 to 2012 and linked to in-hospital data to retrieve comorbidity information was conducted. The predictive performance of established indices, Charlson comorbidity index (CCI), National Cancer Institute comorbidity index (NCI), Elixhauser comorbidity index (ECI), and C3 index was evaluated using the Fine and Gray competing risk regression and reported using measures of calibration and discrimination, area under the curve (AUC), and Brier score. Furthermore, to identify the optimal index, a local CRC comorbidity index (CRCCI) was also developed and its performance compared with the established indices. RESULTS Comorbidity models adjusted for age, sex, and stage showed that all indices were good predictors of mortality as measured by the AUC (CCI: 0.738, NCI: 0.742, ECI: 0.733, C3: 0.739). CRCCI had similar mortality prediction as established indices (CRCCI: 0.747). There was a significant increase in cumulative risk of noncancer and CRC-specific mortality with increase in comorbidity scores. The two most prevalent comorbidities were hypertension and diabetes. CONCLUSIONS The existing indices are still valid for adjusting for comorbidity and accurately predicting mortality in an SA CRC population. Internationally developed indices are preferred when policymakers and researchers wish to compare local study results with those of studies (national and international) that have used these indices. Comorbidity is a predictor of mortality and should be considered when assessing CRC survival.
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Affiliation(s)
- Lettie Pule
- Cancer Epidemiology and Population Health Research Group, University of South Australia Cancer Research Institute, Adelaide, South Australia, Australia
| | - Elizabeth Buckley
- Cancer Epidemiology and Population Health Research Group, University of South Australia Cancer Research Institute, Adelaide, South Australia, Australia
| | - Theo Niyonsenga
- Cancer Epidemiology and Population Health Research Group, University of South Australia Cancer Research Institute, Adelaide, South Australia, Australia.,Centre for Research and Action in Public Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - David Roder
- Cancer Epidemiology and Population Health Research Group, University of South Australia Cancer Research Institute, Adelaide, South Australia, Australia
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12
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Jewell A, Broadbent M, Hayes RD, Gilbert R, Stewart R, Downs J. Impact of matching error on linked mortality outcome in a data linkage of secondary mental health data with Hospital Episode Statistics (HES) and mortality records in South East London: a cross-sectional study. BMJ Open 2020; 10:e035884. [PMID: 32641360 PMCID: PMC7342822 DOI: 10.1136/bmjopen-2019-035884] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Linkage of electronic health records (EHRs) to Hospital Episode Statistics (HES)-Office for National Statistics (ONS) mortality data has provided compelling evidence for lower life expectancy in people with severe mental illness. However, linkage error may underestimate these estimates. Using a clinical sample (n=265 300) of individuals accessing mental health services, we examined potential biases introduced through missed matching and examined the impact on the association between clinical disorders and mortality. SETTING The South London and Maudsley NHS Foundation Trust (SLaM) is a secondary mental healthcare provider in London. A deidentified version of SLaM's EHR was available via the Clinical Record Interactive Search system linked to HES-ONS mortality records. PARTICIPANTS Records from SLaM for patients active between January 2006 and December 2016. OUTCOME MEASURES Two sources of death data were available for SLaM participants: accurate and contemporaneous date of death via local batch tracing (gold standard) and date of death via linked HES-ONS mortality data. The effect of linkage error on mortality estimates was evaluated by comparing sociodemographic and clinical risk factor analyses using gold standard death data against HES-ONS mortality records. RESULTS Of the total sample, 93.74% were successfully matched to HES-ONS records. We found a number of statistically significant administrative, sociodemographic and clinical differences between matched and unmatched records. Of note, schizophrenia diagnosis showed a significant association with higher mortality using gold standard data (OR 1.08; 95% CI 1.01 to 1.15; p=0.02) but not in HES-ONS data (OR 1.05; 95% CI 0.98 to 1.13; p=0.16). Otherwise, little change was found in the strength of associated risk factors and mortality after accounting for missed matching bias. CONCLUSIONS Despite significant clinical and sociodemographic differences between matched and unmatched records, changes in mortality estimates were minimal. However, researchers and policy analysts using HES-ONS linked resources should be aware that administrative linkage processes can introduce error.
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Affiliation(s)
- Amelia Jewell
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Richard D Hayes
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Ruth Gilbert
- Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, London, UK
| | - Robert Stewart
- South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Johnny Downs
- South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
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13
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Udayasiri DK, MacCallum C, Da Silva N, Skandarajah A, Hayes IP. Impact of hospital geographic remoteness on overall survival after colorectal cancer resection using state-wide administrative data. ANZ J Surg 2020; 90:1321-1327. [PMID: 32496014 DOI: 10.1111/ans.15991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 04/22/2020] [Accepted: 04/25/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND This study aimed to use administrative data (AD) linked to the Victorian death index (VDI) to report on overall long-term survival following colorectal cancer (CRC) surgery, comparing regional to metropolitan hospitals. METHODS A retrospective cohort study using prospectively gathered AD linked to VDI. The primary outcome was overall survival (OS). Outcomes were adjusted for potential confounders via multivariable Cox proportional hazard regression analysis. RESULTS Total of 17 533 patients: 12 879 metropolitan patients, 3835 inner regional patients and 719 outer regional patients. Multivariable Cox regression, adjusted for the effects of age, ASA score, Charlson score, position of tumour, mode of access, admission type, lymph node metastases, distant metastases, return to theatre, length of stay, HDU admission and discharge destination showed no difference in OS comparing CRC resection patients from inner or outer regional hospitals to metropolitan ((HR 1.02, 95% CI 0.95-1.09, P = 0.59) and (HR 0.97, 95% CI 0.85-1.11, P = 0.68) respectively). CONCLUSION This is the largest and most detailed study concerning OS after CRC resection involving Victorian public hospitals. There was no difference in OS following CRC resection when inner or outer regional hospitals were compared to metropolitan hospitals in Victoria. The study demonstrated the utility of AD with validated algorithms, linked to death data for reporting CRC survival outcomes.
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Affiliation(s)
- Dilshan K Udayasiri
- Colorectal Surgical Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Caroline MacCallum
- Colorectal Surgical Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Nigel Da Silva
- Colorectal Surgical Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anita Skandarajah
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ian P Hayes
- Colorectal Surgical Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
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14
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Bergin RJ, Thomas RJS, Whitfield K, White V. Concordance between Optimal Care Pathways and colorectal cancer care: Identifying opportunities to improve quality and reduce disparities. J Eval Clin Pract 2020; 26:918-926. [PMID: 31287616 DOI: 10.1111/jep.13231] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/24/2019] [Accepted: 06/27/2019] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Care pathway policies for cancer aim to reduce variation and improve the quality of patient care, and there is increasing evidence that adherence to such pathways is associated with improved survival and lower health care costs. Australia is implementing Optimal Care Pathways (OCPs) for several cancers, including colorectal cancer, but studies evaluating how well care conforms to OCP recommendations are rare. This study examined concordance between OCP recommendations and colorectal cancer care prior to policy rollout and disparities for vulnerable populations. METHOD Cross-sectional survey (2012-2014) of cancer registry-identified colorectal cancer patients aged ≥40 approached within 6 months of diagnosis (n = 433), their general practitioner (GP, n = 290), and specialist (n = 144) in Victoria, Australia. We measured concordance with 10 OCP recommendations and variation by geography, socio-economic, and health insurance status using age- and sex-adjusted logistic regression models. RESULTS Use of recommended GP investigations varied from 66% for colonoscopy to 13% for digital rectal exam. Recommended waiting times to receive a colonoscopy, see a specialist after referral, and begin adjuvant chemotherapy were exceeded for around a third of patients. Twenty-eight percent of specialists reported a pretreatment multidisciplinary meeting. Most patients received surgery in a hospital with an intensive care unit (92%) and chemotherapy for high risk disease (84%). In general, care was similar across sociodemographic groups. However, receipt of GP investigations tended to be higher and waiting times longer for rural, low socio-economic, and non-privately insured patients. For example, receiving a colonoscopy within 4 weeks was significantly less likely for rural (51%) than urban (78%) patients (odds ratio = 0.30; 95% confidence interval, 0.11-0.79). CONCLUSION Prior to implementation, a significant proportion of colorectal cancer patients received care that did not meet OCP recommendations. Low concordance and inequities for rural and disadvantaged populations highlight components of the pathway to target during policy implementation.
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Affiliation(s)
- Rebecca J Bergin
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia.,Department of General Practice/Centre for Cancer Research, University of Melbourne, Melbourne, Australia
| | - Robert J S Thomas
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Kathryn Whitfield
- Department of Health and Human Services Victoria, Victorian Government, Melbourne, Australia
| | - Victoria White
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia.,School of Psychology, Deakin University, Melbourne, Australia
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15
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Udayasiri DK, MacCallum C, Silva ND, Skandarajah A, Hayes IP. Impact of hospital geographic remoteness on short-term outcomes after colorectal cancer resection using state-wide administrative data. ANZ J Surg 2020; 90:1328-1334. [PMID: 32455508 DOI: 10.1111/ans.15992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 04/22/2020] [Accepted: 04/25/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND This study aimed to use validated coding algorithms, applied to a central repository of administrative data (AD), to report on short-term outcomes following resection for colorectal cancer (CRC) comparing regional to metropolitan Victorian hospitals. METHODS This is a retrospective cohort study using prospectively gathered AD. The primary outcome was prolonged length of stay (LOS). Secondary outcomes were: inpatient mortality, return to theatre, discharge destination and need for mechanical ventilation/intensive care unit support. Outcomes were adjusted for potential confounders via multivariable logistic regression analysis. RESULTS This study of 18 470 patients found strong evidence for lower odds of prolonged LOS (odds ratio (OR) 0.53, 95% confidence interval (CI) 0.48-0.58, P ≤ 0.001) and inpatient mortality (OR 0.67, 95% CI 0.49-0.91, P = 0.01) in inner regional hospital compared with metropolitan hospitals. For outer regional hospitals, there was strong evidence of decreased odds of prolonged LOS (OR 0.64, 95% CI 0.52-0.77, P = <0.001) and return to theatre (OR 0.67, 95% CI 0.47-0.95, P = 0.03). CONCLUSION This is the largest and most detailed study concerning short-term outcomes following CRC resection in Victorian public hospitals. Inner and outer regional centres had similar or better short-term outcomes than metropolitan hospitals after CRC resection. AD with validated algorithms serves as a large accurate database to report on CRC outcomes.
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Affiliation(s)
- Dilshan K Udayasiri
- Colorectal Surgical Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Caroline MacCallum
- Colorectal Surgical Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Nigel Da Silva
- Colorectal Surgical Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anita Skandarajah
- Colorectal Surgical Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Ian P Hayes
- Colorectal Surgical Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
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16
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Cooper EA, Buxey KN, Maslen BJ, Muhlmann M. Retrospective analysis of a Bi-National Colorectal Cancer Audit to characterize stage II colon cancer patients who were offered adjuvant chemotherapy. ANZ J Surg 2020; 90:1136-1140. [PMID: 32072761 DOI: 10.1111/ans.15735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/09/2020] [Accepted: 01/20/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Adjuvant chemotherapy for stage II colon cancer is a controversial area with treatment often reserved for patients with high-risk clinicopathological features. The aim of this study was to characterize which patients with stage II disease were offered adjuvant chemotherapy in an Australian and New Zealand setting. METHODS Data was retrospectively collected from the prospectively maintained Bi-National Colorectal Cancer Audit. Data from all patients with their first episode of stage II colon cancer from January 2007 to January 2019 were included. RESULTS A total of 3763 patients were identified in the Bi-National Colorectal Cancer Audit database with stage II colon cancer, of which 715 were offered chemotherapy (19%). Patients were at significant greater odds of being offered chemotherapy for stage II disease if they were <55 years old, from an urban area, discussed in a multidisciplinary team (MDT) meeting, had a greater operative urgency, a lower American Society of Anesthesiologists score, had a T4 tumour or had less than 12 lymph nodes harvested. CONCLUSION In Australia and New Zealand the appropriate patients with high-risk features are more likely to be offered chemotherapy in line with current guideline recommendations; however, this may not be the case for regional patients. A large proportion of patients were not discussed at MDT meeting- given the decision to provide adjuvant chemotherapy for stage II disease remains a controversial area, and the likely small survival benefit offered by adjuvant chemotherapy, appropriate patient selection is critical and best discussed in an MDT setting.
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Affiliation(s)
- Edward A Cooper
- Department of Colorectal Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Kenneth N Buxey
- Department of Colorectal Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Ben J Maslen
- Mark Wainwright Analytical Centre, The University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Muhlmann
- Department of Colorectal Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia
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17
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The effects of comorbidity on colorectal cancer mortality in an Australian cancer population. Sci Rep 2019; 9:8580. [PMID: 31189947 PMCID: PMC6561932 DOI: 10.1038/s41598-019-44969-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 05/29/2019] [Indexed: 01/18/2023] Open
Abstract
This study estimated the absolute risk of colorectal cancer (CRC) specific and other-cause mortality using data from the population-based South Australian Cancer Registry. The impact of competing risks on the absolute and relative risks of mortality in cases with and without comorbidity was also investigated. The study included 7115 staged, primary CRC cases diagnosed between 2003 and 2012 with at least one year of follow-up. Comorbidities were classified according to Charlson, Elixhauser and C3 comorbidity indices, using hospital inpatient diagnoses occurring five years before CRC diagnosis. To estimate the differences in measures of association, the subdistribution hazard ratios (sHR) for the effect of comorbidity on mortality from the Fine and Gray model were compared to the cause-specific hazards (HR) from Cox regression model. CRC was most commonly diagnosed in people aged ≧ 70 years. In cases without comorbidity, the 10-year cumulative probability of CRC and other cause mortality were 37.1% and 17.2% respectively. In cases with Charlson comorbidity scores ≥2, the 10-year cumulative probability of CRC-specific and other cause mortality was 45.5% and 32.2%, respectively. Comorbidity was associated with increased CRC-specific and other cause mortality and the effect differed only marginally based on comorbidity index used.
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18
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Odgaard M, Lohse N, Petersen AJ, Bæksgaard L. Oncological treatment and outcome of colorectal cancer in Greenland. Int J Circumpolar Health 2018; 77:1546069. [PMID: 30458696 PMCID: PMC6249539 DOI: 10.1080/22423982.2018.1546069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 10/25/2018] [Accepted: 10/30/2018] [Indexed: 01/28/2023] Open
Abstract
Oncological treatment of colorectal cancer (CRC) has been available in Greenland since 2004. Treatment is provided by Queen Ingrid´s Hospital (QIH), under supervision from the Department of Oncology, Rigshospitalet, Denmark. The study describes patient characteristics, oncological treatment and survival for the first 8 years of treatment. The study was a registry-based observational study of all patients in Greenland diagnosed with histologically verified CRC from August 2004 to August 2012. Analyses were stratified according to stage and discussed in relation to reported data from patients with CRC in Denmark. 180 patients were included. . Stage I, II, III, and IV comprised 15, 34, 23, and 23%, respectively. 5% presented with unknown stage. A total of 51% received oncological treatment. 79% of patients with Stage III disease received adjuvant chemotherapy, 61% of patients with metastatic CRC received palliative chemotherapy. Five-year survival was 48 and 53% for colon and rectum cancer, respectively. An insignificant trend towards higher survival in men than in women was seen; adjusted hazard ratio for death (women vs men) = 1.46 (95% CI = 0.97-2.19). In conclusion; Stage distribution, provision of oncological treatment and 5-year survival were comparable to patients diagnosed and treated in Denmark.
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Affiliation(s)
- Marie Odgaard
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark
- Department of Medicine, Queen Ingrid´s Hospital, Nuuk, Greenland
| | - Nicolai Lohse
- Department of Medicine, Queen Ingrid´s Hospital, Nuuk, Greenland
- Department of Anaesthesiology and Intensive Care, Nordsjællands Hospital, Hillerød, Denmark
| | | | - Lene Bæksgaard
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark
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19
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Bergin RJ, Emery J, Bollard RC, Falborg AZ, Jensen H, Weller D, Menon U, Vedsted P, Thomas RJ, Whitfield K, White V. Rural–Urban Disparities in Time to Diagnosis and Treatment for Colorectal and Breast Cancer. Cancer Epidemiol Biomarkers Prev 2018; 27:1036-1046. [DOI: 10.1158/1055-9965.epi-18-0210] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/10/2018] [Accepted: 06/26/2018] [Indexed: 11/16/2022] Open
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20
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Crawford-Williams F, March S, Ireland MJ, Rowe A, Goodwin B, Hyde MK, Chambers SK, Aitken JF, Dunn J. Geographical Variations in the Clinical Management of Colorectal Cancer in Australia: A Systematic Review. Front Oncol 2018; 8:116. [PMID: 29868464 PMCID: PMC5965390 DOI: 10.3389/fonc.2018.00116] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 03/29/2018] [Indexed: 12/17/2022] Open
Abstract
Background In Australia, cancer survival is significantly lower in non-metropolitan compared to metropolitan areas. Our objective was to evaluate the evidence on geographical variations in the clinical management and treatment of colorectal cancer (CRC). Methods A systematic review of published and gray literature was conducted. Five databases (CINAHL, PubMed, Embase, ProQuest, and Informit) were searched for articles published in English from 1990 to 2018. Studies were included if they assessed differences in clinical management according to geographical location; focused on CRC patients; and were conducted in Australia. Included studies were critically appraised using a modified Newcastle–Ottawa Scale. PRISMA systematic review reporting methods were applied. Results 17 articles met inclusion criteria. All were of high (53%) or moderate (47%) quality. The evidence available may suggest that patients in non-metropolitan areas are more likely to experience delays in surgery and are less likely to receive chemotherapy for stage III colon cancer and adjuvant radiotherapy for rectal cancer. Conclusion The present review found limited information on clinical management across geographic regions in Australia and the synthesis highlights significant issues both for data collection and reporting at the population level, and for future research in the area of geographic variation. Where geographical disparities exist, these may be due to a combination of patient and system factors reflective of location. It is recommended that population-level data regarding clinical management of CRC be routinely collected to better understand geographical variations and inform future guidelines and policy.
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Affiliation(s)
- Fiona Crawford-Williams
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, Australia.,School of Psychology and Counselling, University of Southern Queensland, Springfield Central, QLD, Australia
| | - Sonja March
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, Australia.,School of Psychology and Counselling, University of Southern Queensland, Springfield Central, QLD, Australia
| | - Michael J Ireland
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, Australia.,School of Psychology and Counselling, University of Southern Queensland, Springfield Central, QLD, Australia
| | - Arlen Rowe
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, Australia.,School of Psychology and Counselling, University of Southern Queensland, Springfield Central, QLD, Australia
| | - Belinda Goodwin
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, Australia.,School of Psychology and Counselling, University of Southern Queensland, Springfield Central, QLD, Australia
| | - Melissa K Hyde
- Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
| | - Suzanne K Chambers
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, Australia.,Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia.,Prostate Cancer Foundation of Australia, St Leonards, NSW, Australia.,Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia
| | - Joanne F Aitken
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, Australia.,Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Jeff Dunn
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, Australia.,Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, QLD, Australia.,School of Social Science, University of Queensland, Brisbane, QLD, Australia.,School of Medicine, Griffith University, Brisbane, QLD, Australia
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21
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Adelson P, Fusco K, Karapetis C, Wattchow D, Joshi R, Price T, Sharplin G, Roder D. Use of guideline-recommended adjuvant therapies and survival outcomes for people with colorectal cancer at tertiary referral hospitals in South Australia. J Eval Clin Pract 2018; 24:135-144. [PMID: 28474459 DOI: 10.1111/jep.12757] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 03/14/2017] [Accepted: 03/14/2017] [Indexed: 12/12/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Adjuvant care for colorectal cancer (CRC) has increased over the past 3 decades in South Australia (SA) in accordance with national treatment guidelines. This study explores the (1) receipt of adjuvant therapy for CRC in SA as related to national guideline recommendations, with a focus on stage C colon and stage B and C rectal cancer; (2) timing of these adjuvant therapies in relation to surgery; and (3) comparative survival outcomes. METHODS Data from the SA Clinical Cancer Registry from 4 tertiary referral hospitals for 2000 to 2010 were examined. Patterns of care were compared with treatment guidelines using multivariable logistic regression. Disease-specific survivals were calculated by treatment pathway. RESULTS Four hundred forty-three (60%) patients with stage C colon cancer and 363 (46%) with stage B and C rectal cancer received guideline-recommended care. While an overall increase in proportion receiving adjuvant care was not evident across the study period, the proportion having neoadjuvant care increased substantially. Older age was an independent predictor of not receiving adjuvant care. Patients with stage C colon cancer who received recommended adjuvant care had a higher 5-year survival than those not receiving this care, ie, 71.2% vs 53.2%. Similarly adjuvant therapy was associated with better outcomes for stage C rectal cancers. The median time for receiving adjuvant care was 8 weeks. CONCLUSIONS Survival was better for stage C CRC treated according to guidelines. Adjuvant care should be provided except where clear contraindications present. Other possible contributors to guideline adherence warranting additional investigation include co-morbidity status, multidisciplinary team involvement, and choice.
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Affiliation(s)
- Pamela Adelson
- Cancer Council South Australia, Adelaide, South Australia, Australia.,Rosemary Bryant Research Centre, School of Nursing and Midwifery, University of South Australia, Adelaide, Australia
| | - Kellie Fusco
- South Australia Clinical Cancer Registry, University of South Australia, Adelaide, South Australia, Australia
| | - Christos Karapetis
- Flinders Centre for Innovation in Cancer, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - David Wattchow
- Department of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Rohit Joshi
- Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Timothy Price
- Medical Oncology, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Greg Sharplin
- Cancer Council South Australia, Adelaide, South Australia, Australia
| | - David Roder
- Cancer Epidemiology & Population Health, University of South Australia, Adelaide, South Australia, Australia
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22
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Beckmann K, Moore J, Wattchow D, Young G, Roder D. Short-term outcomes after surgical resection for colorectal cancer in South Australia. J Eval Clin Pract 2017; 23:316-324. [PMID: 27480799 DOI: 10.1111/jep.12612] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/30/2016] [Accepted: 06/30/2016] [Indexed: 12/24/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVE Short-term outcomes (unplanned readmission, post-surgical complication rates, 30-day and 90-day post-surgical mortality) are often used as indicators of quality of surgical care for colorectal cancer (CRC). Differences in these immediate outcomes can highlight disparities in care across patient subpopulations. This study aimed to document short-term outcomes following major surgery for CRC and to identify whether there were any sociodemographic differences across South Australia (SA). METHODS This population-based study included all CRC resections among SA residents diagnosed with CRC aged 50-79 years in 2003-2008 (n = 3940). Clinical, treatment, comorbidity and outcomes data were compiled through linkage of administrative and surveillance datasets across SA. A retrospective cohort design was used to examine short-term outcomes including post-operative complications, 28-day emergency readmission and 30-day and 90-day mortality. We used multivariable logistic regression to identify factors associated with each outcome. RESULTS Post-operative complications occurred in 28% of cases. Thirty-day and ninety-day mortality were 1.3% and 3%, respectively. Later stage, older age, multiple comorbidities and emergency admissions were associated with poorer short-term outcomes. Risk of complications was lower among patients from higher socio-economic areas (OR = 0.77, 95%CI 0.62-0.98). Risk of 30-day mortality was higher among non-metropolitan patients (OR = 2.33, 95%CI 1.22-4.46). Post-operative complications increased the risk of emergency readmission and short-term mortality. CONCLUSIONS Short-term outcomes following CRC surgery may be improved through strategies to increase earlier detection and reduce emergency admissions. Socioeconomic and regional disparities require further examination of health system factors.
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Affiliation(s)
- Kerri Beckmann
- Centre for Population Health, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - James Moore
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - David Wattchow
- Department of General and Digestive Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Graeme Young
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, South Australia, Australia
| | - David Roder
- Centre for Population Health Research, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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23
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Ireland MJ, March S, Crawford-Williams F, Cassimatis M, Aitken JF, Hyde MK, Chambers SK, Sun J, Dunn J. A systematic review of geographical differences in management and outcomes for colorectal cancer in Australia. BMC Cancer 2017; 17:95. [PMID: 28152983 PMCID: PMC5290650 DOI: 10.1186/s12885-017-3067-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 01/18/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Australia and New Zealand have the highest incidence of colorectal cancer (CRC) in the world, presenting considerable health, economic, and societal burden. Over a third of the Australian population live in regional areas and research has shown they experience a range of health disadvantages that result in a higher disease burden and lower life expectancy. The extent to which geographical disparities exist in CRC management and outcomes has not been systematically explored. The present review aims to identify the nature of geographical disparities in CRC survival, clinical management, and psychosocial outcomes. METHODS The review followed PRISMA guidelines and searches were undertaken using seven databases covering articles between 1 January 1990 and 20 April 2016 in an Australian setting. Inclusion criteria stipulated studies had to be peer-reviewed, in English, reporting data from Australia on CRC patients and relevant to one of fourteen questions examining geographical variations in a) survival outcomes, b) patient and cancer characteristics, c) diagnostic and treatment characteristics and d) psychosocial and quality of life outcomes. RESULTS Thirty-eight quantitative, two qualitative, and three mixed-methods studies met review criteria. Twenty-seven studies were of high quality, sixteen studies were of moderate quality, and no studies were found to be low quality. Individuals with CRC living in regional, rural, and remote areas of Australia showed poorer survival and experienced less optimal clinical management. However, this effect is likely moderated by a range of other factors (e.g., SES, age, gender) and did appear to vary linearly with increasing distance from metropolitan centres. No studies examined differences in use of stoma, or support with stomas, by geographic location. CONCLUSIONS Overall, despite evidence of disparity in CRC survival and clinical management across geographic locations, the evidence was limited and at times inconsistent. Further, access to treatment and services may not be the main driver of disparities, with individual patient characteristics and type of region also playing an important role. A better understanding of factors driving ongoing and significant geographical disparities in cancer related outcomes is required to inform the development of effective interventions to improve the health and welfare of regional Australians.
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Affiliation(s)
- Michael J. Ireland
- Institute of Resilient Regions, University of Southern Queensland, Springfield Central, Australia
- School of Psychology and Counselling, University of Southern Queensland, Springfield Central, Australia
| | - Sonja March
- Institute of Resilient Regions, University of Southern Queensland, Springfield Central, Australia
- School of Psychology and Counselling, University of Southern Queensland, Springfield Central, Australia
| | - Fiona Crawford-Williams
- Institute of Resilient Regions, University of Southern Queensland, Springfield Central, Australia
- School of Psychology and Counselling, University of Southern Queensland, Springfield Central, Australia
| | - Mandy Cassimatis
- Non-communicable Disease Control Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC Australia
| | - Joanne F. Aitken
- Institute of Resilient Regions, University of Southern Queensland, Springfield Central, Australia
- Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, 4006 QLD Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, QLD Australia
| | - Melissa K. Hyde
- Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, 4006 QLD Australia
- Menzies Health Institute Queensland, Griffith University, Southport, QLD Australia
| | - Suzanne K. Chambers
- Institute of Resilient Regions, University of Southern Queensland, Springfield Central, Australia
- Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, 4006 QLD Australia
- Menzies Health Institute Queensland, Griffith University, Southport, QLD Australia
- Prostate Cancer Foundation of Australia, St Leonards, NSW Australia
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA Australia
| | - Jiandong Sun
- Institute of Resilient Regions, University of Southern Queensland, Springfield Central, Australia
| | - Jeff Dunn
- Institute of Resilient Regions, University of Southern Queensland, Springfield Central, Australia
- Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, 4006 QLD Australia
- School of Social Science, University of Queensland, Brisbane, Australia
- School of Medicine, Griffith University, Brisbane, QLD Australia
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24
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Roder D, Buckley E. Administrative data provide vital research evidence for maximizing health-system performance and outcomes. Asia Pac J Clin Oncol 2017; 13:111-114. [PMID: 28120376 DOI: 10.1111/ajco.12644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 08/29/2016] [Accepted: 10/03/2016] [Indexed: 11/30/2022]
Abstract
Although the quality of administrative data is frequently questioned, these data are vital for health-services evaluation and complement data from trials, other research studies and registries for research. Trials generally provide the strongest evidence of outcomes in research settings but results may not apply in many service environments. High-quality observational research has a complementary role where trials are not applicable and for assessing whether trial results apply to groups excluded from trials. Administrative data have a broader system-wide reach, enabling system-wide health-services research and monitoring of performance markers. Where administrative data raise questions about service outcomes, follow-up enquiry may be required to investigate validity and service implications. Greater use should be made of administrative data for system-wide monitoring and for research on service effectiveness and equity.
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Affiliation(s)
- David Roder
- Centre for Population Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Elizabeth Buckley
- Centre for Population Health Research, University of South Australia, Adelaide, South Australia, Australia
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25
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Roder D, Karapetis CS, Wattchow D, Moore J, Singhal N, Joshi R, Keefe D, Fusco K, Buranyi-Trevarton D, Sharplin G, Price TJ. Metastatic Colorectal Cancer Treatment and Survival: the Experience of Major Public Hospitals in South Australia Over Three Decades. Asian Pac J Cancer Prev 2016; 16:5923-31. [PMID: 26320474 DOI: 10.7314/apjcp.2015.16.14.5923] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Registry data from four major public hospitals indicate trends over three decades from 1980 to 2010 in treatment and survival from colorectal cancer with distant metastases at diagnosis (TNM stage IV). MATERIALS AND METHODS Kaplan-Meier product-limit estimates and Cox proportional hazards models for investigating disease-specific survival and multiple logistic regression analyses for indicating first-round treatment trends. RESULTS Two-year survivals increased from 10% for 1980-84 to 35% for 2005-10 diagnoses. Corresponding increases in five-year survivals were from 3% to 16%. Time-to-event risk of colorectal cancer death approximately halved (hazards ratio: 0.48 (0.40, 0.59) after adjusting for demographic factors, tumour differentiation, and primary sub-site. Survivals were not found to differ by place of residence, suggesting reasonable equity in service provision. About 74% of cases were treated surgically and this proportion increased over time. Proportions having systemic therapy and/or radiotherapy increased from 12% in 1980-84 to 61% for 2005-10. Radiotherapy was more common for rectal than colonic cases (39% vs 7% in 2005-10). Of the cases diagnosed in 2005-10 when less than 70 years of age, the percentage having radiotherapy and/or systemic therapy was 79% for colorectal, 74% for colon and 86% for rectum (and RS)) cancers. Corresponding proportions having: systemic therapies were 75%, 71% and 81% respectively; radiotherapy were 24%, 10% and 46% respectively; and surgery were 75%, 78% and 71% respectively. Based on survey data on uptake of offered therapies, it is likely that of these younger cases, 85% would have been offered systemic treatment and among rectum (and RS) cases, about 63% would have been offered radiotherapy. CONCLUSIONS Pronounced increases in survivals from metastatic colorectal cancer have occurred, in keeping with improved systemic therapies and surgical interventions. Use of radiotherapy and/or systemic therapy has increased markedly and patterns of change accord with clinical guideline recommendations.
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Affiliation(s)
- David Roder
- Centre for Population Health Research, University of South Australia, South Australia E-mail :
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26
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Roder D, Karapetis CS, Wattchow D, Moore J, Singhal N, Joshi R, Keefe D, Fusco K, Powell K, Eckert M, Price TJ. Colorectal cancer treatment and survival over three decades at four major public hospitals in South Australia: trends by age and in the elderly. Eur J Cancer Care (Engl) 2016; 25:753-63. [PMID: 27255681 DOI: 10.1111/ecc.12515] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2016] [Indexed: 11/29/2022]
Abstract
Data from registries at four major public hospitals in South Australia indicate increased 5-year disease-specific survivals for colorectal cancer from 48% to 63% between 1980-1986 and 2005-2010. For 80+ year olds, the increase was smaller, from 47% to 52%. Risk of case fatality halved overall, adjusting for age, gender, stage, differentiation and sub-site. Patients aged 80+ years had a lower risk reduction of about a third (hazards ratio: 0.69; 95% confidence limits, 0.52-0.92). Percentages having surgery and other specified treatments were lower for 80+ year olds than younger cases, although increases in treatment intensity occurred in this age range during 1980-2010, as seen in younger ages, in accordance with guidelines. The study illustrates the important feedback clinical registries can provide to clinicians on care patterns and outcomes in their hospital settings. Feedback can be the subject of local deliberations on how to achieve the best outcomes, including in the elderly by considering the best trade-offs between optimal cancer care and accommodations for co-morbidity and frailty. Clinical registry data can be used in comparative effectiveness research in local settings where there are sufficient case numbers.
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Affiliation(s)
- D Roder
- Centre of Population Health Research, University of South Australia, Adelaide, SA, Australia.,South Australian Clinical Cancer Registry, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - C S Karapetis
- Department of Medical Oncology/Medical Oncology, Clinical Research Flinders Medical Centre and Flinders University, Bedford Park, SA, Australia
| | - D Wattchow
- Department of Surgery, Flinders University, Bedford Park, SA, Australia
| | - J Moore
- Colorectal Surgery/General Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia.,Department of Surgery, University of Adelaide, Adelaide, SA, Australia
| | - N Singhal
- Cancer Centre, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - R Joshi
- Medical Oncology, University of Adelaide, Adelaide, SA, Australia.,Medical Oncology, Lyell McEwin Hospital, Adelaide, SA, Australia
| | - D Keefe
- Faculty of Health Sciences, University of Adelaide, Adelaide, SA, Australia
| | - K Fusco
- Centre of Population Health Research, University of South Australia, Adelaide, SA, Australia
| | - K Powell
- South Australian Clinical Cancer Registry, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - M Eckert
- Support, Research and Policy, Cancer Council South Australia, Eastwood, SA, Australia
| | - T J Price
- Haematology and Oncology Unit, Cancer Clinical Research, Queen Elizabeth Hospital, Adelaide, SA, Australia
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27
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Roder D, Karapetis CS, Wattchow D, Moore J, Singhal N, Joshi R, Keefe D, Fusco K, Powell K, Eckert M, Price TJ. Colorectal cancer treatment and survival: the experience of major public hospitals in south Australia over three decades. Asian Pac J Cancer Prev 2016; 16:2431-40. [PMID: 25824777 DOI: 10.7314/apjcp.2015.16.6.2431] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Registry data from four major public hospitals indicate trends in clinical care and survival from colorectal cancer over three decades, from 1980 to 2010. MATERIALS AND METHODS Kaplan-Meier product- limit estimates and Cox proportional hazards models were used to investigate disease-specific survival and multiple logistic regression analyses to explore first-round treatment trends. RESULTS Five-year survivals increased from 48% for 1980-1986 to 63% for 2005-2010 diagnoses. Survival increases applied to each ACPS stage (Australian Clinico-Pathological Stage), and particularly stage C (an increase from 38% to 68%). Risk of death from colorectal cancer halved (hazards ratio: 0.50 (0.45, 0.56)) over the study period after adjusting for age, sex, stage, differentiation, primary sub-site, health administrative region, and measures of socioeconomic status and geographic remoteness. Decreases in stage were not observed. Survivals did not vary by sex or place of residence, suggesting reasonable equity in service access and outcomes. Of staged cases, 91% were treated surgically with lower surgical rates for older ages and more advanced stage. Proportions of surgical cases having adjuvant therapy during primary courses of treatment increased for all stages and were highest for stage C (an increase from 5% in 1980-1986 to 63% for 2005-2010). Radiotherapy was more common for rectal than colonic cases. Proportions of rectal cases receiving radiotherapy increased, particularly for stage C where the increase was from 8% in 1980-1986 to 60% in 2005-2010. The percentage of stage C colorectal cases less than 70 years of age having systemic therapy as part of their first treatment round increased from 3% in 1980-1986 to 81% by 1995-2010. Based on survey data on uptake of adjuvant therapy among those offered this care, it is likely that all these younger patients were offered systemic treatment. CONCLUSIONS We conclude that pronounced increases in survivals from colorectal cancer have occurred at major public hospitals in South Australia due to increases in stage-specific survivals. Use of adjuvant therapies has increased and the patterns of change accord with clinical guideline recommendations. Reasons for sub-optimal use of radiotherapy for rectal cases warrant further investigation, including the potential for limited rural access to impede uptake of treatments at metropolitan-based radiotherapy centres.
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Affiliation(s)
- David Roder
- School of Population Health, University of South Australia, Adelaide, South Australia E-mail :
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28
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Goldvaser H, Purim O, Kundel Y, Shepshelovich D, Shochat T, Shemesh-Bar L, Sulkes A, Brenner B. Colorectal cancer in young patients: is it a distinct clinical entity? Int J Clin Oncol 2016; 21:684-695. [PMID: 26820719 DOI: 10.1007/s10147-015-0935-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 11/26/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND The incidence of colorectal cancer in young patients is increasing. It remains unclear if the disease has unique features in this age group. METHODS This was a single-center, retrospective cohort study which included patients diagnosed with colorectal cancer at age ≤40 years in 1997-2013 matched 1:2 by year of diagnosis with consecutive colorectal cancer patients diagnosed at age >50 years during the same period. Patients aged 41-50 years were not included in the study, to accentuate potential age-related differences. Clinicopathological characteristics, treatment, and outcome were compared between groups. RESULTS The cohort included 330 patients, followed for a median time of 65.9 months (range 4.7-211). Several significant differences were noted. The younger group had a different ethnic composition. They had higher rates of family history of colorectal cancer (p = 0.003), hereditary colorectal cancer syndromes (p < 0.0001), and inflammatory bowel disease (p = 0.007), and a lower rate of polyps (p < 0.0001). They were more likely to present with stage III or IV disease (p = 0.001), angiolymphatic invasion, signet cell ring adenocarcinoma, and rectal tumors (p = 0.02). Younger patients more frequently received treatment. Young patients had a worse estimated 5-year disease-free survival rate (57.6 vs. 70 %, p = 0.039), but this did not retain significance when analyzed by stage (p = 0.092). Estimated 5-year overall survival rates were 59.1 and 62.1 % in the younger and the control group, respectively (p = 0.565). CONCLUSIONS Colorectal cancer among young patients may constitute a distinct clinical entity. Further research is needed to validate our findings and define the optimal approach in this population.
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Affiliation(s)
- Hadar Goldvaser
- Davidoff Cancer Center, Rabin Medical Center, Institute of Oncology, Beilinson Hospital, 39 Jabotinski St., Petach Tikva, 49100, Israel
| | - Ofer Purim
- Davidoff Cancer Center, Rabin Medical Center, Institute of Oncology, Beilinson Hospital, 39 Jabotinski St., Petach Tikva, 49100, Israel.,Sackler Faculty of Medicine, Tel Aviv University, P.O Box 39040, Tel Aviv, Israel
| | - Yulia Kundel
- Davidoff Cancer Center, Rabin Medical Center, Institute of Oncology, Beilinson Hospital, 39 Jabotinski St., Petach Tikva, 49100, Israel.,Sackler Faculty of Medicine, Tel Aviv University, P.O Box 39040, Tel Aviv, Israel
| | - Daniel Shepshelovich
- Department of Medicine A, Rabin Medical Center, Beilinson Hospital, 39 Jabotinski St., Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, P.O Box 39040, Tel Aviv, Israel
| | - Tzippy Shochat
- Statistical Consulting Unit, Rabin Medical Center, Beilinson Hospital, 39 Jabotinski St., Petach Tikva, Israel
| | | | - Aaron Sulkes
- Davidoff Cancer Center, Rabin Medical Center, Institute of Oncology, Beilinson Hospital, 39 Jabotinski St., Petach Tikva, 49100, Israel.,Sackler Faculty of Medicine, Tel Aviv University, P.O Box 39040, Tel Aviv, Israel
| | - Baruch Brenner
- Davidoff Cancer Center, Rabin Medical Center, Institute of Oncology, Beilinson Hospital, 39 Jabotinski St., Petach Tikva, 49100, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, P.O Box 39040, Tel Aviv, Israel.
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29
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Beckmann KR, Bennett A, Young GP, Cole SR, Joshi R, Adams J, Singhal N, Karapetis C, Wattchow D, Roder D. Sociodemographic disparities in survival from colorectal cancer in South Australia: a population-wide data linkage study. BMC Health Serv Res 2016; 16:24. [PMID: 26792195 PMCID: PMC4721049 DOI: 10.1186/s12913-016-1263-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 01/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inequalities in survival from colorectal cancer (CRC) across socioeconomic groups and by area of residence have been described in various health care settings. Few population-wide datasets which include clinical and treatment information are available in Australia to investigate disparities. This study examines socio-demographic differences in survival for CRC patients in South Australia (SA), using a population-wide database derived via linkage of administrative and surveillance datasets. METHODS The study population comprised all cases of CRC diagnosed in 2003-2008 among SA residents aged 50-79 yrs in the SA Central Cancer Registry. Measures of socioeconomic status (area level), geographical remoteness, clinical characteristics, comorbid conditions, treatments and outcomes were derived through record linkage of central cancer registry, hospital-based clinical registries, hospital separations, and radiotherapy services data sources. Socio-demographic disparities in CRC survival were examined using competing risk regression analysis. RESULTS Four thousand six hundred and forty one eligible cases were followed for an average of 4.7 yrs, during which time 1525 died from CRC and 416 died from other causes. Results of competing risk regression indicated higher risk of CRC death with higher grade (HR high v low =2.25, 95% CI 1.32-3.84), later stage (HR C v A = 7.74, 95% CI 5.75-10.4), severe comorbidity (HR severe v none =1.21, 95% CI 1.02-1.44) and receiving radiotherapy (HR = 1.41, 95% CI 1.18-1.68). Patients from the most socioeconomically advantaged areas had significantly better outcomes than those from the least advantaged areas (HR =0.75, 95% 0.62-0.91). Patients residing in remote locations had significantly worse outcomes than metropolitan residents, though this was only evident for stages A-C (HR = 1.35, 95 % CI 1.01-1.80). These disparities were not explained by differences in stage at diagnosis between socioeconomic groups or area of residence. Nor were they explained by differences in patient factors, other tumour characteristics, comorbidity, or treatment modalities. CONCLUSIONS Socio-economic and regional disparities in survival following CRC are evident in SA, despite having a universal health care system. Of particular concern is the poorer survival for patients from remote areas with potentially curable CRC. Reasons for these disparities require further exploration to identify factors that can be addressed to improve outcomes.
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Affiliation(s)
- Kerri R. Beckmann
- Centre for Population Health Research, University of South Australia, GPO Box 2471, Adelaide, SA 5001 Australia
| | - Alice Bennett
- Flinders Medical Centre, Flinders Drive, Bedford Park, SA 5042 Australia
| | - Graeme P. Young
- Flinders Centre for Innovation in Cancer, Flinders University, Flinders Drive, Bedford Park, SA 5042 Australia
| | - Stephen R. Cole
- Flinders Centre for Innovation in Cancer, Flinders University, Flinders Drive, Bedford Park, SA 5042 Australia
| | - Rohit Joshi
- Lyell McEwin Hospital, Elizabeth Vale, SA 5112 Australia
| | - Jacqui Adams
- Country Health SA, Adelaide, SA 5000 Australia
- Lyell McEwin Hospital, Elizabeth Vale, SA 5112 Australia
| | - Nimit Singhal
- Medical Oncologist, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA 5001 Australia
| | - Christos Karapetis
- Flinders Centre for Innovation in Cancer, Flinders University, Flinders Drive, Bedford Park, SA 5042 Australia
- South Adelaide Health Network, Medical Oncology, Flinders Medical Centre, Flinders Drive, Bedford Park, SA 5042 Australia
| | - David Wattchow
- Flinders University, Flinders Medical Centre, Bedford Park, SA 5042 Australia
| | - David Roder
- Centre for Population Health Research, University of South Australia, GPO Box 2471, Adelaide, SA 5001 Australia
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30
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Ellis DW, Srigley J. Does standardised structured reporting contribute to quality in diagnostic pathology? The importance of evidence-based datasets. Virchows Arch 2015; 468:51-9. [DOI: 10.1007/s00428-015-1834-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 08/08/2015] [Accepted: 08/13/2015] [Indexed: 01/07/2023]
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31
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Roder D, Buckley E. Translation from clinical trials to routine practice: How to demonstrate community benefit. Asia Pac J Clin Oncol 2015; 11:1-3. [DOI: 10.1111/ajco.12338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- David Roder
- Cancer Epidemiology and Population Health; University of South Australia and South Australian Health and Medical Research Institute; Adelaide South Australia Australia
| | - Elizabeth Buckley
- Cancer Epidemiology and Population Health; University of South Australia; Adelaide South Australia Australia
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Roder D, Creighton N, Baker D, Walton R, Aranda S, Currow D. Changing roles of population-based cancer registries in Australia. AUST HEALTH REV 2015; 39:425-428. [DOI: 10.1071/ah14250] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 02/04/2015] [Indexed: 11/23/2022]
Abstract
Registries have key roles in cancer incidence, mortality and survival monitoring and in showing disparities across the population. Incidence monitoring began in New South Wales in 1972 and other jurisdictions soon followed. Registry data are used to evaluate outcomes of preventive, screening, treatment and support services. They have shown decreases in cancer incidence following interventions and have been used for workforce and other infrastructure planning. Crude markers of optimal radiotherapy and chemotherapy exist and registry data are used to show shortfalls against these markers. The data are also used to investigate cancer clusters and environmental concerns. Survival data are used to assess service performance and interval cancer data are used in screening accreditation. Registries enable determination of risk of multiple primary cancers. Clinical quality registries are used for clinical quality improvement. Population-based cancer registries and linked administrative data complement clinical registries by providing high-level system-wide data. The USA Commission on Cancer has long used registries for quality assurance and service accreditation. Increasingly population-based registry data in Australia are linked with administrative data on service delivery to assess system performance. Addition of tumour stage and other prognostic indicators is important for these analyses and is facilitated by the roll-out of structured pathology reporting. Data linkage with administrative data, following checks on the quality of these data, enables assessment of patterns of care and other performance indicators for health-system monitoring. Australian cancer registries have evolved and increasingly are contributing to broader information networks for health system management.
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Roder DM, Fong KM, Brown MP, Zalcberg J, Wainwright CE. Realising opportunities for evidence-based cancer service delivery and research: linking cancer registry and administrative data in Australia. Eur J Cancer Care (Engl) 2014; 23:721-7. [PMID: 25244252 DOI: 10.1111/ecc.12242] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2014] [Indexed: 11/29/2022]
Abstract
The traditional roles of Australian cancer registries have been incidence, mortality and survival surveillance although increasingly, roles are being broadened to include data support for health-service management and evaluation. In some Australian jurisdictions, cancer stage and other prognostic data are being included in registry databases and this is being facilitated by an increase in structured pathology reporting by pathology and haematology laboratories. Data linkage facilities are being extended across the country at national and jurisdictional level, facilitating data linkage between registry data and data extracts from administrative databases that include treatment, screening and vaccination data, and self-reported data from large population cohorts. Well-established linkage protocols exist to protect privacy. The aim is to gain better data on patterns of care, service outcomes and related performance indicators for health-service management and population health and health-services research, at a time of increasing cost pressures. Barriers include wariness among some data custodians towards releasing data and the need for clearance for data release from large numbers of research ethics committees. Progress is being made though, and proof of concept is being established.
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Affiliation(s)
- D M Roder
- Cancer Epidemiology and Population Health, University of South Australia, Adelaide, South Australia, Australia; South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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