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Venning B, Emery JD. Symptomatic cancer diagnosis in general practice: a critical perspective of current guidelines and risk assessment tools. Med J Aust 2024. [PMID: 38679756 DOI: 10.5694/mja2.52287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 03/26/2024] [Indexed: 05/01/2024]
Affiliation(s)
- Brent Venning
- Centre for Cancer Research, University of Melbourne, Melbourne, VIC
| | - Jon D Emery
- Centre for Cancer Research, University of Melbourne, Melbourne, VIC
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Venning B, Pearce A, De Abreu Lourenco R, Hall R, Bergin R, Lee A, Donohoe K, Emery J. Patient Preferences for Investigating Cancer-Related Symptoms in Australian General Practice: A Discrete Choice Experiment. Br J Gen Pract 2024:BJGP.2023.0583. [PMID: 38395444 DOI: 10.3399/bjgp.2023.0583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Striking the right balance between early cancer diagnosis and the risk of excessive testing for low-risk symptoms is of paramount importance. Patient-centred care must also consider patient preferences for testing. AIM To investigate diagnostic testing preferences of the Australian public for symptoms associated with oesophagogastric (OG), bowel, or lung cancer. DESIGN AND SETTING One of three discrete choice experiments (DCEs) related to either OG, bowel, or lung cancer were administered to a nationally representative sample of Australians aged 40 and above. METHODS Each DCE comprised three scenarios with symptom positive predictive values (PPVs) for undiagnosed cancer ranging from 1% to 3%. The numerical risk was concealed from participants. DCE attributes encompassed the testing strategy, GP familiarity, test and result waiting times, travel duration, and test cost. Preferences were estimated using conditional and mixed logit models. RESULTS A total of 3013 individuals participated in one of three DCEs: OG (n=1004), Bowel (n=1006), and Lung (n=1003). Preferences were chiefly driven by waiting time, test cost followed by the test type. There was preference for more invasive tests. When confronted with symptoms carrying an extremely low risk (symptom PPV of 1% or less), participants were more inclined to abstain from testing. CONCLUSIONS Access-related factors, particularly waiting times and testing costs, emerged as the most pivotal elements influencing preferences, underscoring the substantial impact of these systemic factors on patient choices regarding investigations.
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Affiliation(s)
- Brent Venning
- The University of Sydney, Daffodil Centre, Sydney, Australia
- The University of Sydney, Sydney School of Public Health, Sydney, Australia
| | - Alison Pearce
- The University of Sydney, Daffodil Centre, Sydney, Australia
- The University of Sydney, Sydney School of Public Health, Sydney, Australia
| | - Richard De Abreu Lourenco
- University of Technology Sydney, Centre for Health Economics Research and Evaluation, Haymarket, Australia
| | - Rebekah Hall
- Acaster Lloyd Consulting Limited, London, United Kingdom
| | | | - Alex Lee
- University of Melbourne, Department of General Practice and Primary Care, Melbourne, Australia
- University of Melbourne, Centre for Cancer Research, Melbourne, Australia
| | - Keith Donohoe
- Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Jon Emery
- University of Melbourne Department of General Practice and Primary Health Care, Melbourne, Australia
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Lee A, McCarthy D, Bergin RJ, Drosdowsky A, Martinez Gutierrez J, Kearney C, Philip S, Rafiq M, Venning B, Wawryk O, Zhang J, Emery J. Data Resource Profile: Victorian Comprehensive Cancer Centre Data Connect. Int J Epidemiol 2023; 52:e292-e300. [PMID: 37889594 PMCID: PMC10749758 DOI: 10.1093/ije/dyad148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Affiliation(s)
- Alex Lee
- Department of General Practice, Faculty of Medicine, University of Melbourne and Centre for Cancer Research, Parkville, VIC, Australia
| | - Damien McCarthy
- Department of General Practice, Faculty of Medicine, University of Melbourne and Centre for Cancer Research, Parkville, VIC, Australia
| | - Rebecca J Bergin
- Department of General Practice, Faculty of Medicine, University of Melbourne and Centre for Cancer Research, Parkville, VIC, Australia
| | - Allison Drosdowsky
- Department of General Practice, Faculty of Medicine, University of Melbourne and Centre for Cancer Research, Parkville, VIC, Australia
| | - Javiera Martinez Gutierrez
- Department of General Practice, Faculty of Medicine, University of Melbourne and Centre for Cancer Research, Parkville, VIC, Australia
- Department of Family Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Chris Kearney
- Department of General Practice, Faculty of Medicine, University of Melbourne and Centre for Cancer Research, Parkville, VIC, Australia
| | - Sally Philip
- Department of General Practice, Faculty of Medicine, University of Melbourne and Centre for Cancer Research, Parkville, VIC, Australia
| | - Meena Rafiq
- Department of General Practice, Faculty of Medicine, University of Melbourne and Centre for Cancer Research, Parkville, VIC, Australia
- Epidemiology of Cancer and Healthcare Outcomes (ECHO) Group, UCL, London, UK
| | - Brent Venning
- Department of General Practice, Faculty of Medicine, University of Melbourne and Centre for Cancer Research, Parkville, VIC, Australia
| | - Olivia Wawryk
- Department of General Practice, Faculty of Medicine, University of Melbourne and Centre for Cancer Research, Parkville, VIC, Australia
| | - Jianrong Zhang
- Department of General Practice, Faculty of Medicine, University of Melbourne and Centre for Cancer Research, Parkville, VIC, Australia
| | - Jon Emery
- Department of General Practice, Faculty of Medicine, University of Melbourne and Centre for Cancer Research, Parkville, VIC, Australia
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Venning B, Bergin R, Pearce A, Lee A, Emery JD. Factors affecting patient decisions to undergo testing for cancer symptoms: an exploratory qualitative study in Australian general practice. BJGP Open 2023; 7:BJGPO.2022.0168. [PMID: 36750375 DOI: 10.3399/bjgpo.2022.0168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 11/21/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Patients presenting to their GP are often concerned their symptoms may be due to cancer. However, there is a lack of evidence on the factors that influence patient decisions to undergo investigation for suspected cancer in the general practice setting. AIM To identify the factors influencing patient decisions to undertake investigations for suspected cancer in general practice. DESIGN & SETTING An exploratory qualitative, semi-structured interview study of patients attending rural and metropolitan general practices in Victoria, Australia. METHOD A purposive sample of 15 general practice patients aged ≥40 years participated. Thematic analysis of transcripts drew on interpretative description methodology and shared decision-making (SDM) theory. RESULTS Cancer-related concerns such as 'cancer worry' prompt patients to seek investigations from their GP. Participants prefer that their symptoms are investigated regardless of cancer risk. The perceived 'best test' provides the most reassurance. Trust and SDM enhance dialogue between patients and GPs about diagnostic testing strategies. Deterrents to testing included out-of-pocket costs, waiting time, travel time, and competing work and family demands. CONCLUSION There may be a mismatch between efforts to rationalise investigation use and patient preferences for investigation. SDM that incorporates patient concerns, facilitators, and barriers to testing may ensure appropriate and timely investigation of cancer symptoms.
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Affiliation(s)
- Brent Venning
- Department of General Practice, Melbourne Medical School, University of Melbourne, Melbourne, Australia
- Centre for Cancer Research, University of Melbourne, Melbourne, Australia
| | - Rebecca Bergin
- Department of General Practice, Melbourne Medical School, University of Melbourne, Melbourne, Australia
- Centre for Cancer Research, University of Melbourne, Melbourne, Australia
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
| | - Alison Pearce
- Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Alex Lee
- Department of General Practice, Melbourne Medical School, University of Melbourne, Melbourne, Australia
- Centre for Cancer Research, University of Melbourne, Melbourne, Australia
| | - Jon D Emery
- Department of General Practice, Melbourne Medical School, University of Melbourne, Melbourne, Australia
- Centre for Cancer Research, University of Melbourne, Melbourne, Australia
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Venning B, Saya S, De Abreu Lourenco R, Street DJ, Emery JD. Preferences for a polygenic test to estimate cancer risk in a general Australian population. Genet Med 2022; 24:2144-2154. [PMID: 35947108 DOI: 10.1016/j.gim.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 11/17/2022] Open
Abstract
PURPOSE There is significant interest in the use of polygenic risk score (PRS) tests to improve cancer risk assessment and stratified prevention. Our current understanding of preferences regarding different aspects of this novel testing approach is limited. This study examined which attributes of a PRS test most influence the likelihood of testing. METHODS A discrete choice experiment was developed to elicit preferences for different aspects of a PRS test by surveying an online sample of the Australian population. Preferences were assessed using mixed logistic regression, latent class analysis, and marginal willingness to pay. RESULTS The 1002 surveyed respondents were more likely to choose a PRS test that was more accurate, tested for multiple cancer types, and enabled cancer risk reduction through lifestyle modification, screening, or medication. There was also a preference for testing through a primary care physician rather than online or through a genetic specialist. A test that did not impact life insurance eligibility or premiums was preferred over the one that did. CONCLUSION This study found that the Australian population prefer a PRS test that is highly accurate, tests for multiple cancers, has noninvasive risk reduction measures, and is performed through primary care.
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Affiliation(s)
- Brent Venning
- Department of General Practice, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia; Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia.
| | - Sibel Saya
- Department of General Practice, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia; Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Haymarket, New South Wales, Australia
| | - Deborah J Street
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Haymarket, New South Wales, Australia
| | - Jon D Emery
- Department of General Practice, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia; Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia
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Khalili E, Venning B, Boggild M, Broadley SA. 082 Real world experience of treating multiple sclerosis with alemtuzumab. J Neurol Neurosurg Psychiatry 2018. [DOI: 10.1136/jnnp-2018-anzan.81] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
IntroductionAlemtuzumab is a highly effective therapy for multiple sclerosis that has a significant, but well-defined adverse event profile. We report cases treated since the commercial release of alemtuzumab at two centres in Queensland with the aim of comparing real-world experience with trial data.MethodsThis was a retrospective case note review of patients treated with alemtuzumab for multiple sclerosis since becoming commercially available in Australia. The two sites were the Gold Coast University Hospital and the Townsville Hospital. Demographic, clinical and MRI data were systematically collected from the available records at each site. De-identified aggregated data were analysed using descriptive statistics (mean (±SD), median (range)) and compared with phase III clinical trial data.Results104 cases treated with alemtuzumab were identified at the two sites. The median age at first treatment was 3817–55 years, slightly older than the trial populations (33 and 35 years) and two-thirds were female. The mean disease duration was 8.4 (±7.0) years, which is longer that seen in the trials (2.1 and 4.5 years). The median number of prior relapses was 31–12 with 1 (0–3) in the prior 2 years. The median number of prior treatments for MS was 1.5. The median follow up was 201–35 months. The median EDSS at time of first treatment was 2 (0–7) and at last follow up was 1.5 (0–7). At last follow up, 24/104 (23%) had improved, 61/104 (58%) were stable and 9/104 (9%) had worsened. Autoimmune adverse events were seen in 18/104 (17%) with autoimmune thyroid disease being the most common (13/104 (13%).ConclusionAlemtuzumab is an effective therapy for MS. Clinical outcomes in a real world setting were similar to those seen in phase III clinical trials. Autoimmune diseases occurred in a similar proportion to those seen in clinical trials.References. Cohen JA, Coles AJ, Arnold DL, et al. Alemtuzumab versus interferon beta 1a as first-line treatment for patients with relapsing-remitting multiple sclerosis: A randomised controlled phase 3 trial. Lancet2012;380(9856):1819–28.. Coles AJ, Twyman CL, Arnold DL, et al. Alemtuzumab for patients with relapsing multiple sclerosis after disease-modifying therapy: A randomised controlled phase 3 trial. Lancet2012;380(9856):1829–39.
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