Topics
Cancer
Severe symptomatic hypocalcaemia following a single dose of denosumab
First-line monoclonal antibody therapy to prevent bone loss in bone-metastatic breast and prostate cancers is delivered subcutaneously, often by general practitioners who need to be aware that this treatment in patients with low vitamin D levels, impaired renal function and poor calcium absorption (all often seen in older patients) can lead to serious hypocalcaemia.
Jennifer M McLachlan · Gavin M Marx · Margaret Bridgman
The impact of a genomic assay (Oncotype DX) on adjuvant treatment recommendations in early breast cancer
This first decision-impact study of the Oncotype DX breast cancer assay in Australia provides evidence that recurrence score information influences treatment recommendations for hormone receptor-positive early-stage invasive breast cancer in the multidisciplinary meeting setting
Richard H de Boer MB BS, FRACP · Caroline Baker MB BS, FRACS · David Speakman MB BS, FRACS · Calvin Y Chao MD · Carl Yoshizawa PhD · G Bruce Mann MB BS, PhD, FRACS
Should we screen for lung cancer in Australia?
CT screening of high-risk individuals approaches acceptable cost-effectiveness. But is there a better way?
Mark Hew MB BS, PhD, FRACP · Robert G Stirling BSc(Hons), MB BCh(Hons), FRACP · Michael J Abramson MB BS, PhD, FAFPHM
The drover’s wife
Family stories provide the key to understanding the patient’s wishes and open doors to plain speaking, in this reflection on caring for a woman who is unable to communicate.
Matthew J Links MB BS, PhD, FRACP · Theodora Bikou BSW
The dilemmas of prostate cancer screening
It is unquestionable that prostate-specific antigen screening is associated with overdiagnosis. However, the magnitude of this problem still remains uncertain because of the lack of sufficient robust, long-term follow-up data from ongoing trials.
Jonas Hugosson MD, PhD · Sigrid V Carlsson MD, PhD
Stent insertion for palliation of advanced oesophageal carcinoma symptoms by level of socioeconomic disadvantage in urban New South Wales
Linked records for patients who died from primary advanced oesophageal carcinoma reveal an unfortunate trend in access to palliative care — greater socioeconomic disadvantage is significantly associated with decreasing odds of stent insertion for palliation of symptoms such as dysphagia and odynophagia
Jason P Bentley · David E Goldsbury · Guy D Eslick · Michael R Cox · Dianne L O’Connell
Public misperception of new regulations supports a call for a nationwide solarium ban
A national survey found that many respondents were under the false impression that solariums are safer since regulations were introduced to ban their use by certain vulnerable groups of people, backing calls for a complete nationwide ban on solariums.
Suzanne J Dobbinson · Angela Volkov · Melanie A Wakefield
Early success for Australia's bowel screening program: let's move it along
The early positive results of the National Bowel Cancer Screening Program should provide encouragement to the government to accelerate its implementation
Ian N Olver MD, PhD, FRACP · Paul B Grogan
Improving coordination of care between specialist and general practice for people with chronic pain
Australia's National Pain Strategy describes three points in the current model of care where sufferers of chronic pain (defined as constant pain on a daily basis for 3 months or more in the past 6 months) encounter “fault lines” or disruptions in their treatment journey.1 The first of these is the prolonged cycle of tests, medicinal therapy and referrals that occurs in the community, delaying ...
Geoffrey K Mitchell MB BS, PhD, FRACGP
Shift to earlier stage at diagnosis as a consequence of the National Bowel Cancer Screening Program
A cohort comparison of colorectal cancer patient data from the National Bowel Cancer Screening Program register and the South Australian Cancer Registry found that cancers were diagnosed at a significantly earlier stage in people invited to the screening program compared with those who were not invited. A further shift towards earlier stage was seen in those who participated in screening and those with positive test results compared with the rest of the study population.
Stephen R Cole BSc, MPH · Graeme R Tucker BSc · Joanne M Osborne MPH · Susan E Byrne BN · Peter A Bampton MD, FRACP, AGAF · Robert J L Fraser MB BS, FRACP, PhD · Graeme P Young MD, FRACP, FTSE
Dr Burnt’s consultation
Early recognition and rectification of burnout in oncology registrars and oncologists is needed to ensure the wellbeing of both doctors and patients.
Muhammad A Khattak MB BS
Ethics in medicine: is it a futile exercise?
Introducing the MJA Ethics series, the series editor outlines some of the ethical challenges for medicine and society in the 21st century. The long-unresolved ethical conflicts surrounding the issue of providing “futile” care are discussed from clinical, ethical and legal perspectives, in this, the first instalment of the series.
Dominic J C Wilkinson MB BS, DPhil, FRACP
What is futile and who decides? The clinician’s dilemma
Deciding when to stop treatment can be a challenging task for health professionalsWith advances of modern medicine come increased expectations from society, and dilemmas regarding when to stop treatment are becoming increasingly common. The Medical Board of Australia code of conduct explicitly states “you do not have a duty to try to prolong life at all cost. However, you do have a duty to know ...
Bogda Koczwara BM BS, MBioethics, FRACP
Futile treatment: the ethicist’s perspective
We need to pay attention to the reasons why treatment is judged to be futileWhen doctors are confronted with making treatment decisions in the context of a terminally ill patient, the way forward is often difficult and confused. Bringing an ethics perspective to bear on the problem can help to resolve what the essential issues are, in turn enabling a clearer path to appropriate decisions ...
Dominic J C Wilkinson MB BS, DPhil, FRACP
Liver cancer is the fastest increasing cause of cancer death in Australians
To the Editor: In September 2012, the Australian Institute of Health and Welfare (AIHW) released its report on cancer survival and prevalence in Australia from 1982 to 2010, incorporating incidence and mortality estimates for all malignancies reported to Australian cancer registries.1 Cancer is a leading cause of morbidity and mortality in Australia, accounting for about 20% of the total disease burden and 30% of deaths.2 Liver cancer ...
Jennifer H MacLachlan · Benjamin C Cowie
More than the sum of our parts
Australian cancer care is among the best provided in the world. Yet, many cancer patients choose to either forgo aspects of conventional treatment or seek unproven complementary therapies. My own recent cancer treatment prompted me to wonder whether these choices may, at least in part, be due to the failure of Western medicine to address the psychological ...
Tanya L Hall BMed, FRANZCP
Cancer care engages with CAM
ALTHOUGH THIS compendium cannot possibly encompass the depth and breadth of complementary and alternative medicines (CAMs) as they are practised today, it does provide an array of interesting insights into what is a relatively uncharted field within the “modern occidental” medical community.Aligned with the background of the editors — Ian Olver and Monica Robotin — from the Cancer Council Australia, Perspectives has a clear focus ...
Hosen Kiat
Drug treatment for melanoma: progress, but who pays?
Making cancer drugs affordable requires coherent policy and cannot be left to market forcesMelanoma is 10 times more common in Australia than in most countries,1 and kills more than 1300 Australians every year.2 The good news is that we now have effective drug treatments for metastatic melanoma. Two drugs, ipilimumab3,4 and vemurafenib,5 are now approved by the United States Food and Drug Administration and the Australian Therapeutic ...
Richard F Kefford AM, PhD, FRACP
The need for data beyond primary diagnosis
Information from clinical trials informs our treatment of breast cancer, as it does that of many other common diseases. The trials establish “ideal” management, but the relevance of this information to any individual patient varies because the strict inclusion criteria used for trials exclude many important groups in the community. In breast cancer trials, the old, the poor and the rural-dwelling are often underrepresented. So, ...
Annette Katelaris MB BS, MPH, FRACGP
Do the benefits of screening mammography outweigh the harms of overdiagnosis and unnecessary treatment?
To the Editor: Although both sides of the debate about screening mammography1,2 acknowledge the mortality benefit due to screening and the risk of overdiagnosis, the magnitude and relative value of these need further clarification and reflection. In calculating the number of breast cancer deaths averted using a relative risk reduction of 35%, Roder and Olver overstate the benefit. Other estimates of effect are lower (eg, ...
Alexandra L Barratt · Paul P Glasziou
Incidence of metastatic breast cancer in an Australian population-based cohort of women with non-metastatic breast cancer at diagnosis
Objectives: To estimate the incidence of metastatic breast cancer (MBC) in Australian women with an initial diagnosis of non-metastatic breast cancer.Design, setting and participants: A population-based cohort study of all women with non-metastatic breast cancer registered on the New South Wales Central Cancer Register (CCR) in 2001 and 2002 who received care in a NSW hospital.Main outcome measures: 5-year cumulative incidence ...
Sarah J Lord MB BS, MS, FRACGP · M Luke Marinovich BA, MPH · Jillian A Patterson BSc, MBiostats · Nicholas Wilcken MB BS, PhD, FRACP · Belinda E Kiely MB BS, FRACP · Val Gebski BA, MStats, FRANZCR(Hons) · Sally Crossing AM, BEc · David M Roder AM, MPH, DDSc · Melina Gattellari PhD, MPH, BSc(Psychol) · Nehmat Houssami MB BS, PhD, FAFPHM
Effect of false-positive screening mammograms on rescreening in Western Australia
Objectives: To quantify the effect of previous false-positive mammogram results on rescreening rates in a population of women participating in the BreastScreen WA (BSWA) program.Design and participants: Retrospective cohort study of women aged 50–69 years who received free screening mammograms at BSWA between 1 January 1995 and 31 December 2007.Main outcome measures: Percentages of women attending rescreening, and risk ratios for rescreening.Results: ...
Marcus J H Sim · Siva Prema Siva · Intan S Ramli · Lin Fritschi MB BS, PhD, FAFPHM · Janette Tresham BSc(Agric) · Elizabeth J Wylie MB BS, FRANZCR
The urgency of saving lives through bowel cancer screening
While the government’s implementation of the National Bowel Cancer Screening Program remains stalled, Australians are dying unnecessarilyOne in 12 Australians will develop colorectal cancer (CRC), and it is the second most common cause of cancer death. It is one of only three cancers for which organised population screening is recommended, and it is the first to ...
Ian N Olver MD, PhD, FRACP · Graeme P Young MD, FRACP, AGAF
Survival from pancreatic cancer: it’s not just about the surgical mortality
Has the time come to form specialised centres for complex surgical procedures?The article by Speer and colleagues in this issue of the Journal reporting outcomes in patients undergoing pancreatectomy for pancreatic cancer in Victoria in 2002–2003 indicates the poor outcome for this condition on a population basis.1 Consistent with international series are the observations that only ...
Robert T A Padbury MB BS, FRACS, PhD
Colorectal cancer screening in Australia: a community-level perspective
Objectives: To determine current colorectal cancer (CRC) screening rates and the level of adherence to screening guidelines at a community level.Setting: A cross-sectional cohort of at-risk people aged 56–88 years randomly selected from the Hunter Community Study (HCS), Australia.Main outcome measures: Proportion ever reporting undertaking any CRC testing; current screening ...
Ryan J Courtney BPsych(Hons) · Christine L Paul PhD · Robert W Sanson-Fisher PhD, MClinPsych · Finlay A Macrae MD, FRACP, FRCP · Mariko L Carey PhD · John R Attia MD, PhD · Mark A McEvoy MClinEpi