Digestive system diseases

Objective To leverage the Treatment of Recurrent and Advanced Colorectal Cancer (TRACC) registry (an Australian cancer database) to explore the ideal timing and sequence of therapies and the factors influencing these decisions in colorectal cancer (CRC) patients with liver-only metastases to inform contemporary decision-making and future trials.Study TypeRetrospective registry-based cohort study using the TRACC registry.Setting and ParticipantsConsecutive patients with liver-only metastatic CRC enrolled in the TRACC registry.Main Outcome MeasuresTo explore cancer biology, intended treatment at presentation, actual treatment received and the resultant outcomes for early-onset CRC (EOCRC) (≤ 50 years) and late-onset CRC (LOCRC) (> 50 years) patients with liver-only metastases from a real-world perspective.ResultsBetween 14 January 2009 and 2 September 2024, 1691 patients with liver-only metastatic CRC were enrolled in TRACC. These included 276 EOCRC patients (16.3%) and 1415 LOCRC patients (83.7%). In the EOCRC subset, there were more females (48.2% vs. 34.5%, p < 0.001), less comorbidity (Charlson comorbidity index score 0, 90% vs. 59%, p < 0.001), more left-sided primaries (76.1% vs. 65.7%, p < 0.001), more synchronous disease (53.3% vs. 42.1%, p < 0.001) and BRAF V600E mutations (13.9% vs. 8.1%; p = 0.010). Overall, EOCRC patients had a longer median survival compared with LOCRC patients (3.20 vs. 2.38 years, p < 0.001). For the 662 patients (39.1%) undergoing liver resection, median survival was 5.99 years in EOCRC patients and 5.88 years in LOCRC patients. For all patients and for those undergoing resection, respectively, B-Raf proto-oncogene, serine/threonine kinase (BRAF) (hazard ratio, 1.97 [p < 0.001] and hazard ratio, 2.25 [p < 0.001]) and Kirsten rat sarcoma viral oncogene homologue (KRAS) mutations were associated with worse outcomes (hazard ratio, 1.29 [p < 0.001] and hazard ratio, 1.34 [p = 0.003]).ConclusionDifferences in sex distribution, BRAF mutation rates, primary tumour site and overall survival suggest biological differences between EOCRC and LOCRC. Liver resection was associated with improved survival in LOCRC, with the benefits of all therapies varying depending on age, primary tumour site and whether patients presented with synchronous or metachronous liver-only metastases.

Savio G. Barreto, Christos S. Karapetis, Shahid Ullah, Matthew Burge, Susan Caird, Angus Campbell, Azim Jalali, Ross Jennens, Muhammad A. Khattak, Belinda Lee, Stephanie H. Lim, Shehara Mendis, Louise Nott, Timothy J. Price, Jeremy D. Shapiro, Jeanne Tie, Javier Torres, Colin Williams, Rachel Wong, Vanessa Wong, Peter Gibbs

IntroductionDespite evidence of improved outcomes, people with pancreatic cancer have highly variable access to effective pain relief and palliative care. We aimed to develop evidence-based, community-informed standardised pathways to timely pain management and early palliative care for people with pancreatic cancer.Main RecommendationsUsing a multi-method, comprehensive, community engagement and evidence-informed approach, we developed pathways to standardise referral to pain management and early palliative care for people with pancreatic cancer. Community engagement included representation from multidisciplinary clinicians, community groups and people with lived experience from across regions and all Australian states. We developed two pathways: (i) a pathway for pain management for people with resectable pancreatic cancer and (ii) an integrated pathway for pain management and palliative care for people with unresectable pancreatic cancer (https://www.pancare.org.au/pancreatic-cancer-roadmap-projects/pancreatic-cancer-pathways). Clinical guidance providing practical steps and links to evidence accompany the pathways. Key elements of the pathways included:screening for pain at each encounter, comprehensive holistic assessment and management;early consideration of interventional pain management in the event of refractory pain;introduction of palliative care at time of diagnosis of metastatic or unresectable pancreatic cancer with links to suggested language to address potential community hesitancy; andrecommendation to discuss referrals for palliative care and interventional pain management at cancer multidisciplinary meetings.Changes in Management as a Result of the GuidelinesThe pathways developed have set forth best practice standards grounded in evidence and expert consensus. The extensive clinical and community engagement ensures the relevance and ownership of these pathways. Implementation of the pathways will reduce existing variation in access and enhance the quality of care for people with pancreatic cancer. Furthermore, the pathways offer an opportunity to benchmark practice within and between services.

Jennifer Philip, Melanie R. Lovell, Kylee Bellingham, Gail Garvey, Gregory B. Crawford, Nicole M. Rankin, Kara Burns, Isabel Young, Vivienne Milch, Dorothy Keefe, Katrina Anderson, James Lawson, Meinir Krishnasamy

Targeted public health measures for particular patient subgroups are required to save lives among people with cirrhosis

Vikas Bhasker · Jessica R Fong · Paul J Clark · Gunter F Hartel · Richard Skoien · James O’Beirne · Elizabeth E Powell · Patricia C Valery

A summary of recommendations and practice points for key population subgroups who were identified as potentially benefitting from routine hepatocarcinoma surveillance in the form of ultrasound scans, with or without ?-fetoprotein testing

Jacob George · Nicole L Allard · Stuart K Roberts · Leon A Adams · Jane Davies · Behzad Hajarizadeh · Jennifer H MacLachlan · Suzanne E Mahady · Rosalie Altus · Catherine Brown · David C Fry · Belinda Greenwood‐Smith · Natali Smud · Patricia C Valery · Nafisa Yussf · Kate Broun · Denise Campbell · Karen Canfell · Chelsea Carle Harrison · Victoria Freeman · Paul Grogan · Catherine Holliday · Suzanne Hughes · Anna Kelly · Cathelijne Kemenade · Claire Latumahina · Amanda McAtamney · Megan Varlow · Joachim Worthington · Susan Yuill · Eleonora Feletto

Greater awareness of care integrated into primary care services for people who use drugs would support HCV elimination strategies

Elly Layton · Nicole Matthews · Brendan Quinn · Nasra Higgins · Gabrielle Lindeman · Mielle Abbott · Jennifer MacLachlan · Elizabeth Birbilis · Margaret E Hellard · Joseph Doyle · Benjamin C Cowie · Mark Stoové

In recognition of the increasing burden of metabolic dysfunction-associated fatty liver disease (MAFLD) in Australia, and the lack of clear guidelines for general practitioners, this consensus statement summary presents 21 recommendations on the assessment and monitoring of MAFLD in adult patients in primary care

Leon A Adams · William W Kemp · Kate R Muller · Elizabeth E Powell · Stuart K Roberts · Luis Calzadilla Bertot · Stephanie Best · Gary Deed · Jon D Emery · Samantha L Hocking · Graham R Jones · John S Lubel · Sinead Sheils · Stephen M Twigg · Gerald F Watts · Jacob George

A 70-year-old woman presented to the emergency department with symptomatic hyperkalaemia after excessive ingestion of potassium bitartrate to relieve constipation

Daniel Yee Lee Ng · Laksmi Govindasamy · Andrew Hughes · Hwee Min Lee

Needle and syringe programs are evidence-based best practice interventions that reduce the harm associated with needle sharing

Alexander J Thompson · Michael H Levy

A 26-year-old man with central obesity (body mass index, 32.7 kg/m2) and a history of drinking up to 22 standard drinks over weekends, collapsed 5 minutes following a 5 km run in hot and humid conditions in Brisbane, Australia

Nicholas Smith · Richard Skoien · Melita Andelkovic

Current knowledge and service limitations in treating the complex interplay between eating disorders, gut–brain disorders and motility disorders

Trina Kellar · Chamara Basnayake · Rebecca E Burgell · Michael Kamm · Hannah W Kim · Kate Lane · Kate Murphy · Nicholas J Talley

A 72-year-old man with a history of well controlled type 2 diabetes was admitted to a tertiary metropolitan hospital for investigation of fevers, night sweats and unintentional weight loss of 18kg over six months

Vinny Ea · Brigitte Papa · Rimma Goldberg

Key action measures to help address disparities in hepatocellular carcinoma incidence and mortality in First Nations Australians

Jessica Howell · Troy Combo · Paula Binks · Kylie Bragg · Sarah Bukulatjpi · Kirsty Campbell · Paul J Clark · Melissa Carroll · Jane Davies · Teresa de Santis · Kate R Muller · Bella Nguyen · John K Olynyk · Nicholas Shackel · Patricia C Valery · Alan J Wigg · Jacob George · Stuart K Roberts

In August 2023, an otherwise healthy 54-year-old woman presented to hospital with acute onset fevers and sweats, followed by four days of nausea, vomiting, generalised severe abdominal pain and diarrhoea.

Samuel WL‐W Baumgart · Suzanne English · Tony Sebastian · Sarika Suresh · Timothy J Gray

Even when it looks, smells and sounds like inflammatory bowel disease, it might not be

Kathryn Demase · Mark G Ward

The rising prevalence of steatotic liver disease parallels that of obesity in regional and rural Victoria

Karl Vaz · William W Kemp · Ammar Majeed · John Lubel · Dianna Magliano · Kristen Glenister · Lisa Bourke · David Simmons · Stuart K Roberts

Hepatocellular carcinoma is a leading cause of cancer-related death worldwide, and is increasing in incidence in Australia

Samuel Hui · Sally Bell · Suong Le · Anouk Dev

Screening for and monitoring diabetes mellitus in people with NAFLD/NASH, and proactively managing it, are important

Daniel Clayton‐Chubb · Stuart K Roberts

Multidisciplinary models of care including dietary therapy are needed in Australia

Jessica Fitzpatrick · Sarah L Melton · Rebecca E Burgell