News
GP cancer campaigns don’ t work
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MICHAEL WOODHEAD GP and patient cancer awareness campaigns don’ t result in improved time to diagnoses, according to WA researchers.
The University of WA team assessed the effectiveness of a $ 1.4 million, two-pronged awareness campaign run by Cancer Council WA that was designed to reduce the gap between rural and urban areas in terms of the timeliness of cancer diagnoses.
However, the researchers found that after two years, the timeliness of diagnoses for 1358 people with breast, prostate, colorectal and lung cancers was no different in the regions targeted by the campaign compared with those in control regions.
The findings indicated that fasttrack specialist pathways could be a more important strategy for improving cancer care for rural patients, the authors said.
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PHOTO: Peter Casamento
“ Alternative strategies, possibly focused on fast-track specialist pathways and improved access to diagnostic tests, may be more important in reducing diagnostic delays and improving cancer outcomes,” they concluded.
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The GP arm of the trial provided 40 practices with resources and educational visits.
GPs were issued with academic details of cancer diagnostic pathways, case studies, resource materials and risk-assessment tools.
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‘ Fast-track specialist pathways... may be more important in reducing diagnostic delay and improving cancer outcomes.’
— Professor Jon Emery and colleagues
The researchers found the interventions had no effect on the timeliness of diagnoses for any of the cancers targeted.
The community arm of the campaign, called‘ Find Cancer Early’, included symptom checklists and
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encouraged people to see their GP for red flags, such as a three-week cough.
This arm also had no effect on time to cancer diagnoses when compared with control areas in regions of rural WA from 2012-2013.
Lead researcher Professor Jon Emery, a GP and primary care researcher at the university, and coauthors said the interventions may have failed because the campaign lacked sufficient resources, such as TV advertising, to get the message across to the public.
However, there was evidence of improvements in symptom awareness and intentions to seek help in surveys carried out in the target regions, he noted.
Another explanation might be lack of timely access to diagnostic services, such as“ one-stop prostate cancer clinics.”
British Journal of Cancer 2017; online.
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Robotic surgeries shift to older, high-risk prostate patients
MICHAEL WOODHEAD ROBOTIC prostate surgery has fallen out of favour for younger men with low-grade disease, Victorian urological surgeons say.
Practice patterns for six surgeons performing high volumes of robotic prostate surgery show that they are now operating more on older men with higher-risk disease compared with a decade ago.
In the review that covered surgeries performed on 3075 men, the average age of patients increased from 61 to 65 between 2004 and 2016.
At the same time, the proportion of high-risk patients rose from 13 % to 28 %, while the proportion of surgical procedures performed on low-risk patients fell from 41 % to just 6 %. The study authors said the changes reflected the reversal in screening practices for prostate cancer following the US Preventive Services Task Force statement in 2012, which stated that the harms of PSA testing outweighed the benefits.
“ These changes have primarily been driven by the alteration in PSA screening guidelines and uptake of active surveillance for low-risk disease, and by recognition that good outcomes can be achieved in higher-risk patients,” said researchers from the Peter
MacCallum Cancer Centre in Melbourne.
They also noted that the proportion of robotic prostate procedures performed on later-stage disease had increased from 22 % to 50 %.
“ Further work is needed to assess whether the stage shift may relate partially to a decline in screening and increased presentation of higher-risk disease,” they said. ANZ Journal of Surgery 2017; online.
Clinical chocolate trial goes into meltdown after volunteers flake out
Most women in the chocolate-free control group refused to take part.
MICHAEL WOODHEAD ON paper it should have been a cakewalk, but a trial of chocolate to prevent pre-eclampsia has been abandoned because women had no appetite for eating the confectionary on a daily basis in the name of medical science.
With observational studies suggesting that flavenol-rich chocolate has benefits on vascular endothelium, Queensland researchers hoped to assess the effect of consuming 25g of dark chocolate daily during pregnancy on rates of pre-eclampsia.
They set up a clinical trial in Cairns that aimed to recruit 1200 pregnant women from antenatal clinics to be randomised to either a chocolate intervention group or a control group.
Despite a lot of favourable publicity and support from GPs, they found it“ extraordinarily and unexpectedly difficult” to attract any takers for a supply of free chocolate.
After just over a year they had found only 42 volunteers and were forced to abandon the trial when most of the women dropped out or did not eat the chocolate provided.
Many women found the taste of the dark chocolate unappealing, others had worries about weight gain and some could not eat chocolate because of pregnancy-related nausea, the researchers said.
The perception of chocolate as a pleasurable treat made it difficult to take seriously as a therapeutic intervention, the researchers said, adding that this was another obstacle to recruiting women to the trial.
Also, most women assigned to the control group refused to take part when they learned they would not receive any chocolate, the researchers found. To overcome this problem in future trials, they suggested using a placebo chocolate without any flavenol content.
Despite the setback, they believed there was still a need to investigate the role of flavenoid-rich chocolate in pre-eclampsia.
“ Although recruitment difficulties halted this trial, the results of shortterm studies from men and nonpregnant women certainly suggest that the topic is worth pursuing with a well-designed trial,” they concluded. Australian and New Zealand Journal of Obstetrics and Gynaecology 2017; online.
6 | Australian Doctor | 29 September 2017 www. australiandoctor. com. au