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Port Adelaide, Australia

Roder D.,Cancer Australia | Roder D.,University of South Australia | Zorbas H.M.,Cancer Australia | Kollias J.,Breast Quality Audit Steering Committee | And 9 more authors.
Australian Health Review | Year: 2014

Objective To investigate patient, cancer and treatment factors associated with the residence of female breast cancer patients in lower socioeconomic areas of Australia to better understand factors that may contribute to their poorer cancer outcomes. Methods Bivariable and multivariable analyses were performed using the Breast Quality Audit database of Breast Surgeons of Australia and New Zealand. Results Multivariable regression indicated that patients from lower socioeconomic areas are more likely to live in more remote areas and to be treated at regional than major city centres. Although they appeared equally likely to be referred to surgeons from BreastScreen services as patients from higher socioeconomic areas, they were less likely to be referred as asymptomatic cases from other sources. In general, their cancer and treatment characteristics did not differ from those of women from higher socioeconomic areas, but ovarian ablation therapy was less common for these patients and bilateral synchronous lesions tended to be less frequent than for women from higher socioeconomic areas. Conclusions The results indicate that patients from lower socioeconomic areas are more likely to live in more remote districts and have their treatment in regional rather than major treatment centres. Their cancer and treatment characteristics appear to be similar to those of women from higher socioeconomic areas, although they are less likely to have ovarian ablation or to be referred as asymptomatic patients from sources other than BreastScreen. What is known about this topic? It is already known from Australian data that breast cancer outcomes are not as favourable for women from areas of socioeconomic disadvantage. The reasons for the poorer outcomes have not been understood. Studies in other countries have also found poorer outcomes in women from lower socioeconomic areas, and in some instances, have attributed this finding to more advanced stages of cancers at diagnosis and more limited treatment. The reasons are likely to vary with the country and health system characteristics. What does this paper add? The present study found that in Australia, women from lower socioeconomic areas do not have more advanced cancers at diagnosis, nor, in general, other cancer features that would predispose them to poorer outcomes. The standout differences were that they tended more to live in areas that were more remote from specialist metropolitan centres and were more likely to be treated in regional settings where prior research has indicated poorer outcomes. The reasons for these poorer outcomes are not known but may include lower levels of surgical specialisation, less access to specialised adjunctive services, and less involvement with multidisciplinary teams. Women from lower socioeconomic areas also appeared more likely to attend lower case load surgeons. Little difference was evident in the type of clinical care received, although women from lower socioeconomic areas were less likely to be asymptomatic referrals from other clinical settings (excluding BreastScreen). What are the implications for practitioners? Results suggest that poorer outcomes in women from lower socioeconomic areas in Australia may have less to do with the characteristics of their breast cancers or treatment modalities and more to do with health system features, such as access to specialist centres. This study highlights the importance of demographic and health system features as potentially key factors in service outcomes. Health system research should be strengthened in Australia to augment biomedical and clinical research, with a view to best meeting service needs of all sectors of the population. © AHHA 2014.

Aspinall S.R.,Northumbria Healthcare NHS Foundation Trust | Boase S.,Nose and Throat Surgery | Malycha P.,Endocrine and Surgical Oncology Unit
World Journal of Surgery | Year: 2010

Background: The affect of the surgical approach for primary hyperparathyroidism (1HPT) on long-term symptom relief has not been studied. This study compares the longterm relief of symptoms assessed by the Parathyroidectomy Assessment of Symptoms (PAS) score in patients undergoing bilateral neck exploration (BNE) and minimally invasive parathyroidectomy (MIP). Methods: In this case-control study, patients with 1HPT who had followed a protocol to assess symptoms before and after parathyroid surgery between 1999 and 2008 were contacted by letter and had blood taken to assess calcium, ionized calcium, and parathyroid hormone (PTH). The main aim was to assess symptoms at long-term follow-up using the PAS score. The incidence of persistent or recurrent 1HPT at long-term follow-up after MIP and BNE was also compared. Results: Two hundred and forty-six patients underwent parathyroid surgery and 142 responded to our correspondence, of which 64 underwent MIP and 78 BNE. Follow-up after BNE was longer than MIP (61 vs. 41 months). At long-term follow-up, the mean PAS score fell by 125 and 175 in the MIP and BNE groups, respectively. There was no statistically significant difference in the decline of the PAS score between the MIP and BNE groups. Six patients developed persistent or recurrent 1HPT following MIP compared to three after BNE; this difference was not statistically significant. Conclusions: This study is the first to report on long-term symptom relief from 1HPT after MIP, and demonstrates that both MIP and BNE can achieve this. In order to establish whether the long-term outcomes from these procedures are equivalent, further adequately powered studies are required. © Société Internationale de Chirurgie 2010.

Roder D.,Cancer Australia | Roder D.,University of South Australia | Zorbas H.,Cancer Australia | Kollias J.,Quality Audit Steering Committee | And 8 more authors.
Breast | Year: 2013

Purpose: To investigate person, cancer and treatment determinants of immediate breast reconstruction (IBR) in Australia. Methods: Bi-variable and multi-variable analyses of the Quality Audit database. Results: Of 12,707 invasive cancers treated by mastectomy circa 1998-2010, 8% had IBR. This proportion increased over time and reduced from 29% in women below 30 years to approximately 1% in those aged 70 years or more. Multiple regression indicated that other IBR predictors included: high socio-economic status; private health insurance; being asymptomatic; a metropolitan rather than inner regional treatment centre; higher surgeon case load; small tumour size; negative nodal status, positive progesterone receptor status; more cancer foci; multiple affected breast quadrants; synchronous bilateral cancer; not having neo-adjuvant chemotherapy, adjuvant radiotherapy or adjuvant hormone therapy; and receiving ovarian ablation. Conclusions: Variations in access to specialty services and other possible causes of variations in IBR rates need further investigation. © 2013 Elsevier Ltd.

Abbott D.,University of Adelaide | Ashdown M.L.,University of Melbourne | Robinson A.P.,University of Melbourne | Yatomi-Clarke S.L.,Berbay Biosciences | And 5 more authors.
F1000Research | Year: 2015

Complete response (CR) rates reported for cytotoxic chemotherapy for late-stage cancer patients are generally low, with few exceptions, regardless of the solid cancer type or drug regimen. We investigated CR rates reported in the literature for clinical trials using chemotherapy alone, across a wide range of tumour types and chemotherapeutic regimens, to determine an overall CR rate for late-stage cancers. A total of 141 reports were located using the PubMed database. A meta-analysis was performed of reported CR from 68 chemotherapy trials (total 2732 patients) using standard agents across late-stage solid cancers-a binomial model with random effects was adopted. Mean CR rates were compared for different cancer types, and for chemotherapeutic agents with different mechanisms of action, using a logistic regression. Our results showed that the CR rates for chemotherapy treatment of late-stage cancer were generally low at 7.4%, regardless of the cancer type or drug regimen used. We found no evidence that CR rates differed between different chemotherapy drug types, but amongst different cancer types small CR differences were evident, although none exceeded a mean CR rate of 11%. This remarkable concordance of CR rates regardless of cancer or therapy type remains currently unexplained, and motivates further investigation. © 2015 Ashdown ML et al.

Boyle S.T.,University of Adelaide | Ingman W.V.,University of Adelaide | Poltavets V.,University of Adelaide | Faulkner J.W.,University of Adelaide | And 4 more authors.
Oncogene | Year: 2016

The chemokine receptor CCR7 is widely implicated in breast cancer pathobiology. Although recent reports correlated high CCR7 levels with more advanced tumor grade and poor prognosis, limited in vivo data are available regarding its specific function in mammary gland neoplasia and the underlying mechanisms involved. To address these questions we generated a bigenic mouse model of breast cancer combined with CCR7 deletion, which revealed that CCR7 ablation results in a considerable delay in tumor onset as well as significantly reduced tumor burden. Importantly, CCR7 was found to exert its function by regulating mammary cancer stem-like cells in both murine and human tumors. In vivo experiments showed that loss of CCR7 activity either through deletion or pharmacological antagonism significantly decreased functional pools of stem-like cells in mouse primary mammary tumors, providing a mechanistic explanation for the tumor-promoting role of this chemokine receptor. These data characterize the oncogenic properties of CCR7 in mammary epithelial neoplasia and point to a new route for therapeutic intervention to target evasive cancer stem cells. © 2016 Macmillan Publishers Limited.

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