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Clements M.S.,Karolinska Institutet | Clements M.S.,Australian National University | Roder D.M.,National Breast and Ovarian Cancer Center | Yu X.Q.,Cancer Council NSW | And 5 more authors.
Cancer Causes and Control

Purpose To develop and validate a method for estimating numbers of people with distant cancer metastases, for evidence-based service planning. Methods Estimates were made employing an illness-death model with distant metastatic cancer as the illness state- and site-specific mortality as an outcome, using MIAMOD software. To demonstrate the method, we estimated numbers of females alive in Australia following detection of distant metastatic breast cancer during 1980-2004, using data on patient survival from an Australian population-based cancer registry. We validated these estimates by comparing them with direct prevalence counts. Results Relative survival at 10 years following detection of distant metastases was low (5-20 %), with better survival experienced by: (1) females where distant metastatic disease was detected at initial diagnosis rather than subsequently (e.g., at recurrence); (2) those diagnosed in more recent calendar years; and (3) younger age groups. For Australian females aged less than 85 years, the modeled cumulative risk of detection of distant metastatic breast cancer (either at initial diagnosis or subsequently) declined over time, but numbers of cases with this history rose from 71 per 100,000 in 1980 to 84 per 100,000 in 2004. The model indicated that there were approximately 3-4 prevalent distant metastatic breast cancer cases for every breast cancer death. Comparison of estimates with direct prevalence counts showed a reasonable level of agreement. Conclusions The method is straightforward to apply and we recommend its use for breast and other cancers when registry data are insufficient for direct prevalence counts. This will provide estimates of numbers of people who would need ongoing medical surveillance and care following detection of distant metastases. © 2012 Springer Science+Business Media B.V. Source

De Morgan S.E.,University of Newcastle | De Morgan S.E.,University of Sydney | Butow P.N.,University of Sydney | Lobb E.A.,University of Sydney | And 2 more authors.
Supportive Care in Cancer

Purpose: The literature highlights the confusion amongst women diagnosed with ductal carcinoma in situ (DCIS) about aspects of their disease and treatment and the wide variation in how doctors communicate about DCIS. The DCIS communication aid (CA) was developed to assist clinicians to communicate with women diagnosed with DCIS and to improve women's understanding about their disease, prognosis and treatment options. This study aimed to assess patient and clinician perceptions of the CA. Methods: The CA included information and diagrams about key aspects of the diagnosis, prognosis, treatment and support. It was designed to be used in clinical consultations and taken home after the consultation. Australian women with DCIS (n=18) participated in structured interviews and clinicians (n=7), including surgeons and radiation oncologists, completed surveys to assess their perceptions of the CA. Main outcome measures included satisfaction with the content, design and diagrams in the CA, and perceptions of the benefits of the CA and its impact on doctor-patient communication. Results: All clinicians and women with DCIS reported that the CA would assist communication and help women understand their diagnosis. Conclusions: This is the first intervention designed to decrease the confusion amongst women with DCIS and improve doctor-patient communication in this area. This study highlights that interventions such as the DCIS communication aid may be a valuable resource for clinicians and women with DCIS. This study also highlights key communication challenges relating to DCIS. © Springer-Verlag 2010. Source

Jordan S.J.,University of Queensland | Jordan S.J.,Queensland Institute of Medical Research | Francis J.E.,National Breast and Ovarian Cancer Center | Nelson A.E.,National Breast and Ovarian Cancer Center | And 3 more authors.
Medical Journal of Australia

Objective: To describe the diagnostic pathways experienced by a large, representative group of Australian women with ovarian cancer, and to document the time between first presentation to a medical professional and clinical diagnosis. Design, setting and participants: 1463 women with epithelial ovarian cancer from an Australia-wide population-based study (2002-2005) completed a telephone interview in which they described the events that led to the diagnosis of their cancer. Main outcome measures: Number and type of doctors consulted, investigations performed, referral patterns and the time from first presentation to diagnosis. Results: Of the 1463 women, 145 had their cancer diagnosed incidentally and were excluded from analysis. Most of the remaining 1318 women (1222, 93%) presented first to their general practitioner. As a result of their first medical consultation, 75 women (6%) were given a diagnosis, and 484 (37%) were referred to a gynaecologist, gynaecological oncologist or oncologist for further assessment. Overall, 85% of women visited three or fewer doctors before their cancer was diagnosed; 66% of cancers were diagnosed within 1 month of the initial presentation, and 80% were diagnosed within 3 months. For 12% of women, the diagnostic process took longer than 6 months; this was more likely for women residing in remote Australia, those with lower incomes, and those presenting with abdominal pain or bowel symptoms, or with more than one symptom. Conclusions: Despite anecdotal suggestions to the contrary, most women with ovarian cancer in Australia are investigated and diagnosed promptly. The diagnostic process is more protracted for a minority of women, and the factors we found to be associated with diagnostic delay warrant further investigation. Source

Wilcoxon H.,National Breast and Ovarian Cancer Center | Luxford K.,National Breast and Ovarian Cancer Center | Saunders C.,University of Western Australia | Peterson J.,National Breast and Ovarian Cancer Center | Zorbas H.,National Breast and Ovarian Cancer Center
Asia-Pacific Journal of Clinical Oncology

Aim: Multidisciplinary care (MDC) is accepted as best practice in cancer treatment planning and care. Despite recognition of the importance of a team approach, limited data are available about the extent to which MDC has been implemented in Australia. The aim of the audit was to investigate the implementation of MDC for five main cancer types across Australia in line with best practice. Methods: A sample of 155 hospitals was surveyed to investigate the status of MDC for cancer treatment planning in Australia across five cancer types (breast, gynecological, lung, prostate and colorectal). The survey investigated team structure, meetings, patient consent, documentation of team recommendations and communication with the patient. Results: Two-thirds of hospitals surveyed did not have a multidisciplinary team. Of those with such a team; in one-third patients were not informed their case would be discussed by the team, in half patient consent was not sought for all cases discussed by the team, in one-quarter the team's recommended treatment plan was not noted in the patient record. Less than 1% of teams reported routine attendance by the tumour-specific minimum core team. Conclusion: MDC is not being implemented in line with best practice or applied consistently across Australia. This audit has highlighted gaps in care delivery, despite national recommendations about MDC. Areas being neglected can affect the quality of care provided and may put clinicians at medico-legal risk. Recommendations to improve uptake and effectiveness of MDC are provided. © 2011 Blackwell Publishing Asia Pty Ltd. Source

Whitfield R.,Royal Adelaide Hospital | Kollias J.,Royal Adelaide Hospital | Zorbas H.,National Breast and Ovarian Cancer Center | Maddern G.,University of Adelaide
ANZ Journal of Surgery

Background: Trastuzumab increases disease-free and overall survival in HER-2-positive, early breast cancer. In 2007, the National Breast and Ovarian Cancer Centre recommended that patients with HER-2 positive cancers (node positive or node negative tumours >1cm) be offered adjuvant trastuzumab with chemotherapy. The aim of this study was to evaluate recent trends in trastuzumab therapy in Australia and New Zealand. Methods: Following data were obtained from the National Breast Cancer Audit for patients treated between 2006 and 2008: tumour size, number of cases recorded per surgeon per year, location of hospital, HER-2 receptor status, age, lymph node status, chemotherapy and trastuzumab treatment. Results: Data were available from 23290 patients. During the study period, the percentage of breast cancers tested for HER-2 rose from 77% to 91%. Patients over 70 had fewer HER-2 tests than their younger counterparts. Fourteen percent of tumours were HER-2 positive; the proportion treated with trastuzumab in 2006, 2007 and 2008 was 50%, 66% and 74%, respectively. Significantly more node-positive patients (77%) were given trastuzumab than node-negative patients (52%). All the patients prescribed trastuzumab also received chemotherapy. Patients under 70 years, patients treated in Australia and patients treated by higher caseload surgeons were more likely to be prescribed trastuzumab than those over 70, patients in New Zealand and patients treated by lower caseload surgeons. Conclusions: Trastuzumab-prescribing trends conform to the published guidelines. However, older patients and those with HER-2 positive, node-negative tumours >1cm may be undertreated in some cases. © 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons. Source

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