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1
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Chin A, Ismail AGM, Fan W, Cheng W, Kontorinis N, Chin J, Kong J, Doyle A, Mitchell T. Reduced survival for rural patients with hepatocellular carcinoma within a tertiary hospital network: treatment equality is not enough. Intern Med J 2025; 55:767-776. [PMID: 40062567 DOI: 10.1111/imj.70032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Accepted: 02/15/2025] [Indexed: 05/15/2025]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality globally, with increasing incidence rates in Australia. As most treatments are performed in metropolitan centres, we hypothesised that rural patients may be adversely affected. AIMS To investigate survival outcomes and treatment access between rural and metropolitan HCC patients within a single tertiary hospital network. METHODS Retrospective cohort study of HCC patients treated at Royal Perth Hospital from May 2012 to May 2023. Analysed variables included clinical and demographic factors, HCC characteristics (including staging), treatment outcomes and adherence to post-intervention surveillance. Overall survival was compared using Kaplan-Meier analysis and multivariable Cox regression to assess potential confounders. RESULTS Among 400 patients, 305 were from metropolitan (76.2%) and 95 were from rural (23.8%) areas. Baseline characteristics, including demographics, comorbidities, performance status, HCC stage and alpha-fetoprotein levels at diagnosis, were similar between the two groups. Median overall survival was significantly lower for rural patients compared to metropolitan patients (2.53 vs 4.70 years; P = 0.035). Multivariable analysis indicated that rural residence was an independent predictor of poorer survival (adjusted hazard ratio 1.45, P = 0.026). There was no difference in time to treatment or treatment allocation between groups. Surveillance adherence post-curative intervention was lower in rural patients (63% vs 96%, P < 0.001). CONCLUSIONS This study highlights a significant survival disadvantage for rural HCC patients, emphasising geographical disparities in healthcare outcomes. While our patients had equal access to treatment, disparities may emerge from challenges in post-treatment care and surveillance adherence. Strategies targeting rural healthcare delivery and patient follow-up are necessary to mitigate these disparities.
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Affiliation(s)
- Andrew Chin
- Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Ali Galalah Mostafa Ismail
- Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Weiyuan Fan
- Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Wendy Cheng
- Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Nick Kontorinis
- Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Justin Chin
- Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Jee Kong
- Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Adam Doyle
- Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Tim Mitchell
- Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Western Australia, Australia
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Howell J, Combo T, Binks P, Bragg K, Bukulatjpi S, Campbell K, Clark PJ, Carroll M, Davies J, de Santis T, Muller KR, Nguyen B, Olynyk JK, Shackel N, Valery PC, Wigg AJ, George J, Roberts SK. Overcoming disparities in hepatocellular carcinoma outcomes in First Nations Australians: a strategic plan for action. Med J Aust 2024; 221:230-235. [PMID: 39107943 DOI: 10.5694/mja2.52395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/18/2024] [Indexed: 09/02/2024]
Affiliation(s)
- Jessica Howell
- St Vincent's Hospital, Melbourne, VIC
- Burnet Institute, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
- Monash University, Melbourne, VIC
| | | | | | - Kylie Bragg
- Southern Adelaide Local Health Network, Adelaide, SA
- Flinders University, Adelaide, SA
| | - Sarah Bukulatjpi
- Charles Darwin University, Darwin, NT
- Miwatj Health Aboriginal Corporation, Nhulunbuy, NT
| | | | - Paul J Clark
- University of Queensland, Brisbane, QLD
- Princess Alexandra Hospital, Brisbane, QLD
| | | | - Jane Davies
- Charles Darwin University, Darwin, NT
- Royal Darwin and Palmerston Hospitals, Darwin, NT
| | | | - Kate R Muller
- University of Queensland, Brisbane, QLD
- Flinders University, Adelaide, SA
| | - Bella Nguyen
- Fiona Stanley Fremantle Hospital Group, Perth, WA
| | - John K Olynyk
- Fiona Stanley Fremantle Hospital Group, Perth, WA
- Curtin University, Perth, WA
- Edith Cowan University, Perth, WA
| | | | | | - Alan J Wigg
- Southern Adelaide Local Health Network, Adelaide, SA
- Flinders University, Adelaide, SA
| | - Jacob George
- Storr Liver Centre, Westmead Millenium Institute, Sydney, NSW
- Westmead Hospital, Sydney, NSW
- University of Sydney, Sydney, NSW
| | - Stuart K Roberts
- Monash University, Melbourne, VIC
- Alfred Hospital, Melbourne, VIC
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3
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Han C, Karamatic R, Hanson J. Chronic hepatitis B care in regional Australia: implications for clinical practice and public health policy. Intern Med J 2024; 54:1155-1163. [PMID: 38488685 DOI: 10.1111/imj.16364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/25/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND Australia is struggling to meet its National Hepatitis B Strategy care targets, particularly in nonmetropolitan settings. It is vital to engage priority populations and improve their access to recommended care to reach these targets. AIMS This retrospective study examined people living with chronic hepatitis B (CHB) in regional North Queensland, Australia, and determined whether their care adhered to current national CHB management guidelines. The analysis aimed to identify gaps in care that might be addressed to improve future outcomes. METHODS All individuals referred to the gastroenterology clinic at the Townsville University Hospital in regional North Queensland, Australia, for CHB care between January 2015 and December 2020 were identified. Their linkage to care, engagement in care and receipt of guideline-recommended CHB care were determined. RESULTS Of 255 individuals, 245 (96%) were linked to care; 108 (42%) remained engaged in care and 86 (38%) were receiving guideline-recommended care in 2021. There were 91/255 (36%) who identified as Indigenous Australians. Indigenous status was the only independent predictor of not being linked to care (odds ratio (OR): 0.13 (95% confidence interval (CI): 0.03-0.60), P = 0.01), not being engaged in care (OR: 0.19 (95% CI: 0.10-0.36), P < 0.0001), not receiving guideline-recommended CHB care (OR: 0.16 (95% CI: 0.08-0.31), P < 0.0001) or not being engaged in a hepatocellular carcinoma surveillance programme (OR: 0.08 (95% CI: 0.02-0.27), P < 0.0001). CONCLUSION Current approaches are failing to deliver optimal CHB care to Indigenous Australians in regional North Queensland. Targeted strategies to ensure that Indigenous Australians in the region receive equitable care are urgently needed.
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Affiliation(s)
- Chaw Han
- Department of Gastroenterology, Townsville University Hospital, Townsville, Queensland, Australia
- Department of Gastroenterology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Rozemary Karamatic
- Department of Gastroenterology, Townsville University Hospital, Townsville, Queensland, Australia
| | - Josh Hanson
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
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4
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Draidi Areed W, Price A, Arnett K, Mengersen K. Spatial statistical machine learning models to assess the relationship between development vulnerabilities and educational factors in children in Queensland, Australia. BMC Public Health 2022; 22:2232. [PMID: 36451182 PMCID: PMC9710117 DOI: 10.1186/s12889-022-14541-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 11/03/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The health and development of children during their first year of full time school is known to impact their social, emotional, and academic capabilities throughout and beyond early education. Physical health, motor development, social and emotional well-being, learning styles, language and communication, cognitive skills, and general knowledge are all considered to be important aspects of a child's health and development. It is important for many organisations and governmental agencies to continually improve their understanding of the factors which determine or influence development vulnerabilities among children. This article studies the relationships between development vulnerabilities and educational factors among children in Queensland, Australia. METHODS Spatial statistical machine learning models are reviewed and compared in the context of a study of geographic variation in the association between development vulnerabilities and attendance at preschool among children in Queensland, Australia. A new spatial random forest (SRF) model is suggested that can explain more of the spatial variation in data than other approaches. RESULTS In the case study, spatial models were shown to provide a better fit compared to models that ignored the spatial variation in the data. The SRF model was shown to be the only model which can explain all of the spatial variation in each of the development vulnerabilities considered in the case study. The spatial analysis revealed that the attendance at preschool factor has a strong influence on the physical health domain vulnerability and emotional maturity vulnerability among children in their first year of school. CONCLUSION This study confirmed that it is important to take into account the spatial nature of data when fitting statistical machine learning models. A new spatial random forest model was introduced and was shown to explain more of the spatial variation and provide a better model fit in the case study of development vulnerabilities among children in Queensland. At small-area population level, increased attendance at preschool was strongly associated with reduced physical and emotional development vulnerabilities among children in their first year of school.
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Affiliation(s)
- Wala Draidi Areed
- grid.1024.70000000089150953School of Mathematical Science, Center for Data Science, Queensland University of Technology, Queensland, Australia
| | - Aiden Price
- grid.1024.70000000089150953School of Mathematical Science, Center for Data Science, Queensland University of Technology, Queensland, Australia
| | - Kathryn Arnett
- grid.512914.a0000 0004 0642 3960Children’s Health Queensland, Queensland, Australia
| | - Kerrie Mengersen
- grid.1024.70000000089150953School of Mathematical Science, Center for Data Science, Queensland University of Technology, Queensland, Australia
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Sempokuya T, Warner J, Azawi M, Nogimura A, Wong LL. Current status of disparity in liver disease. World J Hepatol 2022; 14:1940-1952. [PMID: 36483604 PMCID: PMC9724102 DOI: 10.4254/wjh.v14.i11.1940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 11/09/2022] [Accepted: 11/16/2022] [Indexed: 11/24/2022] Open
Abstract
Disparities have emerged as an important issue in many aspects of healthcare in developed countries and may be based on race, ethnicity, sex, geographical location, and socioeconomic status. For liver disease specifically, these potential disparities can affect access to care and outcome in viral hepatitis, chronic liver disease, and hepatocellular carcinoma. Shortages in hepatologists and medical providers versed in liver disease may amplify these disparities by compromising early detection of liver disease, surveillance for hepatocellular carcinoma, and prompt referral to subspecialists and transplant centers. In the United States, continued efforts have been made to address some of these disparities with better education of healthcare providers, use of telehealth to enhance access to specialists, reminders in electronic medical records, and modifying organ allocation systems for liver transplantation. This review will detail the current status of disparities in liver disease and describe current efforts to minimize these disparities.
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Affiliation(s)
- Tomoki Sempokuya
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, United States
| | - Josh Warner
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, United States
| | - Muaataz Azawi
- Division of Gastroenterology and Hepatology, Sanford Center for Digestive Health, Sioux Falls 57105, SD, Uruguay
| | - Akane Nogimura
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Aichi, Japan
- Division of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Aichi, Japan
| | - Linda L Wong
- Department of Surgery, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, United States
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Yang WJ, Kang D, Song MG, Seo TS, Kim JH. The Impact of Socioeconomic Status on Mortality in Patients with Hepatocellular Carcinoma: A Korean National Cohort Study. Gut Liver 2022; 16:976-984. [PMID: 35466091 PMCID: PMC9668501 DOI: 10.5009/gnl210567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/06/2022] [Accepted: 01/18/2022] [Indexed: 11/04/2022] Open
Abstract
Background/Aims We studied the impact of socioeconomic status (SES) on mortality in hepatocellular carcinoma patients and analyzed the effect of SES on initial treatment allocation. Methods A cohort study was conducted using data from the National Health Insurance Service- National Sample Cohort of Korea. A total of 3,032 hepatocellular carcinoma patients who were newly diagnosed between January 2003 and December 2013 were included. Income level was categorized as Medical Aid and ≤30th, 31st-70th, or >70th percentile as an SES indicator. Results The proportion of Medical Aid was 4.3%. The highest risks of all-cause mortality associated with Medical Aid were evident in the transcatheter arterial chemoembolization group (fully adjusted hazard ratio [HR], 2.40; 95% confidence interval [CI], 1.25 to 4.58), the other treatments group (fully adjusted HR, 2.86; 95% CI, 1.85 to 4.41), and the no treatment group (fully adjusted HR, 2.69; 95% CI, 1.79 to 4.04) but not in the curative treatment group. An association between the lower-income percentile and higher liver cancer-specific mortality was also observed, except in the curative treatment group. The association between income percentile and all-cause mortality was nonlinear, with a stronger association in the lower-income percentiles than in the higher income percentiles (p-value for nonlinear spline terms <0.05). Conclusions Patients in the lower SES group, especially patients not eligible for curative treatment, had an increased risk of mortality. In addition, the association between SES and the risk for mortality was stronger in the lower-income percentile than in the moderate to higher income percentiles.
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Affiliation(s)
- Woo Jin Yang
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Danbee Kang
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Myung Gyu Song
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Tae-Seok Seo
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ji Hoon Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Tibballs J, Clements W. Immunotherapy and Transarterial therapy of HCC: What the interventional radiologist needs to know about the changing landscape of HCC treatment? J Med Imaging Radiat Oncol 2022; 66:478-482. [PMID: 35357076 PMCID: PMC9311219 DOI: 10.1111/1754-9485.13405] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/10/2022] [Accepted: 03/15/2022] [Indexed: 02/06/2023]
Abstract
Hepatocellular carcinoma (HCC) is the fourth most common cancer worldwide and its incidence is increasing in Australia. Transarterial therapy, predominantly transarterial chemoembolization (TACE) but increasingly transarterial radioembolization (TARE), plays an important role in patients with intermediate‐stage disease and preserved liver function. However, despite advances in TACE, TARE and adjunctive procedures, overall survival has only modestly increased over the last 20 years. Immunotherapy has emerged as a newer cancer treatment and uses antibodies directed at checkpoint inhibitors to upregulate T‐cell mediated tumour‐specific death. These drugs have been shown to increase survival in patients with HCC and have changed the landscape for advanced disease. Trials are now ongoing combining transarterial therapy and immunotherapy. This manuscript introduces these trials and interventional radiologists should be aware of the changing landscape so that they can partner with immunotherapy and remain relevant in the HCC multidisciplinary group as immunotherapy use increases.
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Affiliation(s)
- Jonathan Tibballs
- Department of Radiology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Warren Clements
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Monash University Central Clinical School, Melbourne, Victoria, Australia.,National Trauma Research Institute, Melbourne, Victoria, Australia
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8
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Taye B, Valery P, Liddle B, Woodward A, Shahid S, Farley R, Sackey D, Clark P. Australian general practitioners’ perceptions of the barriers and opportunities for community-based care of patients with viral hepatitis: a mixed methods study. J Prim Health Care 2022; 14:229-236. [DOI: 10.1071/hc22005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 06/21/2022] [Indexed: 11/23/2022] Open
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9
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Taye BW, Clark PJ, Hartel G, Powell EE, Valery PC. Remoteness of residence predicts tumor stage, receipt of treatment, and mortality in patients with hepatocellular carcinoma. JGH OPEN 2021; 5:754-762. [PMID: 34263069 PMCID: PMC8264246 DOI: 10.1002/jgh3.12580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 12/26/2022]
Abstract
Background and Aim Surveillance and early detection and curative treatment of hepatocellular carcinoma (HCC) are the mainstay of improving survival for patients, but there are several barriers to achieving this goal. We reported the impact of remoteness of residence on receipt of treatment, tumor stage, and survival in patients with HCC in Queensland. Methods We conducted a retrospective cohort study of 1651 HCC patients (147 migrants) from 1 January 2007 to 31 December 2016. We used Wilcoxon rank‐sum test to compare the median age at the time of diagnosis and Bayesian Weibull accelerated failure time regression to identify independent predictors of time to death. Results The median survival time after HCC diagnosis was 9.0 months (interquartile range 2.0–24.0). Metropolitan residence (P = 0.02), non‐English language (P < 0.001), foreign country of origin (P < 0.001), and HBV etiology (P < 0.001) were significantly associated with receiving surgical resection for HCC treatment. The strongest predictors of time to death were undifferentiated tumor at presentation (time ratio [TR] = 0.30, 95% credible interval (CrI) 0.23–0.39), age ≥70 years (TR = 0.42, 95% CrI 0.34–0.53), living in remote areas (TR = 0.67, 95% CrI 0.55–0.80), and presence of ≥1 comorbidity (TR = 0.69 95% CrI 0.54–0.90). All the other covariates adjusted, including country of birth (TR = 0.76, 95% CrI 0.49–1.06), did not predict survival time. Conclusions Patients living in rural and remote areas had late stage clinical presentation and poor survival. Remoteness of residence may limit access to HCC surveillance in at‐risk patients such as those with cirrhosis, and timely curative treatment to improve survival in these patients.
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Affiliation(s)
- Belaynew W Taye
- Faculty of Medicine University of Queensland Brisbane Queensland Australia.,Cancer and Chronic Disease Epidemiology Group QIMR Berghofer Medical Research Institute Brisbane Queensland Australia.,Mater Research Institute University of Queensland Brisbane Queensland Australia
| | - Paul J Clark
- Faculty of Medicine University of Queensland Brisbane Queensland Australia.,Mater Research Institute University of Queensland Brisbane Queensland Australia.,Department of Gastroenterology and Hepatology Mater Hospitals Brisbane Brisbane Queensland Australia.,Department of Gastroenterology and Hepatology Princess Alexandra Hospital Brisbane Queensland Australia
| | - Gunter Hartel
- Cancer and Chronic Disease Epidemiology Group QIMR Berghofer Medical Research Institute Brisbane Queensland Australia
| | - Elizabeth E Powell
- Department of Gastroenterology and Hepatology Princess Alexandra Hospital Brisbane Queensland Australia
| | - Patricia C Valery
- Faculty of Medicine University of Queensland Brisbane Queensland Australia.,Cancer and Chronic Disease Epidemiology Group QIMR Berghofer Medical Research Institute Brisbane Queensland Australia
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10
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Wigg AJ, Narayana SK, Hartel G, Medlin L, Pratt G, Powell EE, Clark P, Davies J, Campbell K, Toombs M, Larkin M, Valery PC. Hepatocellular carcinoma amongst Aboriginal and Torres Strait Islander peoples of Australia. EClinicalMedicine 2021; 36:100919. [PMID: 34142069 PMCID: PMC8187829 DOI: 10.1016/j.eclinm.2021.100919] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/25/2021] [Accepted: 05/06/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Liver disease and hepatocellular carcinoma (HCC) are important contributors to the mortality gap between Indigenous and non-Indigenous Australians. However, there is a lack of population based high quality data assessing the differences in HCC epidemiology and outcomes according to Indigenous status. The aim of this study was therefore to perform a large epidemiological study of HCC investigating differences between Indigenous and non-Indigenous Australians with HCC. METHODS Study design was a retrospective cohort study. Data linkage methodology was used to link data from cancer registries with hospital separation summaries across three Australian jurisdictions during 2000-2017. Cumulative survival (Kaplan-Meier) and the differences in survival (Multivariable Cox-regression) by Indigenous status were assessed. FINDINGS A total of 229 Indigenous and 3587 non-Indigenous HCC cases were included in the analyses. Significant epidemiological differences identified for Indigenous HCC cases included younger age at onset, higher proportion of females, higher rurality, lower socioeconomic status, and higher comorbidity burden (all p < 0.001). The distribution of cofactors was also significantly different for Indigenous Australians including higher prevalence of alcohol misuse, hepatitis B, and diabetes and more frequent presence of multiple HCC cofactors (all p < 0.001). Indigenous Australians received curative HCC therapies less frequently (6.6% vs. 14.5%, p < 0.001) and had poorer 5-year survival (10.0% vs. 17.3%, p < 0.001; unadjusted hazard ratio (HR) =1.42 96%CI 1.21-1.65) compared to non-Indigenous Australians. The strength of the association between indigenous status and survival was weaker and statistically non-significant after adjusting for rurality, comorbidity burden and lack of curative therapy (adjusted-HR=1.20 95%CI 0.97-1.47). INTERPRETATION Such data provide a call to action to help design and implement health literacy, liver management and HCC surveillance programs for Indigenous people to help close the liver cancer mortality gap.
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Affiliation(s)
- Alan J Wigg
- Hepatology and Liver Transplant Medicine Unit, Southern Adelaide Local Health Network, Adelaide, SA, Australia
- Flinders University of South Australia, Adelaide, South Australia, Australia
- Corresponding author.
| | - Sumudu K Narayana
- Hepatology and Liver Transplant Medicine Unit, Southern Adelaide Local Health Network, Adelaide, SA, Australia
- Flinders University of South Australia, Adelaide, South Australia, Australia
| | - Gunter Hartel
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Linda Medlin
- Aboriginal and Torres Strait Islander Health and Wellbeing, Central Queensland Hospital and Health Service, Queensland, Australia
| | - Greg Pratt
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Elizabeth E. Powell
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Paul Clark
- Mater Hospitals, Brisbane, Queensland, Australia
| | - Jane Davies
- Menzies School of Health Research, Royal Darwin Hospital, Darwin, The Northern Territory, Australia
- Royal Darwin Hospital, Darwin, The Northern Territory, Australia
| | - Kirsty Campbell
- Royal Darwin Hospital, Darwin, The Northern Territory, Australia
| | - Maree Toombs
- University of Queensland, Herston, Queensland, Australia
| | - Michael Larkin
- The Aboriginal Health Council of South Australia, Adelaide, Australia
| | - Patricia C Valery
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
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11
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Menahem B, Dejardin O, Alves A, Launay L, Lubrano J, Duvoux C, Laurent A, Launoy AG. Socioeconomic Deprivation Does Not Impact Liver Transplantation Outcome for HCC: A Survival Analysis From a National Database. Transplantation 2021; 105:1061-1068. [PMID: 32541559 DOI: 10.1097/tp.0000000000003340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND To investigate the value of European deprivation index (EDI) and hepatocellular carcinoma (HCC) characteristics and their relationships with outcome after liver transplantation (LT). METHODS Patients undergoing LT for HCC were included from a national database (from "Agence de la Biomédecine" between 2006 and 2016. Characteristics of the patients were blindly extracted from the database. Thus, EDI was calculated in 5 quintiles and prognosis factors of survival were determined according to a Cox model. RESULTS Among the 3865 included patients, 33.9% were in the fifth quintile (quintile 1, N = 562 [14.5%]; quintile 2, N = 647 [16.7%]; quintile 3, N = 654 [16.9%]; quintile 4, N = 688 [17.8%]). Patients in each quintile were comparable regarding HCC history, especially median size of HCC, number of nodules of HCC and alpha-fetoprotein score. In the univariate analysis of the crude survival, having >2 nodules of HCC before LT and time on waiting list were associated with a higher risk of death (P < 0.0001 and P = 0.03, respectively). EDI, size of HCC, model for end-stage liver disease score, Child-Pugh score were not statistically significant in the crude and net survival. In both survival, time on waiting list and number of HCC ≥2 were independent factor of mortality after LT for HCC (P = 0.009 and 0.001, respectively, and P = 0.03 and 0.02, respectively). CONCLUSIONS EDI does not impact overall survival after LT for HCC. Number of HCC and time on waiting list are independent prognostic factors of survival after LT for HCC.
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Affiliation(s)
- Benjamin Menahem
- Department of Digestive Surgery, CHU de Caen, Caen cedex, France
- Anticipe, INSERM U1086, Pôle de Recherche du CHU de Caen, Centre François Baclesse, Caen cedex, France
| | - Olivier Dejardin
- Anticipe, INSERM U1086, Pôle de Recherche du CHU de Caen, Centre François Baclesse, Caen cedex, France
- Department of Research, CHU de Caen, Caen cedex, France
| | - Arnaud Alves
- Department of Digestive Surgery, CHU de Caen, Caen cedex, France
- Anticipe, INSERM U1086, Pôle de Recherche du CHU de Caen, Centre François Baclesse, Caen cedex, France
| | - Ludivine Launay
- Anticipe, INSERM U1086, Pôle de Recherche du CHU de Caen, Centre François Baclesse, Caen cedex, France
| | - Jean Lubrano
- Department of Digestive Surgery, CHU de Caen, Caen cedex, France
- Anticipe, INSERM U1086, Pôle de Recherche du CHU de Caen, Centre François Baclesse, Caen cedex, France
| | - Christophe Duvoux
- Department of Hepatology, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Alexis Laurent
- Department of Hepatobiliary, Pancreatic Surgery and Liver Transplantation, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
- INSERM, UMR 955, Créteil, France
| | - And Guy Launoy
- Anticipe, INSERM U1086, Pôle de Recherche du CHU de Caen, Centre François Baclesse, Caen cedex, France
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12
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Howell J, Ward JS, Davies J, Clark PJ, Davis JS. Hepatocellular carcinoma in Indigenous Australians: a call to action. Med J Aust 2021; 214:201-202.e1. [PMID: 33608890 DOI: 10.5694/mja2.50961] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/27/2020] [Accepted: 10/13/2020] [Indexed: 11/28/2024]
Affiliation(s)
| | - James S Ward
- University of Queensland, Brisbane, QLD
- Poche Centre for Indigenous Health, University of Queensland, Brisbane, QLD
| | - Jane Davies
- Menzies School of Health Research, Darwin, NT
| | | | - Joshua S Davis
- Menzies School of Health Research, Darwin, NT
- John Hunter Hospital, Newcastle, NSW
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13
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Lubel JS, Roberts SK, Howell J, Ward J, Shackel NA. Current issues in the prevalence, diagnosis and management of hepatocellular carcinoma in Australia. Intern Med J 2021; 51:181-188. [DOI: 10.1111/imj.15184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 12/19/2022]
Affiliation(s)
- John S. Lubel
- Department of Gastroenterology Alfred Hospital Melbourne Victoria Australia
- Central Clinical School Monash University Melbourne Victoria Australia
| | - Stuart K. Roberts
- Department of Gastroenterology Alfred Hospital Melbourne Victoria Australia
- Central Clinical School Monash University Melbourne Victoria Australia
| | - Jessica Howell
- Department of Gastroenterology St Vincent's Hospital Melbourne Melbourne Victoria Australia
- Department of Medicine University of Melbourne Melbourne Victoria Australia
- Disease Elimination Program Burnet Institute Melbourne Victoria Australia
- Department of Epidemiology and Preventive Medicine Monash University Melbourne Victoria Australia
| | - James Ward
- School of Public Health University of Queensland Brisbane Queensland Australia
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Valery PC, Bernardes CM, Stuart KA, Hartel GF, McPhail SM, Skoien R, Rahman T, Clark PJ, Horsfall LU, Hayward KL, Gupta R, Powell EE. Development and Evaluation of the Supportive Needs Assessment Tool for Cirrhosis (SNAC). Patient Prefer Adherence 2020; 14:599-611. [PMID: 32256051 PMCID: PMC7094148 DOI: 10.2147/ppa.s236818] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/18/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND We report the development and psychometric testing of a Supportive Needs Assessment tool for Cirrhosis (SNAC). METHODS The 50-item SNAC was administered to patients (n=465) diagnosed with cirrhosis recruited from five metropolitan hospitals in Queensland, Australia. Items were assessed for ceiling and floor effects, and exploratory factor analysis was used to assess the factor structure. Identified factors were assessed for internal consistency and convergent validity to validated psychosocial tools. RESULTS Exploratory factor analysis identified 4 factors (39 items), which together accounted for 49.2% of the total variance. The 39-item SNAC met the requirements of a needs assessment tool and identified a range of needs important to patients with cirrhosis that were grouped in four subscales: "Psychosocial issues", "Practical and physical needs", "Information needs", and "Lifestyle changes". Cronbach's alpha values for the four subscales ranged from 0.64 to 0.92. Convergent validity was supported by a strong correlation between the total SNAC score and that of the Chronic Liver Disease Questionnaire (CLDQ; Spearman rho -0.68; p<0.001), and moderate correlations with the Distress Thermometer (Spearman rho 0.53; p<0.001) and seven subscales of a generic health-related quality of life instrument (Short Form 36; Spearman rho ranged from -0.48 to -0.57; p<0.001). The SNAC discriminated patient groups with respect to sex (p=0.013), age group (p<0.001), and hospital admission status (admitted vs not; p<0.001). CONCLUSION These data provide initial evidence for the validity and reliability of the SNAC, an instrument designed to measure type and amount of perceived unmet practical and psychological needs of people diagnosed with cirrhosis.
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Affiliation(s)
- Patricia C Valery
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
- Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | | | - Katherine A Stuart
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Gunter F Hartel
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Steven M McPhail
- Centre for Functioning and Health Research, Queensland Health and the School of Public Health and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Richard Skoien
- Department of Gastroenterology, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
| | - Tony Rahman
- Gastroenterology & Hepatology Department, The Prince Charles Hospital, Chermside, QLD, Australia
| | - Paul J Clark
- Department of Gastroenterology and Hepatology, Mater Hospitals, Brisbane, QLD, Australia
| | - Leigh U Horsfall
- Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Kelly L Hayward
- Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Rohit Gupta
- Department of Gastroenterology and Hepatology, Sunshine Coast University Hospital, Birtinya, QLD, Australia
| | - Elizabeth E Powell
- Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
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15
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Dasgupta P, Henshaw C, Youlden DR, Clark PJ, Aitken JF, Baade PD. Global Trends in Incidence Rates of Primary Adult Liver Cancers: A Systematic Review and Meta-Analysis. Front Oncol 2020; 10:171. [PMID: 32185125 PMCID: PMC7058661 DOI: 10.3389/fonc.2020.00171] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/31/2020] [Indexed: 12/24/2022] Open
Abstract
Background: Primary liver cancer is a leading cause of cancer deaths worldwide. Global burden varies, reflecting geographical distribution of viral hepatitis. Our objective was to perform a systematic review and meta-analysis of published current trends in incidence of adult liver cancers and histological types worldwide. Methods: This study used systematic searches of PubMed, Embase, CINAHL, and Web of Science databases for English-language peer-reviewed articles published from 1 January 2008 to 01 September 2019. Inclusion criteria were population-based studies of adult liver cancer patients with quantitative estimates of temporal trends in incidence for liver cancers and/or histological types. For multiple studies from the same geographical area, only the publication that reported the most recent trends for the same cancer type and population subgroup was included. Review was conducted per PRISMA guidelines. Two authors independently extracted data and critically assessed studies. Proposed contributors to observed trends were extracted from included articles. Study-specific estimates of the annual percentage change (APC) in incidence rates with 95% confidence intervals (CIs) were pooled using random-effects meta-analysis models. Heterogeneity was measured using the I2 statistics and publication bias evaluated using funnel plots and Egger's tests. Results: Overall, 53 studies met the inclusion criteria, of which 31 were included in the meta-analysis. Overall, pooled APC estimates were +0.8 (95% CI −0.3, +2.0) for liver cancers combined, +2.6 (95% CI +1.2, +4.0) for hepatocellular carcinoma (HCC), and +4.3 (95% CI +2.5, +6.1) for intrahepatic cholangiocarcinoma. Subgroup analyses indicated increasing trends for liver cancers (APC +3.2, 95% CI +2.5, +3.9) and HCC (APC +3.6, 95% CI +2.9, +4.4) in the region of North America/Europe/Australia, whereas corresponding trends were decreasing (APC −1.7, 95% CI −2.2, −1.1) and stable (APC −0.7, 95% CI −1.9, +0.5) in Asia, respectively. Conclusions: Incidence is increasing for adult liver cancers and HCC in Western countries, whereas trends are decreasing in the Asian region, although still remaining high. Our findings highlight the importance of viral hepatitis control and lifestyle interventions to reduce global liver cancer burden. Ongoing surveillance is also vital to detect early shifts in incidence trends.
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Affiliation(s)
- Paramita Dasgupta
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia
| | - Chloe Henshaw
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia
| | - Danny R Youlden
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Paul J Clark
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,Mater Research Institute, Brisbane, QLD, Australia.,Princess Alexandra Hospital & Mater Hospital, Brisbane, QLD, Australia
| | - Joanne F Aitken
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.,Institute for Resilient Regions, University of Southern Queensland, Toowoomba, QLD, Australia.,School of Public Health, University of Queensland, Brisbane, QLD, Australia
| | - Peter D Baade
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.,School of Mathematical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
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16
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Sellers CM, Uhlig J, Ludwig JM, Taddei T, Stein SM, Lim JK, Kim HS. The impact of socioeconomic status on outcomes in hepatocellular carcinoma: Inferences from primary insurance. Cancer Med 2019; 8:5948-5958. [PMID: 31436905 PMCID: PMC6792508 DOI: 10.1002/cam4.2251] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 03/28/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND To investigate the impact of insurance status on outcomes in patients with hepatocellular carcinoma (HCC). METHODS Patients diagnosed with HCC in the cancer registry from 2005 to 2016 were retrospectively stratified by insurance group. Overall survival was assessed via Kaplan-Meier curves and Cox proportional hazard models including potential confounders in multivariable analyses. RESULTS Seven hundred and sixty-nine patients met inclusion criteria (median age 63 years, 78.8% male, 65.9% Caucasian). 44.5% had private insurance (n = 342), 29.1% had Medicare (n = 224), and 26.4% had Medicaid (n = 203). At diagnosis, Medicaid patients had higher rates of Child-Pugh B (32.0%) and C disease (23.6%) vs Medicare (28.6% and 9.8%) and private insurance (26.9% and 6.7%, P < 0.0001) and higher MELD scores (median 11.0) vs Medicare (9.0) and private insurance (9.0, P = 0.0266). Across insurance groups, patients had similar distribution of American Joint Committee on Cancer stage, tumor size, and multifocal tumor burden. Patients with private insurance had the highest survival (median OS 21.9 months) vs Medicare (17.7 months) and Medicaid (13.0 months, overall P = 0.0061). On univariate analysis, Medicaid patients demonstrated decreased survival vs private insurance (HR 1.40, 95% CI: 1.146-1.715, P = 0.0011). After adjustment for liver disease factors, this survival difference lost statistical significance (Medicaid vs private insurance, HR 1.02, 95% CI: 0.819-1.266, P = 0.8596). CONCLUSION Medicaid was associated with advanced liver disease at HCC diagnosis; however, insurance status is not an independent predictor of HCC survival.
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Affiliation(s)
- Cortlandt M. Sellers
- Section of Interventional Radiology, Department of Radiology and Biomedical ImagingYale School of MedicineNew HavenCT
| | - Johannes Uhlig
- Section of Interventional Radiology, Department of Radiology and Biomedical ImagingYale School of MedicineNew HavenCT
- Department for Diagnostic and Interventional RadiologyUniversity Medical Center GoettingenGoettingenGermany
| | - Johannes M. Ludwig
- Section of Interventional Radiology, Department of Radiology and Biomedical ImagingYale School of MedicineNew HavenCT
- Department of Diagnostic and Interventional Radiology and NeuroradiologyUniversity Hospital Essen, University of Duisburg‐EssenEssenGermany
| | - Tamar Taddei
- Section of Digestive Diseases, Department of Internal MedicineYale School of MedicineNew HavenConnecticut
| | - Stacey M. Stein
- Section of Medical Oncology, Department of Internal MedicineYale School of MedicineNew HavenConnecticut
- Yale Cancer Center, Yale School of MedicineNew HavenConnecticut
| | - Joseph K. Lim
- Section of Digestive Diseases, Department of Internal MedicineYale School of MedicineNew HavenConnecticut
| | - Hyun S. Kim
- Section of Interventional Radiology, Department of Radiology and Biomedical ImagingYale School of MedicineNew HavenCT
- Section of Medical Oncology, Department of Internal MedicineYale School of MedicineNew HavenConnecticut
- Yale Cancer Center, Yale School of MedicineNew HavenConnecticut
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17
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Carville KS, MacLachlan JH, Thursfield V, Cowie BC. Hepatocellular carcinoma over three decades in Victoria, Australia: epidemiology, diagnosis and trends, 1984-2013. Intern Med J 2018; 48:835-844. [PMID: 29604152 DOI: 10.1111/imj.13823] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 03/22/2018] [Accepted: 03/28/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Liver cancer continues to be a health priority in Australia, with the majority attributable to preventable causes, and certain populations at higher risk. AIMS Epidemiological assessment of incidence, trends and distribution to inform prevention, and reassessment of data in light of recent changes to registry case definitions. METHODS Reported cases of hepatocellular carcinoma (HCC) in Victoria, Australia, 1984-2013, were obtained from the Victorian Cancer Registry. Demographic characteristics were examined, incidence and survival assessed using Poisson and Cox regression, and geographic distribution mapped. Incidence was compared before and after inclusion of non-histologically confirmed cases in Registry data to assess impacts on incidence trends. RESULTS Diagnoses of HCC rose substantially between 1984 and 2013, increasing sixfold from 0.9 to 5.9 per 100 000. The rate of increase per year accelerated from 5.3% between 1984 and 2003 to 9.5% between 2004 and 2013. Cases were disproportionately male (80%), median age at diagnosis was 66 years and 53% were born overseas. Even during 2004-2013, 5-year survival was only 16%, although higher among younger people, metropolitan residents and people born overseas. Incidence showed strong geographic clustering. The proportion of cases diagnosed clinically increased from 1% during 1984-2004 to 43% in 2009-2013. The revised case definition added 993 cases (27.3% of total). CONCLUSION Cases of HCC are becoming increasingly common, and revised incidence estimates highlight the impact of case definitions in the context of changing diagnostic approaches. The ongoing burden, disproportionate population distribution and low survival emphasise the importance of prevention and early detection as a public health imperative.
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Affiliation(s)
- Kylie S Carville
- Epidemiology Unit, The Doherty Institute, Melbourne, Victoria, Australia
| | - Jennifer H MacLachlan
- Epidemiology Unit, The Doherty Institute, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Vicky Thursfield
- Victorian Cancer Registry, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Benjamin C Cowie
- Epidemiology Unit, The Doherty Institute, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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18
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Keogh K, Clark P, Valery PC, McPhail SM, Bradshaw C, Day M, Smith AC. Use of telehealth to treat and manage chronic viral hepatitis in regional Queensland. J Telemed Telecare 2017; 22:459-464. [PMID: 27799448 DOI: 10.1177/1357633x16673794] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 09/19/2016] [Indexed: 11/15/2022]
Abstract
For regional and rural Queenslanders, chronic viral hepatitis treatment is a major unmet health need, with restricted access to specialists outside of tertiary, largely metropolitan hospitals. To increase treatment of chronic viral hepatitis in regional Queensland, a team-based telehealth model was expanded. This expansion embedded an initial nursing consultation prior to specialist telehealth consultation. We conducted a retrospective audit of the introduction and expansion of hepatology telehealth services. Activity from July 2014-June 2015 (pre-expansion) was compared with July 2015- June 2016 (post-expansion). Interviews were conducted with key staff to determine factors contributing to success of the service and identify ongoing challenges to the service model. A greater than four-fold increase in clinical consultation was observed (131 telehealth consultations pre-expansion vs 572 post-expansion; p < 0.001). The failure to attend rate decreased (13.0% vs 6.5%, pre vs post-expansion respectively; p = 0.030), suggesting engagement with the service increased. Staff cited nurse-conducted primary assessment prior to specialist consultation and personalised patient treatment packs as key contributors to increased patient flow and engagement. This expanded team approach appears effective in delivering specialised treatment to an underserved area in regional Central Queensland. It may serve as a model to further expand telehealth management of chronic disease for regional Queenslanders.
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Affiliation(s)
- Kandice Keogh
- School of Medicine, University of Queensland, Australia
| | - Paul Clark
- QIMR-Berghofer Medical Research Institute, Australia.,Princess Alexandra Hospital, Metro South Health, Australia
| | - Patricia C Valery
- School of Medicine, University of Queensland, Australia.,QIMR-Berghofer Medical Research Institute, Australia
| | - Steven M McPhail
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia.,Centre for Functioning and Health Research, Metro South Health, Australia
| | - Candise Bradshaw
- Blood Borne Virus and Sexual Health Service, Queensland Health, Australia
| | - Melany Day
- Blood Borne Virus and Sexual Health Service, Queensland Health, Australia
| | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Australia
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19
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Tervonen HE, Walton R, You H, Baker D, Roder D, Currow D, Aranda S. After accounting for competing causes of death and more advanced stage, do Aboriginal and Torres Strait Islander peoples with cancer still have worse survival? A population-based cohort study in New South Wales. BMC Cancer 2017; 17:398. [PMID: 28577351 PMCID: PMC5457659 DOI: 10.1186/s12885-017-3374-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 05/18/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Aboriginal and Torres Strait Islander peoples in Australia have been found to have poorer cancer survival than non-Aboriginal people. However, use of conventional relative survival analyses is limited due to a lack of life tables. This cohort study examined whether poorer survival persist after accounting for competing risks of death from other causes and disparities in cancer stage at diagnosis, for all cancers collectively and by cancer site. METHODS People diagnosed in 2000-2008 were extracted from the population-based New South Wales Cancer Registry. Aboriginal status was multiply imputed for people with missing information (12.9%). Logistic regression models were used to compute odds ratios (ORs) with 95% confidence intervals (CIs) for 'advanced stage' at diagnosis (separately for distant and distant/regional stage). Survival was examined using competing risk regression to compute subhazard ratios (SHRs) with 95%CIs. RESULTS Of the 301,356 cases, 2517 (0.84%) identified as Aboriginal (0.94% after imputation). After adjusting for age, sex, year of diagnosis, socio-economic status, remoteness, and cancer site Aboriginal peoples were more likely to be diagnosed with distant (OR 1.30, 95%CI 1.17-1.44) or distant/regional stage (OR 1.29, 95%CI 1.18-1.40) for all cancers collectively. This applied to cancers of the female breast, uterus, prostate, kidney, others (those not included in other categories) and cervix (when analyses were restricted to cases with known stages/known Aboriginal status). Aboriginal peoples had a higher hazard of death than non-Aboriginal people after accounting for competing risks from other causes of death, socio-demographic factors, stage and cancer site (SHR 1.40, 95%CI 1.31-1.50 for all cancers collectively). Consistent results applied to colorectal, lung, breast, prostate and other cancers. CONCLUSIONS Aboriginal peoples with cancer have an elevated hazard of cancer death compared with non-Aboriginal people, after accounting for more advanced stage and competing causes of death. Further research is needed to determine reasons, including any contribution of co-morbidity, lifestyle factors and differentials in service access to help explain disparities.
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Affiliation(s)
- Hanna E. Tervonen
- School of Health Sciences, Centre for Population Health Research, University of South Australia, GPO Box 2471, Adelaide, SA 5001 Australia
| | - Richard Walton
- Information Analysis Unit, Cancer Institute NSW, GPO Box 41, Alexandria, Sydney, NSW 1435 Australia
| | - Hui You
- Information Analysis Unit, Cancer Institute NSW, GPO Box 41, Alexandria, Sydney, NSW 1435 Australia
| | - Deborah Baker
- Information Analysis Unit, Cancer Institute NSW, GPO Box 41, Alexandria, Sydney, NSW 1435 Australia
| | - David Roder
- School of Health Sciences, Centre for Population Health Research, University of South Australia, GPO Box 2471, Adelaide, SA 5001 Australia
- Cancer Institute NSW, GPO Box 41, Alexandria, Sydney, NSW 1435 Australia
| | - David Currow
- Cancer Institute NSW, GPO Box 41, Alexandria, Sydney, NSW 1435 Australia
| | - Sanchia Aranda
- Cancer Institute NSW, GPO Box 41, Alexandria, Sydney, NSW 1435 Australia
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20
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Singal AG, Tiro JA, Marrero JA, McCallister K, Mejias C, Adamson B, Bishop WP, Santini NO, Halm EA. Mailed Outreach Program Increases Ultrasound Screening of Patients With Cirrhosis for Hepatocellular Carcinoma. Gastroenterology 2017; 152:608-615.e4. [PMID: 27825963 PMCID: PMC5285373 DOI: 10.1053/j.gastro.2016.10.042] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 10/25/2016] [Accepted: 10/28/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Surveillance of patients with cirrhosis increases early detection of hepatocellular carcinoma (HCC) and prolongs survival. However, its effectiveness is limited by underuse, particularly among racial/ethnic minorities and individuals of low socioeconomic status. We compared the effectiveness of mailed outreach strategies, with and without patient navigation, in increasing the numbers of patients with cirrhosis undergoing surveillance for HCC in a racially diverse and socioeconomically disadvantaged cohort. METHODS We performed a prospective study of patients with documented or suspected cirrhosis at a large safety-net health system from December 2014 through March 2016. Patients were assigned randomly (1:1:1) to groups that received mailed invitations for an ultrasound screening examination (n = 600), mailed invitations for an ultrasound screening examination and patient navigation (barrier assessment and motivational education for patients who declined screening; n = 600), or usual care (visit-based screening; n = 600). Patients who did not respond to outreach invitations within 2 weeks received up to 3 reminder telephone calls. The primary outcome was completion of abdominal imaging within 6 months of randomization. RESULTS Baseline characteristics were similar among groups. Cirrhosis was documented, based on International Classification of Diseases, 9th revision, codes, for 79.6% of patients, and suspected, based on noninvasive markers of fibrosis, for 20.4%. In an intent-to-treat analysis, significantly greater proportions of patients who received the mailed invitation and navigation (47.2%) or the mailed invitation alone (44.5%) underwent HCC screening than patients who received usual care (24.3%) (P < .001 for both comparisons). However, screening rates did not differ significantly between outreach the outreach groups (P = .25). The effects of the outreach program were consistent in all subgroups, including Caucasian vs non-Caucasian race, documented vs suspected cirrhosis, Child-Pugh A vs B cirrhosis, and receipt of gastroenterology care. CONCLUSIONS In a prospective study, we found outreach strategies to double the percentage of patients with cirrhosis who underwent ultrasound screening for HCC. However, adding patient navigation to telephone reminders provided no significant additional benefit. ClinicalTrials.gov no: NCT02312817.
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Affiliation(s)
- Amit G Singal
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Parkland Health and Hospital System, Dallas, Texas; Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas; Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Jasmin A Tiro
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas; Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jorge A Marrero
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Katharine McCallister
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Caroline Mejias
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Brian Adamson
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Wendy Pechero Bishop
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas; Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Ethan A Halm
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Parkland Health and Hospital System, Dallas, Texas; Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas; Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
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21
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Gibney KB, Cheng AC, Hall R, Leder K. Sociodemographic and geographical inequalities in notifiable infectious diseases in Australia: a retrospective analysis of 21 years of national disease surveillance data. THE LANCET. INFECTIOUS DISEASES 2016; 17:86-97. [PMID: 27789179 DOI: 10.1016/s1473-3099(16)30309-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/20/2016] [Accepted: 07/29/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Australia is a high-income country with a well established and largely publicly funded health-care system. However, some populations within Australia have shorter life expectancy and worse health outcomes than others. We explored geographical variations and sociodemographic inequities in infectious disease notifications in Australia. METHODS In this retrospective study, we analysed National Notifiable Diseases Surveillance System (NNDSS) notifications from 1991-2011 (n=2·4 million). We assessed the effect of socioeconomic disadvantage and remoteness of residence on national notification incidence. We calculated Gini coefficients, adjusted relative risks (aRRs), population attributable fractions (PAFs), and attributable notifications. We reported aRRs for Indigenous status in three jurisdictions with more than 75% completeness of Indigenous status reporting from the Northern Territory, South Australia, and Western Australia. FINDINGS Of the eight most commonly notified diseases from Jan 1, 1991, to Dec 31, 2011, gonococcal infection was the most geographically unequal and campylobacteriosis was the most evenly distributed across the country. Overall, notification incidence was higher in remote and very remote areas than in major cities (aRR 3·37), and higher in the most socioeconomically disadvantaged quintiles compared with less disadvantaged quintiles (aRR 1·15). The PAF for socioeconomic disadvantage was high for blood-borne viral hepatitis but decreased in other disease groups. In 2011, sexually transmitted infections had 11 093 notifications attributed to remoteness and 5597 notifications attributable to socioeconomic disadvantage. Notification incidence was higher in Indigenous than in non-Indigenous Australians (aRR 5·3). INTERPRETATION All diseases had differing geographical concentration and sociodemographic risk. Overall, sociodemographic inequities in infectious disease notifications have decreased, but remain unacceptably high. National communicable disease control is complex, requiring both targeted and population-wide interventions. FUNDING None.
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Affiliation(s)
- Katherine B Gibney
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, Melbourne, VIC, Australia; Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia; Royal Melbourne Hospital, Melbourne, VIC, Australia.
| | - Allen C Cheng
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, Melbourne, VIC, Australia
| | - Robert Hall
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, Melbourne, VIC, Australia
| | - Karin Leder
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, Melbourne, VIC, Australia
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