News in brief: First targeted treatment for EoE on the PBS; Conjoint committee to take over colonoscopy recertification in Australia; Poor symptom awareness may impact pancreatic and oesophagogastric cancer diagnoses

Tuesday, 10 May 2022

First targeted treatment for EoE on the PBS

An orally disintegrating tablet formulation of budesonide (Jorveza) is now on the PBS for adults living with eosinophilic oesophagitis (EoE).

The topically-acting glucocorticosteroid, available at both 1 mg and 0.5 mg dosing strengths for induction and maintenance therapy, was recommended for listing at the November 2021 PBAC meeting.

The decisions were supported by data from the EOS-1 and EOS-2 trials which found the corticosteroid was effective in inducing and maintaining clinical and histologic remission out to 48 weeks.

“Although uncertainty remained regarding the cost-effectiveness, the PBAC considered BOT [budesonide orodispersible tablet] likely cost-effective at the proposed price,” the PBAC Public Summary Document said.

The EOS-2 study said long-standing eosinophilic inflammation leads to esophageal remodeling resulting in fibrosis with stricture formation and functional damage. EoE is currently the most common cause of esophageal dysphagia and food bolus impaction.

Conjoint committee to take over colonoscopy recertification in Australia

Colonoscopists seeking recertification could soon answer to a new committee formed by the Gastroenterological Society of Australia (GESA), the Royal Australasian College of Surgeons and the Royal Australasian College of Physicians.

Expected to commence early 2023, the expert committee will oversee objective, local and international, evidence-based criteria needed for nationally-recognised certification, according to a joint statement.

It replaces the current GESA Colonoscopy Recertification Committee which has undertaken recertification since 2015 and aims to provide “equal representation of surgeons and physicians to ensure high standards in colonoscopy in metropolitan, regional and rural Australia”.

It’s hoped the move will help improve consistency of care and reduce friction between clinicians and surgeons.

“Rather than differentiating ourselves as physicians or surgeons, it’s essential we think of ourselves as colonoscopists with a common goal of excellence in patient care,” said GESA President Professor Benedict Devereaux in the statement.

Poor symptom awareness may impact pancreatic and oesophagogastric cancer diagnoses

Increased awareness of pancreatic and oesophagogastric (OG) cancer symptoms could lead to more urgent investigations and earlier diagnoses, Australian researchers say.

A review of 27 surveys and 13 interviews revealed patients had little cognisance of pancreatic or OG cancer symptoms prior to diagnosis.

This led patients to normalise, dismiss or misattribute symptoms, such as fatigue or unusual tiredness, stomach pain, unexplained weight loss and a general feeling of being unwell.

“Pancreatic and OG cancer symptoms are often subtle and did not cause alarm” — leading some patients to self-manage symptoms and/or delay help-seeking until they got worse or had jaundice, the authors wrote in the European Journal of Cancer Care.

“Competing priorities, beliefs about illnesses and difficulties accessing healthcare delayed help-seeking,” they added.

When patients did seek help, some reported being dismissed by their GP and while some pushed for further investigation, others “trusted and followed their long-term GP’s guidance”.

While more research is needed to identify modifiable patient and relationship factors that could reduce diagnostic delays, the authors saw some evidence that patient assertiveness and health literacy may play important roles in timely identification.

Further, “increased awareness of insidious pancreatic and [OG] cancer symptoms in patients and general practitioners may prompt more urgent investigations and lead to earlier diagnosis,” they concluded.

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