News in brief: AML shows seasonality variation; Call to action on cancer clinical trial equity; My Health Record underused despite $2 billion spend

AML shows seasonality variation

Seasonal risk factors could be playing a role in the development and/or proliferation of AML suggests research that found “strong evidence” of variation in diagnoses according to the time of year.

The study, which looked at 26,472 cases of AML diagnosed in Spain between 2004 and 2015, found the highest incidence rate was  in January, which was 16% higher than in November and in August, and 7% higher than in February.

The trial also discovered “an upward long-term trend” with monthly incidence rates of AML annually rising by 0.4%.

“While the underlying reason for this result is unknown, it is possible that the observed peak in monthly AML risk coincides with seasonal elevations in the rates of infectious disease processes which are capable of precipitating or accelerating the course of AML,” the authors suggested in their paper published in the British Journal of Haematology.

Also of note, the study indicated that seasonality in AML diagnoses was more pronounced within certain age groups, as the data showed a significant seasonal effect among patients aged 0-4 years old, but not for the 5-19 years age group.

Seasonal variation was also evident in the other age groups except for in the oldest patients.

“Elderly patients are frequently diagnosed with AML with myelodysplasia-related changes, whilst younger patients are more commonly diagnosed with AML with recurrent genetic abnormalities. Such variations in the molecular background of AML between the older and younger AML cases may explain the disappearance of seasonal variation in the oldest group,” the authors said.

Despite limitations such as narrow classification of AML and a lack of information on the onset of clinical symptoms, the researchers concluded that the study provides “strong evidence” of seasonal variation in the diagnosis of AML, which suggests that “seasonal risk factors, such as infectious agents or environmental factors, influence the development and/or proliferation of AML”.

This finding paves the way for further assessment of “specific hypotheses relating to the etiological role of specific seasonal risk factors, such as infectious agents, allergens, or sunlight exposure,” they added.

Call to action on cancer clinical trial equity

Australian cancer researchers have issued a ‘call to action’ on equity in clinical trial participation, saying there is a paucity of local information about barriers based on factors such as ethnicity and geography.

While an estimated 95,000 Australian patients will join a study in any given year, there are claims the local industry falls behind countries such as the UK on a per-capita basis.

Based on the limited available data, “Australian patients with cancer face similar barriers to clinical trial participation as those documented in other countries, such as inequity based on race, ethnicity, and geography,” said researchers from University of Queensland and Monash University in Melbourne.

Beyond that, little is known about which patients are being invited to participate and who is missing out, they wrote in Seminars in Oncology.

“We cannot ignore that a better understanding of the factors influencing oncology trial participation in Australia is needed,” the researchers wrote.

“By improving our understanding and with a concerted effort, the Australian clinical trial community can contribute further to best practice clinical care for oncology patients and their carers in their respective journeys, both nationally and internationally.”

They said they were aiming to perform a scoping review of the current literature on the topic, followed by a 3-round Delphi study including stakeholders.

“With this foundational backbone of knowledge, we can start to implement steps to improve trial participation, by designing interventions targeting the key barriers and assessing their efficacy,” they said.

My Health Record underused despite $2 billion spend

The digital My Health Record remains rarely used by either patients or doctors, despite more than $2 billion being spent on it since it was launched in 2012.

Research shows it was accessed during just 2% of ED presentations and a survey of 40 emergency medicine clinicians in Victoria also found nearly half had never used the multi-billion dollar system.

First reported in Guardian Australia this week, the survey was compiled by Monash University PhD candidate Alex Mullins, who said problems included lack of trust and records that were outdated.

She told the publication: “Areas for improvement include both technical improvements to the system itself … and more data flowing into the system, and improvements with respect to clinician engagement with the system.”

Some 2.7 million patients, or just of 10% of those registered for a My Health Record opened their file in 2020-21, according to the Australian Digital Health Agency.

While this was an increase of 14% on the previous year, it was most driven by patients accessing their vaccination records, the agency said in its most recent annual report.

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