Blood cancers

News in brief: Haematology the most difficult speciality; Anticoagulant gap; Blood cancers diagnosis delayed in pandemic

Haematology ‘too difficult’ for medical students

Haematology has been rated as one of the most difficult specialities to master in a survey of Australian medical students and junior doctors.

When asked to rate eleven medical specialities based on their perceived difficulty, the 114 would-be specialists at Western Health, Melbourne, nominated haematology as among the most difficult, along with oncology, rheumatology and nephrology.

Neurology was rated as the most difficult speciality, based on the complexities of neuro-anatomy and the challenges of making a diagnosis based on uncertain symptoms. Haematology was rated highest in terms of comfort with differential diagnosis. However, participants’ rating of teaching quality was marginally lower for haematology than for other specialities, according to the study, conducted by Dr Alex Yeung colleagues at  Western Health and Melbourne University.

Anticoagulants not prescribed for high risk AF patients

Many patients with atrial fibrillation (AF) have an increase stroke risk over time but are not started on an oral anticoagulant (OAC), findings from Australian primary care shows.

A review of  data from 594 adults with AF deemed low risk according to the sexless CHA2DS2-VASc (CHA2DS2-VA) score showed that over a period of 10 years 34% were reclassified as medium risk and 29% reclassified as high risk for stroke.

However nearly one-third of patients reclassified as being at high risk of stroke during the study period were not prescribed oral anticoagulant therapy. In addition, the delay in oral anticoagulant initiation following re-classification as high risk was a median of 2 years, according to researchers from the University of Tasmania writing in the European Journal of Clinical Investigation.

Blood cancer diagnosis delayed during pandemic

Victoria’s pandemic restrictions in 2020 led to the around 160 haematological cancer diagnoses  being either delayed or missed, according to modelling  of observed vs expected cases released by the Victorian Cancer registry. Published in the MJA, the analysis found that 10,011 haematologic cancers were predicted for the period of 1 April – 15 October 2020 in Victoria but only 9321 were recorded. The absolute -6.9% difference of 690 cases translated into an estimated 162 missed or delayed haematological cancers, the researchers said.

Overall there was a 10% reduction in cancer pathology notifications during the restrictions, with the  biggest reductions being for prostate (-26%), head and neck cancer (-15%) and melanoma (-13%).

“Planning for a possible surge in cancer diagnoses over the coming 6-12 months, and media campaigns encouraging people to not further delay seeking medical attention, may ameliorate any negative impact of delayed cancer diagnosis,” they wrote.

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