News in brief: Aggressive course of fatal SCCs in renal transplant recipients; Rural training the answer to specialist shortage, says RACP; Which factors impact oncology trial participation in Australia?


5 May 2022

Aggressive course of fatal SCCs in renal transplant recipients

Squamous cell carcinomas (SCCs) in kidney transplant recipients may be more aggressive, with higher rates of invasion, recurrence, and mortality than SCCs in the general population, Queensland researchers say.

A study of fatal cases of keratinocyte cancers in kidney transplant recipients between 1995 and 2014 found all but one death was due to SCC.

Fatal primary SCCs were mainly located on the head and neck – especially the face or ear (52%) and scalp (20%). The most common site of distant metastasis was the lung or pleura (85%).

The median time from transplantation to diagnosis of primary fatal SCC was 10 years, from diagnosis of SCC to metastasis was 5 months and from diagnosis to death was 8 months.

Histological features of fatal keratinocyte cancers included a high proportion with poor to moderate differentiation and lymphovascular and perineural invasion.

The study said treatment options for metastatic SCC including platinum-based chemo and checkpoint inhibitors were limited due to nephrotoxicity and the risk of rejection.

“Sun protection and regular skin cancer assessment are paramount for the prevention and early detection of keratinocyte cancers,” the researchers concluded.

Read more in Dermatology

Rural training the answer to specialist shortage, says RACP

Additional specialist training places are needed in rural and remote areas to combat doctor shortages outside the major cities, the RACP is arguing.

With well over 100 doctors currently on the waitlist for its registrar program, the college says it is confident of filling any number of extra positions if funded by the Federal Government.

“There is no shortage of interest in these positions – the limiting factor is available government funding,” says RACP president-elect Dr Jacqueline Small.

“We also would like to see commitments of longer-term planning and funding to address regional healthcare shortages that go beyond election cycles.”

It comes after the Coalition announced it would inject an extra $145 million in new funding for rural health if re-elected later this month, mostly focused on additional training places in general practice.

“Any move that increases the capacity of our healthcare system in regional areas is a welcome one,” Dr Small said.

“Unfortunately, there remains a significant shortage of non-GP specialists in many rural and regional areas, and we encourage the Government to expand the program to allow for more positions for specialists to be trained.

The RACP administered around 380 positions annually under the Federal Government’s specialist training program, she added.

Which factors impact oncology trial participation in Australia?

Despite being a top-tier country for clinical trial activity there is a paucity of understanding about what influences oncology trial participation in Australia, researchers say. 

Australia has enjoyed success in the global clinical trials sphere, particularly during the COVID pandemic, yet not enough is known about the barriers cancer patients face when it comes to participating in trials, researchers from Queensland and Victoria noted. 

“We cannot ignore that a better understanding of the factors influencing oncology trial participation in Australia is needed,” they wrote in their paper published in Seminars in Oncology. 

The research team are proposing a two pronged approach  – a review of the literature and a 3-round delphi study of stakeholders – to assess health factors influencing oncology clinical trial participation in an Australian context. 

“We aim to capture all factors – potential barriers and enablers – that influence cancer trial participation and reveal the nuances of the clinical trial sector within the broader health care system, from a 360º perspective” they 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 added. 

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