News in brief: Suboptimal standard therapy for early NSCLC patients; COSA program boosts smoking cessation in oncology centres; Doctors win, nurses lose under tax changes

Thursday, 31 Mar 2022

Suboptimal standard therapy for early NSCLC patients

Many patients with early-stage NSCLC do not receive guideline-recommended standard treatment such as surgery and adjuvant chemotherapy, Australian oncologists say.

An analysis of 2833 patients considered for enrolment into adjuvant therapy trials found that only 53% had adequate lymph node dissection, and 57% received any adjuvant chemotherapy. The findings published in JAMA Oncology also showed that 44% received at least four cycles of adjuvant platinum-based chemotherapy, and 34% received any cisplatin-based adjuvant chemotherapy.

The ‘surprising’ findings in a cohort of generally younger patients eligible for clinical trials highlighted the need for more research into the barriers to widespread adoption of evidence-based treatment guidelines in routine practice said Dr Monica Tang and Associate Professor Chee Khoon Lee of the St George Hospital Cancer Care Centre, Sydney, in an accompanying editorial.

The findings also had implications for the extrapolation of evidence from RCTs of novel therapies into routine care, they added.

“When real-world evidence does not support the use of existing treatments, such as extensive nodal dissection or cisplatin-based chemotherapy for older patients with poor performance status, additional prospective clinical trial evidence will be needed to investigate more appropriate treatment strategies for these patient populations,” they wrote.

COSA program boosts smoking cessation in oncology centres

Cancer centres are overcoming a lack of enthusiasm for smoking cessation advice provision thanks to a program developed by the Clinical Oncology Society of Australia, (COSA).

In 2020 COSA developed an “Smoking cessation in oncology” implementation strategy on how to integrate smoking cessation advice within hospital-based cancer care. The COSA strategy includes improved record capture of hospital smoking information; upskilling all clinical staff to identify smokers, and switching to a routine “patient opt out” referral system to smoking cessation resources such as the Quitline.

Early pilot work in NSW shows that the proportion of smokers newly diagnosed with cancer who receive quit intervention has increased from 55% in 2016 to 72% in 2019, according to a paper published in Cancer Epidemiology.

Professor Bernard Stewart said implementation of the COSA statement would be rolled out to other centres in 2022 and further results would be obtained on quit rates.

Doctors win, nurses lose under tax changes

High-income medical specialists such as surgeons will get a $9,000 windfall from the government’s planned stage 3 tax cuts, whereas other healthcare workers such as nurses will be worse off, a new analysis suggests.

The stage 3 tax cuts, worth $15.7 billion per year will come into effect in July 2024, and will increase the income at which the top tax bracket begins from $180,001 to $200,000.

According to the Australia Institute think tank, this will mean that medical practitioners such as surgeons and anaesthetists with average incomes over $200,000 will get the maximum tax cut worth $9,075 per year.

In contrast, healthcare occupations that currently qualify for the Low- and Middle-Income Tax Offset (LMITO), worth $7 billion per year, will be net losers when it is discontinued at the end of this year, the institute says.

It cites the example of a midwife with a salary of $78,784 who will gain $845 from the stage 3 tax cuts but lose $1,080 when the LMITO is removed.

Workers on incomes below $50,000 such as aged care staff, secretaries and receptionists will be worst off, receiving no tax cuts and losing up to $832 from the LMITO, the institute predicts.

Treasurer Josh Frydenberg confirmed in the 2022 Budget that the government has chosen to phase out the LMITO, but it will increase the payment for everyone, by $420, for its last year of operation.

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