News in brief: Three year wait for medical oncology appointments; Breast cancer prognosis poor with brain mets; COSA commits to Closing the Gap on cancer

Thursday, 28 Jul 2022

Three year wait for medical oncology appointments

Some patients in South Australia are waiting three years for a medical oncology appointment in public hospitals, according to latest outpatient waiting time report released by SA Health.

The figures show that for the reporting period up to 31 March 2022 the maximum waiting times for medical oncology appointments were 38 months at Flinders Medical Centre.

Maximum waiting times for medical oncology were much lower at other hospitals, but times for breast clinics were 7 and 15 months at the Royal Adelaide Hospital and The Queen Elizabeth Hospital, respectively.

Urology clinic appointments had maximum waiting times of more than six years (71-83 months) at some hospitals.

However, waiting times have improved somewhat since 2018 when waiting lists for an outpatient consultation in medical oncology departments were estimated to be four to 16 years at some hospitals.

Chief medical officer Dr Michael Cusack said there had been several programs to reduce waiting lists for outpatient appointment, including asking GPs to audit all patients who have been waiting three years or longer in an effort to clear the backlog, a focus on alternative care pathways and putting patients back in GP care after a specialist consultation rather than clogging the system with ongoing outpatient reviews.

There are also moves to develop centralised waiting lists to address variances in waiting times between hospitals, the Advertiser reports.

Breast cancer prognosis poor with brain mets

Despite advances in HER2-targeted therapy, Australian patients with brain metastases secondary to HER2-positive metastatic breast cancer (MBC) patients continue to have a relatively poor prognosis, a Victorian study has shown.

A review of real world outcomes for 361 MBC patients derived from the TABITHA registry showed that median overall survival in those who developed brain metastases (n = 135) was significantly shorter than those who never developed brain metastases (58.9 vs. 96.1 months, p=0.02).

Most patients received first-line HER2-targeted treatment with trastuzumab and pertuzumab followed by second-line trastuzumab emtansine (T-DM1) but third-line therapy was heterogenous, according to study investigators led by Dr Iris Tung.

The most common local therapy given was whole brain radiation therapy(36%) followed by multi-modality treatment with both surgery and radiation therapy (27%), the study showed.

“The treatment landscape of HER2-positive MBC continues to evolve with the development of new HER2-targeted agents, that may offer greater intracranial activity. Nevertheless, many questions remain unanswered regarding optimal treatment in patients with brain metastases,” they wrote in Clinical Breast Cancer.

“There is a pressing need to improve prognosis in patients with brain metastases in the era of new HER2-targeted agents and this can only be achieved via clinical trials that focus on this cohort of patients,” they concluded.

COSA commits to Closing the Gap on cancer

The Clinical Oncology Society of Australia (COSA) has committed to addressing cancer care inequities for Indigenous Australians  in a new Closing the Gap position statement

In the statement release in July 2022 COSA notes that Aboriginal and Torres Strait Islander people experience 43% worse cancer outcomes than non-Indigenous Australians

“COSA stands with our Aboriginal and Torres Strait Islander brothers and sisters in calling out racial inequities,” it says.

Recent work by COSA researchers has shown that Indigenous people have higher rates of risk factors and cancer incidence than non-Indigenous people and yet are less likely to receive timely diagnosis and treatment.

“Our vision is that ALL Australians receive quality multidisciplinary cancer care from supported and informed health professionals who work in a multidisciplinary manner.

“We are committed to closing the gaps in health outcomes and will continue to work with our members to ensure Aboriginal and Torres Strait Islander people with cancer are treated fairly and equally.”

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