ABSTRACT
BACKGROUND: Direct access colonoscopy (DAC) allows general practitioners to refer directly for colonoscopy, without specialist review. Research suggests DAC reduces times to diagnosis and treatment of colorectal cancer. However, there is no information about outcomes of DAC in Australia. AIM: To determine if DAC in North West Tasmania expedited colorectal diagnosis and treatment. METHODS: Pre-post intervention study evaluating time from referral to diagnosis and definitive treatment. Patient demographic characteristics, referral, colonoscopy and treatment information was retrieved from hospital records. Timelines were investigated in standard referrals (SR), emergency department/inpatient referrals and DAC using survival analysis. RESULTS: Two hundred and six colorectal cancer cases were identified (117 SR, 26 DAC, 48 emergency department/inpatient and 15 unknown pathways). Median time to colonoscopy/diagnosis (DAC 6 weeks vs SR 7 weeks, P = 0.55) or definitive treatment (surgery/chemoradiation) (DAC 8 weeks vs SR 9 weeks, P = 0.81) was not significantly improved with DAC. Among SR only, time to diagnosis was 9 weeks pre-intervention versus 5 weeks post-intervention (P = 0.13), and time to treatment was 11 weeks pre-intervention versus 6 weeks post-intervention (P = 0.07). CONCLUSION: There was no statistically significant improvement in time to colorectal cancer diagnosis or treatment among patients referred through DAC compared to SR. There was a trend towards improved waiting times for SR concurrent with the introduction of the DAC pathway, indicating improvement of all referral processes. DAC may not be effective at expediting colorectal cancer diagnosis if it is not accompanied by strict referral guidelines. Larger evaluations of DAC are required in the Australian context.
Subject(s)
Colonoscopy/trends , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/therapy , Early Detection of Cancer/trends , Referral and Consultation/trends , Time-to-Treatment/trends , Adult , Aged , Aged, 80 and over , Colonoscopy/methods , Colorectal Neoplasms/epidemiology , Early Detection of Cancer/methods , Female , Follow-Up Studies , Humans , Male , Middle Aged , Retrospective Studies , Tasmania/epidemiology , Treatment OutcomeABSTRACT
The preferential metastasis of prostate cancer cells to bone disrupts the process of bone remodeling and results in lesions that cause significant pain and patient morbidity. Although prostate-specific antigen (PSA) is an established biomarker in prostate cancer, it provides only limited information relating to bone metastases and the treatment of metastatic bone disease with bisphosphonates or novel noncytotoxic targeted or biological agents that may provide clinical benefits without affecting PSA levels. As bone metastases develop, factors derived from bone metabolism are released into blood and urine, including N- and C-terminal peptide fragments of type 1 collagen and bone-specific alkaline phosphatase, which represent potentially useful biomarkers for monitoring metastatic bone disease. A number of clinical trials have investigated these bone biomarkers with respect to their diagnostic, prognostic, and predictive values. Results suggest that higher levels of bone biomarkers are associated with an increased risk of skeletal-related events and/or death. As a result of these findings, bone biomarkers are now being increasingly used as study end points, particularly in studies investigating novel agents with putative bone effects. Data from prospective clinical trials are needed to validate the use of bone biomarkers and to confirm that marker levels provide additional information beyond traditional methods of response evaluation for patients with metastatic prostate cancer.
Subject(s)
Biomarkers, Tumor/physiology , Bone and Bones/metabolism , Carcinoma/diagnosis , Prostatic Neoplasms/diagnosis , Biomarkers, Tumor/blood , Biomarkers, Tumor/metabolism , Biomarkers, Tumor/urine , Bone Neoplasms/diagnosis , Bone Neoplasms/metabolism , Bone Neoplasms/secondary , Carcinoma/metabolism , Carcinoma/pathology , Carcinoma/therapy , Humans , Male , Models, Biological , Molecular Targeted Therapy/methods , Molecular Targeted Therapy/trends , Orchiectomy/methods , Predictive Value of Tests , Prognosis , Prostatic Neoplasms/metabolism , Prostatic Neoplasms/pathology , Prostatic Neoplasms/therapy , Treatment FailureABSTRACT
During the initial phases of a study focussed on discovering new urinary biomarkers for renal cell carcinoma, a number of challenges and limitations were identified, which we subsequently investigated. The purpose of this report is to provide insight into experimental design for such investigations and potential confounding factors that can impact on such studies. Sixty urine samples from 20 patients with clear cell renal cell carcinoma and ten live renal transplant donor patients, pre- and post-nephrectomy, were profiled using SELDI-TOF-MS incorporating stringent quality control and in-house data processing/analysis. There were 65 significantly differentially expressed peaks (five solitary peaks and four peak clusters that increased post nephrectomy and four peak clusters that decreased). Peak 3934 Da m/z and peaks within 11731-11961 Da m/z, which increased post nephrectomy were identified as the 36 amino acid isoform of ß-defensin-1 and ß(2) -microglobulin, respectively. However, changes in these two protein forms were also seen in healthy donors following nephrectomy implying a relationship with kidney removal per se rather than tumour removal. This study indicates the difficulties in identifying SELDI peaks for subsequent validation and illustrates the need for appropriate controls in biomarker studies to determine whether changes are indirect consequences of treatment.
