Oesophageal cancer treatment patterns, timeliness of care and outcomes in the Loddon Mallee region of Victoria: A retrospective cohort study.

INTRODUCTION: Few studies have investigated oesophageal cancer care in regional areas. This study aimed to describe treatment patterns for oesophageal cancer in a regional area, and to identify factors associated with radiotherapy utilisation, timeliness of care, and death. METHODS: In a retrospective cohort study, medical records were reviewed to source data on all patients diagnosed with and/or treated for oesophageal cancer at two regional Victorian hospitals over July 2015-June 2018. Cox proportional hazards regression was employed to identify factors associated with time from diagnosis to death while binary logistic regression was used to identify factors associated with radiotherapy utilisation and treatment within 28 days of diagnosis - a time frame derived from the relevant optimal care pathway. RESULTS: Of 95 patients, 72% had radiotherapy, 32% received any treatment within 28 days, and 78% died over a median time of nine months. Odds of not receiving radiotherapy were decreased (odds ratio [OR] = 0.26, 95% confidence interval [CI] = 0.08-0.87) for histology other than adenocarcinoma. Odds of timely care were increased for any palliative radiotherapy (OR = 3.47, 95% CI = 1.15-10.5) and decreased for older age (OR = 0.95, 95% CI = 0.91.0.999). Hazard of death was elevated for stage IV disease (hazard ratio [HR] = 2.73, 95% CI = 1.64-4.54) and reduced for radical intent (HR = 0.27, 95% CI = 0.15-0.48). CONCLUSION: Nearly three-quarters of regional oesophageal cancer patients had radiotherapy while approximately one-third received any treatment within the recommended 28 days. Any palliative radiotherapy and younger age were associated with timely treatment. Future studies could further investigate factors related to timely oesophageal cancer care.

What is the viva experience of phase 2 Radiation Oncology examination candidates? Survey and advice for future candidates.

INTRODUCTION: Medical speciality examination is a very stressful event in medical careers. We aimed to determine the subjective experience of Radiation Oncology Royal Australian and New Zealand College of Radiologists (RANZCR) oral examination candidates. It was hoped the results would provide reassurance and advice for future candidates. METHODS: We distributed an anonymous online survey through the RANZCR membership database to Radiation Oncology Trainees and fellows who may have sat their oral examination within the last 3 years. RESULTS: There were 21 responses, yielding a response rate of 21%. Nineteen percent of respondents were moderately or very surprised during their viva and the most frequently noted cause was the demeanour of the examiners. The clinical cases and clinical examination station were rated very fair by over 80% of responders while the planning cases were rated very fair by 57%. During the viva, 33% thought they passed and 71% of these candidates were successful. Forty-three percent felt they were borderline, and all of these respondents passed. Five participants (24%) failed in the first attempt and four described being unable to convey their actual knowledge. Candidates found mock examinations to be the most useful examination preparation activity. The most frequently given advice was to focus on the planning examination. CONCLUSIONS: The majority of this select group of candidates indicated that the oral examination cases were very fair. Candidates rated the planning exam as least fair, indicating this may be the area that would benefit most from better preparation.

Numb chin syndrome: a case series of a clinical syndrome associated with malignancy.

INTRODUCTION: Information regarding the appropriate work-up and outcomes in patients receiving palliative treatment for numb chin syndrome (NCS) in the setting of malignancy is sparse. This study aims to describe NCS in malignancy and evaluate the disease trajectory, significance of diagnostic modalities and outcomes with palliative treatment. METHODS: A retrospective study was performed on patients presenting with NCS between March 2007 and October 2013 at the Capital Region Cancer Service, Canberra. RESULTS: Thirteen patients were identified who presented with numbness of the chin between March 2007 and October 2013. Seven patients had breast cancer, two had prostate cancer, two had multiple myeloma, one had medulloblastoma and one had an adenoid cystic salivary gland tumour. The mean interval from initial cancer diagnosis to development of the syndrome was 4.32 years. Twelve out of 13 patients had had prior chemotherapy with two or more lines of treatment (with a median of two lines), indicating this condition tended to present late in the course of disease in our patients. Four patients developed bilateral symptoms, and in two of these cases the metastatic lesion was in the base of the skull. Eleven out of 13 patients had positive signs on imaging. Nine out of 13 patients received palliative radiotherapy, with clinical response in eight patients. CONCLUSION: Patients with malignancy presented with NCS late in the disease trajectory, often after multiple lines of treatment. In our cohort of patients, 84% had positive imaging signs to aid diagnosis, and 77% had resolution of numbness with palliative treatment.