Cancer Health Services Utilisation Across the Continuum of Care
Project Details
This program of work will allow for in-depth analyses utilising state-wide hospital data alongside available primary care data to map how patients engage with and move between these services.
Patron ID: PAT073/PAT1032
Project Lead:
Little work has been done to date in Victoria using linked data to understand the use of cancer services by patients across the continuum of care. This project seeks to describe the role of primary and acute services in cancer care, including diagnosis, access, treatment and follow-up/survivorship. As an example, colorectal and lung cancers represent two of the most common cancers in Victoria, while sarcoma/bone & soft tissue cancers are relatively rare and occur disproportionately in younger people.
This project seeks to understand how patients are diagnosed with cancers such as these, including the involvement of general practitioners in early detection, access to treatment and their role in survivorship and follow-up. Comparisons of outcomes associated with patients of varying demographics in rural, regional and metropolitan locations and how they engage with care providers will allow for future investigations that target areas of greatest need.
Sub Projects:
PAT1032_2 ‘Feasibility analysis for research concepts’.
Exploring the CVDL and linked Patron dataset to assess the feasibility of cancer research proposals on behalf of the Data Connect team and external researchers.
Project Lead: Alex Lee
PAT1032_3 ‘Patterns of diagnostic testing for OG cancer related symptoms including cost analysis of testing’.
Symptoms associated with cancer, referred to as 'cancer symptoms,' often share characteristics with non-cancer conditions commonly seen in general practice. The diversity of potential diagnoses in primary care, combined with low cancer prevalence, can result in significant testing variations, the full extent and implications of which remain unclear. This project aims to enhance our understanding of diagnostic testing patterns for common upper gastrointestinal symptoms associated with oesophagogastric cancer in Victorian general practice. Project Lead: Prof Jon Emery
PAT1032_4 ‘Diagnostic intervals, predictors of diagnostic delays and associated survival outcomes in haematological malignancies’.
Investigating diagnostic intervals, predictors of diagnostic delays and associated survival outcomes in haematological malignancies.
Project Lead: Prof Jon Emery
PAT1032_5 ‘Rural & regional disparities - prostate cancer project’.
Survival rates for regional men in Australia with prostate cancer are below their metropolitan counterparts. In Victoria, outcomes are worse for men diagnosed with Prostate cancer in regional areas, compared to their Metropolitan, state-wide and national counterparts. Treatment outcomes will be examined to understand this disparity.
Project Lead: Dr Meena Rafiq
PAT1032_6 ‘Platelet validation’.
Exploring the CVDL and linked Patron dataset to assess the feasibility of cancer research proposals on behalf of the Data Connect team and external researchers. This project examines the risk of cancer following detection of a raised platelet count in primary care, stratifying results by cancer site and applying different thresholds for defining a raised platelet count.
Project Lead: Dr Meena Rafiq
PAT1032_7 ‘Primary care activity prior to cancer diagnosis in adolescents and young adults (PAPAYA)’.
Primary care Activity Prior to cancer diagnosis in Adolescents and Young Adults (PAPAYA) will examine patients aged 18-39 years with a cancer diagnosis, stratifying cancers by site. It will examine GP activity in the two years before cancer diagnosis for different cancer sites and different types of GP activity to evaluate if potential opportunities for earlier diagnosis exist. It will examine whether patients with multiple GP consults in the year before cancer diagnosis differ by different patient factors e.g. age, sex, rurality, to determine if there are high-risk populations for recurrent presentations who may benefit from interventions to streamline diagnosis. All patients aged 18-39 with a new diagnosis of cancer recorded in VCR and with a General Practice (GP) encounter in a pre-specified period (e.g. 3 years) pre-diagnosis will be identified for further analysis.
Project Lead: Dr Meena Rafiq
PAT1032_8 ‘FIB-4 as a predictor of advanced liver diseases’.
The FIB-4 index is a widely recognised marker for liver fibrosis, and research suggests its potential use as a risk indicator for other serious liver conditions, including liver cancer. To establish a clinically relevant cut-off for identifying patients at risk of developing severe liver disease, we will compare FIB-4 thresholds based on their optimal predictive value with those currently recommended to general practitioners (1.3 and 2.67). This comparison will also be conducted within a sub-group of patients diagnosed with diabetes to determine if a different FIB-4 cut-off is more appropriate for this high-risk population. Additionally, further analyses explore the risk profiles of various age groups and how the predictive accuracy of FIB-4 may change with age.
Project Lead: Silja Schrader.
PAT1032_9 ‘Assessment of existing early risk detection tools for pancreatic cancer used in primary care’.
Pancreatic cancer has one of the lowest survival rates due to its frequent late-stage diagnosis, making early detection critical. To aid in identifying underlying pancreatic cancer in primary care, several tools and guidelines have been developed. Three of these tools have been selected for testing in the Australian primary care context. Two of the tools, eRAT and QCancer, were developed and integrated into clinical systems in the UK, while QPaC is an Australian guideline for practitioners. This study evaluates the three tools/guidelines by applying them to a symptomatic cohort identified through general practitioner encounter notes in Victoria. Their predictive values are assessed and compared to determine their suitability for implementation in general practice in Australia.
Project Lead: Silja Schrader
PAT1032_10 ‘Examining diagnostic pathways for people with early-onset colorectal cancer using linked primary care, cancer registry and health administrative datasets’.
The incidence of colorectal cancer in people aged younger than 50, early-onset colorectal cancer (eoCRC), is increasing globally. In addition to growing number of people affected by this disease, younger adults tend to have later stage disease at diagnosis than their older counterparts. Delayed time to diagnosis and treatment may be contributing to poorer outcomes for younger adults, but there are no studies in Australia examining intervals for people with eoCRC. One method to investigate diagnostic intervals is the use of primary care data. Unlike patient self-report or hospital/health administrative data, primary care data can provide a detailed understanding of eoCRC management in the pre-diagnosis phase. This study will use linked primary care, cancer registry and health administrative data to compare diagnostic pathways for younger and older adults with colorectal cancer.
Project Lead: Rebecca Bergin