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Promoting best practice in cancer
 

Promoting best practice in cancer

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A presentation by Australia's Chief Medical Officer, Professor Jim Bishop AO, Tom Reeve Lecture 4 May 2010.

A presentation by Australia's Chief Medical Officer, Professor Jim Bishop AO, Tom Reeve Lecture 4 May 2010.

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    Promoting best practice in cancer Promoting best practice in cancer Presentation Transcript

    • PROMOTING BEST PRACTICE IN CANCER Tom Reeve Lecture Tuesday 4 May 2010 Professor Jim Bishop AO Chief Medical Officer Australian Government Department of Health and Ageing
    • Born November 23, 1923 – Queanbeyan NSW Qualifications: MB BS, MD (Hon), DDU, FRACS, FACS, FRACR (Hon) Special Interests and Appointments • Emeritus Professor of Surgery, University of Sydney • Emeritus Consultant Surgeon, Royal North Shore Hospital • Executive Officer, Australian Cancer Network Career Nat. Cancer Control Initiative 1998-2003, Nat. Breast Cancer Centre 1997-2003, Exec. Off. Aust. Cancer Network 1994-2002, Snr. Med. Adv; Chrmn Bd Dirs Inst. Magnetic Resonance Res. 1998-99, Pres. Aust. Socy Ultrasound Med. 1984-85, V-Pres. 1979-82, V-Pres. Aust. and Oceania Thyroid Assn 1980-89, Memb. Exec. Internat. Assn Endocrine Surgery 1979-87, Pres. 1987-89, Cl RACS 1979-91, Pres. 1989-91, Memb. NSW State Cttee 1970-78, Vstg Surgn Royal Nth Shore Hosp. 1976-88, Emeritus Consult. since 1989, Consult. Ultrasonics Inst. Aust. Dept Health 1974-90, Pres. Kur-ing-gai Dist Med. Assn 1972-73, Surgical Res. Socy A'asia 1967, Hon. Surgn Royal Nth Shore Hosp. 1963-76, Snr Surgical Res. Off. 1958-61, Retail Traders Fell. Surgical Res. 1956-57, Unit Clinical Investigation; Emeritus Prof. Surgery Univ. Syd. 1989, Hon. Memb. American Surgical Assn 1989, Coller Surgical Assn 1988, Assoc. Prof. Surgery 1963, Snr Lectr 1961, Surgical Training Albany Med. Centre USA 1950-55, Supt Collinsville Hosp. Qld 1950, MO Marrickville Dist Hosp. NSW 1947-48; Memb. Bd Royal Nth Shore Hosp. 1989-96, Chrmn Nthn Syd. Area Health Svce 1988-96; Diplomate American Bd Surgery 1958 Publications: Following Fortunes Path 2004; var. papers on thyroid disease and surgery Awards: recipient Sir Hugh Devine Medal RACS 2000 Tom’s words or thoughts (work ethic, life ethic) "The greatest fun comes from making it work."
    • Cancer in NSW 1972 - 2005 MALES 1972 % 2005 % All sites 5,827 19,316 Lung 1,245 21% 1,784 9% Bowel 772 13% 2,448 13% Prostate 675 12% 5,913 31% Stomach 380 7% 426 2% Melanoma 380 7% 2,024 10% Tracey et al Cancer in NSW 2005
    • Cancer in NSW 1972 - 2005 FEMALES 1972 % 2005 % All sites 5,725 14,911 Breast 1,456 25% 4,035 27% Bowel 949 17% 2,035 14% Melanoma 465 8% 1,481 10% Cervix 343 6% 208 1% Tracey et al Cancer in NSW, 2005
    • Changes in Incidence Rates for all Cancer in Males using Joinpoint Analysis
    • Changes in Incidence Rates in Females using Joinpoint Analysis
    • Changes in Deaths rates in Males using Joinpoint Analysis
    • Changes in Deaths Rates in Females using Joinpoint Analysis
    • Cancers with reducing death rates 1997 to 2006 – all ages 0 -5 -10 -15cancers, -13.8 All Breast, -13.8 -7.9 -20 Lung, -18.5 Bladder, -18.5 Colon, -19.6Rectum Prostate, -19.7 Bowel -19.0 , -19.9 , -19.7 -25 -19.0 Leukaemia, -23.7Head and Neck, -23.7 , -18.9 Unknown, -24.8 , -15.2 , -24.3 Kidney , -21.1 , -24.1 -30 Stomach, -29.4 -18.5 NHL, -25.1 -35 -31.9 -40 Cervix, -38.3 Testicular, -42.2 -45 Male Female
    • Mortality/Incidence 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0 Eg yp t R us si a Ke ny Vi a et N am N ig er ia Tu rk ey C hi na So Ind ut ia C h ze Af ch ric Re a pu bl ic G re ec e Ja pa n U K Br az il Ita G ly er m an Sw y ed en C an N Male ew ad a Female Ze al an Selected Countries Au d st ra lia U ALL CANCER SA Mortality/Incidence ratios 2002 for
    • CANCER Milestones in Survival Improvement • Preventions – Tobacco control • Early detection – Screening – Interventions • Better treatments – medical research • Clinical trials of better approaches • Evidence based standard practice
    • Projected YLLs – Three scenarios Australia, 1980 - 2016
    • IMPROVING CANCER CONTROL 5 KEY PRINCIPLES Prevention Early Detection Optimal Treatment Research and Innovation Monitoring and Reporting
    • The Keys to Prevention Tobacco Blood pressure Overweight/obesity Physical inactivity Blood cholesterol Alcohol Fruit/vegetables Illicit drugs Total of 32% Air pollution Unsafe sex 0.0 2.0 4.0 6.0 8.0 % DALYs Source: Table 4.1 AIHW Australia’s Health 2008
    • SMOKING IN AUSTRALIA SMOKING NSW VIC QLD WA SA TAS ACT NT AUS STATUS Daily 16.4 16.5 17.2 14.8 16.5 22.7 14.7 25.3 16.6 Weekly 1.2 1.5 1.4 1.2 1.5 0.6 0.9 1.2 1.3 Less than 1.4 1.7 1.3 1.4 1.8 1.6 1.6 1.3 1.5 Weekly Ex-smoker 24.7 24.4 25.7 28.3 24.1 26.5 24.8 22.4 25.1 Never 56.3 55.9 54.5 54.3 56.2 48.6 57.9 49.8 55.4 smoked Drug Strategy Household Survey 2007 National
    • AUSTRALIA’S INITIATIVES IN TOBACCO CONTROL • Advertising Bans • Under the counter at retail sites • Banning smoking in restaurants, pubs and cars • Anti-tobacco campaigns • Increase in tobacco excise • Plain packaging
    • Lung Cancer Time trends - incidence
    • NSW Smoking Prevalence Rates (1977-2036)
    • OBESTITY INCREASING FOR ALL
    • High BMI Prevalence rates New South Wales Prevalence Rate of Population Risk Factor Simulated: BMI Greater than 25 Total Population, Male and Female, All Age Groups Simulated Expectation 90% 80% Percentage of People per Year 70% 60% 50% Total Males 40% Females 30% 20% 10% 0% 90 93 96 99 02 05 11 08 14 17 20 23 26 29 32 35 19 19 19 19 20 20 20 20 20 20 20 20 20 20 20 20 Year Simulations and Analysis: Smetanin, P. and Kobak, P. RiskAnalytica Life at Cancer Risk Analysis for New South Wales Cancer Institute, November 2006. Historical Risk Factor Data: Centre for Epidemiology and Research. 2005 Report on Adult Health from the New South Wales Population Life at Cancer Risk Output LG12
    • OBESITY and CANCER Increased Risk Body Fatness Oesophagus Pancreas Colorectal Breast (PM) Endometrum Abnormal Fatness Colorectal Reduced Risk Physical exercise Colon World Cancer Research Fund: Food, nutrition, physical activity and prevention of cancer, 2007
    • The difference between localised and regional extent of disease at diagnosis T h yroid 5% Breast 12% Prostate 9% Melan om a 33% Uterin e 26% Kid n ey 40% Rectal 21% Colon 21% L arg e b owel 20% Ovary 29% Cervix 23% All can cer 22% Con n ective tissu e 28% Regional Small in testine 24% Localised L aryn x 28% Blad d er 38% Head an d Neck 21% Mou th 26% T on g ue 23% Stom ach 23% Un known 6% Gallb lad d er 14% Lung 11% Oesop h ag eal 1% L iver 10% Pan creatic 1% 0% 20% 40% 60% 80% 100% 120%
    • Results: Comparison of total costs by stage of disease (per cent deviation from average costs)
    • Total cancer cases and deaths per year (1972 to 2036)
    • NSW Cancer Deaths, Major Cancer Types (2007-2036)
    • CLINICAL GUIDELINES Supports for Clinical Decision Making Evidence Base Highest Impact Range of best practice tools Successful implementation methods Monitor and report
    • Breast cancer mortality NEJM 2005
    • CLINICAL GUIDELINES Highest Impact Greatest burden of disease Greatest harm from poor practice Greatest demonstrated need: - New Standard of Care - Proven variation in practice Greatest time spent/cost to health system
    • REVIEW OF CLINICAL GUIDELINES N – 313 N % CANCER 17 5% CARDIOVASCULAR 18 6% RENAL 22 7% MENTAL ILLNESS 22 7% NEUROLOGICAL 0 0% INJURIES 13 14% CHRONIC RESPIRATORY 0 0% DIABETES 11 4% OTHER 173 67% TOTAL 313 100% Buchan et al 2006
    • www.clinicalguidelines.gov.au
    • NICE: TYPES OF GUIDANCE CLINICAL GUIDELINES CLINICAL GUIDELINE UPDATES SHORT CLINICAL GUIDELINES PUBLIC HEALTH INTERVENTIONS PUBLIC HEALTH PROGRAMS INTERVENTIONAL PROCEDURES TECHNOLOGY APPRAISALS
    • CLINICAL GUIDELINES Range of best practice tools • Literature review • Check lists • Decision aids • Clinical Guidelines • Access to national/overseas websites
    • NATIONAL COMPREHENSIVE CANCER NETWORK (NCCN) www.nccn.org/index.asp
    • BEST PRACTICE IN CANCER CARE CONCLUSIONS Cancer incidence and mortality by cancer type 1972 – 2036 represent changes in needs Best practice is needed in all aspects of effective cancer control Collaborative and strategic approach is now needed for clinical decision making supports