Wee Loon Ong

A standard set of value-based patient-centered outcomes for breast cancer: The International Consortium for Health Outcomes Measurement (ICHOM) initiative

A major challenge in value-based health care is the lack of standardized health outcomes measurements, hindering optimal monitoring and comparison of the quality of health care across different settings globally. The International Consortium for Health Outcomes Measurement (ICHOM) assembled a multidisciplinary international working group, comprised of 26 health care providers and patient advocates, to develop a standard set of value-based patient-centered outcomes for breast cancer (BC). The working group convened via 8 teleconferences and completed a follow-up survey after each meeting. A modified 2-round Delphi method was used to achieve consensus on the outcomes and case-mix variables to be included. Patient focus group meetings (8 early or metastatic BC patients) and online anonymized surveys of 1225 multinational BC patients and survivors were also conducted to obtain patients’ input. The standard set encompasses survival and cancer control, and disutility of care (eg, acute treatment complications) outcomes, to be collected through administrative data and/or clinical records. A combination of multiple patient-reported outcomes measurement (PROM) tools is recommended to capture long-term degree of health outcomes. Selected case-mix factors were recommended to be collected at baseline. The ICHOM will endeavor to achieve wide buy-in of this set and facilitate its implementation in routine clinical practice in various settings and institutions worldwide.

Transperineal biopsy prostate cancer detection in first biopsy and repeat biopsy after negative transrectal ultrasound-guided biopsy: the Victorian Transperineal Biopsy Collaboration experience.

To present the Victorian Transperineal Biopsy Collaboration (VTBC) experience in patients with no prior prostate cancer diagnosis, assessing the cancer detection rate, pathological outcomes and anatomical distribution of cancer within the prostate.

Comparison of oncological and health-related quality of life outcomes between open and robot-assisted radical prostatectomy for localised prostate cancer - findings from the population-based Victorian Prostate Cancer Registry.

To compare the short‐term oncological and health‐related quality of life (HRQOL) outcomes between open (ORP) and robot‐assisted (RARP) radical prostatectomy in the population‐based Victorian Prostate Cancer Registry.

Long-term erectile function following permanent seed brachytherapy treatment for localized prostate cancer.

BACKGROUND AND PURPOSE Erectile function (EF) is commonly affected following prostate cancer treatment. We aim to evaluate the long-term EF following seed brachytherapy (BT) treatment. MATERIALS AND METHODS The study consisted of 366 patients treated with BT at our institution, who completed the IIEF-5 questionnaire and reported no or mild erectile dysfunction (ED) pre-BT. The probability of EF preservation post-BT was estimated using the Kaplan-Meier methods. The difference in EF preservation by patient-, tumour- and treatment-related factors was assessed using the log-rank test. Multivariate Cox regression was used to estimate the effect of each factor on EF preservation. RESULTS Of the 366 patients, 277 (76%) reported normal EF, and 89 (24%) reported mild ED. The patients were followed-up for a median of 41 months (range: 3-124), and the 5-year actuarial rate of EF preservation was 59%. Age at BT seed implant, presence of medical comorbidities, Gleason score and the biologically effective dose (BED) are associated with EF preservation (P < 0.005). The association for these four factors remains statistically significant in multivariate analysis, with Gleason score having the strongest effect (HR = 3.7; 95% CI = 2.6-5.4). CONCLUSION The 5-year actuarial rate of EF preservation post-BT in our cohort is 59%, and is influenced by multiple factors.

Large institutional variations in use of androgen deprivation therapy with definitive radiotherapy in a population-based cohort of men with intermediate- and high-risk prostate cancer

To evaluate the pattern of use of androgen deprivation therapy (ADT) with definitive radiotherapy (RT) in men with prostate cancer (PCa) in a population‐based study in Australia.

Prevalence of Baseline Erectile Dysfunction (ED) in an Australian Cohort of Men with Localized Prostate Cancer

INTRODUCTION Erectile dysfunction (ED) is a common complication following prostate cancer treatment. Post-treatment erectile function (EF) preservation is strongly dependent on the baseline EF prior to treatment. AIM To assess the baseline EF among patients with localized prostate cancer, and the factors associated with baseline EF. METHODS All men with clinically localized prostate cancer had their baseline EF assessed prior to brachytherapy at our institution. Six hundred ninety-nine men who completed the International Index of Erectile Function five-item questionnaires pre-treatment between 2001 and 2013 were included in the study. Data on patient factors (medical comorbidities and smoking history) and prostate cancer clinicopathological characteristics were recorded. Ordinal logistic regressions were used to estimate the effects of each variable on the severity of ED. MAIN OUTCOME MEASURES Baseline EF among men with localized prostate cancer, and factors associated with ED. RESULTS Prior to permanent seed brachytherapy, 335 (48%) patients reported no ED, 129 (17%) mild ED, 42 (6%) mild-moderate ED, 37 (5%) moderate ED, and 165 (24%) severe ED. In multivariate analyses, age, diabetes, and hypertension remained to be independently associated with ED, with diabetes most strongly associated with worse ED (odds ratio = 2.6; 95% confidence interval = 1.3-5.3). CONCLUSIONS ED is common among patients with localized prostate cancer prior to any curative treatment. Assessment of baseline ED is important prior to curative treatment of prostate cancer in order to offer appropriate advise on likelihood of EF preservation post-treatment and avoid patient dissatisfaction with treatment outcomes due to unrealistic expectations.

Clinicopathological characteristics and management of prostate cancer in the human immunodeficiency virus (HIV)-positive population: experience in an Australian major HIV centre.

To characterise clinicopathological characteristics of prostate cancer among human immunodeficiency virus (HIV)‐positive men and to evaluate the current practice patterns in the management of prostate cancer in these men.

Prevalence of transfusion-acquired hepatitis C in an Australian bleeding disorders population

In Australia prior to 1992, many patients with bleeding disorders were exposed to hepatitis C through blood products. However, the incidence, complications and response to treatment of chronic hepatitis C (CHC) in this population are poorly characterized. The aim of this study was to examine the prevalence of CHC and response to treatment in an Australian bleeding disorders population. Demographic data, virological data and liver disease status from these 700 patients with inherited bleeding disorders were analysed. Of these 700 patients, 424 (61%) had been tested for CHC infection and 219 (52%) were hepatitis C antibody positive, with the prevalence approaching 100% in patients with severe bleeding disorders. Of 219 patients, 73 (33%) had received treatment for their infection with a response rate of 33/73 (45%) across all genotypes. Of 219 patients, 34 (16%) had spontaneous viral clearance. When measured with transient elastography, 44/98 (45%) patients with CHC had significant liver fibrosis and 15/98 (15%) had liver cirrhosis. Of 130 patients, 38 (29%) with CHC infection had no evidence of follow‐up with an appropriate clinician in the past 2 years. This study demonstrates that testing for CHC in this population is incomplete and treatment rates are low. Given the substantial morbidity and mortality associated with CHC and new therapeutic options becoming available, it seems important to reengage patients to diagnose, offer treatment and monitor this infection.

Patterns of health services utilization in the last two weeks of life among cancer patients: Experience in an Australian academic cancer center

To report the trend in end‐of‐life health services (HS) utilization among cancer patients treated in a large Australian academic cancer center over a 12‐year period.

In Regard to Yang et al

To the Editor: The article by Yang et al (1) describes an interesting approach for markerless lung tumor detection and tracking in cone beam computed tomography (CBCT) projections, using prior CT information to remove overlying anatomy signals. The proposed method is strikingly similar to the CT-based contrast-enhancement technique that we described previously (2), although some differences are evident. The authors obtain the “anatomy-without-tumor” dataset from the CT volume by masking the tumor with the average lung tissuevalue.Weproposed themasking not only of the lesion but of the whole lung region, because simply masking the tumor was proved to lead to higher tracking sensitivity to tumor position on CT scans. In addition, the rigid registration described by the authors between CBCT projections and “anatomy-without-tumor” digitally reconstructed radiographs may not take into account nonrigid mismatches of the anatomic structures. Our approach was based on deformable registration between the “anatomy-without-tumor” dataset and the reconstructed CBCT volume, before generating digitally reconstructed radiographs. Finally, we proposed to derive the “tumor-only” templates for cross-correlation from a single 4dimensional (4D) CT phase. Conversely, Yang et al used the “average CT” dataset, which may not reflect the lesion’s size and shape in CBCT projections. In light of these considerations, we were highly surprised by the fact that Yang et al reported lung tumor position detection capability on every CBCT projection obtained with 180 angular range. According to our experience (2), testing on CBCT projections coming from the same Elekta Synergy machine on lung cancer patients treated by stereotactic body radiation therapy revealed that, especially on projections close to the latero-lateral direction, the overlap of the surrounding anatomic structures completely hindered lesion visibility, thus excluding any detection possibility both with conventional and contrast-enhancement methods. A comparison between the detection capability of the proposed markerless technique and the state-of-the-art algorithm, based on templates generated from planning 4D CT images (3), would have allowed an objective assessment of the effective gain of the described technique on the specific 4-patient dataset used for testing. Our final remark concerns the way in which the target tracking accuracy was measured. Yang et al compared the supero-inferior distance between the average tumor positions identified on CBCT images and the projected isocenter with the supero-inferior distance between the 3-dimensional (3D)/4D CBCT average tumor position and the 3D isocenter. We believe that tracking accuracy should be investigated along the 3 main anatomic axes, by directly comparing the reference 3D lesion coordinates extracted from 3D/4D CBCT and the 3D tumor coordinates reconstructed from the detected positions on CBCT projections.