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Where Are We Going with Cancer Treatment in New Zealand?

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Where Are We Going with Cancer Treatment in New Zealand? Journal of the New Zealand Medical Association Vol 132 | No 1491 | 8 March 2019 Where are we going with cancer treatment in New Zealand? New Zealand Society of Gastroenterology Guidelines on Therapeutic Drug Monitoring in Inflammatory Bowel Disease Developing a regional Lifespan of New Zealand Advancing transgender cancer service; lessons Second World War veterans healthcare teaching in from the Waitemata Cancer from one large cemetery: the Aotearoa/New Zealand Patient Experience Survey case for a national-level study Publication Information published by the New Zealand Medical Association NZMJ Editor NZMA Chair Professor Frank Frizelle Dr Kate Baddock NZMJ Production Editor NZMA Communications Manager Rory Stewart Diana Wolken Other enquiries to: NZMA To contribute to the NZMJ, fi rst read: PO Box 156 www.nzma.org.nz/journal/contribute The Terrace Wellington 6140 © NZMA 2019 Phone: (04) 472 4741 To subscribe to the NZMJ, email [email protected] Subscription to the New Zealand Medical Journal is free and automatic to NZMA members. Private subscription is available to institutions, to people who are not medical practitioners, and to medical practitioners who live outside New Zealand. Subscription rates are below. All access to the NZMJ is by login and password, but IP access is available to some subscribers. Read our Conditions of access for subscribers for further information www.nzma.org.nz/journal/subscribe/conditions-of-access If you are a member or a subscriber and have not yet received your login and password, or wish to receive email alerts, please email: [email protected] The NZMA also publishes the NZMJ Digest. This online magazine is sent out to members and subscribers 10 times a year and contains selected material from the NZMJ, along with all obituaries, summaries of all articles, and other NZMA and health sector news and information. Subscription rates for 2019 New Zealand subscription rates Overseas subscription rates Individuals* $317 Individual $442 Institutions $549 Institutions $591 Individual article $30 Individual article $30 *NZ individual subscribers must not be doctors (access is via NZMA Membership) New Zealand rates include GST. No GST is included in international rates. Note, subscription for part of a year is available at pro rata rates. Please email [email protected] for more information. Individual articles are available for purchase by emailing [email protected] NZMJ 8 March 2019, Vol 132 No 1491 ISSN 1175-8716 © NZMA 2 www.nzma.org.nz/journal CONTENTS EDITORIAL 63 7 Vision screening in New Zealand: Where are we going with cancer an audit of the B4 School Check treatment in New Zealand? William Muller, Logan Mitchell, Tamara Mullaney, Frank Frizelle Graham Wilson ARTICLES 71 Considering evidence for ethnicity 11 bias using assessment case Relationship between estimated scenarios and medical student glomerular ltration rate and correctness and certainty incident cardiovascular disease Mike Tweed, Gordon Purdie, in an ethnically diverse primary Cameron Lacey care cohort Emma Church, Katrina Poppe, 78 Matire Harwood, Suneela Mehta, District health board of residence, Corina Grey, Vanessa Selak, ethnicity and socioeconomic Mark R Marshall, Susan Wells status all impact publicly funded insulin pump uptake in 27 New Zealand patients with The factors that lead to a delay type 1 diabetes between general practitioner Benjamin J Wheeler, Rhiannon Braund, referral of symptomatic patients Barbara Galland, Anastasia Mikuscheva, and specialist diagnosis of Esko Wiltshire, Craig Je eries, colorectal cancer: an audit in the Michel de Lange Bay of Plenty District Health Board Ada Yee, Tara Linton, Mei-Sze Lee, CLINICAL CORRESPONDENCE Simon Raimes 90 38 Beau lines and telogen ef uvium Developing a regional cancer following aluminium phosphide service; lessons from the poisoning Waitemata Cancer Patient Samaneh Nakhaee, Nasim Zamani, Omid Mehrpour Experience Survey Jonathan Koea, Sue French, 93 Karen Hellesoe, Peter Sandiford Successful intravascular 46 lithotripsy for severely calci ed New Zealand Society of le anterior descending coronary Gastroenterology Guidelines on artery stenosis Therapeutic Drug Monitoring in Aleksandra Pineda, Aniket Puri, Bijan Jahangiri In ammatory Bowel Disease Afrasyab Khan, Arvenia B Berahmana, RESEARCH LETTER Andrew S Day, Murray L Barclay, Michael Schultz 96 Lifespan of New Zealand Second World War veterans from one large cemetery: the case for a national-level study Nick Wilson, Glyn Harper NZMJ 8 March 2019, Vol 132 No 1491 ISSN 1175-8716 © NZMA 3 www.nzma.org.nz/journal CONTENTS LETTERS 107 99 Nothing short of universal Comment on: “Quality of electronic healthcare coverage, fully funded records documenting adverse drug and without charge both in primary reactions…” and hospital care is good enough John S Fountain, Susan H Kenyon for New Zealand Stephen Main 101 Switching from gabapentin to METHUSELAH pregabalin Pauline McQuoid 109 Pre-eclampsia and risk of dementia 104 later in life Advancing transgender healthcare 100 YEARS AGO teaching in Aotearoa/New Zealand Althea Gamble Blakey, Gareth Treharne 110 Subclavian Aneurysm Cured by Proximal and Distal Ligature By STANLEY BROWN, F.R.C.S. NZMJ 8 March 2019, Vol 132 No 1491 ISSN 1175-8716 © NZMA 4 www.nzma.org.nz/journal SUMMARIES Relationship between estimated glomerular ltration rate and incident cardiovascular disease in an ethnically diverse primary care cohort Emma Church, Katrina Poppe, Matire Harwood, Suneela Mehta, Corina Grey, Vanessa Selak, Mark R Marshall, Susan Wells This is a large study examining whether there is a relationship between kidney function (eGFR) and the risk of having a cardiovascular event such as a heart attack or stroke in New Zealanders. The esti-mated Glomerular Filtration Rate (eGFR) result indicates how well the kidneys fi lter waste from the blood and it can identify the presence of kidney damage. The study found that participants with worse kidney function were more likely to go on to have a cardiovascular event. Patients included in the study attended their family doctor for their heart and diabetes check. At this check, a doctor or nurse collects information on any risk factors and calculates a patient’s risk of having a heart attack or stroke over the next fi ve years. The CVD risk is used to guide treatment decisions. After taking into account other CVD risk factors such as smoking, blood pressure and cholesterol levels, Māori and Pa-cifi c patients without diabetes or CVD were at higher risk of developing heart disease with worsen-ing eGFR compared to Europeans. Indian people had similar risk and Other Asians had lower risk compared to Europeans. Further studies are needed to understand whether including kidney func-tion as part of the heart and diabetes check could improve the accuracy of risk prediction and lead to more tailored care of patients seeing their doctor. The factors that lead to a delay between general practitioner referral of symptomatic patients and specialist diagnosis of colorectal cancer: an audit in the Bay of Plenty District Health Board Ada Yee, Tara Linton, Mei-Sze Lee, Simon Raimes Most patients diagnosed with colon or rectal cancer (CRC) have been referred to a specialist by their GP. The Ministry of Health provides guidelines for symptoms that raise a High Index of Suspicion (HIS) for CRC and if GPs refer patients with HIS then they should have a fast track diagnosis within two weeks. This audit examined the referral information of 181 patients who were referred by their GP and subsequently diagnosed with CRC and found that only 36% actually satisfi ed the HIS criteria. Patients who did not satisfy the criteria generally waited a lot longer for a diagnosis. This suggests that the HIS criteria are too strict, and we believe it is now necessary to review these and also to in-troduce a national referral form that prompts the GP to include all the essential information that might then facilitate a more rapid diagnosis. Developing a regional cancer service; lessons from the Waitemata Cancer Patient Experience Survey Jonathan Koea, Sue French, Karen Hellesoe, Peter Sandiford A cancer patient experience survey used in the National Health System (NHS) in the UK was administered to patients with a diagnosis of cancer at Waitemata District Health Board in 2013 and 2015. Overall patient experience benchmarked with or exceeded that of the NHS in clinical metric’s such as wait for clinic appointment, provision for family support and confi - dence in medical care. The survey did indicate further need for detailed information to be available to patients on fi nancial support such as the pharmaceutical subsidy card. NZMJ 8 March 2019, Vol 132 No 1491 ISSN 1175-8716 © NZMA 5 www.nzma.org.nz/journal SUMMARIES New Zealand Society of Gastroenterology Guidelines on Therapeutic Drug Monitoring in In ammatory Bowel Disease Afrasyab Khan, Arvenia B Berahmana, Andrew S Day, Murray L Barclay, Michael Schultz Various medications are available for the treatment of infl ammatory bowel disease. The effective use of these medications is important and leads to better outcomes. Monitoring the level of medications and/or their breakdown products (therapeutic drug monitoring) in a patient’s blood can lead to more effective and individualised dosage recommendations. These blood tests are available in New Zealand. Therapeutic drug monitoring can decrease the risk of drug toxicity and help in decision making for further treatment if one therapy seems to be failing. This document represents the New Zealand Society of Gastroenterology Guidelines on Therapeutic Drug Monitoring in Infl ammatory Bowel Disease. Vision screening in New Zealand: an audit of the B4 School Check William Muller, Logan Mitchell, Graham Wilson This study reviewed the results of the four-year-old vision screening programme (B4 School Check) in Southern and Tairawhiti DHBs over a six-month period in 2016. Of the 2,109 children screened, 176 (8.3%) ‘failed’ the vision test and were referred on to either optometrist or DHB ophthalmology clinic.
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