News in brief: Aggressive course of fatal SCCs in renal transplant recipients; Is it time to get rid of the term ‘elective surgery’?; NPS MedicineWise calls for review on its funding

Skin cancers

10 May 2022

Aggressive course of fatal SCCs in renal transplant recipients

Squamous cell carcinomas (SCCs) in kidney transplant recipients may be more aggressive, with higher rates of invasion, recurrence, and mortality than SCCs in the general population, Queensland researchers say.

A study of fatal cases of keratinocyte cancers in kidney transplant recipients between 1995 and 2014 found all but one death was due to SCC.

Fatal primary SCCs were mainly located on the head and neck – especially the face or ear (52%) and scalp (20%). The most common site of distant metastasis was the lung or pleura (85%).

The median time from transplantation to diagnosis of primary fatal SCC was 10 years, from diagnosis of SCC to metastasis was 5 months and from diagnosis to death was 8 months.

Histological features of fatal keratinocyte cancers included a high proportion with poor to moderate differentiation and lymphovascular and perineural invasion.

The study said treatment options for metastatic SCC including platinum-based chemo and checkpoint inhibitors were limited due to nephrotoxicity and the risk of rejection.

“Sun protection and regular skin cancer assessment are paramount for the prevention and early detection of keratinocyte cancers,” the researchers concluded.

Read more in Dermatology

Is it time to get rid of the term ‘elective surgery’?

The term ‘elective surgery’ should be abandoned because it gives the false impression that some procedures are optional and can be delayed indefinitely, the Royal Australasian College of Surgeons says.

With lower tier surgeries repeatedly placed on hold throughout the pandemic, the college wants a national review of urgency categories to reduce the risk of future blanket bans on certain procedures.

The key issue is that procedures are not always categorised consistently, creating unfair outcomes for doctors and patients waiting for category 2 or 3 surgeries, it says.

The college has pointed to data from the Australian Institute of Health and Welfare showing 32% of patients were waiting over a year for knee replacements by January 2022 – up from 11% two years previously.

“COVID-19 shutdowns caused a significant deterioration in elective surgery waiting lists,” says RACS Councillor Professor Mark Frydenberg.

“The sector must be careful that the terminology used to define types of surgery does not result in the importance of these procedures being diminished, or be used to implicitly justify long waiting times

The college is yet to say what term should be used instead.

NPS MedicineWise calls for review on its funding

The future of NPS MedicineWise is under a cloud because the service has lost almost its entire Federal Government funding, its CEO says.

It follows the federal budget announcement back in March that the NPS would no longer receive uncontested funding to promote quality use of medicines, a cut of around $25 million annually.

The money will instead go to the Australian Commission on Safety and Quality in Health Care (ACSQHC), which will also take over the service’s website and the MedicineInsight dataset and.

The Practice Review letters sent to doctors comparing their prescribing of PBS-listed medicines with others in their specialty are also now expected to come from the commission.

NPS MedicineWise CEO Katherine Burchfield says the decision is a mistake.

“We are disappointed and concerned with what this means for Australia at a time when quality and safe use of medicines is listed as a national health priority,” she says.

“While there is no doubt that the ACSQHC has a key role to play in quality use of medicines, and has strong capabilities and networks, it performs a different role and function in the health system to that of NPS MedicineWise.”

“The two organisations should work together, using their different strengths and levers, to enact change.”

She said the service had contacted Minister for Health Greg Hunt to request he reconsider.

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