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Evidence‐based care to support longer, healthier lives for cancer survivors

Emily Banks and Grace Joshy
Med J Aust 2021; 214 (7): . || doi: 10.5694/mja2.50995
Published online: 19 April 2021

Improving integrated care and systematically targeting major cancer and non‐cancer causes of morbidity and mortality could yield major benefits

Cancer is the leading cause of death and disability in Australia, and it is estimated that more than 1.6 million people were living with cancer at the end of 2015.1 Most of these people will live with the disease for many years; for all cancers combined, five‐year relative survival in 2012–2016 was about 69%.1 Although cancer is regarded by many people as a single condition, it is highly heterogeneous, with extreme variations in experiences and outcomes according to the type, aggressiveness, treatment, and stage of the cancer, and the age and comorbid conditions of the patient.


  • National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT


Correspondence: emily.banks@anu.edu.au

Acknowledgements: 

Emily Banks is supported by a Principal Research Fellowship from the National Health and Medical Research Council.

Competing interests:

No relevant disclosures.

  • 1. Australian Institute of Health and Welfare. Cancer data in Australia (Cat. vol no. CAN 122). Canberra: AIHW, 2020: https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia (viewed Mar 2021).
  • 2. Koczwara B, Meng R, Miller M, et al. Late mortality in people with cancer: a population‐based Australian study. Med J Aust 2021; 214: 318–323.
  • 3. Zaorsky NG, Churilla TM, Egleston BL, et al. Causes of death among cancer patients. Ann Oncol 2017; 28: 400–407.
  • 4. Australian Institute of Health and Welfare. Australian Burden of Disease Study: impact and causes of illness and death in Australia 2015 (Australian Burden of Disease series no. 19; Cat. no. BOD 22); supplementary table S4.5. Canberra: AIHW, 2019. https://www.aihw.gov.au/getmedia/a67416f3-7713-43f0-b96b-a7ab3c104845/ABDS2015-detailed-report-supplementary-tables-final.xlsx.aspx (viewed Mar 2021).
  • 5. Strongman H, Gadd S, Matthews A, et al. Medium and long‐term risks of specific cardiovascular diseases in survivors of 20 adult cancers: a population‐based cohort study using multiple linked UK electronic health records databases. Lancet 2019; 394: 1041–1054.
  • 6. Baade PD, Fritschi L, Eakin EG. Non‐cancer mortality among people diagnosed with cancer (Australia). Cancer Causes Control 2006; 17: 287–297.
  • 7. Banks E, Crouch SR, Korda RJ, et al. Absolute risk of cardiovascular disease events, and blood pressure‐ and lipid‐lowering therapy in Australia. Med J Aust 2016; 204: 320. https://www.mja.com.au/journal/2016/204/8/absolute-risk-cardiovascular-disease-events-and-blood-pressure-and-lipid
  • 8. Weaver KE, Foraker RE, Alfano CM, et al. Cardiovascular risk factors among long‐term survivors of breast, prostate, colorectal, and gynecologic cancers: a gap in survivorship care? J Cancer Surviv 2013; 7: 253–261.
  • 9. National Center for Chronic Disease Prevention; Health Promotion (US) Office on Smoking and Health. The health consequences of smoking: 50 years of progress. A report of the Surgeon General. Atlanta (GA): US Centers for Disease Control and Prevention, 2014. https://www.ncbi.nlm.nih.gov/books/NBK179276 (viewed Mar 2021).
  • 10. Paul CL, Tzelepis F, Boyes AW, et al. Continued smoking after a cancer diagnosis: a longitudinal study of intentions and attempts to quit. J Cancer Surviv 2019; 13: 687–694.
  • 11. Chiuve SE, McCullough ML, Sacks FM, Rimm EB. Healthy lifestyle factors in the primary prevention of coronary heart disease among men: benefits among users and nonusers of lipid‐lowering and antihypertensive medications. Circulation 2006; 114: 160–167.
  • 12. Chiuve SE, Fung TT, Rexrode KM, et al. Adherence to a low‐risk, healthy lifestyle and risk of sudden cardiac death among women. JAMA 2011; 306: 62–69.
  • 13. National Vascular Disease Prevention Alliance. Guidelines for the management of absolute cardiovascular disease risk. 2012. http://www.cvdcheck.org.au/pdf/Absolute_CVD_Risk_Full_Guidelines.pdf (viewed Mar 2021).
  • 14. Chidwick K, Strongman H, Matthews A, et al. Statin use in cancer survivors versus the general population: cohort study using primary care data from the UK clinical practice research datalink. BMC Cancer 2018; 18: 1018.

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Does Australia need more catheterisation laboratories to treat heart attack?

Peter L Thompson
Med J Aust 2021; 214 (7): . || doi: 10.5694/mja2.50994
Published online: 19 April 2021

Patients receive similar treatment and have similar outcomes whether their initial hospital has cardiac catheterisation facilities or not

That early reperfusion in a cardiac catheterisation laboratory (“cath lab”) can preserve heart muscle in patients with ST‐elevation myocardial infarction (STEMI) is universally accepted,1 as captured in the “time is muscle” mantra. The reperfusion era for patients with STEMI has delivered better outcomes and reduced the number of deaths.2 Debate about whether to achieve reperfusion by lytic therapy or percutaneous coronary intervention (PCI) has also been settled, with agreement that PCI is preferable when available.3


  • Heart Research Institute, Sir Charles Gairdner Hospital, Perth, WA



Competing interests:

No relevant disclosures.

  • 1. Ibanez B, James S, Agewall S, et al; ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST‐segment elevation. Eur Heart J 2018; 39: 119–177.
  • 2. Briffa T, Hickling S, Knuiman M, et al. Long term survival after evidence based treatment of acute myocardial infarction and revascularisation: follow‐up of population based Perth MONICA cohort, 1984–2005. BMJ 2009; 338: b36.
  • 3. Keeley EC, Boura JA, Grines CL. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet 2003; 361: 13–20.
  • 4. Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non‐st-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 23: e139–e228.
  • 5. Collet JP, Thiele H, Barbato E, et al; ESC Scientific Document Group. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST‐segment elevation. Eur Heart J 2020; ehaa575.
  • 6. Fox KAA, Clayton TC, Damman P, et al; FIR Collaboration. Long‐term outcome of a routine versus selective invasive strategy in patients with non‐ST-segment elevation acute coronary syndrome: a meta‐analysis of individual patient data. J Am Coll Cardiol 2010; 55: 2435–2445.
  • 7. Chew DP, Scott IA, Cullen L, et al; NHFA/CSANZ ACS Guideline 2016 Executive Working Group. National Heart Foundation of Australia & Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of acute coronary syndromes 2016. Heart Lung Circ 2016; 25: 895–951.
  • 8. Thompson SC, Nedkoff L, Katzenellenbogen J, et al. Challenges in managing acute cardiovascular diseases and follow up care in rural areas: a narrative review. Int J Environ Res Public Health 2019; 16: 5126.
  • 9. Ayad M, Hyun K, D'Souza M, et al. Factors that influence whether patients with acute coronary syndromes undergo cardiac catheterisation. Med J Aust 2021; 214: 310–317.
  • 10. Tideman PA, Tirimacco R, Senior DP, et al. Impact of a regionalised clinical cardiac support network on mortality among rural patients with myocardial infarction. Med J Aust 2014; 200: 157–160. https://www.mja.com.au/journal/2014/200/3/impact-regionalised-clinical-cardiac-support-network-mortality-among-rural

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Persistent symptoms up to four months after community and hospital‐managed SARS‐CoV‐2 infection

David R Darley, Gregory J Dore, Lucette Cysique, Kay A Wilhelm, David Andresen, Katrina Tonga, Emily Stone, Anthony Byrne, Marshall Plit, Jeffrey Masters, Helen Tang, Bruce Brew, Philip Cunningham, Anthony Kelleher and Gail V Matthews
Med J Aust 2021; 214 (6): . || doi: 10.5694/mja2.50963
Published online: 5 April 2021

The spectrum of recovery for people infected with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) remains uncertain.1,2,3,4 The ADAPT study is a prospective cohort study that follows up all adults diagnosed with coronavirus disease 2019 (COVID‐19) at St Vincent’s Hospital, Sydney. Our goal is to characterise the effects of infection during the 12 months after diagnosis, by initial severity of COVID‐19. Our specific aims were to determine the prevalence and nature of persistent symptoms; to evaluate lung function, health‐related quality of life, neurocognitive and olfactory abnormalities during the recovery period; and to characterise the longitudinal immune response to infection.

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  • 1 St Vincent's Hospital, Sydney, NSW
  • 2 St Vincent's Clinical School, University of New South Wales, Sydney, NSW
  • 3 Kirby Institute, University of New South Wales, Sydney, NSW
  • 4 Institute for Applied Medical Research, St Vincent's Hospital, Sydney, NSW
  • 5 University of New South Wales, Sydney, NSW
  • 6 The University of Notre Dame Australia, Sydney, NSW
  • 7 The University of Sydney, Sydney, NSW


Correspondence: David.Darley@svha.org.au

Acknowledgements: 

We thank the research staff at the St Vincent’s Institute for Applied Medical Research and St Vincent’s Hospital Pulmonary Function Laboratory. We appreciate grant support from the St Vincent’s Clinic Foundation and the Curran Foundation.

Competing interests:

No relevant disclosures.

  • 1. Carfì A, Bernabei R, Landi F; Gemelli Against COVID‐19 Post‐Acute Care Study Group. Persistent symptoms in patients after acute COVID‐19. JAMA 2020; 324: 603–605.
  • 2. Tenforde MW, Kim SS, Lindsell CJ, et al; IVY Network Investigators; CDC COVID‐19 Response Team. Symptom duration and risk factors for delayed return to usual health among outpatients with COVID‐19 in a multistate health care systems network; United States, March–June 2020. MMWR Morb Mortal Wkly Rep 2020; 69: 993–998.
  • 3. Mo X, Jian W, Su Z, et al. Abnormal pulmonary function in COVID‐19 patients at time of hospital discharge. Eur Respir J 2020; 55: 2001217.
  • 4. Fumagalli A, Misuraca C, Bianchi A, et al. Pulmonary function in patients surviving to COVID‐19 pneumonia. Infection 2020; 28: 1–5.
  • 5. Dalton P, Doty RL, Murphy C, et al. Olfactory assessment using the NIH Toolbox. Neurology 2013; 80 (11 Suppl 3): S32–S36.
  • 6. Parker G, Hilton T, Bains J, Hadzi‐Pavlovic D. Cognitive‐based measures screening for depression in the medically ill: the DMI‐10 and the DMI‐18. Acta Psychiatr Scand 2002; 105: 419–426.
  • 7. Quanjer PH, Stanojevic S, Cole TJ, et al. Multi‐ethnic reference values for spirometry for the 3–95‐yr age range: the global lung function 2012 equations. Eur Respir J 2012; 40: 1324–1343.
  • 8. Stocks J, Quanjer PH. Reference values for residual volume, functional residual capacity and total lung capacity. ATS Workshop on Lung Volume Measurements. Official statement of the European Respiratory Society. Eur Respir J 1995; 8: 492–506.
  • 9. Stanojevic S, Graham BL, Cooper BG, et al; Global Lung Function Initiative Tlco working group. Official ERS technical standards: Global Lung Function Initiative reference values for the carbon monoxide transfer factor for Caucasians. Eur Respir J 2017; 50: 1700010.

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Clinically significant localised prostate cancer: deciding what will provide the best clinical outcomes

Henry H Woo and Amy Teh
Med J Aust 2021; 214 (6): . || doi: 10.5694/mja2.50983
Published online: 5 April 2021

Prostate cancer specialists working in collegiate, multidisciplinary teams are most likely to provide the best outcomes for patients

In the absence of formal comparative studies, there is no real evidence that the outcomes of surgery or radiotherapy for patients with localised prostate cancer differ significantly. However, most men in Australia with clinically significant localised prostate cancer undergo surgery rather than radiotherapy.


  • 1 Sydney Adventist Hospital Clinical School, University of Sydney, Sydney, NSW
  • 2 Chris O’Brien Lifehouse, Sydney, NSW
  • 3 Icon Cancer Centre, Sydney, NSW


Correspondence: henry.woo@sydney.edu.au

Competing interests:

Henry Woo has received speaker’s and advisory board fees from Astellas, Janssen, and Boston Scientific.

  • 1. Yap ML, O’Connell DL, Goldsbury DE, et al. Patterns of care for men with prostate cancer: the 45 and Up Study. Med J Aust 2021; 214: 271–278.
  • 2. Mottet N, van den Bergh RCN, Briers E, et al. EAU‐EANM-ESTRO‐ESUR-SIOG guidelines on prostate cancer, 2020 update. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol 2020; 79: 243–262.
  • 3. te Marvelde L, Milne RL, Hornby CJ, et al. Differences in treatment choices for localised prostate cancer diagnosed in private and public health services. Med J Aust 2020; 213: 411–417. https://www.mja.com.au/journal/2020/213/9/differences-treatment-choices-localised-prostate-cancer-diagnosed-private-and
  • 4. Australian Department of Health. Medicare Benefits Schedule, note TN.8.161. Urology oncology: prostatectomy. (items 37210, 37211, 37213 and 37214). http://www9.health.gov.au/mbs/fullDisplay.cfm?type=note&qt=NoteID&q=TN.8.161 (viewed Jan 2021).
  • 5. Mazariego CG, Egger S, King MT, et al. Fifteen year quality of life outcomes in men with localised prostate cancer: population based Australian prospective study. BMJ 2020; 371: m3503.
  • 6. Matta R, Chapple CR, Fisch M, et al. Pelvic complications after prostate cancer radiation therapy and their management: an international collaborative narrative review. Eur Urol 2019; 75: 464–476.
  • 7. Kneebone A, Fraser‐Browne C, Duchesne GM, et al. Adjuvant radiotherapy versus early salvage radiotherapy following radical prostatectomy (TROG 08.03/ANZUP RAVES): a randomised, controlled, phase 3, non‐inferiority trial. Lancet Oncol 2020; 21: 1331–1340.
  • 8. Valle LF, Lehrer EJ, Markovic D, et al. A systematic review and meta‐analysis of local salvage therapies after radiotherapy for prostate cancer (MASTER). Eur Urol 2020; S0302‐2838(20)30874‐5 [online ahead of print].
  • 9. Yuh B, Ruel N, Muldrew S, et al. Outcomes of salvage robot‐assisted prostatectomy. BJU Int 2014; 113: 769–776.
  • 10. Australian Department of Health. Overview: key Medicare safety net arrangements. Updated 20 Dec 2019. https://www1.health.gov.au/internet/main/publishing.nsf/Content/EMSN-overview-key-medicare-safety-net-arrangements (viewed Jan 2021).
  • 11. Evans SM, Nag N, Roder D, et al. Development of an international prostate cancer outcomes registry. BJU Int 2016; 117 (Suppl 4): 60–67.

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Assessing and modifying cardiovascular risk in people who present to a chest pain clinic with non‐cardiac causes

Johannes T Neumann and Andrew M Tonkin
Med J Aust 2021; 214 (6): . || doi: 10.5694/mja2.50984
Published online: 5 April 2021

Managing patients with acute chest pain should include opportunistic discussion of strategies for preventing coronary artery disease

Chest pain is a frequent symptom in patients presenting to emergency departments. Assessing blood troponins is critical for rapid diagnosis,1 and guidelines clearly outline therapeutic strategies for patients diagnosed with acute myocardial infarction.2 However, evidence for guiding further management when myocardial infarction has been excluded — that is, for most people who present with chest pain — is less definite. As the risk of myocardial infarction or death within 12 months for such patients is 2–9%,1 accurate risk estimation and further preventive treatment are important. The 2020 European Society of Cardiology guidelines for non‐ST‐elevation myocardial infarction recommend non‐invasive cardiac imaging in patients without acute coronary syndrome only when coronary artery disease is nevertheless suspected.3 Further evaluation is often undertaken in chest pain clinics.


  • 1 Monash University, Melbourne, VIC
  • 2 University Heart and Vascular Center Hamburg, Hamburg, Germany


Correspondence: andrew.tonkin@monash.edu

Acknowledgements: 

Johannes Neumann is supported by a fellowship from the Deutsche Forschungsgemeinschaft (NE 2165/1‐1).

Competing interests:

No relevant disclosures.

  • 1. Neumann JT, Twerenbold R, Ojeda F, et al. Application of high‐sensitivity troponin in suspected myocardial infarction. N Engl J Med 2019; 380: 2529–2540.
  • 2. Chew DP, Scott IA, Cullen L, et al; NHFA/CSANZ ACS Guideline 2016 Executive Working Group. National Heart Foundation of Australia & Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of acute coronary syndromes 2016. Heart Lung Circ 2016; 25: 895–951.
  • 3. Collet JP, Thiele H, Barbato E, et al; ESC Scientific Document Group. 2020 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST‐segment elevation. Eur Heart J 2020; https://doi.org/10.1093/eurheartj/ehaa575 [online ahead of print].
  • 4. Black JA, Campbell JA, Parker S, et al. Absolute risk assessment for guiding cardiovascular risk management in a chest pain clinic. Med J Aust 2021; 214: 266–271.
  • 5. Klimis H, Chow CK. Are we behind the times on cardiovascular risk assessment in Australia? Med J Aust 2020; 213: 168–169. https://www.mja.com.au/journal/2020/213/4/are-we-behind-times-cardiovascular-risk-assessment-australia
  • 6. National Vascular Disease Prevention Alliance. Guidelines for the management of absolute cardiovascular disease risk. 2012. http://cvdcheck.org.au/pdf/Absolute_CVD_Risk_Full_Guidelines.pdf (viewed Feb 2021).
  • 7. Chiuve S, McCullough ML, Sacks FM, Rimm EB. Healthy lifestyle factors in the primary prevention of coronary heart disease among men. Circulation 2006; 114: 160–167.
  • 8. Jackevicius CA, Mamdani M, Tu JV. Adherence with statin therapy in elderly patients with and without acute coronary syndromes. JAMA 2002; 288: 462–467.
  • 9. Jelinek MV, Santamaria JD, Thompson DR, Vale MJ. “FIT FOR PURPOSE”. The COACH program improves lifestyle and biomedical cardiac risk factors. Heart 2012; 98: 1608.
  • 10. The SCOT‐HEART Investigators; Newby DE, Adamson PD, Berry C, et al. Coronary CT angiography and 5‐year risk of myocardial infarction. N Engl J Med 2018; 379: 924–933.
  • 11. Mortensen MB, Dzaye O, Steffensen FH, et al. Impact of plaque burden versus stenosis on ischemic events in patients with coronary atherosclerosis. J Am Coll Cardiol 2020; 76: 2803–2813.
  • 12. Venkataraman P, Stanton T, Liew D, et al. Coronary artery calcium scoring in cardiovascular risk assessment of people with family histories of early onset coronary artery disease. Med J Aust 2020; 213: 170–177. https://www.mja.com.au/journal/2020/213/4/coronary-artery-calcium-scoring-cardiovascular-risk-assessment-people-family
  • 13. Kalia NK, Miller NG, Nasir K, et al. Visualising coronary calcium is associated with improvements in adherence with statin therapy. Atherosclerosis 2006; 185: 394–399.

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Closing the Gap: where to now?

Talila Milroy and Lilon G Bandler
Med J Aust 2021; 214 (5): . || doi: 10.5694/mja2.50959
Published online: 15 March 2021

Let us move our focus to building health care relationships and partnerships that optimise care for every Indigenous patient

In 1978, the International Conference on Primary Health Care declared that “governments have a responsibility for the health of their people which can be fulfilled only by the provision of adequate health and social measures.”1 In 2007, Closing the Gap was heralded by the Australian government as a shift in health policy for Indigenous Australians, proposing drastic action that would be measured against clear benchmarks.2 The flaw in this policy was the assumption that a homogenous approach, unaccompanied by deep, meaningful engagement with Indigenous people, communities, and health care services would be sufficient. Fourteen years later, the goal of closing the gap in life expectancy between Indigenous and non‐Indigenous Australians by 2031 “is not on track”.3 In 2020, the incorporation of Indigenous perspectives into health care, and greater control of health‐related targets and programs by Indigenous‐led organisations promised change, despite risks, including peak Indigenous health care bodies being “held responsible for any future policy failings.”4

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  • 1 The University of Western Australia, Perth, WA
  • 2 Leaders in Indigenous Medical Education (LIME) Network, University of Melbourne, Melbourne, VIC
  • 3 Royal Flying Doctor Service of Australia, Broken Hill, NSW


Correspondence: lbandler@unimelb.edu.au

Competing interests:

No relevant disclosures.

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Hepatocellular carcinoma in Indigenous Australians: a call to action

Jessica Howell, James S Ward, Jane Davies, Paul J Clark and Joshua S Davis
Med J Aust 2021; 214 (5): . || doi: 10.5694/mja2.50961
Published online: 15 March 2021

Liver disease and liver cancer incidence and mortality are unacceptably high among Indigenous Australians

Hepatocellular carcinoma (HCC) is an urgent public health issue in Australia.1 Indigenous Australians are disproportionately affected by liver disease and HCC,2 and suffer substantially greater HCC‐related mortality than non‐Indigenous Australians.2,3 With the release of the Australian national consensus statement on hepatocellular carcinoma in December 20204 and international focus on equity and the rights of Indigenous peoples, it is timely to reflect upon the key actions that must be taken to reduce HCC incidence and mortality for Indigenous Australians.

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  • 1 St Vincent’s Hospital, Melbourne, VIC
  • 2 University of Queensland, Brisbane, QLD
  • 3 Poche Centre for Indigenous Health, University of Queensland, Brisbane, QLD
  • 4 Menzies School of Health Research, Darwin, NT
  • 5 John Hunter Hospital, Newcastle, NSW


Correspondence: jessica.howell@svha.org.au

Acknowledgements: 

Jessica Howell is supported by a University of Melbourne CR Roper Faculty Fellowship and a National Health and Medical Research Council Program Grant.

Competing interests:

Jessica Howell has received an Australia Fellowship from Gilead Sciences in 2017 and 2019, and investigator‐initiated grant funds and speaker fees from Gilead Sciences.

  • 1. Wallace MC, Preen DB, Short MW, et al. Hepatocellular carcinoma in Australia 1982–2014: increasing incidence and improving survival. Liver Int 2019; 39: 522–530.
  • 2. Parker C, Tong SY, Dempsey K, et al. Hepatocellular carcinoma in Australia’s Northern Territory: high incidence and poor outcome. Med J Aust 2014; 201: 470–474. https://www.mja.com.au/journal/2014/201/8/hepatocellular-carcinoma-australias-northern-territory-high-incidence-and-poor
  • 3. Banham D, Roder D, Keefe D, et al. Disparities in cancer stage at diagnosis and survival of Aboriginal and non‐Aboriginal South Australians. Cancer Epidemiol 2017; 48: 131–139.
  • 4. Lubel JS, Roberts SK, Strasser SI, et al. Australian recommendations for the management of hepatocellular carcinoma: a consensus statement. Med J Aust 2020; https://www.mja.com.au/journal/2020/214/10/australian-recommendations-management-hepatocellular-carcinoma-consensus [online ahead of print].
  • 5. Condon JR, Zhang X, Dempsey K, et al. Trends in cancer incidence and survival for Indigenous and non‐Indigenous people in the Northern Territory. Med J Aust 2016; 205: 454–458. https://www.mja.com.au/journal/2017/207/1/trends-cancer-incidence-and-survival-indigenous-and-non-indigenous-people
  • 6. Graham S, Guy RJ, Cowie B, et al. Chronic hepatitis B prevalence among Aboriginal and Torres Strait Islander Australians since universal vaccination: a systematic review and meta‐analysis. BMC Infect Dis 2013; 13: 403.
  • 7. Graham S, Harrod ME, Iversen J, Hocking JS. Prevalence of hepatitis C among Australian Aboriginal and Torres Strait Islander people: a systematic review and meta‐analysis. Hepat Mon 2016; 16: e38640.
  • 8. Li M, Roder D, McDermott R. Diabetes and smoking as predictors of cancer in Indigenous adults from rural and remote communities of North Queensland – a 15‐year follow up study. Int J Cancer 2018; 143: 1054–1061.
  • 9. Dyer SM, Gomersall JS, Smithers LG, et al. Prevalence and characteristics of overweight and obesity in indigenous Australian children: a systematic review. Crit Rev Food Sci Nutr 2017; 57: 1365–1376.
  • 10. Valery PC, McPhail S, Stuart KA, et al. Changing prevalence of aetiological factors and comorbidities among Australians hospitalised for cirrhosis. Intern Med J 2020; https://doi.org/10.1111/imj.14809 [online ahead of print].
  • 11. Clark PJ, Stuart KA, Leggett BA, et al. Remoteness, race and social disadvantage: disparities in hepatocellular carcinoma incidence and survival in Queensland, Australia. Liver Int 2015; 35: 2584–2594.
  • 12. Howell J, Pedrana A, Cowie BC, et al. Aiming for the elimination of viral hepatitis in Australia, New Zealand, and the Pacific Islands and Territories: where are we now and barriers to meeting World Health Organization targets by 2030. J Gastroenterol Hepatol 2019; 34: 40–48.
  • 13. Davies J, Bukulatjpi S, Sharma S, et al. Development of a culturally appropriate bilingual electronic app about hepatitis B for Indigenous Australians: towards shared understandings. JMIR Res Protoc 2015; 4: e70.
  • 14. Davies J, Li SQ, Tong SY, et al. Establishing contemporary trends in hepatitis B sero‐epidemiology in an Indigenous population. PLoS One 2017; 12: e0184082.
  • 15. Australian Institute of Health and Welfare. Aboriginal and Torres Strait Islander Health Performance Framework 2020 summary report (Cat. No. IHPF 2). Canberra: AIHW, 2020. https://www.aihw.gov.au/reports/indigenous-health-welfare/health-performance-framework/contents/overview (viewed Feb 2021).
  • 16. Hosking K, Stewart G, Mobsby M, et al. Data linkage and computerised algorithmic coding to enhance individual clinical care for Aboriginal people living with chronic hepatitis B in the Northern Territory of Australia – is it feasible? PLOS One 2020; 15: e0232207.
  • 17. Bradley C, Hengel B, Crawford K, et al. Establishment of a sentinel surveillance network for sexually transmissible infections and blood borne viruses in Aboriginal primary care services across Australia: the ATLAS project. BMC Health Serv Res 2020; 20: 769.
  • 18. Sullivan RP, Davies J, Binks P, et al. Point of care and oral fluid hepatitis B testing in remote Indigenous communities of northern Australia. J Viral Hepat 2019; 27: 407–414.
  • 19. Hla TKBS, Binks P, Gurruwiwi GG, et al. A “one stop liver shop” approach improves the cascade‐of-care for Aboriginal and Torres Strait Islander Australians living with chronic hepatitis B in the Northern Territory of Australia: results of a novel care delivery model. Int J Equity Health 2020; 19: 64.
  • 20. Treloar C, Hopwood M, Cama E, et al. Evaluation of the Deadly Liver Mob program: insights for roll‐out and scale‐up of a pilot program to engage Aboriginal Australians in hepatitis C and sexual health education, screening, and care. Harm Reduct J 2018; 15: 5.
  • 21. Ivers R, Jackson B, Levett T, et al. Home to health care to hospital: Evaluation of a cancer care team based in Australian Aboriginal primary care. Aust J Rural Health 2019; 27: 88–92.
  • 22. Mohsen W, Chan P, Whelan M, et al. Hepatitis C treatment for difficult to access populations: can telementoring (as distinct from telemedicine) help? Intern Med J 2019; 49: 351–357.
  • 23. Herman A, Bullen C, Finau S, Ofanoa M. Mobilising Pacific people for health: insights from a hepatitis B screening programme in Auckland, New Zealand. Pac Health Dialog 2006; 13: 9–15.
  • 24. Becker DM, Tafoya CA, Becker SL, et al. The use of portable ultrasound devices in low‐ and middle‐income countries: a systematic review of the literature. Trop Med Int Health 2016; 21: 294–311.
  • 25. Ladep NG, Dona AC, Lewis MR, et al. Discovery and validation of urinary metabotypes for the diagnosis of hepatocellular carcinoma in West Africans. Hepatology 2014; 60: 1291–1301.

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The indirect impacts of COVID‐19 on Aboriginal communities across New South Wales

David Follent, Cory Paulson, Phillip Orcher, Barbara O'Neill, Debbie Lee, Karl Briscoe and Tara L Dimopoulos‐Bick
Med J Aust 2021; 214 (5): . || doi: 10.5694/mja2.50948
Published online: 1 March 2021

Evidence to inform conversations on Aboriginal health issues — in response to COVID‐19 and beyond

Nearly everyone has been affected in some way by the coronavirus disease 2019 (COVID‐19) pandemic, and it is a public health risk for Aboriginal peoples and communities.1 The impacts of the pandemic are pervasive, wide‐ranging and continue to affect people and communities differently. Concerns about the indirect impacts of COVID‐19, caused by missed, delayed and avoided health care — not as a direct consequence of COVID‐19 infections — are shared internationally.2,3,4

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  • 1 Agency for Clinical Innovation, Sydney, NSW
  • 2 Far West Mental Health Drug and Alcohol Service, Broken Hill, NSW
  • 3 Junction Neighbourhood Centre, Sydney, NSW
  • 4 First Peoples Disability Network, Sydney, NSW
  • 5 National Association of Aboriginal and Torres Strait Islander Health Workers and Practitioners, Canberra, ACT



Acknowledgements: 

We acknowledge the contributions of everyone who participated in these important conversations. We acknowledge that as the host of these conversations, NSW Health was privy to the ancient and traditional process of yarning and the respect and sharing of knowledge that this involves. We acknowledge the lands on which these conversations took place, the lands of an ancient and continuing culture, and we acknowledge and pay respect to the elders past, present and emerging of these Aboriginal lands. These lands always were and always will be Aboriginal land. We thank Kim Sutherland and Jean‐Frederic Levesque from the Agency for Clinical Innovation and the Critical Intelligence Unit for their ongoing support.

Competing interests:

No relevant disclosures.

  • 1. Crooks K, Casey D, Ward JS. First Nations peoples leading the way in COVID‐19 pandemic planning, response and management. Med J Aust 2020; 213: 151–152. https://www.mja.com.au/journal/2020/213/4/first-nations-peoples-leading-way-covid-19-pandemic-planning-response-and
  • 2. Sud A, Jones ME, Broggio J, et al. Collateral damage: the impact on outcomes from cancer surgery of the COVID‐19 pandemic. Ann Oncol 2020; 31: 1065–1074.
  • 3. Newby JM, O’Moore K, Tang S, et al. Acute mental health responses during the COVID‐19 pandemic in Australia. PLoS One 2020; 15: e0236562.
  • 4. Power T, Wilson D, Best O, Brockie T, et al. COVID‐19 and Indigenous peoples: an imperative for action. J Clin Nurs 2020; 29: 2737–2741.
  • 5. McAnulty JM, Ward K. Suppressing the epidemic in New South Wales. N Engl J Med 2020; 382: e74.
  • 6. Sutherland K, Chessman J, Zhao J, et al. Impact of COVID‐19 on healthcare activity in NSW. Australia. Public Health Res Pract 2020; 30: 3042030.
  • 7. Moynihan R, Sanders S, Michaleff ZA, et al. Pandemic impacts on healthcare utilisation: a systematic review [preprint]. medRxiv 2020; 2020.10.26.20219352.
  • 8. Yashadhana A, Pollard‐Wharton N, Zwi AB, Biles B. Indigenous Australians at increased risk of COVID‐19 due to existing health and socioeconomic inequities. Lancet Regional Health Western Pacific 2020; 1: 100007.
  • 9. Eades S, Eades F, McCaullay D, et al. Australia’s First Nations’ response to the COVID‐19 pandemic. Lancet 2020; 396: 237–238.
  • 10. Carson B, Dunbar T, Chenhall R, Bailie R editors. Social determinants of Indigenous health. London: Routledge, 2007.
  • 11. World Health Organization. Social determinants of health. https://www.who.int/social_determinants/en/ (viewed Oct 2020).
  • 12. Kingsley J, Munro‐Harrison E, Jenkins A, Thorpe A. “Here we are part of a living culture”: understanding the cultural determinants of health in Aboriginal gathering places in Victoria, Australia. Health Place 2018; 54: 210–220.
  • 13. Abrams EM, Szefler SJ. COVID‐19 and the impact of social determinants of health. Lancet Resp Med 2020; 8: 659–661.
  • 14. Shah GH, Shankar P, Schwind JS, Sittaramane V. The detrimental impact of the COVID‐19 crisis on health equity and social determinants of health. J Public Health Manag Pract 2020; 26: 317–319.
  • 15. Australian Health Practitioner Regulation Agency. Aboriginal and Torres Strait Islander Health Strategy – statement of intent. https://www.ahpra.gov.au/About-Ahpra/Aboriginal-and-Torres-Strait-Islander-Health-Strategy/Statement-of-intent.aspx (viewed Jan 2021).
  • 16. Child Family Community Australia. LGBTIQA+ communities: glossary of common terms. CFCA resource sheet – Nov 2019. https://aifs.gov.au/cfca/publications/lgbtiq-communities (viewed Jan 2021).
  • 17. Hindman L. COVID‐19: ethical decision‐making for First Peoples living with disability. First Peoples Disability Network Australia, 2020. https://fpdn.org.au/covid-19-ethical-decision-making-for-first-peoples-living-with-disability/ (viewed Jan 2021).
  • 18. Katz I, Jones A, Newton B, Reimer E. Life journeys of victim/survivors of child sexual abuse in institutions: an analysis of Royal Commission private sessions. Royal Commission into Institutional Responses to Child Sexual Abuse. Canberra: Commonwealth of Australia. 2017. https://www.arts.unsw.edu.au/sites/default/files/documents/Life_journeys_of_victims_survivors_of_child_sexual_abuse_in_institutions.pdf (viewed Jan 2021).
  • 19. Dudgeon P, Derry K, Wright M. A national COVID‐19 pandemic issues paper on mental health and wellbeing for Aboriginal and Torres Strait Islander Peoples. Perth: University of Western Australia, 2020. https://apo.org.au/sites/default/files/resource-files/2020-06/apo-nid306661.pdf (viewed Jan 2021).

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Seroprevalence of SARS‐CoV‐2‐specific antibodies in Sydney after the first epidemic wave of 2020

Heather F Gidding, Dorothy A Machalek, Alexandra J Hendry, Helen E Quinn, Kaitlyn Vette, Frank H Beard, Hannah S Shilling, Rena Hirani, Iain B Gosbell, David O Irving, Linda Hueston, Marnie Downes, John B Carlin, Matthew VN O'Sullivan, Dominic E Dwyer, John M Kaldor and Kristine Macartney
Med J Aust 2021; 214 (4): . || doi: 10.5694/mja2.50940
Published online: 1 March 2021

Abstract

Objectives: To estimate SARS‐CoV‐2‐specific antibody seroprevalence after the first epidemic wave of coronavirus disease 2019 (COVID‐19) in Sydney.

Setting, participants: People of any age who had provided blood for testing at selected diagnostic pathology services (general pathology); pregnant women aged 20–39 years who had received routine antenatal screening; and Australian Red Cross Lifeblood plasmapheresis donors aged 20–69 years.

Design: Cross‐sectional study; testing of de‐identified residual blood specimens collected during 20 April – 2 June 2020.

Main outcome measure: Estimated proportions of people seropositive for anti‐SARS‐CoV‐2‐specific IgG, adjusted for test sensitivity and specificity.

Results: Thirty‐eight of 5339 specimens were IgG‐positive (general pathology, 19 of 3231; antenatal screening, 7 of 560; plasmapheresis donors, 12 of 1548); there were no clear patterns by age group, sex, or location of residence. Adjusted estimated seroprevalence among people who had had general pathology blood tests (all ages) was 0.15% (95% credible interval [CrI], 0.04–0.41%), and 0.29% (95% CrI, 0.04–0.75%) for plasmapheresis donors (20–69 years). Among 20–39‐year‐old people, the age group common to all three collection groups, adjusted estimated seroprevalence was 0.24% (95% CrI, 0.04–0.80%) for the general pathology group, 0.79% (95% CrI, 0.04–1.88%) for the antenatal screening group, and 0.69% (95% CrI, 0.04–1.59%) for plasmapheresis donors.

Conclusions: Estimated SARS‐CoV‐2 seroprevalence was below 1%, indicating that community transmission was low during the first COVID‐19 epidemic wave in Sydney. These findings suggest that early control of the spread of COVID‐19 was successful, but efforts to reduce further transmission remain important.

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  • 1 National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Sydney, NSW
  • 2 Northern Clinical School, University of Sydney, Sydney, NSW
  • 3 Women and Babies Research, Kolling Institute, Sydney, NSW
  • 4 The Kirby Institute, University of New South Wales, Sydney, NSW
  • 5 The University of Sydney, Sydney, NSW
  • 6 Centre for Women’s Infectious Diseases, Royal Women’s Hospital, Melbourne, VIC
  • 7 Australian Red Cross Lifeblood, Sydney, NSW
  • 8 Western Sydney University, Sydney, NSW
  • 9 University of Technology Sydney, Sydney, NSW
  • 10 NSW Health Pathology–Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, NSW
  • 11 Murdoch Children’s Research Institute, Melbourne, VIC
  • 12 The University of Melbourne, Melbourne, VIC
  • 13 Centre for Infectious Disease and Microbiology, Westmead Hospital, Sydney, NSW
  • 14 Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW



Acknowledgements: 

This study was funded by the NSW Ministry of Health. The National Centre for Immunisation Research and Surveillance is supported by the Australian Department of Health, the NSW Ministry of Health, and the Children’s Hospital at Westmead. Heather Gidding and John Kaldor are supported by National Health and Medical Research Council fellowships. Australian governments fund Australian Red Cross Lifeblood to provide blood, blood products and services to the Australian community.

We thank everyone who contributed to this investigation, especially the laboratory staff who collected the specimens and the scientific staff who performed the IFA and neutralisation assays, including Katherine Tudo, Melanie Lograsso and Bassam Al Zahroon (NSW Health Pathology–Institute of Clinical Pathology and Medical Research); Andrew Cullen, Ian Chambers, Annabelle Farnsworth, Karen Wagner and Daniel Clifford (Douglass Hanly Moir Pathology); Agustin Franco, Pratibha James and Michael Mark (4Cyte Pathology); Juliette Holland and Kartik Naidu (Laverty Pathology); Rebecca Burrell, Philip Britton and Alex Micati (Children’s Hospital at Westmead); Elizabeth Knight (Australian Red Cross Lifeblood); and Darren Croese (NSW Health Pathology incident management team). We are grateful to Lucy Armstrong (National Centre for Immunisation Research and Surveillance) for her help with coordinating the study; Heather Whitaker and Nick Andrews (Public Health England) for their statistical advice and sharing their analysis code; James McCaw and Jodie McVernon (Peter Doherty Institute) for their advice on the initial study design; and Michelle Cretikos, Roy Byun, Sheena Adamson and Laura Collie (NSW Ministry of Health) for their helpful advice.

Competing interests:

No relevant disclosures.

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Preventing suicide by young people requires integrative strategies

Michael J Dudley and Ping-I Lin
Med J Aust 2021; 214 (3): . || doi: 10.5694/mja2.50939
Published online: 15 February 2021
Correction(s) for this article: Erratum | Published online: 5 April 2021

We need more robust strategies with targeted, customised approaches, and funding for evidence‐based interventions

Suicide is the leading cause of death of young people in Australia,1 despite extensive research into risk factors for self‐harm. In this issue of the MJA, Hill and colleagues2 report their analysis of National Coronial Information System (NCIS) data for the 3365 young people (10–24 years old) who died by suicide in Australia during 2006–2015. Most were boys or young men (74%); many had diagnosed or possible mental health problems (57%), but fewer than one in three had been in contact with mental health services. A large proportion (38%) were not employed or in education or training at the time of their deaths; 14% were Indigenous Australians, 8% resided in remote locations, and 38% lived in the socio‐economically most disadvantaged regions of Australia.2 Although Hill and her co‐authors could not assess causal relationships between these factors and suicide, their statistics suggest potential targets for focused prevention.


  • 1 Adolescent Service, Prince of Wales and Sydney Children's Hospitals, Sydney, NSW
  • 2 University of New South Wales, Sydney, NSW
  • 3 South Western Sydney Local Health District, Sydney, NSW


Correspondence: m.dudley@unsw.edu.au

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No relevant disclosures.

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