Medicine (RMH) - Theses
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ItemThe effect of patient factors and clinician choices on management of colorectal cancer and other malignancies( 2011)Cancer is one of the leading causes of morbidity and mortality world-wide, and colorectal cancer is one of the most common malignancies in the developed world. Being able to predict the most appropriate strategies for diagnosis, treatment and monitoring for any malignancy, both in the adjuvant and metastatic disease settings, is crucial as more management options come into play. In particular, the choices surrounding chemotherapy dosing can depend on many factors, and increasing interest is developing regarding optimization and individualization of treatment strategies for cancer based on these factors. Modern oncology is currently focused on biomarker-based research and translation to care. Although this thesis does not incorporate any pre-clinical biomarker-based research, patient variables (such as age and comorbidities) can be regarded as a type of clinical ‘biomarker’ – for example, age is a very strong prognostic factor for a number of malignancies, perhaps even more important than particular laboratory-based biomarkers in many circumstances. This research will focus on key aspects of patient care, from surgery to chemotherapy, radiation therapy and disease monitoring, which may be potentially regarded as ‘biomarkers’ - stratifying patients into those who may benefit the most, and least, from various treatment modalities and strategies. This body of work focuses primarily on colorectal cancer. The thesis provides a comprehensive ‘snapshot’ of current management strategies in Australia for colorectal cancer – from diagnosis through to surgical and oncological management – and each paper compares the findings with what is currently regarded as ‘gold-standard’ practice. It is well known that patients on clinical trials are mostly younger and fitter than those seen in routine practice, and treating physicians cannot always apply the findings from randomized controlled studies to the individual cancer patient. It is useful to understand in parallel with the evidence gained from clinical trials, its applicability and modifications employed in routine practice and as such, this research has been largely conducted using a prospectively collected comprehensive cancer database; together with surveys of Australian oncologists and review of available literature. Many issues requiring treatment decisions for colorectal cancer are also applicable to many malignancies, and the thesis also includes some papers which relate to cancer management in general – in particular, the impact of patient age and comorbidity on treatment decisions, and the effect of liver dysfunction on chemotherapy choices for cancer patients.