Published: 25 February, 2022
Contents
February was Ovarian Cancer Awareness Month
This month is Ovarian Cancer Awareness Month. Ovarian cancer is the leading cause of gynaecological cancer related deaths in New Zealand, and it is estimated that
one person dies of ovarian cancer every 48 hours in New Zealand.
Symptoms are often vague, non-specific and not gynaecological in nature which makes early detection challenging; approximately 85% of people are diagnosed with ovarian
cancer in the later stages of disease where treatment options are limited.
Early detection relies on recognising the significance of the symptoms and signs of ovarian cancer that patients present with as there is no screening test available.
Common symptoms include:
- Persistent abdominal distension or bloating
- Early satiety or loss of appetite
- Pelvic or abdominal pain with unknown cause
- Increased urinary frequency or urgency
- Irritable bowel symptoms, especially if new onset and aged > 50 years
- Unexplained weight loss or fatigue
Further information and resources on gynaecological cancers, is available from: Te Aho o Te Kahu – Cancer Control Agency.
Patient information is available from: Talk Peach Gynaecological Foundation,
Cure Our Ovarian Cancer and the New Zealand Gynaecological Cancer Foundation.
Later this year we will be publishing a series on gynaecological cancers, supported by Te Aho o Te Kahu – Cancer Control Agency, covering the early detection, follow-up and surveillance of cervical, ovarian, uterine, vaginal and vulval cancers.
Abortion telehealth service to launch this year
Associate Health Minister Dr Ayesha Verrall has announced a new national abortion telehealth service, Decide, that will be launched in three phases later this year. Information, advice and counselling will be available via a free dedicated number, 0800 DECIDE. The initiative will be jointly operated by Family Planning New Zealand and Magma Healthcare (The Woman’s Clinic) and funded by the Ministry of Health.
Read more
The Ministry of Health stresses that the telehealth service is not a replacement for in-person care but is intended to make it easier for individuals to access sexual health experts and abortion services. As abortion telehealth services are currently only offered by some District Health Boards, a free, 24/7 service will improve health equity across the country.
From 26 April, www.decide.org.nz will be live, offering referrals and information about abortion services. Counselling and follow-up care is expected to be available from 1 July and the full telemedicine service, including clinical consultations and access to couriered medicines is planned for November.
Medicines Monitoring Communications
Possible risk of vasculitis with vildagliptin products
Medsafe has issued a Monitoring Communication on the possible risk of vasculitis with the use of vildagliptin products (Galvus, Galvumet). Currently, vasculitis is not listed as a reaction on vildagliptin data sheets. Healthcare professionals and patients are encouraged to report any cases of vasculitis associated with vildagliptin use to the Centre for Adverse Reactions Monitoring (CARM).
Medsafe has previously cautioned prescribers to be aware of the potential increased risk of angioedema in patients who take vildagliptin and an ACE inhibitor. See Bulletin 20 for further information
For further information on the use of vildagliptin in patients with type 2 diabetes, see: https://bpac.org.nz/2021/diabetes-vildagliptin.aspx
Dihydrocodeine: review of risks and benefits
As reported in Bulletin 32, in August 2021, Medsafe sought a review into the risks and benefits of dihydrocodeine as part of an ongoing evaluation on the risks of opioid misuse and dependence. In February, 2022, Medsafe issued an update to the original communication following review by the Medicines Adverse Reaction Committee (MARC) in December, 2021. The Committee found insufficient evidence to recommend revoking consent of the approved dihydrocodeine products in New Zealand and recommended imposing two conditions on the use of these medicines.
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The MARC recommended that:
- The indications for use in New Zealand data sheets be aligned with the Australian class statements for modified release products
- [Product] is indicated for the management of severe pain where:
- Other treatment options have failed, are contraindicated, not tolerated or are otherwise inappropriate to provide sufficient management of pain, and
- The pain is opioid-responsive, and
- Requires daily, continuous, long-term treatment
- [Product] is not indicated for use in chronic non-cancer pain other than in exceptional circumstances
- [Product] is not indicated as an as-needed (PRN) analgesia
- Sponsors supply a Consumers Medicines Information leaflet
Click here to read the full report.
Buccaline: review of the benefits and risks
Buccaline is a Pharmacist Only medicine indicated for oral antibacterial prophylaxis of complications of colds. Following a review by the Medicines Adverse Reactions Committee, on 18 January, 2022, Medsafe issued a notice to the sponsor to provide evidence of the efficacy and safety of Buccaline tablets.
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In December, 2021, the Medicines Adverse Reactions Committee (MARC) reviewed the available evidence for the efficacy and safety of Buccaline tablets. The Committee raised concerns about a lack of evidence of efficacy and considered the associated harms, including hypersensitivity reactions and the use of Buccaline as an alternative to receiving influenza vaccination. The MARC recommended that a review of the benefits and risks of Buccaline be conducted under section 36 of the Medicines Act, 1981.
Consultation on new warning and advisory statements for opioid medicines
Medsafe has issued a consultation proposing a new warning and advisory statement for opioid medicines. In June, 2021, the Medicines Adverse Reactions Committee recommended a warning and advisory statement be added for all opioid medicines following international and national concerns over opioid abuse, misuse and dependence.
Currently, codeine is the only opioid medicine that has a warning and advisory statement – "codeine is an addictive substance". Proposed warning and advisory statements for all opioid medicines include:
- [Name of opioid] is an addictive substance; or
- Use of this medicines has the risks of overdose and dependence; or
- Contains opioid
Read more about the proposal here, including how to submit a response.
For information on the role of opioids in pain management, see: https://bpac.org.nz/2018/opioids.aspx and https://bpac.org.nz/2018/opioids-chronic.aspx
Ethinyloestradiol 10 microgram tablets to be discontinued
PHARMAC has been advised by the supplier that ethinyloestradiol 10 microgram tablets indicated for post-menopausal symptoms including osteoporosis prophylaxis, will be discontinued with stock anticipated to run out mid-to-late 2022. Patients currently taking ethinyloestradiol need to be transitioned to a different treatment and no new patients should be started on ethinyloestradiol.
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- As of 1 March, 2022, ethinyloestradiol is only funded by endorsement for those who were taking ethinyloestradiol prior to March 1, 2022 (pharmacists can annotate the prescription as endorsed if there is record of prior dispensing)
- Stat dispensing of ethinyloestradiol will be removed from 1 March, 2022
- As of 1 February, 2023, ethinyloestradiol will be no longer funded
- Prescribers should start to transition patients who are currently taking ethinyloestradiol to an alternative funded oestrogen treatment, and ensure that no new patients are started on ethinyloestradiol from 1 March, 2022
For further information on available oestrogen treatment options and menopausal hormone therapy, see https://www.nzf.org.nz/nzf_3855 and https://bpac.org.nz/2019/mht.aspx
Paper of the Week: Clinician's opinions on HPV self-screening
After several years of consultation, it is now confirmed that from July, 2023, the primary test for cervical cancer screening will be human papillomavirus (HPV) testing. Testing can be carried out by the clinician or by the patient in private at the health clinic or at home (or another non-clinical location). If the patient tests positive for HPV, this is followed up by a speculum examination and cervical smear or in some cases direct referral for colposcopy. Routine cervical screening will occur every five years. The combination of HPV testing and follow-up is more effective at detecting cervical cancer than the current method and the new screening programme is expected to result in reduced rates of cervical cancer, while also addressing equity issues. Pilot programmes are now underway in some regions of New Zealand.
The move to HPV testing signifies a major shift in practice for many clinicians, and there will be varying degrees of confidence with this. HPV testing as the primary method of cervical screening began in 2017 in Australia. In Canada, cervical Pap smear is the primary screening method, but some provinces have recommended moving to HPV testing. In a recently published study, researchers surveyed primary care clinicians (doctors and nurses) and obstetrician-gynaecologists about their knowledge, acceptability and opinions on HPV self-screening. Overall, knowledge about self-screening was poor but it was generally acceptable if certain test conditions were met. There was concern about missed opportunities to examine the patient and address other health needs. The findings of the study make interesting reading for clinicians in New Zealand.
Read more
General background to the study:
- HPV infection is detected in 99.7% of cervical cancers
- HPV testing is more sensitive than Pap smear screening for detecting high-grade cervical abnormalities
- Most HPV infections are transient and self-resolve in younger people; US guidelines recommend screening with HPV testing begins at age 30 (screening currently starts at age 25 in New Zealand)
- Approximately 70% of eligible people in Canada currently undergo Pap screening; many of those who are not screened belong to groups such as LGBTQIA+, immigrants, indigenous peoples, older people or people of lower socioeconomic status
- HPV self-sampling is highly acceptable to eligible people
For this study, an anonymous online survey was distributed to doctors and nurse practitioners in the Department of Family and Community Medicine and the Department of Obstetrics and Gynaecology in Toronto, Ontario. Responses were received from 58 out of 188 eligible clinicians (41 general practitioners, 4 nurse practitioners and 13 OB-GYNs; 75% female).
- ~ 75% would recommend HPV self-sampling as an alternative to Pap testing if all test conditions were met
- Participants were more likely to offer it to women aged > 30 years than those aged < 30 years
- The highest level of support for HPV self-testing was for women who are survivors of abuse, under-screened or never screened people, trans men and post-menopausal women
- Important advantages included likely increased screening rates, decreased pain and embarrassment and time-saving for both clinicians and patients
- Important concerns included missed opportunities to address other health issues such as sexually transmitted infections and abnormal pathology, and failure of the patient to attend follow-up after a positive HPV result
Read the full paper here: Zelli J, Hum S, Lofters A, Dunn S. Clinician acceptability of self-collected human papillomavirus swabs as a primary cervical cancer screening method. Can Fam Physician 2022;68(2):e31-e38
This Bulletin is supported by the South Link Education Trust
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