Cancer in Primary Care | Professor Jon Emery

The SCRIPT trial (Snp Cancer Risk Prediction Trial) is the world’s first randomised controlled trial (RCT) to test the implementation of a novel polygenic risk score to tailor colorectal cancer screening in primary care. It seeks to address several key implementation challenges of precision cancer screening.

Intervention in the SCRIPT trial includes a DNA test which provides personal risk of bowel cancer, along with recommendations for what type of bowel cancer screening is best for them. It measures if this personalised risk information and screening recommendation helps participants make better decisions about the most suitable form of bowel cancer screening for them.

Increasing participation in the Australian National Bowel Cancer Screening Program (NBCSP) is the most efficient and cost-effective way of reducing mortality associated with colorectal cancer by detecting and treating early-stage disease.

The SMARTscreen trial tested whether an SMS intervention is an effective method for increasing participation in the NBCSP. The SMS included an endorsement from the patient’s general practice, a positive narrative video about bowel cancer screening and an animated video describing how to do the screening test.

It demonstrated an absolute increase in uptake of 16.5 per cent for people sent an SMS with motivational and instructional videos from their general practice prior to receiving their at-home NBCSP kit, compared to those receiving usual care.

Building on the strengths of the SMARTscreen trial and addressing limitations, the 'SMARTERscreen' trial tests the effect on participation in the NBCSP of sending either an SMS only or an SMS with online video material to general practice patients due to receive their NBCSP.

The IC3 trial is a randomised control trial aiming to improve early diagnosis and patient health outcomes in liver cancer.

Undetected liver disease can lead to liver scarring (called cirrhosis). Cirrhosis is a major risk factor for liver cancer, which, although rare, is increasing globally including in Australia, and has low survival rates.

This trial, co-led by Professor Jon Emery and Professor Leon Adams at the University of Western Australia, is an Australia-wide multi-centre randomised controlled trial of 2,804 adults aged 45-75 years with risk factor(s) for chronic liver disease, testing blood biomarkers for liver fibrosis and a pathway to identify patients requiring surveillance for liver cancer .

Chronic liver disease is common with 1 in 4 Australians having fatty liver. Those living with advanced liver fibrosis are at greatest risk of developing hepatocellular carcinoma (HCC) and liver failure, which are both increasing in Australia. Data shows that up to 66% of cirrhosis cases are unrecognised in primary care. Complications of chronic liver disease including HCC and liver failure, are responsible for an increasing number of deaths in Australia.

A multidisciplinary research team of researchers led by Professor Leon Adams (University of Western Australia) and our own leading GP researcher Professor Jon Emery (Department of General Practice and Primary Care, University of Melbourne), will lead IDEAL Care, an innovative trial in partnership with urban and rural general practices across Western Australia and Victoria to test the real-world effectiveness of an integrated general practice-based diagnostic pathway to detect advanced liver fibrosis in the community.

Outcomes from this study will provide the evidence to introduce clinical pathways to identify at-risk patients who may benefit from specialist review and avoid needless referral for those not at risk. As the intervention is designed to consist of current and available technologies incorporated into existing software platforms, the research team anticipate that the implementation of findings will be rapid.

The CASSOWARY (CAncer genomic riSk ScOres in primARY Care) trial is exploring whether a new DNA test collected via a saliva swab at a GP clinic could be a cost-effective and efficient way to identify a person’s cancer risk.

It is a multi-site study led by Professor Emery in partnership with Queen Mary University of London, Royal Melbourne Hospital, Royal Marsden NHS Foundation Trust and the Daffodil Centre, using genomics-based tests developed by Genetic Technologies Limited.

The study will recruit almost 600 people from eight general practice sites across Victoria to assess the viability of using DNA testing to screen for risk for four common cancers — breast, colorectal, prostate and melanoma. During the four-year trial, participants will be followed up for one year to see what screening tests they do and then they will be followed up later to look at their long-term screening behaviour.

This program was $2.4 million from the Medical Research Future Fund (MRFF) in 2023.

The Cancer in Primary Care group is linking primary care data to hospital and clinical cancer registries to study how patterns of care impact patient outcomes, as part of a Victorian Comprehensive Cancer Centre (VCCC) Alliance research program.

Data Connect provides expert support to researchers, allowing them to access multiple linked data sets. These can be studied to answer key questions about cancer diagnosis and care to benefit people affected by cancer in the future. It is a major collaboration between the VCCC Alliance, the University of Melbourne, hospitals and BioGrid Australia, that has enabled the linking of primary care and hospital data for the first time in Australia.