Deep brain stimulation for depression, melanoma controversy, early-onset Parkinson's and the joy and fear of donating blood

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Health Report 28 min 4 speakers 3 chapters transcribed 3 days ago

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What is the overall focus of today’s Health Report episode?

Claire Watson 0:01

This is an ABC podcast.

Dr. Norman Swan 0:05

Hello and welcome to this week's Health Report with me, Norman Swan. Today, the role of emotion in getting people to donate their blood on a regular basis. Deep brain stimulation for depression. Could an electrode work when medications fail? And we'll hear from someone who has an electrode in his brain. But we're going to start with the controversy that's been brewing for a while, but broke in the Sydney Morning Herald and The Age last week. It's about melanoma, the deadliest form of skin cancer, the one you don't want to miss because when it's diagnosed late, it may have already spread. The allegation in this story last week was that around the retraction of two papers written by a Melbourne-based GP who specialises in skin cancer and has been teaching his fellow GPs that the way melanoma experts diagnose melanoma spread doesn't have the touted benefits, could do harm, and that ultrasound of the lymph nodes is the way to go.

Dr. Norman Swan 0:54

The retracted papers were in the Australian Journal of General Practice. The technique in question is called sentinel node biopsy. It's commonly used in breast cancer, where the lymph node in the groin or the armpit, which first receives the drainage from the leg or arm, is biopsied to see if there are melanoma cells in it. If there aren't, then it's unlikely there has been spread. Professor John Thompson is a leading melanoma surgeon and researcher and was one of the pioneers of sentinel node biopsy in melanoma. Welcome to The Health Report, John. Pleasure to be here, Norman. Does staging, in other words, finding out how far the melanoma has spread using central node biopsy, make a difference?

John Thompson 1:31

Absolutely. And that's the crux of the question, really. It's not just an academic exercise. This tells us whether there has been spread of melanoma to the lymph nodes. And if there has been, then the treatment is very different. And these days, we have available adjuvant drug therapy that is making a big difference to the outcome of patient survival.

Dr. Norman Swan 1:53

These are the new immunotherapy drugs?

John Thompson 1:54

The new immunotherapy drugs.

Dr. Norman Swan 1:55

We'll come back to that later. We've got some time. I was looking up some papers on this when I saw the article and looking at... what's called statistically the effect size on survival of central node biopsy. And some of the papers were saying it's not huge. I mean, and not papers by the person that the City Morning Herald was covering. How much of a difference does it make?

John Thompson 2:16

It's difficult to tell because it's very hard to assess in a prospective trial. There was a very large trial, the first trial that was ever done in central node biopsy called the first multicenter selective lymphonectomy trial. And the patients who were sentinel node positive, who had melanoma in their sentinel nodes, who had surgery and their sentinel node removed, did much, much better than the patients who subsequently became apparent with melanoma in their lymph nodes. But of course they weren't a pre-randomized group, so you can't statistically say. And there was a huge benefit in them, but not statistically proven.

Dr. Norman Swan 2:52

And if you didn't do a sentinel node biopsy, how would you stage the melanoma?

John Thompson 2:57

Or how did

Dr. Norman Swan 2:59

they do it before that came

John Thompson 3:00

along? Well, they weren't staged. The melanoma was widely excised and the lymph nodes were simply observed. And about 20% of patients would ultimately develop disease in their regional lymph nodes and then you would know that they had advanced disease. These papers that were retracted,

Dr. Norman Swan 3:17

they made a couple of allegations. One is that there were no valid guidelines, I think, on melanoma. And the second was that ultrasound was just as good, or words to those effect. Sure. That you would ultrasound the lymph nodes, and presumably if they were bulky and solid, then that

John Thompson 3:31

was a warning sign. Well, to deal with the first matter first, Cancer Council Australia has a very well-organized set of melanoma management guidelines that Evidence-based, it's all there on the Cancer Council website for anyone to look at, with the levels of evidence for every statement and recommendation that's made.