Proceedings of the Waikato Clinical Campus Research Seminar, Thursday 11 September 2025

BOWELING OVER BOWEL CANCER BY EARLY DETECTION, AN AUDIT OF THE NATIONAL BOWEL SCREENING PROGRAM IN THE WAIKATO REGION

Printha Ramachandran,¹ Dushyanti Samarasinghe¹

¹Histopathology Department, Waikato Hospital, Hamilton, New Zealand

BACKGROUND

New Zealand has one of the highest incidence of bowel cancers globally.¹ Hence a national bowel screening program was implemented for 60–74 year olds in 2017, and Waikato DHB was inducted in March 2021.² Since December 2023 Waikato lowered its age for Māori/Pacific people to start screening from the age of 50, as a higher proportion of bowel cancer occurs in Māori and Pacific people before reaching 60.²

AIM

To analyse the effectiveness of the bowel screening program, and its implication for Māori/Pacific people.

METHOD

Retrospective chart audit of polyps removed following positive faecal immunochemical test (FIT), with subgroup analysis of high grade dysplasia (HGD), adenocarcinomas and adenocarcinomas arising from polyps.

RESULTS

From March 2021 to June 2025, FIT positive patients were scoped and 11,407 polyps/masses were sampled.

Of these, 273 (2.39%) showed high grade dysplasia, and 211 (1.85%) were adenocarcinoma of which 60 (28%) arose from polyps.

HGD and adenocarcinoma diagnoses (154) from December 2023 to June 2025 comprised 39 (25%) Māori and 18 (46%) of these were in the 50–59 age group.

CONCLUSION

A significant proportion of early colorectal cancer is detected in Māori by commencing screening at age 50. This justifies the need to implement this screening strategy nationwide to achieve early detection for this high risk group.

REFERENCES

1.      Bowel Cancer New Zealand. About bowel cancer: Symptoms & statistics [Internet]. 2023 [cited 2024 Aug 15]. Available from: https://bowelcancernz.org.nz/about-bowel-cancer/what-is-bowel-cancer/symptoms-statistics/

2.      Health New Zealand – Te Whatu Ora. Bowel screening for Maori and Pacific people [Internet]. 2024 [cited 2024 Aug 15]. Available from: https://info.health.nz/keeping-healthy/cancer-screening/bowel-screening/maori-and-pacific-screening

PHASE 1B DOSE-ESCALATION TRIAL OF SELENIUM COMPOUNDS IN CANCER PATIENTS

Catherine Turnbull,¹ Stephen Evans,² Linda Peters,³ Renee Goodall,³ Craig Burns,³ Hugh Goodman,⁴ Michael Jameson^1,5

¹Waikato Clinical Campus, The University of Auckland, Hamilton, New Zealand

²School of Pharmacy, University of Waikato, Hamilton, New Zealand

³School of Science, University of Waikato, Hamilton, New Zealand

⁴Department of Haematology, Waikato Hospital, Hamilton, New Zealand

⁵Department of Oncology, Waikato Hospital, Hamilton, New Zealand

AIMS
Selenium (Se) compounds have shown therapeutic synergy with anticancer treatments (including radiotherapy and chemotherapy) while reducing off-target toxicities in experimental models. This trial aimed to evaluate safety and pharmacokinetic–pharmacodynamic (PK–PD) relationships of three Se compounds in cancer patients, to inform optimal compound selection and dosing for future clinical trials.

STUDY METHODS

This double-blinded, intra-subject dose-escalation trial enrolled nine patients with metastatic cancer not currently receiving cytotoxic treatment. Patients were randomised to receive one of three Se compounds orally: Se-methylselenocysteine, L-selenomethionine or sodium selenite, dosed at 1,600µg of elemental Se/day for 4 weeks followed by 6,400µg/day for 4 weeks. An earlier 400µg/day dose cohort has been reported previously. Safety, PK and PD parameters were assessed at baseline, after each dose period, and 1 month post-dosing. PD investigations in peripheral blood mononuclear cells focused on ER stress, angiogenesis, plasma antioxidant activity, DNA damage and repair, methylation and gene expression pathways.

RESULTS

All three selenium compounds were well tolerated, with no treatment-related toxicities exceeding grade 2. Pharmacokinetic analyses indicated that L-selenomethionine produced the greatest increases in plasma selenium concentrations at both dose levels. Nuclear DNA (nDNA) and mitochondrial DNA (mtDNA) damage demonstrated variability without consistent trends. Analyses of ER stress and angiogenesis by Western blot, as well as intracellular glutathione assays, are ongoing.

CONCLUSIONS
All three Se compounds were well tolerated at 1,600 and 6,400µg/day. L-selenomethionine accumulated most strongly in plasma, but there was no evidence of significant genotoxicity. These findings will contribute to an understanding of the safety and PK–PD relationships of Se compounds, supporting rational selection of agents for future clinical trials in combination with cancer therapies.

WHIRI WĀHINE HAPŪ: A HOLISTIC, CULTURALLY SAFE MODEL ENHANCING CARE FOR PREGNANT MĀORI WOMEN

Amy Jones,¹ Ross Lawrenson² (principal investigator), Nina Scott,¹ Lynley Uerata,² Polly Atatoa-Carr,^1,4 Jade Tamatea,^1,3 Lynne Chepulis,² Nikki Barrett,⁴ Tina Baty¹

¹Health New Zealand – Te Whatu Ora

²Division of Health, University of Waikato, Hamilton, New Zealand

³Te Kupenga Hauora Māori, The University of Auckland, Hamilton, New Zealand

⁴Te Ngira Institute for Population Research, University of Waikato, Hamilton, New Zealand

INTRODUCTION

Midwife shortages and the complexity of navigating maternity services has contributed toward stark and significant health inequities in birth and maternal outcomes for Māori wāhine hapū/pregnant women. Compared to non-Māori, wāhine hapū have poorer access to lead maternity carers and young wāhine hapū report many systemic barriers from their first health contact. Wāhine hapū are at increased risk of adverse mental health outcomes, and maternal experiences of discrimination are associated with lower birth weight and shorter gestation length. We aimed to explore wellbeing needs of pregnant Māori women, then codesign and test a wellbeing assessment and clinical support to enhance wellbeing.

METHODOLOGY AND METHODS

Using Kaupapa Māori theory, the He Pikinga Waiora framework and a mixed method approach, our team codesigned, piloted and evaluated a Whiri model of care for wāhine hapū. This was codesigned with >100 stakeholders including whānau/family, community, researchers and healthcare providers in the Waikato region. The Whiri model of care is structured around navigators and a holistic wellbeing assessment that identifies unmet needs and has support referral pathways, and links to a multidisciplinary, nurse-led clinical team to address clinical need. Overseen by Indigenous clinical governance, the model of care was piloted with wāhine hapū in the Waikato region.

OUTCOMES

Codesign stakeholders identified four health domains in Te Whare Tapa Whā as an important approach for the Whiri model of care, adding the importance of Te Ao Māori (Māori worldview) and Kaupapa Māori. We recruited 31 wāhine hapū participants (aged 16–44 years, Ɱ=29, 15 urban/14 rural) into the pilot, between August 2023 and June 2024. Significant need (345 unmet needs; 11/wāhine) was identified and supported by the navigator and nurse. The most common unmet needs supported: mental health support (21; 75%), social support, referrals to healthy home, information on the National Travel Assistance scheme and food nutrition and access to more kai/food for the whānau. Over half (19; 61%) were referred to the Whiri nurse for clinical support for a variety of health concerns: mental health support, diet and nutrition information, pregnancy or medication advice or support for gestational diabetes. When asked in a phone survey, wāhine valued the reassurance and advice the nurse provided.

CONCLUSIONS

Significant social and clinical unmet needs were identified and supported using the Whiri approach. Engagement with maternity service end-users is essential to understand the wellbeing needs of wāhine hapū, providing valuable insight to inform health policy and practice.

A SURVEY EVALUATING THE ATTITUDES OF CANCER PATIENTS IN AOTEAROA NEW ZEALAND TO FAECAL MICROBIOTA TRANSFER

Ankita Aneesh,¹ George Laking,² Laird Cameron,² Justin O’Sullivan,³ Nicky Lawrence,² Wayne Cutfield,³ Michael B Jameson¹

¹Waikato Clinical Campus, The University of Auckland, Hamilton, New Zealand

²Department of Oncology, The University of Auckland, Auckland, New Zealand

³ Liggins Institute, The University of Auckland, Auckland, New Zealand

AIM

Faecal microbiota transfer (FMT), also known as gut microbiome transfer, is intended to favourably change the gut microbiome in patients with various health disorders. Early studies in cancer patients suggest that FMT might improve efficacy of treatment and reduce some toxicities, but little is known about the patients’ perspectives. The primary aim of this study of patients with cancer was to describe their awareness of, and potential willingness to undergo, FMT in conjunction with cancer therapies. Secondary aims were to evaluate differences in responses according to patient demographic, cancer type and treatment, and to compare the characteristics of participants versus non-participants in the survey.

METHOD

This study was conducted through online surveys accessed by posters displayed at oncology treatment facilities. Patients were questioned about awareness of FMT, willingness to undergo FMT, attitudes to FMT administration method and donor preferences.

RESULTS

Thirty-four surveys were submitted from participants in Auckland (n=19) and Waikato (n=15). Twenty-one participants (62%) were female, 27 (79%) were >45 years old and 26 (76%) had a post-secondary educational qualification. Self-reported ethnicity was 27 (79%) NZ European, three (9%) Māori, one (3%) Pacific people and three (9%) other participants. The most common cancers were bowel and breast, each with eight participants (24%). Seventeen (50%) of survey participants had heard of a “microbiome transfer”, of whom 14 (82%) reported knowing “a little” about FMT. Overall 97% of survey respondents were receptive to having a microbiome transfer if it was proven effective, 14/21 (67%) preferred FMT via oral capsules and 28/33 (85%) had no preference for donor characteristics. Of 317 potentially eligible Chemotherapy Daystay attendees at Waikato Hospital during the survey period, 15 (4.7%) participated in the survey; two of 26 (7.7%) Māori participated. Patient characteristics were similar in those who did and did not participate in the survey.

CONCLUSION

This study indicates that many cancer patients in Aotearoa New Zealand would be willing to undergo FMT for treatment benefit. Our study was limited by the low number of survey responses, indicating the importance of addressing recruitment strategies in future intervention clinical trials.

ACCURACY AND PRECISION OF THE CLEARSIGHT™ NON-INVASIVE MONITORING DEVICE IN THE NEW ZEALAND POPULATION UNDERGOING TRANSCATHETER AORTIC VALVE INTERVENTION

James Kennedy,¹ Pranesh Jogia,^1,2 Martin Stiles^1,3

¹Department of Cardiology, Waikato Hospital, Hamilton, New Zealand

²Department of Intensive Care Medicine, Waikato Hospital, Hamilton, New Zealand

³Waikato Clinical Campus, The University of Auckland, Hamilton, New Zealand

BACKGROUND

Transcatheter aortic valve implantation (TAVI) is a rapidly expanding treatment for severe aortic stenosis (AS), the most common valvular pathology in the ageing population. Accurate, continuous haemodynamic monitoring is crucial during TAVI to guide decision-making and ensure patient safety. Invasive arterial pressure monitoring is the gold standard but carries risks of complications. The ClearSight™ (CS) device (Edwards Lifesciences, Irvine, CA) offers a non-invasive alternative based on the volume clamp method, but its accuracy in the TAVI setting remains uncertain, with mixed results in prior studies. No published data exists in the New Zealand population. This study evaluated the clinical equivalence of CS compared with invasive arterial monitoring in patients undergoing TAVI for true severe native valve AS. The primary hypothesis was that CS provides accurate and precise alternatives to invasive measurements.

METHOD

This single-centre, prospective observational study was conducted at Health New Zealand – Te Whatu Ora Waikato, enrolling 25 consecutive patients with severe high-gradient AS undergoing elective TAVI between March and June 2023. Patients with low-flow, low-gradient AS or valve-in-valve procedures were excluded. Simultaneous blood pressure measurements were obtained from CS and invasive monitoring via femoral arterial sheath or pigtail catheter. CS was applied using a finger cuff and HemoSphere™ monitor. Measurements of systolic (sBP), diastolic (dBP) and mean arterial pressure (MAP) were recorded at 20-second intervals. Statistical analysis included Bland–Altman and error grid assessments. Clinical equivalence was defined as a bias of ±5mmHg and percentage error ≤30%. Error grid thresholds were: zone A >90%, zones B and C <5%, zone D <4% and zone E <2%.

RESULTS

A total of 4,063 paired measurements were analysed. The mean age was 80.2 years, with near-equal sex distribution. Most participants were New Zealand European, with one Māori patient. CS showed poor correlation with invasive sBP and dBP, with Bland–Altman biases of −7.98mmHg and −5.34mmHg, and percentage errors of 39% and 37%, respectively. MAP correlation was considered equivalent, with a bias of −1.74mmHg and a percentage error of 28.8%, meeting equivalence criteria. Error grid analysis showed 71.1% of MAP points in zone A, 25% in zone B and 3% in zone C. In hypotension (MAP ≤65mmHg), CS overestimated MAP with large negative biases and unacceptable error grid performance.

CONCLUSION

CS demonstrated acceptable accuracy for MAP but not for sBP or dBP in New Zealand TAVI patients. Overestimation of MAP during hypotension is a key limitation with potential clinical risk. CS may serve as a non-invasive alternative for MAP monitoring, but reliance on systolic or diastolic readings is discouraged. Further investigation is required in physiological hypotension and additional derived haemodynamic parameters provided by this device.