Proceedings of the Waikato Clinical Campus Biannual Research Seminar, Wednesday 4 March 2026

EVERYTHING EVERYWHERE ALL AT ONCE: DEVELOPING A SPATIAL ACCESSIBILITY MATRIX FOR NON-SPECIALIST GEOSPATIAL DATA USERS

Jesse Whitehead,¹ Sam Quinsey,² Mitchell Pincham,¹ Talis Liepins,^3,4 Rory Miller,^3,4

Jason Gurney,⁴ Anna Davies,⁴ James Stanley,⁴ Stefan Heinz,⁵ Mariana Hudson,⁶ Emily Gill,⁶ Vincent Versace,² Marcus Blake²

¹Te Ngira Institute for Population Research, University of Waikato, New Zealand

²Centre for Australian Research into Access, Deakin Rural Health, Australia

³Health New Zealand – Te Whatu Ora, New Zealand

⁴University of Otago, New Zealand

⁵Te Wānanga Waiora Division of Health, University of Waikato, New Zealand

⁶The University of Auckland, New Zealand

AIMS

To address persistent inequities in access to health services in Aotearoa New Zealand, particularly for Māori, Pacific and rural populations, this study aimed to develop a national suite of spatial accessibility matrices designed for non-specialist users. The goal was to provide flexible, high-resolution travel-time and distance datasets that enable equitable, spatially informed health-service planning.

METHOD

Using address-weighted centroids for meshblock, SA1, SA2 and domicile code geographies, shortest-path drive times and distances were estimated to general practitioner (GP), pharmacy, hospital and cancer-treatment facilities. Seventeen national travel-time and distance matrices were produced. Validation against 17,000 Google Maps Distance Matrix API samples assessed correlation between estimated and reference travel times and distances.

RESULTS

All 17 matrices were successfully generated and demonstrated very high validity. Pearson correlation coefficient with Google Maps estimates were extremely strong and statistically significant (p<0.001), with all travel-time correlations >0.9. The “weakest” correlation (r=0.876) was for SA2-to-pharmacy distances. Four use cases for these matrices were tested: 1) dynamic health facility travel time isochrone maps; 2) access to computed tomography (CT) scanners in Te Manawa Taki and Southern regions; 3) travel to treatment for cardiovascular disease (CVD) patients enrolled with a primary health organisation and 4) cancer treatment pathways.

CONCLUSIONS

This work provides the first comprehensive, publicly available suite of national health-service accessibility matrices for New Zealand. The datasets enable rapid scenario testing and equity-focussed analysis without specialised Geographic Information Systems (GIS) expertise, supporting improved spatially informed decision-making across the health.

CLASSIFYING GASTRIC NEUROENDOCRINE NEOPLASMS: POTENTIAL FOR A PROTON PUMP INHIBITOR–ASSOCIATED SUBTYPE

Rihoko Suzuki,¹ Jerry Chin,² Emily Carr-Boyd,³ Ben Lawrence,^4,5 Peter Johnston,⁶ Marianne Elston,^7,8 Veronica Boyle^4,7,8

¹The University of Auckland, New Zealand

²Department of Gastroenterology, Health New Zealand – Te Whatu Ora Waikato, New Zealand

³Department of Pathology, Health New Zealand – Te Whatu Ora Te Toka Tumai Auckland, New Zealand

⁴Department of Oncology, Te Pūriri o te Ora, Health New Zealand – Te Whatu Ora Te Toka Tumai Auckland, New Zealand

⁵Department of Oncology, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand

⁶Department of General Surgery, Health New Zealand – Te Whatu Ora Te Toka Tumai Auckland, New Zealand

⁷Department of Endocrinology, Health New Zealand – Te Whatu Ora Waikato, New Zealand

⁸Waikato Clinical School and School of Medicine, The University of Auckland, New Zealand

INTRODUCTION

Gastric neuroendocrine neoplasms (gNENs) are classified by aetiology as type 1, 2 or 3 gastric neuroendocrine tumour (gNET) or gastric neuroendocrine carcinoma (gNEC). Recommendations for management depend upon classification. A new subtype associated with prolonged protein pump inhibitor (PPI) use is increasingly recognised. This study aims to classify gNENs presented at the national Neuroendocrine Tumour Multi-Disciplinary Meeting (NETMDM) to assess how often adequate information is provided to determine classification and how frequently gNENs appear to be associated with PPI use.

METHODS

We retrospectively analysed gNEN cases presented to the NETMDM between July 2017 and December 2024. gNENs were classified by type. Histological evidence of background mucosal changes suggestive of PPI effect, along with a medication prescribing history of PPI use exceeding 1 year, were used to determine how many cases classified as type 3 or unclassified may have been PPI–associated. This study was approved by the Southern Health and Disciplinary Ethics Committee (2024/FULL/21218).

RESULTS

Fifty-five patients were identified as having a gNEN. Sixteen were classified as type 1 gNET, one as type 2, 12 as type 3, and four as gNECs. Twenty-two were unclassified due to insufficient information. Fourteen patients were identified as having possible PPI–associated gNETs; of these, median Ki-67 was 6.5% (range 1–37), and three patients had metastatic disease. Thirty-two patients had either no serum gastrin test done or were tested while on PPI (or unknown PPI status).

CONCLUSIONS

Ki-67% and rate of metastasis were similar between type 3 gNETs with low or no history of PPI use and those with greater than 1 year of PPI use. All classifications were predominantly indolent. This study highlights the need to improve gastrin testing (off PPI), assessment of background mucosal histology and documentation of PPI use for accurate gNET classification. Future audits should focus on the rate of classification and long-term outcomes of more conservative management.

EVALUATING THE TOLERABILITY, TOXICITY AND EFFICACY OF CONCURRENT DOCETAXEL CHEMOTHERAPY AND RADIATION IN PATIENTS WITH OROPHARYNGEAL SQUAMOUS CELL CARCINOMA

Nicola Andrzejowska,¹ Marina Izman,² Michael B Jameson^2,3

¹School of Medicine and Population Health, University of Sheffield, United Kingdom

²Oncology Department, Waikato Hospital, Hamilton, New Zealand

³Waikato Clinical Campus, Faculty of Medical and Health Sciences, The University of Auckland, Hamilton, New Zealand

BACKGROUND

Concurrent cisplatin and radiation is used for many cancers. For cisplatin-ineligible patients (e.g., due to renal function or hearing loss), docetaxel is an alternative, though can cause severe toxicity.

METHODS

A retrospective study of the tolerability, toxicity and efficacy of concurrent weekly docetaxel and radiotherapy for oropharyngeal squamous cell carcinoma given between 19 January 2023 and 28 August 2025.

RESULTS

Fourteen patients received this regimen (due to hearing impairment), median age 67 years, 13 male, 10 NZ European, two Māori and 11 stages I-II. Mean (SD) docetaxel doses given was 5.71 (1.44), 83.3% of intended; six patients (42.9%) received all doses. Reasons for missed doses: infection (n=4); aspiration pneumonia; mucositis; weight loss and patient decision (one each). Two single-day radiation breaks occurred; 13 patients (92.9%) received the intended dose. All patients developed oral mucositis (eight grade 2, four grade 3), and 13 developed radiation dermatitis (seven grade 2, five grade 3). Toxicities persisted at 4 weeks (seven mucositis, three dermatitis) and 3 months (three mucositis). Seven patients required eight admissions (due to infection, aspiration pneumonia, mucositis or adjustment disorder), for mean (range) 3.5 (2–20) days. At median follow-up of 21 months, eight of 13 (61.2%) evaluable patients achieved complete metabolic and anatomical response on PET-CT; none relapsed. One of two patients with complete-metabolic but partial-anatomical response relapsed and died of metastatic disease. Two patients with incomplete metabolic and anatomical response had residual disease on neck dissection, without subsequent relapse. One patient died of refractory disease.

CONCLUSIONS

Docetaxel did not compromise radiation delivery, but 50% of patients required admission and late mucosal toxicity was concerning. Eleven of 13 evaluable patients achieved remission, three of whom required surgery.

EXAMINING REPRODUCTIVE HEALTH PATTERNS AMONG WOMEN WITH SYSTEMIC LUPUS ERYTHEMATOSUS IN AOTEAROA NEW ZEALAND

Zhaochu Geng,¹ Douglas White,² Ross Lawrenson,³ Chunhuan Lao⁴

¹Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand

²Rheumatology Department, Waikato Hospital, Hamilton, New Zealand

³School of Medicine, The University of Waikato, Hamilton, New Zealand

⁴School of Health Equity and Innovation, The University of Waikato, Hamilton, New Zealand

BACKGROUND

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects women of reproductive age and is associated with increased maternal and neonatal morbidity. While international studies have described adverse pregnancy outcomes in women with SLE, contemporary population-based data from New Zealand remain limited. This study describes pregnancy and delivery outcomes among women with SLE at a national level and examines how these outcomes differ from those of the general obstetric population.

METHODS

A retrospective population-based cohort study was conducted using routinely collected national health datasets. Women aged 18–45 years with SLE were identified using diagnostic coding and linked to pregnancy records in 2005–2022. Maternal, obstetric and neonatal outcomes were examined. Multivariate analyses were undertaken between pregnancies before and after SLE diagnosis, with adjustment for key demographic and clinical characteristics.

RESULTS

Among 1,532 women with SLE, 675 (44.1%) experienced at least one pregnancy. Among these women, two-thirds of pregnancies did not progress to delivery, and one-fifth of deliveries were preterm. The pregnancy and delivery outcomes of women with SLE were substantially worse than the general obstetric population. Although worse pregnancy and delivery outcomes were observed in Māori and Pacific women, these differences were attenuated after adjustment for age and socio-economic deprivation.

CONCLUSIONS

SLE is associated with increased pregnancy risk and higher healthcare utilisation compared with the general obstetric population. Improved understanding of these patterns has important implications for antenatal risk stratification, multidisciplinary care and patient counselling for women with SLE.

Compliance with ethical standards: Ethics approval for the study was granted through the Northern B Health and Disability Ethics Committee (reference: 2022 EXP 13741).

Funding: This study is funded by The University of Waikato (summer research academic project).

Competing interests: No conflict of interests have been declared by the authors.

Authors contributions: All authors whose names appear on the submission: 1) made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data 2) drafted the work or revised it critically for important intellectual content; 3) approved the version to be published; and 4) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Acknowledgement: We would like to acknowledge The University of Waikato for the financial support and Manatū Hauora – Ministry of Health for providing the detailed data.

MDMA-ASSISTED THERAPY IN PALLIATIVE CARE: PROMISE AND PROBLEMS

David Menkes,¹ Chiranth Bhagavan,² Paul Glue³

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

²Department of Psychiatry, University of Melbourne, Austin Health, Australia

³University of Otago, New Zealand

AIM

To review progress in the EMMAC study,¹ our Auckland and Otago-based randomized trial of MDMA-assisted therapy (MDMA-AT) in stage IV cancer.

METHOD

We consider the pharmacological rationale for using MDMA in this setting,^1,2 review the legal and logistical challenges of planning and conducting this trial in New Zealand, and provide a clinical overview of cases to date.

RESULTS

Despite significant delays in launching the trial, unblinded results thus far have been encouraging, both in terms of validating the rationale for the study (identifying and addressing unmet need with a novel treatment) and in demonstrating extraordinary results from the intervention.

CONCLUSION

Conventional palliative care exemplifies an ethical and humane approach to assisting people at the end of life. Nonetheless, unresolved psychiatric symptoms and existential distress prompt many to consider a medically assisted death (3). Our preliminary results, together with those of others (4), suggest that MDMA-AT may offer an effective alternative for patients (and their families) struggling with these issues.

REFERENCES

1.      Bhagavan C, Glue P, Evans W, et al. Effect of MDMA-assisted therapy on mood and anxiety symptoms in advanced-stage cancer (EMMAC): study protocol for a double-blind, randomised controlled trial. Trials. 2024 May 21;25(1):336. doi: 10.1186/s13063-024-08174-x.

2.      Nutt DJ, de Wit H. Putting the MD back into MDMA. Nat Med. 2021 Jun;27(6):950-951. doi: 10.1038/s41591-021-01385-8.

3.      Menkes DB. Psychedelic and related medicines at the end of life. N Z Med J. 2021 Dec 17;134(1547):132-133.

4.      Wolfson PE, Andries J, Feduccia AA, et al. MDMA-assisted psychotherapy for treatment of anxiety and other psychological distress related to life-threatening illnesses: a randomized pilot study. Sci Rep. 2020 Nov 24;10(1):20442. doi: 10.1038/s41598-020-75706-1.