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Index
SWSLHD CANCER EXECUTIVE DIRECTOR’S REPORT ............................................................................ 3
FACILITY REPORTS ............................................................................................................... 8
BANKSTOWN CANCER THERAPY CENTRE DIRECTOR’S REPORT ............................................................... 9 LIVERPOOL CANCER THERAPY CENTRE DIRECTOR’S REPORT ................................................................ 13 MACARTHUR CANCER THERAPY CENTRE DIRECTOR’S REPORT ............................................................. 19
SWSLHD CLINICAL CANCER SERVICES AND DEPARTMENTS ................................................. 22
SWSLHD CANCER GENETICS ....................................................................................................... 23 GYNAECOLOGIC ONCOLOGY ......................................................................................................... 25 MEDICAL ONCOLOGY LIVERPOOL .................................................................................................. 27 MEDICAL ONCOLOGY MACARTHUR ............................................................................................... 29 SWSLHD HAEMATOLOGY ........................................................................................................... 31 SWSLHD DERMATOLOGY ........................................................................................................... 33 SWSLHD PALLIATIVE CARE ......................................................................................................... 37 SWSLHD RADIATION ONCOLOGY ................................................................................................. 47 ‐MEDICAL PHYSICS ..................................................................................................................... 51 ‐RADIATION THERAPY ................................................................................................................. 53 SWSLHD CONSUMER PARTICIPATION COMMITTEE ......................................................................... 57 SWSLHD CANCER INFORMATION PROGRAM .................................................................................. 59 SWSLHD EDUCATION COMMITTEE ............................................................................................... 63 SWSLHD QUALITY COMMITTEE ................................................................................................... 68 SWSLHD AMBULATORY CANCER CARE ......................................................................................... 72 SWSLHD ALLIED HEALTH ........................................................................................................... 76 SWSLHD CANCER NURSING TEAM ............................................................................................... 83 ONCOLOGY PHARMACY: LIVERPOOL .............................................................................................. 95 ONCOLOGY PHARMACY: MACARTHUR ........................................................................................... 96
MULTIDISCIPLINARY CARE: TUMOUR GROUPS ................................................................... 98
MULTI‐DISCIPLINARY TEAM SUPPORT ............................................................................................ 98 BREAST MDT GROUP ................................................................................................................. 99 COLORECTAL MDT GROUP ........................................................................................................ 100 HEAD AND NECK MDT GROUP ................................................................................................... 103 HAEMATOLOGY MDT GROUP .................................................................................................... 105 LUNG MDT GROUP.................................................................................................................. 107 NEURO‐ONCOLOGY MDT GROUP ............................................................................................... 109 UPPER GASTRO INTESTINAL MDT GROUP .................................................................................... 112 GYNAECOLOGY ONCOLOGY MDT GROUP ..................................................................................... 115 BREAST RADIOTHERAPY INTEREST GROUP ..................................................................................... 116 BRACHYTHERAPY RADIOTHERAPY INTEREST GROUP ........................................................................ 117 GU SPECIAL INTEREST GROUP .................................................................................................... 118 GENITOURINARY MDT GROUP ................................................................................................... 118 THORACIC RADIOTHERAPY INTEREST GROUP ................................................................................. 119 CARERS SUPPORT INITIATIVES ..................................................................................................... 120
ACKNOWLEDGEMENTS .................................................................................................... 122
VOLUNTEERS ........................................................................................................................... 122 DONATIONS 2011‐2012 .......................................................................................................... 125 VALUED EMPLOYEES OF THE MONTH 2011/2012 ........................................................................ 127
RESEARCH ACHIEVEMENTS .............................................................................................. 128
INGHAM CANCER RESEARCH STEERING COMMITTEE ....................................................................... 129 COLLABORATION FOR CANCER OUTCOMES, RESEARCH AND EVALUATION (CCORE) ............................ 131 CLINICAL CANCER TRIALS ‐ NETWORK .......................................................................................... 137 PUBLICATIONS & PRESENTATIONS ............................................................................................... 147
3
SWSLHD Cancer Executive Director’s Report
Under the 2011 NSW Health Reform, cancer services split from the South Western Sydney Area Health Service into 2 Local Health Districts. SWSLHD Cancer Services remains by no means a small enterprise with 31 service responsibilities, 10 departments and 8 different facilities, whose achievements have been described within this year’s report. Strategic issues that affect cancer services are continually reviewed by the executive team to promote and advocate for services, staff, patients and carers within these responsible areas. Enormous effort has gone into planning the new look structure (see page 6), resulting in several dynamic and visionary plans, including:
Allied Health Strategic plan
Palliative Care Strategic Plan
Cancer Information Program Plan
SWS Cancer Research Strategic plan 2011‐2014
Service Development Plan, Liverpool, Macarthur
NSW Carers Action plan
SWSLHD Strategic Priority Services Planning to 2021
CINSW RBCO Quality Improvement Plan
Oncology Information System Quality Framework
Liverpool Hospital Transformation Plan 2012‐13
Highlights The transition to SWSLHD has been an extraordinary challenge, and the cancer executive team began working in both LHDs for the first half of the financial year, but by January 2012 the governance structure for SWSLHD was agreed, and is now led by the new SWSLHD Cancer Council. An important initiative was to ensure we are being informed by consumers and carers about the best way to provide services, so consumer representatives are members of our SWSLHD Cancer Council and the newly formed SWSLHD Cancer Consumer Advisory Committee was established, with participation from consumers and community representatives, to inform the direction of patient focused service delivery, and improve patient experiences and customer service. The SWSLHD Cancer Services strategic priorities until 2014 were drafted and endorsed by the SWSLHD Cancer Council, and the SWSLHD Clinical Council, and further work is being undertaken with the SWSLHD to incorporate our needs into its’ priority planning to 2021.
4
A SWSLHD Cancer Research Advisory group was established and a strategic plan was developed for improved cancer research collaboration across facilities and services. This group is focusing on developing important links between research groups and setting strategic direction for the future. This plan was recognised by the NSW Cancer Institute when they awarded our research efforts with a Translational Cancer Centre grant ($1.67M over 3 years). Multidisciplinary tumour group meetings have been established, and continue to focus on sub‐specialty care, with access to nine groups at Liverpool, four at Bankstown and seven at Macarthur. Partnering with the CINSW, the CanRefer website was launched in 2011, providing General practitioners and the community with contact details and information on how to access cancer services in their local area (www.Canrefer.org.au). A new information strategy to provide cancer services with a cohesive and more durable support network and more intelligent utilisation of electronic information systems was formulated, and commenced implementation. I am very proud of the achievements of the cancer service with a number of very large, important initiatives being developed by several of the services.
Key Performance Indicators In SWSLHD, the projected number of new patients diagnosed annually by 2016 will be 4,470, representing a 63% increase in new cancers. It is expected that the number of cancer deaths will reach 1,542 per annum, and increased survivorship and follow up needs puts additional pressure on current resources. The burden on SWSLHD Cancer outpatient services in 2011 were: Attendance Average wait
Chemotherapy treatment 23,995 11 days Radiotherapy treatment 23,391 10 days Consultations 35,225 9 days
There were 309FTE dedicated staff that provided this service over 2011/12. The total cost for cancer service was $38.3m
Research, Education, Grants, Development The new Ingham Research Institute was built this year, and presents many exciting opportunities. The Ingham Research Advisory group was established to lead research directions for the LHD, producing a strategic cancer research plan. The Australian Research Bunker facility has almost completed the building phase at Liverpool Hospital, and is part of a joint Ingham Research Institute initiative, along with the Federal government, University of Western Sydney and University of NSW. It is an extremely exciting project and represents the opportunity to make a substantial difference to the way that radiotherapy is performed in the future internationally. The project involves treatment with a radiotherapy linear accelerator while visualising the tumour and normal tissues with an MRI scanner ‐ increasing treatment accuracy. It is one of three such facilities in the world as there are some significant challenges in placing an MRI scanner and linear accelerator in close proximity. The project is being led by Professor Paul Keall, an internationally‐renowned medical physics researcher and involves collaboration with 7 different Universities including University of Sydney, University of NSW, University of Queensland, University of Western Sydney, University of Wollongong, University of Newcastle and Stanford University in California. The research group was successful in obtaining a $5.7M NHMRC research program grant.
SWSLHD Cancer Services’
Strategic priorities ‐
endorsed by new peak
committees
5
We have worked closely with the NSW Cancer Institute, who redesigned their statewide initiatives under their Reporting for Better Cancer Outcomes Program, and SWSLHD has been awarded new contracts under several of these. SWSLHD has been allocated $2.8m under a block funding agreement for infrastructure support which includes lead clinicians, service development, care co‐ordination and psycho‐social support as well as supporting non‐pharmaceutical clinical trials, the clinical cancer registry and multi‐disciplinary support.
Competitive grants awarded in 2011/12 of $240,000 included education scholarships and projects that support key initiatives such as enhancing chemotherapy protocol utilisation, implementation of wireless technology by the bedside, aboriginal and primary health care initiatives, and quality improvement projects for reporting strategic directions, providing support for carers and patient experience tracking devices.
Redevelopment of the Liverpool Cancer Therapy Centre, relocating wards and clinic rooms was a major achievement for the facility, expanding the service that has been at capacity for some years. Some of the changes include;
Establishment of an Allogeneic Bone Marrow Transplant service; Redevelopment of Outpatient Clinics and Chemotherapy Suite including a Haematology step down unit, and a PIXI unit for ambulatory, non‐cytotoxic procedures.
Expansion of Radiation Planning and Medical Physics departments.
Upgrade and refurbishment of the Multidisciplinary Team meeting facility. Upgrade of the NSW Cancer Council resource & information kiosk, manned by it’s volunteer group.
Genetics high risk women’s clinic, that commenced in July.
Pre‐treatment clinics for Head & Neck patients.
Telephone support service for Breast cancer survivors. Building works have also occurred at Macarthur Cancer Therapy Centre, with renovations to the Complementary Therapies area, and refurbishment of the area known as ‘the gymnasium’ to provide additional clinic space to accommodate the newly established Haematology consultation service. A specialty 20 bed inpatient oncology ward commenced after many years of lobbying for this service. Bankstown has also undergone some expansion building works to cope with the increasing demand of that service, and has now re‐established a consultant Palliative care service, and a Haematology consult service, on outreach from Concord. Urological Surgical planning has commenced, the service continues to review it’s directions under the leadership of Professor Les Bokey as the Professor of Surgery UWS and Colorectal Surgeon. A/Prof Meera Agar was appointed as Head of Palliative Medicine, Braeside Hospital and Researcher in clinical palliative care. Professor Paul Keall was appointed as lead on the Research Bunker with University of Sydney Medical Physics. Professor Paul DeSouza, dual appointment as Director, Translational Cancer Research Unit and Medical Oncology. Professor Afaf Girgis, Executive Director, Translational Cancer Research Unit.
6
Challenges New models of care and strategies will be required to deal with the following issues that contribute to service growth.
Increased cancer cases within an aging population.
Increased survivorship and strategies required for patient wellness
Outpatient space is at full capacity at Liverpool, Macarthur & Bankstown.
Palliative Care services are under‐resourced.
Haematology service growth is required at Bowral & Macarthur.
Melanoma and sarcoma services need to be established.
Increased Urology theatre space is required at Liverpool
Gynae Oncology staffing & theatre time need to be increased within the LHD.
Enhancement of support services (eg Allied health services, Care co‐ordination, Psycho‐oncology, Cancer Genetics screening)
Impact of Episode based funding models is as yet unknown.
Future Projects/Expansion of Services Some of the future directions that will be explored, include
Continue, and improve Multi Disciplinary Teams
Maintain a strong network structure across facilities
Increase utilisation of advanced technology
Improve and increase community care
Investigate on‐site specialist paediatrics & adolescent cancer services
Increase access to Genetics screening
Establish Prostate Brachytherapy service
Establish nurse practitioner clinics linking acute services
Increasingly support GP and nurse practitioner follow‐up.
Improve financial management
Foster key partnerships required to enhance services
Develop Wellness Centres that will support patients and address the less‐acute, survivorship issues for the long‐term well.
Staffing Cancer Stream Director Prof Geoff Delaney Cancer Services Development Manager/ Cancer Information Program Manager Ms Sandra Avery Cancer Information Program Manager Nasreen Kaadan Clinical Manager Ms Jayne Robinson Executive Assistant Mrs Caryn Knight Administrative Assistant Ms Melissa Carmagnola
New strategies are required
to deal with projected
service demands
7
SWSLHD Clinical and Quality Council
SWSLHD Cancer Clinical Stream Council Chair: Director of Cancer Stream
COMMITTEE STRUCTURE
Research Committee
Chair: G Delaney
Education Committee
Chair: J Robinson
Quality Committee
Chair: J Robinson
Cancer Information Committee
Chair: G Delaney
Ambulatory Care Committee
Chair: S Avery
Facility Cancer Executive Committee Chair: Facility Directors
Facility Cancer Consumer Advisory
Committees Chair: Consumer
Clinical Trials Chair: M Harvey
IT support Mosaiq Clinical Registry Chemo Protocols
OH&S Sub-Committee
9
Bankstown Cancer Therapy Centre Director’s Report
Bankstown Hospital Cancer Centre provides the following services:
Medical Oncologists deliver both outpatient and inpatient consultations and onsite medical support for chemotherapy treatment.
Radiation Oncologists offer outpatient consultations, with referrals to Liverpool and Campbelltown for radiation treatment.
Palliative Care specialists provide inpatient and outpatient consultative services, and referrals to community support.
Haematology provides inpatient and outpatient consultative service, with referrals to Concord for treatment.
Supportive disciplines also attached to the centre include Social work, Psychology, Dietetics.
There are expert teams of Urological, Upper Gastro‐intestinal, Breast and Colorectal cancer surgical specialties provided at Bankstown Hospital.
Integrated multi‐disciplinary (MDT) care is planned by a team of specialist clinicians. Bankstown hosts a Breast, Colorectal, Lung and Upper GI MDT, and contributes to Head and Neck, Genito‐urinary and Neurological cancer networks.
Highlights Recognised as a high achievement by the Clinical Excellence Commission, Bankstown have implemented a Survivorship Care Plan (CCSCP) for Colon Cancer patients. By incorporating the CCSCP that has been developed by ASCO (American Society of Clinical Oncology), into routine management of at least 90% of eligible patients with stage II/III colon cancer over next 3 years, to improve compliance to protocols and improve outcomes. (team pictured left) The next step is to collaborate with the Ingham Research Institute to expand this throughout the Local Health District, and we are considering a Colorectal survivorship committee and survivorship clinics throughout the LHD. Care coordination is an important factor to ensure patients have access to services. This year, the Upper Gastro‐intestinal cancer group appointed a nurse to facilitate patient care. Adding to our integrated service this year, we welcomed a new Staff Specialist in Medical Oncology, Dr Sandra Harvey, and a Palliative care CNS position was established to provide clinical support. Accreditation and skill maintenance for hospital staff ensures continuity of care for patients moving around the hospital. Nine anti‐neoplastic drug administration courses were provided by the oncology CNC, and continues. Oncology nursing have been actively involved in the accreditation of staff, in the management of implanted port‐a‐caths across the Bankstown hospital.
10 new chemotherapy chairs were purchased with $50,000 that was kindly donated by the Revesby Workers club, and installed in the Cancer Centre, providing a fresh and comfortable environment for patients. (Plaque pictured left) We are currently developing chemotherapy order sets and pre‐printed chemotherapy protocols in consultation with the oncologists, to eliminate possible handwritten errors and omissions in standard drug combinations, and utilisation of tools and resources from the Institute for Safe Medication Practices (ISMP) to prevent errors and ensure that medications are used safely.
Dr Ray Asghari Director,
Bankstown Cancer Centre
10
The Oncology CNC has been instrumental in the implementation of a chemotherapy consent form was developed specifically to ensure patients receive adequate information about their treatment, outcomes and side‐effects, together with the implementation of a Time Out Sheet, which is a checklist to identify that chemotherapy is safely administered.
Electronic documentation in the patient administration system of chemotherapy treatments, patient history and letters.
The Oncology CNC led the Implementation of patient satisfaction surveys in 4 languages (English, Arabic, Chinese and Vietnamese) Nursing and psychology departments have combined efforts to ensure this survey gets to the core issues. Establishment of the Bankstown Cancer Centre Wig Library (Thanks to Jayne Robinson, Sharelle Ioannou, Pharmila Sapkota and Fida Hajar for their assistance) Sharelle Ioannou and Dr Sandra Harvey have established regular education sessions for all clinical staff.
Key Performance Indicators The chemotherapy suite accommodates 10 chairs and delivered 3,338 treatments in 2011. There were 4,547 patient attendances for consultative services.
Challenges Projections for Bankstown residents diagnosed with Cancer for 2011 is 895, growing to 956 per year by 2016. There are currently 10 chemotherapy chairs, and the expected chemotherapy chairs required by 2016 is 15. Bankstown Cancer Therapy centre is confined to a space that is unable to be expanded without sacrificing other services. Developing new models of service delivery is required in the future to meet the growing demand on treatment services. Pictured left is the administration team in the reception of Bankstown Cancer Centre.
Future Projects/Expansion of Services Bankstown clinicians take a strategic approach to service planning, and have identified the following areas to focus on next year to drive continuous quality improvement:
Develop a service plan for future resources
Increase Haematology presence at Bankstown with options for inpatient care and outpatient chemotherapy delivery.
Enhance Medical Oncology services
Increase access to care co‐ordination and further enhance clinical trials, to improve outcomes.
Continue discussions with NSW Department of Health regarding onsite Radiation Oncology facilities
Explore alternative models of care for provision of cancer care, including community & primary health care linkages, integrated psychosocial care and telephone support networks.
Development of a Palliative Care inpatient ward at Bankstown to address the ageing population in the LGA.
Establish a Cancer Genetics service.
Dedicated oncology and clinical trial pharmacists
One stop breast cancer services
11
Research and Education
Actively involved in the implementation and facilitation of Antineoplastic drug administration course (ADAC) for Bankstown
Regular education sessions were established on Thursday mornings for nurses and medical staff. Dr Sandra Harvey has been instrumental in delivering ongoing education to all our staff.
Bankstown has established their own clinical trials unit, and continues to participate and recruit to valid trials within the service. There are currently 30 open trials at Bankstown.
Staff Medical Oncology Dr Ray Asghari Dr Fred Kirsten Dr Sandra Harvey Nursing Patrick McQuaide Sharelle Ioannou Judith Merry Connie Rosevear Mary McLean Zami Nyathi Jennifer Mitchell
Palliative Care Anna Nicholas Nikki Oakley Laurel Walker Clinical Psychologist Mariad O’Gorman Administrative Support Fida Hajar Sveta Miokovska Nina Barone Clinical Trials Mafizul Hoque Roseanne Wong
13
Liverpool Cancer Therapy Centre Director’s Report
Substantial physical change continues to be the theme for Liverpool Cancer Service this year, building on some of the development works that occurred last year. Whilst moving into our new clinic and office space within the Cancer Therapy Centre has initially meant quite an inconvenience, ultimately this has been for the benefit of our patients as we now have more clinic spaces and larger treatment areas. We also moved into our new clinical building and new medical wards, with most of our patients being housed in 5C and 4E. In addition, the radiotherapy area has been enlarged with an additional 2 radiotherapy treatment bunkers and the installation of Tomotherapy into one of these bunkers. Tomotherapy is a newer type of radiotherapy device. It still delivers radiation but does so in a different way to the conventional treatment machines (linear accelerators). We are very privileged to have been allowed to purchase this machine as it will be the first machine of its type installed in NSW and only the third in Australia. Further to this, the building works for the new Ingham Applied Health Research Institute building are almost complete at the time of the writing of this report (pictured left), and the Phase I clinical trials research unit will commence building works shortly. The Radiation Oncology research bunker project is one of the largest translational cancer research projects in Australia and is nearing completion of the initial building works. This project team, led by Professor Paul Keall, were successful this year in receiving an NHMRC programme grant of $5M over the next 5 years. Collaborations have been established with a number of other research groups such as the University of Sydney, University of Wollongong, University of Queensland, University of Western Sydney, University of Newcastle, University of New South Wales and Stanford University in USA. However, this is not the end of the building story as further development of the Liverpool precinct is planned over the next few years. It is predicted that the population in South Western Sydney will grow enormously over the next 5 years and we will be seeing approximately twice the numbers of patients than are currently seen. Further redevelopment of the Alex Grimson building will occur and Cancer Services will move into Level 2 of the building. This will provide some new office spaces for the additional staff that we have and also allow all of the staff to be housed in closer proximity to each other. It will also provide a new meeting room. In addition, part of the old Cancer Therapy Centre will be re‐developed into a Cancer Wellness Centre. Wellness Centres have been developed in a number of Cancer Units around the world. They are sites that patients can visit to receive high‐quality after‐ care, including ongoing education and support, ongoing counseling, lymphoedema management, rehabilitation and management of any long‐term side effects of their treatment. The 4E ward area will soon be made available to accommodate cancer inpatients and the new Palliative Care inpatient service will commence in 4E from early 2013. This ward has been purpose‐built for palliative care with a higher than normal ratio of single rooms, a balcony with views over South Western Sydney and a dining room. It is quite amazing the amount of development work that has gone on in the last 2 years.
Professor Geoff Delaney Director,
Liverpool Cancer Therapy Centre
14
I would like to acknowledge the hard work and dedication of our staff, particularly during this very disruptive time. I really appreciate the amount of effort and goodwill that has gone into the planning and realisation of additional work space and the camaraderie and team work of all cancer services. We have also seen a significant increase in the number of staff with recent enhancements to Medical Oncology, Haematology, Palliative Care and Nursing Staff. The main focus this year with regard to departmental development has been to enhance the palliative care, medical oncology, nursing, and haematology workforce. We have had some success with recruitment of additional staff in most of these disciplines. Palliative care remains a significant focus with plans to establish the inpatient palliative care unit next year. There have been difficult times in the past year for some groups with respect to workforce, including a reduction in our Clinical Trials workforce. We are currently taking measures to improve this situation so that we can enhance clinical trials in the future.
Patient Care The service continues to grow at a rate of approximately 10‐15% per year. Over 6,000 new patients were seen at Liverpool Cancer Therapy Centre; 12,108 chemotherapy treatments and 13,233 radiotherapy treatments were delivered. This growth continues to be restrained by our lack of space, although there are strategies in place to rectify this in the next year. Multi‐disciplinary case discussions continue to occur across most of the cancer tumour sites. The University of New South Wales have funded all of the video‐conferencing equipment in our new dedicated multi‐disciplinary tumour meeting room which will further enhance multidisciplinary discussion of patients. Thanks to Craig Smith and our IT staff for all of their hard work through this period. The main new patient service that has been established is the Allogeneic Bone Marrow Transplant service at Liverpool Hospital. Previously, patients with acute leukaemia requiring this type of treatment would be transferred after diagnosis to a hospital further away from their homes to undergo treatment that would often see them remain in hospital for weeks or months, thus making it hard for family members to visit them. We have almost completed recruitment to the Bone Marrow Transplant Team and I am grateful to Dr Anne‐Marie Watson and her team for all of the hard work that has been done to ensure this service commences smoothly and safely. We remain committed to high quality Customer Service, including Customer Service Training for all our staff, patient focus groups and personalised interviews assessing experiences throughout the cancer journey. We have also developed patient satisfaction surveys administered with Patient Experience Trackers which we have trialed for the Department of Health. We are also re‐invigorating the Staff Satisfaction Survey and ensuring that we meet the needs of our staff. Judging by the increase in positive feedback that I have personally received about the quality of the service this year this seems to have been a great success. We will continue to work towards high quality patient service.
Redeveloped clinic and procedure rooms.
“I would like to
acknowledge the hard work and dedication of our staff, particularly during this very
disruptive time.”
15
The Liverpool Consumer Advisory Group comprising patients, carers, friends and the wider community, to provide some external advice about how we might improve care further continues to develop. The group meet regularly and have provided some excellent ideas that have enhanced the Cancer Service. I remain thankful to Laurel Peel as Chair of this group. It is anticipated that this group will be involved in advising about our future building plans, designs, comfort features for patients and the way that we do business with patients and carers. The Annual General Meeting continues to be a success. The feedback that we received from participants at the last meeting was that we had the balance between staff engagement and community engagement right. We will endeavour to continue to respond to feedback with regard to this meeting. I am grateful for all of the assistance we have received from the Liverpool Cancer Therapy Centre volunteers and the NSW Cancer Council volunteers, who continue to provide support and advice to cancer patients and their carers. I would like to personally thank them for their assistance. I would also like to thank all of the groups that have helped fund‐raise for our Centre this year. Maree Cain, Narelle Barnett and Maryann Ciccone have worked tirelessly to make this the most successful fund‐raising year ever. Fundraising is always an important part of a Cancer Service. I particularly want to thank the organizers of Dry July, the Inner Wheel Rotary Liverpool, The Rotary Club, Lions Club, Cabra‐Vale Diggers, the Kuhlmann Foundation and the St Raphael Greek Orthodox Church in Liverpool, who have performed significant fund‐raising events for us in the past 12 months. I would also like to thank Mr Paul Warren, Chief Executive Officer of Peter Warren Group their generous offer of a transport vehicle to help patients attend the Liverpool Cancer Therapy Centre. Recent fundraising has enabled the purchase of chemotherapy chairs, DVD players and furniture for our patients.
Research and Education Research and Education continues to be a strong point in our Cancer Therapy Centre. The long list of publications, grants and awards in this annual report is testament to the hard work and innovative nature of a lot of our staff. This makes an exciting environment in which we work and helps stimulate us to try new methods of health care delivery. As highlighted in my discussion as the Area Director of Cancer Services, there are major improvements in the Cancer Research programme in the next 12‐24 months that will set the path for establishing our research group for international recognition.
Challenges As the population ages and grows in number, the incidence of cancer goes up. The expected growth in the number of cancers expected to be seen at the Liverpool Cancer Therapy Centre is mind‐blowing when you consider that it was only 15 years ago that the centre opened. We have come a significant way in a relatively short amount of time. However, the growth we have seen to date will be out‐stripped by the expected growth in the next few years.
Redeveloped Cancer Council Information
Centre (CCIC)
16
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
WZ 819,000 880,000 958,000 1,058,000
2006 2011 2016 2021
This creates some exciting challenges for us to ensure our future recruitment of staff is done in a way that attracts the very best staff members to come and work in our centre, ensure our current staff remain appropriately trained and supported, ensure our teamwork and goodwill between staff members continues to improve and ensuring that our physical resources enable high‐quality care and a caring environment for patients and carers.
Population Projections in SWSLHD (2006 – 2021)
In addition, we have really only just commenced our research journey. With the assistance of the SWSLHD administration, the Universities of Western Sydney and New South Wales, the challenge will be that within the next 5 years we have developed an international reputation for high quality cancer research, on top of the reputations that some of the cancer research groups have already developed. The growth of the service is very exciting indeed.
Professor Geoff Delaney Director
Liverpool Cancer Services
17
Tribute to Denise Lonergan
Associate Professor Denise McGuigan (nee Lonergan) 1953‐2012 Associate Professor Denise Lonergan passed away in October 2012 after a relatively brief illness. She was a remarkable oncologist. She was a caring, thoughtful person, with a keen sense of humour, who devoted herself to her family and her work as a radiation oncologist. She was loved dearly by her patients and staff. Her greatest strengths were her holistic, compassionate patient care and the kindness support and wisdom she gave to her colleagues. The respect that she had with patients was reflected by the huge number of messages wishing her well that she received at the time of her sudden illness, including a substantial proportion from patients she had treated many years ago and from relatives of patients. Her family can be enormously proud of the way that she performed her duty to cancer patients. It was in 2006 that Professor Lonergan moved from Prince of Wales Hospital to Macarthur Cancer Therapy Centre, where she provided specialist care in radiation oncology in lung cancer and breast cancer. She also provided clinical services at Liverpool and Bankstown hospitals. She was a substantial contributor to each of those hospital's multi‐disciplinary teams and her opinion was always well‐considered and respected. Denise also provided substantial mentorship to trainees and medical students and established the first training network in radiation oncology. Her efforts in developing the training programme and commitment to undergraduate teaching of cancer were recognised by her appointment as Associate Professorship with the University of NSW as well as winning several teaching awards including the University of Western Sydney Clinical Dean’s Award, the University of NSW Clinical Associate Dean Teaching Award and the RANZCR Faculty of Radiation Oncology Excellence in Teaching award. Denise was also an active member of a number of research projects into radiation oncology, especially with respect to the management of breast cancer. She will be sorely missed. .
18
Tribute to Vicky McCarthy Victoria (Vicky) McCarthy was diagnosed with Breast Cancer in 1997. Her treatment at the Liverpool Hospital Cancer Therapy Centre had impressed her so deeply that she returned as a volunteer the next year. Vicky wanted to make her contribution both to the LCTC and also to her fellow patients and their families and friends. Vicky is a long‐term member of the LCTC Patients Support Group. She also contributed her time to events such as Daffodil Day, Pink Ribbon Day, Biggest Morning Tea and Christmas morning tea for patients and staff. On Tuesdays and Thursdays each week she provided assistance to staff and provided support to patients visiting the centre. She conducted of all these varied roles with unfailingly kindness, generousity, was sociable with a cheeky sense of fun that always brought a smile to people’s face. Vicky continued her tireless effort as a volunteer until she passed away on 28th of February this year. Our thoughts are with Vicky’s husband Fred and his family; we wish them well with peace and comfort. LCTC will sadly miss Vicky’s presence as she has been a part of the Centre for more than a decade. On behalf of all the people she has helped, we would like to pay tribute to Vicky in a way that she would truly appreciate with a rousing 3 cheers!!
19
Macarthur Cancer Therapy Centre Director’s Report
2012 saw a steady increase in activity at the Macarthur Cancer Therapy Centre (MCTC) and inpatient workload in Campbelltown Hospital. The workload demand was met with an extra 2 clinic rooms being built to accommodate the population growth. The Macarthur and Southern Highlands Cancer Service is the second busiest cancer unit in South West Sydney Local Health District. We were pleased to see the commencement of a clinical haematology service in the centre and a consultative service for inpatients.
Highlights Feedback from our regular Patient Satisfaction Surveys remains positive with staff from all departments being recognised for their patient‐centred care, customer service, providing education and information and teamwork. The quality of the service was reflected as a recipient of a Local Health District Quality Award for our Nurse Assessment Unit. Excellent results in regular hand hygiene audits and above benchmark measurements in the National Medication Chart and Institute for Safe Medication Practice audit on chemotherapy have been attained. The centre contributed significantly to the EQUIP accreditation of the hospital. The Centre was successful in a Federal Government grant for rural medical oncology trainees and the building of a cancer centre in Bowral to provide additional allied health, nursing and treatment facilities. The Oncology Nurse Assessment Unit was a finalist in the NSW Health Awards in the section of Excellence in Cancer Care. This innovation has provided a model of care adopted by other oncology units as well as surgical and cardiology units with the National Emergency Access Target programme commencing. Our commitment to education continues with attachment of nursing, radiation therapy and allied health students. The “24 Hour Fight Against Cancer, Macarthur” event was held again in October 2011, raising $282,000, supporting the MCTC, Camden Palliative Care, Paediatric Ambulatory Care, the inpatient oncology unit as well as surgical services. This group has raised more than $1.3 million in 6 years, an outstanding effort from the local community reinvesting in their cancer service, where every dollar raised stays in the Macarthur and Wollondilly region. Our volunteers continue to provide great work and their dedication is greatly appreciated by patients, families and staff, with the sad loss of Beatrice Atwell, a volunteer since the opening of the centre and great support to patients and staff over the years. I am thankful for the generosity of our donors. A special thanks to our valued employees recognised by their managers for outstanding work. Sydney School of Medicine (pictured left), with some of these interns now working within the centre. I would like to thank all staff involved in teaching the principles of cancer care and being exceptional role models for students of all the health disciplines.
Associate Professor Stephen Della‐Fiorentina
Director, Macarthur Cancer Therapy Centre
20
Research activity continues although withdrawal of funding from the Cancer Council to the Cancer Institute has put a significant strain on the service to provide clinical trial opportunities for our community. The Southern Highlands Cancer Centre recruited well to 3 breast cancer prevention trials. The centre cannot provide the excellent service it does without the commitment and dedication of all our staff, providing patient focused services and the strong teamwork commented on by our patients. Their continued drive for quality, safety and excellence in cancer care allows the Macarthur and Southern Highlands Cancer Centres to achieve our goal of delivering the best possible care to patients, their carers and families of Macarthur, Wollondilly and Wingecarribee. We look forward to 2013, our 10th anniversary year.
Associate Professor Stephen Della‐Fiorentina Director
Macarthur Cancer Therapy Centre
21
Tribute to Beatrice Atwell Beatrice commenced as a volunteer in Macarthur Cancer Therapy Centre (MCTC) when our centre opened in 2003 and worked tirelessly with our patients, carers, visitors and staff. She provided timely and heartfelt support and comfort and her ability to detect distress and anxiety was a great gift that we were fortunate to have experienced. Beatrice had a wonderful sense of humour and could always be relied upon to see ‘the positive side of life’. She was strongly involved with the NSW Cancer Council and was instrumental in organising events including Australia’s Biggest Morning Tea, Daffodil Day, Pink Ribbon Day and Bandana Day for Campbelltown Hospital. Beatrice spent hours knitting, sewing and making various items for Easter and Xmas and would then donate the proceeds raised to the MCTC Patient Care Trust Fund.
Beatrice’s other achievements include: Member of Macarthur Cancer Community Council (MCCC)
Volunteer at Camden Palliative Care Unit
Finalist in the 1995 Sydney Electricity Community Spirit Awards
Volunteer for the 2000 Paralympics
Co‐Founder of National Association Loss and Grief (NALAG) St George chapter
Founder of PALLS of Palliative Care, a registered charity that helps the community and supports those with a life threatening illness and their families
Hospital Chaplain at Calvary and St George Hospitals
Trauma Teddy co‐ordinator
Recipient of the 2006 Les Underwood Volunteer of the Year Award from Rotary, Macarthur Sunrise Club
Beatrice is acknowledged on our MCTC Honour Board for her dedication and contribution to MCTC.
23
SWSLHD Cancer Genetics The cancer genetics service continues to operate across both SWSLHD and SLHD where clinics are held at both Liverpool Hospital and Royal Prince Alfred Hospital. We attend the breast cancer MDTs weekly at both sites, to provide advice about referrals to Cancer Genetic Service. In some cases, recognition of a strongly inherited genetic cause (such as an inherited mutation in BRCA1 or BRCA2) at the time of diagnosis may influence early surgical management, so rapid access to genetic counselling and genetic testing is facilitated. As well as seeing patients referred by other cancer clinicians in both districts, we also see patients referred by general practitioners for assessment of their cancer risk, providing advice about an appropriate cancer screening plan. Some individuals contact us directly to arrange predictive genetic testing when they are aware that some family members have an inherited mutation in a cancer predisposition gene. For women who are recognized to be at potentially high risk of breast cancer, we have started a new High Risk Screening clinic at Liverpool. This multidisciplinary clinic is supported by Breast Radiologist, Elizabeth Lazarus, breast surgeon, Dr Ash Shah, Cancer Genetics specialist, Dr Annabel Goodwin, medical oncologist, Dr Sandra Harvey, breast cancer nurse Pharmila Sapkota. Breast screening including breast MRI (for women under 50), mammography and ultrasound are arranged annually at Concord Hospital and then breast ultrasound is performed 6 months later. Women attend clinic once every 6 months for review of imaging, clinical breast examination and to review the role for risk reducing surgery and any genetic counseling issues. There is a High Risk Clinic established at RPAH as well. We see families with rare complex cancer genetic predisposition syndromes which need specialist co‐ordination of screening such as VHL. Regular screening with MRI and biochemical assessments are required and we will follow up these individuals annually to ensure they have access to MRI screening.
Education We have been involved with education of cancer service staff at the Education Meeting, Basic Physician Trainees and general genetics counsellors. We have participated in the NSW Clinical Genetics Fellow’s Orientation Day held at Liverpool Hospital and introduced them to the cancer genetics services in SWLHD and in NSW. The NSW Family Cancer Clinic Education Day is held monthly and we attend this meeting. Dr Goodwin is part of the group developing National EVIQ Guidelines for cancer genetics.
Key Performance Indicators We received 200 referrals for SWLHD in 2011 and 225 in SLHD. The genetic counsellors are required to contact all patients prior to clinic to take a family history and verify cancer diagnosis which influence our assessment of the family. Of these referrals, we have completed the intake process for 249 families and 124 were assessed by the service without requiring the formal intake. There were 781 clinic consultations in 2011 (526 were first clinic appointments and 255 were subsequent clinic visits). We have seen families with breast/ovarian cancer, bowel cancer (Lynch Syndrome, Familial Adenomatous Polyposis (FAP) and Familial Bowel cancer) and other rare syndromes. Most families are seen as outpatients in clinic. We have performed ward consultations when required at Liverpool Hospital.
L‐R Dr Annabel Goodwin Cameron Ebzery, Annabelle Ng
L‐R Brad Woodward; Deborah Young; Georgina Fenton
24
There were 420 additional phone calls with patients, either to discuss genetic test results or other patient enquiries. Currently (August 2012), there are 70 outstanding referrals requiring assessment. At Liverpool Hospital, causative mutations were identified in BRCA2 for 4 families, BRCA1 for two families and Lynch Syndrome for one family. The overall mutation detection rate for both districts was 15 of the 86 individuals who had a mutation search (17%). We achieved above the 10% threshold, as we follow the National Testing Guidelines to determine who to offer a mutation search. We arranged predictive genetic testing for 44 individuals from families with known mutations.
Quality Projects This year we have contacted all women known to our service who tested positive for an inherited mutation in BRCA1 or BRCA2. Their management was reviewed and we offered information about the annual BRCA support day held by the Association of Genetic Support of Australasia (AGSA).
Challenges Ongoing challenges are the training of our two new genetic counsellors who are training to become Board Certified cancer genetic counsellors. Astrid Przezdziecki (clinical psychologist) is supervising Camron Ebzery to support her counsellor training. To become Board Certified, they require “cross training” with general genetics clinical exposure as well as cancer genetics. We will need to arrange for them to spend some time in general genetics for this training need. The High Risk Clinic for BRCA mutation carriers faces several challenges. At present, women are required to travel to Concord Hospital to have their screening and then attend clinic at Liverpool Hospital for clinical review. In the future, we would like to be able to offer MRI imaging at Liverpool Hospital. Other challenges for our service is to reduce the need for paper files and increase the amount of information stored in the electronic record, MOSAIC. We need to comply with minimum standards for entry of data into the state‐wide database, kintrak, which does not yet have the capacity to be an electronic record and we have no permanent data manager. We are aware of the need for some patients to travel to clinic appointments, and we will consider the use of telehealth for consultations if genetic counsellors are available to be present with patients during the consultation.
Research This year we commenced a collaborative research project with NSW Family Cancer Clinics about women diagnosed with breast cancer under age 31 who have attended Cancer Genetics Clinics in NSW. We have contributed to the National EVIQ development of evidence based guidelines for cancer genetics. Results of genetic testing for 2011 (Combined SWSLHD and SLHD districts)
71
24
15
20
0
50
100
Mutation Search Predictive
DeferredPositiveNegative
25
Gynaecologic Oncology The Gynae Oncology unit provides a consultative service to patients with familial cancer syndrome and facilitates the delivery of prophylactic surgery. The team has been involved in the diagnosis, management and psychosocial support for women with gynaecological malignancies. The most common gynaecological cancers we managed were ovarian, endometrial and cervical cancers. We were also involved in the care of patients with other genital tract malignancies such as vaginal, vulval and gestational trophoblastic disease. The unit managed another challenging year of clinical work, training and research. The number of new patients and follow up visits continue to rise in response to increasing population.
Highlights Multi‐disciplinary team meetings are held weekly to discuss the management of patients. These meetings enable several specialty disciplines to discuss newly diagnosed patients, their pathology, recent surgery and points of interest. During these discussions, a management plan is established and on‐going psycho‐social follow up is arranged. Regular morbidity and mortality meetings are combined with Sydney LHD to discuss the management of complex cases. These teleconferences face the ongoing challenge of a growing number of patients with complex health problems who present with gynaecological cancer. Ongoing psychological support is paramount to ensure patients recover from the emotional impact of the diagnosis and treatment. Our patient support group has been meeting monthly, facilitated by experts to empower patients to help and support each other during this difficult time. The number attending this meeting continues to grow. Social workers assist with access to community services and financial assistance available from the government. Clinical training and research is strongly encouraged within the unit. With a single practicing gynaecological oncologist, the unit is actively looking for a suitable additional specialist to cope with the workload into the coming years. Gynaecological Oncology has become an integral part of Local Health District Cancer Service, with offices and clinics co‐located with the Liverpool Cancer Therapy Centre. This allows opportunities for future development and research. Local Rotary clubs and societies were approached, and presentations made, to increase awareness of gynaecological cancer and raise funds for the gynaecological oncology service. With the help of patients and local community, a successful fundraising effort contributed to the purchase of new equipment. (Pictured left is the official acceptance of specialized equipment)
Dr Felix Chan Director,
Gynaecological Oncology
26
Research and Education Dr Felix Chan (Director, Gynae Oncology) was nominated for Australian of the Year Award 2012 for his contribution and dedication as a Specialist, as well as his community work. He also received the Vocation Excellence Award 2012 from Rotary District 9680 for his outstanding contribution made to Gynaecological Oncology and the wider community, and for promoting the highest standards within his career. Dr Chan was nominated for Citizen of the year 2012 at Parramatta. Congratulations.
Future Projects/Expansion of Services The unit looks forward to another busy year within the constraint of limited resources available to the area.
Gynae Oncology MDT Group/Gynae Oncology Team Director Dr Felix Chan Staff Specialist Dr Carl Miller Clinical Fellow Dr Jason Ting Clinical Nurse Consultant Rosemary Craft
Clinical Psychologist Mariad O’Gorman Clinic Support Officer Therese McCabe Medical Oncologists Dr Michelle Harrison Dr Diana Adams Radiation Oncologists Dr Miriam Boxer A Prof Shalini Vinod
Gynaecological Pathologist Dr Leonardo Santos Physiotherapist Susan Cao Data Manager Victor Ye Medical Team Registrars/Residents
27
Medical Oncology Liverpool The department of Medical Oncology continues to strive to provide an excellent service. It is predominantly an outpatient – based specialty, and the increasing local population provides an ever increasing demand for consultation and chemotherapy. Other core services for the department include inpatient care, teaching, research, and support for many other specialties, most obviously in the form of multidisciplinary team meetings for each major cancer type. From the period 2011 – 2012, we have had a number of staff changes. In 2011, three locums worked in our department (Drs M Bagia, S Ali, K Mok). In late 2011, Drs Michelle Harrison and Wei Chua returned from maternity leave, and we also appointed Drs. Victoria Bray and Kelly Mok. Dr. Amanda Goldrick resigned in May 2012, after 15 years of service as a staff specialist. She will be missed, and we thank her for her contribution to Liverpool Hospital over many years. Dr. Mahmood Alam also resigned late in 2011. We also thank him for his years of service. Continuing members of the department include Drs. Weng Ng, Michelle Harrison, and Professor Paul de Souza. I am very grateful to all the nursing and administrative staff, who have played a major role in keeping a medical oncology service running during the last 18 months. I am also grateful to the Cancer Centre Directors and senior hospital staff, who have been very supportive of the department.
Highlights Over the period 2011 – 2012, there continues to be a 13% annual growth in chemotherapy treatments (as measured over 5 years), even in years when there have been fewer staff. We have been fortunate this year to have a dedicated inpatient ward (4E), which is shared with the radiation oncology and palliative care departments. In July 2012, we won a grant from the Federal government for an extra medical oncology advanced trainee position through the STP program. This 4th trainee will rotate with the other trainees, and provide extra services to inpatients, the Private Hospital and Bathurst Hospital one day a week.
Key Performance Indicators Chemotherapy administrations have now reached over 8000 occasions of service per annum (see Figure)
03/04 04/05 05/06 06/07 07/08 08/09 09/10 10/11
Occasions 4518 4618 5161 5679 5379 5679 8585 8949
0
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4000
6000
8000
10000
Chemotherapy by year (to april 2011)
Federal Government has granted an extra Medical Oncology Advanced Trainee
Position
Professor Paul De Souza Director,
Medical Oncology
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Research and Education At the time of writing, the building works for the new Ingham Applied Health Research Institute building are almost complete, and will house laboratory facilities, a clinical skills laboratory, and office space for health service researchers and clinical trials coordinators and research nurses. Our clinical trials unit suffered from lack of staff for about a year, but over the past 12 months, we have seen increasing research activity and patient recruitment for clinical trials. Space for a Phase I clinical trials unit has been identified, and refurbishment is due to commence shortly. We look forward to conducting our first Phase I trials later in 2012. The medical oncology department also has a laboratory in the new Ingham Institute building, and our plans are to increase our basic and translational science capabilities. We have applied for over six research grants in 2012, including NHMRC grants. All our staff are involved in medical student teaching (UWS and UNSW), JMO teaching, and registrar teaching. Members of staff are also examiners in the FRACP examinations each year.
Challenges As always, we have significant challenges to our plans for the future. The issue of ever‐increasing demand for consultations and chemotherapy administration needs to be addressed, as does our ability to attract new and skilled staff in all facets of the service. We are determined to improve not only the quality of our service, but also attract more patient referrals, particularly in areas of service gaps (eg. melanoma and sarcoma) so that in future, we are known as a centre of excellence for all things related to medical oncology.
Future Projects/Expansion of Services
Our plans for the future include
Relocation of the department offices back to the Cancer Centre, which will increase the efficiency of the department.
Establishment of a Phase I clinical trials unit
Increase patient recruitment for clinical trials
Establishment of a translational research group to enhance bed‐to‐ bedside, and bedside‐to‐bench as well as evidence‐to‐practice research.
Develop a more robust training pathway to allow trainees to develop their teaching and research skills in parallel to their clinical skills
Establishment of a named quality improvement project each year.
Establishment of Phase 1 Clinical Trials Unit and Translational Research
Group
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Medical Oncology Macarthur The Department of Medical Oncology, Macarthur Cancer Therapy Centre, has continued to grow. At Campbelltown the department saw 629 new patients, a 20% increase on previous year, 4281 follow‐ups in clinics and the Oncology Ward and 6092 chemotherapy occasions of service, an increase of 26%. We welcomed Dr Po Yee Yip to our team of 2.9 medical oncologists; Dr Diana Adams, Dr Lorraine Chantrill, Dr Belinda Kiely and Associate Professor Stephen Della‐Fiorentina. Three staff are enrolled in PhD’s which will enhance the training and research capacity of the unit. With the dissolution of the Area Health Service our training network will change in 2013 with the addition of St Vincents and Bankstown Hospitals to Macarthur and Liverpool. The transition of our basic physician trainees to advanced trainees will hopefully continue with this new network. Successful accreditation by the College of Physicians of the training programme at Bowral was attained. Longer terms at MCTC this year has been well received and has enhanced the advanced trainee programme. Our oncologists provide clinical leadership at national and state level in education, research, quality, innovation and service delivery. The Southern Highlands Cancer Centre in Bowral continues to expand with 206 new patients and 1274 follow‐up patients seen and 1733 chemotherapy occasions of service delivered. Attaining a Federal Government grant to develop a purpose built Cancer Centre to enhance clinic space and treatment areas and augment the allied health and nursing services available. The clinical trials unit was the second highest recruiting centre in NSW in breast cancer prevention studies.
Research and Education The medical oncologists continue to be the major educators of the University of Western Sydney Medical School with some of its first graduates working as our interns. We lecture to Year 1 and 2 students, co‐ordinate the 4‐week clinical placement of Year 4 students within the Macarthur Cancer Centre and this year has seen the first Year 5 pre‐intern ward attachment. Publications, presentations and invitations to lecture have increased.
Highlights The Macarthur unit continues to innovate with our Nurse Assessment Unit being a finalist in NSW Health Excellence in Cancer care. We continue to lead in the electronic cancer record and paperless chemotherapy prescribing. The New South Wales Cancer Institute has recognised this by awarding Macarthur a grant to be a lead site for collection of chemotherapy data and to roll this out to the units at Liverpool and Bowral. We remain a resource for cancer units in Australia and New Zealand visiting us to gain understanding in implementing electronic prescribing. The teamwork and integration of the medical, nursing, allied health and pharmacy staff in education, quality, service planning has led to a quality service to our patients, their families and carers and created a desirable and dynamic place to work.
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SWSLHD Haematology The Haematology Department provides comprehensive in and outpatient treatment for all haematological and a number of neurological conditions. It treats malignant and non‐malignant cases coming from around the whole Area comprising close to a million people. The Department is affiliated with and most staff are doubly appointed to the Universities of Western Sydney and New South Wales. Undergraduate teaching is provided to students and post grad training to hospital RMO staff and nursing and scientific staff. Staff haematologists are A/Prof Lindsay Dunlop, Penelope Motum, Anne‐Marie Watson, Samantha Day, Lye‐Lin Ho, Michael Harvey, Nicholas Viiala, Silvia Ling, Danny Hsu and Adam Bryant. The department has been fortunate to have 7 advanced trainees and has been very successful in passing examination hurdles
Highlights This last year the department has appointed 3 new haematologists, Dr Samantha Day appointed to Campbelltown, Dr Danny Hsu at Liverpool and Dr Adam Bryant to allogeneic marrow transplantation at Liverpool. The unit has been successful in being approved/funded to commence an Allogeneic BMT Program under the leadership of Dr Anne‐Marie Watson. With the assistance of the clerical staff led by Karen Clark, Nursing staff led by Tania Luxford and Aaron Manson, the department has been able to grow and treat more patients.
Key Performance Indicators Reduction in time from referral to first treatment has been a challenge and using Health Round Table Lean thinking program has reduced this from around 6 weeks to 20 days, below is the growth in new referrals monthly. The unit has established an Ambulatory Haematology Unit which will be staffed by 2 nurses funded by the haematologists. This will facilitate ED avoidance, more rapid admission and facilitate early discharge. This especially so for the Ambulatory Haematology Unit, this even before appropriate staff have been appointed.
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AHU
AHU
Commence an Allogeneic BMT
Program.
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Research and Eduation The Unit has agreed to funding 2 clinical trials data managers which should facilitate clinical trials involvement. Dr Ling has been successful in obtaining Primary Healthcare Grants. The department has enrolled many patients in clinical trials, allowing our patients to access unavailable research medications. Basic scientific research is being undertaken within the laboratory precincts of SSWPS and IHRI. Scientific staff are being funded by haematology Funds.
Challenges Workload is growing faster than resources are available to service that load. This when efficiency savings limit mechanisms to cope.
Expectations by our patients and referrers to see and treat in ever reducing timeframes.
Referring institutions are requiring greater presence in diverse and widely spaced locations for increasing amounts of time
Future Projects/Expansion of Services As the workload grows in the Campbelltown sector the unit the department will seek to appoint additional staff to this sector. As the LHD reincorporates clinical haematology services back within Bankstown, expectations will be for the Haematology Department to provide this service. At this time, it would be expected that another haematologist would be appointed. With all envisioned additional staff, this will bring the unit up to 13.5 FTE staff Haematologists.
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Jun‐10
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Oct‐10
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Dec‐11
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Apr‐12
Jun‐12
Series1
Efficiency savings limit mechanisms to cope.
33
SWSLHD Dermatology The Dermatology Department, located in Goulburn Street is the only public service within the SWSLHD providing an inpatient and outpatient general and tertiary consultative diagnostic and treatment of dermatological skin conditions.
Hand Dermatoses
Biologics
Advanced Patch test
Photodynamic and phototherapy
Surgical skin procedures – grafts, biopsies The department is supported by 9.2 FTE Nurses Adm Dermatologists Registrars VMO Temporary
positions 3 FTE 1x EN 2x RN
3 FTE 2 xAOL2 1xSecretary L3
1.2 xSS 2 FTE 2 1x research from SP&T 1xEN from revenue
Highlights Establishment of 4 clinical indicators ‐ the Skin Procedure worksheet adopted for the Registrars training curriculum by the College of Dermatology :
Inpatient consultations
Visit Management
Skin Procedures and procedure safety worksheet
PDT
Development of flowcharts for Biologic clinics and phototherapies with interest generated from other Dermatology Services Ongoing audits for phototherapy, infection rates Development of patient information brochures in different languages for phototherapy & Biologics Orientation manual for Registrars Successful application for funding from Commonwealth for 2 years 1.00 FTE Registrar (International Medical Graduate Specialist Training Position – IMG STP)
34
Key Performance Indicators/Activities
Dermatology Clinical Indicators
Skin procedures – infection rates
PDT – 8 per month
Visit Management
Inpatient consultations – 60 per month
Phototherapy‐ 450 treatments per month
July 2008 to June 2009
July 2009 to June 2010
July 2010 to June 2011
July 2011 to June 2012
Total Procedures 743 717 759 700 Antibiotics 9 11 4 1 Other 0 0 0 0 Post procedure Infecton Rate
0 0 0 0
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Research and Education
Research activities :
Psoriasis registry database
NHMRC Multi Centre ‐ High risk Melanoma monitoring clinic
Observational Study – Effects of TNF Blockades in pts with severe to moderate Psoriasis with metabolic syndrome
Impact of Psoriasis on QOL Education:
Monthly Clinical meetings
Grand Rounds
Annual Scientific Meeting 16th September 2011 – 35 participants
SWAPS Histopathology tutorial
Overseas Speaker – Dr Kim Papp presentation and case discussions
Presentation at the Annual Dermatology Conference held in 2012
Attendance at Master class for Biologics in Melbourne – Medical and Nursing
Nursing Competencies in Phototherapy and Advanced patch Testing
Challenges
IT support
Submission sent for hard copy flow sheets to electronic & Databases
Digital images to interface with Power chart – awaiting >2 years
Goulburn Building – Creation of Space and minor refurbishments
Workforce – Recruitment of Dermatologists – Establishment of Chair of Dermatology
Telederm – Business case for consideration
Resources enhancements – submission to enhance the Service
Revenue generation – Adm support
Consultations for patients arriving on stretchers seen in Main Hospital
Activity Based Funding
Future Projects/Expansion of Services Expansions for the following 1. Skin Cancer and Surgical Dermatology 2011 – 2014
Establishment of Multidisciplinary High risk Skin Cancer Clinic involving radiotherapy and plastic surgery in 2011 – 2012 – commencing on 6/11/2012
MOHs Surgery 2012‐ 2013 2. Medical Dermatology in 2011‐2016
Occupational Hand Dermatoses Clinic 2011 ‐2012
Biologic Clinic 2011‐ 2012
Vulval Dermatology Clinic in 2014‐2016
Research /Teaching/Clinical Trials
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SWSLHD Palliative Care
The Area Palliative Care Service is based at Braeside Hospital and includes the Area Manager, Nurse Coordinator, Volunteer Coordinator, Data Manager, Service Development Project Officer, Area Admin and community Registrar positions. The Area Service is the “hub” for connecting all of the Palliative Care teams across the district including hospital consultative teams, Braeside & Camden inpatient Palliative Care units and community services. In October 2011, Dr Amanda Walker stepped down as Area Director Palliative Care after 4 years and a new governance model was commenced with Janeane Harlum as Area Manager/ Service Development working with Therese Smeal (Area Nurse Coordinator), Nicole Girotto (Project Officer‐ part time), Patricia Rebello (Admin Officer – part time), James Nguyen (Data Manager), Arlene Roache (Area Volunteer Coordinator), Dr Vanessa Tung (Community Registrar – part time), Dr Annie Lee (RACF COAG funded Registrar) The Macarthur & Wingecarribee Palliative Care Service incorporates the 10 bed Inpatient Unit and Day Therapy Centre at Camden Hospital, the Macarthur Cancer Therapy Centre with outpatient services, Consultative Services to Bowral, Campbelltown & Camden public hospitals, Southern Highlands Private Hospital and Community services based at Rosemeadow (Macarthur) and Bowral (Wingecarribee) spanning 5,756 km. Staff work across Macarthur Wingecarribee Staff specialists Dr Amanda Walker Dr Jackie Kerfoot Dr Lynne Kuwahata Nursing consultative service
Colleen Carter Camden Palliative Care unit NUM Roberta (Bobbie) Elston Nursing Team Allied health and admin support staff.
The Liverpool Hospital Palliative Care Service is part of the SSWLHD Palliative Care Service. It is a consultative service providing inpatient consultations, outpatient clinics and occasional community consultations. The medical staff provide an on call after hours service to all hospitals, community and Braeside/Camden Palliative Care units. In January 2011 Liverpool Palliative care service agreed to amalgamate with the Bankstown Hospital Palliative Care Service to help provide continuity of care and reduce staff isolation at Bankstown Hospital. The consultative service at Liverpool Hospital continues to be very active. The medical service is seeing an average of 80 ‐ 90 new patients per month as well as providing a daily on‐call service for the community. There are 4 outpatient clinics per week at Liverpool and 1 outpatient clinic at Bankstown. The nursing service is also very active and deals with nursing referrals but also sees every medical referral . The palliative care team is actively involved in many Multidisciplinary teams(MDT) in particular lung, head and neck, neuro‐oncology, medical oncology and haematology MDTs. Liverpool Palliative care team has a strong relationship with non‐cancer services with close to 40% of consults being for non‐cancer patients. The service is supported by a regular palliative care volunteer visiting program. Staff specialists Dr. Jennifer Wiltshire Dr. Rebecca Strutt Dr Rajesh Aggarwal Dr. Louise Elliott
Dr Thang Huynh Nursing Charmaine O’Connor Naomi Ellis Achamma Roy
Leslie Regaldo Secretary Charity Earnshaw
Basic Physician Trainee and Advanced Trainee is networked through the Sydney Institute of Palliative Medicine.
Janeane Harlum Director,
Palliative Care
38
Bankstown is a consultative service comprising staff specialist, Advanced Trainee Registrar and CNC. The nursing consultative service was provided by Anna Nicholas CNC who is on maternity leave. On secondment to CNC role is Nikki Oakley, with the addition of CNS, Laurel Walters who commenced in April 2012 for 6 months due to limited staff specialist resources. Dr Louise Elliott was providing 0.4FTE consultative service prior to going on LSL.
Highlights This year during National Palliative Care Week the Inaugural Area palliative care awards were held to celebrate the achievements of both Specialist & Primary Palliative Care from across the LHD. The event was a huge success with many nominees in each award category. The winners were:
• Excellence in Provision of Primary Care to Palliative Care Clients: Campbelltown Hospital Palliative Care Resource Nurse Program led by Colleen Carter CNC (Margaret Allerton, Maria Horgan, Lynda Marov, Patricia Thompson, Jane Richards, Carol Hicks, Cathy Anthofer)
• Outstanding Contribution to Specialist Palliative Care: Mira Glavan, CNC palliative Care Wingecarribee, Bowral CHC
• Volunteers Supporting Palliative Care: Joan Casey, Palliative Care volunteer in the Bankstown LGA
• Quality Improvement or Innovations to Local Palliative Care Service Awards: • Innovation Award Winner: Jodie Peronchik, End of Life Care Coordinator,
Liverpool Hospital for development of a pamphlet “How to Support a Person who is bereaved.”
• Quality Award Winner: Braeside Hospital Carers Project/ Workshops led by Jenny Downes social worker Braeside Hospital and Arlene Roache, SWSLDH Volunteer Coordinator
Esarda Scholarship and John Edmonston VC Memorial Club Scholarship Award 2012 Jodie Peronchik, End of Life Care Coordinator at Liverpool Hospital. Other highlights were several successful grants for enhancement of Equipment Loan Pool $82,631, Carers grants x2 totalling $10,000. This year saw the launch of the volunteer program into Bankstown Hospital which included several media releases in local papers. The volunteer program continues to grow and deliver direct patient/carer support services as well as promotion opportunities such as National Palliative Care week and fundraising to improve/ enhance our services. We thank them for their tireless effort. Enhancement provided to the Area Palliative Care Service and community through COAG funding to develop a RACF (Residential Aged Care Facility) consultative and education program. This program is funded till June 2013
Macarthur and Wingecarribee: 2011 marked the expansion of the CERNER Powerchart Electronic Medical Record Pilot Project (eMR) from the Community Nursing Service to include the inpatient unit, outpatient setting and Hospital consultative service. This had led to easier access to the medical record and improvements in communication across care settings. This work has been presented to the Area Palliative Care Service and the Area Nursing Documentation Committee. The Campbelltown Hospital Palliative Care Resource Nurse program was developed and maintained by Colleen Carter. During National Palliative Care Week the Inaugural Area Palliative Care Awards were held to celebrate the achievements of both Specialist & Primary Palliative Care from across the LHD. Macarthur / Wingecarribee featured as winners in:
39
• Excellence in Provision of Primary Care to Palliative Care Clients: Campbelltown Hospital Palliative Care Resource Nurse Program led by Colleen Carter CNC (Margaret Allerton, Maria Horgan, Lynda Marov, Patricia Thompson, Jane Richards, Carol Hicks, Cathy Anthofer)
• Outstanding Contribution to Specialist Palliative Care: Mira Glavan, CNC Palliative Care Wingecarribee, Bowral CHC
We remain extremely well supported by the 24 Hour Fight Against Cancer, Macarthur, assisting with the purchase of equipment and allied health positions for the Day Therapy Centre and transport for patients. The Day Therapy Centre has grown dramatically with the support of our new Diversional Therapist Kate Rogers. The volunteer program continues to grow and deliver direct patient & carer support services as well as promotion opportunities such as National Palliative Care week and fundraising to improve/ enhance our services. We thank them for their tireless efforts.
End of Care Life Pathway (EOLCP) In October 2011 a permanent part time facilitator was employed at Liverpool Hospital for EOLCP. During this time the roll out of the pathway hospital wide has commenced, with ongoing education and support. Palliative care staff specialist education regarding end of life care has commenced on MAU. Respiratory ward (4F) has commenced education on the Pathway. Focus groups have commenced on Vascular (3e) and Coronary Care Unit (3C) education to commence on these wards shortly. Commencement plan for EOLCP for 3E and 3C is the 1st week in August.
Sustainability Daily ward rounds by facilitator with ongoing education and support for wards that already have the EOLCP, with emphasis on communication and symptom management in‐services. 1‐1 education around the use of the EOLCP on a daily basis as required, and support in initiating the EOLCP with medical and nursing staff. Bi monthly meetings with ward linkage nurse. New graduate education sessions and the care of the dying have been given x 3 in 2012. In discussion with new graduate coordinator End of Life care (EOLC) will be a part of their orientation day. Ward educators have begun putting the EOLCP in ward orientation package. Junior Medical Officers each term have a session on EOLC. Six monthly, Claims, concern and issues meetings regarding the EOLCP on each individual ward/unit. The staff is asked to document what their claims, concerns and issues regarding the EOLCP are and these are addressed accordingly with focus groups and education.
Key Performance Indicators The Area service across all sites cares for 1400 new patients per year. There are approx. 1200 deaths per year. Both inpatient palliative care units at Braeside and Camden participate in the national data collection called PCOC (Palliative Care Outcomes Collaboration). The Macarthur region is seeing a growth in the number of referrals <65 years which impacts on families physically, emotionally and financially.
Campbelltown Hospital Nursing Consultancy Service: Growth in referrals; 533 over 2011‐2012 increasing from 471 2010‐2011, with a reduction in the number of non‐cancer referrals from 31.34% to 26.95%.
596
4143
5496
3024
4697
4085
3665
4536
4817
2283
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2008
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2010
2011
Medical
Nursing
Liverpool Hospital Palliative Care
Consultative Service
40
Liverpool Activity New ward consults run at an average of 65‐70 per month with average of 257 medical consultations on the ward each month. Each staff specialist has one clinic per week and see an average of 4 new patients and 10 follow up patients per week.
Research and Education The Area nursing palliative care ABC workshops led by Therese Smeal and Area Bereavement workshops continue to go from strength to strength with newly designed curriculum and positive feedback from participants such as this November 2011
Macarthur & Wingecarribee participate in the LHD Palliative Care Research Program (part of Palliative Care Clinical Studies Collaborative) based at Braeside Hospital and led by A/Prof Meera Agar. Medical Students from University of Western Sydney and University of New South Wales rotate through the Macarthur Palliative Care Service, and University of Wollongong medical students accompany the Wingecarribee Palliative Care team. Nursing students from University of Western Sydney, University of Notre Dame, and University of Wollongong rotate through the Palliative Care Unit, and Allied Health students including Social Work, Occupational Therapy, Diversional therapy and Physiotherapy are attached to team members working across the Palliative Care Service. Excellent feedback is returned by our rotating students. Congratulations to Colleen Carter and Jacinta Humphries for the success of the Inaugural Campbelltown Hospital Resource Nurse Education Day. The team has been involved in the ABC of Palliative Care Nursing Education workshops as well as the Area Palliative Care Quality project on “Patients/Carers experiences of Palliative Care/End of Life Care provision across the LHD: Conversations, stories and reflections‐What Do They Want us to Hear?” Education is provided for staff and families on Liverpool wards on a one to one basis and formal education on Palliative care is given on the wards on a regular basis by the palliative care RN’S. Education is given fortnightly to new nursing staff at their hospital orientation by the CNC. There is also education given to New grads within their education programme by CNC. The CNC with other Palliative care CNC’S in the area provides education within SSWAHS for community and hospital staff at ABC education days. We have started using the new NIKI T34 syringe driver and there is education being given to all the wards. There is a quality project being done around the education in the use of syringe drivers. Targeted nursing education has been given to ED, MAU and Oncology. Palliative Care have been participating in the combined education programme for medical and radiation oncology registrars as well as palliative care registrars, basic trainees and RMO’s. These sessions are teleconferenced to both Campbelltown and Wollongong. Eight lectures are presented across the year on core palliative care topics such as analgesia, neuropathic pain, gastrointestinal symptoms, terminal care. In addition to this there have been bimonthly groups of medical students from UNSW who attend clinic and ward rounds over a 2 day period to gain an insight into the role of palliative care and to write up a case report on a patient focusing on their experience of illness. Rotating basic trainees are also given teaching rounds possible and sessions on the core topics fitting around their clinical load. This year we have had 4 UNSW ILP students attached to Palliative Care for 4 months and supported them in research projects in Palliative care. Dr Jennifer Wiltshire as Lead Clinician in the End of life care project has given a series of education sessions to Senior and junior medical staff across all clinical streams.
“Thank you for your hard work and effort .in
producing the ABC of Palliative care course. I’ve been to many courses but this stood out as one of the best… you have inspired me
to keep nursing!” (RN Campbelltown)
41
Quality Projects • Carers/Patients experiences of Palliative Care/ End of Life Care provision across
the LHD “Conversations, Stories and Reflections – What do they want us to hear?” Janeane Harlum/ Nicole Girotto
• Family Evaluation of Palliative Care NSAP – bereavement tool – Postal survey • Effectiveness of a Pilot quality improvement strategy to support transition of the
new NIKI T34 syringe driver in Liverpool Hospital Charmaine O’Connor • AUDIT OF CHAIN ‐ Community health access intake Nursing Naomi Ellis • Implementation, education, audit of EDL Care and roll out of Pathway Jodi
Peronchik, Dr Jennifer Wiltshire. • Development of Palliative Care information Pack for RACF and GP’s on discharge
Jodie Peronchik; Dr Thang Huynh; Val Wellar; • Bereavement Follow up and satisfaction Survey: Gerald Au, Stephan Durlach
Challenges A significant challenge for the Area Palliative Care service, in general, is maintaining existing staffing and looking for opportunities to grow as demand outweighs resources. We strive to look for new models of care that will support primary providers to care for dying patients in a dignified and caring manner. A significant challenge for Macarthur Palliative Care service is meeting increasing demand for services in the face of population growth, especially considering the relative youth of our population. The Macarthur & Wingecarribee population is growing dramatically, and whilst the re‐development of Campbelltown Hospital is planned, it is unclear what enhancements will be available for palliative care. Distances travelled to provide a domiciliary service impact on staff occasions of service: Macarthur & Wingecarribee account for > 92% of the area of SWSLHD. These distances also make it inefficient for the Area Palliative Care Community Service Registrars (based at Braeside Hospital in Prairiewood) to significantly service the southern sector population. As there are only 10 inpatient beds to service this growing population, strict limits are set to define the patient population that would most benefit from admission to the Palliative Care Unit. However as >80% of our inpatient admissions are under the age of 70, there are limited options for longer term care for this group. Waiting times to outpatient clinic appointments is an issue, with many patients requiring admission before they can be seen. Senior Medical Staffing is limited, with only 2.1 FTE covering the entire service. Enhancements to our specialist nursing profile will be required to maintain accreditation of the Advanced Trainee Position in Campbelltown hospital.
42
Even with much appreciated resource enhancements, Liverpool will still be staffed at levels below national (PCA 2012) and international (Nice, UK gold standards 2009) guidelines. Therefore matching need, demand and resources will remain a challenge. Paediatric and adolescent palliative care remains an area of need; Space and staff accommodation; Lack of designated social work, psychology, allied health; Admission Policy which is accessible rather than blocking but clear criteria to match patient needs and resources to avoid immediate overloading of service; Trying to apply principles of whole‐person care which underpin Palliative Medicine in an acute Hospital setting and providing services 2 across sites with mismatched budgets.
Future Projects/Expansion of Services The establishment of a new LHD committee led by the CE to work towards improved end of life care and advance care planning across the district is welcomed by the Palliative Care Service. The Liverpool End of Life Care Pathway may soon be initiated at all facilities across South Western Sydney. The COAG funding for 2012 has allowed development of a Residential Aged Care Facility program for specialist palliative care medical and nursing to provide regular consults and education. Recruitment for positions is currently underway The Macarthur Community Palliative Care Nursing Service is awaiting enhancement with 2 COAG funded positions – one is a specialist palliative care nurse for the community service, and one is a specialist palliative care nurse position to provide support to the Residential Aged Care Facilities. Benchmarking of the Hospital Consultancy Service with Liverpool has commenced, with planned expansion to include data from the Concord Repatriation General Hospital. Whilst Campbelltown Hospital will undergo redevelopment over the next 4 years, it is not yet clear as to whether there will be significant enhancements for the palliative care service Recruitment is in process for three staff specialists in preparation for the opening of a 20 beds inpatient unit by 2013 and an expanded consultative service, developing partnerships in non‐cancer domains such as renal, ICU, respiratory, Cardiac and degenerative conditions. We also hope to develop palliative care paediatric and adolescent services.
Commencement of the "Pathfinder" A newsletter to discuss where the pathway is up to and sharing of stories amongst staff
Intranet site for resources and linkage to education material for the care of the dying.
Update pathway to version 12 in line with Liverpool UK pathway. Waiting on correspondence regarding version 12.
Ongoing auditing and benchmarking
Commencement of committee to oversee governance of EOLCP.
Assistance from CEWD.
Liverpool 20 bed inpatient
Palliative Care unit to open in 2013
COAG funds Macarthur Community Palliative
Care Nursing
43
Grants
Funding body Chief Investigators Title of Project
PaCCSC A/Prof Paul Glare Megestrol Study
University of Queensland Dr Geoff Mtichell Paracetamol Study
Sydney south West Area Palliative Care Service
Dr Meera Agar Methylphenidate for Fatigue Study EACH
PaCCSC Prof Janet Hardy
Flinders University Prof David Currow Ketamine for pain Study
Flinders University Prof David Currow Morphine/Oxycodone Study
PaCCSC A/Prof Meera Agar Risperidone for Delirium Study
PaCCSC Prof David Currow Octreotide Study
Flinders University Ms Kahren White Measurement of Function in Advanced Cancer Patients
University of QLD Prof Geoffrey Mitchell
Pilocarpine for Dry Mouth Study
PaCCSC Prof Patsy Yates Nausea Study 1
PaCCSC Prof Janet Hardy Nausea Study 2
COGNO (NHMRC Clinical Trials Centre)
A/Prof Meera Agar SEED Study
HammondCare Dr Megan Best Lymphoedema Study
Commonwealth Dept of Health and Ageing and HammondCare
A/Prof Meera Agar Dementia End of Life Care Pathway
University of Newcastle (NHMRC)
A/Prof Katy Clark Constipation Study
Volunteers statistics 1/7/2011 – 30/6/2012
Northern Sector Bankstown/Fairfield/Liverpool
Southern Sector Macarthur & Wingecarribee
Occasions of service provided for palliative care patients/carers in Liverpool/Bankstown Hospital, the Camden Palliative Care Unit and Day Therapy Centre @ Camden Hospital
1063 3181
Total No of Home Visits in the community 118 70
Other (includes attendance at meetings, Fundraising initiatives, writing bereavement cards, memorial service, gardening, and attendance on other palliative care committees)
71 322
Total no of hours in face to face visits 734 2098
Total kms travelled to provide the service 2662 13289
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Publications and Research Shelby‐James T, Hardy J, Agar M, Yates P, Mitchell G, Sanderson C, Luckett T, Abernethy A, and Currow D. Designing and conducting randomised controlled trials in palliative care: a summary of discussions from the 2010 clinical research forum of the Australian Palliative Care Clinical Studies Collaborative (PaCCSC). Palliative Medicine. 2011 Aug 15 epub ahead of print Agar M, Draper B, Phillips P, Phillips J, Collier A, Harlum J, and Currow D. Palliative Medicine. Making decisions about delirium: A qualitative comparison of decision making between nurses working in Palliative Care, Aged Care, Aged Care Psychiatry, and Oncology. Palliative Medicine. Sept 9 (Epub ahead of print). Lobb L, Swetenham K, Agar M,and Currow D. A collateral benefit of research in palliative care (letter to editor) Journal of Palliative Medicine Vol 14 Issue 9 Pages 986‐987 Connell T, Griffiths R, Fernandez R, Duong T, Agar M, and Harlum J Quality‐of‐life trajectory of clients and carers referred to a community palliative care service. International Journal of Palliative Nursing Vol 17 Issue 2 Pages 80‐85 Currow D, Burns C, Agar M, Phillips J, McCaffrey N, and Abernethy A Palliative caregivers who would not take on the caring role again Journal of Pain and Symptom Management Vol 41, Issue 4, Pages 661‐672 Davidson P, Jiwa M, Goldsmith A, McGrath S, DiGiacomo M, Phillips J, Agar M, Newton P, and Currow D Decisions for lung cancer chemotherapy: the influence of physician and patient factors Supportive Care in Cancer Vol 198, Issue 8, Pages 1261‐1266 Agar M. Pain and opioid dependence: is it a matter for concern? Indian Journal of Palliative Care. Vol 17, Issue 4, Pages 36‐ 38 To T, Greene A, Agar M and Currow D “A cross sectional point prevalence survey of people whose goals of care are palliative in acute hospitals” Internal Medicine Journal. Vol 41, Issue 5, Pages 430‐433 Dimoska A, Butow P, Lynch J, Hovey E, Agar M, Beale P, and Tattersall M. Implementing patient question prompt lists into routine cancer care in NSW Patient Education and Counselling. 2011. July 6. Epub ahead of print. Connell T, Fernandez R, Griffiths R, Duong T, Agar M, Harlum J, and Langdon R. Perceptions of the impact of health‐care services provided to palliative care clients and their carers. International Journal of Palliative Care Nursing. Vol 16, Issue 6, Pages 274‐284 Currow, D; Agar, M, and Abernethy A. Tackling the challenges of clinical trials in palliative care. Pharmaceutical Medicine. Vol 25, Issue 1, Pages 7‐15 Currow D, Agar M, To T, Greene A, and Abernethy A. Adverse events in hospice and palliative care: A pilot study to determine feasibility of collection and baseline rates. Journal of Palliative Medicine. Vol 14, Issue 3, Pages 309‐314 Hosie A, Fazekas B, Shelby‐James T, Mills E, Byfieldt N, Margitanovic V, Hunt J, and Phillips J. 2011. Palliative care clinical trials: how nurse are contributing to integrated evidence – based care. International Journal of Palliative Nursing. Vol 17, Issue 5, Pages 224‐230 Collier A. How People with Life‐Limiting Illness Construct ‘Safety’ and ‘Healing’‐Results of a Pilot Study to Explore Safe Healing Environments Using Visual Methods’ PhD project‐ 4 ILP students from UNSW doing their research projects with Liverpool Palliative care service
45
Tribute to Susan Hazelton Susan commenced work at Braeside Hospital in 1996 as the first secretary working with Dr Jennifer Wiltshire, Janeane Harlum, Patricia Rebello, Toni Bannon, Lynne Kuwahata and many others. Soon after, she took on the role as Area Palliative Care secretary and quickly became the ‘hub’ of the service. She talked with doctors, nurses, managers, patients and their families on a daily basis and always treated everyone with dignity and respect. Susan always took time to listen attentively, offer advice and assist with finding a solution to a problem. The spare chair in her office was usually occupied by one of us having a chat with her or seeking a kind ear after dealing with a sad situation. Her mentoring of new staff enabled a smooth transition for all concerned. Susan was more than a colleague to many of us; she was a dear friend. Everyone who knew Susan enjoyed working with her, admired her ability to remain calm in a crisis, laughed at her stories and everyone knew that if they did not know where something or someone was, they would say “just ask Susan, she will know.” Susan was very fondly thought of by all who knew her. Susan lived for her family and loved travelling, art and music, gardening and reading. We would like to acknowledge and thank Dr Amanda Goldrick, Dr Mamta Bagia and the Liverpool CTC staff, Dr Diana Adams and Macarthur CTC staff for their care of Susan during her illness. Susan died peacefully in the Camden PCU. To Drs Jackie Kerfoot, Lynne Kuwahata and Amanda Walker, Jacinta Humphries Social Worker, Colleen Carter CNC, Roberta Elston NUM and all the Nursing Staff, Allied Health and volunteers/ ward staff who cared for Susan, we thank you very much. Susan, you are greatly missed but will never be forgotten. Your strength and courage is an inspiration to all of us.
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SWSLHD Radiation Oncology The service provides inpatient and outpatient Radiation Oncology services at Liverpool and Campbelltown Hospitals. There are three standard C‐arm linear accelerators at Liverpool, two at Campbelltown, brachytherapy services at Liverpool, and outreach clinics are provided at Bankstown Hospital and Bowral. In late May 2012 a Tomotherapy unit was installed at Liverpool, the first such treatment unit in NSW and Liverpool is only the second facility in Australia to have one of these units. This Tomotherapy unit allows the helical delivery (as with a CT scanner) of radiation. It allows highly conformal radiation to be delivered to very complex treatment volumes. Along with this machine and existing equipment we have advanced image guided radiotherapy (IGRT) abilities. This machine comes with staffing enhancements which we are in the final stages of completing
Highlights The building works in the treatment and clinic area of Liverpool Cancer Therapy Centre were completed this year. This has resulted in 2 new bunkers. One bunker has the Tomotherapy unit and the second bunker will allow expansion of services in the future. We also have a new procedure room that will allow expansion of brachytherapy services. The MRI research bunker, detailed elsewhere in this report, has been progressing well with significant involvement of many members of our department. The program led by Professor Paul Keall was successful in obtaining a large NHMRC grant. Professor Michael Barton OAM was awarded The Medical Oncology Group of Australia (MOGA)‐Novartis Oncology Cancer Achievement Award. Denise Lonergan was promoted to Associate Professor and received a UNSW Dean’s award for her contribution to teaching. She was also awarded the Royal Australian & New Zealand College of Radiologists Educational Service Award for her significant contribution to Registrar Training. We had one staff specialist, Dr Eng‐Siew Koh, return from maternity leave and 2 staff specialists, Dr Karen Wong and Dr Karen Lim go off on maternity leave. We welcomed Dr Apsara Windsor and Dr Marcus Dreosti to locum staff specialist positions. Our Radiotherapy Quality Improvement Committee and Radiation Oncology Morbidity & Mortality meetings have continued on a monthly basis.
Key Performance Indicators We report our main clinical activity and workload externally to NSW Ministry of Health. This has been stable over the last 12 months. Over the last 12‐18 months we have increased reporting requirements with new performance indicators. At least one of these has driven significant change in patient scheduling and resulted in the majority of patients getting treated within 10 minutes of their scheduled treatment time.
48
0
5000
10000
15000
20000
25000
30000
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011Treatments
Year
Radiotherapy Treatments
010002000300040005000600070008000
2003 2004 2005 2006 2007 2008 2009 2010 2011
No of Patients
Year
New & Follow up Radiotherapy Patients (up to Dec 2011)
New Patients
FU Patients
0
100
200
300
400
500
600
700
800
900
1000
Aug‐0
8Sep
‐08
Oct‐0
8Nov‐0
8Dec‐0
8Jan
‐09
Feb‐09
Mar‐0
9Apr‐0
9May‐0
9Jun‐09
Jul‐0
9Aug‐0
9Sep
‐09
Oct‐0
9Nov‐0
9Dec‐0
9Jan
‐10
Feb‐10
Mar‐1
0Apr‐1
0May‐1
0Jun‐10
Jul‐1
0Aug‐1
0Sep
‐10
Oct‐1
0Nov‐1
0Dec‐1
0Jan
‐11
Feb‐11
Mar‐1
1Apr‐1
1May‐1
1Jun‐11
Jul‐1
1Aug‐1
1Sep
‐11
Oct‐1
1Nov‐1
1Dec‐1
1
SWSCS Rad Onc Oncology Consultations Aug 08 ‐ Dec 11
49
Research and Education We have a Radiation Oncology Research Executive that is chaired by Dr Lois Holloway who is assisted by Ms Shivani Kumar and Ms Vikneswary Batumalai, our two research Radiation Therapists. The executive aims to align our research activity with our research strategic plan. Again this year there has been significant research output with approx 47 publications, 88 conference presentations. For the first time Radiation Oncology has a dedicated Clinical Trials Officer and we hope this will lead to improvements in trial enrolments and administration. Pictured left is the Tomotherapy unit at Liverpool We have contributed significantly to medical student teaching of oncology at both UNSW and UWS.
Liverpool & Campbelltown Hospitals are part of the southern NSW Radiation Oncology Training Network. A/Prof Denise Lonergan is Network Director, with Dr Dion Forstner filling in her absence. Four registrars sat the RANZCR phase 1 exams in 2011 and all passed. Well done to Dr Jeremiah de Leon, Dr Eve Tiong, Dr Eunice Ho and Dr Senthilkumar Gandhidasan.
Dr Marion Dimigen is a diagnostic radiologist who worked with us for 12 months and contributed to several research projects. Her position was funded by our trust fund and UWS. We hope that this position will continue into the future given our convergence with diagnostic imaging and desire for strong clinical and academic collaborations with imaging departments.
Challenges Our OIS (oncology information system) had a major upgrade in 2010 with a further upgrade in 2011, ongoing development work continues to improve the performance of this system. In Feb 2012 environmental factors challenged the integrity of the system, the recovery from this significant event was a credit to our IT staff, led by Ms Nasreen Kaadan. Our services at Macarthur Cancer Therapy Centre are very close to capacity. One of these treatment machines is 9 years old and we will be looking at replacing it in the coming year. Patient transport continues to present logistical challenges, and we look forward to working towards improving access with support from donations and enhancements.
Future Projects/Expansion of Services In the next 12 months we are very keen to install a MRI scanner in Liverpool Cancer Therapy Centre that will be dedicated to radiotherapy planning and research. The funding for this is available but there are number of other barriers to it’s procurement. We are planning to replace the CT scanner at Liverpool with a wide bore 4D CT scanner which will allow us to assess motion of tumours and organs during the planning scan. The larger bore will allow us to scan larger patients, and patients in different positions. With the completion of the building works in the Liverpool Cancer Therapy Centre treatment area we are now in a position to move forward with expansion of brachytherapy services to include prostate brachytherapy.
50
Other techniques we would hope to implement in the next 12 months are i) VMAT (Volumetric Arc Therapy – an arc based delivery of IMRT) on at least one of our standard C‐arm linear accelerators ii) a limited stereotactic service using our Tomotherapy unit. With the implementation of this new equipment we expect that in next 12 months we will see further enhancement of image guidance in the treatment of our patients (IGRT) and move to more adaptive treatments.
Staffing Radiation Oncologists Dr Dion Forstner Professor Geoff Delaney Professor Michael Barton Dr Allan Fowler Associate Professor Shalini Vinod Associate Professor Denise Lonergan Dr George Papadatos Dr Eng‐Siew Koh Dr Karen Wong Dr Mark Sidhom Dr Karen Lim Dr Miriam Boxer Dr Apsara Windsor Dr Marcus Dreosti
Radiation Oncology Research Fellow Dr Timothy Hanna Radiation Oncology Registrars Dr Kim‐Lin Chiew Dr Jeremiah de Leon Dr Senthilkumar Gandhidasan Dr Eunice Ho Dr Chelsie O’Connor Dr Alex Petrushevski Dr Eve Tiong Dr Jacqueline Veera Dr Neetu Tejani (on rotation from Canberra Hospital)
51
‐Medical Physics The Medical Physics group has seen considerable change over the 2011 – 2012 year in a number of areas with physics involvement:‐
Construction of two new clinical bunkers at Liverpool
Expansion of the clinical IMRT treatment program
Commissioning of Total Body Irradiation (TBI) technique
Release of Pinnacle Treatment Planning System (TPS) for IMRT planning
Installation, acceptance and commissioning (underway) of the new Tomotherapy treatment accelerator at Liverpool
Relocation of Liverpool medical physics staff offices to new location
Increasing research activity of staff and students
Design of research MRI‐linac and facility Two new radiotherapy bunkers were constructed during the year with the site handed over to the hospital in May 2012 for installation of the new Tomotherapy accelerator. Installation and acceptance took approximately 3 weeks after which a 2 month commissioning programme commenced.
By means of developing new local techniques of performing patient specific quality assurance (QA) more efficiently the physics group has been able to support increased demand for IMRT treatment. These techniques include software to evaluate the deliverability of IMRT fields as well as analysis of IMRT fields exposed to Electronic Portal Imaging Devices (EPIDs). This has significantly reduced the time required to undertake this necessary QA so that more patient specific measurements can be routinely performed. In preparation for a new allogeneic service at Liverpool Hospital, Medical Physics and Radiation Therapy staff developed the capacity to treat with the Total Body Irradiation (TBI) technique. A renewed effort by a number of the Medical Physics team saw the Pinnacle TPS models for IMRT planning released for clinical use. This has resulted in a number of improvements in deliverability of IMRT, including reduced treatment time for greater patient throughput. Congratulations to Tony Young who completed his ACPSEM Accreditation via its 5 year Training Education Accreditation Program and has since taken on a permanent position with the department as a Medical Physicist Specialist in one of the positions allocated with the new accelerator. Jarrad Begg, one of the teams Medical Physics Registrars, was awarded the other new establishment position. Other staff to join the department are Richard Short and Alison Gray, both previously from Royal North Shore Hospital. During 2011/2012 we have enjoyed watching the research bunker and research building move from plans to reality. Our research group, together with many others, will have dedicated space in the Ingham research building providing space for students, staff and other collaborators which we are all looking forward to. The research bunker will also be completed during the second half of 2012. The Australian MRI‐linac program is building rapidly. Equipment orders for the MRI‐linac have been placed and simulation work to consider design options are well underway by collaborations between the University of Sydney, the University of Wollongong and Stanford University. At the end of 2011 Profs Keall, Crozier and Barton were awarded a prestigious NHRMC program grant which will fund research staff and equipment for the MRI‐linac program from 2013‐2017.
Delivery of
Tomotherapy
accelerator
Tomotherapy after
subsystems attached
to the rotating frame
Gary Goozee Director,
Medical Physics
52
Profs Keall and Crozier were also successful in an NHMRC project grant to consider engineering development for future design options of an MRI‐linac appropriate Magnet. To provide local expertise on MRI, the Ingham Institute has also offered two MRI physicist positions and we look forward to these physicists starting work with us towards the end of 2012. More information on the MRI‐Linac facility is online at http://inghaminstitute.org.au/mri‐linac.html. Research into the use of MRI in radiotherapy generally has also been growing within the department. Drs Holloway, Delaney, Metcalfe, Koh and Vial were successful in obtaining a national breast cancer and cancer Australia grant to investigate the use of breast MRI for the purpose of radiotherapy treatment planning and verification, which was initiated the beginning of 2012. Studies into MRI image distortion and the impact of this on radiotherapy treatment planning have also been commenced as well continuing work assessing the impact of contour variation resulting from improved imaging modalities. Work on the assessment of cone beam CT dose has also continued including collaborative work with the University of Madison, USA. Patient safety and quality assurance is another active area of research with a number of projects assessing uncertainties in radiotherapy processes and development of methodology and equipment to reduce these. Dr Vial and collaborators are continuing to develop and assess design options for a next generation electronic portal imaging device working to achieve high quality patient imaging and dose verification during treatment. Dr Aruguman and others have also undertaken a number of projects to streamline radiotherapy quality assurance processes for advanced techniques such as IMRT and VMAT as well as developing methodology to simulate the impact of uncertainties, providing information on how our practices could be improved. Within the group we currently have 7 PhD students and 3 Masters students together with the majority of the clinical group actively involved in projects. We have also benefited from the regular involvement of Professor Peter Metcalfe from the University of Wollongong and ongoing collaborations with the University of Sydney. We are looking forward to seeing our group expand further as our research projects develop.
Above: Testing TBI couch & setup
Below: Conceptual design for MRI‐
linac
Physicists on the
commissioning team
53
‐Radiation Therapy
2011/12 has again been a busy time for Radiation Therapy at Liverpool and Campbelltown Hospital and we continue to provide a high quality service with great Quality and Research activities. There has been a small staff turnover due to some colleagues moving on to other roles elsewhere, but in the main our service is expanding, including the additional nine enhancement RT positions that accompanied the new Tomotherapy linear accelerator, bringing our establishment up to nearly seventy RT staff now.
Staffing levels have been maintained at or near maximum in order to maintain service provision, including the back‐fill positions to cover maternity leave or reduced hours working. Our staff profile is changing with time as many more RT’s now are juggling their carers responsibilities for their young families with their professional responsibilities here at work and the impact of this on the RT workforce overall is acknowledged.
In addition to promotion opportunities with the new positions, Higher Grade Duty opportunities have again been available and it has been fantastic to see people stepping up into these more senior roles and performing excellently. Several staff have also gained their personal re‐grades to level 3.
Six new graduates completed their national professional Development Programme Year with us in January 2012 and moved on to their next roles in the RT workforce, some here & others elsewhere. Six more new graduates joined us and are also progressing well through their NPDP year, including maintaining the close links forged with RPAH over the past few years by rotating through both departments during the course of their 48 week programme.
Highlights We have consolidated improvements in patient care and continue to participate in the NSW Health Essentials Of Care programme as one of the few non‐nursing participants.
The redevelopments at Liverpool have provided us with significant challenges and all staff must be praised for continuing to provide excellent patient care in difficult circumstances as the Radiotherapy department continued to function in the centre of a building site. Now that the renovations are complete, Computer Planning, RT offices etc have all relocated to the nearby Grimson building and the two new clinical bunkers have been handed over.
Key Performance Indicators RT staff have continued to provide regular reports of activity to both internal and external committees, including the RMIS and Operational Performance Measure reporting to NSW Health. These statistics have shown that our service is very comparable to others benchmarked around the state and can meet & report on KPI’s as required. RT staff (particularly Daniel Moretti & Nasreen Kaadan) have been instrumental in writing custom reports that are able to extract this required information from the Oncology Information System and some of these reports have been able to be shared with other departments e.g. the reporting of the percentage of patients that are treated within 10 minutes of their scheduled appointment times was not possible before.
Consolidation and
improvements in
patient care, despite
the challenges of the
LCTC redevelopment.
Lynette Cassapi Director,
Radiation Therapy
54
Research and Education Over the year and during the redevelopment, many research and development projects have continued. Many projects are ongoing in collaboration with the Medical Physics & Radiation Oncology teams in preparation for the completion of the Ingham Institute & particularly the Research Bunker with its MRI / Linear accelerator project. These projects often require the staff involved to put in additional time outside standard working hours in order to gather and analyze the required data and these efforts are acknowledged.
Other staff have worked in multi‐disciplinary groups to ensure that we have a Total Body Irradiation (TBI) service developed and ready to commence clinical delivery, in conjunction with the new Bone Marrow Transplant team, and of course there is the Tomotherapy implementation group. This is the team of Radiation Therapy, Medical Physics and Radition Oncologist staff that have been preparing the department for the arrival of the new Tomotherapy linear accelerator (the first in NSW & only the 3rd in Australia). The team have undertaken site visits both nationally and internationally, prepared protocols, commissioned equipment and are ready for the clinical commencement of this new unit in late August 2012.
Research & development projects also continue in many other areas of the department with many presentations being made at conferences during the year. These include many diverse topics such as Lung RT, IMRT, IGRT, CBCT, Breast RT, patient Immobilisation, Imaging, Prostate RT, workflow & BTE measurements.
Challenges We aim to continue to integrate the Pinnacle computer planning system into daily use in the department, not just for IMRT treatments, plus have the challenge of integrating our third linac vendor into the department (Tomotherapy). This has it’s challenges for staff orientation and training, but with the purchase and use of the Knowledge Presenter software programme, our Radiation Therapy Educators are working with key RT staff and striving to make as much of our in‐service and routine educational materials available online as possible. This is now being rolled out for all core educational activities and will greatly assist us to maintain consistent standards of education when rotating staff between our two departments and between the different equipment vendors.
The Radiation Therapy team is also looking forward to working with the expanded Radiation Oncology nursing team as they settle into their new Radiation Bay facilities and anticipate the collaborations that will come from expanded joint service provision. Pictured left is the tomotherapy unit installed in its new clinical treatment bunker, with the installation team.
Future Projects/Expansion of Services Over the next 12 months we hope to continue to consolidate our clinical service with the introduction of Tomotherapy and TBI. We also look forward to purchasing an MRI Scanner for Planning use and replacing the Liverpool CT Scanner with a big bore 4DCT in the coming months and the associated benefits to our patients that these new imaging modalities will bring.
We also look forward to developing a stereotactic service in conjunction with the Tomotherapy unit and to development of the VMAT software on the existing linacs. The staffing enhancements for radiation therapy have also allowed the recruitment of a Head of Quality position and a Brachytherapy Specialist post.
These two roles will allow us to strengthen our Service in these areas and expand safely into new sites and techniques.
Key educational
materials now
online to assist
staff with multi‐site
and multi‐vendor
challenges
55
All together, the future for our service is very bright and with the fantastic Radiation therapy staff employed here, we can continue to offer outstanding care to our patients now & into the future.
Radiation Therapist Staffing Lynette Cassapi Daniel Moretti Nicole Cusack Kirrily Cloak Joanne Veneran Rebecca Ko Andrew Wallis Christine Tawfik Odette King Annie Lau Alison Dunning James Latimer Somkhit Rattanavon Jim Yakobi Shivani Kumar Vicky Batumalai Carol Nguyen Melanie Rennie Skye Blakeney Vanessa Leong Sarah Payne Judy Plante
James McKay Minh Ngo Hung Nguyen Kathy Andrew Giselle Condos Joanna Falkowski Alicia Haman Cindy Hills Ewa Juresic Sarah Keats Thien Le Cara McKibbin Ashika Maharaj Cesar Ochoa Danielle Parrot Penny Phan Megan Ryan Adrianna Scotti Reyna Stirton Admir Trtovac Sandie Watt Adam Zammit
Carly Ballard Callie Choong Glen Dinsdale Janelle Hardie Leisa Holmes Josip Juresic Sonny Tin Lok Lai Lucy Ohanessian Steven Tran Aminata Bangura Josh Sams Fahim Siddiqi Tess Vuong Shirley Zhang Lara Nguyen Mitchell Galayini Rohan Gray Mark Udovitch Andy Lai Nicholas Livio John Park
57
SWSLHD Consumer Participation Committee
This committee was established to enhance consumer engagement in the development of improved models of care and cultural changes within the health system. As well as providing direct input, members will act as a conduit to key community groups where more detailed consideration of particular services and programs is required. It’s Terms of Reference are:
To provide advice on needs, demands, and service development from a consumer perspective whilst harnessing community support for cancer services.
To develop and monitor the implementation and effectiveness of community representation in the governance of cancer services.
To assist the current Cancer Services Council and Executive in their communication with the SWSLHD services, community and consumers.
To advise the Cancer Services Council and Executive on major strategic issues and initiatives.
To participate in the Cancer Services Council and Executive broad strategic planning and service development processes.
To assist the Cancer Services Council and Executive in the development and ongoing monitoring of key performance indicators for service quality and accessibility.
To encourage consumer engagement in research ‐ especially in the matter of communication to patients and other consumers
Progress so far Some of the issues discussed have already had positive outcomes that have been contributed to by the community participation group.
Customer service program at Liverpool Cancer Services
Suggestion boxes – Wishing Wells arranged through contacts within the group.
Patient satisfaction surveys & experience trackers reports reviewed by group to assist in providing input into solutions.
Staff feedback reviewed by the group.
Improving patient experiences
Patient diaries & information folders being developed by Education committee – feedback (pictured).
Aboriginal awareness framework discussed, and grant application developed from members within the group.
Carers action plan reviewed for information.
Wellness Centre / accommodation for patients who need to travel long distances for treatment – ideas on inclusions in the facility, and fundraising suggestions.
Chair, Laurel Peel
58
Dry July –Liverpool participation in fundraising, and ideas around use of the funds.
CanRevive – chinese support group is expanding into Liverpool/Macarthur, to provide links for this patient group.
Affects of the redevelopment at Liverpool – revitalisation of courtyard, information displayed.
Patient information
Co‐ordination of Volunteer services & information booth.
Improving access to services
Patient Transport – issues & solutions, including Buses, community transport & volunteer drivers.
Parking – council carpark passes.
Web‐based patient follow up systems/email/web forums
Community centre treatment plans.
Consumer health forums that provide training for consumers.
Strategic planning priorities for SWSAHS, highlighted the upcoming issues for the group.
Cancer Services Strategic plan was circulated articulating the goals for the service over the next few years.
Networking with NSW Cancer Council and local community groups on cancer control initiatives and opportunities
Redevelopment and expansion of the information kiosks at LCTC.
Patient and Staff evaluation of information kiosk
Expansion of CCNSW trained volunteers
Patient information packs on screening, prevention, treatment & care
Monthly nutritional inservices by CCNSW.
CCNSW/Allied health meetings Liverpool/Bankstown
Members Laurel Peel (Chair) Elaine Crockett Janet Harrison Janice Low Jenny Chau Joan Lewis John Newson
Geoff Delaney Sandra Avery Lynda Johnston Monica Vasques Ron Delaney Pino Coppola Leanne O’Grady
Narelle Barnett
59
The Chemotherapy
enhancement project
delivers automated
collection of guideline
protocols to the Clinical
Cancer Registry
SWSLHD Cancer Information Program The Cancer Information Program reviewed its structure this year, following the transition of health services to local health districts (LHDs). SWSLHD will continue to host the Clinical Cancer Registry program for SWSLHD and SLHD, collecting disease, staging, treatment and quality of care information for patients seen within the public sector. A major review of the SWSLHD Information Technology and Support service saw a new governance structure implemented to improve communication and support. The new look program will incorporate the Clinical Cancer Registry, SWSLHD Oncology Information Systems and Cancer Information Management and Technology Support groups, all working towards the same goals for supporting patient information systems.
Highlights Quality improvement projects are ongoing, to review and audit data that improves source information in cancer systems. • The registry participated in a major quality project linking Central Cancer
Registry and admitted patient databases. • A collaboration between Sydney Cancer Centre Breast Surgical group and the
registry was created to expand the registry scope and incorporate the National Breast Cancer Audit in its database for this group.
• A successful grant of $30,000 was used to develop electronic notification to NSW Cancer Registry of a NSW Medical Oncology dataset extension. This will provide more robust reporting on guideline protocols, and has led to a paperless prescribing project, to improve electronic workflow for clinicians.
• Palliative care EMR was piloted this year, and plans are in place to roll this out across the SWS & SLHDs.
• Hospital electronic medical record (EMR) interfaces from Radiation systems were successfully implemented this year, from Aria, making treatment and scheduling information available to clinicians in all facilities.
• Mosaiq documents are now available in hospital EMR. This project successfully loads dictated correspondence, multidisciplinary team meeting discussions and radiation therapy summaries to the hospital information system, ensuring a comprehensive clinical record across the LHD.
• Registry and Haematology departments have commenced work on data collection for Bone Marrow Transplants at Liverpool Hospital.
• Both the registry database (Metriq) and the web‐based casefinding and data collection application were upgraded in 2011
The Cancer Information Program aims to provide a robust source of cancer
information, enabling the monitoring of cancer trends, activity and
patterns of care for planning and improvement of service delivery and
quality of care for our patients
60
Key Performance Indicators
Challenges Improving the utilisation of electronic medical records is the key to improving the timeliness and quality of information around cancer treatment and outcomes. However, increasing utilisation of systems such as MOSAIQ puts pressure on the infrastructure of the system, that requires constant maintenance. Clinician‐reported data requires electronic data fields being entered into the appropriate systems. There is a lot of work being done by multi‐disciplinary groups in NSW, in particular the Liverpool GU, CRC & UGI, and Breast & Thoracic groups at RPAH, and Haematology at Concord. This is reflected in the quality of reported data at these tumour group meetings. Transition proposals and service level agreements have been established between SWSLHD and SLHD to host the Clinical Cancer Registry in one LHD. This will provide standard data collection and continuity of access to information for both LHDs.
0 2000 4000 6000 8000 10000
Upper GI
Neurology
Melanoma
Haematology
Genitourinary
Breast
Surgery
Radiation
Chemotherapy
Horm/Immuno
Other
No Treatment
The registry is funded by
the CINSW to capture the
Minimum Data Set for all
cancer patients, to
improve standardization
of outcomes.
The database has
collected disease and
treatment information for
over 30,000 tumours
diagnosed from July 2005
to December 2010 for
SWSLHD and SLHDs these
graphs show a cross
section of these tumours
by gender and treatment
type.
61
Research and Education
Congratulations to Sandra Farrugia (left), who completed her Bachelor of Science in Health Information Management (Curtin University WA) in 2011.
Elekta hosted their inaugural user group meeting this year, for Metriq cancer registry users in Australia and New Zealand
Several presented posters were co‐authored by registry & OIS staff during the year, and can be found on the Cancer Services research website: http://www.sswahs.nsw.gov.au/sswahs/cancer/: Clinical Oncological Society of Australia (COSA) 2011 Annual Scientific Meeting in November in Perth, WA • Surgical management of patients with primary colorectal cancer over 12
years in the South Western Sydney Local Health District public hospitals: M Sharmin, A Berthelsen, M Morgan
• Radiotherapy utilisation in rectal cancer patients: 12 year data from the South Western Sydney Local Health District Clinical Cancer Registry M Sharmin, A Berthelsen, M Morgan, A Fowler, S Avery
World Lung Cancer Convention (WLCC) 2011 Amsterdam • Treatment patterns for lung cancer in South Western Sydney, Australia: Do
patients get treated according to guidelines. K Duggan, SK Vinod Annual Scientific Meeting and Trade Exhibition of the HAA 2011 Sydney • Multiple Myeloma, Plasmacytoma and Extramedullary plasmacytoma:
Incidence within Sydney South West Area Health Service from July 2005 – June 2009 J Prakash, K Duggan, S Ling, D Rosenfeld, L Dunlop, AM Watson, P Motum, L Lin Ho, N Viiala, M Harvey
Elekta Australasian Users Meeting in Sydney – August 2011 • Mosaiq Reporting in Practice Nasreen Kaadan ASMMIRT in Sydney – February, 2012 • Optimising the Use of Automated Capture of Treatment Appointment Times
in Mosaiq – Creation of a Dynamic Treatment Schedule D Moretti, A Wallis
Future Projects/Expansion of Services The SWS & SLHD Clinical Cancer Registry has been working with the CINSW on the NSW Cancer Registry (NSWCR). This world‐first amalgamation of clinical and central cancer registries is an exciting and challenging new direction. Launched in June 2012, the benefits will include a more comprehensive database and reduction in the duplication of data collection effort across the state. The registry staff continue to play an important role in system development, user testing and documentation of procedure guides, to support the migration to NSWCr. The Clinical Cancer Registry will align with researchers in the new Ingham research institute building at Liverpool, scheduled to move in 2012. Development of the Oncology Information Systems continue in 2012, to improve clinical access to information, including further linkages between cancer systems and the area electronic medical record. MOSAIQ is scheduled for a major upgrade for ongoing vendor support, and to improve functionality, output and capacity for images and stability, and is necessary for the connectivity of new Tomotherapy machine. A major project that is currently underway is the import of laboratory results into Mosaiq, providing clinicians with improved decision support for patients’ cancer and/or disease management.
MDT groups are
putting in a lot of effort
to collect data, but
there’s still a long way
to go for electronic
data, and the pressure
on infrastructure is
exponential.
After the Mosaiq
upgrade, many projects
will be completed and
new ones started
including Lab Results
import, Wireless
Connectivity and
Email/Faxing
correspondence
62
Wireless network connectivity is planned to be complete in 2012/13 in Cancer Services at both Liverpool and Campbelltown taking patient care to the bed‐side and into the waiting rooms
Staff who make it happen… Many staff have contributed to the program this year, and fall under the governance of either the Cancer Information Program Committee or the IM&TD Committee, these two groups will merge in 2012.
Cancer Information Program Manager Nasreen Kaadan/Sandra Avery Chair Professor Geoff Delaney, Director, SWSLHD Cancer Services Members Amanda Turville, IMTD Manager Brigid Gaffney, Lifehouse Fida Hajar, Team Leader, Bankstown
James Nguyen, Palliative Care Stephen Della‐Fiorentina, Director, Macarthur Cancer Services William Liu, Radiation Oncology, RPA Phan Sayaloune, Data Manager John Newsome, Community Anurag Giri, IT Support, RPAH
IM&TD Committee (Liverpool/Macarthur) Chair Dr Allan Fowler, Radiation Oncologist Members Lynette Cassapi, Director, Radiation Oncology Gary Goozee, Director, Physics David Warner, Janice Warner, Brad Watson, IT Support
Phan Sayaloune, Data Manager Oncology Information System (MOSAIQ) Team (Pictured left) Nasreen Kaadan, Callie Choong, Thanh Tranh, Vikneswary Batumalai
Clinical Cancer Registry Team Kirsten Duggan, Sandra Farrugia, Mahbuba Sharmin, Nathaya Muadjienga, Angela Berthelsen, Joyiti Prakash, Isobelle Anscombe, (Pictured below) also part of the team were Christine MacDonald, Sandra Avery & Nasreen Kaadan.
63
SWSLHD Education Committee The Education Committee has a dual focus, the first is on patient education, ensuring the right information is provided at the right time for patients. The other is on staff education and development, to ensure our staff have the skills required to deliver the highest quality care within their service.
Patient Education & Information The Education committee was revamped in March 2011 and has broad representation from facilities, clinical and non‐clinical disciplines across the LHD. The primary focus of the group is to monitor, implement and review the educational material provided to cancer patients in SWSLHD. Ensuring information is up to date, in a language/format that can be understood by the reader, delivered at the right time and is appropriate for each individual is fundamental to the cancer care provided by the LHD. The group performed an extensive review of all material that was provided to cancer patients and have developed a core set of information/education resources that are relevant for all patients irrespective of tumour type or treatment plan. Staff education is also important, and there have been several projects underway this year. Wednesday multi‐disciplinary education sessions have exposed staff to a variety of clinical and cancer‐related speakers, a list is attached. The Administration staff undertook a Customer Service Program, to improve the patient experience when they meet our staff
Highlights The highlight for the committee to date is the development of a ‘patient diary’. The diary will be given to all new cancer patients across the LHD and will assist both staff and patients in the transfer of information. The diary is an A5 ring binder divided in to 4 main sections; general; first appointment; treatment; post treatment. Plastic sleeves, business card holders, loose leaf paper as well as the relevant information sheets will be assembled into the folder and the patient will be asked to bring the folder to any appointments or treatment sessions related to their cancer diagnosis. Staff will be able to determine what information each patient has been given and/or what is required and the patient will have information that is easily accessible when needed.
Key Performance Indicators A patient survey was developed and distributed to patients across the LHD. Over 150 surveys were returned and the results were good, however there were areas identified for improvement. For example approximately 30% of those surveyed were not always able to understand the information they were given and approximately 17% indicated that they did not receive information regarding the dietician but would have liked to. This survey will be repeated 6 months after the diaries have been introduced to ascertain if this focused approach to patient education is addressing some of the gaps identified
Patient education has
been a major focus and
staff education
continues to be a high
priority
Patient diaries will be
given to patients to assist
with transfer of
information
64
Challenges The committee has over 40 current members and hence meetings have been challenging at times to coordinate. Access to videoconferencing and 2nd monthly meetings has assisted the group with attendance and reduced travel times for those coming from other facilities. The sheer volume of information available for cancer patients is daunting and the committee members were required to be extremely diligent when reviewing the type and content of the information they felt should be included in the core package. The inclusion or exclusion of information will remain an ongoing challenge for the group to ensure evidence based information is at the forefront.
Future Projects/Expansion of Services An evaluation of the diary is planned approximately 6 months after implementation. If the outcomes from the patient diary are as positive as expected the group is planning to develop a ‘Carer diary’ to specifically target the educational needs of carers.
Committee members Aaron Manson Amy Wholohan Brigida Sbezzi Candice Baxter Charmaine O’Connor Colleen Carter Denise Burns Gai Fairnham Gerald Au Jacinta Humphries Janice Low Jayne Robinson Jeanette Suurdt Jodie Peronchik Judith Merry Karen Clark Karl Jobburn Kate Carlin Katherine Bell Lenore Knapman
Luci Dali’Armi Maree Cain Mariad O’Gorman Melanie Rennie Michelle Forbes Nasreen Kaadan Patricia Mason Patrick McQuaid Pharmila Sapkota Rebecca Grundy Rebecca Ko Rosemary Craft Sharelle Ioannou Sharon Linden Susan Connor Tania Luxford Teresa Simpson Vicki Buglass Vy‐Vy Tran Wafa Trad
65
Staff Education & Development Programs A weekly multidisciplinary journal club gives all staff an opportunity to develop their skills and knowledgebase through a variety of seminars and presentations from nursing care to research and corporate mandatory education.
Journal Club Speakers Topic
Mel Grand / Lynette Cassapi Radiation Therapy TROG ANROTAT Project / Research and Development
Alexander Petrushevski Radiation Oncology Registrar
Cardiac effects of breast radiotherapy
Dr Anand Karvat Clinical Assistant Professor Department Head: Radiation Oncology, British Columbia Cancer Agency
IMRT For Prostate Cancer: BCCA Experience
Astrid Przdzieczki Clinical Psychologist Psychological Distress, Body Image and Self‐Compassion
Kathy Chapman NSW Cancer Council: ENRICH programme
Benefit of Nutrition and Physical Activities for Cancer Survivors and the ENRICH Programme
Dr Donald Angstetra Gynae‐Oncology Fellow 12‐Year Retrospective Review on Management of Early Uterine Cancer: Laparoscopic‐Assisted Vaginal Hysterectomy (LAVH) versus Total Abdominal Hysterectomy (TAH)
Dr Jason Dowling Professor Olivier Salvado Royal Brisbane and Women’s Hospital
CSIRO Biomedical Imaging research focussing on radiation therapy treatment planning
Daniel Moretti / Sandi Watts Deputy Director of Radiation Therapy / Radiation Therapist
Improving the patient flow / Soft tissue matching with cone beam
Kirsten Duggan Cancer Registry Treatment patterns for Lung cancer – SWSAHS
Ariyanto Pramana Radiation Oncology Registrar Molecular Imaging–Based Dose Painting
Annabel Goodwin Cancer Geneticist Family History of Cancer‐Role for genetic testing
Connie Diakos Medical Oncology Registrar Osteoclast Inhibitors in Metastatic Cancer
Apsara Windsor Radiation Oncology Staff Specialist
Characteristics and outcomes of whole brain radiotherapy for brain metastases
Sandy Ho Radiation Oncology Registrar Management of Endometrial Carcinoma
Merran Findlay Dietitian New EBP guidelines for nutritional management of H+N cancer
Daniel Moretti Deputy Director, Radiation Therapy
Planning QCL Review
Queenie Low & Liz Radiation Oncology Staff Specialist
Update of the cardiac ECHO study
Melanie Rennie Radiation Therapist XVI Training with Knowledge Presenter
Kate Webber Cancer survivorship and an introduction to the NSW Cancer Survivors Centre.
Sayed Ali Medical Oncology Staff Specialist Ipilumimab ‐ new frontier in managing cancer and a medical oncologist nightmare
Tania Luxford NUM Cancer Services Triage Assessment Nurse
Dr Florian Sterzing University of Heidelberg, Germany
What can we do with tomotherapy?
Michael Barton Radiation Oncology Staff Specialist
Frequent Flyers: Retreatment by radiotherapy
Peter Fox Medical Oncology Registrar Updates From ESMO
Carol Doherty / Diana Ngo Nurses Essentials Of Care: Assessment Nurse / Buzzer System
Letitia Lancaster Gynae Onc CNC ‐ Westmead Hospital
Palliative Care In India
Richard Short Physicist Xio / Focal 4.62 Update
Rachael Beldham‐Collins Radiation Therapist Research Coordinator, Westmead Hospital
Large Breast Immobilisation Study
66
Journal Club Speakers Topic
Diana Adams Medical Oncology Staff Specialist Advances in Management of Castrate Resistant Prostate Cancer
Karl Jobburn Haematology CNC Multiple Myeloma ‐ Are you sure it is a leg ulcer?
Andrew Truscott OH&S Coordinator Manual Handling
Maria Karkousi Acting Medico‐Legal Manager Health Information Privacy
Mary K Gospodarowicz Clinical Studies Resource Centre Member, Ontario Cancer Institute ‐ Clinical Department Head
Urological Malignancies
Andrew Wallis Radiation Therapist Pinnacle Tutorial
Nick Coupe Medical Oncology Registrar Neuro‐Endocrine Tumours
James Kelly Radiation Oncology 4th Year Medical Student
Timelines in Diagnosis and Treatment of Lung Cancer in SWS
Katherine Kelly Speech Pathologist Speech Pathology Clinical Indicator Trial in Head and Neck Oncology
Dr Raj Aggarwal Palliative Care Staff Specialist Prognostication
Kathy Schofield / Maureen Bainbridge Palliative Care CNC / Community Health Nurse
Community Nursing in SWS
Chelsie O'Connor Radiation Oncology Registrar Adjuvant Radiotherapy for Pancreatic Cancer
Assoc Prof Winston Liauw Medical Oncology Appendiceal neoplasms and peritoneal mucinous neoplasia: More than just colon cancer
Alison Zhang Medical Oncology Registrar Radiation‐induced sarcomas
Dion Forstner Radiation Oncology Staff Specialist The outsiders view – what we report
Phil Vial Medical Physicist Development of novel devices for improved radiotherapy treatment verification
Amy Walker Physics Student MRI distortion: Investigation of considerations for radiotherapy treatment planning
Brendan Whelan Physics Student A proposal for a rotating couch design and assessment
Eunice Ho Radiation Oncology Registrar Patients from culturallyand linguistically diverse (CALD) background: What are the issues?
Kelly Mok Medical Oncology Staff Specialist Skeletal metastases in women with breast cancer
Sue Warren Radiation Oncology Clinical Evidence for TomoTherapy
Shalini Vinod Radiation Oncology Staff Specialist Multisource feedback for Radiation Oncologists
Weng Ng Medical Oncology Staff Specialist Do you get the GIST?
Carl Miller Gynae Oncology Staff Specialist So what is HE4?
Rebecca Strutt Palliative Care Staff Specialist The cost of cure
Florian Honeyball Medical Oncology Registrar The history of statistical significance
Alex Petrushevski Radiation Oncology Registrar Androgen deprivation therapy for advanced prostate cancer
May Mak Dietician What have I missed? Why is my patient still losing weight?
Dr Michael Robertson Clinical Assoc Prof, Centre For Values & Law in Medicine, University of Sydney
The multiple faces of risk
Kim Faulkner ev‐iQ Radiation Oncology Coordinator
Overview of the eviQ Management and Guidelines for the use of IV Contrast in Radiotherapy Planning
Ross Hughes Security Manager Mandatory Training – Security
Neetu Tejani Medical Oncology Registrar Merkel Cell Carcinoma
Erin Moth Medical Oncology Registrar Cancer and Coagulation
Professor Franz University of Amsterdam (Institute of Phonetic Sciences)
Oncology related voice and speech disorders, especially in laryngectomized individuals
67
Neuro‐oncology Group Clinical Professional Day (CPD) The inaugural COSA (Clinical Oncological Society of Australia) Neuro‐oncology Group Clinical Professional Day (CPD), was held on Friday, March 9th 2012 at the Sydney Convention and Exhibition Centre. The Day was programmed in conjunction with the Royal College of Pathologists of Australasia (RCPA) ‘Pathology Update’ 2012 and the ‘Genetics and Genomics in Personalised Medicine’ Conferences. The title for the day’s program was “Brain Tumours: New tools for Diagnosis, Treatment and Research”. Two of the world’s leading clinicians in the field of neuro‐oncology were our international guest speakers: Professor Martin van den Bent, Neuro‐oncologist, The Netherlands, and Professor Paul Kleihues, Neuro‐pathologist, Switzerland. There was also a host of prominent Australian multi‐disciplinary speakers involved in the management of brain tumour patients. Specific topics included:
Pathological diagnosis and biomarkers in Glioma
The definition of primary and secondary glioblastoma
CNS tumours ‐ RCPA structured reporting protocol
Established and potential roles for PET imaging biomarkers in glioma management
Use of 5‐ALA in glioma resection
Informational needs & quality of life in brain tumour patients
The impact of neuro‐oncology Care Coordination
Managing Glioma in 2012: are we ready for personalised medicine? (includes an interactive panel discussion).
There was an excellent response from health professionals and key consumer advocates, with 161 attendees from all Australian states and territories (except NT) and also New Zealand, with a further 13 persons on the waiting list. Feedback post‐event was very positive. The Organising Committee was led by Dr Eng‐Siew Koh, SWSLHD Neuro‐oncology Tumour Stream Leader and current Chair of the COSA Neuro‐oncology Group, and comprised Deputy Chair A/Professor Kate Drummond (Victoria), Dr Michael Buckland and Dr Michael Rodriguez, Neuropathologists (NSW), Dr Elizabeth Hovey, Medical Oncologist (NSW), Dr Kerrie McDonald, Translational Scientist (University of NSW) and Ms Mhairi Mackinnon, Neuro‐oncology Care Coordinator from Qld. Ms Narelle Barnett, from Liverpool Hospital, Cancer Services provided invaluable administrative support and oversight of the event. We thank all sponsors for the event – COSA, Roche (supporting Professor van den Bent), The Cure for Life Foundation and University New South Wales (supporting Professor Kleihues), RCPA, and Liverpool Cancer Therapy Centre, SWSLHD.
Radiation Oncology seminar – Adapt to the Future Approximately 120 people attended the Radiation Oncology Seminar – Adapt to the Future at Liverpool Hospital. Prominent national and international speakers were invited to speak on the future trends of treating malignancies. These speakers included Professor Chris Langton from Queensland University of Technology, Mr Daniel Pham from Radiation Oncology Victoria, Professor Paul Keall and Professor David Thwaites from the University of Sydney, Professor Dale Bailey from Royal North Shore Hospital, Professor Andrew Miller from the Illawarra Cancer Care Centre, Dr Gary Liney from Castle Hill Hospital in United Kingdom and Dr Jonathon Sykes from Leeds Hospital in United Kingdom. It was a very informative meeting as treatment strategies were outlined during the morning session for Head & Neck, Cervical and Bladder cancers. The afternoon sessions dealt more with the technical aspects in relation to Ultrasound, MRI and CBCT treatments (pictured left).
Two of the world’s leading
clinicians in the field of
neuro‐oncology were our
international guest
speakers: Professor Martin
van den Bent, Neuro‐
oncologist, The Netherlands,
and Professor Paul Kleihues,
Neuro‐pathologist,
Switzerland
68
SWSLHD Quality Committee The Cancer Services Quality Committee draws from several groups who practice continuous quality improvement. In 2012 a combined group will be formulated to capture the depth of projects going on around the LHD.
Highlighted projects 2011/12 • Early identification and management of potential/actual extravasations. To
decrease incidence, all suspected extravasations are reviewed by Medical Oncology or Haematology CNCs. All patients are reviewed by consultant or advanced trainee prior to discharge. Patients have plastic surgeon review within 24hrs. Simulated care of Extravasations (in development). Extravasation Task Force Committee (Nursing/Medical Oncology).‐Recognition and planning of a venous assessment clinic. Reviewing education & annual accreditation in the care and management of Intra Venous Catheters (IVC) and Central Venous Access Devices (CVAD).
• 100% compliance Standard Adult General Observation Charts (SAGO) for earlier recognition and management of the deteriorating patient (Between the Flags project)
• Implementation of STERIS cleaning system in the LCTC with associated management of nasopharyngeal scopes including audits and incident monitoring. This provides faster turnaround times and a more efficient cleaning system.
• CTC Carers information brochure developed by Social Work Department was reviewed by clinicians and feedback received from carers. Resource booklet available for cancer carers & a multilingual poster. Piloted Multicultural Information Carers Cart (MICC) in ward to raise awareness (Pictured left)
• All H&N patients are seen at a pre‐treatment assessment clinic (Care coordinator, dietitian, speech pathology, social work) to identify any issues pre‐operatively.
• Patient Experience Trackers (PETs) – Surveying patients electronically. • Meet and Greet ‐ Orientation to the department for patients/visitors by Cancer
Council Information Centre (CCIC) volunteers. • Patient Education committee is developing a personal diary to be given to each
patient instead of loose leaf information. Patient Education Folders • Customer Service Committee focusing on improving patient experiences.
Customer Service 2011 • Cancer Therapy Nursing, inpatient unit and Radiation Therapy (RT) Departments
have commenced the Essentials of Care (EOC) program. 5 staff have attended facilitator training and a patient care interest group was formed to oversee the program. Some changes identified included privacy screens in waiting areas. Presentation on Radiation Oncology involvement in EOC given at the Australian Institute of Radiography National conference April 2011. Preparation phase completed.
• Evaluating the joint Head and Neck cancer clinic with Dietetics. Patient satisfaction surveys completed. Weight loss during RT is being reviewed
• Planning Quality Checklist (QCLs) implementation in Mosaiq. Streamlines workflow and communication in planning. This is benchmarked against MoH recommendations. RT Planning Key Performance Indicators (KPI) Management group is being formed to evaluate the KPI”s and manage any necessary changes required. See planning KPI tool
• RT Patient Review Audit monthly: Dose and plan/Review of notes and documentation in Mosaiq from CT to Final treatment/ Patient timeline in department/Patient waiting time /Patient feedback.
• ‘Whole Brain Radiotherapy Treatment’ information sheet written by Neuro Oncology containing all relevant information available on the network for distribution. Whole brain information sheet
Multicultural
Information Carers
Cart (MICC) in ward
to raise awareness
Essentials of Care
rolled out to
Radiation.
Lean thinking
shows the way
towards efficient
practice.
NEAT collects
inpatients statistics
69
• Medical Clinical Handover tool in electronic medical Record (eMR) to add inpatient note to power chart.
• RT Handover Policy to ensure appropriate handover between staff in Radiation Oncology documented in Handover Policy. Presentation and poster of RT planning Handover Tool “Act Sharp” given at Australian Institute of Radiography national conference in April 2011.
• Upgraded EMR from Multi‐Access to Mosaiq. • All nursing staff given a practical assessment and quiz on Peripheral Cannulation
annually for reaccreditation • Establishment of a competency program which allows non‐senior Radiation
Therapy (RT) staff to be credentialed to undertake quality assurance on the plans of radiotherapy patients. 8 RTs have commenced the program
• 100% compliance Nationwide AHPRA Registration • Establishment of a competency program to enable RT’s to treat patients with
Intensity Modulated Radiation Therapy (IMRT). This technique varies to conventional treatment so a competency assessment was developed to ensure treatment using IMRT is done safely and with credentialed staff. 90% of RT staff has completed this program.
• High risk clinical issues are audited for compliance to policy. Clinical Audits are conducted by wards/ units and data is collated and reports compiled for review and comparison. Includes: Falls documentation; Pressure Ulcer prevention and treatment; S8 and S4 drug audits; Observation Chart Audits; Patient Identification and alert band audit; Resuscitation Trolley Audits; Bedside Oxygen and Suction audit; Consent Form audits; Medication Chart MR70 Audit; Adult Admission and Discharge Form. Managers are provided with audit reports from their wards as well as compared with other wards. Most reports are discussed in the relevant Clinical Standards
• Radiation Therapy policies and protocols, staff rosters and links to appropriate websites are now included on a Wiki System. Previously documentation for Radiation Therapy policies, protocols and work instructions were difficult for staff to locate on the network system due to the large number of drives and folders. It was also difficult to ascertain if staff was accessing the most up to date information.
• A wiki system was developed. This is set as the home page for all radiation therapy staff. There is a bulletin board that details recent changes or additions to the Wiki. There are also links to work‐related websites including SSWAHS Intranet. There is now instant access to over 50 documents through hyperlinks on the wiki home page which will increase as documents are reviewed. Staff are now utilising up to date information when planning and treating radiation therapy patients. There is also easier access to rosters, particularly changes to staff rosters. See RT Wiki.
• An in house radiotherapy contouring atlas for head and neck cancers has been accepted to appear on the Cancer Institute website as a standard protocol for head and neck contouring. The eviQ Cancer Treatments Online website provides over 900 treatment protocols and accompanying patient information which has been peer reviewed. Ensuring that all content development complies with a rigorous data governance model has led to clinicians viewing the resource as a credible information system for the Australian context.
• OHS&IM Profile audit undertaken & Development of OH&S Intranet site. To increase access and dissemination to staff.
• Review of Radiation Oncology Incident policy and database. Presentation on the incident policy and database was done at Australian Institute of Radiography national conference.
• An electronic reporting system has been written and is being trialled. • Annual Audit of CVAD care at LCTC to ensure appropriate care bookings are
made. If CVAD not needed the device is removed. Presented at Clinical Oncology Society of Australia (COSA 2010 and Ingham Research Institute Showcase 2010
70
• Implementation of monthly nursing KPIs and Clinical Indicators collection • Completion of the Clinical Excellence Commission Quality Safety Assessment
(QSA) Audits. Areas of concern, such as identification of a deteriorating patient, Clinical Handover, Medication Safety were noted as areas to be addressed. Strategies are being implemented to address the same and are discussed in the relevant Clinical Criteria.
• “Going home with a Laryngectomy Stoma” patient education booklet revised and reprinted by the H&N CCC
• Introduction of Assessment Nurse & Assessment unit protocols in the LCTC.
Continuous Projects • Clinician‐driven morbidity and mortality meetings to discuss incidents,
procedures and outcomes. • Ongoing Review of the completion rates of the SAC 2 Reportable Incidents • Completion of Correct Site Audits as per NSW MoH requirements. • Department audits of S4 and S8 Drugs to ensure compliance. • OH&S Monthly Environmental Checklist completed & risk registers updated (a
new intranet register has been established) • Regular Mosaiq Audits to identify and improve medical records: Patient Photo • Hand Hygiene Audits continue • 100% Compliance with placing updates into the Liverpool Hospital Policy and
Guideline Manuals • Implementation of ADAC = Antineoplastic Drug Administration Course across the
LHD to standardize chemotherapy accreditation processes.
Haematology and Medical Oncology Lean Thinking projects96
Future Quality Improvement Projects • Patient Education Support Information for English & NESB patients will run through large
screen TV’s in waiting areas of the new centre. • Consent for Chemotherapy Treatment form developed • Implementing treatment KPI tool which will review patient’s treatment times on a weekly
basis and waiting times within the department. • Implementation of PETs across the LHD to capture patient feedback an benchmark
services on Cancer Service delivery. • Review of medication Administration Practices • High alert drug list developed and all related policies have been reviewed. • Adult Peripheral Cannulation /Venepuncture Staff Survey • Venous Assessment Clinic • Review of Chemotherapy Bookings process. • Patient Controlled Analgesia forms and policies to be reviewed so basic observations are
recorded on the SAGO Chart and remaining observations on the specific chart. • Review of Mattress Rental Selection Policy. • Implementation of new credentialing policies to meet the recommendations generated
by the Garling Inquiry. • Competency assessment for electronic image review in radiation therapy • All Cancer services Policies to be reviewed • Manual audit to check compliance with placing updates into the Liverpool Hospital Policy
and Guideline Manuals. • Develop further tools and training resources to assist managers to implement safety
management systems online with changes in OH&S Legislation due out in 2012 • Ongoing implementation of key items identified in the Radiation Management Plan. • Fire Inspection Report Action Plan developed. Recommendations currently being
implemented. • Review Disaster, Critical Operating Safe Operating Procedures (COSOPs) and Pandemic
Manuals on completion of stage 2 redevelopment.
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SWSLHD Ambulatory Cancer Care With a focus on consistent, quality patient experiences, a working group has been established to review and improve customer service and administrative support functions such as transcription times, bookings and clinical support. The program aims to increase use of competency based training tools, customer service training, and shared services. Resourcing the required services is becoming increasingly difficult, and using the available resources to meet increasing demands on services is the key challenge for this group. The Terms of reference were developed to provide a forum for discussion regarding performance and change management that will ultimately improve work processes and align the patient experience across cancer treatment facilities through:
• Review of departmental processes & procedures, to identify areas for improvement.
• Forming workgroups to target identified areas for improvement. • Implement/trial new initiatives relating to process improvements. • Document new processes & improvements. • Produce data that supports change requirement.
Challenges The key challenge for this group is the diversity of systems, processes and services within Oncology. Our goal is to provide consistent administrative support for cancer services across multiple facilities and disciplines, by aligning data and services as much as possible.
C=Consultative service Tx=Treatment In=Inpatient visits
The second challenge is the diverse population we service. Our activity shows us that we have 600 Chinese patients registered in our system, so we have developed partnerships with CanRevive to better support our Chinese speaking patients. This multi‐cultural analysis has been applied to all our patients with English as a second language.
Medical Oncology
Radiation Oncology
Palliative Care
Haema-tology
Gynae Oncology
Dermatology Head & Neck Surgery
Breast Surgery
Urology
C Tx
C Tx C In
C Tx C Tx
C Tx C Tx C Tx
C Tx
Bankstown
Braeside Bowral C’ town
Camden Community Fairfield
Liverpool
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2000/01 2001/02 2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12
Budget 10,147,684 10,648,402 11,351,782 12,731,353 12,516,542 11,655,408 18,908,727 19,213,116 20,518,993 24,043,985 23,807,647 34,398,082
Actual 10,169,796 11,181,455 12,044,901 13,544,323 15,042,848 11,994,310 17,001,265 18,210,653 21,442,226 24,815,885 27,581,083 39,865,767
No. of Staff 123.85 121.75 125.75 112.96 124.94 141.04 194.87 203.04 209.00 228.71 250.59 310.81
NAPOOS 38,385 39,634 37,714 37,519 41,661 47,790 65,288 67,062 54,370 64,417 83,808 82,611
123.85 121.75 125.75112.96
124.94141.04
194.87203.04 209.00
228.71
250.59
310.81
0
50
100
150
200
250
300
$0$2,000,000$4,000,000$6,000,000$8,000,000
$10,000,000$12,000,000$14,000,000$16,000,000$18,000,000$20,000,000$22,000,000$24,000,000$26,000,000$28,000,000$30,000,000$32,000,000$34,000,000$36,000,000$38,000,000$40,000,000$42,000,000
Sta
ffing
num
bers
12 year resource comparisonShows Budget & Actual expenditure (left axis)Number of Staff (right axis)Non-Admitted Occasions of service (number shown)
38,385 39,634 37,714 37,519 41,661
47,790
65,288 67,062
54,370
64,417
83,808
97,415
Budget, Staffing and Activity Performance The table below shows the last 12 years of cancer services performance. Outpatient activity has increased by 90%. There have been some significant changes to the structure and services over the period of this graph: • Commissioning of a linear accelerator at Macarthur in 2005, and a second in
2006, and established an oncology ward in 2011. • In 2006, services restructured when we merged with Central Sydney. Genetics,
Dermatology, Gynae‐Oncology & Urology services were added to the group in 2008.
• Palliative care positions were transferred from Braeside 2007‐2008. • Between 10‐19 Cancer Institute funded positions per year appear across the
spectrum since 2006. • The local health districts restructured in 2010, and Liverpool underwent a
physical redevelopment that came with additional resources in 2011. A new Bone Marrow Transplant service was funded in 2011/12.
Bankstown Administrative Support The small but effective administrative support team at Bankstown Cancer Therapy Centre operate on a shoestring, and develop new and inventive ways to meet the increasing demand on their service. Some of the quality projects they have been involved with this year include:
Restructure and appointment of a team leader.
Update of centre policies and review of clinic procedures.
Culling inactive records to provide some extra space within the centre.
Clinic letters are updated in powerchart to provide hospital access to cancer information.
Service enhancements
in 2006 & 2011 have
realized a 90%
increase in outpatient
occasions of service
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Macarthur Administrative Support The MCTC administration team have worked tirelessly over the preceding 12 months. The Administration Team continually maintain a high level of customer service to the patients and staff of the MCTC.
In keeping with our Key Value, training and developing our staff is a priority and I am delighted to advise that the following staff have completed training programs within the Local Health District.
Leanne Radovic Certificate IV in Business Management, Dealing with Conflict Annette Ryan Supervisor Development Program Sharon Davidson Medical Terminology Amanda Margharitis Minute Taking
Performance Development is undertaken with the Administration/Secretarial staff where we commence an annual revision of process competencies to ensure our Staff maintain a high standard of performance. The MCTC will again be involved in the Aboriginal Traineeship program over the next 12 months. We were fortunate to be involved in this development program 3 years ago and were successful in providing a supportive encouraging environment that contributed to ‘Our Trainee’ taking up a permanent position with the Macarthur Health Service. Maintaining a Healthy and Safe environment for our staff requires all staff to attend a number of mandatory training courses on an annual basis. This training includes: Fire Safety Infection Control Manual Handling Workstation assessment checklists are completed every 3 years with new staff completing a workstation assessment checklist upon commencement. Reviewed this year was the Compurs program (Communication with Purpose) which incorporates Above and Below the Line Behaviour.
Staff Manager Susan Connor Transcription Delma Bird Driver Stewart Bow
Secretarial Support Sharon Davidson Leanne Aarts Amanda Margharitis Kim Caines
Clinical Administration Annette Ryan Leanne Radovic Lorraine Laird Emma Murph
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Liverpool Administrative Support The Liverpool staff continued to provide our cancer patients with a friendly supportive and professional service. Our job was particularly complex due to redevelopments within our facility that has ultimately improved access and comfort for our patients. Having been through 2 relocations in the last 12 months into refurbished clinic areas, our newly perfected skills now include the ability to uplift and move departments with the minimum of disruption to service. Our new facilities house additional clinic rooms, procedure rooms, pathology rooms and are co‐located with nursing support and clinical trials. With all these services so close to the clinics – all fitted with new furniture, it adds that little extra care for the increasing number of newly diagnosed cancer patients we see each year.
Having new clinic areas and treatment waiting areas has been a welcome relief for our Cancer Council and hospital volunteers ‐ who have worked together to provide support to patients, and tea and coffee facilities while they wait.
All our staff participated in a Customer Service Pilot program, which involved staff looking for ways to make patients feel relaxed when they come into our centre. Patient feedback surveys have been conducted to discover how we can provide a better service. The cakes, chocolates and treats patients bring in for the staff is an indication that we must be doing something right!
Competency‐based training & assessments, education and dedication to the improvement of our service is ongoing. Administration staff have shown an interest in learning new skills which has provided opportunities for staff progression, and a career development structure. Our transcription performance has remained steady over the past 12 months with the secretaries, transcriptionist and clinic support officers pulling together to ensure patient letters go out to family doctors in a timely manner. In 2012 over 34,200 letters went out to GP’s with an average time of 12 days from dictation to approval.
Staff Operations Manager Maree Cain Administration Team Supervisor (Brigida Sbezzi) Team Leader (Naomi Holm) Team Leader (Kristy Jemison) Holanda Bentancor Kriston Nicholls Franca Serafin Michelle Coggans Jessica Nand Melica Aleksic Karen Franklin Ida Ravindraraj
Karla Jaji Transcriptionists Suzanne McIntyre Heather Patchett Julie McCarthy Secretarial Senior Secretary (Narelle Barnett) Charity Earnshaw Rina Valerio Michelle Moors Natalie Girard Pari Mohanvelu Deborah Young Therese McCabe
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SWSLHD Allied Health Liverpool Cancer Therapy Centre The Allied Health at Liverpool Cancer Therapy Centre comprises Social Workers, Dietitian, Speech Pathologist, Occupational Therapists, Physiotherapists, and Clinical Psychologists. They work together with other Cancer Therapy staff to provide quality services to inpatients and outpatients, and their families and carers. A summary of their work and achievements throughout the past year is outlined below:
Planning Allied health representatives attend various service committees with a view to strengthening its working relationship with the rest of the cancer centre and contributing to relevant planning/decision making processes:
LCTC Operational Meetings
SSWAHS Cancer Council Meetings
LCTC AH planning day to plan for quality activities into 2013. Five key objectives were developed as a result of the planning day. These objectives have been developed into a strategic plan for AH to be working on. These objectives relate to the following area:
AH to be represented at the tumour streams’ multidisciplinary team (MDT) meetings within CTC with the objective to identify need for early AH involvement.
Raising AH profile within CTC
Increase AH awareness and involvement in research activities
AH to ensure resources available in multi languages to cater for the needs of the CALD population.
Working towards a pilot of an AH screening clinic for a specific high risk tumour group – Breast Ca.
LCTC Allied Health maintains regular liaison within its disciplines and with LCTC management on related issues:
Monthly LCTC allied health meetings
Quarterly LCTC AH meetings with Director of Cancer Services
LCTC AH planning day to plan for quality activities into 2013
Patient Focus Allied health representatives participate in various internal and external meetings regarding patient care/services:
Attendance to majority of MDT meeting within LCTC
Combined Occupational Therapy/Physiotherapy intake meetings for management of lymphoedema clients
LCTC Customer Service Committee Meetings
Clinical Psychology has been working on a document to provide information to patients on accessing Clinical Psychology Services in a public service to enhance understanding of related issues.
Dietitian participated in the development of Evidence Based Practice Guidelines for the Nutritional Management of Patients with Head and Neck Cancer which was published in 2011.
Cross‐discipline initiatives within Allied Health to provide patient‐focused care:
The Lymphoedema service is a joint Occupational Therapy and Physiotherapy service, providing a comprehensive service to patients.
The joint Speech and Dietetics Clinic runs twice weekly in LCTC providing a holistic service to those undergoing radiation +/‐ chemotherapy for Head and Neck cancer.
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Continuation of the Head and Neck pre‐treatment multidisciplinary clinic for high risk head and neck cancer patients.
Occupational Therapy and Physiotherapy Initiative – Implementation of Education and Screening Clinic for the early detection of Lymphoedema in at risk patients Acquisition of the digital swallow workstation (DSW) and stroboscopy (approximately $150,000 worth of equipment) as a shared purchase between Cancer Service and Speech Pathology to significantly enhance swallowing and voice services for patients undergoing cancer treatment. Liverpool Hospital is one of the few hospitals in Australia to acquire this equipment, which will provide significant multidisciplinary research opportunities to improve patients’ swallowing and voice outcomes. The lymphoedema service has implemented an Education and Screening clinic for the early detection of lymphoedema.
Professional Standards Allied health staff continues to attend relevant training, workshops, or conferences, both in‐house and externally, to enhance service quality and standards, for instance:
All staff in Lymphoedema service have attended training.
Lymphoedema therapists have attended garment measurement workshops and in‐services to ensure up to date knowledge and measurement techniques.
Supervision of rotational staff in Occupational Therapy and Speech Pathology as they rotate into the clinical area of cancer to ensure skill development and competency.
Clinical Psychology continued attendance at training, workshops, conferences both in‐house and externally to enhance service provision.
Clinical Psychology provides professional supervision to early career psychology and genetic counselling colleagues.
Professor Hilgers (international speaker) presented at the CTC Journal Club organized by Speech Pathology on global post‐laryngectomy rehabilitation as part of his Australian tour.
Speech Pathologist won a UNSW Oncology Research Education Grant to attend the international Advanced Practices in Voice and Dysphagia in Las Vegas. The trip included a visit to Dr. Belafsky’s leading voice and swallowing clinic in Sacramento.
Speech Pathologists continue to attend workshops and training to enhance service provision.
Organisational Development Ongoing issues with demand on lymphoedema service being disproportional to the number of dedicated FTE working in lymphoedema leading to waitlists for treatment. Occupational Therapy cover of inpatient beds in cancer has been difficult with increased demands. Staffing levels for Dietetic oncology outpatient service (including Radiation Oncology, Medical Oncology and Haematology) has been reduced from 1.0 FTE to 0.5 FTE in 2012 due to staff on maternity leave. Despite this, Dietetics Department continues to provide services to meet the demand for the increasing number of referrals. Despite reduction in outpatient service, Dietitian has prioritized and focused on service for high risk patients, e.g. continue to participate in the combined allied health and nursing pre‐treatment clinic for high risk head and neck cancer patients, and the Dietitian/Speech Pathologist joint clinic. Speech Pathology has experienced significant growth in demand for services. With no change in dedicated FTE, this impacts sustainability of workload and availability of services.
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Population Focus Allied Health regularly conducts, or co‐conducts with other disciplines, various
patient education and support group programmes, or involved in providing relevant education to participants during such programmes:
Occupational therapy has collaborated with other disciplines to provide education sessions within support group programmes.
‘Living Well’ Clinic which focuses on survivorship in lymphoma was launched in May in the Liverpool Cancer Therapy Centre and is run by social work and CNC in Haematology.
‘Self Care and Communication Skills’ in‐services run on 5C and MAU by the Oncology Inpatient and Haematology Social Work Service. This programme was also presented at the Liverpool Social Work Conference in March 2012.
‘Relax in Colour’ programme launched in the Liverpool Cancer Therapy Centre by social work, psychology and CNC was presented as a poster at the Liverpool Social Work Conference in March 2012.
Carers Focus ‘Mobile Carer Information Centre’ launched in the Oncology ward in September 2011 by the multidiscipline Liverpool Cancer Services Carer Support Committee. ‘Mobile Carer Information Centre’ programme presented at Liverpool Social Work Conference in March 2012.
Research Clinical Psychology is piloting a novel intervention approach for women experiencing body image distress post breast cancer treatment. Dietitian’s research and QI projects, namely, “Identifying factors that contributing to non‐compliance of nutritional therapy among Head and Neck cancer patients” and “Audit on nutrition management for Bone Marrow Transplant patient admitted to Liverpool Hospital” are in progress.
Academic Focus Senior occupational therapist completed Diploma of Management in 2011
Clinical Psychologist has Conjoint Lecturer position with University of New South Wales (South Western Clinical School), and also as visiting speaker to organisations such as Macquarie University, Association of Genetic Support Australia and Encore breast cancer exercise program.
Clinical Psychology has had a poster accepted for presentation at IPOS‐COSA World Congress 2012.
Clinical Psychology is involved in providing training to SWSLHD Psychologists for ClinConnect.
Physiotherapy is involved in the CHALLENGE (Colon Health And Life Long Exercise chaNGE) randomised control study looking at the impact of a physical activity program on disease‐free survival in patients with high risk stage 2 or 3 colon cancer, through conducting physical assessments and acting as Physical Activity Consultants.
All AH disciplines are involved in providing education to UNSW medical students on the role of allied health team members in Oncology.
Dietitian provides inservice for ward staff.
Speech Pathology is part of a small group of clinicians across Australia producing the latest Speech Pathology Australia position paper on laryngectomy clinical practice.
Social Work has provided placement and supervision to two social work students in haematology and oncology respectively.
Social Work contributed to the following two journal articles:
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Dall’Armi L, Simpson GK, Forstner D, Simpson T, Roydhouse JK, White KJ. The information needs of patients with head and neck cancer and their caregivers: a short report of instrument development and testing. Applied Nursing Research (In press) This details the first comprehensive needs‐based assessment instrument that surveys the information needs of both patients with head and neck cancer and family members about all aspects of the disease and related psychosocial consequences. The instrument can be used to ensure that particular areas of concern requiring information/education are addressed.
Whiting DL, Simpson GK, Koh E‐S, Wright K, Simpson T, Firth R. A multi‐tiered intervention to address cognitive and behavioural changes after primary brain tumour: A feasibility study. Brain Injury, 2012; 26:950‐961. This is the first trial of an approach to provide support to families and patients in managing both the behavioural as well as cognitive sequelae of brain tumour in the home and community‐based settings. The pilots provide preliminary support for the efficacy of education/training in improving the knowledge and skills of family members and staff in dealing with these challenging changes when they are observed.
Future Plans
Possibility of implementing an allied health screening clinic for the breast cancer tumour group targeting early allied health input for patients who are identified as high risk.
Plans to collect objective data through the Lymphoedema Education and Screening Clinic in order to robustly evaluate clinic outcomes.
Ongoing service development in Lymphoedema in order to provide best practice and comprehensive services to patients.
Future research/QI projects for Dietitan include: “Identifying strategies or factors which may assist in Head and Neck patient’s compliance to nutritional therapy”, “Establish feeding protocol for Bone Marrow Transplant patients”, and “Identifying prevalence and type of complementary diet used in patients receiving chemotherapy” (project collaborated with Concord Hospital).
Dietitian would strive for 1 FTE enhancement for Bone Marrow Transplant and Radiation Oncology Service.
Development of the speech pathology service for patients undergoing treatment for tumours of the CNS group across the Liverpool and Macarthur sites. The aim is to improve identification and access for people with communication and swallowing impairment associated with their diagnosis and treatment.
Development of an ongoing “Living Well after Breast Cancer treatment’ group information session facilitated by social work and nursing.
Clinical Psychologists Gerald Au Mariad O’Gorman Astrid Przezdziecki Dieticians Katherine Bell Christina Jandzio May Mak
Occupational Therapists Lauren Parkinson Monica Vasquez Physiotherapists Scott Morrow Social Workers Kim Brauer
Racheal Curry Simone Hallett Teresa Simpson Speech Pathologists Christina Youssef Candice Baxter Emma Charters
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Macarthur Cancer Therapy Centre Allied Health at Macarthur Cancer Therapy Centre has continued to grow over the past year with further staff turnover and recruitment. Allied Health consists of Clinical Psychologists, Dieticians, Diversional Therapists, Occupational Therapists, Physiotherapists, Social Workers, and Speech Pathologists. These allied health clinicians work within the Macarthur Cancer Therapy Centre, Campbelltown Hospital Oncology Ward, Camden Palliative Care Unit, Palliative Care Day Therapy Centre and Macarthur Community Palliative Care to provide services to inpatients and outpatients, their families and carers. They work together with other Cancer Therapy and Palliative care staff to meet the range of patient needs and continually strive to provide a quality service. The Clinical Psychology service seeks to assist people in managing emotional and behavioural difficulties at any stage of their cancer journey from diagnosis, through treatment, survivorship and bereavement. It is focused on delivering evidenced based psychological therapies to address distress that may result in mental health difficulties such as depression or anxiety and functional difficulties such as insomnia. The service also provides supportive counseling and treatment for patients and concerned others affected by the cancer journey. Social Work provides a Therapeutic Counselling Service as well as Case Management and Practical assistance to clients. The model of care Social Work practices from is an Client Focused Continuity of Care Model. The Occupational Therapy service provides assessment and intervention for oncology and palliative patients who are experiencing functional limitations and require equipment or task modification to maintain their independence or support their carers as their functional abilities change. The Lymphoedema Clinic is also a part of the Occupational Therapy department and provides early education and intervention to clients who have had surgery to remove lymph nodes, and to monitor and manage any changes to their limb volume over time. The Physiotherapy department provides a service to oncology ward, palliative care ward, palliative care day hospital and Cancer therapy centre. Community palliative care patients’ are referred to and followed up by the community therapy team. The focus of physiotherapy is to provide education and intervention to aim to maintain safe and independent mobility and function.
Staff Clinical Psychology Mey Teoh Hayley MacDonald Occupational Therapy Stacey Wheeler Hannah Woods Renee Distler Diversional Therapy Kate Rogers
Physiotherapy Ben Evans Roanna Thomas Paul Bowron Social Work Jacinta Humphries Kate Carlin Phy Vann Christine Fazzolari
Speech Pathology Katherine Kelly Armalie Muller Katherine Symeou Kasia Czachorowski Dietetics Melissa Legovic Anneka Janson
Highlights Dietetics has commenced a review of food provided to patients undergoing chemotherapy with the goal to improve the selection of food and drinks available and overall patient nutrition during their treatment.
Allied Health consists
of Clinical
Psychologists,
Dieticians,
Diversional
Therapists,
Occupational
Therapists
Physiotherapists,
Social Workers, and
Speech Pathologists.
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Speech Pathology staff worked together with Speech Pathologists from Liverpool CTC to develop referral guidelines to facilitate early referrals for patients with brain tumours, to specifically target education and early management of communication deficits.
The Speech Pathology team received and began trialing a Myotrac surface electromyography biofeedback device for swallow rehabilitation with head and neck cancer patients. (pictured left)
2012 has seen the clinical psychology service double with the start of a new clinical psychologist working 0.6 FTE at MCTC. The service completed an orientation manual for the induction of a new staff member. The focus this year was to design and publish a brochure about Clinical Psychology to better inform patients about the availability of the service.
Occupational Therapy successfully obtained palliative care grant funding to increase, across SWSLHD, equipment resources availability for clients to hire with a particular focus on high cost equipment( hospital beds, hoists and pressure care).
The Occupational Therapy Lymphoedema Clinic has begun to focus on the early identification of lymphoedema, which has resulted in a reduced need for upper limb bandaging programs for clients. The clinic has been utilizing a Bioimpedance machine (pictured left) with clients seen pre‐admission to ensure early identification.
2012 has seen the clinical psychology service double with the start of a new clinical psychologist working 0.6 FTE at MCTC. The service completed an orientation manual for the induction of a new staff member. The focus this year was to design and publish a brochure about Clinical Psychology to better inform patients about the availability of the service.
Occupational Therapy successfully obtained palliative care grant funding to increase, across SWSLHD, equipment resources availability for clients to hire with a particular focus on high cost equipment( hospital beds, hoists and pressure care). The Occupational Therapy Lymphoedema Clinic has begun to focus on the early identification of lymphoedema, which has resulted in a reduced need for upper limb bandaging programs for clients. The clinic has been utilizing a Bioimpedance machine with clients seen pre‐admission to ensure early identification.
Key Performance Indicators The Speech Pathologists participated in a trial of new performance and clinical indicators with Head and Neck Cancers. These indicated that 100% of patients receiving radiotherapy referred to Speech Pathology were seen by their second week of treatment. All patients maintained essential swallowing function. These results are being collated with results from other sites in NSW. There has been interstate and international interest in participating in further data collection in order for appropriate benchmarks to be developed. Dietetics have recently commenced collecting data on patients with head and neck cancers with respect to: frequency of prophylactic PEG insertion, rates of hospital admission and percentage weight loss. Occupational Therapy collect indicators on goal attainment for patients referred. The benchmark is 80% which has consistently been met or surpassed. The Lymphoedema Clinic collected data on limb volume changes, with the aim that 75% of client’s limb volume measures would remain stable or reduce at each appointment. This too was consistently met, even when referrals to the clinic doubled.
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Research and Education
Kasia Czachorowski and Katherine Symeou received training in incidental counseling to support their work with patients in the palliative setting.
Katherine Kelly and Mey Teoh attended the Cancer Institute’s Brain Tumour Education Forum.
Anneka Janson and Melissa Legovic regularly attended the Dietetics Association of Australia NSW Oncology Interest Group.
Clinical Psychology staff attended Mindfulness in Cancer workshop
International Psycho‐Oncology Society 14th World Congress and Clinical Oncology Society of Australia 39th Annual Scientific Meeting.
IPOS Psycho‐social academy.
Occupational Therapy staff attended pressure care courses, and the Australasian Lymphology Conference.
Social Work provided education to other professionals within their teams in relation to Communication with the Dying, Relaxation Techniques,Self Care for Professionals working in Cancer and Palliative Care
Challenges As the Allied Health staff are dispersed across a number of physical locations, finding a regularly suitable time for all staff to meet together to discuss business, clinical issues and participate in professional development has been increasingly difficult in 2012. The team is in the process of re‐evaluating the most effective channels of communication within the constraints of working in multiple caseloads and locations.
Future Projects/Expansion of Services Katherine Kelly and Armalie Muller have (as part of the Sydney metropolitan Head and Neck Speech Pathology Peer Supervision Group) been involved in organizing and running an education day on working with patients with Head and Neck Cancers for Speech Pathologists in Australia and New Zealand.
The Speech Pathology team aim to increase awareness of laryngectomy specific care requirements amongst nursing and medical staff in the ED and inpatient wards. Part of this project will involve the development of a policy guiding care and the development of resource packages containing some of the specific equipment required to care for a laryngectomy in a generalist setting.
The Clinical Psychology department is currently developing a short‐term group therapy course akin to Mindfulness Based Stress Reduction and is currently developing policies for the service.
The Occupational Therapy department is continuing to obtain more resources to help facilitate patients’ independence in the home.
Physiotherapy will be aligning cancer services into one physiotherapy position/rotation to improve continuity of care for these patients’ through the cancer services and patient journey. This increased presence and continuity will enable physiotherapy to increase its effectiveness and responsiveness for these patients and enhance interdisciplinary teamwork. With emerging evidence of the benefits of cancer rehabilitation in maintaining function physiotherapy is very excited about the potential scope and benefit of intervention for these patients and their families.
The Lymphoedema Clinic aim to conduct research into a revised limb monitoring program for clients and its impact on the progression of lymphoedema.
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SWSLHD Cancer Nursing Team Cancer nursing services across the LHD continue to provide the highest standard of nursing care for their patients and have celebrated some great achievements over the past year. The exploration of new models of care and the integration of new services has provided the opportunity for many of our nursing staff to collaborate with both the multidisciplinary teams and Executive members to plan ‘what’ and ‘how’ services are delivered within their unit and/or tumour streams over the next five to ten years. Involvement in future service planning has motivated many of our nurses to seek further professional development opportunities to ensure they will have the right skills and knowledge to care for their patients needs. Additionally we have seen the introduction of some exciting new nursing roles e.g. Bone Marrow Transplant Clinical Nurse Specialist, which provide career pathway options for many of our novice nurses and offer our more experienced nurses roles where they can specialize in their chosen field. This section showcases the nursing services and achievements at each site across the LHD and collectively, they represent the ‘SWSLHD Cancer Nursing Team’. I would like to thank all of the SWSLHD Cancer Nurses for a great year of nursing and look forward to the year ahead.
Macarthur Cancer Nursing Service The Acute Ambulatory Nursing Assessment Unit was opened in MCTC in March 2008 and continues to operate from 0830 to 1700 Monday to Friday. The unit provides assessment and management of toxicities and complications for patients receiving chemotherapy and/or radiation therapy. The implementation of the Assessment Unit and establishment of the Assessment Nurse role continues to demonstrate reduced waiting times from patient presentation to review by the Assessment Nurse and Medical Officer, decreased time from patient presentation to commencement of treatment and less patients requiring presentation and admission to the Emergency Department. The majority of patients presenting to the Assessment Unit who require admission to hospital are now admitted directly from MCTC to the ward area. This has resulted in reduced transfer time and eliminates the need for patients to be admitted via the Emergency Department. 2351 occasions of service were provided by the Assessment Unit from January 2011 to December 2011.
The MCTC Acute Ambulatory Nursing Assessment Unit (‘Oncology Patients Emergency Assessment Outside of the ED’) was a finalist in the 2011 NSW Health Awards in the category ‘Cancer Services Award for Excellence in the Provision of Cancer Services’. Wireless tablets are currently being trialed in the chemotherapy suite in preparation for transfer to a paperless prescribing and administration process. The ‘Above and Below the Line Behaviour Program’ was implemented by the nursing team in February 2010. A number of key criteria were identified and have been monitored and evaluated. The original key criteria were reviewed and amended in July 2011 and March 2012. The Communication with Purpose program was implemented in 2 departments (ICU and Stroke Ward) at Campbelltown Hospital in 2010. The MCTC nursing team was the third team/department to participate in this initiative. We began our participation in March 2011 with Leader Rounding with Nursing Staff. Staff Acknowledgement and Appreciation Awards have been presented to the majority of the nursing team. The
Denise Burns NUM, MCTC
Jayne Robinson Clinical Manager
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MCTC Nursing Unit Manager commenced Leader Rounding with patients in June 2011. This program has been embraced by the MCTC nursing team and is soon to be rolled out to other teams within MCTC. Staff and Patient Rounding are now known as ‘Staff and Patient Catch‐up’. MCTC nursing staff conducts 2nd monthly Hand Hygiene Audits. 3 of the Registered Nurses are trained as Hand Hygiene champions. There is documented evidence of staff compliance ranging from 80 ‐ 100% per audit since the introduction of the ‘5 Moments for Hand Hygiene’ program. Hand Hygiene Audit results are displayed in the Clinic Waiting Room. A Xeloda Nurse Review Clinic was implemented in June 2011 and reviewed in June 2012. The MCTC nursing staff review and assess patient’s toxicities (during treatment with Xeloda) according to an assessment grading tool which was developed by the nursing staff. All MCTC nursing staff have attended Customer Service Training and actively participate in customer service activities and promotion including nomination of 2 Nursing Customer Service Champions. The Nursing Unit Manager is a member of the Communication Strategies and Customer Service Working Group. Monthly quality audits including documentation, emergency equipment, medication charts and anaphylaxis kits are completed, documented and evaluated by the MCTC nursing staff. Twice weekly nursing in‐services are conducted with presentations and guest speakers from the medical, nursing, allied health, community and pharmaceutical companies. Key Performance Indicators were developed and implemented by the MCTC Radiation Therapy nursing staff. Electronic reports of KPI’s have been generated since June 2011. The content of these reports is currently being reviewed. Kelly Bourke was appointed to the role of Clinical Nurse Educator (CNE) in MCTC in January 2012, providing an outreach service to the Oncology Ward. Yamileth Aguilar completed the Graduate Certificate in Cancer Nursing at the College of Nursing in July 2011. MCTC is allocated two Transitional Registered Nurses per year and a number of students from various university faculties who are undertaking their degree in nursing. Jenny Treloar ‐McGrath Foundation Breast Care Nurse resigned from her position in May 2012. Therese Harris has been acting in this role since August 2011. Vicki Buglass ‐ McGrath Foundation Breast Care Nurse is working full‐time and is providing services between Campbelltown, Camden and Bowral Hospitals. Colleen Carter ‐ Palliative Care Clinical Nurse Consultant is working full‐time and is providing services between Campbelltown and Camden Hospitals. Samantha Beverley continues as our MCTC Wound Care Link Nurse. Samantha has attended several wound care and education courses and has developed a Wound Care Resource Folder for the unit. Bernadette de Souza is our MCTC Infection Control Link Nurse and is involved in the RIPCORD project which is reviewing cannulation practice, documentation and recommendations in MHS.
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Macarthur Cancer Therapy Centre Nursing Staff Nurse Unit Manager Denise Burns Clinical Nurse Educator Kelly Bourke McGrath Foundation Breast Care Nurses Vicki Buglass Jenny Treloar Therese Harris
Palliative Care CNC Colleen Carter Registered Nurses Yamileth Aguilar Samantha Beverley Kelly Bourke Linda Craig (part‐time) Deborah Denholm Bernadette de Souza
Gail Dwyer (part‐time) Michelle O’Mochain Chong Noi Peacock Suzanne Rochfort Florence Singh Transitional RNs Peta Lucia Hyangna (Hayley) Oh
Campbelltown Hospital Oncology Ward The multidisciplinary team in the Oncology Ward works in conjunction with the Cancer Therapy Centre and the Palliative care team to provide optimal treatment for those inpatients requiring specialised medical and nursing care. Through a plan of care, patients receive education concerning their medical condition and progress as well as information and advice on their medications and pain management. The focus for the Oncology ward this year is staff education to increase and improve the knowledge base of all nursing staff.
Professional/Personal Achievements Meghan Sandoz is near completion in the Certificate 4 in Management Meghan Sandoz was awarded Nursing & Midwifery Executive Award 2011 Anthea Edwards has completed training to be falls champion in the ward Colleen Starr & Helen Samorukoff are the ward Palliative Care Resource Nurses Grecy Joseph has enrolled to do the Graduate Certificate in Cancer at the College of Nursing. Justin Goldrick continues in his studies towards a Bachelor of Nursing Gennivieve Hurst‐Barber is currently studying Midwifery Elaine Taylor completed her Endorsed Enrolled Nurse Certificate Casey Hocking continues in her studies towards a Bachelor of Nursing Helen Samorukoff has been successful in a secondment to MCTC for 6 months Diane Maguire undertook a 9 week secondment in the Specialised Palliative Care Ward at Camden Hospital, gaining knowledge and learning new skills that have been demonstrated in the Oncology Ward. The Oncology ward has accredited 7 x registered nurses in Port o Cath accessing and de‐accessing and 4 registered nurses are in training. Oncology also welcomed Allison Russell who is Oncology’s permanent Ward Clerk. All ward staff are accredited in the use and maintenance of NIKKI pumps, these administer 24hr pain relief to our patients. On discharge the patient is linked to the Palliative Care Nurses for ongoing treatment and management o f the NIKKI pump.
The Oncology ward is supported by the Palliative Care CNC Colleen Carter and the MCTC Clinical Nurse Educator (CNE) Kelly Bourke.
The above and below the line program was implemented by nursing staff, key criteria were identified, implemented and evaluated, the criteria has recently been updated, this is in consultation with all staff. The communication with purpose program was implemented in 2 departments (ICU & Stroke Ward) at Campbelltown Hospital in 2010. The NUM of Oncology had the privilege to implement this program in the Stroke Ward and was happy to implement the program in the Oncology Ward. We began our participation in September 2011 with the leader rounding with nursing staff. This program has been embraced by the
Patricia Mason NUM, Oncology
Ward, Campbelltown
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nursing team and will progress to patient rounding. The benefit is improved staff moral and communication, both are important in having a happy productive team.
Oncology Ward are combined with the MAU unit in providing Hand hygiene audits, to date nursing compliance is on average 80‐100%. Monthly quality audits are performed by staff, these include S8/S4 medications, Waterlow Wednesday, Falls Friday, Pressure Ulcer audits, Oxygen and suctions as well as documentation, and results are displayed In‐service is run bi‐weekly by the CNE and monthly by the Palliative Care CNC. Members from the multidisciplinary team provide regular education. Staff debriefing sessions continue with the staff counsellor, sessions on grief, death and dying as well as general coping are welcomed by the staff.
Oncology Ward Team NUM Patricia Mason Grecy Joseph Diane Maguire Meghan Sandoz Colleen Starr Anthea Edwards
Dzenita Delic Monic Ballesteros Diane Anger Helen Samorukoff Anne Norris Isabella Ansuh‐Yeboah
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Liverpool Cancer Nursing Service
Chemotherapy Nursing In October 2011 LCTC opened the newly renovated chemotherapy suite. Additional space for treatment has increased our future capacity to 21 chairs and 4 beds. We were also recipients of Dry July fundraising money and as a result we received 17 brand new treatment chairs. We also received 25 DVD players which mount onto the chairs. This provides our patients with a more comfortable stay and also provides entertainment for patients having long treatments.
Radiation Nursing The most significant change to Radiation Nursing this year has been the introduction of Graduate Registered Nurses. This has been a great opportunity to teach novice nurses about pre and post radiation therapy care and may result in some of the graduate nurses choosing to work in the CTC permanently once their rotations are complete (which would be fantastic). We also now have a new radiation nurses bay area which has 5 beds and 2 chairs. The new location is easily accessible for all radiation therapy staff waiting for patients to be treated. Future plans for the radiation bay is to have a recovery area for patients following gynae brachytherapy and prostate brachytherapy. The nurses are working with the brachytherapy working parties to help implement this.
Achievements The following nurses were nominated and successful recipients for 2012 International Nurses Day Awards; Lenore Knapman, Joanne Bartley, Vinodini Onawale, Christine Hardy and Leah Baker This year has focused on the Assessment Unit at LCTC and what a success this role has been. The assessment nurse commenced on 28th November 2011 and aim of this role is to ensure our patients receive the right care at the right time by the right clinician. Data collected from December 2011‐May 2012 reveals that the assessment nurse has triaged and treated 403 patients and 44 patients have been direct admissions to the inpatient unit. All of these cases have been directed to the CTC for treatment rather than the emergency department and all have given us positive feedback about this service. The nurses rotating in this position have found this role to be very rewarding. The nurses who have spent time in the assessment nurse role are; Diana Ngo, Joanne Bartley, Leah Baker, Kim Sharkey, Tania Luxford and Lenore Knapman. The LCTC nurses are currently using a wireless notebook to attend to cytotoxic assessments. This initiative was part of a successful grant submission received by Sandra Avery, Operations Manager. In December 2011 the LCTC nurses entered the hospital Christmas decoration competition. Our theme was multicultural and our message was that cancer is not discriminative. Each day we are faced with new patients for treatment and these patients come to us with different backgrounds, cultures, beliefs, family values. We also acknowledged that some of our patients do not celebrate Christmas. Our decorations consisted of flags from all over the world and Merry Christmas in all different languages.
Tania Luxford NUM, LCTC
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As a result our message touched the judges and we came second in the hospital competition. The prize will be shared amongst all LCTC staff members, and at this stage will most likely be a new coffee machine for staff when our new tea room opens.
Professional & Staff Development Our nursing staff are always striving to improve their knowledge and as a result have undertaken a variety of on and off the job training. Diana Ngo RN has completed her masters in Cancer and Haematology Nursing Vinodini Onawale has completed her Graduate Certificate in Cancer Nursing via the College of Nursing Joanne Bartley has completed her Oncology Certificate via UTAS Amanda Baldwin is continuing her studies towards a Bachelor of Nursing degree Amy Wholohan has completed her Oncology Certificate via UTAS Christine Hardy‐Commenced chemotherapy accreditation Amy Wholohan is now the permanent CNE for LCTC. Amy has spent the last year being very proactive in the development of education for all CTC nurses We welcome some new nursing staff members to our team. Jinky De la Paz (RN) has joined us and Christine Hardy is now a permanent RN with LCTC. Lesly Regaldo was successful in the permanent RN position with palliative care nursing at Liverpool Hospital. Achamma Roy was successful in a 6 month secondment into palliative care, whilst Naomi Ellis is on maternity leave. Jodie Peronchik was successful in the permanent part time CNC position in End of Life Care. Joanne Rosemary joins Cancer services as the part time Multiple Myeloma research nurse and is working with Dr Silvia Ling to improve the care for multiple myeloma patients. Alana Paterson was successful in the Bone Marrow Transplant CNS2 position. This will have a huge impact on our BMT Unit and Haematology outpatient service. This year we welcomed a rotation of 2 new graduate nurses. The rotations will occur every 6 months. The new graduate RN’s that joined our service were; Rani Prasad and Vu Tran. They have been working in the radiation bay and have been a valuable asset to our nursing team. Sadly we also farewelled one of our long standing team members EEN Amanda Baldwin. Amanda was an excellent nurse who was successful in securing a position at Westmead Children’s Hospital. We thank Amanda for all of her hard work and dedication she gave to nursing whilst in LCTC. We are a happy team of nurses and continually strive to provide optimal care for all of our patients. Nurse Unit Manager Tania Luxford Nurse Educator Amy Wholohan Nurse Consultants Lenore Knapman Karl Jobburn Rosemary Craft Charmaine O’Connor Gai Fairnham Jodie Peronchik Nurse Specialists Alana Paterson Betty Silaphet
Registered Nurses Joanne Bartley Rhonda Eke Diana Ngo Vinodini Onawale Kim Sharkey Tanya Tesauro Leah Baker Samuel Hughes Christine Hardy Jinky De La Paz Rani Prasad Vu Tran Enrolled Nurses
Amanda Baldwin Carol Doherty Yvette Furney Palliative Care Nurses Naomi Ellis Lesley Regaldo Achamma Roy Care Co‐Ordinators Sharon Linden Jeanette Suurdt Luci Dall’Armi Pharmila Sapkota Wafa Trad Abby Krige
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Liverpool Oncology Ward CB5C It has been an exciting 12 months for the Haematology ward and the Apheresis unit. The introduction of Allogeneic Bone Marrow Transplant (BMT) service has bought with it new medical, nursing and clerical staff and provided an opportunity for staff to attend BMT education. New Apheresis machines have enabled the staff to deliver an improved service and the commencement of a ward rotation into Apheresis will allow training to be provided to more nurses in this specialized field.
PROFESSIONAL DEVELOPMENT Professional development within the unit is encouraged and has been ongoing throughout the year. In‐services are run at unit level and all staff are given the opportunity to attend. Many staff have attended or have been booked into a workshop over the coming months. These increase their clinical skills and some will become our resource nurses from attending these workshops. Wound Management – Aishna Shrestha, Swastika Rajan OH&S – Lisa Ellis. ABC Palliative Care – Nardy Lucero, Lissy Joy, Achamma Roy Falls Management – Eila Galeng, Melissa Keough Cannulation – Indu Sapkota, Susanna Samcam, Aishna Shrestha, Naga Ponnam CPR Train the Trainer‐ Joan Losloso In Charge Workshop‐ Mandeep Kaur, Aishna Shrestha Hand Hygiene Workshop – Sasikan Nontapan, Susanna Samcam, Lisa Ellis Introduction to Haematology‐ Karen Baker, Mandeep Kaur, Lisa Ellis Graduate Certificate in Cancer and Haematology‐ Swastika Rajan is currently undertaking the course. Graduate Certificate in Apheresis‐ both Julie Stone, Sinuu Seuala‐Talagi have undertaken this. Successions (Apheresis) ‐ Julie Stone, Sinuu Seuala‐Talagi 1 day each.
CHEMOTHERAPY EDUCATION Work has continued over the last 12 months to facilitate the staff in chemotherapy accreditation. A new electronic accreditation program, Antineoplastic Drug, Administration course (ADAC) has been implemented which will standardize this process.
QUALITY ACTIVITIES There are numerous quality activities occurring within the unit including our regular clinical audits. Julie Stone and the CNS complement have taken ownership of this and provide a report of the data collected to the Director of Nursing & Midwifery (DONM). Aaron Manson attends to the OH&S audits. Falls risk assessments and reduction in falls strategies are an ongoing quality activity and the wards compliance with falls assessments remains over the 80% mark. Work is continually ongoing to improve this. The five moments of hand hygiene audit is also conducted regularly. CB5C performs well in the audit scoring around 96%. The ward is also engaged in the Essentials of Care program and Communities of Practice. Work continues around infection control. It has been a very busy 12 months. Over the next 12 months we plan to continue the professional development of staff so that we can maintain a safe and high standard of care for our patients.
Aaron Manson NUM, Liverpool Oncology Ward
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Staff Recruitment has continued over the last 12 months and our vacancies are steadily reducing. Recruitment has focused on the BMT staffing and the enhancement to nursing profile following application of the new “Nursing Hours Per Patient Day” award which came into effect for us as of 1 July 2012. These positions have been recruited to and the successful applicants are awaiting start dates. The Nursing Unit Manager (NUM) position, previously held by Donna Boman, was advertised and the recruitment is currently being finalized. Recruitment for the Clinical Nurse Educator position will be pursued after the NUM position is complete. Staff members include:‐ A/NUM Aaron Manson Educator Joan Losloso Chemo Coordinator Sara Hitchcock Clinical Nurse Specialist Karen Baker June McEachern May Valdez Registered Nurses Hang Gilbang Georgina Rees Milagros Rivero
Achamma Roy Lissy Joy Lisa Ellis Alexey Rudnitskiy Mandeep Kaur Alison Hill Swastika Rajan Katarzyna Rybka Jessica Dickford Fafi Awad Naga Ponnam Aishna Shrestha Sasikan Nontapan Eila Galeng
Susanna Samcam Thi Thu Phuong Lai Indu Sapkota Enrolled Nurses Sladjana Starcevic Melissa Keough Nardy Lucero Apheresis Staff Sinuu Seuala‐Talagi Julie Stone
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Breast Cancer Care Coordinator Since commencing my new role in July 2011, I have been providing information, education, support and counseling to breast cancer patients from diagnosis through to completion of their cancer treatment. I have been attending care in their various stages of the cancer journey for example; pre‐surgery consult, meeting patients in the ward post mastectomy, follow‐up calls after surgery, Radiation Oncology new Consults, Medical Oncology new consults, support on the first day of chemotherapy and at the end of their treatment and providing survivorship education. Some of my achievements over the past year include; Research: I have been participating in ‘Healthy Me research project’ lead by Professor Delaney’s team. I have assisted this project by recruiting 25 breast cancer patients. Recruitment completed in June 2012. I have also participated in focus group face to face interview sessions to get the feedback for this project. The project is in the process of publication. Quality improvement Projects: Successfully implemented survivorship education program for breast cancer patients at Liverpool Hospital with the support and team work of Oncology Social worker Kim Brauer. This program is currently running every second Thursday from 10:30am to 12:00 at the education centre, Liverpool Hospital. I identified the need for a Wig Library at Bankstown Hospital for cancer patients who are undergoing chemotherapy. With the effort and support from Medical Oncology CNC Sharelle Ioannou and support from my manager Jayne Robinson the library has now been successfully established. I provide In‐service to CTC radiation therapy and Chemotherapy staff on the survivorship program “living well after breast cancer treatment” program. In‐service to nursing staff on “post mastectomy resources” Presentation at the Education Centre at Liverpool Hospital to SWSLHD and SLHD Nurses on “Post mastectomy issues and support options”
Pharmila Sapkota
Bone Marrow Transplant Care Coordinator The introduction of Allogeneic Transplantation service at Liverpool Hospital has kept the entire BMT team busy over the past year. Recruiting and training of new staff, educating current staff and developing models of care suitable for this new service has been a major focus for the BMT Coordinator. Some of the highlights include:
June 2012 1st Sibling Allogeneic Transplant
Presented at “Malignant Haematology Resulting in Transplant” ‐ ACI NSW Agency for Clinical Innovation, June 2012
Stem Cell Transplant Patient Education Sessions (half day education) June 2011, October 2011, May 2012
Coordination of 9 education sessions for CB5C Nursing Staff regarding “Commencement of Allogeneic Transplant”
Chair – Cancer Services Quality Committee
Clinical Supervision – New Graduate Nurses (Monthly, ongoing)
Gai Fairnham
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Haematology Care Coordinator
Co‐Chair of Haematology/Oncology/Palliative Care Community of Practice at Liverpool Hospital.
Chair of Cancer Services Carer Support Committee.
Contributed to the development & promotion of Cancer Carers Resource Booklet: applied for and received funding to make booklet multi‐lingual.
Development & promotion of Cancer Carer Resource Booklet.
Contributed to the development & promotion of a Mobile Information Carer Centre on ward 5C.
Presented poster at Multi‐National Association of Supportive Care in Cancer held in Athens, Greece.
Commencement of Living Well Clinic for newly diagnosed Lymphoma Patients post treatment (in conjunction with Social Workers).
Currently working within the department to develop a referral pathway for GPs as well as GP care during and after treatment (involving development of a survivor care plan).
Continue to develop role of Care Coordinator within Haematology.
Continue to work on issues within the department as they arise.
Monthly attendance at Haematology M & M meeting: create report generated by discussion.
Secretary of Haematology Business Meeting for service development, planning and trouble shooting.
Abby Krige
Lung Care Coordinator Jeanette joined the oncology team as the Lung Care Coordinator in late October 2012 after the position had been empty for almost one year. She has been working three days per week over the last 8 months concentrating on supporting patients through their lung cancer journey. The high percentage of non English speaking patients has required coordination of resources in 25 different languages. Jeanette has updated current lung cancer patient and family resources and we have secured funding to update translated documents in the near future. Jeanette has organized a GP education night where lung cancer consultants (medical oncology, radiation oncology, thoracic surgeon, palliative care and a respiratory consultant) spoke to a group of 40 local General Practitioners. In addition to attending all Lung MDT meetings, Jeanette tries to see all new lung cancer patients at their first lung cancer appointment, providing information and support materials. Jeanette also completes the distress thermometer on all new lung cancer patients presenting to clinic. This provides the clinical team a consistent way to screen for issues and refer patients appropriately in a timely fashion. Jeanette spends one day every three weeks at Campbelltown Hospital with lung cancer patients and in the future (with a full time lung co‐ordinator) the goal is every other week a lung care coordinator would be present at Campbelltown In the interim, Campbelltown patients are contacted by phone and materials are posted to them. Jeanette has also focused on nursing education. She has given many presentations on lung cancer (non small cell, small cell and mesothelioma) in addition to symptoms assessment in‐services. Jeanette is collating data comparing allied health assessments for lung cancer patients, pre & post implementation of the lung care coordinator.
Jeanette Suurdt
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Head & Neck Care Co‐ordinator
Accepted journal article for publication in Applied Nursing Research journal: ‘The information needs of patients with head and neck cancer and their caregivers: a short report of instrument development and testing’.
Organise and run a multidisciplinary nursing and allied health Pre‐Treatment clinic for the ‘Quality improvement in H&N cancer patient management’ project.
Write and edit the patient information booklet ‘Going home with a Laryngectomy stoma: A guide for patients and carers’. Booklet awaiting printing.
Recruitment of patients for research project ‘Investigation of function following Neck Dissection surgery’ for Discipline of Physiotherapy, University of Newcastle.
Establish discharge protocol with the Ambulance Service NSW for the safety of patients going home as ‘neck breathers’ and the provision of a MedicAlert bracelet.
Co‐chair Haematology/Oncology/Palliative Care Community of Practice (HOP COP).
Member of Cancer Institute NSW, Cancer Care Coordinators Community of Practice Steering Group. Planning WebEx seminars for all NSW care coordinators.
Assist with facilitation of Laryngectomee Support Group.
Prepare and record online presentation for 3rd year Bachelor of Nursing students of University of Wollongong on ‘Chronic care & conditions: Care coordination & cancer.
Submitted entry for NSW Ministry of Health Award for project ‘Quality improvement in Head and Neck cancer patient management: Pre‐treatment clinic’ which has been nominated as a finalist project.
Luci Dall’Armi
Neuro‐Oncology Cancer Care Coordinator I started in the Nero‐Oncology Cancer Care Coordinator role just a short time ago and I am excited about the potential care and support I will be able to provide the Neuro‐oncology patients and their carers in the year ahead. The NOCCC is an advocate for the patient and the carer to coordinate care, support and resources for patients and carers for inpatient, outpatient and/or community services. The role of the NOCCC is to ultimately facilitate patient‐centred care by liaising with the appropriate members of the MDT to ensure the patient’s physical, social, environmental, psychological and spiritual needs are fulfilled.
Wafa Trad
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Bankstown Upper GI Cancer Care Co‐ordinator I was appointed the first Cancer Care Co‐ordinator (20hrs/wk) at Bankstown Hospital in late December 2011. Due to the large number of Upper Gastro‐intestinal (UGI) surgeries that are performed at Bankstown, the focus of my role is mainly on UGI patients. I participate in Oncology team meetings and the UGI meeting weekly to identify patient &/or carer needs and discuss how these can be met. In this role I have worked closely with the Oncology CNC to streamline our oncology patient care. We have initiated new practices for patient chemotherapy education, including review of protocols for bowel management, and development of a flowchart for the ‘care of patients with portacaths and chemotherapy’ protocol. In collaboration with the Oncology CNC & psychologist, I am reviewing psychosocial needs assessment tools for implementation in Bankstown Cancer Centre. I have identified this tool will be invaluable to my practice to meet patient needs. I also work closely with the Palliative Care CNC to achieve good patient outcomes. As I was the first Care Coordinator employed by Bankstown hospital, I developed a brochure about care co‐ordination and my role in patients’ cancer journeys at Bankstown Hospital. These are available throughout the hospital wards and Cancer Centre. I am also developing in‐services for ward staff about care co‐ordination. In March 2012 I attended the COSA Cancer Care Coordinator’s conference in Melbourne which allowed for valuable networking and learning opportunities. I am now part of an email network for Upper GIT care co‐coordinators throughout Australia. I am currently directing a health promotion & fundraising morning for the Cancer Council on Daffodil Day at Bankstown Hospital.
Judith Merry
Colorectal Care Co‐ordinator As the Colorectal Cancer Coordinator I attend Liverpool, Bankstown and Campbelltown hospitals on a regular basis seeing both medical and surgical inpatients & outpatients. I facilitate the Colorectal Care Coordination Clinics for medical oncology and radiation oncology patients at both Liverpool and Bankstown Hospitals. Over the past 12 months I have reviewed and updated the information packages for Colorectal Cancer patients and have distributed them to the Colorectal surgeons across the LHD. These packs provide patients with information brochures and contact numbers at the time of diagnosis to ensure they have the access to care and support as required. This process will be audited in the future to measure its effectiveness. I have also been involved in developing and implementing a survivorship care plan with staff at Bankstown Hospital which will be provided to patients at completion of their treatment and guide them through the months/years that follow.
Sharon Linden
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Oncology Pharmacy: Liverpool In the past year, Liverpool Cancer Therapy Pharmacy have continued to deliver outpatient services to the Medical Oncology and Haematology Departments. Staffing levels have changed over the past year with Rebecca Grundy currently on maternity leave. Due to the increased patient and workload in the Cancer Therapy Centre, we have a third pharmacist joining the department to help ensure that quality clinical pharmacy services are delivered in a timely and satisfactory manner. The pharmacy has relocated in November 2011 to a bigger and brighter space towards the front entrance of the Cancer Centre. We continue to provide the same quality service which includes:
Provision of a Clinical Pharmacy service to Medical/Radiation Oncology and Haematology inpatients and outpatients
Provision of information to Medical and Nursing staff
Provision of chemotherapy to other departments: rheumatology, gastroenterology, ambulatory care, bone marrow stepdown unit, eye clinic
Established patient education service
Chemotherapy production service
Involvement with the Cancer Therapy Research Committee and Clinical Trials
Involvement with compassionate use programmes
Participation in multidisciplinary team meetings
Team Pharmacists Rebecca Grundy Vy‐Vy Tran Raymond Kumar
Sugantha Thumbadoo Pharmacy Assistant David House
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Oncology Pharmacy: Macarthur Our Pharmacy Department continues to provide clinical oncology pharmacy services to Campbelltown Hospital. We are responsible for :‐ • The provision of all cytotoxic drugs within the organization • Administrative responsibilities within the Pharmacy • Maintaining and implementing procedures to ensure safe and effective use
of all cytotoxic and associated medications • The provision of counselling to our outpatients • Liaising with Medical staff , nursing and administration staff • Participating in continuing education programs • Participating in clinical drug trials
Staffing Senior Oncology Pharmacist Pirkko Boyd Oncology Pharmacist Henry Huynh
Pharmacy Technician Nicole Dewar Pharmacy Technician Debra Vandine
Highlights Our centre participated in the 2012 TSMP International Medication Safety Self Asessment for Oncology Survey. This is a self‐assessment survey which allows us to benchmark our performance against other centres across Australia and the rest of the world . The 2012 ISMP International Medication Safety Self Assessment® for Oncology was developed by the Institute for Safe Medication Practices (ISMP) and the Institute for Safe Medication Practices Canada (ISMP Canada), through a grant from the International Society of Oncology Pharmacy Practitioners (ISOPP) to help hospitals and ambulatory care centers throughout the world evaluate oncology medication safety. Chemotherapy and biotherapy agents used in cancer treatment are considered to be "high‐alert" drugs which are more likely to cause patient harm when involved in an error. The self assessment is designed to heighten awareness of the distinguishing characteristics of a safe medication system, with a specific focus on management of chemotherapy, biotherapy, and treatment‐related drugs. In June 2012,our senior pharmacist convened a multi‐disciplinary team consisting of 9 staff members. We had two Medical Oncologists, Nurse Unit manager, two pharmacists, Business Manager, IT Analyst, Director of Pharmacy and Oncology Information Systems manager. As a group, the survey questions were discussed and answered once consensus was reached.
ISMP Survey.
we scored 81% with
many sections
achieving scores of
80 – 90+.
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Key Performance Indicators • The ISMP survey allowed us to assess ourselves in 10 Key competencies.
• Patient information
• Drug information
• Communication of drug orders
• Drug labelling, packaging and nomenclature
• Drug standardisation, storage, distribution
• Medication device acquisition, use and monitoring
• Environmental factors, workflow and staffing
• Staff competency and education
• Patient education
• Quality processes and risk management
• Overall across all sections we scored 81%, with many sections achieving scores of 80 to 90+
• The final results of how we compare with the other participants will not be available until later in 2012.
Research and Education Staff development continues to improve with several staff members attending conferences, seminars and undertaking further training. Henry Huynh attended the Introductory Oncology Symposium run by the Society of Hospital Pharmacists in April 2012 and found it very useful to consolidate his “on the job” training here in the MCTC Pharmacy. Nicole Dewar has enrolled in the Certificate 1V Pharmacy Technicians Course run by the Charles Sturt University. Nicole completed Certificate 111 in 2011. Pirkko Boyd attended the International ISOPP Meeting ( for Pharmacy Practitioners) in May 2012. Two 4th year pharmacy students have spent some time here in the Oncology pharmacy to undergo orientation and some initial training in oncology pharmacy.
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Multidisciplinary Care:
Tumour Groups
Multi‐Disciplinary Team Support The two dedicated MDT Coordinators’ role is to provide administrative support for the 13 tumour groups’ MDT meetings. (Pictured left Rosalyn Frederick, Kerrianne Hancock)
They collate agendas for patients to be presented at the MDT Meetings. Clinicians advise as to which patients they would like presented and what is to be presented (pathology, radiology, PET). They order various results including pathology and imaging, register and schedule patients for discussion on Mosaiq and PowerChart.
After the meetings they type and send GP letters and MDT discussion notes to the various doctors involved in patient care.
They organise and minute Business Meetings for the groups and assist in scheduling and organising GP education sessions in correlation with Sydney South West GP Link and the Clinicians.
Liaise with Pharmaceutical Reps to organise and maintain sponsorship calendars for the MDT meetings (Catering is sometimes provided by these companies).
Liaise with care‐coordinators on a regular basis.
Respond to a range of enquires (in person and over the phone) providing information and referring enquires in an effective and responsive manor.
MDT billing
Maintain attendance records for the meetings and the MDT filing system.
Scanning and other assorted administration tasks as requested and necessary.
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Breast MDT Group During the 12 month period from 1 July 2011 to 30 June 2012 there have been 400 new breast cancer patients referred to our Centres. Weekly breast Multi‐Disciplinary Team (MDT) meetings are held at Liverpool Hospital as well as fortnightly meetings at Campbelltown and Bankstown Hospitals. In addition, patients referred to the Bowral service are discussed at the Macarthur meetings.
Highlights We continue to have an increasing attendance of health care professionals at these meetings and an increase in the number of patients discussed at the MDT meetings. Regular weekly attendance for each of these MDT meetings include Radiation and Medical Oncology, Surgery, Pathology, Radiology, Cancer Genetics, Clinical Trials, Social Work, Clinical Psychology and the Breast Care Nurse Coordinators. Dr. Annabel Goodwin and Dr Aashit Shah have commenced a high‐risk breast clinic at Liverpool, to cater for those patients with genetic mutations that suggest that they are at heightened risk of developing breast cancer. We have developed some MDT forms that are routinely filled out at each Multi‐Disciplinary meeting and will appear in the hospital electronic record to enable a greater proportion of health care providers access to the recommendations. The group continue to work hard to ensure that multi‐disciplinary care occurs in breast cancer.
Breast Tumour Group Nursing/Allied Health Vicki Buglass Jenny Treloar Therese Harris Pharmila Sapkota Kim Brauer Astrid Przezdziecki Sharelle Ionnou Surgeons Dr Aashit Shah Dr Scott D’Amours Dr Richard Lee Dr Luci Saliba Dr Kathryn Stewart Dr Joon Kim Dr Davendra Segara Dr Patsy Soon Dr Andy Ong Dr Khiem Hong Dr Simon Yarrow
Dr George Kourtesis Pathology Dr Alar Enno Professor Jim Yong Dr Leo Santos Dr Kasim Ismail Imaging Dr Jeffrey Sacks Dr Seymour Atlas Dr Diana Tran Dr Elizabeth Lazarus Radiation Oncologists Professor Geoff Delaney Dr George Papadatos Dr Denise Lonergan Dr Karen Lim Dr Miriam Boxer Dr Marcus Dreosti Clincial Psychologist Dr Mey Teoh
Medical Oncologists A/ Prof Stephen Della‐Fiorentina Dr Sandra Harvey Dr Lorraine Chantrill Dr Diana Adams Dr Belinda Kiely Dr Kelly Mok Dr Michelle Harrison Dr Ray Asghari Genetics Dr Annabel Goodwin Camron Ebzery Annabelle Ng Occupation Therapy Stacey Bradshaw MDT co‐ordination Roslyn Frederic Kerrianne Hancock
Dr Edwin Lim
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Colorectal MDT Group The South Western Sydney Colorectal Group strives to decrease the incidence of, and mortality from colorectal cancer in South Western Sydney Local Health District, by promoting prevention and early detection through raising community awareness and identifying opportunities for screening. Initiated in 2001, it encompasses multidisciplinary expertise from Surgeons, Radiation Oncologists, Medical Oncologists, Pathologists, Nuclear Medicine Specialists, Radiologists, a Cancer Care Coordinator, Nurses, and Allied Health professionals. The members of the group are principally located at Liverpool, Campbelltown, Bankstown and Fairfield Hospitals, yet also service the entire South Western Sydney Local Health District. The group meets fortnightly to discuss cases. In addition, Bankstown Hospital runs a Colorectal MDT which is combined with their Upper GI MDT which meets weekly. A number of clinicians are involved in both meetings, with attendance by fellows and registrars of the involved specialties, and is open to students of UNSW and UWS, providing an overview of the complex co‐ordination involved and the issues that arise in the care of patients with colorectal cancer. The aim of the Colorectal Tumour Group is to provide a comprehensive service for people with colorectal cancer living within the district. The team endeavors not only to provide patients of the district with timely diagnosis, treatment and ongoing management, but also to deliver psychosocial assessment and support. The MDT has welcomed the development of an academic CR unit at Liverpool Hospital under the Direction of Professor Les Bokey since his appointment in early 2011.
Research and Education The South Western Sydney Colorectal Tumour Group Database (established in 1997) has over 6900 patients registered. Molecular research related to the database is currently underway looking at biomarkers of prognosis and response to therapy in colorectal cancers Data from cancer registry (2010 latest available)
388 new patients with CRC (including SCC anal canal)
Colon (68%) Rectum (29%) Anus (3%)
66% of patients documented as being discussed at MDT Further data on surgical outcomes, chemotherapy and radiotherapy utilisation will be available in the near future. Clinical trials The A La CaRT1 study opened in SWSLHN this year with A/Prof Morgan currently randomizing patients. Sponsored by AGITG and NHMRC, the trial accreditation will be completed shortly by Dr Turner and Dr D Kozman. Publications McKay GD, M Morgan, SKC Wong, A Gatenby et al Improved short‐term outcomes of laparoscopic versus open resection for colon and rectal cancer in an area health service: a multicenter study; Diseases of the Colon & Rectum. 55(1):42‐50, 2012 Jan.
1 Australasian Laparoscopic Cancer of the Rectum Trial ‐ A Phase III randomized trial comparing laparoscopic‐assisted resection versus open resection for rectal cancer.
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Lin M, Koo JH, Abi‐Hanna D Management of patients following detection of unsuspected colon lesions by PET imaging. Clin Gastroenterol Hepatol 2011;9(12):1025‐1032 Lin M Molecular imaging using Positron Emission Tomography in colorectal cancer. Discov Med 2011;11(60):435‐447 Lin M, Wong K, Ng WL, Ho Shon I, Morgan M Positron Emission Tomography and colorectal cancer. Crit Rev Oncol Hematol 2011; 77 (1):30‐47 Lin M, Chicco A Surgical management and outcomes of colorectal cancer liver metastases. [Letter]. Br J Surg 2010; 97(11):1743‐4 Oral and Poster Presentations Park C, Lin M, Hugh T, Ng W. The prognostic utility of metabolic information provided by FDG PET in the evaluation of solitary colorectal hepatic metastases. 14th World Congress on GI Cancer, Barcelona 2012 Mahbuba Sharmin, Angela Berthelsen, Matthew Morgan Surgical Management of patients with Primary Colorectal Cancer over 12 years in the South Western Sydney Local Health District public hospitals, Poster presentation, Annual Scientific Meeting, Clinical Oncological Society of Australia (COSA) 2011 Mahbuba Sharmin, Angela Berthelsen, Matthew Morgan, Sandra Avery Radiotherapy Utilisation in Rectal Cancer Patients: 12 year data from the South Western Sydney Local Health District Clinical Cancer Registry, Oral and poster presentation, Annual Scientific Meeting, COSA, 2011 Gary D McKay et al Safety of Laparoscopic Colorectal Cancer Surgery During its Introduction to the Western Zone of Sydney South West Area Health Service (SSWAHS), Oral and poster presentation, Annual Scientific Meeting, COSA, 2011 Current Projects in progress Phil Malouf, M Morgan, A Berthethelson et al. Laparoscopic versus open resection for rectal cancer in an area health service: pathological, local recurrence and survival outcomes from 2001‐2008. PhD Project Dr P De Lacavalerie: The impact of the mutated in colorectal cancer (MCC) defect on treatment responsiveness in colorectal cancer. Requires co‐ordinated access to rectal cancer tissue preoperatively with involvement of colorectal surgeons. Colorectal Cancer Surgery Database Group: Prof Bokey, Prof Chapuis, Prof Dent, Dr MacKenzxie, Dr Basilakis. Development of a networked clinico‐pathological database system. Dr Scott MacKenzie, Fellow Dr Stephen Tang (TCRU Research Fellow 2012). A UWS based research project funded by the TCRU looking at the development of synoptic operation reports in colorectal cancer surgery. Prof Pierre Chapuis, Prof Bokey, Dr Stephen Tang: The anatomy of the Fascia of Dennvillier. An anatomical treatise on Denonvillier’s and its relevance to rectal cancer surgery.
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Future Projects/Expansion of Services Dr Ray Ashgari has developed a survivorship clinic in CRC to provide a more consistent follow‐up model for cancer patients: Where patients can see an ad‐hoc variety of GPs & specialists after their treatment, leading to repetition of services and uncertainty, the new model proposes a system where the patient carries a basic information package to allow any medical practitioner or allied health professional to see significant results and co‐ordinate follow‐up. The UWS Colorectal Cancer Research Group has been founded at Liverpool by Prof Bokey, Prof De Souza and Prof Soon Lee to facilitate and prompt inter‐disciplinary cancer research. The group has already been successful in securing grant funding and is closely affiliated to the Ingham Institute for Applied Medical Research. Current projects include the tumour tissue bank and investigations into operative techniques’ impact on cancer outcome. Future endeavours of the group include: Providing better access to PET/CT imaging results at Bankstown CRC/Upper GIT meeting. Improving access to documented MDT discussion for each patient. Increasing the proportion of patients discussed at MDT meetings. Funding to establish a position for the role of patient coordinator to improve efficient and comprehensive follow‐up for patients who have completed all initial treatment.
Colorectal group membership Colorectal Surgeons A/Prof Matthew Morgan Professor Les Bokey Dr Andrew Gatenby Dr Catherine Turner Dr Katherine Gibson Dr Scott Mackenzie Dr Steve Fulham Upper GI Surgeon Dr Amithabha Das
Pathologist Dr Christopher Henderson Radiation Oncologists Dr Allan Fowler Dr Karen Wong Dr Apsara Windsor Medical Oncologists Dr Weng Ng Dr Wei Chua Dr Lorraine Chantrill
Nuclear Medicine Physician Dr Michael Lin Radiologist Dr Nira Borok Nurse Care Co‐ordinator Ms. Sharon Linden MDT Co‐ordinators Ms. Roslyn Frederick Ms. Kerrianne Hancock
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Head and Neck MDT Group The Head and Neck Tumour group holds a weekly clinic to provide multidisciplinary care for patients with cancers of the head and neck region. A large number of staff attend the clinic and patient numbers can be high. Patients’ needs can be complex and where required, patients can see a Head and Neck Surgeon, ENT specialist, Radiation Oncologist, Care Coordinator, Speech Pathologist and Dietician in one day. Bookings for surgery, radiotherapy and chemotherapy are made as required. A formal multidisciplinary case discussion conference is held every second week with input from Radiology, Nuclear Medicine and Anatomical Pathology. A summary of the discussion for each patient is made electronically and subsequently mailed to family physicians. A monthly research meeting is now held where clinical trials and other research projects are discussed.
Highlights Achievements of the past year include:‐
An advanced form of radiation treatment delivery, Intensity Modulated Radiation Therapy (IMRT) is now in routine use for almost all head and neck patients at both Liverpool and Macarthur
Macarthur. This has been further developed with the introduction of cone‐beam CT at Liverpool which allows for daily verification and monitoring of treatment.
Complex surgical procedures such as extended radical resections with free flap reconstruction are commonly performed
A plastic surgeon now attends the clinic to provide services to the large number of patients with advanced skin cancers requiring surgery
A head and neck cancer clinical nurse consultant now attends the clinic and helps coordinate patients for surgical care
Patients continue to benefit from a comprehensive care coordination and allied health assessment clinic.
An information booklet for Laryngectomy patients has been published
SNIC trial (Sentinel Node biopsy for high risk non‐melanoma skin cancer)
Representation on a steering group with the Cancer Institute of NSW to develop a ‘Community of Practice’ for care coordinators across NSW.
Initiative to improve safety of patients who are neck breathers when discharged into the community (i.e. with a tracheostomy or post‐laryngectomy) – these patients are provided with a MedicAlert Foundation bracelet to identify as neck breather if require resuscitation by ambulance officers AND a new discharge protocol where these patients are linked in with the NSW Ambulance Service on discharge.
“An advanced form of
radiation treatment
delivery; Intensity
Modulated Radiation
Therapy (IMRT) is now in
routine use for almost all
head and neck patients at
both Liverpool and
Macarthur”
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Head and Neck Tumour Group members Palliative Care Dr Rebecca Strutt Radiology Dr Ramesh Cuganesan Pathology Dr Kasim Ismail Gastroenterology Dr David Abi‐Hanna Care Coordinator Luci Dall’Armi Clinical Nurse Consultant Hei Lan Byun Surgeons Dr Jonathan Clark Dr John McGuinness
Dr Bruce Ashford Dr Navin Niles Dr Marcus Brunner Dr Quan Ngo Dr Philip Yeung Radiation Oncologists Dr Dion Forstner Dr Allan Fowler Medical Oncologists Dr Victoria Bray Dr PoYee Yip Dental Dr Sue Yeoh Dr Lan Pham Nuclear Medicine Dr Peter Lin
Nursing Carol Doherty Yvette Furney Dietetics Katherine Bell May Mak Anneka Janson Speech Pathology Candice Baxter Armalie Muller Katherine Kelly Katherine Symeou Social Work Teresa Simpson
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Haematology MDT Group The Haematology MDT meeting is held weekly with attendance by Clinical Haematologists, Radiation Oncologists, Medical Imaging ‐ Radiology and Nuclear Medicine, Haematology Care Co‐Ordinator and Haematology CNC with fortnightly Pathology review meetings. Patients discussed at the meeting include patients with newly diagnosed and relapsed lymphoma (Hodgkin and non‐Hodgkin lymphoma) and multiple myeloma as well as acute and chronic leukaemia with treatment plans formulated and recorded in the patient health record.
Highlights
Recruitment of a part‐time myeloma nurse to assist in the management of patients with multiple myeloma in conjunction with establishment of a myeloma clinic.
Establishment of the allogeneic stem cell transplantation service at Liverpool Hospital in 2012.
Commencement of weekly bone marrow transplant MDT meeting with videoconferencing to Westmead Hospital including representation from Social Work, Dietetics, Data Manager, BMT Co‐Ordinator, BMT Step Down Unit CNS, BMT Registrar and BMT physicians followed by BMT clinic.
Establishment of total body irradiation (TBI) in conjunction with Radiation Oncology as treatment modality for allogeneic stem cell transplant conditioning therapy
Awarded Cancer Institute NSW Primary Health Care Grant to facilitate referral of newly diagnosed patients to a Clinical Haematologist, encourage GP participation in care of patients during therapy and assist in monitoring of patients and rehabilitation post therapy in a multidisciplinary community setting.
Establishment of a survivorship program.
Increased clinical trials activity including being third highest national recruiter for ENESTxtnd chronic myeloid leukaemia study.
KPI’s 489 cases were presented over a 12 month period from July 2011 to July 2012. This included 78 new cases of lymphoma representing 97.5% of newly diagnosed lymphoma patients, 30 cases of newly diagnosed multiple myeloma representing 67% of newly diagnosed multiple myeloma patients, 203 post treatment evaluation and relapsed/refractory lymphoma patients (57% of cases) and 31 patients (8% of cases) with progressive multiple myeloma. Other cases that were discussed included acute and chronic leukaemia patients as well as non‐malignant haematology patients.
Challenges
Increasing numbers of patients being diagnosed with lymphoma and multiple myeloma.
Ensuring 100% newly diagnosed patients with lymphoma, multiple myeloma and acute leukaemia are discussed in a Haematology MDT meeting.
Obtaining appropriate diagnostic and staging investigations and delivery of chemotherapy in a timely fashion.
Low participation rate in clinical trials.
Access to outpatient supportive care with blood products etc for patients receiving intensive therapy to enable early discharge and outpatient therapy that otherwise would necessitate inpatient therapy.
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Future
Increased clinical trials staffing for Haematology trials to expand suite of a clinical trials available to patients.
Improved relationship with primary health care practitioners to optimise patient care during and post therapy.
Establishment of an Ambulatory Haematology Unit.
Research and Education
Current clinical trials: MDS4, NHL‐21, ENESTxtnd, ALL6, Denosumab Multiple Myleoma SRE Study.
Involvement in various patient education seminars on lymphoma and multiple myeloma being conducted by Leukaemia Foundation as well as BMT patient education seminars.
Areas of research include:
Prognostic significance of interim and post treatment PET‐CT results in diffuse large cell lymphoma and low grade lymphoma.
Prognostic significance of interim and post treatment PET scan results in Hodgkin lymphoma.
JAK2 mRNA expression and relationship to myeloproliferative disorder phenotype.
Factors affecting response and resistance to proteasome inhibitor therapy in multiple myeloma.
Significance of SNPs in XBP‐1in multiple myeloma.
Development of assays for molecular markers such as WT‐1, IDH, CEBPA as prognostic markers in acute myeloid leukaemia.
Analysis of impact of presence of FLT‐1 and NPM‐1 mutations on outcome of patients with acute myeloid leukaemia at Liverpool Hospital.
Membership Staff Specialists Dr David Rosenfled Dr Michael Harvey Dr Anne‐Maree Watson Dr Lindsay Dunlop Dr Penelope Motum Dr Sylvia Ling Dr Nicholas Viiala Dr Samantha Day Dr Danny Hsu Dr Adam Bryant Cancer Care Coordinator Abby Krige Clinical Nurse Consultant Karl Jobburn
Radiation Oncologists Dr Michael Barton Dr Eng‐Siew Koh Radiologist Dr Praneal Sharma Nuclear Medicine Dr Peter Lin Dr Michale Lin Dr Ivan Ho Shon Dr June Yap Nursing Joanne Roseman Pathologist Chris Chow
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Lung MDT Group
The Lung MDT meets at a weekly videoconferenced meeting between Liverpool and Macarthur Cancer Therapy Centres. It is attended by respiratory physicians, medical and radiation oncologists, cardiothoracic surgeons, palliative care physicians and nurses, a radiologist, a nuclear medicine physician and lung cancer care coordinator. The MDT discusses management of patients with newly diagnosed lung cancer, mesothelioma, thymoma as well as some patients with lung metastases. A minimum dataset is collected on patients presented and a consensus entered into an electronic database. The MDT consensus is sent to the patients GP and referring specialist.
Highlights Recruitment of a Lung Cancer Coordinator in January 2012 who provides patients with information and screens them for psychosocial distress. Lung MDT meeting chosen for Cancer Australia review of Lung Cancer MDTs
Key Performance Indicators
For the period July 2011‐May 2012, 224 patients were discussed at the Lung MDT meeting.
93% of patients had a MDT consensus letter sent to the GP.
For the period Jan 2012‐April 2012, 99% of patients were assessed by the Lung CC and 63% screened using the Distress Thermometer.
Challenges
Access to endobronchial ultrasound (EBUS) at Liverpool Hospital
Access to bronchoscopy at Campbelltown Hospital
Greater tissue acquisition for mutation testing
Access to timely lung cancer surgery
Standardising lung cancer pathology reporting
Pathology attendance at Lung Cancer MDT meeting
Access
Members of the Lung MDT team are progressing these issues through hospital management and discussions with the pathology department.
Future Projects/Expansion of Services Rapid access lung cancer clinic – proposed but depends on resource availability. Routine EGFR testing – will need further discussion with pathology. Stereotactic Lung Radiotherapy. Once the radiation oncology department has a 4D CT for radiotherapy planning, we plan to offer stereotactic lung radiotherapy and participate in the CHISEL study, a multicentre study comparing stereotactic radiotherapy to conventional radiotherapy in patients with medically inoperable Stage I&II NSCLC.
Research and Education
Member contributions A/Prof Shalini Vinod – Revision of NHMRC Lung Cancer Guidelines, Management Advisory Committee of ALTG, Chair eviQ radiation oncology group, Member of Lung Cancer Stigma Project Working Group
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Publications Kang S, Koh E‐S, Vinod SK, Jalaludin B. Cost analysis of lung cancer management in South‐Western Sydney. J Med Imaging Radiat Oncol 2012; 56: 235‐241. Sam S, Ho‐Shon I, Vinod SK, Lin P, Lin M. Workflow and radiation safety implications of 18 FDG PET/CT scans for radiotherapy planning. Accepted Journal Nuclear Medicine Technology Jan 2012. Morarji K, Fowler A, Vinod SK, Ho Shon I, Laurence JM. Impact of FDG‐PET delineation for radiotherapy. J Med Imaging Radiat Oncol 2012; 56:195‐203. Yip PY, Barnes D, McCaughan B, Boyer M. Diagnosis and treatment of lung cancer: a focus on the GP’s role. MedicineToday 2012; 13: 30‐36 ILP project Kelly J, Shafiq J, Vinod SK. Timelines in lung cancer Diagnosis and Treatment in South Western Sydney
Current Research Evaluating the proportion of patients discussed at the Lung MDT meeting who were treated according to NHMRC guidelines (2005‐2010).
Clinical trials First Line Crizotinib v Chemotherapy for NSCLC with ALK mutation
PACT: Preferences for Adjuvant Chemotherapy in NSCLC: What makes it worthwhile to patients and their doctors ?
Pilot study of MRI for Lung Cancer Radiotherapy planning
Active Breathing Coordinator for lung cancer radiotherapy planning
Palliative care trials evaluating medical therapy for the treatment of dyspnoea, fatigue and anorexia.
Education
A GP education session was held for the Sydney South West GP Link in February 2012.
The Lung Care Coordinator has been involved in education of ward and clinic staff. She has also spoken at the Respiratory Nursing Conference.
The Lung Care Coordinator has been updating and collating patient and family patient Information
Membership Nursing/Allied Health Jeanette Suurdt Gerald Au Surgeons Prof Bruce French Dr Manish Jain Imaging Dr Ivan Ho‐Shon Dr Peter Lin Dr Michael Lim Dr Anthony Kaplan Pathologist Dr Cherie Wong
Physicians Dr Claudia Dobler Dr Graeme Thompson Prof Guy Marks Dr Jonathan Williamson Dr Peter Collett Dr Peter Buchanan Dr Zinta Harrington Dr Hima Vedam Dr Soo Wei Foo Dr Kevin Chan Dr Anthony Aouad Dr Belinda Cochrane
Palliative Care Dr Jennifer Wiltshire Dr Rebecca Strutt Radiation Oncologists A/Prof Shalini Vinod Dr Eng‐Siew Koh Dr Marcus Dreosti Medical Oncologists A/Prof Stephen Della‐Fiorentina Dr Victoria Bray Dr Po Yee Yip
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Neuro‐Oncology MDT Group The Neuro‐oncology MDT meets fortnightly attended by staff from Liverpool Hospital, and Liverpool and Macarthur Cancer Therapy Centres. It is attended by neuro‐surgeons, the neurosurgical CNC and other nurses, radiation and medical oncologists, palliative care physicians, a radiologist, a pathologist, the neuro‐oncology care coordinator, relevant specialty trainees, and allied health. The MDT discusses management of patients with newly diagnosed and recurrent malignant and benign primary brain tumours, as well as other rare nervous system tumours and selected cases of brain metastases. A minimum dataset is collected on patients presented and a consensus entered into an electronic database. The MDT consensus is sent to MDT members.
Highlights After a nine month period without a Neuro‐oncology Care Coordinator, Ms Wafa Trad began in this role in May 2012. She brings significant neuro‐surgical and ICU nursing experience and has been a real asset to the team. The highly successful Brain Tumour Support Group, coordinated by Kylie Wright and Teresa Simpson enters it’s ninth year providing invaluable support to patients and carers.
Key Performance Indicators • 95% of all newly diagnosed and recurrent malignant and benign primary
brain tumours diagnosed across SWSLHD discussed at the MDT • Comprehensive collection of benign brain tumour data • Pre‐operative MRI performed in >90% of cases Increasing use of post‐
operative MRI in most glioma cases undergoing resection
Research and Education
Member contributions Dr Eng‐Siew Koh– Chair, Clinical Oncological society of Australia (COSA) Neuro‐oncology Group input into Cancer Institute NSW eviQ CNS Tumour protocols, Member of the COGNO Management Advisory Committee, Co‐Convenor – 4th COGNO ASM, Sydney, August 2011 ; co‐investigator – AGOG and SEED studies ; Invited panelist for NSW Brain Cancer Action Week 2012. Convenor – inaugural COSA Neuro‐oncology Clinical Professional Day (attended by over 160 clinicians across ANZ). March 2012. Contributor to “it’s my Health” website – Overview of Brain Cancer Kylie M Wright, Teresa Simpson and our neuro‐oncology care coordinator are active participants in Cancer Institute NSW NSWOG Neuro‐Oncology Group.
MDT members ‐ Involvement in the NSW Brain Cancer Action Week – May 2012. A/Professor Matthias Jaeger and Kylie M Wright: ACI Neurosurgery Network –Executive members / SWSLHD Representatives. Prof Paul de Souza and Dr Eng‐Siew Koh – CINSW Neuro‐oncology Surgical Outcomes Advisory Group members.
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Publications 1. Whiting DL, Simpson GK, Koh ES, Wright KM, Simpson T, Firth R. Brain Injury 2012;26(7‐8):950‐61. Epub 2012 May 25. A multi‐tiered intervention to address behavioural and cognitive changes after diagnosis of primary brain tumour: A feasibility study.
Published Abstracts 1. Robinson KM, Koh E‐S, Hovey EJ, Wright KM, Simpson T, Price MA, Shafiq
J, Kaadan N, Barton MB. Evaluating the impact of a Neuro‐ oncology nurse coordinator In South West Sydney. (poster presentation). Society for Neuro‐oncology ASM, November 2011. Neuro Oncology 2011, 13 (suppl 3): iii121‐iii126 and Australasian Neuroscience Nurses Association (ANNA) ASM, Perth, October 2011 (poster presentation).
2. Characteristics and outcomes after whole brain radiotherapy for brain metastases in a large international cohort.Windsor A, Koh E‐S, Allen S, Yeo AET, Allison R, Barton MB. ESTRO ASM, Sept 2011 (oral presentation).
UNSW Medical Student ILP projects Alina Mahmood, Daniel Park, Hung Diep are all medical students from UNSW, and are currently working on anti‐angiogenesis projects in brain cancer cell lines. Specifically, they are investigating potentially synergistic combination treatments including BBIF1120, a multi‐tyrosine kinase inhibitor.
Presentations Dr Koh – Overview of Radiotherapy in CNS tumours. Neurosurgical Nursing Professional Development Scholarship Committee (NNPDSC) Conference, Sydney. June 2012. Impact of Neuro‐oncology Care Coordination. COSA Neuro‐oncology Clinical Professional Day, Sydney, March 2012. Kylie M Wright – CINSW Brain Tumour Consumer Forum, Sydney, May 2012. Speaker / Panellist.
Clinical trials 1. Australian Genomics and Clinical Outcomes of Glioma (AGOG), Cancer
Council NSW (epidemiologic, blood and tumour sample‐based study) 2. Self reported evaluation of the adverse effects of Dexamethasone (SEED)
pilot study recruiting patients on steroids with recurrent high grade glioma or brain metastases.
Challenges • Funding for the upgrade for neuro‐surgical microscope for use of 5‐ALA for
glioma resection. • Establishing ability to perform specific pathology testing and biomarker
assessment for selected brain tumours Routine and consistent use of MRI in follow‐up of brain tumour patients. Establishing recurrent funding for the neuro‐oncology care coordinator position.
Future Projects/Expansion of Services
Establishment of Skull base service with ENT and expanding service to include more skull base pathology/tumours in our MDT
Tomotherapy (specialized radiation technique) for use in selected cases of brain and spinal tumours
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Biospecimen bank to be set up in 2013‐4, pending ethics committee approvals
Membership Nursing/Allied Health Wafa Trad Kylie Wright Candice Baxter Katherine Kelly Emma Charters Armalie Muller Teresa Simpson Surgeons Dr Balsam Darwish A/Prof James Van Gelder A/Prof Mark Sheridan A/Prof Matthias Jaeger Dr Peter Khong
Dr Simon McKechnie Dr Renata Abraszko Dr Renata Bazina Dr Vanessa Perotti (reg) Dr Michael Hecklemann (reg) Pathology Dr Alar Enno Dr Tao Yang Imaging Dr Ramesh Cuganesan Medical Oncologist Prof Paul DeSouza
Radiation Oncologists Dr Eng‐Siew Koh Dr George Papadatos Prof Michael Barton Palliative Care Thang Du Huynh Rajesh Aggarwal Cancer Information Kirsten Duggan MDT Coordinators Kerrianne Hancock Roslyn Frederic
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Upper Gastro Intestinal MDT Group The Upper GI surgery department in the LHD has well established MDT’s to discuss all potential oncological cases of the upper gastro intestinal tract. The MDTs encompass sub‐disciplines of oesophagastric and hepatobiliary surgery. There are two MDT meetings across the LHD per week. The Bankstown Upper GI MDT is combined with the lower GI group, while the Liverpool Upper GI MDT is a standalone team. The Liverpool MDT group meets weekly and is attended by Upper GI Surgeons, oncologists, radiotherapists, gastroenterologists, pathologists, nuclear medicine physicians, radiologists and dieticians. Staff from any of our facilities across the district are welcome, and the meeting runs in collaboration with the Bansktown UGI MDTC which also meets weekly to deal with the large patient load. The meeting discusses the management patients with newly diagnosed and recurrent oesophageal, gastric, pancreaticobiliary and hepatic neoplasms, both primary and secondary, curative and palliative with the intention that all cases are discussed at least once during the patient journey. The MDTC recommendations are entered onto a database with recommendations sent to the treating specialists. The MDT meetings have regular representation from radiology, pathology, surgery, gastroenterology, administrative support, medical oncology and radiation oncology. The Liverpool meeting also has representation from nuclear medicine.
Member contributions Upper GI NSWOG (oesophagastric): Prof Neil Merrett Upper GI NSWOG (pancreatic): Prof A Biankin, Dr D Chan Upper GI NSWOG (liver): Dr A Das Cancer Institute NSW Ethics Committee: Prof Neil Merrett ANZGOSA Board: Prof Neil Merrett ANZGOSA Training committee: Prof Neil Merrett
Publications, abstracts and talks 2011/12 Humphris JL, Chang DK, Johns AL, Scarlett CJ, Pajic M, Jones MD, Colvin EK, Nagrial A, Chin VT, Chantrill LA, Samra JS, Gill AJ, Kench JG, Merrett ND, Das A, Musgrove EA, Sutherland RL, Biankin AV; The prognostic and predictive value of serum CA19.9 in pancreatic cancer Ann Oncol. 2012 Jul;23(7):1713‐1722 (IF=2.27) Chua TC, Merrett ND. Clinicopathological factors associated with HER‐2Positive gastric cancer and its impact on survival outcomes – a systematic review Int J Cancer. 2012 Jun 15;130(12):2845‐56doi: 10.1002/ijc.26292.(IF:4.7) Nguyen NQ, Johns AL, Gill AJ, Ring N, Chang DK, Clarkson A, Merrett ND, Kench JG, Colvin EK, Scarlett CJ, Biankin AV. Clinical and immunohistological features of 34 solid pseudopapillary tumours of the pancreas J Gastroenterol Hepatol. 2011 Feb;26(2):267‐74. (IF 2.3
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Published Abstracts Cosman PH, Chang D, Biankin AV, Das A, Merrett ND Tumour seeding along needle biopsy tract in pancreatic cancer ANZ J.Surg 2012: 82 (Suppl.1) HP66P; 101 Francis S, Eviston T, Biankin AV, Cosman PH, Chang D, Merrett ND Renal Cell Cancer metastatic to the thyroid and pancreas ANZ J.Surg 2012: 82 (Suppl.1) HP61P; 100 Chen Y, Haveman J, Apostolou C, Chang D, Biankin AV, Merrett ND Predictors of 5 year survival in gastric cancer: The experiences of a single Australian centre ANZ J.Surg 2012: 82 (Suppl.1) HP59P; 99 Chen Y, Haveman J, Apostolou C, Chang D, Biankin AV, Merrett ND Long‐term survival in gastric cancer: The experiences of a single Australian centre ANZ J.Surg 2012: 82 (Suppl.1) HP50P; 97 Merrett ND, Das A, Chang D, Biankin AV Feasibility, safety and efficacy of laparoscopic resection of gastric GIST ANZ J.Surg 2012: 82 (Suppl.1) HP40P; 94 Chen Y, Haveman J, Apostolou C, Chang D, Biankin AV, Merrett ND Asian Gastric Cancer patient show superior survival: The experiences of a single Australian centre ANZ J.Surg 2012: 82 (Suppl.1) HP32P; 93 Karikios D, Lin P, Nasgrial A, Merrett ND, Wilson RB, NG W The role of 18F‐Fluorodeoxyglucose positron emission tomography/computed tomography (18FDG PET‐CT) in the role of pretreatment staging of gastric cancer ANZ J.Surg 2012: 82 (Suppl.1) HP17; 89 Saxena P, Leong R, Pavey D, Merrett ND Multimodality endoscopic management of dysplastic Barrett’s oesophagus using radiofrequency ablation and endoscopic mucosal resection following assessment with EUS and CEM ANZ J.Surg 2012: 82 (Suppl.1) HP11; 88 Merrett ND, Chang DK, Biankin AV Recurrent pain following primary operation for chronic pancreatitis : Management options HPB 2011 13 (supp 3) c‐059 18 Lefter LP, Chang DK, Das A, Biankin AV, Merrett ND Ruptured pseudoaneurysm of the splenic artery complicating central pancreatectomy HPB 2011 13 (supp 3) P120 238 Merrett ND Haemorrhage following PD HPB 2011 13 (supp 3) BS‐16 163 Apostolou C, Haveman JW, Chang DK, Biankin AV, Merrett ND Pancreatic Visceral aneurysms : Report of 3 cases and literature review HPB 2011 13 (supp 3) A148 111
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D. J. Karikios1, M. Lin2, A. M. Nagrial1, N. D. Merrett3, R. Wilson3, W. Ng1 The role of 18f‐fluorodeoxyglucose positron emission tomography/computed tomography (18fdg pet‐ct) in the preoperative staging of gastric cancer: a retrospective review at a single institution
Membership Surgeons Dr Das A/Professor P Cosman A/Professor R Wilson Professor N Merrett Dr S Fedorine Dr Apostolou A/Prof A Biankin Dr David Chan Pathology Dr Chris Chow Dr Tao Yang Gastroenterologist Dr Abi‐Hanna Dr Ken Koo Dr Miriam Levy Dr Robert Nguyen
Dr Watson Ng Dr Scott Davison Imaging Dr Nira Borok Dr Glen Schlaphoff Dr Michael Lin Dr Ivan Ho‐Shon Dietician Ruth Vo Medical Oncologists Dr Weng Ng Dr Victoria Bray Radiation Oncologists Dr Karen Wong (Dr Apsara Windsor locum cover)
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Gynaecology Oncology MDT Group
Please refer to Gynaecologic Oncology Report – Page 25 of this report
Membership Surgeon Dr Felix Chan Medical Oncologists Dr Michelle Harrison Dr Diana Adams Radiation Oncologists
Dr Shalini Vinod Dr Miriam Boxer Dr Allan Fowler Imaging Dr Michael Lin Dr Ivan Ho Shon
Pathologists A/Prof Leo Santos Dr Richard Jin Nursing/Allied Health Rosemary Craft Mariad O’Gorman
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Breast Radiotherapy Interest Group The Breast Interest Group strives to improve service delivery with regard to radiation treatment of breast malignancies by engaging in research and development. The group meets bi‐monthly with representatives from radiation oncology, radiation therapy and medical physics.
Highlights
Grant funding for the Breast MRI project by Cancer Australia & National Breast Cancer Foundation‐ lead by Dr Lois Holloway.
Oral presentation at Faculty of Radiation Oncology (FRO) Annual Scientific Meeting‐ Batumalai et al, Acute Radiation Induced Changes in Cardiac Function after Radiotherapy to the Left Breast.
Research and Education
Trans Tasman Radiation Oncology Group (TROG) trials: TROG 08.06 STARS
TROG 07.01 DCIS
TROG 11.01 SUPREMO
In‐house projects
Breast setup study
Breast MRI study
Integrated breast boost Other projects
Breast ECHO study
Large breast immobilization study
Challenges One of the main challenges of the breast interest group is patient recruitment to clinical trials due to the large number of studies we are involved in and the high proportion of patients from a Non‐English speaking background.
Future Projects/Expansion of Services Pre‐treatment MRI scans to assess CTV before and after surgery for partial breast irradiation.
Membership Radiation Oncologists Geoff Delaney George Papadatos Denise Lonergan Karen Lim Medical Physicists Lois Holloway Satya Rajapakse Tony Young
Radiation Therapists Vikneswary Batumalai James Latimer Thien Le Adrianna Scotti Penny Phan Callie Choong Vanessa Leong Janelle Hardie Steven Tran Giselle Condos
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Brachytherapy Radiotherapy Interest Group The Brachytherapy group meets monthly with representatives from Radiation Oncology, Radiation Therapy, Medical Physics and Radiation Nursing. We strive to improve service delivery with regards to Brachytherapy treatment of gynaecological malignancies, oesophageal, bronchial and head and neck cancers.
Highlights Upon the acquisition of the new planning system “Oncentra” in Nov 2011, our main aim is moving towards implementation of adaptive planning using MR images for cervix brachytherapy. In late November 2011, a major milestone achieved in this process was the acquisition of MR images with applicators in place. A total of 4 data sets are recruited to date, and since the last report we have recruited an additional 1 patient with pre‐brachytherapy MR images which makes a total of 9 patients. Organs at risk (OAR) were contoured on all available MR data sets; parallel plans were carried out on MR data sets with applicators in place. A Brachytherapy Specialist was appointed in June 2012, whom will coordinate all brachytherapy related issues and future developments.
Key Performance Indicators
Acquisition and commissioning of the new Brachytherapy planning system “Oncentra”
Completion of the new planning system training by key members of the brachytherapy group (including prostate brachy group)
Established the process of MR data set acquisition with applicators in place for cervix patients
MR image training given by Radiologist to the RT brachy group
Contouring atlas for OAR for cervix developed for Oncentra
Experience gained for OAR contouring on MR images for cervix patients by key members of brachytherapy group
Experience gained for target contouring on MR images for cervix patients by the RO group with Radiologist advice
All Vaginal plans have been converted into electronic PDF files since we are heading towards a ‘paperless’ department
Research and Education Recruiting new members for the brachy team & updating all existing protocols.
Cervix Brachytherapy Dose records and data collection for all previous cervix patients Implement planning process using MR alone Continue to improve contouring skills for target and OAR on MR images Move towards adaptive planning e.g: full volume based with the purchase of “Vienna applicators”
Membership Radiation Oncology A/Prof Shalini Vinod Dr Allan Fowler Dr Karen Lim Dr Miriam Boxer Medical Physicists Virendra Patel Sankar Arumugam
Radiation Therapists Lucy Ohanessian Annie Lau Alison Dunning Daniel Moretti Adrianna Scotti Ewa Juresic Reyna Stirton
Thien Le James Mackay Glen Dinsdale Radiation Nursing Tania Luxford Leah Baker
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GU Special Interest Group The Genitourinary (GU) group is led by a sub‐specialist interest group that meets 3 times a month with representation from Radiation Oncology, Radiation Therapy, Medical Physics and Clinical Psychology. Prostate cancer, being the most commonly diagnosed cancer in men in Australia, forms the majority of both the clinical work, and also the development and research work of this group. Other genitourinary umours include renal, ureteric/bladder, penis and testis cancer.
Highlights We now treat approximately 30% of our radical and post‐operative prostate patients with IMRT. Our departmental prostate IMRT protocol continues to be further developed and refined. We are now using cone beam CT for treatment verification routinely for patients undergoing post‐prostatectomy radiotherapy at Liverpool Cancer Therapy Centre where this imaging modality is available. We have also finalized the imaging protocol on low dose CT at Macarthur Cancer Therapy Centre. We have been utilizing fiducial seeds for daily image guidance for a number of years. With cone beam CT however, we now have the ability to perform daily soft tissue matching in patients who have a contraindication to the fiducial seed insertion.
Research and Education We continue to actively participate in the RAVES study, a Trans‐Tasman Radiation Oncology Group study comparing adjuvant radiotherapy with early salvage radiotherapy following radical prostatectomy. This year we commenced a study exploring the use of rectal balloons in patients undergoing post‐prostatectomy radiotherapy (see picture) with the aim of improving daily reproducibility for treatment, and decreasing radiation dose to the rectum. The initial experience with the endorectal balloons, a first for Australia, was presented at the RANZCR College Annual Scientific Meeting, as well as a number of local and international meetings.
Future Projects/Expansion of Services High Dose Rate brachytherapy for prostate cancer offers a technique to significantly escalate the dose delivered to the prostate, while limiting dose to normal tissues such as the rectum. A new brachytherapy procedure suite has been built, and the process of developing a protocol to commence a prostate HDR service is ongoing. The acquisition of the new tomotherapy unit will provide new opportunities in the management of challenging cases such as patients with hip replacements.
Genitourinary MDT Group Membership Radiation Oncologists Dr Apsara Windsor Dr Karen Lim Dr Mark Sidhom Dr Karen Wong Dr Miriam Boxer
Medical Oncologists Dr Diana Adams Dr Wei Chua Radiologist Ryan Rudolph Pathologist Prof Jim Yong
Tamadur Mahasneh Surgeons Dr Lawrence Hayden Dr Paul Gassner Dr Nestor Lalak Dr Pascal Mancuso Dr Kayvan Haghighi
“prostate cancer…the
most commonly
diagnosed cancer in
men in Australia…”
“The initial experience
with the endorectal
balloons, a first for
Australia…”
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Thoracic Radiotherapy Interest Group The Thoracic Interest Group meets monthly with representatives from Radiation Oncology, Radiation Therapy and Medical Physics. We strive to improve service delivery with regard to treatment of thoracic malignancies (mainly lung and oesophageal cancer) by engaging in research and development
Highlights This year the focus has been on improving radiotherapy treatment delivery for lung cancer patients. Patients at Liverpool now receive daily cone beam CT verification. Any Macarthur patients for whom this technology would be beneficial are offered treatment at Liverpool. The clinicians are also utilising a hybrid planning technique which incorporates IMRT and 3D conformal radiotherapy to deliver better conformal radiotherapy for Thymoma patients whilst minimising doses to normal tissues. The Lung Specialist RO’s also meet weekly to audit Lung contours to improve accuracy and to be used as training and education.
Key Performance Indicators The group has completed “impact of incorporating PET data in radiotherapy planning for oesophageal cancer” study along with “Toxicity and outcomes of definitive chemoRT in lung cancer 2000‐2010”. Results of both studies were presented at the RANZCR meeting this year. Preliminary results from the ABC study will also be presented at the ELEKTA users meeting this year.
Research and Education
Current projects: 1. Active breathing coordinator‐ Comparing tumour motion measured on
ABC vs. PET vs. KV conebeam CT. 2. Lung hybrid IMRT planning study – determine whether a combination of
3DCRT and IMRT can provide improved dosimetery for radical lung planning.
3. Lung MRI study – determine the feasibility of incorporating MRI data on lung radiotherapy and evaluate workflow impact.
4. Conebeam CT viewing settings ‐ To determine if daily soft tissue verification is feasible for thoracic patients.
Challenges
Lack of 4DCT for simulation to determine motion for lung cancer patients – there are plans to acquire this.
Lack of CBCT at Macarthur
Future Projects/Expansion of Services
Utilising MRI in radiotherapy for Lung cancer
Adaptive radiotherapy based on changes on CBCT.
Setting up a stereotactic protocol within the department
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Carers Support Initiatives
Carers Week and Activities for Carers A total of 8 events for carers have been held across different sites by Cancer Services and Palliative Care providing information, self‐care skills and support to carers, and also for promoting carer‐related initiatives. One of these events was specifically organized for major community groups within the district.
Information and Support to Carers Cancer Care Coordinators of different tumour streams have been sourcing information, booklets, DVDs etc in different community languages for their respective tumour sites. These information are also available to carers to assist with their understanding and coping with the illness, the patient’s experience, and with looking after the patient. For instance, the Lung Tumour Stream has so far sourced information related to the cancer in 25 languages. The “Cancer Carer Resource Booklet” (produced in 2010) was translated into five additional languages, namely, Arabic, Chinese, Croatian, Spanish and Vietnamese, reflecting the largest CALD communities attending Liverpool Cancer Services. The Liverpool Cancer Services Carers Support Committee piloted the “Mobile Information Carers Centre” (MICC) project in which the mobile information centre was taken through the ward during visiting hours to provide education for carers about their roles and resources available to them and where necessary link them with appreciate services. A pamphlet on “How to Support a Bereaved Person” was published in English, Arabic and Vietnamese to facilitate relatives and friends to provide support to the bereaved carers. Carers of patients suffering from neurological cancers are routinely screened to identify their psycho‐social distress and needs and to initiate referrals to related services. The Brain Tumour Support Group continues to provide on‐going education and support to patients and carers regarding their conditions and treatment.
Research on Carers The Palliative Care Services Development Team is conducting the “Conversations, Stories & Reflections: What do they want us to hear?” project in which carers are interviewed for their experiences with the care and support they have received from the services. The carers’ feedbacks are provided back to respective service sites to improve service delivery and development.
Staff Education The Palliative Care Services is considering the possibility of promoting and educating staff on the services of carers telephone support and carers mentoring provided by the organization called “Life Circle”, after having met with its representatives.
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Plans have been drawn up to liaise with CEWD to set up ongoing educational training for palliative care volunteers and health staff on issues relating to carers support and involvement. Medical students were involved in assisting with the planning of the carer support days and provided assistance on the day. One of the medical students presented on the carer support day she attended at the recent World Social Work and Social Development Conference at Stockholm, Sweden in July 2012.
Carers participation in Service Delivery, development and Planning The Cancer Services Council has regular meetings to discuss strategy. Consumer and carer representatives sit on this committee. In addition, there are consumer cancer groups that meet regularly at Macarthur and Liverpool, and provide input into the provision of cancer services. It is also planned that consumers and carers are involved in the development of Wellness Centres.
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Acknowledgements
Volunteers
Look Good, Feel Better Look Good…Feel Better is a free, non‐medical, brand‐neutral, national Community service program created to help individuals with cancer look good, improve their self‐esteem, and thereby manage their treatment and recovery with greater confidence. Guided by volunteers through our program, they master simple cosmetic techniques, explore hair alternatives, and learn about cosmetic hygiene, and skin care. Participants take home a complimentary kit of cosmetics that are generously donated by the Cosmetic industry. Liverpool hospital holds eight, Campbelltown hospital nine & Bankstown hospital six workshops per year. Check out www.lgfb.org.au Our volunteer facilitator for the Liverpool program Lyn Georgeson is the NSW/ACT Metropolitan Volunteer of the year for 2011. This award is to recognize the tireless efforts and wonderful dedication of the volunteer. Similarly in 2010 our Bankstown & Campbelltown facilitator Merrilyn Usher was the Metropolitan Volunteer of the Year. Both Lyn & Merrilyn are longtime volunteers and very worthy recipients. Merrilyn Usher – Facilitator Carolyn Poglaise Kim Cawthorne Peita Papp Yvonne Hosking
Lyn Georgeson – NSW Metropolitan Volunteer of the Year Maureen Thackeray Rhian Davies Ly Stewart
Cancer Council Volunteers ‐ Liverpool Cancer Council Information Centre (CCIC) was opened in 2009 within LCTC, at present there are 23 CCIC volunteers who support patients, carers and family members. Since opening in 2009 volunteers have provided staff and patients with over 27,000 Understanding Cancer Booklets. There are three lots of four hour shifts where volunteers provide printed, telephone and internet support to patients from 8.30am and finishing at 4pm. The service not only provides information to patients but as volunteers interact with patients, offer tea and have a chat, it can also ease the anxiety that patients may feel while waiting for treatment or an appointment. June Harrison Lorraine Mahoney Judith Rose Poultons Gillian Tindale Gloria Worthington Kamal Hadid Pronita Karki Joan Lewis
Janelle Southwell Robyn McNamara Pilar Maloney Norma Itte Kwasi Anti‐Aboagye Sindy Luu David Price Mona Mansour
Shanti Premji Berenice Elston Betty Eggleston Brian Knapp Joan Hilton Bronwyn Lewis Beryl Delaney
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Macarthur Cancer Centre Volunteers The MCTC volunteers provide an invaluable support service to the patients, carers, visitors and staff of MCTC. They assist patients to complete relevant paperwork at their initial visit to MCTC and where possible they provide a ‘Meet and Greet’ Patient Orientation to our centre. The volunteers offer refreshments to patients and their carers and provide the opportunity for that ‘ever important chat’. Where appropriate, our volunteers are available to escort patients and carers to other areas of the hospital. The MCTC Volunteers enthusiastically organise and participate in Cancer Council events including Australia’s Biggest Morning Tea, Daffodil Day and Pink Ribbon Day. They pride themselves on decorating our centre and the MCTC Christmas Tree each year in preparation for the patient and carers Christmas Party. Noelene Wright Mary Walters Beatrice Atwell Kathleen Forshaw
Arelin (Rell) Hodgson Paulette Medbury Catherine Bourke Grant O’Donnell
Complementary Therapy Centre Volunteers Our complementary therapy volunteers give freely and willingly of their time. Creating an ambience for total relaxation to help our patients forget about their illness is always appreciated. Bob Valk Nicole Psaroudis Bettina Mandera
Liverpool Hospital – Cancer Volunteers Our Hospital Volunteers continue to play an important role within our Centre working from Tuesday to Thursday. They take on a variety of tasks on the days that they are here. These duties include providing tea and coffee to patients and carers, keeping the urns filled, keeping supplies on hand, talking to patients and making them feel at ease, distributing magazines as well as providing assistance to the administrative staff with filing. The ladies have also assisted once again with “Biggest Morning Tea”. Barbara Wright Dutch Day Joy Maloney Vicky McCarthy
Fay Cooper Carol Keogh Elizabeth Lowe
Wig library Fiona Gould Robyn Cavan Roberta Turnbull
Bankstown – Cancer Volunteers Christine Jones Claudia Hardy Betty Whyburn
Judy Fisher Madge Lindwood Ruth Rendall
Tanya Wall Leonie Pacitti
A ‘HUGE’ thank you to a
great team of volunteers
who make a difference in
someone’s life
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SWS LHD Palliative Care Volunteers The volunteer program continues to grow and deliver direct patient/carer support services as well as promotion opportunities such as National Palliative Care week and fundraising to improve/ enhance our services. The program includes a regular volunteer visiting service Monday to Friday at Liverpool Hospital, and Camden Palliative Care unit and the Day Therapy Centre, providing support and patient activities. This year saw the launch of the volunteer program into Bankstown Hospital which included several media releases in local papers. This service operates Tuesday am & Wednesday pm. Our Community visiting program continues to support patients and carers in the home. We obtained funding through ‘SWSLHD Caring for Carers Project’ to develop an informative and support program for Palliative Care primary carers and palliative care volunteers. The Volunteer Coordinator developed a program of three events to focus on needs of carers and volunteers in Bankstown, Liverpool and Fairfield LGAs, and a fourth event aimed at carers from Vietnamese and Arabic communities. Each year the outstanding efforts of 2.4million volunteers in NSW is recognised. We were pleased to nominate Peter Teng, of Liverpool Hospital who won the highly commended ‘2011 NSW Volunteer Award for Sydney Outer West/blue Mountains’. Thank You to our volunteers for their tireless effort. (* Liverpool Hospital # Liverpool Community) Anna Muscatello Bibi Farida * Christine Jones* Heather Parkes Jacquelin Bedford Janet Perry Joan Casey Jennifer Harris Jenny Ross Karisha Khalil* Kerry Wheatley
Luci Rossi Lynn Harris Margaret Fecht Mary Carey Maureen Miller* Milan Malunec Nada Muller Pamela Bocking Peter Teng * Rita Centurion* Robyn Burton
Sandra Wales Stephen Prior Thanh‐Lan Bui Tina Mangione# Yvonne Kerr Judith Margaret Ann Smith Diana Popovic‐Brankovic* Jo‐Anne Craik‐Cooper# Rosalie Englebrecht
Volunteers statistics 1/7/2011 – 30/6/2012
Northern Sector
Bankstown/Fairfield/ Liverpool
Southern Sector
Macarthur & Wingecarribee
Occasions of service provided for palliative care patients/carers in Liverpool/Bankstown Hospital, the Camden Palliative Care Unit and Day Therapy Centre @ Camden Hospital
1063 3181
Total No of Home Visits in the community 118 70
Other (includes attendance at meetings, Fundraising initiatives, writing bereavement cards, memorial service, gardening, and attendance on other palliative care committees)
71 322
Total no of hours in face to face visits 734 2098
Total kms travelled to provide the service 2662 13289
Volunteers’ Jolly Trolley on Daffodil Day
2011
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Donations 2011‐2012 We would like to thank those who have made donations to Cancer Services, without support from our community, we could not provide the additional patient comfort and programs that make their journey easier.
Bankstown Donations Revesby Workers Club Bankstown Hospital Volunteers Mr Hoang Mr Hardie Danny Quach
Abi‐Assaf Family Loins Club of Yagoona Mrs Lee Pacitti Abdullah Family Mi Jorja Fashions
Liverpool Donations Substantial effort has gone into fundraising for Liverpool, 2011s Dry July effort raised $128,000 together with our community, we have raised over $300,000 this year for patient comfort, research and education.
Patient Care Lend Lease Bevisco Commercial Interiors Pty Ltd Metrotex Painters & Decorators Pty Favetti Bricklaying Pty Ltd P C Scaffolding & Rigging Pty Ltd Hoslab Pty Ltd Demolition Plus Pty Ltd Langton Roofing & Construction Pty Ltd John R Keith (NSW) Pty Ltd W P Projects Onsite Group Pty Ltd H Dallas Industries Pty Ltd Stowe Australia Pty Ltd Regal Landscapes Pty Ltd Boone & Willard Plumbing Pty Ltd Nilsen (NSW) Pty Ltd Cliff Reece & Associates Pty Ltd The Dry July Foundation Elizabeth Low
Jennifer & David Scott Cabra‐Vale Ex‐Active Ladies Auxiliary Fred McCarthy Barbara Fleming Mr & Mrs John Lees Holy Trinity Anglican Church Liverpool South Trump Property Maintenance Pty Ltd CRC Commercial & Residential Ceramics T K Pham & V L Pham Rice Daubney Group (NSW) Pty Ltd Jimmy Howach T/a Fine Seal Italian Catholic Federation Liverpool Jany Lo, Jenny & Linda Barry Blue Eric Chan My Lam William Chen
Palliative Care Donations A special note of thanks to all the donors who have donated towards the Palliative Care Volunteer program in cash and or in kind Aileen Collier Jahnvi Singh Sean Nolan Antoinette Riley Katie Carr Scott and Nicole Sutton Linda Callaghan Macarthur Anglican School Schweppes Australia Bidvest Fresh Louise Fox Simplicity Funerals Camden Men’s Shed Club Marconi
Australian Institute of Music St Johns Park Bowling Club Masters Camden SSWAHS Carers Program Franklins Wetherill Park Knitters Guild NSW, Macarthur Group Line Dancers, Campbelltown Fairlie Bournes Dr Michael Barbato Nada Damcevska Dr Frank Brennan
Mounties Ying Wu Gail reeves Lisa Firth Trevor Beck Freeman Catholic High School Ulysses Motorcycle Club, Macarthur Natalie Silva Santisteban Palma Hoyts Wetherill Park Wendy Edmonds Woolworths Camden
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Macarthur Donations Without help from our donors, we could not achieve the level of comfort we offer our patients, pictured left, the Director, Cancer services receives a welcome donation for the wig library from the Macarthur Ladies Night Out . Martin O'Donnell David Baird Alice Mallison William Carter Art Robinson Lynette Vlot Toll Transport Group Mary Kay Skin Care Nancia Jong Jean Olsen Pritpal Pooni Beatrice Atwell Mr & Mrs Alexander Geoffrey Knowles Erica Berchtold Dennis Rae
Nola Douglas Stephen Fulham Alan Hudson Dean Jalocon Louise Allen Ross Keys Joan Churchill Feliciana Gob Mark Pearse HL + KA Gardiner Kerry Walker William Carter SNP Security Matthew Pontin Kerry Walker Sharon Fitzpatrick
Ross & Helen Fitzpatrick Constantina Zannettou Macarthur Ladies Night Out Macarthur Older Women Network 24 hr Fight Against Cancer Macarthur Camden Womens Bowling Club Douglas Hanly Moir Pathology Bradmere Tool & Engineering Spoilt Rotten Hair & Beauty Pollards Mowing & Garden Service
24 hour Fight Against Cancer Macarthur The 24hr Fight against Cancer Committee – Macarthur lead the community in supporting Cancer Services across the Macarthur Health Service. This committee works tirelessly to raise funds for services and equipment for Cancer patients at the MCTC, Palliative Care and Paediatric Ambulatory Care at Campbelltown and Camden Hospitals. At this year’s fundraising launch A/Prof Stephen Della‐Fiorentina was presented with a cheque for $282,000.00. This brings the total of funds raised by the Campbelltown/Camden community to well over $1,000,000.00. (Committee pictured left)
Utilisation of funds over the year Funding for support positions Digital signage Storage units for Complimentary Therapists Falls monitors Commode Chairs Books for Social Work, Clinical Psychology and Dietetics
Cab charge vouchers Gardener for the Palliative Care Unit Pressure cushions and mattresses DVD for the MCTC and Palliative Care Unit Laryngectomy tubes Televisions for the Oncology Ward
Clinical Trials Donations Berrin Savage Jany Lo, Jenny & Linda
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Valued Employees of the Month 2011/2012
Macarthur Cancer Therapy Centre Sarah Payne August 2011 Katherine Symeou September 2011 Administration Team October 2011 Dr George Papadatos November 2011 Dr Belinda Kiely December 2011 Maria Martinez January 2012 Christine Fazzolari February 2012 Gail Dwyer March 2012 Kelly Bourke April 2012 Amanda Margharitis May 2012 Tania Tehovnik June 2012
Liverpool Cancer Therapy Centre
Karl Jobburn July 2011 Steven Tran August 2011 Tania Luxford September 2011 Franca Serafin October 2011 Rhonda Eke November 2011 Kathy Andrew December 2011 Roslyn Frederic January 2012 Julie Stone February 2012 Tanya Tesauro March 2012 Karen Clark April 2012 Joe Attard May 2012 Vinodine Onowale June 2012
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Ingham Cancer Research Steering Committee A Cancer Research Planning Day was held in 2011, and identified a need to establish an over‐arching Cancer Research Steering group. This would encourage pooling of resources for Cancer research within the SWSLHD and maximize collaboration opportunities. The Committee reports to the Ingham Research Board, and aims to increase the capacity for high quality, collaborative cancer research throughout the SWSLHD, and oversee the orderly development of Cancer Research. This group was established in 2011 with the following terms of reference: 1. To establish and maintain a centralized research steering committee
with representation by all key stakeholders including Surgery, Radiation Oncology, Medical Oncology, Haematology, Palliative Medicine, Medical Physics, Imaging, General Practice, Laboratories, Biobanks and the Clinical Cancer Registry
2. To develop and implement a strategic direction for Cancer Research in SWSLHD
3. To identify and foster research collaborations (both internal and external to SWSLHD) that maximize the output from any cancer research project
4. To identify and support collaborative funding opportunities 5. To focus research resources in areas of greatest priority 6. To review progress of research and provide advice on achievement of
the desired project endpoint/s 7. To overview and encourage collaborative research projects both
internal and external to the cancer service 8. To foster mentorship and staff development in Cancer Research 9. To assist in information exchange regarding all aspects of SWSLHN
Cancer research activity 10. To liaise with other clinical trials and research groups as needed 11. To establish and maintain a centralized system to monitor current
and future research projects output with in‐built accountability/ reporting systems to help ensure timely project completion and output.
12. Identify and attempt to rectify barriers preventing researchers from efficient, high‐quality research
Areas of research discussed include: 1. The Australian Radiation Research Bunker Project – a project led by Professor
Paul Keall, University of Sydney. This is an exciting project that, this year, received a $5M research programme grant from the National Health and Medical Research Council to develop a system where an MRI scanner and a radiation linear accelerator work together to allow better targeting of tumours for radiation treatment. This is one of only three such facilities that have been developed internationally and the only one of it’s type in the Southern Hemisphere.
2. Translational Cancer Research – this is a programme of work to ensure that research in the laboratory helps inform clinical decision making and also ensures that clinical outcome trends are fed back to the laboratory. This programme of work is being led by Professor Paul DeSouza, Dr. Norbert Kiezle, A/Prof Meera Agar and Professor Afaf Girgis.
3. Healthy Me – a project developing a web‐based resource for Cancer patients, carers including their general practitioners. This project is led by Professor Afaf Girgis
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4. Tumour biobanking – under Professor Soon Lee’s leadership, a programme of work has been developed to store cancer specimens and use them for molecular research to examine issues such as linking certain molecular markers to tumour outcome. This type of research helps identify what the possible targets are for more effective drug development.
5. Pancreatic laboratory research – this group of projects is being led by Professors Jeremy Wilson and Minoti Apte, investigating biological mechanisms for the development and growth of pancreatic cancer.
6. General practice – Professor Siaw‐Teng Liaw is running a series of projects examining the needs of general practitioners with respect to information to assist them in treating patients in the community
7. Colorectal cancer research – this area of research is being led by Professors Les Bokey and Pierre Chapuis. Colorectal cancer specimens are being examined and correlated with patient outcome.
8. Clinical Cancer registry – this is being led by Ms Nasreen Kaadan – this is a programme of work collecting data on every cancer patient from South Western Sydney. These data are used to facilitate outcomes‐based research.
9. Cancer Clinical Trials – this is led by Dr Michael Harvey, co‐ordinating all of the clinical trials that are being done for cancer patients in South‐Western Sydney. We currently have 42 clinical trials open for patients.
10. Cancer Imaging – with the assistance of Dr Peter Lin, and in conjunction with the Radiation Oncology department a series of imaging‐based projects are currently being conducted to better use imaging for the targeting of tumours for safe radiation delivery.
Membership: Cancer Clinical Services: Professor Geoff Delaney (Chair) Area Cancer Services/Radiation Oncology/ Health services Professor Paul de Souza Medical Oncology Professor Les Bokey Surgery Professor Andrew V. Biankin Bankstown Hospital and Head of Pancreatic Cancer Research at the Garvin Institute A/Prof Meera Agar Palliative Medicine Dr Michael Harvey Malignant Haematology Dr Lorraine Chantrill Clinical Trials Dr Eng‐Siew Koh Survivorship Dr Peter Lin Imaging Ingham Institute Professor Michael Barton (deputy chair)
Ingham Institute, research/ radiation oncology/ health service research A/Prof Greg Kaplan Chief Operating Officer, Ingham Institute Professor Afaf Girgis Executive Director, Translational Cancer Research Unit Dr Norbert Kienzle Manager, Translational Cancer Research Unit General Practice: Professor Siaw‐Teng Liaw Pathology, Laboratory and Biobanking Professor Soon Lee Professor Minoti Apte Universities: Professor Jeremy Wilson – UNSW Professor Neil Merrett – UWS Professor Paul Keall – USyd Cancer Registry and Clinical Data Ms Sandra Avery Administrative Support (Meeting Minutes): Mrs Caryn Knight
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Collaboration For Cancer Outcomes, Research and Evaluation (CCORE)
CCORE, established in 1999, is affiliated with the Cancer Therapy Centre, Liverpool Hospital, and is headed by Research Director, Michael Barton, Professor of Radiation Oncology, Faculty of Medicine, University of New South Wales. The Liverpool Hospital Cancer Therapy Centre is a tertiary referral centre for the treatment of cancer patients in South Western Sydney. CCORE aims to improve cancer outcomes through research and the implementation of best practice measures into routine clinical practice in the treatment of cancer. The CCORE unit has particular expertise in radiotherapy but also has broad interests in all areas of cancer management. Staff members include radiation oncologists, a medical oncologist, epidemiologist, project managers and data managers.
Highlighting our projects
Patterns of Retreatment by Radiotherapy: This study of over 60,000 patients aimed at describing patterns of radiotherapy retreatment by cancer type in order to develop methods of modeling retreatment for better service planning and benchmarking. Review of radiotherapy optimal utilisation rates (2011‐current): Commonwealth Dept. of Health and Ageing funded project on update of radiotherapy utilization model based on the existing CCORE model of optimal radiotherapy utilisation that had been completed in 2003. The project activities involve:
review of the indications for radiotherapy for specific patient and tumour‐related attributes recommended in the clinical practice guidelines
update of the epidemiological data in the model using the latest available Australian national, state or cancer registry data and
construction of an optimal radiotherapy utilization rate for individual cancer sites. A report is being prepared for each cancer site that includes brief description of the changes to radiotherapy utilisation compared to the previous model together with diagram of revised radiotherapy utilisation model. The drafts are being sent for peer review to a broad range of multidisciplinary reviewers in order to ensure the widest degree of input.
Evidence‐based estimation of survival and local control benefit of radiotherapy (2011‐current): Ongoing project on development of models for estimation survival and local control benefit of radiotherapy for selected cancers. The Southern Network has been selected to be involved in the RANZCR accreditation pilot for later in 2012 and we have successfully completed all of the required documentation. The Commonwealth Department of Health and Ageing has agreed to provide RANZCR with funds under the BARO program to pilot Radiation Oncology Training Networks across Australia over a period of three years. This will fund the Network Director position for one day per week and the ESO fulltime This is a research project for two PhD students that involves estimating the contribution that radiotherapy alone and in combination with chemotherapy (where indicated) would make to local control and survival for common cancer sites if all are treated according to evidence‐based treatment guidelines.
Head of Department Michael Barton OAM
Professor, Radiation Oncology Faculty of Medicine, UNSW
Research Director: Ingham Institute for Applied Medical Research (IIAMR)
Collaboration for Cancer Outcomes Research & Evaluation (CCORE)
Conjoint Professor, School of
Medicine, University of Western Sydney
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Timelines in lung cancer diagnosis and treatment in South Western Sydney (2011‐2012): Supervision of the above mentioned independent learning project (ILP) of a medical student from UNSW that involved retrospective audit of all newly diagnosed primary lung Cancer patients from 1/1/2009‐ 31/12/2009 who attended Macarthur or Liverpool Cancer Therapy Centres, estimation of time intervals from diagnosis to treatment for these patients and identification of any time lag in the treatment process and the reasons for the delay.
Radiation Oncology Network: The Southern NSW Radiation Oncology Training Network was initiated with a pilot programme in 2008. The participating hospitals include Prince of Wales, St George, Liverpool, Campbelltown, Wollongong and Canberra. Initially five registrars were appointed to the network and these trainees are now in their 5th year of specialist training. During 2011, the number of Network trainees has increased to 29. Successful rotation of trainees to all of the participating hospitals has taken place. Two rotations have been successfully completed to The Canberra Hospital with another two NSW trainees due to rotate there in July 2012. Accommodation issues in the past have been overcome with the addition of a “Network assigned Unit” at Campbelltown hospital and the use of a unit at Liverpool Hospital. The Southern Network has been selected to be involved in the RANZCR accreditation pilot for later in 2012 and we have successfully completed all of the required documentation. The Commonwealth Department of Health and Ageing has agreed to provide RANZCR with funds under the BARO program to pilot Radiation Oncology Training Networks across Australia over a period of three years. This will fund the Network Director position for one day per week and the ESO fulltime
Research and Education The following four CCORE researchers continued their PhD studies during 2011/12 in the following areas: Dr Karen Wong, Radiation Oncologist ‘Estimation of the Optimal Number of Radiotherapy Fractions for Cancer Patients’. Commenced 2007 Supervisors: Professors Michael Barton and Geoff Delaney. Dr Gabriel S Gabriel, Program Manager – ‘The effect of geographic variations on radiotherapy utilization rates in NSW’. Commenced 2007 Supervisors: Professors Michael Barton and Geoff Delaney (from Oct 2008). Dr Jesmin Shafiq, Program Manager ‘Model of estimation of local control and survival benefit of external beam radiotherapy for selected cancers’. Commenced 2011. Supervisors: Professors Michael Barton and Geoff Delaney. Dr Timothy Hanna, Clinical Research Fellow, Radiation Oncology – ‘The Overall Survival and Local Control Benefit of External Beam Radiation Therapy for Selected Cancers’. Commenced 2011. Supervisors: Professors Michael Barton and Geoff Delaney.
Challenges With the completion of the Ingham Institute for Applied Medical Research (IIAMR) building mid 2012, the CCORE research unit is currently making plans for the move from the eastern campus of Liverpool Hospital to this purpose built facility. The IIAMR is to bring together researchers with expertise in many areas including translational cancer research, basic research, the SWS Clinical Cancer Registry and the Medical Physics research group which will complement research expertise within CCORE
KPIs
Dr Susannah Jacob
Completed her PhD
14 Published papers
3 Book Chapters
CCORE Research
staff continue their
PHD studies
CCORE research
unit on the move
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Future Projects/Expansion of Services “The Australian MRI‐Linac Program: Improving cancer treatment through real‐time image guided adaptive radiotherapy” The approval of this application was as a result of the combined effort of many people from a diverse range of backgrounds and skills who contributed to the input. The collaborative team consists of researchers from SWSLHD, University of Sydney, University of Queensland, University of Wollongong, and University of Western Sydney, This Grant will allow the collaborative team to build a strong research program. The development of the MRI‐Linear accelerator project will have significant potential to improve overall survival rates of cancer sufferers, with substantial reduction of toxicity by way of targeting of the radiation beam to the tumour in real time to avoid off‐target radiation – an area of great clinical need. Expectations are that this research will result in improved treatment outcomes and changed clinical practice. This program will also include training and mentoring of young clinicians and scientists with an expertise in radiation oncology.
Publications
BOOKS Cancer Council Australia. Adult gliomas (astrocytomas and oligodendrogliomas): a guide for patients, their families and carers. Sydney: Cancer Council Australia; 2011
BOOK CHAPTERS Hanna TP. Radiation Oncology in the Developing World. Principles and Practice of Radiation Oncology 6th Ed. Perez CA, Brady LW, Halperin EC, Schmidt‐Ullrich RK, eds. Lippincott Williams and Wilkins. New York, In Press. Goodwin R, Hanna TP, Meyer RM. Overview of Cancer and Cancer Treatment Modalities. In: Hospital Medicine‐Oncology. McGraw‐Hill Professional. 2012. Barton MB, M Lehman. “Counterpoint on Glioma” in Patient Surveillance after Cancer Treatment“ editors F E Johnson, K S Virgo, R A Audisio, J F Thompson, Y Maehara, J A Margenthaler, C C Earle, and G P Browman. Humana Press, Totowa, NJ, USA (in press). 1ST Edition 2012, approx. 950 p.
REPORTS Barton MB. North West Radiotherapy Clinical Expert Panel. Advice for provision of radiotherapy services to people with cancer from North West Tasmania. June 2011
CONFERENCE ATTENDANCE, INVITED SPEAKERS ETC Barton M. Invited speaker: International Association for the Study of Lung Cancer (IASLC). 14th World Conference on Lung Cancer, 3‐7 July, 2011. Amsterdam, The Netherlands. ‘Improving access to education and cancer care in developing countries’. Barton M. RORIC (Radiation Oncology Reform Implementation Committee) ‐ ‘Beyond Bricks and Mortar – Building Quality Clinical Cancer Services Symposium’ (Dept of Health and Ageing). 10 – 11 August, 2011. Barton, M. Invited speaker: RANZCR 62nd Scientific Meeting. Michael Barton. 6‐9 October, 2011, Melbourne Convention and Exhibition Centre. ‘Patterns of Retreatment by Radiotherapy’ Hanna T. RANZCR 62nd Scientific Meeting. 6‐9 October, 2011, Melbourne Convention and Exhibition Centre. Hanna T, Shafiq J, Delaney G, Barton M. An estimation of the population benefit of radiotherapy for cervical Cancer: local Control and survival. Abstract presented at the
NHMRC Program
Grant Application
Success
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62nd Annual Scientific Meeting of the RANZCR Faculty of Radiation Oncology, Melbourne, 6 – 9 October 2011. Shafiq J. COSA 38th Annual Scientific Meeting. Perth 15‐17 November, 2011. Poster presentation. ‘An evidence‐based estimation of survival and local control benefit of radiotherapy for lung cancer’. Barton M. Invited Speaker: COSA 38th Annual Scientific Meeting: ‘Partnerships against cancer – bridging gaps, breaking barriers’. Perth: 15‐17 November, 2011. ‘Australian Medical Oncologist Workforce Study – general workforce shortage’ Barton M. COSA Neuro‐Oncology Clinical Professional Day, Sydney Convention and Exhibition Centre, Darling Harbour. Friday 9 March, 2012. Barton M. ISMRM (International Society for Magnetic Resonance in Medicine) 20th Annual Meeting: Adapting MRI in a Changing World, Melbourne, 5‐11 May, 2012 Barton M. International Symposium on MRI, 18‐19 June, 2012. Utrecht, The Netherlands.
JOURNAL PUBLICATIONS Boxer MM, Vinod SK, Shafiq J, Duggan KJ. Do multidisciplinary team meetings make a difference in the management of lung cancer? Cancer 2011. April 26 – epub ahead of print. Cancer. Vol 117, Issue 22, Pages 5112‐5120. Lin P, Koh E‐S, Lin M, Vinod SK, Ho‐Shon I, Yap J, Som S. Diagnostic and staging impact of radiotherapy planning FDG‐PET‐CT in non‐small‐cell lung cancer. Radiotherapy and Oncology Vol 101, Issue 2, Pages 284‐290. (Available on line 22 July, 2011) Barton MB, Delaney GP. A decade of investment in radiotherapy in New South Wales: Why does the gap between optimal and actual persist? Journal of Medical Imaging and Radiation Oncology 2011 Vol 55, Issue 4, Pages 433‐441. Barton MB. Careers ‐ Medical Mentor: Professor Michael Barton reflects on his career in radiation oncology. Medical Journal of Australia ‐ MJA Careers 2011 (3 October), 195(7):C5 Mahmud A, Brydon B, Tonita J, Hanna TP, Schmidt M, Tai P: A population‐based study of cervix cancer: incidence, management and outcome in the Canadian province of Saskatchewan. Clin Oncol (R Coll Radiol) 2011, 23(10):691‐695. Sam S, Ho‐Shon I, Vinod SK, Lin P, Lin M. Workflow and radiation safety implications of 18 FDG PET/CT scans for radiotherapy planning. Accepted Journal Nuclear Medicine Technology Jan 2012. Vinod SK, Wai E, Alexander C, Tyldesely S, Murray N. Stage III Non‐Small Cell lung Cancer (NSCLC): Population‐based patterns of treatment in British Columbia, Canada. Accepted Journal Thoracic Oncol Feb 2012. Kang S, Koh E‐S, Vinod SK, Jalaludin B. Cost analysis of lung cancer management in South Western Sydney. Journal of Medical Imaging and Radiation Oncology (April 2012), 56:235‐241. Morarji K, Fowler A, Vinod SK, Ho Shon I, Laurence JM. Impact of FDG‐PET on lung cancer delineation for radiotherapy. Journal of Medical Imaging and Radiation Oncology (April 2012) 56:195‐203. Ginsburg OM, Hanna TP, Vandenberg T, Joy AA, Clemons M, Game M, Maccormick R, Elit LM, Rosen B, Rahim Y et al: The global cancer epidemic: opportunities for Canada in low‐ and middle‐income countries. CMAJ 2012. (Canadian Medical Association Journal). Published ahead of print April 10, 2012 Hanna TP, Richardson H, Peng Y, Kong W, Zhang‐Salomons J, Mackillop WJ: A Population‐Based Study of Factors Affecting the Use of Radiotherapy for Endometrial Cancer. Clin Oncol (R Coll Radiol) 2012. Fong A, Shafiq J, Saunders C, Thompson AM, Tyldesley S, Olivotto IA, Barton MB, Dewar JA, Jacob S, Ng W, Speers C, Delaney GP. A comparison of breast cancer endocrine and chemotherapy utilization rates in British Columbia, Scotland, and Western Australia, and a comparison with models of "optimal" therapy. Breast 2012 (in press).
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Fong A, Shafiq J, Saunders C, Thompson AM, Tyldesley S, Olivotto IA, Barton MB, Dewar JA, Jacob S, Ng W, Speers C, Delaney GP. A comparison of breast cancer surgery and radiotherapy utilization rates in Canada (British Columbia), Scotland (Dundee), and Australia (Western Australia)and a comparison with models of “optimal” therapy. The Breast 2012 (in press).
APPOINTMENTS/AWARDS Barton MB ‐ appointed Member SWSLHD HREC (Human Research Ethics Committee) ‐ October 11, 2011. Barton MB – appointed as Clinical Lead, National Cancer Workforce Strategy – October 2011 Wong Karen & Prof Geoff Delaney ‐ RANZCR 62nd Scientific Meeting, Melbourne, 6‐9 October, 2011. Best Radiation Oncology Scientific Paper Presentation ‐ for presentation of Karen’s PhD work ‐ presented by G Delaney – An Evidence based Estimation of the Optimal Number of Radiotherapy Fractions for Cancer Patients. Barton MB. Re‐appointed to a further 2 year term on the Cancer Institute NSW Clinical Research Ethics Committee ‐ November, 2011. Barton MB – Invited as member of the Editorial Board of Clinical Oncology Journal, London, November 2011 – November 2016 (5 year appointment period).
INVITED EXPERT/SPEAKER Barton MB. IAEA Consultants Meeting – Developing Teaching Materials for Education on National Radiotherapy Services for Curative / Palliative Treatment of Common Cancers, 17‐19 October, 2011 ‐ IAEA headquarters, Vienna International Centre (VIC), Vienna Barton MB. "Evidence based assessment of the demand for cancer services". Covering optimal and actual utilisation of chemotherapy and radiotherapy. Per invitation to North Coast Cancer Institute seminar, 21 March, 2012 ‐ North Coast Area Health Service. Hanna TP. Radiation Oncology and Cancer Control. Sydney University, Master of Public Health Program. 18 June 2012.
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CCORE RESEARCH STAFF MEMBERS 2011/12 CCORE Research Director Michael Barton OAM Professor Radiation Oncology Faculty of Medicine, UNSW Project Managers Dr Gabriel S Gabriel – UNSW Dr Susannah Jacob – SWSLHD Dr Jesmin Shafiq – SWSLHD Director of Cancer Services, SWSLHD Professor Geoff Delaney Director of Radiation Oncology, SWSLHD Dr Dion Forstner Radiation Oncologists Dr Eng‐Siew Koh
A/Prof Shalini Vinod Dr Karen Wong Dr Apsara Windsor Medical Oncologist Dr Weng Ng Clinical Research Fellow Radiation Oncology Dr Timothy Hanna Research Assistant/Data Manager Mr Stuart Allen ‐ UNSW Biostatisticians Mr Zhipeng Hao ‐ UNSW Dr Anthony Yeo ‐ Ingham Health Research Institute – (IHRI)
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Clinical Cancer Trials ‐ Network The South Western Sydney Cancer Trials Network and Support Office (NSO) were established in 2010 as a result of a Cancer Institute NSW Grant, to enhance and increase trial activity in SWSLHD. The NSO is located at the Cancer Therapy Centre in Campbelltown Hospital, and supports cancer trials units at Liverpool, Campbelltown, Bankstown, Southern Highlands and Palliative Care Service at Braeside Hospital. The NSO works with trials staff, sponsors, and other essential partners to support and streamline regulatory processes, including amendments, safety reports and other associated ethical, scientific and research governance issues as well as helping with lead site activities for multi‐centre trials. We participated in complex audits for several multi‐centre trials and contributed to grant applications for continued SWSLHD Oncology Trial Unit funding. The NSO works with the units to provide regular progress reporting, portfolio summaries, contact updates and annual financial reporting to CINSW, and promotes cancer trial activity by representing researchers and communicating trial activity within the LHD and to the CINSW. The NSO co‐ordinated local orientation, training & education programs for cancer clinical trials staff.
NSO Staffing 2011/2012 There have been major changes and developments to the Network Office this year. Lorraine Chantrill, Niki Sansey and Angela Bennett were instrumental in establishing the Network Support Office and its role, from applying for the Grant through to successfully moving a large regulatory workload from SWS LHD clinical trials staff to the central management of Network Office staff. This enabled trials staff to focus on core clinical trials activities and improve recruitment, the main aim of the Network Grant and a key objective of the NSW Cancer plan 2011‐2015 ‐ to increase Clinical Trial participation. In 2011, the NSO experienced a loss of momentum, when Niki & Angela took up permanent roles at the CINSW and St George Hospital respectively, and Lorraine pursued her PhD studies at the Garvan Institute, reducing the expected impact of the NSO. However the Network Office has reached full staffing capacity again after the following appointments: ‐ SWSLHD Cancer Trials Network Director: Dr Michael Harvey Manager: Anne Whatman Research Administration Officer: Debra Vandine
Highlights We welcomed the CINSW decision to continue Grant funding for the NSOs, until the end of 2012, facilitating long term sustainability of clinical trial units within the SWSLHD. Major achievements include: 1. Completion and submission of the successful SWSLHD Clinical Trials Grant
Application for 4 positions shared between Liverpool, Bankstown, Campbelltown, Braeside and Southern Highlands Hospitals
2. implementation of CINSW projects such as the Trials Portfolio, and commitment to work on those trials.
3. development of the CI Web Portal and Online Reporting tool providing a functional web portal with real‐time reporting for the management of existing and ongoing clinical trials activity data, with capacity to publish an up to date portfolio on the CINSW website. This is linked to the Performance Monitoring & Management Framework including a Workload Rating System, a result of contributions from all NSW NSOs to the ratings paper.
300 Target
404 Actual
Patients
30 Target
60 Actual
Trials
Key Performance
Targets were
exceeded in 2011,
recruiting 404
patients to 60 open
trials, with 20 new
projects submitted to
HRECS.
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4. success in activation of investigator‐initiated and cooperative group trials, such as the SORBET study; designed by Dr Belinda Kiely, MCTC and supported by the ANZBCTG. The activation of these trials will contribute to recruitment to CI supported trials in 2012 across all the oncology trial units.
Trials addressing less common cancers opened across the trials units, including:
Glioma, metastatic Gastric adenocarcinoma, hepatocullular carcinoma, pancreatic cancer, cervical cancer, Haematology CLL 11 and CML trials,
A new trial for EML‐ALK lung cancer has been initiated for this rare subgroup of lung cancer,
Campbelltown is the lead site for a first line metastatic pancreas cancer study,
Several Haematology trials have been initiated The NSO has been crucial in facilitating new trials and processing amendments by providing:
Centralised regulatory processing on behalf of 3 major clinical trials units, providing standardisation and consistency in submissions to HRECs.
Submissions to Lead HRECs for new trials.
Assistance in governance submissions for new trials.
Liaison with Research Governance Office on issues associated with trials.
Contact for study sponsors regarding submission of new trials, amendments, safety issues and contracts
Improvements to quality of submissions and extensive revision of a backlog of regulatory work.
This support has indirectly added a critical mass to the oncology units of SWSLHD during a period of resourcing difficulties at some sites. Operationally, the NSO commenced standard operating procedures and quality checklists for use by NSO and clinical trials staff, and ongoing training and support for staff attendance at research meetings at Liverpool/Campbelltown and Bankstown Hospitals.An overview of SWSLHD Network Office purpose and activities was presented to Southern Highlands and BraesideUnits. The Office also successfully negotiated with the pathology department for ongoing support of clinical trials, and is contributing to a Network review of Clinical Trial Pharmacy fees.
Individual Clinical Trials Units in this District The SWSLHD Oncology Trial Units service a diverse, rapidly growing population approaching one million, over a large geographic area, that officially extends from the cities of Bankstown and Liverpool to the rural landscapes of the Southern Highlands. However patients participate in trials from as far away as Canberra, Newcastle & Ulladulla. We endeavour to open a range of trials across the District and promote cross‐referral to give patients greater access to promising new treatments.
Southern Highlands Cancer Therapy Centre This smaller trial unit located in Bowral has continued to recruit well reaching ‘ % highest recruiter’ status in NSW for the SOLE trial. Staff attended the Annual ANZBCTG Scientific Meeting & clinical trial workshop and report that it provided invaluable training for their breast cancer trial work.
Clinical Trials Staff Director A/Prof Stephen Della‐Fiorentina Research Nurse Coordinator Isobel Davis Oncology Nurse Jo Pearson
02468
1012141618
No of open trials @ Feb 2012
Pharma Collaborative
2010 = 150
2011 = 155
2011 increase in patients
recruited to trials
All trials units contributed
to the successful clean‐up of
the SWSLHD Portfolio,
meeting CI requirements for
an updated 2012 Report
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Braeside Hospital Palliative Care Trial Unit Staff had another successful year of recruitment. Their lead site trial Octreotide, ”A randomised double blind placebo controlled trial of infusional subcutaneous octreotide in the management of malignant bowel obstruction at the end of life”, was completed and results presented Internationally in Trondheim Norway and ASCO, with A/Prof Meera Agar part of authorship team. Recruitment to Portfolio trials should stay high for this productive unit with 2 more Investigator Lead trials about to open including one where A/Prof Meera Agar is PI. Palliative care trials nurses have been included in Network planning and education.
Clinical Trials Staff Director A/Prof Meeera Agar
Research Staff Jane Hunt
Nicole Petrie Julie Wilcock
Bankstown Hospital Clinical trial Unit Bankstown continued to benefit from a stable trials workforce, demonstrated in their consistent trial performance again this year, providing valuable recruitment statistics for SWSLHD. Dr Sandra Harvey, Medical Oncology, joined Bankstown in 2012 and is co‐investigator for trial patients with gynaecological and breast cancers.
Clinical Trials Staff Director Dr Ray Asghari
Trials Manager Mafizul Hoque
Research Nurse Shuet‐oi Wong
Liverpool/Campbelltown CTC Clinical Trials Unit The Clinical Trials Unit (CTU) had significantly enhanced data management and recruitment at both Liverpool and Campbelltown sites in 2011‐2012, with three new staff members recruited this year, and a further three next year, the CTC Clinical Trials Unit has had increased activation of clinical trials, including participation in studies for rare cancer types. The CTU offices will move in the near future to a purpose‐built research environment at the Ingham Institute of Medical Research in September 2012.
Some of the significant achievements are: Introduction of a clinical trials Pharmacist role into the trials unit.
Streamlining the process of submitting SSA with our Regulatory Governance Officer (as evidenced by the volume of studies approved by the RGO this year).
Total number of patients recruited to studies at the site, increased from 150 in the previous year reported (2010) to 155 in 2011.
Increased participation in the labour intensive pharmaceutical sponsored studies.
Two site audits in 2011 (COMPLETE & IBIS II), with no adverse findings.
Trials staff attended the relevant National Cancer Trials meetings (ANZGOG, ANZBCTG;ATITG; ALLG, TROG) to increase knowledge and staff satisfaction.
Clinical Trials Staff: Director Dr Michael Harvey Clinical Trials Nurses Aura Serrano LCTC Suma Santhosh MCTC
Research Manager Jennifer Aung Volunteer Danielle Gibbs LCTC
Study Coordinators Sheela Subramani MCTC/LCTC Anne Whatman MCTC Jason Gao LCTC
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NSO Future Projects/Expansion of Services The NSO will focus on supporting units with the potential to increase recruitment numbers while providing oncology patients with high quality treatment and supportive trials. We will continue to support understaffed Units through Regulatory work, while preparing units for a reduction in local support due to the end of Grant funding. The NSO aims to:
Keep trial units up to date on CINSW reporting requirements and developments with performance monitoring plans.
Continue with a quality assurance program, including a standard operating procedures manual.
Develop an education and training plan, including GCP training with recognised accreditation, in conjunction with other NSOs.
“ask about” Campaign
NSO teams are looking forward to working with trial staff on a campaign to promote Clinical Trial participation, to be launched in each LHD. NSOs in collaboration with the CINSW developed a series of posters, brochures and badges with the tag lines... Ask about clinical trial participation... and ... Ask if a clinical trial is right for you. This call to action encourages patients and/or family members to engage with staff. Staff will then either communicate options, provide hand out information for the patient to consider further or explain the website options. This is a critical moment for converting patient enquiry to trial enrolment.
The NSO works with dedicated SWS cancer researchers to increase the quantity and quality of clinical trials available to cancer patients and to increase the number of participants to cancer clinical trials within the region. Network Office Staff can be contacted on 4634 4342.
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Clinical Trials Open to Recruitment at Southern Highlands
CancerType Acronym Description
Colon CHALLENGE Phase III study of the impact of a physical activity program on disease free survival in patients with high risk stage II or III colon cancer : a randomised controlled trial (CHALLENGE)
Lung BIOVEN A phase III ,open label, multicentre, randomised trial to establish safety & efficacy of an EGF cancer vaccine in operable, late stage (IIIB/IV) NSCLC patients eligible to receive standard treatment & supportive care.
Breast LATER Later adjuvant Aromatase inhibitor Therapy for postmenopausal women with Endocrine Responsive tumour. A randomised double blind trial in postmenopausal women who have completed 5 years of adjuvant endocrine therapy for early, hormone sensitive breast cancer more than one (1) year previous, and who are disease‐free at study entry.
Breast SOLE SOLE, Study of Letrozole Extension, A Phase III Trial Evaluating the Role of Continuous Letrozole Versus Intermittent Letrozole Following 4 to 6 Years of Prior Adjuvant Endocrine Therapy for Postmenopausal Women With Hormone‐Receptor Positive, Node Positive Early Stage Breast Cancer
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Clinical Trials Open to Recruitment at Liverpool
TumourSite Acronym Description BRAIN AGOG Australian Genomics and Clinical Outcomes of Glioma ACT IV Glioblastoma: An International, Randomized, Double‐Blind,
Controlled Study of Rindopepimut/GM‐CSF with Adjuvant Temozolomide in Patients with Newly Diagnosed, Surgically Resected, EGFRvIII‐positive Glioblastoma
BREAST Bayer RESILENCE study
A Phase III Randomized, Doubleblind, Placebo controlled Trial Comparing Capecitabine Plus Sorafenib Versus Capecitabine Plus Placebo in the Treatment of Locally Advanced or Metastatic HER2Negative Breast Cancer
Breast Mask Study
Large Breast Mask Immobilisation Study: LBIS
BREAST Setup Study
‘What factors affect the level of set‐up error for radiation therapy to the breast and is cone beam an accurate method for determining breast set‐up error?’
BONES Study
Prevention of osteoporosis as a consequence of hormone treatment in postmenopausal women treated for breast cancer
CATS(BNP) Prediction of cardiotoxicity using serum N‐terminal pro‐B‐type natriuretic peptide in breast cancer patients receiving adjuvant trastuzumab
Radiation Echo Study
The Use of Advanced Echocardiographic Techniques for the Assessment of Cardiac Function during the Acute Phase after Radiation Treatment for Left Sided Breast Cancer
STARS 08.06
A randomised comparison of anastrozole commenced before and continued during adjuvant radiotherapy for breast cancer versus anastrozole and subsequent anti‐oestrogen therapy delayed until after radiotherapy [STARS – Study of Anastrazole and Radiotherapy Sequencing
TROG DCIS Randomised Phase III Study of Radiation Doses and Fractionation Schedules in Non‐Low Risk DCIS of the Breast
COLORECTAL CHALLENGE A phase III randomized study of the impact of a physical activity program on disease‐free survival in patients with high risk stage II or stage III colon cancer.
I4T‐MC‐JVBB
A Randomized, DoubleBlind, Multicenter Phase 3 Study of Irinotecan, Folinic Acid, and 5Fluorouracil (FOLFIRI) Plus Ramucirumab or Placebo in Patients With Metastatic Colorectal Carcinoma Progressive During or Following FirstLine Combination Therapy With Bevacizumab, Oxaliplatin, and a Fluoropyrimidine
GASTRIC RAINBOW A Randomized, Multicenter, DoubleBlind, PlaceboControlled Phase 3 Study of Weekly Paclitaxel With or Without Ramucirumab (IMC1121B) Drug Product in Patients With Metastatic Gastric Adenocarcinoma, Refractory to or Progressive After FirstLine Therapy With Platinum and Fluoropyrimidine
TOPGEAR A randomised phase II/III trial of preoperative chemoradiotherapy versus preoperative chemotherapy for resectable gastric cancer
GYNAECOLOGY PARAGON Phase II study of Aromatase inhibitors in women with potentially hormone responsive recurrent/metastatic gynaecological neoplasms
PORTEC‐3 Randomized Phase III Trial Comparing Concurrent Chemoradiation and Adjuvant Chemotherapy with Pelvic Radiation Alone in High Risk and Advanced Stage Endometrial Carcinoma
OUTBACK A Phase III trial of adjuvant chemotherapy following chemoradiation as primary treatment for locally‐advanced cervical
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TumourSite Acronym Description
cancer compared to chemoradiation alone
HCC REACH A Multicenter, Randomized, Double‐Blind, Phase 3 Study of Ramucirumab (IMC‐1121B) Drug Product and Best Supportive Care (BSC) Versus Placebo and BSC as Second‐Line Treatment in Patients With Hepatocellular Carcinoma Following First‐Line Therapy With Sorafenib
LUNG ABC ITV Active Breathing Coordination to measure tumour motion in lung cancer patients: A feasibility study
MRI A feasibility study on incorporating dynamic MRI data in radiotherapy planning for lung cancer
NITRO A phase III randomised trial of adding nitroglycerin to first line chemotherapy for advanced non‐small cell lung cancer
PANCREAS LAPC Phase 2 Placebo‐controlled Double‐Blind Trial of Dasatinib Added to Gemcitabine for Subjects with Locally‐Advanced Pancreatic Cancer
PROSTATE RAVES A Phase III Multi‐Centre Randomised Trial Comparing Adjuvant Radiotherapy (RT) With Early Salvage RT In Patients With Positive Margins Or Extraprostatic Disease Following Radical Prostatectomy
RENAL CELL CARCINOMA
SORCE A Phase III Randomised Double‐blind Study Comparing Sorafenib With Placebo In Patients With Resected Primary Renal Cell Carcinoma at High or Intermediate Risk of Relapse
SKIN MP3 A phase II efficacy study of Chemo‐radiotherapy in PET stage II and III Merkell Cell Carcinoma of the skin
PALLIATIVE SEED Self‐reported evaluation of the adverse effects of Dexamethasone HAEMATOLOGY ENESTxtnd Extending molecular responses with Nilotinib in newly diagnosed
chronic myeloid leukaemia (CML) patients in chronic phase MDS4 A Randomised Phase II study comparing the efficacy of
5azacitidine alone versus combination therapy with lenalidomide and 5azacitidine in patients with higher risk myelodysplastic syndromes (MDS) and low marrow blast count acute myeloid leukaemia (AML).
NHL21 Early treatment intensification with R‐ICE chemotherapy followed by autologous stem cell transplantation using Z‐BEAM for patients with poor prognosis diffuse Large B‐Cell lymphoma as identified by interim PET/CT scan performed after four cycles of R‐CHOP‐14 chemotherapy
Ablynx ATTP
A Phase Ii, Singleblind, Randomised, Placebocontrolled Trial To Study The Efficacy And Safety Of Antivon Willebrand Factor Nanobody Administered As Adjunctive Treatment To Patients With Acquired Thrombotic Thrombocytopenic Purpura
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Clinical Trials Open to Recruitment at Campbelltown
TumourSite Acronym Description BREAST BONES
Study Prevention of osteoporosis as a consequence of hormone treatment in postmenopausal women treated for breast cancer
CATS(BNP) Prediction of cardiotoxicity using serum N‐terminal pro‐B‐type natriuretic peptide in breast cancer patients receiving adjuvant trastuzumab
SORBET A Single Arm Phase II Study of the Efficacy of Tamoxifen in Triple Negative (oestrogen receptor a negative, progesterone receptor negative, HER‐2 negative) but Oestrogen Receptor
STARS 08.06
A randomised comparison of anastrozole commenced before and continued during adjuvant radiotherapy for breast cancer versus anastrozole and subsequent anti‐oestrogen therapy delayed until after radiotherapy [STARS – Study of Anastrazole and Radiotherapy Sequencing
TROG DCIS A Randomised Phase III Study of Radiation Doses and Fractionation Schedules in Non‐Low Risk DCIS of the Breast
COLORECTAL SCOT Short Course Oncology Therapy, a study of adjuvant chemotherapy in colorectal cancer
GENITO‐URINARY
OUTBACK A Phase III trial of adjuvant chemotherapy following chemoradiation as primary treatment for locally‐advanced cervical cancer compared to chemoradiation alone
RRR Decision Aid
Evaluation of a decision aid to help women with platinum resistant or refractory recurrent ovarian cancer decide whether or not to have chemotherapy
LUNG PACT NSCLC
Preferences for adjuvant chemotherapy in non‐small‐cell lung cancer: What makes it worthwhile to patients and their doctors
Pfizer A8081014 NSCLC
Phase 3, Randomized, Open‐Label Study Of The Efficacy And Safety Of Crizotinib Versus Pemetrexed/Cisplatin Or Pemetrexed/Carboplatin In Previously Untreated Patients With Non‐Squamous Carcinoma Of The Lung Harboring A Translocation Or Inversion Event Involving The Anaplastic Lymphoma Kinase (Alk) Gene Locus
PROSTATE RAVES A Phase III Multi‐Centre Randomised Trial Comparing Adjuvant Radiotherapy (RT) With Early Salvage RT In Patients With Positive Margins Or Extraprostatic Disease Following Radical Prostatectomy
SKIN MP3 A phase II efficacy study of Chemo‐radiotherapy in PET stage II and III Merkell Cell Carcinoma of the skin
PSYCHOLOGY CeMPED Improving quality of life in advanced, incurable cancer:A randomised controlled trial of a combined oncologist and nurse‐led intervention
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Clinical Trials Open to Recruitment at Bankstown TumourSite Acronym Description Breast SOLE SOLE, Study of Letrozole Extension, A Phase III Trial Evaluating the Role of
Continuous Letrozole Versus Intermittent Letrozole Following 4 to 6 Years of Prior Adjuvant Endocrine Therapy for Postmenopausal Women With Hormone‐Receptor Positive, Node Positive Early Stage Breast Cancer
Breast A Multicenter, Multinational, Randomized, Double‐Blind, Phase III Study of IMC‐1121B Plus Docetaxel Versus Placebo Plus Docetaxel in Previously Untreated Patients With HER2‐Negative, Unresectable, Locally‐Recurrent or Metastatic Breast Cancer
Colon SCOT Short Course Oncology Therapy (SCOT). A study of post operative chemotherapy for 12 weeks versus 24 weeks with oxaliplatin/Fluorouracil (5FU) to establish disease free survival outcomes in locally advanced colon cancer.
Breast CATS BNP Prediction of cardiotoxicity by measurement of serum N‐terminal pro‐B‐type natriuretic peptide and troponin 1 levels in breast cancer patients receiving adjuvant trastuzumab
Colon CHALLENGE A phase III study of the impact of a physical activity program on disease‐free survival in patients with high risk stage II or stage III colon cancer: a randomised controlled trial
Gynae‐cological
PARAGON Phase II study of aromatase inhibitors in women with potentially hormone responsive recurrent/metastatic gynaecological neoplasms: ANZGOG 0903
NSCLC Morphotek A randomised, double‐blind, placebo‐controlled, study of the safety and efficacy of MORAb‐009 in combination with Pemetrexed and Cisplatin in chemotherapy –naïve subject with advanced adenocarcinoma of the lung
NSCLC NITRO A Phase III, randomised trial of adding nitroglycerin to first line chemotherapy for advanced non‐small cell lung cancer.
Prostate PROCELICA Randomised, open label, multi‐centre study comparing Cabazitaxel at 20 mg/m2 and at 25 mg/m2 in combination with Prednisone every 3 weeks for the treatment of hormone refractory metastatic prostate cancer treated with a Docetaxel‐containing regimen.
Prostate FIRSTANA Randomised, open label, multi‐centre study comparing Cabazitaxel at 25 mg/m2 and at 20 mg/m2 in combination with Prednisone every 3 weeks to Docetaxel in combination with Prednisone in patients with hormone refractory metastatic prostate cancer not pre‐treated with chemotherapy.
Pancreas DNA Circulating DNA as a personalised biomarker for patients with pancreatic cancer.
Colorectal A La CaRT
Australasian Laparoscopic Cancer of the Rectum Trial A phase III prospective randomised trial comparing laparoscopic‐assisted resection versus open resection for rectal cancer
Hepato‐cellular
REACH A multicentre, randomised, double‐blind, phase 3 study of Ramucirumab (IMC‐1121B) drug product and best supportive care (BSC) versus placebo and BSC as second‐line treatment in patients with hepatocellular carcinoma following first‐line therapy with sorefenib.
Gastric Advanced
RAINBOW A randomised, multicentre, double‐blind, placebo‐controlled phase 3 study of weekly paclitaxel with or without Ramucirumab (IMC‐1121B) drug product in patients with metastatic gastric adenocarcinoma, refractory to or progressive after first‐line therapy with platinum and fluoropyrimidine.
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Clinical Trials Open to Recruitment at Braeside
CancerType Acronym Description Advanced Cancer
A two‐stage trial of response to antiemetic therapy in patients with cancer and nausea not related to anticancer therapy. Study 1: A randomised open label study of guideline driven targeted antiemetic therapy versus single agent antiemetic therapy.
Advanced Cancer
A two‐stage trial of response to antiemetic therapy in patients with cancer and nausea not related to anticancer therapy. Study 2: A randomised controlled double blind study of levomepromazine or ondansetron versus placebo with rescue antiemetics (best supportive care) in patients with refractory nausea
Advanced Cancer
The Measurement of function limited by breathlessness in advanced cancer: Comparison of the 6‐minute walk test;2‐minute walk test, isometric arm exercises and reading numbers
All types/Various
A multi‐site randomised controlled trial comparing the severity of constipation symptoms experienced by palliative care patients receiving usual care compared to those diagnosed and managed according to the underlying pathophysiology
Advanced Cancer
Efficacy of Elastic Compression Stockings in Treatment of chronic oedema in Palliative Care Patients
Advanced Cancer
A randomised, placebo‐controlled,crossover trial of acetaminophen / paracetamol in cancer patients on strong opioids
Advanced Cancer
005/07 V.3.3 Randomised, double blind control trial of megestrol acetate, dexamethasone and placebo in the management of anorexia in people with cancer
Advanced Cancer
003/07 V1.1.4
A randomised double blind placebo controlled trial of infusional subcutaneous octreotide in the management of malignant bowel obstruction at the end of life.
Advanced Cancer
002/07 V1.4.3
Oral risperidone, oral haloperidol, and oral placebo in the management of delirium in palliative care.
Advanced Cancer
Using single patient trials to determine the effectiveness of psychostimulants in fatigue in advanced cancer patients
Advanced Cancer
008/08 A randomised double‐blind multi‐site parallel arm controlled trial to assess relief of refractory comparing fixed doses of morphine, oxycodone and placebo
Advanced Cancer
A randomised double‐blind multi‐site parallel arm controlled trial to assess relief of refactory breathlessness comparing oral sertraline to placebo
all types Randomised double blind placebo controlled pilot phase II trial of oral melatonin for the prevention of delirium in hospital in people with advanced cancer
All types SEED Self‐reported evaluation of the adverse effects of Dexamethasone
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Publications & Presentations
Awards
July 2011 – December 2011 Agar M Palliative Care New South Wales Award for Significance in Palliative Care Research 2011 Award Palliative Care New South Wales Award for Significance in Palliative Care Research 2011 Denise Burns and the Macarthur Nursing Team Oncology patients Emergency Assessment Outside of the ED Award Finalist in the 2011 NSW Health Awards Sydney, Australia Jameson M, Bailey M, Foo K, Holloway LC, and Metcalfe P Methodology for assessment of impact of contouring variation on clinical trial design Award Postgraduate Prize Darwin, Australia Jones C Palliative Care NSW Volunteers Supporting Pall Care Award 2011 Award Palliative Care NSW Volunteers Award Sydney, Australia Przezdziecki A, Sherman K, Baillie A, Taylor A, Foley E, and Stalgis‐Bilinski K Rapid Communication Poster Award Best Abstract, Christchurch, New Zealand Teng, P 2011 Sydney Outer West/Blue Mountains Highly Commended Volunteer of the Year Award Veera J Is Multiplicity of Tumours a risk Factor for Loco‐regional Recurrence following Mastectomy for Breast Cancer? Award Best Exhibit Award, Melbourne, Australia Wong K, Barton MB, and Delaney GP An Evidence‐based Estimation of the Optimal Number of Radiotherapy Fractions for Cancer Patients 2011 Award Best Radiation Oncology Scientific Paper Presentation Melbourne, Australia
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January 2012 – June 2012 Barton MB The Medical Oncology Group of Australia (MOGA) Novartis Oncology Cancer Achievement Award Boxer M, Vinod SK, Shafiq J, and Duggan K Do Multidisciplinary teams make a difference in the management of lung cancer ? Award Paper of the Year Liverpool, Australia Campbelltown Hospital Palliative Care Resource Nursing Program Excellence in Provision of Primary Care to Palliative Care Clients Award Certificate and Dinner Vouchers to Group Braeside Hospital, NSW, Australia Casey J Volunteers Supporting Palliative Care Award Certificate and Dinner Vouchers to Group Braeside Hospital, NSW, Australia Downes J and Roache A Quality Improvement to Local Palliative Care Service Award 2012 Award Certificate and Dinner Vouchers to Group Braeside Hospital Carers Project/Workshops Braeside Hospital, NSW, Australia Glavan M Outstanding Contribution to Specialist Palliative Care Award Certificate and Dinner Vouchers to Group Braeside Hospital, NSW, Australia O'Connor C Outstanding Contribution to Specialist Palliative Care ‐ Runner Up Award Certificate and Dinner Vouchers to Group Braeside Hospital, NSW, Australia Parkes H Volunteers Supporting Palliative Care ‐ Runner Up Award Certificate and Dinner Vouchers to Group Braeside Hospital, NSW, Australia Peronchik J Innovations to Local Palliative Care Service Award Award Certificate and Dinner Vouchers to Group Development of a Pamphlet "How to Support a Person who is bereaved" Braeside Hospital, NSW, Australia Perrin G Excellence in Provision of Primary Care to Palliative Care Clients ‐ Runner Up Award Certificate and Dinner Vouchers to Group Braeside Hospital, NSW, Australia
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Book Chapters Apte, M. V., Pirola RC, and Wilson JS Stellate Cells and the Pancreas Recent Advances in the Pancreas Stellate Cells and the Pancreas 2011 Reed Elsevier India Pvt Ltd Barton M, Delaney GP, and Noble DJ Radiotherapy: Identifying close calls and errors in the process of care for risk profiling The Value of Close Calls in Improving Patient Safety: Learning How to Avoid and Mitigate Harm Joint Commission Resources Apte, M. V. and Wilson J Experimental models of pancreatic fibrogenesis FALK Symposium Proceedings Clark JR and Martin R Surgery by primary site: Skin and melanoma Hodder London Clark JR and Martin R Defect based reconstruction : Pharynx Hodder London Goodwin R, Hanna, T. P., and Meyer RM Overview of Cancer and Cancer Treatment Modalities Hospital Medicine‐Oncology McGraw‐Hill Professional Hanna, T. P. Radiation Oncology in the Developing World Principles and Practice of Radiation Oncology Lippincott Williams and Wilkins
Book Reviews Barton M Brain Tumours ‐ A quick scan. Medical Journal of Australia Fast facts: brain tumours‐ 2nd Edition (Editors Lauren E Abrey, Warren P Mason) Oxford : Health Press 2011, 479. 2011. Carter C. Cancer Pain Assessment, Diagnosis and Management ‐ 2011. Della‐Fiorentina S When cancer crosses Specialities, Cancer Forum Della‐Fiorentina S The Bethesda Handbook of Clinical Oncology.Cancer Forum
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Conference Presentations
July 2011 – December 2011
Arumugam S, Xing A, Jameson M, Goozee G, and Holloway LC Development of a software and methodology to perform control‐point based dose verification of VMAT delivery using EPID EPSM ‐ ABEC Conference, Darwin, Australia (Poster)
Arumugam S, Xing A, Goozee G, and Holloway LC A Study on the Sensitivity of VMAT and IMRT Prostate Plans Considering Uncertainties in Treatment Delivery and Patient Positioning Health Communication Network, Vancouver, Canada (Poster)
Arumugam S, Xing A, Jameson M, and Goozee G Independent Monitor Unit (MU) verification of IMRT plans using a 3D dose calculation engine in a different treatment planning systems EPSM ‐ ABEC Conference, Darwin, Australia (Poster)
Barton MB, Delaney GP, Allen S, and Hudson M An assessment of actual radiotherapy re‐treatment rates RANZCR Annual Scientific Meeting, Melbourne, Australia (Oral Presentation)
Batumalai V., Jameson M, Blakeney S, Franji I, Andrew K, Nguyen C, Wallis A, Forstner D, Vial P, and Holloway LC How much experience is enough? A comparative analysis of IMRT Plans Clinical Perspectives in Radiation Oncology, London, UK (Oral Presentation)
Batumulai V, Jameson M, Blakeney S, Franji I, Andrew K, Nguyen C, Wallis A, Forstner D, Vial P, and Holloway LC How much experience is enough? A comparative analysis of IMRT plans Inghams Institute 2011 Research and Teaching Showcase, Sydney Australia (Poster)
Bell K New Head and Neck Cancer Nutrition Guidelines using the Wiki Platform ‐ the way of the future in enhancing multidisciplinary care SWSLHD Allied Health Research Forum, Liverpool, Australia (Oral Presentation)
Blake S, Vial P, Holloway LC, Greer P, and Kuncic Z An investigation into Optical Photon Transport Effects on Electronic Portal Imaging Performance Using Geant4 AAPM , Vancouver, Canada (Oral Presentation)
Blake S, Vial P, Holloway LC, and Kuncic Z Preliminary Investigation of Optical Photon Transport in Electronic Portal Imaging devices EPSM ‐ ABEC Conference, Darwin, Australia (Poster)
Blake S, Vial P, Holloway LC, Greer P, and Kuncic Z Monte Carlo simulation of optical photon transport effects on electrical portal imaging device response Inghams Institute 2011 Research and Teaching Showcase, Sydney Australia (Poster)
Blake S, Vial P, Holloway LC, Greer P, and Kuncic Z An Investigation Into Optical Photon Transport Effects on Electronic Portal Imaging Performance Using Geant4 Health Communication Network, Vancouver, Canada (Poster)
Boxer M, Vinod SK, Shafiq J, and Duggan K Do Multidisciplinary Team (MDT) Meetings make a difference in the management of Lung Cancer?
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World Conference on Lung Cancer 2011, Amsterdam, Holland (Oral Presentation and Poster)
Constantin D, Holloway LC, Keall P, and Fahrig R Robotic Linac Adaptation (RLA) with a Novel Electron Gun Design for the In Line MRI Linac Configuration Health Communication Network, Vancouver, Canada (Oral Presentation)
Dall'Armi L, Simpson G, Forstner D, and Simpson T Patterns of Information Needs and Affective Distress for People with Head and Neck Cancer and their family members Supportive Care Makes Excellent Cancer Care Possible, Athens, Greece (Oral Presentation)
Della‐Fiorentina S Oncology Patients Emergency Assessment Outside of the ED NSW Health Expo‐Finalists Forum, Sydney, NSW, Australia (Oral Presentation)
Deshpande S, Vial P, and Holloway LC Image Acquisition and Processing Characteristics of a Siemens EPID: Potential Problems for EPID Dosimetry Health Communication Network, Vancouver, Canada (Medical Physics, 38:3538)
Downes J Challenges faced by Students in Undertaking a placement in Palliative Care Field Education Colloquium, Sydney, Australia (Abstract)
Duggan K, Vinod SK, and Yeo A Treatment patterns for lung cancer in South Western Sydney, Australia: Do patients get treated according to guidelines? World Conference on Lung Cancer 2011, Amsterdam, Holland (Oral Presentation and Poster)
Gabriel G, Delaney GP, and Barton, M. B. An assessment of actual radiotherapy re‐treatment rates RANZCR Annual Scientific Meeting, Melbourne, Victoria (Poster)
Gano C, Mahns D, DeSouza P, and Patel MI Phytochemicals and prostate cancer Australain Prostate Cancer Conference, Melbourne, Sydney (Poster)
Hanna T.P., Shafiq J., Delaney G.P., Barton M.B. An Estimation of the Population Benefit of Radiotherapy for Cervical Cancer: Local Control and Survival RANZCR Annual Scientific Meeting, Melbourne, Victoria (Oral Presentation) Hanna T.P. Delaney G.P., Barton M.B. The Population Benefit of Radiotherapy for Gynaecological Malignancies: Local Control and Survival Estimates for Optimally Utilized Radiotherapy and Chemoradiation. RANZCR FRO Annual Scientific Meeting, Cairns, Queensland (Oral Presentation)
Holloway LC, Constantin D, Keall P, and Fahrig R Electron Gun Design for an MRI‐linac Ingham Institute 2011 Research & Teaching Showcase, Sydney, Australia (Poster)
Holloway LC, Constantin D, Keall P, and Fahrig R Geometric adaptations to an electron gun design for use in an in‐line MRI‐linac 11th Biennial on Physics & Radiation TechnologyFor Clinical Radiotherapy, London, England (Oral Presentation)
152
Hosie, A., Hunt J, Fazekas B, and Phillips J Contributing to Palliative Research: The role of the palliative care clinical trials nurse Palliative Care NSW State Conference, Hunter Valley, NSW, Australia (Oral Presentation)
Howie A, Holloway LC, Wilfert, and Franich R Use of an energy conversion factor when utilising TLD‐100 rods for Ir‐192 prostate brachytherapy verification Annual scientific meeting of the Australasian brachytherapy group, Perth, Australia (Poster)
Hudson M, Barton, M. B., Delaney GP, and Hao Z Age‐Cohort Models for Recurrent Events in Longitudinal Studies Annual Conference of the International Society of Clinical Biomathematics, Ottowa, Canada (Oral Presentation)
Hudson M, Barton MB, Delaney GP, and Hao Z Age‐Cohort Models for Recurrent Events in Longitudinal Studies Annual Conference of the International Society of Clinical Biomathematics, Ottowa, Canada (Poster)
Jameson M, Wong K, Vinod SK, Kumar S, and Holloway LC Impact on addition of Positron Emission Tomography data for oesophageal cancer target volume delineation Inghams Institute 2011 Research and Teaching Showcase, Sydney Australia (Poster)
Jameson M, Bailey M, Foo K, Yeo A, and Holloway LC Methodology for assessment of impact of contouring variation on clinical trial design EPSM ‐ ABEC Conference, Darwin, Australia (Poster)
Jameson M, Bailey M, Foo K, Yeo A, and Holloway LC Methodology for assessment of impact of contouring variation on clinical trial design Inghams Institute Research & Teaching Showcase, Sydney, Australia (Poster)
Karikios D, Lin M, and Ng W The role of 18F‐fl uorodeoxyglucose positron emission tomography/computed tomography (18FDG PET‐CT) in the preoperative staging of gastric cancer: A retrospective review at a single institution COSA Annual Conference, Perth, Australia (Poster)
Koh ES, Simpson G, Whiting D, Wright K, Simpson T, and Firth R Patient Functional Status is Strongest Correlate of Challenging Behaviour After Brain Tumour 3rd Quadrennial Meeting of the World Federation of Neuro‐Oncology, Japan (Oral Presentation)
Kumar S, Vial P, Wallis A, and Holloway LC Dosimetric and biological impact of different methods of IMRT prescription for nasopharyngeal cancer 11th Biennial on Physics & Radiation TechnologyFor Clinical Radiotherapy, London, England (Poster)
Marsh J, McDonald K, Wheeler H, Teo C, Martin L, Palmer L, Rodriguez M, Buckland M, Koh ES, Back M, Robinson B, Joseph D, and Nowak AK Australian Genomics and Clinical Outcomes of Glioma (AGOG):characterizing a research population Society for Neuro‐oncology ASM, Washington DC, United States of America (Poster)
153
Martin L, Sieczko PM, Steele N, Rodriguez M, Bynevelt M, Hovey E, Honeybul S, Strangman D, Marsh J, Koh ES, Buckland M, Jeffree R, Wheeler H, Teo C, Joseph D, Robinson B, Palmer L, McDonald K, and Nowak AK AGOG:A comprehensive resource now available to the brain cancer research community Clinical Oncological Society of Australia (COSA) 37th ASM, Melbourne, Australia (Poster)
Melbourne W, Johnson L, Lynch WJ, and DeSouza P SLC29A1 expression in human urothelium and superficial urothelial carcinoma St George Hospital Medical Research Symposium, Sydney, Australia (Oral Presentation)
Metcalfe P, Oborn B, Holloway LC, Rosenfeld A, and Keall P Early simulations for the Australian MRI‐Linac Project (AMP) EPSM ‐ ABEC Conference, Darwin, Australia (
Morarji K, Forstner D, Fowler A, Griffiths A, Holloway LC, Jameson M,Kumar S Interobserver variation in volume delineation in head and neck radiotherapy ANZHNCS ASM 2011, Sydney, Australia (Poster)
Morarji K, Forstner D, Fowler A, Griffiths Y, Holloway LC, Jameson M, Kumar S Interobserver Variability in Target Delineation in Head and Neck Radiotherapy 62nd Annual ASM, Melbourne, Australia (Oral Presentation)
Nelson V, McLean I, and Holloway LC A Dual TLD System for X Ray Energy Discrimination in Personnel Monitoring Health Communication Network, Vancouver, Canada (Poster)
Nelson V Electron Beam Energy Monitoring using "Thermoluminescent Materials and electron Backscattering RSNA 2011, Chicago, Illinois
Prakash J, Duggan K, Ling S, Rosenfeld D, Dunlop, L., Watson, A., Motum P, Lye Lin Ho, Viiala N, and Harvey M Multiple Myeloma, Plasmacytoma and Extramedullary plasmacytoma: Incidence within Sydney South West Area Health Service from July 2005 – June 2009 Annual Scientific Meeting and Trade Exhibition, Sydney, Australia (Poster)
Przezdziecki A, Sherman K, Baillie A, Taylor A, Foley E, and Stalgis‐Bilinski K Self‐compassion, distress and breast cancer ASBHM 8th Annual Scientific Conference, Christchurch, New Zealand (Poster)
Quinn A, Holloway LC, Begg J, Nelson V, and Metcalfe P TLD‐100H accuracy for kilovoltage cone‐beam CT out‐of‐field measurements EPSM ‐ ABEC Conference, Darwin, Australia (Oral Presentation)
Roache A in collaboration with SWS LHD Pall Care Volunteers Strengthening the Effectiveness and Outcomes of the Palliative Care Volunteer Palliative Care In Mainstream Medicine, Penang, Malaysia (Poster)
Robinson KM, Koh ES, Hovey E, Wright K, Simpson T, Price MA, Shafiq J, Kaadan N, and Barton M Evaluating the impact of a Neuro‐Oncology Nurse Coordinator in South West Sydney Society for Neuro‐oncology ASM, Washington DC, United States of America (Poster)
Shafiq J An evidence‐based estimation of survival and local control benefit of radiotherapy for lung cancer COSA 38th Annual Scientific Meeting, Perth, Australia (Oral Presentation and Poster)
154
Sharmin M, Berthelsen A, Morgan M, Fowler A, and Avery S Radiotherapy utilisation in rectal cancer patients: 12 year data from the South Western Sydney Local Health District Clinical Cancer Registry Annual Scientific Meeting, Amsterdam, Holland (Poster)
Sharmin M, Berthelsen A, Morgan M, and Avery S Surgical management of patients with primary colorectal cancer over 12 years in the South Western Sydney Local Health District public hospitals Annual Scientific Meeting, Amsterdam, Holland (Poster)
Thientosapol E, Tran T, Adams D, Della‐Fiorentina S, Chantrill L, and Kiely, B. E. Quantification of typical, best‐case and worst‐case scenarios for metastatic breast cancer patients undergoing first line chemotherapy in south west Sydney: a multicentre retrospective cohort analysis COSA, Melbourne, Australia (Poster)
Thientosapol E, Tran T, Adams D, Della‐Fiorentina S, Chantrill L, and Kiely, B. E. Case and worst‐case scenarios for the survival for women with metastatic breast cancer undergoing first line chemotherapy in South West Sydney: a multicentre retrospective cohort analysis COSA Annual Scientific Meeting, Perth, Western Australia (Poster)
Tyler A, Vial P, Metcalfe P, and Downes S Investigation of the dosimetric properties of flood field corrected Siemens Optivue 1000ST and Elekta iViewGT electronic portal imaging device. EPSM ‐ ABEC Conference, Darwin, Australia (Oral Presentation)
Vinod SK, Wai E Alexander C Christie J. Stage III Non‐Small Cell Lung Cancer (NSCLC): Patterns of treatment in British Columbia, Canada. World Conference on Lung Cancer 2011, Amsterdam, Holland (Oral Presentation and Poster)
Walker A, Holloway LC, and Metcalfe P The Effect of MRI Distortion and its Impact on Radiotherapy Treatment Planning & Delivery Inghams Institute 2011 Research and Teaching Showcase, Sydney Australia (Poster)
Walker A, Holloway LC, and Metcalfe P The effect of varying acquisition sequences on MRI distortion and its impact on radiotherapy planning EPSM ‐ ABEC Conference, Darwin, Australia (Poster)
Weber M, Smith D, O'Connell D, Patel M, DeSouza P, Clements M, Sitas F, and Banks E Age‐related patterns of erectile dysfunction among older Australian men AEA 2011, Perth, Australia (Abstract)
Whelan, B. M., Holloway LC, Greer P, Dowling J, Lambert J, and Salvado O The impact of incorrect electron density data on External Beam Radiotherapy for cervical cancer patients EPSM ‐ ABEC Conference, Darwin, Australia (Poster)
Williams M, Metcalfe P Bailey M Rozenfeld D Forstner D Everitt D Progress report on the ICARIS project Innovative Solutions in Medicine & Health Physics, Darwin, Australia (Oral Presentation)
Windsor A, Koh ES, Allen S, Yeo A, Allison R, and Barton MB Characteristics and outcomes after whole brain radiotherapy for brain metastases in a large Australian study RANZCR ASM, Melbourne, Australia (Oral Presentation)
155
Windsor A, Koh ES, Allen S, Yeo A, Allison R, and Barton MB Characteristics and outcomes after whole brain radiotherapy for brain metastases in a large international cohort 2011 European Multidisciplinary Cancer Congress, Stockholm, Sweden (Oral Presentation)
Won CK, Gurney H, Marx G, DeSouza P, and Patel MI Primary treatment of the prostate improves local palliation in men who ulimately develop castrate resistant prostate cancer Australain Prostate Cancer Conference, Melbourne, Sydney (Poster)
Wong K, Barton MB, and Delaney GP An Evidence‐based Estimation of the Optimal Number of Radiotherapy Fractions for Cancer Patients RANZCR Annual Scientific Meeting, Melbourne, Australia (Oral Presentation)
Xing A, Holloway L Kumar S Ochoa C Vinod SK. The effect of set‐up error on delivered dose in curative radiotherapy for non‐small cell lung cancer. World Conference on Lung Cancer, Amsterdam, Holland (Oral Presentation and Poster)
January 2012 – June 2012
Agar M, Luckett T, Davidson P, McCaffrey, N., Lam L, Girotto N, Harlum J, Wiltshire J, Eckermann S, and Currow D A phase II randomized controlled trial of a rapid response home care intervention for complex palliative care or end of life needs. Poster presentation Multinational Association of Supportive Care in Cancer (MASCC) International symposium on supportive care in cancer, New York, USA (Poster)
Agar M, Draper B, and Plummer J Anticholinergic levels and risk of delirium in advanced cancer Multinational Association of Supportive Care in Cancer (MASCC) International symposium on supportive care in cancer, New York, USA (Poster)
Agar M, Luckett T, Davidson P, Boyle, F., Liauw W, Green A, and Lovell M Australian Survey of current practice and guideline use in adult cancer pain assessment and management: Perspectives of oncologists and hematologists Multinational Association of Supportive Care in Cancer (MASCC) International symposium on supportive care in cancer, New York, USA (Poster)
Agar M, Draper B, Phillips P, Phillips J, Collier A, Harlum J, and Currow D Making decisions about delirium: A Qualitative comparison of nurses decision making between nurses working in palliative care, aged care, aged care psychiatry and oncology Multinational Association of Supportive Care in Cancer (MASCC) International symposium on supportive care in cancer, New York, USA (Poster)
Batumalai V., Quinn A, Holloway LC, and et al Is Breast size a factor in dose from megavoltage planar and cone beam computed tomography imaging? EP12k12, Sydney, Australia (Poster)
Batumalai V., Quinn A, Jameson M, and et al Analysis of Megavoltage Cone Beam Computer Tomography and Planar Imaging with Different Breast Size ASMMIRT 2012, Sydney, Australia (Poster)
Batumalai V., Quinn A, Holloway LC, and et al Comparison of image registration methods in supine breast radiotherapy to measure set‐up errors EP12k12, Sydney, Australia (Poster)
156
Batumalai V., Lo Q, Hee L, Allman C, Delaney GP, Lonergan D, and Thomas L Acute radiation induced changes in cardiac function after radiotherapy to the left breast Annual Scientific Meeting, Cairns, Queensland, Australia (Poster)
Choong C, Batumalai V., Phan P, and et al Setup errors in breast radiotherapy with CBCT: Comparison between two registration methods ESTRO ASM, Barcelona, Spain (Poster)
Currow D, Hardy J, Quinn S, Fazekas B, Plummer J, Eckermann S, Agar M, Spruyt O, and Rowett D A randomized double blind placebo controlled study to assess the efficacy and toxicity of subcutaneous ketamine in the management of cancer pain American Society of Clinical Oncology Meeting 2012, Chicago, USA (Poster)
Currow D, Clark K, Cartmill J, Craig A, Pather S, Plummer J, Exckermann S, Agar M, and Hardy J A randomized double blind placebo controlled trial of infusional subcutaneous octreotide in the management of malignant bowel obstruction in people with advanced cancer 7th World Research Congress of the European Association for Palliative Care, Trondheim (Oral Presentation)
Dimigen M, Vinod S Borok N Holloway L Dowling J Lim K The use of Cervical Cancer MRI Contouring Guidelines in Clinical Practice Faculty of Radiation Oncology Annual Scientific Meeting , Cairns, QLD, Australia (Oral Presentation)
Dimigen M, Vinod S Borok N Holloway L Dowling J Lim K How do Software Generated Contours compare with Manually Created Consensus Contour for Definition of Cervical Cancer Volumes on MRI? Faculty of Radiation Oncology Annual Scientific Meeting , Cairns, QLD, Australia (Oral Presentation)
Dimigen M, Vinod S Tran T Lim K Incorporating a Radiologist into a Radiation Oncology Department: A New Model of Care? Faculty of Radiation Oncology Annual Scientific Meeting , Cairns, QLD, Australia (Oral Presentation)
Downes J and Singh J Challenges faced by Students in Undertaking a Placement in Palliative Care Joint World Conference of Social Work and Social Development, Stockholm, Sweden (Oral Presentation)
Downes J, Roache A, and Tang E Challenges faced in Suppporting Carers of Patients with a Life Limiting illness Innovations at Social Work ‐ Day Conference, Liverpool Hospital, Sydney, Australia (Oral Presentation)
Downes J, Roache A, and Tang E Addressing the needs of carers of patients with a life limiting illness Stockholm, Sweden (Oral Presentation)
Hanna TP, Shafiq J, Delaney GP, and Barton MB Estimating the population benefit of radiotherapy : Larynx Cancer as an example UICC 2012, Montreal, Canada (Poster)
Hanna TP, Delaney GP, and Barton MB The Population benefit of radiotherapy for head and neck malignancies : Local control and survival estimates for larynx cancer and oral cancer ANZ Society for Head and Neck Cancer, Brisbane, Australia (Poster)
157
Hau E, Graham P, Nasser E, Kearsley J, Delaney GP, and Papadatos G The impact of breast cosmetic and functional outcomes on quality of life: long term results from the St George adn Wollongong Randomized Breast Boost Trial Faculty of Radiation Oncology annual Scientific Meeting, Cairns, Queensland, Australia (Poster)
Hovey E, DeSouza P, Marx G, Parente P, Rapke T, Hill A, Bonaventura A, Michele A, Craft P, and Lloyd A Randomized, Open label, Phase III Trial of Pazopanib versus Sunitinib in First‐line Treatment of Patients with Metastatic Renal Cell Carcinoma (mRCC); Results of the COMPARZ Trial. ESMO, Vienna, Austria (Oral Presentation)
Hovey E, DeSouza P, Marx G, Parente P, Rapke T, Hill A, Bonaventura A, Michele A, Craft P, and Lloyd A Phase III, Randomised, Double‐Blind, Placebo‐Controlled Study of Modafenil for Fatigue in PatientsTreated with Docetaxel‐Based Chemotherapy. MOGA ASM, Brisbane, Australia (Oral Presentation)
Hovey E, DeSouza P, Marx G, Rapke T, Parente P, Hill A, Bonaventura A, Michele A, Craft P, Abdi EA, and Lloyd AR Modafinil for fatigue associated with docetaxel‐based chemotherapy: Arandomized controlled trial. ASCO ASM, Chicago, USA (Poster)
Kiely, B. E. Using scenarios to explain survival time: attitudes of people with a cancer experience ASCO Annual Meeting, Chicago, USA (Poster)
Kiely, B. E. Usefulness of medical oncologists' estimates of survival time in people with advanced cancer International Symposium of Supportive Care in Cancer, New York, USA (Poster)
Kiely, B. E. ANZ 1001: SORBET. Study of Oestrogen Receptor Beta and Efficacy of Tamoxifen. ASCO Annual Meeting, Chicago, USA (Poster)
Kiely, B. E. Using scenarios to explain survival time: attitudes of people with a cancer experience International Symposium of Supportive Care in Cancer, New York, USA (Poster)
Kiely, B. E. Usefulness of Medical Oncologists' estimates of survival time in people with advanced cancer ASCO Annual Meeting, Chicago, USA (Poster)
Kumar S, Holloway L Koh E‐S Choong C Phan P Vinod S Active Breathing Coordination to measure tumour motion in lung cancer patients: A feasibility study. Australasian Radiation Oncology Elekta Users Meeting , Cairns, QLD, Australia (Oral Presentation)
Kumar S, Wong K Jameson M Vinod S Choong C Holloway L Impact of FDG PET information for target volume delineation in Oesophageal Cancer Faculty of Radiation Oncology Annual Scientific Meeting , Cairns, QLD, Australia (Oral Presentation)
158
Lemech C, Fontela A, Arkenau HT, Chin M, Liauw W, Thomas D, Li S, and DeSouza P Phase I Study of Everolimus in Combination with Fluvastatin and Zoledronic Acid in Patients with Solid Tumours ASCO ASM, Chicago, USA (Poster)
Lim S, Descallar J, Sayaloune P, Delaney GP, Papadatos G, and DeSouza P Outcomes of ethnic minority groups with node‐positive, non‐metastatic breast cancer in a tertiary referral centre in Sydney European Society for Medical Oncology, Barcelona, Spain (Poster)
Lim S, Descallar J, Sayaloune P, Delaney GP, Papadatos G, and DeSouza P Outcomes of ethnic minority groups with node‐positive, non‐metastatic breast cancer in a tertiary referral centre in Sydney MOGA ASM, Brisbane, Australia (Oral Presentation)
O'Connor C Effectiveness of a pilot quality improvement strategy to support transition to implement the NIKI T34 syringe driver in Palliative Care NSW Palliative Care Conference, Dubbo, Australia (Poster)
Phan P, Kumar S, Vinod SK, and et al Active Breathing Coordination to measure tumour motion in lung cancer patients: A feasibility study 2012 Australasian RO Elekta User Meeting, Perth, Australia (Poster)
Pramana A, Descallar J Vinod S Outcomes of definitive radiotherapy +/‐ chemotherapy for NSCLC patients 2000‐2010. Faculty of Radiation Oncology Annual Scientific Meeting , Cairns, QLD, Australia (Oral Presentation)
Ryan CJ, Smith MR, DeBono JS, Molina A, Logothetis C, DeSouza P, Fizazi K, Mainwaring PN, Rodriguez JMP, and Ng W Interim analysis results of COU‐AA‐302, a randomized, phase III study of abiraterone acetate in chemotherapy‐naïve patients with metastatic castration‐resistant prostate cancer (mCRPC). ASCO ASM, Chicago, USA (Oral Presentation)
Thientosapol ES, Descallar J, Nelson M, and DeSouza P An exploratory analysis of the longitudinal relationship between prostate specific antigen and the inflammatory markers C‐reactive protein and erythrocyte sedimentation rate MOGA ASM, Brisbane, Australia (Poster)
To T, Agar M, Shelby‐James S, Abernethy A, Agar M, Dooge M, Rowett D, and Currow D Off label prescribing in palliative care – a cross sectional national survey of Australian Palliative Medicine doctors. Multinational Association of Supportive Care in Cancer (MASCC) International symposium on supportive care in cancer, New York, USA (Oral Presentation)
Vinod SK, Lonergan DM Gillett L Simpson G Multisource Feedback for Radiation Oncologists Faculty of Radiation Oncology Annual Scientific Meeting , Cairns, QLD, Australia (Oral Presentation)
Whelan B, Hollosay L Dowling J Kumar S Begg J Lambert J Lim K Vinod S Greer P Salvado O The impact of incorrect electron density data on dose calculation accuracy and IMRT optimisation for cervical cancer patients. American Association of Physicists in Medicine, Charlotte, NC, USA (Poster)
159
Yip PY and Kiely, B. E. New Lung Cancer Treatments Discussing Prognostication Patients' views about how oncologists should explain prognosis in advanced cancer? Campbelltown Hospital Grand Rounds, Campelltown Hospital (Oral Presentation)
Yip PY and Kiely, B. E. New Lung Cancer Treatments Discussing Prognostication Patients' views about how oncologists should explain prognosis in advanced cancer? San Antonio Breast Cancer Symposium, San Antonio, Texas, USA (Oral Presentation and Poster)
Grants
July 2011 – December 2011 Agar M. The preventative role of exogenous melatonin administration in patients with advanced cancer who are are at high risk of delirium; a feasibility study prior to a larger randomized controlled trial. University of Ottawa $58,761
Agar M. Strategies to decrease pain through implementing a dual clinical pain pathway: Stop Pain path phase 1. UTS $29,261
Apte M and McNeil P. Salary for Senior Research Coordinator, Ingham Health Research Intitute, Liverpool. UNSW $99,500
Apte M, Xu Z, Wilson J, Pirola R, and Goldstein D. Does nab‐Paclitaxel cause stomal depletion in pancreatic cancer by targeting pancreatic stellate cells? Abraxis Bioscience $110,065
Biankin, A. V., Grimmond S, Apte M, Goldstein D, Clarke S, Kench J, Samra J, Gebski V, Wu J, Mead S, and Horvath L. Genotype guided cancer therapy (Genomic theragnostics) PIs. NSW Cancer Council $1,500,000
Bokey EL. Grant In Aid. 2011 Merrylands RSL $40,000
Bryant K, McNeil P, Phillips P, and Apte M. Guava easyCyte 8HT Flow Cytometry System (Millipore Australia). UNSW $95,250
Keall P, Barton M, and Crozier S. The Australian MRI‐LINAC Program: Impoving Cancer treatment through real‐time image guided adaptive radiotherapy. NHMRC $5,705,308
Keall P, Jackson M, Rosenfeld A, Barton M, Metcalfe P, Thwaites P, Junncic Z, and Holloway LC. The development, investigation & application of a mini‐linear accelerator system. ARC LIEF $600,000
Liu Z, Perrier S, Mai YW, Young PM, Bandyopadhyay S, Braet FC, Burford RP, Housley GD, Apte M, and Thordarson P. Accessing the third dimension in scanning electron microscopy for rapid, high resolution tomography of large samples. ARC LIEF $250,000
160
Phillips P, Apte M, and McNeil P. Applied Biosystems ViiA7 Real‐Time PCR System. University of New South Wales $115,000
Vial P, Kuncic Z, Greer P, Baldock C, Holloway LC, Barton MB, Meikle SA, and Hodgkinson SA. A next generation detector for radiotherapy treatment verification with dual capability for simultaneous imaging and dosimetry. University of New South Wales $336,125
January 2012 to June 2012 Agar M. Improving palliative care for people with advanced dementia living in residential aged care. Commonwealth Department of Health and Ageing $1,528,295
Apte M, McNeil P, and Scott K. Olympus Microscope System University of New South Wales $99,990
Apte M and Wilson J. Tumour‐Epithelial interactions in the pathogenesis of pancreatic cancer. UNSW Faculty Research Grants Program $20,000
Bokey EL. Fellowship in Laparaoscopic Colorectal Srugery UWS $75,000
Bonevski B and Girgis A. Development of a web based CME program on "Sun and Vitamin D" for general practitioners. Cancer Institute NSW, Research Innovation Grant $49,947
Butow P, Thewes B, Turner J, Gilchrist J, Sharpe L, Bell M, Beith J, Mihalopoulos C, Boyle F, Clarke S, King M, Boyes A, Hill G, and Armstrong D. Evaluation of a psychological and educational intervention for fear of cancer recurrence: A Cluster randomised controlled trial. Cancer Australia, Behond blue and National Breast Foundation $496,702
Chambers SK, Newton R, Girgis A, Lepore S, Mihalopoulos C, Gardiner RA, Galvao D, and Occhipinti S. ProsCan for Life: A mulitimodal supportive care intervention for men with prostate cancer. Cancer Australia and beyond blue $598,194
Della‐Fiorentina S. Specialist Training Program. Royal Australian College of Physicians $310,000
Di Girolamo N, Lloyd A, Gunning P, Gaus K, Kavallaris M, Geczy C, Apte M, Tedla N, Phillips P, McCarroll J, Polly P, Simar D, McNeil P, Bryant K, & Whan R. IncuCyte‐FLR in vitro live‐cell imaging system. University of New South Wales $160,000
Girgis A, Lambert S, Turner J, McElduff P, Kayser K, and Mihalopoulos C. Coping‐Together: A randomised controlled trial of a self‐directed coping skills intervention for patients with cancer and their carers. National Health and Medical Research Council $718,022
161
Girgis A and Kelly B. Feasibility study of an integrated, patient‐centred psychosocial care model for patients with urological and head and neck cancers. Cancer Insitute NSW $580,995
Girgis A, Short C, James E, and Plotnikoff R. Move more for life: A tailored physical activity program for Australian breast cancer survivors. Cancer Insitute NSW $49,849
Holloway LC, Delaney GP, Metcalfe P, Koh ES, and Vial P. Quantifying the impact of imaging choice for breast cancer radiotherapy. Cancer Australia & National Breast Cancer Foundation $391,596
Ingham J, O'Connol D, Davidson P, Girgis A, Goldsbury D, Phillips J, Pigot M, Piz M, and Wilkinson A. Last days of life linkage study: Patterns of health services use and experiences of adult NSW residents in the year prior to death from illness. Cancer Insitute NSW $83,748
Kiely, B. E. Evaluation of a web‐based tool for estimating andn explaining prognosis in advanced cancer Cancer Australia and beyond blue $254,425
Kiely, B. E. Study of Oestrogen Receptor Beta and Efficay of Taxoxifen (SORBET). ANZBCTG Discretionary funding $60,000
Kiely, B. E. Evaluation of a web‐based tool for estimating andn explaining prognosis in advanced cancer. Conquer Cancer Foundation of ASCO $50,000
Lam W, Fielding R, Girgis A, Poon J, and Fong D. A longitudinal study of psychosocial needs, physical symptom distress, and psychological distress of Chinese patients with colorectal patients. Health and Health Services Research Fund $73,980
Philips P, Kavallaris M, McCarroll J, and Apte M. Targeting Microtubles to Overcome Chemoresistance in Pancreatic Cancer. NHMRC $573,765.00
Wong F, Kearney A, Rosenfeld D, and Harvey M. Feasibility Study of a Thalassemia Community Screening. Haematology Research & Education Fund $1,150
Invited Speakers
July 2011 – December 2011 Adams D Topic "Principles of chemotherapy" Conference Week UWS
Agar M Topic "Palliative Care and supportive care trials in Glioma." Cooperative trials group in neuro‐oncology Sydney, Australia
162
Agar M Topic "Delirium: State of the art update" Australian and New Zealand Society of Palliative Medicine medical and surgical update. ANZSPM 2011
Agar M Topic "Palliative Care and supportive care trials in Glioma" Cooperative trials group in neuro‐oncology Annual Scientific Meeting. COGNO
Barton M Topic "Patterns of Treatment by Radiotherapy" 62nd Scientific Meeting Royal Australian & New Zealand College of Radiologists
Barton M Topic "Australian Medical Oncologist Workforce Study ‐ general workforce shortage" 38th Annual Scientific Meeting COSA
Barton M Topic "Improving access to education and cancer care in developing countries" International Association for the Study of Lung Cancer (IASLC)
Chantrill L Topic "Introduction to Oncology/Cancer Biology" Conference Week UWS
Delaney GP Topic "Oncological Emergencies" Grand Rounds Fairfield Hospital
Delaney GP Topic "Multi‐disciplinary Management of Breast Cancer" Information Evening Liverpool Division of General Practice Meeting
Della‐Fiorentina S Topic "Emerging Cancer Therapies" Conference Week UWS
Della‐Fiorentina S Topic "Oncology meets Palliative Care" Southern Highlands Division of GP's Southern Highlands Division of GP's
DeSouza P Topic "Prostate Cancer ‐ Pathology, Advanced Disease, Rehabilitation" UNSANZ Trainee Week UNSANZ
DeSouza P Topic "Phase 1 Clinical Trials in Cancer" Ingham Institute Research Showcase Meeting 2011 Ingham Institute
DeSouza P Topic "A novel PLA2 inhibitor in development for clinical trials in advanced prostate cancer." Prostate Cancer Foundation of Australia meeting in partnership with National Prostate Cancer Conference Prostate and National Prostate Cancer Foundations
163
DeSouza P Topic "Modern management of opioid side effects" The Opioid and the Anesthetist Conference Australian & New Zealand College of Anaesthetists
Przezdziecki A Topic "Breast Cancer and Body Image" BRCA Information Day The Association of Genetic Support of Australia (AGSA
January 2012 to June 2012 Adams D Topic "Prostate Cancer ‐ New Drugs" ACTNOW COSA
Agar M Topic "Outcome Assessment in Palliative Care" 3rd International congress on supportive and palliative care in cancer, Cancer Research Centre Cancer research centre Tehran
Agar M Topic "The epidemiology of delirium in palliative care settings. Planning Meeting on Studies to UNderstand Delirium In Palliative Care Settings (SUNDIPS), Width3Width13080Width3Width2880" Studies to Understand Delirium In Palliative Care Settings (SUNDIPS) Studies to Understand Delirium In Palliative Care Settings (SUNDIPS)
Agar M Topic "Developing Research in Palliative Care: the way forward" 3rd International congress on supportive and palliative care in cancer, Cancer Research Centre Cancer research centre Tehran
Agar M Topic "Rehabilitation in Advanced Cancer" 3rd International congress on supportive and palliative care in cancer, Cancer Research Centre Cancer research centre Tehran
Agar M Topic "Delirium in advanced cancer" 3rd International congress on supportive and palliative care in cancer, Cancer Research Centre Cancer research centre Tehran
Agar M Topic "Methodological and other lessons learned in conducting a trial of antipsychotic agents in palliative care settings. Planning Meeting on Studies to UNderstand Delirium In Palliative Care Settings (SUNDIPS), " Studies to Understand Delirium In Palliative Care Settings (SUNDIPS) Studies to Understand Delirium In Palliative Care Settings (SUNDIPS)
Barton MB Topic "Adapting MRI in a Changing World" ISMRM Annual Meeting International Society for Magnetic Resonance in Medicine
Della‐Fiorentina S Topic "Audit of Booking Processes of Breast Cancer 2008‐2011" UWS Research Symposium UWS
164
Della‐Fiorentina S Topic "Auditing for the QSA" Quality Systems Assessment 2012 Clinical Excellence Commission
Della‐Fiorentina S Topic "6 Most Important Papers of 2011" ACTNOW COSA
Hanna, T. P. Topic "Radiation Oncology & Cancer Control ‐ Master of Public Health Program" Radiation Oncology and Cancer Control, Master of Public Health Program Univeristy of Sydney
Kiely, B. E. Topic "Discussing prognosis with patients with incurable cancer" Advanced Trainees Oncology Meeting (ATOM) Roche
Koh ES Topic "Current approaches in the use of radiation therapy for central nervous system tumours" NNPDSC NNPDSC
Walker A Topic "Palliative Care" ACTNOW COSA
Walker A Topic "Preparation for QSA Auditing" Quality Systems Assessment 2012 Clinical Excellence Commission
Yip PY Topic "Tissue Microarrays" Basic Sciences in Oncology MOGA
Invited Expert
Barton MB Topic "IAEA Consultants Meeting ‐ Developing teaching materials for education on National Radiotherapy Services for Curative/Palliative treatment of common cancers" IAEA/PACT (Program for Action for Cancer Therapy) 2011
Barton MB Topic "Australian MRI Linac Project" University of Cambridge, Addenbrookes Hospital, Cambridge Cooper T, Associate Director (NCAT), Mike Williams, University of Cambridge, Addenbrookes Hospital, Cambridge 2012
Barton MB Topic "Update on Australia including fractionation" University of Cambridge, Addenbrookes Hospital, Cambridge Cooper T, Associate Director (NCAT), Mike Williams, University of Cambridge, Addenbrookes Hospital, Cambridge 2012
Barton MB Topic "Evidence based assessment of the demand for cancer services (Covering optimal and actual utilisation of chemotherapy and radiotherapy)" North Coast Cancer Institute, NSW, Australia McKay M 2012
165
Journal Publications
July 2012 – December 2012 Apte M Isolation of quiescent Pancreatic Stellate Cells from Rat and Human Pancreas The Pancreapedia: Exocrine Pancreas Knowledge Base Pages Http://dx.doi.org/10.3998/panc.2011 ‐ Apte, M. V., Pirola, R., and Wilson, J. The fibrosis of chronic pancreatitis: new insights into the role of pancreatic stellate cells Antioxid.Redox.Signal. Vol 15, Issue 10, Pages 2711 ‐ 2722
Au, A., Lam, W. W., Kwong, A., Suen, D., Tsang, J., Yeo, W., Suen, J., Ho, W. M., Yau, T. K., Soong, I., Wong, K. Y., Sze, W. K., Ng, A., Girgis, A., and Fielding, R. Validation of the Chinese version of the short‐form Supportive Care Needs Survey Questionnaire (SCNS‐SF34‐C) Psychooncology. Vol 20, Issue 12, Pages 1292 ‐ 1300
Barton MB Medical Mentor: Prof Michael Barton reflects on his career in Radiation Oncology Medical Journal of Australia Issue 7, Pages C5 ‐ C5
Bonevski, B., Paul, C., D'Este, C., Sanson‐Fisher, R., West, R., Girgis, A., Siahpush, M., & Carter, R. RCT of a client‐centred, caseworker‐delivered smoking cessation intervention for a socially disadvantaged population BMC.Public Health Vol 11, Issue 1, Pages 70
Boxer M, Vinod, S. K., Shafiq, J., and Duggan, K. J. Do multidisciplinary team meetings make a difference in the management of lung cancer? Cancer 2011 Vol 117, Issue 22, Pages 5112 ‐ 5120
Boyes, A. W., Girgis, A., D'Este, C., and Zucca, A. C. Flourishing or floundering? Prevalence and correlates of anxiety and depression among a population‐based sample of adult cancer survivors 6months after diagnosis J Affect.Disord. Vol 135, Issue 1‐3, Pages 184 ‐ 192
Burridge, L. H., Mitchell, G. K., Jiwa, M., and Girgis, A. Consultation etiquette in general practice: a qualitative study of what makes it different for lay cancer caregivers BMC.Fam.Pract. Vol 12, Pages 110
Ch'ng, S. and Clark, J. R. The scapular angle adds versatility to the latissimus dorsi free flap in complicated scalp reconstruction J Plast.Reconstr.Aesthet.Surg. Vol 64, Issue 9, Pages e248 ‐ e249
Chambers, S. K., Newton, R. U., Girgis, A., Nielsen, L., Lepore, S., Mihalopoulos, C., Gardiner, R., Galvao, D. A., and Occhipinti, S. Living with prostate cancer: randomised controlled trial of a multimodal supportive care intervention for men with prostate cancer BMC.Cancer Vol 11, Pages 317
166
Chan, P., Moller, A., Liu, M. C., Sceneay, J. E., Wong, C. S., Waddell, N., Huang, K. T., Dobrovic, A., Millar, E. K., O'Toole, S. A., McNeil, C. M., Sutherland, R. L., Bowtell, D. D., and Fox, S. B. The expression of the ubiquitin ligase SIAH2 (seven in absentia homolog 2) is mediated through gene copy number in breast cancer and is associated with a basal‐like phenotype and p53 expression Breast Cancer Res. Vol 13, Issue 1, Pages R19
Colvin, E. K., Susanto, J. M., Kench, J. G., Ong, V. N., Mawson, A., Pinese, M., Chang, D. K., Rooman, I., O'Toole, S. A., Segara, D., Musgrove, E. A., Sutherland, R. L., Apte, M. V., Scarlett, C. J., and Biankin, A. V. Retinoid signaling in pancreatic cancer, injury and regeneration PLoS.One. Vol 6, Issue 12, Pages e29075
de, Lusignan S., Liaw, S. T., Krause, P., Curcin, V., Vicente, M. T., Michalakidis, G., Agreus, L., Leysen, P., Shaw, N., and Mendis, K. Key Concepts to Assess the Readiness of Data for International Research: Data Quality, Lineage and Provenance, Extraction and Processing Errors, Traceability, and Curation. Contribution of the IMIA Primary Health Care Informatics Working Group Yearb.Med Inform. Vol 6, Issue 1, Pages 112 ‐ 120
de, Lusignan S., Liaw, S. T., Michalakidis, G., and Jones, S. Defining datasets and creating data dictionaries for quality improvement and research in chronic disease using routinely collected data: an ontology‐driven approach Inform.Prim.Care Vol 19, Issue 3, Pages 127 ‐ 134
de, Lusignan S., Pearce, C., Shaw, N. T., Liaw, S. T., Michalakidis, G., Vicente, M. T., Bainbridge, M., International and European Medical Informatics Association and Federation Primary, and Care Informatics Working Group What are the barriers to conducting international research using routinely collected primary care data? Stud.Health Technol.Inform. Vol 165, Pages 135 ‐ 140
Dent, O. F., Chapuis, P. H., Haboubi, N., and Bokey, L. Magnetic resonance imaging cannot predict histological tumour involvement of a circumferential surgical margin in rectal cancer Colorectal Dis. Vol 13, Issue 9, Pages 974 ‐ 981
Ebrahimi, A., Murali, R., Gao, K., Elliott, M. S., and Clark, J. R. The prognostic and staging implications of bone invasion in oral squamous cell carcinoma Cancer Vol 117, Issue 19, Pages 4460 ‐ 4467
Ebrahimi, A., Zhang, W. J., Gao, K., and Clark, J. R. Nodal yield and survival in oral squamous cancer: Defining the standard of care Cancer Vol 117, Issue 13, Pages 2917 ‐ 2925
Ebrahimi, A., Clark, J. R., Zhang, W. J., Elliott, M. S., Gao, K., Milross, C. G., and Shannon, K. F. Lymph node ratio as an independent prognostic factor in oral squamous cell carcinoma Head Neck Vol 33, Issue 9, Pages 1245 ‐ 1251
167
Girgis, A., Lambert, S., and Lecathelinais, C. The supportive care needs survey for partners and caregivers of cancer survivors: development and psychometric evaluation Psychooncology. Vol 20, Issue 4, Pages 387 ‐ 393
Girgis, A., Stacey, F., Lee, T., Black, D., and Kilbreath, S. Priorities for women with lymphoedema after treatment for breast cancer: population based cohort study BMJ Vol 342, Pages d3442 ‐
Girgis, A., Stojanovski, E., Boyes, A., King, M., and Lecathelinais, C. The next generation of the supportive care needs survey: a brief screening tool for administration in the clinical oncology setting Psychooncology.
Gladwish, A., Koh, E. S., Hoisak, J., Lockwood, G., Millar, B. A., Mason, W., Yu, E., Laperriere, N. J., and Menard, C. Evaluation of early imaging response criteria in glioblastoma multiforme Radiat.Oncol. Vol 6, Pages 121 ‐
Gustafsson, H., Vial, P., Kuncic, Z., Baldock, C., Denham, J. W., and Greer, P. B. Direct dose to water dosimetry for pretreatment IMRT verification using a modified EPID Med Phys. Vol 38, Issue 11, Pages 6257 ‐ 6264
Hall, A. E., Boyes, A. W., Bowman, J., Walsh, R. A., James, E. L., and Girgis, A. Young adult cancer survivors' psychosocial well‐being: a cross‐sectional study assessing quality of life, unmet needs, and health behaviors Support.Care Cancer
Hasan, Z., Clark, J. R., and Fowler, A. A facial dismasking approach for resection of an infratemporal fossa sclerosing epithelioid fibrosarcoma ANZ.J Surg. Vol 81, Issue 12, Pages 947 ‐ 948
Hollingsworth, J., Cooper, W. A., Nicoll, K. D., Wills, E. J., Thiruvilangam, V., Lee, C. S., and Scolyer, R. A. Follicular dendritic cell sarcoma of the lung: a report of two cases highlighting its pathological features and diagnostic pitfalls Pathology Vol 43, Issue 1, Pages 67 ‐ 70
Hong, A. M., Dobbins, T. A., Lee, C. S., Jones, D., Fei, J., Clark, J. R., Armstrong, B. K., Harnett, G. B., Milross, C. G., Tran, N., Peculis, L. D., Ng, C., Milne, A. G., Loo, C., Hughes, L. J., Forstner, D. F., O'Brien, C. J., and Rose, B. R. Use of cyclin D1 in conjunction with human papillomavirus status to predict outcome in oropharyngeal cancer
James, E. L., Stacey, F., Chapman, K., Lubans, D. R., Asprey, G., Sundquist, K., Boyes, A., and Girgis, A. Exercise and nutrition routine improving cancer health (ENRICH): the protocol for a randomized efficacy trial of a nutrition and physical activity program for adult cancer survivors and carers BMC.Public Health Vol 11, Pages 236
168
Jankova, L., Chan, C., Fung, C. L., Song, X., Kwun, S. Y., Cowley, M. J., Kaplan, W., Dent, O. F., Bokey, E. L., Chapuis, P. H., Baker, M. S., Robertson, G. R., Clarke, S. J., and Molloy, M. P. Proteomic comparison of colorectal tumours and non‐neoplastic mucosa from paired patient samples using iTRAQ mass spectrometry Mol.Biosyst. Vol 7, Issue 11, Pages 2997 ‐ 3005
Johnson CE, Girgis A, Paul C, and Currow D Palliative Care referral practices and perceptions: the divide between metropolitan and non‐metropolitan general practitioners Palliative & Supportive Care Vol 9, Pages 181 ‐ 189
Johnson, C., Girgis, A., Paul, C., Currow, D. C., Adams, J., and Aranda, S. Australian palliative care providers' perceptions and experiences of the barriers and facilitators to palliative care provision Support.Care Cancer Vol 19, Issue 3, Pages 343 ‐ 351
Johnson, C., Paul, C., Girgis, A., Adams, J., and Currow, D. C. Australian general practitioners' and oncology specialists' perceptions of barriers and facilitators of access to specialist palliative care services J Palliat.Med Vol 14, Issue 4, Pages 429 ‐ 435
Kiely, B. E., Hossack, L. K., Shadbolt, C. L., Davis, A., Cassumbhoy, R., Moodie, K., Antill, Y., and Mitchell, G. Practicalities of developing a breast magnetic resonance imaging screening service for women at high risk for breast cancer ANZ.J Surg. Vol 81, Issue 10, Pages 688 ‐ 693
Kiely, B. E., Stockler, M. R., and Tattersall, M. H. Thinking and talking about life expectancy in incurable cancer Semin.Oncol. Vol 38, Issue 3, Pages 380 ‐ 385
Kiely, B. E., Friedlander, M. L., Milne, R. L., Stanhope, L., Russell, P., Jenkins, M. A., Weideman, P., McLachlan, S. A., Grant, P., Hopper, J. L., and Phillips, K. A. Adequacy of risk‐reducing gynaecologic surgery in BRCA1 or BRCA2 mutation carriers and other women at high risk of pelvic serous cancer Fam.Cancer
Kiely, B. E., Wilcken, N. R., and Stockler, M. R. Life after adjuvant chemotherapy for breast cancer: the news is mostly good J Clin.Oncol. Vol 29, Issue 9, Pages 1092 ‐ 1093
Kiely, B. E., Friedlander, M. L., Milne, R. L., Stanhope, L., Russell, P., Jenkins, M. A., Weideman, P., McLachlan, S. A., Grant, P., Hopper, J. L., and Phillips, K. A. Adequacy of risk‐reducing gynaecologic surgery in BRCA1 or BRCA2 mutation carriers and other women at high risk of pelvic serous cancer Fam.Cancer Vol 10, Issue 3, Pages 505 ‐ 514
Lambert, S., Pallant, J. F., and Girgis, A. Rasch analysis of the Hospital Anxiety and Depression Scale among caregivers of cancer survivors: implications for its use in psycho‐oncology Psychooncology. Vol 20, Issue 9, Pages 919 ‐ 925
Liaw ST Computerised decision support in general practice ‐ a research journey Australian Family Physician Vol 40, Issue 9, Pages 711 ‐ 711
169
Liaw ST An Opportunity or threat to general practice research? Australian Family Physician Vol 40, Issue 12, Pages 1016 ‐ 1017
Liaw, S. T., Lau, P., Pyett, P., Furler, J., Burchill, M., Rowley, K., and Kelaher, M. Successful chronic disease care for Aboriginal Australians requires cultural competence Aust.N.Z.J Public Health Vol 35, Issue 3, Pages 238 ‐ 248
Liaw, S. T., Taggart, J., Dennis, S., and Yeo, A. Data quality and fitness for purpose of routinely collected data‐‐a general practice case study from an electronic practice‐based research network (ePBRN) AMIA.Annu.Symp.Proc. Vol 2011, Pages 785 ‐ 794
Lin P, Koh, E. S., Lin, M., Vinod, S. K., Ho‐Shon, I., Yap, J., and Som, S. Diagnostic and staging impact of radiotherapy planning FDG‐PET‐CT in non‐small‐cell lung cancer Radiation Oncology 2011 Vol 101, Issue 2, Pages 284 ‐ 290
Luckett T, Goldstein, D., Butow, P. N., Gebski, V., Aldridge, L. J., McGrane, J., Ng, W., and King, M. T. Psychological morbidity and quality of life of ethnic minority patients with cancer: a systematic review and meta‐analysis Lancet Oncol. Vol 12, Issue 13, Pages 1240 ‐ 1248
Mahmud, A., Brydon, B., Tonita, J., Hanna, T. P., Schmidt, M., and Tai, P. A population‐based study of cervix cancer: incidence, management and outcome in the Canadian province of Saskatchewan Clin Oncol (R Coll Radiol) Vol 23, Issue 10, Pages 691 ‐ 695
Nguyen, N. Q., Johns, A. L., Gill, A. J., Ring, N., Chang, D. K., Clarkson, A., Merrett, N. D., Kench, J. G., Colvin, E. K., Scarlett, C. J., and Biankin, A. V. Clinical and immunohistochemical features of 34 solid pseudopapillary tumors of the pancreas J Gastroenterol.Hepatol. Vol 26, Issue 2, Pages 267 ‐ 274
Quinn, A., Holloway, L., Cutajar, D., Hardcastle, N., Rosenfeld, A. & Metcalfe, P. Megavoltage cone beam CT near surface dose measurements: potential implications for breast radiotherapy Med Phys. Vol 38, Issue 11, Pages 6222 ‐ 6227
Saunders, C. and Girgis, A. Enriching health research through consumer involvement‐‐learning through atypical exemplars Health Promot.J Austr. Vol 22, Issue 3, Pages 196 ‐ 202
Scarlett, C. J., Colvin, E. K., Pinese, M., Chang, D. K., Morey AL, Musgrove, E. A., Pajic M, Apte, M. V., Henshall SM, Sutherland R, Kench JG, and Biankin, A. V. Recruitment and activation of pancreatic stellate cells from teh bone marrow in pancreatic cancer: a model of tumour‐host interaction. PLoS.One. Vol 6, Issue 10, Pages e26088
Shin, J. S., Jalaludin, B., Solomon, M., Hong, A., and Lee, C. S. Histopathological regression grading versus staging of rectal cancer following radiotherapy Pathology Vol 43, Issue 1, Pages 24 ‐ 30
170
Short, C. E., James, E. L., Plotnikoff, R. C., and Girgis, A. Efficacy of tailored‐print interventions to promote physical activity: a systematic review of randomised trials Int J Behav.Nutr.Phys.Act. Vol 8, Pages 113
Tan, K. L., Jankova, L., Chan, C., Fung, C. L., Clarke, C., Lin, B. P., Robertson, G., Molloy, M., Chapuis, P. H., Bokey, L., Dent, O. F., and Clarke, S. J. Clinicopathological correlates and prognostic significance of glutathione S‐transferase Pi expression in 468 patients after potentially curative resection of node‐positive colonic cancer Histopathology Vol 59, Issue 6, Pages 1057 ‐ 1070
To T, Greene A, Agar M, and Currow D A cross sectional point prevalence survey of people whose goals of care are pallaitive in acute hospitals Internal Medicine Journal Vol 41, Issue 5, Pages 430 ‐ 430
Tzelepis, F., Paul, C. L., Wiggers, J., Walsh, R. A., Knight, J., Duncan, S. L., Lecathelinais, C., Girgis, A., and Daly, J. A randomised controlled trial of proactive telephone counselling on cold‐called smokers' cessation rates Tob.Control Vol 20, Issue 1, Pages 40 ‐ 46
Vonlaufen, A., Phillips, P. A., Xu, Z., Zhang, X., Yang, L., Pirola, R. C., Wilson, J. S., and Apte, M. V. Withdrawal of alcohol promotes regression while continued alcohol intake promotes persistence of LPS‐induced pancreatic injury in alcohol‐fed rats Gut Vol 60, Issue 2, Pages 238 ‐ 246
Yip, P. Y., Kench, J. G., Rasiah, K. K., Benito, R. P., Lee, C. S., Stricker, P. D., Henshall, S. M., Sutherland, R. L., and Horvath, L. G. Low AZGP1 expression predicts for recurrence in margin‐positive, localized prostate cancer Prostate Vol 71, Issue 15, Pages 1638 ‐ 1645
Zucca, A., Boyes, A., Newling, G., Hall, A., and Girgis, A. Travelling all over the countryside: travel‐related burden and financial difficulties reported by cancer patients in New South Wales and Victoria Aust.J Rural.Health Vol 19, Issue 6, Pages 298 ‐ 305
January 2012 to June 2012 Agar M Pain and Delirium. Geriatric Medicine Vol 14, Issue 1, Pages 9 ‐ 15
Apte, M. V. and Wilson, J. S. Dangerous liaisons: pancreatic stellate cells and pancreatic cancer cells J Gastroenterol.Hepatol. Vol 27 Suppl 2, Pages 69 ‐ 74
Bonevski, B., Girgis, A., Magin, P., Horton, G., Brozek, I., and Armstrong, B. Prescribing sunshine: a cross‐sectional survey of 500 Australian general practitioners' practices and attitudes about vitamin D Int J Cancer Vol 130, Issue 9, Pages 2138 ‐ 2145
171
Boyer, M., Horwood, K., Pavlakis, N., de, Souza P., Millward, M., Stein, B., Johnston, M., Abell, F., and Rischin, D. Efficacy of erlotinib in patients with advanced Non‐small‐cell Lung Cancer (NSCLC): Analysis of the Australian subpopulation of the TRUST study Asia Pac.J Clin Oncol Vol 8, Issue 3, Pages 248 ‐ 254
Brunner, M., Veness, M. J., Ch'ng, S., Elliott, M., and Clark, J. R. Distant metastases from cutaneous squamous cell carcinoma‐analysis of AJCC stage IV Head Neck
Butow, P. N., Lobb, E., Jefford, M., Goldstein, D., Eisenbruch, M., Girgis, A., King, M., Sze, M., Aldridge, L., and Schofield, P. A bridge between cultures: interpreters' perspectives of consultations with migrant oncology patients Support.Care Cancer Vol 20, Issue 2, Pages 235 ‐ 244
Cameron, B. A., Bennett, B., Li, H., Boyle, F., Desouza, P., Wilcken, N., Friedlander, M., Goldstein, D., and Lloyd, A. R. Post‐cancer fatigue is not associated with immune activation or altered cytokine production Ann.Oncol
Ch'ng, S., Ashford, B. G., Gao, K., McGuinness, J., and Clark, J. R. Reconstruction of post‐radical parotidectomy defects Plast.Reconstr.Surg. Vol 129, Issue 2, Pages 275e ‐ 287e
Ch'ng, S., Palme, C. E., Wong, G. L., Brunner, M., Ashford, B., McGuinness, J., and Clark, J. R. Reconstruction of the (Crico)trachea for malignancy in the virgin and irradiated neck J Plast.Reconstr.Aesthet.Surg.
Ch'ng, S., Clark, J. R., Brunner, M., Palme, C. E., Morgan, G. J., and Veness, M. J. Relevance of the primary lesion in the prognosis of metastatic cutaneous squamous cell carcinoma Head Neck
Ch'ng, S., Pinna, A., Ioannou, K., Juszczyk, K., Shannon, K., Clifford, A., Uren, R., and Clark, J. R. Assessment of second tier lymph nodes in melanoma and implications for extent of elective neck dissection in metastatic cutaneous malignancy of the parotid Head Neck
Chambers, S. K., Girgis, A., Occhipinti, S., Hutchison, S., Turner, J., Morris, B., and Dunn, J. Psychological distress and unmet supportive care needs in cancer patients and carers who contact cancer helplines Eur.J Cancer Care (Engl.) Vol 21, Issue 2, Pages 213 ‐ 223
Chapuis, P. H., Bokey, L., Chan, C., and Dent, O. F. Colorectal cancer staging revisited: time for critical evaluation? Colorectal Dis. Vol 14, Issue 9, Pages 1043 ‐ 1044
Chua, T. C. and Merrett, N. D. Clinicopathologic factors associated with HER2‐positive gastric cancer and its impact on survival outcomes‐‐a systematic review Int J Cancer Vol 130, Issue 12, Pages 2845 ‐ 2856
172
Clark, J. R., Rumcheva, P., and Veness, M. J. Analysis and Comparison of the 7th Edition American Joint Committee on Cancer (AJCC) Nodal Staging System for Metastatic Cutaneous Squamous Cell Carcinoma of the Head and Neck Ann.Surg.Oncol
Deshpande S, Vial P, and Holloway LC 2‐D radition therapy dosimetry using EPIDs: Dose response variation between 3 siemens electronic portal imaging devices (EPIDs) Radiation Measurements
Ebrahimi, A., Clark, J. R., Lorincz, B. B., Milross, C. G., and Veness, M. J. Metastatic head and neck cutaneous squamous cell carcinoma: defining a low‐risk patient Head Neck Vol 34, Issue 3, Pages 365 ‐ 370
Ebrahimi, A., Ashford, B. G., and Clark, J. R. Improved survival with elective neck dissection in thick early‐stage oral squamous cell carcinoma Head Neck Vol 34, Issue 5, Pages 709 ‐ 716
Erkan, M., Adler, G., Apte, M. V., Bachem, M. G., Buchholz, M., Detlefsen, S., Esposito, I., Friess, H., Gress, T. M., Habisch, H. J., Hwang, R. F., Jaster, R., Kleeff, J., Kloppel, G., Kordes, C., Logsdon, C. D., Masamune, A., Michalski, C. W., Oh, J., Phillips, P. A., Pinzani, M., Reiser‐Erkan, C., Tsukamoto, H., and Wilson, J. StellaTUM: current consensus and discussion on pancreatic stellate cell research Gut Vol 61, Issue 2, Pages 172 ‐ 178
Fong, A., Shafiq, J., Saunders, C., Thompson, A. M., Tyldesley, S., Olivotto, I. A., Barton, M. B., Dewar, J. A., Jacob, S., Ng, W., Speers, C., and Delaney, G. P. A comparison of surgical and radiotherapy breast cancer therapy utilization in Canada (British Columbia), Scotland (Dundee), and Australia (Western Australia) with models of "optimal" therapy Breast Vol 21, Issue 4, Pages 570 ‐ 577
Fong, A., Shafiq, J., Saunders, C., Thompson, A., Tyldesley, S., Olivotto, I. A., Barton, M. B., Dewar, J. A., Jacob, S., Ng, W., Speers, C., and Delaney, G. P. A comparison of systemic breast cancer therapy utilization in Canada (British Columbia), Scotland (Dundee), and Australia (Western Australia) with models of "optimal" therapy Breast Vol 21, Issue 4, Pages 562 ‐ 569
Fox, P. N., Chatfield, M. D., Beith, J. M., Allison, S., Della‐Fiorentina, S., Fisher, D., Turley, K., and Grimison, P. S. Factors delaying chemotherapy for breast cancer in four urban and rural oncology units ANZ.J Surg.
Ginsburg, O. M., Hanna, T. P., Vandenberg, T., Joy, A. A., Clemons, M., Game, M., Maccormick, R., Elit, L. M., Rosen, B., Rahim, Y., Geddie, W., Sutcliffe, S. B., and Gospodarowicz, M. The global cancer epidemic: opportunities for Canada in low‐ and middle‐income countries CMAJ.
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Graham, P. H., Plant, N. A., Graham, J. L., Browne, L. H., Borg, M., Capp, A., Delaney, G. P., Harvey, J., Kenny, L., Francis, M., and Zissiadis, Y. Digital photography as source documentation of skin toxicity: An analysis from the Trans Tasman Radiation Oncology Group (TROG) 04.01 Post‐Mastectomy Radiation Skin Care Trial J Med Imaging Radiat.Oncol Vol 56, Issue 4, Pages 458 ‐ 463
Hardy, J., Quinn, S., Fazekas, B., Plummer, J., Eckermann, S., Agar, M., Spruyt, O., Rowett, D., and Currow, D. C. Randomized, Double‐Blind, Placebo‐Controlled Study to Assess the Efficacy and Toxicity of Subcutaneous Ketamine in the Management of Cancer Pain J Clin Oncol
Holloway LC, Miller, J. A., Kumar, S., Whelan, B. M., and Vinod, S. K. Comp Plan: A computer program to generate dose and radiobiological metrics from dose‐volume histogram files Med.Dosim.
Hong, A. M., Martin, A., Armstrong, B. K., Lee, C. S., Jones, D., Chatfield, M. D., Zhang, M., Harnett, G., Clark, J., Elliott, M., Milross, C., Smee, R., Corry, J., Liu, C., Porceddu, S., Vaska, K., Veness, M., Morgan, G., Fogarty, G., Veivers, D., Rees, G., and Rose, B. Human papillomavirus modifies the prognostic significance of T stage and possibly N stage in tonsillar cancer Ann.Oncol
Hughes, J., Holloway, L. C., Quinn, A., and Fielding, A. An investigation into factors affecting electron density calibration for a megavoltage cone‐beam CT system J Appl.Clin Med Phys. Vol 13, Issue 5, Pages 3271 ‐
Humphris, J. L., Chang, D. K., Johns, A. L., Scarlett, C. J., Pajic, M., Jones, M. D., Colvin, E. K., Nagrial, A., Chin, V. T., Chantrill, L. A., Samra, J. S., Gill, A. J., Kench, J. G., Merrett, N. D., Das, A., Musgrove, E. A., Sutherland, R. L., and Biankin, A. V. The prognostic and predictive value of serum CA19.9 in pancreatic cancer Ann.Oncol Vol 23, Issue 7, Pages 1713 ‐ 1722
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Kang, S., Koh, E. S., Vinod, S. K., and Jalaludin, B. Cost analysis of lung cancer management in South Western Sydney J Med Imaging Radiat.Oncol Vol 56, Issue 2, Pages 235 ‐ 241
Kelder, W., Ebrahimi, A., Forest, V. I., Gao, K., Murali, R., and Clark, J. R. Cutaneous head and neck squamous cell carcinoma with regional metastases: the prognostic importance of soft tissue metastases and extranodal spread Ann.Surg.Oncol Vol 19, Issue 1, Pages 274 ‐ 279
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Luckett, T., Davidson, P. M., Lam, L., Phillips, J., Currow, D. C., and Agar, M. Do Community Specialist Palliative Care Services That Provide Home Nursing Increase Rates of Home Death for People With Life‐Limiting Illnesses? A Systematic Review and Meta‐Analysis of Comparative Studies J Pain Symptom Manage
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Thompson, S. R., Delaney, G. P., Gabriel, G. S., Jacob, S, Das, P., & Barton, M. B. Estimation of the Optimal Brachytherapy Utilization Rate in the Treatment of Gynecological Cancers and Comparison With Patterns of Care Int J Radiat.Oncol Biol.Phys.
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Symposium Panel Member Forstner D Topic "Change Champions Leadership and Management for health professional ‐ sharing the experience", NSW Parliament House, Sydney, Australia Adams D Topic "ACTNOW", Bowral, NSW, Australia Della‐Fiorentina S Topic "ACTNOW", Bowral, NSW, Australi a 2012 Delaney GP ACORD Workshop, Qld 2011 Koh ES Topic "Brain Tumour Consumer Forum" Cancer Institute NSW
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University Achievements/Currently Enrolled in PhD Studies
Batumalai V. Image Guided radiotherapy in breast cancer Supervisors :Delaney GP and Holloway LC Date Commenced : 2012 UNSW Degree PhD Blake S An EPID Monte Carlo Model Date Commenced : 2012 UNSW Degree PhD Chantrill L Defining the molecular landscape of pancreas cancer and applying it to the treatment in the oncology clinic Supervisor :Biankin A Date Commenced :2012 Supervisors :Biankin A UNSW Degree PhD Cho G Radiobiological modelling for radiotherapy 2007 UWS Degree PhD
Desponde S EPID dosimetry Supervisors :University of Wollongong Degree PhD
Gabriel G The effect of geographic variations on radiotherapy utilisation rates in NSW Barton M and Delaney GP Date Commenced :2007 Supervisors :Barton M and Delaney GP UNSW Degree PhD Griffiths Y Contouring Variability and it's Effect on Radiobiology Parameters for Head and Neck Cancer Date : Awarded Institute of Medical Physics, The University of Sydney Degree MSc Hanna TP The Overall Survival and Local Control Benefit of External Beam Radiation Therapy for Selected Cancers Date commenced : 2011 Supervisors: Barton MB, Delaney GP Degree PhD Hosie, A. Delirium in Palliative Care Date Commenced : August 2011 Supervisors :Phillips J, Lobb L, and Agar M University of Notra Dame Degree PhD
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Jameson M The impact of contouring uncertainty on radiotherapy 2012 University of Wollongong Degree PhD Kumar S Quantifying impact of MRI in Lung Cancer RT Supervisors : Vinod SK and Holloway LC¬ Date Commenced :2012 UNSW Degree PhD Przezdziecki A Self‐compassion, breast cancer and psychological distress Supervisor : Dr Kerry Sherman Date Commenced :2008 Macquarie University Degree PhD ‐ Psychology Quinn A Breast Imaging doses for radiotherapy 2012 University of Wollongong Degree PhD Shafiq J Model of Estimation of local control and survical benefit of external beam radiotherapy for selected cancers Date Commenced : 2011 Supervisors Barton MB, Delaney GP. UNSW Degree PhD
Tyler M IMRT dose verification with EPIDs Vial P, Holloway LC, and Metcalfe P¬ Date Commenced :2010 Supervisors :Vial P, Holloway LC, and Metcalfe P University of Wollongon Degree MSc Walker A The Impact of MRI distortion on radiotherapy treatment planning University of Wollongong Degree PhD Whelan B Development for an MRI Linac University of Sydney Degree PhD Wong K Estimation of the optimal number of radiotherapy fractions for cancer patients Supervisors :Barton M and Delaney GP Date Submitted : July 2012 UNSW Degree PhD