SOUTH WESTERN SYDNEY CANCER SERVICES ANNUAL …

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SOUTH WESTERN SYDNEY

CANCER SERVICES

AAANNNNNNUUUAAALLL RRREEEPPPOOORRRTTT

2012/2013

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CONTENTS FOREWORD ........................................................................................................................................................ 4 SWSLHD CANCER EXECUTIVE DIRECTOR’S REPORT ................................................................................................... 6

FACILITY REPORTS ...................................................................................................................................... 12

BANKSTOWN CANCER THERAPY CENTRE DIRECTOR’S REPORT ...................................................................................... 14 LIVERPOOL CANCER THERAPY CENTRE DIRECTOR’S REPORT ........................................................................................ 16 MACARTHUR CANCER THERAPY CENTRE DIRECTOR’S REPORT ..................................................................................... 20

CLINICAL SERVICES & DEPARTMENTS ......................................................................................................... 22

SWSLHD CANCER GENETICS ............................................................................................................................... 23 GYNAECOLOGIC ONCOLOGY ................................................................................................................................. 26 MEDICAL ONCOLOGY LIVERPOOL .......................................................................................................................... 29 MEDICAL ONCOLOGY MACARTHUR ....................................................................................................................... 32 SWSLHD HAEMATOLOGY ................................................................................................................................... 33 SWSLHD DERMATOLOGY ................................................................................................................................... 36 SWSLHD PALLIATIVE CARE ................................................................................................................................. 39 BRAESIDE PALLIATIVE CARE .................................................................................................................................. 43 LIVERPOOL PALLIATIVE CARE ................................................................................................................................ 45 MACARTHUR & WINGECARRIBEE PALLIATIVE CARE ................................................................................................... 51 BANKSTOWN PALLIATIVE CARE ............................................................................................................................. 54 SWSLHD PALLIATIVE CARE VOLUNTEER SERVICE ..................................................................................................... 56 SWSLHD RADIATION ONCOLOGY ......................................................................................................................... 59 SWSLHD CANCER INFORMATION PROGRAM .......................................................................................................... 73 SWSLHD ADMINISTRATIVE SUPPORT REPORT ......................................................................................................... 77 SWSLHD ALLIED HEALTH ................................................................................................................................... 81 MACARTHUR CANCER NURSING SERVICE ................................................................................................................ 95 LIVERPOOL CANCER NURSING SERVICE ................................................................................................................... 98 LIVERPOOL 5C HAEMATOLOGY WARD / APHERESIS UNIT ......................................................................................... 102 BANKSTOWN NURSING SERVICE .......................................................................................................................... 104 CANCER CARE COORDINATORS ........................................................................................................................... 105 ONCOLOGY PHARMACY ‐ LIVERPOOL .................................................................................................................... 110 ONCOLOGY PHARMACY ‐ MACARTHUR ................................................................................................................. 111

COMMITTEES, PROJECTS & PROGRAMS .................................................................................................... 114

SWSLHD CONSUMER PARTICIPATION COMMITTEE ................................................................................................ 115 SWSLHD EDUCATION COMMITTEE ..................................................................................................................... 117 STAFF EDUCATION & DEVELOPMENT PROGRAMS ................................................................................................... 118 SWSLHD QUALITY COMMITTEE ......................................................................................................................... 119 SWSLHD CANCER INNOVATION PROJECTS ........................................................................................................... 121

MULTIDISCIPINARY CARE: TUMOUR GROUPS ............................................................................................ 124

BREAST MDT GROUP ‐ LIVERPOOL ...................................................................................................................... 127 BREAST MDT GROUP ‐ BANKSTOWN ................................................................................................................... 128 BREAST MDT GROUP ‐ MACARTHUR ................................................................................................................... 129 HEAD AND NECK MDT GROUP ........................................................................................................................... 130 HAEMATOLOGY MDT GROUP ............................................................................................................................ 131 LUNG MDT GROUP ......................................................................................................................................... 133 NEURO‐ONCOLOGY MDT GROUP ....................................................................................................................... 135 GYNAECOLOGY ONCOLOGY MDT GROUP ............................................................................................................. 138 CARERS SUPPORT INITIATIVES ............................................................................................................................. 139

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ACKNOWLEDGEMENTS ............................................................................................................................. 140

VOLUNTEERS .................................................................................................................................................. 141 DONATIONS 2012‐2013 .................................................................................................................................. 145 VALUED EMPLOYEES OF THE MONTH 2012‐2013 ................................................................................................. 147

RESEARCH ................................................................................................................................................. 148

INGHAM CANCER RESEARCH STEERING COMMITTEE ................................................................................................ 149 COLLABORATION FOR CANCER OUTCOMES, RESEARCH AND EVALUATION (CCORE) ....................................................... 152 CLINICAL TRIALS CANCER NETWORK .................................................................................................................... 161 CLINICAL TRIALS ‐ LIVERPOOL ............................................................................................................................. 161 CLINICAL TRIALS ‐ MACARTHUR .......................................................................................................................... 163 CLINICAL TRIALS BANKSTOWN ............................................................................................................................ 166 ACHIEVEMENTS ............................................................................................................................................... 171

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Foreword South Western Sydney Local Health District (SWSLHD) provides world‐class, comprehensive cancer services including chemotherapy, medical oncology, radiation oncology, gynaecology oncology haematology and palliative care. It’s been a busy year for the District’s cancer services, with staff providing almost 112,000 occasions of service. SWSLHD is one of the fastest‐growing regions in NSW. The population is expected to reach more than a million people in the next decade, with new cancers expected to increase by 25 per cent. To ensure we meet the increasing demand for high‐quality healthcare services in the community, it is vital that we continue to enhance and develop cancer services throughout the District. Liverpool Hospital recently commenced allogeneic stem cell transplantation for cancer patients requiring bone marrow transplants from a donor and also installed a new $3.8 million tomotherapy machine to treat cancer patients with precise radiation therapy. The Macarthur Cancer Therapy Centre celebrated its 10th anniversary and BreastScreen NSW opened a spacious new clinic in Liverpool to aid the early detection of breast cancer. The District, in partnership with the Ingham Institute of Applied Medical Research continues to lead the way in innovative health and medical research. Liverpool recently became the first Hospital in Australia to co‐locate an MRI medical imaging machine in a Cancer Therapy Centre. The new $3 million MRI machine is helping radiation oncologists improve the way they plan radiotherapy treatment and will also be used to undertake cancer research. It will give researchers a foundation on which to prepare for the arrival of the much‐awaited MRI‐Linear Accelerator As we continue to improve the diagnosis and treatment of cancer through these new technologies and services, survival rates increase. Approximately 65 per cent of patients will now live longer than five years after their diagnosis, with a vast proportion completed cured of their cancer. This means our focus must shift from illness to wellness. Rather than simply treating the cancer, we are now looking at how we can support the patient and their carers once treatment is completed. Many cancer survivors have ongoing physical, emotional and psychological needs that are best treated holistically.

Amanda Larkin,

Chief Executive Officer,

SWSLHD

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The recent opening of a purpose‐built Wellness Centre at Liverpool Hospital is the first step in supporting these needs, with additional centres planned for the District. The Liverpool Wellness Centre will provide services tailored to cancer survivors including a physiotherapy room, wig library, beauty room, support and education groups, occupational therapy assessment clinics, exercise classes, psychology and social work clinics. The Wellness Centre is run by allied health staff and nursing care coordinators who provide a warm, supportive environment to support cancer survivors and their carers on their journey to recovery. We have a long history of working closely with our community and our achievements over the past year would not have been possible without their support. The community played an important role in the fundraising, planning and development of the Wellness Centre and we value their contribution. I am proud of our accomplishments and would like to thank the Cancer Services team, led by Professor Geoff Delaney, for their invaluable contribution to providing such a high level of care to patients throughout the District.

Ms Amanda Larkin Chief Executive

South West Sydney Local Health District

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SWSLHD Cancer Executive Director’s Report

Our Cancer Service continues to excel in quality, diversity and innovative concepts. I hope you find this year's Report interesting and are impressed by the array and amount of quality work that occurs here. It has been another productive year, despite the pressures of an increasingly ageing population ‐ leading to a greater incidence of cancer across the Local Health District. In addition, the excellent service provided to our patients has earned us a reputation that has led to positive changes in referral patterns. I am indebted to Cancer Service staff, who work hard every day to improve the lives of Cancer Patients and their carers. It is very gratifying to see the excellent commendations made by patients and their relatives regarding the care that they have received. We continue to strive for excellence in health care and I am sure you will agree that throughout this report there are quite significant achievements. It is not possible in a brief summary to highlight all of these achievements although some of these are discussed in the next few paragraphs. The numbers of cancer patients utilising our services has increased by approximately 10% over the past twelve months. Our service is one of the larger clinical streams within the Health District, comprising 31 service responsibilities, 10 Departments and 8 different facilities. In addition, we have significant relationships with the Health Round Table, the Medicare Locals, the academic GP Unit at Fairfield and the NSW Cancer Institute. Strategic issues that affect Cancer Services are continually reviewed to promote and advocate for services, staff, patients and carers within these areas. One of the more significant achievements in the most recent year has been the development of the South Western Sydney draft Strategic Plan for Cancer Services 2013‐2015 and the Strategic Plan for Bankstown Cancer Services. In addition, the Bankstown Oncology group has contributed to the development of a Bankstown Health Service Strategic Plan. Cancer services at a Local Health District level have also had significant input into recent Strategic Plans such as the SWSLHD Strategic Priority Services Planning to 2021, the South Western Sydney Local Health District Research Strategic Plan and the Surgical Priorities Strategic Plan for the District.

Cancer Services

continues to strive for

excellence in health care,

highlighted in this report

are some of the

achievements in quality,

diversity and innovative

concepts

Prof Geoff Delaney, Director

Area Cancer Services

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Highlights Some of the highlights of the year have included:

Macarthur Cancer Therapy celebrated its 10th Anniversary of operation.

Medical Student numbers continue to rise throughout the Cancer Service, exposing a larger number of Medical Students to the experience of seeing cancer patients as inpatients and outpatients.

We also continue to provide education for nursing, radiation therapy and allied health students.

A number of fundraising activities have been successful throughout the year. The Macarthur Cancer Therapy Centre participated in Dry July for the first time and Liverpool completed its 3rd year of involvement. In addition, the 24 hour fight against cancer continues to support the Macarthur Cancer Therapy Centre, Camden Palliative Care and the Inpatient Oncology Unit. This group has raised more than $1.5 Million in seven years which is an outstanding effort for the local community. An increasing number of other fundraising activities have occurred throughout the year and are listed in the Annual Report. We are grateful to the community for their generous donations of time, effort and money.

There has been a steady increase in the amount of positive feedback received by staff and patients.

The Consumer Advisory Committee continues to progress with increasing numbers of patients and carers being involved in this initiative. The most exciting project that this group is currently involved in is the development of a Wellness Centre Plan.

The two Wellness Centre projects (building works at Camden and Liverpool) have undergone steady progress throughout the year including the development of a Design Brief and discussion with possible Vendors about the building of these projects. Our Fund Raising Manager, Anne‐Marie Curry, has commenced and a strategic fundraising plan will include a very strong emphasis on the Wellness Centre projects.

We have increasing engagement with other cancer groups such as the NSW Cancer Council and CanRevive, and have re‐engaged with CINSW initiatives such as CanRefer (service directory) and EViQ (treatment guidelines).

The Inpatient Palliative Care Unit for Liverpool hospital commenced operation in April 2013. It was officially opened by the NSW Minister for Health in July 2013.

The Multi‐Disciplinary Tumourgroup Coordinators have continued to work tirelessly to improve the processes within the Multi‐disciplinary teams. This is in addition to a review of current process and an attempt at streamlining and standardising some of the systems and documentation. This has been a very difficult exercise due to the different needs of the Multi‐disciplinary groups and this project will enter it’s implementation phase throughout 2013.

There have been a number of projects that have received NSW Cancer Institute grants. I am particularly indebted to Ms Sandra Avery for her dedication to developing our Quality Improvement Plan in conjunction with NSW Cancer Institute and in coordinating the Grants.

A number of the projects that have emanated from this have included provider assessments of the specific needs of Aboriginals with cancer,

Sandra Avery,

Cancer Systems

Innovation Manager

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development of pathways for improved GP/specialist communication and the development of programmes to improve the collection of data regarding patient reported outcomes.

The Australian MR Linac Project continues to develop with an increasing portfolio of sub‐projects emerging in preparation for the delivery of the Magnet and the Linear Accelerator which is due in late 2013/early 2014.

Work continues to progress for the planning of a Phase 1 Clinical Trials Centre at Liverpool Hospital.

Key Performance Indicators The new Strategic Plan for Cancer Services for 2013‐2015 will be available on the Cancer Services Website, at http://www.swslhd.nsw.gov.au/cancer/This has been an initiative sponsored by the Cancer Institute to strategically develop Cancer Services across NSW. I am thankful to all the staff and consumers who had input into this Strategic Plan. An overview of the budget, expenditure, staffing and patient attendance comparisons for the last 10 years can be found in the Business Unit section of this report, and a number of key performance indicators will be developed as an ongoing strategy to improve our service. Some of these will include:

Raise the profile of the services, to improve appropriate referrals/access

Reduce treatment waiting times

More timely information for patients and GP’s following treatment

Improved documentation of MDT care plans

Increase in Clinical Trials recruitment

Research and Education The SWSLHD Cancer Services Strategic Research Group continues to work towards coordination of research efforts throughout the Local Health District. A grant received from the NSW Cancer Institute to develop a Translational Cancer Research Unit (TCRU) provides funding for this group. There are important initiatives underway to systemise the collection of patient consent, data and tissue so that a large data base of all cancer patients undergoing patients in South Western Sydney is maintained. This has taken considerable work and I am indebted to a number of staff that were involved in this initiative particularly Professor Paul DeSouza who is the leader of this project and Mr Norbert Kienzle the TCRU Manager. We are also appreciative of the efforts of Professor Soon Lee and Nicole Caixeiro for their work in increasing Biobanking for tumours that have been resected at South Western Sydney. The main initiative that this group has developed is what has been referred to as the “Flagship Project” which will be piloted in colorectal cancer and will attempt to recruit patients at diagnosis and develop techniques so that we can collect patient reported outcomes, blood and tissue and attempt to correlate each of these in a way that drives clinical decision making in the future. The Illawarra and Shoalhaven Local Health District Cancer Service (ISHLHD) officially joined our TCRU and discussions are progressing well for the first joint initiative to be progressed through the latter half of 2013. Led by Professor Afaf Girgis, this NSW Cancer Institute‐funded study seeks to develop electronic means for the routine collection of patient reported outcomes at various times in the patient journey.

Nasreen Kaadan,

Cancer Information

Manager

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This is a very important project that will streamline the collection of data, made available to clinicians in real time in order to act upon any variations in patient status. We look forward to seeing progress of this study which has been in development for the past few years. The SWSLHD Clinical Cancer Registry continues to gather data on all cancer patients diagnosed or treated in South Western Sydney. Credit goes to Ms Nasreen Kaadan and her staff for their tireless efforts in streamlining data collection and providing an excellent reporting service to the Multi‐Disciplinary groups with respect to patients discussed in their clinical group. The Australian MRI Linac Project has progressed successfully. The building has been officially handed over to the Ingham Institute and we are currently awaiting the delivery of equipment, including a custom designed magnet from Japan and a Linear Accelerator. In the meantime, the Radiation Oncology Department has taken delivery of an MRI simulator to start the assessment of the use of MRI in radiotherapy planning and treatment delivery. This project is a very exciting initiative and we have already started to see some excellent studies come from this group. Due credit to Professor Paul Keall and his group for their ongoing efforts. There are a large number of grants received by the members of South Western Sydney Cancer Service that are listed throughout this report and I congratulate each and every one of them for their efforts in getting these projects off the ground. These grants provide a continued high level of productivity to occur throughout our service. A number of amazing Awards have occurred throughout 2012/2013 and these are listed on page 163 Of particular note were the awards received by Associate Professor Meera Agar who was awarded The Early Researcher Award at the European Association for Palliative Care in Prague for her project “A Study of Delirium”. Professor Afaf Girgis was awarded the Inaugural COSA Australian Pyscho Oncology Award for Excellence in Pyscho Oncology Research. The number of awards received by staff was substantial over the past 12 months and I congratulate all of those that were nominated or awarded the various different awards.

Challenges

The NSW Cancer Institute recently published data to show that NSW has one of the best cancer survival rates in the world. While this is very pleasing, it also creates some challenges with respect to the increasing need for long‐term follow‐up of cancer patients, especially support for those who have ongoing problems related to the original disease or its treatment. A growing body of evidence supports wellness and survivorship programmes for cancer patients. This is challenging because of the increased number of patients that will need this type of care. Strategies that we are hoping to grow, include development of new models of care for Wellness & Survivorship, adopting a systematic approach to ongoing patient needs, assistance for general practitioners to provide long‐term supportive care, and improved communication with primary health care practitioners.

Jayne Robinson,

Clinical Manager

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Future Projects/Expansion of Services There are a number of initiatives that we will continue to work on over the next few years. These include:‐

The development of Wellness Centres at Camden and Liverpool .

The continued streamlining and expansion of research throughout the South Western Sydney Local Health District

The development of models of care that include systematic collection of patient reported outcomes, tissue and blood.

Multi‐disciplinary Care Coordination with consistent models of care

Advocate the need for growth of comprehensive, integrated Cancer Centres at Liverpool, Bankstown and Campbelltown.

Redevelopment of our website at http://www.swslhd.nsw.gov.au/cancer/

Liverpool Hospital plans for celebrating their 20th Anniversary in March 2015.

Launch a fundraising campaign with a new brand for SWS Cancer Services

Staffing Cancer Stream Director Professor Geoff Delaney Cancer Services Innovation Manager Ms Sandra Avery Cancer Information Program Manager Ms Nasreen Kaadan Clinical Manager Ms Jayne Robinson Executive Assistant Ms Caryn Knight Administrative Assistant Ms Melissa Carmagnola

Professor Geoff Delaney Director

Liverpool Cancer Services

Caryn Knight,

Executive Assistant

Melissa Carmagnola,

Administrative Assistant

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FACILIT

Y R

EPORTS

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Bankstown Cancer Therapy Centre Director’s Report

Bankstown oncology provides Outpatient Clinics and inpatient consultations for Medical Oncology, Radiation Oncology, Haematology, Palliative Care and Gynae‐Oncology as well as allied health services including Social Work, Dietetics and Clinical Psychology.

Highlights

We were pleased to facilitate the inaugural Bankstown Cancer Services Planning Day forum in December 2012 at Bankstown Sports Club. It generated a lot of enthusiasm, and some strategic and visionary goals that we will present in a strategic action plan for endorsement by our executive team. This plan will assist to align our service directions in a co‐ordinated and agreed way. We have successfully implemented the ASCO Colorectal Survivorship plan, that helps survivors understand their risks and plan for the future, and assists us in pro‐actively managing the increasing burden of follow‐up care. As a growing service, we have established some new positions this year, including a Palliative Care CNS and an Advanced Trainee in Medical Oncology.

Key Performance Indicators

Outpatient activity for Bankstown Cancer Centre in 2012/13

Specialty Consultations Treatment attendance

Haematology 636 196

Medical oncology 2990 3762

Radiation Oncology 632 n/a

Palliative Care 26 n/a

Gynae‐Oncology 97 n/a

4381 3958 Some of the quality activities that continue at Bankstown, include;

Multi‐disciplinary approach to planning cancer treatment, with local specialty groups established for Upper Gastro Intestinal, Colorectal, Breast and Lung Cancer. In addition to regular M&M review meetings, these improve clinical care.

Patient Satisfaction Surveys are administered and monitored regularly to evaluate our patients’ needs. This includes an electronic patient experience tracker device, to compare our patient experiences with other cancer facilities in the local area.

Chemotherapy consent forms have had better responses, with the production of improved patient education materials.

Funding for Clinical Trial Pharmacist has been approved, to assist with developing new & improved chemotherapy protocols.

Oncology nursing have accessed ADAC courses for skill development.

Dr Ray Asghari, Director,

Bankstown Cancer Centre

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We have implemented a systematic phone follow up to our chemotherapy patients, which has reduced unplanned admissions, and prevented some patients having to go to hospital.

A medication safety self assessment group has been established to pro‐actively prevent medication errors, and have been involved in the development and implementation of chemotherapy dose change forms.

Research and Education

The 2 person Clinical Trials unit at Bankstown has commenced a new trial in Breast Cancer, bringing the current open trials to 30. Our service provides teaching at all levels, including Medical Students, RMOs Basic Physician Trainee, AT, Palliative Care students

Challenges

Although we have a Radiation Oncology consultative service, there is no onsite radiotherapy service, so patients are required to go to Liverpool for treatment. Palliative care inpatient services are minimal, and our supportive nursing and administrative staffing is critically low. We are negotiating transfer of Haematology medical services from a Concord outreach service to a closer, Liverpool hub‐spoke consultative service. This will place more pressure for space on our small facility.

Future Projects/Expansion of Services

We expect to have an additional basic physician trainee soon for Palliative Care, to assist with our inpatient load, as well as a new Oncology Medical Student from UNSW. We will work towards additional Chemotherapy chairs to better meet the increased demand for treatments, including treatment of patients with malignant haematology conditions that are currently sent to concord for this service. With this will be the required staffing to provide the service. MOSAIQ is an oncology‐specific electronic medical record, that helps with the quality of records and management of patients. The system is used in other local cancer facilities, and rolling this system out to Bankstown is a priority for the LHD cancer services. Despite the space restrictions, we plan to development Cancer survivorship programs, leveraging off the LHD plans to build Wellness & survivorship centres. Allied Health Clinics provide important continuity of care, and we propose to expand these in the near future.

Bankstown Cancer Centre

Staff

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Liverpool Cancer Therapy Centre Director’s Report

The Liverpool Cancer Therapy Centre provides cancer treatment for patients in the Liverpool Area, as well as providing haematological outpatient treatment delivery for the South Western Sydney Local Health District. We have two inpatient wards (5C) and the newly opened 4C (which is being developed as an Inpatient Palliative Care Unit). We saw approximately 2,000 new patients in Radiation Oncology and Medical Oncology in the past 12 months. We provide Outpatient Services for approximately 270 Outpatient Clinics per week.

Highlights We continue to have increasing demand for treatment services. The reasons for this include the growth of the Liverpool population, the ageing of the population, the increasing survivorship from cancer and the more prolonged and complicated treatment regimens that have developed for some cancers. In addition, as referring doctors are increasingly happy with the services provided we have successfully reversed some pre‐existing outflows to other hospitals, which is pleasing. The Care Coordinators have worked on developing models of care that systematize the education and collection of information from cancer patients and carers regarding their ongoing needs. Our Allied Health Service have also provided excellent ongoing support. Resource constraints have meant that they have worked together to develop models of care that allow the use of group educations sessions and group therapy sessions in a way that we maximize care for the largest number of patients. The opening of the Inpatient Palliative Care Unit has been looked forward to for the past few years. The Minister for Health officially opened the Unit in July. It is purpose‐built for palliative care and includes a dining room for patients and their families, a nice balcony and a large proportion of rooms are single rooms. Credit goes to the palliative care team, the newly recruited nursing staff and especially their Nursing Unit Manager, Sonya Green. This will enable the Unit to be used in a way that allows patients to be nursed in a systematic palliative care way with specialist palliative care medical and nursing staff input. The palliative care service has grown significantly over the past few years and not only provides excellent palliative care for cancer patients but also an increasing proportion of non cancer patients. An Allogeneic Bone Marrow Transplantation service has commenced at Liverpool Hospital and I am indebted to the Haematology Group, and the Nursing Unit Manager of 5C Mr Aaron Manson, for the development of this service. We also recently had the news that the position of Professor in Haematology, a jointly funded position by the South Western Sydney Local Health District and the University of NSW has been accepted and we will now go through the process of appointment.

Professor Geoff Delaney,

Director, Liverpool Cancer

Therapy Centre

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The Medical Oncology Group has undergone growth throughout the year reflecting their need for additional medical service. In addition, the Chemotherapy Nursing contingent has also increased in number to cope with the increasing demand. I thank all of the staff for enduring a difficult year of growth. The growth in chemotherapy treatments this year has been very large and very rapid, so these staff deserve particular recognition. In Radiation Oncology we saw the delivery of the Tomotherapy Unit which is the first of this type of technology to be used in NSW and only the second Department in Australia. This will allow particularly focused radiotherapy to be delivered for specific clinical situations. In addition, we took delivery of an MRI Simulator which makes us the first department in Australia to have a dedicated MRI scanner for the clinical planning of patients within a Radiation Oncology Department. The MRI scanner will also enable us to strengthen our research programme in the use of MRI in Radiotherapy treatment delivery. This will complement the Australian MRI Linac Project. A special thanks to all of our hard‐working staff and volunteers. It always amazes me the quality of the staff that work within such a potentially stressful environment as Cancer. Having said that, the rewards to staff that we get from our patients appreciation keeps us working towards our goal of providing high quality care. I would like to particularly thank those staff that work “behind the scenes” who maybe don’t get as much recognition and acknowledgement from our patients as those that work in direct patient care. We continue to have a good working relationship with the NSW Cancer Council (including their volunteers that provide information support in our waiting rooms), our Cancer Therapy Centre volunteers, Dry July and other fundraising organizations that have helped with the tremendous fund‐raising that has occurred this year. Thank you to all.

Key Performance Indicators The activity levels for departments that run clinics in the Liverpool Cancer Therapy Centre are:

2012/13 service New F/Up Tx

Facility Liverpool

Haematology 1245 11878 2982

Genetics 165 86

Gynae Oncology 166 700

Palliative Care 137 235

Medical Oncology 725 6470 13663

Radiation Oncology 1112 4967 17099

Trials 2003

Totals 5553 24336 33744

Total facility 63633

Cancer Council

Information Centre

Tomotherapy Unit

Dry July fundraising

activies

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Professor Paul deSouza has developed a business model for the Phase 1 Clinical Trials Unit that is due to be built at Liverpool Hospital within the next twelve months.

The MRI Linac Project building was recently handed over to the Ingham Health Research Institute and we look forward to the imminent arrival of the purpose built equipment for this project.

Other projects are listed in the publications, grants and research report sections of this Annual report. Research activity continues to rise throughout the service, and what is particularly pleasing is the increasing projects that involve collaboration between departments.

Challenges

The main challenge continues to be the increasing growth in demand and the increasing complexity of therapy and the fact that we are quite space‐constrained currently. There are long‐term plans to re‐design the Cancer Centre and this will require a funding source to be identified. In the meantime we continue to work on models of care that allow us to maximise our use of resources.

Future Projects/Expansion of Services Plans are underway to develop a design for a new Liverpool Integrated Cancer Centre and then plan to seek funds to develop this plan into architectural drawings and costings. The plans will include better integration of some services that currently do not exist within the Cancer Therapy Centre, including a melanoma and skin unit and a surgical oncology unit. We continue working towards developing a Wellness and Survivorship strategic plan and we continue with the development of the Wellness Centre at Liverpool including a plan for significant fund‐raising to help fund the project. The Liverpool Cancer Therapy Centre turns 20 in 2015 and plans are developing regarding possible events throughout the year including a possible staff reunion.

Professor Geoff Delaney Director

Liverpool Cancer Services

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Macarthur Cancer Therapy Centre Director’s Report

2013 was the 10th Anniversary of the Macarthur Cancer Therapy Centre [MCTC] with ongoing growth in activity of 8% over 2012 within the Centre and the inpatient unit in Campbelltown Hospital. A celebratory dinner was held in May to mark the event and special mention should go to Denise Burns, Gail Dwyer, Satya Rajapakse and Vinod Nelson who have worked with me throughout the past ten years in the centre. The workload demand has meant limitation in available consulting and treatment space and off site options were considered but unable to be meet the integrating patient centred service required. As the initial Campbelltown Hospital building redevelopment has not provided extra space we are considering opening longer hours to avoid unacceptable waiting lists for our community and their needs in the upcoming years. Implementation of the patient Experience Trackers within the MCTC and on the ward demonstrate the high levels of patient and carer satisfaction with staff from all departments being recognised for their patient centred care, customer service, provision of education, treatment information and teamwork. Sharon Tyson and Dr Diana Adams were recognised by the Camden and Campbelltown Hospital as their Employees of the Month in April and May 2013. Our award winning Nurse Assessment Unit has been duplicated in other hospitals and the electronic cancer record work continues to be recognised by the Cancer Institute NSW. 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 continue. The Centre continues to provide medical and radiation oncology services to the Southern Highlands Cancer Centre in Bowral and clinical trial research. We provided the first Telehealth cancer clinic within Cancer Services to patients in Bathurst this year minimising the inconvenience for treatment with this service being recognised by the Cancer Institute at it’s Innovation in Cancer Care Conference in September 2012. Our commitment to education continues with attachment of nursing, radiation therapy and allied health students. Education of students in all years of the University of Western Sydney School of Medicine course continues. The increased student numbers will continue in 2014 with additional funding being made available recognising the increased work required to provide the cancer curriculum and supervising student research projects. 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. The “24 Hour Fight Against Cancer, Macarthur” event was held again in October 2012, raising $302,000, supporting the MCTC, Camden Palliative Care, Paediatric Ambulatory Care, the inpatient oncology unit as well as surgical services.

Associate Professor

Stephen Della‐Fiorentina,

Director, Macarthur

Cancer Therapy Centre

24hr Fight Againist Cancer

Committee, Macarthur

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This group has raised more than $1.5 million in 7 years, an outstanding effort from the local community reinvesting in their cancer service, where every dollar raised stays in the Macarthur and Wollondilly region. We are pleased that they are a foundation donor to the Wellness Centre approved to be built at Camden Hospital. Research activity continues with the set up of an independent medical oncology trials centre with Camden and Campbelltown Hospitals commencing a research committee. Our volunteers continue to provide great work and their dedication is greatly appreciated by patients, families and staff. I am thankful for the generosity of our donors and was pleased to be accepted as a beneficiary of the Dry July programme this year raising over $50,000. A special thanks to our valued employees recognised by their managers for outstanding work. The commencement of a Therapy Pets programme and free exercise programme and massages shows our ongoing commitment and innovation in complementary therapy at MCTC. The centre cannot provide the excellent service it does without the commitment and dedication of all of our staff in providing patient focused service 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 deliver our goal of delivering the best possible care to the patients, their carers and families of Macarthur, Wollondilly and Wingecarribee.

Associate Professor Stephen Della‐Fiorentina Director

Macarthur Cancer Therapy Centre

The Macarthur Cancer

Therapy Centre held a BBQ

and lamington drive to

marke the end of Dry July

MCTC Staff Photo

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CLIN

ICAL S

ERVICES

& D

EPARTMENTS

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SWSLHD Cancer Genetics The Cancer Genetics Service offers a service across both SLHD and SWSLHD. The staff of the department comprise of a clinician (Dr Annabel Goodwin) working in 0.6 FTE in Cancer Genetics, two fulltime Associate Genetic Counsellors‐ Annabelle Ng (permanent position and Camron Ebzery (a maternity relief position) who both commenced working with us in 2011. Georgina Fenton is a Senior Genetic Counsellor, who was on maternity leave from April 2011 until August 2012 when she returned at 0.4 FTE. She commenced maternity leave in May 2013 and Camron Ebzery continues to work fulltime in the department. Deborah Young is the secretary for our department and she is based at Liverpool Hospital. We attend the breast cancer MDTs weekly at both Liverpool Hospital and Royal Prince Alfred Hospital. At the meeting, we provide advice about the appropriateness of 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. 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 seeing patients referred by local GPs for assessment of their cancer risk and provide 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 Hospital. This multidisciplinary clinic is supported by: breast radiologist, Dr 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 Liverpool Hospital. Women attend clinic annually for review of imaging, clinical breast examination and to review the role for risk reducing surgery and any genetic counselling issues which may arise. There is an established High Risk Clinic 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 see these individuals annually to ensure they have access to MRI screening.

Highlights The abstracts submitted for the National Familial Cancer meeting, kConFab were accepted. Camron Ebzery gave an oral presentation regarding women diagnosed with breast cancer under age 30 who presented to the NSW Family Cancer Clinics. A poster was prepared to present the rare condition, Multiple

Above:

Dr Annabel Goodwin,

Camron Ebzery &

Annabelle Ng

Page 24 of 192

Self‐Healing Epitheliomas (MMSE). For the 2013 conference, we submitted an abstract detailing the followup of families with Familial Adenomatous Polyposis (FAP).

Key Performance Indicators Between July 2012 and June 2013, we have received 611 doctor referrals to the service encompassing both SWSLHD and SLHD, which is around a 20% increase in referrals. Around one third of referrals (198) were received in the months of May and June after the recent media publicity of hereditary breast and ovarian cancer. The genetic counsellors are required to contact all patients prior to clinic to take the family history and verify some cancer diagnoses which influence our assessment of the family. In 2012/2013, 386 new family assessments (intakes) were performed. After verification of the cancers reported in the family and obtaining relevant pathology records, clinic visits were arranged. There were 464 clinic consultations, and 307 of these were first appointments with the service. 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 (n=2) at Liverpool Hospital and RPAH (n=3). There were 280 additional phone calls with patients, either to discuss genetic test results or discuss other patient enquiries. Currently (August 2013), there are 300 outstanding referrals requiring assessment. In 2012/13, we tested 100 individuals for a heritable mutation in BRCA1 and BRCA2, and 15 received positive genetic test results, well over the required 10% threshold. Predictive genetic testing of BRCA1 or BRCA2 was arranged for 40 individuals, and 14 limited mutation searches (Ashkenazi screens) were arranged. We arranged a mutation search for 17 individuals for possible Lynch Syndrome and a heritable mutation was found for 5 families. We arranged predictive genetic testing for 10 individuals for Lynch Syndrome. Predictive testing for other rare heritable conditions were arranged for 10 individuals. Referrals for predictive genetic testing have increased by 50%, from 43 to 60.

Above:

Brad Woodard, Deborah

Young & Georgina Fenton

Page 25 of 192

Research and Education Lectures have been given to basic physician trainees and medical students across both SLHD and SWSLHD. Both associate genetic counsellors are preparing cases required for their certification, and Camron Ebzery has made her first submission of cases. We have become involved in new collaborative research projects, including a national genetics research group (ICCON) and we hope to start recruiting patients to these new projects in 2013/2014 once ethics approvals have been received.

Challenges Recent media has increased the awareness of hereditary breast and ovarian cancer in the community. Our challenge has been to manage the large number of additional referrals with a small workforce. Secretarial staff have assisted us greatly across the district, by explaining the referral process and waiting time to those who call for assessments. The waiting time to speak to a genetic counsellor has increased and there is little capacity to expand clinics at present without additional staff. We will explore options to improve access to the clinic in 2013/2014.

Page 26 of 192

Gynaecologic Oncology

The Gynaecological Oncology unit has continued to expand in response to the increasing demands of the local population in providing comprehensive care for 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. We are also providing a consultative service to patients with familial cancer syndrome and facilitate the delivery of prophylactic surgery. We have also expanded our services to include complex benign gynaecological surgery, improved pre‐invasive diagnostic and management as well as surgical cover for the busy maternity ward.

STAFFING: STAFFING: Director Dr Felix Chan Staff Specialist Dr Unine Herbst Clinical Fellow Dr Nic Georgallis Clinical Nurse Consultant Rosemary Craft Clinical Psychologist Mariad O’Gorman Social worker Kim Brauer Clinic Support Officer Therese McCabe Physiotherapist Susan Cao Data Manager Victor Ye Medical Team Registrar and students

Dr Felix Chan, Director

Gynaecologic Oncology

Page 27 of 192

Highlights It has been an eventful year as surgical history was made by Dr Felix Chan by performing the first single port robotic hysterectomy in Australia and the southern hemisphere on the 30th of August 2013. He has established the Robotic surgical program at Macquarie University, Westmead Private and Sydney Adventist Hospital. Dr Chan is also the recipient of Gold companion for Rotary Health Australia, Vocation Excellence Award and Paul Harris Fellowship 2013. Dr Unine Herbst was appointed as Staff Specialist to assist with the ever growing demand of the local health district. The appointment has lead to expansion of the outpatient services as well as increased theatre time. Dr Nic Georgallis was appointed as Pelvic Fellow and he has completed is Masters in Reproductive Health. Monthly morbidity and mortality meetings are held to discuss the management and outcomes of complex cases. A number of presentations were made to the local Rotary Clubs and Societies to increase the awareness of gynaecological cancer and to raise funds for the gynaecological oncology services. The Gynaecological Oncology Support Group has been running for approximately 10 years. It is a forum in which women who have been diagnosed with a gynaecological cancer can come and meet other women who have experienced the same or very similar diagnosis, treatment and recovery. The group is facilitated by Rosemary Craft, Clinical Nurse Consultant and Mariad O'Gorman, Clinical Psychologist. This past year has seen regular attendance by a core group of ladies with a couple of new recruits, who have been a welcome addition to our group. We have had educational presentations from Cancer Services staff such as our Senior Dietitian, Katherine Bell (Eating for Wellness), Physiotherapist, Sue Cao (Incontinence) and Occupational Therapist, Monica Vasquez, (Lymphoedema). The group has also enjoyed outings together in June and December. These outings are now self‐funded by our patients; previously we enjoyed generous sponsorship from the Kuhlmann Foundation. We have collated a booklet of recipes from our group members and each member will receive a copy at the end of the year. We're looking forward to another year ahead of support and education.

Key Performance Indicators Over the past year more than 820 patients were seen in the clinics of which 151 were new referrals. A total of 210 surgical procedures were performed of which 107 were major staging procedures for gynaecological malignancies. All surgical cases are discussed in the weekly MDT meeting.

Page 28 of 192

Research and Education As we are expanding our services the research opportunities will increase as active participation is encouraged and collaborations will be established with other disciplines and health districts. The unit is actively involved in training of pelvic fellows, registrars and medical students. We are collaborating with Anna‐Lena Lopez, PhD candidate from the University of Sydney on research entitled: Assessing the unmet needs of women with gynaecological cancers. Anna‐Lena is supervised by Professor Phyllis Butow and Dr Ilona Juraskova. The study is currently at the ethics stage of approval for Liverpool Hospital.

Challenges As we are currently expanding our service we are facing challenges, but with the dedicated staff and continued support from the other disciplines and the community we will work hard to overcome them. These include data capturing, research effort, training and certification requirements of fellows, staffing and that the demand exceeds our current service delivery.

Future Projects/Expansion of Services We would like to increase our research effort and expand our services with the establishing a gynaecological oncology training unit as well as improvement to the current coloposcopy service.

Lynda Chamberlain, Dr Felix Chan and Catherine Potter with the

new equipment donated by the Eggtober Foundation

Page 29 of 192

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 2012 – 2013, we have been fortunate in attracting more staff to our unit. In 2013, Dr. Bavanthi Balakrishnar joined us from Westmead Hospital, where she worked as a Research Fellow, and prior that, medical oncology training at the St George and Prince of Wales Hospitals. We also welcomed back Dr. Eugene Moylan, after he spent 2007‐2012 in Ireland working as a medical oncologist. Both are part‐time staff specialists. In addition, we welcomed Drs. Stephanie Lim, Annette Tognela, and Sumit Lumba, all third year medical oncology trainees acting as Fellows in the department. Continuing members of the department include Drs. Weng Ng, Wei Chua, Victoria Bray, Kelly Mok, Michelle Harrison, and Prof. Paul de Souza. I am very grateful to all the nursing and administrative staff who continue to play a major role in keeping a medical oncology service running during the last couple of years. 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 2012 – 2013, the rate of increase in chemotherapy treatments slowed somewhat, due to a temporary shortage of nursing staff for a significant period. However, the waiting list has dramatically improved over the past 4 months and patients now do not have to wait more than about a week for treatment. We share an inpatient ward (4C) with the radiation oncology and palliative care departments, but most of our inpatients are housed in other wards in the hospital. 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 rotates services with the other trainees, and provides extra services to inpatients, the Private Hospital and Bathurst Hospital one day a week.

Key Performance Indicators Chemotherapy administrations reached over 8000 occasions of service in 2011 (see Figure), but have stabilized at just under 8000 over the last couple of years due to chemotherapy nurse staff shortages. In 2011/12, there were 7540 treatments, and in 2012/13, there were 7689 treatments.

Federal Government

has granted for an extra

medical oncology advanced

trainee position

Professor Paul De Souza

Director of Medical Oncology,

Liverpool

Page 30 of 192

Research and Education In October 2012, the new Ingham Institute building was opened by the Prime Minister of Australia, Ms. Julia Gillard. The Institute houses laboratory facilities, a clinical skills laboratory, and office space for health service researchers and clinical trials coordinators and research nurses. Our clinical trials unit continues to suffer from lack of staff due to recruitment issues, 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. In 2013, we opened a first‐in‐human Phase I clinical trial of a novel c‐Met inhibitor, and a second first‐in‐human Phase I clinical trial is about to open for recruitment at the time of writing.

The medical oncology department continues to run a laboratory in the new Ingham Institute building, and our plans are to increase our basic and translational science capabilities. In late 2012 and early 2013, we were fortunate to obtain grant funding from the University of NSW and from the Prostate Cancer Foundation of Australia to fund a Circulating Tumour Cell (CTC) machine as well as associated equipment. This machine will enable us to add value to any clinical trial we perform, and also allow us to investigate the basic biology of how cancer cells metastasize. All three of our Fellows have written reviews for publication as well as clinical trial protocols for various cancers that will test the utility of detecting CTCs. Ethics approval for our first study has been recently granted. Other translational research projects have commenced and we are working with many other researchers and departments. Dr. Stephanie Lim was successful in obtaining an Australian Postgraduate Research Scholarship that will fund her PhD beginning in 2014.

Chemotreatments by year (up to 30April 2011)

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Series1 4518 4618 5161 5679 5379 5679 8585 8949

03/04 04/05 05/06 06/07 07/08 08/09 09/10 10/11

Julia Gillard at the opening of the

new Ingham Institute building

Page 31 of 192

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 train and keep 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: 1) Relocation of the department offices back to the Cancer Centre, which

would most likely increase the efficiency of the department. 2) Establishment of a Phase I clinical trials unit. 3) Increase of patient recruitment for clinical trials. 4) Establishment of a translational research group to enhance bed‐to‐ bedside,

and bedside‐to‐bench as well as evidence‐to‐practice research. 5) Develop a more robust training pathway to allow trainees to develop their

teaching and research skills in parallel to their clinical skills 6) Establishment of a named quality improvement project each year.

Establishment of Phase 1

Clinical trials unit and

translational Research Group.

Page 32 of 192

Medical Oncology Macarthur

The Department of Medical Oncology, Macarthur Cancer Therapy Centre, has continued to grow. The service saw 633 new patients, a similar amount to the previous year, 6298 follow‐ups in clinics and the Oncology Ward and 6363 chemotherapy occasions of service, an increase of 15%. Dr Belinda Kiely was awarded a PhD in “The art of oncology: communicating survival expectancy to patients with cancer” and Dr Po Yee Yip was awarded the award at the Medical Oncology Group of Australia for her current thesis in “Phosphorylated –Akt expression is a prognostic marker in early Non Small Cell Lung cancer”. We provided the first Telehealth cancer clinic within Cancer Services to patients in Bathurst this year. 2013 saw the commencement of a four hospital advanced training network with the addition of St Vincents and Bankstown Hospitals to Macarthur and Liverpool. We have seen our past physician trainees make the transition to advanced trainees indicating the quality of teaching provided within the LHD. 2013 saw the commencement of a clinical gastrointestinal cancer fellow working also at the Clinical Trials Centre in Sydney, Dr Chantrill has led this important clinical position to enhance training in these malignancies. Dr Diana Adams leads the program of lifestyle changes after cancer diagnosis and promotes the survivorship issues of our patients. Longer terms at MCTC this year has been well received and has enhanced the advanced trainee program. 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 saw 174 new patients and 1262 follow‐up patients seen and 1306 chemotherapy occasions of service delivered. This was a reduction in previous years due to my extended leave in late 2012. The clinical trials unit is expanding to run trials in pain, lung and colorectal cancer. The medical oncologists continue to be the major educators of the University of Western Sydney Medical School with many of their 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. This work has been recognised with a funding enhancement of a clinical senior lecturer to commence in 2014. Publications, presentations and invitations to lecture have increased. The Macarthur unit continues to innovate with our Nurse Assessment Unit being adopted at other hospitals and other disciplines. We continue to lead in the electronic cancer record and paperless chemotherapy prescribing and maximising data collection for patient reported outcomes and Activity Based Funding. We remain a resource for cancer units in Australia 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.

Medical Oncology staff at

Macarthur

Page 33 of 192

SWSLHD Haematology The Haematology Unit provides both clinical and laboratory services to South Western Sydney LHD. Inpatient services are based at Liverpool Hospital with clinics at both Liverpool and Campbelltown Hospitals. It is anticipated that clinics will be provided by our unit at Bankstown Hospital from 2014 in place of the service provided by Concord Hospital. Medical staffing consists of 10 Haematologists and 7 Advanced Trainees. Senior nursing staffing includes three Clinical Nurse Consultants (CNC), one Clinical Nurse Educator, two Clinical Nurse Specialists 2 (CNS2), and three CNS I. The unit provides a range of services covering haematological oncology, thrombosis and haemostatic disorders, haemoglobinopathies and general consultative haematology. Autologous stem cell transplantation has been provided for twenty years and matched sibling allogeneic blood and marrow stem cell transplantation (BMT) was successfully initiated in 2012 and is anticipated to rapidly expand.

Highlights The development of an allogeneic BMT service over the last two years has been an exciting development for the unit. This has occurred under the leadership of Anne‐Marie Watson, in conjunction with Lindsay Dunlop and Adam Bryant (Haematologists), Gai Fairnham (BMT Coordinator), Alana Paterson (BMT CNS2), our Apheresis Unit Staff (Julie Stone and Sinuu Seuala‐Talagi), Aaron Manson (Nursing Unit Manager), Sara Hitchcock (Chemotherapy Coordinator), Vinita Agarwal (BMT Scientist) and numerous other scientific and nursing staff. We are very pleased to welcome Alana Paterson (CNS2) and Kim Sharkey (RN) to the Ambulatory Haematology Unit (AHU), which we see as a major enhancement and increasingly important part of our unit, under the leadership of Tania Luxford (Nursing Unit Manager, Cancer Therapy Centre). The AHU has increased our capacity to treat patients requiring intensive support as outpatients. Karl Jobburn (CNC) has contributed significantly to the development of our clinical trials capacity and our transition to electronic prescribing in Mosaiq. Penelope Motum (Haematologist) and Karl Jobburn (CNC) developed an obstetric haematology service which is important in an area with a large obstetric population. Samantha Day (Haematologist) has established haematology clinics at Campbelltown Hospital as well as providing a consultative service. Silvia Ling (Haematologist) has received a primary health care grant of $50,000 from the Cancer Institute NSW for a research proposal to improve cancer outcome and survivorship through primary health care.

Allogeneic stem cell

transplantation was

successfully initiated in 2012

and is anticipated to rapidly

expand.

Assoc Prof David Rosenfeld

Page 34 of 192


Research and Education The university of NSW has recruited to the position of Professor in Haematology at Liverpool Hospital and we are optimistic that the successful candidate, who has directed a large overseas BMT unit, will commence in this role in early 2014, contributing both to the academic output of the unit and the development of the BMT service. Clinical trials remain an important component of our unit and we welcome Vinodini Onawale (CNS1) and Karina Chui (CNS1 at St George Hospital) who have joined us this year as clinical trials nurses. Karina Chui comes from St George Hospital where she has extensive experience as a Clinical Nurse Specialist (Research) in the Clinical Trials Unit. Two of our Advanced Trainees, Riton Das and Paul Downe successfully sat the Fellow of the Royal College of Pathologists Australasia (FRCPA) Part 1 examinations. Silvia Ling (Haematologist) leads an active research group with projects in the area of myeloma, multiple myeloma, lymphoma and the use of next generation sequencing in acute myeloma leukaemia. Abby Krige (Care Coordinator) and Racheal Curry (Social Worker) has established a weekly survivor clinic for Lymphoma patients who have completed treatment entitled the ‘Living Well Clinic’. They have had very positive verbal feedback and are currently working in partnership with Ingham Institute for Research to evaluate this service. Ingham Institute has also commenced a research study which involves Haematology patients and explores the information needs and information seeking behaviours of the patient and their carers from diagnosis onwards. This is a very exciting study as little research has been done for this group of patients in this area.

Activity for 2012 calendar year

Page 35 of 192

Challenges The demand for haematology services at Campbelltown and Bankstown Hospital will put pressures on the unit in terms of staffing and resources. The resumption of clinics at Bankstown Hospital when Concord Hospital withdraws from providing these at the end of 2013 will be a major challenge, and we hope to appoint a haematologist to Liverpool and Bankstown Hospitals in the second half of 2013 to develop this service. Pressures on inpatient bed access have provided an imperative to develop alternative models of outpatient care for patient groups that we have historically treated as inpatients. As the allogeneic stem cell transplantation service expands, there will be increased requirement for a range of supportive services and cross‐specialty consultation.

Future Projects/Expansion of Services Penelope Motum (Haematologist) and Abby Krige (Care Coordinator) are coordinating the development an ambulatory service for venous thromboembolism, which is a common problem in both patients with cancer and the general medical and surgical populations and will potentially reduce the requirement for inpatient admission for this large group of patients. Penelope Motum, Danny Hsu (Haematologist) and Karl Jobburn (CNC) are developing the thrombosis and haemostasis service, and we hope to obtain the status of an affiliated haemophilia centre in 2014.

Page 36 of 192

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

Nursing Admn Dermatologist VMO Registrars IMG

4 FTE 3 FTE 1.2 FTE 2 2 FTE 1.00

Highlights Reaccreditation Site Inspection for Trainees on 24th Oct 2012‐ Two provisos & one recommendation Quality Award – Skin Cancer MDT Clinic – One point of care CNS Nanette Lock winner of award at Australian Dermatology Nurses Assoc Conference held in May 2013 Successful funding for 24 months for IMG STP Review of clinics, referral triaging guidelines

Key Performance Indicators Data collection – Patient surveys – positive feedback Clinical audits – consents, use of interpreters, infection rates

Liverpool Hospital Dermatology Consults July 2012- March 2013

221

287 4 4 1

265

0

50

100

150

200

250

300

Live

rpoo

l

Banks

town

Fairfield

Cam

pbellto

wn

Cam

den

Nursing

Hom

e

Total

Consults

Page 37 of 192

Dermatology Time to assessment Triage

July 2012 - March 2013

0 1 2 3 4 52

58

21

89

22

436

46

30

64

2 2 1 0

12

1 0 0 1 00

10

20

30

40

50

60

70

80

90

100

1 2 3 4 5 6

Time to Assessment Triage Time to Assessment <24 Time to Assessment <48 Time to Assessment <5days Time to Assessment >1wk

Dermatology Department Clinical Indicators Procedures

Sept 2012- Feb 2013

55 72 8944 41 59

360

1 0 1 1 2 1 60 0 1 0 2 0 30 0 0 0 0 0 00

50100150200

250300350400

Sept Oct Nov Dec Jan Feb Total

Number of procedures Number of reported infections Oral Anitbiotics Admission

Dermatology

11

12

8

02468

1012

01/07/2012- 01/02/2013

use of Interpreters Mandarin Cambodian Vietnamese

Page 38 of 192


Align Study

Psoriasis Registry

Education

Clinical meetings

Grand Rounds

Annual meeting 2013

SWAPS Histopathology tutorial

Challenges

Minor refurbishments – painting and replacement of furniture

Recruitment to Admin positions – delays with approval


Submission sent for hard copy flow sheets to electronic & Databases

Digital images to interface with Power chart – awaiting >2 years

Workforce – Recruitment of Dermatologists

Establishment of Chair of Dermatology

Teledermatology

Resources enhancements – submission to enhance the Service

Revenue generation – Admin support

Consultations for patients arriving on stretchers seen in Main Hospital

Activity Based Funding

Page 39 of 192

SWSLHD Palliative Care

The SWSLHD Palliative Care Service comprises staff with LHD roles based at Braeside Hospital who work with all sites/ facilities across the district. The service is fortunate to be accommodated at Braeside which has enabled a strong working relationship to develop, not only with the palliative care service, but with Hammondcare Executives. Strong partnerships have also developed with the Clinical Trials team and the Bereavement Coordinator, who provides a district approach for counseling, information and memorial services. The Area Palliative Care team includes: Janeane Harlum, Area Manager and Service Development Patricia Rebello, Administrative Officer Therese Smeal, Area Nurse Coordinator Nicole Girotto, Project Officer James Nguyen, Data Manager Arlene Roache, Volunteer Coordinator The Area Palliative Care Service works within the Cancer Stream along with all staff in consultative teams at Bankstown, Liverpool, Campbelltown and Camden Hospitals. The community stream includes specialist palliative care nursing and some allied health and works closely with Area medical staff. A strong governance model exists between Area Palliative Care and community executive in delivery of, and governance of palliative care services. Both Fairfield and Bowral hospitals have an inreach consultative service. At Fairfield this is provided by community Nurse Practitioner and Braeside Medical staff and Bowral by community CNC and Macarthur medical staff.

Highlights The COAG funded RACF consultative service was established from October 2012 to June 2013 and included Staff Specialist, Dr Elspeth Correy, CMO Dr Lourdes Tilde and a nursing position at Macarthur, Sarah Karacsony. Whilst this programe was late in starting, it achieved stronger linkages to RACF’s, specific education programs, increased consultation and care planning and enabled increasing numbers of residents to remain in their place of care for end of life care.

The commencement of the palliative care ward 4C at Liverpool Hospital in April 2013. This ward has been planned for several years and has opened due to the efforts and vision of the Hospital Executive, Dr Jennifer Wiltshire (Head of Dept) and Professor Delaney (Area Director of Cancer services) .The ward has opened initially with 8 beds under palliative care until further medical staff can be recruited. The Area service welcomes Sonya Green (NUM) and all staff of 4C Therese Smeal, Area Nurse Coordinator, was the recipient of the Palliative Care NSW Award (May 2013) for excellence in leadership. Therese was nominated by her peers and accepted her award at the State Palliative Care ceremony & dinner.

Area Palliative Care Team

Minister Skinner with Liverpool Hospital staff for the

opening of the new acute Palliative Care Ward

Page 40 of 192

Therese was also acknowledged at this years SWSLHD international nursing day awards as a finalist for nurse of the year and gave a keynote address on “The Art of Dying”.

Key Performance Indicators The 1300 number that operates through both Braeside and Camden Palliative Care units to provide after hours advice and support to registered palliative care patients and their carers has provided a total of 555 OOS during July 2012 – June 2013. The community sites continue to collect data to demonstrate care at home and where patients die. Data is collected in the palliative care EMR at Macarthur, in community health Cerner and some data is collected manually.

Page 41 of 192

Research and Education The Area service continues to participate in the clinical trials program led by Associate Professor Meera Agar and other research projects (see Braeside research report). The Staff Specialists continue to support and mentor Advanced Trainees undertaking their final research projects. Associate Professor Meera Agar has recently submitted her PhD thesis on Management of Delirium at End of Life. Aileen Collier (RN) has also submitted her PhD conducted at Liverpool and Braeside Hospitals on How People with Life‐Limiting Illness Construct ‘Safety’ and ‘Healing’‐ Results of a Pilot Study to Explore Safe Healing Environments Using Visual Methods. Charmaine O’Connor, CNC Liverpool, graduated from Flinders University Masters of Palliative Care. The Medical staff continue to contribute to undergraduate teaching, local inservice programmes and journal clubs, Registrar teaching and grand rounds. Palliative Care nursing continues to deliver a 3day workshop “the ABC of Palliative Care”, x3 per year which has seen around 70 nurses complete the course over the past year. The nursing team also provides local inservice programs and has taken increasing numbers of students this year. The Area bereavement coordinator Stefan Durlach continues to deliver a workshop several times per year on Grief & Bereavement skills for staff. A major quality initative undertaken by the service this year with a grant from SWSLHD Carers has been a project interviewing patients and carers titled “Conversations, Stories & Reflections‐What do they want us to hear?” This is being coordinated by Nicole Girotto (project officer) .Stage one of the project is nearing completion and has involved (20) patients/carers in each community setting being interviewed about their experiences. To date Wingecarribee, Macarthur, Hoxton Park are complete (a total of 60 interviews) and Fairfield and Bankstown will soon be completed. There has been good feedback for the community teams about the services provided as well as highlighted areas for improvement including after hours visiting, access to medications, ensuring discharges from hospital are referred to community health, improving general education on nutrition, equipment use, and oxygen. A major theme emerging from the interviews is the carer strain when caring for a deteriorating loved one at home. Some of this strain is now and also anticipatory as the carer worries about future care needs, end of life care, and services available to assist them. The service also contributes to the National Standards Assessment Program (NSAP) and is currently using the grief and bereavement tool for carer feedback.

Challenges By far, the biggest challenge for the palliative care service has been staffing. Over the past 12 months, there have been huge gaps in registrar staffing (from Jan 13 – June 13) there were only 5 out of 9 positions filled and despite wide recruitment strategies, we were unable to fill these positions. This was further impacted as other staff went on maternity leave.

Braeside Clinical Trials

Research Team

Page 42 of 192

Additionally, the service has struggled with Staff Specialist vacancies which has greatly impacted day to day service delivery. Nursing has also been impacted through key senior positions. June 2013 saw the retirement of Nurse Practitioner Pauline Davis from Fairfield Community who has been a valuable and highly skilled member of the team for the past 10years, and Bankstown Community CNC through maternity leave and vacant RN positions that have been difficult to recruit appropriate people to. The palliative care service continues to strive for appropriate services and resourcing for all people requiring palliative care and will require additional resources if the service is to grow to match demand especially in the community setting. As a key strategy to assist with reduced staffing in Campbelltown Hospital, a temporary RN position was established to work with the CNC and additionally Liverpool medical staff have provided much needed and appreciated additional support in Macarthur. The palliative care staff across the LHD are to be commended for the manner in which they have continued to try to deliver services despite this major staffing crisis.

Future Projects/Expansion of Services The Area Palliative Care service recognizes that if it is to deliver appropriate and timely services to palliative care patients in the future, we need to:

Expand programs into RACF with appropriate resourcing to enable timely consultation and care planning that will enable optimum care to be delivered within the facility and limit unnecessary transfer to hospital

Work with the LHD to look at appropriate facilities for those younger patients <65 years (and especially young adults) who require ongoing care and for who a RACF setting is inappropriate.

Strengthening the model of care with GPs to ensure adequate primary medical care in the community setting through stronger networking with Medicare Local

Ensure timely access to medications for patients, especially those being discharged to home for End of Life Care

Macarthur/ Wingecarribee Palliative Care service requires resources to match the growing needs of the populations, both for consultative service, access to beds and community services.

Page 43 of 192

Braeside Palliative Care

Braeside hospital 20 bed inpatient palliative care unit has a full multidisciplinary team, and had 413 admissions over the 2012 – 2013 financial year. The service also actively contributes to the community based palliative care service, with medical, physiotherapy, occupational therapy, social work, pastoral care and diversional therapy home visits. The COAG funded day hospital additional days closed on 30th of June 2013, and a new model has been developed to maintain as many of these services as possible with three days of services planned. A particularly exciting initiative is our nurse led clinic which will start in July 2013. The Lavender palliative care suite, based at our residential facility Bond House, in Hammondville continues to be a success and provides longer term care for palliative clients who need more specialised palliative care or end of life care within the aged care setting. The unit contributes significantly to undergraduate teaching hosting student placements from nursing, allied health, and medicine (both UWS and UNSW phase 1 and 2) The service is led by Associate Professor Meera Agar along with Dr Elspeth Correy and Dr Fiona Stafford‐Bell. The unit is supported by an Advanced Trainee and a trainee from a Commonwealth grant to support Day Centre, outpatients and Lavender Suite (RACF). The nursing service is led by NUM Claudette Elias‐Milan along with CNC Jenny Smith and a great team of nurses who also contribute to after hours care of patients in the community via a 1300 number to provide phone advice & support to patients and their carers.

Highlights

The service participates in the collection of PCOC (Palliative Care Outcomes Collaboration Data). Under the leadership of Associate Professor Agar, Braeside is the central point for palliative care clinical trials across the LHD, and continues to involve and develop other sites in clinical trials.


Braeside Palliative Care Unit (D204)

July 12

Aug 12

Sep 12

Oct 12

Nov 12

Dec 12

Jan 13

Feb 13

Mar 13

April 13

May 13

Jun 13

TOTAL MTHLY AVG

No of admissions to Braeside Hospital

30 44 28 31 32 23 23 28 24 30 36 35 364 30.3

No of deaths (before discharge) Braeside

24 29 20 24 23 15 16 23 13 19 29 28 187 20.8

No of discharges – Braeside

30 42 25 30 29 22 19 28 22 30 32 35 344 28.7

Total Discharges (Deaths & Discharges) BRAESIDE

54 71 45 54 52 37 35 51 35 49 61 63 607 50.6

Braeside Clinical Trials Research Team

Associate Professor Meera Agar

Page 44 of 192

FAIRFIELD HOSPITAL (D206)

July 12

Aug 12

Sep 12

Oct 12

Nov 12

Dec 12

Jan 13

Feb 13

Mar 13

April 13

May 13

Jun 13

TOTAL MTHLY AVG

Total No. of Medical Inpatient Face to face Consults ‐ Fairfield

11 22 15 26 4 4 11 5 9 9 5 9 130 10.8

BRAESIDE PALLIATIVE CARE

UNIT (D204)

July 12

Aug 12

Sep 12

Oct 12

Nov 12

Dec 12

Jan 13

Feb 13

Mar 13

April 13

May 13

Jun 13

TOTAL MTHLY AVG

No. of Day Hospital Admissions to Braeside Hospital

52 67 64 63 64 53 61 75 88 102 83 58 830 69.2

Research and Education GRANTS, PULICATIONS, AWARDS – See ACKNOWLEDGEMENTS section

Future Projects/Expansion of Services The Braeside Palliative Care Service continues to work closely with Lavender Palliative Care Suite at Hammondville‐ RACF .This partnership is providing ongoing education and clinical expertise for staff as well as high satisfaction from residents and their families. The model continues to be evaluated and this has contributed to various conference presentations about successful RACF models for Palliative Care. The Clinical Trials program will continue to develop and look for opportunities to grow access to trials for Palliative Care patients across the LHD as well as continuing with ongoing research activities.

Page 45 of 192

Liverpool Palliative Care

Part of SWSLHD Palliative Care Service

Area‐wide Model

Provides Consultative Service and clinics within Liverpool & Bankstown Hospitals and community service across LHD.

Clinics

4 sessions Palliative medical Specialists + Nursing Liverpool

1 session Bankstown Hospital ( on hold until we have admin support)

After Hours and on‐call and admitting rights for inpatient units at Braeside (20Beds) and Camden (10 Beds) and 4C Liverpool ( 8 beds)

After hours and on‐call for all SWSLHD facilities and community.

Volunteer Service

For most of 2013 have been covering clinic in Macarthur

Since Mid April 2013 have commenced admitting up to 8 inpatients in 4C

2. STAFFING: Medical Consultants – Funding for 7 FTE (for Liverpool and Bankstown) – 4.6FTE Filled

(2.4 FTE vacancy)

Dr Jennifer Wiltshire (HOD Liverpool and Bankstown)– 0.8 FTE

Dr Rebecca Strutt – 0.8 FTE

Dr Louise Elliot – 0.4 FTE

Dr Rajesh Aggarwal 1.0 FTE

Dr Amanda Fernando 0.6 FTE

Dr Thang Huynh – 1.0 FTE For most of 2013 have provided 0.4 FTE to Macarthur, leaving 4.2 FTE for Liverpool and Bankstown

Regular leave relief and cross cover across the LHD

Registrars

1 BPT

2 Advanced trainees in Palliative Medicine – networked position through Sydney Institute of Palliative Medicine.( 1FTE vacancy due to unfilled maternity leave)

1FTE resident for inpatient ward

Nursing Consult Service 1 CNC Charmaine O’Connor ( now spends majority of time on inpatient) 2 RNS,

Lesley Regalado, Naomi Ellis, Achamma Roy

Administrative Support Secretary 1 FTE Charity Earnshaw

Page 46 of 192

Highlights • Acknowledgement by the LHD to rollout the EOLCP programme initiated at

Liverpool Hospital to all facilities across the District. • Dr Jennifer Wiltshire nominated by her peers for the Palliative Care NSW

Awards in the Outstanding Leadership category (May 2013) • Charmaine O’Connor ,CNC completed her Masters of Palliative Care at Flinders

University &awarded best poster at State Palliative Care conference for her work on “implementing an education program for Niki Syringe Drivers”.


Page 47 of 192

Booking Date (referral date) to New Palliative Care Consults (1st consult)

Month Patients waiting for more than 14 days

Total Patients % LCTC Avg Wait (Days)

Sep‐11 2 9 22.2% 7.2

Oct‐11 2 6 33.3% 15.6

Nov‐11 4 7 57.1% 19.6

Dec‐11 4 10 40.0% 14.9

Jan‐12 6 6 100.0% 37.8

Feb‐12 8 12 66.7% 31.2

Mar‐12 9 15 60.0% 25.1

Apr‐12 3 7 42.9% 19.3

May‐12 9 13 69.2% 19.9

Jun‐12 5 7 71.4% 19

Jul‐12 8 12 66.7% 16.3

Aug‐12 12 19 63.2% 17.1

Sep‐12 5 7 71.4% 24.3

Oct‐12 8 15 53.3% 21.3

Nov‐12 5 14 35.7% 14.7

Dec‐12 6 9 66.7% 15.9

Jan‐13 7 11 63.6% 25.4

Feb‐13 4 17 23.5% 12.5

Mar‐13 2 13 15.4% 8.6

Apr‐13 0 1 0.0% 14

Page 48 of 192

Outpatient Clinic 2012 New patients seen in 2012 134

Follow Up Patients seen in 2012 190


The Liverpool palliative care service is involved in many palliative care clinical trials and projects (see Associate Professor Meera Agar’s report for Braeside Hospital)

Current research projects The team is involved in the following clinical trials at Liverpool

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

Hammond Care Dr Megan Best Lymphoedema Study

Commonwealth Dept of Health and Ageing

and Hammond Care

A/Prof Meera Agar

University of Newcastle (NHMRC) A/Prof Katy Clark Constipation Study

Flinders University Prof David Currow

Flinders University A/Prof Meera Agar

Page 49 of 192

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.

QUALITY PROJECTS: Implementation Evaluation and Audits of Nikki T34 Syringe devices to

Liverpool Hospital: Charmaine O’Connor, CNC

AUDIT OF CHAIN ‐ (Community health access intake Nursing): Naomi Ellis, RN Pall Care.

Implementation, education, audit of EDL Care and roll out of Pathway: Jodi Peronchik, EOLC Co‐coordinator and Dr Jennifer Wiltshire, Project Clinical lead.

Bereavement Follow up and satisfaction Survey: Gerald Au and Stephan Durlach

EDUCATION: UNSW Phase 2 & 3 Med Student

UWS Med students

Part of Sydney Institute of Palliative Medicine, organised annual Symposium

Regular BPT, AT, intern teaching

Staff Specialist Education around EOLCP

Lead site for EOLP across LHD, JW presented to all facilities and at executive and clinical levels.

Nursing and Allied health – within hospital and community

MDTs

Liverpool and Fairfield GP lectures

LHD ABC of Palliative Care course

Challenges Even with much appreciated resource enhancements, 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.

Limited access to administration staff

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. Nursing Staff on 4C already overwhelmed

Page 50 of 192

Future Projects/Expansion of Services Opening of 20 Beds inpatient unit by end 2013 staged admission plan based on

recruiting to Staff Specialist vacancies

Expanded Consultative Service developing partnerships in non‐ cancer domains such as renal, ICU, respiratory, Cardiac and degenerative conditions. Commencing Renal Palliative care Clinic July 2013

Developing paediatric and adolescent service

Page 51 of 192

Macarthur & Wingecarribee Palliative Care

The Macarthur and Wingecarribee Palliative Care Service covers an area spanning 5,756km and incorporates the 10 bed inpatient unit at Camden Hospital, outpatient palliative care clinic at Macarthur Cancer Therapy Centre, Campbelltown Hospital and consultative services to Campbelltown, Camden, Bowral and Southern Highlands Private Hospital. There are also community Palliative care nursing services at Rosemeadow (Macarthur) and Bowral (Wingecarribee) and community medical consultations available. Medical staff provide an on call after hours service to Camden, Braeside, Liverpool Palliative care units, all hospitals and registered community patients across the area. Staff specialist shortages over the last year have reduced the consultative service in Campbelltown and ability to see community consultations at times. For the period July 2012 – June 2013, there were 289 admissions to the palliative care unit at Camden Hospital. The palliative care volunteers have an active role in the Camden palliative care unit talking with patients and families, foot massages, happy hour trolley and decorating the ward for special occasions. Staff: There is funding for 2.6 FTE staff specialist/s across Macarthur Wingecarribee. Dr Jackie Kerfoot (currently working 0.6FTE) and Dr Lynne Kuwahata (0.8FTE) rotating between the inpatient unit and community. Dr Eve Lyn Tan (1FTE) commenced at Campbelltown Hospital in February 2013 as a locum for Dr Amanda Walker who went on secondments in July 2012 .Currently Dr Tan is working as a Registrar while awaiting her Staff specialist credentials. Campbelltown/ Camden nursing consultative service is provided by Colleen Carter and the Camden Palliative Care unit is led by NUM, Roberta (Bobbie) Elston and a great team of nurses, allied health and admin support staff. Advanced Trainees in palliative medicine are networked through the Sydney Institute of Palliative Medicine to provide cover for Campbelltown Hospital and the palliative care unit at Camden.

Highlights The palliative care Resource Nurse Programme continues throughout Camden and Campbelltown Hospitals and was a finalist in the NSW Palliative Care Awards this year. One of the resource nurses, Carol Hicks was seconded into the Campbelltown consultative service for 6 months to enhance the team with great success. Additionally the CNC position was covered by Michelle Forbes and Sue O’Brien from the inpatient unit during longer periods of leave.

Campbelltown Hospital

registrar Vanessa Tung, Staff

Specialist Eve Lyn Tan and CNC

Colleen Carter

Page 52 of 192

The Camden Palliative Care unit participates in the Palliative Care Outcomes Collaboration (PCOC), a benchmarking programme aiming to improve palliative care outcomes on the ward. A focus on ward staff education and improvement in the process of data collection has resulted in routine and consistent collection of information and utilization of validated tools. The COAG funded Palliative Care Day Centre operated at Camden Hospital 2 days per week over the past 18months. This service was supported by nursing, diversional therapist, admin and volunteer coordinator/volunteers who all esthetically tried to develop the Day Centre ,and most importantly provide an opportunity for patients to have a social experience while also receiving therapy. The Day Centre had few attendees and transport of patients to the centre was a limitation. The programme ceased on 30th June 2013 and all staff involved are thanked for the time, effort and enthusiasm that they brought to the patients who attended.


CAMDEN PALLIATIVE

(D205)

July 12

Aug 12

Sep 12

Oct 12

Nov 12

Dec 12

Jan 13

Feb 13

Mar 13

April 13

May 13

Jun 13

TOTAL MTHLY AVG

No of admissions to Camden Hospital

22 32 21 16 23 19 19 15 24 25 24 18 258 21.5

No of deaths (before discharge) CAMDEN

22 25 14 11 20 18 17 13 20 17 15 13 160 17.8

No of discharges – CAMDEN

23 25 20 14 22 21 19 17 25 19 18 18 241 20.1

Total Discharges (Deaths & Discharges) CAMDEN

45 50 34 25 42 39 36 30 45 36 33 31 446 37.2

CAMPBELLTOWN HOSPITAL (D215)

July 12

Aug 12

Sep 12

Oct 12

Nov 12

Dec 12

Jan 13

Feb 13

Mar 13

April 13

May 13

Jun 13

TOTAL MTHLY AVG

Total No.of Medical Inpatient Face to Face Consults CAMPBELLTOWN

65 69 73 84 116 84 31 128 129 132 132 132 1175 97.9

Total No. of Medical Clinical Phone Calls

9 13 14 9 9 13 14 12 9 8 8 8 126 10.5

TOTAL MACARTHUR

74 82 87 93 125 97 45 140 138 140 140 140 1301 108.4

Research and Education Colleen Carter, palliative care CNC has an ongoing role in the nursing in‐service programme throughout Camden and Campbelltown hospitals. She is also involved in monthly education sessions to the Resource Nursing programme and is involved in the ABC of Palliative Care Nursing Education workshops. CNC and medical staff are also asked at times to provide education sessions to pharmacy, oncology nurses and other departments throughout the hospital.

Page 53 of 192

The palliative care service presents Grand Rounds biannually at Campbelltown/

Camden hospitals. There is a regular inservice education programme on the

palliative care ward with presentations by CNC, staff specialists and visiting

speakers. There is informal and more formal teaching ongoing on the ward for

JMO by staff specialists and registrar.

Medical students from University of Western Sydney and University of NSW regularly rotate through the Macarthur palliative care service and spend time on the palliative care unit and sitting in on clinics at Campbelltown Hospital. University of Wollongong medical students spend time in the community in Wingecarribee. Nursing students from University of Western Sydney, University of Notre Dame and University of Wollongong rotate through the Palliative Care Unit throughout the year.

Challenges Maintaining the increasing demand for services in the face of population growth is an ongoing challenge. The redevelopment of Campbelltown Hospital has commenced but there are no plans for enhancement of palliative care services at this time. Staffing has been a particular challenge in the last 12 months with one of the staff specialists (0.8FTE) going on extended secondment from the last half of 2012 leaving 2.2 FTE staff specialists to cover the 3 sectors of the service and has put considerable pressure on medical and specialist nursing staff. The assistance of staff specialists from other sections of the Area, in particular Liverpool Hospital, has allowed us to maintain a service across Macarthur/ Wingecarribee and has been much appreciated. This was further impacted by Registrar shortages at both Campbelltown and Camden primarily due to maternity leave and despite wide recruitment strategies an inability to attract suitably qualified staff. Shortages in the social work department at Campbelltown/ Camden has impacted on patient care in the palliative care unit.

Future Projects/Expansion of Services The Palliative Care service in Macarthur/ Wingecarribee will participate in the roll out of the End of Life Care Plan at Campbelltown, Camden Hospital and Bowral hospitals. Recruiting to vacant staff specialist and registrar positions is ongoing.

Page 54 of 192

Bankstown Palliative Care

The Bankstown Hospital Palliative Care Service in an Area based service linked to Braeside and Liverpool Hospital. The service is staffed by: 0.8 FTE Staff Specialist Dr Rebecca Strutt (seconded from Liverpool Hospital) 0.6 FTE Departmental Secretary Sveta Mickovska 1.0 FTE Acting CNC‐ Nikki Oakley (for Anna Nicholas on Maternity leave) 0.6 FTE‐ Laurel Walter (currently a temporary position) 1.0 FTE Advanced Trainee in Palliative Medicine The service provides a consultancy service to the whole of the hospital. About half of our referrals come from the oncology department and half from other specialties. We see many patients from the Gastroenterology, respiratory, geriatric and cardiology departments. Also we see an increasing number of patients in ICU to assist with end of life care and ethical decision making. Palliative Care Outpatient clinic will resume in August 2013. The CNC and Staff Specialist also attend the Bankstown Community Health Centre case review meeting where palliative care patients, resident in the community, are discussed. We wish to improve the flow of information between inpatient and outpatient settings, to improve patient care and minimise unnecessary patient representations to Accident and Emergency. The staff specialist also does home visits where possible, but this is on an infrequent basis due to staffing levels. The oncology MDTs are attended by the staff specialist with the CNC and CNS. The nursing staff are closely involved in the transition from hospital to community, which can involve many different services and care givers. We are also supported by the Area Palliative Care volunteer program. The volunteers visits on Tuesday morning (Milan Malunec) and we have a new volunteer commencing on Wednesday morning in the near future.

Key Performance Indicators The End of Life Steering Committee commenced regular meetings in 2013 to start rolling out the End of Life Care Plan (EOLCP) in Bankstown Hospital. The project will begin on ward 2G (predominantly respiratory). The committee will be chaired by Carol Farmer (DON)

BANKSTOWN HOSPITAL (D227)

July 12

Aug 12

Sep 12

Oct 12

Nov 12

Dec 12

Jan 13

Feb 13

Mar 13

April 13

May 13

Jun 13

TOTAL MTHLY AVG

Total No. of Medical Inpatient Face to Face Consults ‐ BANKSTOWN

40 190 250 280 295 242 411 119 150 200 150 200 2527 210.6

Total No. of Medical Clinical Phone Calls Consults

160 160 150 145 140 140 130 160 130 140 130 140 1725 143.8

Dr Rebecca Strutt

Senior Staff Specialist

Bankstown Hospital

Page 55 of 192

Research and Education Education around the EOLCP is commencing on the relevant wards. Patient records are being audited as a baseline to determine the quality of care for dying patients on 2G so this can be compared with audits after the pathway has been introduced. The department has successfully recruited patients for clinical trials at Braeside hospital. We hope to involve Bankstown in more Palliative Care clinical trials in the future. The department regularly hosts medical students from UNSW and UWS, who come for placements ranging from one day to one week. The department also hosts nursing students from UWS. The feedback from the student’s has been excellent. Also several ILP students have been involved in Palliative Care projects. The CNC and CNS conduct and/or are involved in a variety of education formats such as in‐services for the wards, nursing grand rounds, ABC of palliative care and VET students. The CNC and CNS are also involved with education days for the extensive CALD population of the Bankstown area.

Challenges The service has recently appointed a secretary who is due to start August 2013. This will enable the outpatient service to resume. It will also mean that a Palliative Care database will be set up to record staff activity and patient information. It will ensure better communication between the hospital and the various community centres that provide outreach Palliative Care services.

Future Projects/Expansion of Services The temporary Palliative Care CNS position(0.6FTE) working with the CNC may become permanent if enhancement is successful with MoH Nursing and Midwifery Office .This will provide much needed support to Bankstown Hospital. If the service is to expand and provide ongoing support to community patients in a timely way then further Staff Specialist resources to the current 0.8FTE will be required.

Page 56 of 192

Above:

2013 volunteer intake

SWSLHD Palliative Care Volunteer Service 26 active volunteers continue to deliver direct patient/carer support as well as undertake promotional /fundraising activities to enhance and improve palliative care services. The volunteer program contributes much time and effort in assisting with memorial services and other bereavement activities. The service is led by Volunteer Coordinator Arlene Roache and is responsible for the delivery of volunteer services in community setting across the LHD (Bankstown, Liverpool, Fairfield, Macarthur & Wingecarribee), Bankstown &Liverpool Hospitals and Camden Palliative Care unit The LHD Palliative Care Team is grateful to be able to support and work with such a wonderful group of volunteers who give so generously of their time and expertise.

Highlights To commence pilot project for volunteer supporting patients/carers on EOLCP in Liverpool Hospital. The volunteer service and Coordinator were finalists in the NSW Palliative Care State awards in the Category of “Volunteers Supporting Palliative Care”


Statistics recorded for the period of 1/7/12 – 31/6/13 Northern Sector

Bankstown/Fairfield/Liverpool

Southern Sector Macarthur and Wingecarribee

OOS provided for palliative Care patients/carers in Liverpool Hospital, Camden Palliative Care inpatient unit and Day Therapy Centre @ Camden Hospital

976

3187

Total number of home visits in 148 57

Others (includes attendance at meetings, fundraising initiatives, writing bereavement cards, memorial service, representation on other palliative care committees)

78

336

Total number of hours in face to face visits 664 1968

Total hours travelled to provide service (not all volunteers record hours travelled)

4071.25

10958.57

AboveL Chris Leahy, General Manager,

Bankstown Hospital and staff

acknowledge the LHD volunteers during

Volunteer Appreciation Week

Above: Peter Teng, Palliative Care Volunteer with Charmaine O’Connor

Palliative Care CNC, Liverpool Hospital

Page 57 of 192

Research and Education Oral presentations at the NSW 2012 Palliative Care Conference at Dubbo by Jenny Downes, Social Worker, Braeside Hospital and Volunteer Coordinator Arlene Roache on ‘The Importance of Partnership in Caring for Carers’. As one way of providing support to carers from the LHD the Palliative Care Volunteer Service and the Palliative Care Service at Braeside Hospital organised a series of Carer Support Days. These were designed to allow carers to engage and network with others in similar situations to themselves and also to address their emotional, support and information needs. Palliative Care Volunteer Jo‐Anne Craik‐Cooper and Volunteer Coordinator, Arlene Roache gave oral presentation on ‘The Volunteers ‐ An Integral part of the Palliative Care Service’ It aimed to raise awareness of the importance of volunteers in ensuring quality care at the end of life. The presentation discussed the many and diverse activities undertaken by the SWSLHD Volunteer Service and the challenges posed by the diverse client group in the different geographical areas. It showcased that a well run volunteer service requires creativity and flexibility in responding to the needs of the palliative care clients and staff in maximising quality of life.

Challenges Significant challenge recruiting volunteers to support clients in the community and referral demand often outweighs resources available.

Future Projects/Expansion of Services Recruitment and training in process for community volunteers and volunteers to support the Liverpool Palliative Care Ward 4C.

Above: The Jolly Trolley activity at Camden

Palliative Care Unit with Margaret Fecht and Luci Rossi, PC volunteers

Above: Bunnings Narellan donate 10 Chrysanthemums for Mothers Day to support Mothers Day Lunch hosted by the volunteers for patients and their loved ones Camden PCU

Above: ‘We’re in this together’. Volunteers Lynn Harris and Heather Parkes promoting palliative care during National Palliative

Care Week in Bowral Hospital with David Ryan,

Director of Nursing

Page 58 of 192

THANK YOU TO DONORS – PALLIATIVE CARE VOLUNTEER SERVICE Anau Speizer Ben Goldstein Carlos Lara Charmaine O’Connor Daniel belle Dave Loew Flora International Janet McGregor Mrs J Watt ‐ the Bunbury Rd Biggest Morning Tea Ladies Janeane Harlum Jennifer Wiltshire Katie Carr Katie Reeve Line Dancers Macarthur

Linda Gardiner Luke Zancanaro Lucia Tumillo Luci Dall’Armi Mary Boson Matt Cochran Narellan Bunnings Narellan Town Centre Norman Conyers Simplicity Funerals Schweppes Australia Tom Lindner Thornton Brother Roses Ulysee Bike Club

Above: Volunteers Judy Smith, Pamela Bocking and Anna Muscatello at work in the Camden Palliative Care

Unit

Above: Volunteer Karisha Khalil at Liverpool Hospital, whilst Janet Perry listens to client playing the piano in the community, his wish for someone to listen to him playing.

Page 59 of 192

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, a Tomotherapy unit and brachytherapy services at Liverpool, and outreach clinics are provided at Bankstown Hospital and Bowral. New CT scanners were installed at our Liverpool and Campbelltown centres this year. In August 2013 a dedicated 3Telsa MRI scanner was installed at Liverpool Cancer Therapy Centre. This is the first dedicated radiotherapy planning MRI scanner in the country. It has integral links with the Australian MRI Linac Program based at Liverpool.

Highlights 2013 has been a year of enormous developments within our service and this has only been possible through the magnificent efforts of all staff. We were fortunate this year to get approval to install a dedicated MRI scanner for treatment planning, known as MRI Simulator. This has been a long‐term project that we have been advocating to install for some years. We are in the first phase of its clinical implementation. An important focus and commitment is to demonstrate the utility of this scanner in radiotherapy planning. It allows us to better visualize the soft tissues than a CT scanner. This MRI simulator is closely linked with the Australian MRI Linac Program described elsewhere in this report. With a lot of hard work from staff we were able to replace both existing CT simulators mid‐year in a very short timeframe to minimize clinical inconvenience. These have been replaced with wide‐bore 4D CT scanners which will allow us to scan larger patients and to quantitate organ motion. An upgraded planning system was installed mid‐year also. Multi‐disciplinary implementation teams for the new Big Bore 4DCT scanners, the MRI Simulator and the upgraded Pinnacle Enterprise computer planning system have enabled these projects to progress to the expected timeframes and become operational very quickly. With new software a new treatment technique is in the process of being installed on 2 Liverpool linear accelerators. This is known as volumetric arc radiotherapy (VMAT) and allows highly conformal treatment delivery, with a short treatment time. The Tomotherapy accelerator was commissioned in the 2nd half of 2012 and has since had great success in treating numerous patients with complex dose delivery requirements.

Dr Dion Forstner, Director

Radiation Oncology

Lynette Cassapi, Director

Radiation Therapy

Gary Goozee, Director

Medical Physics

Page 60 of 192

In the middle of this year we also commenced a limited stereotactic liver and lung radiotherapy service, allowing very high doses of radiation to be delivered to smaller areas within these organs. Dr Karen Wong was awarded her PhD thesis entitled “Estimation of the Optimal Number of Radiotherapy Fractions for Cancer Patients”, supervised by Profs Barton & Delaney. We welcomed 3 new permanent staff specialists – Dr Mark Lee and Dr Miriam Boxer at Liverpool and Dr Mei Ling Yap at Campbelltown. We also welcomed several new Radiation Therapy staff to fill the remaining enhancement positions from the Tomotherapy installation to maintain RT staffing levels at near maximum, as well as additional administrative and dietetic staff to support our service provision. We are also looking forward to filling a dedicated Radiation Oncology CNC position and an MRI Radiographer post in the near future to further enhance our profile. Our Radiotherapy Quality Improvement committee and Radiation Oncology Morbidity & Mortality meetings have continued on a monthly basis.

Within Medical Physics the team was joined by 3 new Physics Registrars. Tania Erven (nee Tehovnik) successfully completed her training programme and was awarded ACPSEM Certification.


0

10000

20000

30000

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Treatments

Year

Radiotherapy Treatments

0

2000

4000

6000

8000

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

No. o

f Patients

Year

New & Follow up Radiotherapy Patients (up to Dec 2012)

New Patients

FU Patients

Delivery of MRI Simulator

MRI Simulator after

installation

Page 61 of 192

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 59 publications and 49 conference presentations. Our clinical trials participation has continued but 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. We have contributed significantly to medical student teaching of oncology at both UNSW and UWS and continue to take Radiation Therapy students from both the University of Sydney and the University of Newcastle. Liverpool and Campbelltown Hospitals are part of the Southern NSW Radiation Oncology Training Network. Dr Dion Forstner had been the Training Network Director but has now passed this on to Dr Yaw Chin of St George Hospital. The success of the training network is a credit to Professor Michael Barton and the late Denise Lonergan. One of our trainees Dr Jacqueline Veera passed her final exams in 2012 and is now doing a fellowship with us and completing a Masters. The late Denise Lonergan was awarded multiple honours, including Supervisor of the Year by the AMA (NSW) and there was a tribute to her in state parliament by Dr Andrew McDonald. Two radiation therapy researchers, Mrs Shivani Kumar and Mrs Vikneswary Batumalai have both continued work on their PhD’s and numerous other Radiation Therapists are currently undertaking MBA’s, Masters Degrees and other postgraduate qualifications. Six Radiation Therapy graduates completed their National Professional Development Year (NPDP) with us in January 2013 and moved on to roles as fully qualified staff, some with us & some elsewhere, and three new NPDP graduates joined us.

Page 62 of 192

Challenges By far the biggest challenge we have faced in the last 12 months was the passing of our colleague, mentor and friend Associate Professor Denise Lonergan. As I indicated last year we miss her experience, wisdom and guidance very much. There are very significant challenges for us in the delivery of timely advanced radiation therapy at Macarthur Cancer Therapy Centre. The treatment machines have been operating at capacity causing stress for the staff and intermittently a waiting list for patients to start treatment. The machines are not equipped with latest onboard imaging equipment. Both machines are due for replacement in the next 12 months. Patient transport has been somewhat problematic, particularly at Liverpool and we would hope to be able to improve the access to it for our patients with support from donations and enhancement from facilities within SWS LHD. Parking for patients at Liverpool also remains a difficult problem.

Future Projects/Expansion of Services We need to work towards increasing capacity at Macarthur Cancer Therapy Centre and to replace equipment there that is now a decade old. We are developing a MRI research program under the leadership of Associate Professor Shalini Vinod. In 2014 we will be employing two postgraduate radiation oncology fellows with MRI focused research – in areas of gastrointestinal and head and neck cancers. Later this year we expect to implement a limited cranial 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. We would hope that in the next 6‐12 months the radiation oncologists offices will return to being onsite at Liverpool Hospital

Staffing

Radiation Oncologists Dr Dion Forstner Professor Geoff Delaney Professor Michael Barton Dr Allan Fowler A/Professor Shalini Vinod Dr George Papadatos Dr Eng‐Siew Koh Dr Karen Wong Dr Mark Sidhom Dr Karen Lim Dr Miriam Boxer Dr Mark Lee Dr Mei Ling Yap

Radiation Oncology Research Fellow Dr Jacqueline Veera Radiation Oncology Registrars Dr Chelsie O’Connor (on maternity leave) Dr Jeremiah de Leon Dr Eve Tiong Dr Senthilkumar Gandhidasan Dr Eunice Ho Dr Kim‐Lin Chiew Dr Alex Petrushevski Dr Andrew Oar Dr Yew Lim Cheng

Page 63 of 192

We also have Dr Dominique Lee on rotation to us from St George Hospital and Dr Vicky Chin from Prince of Wales Hospital

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 Rattanavong Kathy Andrew Isabella Franji Jim Yakobi Shivani Kumar Vicky Batumalai Carol Nguyen Melanie Rennie Skye De Gruyter Vanessa Leong Sarah Payne Judy Plante James McKay Minh Ngo Hung Nguyen Giselle Condos Joanna Falkowski Alicia Haman Cindy Hills Ewa Juresic Sarah Keats Thien Le

Cara Hart Cesar Ochoa Danielle Parrot Penny Phan Adrianna Scotti Reyna Stirton Admir Trtovac Sandie Watt Adam Zammit Carly Ballard Sarah Payne Fiona Gordon Callie Choong Glen Dinsdale Janelle Hardie Leisa Holmes Josip Juresic Lucy Ohanessian Steven Tran Aminata Bangura Josh Sams Fahim Siddiqi Tess Vuong Shirley Zhang Lara Chen Mitchell Galayini Rohan Gray Mark Udovitch Andy Lai Nicholas Livio John Park Banaz Gardawan Annie Van Ezra Kang

Medical Physicist Staffing Gary Goozée Virendra Patel Dr Lois Holloway Satya Rajapakse Dr Philip Vial Dr Sankar Arumugam Richard Short Vinod Nelson Shrikant Deshpande Aitang Xing Armia George Tony Young Tania Erven Alison Gray Jarrad Begg Michael Jameson Bradley Beeksma Daniel Truant Rosemerie Alvarado‐Barrientos

Page 64 of 192

Breast Radiotherapy Interest Group

The Breast Interest Group is comprised of Radiation Oncologists, Radiation Therapists and Medical Physics staff. The group meets monthly and is currently involved in a number of exciting projects aimed at improving service delivery and treatment outcomes for patients with breast cancer. The Breast Interest Group has a keen focus on not only reviewing policies and procedures relating to breast radiotherapy but continues to identify areas for improvement and service development through the implementation and trialing of novel equipment, treatment techniques, research and development.

Highlights This year the group welcomed on board Radiation Oncologist’s Dr Miriam Boxer and Dr Mei Ling Yap who bring fresh perspectives on breast radiotherapy to the group. Dr Boxer brings many years of experience to the team having previously worked with the service as both a registrar and a locum. Dr Yap also worked with the service as a registrar and more recently at Princess Margaret Hospital in Toronto for 2 years as a fellow, part of which was with a breast fellowship working with Prof. Anthony Fyles. We also welcomed back to the group Kylie Dundas in a research capacity funded by a Cancer Australia grant. She continues on with her keen focus on breast radiotherapy working at both Liverpool Hospital as an honorary Associate Research Fellow and the University of Wollongong as an Associate Research Fellow. There has been active recruitment of patients to both the Breast MRI study and the Breast Setup Study over the course of the last 12 months. Recruitment is near completion for this study and in October of this year, Radiation Therapist Callie Choong will present at the RANZCR Conference on behalf of the project team. A number of RT’s and RO’s are involved in the Breast Boost Planning Study that will aim to improve on current breast radiotherapy planning techniques including integrated breast boost and breast IMRT planning. A site visit to Nepean Cancer Centre is planned for later in the year. Positive changes continue with respect to patient positioning, planning processes to improve efficiencies including trialed volume based planning and the team continues to target areas for improvement and produce data that supports change for breast radiotherapy planning and future outcomes for patients.

Research and Education Trans Tasman Radiation Oncology Group (TROG) Trials:

STARS trial

DCIS study

Page 65 of 192

In‐house Projects:

Breast setup study

Breast MRI study

Breast Planning Study Other Projects

Breast Boost Planning study / Integrated Breast Boosts & Breast IMRT planning.

Challenges Breast Set‐up Study

Patient recruitment slow due to extra radiation and risk of secondary cancer.

Machine limitations i.e. gantry and conebeam for patients of large body habitus.

MRI Study

Delay in recruitment for approximately 1.5 months due to commissioning of new CT.

Limitations of MRI and CT resulting in certain patients not clearing the machine while on the prone breast jig.

Future Projects/Expansion of Services Active Breath Control for breast radiotherapy

Page 66 of 192

Brachytherapy Interest Group

The Brachytherapy Interest 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 Since November 2012, MR based planning has been implemented for all cervix brachytherapy patients. MR datasets have provided better soft tissue visualization, thus allowing the radiation oncologist to delineate high risk clinical target volumes. The team is also following GEC‐ ESTRO guidelines, by ensuring that the HR CTV receives the recommended biological dose and also recording 0.1cc doses received by surrounding organs at risk. In Aug 2013, one of our cervix brachytherapy patients was the first patient to be scanned using our in house MRI simulator.

Key Performance Indicators Implemented MR based brachytherapy planning for gynaecological cases

(previously CT based).

Implementing the use of ultrasound during cervix brachytherapy insertions, allowing for correct applicator placement & minimising the chances of uterine perforations.

Installation of MRI unit within the department, allowing for all cervix patients to be scanned using our own scanner.

Experience gained for target contouring on MR images for cervix patients by the RO group with Radiologist advice.

Moving away from ‘point based’ planning, moving towards ‘target volume based’ planning‐ prescribing dose to cover HR CTV instead. One step closer to comprehensive volume based planning with interstitial implantation technique.

Providing ongoing training to staff members to keep skills and knowledge base up to date.

Extensively updating our HDR unit emergency procedures protocol.

Research and Education Recruiting new members to join the brachytherapy team.

Updating all existing protocols.

Performing an audit for all previous cervix patients to check for uterine perforations.

Implement planning process using MR alone.

Continue to improve contouring skills for target and OAR on MR images.

Providing emergency procedures in services & mandatory training for all brachytherapy group members to complete.

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Challenges Patient referral numbers‐ at times there might be multiple patients that require

brachytherapy at the same time which can be a bit of a strain on staff & workflow; whilst at other times there might be a large gap in between patients, making it difficult for staff to keep their brachytherapy skills refreshed.

Future Projects/Expansion of Services Purchasing “Vienna applicators” i.e. interstitial applicators, which would allow

for improved dose coverage in bulkier tumours.

Utilising our brachy theatre suite, therefore allowing us to perform all procedures within the department; Would need support from anaesthetics and nursing .

Page 68 of 192

GU GU Radiotherapy Special Interest Group

The GU radiotherapy special interest group is comprised of radiation therapists, medical physicists, nursing, psychologists, social workers and doctors with an identified interest in the management of genitourinary malignancies with radiotherapy.

Highlights 2013 has been a very exciting and active year for the group with the following projects progressing or coming to completion through the year: 1. Definitive prostate IMRT protocol comprehensively updated to standardize

treatment approaches and reflect ICRU 83 recommendations. 2. Institution of daily cone‐beam CT with automatic fiducial seed registration. 3. Development of scripting in the treatment planning system to reduce the time

required to plan patients, and improve plan quality. 4. New hypofractionated radiotherapy protocol developed to treat elderly or

borderline performance patients with a shorter course of treatment. 5. Commencement of the GU Care Co‐ordinator leading to markedly improved

patient support, education and monitoring. 6. Development of the collaborative “virtual HDR” prostate stereotactic body

radiotherapy (SBRT) “Prometheus” trial protocol and submission to ethics. 7. Development of prostate MRI protocols to prepare for MRI simulation to

become a standard component of planning for definitive prostate patients. 8. Institution of labeled water bottle system to improve patient compliance with

bladder filling protocols for planning and treatment. 9. Automated GU data audit and quarterly report.

Research and Education In 2013 the GU group continued recruiting to the TROG “RAVES” trial investigating the timing of post‐prostatectomy radiotherapy. We remain one of the top 10 recruitment sites in Australia and New Zealand. The group also began recruiting to the Cancer Institute “Coping Together” trial. The Endorectal Balloon trial conducted in 2012 culminated in a number of oral and poster presentations at national and international scientific meetings. One publication from this project has been accepted in Radiotherapy and Oncology, and further publications are pending submission. The “Prometheus” SBRT trial will be a major research project in 2014, as will be the development of an MRI research program.

Future Projects/Expansion of Services Ongoing development of IMRT, scripting, SBRT, MRI utilisation

Development of VMAT

Rewrite post‐prostatectomy planning protocol

Commencement of GU specific contour and plan audit meeting

Above: Virtual HDR

stereotactic

radiotherapy dose

distribution

Above: Water bottle and

instructions for daily pre‐

radiotherapy bladder and

bowel preparation

Page 69 of 192

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 3DCBCT as well as a 4DCBCT on the first day of treatment to ensure the tumour is within the treatment field during a patients breath cycle. Any Macarthur patients for whom this technology would be beneficial are offered treatment at Liverpool. The clinicians are utilising a full IMRT technique as well as a hybrid planning technique which incorporates IMRT and 3D conformal radiotherapy to deliver better conformal radiotherapy for patients whilst minimising doses to normal tissues. The group has successfully implemented Lung Stereotactic Ablative Radiotherapy (SABR)into the department which aims to deliver higher doses per fraction and increase the biological effective dose being delivered to the tumour. The Lung Specialist Radiation Oncologists also meet weekly to audit each others lung contours to improve accuracy of tumour volume definition.

Key Performance Indicators The Thoracic Interest group meets monthly to discuss and implement current projects. The group had a Planning Day in May 2013 to review what had been accomplished in the past 2 years and set realistic goals for future direction including implementation of SABR, IMRT and 4DCT. Results from the ABC study will be presented at the World Lung Conference this year. Along with pilot data results from the Lung MRI study.

Research and Education Completed projects: 1. Active breathing coordinator‐ Comparing tumour motion measured on ABC

vs. PET vs. 2. 2. KV conebeam CT.

Current projects: 1. Adaptive Radiotherapy ‐ Determine whether adaptive RT planning allows

dose escalation and reduced OAR dose for NSCLC

Page 70 of 192

2. PET Oesophagus Study – Comparing CT only based oesophageal tumour delineation with two PET/CT based methods

3. Lung MRI study – Determine the feasibility of incorporating MRI data on lung radiotherapy and evaluate workflow impact

4. Soft tissue matching on Conebeam CT by RTs

Research accepted for presentation: 1. Watt S, Vinod SK, Dimigen M, Descallar J, Zogovic B, Ateyo J, Holloway LC,

Wallis S. Inter‐observer variability in Gross Tumour Volume Delineation on Kilo‐voltage Cone Beam Computed Tomography (CBCT) scans for Lung Cancer Radiotherapy Treatment Verification. Accepted as oral presentation, 15th World Conference on Lung Cancer, Sydney, 2013.

2. Kumar SS, Holloway LC, Koh E‐S, Choong C, Phan PDT, Vinod SK. Active breathing coordination to measure tumour motion in lung cancer patients: a feasibility study. Accepted as poster presentation, 15th World Conference on Lung Cancer, Sydney, 2013.

3. Kumar S, Holloway L, Vinod SK. Utility of MRI in Lung Cancer Radiotherapy: a literature review. Accepted as poster presentation, 15th World Conference on Lung Cancer, Sydney, 2013.

4. Kumar S, Holloway L, Moses D, Liney G, Vinod SK. The potential use of MRI to delineate lung cancer volumes for radiotherapy. Accepted as poster presentation, 15th World Conference on Lung Cancer, Sydney, 2013.

5. Kumar S, Holloway L, Moses D, Vinod SK. Inter‐observer variability of GTV delineation based on Lung MRI: impact of radiologist led workshop. Accepted as poster presentation, 15th World Conference on Lung Cancer, Sydney, 2013.

6. Ho G, Kumar S, Arumugam S, Jameson MG, DeGruyter S, Holloway LC, Vinod SK. Non‐small cell lung cancer (NSCLC): Changes in volume during radiotherapy and potential adaptive radiotherapy planning. Accepted as poster presentation, 15th World Conference on Lung Cancer, Sydney, 2013.

Challenges 1. Lack of CBCT at Macarthur 2. Implementation of 4DCBCT at both centres 3. Soft tissue matching of lung cancers by radiation therapists 4. Pinnacle scripting of lung cancer plans

Future Projects/Expansion of Services 1. Utilising MRI in radiotherapy for Lung cancer 2. Adaptive radiotherapy based on changes on CBCT. 3. Further developing Stereotactic lung protocol to include VMAT and IMRT

treatment techniques. 4. Improving treatment techniques for MCTC patients. 5. Scripting of radiotherapy plans in Pinnacle

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CNS Radiotherapy Interest Group

The Central Nervous System (CNS) Interest Group is comprised of Radiation Therapists, Medical Physics representatives and Radiation Oncologists. The group meets bi‐monthly and addresses the quality improvement, ongoing development of new techniques and research as they relate to patients undergoing radiation therapy for brain and spinal tumours. In addition, a sub‐group involved in the development and implementation of cranial stereotactic Radiotherapy (SRT) for smaller intracranial targets meets fortnightly. This technique is designed for implementation on the newly installed Tomotherapy Hi‐Art radiotherapy unit and aims to deliver high precise high dose treatments, whilst minimizing radiation dose to surrounding healthy tissues.

Highlights Completed protocols that have undergone updates in the past 12 months include:

Updated 3D conformal and IMRT protocols for radical brain treatments

Training for the core multi‐disciplinary group of staff in use of the I‐Fix stereotactic head frames, both fixed and re‐locatable.

Protocols in development/implementation phase:

Cranial stereotactic radiotherapy for small intracranial targets eg single and multiple brain metastases (simulation/planning and clinical selection protocols)

Craniospinal radiation delivery using Tomotherapy

Research and Education Two members of the team attended the June 2013 International Stereotactic

Radiosurgery Society Congress in Toronto, Canada. This conference provided key information in regards to planning and dose regimens for glioma, brain and spinal metastases and skull base treatments.

Conference Presentations / Abstracts

Impact of patient rotational errors on target and critical structure dose for radical CNS IMRT patients: A 3D simulation study. A. Scotti, R. Stirton, S. Arumugam, E‐S Koh. Oral presentation at Elekta Users Group meeting, Melbourne, August 2013

R. Stirton, A. Scotti, S. Arumugam, E‐S Koh Oral presentation at Pinnacle Users Group meeting, Sydney, August 2013

GTC Relocatable Stereotactic

Head frame

Page 72 of 192

Submitted Abstracts

Towards clinical implementation of intra‐cranial stereotactic radiotherapy with a Helical Tomotherapy Approach.

S. Deshpande, M.G. Jameson, A. George,I. Franji,C. Ochoa, S.Watt, E. S. Koh, P.Vial, L. Holloway. (Engineering and Physical Sciences in Medicine Conference 2013).

A comparison of Helical Tomotherapy and Static Field Intensity modulated radiation therapy (IMRT) for primary brain tumours; a comparative dosimetric planning study. G.J. Dinsdale, I. Franji, I, E‐S. Koh, C. Ochoa, S.Deshpande, M. Jameson, S. Watt. (Ingham Health Research institute Research Showcase Nov 2013).


Research protocols for the incorporation of MRI in CNS radiation techniques and for treatment response monitoring

Page 73 of 192

SWSLHD Cancer Information Program

The SWSLHD Cancer Information Program is comprised of the Inter‐district Clinical Cancer Registry, SWSLHD Oncology Information System, Cancer Services Information Management and Technology and the Data Management support groups. Following the split of the local health districts (LHDs), an inter‐district agreement now exists that will see SWSLHD continue to host the Clinical Cancer Registry program.

Highlights Quality assurance and improvement projects are ongoing, to review and audit data that improves source information in Cancer Services information systems.

The Clinical Cancer Registry continues its involvement in the Cancer Institute initiative to combine the Central and Clinical Cancer Registries into one application; the NSW Cancer Registries (NSWCRs)

The Clinical Cancer Registry moved into its new home in the Ingham Institute, Applied Medical Research.

The Registry and Haematology Department have collaborated on data capture and collection for Bone Marrow Transplant patients at Liverpool Hospital.

The Registry Database (Metriq) was upgraded in 2012.

We said goodbye to Christine MacDonald and Nathaya Muadjienga but welcomed Amrita Chandra to the Registry team.

Kirsten Duggan’s “Is there a survival benefit with the receipt of guideline recommended therapy for non‐metastatic NSCLC?” poster was featured at the COSA Best of the Best Poster presentation session for Translational Research.

Recommenced the Clinical Cancer Registry’s collaboration with the Cancer Council to recruit patients into the Clear Study.

The Oncology Information System (OIS) team welcomed Vanessa Leong into the Mosaiq support role.

The Mosaiq interface to PBRC was implemented in 2013 enabling more efficient turn‐around of billing in Cancer Services.

The Haematologist’s at Liverpool and Campbelltown Hospitals are now prescribing chemotherapy in Mosaiq with ongoing collaboration to ensure all protocols electronically.

Callie Choong and Thomas Tran submitted projects for SWSLHD Quality Awards highlighting their achievements in activity audits in Mosaiq and improving patient schedule printouts (respectively).

The Information Management team provided comprehensive Quality Assurance (QA) reports for the Prostate & Breast Groups assessment information.

QA reports auditing the requirements of PBRC billing; patient referrals exist, are updated in a timely manner and patient activities match the referral information, will ensure efficiency in the new billing process.

Clinical Cancer Registry Team

Page 74 of 192

The introduction of WebNap for reporting of non‐admitted patient occasions of service meant the roll out of a new reporting tool for the Information team.

SWSLHD Information Technology and Support team’s new governance structure has improved communication and support within the team.

A major review of Cancer Services’ IM&T documentation and infrastructure mapping, in collaboration with IM&TD, was a major undertaking in 2013. It is anticipated that this will facilitate an improved service and response to critical events in Cancer Services IM&T.

The Cancer Services Dictation system, Winscribe, was upgraded.

An upgrade to the backup systems for Cancer Services infrastructure was completed.

Maintenance and support contracts were put in place for Cancer Services infrastructure which has meant improved response times to critical events and efficient notification of issues as they arise.

Wireless networking was successfully implemented in both Liverpool and Macarthur Cancer Therapy Centres.


10000 5000 0 5000 10000

Melanoma

Gyneacological

Head and Neck

Upper GI

Colorectal

Urogenital

Tumour Group by Gender

Female

Male

0 2,000 4,000 6,000 8,000 10,000 12,000 14,000

Neurological

Gyneacological

Head and neck

Haematology

Upper GI

Respiratory

Colorectal

Urogenital

Breast

Treatment Utilisation by Tumour Group

Surgery

Radiation

Chemotherapy

Other

No Treatment

Page 75 of 192

Research and Education A number of posters and presentations were authored and co‐authored by Registry and the OIS staff in 2012/13

Is there a survival benefit with the receipt of guideline recommended therapy for non‐metastatic NSCLC? Asia Pacific Journal of Clinical Oncology; Vol 8 (Suppl. 3): pp303, Abs 712. Duggan K, Vinod SK, Descallar J (2012) (Best of the Best Poster & Oral presentation at Clinical Oncological Society of Australia (COSA) 2012 Annual Scientific Meeting in November in Brisbane, QLD

Merkel Cell Carcinoma in South Western Sydney Local Health District: A Six Year Retrospective Review. Asia Pacific Journal of Clinical Oncology; Vol 8 (Suppl. 3): pp310, Abs 732. Sharmin M, Prakash J, Muadjienga N, Duggan K, Forstner D, Fowler A (2012) (Poster presentation at Clinical Oncological Society of Australia (COSA) 2012 Annual Scientific Meeting in November in Brisbane, QLD

Incidence and extent of disease at diagnosis of cancer in the CALD Population in SWSLHD. Kaadan, N., Farrugia, S., Sharmin, M., Vinod, S., Descallar J. (2012) (Poster Presentation at Ingham Institute Research & Teaching Showcase in November, 2012 in Sydney, NSW

A paperless department in a powerless environment. Cusack, N., Kaadan, N. (2013) .Oral Presentation at 10th Annual Scientific Meeting of Medical Imaging and Radiation Therapy.

Mosaiq Uncaptured Activities Audit Report. Choong, C. (2013) SWSLHD Quality Awards submission.

Redesigning the Patient Schedule, to improve efficiencies in information transfer to patients, their carer/s, and staff; in the aim of improving the patient journey through Cancer Services. Tran, Thomas (2013) SWSLHD Quality Awards submission.

Challenges Improve the utilisation of electronic medical records to improve the timeliness and quality of information around cancer treatment and outcomes. This increased utilisation and the demand for Mosaiq projects in the service will require care in monitoring and proactively maintaining the infrastructure at the core of the service. Documentation of ECOG and MDT meetings will be a focus, as well as the quality of staging information reported by clinicians in source systems. Increasing demand on extracts from source systems, like Mosaiq, to submit reportable data to the Cancer Institute will require an enhanced auditing program around these key data items.

51.26% 49.47%

48.74% 50.53%

0%10%20%30%40%50%60%

Localised Extensive

% of Patients

Degree of spread

Degree of Spread for CALD vs Australian born

patients in SWSLHD

Australia

CALD

Page 76 of 192

Future Projects/Expansion of Services The SWS & SLHD Clinical Cancer Registry has been working with the CINSW

on the NSW Cancer Registries (NSWCRs). Launched in June 2012, the benefits of the new amalgamated registry 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 NSWCrs.

Successful Grant of $60,000 will be used to assess Upper Gastrointestinal (UGI) Surgical outcome data in the Clinical Cancer Registry for SLHD.

Cancer Services will be looking to appoint a new Computer Manager to complete the new governance structure in IM&T.

Cancer Services was awarded a Cancer Institute grant of $200,000 which will be used to assess and implement a Patient Reported Outcome Measures tool that interfaces with Mosaiq. This is a major undertaking in collaboration with Illawarra Local Health District and will be led by Prof Afaf Girgis who is a renowned psycho‐oncology researcher.

Successful Grant of $30,000 will be used to assess and implement Email/Fax technology with Mosaiq to distribute correspondence to external clinicians involved in patient cancer care.

A number of projects are planned for Mosaiq in the upcoming year including the use of signature pads for patient and clinician signatures and barcode scanning to streamline the patients experience in clinics.

Importing laboratory results into Mosaiq providing clinicians with improved decision support for patients’ cancer and/or disease management.

The OIS and Information team will be migrating Crystal Reports server, which is used for the automated distribution of reports, to Microsoft SQL Server Reporting Services.

Planned upgrade to Cancer Services current dictation system, Winscribe, to incorporate embedded Speech Recognition, streamlining transcription processes and improving the turn around time from dictation to mail out of correspondence to external clinicians involved in patient cancer care.

Work is currently underway by both the Registry and OIS team on the Chemotherapy extract from source systems to provide data to the NSWCRs for automated import. Pilots are being conducted on and Radiation Therapy extracts around the state and it is anticipated to be available over the next 12 months to our service.

Mosaiq implementation at Bankstown Oncology will further close the gaps in documentation ensuring efficient and effective continuity of patient care in Cancer Services across the district.

Page 77 of 192

SWSLHD Administrative Support Report Administrative services are responsible for ensuring that patients are provided with a professional and courteous service while providing skilled support to the multi‐disciplinary clinical staff. The administration team is the first point of contact for all patients when attending the Cancer Centres capturing over 103,000 attendances over the past year. They register all new patients, make clinic appointments, transcribe clinical communications to referring medical practitioners, scan patient correspondence into Cancer medical records (MOSAIQ) and process medicare transactions.

Highlights The Macarthur team has provided support to one another over a difficult year of severe staff shortages. They are often praised for their customer service skills when communicating with patients and staff, and are to be congratulated for their efforts. The team has set a high standard in keeping with our Organisational Values ‘Communication and Team Work’. Liverpool staff have initiated a ‘Meet and Greet’ project to help with patient flow in the clinic area. The project aims to assist patients who are not feeling well by removing queues. Patients are met at the door by administration staff, who take their details and offer them a seat rather than wait in line. When they are required for their scheduled appointment their details are ready and they are called in. Last year’s Dry July fundraising, was used to refurbish the administrative offices into a patient Wellness Centre, providing supportive therapies for patients on treatment. The Business Manager, Maree Cain, worked assiduously with the Capital Works staff to complete this project on schedule, decanting staff and moving people about on the facility chessboard.

Challenges Increase in activity always places a level of anxiety upon staff, as they try to maintain timeframes for new patient registrations and appointments, particularly when the department suffers staff shortages. However the MCTC administration staff continually work together in providing our patients with appointment times that fit in with their day to day routines, as well as maintain booking timeframes without the need to increase waiting times for appointments with our Oncologists. With growth also comes a requirement for additional clinic space to deliver services. There have been several moves this year, uplifting staff, changes in processes and new faces to contend with. In an ever‐increasing service, we haven’t seen the last yet. Staff continue to work closely with the implementation team to ensure that PBRC meets our financial reporting needs, while maintaining existing revenue processing systems, and develop the new procedures at the same time.

The team is responsible for

ensuring that patients are

provided with a professional

and courteous service.

The “Meet and Greet”

project is aimed at

eliminating queues for

patients – they no longer

wait in line, they are met at

the door.

Page 78 of 192

Key Performance Indicators The administration team have continued their professional level of support to Cancer Services while carrying vacancies. The transcriptionists have typed approximately 51,254 patient clinical letters to GP’s and referring clinicians while the clinic support staff have scanned 17,393 documents into patient records. The administration team has processed:

Education Several staff have attended Business Administration courses, and developed skills in staff, recruitment and finance systems (Mercury, SMRT, Stafflink). Power Billing Revenue Collection (PBRC) is a new system that will improve the timeliness of revenue returns from medicare, and a number of staff have been involved in the implementation of this system across the district. Monthly departmental In‐services are carried out to further develop supportive skillsets. There have been opportunities this year for administration staff to take on more responsibility in roles that have improved their knowledge base. Bankstown has recruited a new secretarial position that will provide direct support to Palliative care staff. The position will also help establish the online booking system and provide chemotherapy bookings support.

MACARTHUR ACTIVITY 2011/2012 2012/2013 Increase %

New Patient Reg. 1348 1693 348 20

F/Up Appointments 10299 11040 741 6

Transcriptions 3769 5007 1237 25

Attendances 31894 33067 1173 4

51257

17393

84967

0

20000

40000

60000

80000

100000

Transcription Scanning Bookings

Liverpool Activity 2012/13

Sue Connor,

Operations Manager,

Macarthur

Maree Cain,

Business Manager,

Liverpool

Page 79 of 192

Future Projects/Expansion of Services The creation of a district‐wide Cancer Services relief pool is being reviewed this coming year. With unexpected absences and resignations it is anticipated that Cancer Services Administration can call upon our ‘pool’ of clerical relief to provide support at times of high demand and whilst undertaking recruitment exercises. A project team has been established to implement MOSAIQ at Bankstown Cancer Services, to allow greater standardisation of information systems across the District. It is anticipated that MOSAIQ will be fully implemented at Bankstown prior to January 2014. Major refurbishments and building works have been surrounding our services at Liverpool and Macarthur, to accommodate growth in hospital services. With this work, the cancer service will occupy old buildings that are vacated, as a temporary decanting and expansion strategy, to prolong our need for new accommodation. Unfortunately, this means several more moves for staff over the next few years.

Above: Bankstown

Right: Macarthur

Below: Liverpool

Page 80 of 192

2012/13 Resource Utilisation report The busy graph below aims to show several components of our service usage. In summary; 340 staff attended to 102,995 patient visits in the outpatient centres, and more than 17,000 bed days at a cost of $41m for the 2012/13 year.

The red line is the ratio of patient visits to staff. The complexity of treatments and services has increased markedly, so the consistent average of 315 patient visits per staff member over 13 years, demonstrates our continued efficiency, in maintaining the ratios, despite extra difficulty levels. We can corroborate this assumption by comparing the budget to the occasions of service, with an average cost per patient visit of $317. The bars show the budget (light) and actual expenditure (dark) for each year, showing that we have a good track record of working within our budget. With the addition of an Oncology ward in Macarthur and a Palliative care ward at Liverpool, inpatient activity has been incorporated into the graph to enable us to trend the occupancy of these services – you can see that the additional oncology specific wards have enabled us to capture the service influx, showing 17,055 occupied bed days in these 4 wards last year (CBC4, CBC5, Camden, Campbelltown).

The blue dots are the

number of staff employed

throughout the year (this

aligns to the right axis) ‐ an

average of 190 over the

period shown.

The top blue line shows the

number of patient visits ‐

some patients attend many

times for treatment and

follow up clinic visits. Each

of these occasions uses

resources for bookings,

rooms, clinical staff and

consumables. Our average

over 13 years is 59,000

occasions per year.

Page 81 of 192

SWSLHD Allied Health

Liverpool Cancer Therapy Centre Allied Health The Allied Health team at LCTC consists of Clinical Psychology, Dietetics, Occupational Therapy, Physiotherapy, Social Work and Speech Pathology. Clinical Psychology has 2.5 FTE psychologists. Dietetics The oncology dietitians provide a range of different services to patients with cancer. These include:

Nutritional assessment of both in and out patients.

Providing advice on medical nutrition therapy including oral, enteral and parenteral nutrition support.

Providing advice and education regarding the management of cancer and treatment related symptoms.

The cancer therapy dietitians also act as a resource person for the continuing development and improvement of oncology services. Lymphoedema Service The lymphoedema team comprises an Occupational Therapist and Physiotherapist. The service provides a screening clinic to those patients identified by care coordinators as at risk of developing secondary lymphoedema; provision of assessment and treatment to those clients identified as having lymphoedema. Occupational Therapy During the year, staffing in Occupational Therapy has predominantly been the equivalent of 1 FTE, providing services in both inpatient and outpatient settings. This has included acceptance of referrals for clients who required assessment and intervention due to decreased functional capacity and engagement in every day activity following their cancer treatment. Physiotherapy The physiotherapy department provides both inpatient and outpatient assessment and treatment of cancer patients which is evidence based.

Inpatient services currently include hematology (5C) and palliative care (4C). Medical oncology and radiation oncology patients on these wards are also included. Workload consists of mobility aid prescription, improving independence with mobility and carer training.

In addition to the lymphoedema clinic, Outpatient services also include musculoskeletal conditions associated with cancer diagnosis/treatment, fatigue management and exercise rehabilitation.

The Allied Health team

at LCTC consists of Clinical

Psychology, Dietetics,

Occupational Therapy,

Physiotherapy, Social Work

and Speech Pathology

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The physiotherapy department now has a full time senior cancer therapy/palliative care physiotherapist who commenced in July 2013. There is also a part time rotator position and soon to have another physiotherapist returning from maternity leave for 2 days a week. Social Work The social work team provides comprehensive psychosocial care for oncology, hematology and palliative care patients of Liverpool Hospital. Speech Pathology The oncology speech pathology team provides communication and swallowing intervention pre‐, during and post‐ treatment. This includes:

Laryngectomy management

Tracheostomy management

Clinical Swallowing assessment and intervention

Collaborative management with dietitian of side effects of radiation toxicities on swallowing and nutrition

Onsite Fibreoptic Endoscopic Evaluation of Swallow (FEES) within Head and Neck Clinic to further assess and visualize secretion management and swallow motor and sensory function.

Modified Barium Swallows – for instrumental evaluation of swallow function and laryngectomy voicing issues using x‐ray

Communication assessment and intervention

Education and counseling regarding communication, swallowing and lifestyle changes with regards to laryngectomy, tracheostomy and general swallow and communication impairments

Joint coordinator of Head & Neck Education and Support Group

Highlights Clinical Psychology There are plans for the recruitment of a Clinical Psychologist dedicated to Palliative Care. Plans for the wellness centre are underway and the Clinical Psychology team have been collaborating on services and information tailored to this new chapter in cancer services. Dietetics

The Dietetic Department continued to provide services to meet the demand for the increasing number of oncology referrals throughout 2012.

Enhancement of the Dietetic oncology outpatient service (including radiation oncology, medical oncology and haemotology) with the appointment of a 0.4FTE Bone marrow transplant dietitian and 0.6FTE radiotherapy dietitian in late 2012.

Initiation of a pre transplant assessment clinic and post transplant follow up clinic.

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Lymphoedema service Having a second physiotherapist becoming lymphoedema trained, thus ensuring the lymphoedema clinic has been staffed whilst other therapists on leave to provide ongoing service to referred patients. Occupational Therapy With the expansion of Palliative Care services at Liverpool Hospital, a 0.4 FTE Diversional Therapist has been employed to provide services to patients admitted to the palliative care ward. In addition, a full time senior Occupational Therapist will join the Palliative Care ward team in August. Physiotherapy Establishment of physiotherapy service to Palliative Care and enhancing physiotherapy cancer therapy services following the enhancement and recruitment of a full time senior cancer therapy/palliative care physiotherapist. Social Work

Finalist Ministry of Health award, Oncology category. Establishment of the head and neck pre‐treatment clinic. Dall’Armi L, Forstner D, Simpson T, Bell K, Baxter C

Ethics approval of ‘Living Well after Treatment’ programmes

The Liverpool Blood Cancer Information and Support Program in partnership with the Leukaemia Foundation.

Appointment to the Bone Marrow Transplant 0.5 FTE Social Work position.

2013 Oncology Social Work Australia Conference Presentation 'Expanding the social work role in hospital wards to transfer self‐care and communication skills to other disciplines' won best poster. R.Curry & C. Youssef

Development of “Living Well after Breast Cancer Treatment” group programme.

Development of the “Living Well After Lymphoma Treatment” Clinic

Establishment of the Head and Neck Support Group (multidisciplinary)

10th Anniversary Lunch of the Liverpool Hospital Brain Tumour Education and Support Group

Speech Pathology

Review and streamlining of speech pathology services across the Speech pathology and Dietitian Joint Tuesday and Thursday Clinic

Increased number of Fibreoptic Endoscopic Evaluation of Swallow (FEES) being undertaken in Head and Neck Clinic

Review of current swallow workstation station / nasoendoscopes equipment and sterilization practices with appropriate stakeholders ‐senior nursing, and ENT and radiation oncology consultants, and equipment reps, sterilizing services

Review and update of speech pathology laryngectomy equipment sterilizing procedures with appropriate stakeholders

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Key Performance Indicators Dietetics has collected the following clinical indicators:

Identifying weight changes and nutrition status changes (PG‐SGA) for head and neck cancer patients undergoing radiotherapy

Identifying weight changes and nutritional status changes (PG‐SGA) for upper GI cancer patients undergoing chemotherapy or radiotherapy +/‐ chemotherapy.

Preliminary results: 67% of patients undergoing chemo/RT lost <5% of body weight during treatment, weight change range during treatment: ‐3.0% ‐ ‐11.7%, average LOW: 6.1%

Preliminary results: 100% of patients undergoing pre‐op chemotherapy lost <5% of body weight during treatment, weight change range during treatment: ‐1.7% ‐ ‐2.7%, average LOW: 2.2%

There has been a marked increase in occasions of service in 2013 attributed to BMT/Radiation Oncology enhancements and return of a staff member from maternity leave.

Physiotherapy

Inpatients are seen within 24hours of a referral being received.

Outpatient referrals are screened and prioritised on a weekly basis. Social Work Continuity of care model implemented with key performance indicators on Social Work referrals and frequency of contact. Speech Pathology There has been a steady increase in outpatient CTC Occasion of Service & referrals since March 2013 compared to 2012. Clinical demands continue to outweigh clinical capacity with existing Speech Pathology services given the complex and ongoing nature of their difficulties across the inpatient and outpatient settings.

Research and Education The Allied Health Team routinely offers In‐services to nursing staff on wards and CTC, presents at Medical student oncology tutorials and offers education to patients and carers as part of wellness support groups (eg. Breast ENCORE, Haematology and Gynaecology support groups). More specifically, Clinical Psychology facilitates the monthly Gynae‐oncology support and education group with the Clinical Nurse Consultant in Gynae‐oncology. Clinical psychology continues to be involved with research into the psychological aspects of oncology.

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Dietetics Research/ Quality Improvement activities

Identifying factors and patient characteristics that contribute to non compliance of nutritional therapy among Head and Neck Cancer patients. Oral presentation conducted at SWSLHD Dietetics Quality and Research Forum, 2013.

Audit of nutritional management of BMT patients admitted to Liverpool Hospital.

Co‐authored article published in Journal of Human Nutrition and Dietetics. Brown T, Findlay M, von Dincklage J, Davidson W, Hill J, Isenring E, Talwar B, Bell K, Kiss N, Kurmis N, Loeliger J, Sandison A, Taylor K, Bauer J. Using a wiki platform to promote guidelines internationally and maintain their currency: evidence‐based practice guidelines for the nutritional management of adult patients with head and neck cancer. J Hum Nutr Diet (England), Apr 2013, 26(2):182‐90.

Education

Patient education sessions‐ Nutritional support post bone marrow transplant.

Dietetic participation in the planning committee responsible for initiating a head and neck cancer support and education group.

Lectures to Dietitians‐in‐Training at the University of Wollongong Lymphoedema Service (Occupational Therapy and Physiotherapy) In 2013, the Lymphoedema service has partnered with the University of Sydney to participate in a research study investigating the benefits of exercise for patients who have breast lymphoedema. The new physiotherapist attended the level 1 lymphoedema course. Physiotherapy Currently a quality project is underway looking at the effects of exercise on cancer survivors. Referrals are made through MOSAIQ and patients are assessed one on one and if suitable are then placed into an already existing chronic disease exercise group. Outcome measures being assessed include: BMI, waist circumference, QOL, fatigue, cardiovascular endurance and lower limb strength. From this project we plan to set up a cancer only exercise class in conjunction with the survivorship centre. Social Work

Poster presentation of the “Living Well after treatment – a Wellness Approach” at the Cancer Survivorship Conference in Adelaide (Feb 2013) (Kim Brauer, Racheal Curry & Teresa Simpson

Poster presentation of the “Living Well after treatment – a Wellness Approach” at the Oncology Social Workers Australia Conference in Canberra (April 2013) (Kim Brauer & Racheal Curry)

Attendance at Robert Neimeyer 2 day workshop: Creative Practices for Counselling the Bereaved (Simone Hallett)

Attendance at Gynae‐Oncology Seminar, NSW Agency for Clinical Innovation (Kim Brauer)

Attendance at Palliative Care Education Forum, Palliative Care NSW (Simone Hallett & Christina Youssef)

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Kim Brauer and Simone Hallett currently working towards attainment of certificate in Practical Project Management

Participation in research project Simpson G, Koh E‐S, Gillett L, Hallab L, Simpson T, Trad W, Wright K. “Field testing of the Strategy Use Measure”

Articles published in peer review journals

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.

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 2013; 26: 40‐44.

Articles submitted for review to peer review journal Simpson GK, Dall’Armi L, Roydhouse J, Forstner D, Daher M, Simpson T, White K. Does resilience mediate family caregiver distress after head and neck cancer? Cancer Nursing Dall’Armi L, Simpson GK, Forstner D, Simpson T. (2013) Head and Neck Cancer Information Needs Survey 1.0. Sydney: Sydney South West Area Health Service. Speech Pathology Research Speech Pathologists are currently involved in two studies involving i) speech deficits with oral defects with the head and neck surgeons and ii) tracheostomy risk profiles with the ENT and the tracheostomy multidisciplinary team (MDT). Quality Improvement The Speech Pathology team is currently reviewing their educational patient resources in terms of creating a “Top 5” Package of general speech pathology related handout resources to be translated as part of the “CTC Translating Handouts Project”. A review of evidence based baseline and intervention outcome measurement tools to be used pre and post‐speech pathology intervention is currently in progress. Once established, this will be used with patients undergoing (chemo) radiation treatment and surgery to identify and quantify swallow and communication changes in a simplified timely manner. Education The CTC Speech pathologists are:

Joint co‐ordinators and presenters of the Head and Neck Education and Support Group held monthly at Liverpool Education Centre.

Routine involvement in the Head and Neck CTC MDT Pre‐Treatment Clinic held weekly for pre‐education and counseling of newly diagnosed head and neck oncology patients

Challenges Dietetics Dietetic referrals have continued to steadily increase over the past years with 230 referrals in 2009‐10 to 285 in 2012‐13 via Mosaiq. Additional referrals are received via email, page.

Dietetic referrals have

continued to increase.

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Lymphoedema service (Occupational Therapy and Physiotherapy) Meeting the increasing demand and maintaining staffing capacity and skills remain a challenge. Education about waiting times has occurred with key referrers. Social Work Research and service development presents an ongoing challenge in a busy hospital with staff vacancies to cover and priority given to ensuring timely discharge of patients Speech Pathology The redevelopment of level one into the Wellness Centre has been and continues to be an exciting and challenging experience. The improvements and service potential for the near future is obvious. However the frequent office changes and high clinical demands on speech pathologists meant Research and Quality Projects have been de‐prioritized in lieu of high demands across the oncology inpatient and outpatient caseloads. Increased speech pathology staffing would allow for increased research and QI initiatives aimed at gold standard provision.

Future Projects/Expansion of Services The Allied Health team will focus on wellness and the needs of cancer survivors for future projects and services, within the Wellness Centre at Liverpool Hospital. This will involve consultation and development of survivorship programs, expansion of support services, and partnership with other facilities that are looking at similar models of care to cater for the needs of this population. Other projects for Allied Health are as follows: Clinical Psychology Continuation of research and academic publications into the psychological

aspects of cancer Continuing association in education of medical students on placement Dietetics

Qualitative research to further explore the reasons for non compliance with nutritional recommendations for head and neck cancer patients.

Evaluating the clinical nutritional outcomes of head and neck cancer patients after the commencement of a pre treatment clinic.

Investigating PEG dependency post head and neck radiotherapy at Liverpool Hospital.

Identifying the characteristics of head and neck cancer patients who receive prophylactic PEG insertion at Liverpool and Campbelltown Hospitals.

Development of BMT nutritional management guidelines.

Evaluating methods of detecting changes in nutritional status post stem cell transplant.

Identifying prevalence and type of complementary diets used in patients receiving chemotherapy (project collaborated with Concord Hospital)

Ongoing role in the updating of the Evidence‐Based Practice Guidelines for the Nutritional Management of Patients with Head and Neck Cancer

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Lymphoedema Service (Occupational Therapy and Physiotherapy) With the increasing demands on existing resources and research demonstrating the importance of early screening, a project investigating alternative models of care will be undertaken in the coming months. Participation in a research study as outlined in the previous Research and Education section will continue into 2014. Occupational Therapy One particular project will be about an evidence based clinic in fatigue and energy management which is a health outcome many cancer patients experience during treatment as well as post treatment. The project will entail collaboration with other Allied Health professionals a holistic approach to patient care. Physiotherapy

Future plans include starting up a cancer survivors exercise group and its formal assessment. Social Work

Development of a bereavement support model of care and follow up protocol; practice research to measure efficacy

Training in and implementation of dignity therapy for palliative/end of life care patients; practice research to measure efficacy

Development and establishment of inpatient palliative care social work service

Speech Pathology

The two current research projects as outlined in the previous Research and Education section will continue into 2014.

It is hoped the Pre‐ and Post‐ Measure Tool quality project will lead to timing data collation of pre and post treatment information allowing for future speech pathology driven research project(s)

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Macarthur Cancer Therapy Centre Allied Health The Allied Health team at MCTC consists of Clinical Psychology, Dietetics, Occupational Therapy, Physiotherapy, Social Work and Speech Pathology. 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. The service caters for patients, families and concerned others affected by the cancer journey. 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 participates in research and education of psycho‐oncology issues. The Dietitian provides nutrition assessment, information and support to patients undergoing chemotherapy and/or radiotherapy to assist with meeting nutritional needs and managing side effects. Occupational Therapy provides services to Outpatient CTC, Community Palliative Care, Inpatient Palliative Care Unit and Palliative Care Day Therapy Centre (no longer in operation). This involves assessment of patients and interventions including home visits, equipment prescription, task modification as well as patient and carer education. Referrals are received through a variety of sources including medical teams via QCL, community nursing via eMR, and patient self referrals. Occupational Therapy also operates the lymphoedema clinic. This provides early post‐operative education and assessment of patients at risk of developing lymphoedema as well as treating established primary and secondary lymphoedema. The majority of referrals for early assessment and education are received via QCL. Some clients are referred pre‐operatively which is the ideal time to take baseline measurements to assist with early detection of lymphoedema. The Physiotherapy service aims to provide patients and carers with evidenced based physiotherapy intervention and education to optimise physical functioning and independence throughout the cancer journey. Physiotherapy may relate to limitation in a specific location such as limited shoulder movement post mastectomy to prescription of aids and devices to maximize independent movement, mobility and to minimise risk of falls. A newly created rotation was established to ensure a designated physiotherapy position is allocated to inpatient Oncology Ward and Cancer Therapy Centre. Physiotherapy also provides a service on a referral basis to inpatient Palliative Care ward and Community Palliative Care Physiotherapy Social Work takes a holistic approach to service provision. The service provides a therapeutic counseling service to both patients and their carers. The aim is to provide a continuity of care which carries over to home and palliative care when required. This ensures that the patient and carers develop a close relationship with the social worker and that their needs are met in a timely efficient manner. Social workers are able to assist with financial concerns as well as liaise with other services on behalf of patients.

The Allied Health team

at MCTC consists of Clinical

Psychology, Dietetics,

Occupational Therapy,

Physiotherapy, Social Work

and Speech Pathology

Page 90 of 192

They also able to liaise with various interested parties on behalf of the patient such as schools, employers and sport and recreation facilities to ensure the patient and family are well supported. Speech Pathologists assess and provide management for communication and swallowing difficulties associated with a patient’s cancer, or arising as a side effect from surgery, radiation or chemotherapy. These services are provided to oncology inpatients, outpatients in CTC and the community, palliative care inpatients and those in the community. As a result of the skill mix required for these caseloads, the Campbelltown‐based Speech Pathology staff see patients from the Campbelltown, Camden, Wollondilly and Wingecaribee areas. The strong relationship between swallowing and nutrition requires working closely with the Dieititian.

Highlights Clinical Psychology

The service designed and published a brochure about Clinical Psychology to better inform patients and families about the availability and role of the service. As a result, referral sources have broadened with an increase in referred patients from GPs, Palliative Care services and self‐referrals.

The service commenced participation in its first ever national Randomised Control Trial headed by researchers at the Psycho‐Oncology Co‐Operative Research Group (PoCoG) – Conquer Fear.

A member of the team was recognised by her Clinical Psychology peers with an award for her efforts in maintaining the profile of Clinical Psychology in MCTC; and she was also nominated for an Employee of the Month by a consumer this year.

Dietetics

Bimonthly SWS LHD Oncology Dietitian meetings have been attended which has allowed for cross‐centre support, development of area wide patient education resources and ongoing professional development.

There has been an increase in frequency of joint Dietitian and Speech Pathology appointments. These appointments are being made at times which complement patient’s treatment schedules with an aim to develop a more patient centered approach.

Dietetics has continued to review the food provided to patients undergoing chemotherapy with the goal to improve the selection and suitability of food and drinks available and overall patient nutrition during their day treatment. A patient satisfaction survey was completed and recommendations are being finalised.

Occupational Therapy

The majority of quality improvement within the Oncology/Palliative Care role has been focused on improving referrals and also targeting how the Occupational Therapy service is explained to patients. The aim is ensure that referrals, as well as pre‐referral discussions with patients and carers, focuses on identified issues rather than making recommendations on behalf of the service before an appropriate assessment can be carried out.

Equipment and resources are continually being improved and updated with the assistance of 24 Hour Fight and department funding to ensure that

Figure 1: Clinical Psychology

brochure

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patients have access to necessary equipment in a timely manner. Pressure cushions in the Equipment Loan Pool as well as the District High Cost Loan Pool stock which supplies hospital beds, pressure mattresses and hoists have been increased.

The lymphoedema clinic is continuing to trial new products in the management of established lymphoedema, in particular breast lymphoedema, and alternatives to traditional bandaging programs.

Physiotherapy

Development of the Physiotherapy role on Oncology Ward and Cancer Therapy Centre has seen an increase in physiotherapy service to patients with Physiotherapy needs. Physiotherapy now have an established referral pathway from Cancer Therapy Centre with availability of allocated clinic time and space to provide patients with physiotherapy needs within the Cancer Therapy Centre.

A Physiotherapist attends the weekly Cancer therapy Centre case conference to assist with identifying patients whom will benefit from Physiotherapy intervention as well as providing feedback to the multidisciplinary team on patient care.

Social Work

After a period of significant staffing constraints, the Social Work team now has a full complement of staff allowing a wider service to be provided.

Speech Pathology

Armalie Muller and Katherine Kelly, together with other specialist Speech Pathologists in Sydney metropolitan hospitals, planned and hosted a 2‐day education program on working with patients with head and neck cancers for Speech Pathologists from throughout Australia and New Zealand. The small profit generated by registrations was donated entirely to the Cancer Institute.

Speech Pathology and Dietetics have been establishing an increasingly transdisciplinary service, largely with patients with head and neck cancers. Anecdotally, this has resulted in improved efficiency in caseload management, and more patient oriented care.

The Speech Pathology stock of specialist laryngectomy equipment has been expanded and replenished with assistance from the 24 Hour Fight Against Cancer. This has allowed patients to use and trial novel or specialist equipment without bearing a significant financial burden to do so.

The Speech Pathology team have enjoyed a close working relationship with their counterparts in LCTC, supporting shared patient management and providing cross‐site clinical support.

Key Performance Indicators Clinical Psychology This year referral sources have broadened with an increase in referrals in self, GP and palliative care referrals. There has been also an increase in concerned others attending. Dietetics Referrals and demand for the dietetic service continues to grow

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Occupational Therapy Occupational Therapy Cancer Services have continually met all KPIs and Clinical Indicators including attending to referrals within 48hours, meeting all identified client goals, and lymphoedema clients who undertake a bandaging program have achieved at least a 50% reduction in excess limb volume. Physiotherapy Physiotherapy activity has grown in the 2012/13 year to Cancer services including both the oncology and palliative care ward and The Cancer therapy centre. More than 90 % of referrals are responded to within 48 hours which ensures a timely physiotherapy service is provided. Speech Pathology Armalie Muller is a representative on the NSW Speech Pathology Performance and Clinical Indicator (PICI) Group. She has coordinated, with input from other Speech Pathology staff in MCTC and in the NSW Head and Neck Peer Supervision Group, the revision of the existing Speech Pathology performance indicators pertaining to patients undergoing radiation for head and neck cancers.

Research and Education Clinical Psychology attended:

Association for Contextual Behavioural Science 11th World Conference

Grief and Attachment workshop The service also assisted in providing expert advice at a BSOC workshop with Physics Interns. The Dietitian:

Is a member of DAA (Dietetics Association of Australia)

Regularly attends DAA NSW Oncology Interest Group meetings

Attended the International Congress of Dietetics conference

Has provided nutrition education to staff during continuing education meetings

Occupational Therapy in Lymphoedema:

Have attended measurement courses through two prominent garment suppliers

Attended the Australasian Lymphology Association’s Biennial Symposium Physiotherapy

The physiotherapy team has been working throughout 2012/2013 to strengthen multidisciplinary care by providing education to staff working within the Cancer streams on patient problems amenable to physiotherapy intervention to ensure timely and appropriate referrals/intervention.

Social Work:

Presented an overview of the service to a group of alternative therapists. This presentation was an exchange of ideas for all participants.

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Speech Pathology:

Are targeting increased awareness of the specific anatomy and needs of patients who have had a laryngectomy for treatment of laryngeal cancer within Campbelltown Hospital, in conjunction with nursing and medical staff. The Speech Pathology Head of Department is coordinating a project to this end. Significant education has been provided to nurses in the emergency department to assist in correct identification of these patients at the point of entry to the service. Multidisciplinary presentations were also made at nursing grand rounds at Campbelltown and Camden and to CMO’s. Work towards the development of ongoing education packages, appropriate policies and acquisition of resources to support care of laryngectomy patients on generalist wards is progressing.

The senior Speech Pathologists continue to be active participants in the NSW Head and Neck Speech Pathology Peer Supervision Group and the SWSLHD Speech Pathology clinical network for which head and neck oncology is a focus.

Challenges Clinical Psychology The service has seen an increase in referrals and balancing the need between a growing community need for treatment and the fixed resources of a service poses a constant challenge. Clinical Psychology continues to attempt to address these issues by triaging patients and reviewing in accordance to inclusion and exclusion criteria of the service. Dietetics and Speech Pathology Growth in patient referrals has led to more transdisciplinary and joint patient appointments for suitable patients, as well as the need to be innovative and flexible with clinic space and times. Provision of Speech Pathology services from Campbelltown to the Southern Highlands can present resource and access challenges, especially as local services may not have the expertise to manage this highly complex patient group. A combination of clinic‐based services, home visits, joint work with the Bowral Hospital Speech Pathology department and Southern Highlands transport is used to best meet the needs of the patients. Occupational Therapy Providing a lymphoedema service to clients from Bowral/Southern Highlands continues to be a challenge. There is no public lymphoedema service available in Bowral and often clients are unable to travel the distance, particularly if they require daily treatment. Physiotherapy Due to geographical location of services and structure of physiotherapy departments/services providing intervention to Cancer services continuity of care can be disrupted due to different physiotherapists working across different services. Eg community and inpatient. The physiotherapy department is reviewing the handover process between these areas to ensure transfer of care is optimal.

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Social Work Social Work’s main challenge is constraints on space particularly for counseling, however a quality service continues to be provided.

Future Projects/Expansion of Services Clinical Psychology will continue to participate in the Conquer Fear national research trial and hope to develop further services in conjunction with current Survivorship Care and Research initiatives. Dietetics plans to perform a cross centre quality improvement project between MCTC and LCTC assessing prophylactic PEG use in head and neck cancer patients in consideration of recently published COSA best practice guidelines. The increase in pre‐admission referrals to the lymphoedema clinic continues to be a priority for the future of the service in line with ALA recommendations for best practice in the early identification of lymphoedema. Physiotherapy Physiotherapy is very excited regarding the up and coming Wellness Centre at Camden and the opportunity this will provide for Cancer patients to participate in Cancer Rehabilitation. We anticipate this will provide vast opportunities for development of innovation and positive approaches to not only improving the physical functioning but also the quality of life of patients through their Cancer journey Social Work’s main aim this year is to develop and implement support group sessions for patients. These groups will offer such topics as, relaxation, discussion and information sharing as well as support. An additional project is the development of a new social work brochure outlining our services. Speech Pathology will continue to progress the current project targeting increased awareness of laryngectomee’s specific anatomy and needs with staff on in the Campbelltown and Camden inpatient settings in conjunction with nursing and medical staff. Speech Pathology continue to be involved in the collection of performance and clinical indicators, per current PICI requirements.

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Macarthur Cancer Nursing Service

The past year has been a time of further change, development and growth within our Macarthur Cancer Therapy Centre (MCTC) nursing team. We have experienced decreased staffing levels for the majority of the year due to full time and part time

vacancies.

Achievements:

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. 2862 occasions of service were provided by the Assessment Unit from July 2012 to June 2013 (inc.).

MCTC nursing staff actively participate in providing ongoing support and input into the implementation and evaluation of the nursing component of updated versions of ‘Mosaiq’ (Cancer Services electronic information system).

Wireless tablets were trialled in the chemotherapy suite in preparation for transfer to a paperless prescribing and administration process but were found to be unsuccessful and have therefore not been implemented.

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 key criteria are regularly reviewed and updated in consultation with all members of the MCTC nursing team.

The Macarthur Health Service (MHS) Safety Challenge is another initiative that the nursing team have been participating in. The nursing staff chose ‘Making Our Workplace Time and Resource Efficient As Well As Safe’ as their challenge. Several strategies were identified and implemented to successfully address this challenge. Staff continue to successfully manage the daily workload in accordance with this initiative.

Denise Burns,

Nurse Unit Manager,

Macarthur

Page 96 of 192

The Communication with Purpose program was implemented in 2 departments 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. Staff Rounding is now known as ‘Staff Catchup’.

The MCTC Nursing Unit Manager commenced Leader Rounding with patients in

June 2011 using a paper‐based assessment tool. Patient Experience Trackers (PET’s) have now been implemented to replace the paper‐based assessment forms. Patient Rounding is now known as ‘Patient Catchup’.

MCTC nursing staff continue to conduct 2nd monthly Hand Hygiene Audits. 2 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 and are also now displayed on the electronic noticeboards throughout MCTC.

A number of policies and procedures have been developed, reviewed and updated. Our 5 High Risk Policies have been placed on the intranet.

100% of MCTC nursing staff have attended Customer Service Training and have completed Respect the Difference Training. The nursing staff actively participate in customer service activities and promotion including the nomination of 2 Nursing Customer Service Champions. The Nursing Unit Manager is a member of the Communication Strategies and Customer Service Working Group.

Quality audits are conducted and documented on a monthly basis. The audits include documentation, emergency equipment, medication charts, S8/S4D drugs and anaphylaxis kits. The audit results are presented, discussed and evaluated at the monthly MCTC nursing team meetings.

Scheduled nursing inservices are conducted twice weekly with presentations and guest speakers from the medical, nursing, allied health, community and pharmaceutical companies.

Deborah Denholm has been successful in her application to undertake the Graduate Certificate in Cancer Nursing at the College of Nursing.

A number of students from various university faculties who are undertaking their degree in nursing have completed placements in MCTC.

Vicki Bell and Therese Harris ‐ McGrath Foundation Breast Care Nurses are working full‐time and are 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.

MCTC Nursing Staff

Page 97 of 192

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 continues in her role as our MCTC Infection Control Link Nurse and has been actively working with the Infection Prevention Committee to review cannulation practice and guidelines, implement pre‐assembled blood culture collection packs and monitor hand hygiene practice throughout the organisation.

Staffing

Nursing Unit Manager

Registered Nurses

Clinical Nurse

Educator

Clinical Nurse Consultants

Transitional Registered Nurses

Denise Burns Yamileth Aguilar

Samantha Beverley

Deborah Denholm

Bernadette de Souza

Gail Dwyer

Hyangna (Hayley) Oh

Michelle O’Mochain

Chong Noi Peacock

Suzanne Rochfort

Florence Singh

Kelly Bourke

Colleen Carter – Palliative Care CNC

Vicki Bell ‐ McGrath Foundation Breast Care Nurse

Therese Harris ‐ McGrath Foundation Breast Care Nurse

Kristen Chittick

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Liverpool Cancer Nursing Service

Having worked in Cancer Services for 16 years, I am very proud of the developments in nursing over the last 12 months. I have a great team of nurses who provide the utmost care to all patient’s that are being treated. I have sat with many of these patient’s and heard some patient journeys, both happy and sad. These patient’s have spoken to me about the wonderful group of nurses that have helped them throughout their journey. It is these same patients that reinforce why I enjoy what I do each day.

Staffing developments Another year has passed and there has been many changes within Cancer nursing. LCTC nursing was fortunate to receive an increase in nursing FTE this year.

We welcome some new nursing staff members to our team. Tim Zhou (RN) joins us having worked at the Peter McCullam hospital in Melbourne. Tim is an experienced nurse who has enlightened CTC nursing with some of his contagious humour. Elaine Barrett (RN) joins us from CB5C Haematology ward. Elaine joins us with extensive experience in the UK. Prior to coming to Liverpool she worked in cancer Services Newcastle. Naga Ponnam (RN). Joins us from CB5C Haematology. Naga also has been trained in apheresis procedures. Naga has a passion in cancer services and is another valuable asset to CTC nursing.

Tania Luxford,

Nurse Unit Manager,

Liverpool

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May Valdez (CNS1). May has joined CTC nursing part time. May comes to us from CB5C and works both in CTC and on the ward. May is a CNS1 who also has extensive experience in cancer nursing for 19 years. May has also been working with our medical oncology team in opening a chemotherapy service with South West Sydney Private Hospital. Megan Guy (RN) joins us after her first year of nursing in a permanent position. She has some valuable experience in recovery which assisted the radiation nurses bay with brachytherapy management. Kim Sharkey (RN) was successful in a permanent position in the ambulatory haematology unit. Vinodini Onawale (CNS1) was successful in joining LCTC clinical trials team for haematology. The new graduate RN’s that joined our service were; Megan Guy, Charles Lu and Cindy Bowman. Charles Lu has gone on to his 2nd new grad rotation and Cindy Bowman has joined CTC for her second rotatation.They have been working in the radiation bay and have been a valuable asst to our nursing team. We also farewelled one of our team members. Jeanette Suurdt. Jeanette and her husband Tim returned back to Canberra. Jeanette was such a valuable asset to CTC nursing and the Lung team within LCTC.

Professional development Many cancer nurses have been working hard throughout the year in maintaining their professional development. I am proud to add that we have many nurses currently studying at University.

Joanne Bartley‐ has completed her bachelor of nursing with professional honours in oncology with UTAS. Joanne has also completed her radiation nursing certificate Joanne has almost finished her masters in nursing with UTAS

Yvette Furney has completed her transition to nursing with Charlesturt university. Yvette is also in her first year of Bachelor of Nursing at Charlesturt University

Lalyne Ing is currently doing her masters in oncology and haematology with Sydney university

Alana Paterson is currently doing her masters in haematology with Sydney university.

Naga Ponnam is currently doing his Masters in haematology at University of Tasmania.

Amy Wholohan has completed her Oncology Certificate via UTAS

Megan Guy is currently doing her post graduate certificate in nursing education.

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Ambulatory Haematology Unit One of our biggest achievements in the last year has been the opening of the ambulatory haematology unit. This unit has 3 beds and 3 chairs. The unit also supports the bone marrow biopsy room. The unit is staffed with 1 CNS2 and 1 RN, with a second RN joining the team soon. This unit includes management of bone marrow transplant patient’s pre and post transplant. Through the work maintained in the unit, there has been a high report of patient satisfaction. This unit has prevented bed block as a result of supportive treatment and ongoing treatment such as blood product transfusions.

Radiation Nursing Radiation nursing has had a busy year. We now have 4 nurses who work in radiation bay. LCTC has been successful in getting a radiation oncology CNC1, who will work with the radiation bay nurses to develop nurse led clinics and many more activities. The nurses in the radiation bay are also looking at ‘models of care’ for radiation nurses and in the next year there will be some positive changes made as a result.

Chemotherapy Nursing The chemotherapy has had a significant increase in patients treated at LCTC within the last year. We have such an amazing team of nurses, whom have truly put in some hard yards in the last year. All nurses are looking at ‘models of care’ and the future for LCTC nursing. This involves looking at what we do within the unit and identifying ways to improve. It will be an ongoing project with some positive outcomes. The assessment unit reopened this year and has already proven to be a valuable clinic for all LCTC patient’s. The assessment unit was one of the nominations in the SSWLHD quality awards. Whilst we did not win we are very proud of this service. All LCTC nurses have been given profiles to work on and there is some great work planned for CTC nursing. A huge thank you to Amy Wholohan, whom has worked with all nurses to achieve this. Samuel Hughes and Tania Luxford joined the LCTC Dry July Team this year. Samuel was also on the Dry July promotional DVD with 2 patients currently having treatment. All other nurses supported this event by purchasing a Dry July T‐shirt and sponsoring either Sam or Tania.

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Staffing

NURSE UNIT MANAGER Tania Luxford

Clinical Nurse Educator Amy Wholohan

CLINICAL NURSE CONSULTANTS Lenore Knapman ‐ Medical Oncology Karl Jobburn ‐ Haematology Rosemary Craft ‐ Gynae Oncology Charmaine O’Connor ‐ Palliative Care Gai Fairnham ‐ Bone Marrow Transplant Jodie Peronchik‐End of Life Care

CARE CO‐ORDINATORS Sharon Linden ‐ Colorectal Jeanette Suurdt ‐ Lung Luci Dall’Armi ‐ Head & Neck Pharmila Sapkota ‐ Breast Wafa Trad ‐ Neuro Oncology Abby Krige – Haematology Greg Webb‐ Lung Diana Ngo‐ GU Amy Wholohan part time acting CC for colorectal

CLINICAL NURSE SPECIALIST GRADE 2 Alana Paterson

CLINICAL NURSE SPECIALIST GRADE 1 Betty Silaphet Vinodini Onawale May Valdez

REGISTERED NURSES Joanne Bartley Rhonda Eke Kim Sharkey Tanya Tesauro Leah Baker Samuel Hughes Christine Hardy Jinky De La Paz Tim Zhou Elaine Barrett Naga Ponnam Rani Prasad Vu Tran Megan Guy Cindy Bowman

ENROLLED NURSES Carol Doherty Yvette Furney Rhonda young PALLIATIVE CARE NURSES Naomi Ellis Lesley Regaldo Achamma Roy

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Liverpool 5C Haematology Ward / Apheresis Unit 5C is a 26 bed specialist Haematology ward, inclusive of bone marrow transplant servcies. Staff provide the highest quality of care to haematology patients and their families and are constantly updating their knowledge to ensure best practice. The nursing staff are led by the Nurse Unit Manager, Aaron Mason and supported by a Clinical Nurse Educator and a Chemotherapy Clinical Nurse Specialist The Apheresis Unit is a Monday to Friday outpatient unit. Apheresis deals with the separation of blood cells and the collection or removal of a component of blood, e.g. Stem Cells, Red Blood, White Blood, Platelets or Plasma are removed. This is to help people with varying Haematological, Neurological, Renal, Respiratory and Dermatological diseases. Examples of treatments and diseases are: Haemopoietic Progenitor Cell Collection (Stem Cell Collection) e.g. Multiple

Myeloma, Leukaemia, Non Hodgkin's and Hodgkin’s Lymphoma. Therapeutic Plasma Exchange (TPE) e.g. Multiple Myeloma, Waldenstrom’s

Macroglobulinaemia, Myasthenia Gravis, Peripheral Neuropathy. White Blood Cell (WBC) or Platelet (PLT) Depletion e.g. for Leukaemia,

Lymphoma and Myeloproliferative disorders.

Red Cell Exchange (RBCX) e.g. Sickle Cell and Thalassemia diseases.

Highlights Staff presented a poster regarding conversion of the ward into a Bone

Marrow Transplant Unit at the EBMT in London, Karen Baker, Alison Hill and Alexey Rudnitskiy will be travelling to the UK to present this poster.

The first Allogeneic Bone Marrow Transplant was performed at LVH and the team continues to streamline this service.

The successful regrading of two Haematology RN positions to Clinical Nurse Specialist 2 level one position in the Apheresis Unit and other for the Chemotherapy Nurse position.

Upgrading of the Cobe Optia machines with Bone Marrow processing software. This now completes the phasing out of the previous Cobe Spectra machines.

Key Performance Indicators Hand hygiene compliance rates are currently sitting at 91 %. Work is ongoing

to improve infection control standards and the BMT network and infection control unit have been involved with this process.

New NARCO spray has been implemented to improve single room disinfection post patient discharges.

Work continues to improve falls and pressure sore management; all 5C staff should be commended for their efforts and their commitment to improving patient care.

NATA accreditation has been achieved for the Apheresis Unit through the hard work of Julie Stone, Karl Jobburn and Gai Fairnham.

Aaron Manson,

Nurse Unit Manager

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Research and Education Staff are encouraged to attend relevant courses and are supported by both the unit and the facility. Specific inservices are provided to staff to ensure a high level of care can be delivered. This has been achieved over the year to increase core knowledge base of all nursing staff.

Challenges Recruitment is always a challenge in the health care arena. Recruitment has been ongoing throughout the year with a number of experienced new nurses commencing in 2012/13. Some of our permanent nurses have moved on to other challenges and we continue to support graduate nurses in the first year during their 6 monthly rotations.

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Bankstown Nursing Service

With increase in patient treatments and limited space in the department the nursing staff have maintained a high standard of service and care. The patient treatments in the Chemotherapy Suite have increased by 100% over the last 5 years.

Achievements

Staff have been able to attend conferences and meetings, usually in their own time so they can learn, network and transfer the knowledge to other staff. These conferences include survivorship/wellness and COSA.

The unit was nominated for Excellence in Nursing and Midwifery award in the category of Excellence in Team Clinical Practice Award.

Two nurses are currently undertaking a Diploma in Oncology Nursing via UTAS.

Weekly formal inservices have been conducted.

Hosted a Education Day for Arabic speaking patients, families and friends.

Patient satisfaction survey for Cancer Centre translated into three languages (Chinese, Arabic and Vietnamese).

Developed patient telephone survey to assess the benefit of follow up phone calls post 1st cycle of chemotherapy.

Planning Day held to discuss the direction of the Cancer Centre.

Participation in MSSA pharmacy survey to establish a benchmark in the safe administration of chemotherapy.

Four staff members attended WOOLCOCK Epidemiology research workshop this year.

All nurses have undertaken ADAC in Medical Oncology

Communities of Practice has been introduced in the Department.

The Unit has been involved in hospital based quality activities.

The education of University Nursing students has been ongoing.

A permanent part‐time position for CNS in Palliative Care has been developed.

Development of end of life pathway has also been developed. An advertisement has been placed for CNS permanent part‐time for this role.

Nursing Staff:

Patrick McQuaid – NUM Sharelle Ioannou – CNC Judith Merry – CNC Cancer Care Co‐ordinator Upper GI Mary Maclean‐ RN Zami Nyathi – RN

Connie Rosevear – RN Jennifer Stewart – RN Roseanne Wong – RN Clinical Trials Nikki Oakley – CNC Palliative Care Laurel Walter‐ CNS Palliative Care

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Cancer Care Coordinators Neuro Oncology Cancer Care Coordinator‐ Wafa Trad I am the Neuro‐Oncology Cancer Care Coordinator for all patients diagnosed and treated with a Primary Central Nervous System Tumour within SWSLHD. I am primarily based at Liverpool and Campbelltown Hospitals. I commenced my role as Neuro‐Oncology Cancer Care Coordinator in May 2012 and have found that the patient journey within the health system is often complex and tumultuous because of the symptomatic repercussions experienced due to the difficult nature of their disease. I am the primary point of contact for patients and carers and coordinate inpatient, outpatient and/or community patient‐centred care by liaising with the appropriate members of the MDT to ensure that the patient physical, social, environmental, spiritual and psychological needs are fulfilled as required. My role encompasses symptom identification and facilitation in management of patients in a clinical outpatient setting as well as psycho‐social screening ensuring that patients and carers are referred to the appropriate services. In addition, I am a resource to colleagues, patients and carers on primary brain and spinal tumours, their treatment and facilitation of patient recruitment to relevant trials and studies.

Haematology Cancer Care Coordinator‐ Abby Krige Some of the highlights from my role as the Haematology Care Coordinator during 2012/13 included:

Provide patient education and counseling of Haematology patients ‐ MDT referrals; psychosocial assessment; provide relevant literature; follow up; coordinate the scheduling of tests, appointments and treatment

Run weekly ‘Living Well’ (survivor) Clinic with Haematology Social Worker for newly diagnosed Lymphoma patients post treatment. All newly diagnosed Lymphoma patients who complete chemotherapy, chemo‐radiotherapy and/or stem cell transplant are invited to attend a clinic run by myself and Social Worker to help debrief, assess psychological and physical impact of treatment, teach self care, teach self monitoring for recurrence and ensure follow up plan understood. Clinic structured around concept of Wellness based on ‘Hettler’s Wellness Wheel’. Currently evaluating this clinic.

Arrange booked admissions for planned inpatient chemotherapy and liaise between ward and patient on the day of admission as well as arrange unplanned admissions from clinic via bed manager and arrange area for patient to stay in whilst waiting for bed i.e. Ambulatory Haematology Unit

Wafa Trad, Neuro Oncology

Care Coordinator

Abby Krige, Haematology

Care Coordinator

Cancer Care Coordinators

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Commenced ‘Practical Project Manager’ Course ‐ working on project involving the development of an outpatient DVT clinic to help clear ED and ward beds; created project proposal and project plan; working on Patient Information pamphlet and liaising with others in Project Team for development of education and policy

Working with Ingham Institute on larger project involving Haematology patients; plan to evaluate their information seeking behaviours and information needs

Developed ‘medication list’ to give to patients who are on certain chemotherapy protocols as discovered a lot of confusion amongst patients with new medications, what they are for and how to take them which has decreased phone calls for medication clarification

Co‐Chair of Haematology/Oncology/Palliative Care Community of Practice at Liverpool Hospital

Presented poster at Survivor Conference, Adelaide and HAA, Melbourne

Continue to develop role of Care Coordinator within Haematology

Genitourinary Care Care Coordinator‐ Diana Ngo Since commencing the new role as GU CCC in October 2012, I have been providing information, education, and support and counseling to GU patients from diagnosis through to completion of their cancer treatment. My role as the GU CCC at a clinical level involves:

Participating in GU MDT meetings and communicating outcomes to the patient

Coordinating the implementation of a patient care plan including the provision of information and referral to appropriate support services

Coordinating and facilitating the continuity of patient care

Facilitating the scheduling of appointments/treatment with Urology, Radiation Oncology and Medical Oncology

Providing psychosocial support to patients and carers

Providing education to patients and carers

Identifying patients for clinical trials

Monitoring the implementation of care against the patient care plan

Run Androgen Deprivation Therapy (ADT) Clinics for high risk Prostate Cancer patients undergoing ADT. Provide education on side effects of ADT and how best to manage these side effects and inform their General Practitioner of same.

Run ‘Seed Chat’ Clinics for Prostate patients undergoing Radiotherapy. Educate them on the procedure and preparations prior to procedure.

Diana Ngo,

Genitourinary Care

Coordinator

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My role as the GU CCC on a professional development level involves:

Development and distribution of patient information brochure titled ‘Hormone Therapy for Prostate Cancer’ to alert patients on possible side effects of hormone therapy and how to manage some of the side effects

Implementing the new regime for the ADT clinic (with GU tumour stream Radiation Oncologists) for better management of high risk Prostate Cancer patients on Hormone Therapy. Have also developed pathways to demonstrate same.

Reviewing and updating all GU patient information in collaboration with Radiation Therapist.

Conducting presentations on my role as a care coordinator to new graduates, ward staff and allied health.

Conducting presentations to 2nd and 3rd year Phase III Medical students on the role of care coordinators.

Developing (in collaboration with other Cancer Care Coordinators) the Cancer Care Coordinator/Clinical Nurse Consultant Resource Manual as the first step for future succession planning of Care Coordinators‐ in progress and currently under review

Head & Neck Cancer Care Coordinator‐ Luci Dall’Armi The Cancer Care Coordinator (CCC) acts as a ‘primary point of contact’ for people with Head and Neck (H&N) cancer, their carer or family members and their medical, surgical, nursing, allied health, general practitioners and community service providers. The aim of the service is to meet the complex needs of these patients and assist them to travel more smoothly through the health system, gain optimum outcomes and improve the overall experience. The CCC provides information, education and support; makes functional and psychosocial assessments and appropriate referrals; and troubleshoots any queries or concerns throughout the entire journey from time of diagnosis, throughout treatment and into survivorship and wellness or into palliative care. The H&N CCC supports the Multidisciplinary team comprised of radiation and medical oncology, surgery, oral medicine/dental, imaging and pathology, nursing and allied health. Some of the highlights from the past year include:

Certificate of Achievement ‐ International Nurses & Midwives Day, May 2013.

Conference presentation ‐ Dall’Armi, L., Simpson, T., Bell, K., Baxter, C. & Forstner, D. A Pre‐treatment clinic for high‐risk Head & Neck cancer patients. The Power of Innovation: A health care system to meet our needs. NSW Health Symposium. 19 Oct 2012. (Poster)

Finalist 2012 NSW Health Awards ‐ Cancer Services, South Western Sydney Local Health District. For Quality improvement project: ‘A Pre‐treatment clinic for high risk Head & Neck Cancer Patients’. Sep 2013.

Invited to join Cancer Institute NSW, Cancer Care Coordinator, Community of Practice steering group ‐ An initiative to support the role of cancer care coordinators throughout NSW and provide online education forums.

Luci Dall’Armi,

Head & Neck

Care Coordinator

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Author and editor of patient information booklet ‘Going home with a Laryngectomy Stoma: A guide for patients and carers’. Now available on line on SWSLHD Cancer Services webpage.

Co‐founder and co‐chair of Haematology/Oncology/Palliative Care Community of Practice (HOP COP) senior nursing committee for Liverpool Hospital. Also represented this group at the Liverpool Hospital Nursing and Midwifery Clinical Practice Committee.

Continue to organise and run a multidisciplinary nursing and allied health (social work, dietetics and speech pathology) Pre‐treatment clinic for high‐risk H&N cancer patients for assessment, education and support. Conduct post‐treatment follow‐up assessments.

Future plans include:

Invited to be co‐investigator on research project: ‘Working towards improving the psychosocial outcomes for cancer patients who undergo head and neck surgery through addressing unmet information needs’. Hunter New England Cancer Services and Hunter Medical Research Institute. Aug, 2013.

Developing and planning a new Model of Care for all Cancer Care Coordinators of SWSLHD.

Write and develop a ‘Survivorship Care Plan’ for the H&N Cancer Service of Liverpool and Macarthur Cancer Therapy Centres.

Partnership with Prof A Girgis, Translational Cancer Research Unit (TCRU) Ingham Institute for Applied Medical Research for research and statistical support for evaluation of ‘Quality improvement in H&N cancer patient management: Pre‐treatment clinic’ project. From Oct 2012.

Lung Cancer Care Coordinator‐ Gregory Webb I started in the lung 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 Lung Cancer patients and their carers in the year ahead. The role has been empty for almost one year. I will be organizing the GP education night in the New Year where lung cancer consultants (medical oncology, radiation oncology, thoracic surgeon, palliative care and respiratory consultant) will speak with a group of local General Practitioners. In addition to attending all Lung MDT meetings, I see all new lung cancer patients at their first appointment, providing information and support materials. I also spend one day a week at Campbelltown Hospital seeing lung cancer patients and their carers/families.

Bone Marrow Transplant Coordinator‐ Gai Fairnham 2013 began with a rush with seven transplant admissions in January. Stem cell collections and transplant admissions have continued steadily including three sibling allogeneic transplants one of which included a trip to Sweden for our BMT Clinical Nurse Specialist Alana Paterson to collect stem cells. The experience was a major learning curve requiring liaison with the BMT Coordinator in Sweden, education from the Australian Bone Marrow Donor Registry and consultation with the Bone Marrow Transplant Program at the Department of Health and Aging in Canberra. Fortunately all went smoothly.

Greg Webb,

Lung Care Coordinator

Gai Fairnham, Bone

Marrow Transplant Care

Coordinator

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Six Liverpool patients have been referred to Westmead Hospital, two to St Vincent’s Hospital and one to Royal Prince Alfred Hospital for unrelated allogeneic transplant. Successful NATA (National Association of Testing Authorities Australia) accreditation took place in July, 2013. Assessment of Donor Work up, Stem Cell Collection in the Apheresis Unit and the Bone Marrow Transplant Laboratory took place over two days. Results were very pleasing. Patient Education sessions have taken place in March and October and continue to be well received by patients and their families. Abstract and Poster “Conversion of medical haematology oncology ward to a specialised BMT ward” was presented at the European Bone Marrow Transplant Meeting in London in March, 2013 by nursing staff Karen Baker, Allison Hill and Alexey Rudnitskiy to which I contributed. Congratulations to these staff for their efforts. Outpatient chemotherapy for stem cell mobilisation has commenced in the BMT Stepdown Unit with those patient’s deemed suitable spending approximately six hours receiving their treatment and education then going home instead of requiring a stay on CB5C for 24‐72hours.

Colorectal Care Coordinator‐ Sharon Linden & Amy Wholohan Currently the position of Colorectal Cancer Coordinator is shared by two staff members, Sharon Linden & Amy Wholohan. Amy commenced her secondment in March to cover a portion of Sharon’s maternity leave. They are currently job sharing the position with Amy working 3 days & Sharon working 2 days per week. The Colorectal Cancer Coordinator attends Liverpool, Bankstown and Campbelltown hospitals seeing both medical and surgical inpatients & outpatients. Colorectal Care Coordination Clinics are facilitated by the coordinators for medical oncology and radiation oncology patients at both Liverpool and Bankstown Hospitals. The aim of these clinics is to see patients at diagnosis/ their first oncology visit and to provide them with information brochures, resources and contact numbers, and to make appropriate referrals to ensure they have the access to care and support as required. Over the past 6 months Amy has completed the Metastatic Colorectal Cancer online course & has been working on developing ‘patient education & decision making aides’ to use in clinics for Colorectal Cancer patients. Sharon is involved in developing and implementing a survivorship care plan with a working party at Bankstown Hospital which will be provided to patients at completion of their treatment to streamline colorectal cancer follow up. Both care coordinators are collaborating on generic projects such as the development of a Care Coordination Resource Manual, survivorship pathways, Care Coordination models of care & development and implementation of a generic Care Coordination Clinic.

Alana Patterson, Bone

Marrow Transplant

Clinical Nurse Specialist

Sharon Linden,

Colorectal Cancer

Care Coordinator

Amy Wholohan,

Colorectal Cancer

Care Coordinator

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Oncology Pharmacy ‐ Liverpool 2012‐2013 has been a busy year for the Cancer Therapy Centre (CTC) Pharmacy with a number of changes to staffing. Vy‐Vy Tran has been acting up as Senior Pharmacist (to cover for Rebecca Grundy’s maternity leave) and will start her own maternity leave in October 2013. Rebecca Grundy returned from maternity leave in July 2013 to take up her previous position as Senior Pharmacist CTC on a part time basis of 3 days per week. Sugantha Thumbadoo and Raymond Kumar continue as full time Pharmacists in CTC. David House continues as full time Pharmacy Assistant. The CTC Pharmacy workload has increased this year which has been made possible by employing an additional Pharmacist. There are still plans to employ a second additional Pharmacist who will be responsible for work associated with Haematology/Oncology Clinical Trials and the new allogeneic stem cell transplantation service. CTC Pharmacy continues to provide the following quality services:

Onsite chemotherapy production

Provision of a Medical information to Medical and Nursing staff

Provision of a Clinical Pharmacy service to Medical Oncology/Radiation Oncology and Haematology inpatients and outpatients

Management of compassionate drug programmes

Regular participation in multidisciplinary team meetings

Patient Education

Involvement with Medical Oncology/Haematology Clinical Trials and Research Committee

Protocol development for Medical Oncology/Haematology

Utilisation of the electronic prescribing system (MOSAIQ) for outpatient chemotherapy

Rebecca, Vy‐Vy, Sugantha and Raymond are members of the Society of Hospital Pharmacists of Australia (SHPA) and Vy‐Vy and Rebecca are also members of the International Society of Pharmacy Practitioners (ISOPP). They continue to update their knowledge with a variety of continuing professional development activities. Sugantha, Vy‐Vy and Ray attended the ISOPP symposium held in Melbourne in August 2013. Raymond was also selected to attend the Clinical Oncology Society of Australia (COSA) conference in Brisbane in November 2012.

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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 including the Chemo Suite, PACS , ICU, Immunology Clinic, EPAS and the Day Surgery Unit.

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

Liasing with Medical staff , nursing and administration staff

Administration of Compassionate and Cost‐Sharing medication programmes.

Participating in continuing education programs

Participating in clinical drug trials

Provision of staff education to other departments

Senior Oncology Pharmacist 1 FTE Pirkko Boyd Oncology Pharmacist 0.4 FTE Henry Huynh Pharmacy Technician 0.8FTE Nicole Dewar Pharmacy Technician 02.FTE Michele Joyce

Highlights The Pharmacy department implemented on‐line claiming through Medicare for Section 100 High‐Cost drugs in March 2013. Staff training was undertaken and notifications of the proposed changes were provided to our Medical Oncology team. This on‐line claiming process has meant faster reimbursement of funds for high cost drugs used in the organization.The implementation went smoothly with little disruption to our usual services.

Key Performance Indicators Our i‐Pharmacy dispensing program allows us to report the number of dispensing of chemotherapy drugs. In the financial year ending 2013, MCTC Pharmacy engaged in 5753 dispensings of cytotoxic medications. This is an approx 15% increase compared to 2012 when it was 4987.This does not include dispensing of all non‐cytotoxic medications which are Included in our patients chemotherapy protocols.

Research and Education This year, Nicole Dewar has been awarded Certificate 1V in the Pharmacy Technicians Course run by the Charles Sturt University. Nicole completed Certificate 111 in 2011. Michele Joyce (pictured) was awarded Certificate IV in 2012. Intern pharmacists and Pharmacy students are given orientation and introductory training in Pharmacy Oncology services.

Pirkko, Nicole & Henry

Michele Joyce

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Henry and Pirkko attend and presented in‐services conducted in the Main Pharmacy and attend in‐services conducted by pharmaceutical companies. Pirkko attends the quarterly Oncology Pharmacists Network Group meetings. In October 2013 Henry will attend the Society of Hospital Pharmacists Haematology/Oncology Advanced Seminar. In Nov 2013 Pirkko will attend the COSA Annual Scientific Meeting.

Challenges This year has seen tremendous growth in the number of chemotherapy treatments with no enhancement of staffing. Clinical trial participation continues to grow as well, so our existing staff have had to cope with the increased workload. Staff shortages in the Main Pharmacy has meant additional pressure on CTC staff who are also required to assist in the main Pharmacy.

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Page 114 of 192

COMMITTEES, P

ROJE

CTS &

PROGRAMS

Page 115 of 192

SWSLHD Consumer Participation Committee

The Consumer Participation Committee operate under the SWSLHD community participation framework for service involvement to contribute to the development of our service. The membership aims to collect the views of patients and carers from diverse backgrounds and locations throughout the local district.

Achievements This year, the group has been pivotal in providing patient transport, through a bus donated from Peter Warren. The group have also provided advice on local bus routes and appropriate stops, suggested access points to services during refurbishments, and hospital wide golf cart transport. We have tested patient education materials, wellness programs, saturation of web information. We have also discussed fundraising, use of volunteers and better use of patient wristbands. Discussions and work has commenced on future design of wellness centre and programs.

Challenges Coming up with new ideas can be difficult for any group, so a strategic approach has been adopted to focus on areas of need that have been identified, and seek advice from a user perspective. Appointment of new members has been low this year, so we will introduce a recruitment drive in 2013, to increase awareness of this unique opportunity to join the group and contribute to the service.

Future Projects/Expansion of Services Consumer involvement has been incorporated into SWSLHD Cancer Services strategic plan, with responsibility for key strategies falling to the Consumer Participation Committee. Our priorities for 2013/14 will be:

Revamping the SWSLHD Cancer Website, introducing new information.

Participation in the design and build of Wellness centre programs

Road‐testing patient self‐management tools.

Options to be involved with fundraising activity.

Designing solutions for Volunteer utilisation.

Further engagement from Culturally and Linguistically Disadvantaged people in the service

Review of patient feedback and satisfaction surveys

Review of patient information provided throughout cancer care

Patient access to services

Carers support and informative resources

Consumer involvement has

been incorporated into the

SWSLHD Cancer Services

strategic plan.

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Members Sandy Avery (Chair) Melissa Carmagnola (Minutes) Geoff Delaney Ann Wood Brian Rope Elaine Crockett Elizabeth Lowe Jayne Robinson Janet Harrison

Janice Low Jenny Chau Joan Lewis John Newsom Laurel Peel Leanne O’Grady Monica Vasquez Maureen O’Sullivan

Above: L to R – Sandy Avery, Jayne Robinson, Janice Low, Melissa Carmagnola, Laurel Peel, Elaine Crockett, Geoff Delaney, Joan Lewis,

Janet Harrison, Maureen O’Sullivan

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SWSLHD Education Committee

The Patient Education Committee (formerly the Education Committee) focuses on all aspects of patient information/education needs; our goal is to ensure that the right information is provided at the right time in the right format. The committee is now in it’s second year and continues to have broad representation from facilities and disciplines across the LHD. The committee convenes on a monthly basis to monitor, implement and review the educational material provided by our clinicians to cancer patients in SWSLHD. Ensuring our information is up to date, easy to access, in a language/format that can be understood by the reader/listener, delivered at the right time and is appropriate for each individual is fundamental to the cancer care provided by the LHD.

Highlights The focus for the committee this year has been on the SWSLHD Cancer Services website. A detailed review of the educational content and recommended links has provided the group with the opportunity to update and streamline the information available. This process remains ongoing but has already improved the quality and availability of evidence based information for our patients, carers and colleagues. Another key piece of work has been the development of the ‘General Treatment Information Booklet’. This ten page booklet is suitable for all cancer patients and their relatives. This booklet provides an overview of services and treatments, including staff contact details and links to relevant websites.

Key Performance Indicators Over the past year the committee has been trialling the patient diary (developed in 2011/12) across the district. Cancer Therapy Centres at Bankstown, Macarthur and Liverpool have offered their patients and carers the opportunity to utilise the folder as a simple way to collate and carry information. An evaluation of this folder is currently underway.

Challenges Overseeing the educational material available for our patients and carers requires ongoing commitment from our staff. The Patient Education committee does an exceptional job of ensuring that patients and carers from SWSLHD are able to receive and access timely and relevant cancer care resources. The ever expanding ‘world wide web’ offers our consumers a plethora of information that can sometimes be misleading and hence the overarching challenge for this committee is to maintain the validity and evidence base of the information we provide.

Above: General Treatment

Information Booklet

Page 118 of 192

Staff Education & Development Programs

Journal Club Speaker(s) Topic Joanne Bartley Burnout and Stress in Oncology Employees

Geoff Delaney Cancer Survivorship – examples of evidence, barriers to implementation and developing a plan

Eng‐Siew Koh Key messages from the February 2013 FCIC Cancer Survivorship Conference

Associate Professor Yves De Deene Quantitative MRI and MRS in Radiation

Annabel Goodwin Psychosocial Aspects of Genetic Testing and Contralateral Breast Cancer Risks & Family History

Dr Joanne Fardell Conquer Fear: A Psychological Intervention For Fear

Sumit Lumba and Stephanie Lim The Black Cancer

Kim Chiew Radiation Pneumonitis

Annette Tognela Two Cases of weakness

Carol Nguyen / Hung Nguyen Radiotherapy workshop in Vietnam

Paul De Souza Update On Renal Cancer

Kerrie Noonan The Groundswell Project

Mark Lee Liver stereotactic ablative radiotherapy

Nasreen Kaadan Health Informatics Summer School

Amanda Fernando Adolescent Oncology

Christine Tawfik, Cesar Ochoa, Glen Dinsdale Tomotherapy Update

Radiation Oncology Research Showcase

Ashanya Malalasekera It’s now or never: Dilemmas in Fertility Preservation in two Breast Cancer Patients

M&M Presentation

Philip Stevens Clinical Yoga: Applications of evidence based techniques for use in clinical practice ‐ stress, sleep and quality of life

Professor Jake Van Dyk Technological Evolution of Radiation Oncology: What Else is New?

Gary Liney The Use of MRI in Radiotherapy Planning

Kelly Mok ASCO Update

Jacquie Oehme Using an ethical framework for clinical discussion making in advanced illness.

Karen Wong Evidence‐based estimation of the optimal number of radiotherapy fractions

Page 119 of 192

SWSLHD Quality Committee Cancer services are committed to providing quality care for the patients of SWSLHD. Care that is safe, accessible, patient centered, efficient and effective underpins our strategic plan and drives our operational focus. The goal of the SWSLHD Cancer Services Quality Committee is to provide a forum for central reporting & communications related to Cancer Services quality projects and activities. The SWSLHD Cancer Services Quality Committee had its inaugural meeting in February 2013. The committee has membership representing each of the SWSLHD facilities, services and disciplines. The group meets on a bi‐monthly basis and aims to: 1. Facilitate the promotion of Cancer Services’ quality activities 2. Oversee the development and review of LHD Cancer services policies &

procedures 3. Develop & monitor a SWSLHD Cancer Services Quality Action Plan 4. Facilitate LHD customer service initiatives to improve services to patients

and carers 5. Review RCA’s and incident trends

Highlights One of the highlights for the committee to date is the development of a Cancer Services Quality newsletter. Communication is key to promoting, supporting and encouraging quality activities and the committee has prioritized the development of new and user friendly communication strategies. Our first publication is currently under review with plans for distribution in September 2013. Another emphasis has been on the sharing of relevant information amongst the group to determine where the strengths and weaknesses of our quality activities lay. This is helping to shape the direction of our future efforts in terms of supporting and engaging the staff in all quality related actions. Some of the projects commenced and/or completed in the past 12 months include:

Patient Experience Trackers Survey Project implemented at Bankstown, Macarthur and Liverpool cancer services

“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.

Outpatient DVT Management project

Review of Chemotherapy utilization and booking process at LVH

Review and update of all Cancer services LHD policies

Implementation of ADAC = Antineoplastic Drug Administration Course across the LHD to standardize the chemotherapy accreditation processes.

Development of monthly quality dashboards

Cancer services website update

Patient Experience

Tracker

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MDT projects reviewing the admission, administration and discharge of patients

Update and development of patient information resources

Patient satisfaction survey for patients’ cancer experience at Bankstown

Retrospective descriptive study on compliance with nutrition intervention for H&N patients

Current nutritional intervention practices in patients receiving autologous stem cell transplants at Liverpool Hospital

Evaluation of patient satisfaction on meal option in Haematology and palliative/oncology ward

Characteristics of patients receiving prophylactic gastrostomy tubes in head and neck cancer patients

Gastrostomy tube dependency in head and neck cancer patients undergoing chemo‐radiation at Liverpool Cancer Therapy Centre

Effectiveness of a pre‐treatment clinic on nutritional outcomes for head and neck cancer patients

Bereavement Support Model of Care development

Living well after breast cancer treatment – evaluation of program

Evaluation of the Lymphoma Living Well after treatment

Cancer Survivors Exercise Program

Quality Improvement Project for Bereavement Support Services – What happens to the carer after the patient died? Phase One – Braeside Hospital

Collection of Functional Oral Intake Scale in head and neck cancer patients

Development of a Quality newsletter for all staff

Future Projects Alternative diet therapy and supplement use among patients receiving

chemotherapy

Qualitative study on barriers for adhering to the nutrition therapy among H&N patients

Development of electronic discharge guidelines for cancer patients

Improved communication with GP’s re: patient care

Committee Members Nursing/Bankstown Patrick McQuaid Radiation Therapy‐BNK & Macarthur Kirrily Cloak Haematology – LVH Karl Jobburn Nursing/Macarthur Denise Burns Palliative Care/LHD Janeane Harlum & Therese Smeal Allied Health (rotating attendance) Katherine Bell, Christina Jandzio,

Simone Hallet Fairfield (distribution list only) Fairfield Executives

(Sandra Lombardini) Bowral David Ryan Community Health Penny Waldon Medical – BNK Sandra Harvey SWSLHD Jayne Robinson ‐ CHAIR SWSLHD Janeen Jackson – SECRETARY

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SWSLHD Cancer Innovation Projects

The Cancer Institute of NSW (CINSW) has been working with health services across NSW to develop and improve cancer services. Each year, the CINSW meets with the Cancer Services Directors and Chief Executives, to discuss the performance of the service in each district. This program is called Reporting for Better Cancer Outcomes (RBCO), and provides some grant opportunities for funds to support service improvement.

Key Performance Indicators 1. Planned Cancer services linked with NSW Cancer Plan. SWSLHD Cancer Services

held a planning day in Feb 2013, and developed a Strategic Cancer Plan.

2. A Quality Improvement plan was developed, and submitted to CINSW to verify our commitment. It prioritised 7 innovation projects (see left), and we have a consumer group who review and provide insight into key aspects of this plan.

3. Participation in community of practice: Representation at innovation forums, including a poster award at the CINSW Innovation symposium in August. Also attending the QSEAC and innovation teleconferencing.

4. Clinical Redesign: Working with redesign unit on improving Multi‐disciplinary care,

discharge planning and referral guidelines.

5. RBCO performance reviews with CINSW; annually.

6. Clinical Trials: Growth in trial recruitment has been demonstrated this year.

7. Communication: a strategy for good links with CINSW‐funded staffing. We have been working with local General Practice to improve communication. Through the Medicare Locals, we hope to provide education and disseminate information regarding our service, to build meaningful GP messaging. A small working group has been updating our website. We hope that the new look webpages will attract greater interest, and links with our referral guidelines project, and improves relationships with local providers.

Cancer Services have also partnered with the Ingham Institute, the South West Sydney Medicare Local and the Fairfield GP Unit. This project, headed by Dr. Andrew Knight aims to complete a qualitative study exploring general practitioner views about what is required to improve integration of cancer care across our district. GP’s were generally positive about cancer services but called for more timely communication, easier access for information and for improved clarify around roles in long term cancer care. A new project has commenced aimed at addressing some of these issues.

CANCER INNOVATION

1. Information systems usage

2. Co‐ordination of MDT care 3. Web technology for

patients

4. Wellness models of care

5. Access to palliative care

6. Strategic research 7. Consumer engagement

Sandra Avery, Cancer

Systems Innovation

Manager

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8. NSW rollout of projects: Multidisciplinary care is under review in this LHD. We expect to have 3 portable aspects that can be taken up across the state; referral guidelines, including enhancement to the CanRefer.org.au website for GPs, and discharge careplans, that we hope will be taken up by CINSW as an enhancement to the EVIQ online guidelines. As well as an electronic MDT referral form for meeting discussions that can be used as a data collection tool for ECOG and MDT data items.

Future Initiatives Wellness and Survivorship will be a key focus area for our service in 2014 to enable us to maintain appropriate care for our increasing numbers of patients. We will undertake the design and build of 2 Survivorship Centres, including an ambitious fundraising and marketing campaign, as well as strategically planned, robust, evidence‐based survivorship programs for patients and carers. These programs will be in addition to the current supportive groups and therapies already offered in our wellness areas at Liverpool and Macarthur Cancer Therapy Centres, and co‐ordination of a Bankstown wellness program. Working with other health services and universities, we will develop an online tool that collects patient reported outcome measures, and provides assistance for patient self‐managed care. This will be a first in NSW, and we hope that working with the CINSW and BUPA will assist in rolling out this integrated program across Australia. Asking about a service and it’s direction, provides key information for improvement ‐ some of the ways we have extracted feedback this year have included patient experience surveys, a provider review into aboriginal awareness, Multi‐disciplinary co‐ordination of care, an LHD strategic planning day, Bankstown Cancer Service planning day and a Survivorship planning day. All have produced valuable insights for planning.

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MULT

IDISCIPIN

ARY CARE:

TUMOUR GROUPS

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Multidisciplinary Care: Tumour Groups Multidisciplinary teams are a method to ensure best practice in cancer care by encouraging peer review and peer support. Tumour specific teams ensure all relevant expertise is focused on individual patient’s problems. Meetings provide opportunities for discussion of standard evidence‐based treatments and new research results that can be introduced into practice, as well as a consistent training and mentoring forum for junior staff and continuing professional development for clinicians. Teams vary, depending upon the requirements for each Tumourgroup, and can include surgeons, a range of specialists, radiation and medical oncologists, pathologists, nuclear medicine technicians, radiologists, nursing, general practitioners, psychiatrists, psychologist, social workers, dieticians and other health professionals involved in patient treatments.

Achievements Recording agreed treatment plans forms part of patient clinical notes, and have been inconsistently collected across the groups. Largely because although a treatment plan is discussed and agreed at an MDT, sometimes things change, more information becomes available or an alternative plan presents itself, so it is best practice that the clinician has the final recommendation regarding the appropriate pathway, and the patient has the options presented to them, and provides final consent for their preferred care.

Challenges With 4500 new patients presenting every year, across several facilities, there are 18 active multi‐disciplinary tumour groups in our district. Keeping up with current members and standardizing the processes across them all is a major challenge that we are working to improve.

Tumour Groups LIVERPOOL BANKSTOWN MACARTHUR

Breast Colorectal * Gynaecological * Haematology Head & Neck * Lung * Melanoma Neurological Upper GI * Urological *

We want the most relevant

information to be available

to those involved in patient

care, MDTs are a perfect

way to do this.

MDT Admin Support, Roslyn

Frederick & Kerrianne Hancock

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Future Projects/Expansion of Services A complete review of the way we organise, conduct and record group‐directed care is underway, to share best practice and an improved standard of support to each of the groups, and to provide the most appropriate information to everyone involved in the care of our patients, including the patient and their referring doctor. Our key goals are to: 1. Improve the referral and access points to Cancer services by providing

information on our website for referring doctors about necessary investigations, and how to make appropriate referrals.

2. Continue to provide contact information on CanRefer.org.au for easy access by clinicians to local services.

3. Timely reporting of patient information back to referring doctors, for

improved ongoing management.

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Breast MDT Group ‐ Liverpool

During the 12 month period from 1st July, 2013 to 30th June, 2013 there has been 336 new breast cancer patients discussed in our weekly multi‐disciplinary discussion at Liverpool Hospital. These meetings are well attended and include representation from Surgery, Pathology, Radiology, Social Work, Care Coordination, Radiation and Medical Oncology. They are also opportunities for learning and a number of Registrars and Medical Students attend these sessions.

Highlights Our group continues to look at strategies to improve education and access to programmes. Recently, our Allied Health Group has commenced an exercise programme for patients who have completed their breast cancer therapy. Studies have shown that an improvement in body mass index, increased exercise and reduced dietary fat intake leads to a better breast cancer survival. We are specifically targeting patients considered overweight for education and ongoing support for their exercise and nutrition. Pharmila Sapkota, our Breast Care Coordinator, and Kim Brauer (Social Worker) commenced the “Living Well After Breast Cancer Treatment” programme in late 2011. This programme involves a monthly two‐hourly education group to address survivorship issues. At this time the programme is only available in English. Topics of wellness, self care and follow up care are discussed at these educational meetings. Patients are also provided with a resource pack including information of local resources. In the period 1st July 2012 to 30th June 2013 a total of 13 sessions have been conducted with 67 patients attending during this time. In collaboration with the Ingham Health Research Institute, the “Living Well After Breast Cancer Treatment” is to be evaluated using a valid survey developed by the Ingham Health Research Institute. Ethics Committee approval has been received for this research. We have re‐introduced a Journal Club once per month for additional education opportunities. Dr. Annabel Goodwin and Dr Aashit Shah have commenced a High Risk Breast Cancer Clinic at Liverpool to cater for those patients with genetic mutations that suggest that they are at heightened risk of developing breast cancer.

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Breast MDT Group ‐ Bankstown

The Bankstown Breast MDT Group meets fortnightly and discusses management of all breast cancer patients treated at Bankstown Hospital. The group comprises breast surgeons, medical oncologists, radiation oncologists, pathologists and radiologists as listed below: Surgeons: D Segara, P Soon, S Yarrow Medical Oncologists: R Asghari, S Harvey Radiation Oncologists: M Boxer, M Dreosti Pathologist: L Santos Radiologists: S Atlas, J Sacks, D Tran Breast Nurse: P Sarkota

Highlights Introduction of Breast MRI to Bankstown Hospital. Establishment of a wig library for patients undergoing chemotherapy at Bankstown Cancer Centre.

Key Performance Indicators From July 2012 to June 2013, a total of 149 patients were discussed at the Bankstown Breast MDT. All MDT discussion outcomes were documented in the electronic medical record.

Research and Education Research Projects: 1. Correlation of breast MRI findings with histopathology 2. Potential predictors of febrile neutropenia in women receiving TC

chemotherapy. 2. Survey of patient preferences discussing extensive anticancer drugs in

collaboration with Peter Mac Cancer Centre. Presentation:

1. E Clout, D Segara, P Soon. Predictors of residual cancer in breast re‐excisions in close and positive margin BCS. General Surgeons’ Australia annual scientific meeting 2012.

Challenges Access to full time breast care nurse

Future Projects/Expansion of Services Integrated electronic medical record with prescribing and pathology testing. Consensus letter generated from the MDT electronic medical record to be sent to the patients’ GP.

Bankstown Breast MDT Group

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Breast MDT Group ‐ Macarthur

The Macarthur Cancer Centre Breast Group meets fortnightly and discusses management of breast cancer patients treated within the Macarthur and Southern Highlands area. The group comprises breast surgeons, medical oncologists, radiation oncologists, pathologists and radiologists as listed below: Surgeons: E.Lim, A.Ong, K.Stewart Medical Oncologists: S.Della‐Fiorentina, B.Kiely Radiation Oncologists: G.Papadatos, K.Lim Pathologist: J.Yong Breast Nurses: V.Bell, T.Harris Nuclear Medicine: V.Fernandez Psychologist: M.Teoh

Highlights Year 3 and 4 Medical Student Teaching at each meeting Development of a “Fast‐Track” referral system through the McGrath Breast Care Nurses

Key Performance Indicators From July 2012 to June 2013, a total of 299 patients were discussed at the Breast MDT. All MDT discussion outcomes were documented in the electronic medical record. All new patients entered into Breast Cancer database.

Research and Education Research Projects: 1. ANZ Breast Cancer Trial IBIS 2 Prevention Trial. 2. ANZ SORBET study in triple negative breast cancer. 3. ANZ LATER and SOLE trial of late introduction of endocrine therapy. 4. CARE Survey on use of Oncotype Dx as decision support for early stage breast

cancer.

Challenges Increased case load may require weekly meetings in 2014

Future Projects/Expansion of Services Consensus letter generated from the MDT electronic medical record to be sent to the patients’ GP.

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Head and Neck MDT Group

The Head and Neck Tumour group holds a weekly multidisciplinary clinic to care for patients with head and neck cancer. It is the busiest of all Cancer Therapy clinics. Patients’ can have varied and complex needs and problems. To address this they can be seen by Head and Neck Surgeon, Radiation Oncologist, Dentist, Care Coordinator, Nursing Specialists, Speech Pathologist, Dietician and Social worker/counsellor in a single clinic visit. Every second week a multidisciplinary case discussion conference is held with additional input from Radiology, Nuclear Medicine and Anatomical Pathology. New patients and patients with new problems are presented and discussed. The results of the discussion are published to the Mosaiq record and Powerchart and mailed to General Practioners. A monthly research meeting is held with a large variety of projects and contributors.

Highlights Achievements of the past year include:

A new and sophisticated radiotherapy treatment machine, Tomotherapy, now provides treatment for the majority of head and neck and complex skin cancer patients. Tomotherapy has an enhanced ability to avoid normal tissues during cancer treatment. Radiation field junctions, which were previously problematic, are no longer required. A CT scan done by the tomotherapy machine verifies patient position prior to each treatment.

A Survivorship Care Plan for Head and Neck Patients has been developed.

New H&N Education & Support Group

A Dental Rehabilitation and Prosthetic service is in development

Selected patients can now have robotic surgery at Macquarie University Hospital.

Membership Palliative Care – Dr Thang Huynh Radiology – Dr Ramesh Cuganesan Pathology – Dr Kasim Ismail Gastroenterology – Dr David Abi‐Hanna Care Cordinator – Luci Dall’Armi CNC – Hei Lan Byun Surgeons – Dr Jonathan Clark, Dr John McGuinness, Dr Bruce Ashford, Dr Navin Niles, Dr Quan Ngo, Dr Phillip Yeung Radiation Oncologists – Dr Dion Forstner, Dr Allan Fowler, Dr Mark Lee

Medical Oncologists – Dr Victoria Bray, Dr PoYee Yip, Dr Bavanthi Balakrishnar Dental – Dr Sue Yeoh, Dr Lan Pham Nuclear Medicine – Dr Peter Lin Nursing – Rhonda Young, Yvette Furney, Sue Rochfort Dietetics‐ Anneka Janson, Katherine Bell, Christina Jandzio, May Mak Speech Pathology – Monique Signorelli, Katherine Kelly, Armalie Muller, Emma Chaters Data Registry – Joyiti Prakash, Mahbuba Sharmin Social Work – Teresa Simpson MDT coordination and bookings – Roslyn Frederic, Milica Aleksic

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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 Establishment of the allogeneic stem cell transplantation service at Liverpool

Hospital in 2012 and expansion of the service.

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 a survivorship program.

Increased clinical trials activity including being third highest national recruiter for ENESTxtnd chronic myeloid leukaemia study.

Appointment of Clinical Trials staff funded by the Staff Specialists Haematologists.

Establishment of an Ambulatory Haematology Unit.

KPI’s 546 cases were presented over a 12 month period from July 2012 to July 2013. This included 98 new cases of lymphoma representing 98.5% of newly diagnosed lymphoma patients, 48 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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Access to therapy facilities at Macarthur and Bankstown

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.

Research and Education Current clinical trials: MDS4, NHL‐21, ENESTxtnd, ALL6, Denosumab Multiple

Myeloma 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.

Improving outcome of haematological malignancies through primary health care.

Membership Staff Specialists Assoc Prof David Rosenfeld Dr Michael Harvey Dr Anne‐Marie Watson Assoc Prof Lindsay Dunlop Dr Penelope Motum Dr Silvia Ling Dr Nicholas Viiala Dr Samantha Day Dr Danny Hsu Dr Adam Bryant Dr. Nagendra Sungala Dr. Lye Lin Ho 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 Michael Lin Dr Ivan Ho Shon Dr June Yap Pathologist Chris Chow

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Lung MDT Group

The Lung Cancer Multidisciplinary Team consists of a team of clinicians and allied health staff committed to ensuring evidence‐based best practice treatment of lung cancer patients. The team includes respiratory physicians, cardiothoracic surgeons, radiation and medical oncologists, palliative care physicians and nurses, a radiologist, a nuclear medicine physician and a pathologist. The team meets weekly at a videoconference between Liverpool and Macarthur Cancer Therapy Centres. Patients discussed include those with primary lung cancer, mesothelioma, thymoma and lung metastases. All patients presented are recorded in a prospective electronic database. The consensus of the meeting is documented and communicated to the patients GP.

Highlights Interventional bronchoscopy services at Liverpool Hospital providing advanced bronchoscopic techniques for diagnosis (e.g. endobronchial ultrasound) and management of malignant central airway obstruction (stent insertion, tumor ablation). Stereotactic Ablative Body Radiotherapy (SABR) for lung cancers is now implemented at Liverpool

Key Performance Indicators From July 2012 – June 2013, there 223 new patients and 144 follow‐up patients were discussed at the Lung MDT meeting. A total of 321 GP letters were sent out during this time.

0

5

10

15

20

25

30

35

40

45

Jul‐12

Aug‐12

Sep‐12

Oct‐12

Nov‐12

Dec‐12

Jan‐13

Feb‐13

Mar‐13

Apr‐13

May‐13

Jun‐13

No of patients

Lung MDT Meeting Activity

Follow‐Ups

New Patients

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Research and Education ABSTRACTS ACCEPTED FOR PRESENTATION M Boxer, K Duggan, J Descallar, SK Vinod. Do patients discussed at Lung Cancer Multidisciplinary Team Meetings receive guideline‐recommended treatment? Accepted as poster presentation, 15th World Conference on Lung Cancer, Sydney, 2013. A Tognela, S Lim, J Descallar, S Vinod, PY Yip, V Bray. Patterns of care in patients receiving adjuvant chemotherapy for resected non‐small cell lung cancer (NSCLC) in South Western Sydney Local Health District (SWSLHD). Accepted as poster presentation, 15th World Conference on Lung Cancer, Sydney, 2013. K Duggan, J Descallar, SK Vinod. Clinical guideline adherence in locally advanced non‐small cell lung cancer: A South Western Sydney perspective. Accepted as poster presentation, 15th World Conference on Lung Cancer, Sydney, 2013. A Pramana, J Descallar, SK Vinod. A decade of community‐based outcomes of patients treated with curative radiotherapy (RT) +/‐ chemotherapy for Non‐Small Cell Lung Cancer (NSCLC). Accepted as poster presentation, 15th World Conference on Lung Cancer, Sydney, 2013. PUBLICATIONS Vinod SK & Ball DL. Radiotherapy in Lung Cancer. Accepted Cancer Forum June 2013. Lin M, Ambati C. The management impact of clinically significant incidental lesions detected on staging FDG‐PET scans in patients with non‐small cell lung cancer (NSCLC) – an analysis of 649 cases. Lung Cancer 2012;76:344‐9. CURRENT CLINICAL TRIALS IN LUNG CANCER CHISEL trial – multicenter trial comparing SABR to conventional radiotherapy for medically inoperably early stage NSCLC NITRO trial ‐ A phase III, randomised trial of adding nitroglycerin to first line chemotherapy for advanced NSCLC PROFILE 1014 ‐ Randomised, 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 Harbouring a Translocation or Inversion Event Involving the Anaplastic Lymphoma Kinase (ALK) Gene Locus.

Challenges Recruitment of a Lung Cancer Care Coordinator

Timely access to diagnostic procedures and surgery

Future Projects/Expansion of Services Standardised imaging protocols for follow‐up of lung cancer patients

Standardised patient information for patients undergoing radiotherapy and chemotherapy

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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, and representation from palliative care specialists, radiology and pathology, the neuro‐oncology care coordinator, relevant specialty trainees, and other allied health professionals. 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 and spinal 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 The highly successful Brain Tumour Education and Support Group, coordinated by Kylie Wright and Teresa Simpson celebrates a significant milestone, it’s tenth year anniversary providing invaluable support to patients and carers affected by primary brain tumours. Contribution to a state‐wide approach to the role and workload of Neuro‐oncology Care Coordinator. (W. Trad, E‐S Koh). Kylie M Wright. Australasian Neuroscience Nurses Association ASM 10‐12th October 2012. ‘Boswellia Serrata as an alternative to Dexamethasone in neuro‐oncology patients’ (selected oral presentation). Winner of Best Neurosurgical Paper at the Conference – Neurological Surgeons Association Prize.

Key Performance Indicators More than 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

Immediate post‐operative MRI in the majority of glioma cases undergoing total or sub‐total resection

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Member contributions Dr Eng‐Siew Koh:

Chair, Clinical Oncological society of Australia (COSA) Neuro‐oncology Group 2011‐2014

Member of the COGNO (Cooperative Trials Group for Neuro‐Oncology) Management Advisory Committee

Convenor – 6th COGNO ASM, Sydney, October 2013

Co‐investigator – AGOG and SEED studies ;

Kylie M Wright, Teresa Simpson and Wafa Trad are active participants in Cancer Institute NSW NSWOG Neuro‐Oncology Group.

MDT members ‐ Involvement in the NSW Brain Cancer Action Week – May 2013

A/Professor Matthias Jaeger and Kylie M Wright: ACI Neurosurgery Network – Executive members / SWS LHD Representatives.

Kylie Wright ‐ Australasian Neuroscience Nurses Association Vice President

Publications 1. Windsor A, Koh E‐S, Allen S, Yeo AET, Allison R, Barton MB.

Characteristics and outcomes after whole brain radiotherapy for brain metastases in a large international cohort. (accepted 2013, Clinical Oncology)

2. Wright,K.M.(2013). Boswellia serrata as an alternative to Dexamethasone to treat peritumoral oedema. Australasian Journal of Neuroscience, 23(1):p15‐22.

Published Abstracts 1. S Pillay, R Cuganesan, SC Hall, P de Souza, MM Boxer, MJaeger, J Descallar, E‐

S Koh. Application of the Response Assessment in Neuro‐Oncology (RANO) imaging criteria in high grade glioma in a clinical setting: a feasibility study. RANZCR ASM, October 2013, Auckland (poster presentation).

2. W.Trad, T.Simpson, K.M. Wright, T. Tran, C.Choong, M. B. Barton, E. J. Hovey, E‐S. Koh. The Neuro‐oncology Care Coordinator: a key role in facilitating complex care. (Society of Neuro‐Oncology ASM, November 2013)

UNSW Medical Student ILP projects 2012: Alina Mahmood, Daniel Park, Hung Diep are medical students from UNSW, who worked on anti‐angiogenesis projects in brain cancer cell lines. 2013: Waka Yanagisawa and Andrew Do, two UNSW ILP students, are working on aspects of the SWS LHD Biospecimen banking project and ‘Biomarkers for Brain Cancer’.

Presentations Dr E‐S Koh ‐ Invited speaker – COGNO 5th ASM 2012, August, Brisbane. “Late

treatment effects on Neurocognition”.

Dr E‐S Koh: Invited speaker ‐ Brain Cancer Action Week 2013, Clinical Professional Day, Brisbane, Cancer Council Qld, May 2013. Talk “Assessing the Impact of Neuro‐oncology Care Coordination”.

Kylie M Wright. Australasian Neuroscience Nurses Association ASM 10‐12th October 2012. ‘Boswellia Serrata as an alternative to Dexamethasone in neuro‐oncology patients’ (selected oral presentation). Winner of Best Neurosurgical Paper at the Conference – Neurological Surgeons Association Prize.

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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.

3. An International, Randomized, Double‐Blind, Controlled Study of Rindopepimut/GM‐CSF with Adjuvant Temozolomide in Patients with Newly Diagnosed, Surgically Resected, EGFRvIII‐positive Glioblastoma (The ACT IV Study).

Studies to commence in July/August 2013: 1. SWSLHD Biospecimen banking for primary brain tumours (lead Investigator

Prof. Paul De Souza). 2. Field testing the Strategy Use Measure (SUM) in both a Primary Brain Tumour

and Traumatic Brain Injury population.

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

Establishing recurrent funding for the neuro‐oncology care coordinator position.

Future Projects/Expansion of Services Establishment and evolution of a Skull base service with ENT and expanding

service and a quarterly dedicated MDT meeting

Improved communication and management of pituitary tumour patients vaia a bi‐monthly endocrine / pituitary MDT

Application of stereotactic Tomotherapy (specialized radiation technique) for use in selected cases of brain and spinal tumours

Membership

Neurosurgery A/Prof Matthias Jaeger Dr Balsam Darwish Dr Renata Bazina A/Prof Mark Sheridan A/Prof James Van Gelder Dr Simon McKechnie Dr Renata Abraszko Dr Hazem Akil (registrar) Dr Omprakash Damodaran (registrar) Dr Ganesh Shivapathsundram (registrar) Radiation Oncology Dr Eng‐Siew Koh

Dr George Papadatos Prof Michael Barton Medical Oncology Prof Paul DeSouza Annette Tognela (Fellow) Palliative Care Thang Du Huynh Rajesh Aggarwal Pathology Dr Alar Enno Dr Tao Yang Neuro‐radiology Dr Ramesh Cuganesan Nursing/Allied Health Wafa Trad (Care Coordinator) Kylie Wright (CNC)

Teresa Simpson (Senior Oncology Social Worker) Gerald Au (Clinical Psychologist) Angela Louie (Speech Pathologist) Katrina Speechley (Speech Pathologist) Katherine Kelly (Speech Pathologist) Armalie Muller (Speech Pathologist) Monika Goldberg (Speech Pathologist) Cancer Information Kirsten Duggan MDT Coordinators Kerrianne Hancock Roslyn Frederic Andrea Lee

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Gynaecology Oncology MDT Group

MDT meetings are held weekly and the aim of this group is to provide comprehensive management services to newly diagnosed patients as well as patients presenting with recurrences. Ongoing psychosocial support and follow up is also arranged. TEAM MEMBERS: Surgeons Dr Felix Chan Dr Unine Herbst Medical Oncologists Dr Michelle Harrison Dr Diana Adams Radiation Oncologists Asos/Prof Shalini Vinod Dr Karen Lim

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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Carers Support Initiatives

Information and Support for Carers There is a high level of staff awareness of the important role carers play in the care

and management of patients’ illness and treatments.

Where appropriate, carers are involved in consultations and discussions of the patient’s illness and treatments to facilitate carers in caring for the patient.

Carers are encouraged and welcome to attend information and support programmes for them and for patients to enhance their knowledge and capacity to carry out their role.

Carers are welcome to seek professional psycho‐social support to assist them to handle their role. Carers who are noted by staff to be in distress are referred for psycho‐social assistance.

At Macarthur CTC, primary carers can receive complimentary massage, Reiki, and/or meditation sessions.

Bereavement support is also available to carers.

A “Carers Information and Support” webpage has been created in the Cancer Services website to provide information and resources to carers. Links to community resources and support services for carers and patients are also provided on this webpage.

Support for CALD Carers The “Cancer Carer Resource Booklet” produced by staff of the Cancer Services has

been translated into five community languages, namely, Arabic, Chinese, Croatian, Spanish, and Vietnamese, and they are now available on the “Carers Information and Support” webpage of the Cancer Services website.

Partnership has been formed with CanRevive, an NGO for cancer patients and their carers of the Chinese community, to strengthen information provision and support to carers and patients in the local areas. Volunteers from CanRevive also attend the centres to provide support to patients and carers.

Carers Participation in Service Delivery, Development and Planning

Carer and consumer representatives sit on the Cancer Services Council to provide inputs on cancer services.

Carers and consumers have been involved in the development of the Cancer Services’ Wellness Centres.

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ACKNOW

LEDGEMENTS

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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

Donna Pethybridge

Jessica Finn

Melissa Arthonsri

Yvonne Hoskings

Peita Papp

Jes Campbell

Visitacion Carlyon

Susan Saad

Rhonda Theuma

Rhian Davies

Kim Cawthorne

CanRevive Living with cancer – Information and Support for Chinese Consumers In partnership with Cancer Council NSW and Cancer Therapy Centre of Liverpool Hospital, a funding application on ‘Living with Cancer – Information and Support for Chinese consumers’ was submitted to Cancer Australia and successful received a two years grant to employ a part‐time staff (14 hours per week) to provide outreach cancer support services to the Chinese cancer patients/carers living in the South West Sydney Region. The objective of this project is to provide immediate information and emotional support to cancer patients and carers, by extending hospital visits and telephone support by Chinese volunteers who may be survivors/carers themselves, and also raise awareness of cancer and related issues, and improve access to existing information and resources. Details of the services provided included:

1. Hospital Visit: 4 volunteers were recruited, mentored and commenced to visit the Cancer Therapy Centre of Liverpool Hospital on a weekly basis, usually is on Tuesday and Thursday. A total of 44 visits were made by the team and the total no. of hours spent was 92 hours. A total no. of 201 client contacts was made from 1 Nov 2012 to 30 June 2013 (137 patients and 64 carers).

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2. Living with Cancer Program: A 4‐session ‘Living with Cancer Program’ was held in Feb 2013. Topics included 1) Understanding cancer and its treatment 2) Chemotherapy (CT) & Radiotherapy (RT) ‐ Side Effects and Aftercare 3) Cancer & Diets 4) Living well with cancer. Guest speakers were the health professionals of Liverpool Hospital, including oncologist, dietitian, CT & RT nurse and the social worker. A total of 26 participants (11 patients & 15 carers; 18 Cantonese & 8 Mandarin; 19 female & 7 male) attended at least one session of the program. The range of attendance was 12 – 19.

3. Support Groups: Followed the Living with Cancer Program, a 8‐session Cantonese Support Group was run from March to May. A total of 11 patients and 7 carers attended at least one session. The range of attendance was 5 to 11. Group members actively participated in the group programs including learning exercise, sharing their survival experience, supporting each other and learning new coping skills. The Mandarin Support Group was run from June to July. A total of 11 patients and 6 carers attended at least one session. The range of attendance was 8 to 13. Group members actively participated in the group programs including learning exercise, sharing their survival experience, supporting each other and learning new coping skills.

4. Information Sessions: a) Healthy Lifestyles Prevent Cancer Seminar : Around 200 participants attended the seminar & received information on hepatitis and liver cancer, as well as other cancers. b) Bring Knowledge To Life – How Women Can Prevent Cancer : A total of 27 participants attended the information session.

Ann Ngo

Jenny Chau

Janice Ying

Jan Tran

Cancer Council Volunteers ‐ Liverpool Cancer Council Information Centre (CCIC) opened in 2009 within LCTC, at present there are 17 CCIC volunteers who support patients, carers and family members. Since opening in 2009 volunteers have provided staff, patients and carers with over 30,000 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 (Friday 2pm). 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

Kamal Hadid

Pronita Karki

Joan Lewis

Robyn McNamara

Pilar Maloney

Norma Itte

Mona Mansour

Shanti Premji

Berenice Elston

Betty Eggleston

Joan Hilton

Elizabeth Dakash

Vinh Nghi Ma

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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 ‘all important chat’. This year has seen the successful reintroduction of the ever popular ‘tea trolley” rounds. Where appropriate, our volunteers are available to escort patients and carers to other areas of the hospital, this has become a large part of their role due to all the changes associated with redevelopment program within 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 carer’s Christmas Party.

Noelene Wright

Mary Walters

Rell (Arelin) Hodgson

Grant O’Donnell

Paulette Medbury

Catherine Bourke

Denise Madden

Fiona Gould

Robyn Cavan

Complementary Therapy Centre Volunteers

Delta Pet Therapy ‐ Leah Curnovic and Shadow, Olivia Brownlee and Demon.

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

Elizabeth (Betty) Bell

Fay Cooper

Carol Keogh

Elizabeth Lowe

Wig Library Fiona Gould

Robyn Cavan

Roberta Turnbull

Bankstown – Cancer Volunteers Claudia Hardy

Ruth Rendall

Gloria Worthington

Tanya Wall

Leonie Pacitti

Above: MCTC Volunteers,

Rell Hodgson & Joan

Above: MCTC Volunteers,

Mary Walters &

Noelene Wright

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SWSLHD Palliative Care Volunteers Diana Popovic‐Brankovic

Peter Teng

Joan Casey

Maureen Miller

Patricia Frutos

Bibi Farida

Karisha Khalil

Milan Malunec

Robyn Burton

Tina Mangione

Susie Thomas

Sandra Skarsky

Roman Skarsky

Helia Palma‐Olivares

Mary Carey

Margaret Fecht

Anna Muscatello

Luci Rossi

Jo‐Anne Craik‐Cooper

Pamela Bocking

Sandra Wales

Yvonne Kerr

Jacquelin Bedford

Kerry Wheatley

Judith Smith

Kaylene Love

Janice Spinley

Leanne Blaker

Rebecca‐Anne Sheely

Lynn Harris

Heather Parkes

Rosalie Englebrecht

Isabella Albiston

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Donations 2012‐2013

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.

Liverpool Donations Estate of Late Anna Glowacki The D & J Capitani Family Trust E D & M A McDonald Sook May Lee (May & Tony Barry) V & P Lagoutaris / S & A Lagos St Raphael's Greek Orthodox Church (Parish of Liverpool & District) Thi Minh C Nguyen The Dry July Foundation Westfield Ltd Shopping Centre Sonia O'Connor Cathy Duggan

Cabra‐Vale Ex‐Active Ladies Auxiliary Norma Overs Valerie Todd Italian Catholic Federation Alex Vella Andrew Demetrius Aspic Holdings M Thompson Glenn Watson Margaret Beggs Laura Valli Shylashree Seshamurthy

Michelle Johnson Hagop Hagoplan John Richard Kuhlmann Foundation Rainee Naidu

Palliative Care Donations Thank you to Donors – Palliative Care Volunteer Service Anau Speizer Ben Goldstein Carlos Lara Charmaine O’Connor Daniel belle Dave Loew Flora International Janet McGregor Mrs J Watt ‐ the Bunbury Rd Biggest Morning Tea Ladies Janeane Harlum Jennifer Wiltshire Katie Carr Katie Reeve Line Dancers Macarthur

Linda Gardiner Luke Zancanaro Lucia Tumillo Luci Dall’Armi Mary Boson Matt Cochran Narellan Bunnings Narellan Town Centre Norman Conyers Simplicity Funerals Schweppes Australia Tom Lindner Thornton Brother Roses Ulysee Bike Club

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Macarthur Donations24hr Fight again Cancer Committee Louise Allen Len & Sylvia Bailey Ana Begic Erica Berchtold Camden Lakeside Country Club Dawson Family Nola Douglas Stephen Fulham

Feliciana Gob Alan Hudson Geoffrey Knowles Mark Pearse Pollard Family Dennis Rae SNP Security Spoilt Rotten hair & Beauty Kerry Walker

Bankstown DonationsJ Judd – Stall donation Bourne Family J Kane L Nguyen Sheargold family Vawser & Associates

C Hardy – Stall donation Sealey Family C Conti D Connolly D Gillan

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 $304,000.00. This brings the total of funds raised by the Campbelltown/Camden community to well over $1,800,000.00. Equipment purchased over the year:

Electronic notice boards

Chair recliners

Funding for a number of positions within the Cancer Unit and Palliative Care Unit

Erbe VIO/APR workstation

Nocospray disinfection system

Playstation and games

Delta dog therapy

Massage therapy

Health exercise

Bariatric scales

Kids packs

iTune vouchers

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Valued Employees of the Month

2012‐2013

Macarthur Cancer Therapy Centre August 2012 Nicole Cusack September 2012 Sharon Tyson October 2012 Delma Bird January 2013 Mey Teoh February 2013 Sharon Tyson March 2013 Dr. Diana Adams June 2013 Yamileth Aguilar

Liverpool Cancer Therapy Centre August 2012 Rina Valerio September 2012 Jeanette Suurdt October 2012 Shrikant Deshpande November 2012 Aaron Manson December 2012 Sarah Hitchcock January 2013 Narelle Barnett February 2013 Cesar Ochoa March 2013 Naomi Holm April 2013 Karen Franklin May 2013 Alana Patterson June 2013 Lucy Ohanessian

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RESEARCH

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Ingham Cancer Research Steering Committee

This group was established in 2011 following a strategic planning day, 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 received a $5M NHMRC programme grant 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 its type in the Southern Hemisphere. This project is complemented by the MRI simulation project team who are examining and developing the role of MRI in tumour imaging and radiotherapy delivery.

2. Translational Cancer Research Unit – this is a programme of work to ensure that research is translated from the laboratory to the bedside and from bedside to laboratory. It is supported by funding from the NSW Cancer Institute. This programme of work is being led by Professor Paul DeSouza, Dr. Norbert Kiezle, A/Prof Meera Agar and Professor Afaf Girgis.

Ingham Institute building

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The flagship project of routinely collecting patient information, patient reported outcomes, tumour tissue and patient blood and linking these data with outcomes has commenced, with Colorectal Cancer being the first tumour site studied.

3. Patient Reported Outcomes Measures for Personalised Therapy (PROMPT) – a project developing IT methods of data collection of patient reported outcomes and for that data to be available at the time the patient is seen is a new project, recently funded by the NSW Cancer Institute for funding. This project is led by Professor Afaf Girgis and this project is in partnership with the NSW Cancer Institute and the Illawarra and Shoahaven LHD Cancer Service.

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. In addition, Dr Kevin Spring has received a NSW Cancer Institute grant to develop a database strategy to lin biomarkers with patient outcomes.

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. In addition, Dr Andrew Knight from the Academic GP Unit at Fairfield, Sandra Avery and Dr Sylvia Ling have received grants from the NSW Cancer Institute to work on aspects of improving communication between GPs and the cancer service.

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. The Clinical trials department is still under‐developed compared with our needs and we will continue building this group. The Ingham Research Institute plans to consolidate clinical trials staff into a single co‐operative group.

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.

11. The Head and Neck Cancer group have joined the steering committee. They have a number of diverse projects including biobanking and nerve graft research.

12. Phase I clinical trials – Professor Paul DeSouza is developing a plan for the building of a purpose‐built clinical trials unit at Liverpool Hospital to test new drugs.

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The most significant work in the past 12 months has been the development of the Translational Cancer Research Unit, a NSW Cancer Institute‐funded initiative to encourage research groups to develop a collaborative approach to translating laboratory research to the bedside and to feed this information back to the laboratory for further development. The TCRU group has grown, including the development of a partnership with the Illawarra and Shoalhaven Local Health District. This group have been working on a few large‐scale project ideas that will develop a more systematic approach to data capture and development of analysis strategies that ultimately lead to point‐of‐care data analysis, collection of tissue and blood, storing of data, analysis of biomarkers and analysis of outcome. This is planned for pilot in colorectal cancer. In the past 12 months there have been many significant research achievements as listed in the section on grants, publications and presentations. It is impossible to highlight everyone. However, special commendation must go to Professor Afaf Girgis and Professor Meera Agar for both winning prestigious national and international research awards respectively and to the list of people who gained higher degrees or significant grant funding this year.

Membership Cancer Clinical Services: Area Cancer Services/Radiation Oncology/ Health services Professor Geoff Delaney (Chair) Sandra Avery Medical Oncology Professor Paul de Souza Surgery Professor Les Bokey Dr Navin Niles Bankstown Hospital Dr Patsy Soon Palliative Medicine Dr Meera Agar Clinical Trials/Malignant Haematology Dr Michael Harvey Survivorship Dr Eng‐Siew Koh Imaging

Dr Peter Lin Ingham Institute Professor Michael Barton (Deputy chair) A/Prof Greg Kaplan Professor Afaf Girgis Translational Cancer Research Unit Dr Norbert Kienzle General Practice: Professor Siaw‐Teng Liaw Biobanking Professor Soon Lee Universities: Professor Minoti Apte Professor Jeremy Wilson – UNSW Professor Paul Keall – USyd Cancer Registry and Clinical Data Ms Nasreen Kaadan Administrative Support (Meeting Minutes): Mrs Caryn Knight

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Collaboration For Cancer Outcomes,

Research and Evaluation (CCORE) The CCORE unit, affiliated with the Cancer Therapy Centre, Liverpool Hospital, was formed originally in 1999 to improve cancer outcomes through research and the implementation of best practice measures into 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 comprise of various researchers from clinical backgrounds including radiation oncologists, an epidemiologist and research project managers.

Highlights National & International Benchmarks set following study of delivery of Radiotherapy Services: ‘Review of Radiotherapy Optimal Utilisation Rates (2011‐2012)’ M Barton, S Jacob, J Shafiq, K Wong, S Thompson, G Delaney, T Hanna December 2012 saw the finalization of a study into optimal radiotherapy utilization for all cancers in Australia. This study was funded by the Commonwealth Department of Health & Ageing and updated an earlier study by CCORE during 2001‐2003. This latest study reviewed the evidence to determine a contemporary estimate of the optimal proportion of new cancers that would benefit from radiotherapy as part of a treatment plan. The report covered each cancer site including brief description of the changes to radiotherapy utilisation compared to the previous model and was submitted and accepted following peer review by a broad range of multidisciplinary reviewers in order to ensure the widest degree of input. The epidemiological data in the model was updated using the latest available Australian national, state or cancer registry data where applicable and the overall rates of optimal radiotherapy utilisation for each of the States and Territories were calculated. Other areas of this study involved:

the incorporation of indications for concurrent chemoradiotherapy and brachytherapy into the updated model of optimal radiotherapy utilisation, where appropriate;

sensitivity analysis of the benchmark optimal utilisation rate to estimate its robustness;

assessment of the effect of factors that may affect actual utilisation by incorporating patient preference data into the breast cancer and prostate cancer models where available;

the trends in radiotherapy indications over time, and,

discussions relating to changes in technology that may affect radiotherapy treatment in the future.

Above: Head of Department

Michael Barton OAM

Professor, Radiation

Oncology, UNSW Medicine

Research Director

The Ingham Institute for

Applied Medical Research

(IIAMR)

Collaboration for Cancer

Outcomes Research &

Evaluation (CCORE)

New Study sets Benchmarks

for delivery of Radiotherapy

Services

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This study will set the benchmark for the delivery of radiotherapy services in Australia and internationally for the next decade. 2012 Medical Oncology Group of Australia (MOGA)‐Novartis Oncology Cancer Achievement Award 2012. Congratulations go to Professor Michael Barton, Research Director, The Ingham Institute for Applied Medical Research, who received this prestigious award at a special presentation night in Brisbane in August, 2012, to recognize Professor Barton’s contribution to research activities; valued commitment to MOGA research projects such as the Workforce Study and radiation oncology workforce issues; dedication to improving the training of young oncologists and important work influencing policy at a governmental level. Key Appointments: Professor Michael Barton 2012 ‐ appointed as Member of the NHMRC Grant Review Panel 2012 ‐ appointment extended for 5 year period 1 January, 2012 – 31 December, 2016: Conjoint Professor in School of Medicine, College of Health and Science, University of Western Sydney. 2013 ‐ appointed to Cancer Control Steering Group for the NHMRC Research Translation Faculty.

Key Performance Indicators Following receipt of a $5.7 million grant during 2011, the specialized research

bunker at Liverpool Hospital was finalized and handed over late 2012. The research bunker was built to house a dedicated research MRI linear accelerator (MRI‐Linac) machine. This Grant was awarded in conjunction with Universities of NSW, Sydney, Wollongong, Queensland, Western Sydney, Stanford University in the United States, The Ingham Institute and SWSLHD for the provision of an adaptable and dedicated linear accelerator for medical radiation research – one of only 3 other similar developments worldwide. This machine will enable real time imaging of patient anatomy during radiotherapy treatment resulting in improved cancer targeting. Upon operation the MRI‐Linac will have the potential to reduce side effects of radiation treatment in over 50% of cancer patients by the accurate location of tumours during a treatment session.

A recent meeting was convened at the Ingham Institute and attended by leading cancer specialists from around Australia in preparation for the arrival of the dedicated MRI system. The meeting determined the direction that radiotherapy research will take in future.

The move of the CCORE research unit from the eastern campus to the Ingham Institute building in August 2012 has proved extremely beneficial with the close proximity of researchers with expertise in many areas including Translational Cancer Research, the SWS Clinical Cancer Registry, Medical Physics, Haematology.

Below: Research Bunker Liverpool Hospital

Below: Newly completed Research Bunker Liverpool

Hospital

Prestigious Award

Presented to Ingham

Institute Research Director

Prof Michael Barton

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Southern NSW Radiation Oncology Training Network The Southern NSW Radiation Oncology Training Network was established in 2007 via a Cancer Institute NSW Health Services Innovation Grant. The aim is to develop and maintain a network for training Radiation Oncology registrars and for rotating them through a number of different Radiation Oncology Centres throughout their training. The Network has been established with the co‐operation of the Hospitals associated with the University of New South Wales as well as The Wollongong Hospital and Canberra Hospital. Five registrars commenced their training in January 2008 and we now have 26 trainees within our Network. The Network has developed a common teaching programme for all the registrars within the group. This will provide continuity in registrar education and as such will ensure the quality of the teaching programme

The goals of the Network are to:

Demonstrate feasibility of a rotational Radiation Oncology Network

Identify resources, governance procedures and organisational issues

Identify and overcome barriers

Enhance the educational environment for Radiation Oncology registrars

Facilitate rotation between Network hospitals and departments

Create a template for roll‐out of Networks in other parts of Australia and NZ With the sad passing of Dr Denise Lonergan in October 2012, Dr Yaw Chin, St George Hospital, will take over as the Network Director.

Research and Education PhD Thesis awarded, November 2012. Dr Karen Wong, Staff Specialist, Radiation Oncology. PhD thesis – “Estimation of the Optimal Number of Radiotherapy Fractions for Cancer Patients”. Supervisors: Professor Michael Barton, Professor Geoff Delaney Submitted: July, 2012. Awarded November 2012 The aim of this research was to construct an evidence‐based model to estimate the optimal number of radiotherapy fractions per cancer patient and per treatment course, building on the existing optimal radiotherapy utilisation model. These data can provide a benchmark for services delivery and for comparison with actual fractionation in practice. This model can also be applied to predict future radiotherapy workload and hence aid in future radiotherapy services planning in Australia. The following CCORE staff continue their PhD studies during 2012/13: Dr Jesmin Shafiq, Research Project Manager, CCORE. PhD thesis: ‘Model of estimation of local control and survival benefit of external beam radiotherapy for selected cancers’. (2011‐2014). Supervisors: Professor Michael Barton, Professor Geoff Delaney. Commenced 2011. Dr Timothy Hanna, Clinical Research Fellow Radiation Oncology, CCORE ‐ PhD Thesis– ‘The Overall Survival and Local Control Benefit of External Beam Radiation Therapy for Selected Cancers’. Supervisors: Professor Michael Barton, Professor Geoff Delaney. Commenced 2011

Congratulations extended ‐

Awarding of PhD Thesis

Dr Karen Wong

Major Study nearing

completion

Dr Gabriel S Gabriel

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Dr Gabriel S Gabriel, Project Manager, CCORE. PhD Thesis The effect of geographic variations on radiotherapy utilization rates in NSW. Supervisors: Professor Michael Barton, Professor Geoff Delaney PhD Studies Commenced 2012

Dr Viet Do, Radiation Oncologist Westmead Hospital, PhD Student UNSW The overall survival benefit of chemotherapy for selected solid cancers. Supervisors: Professor Michael Barton, Professor Geoff Delaney, Dr Weng Ng

The following major study is being conducted by CCORE Project Manager, Dr Gabriel S Gabriel. ‘Radiotherapy utilisation in NSW and ACT [2004‐06], a data linkage and GIS experience’ Radiotherapy treatment data were collected from all 17 radiotherapy departments (RTD) in NSW and ACT for the period January 2004‐June 2007. Through Centre for Health Record Linkage the radiotherapy data and Central Cancer Registries (CCR) records in NSW & ACT were linked. All patients’ residential addresses were geocoded. A Geographic Information System (GIS) software was used to calculate the road distance between patients’ residential address and the closest RTD. Patients were excluded from the study if their nearest RTD was outside NSW or ACT. This is the first study to use data linkage to match radiotherapy treatment data received from all RTD to all CCR records in NSW and ACT. It is also the first study to calculate the road distance between patient residence and the nearest radiotherapy facility. There was a statistically significant difference in radiotherapy access based on road distance. The objectives of this study are: 1) To calculate the actual Radiotherapy Utilisation (RTU) rates in NSW & ACT

(2004‐06) directly from patient treatment records with special emphasis on the effect of geographic variation on RTU.

2) To identify factors affecting radiotherapy utilization. National Prizes received: Paper of the Year 2012 ‐ awarded by UNSW South West Sydney Clinical School (SWSCS). Boxer MM, Vinod SK, Shafiq J, Duggan KJ. Do multidisciplinary teams make a difference in the management of lung cancer? Cancer 2011:117:5112‐5120 Best of the Best Poster Presentation – awarded at 39th Annual Scientific Meeting of the Clinical Oncology Society of Australia (COSA), Brisbane, 13‐15 November, 2012. Kelly J, Vinod SK, Shafiq J. ‘ Timelines in lung cancer diagnosis and treatment in South West Sydney’. Nominated as one of twenty for the ESTRO Best Poster Award in the category: Clinical. Gabriel G. Poster and for Poster Discussion Session ESTRO Scientific Meeting, Geneva, 19‐23 April 2013 – oral presentation: ‘Radiotherapy utilisation rates in NSW and ACT (2004‐06), a data linkage and GIS experience’

Paper of Year and Best of

Best Poster Presentation

Prizes Awarded

Health Economics in

Radiation Oncology (HERO)

Meeting, Geneva, April 13

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Future Projects/Expansion of Services Modelling Demand for Radiotherapy During April 2013 an international meeting, Health Economics in Radiation Oncology (HERO), was arranged to precede the 2nd ESTRO Forum in Geneva, Switzerland. This meeting was convened by Professor Michael Barton, Research Director, CCORE/The Ingham Institute, in conjunction with Prof Yolande Lievens of the European Society for Radiotherapy & Oncology (ESTRO), Belgium, and the International Atomic Energy Agency (IAEA), Vienna. The meeting was attended by participants from Australia, England, Belgium, Austria, Canada and Scotland to discuss Modelling Demand for Radiotherapy. The aim of the meeting was to present a range of approaches to radiotherapy modelling and to develop a new collaborative project that would integrate demand modelling for radiotherapy with cost estimates. Future aims will be to unify and shape a template for radiotherapy in different countries using consistent methodology, thereby allowing the analysis of cost and demand comparisons between countries.

Journal Publications July 2021 – June 2013 1. 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. J Thorac Oncol. 2012 Jul;7(7):1155‐63

2. Thompson S, Delaney GP, Gabriel GS, Jacob S, Barton MB. Estimation of the optimal brachytherapy utilisation rate in the treatment of vaginal cancer and comparison with patterns of care. Journal of Medical Imaging and Radiation Oncology 2012 Aug;56(4):483‐489.

3. Thompson S, GP Delaney, GS Gabriel, S Jacob, P Das and MB Barton. Estimation of the Optimal Brachytherapy Utilization Rate in the Treatment of Gynaecological Cancers and Comparison with Patterns of Care. Int J Radiation Oncol Biol Phys, Vol. 85, No. 2, pp. 400‐405, 2013

HERO Meeting participants, Geneva, April 2013, including Professors Michael Barton & Geoff Delaney, A/Prof Shalini Vinod, Dr Timothy Hanna, Dr Jesmin Shafiq, Dr

Gabriel S Gabriel, Dr Karen Wong

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4. 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 systemic breast cancer therapy utilization in Canada (British Colombia), Scotland (Dundee), and Australia (Western Australia) with models of "optimal" therapy. The Breast 2012 Aug: 21(4) 562‐569. (epub ahead of print ‐ 30 Jan 2012)

5. 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 surgical and radiotherapy breast cancer therapy utilization in Canada (British Columbia), Scotland (Dundee), and Australia (Western Australia) with models of "optimal" therapy. The Breast 2012 Aug: 21(4) 570‐577. (epub ahead of print ‐ 16 March 2012).

6. 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. (In press) (epub ahead of print – 7 March, 2012)

7. Goldsbury D, Harris M, Pascoe S, Barton M, Olver I, Spigelman A, Bielby J, Veitch C, Weller D, O’Connell D. The varying role of the GP in the pathway between colonoscopy and surgery for colorectal cancer: a retrospective cohort study. British Medical Journal Open 2013;3:e002325. Doi:10.1136/bmjopen‐2‐12‐02325

8. Metcalfe P, GP Liney, L Holloway, A Walker, M Barton, GP Delaney, S Vinod, W Tomé. The potential for an enhanced role for MRI in radiation‐therapy treatment planning. Technology in Cancer Research and Treatment. 2013 April 24. PMID:23617289.

9. Kenny LM, LJ Peters, M Barton, C Milross. Radiotherapy ‐ a leap forward in cancer care. Cancer Forum (in press)

10. 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. Canadian Medical Association Journal (CMAJ). Published ahead of print April 10, 2012 (in press)

11. Hanna TP, Delaney GP, Barton MB. The population benefit of radiotherapy for gynaecological malignancies: local control and survival estimates for optimally utilized radiotherapy and chemoradiation. Journal of Medical Imaging and Radiation Oncology (in press)

12. Hanna TP, Shafiq J, Delaney GP, Barton MB. An estimation of the population benefit of radiotherapy for cervical cancer: local control and survival. Journal of Medical Imaging and Radiation Oncology (in press)

Conference Presentations / Invited Speaker / Expert Barton, M. Invited Speaker. ‘ Is VUCCnet Africa a replicable model’. Union of International Cancer Control (UICC) World Cancer Congress – Connecting for Global Implact, Montreal, 27‐30 August, 2012. Barton M. Invited speaker. Burnie versus Darwin: a tale of two cities. Safe and sustainable radiotherapy in regional Australia; from Darwin to Burnie‘. 4th National Cancer Centres Symposium. Melbourne, Australia. 25‐26 September, 2012

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Hanna T. UICC World Cancer Congress. 27‐30 August, 2012. Montreal, Canada. Oral Presentation: ‘Estimating the population benefit of radiotherapy: Larynx cancer as an example’. Barton M. UICC World Cancer Congress. 27‐30 August, 2012. Montreal, Canada. Invited Speaker. ‘VUCCnet Africa a replicable model’ in session: Regional cancer workforce solution – VUCCnet. (IAEA). Shafiq J, Hanna T, Delaney G, Vinod S, Barton M. ‘An evidence‐based estimation of survival and local control benefit of radiotherapy for lung cancer’. An abstract presented at the 1st Innovations in Cancer Treatment and Care NSW Conference 2012, Cancer Institute NSW, Sydney, 7 September 2012. Barton, M. Invited Speaker. ‘Safe and sustainable radiotherapy in regional Australia – from Darwin to Burnie’. 4th Annual National Cancer Centres Symposium, Melbourne, 25‐26 September, 2012. Barton, M. Invited Expert. Implementation of Radiation Oncology Programs in Developing Countries. ‘Core competencies: are they applicable in developing countries?’. International Atomic Energy Agency (IAEA) Vienna, 15‐17 October, 2012. Hanna T. Oral presentation. ‘The Population Benefit of Radiotherapy for Head and Neck Malignancies’. ANZHNCS Annual Scientific Meeting, International Federation of Head & Neck Oncological Societies, 24‐26 October, Brisbane. Shafiq J. ‘An evidence based estimation of radiotherapy benefit for selected cancers’. An abstract presented at the Annual Research Seminar, South West Clinical School, UNSW, Liverpool Hospital, 31 October 2012. Barton, M. Invited Expert. Radiotherapy Innovations Summit. Royal Australian and New Zealand College of Radiologists (RANZCR), Canberra, 29 November, 2012. Barton, M. Invited Expert. Asia‐Pacific Radiation Oncology Special Interest Group (APROSIG) – Evaluation of Cancer Services, Papua, New Guinea. 12‐18 May, 2013. Barton, M. Health Economics In Radiation Oncology (HERO) meeting, Geneva, 18‐19 April, 2013 – oral presentation: ‘Radiotherapy Utilisation (RTU) old and new’ Barton M. 2nd European Society for Radiotherapy & Oncology (ESTRO) Forum, 19‐23 April, 2013, Geneva. Barton M. Invited Expert. IAEA Co‐ordinated Research Project Meeting, 24‐26 April, 2013, Vienna, Austria Gabriel G, Barton M, Delaney G. ‘Radiotherapy Utilisation in NSW and ACT (2004‐06) ‐ A Data Linkage and GIS Experience’. 2nd ESTRO Forum, 19‐23 April, 2013, Geneva, Switzerland.

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Gabriel G. COSA 39th Annual Scientific Meeting, Brisbane, 13‐15 November 2012 – oral presentation: ‘Radiotherapy utilisation rates in NSW and ACT (2004‐06), a data linkage and GIS experience’ Shafiq J. COSA 39th Annual Scientific Meeting, Brisbane, 13‐15 November 2012 – poster/abstract presentation: ‘Timelines in Lung Cancer Diagnosis and Treatment in South West Sydney’ Gabriel G. Health Economics in Radiation Oncology (HERO) Meeting ‐ Modeling Demand for Radiotherapy, 18‐19 April 2013, Geneva, Switzerland – oral presentation: ‘Actual utilisation and factors that affect utilisation ‘ Shafiq J. Health Economics in Radiation Oncology (HERO) Meeting ‐ Modeling Demand for Radiotherapy, 18‐19 April 2013, Geneva, Switzerland – oral presentation: ‘Comparisons between AUS, Canada and Scotland for Breast Cancer’. Book Chapters Barton MB, Williams M. ‘Assessing needs and demand for radiotherapy’ in: Radiotherapy in Cancer care: facing the global challenge. Editor: E Rosenblatt International Atomic Energy Agency, Vienna. (in press) Barton MB, Williams M, Shafiq RJ. ‘Radiotherapy in the context of cancer control’ in: Radiotherapy in Cancer care: facing the global challenge. Editor: E Rosenblatt International Atomic Energy Agency, Vienna. (in press) Koh ES, Hanna TP, Barton MB. ‘Current status of Radiotherapy in Australia, New Zealand and Papua, New Guinea’ in: Radiotherapy in Cancer care: facing the global challenge. Editor: E Rosenblatt International Atomic Energy Agency, Vienna. (in press) MB Barton, M Lehman. “Counterpoint on Glioma” in Patient Surveillance after Cancer Treatment editors F Johnson, K Virgo, R Audisio, J Thompson, Y Maehara, J Margenthaler, C Earle, and G Browman. Humana Press, New York, 2013 . Hanna TP. ‘Radiation Oncology in the Developing World’ in: Principles and Practice of Radiation Oncology – 6th Edition, published New York Lippincott, Williams and Wilkins. Editors: Perez CA, Brady LW, Halperin EC, Schmidt‐Ullrich RK. (in press) Reports MB Barton, M Frommer and R Jenkin. Victoria’s Integrated Cancer Services: a review. Sydney. June 2012 MB Barton, S Jacob, J Shafiq, KH Wong, S Thompson, G Delaney and T Hanna. Review of Optimal Radiotherapy Utilisation Rates. CCORE. Sydney December 2012

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CCORE Research Staff Members

Professor Michael Barton OAM, Research Director Dr Gabriel S Gabriel, Research Program Manager (UNSW) Dr Jesmin Shafiq, Research Program Manager (SWSLHD) Dr Susannah Jacob, Research Program Manager (SWSLHD) Dr Karen Wong, Staff Specialist Radiation Oncology (SWSLHD) Dr Jacqueline Veera, Registrar, Radiation Oncology (SWSLHD) Dr Viet Do, PhD student, Staff Specialist Rad Oncology, Westmead Hospital

CCORE staff Members: Left to Right

Dr Gabriel Gabriel, Dr Jesmin Shafiq, Dr Susannah Jacob, Ms Robyn

Hittmann, Dr Jacqueline Veera, Professor Michael Barton, Dr Karen Wong

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Clinical Trials Cancer Network

Clinical trials activity continues to be strong within South West Sydney Local Health District (SWSLHD). There has been a gradual evolution in the organisational structure in our LHD, with the clinical trials units at Bankstown, Braeside, Macarthur‐Bowral and Liverpool Hospitals now functioning semi‐autonomously with staff mostly based at each institution. This has reduced some of the inefficiencies of moving staff across campuses, and we hope will improve the recruitment of clinical trials staff. The NSW Cancer Institute Network Support Officer grants concluded in December 2012. During 2013 the SWSLHD Clinical Trials Committee (Cancer Services) has been formed, with representation from all the individual hospitals and the aim of better coordination of clinical trials between these groups, as well as addressing issues of funding, governance and ethics committee submissions. We hope that this committee will improve communication with both the NSW Cancer Institute and SWSLHD, and allow for efficient coordination in the applications for grants to support clinical trials.

Facility 2012 Patinet recruited to trials

2013 Patient recruited to trials

Bankstown 33 22

Southern Highlands 10 6

Braeside 53 13

Liverpool 133 36

Macarthur 48 21

TOTAL 277 98

Clinical Trials ‐ Liverpool

Description of Service

The Clinical Trials Unit has had a busy 12 months and we have been pleased to see the expansion in our unit, with the number of clinical trials coordinators based at Liverpool Hospital increasing from three to six. This had greatly increased our capacity to undertake new clinical trials and we are optimistic about the continuing expansion of the unit. The network support officer grant from the NSW Cancer Institute concluded in December 2012. Following this, it was decided that it would be operationally more efficient if the clinical trials units at Liverpool Hospital and Macarthur functioned autonomously, apart from Radiation Oncology for which the trials are coordinated across both centres. Good communication between the different clinical trials units exists through the SWSLHD Clinical Trials Committee.

Clinical Trials Manager

Jennifer Aung

MBBS, MPH, MHSM, Dip

Oncology Clinical Research

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Highlights

Successfully opened 1st Phase I ASALN clinical trial at Liverpool Hospital with a total of 10 patients recruited within 10 months.

Our unit has been able to act as a lead site for multicenter clinical trials.

The recruitment of high quality staff to the Clinical Trials Unit, and we have been pleased to welcome Vinodini Onawale and Karina Chui during 2013.

Novel treatments during the stressful period of relocation of the unit and shortage of staffs.


A total of 222 patients were screened and 143 patients recruited during the year. Recruitment slightly decreased compared to 2012, however the number of patients in long term follow‐up continued its upward trend at 768.There has been a consistent increase in the number of trials conducted at Liverpool Hospital & the unit initiated 12 new trials overall in 2012.


Jennifer Aung completed a Graduate Diploma of Oncology Clinical Research from University of Melbourne

Aura Serrano enrolled in the Master of Clinical Research at University of Sydney

Sheela Subramani completed “Introduction to Clinical Research Study Coordinator Training Workshop” from Datapharm Australia

Challenges Our total number of clinical trials coordinators is still less than peer cancer centres and our challenge will be expand the unit to a size which is ideal for a large referral centre. The movement of the unit to the Ingham Institute over the last 18 months has provided greater opportunities for expansion and collaboration with translational research groups, but some logistical challenges with a greater distance between office and clinical areas.


We hope to see a continuing expansion of clinical trials activity

The recruitment of a Clinical Trials Pharmacist is underway

A dedicated phase I clinical trials unit is be established under the leadership of Professor Paul DeSouza.

Liverpool Clinical Trials

Staff

Our key dedication is to

provide novel treatment to

our cancer patients.

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g

Clinical Trials ‐ Macarthur

Description of Service

This year’s report includes the addition of a new autonomous medical oncology trials unit at Campbelltown Hospital. Campbelltown Hospital is being re‐developed to increase its capacity to meet the needs of the growing population in the area, with a subsequent increase in oncology services. In order to expand the research capacity at the Macarthur CTC, a medical oncology trial unit, independent from the Liverpool CTU was established in late 2012. From a strategic perspective this provides a more efficient use of each unit’s time and resources. The research demands on the two Departments are different and geographically they are separated by significant distance and a congested and sometimes chaotic transport corridor. The MCTC Trials unit aims to offer a range of trials in the main tumour groups of breast, bowel, prostrate and lung and also offer additional trials in other less common cancers needed by our patient population. Where possible we will plan to offer complementary rather than competing trials with other SWSLHD Units and promote the cross‐referral of patients. The Trials’ unit shares space with Radiation Oncology trials and continues to collaborate closely on research that crosses the specialities, such as the GAP trial: “Phase II study of pre‐operative gemcitabine and nab‐paclitaxel for resectable pancreas cancer.” This pancreatic trial uses neo‐ adjuvant chemotherapy and has a chemo‐radiotherapy arm, so will require staff to work closely with surgeons and radiation oncologists. In an exciting change of direction for our patient’s cancer treatment, we will also be collaborating closely with the Campbelltown Hospital Physiotherapy Department and an external physiotherapy provider to manage the Challenge trial: “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 (CHALLENGE)”. This trial is based on compelling evidence from: (a) observational studies showing that physical activity (PA) is strongly and inversely associated with colon cancer incidence, recurrence, and disease‐specific and overall survival, (b) intervention studies showing that PA interventions cause changes in biologic mechanisms thought to play a role in colon cancer initiation and promotion,

Currently we have 2.6 FTE staff. We have been fortunate recently to improve our trial facilities including allocation of ample storage space – a must for any growing clinical trials unit.

Macarthur Clinical Trials

Staff

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Expectations are that the Medical Oncology Trials Unit will provide the Centre with improved opportunities to manage its research and facilitate a significant increase in trial activity.

Highlights and achievements

Establishment of independent unit with a new cost centre. Working with Finance to set up an efficient trial accounting system.

From 2013 ‐ 13 medical oncology trials open for recruitment, 3 new trials pending and several sponsor site appraisals in progress.

MCTC ABRAXIS pancreatic trial patient results were part of a sponsor presentation at ASCO 2013 showing ABRAXANE in combination with gemcitabine demonstrated a statistically significant improvement in overall survival compared to patients receiving gemcitabine alone. In particular the sponsor wrote: “The entire team would like to thank you, your staff and your patients for participating in the trial. You worked so hard and diligently to collect the data. This is a great moment for our patients with pancreatic cancer”

Trials Manager contributed to successful CINSW web portal project

Suma Santhosh was successfully appointed to the position of research nurse after a formal interview process.

Debra Vandine was extended in her Research Administration position for a further year.

Full complement of skilled staff. The trial’s team is a small co‐operative team, with a wide range of related experience and qualifications.

Completed backlog (as a result of previous short staffing) on all trials. All trials have data up to date.

In late 2012 the trial’s team hosted Sylvia Villa – a Swiss clinical trial student from Zurich University, requiring a week’s work placement for her Masters in Clinical Trial Management. She chose Campbelltown Hospital as she was visiting Australian friends nearby. We also found the visit very beneficial, learning a lot about the organisation of trials in Switzerland and especially the mouth watering Swiss chocolates she left as a gift for the unit’s assistance with her training.

Education and Training

All staff have completed recent GCP training. This year Debra Vandine completed a 2 day trial management course. Suma Santhosh also attended the CINSW community of practice education day.

The CI NSW trials web portal is a tool for the mandatory reporting of all Grant holders’ trial activity into the CI Trials database. Staff recently completed training for reporting all our trial activity into the new database website.

Each Trial co‐ordinator provides specific trial education for Oncology ward nurses when new trials open.

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Challenges

Staff have put in a lot of effort and used their initiative to maintain the flow of work while new procedures for the unit were established. We still have a lot of work to do to complete the organisation of the trial unit’s administration, finances, QA systems, trial reporting systems and to increase the number of trials activated and patient recruitment. MCTC clinical trials aim is to establish a high quality research unit that is also financially viable. The challenge for a clinical trial unit is to be able to maintain the flow of research, while balancing the available resources against high expectations and competing demands.

Clinical Trials Staff: Director Research Manager A/Professor Stephen Della‐Fiorentina Anne Whatman Research Nurse Research Administration Officer Debra Vandine Suma Santos

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Clinical Trials Bankstown

Title of Project Description

CO7: A clinical trial comparing 5FU plus LV and Oxaliplatin with 5FU plus LV for treatment of patients with Stage II and III carcinoma of the colon.

This study addressed two important areas in the development of adjuvant therapies in colon cancer. The first is to determine a more acceptable and active chemotherapy schedule, in particular to see if adding a new drug to an established chemotherapy schedule results in fewer disease recurrences and in longer survival. The other issue being investigated is the determination of new prognostic factors and their role in selecting patients for treatment on the basis of the risks of relapse and the chance of response to this category of cytotoxic treatment.

ESPAC 3: A phase III adjuvant trial in pancreatic cancer comparing (1) 5FU and D‐L folinic acid vs (2) Gemcitabine.

For ductal adenocarcinoma: This is a two arm trial comparing survival between patients randomised to 5FU/folinic acid and those randomised to gemcitabine. For ampullary and other cancer: This is a three arm trial comparing survival between patients randomised to 5FU/folinic acid, those randomised to gemcitabine and a ‘surgery alone’ arm randomised to no adjuvant treatment.

CALYPSO: A Multi‐National Randomised, Phase III, GCIG Intergroup Study Comparing Pegylated Liposomal Doxorubicin (CAELYX®) and Carboplatin vs. Paclitaxel and Carboplatin in Patients with Epithelial Ovarian cancer in Late Relapse (>6 months)

Ovarian cancer remains the leading cause of gynaecologic cancer deaths. In the majority of patients, at the time of presentation of their disease, surgery as well as chemotherapy is usually required. Previous trials have shown that platinum containing regimens improve survival with combination Carboplatin and Paclitaxel accepted as the standard in first line treatment of advanced ovarian cancer in most countries. Pegylated liposomal doxorubicin (Caelyx®) is a new active drug that has shown promising results and is approved for second line treatment of relapsed ovarian cancer. This trial aims to evaluate the role of Caelyx‐Carboplatin in comparison to Paclitaxel‐Carboplatin in patients who are in late relapse (>6 months since completing prior platinum based chemotherapy).

QUASAR 2: Muticentre international study of Capecitabine +‐ Bevacizumab as adjuvant treatment of colon cancer

QUASAR 2 uses a new combination for adjuvant therapy: an oral chemotherapy drug (capecitabine) and a molecularly targeted therapy (bevacizumab), to define whether this is superior in efficacy and less in toxicity than capecitabine alone, which is a standard of care in this disease.

EISAI Study: A phase III open label, randomized two‐parallel‐arm multicentre study of E7389 verse Capecitabine in patients with locally advanced or Metastatic breast cancer previously treated with Anthracyclines and Taxanes and Refractory of the most recent chemotherapy.

The primary objective of this study is to compare the efficacy of E7389 versus Capecitabine monotherapy in terms of Overall survival and Progression‐free survival (PFS), in patients with locally advanced or metastatic breast cancer. Patients must have been previously treated with Anthracyclines‐based regimen, and failed on Anthracyclines /Taxanes and taxane therapy. In case where it is known that the tumor overexpresses HER2/neu, patients must have been treated with trastuzumab in centers where this treatment is available, and estrogen receptor‐expressing tumors may have been treated with antiestrogen therapy.

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START:A multi‐center phase III randomized, double‐blind placebo‐controlled study of the cancer vaccine Stimuvax®® (L‐BLP25 or BLP25 liposome vaccine) in non‐small cell lung cancer (NSCLC) subjects with unresectable stage III disease

A maintenance therapy for patients who have unresectable stage III NSCLC and have had either stable disease, partial or complete response to their primary chemoradiotherapy. Stimuvax has been used in previous studies with stage IIIb and IV NSCLC patients, with patients having better survival results on active study drug. Stimuvax is an immunotherapeutic drug which raises an immune response against the diseased tissue by targeting specific markers (MUC1 antigen). The study will take place in approximately 250 centres worldwide and will recruit an estimated 1322 subjects.

CA031:A randomised, phase III trial of ABI‐007 and carboplatin with Taxol® Carboplatin as first‐line therapy in patients with advanced Non‐Small Cell Lung Cancer(NSCLC).

This is a controlled, randomized, multicenter, Phase III study to evaluate the safety/tolerability and anti‐tumor effect of intravenously administered ABI‐007/carboplatin combination therapy compared to that of Taxol/carboplatin combination therapy as first‐line therapy in patients with NSCLC. The primary objective is to compare disease response (using RECIST guidelines) of ABI‐007 plus carboplatin (AUC=6) vs Taxol and carboplatin (AUC=6) as first‐line therapy in patients with advanced NSCLC.

EXPAND:Open‐Label, randomised, controlled, multicentre phase III study investigating cetuximab in combination with capecitabine (Xeloda, X) and cisplatin (P) versus XP alone as first‐line treatment for subjects with advanced gastric adenocarcinoma including adenocarcinoma of the gastroesophageal junction.

Main objective of this is to demonstrate superiority of XP chemotherapy regimen plus cetuximab versus XP alone as first‐line treatment for advanced gastric cancer in terms of PFS. It is a multicenter open‐label, randomized, controlled, phase III study. Subjects will be randomized on a 1:1 basis to Group A (Cetuximab q week + XP q 3 weeks) or �Group B(XP q 3 weeks) The study will take place in approximately 150 centres worldwide and will recruit an estimated 870 subjects.

CO.20: A phase III randomised study of Brivanib (BMS‐582664) in combination with Cetuximab (Erbitux®) versus Placebo in combination with Cetuximab (Erbitux®) in patients previously treated with combination chemotherapy for metastatic colorectal carcinoma.

This is a multicentre, prospective, double‐blind, randomized phase III trial of the VEGFR/FGFR tyrosine kinase inhibitor brivanib (BMS‐582664) in combination with the EGFR‐binding chimerized murine monoclonal antibody cetuximab (Erbitux®) versus matched placebo in combination with cetuximab in patients with previously treated advanced, metastatic, K‐Ras wild type, colorectal carcinoma, conducted by the National Cancer Institute of Canada Clinical Trials Group supported by the Bristol‐Myers Squibb Company.

MOTIF: A Prospective, Randomised Phase II Study of Modafinil to Improve fatigue and Quality of Life in Patients Treated with Docetaxel‐Based chemotherapy for Metastatic breast or Prostate Cancer.

Prospective, mulitcentre, randomised, double‐blind, placebo‐controlled, two‐arm, parallel group study. Patients receiving docetaxel chemotherapy will be randomised using 2:1 ratio (Arm 1:Arm 2) to the following two treatments arm: Arm 1: best supportive care plus modafinil 200 mg mane daily. Arm 2: best supportive care plus placebo care mane daily. Primary objective is to determine the efficacy of modafinil in the reduction of fatigue in patients with metastatic breast or prostate cancer undergoing docetaxel‐based chemotherapy.

BNP:Prediction of cardiotoxicity by measurement of serum N‐terminal pro‐B‐type natriuretic peptic levels in breast cancer patients receiving adjuvant trastuzumab.

The primary objective of this study is to determine if an elevated serum level of N‐terminal pro‐B‐type natriuretic peptide after anthracycline‐based chemotherapy is predictive of the development of left ventricular dysfunction due to trastuzumab therapy

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ATTAX3: A randomised phase II study evaluating weekly docetaxel, cisplatin, fluoropyrimidine (wTCF) plus or minus panitumumab in advanced oesophago‐gastric cancer.

This randomised, phase 2 study involves patients with advanced oesophago‐gastric cancer who will be randomised to one of the following treatment regimens: Arm A: Wtcf/X: Docetaxel + Cisplatin +FU or Xeloda Arm B: Wtcf/X+Panitumumab: Docetaxel + Cisplatin + 5FU or Xeloda + Panitumumab. The primary objective of this study is to evaluate the response rates of Wtcf given with or without panitumumab in the treatment of patients with metastatic or locally recurrent oesophago‐gastric cancer.

CA046: A randomised, phase III Study of Weekly ABI‐007 plus Gemcitabine versus Gemcitabine Alone in Patients with Metastatic Adenocarcinoma of the Pancreas.

This is an open‐label, randomised, multi‐centre, Phase III trial to compare ABI‐007 in combination with gemcitabine administered weekly to standard treatment (gemcitabine monotherapy) with respect to overall survival, objective tumour response rate and progression free survival in patients diagnosed with metastatic adenocarcinoma of the pancreas. Patients will be randomised to one of the following treatment regimens: Arm A: ABI‐007 125mg/m2 administered in combination with gemcitabine 1000 mg/m2 weekly for 3 weeks followed by one week rest. Arm B: Gemcitabine, 1000 mg/m2 administered weekly for 7 weeks followed by a week of rest (Cycle 1), followed by cycles of wekly administered for 3 weeks followed by a week of rest (Cycle 2 onward)

LAP07: Randomised Multinational Phase III Study in Patients with Locally Advanced Adenocarcinoma of the Pancreas:Gemcitabine with or without Chemoradiotherapy and with or without Erlotinib.

This is a prospective international multicentre phase III study in patients with locally advanced, non‐resectable, non‐metastatic cancer of the pancreas. The objective of this is to assess whether administering a chemoradiotherapy (CRT) in patients whose tumour is controlled after 4 months of unduction chemotherapy (CT) increases survival compared to continue the same CT.

SOLE: A phase III trial evaluating the role of continuous letrozole versus intermittent letrozole following 4‐6 years of prior adjuvant endocrine therapy for postmenopausal women with hormone‐receptor and node positive, early stage breast cancer.

The main objective of this study is to compare continuous letrozole for five years with intermittent letrozole over a five years period for postmenopausal women who are disease‐free following 4‐6 years of prior adjuvant endocrine therapy with SERMS(s) and /or AI(s) for endocrine‐responsive, node‐positive, operable breast cancer. The primary end point of the study is disease‐free survival.

PETACC6: Preoperative Chemoradiotherapy and Postoperative Chemotherapy with Capecitabine and Oxaliplatin VS. Capecitabine Alone in Locally Advanced Rectal Cancer.

This is an open‐label, randomised, multi‐national, two‐arm phase III study. The main objective of this study is to investigate whether the addition of Oxaliplatin to preoperative fluoropyrimidine‐based chemoradiation and postoperative fluoropyridine‐based chemotherapy improves disease‐free survival in locally advanced rectal cancer.

SCOT: Short course Oncology Therapy‐A study of Adjuvant Chemotherapy in Colorectal Cancer

This is an open‐label, randomised controlled, two arm, multicentre, non‐inferiority trial. The trial will enrol 9500 patients over 5 years. Patients with fully resected high‐risk stage II/stage III colorectal cancer will be randomised to receive either 12 or 24 weeks of adjuvant chemotherapy. The treatment regimen will be either Oxaliplatin /5FU or Oxaliplatin/Capecitabine. Arm A: Oxal + 5FU for 3 months Arm B: Oxal + 5FU for 6 months The primary endpoint of the study is disease‐free survival.

AFFIRM: A Multinational Phase 3, Randomised, Double‐Blind, Placebo‐Controlled Efficacy and Safety Study of Oral MDV3100 in Patients with Progressive Castration‐Resistant Prostate Cancer Previously Treated with Docetaxel‐Based Chemotherapy.

This is a multinational phase III, randomised, double‐blind, placebo‐controlled efficacy and safety study of oral MDV3100 (160mg/day) in patients with progressive castration‐resistant prostate cancer who have been previously treated with docetaxel‐based chemotherapy. Approximately 1,170 patients will be centrally randomised 2:1 (MDV3100:placebo).The primary objective of the study is to determine the benefit of MDV3100 as compared to placebo as assessed by overall survival.

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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.

This is a multicentre, randomised study evaluating the efficacy of ramucirumab DP using a double‐blind, placebo‐controlled design. Approximately 663 patients have been randomised on a 1:1 basis to receive paclitaxel plus ramucirumab DP in Arm A, or paclitaxel plus placebo in Arm B. A treatment cycle is defined as 28 days.

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.

This is a Phase 3 multicentre, randomised study evaluating the safety and efficacy of ramucirumab DP plus BSC as a double‐blind, placebo‐controlled (placebo plus BSC) comparison. Approximately 544 patients with Child‐Pugh Class A score have been randomised, with an expected 438 events. The primary objective is to compare the overall survival(OS; time from randomisation to death) in patients with hepatocellular carcinoma (HCC) who had progression during or following sorafenib therapy, or were intolerant to this agent.

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.

This is a prospective multicentre, multinational, randomised, open label study comparing the efficacy of cabazitaxel at 25 mg/m2 (Arm A) and at 20 mg/m2 (Arm B) plus prednisone versus docetaxel (Arm C) plus prednisone in terms of overall survival (OS) in patients with metastatic castration resistant prostate cancer and not previously treated with chemotherapy.

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.

This is a prospective multi‐centre, multinational, randomised, open‐label study comparing the efficacy of cabazitaxel 20mg/m2 (Arm A) versus 25 mg/m2 (Arm B) in combination with prednisone in patients with metastatic castration resistant prostate cancer previously treated with a docetaxel‐containing regimen.

PARAGON: Phase 2 study of ARomatase inhibitor in women with potentially hormone responsive recurrent/metastatic Gynaecological Neoplasm.

This is a single arm, prospective, multi‐centre phase II study, grouped by tumour type. The main of this study is to assess the activity of anastrozole, in women with oestrogen receptor and/or progesterone receptor positive (ER/PR+ve) potentially hormone responsive recurrent or metastatic gynaecological cancers including selected patients with epithelial ovarian cancer, endometrial cancers, miscellaneous gynaecological sarcomas and granulose and sex cord stromal tumours of the ovary.

NITRO: A Phase III, randomised trial of adding nitroglycerin to first line chemotherapy for advanced non‐small cell lung cancer.

This is a multicentre, phase III, open‐label, randomised trial balanced by minimisation for gender, stage (III vs IV), histology (adenocarcinoma vs squamous vs other), planned chemotherapy (cisplatin + vinorelbine vs carboplatin + gemacitabine vs carboplatin + paclitaxel vs pemetrexed + cisplatin or carboplatin), ECOG performance status (0/1 vs 2), age (less than or equal to 70 years vs older) and site. The main aim of this trial is to determine the effects of adding transdermal nitroglycerin to first line chemotherapy.

IMPACT: A randomised, open label, phase II trial assessing standard first line treatment with gemcitabine or personalised treatment based on tumour molecular signature in patients with recurrent or metastatic pancreatic

A randomised, open label, phase II trial assessing standard first line treatment with gemcitabine or personalised treatment based on tumour molecular signature in patients with recurrent or metastatic pancreatic cancer to evaluate feasibility and activity on progression free survival. The primary endpoint of the study is to assess progression free survival (PFS) rate at 4 month in the personalised treatment arm. PFS will be

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cancer to evaluate feasibility and impact on progression free survival

evaluated as determined by RECIST 1.1 criteria.

GAP: Phase II study of Gemcitabine and nab‐Paclitaxel for Resectable Pancreas Cancer

This is a non‐randomised phase II study of pre‐operative chemotherapy followed by surgery. The main aim of this study is improve complete resection rates(R0) with the addition of pre‐operative chemotherapy in pancreatic cancer. The primary objective is to evaluate R0 surgical resection rate in patients with resectable pancreatic cancer following pre‐operative treatment with gemcitabine and nab‐Paclitaxel (R0 resection rate)

CO.21 CHALLENGE: A phase III randomised 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.

This is a multi‐national, multi‐centre, randomised phase III study comparing patients allocated to a physical activity program (designed to induce increased physical activity participation) plus general health education materials arm to patients allocated to a general health education materials only arm for patients with high risk stage II/III colon cancer. Patients will be randomised to a planned sample size of 962 to receive one of the following treatment:

Physical activity program plus general health education materials( intervention arm)

General health education materials (control arm)

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

This is a randomised phase III trial evaluating the safety and efficacy of laparoscopic resection for rectal cancer. The study is expected to randomise 470 patients from approximately 20 sites in Australia and New Zealand. Patients will be randomised to either open laparotomy and rectal resection or laparoscopic‐assisted rectal resection. The primary objective of this study is to determine whether laparoscopic‐assisted resection is not inferior to open rectal resection as a safe, effective oncologic approach to rectal cancer.

Project:E48‐11: Discussing Expensive Anticancer Drugs – A Survey of the Opinions of Patients With Cancer

The aim of the study is to investigate the views of patients with incurable cancer with regards to being informed about Expensive Anticancer Drugs (EACDs), and their funding. The Primary Objective of this study is to estimate the proportion of patients with advanced cancer who would want to be informed of an available EACD treatment, regardless of ability to pay for it.

Circulating DNA: Circulating DNA as a personalised biomarker for patients with pancreatic cancer.

The primary objective of this study is to assess the relationship between circulating tumour DNA levels and patient outcomes in patients with pancreatic cancer.

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Achievements AWARDS

July 2012 – December 2012 Barton M B Contribution to research activities; valued commitment to MOGA research projects such as the Workforce Study and radiation oncology workforce issues; dedication to improving the training of young oncologists and important work influencing policy at a governmental level. Award: 2012 Medical Oncology Group of Australia (MOGA)‐Novartis Oncology Cancer Achievement Award 2012. MOGA Presentation Night: Brisbane, August, 2012 Della‐Fiorentina S Innovations in Cancer Care Award : Innovation Award Cancer Institute (NSW), Sydney, Australia Dall’Armi L A Pre‐treatment clinic for high‐risk Head & Neck cancer patients. SWSLHD. Award :Finalist: NSW Health Awards. Category: Cancer Services award for excellence in the provision of Cancer services. Dimigen M, Vinod SK, Tran T, and Lim K Incorporating a Radiologist in a Radiation Oncology Department: A New Model of Care Award : Innovations in Cancer Treatment Award Cancer Institute (NSW), Sydney, Australia Duggan K, Vinod SK, and Descallar J Is there a survival benefit with the receipt of guideline recommended therapy for non metastatic NSCLC? Award : Best of the best posters Annual Scientific Meeting, Brisbane, Australia Girgis A COSA Inaugural Psycho‐Oncology Award Award : COSA Inaugural Psycho‐Oncology Award Joint Meeting of IPOS 14th World Congress and COSA's 39th Annual Scientific Meeting, Brisbane, Australia Kelly J, Vinod SK Shafiq J Timelines in lung cancer diagnosis and treatment in South West Sydney Award : Best of the Best Poster Presentation Best of the Best Poster Presentation 39th Annual Scientific Meeting of COSA, Brisbane, Australia Kiely B The median informs the message: the accuracy of individualized scenarios for survival time based on oncologists' estimates Award : Best of the Best Orals: Clinical Sciences, COSA, Brisbane, Australia

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Moth E Carcinoma of unknown primary: presentation and prognosis in South West Sydney Award : Travel Award ‐ Best of the Best Orals: CUP and supportive care COSA, Brisbane, Australia O’Connor C NIKI T34 Continuous Effusion Syringe Drive Award : Best Poster Presentation NSW State Palliative Care Conference, Dubbo, NSW, Australia Przezdziecki, A. Award: UNSW Allied Health Oncology Research Award Presented by LCTC Management $2500 Radiation Oncology Department Liverpool Hospital General Manager's Innovation Award Award : General Manager's Innovation Award Liverpool Hospital Ball , Liverpool, NSW, Australia

January 2013 – June 2013 Agar M Study of Delirium Award : The Early Career Researcher Award European Association for Palliative Care, Prague Carter C Finalist ‐ Excellence in Provision of Primary (non‐specialist) Palliative Care within a non‐specialist care setting Award Award : Finalist in Award Category State Palliative Care Awards and Gala Dinner, Sydney, Australia Curry R, and Youssef C Expanding the Social Work role on hospital wards to transfer self‐care and communication skills to other disciplines Award: Oncology Social Work Australia (OSWA) Best Poster Presentation, Canberra, Australia Davis P Finalist ‐ Outstanding Contribution to Specialist Palliative Care (Quiet Achiever) Award : Finalist in Award Category State Palliative Care Awards and Gala Dinner, Sydney, Australia Gabriel G Radiotherapy utilisation rates in NSW and ACT (2004‐06), a data linkage and GIS experience Award : One of 20 for the ESTRO Best Poster Award. ESTRO, Geneva, Switzerland Lambert S & Girgis A Paper of the year: Health Services and Epidemiological Award: Lambert SD, Jones B, Girgis A, Lecathelinais C. Distressed partners and caregivers do not recover easily: Adjustment trajectories among partners and caregivers of cancer survivors. Annals of Behavioral Medicine, 2012, 44(2), 225‐235. doi:10.1007/s12160‐012‐9385‐2 South Western Sydney Clinical School, UNSW Medicine, UNSW Przezdziecki, A. Macquarie University Centre for Emotional Health Student Publication Prize Presented by Prof Ron Rapee

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Roche A and Volunteers Finalist ‐ Volunteers Supporting Palliative Care Award Award : Finalist in Award Category State Palliative Care Awards and Gala Dinner, Sydney, Australia Smeal T Leadership in Palliative Care Award Award : Leadership in Palliative Care Award 2013 State Palliative Care Awards & Gala Dinner, Sydney, Australia Wiltshire J Finalist ‐ Leadership in Palliative Care Award : Finalist in Award Category State Palliative Care Awards and Gala Dinner, Sydney, Australia Yip PY Best Consultant Paper Award : Travel Grant Medical Oncology Group of Australia Annual Scientific Meeting, Melbourne, Australia

Book Chapters

Barton MB, Lehman M Glioma of the Central Nervous System Surveillance Counterpoint: Australia Patient Surveillance after Cancer Treatment 2013, Humana Press Barton MB, Williams M and Shafiq RJ Radiotherapy in the context of cancer control Radiotherapy in Cancer Care: facing the global challenge IAEA 2013 Barton MB, Williams M Assessing needs and demand for radiotherapy Radiotherapy in Cancer Care: facing the global challenge IAEA 2013 Ch'ng S and Clark JR Non‐melanoma Skin Cancer Encyclopedia of Otolaryngology 1st Ed 2013 Corman M, Nicholls R.J., Fazio VW, Bergamaschi R, and Bokey EL Carcinoma of the Rectum Corman's Colon and Rectal Surgery 2012 Hanna TP Radiotherapy in the context of cancer control Principles and Practice in Radiation Oncology, Lippincott Williams and Wilkins Koh ES, Hanna TP, and Barton MB Current status of Radiotherapy in Australia, New Zealand and Papua, New Guinea Radiotherapy in Cancer Care: facing the global challenge, IAEA 2013 Shaw D and Clark JR Metastatic Skin Cancer Encyclopedia of Otolaryngology 1st Edition 2013

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Conferences

July 2012 – December 2012 Asghari, R Improving implementation of Colon Cancer Survivorship Care Plan (CCSCP) for eligible patients at Bankstown Hospital Clinical Excellence Commission, Sydney, Australia (Oral Presentation) Barton MB Is VUCCnet Africa a replicable model UICC World Cancer Congress ‐ Connecting for Global Impact, Montreal, Canada (Oral Presentation) Barton MB Burnie versus Darwin: a tale of two cities. Safe and sustainable radiotherapy in regional Australia ‐ from Darwin to Burnie 4th Annual National Cancer Centres Symposium, Melbourne, Australia (Oral Presentation) Batumalai V, Lo Q, Hee L, Allman C, Delaney GP, Lonergan D, Thomas L Acute radiation induced changes in cardiac function after radiotherapy to the left breast FRO ASM 2012, Cairns, Australia (Poster) Boxer MM, Duggan KJ, Vinod SK Do patients get discussed at multidisciplinary meetings receive guideline‐recommended treatment? Australian Lung Cancer Conference, Adelaide SA, Australia (Oral Presentation) Carter C Palliative Care is Everyone’s Business NSW State Palliative Care Conference, Dubbo, NSW, Australia (Oral Presentation) Dall’Armi, L., Simpson, T., Bell, K., Baxter, C. , Forstner, D. A Pre‐Treatment clinic for High‐risk Head & Neck cancer patients. The Power of Innovation. NSW Health Symposium, Sydney, Australia (Poster) Della‐Fiorentina S Role of Gemcitabine in Advanced Breast Cancer Taipai International Breast Cancer Symposium, Taiwan (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 ASTRO 2012, Boston, USA (Poster) 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) Duggan K, Vinod SK, and Descallar J Is there a survival benefit with the receipt of guideline recommended therapy for non metastatic NSCLC? Annual Scientific Meeting, Brisbane, Australia (Oral Presentation and Poster)

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Gabriel G Radiotherapy Utilisation in NSW and ACT (2004‐2006) ‐ A data linkage and GIS experience COSA 39th Annual Scientific Meeting, Brisbane, Australia ( 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 Gynaecological Malignancies: Local Control and Survical Estimates for Optimally Utilized Radiotherapy and Chemoradiation RANZCR FRO Annual Scientific Meeting, Cairns, Queensland (Oral Presentation) Hanna TP, Shafiq J, Delaney GP, and Barton MB An Estimation of the Population Benefit of Radiotherapy for Cervical Cancer: Local Control and Survival RANZCR Annual Scientific Meeting, Melbourne, Victoria (Oral Presentation) Kaadan N, Farrugia S, and Sharmin M Incidence and extent of disease at diagnosis of cancer in the CALD Population in SWSLHD Sydney, Australia (Poster) Kelly J, Vinod S, and Shafiq J Timelines in Lung Cancer Diagnosis & Treatment in South West Sydney COSA 2012, Brisbane, Australia (Poster) Kelly K Speech Pathology and Radiotherapy Introductory Head and Neck Workshop for Speech Pathologists, Coogee, NSW (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) Przezdziecki, A., Sherman, K., Baillie, A, Taylor, A., Foley, E., Staglis‐Bilinski, K., My changed body: breast cancer, body image, distress and self‐compassion IPOS‐COSA 39th Annual Scientific Meeting, Brisbane, Australia (Poster) Shafiq J, Hanna T, Delaney GP, and Vinod S An evidence‐based estimation of survival and local control benefit of radiotherapy for lung cancer Innovations in Cancer Treatment & Care Conference, Sydney, Australia (Oral Presentation) Shafiq J An evidence‐based estimation of radiotherapy benefit for selected cancers Annual Research Seminar, Liverpool, NSW, Australia (Oral Presentation) Sharmin M, Prakash J, and Muadijienga J Merkel Cell Carcinoma in South Western Sydney Local Health District: A Six Year Retrospective Review Annual Scientific Meeting, Brisbane, Australia (Poster) Yip PY, Yu B, Cooper WA, Ng CC, Selinger CI, Kohonen‐Corish MM, McCaughan BC, Kennedy C, Trent R, Boyer MJ, Kench JG, and O'Toole SA Mutations in resected node‐negative lung adenocarcinoma Australian Lung Cancer Conference, Adelaide, Australia (Oral Presentation)

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Yip PY, Yu B, Cooper WA, Ng CC, Selinger CI, Kohonen‐Corish MM, McCaughan BC, Kennedy C, Trent R, Boyer MJ, Kench JG, and O'Toole SA Patterns of DNA mutations in resected early state node negative lung adenocarcinoma COSA Annual Scientific Meeting, Brisbane, Australia (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)

January 2013 – June 2013 Baker K, Fairnham G, Hill A, and Rudnitskiy A Conversion of medical haematology oncology ward to a specialised BMT Ward 39th EBMT Meeting 2013, London, United Kingdom (Poster) Barton MB Radiotherapy Utilisation (RTU) old and new Health Economics in Radiation Oncology (HERO) meeting, Geneva, Switzerland (Oral Presentation) Boxer MM, Duggan KJ, Vinod SK Do patients discussed at multidisciplinary meetings receive guideline‐recommended treatment? Australian Lung Cancer Conference, Adelaide, SA, Australia Brauer, K Curry R Krige A Sapkota P Living Well: Delivering Survivorship Hospital Programmes FCIC Survivorship Conference, Adelaide, South Australia (Poster) Gabriel G Actual utilisation and factors that affect utilisation Health Economics in Radiation Oncology (HERO) meeting, Geneva, Switzerland (Oral Presentation) Gabriel G, Barton MB, and Delaney GD Radiotherapy Utilisation in NSW and ACT (2004‐2006) ‐ A data linkage and GIS experience 2nd ESTRO Forum, Geneva, Switzerland (Oral Presentation and Poster) Girgis A, Webber K Bennett B Bonaventura A Boyle F Koh E‐S Friedlander M Segelov E Goldstein D Acceptability of different models of survivorship follow‐up care: A cross‐sectional survey of adult cancer survivors. 11th Behavioural Research in Cancer Control (BRCC) Conference, Adelaide, Australia (Oral Presentation) Girgis A, Webber K Bennett B Bonaventura A Boyle F Koh E‐S Friedlander M Segelov E Goldstein D How can eHealth support self directed and shared survivorship care? FCIC Cancer Survivorship Conference, Adelaide, Australia (Oral Presentation) Knight A, Dennis S, Delaney GP, Girgis A, Vagholkar S, Liaw ST, Pennock R, and Ijamakinwa O Towards seamless cancer care: what do GP's in a metropolitan health district need to facilitate better integration with cancer services 2013 Primary Health Care Research Conference, Sydney, Australia (Poster) Kumar SS, Holloway LC Koh E‐S Choong C Phan PDT Vinod SK Active breathing coordination to measure tumour motion in lung cancer patients: a feasibility study. 15th World Conference on Lung Cancer, Sydney, Australia (Poster)

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Lambert SD, Girgis A, Descallar J. Partners’ and caregivers’ psychological and physical adjustment to cancer within the first five years post survivor diagnosis. Flinders Centre for Innovation in Cancer Survivorship Conference 2013. Stamford Grand Glenelg, South Australia, 1‐3 February, 2013 (Poster) Lo Q, Hee L, Batumalai V, Allman C, Lonergan D, Delaney GP, and Thomas L Sub‐Clinical cardiac dysfunction detected by strain imaging occurs during chest radiation with persistent changes 6 weeks post treatment 61st Annual Scientific Meeting, Gold Coast, Queensland, Australia (Abstract) S Pillay, R Cuganesan SC Hall P de Souza MM Boxer M. Jaeger J Descallar E‐S Koh Application of the Response Assessment in Neuro‐Oncology (RANO) imaging criteria in high grade glioma in a clinical setting: a feasibility study. RANZCR 64th Annual Scientific Meeting , Auckland, New Zealand (Poster) Shafiq J Comparisons between Australia, Canada and Scotland for breast cancer Health Economics in Radiation Oncology (HERO) meeting, Geneva, Switzerland (Oral Presentation) Tiong SS, Delaney GP Lau AYS Koh ES Adams D Bell V Sapkota P Harris T Girgis A A. Przezdziecki D. Lonergan1 J. Treloar E. Coiera Healthy Me: an e‐health tool for breast cancer survivors: a pilot feasibility study. RANZCR 64th Annual Scientific Meeting , Auckland, New Zealand (Poster) Vinod SK Multidisciplinary Decision in Lung Cancer HERO, Geneva, Switzerland (Oral Presentation) W.Trad, T. Simpson K. M. Wright T. Tran C. Choong M. B. Barton E. J. Hovey E‐S. Koh The Neuro oncology Care Coordinator: a key role in facilitating complex care. Society of Neuro‐Oncology Annual Scientific Meeting, San Francisco, USA (Poster) Webber K, Bennett B Bonaventura A Boyle F Koh E‐S Friedlander M Segelov E Goldstein D The needs of cancer survivors and their comfort levels for discussing them with GPs and oncologists ‐ results from a cross‐sectional survey. FCIC Cancer Survivorship Conference, Adelaide, Australia (Oral Presentation) Webber K, Girgis A Bennett B Bonaventura A Boyle F Koh ES Friedlander M Segelov E Goldstein D The unmet needs of cancer survivors and their preferences for discussing them with oncologists and general practitioners (GPs) ASCO Annual Meeting, Chicago, Illinois, USA (Poster ) Wong K An evidence‐based estimation of the optimal number of radiotherapy fractions for cancer patients Health Economics in Radiation Oncology (HERO) meeting, Geneva, Switzerland (Oral Presentation)

Grants July 2012 – December 2012 Apte M, De Souza P, Biankin A, Rajendra S, Girgis M, Agar M, Epstein R, Goldstein D, Della‐Fiorentina S, Kohonen‐Corish M, and Liaw W. Cell Search System 2013 UNSW Major Research Equipment & Infrastructure Scheme, $250,000/SWSLHD Medical Oncology Trust Fund $ 49,056

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Avery S and Delaney GP Design and Implement a strategic cancer plan that considers issues within the LHD and NSW Cancer Plans, and produce a report on the achievements against the plan. Cancer Institute NSW $20,000 Avery S, Liaw ST Service Provider experiences as a basis to inform an Aboriginal Cancer Care Framework within SWSLHD Cancer Institute NSW $50,000 Bokey EL Cancer Research ‐ Liverpool Hospital Merrylands RSL $40,000 Bokey EL Surgical Skills Program Johnson & Johnson (Medical) $39,092 (in kind products for programme) Breaden K, Currow D, Agar M, Phillips JL, Smith J, and Grbich C Carers views of home oxygen use Flinders University $20,000 Butow P, Thewes B, Turner J, Gilchrist J, Girgis A, 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. Beyond Blue and National Breast Foundation $496,702 Chantrill L, Asghari R, Harvey M, Agar M, Della‐Fiorentina S, and DeSouza P Clinical Trials Research Nurses and Data Manager Grant – Cancer Services Cancer Institute NSW $1,151,700 Davidson P, Luckett T, Lovell M, Agar M, Clayton J, and Phillips J Strategies to decrease pain through implementing a dual clinical pain pathway through implementing a dual clinical pain pathway: Stop Pain‐Path Phase I University of Technology Partnership Grants $29,261 De Souza P Circulating Tumour Cells Prostate Cancer Foundation Australia $75,000 Diagacomo M, Luckett T, Agar M, Phillips JL, and Davidson PM Evidence for the effective models of appliative care and population‐based tools for service planning. Sax Institute $18,400 Girgis A Assessing unmet need for psychosocial support of people with cancer in South Australia: Can Cancer Council SA partner with key stakeholders to do more? Cancer Council South Australia, $92,180 Knight A, Dennis S, Girgis A Towards seamless cancer care : what do GP's in South West Sydney need to facilitate better integration with cancer services Cancer Institute NSW $50,000 Lambert S, Girgis A Improving the quality of life of patients and their primary support person: Developing recommendations to address gaps in cancer information resources. Cancer Institute NSW $20,000

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Lawlor P, Bush S, Momoli F, LaPorte C, Periera J, Agar M, Curow D, Elliott H, Tierney S, Allard P, and Dasgupta M The preventative role of exogenous melatonin administration in patients with advanced cancer who are at high risk of delirium: a feasibility study prior to a larger randomized controlled trial. Faculty of Medicine Programme $58,762 Ling S Improving Cancer Outcome and survivorship through primary health care. Cancer Institute NSW $50,000 Przezdziecki, A. 2012 PoCoG, OZPOS & COSA Travel Grant IPOS‐COSA 39th Annual Scientific Meeting, Brisbane, Australia Robinson J Improving the Patient Experience via an electronic tracking system. Cancer Institute NSW $20,000

January 2013 – June 2013 Agar M, et al. Improving Palliative Care through Clinical Trials (ImPaCCT) ‐ the NSW collaborative trials group in palliative care. Cancer Institute NSW $294,484 Agar M, Davidson P, Dods S, Duffield C, Chye R, Currow D, Elliott D, Phillips J, Daly J, Hickman L, Ryan L, Fry M, Agar M, Fry M, Agar M, Macdonald P, Newton P, Inglis S, Luckett T, Flynn T, and Howes T. Advance care planning in the emergency department: identification of barriers, facilitators and technological solutions (ACP‐ED).CSIRO Flagship Project $79,000 Apte M, Wilson JS, Goldstein D, Pirola RC, and Kumar RK. Targeting the stroma in pancreatic cancer ‐ a novel therapeutic approach focusing on the HGF/c‐MET pathway. NSW Cancer Council $360,000 Clark J. Head and Neck Visiting Fellow (Dr R. Janakiraman). COSA Funding of Position Delaney GP SWSLHD Cancer Services AGM 2012/2013. Bankstown Sports Club (Venue Hire) $3,000 Girgis A, Delaney GP, Miller A, Arnold A, Carolan M, Della‐Fiorentina S, Kaadan N, Avery S, Van Domberg N, Ng W, and Spring K. Patient reported experience collaborative project. Cancer Institute NSW $200,000 Halkett GKB, Nowak A, Lobb E, Agar M, Miller L, Moorin R, and Shaw T Confidence to Care: A randomised controlled trial of structured home‐based support and education for carers of people with high grade glioma. Cancer Council of Western Australia $99,315 Hovey L, Simes J, Koh ES, and Agar M COGNO infrastructure funding for support, development and conduct of clinical trials and translational research. Cancer Institute NSW $300,000

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Kurrle S, Bird M, Crotty M, Agar M, Cumming A, Koch S, Whitehead C, Biggs S, CameronI, Field S, Gray L, Hilmer S, and Pond D. Dealing with cognitive and associated functional decline in the elderly. NHMRC $25M Lambert S, Girgis A, and Chambers S Is it better to do it in pairs? A coping skills self‐directed intervention for patient‐primary support dyads. Priority Research Centre for Health Behaviour $13,100 Sanson‐Fisher R, Shaw T, Girgis A, Aranda S Developing a priority setting framework for reducing evidence‐practice gaps in cancer control Cancer Institute NSW (Implementation Group Community of Practice grant), $60,582 Shaw T, Braithwaite J, Girgis A, Sanson‐Fisher R Implementation Research Education Program Cancer Institute NSW (Implementation Group Community of Practice grant), $91,387 Soon PSH MicroRNA profiling of stromal cells in breast cancer and pancreatic cancer: influence on stroma‐tumour interactions and cancer progression. UNSW $20,000

Invited Expert

Barton M Topic "Core competencies: are they applicable in developing countries?' Implementation of Radiation Oncology Programs in Developing Countries" International Atomic Energy Agency International Atomic Energy Agency Barton MB Topic "Radiotherapy Innovations Summit" Royal Australian & New Zealand College of Radiologists (RANZCR) Royal Australian & New Zealand College of Radiologists (RANZCR) Barton M Topic "IAEA Co‐ordinated Research Project Meeting" International Atomic Energy Agency International Atomic Energy Agency Barton MB Topic "Evaluation of Cancer Services, Papua, New Guinea, 12‐18 May 2013" Della‐Fiorentina S Topic "Role of Gemcitabine in Advanced Breast Cancer" Cross Straits and Taiwan Cancer Society Taiwan Oncology Society Scientific Meeting Wiltshire J Topic “development of an online search filert for Dementia” Part of invited Expert reference group. Care search Knowledge network and Integrated care framework for advanced Dementia( collaboration)

Invited Speaker July 2012 – December 2012

Delaney GP Topic "Update on radiotherapy in Early Breast Cancer" International Breast Cancer Symposium, Sydney, Australia

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Delaney GP Topic "Detecting Error and Clinical Consequences: Acute & chronic complications of accidents.How can accidents be clinically detected?" Patient Safety in Radiation Oncology Workshop ROSIS Australian Organising Committee Chaired by Prof Geoff Delaney, Melbourne, Australia Delaney GP Topic "Faculty Member and Facilitator" ACORD Workshop ACORD, Queensland, Australia Delaney GP Topic "Update on Cancer Services in South Western Local Health District" South Western Sydney Public Forum SWSLHD, Liverpool, Australia Girgis A “This follow‐up care would meet my needs, but I would still worry that problems with my health would not be found”: A cross‐sectional survey of adult cancer survivors. COSA symposium ‐ The public health approach to cancer survivorship. 2012 Joint Meeting of IPOS 14th World Congress and COSA's 39th Annual Scientific Meeting ‐ Impact through Translation: Cancer Research Informing Practice. Brisbane, Australia 11‐15 November 2012. Girgis A Translational research: Making your research count, whatever shape and size it comes in. 2nd Annual South Western Sydney Local Health District Allied Health Research Forum. Liverpool Hospital, Sydney 21 September 2012. Girgis A The role of e‐health in facilitating needs‐based patient‐centred care? Paving the Future of Supportive Cancer Care: Is E‐health the Way Forwards? (Workshop). International Symposium Multinational Association of Supportive Care in Cancer. New York, USA, June 28‐30, 2012 Yip PY Topic "Tissue Microarrays" Basic Sciences in Oncology MOGA, Sydney, Australia Wiltshire J Topic “Managing Endstage Disease” International Breast Cancer Symposium, Sydney, Australia

Invited Speaker January 2013 – July 2013

Clark J Topic "Thyroid Cancer" 84th Annual Meeting German Society of Oto‐Rhino‐Laryngology Nuremberg, Germany Clark, J. Topic "Oral Cancer Panel Discussion" Australian and New Zealand Head and Neck Meeting Australian and New Zealand Head and Neck Society Brisbane, Queensland, Australia Clark, J. Topic "Tracheal Reconstruction " 8th International Conference on Head and Neck Cancer American Head and Neck Society, Toronto, Canada

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Clark, J. Topic "Instructional course: Non‐Melanoma Skin Cancer" 8th International Conference on Head and Neck Cancer American Head and Neck Society, Toronto, Canada Della‐Fiorentina S Topic "Role of Breast Care Nurses" McGrath Foundation McGrath Foundation Sydney, Australia Girgis A Cancer survivorship: What it means for survivors and caregivers. Prostate Cancer Foundation of Australia and Ovarian Cancer Australia Annual Research Update. Centenary Institute, Camperdown, 14th June 2013. Girgis A Building research capacity at the individual level. Inaugural National Palliative Care Research Colloquium. The University of Melbourne, 18‐19 July 2013. Girgis A Suffering in silence. The impact of cancer on caregivers. Flinders Centre for Innovation in Cancer Survivorship Conference 2013. Stamford Grand Glenelg, South Australia, 1‐3 February, 2013. Girgis A How can eHealth support self‐directed and shared survivorship care? Flinders Centre for Innovation in Cancer Survivorship Conference 2013. Stamford Grand Glenelg, South Australia, 1‐3 February, 2013. Przezdziecki, A Topic “Dietetics & Psychology: Areas of collaboration in oncology” Dietitians Association of Australia Oncology Special Interest Group , RPAH, Sydney, Australia Vinod S Topic "Multidisciplinary Decisions in Lung Cancer" Modelling Demand for Radiotherapy Workshop, Health Economics in Radiation Oncology ESTRO Geneva, Switzerland Vinod SK Topic "Gynaecological Brachytherapy" Clinical Brachytherapy Workshop Australasian Brachytherapy Group Melbourne, Australia

Journals

July 2012 – December 2012 Agar, M. and Luckett, T. Outcome measures for palliative care research Curr.Opin.Support.Palliat.Care Vol 6, Issue 4, Pages 500 – 507 Agar, M., Draper, B., Phillips, P. A., Phillips, J., Collier, A., Harlum, J., and Currow, D. Making decisions about delirium: a qualitative comparison of decision making between nurses working in palliative care, aged care, aged care psychiatry, and oncology Palliat.Med Vol 26, Issue 7, Pages 887 ‐ 896

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Akerstrom, T., Crona, J., Delgado, Verdugo A., Starker, L. F., Cupisti, K., Willenberg, H. S., Knoefel, W. T., Saeger, W., Feller, A., Ip, J., Soon, P., Anlauf, M., Alesina, P. F., Schmid, K. W., Decaussin, M., Levillain, P., Wangberg, B., Peix, J. L., Robinson, B., Zedenius, J., Backdahl, M., Caramuta, S., Iwen, K. A., Botling, J., Stalberg, P., Kraimps, J. L., Dralle, H., Hellman, P., Sidhu, S., Westin, G., Lehnert, H., Walz, M. K., Akerstrom, G., Carling, T., Choi, M., Lifton, R. P., and Bjorklund, P. Comprehensive re‐sequencing of adrenal aldosterone producing lesions reveal three somatic mutations near the KCNJ5 potassium channel selectivity filter PLoS.One. Vol 7, Issue 7, Pages e41926 Biankin, AV., et al Pancreatic cancer genomes reveal aberrations in axon guidance pathway genes Nature Vol 491, Issue 7424, Pages 399 ‐ 405 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., 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. Cho, B., Poulsen, P., Ruan, D., Sawant, A., and Keall, P. J. Experimental investigation of a general real‐time 3D target localization method using sequential kV imaging combined with respiratory monitoring Phys.Med Biol. Vol 57, Issue 22, Pages 7395 ‐ 7407 Choi, P. Y., Gordon, J. E., Harvey, M., and Chong, B. H. Presentation and outcome of idiopathic thrombocytopenic purpura in a single Australian centre Intern.Med J Vol 42, Issue 7, Pages 841 ‐ 845 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 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 Vol 19, Issue 13, Pages 4252 ‐ 4258 Connell, T., Fernandez, R. S., Tran, D., Griffiths, R., Harlum, J., and Agar, M. Quality of life of community‐based palliative care clients and their caregivers Palliat.Support.Care Pages 1 ‐ 8 Crocker, J. K., Ng, J. A., Keall, P. J., and Booth, J. T. Measurement of patient imaging dose for real‐time kilovoltage x‐ray intrafraction tumour position monitoring in prostate patients Phys.Med Biol. Vol 57, Issue 10, Pages 2969 ‐ 2980 Currow D and Agar M Evidence Based Practice ‐ Where does the buck stop? Journal of Pharmacy Practice and Research Vol 42, Issue 2, Pages 91 – 92 Dimoska, A., Butow, P. N., Lynch, J., Hovey, E., Agar, M., Beale, P., and Tattersall, M. H. Implementing patient question‐prompt lists into routine cancer care Patient.Educ.Couns. Vol 86, Issue 2, Pages 252 ‐ 258

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Ch'ng, Ashford B Clark JR Alignment of the Double‐Barrel Fibula Free Flap for Better Cosmesis and Bone Height for Osseointegrated Dental Implants Plastics and Reconstructive Surgery 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 Vol 35, Issue 2, Pages 190 – 194 Ch'ng, S., Corbett‐Burns, S., Stanton, N., Gao, K., Shannon, K., Clifford, A., Gupta, R., and Clark, J. R. Close margin alone does not warrant postoperative adjuvant radiotherapy in oral squamous cell carcinoma Cancer Vol 119, Issue 13, Pages 2427 ‐ 2437 Ch'ng, S., Oates, J., Gao, K., Foo, K., Davies, S., Brunner, M., and Clark, J. R. Prospective quality of life assessment between treatment groups for oral cavity 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 Vol 35, Issue 2, Pages 205 – 208 Ch'ng, S., Choi, V., Elliott, M., and Clark, J. R. Relationship between postoperative complications and survival after free flap reconstruction for oral cavity squamous cell carcinoma Head Neck Chang, D. K., Jamieson, N. B., Johns, A. L., Scarlett, C. J., Pajic, M., Chou, A., Pinese, M., Humphris, J. L., Jones, M. D., Toon, C., Nagrial, A. M., Chantrill, L. A., Chin, V. T., Pinho, A. V., Rooman, I., Cowley, M. J., Wu, J., Mead, R. S., Colvin, E. K., Samra, J. S., Corbo, V., Bassi, C., Falconi, M., Lawlor, R. T., Crippa, S., Sperandio, N., Bersani, S., Dickson, E. J., Mohamed, M. A., Oien, K. A., Foulis, A. K., Musgrove, E. A., Sutherland, R. L., Kench, J. G., Carter, C. R., Gill, A. J., Scarpa, A., McKay, C. J., and Biankin, A. V. Histomolecular phenotypes and outcome in adenocarcinoma of the ampulla of vater J Clin Oncol Vol 31, Issue 10, Pages 1348 ‐ 1356 Chantrill L, Johns A, Nagrial A, Chin V, Chou A, Pinese M, Mead S, Gebski V, Sjoquist K, Lee C, Yip S, Miller D, Sebastian L, Asghari R, Harvey S, Pavlakis N, Mukhedkar S, Grimison P, Miller D, Pearson J, Waddell N, Grimmond S, Simes J & Biankin A. The IMPaCT trial: Individualised Molecular Pancreatic Cancer Therapy. A pilot, randomised, open label phase II trial assessing first line treatment with gemcitabine or personalized treatment based on tumour molecular signature in patients with metastatic pancreatic cancer. 2013 Crowther, H. J., Lindeman, R., Ho, P., Allen, E., Waite, C., Matthews, S., Jobburn, K., Teo, J., Day, S., Seldon, M., Rosenfeld, D., and Kerridge, I. The Health of Adults Living with a Clinically Significant Haemoglobinopathy in NSW, Australia. The NSW Haemoglobinopathy Project, Intern.Med J Currow, D. C., Agar, M., and Abernethy, A. P. Hospital can be the actively chosen place for death J Clin Oncol Vol 31, Issue 5, Pages 651 – 652 Currow D, Agar M and To T Rapid Deaths in hospital Letter to the Editor, Internal Medicine Journal

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Hau, E., Browne, L., Capp, A., Delaney, G. P., Fox, C., Kearsley, J. H., Millar, E., Nasser, E. H., Papadatos, G., and Graham, P. H. The impact of breast cosmetic and functional outcomes on quality of life: long‐term results from the St. George and Wollongong randomized breast boost trial Breast Cancer Res.Treat. Vol 139, Issue 1, Pages 115 – 123 Hong AM, Dobbins TA Lee S jones D Fei J Clark JR Armstrong BK Milross CG Tran N Ng C Milne AG Loo C Hughes LJ Forstner DF O'Brien CJ Rose BR Human papillomavirus modifies the prgnostic significance of T stage and possily N stage tonsillar cancer Annals of Oncology Vol 24, Hong, A., Zhang, M., Veillard, A. S., Jahanbani, J., Lee, C. S., Jones, D., Harnett, G., Clark, J., Elliott, M., Milross, C., and Rose, B. The prognostic significance of hypoxia inducing factor 1‐alpha in oropharyngeal cancer in relation to human papillomavirus status Oral Oncol Vol 49, Issue 4, Pages 354 – 359 Hosie, A., Davidson, P. M., Agar, M., Sanderson, C. R., and Phillips, J. Delirium prevalence, incidence, and implications for screening in specialist palliative care inpatient settings: a systematic review Palliat.Med Vol 27, Issue 6, Pages 486 ‐ 498 Kenny LM, Peters LJ, Barton M, and Millross C Radiotherapy ‐ a leap forwarded in cancer care Cancer Forum Vol 37, Issue 1, Khasraw M, Leow FM, West L, Mitchell G, White K, Oleson I, Prince K, Brandt C, Duan W, Shigdar S, Muscat A, Mukaro V, Hayes T, Harvey SL, Edward M, Singh M, Spoke R, Woolett A & Patil S. Tailored Neoadjuvant epirubicin and cyclophosphamide and nanoparticle bound (NAB) pacliatxel for newly diagnosed breast cancer. Asia‐Pac J Clin Oncol 2013; 9(S2): 37. Lambert, S. D., Girgis, A., McElduff, P., Turner, J., Levesque, J. V., Kayser, K., Mihalopoulos, C., Shih, S. T., and Barker, D. A parallel‐group, randomised controlled trial of a multimedia, self‐directed, coping skills training intervention for patients with cancer and their partners: design and rationale BMJ Open. Vol 3, Issue 7, Lambert, S. D., Girgis, A., Lecathelinais, C., and Stacey, F. Walking a mile in their shoes: anxiety and depression among partners and caregivers of cancer survivors at 6 and 12 months post‐diagnosis Support.Care Cancer Vol 21, Issue 1, Pages 75 – 85 Li, W. W., Lam, W. W., Au, A. H., Ye, M., Law, W. L., Poon, J., Kwong, A., Suen, D., Tsang, J., Girgis, A., and Fielding, R. Interpreting differences in patterns of supportive care needs between patients with breast cancer and patients with colorectal cancer Psychooncology. Vol 22, Issue 4, Pages 792 ‐ 798 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 Vol 45, Issue 2, Pages 279 ‐ 297 McLean, T., Brunner, M., Ebrahimi, A., Gao, K., Ch'ng, S., Veness, M. J., and Clark, J. R. Concurrent primary and metastatic cutaneous head and neck squamous cell carcinoma: Analysis of prognostic factors Head Neck Vol 35, Issue 8, Pages 1144 ‐ 1148

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Metcalfe, P., Liney, G. P., Holloway, L., Walker, A., Barton, M., Delaney, G. P., Vinod, S., and Tome, W. The Potential for an Enhanced Role For MRI in Radiation‐therapy Treatment Planning Technol.Cancer Res.Treat. Olver, S., Apte, S. H., Baz, A., Kelso, A., and Kienzle, N. Interleukin‐4‐induced loss of CD8 expression and cytolytic function in effector CD8 T cells persists long term in vivo Immunology. 2013 Jun;139(2):187‐96. doi: 10.1111/imm.12068 Quinn A, Holloway L, Koh ES, Delaney GP, Arumugam S, Goozee G, and Metcalfe P Radiation dose and contralateral breast cancer risk associated with megavoltage cone‐beam computed tomographic image verification in breast radiation therapy Practical Radiation Oncology Vol 3, Pages 93 ‐ 100 Quinn, A., Holloway, L., Hardcastle, N., Tome, W. A., Rosenfeld, A., and Metcalfe, P. Normal tissue dose and second cancer risk due to megavoltage fan‐beam CT, static tomotherapy and helical tomotherapy in breast radiotherapy Radiother.Oncol Senior, H. E., Mitchell, G. K., Nikles, J., Carmont, S. A., Schluter, P. J., Currow, D. C., Vora, R., Yelland, M. J., Agar, M., Good, P. D., and Hardy, J. R. Using aggregated single patient (N‐of‐1) trials to determine the effectiveness of psychostimulants to reduce fatigue in advanced cancer patients: a rationale and protocol BMC.Palliat.Care Vol 12, Issue 1, Pages 17 – Scheinberg T, Asghari R & Harvey SL. Potential predictors of febrile neutropaenia in women receiving docetaxel cyclophosphamide (TC) for early breast cancer in an ethnically diverse population. Asia‐Pac J Clin Oncol 2013; 9(S2): 42 Soon, P. and Kiaris, H. MicroRNAs in the tumour microenvironment: big role for small players Endocr.Relat Cancer Vol 20, Issue 5, Pages R257 ‐ R267 Soon, P. S., Kim, E., Pon, C. K., Gill, A. J., Moore, K., Spillane, A. J., Benn, D. E., and Baxter, R. C. Breast cancer‐associated fibroblasts induce epithelial‐to‐mesenchymal transition in breast cancer cells Endocr.Relat Cancer Vol 20, Issue 1, Pages 1 – 12 Thompson, S. R., Delaney, G. P., Gabriel, G. S., Jacob, S., Das, P., and 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. Vol 85, Issue 2, Pages 400 – 405 To, T. H., Agar, M., Shelby‐James, T., Abernethy, A. P., Doogue, M., Rowett, D., Ko, D., and Currow, D. C. Off‐label prescribing in palliative care ‐ a cross‐sectio nal national survey of palliative medicine doctors Palliat.Med Vol 27, Issue 4, Pages 320 ‐ 328 To, T. H., Agar, M., and Currow, D. C. Rapid death after hospitalisation Intern.Med J Vol 43, Issue 4, Pages 471 Vas Nunes, J. H., Clark, J. R., Gao, K., Chua, E., Campbell, P., Niles, N., Gargya, A., and Elliott, M. S. Prognostic implications of lymph node yield and lymph node ratio in papillary thyroid carcinoma Thyroid Vol 23, Issue 7, Pages 811 – 816 Vinod SK and Ball DL Radiotherapy in Lung Cancer Cancer Forum Vol 37, Issue 2, Pages 153 ‐ 157

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Vinod, S. K. and Lonergan, D. M. Multisource feedback for radiation oncologists J Med Imaging Radiat.Oncol Vol 57, Issue 3, Pages 384 – 389 Windsor A, Koh ES Allen S Yeo AET Allison R Barton MB. Characteristics and outcomes after whole brain radiotherapy for brain metastases in a large international cohort. The Royal College of Radiologists (2013) Windsor, A. A., Koh, E. S., Allen, S., Gabriel, G. S., Yeo, A. E., Allison, R., van der Linden, Y. M., and Barton, M. B. Poor Outcomes after Whole Brain Radiotherapy in Patients with Brain Metastases: Results from an International Multicentre Cohort Study Clin Oncol (R Coll Radiol)

University Achievements Kiely B Qualification achieved : PhD “The Art of Oncology : communication survival expectancy to patients with cancer “ Sydney University, NSW Kienzle N Qualification achieved: Conjoint Associate Professor Appointment Faculty of Medicine UNSW, South Western Sydney Clinical School O’Connor C Qualification achieved: Masters of Palliative Care Flinders University, SA Wong K PhD Thesis awarded, November 2012. Dr Karen Wong, Staff Specialist, Radiation Oncology. PhD thesis – “Estimation of the Optimal Number of Radiotherapy Fractions for Cancer Patients”. Supervisors: Professor Michael Barton, Professor Geoff Delaney Submitted: July, 2012. Awarded November 2012 The aim of this research was to construct an evidence‐based model to estimate the optimal number of radiotherapy fractions per cancer patient and per treatment course, building on the existing optimal radiotherapy utilisation model. These data can provide a benchmark for services delivery and for comparison with actual fractionation in practice. This model can also be applied to predict future radiotherapy workload and hence aid in future radiotherapy services planning in Australia.

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SOUTH WESTERN SYDNEY CANCER SERVICES ANNUAL …