2012 Innovations in Cancer Treatment and Care Conference

The project, "Healthy and Happy Life in Sydney", will be designed to be culturally sensitive and linguistically appropriate cancer education program.

This abstract has been selected for an oral presentation in the Under Served Populations workshop.

Authors: O Ogunsiji (Lead)

Background

Cancer has a stigmatized image among Chinese and African people and is believed by many to be contagious. It is a taboo topic in both cultures.

This project aims:

1. to develop and implement a tailor-made culturally-sensitive and linguistically appropriate cancer awareness program for addressing misconceptions and myths around cancer and promoting cancer screening participation among Chinese and African-Australians and,
2. to train and place in the community, a number of "Community Health Advocates" to continue ongoing educational work in relation to aim 1 above.

Methods

The project, titled "Healthy and Happy Life in Sydney", will be designed to be culturally sensitive and linguistically appropriate cancer education program and will operate in conjunction with a number of ethnic Chinese and African organisations whereby providing the platform for reaching the maximum target population.

The project will consist of three phases:

• Phase 1 will be cancer education and information. Seminar will be conducted aiming at cancer awareness, addressing myths about cancer as well as the importance of screening and early detection. The presence of a cancer survivor and screening participant from both communities to share their experience will form the focus of the seminar. Participants will be given a take-home kit containing written materials and a CD with the summary of the seminar.
• Phase 2 will be group screening activities. Mammography screening will be organised with the Breast Screening Centre. The group activity will provide an opportunity for women to encourage and support each other and undertake the screening with support from translators and health professionals from similar cultural and linguistic backgrounds. Pap smear test will be provided on site of seminar.
• Phase 3 will be training of community health advocates to continue the role as educators, promoting cancer awareness and cancer screening practices on a long term basis.

Results

N/A

Conclusion

N/A

Please note: Copyright for the abstract is owned by the author(s) listed. The data, conclusions, views or opinions presented in this abstract are solely those of the author(s) and do not necessarily represent those of the Cancer Institute NSW. The Cancer Institute NSW makes no claim to the validity or accuracy of the information provided.

The aim of this project was to create a reliable nomogram able to predict the occurrence of central compartment lymph node metastasis using readily available pre-operative clinical characteristics.

This abstract has been selected as a poster presentation for the Innovation in cancer treatment and care NSW conference.

Authors: A Thompson (Lead), R Turner, A Hayen, A Anassis, M Sywak

Background

Central compartment lymph node metastases in papillary thyroid carcinoma (PTC) are difficult to detect pre-operatively and the role of routine or prophylactic central compartment lymph node dissection (CLND) in the treatment of PTC remains controversial.

Methods

Records from patients undergoing total thyroidectomy and lymph node dissection for PTC in the period 1969–to2011 were analysed.

• Nodal status was based on results of serial H&E examination.
• The variables age, sex, tumour size, tumour site and multifocality were included in a multivariable logistic regression model predicting lymph node metastasis.
• A coefficient-based nomogram was developed and externally validated using 1310 international patients.

Results

The study population included 852 patients (80.5% females) with a mean age of 46 years and mean tumour size of 17.2mm.

• The average nodal yield was 10 per patient with lymph node metastases being present in 382 (45%) of patients.
• The variables with the highest predictive value were age (p<0.001), male sex (p<0.001) and increasing tumour size (p<0.001).
• The nomogram had good discrimination with a concordance index of 75.1%, supported by external validation with 95% confidence interval of (57.0%, 75.4%).
• An online calculator and smartphone application were developed for point of care use.

Conclusion

A validated nomogram utilizing readily available preoperative variables has been developed to give a predicted probability of central lymph node metastases in patients presenting with PTC. This nomogram may help guide operative decision making in PTC.

Please note: Copyright for the abstract is owned by the author(s) listed. The data, conclusions, views or opinions presented in this abstract are solely those of the author(s) and do not necessarily represent those of the Cancer Institute NSW. The Cancer Institute NSW makes no claim to the validity or accuracy of the information provided.

Bilateral hip prostheses present a technical challenge when planning curative external beam radiation treatment for patients with prostate cancer.

This abstract has been selected as a poster presentation for the Innovation in cancer treatment and care NSW conference.

Authors: D Martin(Lead), G Hruby, M Whitaker, K Foo

Background

When following protocols such as AAPM TG 63: Dosimetric considerations for patients with HIP prostheses undergoing pelvic irradiation, compromise is often necessary between target coverage and avoidance of beam entry through the prostheses. We have developed a novel inverse planning technique to overcome these restrictions by constraining beam characteristics, rather than dose, in the inverse planning process.

Methods

Planning was undertaken using the Varian Eclipse Treatment Planning system. Eclipse allows the primary collimators (jaws) to be locked prior to IMRT optimisation. A seven field IMRT technique was used, with gantry angles of 0, 45, 90, 130, 220 and 270 degrees. Heterogeneity corrections were turned off in Eclipse and dose was not permitted to enter through the prostheses, although exit dose through the prostheses, beyond the PTV, was permitted. At treatment, portal imaging was used to confirm that the ipsilateral (entry-side) prosthesis was not in the beam's eye view.

Results

This method of planning has been used in our department for the treatment of post-prostatectomy courses of radiation therapy, for which we do not use implanted fiducial markers. Utilising the locking jaw feature in Eclipse allowed us to completely treat the PTV whilst minimising dose to the structures at risk. Improved DVH results indicate the efficacy of this technique over the more traditional methods of constraining dose to the prostheses or beam angles to avoid the prostheses.

Conclusion

The novel element in this technique is the use of IMRT inverse planning together with a geometric, rather than dosimetric, constraint. Allowing low exit dose to the prosthesis beyond the PTV increases the search space for the inverse planning algorithm, increasing the probability of creating the best plan for the patient.

Please note: Copyright for the abstract is owned by the author(s) listed. The data, conclusions, views or opinions presented in this abstract are solely those of the author(s) and do not necessarily represent those of the Cancer Institute NSW. The Cancer Institute NSW makes no claim to the validity or accuracy of the information provided.

This project, funded by the Cancer Institute NSW CALD Program, aims to address cancer stigma within Macedonian and Serbian communities of the Illawarra taking a collaborative partnership approach.

This abstract has been selected as a poster presentation for the Innovation in cancer treatment and care NSW conference.

Authors: L Phillipson (Lead), SC Jones, L Pitts, T Hunt, J Hall, G Beaven, S Dunn, D Iverson

Background

There is substantial evidence that members of CALD communities in Australia experience higher rates of cancer-related morbidity and mortality than Australian-born counterparts.

The incidence rates do not differ significantly by country of birth, suggesting that these poorer outcomes are a result of delayed diagnosis and treatment.

Important factors that may contribute to delayed diagnosis include:

• association of a cancer diagnosis with certain death or very poor quality of life;
• misconceptions about the causes of cancer;
• cultural taboos around discussing cancer;
• stigma and 'blame' attached to cancer diagnosis; and
• perceptions of discrimination or culturally insensitivity in the delivery of health services.

The small body of research that has been conducted with Macedonian and Serbian communities in Australia has confirmed the existence of these (and other) barriers in these communities.

For example, a Melbourne-based study of Macedonian women's beliefs about breast cancer found that barriers included fatalism about cancer diagnosis, fear that thinking or talking about cancer can cause the disease, misperceptions about causes (such as stress, pollution, personal uncleanliness, fright and 'destiny') and unsupportive male partners.

Methods

This project will use a social marketing framework to:

• Understand attitudes and beliefs through direct engagement with Macedonian and Serbian community members and health service personnel focusing on myths, misperceptions, cancer stigma, and barriers to discussing cancer ;
• Develop culturally sensitive education resources and conduct forums and events to address any identified myths and misperceptions;
• Utilise appropriate media and community channels to communicate key health access messages using culturally, linguistically and religiously appropriate approaches;
• Work with existing cancer services to enhance cultural appropriateness and address barriers for CALD clients to seek diagnosis and promote treatment

Results

N/A

Conclusion

N/A

Please note: Copyright for the abstract is owned by the author(s) listed. The data, conclusions, views or opinions presented in this abstract are solely those of the author(s) and do not necessarily represent those of the Cancer Institute NSW. The Cancer Institute NSW makes no claim to the validity or accuracy of the information provided.

Primary content

Our study aimed at estimating the benefit of definitive or adjuvant radiotherapy to overall survival and local control of lung cancer patients if all are treated according to evidence-based treatment guidelines.

This abstract has been selected as an oral presentation in the Radiation Innovations workshop

Authors: J Shafiq (Lead), TP Hanna, G Delaney, S Vinod, M Barton

Background

Radiotherapy utilisation benchmarks developed by Delaney et al have been used as the basis for planning future radiotherapy services both nationally and internationally.

These utilisation models can be further expanded to estimate the measured value of benefit (eg. increase in survival) for each indication in individual cancer sites using evidence-based approach [Shafiq et al 2007].

Methods

The optimal radiotherapy utilization model previously reported [Delaney et al 2003] for all types of lung cancers, namely, small-cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) was extended to incorporate overall survival and local control benefit from radiotherapy (radiotherapy vs no radiotherapy, concurrent radiotherapy and chemotherapy vs radiotherapy alone) from review of published literature (1990–to2010).

Results

• The gains in 5-year survival and local control from optimal radiotherapy treatment of all lung cancer patients were 5% (95% CI 3.6%–to6.7%) and 11% (95% CI 9.5%–to12.3%) respectively.
• The optimal gains from concurrent chemotherapy and radiotherapy over radiotherapy alone were 4% (95% CI 1.0%–to6.0%) for survival and 5% (95% CI 1.7%–to7.6%) for local control.
• The overall survival benefit for radiotherapy including concurrent chemotherapy were 2% for SCLC and 10% for NSCLC; 5 year local control benefit proportions were: SCLC 10% and NSCLC 17%.

Conclusion

Our model was able to provide a quantitative estimate of benefit from curative radiotherapy for lung cancer at the population level.

It indicated that application of radiotherapy once in their treatment could save 9000 extra lives per 100 000 cases of lung cancer for up to 5 years and prevent 16000 local recurrences in that period.

Please note: Copyright for the abstract is owned by the author(s) listed. The data, conclusions, views or opinions presented in this abstract are solely those of the author(s) and do not necessarily represent those of the Cancer Institute NSW. The Cancer Institute NSW makes no claim to the validity or accuracy of the information provided.

This study aims to gain insight into radiation oncologists' awareness of health literacy amongst their patients, and its effect on communication and decision-making.

This abstract has been selected as a poster presentation for the Innovation in cancer treatment and care NSW conference.

Authors: SK Smith (Lead), L Petrak, J Taylor, C Milross, H Dhillon

Background

Patients with cancer are exposed to complex information as part of treatment and follow-up care. There has been little research with patients who have lower education and literacy, or the clinicians who care for them and their awareness of health literacy.

Methods

This qualitative study used semi-structured interviews with radiation oncologists conducted in person or via telephone. Interviews were audio-recorded and transcribed verbatim. Framework analysis was used to develop a coding schema of themes, and then used to code, and analyse the data and compare and contrast how radiation oncologists experiences differ.

Results

Twenty-six radiation oncologists, aged between 35–to65 years and who had worked in oncology for 9 to 30 years, were interviewed. Nineteen were male, 17 Australian and 18 native English speakers.

Main themes identified included:

• recognition of need to screen patients for characteristics indicative of lower literacy
• using both verbal and visual information is communicate effectively
• using the multi-disciplinary team to communicate with and support patients
• tailoring consultations to meet the expectations, needs and preferences of patients
• confirming patient understanding.

During consultations, radiation oncologists described strategies to help them form a judgment about a patients' literacy level. These included:

• monitoring the questions asked
• vocabulary used
• non-verbal behaviour and demographic information.

Most radiation oncologists identified specific concepts they perceived patients had difficulty understanding, these included:

• disease and treatment information
• risk information
• side-effects of treatment
• the healthcare system.

Conclusion

Radiation oncologists recognised health literacy as important in decision-making, adherence and self-care in radiotherapy.

There are opportunities to improve communication between radiation oncologists and patients, including:

• improved literacy screening tools
• improved information materials about cancer and radiotherapy, and
• increasing communication skills of health professionals in dealing with patients of limited literacy.

Please note: Copyright for the abstract is owned by the author(s) listed. The data, conclusions, views or opinions presented in this abstract are solely those of the author(s) and do not necessarily represent those of the Cancer Institute NSW. The Cancer Institute NSW makes no claim to the validity or accuracy of the information provided.

Care coordination and psycho oncology services for cancer patients has been recognized as an important part of standard patient care. Standard models utilize screening to identify and refer' patients to specialist services.

This abstract has been selected as a poster presentation for the Innovation in cancer treatment and care NSW conference.

Authors: S Turley (Lead), J Carter

Background

Broken Hill Cancer Service identified patients and health care providers alike lacked an understanding of the positive impact that psycho oncology service provide to overall well being and quality of life throughout the illness trajectory.

Cancer Care Coordinator and Psycho oncology counsellor established a model of care, where all patients that entered the service via the care coordinator were introduced to counselling services as part of the routine admission process rather than identified "needs" basis.

Outcomes of this model identified patients indicating greater complex care needs allowing earlier and more effect interventions.

Benefits: provided health care professionals with a greater recognition and acceptance of the role of psycho oncology counselling, both in a direct patient care capacity and in a supportive consultative role for staff support. The impact of early intervention was not fully recognized by staff until psycho oncology services were no longer available due to relocation of the counsellor.

Methods

Distress screening tool established level of input required from counsellor . Psycho education tailored to individual needs of patient Complimentary therapies introduced enabling alternative contact for patients resistant to counselling.

Results

2 groups of patients observed: Group1 patients with early entrance to service via CCC versus Group 2 patients who commenced treatment at a metropolitan centre.

• Group 1 observed to interact with counselling services without hesitation.
• Patients who had early psycho education intervention appeared more likely to engage services in a pro active manner.
• Group 2 patients were more likely to present initially in crisis and were more resistant to early reporting of emotional and physical concerns.

Conclusion

Early introduction to psycho oncology improved patient outcomes.

Please note: Copyright for the abstract is owned by the author(s) listed. The data, conclusions, views or opinions presented in this abstract are solely those of the author(s) and do not necessarily represent those of the Cancer Institute NSW. The Cancer Institute NSW makes no claim to the validity or accuracy of the information provided.

The aims of this study were to report the development and evaluation of a culturally sensitive support group programme for Chinese-Australian women with breast cancer and to evaluate the informational and psychosocial impact of the programme.

This abstract has been selected as an oral presentation in the Under Served Populations workshop.

Authors: Kwok C. (Lead), Ho M.

Background

Cancer support groups are an important vehicle for providing informational and psychosocial support to cancer survivors. Studies suggest that people from minority cultures are under-represented in cancer support groups.

Methods

In collaboration with a Chinese cancer support organisation, 29 women were enrolled in the programme which was evaluated by a combination of quantitative and qualitative approaches. The contents were designed to be relevant to Chinese beliefs and norms.

Results

The results indicated that the programme was well received by the participants who suggested that the content was useful and relevant. Obtaining practical information, particularly what was relevant to women's cultural beliefs and norms, was clearly valued by the participants.

In addition, the findings indicated that the programme, designed to be culturally sensitive and linguistically appropriate, was effective in providing informational support and psychosocial support for the participants.

A methodology for giving breast cancer survivors a sense of interconnectedness and thus minimising their feelings of isolation and helplessness, were also among the chief outcomes of this study.

Conclusion

The study provided some insight into the development of supportive cancer survivorship care for women being treated for breast cancer in the Australian-Chinese community.

Please note: Copyright for the abstract is owned by the author(s) listed. The data, conclusions, views or opinions presented in this abstract are solely those of the author(s) and do not necessarily represent those of the Cancer Institute NSW. The Cancer Institute NSW makes no claim to the validity or accuracy of the information provided.

Primary content

With the support of a grant from Cancer Australia, Cancer Council NSW has researched the unique experiences and unmet support and information needs of people affected by cancer of unknown primary.

This abstract has been selected as a poster presentation for the Innovation in cancer treatment and care NSW conference.

Authors: K Skinner, A Beaumont, G Batt (Lead)

Background

With the support of a grant from Cancer Australia, Cancer Council NSW has researched the unique experiences and unmet support and information needs of people affected by cancer of unknown primary (CUP).

CUP is a heterogeneous group of cancers characterised by evidence of metastatic disease where the location of the primary site cannot be identified despite appropriate investigation. In NSW CUP diagnoses represent around 4% of all new cancer cases, and is the third most common cause of cancer deaths (1).

The overall prognosis is generally poor (31.2% one year relative survival rate) with only 18.7% of those diagnosed still alive at five years.

Methods

A comprehensive literature review of psychosocial impact of CUP diagnosis and support needs of people affected by CUP was conducted.

Qualitative methods (thematic analysis using grounded theory framework of semi-structured in-depth telephone interviews) were used to identify the needs of the target population and the perceived gaps in information and support available to this demographic [N=30 (n=15 patients, n=15 carers/family members)].

Results

The findings suggest that many people affected by CUP experience difficulties finding information about CUP, understanding and explaining their diagnosis, and uncertainty associated with the fact that the cancer is advanced and identification of optimal treatment is difficult because their primary cancer site cannot be identified.

Access to information about CUP and opportunities to connect with other people affected by CUP were identified as important supports.

Conclusion

The findings of this research were used to inform the development of a multimodal suite of information and support resources including:

• Understanding Cancer of Unknown Primary booklet
• Dedicated CUP information webpage
• Video resources with information about CUP diagnosis, treatment, research and palliative care
• Creation of a space for a CUP online community on the Cancer Connections website to provide online peer support.

Please note: Copyright for the abstract is owned by the author(s) listed. The data, conclusions, views or opinions presented in this abstract are solely those of the author(s) and do not necessarily represent those of the Cancer Institute NSW. The Cancer Institute NSW makes no claim to the validity or accuracy of the information provided.

Pain is almost universally experienced by people cared for by specialist palliative care nurses. Effective pain management is a complex process founded on robust assessment, intervention and reassessment. Yet, there is often little documented evidence of a comprehensive pain assessment having been undertaken for patients who report pain.

This abstract has been selected as a poster presentation for the Innovation in cancer treatment and care NSW conference.

Authors: J Phillips (Lead), N Heneka, L Lam, T Shaw

Background

Nurses' pain assessment capabilities are one of many factors that contribute to sub-optimal pain management. Translating existing evidence into practice is challenging and requires consideration of a range of targeted strategies, including educational interventions.

Spaced Education is a novel form of on-line learning that has been demonstrated to increase knowledge, and retention of new knowledge, whilst demonstrating a capacity to change entrenched clinical practice.

Methods

This pre-post test pilot study aimed to test the impact of Spaced Education on specialist palliative care nurses (n=33) pain assessment practices. Survey and chart audit data was collected at four time points: T1, T2, T3 and T4.

Results

• Most participants were registered nurses (88%).
• Participants' pain management knowledge increased from T1 [x 7.21, n=33] to T2 [x 7.75, n=13], and sustained at T4 [x 8.17, n=7].
• Participant's ability to differentiate between nociceptive and neuropathic pain also increased from T1 [x 5.42, n=33] to T2 [x 7.08, n=13] and this trend was observed in the remaining participants at T4 [x 7.83, n=7].
• Pain assessment documentation increased from T1 [x 2.48] to T2 [x 4.20] per admission, with the majority of notations made by Spaced Education participants at all time points following the intervention:[T2] 81%; [T3] 87% and [T4] 72%.

Conclusion

This pilot data suggests that Spaced Education is a potentially effective format for delivering specialised clinical content that translates into practice change, but this trend needs to be confirmed.

Please note: Copyright for the abstract is owned by the author(s) listed. The data, conclusions, views or opinions presented in this abstract are solely those of the author(s) and do not necessarily represent those of the Cancer Institute NSW. The Cancer Institute NSW makes no claim to the validity or accuracy of the information provided.

These technologies will improve the experience of people with cancer and their carers, giving health care professionals vastly greater opportunity to share patient information.

This abstract has been selected as an oral presentation in the Innovations using Technology session.

Authors: K Daro (Lead)

Background

MNC and NNSW LHD were awarded a competitive grant through Cancer Institute NSW Primary Health Grants program to deliver a project that would enhance communication between North Coast Cancer Institute's (NCCI) specialist treatment centres and a number of primary health care providers.

Methods

Collaboration between NCCI and Primary Health Care will improve significantly by implementing E-faxing and Internet Conferencing Technology leveraging existing technical capabilities within Mosaiq™, as well as utilise existing IT Infrastructure including Hardware, Software and network architecture (WAN/LAN).

Electronic Faxing will greatly streamline and simplify communications, reduce paper based processes between NCCI and Primary Heath Care Providers, thus decreasing our carbon footprint and lessen the laborious burden of manual paper work placed on administrative staff.

Internet Based Video Conferencing will further improve communication and collaboration, provide benefits in terms of education, tele-health and improve patient care in rural and regional areas.

Results

Combining both technologies will deliver an innovative model of multidisciplinary, coordinated care by further developing and enhancing clinical service networks in rural and regional areas.

These technologies will improve the experience of people with cancer and their carers, giving health care professionals vastly greater opportunity to share patient information.

Conclusion

The project is yet to be completed and this presentation will be identifying the needs of the various users and the proposed solutions that will be delivered within the project's scope.

Please note: Copyright for the abstract is owned by the author(s) listed. The data, conclusions, views or opinions presented in this abstract are solely those of the author(s) and do not necessarily represent those of the Cancer Institute NSW. The Cancer Institute NSW makes no claim to the validity or accuracy of the information provided.

Endorectal balloons leads to improved geometric and dosimetric stability of the TV and OAR in P-P radiotherapy and is well tolerated by patients.

This abstract has been selected as a poster presentation for the Innovation in cancer treatment and care NSW conference.

Authors: A. Windsor, J. De Leon, M. Jameson, K. Cloak, R. Ko, A. Zammit, S. Keates, J.Mackay, L. Holloway, P. Vial, K.Wong, K. Lim, M. Sidhom, P.Metcalfe

Background

As the Clinical Target Volume(CTV) in post-prostatectomy(P-P) radiotherapy is defined by the anterior rectum and posterior bladder, deformation of these and hence CTV can result in geographical miss and increased dose to Organs At Risk(OAR).

This is the first reported Australian clinical trial in P-P radiotherapy evaluating the use of endorectal balloons (ERB) to

• Achieve geometric and dosimetric stability of the CTV and OAR.
• Assess tolerability of ERB by patients

Methods

Ten consecutive P-P patients were prospectively recruited and treated with ERB and compared to ten P-P patients treated without. All patients were treated with Intensity Modulated Radiation Therapy. The CTV and OAR were contoured on the Planning CT and re-contoured on Cone Beam images (CBCT) obtained days 1 to 5, then weekly on treatment. CBCT datasets were registered to the planning dataset. Geometric stability was quantified by the concordance index(CI) of treated and planned volumes. Minimum margins required to account for organ motion were calculated using the Van Herk formula. Each patient plan was recalculated on CBCTs to determine the actual dose delivered. Patients completed tolerability and quality of life questionnaires at baseline, weeks 2, 4, 6 and 8 of treatment.

Results

Preliminary results suggests that CTV stability was superior with ERB (CI 72% vs.68%, p=0.02). Rectal stability was superior with the ERB (CI 71% vs. 49%, p <0.0001) with no difference in bladder stability (CI 54% ERB vs. 50% non-ERB, p=0.20). The minimum anteroposterior margin to account for organ motion alone with and without ERB was 1.02cm vs. 1.70cm respectively. The ERB was well tolerated by majority of patients with one patient discontinuing treatment due to toxicity.

Conclusion

Endorectal balloons leads to improved geometric and dosimetric stability of the TV and OAR in P-P radiotherapy and is well tolerated by patients.

Please note: Copyright for the abstract is owned by the author(s) listed. The data, conclusions, views or opinions presented in this abstract are solely those of the author(s) and do not necessarily represent those of the Cancer Institute NSW. The Cancer Institute NSW makes no claim to the validity or accuracy of the information provided.

Engaging youth via digital media will cultivate a dialogue on stigmatising disease and address gaps in liver cancer information in culturally and linguistically diverse communities.

This abstract has been selected as an oral presentation in the Under Served Populations workshop.

Authors: M Porwal (Lead), B Hillman, R Matthew, R Monica

Background

In NSW hepatocellular cancer (HCC) incidence is rising faster than any other cancer, particularly among migrants born in countries of high hepatitis B (HBV) prevalence. As chronic hepatitis B (CHB) treatment can effectively prevent HCC, low community awareness and stigma related to these diagnoses represent missed opportunities for cancer control.

Earlier this year we conducted a CHB awareness survey among participants at the "Bring It on" Youth Festival, which identified common misconceptions about CHB disease causation.

As youth were more knowledgeable about HBV than the older population, we propose to collaborate with community organisations in Fairfield City to make CALD youth (people aged between 14–to24 years old) aware and committed to raising community awareness of HBV and HCC, while providing them with opportunities to attain skills in digital media

Methods

Youth will be identified through community networks and offered opportunities for training in developing short-films. They will be coached on HBV and develop community messages about HBV and HCC, which will be incorporated into developing short films addressing HBV related stigma, myths and misconceptions about cancer in CALD communities.

The short films will be entered into the popular 'SHORTCUTS Film Festival' hosted by Fairfield City in 2013 and screened at the Bring It on Festival in 2013

Results

The publicity surrounding both events will be used to foster community dialogue about HBV and cancer prevention and discussions around CHB and HCC and a repeat knowledge survey will be distributed following the screening of the films, to ascertain changes from baseline.

Conclusion

Engaging youth via digital media will cultivate a dialogue on stigmatising disease and address gaps in liver cancer information in CALD communities

Please note: Copyright for the abstract is owned by the author(s) listed. The data, conclusions, views or opinions presented in this abstract are solely those of the author(s) and do not necessarily represent those of the Cancer Institute NSW. The Cancer Institute NSW makes no claim to the validity or accuracy of the information provided.

Radiotherapy provides a significant benefit to the gynaecological cancer patient population in Australia when optimally utilized.

This abstract has been selected as an oral presentation in the Radiation Innovations workshop

Authors: TP Hanna (Lead), J Shafiq, GP Delaney, MB Barton

Background

To determine the population-based benefit of radiotherapy for gynaecological cancer.

Clinical trials describe the benefit of radiotherapy for highly selected subgroups. Population benefits if evidence-based guidelines were followed are unknown. This information would be useful for planning, government advocacy and economic analysis.

Methods

• A decision tree with evidence-based indications for external beam radiotherapy (XRT) has been previously defined.
• The proportional radiotherapy benefit over alternative treatments was added for each indication.
• XRT benefit was the absolute benefit of radiotherapy over no treatment for radical indications, and the absolute benefit over surgery alone for adjuvant indications.
• Chemoradiation (CRT) benefit was the incremental benefit of CRT over XRT. 5-year local control and overall survival were investigated.
• Multiple electronic citation databases were systematically queried. If there were multiple sources of the same level of evidence, a meta-analysis was performed.
• To determine the precision of our estimates, a sensitivity analysis was performed.

Results

• Guidelines supported 28 XRT indications and 11 CRT indications.
• 35 relevant studies were identified. 11% of treated patients had XRT indications supported by level I/II evidence, and 86% for CRT.
• The estimated 5-year local control (LC) and overall survival (OS) benefit of optimally utilized XRT were: endometrial cancer (LC 5%(95%CI 4,7), OS 4%(3,4)), vulvar cancer (LC 10%(1,18), OS 8%(1,16)), ovarian cancer (nil) and cervical cancer (LC 33%(32,34), OS 28%(26,30)).
• For all gynaecological cancers together, the XRT benefit was (LC 9%(8,10), OS 7%(7,8)).
• The incremental CRT benefit was (LC 1.1%(1.0,1.2)), OS 0.6%(0.5,0.6)).
• In univariate sensitivity analysis, individual elements of uncertainty had little effect on estimates.

Conclusion

Radiotherapy provides a significant benefit to the gynaecological cancer patient population in Australia when optimally utilized. The additional population benefit of chemoradiation over radiation alone is modest.

This methodology is now being applied to all other cancers and could be readily adapted to other populations.

Please note: Copyright for the abstract is owned by the author(s) listed. The data, conclusions, views or opinions presented in this abstract are solely those of the author(s) and do not necessarily represent those of the Cancer Institute NSW. The Cancer Institute NSW makes no claim to the validity or accuracy of the information provided.

A pilot implementation of CharmHealth CPMS has been shown to enhance patient care, treatment safety, streamline workflow and assist in planning for service enhancement and clinical network integration.

This abstract has been selected as an oral presentation in the Innovations using Technology session.

Authors: D D'Souza (Lead), S Barbeau, G Tang, L Watson

Background

The 10-chair Blacktown Cancer Care Centre at BH is a member of the SWCN comprising the Crown Princess Mary Cancer Centre at the Westmead Hospital and the Nepean Cancer Care Centre at the Nepean Hospital.

Treatment referrals are sourced from Haematologists and Oncologists of the SWCN. Paper-based appointments, ordering and record systems relied on fax and phone communication of treatment plan and modifications.

Implementation of an integrated CPMS was planned to improve patient care and support and streamline workflow practices.

Methods

A multidisciplinary project team assessed functional requirements, mapped workflow and reviewed available CPMS. The implementation schedule encompassed technical interfacing, system testing, formulary and protocol data entry, pathway verification, staff training and treatment allocation for current patients.

The CharmHealth CPMS was piloted in Sept 2011 to

• manage appointment bookings
• maintain electronic medical records
• prescribe chemotherapy using evidence based protocols
• coordinate pharmacy chemotherapy review, external order processing, reporting, correspondence and billing functions.

Results

CharmHealth improved communication and safety of patient care delivery, streamlined appointment management, resource allocation, chemotherapy prescribing, external order and nursing documentation.

• Complex treatment pathways are easily mapped compared to repetitive hand-written charts.
• Clinical alerts improved treatment monitoring and administration safety.
• Review and analysis of reporting on activity trends and complexity facilitated service and resource planning.
• Data entry for patient record including history, medications and encounter notes was time consuming. System improvements to manage these are under development.

Conclusion

CharmHealth implementation has enhanced patient care, treatment safety, streamlined workflow and assisted planning for service enhancement and clinical network integration. Utilisation of PBS prescribing, clinical trial management, cancer registry and tumour staging functionality will further innovate current practices.

Please note: Copyright for the abstract is owned by the author(s) listed. The data, conclusions, views or opinions presented in this abstract are solely those of the author(s) and do not necessarily represent those of the Cancer Institute NSW. The Cancer Institute NSW makes no claim to the validity or accuracy of the information provided.

This abstract has been selected for an oral presentation in the Innovations using Technology session.

This abstract has been selected as an oral presentation in the Innovations using Technology session

Authors: J Rutherford (Lead), C Adams, G Otton

Background

Hunter New England Centre for Gynaecological Cancer (HNECGC) provides a service for women with/suspected of having a gynaecological malignancy.

Due to the geographical area of our Local Health Network women and their families are required to travel up to 300km for their consultations and treatment. This provides significant financial and emotional strain on many patients and their families.

The commencement of video conferencing for women in the Tamworth and Coffs Harbour is saving women and their families from having to travel for their new patient consultation.

Methods

The role of care coordinators is essential in establishing and providing this service. Core aspects of care coordination are demonstrated within the context of this service.

The complex process of defining appropriate patient selection, scheduling the appointments and ensuring the patients are fully informed about the type of consultation has been the role of the coordinators will be expanded on in the presentation.

Results

Data for the first 30 patients are presented

• Patients/Carers meet their doctor and the gynaeoncology care coordinator via video link and sit with the rural coordinator who provides relevant disease and treatment information and is a local contact
• Preoperative appointments with the anaesthetic team in Tamworth are arranged to determine if further assessments are required prior to surgery ensuring that the woman is appropriately prepared
• Following surgery the transition back to Tamworth and Coffs Harbour oncology unit for adjuvant chemotherapy is streamlined due to the communication with the rural Care Coordinator
• This process has ensured that women are provided care close to home, reducing anxiety, distress, financial burden and travel
• Patient experience surveys' demonstrate positive feedback.

Conclusion

Telehealth allows timely and effective consultations for rural and remote patients.

Please note: Copyright for the abstract is owned by the author(s) listed. The data, conclusions, views or opinions presented in this abstract are solely those of the author(s) and do not necessarily represent those of the Cancer Institute NSW. The Cancer Institute NSW makes no claim to the validity or accuracy of the information provided.

Oncology information system Mosaiq in SWSLHD has been developed extensively to be a comprehensive electronic medical record for oncology and haematology patients.

This abstract has been selected as a poster presentation for the Innovation in cancer treatment and care NSW conference.

Authors: N Kaadan (Lead)

Background

The development stemmed from improving communication within the department to track and monitor patients journey through the department.

The wealth of information that exists in Mosaiq has meant an increased demand for access from staff and departments outside of the cancer therapy centre.

Authorised users who need information for legitimate health purposes have access to MOSAIQ via Citrix; recognising that if clinical information is not readily available to providers of health services, the care or interests of cancer patients may be compromised.

All users across the health service have access to Cerner Powerchart, an area wide electronic medical record.

The SWSLHD cancer centre embarked on a project to export documentation out of Mosaiq and store them in Cerner Powerchart using an HL7 interface.

Methods

• Key stakeholders where invited to meet for a scoping meeting.
• Documents from Mosaiq with a particular document type and status were chosen to be exported to Powerchart and the naming convention was decided upon.
• Radiation Therapy summary letters, multi-disciplinary team meeting discussions and general correspondence were to be exported to Powerchart.
• A test plan was established between the Oncology IT team and the area EMR team to test various scenarios.
• The interface was configured in a testing environment for both Mosaiq and Powerchart.
• Letters were generated in Mosaiq and these were sent via the interface to Powerchart.

Results

After thorough testing, limitations were identified and mitigation strategies were put in place. The interface was put into production three months post commencement of project.

Conclusion

The outcome was improved access to patients' cancer management documentation within the area electronic medical record. Consolidation of patient documentation in one system was achieved.

Please note: Copyright for the abstract is owned by the author(s) listed. The data, conclusions, views or opinions presented in this abstract are solely those of the author(s) and do not necessarily represent those of the Cancer Institute NSW. The Cancer Institute NSW makes no claim to the validity or accuracy of the information provided.

Increasingly complex cross sectional imaging techniques such as CT, MRI and PET/CT scans are being used by radiation oncologists to improve the accuracy of their radiotherapy planning contours, despite little formal training in diagnostic imaging.

This abstract has been selected as a poster presentation for the Innovation in cancer treatment and care NSW conference.

Authors: M Dimigen (Lead), S Vinod, K Lim, T Tran

Background

This study aimed to assess whether the availability of an 'on-site' radiologist, would be beneficial in enhancing the interpretation of oncological imaging and accuracy of contouring

Methods

A radiology/ oncology fellow was based in the oncology department, providing radiological advice on diagnostic and planning images, for two sessions per week over a nine month period. Oncology staff were able to book a time slot with the radiologist on a MOSAIQ cancer database and recorded the reason for the consultation and its outcome.

The radiologist also reviewed the accuracy of the patient's contours for the weekly quality assurance audit meetings and was involved in oncological research.

Results

• Over a nine month period, the radiologist provided 49 consultation sessions, where 56 diagnostic imaging or treatment planning scans were reviewed.
• Eight-eight percent of the requests were made by radiation oncologists staff specialists and 12% by registrars.
• Reviewing diagnostic images (47%), planning images (44%) and assistance with target volume delineation (44%) were the main reasons for the consultations.
• In 42% of cases this resulted in a change of practice, ranging from the changing of target volumes to carrying out further imaging.
• For the quality assurance audit meetings, the planning contours of 165 patients were reviewed by the radiologist.
• In 20% of the cases, queries over the accuracy of the contours were raised, which resulted in a significant change of management in 7% of cases.

Conclusion

The availability of an 'on-site' radiologist had a significant impact on the management of radiation oncology patients over the period audited.

Please note: Copyright for the abstract is owned by the author(s) listed. The data, conclusions, views or opinions presented in this abstract are solely those of the author(s) and do not necessarily represent those of the Cancer Institute NSW. The Cancer Institute NSW makes no claim to the validity or accuracy of the information provided.

This multi-centre study will compare both methods of prostate localisation by quantifying the accuracy of prostate localisation at treatment.

This abstract has been selected as a poster presentation for the Innovation in cancer treatment and care NSW conference.

Authors: J Hatton (Lead), A Moore, D Cornes, T Kron

Background

Image Guided RadioTherapy (IGRT) and Intensity Modulated RadioTherapy (IMRT) are advanced technologies being introduced in NSW and Australia.

IGRT uses daily imaging before treatment, giving accurate localisation of the target. Image guided radiotherapy (IGRT) is a two-part process: firstly acquiring the images at the time of treatment, and secondly using these images in comparison with reference planning images to adjust patient position for optimal target localization.

IGRT imaging uses:

• Orthogonal kV X-ray images with the implantation of fiducial markers into the target.
• Volumetric 3D imaging of the target area using Cone Beam Computerised Technology, providing detailed anatomical information about the prostate and normal critical structures, eg rectum and bladder.

Despite common assumptions that both methods give similar results, there is no published objective evidence to support their equivalence. This multi-centre study will compare both methods of prostate localisation by quantifying the accuracy of prostate localisation at treatment.

Methods

With funding from the Cancer Institute, the Virtual Human Male phantom (CIRS Inc, Virginia, USA) has been customised with interchangeable anatomical prostate inserts with and without fiducials. Further inserts allow point and planar dose measurements.

At each centre, the phantom will be set up for treatment following local protocol, then specified moves will be made by the visiting team.

The centre will image the phantom using both methods to determine the applied moves, which will be compared against the specified.

Dosimetric assessment of the IMRT treatment delivery will be performed.

Results

The phantom with anatomical detail is straightforward to use for both IGRT methods, and for dose measurements. Pilot results show very good agreement between specified and determined moves, and between planned and delivered doses.

Conclusion

The anatomical detail of the phantom and ability to insert fiducial markers has made this IGRT study realistic and scientifically robust.

Please note: Copyright for the abstract is owned by the author(s) listed. The data, conclusions, views or opinions presented in this abstract are solely those of the author(s) and do not necessarily represent those of the Cancer Institute NSW. The Cancer Institute NSW makes no claim to the validity or accuracy of the information provided.

This abstract has been selected as a poster presentation for the Innovation in cancer treatment and care NSW conference.

Authors: P Saxena, RW Leong, N Merrett, DA Pavey (Lead)

Background

This study assessed the safety and efficacy of a combined endoscopic management approach including assessment with endoscopic ultrasound (EUS) and confocal endomicroscopy (CEM) followed by combination radiofrequency ablation (RFA) and endoscopic mucosal resection (EMR).

Methods

Patients were excluded if they had an oesophageal stricture that did not respond adequately to dilatation or ≥T2 lesion on EUS. In the absence of nodules, the first RFA treatment was performed. If a nodule was identified, EMR was performed, followed by two RFA treatments at 8 week intervals. Subjects underwent further RFA if there was residual dysplastic Barrett's or EMR if there were persisting nodules.

Results

A total of 148 procedures were performed in 38 included patients in the study between January 2010 and May 2012.

Mean age was 66 (±12) years, 34 were men. Of these, 23 had high grade dysplasia (HGD), 14 had low grade dysplasia (LGD), 1 had intramucosal carcinoma (IMC). Six patients required EMR prior to RFA. At median follow-up of 18 months, 100% have complete remission of dysplasia (CR-D) and 73% have complete remission of metaplasia and dysplasia (CR-IM, CR-D) with 2± 0.63 RFAs and 0.36±0.92 EMRs.

Three patients were found to have early cancer whilst progressing through the protocol. Two of these developed a nodule after undergoing four radiofrequency ablations and the third patient developed a nodule after 1 RFA.

For 772 patient-years of follow-up, there were 4 adverse events: 1 patient had post procedure chest pain, 1 patient had a minor post EMR bleed, 1 patient had minor bleeding post RFA and 1 had a mucosal tear post RFA.

Therefore, the complication rate was 2.70% (95%CI 1.06–to6.74%).

Conclusion

Multimodal endoscopic therapy for dysplastic Barrett's and early oesophageal cancer in an Australian quaternary referral setting is associated with high remission rates and a low complication rate.

Please note: Copyright for the abstract is owned by the author(s) listed. The data, conclusions, views or opinions presented in this abstract are solely those of the author(s) and do not necessarily represent those of the Cancer Institute NSW. The Cancer Institute NSW makes no claim to the validity or accuracy of the information provided.

In 2009, the Illawarra Cancer Care Centre (ICCC) reviewed its systems for prescription and administration of chemotherapy. The review targeted improved patient safety in the prescription and administration of chemotherapy, developing processes to support the changes.

This abstract has been selected as an oral presentation in the Service Delivery Innovations session

Authors: G Bell (Lead)

Background

The Australian Commission on Safety and Quality in Health Care (2008) estimates 2–to5% of Australian drug charts contain prescribing errors, and administration errors occur at 5–to18%.

A chemotherapy medication incident has the potential to cause significant mortality or morbidity, as chemotherapy medications possess a narrow therapeutic window and are associated with potentially high incidences of toxicities, even at therapeutic dosages. (Shulman 2008).

Methods

In 2009, the Illawarra Cancer Care Centre (ICCC) reviewed its systems for prescription and administration of chemotherapy. The review targeted improved patient safety in the prescription and administration of chemotherapy, developing processes to support the changes.

It was identified, as had previously been recognised by the Institute of Safe Medicines Practice (2000) that the use of an Oncology Information System (OIS) providing electronic prescribing, administration and comprehensive clinical decision support could assist in the reduction of medication errors within our service.

Additionally, use of current evidence based, best practice cancer treatment protocols, such as the Cancer Institute NSW's eviQ chemotherapy protocols, would standardise the prescription process, as they provide predictability, support accuracy, reduce errors, and enhance workflow by decreasing ambiguity. (Shulman et al 2008)

Results

In January 2011, the use of eviQ chemotherapy protocols in an oncology information system was launched. This has resulted in a dramatic 63% reduction in reported adverse medication incidents. Additionally, significant cost savings were directly associated with decreased use of anti-emetic drugs.

Conclusion

The use of standardised, best practice cancer treatment protocols combined with an introduction of an Oncology Information System with comprehensive clinical decision support and thorough planning, has resulted in significant gains for patient safety.

Please note: Copyright for the abstract is owned by the author(s) listed. The data, conclusions, views or opinions presented in this abstract are solely those of the author(s) and do not necessarily represent those of the Cancer Institute NSW. The Cancer Institute NSW makes no claim to the validity or accuracy of the information provided.

The adoption of complete electronic recording methods for all patient data and non-patient centric processes has led to a concise, integrated electronic patient management workflow.

This abstract has been selected as a poster presentation for the Innovation in cancer treatment and care NSW conference.

Authors: A Heaney (Lead), L Daries, R Lin

Background

As a new cancer facility, Medica Oncology has advanced technology pre-built into the core building architecture. This has enabled the adoption of a complete electronic system ("e-ness"). By streamlining all processes, it was identified that patient care could be improved and enhanced through integrated electronic patient management.

Methods

• Assessment of "paperless" systems was conducted to identify areas of patient data duplication.
• Considering legislative reporting requirements, data collected was streamlined to minimise such duplication.
• Analysis of the electronic medical record (EMR) system was performed to develop streamlined processes for data recording.
• Development of 'Topaz' (Total Oncology Package) was undertaken to complement the EMR and manage non-patient centric data such as document management and control, staff training and education, radiation dose monitoring, quality compliance and quality assurance.

Results

• Both patient centric and non-patient centric workflows have been streamlined to support a patient centred care environment.
• All staff across the multidisciplinary team spend less time recording data already captured electronically, and can now focus on the collection of critical data that directly enhances patient care.
• Readily available patient information that can be accessed electronically has enabled comprehensive handover documentation.
• The electronic process ("e-ness") has improved patient care through the easy recording and accessibility of patient records.
• Topaz (a centralised document management system) empowers staff by providing up to date, controlled documentation that leads to optimal care delivery to patients.
• Quality auditing utilising Topaz has enabled fast data collection and analysis in real time. This has facilitated continuous modification to work practices, resulting in accurate, evidence based care delivery.

Conclusion

The adoption of complete electronic ("e-ness") recording methods for all patient data and non-patient centric processes has led to a concise, integrated electronic patient management workflow. Streamlining processes and removing redundant tasks, has led to greater staff efficiency, accurate data recording and enhanced patient care.

Please note: Copyright for the abstract is owned by the author(s) listed. The data, conclusions, views or opinions presented in this abstract are solely those of the author(s) and do not necessarily represent those of the Cancer Institute NSW. The Cancer Institute NSW makes no claim to the validity or accuracy of the information provided.

Prevalence of malnutrition in patients with head and neck cancer is high, impacting on clinical, cost and patient-centred outcomes.

This abstract has been selected as a poster presentation for the Innovation in cancer treatment and care NSW conference.

Authors: M. Findlay (Lead), T. Brown, J. Bauer

Background

Project aims were to:

1. develop evidence-based guidelines for this patient population; and
2. present the best available evidence on a widely accessible and easily updated web-based wiki platform to maintain currency.

Methods

Under the auspices of the Clinical Oncological Society of Australia (COSA) with funding from Cancer Institute New South Wales Oncology Group (Head and Neck), a dietetic sub-committee was established to develop the guidelines in consultation with a multidisciplinary steering committee.

Following systematic literature review, 288 studies were identified for independent critical appraisal. Traditional guideline development methodology utilising recognised appraisal tools addressed 27 clinical questions across the nutrition care pathway. The guidelines are published using wiki technology with Google Analytics tracking usage between June and October 2011.

Results

• Google Analytics demonstrated the guidelines have been accessed by 33 countries including Australia (80%), United Kingdom (8%), Canada (2%) and New Zealand (2%).
• Users accessed the guidelines directly via web browser (37%), Google (27%), COSA homepage (16%) and a range of other sites.
• During the monitoring period there were 2,303 views of the landing or contents page (1,299 new and 1,004 returning visitors).
• Most viewed sections were: Nutrition Screening and Assessment (381 views); Summary of Recommendations (357 views); Executive Summary (276 views); Radiotherapy/Chemotherapy (252 views); and Introduction and Guideline Development (250 views).

Conclusion

The guidelines provide clinicians with access to current, best available evidence for the nutritional care of patients with head and neck cancer. Following endorsement by dietetics associations of Australia, New Zealand and the UK, the guidelines will also influence practice internationally.

The wiki platform proved successful in maintaining currency, facilitating multidisciplinary collaboration and interactive online public consultation.

This approach is recommended for future guideline development and maintenance.

Please note: Copyright for the abstract is owned by the author(s) listed. The data, conclusions, views or opinions presented in this abstract are solely those of the author(s) and do not necessarily represent those of the Cancer Institute NSW. The Cancer Institute NSW makes no claim to the validity or accuracy of the information provided.

Improvements in access to oncology patients to emergency care can be provided in an ambulatory cancer centre.

This abstract has been selected as an oral presentation in the Service Delivery Innovations session

Authors: S Della-Fiorentina (Lead), D Burns

Background

The standard pathway of presentation of cancer patients to Emergency Departments has clinical risks of delay in initiation of treatment, variations in assessment and treatment due to differences in staff experience and knowledge and limited training in managing complications of cancer therapies and symptom control of advanced disease.

Methods

We developed a set of standardised clinical pathways for patients receiving chemotherapy and radiation for management of fever and neutropaenia, mucositis, oesophagitis, diarrhoea and spinal cord compression. The pathways covered initial assessment, investigation and treatment and was led by an oncology nurse team within the ambulatory Macarthur Cancer Centre.

Results

During 2008 –to 2011 there were 2360 occasions of service within the Nurse Assessment Unit. Compared to contemporaneous presentations to Emergency, there were improvements seen in time to patients being seen [ 6 v 10 min], time to initiation of treatment [ 54 v 300 min] and time to placement in a ward bed [ 3 v 19 hours]. Patient and staff satisfaction was measured and found to be high.

Conclusion

Improvements in access to oncology patients to emergency care can be provided in an ambulatory cancer centre and is a model that can be adapted for oncology and non-cancer presentations to Emergency Departments.

Please note: Copyright for the abstract is owned by the author(s) listed. The data, conclusions, views or opinions presented in this abstract are solely those of the author(s) and do not necessarily represent those of the Cancer Institute NSW. The Cancer Institute NSW makes no claim to the validity or accuracy of the information provided.

Pancreaticoduodenectomy is major surgery predominantly performed for periampullary cancer. The aim of the review was to determine how the results in a regional teaching hospital compared with other published data and to better understand our future workforce requirements.

This abstract has been selected as a poster presentation for the Innovation in cancer treatment and care NSW conference.

Authors: D Gillies (Lead), J Gani

Background

Pancreaticoduodenectomy is major surgery predominantly performed for periampullary cancer.

Patient outcomes are sensitive to a number of factors, ranging from technical skills and careful patient selection to the availability of tertiary resources. As such this patient group is a surrogate marker for tertiary surgical services in general. Published data suggest that operative mortality may be higher in surgeons over 60.

The aim of the review was to determine how the results in a regional teaching hospital compared with other published data and to better understand our future workforce requirements.

Methods

A complete retrospective review of prospectively collected data, on the General Surgical Database was analysed to identify all Whipple's procedures between 1 January 2003 to 31 December 2011.

Results

88 patients under went a Whipple's procedure, 8 for benign pathology, 80 for cancer. Median patient age was 64, males 47 (61%). 39/77 (50%) had positive lymph nodes at resection.

Outcome for malignant tumours was as follows:

• 30 day mortality was 6.5% but varied by surgeon (range 0–to33% for surgeons who regularly perform the procedure)
• 1 year survival was 32%
• 5 survival 29%.
• 74% of the procedures were performed by surgeons who are presently >54

Conclusion

• The outcome of pancreaticodudenectomy in our regional tertiary institution is comparable to recent published Australian data.
• These results indicate a satisfactory system of care in a regional tertiary hospital.
• The expertise distribution raises issues about workforce planning.
• A defined succession policy is required to ensure allow a seamless transition as the workforce ages.

Please note: Copyright for the abstract is owned by the author(s) listed. The data, conclusions, views or opinions presented in this abstract are solely those of the author(s) and do not necessarily represent those of the Cancer Institute NSW. The Cancer Institute NSW makes no claim to the validity or accuracy of the information provided.