SOUTH WESTERN SYDNEY AREA
HEALTH SERVICE
LIVERPOOL HOSPITAL
CANCER THERAPY CENTRE
Colo-Rectal Cancer - Patterns of Care in the Western and Wentworth Areas
Principal Investigator: A/Prof. Michael
Barton
The salvage of colo-rectal cancer following recurrence is so poor that primary treatment is critical. The aim of this study is to develop baseline patterns of care data for the treatment of colo-rectal cancer. Patterns of care have been documented by the type and duration of treatment and investigative procedures performed. Long-term follow-up has been monitored with respect to survival, recurrence and morbidity. Three hundred and seventy patients have been entered onto this study and follow-up is nearing completion.
Sites of local recurrence of rectal cancer and the implications for radiotherapy field design
Principal Investigator: Dr. George Hruby
The results of adjuvant radiotherapy for rectal cancer are highly dependent on the balance between tumour control and small bowel damage. The volume of small bowel in the treatment field is the greatest determinant of small bowel damage. This study examines the sites of pelvic recurrence in patients previously untreated with radiotherapy to determine the sites and risks of recurrence within the pelvis. Two hundred and sixty patients referred to Radiation Oncology Departments at Westmead Hospital, Royal Prince Alfred Hospital and Prince of Wales Hospital were included and a paper is now being written for publication.
Touchscreen survey to assess level of anxiety/depression and treatment toxicity of cancer patients
Principal Investigator: A/Prof. Michael Barton
When patients undergo cancer treatment, many problems such as anxiety/depression or treatment toxicity may be unrecognised, due largely to time constraints in a busy department. Most of these problems can be easily treated if identified. Touchscreen computer surveys offer an ideal opportunity for patients to provide a comprehensive report on their symptoms, level of anxiety and quality of life. A pilot study will be conducted on 50 patients newly diagnosed with breast, prostate, bowel or head and neck cancer. Patients will complete a touchscreen survey before starting their radiation treatment, during their treatment, and during follow-up visits after their treatment. The results of the touchscreen survey will immediately be conveyed to the treating oncologist. The pilot study will be evaluated for effectiveness in the diagnosis of anxiety/depression and radiation treatment toxicity, and may later be extended to more patients.
Lung Cancer: A Patterns of Care Study in the South Western Sydney Area Health Service
Principal Investigator: Dr. Shalini Vinod
Lung cancer is an important health problem in NSW particularly so in the South Western Sydney region where the incidence is significantly higher than the state average. It is associated with poor survival of 10%-12% at 5 years. A lung cancer patterns of care study is to be performed in SWSAHS for the years 1993 and 1996. The aim is to identify all lung cancer patients who were diagnosed in those two years and document their management and outcome. As well as providing an audit of results for the Area, we hope to document utilisation rates of the various treatment modalities and assess the relationship of socioeconomic factors to management and outcome. Upon completion we will recommend how processes and outcomes of lung cancer management can be improved and outline areas of priority research.
A Basic Treatment Equivalent for Gynaecological Brachytherapy - A Pilot Study
Principal Investigator: Dr. Shalini Vinod
Brachytherapy is an important part of the radiotherapeutic management of cervical, endometrial and vaginal cancer, involving the insertion of radioactive sources in the vagina and /or uterus. The aim of this study is to see if a Basic Treatment Equivalent (BTE) can be defined for gynaecological brachytherapy. The project involves measuring how the complexity of different parameters, including several patient and treatment variables in gynaecological brachytherapy, affects the duration of treatment. It will be performed at Liverpool Hospital and Royal Prince Alfred Hospital.
Waiting Times for Radiotherapy - A Survey of Patients' Attitudes
Principal Investigators: A/Prof. Michael
Barton, Dr. Geoff Delaney,
Dr. Allan Fowler
Waiting lists for radiotherapy are a global problem, as a result of increasing demand for radiotherapy coupled with a scarcity of health resources. This study aims to assess how patients respond to these waiting times, and their willingness to participate in strategies designed to reduce waiting times. A Trade-off technique is used to determine the maximal acceptable waiting time for radiotherapy before patients elect to seek treatment elsewhere. This is part of a multicentre study involving radiation oncology departments at Liverpool, Westmead, St George and Newcastle Mater hospitals.
Use of Telemedicine in multidisciplinary breast cancer clinics in South Western Sydney
Principal Investigator: Dr. Geoff Delaney
Treatment of breast cancer ideally involves a multidisciplinary team approach, since treatment may include surgery, radiation, chemotherapy, hormone therapy or a combination of these. Multidisciplinary meetings between treating medical specialists are usually held only within the major teaching hospitals. This project aims to test the feasibility of telemedicine as an aid to multidisciplinary breast cancer clinics in the South Western Sydney area. A telemedicine link-up between Liverpool Hospital, Bankstown Hospital and Campbelltown Hospital will enable clinicians at the peripheral hospitals to participate in the multidisciplinary breast meetings held once a week at Liverpool Hospital. A pilot study over 3 months will assess the feasibility of a telemedicine link-up in terms of cost-effectiveness and utility.
The Development of a new model to measure chemotherapy delivery throughput in the outpatient setting
Principal Investigator: Dr. Geoff Delaney
Currently the measure of workload in chemotherapy treatment delivery is based loosely on the ability to treat a certain number of patients in a day, with patient treatment being classified as either of short (1-6 hours) or long (> 6 hours) duration. This is not necessarily a sensitive enough measure to allow for efficient service delivery. The aims of this study are to assess the impact of various treatment-related and patient-related factors on chemotherapy treatment duration; and to develop a better model to measure chemotherapy outpatient throughput. This could then lead to identification of those areas in outpatient chemotherapy delivery where changes in practice could lead to efficiency gains without compromising patient outcome or satisfaction.
PSA driven outcome and toxicity following small volume irradiation for carcinoma of the prostate
Principal investigator: Dr. Andrew Kneebone
Conventional treatment options for men who present with clinically localised prostate cancer include observation, radiation therapy, radical prostatectomy or endocrine manipulation. Whilst external beam radiotherapy is the most commonly used potentially curative treatment, its role in the management of prostate cancer is controversial, as indeed is the use of any other treatment modality. This study aims to determine the PSA driven outcome for patients receiving definitive external beam irradiation for clinically localised prostate cancer; to analyse the prognostic importance of pre-treatment PSA, T stage and Gleason grade on PSA driven outcome; and to analyse clinical outcome following PSA failure. The study is being conducted in the radiation oncology departments of Liverpool and Westmead Hospitals, on all patients with histologically confirmed prostate cancer with no evidence of distant metastases, who commenced radiation with curative intent between May 1993 and December 1997. The study is nearing completion, and will be presented at the Annual Meeting of the Royal Australian and New Zealand College of Radiologists.
Project Proposal to Enhance Appropriate Screening for Individuals at Increased Risk of Colorectal Cancer.
ender for the NSW Cancer Council.
Principle authors: A/Prof Michael Barton,
CCORE; A/ Prof Michael Frommer, Australian Centre for Effective Healthcare [ACEH];
Ms Ann Brassil, Breastscreen NSW.
Australia has one of the highest rates of Colorectal Cancer (CRC) in the world with one in 20 Australians developing the disease in their lifetime Despite improvements in treatment over recent years, there has been little improvement in survival. Pilot studies for 'average risk' screening trials are currently under development. However the recently released NH&MRC Guidelines for the Prevention, Early Detection and Management of CRC recommend that individuals of 'above average' risk of CRC be triaged into more intensive screening or surveillance programmes.
The NH&MRC define above average risk as >3 times higher than background
risk. We have identified six distinct groups which fall into this category.
These are:
| * | Individuals who have had a colorectal cancer | |
| * | First-degree relatives of individuals who were diagnosed with colorectal cancer before the age of 55 years | |
| * | First-degree relatives of individuals who | (a) were diagnosed with colorectal cancer when aged 55 years or older |
| (b) have one other first-degree relative with colorectal cancer | ||
| * | Individuals who have had an adenomatous colonic polyp | |
| * | Individuals with inflammatory bowel disease | |
| * | Individuals with rare familial predispositions to colorectal cancer, such as familial adenomatous polyposis (FAP) or hereditary non-polyposis carcinoma of the colon (HNPCC) |
A model was developed to estimate the burden of illness and numbers of kindred at increased risk, both prevalent and incident. The greatest opportunity to improve outcomes is by targeting screening interventions toward the first degree relatives of Index cases defined in groups 2 and 3 above.
Contract for the IAEA to develop distance learning modules for the Basic Science of Oncology Course.
© Copyright 2002 - Cancer Therapy Centre, Liverpool Hospital, SWSAHS
Disclaimer
Last modified: Tuesday, 8 July 2003