1

NUMBER 21 � APRIL 2016

Antineoplastic DrugAdministration Course(ADAC) Implementation

The Antineoplastic Drug Administration Course (ADAC)supports health professionals develop the necessaryknowledge and clinical skills to administer antineoplasticdrugs and handle related waste safely.

The course standardises the minimum competency requiredfor the safe handling and administration of antineoplastic drugsand allows Gippsland staff to achieve this competency locallyrather than the need to travel to Melbourne.

The course consists of 8 modules, followed by a clinical skillsworkshop that incorporates the theory from all 8 modules intoclinical practice.

� Module 1: Handling antineoplastic drugs and relatedwaste safely

� Module 2: Understanding how antineoplastic drugs work� Module 3: Reviewing protocols and prescriptions� Module 4: Educating the patient and carer� Module 5: Assessing patients� Module 6: Administering oral antineoplastic drugs� Module 7: Administering IV antineoplastic drugs� Module 8: Preventing and managing extravasation

of antineoplastic drugs.

GRICS will be coordinating the implementation of ADACacross the Gippsland chemotherapy sites.

If you would like further information regarding ADAC contactDanielle Roscoe on 5128 0062 or email droscoe@lrh.com.au

Welcome new GRICS Cancer ServiceImprovement CoordinatorsDanielle Roscoe

Danielle commenced with GRICS in November whilst alsocontinuing her clinical work at Latrobe Regional Hospital.Danielle is a Clinical Nurse Specialist with a post graduatedegree in Cancer/Palliative nursing, and ten years’ experiencein the oncology setting; including chemotherapy day oncology,radiotherapy and in-patient/palliative care. Danielle’s passionand dedication to cancer care are sure to make her aninvaluable part of the GRICS team.

Marnie Flowers

Marnie Flowers, who joined the GRICS team late last year,has a background in nursing, as well as a Business andCommerce degree. Marnie has worked in Human Resourcesfor the past five years, and prior to that worked at LatrobeRegional Hospital as a Registered Nurse. Marnie hasexperience managing projects and is looking forward tocombining her business and nursing knowledge for thegreater benefit of cancer services in the Gippsland region.

LRH welcomes Dr Mahesh IddawelaGRICS is pleased to announce the recent appointment ofDr Mahesh Iddawela to the position of Consultant MedicalOncologist at Latrobe Regional Hospital (LRH). Dr Iddawelacomes to LRH with significant experience in delivering anddeveloping high quality cancer services, especially in a regionalsetting. He was previously involved in delivering and drivingchange under the Cancer Reform in the UK prior to movingto Australia. He arrived in Shepparton as the first residentoncologist and whilst there helped develop a patient centredoncology service. During this time Dr Iddawela was the ClinicalDirector at West Hume Integrated Cancer Services.

Thank you and farewell Peter KevekordesGRICS has recently farewelled one of their project staff withPeter Kevekordes leaving to pursue other opportunities.GRICS would like to thank Peter for his contribution andsupport provided to GRICS, in particular, his leadershipwith the recent CDU Redesign projects. GRICS wishesPeter the very best in his future endeavours.

WELCOME

Breast Cancer NetworkAustralia Regional Forum

2

GRICS ConsumerReference Group

For more information please contact GRICS

5128 0138

GRICS attended the Breast Cancer Network Australia’s(BCNA) regional information forum, held in Traralgonduring February.

The forum gave those who are, or have experienced breastcancer, be it personally or through a loved one, the opportunityto speak to many different organisations including GRICS.The forum was an educational experience with guest speakersincluding Dr Yoland Antill, Medical Oncologist, who spokeon care and treatments available; and Dr Carrie Lethborg,Cancer Social Worker, who spoke on emotional wellbeingthrough stages of the journey and after care. Olympian,breast cancer survivor and advocate for BCNA Raelene Boyle,shared her very personal story, giving an inspirational outlookfor those throughout their journey.

There were also many guest speakers from across Gippslandincluding Erme Maxwell, Cancer Care Coordinator fromLatrobe Regional Hospital, along with speakers from LatrobeCity Council, GippSport and BreastScreen who discussedtheir roles in relation to supports each service offer.

GRICS offered information on local supports handing out ourHandy Essentials for Local Patients (HELP) guide that includesmany Gippsland services and supports for those seekinginformation specific to their local area.

If you or someone you love has been diagnosed with breastcancer you can visit www.bcna.org.au for free informationresources and support.

Multidisciplinary CareMultidisciplinary care is an integrated team approachto healthcare in which medical, nursing and allied healthprofessionals consider all relevant treatment options andcollaboratively develop an individual treatment and careplan for each patient. There is increasing evidence thatmultidisciplinary care improves patient outcomes.

In accordance with the Optimal Cancer Care Pathways (DHHS),GRICS is eager to further develop the implementation of Tumourspecific Multidisciplinary Team Meetings (MDM) which is seen asbeing pivotal in providing patients with “Gold standard” care andtreatment.

An MDM is held every Friday and discusses patients who havebeen newly diagnosed with breast, colorectal, uppergastrointestinal, skin and thyroid cancers. Latrobe RegionalHospital (LRH) hosts this meeting with video conferencing tomultiple sites across the region including Bairnsdale RegionalHealth Service (BRHS), Central Gippsland Health Service (CGHS),West Gippsland Healthcare Group (WGHS) and to themetropolitan area. Patient referrals to the meeting haveincreased substantially with the engagement of several newsurgeons across the region and the development of theGippsland Cancer Care Centre.

The Lung MDM is a joint venture between GRICS andCGHS which hosts the meeting. There has been increasedparticipation in the meeting by Cardio Thoracic Surgeonsfrom both the Alfred and Monash Health resulting in a growthin the number of referrals.

Genitourinary cancers have been identified as the mostprevalent in Gippsland accounting for 21% of all newlydiagnosed cancers in the Region (Source: VCR). In

acknowledgment of this and in partnership with BRHSand Urology specialists, GRICS will be involved withthe development of a Urology Cancer specific MDM.The immediate aim will be to reduce variation in practice,increase the timeliness of appropriate consultation and surgeryand a shorter timeframe from diagnosis to treatment. Weconsider this can be achieved through effective informationsharing, collaborative treatment planning and the facilitationof referrals through the meeting.

Another recent innovation is a Palliative Care MDM whichoccurs weekly, hosted by LRH. The purpose of this meetingis to provide a forum, under the auspice of GRICS, whichpromotes open communication between clinicians acrossthe spectrum of health care professions in the region. Thisfacilitates best practice standards in the formulation,development and implementation of individualised treatmentplans for patients with complex palliative care needs.

In discussions with a range of stakeholders we haveencountered a lot of enthusiasm for an ongoing Palliative CareMDM. GRICS believes that by working collaboratively andbuilding relationships with GPs and nurse led communityservices we can improve outcomes for palliative patientsacross the whole region.

Additionally, Multidisciplinary care provides positive outcomesfor clinicians and health services involved in the MDM processthrough improved communication, education and cooperation.

Most importantly the patient can be reassured knowing theirtreatment providers are working together as a team to producethe best treatment options for them.

3

Local Government Area (LGA)Victoria is divided into 79 Local Government Areas (LGA)which are defined as a geographical area and is theresponsibility of local government council.

Of the 79 Victorian LGAs, there are 31 metropolitanand 48 regional which include 6 in Gippsland:

LGA Code Population (2013)

Bass Coast (S) 20740 31,010

Baw Baw (S) 20830 45,205

East Gippsland (S) 22110 43,414

Latrobe (C) 23810 73,846

South Gippsland (S) 26170 31,010

Wellington (S) 26810 42,319

Victorian population: 5,739,340

Gippsland’s population: 266,804 (4.6%)

search the data using one of the Gippsland LGAs to returnall presentations/admissions to their local hospital.

Please feel free to contact me with any questions or datarequests. Jody Neal - Data & Information Analyst on 51280139 or jneal@lrh.com.au

Data can be extracted from the Victorian Admitted EpisodeData (VAED) using the LGA code; an example would be to

4

Scholarship feedbackI attended the Annual Scientific Meeting of HAA (HaematologySociety of Australia and New Zealand, the Australian & NewZealand Society of Blood Transfusion, and the AustralasianSociety of Thrombosis and Haemostasis) at Adelaide on18-21 October 2015.

As the Transfusion Nurse at LRH I predominantly attended theANZSBT stream which covered a variety of topics pertaining totransfusion medicine from both local and international speakers.

Lawrence Goodnough from Stanford University Medical Centrediscussed updates in Patient Blood Management (PBM).Transfusion medicine has a large focus on ensuring ourpatients are receiving the best possible transfusion careor optimising their health in ways to avoid transfusionsand their associated risks.

Debbie Regester.

In October, 2015 I attended Chemotherapy Module Two at thePeter MacCallum Cancer Institute in Melbourne. It is a six daycourse run over 3 weeks.

This is a comprehensive course covering cancer cell biology,tumour staging and markers, drug classifications, clinical trials,patient education, complications of cytotoxic therapiesand the risks associated with same.

By completing the course objectives set out in this program,I now have a greater understanding of the mechanism ofaction, common toxicities and administration considerationsfor cytotoxic agents. My own clinical practice will be improvedby this knowledge. I can better identify common side effects ofcytotoxic drugs and the nursing interventions required tomanage these. This will enable me to educate patients abouttheir cancer and proposed treatments including the potentialfor side effects and how best to manage them.

Improved patient education will mean better outcomes forthe patient by maximising self-care independence.

Wendy Whitechurch.

In November 2015 I attended the Peter McCallum Radiotherapymodules 1 and 2. This was made possible by GRICS and theirscholarship that was made available to me.

Module 1 covered Brachytherapy and stereotacticradiotherapy, defined radioisotopes, nursing managementof patients receiving external beam therapy (EBT) andterminology used in Radiotherapy.

The role of the Radiotherapy nurse was outlined and discussed.This included education, patient assessment, wound care,psychological support, social support and care coordinator.

Other interesting topics that were discussed included themanagement of patients with prostate cancer, oesophagitis,concurrent treatment's dietary interventions andmanagement of a patient with tracheotomy/laryngectomyreceiving Radiotherapy.

Haematological Cancer short courses:Peter MacCallum Cancer Centre 1-2 September 2015

Several comprehensive presentations and visualson haematopoiesis were the grounding for day oneof Haematology Module 1.

Day 1 saw a massive amount of information being providedabout lymphoma, Multiple Myeloma and leukaemia:aetiology,diagnosis, prognosis and treatment for each of thesehaematological conditions.

Case studies were used to demonstrate advances in treatment,supportive care and survivorship care.

Day 2 was the Advanced Haematology Nursing Symposiumcommencing with an interesting presentation on the importanceof combining histopathology and clinical presentation toestablish a diagnosis. Palliative care was also addressedon this day emphasizing the importance of the haematologistand the palliative care team working together for the patient'sbenefit.

Continued on page 5

This opportunity to attend this course has given me a betterunderstanding of Radiotherapy and the role of the nurse andother professionals involved in the care and treatment of acancer patient. With this knowledge I can now effectivelycare for and educate patients and staff about theRadiotherapy Modality.

Thank you GRICS for this opportunity.

Leanne Prosser.

On December the 7-8 December I attended the Ausmed BloodConference in Melbourne.

The learning experience enhanced my knowledge and willundoubtedly enrich my practice as the Blood Transfusiontrainer at West Gippsland Healthcare Group (WGHG).

Physiological review of blood, Cancer emergencies, Sepsis,Clotting and Cancer, Anaemia and Venous Thromboembolismwere just some of the topics covered. I am not from anoncology background however I need to be able to havesome knowledge of our oncology patient’s backgrounds,their associated risk factors and how best these can bemanaged or avoided in order to support staff as part of myrole at WGHG.

This program increased my knowledge base and I feel moreequipped to contribute to better patient outcomes.

The changes I will be making since attending this conferenceare many. It has spurred me on to provide a lot more variedBlood and Blood product education hospital wide.

Thank you very much for giving me the opportunity to attend,I greatly appreciate it.

Eliza Berryman.

5

Scholarship feedback

Late last year GRICS held an educationsession on lower leg swelling - venous andlymphatic disease for the GippslandLymphoedema Practitioners.The day consisted of a presentation by Dr Sue Hodson(GP experienced in Lymphoedema), Janet Milne(Lymphoedema Nurse - Latrobe Community Health Service)and finished with an open discussion on case studies.

The presentations were excellent and the case studies gavethe practitioners the opportunity to discuss and seek adviceon suggested treatment options for their patients.

The day was attended by 10 practitioners from acrossGippsland with future plans currently underway for thenext education day.

GRICS would like to acknowledge Sue and Janet for theirassistance with this session.

LymphoedemaPractitionersEducation Day

Haematological Cancer short courses:Peter MacCallum Cancer Centre 1-2 September 2015

Continued from page 4

An enthusiastic dietician gave a very interesting presentationon nutritional management of haematology patients,highlighting an online e-learning resource on eviQ:www.eviq.org.au/eviQEd/MalnutritioninCancer.aspx. The dayconcluded with a discussion on survivorship and long-termfollow up clinics.

Thank you to Gippsland Regional Integrated Cancer Serviceand Bairnsdale Regional Health Service for their support inattending this event.

Having the opportunity to attend not only helps to updateknowledge in the field of Haematology but it also providesan opportunity for those of us in the regional areas of Victoriato have exposure to what is happening in the city where thereare more resources.

Nancylee Robertson.

Key lessons learned attending Radiotherapy Modules1 and 2 at Peter MacCallum 24-25 November 2015

It has been estimated that 50-60% of all patients diagnosedwith cancer will have Radiotherapy at some point in theirtreatment. The basic principles are to give an adequate doseto eradicate the tumour and a minimal dose to healthy tissues,ensuring critical organs are not treated beyond their tolerancelevels.

Prior to commencing treatment, there is extensive imaging,planning and preparation required. Using concurrentChemotherapy and Radiotherapy enhances the effectivenessof Radiotherapy.

The Nurse assessment of the impact of radiation side effects onthe patients is vital. Common side effects are fatigue and skinreactions to the specific area of treatment. Approximately 95%of patients receiving External Beam Radiation may have skinreactions and fatigue occurs in 60-100% of patients.

Successfully managing the side effects allows the patient tocontinue the planned radiotherapy treatment. By optimising thenursing management of Radiotherapy side effects, the patientgains improved quality of life and treatment outcomes.

Ges Hammer.

CDU RedesignProjects - Phase 2

GRICS held a mid-project forum on 16th February2016 for Health Agencies involved in a chemotherapyday unit (CDU) Redesign Program.

The forum gave Health Agencies an opportunity to presentupdates on work already completed as well as outline thepathway forward on existing and proposed project work.

Each presentation was of a very high standard successfullydemonstrating that progress on each project was wellunderway. Interestingly, presentations were able to demonstratethat beneficial changes can occur at many levels of a CDUsoperations; from the repositioning of unit equipment; toprocedural changes involving in the way Clinicians work withCDU staff; through to larger structural changes such as theestablishment of an infusion unit to assist CDU in periods ofpeak service demand.

In the afternoon session, Christian Pitzner (LRH Redesign Lead)spoke to the group on his own personal experiences andinsights managing a Redesign Program. Christian discussedthe role of communication and its value in underpinning astrong Redesign Project. Different strategies were exploredand recommendations made on how Redesign Projects canbetter communicate achievements to project stakeholders.Thank you also to Julie Lawrence (BRHS Service ImprovementProgram Manager) who actively participated in the conversationoffering her own insights on the challenges of managingRedesign Projects within a health care setting.

Congratulations to everyone involved for making this forumsuch a rewarding experience.

6

GP Education SessionGRICS recently held a discussion forum at BairnsdaleRegional Health Service (BRHS), aimed at providinginformation about the care and treatment of the cancerpatient, to General Practitioners in the region.

We had great support for the evening, with 19 people attendingfrom 8 different health services around the Bairnsdale region.

The forum was well received; generating some greatdiscussion points, and highlighting a number of focus areasfor improvement in practice. Dr Sachin Joshi chaired the

evening, and covered a broad range of topics from OptimalCancer Care Pathways, the role of the GP, regional versusmetropolitan care, diagnosis and referral pathways.

GRICS would like to extend a warm thank you to Mr Servaisede Kock, Dr Arman Kuyumcian and Ms Kay Stephenson forparticipating as panellists, BRHS for providing the facility forthe evening, and everyone else involved who made this eventa success.

Optimal Cancer CarePathways (OCPs)

To help people diagnosed with cancer receive the best possible care, Optimal Cancer Care Pathways havebeen developed for 15 cancer types.

Versions have been developed for both cancer patients and health professionals; they help identify specific steps alongthe patient’s journey and the recommended care at each point.

The clinical guides for health professionals set out key principles for optimal care at each step of the patient journeyfrom prevention through to survivorship / end of life care.

The guides have been endorsed by the National Cancer Expert Reference Group, Cancer Australia and Cancer CouncilAustralia.

Patients and their family and carers can use the consumer versions to better understand an often complex health system,and to know what questions to ask of their health professionals to ensure they receive the best care at every step.

View the Optimal Cancer Care Pathways or download consumer PDFs from www.cancer.org.au/OCP or view theinteractive consumer web portal at www.cancerpathways.org.au

7

GRICS Manager Cancer Service Improvement CoordinatorElaine Wood 5128 0059 Danielle Roscoe 5128 0062ewood@lrh.com.au droscoe@lrh.com.au

Administrative Officer Cancer Service Improvement CoordinatorKathy Nicholls 5128 0138 Marnie Flowers 5128 0075knicholls@lrh.com.au mflowers@lrh.com.au

Cancer Data and Information Analyst Cancer Service Improvement CoordinatorJody Neal 5128 0139 Allison Speairs 5128 0137jneal@lrh.com.au aspeairs@lrh.com.au

Cancer Service Improvement Coordinator Cancer Service Improvement CoordinatorMichelle Pryce 5128 0147 Linda Burton 5128 0137mpryce@lrh.com.au lburton@lrh.com.au

Contact Information

Prostate Cancer Summit

Prostate cancer clinicians are invited to attend a summit meeting to discuss and identify unwarranted variations in tumour basedclinical practice and cancer outcomes that could be addressed through state-wide action.

At each summit clinicians are asked to review data on cancer treatment planning and delivery across Victorian public and private healthservices and agree one or two short-term priorities for collective action.

This work will be supported by the local Integrated Cancer Services though engagement with their cancer multidisciplinary teams.

Make a difference by contributing your expertise!Discussion topics:

� Incidence and survival � Multidisciplinary approach to treatment planning � Treatment options for all stages of prostate cancer.

This clinician-led forum is fourth in a series of tumour specific summit meetings in Victoria. A clinical working party co-chairedby A/Prof Jeremy Millar and Prof Damien Bolton is overseeing the preparation of the data to inform the summit discussion.

For more information contact Tumour Summits Project Manager, Mirela Matthews or 03 9496 3322.

Reducing variations in prostatecancer outcomes in Victoria?

Friday 27 May 2016 from 9am - 1pm.RACV Club

501 Bourke Street Melbourne.Registration opens at 8.30am. A light lunch will follow.

Register now.