matters CANCER

cancermatters
N e w s l et t e r o f T h e We s t e r n A u s t r a l i a n C l i n i c a l O n co l o g y G r o u p
Volume 4
Spring 2008
From the Editor
Welcome to the 4th edition of Cancer Matters -
INSIDE…
Local Matters
National Matters
Prevention
Matters
International
Matters
Cancer in the
News
Consumer Matters
Treatment
Matters
GP Matters
Hot Websites
Upcoming Cancer
Educational
Meetings
WACOG
Executive Officer
Tel: +61 08 9212 4333
Email:
[email protected]
Website:
www.cancerwa.asn.au/
professionals/wacog/
All correspondence should
be directed to:
46 Ventnor Avenue
West Perth WA 6005
Cancer Matters is published
in December, March, June and
September as a service to all
supporters and interest groups.
a newsletter on all clinical aspects of cancer control for Western Australian health professionals
Welcome to the fourth edition of Cancer Matters!
In August 2008 the Cancer Council and the WA Cancer and Palliative Care Network released a report
titled – Overview of Cancer Treatment Services in WA prepared by University of New South Wales
Professor of radiation oncology Michael Barton. The report identified that cancer treatment services
in WA are not sufficient to meet current demand, and the plans for the future will not be adequate
and need to be urgently reviewed. The number of new cases of cancer is increasing every year, and
urgent investment is needed to meet the current shortfalls in treatment services and to cope with
the growing demand. Professor Barton warned WA faced 10,000 new cancer cases a year, rising by
3 to 4% a year, but facilities and equipment were unable to cope. The Barton report is highlighted in
this issue under local matters.
The WA Cancer and Palliative Care Network update includes progress on many important ongoing
projects including the tumour collaboratives models of care exercise, the announcement of clinical
trials grants totalling $1 million, expansion of the services of the cancer nurse coordinators and the
refurbishment of the premises at Shenton Park for the WA State Psycho-Oncology Service.
Under a new section titled Prevention Matters the emergent global issue of cervical cancer
vaccination is highlighted along with a call from the Cancer Council for the Government to set a
timeline and framework for ensuring that cervical cancer screening and human papillomavirus
immunisation work together to further reduce cervical cancer burden in Australia.
The largest single scientific gathering of cancer specialists is the annual meeting of the
American Society of Clinical Oncology – selected practice changing highlights are presented under
international matters. Regarding Treatment Matters – the importance of the multidisciplinary team
for the treatment of adult brain tumours is emphasised by a recent Cancer Council visitor from NSW,
neuro–oncologist Dr Liz Hovey.
Regarding GP Matters, new resources in cancer genetics and a guide for Hepatitis B are profiled
along with new cancer related Medicare items for GPs. Regular sections on cancer websites and
upcoming educational meetings are also detailed.
Finally we hope that the WA cancer health professional community finds Cancer Matters a useful
read and we welcome any feedback from our readers.
Paul Katris – Editor
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1
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LOCAL MATTERS
News from the WA Cancer and Palliative Care
Network (WACPCN)
The Network continues to be active in diverse areas. The Clinical
Trials Grants Scheme (CTGS) has distributed over $1million in
grants to support clinical trials for patients with cancer. This
trials grants scheme aims to build on the excellent record WA
already has in undertaking clinical cancer research. It is hoped
that these grants will allow more cancer patients to participate
in clinical trials, which may not only improve their outcome,
but will improve our knowledge of best treatments for future
patients. Professor Christobel Saunders leads the Network
Research Group and is responsible for administering the CTGS.
The WACPCN recognises the enormous amount of work she has
done in getting this initiative underway.
Work has commenced on the tumour site specific Models of
Care (MOC) that will inform the process of appropriate planning
of cancer services in WA. It was hoped that we would be able
to present all of the MOC to State Health Executive Forum in
August. Loss of staff and difficulties in recruiting replacements
have led to some delay. We currently have several MOC nearly
completed including Psycho-Oncology, Primary Care, Paediatric Adolescent and Young Adult and Colorectal. The initial drafts of
the other MOC have been received and will be further developed
in line with a uniform presentation style. It is hoped to finalise
and deliver all of the MOC by October/November this year. This
will allow for extensive professional and community consultation
that is critical to the development of these important documents.
The Cancer Nurse Coordination service has been boosted by
the appointment of 4 extra nurses who are working in Urology,
Colorectal, Thoracic and Head & Neck. This will improve care to
these important patient areas.
The Palliative Care Network has a full program of activities. An End
of Life Pathway Pilot Project has been completed and planning
is underway for wider implementation of the pathway in the
health system. The Network has been working in collaboration
with the Child and Adolescent Health Service to develop the
Paediatric Palliative Care Service that was launched in May.
Rural palliative care continues to be a priority and the Network
is pleased to report that further Medical Specialist Outreach
Program funding for statewide palliative care medical specialists
visits has been secured for 2008-09. A Rural Model of Care is
being developed and will soon be available for consultation.
The WA State Psycho Oncology Service has relocated to
refurbished premises at the Shenton Park campus of RPH and
is now in a position to increase activity in regard to patient
consultations. This service welcomes patient referrals from
cancer health professionals and also welcomes self referral from
cancer patients and their family members.
The WACPCN Director of Nursing, Violet Platt, participated in
an inaugural meeting in Bunbury involving Nursing and Allied
Health professionals which aims to facilitate discussion around
cancer issues in the region. Violet Platt and Ian Hammond
have been involved in rural consultations and have visited
several regions including Albany (Greater Southern) Kalgoorlie
(Goldfields), Geraldton (Midwest) and Port Hedland (Pilbara).
These consultations are aimed at enhancing cancer services to
patients in these areas by improving access to multidisciplinary
team care using varied strategies including the use of telehealth/
videoconferencing.
Finally the Network will be relocating to accommodation in
Osborne Park in November as redevelopment of the QE2 site
continues. Any queries regarding the activities of the network
should be directed to Ian Hammond or Violet Platt (Ph 9346
3333).
IAN HAMMOND
Director, WA Cancer and Palliative Care Network
2
WA Cancer services suffering because of staff
shortages and inadequate planning
Widespread shortages in the cancer workforce in WA meant
there were not enough staff to meet the current demand for
the treatment and care of cancer patients and planning to meet
future demand was inadequate, according to an independent
report commissioned by Cancer Council Western Australia.
The report ‘Overview of Cancer Treatment Services in WA’ was
commissioned by the Cancer Council in response to concerns
expressed by cancer patients. The report was funded by the
Cancer Council and the WA Department of Health. The report
author, Professor Michael Barton from the University of New
South Wales, who has conducted similar reviews in other
Australian states and territories, said there were not enough
medical oncologists, radiation oncologists and specialist nurses
to adequately deal with the current numbers of cancer patients.
“Cancer services in WA are overstretched. There are very good
people working very hard but the demand far outstrips supply,”
Professor Barton said. “WA cancer specialists have the highest
case load of cancer specialists across Australia. The high
workload of the existing limited number of specialists has led to
long waiting lists for some services.”
Professor Barton has warned that WA was not prepared for
the projected increase in the number of cancer patients. In the
decade 1997 to 2006, there was a 44 per cent increase in new
cases of cancer in WA. In 2006, there were around 10,000 new
cases of cancer and it’s estimated that by 2015 there will be
more than 12,500 new cases a year in WA. “The WA government
has made some very large steps in improving cancer services
but there is a lot of work to do to catch up. “With cancer cases
increasing by three to four per cent every year, cancer services
have not kept up and there’s now a very big gap between what’s
required and what’s supplied,” Professor Barton said.
Professor Barton said even the planned move to the new Fiona
Stanley Hospital would not meet the increased demands for
services and the uncertain future of Royal Perth Hospital had
stopped any expansion of services there in the meantime. He
said the planned comprehensive cancer centre at Sir Charles
Gairdner Hospital could improve service delivery to patients and
provide economies of scale for education and research.
“Urgent investment is needed to meet the current shortfalls in
treatment services and to cope with the inevitable increase in
demand,” Professor Barton said.
The report also identified the Patient Assisted Transport Scheme
(PATS) as the greatest barrier to cancer patients from regional
and rural Western Australia receiving adequate treatment. “Most
rural cancer patients will have major out-of-pocket expenses
that may deter them from seeking adequate treatment. Patients
may also choose less effective or no treatment because of a lack
of access to transport,” Professor Barton said. Access to new
technology was also limited in WA with cancer patients often
having to leave WA for treatment that is readily available in the
rest of Australia. “Investment in new technology is needed to
keep up with the developments in Australia and internationally,”
he said.
On a positive note, Professor Barton said WA had high
quality cancer services and survival rates in WA were as
good as or better than the rest of Australia for many types
of cancers.
The Vice-President of the Cancer Council Western Australia,
Professor Christobel Saunders, said there was an urgent need
to upgrade existing cancer treatment facilities prior to the
new Fiona Stanley Hospital and Sir Charles Gairdner Hospital
cancer centre coming on line. “It’s not good enough to say that
these new facilities will fix everything. In the meantime, there
are almost 10,000 people being diagnosed with cancer in WA
every year who will need to be treated in the outdated and
overcrowded facilities that we have now”.
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LOCAL MATTERS cont/d....
“There needs to be interim investment in the existing
cancer treatment centres for the wellbeing of patients and
the staff that work there,” Professor Saunders said. We
also need to ensure that the new services and facilities
that are planned are worldclass, not just serviceable.”
Professor Saunders said more needed to be done to address the
issue of staff shortages. “It’s not just about training, although that’s
an important part of the solution, it’s also about using incentives
to attract and retain experienced staff,” Professor Saunders said.
The Cancer Council is asking the next State government to ensure
there is no going backwards in cancer control in WA. “As well as
providing for and caring for people who already have cancer, it’s
just as important to maintain the momentum in cancer prevention
and education programs. It’s through prevention and early
detection that we will ultimately reduce the number of people
diagnosed with cancer in the future,” Professor Saunders said.
July 2008
See the full report at the Cancer Council website
under About Us - http://www.cancerwa.asn.au/
or via this direct link:
http://www.cancerwa.
asn.au/resources/Overview_of_cancer_
treatment_services_in_Western_Australia.pdf
WA leads in breast cancer detection
WA is leading the country in finding early breast cancer and
precancerous breast changes, helping the State to achieve
one of the lowest death rates from the disease in Australia.
An Australian Institute of Health and Welfare report for 200405 shows that WA’s breast screening program is picking
up significantly more cases of ductal carcinoma in situ, a
condition which causes changes to the cells lining the breast
ducts and can turn into invasive breast cancer if not treated.
It also shows that substantially more WA women aged 5069, the target age group for mammograms, were screened
compared with five years earlier. Nationally, around 1.2
million women took advantage of free breast screening,
just over half the number of women in the target group.
In the meantime death rates from breast cancer fell 23% between
1990 and 2005, with the biggest fall in women in their 50s and
60s, particularly in WA where the death rate was 49.2 per 100,000
compared with the national average of 53.1 per 100,000.
BreastScreen WA medical director, Dr Liz Wylie said the results
were encouraging.
NATIONAL MATTERS
$31 million allocated for breast prosthesis
National Breast and Ovarian Cancer Centre (NBOCC) has
welcomed an additional $31 million funding over five years
from the Australian Government to allow all Australian women
who have had mastectomy as a result of breast cancer to access
external prostheses.
The Federal budget measure will allow for the replacement
of a woman’s prostheses every two to five years. This is a
significant acknowledgement from the Australian Government
of the importance of practical, emotional and financial support
required throughout a woman’s breast cancer journey. Breast
prostheses help to restore a woman’s body image after surgery
for breast cancer and this funding will help to alleviate concerns
about accessing prostheses that can add to the emotional and
financial burden of women and their families. The National
Breast and Ovarian Cancer Centre looks forward to working with
the Australian Government and key stakeholders in the cancer
community, including Breast Cancer Network Australia, to honour
this commitment to women with breast cancer across the country.
This initiative is currently in its early stages of development.
Taken from The Source, National Breast and Ovarian Cancer
Centre Bulletin
New cervical screening framework needed
when HPV vaccine takes effect
A report released by the Cancer Council Australia suggests
Government should set a timeline and framework for ensuring
cervical cancer screening and human papilloma virus (HPV)
immunisation work together to further reduce cervical cancer
burden in Australia. Releasing the recommendations of a
“roundtable” meeting of Australian experts, Cancer Council Australia
CEO, Professor Ian Olver, said the immunisation program must be
introduced in a way that maximises its potential and complements
Australia’s highly successful cervical screening program.
“Australia’s cervical cancer screening program is the main reason
incidence in women aged 20 to 69 halved between 1991 and
3
2005, while HPV immunisations has the potential to prevent
up to 70 per cent of cervical cancers,” Professor Olver said. “An
evidence-based approach to policy and public information will
help to ensure these two different approaches to cervical cancer
prevention combine to further reduce incidence and mortality”.
Cancer Council Australia President, Professor Ian Frazer,
whose research team developed the HPB vaccine, said
Australia was a world leader in reducing cervical cancer
mortality using Pap testing. “HPV immunisation had the
potential to further reduce cervical cancer mortality, but it
is vitally important that Australian women continue to be
screened through Pap testing for pre-cancerous abnormalities
and that they receive clear advice,” Professor Frazer said.
The Cancer Council has also released the immunisation
section of its National Cancer Prevention Policy, including a
chapter on HPV which identifies opportunities for the vaccine
to reduce cultural inequities in cervical cancer mortality.
Taken from the Cancer Council Australia Report, Wongi Yabber
Newsletter of the Australian Cancer Network Volume 15, Issue
2 May 2008.
Improving consistency and availability of
breast cancer data
The collection of nationally consistent data about all aspects
of breast cancer – from a woman’s age at diagnosis, through to
tumour types and decisions regarding breast reconstruction – is
vital in improving outcomes. Data brings together information
to create a bigger picture of trends in breast cancer incidence
and care across Australia that can be used to help improve
health service delivery. At present, different data is collected in
different ways across Australia and there is no linkage of data
across the public and private sectors or across different states
and territories. To rectify this, NBOCC has developed a National
Data Strategy to improve access to information about breast
cancer, which complements Cancer Australia’s National Cancer
Data Strategy. The aim of NBOCC’s strategy is to ensure there
is consistency across the country in defining recording and
monitoring information about women with breast cancer.
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NATIONAL MATTERS cont/d....
The strategy identifies current gaps in data collection, prioritises
data needs, and promotes the importance of this data being
accessible via regular reports that will help to answer key breast
cancer questions. This strategy will guide NBOCC’s future program
of work in the area of data monitoring, which to date has included the
development of a minimum data set outlining the data that should
be collected for every woman with breast cancer across Australia.
To view the data strategy, visit www.nbocc.org.au/resources.
Taken from The Source, National Breast and Ovarian Cancer
Centre Bulletin Winter 08
Cancer care in the elderly
A Geriatric Oncology Forum Where Geriatrics Meets Oncology was
held at Sydney’s Stamford Airport Hotel on Friday 4 April 2008.
The 1-day workshop was convened by COSA with the aim of :
•
•
•
•
outlining service delivery models for onco-geriatrics
appropriate for the Australian context
identifying the major research questions that can be
addressed by an Australian workforce
identifying the key objectives for a Cancer in the Elderly
COSA Special Interest Group
identifying strategies to promote the issues of Cancer in the
Elderly to the broader community
The workshop, the first of its size to be held in Australia on this
topic, was attended by over 70 participants from the fields of
oncology and geriatrics. Attendees included health professionals
health service administrators, consumers and representatives from
national and international cancer and government organisation.
The keynote speaker was Dr Matti Aapro, Director, Multidisciplinary
Oncology Institute, Genolier, Switzerland and Executive Director
of the International Society for Geriatric Oncology (SJOG).
Taken from the COSA Report, Wongi Yabber Newsletter of
the Australian Cancer Network Volume 15, Issue 2 May 2008
Cancer patients want to be told about
expensive drugs
Australians with terminal cancer want doctors to tell
them about expensive drugs that could add a few months
to their life, even if they cannot afford to take them.
A recent survey found that more than 40 per cent of cancer
specialists do not tell their patients about new unbsubsidised
drug treatments, most of which cost at least $5000 per month.
The information is often withheld for fear of distressing
sick people about options financially out of their reach.
A new Australian study, presented at the American Society of
Clinical Oncology in Chicago this month, found that more than 90
per cent of people would want to be informed, even though only
50 per cent said they would be willing or able to pay for the drugs.
Study leader, Dr Linda Mileshkin, a medical oncologist at
the Peter MacCallum Cancer Centre in Melbourne, indicated
that many of the new targeted anti-cancer therapies
show promise for improving quality of life and extending
survival in early trials, often years before they are made
cheaply available by the Pharmaceutical Benefits Scheme.
Cancer Council Australia chief executive Professor Ian
Olver said a doctor’s decision to withhold drug information
from patients was “compassionate but ill-directed”.
PREVENTION MATTERS
New cervical screening framework needed
when HPV vaccine takes effect
A report released by the Cancer Council Australia suggests
Government should set a timeline and framework for ensuring
cervical cancer screening and human papillomavirus (HPV)
immunisation work together to further reduce cervical cancer
burden in Australia. Releasing the recommendations of a
“roundtable” meeting of Australian experts, Cancer Council
Australia CEO, Professor Ian Olver, said the immunisation
program must be introduced in way that maximises its potential
and complements Australia’s highly successful cervical screening
program. “Australia’s cervical cancer screening program is the
main reason incidence in women aged 20 to 69 halved between
1991 and 2005, while HPV immunisations has the potential to
prevent up to 70 per cent of cervical cancers,” Professor Olver said.
“An evidence-based approach to policy and public information
will help to ensure these two different approaches to cervical
cancer prevention combine to further reduce incidence and
mortality”. Cancer Council Australia President, Professor Ian
Frazer, whose research team developed the HPB vaccine,
said Australia was a world leader in reducing cervical cancer
mortality using Pap testing. “HPV immunisation had the
potential to further reduce cervical cancer mortality, but it
is vitally important that Australian women continue to be
screened through Pap testing for pre-cancerous abnormalities
and that they receive clear advice,” Professor Frazer said.
The Cancer Council has also released the immunisation section
of its National Cancer Prevention Policy, including a chapter on
HPV which identifies opportunities for the vaccine to reduce
cultural inequities in cervical cancer mortality.
Taken from the Cancer Council Australia Report, Wongi
Yabber Newsletter of the Australian Cancer Network
Volume 15, Issue 2 May 2008.
4
Vaccinating to prevent cervical cancer
International efforts to introduce HPV vaccines, above all in
developing countries, need to be accelerated, say Xavier Bosch
and his colleagues Silvia de Sanjosé and Xavier Castellsagué of
the Cancer Epidemiology Research Programme in the Institut
Català d’Oncologia (Barcelona, Spain). Some 500,000 cases of
cervical cancer and 40,000 cases of cancers of the vulva and
vagina are diagnosed every year worldwide.
For decades, prevention of cervical cancer has been partially
fulfilled by expanding the practice of cervical cytology (the Pap
smear), repeated frequently in tens of millions of asymptomatic
women worldwide. The conventional screening technique has
contributed significantly to reducing cervical cancer incidence
and mortality in areas of the developed world where coordinated
programs were implemented for extended periods of time
but has hardly modified the burden of disease in most
developing countries.
Human papillomavirus (HPV) types 16 and 18 are responsible
for at least 70% of cervical cancer worldwide and for some
50% of the pre-neoplastic lesions CIN 2/3. HPV 6 and 11 are
responsible for a small proportion of the CIN 1 lesions and for
the majority of genital warts and the rare cases of respiratory
papillomatosis.
Two
HPV
vaccines
have
contributed
Phase
III
trial
results
and
been
licensed
in
over
120
countries. Several million doses of these vaccines
have
been
already
distributed
and
administered.
The most advanced results are from a quadrivalent vaccine
(Gardasil, MSD) that targets four HPV types (6,11,16 and
18). Interim results are available from a bivalent vaccine
(Cervarix, GSK) that targets two HPV types (16 and 18);
final results of the bivalent vaccine trial are awaited in 2008.
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PREVENTION MATTERS cont/d....
Key results and implications of the Phase III
trials
Cancer Risks can Start Early
With the still moderate (5-6 years) follow up in a few tens of
thousand young women, these two vaccines to date have shown
high efficacy, safety, immunogenicity, longterm protection and a
strong suggestions of induction of immune memory. For women
that are found HPV DNA 16 and 18-negative and negative to
HPV type-specific antibodies at study entry (HPV naïve women),
these vaccines have shown full protection (>95%) from the CIN
2/3 lesions associated with these two HPV types. A moderate
impact on HPV infections and associated lesions related to
other HPV types has been reported or published.
The quadrivalent vaccine has already shown that current HPV
16 and 18 vaccines are capable of offering almost complete
protection against the precursor lesions of the vulva (VIN 2/3)
and the vagina (VAIN 2/3); it also offers high protection against
external genital warts induced by HPV 6 and 11.
These vaccines have not shown any ability to modify the
prognosis of established HPV infections or CIN lesions.
Therefore, the clinical indications are strictly prophylactic. Some
clinically relevant issues remain to be fully described, including
the magnitude and the HPV spectrum included in the crossprotection effect, and the long term effects of HPV vaccines on
cancer-protection and safety.
It also remains to be established if natural exposure
to HPV 16 or 18 will induce a natural boosting effect
or if booster doses of the vaccine will be required. The
long natural history of HPV and cancer requires long term
protection,
hopefully
lifetime
following
adolescent
vaccination.
To
answer
these
questions
requires
additional follow-up time and the organization of large
Phase IV studies, some of which are already in place.
What vaccination will require
The number of women in any one-year age cohort between
10 and 14 has been estimated to be close to 60 million. Of
these, some 52 million (87%) live in developing countries.
Vaccination of the 5-year preadolescent cohorts aged
10 to 14 would require approximately 1 billion doses of
HPV vaccine (allowing for 10 % waste). Should a catch-up
strategy be put in place, increasing the vaccination target
to women 10 to 25 would increase the vaccine requirements
for the initial vaccination rounds to up to 15 billion doses.
Screening will still be needed
Among vaccinated women screening will need to be continued
because of the limitations of current HPV vaccines both in
their lack of therapeutic effect (thus not protecting women
with ongoing neoplastic processes) and in their limited
number of HPV types (thus leaving to evolve some 2530% of cervical cancer cases related to HPV types other
than 16 or 18). However the screening paradigm is likely
to change to HPV-based technology, with cytology being
used as the triage method among HPV positive women.
Unvaccinated women worldwide will rely entirely on their
screening recommendations for cervical cancer prevention.
Again scientific evidence consistently recommends a change
in the technologies to be used. HPV tests are on average 30%
more sensitive against a loss in specificity of 7-10%. It is thus
now proposed that HPV tests be adopted as a primary screening
tool, with cytology focused on triage of HPV-positive women. In
developing countries where screening has proven very difficult,
novel screening methods are being evaluated, such as visual
inspection with or without acetic acid or with Lugol’s iodine (VIA,
VIAM, VILI) paired with screen and treat intervention protocols
than simplify the logistics of follow-up of women that tested
positive and are thus at risk of cancer progression.
Taken from - UICC eNews
5
Cancer development is not a spontaneous event; it is a process
that occurs over time. A strong body of scientific evidence is
now showing that our patterns of growth and development
over the entire lifespan – from conception forward – can
influence the cancer process. Examining the causes of cancer
in this way, across the entire lifetime, is called the “lifecourse approach” to cancer research. “To focus on cancer
prevention only during adulthood is not the best way to
approach it, because there are risks that can accumulate at all
stages of life,” says Dr. Carol Devine, an Associate Professor
in the Division of Nutritional Sciences at Cornell University.
Life Phases and Risk
Three phases of growth are particularly sensitive to factors that
may influence cancer risk:
1.fetal-infant
2.childhood
3.puberty
Nutrition influences birth weight, rate of growth and onset of
sexual maturity. All of these factors interact with body fatness
and with genes. The interactions can alter hormone levels
and cell development, which affect cell mechanisms involved
in the cancer process. The hormone shifts also may influence
an adult’s height – tallness is linked with increased cancer
risk – and a person’s tendency to carry body fat later in life.
Taken from Cancer Research Update - the newsletter of
American Institute for Cancer Research.
http://www.aicr.org/
Recommendations for Cancer Prevention
These ten recommendations for cancer prevention are drawn from
the WCRF/AICR Second Expert Report. Each recommendation
below links to a page with more details. You can use these links
to skip to individual recommendation pages, or you can start with
the first and follow links from page to page through the entire list.
1. Be as lean as possible without becoming underweight.
2. Be physically active for at least 30 minutes every day.
3. Avoid sugary drinks. Limit consumption of energy-dense foods
(particularly processed foods high in added sugar, or low in fiber,
or high in fat).
4. Eat more of a variety of vegetables, fruits, whole grains and
legumes such as beans.
5. Limit consumption of red meats (such as beef, pork and lamb)
and avoid processed meats.
6. If consumed at all, limit alcoholic drinks to 2 for men and 1 for
women a day.
7. Limit consumption of salty foods and foods processed with
salt (sodium).
8. Don’t use supplements to protect against cancer.
Special Population Recommendations
9. It is best for mothers to breastfeed exclusively for up to 6
months and then add other liquids and foods.
10. After treatment, cancer survivors should follow the
recommendations for cancer prevention.
And always remember – do not smoke or chew tobacco.
http://www.aicr.org/site/PageServer?pagename=dc_
home_guides
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INTERNATIONAL MATTERS
44th Annual Meeting
American Society of Clinical Oncology
May 30 - June 3, 2008 | Chicago, Illinois Selected
Highlights
from
ASCO
2008
The results from thousands of cancer research studies
were presented at the 44th annual meeting of the
American Society of Clinical Oncology (ASCO) in Chicago,
Ill., from May 30 - June 3, 2008. Nearly 25,000 cancer
specialists from around the world gathered to discuss the
latest advances in cancer care, treatment, and prevention.
Colorectal Cancer Drugs Require Careful Patient
Selection
Patients with advanced colorectal cancer who have
mutant forms of the gene KRAS in their tumors should
not receive chemotherapy plus cetuximab (Erbitux),
because they are unlikely to benefit from the treatment.
Zoledronic Acid Improves Early Breast Cancer
Treatment
The addition of zoledronic acid (Zometa) to adjuvant
endocrine therapy in premenopausal women with early
stage breast cancer significantly improves clinical outcomes
beyond those achieved with endocrine therapy alone.
Cetuximab Plus Chemotherapy Extends
Survival for Advanced Lung Cancer
Patients with advanced non-small-cell lung cancer who received
cetuximab (Erbitux) plus chemotherapy lived on average five
weeks longer than patients who received chemotherapy alone.
Carboplatin May Be Less Toxic Than Radiation
for Seminoma
One shot of carboplatin may be as effective as radiation
therapy in treating early seminoma, a kind of testicular cancer.
Gemcitabine after Pancreatic Cancer Surgery
Improves Survival
Patients
who
received
the
chemotherapy
drug
gemcitabine after surgery for pancreatic cancer lived
two months longer than patients who had surgery alone.
Taken from the National Cancer Institute U.S website. For
further specific details regarding these highlights visit:
http://www.cancer.gov/clinicaltrials/asco2008/highlights
clinical depression and unfortunately it is not always
adequately treated”. “This new treatment could substantially
improve the way we manage depression in people with cancer
and also in people with other serious medical conditions”.
“This is the first time this type of depression treatment has
been evaluated in cancer patients and the results are very
encouraging.” The study was funded by Cancer Research UK which
recently awarded the research team £4m to continue its work.
From Lancet. 2008 Jul 5;372(9632):40-8
Cancer myth busters
Myths about cancer causes abound and are putting
the lives of many people at risk, research shows.
A survey of almost 30,000 people in 29 countries, including
1271 Australians, found people believe environmental factors
are more of a cancer risk than they are. People also play down the
behavioural factors that are well known to raise the risk of cancer.
The research, presented at the International Union Against
Cancer world congress in Geneva recently, identified key
areas where myths could be dispelled and lives saved.
One of the most important findings is that people in rich
countries, including Australia, were least likely to believe
alcohol raises the risk of cancer, compared with 26% of
people in middle-income countries and 15% in poor nations.
And in rich countries, people incorrectly believed not eating
enough fruit and vegetables was more of a risk than alcohol.
They were also more likely to cite stress and air pollution as higher
risk factors for cancer than alcohol intake, despite the fact stress is
not recognised as a cause and air pollution is only a minor contributor.
The report also found people in all countries were more
ready to accept that things outside their control, such
as air pollution, might be more of a cancer risk than
things within their control, such as being overweight.
Mediterranean Diet for Cancer Prevention
Long studied for its link with heart health, the Mediterranean diet
now has a large study suggesting the diet may prevent cancer
as well. Published in the British Journal of Cancer, the study
looked at overall cancer incidence in more than 25,000 Greeks.
After a median follow up of almost 8 years, the authors found
that people who followed the Mediterranean diet – characterized
by healthy fats, fish, whole grains, legumes, and hearty
portions of fruits and vegetables – had a significantly lower
incidence of cancer than those who least followed the diet.
The more people adhered to the diet, the lower the
cancer risk. It was the diet as a whole, not the individual
components, that was linked to lower risk, note the authors.
Br J Cancer. 2008 Jul 8;99(1):191-5.
New cancer depression treatment
One in ten people who have cancer also experience
clinical
depression - A new treatment program for
cancer patients suffering clinical depression significantly
improved their quality of life, according to researchers.
Patients
received
information
and
problem-solving
therapy to help them overcome feelings of helplessness.
After three months, 20% fewer patients were depressed
compared with those who received standard NHS treatment.
The study, by a team at the University of Edinburgh,
was published in the Lancet medical journal. The
university’s
psychological
medicine
research
group
recruited 200 cancer patients who had clinical depression.
Half were given the new strategy - depression care for people
with cancer - while the rest received standard care, either from
a GP or hospital specialist. The new treatment offered oneto-one sessions with trained cancer nurses to help patients
manage their depression. As well as reduced depression,
this group reported improvements in anxiety and fatigue.
Professor Michael Sharpe believes the therapy, developed by
Cancer Research UK scientists, could help patients with a range
of illnesses. He said: “Ten per cent of cancer patients experience
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6
cancersmatters
INTERNATIONAL MATTERS cont/d....
Panel Recommends Against PSA Testing in
Men 75 or Older
Australian Positions on Screening Men at Normal
Risk of Prostate Cancer
In Australia the issue of population screening for prostate cancer
remains controversial. As a result of the evaluation of prostate
cancer screening against established criteria, the Australian
Health Technology Advisory Committee (AHTAC) recommends
against the screening of asymptomatic men for prostate cancer.
Prostate cancer screening, particularly the PSA test, is a rapidly
evolving area and the position on screening may change when
further evidence on the effectiveness of existing tests and
treatments becomes available. AHTAC recommends that a
monitoring mechanism be put in place to ensure this position on
screening is reviewed when significant developments occur.
It also recommends that men being offered, or requesting,
the PSA test must be fully informed of the limitations of the
available tests and the possible further diagnostic and treatment
choices with which they may be faced should they decide to
proceed with the test. AHTAC recommends that screening tests
for prostate cancer should not be used for non-medical purposes
such as employment, insurance or migration.
In updated recommendations released in August 2008, the U.S.
Preventive Services Task Force (USPSTF) is advising against the
routine use of prostate-specific antigen (PSA) testing to screen
for prostate cancer in men age 75 and older.
Published in Annals of Internal Medicine, the recommendations
state that the potential harms of PSA testing for men in this
age group outweigh any benefits, and that there is “adequate
evidence that the incremental benefits of treatment for prostate
cancer detected by screening are small to none.”
For men under 75, the panel concluded that there was inadequate
evidence to say whether “treatment for prostate cancer detected
by screening improves health outcomes compared with treatment
after clinical detection.”
In its report, the panel added that there is “convincing evidence
that treatment for prostate cancer detected by screening
causes
moderate-to-substantial harms, such as erectile dysfunction,
urinary incontinence, bowel dysfunction, and death.
These harms are especially important because some men with
prostate cancer who are treated would never have developed
symptoms related to cancer during their lifetime.”
The USPSTF is a panel of independent experts convened by the
U.S. Agency for Healthcare Research and Quality. Opinions on
this issue among urologists and prostate cancer researchers run
the gamut, with some arguing that PSA testing in men 75 and
older does indeed save lives.
Dr. Howard Parnes, chief of the Prostate and Urologic Cancer
Research Group in NCI’s Division of Cancer Prevention, notes
that the potential harms of screening are well documented,
while there is no evidence of a mortality benefit from routine
PSA screening in men 75 or older, or in any age group.
The available evidence, he notes, “indicates that the benefit from
treatment of a PSA-detected cancer is not likely to be seen for
10 to 15 years. But the potential harms of being treated now are
immediate.”
Even so, Dr. Parnes stresses, the recommendation is not an
absolute. Clinicians and their patients may decide that PSA
testing is the best course of action. “Every physician should still
individualize care and shouldn’t discriminate on the basis of age,”
he says.
The Cancer Council Australia and the NHMRC do not support the
routine use of PSA tests to screen well men for prostate cancer
until evidence of benefit warrants development of a national
official population screening program. The Royal Australian
College of General Practitioners does not recommend routine
screening for prostate cancer with DRE or PSA.
The position of the Urological Society of Australasia is that
individual men aged 50-70 years with at least a 10-year life
expectancy should have access to screening by annual DRE and
PSA testing, after appropriate counselling regarding the potential
risks and benefits of investigations and the controversies of
treatment. It should be left to the individual doctor to decide
whether to advocate testing in a man not requesting it. Population
screening of asymptomatic men is not recommended.
WA Prostate Cancer Statistics 2006
During 2006, prostate cancer was the most common registered
cancer in males in Western Australia.1 There were 1635 new
cases reported, at an age standardised rate of 93 cases per 100
000 men per year, accounting for 30 per cent of all cancers in
males. Prostate cancer is rare under the age of 50 and becomes
much more common after the age of 65. About 1 in 9 men could
be expected to develop prostate cancer before the age of 75
years. Prostate cancer was responsible for 252 deaths in 2006
(12.3 per cent of all cancer deaths in males). The estimated
lifetime risk of death due to prostate cancer in men was 1 in
107. It accounted for an estimated 390 years of life lost in males
(about 1.5 years per death).
PROSTATE CANCER – SUMMARY
Recommendation: Level I (Insufficient Evidence)
The issue of screening for prostate cancer is controversial at
the moment. Currently, most organisations in Australia and
overseas do not recommend the screening of asymptomatic men
for prostate cancer. If testing is done, the health professional
should discuss the potential benefits, side effects and questions
regarding detection of early prostate cancer and treatment so
that men can make informed decisions about testing.
Methods of screening
Digital rectal examination (DRE) and serum prostate specific
antigen (PSA).
Frequency of screening - Unknown
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7
cancersmatters
CANCER IN THE NEWS
Doctors to trial pain relief with cannabis
Doctors will prescribe cannabis-based drugs to cancer, multiple
sclerosis and AIDS patients in a planned NSW Government trial.
NSW Health Minister Reba Meagher will write to Federal Health
Minister Nicola Roxon in the new few weeks for permission to
import and trial a drug expected to be Sativex, which delivers
cannabis compounds through an oral spray. “While the Iemma
Government is opposed to the legalisation of marijuana, we
do support a therapeutic trial of a cannabis-based drug,” a
spokeswoman for Ms Meagher said. “We want the trial to start as
soon as possible. However, the support of the Rudd Government
would be needed to get TGA approval of the drug for use in the
trial. We’re hopeful the Government will approve.” The Australian
Medical Association welcomed the trial. “We believe medicinal
cannabis may be of benefit in HIV-related wasting cancer
cancer-related wasting,” said chairman of the association’s
public health committee Dr John Gullotta, adding that it might
also relieve nausea and vomiting in cancer patients undergoing
chemotherapy. The Cancer Council NSW also welcomed the
move.
World experts declare HRT safe for women in
early menopause
A wide review of hormone replacement therapy by international
experts has calmed fears surrounding the treatment, concluding
it is safe for healthy women entering menopause. Research
published in 2002 which linked HRT with a greater risk of
breast cancer and heart disease scared off millions of women
worldwide. But the latest review, presented this week in Madrid
at the World Congress on the Menopause, found that HRT in the
early menopausal period, when women are 50 to 59, was safe.
The 40 experts said women going through the first few years
of menopause who needed HRT to ease symptoms should not
fear its use. They found that combined HRT did not increase
the risk of chronic heart disease in healthy women in their 50s
and oestrogen-only HRT actually decreased risk. While they
found that combined HRT could lead to a slightly increased risk
of breast cancer, this was minimal when compared with other
known breast cancer risks such as alcohol consumption. In the
review, the experts said the Women’s Health Initiative (WHI)
Study was flawed because many of the women studied were not
of good health, with 36% suffering hypertension, 50% former or
current smokers and 34% clinically obese.
One of the experts who worked on the review, Riger Lobo,
from Columbia University in New York, said it was important
for women to discuss HRT with their GP. “Each woman is an
individual and it’s important that she comes to an agreement
with her doctor about using HRT,” he said. “For young, healthy
women at the onset of menopause, there is very little risk and
the benefits outweigh the risks for women with symptoms.”
Woeful record of cancer cure for Aborigines
Indigenous people with cancer are more likely to be treated
inadequately and die from the disease than other Australians,
a study has found. The study was conducted by the Menzies
School of Health Research, and was published recently in
The Lancet. It urged a concerted effort to reduce tobacco
use and across-the-board improvements to health services.
Researchers say tobacco-control programs have been
‘inadequate and ineffective’ and that quit-smoking programs
need to be re-designed to make them more effective for
Aborigines and to reduce the ‘alarmingly high’ smoking rates.
“Indigenous people are significantly more likely to have cancer that
have a poor prognosis but are largely preventable, such as lung and
liver cancer,” the study’s head, Professor Joan Cunningham, said.
“Indigenous people with cancer are diagnosed at a later
stage, are less likely to receive adequate treatment and are
more likely to die from their cancers than other Australians.”
8
The authors highlight a lack of national information on
Indigenous cancer rates because data from some states is poor.
Cancer can’t be beaten by positive thinking
The popular belief that a positive attitude can help fight cancer
has been debunked by a group of Australian specialists who have
proved a fighting spirit does not increase a patient’s survival
chances.
The Melbourne researchers, who presented their findings at a
cancer conference in Chicago, studied 708 women who had been
newly diagnosed with localised breast cancer and tracked them
over eight years to see if their cancer relapsed.
Professor Kelly-Anne Phillips, medical oncologist at the Peter
MacCallum Cancer Centre in Melbourne said: “People often really
beat themselves up and blame their attitude if their cancer
relapses. We’ve shown they’re not at fault.”
The research was conducted by the Peter MacCallum Cancer
Centre in conjunction with Cancer Council Victoria. Cancer Council
Australia chief executive officer Professor Ian Olver said he had
been involved in a smaller study about lung cancer that reached
a similar conclusion.
“A positive attitude is great and it clearly helps quality of life when
you’re going through treatment, but it makes an undetectable
difference to disease.”
Research: cancer sufferers in denial
Most people who get cancer blame stress, bad luck or even germs
for their disease and disregard the real causes, such as smoking
and diet, a survey has found.
Oncologists are calling for greater cancer education for
Australians as a result of new findings that show cancer patients
don’t understand what is likely to have triggered the condition,
preferring instead to attribute it to unrelated or emotional
factors.
Half of more than 300 breast and bowel cancer patients
questioned said stress or worry played a role in their disease,
while 40% said bad luck was influential and about 30% said
overwork, poor immunity or their emotional state contributed. A
smaller number thought an accidence, a virus or germ or even
their personality was responsible for their disease, according to
the study presented at the American Society of Clinical Oncology
meeting in Chicago yesterday.
“There is basically no clinical proof any of these things influence
whether you get cancer, yet this is what people seem to believe,”
said lead researchers and oncologist Dr Corona Gainsford. “And
even more worrying is that the real causes of disease, like
smoking, were well down the list of what people thought could
be responsible.”
Shift work may be a risk for cancer
The head of sleep and circadian research at the Woolcock
Institute of Medical Research in Sydney, Dr Ron Grunstein, claims
that shift work seems to be a risk for different types of cancer.
“Melatonin is thought to be a substance that retards the growth
of cancers,” Dr Grunstein says. Dr Grunstein says there are also
negative studies, so the area is not clearly proven.
WHO concluded that night work involving circadian disruption
was “probably carcinogenic” because of studies focusing on flight
attendants and nurses who had a high incidence of breast cancer.
That constitutes the limited evidence of carcinogenity in humans
which, when coupled with sufficient evidence of carcinogenity in
experimental animals, suggests the link.
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cancersmatters
CANCER IN THE NEWS cont/d....
Tumour worry in too many CT scans
Patients and GPs should avoid unnecessary CT scans or risk
the chance of a higher incidence of tumours, a local radiological
expert has warned.
Associate Professor Richard Fox, of the University of WA’s school
of physics, said CT scans had soared over the last 10 to 15 years
because of technological advances that allow for quicker, more
detailed imaging.
“That’s the good news; the bad news is that there is a very small
risk that a patient radiated with a CT scanner will as a result of
that get a tumour in 10 to 15 years time and could potentially
die of cancer.”
Professor Fox said patients sometimes pressured doctors to send
them for a scan and GPs acceded because of possible litigation.
“We need to avoid scans that aren’t actually going to benefit
the patient significantly or scans being done when a better
technique – for example, ultrasound or magnetic resonance
imaging – could tell you just as much or perhaps more without
the radiation risk.”
Breast cancer link to weight
Women who are overweight or show early signs of type 2
diabetes are at far greater risk of advanced breast cancer,
a study led by Melbourne researchers have revealed.
A trial involving more than 60,000 women found that those who
were
overweight,
insulin-resistant
or
had
high
blood sugar levels were 50% more likely to be
diagnosed with advanced forms of the disease.
It’s one of the first studies of its kind to link precursors for type
2 diabetes to the stage of cancer diagnosis. The collaboration
between doctors from the University of Melbourne, Umea
University in Sweden and the German Cancer Research
Centre tracked Swedish women between 1985 and 2005.
The University of Melbourne’s Anne Cust published the research
in the journal Breast Cancer Research and Treatment. Dr Cust
said women who were insulin-resistant or overweight were
less likely to be diagnosed with stage one breast cancers
but
at
greater
risk
of
being
diagnosed
with
stage two to four tumours, which are larger.
“It’s just adding further evidence that women should try
to maintain a healthy weight and remain active,” she said.
The director of epidemiology at the Cancer Council Victoria,
Graham Giles, said the findings were significant. “In a way, it’s
a good thing that these risk factors are converging for all these
diseases our society is afflicted with...because the answer is the
same: do whatever you can to avoid being overweight or obese
by having a healthy diet and being more physically active,” he
said.
CONSUMER MATTERS
Acronyms almost rule our lives starting with DOB and
ending with RIP and too many more in between. IMRT is
one such example (Intensity Modulated Radiotherapy)
which can play a critical part in the treatment of
some cancers, especially those of the head and neck.
Quality of Life for some patients with cancers of the throat and
tongue often relies on access to IMRT especially in context of
parotid function. So its great news that Perth is to have two
IMRT facilities either later this year or early in 2009. Hopefully,
after they are up and running with trained staff, patients won’t
have to spend weeks in Melbourne receiving their treatment.
Nicola Roxon, Australia’s new Federal Health Minister was
in Perth at the end of August, at the time she announced
a $27.5 million grant as Australia’s contribution to
the ICGC - International Cancer Genomics Consortium.
The news got better with another $10 million for clinical trials
in anticipation that they will improve access to ‘innovative
treatments’ and another $10 million for cancer research project
grants. But when the small print is examined dilution occurs
as the $27.5 m is over 5 years and probably the rest as well.
Question: Why can’t federal & state governments
allocate all the money in one hit and let those running
the enterprise sort out how quickly it is spent?
And the ‘good news’ from Nicola Roxon didn’t stop there.
She attached herself with tenacity to the latest data from
(yes, another one) the AIHW – Australian Institute of Health
& Welfare, that cancer survival rates continue to improve.
Yes – good news all round. But meanwhile, before a genomic
inspired treatment hits WA, life for cancer patients and the
health professionals treating them grinds on – especially for
those who live in rural WA and have to battle the inequities
9
of (here we go) the PATS (Patient Assistance Travel Scheme).
Talk about ‘the fight against cancer’ so often quoted in the
media and even more in eulogies – the Patient versus PATS
is the Ben Hur of all struggles. Add to that the problems and
costs for patients who don’t qualify for PATS but have to drive
backwards
and
forwards
for
daily
treatments
from
Perth’s
outer
suburbs
and
even
further.
As one patient said during the 2007 Senate
Inquiry into the PATS system “After what has
happened I just wish I had never heard of it or did not qualify;
it was a battle from day one. And for what? The arguments
and pleading made my husband worse (the patient) and if
stress does cause cancer – then I’m a ready-made candidate”.
So – with all the good news from Nicola Roxon during her
August visit to Perth – why has it taken 6 months for her to
send a letter(received 6/6/08) in response to a query about
PATS raised with her during the new Federal Government’s
Community Cabinet meeting (again in Perth) on 20th January
2008? Yes, the response was tardy but the content worse.
She has asked the Dept of Health & Ageing in Canberra to set up
a ‘Taskforce’ to examine the recommendations from the Senate
Inquiry into PATS which were tabled on 20th September 2007.
The ‘Taskforce’ will then report to – hold it: AHMC
– the Australian Health Ministers’ Conference. This
is ‘expected’ to happen at the end of this year.
This will become the 8th review or report about PATS over
the last 17 years. Yes Minister. As Sir Humphrey noted on his
file: ‘PCDSAAL’ (Present Conditions Don’t Seem At All Likely).
CLIVE DEVERALL - Cancer Voices WA
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cancersmatters
TREATMENT MATTERS
Neuro-Oncology Update – The Mulitidisicplinary
Management of Adult Brain Tumours
progression, as well as quality of life. TMZ, a novel and welltolerated alkylating agent, has extended our therapeutic
armamentarium.
Molecular screening and genetic profiling are expected to lead
to better-targeted treatment and survival for patients with brain
tumours.
Dr Liz Hovey, said the latest research focused on uncovering
the genetic code and molecular structure of individual tumours
to help identify sequences that might indicated casual and risk
factors, which remained poorly understood.
Identifying enzymes or proteins within a tumour that were overexpressed could help reveal the pathways that were amplified
and where mutations had occurred.
Dr Liz Hovey, Prince of Wales Hospital, Sydney recently visited
Perth as a guest of the Cancer Council to give both a public
and health professional lectures on new developments in the
management of adult brain tumours.
In the mulitidisciplinary management of adult brain tumours
patients can meet with a radiation oncologist, a neurosurgeon
and a medical oncologist plus allied health support services such
as nurses, dieticians, speech therapists, physio therapists and
social workers —all at one location and during one visit.
Until recently, treatment options for patients with malignant
glioma were limited and mainly the same for all subtypes of
malignant glioma. Treatment included surgery to the extent
feasible and radiotherapy (RT). Chemotherapy used as adjuvant
treatment or at recurrence had a marginal role.
In 1988, oligodendroglioma was identified as a subtype
of malignant glioma that is more likely to respond to
chemotherapy.
Subsequently, trials evaluating chemotherapy in oligoastrocytoma
and oligodendroglioma were initiated.
Also, during the 1990s, temozolomide (TMZ; Temodar®,
Temodal®; Schering-Plough Corporation, Kenilworth, NJ) was
specifically developed as a chemotherapy agent against primary
brain tumors. It showed some, albeit modest, activity against
recurrent glioma.
Tumour profiling in this way was not frequently done, except
in research, but it was hoped it may be developed in the future
to give an indication of prognosis and lead to more specific
prescription of chemotherapy drugs.
“We are trying to get better at this molecular profiling and
genomic profiling to see if there are particular genetic signatures
which predict the response to certain treatments,” Dr Hovey
said.
Although work was in progress, clinical applications were likely
to be at least four or five years away. A new targeted agent,
Avastin, that blocks blood vessel growth in brain tumours will
be tested in an international trial, starting next year, in which
Australia will be involved.
WA Brain Cancer Statistics
Although relatively rare, brain cancers were diagnosed in around
140 Western Australians each year and often at younger
ages, rob the greatest number of years of life per patient of
all cancers. The risk of developing a brain tumour was 1 in
201 for WA men and 1 in 202 for WA women. In 2006 in WA
60 men and 38 women died from malignant brain tumours.
These statistics are provided by the State Cancer Registry.
Local Neuro-oncology Multidisciplinary Team
In Western Australia an evidence based multidisciplinary
clinic for the management of adult brain tumours
operates
at
Sir
Charles
Gairdner
Hospital.
These developments stimulated clinical and translational
research in neuro-oncology. For example, it was recognised
that the management of patients with glioblastoma might
differ from that of patients with anaplastic astrocytoma or
oligodendroglioma, and that a patient with a progressing, lowgrade glioma may require completely different therapeutic
considerations.
Further details can be provided by the Neuro-Oncology
Nurse Coordinator Karen Jackson Ph. 9346 1509, Mob.
0400 021 649 or email: [email protected]
Progress in the management of malignant glioma has been made
over the past decade. Chemotherapy, previously considered
of marginal benefit at best, has been clearly demonstrated to
produce an impact on survival time and time to tumor
The guidelines are available at: http://www.cancer.org.au/
Healthprofessionals/clinicalguidelines/braintumours.htm
10 The Australian Cancer Network has produced Draft
Clinical Practice Guidelines for the Management of
Adult Gliomas: Astrocytomas and Oligodendrogliomas.
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cancersmatters
GP MATTERS
Familial cancer in general practice
Advances in genetics have led to a major impact upon general
practitioners’ need to better understand and provide information
and referrals on genetic conditions to patients and their families.
GPs, as primary-care providers and the gatekeepers to specialist
services, have a significant role to play in cancer genetics
and related services (Fry et al. 1999). According to Fry et al.
(1999) “GPs perceive their role in cancer genetics services to
be taking a detailed family history, deciding whom to refer to
specialist services, providing emotional support at follow-up,
teaching breast self-examination and discussing the need
for screening”. However, knowledge of available services and
limited consultation time can make this role difficult.
“Genetics in family medicine: The Australian handbook for
General Practitioners” (www.gpgenetics.edu.au) is an online
resource which has been developed to support GPs in managing
the growing impact of genetic medicine on primary care, to
further the knowledge and skills in evaluating family history and
in recognising clinical findings that indicate genetic risk.
In addition, the genetic counsellors at Genetic Services of
Western Australia can help decide which individuals to refer,
confirm family history, assess risk for individual and family,
organize genetic testing if appropriate, refer to high risk clinic
and recommend appropriate surveillance. For more information,
please contact:
Genetic Services of Western Australia
http://www.kemh.health.wa.gov.au/services/genetics/
index.htm
374 Bagot Road, Subiaco WA 6008
Ph: (08) 93401525
Fax: (08) 9340 1678
References
Fry, A. et al. 1999 ‘GPs’ views on their role in cancer genetics
services and current practice’ Family Practice, 16 (5) pp. 468474.
New Hepatitis B Guide
Cancer Council Australia has recently released a new Hepatitis
B Guide: B Positive - all you wanted to know about hepatitis B: a
guide for primary care providers. This monograph is a collaboration
between the Cancer Council NSW and the Australasian Society
for HIV Medicine (ASHM), that provides GPs and other health
care providers with easy-to-access information for managing
patients with hepatitis B.
This valuable and comprehensive new resource contains
information about epidemiology, virology, natural history,
prevention clinical assessment, laboratory assays, diagnostic
strategies, issues in occupational health and confidentiality
and legal issues. It is aimed at all health professionals for whom
hepatitis B may impact on their vocational role. Hepatitis B
infection is the most common cause of liver cancer worldwide.
Liver cancer incidence in Australia will continue to rise, due to
the patterns of immigration and the long latency period between
acquisition of the infection and the onset of malignancy.
Primary care practitioners can play key roles in disease
management. Significant improvements in disease outcomes can
be achieved through screening for chronic infection, effective
disease monitoring, timely institution of antiviral treatment and
liver cancer screening in people at highest risk. This book is
the most up-to-date authoritative account of the topic and is
practical and readable, and therefore appropriate for both health
professionals and patients wishing to gain an understanding of
the disease.
To download a copy, please visit http://www.ashm.org.au/bpositive/
11 CanNET – Medicare items list for GPs
In order to make stronger links between General practice and
cancer services, Cancer Australia’s Cancer Service Networks
National Demonstration program, (CanNET) has put together a
list of Medicare item numbers, to support GPs and other health
providers, leading to increased participation of primary care in
cancer services.
For more information on CanNET, and for the full list of Medicare
item numbers, please visit
http://www.canceraustralia.gov.au/cannet-homepage/
primary-care-involvement/overview.aspx
Cancer Screening Module on
gplearning.com.au
Cancer Council Australia has recently released a cancer screening
module on the RACGP’s gplearning website. This module offers
GPs the latest information and approaches to screening for
major forms of cancer including: breast cancer, cervical cancer,
melanoma, lung cancer, ovarian cancer, prostate cancer, and
bowel cancer.
GPs can complete this activity in one session, or over a number
of sessions. If you leave the activity before completing it, your
progress will be recorded. The next time you attempt this
activity, you will automatically resume at the screen you last
completed. The module takes 2 hours to complete, and has been
approved for 4 Category 2 QA&CPD points.
Fourth Annual Women’s Health Day for
GPs and Practice Nurses
The Women’s Health Day, a collaborative event between Cancer
Council WA, BreastScreen WA, FPWA Sexual Health Services and
King Edward Memorial Hospital, is now in it’s fourth year and in
2008, we’re expanding the event to include practice nurses!
This year’s event on October 25 will feature presentations on
lifestyle impacts on cancer in women, vulval pathology,
investigating infertility, adolescent angst in girls –covering
eating disorders, self harm and behavioural issues and foot pain
in women.
The keynote speaker is Professor Elio Riboli, Chief of the
Nutrition and Cancer Unit, International Agency for Research on
Cancer (IARC) & Chair in Cancer Epidemiology and Prevention,
Imperial College of Science London.
For more information on the 4th Annual Women’s Health Day,
please visit www.cancerwa.asn.au/professionals/gp or
contact Lauren Atkinson on (08) 9212 4363
Upcoming GP Education Events
On now!
RACGP gplearning: Cancer screening module
www.gplearning.com.au
Oct 23
50th Anniversary Cancer State Conference
Hyatt Regency, Perth
Oct 25
4th Annual Women’s Health Day for GPs
UWA Club, Crawley
Nov 5
Occupational cancers: An update for GPs
UWA Club, Crawley
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HOT WEBSITES
BREAST CANCER NETWORK AUSTRALIA
Australian Prostate Cancer
Collaboration
http://www.bcna.org.au/
The Breast Cancer Network Australia is the peak national
organisation for Australians personally affected by breast cancer.
They work to ensure that Australians diagnosed with breast
cancer and their families receive the very best information,
treatment, care and support possible, no matter who they are or
where they live.
They are represented by the Pink Lady silhouette, which depicts
their focus; the women diagnosed with breast cancer.
Several resources are available via the website that provides
quality information and support to those newly diagnosed with
breast cancer, their family, friends and colleagues.
BRAIN TUMOUR AUSTRALIA
AUSTRALIAN PROSTATE CANCER
COLLABORATION
Mission
To reduce mortality and morbidity and improve the quality
of life of men with prostate cancer.
To develop strategies for the prevention of prostate
cancer.
Aims
To promote
http://www.bta.org.au/
Brain Tumour Australia was formed in 2003 and its members
are dedicated to offering hope, information and support to brain
tumour patients and those diagnosed with any tumour of the
central nervous system and their families and care-givers.
• research into all aspects of prostate cancer
• collaboration between individuals and organisations
working in prostate cancer research
• understanding of prostate cancer in the general community and amongst cancer patients
• an evidence-based approach to the assessment and
management of prostate cancer,
• undergraduate and postgraduate education for health
professionals and researchers.
• a forum for a wider appreciation of the scientific, clinical
UPCOMING CANCER EDUCATION MEETINGS
October 22 : 6.00 – 7.00 pm
St John of God Hospital Conference Centre
Prof. Elio Riboli – Chair in Cancer Epidemiology
and Prevention, Imperial College London
Cancer and role of diet - Findings from the
European Prospective Investigation into Cancer
and Nutrition (EPIC)
Enquiries: Paul Katris Ph: 9212 4377
Email: [email protected]
October 23
Cancer Council Conference Challenging cancer - past, present and future
Hyatt Regency, Perth
Enquiries: Emma Croager Ph: 9212 4347
October 25
4th Annual Women’s Health Day for GPs
UWA Club, Crawley
Enquiries: Lauren Atkinson Ph: 9212 4379
Email: [email protected]
If you wish to receive this newsletter electronically please email [email protected]
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