NUMBER 21 APRIL 2016 Antineoplastic Drug Administration Course (ADAC) Implementation The Antineoplastic Drug Administration Course (ADAC)

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1 NUMBER 21 APRIL 2016 Antineoplastic Drug Administration Course (ADAC) Implementation The Antineoplastic Drug Administration Course (ADAC) supports health professionals develop the necessary knowledge and clinical skills to administer antineoplastic drugs and handle related waste safely. The course standardises the minimum competency required for the safe handling and administration of antineoplastic drugs and allows Gippsland staff to achieve this competency locally rather than the need to travel to Melbourne. The course consists of 8 modules, followed by a clinical skills workshop that incorporates the theory from all 8 modules into clinical practice. Module 1: Handling antineoplastic drugs and related waste 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 ADAC across the Gippsland chemotherapy sites. If you would like further information regarding ADAC contact Danielle Roscoe on or droscoe@lrh.com.au WELCOME Welcome new GRICS Cancer Service Improvement Coordinators Danielle Roscoe Danielle commenced with GRICS in November whilst also continuing her clinical work at Latrobe Regional Hospital. Danielle is a Clinical Nurse Specialist with a post graduate degree in Cancer/Palliative nursing, and ten years experience in the oncology setting; including chemotherapy day oncology, radiotherapy and in-patient/palliative care. Danielle s passion and dedication to cancer care are sure to make her an invaluable 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 and Commerce degree. Marnie has worked in Human Resources for the past five years, and prior to that worked at Latrobe Regional Hospital as a Registered Nurse. Marnie has experience managing projects and is looking forward to combining her business and nursing knowledge for the greater benefit of cancer services in the Gippsland region. LRH welcomes Dr Mahesh Iddawela GRICS is pleased to announce the recent appointment of Dr Mahesh Iddawela to the position of Consultant Medical Oncologist at Latrobe Regional Hospital (LRH). Dr Iddawela comes to LRH with significant experience in delivering and developing high quality cancer services, especially in a regional setting. He was previously involved in delivering and driving change under the Cancer Reform in the UK prior to moving to Australia. He arrived in Shepparton as the first resident oncologist and whilst there helped develop a patient centred oncology service. During this time Dr Iddawela was the Clinical Director at West Hume Integrated Cancer Services. Thank you and farewell Peter Kevekordes GRICS has recently farewelled one of their project staff with Peter Kevekordes leaving to pursue other opportunities. GRICS would like to thank Peter for his contribution and support provided to GRICS, in particular, his leadership with the recent CDU Redesign projects. GRICS wishes Peter the very best in his future endeavours. 1

Breast Cancer Network Australia Regional Forum GRICS attended the Breast Cancer Network Australia s (BCNA)

The forum gave those who are, or have experienced breast cancer, be it personally or through a loved one,

The forum was an educational experience with guest speakers including Dr Yoland Antill, Medical Oncologist,

emotional wellbeing through stages of the journey and after care.

an inspirational outlook for those throughout their journey.

from Latrobe Regional Hospital, along with speakers from Latrobe City Council, GippSport and BreastScreen

GRICS offered information on local supports handing out our Handy Essentials for Local Patients (HELP) guide

2 Breast Cancer Network Australia Regional Forum GRICS attended the Breast Cancer Network Australia s (BCNA) regional information forum, held in Traralgon during February. The forum gave those who are, or have experienced breast cancer, be it personally or through a loved one, the opportunity to speak to many different organisations including GRICS. The forum was an educational experience with guest speakers including Dr Yoland Antill, Medical Oncologist, who spoke on care and treatments available; and Dr Carrie Lethborg, Cancer Social Worker, who spoke on emotional wellbeing through 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 outlook for those throughout their journey. There were also many guest speakers from across Gippsland including Erme Maxwell, Cancer Care Coordinator from Latrobe Regional Hospital, along with speakers from Latrobe City Council, GippSport and BreastScreen who discussed their roles in relation to supports each service offer. GRICS offered information on local supports handing out our Handy Essentials for Local Patients (HELP) guide that includes many Gippsland services and supports for those seeking information specific to their local area. If you or someone you love has been diagnosed with breast cancer you can visit for free information resources and support. GRICS Consumer Reference Group For more information please contact GRICS

3 Multidisciplinary Care Multidisciplinary care is an integrated team approach to healthcare in which medical, nursing and allied health professionals consider all relevant treatment options and collaboratively develop an individual treatment and care plan for each patient. There is increasing evidence that multidisciplinary care improves patient outcomes. In accordance with the Optimal Cancer Care Pathways (DHHS), GRICS is eager to further develop the implementation of Tumour specific Multidisciplinary Team Meetings (MDM) which is seen as being pivotal in providing patients with Gold standard care and treatment. An MDM is held every Friday and discusses patients who have been newly diagnosed with breast, colorectal, upper gastrointestinal, skin and thyroid cancers. Latrobe Regional Hospital (LRH) hosts this meeting with video conferencing to multiple sites across the region including Bairnsdale Regional Health Service (BRHS), Central Gippsland Health Service (CGHS), West Gippsland Healthcare Group (WGHS) and to the metropolitan area. Patient referrals to the meeting have increased substantially with the engagement of several new surgeons across the region and the development of the Gippsland Cancer Care Centre. The Lung MDM is a joint venture between GRICS and CGHS which hosts the meeting. There has been increased participation in the meeting by Cardio Thoracic Surgeons from both the Alfred and Monash Health resulting in a growth in the number of referrals. Genitourinary cancers have been identified as the most prevalent in Gippsland accounting for 21% of all newly diagnosed cancers in the Region (Source: VCR). In acknowledgment of this and in partnership with BRHS and Urology specialists, GRICS will be involved with the development of a Urology Cancer specific MDM. The immediate aim will be to reduce variation in practice, increase the timeliness of appropriate consultation and surgery and a shorter timeframe from diagnosis to treatment. We consider this can be achieved through effective information sharing, collaborative treatment planning and the facilitation of referrals through the meeting. Another recent innovation is a Palliative Care MDM which occurs weekly, hosted by LRH. The purpose of this meeting is to provide a forum, under the auspice of GRICS, which promotes open communication between clinicians across the spectrum of health care professions in the region. This facilitates best practice standards in the formulation, development and implementation of individualised treatment plans for patients with complex palliative care needs. In discussions with a range of stakeholders we have encountered a lot of enthusiasm for an ongoing Palliative Care MDM. GRICS believes that by working collaboratively and building relationships with GPs and nurse led community services we can improve outcomes for palliative patients across the whole region. Additionally, Multidisciplinary care provides positive outcomes for clinicians and health services involved in the MDM process through improved communication, education and cooperation. Most importantly the patient can be reassured knowing their treatment providers are working together as a team to produce the best treatment options for them. Local Government Area (LGA) Victoria is divided into 79 Local Government Areas (LGA) which are defined as a geographical area and is the responsibility of local government council. Of the 79 Victorian LGAs, there are 31 metropolitan and 48 regional which include 6 in Gippsland: search the data using one of the Gippsland LGAs to return all presentations/admissions to their local hospital. Please feel free to contact me with any questions or data requests. Jody Neal - Data & Information Analyst on or jneal@lrh.com.au LGA Code Population (2013) Bass Coast (S) ,010 Baw Baw (S) ,205 East Gippsland (S) ,414 Latrobe (C) ,846 South Gippsland (S) ,010 Wellington (S) ,319 Victorian population: 5,739,340 Gippsland s population: 266,804 (4.6%) Data can be extracted from the Victorian Admitted Episode Data (VAED) using the LGA code; an example would be to 3

4 Scholarship feedback I attended the Annual Scientific Meeting of HAA (Haematology Society of Australia and New Zealand, the Australian & New Zealand Society of Blood Transfusion, and the Australasian Society of Thrombosis and Haemostasis) at Adelaide on October As the Transfusion Nurse at LRH I predominantly attended the ANZSBT stream which covered a variety of topics pertaining to transfusion medicine from both local and international speakers. Lawrence Goodnough from Stanford University Medical Centre discussed updates in Patient Blood Management (PBM). Transfusion medicine has a large focus on ensuring our patients are receiving the best possible transfusion care or optimising their health in ways to avoid transfusions and their associated risks. Debbie Regester. In October, 2015 I attended Chemotherapy Module Two at the Peter MacCallum Cancer Institute in Melbourne. It is a six day course 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 therapies and the risks associated with same. By completing the course objectives set out in this program, I now have a greater understanding of the mechanism of action, common toxicities and administration considerations for cytotoxic agents. My own clinical practice will be improved by this knowledge. I can better identify common side effects of cytotoxic drugs and the nursing interventions required to manage these. This will enable me to educate patients about their cancer and proposed treatments including the potential for side effects and how best to manage them. Improved patient education will mean better outcomes for the patient by maximising self-care independence. Wendy Whitechurch. In November 2015 I attended the Peter McCallum Radiotherapy modules 1 and 2. This was made possible by GRICS and their scholarship that was made available to me. Module 1 covered Brachytherapy and stereotactic radiotherapy, defined radioisotopes, nursing management of patients receiving external beam therapy (EBT) and terminology 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 the management of patients with prostate cancer, oesophagitis, concurrent treatment's dietary interventions and management of a patient with tracheotomy/laryngectomy receiving Radiotherapy. This opportunity to attend this course has given me a better understanding of Radiotherapy and the role of the nurse and other professionals involved in the care and treatment of a cancer patient. With this knowledge I can now effectively care for and educate patients and staff about the Radiotherapy Modality. Thank you GRICS for this opportunity. Leanne Prosser. On December the 7-8 December I attended the Ausmed Blood Conference in Melbourne. The learning experience enhanced my knowledge and will undoubtedly enrich my practice as the Blood Transfusion trainer at West Gippsland Healthcare Group (WGHG). Physiological review of blood, Cancer emergencies, Sepsis, Clotting and Cancer, Anaemia and Venous Thromboembolism were just some of the topics covered. I am not from an oncology background however I need to be able to have some knowledge of our oncology patient s backgrounds, their associated risk factors and how best these can be managed or avoided in order to support staff as part of my role at WGHG. This program increased my knowledge base and I feel more equipped to contribute to better patient outcomes. The changes I will be making since attending this conference are many. It has spurred me on to provide a lot more varied Blood and Blood product education hospital wide. Thank you very much for giving me the opportunity to attend, I greatly appreciate it. Eliza Berryman. Haematological Cancer short courses: Peter MacCallum Cancer Centre 1-2 September 2015 Several comprehensive presentations and visuals on haematopoiesis were the grounding for day one of Haematology Module 1. Day 1 saw a massive amount of information being provided about lymphoma, Multiple Myeloma and leukaemia:aetiology, diagnosis, prognosis and treatment for each of these haematological conditions. Case studies were used to demonstrate advances in treatment, supportive care and survivorship care. Day 2 was the Advanced Haematology Nursing Symposium commencing with an interesting presentation on the importance of combining histopathology and clinical presentation to establish a diagnosis. Palliative care was also addressed on this day emphasizing the importance of the haematologist and the palliative care team working together for the patient's benefit. Continued on page 5 4

Scholarship feedback Haematological Cancer short courses: Peter MacCallum Cancer Centre 1-2 September 2015 Continued from page 4 An enthusiastic dietician gave a very interesting presentation on

5 Scholarship feedback Haematological Cancer short courses: Peter MacCallum Cancer Centre 1-2 September 2015 Continued from page 4 An enthusiastic dietician gave a very interesting presentation on nutritional management of haematology patients, highlighting an online e-learning resource on eviq: The day concluded with a discussion on survivorship and long-term follow up clinics. Thank you to Gippsland Regional Integrated Cancer Service and Bairnsdale Regional Health Service for their support in attending this event. Having the opportunity to attend not only helps to update knowledge in the field of Haematology but it also provides an opportunity for those of us in the regional areas of Victoria to have exposure to what is happening in the city where there are more resources. Nancylee Robertson. Lymphoedema Practitioners Education Day Late last year GRICS held an education session on lower leg swelling - venous and lymphatic disease for the Gippsland Lymphoedema 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 gave the practitioners the opportunity to discuss and seek advice on suggested treatment options for their patients. The day was attended by 10 practitioners from across Gippsland with future plans currently underway for the next education day. GRICS would like to acknowledge Sue and Janet for their assistance with this session. Key lessons learned attending Radiotherapy Modules 1 and 2 at Peter MacCallum November 2015 It has been estimated that 50-60% of all patients diagnosed with cancer will have Radiotherapy at some point in their treatment. The basic principles are to give an adequate dose to eradicate the tumour and a minimal dose to healthy tissues, ensuring critical organs are not treated beyond their tolerance levels. Prior to commencing treatment, there is extensive imaging, planning and preparation required. Using concurrent Chemotherapy and Radiotherapy enhances the effectiveness of Radiotherapy. The Nurse assessment of the impact of radiation side effects on the patients is vital. Common side effects are fatigue and skin reactions to the specific area of treatment. Approximately 95% of patients receiving External Beam Radiation may have skin reactions and fatigue occurs in % of patients. Successfully managing the side effects allows the patient to continue the planned radiotherapy treatment. By optimising the nursing management of Radiotherapy side effects, the patient gains improved quality of life and treatment outcomes. Ges Hammer. CDU Redesign Projects - Phase 2 GRICS held a mid-project forum on 16th February 2016 for Health Agencies involved in a chemotherapy day unit (CDU) Redesign Program. The forum gave Health Agencies an opportunity to present updates on work already completed as well as outline the pathway forward on existing and proposed project work. Each presentation was of a very high standard successfully demonstrating that progress on each project was well underway. Interestingly, presentations were able to demonstrate that beneficial changes can occur at many levels of a CDUs operations; from the repositioning of unit equipment; to procedural changes involving in the way Clinicians work with CDU staff; through to larger structural changes such as the establishment of an infusion unit to assist CDU in periods of peak service demand. In the afternoon session, Christian Pitzner (LRH Redesign Lead) spoke to the group on his own personal experiences and insights managing a Redesign Program. Christian discussed the role of communication and its value in underpinning a strong Redesign Project. Different strategies were explored and recommendations made on how Redesign Projects can better communicate achievements to project stakeholders. Thank you also to Julie Lawrence (BRHS Service Improvement Program Manager) who actively participated in the conversation offering her own insights on the challenges of managing Redesign Projects within a health care setting. Congratulations to everyone involved for making this forum such a rewarding experience. 5

Optimal Cancer Care Pathways (OCPs) To help people diagnosed with cancer receive the best possible care, Optimal Cancer Care Pathways have been developed for 15 cancer types.

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

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

au/ocp or view the interactive consumer web portal at www.cancerpathways.org.

6 Optimal Cancer Care Pathways (OCPs) To help people diagnosed with cancer receive the best possible care, Optimal Cancer Care Pathways have been developed for 15 cancer types. Versions have been developed for both cancer patients and health professionals; they help identify specific steps along the 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 journey from prevention through to survivorship / end of life care. The guides have been endorsed by the National Cancer Expert Reference Group, Cancer Australia and Cancer Council Australia. 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 or view the interactive consumer web portal at GP Education Session GRICS recently held a discussion forum at Bairnsdale Regional Health Service (BRHS), aimed at providing information about the care and treatment of the cancer patient, to General Practitioners in the region. We had great support for the evening, with 19 people attending from 8 different health services around the Bairnsdale region. The forum was well received; generating some great discussion points, and highlighting a number of focus areas for improvement in practice. Dr Sachin Joshi chaired the evening, and covered a broad range of topics from Optimal Cancer Care Pathways, the role of the GP, regional versus metropolitan care, diagnosis and referral pathways. GRICS would like to extend a warm thank you to Mr Servaise de Kock, Dr Arman Kuyumcian and Ms Kay Stephenson for participating as panellists, BRHS for providing the facility for the evening, and everyone else involved who made this event a success. 6

Prostate Cancer Summit Reducing variations in prostate cancer outcomes in Victoria?

could be addressed through state-wide action.

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

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

A clinical working party co-chaired by A/Prof Jeremy Millar and Prof Damien Bolton is overseeing the preparation of the data to inform the summit discussion.

7 Prostate Cancer Summit Reducing variations in prostate cancer outcomes in Victoria? Prostate cancer clinicians are invited to attend a summit meeting to discuss and identify unwarranted variations in tumour based clinical 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 health services 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-chaired by 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 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. Contact Information GRICS Manager Elaine Wood Danielle Roscoe ewood@lrh.com.au droscoe@lrh.com.au Administrative Officer Kathy Nicholls Marnie Flowers knicholls@lrh.com.au mflowers@lrh.com.au Cancer Data and Information Analyst Jody Neal Allison Speairs jneal@lrh.com.au aspeairs@lrh.com.au Michelle Pryce Linda Burton mpryce@lrh.com.au lburton@lrh.com.au 7

DRAFT Optimal Care Pathway

DRAFT Optimal Care Pathway 1. Introduction... 3 1.1 Background... 3 1.2 Intent of the Optimal Care Pathways... 3 1.3 Key principles of care... 3 2. Steps in the care of patients with x cancer... 4 Step