Cancer Forum

March 2003 Volume 27 Number 1 ISSN 0311-306X

List of Contents Forum: Clinical trials Overview 3 M Stockler Clinical trials: Benefits and challenges 4 A Coates We’ve got a groovy thing goin’ baby … or have we? Involving women in clinical trials 5 S Lockwood Maximising opportunities for clinical research: The Centre for Developmental Cancer Therapeutics 7 MA Rosenthal HERA – new lessons from a new trial 8 N Wilcken Cancer Trials NSW: A collaborative initiative to support and promote cancer clinical trials research in NSW 9 M Malica Australian New Zealand Breast Cancer Trials Group: IMPACT 11 L Young

Articles Testing for familial cancer susceptibility gene mutations 13 A Rowland, N Breheny, J Goldblatt , I Walpole, P O’Leary The impact of physiotherapy intervention on functional independence and quality of life in palliative patients 15 EL Laakso, AJ McAuliffe, A Cantlay

Reports Support for research 2003 21 From bench to bedside and back again: COSA 29th Annual Scientific Meeting 30 Clinical trials: An open forum for consumers 31 Australian Behavioural Research in Cancer 32 News and Announcements 37

Book Reviews 41

Calendar of Meetings 47 F

Clinical trials: How consumers, clinicians ORUM and researchers can initiate and participate in the best cancer trials

OVERVIEW

M Stockler Clinical Trials Symposium held at Darling Harbour, Sydney in 2002. Co-Director of Cancer Trials, NHMRC Clinical Trials Centre, University of Alan Coates sets the scene by describing the benefits, Sydney beneficiaries and challenges of cancer clinical trials research. Senior Lecturer in He concludes that cancer trials are a good buy for patients, Cancer Medicine and doctors and society. Clinical Epidemiology, University of Sydney Sue Lockwood considers collaboration between consumers and clinician researchers using the example of breast cancer, Director, Cancer Trials NSW, The Cancer Council NSW and the effects of recent controversies surrounding hormone Medical Oncologist, Sydney Cancer Centre replacement therapy. She concludes with the suggestion Royal Prince Alfred Hospital and Concord Hospitals that researchers provide a community information abstract, Camperdown, NSW summarising the results of their studies for an informed lay audience.

These are exciting times. The last 30 years have seen major Mark Rosenthal reflects on the strengths and innovations of reductions in mortality from breast cancer, childhood the Victorian Centre for Developmental Cancer Therapeutics. leukaemia and testis cancer heralding what is possible for The model has been so successful in cancer that it will be other cancers. These improvements are a direct result of clinical applied to neurological and cardiovascular diseases through trials establishing the benefits of mammographic screening, the establishment of Clinical Trials Victoria, which recently adjuvant therapy, and treatments for advanced cancer and received an $8 million grant from the Victorian Government. improving their effectiveness. Changes in community attitudes to sun exposure, tobacco use, and diet should cause major Nicholas Wilcken describes the opportunities and challenges reductions in skin, lung, and colorectal cancer cancers over associated with Australia’s participation in HERA, a large the next 30 years. Despite these major advances, about a international randomised trial of trastuzumab (Herceptin™). quarter of people in the Western world will die from cancer, He concludes that studies like HERA raise new questions about and many more will be affected. Why are clinical trials crucial how trials should be designed and conducted, and reinforce to improving our lot? the need for conducting high quality clinical trials on which to Recent, rapid advances in cell biology, genetics, drug base clinical practice. development, radiation biology and physics, surgery, supportive care and diagnostics have resulted in a plethora of promising Marie Malica describes the development of Cancer Trials new interventions against cancer. These promising new NSW as a model for improving participation in and access to interventions have to be tried, tested and proven before they clinical trials. She emphasises the importance of collaboration, can be adopted in clinical practice. The history of medical inclusion, consumer involvement and improving access and science shows that only a precious few will translate into participation. She concludes that while much needs to be real improvements. Clinical trials are the only reliable way of done, the future looks bright. determining the safety, activity and benefit of these promising new interventions. Leonie Young describes an innovative program to acknowledge the contributions of breast cancer trial participants by The theme of this series is ‘How consumers, clinicians and providing a network, education about breast cancer research researchers can initiate and participate in the best cancer and advocacy training. She concludes that increasing the trials’. Changes in the nature of scientific progress, government community’s awareness of the benefits of breast cancer trials involvement, commercial interests, and regulatory requirements will also help other areas. are forcing us all to rethink our roles in oncology research. Life is getting more complicated, but major improvements are The authors were selected because of their involvement in innovative, successful projects with lessons that I thought on offer. Many have argued, in Australia and overseas, that were applicable beyond their particular area, to other areas of increasing participation and access to high-quality cancer trials oncology and medicine. Authors were asked to focus on what is the best way to improve outcomes for people affected by was innovative and interesting for a general audience, and to cancer. Getting cancer trials on the local political agenda may highlight lessons applicable to cancer trials research in general. be our major battle in the war against cancer. Perseverance All authors made related presentations at the International may be the key to helping more Australians survive the war.

2 Cancer Forum n Volume 27 Number 1 n March 2003 Cancer Forum n Volume 27 Number 1 n March 2003 3 F ORUM 5 . 2 . 3,4 . Until more clinicians 7 . This situation will not have changed from 1996 from 1996 . This situation will not have changed 5 . It is hard to get the resources needed to support active 6 • may turn down the opportunity to participate in trials down the opportunity • may turn • more relevant trials; • increased numbers of participants; and • increased involvement of clinicians. involvement in clinical trials, most importantly access to data managers and study nurses. This may be the greatest barrier to more clinicians becoming involved. Perhaps the move to multidisciplinary teams and greater specialisation will lead to more clinicians offering women entry to clinical trials. Perhaps recruitment will continue to depend on those few Some research. in trials interest a direct have who clinicians clinicians who are very supportive of clinical trials are able to recruit half their patients into trials But there is another side to this litany of problems. Work done litany of problems. another side to this But there is who Centre surveying women Breast Cancer by the National cancer and treated for breast recently diagnosed had been in were not invited to participate showed that most women participate, to asked were women of 6% Only trial. clinical a a That is, 50% of women with whom of these, half said yes. agreed to participate. So, while only 3% trial was discussed in trials, this was 50% of the women of women participated participate. offered the chance to that the main problem is not with These figures indicate to participate in a trial, but that so few the women refusing in the first place. This experience is not women were asked data from other surveys unusual, and fits with when the study was done. So, there need to be more relevant when the study was done. So, there need trials. But relevant to whom - women, researchers, clinicians or all three parties? to clinical women recruiting in involved are few clinicians Too trials. The actual numbers of clinicians involved with clinical trials in breast cancer is unknown in Australia. But it appears to be only a small proportion of the total number of specialists who are treating women with breast cancer. Overseas studies have shown that those specialists who are treating large numbers of women with breast cancer, or are working in larger specialty teams, are more likely to enrol women in trials But, where are the real impediments? Why aren’t women Why aren’t women But, where are the real impediments? being asked to be part of a clinical trial? There are three options: clear that there are Perhaps there are too few trials. It is interest to research many trials, but they all relate to areas of are concerned with scientists and clinicians. Many of these delivering therapy. of modes different chemotherapy and are they as important Although these are important questions, to researchers? There to women with breast cancer as they are fewer surgery and even radiotherapy and few trials in are very study of Australia’s in the areas of psychosocial issues. The carried out by the research into breast cancer which was the National Breast Kathleen Cunningham Foundation and research in Australia: Cancer Centre entitled “Breast cancer demonstrated clearly current research and future priorities” research projects that the views of women about what makes of researchers or worthwhile are very different from those clinicians choose to become involved, it will be difficult to recruit choose to become involved, it will be difficult to recruit increased numbers of women to participate in trials. Despite the fact that so few women actually participate are women Australian of numbers larger trials, clinical in . 1 March 2003 n S Lockwood Action Group Breast Cancer Fairfield, VIC Volume 27 Number 1 n randomisation; result e’ve got a groovy thing goin’ baby… or have we? or have baby… goin’ thing got a groovy e’ve find it difficult to deal with the concept of feel that they are being used as guinea pigs; and, as a • don’t understand the research process; •  •  Involving women in clinical trials clinical in women Involving W Encouraging more people to participate in clinical trials The literature relating to encouraging patients to participate in clinical trials focuses on the fact that patients: Cancer Forum Abstract how the number of women in clinicalThis paper explores and the extent to which researchers,trials might be increased are jointly working to improve outcomesclinicians and women of perspective the from issues the explores It women. for presented herewomen with breast cancer, but the arguments considers the loss ofare applicable to other diseases. It also from inappropriatetrust in the research process that results Initiative trial is usedpromotion of results. The Women’s Health can ensue. Someas an example of how fear and loss of trust such as communitymechanisms to improve trust are suggested, scientific informationinformation abstracts to complement the scientific paper. abstracts which are an integral part of every Introduction want cancer breast with diagnosed been have who Women and other women the best possible treatment for themselves mechanism for with the disease. Clinical trials are an important are very interested improving treatment outcomes, so women in improving in the results of trials. Clinicians are also interested better outcomes outcomes through research. They also want also interested in the for their patients, but many of them are women Both provides. research which challenges intellectual of number the increasing in an interest have clinicians and women in clinical trials. toClinical trials have been very successful date In 2002, 84% of women diagnosed with breast cancer survived five years, whereas just 10 years ago this figure was 72% This is a great improvement, most of which is due to better detection and treatment. Much of the research providing these improvements has come from clinical trials. But 30% of women diagnosed with breast cancer still die of it, and some of those who are cured suffer ongoing side-effects of their treatment, eg lymphoedema. It is therefore imperative that more work be done to improve outcomes. Both the effectiveness and safety of treatments must improve. increase faster is to improved outcomes The only way to get the number of women participating in clinical trials. Greater numbers of women means faster results over a wider range of potential treatment options. J Clin J March 2003 n Volume 27 Number 1 n . 4 Cancer Forum PM Ellis, PN Butow, RJ Simes, et al. “Barriers to participation in PM Ellis, PN Butow, RJ Simes, et al. “Barriers to participation in Australian among cancer breast early for trials clinical randomized cancer specialists.” Aust NZ J Surg, 69 (1999): 486-91. S Horng, EJ Emanuel, B Wilfond, et al. “Descriptions of benefits and risks in consent forms for phase 1 oncology trials.” N Engl J Med, 347 (2002): 2134-40. S Joffe, JC Weeks. “Views of American oncologists about the purposes oncologists American of Weeks. “Views JC Joffe, S of clinical trials.” JNCI Cancer Spectrum, 94 (2002): 1847-53. DA Braunholtz, SJ Edwards, RJ Lilford. “Are randomized clinical trials effect’”. ‘trial a for Evidence term)? short the (in us for good Epidemiol, 54 (2001): 217-24.

References Funding is a perennial problem – especially since research Funding is a perennial problem – especially costs of maintaining grants seldom cover the infrastructure funding tends to cooperative trials groups. Absence of such money to pay for deliver control of the agenda to those with whose trials may trials, largely the pharmaceutical industry, early registration be aimed more at commercial return from approach to clinically of new agents rather than the broader important questions. trial design, conduct Consumer participation is important in Breast Cancer and interpretation. The Australian New Zealand representation on Trials Group for example has had consumer years, and is also its Scientific Advisory Committee for many advised by a Consumer Advisory Panel. accurate receive patients Participating benefits? who So patients Future outcomes. better possibly and treatment, have evidence to assist their decisions. Third party payers (government, private health insurers) gain knowledge about which treatments are effective, acceptable and cost-effective, while participating clinical researchers have the benefits of from early contact with new defined regimens, and benefit developments from other ongoing trials group research. Clinical trials are a good buy for patients, doctors and society. 4 4 3 2 1 popular in many tumour types but comparative trials severely but comparative trials many tumour types popular in attempt to justify government applicability. An early limited its was trials as a good investment the costs of clinical support for medication “alternative” Laetrile was an work. this based on seen the recently we have the 1980s, and more popular in trials in reducing the use of high dose influence of clinical cell support for breast cancer. chemotherapy with stem Challenges problems in multi-centre trials, especially Geography provides modern though involved, are zones time multiple if this aspect of the problem. communication is reducing about information to access want reasonably Consumers United States, few available trials, but apart from the information. Patient countries provide reliable access to such low. There are recruitment is highly variable, but generally to due this is not that claim support the to examples many but rather to barriers patients being unwilling to participate, at the doctor level . While . While 1 . Early access to new and more . Early access to new and more 2 A Coates AM Council Australia CEO, The Cancer Breast Cancer Study International Group Breast Australian New Zealand Cancer Trials Group Sydney, NSW . Satisfaction of helping future patients is . Satisfaction of helping future patients 3 linical trials: Benefits and challenges Benefits trials: linical C these assessments may be subject to bias, they may also bias, they may also these assessments may be subject to of the clear guidelines reflect a better standard of care because by the trial process. and rigour of documentation required noted and objected Interestingly, Joffe and Weeks recently especially paediatric to the view of American oncologists (and was a legitimate oncologists) that benefit to the patient purpose of clinical trials In short, trials tell us what works, such as screening for breast for screening as such works, what us tell trials short, In and bowel cancers, breast conserving surgery, adjuvant systemic therapy in breast cancer and bowel cancer, radiotherapy in breast, rectal cancers and chemo-radiotherapy for cancers of rectum, lung, head and neck, cervix and oesophagus. Trials also tell us what doesn’t work. High dose methotrexate was once Clinical discipline in the use of defined regimens, dose Clinical discipline in the use of defined regimens, dose modifications and documentation may as noted above lead to better outcomes. From the viewpoint of government and doctors, trials provide evidence to give security that the advice offered (and paid for) is appropriate, allowing preferential use of more efficacious, (hopefully) while treatment economical and acceptable discarding treatments shown to be ineffective. Evidence from earlier trials is available to assist patients and patients to assist available is trials earlier from Evidence their doctors in reaching treatment decisions. Such evidence of and impact effects side of treatment, benefits includes treatment on quality of life as judged by similar patients who have had similar treatment. another, purely altruistic motive for trial participation. effective treatments is another potential benefit highly sought effective treatments is another potential in phase I trials may after by patients. Although many patients that the concluded al et Horng doses, low ineffective receive inducements consent forms used did not offer inappropriate to trial participation Benefits treatment under Patients participating in clinical trials receive protocols. There is rigorously defined, ethically scrutinised longer than similar some evidence that such patients survive outside trials patients treated with similar regimens Clinical trials provide the evidence basis for rational decision- Clinical trials provide to benefits provide They therapeutics. medical in making third community, the patients, future patients, participating health insurers) private and (such as governments party payers and to participating clinical researchers.

F ORUM 4 F F recruited than in many other countries. The ANZ Breast Cancer Asking individual women to participate in any sort of research is with excellent results. The abstracts are clear, standardised and more available, and that we get results sooner and achieve our ORUM Trials Group provides a focus for Australian involvement in like asking them to take a leap into the unknown. Any new trial give the results in language that most people in the community mutual objective of improving outcomes for women. ORUM both national and international trials. Australia has a significant assumes, on the basis of the best evidence available, that the can understand. Let’s get a groovy thing goin’ together… so that others may involvement in international trials through its collaborations alternative treatment being offered is at least as good as current Awards for excellence in communicating the results groove for longer. with the International Breast Cancer Study Group, the Breast best practice, and offers a real prospect of improvement. But of trials International Group, and other international groups. until the results of the trial are available, this is an assumption. This paper, and the talk it originated from, is dedicated to Fairlie Howard, a It may be that the results of the trial do not show this, and it In many areas of science there are awards for excellence in the breast cancer consumer with a great interest in clinical trials, who died of her But perhaps there also needs to be some direct requests from may be that the participants in the trial are actually at risk from public communication of science. Every year in Australia, the disease in October 2002. She will be remembered always. the women themselves to participate in trials. This would some factor(s) that are not yet known. For this reason, consumer Eureka Awards acknowledge the role played by scientists and encourage clinicians to become involved and encourage participation in research and clinical trials depends on trust. the media in presenting science to the general community. References women to look for those clinicians who are interested in further Women must be prepared to trust the researchers and clinicians Similar awards could be put in place for excellence in 1 Australian Institute of Health and Welfare. Australia’s Health 2002. research. The proposed national register of clinical trials and to be offering them a new treatment that is, on balance, likely communicating the results of medical research and in particular, AIHW, Canberra, June 2002. protocols will assist women to know what trials are available to work. But this trust is developed before the woman is ever clinical trials. 2 PM Ellis, PN Butow, JR Simes, MH Tattersall, SM Dunn. “Barriers to through different clinicians. This will be an effective tool to participation in randomized clinical trials for early breast cancer among diagnosed with breast cancer. It develops through years of The outcomes of clinical trials are of interest to many members enable women to make their own choices about which trials Australian cancer specialists.” Aust N Z J Surg, 69, 7 (1999): 486-91. experience, largely through stories in the media. of the community. They are not just the domain of clinicians might be of interest to them and approaching their clinicians 3 MS Simon, DR Brown, W Du, P LoRusson, CM Kellogg. “Accrual and researchers. Consumers have a role in the development to see if participation might be possible. This tool will only be In 2002, a selection of research stories given prominence by to breast cancer clinical trials at a university-affiliated hospital in of trials which can attract many more participants. Consumers metropolitan Detroit.” Am J Clin Oncol, 221 (1999): 42-6. effective if it includes consumer summaries. Similarly the New the media were: can encourage the recruitment of more women to trials and 4 PN Lara Jr, R Higdon, N Lim, K Kwan, et al. “Prospective evaluation South Wales Directory of Breast Cancer Treatment and Services • breast self-examination doesn’t work; they can play an important role in the delivery of the results of of cancer clinical trial accrual patterns: identifying potential barriers to shows those clinicians who participate in trials. Again this gives enrollment.” J Clin Oncol, 15, 19, 6 (2001): 1728-33. • breast screening doesn’t work; and research. Consumers can also play a role in improving the trust women the option to choose clinicians who have an interest in 5 A Marlin, S Redman, C Clarke, Rl Clark, F Boyle. Breast cancer research • hormone replacement therapy (HRT) causes breast between researchers, clinicians and the community. Consumer improving practices through clinical trials. in Australia: current research and future priorities. National Breast Cancer cancer. participation in all aspects of clinical trials will provide better Centre, Kathleen Cunningham Foundation, Sydney, 1996. outcomes for everyone. It appears that many of these factors may be related. Trials that These stories undermine the confidence the public has in the 6 CJ Twelves, CS Thomson, J Young, A Gould. “Entry into clinical trials in breast cancer: the impotance of specialist team. Scottish Breast Cancer appear to be relevant to clinicians, researchers and participants research community. These stories suggest that it doesn’t are capable of attracting more recruits than those that are of Conclusion Focus Group and Scottish Cancer Therapy network.” Eur J Cancer, 34, 7 matter what you do to try and find your breast cancer, that (1998): 1004-7. interest to fewer participants. examining your breast is no good, and that if you go to the An effective partnership between researchers, clinicians and 7 Personal communication. J Chirgwin, September 2002 screening service, they won’t find it either. So all the messages consumers will ensure that clinical trials are more relevant, 8 Personal communication. A McPhee, member of the SNAC Executive Sentinel node biopsy trial in Australia: The about finding breast cancer early – being the best way of SNAC trial avoiding dying from this disease – have been eroded by the work of research scientists. Similarly, the outrageous stories Maximising opportunities for clinical research: In 1998, women in Australia identified lymphoedema as one that were associated with the “increased risk of breast cancer of the key problems facing women who have been treated for The Centre for Developmental Cancer Therapeutics because of the use of HRT” just infuriated women. HRT has breast cancer. As a result of this concern, the National Breast been a “life-saver”, physically and psychologially, for many Cancer Centre held a summit in Adelaide in February 2000. women and now they find that their risk of breast cancer is MA Rosenthal such tasks in isolation. However, specialised administrative This included discussion of the need for more research in supposedly so high that they will have to suffer in other areas support can provide high levels of expertise in non-medical and this area. At the same time, the Royal College of Surgeons in Centre for Developmental Cancer of their life to avoid developing breast cancer. The views about non-scientific areas. Indeed, good clinical research infrastructure Australia was developing a proposal to conduct a clinical trial the value of research were totally overwhelmed by the fear Therapeutics, may provide basic scientists, translational scientists, clinicians to ascertain the value of sentinel node biopsy in comparison that was engendered in the community by the way in which Royal Melbourne Hospital and their patients with better access to novel therapeutics by with standard axillary clearance. It was possible to combine the results were provided. This story came directly from the Melbourne, VIC establishing efficient, streamlined and successful organisations. the two needs. One of the advantages of sentinel node researchers and not from the media9. With stories such as Such abilities will be recognised by the pharmaceutical and biopsy is its potential to reduce the need for axillary clearance, these, trust is being eroded. biotechnology industries and will result in more opportunities and hopefully the incidence of lymphoedema. This trial has to conduct clinical research. been enormously successful. It has encouraged surgeons The research industry, like all industries, helps create its own The Centre for Developmental Cancer Therapeutics (CDCT) was to become actively involved in a clinical trial and has given image in the community. Some responsibility for the stories formed in 1993 to provide a focus for cancer clinical research them an opportunity to learn and perfect new techniques. that appear in the media has to lie with the media. And the Abstract in Melbourne. Importantly, the CDCT aimed to establish a Women find the trial of interest because it has the potential media, as a general rule, are not exactly careful to ensure that Clinical research provides laboratory scientists, translational centralised administrative hub for its members in order to to reduce lymphoedema. It is also of interest to breast nurses, the complete picture is presented to the public. So it is easy scientists, clinicians and patients with the opportunity to provide the specialised support detailed above. The CDCT is occupational therapists and physiotherapists. to blame the media, but, if the HRT results are representative of the way in which research results are publicised, some participate in the evaluation of novel therapeutics. However, a a collaboration between oncology units at four Melbourne To date, 478 women and 35 surgeons are participating in 26 responsibility must rest with the research community. significant proportion of clinicians interested in clinical research hospitals (Austin and Repatriation Medical Centre, Peter centres8. This trial has recruited very quickly because it is of interest do not have the administrative wherewithal to conduct such MacCallum Cancer Institute, Royal Melbourne Hospital and to all parties. It is a great example of how a trial can be successful Nurturing trust studies. Novel approaches are required to facilitate and enhance Western Hospital) as well as the Walter and Eliza Hall Research if all those interested in the outcome get together, work up the clinical research in Australia. In Victoria, a new entity, Clinical Institute and the Ludwig Institute for Cancer Research. The six proposal, arrange funding and help sell the concept. We all must be very careful to nurture the trust between the Trials Victoria has been established based on the successful affiliates established an incorporated, not-for-profit company community at large and the research community. There are model of the Centre for Developmental Cancer Therapeutics, a to conduct clinical research in cancer patients. It has over 120 So what can we learn? many ways of doing this. Here are some suggestions. collaborative cancer clinical research organisation. members including scientists, clinicians, research nurses, data Community information abstracts managers, research registrars and administrative staff. The From these experiences, we know some of the factors that Many oncologists seek opportunities to conduct clinical CDCT clinical sites see over 2,500 new cancer patients per year, Each research paper has a scientific information abstract that encourage recruitment into clinical trials. They are: research. Clinical research and clinical trials provide intellectual have conducted over 160 clinical trials, accrue 300 patients describes, in a form of code, the results of the research in such stimulation, access to new therapies and additional options for per year to the clinical trial program and have an international • design win-win trials; a way that other researchers can understand the results. In their patients. Clinical trial medicine is usually conducted at the reputation, particularly in the field of early phase clinical trials. • use end points that are meaningful to participants; the current world, many of the research results are of interest highest level of ethical and clinical care. So much so that in 2002, Pharmacia contracted with the CDCT to the general public. It seems appropriate for community • involve consumers in all aspects of trial design and as one of only 10 “preferred providers” in the world to conduct information abstracts to be provided for some key articles. The effective conduct of clinical research requires substantial management; early phase clinical trials of its products. These community information abstracts would be of use to administrative effort. Interesting new therapeutics must be • educate and resource clinicians; and many different groups as well as consumers of health services. sought, protocols written, budgets agreed, contracts drawn The CDCT has many strengths of which two will be highlighted. • empower people – they are participants, not just Journalists, general practitioners, policy makers, and others up, standard operating procedures established, protocols and First, it is able to collaborate broadly across a range of subjects. would benefit from a simplified version of the abstract written plain language statements submitted to ethics committees, disciplines and expertise. Thus, clinical trial design may include in normal, ie not coded, language. Some journals, such as the adequate data management provided, adverse events reported the use of functional imaging (PET scans) and translational The other side of the coin – loss of trust Annals of Internal Medicine, are already undertaking such a task and accrual achieved. Few Australian oncologists can perform bio-assays. Furthermore, members of the CDCT have a

6 Cancer Forum n Volume 26 Number 3 n November 2002 Cancer Forum n Volume 26 Number 3 n November 2002 7 F F broad range of interests including clinical trial design, sub- shop” for clinical researchers and clinical research groups in rates, time to progression and overall survival were better for two years. Follow-up will continue for 10 years. All breast ORUM specialistation in specific tumor types and biologic interests Victoria. In contrast to CDCT, which is entirely cancer-based, with the addition of trastuzumab. An unexpected finding was tumour samples will require testing in a single reference ORUM including immunotherapy, angiogenesis and apoptosis. Thus, CTV will provide such support for any medical discipline and an increase in cardiotoxicity, especially when trastuzumab laboratory. Frequent cardiac monitoring (either echocardiograms a pharmaceutical or biotechnology company can come to any therapeutic agent or device. was given with an anthracycline. Additionally, as in earlier or radioisotope scans) will be carried out using the same the CDCT knowing that it can provide broad expertise in CTV will act as a service company for clinical researchers, studies of trastuzumab given as a single agent, tumours with protocol for all three arms of the trial. This is an important pre-clinical data evaluation and clinical trial strategies, and providing clinical trial support, marketing, training and an immunohistochemical score of 3+ responded better to point, since such intense cardiac monitoring is not usually done might suggest some novel scientific or imaging approaches to education, quality assurance, database management trastuzumab than those with a score of 2+. in women having chemotherapy alone. This trial will therefore “value–add” to the initial early phase trial. Furthermore, the (bioinformatics), regulatory advice, legal and contractual provide the opportunity to assess prospectively the level of CDCT members can highlight an effective road map for future support. CTV will establish strong links with sources of new Problems with an adjuvant trial cardiotoxicity associated with usual adjuvant chemotherapy clinical trial design in order that a novel therapeutic might find therapeutics including the Victorian College of Pharmacy drug protocols and thus accurately measure any additional effects its way to market in a most efficient yet scientific manner. Given the activity of trastuzumab in advanced disease, an seen with trastuzumab. development program and Bio21, and will aggressively market obvious question is whether it is feasible and effective if given A second strength of the CDCT is the administrative Victoria as a site to conduct clinical research. as part of the adjuvant treatment of early breast cancer. An Because accrual to this trial will be challenging – over 30,000 framework provided for its members. The CDCT has a Board of The degree to which a clinical researcher uses CTV clearly immediate problem is the required size of such a trial, since women will need to be screened – there is a deliberately Management, a Scientific Advisory Board and regular meetings depends on experience. Thus a mature organisation such as it will apply to only 15% of women with early breast cancer between all members. In addition, there are a number pragmatic approach to chemotherapy protocols. Recognising the CDCT will mainly benefit from CTV providing a strong needing adjuvant treatment. It is important that testing for of subcommittees including those for bio-informatics and that evidence from randomised trials supports a number of marketing of the CDCT at a national and international level. HER2 is standardised as much as possible, given the ease pharmacy. The CDCT has eight administrative staff including standard chemotherapy regimens, the choice of chemotherapy This will provide opportunities for the CDCT through new a manager, clinical trials team leader, ethics committee with which inconsistent results can be obtained. Lastly, while is left largely to individual investigators. liaisons with pharmaceutical and biotechnology companies. In co-ordinators, project officers and an administrative assistant. toxicity is always important, it is particularly so when new contrast, novice clinical researchers may seek assistance with More recently, the CDCT has appointed a half-time director. drugs are given to otherwise well women with potentially long Lessons to be learned protocol writing, statistical advice, contracts and the like. CTV The clinical trials team leader is responsible for contracts, lifespans. Thus intensive cardiac monitoring is a crucial part of will encourage new collaborations between clinical researchers Participation in this large new trial offers the opportunity to budgets, developing standard operating procedures and legal any adjuvant trial using trastuzumab. and provide the necessary infrastructure to assist the conduct of learn several lessons that will be increasingly important to issues such as indemnity and insurance. The two project officers clinical trials. clinical trialists over the coming years. As cancer treatments have played crucial roles in the development and co-ordination The HERA trial inevitably become more targeted, so will the requirement of Clinical Trials Victoria and a mutual acceptance program In conclusion, conducting clinical research with new therapeutics Given all these considerations, it is clear that large resources are between four institutional ethics committees. The latter project is an exciting, stimulating and rewarding component of an to coordinate large-scale tissue collection and testing. In the required to conduct an adjuvant trial. The HERA trial therefore is an attempt to streamline the process of ethics committee oncologist’s work. Access to such opportunities is made face of such increasing complexity, it will be important to brings together several clinical trials groups across the world, evaluation of multi-centre clinical trials. significantly easier through collaborative networks and the keep as many aspects of the trial as simple as possible. Thus and has been designed and initiated in close consultation provision of specialised administrative support. The CDCT is HERA trialists will generally be able to employ the adjuvant The Victorian Government recognised that the CDCT provided with the relevant pharmaceutical company, which is providing one successful example of such an organisation where the chemotherapy protocols they are used to. a paradigm for a successful, collaborative clinical trials group strong financial support without impinging on the scientific day-to-day administrative detail is taken out of the hands of with a “one-stop shop” approach providing a centralised The evolving biological agents requiring rigorous testing clinical researchers, leaving them to focus on what they wish independence of the various trial committees. administrative focus. As a result, $8 million was awarded in in randomised trials will also change the way we monitor to do: clinical research. a competitive grant process to establish Clinical Trials Victoria Two biological considerations incorporated into the design clinical trials. For example, we will need to be aware of new (CTV). CTVs founding members are the CDCT (cancer), The establishment of CTV moves this philosophy one step of HERA differentiate it from the concurrent American and occasionally unexpected toxicities. Even the traditional Neurosciences Victoria (neurosciences), Centre for Clinical further. CTV will implement the CDCT paradigm for all trastuzumab trials. Recent information supports the use of endpoints of clinical trials may need to be modified if some Studies (cardiovascular and pharmacology) and Melbourne clinical researchers whatever their medical speciality or area trastuzumab in a three-weekly schedule, rather than the of these agents are found to have disease-stabilising effects Health (multidisciplinary). The grant provides funding for of interest. CTV will provide centralised administrative support weekly schedule that has been used to date. Thus there will rather than inducing tumour regression. We must therefore infrastructure to the CDCT and CCS but more importantly to all clinical researchers, irrespective of their experience. As be the opportunity to make indirect comparisons between continue to scrutinise carefully all available phase II and early establishes CTV. In the same fashion as CDCT, CTV is a not- a consequence, clinical research in Victoria will become more trials about the cost, patient acceptability and toxicity of these randomised trials of new agents before incorporating these for-profit, incorporated entity that will provide a “one-stop streamlined, efficient and successful. schedules. In addition, there are of course not yet any data new drugs into definitive large scale trails, and maintain an on the appropriate duration of trastuzumab in the adjuvant open mind about clinical trial design and conduct. setting, and the American trials are not testing this. HERA – new lessons from a new trial Thus HERA is a three-armed randomised trial. After appropriate Reference adjuvant chemotherapy, 3,000 women will be randomised to 1 DJ Slamon, B Leyland-Jones, S Shak, et al. “Use of chemotherapy plus N Wilcken when stimulated they transmit growth signals to the nucleus. In many cancers, these growth pathways become uncontrolled, either no trastuzumab, trastuzumab for one year or trastuzumab a monoclonal antibody against HER2 for metastatic breast cancer that Staff Specialist in Medical Oncology contributing to cancer development or progression. For example, Westmead and Nepean Hospitals, the receptor may mutate in a way that causes it to always be Cancer Trials NSW: A collaborative initiative to support NSW “switched on”. In the case of HER2, about 15% of breast and promote cancer clinical trials research in NSW cancers have a gene amplification, so that too many receptors are expressed (and activated) on the cell surface. Cancer cell M Malica achieve the mutual aim of improving participation and access activity thus increases and “HER2 positive” breast cancers have to cancer clinical trials. This resulted in the establishment of a worse prognosis than “HER2 negative” breast cancers. Project Manager, Cancer Trials NSW (CTN), a collaborative initiative to support Cancer Trials NSW, The HERA trial is a large international randomised trial and promote a wide range of cancer clinical trials research However, determining the HER2 status of tumours is not as The Cancer Council NSW testing the efficacy of the new biological drug trastuzumab throughout NSW. straightforward as determining the estrogen receptor (ER) Woolloomooloo, NSW (Herceptin) in early breast cancer. HERA is being conducted in status. Immunohistochemical staining is carried out (and Some of the most innovative aspects of the CTN program are: Australia by the Australian New Zealand Breast Cancer Trials scored from 1+ to 3+), but a more accurate and expensive • The extensive consultation and collaboration conducted in Group in collaboration with the International Breast Cancer test is fluorescent in situ hybridisation (FISH), which measures Study Group and the Breast International Group. This is the the actual number of HER2 genes in the cells. Trastuzumab the development and establishment of CTN. first time Australian centres have participated in a trial of a is a humanised monoclonal antibody that can block these People with cancer who are treated in clinical trials are more • A unique trial selection process, developed to ensure the biological agent in the adjuvant setting and is an important overexpressed receptors. satisfied and do better than people who receive the same best trials that need the most support get this crucial learning opportunity for all those involved. treatment outside of a clinical trial. Despite this, less than boost. This means more support for trials of radiation Trastuzumab in metastatic disease 3% of NSW adults with cancer are currently enrolled in trials. therapy, surgery, palliative care and supportive care, not Background The first randomised trial involving trastuzumab compared Recognising the need to build capacity and infrastructure for just for trials of anticancer drugs. HER2 (also known as erbB2 or neu) belongs to a family of chemotherapy with or without trastuzumab in women with clinical trials research, The Cancer Council NSW worked with • A unique centre selection process to direct funds for study receptors that are located on the surface of human cells, and newly diagnosed metastatic breast cancer1. Tumour response key stakeholders to reach agreement on the steps necessary to nurse/data management support.

8 Cancer Forum n Volume 27 Number 1 n March 2003 Cancer Forum n Volume 27 Number 1 n March 2003 9 FORUM Forum Consultation and collaboration with associated regional and rural centres. help establish high quality trials to address them. Through this another important strategy for increasing participation and initiative, CTN will provide a genuine vehicle to support locally access throughout NSW. CTN has already contributed to Comprehensive consultation was done to help develop CTN now funds 14 half-time study nurse/data managers initiated trials and build on the intellectual contribution from training programs for consumers, and plans are in progress the most appropriate model for this collaborative initiative. throughout NSW. NSW to the global trials effort. Consultative committees were convened to provide advice and for educational programs for study nurses, data managers, reach agreement on all aspects of CTN – including issues of Centre Selection Committee A national register of cancer trials clinicians and other researchers. policy, procedure, selection of trials and participating centres, An inclusive Centre Selection Committee was convened with Information about each supported trial and centre is currently finance, governance and management. All committees included Conclusion 19 individuals from all relevant disciplines, including two available on the Cancer Trials NSW website, which is part of consumers, health professionals and researchers. CTN is now consumers, clinicians, researchers, cooperative trials groups, The Cancer Council NSW website at www.cancercouncil.com. CTN provides a successful, effective model for building well established with consensus from all the key stakeholders NSW Health, and staff of The Cancer Council NSW. Every au. We aim to work with our key stakeholders and other state infrastructure to improve participation in and access to on suitable policies and procedures for a fair, rigorous and committee member reviews and rates every centre application cancer councils to further develop this information as a basis cancer clinical trials, and for developing a close collaboration inclusive selection. for the establishment of a national register of cancer clinical using the “CTN centre rating form”, an electronic form that between consumers, clinicians, researchers and funders. allows each centre application to be rated against specific trials. Trial selection Effective involvement means inclusion at all levels including selection criteria developed for CTN. Education and training trial development, management and fund-raising, things that CTN trial selection occurs twice a year, with calls for applications Educating advocates, consumers, clinicians and researchers CTN will continue to champion in the future. CTN has only just in March and September. Continuing review and addition to Centre selection criteria about ongoing trials and the importance of participation is begun and there is a long way to go, but with the continued the portfolio of CTN trials is designed to ensure that the mix To help meet the aims of CTN, selection criteria were developed of cancers and treatments in supported trials reflects the and integrated into a CTN centre rating form that includes 21 Australian New Zealand Breast Cancer Trials Group: experience of cancer in NSW. aspects grouped into seven domains: IMPACT – Improving Participation and Advocacy for The CTN portfolio now includes 47 supported trials. • Participation Clinical Trials Trial Selection Committee • Access and equity a trial are reliant on good communication and full explanations • Quality L Young Our inclusive Trial Selection Committee comprises 26 individuals about the trials they may be considering. • Economy and efficiency from all relevant disciplines, including three consumers, clinicians, IMPACT Consumer Coordinator, Positive community education is vital to influence decision- researchers and staff of The Cancer Council NSW. Three • Multidisciplinary care Australian New Zealand Breast makers, politicians, health professionals and people in the assessment forms are used by the committee. • Contribution to Cancer Council activities Cancer Trials Group general community who may face a diagnosis in the future. The Junction, NSW At least 10 committee members review and rate each trial • Overall rating The myths surrounding cancer clinical trials research need to application using: Ideal applications include substantial, realistic participation in a be openly refuted. 1 the “CTN trial and concept rating form”, an electronic rational subset of CTN supported trials involving collaboration, form that allows raters to score each trial application networking and links between disciplines, centres, areas and Consumer involvement in clinical trials against specific selection criteria developed for CTN. institutions. In their application each centre outlines which research trials they intend to do and their proposed recruitment figures. Clinical trials research A content expert and a methodologic expert do more detailed Hanley et el1 recently made the following points about CTN sponsored centres are encouraged to take up new assessments using two other forms: We are now in the most exciting and productive time ever consumer involvement in research. supported trials as they are approved, and patients recruited in breast cancer research. The genetics of breast cancer are 2 the “Protocol critical appraisal form” developed by Davina are included in the evaluation of that centre. being unravelled, new treatments are being tested and greater “The consumers helped convince researchers and funders Ghersi of the NHMRC Clinical Trials Centre; and understanding of the controls of cell growth and mechanisms that the trial was possible and ethical.” 3 a modified version of the “National cancer grants ranking Vision – “research in practice” of development of breast cancer are being explored. “They were important in helping to refine questions.” form”. We hope that by 2010, throughout NSW: The most significant obstacles to new research are low “More relevant and clearer questions were… asked.” The results of these ratings and assessments are then • Participation in cancer trials is an integral part of clinical recruitment to clinical trials and lack of infrastructure funding. “They helped make a complex trial comprehensive to summarised and form the basis of the committee’s discussions practice. Relying on the generosity of the community and industry most patients.” and decisions. • Everyone suitable is able to participate in cancer clinical does not allow for long-term commitment. Lack of ongoing “They provided insights into issues important to the trials, both patients and clinicians. infrastructure funding makes it difficult for health professionals community and patients.” Trial selection criteria to make a commitment to research and the number of “Their participation led to improved recruitment.” • World-class participation delivers world’s best cancer care institutions which offer clinical trials is limited. To help meet the aims of CTN, selection criteria were developed and outcomes. and integrated into a CTN trial and concept rating form. The Community education about clinical trials research is very • 90% of eligible patients are offered participation in CTN Australian New Zealand Breast Cancer Trials form includes 24 aspects grouped in six domains: important if participation rates are to increase. Not only is the supported trials and 25% choose to take part. The targets Group (ANZ BCTG) general community ill-informed about clinical trials research, • Importance, priority and impact are that everyone is given the choice, and that people are but so are many health professionals who are in a position to Established in 1978 to create a national collaborative approach • Scientific excellence fully informed and free to choose. advise people diagnosed with cancer. to breast cancer research through clinical trials, the ANZ BCTG • Collaboration and involvement What’s in the future? collaborates with over 500 researchers in 60 leading medical • Need and efficiency People diagnosed with cancer should be given as many and research institutions in Australia and New Zealand and opportunities as possible to participate in cancer clinical trials • NSW perspective Increase funding with 15 countries internationally. research. The involvement of partners, families and friends We plan to increase the number of CTN supported study • Overall rating is also important in the decision of whether to participate in The ANZ BCTG initiated the inclusion of consumer representation nurse/data manager positions to 20 FTE over the next a clinical trial. Therefore, the whole community needs to be to research planning in 1994 when a breast cancer survivor and five years, contingent on the success of our fundraising Centre selection informed so appropriate enquiries can be made at the time of a breast nurse counsellor were invited to become members of efforts with The Cancer Council NSW. We anticipate future diagnosis. their Scientific Advisory Committee. They were invited both Part two of the CTN support process is to select the NSW centres applications to support centres will be invited annually as because of their own life experiences with breast cancer, and that can best increase participation and access to the selected funds become available. There are still many myths of how trials are conducted. their academic expertise. They have contributed to the scientific trials. Each successful centre receives a grant of $30,000 per Perceived uncertainty or the “guinea pig” mentality is still very Trials initiation discussion and have been responsible for reviewing and annum, with annual renewal conditional on performance and prominent. evaluation. Each grant is to fund half a full-time equivalent (0.5 Our initial focus has been to improve participation and access commenting on new trial protocols and participant information FTE) study nurse/data manager at the centre. Applicants are in NSW by selecting and supporting greater participation Because of these misconceptions, many people still feel that sheets. They also represent consumers’ perspectives on various encouraged to collaborate with other departments within an in ongoing, high-quality trials. The next step is to identify by participating in a clinical trial they will be giving over their external committees and present consumers’ viewpoints to the institution, and for metropolitan centres to submit applications important gaps in our cancer trials research program, and treatment to chance. People who are eligible to participate in media, at conferences and at symposia.

10 Cancer Forum n Volume 27 Number 1 n March 2003 Cancer Forum n Volume 27 Number 1 n March 2003 11 FORUM ARTICLE Australian New Zealand Breast Cancer Trials breast cancer. Testing for familial cancer susceptibility Group Consumer Advisory Panel The opportunity to network in a non-clinical environment gene mutations In 1998, the ANZ BCTG extended consumer involvement in its and to meet with others who have had similar experiences research planning by establishing its own Consumer Advisory reinforces how important and empowering each woman’s A Rowland1, N Breheny1, J Goldblatt2, I Walpole2, Genetic testing for familial breast cancer contribution is and how much it is valued. 1 Panel (CAP). All CAP members are committed to clinical trials P O’Leary Genetic testing is a complex process and involves searching for research and, as consumer advocates, aim to: The ANZ BCTG wants to help consumers become more 1 Genomics Branch, Department of Health, WA a gene mutation in an affected family member. Should such a • become effective partners with researchers and health effective as advocates so that they can take a greater role mutation be found, predictive genetic testing may be offered 2 Genetic Services of WA providers to increase nationally the number of women in research development and planning. The information and to other family members who currently have no symptoms participating in breast cancer clinical trials; education provided through IMPACT is designed to do this. but are also at risk of carrying the same mutation. Even if a mutation is located, this only indicates that person has a higher The IMPACT Newsletter is distributed regularly and provides • provide a voice for women who may be participating in Abstract risk of developing the disease – there is no certainty they will information on research issues and educates readers about the breast cancer clinical trials; actually go on to develop breast or ovarian cancer. Moreover, research process. It also provides a vehicle for members to have Genetic testing is a useful means of identifying individuals there is no completely effective means of preventing either • raise awareness and understanding about breast cancer a say and maintain a connection. who are at an increased risk of developing familial cancer. This clinical trials and breast cancer issues generally; and information assists such individuals to make lifestyle alterations breast or ovarian cancer once a mutation is discovered. Information sessions are being scheduled nationwide. A and consider surgical intervention to minimise their risk of However, recommended screening and prophylactic strategies • provide advice to researchers of the ANZ BCTG from the brief overview of the IMPACT program and current research might reduce the morbidity and mortality from breast cancer developing cancer. In WA, genetic testing is conducted free perspective of women who have had breast cancer and updates are presented. Most importantly, however, these in family members ascertained to be at “high risk” through of charge to the public through Genetic Services of WA who who are currently or have been clinical trial participants. sessions provide an opportunity for the ANZ BCTG to genetic testing. provide an integrated service. This includes pre- and post-test acknowledge the contributions of participating women to counselling, testing, family support and a surveillance registry. In WA genetic testing is conducted through Genetic Services IMPACT – Improving Participation and its research programs, and for participating women to meet However, the recent granting of an exclusive gene patent of WA (GSWA), which is a multidisciplinary, state-wide Advocacy for Clinical Trials others with similar experiences. licensing agreement for familial breast cancer susceptibility service based at King Edward Memorial Hospital. GSWA has IMPACT was established to further enhance consumer The IMPACT Education Program is offered to members who genes threatens free of charge public testing services Australia- a long-established Familial Cancer Program that provides a involvement. IMPACT aims to provide a positive voice in the continue to show a commitment to the clinical trials process wide. Exclusive licensing effectively creates a monopoly on comprehensive service to families with a history of breast, community about breast cancer clinical trials research. The and an interest in learning the concepts of basic science, breast the testing services available, and accordingly there has been bowel and ovarian cancers, other less common cancers and aims of IMPACT are to: cancer research and policy issues. a great deal of controversy over the breast cancer gene related syndromes. The service incorporates important pre- patent and licensing agreements internationally. This article and post-test counselling, family support, education, genetic • recognise the important contributions made by women to The Education Program runs over three to four days. explores aspects of testing for familial cancer susceptibility testing and liaison with clinical specialists where relevant, for breast cancer clinical trials research of the ANZ BCTG; Presentations are made on subjects specifically designed to individuals or families with a history of cancer. give the participants an understanding of: gene mutations, focusing on experiences with familial breast • increase participation to ANZ BCTG breast cancer clinical cancer. Comprehensive DNA-based testing for cancer susceptibility trials research; • the biology of breast cancer; ­ Genetic technology is revolutionising the way in which diseases gene mutations has been offered through the Familial Cancer • lobby for increased infrastructure funding for breast • genetics; are diagnosed and managed. An important outcome of the Program at GSWA since 1995. This testing detected most cancer clinical trials research; sequence variations, but until recently testing only detected • study design, statistics and interpretation; increasing application of genetic technology to health services specific known deletions or duplications. These sort of • enhance links between health professionals with women has been the introduction of genetic testing, which has had • diagnosis and treatment; mutations are believed to be common in familial breast and who have participated in clinical trials research; particular relevance for cancer treatment. In recent times testing • conducting clinical trials; and has been successfully utilised for detecting familial mutations bowel cancer and are now tested for in the GSWA laboratory • provide reliable up-to-date information on breast cancer in the breast and ovarian cancer susceptibility genes. with a novel test, the Multiplex Ligation-dependent Probe clinical trials research; • advocacy and communication skills. Amplification (MLPA), which identifies any exon deletions Breast cancer is the most common form of cancer among or duplications4. The GSWA laboratory stores DNA and RNA • educate women about the science of breast cancer and IMPACT allows its members to make choices. However Australian women, and it is estimated that it will affect from family members and when new tests appear the stored the processes of clinical trials research so they can become they choose to contribute, their participation is constructive, 1 approximately one in 12 women in their lifetime . While fewer material is re-analysed. The laboratory is currently using these effective advocates for clinical trials research; and valued and they can continue to provide a broader consumer than five per cent of all cases of breast cancer in Australia may perspective. improved technologies to investigate for mutations in stored • educate the wider community about clinical trials be attributed to familial links, the risk of developing the cancer specimens, in which previous studies were inconclusive. research. What sets IMPACT apart is that it specifically aims to address for potentially high-risk persons (less than one per cent of issues relating to clinical trials research. the population) is six to 10 times higher than the population In calculating an individual’s estimated risk of developing The strategies for achieving the IMPACT program’s aims average1. The causes of breast cancer are complicated by cancer, based on mutations in the cancer susceptibility Inevitably, the positive messages about breast cancer trials will include: interactions between environmental factors such as diet, and genes, a multitude of complex issues arise. Mutations in carry over to the benefit of other clinical trials research. This genetic factors. In regard to familial breast cancer, currently these genes increase an individual’s risk for both breast and 1 IMPACT Newsletter is another positive attribute of IMPACT. There is still a long identified environmental risk factors are thought to explain ovarian cancer, however the estimated risk is different. For way to go to eradicate breast cancer. Advocates cooperating 2 Information sessions less than 10 per cent of breast cancers. This indicates there example, in BRCA1 mutation carriers the estimated risk (to and striving for a common cause can help achieve this sooner. is still much to learn about why breast cancer runs in families age 75 years) of developing breast cancer is 40-80% and the 3 IMPACT Education Program IMPACT members will continue to make their contributions to more often than would be predicted by chance alone2. Genes risk of ovarian cancer is 10-60%. Male carriers of the BRCA1 the research process count. The first aim, of recognising the important contributions associated with inherited risk of breast cancer other than BRCA1 mutation also have a slightly higher lifetime risk of developing 1 made by women to breast cancer clinical trials research, is the and BRCA2 are likely to be discovered in the next few years2. cancer of the prostate . Reference most important aspect of IMPACT. High quality breast cancer In BRCA2 mutation carriers the estimated risk (to age 75 years) trials are impossible without the participation of women with 1 B Hanley, A Truesdale, A King, D Elbourne and I Chalmers. “Involving The BRCA genes act as tumour suppressors. Mutations in these genes lead to increased susceptibility to uncontrolled cell of developing breast cancer is 40-80% and the risk of ovarian cancer is 10-40%. Carriers of mutations in the BRCA2 gene replication, thereby resulting in cancer. These mutations, largely also have a slightly higher lifetime risk of developing cancer of specific to a family, may be passed through several members, the pancreas, male breast and prostate4. male and female. Population-based studies conducted internationally indicate that individuals who have inherited Despite these complexities, there are numerous benefits of (deleterious) BRCA mutations have an elevated lifetime risk cancer susceptibility gene mutation testing. These include early of both breast and ovarian cancer3. For those individuals at detection, appropriate surveillance and sometimes the option increased risk of developing familial breast and ovarian cancer, of preventative surgery. Through the course of genetic testing genetic testing may be an appropriate option to refine actual an individual is often alerted to other possible lifestyle changes risk as a component of their risk management. that may keep cancer at bay5.

12 Cancer Forum n Volume 27 Number 1 n March 2003 Cancer Forum n Volume 27 Number 1 n March 2003 13 ARTICLE ARTICLE The Familial Cancer Program also operates a cancer registry you learn to live with it”. Knowledge of the mutation has genes, including BRCA1 and BRCA2. It is expected many more 4 J Schouten, C McElgunn, R Waaijer, D Zwijnenburg, F Diepvens, G that provides surveillance for women identified as being at enabled her to be vigilant and prepared. The daughter states genes that contribute to cancer will be identified as research Pals. “Relative quantification of 40 nucleic acid sequences by multiplex ligation-dependent probe amplification”. Nucleic Acids Research, 30, 12 increased risk of developing various familial cancers, including that “we’re luckier than most people because we know what advances. In order to provide the highest standard of health (2002). breast or ovarian cancer. If no mutation is found in the family, we’re facing and we are watched closely”. Both women are service for individuals identified as being genetically at risk 5 Ontario draft report to Premiers. Genetics, Testing and Gene Patenting: members are still encouraged to follow screening measures undergoing regular surveillance and have been encouraged to of developing familial breast or ovarian cancer, it is essential Charting New Territory in Healthcare, 2002. due to their strong family history of disease. The Familial join the Familial Cancer Registry. that a holistic service continues to be provided with equitable 6 K Metcalfe, A Liede, E Hoodfar, A Scott, W Foulkes, & S Narod. “An Cancer Program also invites such individuals to join the registry access at an affordable cost for all Australians. evaluation of needs of female BRCA1 and BRCA2 carriers undergoing in the event that a new genetic mutation is identified in the Gene patents genetic counselling”, Journal of Medical Genetics, 37 (2000): 866-74. course of future research or technological development. In 7 I Walpole, H Dawkins & P O’Leary. “Human gene patents; possible Despite the benefits clients derive through familial cancer services References addition, the service provides opportunities for individuals to impact on genetic services health care”. Manuscript submitted for such as that offered by GSWA, the ability of public hospitals publication with the Medical Journal of Australia, 2002. participate in approved clinical trials and research projects 1 National Health and Medical Research Council. Familial Aspects of to provide free-of-charge genetic testing services to the public cancer: A guide to clinical practice, 1999. 8 A Williamson. “Gene patents: socially acceptable monopolies or an conducted through the Familial Cancer Program and the Breast is threatened by the implications of gene patenting7. Recently 2 J Cui, A Antoniou, G Dite, M Southey, D Venter, D Easton, G Giles, unnecessary hindrance to research”. Trends in Genetics, 17, (2001): Cancer Risk Assessment Clinic at Royal Perth Hospital. 670-3. a US-based biotechnology company, Myriad Genetics Inc, has M McCredie, J Hopper. “After BRCA1 and BRCA2 - What next? 9 L Andrews. “Genes and patent policy: rethinking intellectual property The holistic and multidisciplinary service in WA provides taken out a broad patent for the BRCA genes in numerous Multifactorial segregation analyses of three-generation, population- based Australian families affected by female breast cancer”. American rights”. Nature Reviews, 3, (2002): 803-8. counselling and information to individuals considering countries, including Australia. Myriad has used the framework of Journal of Human Genetics, 68 (2001): 420-31. 10 Catalyst- ABC Television. Genetic Gold Rush, 2002. undertaking genetic testing. The pre- and post-test counselling exclusively licensing the use of its test to a very limited number of 3 P Goodwin. “Management of familial breast cancer risk”. Breast Cancer Department of Health Director General, Mike Daube approved the current 7 component of the program allows for the mechanisms of commercial genetic laboratories in specific locations . Research and Treatment, 62 (2000): 19-33. document for external publication. The views expressed in this paper do not genetic transmission to be explained, and the likelihood that a Broad-based gene patents raise the controversial issue of whether mutation is present in a family being assessed. It also provides or not it is ethical to patent a naturally occurring substance8, and The impact of physiotherapy intervention on counsellors with an opportunity to clarify the advantages and further to make a commodity out of it. Extending beyond this limitations of genetic testing, as well as possible options for risk functional independence and quality of life ethical issue is perhaps the more critical question of whether it management3. A recent study of women tested for mutations is in the interests of public health and research to allow gene in palliative patients in the BRCA genes suggested that counselling is effective patents, and evidence increasingly suggests it may not be9. in helping women throughout the genetic testing process, contribution of physiotherapy to palliative care. Anecdotal While it is acknowledged that patents support the protection of EL Laakso highlighting the need for a comprehensive genetic service6. reports suggested that while physiotherapy involvement could corporate interests and are a central tenant of international trade School of Physiotherapy and Exercise Science, Griffith value-add to the care of patients in the palliative stage of agreements between industrialised nations10, these corporate University, QLD An experience of genetic testing cancer, there was an inconsistent approach to the referral interests need to be weighed against the public good. The AJ McAuliffe of patients to physiotherapy or even of the involvement of Genetic testing for familial breast cancer mutations raises a exercise of exclusive and monopolistic gene patents will interfere Zonal Quality Co-ordinator, Queensland Health, QLD multitude of psychosocial issues, which need to be considered with patient care by disrupting the integrated testing, clinical physiotherapists in palliative care teams and services. before an individual undertakes testing. For example, in and counselling services already offered throughout Australia. A Cantlay The aim of this study was two-fold: (i) to understand where deciding whether or not to undertake testing the individual It may also compromise the viability and expertise of publicly- Formerly Superintendent Physiotherapist, Newbury physiotherapists were involved in palliative care services in needs to consider the impact of the information on their own funded genetic testing services, and divert testing services away Physiotherapy Service, UK Australia, specifically identifying the impediments to those psychosocial coping, family dynamics and issues such as life from established Australian best practice guidelines7 which serve services, and primarily (ii) to conduct an outcome study of insurance and employment. Ultimately, the choice is a personal to ensure the medical and psychological wellbeing of individuals physiotherapy to patients receiving palliative care, measuring one but genetics professionals can ease the decision-making undertaking testing. Abstract the effects of a standard physiotherapy service compared to an process by equipping individuals with the best information Gene patents also have the potential to compromise public The Physiotherapy Department of the Royal Brisbane Hospital optimised physiotherapy service. In the context of this project, about the issues involved so they can make the best choice for health by inhibiting biomedical research that could prevent an has conducted a review of physiotherapy services to palliative palliative care is defined as adding quality to life for patients in themselves and their family. alternative genetic test from being developed. A researcher care patients in Australia. As part of this review, a trial the non-curative stage of the disease process. In response to the high prevalence of breast cancer in her wanting to find a cure for breast cancer would have to was undertaken to investigate the impact of physiotherapy family, one woman underwent a double mastectomy in order negotiate with the patent holder for access to the BRCA1 and intervention on quality of life and functional level. The results Method to minimise her risk of developing breast cancer. This woman BRCA2 genes. In addition, they must also negotiate with all indicated that the provision of an adequately resourced Stage 1 states that “breast cancer has been casting a long shadow over the other patent holders who have discovered and patented physiotherapy service incorporating early intervention and In order to provide a benchmark service against which to assess the women in my family, it seems as if part of our family is any of the hundreds of other mutations in these genes. The community follow-up can contribute significantly to the physiotherapy outcomes, it was necessary to understand what devoid of women” and is therefore also currently considering stimulus to patent genes in the last decade has been likened to maintenance of functional independence and quality of life constituted standard versus optimal physiotherapy practice. genetic testing in order to add to the genetic knowledge in her a “genetic gold rush”10. A Victorian-based company, Genetic among patients receiving palliative care. Prior to the commencement of the outcome study, a survey of family. Technologies Limited, has patented 95% of all intronic DNA physiotherapy service providers across Australia was conducted. (also known as ‘junk DNA’) in the likelihood that this material Introduction In another family, both mother and daughter undertook The survey identified a number of impediments to the delivery may be found to be important11. genetic testing through GSWA two years ago. Breast cancer In the mid to late 1960s, the concept of rehabilitation as a of a quality physiotherapy service, including the fact that the has affected three generations of their family. They heard Internationally, there have been very few legal challenges part of the cancer treatment process began to flourish. Dietz1 average time spent in providing physiotherapy to palliative about the services offered by GSWA through a family member launched against gene patents, and there certainly have been developed the four-part framework for cancer rehabilitation – patients was less than 10 minutes per occasion of service. who is a GP and who felt that given their strong family history no decisive legal moves to address directly whether human prevention, restoration, support and palliation. Physiotherapy 9 Other limitations included delayed or absent referral to of breast cancer, there might be genetic factors involved. genes are even an appropriate substance to patent . In the involvement in the treatment of cancer patients began to physiotherapy during hospital admission, limited resources Both women were found to carry mutations in breast cancer US, moves to reform legislation on gene patents have been develop at around this time, but with involvement often (such as equipment and funding) to provide adequate services, susceptibility genes, but so far only the mother has developed introduced by Senator Lynn Rivers. The Rivers Bills aim to grant limited to the restorative stage2. During the 1970s, the and a lack of community-based services for follow-up after ovarian cancer. Other family members have also undergone medical researchers and clinical geneticists protection from input of physiotherapy in the support phase began to be hospital discharge. The specialised physiotherapy service genetic testing, however some have elected not to receive this patent infringement, in an effort to minimise negative impact noted. Zislis3 reported the usefulness of physiotherapy to of gene patenting on health services. In Australia, a similar examined during stage two of this study was designed to predictive information. maintain range of motion post-operatively, and Mayer4 noted course of legislative action is yet to be undertaken, and in the reduce the impact of the limitations identified in stage one. The daughter states that she was apprehensive about having that physiotherapists could implement a graduated exercise interim gene patents remain a very real threat to the delivery of the testing done, but the counselling support she received program contributing to maintenance of mobility. The role of Stage 2 genetic testing as a component of our public health service. from the genetic counsellors and valuable written information physiotherapy in cancer rehabilitation was firmly established The study was conducted over 12 months in an oncology assisted her in making the decision. She also noted that the by the end of the 1970s, with many textbooks devoting space ward of a major metropolitan teaching hospital. The subjects Conclusion explanation of the information by the clinical geneticists was to the role of physiotherapy and also of the importance of were patients admitted for symptom control (palliative care most important in assisting her decision-making. Receiving It is currently known that a small number of cases of breast a multidisciplinary approach to palliative care5,6. A series of patients). Forty patients were randomly allocated to receive the the results that she carried a mutation was “frightening but and ovarian cancer may be attributed to mutations in various publications by Doyle7-9 demonstrates the development of the optimal trial physiotherapy service (characterised by time and

14 Cancer Forum n Volume 27 Number 1 n March 2003 Cancer Forum n Volume 27 Number 1 n March 2003 15 ARTICLE ARTICLE resource allocations, based on an experienced physiotherapist’s standing, mobilising (walking), negotiating stairs, toileting and Fully means were 14.6 (supervision with some tasks) and 14.3, 27 ability to provide an enhanced/optimised service). The trial entering/alighting from a car. Each task was graded based independent Standard respectively. The decrease in score at discharge in the project group was compared to a control group of 20 patients who on the degree of assistance required to complete the task: Project group is in the main due to the higher proportion of patients received the usual physiotherapy service provided by the ward independent (3), use of an assistive device (2), requirement for in this group who died during admission (15%). When (characterised by time and resource constraints influenced by assistance provided by a carer ie supervision only (1.8), minimal 18 these patients are excluded, the difference at admission is inadequate staff to patient ratios). assistance (1.5), moderate assistance (1.2), maximal assistance maintained at discharge (17.9). Figure one demonstrates that (0.9), two people to assist (0.5), inability to move (0). A score Subjects were allocated to the study groups in the following there was no statistically significant difference in functional between 0 and 27 was obtained with 27 representing complete way. The project physiotherapist screened new admissions ability between the groups at admission or discharge from independence in all tasks. The tool was assessed for utility in a to the ward, and palliative patients with indications for hospital. At mid-survival follow-up assessment there were number of palliative care services prior to its use in this study. 9 physiotherapy intervention were identified. From this group, weak statistical (p=0.09) and clinically significant differences randomly selected patients were approached and invited to Quality of life was assessed using the EORTC QLQ-C30 that between the project and standard groups. The standard group take part in the trial. These patients received the trial service produces scores ranging from zero to 100 for six function Unable to required light to moderate assistance with all tasks, while the by the project physiotherapist and were known as the “project components and for nine symptom impact components. move 0 project group was functionally independent with the use of a group”. Patients not randomised to the project group became For the function components a score of 100 represents the walking aid in all tasks. Admission Discharge *Mid-survival subjects in the “standard group” when and if they were best possible level of function, thus an increase in score follow-up referred for physiotherapy during their admission. In this way, represents an improvement in function. In the symptom impact Quality of life the standard group was representative of the usual process components, a score of 100 represents the highest possible Neither the standard nor the project groups experienced of referral and physiotherapy service delivery from the ward. impact on QOL thus a decrease in score represents a decrease Figure 1: Functional level of project and standard groups at admission, significant changes in any of the function components of Patients in the standard care group received physiotherapy in the severity of the symptom. discharge and mid-survival follow-up. At mid-survival follow-up assessment the QLQ-C30 questionnaire over the study period. However, from the staff physiotherapist rostered to the ward. Functional level and quality of life were assessed on admission, there were weak statistical (*p=0.09) and clinically significant differences noticeable trends existed within the two groups. The trend The trial service differed from the standard service in three at discharge and at regular intervals following discharge. between the project and standard groups. within the standard group (figure two) was towards a decline main ways: in function whereas the trend within the project group (figure Patient satisfaction of the physiotherapy service received was three) was towards improvement in function. Comparison 1 to overcome problems of delayed referral, patients were assessed at discharge and, where possible, at four week follow- of the functional independence measurement tool with the recruited on admission by the project physiotherapist; up and subsequent regular intervals. Subjects were asked to physical function component of the QLQ-C30 demonstrated rate a number of factors (amount of physiotherapy received, 2 the project physiotherapist limited her patient load to a weak but significant positive correlation (r = 0.629, *p < confidence in the abilities of the physiotherapist, consideration ensure that each patient received enhanced contact time, by the physiotherapist of the patient’s wishes, understanding thus reducing the problem of limited resources; and of advice and instructions given by the physiotherapist and 100 3 the project patients received regular community follow-up helpfulness of advice and instructions given by the treating visits following hospital discharge. physiotherapist) on a five point Likert scale. 80 Both groups received best-practice medical and nursing care In order to develop standards for practice, physiotherapist Admission appropriate to their condition. workload data were collated using a simple bar-code reader. Follow-up Time required for the management of various components of 60 The interventions undertaken by the project physiotherapist the episode of care was recorded when the bar-code reader were numerous and varied but can be grouped into three was scanned across bar-codes according to the intervention intervention categories commonly used by physiotherapists. 40 strategy employed. For reporting purposes, intervention Figure 2: Functional scores a Pain and symptom management, including transcutaneous strategies were grouped into major treatment categories. for standard group subjects electrical nerve stimulation (TENS), appropriate positioning (EORTC QLQ-C30) at 20 of patients to reduce stress on joints and muscles and to Results admission and follow-up. There prevent development of pressure areas, and the treatment was a trend towards decline in Results were analysed using Wilcoxon ranked data analysis and of lymphoedema by a combination of massage, compression function. chi-square frequency analysis. While the group numbers were 0 and exercise. Physical Role Emotional Cognitive Social QOL relatively low, resulting in weak levels of significance, there b Education provided by the physiotherapist covered topics were distinct differences between groups. including safe and comfortable transfer and handling Length of stay, discharge destination and place of death techniques to minimise discomfort and injury to both the Participants in the project group were more likely to be patient and carer, and techniques to reduce work associated discharged home than those in the standard group (p=0.0858). with activities of daily living. Patients in the project group were also more likely to die c Mobility and independence were maximised by designing at home (p=0.0159). There was no statistically significant 100 exercise programs specific to the individuals’ needs, difference in length of stay (LOS) between groups. Patients in Admission providing gait re-education and the provision of appropriate the project group had a mean LOS of 17.55 days, and patients walking aids. in the group that received standard care had a mean LOS of 80 Follow-up The trial outcomes were assessed with respect to: 15.6 days. • discharge destination; Functional level 60 • place of death; A comparison of the functional level between the groups was performed using a post-discharge assessment score obtained • functional level; 40 at a time that was half way between the date of discharge and Figure 3: Functional scores • patient satisfaction; and the date of the patients’ death. This method was chosen to for project group subjects (EORTC • quality of life (EORTC QLQC30). ensure that the groups were comparable with respect to extent QLQ-C30) at 20 of disease and the stage of decline. admission and follow-up. There The functional level of the subjects was measured using a tool was a trend towards improvement developed for the project that assessed nine tasks. The tasks At admission and discharge, patients in the project group had in function. assessed were ability to roll in bed, transferring from side-lying mean functional independence scores of 16.5 (supervision 0 Physical Role Emotional Cognitive Social QOL to sitting up, sitting, transferring from sitting to standing, to complete some tasks) and 15.5 while the standard group

16 Cancer Forum n Volume 27 Number 1 n March 2003 Cancer Forum n Volume 27 Number 1 n March 2003 17 ARTICLE ARTICLE For symptom impact scores between admission and follow- experienced statistically significant decreases in fatigue (**p Discussion the project service increased the variety and effectiveness of the up, the standard group experienced a statistically significant = 0.08), pain (***p = 0.052) and appetite disturbance (*p = physiotherapy interventions undertaken. Length of stay, discharge destination and place of death increase in constipation (**p = 0.027) and a significant 0.09). There were no significant differences in either group for Examination of the length of stay data revealed that patients While the difference in admission levels of functional decrease in sleep disturbance (*p = 0.075). The project group the remaining symptom components. in the project group had a mean stay of two days longer than independence between the project and standard groups may be viewed as significant clinically, the difference reflects a 100 those in the standard group. The specific reason for this was not apparent from the analysis, however it was noted that in crucial variable potentially affecting outcomes for physiotherapy Admission general a higher proportion of patients in the project group intervention in palliative care. The ability to provide timely 80 Follow-up died during admission. This may denote a difference in severity intervention is essential to maximise outcomes. The results of illness status not discernible by other means. from the standard group indicate that due to referral practices in existence at the time of this study, there was a population of 60 ** Patients in the standard group were more likely to be patients passively being denied access to physiotherapy when discharged to another care facility instead of home than Figure 4: Symptom impact they clearly had indicators for physiotherapy. * those in the project group. In order to determine whether this scores for standard group subjects outcome was a consequence of stage or severity of disease While the level of statistical significance is weak, there 40 (EORTC QLQ-C30) at admission or of diagnosis, further examination of the demographics of were distinct clinical differences between groups in patients’ and follow-up. Symptoms of functional abilities. Such differences could be considered to constipation increased (**p = the patients in the standard group revealed that the subjects 20 have greater clinical significance when attached to related 0.027) and sleep disturbance were a representative sample of all patients normally admitted factors such as quality of life and ability to function effectively decreased (*p = 0.075) significantly. to the ward. The fact that patients assigned to the project group were more likely to be discharged home than patients in the home. The comparison of the functional independence 0 measurement tool with the physical function component of Constipation Sleep Pain Fatigue Appetite in the standard group was considered to be a positive outcome of the study. Anecdotal evidence suggests that there is an the QLQ-C30 demonstrated a significant positive correlation, increasing trend towards patients and families wishing to care suggesting that the components assessed were representative for loved ones in the home environment. Where possible, and of factors contributing to the quality of life of the patients. At mid-survival follow-up, the patients in the standard group 100 due to shortages of beds in extended care facilities, the aim of discharge facilitation on the oncology ward is to discharge the required light to moderate assistance of a carer with all tasks, while patients in the project group were independent with the Admission patient home where possible, if the family and patient desire use of a walking aid in all tasks. The level of independence alone 80 Follow-up this outcome and are in a position to facilitate it. strongly supports the benefits of optimising physiotherapy in The success of follow-up community physiotherapy among outcomes for patients requiring palliative care. The deterioration *** ** project group patients was affirmed by the fact that more 60 noted in the standard care group of patients has an impact on patients in the project group were likely to die at home than the amount of carer support required, the costs of that support Figure 5: Symptom impact those patients in the group that received standard care limited (financial, physical and psychological) and the potential need scores for project group subjects by lack of physiotherapist time, resources and community for re-admission to a formal care facility with the attendant 40 * (EORTC QLQ-C30) follow-up. When considering the place of death, it is important at admission and follow-up. costs of such care. to remember that some patients elect to be admitted to a Symptoms of pain (***p = 0.052), Quality of life 20 fatigue (**p = 0.08) formal care facility in preference to dying at home. While there are many factors that influence a person’s ability to remain Patients in neither the standard nor the project group and appetite decreased experienced significant changes in any of the function (*p = 0.09) significantly. at home until death, the ability of the carer(s) to effectively 0 components over the study period. However, noticeable Constipation Sleep Pain Fatigue Appetite manage is a primary concern. The ability of the patient to move or be moved is a major component of the ability to cope at trends existed within the two groups. The trend within the home. The greater proportion of project group patients dying standard group was toward a decline in function, whereas the at home suggests that the contribution of physiotherapy to the trend within the project group was towards improvement in maintenance of mobility and function enhanced the choice of function. These trends are verified by the results acquired from Patient satisfaction Physiotherapist workload data place of death. the functional independence measurement tool. Both the standard and project groups were satisfied with The average times devoted to physiotherapy management While it is intuitively appealing to make sweeping claims from the physiotherapy services received during admission (figure of patients in the project group and the standard group are Functional level these results, it would be unwise to do so in the context of presented in table one. On admission, the project group had a higher level of functional six). For the question regarding the understanding of advice the lack of supporting data regarding pharmacological, dietary independence. This was not considered to be sampling bias but and instructions given by the physiotherapist, patients in the Table 1: Average duration of intervention (minutes:seconds) for each and other factors that may have influenced these results. It is rather a reflection of referral practices on the ward. Patients project group were significantly more satisfied (*p=0.05) than group of patients interesting to note though, that the patients in the standard were randomly recruited to the project group on the initiative those in the standard group. group experienced an improvement in symptoms during the of the project physiotherapist as sufficient time and resources Intervention Standard group Project group inpatient period followed by a decline in five of six function 5 became available through the discharge or death of other Chart review 5:19 9:06 components assessed at follow-up to a point below the patients. Patients recruited to the project group were newly 4 Chart entry 3:39 8:43 admission score. Conversely, the project group maintained Standard admitted patients whose medical notes identified an indication group Cardiorespiratory 12:06 18:24 or improved function in all but one component over the 3 for physiotherapy intervention and who had not at that time Project assessment same period. The results for each group are similar in the group and treatment been referred for physiotherapy. Conversely, patients in the

Rating 2 scores for symptom impact over the same time course. The standard group were those who may have had indications for Mobility assessment 13:10 21:42 links between quality of life factors, well-being, follow-up and treatment physiotherapy intervention at admission but who were not 1 and physical independence/activity have been noted by other Pain assessment 10:58 15:57 referred to the ward physiotherapist by medical or nursing staff authors10-12 and so it would seem reasonable to conclude that 0 and treatment until some time after admission. Such referral was often based the maintenance of independence and physical activity, along Handover/referral 4:14 11:17 on the inability of the patient to manage functionally on the with community follow-up, were likely to have been directly Amount Initial assessment Not available 60 ward even though he or she had been managing earlier in the Confidence Helpfulness related to quality of life scores noted in the project group. ConsiderationUnderstanding and treatment admission. The ward physiotherapist had 15 years of clinical Figure 6: Patient satisfaction for project and standard groups. Follow-up assessment Not available 40 experience and had been working in the field of chronic care Patient satisfaction Understanding of advice and instructions given by the treating and treatment and palliative care over a number of years leading up to this While satisfaction with various aspects of physiotherapy services physiotherapist was significantly better among patients in the project Discharge assessment Not available 80 study. The increased human and material resources available to was high among patients of both groups, patients in the group (*p=0.05). session the project physiotherapist, and the palliative-specific focus of project group were significantly more satisfied with the advice

18 Cancer Forum n Volume 27 Number 1 n March 2003 Cancer Forum n Volume 27 Number 1 n March 2003 19 Reports 21 $15,705 $66,940 $75,548 $63,167 $31,123 $70,000 $70,000 $69,500 $80,000 $80,000 $60,000 $71,649 $36,200 $70,000 $55,000 $13,000 $211,000 $141,800 $135,000 $134,620 $510,320 cancer: a double blind randomised clinical trial Tumour Angiogenesis relapsed leukaemia post stem cell transplantation hormones and the human homologue of the mouse mammary tumour virus Antidepressants and subjective well-being in advanced specific clonal CD8 T cells using TCR transfectants Development of targeted immunotherapy to treat The aetiology of breast cancer and the involvement of diet, cessation intervention in a surgical pre-admission clinic Identification of the specificity of potential myeloma decision aids in patients with incurable metastatic cancer A randomised controlled trial of a computerised smoking and prognosis When the treatment goal is not cure: a randomised trial of MRI/MRS applied to breast cancer detection, diagnosis pathogenesis of hyperplastic polyps and colorectal cancer pathogenesis of hyperplastic polyps and colorectal Tasmania and a national clinical follow-up core Role of 1,25dihydroxyvitamin D3 in photoprotection childhood acute lymphoblastic leukaemia The significance of CpG island methylation in the - WA, Molecular epidemiology of ovarian cancer study prostate cancer Regulation of beta-catenin nuclear trafficking in cancer immune system Targeting angiogenesis signalling pathways in acute lymphoblastic leukaemia The role of FHL1 and SPINK1 in androgen-independent recipients: incidence, risk factors and survival the Sensitization of human melanoma to killing by in mediated via SAP-associating surface receptors health and disease Molecular mechanisms of drug resistance in childhood familial breast cancer Cancer in dialysis patients and kidney transplant Lymphocyte activation and anti-tumour immunity kConFab: A national consortium for research into kConFab: A national consortium for research into Sentinel node vs axillary clearance trial

March 2003 n REPORTS Volume 27 Number 1 n upport for research 2003 upport for S University of NSW Centre for RESEARCH GRANTS RESEARCH GRANTS PROJECT RESEARCH CONTINUING NHMRC Clinical Trials Centre P Hogg Children’s Cancer Institute Australia for Medical Research W Rawlinson SEALS, Prince of Wales Hospital (South Eastern Area Laboratory Service) M Stockler Centenary Institute of Cancer Medicine and Cell Biology A Rice Hunter Centre for Health Advancement D Joshua University of Sydney J Wiggers Institute of Magnetic Resonance Research M Tattersall University of Sydney C Mountford St Vincent’s Hospital A deFazio Westmead Institute for Cancer Research Westmead Institute for Cancer Research R Mason Children’s Cancer Institute Australia for Medical Research R Ward University of Sydney B Henderson Newcastle Mater Misericordiae Hospital R Lock Children’s Cancer Institute Australia for Medical Research Q Dong National Centre in HIV Epidemiology and Clinical Research, University of NSW P Hersey Centenary Institute of Cancer Medicine and Cell Biology R Lock Westmead Hospital A Grulich Collaborative Health Education Research Centre, St Vincent’s Hospital S Tangye Cancer Forum The state and territory cancer organisations, which comprise The Cancer Council Australia, are the major sponsors of cancer The Cancer Council Australia, are the cancer organisations, which comprise The state and territory from funds derived a competitive, peer-reviewed assessment activities in Australia. Grants are made following research and related from donations and bequests. grants is $20 million. In 2003 the value of these listed. The Foundation has National Breast Cancer Foundation are for breast cancer research made by the In addition, the grants in all aspects of breast Board of Trustees to encourage research the Federal Government, with an independent been established by cancer. NSW COUNCIL CANCER THE J Kirk Total research grants J Stevens March 2003 n Volume 27 Number 1 n Cancer Forum , 25 Geriatrics, 25 J Zislis. “Rehabilitation of the cancer patient.” (1970):150-8. , 2 N Mayer “Concepts in cancer rehabilitation.” Seminars in Oncology (1975): 393-8. R Woodruff. Palliative Medicine: Symptomatic and Supportive Care for Patients with Advanced Cancer and AIDS. Asperula, Melbourne, 1993. R Gray. “Physiotherapy” in D Doyle, G Hanks, N MacDonald (eds). The Oxford Textbook of Palliative Medicine. Oxford University Press, Oxford, 1993, pp530-4. D Doyle (ed). Terminal Care. Churchill Livingstone, Edinburgh, 1979. D Doyle. Caring for a Dying Relative. Oxford University Press, Oxford, 1984. D Doyle. Domiciliary Palliative Care: A Guide for the Primary Care Team. Oxford University Press, Oxford, 1994. GM Kiebert, K Welvaart, J Kievit. “Psychological effects of routine follow up on cancer patients after surgery.” European Journal of Surgery, 159 (1993): 601-7. AL Stewart, RD Hays, KB Wells, WH Rogers, KL Spritzer, S Greendfield. “Long-term functioning and well-being outcomes associated with the in conditions chronic with patients in exercise and activity physical medical outcomes study.” Journal of Clinical Epidemiology, 47 (1994): 719-30. MLS Vachon, L Kristjanson, I Higginson. “Psychosocial issues in palliative care.” and outcome of the process The patient, the family, and care: Journal of Pain and Symptom Management, 10 (1995): 142-50. EL Laakso and AJ McAuliffe, Physiotherapy needs of outpatient radiation therapy recipients. Unpublished, 2003. JH Dietz. “Rehabilitation of the cancer patient.” Medical Clinics of North America, 53 (1969): 607. H Rusk. Rehabilitation Medicine. CV Mosby Co, St Louis, 1969.

References 4 5 6 7 8 9 10 11 12 13 1 2 3 In summary, in comparison to the standard treatment group, the standard treatment in comparison to In summary, more likely were significantly the project group patients in to die significantly more likely home and to be discharged physiotherapy service provision of a specialised at home. The higher functional levels on follow-up resulted in significantly towards the maintenance or improvement assessment. A trend of quality of life and significant of the functional component in pain and appetite were noted improvements in fatigue, optimised levels of physiotherapy time patients who received provision of an adequately resourced and resources. The incorporating early intervention and physiotherapy service can contribute significantly to the community follow-up independence, patient satisfaction maintenance of functional care. palliative requiring patients among life of quality and in decreased demand for formal In turn, this may result A physiotherapist inpatient care and subsequent cost savings. produce to order in recommended is 1:12 of ratio inpatient to such results. Acknowledgements of the project and To Ms Elaine Unkles for her sponsorship Ms Pamela McNeil useful suggestions on the manuscript, project, the staff of (social worker) for her support during the and Royal Women’s the Division of Oncology, Royal Brisbane professionalism and Hospitals Health Service District, for their and carers the patients of all to and most in the study, interest who agreed to participate in the research. adjusted accordingly. adjusted Conclusion . 13 it is likely that the project model of service it is likely that the project model of service 9 would attract savings through the reduced utilisation of formal care facilities leading up to death. The nation-wide survey of physiotherapy service providers conducted in stage one found that those patients receiving minutes 10 than less of average an for so did physiotherapy per day. An examination of the workload data of the project physiotherapist identified the time required to conduct an effective assessment and treatment session was well in excess of this (table one). Clearly, the physiotherapy services currently being provided by palliative care services are inadequate and of level current of the inadequacy The outcome. impair severely service is even more apparent when considering the potential numbers of oncology inpatients (and outpatients) who do not receive any physiotherapy despite known indications and instructions given to them by the treating physiotherapist. physiotherapist. treating the by them to given instructions and able to and was more time had project physiotherapist As the intervention adequate patient workload to maintain adjust her would be the project group be expected that time, it may It is received. physiotherapy of amount the with satisfied more approaches individual skills or to emphasise that the important of subject the not were concerned physiotherapists the of service was way in which the but rather the this investigation of extensive knowledge base and skills delivered. Given the not surprising that the two groups were physiotherapists it is of the communication skills of the equally satisfied. Regardless the increased time available to the individual physiotherapists, would have influenced the ability to project physiotherapist of advice and instructions contributing ensure understanding general commentary was given in the to this result. Where that no patients reported dissatisfaction QLQ-C30, it was found professionals healthcare the of any by provided service the with involved in their care. Physiotherapist workload data by the project The individual treatment episodes provided ward the of those than longer were physiotherapist while the project physiotherapist. One must note that the study and her physiotherapist was employed solely for patient enhanced of provision the for quarantined was time the standard level of care, the ward physiotherapist providing medical busy three to service a provide to required was care of results the on Based clinic. outpatient specialist a and wards typical is situation latter the one), (stage survey nation-wide the public hospitals of physiotherapy work allocation in Australian providing palliative care services. services under the The cost of providing the physiotherapy the standard service. project model of care was greater than with each patient This was due to the increased time spent follow-up. However, as well as the addition of community death of place and destination discharge of comparison a less long-term formal indicates that the project group required analysis of the two care. While a detailed cost-efficiency without is not possible service delivery models of physiotherapy costs associated with further investigation, given the increased terminal stage care Given that all patients do not require daily treatment, and allowing time for administrative aspects associated with clinical positions, a conservative recommendation for physiotherapy staff to patient ratio is 1:12 based on the findings of this study. 120 minutes and in Community visits require approximately services where these occur, staff to patient ratios should be

ARTICLE 20 Reports 23 $4,241 $66,000 $56,799 $51,340 $69,658 $67,808 $54,505 $53,376 $64,197 $41,897 $66,808 $36,000 $57,866 $60,000 $103,478 $300,000 $235,000 $500,000 $150,000 $690,000 $330,000 $400,000 $466,667 $616,667 $2,853,039 $1,024,561 $5,749,958 in acute promyelocytic leukaemia model of colorectal tumorigenesis? Regulation of caspase-2 activation and its implications from 5FU chemotherapy for colorectal cancer patients stromal matrix by versican Do dietary interventions protect in a p53 deficient cancer using tumour-specific gene expression markers and immunobead RT-PCR Gender and anatomical site differences in the survival benefit Modulation of prostate cancer cell attachment to and IL-3 receptor signalling in leukaemic cells Detection of disseminated tumour cells in colorectal in operable breast cancer Role of the 14-3-3 family of proteins in human GM-CSF neoplasia in average risk asymptomatic subjects Sentinel lymph node biopsy versus axillary clearance Regulation of HIF-1a by PI3K signalling in breast cancer A comparison of screening tests for colorectal ovarian cancer study – Western Australia, Tasmania and a national clinical follow-up core molecular lesion in polycythemia vera A novel non-toxic approach to bone cancer therapy proteins and breast cancer cell response to chemotherapy proteins and breast cancer prostate cancer: a longitudinal study Molecular epidemiology of ovarian cancer : Australian of a An expression cloning strategy for identification neuroblastoma childhood cancer of breast and prostate pathophysiology Fellowship Cas Career Development Research adjuvant radiotherapy for regional control in patients with completely resected macroscopic nodal melanoma in The influence of coping strategies on outcomes Defining the cause and improving the treatment of the treatment and improving the cause Defining in the growth factor signalling Steroid and Carcinogenesis plus A randomised clinical trial of surgery versus surgery $1,769,932 March 2003 n Volume 27 Number 1 n RESEARCH FELLOWSHIP RESEARCH PROGRAMS RESEARCH OTHER Dept of Haematology Hanson Centre for Cancer Research Flinders Centre for Digestive Health Dept of Gastroenterology Flinders Medical Centre S Kumar B Iacopetta, A Ruszkiewica Dept of Surgery The Queen Elizabeth Hospital D Horsfall Dame Roma Mitchell Cancer Research Laboratories Hanson Institute Y Hu, G Young, R Le Leu Haematology-Oncology Dept The Queen Elizabeth Hospital P Hewett, J Moore, C Platell, Hanson Centre for Cancer Research IMVS J Hardingham, P Hewett Total other research programs Dept of Surgery University of Adelaide G Goodall Hanson Centre for Cancer Research IMVS M Guthridge, A Lopez Strategic research projects Dept of Gastroenterology and Hepatology Royal Perth Hospital G Gill, J Kollias, M Bochner, D Walsh Quality cancer research project Quality cancer research Dept of Orthopaedics and Trauma Royal Adelaide Hospital G Forbes, F Macrae, P Bampton, J Edwards Hereditary bowel cancer registers Hereditary bowel cancer Dept of Research Peter MacCallum Cancer Institute R D’Andrea Child Health Research Institute A Evdokiou, D Findlay, B Coventry Children’s Hospital Westmead Children’s Hospital Westmead program Cancer education research Clinical Epidemiology and Health Outcomes Unit Flinders Medical Centre D Bowtell, A deFazio, M Davy Children’s Cancer Institute Australia for Institute Australia Cancer Children’s Research Medical R Sutherland Institute of Medical Research The Garvan Institute Children’s Medical Research G O’Neill Unit Cancer Epidemiology Research M Smithers, J Thompson, M Henderson Division of Radiation Oncology Peter MacCallum Cancer Institute D Ben-Tovim, A Stapleton, C Pinnock Cancer Forum G Marshall G Marshall grants research program Total continuing R Reddel Total research fellowships Cancer Trials NSW TOTAL RESEARCH FUNDED AUSTRALIA THE CANCER COUNCIL SOUTH RESEARCH GRANTS J Ainslie, W McCarthy, B Burmeister, March 2003 n Volume 27 Number 1 n Cancer Forum 22 Thrombosis and Vascular Research and Vascular Thrombosis

Reports Reports 25 $450 $800 $800 $600 $650 TCCT TCCT DCLF DCLF $4,000 $1,000 $5,000 $3,300 $55,000 $60,000 $50,000 $70,000 $70,560 $16,660 $55,000 $47,900 $60,000 $15,000 $15,000 $45,000 $40,000 $35,000 $25,000 $35,000 $65,000 $235,000 $235,000 $308,860 neoplastic colonic cells methyltransferases on the intestinal epithelium Molecular regulation of migration in normal and engineered T cells The tumorigenic effect of overexpression of DNA regulate growth and progression in osteosarcoma Immunotherapy of cancer using genetically Cancer Council Victoria and Latrobe University) Cancer Council Victoria and Latrobe University) phosphorylation and oligomerization Urokinase plasminogen activator and osteoclast systems Cytogeneticists and also to attend the annual scientific and meeting of the Haematology Society of Australian New Zealand To undertake the Prostate Care Nurse Program (Distance Education under the auspices of The consequences for NK and T cell activation Regulation of the tumour suppressor PTEN by by distance education through Charles Sturt University, by distance education through Charles Sturt University, schools NSW and also to attend three compulsory residential Toward To attend a course on Chromosome to Genes: of best practice guidelines and Australasian Society Australian ovarian cancer study - Western Australia, Tasmania and a national clinical follow-up core MICA expression in malignant melanoma: Bereavement CARE Centre To commence a Graduate Diploma in Genetic Counselling coverage of cancer issues in non-small cell lung cancer Molecular epidemiology of ovarian cancer: transplantation – clinical results and patient outcomes transplantation – clinical arrest and terminal differentiation arrest and terminal stem cells for Long term storage of blood Dendritic Cells in Germany Counselling Course at The To attend a Bereavement Athol Meyer Award – for excellence in media regulation of colon/ovarian cancer growth and metastasis Tumour volume as an independent prognostic factor proteomics cancer using of breast Analysis study cancer ovarian The Australian growth basis of ceramide – mediated The molecular Sumposium on To attend the 7th International Athena Foniadakis Leukaemia Scholarship EGF-dependent alpha-v beta-6 integrin-mediated

March 2003 n Volume 27 Number 1 n Dept of Medicine Colon Molecular and Cellular Biology Unit Ludwig Institute for Cancer Research P Gibson, E Nice Cancer Immunology Research Laboratory Peter MacCallum Cancer Institute M Ernst, P Waring St Vincent’s Hospital P Darcy, J Trapani, M Smyth Registered Nurse Royal Hobart Hospital Dept of Biochemistry and Molecular Biology University of Melbourne P Choong, H Zhou Hospital Scientist Royal Hobart Hospital S Roper Total other research programs Dept of Microbiology and Immunology University of Melbourne H Cheng Genetic Co-ordinator Royal Hobart Hospital C Wren Familial bowel cancer registry support D Gertig, M Friedlander, P Harnett, M Davy, P Blomfield, N Zeps Peter MacCallum Cancer Institute A Brooks, E Maraskovsky

R Lowenthal Nurse Calvary Health Care S Bacic Support for clinical trial data managers Division of Radiation Oncology Peter MacCallum Cancer Institute D Bowtell, A de Fazio, D Wyld, D Whiteman, Royal Hobart Hospital University of Tasmania University of University of Tasmania of Tasmania University P Blomfield Hospital Royal Hobart University of Tasmania P Davies Oncology Nurse E Whinnett, C Kidd Royal Women’s Hospital D Ball RESEARCH GRANTS N Ahmed, M Quinn Cancer Forum R Lord Cancer Council and The Foundation Collins Leukaemia funded by David project jointly Following Tasmania S Ragg Total research grants JEANNE FOSTER SCHOLARSHIPS G Woods Total Jeanne Foster scholarships OTHER RESEARCH PROGRAMS A More TOTAL RESEARCH FUNDED THE CANCER COUNCIL VICTORIA $8,000 $69,757 $25,000 $61,000 $80,000 $68,268 $25,000 $65,041 $10,000 $60,926 $15,000 $47,800 $30,000 $10,000 $68,268 $20,000 $57,860 $60,607 $69,000 $70,165 $30,000 $57,860 $55,000 $62,200 $62,200 $515,000 $115,720 $100,000 $222,000 $124,400 March 2003 $2,201,447 $1,307,162 $1,307,162 n Volume 27 Number 1 n Cancer Forum

proctitis following radiotherapy for prostatic carcinoma

Natural history, pathophysiology and treatment of radiation Natural history, pathophysiology and treatment

approach to the treatment of metastatic prostate cancer approach to the treatment factor in tumourigenesis Role of the hypoxia inducible

and trans-acting factors in DNA instability in cancer and trans-acting factors receptors: a novel Dominant negative androgen

pulmonary metastases : The role of cis-acting elements Chromosomal fragile sites

Written information versus an interactive CD-ROM Written information versus as a strategy against Targeting TIMP gene delivery breast cancer glucuronosyltransferases and their role in colorectal and their glucuronosyltransferases cancer to chemotherapy : Improving informed consent Tasmania KConFab – A consortium for research on familial

resistant to the tyrosine kinase inhibitor imatinib (Glivec) the tyrosine kinase inhibitor resistant to UDP the chemical detoxifying Regulation of immature dendritic cells: Signalling molecules, potential pathways and intervention strategies The molecular genetics of familial prostate cancer in

of BCR/ABL biology of mutant forms Analysis of the Immunosuppression by carcinogen induced

kConFaB : A consortium for research on familial breast cancer breast on familial for research : A consortium kConFaB

24 Total of other research programs M Schoeman, F Bartholomeusz Dept of Radiation Oncology Royal Adelaide Hospital Radiation Therapy Scholarships Molecular Biosciences University of Adelaide E Yeoh, R Holloway, A Luck, Prostate Data Managers Program Chair in Cancer Research University of Adelaide D Peet M Whitelaw, J Gorman, Data Managers Program Dept of Molecular Biosciences University of Adelaide W Tilley, P Neufing, M Yang PhD Scholarship Dept of Thoracic Medicine R Richards Student vacation scholarships Royal Adelaide Hospital Cancer Centre Royal Adelaide Hospital Royal Adelaide Hospital P Reynolds, M Holmes Distinguished visitors Victorian Clinical Genetic Services Dept of Clinical Pharmacology Dept of Clinical Flinders Medical Centre I Olver University of Tasmania D Amor Travel grants Total fellowships Division of Haematology IMVS P Mackenzie University of Tasmania J McKay Chair in Cancer Care – I Olver G Buchanan, University of Adelaide J Goldblatt G Suthers, Laboratory Consortium Breast Cancer Victorian Hall Institute Walter and Eliza Hughes AB Lyons, T RESEARCH GRANTS G Woods TOTAL RESEARCH FUNDED THE CANCER COUNCIL TASMANIA OTHER RESEARCH PROGRAMS FOR 2003 Centre for Cancer Control Research D Peet, University of Adelaide FELLOWSHIP PETER NELSON LEUKAEMIA RESEARCH R D’Andrea, Child Health Research Institute W BRUCE HALL CANCER RESEARCH FELLOWSHIP FELLOWSHIPS A Evdokiou, Hanson Centre C Hahn, Hanson Centre for Cancer Research Total research grants SENIOR FELLOWSHIPS S Stephenson, The Queen Elizabeth Hospital Total senior fellowships G Lindeman, D Amor, J Kirk, D Amor, G Lindeman,

Reports Reports 27 $2,263 $6,788 $70,000 $57,035 $70,520 $72,590 $70,000 $70,000 $50,000 $72,590 $70,000 $72,590 $20,405 $93,888 $72,590 $27,150 $21,150 $21,150 $27,150 $70,000 $42,000 $340,000 $100,000 $922,000 $906,000 $412,000 $200,000 $109,000 $936,000 $199,763 $443,888 $109,000 $1,098,000 $7,047,151 familial breast cancer Comparison of quality of life and standard end-points prostate cancer: use of ejaculate for molecular profiling KconFab: A national consortium for research into susceptibility gene product p16CDKN2A Diagnosis and prediction of the natural history of tolerance to tumour antigen Mitotic regulation of the Ras/RafMEK/ERK pathway Mechanims of UV induction of the melanoma $4,614,000 as a potential leukaemic cell target Evaluating therapeutic interventions to overcome differentiation and morphogenesis antigens and bound to non-self-MHC molecules Characterisation of a new myeloid specific antigen protocadherin in T lymphocyte tumours Investigating the role of BRCA 1 in mammary T cell recognition of peptides derived from tumour $21,150 radiotherapy polymer gel dosimetry phantoms Australian Ovarian Cancer Study: WA, Tas, and a National Clinical Follow-up Core The role of truncated transcripts of the Fat of Development of ultrasonic scanner for evaluation Molecular epidemiology of ovarian cancer. The

March 2003 n Volume 27 Number 1 n J Goldblatt, J Sambrook, J Kirk Peter McCallum Cancer Institute, Melbourne A Green, K Horwood, D Wyld, A Clavarino M Lavin University of Queensland M Gattas G Lindeman, G Suthers, University of Queensland B Gabrielli UQ Centre for Immunology and Cancer Research RA Gardiner, J Clements, V Hyland, University of Queensland Centre for Immunology and Cancer Research B Gabrielli, J Hancock Walter and Eliza Hall Institute of Medical Research Walter and Eliza Hall Institute Council Victoria contribution to VicHealth Centre) VicHealth Centre for Tobacco Control (The Cancer Total cancer control research institute programs Mater Medical Research Institute I Frazer P Colman, Walter and Eliza Hall Institute of Medical Research P Colman, Walter and Eliza Lions Fellowship (variable) Centre for Clinical Research in Cancer University of Queensland S Burrows Queensland Institute of Medical Research G Clark A Roberts, Walter and Eliza Hall Institute of Medical Research A Roberts, Walter and Eliza K & H Fraser Fellowship Health 2000 Centre for Behavioural Research in Cancer Queensland Institute of Medical Research M Brown Research for Cancer Ludwig Institute H Gan, University Molecular Biology, Monash of Biochemistry and K Horan, Dept Institute MacCallum Cancer R Redvers, Peter Melbourne University of of Microbiology and Immunology, W Shi, Dept of Melbourne of Public Health, University J Stone, Dept of Melbourne of Medicine, University S Ting, Dept Vacation Studentships Hall Institute of Medical Research D Metcalf, Walter and Eliza Dunlop Fellowship Victorian Cancer Registry A Whittaker, D Schlect Queensland University of Technology D Bowtell Peter MacCallum Cancer Institute D Wyld, D Whiteman A Boyd, A Yap, G Burns Cancer Forum Research for Cancer Ludwig Institute S Foo, studentships Total scholarships and FELLOWSHIPS Carden Fellowship Total fellowships OTHER RESEARCH PROGRAMS Medical and scientific activities Total other research programs PROGRAMS CANCER CONTROL RESEARCH INSTITUTE Cancer Epidemiology Centre TOTAL RESEARCH FUNDED QUEENSLAND CANCER FUND RESEARCH GRANTS C Baldock, Y De Deene, B Healy, $5,288 $4,969 $60,000 $30,000 $60,000 $60,000 $60,000 $66,000 $55,000 $69,000 $70,000 $50,000 $60,000 $60,000 $20,000 $50,000 $50,000 $30,000 $55,000 $69,000 $21,150 $60,000 $60,000 $50,000 $27,500 $55,000 $21,150 March 2003 $1,598,000 $1,598,000 n Volume 27 Number 1 n Cancer Forum in zebrafish potential tumour suppressor genes Isolation and characterisation of leukaemia mutants SOCS genes in the mammary gland and other organs - FZD7 signalling in colon cancer Mechanisms of cross-presentation in dendritic cells processes in normal and malignant osteoblasts Protein phosphatases and mitosis metastatic spread of cancer Interactions between cell cycle and differentiation beta-3 integrin in cancer in the The role of vascular endothelial growth factors A structural investigation into the role of the alpha-v A structural investigation into the role of the alpha-v progenitor cells by all-trans retinoic acid Role of estrogens in prostate malignancy breast cancer immunity Enhancing ex vivo expansion of primitive haemopoietic The role of a novel suppressive T cell subset, Tr1, in The role of a novel suppressive T cell subset, Tr1, stage T3 adenocarcinoma of rectum The role of the proto-oncogene PU.1 in haemopoiesis polyphosphate 5-phosphatase: regulator of cell death polyphosphate 5-phosphatase: regulator of cell for A randomised trial of preoperative radiotherapy The characterization of a novel 108 kDa inositol The characterization of a novel 108 kDa inositol risk of hereditary colorectal cancer (CAPP2) risk of hereditary colorectal study Australian melanoma family breast cancer resistant starch in people at A trial of aspirin and/or melanoma: effects of Eph receptor activation on cell melanoma: effects of Eph viability during various stages adhesion, mobility and of melanoma progression for research on familial kConFab: A consortium inhibitors: novel anti-cancer drugs anti-cancer drugs inhibitors: novel in cutaneous interactions The role of EphA/ephrin-A

interacts with the CHK2 and PML tumour suppressors the CHK2 and PML tumour interacts with of action of histone deacetylase Mechanism

tumour suppression using both loss- and loss- and using both suppression tumour mutant mice gain-of-function protein that DNA damage response A novel human

An analysis of the Lyn tyrosine kinase in myeloid cell cell kinase in myeloid Lyn tyrosine of the An analysis $82,500 26 School of Biological and Chemical Sciences Deakin University Victorian Breast Cancer Research Consortium A Ward Peter MacCallum Cancer Institute J Visvader Immunology Division Walter and Eliza Hall Institute of Medical Research E Vincan, W Phillips Dept of Biochemistry and Molecular Biology Monash University J Villadangos Dept of Medicine University of Melbourne T Tiganis Melbourne Tumour Biology Branch Ludwig Institute for Cancer Research D Thomas, M Trivett Dept of Biochemistry and Molecular Biology Monash University S Stacker, M Achen Institute of Reproduction and Development Monash University J Rossjohn Division of Haematology and Medical Oncology Peter MacCallum Cancer Institute G Risbridger Austin Research Institute L Purton, D Haylock, P Simmons Immunology Division Walter and Eliza Hall Institute of Medical Research M Plebanski, I McKenzie Division of Radiation Oncology Peter MacCallum Cancer Institute S Nutt, L Wu Dept of Biochemistry and Molecular Biology Monash University S Ngan, S McLachlan, J MacKay, R Fisher G Giles, B Armstrong Dept of Public Health University of Melbourne C Mitchell Dept of Gastroenterology Dept of Gastroenterology Royal Melbourne Hospital R Kefford, G Mann, J Hopper, J Aitken, G Suthers, J Goldblatt Medical Oncology Dept of Haematology and Royal Melbourne Hospital F Macrae, B Leggett, J Jass Ludwig Institute for Cancer Research Ludwig Institute for Cancer Kirk, G Lindeman, D Amor, J Peter MacCallum Cancer Institute Peter MacCallum P Gibbs M Lackmann, L Dow, Peter MacCallum Cancer Institute Institute of Medical Research St Vincent’s R Johnstone A Deans, Peter MacCallum Cancer Institute Melbourne Tumour Biology Branch Biology Branch Tumour Melbourne for Cancer Research Ludwig Institute J Heierhorst R Jarred, Monash Institute of Reproduction and Development Y Cao, Baker Medical Research Institute POSTGRADUATE RESEARCH SCHOLARSHIPS AND VACATION STUDENTSHIPS J Becanovic, Dept of Biochemistry and Molecular Biology, Monash University N Haynes, Peter MacCallum Cancer Institute Total post-doctoral research fellowships Total research grants POST-DOCTORAL RESEARCH FELLOWSHIPS Monash University Monash A Dunn M Hibbs, K Harder,

Reports Reports 29 $36,000 $55,000 $55,000 $54,800 $55,000 $27,500 $55,000 $31,423 $43,670 $47,272 $44,540 $19,500 $55,000 $14,937 $27,000 $55,000 $19,500 $19,500 $19,500 $21,500 $19,500 $19,500 $21,000 $19,500 $19,500 $88,210 $159,600 $198,500 $520,000 $100,000 $232,002 $679,600 $4,069,896 $4,069,896 Ovarian Cancer Study - WA, TAS and a national clinical follow-up core hepatitis C on hepatic oval cells and risk for hepatocellular carcinoma Molecular epidemiology of ovarian cancer: The Australian tumour-infiltrating T cells and tumour growth Determining the effects of antiviral therapy of chronic a prospective cohort study nitroreduction and phase II metabolism Evaluating the effects of intra-tumoural cytokine therapy on into familial aspects of breast cancer Tea consumption and epithelial ovarian cancer survival: Enhancement of cancer gene therapy by combination of endogenous antigens kConFab: The Kathleen Cunningham Consortium for research in average risk asymptomatic subjects Induction of anti-tumour immunity by manipulation of cells by adenoviruses A comparison of screening tests for colorectal neoplasia cell lymphoma An investigation of the specific targeting of cancer YY 1 and AP 1 expression in anaplastic large

March 2003 n Volume 27 Number 1 n Peter MacCallum Cancer Institute Sir Charles Gairdner Hospital Department of Medicine University of Western Australia D Bowtell, N Zeps, I Hammond Department of Medicine University of Western Australia J Olynyk, J McHutchison, G Yeoh School of Public Health Curtin University of Technology R Minchin Laboratory for Cancer Medicine University of Western Australia D Nelson, B Robinson Genetic Services of WA King Edward Memorial Hospital and Princess Margaret Hospital A Lee, C Binns, X Xie, W Lu School of Pharmacy Curtin University of Technology G Lindeman, J Goldblatt Department of Gastroenterology and Hepatology Royal Perth Hospital M Garlepp, S Fox School of Pharmacy Curtin University of Technology G Forbes, J Edwards, R Mendelson, L Fritschi QCF Behavioural Research Unit QCF Behavioural Research registry Australian paediatric cancer Total PhD scholarship program School of Biomedical and Chemical Sciences University of Western Australia B Dix Cancer Forum study of – A case in Queensland of cancer experience UQ: The ethnic Science of Social QCF/School in Brisbane communities and Vietnamese the Chinese oncology) (psychosocial support centre Cancer University: QCF/Griffith science, molecular Biosciences UQ: Genetic Institute for Molecular of Population Health and QCF/School of cancer for the cure and prevention of future prospects and the public’s perceptions biotechnology needs of colorectal Quality of life and unmet of Psychology UQ: of Public Health, QUT/School QCF/School and treatment at the time of diagnosis cancer patients studies Total collaborative BEHAVIOURAL RESEARCH PROGRAMS EPIDEMIOLOGY AND Unit QCF Cancer Epidemiology behavioural research programs Total epidemiology and OTHER RESEARCH GRANTS register Familial adenomatous polyposis Total other research grants PROGRAM PhD SCHOLARSHIP 2001 – 2003 of Queensland R Ali, Dept Physiology and Pharmacology, University Institute of Medical Research S Duffy, Division of Cancer and Cell Biology, Queensland University S Wright, George Roberts Scholar, NQ Dept Physiology and Pharmacology, James Cook 2002 – 2004 M Rinaldis, 2002 John Earnshaw Scholar School of Psychology, University of Queensland University S Joseph, Institute for Molecular Bioscience, Queensland of Medical Research L Papp, Signal Transduction Lab, Queensland Institute 2003 – 2005 Institute of Medical Research L Packer, 2003 John Earnshaw Scholar Division of Cancer and Cell Biology, Queensland Queensland Institute of Medical Research K Jawerth, Division of Cancer Immunotherapy, Institute of Medical Research E Hacker, Division of Cancer and Cell Biology, Queensland R Parlett, Mater Medical Research Institute TOTAL RESEARCH FUNDED WA CANCER FOUNDATION OF RESEARCH GRANTS L Abraham, D Spagnolo $67,410 $72,590 $70,000 $72,590 $72,590 $70,000 $72,590 $70,000 $70,000 $72,590 $70,000 $65,000 $72,590 $70,000 $70,000 $70,000 $72,590 $72,590 $72,590 $70,000 $70,000 $70,000 $70,000 $70,000 $70,000 $95,569 $35,100 $20,100 $35,065 $145,180 $150,769 March 2003 $2,720,815 n Volume 27 Number 1 n Cancer Forum the expression of papillomavirus late genes? Predicting lung cancer metastases and assessment of its role in breast cancer predisposition How does tRNA correlate with codon usage to regulate by the cell adhesion molecule, e-cadherin Analysis of a novel X-linked gene which interacts with BRCA1 of a novel strategy for enhancing radio-therapeutic efficacy Regulation of tumour cell locomotility and invasiveness melanoma development Gene therapy for non small cell lung cancer (NSCLC): the development protein complex in the proliferation, migration and metastasis of breast cancer cells Delineation of the key molecular events that underlie Functional characterisation of a novel IGF-binding Functional characterisation of a novel IGF-binding cancer; their regeneration by novel Kunjim vaccines cancer; their regeneration by novel Kunjim vaccines invasion Extracellular thioredoxin and breast cancer cell effects of high doses of systemic morphine Sustained CD8+ T cell effectors for protection against pathways relevant to skin cancer Pharmacological investigation of the toxicological dendritic cells in patients with metastatic malignancy dendritic cells in patients with metastatic malignancy Understanding and controlling gene expression malignant cells: mechanisms and potential application Phase I study of alpha-galactosyl ceramide pulsed breast tumorigenic cells in Vitamin E analogues as selective inducers of apoptosis The plasma membrane calcium ATPase (PMCA) in The plasma membrane calcium ATPase (PMCA) improve diagnosis, define targets for immunotherapy improve diagnosis, define targets for immunotherapy and understand the biology of ovarian cancer Australian melanoma family study granulocyte-monocyte lineage Exploiting the discovery of the CA125 gene to The roles of Nek2 and TLK 1/2 in mediating BRCA1 genome surveillance The roles of Nek2 and TLK 1/2 in mediating BRCA1 Modulation of graft-versus-host disease by the responses in Hodgkin’s Disease responses in Hodgkin’s Grant The John McCaffrey Memorial 205/DCL-1 expressed in Hodgkin’s Lymphoma 205/DCL-1 expressed in cytotoxic T Cell Profiling dynamics of EBV-specific CTL responses and its implication for tumour clearance CTL responses and its implication fusion transcript of dEC- Characterisation of novel model of tumour immunity model of tumour immunity deviation of tumour-specific Interleukin 4-driven immune doctors’ care of dying patients memory CD8T cells in a Functional plasticity of multiple endocrine neoplasia multiple endocrine to improve of a structured intervention The impact associate antigens for multiple myeloma associate antigens of to understand the development Mouse models couple-based coping program “CanCOPE” for men “CanCOPE” program coping couple-based their partners prostate cancer and with early stage defined tumour DC vaccination with Purified blood of chemotherapy in advanced ovarian cancer in advanced of chemotherapy of a self-directed, evaluation and Development

28 L Clarke, E Duhig Prince Charles Hospital University of Queensland P Zimmerman, K Fong, M Colosimo, Queensland Institute of Medical Research K Zhao, I Frazer University of Queensland D Young, A Spurdle University of Queensland A Yapp, S Grimmond Queensland Institute of Medical Research M Wei, J Ramsay, S Scott, P Chen S McElwain Queensland University of Technology G Walker, I Tonks, S Pavey, N Hayward, G Kay Griffith University Z Upton, D Leavesley, L Chopin, Queensland Institute of Medical Research K Tonissen, F Clarke University of Queensland A Suhrbier Queensland Institute Medical Research M Smith, G Monteith University of Queensland P Parsons, G Boyle Queensland Institute of Medical Research A Nicol, D MacFarlane, R Abraham University of Queensland J Neuzil, L Baseler, A Azzi University of Sydney J Aitken G Monteith, S Roberts-Thomson Mater Medical Research Institute G Mann Queensland Institute of Medical Research M McGuckin, A Lopez Queensland Institute of Medical Research K MacDonald, R Thomas, G Hill S Elliott, P Marlton Medical Research Queensland Institute of D Krause, KK Khanna Mater Medical Research Institute Mater Medical Research Wolf, R Khanna, J Seymour, M Queensland Institute of Medical Research Queensland Institute of K Masato, D Hart Queensland Institute of Medical Research Queensland Institute of N Kienzle, A Kelso J Turner, M Robertson Dept of Psychiatry University of Queensland A Kelso Institute of Medical Research Queensland F Varghese, G Mitchell, B Kelly, P Burnett, Mater Medical Research Institute Mater Medical G Kay N Hayward, University Griffith D Hart M McGuckin, Mater Medical Research Institute QCF Clinical Research Fellow 2003 G Buter, Cancer Epidemiology Group, Queensland Institute Medical Research NQ Cancer Control Scholarship M Nowak, James Cook University, Townsville COLLABORATIVE STUDIES QCF/QUT: Cancer patients’ supportive care needs, awareness and use: Patient and provider perspectives Total fellowships and scholarships Total research grants FELLOWSHIPS AND SCHOLARSHIPS QCF Senior Research Fellow Research of Medical Institute Queensland K Halford, S Steginga, J Scott S Steginga, K Halford,

Reports Reports 31 In each case the more cautious Australian approach won the won approach Australian more cautious case the In each of on management workshop concurrent A vote. audiences leaders major local and overseas with input by liver metastases, followed by This was was running simultaneously. in the field of the ALLG and achievements on the activities a presentation session led needed debriefing and finally, a and ANZBCTG, Burn out in Paul Heinrich on Stewart Dunn and by Professor of Darius Razavi was a much professionals with the assistance attendees. needed change for all our and Gilbert Rozanne to go must thanks of vote huge A executive officer Lawrie Wright, his final amazingly organised off as an impeccably run and efficient COSA meeting pulled shoe string budget! meeting on the usual over 750 delegates and the format The meeting attracted The Perth meeting for 2003 appearsseemed much appreciated. format and should not to be missed! to be following a similar Dr David Goldstein Convenor and death, and some fear they may be randomised to a be randomised to a and death, and some fear they may placebo arm. only relate to drugs Delegates said many people believe trials involving surgery and – they aren’t aware there are also trials Some cancer trials. radiotherapy, as well as non-treatment are involved in trials. people perceive that only public hospitals on fiction rather Many of these negative perceptions are based better information. than fact, and could be redressed through information A lack of high quality, balanced, easily accessible health professionals about clinical trials – both for patients and This includes – was identified as a key barrier to participation. they work as well as information about what trials are and how patients can become which trials are available, where, and how included lack involved. Other barriers to participation identified of health professional support for trials, geographical issues, lack of home support, inadequate government funding, and fears about being treated with something other than standard therapy. Suggestions for overcoming barriers to participation included development of a national clinical trials registry, increased funding for trials, better information for patients (particularly at the time of diagnosis), education of clinicians, longer medical the trials, discuss to opportunity the allow to appointments development of support networks for trials participants, and public awareness campaigns. trials of clinical awareness increase to undertook Delegates in cancer through their networks, and The Cancer Council Australia and other interested parties are working towards implementing some of the key recommendations from the meeting. The Cancer Council Australia thanks Linda Reaby, Sally Crossing and Russell McGowan for their assistance in planning the open forum and the many speakers and delegates who took part, their for Group Truffle and House Opera Sydney as the well as pro bono support. Jennifer Denholm The Cancer Council Australia March 2003 n Volume 27 Number 1 n against and Professor Charles Balch for); against and Professor Gabriel Hortobyagi for); Forbes against and Professor Joseph Lynch for); and against and Professor Ivan Thompson for). adjuvant therapy of melanoma (Professor Peter Hersey melanoma (Professor Peter Hersey adjuvant therapy of for breast cancer (Professor John tamoxifen as prophylaxis Young Graeme (Professor screening cancer colorectal and Professor prostate screening (Dr Geoff Hirst against linical trials in cancer: an open forum linical trials in cancer: an open • • • • • C for consumers Cancer Forum Cassandra Hobbs and Alison Read with “The new way home:new way with “The Read and Alison Hobbs Cassandra patients”. haematology for oncology/ the gap Bridging the food enjoyed partners and members 250 over evening That with the memorable dinner at the annual and entertainment city lights at night. view of the a including content of truly a marathon day was The final care by Dr and cancer the impact of cytokines plenary on of the pioneers in the field) and Dr Ian George Morstyn (one debate great ASCO/COSA joint The Melbourne. from Davis covered four major controversies: cancer would be an A national register of clinical trials in in trials, important step forward in improving participation delegates to this meeting agreed. Sydney the at forum open the attended people 70 About Opera House on October 24 last year. the meeting Australia, by The Cancer Council Organised and awareness of was aimed at boosting understanding increased for support harnessing and cancer, in trials clinical participation. cancer, representatives Meeting participants included people with researchers, clinical of cancer advocacy and support groups, trials coordinators, and health professionals. The Cancer Council In opening the meeting the President of Australia, Professor Ray Lowenthal, said the evidence shows that clinical trials lead to better health outcomes for the patients involved in them, and they contribute to all Australians receiving the best and most up-to-date medical care. “Australia is helping lead the way in trials research, but participation rates are still low – fewer than one in 20 Australians who have cancer currently take part in clinical trials,” he told the meeting. “We’re keen to see this change, and we want to enlist the support of as many people as possible to do this.” Background briefings and presentations from experts including for scene the set ethicists and researchers participants, trial discussions about community perceptions of clinical trials and whether these perceptions are based on fact or fiction, as well as barriers to participation in clinical trials and how they can be overcome. The meeting heard that many people with cancer aren’t aware not trials are trials – part in to take opportunity have the they widely publicised, and many doctors do not offer them. Delegates agreed that some patients perceive trial participants last a as involvement see they that and pigs”, “guinea as resort, after standard therapy has failed. Many people fear effects side of risk their increase will trials in participation that March 2003 n Volume 27 Number 1 n Cancer Forum on minimally invasive surgery and mammography/ultrasound. mammography/ultrasound. invasive surgery and on minimally sessions on and well-attended had comprehensive All the groups and survival geographic as epidemiology, including issues such health of unmet needs, and assessment analysis, communication and drug research symposium, research, a new services delivery innovative support programs.patient care issues and the wares of the Mudgee region A wine tasting highlighting capped a busy day. “meet of range a wide provide to able was meeting The including “Good practice in surgical the professor” sessions Irving Taylor (sponsored by the oncology” by Professor cancer and HRT” by Kathy Pritchard, Surgical Society), “Breast by Dorothy Keefe, “Advances “Management of mucositis” by David Ball and Andrew Turrisi in radiation oncology” by Darius quality of life” “Assessing (sponsored by Aventis), Cancer Breast National the by sponsored (jointly Razavi the Head and Neck Centre), and Ian Tannock (sponsored with literature”. Society) on “Critical interpretation of medical Governor of NSW,The formal opening by Professor Marie Bashir, by a keynoteon the second day of the meeting was followed horizons inaddress by Professor Rick Kefford on molecular knowledgemolecular of translation the of overview His treatment. clinic was forceful andto the delivery of novel therapies in the educational, with an outstanding use of multimedia. management of lung State of the art symposia were held in all disciplines from and breast cancer, with participation of basic science to palliative care. the best” abstracts A highlight of the day was the “best of by each group session. Five presentations, originally nominated were presented. Our and narrowed down by a larger panel, main the of Winners presentations. the judged guests overseas by Pharmacia and Eli international travel prizes kindly donated on “Behavioural paper her for Patsy Yates Professor were Lilly Graham Giles for intervention for cancer pain” and Professor associated with his paper on the “Risk of colorectal cancer food consumption”. A further travel prize by Mayne Pharma was given to Dr Rebecca Hagerty for her paper on “Metastatic cancers”, and book prizes to Dr Trevor Leong for “Radiation in gastric cancer” and Dr Michael Dooley for “Dosing in obese patients”. importance like no other the great This session highlighted of COSA to cancer care delivery in Australia. A session of an epidemiologist, the best research in the meeting included a professor of nursing, a pharmacist, a psychologist and a radiation oncologist, all sharing the podium. No other cancer society in the world successfully combines the talents of so of care the in involved professionals health different many cancer patients. The MOG Pierre Fabre award lecture was by Professor Lester Peters, one of the most famous radiation oncologists Australia has produced, on the international study headed by him and Dr Danny Rischin on a novel approach to treatment of head and neck cancer with a new radiosensitiser tirapazamine. Concurrent workshops on sexuality and cancer, clinical trials recruitment, an update on hereditary cancer and on dealing with cancer in the family meant attendees were never short of options for learning opportunities. Lunch was also combined with poster reviewing and judging of the best awards. The winners were Dr Sayed Rizvi with “Targeting alpha therapy of breast cancer”, and ROM BENCH TO BEDSIDE AND BACK AGAIN BACK AND TO BEDSIDE BENCH ROM F 30 Prof Marie Bashir, Governer of NSW, opening the 29th conference. The 29th annual scientific meeting of COSA was held at at held was COSA of meeting scientific annual 29th The meeting This 2002. November in Sydney in Harbour Darling meeting, the previous Brisbane a departure from represented number of competing group sessions with a decrease in the multidisciplinary and sessions joint on emphasis an and presentations and symposia. of a wide range of speakers, courtesy Delegates heard from or preceding meetings. Joint sessions a number of concurrent Second Sino Australian New Zealand were held with the Oncology, the Australian Society for Conference on Surgical Australian Association of Cancer Registries Breast Diseases, the of Clinical Oncology. and the American Society to individual group meetings. TheThe first day was devoted – with standing room only – was themost heavily attended on SurgicalSecond Sino Australian New Zealand Conference with equivalentOncology, where presentations were made surgeons in colorectalcontributions from Australian and Chinese Major overseascancer, oesophageal, gastric and breast cancers. faculty and Professorspeakers included a distinguished Chinese cancer related liverIrving Taylor from the UK on colorectal from the Netherlandsmetastases, and Dr Hans Bonnenkamp of the largest surgicalon gastric surgery. This proved to be one tolead will it hope we and COSA, at held ever sessions oncology meetings.an increased presence of surgeons at future and for Breast Diseases Society the Australian Concurrently, to Filled program. day-long a held COSA of Group Breast the invasive surgery, capacity, the presentations included minimally of survivorship. In diagnostics, adjuvant therapy and issues speakers included addition to a stellar local cast, the overseas who did a major Professor Kathy Pritchard from Toronto therapy and on HRT, presentation on hormones in adjuvant work on fatigue and Professor Ian Tannock presenting novel and Jay Harness cognitive dysfunction after adjuvant therapy, COSA Annual Scientific Meeting 2002 Scientific Meeting COSA Annual

Reports Reports Reports

Australian Behavioural Research in Cancer to important geographic differences. Fewer women, who are Moralisation, disgust and young people’s response socio-economically disadvantaged and from the country, have to graphic images in anti-tobacco advertising an intact uterus than metropolitan women. While the effects Following the introduction of graphic health warning This is a regular feature in Cancer Forum describing behavioural to reflect the changing nature of the reports included in these on estimated screening coverage of adjusting for geographic images on tobacco packaging in a number of countries, applications in cancer prevention. volumes, the name of the series has been changed from Quit differences in hysterectomy rates generally were small, there the Commonwealth Department of Health and Ageing Evaluation Studies to Quit Victoria Research and Evaluation were some geographic areas where important effects occurred, Australia has five behavioural research centres: the Cancer commissioned this study in order to assist its decision on Studies. The latest volume includes, amongst others, reports especially among older age groups. These findings will be Prevention Research Centre (CPRC) of the University of whether to implement a similar strategy within Australia. The on trends in smoking prevalence and consumption among relevant in the evaluation of screening coverage in South Queensland, the Centre for Health Research and Psycho- resultant study has concluded that young people react as least Victorian adults and secondary students, quitting behaviour, Australia and for setting priorities for health promotion. oncology (CHeRP) of The Cancer Council New South Wales, as much as adults, and possibility more so, to advertisements public opinion, attitudes, knowledge and behaviour related the Centre for Behavioural Research in Cancer (CBRC) of The Canberra Cancer Quality of Life Project depicting graphic images of the ill-health effects of smoking. to environmental tobacco smoke (ETS) and bans on smoking Cancer Council Victoria, the Centre for Behavioural Research It was therefore concluded that the placement of such graphic in public places as well as in the home. There are also reports Further findings: in Cancer Control (CBRCC) at Curtin University of Technology images on tobacco packaging would likely have a strong on several studies funded by VicHealth related to recent A comparison of patients with advanced cancer and their Perth, and the Centre for Cancer Control Research (CCCR) of deterrence effect on young people. amendments made to the Tobacco Act 1987 (Vic). These studies caregiver’s knowledge of treatment intent (117 pairs) The Cancer Council South Australia. examined the processes of adaptation to mandated restrictions identified high levels of congruence (75%) that the illness was The reaction of Bunbury residents to a possible This report has been edited by Anne Gibbs (CHeRP) from the on smoking in dining areas and public opinion related to this, life-threatening but pronounced disagreement in perception total smoking ban in public bars and nightclubs reports received. retailer and industry compliance with legislation that introduced in all other responses to the goals of treatment. One third This study was instigated by the Cancer Foundation of Western bans on point of sale advertising in January 2002 in Victoria, of pairs were aware of the true nature of treatment goals, Australia and the National Heart Foundation of Australia New results staff attitudes towards and experiences of exposure to ETS in and one third were partially aware in that one respondent had correct perception. Among the final third classified as (WA). The study surveyed 506 adult residents in Bunbury who n Centre for Behavioural Research in Cancer the workplace, and the relation between exposure to ETS at “non-aware”, two distinct groups were identified: those frequented licensed drinking establishments and concluded that (CBRC), VIC work and reported respiratory and sensory symptoms. where both respondents considered the aim of treatment the State Government would certainly not unleash a “hotbed” Evaluation of the Prostate Care Nurse Distance n Centre for Cancer Control Research (CCCR) and was to cure (15.4%) and the other group defined as confused of general discontent if it imposed a total smoking ban in Education Program the Tobacco Control Research and Evaluation (22.2%) where both indicated they did not know the purpose hotels, bars and nightclubs. Indeed the study revealed a general Program (TCRE), SA of treatment intent, or one said they did not know, and resignation and apathy of Bunbury residents towards the issue Nurses working with men with prostate cancer require the other party believed treatment was to cure. Significant which seemed to indicate that introducing such a ban would be ongoing education and training in prostate care to meet the Cancer statistics monograph series predictors included gender and whether respondents lived virtually cost neutral, if not positive, to the State Government. multiplicity of needs faced by these men. The 13-week Prostate A fifth report in this monograph series, entitled Lymphomas, in a metropolitan or non-metropolitan area for both patients Care Nurse Distance Education Program developed by The Quantifying smoking incidences in media targeted myelomas and leukaemias, has been completed for printing. and for caregivers, together with patient clinical characteristics Cancer Council Victoria and Latrobe School of Nursing and at the 18 to 30 year old age group As for the earlier monographs, it is directed at providing marked by metastatic spread of disease and time to death. Midwifery is a tertiary-based education package for nurses, secondary school and tertiary students, including students in The Commonwealth Department of Health and Ageing recently which can be undertaken as a stand-alone certificate or as part the health field, and the public with information on cancer n Centre for Health Research and Psycho-oncology received the first draft of this study which monitored various of a graduate diploma in advanced nursing. The program aims trends in South Australia, and opportunities for prevention and (CHeRP), NSW [previously the Cancer Education media specifically targeted at the 18 to 30 year old age group to educate nurses in the specialty areas of prostate cancer and improvement in outcomes. Compared with cancers addressed in Research Program (CERP)] for tobacco content. The media covered by the study included prostate disease so they have access to up-to-date information, previous monographs, limited scope for primary and secondary How might we improve adolescent use of sun newspapers and magazines, movies, web sites, television appropriate services, and ongoing education. It also enables prevention is apparent for these haematological tumours. protection measures? programs, sporting events and music videos broadcast on students to develop the resources to establish a network of Nonetheless, the monograph indicates the desirability of television, and lyrics of popular music broadcast on the radio. information and support across Australia and overseas for avoiding unnecessary exposures to ionising radiation, benzene Australia has one of the highest incidence rates of melanoma Results of interest include that of 255 Internet sites monitored, debriefing and professional development purposes. and other solvents, chemicals, pesticides, herbicides, and to in the world. During the 1980s and 1990s Australia became approximately one in five contained a tobacco depiction and a world leader in implementing public and professional An evaluation of the course, designed and conducted by staff drugs and infections that suppress the immune system. The 93% of these portrayed smoking as socially acceptable. In education campaigns to minimise ultraviolet light exposure at CBRC, was undertaken by students enrolled in the first importance of further research into the causes of these cancers addition, every film analysed contained at least one tobacco- and so decrease the incidence and mortality associated with all two intakes in June and September 2001. Forty-six students is highlighted. Progress is occurring in the treatment of these related scene, with the six films studied containing 73 such forms of skin cancer. Although national monitoring has shown participated in one or more stages of the evaluation. The cancers, with gains in patient survival being most apparent for scenes in total - 95% of which were classified as portraying improvements in sun protection in the Australian population, topics that students reported as most helpful were treatment lymphomas and leukaemias, particularly childhood leukaemias. smoking as socially acceptable. A reduction in mortality of approximately 40% from childhood adolescents’ sun protection practices are particularly poor. options (55%) and understanding and managing side effects n Cancer Prevention Research Centre (CPRC), QLD of treatment (23%). Other topics reported as helpful included leukaemia over a 20-year period in South Australia is attributed Dr Chris Paul and colleagues at the Centre for Health Research the topic on prostate cancer in general (19%), psychosocial to advances in chemotherapy and associated bone-marrow and Psycho-oncology, The Cancer Council NSW/University Sun Protection in Secondary School Communities transplantation. The Cancer Council South Australia also and sexuality issues (19%), anatomy and physiology (14%), of Newcastle, undertook qualitative research to explore SPISC was funded by Queensland Health and has recently has drafted a sixth report in this monograph series, with support services and resources (12%) and grief and loss (12%). adolescents’ perceptions regarding the influences on their sun been completed. It assessed the requirements of Queensland participation from the CCCR, on survivorship following a Thirty-six (78%) students reported planned changes to their protection behaviour. Seventeen focus groups were conducted secondary schools for supporting sun protective behaviour. It diagnosis of cancer. Both monographs are due for release in nursing practices as a result of what they had learned through with 12-17 year-old students, recruited through three public was co-ordinated by Liane McDermott and investigated the early 2003. completing the program and 30 (65%) students reported high schools in the Newcastle region. Single sex focus groups level of implementation of sun protection policies in Queensland changes in their practices three months after completing the were conducted separately with three different age groups: Cervix screening coverage adjusting for secondary schools and explored ways for improving the sun course. Readers interested in the Prostate Care Nurse Distance those in years 7 or 8 (three male and three female groups); hysterectomy rates protective knowledge, awareness and behaviours of secondary those in years 9 or 10 (three male and two female groups); and Education Program should contact Robyn Metcalfe, Cancer school communities. Education Unit, The Cancer Council Victoria, on 03 9635 The CCCR has been examining socio-demographic trends those in years 11 or 12 (three male and three female groups). 5422. in hysterectomy rates in South Australia and their effect on Participants discussed the role of various factors influencing In total, 158 schools participated in a state-wide, web- the likely coverage of the population with cervical screening. sun protection including the risk of discomfort, fear of skin based survey of sun protection policies and practices. While Quit Victoria Research and Evaluation Studies Hysterectomy rates were calculated using hospital inpatient cancer, peers, parents and policies. Age appeared to play a role approximately half of the schools reported having a sun Number 11, 2000-2001 statistics for 1992-2000. The percentages of women with in which factors were seen to be the most important influence protection policy or procedure, the implementation of Edited by Tessa Letcher and Lisa Trotter, Quit Victoria Research an intact uterus were estimated from these data to reduce on behaviour. actual sun safety strategies were generally much higher. The and Evaluation Studies Number 11, 2000-2001 was published across the 20-69 year age span, with approximately 66% of incorporation of sun safety education was very high, but mostly A number of potential avenues for intervention that might in February 2003. This is the 11th volume in the series of Quit South Australian women still having an intact uterus at 70 limited to the year 8 curriculum. The most common strategies have a positive impact on adolescent sun protection emerged evaluation reports, the first having been produced in 1986. years of age. The results were similar to those obtained from used to improve the provision of shade included seating under from this data. These volumes have reported on evaluation and researches a national interview survey which have been used uniformly existing shade trees and providing shade at sporting carnivals conducted since 1985, and are prepared by CBRC for the by Australian cervix screening programs to estimate screening n Centre for Behavioural Research in Cancer and other outdoor events. While student hat-wearing remained Victorian Smoking and Health Program (Quit Victoria). In order coverage in their jurisdictions. The South Australian data points Control (CBRCC), WA the most challenging sun safety strategy for schools, many

32 Cancer Forum n Volume 27 Number 1 n March 2003 Cancer Forum n Volume 27 Number 1 n March 2003 33 Reports 35 Archives of Internal Medicine, 162, 22 (2002): 2632-3. in homes, motor vehicles and licensed premises: Community attitudes and practices.” Australian and New Zealand Journal RA Walsh. “Nicotine lozenge trial: a ‘real-world’ perspective.” RA Walsh, F Tzelepis, C Paul. “Environmental tobacco smoke smoke in the workplace and respiratory and sensory symptoms, symptoms, and sensory respiratory and in the workplace smoke of experiences and towards staff attitudes also measure to and The paper is in the workplace. second-hand smoke exposure to Occupational and Environmental in the Journal of now in press Medicine. Against a International Union has been awarded Victoria White Memorial International Yamagiwa-Yoshida Cancer (UICC) She will spend three months from March Cancer Study Grant. John Pierce in the Department of Family 2003 working with Dr at the University of California, San and Preventive Medicine data collected as part of the evaluation Diego, interrogating Program. The primary focus of her of the Californian Tobacco at adolescent smoking behaviours and research will be looking trends in these behaviours up a five-year appointment in CBRC as Helen Dixon has taken funded by an NHMRC Capacity Building a behavioural scientist researchers epidemiological and behavioural to awarded Grant a Victoria. Helen will be working across at The Cancer Council range of areas, including nutrition and smoking. project grants to CBRC has been awarded two NHMRC Michael and of CBRC White Victoria in 2003. commence School of Department of Psychiatry, Washington Lynskey of the grant for a project Medicine, US have been awarded a two-year the in environment the and genes of role the “Identifying titled behaviours of adults”. development of smoking and drinking influences harmful “Possible investigate will Wakefield Melanie during 2003. of advertising for nicotine gum and patch” n CHeRP Program (CERP) After 14 years, the Cancer Education Research full range of research has changed its name to better reflect its title is the Centre for activities and future directions. The new Health Research and Psycho-oncology (CHeRP). Associate to Associate Professor Afaf Girgis, Congratulations were who Boyes, Allison Ms and D’Este Kate Professor Council Research Medical and Health a National awarded 2003 to 2005 for grant of $440,000 over three years from of cancer survivors’ a population based longitudinal study psychosocial and physical wellbeing’. In November 2002, CHeRP hosted a workshop on “Practical Sydney the at oncology” in assessment needs of aspects Centre. Convention the as conducted was workshop This first step in the development of a user’s manual containing procedures for scoring, analysing, interpreting and reporting data collected via the Supportive Care Needs Survey. Thirty- three participants representing consumer advocacy, health care professionals, researchers, policy makers and health service administrators attended. facilitated by The workshop was Associate Professor Afaf Girgis and focused on the practical aspects of using the survey including: (i) current and potential uses of the perceived needs surveys, (ii) barriers to using (iii) and and data survey the support or resources additional required to facilitate use of the survey. The outcomes of the considered be will workshop of group a by in statisticians March 2003 to consider ways of analysing the data to best meet the identified uses of the survey. CHeRP has had a number of papers published and accepted for publication, including: • • March 2003 IARC Handbooks of Cancer Cancer of Handbooks IARC n Volume 27 Number 1 n News n CBRC A CBRC team comprising Melanie Wakefield, Melissa Cameron, Lisa Trotter, Tessa Letcher, Graeme Inglis and David Hill plus Alistair Woodward from the University of Otago Department of Public Health in New Zealand, has received an award from VicHealth for “Excellence in Health Promotion Research”. The House, award was presented at a ceremony at Government Melbourne in December. The winning research study “Staff exposure to second hand smoke in the hospitality industries”, involved surveying 1078 members of the Australian Liquor branch) (Victorian Union Workers Miscellaneous and Hospitality to assess their relationship between exposure to second-hand Cancer Forum interviews across Australia with medical referrers to palliative to palliative referrers with medical Australia across interviews care health of multidisciplinary focus groups and care services, are to be Focus groups advanced cancer patients. providers to Australia. Victoria and Western in New South Wales, conducted of list a include will research the of phase this from Outcomes perceptions understanding of to referral, an potential barriers identification the and services, care palliative to attitudes and information process. This used to initiate the referral of triggers develop a quantitative instrument that will will then be used to the issues influence these particular how extensively explore nationally. referral of cancer patients interventions may be implemented toAs a result of this research of palliative care services in Australia, andincrease the utilisation for patients with cancer to palliativeto ensure equitable access time in the disease trajectory. Key areascare, at an appropriate and education will be identified.that require publicity n CBRCC “Me No Fry” media campaign Australia’s Western of Foundation Cancer the of Evaluation continues, and a 2002-03 “Me No Fry” media campaign of the National report summarising the findings of the tracking for the third volume Tobacco Campaign has been completed Evaluation Report. of Australia’s National Tobacco Campaign n CPRC The PLACE project as a behavioural Physical inactivity has recently been identified independently and risk factor for breast and colon cancer, both International Agency through its influence on weight gain (see (2002) Cancer on Research for and Physical Activity. Prevention, Volume 6 - Weight Control the case for tobacco Oxford, Oxford University Press). As is successful control and other areas of cancer prevention, initiatives regulatory, public policy and social and environmental in risk. At CPRC, will be required for population-wide reductions the PLACE project Neville Owen and Eva Leslie are conducting Environments) Community and localities in Activity (Physical attributes of local to examine how objectively determined impact on adults’ community environments are likely to contributes and older adults, walking For middle-aged walking. the most to overall activity-related energy expenditure. The findings of PLACE will inform future environmental change strategies that have the potential to increase overall physical activity levels and to prevent weight gain. PLACE is a collaborative project with colleagues at the NSW Centre for Centre National the Health, and Activity Physical for Social Applications of Geographic Information Systems at the University of Adelaide, San Diego State University and the Georgia Institute of Technology in the US. March 2003 n Volume 27 Number 1 n Cancer Forum Evaluation of Quitline 12-week program 12-week of Quitline Evaluation Quitline’s Australian the South evaluating is currently TCRE to the is available to all callers The program 12-week program. callers at advisors ringing back involves Quitline Quitline, and the first support throughout to offer advice and agreed times program of participants in the of quitting. A cohort 12 weeks follow-up interviews 2002 and 12-month recruited in was 2003. Quit rates will be investigated, will commence in early collected regarding the experiences and and data will also be participants. opinions of the program of the Breatheeasy! project Evaluation of phase 2 of by the South Australian Department This project was run 2001-02, and encouraged workplaces Human Services through policies. The project involved the offer to introduce smoke-free and subsidised “quit smoking” courses workplace free of patches for smoking staff at participating (half-price) nicotine project this of phase initial the of evaluation The workplaces. patches, nicotine the for rates uptake low very revealed redeemed. vouchers issued being with only 15% of patches editor, appearing in This finding prompted a letter to the , warning against the December edition of Tobacco Control purchasing into funds project of amounts large investing rates of uptake are nicotine replacement therapy (NRT), as low and underway is currently two phase of evaluation The likely. indicates similarly low rates of uptake. in An audit of nutrition and cancer information popular magazines the extent to which The aim of this project is to determine magazines, and to nutrition and cancer is covered in popular The audit will describe the type and nature of this information. health or food review the 10 most frequently-read general, (over a 12 month related monthly or bi-monthly magazines that mention period) to identify all cancer-related articles be the first phase nutrition. It is intended that this study will nutrition and cancer of a more detailed content analysis of coverage in popular magazines. n CHeRP patients Appropriate and timely referral of cancer to palliative care: a qualitative investigation of perceptions of health professionals There is significant evidence to suggest that in the United States and Europe, a large percentage of cancer sufferers of late in the trajectory care services are referred to palliative the disease. Preliminary investigation indicates that referral patterns may be similar in Australia. While the optimum timing for referral to palliative care has not yet been identified, there is a growing body of evidence to suggest that the needs of later by met adequately not be may patients cancer advanced referral to palliative care. A team of researchers comprising Associate Professor Afaf Girgis, Dr Chris Paul and Claire Johnson from the Centre for Health Research and Psycho-oncology, The Cancer Council to develop research is conducting Newcastle, of NSW/University a deeper understanding of current referral patterns, perceptions of palliative care, and barriers to the appropriate and timely referral of cancer patients to palliative care services. Initially, a qualitative approach will be used to investigate the perceptions and range of potential influences on referral and referral, timely to attitudes behaviour, and patterns patient (eg triggers or predictors of use the investigate to circumstances or characteristics) to initiate referral to palliative telephone semi-structured care services. This will involve CCCR and TCRE 34 Research in the pipeline n CBRC in Testing for the early detection of bowel cancer rural Victoria There is level 1 evidence that screening the population using the faecal occult blood test (FOBT) can reduce colorectal cancer (CRC) mortality by 15%-33% depending on the detection level of curable cancer within the target population, which is the of sensitivity and the participation of adequate product a test. The Commonwealth Government-funded early detection bowel screening pilot program is being implemented in rural and metropolitan sites across Australia. Little is known likely are setting rural in a which people to extent the about to participate in screening if recommended by their general practitioner. A team led by Trish Livingston is aiming to gain an understanding of the factors associated with participation in the early detection of bowel cancer using FOBT. One hundred people aged 50-74 years who presented to a to approached were city, Victorian rural in a clinic medical participate in this study. Written consent was obtained and a brief questionnaire completed prior to the consultation with the doctor, during which the GP recommended that they take the FOBT home for completion. In addition, an anonymous tally was kept of those who declined to participate. The study will document rates of completion of the test and, using elements of the health belief model, investigate the characteristics be will report A tests. return not did and did who those of available shortly. n schools adopted an ‘any hat is better than no hat’ policy with hat’ policy than no hat is better an ‘any adopted schools The hats. caps or ‘bucket’ wearing students of the approval sunscreen was to have made in terms of sunscreen main effort as physical occasions such student use on specific available for common The most sports days and excursions. education, outdoors time students spent minimising the strategy for venues availability of indoor and 3pm was the between 10am and morning breaks. during lunchtimes for students and focus group discussions were also Individual interviews four from parents and students teachers, principals, with held facilitators explored interviews These school communities. development and implementation of sun and inhibitors to the protection sun the improving of ways and policies protection and behaviours of secondary school knowledge, awareness sun protection was recognised as an communities. While priority was relatively low compared to important issue, its issues such as drug abuse, mental other competing health which schools were dealing. health and obesity with relevant as be to seen not was policy protection sun a Having schools, particularly for secondary schools as it is for primary students should be with the expectation that high school and well-being. taking personal responsibility for their health not so much the A key issue for the staff interviewed was in terms of its development of a policy but the implications time, trying to ‘force’ implementation. The major barriers were or manage the policy and teenage compliance. promoting of means effective be an to found was Immediacy out sunscreen sun protective behaviours, such as staff handing of reminder systems to students at sporting events. The use to be important in for both students and staff were believed as having students encouraging sun safe behaviour as well to wear their having choice, particularly with being permitted own hats and sunglasses.

Reports NEWS 37

in May Now in its tenth year, Australia’s Biggest Morning of attention the capture to set looks (ABMT) Tea again this May with yet thousands of participants 40,000 Australians expected to host morning teas. The Cancer Council Australia’s member organisations are already working hard to ensure the popular event – scheduled for 22 May – is a success, and the national target of $6 million is reached. A new creative campaign will launch ABMT in host a as register can interested Anyone April. from March onwards via the new look website calling by or www.biggestmorningtea.com.au at 1300 65 65 85. Hosts will receive a kit containing posters, Bushells tea bags, a donation box and other materials to ensure their morning tea is a huge success. Australia’s Biggest Morning Tea – hosts set to raise their cups again Prof Mark Elwood, Dr Liz Kenny, Prof Brian McAvoy, Prof Lester Peters and Prof Alan Coates at the OCCA launch Prof Lester Peters and Prof Alan Coates at the OCCA demography); quality of care (including ensuring it is evidence- demography); quality of care (including ensuring workforce shortages, based); and resource issues (including services). skills development, and patient access to addressing quality, It contains 12 key recommendations strategy for a proposed issues, plus resource access and are also listed. implementation. A further 19 action items be set up to drive The document proposes a national task force need will in the report the reform process. Recommendations to be assessed, costed and prioritised. website: NCCI the at online available are report the of Copies www.ncci.org.au

March 2003 n NEWS & ANNOUNCEMENTS & NEWS Volume 27 Number 1 n Cancer Forum NEWS of cancer care New report on reform - reform of cancer care in Australia A blueprint for the in Australia – was launched in Sydney Optimising Cancer Care (4 February). on World Cancer Day report was prepared by the Clinical The collaborative of Australia (COSA), The Cancer Council Oncological Society Cancer Control Initiative (NCCI), Australia, and the National the full support of consumer groups. with input from and Minister for Health and Ageing and It provides the Federal a national model for her state and territory counterparts with cancer care. that developed the The chair of the steering committee said the blueprint consultative report, Professor Lester Peters, consultation with had emerged from a process of wide policy-makers. consumers, health care professionals, and survival in Australia “Its essential message is that while cancer could be doing much compares well with world standards, we said. better in the way services are provided,” he to improve need we outcomes, possible best the achieve “To appropriate can access the entire cancer journey so that people a in illness, their of stages all at needs individual their for care coordinated and timely fashion. this in care cancer to approach new a proposing “We’re patient.” country, with services organised around the change is needed: The report sets out three key areas where care is provided and to the way the models of care (relating geography and by whom, keeping in mind Australia’s unique March 2003 n Volume 27 Number 1 n Cancer Forum resigned from his fractional appointment at the Centre in in Centre the at appointment fractional his from resigned 2003. January on sponsored a workshop Queensland Health CPRC and physical people’s daily 2003, titled “Increasing 13 February This environmental benefits”. health, social and activity for the Australian Society Behavioural Health workshop preceded 80 participants. attracted and and Medicine Conference of Dr Lawrence Frank (Georgia Institute The speakers were James Sallis (San Diego State Universty), Technology), Professor University), Associate Professor Billie Giles- Dr J Salmon (Deakin Western Australia) and Professor Neville Corti (University of Owen (CPRC). Mills Narelle TCRE), and (CCCR Beckman Kerri to Thanks Swart (CHPCPR) for (CHeRP), Owen Carter (CBRCC) and Cathy contributions to this report. , 26, 6 (2002): 536-42. (2002): 536-42. , 26, 6 Health of Public Newsletter , December and Health Sciences Joint Medical 2002: 5. of the A qualitative study cancer survivors: needs of breast survivors.” versus older unique needs of younger shared and Psycho-Oncology, in press. and gaming areas: review of Australian literature.” Australianand gaming areas: review of Public Health, in press. and New Zealand Journal A Girgis, K D’Este, A Boyes. “NSW Cancer Survival Study.” Survival Study.” Cancer “NSW A Boyes. K D’Este, A Girgis, Pendlebury. “The psychosocial P Butow, A Girgis, S B Thewes, RA Walsh, F Tzelepis. “Support for smoking restrictions in barsRA Walsh, F Tzelepis. 36 • • • • n CBRCC Carter Owen Dr clutches its into welcomed CBRCC The Fellow in late 2002. Dr Nadine Henley, as a new Research is has moved out of the CBRCC and Senior Research Fellow, Tumak, Health Kerry Cowan University. now based at Edith Region is at the Promotion Officer from the Wheatbelt Health Centre on secondment for four months. n CPRC December 2002 and Dr Alexandra Clavarino left the Centre in The University of has taken a research fellow position with Dr Warren Stanton Queensland’s School of Population Health.

Reports National conference to focus on investment Other members of the interim CAN committee are Dr Don For a copy of the latest issue of Cancer Update – which of WA and the Advanced Program in International Management in tobacco control Baumber, Ms Marilyn Beech, Dr Liz Kenny, Mr Clive Deverall, summarises presentations given at the briefing – please email at the Copenhagen Business School. Ms Merrian Oliver-Weymouth, Ms Emma Sayers, Ms Lyn [email protected]. The case for greater long-term investment to reduce smoking Swinburne, and Professor John Zalcberg. The Cancer Council rates will be the focus of a national conference to be hosted New offices Victoria by The Cancer Council Victoria in April. The launch of CAN Australia is welcomed by The Cancer Council Australia and COSA. The Cancer Council Australia, Clinical Oncological Society of Professor David Hill AM Delegates will hear from a group of outstanding international Australia (COSA) and the Australian Cancer Network (ACN) Before becoming Director and Australian speakers at the 2nd Australian Tobacco Control For more information about CAN, including an ‘expression of have moved. of The Cancer Council Conference, to be held in Melbourne from 9-11 April 2003. interest’ form, contact the Secretariat (Julie Claessens and John Victoria, Professor David Leading international tobacco control experts including Dr Stubbs) at [email protected] Level 5, Medical Foundation Building Hill - a behavioural scientist Michael Cummings and Dr Frank Chaloupka from the US, Dr 92-94 Parramatta Road - was founding Director of Ann McNeil from the UK and New Zealand’s Professor Alistair Common cause for prevention Camperdown NSW 2050 GPO Box 4708, Sydney NSW 2001 the organisation’s Centre Woodward will present keynotes addresses. The Cancer Council Australia has joined with four other major Telephone: (02) 9036 3100 for Behavioural Research in health-related NGOs to form the Australian Chronic Disease A number of high profile Australian speakers will also be Facsimile: (02) 9036 3101 Cancer. Prevention Alliance (ACDPA). giving keynote addresses, including Australian Competition Email: [email protected] Prof Hill is a Professorial Fellow and Consumer Commission Chair Professor Allan Fels, and Other Alliance members are the Australian Kidney Foundation, Website: www.cancer.org.au at the University of Melbourne, Professor Simon Chapman. Diabetes Australia, the National Heart Foundation of Australia The Australian Cancer Network an Adjunct Professor at Deakin University and an Honorary and the National Stroke Foundation. Lawyer Peter Gordon from Slater and Gordon will also give Phone: (02) 9036 3120 Professor at Monash University. In 2001, he was made a a keynote address about tobacco litigation and his firm’s Its first focus will be to promote primary disease prevention Fax: (02) 9036 3121 Member of the Order of Australia (AM) for “services to representation of Rolah McCabe in her lawsuit against tobacco through increased exercise and a healthy diet, especially the Email: [email protected] the promotion of community health, particularly in the company British American Tobacco Australasia. consumption of vegetables and fruit. These measures have Website: www.cancer.org.au/acn development of cancer awareness and prevention programs”. the potential to reduce the incidence of all the disease types Prof Hill, who received his PhD in psychology from the The conference aims to show that tobacco control measures – like represented in the Alliance. Staff changes at The Cancer Council Australia helping smokers quit and reducing the health effects of passive University of Melbourne, has authored or co-authored over 200 smoking – are one of the best investments communities can make The Alliance has received seed funding from the Commonwealth, A pivotal member of the COSA secretariat was farewelled in scientific articles and reports in the medical, public health and NEWS to enhance their health – and their economic wellbeing. and established a joint secretariat in the National Heart March. psychological literature. His published work includes research NEWS Foundation of Australia. It will work closely with the relevant inter- on the prevalence of adolescent and adult smoking, strategies Rozanne Gilbert helped organise five COSA annual scientific It will also focus on new marketing tactics of the tobacco government bodies, the Strategic Intergovernmental Nutritional for smoking cessation, reduction of smoking uptake, smoking meetings during her time at The Cancer Council Australia, and industry. Alliance (SIGNAL) and the Strategic Intergovernmental Forum regulation, behavioural aspects of screening mammography, her name and voice are familiar to many of COSA’s members. on Physical Activity and Health (SIGPAH), as well as the Cancer management of primary operable breast cancer, efficacy of Full details about the conference themes and program can be The Cancer Council and COSA thank Rozanne for her hard Strategies Group and the corresponding specialist committees breast self-examination, monitoring trends in skin cancer found at http://tobaccocontrol03.conference.net.au work and dedication, and wish her all the best with her move for the other disease types. prevention, and exploring determinants of behaviours related to country NSW. to skin cancer prevention. In the news – prostate cancer testing It is encouraging to note that the Commonwealth Government The Cancer Council has new staff in the form of Kerrin has recently given higher prominence to disease prevention – In 1990 he chaired the International Union Against Cancer Debate about the pros and cons of testing for prostate cancer Burgess, PA to CEO Alan Coates; Sonia Gibbons, PA to Finance now known as the `fourth pillar’ (together with the MBS, PBS project on behavioural sciences, and was Secretary to the 1996 has been in the headlines in recent months. and Business Manager Robert Firth; and Matthew Wood, who and the Commonwealth/state agreement on hospitals) of health World Conference for Cancer Organisations. He holds senior joins the accounts department. The Cancer Council Australia’s position on this issue – that the care in Australia. Hopefully resources will follow the rhetoric. positions on major national committees, including the NHMRC decision to be tested is one to be made by individual men, on CEO profiles Health Advisory Committee. the basis of informed consent – is stated in a letter from CEO National Breast Cancer Hospital Services Prof Hill has been successful in winning research grant funds Alan Coates on its website (www.cancer.org.au). The Cancer Directory In each edition of Cancer Forum this year we will be in the NHMRC’S national competition, including as a member Council’s National Cancer Prevention Policy, which has a chapter profiling CEOs of The Cancer Council Australia’s member The first directory of breast cancer services provided by private of teams of Principal Investigators which have been awarded on prostate cancer, is also available in the ‘publications’ section organisations. and public hospitals around Australia is available online. grants totalling over $10m in 2001 and 2002. of the website. It enables women and GPs to search by service, hospital, area, Cancer Foundation of In 1996, the Federal Minister for Health invited him to chair Launch of CAN Australia or postcode. WA the Ministerial Tobacco Advisory Group to establish the first comprehensive national anti-smoking campaign launched in A new national cancer advocacy group was launched on World The directory was developed by the National Breast Cancer Susan Rooney Australia. He is now chairman of the National Expert Advisory Cancer Day (4 February). Centre with the support of consumer groups, medical colleges, The Cancer Foundation of WA Committee on Tobacco, which is responsible for the National government bodies, divisions of general practice and public appointed Ms Susan Rooney as CAN Australia (Cancer Alliance Network) brings together and private hospital organisations. Tobacco Strategy to which all states and territories committed consumers, carers, clinicians and policy-makers to identify and its new Chief Executive Officer in June 1999. work together on shared issues of concern. The directory can be found at www.isourcedirectory.com/ in April 2002, following the hospitals/ resignation of Mike Daube. Prof Hill’s appointment followed the resignation of Professor Interim Chair Mr Russell McGowan says CAN recognises that Robert Burton, who had been Director of The Cancer Council Ms Rooney has had extensive not just individual consumers but also consumer and advocacy Victoria from December 1995. Parliamentary briefing – Eat and Run high-level experience in the groups need to network. The links between cancer and nutrition, obesity and physical leadership and management of Queensland Cancer Fund “One benefit in bringing these groups together nationally activity were the theme of the first meeting in 2003 of The Cancer non-government community Dr Jeff Dunn is for them to collectively identify areas that would make a Council Australia’s Parliamentary Cancer Information Network. organisations, having served as executive with the Fire and real difference to the burden of care for individuals and their Emergency Services Authority, the Sydney Anglican Retirement Dr Jeff Dunn took up the position of Executive Director at the It is estimated that between 30-40% of cancers could be families,” he says. Villages, Rehabilitation Tasmania and the Royal Blind Society Queensland Cancer Fund in January 2003, upon the retirement prevented by appropriate diet and adequate physical activity. of NSW. In each of these positions she has successfully A fundamental principle behind the new non-government of Mr Graeme Brien. Dr Dunn is only the third person to hold Speakers Terry Slevin, Chair of The Cancer Council’s Nutrition implemented major change management programs. organisation is consumer participation in cancer services. this office in the 41-year history of the Queensland Cancer and Physical Activity Committee, and Dr Dallas English, Ms Rooney has a health background in physiotherapy, Fund, and brings to the role substantial experience. “Cancer consumers use services extensively and are often Associate Director of The Cancer Council Victoria’s Cancer graduating from Curtin Dr Dunn has been a staff member of the Queensland Cancer in a good position to identify how to produce better health Epidemiology Centre, addressed federal MPs at the breakfast Fund since 1989, filling the role of Director of Community outcomes,” Mr McGowan says. meeting at Parliament House in Canberra. University. She has since completed a MBA from the University

38 Cancer Forum n Volume 27 Number 1 n March 2003 Cancer Forum n Volume 27 Number 1 n March 2003 39 book reviews 41 REAST CANCER SOURCEBOOK (1ST ED) B The main drawback, as usual, is the high cost (A$346). The as usual, is the high cost (A$346). The The main drawback, containing all chapters in PDF format. book comes with a CD K Bradstock Dept of Haematology Westmead Hospital Westmead, NSW E Prucha et al Published by Omnigraphics ISBN: 0-7808-0244-6. 580 pages plus index. RRP: US$78.00 First impressions of the Breast Cancer Sourcebook provide an enticing array of chapters and topics, which would interest health consumers and professionals alike. It was good to see an overall use of basic medical definitions and a glossary of cancer terms, which were concise and user- overview It was reassuring to read a contemporary friendly. role of antiperspirant around controversial issues, such as the deodorants, oral contraceptives, alcohol and fat intake in excellent an was There cancer. breast of development the overview of complementary and alternative medicines used in managing breast cancer, explaining the origin of each alternative approach and a summary of research to date. Upon closer examination of the book, it was disappointing to find a very clinical, disjointed, lengthy text that was repetitious and resulted in a disturbing overlap between chapters. The greatest deficiency, however, was the lack of regard for psychological and whatIn cancer. breast continuum of the support issues along appeared to have been an afterthought, less than 20 pages of this 580-page text were allocated to address psychological issues of breast cancer for the woman and her family or carers. Similarly, ain addressed were intimacy and image body sexuality, of issues two-line summary, and the consumer voice was almost inaudible poorof minimal and Diagrams were text. clinical throughout the quality, and detail was lacking about specific chemotherapy options or treatment regimes for early breast cancer. Overall, this is not a user-friendly resource book. A Hordern Registered Nurse, VIC There are many breast cancer books to be found in bookshops, and they vary in content and depth. The Breast Cancer Sourcebook is an extremely comprehensive and detailed text March 2003 n BOOK REVIEWS BOOK Volume 27 Number 1 n DULT LEUKEMIAS Aspiring reviewers up to 80 new publications every year. Cancer Forum publishes reviews of in every field of cancer interest. from Australian-based readers for reviewers Self-nomination is invited to [email protected] if phone, fax, mail and email addresses) expertise and contact details (including Email your area(s) of our panel. you would like to join A Cancer Forum P Wernik (2001) Published by BC Dekker ISBN: 1-55009-111-5. 324 pages. RRP: A$346.72 , ambitiouslyThis book, in the Atlas of Clinical Oncology Series aspects of adultsets out to cover diagnostic and management about etiology andleukaemias. The first half of the book is on epidemiology diagnostics. There are excellent chapters immunophenotyping,morphology, pathogenesis, genetics, and general, thesechanges. In associated molecular and cytogenetics and referenced, comprehensively well-written, are chapters omissions resultingbeautifully illustrated. There are inevitable after publishing from “hot” new findings being published ofdiscovery the closed, the major one being have deadlines casesof quarter one in mutations Flt-3 important prognostically of adult acute myeloid leukaemia. book is the frequent My main criticism of the first half of the chapters. For overlap and repetition of material between appear example, overlapping sections on immunophenotyping and five in chapters three (Diagnosis), four (Morphology), are lengthy sections (Immunophenotyping). Similarly, there chapters, with on cytogenetic abnormalities in three different could have avoided much repetition of material. Tighter editing this unnecessary lengthening of the text. The second half of the book covers clinical aspects of adult including treatment, its complications, extramedullaryleukaemias, The care. supportive on brief section a final and leukaemia, largest of these chapters, written by Yousuf Ali and Martin Tallman, is on management, and covers treatment of all acute and chronic leukaemias, a major undertaking that perhaps could have been divided up among a larger group of authors. ofreview comprehensive and excellent an is this Nevertheless, treatment of the various types of adult leukaemias. The section on the use of Glivec (STI-571) in chronic myeloid leukaemia is unfortunately brief and does not include important recent information on the use of this drug, while the section on chronic lymphocytic leukaemia omits mention of the highly promising results using the Fludarabine, Cyclophosphamide, and Rituximab combination. Inevitably, these sorts of issues arise whenever a textbook is written about a rapidly evolving area of medicine. This book will interest advanced trainees in haematology, comprehensive a wanting oncology, medical perhaps and coverage of this topic in the one volume. Haematologists and oncologists regularly dealing with adult leukaemias may be attracted by the extensive bibliographies in each chapter, and aids. teaching as serve might which illustrations, excellent the March 2003 n Volume 27 Number 1 n Cancer Forum South East Asia. South academic and maintains sociology a PhD in holds Dr Dunn Science; School of Social as Adjunct Professor, appointments both at of Population Health Professor, School and Associate Chairman In addition, he is the of Queensland. the University Cancer of the Queensland of Management of the Board Psychosocial for Centre Collaborative University Fund-Griffith located in the Griffith University School Oncology – a project of Applied Psychology. a commitment to volunteering, with Dr Dunn has a long disability. As well as his cancer- special interest in intellectual as worked has he years 14 past for the volunteer work, related of people with an intellectual disability. a volunteer in support Forum will profile The Cancer Council The July edition of Cancer Associate Professor Brenda Wilson, The South Australia’s CEO, and Peters persuaded and the company that owned the patent on tirapazamine to an conduct them let study of theexploratory triple combination. Although this Phase I trial was aimed at simply suitable a developing treatment protocol for further testing, the 16 patients whoresults were unexpectedly good – of the disease, 14 hadwere near the end of the road with advanced and 11 were longdurable local eradication of their disease term survivors. and I’ve “This was an unheard of result in my experience cancer for the worked almost exclusively in head and neck patients. This was past 20 years, so I’ve treated a lot of says. definitely worth pursuing further,” Prof. Peters then went ahead A Phase II trial involving 123 patients under the banner of the Trans-Tasman Radiation Oncology a with therapy combination the comparing (TROG) Group more standard form of chemo-radiotherapy. Preliminary results of the Phase II trial confirmed the excellent results achieved in the Phase I study and showed that patients taking the experimental therapy fared substantially better than those receiving standard therapy. “The survival rates were very good compared with anything seen before.” Professor Peters and Dr Rischin are now leading an 550 which will involve Phase III registration trial international in Australia including 13 83 centres worldwide, patients in and New Zealand. Interim results of this trial should be available in about 2 1/2 years. At the beginning of 2002, Professor Peters resigned his position as Director of Radiation Oncology at Peter Mac to to Foundation new a up setting of responsibility the on take support the strategic goals of the Institute. More recently, he was elected Dean of the Faculty of Radiation Oncology. Award Achievement Cancer Fabre MOG/Pierre The recognises a lifetime of achievement in the field of cancer. Last year’s winner was Emeritus Professor Tom Reeve AC CBE, Executive Officer of the Australian Cancer Network. Services, a department that that department a Services, Prevention the incorporates Unit, Detection and Early Services, the Cancer Support more Helpline and Cancer Cancer Advocacy recently, the While developing Program. these areas, and managing key he has also fulfilled The roles nationally with Australia Cancer Council with the and internationally Against International Union Dr Cancer. In this regard, Dunn has worked extensively REACHING FOR THE STARS – a profile of Professor Lester Peters, winner of the 2002 MOG/ STARS – a profile of Professor Lester REACHING FOR THE Achievement Award Pierre Fabre Cancer One of Australia’s leading cancer specialists could have been One of Australia’s leading cancer specialists lost to the cosmos. Peters wanted As a young boy in country Queensland, Lester to be an astronomer when he grew up. – I’d planned to “I was all set to go into the science faculty family friend told become an astronomer,” he says. “But a options – I should me I was mad, that I’d never have any job that background to do medicine, and if I wanted I could use become a physicist or engineer.” school, there But once Professor Peters, 60, started medical about a career was no going back – he soon became excited – radiation in medicine. He decided on a technical specialty the only medical oncology – which in the late 1960s was specialty related exclusively to cancer. disease – it was “I became fascinated with cancer as a of the treatments such a mystery at the time, and most involved motivated to get seemed empirical. I was strongly in research,” he says. Peters won a After registrar training in Brisbane, Professor Gray Laboratory in scholarship to do research work at the the UK, which at the time was the leading radiobiology lab to pursue no possibility with years later, world. Four in the the joined he Australia, in home back biology radiation prestigious MD Anderson Center in Houston for a mix of clinical and lab work. In 1982, the chair of the radiotherapy department at MD Anderson retired, and the position was offered to Professor Peters. He stayed in this role until 1995, during which time he became internationally recognised as a leader in academic radiation oncology. At age 53, he was lured back to Australia – with his Australian wife and two children – by the creation of the first professorial post in radiation oncology within the University of Melbourne at the Peter MacCallum Cancer Institute. A year after taking up this position, he started work on research which he considers the jewel in the crown of his career. Professor Peters and Peter Mac colleague Dr Danny Rischin, a medical oncologist, recognised the potential for a new treatment approach to advanced head and neck cancer while going through some pre-clinical work. Their idea was to use the triple combination of tirapazamine, cisplatin and radiotherapy. Tirapazamine is a currently unlicenced pro-drug that is selectively toxic to tumour cells starved of oxygen. In tumour systems, it has been shown to enhanceexperimental the effect of both radiotherapy and cisplatin. Drs Rischin 40 in supporting the development of cancer support programs in of cancer support programs in supporting the development

NEWS book reviews 43 as a guideline: it should as a guideline: it should ANDBOOK OF GYN H ONCOLOGY The first chapter provides a succinct outline of fundamental fundamental of outline succinct a provides chapter first The more to in addition genetics to cancer relating concepts methylation, as gene such of importance areas complex analysis, polymorphisms (SNP) single-nucleotide imprinting, with comprehensive and proteomics cDNA microarrays discussion provides a detailed The second chapter referencing. disease-associated for cloning of techniques and referencing audience written, is aimed at an although clearly genes, which knowledge of molecular genetics. The with some background the clinical and molecular aspects following chapters include Complex; Carney Hippel-Lindau disease, Von of MEN1, MEN2, polyposis Juvenile Bannayan-Riley-Ruvalcaba, Cowden, and Large sections of the book are and Peutz-Jeghers syndromes. gene organisation, protein function and devoted to describing which may be of particular interest to signaling pathways, molecular background or research individuals with a strong clinically orientated reader, the molecular interest. For the more as excellent reference material. sections would serve covering clinical presentations, diagnosis,However, the sections members, treatment, genotype/phenotypemanagement of family with apparentlycorrelation and molecular testing in individuals and essentialsporadic endocrine neoplasia are well presented or cancer geneticistsknowledge for specialist endocrinologists referenced andworking in this field. The text is well researched, specialist text, whichindexed. The content detail makes this a oncology orwould be of valuable addition to an endocrinology, clinical genetics department library. T Dudding Hunter Genetics Waratah, NSW Santoso & Coleman Published by McGraw-Hill (2002) ISBN: 0-8385-3532-1. 373 pages plus index. RRP: A$77.95 This handbook was designed for the use of medical students, residents and fellows. In the preface, the authors state their aim that “readers will use this Handbook of Gyn Oncology textbooks not replace the standard and good clinical judgement”. The book meets its stated purpose and is a good quick reference source for those caring for gynaecological oncology patients. As a portable resource it would enable residents to cram in the early hours of the morning prior to the arrival of senior medical staff for a ward round. Its size leads you to believe the book was designed for a white coat pocket. However, Australian may find coats and wear white no longer and fellows residents it difficult to know where to keep their book. There are separate brief chapters for each tumour site with the management recommendations being sound, well referenced and up-to-date. Current concepts such as sentinel node biopsy for vulval cancer and chemoradiation for cervical cancer are covered. There is also a balanced coverage of controversial cancer, endometrial in lymphadenectomy example, for issues, though the recommendations for bowel obstruction discuss modern the management and do not cover only surgical medical and palliative care approaches. A major criticism would be the disproportionately large amount of space dedicated to the diagnosis and management March 2003 n Volume 27 Number 1 n ENETIC DISORDERS OF G ENDOCRINE NEOPLASIA Cancer Forum and carcinogenesis complete a comprehensive overview of of overview a comprehensive complete and carcinogenesis cancer biology. basic therapies biological include treatments on chapters The radiotherapy with and chemotherapy and immunotherapy, articles Specific therapy. photodynamic and radiobiology action of mechanisms of the development and highlight articles agents while a dozen used chemotherapeutic commonly resistance. of drug review of the mechanisms form a useful of updates on chemoprevention. There is also a section on specific tumours means that theyThe brevity of the chapters discussing treatment options in any detail,are of limited use in betteris and collection this of focus the not clearly is which factors,risk aetiology and oncological texts. But other reviewed in chapters,biology basic the in information the by supported when covers the imaging section on tumour A small are well covered. of MRI, MRS and PET scanning.more recent techniques minimised the amount of duplication The editorial staff have of authors, and when this does occur despite the large number viewpoint and tends it examines the material from a different presented. to reinforce and clarify the concepts being excellent an provides that reference up-to-date an is This expanding field overview of multiple areas of the rapidly to the aetiology, of tumour biology, while relating this will be a useful initial diagnosis and management of cancer. It cancer clinicians and reference on a wide range of topics for researchers. IN Olver Professor of Cancer Care University of Adelaide, SA P Dahia et al Published by Karger (2002) ISBN: 3-8055-7203-4. 213 pages plus index. RRP: US$239.25 The main focus of the text is genetics of endocrine neoplasms. Editors, Patrica Dahia and Charis Eng, together with individual chapter authors are renowned for Since field. this in research their the identification of germline RET mutations responsible for Multiple Endocrine Neoplasia type 2 (MEN2) in 1993, there have been rapid advances in our understanding of the molecular basis for this group of conditions. In addition to expanding our understanding of the disease pathogenesis, the availability of molecular testing allows accurate information for family members, which influences screening and management. This text provides a state of the art review on the molecular basis of inherited neoplasia, including its relevance to clinical practice. In addition to the previously well-characterised disorders such as MEN1, MEN2, and Von Hippel-Lindau disease, the text provides a comprehensive review on other conditions of emerging clinical importance such as hamartoma and lentigines syndromes. the body of the text by The introduction entices us into providing a brief, but interesting clinical and molecular overview of the inherited endocrine neoplasia syndromes, which are each covered in more depth in the following chapters. March 2003 n Volume 27 Number 1 n Cancer Forum NCYCLOPAEDIA OF CANCER NCYCLOPAEDIA E 2ND EDITION J Bertino Published by Elselvier Science (2002) ISBN: 0-12-227555-1. 2,800 pages. RRP: $1,568.60 now encyclopaedia revised The contains four rather than three volumes to accommodate the in research cancer in advances 220 articles. Typically of less than 12 pages each, they cover a range of topics from molecular biology and genetics through to epidemiology and cancer The authorship treatment. is predominantly, but not exclusively, North American. The encyclopaedic format, articles arranges which by order alphabetical in title, is somewhat artificial depending on how the title is phrased. Although the results in succeeding articles often bear no relationship to each other, navigation is volumes the through made easier by having the contents grouped by inlisted as well as subject has It order. alphabetical an excellent index of over the at and entries 7,500 end of each article many of the entries are cross-referenced to other chapters. The format of each article, which contains a glossary, outline and defining paragraph to begin, enhances the ease of access to the information contained. The strength of this reference is the excellent overview summaries of the state of knowledge of tumour biology including cell cycle checkpoints, signaling pathways growth factors and cytokines, which are concise and easy to comprehend. They are referenced typically with a few selected recent references for further reading rather than an extensive bibliography, which is clearly the editorial policy of this collection. Chapters on cancer genetics, angiogenesis, oncogenes, immunology dealt with briefly, and here the controversial and diametrically and diametrically the controversial and here with briefly, dealt and bladder-preserving surgery for radical arguments opposing on prostate The final section are ably presented. approaches reviews somewhat superficial contains short and brachytherapy and reports and results, seed implant dosimetry of permanent dose high and hyperthermia, with experience (German) local of rate brachytherapy. reading for make useful would the publication In summary, in training, or specialists wishing to gain radiation oncologists in radiation oncology place of the current refresher on a quick It is likely to lose its currency in the short urological cancer care. to medium future. G Duchesne Institute Peter MacCallum Cancer Melbourne, Vic also provides provides also ONTROVERSIES IN C URO-ONCOLOGY 42 T Wiegel et al Published by Karger (2002) ISBN: 3-8055-7217-4. 191 pages plus index. RRP: US$161.75 This publication covers the International5th the of proceedings Symposium on Special Aspects of Radiotherapy, held in Berlin in May 2002. The topics range from detailed descriptions of the contemporarytechnical aspects of prostate radiotherapy and the rationale for dose escalation, to overviews of many modalities of care in prostate cancer, finishing with sections on bladder cancer and prostate brachytherapy. of many , Uro-Oncology in Controversies entitled Although the articles on prostate cancer are non-contentious and offer helpful reviews of current areas of interest (for example planning volume definition in dose-escalation studies). Some target articles themselves perhaps attempt to provoke controversy in a field of general agreement – the opening review states demonstrate of patients thousands of data “published that … remarkable improvements in terms of higher cure rates”. Many others would contend that dose escalation strategies have yet to demonstrate definitive improvements in prostate cancer cure rates. There are interesting updates on intermittent androgen ablation, chemotherapy and lymph node irradiation, although it is likely that the information they contain will be superseded in the not too distant future. Bladder cancer is on the topic. From a consumer’s point of view a few words a few of view point a consumer’s topic. From on the book Firstly, the this text. on you embark before of caution are all statistics and references and therefore the is American and data, Australian statistics If you required specific American. woman Secondly, not every have to look elsewhere. you would about it in cancer wants to read with breast who is diagnosed to learn all who wants This is a text for someone great depth. the topic. they can about changes breast of explanation an with begins book The It lead to a diagnosis of breast cancer. and factors that may and provides reputable references to back examines risk factors are treatments possible and Screening tools up the content. way. A clear explanation explained in an easy-to-understand of breast cancer is provided and many of the different stages of key terms, and in some sections sections have glossaries questions for consumers to ask health there are suggested Sourcebook Cancer Breast The professionals. detailed sections on clinical trials and genetic testing for people clinical trials and genetic testing for people detailed sections on of breast cancer. with a familial history breast cancer is The final section on coping with life after that a section has helpful although brief. It is pleasing to see cancer and some been included to cover males with breast complementary and alternative therapies. US it may well beAs it is in hard cover form and from the be a useful referenceunaffordable to many consumers. It would support group. book in a library or on loan to women in a D Wilson Consumer Representative Breast Cancer Network Australia Melbourne, Vic

book reviews book reviews 45 RINCIPLES OF PALLIATIVE RINCIPLES OMETHING MORE WONDERFUL P S CARE: AN INTRODUCTION CARE: AN Sonia Orchard Published by Hodder ((2003) ISBN: 0-7336-1593-7. 253 pages. RRP: A$22.95 Something More Wonderful is the true story of two young women – best friends – whose worlds is them of one when apart fall diagnosed with advanced liver cancer. Author Sonia Orchard, who was one of her friend Emma’s from their journey together the reader through carers, takes Emma’s diagnosis to her death five months later. It’s also a story of their special friendship, and a tribute to a unique woman. As well as covering the medical realities of Emma’s illness – from her treatment to dietary changes and palliative care of reactions emotional the explores book the – arrangements from their transition It describes those close to her. Emma and optimism that she would be cured (“We’ll write a book about it, teaching others with cancer how to get through it, how to Clinic St Vincent’s NSW Darlinghurst, Privately published. B Pollard (Ed). 40 Chisholm St Greenwich from Dr B Pollard, Copies available NSW 2065 Ten or more A$8.00 each, plus A$1.00 RRP: Single copy A$9.00, postage discipline of the founding fathers was one of the Brian Pollard Australia. Renowned as a clinician and of palliative care in several years been delivering a well- teacher, he has for this title to medical students at the regarded lecture with Asked by the students for suitable Northern Clinical School. he has responded by producing this short background reading, of the area. book as an overview philosophy and background as the topics such Covering symptoms, pain and other of control of palliative care, an excellent communication and ethical issues, it provides of particular use to summary of current practice. This will be area. nursing and medical students new to the and psychosocial For those interested in communication from lengthy support, Pollard offers insights gathered the role of He highlights and keen observation. experience honestly the health professional in not only communicating choices, but in with patients about their illness and treatment themselves on helping family members communicate amongst argues he hope, to regard In openness. and reality of level a to help channel the that the role of the health care team is destroy them. patient’s hopes along realistic lines, not to in palliative care This book fulfills an important niche literature. F Boyle Dept of Medical Oncology Royal North Shore Hospital St Leonards, NSW March 2003 n Volume 27 Number 1 n ANCREATIC CANCER P Cancer Forum cancer is dealt with. cancer terms value in good fairly it represents I think At A$150, in terms ofexpect too much though don’t of its content, that’s what manual. I think as it is a soft cover presentation, read it from and I was able to accessible however, makes it so cover to cover. O Ung NSW Breast Cancer Institute Westmead, NSW R Pollock (2002) Published by Springer 405 pages ISBN: 0-387-95185-7. plus index. RRP: US$169.00 Pancreatic Cancer, which is part of the MD Anderson Solid Tumour Oncology Series, is an extremely worthwhile reference book for clinicians involved in pancreatic of management the introduces theThe book cancer. pathwaysmolecular the of understanding current the to reader of pancreaticthought to be important in the carcinogenesis markers may onecancer. The hope is that these molecular pancreatic cancerday be used to identify patients with “early” the with dealing Chapters surgery. curative to amenable that supportssurgery of pancreatic cancer and the literature of then follow this. The emerging role practice current staging of pancreaticendoscopic ultrasound in diagnosis and and laparoscopiccancer is discussed, together with radiological inplaying is ERCP that role lesser the to comparison in staging diagnosis. improvement in The factors responsible for the marked procedure have led morbidity and mortality of the “Whipple” referral to centres of to discussion of patient selection and aspects technical Some surgery. of type this for specialisation of surgery are compared, pylorus preserving versus non-pylorus preserving pancreaticoduodenectomy and techniques of reconstruction. The role of more aggressive surgery including tumours is pancreatic head nodal and vascular resection for discussed as well as surgery for periampullary, body and tail of the pancreas tumours. The next section discusses the results of adjuvant and neoadjuvant chemoradiotherapy trials and their differing various of experience The delivery. of modes and regimes centres involved in the development of adjuvant therapies is presented and their results discussed with a view to the running of further randomised trials. The final section on emerging therapies takes one on a journey beginning in the laboratory with experimental models of various of potential the test to used are They cancer. pancreatic identified as being important which have been novel therapies, in the mitogenic pathways responsible for pancreatic cancer. In summary, pancreatic cancer poses a difficult management problem for clinicians. An understanding of tumour biology by clinicians will assist with the introduction of these new undoubtedly will book This practice. clinical into therapies achieve its intended aim. D Fenton-Lee March 2003 n Volume 27 Number 1 n Cancer Forum ANUAL OF BREAST ANUAL M DISEASES I Jatoi (Ed) & by Lippincott Williams Published Wilkins (2002) 538 pages ISBN: 0-7817-2950-5. plus index RRP: A$151.80 this recommend highly would I specialist manual for any medical of breast working in the field a manual diseases. It is, as titled, sized as and therefore perfectly quick and a desktop book for a such covers It reference. ready the field of broad range within of that there will undoubtedly be areas breast cancer diseases clinician, be they interest even for the super-specialised breast For its size, a surgeon, oncologist, pathologist or radiologist. also it’s time, present the At comprehensive. surprisingly is it it will remain so current and evidence-based and hopefully with subsequent editions. disease, The first few chapters deal with non-malignant anatomy The this. which is refreshing to see in a text like as well and physiology is covered reasonably comprehensively nipple discharge and as common benign conditions such as of common mastalgia. There is even a chapter on management is a useful chapter, lactational problems and breastfeeding. This is some excellent which is omitted from most textbooks. There and evaluation of practical advice about the management for that rationale. breast masses and the supporting data risk factors (HRT etc) There is also an excellent overview of the the pre is this While cancer. breast of epidemiology the and unexpectedly, fairly National Women’s Health Study, it is, not chapters dealing with close to the mark. There is a number of diagnostic imaging the principles of breast cancer screening, read for the clinicians and newer techniques, which is a useful chapter 11, though amongst us. Pathology is dealt with in not much information there is a slight North American bias and like phyllodes. Surgery for primary on less common pathologies invasive breast cancer has an historical introduction, which as the chapter title suggests, deals only with surgery (no mention of Beatson or McQuirter). There are a few unsupported statements regarding the surgical management of breast cancer, but I am perhaps being a little more pedantic here, having a surgical background. Overall, the author of this chapter, who is also the editor, has a balanced approach, in particular with dealing with issues of the management of the axilla and sentinel node biopsy. There are then two excellent chapters on adjuvant systemic therapy and the role of radiotherapy, which are evidence- based overviews and reasonably current. Metastic cancer is also well dealt with in chapter 17 and if you have the strength for chapter 18, there is a critical review of hormone replacement therapy. Patty Ganz has contributed with a chapter on psychosocial support. Whilst it can only skim the surface, it covers most areas of concern and the briefness of the chapter precludes in-depth information, but is a good source for a focus on areas that perhaps do not receive enough emphasis in clinical practice. Again, this is an important chapter, often omitted from medical textbooks. Genetic testing and breast cancer predisposition also have a good overview chapter and finally chemoprevention of breast ANDBOOK OF STATISTICS IN CLINICAL ONCOLOGY IN CLINICAL ONCOLOGY H 44 J Crowley Published by Marcel Dekker (2001) ISBN: 0-8247-9025-1. 543 pages plus index. RRP: A$383.55 The intended audience for this book is statisticians working research. cancer clinical in it pages than 500 more At catalogues and describes the strategies associated statistical with clinical cancer research. It concentrates on the design trials, clinical of analysis and including phase I, phase II and phase III trials. There are also chapters on heath-related measurement, life of quality prognostic evaluation, economic factor studies and meta-analysis. The techniques covered have applications in other areas of clinical research. a is it Instead cover. to cover from read be to a book not is It Statisticians arises. the need as consulted to be book reference will find it a useful resource, however, non-statisticians will probably find that much of the material is presented at a more technical level than they require. More than 40 researchers (described as leaders in their fields) (probably the created has This book. the to contributed unavoidable) problem that the chapters are uneven in the way they deal with their topics. Admittedly, the focus of the book is clinical trials, and the chapters that deal directly with this area are comprehensive and up-to-date. However other topics, such in a with dealt are and meta-analyses, evaluation economic as more superficial way. In short, a good reference book for statisticians who will be designing and analysing cancer trials. M Coory Health Information Centre Queensland Health Department Brisbane, Qld of medical diseases, as many of these conditions are rarely are conditions of these as many diseases, of medical reality In practice. oncology gynaecological in encountered referral to a be managed by situations would these complex handbook. pocket with a than consultation rather physician procedures, surgical of description a provides also book The surgical the assist to written been have to seems which dictating operative reports. resident in are to and drug names differences in terminology In all texts, the American and Australian systems. be expected between guidebook, however, these differences In a concise practical therefore limit the usefulness of the appear frequently and brief to be a sole reference source for book. While being too handbook format of the portable the oncology, gynaecological information on cancer types, treatment offers quick access to care. options and follow-up J Maidens Oncology Dept of Gynaecologic Royal North Shore Hospital St Leonards, NSW

book reviews CALENDAR OF meetings 47

Tour Hosts GPO Box 128 Sydney NSW 2001 Tel: +61 2 9248 0800 Fax: +61 2 9248 0894 Web: [email protected] Lesley K Woods SAPMEA Conventions 68 Greenhill Road Wayville SA 5034 Tel: +61 8 8274 6055 Fax: +61 8 8274 6000 Email: [email protected] Web: www.sapmea.asn.au Dianna Crebbin DC Conferences Pty Ltd PO Box 571 St Leonards NSW 2065 Tel: +61 2 9439 6744 Fax: +61 2 9439 2504 Email: [email protected] ICMS 84 Queensbridge Street Southbank VIC 3006 Tel: +61 3 9682 0244 Fax: +61 3 9682 0288 Website: www.ruralhealth.org.au/seventhconf/ seventhconf.htm Australasian Cochrane Centre Services Research Monash Institute of Health Monash Medical Centre Locked Bag 29 Clayton VIC 3168 Tel: +61 3 9594 7530 Fax: + 61 3 9594 7554 email: [email protected] Website: www.aspectsofevidence.org.au DC Conferences PO Box 571 Crows Nest NSW 1585 Tel: +61 2 9954 4400 Fax: +61 2 9954 0666 Email: [email protected] Todd Harper Chair, Conference Organising Committee Email: [email protected] Dr Ming Wei University of Queensland, Prince Charles Hospital Brisbane, Queensland Email: [email protected] Web: www.agts.org.au Michelle McBean MP events Suite 1, 2 Walton Street Kew VIC 3101 Tel: +61 3 9852 9941 Fax: +61 3 9852 9961 Email: [email protected] Secretariat

Sydney NSW Adelaide SA Sydney NSW Melbourne VIC Hobart TAS Melbourne VIC Canberra ACT Melbourne VIC Brisbane QLD Sydney NSW Place March 2003 n CALENDAR OF MEETINGS OF CALENDAR Volume 27 Number 1 n World Congress on Medical Physics and Biomedical Engineering Debates on Radiation Oncology and Chemotherapy 7th Australian Palliative Care Conference – Time to Reflect 6th International Symposium on Paediatric Pain: “Pain in Childhood: The Big Questions” 9th International Conference on Oral Cancer 7th National Rural Health Conference 7th National Rural Health Symposium 2003 Aspects of Evidence Ethics in Human Research Conference 2nd National Tobacco Control Conference Australian Gene Therapy Society 3rd Meeting 6th Annual CNSA Winter Congress Name of Meeting ALENDAR Of MEETINGS – AUSTRALIA AND NEW ZEALAND – AUSTRALIA AND Of MEETINGS ALENDAR C 2003 March August 24-29 September 9-12 November 15-19 16-20 Cancer Forum Date 1-4 29 April 2-4 9-11 30 Apr – 2 May July 25-26 March 2003 n Volume 27 Number 1 n

Cancer Forum IRUSES, CELL V TRANSFORMATION & & TRANSFORMATION CANCER A Zuckerman et al (2001) Published by Elsevier pages. ISBN: 0-444-50496-6. 524 RRP: US$145.00 Viruses are rather like some our take they administrators: best ideas, use them for their nefarious purposes, and own leave us either non-viable or else transformed and ready to kill them, since they do those around us. Still, you have to admire it very effectively. in our knowledge Recent years have seen rapid advances too much greater about viruses and this in turn has led Everything from understanding about the biology of cancer. receptors through signaling molecules associated with various by viruses for their to nuclear transcription factors can be used better we will own ends. As we understand these processes for cancers, even be more able to devise appropriate therapies those that are not related directly to viruses. volume of 524 pages This book is an impressive and heavy on various aspects and contains some very complete reviews own that my see clearly cancer. I relates to of virology as it Having waded understanding of this field was very superficial. informed, better any am I that sure not am I text this through but I am encouraged that so much work has been done and it is handy to have access to a reference such as this. Some of the authors have really gone overboard, with more than 500 references for several chapters. I have not checked them all for accuracy. This level of detail means that the book will be those or field the in those for text reference a as useful most who need a high level of detail. Other more superficial reviews would be more suitable for weekend viro-oncologists. The book is most useful where it describes the mechanisms of factors cellular known with products gene viral of interaction such as those involved in cell cycle regulation. There are as human such agents of biology the chapters on intriguing in virus involved described newly a relatively herpesvirus-8, primary effusion lymphoma and in Kaposi’s sarcoma. Some of vaccine relating to cover areas of the book the later chapters design, with particular reference to human papilloma virus and including a discussion on VLPs, but I was disappointed to find that Ian Frazer’s work was not discussed here. in gene adenoviruses use of the covers chapter final The transfer approaches to cancer, an odd chapter given that it covers a wide range of genes very comprehensively but restricts itself to only one vector. All in all, this book on viruses is not to be sneezed at. Now, if only someone would invent an administrator vaccine… and age. The moral of the book? All cancers can go anywhere, cancers can book? All of the The moral and age. predictable and recognisable some be may there though a book of reference book, or this is a patterns. Essentially, at the NCI,place in libraries and so, as such, it has a curiosities and tidy desk. perhaps on your neat or (less likely) P de Sousa Oncology Dept Hospital St George Kogarah, NSW xNxM1. THE ANATOMY xNxM1. THE ANATOMY AND CLINICS OF METASTATIC CANCER T 46 J Debois Published by Kluwer (2002) ISBN: 0-7923-6195-4. 745 pages plus index. RRP: US$230.00 Is your desk neat and tidy? Are all your articles filed away? This tendencies, andtext will appeal to all those who have obsessive examines in greatanatomists. It is an encyclopaedic work that a variety of cancers.detail the pattern of metastatic disease in metastasis and itsThe book is divided into two parts: (i) the areprimary and its metastases. Chapters the (ii) and primary, groups, and withinarranged according to organs or organ is preserved:each chapter, the same logical order of discussion and diagnosis. Moreanatomical pathways, incidence, symptoms the liver are treatedcommon situations such as metastases to in more depth, with subheadings such as imaging and special situations (eg ruptured liver metastases) included. An extensive endthe at listed is organ relevant the to pertaining bibliography of each chapter. References are up-to-date (circa 2000) and span three decades. Dr Debois has painstakingly gathered and reviewed case reports and compilation is a book The literature. in the series case and study of all possible metastatic sites from a given tumour, and all possible primary cancers for a given metastatic site. One can even find a short paragraph and table on ciliary body metastases. There are many tables, which, in my opinion, are text The the information. display to way best the probably largely supports the tabular information, though some of it is repetitive. The poor editing, occasional spelling mistake, and the small font do not make for easy reading. wasI (ACUP), primary unknown of adenocarcinoma than Other unable to think of situations where the book might be put to practical clinical use. Even here, I found the book of limited use, metastaseshad ACUP with patients recent my of few a since to more than one site. Probably my poor understanding of oftruths the deeper appreciate difficult to it anatomy made the way cancers behave, though there were some interesting insights such as the graph showing a declining linear relationship between metastases at diagnosis for non-small cell lung cancer conquer those odds”) to reluctant acceptance that she would that she reluctant acceptance odds”) to those conquer stop can She said. all As they dying. She’s it. – that’s (“So not I can stop acting.”) acting now. for her for herself – as an outlet wrote this book Sonia Orchard the young death – and for months following Emma’s grief in the reading not be recommended left behind. It may son her friend as it is those caring for them, who have cancer or for people physical woman’s a of portrayal its in honest unapologetically following diagnosis – and the anguish and mental demise disease the as through go her love who those and she that in her death. But as someone who works progresses and after lucky enough not to have someone close the field but has been moving I found it an enlightening and to me die from cancer, journey. insight into the cancer J Denholm The Cancer Council Australia Sydney, NSW

book reviews CALENDAR OF meetings 49 Dr Lisa Elovainio, MD, Secretary Gen Cancer Society of Finland & Pres Finnish Centre for Health Promotion Helskini, Finland Fax: +358 9 135 1093 Email: [email protected] International Conference Services Vancouver, Canada Fax: +1 604 681 1049 Email: [email protected] Website: www.2003worldlungcancer.org ESTRO Office ESTRO 83/12 E. Mounierlaan avenue Brussels 1200 54 94 9340 Fax: +32 2 779 Tel: +32 2 775 Email: [email protected] Website: www.estro.be ESTRO Office 83/12 avenue E. Mounierlaan 1200 Brussels +32 2 779 54 94 Tel: +32 2 775 9340 Fax: Email: [email protected] Website: www.estro.be Nesbitt Vencer e Viver: Dr Henriette de Almeida Lima Da Liga Nucleo Regional Do Sul Portuguesa Contra O Cancro Lisboa, Portugal Fax: +351 21 726 3363 Email: [email protected] ESTRO Office 83/12 avenue E. Mounierlaan 1200 Brussels Tel: +32 2 775 9340 Fax: +32 2 779 54 94 Email: [email protected] Website: www.estro.be ASCO Alexandria, Virginia, USA Fax: +1703 2999 1044 Email: [email protected] Website: www.asco.org ESTRO Office avenue E. Mounierlaan 83/12 1200 Brussels Tel: +32 2 775 9340 Fax: +32 2 779 54 94 Email: [email protected] Website: www.estro.be ESTRO Office avenue E. Mounierlaan 83/12 1200 Brussels Tel: +32 2 775 9340 Fax: +32 2 779 54 94 Email: [email protected] Website: www.estro.be Andrea Oz National Conference of Self Helps Groups 107 Crowther Road London SE25 5QS Tel: +02 0 8656 7520 Fax: +02 0 8656 7910 Email: [email protected] International Society of Chemotherapy University of Natal of Durban Dept of Medical Microbiology Congella, South Africa Fax: +2731 206 4431 Email: [email protected] ESTRO Office avenue E. Mounierlaan 83/12 1200 Brussels Tel: +32 2 775 9340 Fax: +32 2 779 5494 Email: [email protected] Website: www.estro.be Helsinki Finland Copenhagen Denmark Barcelona Spain Lübeck Germany Lisbon Portugal St Petersburg Russia Chicago Illinois USA Berg en Dal l Nijmegen The Netherlands Nice France Manchester UK Durban South Africa Amsterdam The Netherlands March 2003 n Volume 27 Number 1 n 12th World Conference on Tobacco or Health: Global Action for a Tobacco Free Future 10th World Conference on Lung Cancer Dose Determination in Radiotherapy: Beam Beam in Radiotherapy: Dose Determination and Dose Calculation Characterisation, dose Verification Meeting Annual Brachytherapy International 12th Reach to Recovery Gap: the Needs Conference “Bridging the and their Assessment” Physics for Clinical Radiotherapy ASCO: 39th Annual Conference of the American Society of Clinical Oncology 2nd ESTRO Workshop on Biology in Radiation Oncology Imaging for Target Volume Determination in Radiotherapy National Conference of Cancer Self Help Groups Annual Conference 23rd Congress of the International Society of Chemotherapy IMRT and Other Conformal Techniques in Practice August 3-8 10-14 Cancer Forum 6-10 15-17 21-24 25-29 31 May – 3 June June 1-3 1-5 19-22 19-28 22-26 March 2003 n Volume 27 Number 1 n Cancer Forum Email: [email protected] GPO Box 4708 Sydney NSW 2001 Ph: +61 2 9036 3100 Fax: +61 2 9036 3101 Email: [email protected] Jacques Bernier Oncology Institute of Southern Switzerland San Giovanni Hospital Bellinzona – CH-6504, Switzerland Fax: +41 91 820 9044 Email: [email protected] Website: www.osg.ch/ictr2003.html ESTRO Office avenue E. Mounierlaan 83/12 1200 Brussels Tel: +32 2 775 9340 Fax: +32 2 779 54 94 Email: [email protected] Website: www.estro.be KENES International PO Box 50006 Tel Aviv – 61500, Israel Tel: +44 22 908 0488 Fax: +44 845 127 5944 Email: [email protected] AACR Philadelphia, Pennsylvania, USA Fax: +1 215 351 9165 Email: [email protected] Website: www.aacr.org Congress in Psycho-Oncology Email: [email protected] Website: www.capo.ca Oncology Nursing Society Meeting Services Team Pittsburgh, Pennsylvania, USA Fax: +1 412 921 6565 Email: [email protected] Website: www.ons.org ESTRO Office avenue E. Mounierlaan 83/12 1200 Brussels Tel: +32 2 775 9340 Fax: +32 2 779 54 94 Email: [email protected] Website: www.estro.be Conference Manager +61 3 9667 1375 Tel: +61 3 9667 1313 Fax: MP Events +61 3 9852 9961 Tel: +61 3 9852 9941 Fax: Email: [email protected] of Australia Clinical Oncological Society Ruth Lilian Events Pharma 265 PO Box NSW 2038 Annandale 0533 0577 Fax: +61 2 9280 Tel: +61 2 9280 Email: [email protected] Secretariat ACT Lugano Switzerland Cairo Egypt The Hague The Netherlands Toronto Canada Banff Canada Denver USA Tenerife Spain Melbourne VIC Sydney NSW Canberra Perth WA Place Oncology Nursing Society 28th on Translational Research and Pre-Clinical Strategies in Radiation Oncology Modern Brachytherapy Techniques for Palliative Care 94th American Association for Cancer Research (AACR) Annual Meeting 6th World Congress in Psycho-Oncology Annual Congress Radiation Oncology: A Molecular Approach 8th Congress of the European Association ICTR 2003: 2nd International Conference Promotion and Health Education Conference on Care 13th International Cancer Nursing 18th World Conference on Health 18th World Conference Nurses in Cancer International Society for Meeting 31st COSA Annual Scientific Scientific Meeting Annual 30th COSA Name of Meeting ALENDAR Of MEETINGS – International C 48 May 1-4 2003 March 23-27 5-9 23-27 4-8 April 2-5 16-19 Date

November 24-26 August 4-8 25-29 2003 April 26-28

CALENDAR OF meetings CALENDAR OF meetings 51 Society of Thoracic Surgeons Society of Thoracic USA Chicago, Illinois, 6635 Fax: +1312 527 Email: [email protected] D K Kubis, SSO USA Arlington Heights, Illinois, Fax: +1847 427 9656 Email: [email protected] Website: www.surgonc.org Cancer Research American Association for USA Philadelphia, Pennsylvania, Fax: +1 215 351 9165 Email: [email protected] Website: www.aacr.org ONS, Meeting Services Team Pittsburg, Pennsylvania, USA Fax: +1412 921 6565 Email: [email protected] Website: ww.ons.org Cancer Therapy & Research Center SACI, Rich Markow San Antonio, Texas, USA Fax: +1210 949 5009 Email: [email protected] Website: www.sabcs.org San Antonio Texas USA New York City New York USA Orlando Florida USA Anaheim California USA San Antonio Texas USA March 2003 n Volume 27 Number 1 n 40th Annual Meeting of the Society of Meeting of the Society 40th Annual Thoracic Surgeons of the 57th Annual Cancer Symposium Society of Surgical Oncology the American 95th Annual Meeting of (AACR) Association for Cancer Research (ONS) Oncology Nursing Society 29th Annual Congress 27th Annual San Antonio Breast Cancer Symposium Cancer Forum 2004 January 26-28 March 18-21 27-31 April 29 April – 2 May December 3-6 March 2003 n Volume 27 Number 1 n Cancer Forum San Antonio, Texas, USA Fax: +1210 949 5009 Email: [email protected] Website: www.sabcs.org Cancer Therapy & Research Center SACI, Rich Markow Tel: +32 2 775 9340 Fax: +32 2 779 54 94 Tel: +32 2 775 9340 Fax: Email: [email protected] Website: www.estro.be FECS Conference Unit Brussels, Belgium Fax: +322 775 0200 Email: [email protected] Website: www.fecs.be ESTRO Office Brussels, Belgium Fax: +322 779 5494 Email: [email protected] Website: www.estro.be SIOP, Congrex Holland Amsterdam, The Netherlands Fax: +31 (0)20 5040 225 Email: [email protected] Website: www.congrex.nl ESTRO Office Brussels, Belgium Fax: +322 779 5494 Email: [email protected] Website: www.estro.be ASTRO Fairfax, Virginia, USA Fax: +1 703 502 7852 Email: [email protected] Website: www.astro.org International Federation of Gynecological Oncologists London, United Kingdom Fax: +44(0) 207 935 0736 mail: [email protected] Website: www.figo.org/figo2003.asp ESTRO Office Brussels, Belgium Fax: +322 779 5494 Email: [email protected] Website: www.estro.be 10th HKICC Congress Secretariat Department of Surgery University of Hong Kong Medical Centre Queen Mary Hospital Hong Kong Tel: +852 2818 0232 Fax: +852 2818 1186 Email: [email protected] Website: www.hkicc.org ESTRO Office 83/12 avenue E. Mounierlaan 1200 Brussels ESTRO Office ESTRO 83/12 E. Mounierlaan avenue Brussels 1200 54 94 9340 Fax: +32 2 779 Tel: +32 2 775 Email: [email protected] Website: www.estro.be ESTRO Office 83/12 avenue E. Mounierlaan 1200 Brussels +32 2 779 54 94 Tel: +32 2 775 9340 Fax: Email: [email protected] Website: www.estro.be USA San Antonio Texas Copenhagen Denmark Copenhagen Denmark Cairo Egypt Santorini Greece Salt Lake City Utah USA Santiago de Chile Chile Lisbon Portugal Pokfulam Hong Kong Geneva Switzerland Kiel Germany Leuven Belgium Cancer Symposium 26th Annual San Antonio Breast ECCO 12 – the European Cancer ECCO 12 – the European Conference 22nd Annual European Society for Therapeutic Radiology and Oncology (ESTRO 22) Paediatric Oncology Basic Clinical Radiobiology 45th ASTRO Annual Meeting (American Society for Therapeutic Radiology and Oncology) and Obstetrics Evidence-Based Radiation Oncology: Methodological Basis and Clinical Application 10th Hong Kong International Cancer Congress XVI FIGO World Congress of Gynecology SIOP 2003: International Society of Radiation Technology for Clinical Radiation Technology for Radiotherapy 7th ESTRO Meeting on Physics and 7th ESTRO Meeting on Physics Brachytherapy for Prostate Cancer Prostate Cancer for Brachytherapy Physics for Clinical Radiotherapy Physics for Clinical 50

3-6 December 21-25 21-25 12-16 19-23 9-14 19-21 November 2-7 8-11 October

September 15-18 31 Aug – 31 Aug 2 Sept 2 Sept 31 Aug – 4 Sept

CALENDAR OF meetings THE CANCER COUNCIL AUSTRALIA The Cancer Council Australia is the peak national cancer control organisation. Its members are the leading state and territory cancer councils, working together to undertake and fund cancer research, prevent and control cancer and provide information and support for people affected by cancer.

MEMBERS COUNCIL The Cancer Council ACT Office Bearers The Cancer Council New South Wales President The Cancer Council Northern Territory Professor R Lowenthal MBBS, MD, FRCP, FRACP, FAChPM The Cancer Council South Australia The Cancer Council Tasmania Vice-President The Cancer Council Victoria Mrs J Roberts AM SRN Cancer Foundation of Western Australia Members Queensland Cancer Fund Mr G Brien AM, MBA AFFILIATED ORGANISATIONS Professor I Frazer BSc(Hons), MBChB, MD MRCP, FRCP, FRCPA Australasian Association of Cancer Registries Professor D Holman MBBS, MPH, PhD, FACE, FAFPHM Dr G Jennings BSc PhD Dip Ed Clinical Oncological Society of Australia Inc Professor D Hill AM, PhD Palliative Care Australia Dr L Kenny MBBS, FRANZCR CEO Hon S Lenehan BA, DipMan, MBA, FAICD Professor A Coates AM, MD, FRACP, AStat Ms K Schofield Assoc Professor S Smiles RN, RM, ICC, BHA, GradDipPSEM Dr R Walters RFD BMedSc, MBBS, RACGP Professor J Ward MBBS, MHPEd, FAFPHM, PhD Dr K White PHD

THE CLINICAL ONCOLOGICAL SOCIETY OF AUSTRALIA INC The Clinical Oncological Society of Australia (COSA) is a multidisciplinary society for health professionals working in cancer research or the treatment, rehabilitation or palliation of cancer patients. It conducts an annual scientific meeting, seminars and educational activities related to current cancer issues. COSA is affiliated with The Cancer Council Australia.

EXECUTIVE COMMITTEE INTEREST GROUPS President Breast Oncology Dr L Kenny MBBS, FRANZCR Cancer Research President Elect Data Managers Dr S Ackland MBBS, FRACP Epidemiological Gastrointestinal Oncology Council Nominees Gynaecological Oncology Ms C Cameron RN, OncCent, GrDipN, MNSc Lung Oncology Dr D Goldstein MBBS, MRCP (UK), FRACP Medical Oncology Professor J Thompson BSc(Med), MBBS, FRACS, FACS, MD Melanoma and Skin Oncology Nursing (Cancer Nurses Society of Australia) MEMBERSHIP Paediatric Oncology Further information about COSA and membership (ANZ Childhood Cancer Study Group) applications are available from Palliative Care GPO Box 4708, Sydney, NSW 2001. Pharmacy Psycho-Oncology Membership fees for 2003 Radiation Oncology Ordinary Members: $140 Regional and Rural Oncology Associate Members: $80 Social Workers (includes GST) Surgical Oncology

52 Cancer Forum n Volume 27 Number 1 n March 2003