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Prestigious medical journal The Lancet published a series of papers on the care for cancer survivors this week, with significant contributions from Peter Mac clinician researchers and consumers.
The three papers address many of the issues that cancer survivors commonly experience and how to approach these, discuss improved models of cancer care, and consider specific issues for those who are survivors of cancer in childhood and adolescence.
Improvements in the early detection and treatment of cancer mean a growing number of people are living long-term after their diagnosis.
In the past, patients and doctors have understandably focused their attention on whether the cancer has been cured and follow up has emphasised the detection of possible cancer recurrence. Now however, for many people, cancer should be viewed more as a long term condition.
Many cancer survivors experience health problems long after their treatment has ended, including pain, fatigue, worry about the cancer recurring, and a wide range of physical side-effects related to treatment.
The Lancet papers highlight the need for greater involvement of non-oncologists in the care of cancer survivors, suggesting new models of multidisciplinary care.
Professor Michael Jefford, medical oncologist and Director of the Australian Cancer Survivorship Centre at Peter Mac, co-led the series with Prof Jon Emery (University of Melbourne) and Dr Emily Tonorezos (Office of Cancer Survivorship, (US) National Cancer Institute).
Prof Jefford is senior author on the first paper in the series, and lead author of the second. He explains that while there is a growing focus on the issues that survivors may experience, and shared care models are recommended in some state and national plans, there is still a lot of work to do.
“The goal of these papers is to highlight to clinicians, service managers and policymakers how health care systems should adapt to create high-quality, integrated models of survivorship care.”
“Survivors of cancer should receive follow-up care by a range of clinicians: their oncologist, GP, and other health professionals according to their specific needs such as a psychologist, physiotherapist or exercise physiologist.”
Meg Rynderman, cancer survivor and consumer advocate, is a co-author and has shared her own experience in two of the three papers. Meg provides important patient perspective to the papers, as well as invaluable contribution to the Australian Cancer Survivorship Centre, and Peter Mac more broadly.
Dr Jeremy Lewin, the Medical Director of Peter Mac’s ONTrac adolescent and young adult service, contributed to the third paper, which makes long-term care recommendations for young people who have been treated for cancer.
Other Peter Mac contributors are Dr Karolina Lisy, Senior Research Fellow, Department of Health Services Research and Dr Julia Lai-Kwon, medical oncologist and PhD student, Department of Health Services Research.
The papers were produced in collaboration with colleagues from Australia, the United States, the UK, China, Canada, and Singapore.
Read the series at The Lancet's website here.
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**Journalists can email Peter Mac's Communications Team to find out more and speak to the authors.
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Peter Mac research has been well-represented at the American Association of Cancer Research (AACR) Annual Meeting, held in New Orleans last week.
Lead genitourinary medical oncologist Associate Professor Ben Tran gave a prestigious oral presentation at one of the conference's plenary sessions about an exciting new compound called MEDI5752.
MEDI5752 is being evaluated in a first in human phase 1 clinical trial to see how safe and effective it is in adults with advanced solid tumours.
"MEDI5752 is an antibody that targets both PD-1 and CTLA-4 at the same time; these proteins are the key brakes that prevent immune cells from targeting cancers in some patients," Associate Professor Tran says.
In the study he presented, MEDI5752 resulted in substantial immune cell activation exceeding what is achievable with the current therapies in use.
Additionally, MEDI5752 resulted in tumour shrinkage that was seen across a diverse range of tumours, and at multiple dose levels.
"So far, the trial is showing encouraging anti-tumour activity and longer term clinical benefits for patients," Associate Professor Tran says.
There were also two other clinical trial plenary presentations at AACR from trials conducted by Peter Mac investigators in the Early Drug Development trials program.
Medical oncologist Dr Stephen Luen was last author on interim results presented from the ongoing PETRA trial, a first in human phase 1/2a clinical trial of AZD5305, a new generation PARP1-selective PARP inhibitor.
PARP1 is an enzyme that allows cells to repair DNA damage. By blocking this enzyme in cancer cells, PARP1 inhibitors can prevent the cells repairing themselves and hence cause them to die.
Results from PETRA show AZD5305 is better tolerated and more effective in patients with advanced breast, ovarian, prostate or pancreatic cancer who also carry certain genetic mutations, than first generation inhibitors.
Medical oncologist Associate Professor Jayesh Desai was a co-author on an analysis of the long-term efficacy data from the breakthrough KRAS-G12C inhibitor sotorasib in patients with non-small cell lung cancer.
KRAS is a protein that when it is switched on, controls how often a cell divides. A mutated form of this protein KRAS-G12C is always switched on, meaning cells are more likely to divide uncontrollably leading to the formation of tumours.
Forty per cent of patients given sotorasib responded to the therapy, and kept responding for a median duration of just over a year. Importantly, the one and two-year overall survival of patients was 50.8 per cent and 30.3 per cent respectively.
"Trials into this first-in class agent, next-generation KRAS G12C inhibitors and combination strategies are an area of strong research focus for Peter Mac investigators," Associate Professor Desai says.
Medical oncologist Associate Professor Jeanne Tie chaired and presented at an education session about minimal residual disease in solid tumours.
The session provided an overview of the current evidence, the challenges of minimal residual disease detection in solid tumours, clinical implications, and the roadmap to demonstrating clinical utility.
Medical oncologist Professor Sarah-Jane Dawson ran a Meet the Expert session on circulating tumour DNA – small fragments of cancer DNA in a patient's blood.
This followed on from Professor Dawson's 2021 AACR oral presentation on how liquid biopsies – a type of blood test – could be refined to identify circulating tumour DNA, allowing for earlier cancer diagnosis and better tailored treatments.
A number of presentations also showcased the strength of prostate cancer research at Peter Mac.
- Associate Professor Shahneen Sandhu presented a poster on molecular subtyping of prostate cancer to better understand the underlying disease biology.
- Dr Luc Furic presented at a minisymposium about PMR-116, a new inhibitor of ribosome biogenesis (ribosomes regulate protein synthesis) which shows promising results in preclinical models of prostate cancer. PMR-116 is now in a first in human Phase 1 trial at Peter Mac for patients with solid tumours.
- Dr Heidi Fettke presented a poster on preliminary results from an Australian study looking at circulating tumour DNA and outcomes following Lutetium-PSMA treatment in patients with advanced prostate cancer.
- PhD student Rosalia Quezada Urban presented a poster on how single cell RNA analysis revealed a number of distinct subpopulations of cells in aggressive variants of prostate cancer.
Read more about all the Peter Mac research presented at the AACR Annual Meeting on the conference website.
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Peter Mac’s new Nursing Discovery program began last week with eight registered nursing recruits.
Over the 12-18 month program, the nurses will learn to care for people with the most complex cancers, training in the essentials of anti-cancer therapy – chemotherapy, immunotherapy, and targeted therapies.
One of the participants, Emily Salim, moved over 2,000 kilometres from Queensland’s Mackay to join the program.
“I want to learn about this specialised skill from the best, and was willing to move interstate because I knew that this Discovery program was a very special opportunity for me.”
After graduating from nursing at Queensland University of Technology in 2008 Emily worked in aged care, before taking up a position at Mackay’s Mater Hospital. There she worked as a peri-op nurse and endoscopic nurse, before upgrading her clinical skills and working in the medical oncology and palliative wards.
“Ever since then, I have been very interested in cancer nursing,” Emily explains, “I can see how prevalent the disease is and how little some of the nurses in Mackay (especially the young ones like me) know about the best practise of cancer care for such patients.”
“Cancer nursing is a uniquely challenging and rewarding occupation. With this program we’re proud to offer qualified registered nurses a supportive and structured opportunity to learn on the job,” said Acting Chief Nursing Officer Andy Dimech.
The nurses will complete up to three rotations in Peter Mac’s Haematology and Medical Oncology wards, and the Chemotherapy Day Unit.
After her first week, Emily explains “To be honest, I was and probably still am a little nervous, being here out of my comfort zone. But I’m enjoying this steep learning curve, and I’m sure my other seven colleagues agree that we all are excited with this new adventure.”
Having spent week one in the classroom, Emily and her new colleagues are eager to begin their practical induction this week.
“I can’t wait to be fully immersed in Peter Mac and to also contribute my skills to the hospital.”
Andy adds, “We are really lucky to have recruited such a skilled group. I’m looking forward to seeing them out on the ward, delivering the compassionate specialist care that Peter Mac is dedicated to.”
Nursing Discovery program recruit Emily Salim.
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During Patient Experience Week, the Prevention and Wellbeing team delivered the results of the most recent Patient Parliament, which was held virtually at the end of 2021.
Peter Mac strives to deliver the world’s best cancer care.
To achieve this, we value the ideas, advice and feedback from the more than 37,000 patients who visit Peter Mac’s five campuses every year.
Patient Parliaments give Peter Mac an opportunity learn from patients, carers, and families about how to improve services and access to key information.
The results webinar, led by Director of Prevention and Wellbeing Geri McDonald, was an important update for consumers about the steps Peter Mac is taking to improve the patient experience.
Ms McDonald said Peter Mac’s aim is to make patients “partners” in the delivery of care.
“It’s really important that consumers feel empowered by our staff to use the information they have to make informed decision about their care,” Ms McDonald said.
“This includes having all the information, understanding their options, asking questions and making sense of those options.”
The report identified a number of key improvement areas that consumers said are most important to them. These include:
- Better information and communication
- Improving navigation of the healthcare system
- Building capacity for consumers to partner in their healthcare, and;
- Improving support networks.
Peter Mac will use the responses from Patient Parliament to inform the Patient Experience Strategy and to drive immediate improvement projects – many of which have already commenced.
One major area of focus is how Peter Mac staff communicate with patients and their families and carers.
“We know there are some communication challenges working in a busy hospital environment with lots of patients to see, but we also know the way we communicate with our patients has a big impact on their experience,” Ms McDonald told the event.
“Following the extensive consumer feedback, Peter Mac is introducing a new training program for every single staff member, to provide greater focus on what matters to patients, called Your Thoughts Matter.”
Peter Mac will be the first metropolitan health service in Australia to implement the evidence-based training program, delivered by Deakin University, across the entire organisation.
Other issues being addressed from consumer feedback include Health Hub refinements, improvements to appointment systems and patient navigation, improved patient welcome packs and orientation, carer supports (including a newly-funded carer liaison) and better access to wellbeing and support services.
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The Advanced Prostate Cancer Consensus Conference (APCCC) is underway in Switzerland, and Peter Mac’s Professor Declan Murphy is providing his expert insights from this international forum.
You can hear Prof Murphy interview leading figures at the conference in a three-part series on his “GU Cast” podcast. See the links below.
Prof Murphy says the APCCC brings together “top leaders in prostate cancer from around the world” to discuss “the most contentious areas in prostate cancer, and have a series of votes among the expert panel to try to reach consensus on some of the most challenging areas in prostate cancer”.
Discussion points so far include PSMA PET-CT scanning as an emerging way to detect and monitor prostate cancer that has spread outside of the prostate, and implications for treatment.
Prof Murphy is a Consultant Urologist and Director of Genito-Urinary (GU) Oncology at Peter Mac. Also representing Peter Mac as an invited panellist at the APCCC is Prof Michael Hofman – Director of the Prostate Cancer Theranostics and Imaging Centre of Excellence (ProsTIC).
Listen to GU Cast - APCCC Highlights Part 1 or watch this episode on YouTube.
Prof Murphy interviews APCCC Convenors, Dr Silke Gillessen and Dr Aurelius Omlin, and panellists Dr Pierre Blanchard, Dr Jochen Walz, and Dr Bertrand Tombal, along with patient representative David Mathesen. Plus Dr Derya Tilki turns the microphone on Declan!
Listen to GU Cast - APCCC Highlights Part 2 or watch this episode on YouTube
Prof Murphy says imaging has played a very dominant (and disruptive) role at APCCC 2022, especially PSMA PET/CT. Declan interviews four imaging experts to hear their thoughts. Nuclear Medicine physicians Professor Michael Hofman (Melbourne), Professor Stefano Fanti (Bologna) and Dr Ken Herrmann (Essen), were joined by MRI guru Professor Anwar Padhani (London). Dr Marcus Cumberbatch, Consultant Urologist at the University of Sheffield Hospital (Sheffield), and Melbourne alumnus, gives a great perspective of his experience as a delegate at APCCC. Finally (for this episode), Declan speaks with top prostate cancer specialists Dr Neha Vapiwala, Radiation Oncologist at the University of Pennsylvania (Philadephia), and Dr Elena Castro, Medical Oncologist at the Virgen de la Victoria University Hospital (Malaga).
Listen to GU Cast - APCCC Highlights Part 3 or watch this episode on YouTube
Prof Murphy chats with Dr Axel Merseberger (Lubeck), Dr Jochen Walk (Marseille), Ms Jane Fisher (Melbourne), and Dr Chris Sweeney (Boston/Adelaide). Plus listen out for fantastic father and son act, Professor Joe and Oisin O'Sullivan, who played for the crowds outside the Villa Cian.