Gynae Cancer Centre Newsletter July 2010

Thankyou from the National Manager

The Minister announced on 16 June the Government’s intention to amalgamate the National Breast and Ovarian Cancer Centre and Cancer Australia to form a stronger cancer agency. A transition period will begin immediately and during the transition to the single national agency, both Cancer Australia and NBOCC will continue with their current programs of work.

Dr Helen Zorbas has been appointed by the Minister as the new CEO for Cancer Australia and during the transition Dr Zorbas will continue as the CEO for the NBOCC. Stakeholder and consumers can provide their comments on the amalgamation to the Transition Working Group via the email cancerconsultation@health.gov.au.

Cancer Australia has streamlined approaches to better align like programs, build capacity within programs and integrate the consumer program across all areas of Cancer Australia. As a result, the National Centre for Gynaecological Cancers has transferred to the Cancer Networks and Professional Development program and will be led by Dr Joanne Ramadge. The Research, Clinical Trials and Data program, along with the Building Cancer Support Networks Program continues to be led by Dr Cleola Anderiesz. Both Julie Mueller and Ella Curnow will continue to be integrally involved with the work of the National Centre for Gynaecological Cancers. 

The Consumer Networks program led by myself continues to include the National Consumer Advisory Group (NCAG), consumer training, the Australian Cancer Trials project and will also integrate consumer involvement across Cancer Australia’s clinical networks and research programs. In addition, the Consumer Networks program will undertake a project to develop a national framework for consumer involvement in cancer control.

Whilst I will still be involved with the National Centre for Gynaecological Cancers it will no longer be in a leadership role and thus I want to take this opportunity to thank you all for your ongoing support during my involvement.

It has been an absolute pleasure working with you all and I continue to be humbled by your generosity that has seen us improve the availability of information and support available to women with gynaecological cancers, strengthen the workforce to provide quality gynaecological cancer care and help build the evidence in gynaecological cancer care through research and clinical trials. This could not have been achieved without the valuable input of our Advisory Group members and collaborative key stakeholder organisations. I wish you well as you build on previous efforts.

With warm regards

Susan Hanson

What’s New!

The launch of consumer resources

On 20 April, Dr Norman Swan, Professor Sanchia Aranda and Ms Kathryn Crisell launched the NCGC’s consolidated suite of consumer information resources on gynaecological cancers. These resources are now available to down load from Cancer Australia’s website: www.canceraustralia.gov.au

Cancer Support Networks grants

On 4 February, the Parliamentary Secretary for Health, Hon Mark Butler MP, announced the successful applicants for the Building Cancer Support Networks Initiative: Better Cancer Support through Consumers. Two gynaecological cancer specific projects were awarded to Ovarian Cancer Australia and Women’s Health Victoria.

The Jeannie Ferris, National Centre for Gynaecological Cancers Consumer Churchill Fellowship

On 1 July, The Winston Churchill Memorial Trust announced the first Jeannie Ferris, National Centre for Gynaecological Cancers Consumer Churchill Fellow. Merran Williams, a survivor of ovarian cancer, will use the fellowship to visit gynaecological cancer centres of excellence in the United States of America to investigate survivorship programs that support women affected by ovarian cancer.

National Centre for Gynaecological Cancers Advisory Group

Supporting the workforce to provide quality coordinated multidisciplinary gynaecological cancer care

$2.33 million has been committed, of which $1.5 million has been allocated to states and territories to strengthen the workforce to provide quality gynaecological cancer care.

Development of a National Gynaecological Cancer Service Delivery and Resource Framework

The final draft of a National Gynaecological Cancer Service Delivery and Resource Framework (National Framework) has been completed. The development process, steered by Sheila Hirst and Alison Amos, has been an incredible collaborative effort that has involved consultation with a wide variety of people including consumers, state and territory government health representatives and representatives of key professional groups responsible for the care and support of women affected by gynaecological cancers, their families and carers.

Our purpose in developing a National Framework for gynaecological cancers is toguide improvements in the care and support of women with gynaecological cancers over the next ten years and to ensure that all Australian women with, or at risk of, a gynaecological cancer gain access to high quality care wherever they may live in Australia. 

In developing the National Framework the project team established a consumer reference group and, via a survey, consulted with over 50 consumers. This has ensured that the National Framework reflects the views of women affected by gynaecological cancers, their families and carers.

A project working group was also established, which was chaired by Dr Gerard Wain and included representation from key professional groups. This group has provided valuable advice and assistance to ensure that the National Framework addresses the issues of both specialist and generalist service providers involved in the care of women with gynaecological cancers within and across services and sectors.

The consultation process for the National Framework concluded with a very successful national workshop on 19 April in Melbourne. Over 60 people attended, including representatives from: Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG); Australian Society of Gynaecologic Oncologists (ASGO); Medical Oncology Group of Australia (MOGA); Royal Australian and New Zealand College of Radiologists (RANZCOR); and Royal College of Nursing Australia (RCNA).

Framework overview: Some of the challenges facing the nation’s gynaecological cancer workforce include:

• the broader health care issues including access and the burgeoning costs of health care;
• increasing gynaecological cancer service demand;
• variations in practices in gynaecological cancer care;
• a ‘stretched and changing’ workforce; and
• balancing access, equity and efficiency to ensure the best use of available resources.

To address these and other challenges, the National Framework is underpinned by a patient (and family) centred approach to care. The following eight service delivery elements are identified that make up good practice gynaecological cancer care.

 Each element identifies a broad objective to guide practice and the required service delivery components of care and supporting systems and processes.

The National Framework then addresses the workforce resources and skills needed to respond to these elements including the increasing number of gynaecological oncology resources required to meet future service demand.

 In order to make the best use of current and future resources, the National Framework challenges the gynaecological oncology workforce to consider its core functions and the potential role of other providers, including gynaecologists and general practitioners, in supporting women with gynaecological cancers at different points in the pathway.

The final draft of the National Framework was completed in June 2010 and has been released for comment on Cancer Australia’s website. 

State and territory gynaecological cancer workforce projects

The state and territory gynaecological cancers workforce projects are progressing well and spanning all states and territories. These projects provide a local approach to implementing change within the gynaecological cancer sector. The state and territory projects aim to implement elements of the National Framework. Projects include a focus on referral practices and enhancing supportive care for people affected by gynaecological cancers within their jurisdiction.

State and territory project officers, consumers and gynaecological cancer nurse consultants met the day after the National Framework workshop to consider how they can better incorporate elements of the National Framework into their local jurisdictional projects and reflect on the evaluation of the Initiative nationally.

 For more information about the Gynaecological Cancers Workforce Initiative, including recent updates and communiqués, please visit the Centre at www.canceraustralia.gov.au  

Clinical practice guidelines for the management of women with endometrial cancers

The Centre is currently calling for submissions on the following clinical practice guidance material for general practitioners and gynaecologists: 

• Abnormal vaginal bleeding in pre and peri menopausal women: Investigations leading to a diagnosis of endometrial cancer; and
• Vaginal bleeding in post menopausal women: Investigations leading to a diagnosis of endometrial cancer

These two diagnostic flowcharts are based on the consensus of an expert reference group. The Centre is inviting submissions on these two documents until 30 September 2010. To view the flowcharts or to submit feedback, please visit What’s New on Cancer Australia’s website.

We acknowledge the extensive input by our reference group in developing these two resources. The considerable time and effort that members have volunteered has ensured these resources are of a high quality and reflect best practice.  

Work has also commenced on the next priority area for guideline development, - the management and treatment of women with:

• early stage low-risk endometrial cancer;
• early stage high-risk endometrial cancer;
• metastatic endometrial cancer (both nodal and widespread); and
• recurrent endometrial cancer.

The Centre is delighted that these treatment guidelines will be developed in partnership with Cancer Council Australia, lead by Professor Ian Olver. If you are interested in contributing to the development of these guidelines, please contact Ella Curnow at ella.curnow@canceraustralia.gov.au

Development of an interactive training module for health professionals to address the psychosexual care of women affected by gynaecological cancers

Treatment of gynaecological cancers can alter a woman’s feelings, behaviour and attitudes towards sexuality and intimacy. Queensland University of Technology is currently developing a training module for health professionals to address the psychosexual care of women affected by gynaecological cancers.

This project is nearing completion and will soon be pilot tested within the health workforce sector. Six on-line education and training modules have been developed. If you are interested in being involved in the pilot process, or would like further information about this project, please contact the project team at QUT: http://www.canceraustralia.gov.au/ncgc/improving-services/professional-development  

Improving the evidence in gynaecological cancer care

$1.82 million has been committed to new research projects to help build the evidence and research capacity including access to clinical trials

Gynaecological Cancers Data and Reporting Project

The pilot testing of the gynaecological cancers clinical data set for gynaecological cancers is currently underway. The following sites have agreed to be involved in this process:

• Sydney Gynaecological Oncology Group
• Royal Women’s Hospital, Melbourne
• WA Gynaecological Cancer Service
• Hunter New England Centre for Gynaecological Cancer
• Qld Gynaecological Centre
• Tasmania
• Flinders Medical Centre
• Epworth HealthCare Victoria

The pilot testing process will involve both retrospective and prospective data collection. Pilot sites span both the private and public sector.

2010 Priority-driven Collaborative Cancer Research Scheme (PdCCRS)

Cancer Australia and its funding partners are currently in the process of assessing applications for the 2010 PdCCRS. The Centre is committed to co-fund a further two research proposals. Successful applicants will be announced later this year. The research priority areas identified by the Centre’s Advisory Group for 2010 and other funding partners can be found at http://www.canceraustralia.gov.au/research-and-clinical-trials/priority-driven-research.aspx  

NHMRC - NCGC Translating Research into Practice (TRIP) Fellowship

This fellowship aims to provide the opportunity for health professionals to improve the translation of research findings into clinical practice and improve care and outcomes for women affected by gynaecological cancers.

The Centre is inviting comments on the appropriate opportunities to promote this clinical fellowship as two will be offered in 2011. A call for applications for the 2011 TRIP Fellowship will be announced later this year. 

National survey of general practitioners and gynaecologists to establish referral practices for women presenting with a suspected gynaecological cancer

The report on the National survey of general practitioners and gynecologists to establish referral practices for women presenting with a suspected gynaecological cancer was discussed at the last NCGC advisory group meeting.

Some key report findings for general practitioners include:

• For all four cancers (cervical, endometrial, ovarian and vulval), patient factors were stronger predictors of referral than demographic variables
• 47.3 per cent (metro) and 53.1 percent rural) of vignettes with a high probability of vulval cancer were referred by GPs
• 67.7 per cent of vignettes with a high probability of endometrial cancer were referred by GPs
• 80.0 per cent of vignettes with a high probability of cervical cancer were referred by GPs
• 83.3 per cent of vignettes with a high probability of ovarian cancer were referred by GPs
• 40 per cent of metropolitan GPs and 25 per cent of rural GPs reported that private services were associated with a multidisciplinary team.
• 63 per cent of metropolitan GPs and 40 per cent of rural GPs reported that public services were associated with a multidisciplinary team

Some key report findings for gynaecologists include:

• A majority of gynaecologists (94 per cent) reported that they would refer to a gynaecologic oncologist
• The two best predictors of a patient being referred by a gynaecologist for endometrial cancer were biopsy findings and the sex of the clinician (female gynaecologists were more likely to refer a patient than their male counterparts)
• Over 70 per cent of all vulval vignettes with a high probability of cancer resulted in a decision to refer
• 20 per cent of vignettes where the biopsy results indicated Grade 1 endometrial cancer did not result in a decision to refer

Improving information and support for all women affected by gynaecological cancers, their families and carers

$270 000 committed to improving consumer information and support

Developing a ‘one stop shop’ for gynaecological cancer information

Visit What’s New at www.canceraustralia.gov.au

The Centre is delighted to announce that people affected by gynaecological cancers are now able to access quality, evidence based resources from the Centre’s website. The resources span the patient journey and cover cervical cancer, endometrial cancer, fallopian tube cancer, gestational trophoblastic disease, uterine cancer, vaginal cancer and vulval cancer. A link to NBOCC is easily accessed through the Centre’s website to provide information on ovarian cancer resources. A review panel has also recently been established to ensure that these resources are kept up to date and reviewed on a regular basis.

Building Cancer Support Networks Initiatives: Better Cancer Support through Consumers

The Centre is pleased to announce that a cancer support grant has been awarded to the following two organisations:

• Ovarian Cancer Australia: Rural and regional telephone support service www.ovariancancer.net.au

This project aims to reduce the impact of ovarian cancer and improve the health and well-being of rural and regional people affected by ovarian cancer by establishing a rural and regional telephone-support group for family, friends and carers of women with ovarian cancer.

• Women’s Health Victoria: Who does and who doesn’t – the use of information and support services by women from culturally and linguistically diverse backgrounds www.whv.org.au

This project will identify barriers to accessing support and information experienced by women with breast and gynaecological cancers from culturally and linguistically diverse backgrounds.

Visit the websites above for more information about these two projects.

Contact the National Centre for Gynaecological Cancers for more information, contribution or feedback

PO Box 1201, Dickson ACT 2602

Website: www.canceraustralia.gov.au