Download Clinical Oncology Society of Australia 24th Annual Scientific Meeting

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Clinical Oncology Society of Australia 24 Annual Scientific Meeting | November 2015, Hobart By Atholl Reid, TAS Coordinator OM Ltd th
The 24 Annual Scientific Meeting (ASM) of the Clinical Oncology Society of th
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Australia (COSA) was held in Hobart from 15 to 19 November 2015. I live in Hobart (it's a tough life …) and it was great to be able to attend as a member of the oncology massage (OM) community and give some visibility to my OM T-­‐shirt. My green T-­‐shirt was a great conversation starter with many people and both the CEO and president of COSA introduced themselves to me and told me how wonderful they thought that it was to have someone from the OM community at the conference. I, of course, heartily agreed. th
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The main days of the conference were Tuesday 17 , Wednesday 18 and Thursday th
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19 . Activities started on Sunday 15 with a free, as in no cost to attend, public open day, which I attended and guess what I was wearing? Yes: it was a conversation starter with other attendees. There were several presentations, all of which were pitched at an easily understandable level. These included: the role of exercise in the management of cancer -­‐ an exercise physiologist talked about exercise – see later in this review of the ASM for more information; using mindfulness during cancer treatment; models of care for cancer patients; and new cancer therapies, in this case the use of targeted immunotherapy in the treatment of cancers. Throughout the ASM there were many items of interest to me, and hopefully to you, as an OM therapist: in no particular order of importance, some of them were: Psychoneuroimmunology: yes ... covered in OM training. A 15-­‐year prospective study of women at high risk of breast cancer asked if stress increases the risk of cancer. The speaker mentioned the increase in cortisol levels resulting from long term chronic stress and the possible link between an increase in cortisol and an increased incidence of breast cancer. And what has massage been shown to decrease? …. cortisol levels (Hernandez-­‐Reif M, et al. J Psychosom Res. -­‐ 2004 – see: http://www.ncbi.nlm.nih.gov/m/pubmed/15256294/?i=3&from=/16162447/related). The study conclusions: severe chronic stressors increased the likelihood of a breast cancer diagnosis by 70% in women at high-­‐risk. Mood, social support and coping did not moderate this impact. Intervention to reduce severe ongoing stressors may reduce adverse physical and psychological health consequences. I wonder what role OM could have in a suitable intervention? The application of Cognitive Rehabilitation Programmes (CRT), often used for rehabilitation after a brain injury, with people living with a diagnosis of cancer. What caught my attention in this presentation was the use of recognised quality of life (QOL) scoring techniques that would be useful for the evaluation of OM both within an OM therapist's practice and as tools for validating OM in a wider medical context. Investigating such scoring methodologies is one of my many follow up notes from the ASM. The role for exercise for people living with a diagnosis of cancer. This was a presentation on the Life Now program, a 12 week, twice weekly, exercise physiologist run course offered by Cancer WA. Each participant has an individualised program designed for them by the exercise physiologist and the group attends classes together, allowing participants to experience the benefits of exercise in a safe and supportive group environment (see: https://www.cancerwa.asn.au/patients/support-­‐and-­‐services/life-­‐now/exercise-­‐classes/). This was a repeat of the presentation at the Public Forum that I mentioned at the start of this item. The presentation stated that exercising in a controlled manner is considered safe during and after cancer treatment and results in a number of positive outcomes, including; reducing fatigue; managing nausea; managing pain; preventing unwanted weight gain; improving sleep patterns; maintaining muscle mass; improving strength; maintaining metabolism; improving physical function; improving fitness; improving quality of life; enhancing energy levels during and after cancer treatment; and reducing bone mineral density loss. A breakfast (yummy) presentation on pain management. At the end, the presenter went back to what he said was the one slide that he wanted to bring to everyone’s attention. In his presentation he had mentioned that to date cancer pain has mostly been approached from the pharmacological perspective whereas in other pain management situations, pharmacology is only one part of the approach, the other parts being: education; psychological therapies; physical therapies; and interventional therapies. He went on to say that in his opinion cancer pain treatment must move to the same paradigm as other pain management. I later spoke to the presenter about this and he stressed again his belief in a multi-­‐faceted approach and I briefly spoke about OM and the research results showing a reduction in pain. That's the Cassileth & Vickers research that is covered in OM training (Cassileth BR, Vickers AJ, Massage Therapy for symptom control. Outcome study at a major cancer centre. J Pain Symptom Manage 2004; 28:244-­‐249 – see: http://www.jpsmjournal.com/article/S0885-­‐
3924(04)00262-­‐3/fulltext). In one of the plenary sessions, I learned that the first recorded mention of breast cancer is believed to be from 1600bc. Mmmm – that's quite some time ago. The Edwin Smith Surgical Papyrus, currently in the New York Academy of Medicine, is believed to contain the earliest written record of cancer. go here to read about the papyrus -­‐ https://en.wikipedia.org/wiki/Edwin_Smith_Papyrus and then go here for more cancer specific information http://www.cancer.org/acs/groups/cid/documents/webcontent/002048-­‐pdf.pdf and then on as you wish. Watchful waiting as a way of initially treating Ductal Carcinoma In Situ (DCIS) -­‐ abnormal changes in the ducts of the breast. While DCIS may eventually progress into an invasive form of cancer, most cases do not. In some cases, especially those in women over the age of 70, a watch-­‐and-­‐wait program is undertaken with regular monitoring so as to avoid or delay the side effects of breast surgery, chemotherapy or radiation. This method is also sometimes used following a diagnosis of prostate cancer. Rare Cancers Australia Ltd. (RCA) is a charity that was set up to improve awareness, support and treatment of Australians with rare and less common (RLC) cancers. “Rare” is a relative term -­‐ over 42,000 diagnoses of RLC cancers and around 24,000 deaths per year are quite large numbers. This organisation carries out a number of activities, including raising awareness, advocacy, fundraising (see: http://www.rarecancers.org.au/page/1090/sick-­‐or-­‐treat) and has recently released a smartphone application, CAN.Recall. CAN.Recall is designed to help with the recording and remembering of information following a diagnosis of cancer, for the benefit of the patient and their carers (see: http://www.rarecancers.org.au/page/1086/canconsult-­‐app). Dr Dave and his amazing radiotherapy machine is a tool created at the Peter MacCallum Cancer Centre in Melbourne for use by children who are undergoing radiotherapy. It started out in printed comic form and has now been transferred to the web and portable devices. You can read about the printed version on this page -­‐ http://www.minnisjournals.com.au/articles/DrDaveAug09.pdf and watch the two episodes produced so far by going to http://www.petermac.org/patient-­‐care/cancer-­‐type/paediatric-­‐cancers and expanding the section Paediatric Cancer Resources, where you will also find other paediatric cancer resources. There was a review of eviQ, the online service of The Cancer Institute NSW. Once registered, patients and carers, and also others, such as … say … OM therapists … can access a wide range of cancer related information. Start at https://www.eviq.org.au/ and register – it's free! Psycho-­‐Oncology Co-­‐Operative Research Group (PoCoG). From the PoCoG website “The Psycho-­‐Oncology Co-­‐
operative Research Group (PoCoG) was established in 2005, in response to a recognised need to develop the capacity and co-­‐ordinated collaboration to conduct large-­‐scale, multi-­‐centre psycho-­‐oncology and supportive care research.” IN my thinking, OM falls into the “supportive care” bit. This breakfast (again ... yummy) gathering had one item that really grabbed my attention – that people working closely with patients (or in the case of OM therapists, clients) living with a diagnosis of cancer, can greatly benefit from having a mentor or many mentors who they can refer to both on an ad hoc and scheduled basis. In a presentation on how smart phones and portable devices have helped Silver Chain, one of the largest providers of in-­‐home health and care services in Australia, to schedule its workers, a quote leapt out and invaded my consciousness in relation to what we as OM therapists do with our work. “The future is not some place we are going, but one we are creating. The paths are not to be found, but made. And the activity of making them changes both the maker and the destination." John H. Schaar (scholar and political theorist: Professor Emeritus at the University of California, Santa Cruz). As OM therapists we are very much creating the future, making the paths and changing both ourselves and our clients. From a presentation on redesigning cancer care I learned that cancer drugs cost $1 in every $6 of PBS spending. Unfortunately I did not note when this statistic was from and I have been unable to find any references to it on the web. Can any one help me out with this information? Another item that resonated with me in this presentation was: instead of asking “What is the matter with you?” ask ”What matters to you”. This changes the delivery and type of care for someone living with a diagnosis of cancer. Optimal care pathways in Australia for cancer treatment. “The optimal cancer care pathways (OCPs), formerly known as Patient Management Frameworks, describe the optimal cancer care for specific tumour types. They map the patient journey, aiming to foster an understanding of the whole pathway and its distinct components to promote quality cancer care and patient experiences.” from http://www.cancervic.org.au/for-­‐health-­‐
professionals/optimal-­‐care-­‐pathways. This webpage lists the 11 current OCPs and has consumer “what to expect” information leaflets that may be if use to clients and OM therapists. The need to move from silos in healthcare to needs of patients and an interdisciplinary team approach, often referred to as an integrated practice unit (IPU), was presented by a clinician from The Peter MacCallum Cancer Centre in Melbourne. An IPU is funded for outcomes not by what is done, thus relating outcomes to cost and promoting what the presenter termed a “virtuous cycle of innovation”. IPUs are organised around patients not doctors and require commitment from staff to perform optimally. This method of care has been implemented at The University of Texas MD Anderson Cancer Centre (yes: the website does indeed have the name as this with the word cancer featured often with a strikeout font) – see: http://www.mdanderson.org/ . This presentation referenced the book Service Fanatics: How to Build Superior Patient Experience the Cleveland Clinic Way by Dr James Merlino. Epigenetics … again something covered in the OM training. The topic of the COSA 2015 Presidential Lecture was Cancer Epigenitics: The journey from concept to therapy and was presented by Associate Professor Mark Dawson, from The Mark Dawson Cancer Epigenetics Laboratory http://www.petermac.org/research/conducting-­‐research/cancer-­‐therapeutics/mark-­‐dawson-­‐cancer-­‐
epigenetics-­‐laboratory at The Peter MacCallum Cancer Centre in Melbourne. Some interesting facts from this lecture: 1)
A caterpillar, the caterpillar pupae that follows on from the caterpillar and the butterfly that follows on from the pupae … they all have the same DNA. Think about it … 2)
There are approximately two meters of DNA in every human cell, packaged into a nucleus that is about 10 nanometers (very small) in diameter 3)
The DNA from one person, if laid out end to end, would reach from earth to the sun and back not once, not twice, not three times or four times or five times … it would do it about six times. One person's DNA … th
In summary, the COSA 24 ASM was a great event to attend and I can only attempt to convey some of the fascinating topics covered. Some of the presentations were very technical and others were easily accessible to non-­‐medical people such as me. I spoke to many people and many people spoke to me. I have already started to follow up on some of the connections that I made and I have some more to contact. Overall I was in awe of many of the presented research projects completed, underway and planned. The human body is a wonderful thing and what some of those humans are doing to help other humans when they need medical intervention is stupendously-­‐gob-­‐smackingly-­‐take-­‐my-­‐breath-­‐away-­‐great. th
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The COSA 25 ASM is to be held from 15 to 17 November on the Gold Coast and I believe that there will be a public forum on the preceding Sunday. Mark it in your diary if you are a local or if you can travel because I believe that the forum is well worth attending and as I typed earlier in this piece, it’s free to attend. I'll end now with something that a medical person in the UK once said to me and something that I often quote: don't be surprised when a human body goes wrong – be amazed that it goes right most of the time.