1C A B R I N I I N S TIT UTE A N N U A L R E P O RT

2014-15

2EDUC ATION. RESE ARCH. HE ALTH PROMOTION.

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44A B O U T T H E C A B R I N I I N S T I T U T E

Established in 1996, the Cabrini Institute supports a wide

range of research and education activities across Cabrini,

as well as health promotion activities on behalf of the

organisation. Senior medical staff and researchers oversee

a diverse research program, as well as developments

in clinical education. The research program includes

arthritis, back pain, cancer, care of the elderly, health

literacy, medicine, nursing, patient safety and surgery. The

Cabrini Institute plays a significant role in the education of

our current and future health professionals.

4

55CO N T E N T S

6 Chairs message

8 Executive Directors message

10 Monash Department of Clinical

Epidemiology at Cabrini Hospital

14 Cabrini Monash University Department

of Medical Oncology The Szalmuk Family

Department of Medical Oncology

22 Cabrini Monash University Department of Medicine

26 Cabrini Centre for Nursing Education and Research

28 Cabrini Monash University Department of Surgery

The Frhlich West Chair of Surgery

30 Clinical education at Cabrini

38 Szalmuk Family Psycho-oncology Unit

42 Allied Health Research and Education

44 Foundation 49: Mens Health

48 Department staff

54 Supporting ethical research

62 Publications

72 Governance Cabrini Institute Council

77 Supporters

6 It is a pleasure to introduce the Cabrini Institute Annual Report 2014-15, which highlights both the scope and the achievements in education, research and health

promotion across Cabrini. This report also includes

the publications of our outstanding researchers and

projects approved by the Cabrini Human Research Ethics

Committee. I would like to acknowledge the contributions

of the volunteers who serve on this committee under

leadership of Chair Dr Margaret Staples.

Professor Lawry St Ledger retired as Chair of the Cabrini

Institute Council after a decade of service. His breadth

of expertise in education, administration and health

promotion have been of enormous benefit to the

development and evolution of the Cabrini Institute.

As a result of a restructuring within Cabrini Health,

Dr Peter Lowthian has moved to the position of Executive

Director of Medical Services. Since his appointment in

C H A I R S M E S S AG E

2002, Peter worked unstintingly as Executive Director of

the Cabrini Institute, as well as continuing his practice as

a senior consultant rheumatologist. He has ably guided

the expansion of the Cabrini Institute establishing several

new research and teaching departments within it. He also

advocated for the Cabrini Institute in the community and

led external engagements including that with the Monash

Partners Academic Health Science Centre.

It has been a great pleasure to welcome the new

Executive Director, Associate Professor Leanne Boyd, who

has skilfully led the Cabrini Centre for Nursing Education

and Research since July 2014. She also has executive

responsibility for nursing at Cabrini Health. Associate

Professor Boyd has already established several new and

exciting initiatives, including a recent successful grant

funding round.

With the reorganisation of the Cabrini Institute, Jennifer

Burden moved from her former role as Manager of the

Cabrini Institute to the position of Manager, Cabrini

Human Research Ethics Committee and Research

Governance. Jennifer has worked with the Cabrini

Institute for a decade; her commitment and support of

the Cabrini Institute Council has been greatly valued.

Judith Day, in her role as Chief Financial Officer and

Chief Information Officer, served on and capably

supported the Cabrini Institute Council for a decade;

she has departed the Council in light of her new role as

Executive Director of Commercial and Business Systems

and Deputy Chief Executive.

In 2014-15, Professor Gerald Farrell retired from the

Cabrini Institute Council, which he had served since 2007.

His contributions, particularly in the area of academic

nursing, have provided valuable assistance to us, as has

Above: Professor Peter Fuller, Chair of the Cabrini Institute Council

7Professor Robert Thomas AM, who also retired after eight

years on the Cabrini Institute Council. Professor Thomas

provided a broad perspective on academic surgery, as well

as insights into the challenges in cancer service provision

in Victoria, reflecting his role as the Chief Cancer Adviser

to the Victorian Department of Health.

In 2015, it was a great pleasure to welcome Professor Meg

Morris to the Cabrini Institute Council. She is the Head

of the School of Allied Health at La Trobe University.

Professor Morris has a distinguished research and

education career in academic physiotherapy and her

appointment parallels the recent expansion of allied

health research and education in the Cabrini Institute.

I would like to congratulate Professor Rachelle Buchbinder

for her appointment as a National Health and Medical

Research Council (NHMRC) Senior Principal Research

Fellow. She has been duly recognised as a key exemplar

of the high quality researchers active within the member

organisations in the successful application of the

Monash Partners Academic Health Sciences Centre

for recognition by the NHMRC as an advanced health

research and translation centre.

I wish to note that the USA Federal Drug Administration

has recognised Cabrini as an accredited clinical trial

site. This is a substantial achievement, particularly in

the private health setting, and reflects the very active

clinical trials program that continues under the aegis of

the Cabrini Monash University Department of Medical

Oncology, The Szalmuk Family Department of Medical

Oncology. There is compelling evidence that best

practice in clinical oncology is associated with active

clinical trials programs. Also, the exciting new range of

therapeutic agents becoming available, called precision

medicine makes trials an essential way of providing

Cabrini patients with access to the latest advances in

cancer therapeutics.

As Chair of the Cabrini Institute Council, it is always a great

privilege and pleasure to have the opportunity to interact

with an outstanding group of committed researchers

and educators who have continued to provide innovative

approaches in a sector that has not always embraced the

importance of research and education to the provision

of outstanding health services. That the Cabrini Board of

Directors both recognises and supports the importance

of these activities makes the task of Chair fulfilling and

worthwhile. I would like to mention that 2016 marks the

twentieth anniversary of the Cabrini Institute and plans

are well underway to celebrate this important milestone.

Professor Peter Fuller

Chair, Cabrini Institute Council

It is always a great privilege and pleasure to have

the opportunity to interact with an outstanding

group of committed researchers and educators

8 The Cabrini Institute Annual Report 2014-15 highlights the collaborations, research projects, education and health promotion activities underway within Cabrini.

Recently we have identified our Cabrini Institute research

themes, which are as follows: strategically aligned clinical

research; patient and family centred care; safety and

quality; and Catholic healthcare. These themes align

with the Cabrini Strategic Plan 2013-15 and highlight our

commitment to excellence in patient and family care.

Cabrini Foundation grants

In 2014-15, the Cabrini Foundation introduced the

Cabrini Foundation Research Grant Program for a total

of $150,000 with the support of the Cabrini Institute.

The annual internal competitive grant round invited

funding applications for quality improvement and

research projects from all Cabrini staff. Eighteen high

quality applications were received and a Grant Review

Committee chaired by Sylvia Falzon (Chair of the Cabrini

Foundation Board and a Director of the Cabrini Health

Board) spent a considerable amount of time choosing

E X E C U T I V E D I R E C TO R S M E S S AG E

the six successful applications. Quality Improvement

Grants of $15,000 were awarded to Camilla Radia-George

(Manager of Allied Health and Ambulatory Services) and

Dr Michael Rose (consultant physician and geriatrician).

The successful recipients of $30,000 Research Project

Grants were Andrea Rindt (Nurse Director and Program

Manager, Women and Children, Cabrini), Tash Brusco

(Chief Physiotherapist and Manager of Allied Health

and Ambulatory Services Education), Mr Stephen Bell

(consultant surgeon) and Dr Sue Burney (Head, Szalmuk

Family Psycho-oncology Unit). Project outcomes will be

presented at the 2016 Cabrini Research Day.

Peter Meese Memorial Lecture

The annual Peter Meese Memorial Lecture was held on

24 March 2015 at Cabrini Malvern. This was well attended

and received. A panel of five comprising Catherine Carr,

senior pastoral practitioner; Associate Professor Natasha

Michael, Director of Palliative Medicine; Tori Whitman,

Chief Social Worker; Lisa Mahon, occupational therapist;

and Dixie Ward, Cabrini oncology nurse addressed

the topic Incorporating interdisciplinary care in the

cancer patients journey. The event began with a moving

reflection from Sally Holmes about her experiences with

cancer. The 2015 Peter Meese Oncology Travel Grant

was awarded to Bronwyn Flanagan, breast care nurse at

Cabrini Brighton.

Monash Partners Collaboration

Cabrini is an inaugural member of the Monash Partners

Academic Health Sciences Centre. Monash Partners was

officially recognised in March 2015 by the National Health

and Medical Research Council (NHMRC) as one of four

inaugural Advanced Health Research and Translation

Centres in Australia, reflecting the collaborations

capability to improve health outcomes through high

impact translational research. In an announcement

made by the Federal Minister for Health, the Hon

Sussan Ley MP and the NHMRC, the Monash Partners

Academic Health Science Centre was recognised as an

Above: Associate Professor Leanne Boyd, Executive Director of the Cabrini Institute

9international leader in linking clinical practice, research

translation and education.

From Cabrinis perspective, our partnership strengthens

our collaborative opportunities with other Monash

Partners members such as Monash University, Monash

Health, Alfred Health, Epworth HealthCare, Baker IDI,

Burnet Institute and the Hudson Institute.

Cancer Trials Australia

We are able to attract the best oncologists when we

have a thriving research culture and can offer our

patients access to treatments not otherwise available.

The Cabrini Institute has recently partnered with

Cancer Trials Australia (CTA) to ensure that we remain

competitive in the oncology research arena. CTA is a

clinical trial network, which is spread across multiple sites

and provides a comprehensive oncology clinical trials

service that includes the conduct of single or multisite

clinical trials, ethics submissions, research governance

andclinical development advisoryservices.

FDA audit

As mentioned by Professor Fuller, a major oncology

trial undertaken at Cabrini was the subject of a USA

Food and Drug Administration (FDA) audit this year.

These are relatively rare in Australia and involve an

extensive investigation into all aspects of the clinical

trial. The outcome was extremely positive. Cabrini was

commended for excellent preparedness, organisation

and transparency.

Our university partnerships

Our partnerships with major universities continue

to evolve. We welcomed La Trobe University to the

Cabrini Institute through its association with our allied

health service. Our relationship with Monash University

continues to grow through our Monash Partners

relationship and our research department collaborations,

as well as hosting undergraduate medical, nursing and

allied health students. Cabrini also hosts undergraduate

nursing students from Deakin and Australian Catholic

universities. In the past year, we welcomed our first group

of medical students from the University of Notre Dame.

Acknowledgements

None of the excellent work that occurred over the past

year would have been possible without the commitment,

dedication and hard work of the Cabrini Institute staff, our

Cabrini colleagues and our valued donors. During the past

12 months, our staff have worked hard to review, evaluate

and develop our research and education programs and

the underpinning infrastructure. We are most grateful

to our wonderful Cabrini clinicians for their support of

our undergraduate and postgraduate medical, nursing

and allied health students. We thank all involved for their

efforts and continued commitment to the mission and

values of Cabrini.

Associate Professor Lee Boyd

Executive Director, Nursing

Executive Director, Cabrini Institute

Monash Partners was recognised by the National Health

and Medical Research Council as one of four Advanced

Health Research and Translation Centres in Australia

10 The Monash Department of Clinical Epidemiology at Cabrini Hospital focuses on performing high quality clinical research with an emphasis on answering clinically

important questions that can be translated into better

quality patient care and outcomes.

During 2014-15, a major focus has been to set up the

Australia and New Zealand Musculoskeletal (ANZMUSC)

Clinical Trials Network, which has been formed to

support the conduct of large-scale clinical trials designed

to answer the most critical questions for common

musculoskeletal conditions. By focusing on large

evidence- and evidence-practice gaps, the goals are to

enable better care and improved health and quality of

life for people who have musculoskeletal conditions.

Our first summit was held in April 2015, attended by 100

participants affiliated with 22 universities in Australia

and New Zealand, various research institutes, hospitals,

consumer organisations, professional societies, the

National Health and Medical Research Council (NHMRC),

State Departments of Health (NSW and WA), Australian

Commission on Safety and Quality in Health Care,

Australian Clinical Trials Alliance and health insurers

(Medibank Private). The summit produced an agreed

vision, mission statement and set of values, as well

as goals for the next 12 months. A report of summit

proceedings is available online, refer www.anzmusc.org/

The final paper reporting the results from our

vertebroplasty study has been accepted for publication

in Archives of Osteoporosis. In this paper, the two-

year radiologic outcomes were examined. While no

statistically significant between-group differences for

new or progressed fracture risk at 12 and 24 months

were observed between the vertebroplasty and placebo

groups, we noted a consistent trend towards higher

risk of any kind of fracture in the group undergoing

vertebroplasty, however no firm conclusions for this

outcome can be drawn. Dr Margaret Staples led the

analysis and writing of the paper.

Dr Renea Johnston has the role of Managing Editor

of the Cochrane Musculoskeletal Group within our

department. Her role is to manage the editorial process

of systematic reviews that are published within our group

including liaising with potential and current authors and

providing assistance to authors completing protocols,

reviews and updates. A major review of vertebroplasty

for osteoporotic vertebral fractures that included 11 trials

was published this year. Based upon moderate quality

evidence, we concluded that the evidence does not

support a role for vertebroplasty for treating osteoporotic

vertebral fractures in routine practice.

Postdoctoral researcher Dr Susan Slade developed the

Consensus for Exercise Reporting Template (CERT)

planned as an addendum to the Consolidated Standards

of Reporting Trials (CONSORT) Statement. This statement

is an evidence-based, minimum set of recommendations

for reporting randomised trials. It offers a standard way

for authors to prepare reports of trial findings, facilitating

Monash Department of Clinical Epidemiology at Cabrini Hospital

Above: Professor Rachelle Buchbinder

11their complete and transparent reporting, and aiding their

critical appraisal and interpretation. Dr Slade performed

an international Delphi study involving exercise experts

from 14 countries. The final template includes 16 items

that should be reported in all clinical trials investigating

exercise. This is expected to be an important advance,

as currently exercise interventions in trials are poorly

described. More complete descriptions will aid in the

interpretation of trial results, enable comparison between

trials and support uptake of proven effective programs in

clinical practice.

We continued to recruit participants for our NHMRC-

funded, randomised, controlled trial in which we are

comparing the effect of autologous platelet-rich plasma

injection to glucocorticoid injection and placebo for

lateral epicondylitis or tennis elbow (72 participants were

recruited and 14 completed). Two new centres, one in

Sydney and one in Adelaide, have joined and we hope to

complete the trial by the end of 2016.

Staples and colleagues at Deakin University. Our data will

provide a detailed understanding of the health literacy

profile of Cabrini patients and valuable insights into how

we might enhance their care and health outcomes.

Major projects

Is autologous platelet rich plasma injection effective

for tennis elbow?

Understanding the health literacy of patients attending

Cabrini Health

OPtimising Health LIterAcy (OPHELIA) Project

A standardised method for reporting exercise

programs in clinical trials

The long-term outcomes of people with inflammatory

arthritis in Australia (ARAD)

What is the content and quality of consumer

information about arthroscopy in Australia?

The Australia and New Zealand Musculoskeletal

(ANZMUSC) Clinical Trials Network

We are continuing the long-term observation of

participants in the Australian Rheumatology Association

Database (ARAD) to determine long-term outcomes

of biologic therapy in people who have inflammatory

arthritis. Several PhD students are now using the database

for their projects and we are hoping to attract further

honours students to take advantage of the rich data we

have been collecting for more than ten years.

The Cabrini Health Literacy Project overseen by Dr Allison

Macpherson (nee Bourne) is underway with completion

of the data collection phase. This involved distribution of

a mail survey to more than 9000 patients who received

inpatient care at Cabrini Malvern in 2014. The first 1000

responses formed the basis of Shehzaad Muhammad

Peerbuxs Bachelor of Basic Medical Sciences degree,

which he passed with distinction in December 2014. Also,

he won the prize for best poster at 2014 Cabrini Research

Day. More than 3000 responses have been received

and the final analysis is being performed by Dr Margaret

From left: Biostatistician Dr Margaret Staples works on a range of projects within the Cabrini Institute. She has a doctorate in epidemiology, which is the cornerstone of evidence based practice. Student Shehzaad Muhammed Peerbux (right) received the 2014 Cabrini Research Day Prize for Best Poster. He is pictured with Associate Professor Leanne Boyd (left).

12Grants

NHMRC Project Grant (2010-14)

Project title: A randomised controlled trial to evaluate

the efficacy of bisphosphonate therapy in patients

with osteonecrosis of the hip

Applicants: Sambrook P, Little D, March L, Buchbinder R.

ARC Linkage Project Grant 120200111 (2013-15)

Project title: Enhancing health literacy to optimise

health equality across Victorian communities

Applicants: Osborne R, Buchbinder R, Beauchamp A.

Netherlands Organisation for Health Research and

Development (2013-15)

Project title: A patient and professional based multimedia

campaign as innovative implementation strategy

to improve low back pain guideline adherence:

A cost-effectiveness evaluation

Applicants: Anema JA, Boot CRL, Braspenning J,

Buchbinder R, Elders P, Schaafsma FG, van Tulder MW,

van der Wouden JC.

NHMRC Cochrane Funding (2013-15)

Project title: Cochrane Musculoskeletal Review

Group (CMSG), Australian satellite

Applicants: Buchbinder R, Johnston R.

NHMRC Project Grant 1062638 (2014-18)

Project title: A multicentre, double blind, randomised,

placebo-controlled trial of oral anticoagulation

in systemic sclerosis-related pulmonary arterial

hypertension

Applicants: Nikpour M, Buchbinder R, Prior D,

Nandurkar H, Williams T, Gabbay E, Proudman S,

Nash P, Zochling J, Stevens W.

Arthritis Australia Grant In Aid (2014)

Project title: Standardised method for reporting

exercise programs

Applicants: Slade S, Buchbinder R, Underwood M.

NHMRC Senior Principal Research Fellowship (2015-19)

Project title: SPRF ID 1082138 (funding $911,915)

Applicant: Buchbinder R.

M O N A S H D E PA R TM E N T O F C L I N I C A L E P I D E M I O LO G Y AT C A B R I N I H O S P I TA L

NHMRC Centre of Research Excellence in Translation

of Research (2015-19)

Project title: Centre of Research Excellence in Translation

of Research into Improved OUtcomes in Musculoskeletal

Pain & Health (CRE TRIUMPH) ID 1079078 (funding $2.5m)

Applicants: Bennell K, Hunter D, Hodges P, Buchbinder

R, Pirotta M, Hinman R, Harris A, Foster N, Michie S,

Vicenzino B.

Patient-Centered Outcomes Research Institute (PCORI)

Engagement Award (2015-17)

Project title: Development of a core outcome

measurement set for clinical trials in shoulder disorders

(funding $US237,127)

Applicants: Gagnier JJ, Buchbinder R.

13

I n January 2013, Dr Allison Macpherson began her current role as a Research Fellow in the Monash Department of Clinical Epidemiology at Cabrini Hospital. She was drawn to Cabrini

by its reputation and that of Professor Rachelle Buchbinder, who

leads the department.

With a doctorate in biochemistry, Allison was previously a bench

scientist based in a laboratory. In this role, I get to talk to people,

which is what I like most about it, she says. Allison is currently

overseeing the Cabrini Health Literacy Project, the first of its kind

in the private health setting, and is interested in understanding

how health literacy among Cabrinis patients can be improved. She

describes her work as challenging and enjoyable.

Health literacy is about how well someone is able to find and

understand health information, explains Allison. It is important

because a persons level of health literacy influences their ability to

manage their own health effectively and to navigate the healthcare

system, which is becoming increasingly complex. People need

to understand what they are doing and why, for example how

to take their medications correctly. On the other hand, lower

levels of health literacy are associated with decline in health, more

hospitalisations and higher rates of morbidity.

A simple mail survey was used and a 30 per cent response rate

achieved. With analysis of the data underway, the next step is

preparation of a paper to be submitted to a peer-reviewed journal.

The initial results indicate that Cabrini patients have a higher than

average level of health literacy.

Dr Allison MacphersonI M P R OV I N G H E A LT H L I T E R AC Y

14 This department established in 2003 aims to provide compassionate, state-of-the-art care for cancer patients and continued advancements in the prevention,

diagnosis, treatment and cure of cancer via a combination

of research, education and clinical practice.

Research agenda

During 2014-15, there has been significant reorganisation

and expansion in our department. Cabrini has entered

a partnership with Cancer Trials Australia (CTA), which

will take over many of the administrative components of

the clinical trials, including ethics submissions, research

governance and budget negotiations. This will enable

our staff to focus on our core business of entering

patients into clinical trials. CTA has broad connections

with cooperative research groups and pharmaceutical

companies, which will provide the opportunity to

significantly expand our clinical trial program.

Studies with new cancer agents continue to dominate

our cancer research program, although there has been

a move into immunotherapy. Immunotherapies are

treatments that restore or enhance the immune systems

ability to fight cancer. Studies have been completed in

melanoma (skin cancer) and we are embarking on trials in

lung cancer and other malignancies. We continue to have

a large number of trials using targeted therapies, which

block the growth and spread of cancer by interfering with

specific molecules involved in the growth, progression

and spread of cancer. They are a cornerstone of precision

medicine, which uses information about a persons genes

and proteins to prevent, diagnose and treat disease.

Research highlights

Immunotherapy: Using the Immune

System to Treat Cancer

The immune systems natural capacity to detect and

destroy abnormal cells may prevent the development of

many cancers however, some cancers are able to avoid

detection and destruction by the immune system. They

may produce signals that reduce the immune systems

ability to detect and kill tumour cells or they may have

changes that make it harder for the immune system to

recognise and target them.

Immunotherapies are treatments that restore or enhance

the immune systems ability to fight cancer. In recent

years, the rapidly advancing field of cancer immunology

has produced several new methods of treating cancer

that increase the strength of the immune response

against tumours. These therapies either stimulate the

activities of specific components of the immune system

or counteract signals produced by cancer cells that

suppress immune responses.

Research in this area is growing rapidly, and a number of

different approaches are being considered to enhance the

immune systems ability to fight cancer. Agents that are

currently being investigated at Cabrini include:

Cabrini Monash University Department of Medical OncologyThe Szalmuk Family Department of Medical Oncology

Above: Associate Professor Gary Richardson

15 Immune checkpoint inhibitors: One immunotherapy

approach is to block the activity of certain proteins

that limit the strength of immune responses. These

proteins normally keep immune responses in check to

prevent overly strong responses that might damage

normal cells as well as abnormal cells. In cancer cells,

these checkpoint proteins may be abnormal and may

help tumours to evade the immune response. Blocking

one of these checkpoint proteins could support the

immune system in enabling it to destroy cancer cells.

Cancer vaccines: The use of cancer treatment

(or therapeutic) vaccines is another approach to

immunotherapy. These vaccines are usually made from

a patients own tumour cells or from substances taken

from tumour cells. They are designed to treat cancers

by strengthening the bodys natural defences against

the cancer. Treatment vaccines may act in various ways

including delaying or stopping the growth of cancer

cells, causing tumour shrinkage, preventing cancer

from recurring or to eliminating cancer cells that have

not been killed by other forms of treatment.

Adoptive cell transfer: Cytotoxic T-cells that have

invaded a patients tumour, called tumour-infiltrating

lymphocytes (TIL), are harvested. The cells that have

the greatest anti-tumour activity are selected and

large populations of these cells are then grown in the

laboratory and activated with cytokines. The cells

are then infused into the patient. The idea is that TIL

already have the ability to target tumour cells but

may not be present in sufficient amounts to exert an

anti-tumour effect. If the activity of the TIL is being

suppressed by the tumour cells, it may be possible to

overcome that suppression by exposing the tumour to

large amounts of activated TIL.

Chimeric antigen receptor therapy (CAR): Patients

T-cells are collected from their blood and genetically

modified to express hybrid proteins called chimeric

antigen receptors (CAR) before they are expanded

and infused into the patient. The CAR allows the cells

to attach to specific proteins on the surface of cancer

cells, which activates the T-cells to attack those cells.

Cabrini is currently participating in research to:

Increase our understanding of what enables

immunotherapy to work in some patients but not in

others who have the same cancer

Expand the use of immunotherapy to more types

of cancer

Better understand how to use immunotherapies

in combination with targeted therapies and other

standard treatments, such as chemotherapy and

radiation therapy

CheckMate-066 Trial landmark study

Associate Professor Ben Brady (Director of Medical

Oncology and Haemotology at Cabrini) and colleagues

recently published a phase 3 study comparing the anti

From left: Dr Michelle White is an oncologist with Brightways: A Cabrini Breast Cancer Service and a Principal Investigator with the Cabrini Monash University Department of Medical Oncology. Dr David Pook, an oncologist at Cabrini, is an Associate Investigator with the department. Associate Professor Jeremy Shapiro is a Principal Investigator with the department: he is involved in teaching and clinical research and focuses on new treatment options for colon and prostate cancer.

16programmed death 1 (PD-1) antibody nivolumab with

the standard melanoma chemotherapy dacarbazine in

the frontline treatment of patients who have advanced

BRAF wild-type melanoma. In this study, nivolumab

was shown to be better than dacarbazine in improving

overall survival, progression-free survival and objective

response rate. Nivolumab was also associated with a lower

rate of high-grade side effects than dacarbazine. This

study is the first to demonstrate that nivolumab, and any

anti-PD-1 antibody, improves overall survival compared

with a standard comparator in a large, well-conducted,

randomised, placebo-controlled, phase 3 study.

The high response rate and favourable toxicity profile of

nivolumab and pembrolizumab (Keytruda), another anti

PD-1 antibody, in patients who have melanoma have been

well known from large, previously published, early-phase

studies. Yet how these antiPD-1 antibodies perform

in randomised studies against standard chemotherapy

(dacarbazine or carboplatin/paclitaxel) has only recently

begun to emerge. Cabrini recruited the largest number of

patients of any international centre.

Immunology studies in non-small cell lung cancer

Programmed cell death-1 (PD-1) is one of the pathways

that inhibit tumour-specific T-cells. Inhibiting these

T-cells reduces the bodys ability to fight cancer cells.

Increased quantity of PD-1 has been demonstrated in

lung cancer cells, thus protecting them from the bodys

immune system. Being able to block this inhibition can

allow the immune system to be freed to fight the cancer.

Studies have shown that use of anti-PD-1 drugs in patients

who have previously treated lung cancer can produce

meaningful responses.

Cabrini is embarking on an exciting research program in

collaboration with Roche Australia using a new anti-PD-L1

antibody, MPDL3280A, in untreated, non-small cell lung

cancer. Anti-PD-L1 antibodies act in a similar way to

anti-PD-1 antibody in blocking the interaction between

the PD-1 receptor and its PD-L1 ligand, thus restoring

the function of chronically exhausted tumour-specific

T-cells and augment the T-cell response. Two studies

will consider treatment of newly diagnosed patients with

metastatic squamous cell NSCLC and metastatic non-

squamous NSCLC. A third study will consider prevention

of recurrence of NSCLC in patients with high-risk disease

after potentially curative surgery.

New targeted therapies: PARP inhibitors

Poly (ADP-ribose) polymerase (PARP) inhibitors are

pharmacologic agents that inhibit the PARP enzymes

within the cell. This class of agents represents an exciting

potential therapy in patients who have defects in the HR

repair pathway. In particular, PARP inhibitors are being

developed for patients who have germline BRCA1 or

BRCA2 mutations, although the spectrum of tumours that

may be treated effectively by these agents may be larger.

C A B R I N I M O N A S H U N I V E R S I T Y D E PA R TM E N T O F M E D I C A L O N C O LO G YT H E S Z A L M U K FA M I LY D E PA R TM E N T O F M E D I C A L O N C O LO G Y

From left: Associate Professor Lara Lipton is an Associate Investigator with the department. She has a particular interest in cancer genetics and consults at the Cabrini Family Cancer Clinic.

Oncologist Dr Ben Brady is Chair of the Cabrini Medical Staff and Director of Haematology and Oncology. He is a Principal Investigator with the department.

17Due to strong interest in PARP inhibitors as a class, some

pharmaceutical companies have designed PARP inhibitors

and have tested them in a number of clinical scenarios.

Currently, olaparib, rucaparib, niraparib, velaparib and

BMN673 have reached phase 3.

Cabrini is participating in a worldwide access program for

the first PARP-inhibitor (olaparib) to be approved by the

USA Food and Drug Administration. Olaparib is a potent,

orally administered PARP inhibitor tested in patients who

have advanced ovarian cancer and known or suspected

BRCA1 or BRCA2 mutations (about 15 to 20 per cent of

ovarian cancer patients). It has excellent results among

these patients.

Current studies

Current drug trials

There is a wide spectrum of specific disease trials currently

being undertaken. These are mainly phase 2 and 3 studies.

Disease Current trials (patient recruitment phase)

Non-recruiting trials (patients still followed)

Breast cancer 2 4

Colorectal cancer 1 1

Haemotology (cancer of the blood) 1 0

Lung cancer 2 0

Lymphoma 2 2

Multiple myeloma 2 3

Melanoma 0 3

Myelodysplastic syndrome 1 1

Pancreatic cancer 2 0

Prostate cancer 2 3

General 2 0

Total 17 17

From left: Associate Professor Ian Haines, an Associate Investigator with the department, is pictured in his oncology consulting rooms at Cabrini Malvern.

Dr Kirsten Hebert is a haematologist and oncologist who practises at the Cabrini Haematology and Oncology Centre.

18 Abbreviation Protocol number Scientific title

Cancer 2015 Ca2015

(08-05-12-11)

The Cancer 2015 Project proposes a major,

Framingham-type, whole-of-system epidemiologic

study that will enrol 10,000 cancer patients, drawn

from all parts of Victoria, into a research program to

develop, test and implement a new model of cancer

diagnosis and treatment

SUPER SUPER

(06-16-06-14)

The SUPER study is a prospective study of patients

who have cancer of unknown primary to create

a national information resource and improve the

understanding of the molecular biology, clinical,

quality of life and psychosocial characteristics

ABBVIE M14-011

(09-07-04-14)

A randomised, placebo-controlled, double-blind,

phase 3 study to evaluate the safety and efficacy of

the addition of veliparib plus carboplatin versus the

addition of carboplatin to standard neoadjuvant

chemotherapy versus standard neoadjuvant

chemotherapy in subjects who have early stage,

triple negative breast cancer

LORELEI GO28888/BIG-3-13/

SOLTI 1205/ABCSG 38

(05-27-10-14)

A phase 2, randomised, double-blind study of

neoadjuvant letrozole plus gdc-0032 versus

letrozole plus placebo in postmenopausal women

who have ER-positive, HER2-negative, early stage

breast cancer

Abbreviation Protocol number Scientific title

ICECREAM AG0112CR

(03-22-10-12)

Randomised phase 2 study of cetuximab alone or

in combination with irinotecan in patients who

have metastatic CRC with either KRAS WT or G13D

mutation

TEVA TV1011-LC-303

(01-18-03-13)

A multinational, randomised, open-label phase 3

study of custirsen (tv-1011/ogx-011) in combination

with docetaxel versus docetaxel as a second-

line treatment in patients who have advanced or

metastatic stage 4) non-small cell lung cancer

SELECT-1 D1532C00079

(01-29-09-14)

A phase 3, double-blind, randomised, placebo-

controlled study to assess the efficacy and safety of

selumetinib (AZD6244; ARRY-142886) (hyd-sulfate)

in combination with docetaxel, in patients receiving

second-line treatment for KRAS mutation-positive

locally advanced or metastatic non-small cell lung

cancer (stage 3B to 4)

SINE KCP-330-013

(08-01-12-14)

A multicentre, phase 2, open-label study of efficacy

and safety of the selective inhibitor of nuclear

export (SINE) Selinexor (KPT-330) in patients

who have relapsed or refractory peripheral T-cell

lymphoma and cutaneous T-cell lymphoma

Details of studies

C A B R I N I M O N A S H U N I V E R S I T Y D E PA R TM E N T O F M E D I C A L O N C O LO G YT H E S Z A L M U K FA M I LY D E PA R TM E N T O F M E D I C A L O N C O LO G Y

19Abbreviation Protocol number Scientific title

Denosumab 20090482

(02-06-08-12)

A randomised, double-blind, multicentre study

of denosumab compared with zoledronic acid

(Zometa) in the treatment of bone disease in

subjects who have newly diagnosed multiple

myeloma

POLLUX 54767414MMY3003

(07-16-06-14)

Phase 3 study comparing daratumumab,

lenalidomide and dexamethasone (DRd) versus

lenalidomide and dexamethasone (Rd) in subjects

who have relapsed or refractory multiple myeloma

MDS AZA-MDS-003 A phase 3, multicentre, randomised, double-blind

study to compare the efficacy and safety of oral

azacitidine plus best supportive care versus placebo

plus best supportive care in subjects who have

red blood cell transfusion-dependent anaemia

and thrombocytopenia due to IPSS lower-risk

myelodysplastic syndromes

APACT ABI-007-PANC-003

(03-21-07-14)

A phase 3, multicentre, open-label, randomised

study of nab-Paclitaxel plus gemcitabine

versus gemcitabine alone as adjuvant therapy in

subjects who have surgically resected pancreatic

adenocarcinoma

Abbreviation Protocol number Scientific title

Prosper MDV3100-14

(01-28-10-13)

A multinational, phase 3, randomised, double-blind,

placebo-controlled, efficacy and safety study of

enzalutamide in patients who have non-metastatic,

castration-resistant prostate cancer

CtDNA

pancreatic

01-07-04-14 Circulating tumour DNA as a biomarker pancreatic

cancer

LEAF 04-12-05-14 The lymphoma lifestyle, environment and family

study

ACIS 56021927PCR3001

03-22-06-15

A phase 3, randomised, placebo-controlled,

double-blind study of JNJ-56021927 in combination

with abiraterone acetate and prednisone versus

abiraterone acetate and prednisone in subjects who

have chemotherapy-naive metastatic castration-

resistant prostate cancer

Kalobios KB004-01

(04-30-03-15)

A study of the anti-EphA3 monoclonal antibody

KB004 in subjects who have EphA3expressing

haematologic malignancies

20Summary

A total of 17 trials are now closed to accrual and 13 new

studies are to be initiated.

Research grants and funding

1) Cancer Australia Grant SUPER Study

2) VCA Grant Cancer 2015

3) Cooperative Groups

Australasian Gastrointestinal Trials Group

Australasian Leukaemia and Lymphoma Trials Group

National Cancer Research Network (UK)

4) Pharmaceutical Industry

Allos Therapeutics

Amgen Inc

AstraZenica

Beigene

Bristol Myers Squibb

Celgene Corporation

F. Hoffmann-La Roche Ltd

Gilead

Incyte

Janssen Asia-Pacific

Kalobios

Lilly

Medivation Inc

Novartis Oncology

Pfizer

Teva Pharmaceutical Industries Ltd

5) Ulm University (Germany)

Partner organisations

American Association for Cancer Research

American Society of Clinical Oncology

Australasian Gastro-Intestinal Trials Group

Australasian Leukaemia and Lymphoma Study Group

Australia and New Zealand Breast Cancer Trials Group

Australia New Zealand Gynaecological Oncology Group

Clinical Oncology Society of Australia

Clinical Trials Australia

Gynaecology Oncology Group USA

Haematology Society of Australia

International Association for the Study of Lung Cancer

International Society of Gynaecologic Oncology

Medical Oncology Group of Australia

Monash Comprehensive Cancer Consortium

Monash Partners Academic Health Sciences Centre

Peter MacCallum Cancer Institute

Private Cancer Physicians of Australia

Southern Melbourne Integrated Cancer Service

Thoracic Society of Australia

Victorian Cooperative Oncology Group

C A B R I N I M O N A S H U N I V E R S I T Y D E PA R TM E N T O F M E D I C A L O N C O LO G YT H E S Z A L M U K FA M I LY D E PA R TM E N T O F M E D I C A L O N C O LO G Y

Above: Dr Melita Kenealy is a haematologist and oncologist who practises at Cabrini. She is a Principal Investigator with the department and is involved with clinical trials and translational research.

21

J ulia Carlson is unequivocal about why she does her job as Team Leader, Oncology Research. Its the patients, knowing you might be helping them when there are often no

other options left, says Julia.

After completing a Bachelor of Science degree, Julia initially joined

Cabrini as a pharmacy technician. After her aunt was diagnosed

with colorectal cancer and joined a clinical trial, Julia became

interested in clinical trial research. She applied for a Clinical Trial

Study Coordinator role at the Cabrini Institute. Eight years later,

Julia still loves her job in research.

Julia is responsible for overseeing all aspects of clinical trial study

coordination at Cabrini. She is quick to acknowledge that her

role has both highs and lows. It is very rewarding when you see a

patient responding well to a new drug but just as saddening when

they dont respond as you would hope. Things are never dull in

the dynamic world of clinical research. My job is exciting, as the

environment is always changing with new drugs always coming on

trial, says Julia.

Cabrini recently established a partnership with Clinical Trials

Australia (CTA), which will take over many of the clinical trial

administration tasks, allowing the study coordinators to focus on

the patients and results from the trials.

Julias goal for oncology research is an aspirational one. I want

Cabrini to become the biggest clinical trials research centre in

Victoria, to be known for its excellence in conducting the best and

newest trials, she says. I want to be a part of that.

Julia CarlsonA I M I N G H I G H F O R PAT I E N T S

22 Established in 2006, the Cabrini Monash University Department of Medicine provides a focus for research and education in medicine within Cabrini. Our emphasis is

on research that can be translated into improvements in

medical practice and models of care for our patients.

We are primarily interested in research as it relates

to the care of older patients, our focus being

particularly on end-of-life care, incorporating issues

such as communication, quality of death, the role of

cardiopulmonary resuscitation and other treatments at

the end-of-life stage, understanding of language and

shared decision-making.

Current projects

Clinician patient discourse

a multimodal investigation

This qualitative study aims to describe how the work of

the ward round is carried out communicatively and to

investigate whether there are distinctive characteristics

of communicatively effective ward round interactions.

Analysis of the data shows that the ward round

communication is a stylised conversation with a particular

agreed format and rules of engagement. The thesis has

been completed by PhD student Alice Rouse.

Long-term health outcomes in patients aged over

80 years after an intensive care admission

This prospective study examined health outcomes among

patients aged 80 and older including quality of life and

functional status up to two years after discharge from

intensive care. The 24-month follow-up was completed in

October 2014 and showed that quality of life is maintained

after patients admission to intensive care. We explored

motivations, satisfaction with outcomes and factors

affecting medical decision-making in a focus group of

patients (80 years and older) who had undergone cardiac

surgery (Oldroyd et al, 2013).

Diagnosing delirium in older ICU patients

Delirium is a widely encountered problem in the hospital

setting and of particular concern in intensive care. Up

to half of patients admitted to intensive care develop

delirium while in hospital. We have examined the

incidence of delirium following intensive care admission

among patients aged 80 years and older and found that

up to 30 per cent of them met the criteria for delirium.

We also found that patients diagnosed with delirium

had a longer stay in intensive care and longer hospital

admissions. These results highlight the importance of

accurate diagnosis and sufficient training for staff to

enable them to recognise the early symptoms of delirium

in older patients.

Staphylococcus Aureus Bacteraemia and ECG findings

This project was undertaken by Mark Lym, recipient of the

inaugural summer research scholarship (2014). This was a

collaborative project with researchers at Royal Melbourne

Cabrini Monash University Department of Medicine

Above: Associate Professor Michele Levinson

23Hospital. The aim was to assess whether the use of

echocardiography in staphylococcus aureus bacteraemia

(SAB) differed in private and public hospitals. Our results

showed that the private hospital population with SAB

was older with a similar risk factor profile for infective

endocarditis. The use of echocardiography was different

between the two sites. This is being further analysed.

End-of-life care projects

Our work on end-of-life care is addressed in a number

of different ways. We have written on attitudes towards

dying and how the concept of death has been viewed in

changing ways over the course of history. The continued

thrust for treatment at end of life may prolong suffering

and obviate the opportunity for a peaceful and dignified

death. Tackling changes in our perceptions can help

medical professionals provide patients and families with

sensitive, timely guidance to help them through the end-

of-life process (Gellie et al, 2014 and Mills et al, 2014). We

have also written on the default response to in-hospital

cardiac arrest, which is to attempt resuscitation except

in the presence of a do-not-resuscitate order. We argue

that resuscitation status for all elderly patients should be

discussed and decided at the time of admission to hospital

(Levinson and Mills, 2014). This article prompted a debate

on the Medical Journal of Australia website.

We also conducted a multicentre point prevalence

study to investigate the number of advance care plans

and not-for-resuscitation orders across five Victorian

health services. Completion of this study revealed each

site had its own set of forms and policies with respect

to resuscitation status, which combine to contribute

to barriers to the writing of do-not-resuscitate orders

(Levinson et al, 2014). This article has generated

much interest, including a letter to the editor in the

International Medical Journal IMJ in response. The issue

was also covered by the Melbourne Age newspaper

following an interview with Associate Professor Michele

Levinson (published 19 May 2014).

A 12-month retrospective review of medical emergency

team (MET) call data in 2012 illustrated the role of the

MET in end-of-life care, especially with respect to writing

limitations of treatment orders. This review is being

extended by inclusion of more recent data.

We have investigated the use and understanding of

language around concepts of resuscitation. A pilot

study of visitors to the Terrace Caf at Cabrini Malvern

and subsequently, a group of elderly patients who

were admitted to hospital were surveyed to assess

understanding of terminology related to resuscitation

orders. This study showed that despite familiarity,

understanding of the term do not resuscitate was poor,

which has implications for shared decision-making and

conversations between doctors and their elderly patients.

The next step in the project is to survey elderly people

living in the community.

From left: Mark Lym, a fourth-year medical student, received the Inaugural Summer Scholarship in 2014.

Chief Executive Dr Michael Walsh (second from left) and Associate Professor Lee Boyd (far right) are pictured with students of the University of Notre Dame Australia.

Alice Rouse is a higher degree research student with the Cabrini Monash University Department of Medicine.

24We have begun surveys of medical staff about their

attitudes towards, and understanding of, do-not-

resuscitate orders. In January 2015, we surveyed doctors

at Cabrini using the online doctors portal on the Cabrini

website. The survey revealed that a number of factors are

involved in the writing of these orders, including patient

and family wishes and perceived legal issues, as well as

consideration of goals of care. Plans are underway to

survey nursing staff and to include other hospital sites in

these surveys.

Awards

Dr Amber Mills won Best Oral Presentation at Cabrini

Research Day 2014 for her address entitled Quality of life

outcomes in the very elderly six and 12 months post-

ICU admission. She presented follow-up data from the

Long term health outcomes in patients over 80 years

discharged from Intensive Care study. Preliminary results

showed that the good quality of life and functional status

experienced by these patients prior to hospital admission

do not deteriorate post-ICU admission.

Leadership positions and appointments

Associate Professor Levinson continued the following

leadership positions, appointments and commitments

during 2014-15:

Member of Specialist Advisory Committee for Acute

and General Medicine

Co-Chair Royal Australasian College of Physicians-

College of Intensive Care Medicine Working Group on

Joint Training (2014)

Site visit for trainee/site in trouble

Overseas Trained Physicians interviews for Royal

Australasian College of Physicians

Examiner for Fellow of the Royal Australasian College

of Physician clinical examination

Represented Specialist Advisory Committee at the

Advanced Training Forum 2014

Dr Mills continued her role as a Board Member of the

Australian Patients Association, which is an independent,

not-for-profit organisation dedicated to championing and

protecting the rights and interests of all patients.

Future projects

Planning is underway for projects that will evaluate factors

that contribute to the experience of patients and families

when there is a death in hospital. Also, we are planning a

multidisciplinary project (involving clinicians, ethicists,

linguists and legal experts) to interview doctors, nurses

and members of the community about issues relating to

the implementation of advance care plans and do-not-

resuscitate orders.

Our work has been accepted for a number of upcoming

conferences, including a presentation at the Australasian

Association of Gerontology Annual Conference. Two

posters were accepted for the bi-annual International

Advance Care Planning and End of Life Care Conference.

C A B R I N I M O N A S H U N I V E R S I T Y D E PA R TM E N T O F M E D I C I N E

From left: The medical emergency team in action at Cabrini Malvern.

Medical students perform a mock resuscitation exercise under the supervision of Associate Professor Michele Levinson.

25

I t is often said that the only certainties in life are death and taxes. Yet in Australian society, many of us would be more comfortable discussing money than death. Although death

is inevitable, much of the language related to death and dying

characterises death as a foe and dying as something to fight.

Research Fellow Dr Amber Mills has spent much time thinking

about death and dying during the past year, as she and her

colleagues (including Associate Professor Michele Levinson who

leads the department) have worked on multiple research projects

focused on end-of-life care. Amber, who joined Cabrini in June

2012, finds this work fascinating and personally resonant. I have

always taken a strong interest in the lifespan how we change,

grow and evolve over time, she said. The more work we do in

researching end-of-life care, the more questions we have.

End-of-life care is a complex area of research spanning shared

decision-making, person-centred care and the quality of the

patient experience. It involves factors such as the capacity to

make decisions, the use of language and meaning, patients

expectations and the role of healthcare professionals, said Amber.

Amber would like to see more honest public discourse about

death and dying particularly about what community members

want and how they would like the healthcare system to respond.

She encourages patients to focus on the goals of care in all their

healthcare interactions. You should expect to be asked about

what you want anytime you see a doctor or attend hospital.

Dr Amber MillsTO WA R D S A G O O D D E AT H

26 Nursing research at Cabrini is focused on the Cabrini Institute research themes: patient and family centred care, safety and quality and Catholic healthcare. We aim

to continually improve and evaluate the safety and quality

of our services, provide evidence for nurses to inform

their clinical practice and assist our patients and their

families in making informed healthcare decisions. The

Cabrini Centre for Nursing Education and Research has

been established at Cabrini, in order to help us achieve

our goals.

Progress in 2014-15

A research agenda has been established which is based

on the Cabrini Strategic Plan 2013-15 and aligns with the

National Safety and Quality Health Service Standards

evaluation requirements.

There have been two major research highlights in 2014-15:

1) Completion of the Victorian Department of Health

project to develop education resources for the

National Safety and Quality Health Service Standards

for public and private hospitals across Victoria

2) Commencement of a grant with the Federal

Department of Health to develop an online education

resource for cultural and religious elements of advance

care planning

High quality supervision of higher degree research

students remains a priority for the Centre for Nursing

Education and Research. We congratulate Dr Grainne

Lowe who graduated in May 2015. In her thesis, Dr Lowe

investigated the role of nurse practitioners in Australia.

A Research Associate, Amanda Pereira-Salgado, who was

appointed to support the Director, Associate Professor

Leanne Boyd, began work at the Cabrini Institute in July

2014. Two Research Assistants have been appointed to

work on funded grants.

We are continuing to work towards establishment of:

A student support hub for nursing staff

Research partnerships with universities and

other stakeholders

Research expertise within the Cabrini workforce in

leadership, patient centred care and quality and safety

Research secondments where Cabrini nurses who

have an interest in research work on a project while

working part-time clinically. The aim is to enhance the

individuals research skills and embed them within the

practice setting. This will increase our local research

capacity and support the development of a culture of

enquiry in our workforce

Grants

The following grant was awarded in 2014-15:

Australian Government Department of Health

$570,000 (2015-17)

Project title: Developing online resource for religious and

cultural advance care planning.

Applicants: Boyd L, Pereira-Salgado A and Walker, H.

Cabrini Centre for Nursing Education and Research

From left: Associate Professor Leanne Boyd

Research Associate Amanda Pereira-Salgado was a member of the grant-winning team that is working on a new resource for religious and cultural advance care planning.

Jovie Ann Decoyna, a nurse at Cabrini Malvern, is working toward a Master degree: she is pictured volunteering in Rwanda.

27

Having undergone a significant reorganisation since December 2014, several staff within the Cabrini Institute have been appointed to new roles within it and some new people

from other parts of the organisation have also joined.

In June 2015, Jasmine Kopcewicz began work with the Cabrini

Institute in the position of Research Administration Assistant. Hers

is a frontline role, being first point of contact at the reception

desk. She provides valuable support to Dr Emma Baker, Manager

of Research Programs, and many other research staff.

Previously employed in a nursing pre-admission role at Cabrini

Malvern for more than six years, Jasmine brings extensive

experience in medical practice administration and customer

service to her new job. Jasmine says she was drawn to the Cabrini

Institute because of an interest in medical research, the need for

a new challenge and the desire to continue working at Cabrini. I

wanted to extend my experience in the medical field, she said.

Ive been interested in medical research ever since my Dad was

diagnosed with cancer and was involved in a clinical trial as part of

his treatment. I really enjoy working for Cabrini as an organisation

and I am excited by this new challenge.

Jasmine has had a busy start at the Cabrini Institute. Key projects

in her first three months have been assisting Emma in planning,

organising and promoting Cabrini Research Day internally and

externally and preparations for an FDA audit of a clinical trial

conducted at Cabrini.

Jasmine KopcewiczPA S S I O N F O R M E D I C A L R E S E A R C H

28 Established in 1998, the Chair of Surgery at Cabrini Hospital is a joint venture between the Cabrini Institute and Monash University. It was the first of its kind

in the Victorian private medical sector and one of the first

in Australia. The chair was endowed as the Frhlich West

Chair of Surgery in 2004.

During 2014-15, the Cabrini Monash University

Department of Surgery continued to expand its role

in clinical research and quality assurance leadership at

Cabrini and in the Australian medical community.

Community engagement

Through our collaboration with Lets Beat Bowel Cancer,

the Cabrini Monash University Department of Surgery

continued a number of significant initiatives designed

to improve the health of the Australian community,

particularly in relation to bowel cancer.

Crawfs Health Channel

Former AFL player and Brownlow medallist, Shane

Crawford, through his Crawfs Health Channel produced

two audiovisual presentations that were distributed to the

Australian community, designed to increase awareness of

bowel cancer and the National Bowel Cancer Screening

Program. In these recordings, Associate Professor Paul

McMurrick was interviewed by compere Shane Crawford.

Victorian Department of Health National Bowel Cancer

Screening Program, GP Education Series

Associate Professor McMurrick and the Cabrini Monash

University Department of Surgery were commissioned

by the Victorian Department of Health to create a series

of audiovisual presentations designed to increase public

uptake of bowel cancer screening through education of

general practitioners. Associate Professor McMurrick was

joined by broadcaster Dr Norman Swan and GP Dr Julia

Sher in creating the series.

Cabrini Monash University Department of SurgeryThe Frhlich West Chair of Surgery

Above: Associate Professor Paul McMurrick

Public presentations

Members of the Cabrini Monash University Department

of Surgery gave several public presentations over the past

year, including one at the Brighton Blue initiative of the

Brighton Grammar School community.

AL Polglase Visiting Professor Program

The Visiting Professor Program continued in 2014 with the

visit of Dr George Chang from MD Anderson (Texas, USA).

He engaged in various educational initiatives during his

time at Cabrini including an instructive operating theatre

session and, a public lecture, as well as educational

activities with a senior trainee and with Cabrinis

colorectal surgeons. The visit culminated in a dinner

meeting and presentation by Dr Chang to Victorian

members of the Colorectal Surgical Society of Australia

and New Zealand (CSSAZ).

29Professional representation

Members of the department continued their important

work as clinical representatives of professional

bodies including:

Joint Council of Monash Partners Comprehensive

Cancer Consortium: Associate Professor McMurrick

Executive Council, Victorian Clinical Oncology Group:

Associate Professor McMurrick

Member of the Training Board in Colon and Rectal

Surgery: Mr Stephen Bell

Cabrini Director of Surgical Training, Mr Martin Chin

Members of the Victorian Advisory Panel for the

National Bowel Cancer Screening Program:

Mr Stephen Bell and Associate Professor McMurrick

Member of Executive Council, CSSANZ and

International Society of Digestive Surgery:

Associate Professor McMurrick

Leadership of the Monash Partners Comprehensive

Cancer Consortium Colorectal Tumour Stream Research

Group has been maintained through the department,

which also led the Victorian Cancer Agency grant

application.

Educational activities

In 2014-15, we continued our training posts with

accredited registrars from the Royal Australasian College

of Surgeons SET 1. The colorectal fellowship program

continued with the appointment of Dr Raymond Yap with

the annual visit to the Mayo Clinic Colorectal Surgical

Service. Dr Yap was appointed to accredited training in

the CSSANZ program in 2015.

Leadership in clinical research

The Bi-national Colorectal Cancer Audit of the CSSANZ,

derived from the Cabrini colorectal neoplasia database,

continued in 2014-15. It now includes data from more

than 10,000 colorectal cancer treatment episodes across

Australia and New Zealand, with signup from more than

70 centres. This culminated in the inaugural annual report,

From left: Visiting Professor Dr George Chang (second from left) pictured with colorectal surgeons (from left): Mr Peter Carne, Emertius Professor Adrian Polglase and Associate Professor Paul McMurrick.

GP Dr Julia Sher worked with Associate Professor Paul McMurrick and Dr Norman Swan to film an educational resource aimed at GPs and designed to increase bowel cancer screening.

Filming underway in the Stewardson Charitable Trusts Simulation Centre at the Cabrini Institute.

stemming from the updated database. Cabrini continues

to lead the extended dataset and has now passed

highly detailed data entry on more than 2000 cancer

treatment episodes.

Grants

Colorectal Surgical Society of Australia and

New Zealand ($11,420)

Project title: The effect of very low energy diets (VLED)

on the preoperative reduction of mesorectal fat volume

on obese individuals

Applicants: Bell S and Warrier S.

Cabrini Foundation ($30,000)

Project title: ADIPOSe Australasian Decrease in

Intra-Pelvic Obesity for Surgery trial: using VLEDs

to reduce weight and improve outcomes in obese

patients undertaking laparoscopic rectal cancer surgery

Applicants: Bell S, Downey W, Druce J, McMurrick P

and Warrier S.

30 Cabrini is a strong supporter of education in healthcare. Cabrini is a teaching hospital and in fulfilling this role, we participate in undergraduate

and postgraduate education in allied health, medicine

and nursing. The clinical education team supports

the development and delivery of nursing education

programs and other programs that support the continued

accreditation of Cabrini.

Medical education

Undergraduate education

The Cabrini Monash Clinical School is responsible for

delivering the Monash University Bachelor of Medicine,

Bachelor of Surgery medical program (known as MBBS)

curriculum to third-year students and for providing

supervised and assessed clinical placements for Monash

Universitys MBBS years 4 and 5 students. In 2015, 23 third-

year students, 32 fourth-year students and 90 final year

students came to Cabrini under the direction of Associate

Professor Michele Levinson, Clinical Dean.

Third-year MBBS students undertake year-long

placements at Cabrini. They experienced rotations

through the medical and surgical disciplines, in order

to provide them with broad exposure to both clinical

problems and learning opportunities. Bedside clinical

skills were taught by the clinical tutors, registrars and

fifth-year medical students, providing a diversity in

teaching styles. A short lecture series was provided by

Cabrini clinicians in order to teach topics that are less

amenable to the integrated problem-based learning/

simulation program. Formal student feedback was

regularly sought via monthly meetings.

The integration of problem-based learning with

simulation activities is designed to encourage reflective

practice, self-regulated learning, manage uncertainty

and apply theory to practice among third-year students.

For this aspect of the program, students are presented

with a clinical case with associated examination findings

and pathology and asked to list a differential diagnosis.

Readings are provided once this task is attempted.

Discussion of the case and relevant physiology,

pathology, clinical presentation and management are

discussed in the problem-based learning session. On

the same day, a simulation session is held to reinforce

problem-based learning, apply theory to practice and

develop practical skills.

Feedback was sought from the 2014 third-year group via

an anonymous survey asking students to provide a rating

for multiple aspects of the program. A response rate of 80

per cent was achieved. Most students (more than 80 per

cent) stated that problem-based learning assisted them

with clinical reasoning, that they enjoyed the challenge

of and improved their confidence in making differential

diagnosis and found the readings helpful. Two-thirds

of respondents preferred the problem-based learning

format to lectures. More than 90 per cent of students

Clinical education at Cabrini

31stated that simulation sessions were enjoyable; helped

them to apply theory; reinforced knowledge gained

during problem-based learning, lectures and ward work;

developed communication and teamwork skills; improved

their ability to use history and examination to achieve

a differential diagnosis; increased the relevance and

meaning for third-year MBBS learning; and connected

with their ultimate goal of becoming doctors.

At Cabrini, fourth-year MBBS students receive a four-

week rotation in paediatrics. Students are assessed by

way of bedside tutorials, observed clinical examinations,

case reports (both oral and written) and submission of

their clinical clerkship assessment record. Students also

attend various small group and case based tutorials

during their rotation.

Fifth-year MBBS students undergo six-week clinical

placements in medicine, emergency, anaesthesia/

pain management, aged care and general surgery,

in order to provide a pre-intern experience. These

students are expected to contribute to third-year

bedside teaching and mentoring. Students are assessed

by way of professional behaviour forms and a pre-intern

appraisal assessment.

Clinical placements at Cabrini are highly valued by the

students who have performed well when compared to

the overall Monash University cohort. The work of the

Cabrini Monash Clinical School would not be as successful

without the continuing support of the Cabrini clinicians

who volunteer their time for teaching and assessment.

The teaching staff in the Cabrini Monash Clinical School

are as follows:

Associate Professor Michele Levinson, Clinical Dean

Dr Yoland Antill (clinical tutor)

Dr Jonathan Barrett (clinical tutor)

Mr Ash Chehata (clinical tutor)

Dr Chris Yeo (clinical tutor)

From left: Librarian Di Horrigan is pictured in the Lee & Brian Johnstone Library, an integral part of education and research at Cabrini.

Matt Johnson is Director of Education at Cabrini.

32Dr Diane Kelly (simulation)

Dr Krisoula Zahariou (simulation)

Dr Christine Jackman (problem-based learning)

Dr Sara Mackenzie (problem-based learning)

Dr Simon Costello (paediatrics)

The support staff are as follows:

Josh Monester (Moodle support)

Katerina George (Paediatrics Administrator year 4)

Jennie McInerney (Clinical Site Administrator Years 3 and 5)

During 2014-15, the first medical students from the

University of Notre Dame Australia arrived at Cabrini. Their

learning experience involves four weeks of work in one

of the following rotations: obstetrics and gynaecology;

cardiology; palliative care or neuro-oncology, orthopaedics

or rehabilitation. The new relationship with the University

of Notre Dame Australia is expected to enrich Cabrinis

clinical education program and help prepare another 50

or more new Australian doctors each year. With clinical

placements for medical students often hard to find in

Australia, Cabrini is accepting four students at a time. This

initiative will not impinge on our longstanding relationship

with Monash University, as these new students will work in

different areas and be taught by different teachers. Now,

in their fourth and final year, Cabrini is providing valuable,

clinical-based learning in particular specialties.

Postgraduate education

During 2014-15, Cabrini educated specialist trainees in

29 different positions across specialities including

colorectal surgery, emergency medicine,

gastroenterology, general medicine, geriatric medicine,

haematology, intensive care medicine, medical

administration, medical oncology, neurology, palliative

medicine, pathology and upper-gastrointestinal surgery.

The specialist consultants at Cabrini who supervise

the trainees and offer valuable learning opportunities

are commended for their generous contributions to

this program. At the time of their exit interviews, most

trainees commented that they were surprised by the

opportunities offered at Cabrini. Cabrini is a larger

healthcare service with a wider diversity of patients and

learning opportunities than trainees generally expect

when they arrive.

Cabrinis medical education program requires extensive

logistical support and liaison with partner healthcare

services: Alfred Health, Eastern Health, Monash Health,

Peter MacCallum Cancer Centre and Austin Health, as well

as the relevant specialist colleges, the Federal Department

of Health and all the trainees involved. Training continues

throughout the year generally two incumbents during

the course of a year (six monthly rotations) but this

regime varies from specialty to specialty. The specialist

trainees provide teaching to the undergraduate medical

education program.

C L I N I C A L E D U C AT I O N AT C A B R I N I

33

From left: Anne Spence is Director of Institute Infrastructure at Cabrini.

Patient Steve and his wife consult with medical student Thomas Ponsonby for the purpose of a new online resource designed to support clinical education.

Allied health and ambulatory services education

Education in allied health and ambulatory services is an

integral part of allied health research and education at

Cabrini. The team that leads this education comprises

Associate Professor Helena Frawley (Head, Cabrini Centre

for Allied Health Research and Education), Tash Brusco

(Manager of Allied Health and Ambulatory Services

Education) and Jacqui Raymond, Allied Health Clinical

Education Lead.

During 2014-15, overall participation in external

professional development remained strong among allied

health and ambulatory services staff. Four staff enrolled in

a Master degree by coursework, making a total of ten staff

participating in this program.

There was positive attendance at the newly

commenced senior allied health and ambulatory

services staff professional development program,

offered internally at Cabrini. This program provides

professional mentoring to the senior allied health and

ambulatory services staff. Participants were mentored

by members of Cabrinis executive team and

senior management.

Other achievements during the year included:

Development of an allied health and ambulatory

services education structure

Appointments to the positions of Allied Health Clinical

Education Lead and Physiotherapy Clinical Educator

Provision of access for allied health and ambulatory

services students to the Cabrini student Moodle

site for orientation, mandatory training and clinical

placement information

Also, work has commenced on an allied health and

ambulatory services education strategic plan, which will

be part of the broader Cabrini Centre for Allied Health

Research and Education strategic plan.

University partnership agreements

New generic Cabrini Student Clinical Placement

Agreements are now in effect for allied health students,

consistent with the nursing and medical models.

Currently, there are four agreements in place:

Clinical Schools Network Agreement La Trobe

University (allied health)

Student Clinical Placement Agreement La Trobe

University (allied health)

Academic Clinician Service Agreement La Trobe

University (allied health)

Cabrini Holmesglen Partnership Framework

Holmesglen Institute (allied health assistants)

Undergraduate allied health placements

During 2014-15, allied health students completed

62 undergraduate clinical placements compared with

12 the previous year. Sixteen clinical placements were

34completed for allied health assistants. Development of

the student education programs continued with focus

on expanding the Clinical School Network Agreement

with our primary university partner, La Trobe University.

The new Academic Clinician Agreement provides

Cabrinis allied health staff with opportunities to teach

La Trobe University undergraduate subjects to third-year

physiotherapy students. Plans are continuing for student

placements with other university providers in speciality

areas or postgraduate placements. During 2014-15,

Cabrini continued its partnership with Holmesglen

Institute. That is, providing teaching in its Certificate IV

in Allied Health Assistance and accepting clinical

placements of these students.

New graduate 12-month programs

Our new graduate allied health program continues

to flourish. Currently we have eight graduate

physiotherapists, two graduate speech pathologists, three

graduate occupational therapists and one graduate social

worker. Many of these new graduates have remained at

Cabrini in permanent roles.

University appointments

The following appointments are in place with La Trobe

University: one Associate Professor, one Adjunct Senior

Lecturer and 19 Adjunct Lecturers. At Deakin University,

one Adjunct Associate Professor is in place.

Participation in higher degree education

Ten allied health and ambulatory services staff are

enrolled in a Master degree by coursework. Four staff

are enrolled in a Diploma or Graduate Certificate. One

physiotherapist is enrolled in the Australian Physiotherapy

Associations Neurological Physiotherapy Titling and

Specialisation program.

Diverse education program

Providing education to more than 4000 clinical staff

across a diverse range of clinical areas and multiple

locations requires the education department to use

a range of delivery platforms. High-level clinical skills

development and team training occur regularly in the

Stewardson Charitable Trusts Simulation Centre located in

Cabrinis Patricia Peck Education and Research Precinct at

154 Wattletree Road, Malvern. For other courses, we make

use of online learning portals.

In 2015, we have a number of new clinical courses aligned

to workforce planning. For example, we introduced a

new course to improve the ability of clinical staff to act as

preceptors and clinical teachers. Leading up to Cabrinis

C L I N I C A L E D U C AT I O N AT C A B R I N I

Above: Tash Brusco (Chief Physiotherapist and Adjunct Senior Lecturer, La Trobe University) and Associate Professor Helena Frawley

provide leadership of allied health education at Cabrini. Each has a university appointment.

35accreditation survey against the national safety and

quality health service (NSQHS) standards in August 2015,

we introduced a series of interactive case studies focusing

on clinical knowledge, skills and behaviours that are

critical to providing safe and effective patient care.

Innovation

In 2014-15, we supported the introduction of new basic

life support and advanced life support programs. They

are the first of their kind in Australia and provide staff

with anytime access to training and skills designed to

maintain their knowledge and skills. These programs

are the culmination of research that identified gaps

in performance and tested solutions, resulting in

implementation of an organisation-wide program to

improve patient safety. In 2015-16, this process will be

extended to areas such as recognition and response to

clinical deterioration (NSQHS standard 9) and medication

safety (NSQHS standard 4).

Grants

A grant for $26,000 was awarded to Research Associate

Amanda Pereira-Salgado from Deakin University for

her project on strategies for increasing capacity for

undergraduate nursing placements.

Reorganisation of clinical education

In August 2014, Cabrinis clinical education department

was reorganised. We revised the traditional delivery

model for education whereby nurse educators were

previously allocated to specific ward areas and were

available only during day shifts on weekdays. Our new

approach ensures that clinical and education expertise

are available to all staff regardless of their location or

hours of work. The change provided an opportunity

to address issues of duplication and inconsistencies

between the education received and recorded at

different Cabrini locations. Our new model has required a

significant change in the way education is developed and

From left: Medical students Tina Zhou and Daniel Chan have a learning experience at Cabrinis Patricia Peck Education and Research Precinct.

Medical students Cheryl Gatot and Nicole Yap are pictured in the Stewardson Charitable Trusts Simulation Centre.

36delivered, with a shift to online resources for knowledge

development, the use of interactive case studies to

challenge clinical decision-making and more rigorous

assessments to ensure performance.

The use of innovative technologies has allowed the

clinical education department to reach, improve and

support nursing staff who have not previously had access

to Cabrini-based clinical education. This will also help the

department to support the increasing number of allied

health and medical staff entering the Cabrini workforce.

Change in Cabrini Institutes infrastructure

In December 2014, we began a review of the structure of

the Cabrini Institute and consulted our staff throughout

the process. At this time, 66 staff were employed across

34 equivalent full-time positions. Within the Cabrini

Institute, there are various models of employment and

models of funding, providing flexibility for the people who

work with us. This enables clinicians to spend some time

in research and/or educative roles and enables academics

to have appointments with universities and with Cabrini.

As with most research organisations, the greatest concern

among staff was tenure and limited financial security

due to the nature of grant funding. To address this, we

restructured within the Cabrini Institute to ensure that we

have skillsets that allow us to remain knowledgeable in

funding opportunities and acquisitions, to promote those

opportunities and to support researchers in applying for

funding. New appointments include the following:

Dr Emma Baker appointed to the position of

Manager Research Programs, bringing experience and

skills in funding acquisition and research promotion.

For more than ten years, she worked in grant-funded

medical research laboratori