Research Report - Chris O'Brien Lifehouse · 2020-02-20 · At any one time, there are more than...

Artist: Julia Westwood

2017 & 2018

PATIENT CENTRED

RESEARCH DRIVEN

CANCER CARE

Research Report

- Professor Chris O'Brien AO

A place that burns on discovery.

“

”

At any one time, there are more than 100

clinical trials being undertaken by or in

collaboration with our researchers and

clinicians.

Research courses through every department

of Chris O'Brien Lifehouse, from medical

oncology and radiation oncology, to surgery,

nursing, and complementary therapies.

Not only does Chris O'Brien Lifehouse

emphasise continual interaction between

clinicians and researchers to drive standards

of care forward, in many cases the treating

clinician and researcher are one and the

same, eliminating the gap between lab and

clinic altogether.

This report summarises research highlights

from our programs and departments for years

2017 and 2018.

Never to be forgotten are the people behind

this data: real patients and families. The

ultimate benchmarks by which we measure

ourselves are how their lives are improved.

Clinical excellence underpinned by research.

This has always been at the heart of the vision

for Chris O'Brien Lifehouse.

The comprehensive cancer centre model is

internationally accepted as the organisational

setting most likely to generate clinical and

research advantage. It is defined by integrated

co-location of services, contribution to

education and research output.

In 2007, Professor Chris O'Brien AO said, "With

a modern comprehensive cancer centre where

clinical care and research are integrated, and

where treatment is underpinned and, indeed,

driven by research, we are entering a new

era."

We now live in that era.

Today, Chris O'Brien Lifehouse is the largest cancer clinical trials unit in NSW.

Foreword

4

6 20Introduction Research Highlights

22 Medical Oncology

24 Head and Neck

28 Radiation Oncology

31 Gynaecological Oncology

33 Breast

35 Neurosurgery

37 Uro-Oncology

38 Supportive Care and Integrative Medicine

40 Affiliates

8 Message from the CEO

10 Message from the Director of Research

12 Research Snapshots

13 Collaborative Network

14 Research Committee

15 In Focus

CHRIS O'BRIEN LIFEHOUSE

5

44 70

Contents

Publications Grants

72 Medical Oncology

74 Head and Neck



76 Breast


46 Medical Oncology

59 Head and Neck



67 Breast

67 Uro-Oncology


RESEARCH REPORT 2017 & 2018

Introduction

The third point is impact. Chris O'Brien

Lifehouse has participated in — and led

— research that has changed practice and

changed lives.

Our medical oncologists have presented globally and had stakes in some of the most exciting developments in cancer treatment in recent years.

In a hugely significant development, Professor

Michael Boyer AM, our Chief Clinical Officer,

was a co-author in a global study that has

made immunotherapy part of standard

care in lung cancer treatment.

Associate Professor Peter Grimison, one of

our senior medical oncologists, is leading

the world's largest and most definitive

trial of medicinal cannabis' feasibility,

effectiveness and consequences in alleviating

the debilitating side-effects of chemotherapy.

So, what lies ahead for Chris O'Brien

Lifehouse research? In order to achieve

significant impact, we must continue to

reach beyond our own circles and work

actively and collaboratively with partners.

Looking back at the clinical trials that came

across my desk for approval throughout 2017

and 2018, research at Chris O'Brien Lifehouse

has evolved in three critical ways.

The first is sheer quantity. Our clinical trials

program has rapidly expanded. The most

recent data from Cancer Institute NSW's

Cancer Clinical Trials Portal shows Chris

O'Brien Lifehouse has the most cancer clinical

trials in NSW.

This is a testament to the energy and

dedication of our clinicians, researchers and

leaders. It also shows that while we may be a

young organisation (2018 marked five years

of operation), we have become a valuable

contributor to the Australian cancer network.

An evidence-based approach is essential as

we continue to build in both substance and

reputation.

The second way our research has evolved is

in breadth and scope, as various departments

have grown their research programs and

output. There are more strong studies

coming out of our Radiation Oncology and

surgical departments such as Head and

Neck. This can partly be attributed to the

investments in technology that we have made

in the last few years. Our departments of Uro-

Oncology and Neurosurgery have started

their own programs and we look forward to

their results in future years.

Message from the CEOEileen Hannagan


8

'A core part of our mission is finding the answers that will make it easier to treat, and cure, people with cancer tomorrow. It is just part of what we do.'- Professor Michael Boyer AM, Chief Clinical Officer

We are committed to strengthening our

relationships and networks throughout the

precinct, the country and internationally.

Research is pivotal to the Chris O'Brien

Lifehouse vision. From the design of the

building, to the way departments are

organised, to the professional development

and mentoring of staff, we are determined to

break partitions wherever possible, in order to

encourage relationships, propagate ideas, and

give science the opportunity to flourish.

9


Chris O'Brien Lifehouse celebrated a major

milestone in November 2018: five years of

operation. As the clinical service grows and

diversifies, so too does the research program.

Two new departments — Uro-Oncology and

Neuro-Oncology — have launched research

programs in the last year.

This Research Report, covering 2017 and

2018, demonstrates the depth of research

within the cancer centre and its collaborative

network with over 250 publications, more

than 200 national and international

Message from the Director of ResearchProfessor Lisa Horvath

presentations, more than 70 grants and 62

research students (undergraduate, Masters

and PhD).

This should be read as a collaborative

report. Chris O'Brien Lifehouse researchers

have many roles, often numerous affiliations

and do their research as part of networks.

The annual Chris O'Brien Lifehouse Research

Symposia are attracting a range of speakers

and poster presenters from within Lifehouse

and our collaborative network across the


10

spectrum of cancer treatment including

surgery, medical oncology, radiation oncology

and molecular pathology.

In 2018, the symposium celebrated the 40-

year career of Professor Martin Tattersall,

who has influenced many areas of cancer

therapy across sarcoma, breast cancer, ovari-

an cancer and cancer survivorship.

We also held our first Lifehouse Concept De-

velopment workshop in conjunction with the

NHMRC Clinical Trials Centre with more than

20 concept participants including doctors,

nurses and allied health researchers.

A key aspect of the Chris O'Brien Lifehouse

research agenda is patient-focused research,

especially that which changes clinical practice.

Our researchers have been part of a wide range of practice-changing studies.

These include immunotherapy in metastatic

lung cancer, extracorporeal radiotherapy

for sarcomas, improved patient decision-

making in cancer therapy, pre-operative

dietary improvements for surgery and

techniques to address fear of cancer

recurrence.

The research has spanned clinical trials

(phase 1-3), biomarkers, supportive cancer,

surgical techniques, quality of life and can-

cer outcomes.

Collaboration remains the cornerstone of Chris O'Brien Lifehouse research. Our Head and Neck Cancer Research Group

continues to expand their network nationally

and internationally to address this uncommon

cancer. Chris O'Brien Lifehouse is now part of

brain cancer research alliances and sarcoma

research networks.

The national cancer co-operative clinical trials

groups remain important research partners

across genito-urinary cancers (ANZUP), breast

cancer (BCT), gynae cancers (ANZGOG), sar-

coma (ASSG), brain cancer (COGNO), gastro-

intestinal cancers (AGITG), lung cancer (ALTG)

and radiation therapy (TROG).

The NSW Early Phase Clinical Trials Alliance

(NECTA) was established three years ago with

Chris O'Brien Lifehouse, The Kinghorn Can-

cer Centre and Scientia Clinical Research and

aimed to grow the early phase clinical trial

portfolio in NSW. NECTA now has 6 active sites

across metropolitan and regional NSW with

more than 50 active Phase 1 trials across the

network.

11


12

Research Snapshots

2017 2018

200

400

600

Number of Phase 1-3 studies across cancer tumour streams

(2017-18)

Number of participants on clinical trials across cancer

tumour streams (2018)

Number of participants by Phase

Phase 1

Phase 2

Phase 3

Phase 1

Phase 2

Phase 3

Other


13

* Collaborative networks include:

University of Sydney: NHMRC Clinical Trial Centre, Cancer Nursing Research Unit, The Psycho-oncology Co-operative Research Group (PoCoG), The Centre for Medical Psychology & Evidence-Based Decision-Making (CeMPED), Surgical Outcomes Research Centre (SOuRCe).

Research Institutes: Garvan Institute of Medical Research, The Centenary Institute, Asbestos Diseases Research Institute (ADRI), Charles Perkins Centre, The ANZAC Research Institute, Melanoma Institute of Australia, The Institute for Glycomics, The South Australian Health and Medical Research Institute (SAHMRI).

Other Cancer Centres and Hospitals: Concord Repatriation General Hospital - Concord Cancer Centre, St Vincent's Hospital Sydney - The Kinghorn Cancer Centre, Westmead Hospital - The Crown Princess Mary Cancer Centre Westmead, Royal North Shore Hospital - Northern

University ofSydney*

RPA Institute ofAcademicSurgery

Royal PrinceAlfred Hospital

RPA Institute of Academic

Surgery

Pharma / Biotec

ResearchInstitutes*

National CancerConsortia*

Sydney HealthPartners

SydneyCatalyst

Other CancerCentres*

Collaborative Network

Sydney Cancer Centre, Prince of Wales Hospital - Nelune Comprehensive Cancer Centre, Coffs Harbour Health Campus, Mid North Coast Cancer Institute (MNCCI), John Hunter Hospital, Calvary Mater Newcastle, Peter MacCallum Cancer Centre, The Royal Melbourne Hospital, Monash Health, Princess Alexandra Hospital Brisbane. Internationally, Dana-Farber Cancer Institute Boston, University of Southern California (USC).

National Cancer Consortia: Australasian Gastro-Intestinal Trials Group (AGITG), Australia and New Zealand Breast Cancer Trials Group (ANZBCTG), Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP), Australia New Zealand Gynaecological Oncology Group (ANZGOG), Australasian Sarcoma Study Group (ASSG), Trans-Tasman Radiation Oncology Group (TROG).


Rebecca Davies, Board Director, Chris O'Brien Lifehouse

Lisa Horvath, Director of Research, Chris O'Brien Lifehouse (Chair)

Michael Boyer, Clinical Director, Chris O'Brien Lifehouse

Christopher Milross, Director of Radiation Oncology, Chris O'Brien Lifehouse

Jonathan Carter, Director of Gynae Oncology, Chris O'Brien Lifehouse

Sam Saidi, Gynae Oncology, Chris O'Brien Lifehouse

Jonathan Clark, Head and Neck Surgery, Chris O'Brien Lifehouse

Michael Elliott, Head and Neck Surgery, Chris O'Brien Lifehouse

Sanjay Warrier, Breast Surgery, Chris O'Brien Lifehouse

Christopher Young, Head of Colorectal Surgery, Royal Prince Alfred Hospital

Paul Stalley, Program Director Surgery/ Head of Sarcoma, Sydney Local Health District

Charbel Sandroussi, Director of Clinical Research, RPA Institute of Academic Surgery

Paul Bannon, Head of Cardiothoracic Research, Royal Prince Alfred Hospital

Stephen Larsen, Institute of Haematology Research Unit, Royal Prince Alfred Hospital

John Boulas, Head of Urology Department, Royal Prince Alfred Hospital

James Kench, Head of Department, Tissue Pathology and Diagnostic Oncology,

Royal Prince Alfred Hospital

John Simes, Director, NHMRC Clinical Trials Centre

Martin Stockler, Co-Director, Cancer NHMRC CTC

Kate White, Chair, Cancer Nursing Research Unit

Phyllis Butow, Co-Director, CeMPED The University of Sydney

Michael Solomon, Co-Chair, RPA Institute of Academic Surgery

Julie Charlton, Research Governance Manager, Chris O'Brien Lifehouse

Jacquie Harvey, Business Manager, Clinical Trials, Chris O'Brien Lifehouse

Brindha Shivalingham, Director of Neurosurgery, The Chris O'Brien Lifehouse

Natalka Suchowerska, Head of Physics Research and Education, Chris O'Brien Lifehouse

Toni Lindsay, Allied Health Manager, Chris O'Brien Lifehouse

Steven Kao, Thoracic Oncology Research lead, Chris O'Brien Lifehouse

Jane Young, Research Director, RPA Institute of Academic Surgery

David Gattas, Research Lead ICU, Chris O'Brien Lifehouse

Lyndal Trevena, The University of Sydney Professor of Primary Health Care

Bev Noble, Partnership Advisory Council, Chris O'Brien Lifehouse

Sarah Charlton Li, Research Program Manager, Chris O'Brien Lifehouse

Trevor Tejada-Berges, Gynae Oncology, Chris O'Brien Lifehouse

MacDonald Christie, Associate Dean (Research), Sydney Medical School and

NHMRC Senior Principal Research Fellow

Martin Butson, Principal Medical Physics Specialist, Chris O'Brien Lifehouse

Leanne Hodgkiss, Trusts and Foundations, Chris O'Brien Lifehouse

Henry Woo, Director of Urology and Head of Robotics, Chris O'Brien Lifehouse

Carsten Palme, Director of Head and Neck Surgery, Chris O'Brien Lifehouse

Research Committee


14

15

In FocusMeet Our Researchers

Associate Professor Peter GrimisonAssociate Professor Peter Grimison is a senior

medical oncologist. His clinical work focuses on

testicular cancer, sarcoma and upper gastro-

intestinal cancers. He is a leader in producing

high-quality research through clinical trials,

especially in matters of patient quality of life

and cost-effectiveness of treatment.

MEDICINAL CANNABIS TRIAL

Nausea and vomiting are notorious side-

effects of chemotherapy. For many, these

symptoms are alleviated with advanced anti-

nausea drugs but for a small group of patients,

they persist.

The medicinal cannabis trial is aimed at

testing whether it is feasible and effective

to administer medicinal cannabis for these

patients, and what side effects, if any, it

may cause. Professor Grimison says this trial is

an opportunity to create reliable evidence

in an area of acute community demand. Up

until now, this area has had limited scientific

understanding.

"Presently, doctors in Australia can prescribe

medicinal cannabis, but without sufficient ev-

idence and understanding of its side effects,

Associate Professor Peter Grimison (right).


there is still a reluctance to do so," Professor

Grimison said.

"My hope is that this study will provide the

kind of evidence which will allow doctors to

make that decision, and also to know whether

the treatment will be cost-effective."

"The way we are administering the cannabis

treatment is quite novel. Traditionally, pa-

tients who buy cannabis for medicinal needs

will smoke it, or more recently use a vaporiz-

er or an oil. These methods are not practical

in a chemotherapy suite, so we are trialling a

unique oral capsule. If we can show that the

capsule is safe and effective, then it will hope-

fully be easier for patients and doctors to use."

This will be the largest and most definitive trial of its kind in the world.

The first part of the trial is currently recruiting

across 11 cancer centres in NSW, including

Chris O'Brien Lifehouse.

GERM CELL TUMOURS

Professor Grimison's areas of interest extend to

testicular cancer and related cancers known

as germ cell tumours.

Testicular cancer is a disease that dispropor-

tionately affects young men aged between 15

and 40 years old. Most people with testicular

cancer are cured, but a small number are not.

"We are interested in improving treatment for

this group," Professor Grimison said.

Working with the Australian and New Zealand

Urogenital and Prostate Cancer Trials Group

(ANZUP), based at the NHMRC Clinical Trials

Centre at University of Sydney, co-located at

Chris O'Brien Lifehouse, Professor Grimison is

testing the delivery of standard chemotherapy

treatment in a different way.

"It's an important trial in a number of ways,"

he said. "It is recruiting from four different

countries; it's recruiting in both adults and

children; and it's recruiting in men and wom-

en."

"Most trials will focus on only one of these

groups, but germ cell tumours cross over.

They are present in males, females, young and

old. Not only will the phase 3 accelerated BEP

study allow us to test the drug schedule in all

of these groups, but it allows us to form the

kind of cross-national collaborations which will

enable us to do better research in the future."

Nurse Practitioner Justine OatesNurse Practitioner Justine Oates works

alongside Nurse Practitioner Sarah Davies in

the Head and Neck service of Chris O'Brien

Lifehouse. They are leaders in promoting an

evidence-based approach to nursing, using

a research framework to evolve practice and

improve patient quality of life.

In an example of research underpinning

nursing and patient care, Nurse Practitioner

Oates led a retrospective review of head and

neck microvascular free flap surgical out-

comes.

The study was initiated after the clinical

governance board noted head and neck

surgical patients represented a large

proportion of patients who returned to theatre

postoperatively.

16


17

'We wanted to find out if there was something we could improve here.'"Or are there systems in place that aren't

working to the best of their ability?" Ms Oates

said.

"A retrospective review over a two-year period

from 2017 to 2018 was conducted involving

a comprehensive assessment of each case,

responsiveness to the deteriorating patient

and evaluation of outcomes to further identify

causal factors, current clinical practice and

opportunities for improvement."

The study showed positive outcomes in all

areas. The volume of complex surgeries was

extremely large; incidence of microvascular

free flap failure was below international

benchmarks; the response time to re-

exploration was impressive at less than 3.5

hours, 24/7.

"They're really positive outcomes for high

volume, high complexity patients with high

co-morbidities," Ms Oates said.

"Through this study, we recognised the need

for a formal guideline for critical information

and escalation of free flap management.

So while there were clear communication

pathways for the escalation of a deteriorating

patient, we're now formalising a pathway for

escalation management."

Nurse Practitioner Justine Oates.


Tony PorterTony Porter's perspective on clinical trials and

the opportunity to take part in them is deeply

personal, saying "it means the world" to him.

Mr Porter was active and healthy — a keen

cyclist, boxing class instructor, even a triathlon

and Iron Man competitor — when he was

diagnosed with melanoma.

He underwent treatment and it was believed

to be successful until a routine scan in 2017

showed what had first presented as melanoma

was in fact a rare form of soft tissue sarcoma.

Mr Porter had five tumours throughout his

body — in his neck, lungs and hamstring.

"I had trouble walking upstairs, I was coughing

up blood… I was in a fair bit of trouble," he

said. Despite chemotherapy treatment, the

cancer continued to grow.

"They gave me three options. Two of them

were more chemo, and the third was a clinical

trial. I took that option."

Mr Porter enrolled in a trial for INCMGA00012

— a type of immunotherapy. The drug is a

PD-1 inhibitor, which increases the body's im-

mune reaction to the cancer.

"I had read a fair bit about immunotherapy.

The very first day I met Professor Tattersall, I

asked him about it, and he helped to find the

trial," Mr Porter said. "The tumour on my neck

was gone after about three treatments. I now

have scans every three months, and every scan

has shown that the tumours have shrunk."

Mr Porter continues fortnightly treatment,

overseen by oncologist Dr Vivek Bhadri, who is

the study's principal investigator since Profes-

sor Tattersall's retirement.

"I'm appreciative of the opportunity to be on

a trial," Mr Porter said.

'It means the world, because I probably wouldn't be here without it.'

Flavio RoncolatoIn December 2018, Flavio Roncolato was to

undergo a parotidectomy to remove a pea-

sized lump under the corner of his jaw.

Surgery of the parotid gland is particularly

complicated because the facial nerve courses

through the gland. Nearly half of all patients

who undergo a parotidectomy experience

Patient ImpactIn Focus

18


19

moderate to severe nerve dysfunction

afterwards.

Mr Roncolato's surgeon, Professor Jonathan

Clark AM, suggested that Mr Roncolato take

part in a trial aimed at reducing the risk

of infection and problems with swelling,

numbness, and loss of movement.

"It was Professor Clark who suggested the

clinical trial, and I said yeah, no problem. It

can't hurt, just do it," Mr Roncolato said.

During surgery, Professor Clark coated Mr

Roncolato's exposed facial nerve with a

solution of corticosteroid dexamethasone in a

slow release hyaluronic acid gel.

"Considering what they did in surgery, my

recovery [was] great," Mr Roncolato said. "I

[could] eat, I had very little pain – in fact, it was

more a slight discomfort," Mr Roncolato said.

"I think that having clinical trials of any sort

in a hospital just shows that the facility that

you're at is probably pushing boundaries, and

the doctors who want to push those bounda-

ries are generally the better doctors."

'In my mind, that's what you would expect of a good researcher – they're out there looking for the next best thing.'"They're not just sitting there saying 'well this

is the way we've always done it'."

Above, Tony Porter. Right, Flavio Roncolato.


Research Highlights

22

* Includes co-publications with other Chris O'Brien Lifehouse departments

novel TargomiR, a miRNA drug developed in

Australia to target malignant mesothelioma

(Lancet Oncology).

The study of TargomiR represents a highly

successful collaboration between the Asbestos

Diseases Research Institute (University of

Sydney), industry (Engeneic) and clinicians

(Chris O'Brien Lifehouse, Concord Hospital

and Royal North Shore Hospital).

Among the Phase 3 studies, our team have been

involved in studies that have contributed to

the registration of immunotherapy agents

HighlightsThe Medical Oncology department has

excelled in research over the last two years

with more than 160 publications across a

wide range of research areas including clinical

trials, biomarkers, cancer biology, health

economics and quality of life.

The members of our department have

recruited patients to more than 100 clinical

trials (Phase 1-3 trials) and contributed to 41

clinical trial publications in the same period.

These include first-in-human studies of a

novel EGFR inhibitor to treat CNS metastases

from lung cancer, a MET inhibitor and the

Department List Prof Lisa Horvath MBBS FRACP PhD (Director of Medical Oncology)

A/Prof Philip Beale MBBS FRACP PhD

A/Prof Jane Beith MBBS FRACP PhD

Dr Vivek Bhadri MBBS FRACP PhD

Prof Michael Boyer AM MBBS FRACP PhD

A/Prof Peter Grimison MBBS FRACP PhD

Dr Michelle Harrison BSc (Med) MBBS FRACP

Dr Mun Hui MBBS FRACP PhD

Dr Steven Kao MBBS FRACP PhD

Dr Jenny Lee MBBS FRACP

Dr Yeh Chen Lee MBBS BMedSci FRACP

Dr Kate Mahon MBBS FRACP PhD

A/Prof Catriona McNeil MBBS FRACP PhD

Dr Hao-Wen Sim MBBS(Hons) BMedSci FRACP

Prof John Simes BSc (Med) MBBS FRACP SM MD

DepartmentsMedical Oncology

Summary By Numbers

165* publications

59 presentations

7 students

39 grants

Prof Martin Stockler MBBS FRACP MSc (Clin Epi)

Prof Martin Tattersall AO MBBS FRACP PhD

Prof David Thomas MBBS FRACP PhD

Dr Alison Zhang MBBS FRACP


23

in which it was confirmed that a blood marker,

mGTSP1, predicts outcomes after Docetaxel

chemotherapy in men with metastatic

castrate resistant prostate cancer. This marker

may accelerate future clinical trials of new

therapies and be useful in the clinic to guide

treatment decisions. This paper was the

subject of an editorial in the journal European

Urology.

Postgraduate students are essential to the

progress of research. They produce high-

quality research and become part of the next

generation of clinician scientists who bridge

the gap between the lab and the clinic.

Two of our new consultants (Dr Mun Hui and

Dr Alison Zhang) have completed their PhD

studies over the last two years and produced

outstanding papers as part of this. Dr Mun

Hui has been studying aggressive triple

negative breast cancer and published a

study identifying Hedgehog signaling as a key

driver of cross-talk between cancer cells and

stromal cells driving chemoresistance (Nature

Communications).

This raises exciting possibilities for therapeutic strategies in advanced breast cancer.

Dr Alison Zhang published a prospective

multicentre phase 3 validation study of

AZGP1, a tissue biomarker which can

predict outcomes after surgery for localised

prostate cancer (Annals of Oncology).

This study provides robust evidence for the

incorporation of this biomarker into clinical

practice.

as standard of care in melanoma and non-

small cell lung cancer. Professor Michael

Boyer AM was a co-author in a global

study that identified the immunotherapy,

Pembrolizumab, added to chemotherapy

improves survival in patients with newly

diagnosed non-small cell lung cancer (New

England Journal of Medicine).

This study has resulted in immunotherapy with chemotherapy as a new standard of care for lung cancer.

In addition, we have contributed to

randomised trials of exercise in advanced

lung cancer and psychosocial interventions

to address patients' fear of cancer

recurrence. Associate Professor Jane Beith was

part of a collaborative team that completed a

randomised controlled trial of ConquerFear,

a psychological intervention to treat the fear

of cancer recurrence. The anxiety and distress

associated with fear of cancer recurrence is

a substantial problem for patients and this is

one of the first psycho-oncology treatments

to improve patients' quality of life (Psycho-

oncology).

Several of the members of the Medical

Oncology department are clinician scientists

with research interests crossing biomarkers

and cancer biology. More than 20 papers

have been published on new biomarkers

to potentially direct cancer therapy in the

future.

These included two Phase 3 studies of

new biomarkers to guide treatment of

prostate cancer. Dr Kate Mahon led a study


24


Dr Ilias Kotranakis MBBS (Hons) FRACS

Dr Arjuna Ananda MBBS FRACS

Dr Raewyn Campbell FRACS BMed (Hons) BAppSc(Physio) Grad Dip (Ex Sport Sc)

Dr Glen Croxson MBBS FRACS

A/Prof Alexander Saxby MB BChir MA (Hons) (Cantab.) FRACS

Dr Phaethon Karagiannis MBBS MPH

A/Prof Jonathan Kong FRACS FRCS MBBS AMusA

A/Prof Payal Mukherjee MBBS FRACS MS

Dr Eileen Tan-Gore MBBS MDSc FRACDS

Our current research priorities are advanced

and metastatic cutaneous squamous cell

carcinoma, investigating the rising incidence

of oral cancer (particularly in young patients

who have never smoked), aggressive salivary

Department List A/Prof Carsten Palme MBBS FRACS (Director)

Prof Jonathan Clark MBBS (Hons 1) BSc (Med) MBiostat FRACS (Head of Research)

Dr James Wykes Sci (Med) MBBS (Hons) FRACS (Head of Fellowship program)

Dr David Leinkram MBBS, FRACDS (OMS) BDSc

Dr Hubert Low MBBS BSc (Med) (Hons) FRACS

A/Prof Sydney Ch'ng MBBS FRACS PhD

Dr Anthony Clifford MBBS FRACS

Dr Kerwin Shannon MBBS FRACS

A/Prof Michael Elliott MBBS MPhil FRACS

Dr Bruce Ashford MBBS FRACS BDSc (Hons)

Nurse Practitioner Sarah Davies NP, RN, BN (UTS) MN (NP) (Sydney)

Nurse Practitioner Justine Oates NP, RN

Dr Lydia Lim BDS (Hons) FRACDS MDSc FRACDS (OMS)

Dr John McGuinness BDS(Hons) FDS RCS MBChB FRCS(ORL-HNS) FRACS

Dr Daniel Novakovic MBBS FRACS MPH

A/Prof Mark Schrifter BDS MDSc M SND RCSEd M Oral M RCSEd FFD RCSI FRACDS

Dr Jasvir Singh BDS MBBS D ClinDen (OMS) FRACDS (OMS)

Dr Sue-Ching Yeoh BDS (Hons) MDSc FRACDS FRACDS FOMAA FICD

Head and Neck

Summary By Numbers

59* publications

28 presentations

20 students

27 grants

HighlightsThe last two years have been highly productive

for the Sydney Head and Neck Cancer Institute

(SHNCI), which is the research organisation of

the Head and Neck service at Chris O'Brien

Lifehouse.


25

cancer cells. They observed an enrichment

of SOX9 at drug-induced H3K27ac sites,

suggesting tumour evolution could be driven

by stem cell-switch-mediated epigenetic

plasticity. Importantly, JQ1 mediated

inhibition of BRD4 could reverse drug-induced

adaptation. These results provide insights

into the modes of therapy-induced cellular

plasticity and underscore the use of epigenetic

inhibitors in targeting tumour progression.

Cutaneous squamous cell carcinoma is a

common cancer that most often occurs in

the head and neck. Its underlying genetic

mechanisms are poorly understood. Through

targeted sequencing of 48 clinically relevant

genes, researchers gained insights into

somatic mutations in non-metastatic high-

risk head and neck cutaneous squamous cell

carcinoma.

This has led to the identification of potential therapeutic targets. In particular, alterations in FGFR2 and

NOTCH1, which may have roles in local and

distant disease progression.

Working with the Department of Radiation

Oncology on a multi-institutional survey,

researchers aimed to characterise the

experiences and unmet needs of patients

with head and neck cancer with regard

to information and support provision.

While patients were largely satisfied with the

information received about disease process,

prognosis and treatment, they reported

receiving only minimal information related

to stress and anxiety, including such topics

as psychological well-being, patient support

groups, and psychosexual health. Verbal

gland cancers, reconstructive approaches to

assist patients with advanced facial cancers

and facial paralysis, and patient education for

head and neck cancer.

The Head and Neck service at Chris O'Brien

Lifehouse performs the largest number of

head and neck cancer surgeries in NSW,

with more resections than the next two

busiest hospitals combined. (See Graph A).

This high volume of patients generates invaluable data. We hold the largest head and neck patient research database and biobank in Australia, with more than 14,000 registered patients.

This data has contributed to important

developments in research.

In a study of somatic mutations in salivary

duct carcinoma (a rare, highly aggressive

cancer with limited therapeutic options for

disseminated disease), multiple mutations

were identified, some of which are responsive

to drugs while others are resistant to

treatments currently under investigation.

These findings emphasise the need to develop

complementary biomarker and treatment

strategies for salivary duct carcinomas.

Chemo-resistance is one of the major causes

of cancer-related deaths. Using single-cell

transcriptomics, researchers investigated

divergent modes of chemo-resistance in


26

communication needs to be reinforced by

accessible, well-constructed, written and

multimedia resources appropriate to the

patient's educational level.

Researchers have completed the design,

development, data collection and analysis in

an important study of patient and health

system barriers to early diagnosis of head

and neck cancer in Australia. The study

examines geographical variation in pathways

to treatment for head and neck patients

in NSW and investigates patient and carer

perceptions of facilitators and barriers.

This research has the potential to shape health policy to ensure more equitable outcomes for patients with head and neck cancers.Publication is due in 2019.

Graph A: Annual average resections, by NSW public and private hospitals, head and neck cancer, 2016-2017

Chris O'Brien Lifehouse


27


28


Highlights

Researchers in the Radiation Oncology

department at Chris O'Brien Lifehouse have

had a productive two years, participating in

several practice-changing studies as both lead

researchers and collaborators.

In a study initiated by our researchers and

Department List A/Prof Christopher Milross MBBS MD FRANZCR FRACMA FAICD (Director of Radiation Oncology)

Dr Leily Gholemrezai MBBS FRANZCR

A/Prof Angela Hong MBBS MMed PhD FRANZCR

Dr Nitya Patanjali MBBS FRANZCR

Dr Mo Mo Tin MBBS FRANZCR

Dr Regina Tse MBBS MClinEpi FRANZCR

Dr Georgia Harris BSc MBBS MPH FRANZCR

Dr Ee Siang Choong MBBS FRANZCR

Dr Kavita Morarji MBBS FRANZCR

Dr Sandy Sampaio MBBS FRANZCR

Dr Eric Khoo MB ChB FRANZCR

Dr Carol Haddad MBBS FRANZCR

VectorLabA/Prof Natalka Suchowerska PhD MAppSc BSc FACPSEM

Linda Rogers B Med Sc

Dr Ana Esteves BSc PhD

Prof David R McKenzie PhD BSc FAIP (collaborator from University of Sydney)

Radiation Oncology

Summary By Numbers

44* publications

11 presentations

13 students

4 grants

carried out across four institutions, patients

who had received treatment for head and neck

cancer were surveyed to find a relationship

between decision-making preferences and

psychological distress.

Researchers found that while patients do

Medical PhysicsElizabeth Claridge Mackonis BSc (Hons) MMedPhys

Dr Samara Alzaidi BEng (Hons) GradDip (Medical Physics) PhD

Johnny Morales BSc (Hons) MSc (Medical Physics)

Dr Martin Butson BSc (Hons) PhD DScBSc (Hons) PhD DSc

Dr Robin Hill BSc (Hons) MSc (Medical Physics) PhD


29

experience paternalistic decision-making,

most patients would prefer an active or shared

approach to making decisions, especially if

they are tertiary educated or female. However,

psychological distress is more likely in patients

who are actively involved, younger, and

female. The upshot is that clinicians should

be aware of this potential and refer active-

decision makers for psychosocial support.

In a significant collaboration with Royal

Prince Alfred Hospital, researchers undertook

a retrospective review of patients treated

with extracorporeally irradiated allografts

for primary and secondary bone cancers,

studying mid- and long-term survivorship and

functional and radiographic outcomes.

The study looked at patients treated with

extracorporeally irradiated allografts for bone

tumours between 1996 and 2014, examining

the clinical, functional and radiological

outcomes for patients. It demonstrated

that extracorporeal irradiation is a versatile

reconstructive technique for dealing with

large defects after resection of bone tumours

with good functional and radiographic

outcomes. Functional outcomes as measured

by Musculoskeletal Tumor Society (MSTS)

scoring system, the Toronto Extremity Salvage

Score (TESS) and Quality of Life-C30 (QLQ-

30) were strongly correlated to radiographic

outcomes.

Our researchers also contributed to the

national Trans Tasman Radiation Oncology

Group randomised phase 3 trial that looked

at whether postoperative concurrent

chemoradiotherapy, where there is high-

risk cutaneous squamous cell carcinoma

(SCC) of the head and neck, improves patient

outcomes as opposed to postoperative

radiotherapy.

While the combination of surgery and

postoperative radiotherapy was shown to

give excellent results, researchers found that

additional weekly carboplatin (chemotherapy)

brought no added benefit.

These findings eliminate an unnecessary treatment burden for patients.

VectorLAB at Chris O'Brien Lifehouse

combines medicine, physics, biology and

chemistry in order to solve some of the

most urgent problems in cancer. Comprised

of a diverse team of specialist scientists

and clinicians, VectorLAB aims to translate

advances in science and technology to help

people with cancer.

In 2018, VectorLAB acquired a customised

3D printer from the startup company AON3D

in Montreal. Georgio Katsifis, a postgraduate

student from the School of Physics at

University of Sydney, took up the challenge to

use the printer to build bone scaffolds using

the strong polymer Poly-ethyl-ethyl ketone

(PEEK). The scaffolds were then treated using

a plasma gas method to attract bone growth.

(Mr Katsifis was awarded the Robinson Prize by

ACPSEM for the best biomedical engineering

project in 2018.)

The team comprises Head and Neck Surgeon

Jonathan Clark AM, cell biologist Linda Rogers,

and medical physicist Natalka Suchowerska

from Chris O'Brien Lifehouse working in

collaboration with materials physicist Professor

David McKenzie and Georgio Katsifis.


30

This study will ultimately enable patients who have lost bone to receive a customised scaffold implanted to support regrowth of the patient's own cells.

In working to reduce the risk of infection

during cancer surgery and treatment,

VectorLAB has developed an innovation with

the potential to benefit all surgical patients,

not just those being treated for cancer.

The antimicrobial treatments, developed

using a powerful combination of peptides,

in collaboration with the University of NSW,

were tested on urinary catheters and found to

prevent infection in the form of biofilms from

developing. This finding means that patients'

risk of infection, associated with medical

devices, is significantly reduced and the need

for catheter replacement is reduced.

Funds from Tour de Cure were used to create a

magnetic nanoparticle treatment that can

carry therapeutic molecules into cancer

cells. Many types of treatments can now be

considered for targeted delivery to cancer

cells by nanoparticles, one of them being

a gene silencing therapy for hard to treat

cancers such as mesothelioma.


31

Department List Prof Jonathan Carter MBBS Dip RACOG FACS FRANZCOG CGO MS MD

(Director)

A/Prof Selvan Pather MBChB FCOG FRANZCOG CGO

A/Prof Samir Saidi MBChB MRCOG FRANZCOG PhD

A/Prof Trevor Tejada-Berges MD MSc FRCPSC FACOG FRANZCOG

Dr Rhonda Farrell BAppSc MBBS (Hons) Dip ObGyn FRANZCOG CGO MS (Incoming Deputy Director)

Dr Robyn Sayer MD FACOG FRANZCOG CGO

Nurse Practitioner Shannon Philp NP RN BN MN (NP) GradCertCancNurs GradCertWomen'sHealthNurs

Nurse Specialist Katie Dicks RN BN

Dr Gemma Blain MBBS (Hons) MRMed BSc FRANZCOG

A/Prof Michael Cooper OAM MBBS MRCOG FRANZCOG MHKCOG FRCOG

Gynaecological Oncology

Summary By Numbers

15 publications

69 presentations

17 students

1 grant

Dr Paulette Maroun MBBS FRANZCOG

Dr Karuna Raja MBBS MS MOHS FRANZCOG

Dr Anthony Richards MBBS FRANZCOG MBA MRMed CGO

Dr Sofia Smirnova MBBS Mmed (RHHG) FRANZCOG

A/Prof Nesrin Varol PhD MIPH FRANZCOG MBBS

Dr Joyce Wu BSc MBBS FRANZCOG

Highlights

For years, the question of optimal adjuvant

therapy for lymph node-negative cervical

cancer patients with intermediate risk factors

has been debated.

Extra treatment modalities come with

substantial risks to patients, increasing the

chances and severity of complications and

side effects. Yet adjuvant radiotherapy after

radical surgery has been advocated for these

cervical cancer patients since the GOG 92

trial (a Gynecologic Oncology Group study

initiated in 1989) found that it reduced the

rate of recurrence and improved survival.

Through a review of the literature and

retrospective cohort study using data from

multiple institutions, researchers found

adjuvant therapy is not a significant prognostic

factor for these patients. This different and


32

substantially better outcome can be attributed

to improved surgical techniques and more

accurate preoperative and pathological

staging.

The result will lead to fewer patients enduring unnecessary radiotherapy treatment, reducing complications and risks, and improving quality of life.

The role of lymphadenectomy (surgical

removal of one or more groups of lymph nodes)

in patients with early-stage endometrial

cancer is controversial. Previous studies

have grouped patients with varying risks

and histologies together, giving an unclear

picture of the benefits of lymphadenectomies

in different patients. Furthermore, Long-

term morbidity after lymphadenectomy has

remained uncertain.

By analysing data from a large prospective Aus-

tralian National Endometrial Cancer Study, re-

searchers examined the association between

lymphadenectomy and clinicopathological

characteristics, adjuvant treatment, sur-

vival, patterns of disease recurrence, and

morbidity. In a large cohort of patients with

early-stage intermediate- and high-risk endo-

metrioid endometrial cancer, lymphadenecto-

my was found not to improve survival, yet was

associated with significantly higher rates of

critical events and lymphoedema. The result

from these findings will be that fewer patients

in this group will undergo lymphadenectomy

and avoid higher related morbidity.

To date, our understanding of the relationship

between diet and ovarian cancer

survival has been limited. By examining the

relationship between pre-diagnostic diet and

overall survival in a population-based cohort

of Australian women diagnosed with invasive

epithelial ovarian cancer, researchers have

discovered links between ovarian cancer

survival a patient's pre-diagnosis diet.

Researchers observed improved survival linked to fibre intake.

There was suggested further improvement

linked to eating green leafy vegetables, fish

and poly- to mono-unsaturated fat ratio. Also

observed was a worse survival rate associated

with a higher glycaemic index.

This new knowledge about the impact of a

pre-diagnosis diet on survival raises possibili-

ties for dietary choices after diagnosis.


33

Department List Dr Cindy Mak MBBS (Hons) FRACS (Head of Department)

A/Prof Sanjay Warrier BSc (Med) MBBS FRACS MS

Dr Farhad Azimi-Rashti MBBS MS FRACS

Dr Ping-En Chen BHB MBCHB MS FRACS

Dr Deborah Cheung MBBS FRAC

Dr Senarath Edirimanne BMBS (Hons) FRACS

Dr George Fleischer BMBS FRACS

Dr Irandi Jayatilleke BMedSc BMBS(Hons) FRACS

Dr David LittleJohn MBBS FRACS

Dr Belinda Chan MBBS FRACS MS

Breast

Summary By Numbers

5 publications

6 presentations

1 student

1 grant

Dr Joel Symonds BMedSc (Hons) MBBS FRACS GradCertSurg

Dr April Wong MBChB MS FRACS

Dr Michael Yunaev MBBS MPH BMedSc (Hons) MS FRACS

Highlights

In a significant development in reducing the

risk of necrosis (cell death) following complex

breast reconstruction procedures for women

who have had mastectomy, researchers

have demonstrated how intraoperative

assessment of skin flaps using SPY Elite

influences decision-making in direct to implant

and expander-based reconstruction.

SPY Elite technology gives surgeons the ability

to monitor intraoperatively blood flow to

different areas of the breast during surgery.

Surgeons who use this technology have

reported being better informed to consider

delayed techniques or avoid reconstruction

altogether.

Anecdotally, rates of necrosis have decreased and a prospective trial is underway to determine the full impact of this technology.

The role of antibiotics in reconstructive

implant work has been a matter of scrutiny,

with the question of clinical benefits derived

from using antibiotics and antiseptics to

washout the breast pocket or soak the breast

implant during surgery remaining inconclusive.


34

The Centers for Disease Control and Prevention

give a muted recommendation for washing

tissues in iodophor, but until now, the efficacy

and impact of this practice in reducing

infection rates had not been adequately

examined.

Through a systematic review of cohort stud-

ies involving an implant or tissue expander in

augmentative surgery, researchers found that

using antibiotics in pocket washout or implant

immersion does indeed reduce infection rates,

however the evidence is deficient. While data

trends towards better outcomes with beta-

dine and antibiotics, it remains unproven and

a randomised control trial is needed.

As part of an ongoing series, researchers from

multiple hospitals examined approaches to

managing complications relating to breast

implant infections. In one instance, they dis-

cussed treatment using Veraflo™ device and

irrigation, which couples Negative Pressure

Wound Therapy with automated, controlled

delivery of topical wound treatment solutions

to and from the wound bed.

The findings showed rapid cleaning of the

wound and formation of granulations, and

was followed by successful reinsertion of

breast implants.

In what is a relatively simple solution, this treatment was demonstrably capable of salvaging reconstruction in the event of infection.


35

Highlights

The Neurosurgery research program launched

with the aim of improving the clinical manage-

ment and outcomes for patients diagnosed

with primary brain cancer.

While primary malignant brain cancers have

a relatively low incidence, they carry a high

disease burden. The most frequent subtype,

glioblastoma, is incurable and often rapidly

fatal. Despite paradigm-shifting advances in

science, technology and healthcare over the

last 30 years, survival rates for patients with

glioblastoma have remained dismally low.

This is a direct result of a lack of fundamental scientific research.

While community awareness of brain cancer

and its associated burden is growing, critical

research is hampered by the absence of ma-

terials to study.

In 2019, through our partnerships with

Brainstorm Brain Cancer Research at the

Brain and Mind Centre, Sydney University

and RPA Neuropathology Department, we

aim to launch Chris O'Brien Lifehouse as

a new collection site of the Sydney Brain

Tumour Bank. Tumour tissues, cells and blood

specimens will be collected, preserved and

made freely available to researchers world-

wide to support a variety of research into

brain cancer.

With this framework in place, we are working

towards the launch of GlioNET, a multi-centre,

observational trial for newly diagnosed glioma

patients within the next 12 months.

This ambitious project will track Australian

patients diagnosed with glioma over the

entire course of their cancer journey.

This will be the first concerted effort to

record complete longitudinal clinical and

pathological information, bio-specimens

(blood, tumour tissues and cells), imaging

and patient- and caregiver-centred data (self-

reported quality of life questionnaires, sleep

and exercise data). Materials and information

Neurosurgery

Department List Dr Brindha Shivalingam MBBS FRACS (Director)

Dr Benjamin Jonker MBBS MMed FRACS

Dr Rodney Allan MBBS (Hons) FRACS

Dr Johnny Wong MBBS (Hons) MMed PhD FRACS

Dr Kim Kaufman, BMedSc (Hons) PhD


36

captured during GlioNET will create a unique,

open-access platform to:

1. Understand the molecular events driving

tumour evolution and adaptation, and

failure of current standard therapies.

2. Discover and confirm novel biomarkers

that can accurately diagnose and predict

tumour progression and treatment

responses.

3. Identify opportunities for improving

services and patient and carer morbidity.

4. Drive the implementation of adaptive

clinical trials and ultimately, precision

medicine.

GlioNET longitudinal data and specimens will

support a number of specific sub-studies,

including the translation of a non-invasive

blood test for monitoring glioma tumour

progression, published by our group in 2018.1

Here we showed that robust molecular

signatures are detectable in blood exosomes

and are specific to glioblastoma and lower

grade gliomas.

This approach has enormous potential to revolutionise how brain tumours are monitored. It could allow us to detect the very early stages

of treatment failure, tumour recurrence and

progression via simple blood tests.

1 Ebrahimkhani S., Vafaee F., Hallal S., Wei H., Lee M. Y. T., Young P. E., Satgunaseelan L., Beadnall H., Barnett M. H., Shivalingam B., Suter C. M., Buckland M. E., Kaufman K. L. 2018. Deep sequencing of circulating exosomal microRNA allows non-invasive glioblastoma diagnosis. npj Precision Oncology, 2, 28 (2018). URL: https://www.nature.com/articles/s41698-018-0071-0.


37

HighlightsThe Uro-Oncology research program launched

in 2018 and has contributed to several salient

projects in its first months.

Inguinal hernia is a known consequence

of radical prostatectomy that contributes

to patient morbidity and leads to higher

health care costs. Lesser known is that it

is also common after minimally invasive

radical prostatectomy. In a systematic

review of incidence, predictive factors and

preventive measures, researchers found

high-level evidence that clarifies risk factors

and preventive strategies are lacking for

inguinal hernia following robotic and

laparoscopic radical prostatectomy. The study

demonstrated a justification for randomised

control trials to further evaluate this under-

recognised clinical problem, which causes

patients distress and may require a second

operation to fix.

In a multicentre phase 3 trial, researchers

studied whether androgen-deprivation ther-

apy for patients with prostate cancer (who

have relapsed with rising prostate-specific

antigen concentration only or with non-cur-

able but asymptomatic disease at diagnosis),

could adversely affect quality of life at a time

when the disease itself does not. Involving

29 public and private cancer centres across

Australia, New Zealand and Canada, the aim

was to compare the effect of immediate ver-

sus delayed androgen-deprivation therapy on

health-related quality of life over five years.

Researchers found that immediate use of

androgen-deprivation therapy was associated

with early detriments in specific hormone-

treatment-related symptoms, but no other

demonstrable effect on overall functioning

of health-related quality of life. This evidence

can be used to help decision-making about

treatment initiation for men at this disease

stage.

Researchers from multiple institutions sought

to evaluate the impact of publications on

urological participation in social media

by virtue of citations in the urological and

non-urological literature. They found that uro-

logical social media journal articles are highly

cited, particularly in the non-urological litera-

ture. It's likely the magnitude of citations has

positively contributed to the impact factors of

publishing journals.

Department List Professor Henry Woo MBBS FRACS (Director)

Dr Nariman Ahmadi BSc (Med) MBBS FRACS

Dr Norbert Doeuk MBBS MS FRACS

Dr Scott Leslie BSc (Med) MBBS (Hons) FRACS

Uro-Oncology

Dr Paul Sved BSc (Med) (Hons) MBBS (Hons) MMed FRACS

Dr Ruban Thanigasalam MBBS MS FRACS

Dr Arthur Vasilaras MBBS (Hons) FRACS

Dr Tania Hossack MBBS (Hons) FRACS MSPro


38


HighlightsIntegrative oncology is a fast-evolving field as

more patients seek a holistic approach to their

disease and symptoms. The research strategy

of the Supportive Care and Integrative Med-

icine service at Chris O'Brien Lifehouse is fo-

cused on developing a strong evidence base

to support the integration of holistic medical

care, complementary therapies, exercise and

nutrition into standard cancer care.

Furthermore, as people with cancer live

longer, there is a growing need to develop

programs that support them to live well. The

research program in the Supportive Care ser-

vice aims to identify the best ways to support

patients with a focus on symptoms.

Chris O'Brien Lifehouse is committed to

developing integrative oncology research

in Australia, working in collaboration with

the University of Sydney, Western Sydney

University, University of Technology, Sydney,

NSW Health and other institutions nationally

and internationally. The last two years have

been particularly productive as this service has

developed.

Our researchers initiated a practice-chang-

ing study into living well with melanoma

and immunotherapy. Despite an increasing

number of metastatic melanoma patients

receiving immunotherapy treatment, includ-

ing Pembrolizumab, the long term impacts

on their well-being remain underexplored. A

Department List A/Prof Judith Lacey MBBS FRACGP FAChPM (FRACP) (Director)

Dr Suzanne Grant BAppSc (TCM) MPS PhD (Acupuncturist)

Dr Toni Lindsay PhD (Clinical Psychologist)

Mr Michael Marthick BSc GradDipSc (Ex Rehab) MPH (Exercise

Physiologist)

Dr Diana Naehrig (Research Fellow, Supportive Care)

Dr Victoria Choi (Acupuncturist, Researcher)

Supportive Care and Integrative Medicine

Summary By Numbers

14* publications

37 presentations

4 students

9 grants


39

pilot study assessed the feasibility, perceived

benefit, and acceptability of a supportive care

intervention for people with metastatic mela-

noma being treated with immunotherapy.

This pilot has paved the way for a feasible model of care in supportive cancer care and immunotherapy.

It will contribute data to develop guidelines to

support these patients, and will inform a model

of care for programs beyond melanoma.

This research informed a secondary objective,

which was to explore the lived experience of

these patients. The publication highlighted

the patient experience of coping with

uncertainty.

Exercise physiologist and researcher, Michael

Marthick, investigated the feasibility, usability

and acceptability of an interactive web

portal developed to support patients with

cancer to increase daily physical activity

levels. He found that the portal was feasible,

but further research is needed to determine

optimal coaching methods.

In a paper that explored the establishment

of an integrative oncology service in the

Australian healthcare setting, researchers

reflected on the Chris O'Brien Lifehouse

hospital experience.

They found the strategic integration of medical specialist and integrative oncology services, as part of the hospital's supportive care services, led to improved acceptance by specialists and nursing staff.

Researchers have undertaken a retrospective

evaluation over one year, interviewing

oncologists, radiation oncologists, surgeons

and clinical staff, to investigate how they

approach meeting the supportive care

needs of their patients. This qualitative data

is being analysed and written. By evaluating

the unmet supportive care needs of cancer

patients at Chris O'Brien Lifehouse, this

research will inform interventions and service

development and enable benchmarking with

services within Australia and internationally,

promoting collaboration in the integrative

oncology and supportive care space.


The Psycho-oncology Co-operative Research

Group (PoCoG) and Centre For Medical Psy-

chology & Evidence-Based Decision-Making

(CeMPED), are research centres of the Univer-

sity of Sydney collaborating with Chris O'Brien

Lifehouse on a large project that is evaluat-

ing the resources and support required to

implement a clinical pathway to manage

anxiety and depression in cancer patients

(ADAPT).

The ultimate goal of this project is to ensure all patients receive the best care possible, including for the emotional impact of cancer.

In this study, twelve oncology units in NSW are

randomised to receive basic versus extended

support to implement ADAPT.

After training staff members in the clinical

pathway and how to use the online portal

through which ADAPT operates, the project

has these key features:

• All patients are invited to complete reg-

ular screening for anxiety and depression

by completing a short online question-

naire.

• Staff are alerted by the online system if

patients' scores indicate they are experi-

encing anxiety and depression.

• The system recommends appropriate care

for that individual's level of anxiety and

depression.

• Staff are prompted to discuss treatment

options with the patient, and they record

actions taken on the portal, including re-

ferrals to psychosocial health profession-

als.

• The portal triggers treatment comple-

tion reports, and re-screening every three

months.

• An online intervention using cognitive-be-

haviour therapy is available to patients

with mild to moderate anxiety/depres-

sion.

ADAPT has recently 'gone live' at Chris O'Brien

Lifehouse, with two patients registered in

the system in the first week. Chris O'Brien

Lifehouse will use ADAPT for one year. Staff are

surveyed and a small group are interviewed

three times during the year, to gain feedback

on how ADAPT is functioning.

AffiliatesPoCoG & CeMPED

40


41

Chris O'Brien Lifehouse is one of the original

member groups of Sydney Catalyst and the re-

lationship between the two organisations has

gone from strength to strength.

The Sydney Catalyst central office is housed

within the Lifehouse building. This has provided

an important opportunity for the groups

to work closely together across a range of

translational research projects and activities,

challenging institutional and work culture

boundaries. Co-location also provides Sydney

Catalyst staff with a unique opportunity to

experience the inner workings of Chris O'Brien

Lifehouse, enriching their understanding of

clinical practice and breaking down some of

the walls between researchers and clinicians.

The appointment of Professor Michael

Boyer AM as the Director of Sydney Catalyst

further harnesses the relationship, as does

the involvement of Professor Lisa Horvath,

Director of Research, on the Sydney Catalyst

Scientific Advisory Committee.

EnRICH is an important example of translational

research collaboration between Chris O'Brien

Lifehouse and Sydney Catalyst.

The Embedding Research (and Evidence)

in Cancer Healthcare (EnRICH) program

is the major flagship translational cancer

research program for Sydney Catalyst. Chris

O'Brien Lifehouse is a significant partner in this

program.

EnRICH is assembling a clinical cohort of

1,000 patients with lung cancer to:

• Describe the natural history of and

patterns of care for lung cancer;

• Better define, treat and care for patients

across Sydney Catalyst member hospitals,

including Chris O'Brien Lifehouse;

• Create a platform for researchers across

the T1-T3 translational research spectrum

to develop and initiate clinical research

and intervention studies to address gaps.

Professor Boyer is a clinical lead for EnRICH

and more than one-third of patients currently

involved in EnRICH have been recruited from

and/or treated at Chris O'Brien Lifehouse.

Some of the key research questions being

addressed by EnRICH include:

• What are the molecular, disease and pa-

tient characteristics of patients with lung

cancer?

• What is the natural history of patients with

lung cancer in terms of recurrence-free

survival, overall survival and patient re-

ported outcomes?

• What are the main prognostic factors for

these outcomes related to molecular, dis-

ease and patient characteristics?

• What are current patterns of care for pa-

tients with lung cancer? How and why do

patterns of care vary?

Significant new research opportunities have

been made possible by EnRICH enabling Syd-

ney Catalyst members and others locally and

internationally to use the resource to improve

outcomes for people affected by cancer. A

number of sub-studies using biospecimens

and data from the EnRICH cohort are currently

being undertaken.

Sydney Catalyst


The Cancer Nursing Research Unit is a member

group of Sydney Catalyst and advances clinical

nursing practice by supporting cancer nurses

in research, higher degree studies and hosting

postgraduate students.

The CNRU conducts its research activities

under four themes:

• Supportive care;

• Psychosocial and quality of life;

• Models of healthcare delivery; and

• Improving research capacity and skills for

cancer and palliative care nurses.

Recruitment has been completed and data

analysis is well underway in a project that

evaluates shared care pathway interven-

tion to reduce chemotherapy outpatients'

unplanned presentations to hospital (a part-

nership with Lifehouse and Concord Repatria-

tion General Hospital).

A project to assess adolescent and young

adult cancer patients' transition to palli-

ative care and the effect on health care

professionals has been completed to recruit-

ment, with a paper in draft.

Outside of these formal research activities, the

CNRU continues to demonstrate the benefits

of co-location through its informal support

and mentorship of specialist nurses at Chris

O'Brien Lifehouse.

Collaboration and one-on-one mentoring

has led to more nurses working more fre-

quently within a research framework. The

CNRU supports nurses to develop projects,

prepare papers and presentations, and submit

abstracts for presentations.

By encouraging nurses to work within a research framework, the CNRU empowers nurses to proactively respond to patient needs that they observe through their work.

An example is a scalp cooling initiative

which helps reduce the volume of hair that

is lost during chemotherapy. A methodology

has been developed on another site and

CNRU is working with Chris O'Brien Lifehouse

to evaluate factors that will facilitate

implementation.

Cancer Nursing Research

42


43

Established in 2014, the RPA Institute of

Academic Surgery (IAS) supports surgical

departments across the broader Royal Prince

Alfred Hospital (RPAH), Chris O'Brien Lifehouse

and University of Sydney campus to enhance

their research and education. The IAS worked

in close collaboration with a number of

Chris O'Brien Lifehouse surgical and medical

departments on a range of research projects

during 2017 and 2018.

Within the Head and Neck surgery

department this included commencing

pilot studies examining the effectiveness of

designing and printing 3D models to assist

with the surgical planning for complex

reconstruction cases and the utilisation of

the IAS surgical skills facilities to undertake

pre-clinical investigations as part of the

BLINC research project aiming to assist

patients with severe nerve damage to their

eyelids.

The delivery of the Advanced GI Surgical

Program incorporating pelvic exenteration,

peritonectomy and advanced upper GI

malignancy continues to be a strong point of

collaboration between the IAS and a range of

leading clinicians from Chris O'Brien Lifehouse,

from Medical Oncology, Gynae Oncology

and Radiation Oncology. This includes

contributing to the program-wide research

databases (PESQI, PREMIER and HUGO).

This crucially underpins more than 35 studies across the entire Advanced GI Surgical Program.

A new and exciting multi-site study that has

been developed and commenced in 2017/18

is the ReLaPSeD trial. This is a prospective

randomised controlled trial comparing re-

look laparoscopy versus standard follow-up

for early detection and treatment of patients

at high risk of peritoneal metastases after

resection of colorectal cancer.

Within breast surgery, projects were

undertaken looking at the use of 3D printed

models to assist in surgical planning and

patient education, as well as the ongoing

investigation of the use and potential

benefits of SPY imaging technology for

breast reconstruction patients.

In addition to their specific areas of research,

surgical staff from Chris O'Brien Lifehouse also

provide regular teaching and mentoring to

a range of junior medical, nursing and allied

health staff doing research at the IAS, as well

as the supervision of research projects being

undertaken by MD students at the University

of Sydney.

RPA Institute of Academic Surgery


Publications

AHMADZADA, T., KAO, S., REID, G., BOYER, M., MAHAR, A. &

COOPER, W. A. 2018. An Update on Predictive Biomarkers

for Treatment Selection in Non-Small Cell Lung Cancer. J

Clin Med, 7.

AHMADZADA, T., REID, G. & KAO, S. 2018. Biomarkers in

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CARTER, J., HAMMOND, I. & SMITH, M. 2017. The renewal

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department


ELSNER, K., NAEHRIG, D., HALKETT, G. K. B. & DHILLON, H.

M. 2017. Reduced patient anxiety as a result of radiation

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*

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LON, H. M. 2018. A low literacy targeted talking book

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department


Grants

Simes J, Boyer MJ, Young J, Thomas D, Butow P, Vadas M.

Translational Cancer Centre Grant, NSW Cancer Institute.

$6,500,000. (2016-2021).

Barratt A, McCaffery K, Carter S, Glasziou P, Kerridge I,

Semsarian C, Howard K, Doust J, Elshaug A, Moynihan (AI

- Tattersall, M). NHMRC - Centres for Research Excellence

(APP1104136). Creating sustainable healthcare: ensuring

new diagnostics avoid harms, improve outcomes, and di-

rect resources wisely. $2,400,000 over 5 years. (2017-

2021).

Sanson-Fisher R, Butow P, Tattersall M, D'Este C, Doran C,

Martin J. CCNSW Program Grant. Improving and maintain-

ing holistic cancer survivor outcomes. A system-based

program. $2,234,524.91 over 5 years. (2018-2022).

Juraskova I, Butow P, Laidsaar-Powell R, Boyle F, Yates P,

Schofield P, Kay J, Costa D. AI: Tattersall, M. NHMRC Pro-

ject Grant (APP1146383). Empowering the clinician-pa-

tient-carer TRIO: RCT of a novel online education modules

to facilitate effective family carer involvement in oncolo-

gy. $593,201.60 over 3 years. (2018-2020).

CI: Hui, M. NBCF Investigator Initiated Research Scheme.

Discovering new therapeutic strategies for metastatic tri-

ple negative breast cancer at cellular resolution. (2018).

Hui, M. Sydney Breast Cancer Foundation Research Fellow-

ship. (2017).

CI: Hui, M. Roche Research and Development Grant.

(2017).

Hui, M. Sydney Catalyst Prof Rob Sutherland Travel Award.

(2017).

Lindeman G, Mann G, Desai J, Forbes J, Fox S, Liew D,

Mcarthur G, Simes J, Sutherland R, Visvader J. Centre of

Research Excellence for Translational Breast Cancer Re-

search. From Discovery to Better Health Outcomes.

$2,500,000. (2012-2017).

Simes J, Keech A, Gebski A, Stockler M, Caterson I, Cola-

giuri S, Schofield D, Marschner I. Advancing the Evidence

Base for Care and Policy in Priority Health Areas (Program

Grant) 1037786. $10,643,000. (2013-2017).

Simes J. Research Fellowship, 1121008. $863,910.

(2017-2021).

Simes J. Program Grant, 1150467. $12,215,472. (2019-

2023).

Anderson RL, Swarbrick A, Johnstone R, Chua B, Gill A,

Khanna K, Lakhani S, Loi S, O'Toole S, Saunders C. AI 4: Be-

ith J. Development of a national resource of primary and

secondary metastatic breast cancers to test new drugs

and identify the genetic changes that drive breast can-

cer growth and metastasis. NBCF National Infrastructure

Grant. $1,834,335 (2015-2019) AI 4

Mahon, K. Movember Prostate Cancer Foundation of Aus-

tralia Clinician Scientist Award. $450,000. (2016-2018)

Movember Revolutionary Team Award. $3 million. (2015-

2020).

Butler L, Hoy A, Swinnen J, Wittert G, Scott A, Tilley W.

Exploiting alterations in lipid metabolism to improve di-

agnosis, treatment and molecular imaging of prostate

cancer. Role: Team member – Kate Mahon

CIs: Butler L, Horvath L, Tilley W, Stricker P. Cancer Austral-

ia/Prostate Cancer Foundation of Australia. 1050880. A

pharmacodynamics study of the heat shock protein 90

(Hsp90) inhibitor, AUY922, in high-risk, localized prostate

cancer. $590,000. (2013-2019).

Medical Oncology

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CIs: Thomas D, Horvath LG. Cancer Gene Discovery and

Validation Program. RT Hall. $334,425. (2016-2018).

CI: Horvath LG. Peer-reviewed Astellas research project

grant. Exploiting lipid metabolism to predict response

to treatment in advanced prostate cancer. $200,000.

(2016-2018).

CIs: von Itzstein M, Horvath LG. Peer-reviewed grant from

private foundation. The Cancer Glycome Project. $2.54

million. (2016-2018).

CIs: Hart D, Clark G, Horvath L. CINSW Translational Pro-

gram Grant. Therapeutic Antibody Translation into Pa-

tients. $3.45 million. (2017-2022).

Horvath L. Below the Belt ANZUP. Statins in metastat-

ic castration-resistant prostate cancer study. $36,000.

(2017-2019).

CIs: Stricker PD, Clark SJ, Hayes VM, Horvath LG, Kench JG,

Rasiah K, Joshua A. Australian Government Department

of Health and Aging. Australian Prostate Cancer Research

Centre - NSW. Integrating research into clinical practice in

prostate cancer. $1.5 million. (2017-2018).

CIs: Horvath LG, Stricker PD, Kench J, Joshua A, Clark S,

Emmett L, Hayes V. CINSW Translational Program Grant.

TPG172146. $3.75 million. (2018-2023).

CIs: Butler L, Lynn D, Hayes V, Horvath L, Mills I, Centen-

era M. PdCCRS Cancer Australia Project Grant. Novel

co-extinction strategies for treatment of prostate cancer.

$596,409. (2018-2020).

CIs: Sandhu S, Horvath LG. Prostate Cancer Founda-

tion Challenge Award. Harnessing synergies between

177Lu-PSMA therapy and olaparib to improve clinical out-

come of men with metastatic castration resistant pros-

tate cancer (CRPC). (2017-2019).

Butler LM, Swinnen JV, Tilley WD, Scott AM, Hoy AJ, Wittert

GA, Horvath LG. Movember Foundation / Prostate Can-

cer Foundation of Australia (Revolutionary Team Award).

Exploiting alterations in lipid metabolism to improve

diagnosis, treatment and molecular imaging of pros-

tate cancer. Phase I: 2015-2018, $3,250,000. Phase II:

2019-2020, $2,000,000.

Fazekas de St Groth B, Kao S, Brown M, de Souza P, Grimison

P, Ormerod J, McGure H. Predicting responses to cancer

immunotherapy. Cancer Council Australia Project Grant,

$599,705. (2018-2020).

Keebone A, Samra J, Le H, Nguyen N, Goldstein D, Apte M,

Barbour A, Oar A, Chander S, Espinoza D. AI Grimison, P.

mFOLFIRINOX And STEreotactic body Radiotherapy (SBRT)

for Pancreatic cancer with high-risk and Locally AdvaNced

disease (MASTERPLAN): a multicentre, randomised phase

II study of the Australian Gastrointestinal Trials Group

(AGITG). NHMRC MRFF Low Survival Cancers and Diseases

(LSCD) Grant, $1,470,201. (2018 - 2022).

Rasko J, Sandroussi C, Grimison P, Adelstein S. Cellular im-

muno-gene therapy for pancreatic cancer. Cancer Coun-

cil NSW Pathways to a cancer-free future Grant Scheme,

$2,000,000. (2018 - 2022).

Grimison P, Haber P, Stockler M, Lintzeris N, Simes J,

McGregor I, Oliver I, Allsop D, Gedye C, Kirby A. Pilot

and definitive randomised double-blind placebo-

controlled trials evaluating an oral cannabinoid-rich

THC/CBD cannabis extract for secondary prevention of

chemotherapy-induced nausea and vomiting. NSW Health.

$2,792,269. (2015 – 2021).

Goldstein D, Friedlander M, Kiernan M, Krishnan A, Boyle

F, Moalem-Taylor G, Haas M, Cohn R, Farrar M. AI Grimison

P. Chemotherapy-induced Peripheral Neuropathy: Assess-

ment strategies, Treatments and Risk Factors. Cancer In-

stitute NSW Program Grant for Excellence in Translational

Research. $3,040,000. (2015 – 2019).

Butow P, Andrews G, Kelly B, Girgis A, Aranda S, Viney R,

Clayton J, Hack T, Price M, Beale P. AI Grimison P. A sus-

tainable and supported clinical pathway for managing

anxiety and depression in cancer patients: Developing and

evaluating components and testing implementation strat-

egies. Cancer Institute NSW Program Grant for Excellence

in Translational Research. $3,643,992. (2015 - 2019).

Grimison P, Toner G, Stockler M, Friedlander M, Thomson D,

Gebski V, King M, Quinn D, Singhal N. Accelerating first-line

chemotherapy to improve cure rates for advanced germ

cell tumours: an Australian-led, international randomised

trial. Cancer Australia and Cancer Council Australia Project

Grant, $595,342. (2013 - 2018).


Kao S. Cancer Council NSW Competitive Grant 2018. Pre-

dicting response to checkpoint therapy in lung cancer pa-

tients as CIB. $758,033.50 over 5 years.

Kao S. Cancer Institute Research Infrastructure Grant

2015: "Expanding the Asbestos Diseases Research Insti-

tute (ADRI) biobank to create a state-wide repository for

research into thoracic cancers" as CIA. $300,000. (2015

- 2018).

Head and Neck

CI: Luk P. Sydney Catalyst 2018. Understanding the Body's

Response to Cancer Invasion and Progression: Towards

Assisting the Body's Defence System in Fighting Cancer.

$50,000.

CI: Gupta R. ANZHNCS 2018. Can Clinical Validation of

Biologic Predictors of Metastases in Head and Neck Cu-

taneous Squamous Cell Carcinoma be Achieved by Tran-

scriptomic Profiling. $10,000.

CI: Clark J. ANZHNCS Reconstructive Surgery Grant 2018.

The Bionic Lid Implant for Natural Eye Closure (BLINC).

$10,000.

Awarded to Beyond Five. NSW Department of Health

2018. Developing a sustainable structure for Beyond

Five. $15 000.

Awarded to Beyond Five. Brady Cancer Support Founda-

tion 2018. Development of Head and Neck Cancer Pod-

casts. $10,000.

CI: Vasan K. General Surgeons Australia 2018. Young pa-

tients with head & neck squamous cell carcinoma – Iden-

tification of mismatch repair gene mutations. $1,000.

CI: Satgunaseelan L. RCPA Foundation Postgraduate Re-

search Fellowship 2018. Identifying actionable mutations

in young patients with oral cavity squamous cell carcino-

ma. $25,000.

Awarded to Beyond Five. Dry July 2018. Dry July Founda-

tion grant to develop evidence based and easy to follow

animations that help patients maintain good nutrition

and stay well hydrated before, during and after treat-

ment. $34,000.

CI: Clark J. ANZHNS Reconstructive Surgery Grant. The Bi-

onic Lid Implant for Natural Eye Closure (BLINC). $10,000.

Venchiarutti R. COSA Travel Grant. $425.

Venchiarutti R. Cancer Research Network University of

Sydney. Cancer Research Network Postgraduate Student

Conference Travel Grant. $1,716.

Venchiarutti R. Primary Care Collaborative Cancer Clinical

Trials Group (PC4): Self-reported management of possi-

ble symptoms of head and neck cancer: a primary care

vignette survey. $4,000.

Satgunaseelan L. RCPA Foundation Research Postgradu-

ate Fellowship. $25,000.

CI: Clark J. Equity Trustees. Identifying the genetic drivers

of Metastasis in skin cancer. $30,000.

CI: Findlay M. Sydney Research Health Informatics Re-

searcher PhD Scholarship. Towards Value-Based Compre-

hensive Cancer Care: Development and Implementation

of a Next Generation Nutrition Care Analytical Dashboard

for Patients with Head and Neck Cancer. $120,000.

CI: Findlay M. Australia and New Zealand Head and Neck

Cancer Society Research Foundation. Enhanced Recovery

After Surgery: Feasibility of Pre-operative Carbohydrate

Loading in Patients Undergoing Major Head and Neck

Cancer Surgery with Free Flap Reconstruction. $5,000.

CI: Bhadri V. Australian Young Cancer Patient Clinical Trials

Initiative 2018 – Ewing sarcoma. $522,000.

CI: Bhadri V. Australian Young Cancer Patient Clinical Trials

Initiative 2018 – Medulloblastoma. $965,000.

AI: Bhadri V. Australian Young Cancer Patient Clinical Trials

Initiative 2018 – Genomic Screening. $950,000.

74


75

CI: Clark J. University of Sydney: Biomedical Research Col-

laboration Scheme. $15,000. (2017-2018).

CI: Nadia Rosin. Tour de Cure 2018. Australia and New

Zealand's first Head and Neck Cancer Patient Support

Group Portal. $31,000.

CI: Clark J. Sydney Local Health District. Building the IT

Infrastructure Needed to Support the SHNCI Research Pro-

gram and to Improve Outcomes in Head and Neck Can-

cers. $300,000.

CI: Clark J. Sydney Local Health District. Identification of

therapeutic targets, prognostic and predictive markers in

high grade head and neck cancers that currently lack sec-

ond line therapies. $300,000.

CI: Clark J. Sydney Local Health District. The Bionic Lid Im-

plant for Natural Lid Closure (BLINC) for facial paralysis.

$150,000.

CI: Bruce Ashford. Genomic Landscape of metastatic cu-

taneous squamous cell carcinoma ANZHNCS Research

Grant. $5,000. (2016-2017).

CI: Clark J. Australian and New Zealand Head and Neck

Cancer Society Foundation 2016: Markers of metastases

in cutaneous SCC using Nanostring. $5,000.

CI Findlay M. NHMRC-Cancer Institute NSW Translating

Research Into Practice Fellowship. Best evidence to best

practice: Implementing an innovative model of care for

nutritional management of patients with head and neck

cancer. $272,911. (2015-2017).

Prostate Cancer Foundation of Australia. Biologically Smart

Radiotherapy: killing more prostate cancer by stimulating

immune responses. $98,180.

University of Sydney ECR/MCR Seed Grant. Improving pa-

tient outcomes in radiation therapy: does imaging dose

affect the tumour response. $10,000.

University of Sydney Research Equipment Grant. To deter-

mine the impact of an additional imaging CBCT dose on

cell survival following radiation therapy. $9,906.

Radiation Oncology

CI: Suchowerska N. Prostate Cancer Foundation of Aus-

tralia. Biologically Smart Radiotherapy: killing more pros-

tate cancer by stimulating immune responses. $98,180.

CI: Suchowerska N. University of Sydney ECR/MCR Seed

Grant. Improving patient outcomes in radiation therapy:

does imaging dose affect the tumour response. $10,000.

CI: Suchowerska N. University of Sydney Research Equip-

ment Grant. To determine the impact of an additional

imaging CBCT dose on cell survival following radiation

therapy. $9,906.

CI: Suchowerska N. Sydney Breast Cancer Foundation.

Breast cancer research. $10,000. 2017.


ASCCP. A cohort of patients with HPV negative, High

grade cervical dysplasia. $10,000.


Lacey J. MSD. Living well with melanoma. $135,000.

(2017-2018).

Marthick M. Donor. Livingroom@home. $100,000.

Lacey J, Marthick M, Templeton S. Dry July. Lymphoedema

(LEAP). $30,000.

Lacey J, Marthick M, Dickson C. Donor. Mindfulness@

home. $10,000.

Lacey J, Marthick M, Dickson C. Tour de Cure 2018. Mind-

fulness@home. $70,000.

Lacey J, Grant S, Spiegel G. Donor. Reflexology and Acu-

puncture in day therapy unit. $20,000.

Lacey J. Donor. Supportive care study. $100,000.

Lacey J, Grimmison P. NSW Health. Medicinal Cannabis

NSW health observational and PK study. $3,600,000.

Lacey J. Bioceuticals. Medicinal Cannabis: Recurrent GBM.

$500,000.


Breast

AirXpander: Satisfaction of Carbon Dioxide Based Tissue

Expander for Breast Reconstruction. $5,000.

76


Featured Artist: Julia Westwood

All artworks in this report are acrylic on canvas

paintings by Julia Westwood. Julia, a National

Art School graduate, was Artist In Residence

at Chris O'Brien Lifehouse in 2019. The Artist

in Residence program is an initiative by Arterie

that brings practising artists to demonstrate

in the main foyer of Chris O'Brien Lifehouse.

www.juliawestwood.com.au.

Chris O'Brien Lifehouse

119 - 143 Missenden Road

Camperdown NSW 2050

PO Box M5 Missenden Road

Camperdown NSW 2050

www.mylifehouse.org.au

General Enquiries

T: (02) 8514 0000

[email protected]

Donations & Support

T: (02) 8514 0006

[email protected]

ABN 70 388 962 804

Registered Charity Number CFN 17573

Hospital Provider Number 0027350Y

© 2019 Chris O'Brien Lifehouse

Report produced by Professor Lisa Horvath,

Sarah Charlton Li and Juliette O'Brien.

Designed by Juliette O'Brien.

Printed by Vertifix Printing.

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