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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.
2
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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