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Vinod S.K.,Liverpool Cancer Therapy Center | Vinod S.K.,University of New South Wales | Vinod S.K.,University of Western Sydney | Lonergan D.M.,University of New South Wales | And 2 more authors.
Journal of Medical Imaging and Radiation Oncology

Introduction Multisource feedback (MSF) is an assessment of performance through evaluation of an individual's competence from multiple perspectives. It is mandated in many specialist training schemes in medicine. The aim of this study was to test the feasibility of implementing MSF for consultant radiation oncologists. Methods A validated tool consisting of a self-assessment questionnaire, medical colleague questionnaire, co-worker questionnaire and patient questionnaire was used for MSF. Statements were rated on a 5-point Likert scale with 1 being a low rating and 5 a high rating. Seven radiation oncologists volunteered to undergo MSF. They each nominated 10 medical colleagues, 10 co-workers and 10 patients to be surveyed. Clinician feedback was provided as an individual report with a mean score and range for each data item. Results Two hundred ten surveys were mailed out and seven self-assessments were completed. The response rate was 87% for medical colleagues, 89% for co-workers and 79% for patients. The mean feedback scores averaged for the radiation oncologists ranged from 4.4 to 4.9, significantly higher than self-assessments scores which ranged from 3.2 to 3.7. MSF identified areas for potential improvement including communication and collaboration with co-workers and accessibility to and adequacy of clinic space for patients. All radiation oncologists found the MSF a positive experience, and five planned to make changes in their practice in response to this. Conclusions The high response rate to the surveys has shown that it is feasible to implement MSF for radiation oncologists. This could potentially be used as a method for ongoing revalidation. © 2013 The Authors. Journal of Medical Imaging and Radiation Oncology © 2013 The Royal Australian and New Zealand College of Radiologists. Source

Millar E.K.A.,Garvan Institute of Medical Research | Millar E.K.A.,South Eastern Area Laboratory Service | Millar E.K.A.,University of Western Sydney | Millar E.K.A.,University of New South Wales | And 20 more authors.
British Journal of Cancer

Background: The aim of this study is to determine whether immunohistochemical (IHC) assessment of Ki67 and p53 improves prognostication of oestrogen receptor-positive (ER) breast cancer after breast-conserving therapy (BCT). In all, 498 patients with invasive breast cancer from a randomised trial of BCT with or without tumour bed radiation boost were assessed using IHC.Methods:The ER tumours were classified as luminal A (LA): ER and/or PR, Ki-67 low, p53, HER2 or luminal B (LB): ER and/or PRand/or Ki-67 high and/or p53 and/or HER2. Kaplan-Meier and Cox proportional hazards methodology were used to ascertain relationships to ispilateral breast tumour recurrence (IBTR), locoregional recurrence (LRR), distant metastasis-free survival (DMFS) and breast cancer-specific survival (BCSS).Results:In all, 73 patients previously LA were re-classified as LB: a greater than four-fold increase (4.6-19.3%) compared with ER, PR, HER2 alone. In multivariate analysis, the LB signature independently predicted LRR (hazard ratio (HR) 3.612, 95% CI 1.555-8.340, P=0.003), DMFS (HR 3.023, 95% CI 1.501-6.087, P=0.002) and BCSS (HR 3.617, 95% CI 1.629-8.031, P=0.002) but not IBTR.Conclusion:The prognostic evaluation of ER breast cancer is improved using a marker panel, which includes Ki-67 and p53. This may help better define a group of poor prognosis ER patients with a greater probability of failure with endocrine therapy. © 2011 Cancer Research UK All rights reserved. Source

Hau E.,Cancer Care Center | Hau E.,University of New South Wales | Browne L.,Cancer Care Center | Capp A.,Calvary Materials Newcastle | And 15 more authors.
Breast Cancer Research and Treatment

The aims of this study were to evaluate the impact of cosmetic and functional outcomes after breast-conserving surgery (BCS) and radiation on quality of life (QOL). In this exploratory analysis; baseline, 5 and 10 years data of patient's assessment of breast cosmesis, arm swelling/pain, limitation of movement, loss of feeling in fingers and breast sensitivity/tenderness were dichotomized and their impact on QOL (QLQ-C30) were assessed. Multivariable modelling was also performed to assess associations with QOL. The St. George and Wollongong randomized trial randomized 688 patients into the boost and no boost arms. 609, 580, and 428 patients had baseline, 5 and 10 years cosmetic data available, respectively. Similar numbers had the various functional assessments in the corresponding period. By univariate analysis, cosmesis and a number of functional outcomes were highly associated with QOL. Adjusted multivariate modelling showed that cosmesis remained associated with QOL at 5 and 10 years. Breast sensitivity, arm pain, breast separation, age and any distant cancer event were also associated with QOL on multivariate modelling at 10 years. This study highlights the importance of maintaining favorable cosmetic and functional outcomes following BCS. In addition, the clinically and statistically significant relationship between functional outcomes and QOL shows the importance for clinicians and allied health professionals in identifying, discussing, managing, and limiting these effects in women with breast cancer in order to maintain QOL. © 2013 Springer Science+Business Media New York. Source

Chantrill L.A.,Garvan Institute of Medical Research | Chantrill L.A.,Macarthur Cancer Therapy Center | Chantrill L.A.,University of Sydney | Nagrial A.M.,Garvan Institute of Medical Research | And 37 more authors.
Clinical Cancer Research

Purpose: Personalized medicine strategies using genomic profiling are particularly pertinent for pancreas cancer. The Individualized Molecular Pancreatic Cancer Therapy (IMPaCT) trial was initially designed to exploit results from genome sequencing of pancreatic cancer under the auspices of the International Cancer Genome Consortium (ICGC) in Australia. Sequencing revealed small subsets of patients with aberrations in their tumor genome that could be targeted with currently available therapies. Experimental Design: The pilot stage of the IMPaCT trial assessed the feasibility of acquiring suitable tumor specimens for molecular analysis and returning high-quality actionable genomic data within a clinically acceptable timeframe. We screened for three molecular targets: HER2 amplification; KRAS wild-Type; and mutations in DNA damage repair pathways (BRCA1, BRCA2, PALB2, ATM). Results: Tumor biopsy and archived tumor samples were collected from 93 patients and 76 were screened. To date 22 candidate cases have been identified: 14 KRAS wild-Type, 5 cases of HER2 amplification, 2 mutations in BRCA2, and 1 ATM mutation. Median time from consent to the return of validated results was 21.5 days. An inability to obtain a biopsy or insufficient tumor content in the available specimen were common reasons for patient exclusion from molecular analysis while deteriorating performance status prohibited a number of patients from proceeding in the study. Conclusions: Documenting the feasibility of acquiring and screening biospecimens for actionable molecular targets in real time will aid other groups embarking on similar trials. Key elements include the need to better prescreen patients, screen more patients, and offer more attractive clinical trial options. © 2015 AACR. Source

Tebbutt N.C.,Austin Health | Murphy F.,Austin Health | Zannino D.,University of Sydney | Wilson K.,University of Sydney | And 13 more authors.
Annals of Oncology

Background: Bevacizumab is an antiangiogenic mAb with efficacy against several cancers, but it is associated with risk of arterial thromboembolism (ATE). Further data are needed to determine the safety of bevacizumab. Patients and methods: We recorded grade 3, 4, or 5 ATE events and other data (including age, baseline cardiovascular risk factors, history of ATE, and aspirin use) from 471 patients with metastatic colorectal cancer in the MAX (Mitomycin, Avastin, Xeloda) trial of capecitabine monotherapy versus capecitabine with bevacizumab with or without mitomycin C. Results: Bevacizumab-treated patients had 12 grade 3, 4, or 5 ATEs (3.8% incidence). ATEs occurred in 2.1% of patients >65 years, 5% of those with a history of ATE, and 5% of those with cardiac risk factors. Age, history of ATE, or vascular risk factors did not increase risk. Aspirin users had a higher incidence than nonusers (8.9% versus 2.7%) but had higher rates of vascular risk factors. Conclusions: Bevacizumab was associated with a modestly higher risk of ATE, but safety was not significantly worse in older patients or patients with a history of ATE or vascular risk factors. The effect of aspirin in preventing ATE in patients receiving bevacizumab could not be determined from this study. © The Author 2011. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. Source

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