PaCCSC Quarterly. Goodbye Tania New Funding

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1 Issue Issue 11 August 2011 New Funding A new Funding Agreement between the Department of Health and Ageing and Flinders University of SA was signed on 27 June 2011 for $8.3 million over three years. This will allow PaCCSC to support clinical sites to finalise the octreotide, megestrol acetate, risperidone, morphine/oxycodone and sertraline studies and disseminate the results in a timely way. So, a busy three years ahead. Goodbye Tania After four foundational years with PaCCSC, National Manager Tania Shelby-James has taken on a new role as Senior Research Fellow with the Discipline of General Practice at Flinders University. Her last week here was a flurry of custom baked PaCCSC cup cakes and lunch as people from the Southern Palliative Care Services and PaCCSC took the opportunity to farewell her in style. Tania has contributed a great deal to PaCCSC and, through both publications and her inimitable style, to palliative care. Tania remains a PaCCSC Investigator. She will be missed but we wish her all the best in her future endeavours. International Conferences EAPC PaCCSC had a presence at the 12th Congress of the European Association for Palliative Care in Lisbon, Portugal on May this year. David Currow chaired one session and spoke about the Ketamine Trial and on the topic Old Challenges of Palliative Care Research - Any New Solutions? in relation to national and Governmental Perspectives in Australia. His talks were well attended and reportedly aroused a great deal of interest and respect for PaCCSC. Tania Shelby-James gave two presentations about providing infrastructure for palliative care research and learning from experience. Her two giant posters on the megestrol study and a PaCCSC research methodology overview, were also on display. MASSC Prof Janet Hardy presented a paper on ketamine and a poster at the International Symposium of the Multinational Association for Supportive Care in Cancer in Athens June Inside Goodbye Tania New Funding International Conferences Site News 2 Study Updates Recruitment Summary 3 In the Spotlight Congratulations People Movement Coming Up End of an Era Agency Contacts PaCCSC is part of Flinders University Palliative and Supportive Services. The Coordinating Agency is adjacent to the Hospice at the Repatriation General Hospital,Daw Park.

2 Issue 11 August 2011 Site News Calvary Health Care Our team (Chris, Louise & Lesley) have been working hard these past months with screening & recruitment. Dr Chris Sanderson has been educating medical staff in readiness for the commencement of the new studies. We are looking forward to recruiting for the nausea studies (once TGA approved). Our team has renewed enthusiasm with the wonderful news of PaCCSC being funded until Recruitment for the risperidone study remains steady with another patient randomised last week. We are consistently screening for delirium & are positive the NuDESC Form will become part of the admission package in the coming weeks. We remain optimistic with octreotide & doctors prescribing octreotide off study can expect a phone call from pharmacy to check whether the patient should be considered for the study they can also expect a call from the research team Chris Sanderson will commence an OPD Clinic at Calvary on Wednesdays & we hope this will boost recruitment for the respiratory studies. Dr Tracey Smith, a respiratory physician at St George Hospital and a locum palliative care physician at Sutherland Hospital will assist in referring patients to this study. Our Research Department held a Planning Day at Dr Sanderson s patch of paradise on Dangar Island. It was a very productive & thought provoking day. Future plans; strategies & team building were accomplished in a beautiful setting. Lesley White, Site Coordinator Mater Brisbane The Mater in Brisbane welcomes Dr Phillip Good to their team and look forward to many referrals and assistance with ongoing PaCCSC studies. Investigator Prof Janet Hardy and Site Coordinator, Angela Tapuna, are now both members of the Mater HREC. This experience will bring valuable new insights into the research department. The Alfred Julia Brinsdon-Farr will be taking twelve months maternity leave from 20 July. We look forward to meeting her replacement and wish Julia all the best till she returns. NHMRC Nausea Studies update July 2011 Two stage trial of antiemetic therapy in patients with cancer and nausea not related to anticancer therapy. Aim study 1 - to determine whether guideline driven antiemetic therapy is superior to single agent therapy. Aim study 2 - to compare effectiveness of parenteral levomepromazine and parenteral ondansetron vs placebo for people with refractory nausea. The process of approval by multiple ethics committees across Australia has been very slow but finally approval for both studies has been obtained for all 9 participating sites. Further, all sites have completed regulatory requirements and are open for recruitment. The Mater Hospital in Brisbane recruited the first patient to Study 1 in October 2010 and also randomised the first Study 2 recruit in February this year. It is anticipated that additional sites that have expressed interest in participating will join the trial over the coming few months. The primary activity over the next year will be recruitment of patients and as this has fallen behind schedule due to the slow implementation of the trial, the key objective will be to achieve required recruitment targets at all sites. To this end, the investigators are working with the sites to develop further strategies as required to enhance recruitment. As at the beginning of July 2011, a total of 92 patients have been screened resulting in 20 patients commencing Study 1and 8 patients randomised to Study 2, of which a total of 23 have completed the study period. Janene Leslie Queensland University of Technology UT PaCCSC Improving quality of care for patients through access, awareness and quality use of palliative care medicines.

3 Issue 11 August 2011 At present there are eight phase III randomised controlled studies open for recruitment. Risperidone/haloperidol for delirium. This study is approximately one third through recruitment, with all sites now open and recruiting. Octreotide for bowel obstruction. This study will complete the expected recruitment within the next 2 to 3 months and will be the second PaCCSC phase 3 study to complete. Megestrol acetate/dexamethasone for loss of appetite. This study in now at halfway through recruitment and will undergo a safety analysis next month. Morphine/oxycodone for breathlessness. This study is continuing to recruit with new sites still opening. Sertraline for breathlessness. This study is also in the process of new sites opening for recruitment. PaCCSC Phase III Study Updates Guideline therapy/haloperidol for nausea. This NHMRC funded study is now open for recruitment at all sites, with recruitment numbers expected to increase over the next month. Levomepromazine/ondansetron for nausea. This is the second part of the NHMRC grant and is also open for recruitment at all sites, with recruitment numbers expected to increase over the next month. Aetiology based treatment of constipation. This NHMRC funded study has now completed all regulatory requirements and will commence recruitment shortly in NSW, Vic. Recruitment Summary Recruitment Summary Study #needed #completed Top Sites over past 3 months Risperidone Calvary, Barwon Octreotide Mater, SAPS Megestrol acetate Sacred Heart, Alfred Morphine Oxycodone SAPS, Barwon Sertraline Austin, SAPS Nausea Mater, Barwon Nausea Mater, Braeside Puffer Fish - 4 Mater, Royal Melbourne PaCCSC is funded under the National Palliative Care Program and is supported by the Australian Government Department of Health and Ageing

4 Issue 11 August 2011 Congratulations ImPaCCT Chair Prof Meera Agar is congratulated for winning not one but two of the seven Palliative Care NSW 2010 awards announced on 24 June: Significance in Palliative Care Research and (for PEACH) Innovation in Palliative Care Practice. In the SPOTlight, PaCCSC Member Debra Rowett Debra Rowett is the Director of the Drug and Therapeutics Information Service based at the Repatriation General Hospital at Daw Park, South Australia. She has been involved both nationally and internationally in research and service delivery focussing on the translation of evidence into practice. Debra delivers training programs in academic detailing which are used by the national NPS. Debra is a PaCCSC Chief Investigator and was Lead Investigator for Phase IV studies and was a member of the Palliative Care Medicines Working Group at the outset of PaCCSC. She now leads the development of a Medicines Management study and is an Investigator in the new Rapid study, a Phase IV prospective pharmacovigilance reporting project for key medications. With growing international recognition of the need to balance symptom control against the risk of adverse events, Debra s interest in trying to maximise outcomes for medicine while minimising harm led her to advocate for pharmacovigilance in palliative care. Listening to patients stories about the impact of medicines on their lives was a strong motivator for her involvement in the development of PaCCSC. While Debra s primary research focus is to discover how best to synthesize evidence into something relevant to doctors at the point of decision-making, with the evidence now emerging, she sees the next step as identifying barriers to getting it into policy and practice. Meet Zac Vandersman Zac Vandersman has moved into the world of PaCCSC from SAPS, assisting in anyway he can whether it s checking data or eating majority of the biscuits at the team meetings he s a great help with all the essentials. Hello and Welcome Courtney Bamford at Peter Mac Gillian McCarthy at Royal Melbourne Goodbye and Thanks Elaine Mills Eliade Yap Carolyn Hastie In addition to Tania, the Coordinating Agency has also said goodbye to Tamzin Bullock and Carman Wilson. Christine Wiltshire is temping as our Finance Officer. PaCCSC can be found adjacent to Daw House in the grounds of the Repatriation General Hospital 700 Goodwood Road, Daw Park SA 5041 Phone:

5 Coming Up Issue 11 August July 2011 Asia-Pacific Hospice Network Conference. Palliative Care in Mainstream Medicine. Penang, Malaysia. End of an Era What you see in the collage below is the destruction of the Research Cottage at SAPS. This cute little building has been home to the SAPS research team, and before that the PaCCSC coordinating agency team. The demolition spells the end of an era! August 2011 Optimising the Management of Pain Melbourne, Victoria 30 Aug - 2 Sep 2011 Diversity, 11th Australian Palliative Care Conference, Cairns QLD A car park will replace it shortly and a new transportable building will very likely block the view of the wonderful Daw Park gardens that we now enjoy Going Going Gone Homeless L-R Heather, Aine, Vera, Aileen Agency s A/National Manager belinda.fazekas@flinders.edu.au Research Project Officer lindy.warrell@health.sa.gov.au A/Finance Officer christine.wiltshire@flinders.edu.au Data Assistant zac.vandersman@flinders.edu.au PaCCSC can be found adjacent to Daw House in the grounds of the Repatriation General Hospital 700 Goodwood Road, Daw Park SA 5041 Phone: