Ballarat Cancer Care & Haematology Latest News

Consultant Haematologist Dr Adam Facey joins Ballarat Cancer Care

Mon, 02 Feb 2026 02:09:42 GMT

Consultant Haematologist Dr Adam Facey joins Ballarat Cancer Care

Adam completed his medical and medical science Honours degrees at Monash University in 2014. He completed basic physician training at Alfred Health with advanced clinical and laboratory training at Alfred Health, Monash Health, Melbourne Pathology and University Hospital Geelong. He maintains good working relationships with haematologists at these metropolitan health services, expanding access to clinical trials and other specialist treatments not available in the region.

Having grown up in Ballarat, Adam is passionate about equitable access to good quality specialist healthcare. He also works at Grampians Health (Ballarat and Horsham), Dorevitch Pathology, and teaches medical students at Deakin University’s Ballarat Clinical School.

He loves the diversity that haematology specialisation brings, competent in the diagnosis and management of both malignant (leukaemia, lymphoma and myeloma) and non-malignant (bleeding and thrombosis) diseases. Adam prides himself on clear patient communication, education and shared patient decision-making, particularly in complex cases.

Haematologist Dr Marsali Maclean joins Ballarat Cancer Care

Sun, 16 Feb 2025 23:38:59 GMT

Haematologist Dr Marsali Maclean joins Ballarat Cancer Care

Dr Marsali Maclean is a clinical haematologist who treats blood cancers and non-malignant blood disorders. She has a broad range of experience within haematology and has recent experience of emerging cutting-edge therapies in the Cancer Clinical Trial Centre at the Olivia Newton John Centre, Austin hospital. She works at Ballarat Base hospital and St John of God Hospital as a clinical haematologist.

Dr Maclean graduated from the University of Glasgow, United Kingdom in 2010. She undertook Basic Physician training at Peninsula Health, Victoria; and completed haematology advanced training at Alfred Health, Monash Health, Epworth Health, and Melbourne Pathology. She is a fellow of the Royal College of Physicians Australia and Royal College of Pathologists Australia. She is dedicated to optimal patient-centred care using the latest evidence-based approach.

New palliative care physician joining the Ballarat Cancer Care team

Tue, 03 Dec 2024 02:55:21 GMT

We are pleased to announce palliative care physician Dr Russell Pearce will be joining our team in February 2025.

Russell is a Palliative Care Physician who grew up in Alexandra, a rural town in Victoria, before moving to Ballarat in 2013 to undertake his medical training. He completed General Practice training through the Royal Australian College of General Practitioners in Ballarat and subsequently specialised in Palliative Medicine through the Royal Australasian College of Physicians. His specialist training included experiences at Ballarat, Bendigo, Geelong, and the Monash and Austin Hospitals.

Russell provides care for individuals with life-limiting illnesses, including both cancer and non-cancer conditions. He focuses on managing complex physical and emotional symptoms, assisting with advance care planning, and ensuring coordinated, multidisciplinary care tailored to each patient’s needs.

With extensive experience in both urban and regional healthcare settings, Russell is dedicated to ensuring accessible, high-quality palliative care for patients in Ballarat and surrounding areas. He has a particular interest in facilitating care for people affected by disabilities, working to address their unique needs and challenges within the healthcare system.

Outside of work, Russell enjoys running, reading science fiction and fantasy novels, and spending time with his family.

New haematologist joining the Ballarat Cancer Care team

Tue, 27 Aug 2024 23:23:38 GMT

We are excited to announce Dr Tishya Indran will be joining our team as of 18th September 2024.

Dr Tishya Indran is a haematologist with an interest in platelet and blood disorders. She graduated from The University of Adelaide and completed dual training in clinical and laboratory haematology in 2018. She trained at The Royal Adelaide Hospital, The Queen Elizabeth Hospital, SA, Liverpool Hospital, NSW, Monash VIC, Peter MacCallum Cancer Centre and The Alfred Hospital, VIC. She has experience in treating benign and malignant haematological disorders.

Dr Tishya Indran has also undertaken a laboratory haemostasis fellowship in Loyola University Medical Centre, Chicago. At present, she is completing her PhD through the Walter and Eliza Hall Institute with a focus in haemostasis and thrombosis. She also has a clinical and laboratory attachment with the Royal Melbourne Hospital haematology laboratory while undertaking her PhD.

During her free time, she enjoys playing tennis and spending time with her family.

4th Dose COVID-19 Vaccine for Immunocompromised Patients

Tue, 01 Mar 2022 00:40:31 GMT

The Australian Technical Advisory Group on Immunisation (ATAGI) has approved a fourth dose of a COVID-19 vaccine for people with weakened immune systems.

People aged 18 years or older with weakened immune system who received a 3-dose primary course of the COVID-19 vaccine are now recommended to receive the fourth dose ≥ 3 months after their third dose.

This is expected to improve protection against symptomatic infection, serious illness, or death from COVID-19 infection.

Many immunocompromising conditions are associated with a higher risk of severe illness and complications from COVID-19. These include solid organ transplantation, blood and solid organ cancers, or their treatments including immune therapy, chemotherapy, radiotherapy, blood/marrow stem cell transplant and CAR-T cell therapy

Protection from COVID-19 infection with or without a booster dose in severely immunocompromised individuals may still be lower than the general population. Risk mitigation strategies such as mask-wearing and social distancing should continue to be used even after receipt of a 3rd dose or 4th dose.

Antibody testing is not recommended to assess for immunity to SARS-CoV-2 following COVID-19 vaccination as no serological assays provide a definitive correlate of immunity to the COVID-19 virus.

Article by Dr Swe Htet

COVID-19 Vaccine Booster Shots In Our Patients With Cancer

Mon, 08 Nov 2021 00:18:28 GMT

The Government and the Medical advisory group (ATAGI) have release new recommendations last week for individuals who are severely immunocompromised in regards to the COVID-19 vaccine.

What are the recommendations?

These recommendations will affect some (but not all) of our patients. As always, we are happy to discuss any of the recommendations further with all of our patients.

Recommendations are that all individuals > 12y.o with certain malignant conditions (see below) receive a 3 ^rd BOOSTER shot of the COVID- 19 vaccine. The third dose is suggested to be one of the two available mRNA vaccines (Pfizer of Moderna) rather than the AstraZeneca vaccine, if they are available.

Which patients will require a third dose?

The patients in whom a third dose of the COVID-19 vaccination is suggested are:

All patients with an active haematological (blood) cancer (i.e. leukaemia, lymphoma, myeloma) regardless of their treatment.
All patients with a solid tumour (ie. breast, lung, colon, prostate) cancer
- who are currently on ACTIVE treatment with CHEMOTHERAPY or RADIATION THERAPY or HORMONE therapy
- those patients on IMMUNOTHERAPY (ie. pembrolizumab or nivolumab) do not require a third dose of the COVID19 vaccine.
Ongoing treatment with Immunosuppression with high-dose corticosteroids (PREDNISOLONE or DEXAMETHASONE)
All patients who have had a haematopoietic stem cell transplant or CAR-T therapy

Are there patients with cancer who do NOT need the booster vaccine?

Our patients who have cancer and are receiving ONLY immunotherapy are not recommended to have a 3 ^rd booster COVID-19 vaccination. This is a small group of patients only and the information around this recommendation may be updated in the future.

When do I need to get the vaccine?

We recommend that this booster is given between 2 to 6 months following the 2 ^nd dose of vaccine. For many of our patients who received their original doses more than 6 months ago that time is now and we encourage you to book in as soon as possible.

Is it safe to have a booster COVID 19 vaccine?

The safety profile has been reported as similar to that of the first and second doses. There is ongoing information being gathered regarding this.

Why is a third dose necessary?

Patients with a compromised immune system are at increased risk of severe complications if they become unwell with COVID-19. Studies have shown both a prolonged period of illness and higher risk of death from COVID-19.

The ability of the immune system in an immunocompromised individual to respond to any vaccine is decreased, meaning that the vaccine after 2 doses may not provide as much protection against COVID-19 as we would like.

This means that even when fully vaccinated with 2 doses of the vaccine, in those individual with a compromised immune system, there is a higher risk of contracting and becoming unwell with COVID-19. Therefore, to maximise protection against COVID-19 a third injection has been recommended.

Why is the recommendation for the third BOOSTER shot to be the mRNA vaccines (Pfizer and Moderna)?

The recommendation for a mRNA vaccine as a third booster shot is the research available, most of these studies have been undertaken using one of the mRNA vaccines, therefore this is the recommendation.

If there is a contra-indication for having a mRNA vaccine then an alternative brand (Astrazeneca) can be used.

Article by Dr Kortnye Smith

COVID-19 Vaccination FAQs July 2021

Tue, 20 Jul 2021 03:26:49 GMT

Disclaimer: The information shared in this article is accurate at the time of writing on the 17th July 2021, please check for further updates in the future as the information may evolve rapidly

In the last few months, I have been inundated with many questions regarding COVID-19 vaccination and blood clots from patients and other health practitioners. In this article, I have compiled these frequently asked questions.

Summary Recommendations:

1. Australian Technical Advisory Group on Immunisation (ATAGI) advises that Pfizer is preferred to AZ vaccine from the age of 16 to under 60 years.

2. ATAGI considers the benefit of vaccination in preventing COVID-19 with AZ vaccine outweighs the risk of VITT in people aged 60 and above.

3. AZ vaccine can be used in adults aged under 60 years for whom Pfizer vaccine is not available, the benefits are likely to outweigh the risks for that individual and the person has made an informed decision.

4. People of any age without contraindications who have had their first dose of AZ vaccine without any serious adverse events should receive the second dose.

Dr Pohan Lukito

Consultant Haematologist

MBBS, B Med Sci, FRACP, FRCPA

New PBS listings!

Fri, 02 Jul 2021 03:43:39 GMT

Despite a global pandemic, new data relating to oncology treatments continues to be published, and it seems that this is increasingly translating into improved drug access here in Australia.

As oncologists, we are always considering the best treatment option for a patient. Whilst most ‘standard of care’ treatments are available and reimbursed on the PBS system, this is not always the case.

We’re excited that there has been a recent run of agents newly listed on the PBS, or expanded listings that enable us to access a drug or drug combination in more clinical situations. Here’s a quick look at the recent listings:

Ipilimumab + Nivolumab as 1st line treatment of metastatic mesothelioma

Previously combination chemotherapy was our standard first line therapy for unresectable metastatic mesothelioma, but there is now evidence that combination immunotherapy is superior in most instances, and overall pretty well tolerated. This has been approved by the PBAC (the pharmaceutical advisory committee), and we await an upcoming date for reimbursement.

Fulvestrant in combination with ribociclib in metastatic breast cancer, beyond first line therapy

Fulvestrant has been a treatment option for hormone positive metastatic breast cancer for many years, however has not been reimbursed until the recent listing of a generic form of the drug. Ribociclib has been available for several years for the first line treatment of metastatic hormone positive breast cancer, but is now accessible for those who have already had multiple lines of treatment.

Ipilimumab + nivolumab (with chemotherapy) as 1st line treatment in metastatic squamous cell carcinoma of the lung

This is now one of many approved regimens in the first line treatment of metastatic lung cancer now.

Bevacizumab biosimilar (Mvasi) – listed unrestricted

Bevacizumab has been used for many years in metastatic colorectal cancer, and ovarian cancer, and more recently in Glioblastoma Multiforme (stage IV glioma). PBS reimbursement has, however, previously been limited to specific scenarios. The unrestricted listing will allow oncologist to prescribe the drug according to the data, rather than being restricted by reimbursement.

- Dr Heather Francis

Astra Zeneca (AZ) vaccine safety information

Fri, 26 Mar 2021 00:18:42 GMT

In light of recent reports of clotting events following Astra Zeneca (AZ) vaccine in Europe - we have been frequently asked questions regarding the safety of AZ vaccine in patients with previous clot events and/or blood problems.

We would like to draw your attention to the following publication from Australian Technical Advisory Group on Immunisation (ATAGI) on the 25th March 2021.

The salient points of this publication:

There is no increase in the rates of general thromboembolic disorders after vaccination over expected rates, noting these conditions occur commonly in the absence of vaccination.

It is not known whether the clot event is linked to vaccination. Cases of specific clot called “Cerebral Venous Sinus Thrombosis or CVST” reported overseas have mostly occurred 4 to 14 days following the AstraZeneca vaccine and have been rare (varying reports of 1 to 8 per million doses of vaccine given). Further studies in these patients are ongoing to understand if there is a potential link with vaccination.

Overall, ATAGI emphasises that the benefits of the COVID-19 vaccine far outweigh this potential risk.

The recommendation considers that there is no evidence of a risk of clot after COVID-19 vaccination in people with a history of clotting conditions. This includes those with clotting events in legs or lungs; people with risk factors for thrombosis (such as use of oral contraceptives or smoking); people with thrombocytopenia (low platelets that can occur with clotting conditions); people with known clotting disorders; people on blood-thinners (e.g. warfarin) and people with a history of cardiovascular disease (such as heart attack or stroke).

The publication also recommends that COVID vaccines should be deferred for patients with 2 very rare, specific blood clot conditions called “Cerebral venous sinus thrombosis or CVST” and “Heparin induced thrombocytopenia or HIT”. This is until further information from ongoing investigations in Europe is available and is only a precautionary measure.

We need to emphasize that these are very rare conditions; most patients with clotting disorders do not have these conditions. You can speak to your GPs or our haematologists if you have any concerns, prior to receiving the COVID vaccine.

For full publication, visit this l ink: www.health.gov.au/news

Disclaimer: This information is up-to-date at the time of sending, on 26 ^th March 2021. Please check for further updates regarding this topic to ensure that the information is still current.

Dr Pohan Lukito

Consultant Haematologist

MBBS, B Med Sci, FRACP, FRCPA

COVID-19 Vaccines and Cancer

Thu, 25 Feb 2021 03:50:30 GMT

Two vaccines against the coronavirus have now been approved for use in Australia, role-out of the vaccine begins this week in high-risk populations.

How does it work?

Vaccines (also called immunisations) are used to help a person’s immune system recognise and then protect the body from certain infections.

The new COVID-19 vaccination does not contain a live virus, instead it contains messenger RNA (mRNA) which is genetic material. After a person receives their first injection, the mRNA tells the cells in the body to make copies of part of the virus (the “spike” protein). This does NOT cause disease or illness but it does help the immune system learn to protect the body to fight the virus if it is exposed in the future.

If I have cancer, or have had cancer, am I at higher risk for illness with COVID-19?

There are a number of risk factors for severe illness with COVID-19, including a diagnosis of cancer. Additional factors include older age (>65), obesity, chronic kidney issues, emphysema, heart conditions, diabetes and smoking.

If I have, or have had cancer, should I get the coronavirus vaccine?

People, including those with underlying medical conditions and cancer, may get vaccinated if they have no other contra-indications (ie. history of severe allergic reaction to vaccines). Many medical groups are now recommending that most people with cancer or a history of cancer have the COVID-19 vaccine when it becomes available to them.

Clinical trials of the vaccine did not include people getting treatment that suppresses the immune system (like chemotherapy, radiation or immunotherapy). The trials did however include people with similar medical conditions, and we also know that other vaccines (for example the flu vaccine) are safe for people with cancer.

The main concern of doctors, is not whether it is safe for people with cancer, but if it will be as effective for those with a lowered immune system.

When will the vaccine become available for people with cancer in Australia?

People with cancer will receive their vaccinations as part of the Phase 1b of the COVID vaccine role out (as an adult with an underlying medical condition).

What else can I do?

As well as having your vaccination it is important to ensure that you follow the current government recommendations in regards to masks, hand washing and social distancing.

Special advice for patients with breast cancer.

As one of the side effects from vaccines can be swollen lymph nodes it is best to have the vaccine on the opposite side to your breast cancer.

Special advice for patients with blood cancer.

Recommendation from different advisory groups has consistently stated that there are no reasons to believe that the vaccines would be unsafe for patients with blood cancer. However, it is worth noting that there is a lack of research data, especially when it comes to the question of effectiveness of the vaccines. This is particularly true for patients with lymphoma and treatments that affect the blood cells which produce the antibodies for the vaccines to work.

Whilst patients with blood cancer are encouraged to have the COVID-19 vaccines unless there are specific contraindications, we recommend discussing this issue further with your GP/haematologists.

If you have any additional concerns we would be happy to talk to you further.

For more information:

Cancer.org.au/support-and-services/cancer-and-covid-19

Cancer.gov/about-cancer/coronavirus

Canceraustralia.gov.au/affected-cancer/information-about-cancer-and-covid-19

Health.gov.au/initiatives-and-programs/covid-19-vaccines

Dr Kortnye Smith

Medical Oncologist

MBBS, FRACP

Acute Myeloid Leukaemia in the elderly

Mon, 18 Jan 2021 22:46:05 GMT

Dr Swe Myo Htet

Consultant Haematologist

MBBS, FRACP, FRCPA, MRCP

Blood clot disorder and long distance car-travel

Wed, 02 Dec 2020 22:50:50 GMT

Blood specialist, Dr. Pohan Lukito, answers frequently asked question regarding blood clot disorder and long distance car-travel.

Disclaimer: Advice given in this article is generic and may not apply to your specific situation – please consult your GP or blood specialist if you require further specific advice

Question:

I have history of blood clot in my leg many years ago, and I am about to drive up to see my family in Sydney. Do I have any risks of developing blood clots during/after travel? What can I do to minimize these risks?

Answer:

The risk of developing blood clot during long haul travel (>6 hours, can be by plane/car/train) is low. However, this risk could be increased if one has additional risk factors for blood clot; for example older age, obesity, recent surgery or immobilization, oral contraceptive pill, active cancer, smoking, strong family history and previous history of blood clot(s).

Blood clot develops in the legs (deep vein thrombosis) due to immobility for prolonged period during travel causing pooling of blood in the leg veins. This is often in combination with dehydration and being in high altitude (in the case of flying), however, the risk may also be applicable for long-haul car travel. In theory, short duration travels have very low risk of blood clots, and require no specific precautions.

To minimize the risks, the following recommendation is useful for most travellers:

Picturpicture from all-free-download.com

Drink plenty of (non alcoholic) fluid
Regularly moving ankles/massage calves
Break up the car trip by doing regular stops every few hours to stretch your legs
Be vigilant about the symptoms of clot in the legs or lungs – swelling/discomfort in calves, unusual shortness of breath or chest pain
Compression stockings can be used to reduce swelling in the legs

For those with previous history of blood clot and additional risk factors above, but not currently on any blood thinner – it may be appropriate to consider covering themselves with low dose blood thinner such as Clexane, Xarelto and Eliquis (note: Xarelto and Eliquis use in this context is off-label). One approach is to take the low dose blood thinner starting on the day of travel for 72 hours, and then do the same thing again on travel back home, recognizing the lack of evidence in this area and low bleeding risk in taking blood thinners.

It is important to consider symptoms of blood clot even when one has returned home, as blood clot can still develop for up to 2-4 weeks following long haul travel.

Please consult your doctor/specialist if you have any of these symptoms, or more questions about this topic.

Exercise and Cancer

Mon, 26 Oct 2020 05:28:23 GMT

Patients with a malignancy, and in particular those receiving treatment for a malignancy, often experience fatigue. And while adequate rest is important, there has been increasing evidence over the past few years that a regular exercise programme can have a considerable benefit on this fatigue, as well and many other treatment related side effects.

The Clinical Oncology Society of Australia (COSA) released a position statement in 2018, which was been updated in April 2020, clarifying the role of exercise in cancer care. It suggests that exercise be “embedded as part of standard practice in cancer care” and that it be “viewed as an adjunct therapy that helps counteract the adverse effects of cancer and its treatment”. The statement goes further to recommend:

At least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic exercise each week; and
Two to three resistance exercise (ie. lifting weights) sessions each week involving moderate to vigorous-intensity exercises targeting the major muscle groups. ¹

Moderate-intensity exercise refers to exercise that requires a moderate amount of effort, and noticeably accelerates the heart rate, such as walking, cycling, or swimming at a ‘somewhat hard’ pace. Vigorous-intensity exercise is perceived as ‘hard to very hard’, such as running, or cycling / swimming at a hard pace. During vigorous exercise, you would expect to be a little breathless, and unable to talk in full sentences.

For many with a cancer diagnosis, these targets may seem optimistic, or even unrealistic, and certainly exercise plans need to be tailored to an individual’s abilities and health status. For this reason, accredited exercise physiologists or physiotherapist are well-placed to guide and prescribe an appropriate programme.

The proven benefits of an exercise regimen in those receiving treatments for a malignancy are multiple. Evidence suggests regular exercise improves physical functioning, reduces cancer or treatment related fatigue, alleviates psychological distress, and improves quality of life. ² This is, of course, in addition to other well establish benefits of improving cardiovascular health, and preventing conditions such as cardiovascular disease and osteoporosis. There is also evolving epidemiological research suggesting that exercise may have an impact on reducing cancer recurrence. Further research is being undertaken to evaluate the impact of exercise on cancer-related survival.

The year 2020 has proven challenging in many ways, including barriers to maintaining an exercise regimen through gym and pool closures, and lockdown orders. But with the gradual relaxation of restrictions, and the weather warming, the opportunities are increasing.

Consider talking with your doctor / oncologist to arrange referral to an appropriate exercise specialist.

Dr Heather Francis

Ballarat Cancer Care & Haematology

¹ https://www.cosa.org.au/media/332637/cosa-exercise-position-statement-april-2020-1.pdf

² Cormie, P., et al., The impact of exercise on cancer mortality, recurrence, and treatment-related adverse effects. Epidemiol Rev, 2017. 39(1): p.71-92.

World Thrombosis Day 13 October 2020

Tue, 13 Oct 2020 01:59:32 GMT

Today (13th Oct) is World Thrombosis Day. We are raising awareness of blood clotting disorders - please find this informative article written by Dr Swe Htet.

Patients - you can refer to educational material written by Thrombosis & Haemostasis society of Australia and New Zealand (THANZ) - Preventing another clot (download PDF here)

More information regarding thrombosis from THANZ https://www.thanz.org.au/educationandtraining/education-training

Clinicians/GPs - you can refer to the Thrombosis Quick Guide developed by our haematologists to help you manage patients with thrombosis (download PDF here)

----------------------------

1 in 4 people are dying from conditions caused by thrombosis.

Blood clotting is a biological plumber fixing a leaking blood vessel. Blood clot will save your life from bleeding if you have a cut in your finger. However, if a blood clot forms unnecessarily in blood vessels called thrombosis, it can lead to significant medical issues.

Thrombosis can develop either in the arteries or veins. If there is a clot in an artery supplying the brain, that part of the brain will die leading to stroke. The same principle applies for heart attack when there is a blood clot in the coronary arteries supplying blood to the heart. Whilst many people are aware of the signs and symptoms of a heart attack or stroke, the symptoms of blood clot in the veins can be more difficult to recognized, leading to delayed presentation and treatment.

Blood clot forming in the deep veins of the legs is called deep vein thrombosis (DVT). Whilst DVT in the lower limbs is not usually life-threatening, if a large clot breaks off and travels to the lung(s), it can cause blockage of blood flow into the lung(s) causing pulmonary embolism (PE) that can be extremely dangerous to patients. Symptoms of DVT in the legs can be pain, swelling or redness in the calf. Patients can present with palpitation, chest pain, and shortness of breath if there is PE.

There are three main risk factors for thrombosis in the veins - immobility, sticky blood, and changes in the lining of the veins. These risks could be acquired, such as immobility during long distance travel (flights) and patients lying in bed following surgery, or specific conditions e.g. cancer that could cause blood to be “more sticky”. However, some of the risks could also be familial (passed down from families). Please speak to your doctor regarding these risks if you are concerned. These are quite different to the risk factors of arterial thrombosis; which are mainly smoking, high cholesterol, diabetes, and hypertension.

Venous thrombosis can be treated with blood thinning agents. Different blood thinning agents used for venous thrombosis include Warfarin, Clexane, and more recently - Rivaroxaban and Apixaban. Main complication of blood thinning agent is bleeding. The choice and duration of blood thinning agent varies among different individuals. Please discuss this with your doctor. Blood Specialists at Ballarat Cancer Care and Haematology will be available to have further conversation regarding management of blood clots.

~ Article written by Dr Swe Htet

Cancer deaths reduce Australia wide

Wed, 16 Sep 2020 05:03:26 GMT

This year the annual release of cancer statistics generated quite a buzz in the cancer community.

We have seen an ongoing and significant decline in the overall number of cancer deaths through Australia. Improvements in the number of deaths from lung cancer, which account for more cancer deaths than breast, prostate and colorectal cancer combined, was the main driver for this decline.

There are many possible contributors to this, perhaps the most important being the impact of improved tobacco control and a decline in the number of individuals taking up smoking. However, in addition to a decrease in the number of people being diagnosed with lung cancer there has also been a significant improvement in our treatment of lung cancer and therefore the number of deaths from this disease. So much so that the current treatment for lung cancer was not used even 2 years ago and continues to rapidly evolve on a month-to-month basis.

The main change to lung cancer treatment is the addition of new drugs to our treatment regimens of non-small cell lung cancer. There are now a range of different anti-cancer drugs which are used to treat metastatic (advanced) lung cancer. Currently, this type of lung cancer is not curable. The aim of treatment for advanced lung cancer is control of the disease and this control has been improved with the introduction of immunotherapy drugs including pembrolizumab (Keytruda), nivolumab (Opdivo) and atezolizumab (Tecentriq) either alone or with chemotherapy.

Clinical trials have shown that one or a combination of drugs improved the survival of patients with lung cancer compared to chemotherapy alone. Deciding between and tailoring treatment options needs to take into account an individual’s age, fitness and their own priorities as well as specific attributes of the cancer including size, stage and type of cancer cell involved. The oncologists at Ballarat Cancer Care and Haematology have extensive experience in the treatment of lung cancer, including involvement in clinical trials and multi-disciplinary meetings both in Ballarat and Melbourne.

COVID-19 Update - August 2020

Tue, 04 Aug 2020 03:46:26 GMT

COVID-19 Update - August 2020

An update today from Dr Kortnye Smith about our current approach to COVID-19 restrictions.

New combination treatment approved for Myeloma patients in Australia

Thu, 30 Jul 2020 02:48:05 GMT

Myeloma is a blood cancer that affects a particular type of white cells called plasma cells. There are approximately 1,800 new cases of myeloma diagnosed in Australia each year.

Myeloma patients could present with different symptoms; these include bone pain from bony lesions/fractures, breathlessness and fatigue due to low red cell count (anaemia), kidney damage and recurrent infections. If you have concerns regarding any of these symptoms – please discuss with your GP about potentially getting further investigations for myeloma.

Currently, myeloma is not curable. The aim of treatment for myeloma patients is to produce durable control of the disease. In general, myeloma treatment is divided into 3 phases – induction, consolidation and maintenance – depending on patients’ age and fitness level.

Following initial treatment (induction), patients age < 70 years old, fit and with no significant health issues will be considered for consolidation treatment of high dose chemotherapy and stem cell transplant in one of the tertiary hospitals in Melbourne.

For many years, myeloma patients in Australia have received either Velcade (Bortezomib) injection under the skin (subcutaneous), or Revlimid (Lenalidomide) oral tablet, to start their treatment when first diagnosed with myeloma. Velcade works by causing accumulation of ‘waste products’ within the myeloma cells causing them to self-destruct. Revlimid, on the other hand, is effective in eliminating myeloma cells through multiple mechanisms including modulating the body’s immune system.

Starting from 1 ^st June 2020, Pharmaceutical Benefits Scheme (PBS) has approved the treatment of myeloma patients in Australia with “triplet therapy” – using combination of Revlimid/Velcade/Dexamethasone (RVd) treatment as first line therapy, regardless of whether patients will be eligible for consolidation treatment with high dose chemotherapy and stem cell transplantation later on.

Figure 1 – Treatment journey for myeloma patients in Australia with new RVd “triplet therapy” approved in June 2020

Clinical trials have shown that the triplet combination improves survival in myeloma patients, compared to if the drugs are used individually. Maximizing treatment for myeloma patients upfront provides the best opportunity to optimize long-term outcome. Our haematologists at Ballarat Cancer Care and Haematology would be available for further discussion about this new treatment.

Dr Pohan Lukito

Sentinel signs of cancer

Wed, 17 Jun 2020 04:18:23 GMT

The current COVID-19 climate is posing challenges for all of us.

For many of us, our priorities have shifted a little, our fears have changed a little, our days look different than they used to. For some, there may be a sense of wanting to ignore physical symptoms that arise – perhaps a fear of burdening the health system with something trivial, or a concern in breaking out of social isolation and increasing the risk of contracting coronavirus.

It is important, as such, to seek medical attention for any new unexplained symptoms. In particular, there are a few physical symptoms that require prompt investigation, given a small possibility of an underlying diagnosis of cancer, or another serious medical condition.

Although any symptom can have a variety of underlying causes, and any cancers can present in a variety of ways, there are certain symptoms that shouldn’t be ignored if present. Such symptoms do not equate to a diagnosis of cancer – rather they require prompt investigation to exclude a diagnosis of cancer.

Such symptoms include:

Jaundice - yellow eyes / skin
Unexplained loss of weight, significant loss of appetite, and severe fatigue
Coughing up blood, hoarseness, or nagging cough
Unexplained lump in neck / groin / armpit
Unexplained night sweats
Breast lump or thickening
Trouble swallowing or pain after swallowing
Abdominal pain
Bleeding in the urine
Blood in stools or significant changes in bowel movement e.g. diarrhoea
Lumps in a testicle
Unexplained vaginal bleeding

So, although social isolation has been encouraged to reduce the spread of coronavirus, this does not mean that new physical symptoms should be ignored. Speaking to one’s general practitioner (GP) will be an important first step. Everyone should encourage their family members’ with these symptoms to do the same. For those patients with known history of cancer, these symptoms may represent relapse or progression of the cancer; contacting one’s GP or Oncologist/haematologist will be appropriate for an earlier review.

And even if you do not have symptoms of concern, it is timely to catch up with your GP for a review of your general physical and mental health. Breast screen is now back up and running, and bowel screen and skin checks should continue to be carried out, in conjunction with your GP.

With early presentation, and prompt investigation, whatever the underlying medical condition, outcomes are likely to be improved.

Haemochromatosis

Sun, 14 Jun 2020 23:27:15 GMT

Haematologists do see patients with elevated iron stores (ferritin) in the clinic.

In a large proportion of patients, this issue is contributed by increase liver inflammation due to fat in the liver (fatty liver) and excess of alcohol intake. However, high iron stores can also be caused by a familial condition called haemochromatosis.

Haemochromatosis is the most common inherited disorder resulted from too much iron being absorbed and stored in the body. It affects 1 in 200 Australians of European origin.

Haemochromatosis can be entirely asymptomatic initially but if the iron overload is not addressed, it can lead to heart failure, liver failure, diabetes mellitus, joint pain, and hormonal disturbances. Symptoms tend to occur after the age of 40 but may be earlier or later. Early symptoms may include fatigue, abdominal pain and joint aches. Women develop iron overload usually after menopause due to a lack of blood loss from periods and childbirth, and increased demand of iron during pregnancy.

Haemochromatosis can easily be diagnosed by a simple blood test. Please ask your GP to request iron studies and haemochromatosis gene studies if there is any family member being diagnosed with the disease.

Not all patients with haemochromatosis gene will develop iron overload and the symptoms associated with it. However, if patients are at risk of iron overload, haemochromatosis can be managed by taking the blood out regularly (“blood letting” or venesection) given that 75% of body iron is stored in red blood cells. The blood from haemochromatosis patients can safely be used for other patients who need blood transfusion. If the venesection happens at pathology providers, hospitals and clinics, the blood will be discarded. If you have no significant medical problems, you can become a lifetime blood donor at Red Cross Lifeblood.

Patients with haemochromatosis can save multiple lives and at the same time getting the iron level maintained in a safe level. Early diagnosis and treatment prevent complications and result in a normal life expectancy.

#CrazySocks4Docs

Fri, 05 Jun 2020 05:53:58 GMT

#CrazySocks4Docs

We are wearing crazy socks today (5th June 2020), participating in raising awareness of mental health for health care practitioners.

This issue is all the more relevant with the current COVID-19 pandemic.

Stay safe, and have a great long weekend!

...from the team at Ballarat Cancer Care and Haematology

Comment on our Facebook post who you think has the best socks!

Medications drastically improve breast cancer landscape

Wed, 27 May 2020 02:36:10 GMT

Medications drastically improve breast cancer landscape

Breast cancer, the most common malignancy in Australian women, will affect 1 in 7 women before the age of 85. Thankfully, due to improvements in treatments, and earlier diagnosis through Breast screen, outcomes continue to improve.

There are several subtypes of breast cancer, each managed with slightly different treatment approaches. Around 15% of breast cancers are what we refer to as Her2 positive – that is, the cancer cell expresses the Her 2 receptor on the surface of the cell. Although Her 2 positive cancers were originally considered to be associated with a worse prognosis, the growing list of well tolerated and widely available medications used in Her 2 positive breast cancer has changed this dramatically for the better.

Trastuzumab (Herceptin) has been available in Australia now for around 15 years. It is used as “adjuvant” (post surgical) treatment, where it is given for 12 months, intravenously, is exceedingly well tolerated, and has improved cure rates considerably. It is also increasingly used in the neoadjuvant (pre surgical) setting, and is also active in metastatic (secondary) breast cancer.

Pertuzumab (Perjeta) became available in Australia around 5 years ago. In combination with trastuzumab and chemotherapy, it has improved outcomes for those with metastatic Her 2 positive breast cancer, with many patients stable on this treatment for some years, and is reimbursed by the PBS for this indication. It is now being increasingly also used as neoadjuvant (pre-surgical) treatment, and occasionally as adjuvant treatment. At this stage, there is an out of pocket associated with this in Australia, but this is likely to change soon.

Trastuzumab emtansine (Kadcyla) is another Her 2 directed treatment, again given intravenously, that has been available for several years for metastatic breast cancer. A large clinical trial, the KATHERINE study, published in 2019, demonstrated a benefit in trastuzumab emtansine being given post-surgery, after neoadjuvant (pre-surgery) Her 2 directed therapy. As recently as February 2020, this has reimbursed by the PBS in Australia.

The above medications have drastically improved the landscape of Her-2 positive breast cancer. In addition, they are associated with many less side effects that standard chemotherapy, leading to improved quality of life. All are associated with a small risk of heart toxicity, usually reversible, but necessitating regular assessment of heart function. An echocardiogram, or similar test, is recommended every three months while on therapy.

There are also tablet treatments that target Her 2. Lapatinib is a tablet that has a role in the treatment of metastatic disease, and the role of newer drugs, neratinib and tucatinib, are being determined.

With further potential treatments on the horizon, and a growing list of available treatments the management of Her 2 positive breast cancer in Australia is changing rapidly, and for the better!

Dr Heather Francis

Ballarat Cancer Care & Haematology

Personalising Cancer Care

Sun, 26 Apr 2020 00:38:08 GMT

The treatment of cancer has changed significantly over the last 10 years. While cancer has traditionally been treated with surgery, chemotherapy and radiation, the modern oncologist has many additional therapy options available. While chemotherapy remains the best option for many patients, increasingly drug therapies that attack specific molecular targets in the cancer are being used to stop tumour growth. The challenge is that not all types of cancer can be treated with this type of therapy, and working out the correct treatment for each individual is extremely important.

Cancer is caused by abnormal changes within the DNA of its cells which result in uncontrolled tumour growth. These DNA changes are known as mutations and they result in molecular targets on the surface of the cell. While mutations can be inherited, most cancers are caused by new mistakes in the DNA that build up over a lifetime leading to uncontrolled tumour growth. This approach to the investigation and treatment of cancer is a new field of medicine, and progress in occurring rapidly. Understanding if a cancer has a particular mutation may help determine suitable treatment options that have been shown to work on other cancers caused by that faulty gene. This is done by testing the DNA from within a tissue sample taken from the cancer.

Until recently, testing cancer tissue relied on laborious, and necessarily limited, one-gene-at-a-time approaches. My research, as part of a team from Peter MacCallum Cancer Centre and Melbourne Genomics looked at the use of massively-parallel-genomics-sequencing to examine 350 different molecular targets at the same time.

For each individual tumour, we created a molecular profile, which reveals the unique characteristics of that individual’s cancer at the molecular level, providing their oncologist with knowledge about which treatments were most likely to produce the best results. Over 350 people had a molecular profile created, 25% of these patients came from regional centres and most did not have to travel into Melbourne for testing. Each tumour profile was analysed, then evidence-guided cancer treatment options were discussed by a tumour-board of oncologists, molecular scientist, geneticists and pathologists. In 63% of the people who had successful tests, we were able to identify a mutation that was influencing the cancers growth. Promisingly, in 17% the information about this mutation was used to personalise a change in the patient’s therapy, including new treatments that had previously not been considered in their case.

If you have any questions regarding genomics sequencing or personalising cancer therapy, please contact Ballarat Cancer Care and Haematology.

Dr Kortnye Smith

Medical Oncologist

MBBS, FRACP

COVID-19 and Patients with Cancer

Thu, 02 Apr 2020 22:36:00 GMT

For all of us, these can be troubling times, full of changing information about COVID-19 statistics, new information from abroad and in Australia, and lots of changes to personal circumstances for us and our families.

For patients with cancer or their loved ones, things can be especially intense/ worrying/ confusing. They might have questions like: how will all of this affect me? How will my cancer be treated if the health system is under stress from COVID-19? What is my risk of contracting the COVID-19 infection?

All of this concern is understandable, and some of it makes sense to think about. Patients should talk to their treating team about this. It is well known from experience in China and elsewhere that patients with other medical conditions such as cancer can have worse outcomes if they do become infected with COVID 19. Some treatments for cancer (not all) can lead to suppressed immunity making catching the virus easier, and dealing with it harder.

Some treatments for patients with cancer may change over the coming weeks and months. Often there are gentler choices of treatment which may be as effective but lead to fewer potential side effects. Sometimes breaks in treatment can be offered without compromising long term outlook. Sometimes priorities and timing of operations, chemotherapy and radiotherapy may change depending on the situation.

Recommendations for patients with cancer:

Patients with cancer should follow the advice of the Department of Health. In particular, it is important that patients isolate themselves at home. Visits to the supermarket, pharmacies, or medical centres can still continue, although for some it may be best to have other family members do this for patients.

Hand washing is important because the virus that causes COVID-19 is destroyed by soap. When people are out and about and touching surfaces or people that may have the virus on them, as long as ones’ hands are washed the virus will be destroyed.

Cancer patients may become so focused on the risk that COVID 19 brings that they may ignore symptoms relating to the cancer- it is important that in combination with the treating team, one keeps on the front foot with respect to managing the cancer. Likewise, during this time when COVID-19 remains so much of the focus , it is important to note that other medical conditions like cancer could still arise. The earlier cancers are found the better, so patients should not put off getting assessed for concerning symptoms by their GPs if there are concerns.

Ways to improve quality of life for patients with cancer:

During this time, it is important to keep exercising, maintain a healthy diet, and generally look after oneself. Exercise remains important in maximising lung function, improving general wellness, and reducing risks of heart and lung conditions, and diabetes. As long as one keeps distance from others and doesn’t touch playground equipment etc, it would be very unlikely to risk catching anything from a walk in the great outdoors.

Managing anxiety and worry during this time is also particularly important, and all of us will experience fluctuations in how we feel about the general situation, finances, and all the other worries of a complicated world. Overly worrying, or allowing worry to ruin one’s quality of life, sleep, and relationships, however, seems counterproductive.

There are various techniques to deal with anxiety and worry. One of the most useful is meditation or mindfulness. This allows for focussing on the present, not worrying bout the future or the past, and getting the most out of the current day and small activities and pleasures in it. Smiling mind is one app that is one of many apps that might be appropriate to look into. Beyond blue, Headspace, and Lifeline are some of many options that one can access. A good first step would be to talk to the GP about how one is coping.

Social interactions have never been so crucial and have never been so hard to achieve! Often the only thing we can do is talk by phone or computer, which can seem stilted at first but with a bit of regularity can become the norm.

Cancer Services:

Cancer services are all functioning as “essential services”, both in Ballarat and more regionally. There are extensive resources about COVID-19 and cancer patients which are available to Cancer services. Often consultations can be carried out by telephone or tele-health.

There is good communication and cooperation between the public and private sectors in this environment, all working together to keep patients with cancer well.

So keep safe, strong and well- one day this crisis will pass and everything will come back to a new normal. Between now and then, there are lots of good things available within ourselves and between each other, to keep us going.