Melanoma vax grows hope
An mRNA vaccine trial run by leading melanoma expert ECU Professor and Director of the Medical Oncology Clinical Trials unit at FSH Adnan Khattak is showing promising findings.
Professor Khattak presented at the 2023 American Society of Clinical Oncology congress in early June, which attracted more than 45,000 attendees. He outlined how survival and disease recurrence rates among people who had high-risk skin cancers (melanomas) removed, improved significantly when an mRNA vaccine tailored to suit an individual’s tumour genetics was added to common immunotherapy treatment.
After 18 months, cancer-free survival among patients who received the vaccine and the immunotherapy treatment was 78.6%, compared to 62.2% of those who only received immunotherapy.
Two years after treatment, 22.4% of patients who had received the vaccine/immunotherapy combination had either died or seen a recurrence of the disease, which rose to 40% for the immunotherapy-only group.
Overall, after an average of two years, those who received the vaccine saw a 44% lower risk of death or melanoma returning to the same area of the body, and a 65% reduction in the risk of death or the cancer returning in a different area of the body.
There was no significant increase in rates of adverse side effects.
The global trial, with the biggest recruitment taking place at Hollywood Private Hospital, may be a herald of things to come in cancer care.
“This is the biggest trial to show treatment improves with an individualised approach — and I think research into personal cancer vaccines is going to increase dramatically after this positive study,” Professor Khattak said.
Voting with their feet
Changes to working conditions at North Metropolitan Health Service sites have been given the thumbs up by the junior doctors the service hopes to attract and retain.
The Junior Doctor Manifesto, devised by Dr George Eskander and his team, has seen 33 part-time positions created, which as has led to a drop in vacancy rates from 42 positions to nil in February 2023. It has been a remarkable turnaround from a previously stressed junior doctor cohort that saw increasing absenteeism, to a workforce that is enjoying part-time flexibility.
“These part-time opportunities – enshrining a culture of psychological safety, creating a streamlined overtime approval process, embedded leave-taking and implementing a medical workforce on-call, along with a below the line pathway for reporting – have really challenged previous behaviours and traditions within the group,” Dr Eskander said.
“Our doctors are [now] reporting much greater satisfaction. We increased our retention rate and approved 75% of requests for annual leave within five days and 94% of our interns have renewed their contracts to further their medical careers and, for us, that has had a profound impact on our overall workforce.”
Referral reform now!
RACGP is calling on changes to referral protocols saying they waste too much of GPs’ precious time.
Too many GP hours are wasted on non-standardised templates, unnecessary naming of specific specialists in referrals, and outdated data-sharing, it says in its submission to the National Health Reform Agreement (NHRA) Addendum 2020-2025 Mid-term Review.
To achieve this, the RACGP said the NHRA review should:
- put an end to hospital named referral requirements, which require GPs to name a specific specialist for a referral
- support hospitals and other health services to use standardised, secure, interoperable digital systems for data sharing, referral, and discharge between general practices and hospitals
- pilot data-sharing between hospitals and primary care to better identify at-risk patients, reduce low-value care and meet community needs
- set an objective to reduce demand for hospital services through Commonwealth- and state-funded preventative healthcare by GPs, with a future objective to add GP services in hospitals to coordinate care for patients with complex needs and identify and manage preventable admissions.
“These changes would streamline the whole system,” RACGP president Dr Nicole Higgins she said.
“GPs should be spending time with their patients, not on navigating long forms and frustrating processes that can be unique to each hospital. It’s not facilitating quality health care, it’s just exporting hospital bureaucracy into general practice.”
WA procedural GP Olga Ward said hospital-specific templates can be clunky, full of boxes to tick, and wasteful of GPs’ time.
“I’m starting to want the Danish system where all the health software across all systems has to, by law, be compatible, communicate and contain all the information and be readily available,” she said. “Imagine how many tests would not have to be endlessly repeated if you could see it all there at once and look up what has gone before.”
Clinician research
Two Perth Children’s Hospital clinicians – oncologist Dr Neha Jain and Dr Fran Gehrmann, a clinical fellow in endocrinology – have been selected to undertake a new PhD pathway program supported by Child and Adolescent Health Service, University of WA, PCH Foundation and Telethon Kids Institute.
Dr Jain will be researching an RNA-based treatment for children with solid tumours, which will aim to target the tumour microenvironment to stop the cancer cells from returning after surgery. Dr Gehrmann will investigate new models of care for children with type 1 diabetes using changes in a child’s Continuous Glucose Monitoring (CGM) data to target personalised treatment.
Both doctors will begin their degree preparation this year, with formal studies to commence in 2024.
Skills going to waste
A national survey of primary health care (PHC) nurses has shown that their skills are not being used to their full potential often or most of the time. The 2022 survey was conducted by the Australian Primary Health Care Nurse Association (APNA) to the nearly 100,000 nurses.
Other findings include more than half (53%) of under-utilised nurses had requested to use more skills or experience; less than 39% successfully negotiated a change; 26% were denied the request with 43% of that group being told it was because there was no financial benefit to their employer.
APNA says with the growing nurse shortage and the exponential rise in chronic disease, it is critical that nurses be empowered to do more to meet the healthcare needs of the nation.
“Nurses are prevented from working independently to their full scope of practice by outdated Medicare billing protocols. Many patients are managed by nurses for chronic disease management, lifestyle and self-care support visits, immunisation, dressings, and care coordination catch-ups,” APNA President Karen Booth said.
“The 2023 Federal Budget announced Medicare reforms around a multidisciplinary model of care, which lays the groundwork for structural change, but there is more work to be done. Adequately funded bundled payments for individuals with chronic and complex health issues would allow flexible use of nurses within a multidisciplinary team. Such models free up GP time to focus on the higher level and acute needs of their patients, while the nurse provides support through planned care activities.”
Community support of Babbingur Mia
Proud Yamatji Naaguja woman Jenna Greaves – the much-loved Clinical Coordinator & Child-Health Nurse at Aboriginal health service South Coastal Babingurr Mia in Rockingham – as won the 2023 NAIDOC Nursing and Midwifery Award.
Jenna, who is committed to supporting self-empowerment of young Indigenous women and their families at a time that can be particularly challenging, was first motivated to pursue her nursing career as a young patient of the clinic 16 years ago.
“I attended South Coastal Babbingur Mia (BBM) as a young pregnant mum 16 years ago and now here I am as the clinical coordinator and child-health nurse, it really is a full circle.
“Helping my community as a nurse is the most amazing reward in life. I love to be able to help young Aboriginal mums and families be the best possible parents they can be,” she said.
BBM CEO Dr Gill Walker said she was extremely proud to see Jenna honoured in the NAIDOC Awards 2023 – and was touched that the community of their not-for-profit organisation put Jenna forward for the honour.
“This is the second consecutive NAIDOC Awards honour for our staff here at South Coastal Babbingur Mia” said Dr Walker. “Babbingur Mia came Runner-Up in last year’s Program of the Year.”
Babbingur Mia’s Midwife and Aboriginal Health Services offer support during and after pregnancy, by providing in-home and clinic care before the birth, in-home and clinic care after the birth, doctor and hospital appointments, transport and emotional wellbeing.
Know thy man
A Monash IVF commissioned poll of more than 500 Australian women aged 28-42 has revealed that many have poor knowledge about men’s fertility. Almost one quarter believed men never experience a decline in fertility, while nearly one in five were unsure at what age male fertility declined (for the record it starts from about the age of 40).
“My advice to women and men is not to ignore the male biological clock – it does exist, and it too can affect your chances of conceiving a baby. Don’t simply assume the issue lies with the female partner,” said Monash IVF fertility specialist Professor Beverley Vollenhoven.
Monash Professor Rob McLachlan added that while age is a major cause of fertility issues for both men and women, fertility struggles also happen at any age.
“About 30% of problems can be attributed to what we refer to as male factor, which can include blockages in the sperm tubes or poor semen quality of known – especially genetic problems – or unknown cause.”
Helping prems thrive
Preterm babies in WA will benefit from new research findings that show the benefits of different probiotics on infant nutrition.
The work by consultant neonatologist Dr Gayatri Jape will be used to help the most premature babies in the Child and Adolescent Health Service’s neonatal intensive care units at King Edward Memorial Hospital and Perth Children’s Hospital.
Dr Jape completed a randomised controlled trial known as SiMPro as part of her recent PhD award from the University of WA. Her trial looked at the effect of single or three-strain probiotic supplements in extremely premature babies, born at less than 28 weeks gestation.
The trial also examined prevention of necrotising enterocolitis, a disease that contributes to significant death and disability in premature babies, and the impact on timing for the baby to achieve full milk feeds.
“My research compared the use of different probiotics given to our premature babies to maximise their prospects of surviving and thriving through new and improved nutritional options,” Dr Jape said.
The three-strain probiotic proved superior with decreased rates of NEC. The babies also achieved better oral nutrition and they moved onto full milk feeds faster.
Following the SiMPro study and strong evidence supporting the use of multi-strain probiotics from other parts of the world, the new probiotic has recently been introduced for routine supplementation in the NICU units at KEMH and PCH for babies born at less than 35 weeks, who are the most vulnerable for developing feed intolerance and NEC.
Bowel screening down
The promotional campaign to get bowel screening rates up has started as a response to the participation rate dropping to 40.9% of the eligible population down from 43.8%. The latest participation rate (2020-21) is the same as it was in 2015-16 despite almost $20 million invested by the Australian Government in raising awareness of the National Bowel Cancer Screening Program (NBCSP) since 2019. In WA, participation rate was 41.5%
The latest NBCSP report also reveals that colonoscopy wait times exceed the recommended 30 days in every state and territory, with WA recording the lowest of 119 days and Tasmania the highest (235 days), results that negate the benefits of early detection.
Only 15.6% participants were recorded as receiving a colonoscopy within the recommended 30-day time frame following a positive screening result.
According to the report, 6.1 million people aged 50-74 were invited to participate in the NBCSP in 2020-21 and 2.49 million tests were returned. Of those who participated, 76,880 received a positive result.”
Child’s play for doctor
Prolific author Helen Milroy – who has many other roles to her name including commissioner with the National Mental Health Commission – has added a new children’s picture book to the bookshelf.
The child and adolescent psychiatrist and proud descendant of the Palyku people of the Pilbara region is the author of the bestselling Backyard series which has been reprinted several times.
Her latest book – Bush Birds – aims to help young readers better observe local birds such as blue wrens, lorikeets and eagles when out for a walk in the bush. It features Helen’s familiar bold illustrations, and marks her sixth book to be published by Fremantle Press.
Masterclass reach is growing
There were 300 delegates from around the state at Perth Urology Clinic’s sixth urology masterclass, which has been accredited by the RACGP for CPD hours.
The day started with a moving Welcome to Country by Dr Robert Isaacs OAM, and was followed by 18 separate presentations, quizzes, and Q&A sessions. The program included presentations on a wide spectrum of urological conditions from PUC consultants, regular associates Ms Melissa Hadley-Barrett and Dr Ahmed Kazmi, and invited guest speakers Dr Donald Latchem and Dr Duncan McLellan.
Perth Urology Clinic acknowledge the ongoing support of sponsors Ramsay Health Care, St John of God Health, Genesis Care and Icon Cancer Care among others, many of whom have supported the conference since its inception.
