The Medical Link – Issue 144

Page 1

Bungee Jumping into the 21st Century: Health in Vanuatu and the Blue Pacific

"The number of public and private hospitals in Australia and New Zealand totals 1,350 with one hospital per 18,500 of population. The number of hospitals in the Blue Pacific totals 95 with one hospital per 189,000 of population."

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THE OFFICIAL PUBLICATION OF THE GOLD COAST MEDICAL ASSOCIATION INC. medical
ISSUE 144 | APRIL – MAY 2023

PIMPAMA

OPENING 17 APRIL 2023

South Coast Radiology is pleased to announce the opening of a new imaging practice in Pimpama, April 2023. For over 50 years, South Coast Radiology has serviced the Gold Coast community by providing expert and compassionate medical imaging for patients. Now expanding into the northern Gold Coast suburbs, the new Pimpama site will offer a comprehensive range of services including MRI, CT and Nuclear Medicine, same day appointments, acceptance of all referrals, free easy access parking and prompt report turnaround times.

We look forward to welcoming our patients to a brand new, bright and inviting practice!

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7 Attenborough Blvd, QLD 4209

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Online business literacy training is available from April 2023

Face-to-face entrepreneurial workshops (about 40 hours) are delivered June – September 2023 in the heart of our Precinct.

THE MEDICAL LINK • medicallink.com.au • 5 06 A Message From the GCMA President Prof Philip Morris AM FEATURE STORY 10 Bungee Jumping into the 21st Century: Health in Vanuatu and the Blue Pacific Dr Graham Sivyer EDITORIALS 14 New Clinician Entrepreneurship Program to Take healthtech Ideas from Bedside to Business Kathy Kruger –Griffith University 18 Expanding Patient Access to Diagnostic Imaging: South Coast Radiology Pimpama, Opening 17 April 2023 South Coast Radiology 24 The Gold Coast Hepato–Pancreatic and Biliary MDT Meeting: A Service for GPs to Improve Care and Outcomes A/Prof Harald Puhalla, Dr Kashif Sheikh, Dr Muddassir Rashid, Dr Ramesh Damodaran Prabha 26 Improving Access to Lymphoedema Screening and Early Intervention Dr Mohammed Islam 28 The Role of Radiation Therapy in Keratinocyte Cancer Management Prof David Christie SOCIALS 20 The Gold Coast Medical Association Annual General Meeting 2023 Contents

A Message from the GCMA President

Dear GCMA Colleagues,

I produced a President’s Report for the GCMA recent 2023 Annual General Meeting in March. I include sections of that report in this report for you.

I have been most honored and privileged to be the president of the GCMA over the past four years. During this time we have managed to keep the association running during the Covid-19 pandemic and provided an informative monthly meeting program for members. We have also managed to keep the association financially afloat and improved our bottom line.

While the intensity of the Covid-19 pandemic has abated a little, the infection is still circulating in the community. We are now somewhere between a pandemic and endemic stage of this disease. The Omicron variant and its derivative forms seem to be less virulent and are morphing into a severe type of common cold for the healthy members of our community. We are seeing less spread of the

virus into tissues and organs beyond the upper respiratory tract. This is probably due in part to the increased immunity of the population from vaccination and natural infections. This is good news.

But there are still members of our population who are susceptible to severe disease from Covid-19. These individuals include the elderly, people with multiple comorbid medical conditions, and especially those with compromised immune systems. We need to do all we can, using appropriate public health measures and protective personal hygiene methods, to prevent these members of our community getting infected. Early treatment with the antiviral medications is an important way of reducing the risk of severe illness.

The Covid-19 vaccines are effective in preventing hospitalisation and severe disease from Covid-19. However we have found that the vaccines are not as good as we hoped at preventing people getting infected with the virus or passing it on to others. And the vaccines are not without their problems.

We are hearing more about vaccine-related injuries. While not common, these reactions to the vaccines need to be taken seriously. For a small number of individuals the vaccines may not be suitable. It is important that persons contemplating further vaccination with boosters check with their doctor for advice.

We are now embarking on our fourth Pacific island nation medical education event in Samoa from 2930 September 2023. This medical conference is a joint effort with our sister association, the Samoan Medical Association, and is in collaboration with the Oceania University of Medicine, the National University of Samoa Medical School, and the Samoan Ministry of Health. The meeting is sponsored and supported by our own Bond and Griffith Universities.

Please consider attending. The meeting is being held within the September/October school holidays, so bring the family along too. Accommodation at the splendid resort in Apia is at very competitive ‘local’ rates. Just quote the Code

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number found on the registration website below to get this benefit. The website for registrations and further information about the program and excellent venue is:

www.eventbrite.com.au/e/gcma-samoan-medicalconference-2023-tickets-524227046207

At a recent GCMA executive meeting we decided that for this year we would have clinical/ educational meetings each two months. The schedule of meetings is now Thursday 18 May, Thursday 20 July, and in September the Samoan medical conference from Friday 29 to Saturday 30 September will replace the Thursday evening meeting. Our last Thursday evening meeting for the year will be Thursday 16 November. We have an exciting program planned for Thursday May 18. Dr Harald Puhalla and Dr Mark Forbes will examine the topic of weight loss from the surgical and medical perspective. In July we plan an informative session from the Genesis Care Cancer Service on the Gold Coast.

In our new meeting format we will include in the speakers’ presentations activities that can be claimed as ‘Reviewing Performance and Measuring Outcomes’ for Continuing Professional Development credits. This development will make our educational and clinical program more attractive to local general practitioners and specialists alike.

Working in the position of president of the GCMA is a joy. And it is made even more enjoyable by the hard work and support of my executive team members: A/Prof John Kearney, Prof Gordon Wright, Dr Maria Coliat, Dr Cassie Joyce, Dr Amy Doumany, A/Prof Stephen Weinstein, and our administrative officer Marnie Masor. This year Dr Graham Sivyer joins us as the GP representative and Prof Alfred Lam joins us as the academic representative.

I would also like to thank the loyal support of you, our GCMA members, through what have been at times difficult circumstances to navigate. Please join or rejoin the GCMA for this year and please

invite your medical colleagues to join the GCMA at the website link:

www.gcma.org.au/becoming-a-member

The Medical Link remains as our bi-monthly magazine. Please consider contributing articles on clinical, political, or personal hobbies or interest themes, as well as administrative and other topics of interest to our medical colleagues and the general public (who often read the magazine in clinical facilities and medical offices).

I look forward to meeting you at the next GCMA Thursday evening dinner meeting on 18 May at the Southport Golf Club.

Yours sincerely,

THE GCMA PRESIDENT'S REPORT •

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MEDICAL EDITORIAL COMMITTEE

Philip Morris, Geoff Adsett, Stephen Withers, John Kearney, Maria Coliat GCMA MEMBERS gcma.org.au

GCMA EXECUTIVE COMMITTEE

President Prof Philip Morris 5531 4838

Vice-President Dr Maria Coliat 5571 7233 Secretary Prof Philip Morris 5531 4838

Immediate Past President Dr Sonu Haikerwal 5564 6255

Treasurer Dr Geoff Adsett 5578 6866

Specialist Representative Prof John Kearney 5519 8319

GP Representative Dr Katrina McLean 5564 6501

Academic Representative Prof Gordon Wright 5595 4414

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"The number of public and private hospitals in Australia and New Zealand totals 1,350 with one hospital per 18,500 of population. The number of hospitals in the Blue Pacific totals 95 with one hospital per 189,000 of population."

10

Bungee Jumping into the 21st Century: Health in Vanuatu and the Blue Pacific

A Brief Summary of History and Politics of the Pacific

Around 3000 BC. the people of the Lapita culture (named after the archaeological site first excavated in New Caledonia) commenced populating the islands of Indonesia, the Philippines and New Guinea. Genetic, archeological and linguistic studies indicate that these people sailed from Taiwan and the southern islands of Japan – there are some Maori words similar to those of Japan.

Around 1500 – 1300 BC, the population of Micronesia and Melanesia occurred with extension outwards to colonise Polynesia over the following 500 years. Hawaii was colonised around 900 AD and New Zealand, the last to be colonised, around 1200 AD.

‘Pacific’ was the name given to this vast ocean by Ferdinand Magellan in the 16th century because it was peaceful and unlike the ‘stormy’ Atlantic. ‘Oceania’ is the name given to the 8.5 million square kilometre water-land mass, which also includes New Guinea and Hawaii.

The area now called ‘Blue Pacific’ (by the Pacific Island Forum) excludes western New Guinea (claimed by Indonesia) and Hawaii (the 50th state of the United States of America). Western countries started to ‘discover’ and claim the islands in the Pacific from around 500 years ago. These

countries included Portugal, Spain, England, France, Germany and the USA. More than eighteen islands have gained their independence within the last century and despite of individual independence, are loosely governed by the Pacific Island Forum.

The Pacific Island Forum (PIF) was formed in 1971, and includes Australia and New Zealand and sixteen Pacific islands. The PIF meets annually, is based on the UN Charter, and their vision is one of “good governance, democratic values, rule of law, human rights, gender equality and just societies.”

Western ‘colonisation’ has not been kind to the Blue Pacific. It has resulted in damage to local cultures, ‘black birding’ of islanders, river run-off resulting in acidification and coral reef damage, plastic accumulation (an area of the size of France in the north eastern Pacific), climate change with rising water levels, nuclear damage and waste, and the introduction of the western diet. The primary concern of the PIF is climate change.

A health survey of Vanuatu by DFAT, in 2015, as an example of one of the Blue Pacific islands, indicated high infant mortality, low vaccination uptake, childhood malnutrition and adult obesity with increasing cases of ‘western disease’ such as diabetes and heart disease.

Australia and New Zealand are the major donors of aid to the PIF countries. In the financial year

2019 to 2020, DFAT donated $1,381.4 million to eleven Blue Pacific countries. This distribution included $572.2 million to Papua New Guinea, $187 million to the Solomons, $66.2 million to Vanuatu and $58.1 million to Fiji. Of the $66.2 million donated to Vanuatu, $15 million was directed towards health. The agreement with DFAT was to direct the health funds to hospitals, village health workers, malaria prevention and immunisation.

The number of public and private hospitals in Australia and New Zealand totals 1,350 with one hospital per 18,500 of population. The number of hospitals in the Blue Pacific totals 95 with one hospital per 189,000. The number of available medical schools in Australia and New Zealand is twenty-three, with one medical school per 1,370,000 population. Medical schools in the Blue Pacific total six, with one school per 3,000,000 population.

medicallink.com.au • 11
Migration since 3000 BC
Pentecost Island

Mauna Health Centre Pentecost Island: A Case Study

Vanuatu is a volcanic archipelago of islands stretching over approximately 1,000 kilometres and situated about 1,500 kilometres to the north east of Australia and between the Solomon and Fiji islands. There are 83 islands inhabited with approximately 40 different languages spoken. Bislama (pigeon English), English, French and local dialect are languages spoken in Vanuatu.

The capital of Vanuatu is Port Vila on the island of Efate. Vanuatu has a total population of around 318,000. Pentecost Island to the north east of Efate has a population of around 18,000. The island is home to bungee jumping (southern Pentecost) which is a ritual associated with the annual yam harvest.

Mauna Health centre is situated towards the northern tip of Pentecost in the village of Abwatuntera. Mauna, which in local dialect means ‘cry no more’, was established as a ‘hospital’ in 1951.

In 2019, Dr Richard Leona, now the chief of surgery, Vanuatu and a tribal chief on Pentecost, spoke at the AGM of the Gold Coast Medical Association (GCMA). He had recently arranged and built a surgical theatre in the Mauna Health centre, and requested assistance in adding a portable XR and ‘pathology auto-analyser’ to complement the theatre. At this meeting, a number of medical practitioners and rotarians decided to assist Dr Leona in his request.

In October 2019, a group of doctors and rotarians flew to Port Vila. The following day we flew to Lonorore airport in the south of Pentecost. We were introduced to local chiefs and health care workers. The group including ‘local dignitaries’ and at times totalling ten persons (maximum seating usually five persons) drove by four-wheel drive utility, winding along an unpaved boulder littered road called ‘Highway One’. We traversed rivers and mountains to arrive at Mauna in the north after eight hours.

During the trip we stopped at a number of health centres to inspect the facilities and to be welcomed by village health workers. It was obvious that Dr Leona was well respected throughout Pentecost as at every stop we were treated to food, gifts and a welcome by the local chief.

Mauna health centre provides care to obstetric, medical, trauma and paediatric patients. The centre also provides out-patient care and a vaccination program. Seriously ill patients require transport to the airport (Lonorore) in the south of Pentecost about six hours on a four-wheel drive road, or a four-hour outboard boat ride. Hot water and electricity at Mauna is virtually nonexistent. A few solar panels and diesel-generated electricity are used to charge torches and phones.

The visiting group agreed that an XR and autoanalyser pathology system as requested by Dr. Leona would be a valuable asset to the centre. Rotary International has provided matching grants for the money raised by Broadbeach, Surfers Sunrise, Gold Coast, Tauranga and Kasoke Rotary Clubs to pay for the portable XR and pathology auto-analyser. Both items of equipment have been purchased from the Chinese Company, Healicom. These have recently been shipped from China and will arrive in Port Vila within the next month.

The local Rotary district has funded the building of an annexe to be erected next to the theatre at Mauna which is to house the XR and Pathology systems. Solar-generated electricity will be arranged with solar panels and appropriate wiring to the annexe. Over the last few years this annexe has been built to cyclone resistant standards, disassembled, flat-packed and is now being transported by container ship to Vanuatu.

The work on the annexe has been carried out by volunteers at the Men’s Shed in Arundel on the Gold Coast. A group of eight volunteers, depending upon recovery from the recent cyclones, will be traveling to Pentecost and assisted by villagers, will reassemble the annexe at Mauna.

Once the annexe has been reassembled and the portable XR machine and blood pathology

auto-analyser installed in Mauna we will be seeking volunteers from the Gold Coast medical community to travel to Pentecost as a ‘Vocational Training Team’ to assist managing the equipment.

Pentecost Island is a wonderful mountainous tropical island inhabited by a welcoming people. Most of the islanders exist through subsistence farming of crops and fishing. They are dependent on such visionaries as Ni-Vanuatans, Dr Leona who work hard in difficult circumstances to bring Vanuatu into the 21st Century.

Australians and New Zealanders are held in high esteem and they look to us for help improving their living standards. New Zealand, as a Polynesian island, is considered one of their own. They are grateful for the role of DFAT and the opportunities provided by our government through for example work visas. They do have concerns about the role of China in the pacific but are happy to negotiate, with the proviso, as stated by Rory Medcalf, National Security College ANU: “China has a rightful place in the Pacific, just not the right to dominate.”

Vanuatu and the islands of the Blue Pacific have suffered immensely over the last half century, particularly with increasing and more ferocious cyclones. The concern of all the people of the Blue Pacific is climate change

Involvement with the people of Vanuatu and in particular, working and learning from Dr Richard Leona, has been an immensely rewarding and enriching experience. I hope to continue my association with Richard and the Blue Pacific over subsequent years.

12 • Issue 144 FEATURE STORY • THE MEDICAL LINK
Highway 1 Completed Annexe Mauna Theatre Meeting with Minister of Health

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14
"Doctors and practitioners with ideas for new healthcare products or services will be helped along the path to commercialisation through a free training and support program offered in the Gold Coast Health and Knowledge Precinct."

New Clinician Entrepreneurship Program to Take healthtech Ideas from Bedside to Business

(07)

Doctors and practitioners with ideas for new healthcare products or services will be helped along the path to commercialisation through a free training and support program offered in the Gold Coast Health and Knowledge Precinct.

Delivered by Griffith University’s renowned Griffith Business School, with Gold Coast Health as supporting partner, the initiative is open exclusively to qualified clinicians, who only need an innovative idea and the commitment to learn about the entrepreneurial process.

The program, which aims to drive healthcare innovation and create new healthtech jobs, is proudly supported by the Queensland Government through an Advance Queensland Regional Collaborative Futures Grant.

Participants will be coached on everything from foundational business literacy to the steps to take a product, device, digital/AI application or innovation all the way to market or into organisational clinical practice.

Providing opportunities for clinicians to engage with a diverse experts, be supported by Griffith University students, and get tips from case studies and experienced mentors, the Clinical Entrepreneur Change Agents Program (CECAP) seeks to spread a new innovation mindset.

Clinician entrepreneur and Orthopaedic Surgeon Professor Randy Bindra, whose novel artificial wrist ligament is nearing market readiness, says the most important ingredient for clinical innovation is a supportive team.

medicallink.com.au • 15
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Prof Randy Bindra (second from left)

"As clinicians, we are uniquely placed to identify clinical problems and work out solutions to improve patient care, “Professor Bindra says.

“The key is collaboration and building a team with different skill sets around you to advance ideas, both from technology development and business perspectives.

"Through R&D with colleagues at Griffith University with diverse experience - biomedical engineering, anatomy, industrial design and robotics and with business and IP protection support, we have been able to advance towards bringing our unique artificial wrist ligament product ready for commercial agreements with global industry partners."

The technology addresses a pressing clinical problem Professor Bindra encounters: a disabling wrist injury to the Scapholunate Interosseous Ligament (SLIL) commonly caused by falls in sport.

“What we’ve done is create a 3D printed ligament scaffold that is customised to the patient and is seeded with cells, so it’s a live ligament that is ready to grow and heal,” says Professor Bindra, whose innovation has been backed by a $1million grant and proven in animal models.

And immersion in this collaborative R&D environment over the last five years has spawned more ideas.

Professor Bindra’s identification of a market need and technological solution led to his recent cofounding of startup Ontic Ortho Solutions, with collaborators experienced in biomedical engineering and commercial medical product design for additive manufacturing.

“In order to address the need for realistic bone models for training orthopaedic surgeons of tomorrow, I teamed up with Associate Professor David Saxby (Chief Scientist) and Monica Russell (CEO) to create a startup right here on the Gold Coast,” he says.

“The models will be designed and manufactured in Australia for use in surgical courses worldwide.

"When you have a team of clinical and commercial mindsets working together in a supportive environment, there is no limit to innovation. All you need is an idea. "

CECAP training is led by Professor Entrepreneurship and Business Innovation Naomi Birdthistle, an award-winning academic and researcher, author and long-time entrepreneur, who has advised and mentored 450+ entrepreneurs

and taught enterprise skills to 8,000+ students. Dr Brent Richards, the Medical Director of Research Commercialisation, Adj. Professor of Critical Care Research, Gold Coast Health is the program’s clinical conduit.

Striving to continuously improve patient and system outcomes in healthcare, this former Director of Intensive Care and now Chair of the Queensland AI Hub Advisory Board, has a passion for the power of AI in medical innovation and will oversee a Datathon as part of the overall pilot program.

Self-paced online business literacy training will be available for successful applicants to the program from April 2023, with the full program launching in May and the first modules of face-to-face training workshops kicking off on the Gold Coast in late June.

Approximately 40 hours of training, plus additional mentoring and advice from an expert entrepreneur-in-residence is being offered through the main program, via expression of interest application process.

There will also be potential opportunities to bring Griffith University students into the innovation teams supporting clinicians.

Those ready to take the leap will be able to access customised commercialisation training in 2024. To find out more and apply for the program visitgchkp.com.au/clinical-entrepreneurship/

16 • Issue 144 • THE MEDICAL LINK
Dr Brent Richards Prof Naomi Birdthistle

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"The opening of South Coast Radiology's new practice in Pimpama is a significant development for the Gold Coast community."

Expanding Patient Access to Diagnostic Imaging: South Coast Radiology Pimpama, Opening 17 April 2023

The opening of South Coast Radiology's new practice in Pimpama is great news for the northern suburbs of the Gold Coast community! With the growing demand for diagnostic imaging services, the addition of a state-of-the-art practice in Pimpama is a much-needed resource for residents and medical professionals in the area.

Located just off the Pacific Motorway at EXIT 49, this new practice in Pimpama offers the latest in imaging technology including MRI, ultra-low dose CT imaging, Nuclear Medicine, Calcium Score, General X-Ray, Ultrasound, and a range of Interventional procedures, ensuring patients receive the highest quality of care.

At South Coast Radiology, our team of highly trained professionals strive to provide patients with comfort and information throughout their scan, starting from the moment they step into our facility until the completion of their imaging procedure. SCR provides a large network of subspecialised radiologists trained in Nuclear Medicine, Cardiac, MSK, Breast, Prostate, Neuro, Paediatrics, Body, Head & Neck imaging and Interventional procedures. Our compassionate team at South Coast Radiology is committed to supporting patients every step of the way.

In addition to our commitment to patient care, South Coast Radiology also places a strong

emphasis on investing in the latest technology and equipment. By staying up to date with the latest advancements in imaging technology, we are able to provide the most accurate diagnoses and treatment plans for our patients. Our new practice in Pimpama will offer:

• 3T MRI

With AIR Recon Deep Learning Technology for superior image quality and significantly reduced scan times

• Nuclear Medicine SPECT/CT

Offering the added flexibility of a standalone CT that includes the latest advancements in dose, metal artifact reduction and fusion technology for SPECT/CT bone, brain, and cardiac scans.

• Ultra Low Dose, High Resolution

CT imaging

AiCE Deep Learning Reconstruction technology improves the ability to detect subtle pathology and resolve fine structures, delivering high resolution images at 25% - 50% less dose as compared to other scanners without AiCE.

SCR Pimpama will also be offering bulk billing for majority of Medicare eligible exams, same day appointments, acceptance of all referrals, free parking and prompt report turnaround times.

For over 50 years, South Coast Radiology has been the Gold Coast’s leader in diagnostic medical imaging and is one of the largest and longest standing radiology organisations in Southeast Queensland. SCR operates in 17 practice locations, including two private hospital based sites at Pindara and John Flynn Private Hospital and two regional sites in Toowoomba and Mackay.

Overall, the opening of South Coast Radiology's new practice in Pimpama is a significant development for the Gold Coast community. With our dedication to patient care and investment in the latest imaging technology, patients can feel confident they are receiving the highest quality of care available.

We look forward to welcoming our patients to a brand new, bright and inviting practice in Pimpama!

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medicallink.com.au • 19 South Coast Radiology Varsity One, Level 3, 1 Lake Orr Drive, Varsity Lakes 1300 197 297 | www.scr.com.au
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Gold Coast Medical Association Annual General Meeting 2023

SOCIALS • THE MEDICAL LINK
Prof. Stephen Weinstein, Dr. Tony Dare, Dr. Dianne Nichol Evelyn Pochapski, Hayley Constable Akiko Sivyer, Dr. Graham Sivyer Dr. Amy Doumany, Prof. Philip Morris Dr. Gary Swift, Dr. Maria Coliat
SOCIALS • THE MEDICAL LINK
Prof. Philip Morris, Dr. Graham Sivyer Dr. Aleks Baruksopulo, Dr. David Grosser, Prof. Stephen Weinstein, Dr. Greg Aroney Dr. Mohammed Khateeb, Sarah Khateeb Dr. Mark Doudle, Dr. Edwina Duhig Dr. Amy Doumany, Dr. Gretchen Hitchins Dr. Pankaj Kothari, Dr. David Grosser
24
"The Gold Coast Liver and Pancreatic Meeting is now firmly established and expanding due to a growing need in the multidisciplinary management of liver and pancreatic pathology in the private sector."

The Gold Coast Hepato–Pancreatic and Biliary MDT Meeting: A Service for GPs to Improve Care and Outcomes

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Multidisciplinary meetings are a vital aspect of modern medical care. The Gold Coast Liver and Pancreatic Meeting is now firmly established and expanding due to a growing need in the multidisciplinary management of liver and pancreatic pathology in the private sector.

With increasing availability of imaging, it's not uncommon to come across a wide array of liver and pancreatic pathology, some of which are incidental, whilst others are more relevant to the patient's symptoms.

These collaborative meetings bring together health care professionals from related medical disciplines to discuss and coordinate patient care. The meeting is chaired by A/Prof Harald Puhalla, an experienced HPB surgeon who is supported by advanced interventional radiologist Dr Muddassir Rashid (Qld X-ray), the senior gastroenterologist with an interest in liver and pancreatic issues, Dr Kashif Sheikh, and the dedicated HPB surgeon Dr Ramesh Damodaran Prabha.

The team brings together a wide collaborative experience in the field and helps GPs to improve efficiency in patient care, management and outcomes.

The aim of this platform is to keep patients in the care of their GP but still provide specialist guidance, and be able to identify early potential malignant HPB lesions. If imaging reports a benign or potential malignant finding in the liver, bile duct, or pancreas, or if the GP is concerned about any findings, the patient can be referred to the Gold Coast HPB Meeting through a templated pathway. The GPs can refer patients directly to the chair for discussion. Imaging and pathology from any provider are accepted.

The Gold Coast HPB MDT meeting meets once a fortnight and outcomes are communicated via a correspondence back to the GP, either for monitoring or for further investigations. A clinical review of the patient by any of the participating specialists is only intended if a consultation with the patient is indicated for further clarification of the patient’s pathology.

This HPB Multidisciplinary service is free of charge but due to the potential need for further investigations or consultations which would be done outside the public system, we currently can only accept private patients.

To download the referral, please visit: https:// weightlossoperation.com.au/wp-content/ uploads/2023/03/Gold-Coast-HPB-MDTReferral.docx

For referrals, please include full patient details including Medicare/private health, referring GP details, diagnosis, symptoms & duration, comorbidities and medications, plus relevant investigations, pathology, radiology, and endoscopy.

THE MEDICAL LINK • ADVERTORIAL
A/Prof Harald Puhalla Dr Muddassir Rashid Dr Kashif Sheikh Dr Ramesh Damodaran Prabha
26
"Breast cancer is one of the most devastating diseases in Australia. It is currently the most prevalent cancer and the second most common cause of death in Australian women."

Improving Access to Lymphoedema Screening and Early Intervention

Icon Cancer Centre

Lower Ground 3, 14 Hill Street Southport (07) 5634 2400 | admin.goldcoastprivate@icon.team

Breast cancer is one of the most devastating diseases in Australia. It is currently the most prevalent cancer and second most common cause of death in Australian women.

However, diagnosis and treatment are only the first part of breast cancer care.

During Lymphoedema Awareness Month in March, the team at Icon Cancer Centre Gold Coast Private spread the word about the importance of remaining vigilant during and after breast cancer treatment, as secondary lymphoedema can develop weeks, months or even years post-treatment.

One in five breast cancer patients will develop secondary lymphoedema, where failure of the lymphatic system following treatment results in swelling of one of more regions of the body.

Lymphoedema is a chronic and permanent condition.

It’s more than just a physical condition as it can be debilitating and disfiguring, affecting people physically and emotionally.

Icon Cancer Centre Gold Coast Private provides a lymphoedema screening and early intervention service for people during and following their breast cancer treatment.

Icon’s screening service provides:

• Complimentary screening professionals to identify a person’s identify risk

developing lymphoedema using a SOZO machine - the latest technology for breast cancer-related lymphoedema

• Follow-up screening to monitor any changes

• Free screening for one year after treatment finishes

• No referral required for the screening service

• Access to further treatment if required

Beaudesert resident, Carolyn Drynan was diagnosed with breast cancer in November last year following a routine mammogram.

The 65-year-old works alongside her husband and three children on the family’s properties, farming beef cattle.

“I’ve been having mammograms every two years and I’d had no symptoms leading up to that screening,” says Carolyn.

“Two weeks after my mammogram, they called me back to have an ultrasound done.

“That picked up a small lump, which I couldn’t even feel.

“I had a biopsy and that confirmed it was cancer.

“Thankfully my husband was with me with I received the news because I was in shock and I didn’t take in what they were saying.”

Carolyn had surgery on 30 December and started radiation therapy at Icon Cancer Centre Gold Coast Private in February.

During her first week of radiation therapy, Carolyn drove the three hour round trip from Beaudesert to the Gold Coast each day for treatment.

She then opted to stay in the area during the week to have her treatment, returning home to Beaudesert on weekends.

Carolyn recently completed her treatment and has now turned her attention to monitoring for lymphoedema.

“The team (at Icon Cancer Centre Gold Coast Private) have been great in giving me all the information I need to stay on top of lymphoedema,” says Carolyn.

“I’ve started the screening process using the (SOZO) machine.

“I’m doing everything possible not to develop it.

“I do my exercises twice a day and I’ll definitely keep up with my screenings after I’ve finished treatment.”

For more information about lymphoedema, visit iconcancercentre.com.au/treatment/ lymphoedema

medicallink.com.au • 27
ADVERTORIAL
28
"Australia continues to have the unenviable status as the skin cancer capital of the world1."

The Role of Radiation Therapy in Keratinocyte Cancer Management

(07) 5598 0366 |

Australia continues to have the unenviable status as the skin cancer capital of the world.1 The incidence of keratinocyte cancers, basal and squamous cell carcinomas (BCCs and SCCs), has increased consistently for the past 30 years, and approximately 70% of Australians will have at least one BCC or SCC excised in their lifetime1, 2. This is an enormous disease and treatment burden, both to patients and the healthcare system, particularly as many patients have multiple lesions. The economic burden is now estimated at $1.2 billion in Australia3. In 2020, there was a significant reduction in skin cancer diagnoses, related to impact of COVID-19, rather than a genuine reduction in skin cancer prevalence4. A rebound in diagnoses is expected, as is identification of more advanced disease. Although treatment success rates for keratinocyte carcinomas is very good in comparison to other cancers, early diagnosis and treatment is important to prevent morbidity,5 and in the setting of SCCs reduce the risk of metastatic spread6

A prior diagnosis increases the risk of future skin cancers as patients age. This is associated with lifestyle patterns and often widespread areas of sun exposure. Extended skin field cancerisation (EFSC) refers to the accumulation of ultra-violet light (UVL)-damage and genetic mutations that heighten the risk of cancerous transformation7 EFSC is frequently associated with widespread areas of pre-cancerous actinic keratoses that also require treatment. Often these patients

have a protracted history of multidisciplinary management and combination therapy such as topical antineoplastics, photodynamic therapy (PDT), cryotherapy, curettage & electrodessication, and excisions8. Some patients, with persistent changes despite trialling other therapeutic options, are looking for non-invasive strategies to manage disease.

Radiation therapy is a well-established treatment for skin cancer, with long-term cure rates similar to surgery for certain presentations9-12. It is effective as a non-invasive option for lesions in areas where surgery would result in significant cosmetic imperfections, for patients unsuitable for surgery or in the adjuvant setting for high-risk lesions13-15. Technological advances in radiation therapy, such as volumetric modulated arc

therapy (VMAT) allow treatment to be sculpted to large areas of skin affected by pre-cancerous lesions and invasive disease, known as wide field radiotherapy16,17. Recent 12-month follow-up data has revealed promising outcomes for patients with extensive disease who were treated with widefield radiotherapy18. These data underscore some promising advances in the radiation therapy space, particularly how it can be applied to different presentations of skin cancer.

A patient treated with widefield radiation therapy, showing scalp before treatment commenced, and at 24-month follow-up

General Practitioners (GPs) are integral to the diagnosis and treatment of skin cancer, and the longitudinal management of patients with

medicallink.com.au • 29
www.genesiscare.com/au
Figure 1 and 2: A patient treated with widefield radiation therapy, showing scalp before treatment commenced, and at 24-month follow-up. Figure 1
ADVERTORIAL
Figure 2

widespread disease. As such, we are pleased to offer a holistic GP-focussed education program on skin cancer and the role of radiation therapy, covering definitive, adjuvant treatment both for local and regional control and widefield interventions.

Modern Radiation Therapy techniques for the treatment of Keratinocyte Carcinomas (NonMelanoma Skin Cancer).

This program is comprised of 4 modules, each running for 1 - 1.5 hours, covering:

1) keratinocyte cancer incidence, risk factors and treatments

2) radiation therapy advances, its application to skin cancer and treatment guidelines

3) radiation therapy skin reactions, patient management and FAQs

4) interactive case study analysis and referral guidelines.

The first three modules are completed online at the learner’s own pace with incorporated assessment and feedback. The final module is a live, interactive webinar led by a local radiation oncologist, with a focus on real-world case studies. These sessions are small (~10-15 participants) to encourage participation and provide an opportunity to ask direct questions.

This program is accredited as part of the RACGP continuing professional development (CPD) program for six CPD hours (4-education activities;

2 – reviewing performance). It is also eligible for ACRRM and Skin Cancer College CPD hoursbased learning.

To register, visit this website: https:// GenesisCareLearning.litmos.com.au/self-signup/ Please use the code: SKINRT when registering for the online education program.

Once you have registered, log-in to the online education program at: https://genesiscarelearning. litmos.com.au/

References

1) Olsen et al. Keratinocyte cancer incidence in Australia: a review of population-based incidence trends and estimates of lifetime risk. Public Health Research and Practice. 2022; 32:1.

2) Staples et al. Non-melanoma skin cancer in Australia: the 2002 national survey and trends since 1985. Med J Aust 2006 Jan 2;184(1):6-10

3) Gordon et al. ”Estimated Healthcare Costs of Melanoma and Keratinocyte Skin Cancers in Australia and Aotearoa New Zealand in 2021” Int. J. Environ. Res. Public Health 2022, 19(6), 3178

4) Roseleur et al. Skin checks and skin cancer diagnosis in Australian general practice before and during the COVID-19 pandemic, 2011-2020. Br J Dermatol. 2021 Oct;185(4):853-855.

5) Mathias et al. Assessing health-related quality of life for advanced basal cell carcinoma and basal cell carcinoma nevus syndrome: development of the first disease-specific patientreported outcome questionnaires. JAMA Dermatol. 2014 Feb;150(2):169-76.

6) Brougham et al.  The incidence of metastasis from cutaneous squamous cell carcinoma and the impact of its risk factors.  J Surg Oncol. 2012;106(7):811-5.

7) Willenbrink et al. Field cancerization: Definition, epidemiology, risk factors, and outcomes. J Am Acad Dermatol. 2020 Sep;83(3):709-717.

Bariatric and General Surgeon

8) Cornejo et al. Field cancerization: Treatment. J Am Acad Dermatol. 2020 Sep;83(3):719-730.

9) Hernandex-Machin et al. Office-based radiation therapy for cutaneous carcinoma: evaluation of 710 treatments. Int J Dermatol. 2007. 46:453-459

10) Cognetta et al. Superficial x-ray in the treatment of basal and squamous cell carcinomas: a viable option in select patients. J A Acad Dermatol. 2012. 67:1235-1241

11) Schulte et al Soft x-ray therapy for cutaneous basal cell and squamous cell carcinomas. J Am Acad Dermatol. 2005; 53:9931001

12) Grossi Marconi et al. Head and Neck non-melanoma skin cancer treated by superficial x-ray therapy: An analysis of 1021 cases. PLoS One 2016; 11:e0156544

13) Likhacheva et al., 2020, ‘Definitive and Postoperative Radiation Therapy for Basal and Squamous Cell Cancers of the Skin: Executive Summary of an American Society for Radiation Oncology Clinical Practice Guideline’, Practical Radiation Oncology, vol. 10, no. 1, DOI <https://doi.org/10.1016/j. prro.2019.10.014>.

14) NCCN Clinical Practice Guidelines in Oncology. Basal cell skin cancer. Version 1.2017. Published October 3, 2016. https:// www.nccn.org/professionals/physician_gls/pdf/nmsc.pdf

15) NCCN Clinical Practice Guidelines in Oncology. Squamous cell skin cancer. Version 1.2017. Published October 3, 2016. https://www.nccn.org/professionals/physician_gls/pdf/squamous. pdf

16) Wills et al. Dosimetric comparison of volumetric modulated arc therapy (VMAT) and high-dose-rate brachytherapy (HDR-BT) for superficial skin irradiation with significant curvature in one or more planes. Strahlenther Onkol. 2021 Jun;197(6):547-554.

17) Ostheimer et al. Dosimetric comparison of intensitymodulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) in total scalp irradiation: a single institutional experience. Radiat Oncol J. 2016 Dec;34(4):313-321.

18) Potter et al. Preliminary efficacy and safety analysis: 12-month results in 83 patients using a novel approach of widefield radiation therapy for extensive skin field cancerization with or without keratinocyte cancers. J Dermatol. Treat. 2022 23:1-9

Assoc. Prof Harald Puhalla MD FRACS

An experienced general surgeon with a sub-specialist interest in bariatric and upper gastrointestinal surgery.

Using the latest surgical techniques, including minimally invasive treatment technologies, Harald has helped thousands of people achieve the best health outcomes. Bariatric patients especially benefit from his close partnership with bariatric dietitians, exercise physiologists and psychologists. It is this dedication to holistic care, and Harald’s compassionate manner, that give his patients individual solutions for long-term results.

Bariatric Surgery has substantial health benefits:

No or reduced medication for:

• Type 2 diabetes

• Hypertension

• High cholesterol

• Osteoarthritis / joint pain

• Decreased risk of heart attacks, strokes, blood clots

Decreased risk of developing 13 types of cancer (e.g. large bowel, ovarian)

• Better quality of life and increased physical activity

• Prolonged life expectancy (calculated from the age of 40 years)

• Improved fertility female (polycystic ovarian syndrome) and male

30 • Issue 144 • THE MEDICAL LINK
Pacific Private Clinic Suite 4, Level 6, 123 Nerang Street, Southport, QLD, 4215 Regular operating lists at Gold Coast Private Hospital and Pindara Private Hospital F (07) 5636 6275 E admin@generalsurgerygoldcoast.com.au PHONE (07) 5667 9766 weightlessoperation.com.au Bariatric Services Gastric Sleeve | Roux-en-Y Gastric Bypass Single Anastomosis Gastric Bypass | Revision Bariatric Surgery

Modern radiation therapy techniques for the treatment of keratinocyte carcinoma and

skin field

cancerisation

RACGP-accredited education program: 6 CPD hours

This education program is accredited by RACGP (6 CPD hours) and ACRRM (4-education activities; 2 - reviewing performance), and provides GPs with a holistic learning experience on the role of modern radiation therapy in the management of keratinocyte carcinoma and skin field cancerisation. Learning hours are also recognised by the Skin Cancer College Australasia.

The learnings from this program include: disease presentations that may be suitable for radiation therapy, treatment efficacy rates, technological advances, as well as the patient care pathway.

Divided into 4 components, modules 1 - 3 are completed online at the learner’s own pace (4 hours, including assessment). Module 4 is a 1-hour live interactive webinar with a local radiation oncologist, providing an opportunity to engage with the specialist on real-world case studies.

Radiation therapy for keratinocyte carcinomas and skin field cancerisation

Management of radiation side effects; and the patient referral and treatment pathway

Live, interactive radiation oncologistled webinar

Register for the accredited education program via the QR code, or visit:

GenesisCareLearning.litmos.com.au/self-signup

To complete your registration please use the code: SKINRT

Once you have registered, log-in to the online program at: genesiscarelearning.litmos.com.au

or 1800 314 430

Introduction to keratinocyte carcinomas and current treatments
Module 1 Module 2 Module 3 Module 4
skin@genesiscare.com
3.5 0 2.5 AU_3168_P_V1_02.2024
For further details, contact:

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