Health informatics research department

Medical oncology research department

• Sharon Guo, Database Manager
• Dr Shehara Mendis, Lead Researcher

Upper Gastrointestinal (GI) cancers are those arising from the oesophagus, stomach, pancreas, liver, biliary tract, and small bowel. One-year survival rates are less than 50 per cent in upper GI cancers and a mere 25 per cent in pancreatic cancer. At five years, survival rates drop to less than 25 per cent for all upper GI cancers.

Patients with upper gastrointestinal tract abnormalities cancer generally require extensive diagnostic work-up prior to formulation of a management plan. Treatment may include systemic therapy (such as chemotherapy), radiotherapy or surgery, or a combination of these depending on the type and extent of cancer. Patient, tumour, and treatment factors impact upon how well the cancer can be cured or controlled.

CAPSTONE is designed to help researchers and doctors treating these cancers understand more about patients diagnosed with upper GI cancers—how they are diagnosed, what treatments they have, how well they do with these treatments, and ultimately use this information to improve care of these patients in the future.

Generous bequests from the late Veronica Choo Neo Png and Elaine Louise Benger have helped Cabrini Research pave the way in upper GI cancers by establishing the CAPSTONE registry. Veronica and Elaine’s legacies will make an important difference in how we help others.

Medical oncology research department

• Matthew Horrigan, Database Manager
• Professor Gary Richardson OAM, Lead Researcher

In Australia, it is estimated that there will be 6652 newly diagnosed cases and 2096 deaths from gynaecological cancer in 2020. In total, 9.4 per cent of all female deaths from cancer will be attributable to gynaecological cancers.

The Cabrini Gynaecological Oncology Registry (CGOR) is a clinical quality data registry managed by Cabrini Research, and reports a data subset to the National Gynae-Oncology Registry (NGOR). The objective of the database is to monitor and improve the quality of care patients diagnosed with gynaecological cancers receive. The registry collects information about diagnosis, treatment, and outcomes of women with gynaecological cancers. The process of improving healthcare systems by providing the hospital with the quality of care data takes time. CGOR is expected to benefit people diagnosed with these cancers in the future. The long-term aim for the registry is to help facilitate national and international benchmarking against agreed best practice. The collection and analysis of data will hopefully allow changes in practice that will improve key patient outcomes including overall survival, disease-free survival and quality-of-life.

The establishment of the CGOR was made possible by a generous bequest from the late Paula Reinders. Paula’s legacy will ensure more needed research is conducted into gynaecological cancers.

Medical oncology research department

• Dr Stefanie Elbracht-Leong, Database Manager
• Professor Gary Richardson OAM, Lead Researcher

Lung cancer is the fifth most commonly diagnosed cancer in Australia, yet it consistently remains the leading cause of cancer related death¹. Although incidence and mortality rates have improved over the past four decades, the five-year survival rate for lung cancer patient currently remains one of the lowest survival rates of any cancer in Australia at just 18 per cent averaged across all diagnosis stages²; and only 3.2 per cent of patients diagnosed with stage IV lung cancer will survive five years after diagnoses¹.

In order to achieve improvements in outcomes for patients living with lung cancer and alleviate the burden of this disease, more research is required. Real world data derived from population-based databases and clinical registries is increasingly recognised as an important complement to clinical trials³. Databases and registries are used to perform cohort studies and address clinical questions such as the efficacy of treatment, variations in clinical decision-making across treatment settings and influences on patient outcomes. When undertaken by investigators with clinical expertise and a thorough understanding of databases advantages and limitations, these studies can significantly enhance quantitative research regarding lung cancer treatment.

Patient data collected will include but is not limited to demographics, histopathology and genomic analysis, stage of disease, exposure history, treatments, and survival. Data will be obtained from prospective patients diagnosed with lung cancer being treated at both Cabrini Malvern and Brighton sites. Data will be extracted from their treating physician, medical records, clinical systems (PAS and CHARM), multi-disciplinary team meetings and hospital coded data that applies financial costs to diseases, health related problems and procedures performed in hospital (ICD­10 coded extracts).

The database will be used for internal audits, generating reports to feedback to treating physicians and multi-disciplinary team meetings. De-identified patient data will also be used by researchers to address important clinical questions. Overall the main aim for establishing the Cabrini lung cancer registry is to capture all lung cancer patients’ clinical data and to monitor health outcomes which will lead to improved quality of care of patients treated at Cabrini.

Generous donations from Freda Castan has enabled the launch of the lung cancer database. Freda’s commitment will lead to improved quality of care of patients treated at Cabrini and support new research.

¹Australian Institute of Health and Welfare 2019. Cancer in Australia 2019. Cancer series no.119. Cat. no. CAN 123. Canberra: AIHW. https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia

²Noone, A., et al., SEER Cancer Statistics Review, 1975-2015, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2015/, based on November 2017 SEER data submission, posted to the SEER web site, April 2018.

³Booth, C.M., S. Karim, and W.J. Mackillop, Real-world data: towards achieving the achievable in cancer care. Nat Rev Clin Oncol, 2019. 16(5): p. 312-325.

⁴Victorian lung cancer Registry https://vlcr.org.au/

Urology research department

• Justin Lang, Database Manager
• Professor Mark Frydenberg, Lead Researcher

According to the World Health Organisation, Australia and New Zealand have one of the highest rates of prostate cancer. Fortunately, the improvement in screening and treatment is contributing to better survival rates. An important part of helping more men survive is enabling best-practice treatment and improvements in quality of life. The Prostate Cancer Outcomes Registry—Australia and New Zealand (PCOR-ANZ) database is building a population-based prostate cancer clinical registry to improve the quality of care provided to men diagnosed with prostate cancer. PCOR-ANZ aims to build understanding of the disease burden of prostate cancer, and aid the implementation of evidence-based support services.

The registry collects treatment data as well as surveying patients’ quality of life before and after treatment. By reporting on these factors, the goal is to reduce the negative effects of urinary, bowel, and sexual function and increase general physical health and mental wellbeing. The reported quality indicator reports to clinicians provide a cross-sectional view of clinical and demographic aspects of prostate cancer and patterns of care, which helps understand the uptake of evidence-based practice. By contribution to a robust dataset, patient data across many institutions assists in the design of clinical trials and identification of questions for study. Overall, clinicians and institutions can be provided with mortality and morbidity data associated with various risk and treatment groups, both for their own patients and the wider cohort of men with prostate cancer. PCOR-ANZ seeks to deliver data that is fully representative of prostate cancer practice and outcomes across Australia and New Zealand in the near future.

Cabrini Monash University Department of Surgery

• John Paul Plazzer, Database Manager
• Professor Paul Mcmurrick, Lead Researcher

The Cabrini Monash Colorectal Neoplasia Database (CMCND), funded by the Cabrini Monash University Department of Surgery, commenced in 2010 and was spearheaded by surgeons committed to excellence in the prevention, diagnosis and treatment of patients with colorectal cancer. The database continues to grow as an essential tool allowing surgeons to benchmark their performance amongst their peers by capturing data on patients with either bowel cancer or benign bowel neoplasia surgically treated at Cabrini Health and other Monash affiliated hospitals including The Alfred, Peninsula Health, and Monash Medical Centre. In 2013, the Colorectal Surgical Society of Australia and New Zealand (CSSANZ) developed the Bi-National Colorectal Cancer Audit (BCCA), a minimally scaled duplicate version with participation from over 435 registered contributors across Australia and New Zealand contributing data on over 46,000 patients.

Bowel cancer is the second most common cause of cancer death in Australia. The database revealed only 14 per cent of patients present as a consequence of bowel cancer screening. Screening detects bowel cancer when it is at an early stage in people with no symptoms. This is when treatment is more likely to be effective. Screening can also find polyps. These are abnormal clumps of cells in the bowel. Polyps are not cancers, but may develop into cancers over time. Polyps can be easily removed, which reduces the risk of bowel cancer developing. In Australia, the National Bowel Cancer Screening program (NBCSP) invites all Australians aged 50-74 to complete screening biannually however our data indicates 10 per cent of all patients diagnosed with bowel cancer are aged under 50 with seven per cent in the 40-49 age group, currently not captured by NBCSP. In May 2021, the US Preventive Services Task Force (USPSTF), recommended screening start at age 45 with guidelines in Australia today stating GPs can offer a Faecal Occult Blood Test (FOBT) every two years to people aged 45-49 who request it, thereby supporting the USPSTF recommendation—which is very encouraging moving forward. We also know 40 per cent of people diagnosed with cancer in Australia will be of working age (25–64 years). Our data indicates 35 per cent of patients diagnosed with bowel cancer are in that working age group and, depending on type of treatment received, may have a significant impact on work ability. By looking at what is being done now, the audit can suggest changes to improve care for people with bowel cancer in the future.

Launch of the Patient-Reported Outcome Measures (PROMS) program

There are many challenges we face such as raising screening rates, defining optimal care pathways and addressing many clinical research questions. We strongly believe the patient voice and bowel cancer experience truly matters and we are interested in gathering information from as many patients as possible about their quality of life before and after treatment. To this end, we launched the Patient-Reported Outcome Measures (PROMS) program at Cabrini and Alfred hospitals in July 2021. The program will allow patients to inform clinicians seamlessly and securely, in real-time, of the symptomatic and functional outcomes they are experiencing. With what we learn, we’re hoping more patients will be able to get back to doing the things they love, with the people they care about most.

Medical oncology research department

• Melissa Vereker, Database Manager
• Professor Gary Richardson OAM, Lead Researcher

Breast cancer is the most common cancer and the second leading cause of cancer-related death in Australian women. One in seven Australian women will be diagnosed with breast cancer in their lifetime. The rate of mortality is decreasing due to earlier detection by screening mammography and advances in treatment.

The purpose of the Cabrini Breast Cancer Database is to improve the safety and quality of cancer treatment and outcomes for patients diagnosed with early and locally advanced breast cancer at Cabrini. The database was established in November 2016 and data has been collected for 1950 patients at Cabrini. The database records detailed information about diagnosis, tumour characteristics, stage, treatment and outcomes of patients with breast cancer, which allows health professionals to monitor standards of care at Cabrini and benchmark against national and international treatment standards.

Monitoring and measuring safety and patient care is an essential part of healthcare delivery. At the Cabrini breast cancer service, routine data collection is integrated with clinical practice to support the management of multidisciplinary team meetings, document patient treatment summaries and care plans, and drive quality activities and research. Data is captured throughout the patient’s journey, from diagnosis to follow-up care. The data is used to measure quality of cancer care, compliance with best practice guidelines, identify areas for service improvement, and ensure patients receive safe and effective treatment. The data will help improve the management, treatment and outcomes of future breast cancer patients, identify patients who may benefit from new treatments or clinical trials, and evaluate long term effects and outcomes for treatment that was provided many years ago.

The Breast Cancer Database has been specifically designed to capture details about the complexity and variation in breast cancer tumours including hormone-receptor expression, as well as core biopsy, primary, and metastatic tumour information. The database also collects vital outcomes information including treatment modification, response to therapy, toxicity, disease progression, recurrence and cancer status at death.

Cardiac Surgical Registry of the Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS)

Mr Gil Shardey, Chair And Database Manager

As a highly technical and specialized area of medicine, cardiothoracic surgery is constantly advancing in techniques and knowledge base. Integral to this advancement is the requirement to ensure the attainment and maintenance of best practice at an individual and national level.

The Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) views routine systematic collection of data related to each surgical procedure and the monitoring of that data as the cornerstone of best practice. Surgical performance data is communicated to the Australian cardiac surgery community in the hope that knowledge of performance will lead to improved outcomes. The ANZSCTS Database Steering Committee welcomes feedback from participating sites about how to improve program initiatives.

Cabrini is one of the 26 public, and 30 private hospitals contributing to the ANZSCTS Cardiac Surgery Database. Inofrmation from over 153,000 cardiac surgeries has been input into the database so far.