1 RADIATION ONCOLOGY GROOTE SCHUUR HOSPITAL & UNIVERSITY OF CAPE TOWN AUDIT OF ACTIVITIES 2012 SUMMARY New Patients Follow up visits Patient Chemotherapy Administrations New Patients treated with external beam irradiation Patient attendees for irradiation Number of radiation fields Patients planned for irradiation (computer plans) Total Procedures in planning Radio-active implants – largely for the eye Gynaecological sealed radio-active procedures Radioactive iodine administrations for cancer Registrars qualified as specialists Scientific Presentations Scientific Publications CONTENTS A. B. C. D. E. F. G. H. VISION STATMENTS KEY EVENTS CLINICAL SERVICES STAFF TRAINING ACADEMIC ACTIVITIES PROFESSIONAL ORGANIZATIONAL ACTIVITIES STRATEGIC PLAN FOR 2012 2011 2879 39879 7897 1478 18538 54184 2044 32361 65 419 32 4 22 6 2012 2922 36407 8071 1427 16388 55793 2173 30542 41 354 24 6 22 11 2 A. VISION AND VALUE STATEMENTS To Care Clinical Excellence To serve patients with cancer Academic Activities To grow through training, and research Relationships To flourish as a community Environment To uplift us all - - - Our Path to Care Positive Assumption About all people and what we can jointly achieve. Accomplishments Which reflect our aims and professionalism Teamwork That is built on openness, responsiveness and fidelity. Higher Values Which come from a sense of purpose and our common humanity 3 B. KEY EVENTS 1. Clinical Service Radiation Oncology maintains an Oncology service to cancer patients in the Western Cape. The service is organized around 23 multidisciplinary clinics. The Department provided support for patients from the George region; a Public Private Initiative was successfully introduced so that State patients in the George region could receive their treatment in George, instead of having to travel to Cape Town. Activities are reviewed by teleconference every 3 months. One of the departments Linear accelerators was condemned in August 2012 and will be replaced by a sophisticated new unit in a refurbished bunker. The therapy radiographers organized themselves into late night shifts to continue to provide a service to patients. The number of radiation fields delivered and new patients treated by radiation was maintained compared to 2011, largely due to their efforts. Departmental protocols (approximately 80), teaching programmes and educational resources have been placed on-line on the UCT intranet. An Electronic Patient Registry (EPR) is running which provides a synopsis of all patients seen at the clinics. This currently has 60 000 records. 2. Academic Activities The revised SA College of Radiation Oncology syllabus has been successfully implemented. It is now a unified national exam. This places emphasis on the candidates demonstrating their practical abilities through formalised case reports and clinical audits. The Department hosted a 5-day teaching course on behalf of the American Society of Therapeutic Radiology and Oncology (ASTRO)at the University of Cape Town. There were 6 USA Faculty members in attendance. The course was fully subscribed. The course was also supported by the SA Society of Clinical Radiation Oncology. Dr. Alistair Hunter ran a weekend Radiobiology course with approximately 30 attendees from all parts of South Africa. A Departmental Oncology Research Group was established to support Departmental research and increase research output. 4 3. Relationships A Strategic planning meeting was held in October 2011 with an outside facilitator. The Strategic Plan for 2012 was determined as described in this document. An empowerment event for our patients, their caregivers and staff was hosted at Groote Schuur Hospital. A multi-disciplinary team led by the Social Workers initiated and planned this outstanding event. The primary focus was to inform persons living with cancer of the resources available to them in the community, thereby ensuring that they make informed decisions about their care. The event was oversubscribed. The support group for persons living with cancer meets twice a week. Many of the patients report on how the group has successfully instilled hope in them and also helped them to deal with news of poor prognosis. Relationships have been established with CANSA and People Living with Cancer (PLWC). 4. Environment & Facilities A new linear accelerator was installed at the end of 2012 and will be commissioned in early 2013. At the same time, major new developments in technology will be introduced in 2013. The upgrading of the Department included: the creation of a Seminar Room and Rehabilitation Centre in G7 and G8. A liaison room for coordination of radiation treatment is planned for 2013. 5 C. CLINICAL SERVICES 1) Weekly Multidisciplinary Combined Oncology Clinics Clinics New Patients Other Clinic Visits Sarcoma Melanoma Lymphoma Haematology ENT Head and Neck Ocular Tumour Skin Kaposi Sarcoma Miscellaneous LE32 Breast Clinic Gynae Neuro Pituitary Paediatric neurononcology Paediatric oncology Miscellaneous LE33 Bronchus Urology Thyroid Thyrotoxicosis Oesophagus GIT Unknown Primary Miscellaneous LE34 Clinic includes Radiation Oncology + other departments as in list below Orthopaedics, General Surgery Plastic Surgery Haematology, Radiology, Pathology, Haematopathology, Nuclear Medicine Haematology, Radiology, Pathology, Haematopathology, Nuclear Medicine ENT Surgery, Radiology, Speech Therapy, Dietetics ENT Surgery, Plastic Surgery, Oral & Dental Surgery, Radiology, Dietetics Ophthalmology, Medical Physics Plastic Surgery, Dermatology Surgery, Plastic Surgery, Pathology, Radiology Gynaecological oncology & Pathology Neurosurgery, Neuro-radiology, pathology, Neurology Neurosurgery, Endocrine Paediatric oncology, paediatric endocrine, paediatric neurosurgery Coordinated at Red Cross Hospital Respiratory Medicine, Radiology, Thoracic Surgery Urology, Radiology, Private Sector General Surgery, Nuclear medicine, Endocrinology, pathology Thoracic surgery, dietician Surgery, Radiology - 2011 2012 2879* 2924 39879 36405 72 57 30 32 154 134 14 102 97 136 185 51 130 128 83 464 43 109 111 17 504 287 76 309 75 15 24 30 37 N/A 50 295 16 332 206 21 174 30 * 135 213 170 37 104 244 180 90 These figures are from Clinicom. N/A = these patients are registered under Misc for Admin logistical reasons 6 2) Outpatient Clinics Attendances - E Floor New Patients 2011 2012 Clinic Follow Ups 2011 Radiotherapy Treatment checks 2011 2012 2012 LE 32 979 908 9089 9070 933 932 LE 33 823 862 16069 14256 1957 1716 LE 34 1077 1154 11368 10049 463 382 Total 2879 2924 36526 33375 3353 3030 3) Ward Statistics Total beds = 41 No of pt. Admissions Discharges Bed Occupancy* WARD G7 2011 2012 6481 6264 998 913 921 818 86% 77.5% WARD G8 2011 2012 5946 5939 873 974 758 878 80% 73.4% * This includes as vacancy the weekends.. There is a Weekly Continuing Care Ward Round (CCWR) with involvement of Occupational therapy, Dietetics, Social Work, nursing staff, St Luke’s Hospice, Radiation Oncology and medical students. This is in addition to the Oncology care rounds. 4) Radiotherapy Planning 2011 Total Patients 2023 New Patients 1524 Repeat Patients 466 Planning CT scans 446 Diagnostic CT 90 Simulated Patients 1683 No. Field Simulations 2927 Total Procedures* 32361 * Includes other procedures e.g. computer plans. 2012 2123 1608 515 519 78 1545 2723 30542 7 5) External Beam Radiotherapy Administration New Patients / Retreatments Attendances Fields 2011 2012 2011 2012 2011 2012 Linac.2 331 142 5399 1756 15728 4459 Linac.3 417 519 8355 10314 28341 42318 Theratron 2 11 258 45 1479 83 3084 Theratron 3 702 504 4601 2805 9735 5830 Med. Voltage 17 4 138 34 297 102 1478 1427 18538 16388 54184 55793 -See comment TOTAL Comments: Linac 2 - Condemned August 2012. Linac 3 - Extended hours Jan – Dec 2012. Ther 2 - Operational mid-August 2012 – Dec 2012. Ther 3 - Operational Jan 2012 – August 2012 only due to renovation. Medium Voltage - Condemned June 2012. 8 6) Radioactive Implants I-125 Seeds 2011 Eye plaques (I-125) 35 2012 20 I-125 Claws / eye applicator 2 Sr-90 applicator: 11 I-125 Orbits implant 7 9 Patients Other / oral cavity implants Other (keloids) 9 3 5 5 Insertions TOTAL all implants 65 41 Beta Plaque 2011 15 2012 21 48 40 7) Intracavitary Administrations GYNAE CT/ RECORDS C9 Procedure Number of patients treated = 2011 2012 126 114 384 299 Tandem/Ovoid/Ring Combinations = Vaginal cylinders = 35 _______ = 419 Total number of procedures 55 ______ 354 8) Internal Administrations Radioactive Iodine administration for cancers 2011 32 2012 24 9 7. Gynae Oncology - Sample Registry Data All Cervix Uterus Ovary Vulva Vagina GTN TOTAL CERVICAL CANCER 14 YEARS INCL 2012 250 200 150 100 Series1 50 Linear (Series1) 0 1 3 5 7 9 11 13 UTERINE CANCER 14 YEARS INCL 2012 100 80 60 Series1 40 Linear (Series1) 20 0 1 3 5 7 9 11 13 2011 2012 177 67 39 18 1 7 309 185 78 46 18 4 4 335 10 OVARIAN CANCER 14 YEARS INCL 2012 70 60 50 40 30 20 10 0 Series1 Linear (Series1) 1 3 Cervix Stage I II III IV Recurrence Uterus Stage I II III IV Recurrence Sarcoma Stage Ovary I II III IV GCT Stromal presumed 5 7 9 11 13 2011 66 48 67 2 2012 48 53 62 20 2 2 2011 31 3 10 8 2012 34 3 11 8 0 1 15 20 2011 11 2 12 1 2012 21 4 6 3 4 3 5 1 0 10 11 D. STAFF Medical Staff RP Abratt Professor and Head of Department: Dr J Parkes Head of Clinical Unit Neurosurgery, Sarcoma and Paediatric Dr L Van Wijk Gynaecology Dr H Simonds Breast Dr Z Mohamed Lymphomas and Kaposi Sarcomas Dr B Robertson GIT, Thyroid, Unknown Primary Dr J Wetter Head and neck, Eyes Dr S Dalvie Bronchus, Melanoma and Ear Nose and Throat Dr R Burger Urology and Oesophagus Dr L Shepherd Principal Medical Officer Registrars: 8 Supernumerary Registrars: 8 A number of doctors have been appointed to assist with teaching through clinics. Radiobiologists Dr A Hunter and Dr A Hendrikse Radiation Therapists 33 Full Time Equivalents - i.e. including 1 x 6/8, 1 on contract and 3 Community Service. Nursing Staff For the Wards and Out Patients: 22 Sisters and 33 Nurses. Total = 55 Social Workers For the Wards and Out Patients: Total = 4 Pharmacists In Outpatients = 2 12 Research Nurses and Study Personnel Total = 6, mainly on a part time basis. Administrative Staff Chief Clerk : 1 Senior Admin Clerk: 16 Registry Clerks: 1 13 SPECIALIST PORTFOLIOS CLINICS SERVICE Clinical & RT Protocols RT Users group Pharmacy IPP George Hosp services Community Outreach L van Wijk Clinic Specialist J Parkes & H Simonds B. Robertson L van Wijk L van Wijk, Z Mohamed, H Simonds L van Wijk & R Burger ACADEMIC ACTIVITIES - TEACHING Procedures in Learning Portfolio’s J Club, Bun Club T & P Monday Mtg Med Student tuts Under grad program Post grad program Tues pm Tutorials CPD records J Parkes Clinic Specialist B Robertson S Dalvie J Wetter & R Burger J Wetter & R Burger J Parkes & H Simonds J Wetter S Dalvie ACADEMIC ACTIVITIES - RESERACH Commentaries & Mini theses EPR Data base of Research projects H Simonds R Abratt H Simonds L van Wijk, H Simonds A. Hunter RELATIONSHIPS External Relationships Internal Relationships Human Resources Registrar support Supernumerary Reg support Registrar Leave Registrar Rotation Physics & RT rotations Z Mohamed R. Abratt Clinic Specialist Z Mohamed J Parkes & Z Mohamed Clinic specialist R Burger B Robertson & R Burger R Burger ENVIRONMENT Finances & fund raising Functional Business Unit audits Facility Upgrade Library Facility Safety Officer Maintenance D floor Maintenance E floor Safety D floor R Abratt R Abratt R. Burger J Parkes B Robertson A Hendrikse E Greeff & area managers R Burger S Tovey 14 E. TRAINING Departmental Programme Day Monday Time Activity Venue Convenor 1:15 pm Techniques & Protocols 4.00 pm Any Additional Lectures, ad hoc As arranged Tuesday 4:30 pm Clinical Tutorials Dr J Wetter Wed. 4:00 – 6:00 pm Physics & Statistics Med Physics Seminar room Thursday 1:15 pm Journal Club D35 Lecture Theatre Dr B. Robertson Last 2 wks of month Other 1. D35 Lecture Theatre Dr S. Dalvie Hester Burger Bun Club Radiobiology Lectures arranged at time which is mutually suitable – usually Thursday 4.00 pm Lecturers are Dr. Hunter and Dr. Hendrikse Other 2. 5th year Medical Students: Tutorials: Thursday and Friday from noon to 1.00 pm Other 3 Firm based Activities include review of logbooks & tutorials e.g. RT planning. These are arranged within each firm. A logbook of procedures is maintained by all Registrars and reviewed by their supervising Specialists. Graduation as specialists in 2012 = 6: Drs D. Anderson, S. Ibrahim, M. Elhassan, K. Mohamed, K. Alleyne-Mike and N. Vawda. 15 F: ACADEMIC ACTIVITIES Publications 2012 1. Cancer Care in South Africa (correspondence) RP Abratt, L Dreosti and P Ruff LANCET ONCOLOGY - 13, 324, 2012. 2. The fast neutron therapy program in South Africa should come to an end (letter) R P Abratt SOUTH AFRICAN MEDICAL JOURNAL -103, 58, 2012. 3. Neutron radiotherapy in South Africa Abratt response (letter) RP Abratt SOUTH AFRICAN MEDICAL JOURNAL - 102, 269-270, 2012. 4. Radiotherapy for ocular tumours C Stannard, W Sauerwein, G Maree, K Lecuona Eye ( London, England) 11/2012; DOI:10.1038eye.2012.241. 5. Radiation biology – An important science for an advanced nuclear nation like South Africa A. Hunter South African Journal of Science 2012;108(7/8) 1-10. 6. Treatment of carcinoma of the anal canal at Groote Schuur Hospital B Robertson, L Shepherd, R P Abratt, A Hunter, P Goldberg South African Medical Journal 2012; 102(6):558-561. 7. Tumour lysis syndrome M Irhuma, Z Mohamed, G. Maartens South African Medical Journal CME Vol 30, No2, 79, 2012. 8. Completion of and early response to chemoradiation among human immunodeficiency virus (HIV)-positive and HIV-negative patients with locally advanced cervical carcinoma in South Africa. HM Simonds, J.D Wright, N du Toit, AI Neugut, and JS Jacobson, Cancer 118(11), pp. 2971-2979. 2012. (The work for this publication took place at Tygerberg Hospital). 9. Lung Cancer – (Book Chapter) RP Abratt and S. Dalvie MIMS Handbook of Oncology – in press. 16 10. A Late Haemorrhagic Complication in an ArterioVenous Malformation Cured with Radiosurgery, Case Report D.E.J Le Feuvre, J.D Parkes, P. Mukheiber, R. James, A.G Taylor Interventional Neuroradiology 18: 000-000, 2012. 11. Distinct genetic association at the PLCE1 locus with oesophageal squamous cell carcinoma in the South African population. Bye H, Prescott NJ, Lewis CM, Matejcic M, Moodley L, Robertson B, v.Rensburg C, Parker MI, Mathew CG. Carcinogenesis. 2012 Nov;33(11):2155-61. doi: 10.1093/carcin/bgs262. Epub 2012 Aug PMID: 22865593 [PubMed - in process]. PRESENTATIONS 2012: 1. Results of irradiating post-enucleated non-metastatic retinoblastoma patients with a positive optic nerve resection margin beyond the orbital apex. Jeffrey Kotzen, Clare Stannard et al. SIOP (International Society of Paediatric Oncology) Africa 2012, Cape Town. March 2012. 2. Poster. Brachytherapy of the orbit in young children W Sauerwein, C Stannard, G Maree, et al. ESTRO 31, World Congress of Brachytherapy Barcelona, Spain. May 2012. 3. Poster: The “Claws” – A gold applicator loaded with I-125 seeds for localised whole eye radiotherapy C J Trauernicht, G J Maree, E R Hering, F C P du Plessis, C Stannard, K Lecuona, R Munro, S Tovey, R Mateyse ESTRO 31, World Congress of Brachytherapy, Barcelona, Spain, May 2012. 4. Poster: Ergebnisse der Bestrahlung der Orbita bei Kindern mit Augentumoren. W. Sauerwein, C. Stannard, G. Maree, D. Fluhs, A. Wittig, P. Temming, B. Timmerman, E. Biewald, N. Bornfeld. 18. Jahrestagung der Deutschen Gesellschaft fur Radioonkologie Wiesbaden,Germany, June 2012. 5. Invited talk. Radiotherapy for ocular tumours. Clare Stannard, Wolfgang Sauerwein, Gerrie Maree, Karin Lecuona. 42nd Cambridge Ophthalmology Symposium 2012. Cancer and the Eye, Cambridge, England.2012. 6. Head and Neck Roundtable: Radiotherapy for Nasopharynx Carcinoma Khadiga Mohammed: ASTRO conference May 2012. 7. CNS Roundtable- Glioblastoma Multiforme: A case presentation Kellie Alleyne-Mike: ASTRO conference May 2012 8. Urology Roundtable Salvage Radiotherapy in a Patient with Biochemical Failure post Radical Prostatectomy Sebathu Chiyapo: ASTRO conference May 2012. 17 9. Head and Neck Roundtable: Squamous cell carcinoma of the oral cavity Moawia El Hassan: ASTRO conference May 2012. 10. GIT Roundtable: Long-course pre-operative radiotherapy in a patient with rectal adenocarcinoma and a single liver metastasis. Komeela Naidoo: ASTRO conference May 2012. 11. A Descriptive Analysis of HIV-positive patients with Multicentric Castleman’s Disease seen at Groote Schuur Hospital Oncology Department from 20052011 Z Mohamed and N Novitzky 6th Annual Haematology – Oncology Symposium Cape Sun Hotel, Cape Town. 2012. 12. Hodgkin’s Lymphoma: 2004-2009, A Groote Schuur Hospital Experience N Vawda, Z Mohamed and N Novitzky 6th Annual Haematology – Oncology Symposium Cape Sun Hotel, Cape Town.2012. 13. Submyeloablative Therapy and Tandem Transplantation for patients with Multiple Myeloma at the UCT Myeloma Clinic N Novitzky, C Du Toit, V Thomas and Z Mohamed 6th Annual Haematology – Oncology Symposium Cape Sun Hotel, Cape Town 2012. 14. Invited Speaker; General Oncology talk: “The Smart and the Art of Oncology” Zainab Mohamed Western Cape Provincial Pharmacy Conference Protea Hotel, Stellenbosch.2012. 15. A 30 year audit of patients presenting with ependymoma to Red Cross and Groote Schuur Hospitals, Cape Town Jeanette Parkes SIOP Africa, March 2012. 16. Invited Speaker: Developing radiotherapy services in Africa Jeanette Parkes SIOP Africa, Cape Town, March 2012. 17. A Descriptive Analysis of HIV-positive patients with Multicentric Castleman’s Disease seen at Groote Schuur Hospital Oncology Department from 20052011. Z Mohamed and N Novitzky 6th Annual Haematology – Oncology Symposium Cape Sun Hotel, Cape Town. 2-3 November 2012. 18 18. Hodgkin’s Lymphoma: 2004-2009, A Groote Schuur Hospital Experience N Vawda, Z Mohamed and N Novitzky 6th Annual Haematology – Oncology Symposium Cape Sun Hotel, Cape Town. 2-3 November 2012. 19. Submyeloablative Therapy and Tandem Transplantation for patients with Multiple Myeloma at the UCT Myeloma Clinic N Novitzky, C Du Toit, V Thomas and Z Mohamed 6th Annual Haematology – Oncology Symposium Cape Sun Hotel, Cape Town. 2-3 November 2012. 20. Invited Speaker; General Oncology talk: “The Smart and the Art of Oncology” Zainab Mohamed Western Cape Provincial Pharmacy Conference Protea Hotel, Stellenbosch. 24-26 August 2012. 21. Paediatric CNS tumours: The Groote Schuur and Red Cross Children's Hospital experience. Elhassan, M, Parkes, J. Poster at SIOP Africa 2012, Cape Town. 22. A case review of a child with craniopharyngioma and the use of intratumoral Interferon alfa (IFNa )at Groote Schuur Hospital (GSH), Cape Town. Mohammed. K., Parkes. J. Poster SIOP Africa 2012. G. PROFESSIONAL ORGANIZATIONAL ACTIVITIES International Professional Organizations American Society of Therapeutic Radiation and Oncology RP Abratt - Member of International Educational Committee Lancet Oncology RP Abratt – member of the International Advisory Committee Editorial Board of Radiotherapy and Oncology RP Abratt Editor J Clinical Oncology South Africa. (International appointment) RP Abratt Oncology at the Limits , 3nd Meeting. London 2012 RP Abratt – Member of Scientific Committee African Regional Agreement L van Wijk: Project coordinator International Breast Cancer Study Group for Management of Common Cancers in Africa 19 South African Professional Organizations University of Cape Town A Hunter – member of the Faculty Research Committee A Hunter – Member of Faculty Research Ethics Committee South African Society of Clinical and Radiation Oncology RP Abratt – Member of the Executive Committee College of Radiation Oncology of South Africa President of the College RP Abratt Member of Senate of Colleges of Medicine of South Africa RP Abratt Member of Council of the College of Radiation Oncology RP Abratt, J Parkes Society of Radiographers of S.A. Treasurer: A V Gordon Secretary.: SA Tovey National Council Representative of the Cape Town Branch: S A Tovey RT Rep. : J Van Niekerk Combined Radiography Advisory Committee – W. Cape Member: E A Greeff South African Radiobiology Society (SARS) A Hunter - Chairman South African Association of Physicists in Medicine and Biology (SAAPMB) A Hunter – Council member 16 Jan 2013