Beautiful spaces inside the Victorian Comprehensive Cancer Centre, the new home of the Peter MacCallum Cancer Centre in Melbourne, Australia

[The following article by Dr Sarah Dunlop, advanced trainee in palliative medicine, was first published in the Australian & New Zealand Society of Palliative Medicine (ANZSPM) Newsletter. The next ANZSPM study day will be held on September 6th in Sydney prior the the upcoming ANZSPM 2018 Conference. Follow #ANZSPM18 for updates from this biennial meeting – Chi] 

While there are many benefits of living in Western Australia (the weather, the beaches, and charming, debonair palliative medicine trainees), there are also downsides to living in one of the most isolated cities in the world… specifically the isolation! The decision to travel interstate to a course or conference usually hinges on three questions: can I get the time off, can I afford it, and is it going to improve my practice? So after charming my colleagues into giving a debonair trainee a day off and boarding the red-eye to Melbourne, I can confirm that the Study Day for Trainees and New Fellows met all my requirements. 

The Peter MacCallum Cancer Centre needs no introduction as a pioneering site of cancer care and research in Australia. What is less talked about is the innovative architecture of the building, serene roof garden, cafes and restaurants that make for a very hospitable learning environment.

Peter MacCallum Cancer Centre / Victorian Comprehensive Cancer Centre

After a welcome from ANZSPM trainee representative Dr Emily Cooper, the day started with a lecture on grief and bereavement from Chris Hall, psychologist and Chief Executive Officer of the Australian Centre for Grief and Bereavement. His reflective talk moved beyond the Kubler Ross model to discuss newer perspectives on grief. Chris explained that the emphasis has changed from time focused “moving on”, instead recognising bereavement as a profound event and an opportunity for growth and a new perspective on life. He went on to discuss patients at risk of complex grief reactions and management, punctuated with case examples helping to develop what can appear nebulous concepts.

Chris Hall from the Australian Centre for Grief and Bereavement

A/Prof Michael Franco, dual-trained in palliative medicine and medical oncology, gave a lively and engaging presentation on the current management of lung cancer. Michael explained that while small cell lung cancer is still associated with a poor prognosis, there have been significant changes in the management of non-small cell lung cancer over the last few years. While patients with actionable mutations remain in the minority, immunotherapy for such patients can significantly improve their survival. Similarly, the use of PD-1 antagonists (such as pembrolizumab) has become part of standard treatment for patients with high expressions of PD-1. The challenge of distinguishing between disease progression and immunotherapy-related adverse events was also covered, as was anticipated data from the PEARL study, Australia’s answer to the widely cited Temel study.^1-2 

Dr Tim Hucker presented on interventional pain control and made a strong argument for earlier involvement of pain teams. The use of opioids for pain relief has become an increasingly unattractive option in the field of chronic non-cancer pain management, against the background of the opioid epidemic in the United States. While touching upon intrathecal analgesia, the focus of Tim’s presentation was on neuromodulation and different interventions for focal pain, many of which were completely new to me. He described sphenopalatine ganglion blocks for patients with neuropathic facial pain, ganglion impar blocks for tenesmus, as well as coeliac plexus blocks and radiofrequency ablation.

Dr Keryn Taylor on the intersection between palliative medicine and psycho-oncology

A series of case vignettes served as the basis of psychiatrist Dr Keryn Taylor’s presentation on the intersection between anxiety and depression. The vignettes focused on history taking in patients presenting with symptoms of anxiety and depression, as well as risk assessment, differential diagnosis and finally a very practical consideration of medications. Like Tim, Keryn made a strong case for collaboration between specialties in managing challenging cases.

Finally, the day was rounded off by A/Prof Brian Le with a presentation on “consultant-level skills”, a particular draw for me as a final-term trainee. Brian’s dry humour illuminated the shadowy art of responding to complaints, the benefits and challenges of working in public and private practice, performance management, and service development. We were encouraged to identify our leadership styles, to make the best of our attributes and improve on our weaknesses in an admirably honest and self-effacing presentation.

So did the study day improve my practice? I can honestly say it has. In only a few days of my return, I have found myself referring to the pain team for consideration of a sphenopalatine block; I understood why my patient with non-small cell lung cancer was being considered for immunotherapy under a special access scheme; I have asked a patient refusing treatment what gives her life meaning; and taken a personality test as the first step towards improving my leadership skills.

Throughout training I have attended a multitude of courses and conferences, but few have been so specifically applicable to my practice. While the multidisciplinary nature of palliative medicine is a huge advantage to practice, it can be challenge for presenters to ensure their presentation has broad appeal, occasionally to the detriment of the take-home message. I found that with the focus on trainees and new fellows, I was kept engaged and had a clearer sense of how to apply this new knowledge to my practice. Similarly, I have attended conferences where sessions begin at 7.30am and continue through till 6pm.  The cost of attendance and the pressure to assimilate the most information for your buck can leave me feeling overwhelmed and exhausted. The Trainee and New Fellow Day had a much more manageable start time of 8.45am and close of 4.15pm and allowed an hour per presentation with time between to network with attendees from across the country. I would like to thank the organisers – Dr Emily Cooper, Dr Chi Li and Dr Sadie Dunn – as well as all of the presenters for a thoroughly engaging day and take the opportunity to encourage this as a date in the diary for all trainees.

References

1. Mileshkin L, Yoong J. ALTG 13/008 PEARL: Investigating the impact of early palliative care [Internet]. The Australian Lung Cancer Trails Group; 2017 [Available from: https://altg.com.au/altg-13008/.
2. Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, et al. Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung Cancer. New England Journal of Medicine. 2010;363(8):733-42.