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RADIATION ONCOLOGY
GROOTESCHUURHOSPITALUNIVERSITY OF CAPE TOWN
AUDIT OF ACTIVITIES 2012
SUMMARY
2011 2012
New Patients / 2879 / 2922Follow up visits / 39879 / 36407
Patient Chemotherapy Administrations / 7897 / 8071
New Patients treated with external beam irradiation / 1478 / 1427
Patient attendees for irradiation / 18538 / 16388
Number of radiation fields / 54184 / 55793
Patients planned for irradiation (computer plans) / 2044 / 2173
Total Procedures in planning / 32361 / 30542
Radio-active implants –largely for the eye / 65 / 41
Gynaecological sealed radio-active procedures / 419 / 354
Radioactive iodine administrations for cancer / 32 / 24
Registrars qualified as specialists / 4 / 6
Scientific Presentations / 22 / 22
Scientific Publications / 6 / 11
CONTENTS
- VISION STATMENTS
- KEY EVENTS
- CLINICAL SERVICES
- STAFF
- TRAINING
- ACADEMIC ACTIVITIES
- PROFESSIONAL ORGANIZATIONAL ACTIVITIES
- STRATEGIC PLAN FOR 2012
- 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
Aboutall people and what we can jointly achieve.
Accomplishments
Which reflect our aims andprofessionalism
Teamwork
That is built on openness, responsiveness and fidelity.
Higher Values
Which come from a sense of purpose and our common humanity
- KEY EVENTS
- 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.
- 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 DepartmentalOncology Research Group was established to support Departmental research and increase research output.
- 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 GrooteSchuurHospital. 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).
- 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.
C.CLINICAL SERVICES
1) Weekly Multidisciplinary Combined Oncology Clinics
Clinics / Clinic includes Radiation Oncology + other departments as in list below / 2011 / 2012New Patients / 2879* / 2924
Other Clinic Visits / 39879 / 36405
Sarcoma / Orthopaedics, General Surgery / 72 / 57
Melanoma / Plastic Surgery / 30 / 32
Lymphoma / Haematology, Radiology, Pathology, Haematopathology,Nuclear Medicine / 154 / 134
Haematology / Haematology, Radiology, Pathology, Haematopathology,Nuclear Medicine / 14
ENT / ENT Surgery, Radiology, Speech Therapy, Dietetics / 102 / 97
Head and Neck / ENT Surgery, Plastic Surgery, Oral & Dental Surgery, Radiology, Dietetics / 136 / 185
Ocular Tumour / Ophthalmology, Medical Physics / 51 / 43
Skin / Plastic Surgery, Dermatology / 130 / 109
Kaposi Sarcoma / - / 128 / 111
Miscellaneous LE32 / - / 83 / 17
Breast Clinic / Surgery, Plastic Surgery, Pathology, Radiology / 464 / 504
Gynae / Gynaecological oncology & Pathology / 287 / 309
Neuro / Neurosurgery, Neuro-radiology, pathology, Neurology / 76 / 75
Pituitary / Neurosurgery, Endocrine / 15 / 30
Paediatric neuron-oncology / Paediatric oncology, paediatric endocrine, paediatric neurosurgery / 24 / 37
Paediatric oncology / Coordinated at RedCrossHospital / N/A
Miscellaneous LE33 / - / 50 / 16
Bronchus / Respiratory Medicine, Radiology, Thoracic Surgery / 295 / 332
Urology / Urology, Radiology, Private Sector / 206 / 174
Thyroid / General Surgery, Nuclear medicine, Endocrinology, pathology / 21 / 30
Thyrotoxicosis / - / *
Oesophagus / Thoracic surgery, dietician / 135 / 104
GIT / Surgery, Radiology / 213 / 244
Unknown Primary / - / 170 / 180
Miscellaneous LE34 / - / 37 / 90
These figures are from Clinicom.
N/A = these patients are registered under Misc for Admin logistical reasons
2) Outpatient Clinics Attendances - E Floor
New Patients / Clinic Follow Ups / Radiotherapy Treatment checks2011 / 2012 / 2011 / 2012 / 2011 / 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
WARD G7 / WARD G82011 / 2012 / 2011 / 2012
No of pt. / 6481 / 6264 / 5946 / 5939
Admissions / 998 / 913 / 873 / 974
Discharges / 921 / 818 / 758 / 878
Bed Occupancy* / 86% / 77.5% / 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 / 2012Total Patients / 2023 / 2123
New Patients / 1524 / 1608
Repeat Patients / 466 / 515
Planning CT scans
Diagnostic CT / 446
90 / 519
78
Simulated Patients / 1683 / 1545
No. Field Simulations / 2927 / 2723
Total Procedures* / 32361 / 30542
* Includes other procedures e.g. computer plans.
5) External Beam Radiotherapy Administration
New Patients / Retreatments / Attendances / Fields2011 / 2012 / 2011 / 2012 / 2011 / 2012
Linac.2 / 331 / 142 / 5399 / 1756 / 15728 / 4459
Linac.3 / 417 / 519 / 8355 / 10314 / 28341 / 42318
Theratron 2
-See comment / 11 / 258 / 45 / 1479 / 83 / 3084
Theratron 3 / 702 / 504 / 4601 / 2805 / 9735 / 5830
Med. Voltage / 17 / 4 / 138 / 34 / 297 / 102
TOTAL
/ 1478 / 1427 / 18538 / 16388 / 54184 / 55793Comments: 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.
6) Radioactive Implants
I-125 SeedsEye plaques (I-125) / 2011 / 2012
35 / 20
I-125 Claws / eye applicator / 11 / 2 / Sr-90 applicator: Beta Plaque
2011 / 2012
I-125 Orbits implant / 7 / 9 / Patients / 15 / 21
Other / oral cavity implants / 9 / 5 / Insertions / 48 / 40
Other (keloids) / 3 / 5
TOTAL all implants / 65 / 41
7) Intracavitary Administrations
GYNAE CT/ RECORDS C9Procedure 20112012
Number of patients treated =126 114
Tandem/Ovoid/Ring Combinations =384 299
Vaginal cylinders = 35 55
______
Total number of procedures = 419 354
8) Internal Administrations
2011 / 2012Radioactive Iodine administration for cancers / 32 / 24
7. Gynae Oncology - Sample Registry Data
All / 2011 / 2012Cervix / 177 / 185
Uterus / 67 / 78
Ovary / 39 / 46
Vulva / 18 / 18
Vagina / 1 / 4
GTN / 7 / 4
TOTAL / 309 / 335
Cervix Stage / 2011 / 2012
I / 66 / 48
II / 48 / 53
III / 67 / 62
IV / 2 / 20
Recurrence / 2 / 2
Uterus Stage / 2011 / 2012
I / 31 / 34
II / 3 / 3
III / 10 / 11
IV / 8 / 8
Recurrence / 0 / 1
Sarcoma / 15 / 20
Stage Ovary / 2011 / 2012
I / 11 / 21
II / 2 / 4
III / 12 / 6
IV / 1 / 3
GCT / 4 / 1
Stromal / 3 / 0
presumed / 5 / 10
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 GynaecologyDr H SimondsBreast
Dr Z MohamedLymphomas and Kaposi Sarcomas
Dr B RobertsonGIT, Thyroid, Unknown Primary
Dr J WetterHead and neck, Eyes
Dr S DalvieBronchus, Melanoma and Ear Nose and Throat
Dr R BurgerUrology and Oesophagus
Dr L ShepherdPrincipal 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
33Full Time Equivalents - i.e. including 1 x 6/8, 1 on contract and 3Community 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
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
SPECIALIST PORTFOLIOS
CLINICS SERVICEL van Wijk
Clinical & RT ProtocolsClinic Specialist
RT Users groupJ Parkes & H Simonds
PharmacyB. Robertson
IPPL van Wijk
George Hosp servicesL van Wijk, Z Mohamed, H Simonds
Community OutreachL van Wijk R Burger
ACADEMIC ACTIVITIES- TEACHINGJ Parkes
Procedures in Learning Portfolio’sClinic Specialist
J Club, Bun Club B Robertson
T & P Monday MtgS Dalvie
Med Student tutsJ Wetter & R Burger
Under grad programJ Wetter & R Burger
Post grad programJ Parkes & H Simonds
Tues pm TutorialsJ Wetter
CPD recordsS Dalvie
ACADEMIC ACTIVITIES- RESERACHH Simonds
Commentaries & Mini thesesR Abratt H Simonds
EPRL van Wijk, H Simonds
Data base of Research projectsA. Hunter
RELATIONSHIPSZ Mohamed
External RelationshipsR. Abratt
Internal RelationshipsClinic Specialist
Human ResourcesZ Mohamed
Registrar supportJ Parkes & Z Mohamed
Supernumerary Reg supportClinic specialist
Registrar LeaveR Burger
Registrar Rotation B Robertson & R Burger
Physics & RT rotations R Burger
ENVIRONMENTR Abratt
Finances & fund raisingR Abratt
Functional Business Unit auditsR. Burger
Facility Upgrade J Parkes
LibraryB Robertson
Facility Safety OfficerA Hendrikse
Maintenance D floorE Greeff & area managers
Maintenance E floorR Burger
Safety D floorS Tovey
E. TRAINING
Departmental Programme
Day / Time / Activity / Venue / ConvenorMonday / 1:15 pm
4.00 pm / Techniques & Protocols
Any Additional Lectures, ad hoc / D35 Lecture Theatre / Dr S. Dalvie
As arranged
Tuesday / 4:30 pm /
Clinical Tutorials /
Dr J Wetter
Wed. / 4:00 – 6:00 pm / Physics & Statistics / Med Physics Seminar room / Hester Burger
Thursday
Last 2 wks of month / 1:15 pm / Journal Club
Bun Club / D35 Lecture Theatre / Dr B. Robertson
Other 1. / 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:
DrsD. Anderson, S. Ibrahim, M. Elhassan, K. Mohamed, K. Alleyne-Mike and N. Vawda.
F: ACADEMIC ACTIVITIES
Publications 2012
- Cancer Care in South Africa (correspondence)
RP Abratt, L Dreosti and P Ruff
LANCET ONCOLOGY - 13, 324, 2012. - The fast neutron therapy program in South Africa should come to an end (letter)
R P Abratt
SOUTH AFRICAN MEDICAL JOURNAL -103, 58, 2012. - Neutron radiotherapy in South Africa Abratt response (letter)
RP Abratt
SOUTH AFRICAN MEDICAL JOURNAL - 102, 269-270, 2012. - Radiotherapy for ocular tumours
C Stannard, W Sauerwein, G Maree, K Lecuona
Eye ( London, England) 11/2012; DOI:10.1038eye.2012.241. - 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. - 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. - Tumour lysis syndrome
MIrhuma, Z Mohamed, G. Maartens
South African Medical Journal CME Vol 30, No2, 79, 2012. - 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). - Lung Cancer – (Book Chapter)
RP Abratt and S. Dalvie
MIMS Handbook of Oncology – in press. - 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
InterventionalNeuroradiology 18: 000-000, 2012. - 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:
- Results of irradiating post-enucleated non-metastaticretinoblastoma patients with apositive 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.
- 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. - Poster: The “Claws” – A gold applicator loaded with I-125 seeds for localised wholeeye 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.
- Poster:Ergebnisse der Bestrahlung der OrbitabeiKindernmitAugentumoren.
W. Sauerwein, C. Stannard, G. Maree, D. Fluhs, A. Wittig, P. Temming,
B. Timmerman, E. Biewald, N. Bornfeld.
18. Jahrestagung der DeutschenGesellschaft fur Radioonkologie
Wiesbaden,Germany, June 2012.
- 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.
- Head and Neck Roundtable: Radiotherapy for Nasopharynx Carcinoma
Khadiga Mohammed: ASTRO conference May 2012.
- CNS Roundtable- Glioblastoma Multiforme: A case presentation
Kellie Alleyne-Mike: ASTRO conference May 2012 - Urology Roundtable Salvage Radiotherapy in a Patient with Biochemical Failure postRadical Prostatectomy
Sebathu Chiyapo: ASTRO conference May 2012.
- Head and Neck Roundtable:Squamous cellcarcinoma of the oral cavity
Moawia El Hassan: ASTRO conference May 2012.
- GIT Roundtable:Long-course pre-operative radiotherapy in a patient with rectaladenocarcinoma and a single liver metastasis.
Komeela Naidoo: ASTRO conference May 2012.
- A Descriptive Analysis of HIV-positive patients with Multicentric Castleman’s Diseaseseen at Groote Schuur Hospital Oncology Department from 2005-2011
Z Mohamed and N Novitzky
6th Annual Haematology – Oncology Symposium
Cape Sun Hotel, Cape Town. 2012. - 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. - Submyeloablative Therapy and Tandem Transplantation for patients with MultipleMyeloma 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. - Invited Speaker; General Oncology talk: “The Smart and the Art of Oncology”
Zainab Mohamed
Western Cape Provincial Pharmacy Conference
Protea Hotel, Stellenbosch.2012. - A 30 year audit of patients presenting with ependymoma to Red Cross and Groote Schuur Hospitals, Cape Town
Jeanette Parkes
SIOP Africa, March 2012. - Invited Speaker: Developing radiotherapy services in Africa
Jeanette Parkes
SIOP Africa, Cape Town, March 2012. - A Descriptive Analysis of HIV-positive patients with Multicentric Castleman’s Disease seen at Groote Schuur Hospital Oncology Department from 2005-2011.
Z Mohamed and N Novitzky
6th Annual Haematology – Oncology Symposium
Cape Sun Hotel, Cape Town. 2-3 November 2012.
- Hodgkin’s Lymphoma: 2004-2009, A Groote Schuur Hospital Experience
N Vawda, Z Mohamed and N Novitzky
6th Annual Haematology – Oncology Symposium
Cape SunHotel, Cape Town. 2-3 November 2012.
- Submyeloablative Therapy and Tandem Transplantation for patients with Multiple Myeloma at the UCT Myeloma Clinic
N Novitzky, C Du Toit, V Thomas andZ Mohamed
6th Annual Haematology – Oncology Symposium
Cape SunHotel, Cape Town. 2-3 November 2012.
- 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. - Paediatric CNS tumours: The Groote Schuur and Red Cross Children's Hospital experience. Elhassan, M, Parkes, J. Poster at SIOP Africa 2012, Cape Town.
- 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
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