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13 december

Newsletter

FROM THE PRESIDENT

Hello all,

Christmas is drawing near and I am sure you are all looking forward to spending time with your families over the break. Can I take this opportunity to pass on my best wishes for the festive period and the New Year ahead.

Professional Development News ? ANZUNS continues to be very active in supporting our members. We have undertaken a survey of our members views of ANZUNS and will be using this information next year to help us plan our future activities.

We are very pleased to be able to offer a Nursing Professional Development Grant sponsored by ABBVIE for 2014. Further details about how to apply for this grant are in the Newsletter and also on the ANZUNS website so please consider applying for this wonderful opportunity to learn more to enhance your practice. This award closes to application 15th January 2014. Please contact your state group if you have not yet received the details.

Included in this newsletter is a report from a nurse who received professional development support from ANZUNS in 2013. I hope her story helps you in your practice and also motivate you the learn more about urology nursing.

Executive Committee membership ? As mentioned previously, we will have a number of positions coming available on the ANZUNS committee following next year's AGM. This is going to be discussed by each State member group. It is a fantastic way to learn more about the operational end of the group and I would encourage you to contact your local membership group to discuss any Expressions of Interest.

ANZUNS 2014 ASM ? Leanne and Shona continue planning for a fantastic conference for next year which will be held in Brisbane 16th ? 19th March 2014. Be sure to register before the 7th February to qualify for the early bird rates. PCFA are proving 5 ANZUNS program registrations to support this meeting and they can be applied for using the link on the PCFA website articleLive/pages/PCFA-ANZUNS-19th-Annual-ScientificMeeting.html

I am looking forward to catching up with friends in Brisbane and making some new alliances.

I will close by once again thanking the committed team and also those who involve themselves within the respective state groups. ANZUNS is an organisation committed to supporting its members and we warmly invite your ideas and participation in the delivery of the organisation.

Kind regards

Julie ANZUNS President

IN ITHSISS UE...

Report from the President..................................................................... 1

Representative Reports......................................................................2-3

The ANZUNS December Conference.................................................... 4

Nurse practitioner and Advanced practice nurses SIG.......................... 4

PCFA ? Support Group Information....................................................... 5 Awards and Sponsorships..................................................................... 6 5th Triennial Best Practice Workshop.................................................6-8 NZuns report................................................................................... 9-11

ANZUNS would like to thank AstraZeneca for their support in the development and distribution of this newsletter

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Representative Reports

SUNWA

SUNWA currently has a committed membership of 55, the majority of whom recently attended our last educational evening for the year, held at the Mt Lawley Golf Club with the theme, Advances in Technology ? Interventional Radiological techniques in Urology. The keynote speaker was Dr Jim Anderson, Consultant radiologist at Royal Perth Hospital, followed by a radiological nursing perspective presented by Jill Lowes, Staff Development/Clinical Nurse in Radiology at Royal Perth Hospital. The presentations focused on Dr Andersons experience with transperineal prostatic biopsies.

The evening was kindly sponsored by Medivenn and Olympus. The representative for Medivenn presented an overview on the Space

Oar product designed to reduce radiation exposure to rectal tissue, currently under trial in a number of Perth hospitals. The Olympus representative presented on the 3D Laparoscope with an overview on its use in particular surgical procedures.

Planning is underway for next year's educational events, please check the website for updates.

On behalf of the SUNWA committee we would like to wish our members and fellow ANZUNS colleagues a very Merry Christmas and wonderful 2014!

Kyla Tilbury WA State Representative

SAUNS

SAUNS are very excited to be hosting the 2015 ANZUNS Scientific Meeting. We look forward to an exciting 2014, planning and organising a meeting which will aim to be innovative, inspiring and informative for attendees.

The USANZ SA/NT annual meeting was held last month with a number of SAUNS members attending. Dr Denby Steele and Dr Nick Brook did an outstanding job as conveners, presenting a program which was educational and thought provoking, with a range of local and international speakers presenting the latest evidence in the field of urology. The day also provided a great opportunity for networking and collaborating with our medical, nursing and trade colleagues.

Robotic Assisted Laparoscopic Prostatectomies have been performed at the RAH for approximately 10 years following the acquirement of the da Vinci Robot. This has now been decommissioned however a new one has been purchased and is located at St Andrews Hospital. Public patients will continue to have all their pre and post-operative appointments as previously but their surgery and inpatient stay will now occur at St Andrews.

For the third year in a row, The Urology and Continence Clinic team at Calvary Hospital, North Adelaide hosted a Big Aussie BBQ in support of prostate cancer. The group successfully raised nearly $900 for the cause whilst also raising awareness surrounding prostate cancer and the importance of early detection.

Finally, Congratulations to Lauren Wood, SAUNS member, who was the worthy recipient of the AMS Professional Development award 2013. Lauren was awarded this scholarship at the ANZUNS Scientific Meeting in Melbourne and chose to attend the SUNA Annual Conference in Chicago last month.

"In October I had the privilege of attending the SUNA (Society of American Nurses and Associates) meeting in Chicago, USA. I was able to do this as the recipient of the AMS Professional Development Award. Thank you AMS and ANZUNS. The meeting was excellent. Some of the key points that I have been able to bring back to my practice as Prostate Cancer Specialist Nurse at Royal Adelaide Hospital include advancements in the treatment of castrate resistant prostate cancer and treatments for erectile and sexual dysfunction. I was also able to spend a day in clinic with Ken Mitchell, in Minneapolis. Ken is a Physician Assistant who specialises in erectile dysfunction. During my visit I saw many post radical prostatectomy patients and Ken was valuable source of knowledge. It was very interesting to see how things are done in the USA, but also a pleasant reminder that our meetings and practice are also of a high standard. I would encourage anyone to take an opportunity of an award to visit another country to investigate practice. It was an amazing experience." Lauren Wood, Prostate Cancer Specialist Nurse, Royal Adelaide Hospital.

Personally, I would like to thanks SAUNS members for supporting me in this role for 2013. It has been a great experience and I have really enjoyed representing you at state level.

To all SAUNS and ANZUNS members, have a wonderful Christmas and relaxing New Year.

Kerry Santoro SAUNS Representative

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QUNS

QUNS Inc. had our annual Urological Nursing Day on the 23rd of August at the Bronco's Leagues Club with over 170 registered delegates attending. We had a variety of interesting topics including Post-Obstructive Diuresis, Alternative Medicines, Kidney Stones and Prostate Cancer to name a few. With some dynamic speakers our delegates found the day very informative and a great way to catch up with urological colleagues. We also held our AGM at this educational day and elected a new committee to take us forward for the next 12 months. Anne Crowley was elected as President, Karen Walsh as Secretary, Trudy Wilson was re-elected as Treasurer, Michelle Roberts as Public Officer, myself as State rep. (also ANZUNS Vice President), and the following as Committee members: Leanne Morton (ANZUNS Conference Convenor for 2014), Rachael Oxford (past President), Sandra Warden (also ANZUNS secretary), Yvette Sullivan (Newsletter Editor), Ariane McKinnon, Elizabeth Winslade, Patricia ThomasGabbett and Robert Akbar. With six new members on the Committee, we are looking forward to a great year ahead.

We continue to hold our quarterly educational dinners which are sponsored by our Trade partners. The most recent ones on Radiation Oncology by Dr Tania Holt and Dee Kiernan from the Mater and Dr Troy Gianduzza and Kylie Everett presented on

Lasers, giving two different perspectives on patient care and surgical techniques. Kylie travelled all the way from Toowoomba (her new home) to present for us for which we were very grateful. Earlier in the year we had an education dinner on Radiation Oncology

Leanne and Shona are doing a fantastic job planning for the next ANZUNS Conference. They have secured Keynote Speakers and several sponsors and now have the unenviable task of selecting the papers to be presented. Thank you to those who have sent in abstracts. We wish you good luck.

We would also like to wish Rachael Oxford a speedy recovery and miss her at QUNS inc. events. On behalf of the QUNS inc. committee we wish our members and urological colleagues a very safe and happy Christmas and a prosperous New Year. Roll on 2014!

Maryanne Sinon QUNS Inc. State Rep.

VUNS

Victoria are still maintaining strong membership numbers currently at 160 with about 7 Affiliate members.

Our final education session for the year was our country meeting which is held in conjunction with the USANZ section meeting. This year it was held at Cape Schank and we were fortunate to secure some marvellous speakers and sponsorship from Astra Zeneca for the day was much appreciated.

We are offering sponsorships again to attend The Bladder/ Kidney Symposium held in Melbourne in 7-9 Feb 2014 and for the USANZ/ANZUNS ASM in Brisbane 16-19TH March 2014. Application open to members who meet the criteria which is on the website.

TUNS have finally decided to fold as a group and we are finalising the transfer of funds to VUNS. We welcomed TUNS

members to VUNS last year when they went into recess unfortunately they were unable to reconvene so now the process of amalgamation with VUNS has commenced

We are hosting a Christmas break up for all members and affiliates on the 17th Dec

Wishing everyone all the best for the New Year and to thank everyone for their dedication and support to each other throughout the 2013

We also would like to extend our festive wishes to our support staff at ANMF

Alison Overton VIC Rep for ANZUNS

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ANZUNS Conference 2014 Update

The 19th Australian and New Zealand Urological Nurses Society Annual Scientific meeting is well in the swing of things now. We hope that you all are well and looking forward to the upcoming meeting. We have been working hard to make this meeting the best you have ever been too.

We have 3 days of education planned with lots of social and networking opportunities to be had. Our workshops will be held on Sunday16th with 4 different workshops to choose from.

1. Advanced Nursing Practice Workshop ? looking at how we as nurses set up nurse led clinics. The problems and barriers we will face and how to overcome these. We also will discuss how to complete a comprehensive Urological assessment on a patient.

2. Uro-Oncology Nursing Practice Workshop ? looking at 2 case studies following patients with prostate cancer and hormone treatment and bladder cancer and intravesical treatment.

3. Urology Professional Development Workshop ? ask yourself this question ? "Am I happy with the direction my Urology Nursing career is taking me?" We will explore what a Urology Nurse is and the scope of what we do and could do.

4. Urology Nursing Practice Workshop ? this is the workshop for the new urology nurse wanting to know more about what is out there other than ward nursing. It is also a great opportunity for a refresher of all things Urology for those nurses who feel like they are just not up to date.

Following the workshops are the welcome drinks. Monday and Tuesday are two action packed days of key note speakers, guest international speakers and hearing from our own colleagues presenting their work in paper and poster presentations. We will also join our medical colleagues in combined plenary sessions.

The Bard education evening will be held on Monday night as something a little bit different and then to finish things off on Tuesday night we have the Gala Evening at the amazing Brisbane City Hall.

All in all it should be a stimulating, motivating, knowledge gaining scientific meeting. We hope to see as many of you there as possible. If you are thinking about it ? stop thinking and just do it. Maybe even tack on a holiday in our wonderful state.

Leanne Morton ANZUNS Convenor 2014

Shona McKenzie ANZUNS 2014 Scientific Program Convenor

Nurse practitioner and Advanced practice nurses SIG

The conference next March in Brisbane will see the return of the advanced practice workshops. The group is organising a workshop on nurse led clinics. This workshop will look at the process of establishing a nurse led clinic as well as addressing aspects of conducting a comprehensive urological assessment on your patients. Yvette Sullivan will be running this very informative workshop so don't forget to register.

There will also be a SIG group meeting at the conference. This group provides support for those nurses who are progressing toward or considering working toward NP endorsement as well as nurses who are working in advanced nursing roles. All nurses are welcome to attend the meeting so I hope to see you there.

Shona McKenzie Chair NP / Advanced practice SIG

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PCFA ? Support Group Information

Prostate Cancer Foundation of Australia is the peak national body for prostate cancer in Australia. We are dedicated to reducing the impact of prostate cancer on Australian men, their partners and the wider community.

We do this by:

? Promoting and funding world leading, innovative research in prostate cancer

? Implementing awareness campaigns and education programs for the Australian community, health professionals and Government

? Supporting men and their families affected by prostate cancer through evidence-based information and resources, support group and Prostate Cancer Specialist Nurses

PCFA is proud to have so many dedicated Affiliated Support Groups who conduct a valuable service for men, women, families and friends affected by prostate cancer. This national network of Affiliated Support Groups consists of men and women who have a passion for assisting others who are affected by this disease. The network is currently made up of 147 Affiliated Support Groups who meet locally to provide peer support, giving a vision of life and hope after a diagnosis of prostate cancer.

Support groups provide a safe place for people affected by cancer to come together to support each other, develop friendships, share ideas and thoughts, obtain information from health professionals and each other, and learn coping skills in a non-judgmental and caring environment.

Research has shown that people with cancer who take part in support groups have lower levels of anxiety and depression than those who don't. People can often feel isolated and unsupported when they are diagnosed with cancer. By joining a support group people can develop a sense of belonging and feel comfortable enough to share their feelings with others who have had similar experiences. Groups develop a sense of community and this can assist with the psychological effects of cancer and may improve the person's ability to cope.

As an evidence-based organisation, PCFA is responsible for ensuring that the tools and resources used by PCFA Affiliated Support Groups are based on best practice standards and that Affiliated Support Groups operate in a way that is consistent with PCFA's organisational values. PCFA is also committed to supporting Affiliated Support Groups through training and peer development opportunities as a means to support the community in reaching these standards.

We already have a number of nurses within the community who have taken the lead to establish prostate cancer support groups, either in their place of employment or within their community but we are always keen to grow our support group network further. If there is not a prostate cancer support group in your local area and you are keen to develop one, PCFA is equipped to assist you and provide you with the resources required to establish a support group.

If you are interested in discussing this further, please contact PCFA using the details below:

Lorraine Hagaman Support Group & Outreach Coordinator (Queensland) Tel: 07 3166 2148 Email: Lorraine.Hagaman@.au

Evan Kallipolitis Support Group & Outreach Coordinator (NSW/ACT) Tel: 02 9438 7062 Email: Evan.Kallipolitis@.au

Amanda Pomery Support Group & Outreach Coordinator (VIC/TAS) Tel: 03 9948 2078 Email: Amanda.Pomery@.au

Ian Richards Support Group & Outreach Coordinator (SA/NT) Tel: 0402 125 806 Email: Ian.Richards@.au

Emilia Hay Support Group & Outreach Coordinator (WA) Tel: 08 6103 8756 Email: Emilia.Hay@.au

Carla Demos Administrator ? Support Group Operations Tel: 02 9438 7045 Email: Carla.Demos@.au

Charlotte Houghton Project Office Administrator (Support Groups) Tel: 02 9438 7022 Email: Charlotte.Houghton@.au

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Abbvie Nursing Professional Development Award

The Abbvie 2014 Nursing Professional Development Award is available for Registered Nurses to use for personal professional development which can be shown to enhance urology nursing practice. The award can be utilised in the following ways: ? Travel Scholarship (International or within Australia / NZ) ? Conference or other formal education forum ? Other PD activity with direct link to patient care benefit The award is for $5000, with the closing date for applications 15th January 2014 Application forms and further details for this award can be obtained from the ANZUNS website

Prostate Cancer Foundation of Australia Sponsorships

Prostate Cancer Foundation would like to offer ANZUNS members the opportunity for nurses to apply for sponsorship to attend The 19th Annual Scientific Meeting in Brisbane on 16th -19th March 2014. We will be offering 5 registrations. Details of the grant and application forms are available on the PCFA website: .au

5th Triennial Best Practice Workshop in Urological Oncology

Virginia Ip

This meeting was organized by Urology Oncology Program NSW. It was held at the Sydney Convention & Exhibition Centre from Friday 1st November to Saturday 2nd November 2013. Seventy delegates who include urologists, radiation oncologists and oncologists registered for the meeting, with approximately 70 % from NSW.

In each session, local urologists, radiation oncologists and medical oncologists provide their perspectives on current evidence based best practice and controversies in prostate, bladder, renal and testicular cancers. Three esteemed international guest speakers from the MDT contributed in difficult cases presentation at the end of each session as well as individual presentations. The following is a summary of some of the interesting presentations:

Prostate cancer

Screening ? science or philosophy Prof. David Gillatt, Macquarie University

Screening is in line with other cancer diagnosis. Systematic screening in general population aids in the diagnosis of prostate cancer in men. The key question is: Does screening do more good than harm?

He discussed the findings form various studies which include European Randomized Study of Screening for Prostate Cancer (ERSPC), Protect Prostate Cancer Clinical Trial (ProtecT), Prostate, Lung, Colorectal and Ovarian Cancer Screening (PLCO) and Cochrane. In August, at the 2013 Prostate Cancer World Congress in Melbourne world prostate cancer experts released following set of consensus statements regarding the use of PSA testing

The Melbourne Consensus Statement on Prostate Cancer Testing

Consensus Statement 1: For men aged 50-69, level 1 evidence demonstrates that PSA testing reduces prostate cancer-specific mortality and the incidence of metastatic prostate cancer.

Consensus Statement 2: Prostate cancer diagnosis must be uncoupled from prostate cancer intervention.

Consensus Statement 3: PSA testing should not be considered on its own, but rather as part of a multivariable approach to early prostate cancer detection

Consensus Statement 4: Baseline PSA testing for men in their 40's is useful for predicting the future risk of prostate cancer.

Consensus Statement 5: Older men in good health with over ten year life expectancy should not be denied PSA testing on the basis of their age.

For more details on each consensus statement, please check the Prostate Cancer Congress website `Consensus statement on prostate cancer testing `)

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Active Surveillance ? who to survey and how to do it better? Prof. Badrinath Konety, Chair of Urology, University of Minnesota Active Surveillance (AS) is more active and engaging with patient than watchful waiting. Criteria for AS: Cancer of the Prostate Risk Assessment Score (CAPRA) The CAPRA Score is developed by University of California, San Francisco. The score is calculated using points assigned to: age at diagnosis, PSA at diagnosis, Gleason Score of the biopsy, clinical stage and percent of biopsy score involved with cancer. The score is from 0 to 10, with 0 to 2 indicates low risk cancer. Epstein Criteria An active surveillance program developed at the Brady Urological Institute under the direction of urologist Dr. Ballestine Carter and surgical pathologist Dr. Jonathan Epstein. They have followed more than 900 men over more than 15 years who are thought to have tumours which can be safely managed without immediate treatment AS for low risk cancers: ? Stage less than or equal to T2a, ? PSA less than or equal to 10ng/ml, ? PSA density less than or equal to 0.15 ? Gleason grade 3+3 ? Positive scores less than or equal to 2 or cancer involving no more than 50% of any core ( at least a 12 core biopsy ) When we take into the account of the repeat biopsies, ongoing monitoring of markers and imaging, cost of AS for 8 to 9 years is calculated to be more expensive than treatment. Compares with treatment group, one study shows 0.15 year life lost. There are genetic tests, cost $3000 to differentiate who will progress (Prolaris ? 31 CCP genes) or identify likelihood of high risk disease (Oncotype Dx-17 genes) Controversies in Testicular Cancer. Dr Peter Grimison, Sydney Cancer Centre, RPAH This is a summary is from Dr. Grimision's power point presentation with permission: Are there any controversies in testicular cancer? ? Stage I Non-seminoma - relapse < 5% with adjuvant Bleomycin, Etoposide, Cisplatin ( BEP )(Tandstad ASCO 2013) ? Stage I seminoma -15-year cause-specific survival 99.2% with surveillance (Mortensen ASCO 2013) ? Poor-risk metastatic GCT with poor tumour marker decline -dose-intense chemotherapy regimen, 3-year survival 73%

(Fizazi ASCO 2013) Evolution in prognostic classification ? Prognostic biomarkers are inadequate

? S tage I: Insufficient to guide use of adjuvant therapy ? Metastatic disease: Need updating given improved cure rates, shrinkage of intermediate-risk group ? Lack of molecular predictors of outcomes Stage I disease Grimison et al (2013 BJU International) found considerable variations in management amongst medical oncologist in Australia for stage 1 testicular cancer. The infrequent use of surveillance and frequent use of carboplatin f for seminoma differs from international guidelines. The study recommended that radiation exposure from CT imaging should be reduced through standardized follow ?up protocol and possibly by alternate imaging methods if validated in appropriate studies Cancer risk from CT scans ? True long- term effects are unknown as CT scanning only introduced in 1970s ? Modelling derived from atomic bomb survivors ? 1:2000 risk of second malignancy from single CT Scan ? H igher risk if younger age of exposure ( Brenner NEJM 2007) ? Contemporary Canadian Cohort ? 2 569 testicular cancer patient diagnosed 1991 -2004 ? Median 10CT abldo-pelvis ( 110mSV) ? 5 :10,000 patient-year risk of second malignancy

? Limitation ?follow ?up limited to median of 11 years ( Van Walvaren JCO 2011)

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How to reduce cancer risk from CT scans 1. Standardize surveillance CT imaging protocols

No of CT abdomen over 5 years Seminoma in contemporary protocols

Marsden 2008

7

ESMO 2010

7

EAU 2011

4

Princess Margaret 2012

8

NCCN 2013

9

? Consider absolute risk and timing of recurrence in developing protocols ? Seminoma: 60% recur < 2 years, 40% at 2-10 years ? Non-seminoma: 75% recur < 2 years, 25% at 2-4 years

2. Integrate protocols into routine practice to reduce variations

Non-seminoma

3 3 2 5 10

No of CT abdomen over 5 years Seminoma

Non-seminoma

ANZUP Survey 2011

8 (1-14)

9 (1-15)

? Role of multi-disciplinary teams, leadership from national cancer groups

3. Use CXR in preference to Chest CT

4. Research MRI, low-dose CT, ultrasound, less intensive follow-up

Survivorship: ANZUP-PoCoG cross-sectional study of supportive care needs in testicular cancer survivors by Ben Smith et al, 2010 (unpublished)

10 most frequently endorsed unmet needs:

I need help to reduce stress in my life I need help to address problems with my/our sex life I need help to find out about financial support and/or government benefits to which I am entitled I need help to manage concerns about the cancer coming back Due to my cancer I need help getting life and/or travel insurance I need help to cope with others not acknowledging the impact that cancer has had on my life I need more accessible hospital parking I need to talk to others who have experienced cancer I need help to deal with my own and/or others expectations of me as a "cancer survivor" I need emotional support to be provided for me

Acknowledgment The author would like to thank the financial support from Australian and New Zealand Urological Nurses Society to attend this meeting

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