Q1 - What is palliative care and how do you get referred?
Professor Phillip Good provides a clear explanation of palliative care and addresses common misconceptions about the service. He also discusses the process of referrals, emphasising the importance of the relationship between the patient, the caregiver, and the referrer.
Q2 - About carers
Professor Phillip Good shares some profound insights into the lives of carers, exploring the challenges they encounter and their own emotional experiences in this role. He reveals the prevalent sense of guilt experienced by many carers, while also explaining the underlying reasons behind this common and natural feeling.
Q3 - How do you get referred to palliative care?
It is stressed by Professor Phillip Good that a doctor, be it a specialist or a general practitioner, should be the one to refer a patient to palliative care services. He explores the effects of early versus late referrals on a patient’s quality of life and underlines the holistic support that palliative care can offer.
Q4 - Supportive care
In relation to the term ‘palliative care’, Professor Phillip Good highlights the fact that although alternative names are used to refer to this service, he tries to clarify what is involved when asked, regardless of the terminology used.
Q5 - When is the right time to reach out to palliative care?
Professor Phillip Good explores the factors that should be considered when thinking about contacting palliative care and shares his views and some benefits of contacting the service earlier rather than later.
Q7 - What are the services available to patients living in remote areas?
Professor Phillip Good provides an overview of the telehealth palliative care service offered in rural Queensland. He details the operational process of the service and outlines the referral procedure for patients.
Q6 - What are your thoughts on CBD oil and alternative medication?
Professor Phillip Good starts by clarifying that CDB oil that is prescribed is not an ‘alternative’ medication. He notes that every prescription will have identical quantities of CBD in it, whereas this cannot be guaranteed with non-prescribed forms of cannabis. He also touches on the mistaken idea that cannabis cures cancer - there is no evidence of this - and he would be concerned if people chose untested medications as an ‘alternative’ to proven treatments.
Q8 - End of life care at home
In his findings, Professor Phillip Good discusses the statistics surrounding patients who die at home. He delves into the factors that influence where patients die and advises early preparation for those who have a preference to die in the comfort of their home.
Q10 - How does palliative care at home works?
Professor Phillip Good explains what a community palliative care service is and how it works. He explains the specialised skills that are available, such as counsellors and physiotherapists, and touches on equipment requirements. He then elaborates on the potential difficulties that patients and caregivers may encounter when administering care from home.
Q18 - Are some types of breast cancer more likely to metastasise to the brain?
Dr Rebecca Moor refers to ductal and lobular forms of breast cancer and the differences in their potential to metastasise to the brain. She talks about the advice she offers her patients on recognising symptoms that are specific to their particular type of cancer.
Q17 - Different types of scans
Dr Rebecca Moor provides a detailed explanation of the various scans utilised by oncologists during cancer treatment. She assesses the advantages and disadvantages of each type of scan, as well as their specific applications for different types of cancers.
Q16 - More about clinical trials
Dr Rebecca Moor explains how drug trials are conducted, what’s involved, and the factors that patients need to consider when thinking about joining a clinical trial.
Q15 - Clinical trials
Dr Rebecca Moor explains how drug trials are conducted, specifically around the use of placebos and the consequent impact on participating patients. She highlights the infrequency of trials where patients are exclusively administered placebos, attributing this to the many treatment options available.
Q14 - Bones
Dr Rebecca Moor provides detailed insights into the drug Denosumab, highlighting its role in complementing breast cancer treatments by alleviating bone pain and reducing the risk of fractures.
Q13 - Are women living longer with advanced breast cancer?
Dr Rebecca Moor outlines the therapies that have extended the lives of women with metastatic hormone positive cancer. She says that, in certain instances, the duration patients can remain on a specific medication has more than doubled. She then goes on to discuss advancements in new therapies for different cancer types.
Q12 - Finding solutions
Dr Rebecca Moor talks about what action can be taken if a patient feels like they are not being listened to by their oncologist. She suggests reasons as to why this may occur and offers advice for patients to attain a positive outcome.
Q11 - Liaising with your oncologist
Dr Rebecca Moor discusses the dynamics between a patient and their oncologist. She emphasises the evolving nature of this relationship and stresses the vital role of maintaining an open and ongoing dialogue between them.
Q10 - Pain relief and cannabis
Dr Rebecca Moor addresses the use of cannabis and its potential benefits for patients. She emphasises that the effectiveness of treatment varies among individuals, and her experience suggests that while some people have found it helpful for various reasons, others have not. She suggests that patients looking to try it inform their oncologist.
Q9 - Treatment options and hair loss
Dr Rebecca Moor elaborates on the differences in chemotherapy treatments for metastatic cancer, emphasising the need to take into account factors like quality of life when formulating a treatment plan. She also outlines specific chemotherapy options and the associated side effects.
Q8 - Can you go back on hormone treatment if other treatments stop working?
Dr Rebecca Moor explains that hormone positive breast cancers can develop resistance to hormone blocking therapies. And that unfortunately, once this resistance is established, the likelihood of hormone therapies regaining their effectiveness is minimal.
Q7 - Is there a link between sugar and cancer?
Dr Rebecca Moor addresses what she thinks may be the source of the perceived association between sugar and cancer but says that there is insufficient evidence to support the exclusion of sugar from a patient’s diet.
Q6 - Should we still have mammograms?
Dr Rebecca Moor explains that although mammograms are typically not necessary for individuals with metastatic breast cancer, there are certain circumstances in which an oncologist may recommend it for their patient.
Q5 - What are the problems associated with low calcium levels?
Dr Rebecca Moor discusses low calcium levels further, highlighting its impact on the digestive system but also the cardiovascular and renal systems. She elaborates on why oncologists conduct routine blood tests to monitor levels and ensure they remain within a healthy range.
Q4 - Is there a connection between breast cancer and dairy or soy products?
Dr Rebecca Moor addresses the misconception regarding the potential risk of dairy or soy products in relation to breast cancer. She clarifies the origins of such information and emphasises the lack of substantial research supporting any connection. Additionally, she highlights valid dietary concerns such as lactose intolerance that patients may take into consideration when deciding whether to include these products in their diet.
Q3 - What are the benefits of calcium supplements?
Dr Rebecca Moor addresses the consequences of low calcium levels and emphasises the role of diet in influencing these levels. She also highlights the significance of calcium supplements in ensuring the proper balance, particularly for individuals taking medications for bone health.
Q2 - Should we have bones density tests?
In a discussion on bone density, Dr. Rebecca Moor sheds light on the significance of Denosumab and Xgeva in alleviating bone pain and minimising fracture risks. She explains the role these medications, along with vitamins D and C, have in maintaining bone health. Additionally, she explains the guidelines regarding the requirement for bone density tests.
Q1 - Does Nexium affect the efficacy of Xgeva?
Dr Rebecca Moor discusses the impact of Nexium on calcium absorption and offers guidance on its proper intake alongside other medications. She also notes the effects of reflux on quality of life and the advice she gives her patients regarding PPI’s (Proton-pump inhibitors ie medications to reduce stomach acid).
Q10 - Palliative Care
Ms Head talks about the best time for a patient to consider palliative care and discusses its many benefits.
Q9 - Discussing Scan Results
Ms Crowe explains why it is preferable to discuss scan results with an oncologist before talking to a breast care nurse.
Q8 - More about the Role of the McGrath Nurse
Ms Crowe explains the McGrath Foundation’s model of care and how it governs the way they support patients. In addition, she delves into the various responsibilities that make up the role of a breast care nurse, shedding light on the tasks they undertake.
Q7 - How to Access CBD Oil
When inquiring about CBD oil, Ms Head suggests obtaining it through a prescription from an oncologist or palliative care physician. However, she notes that healthcare providers may be hesitant due to the lack of clinical trials. Ms Head emphasises the importance of discussing the use of CBD oil with a healthcare provider beforehand to ensure it does not interact with any other prescribed medications.
Q6 - Supportive Therapies
Ms Crowe discusses various supportive therapies and emphasises the importance of breast care nurses being knowledgeable about them, comprehending their significance, and effectively sharing this information with interested patients.
Q5 - Supporting Family Members
Pia inquires about support for family members and Ms Crowe explains that often with metastatic patients, it is common for nurses to engage in more conversations with family members than the patients themselves.
Q4 - Lobbying for Support
Ms Crowe talks about how the McGrath Foundation actively lobbies for new breast care nurses and funding. She also highlights that in a bid to increase numbers, the foundation is incorporating non-foundation nurses into their services.
Q3 - Regional Patients
Ms Crowe talks about how the McGrath Foundation strives to provide free access to a breast care nurse regardless of location. Additionally, she emphasises the benefits of being local and why she prefers to refer patients to a nurse in their area. Ms Head then gives further insights into the McGrath Foundation’s commitment to employing metastatic breast care nurses.
Q2 - Immunotherapy Response
Dr. Andelkovic sheds light on immunotherapy, stating that although research projects are underway, it has not yet become a mainstream treatment. He further elaborates how immunotherapy can serve as a viable option in areas where treatment options are limited e.g. triple negative breast cancer.
Q1 - On Referrals
Joining Dr Vlad Andelkovic Medical Oncologist for our question and answer session are Ms Katie Head and Ms Beth Crowe both Metastatic Breast Care Nurses. Ms Head discusses referrals and the different ways she might come into contact with new patients. Additionally, she mentions the McGrath Foundation’s commitment to employing specialist metastatic breast care nurses. Dr Andelkovic further elaborates how breast care nurses frequently possess knowledge of patients ahead of him.
Q13 - Why Does Cancer Recur?
Dr Andelkovic explains the various reasons why cancer can recur in some patients and provides details on some of these reasons. Additionally, he describes different types of recurrences and how oncologists would respond to them.
Q12 - Combination Therapies
Dr Andelkovic talks about how oncologists respond when drug combinations do not work for a patient. He gives examples of when a drug may need to be replaced with another.
Q11 - On Zoladex
Dr Andelkovic answers a question about Zoladex and explains its mechanism of action and why it can be used for a prolonged period. He also points out alternatives to this treatment and when a patient might consider this.
Q10 - The Uses of Radiation Therapy
Dr Andelkovic explains how and when radiation is used, which types of cancers it treats, and what benefits the patient receives from the treatment.
Q9 - Cumulative Effects of Long Term Treatment
Dr Andelkovic discusses the effects of specific medication when asked about long term treatment.
Q8 - Remission
Dr Andelkovic talks about when oncologists choose to use the term “remission” to describe a patient’s condition.
Q7 - Financial Implications of Outliving your Prognosis
Dr Andelkovic is asked about the financial implications of out-living a prognosis. He offers a medical perspective, talking about how these situations can arise when someone responds well to treatment.
Q6 - New Developments in Drug Treatment
Dr Andelkovic talks about a new treatment involving a new type of drug called antibody-drug conjugates or ADCs. He describes how they function and the benefits they offer.
Q5 - When Should Our Daughters Be Screened for Breast Cancer?
Dr Andelkovic discusses the appropriate time for daughters of breast cancer patients to undergo testing. He outlines the factors that are taken into account when determining the optimal timing for testing and how to begin this process.
Q4 - Genetic Testing
Dr Andelkovic is asked about genetic testing. He talks about how increasingly common it is becoming, before distinguishing between genetic and genomic testing. He then goes on to explain how the data obtained from these tests can be used to develop and apply certain treatments.
Q3 - On Team Work
Dr Andelkovic continues the discussion by explaining how oncologists work together in various ways and the advantages of sharing their experiences and challenges.
Q2 - Can we Drive our Treatment?
Dr Vladimir Andelkovic answers the question about the appropriateness of patients driving their own treatment. He explains that this varies among Oncologists, but he personally considers several factors when discussing treatments, including the patients’ opinions.
INTRO and Q1 - Treatment Choices
Mary O’Brien starts our March workshop by explaining the question and answer format and presenting Dr Vladimir Andelkovic. Vlad then talks about the factors that are taken into account when determining a treatment plan for someone who has just been diagnosed with Metastatic Breast Cancer.
