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Oncology and Malignant Haematology – public patients

Purpose

This page contains information for general practitioners on how to refer patients aged 16 years and over to Oncology and Heamatology services at Mater Hospital Brisbane. Consultation and treatment is delivered at the Mater Cancer Care Centres at South Brisbane and Springfield. The clinical condition and address for each patient will be considered when determining the consultation/treatment location.

Service

The Mater Cancer Care Centre (MCCC) provides treatment for a wide range of cancers in a multi-disciplinary environment consisting of medical specialists, clinical nurse consultants and specialised nurses with access to allied health services including physiotherapy, psychology, social work, occupational therapy and dietetics.

Patients also have access to a range of complementary therapies including:

  • Art Therapy
  • Music Therapy
  • Pastoral Care.

Providing patients with access to care and treatment that is specifically designed for individual needs is an essential focus for the Mater Cancer Care Centre team. Patients receive their cancer treatment onsite at the centre and to ensure there are no unnecessary delays with dispensing medicines, pharmacy services are available on-site. The South Brisbane campus also offers access to radiation therapy, an intensive care unit, CT scanner, MRI imaging and pathology.

In addition to providing treatment for a number of Haematological conditions, the autologous stem cell transplantation unit at South Brisbane includes a NATA accredited cryopreservation laboratory for the collection, storage, and re-infusion of peripheral blood haematopoietic stem cells. 

The Mater Cancer Care Centre has strong links with clinical trials ranging from early phase studies to multinational phase III studies.

How to Refer

If referral for care is indicated please list all of the general referral information  and reason for request, and essential information as indicated below.

To refer, please fill in the Mater Adult Referral Form, available to download and embed into most major Practice Management software applications.

Referrals can be sent by:

Secure messaging  Medical Objects:   HM4101000R8
  HealthLink EDI:    materref   
Fax    07 3163 8548

 

 

 

 

Emergency 

If any of the following are present or suspected, phone 000 to arrange immediate transfer to the emergency department or seek emergency medical advice if in a remote region:

 

View list of conditions:

  • Symptoms of airway obstruction, SVC obstruction
  • Severe gastrointestinal (GI) bleeding
  • Bowel obstruction
  • Febrile neutropenia
  • Symptomatic hypercalcaemia
  • Other organ failure/dysfunction
  • Uncontrolled and disabling pain
  • Massive haemoptysis and/or stridor
  • Neurological signs suggestive of brain metastases or cord compression
  • Very high calcium (3.0mmol/L)
  • Severe dysphagia with dehydration
  • Biopsy proven small cell lung cancer
  • Patients with symptoms of shortness of breath, deteriorating organ function
  • Metastatic germ cell tumour (GCT) confirmed (biopsy) or suspected (tumour markers)
  • Patients with severe symptoms, organ failure or life threatening complications
  • Highly aggressive lymphoma
  • Burkitt’s lymphoma
  • Lymphoblastic lymphoma
  • Acute leukaemia

 

Scope of Service

Conditions in scope

 

Breast Cancer

Essential information (Referral will be declined without this)

  • General referral information
  • Family history
  • Previous cancer treatment details
  • FBC ELFTs results
  • Histology /cytology results – current +/- previous
  • Mammograms results +/- breast US +/- axilla

Additional referral information (useful for processing the referral)

  • No additional information

Other useful information for management (not an exhaustive list)

  • Women with inflammatory breast cancer receive chemotherapy as their first cancer treatment (not surgery).
  • Histology (biopsy or surgical specimen) should include ER/PR/ HER2 neu status
  • Serum tumour bio-markers CEA, CA15-3 or others should not be used as diagnostic tests
  • For women who have not completed their family, fertility preservation needs to be discussed
  • Refer suspected breast lumps through local surgical pathway for further investigation and biopsy
  • For patients with incurable (metastatic or recurrent) cancer consider  the following:
  • documentation of discussions with the patient (and their carers where appropriate) regarding the intent of treatment (anti-cancer therapy to improve quality of life and/or longevity without expectation of cure or symptom palliation), the woman’s prognosis and their understanding of their prognosis
  • whether Advance Care Planning (ACP) conversations have been undertaken and their outcome
  • specific patient goals and values that may impact on treatment choices
  • whether the patient has been referred to a palliative or supportive care service
  • Optimal care pathway for women with breast cancer
  • http://www.cancervic.org.au/downloads/health-professionals/optimal-care-pathways/Optimal_care_pathway_for_women_with_breast_cancer.pdf
  • Quick reference guide
  • http://www.cancervic.org.au/downloads/health-professionals/optimal-care-pathways/Breast_cancer_-_quick_reference_guide.pdf

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Emergency Treatment

Needs discussion with on-call specialist and / or Emergency Department

  • Uncontrolled or disabling pain
  • Neurological symptoms and signs suggestive of cord compression
  • Brain metastasis
  • Febrile neutropenia
  • Symptomatic hypercalcaemia
  • Other organ failure

Category 1 – urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Inflammatory breast cancer and patients requiring neoadjuvant chemotherapy (biopsy confirmed) For optimum care, patient should be seen within 2 weeks.

Breast cancer for adjuvant chemotherapy

Metastatic breast cancer (biopsy confirmed)

Patient on adjuvant hormone treatment for breast cancer and has problem with tolerance

Previously treated breast cancer patient from another center requiring routine follow-up

No category 3 criteria

 

Colorectal Cancer

Essential information (Referral will be declined without this)

Additional referral information (useful for processing the referral)

  • Any relevant XR results and/or relevant CT results
  • MRI of pelvis [1]and endorectal US [2]for rectal cancer for selected patients
  • PET scan results for selected patients
  • Colonoscopy results (if applicable)

Other useful information for management (not an exhaustive list)

  • Most patients with radiological evidence of metastatic cancer need biopsy confirmation. These patients need to be seen by a colorectal surgeon.
  • Some patients with liver metastases can undergo curative liver resection
  • The majority of stage II and stage III rectal cancer benefit from pre-operative chemotherapy and radiation
  • Suspected colorectal cancer due to symptoms or iron deficiency anaemia needs to be referred through local gastroenterology or surgical pathways
  • For patients with incurable (metastatic or recurrent) cancer, consideration of the following:
  • documentation of discussions with the patient (and their carers where appropriate) regarding the intent of treatment (anti-cancer therapy to improve quality of life and/or longevity without expectation of cure or symptom palliation), the patient’s prognosis and their understanding of their prognosis
  • whether Advance Care Planning (ACP) conversations have been undertaken and their outcome
  • specific patient goals and values that may impact on treatment choices
  • whether the patient has been referred to a palliative or supportive care service
  • Optimal care pathway for people with colorectal cancer
  • http://www.cancervic.org.au/downloads/health-professionals/optimal-care-pathways/Optimal_care_pathway_for_people_with_colorectal_cancer.pdf
  • Quick reference guide
  • http://www.cancervic.org.au/downloads/health-professionals/optimal-care-pathways/Colorectal_cancer_-_quick_reference_guide.pdf

 

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Emergency Treatment

Needs discussion with on-call specialist and / or Emergency Department

  • Severe gastrointestinal (GI) bleeding
  • Bowel obstruction
  • Uncontrolled or disabling pain
  • Neurological symptoms and signs suggestive of cord compression
  • Brain metastasis
  • Febrile neutropenia
  • Symptomatic hypercalcaemia
  • Other organ failure

Category 1 – urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Metastatic colon cancer with rapid progress or organ dysfunction.  For optimum care, patient should be seen within 2 weeks.

Neoadjuvant chemotherapy with radiation prior to surgery (usually referred by Surgeon after MDT). For optimum care, patient should be seen within 2 weeks.

Adjuvant treatment after surgery (usually referred after MDT by surgeon)

Metastatic colon cancer (De novo or following treatment for early-stage cancer) and has tissue confirmation

No category 2 criteria

No category 3 criteria

 

Head and Neck Cancer

Essential information (Referral will be declined without this)

  • General referral information
  • Past medical history, current medications, weight loss
  • Height & weight
  • Smoking and alcohol history
  • Previous cancer treatment details
  • Physical examination of the affected area, i.e. throat, neck
  • Pertinent social history/support
  • Biopsy results
  • Endoscopy results
  • Any relevant CT, PET scan +/- MRI results

Additional referral information (useful for processing the referral)

  • History of significant hearing impairment can help guide treatment

Other useful information for management (not an exhaustive list)

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Emergency Treatment

Needs discussion with on-call specialist and / or Emergency Department

  • Uncontrolled or disabling pain
  • Airway compromise
  • Significant bleeding
  • Neurological symptoms and signs suggestive of cord compression
  • Brain metastasis
  • Febrile neutropenia
  • Symptomatic hypercalcaemia
  • Other organ failure

Category 1 – urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

  • Biopsy confirmed head and neck malignancy (oral and nasal cavity, larynx, pharynx, salivary glands) for combined chemo-radiotherapy or induction chemotherapy. For optimum care, patient should be seen within 2 weeks.
  • Biopsy confirmed head and neck malignancy not amenable to surgery or radiotherapy and for palliative chemo-therapy. For optimum care, patient should be seen within 2 weeks.
  • Resected head and neck malignancy with high risk features for adjuvant radiation or chemo-radiotherapy

 

  • No category 2 criteria
  • No category 3 criteria

 

Lung Cancer

Essential information (Referral will be declined without this)

GP Essential Referral Information

  • General referral information
  • Past medical history, current medications
  • Smoking history
  • Previous cancer treatment details
  • FBC ELFTs results
  • Any relevant XR results +/- relevant CT reports
  • CT chest, upper abdomen and pelvis
  • If available attach CT or MRI of the brain and bone scan

Specialist Essential Referral Information

  • general referral information
  • Tissue pathology +/- cytology results
  • Physiological assessment - pulmonary function test if applicable
  • Bronchoscopy including endobronchial USS (EBUS) if applicable
  • PET scan reports for selected patients

Additional referral information (useful for processing the referral)

  • No additional information

Other useful information for management (not an exhaustive list)

  • Suspected lung cancers (mass on chest XR or CT chest) needs to be referred to the appropriate specialist (usually respiratory physician) for work-up.  Specialist review optimally should be within 2 weeks
  • Most referrals for locally advanced disease for concurrent chemotherapy and radiation come through respiratory or cardio-thoracic team and after MDT review
  • Suspected spinal cord compression, superior vena cava syndrome (SVC), massive haemoptysis, very high calcium (>3.0mmol/L), febrile neutropenia need to be referred to emergency urgently
  • Lung cancer patients diagnosed and treated via an MDT have improved outcomes
  • For patients with incurable (metastatic or recurrent) cancer, consideration of the following:
  • documentation of discussions with the patient (and their carers where appropriate) regarding the intent of treatment (anti-cancer therapy to improve quality of life and/or longevity without expectation of cure or symptom palliation), the patient’s prognosis and their understanding of their prognosis
  • whether Advance Care Planning (ACP) conversations have been undertaken and their outcome
  • specific patient goals and values that may impact on treatment choices
  • whether the patient has been referred to a palliative or supportive care service
  • Quick reference guide
  • http://www.cancervic.org.au/downloads/health-professionals/optimal-care-pathways/Lung_cancer_-_quick_reference_guide.pdf

 

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Emergency Treatment

Needs discussion with on-call specialist and / or Emergency Department

  • Massive haemoptysis and/or stridor
  • Symptoms of airway obstruction, SVC obstruction
  • Uncontrolled or disabling pain
  • Neurological symptoms and signs suggestive of cord compression
  • Brain metastasis
  • Febrile neutropenia
  • Symptomatic hypercalcaemia
  • Other organ failure
  • Biopsy proven small cell lung cancer
  • patients with symptoms of shortness of breath, deteriorating organ function

Category 1 – urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

All small cell lung cancer that does not need emergency treatment (see emergency).  For optimum care, patient should be seen within 2 weeks.

Biopsy proven non-small cell lung cancer

Locally advanced disease for concurrent chemotherapy and radiation

Metastatic disease

Adjuvant treatment following curative surgery

Recurrence following previous treatment

(Patients on surveillance after previous treatment for lung malignancy may be referred directly to medical oncology)

Patients with previously treated lung cancer

No category 3 criteria

 

Lymphadenopathy for Investigation

Essential information (Referral will be declined without this)

  • General referral information
  • Detailed history of present signs and symptoms
  • Past medical history/pertinent social history
  • Current medications and allergies
  • FBC U&E LFTs LDH CMP results

Additional referral information (useful for processing the referral)

  • No additional information

Other useful information for management (not an exhaustive list)

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Emergency Treatment

Needs discussion with on-call specialist and / or Emergency Department

  • Symptomatic hypercalcaemia
  • Severe or life threatening symptoms (spinal cord, SVC compression, ureteric compression, airway compromise etc)
  • Other organ dysfunction

Category 1 – urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Abnormal lymph node (LN) detected clinically or via imaging – and not biopsied (or inconclusive biopsy). For optimum care, patient should be seen within 2 weeks.

AND if ANY of the following are present (For optimum care, patient should be seen within 2 weeks):

  • symptomatic lymphadenopathy
  • raised LDH
  • bulky disease (>3cm diameter of LN mass)
  • presence of fever, night sweats, weight loss or new onset pruritus
  • concurrent recent onset cytopenias (e.g. anaemia, thrombocytopenia)
  • extranodal massesclinical history of rapid growth

AND if ALL the following are present:

  • Asymptomatic or minimally symptomatic lymphadenopathy
  • Normal FBC and stable creatinine and liver function
  • Clinical history of slow growth
  • Non bulky disease

Clinically well (absence of the following - fever, night sweats, weight loss or pruritus)

 

No category 2 criteria

No category 3 criteria

 

Lymphoma (Newly Diagnosed, Biopsy Confirmed)

Essential information (Referral will be declined without this)

  • General referral information
  • Detailed history of present signs and symptoms
  • Past medical history/pertinent social history
  • Current medications and allergies
  • Histology report
  • FBC U&E LDH results

Additional referral information (useful for processing the referral)

  • Histological diagnosis does not necessarily predict clinical behaviour and as such, some low grade lymphomas may be treated as Cat 1 urgent and some aggressive lymphomas may be treated as Cat 2.  This decision should always be made on clinical assessment

Other useful information for management (not an exhaustive list)

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Emergency Treatment

Needs discussion with on-call specialist and / or Emergency Department

  • Highly aggressive lymphoma
  • Burkitt’s lymphoma
  • Lymphoblastic lymphoma
  • Symptomatic hypercalcaemia
  • Severe or life threatening symptoms (spinal cord, SVC compression, ureteric compression, airway compromise etc)

Category 1 – urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Aggressive lymphoma

  • diffuse large b cell NHL
  • grade 3 follicular lymphoma
  • Hodgkin lymphoma
  • T cell NHL (any subtype excluding cutaneous mycoses fungoides)
  • mantle cell lymphoma

For optimum care, patient should be seen within 2 weeks.

Low Grade lymphoma

  • follicular lymphoma (grade 1 or 2)
  • Waldenstroms macroglobulinaemia
  • Mycosis fungoides
  • CLL / SLL*

*Some CLL behaves very indolently and an appointment time within 90 days may be acceptable – this decision will be made by the triaging clinician.

No category 2 criteria

No category 3 criteria

 

Multiple Myeloma

Essential information (Referral will be declined without this)

  • General referral information
  • Past medical history, current medications
  • Previous cancer treatment details
  • FBC U&E calcium serum EPP FLC urine BJP results

Additional referral information (useful for processing the referral)

  • No additional information

Other useful information for management (not an exhaustive list)

  • If any life threatening symptoms present (new hypercalcaemia) or severe or life threatening symptoms present (e.g. spinal cord compression, SVC compression, ureteric compression, airway compromise etc.) – then call the haematologist on call, or send direct to emergency.
  • Bone scans are usually negative for the lytic lesions seen in myeloma. Plain film skeletal survey is recommended
  • IgM monoclonal protein is exceedingly rare in myeloma and is more commonly seen in low grade lymphomas

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Emergency Treatment

Needs discussion with on-call specialist and / or Emergency Department

  • Symptomatic hypercalcaemia
  • Severe or life threatening symptoms (spinal cord, SVC compression, ureteric compression, airway compromise etc.)
  • New severe renal impairment

Category 1 – urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

PRESENCE OF ONE IS REQUIRED

  • Abnormal serum protein electrophoresis
  • Abnormal free light chains
  • Bence Jones protein in urine

AND if ANY of the following present

  • Recent onset unexplained anaemia
  • Lytic bone lesions
  • Recent unexplained mild to moderate renal impairment

 

PRESENCE OF ONE IS REQUIRED

  • Abnormal serum protein electrophoresis
  • Abnormal free light chains
  • Bence Jones protein in urine

AND if ALL of the following present

  • Well, asymptomatic patient
  • Normal FBC and chemistry
  • No history of bone pain or new unexplained back pain.

 

Categorisation depends on subtype and amount of monoclonal protein

No category 3 criteria

 

Testicular Cancer

Essential information (Referral will be declined without this)

  • General referral information
  • Past medical history, current medications
  • Previous cancer treatment details
  • Histopathology
  • FBC U&E LFT Alpha-fetoprotein  ß-human chorionic gonadotropin LDC results
  • Any relevant XR results and/or relevant CT results

Additional referral information (useful for processing the referral)

  • No additional information
  • Other useful information for management (not an exhaustive list)
  • Patients with testicular mass should be referred to Urologists
  • Discuss sperm banking with the patient prior to treatment. Sperm count (with or without banking as appropriate) if fertility is a concern [5]
  • In very rare cases where there is a possibility of a benign tumour, excisional biopsy with a frozen section should be performed prior to definitive orchiectomy to allow for possibility of organ-sparing partial orchiectomy [6]
  • If there are signs suggestive of metastases consider:[7]
  • brain and spinal CT
  • bone scan
  • liver USS
  • brain or bone MRI

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Emergency Treatment

Needs discussion with on-call specialist and / or Emergency Department

  • Metastatic germ cell tumour (GCT) with severe symptoms, organ failure or life –threatening complications confirmed (biopsy) or suspected (tumour markers)  
  • Uncontrolled or disabling pain
  • Neurological symptoms and signs suggestive of cord compression
  • Brain metastasis
  • Febrile neutropenia
  • Symptomatic hypercalcaemia
  • Other organ failure

Category 1 – urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Metastatic germ cell tumour (GCT)-confirmed (biopsy, orchidectomy) not requiring emergency treatment (see emergency) For optimum care, patient should be seen within 2 weeks.

Resected GCT (after orchidectomy) for consideration of adjuvant chemotherapy or surveillance

No category 2 criteria

No category 3 criteria

 

Other Oncology and Haematology Conditions

Essential information (Referral will be declined without this)

  • General referral information
  • Relevant condition information
  • Relevant pathology and imaging reports
  • Histology
  • Operative Reports
  • Previous cancer treatments 

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 – urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

 

 

Our Specialists 

Dr Ray Banh

Director of Haematology

Dr Emad Abro

Haematologist

Dr Naadir Gutta 

Haematologist

Dr Cath Shannon

Director of Medical Oncology

Dr Vikram Jain

Specialist Medical Oncologist

Dr Kathryn Middleton

Specialist Medical Oncologist

Dr Felicity Murphy

Specialist Medical Oncologist

Dr Niara Oliveria

Specialist Medical Oncologist

Dr Amit Sharma

Specialist Medical Oncologist

Dr Natasha Woodward

Specialist Medical Oncologist

Bulk Billed Clinics

Mater Health offers patients the opportunity to attend bulk billed clinics. To provide your patient with the opportunity to attend a bulk billed clinic, please provide a named referral to one of the specialists listed above.

Contact Us 

If you would like to discuss a referral, including clinical criteria, or update the status of a current patient please contact our priority GP phone line on 07 3163 2200 

Current Waiting Time for Appointments 

We provide up to date data on how long patients are waiting for their first appointment by specialty here.

Referral Guideline Development

These Mater Referral Guidelines align with standardised best practice tools for referral to publicly funded specialist outpatient services developed in Queensland through the Clinical Prioritisation Criteria project.

 

Content last reviewed: 15 February 2018

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