NEWSLETTER

No. 49 September, 2006

Editor: Mark Tweeddale

1. COMING EVENTS

(Meetings are normally held (unless otherwise advertised) at 6.30 pm on the first Tuesday of each month in the Palliative Care Cottage, Mona Vale Hospital)

Tuesday 3 October

Associate Professor Phillip Stricker, St Vincent's Clinic, Darlinghurst: New technology for prostate cancer: what's place? Professor Stricker

is well known to us all. His session will deal with HIFU and robotic surgery. Please invite friends or family who might be interested in

these treatments to come along.

Tuesday 7 November

Associate Professor Susan Henshall, Head, Prostate Cancer Research Program, Garvan Institute of Medical Research: Prostate Cancer,

Genetics and Gene Therapy.

Tuesday 5 December

Christmas Get-together

2. Report on our September meeting

There were two speakers at this meeting:

Sr Diana van der Saag, Nurse Coordinator, Royal North Shore Hospital, speaking on "The Role of the Nurse Coordinator".

Dr Enzo Lazzaro, Urologist, speaking on "Hormone Therapy for Prostate Cancer".

Sr van der Saag is care coordinator for prostate and urological cancers, based at RNSH. She is a registered nurse with postgraduate certificates in oncology, and prostate care nursing at La Trobe University. She has been a Cancer Helpline Coordinator for five years, has experience with clinical trials in oncology and oncology ambulatory care.

The Cancer Institute NSW was formed in 2003 by an act of parliament. The Cancer Plan was set up as a priority, with the aims of providing a more integrated, coordinated and patient-focused approach to treatment across the Health area, with access to appropriate clinical services and multidisciplinary care. It will enhance education, training and continuing professional development.

Sixty nurse coordinator positions have been funded across the State, with six of these in the Northern Sydney Central Coast Area Health.

Coordination will entail a) case management and facilitation of each patient's cancer journey; b) integration of the various services; c) provision of patient information and psychosocial support; and d) linking each patient and his treatment team.

The Nurse Coordinator can help in many ways. These include: providing information about diagnosis, prognosis, treatment choices and clinical trials. She can also help with the management of the side effects of treatment, and help with care following discharge from hospital.

The Patient Pathway typically comprises - initial referral from the urologist/radiation oncologist/medical oncologist;

pre-treatment visit/telephone call hospital visit post-hospital telephone call followup telephone calls availability to take calls / emails from

patient/family members.

The Nurse Coordinator - undertakes preadmission clinic and radiotherapy planning - patient & family education and support provides the Cancer Council SIP package undertakes patient assessment - identifying any needs or concerns coordinates appointments, referrals and followup care.

When the patient is an in-patient, the Nurse Coordinator- visits each patient every day or second day assesses how the patient is recovering from surgery and how the carer is coping communicates in the medical records and directly with the consultant identifies support group or peer support program for patients.

When the patient is being treated with radiotherapy, the Nurse Coordinator - assists the registrar during the weekly patient reviews coordinates referrals to allied health provides information and support tailored to the needs of individual patients reports to Cancer Nurse Coordinators on the North Coast about the progress of their patients.

When the patient goes home, the Nurse Coordinator - calls the patient around 24 hours after discharge to check how he is calls again after a week to check progress (e.g. continence, pelvic floor exercises etc.) calls again after around 2 months to check progress.

The benefits of coordination of care include -: information tailored to each patient's needs and wants increased opportunities for each patient to discuss concerns or issues provision of practical support e.g. continence products referral to support services.

Multidisciplinary care: the Nurse Coordinator coordinates multidisciplinary care meetings with urologists, radiation oncologists, medical oncologists, and delivers a range of services and skills to improve care and outcomes. (At RNSH, urology multidisciplinary team meetings are held every second Thursday.)

Contact Details: Diana Van der Saag. Royal North Shore Hospital Tel 9926 5218

Hours: Monday - Friday.

Dr Lazzaro said that hormone treatment was used at some stage of the treatment of around 75% of prostate cancer patients.

Hormone therapy or Androgen deprivation therapy (ADT) has been the main tool in the management of advanced prostate cancer for more than 60 years. In 1941 Huggins and Hodges published their initial research on the effect of hormone manipulation on prostate cancer. They were awarded the Nobel Prize for Medicine for their work.

Initially ADT involved the use of female hormones such as Stilboestrol. A common side effect of these drugs is that they increase fluid retention and increase blood clotting thus increasing the risk of Heart attacks, strokes and blood clots.

Orchiectomy i.e. removal of the testes became the gold standard of hormone treatments. This simple surgical procedure eliminated all the Testosterone produced in the testes, without the side effects associated with Stilboestrol. However there was the psychological scarring associated with the procedure. Despite this it was well accepted by men with advanced Prostate Cancer and remained standard treatment for many years, until the development of the currently used drugs.

Currently ADT involves the use of LHRH agonists, or Antiandrogens or in some cases both (Maximal or Total Androgen blockade).

LHRH agonists work by misleading the body into believing that there is too much testosterone present and shuts down the production of testosterone by the testes.

LHRH agonists are administered in the form a depot injection which last for 1,3,4 or 6 months depending on the one used. The LHRH agonists currently available are Zoladex, Lucrin and Eligard.

Antiandrogens work by reducing the effect of the androgens on the target cells ie the prostate cells. They are often used in combination with LHRH agonists and seldom used on their own. Currently available antiandrogens include Androcur, Cosudex, Flutemide and Nilutemide. There are also now a number of generics on the market that the pharmacist may substitute. All antiandrogens come as tablets.

80 - 90% of patients with Prostate Cancer have hormone dependant cancers and therefore respond to ADT by reduction of the cancer and lowering of the PSA. The effect typically lasts for about 4-5 years before the cancer becomes hormone independent and starts to progress again, although the effect can be shorter or longer.

ADT has a number of applications in the treatment of Prostate Cancer:

Metastatic disease. Most commonly used as an LHRH agonist alone. This can sometimes lead to a transient increase in the serum Testosterone level and a transient increase in tumour activity (Tumour flare). This can have serious consequences in patient with bone metastases and lead to fractures and other complications. An antiandrogen is often used to protect patient from a flare. The timing of the commencement of ADT remains controversial.

Rising PSA. Disease progression is now detected with a rise in the PSA much earlier than it becomes evident clinically or on imaging. Again the timing of ADT is controversial.

As additional treatment in patients receiving radiotherapy. It has become common practice to use ADT pre and post Radiotherapy.

Intermittent therapy. In patients who have had good responses to ADT usually PSA below 4 but preferably below 1 Hormone treatment can be suspended till the PSA rises again. This will reduce the side effects and there is no evidence that this leads to earlier progression of the disease.

Side effects of hormone treatment include: hot flushes, reduction of libido, difficulty in getting erections, lassitude, muscle weakness, osteoporosis, sleep disturbance.

A treatment to combat the osteoporosis (and the consequent risk of breaking bones) in patients with bone metastases is the use of a bisphosphonate such as Zometa, used in conjunction with the LHRH agonist (e.g. Zoladex). It also reduces the growth of secondaries in the bones which can impinge on the spinal cord.

Chemotherapy is showing some prospects. Drugs being used include Mitoxantrone and Taxotere, and a great deal of research is being done to find other treatments.

Our thanks to Sr van der Saag and Dr Lazzaro for their presentations.

3. Reports on meetings held elsewhere

3.1 "Management of Radiation Proctitis" Presentation by Prof. Pierre Chapuis, Colorectal Surgeon, to the SAH Prostate Cancer Support Group at Jacaranda Lodge, the Sydney Adventist Hospital, on Monday 24th July, 2006 at 7.00 pm.

Radiotherapy is frequently used in the treatment of cancer in combination with other treatments. In men the two most prevalent cancers requiring radiotherapy are cancer of the bladder and prostate. "As after radical surgery where complications may occur radiotherapy is not without problems".

Rectal bleeding is a known treatment complication of prostate cancer. Three different terms are used to describe this condition. They are:

Actinic proctitis

Radiation proctitis

Chronic radiation-induced rectal bleeding (CRRB).

Rectal bleeding may complicate treatment in 5 to 10 per cent of patients.

Rectal bleeding caused by radiation thickening of the walls of small arteries supplying the rectum, and so by narrowing them restrict the blood flow to the rectal wall. To compensate for this, new thread-like capillaries grow in profusion very close to the internal surface of the rectum. It is the fragility of these capillaries that causes the bleeding. As this does not involve true inflammation, "proctitis" is an inappropriate term, and Prof Chapuis prefers the third description (CRRB).

The rectal bleeding may not start until some 12 months to three years after treatment. Because bleeding is a known side effect of radiation therapy for prostate cancer, and rarely may be life threatening patients should be informed of this risk and consent to such treatment.

Rectal symptoms can fall into two broad categories which are partly dose related:

Acute: Symptoms include tenesmus (pain on passing stools); diarrhoea; urgency of defaecation; bleeding;

Chronic: Symptoms include stricture (narrowing or restriction); fistula (abnormal passage); CRRB; varying degrees of incontinence; loss of compliance & storage capacity of the rectum.

Clinical features of CRRB include:

It is classed as Grade III on a scale of seriousness from I to IV, i.e. quite serious. Around 50% of cases are late onset (i.e. starting later than

one year after treatment). From a situation with the patient not experiencing any problems it may become chronic with progressively

increasing bleeding resulting in iron deficiency anaemia which may require daily dosage of iron tablets. Fifteen to 20 years ago it quite often

led to transfusion-dependent anaemia, necessitating frequent blood transfusions, but this is now very unusual as a result of much improved

radiotherapy techniques.

It is important for prostate cancer patients to recognise that some degree of "collateral" damage will inevitably occur to the rectum due to the radiation treatment. Late development of bleeding will be experienced by a small proportion of these patients, but this is nowhere near as common or severe a problem as in the past. A critical decision is whether the benefit of the radiation treatment of the cancer outweighs the risks of rectal bleeding or other complications as a result of that treatment.

The factors which affect the risk include:

the total dose of the radiation;

the fractionation of the dose, i.e. how it is delivered;

the build of patient, as obese people are more susceptible;

diabetes;

hypertension;

previous abdominal or pelvic surgery (adhesions);

chronic diverticular disease of the proximal bowel;

Bleeding may be exacerbated if taking drugs such as aspirin, Warfarin or Plavix.

Possibly because of their genetic makeup, some men are inherently more sensitive to radiation.

Quality of life issues that may influence the decision whether to opt for/out of radiotherapy include:

the alarm caused by unexpected bleeds;

the late onset (leading to several years of anxiety about whether bleeding will occur);

the absence of identifiable risk factors in many cases, preventing prediction of whether any particular patient will be affected;

whether the patient has other conditions, such as diabetes or hypertension.

Additional issues include:

the unpredictable nature of the bleeding which is socially inconvenient and acutely embarrassing;

the resulting anaemia is debilitating;

poor response to treatment;

simple treatments often prescribed (e.g. steroid suppositories or enemas) are usually of little benefit

the condition can last for a long time;

there is a (small) possibility of it progressing to Transfusion Dependent Anaemia

Dr. Chapuis says: "It is fundamentally important that the prospective radiotherapy patient be informed about the possibility of CRRB, so that he can make an informed decision whether to go ahead."

Patients with CRRB should be thoroughly assessed, including their history and a physical examination, a blood test including a full blood count, iron studies and coagulation profile. Then a safe and thorough examination by colonoscopy of the large bowel enables the severity of the condition to be determined and identification of any other sources of bleeding. A cystoscopy and/or special small bowel x-ray are sometimes appropriate. Sometimes anorectal manometry is needed to test the strength of the sphincter muscle prior to treatment. The patient may be asked to keep a record of bleeds by marking a calendar as treatment progresses.

There are several options for treatment, which will be influenced by the location of the source of bleeding and the extent of the condition.

Minimally invasive therapy includes:

electrocautery;

Argon plasma coagulation therapy (APC);

endoscopic laser;

formalin (formaldehyde) dressings applied under a general anaesthetic;

hyperbaric oxygenation with multiply treatment episodes required.

In the case of APC or endoscopic laser, each potential bleeding point needs to be separately treated. The procedure may require several visits, spaced a few weeks apart, to allow the lining of the rectum to recover. The procedure may be undertaken under conscious sedation or general anaesthesia.

The use of formalin began in the 1960's. It was found that the formalin destroyed the superficial lining (which then separated off) thus causing the bleeding to stop and allowing the new lining to re-grow without blood vessels. However, the appropriate concentration for the formalin was uncertain, and the approach was abandoned until more recently, when a particular low concentration has been found to be both effective and safe. A blood count is taken before and after treatment. The patient undergoes a general anaesthetic and is prepared by applying plastic skin dressings applied to the skin surrounding the anal passage. A speculum is inserted and dressings containing formalin are packed into the rectum through it and left for five to ten minutes before being removed. This is repeated until bleeding ceases.

Up to 20 per cent of patients treated with the formalin method experience complications such as:

mucus incontinence either from treatment or from the initial Radiotherapy;

some patients may need to wear a pad;

acute prostatitis (very rare);

narrowing of the rectum (very rare);

ischaemic ulcer - prevented by taking care to cover exterior of anus with a plastic skin during treatment.

Use of either the laser or the formalin method, or both together, results in 75 - 80% success. However, treatment and follow-up may be necessary for up to 12 months

For otherwise intractable cases, several surgical options exist.

(Pam Sandoe & Mark Tweeddale)

4. GENERAL NEWS

4.1 PSA Testing

The Prostate Cancer Foundation of Australia (PCFA) recently issued their policy statement on PSA and DRE testing for early detection of prostate cancer.

"Early detection is the key to enabling better outcomes and potential cure of prostate cancer. Accordingly the PCFA recommends that men at 50 with no family history of prostate cancer, and men at 40 with a family history, should seek voluntary assessments in the form of a Prostate Specific Antigen (PSA) blood test together with a Digital Rectal Examination (DRE). It can be life threatening to wait for symptoms before seeking assessment."

(Taken from the September/October Newsletter of the Prostate Cancer Support Group at the Sydney Adventist Hospital, Wahroonga)

Not so long ago it used to be said that early detection did not help with treatment and cure of prostate cancer. Then it was said that early detection would result in unnecessary treatment of cancers that would never have been a problem. But there is now ample evidence that PSA testing enables recognition of the existence of the cancer which enables further testing to determine whether it should be treated or left with active surveillance.

While the policy statement cannot help those with prostate cancer already, it is an important statement for other men. We should use the remainder of September, Prostate Cancer Awareness Month, as a particular opportunity to tell those we meet about it; not just the men, but their partners too (to ram the message home!). Certainly, we should impress on our sons, who are at around three times the risk of other men, of the message about their needing to be tested from the age of 40 !

Diet and Exercise

Last February the NSW Cancer Council issues a Media Release entitled: "Boosting diet and exercise may improve cancer survival". It reported that there is strong evidence that eating more fruit and vegetables and less saturated fat, and maintaining a healthy weight, reduces the likelihood of return of breast cancer, and that increased exercise reduces the likelihood of return of bowel cancer. While prostate cancer was not specifically mentioned, our quality of life will be enhanced if we eat better and exercise more, quite independently of the possibility of a reduced risk of recurrence of our cancers.

(In an article in the May 2006 issue of Prostate News, issued by the Prostate Cancer Foundation of Australia, Dr Manish Patel reported that while lycopenes from tomatoes and selenium each reduce the risk of getting prostate cancer, so far there is no good evidence that they may slow its growth once one has it. However, there is some evidence that Vitamin E might slow the growth, although there were dangers with overdosing.)

One approach to deciding about diet and exercise is to ask one's GP for a referral to a dietician and to an exercise physiotherapist. (Some of the latter can be found at the rehabilitation sections of major hospitals).

Pomegranate Juice

It was reported in the popular press some months ago that a trial indicated a substantially reduced rate of rise of PSA for those who drank the juice daily. It seems that the trial was not a rigorously conducted "double blind" trial, so the results may be questioned. The problem is that the cost of a rigorous double blind trial, in which neither the patients nor their treating doctors know whether they are receiving the medication (or in this case, juice) or an inactive "placebo", costs many tens or hundreds millions of dollars. Such trials are usually only able to be funded by very large organisations, and such funding is highly unlikely to be available for a natural product such as pomegranate juice. So we are unlikely (ever?) to get a definitive answer about the value or uselessness of pomegranate juice. As pomegranate juice is still quite expensive (at around $20 per litre), it is up to each of us individually to decide whether we think the uncertain but possibly useful benefit to our health is worth the certainty of substantial cost.

Seminar

The following information has been received from Professor Karen Phelps about a forthcoming seminar about a newly opened multi-disciplinary clinic for chronically ill patients:

"It is never too late for prevention, even those suffering with a chronic disease can still take stock, get the right advice and make lifestyle changes that will help them recover, heal or improve how well they are able to feel. This concept works best if the practitioners involved in a person's health care communicate closely. We have recently opened a multi-disciplinary clinic on the old St Margaret's site at 421 Bourke Street, Surry Hills, bringing together expertise in the areas of general medical practice, public health and clinical preventative medicine, mind-body medicine, sports medicine, nutrition, dietetics, naturopathy, herbal medicine, exercise physiology and massage.

We are continually seeing patients achieve amazing results through questioning, exploring options and demanding alternatives.

One of Uclinic's programs which we believe would be of benefit to group (members) is our Chronic Disease Management Plan. So many health problems are diet and lifestyle related and so are the solutions.

At Uclinic we offer a new health initiative whereby those suffering with a chronic disease may be entitled to a health overhaul at no cost to them.

We are holding a free seminar Thursday 28th September at Uclinic in Surry Hills from 1800 - 1930 hours. The seminar is designed to give people the opportunity to understand what is available to help them live and manage their disease and lead to ongoing lifestyle changes which we expect will reduce further complications for them. All under the supervision of accredited professionals.

Should you require any more information please do not hesitate to contact me on 93320400, 0402 286786 or email sarah@uclinic.com.au."

4.5 From the PCFA

4.5.1. "Movember" is November is "Movember".

"This is a charity event held during November each year. At the start of Movember guys register with a clean shaven face. The Movember participants known as Mo Bros then have the remainder of the month to grow and groom their moustache and along the way raise as much money and awareness about male health issues as possible.

Movember culminates at the end of the month at the gala parties. These glamorous and groomed events will see Tom Selleck and David Boon look-alikes battle it out on the catwalk for their chance to take home the prestigious "Man of Movember" title.

In 2006, the key male heath issues Movember is supporting include:

Prostate cancer because every year in Australia 2 700 men die of prostate cancer - more that the number of women who die from breast cancer.

Male depression because 1 in 6 men are affected by depression. Most don't seek help. Untreated depression is a leading risk factor for suicide. Rates of suicide are more than double the national road toll.

For more info go to www.movember.com.au"

4.5.2. Group Affiliation with the PCFA

The PCFA has promulgated a revised set of Affiliation Rules and a new Application for Affiliation pro-forma. This will be discussed by your Management Committee at its next meeting prior to completing and returning the Application. Any member who wishes to peruse these documents should contact John Conroy (9918 9358).

5. BOOK REVIEWS

5.1 Quest for Life by Petrea King, published by Random House Australia

The subtitle of this book is "A handbook for people with cancer and life threatening illnesses". The value of books like this depends very much on the health situation and state of mind of the reader at the time of reading. For me, this book came at precisely the right time, a time when I had just learned that the hormone treatment was no longer holding the cancer and the future did not look too good.

Petrea writes from experience, having herself been diagnosed with cancer and given three months to live. Many years later, she is still going strong but, like all people in that situation, is living with the possibility of a recurrence or relapse.

I found the early chapters more helpful than the later ones, but this is just my experience. She notes that many people with cancer are "very late for their funerals", and discusses what these people have in common. She reports that they have a) a refusal to accept the fatality of the disease; b) a purpose for living; c) the ability to express their feelings (instead of bottling them up); and d) a willingness to follow their own inner guidance for healing. The first of these may seem a bit difficult, but when one considers Petrea's own case, and those of many others of whom one hears who have unaccountably recovered against all the odds, this unpredictability of the disease provides one with hope.

The book contains numerous memorable quotes, such as:

"It's not what happens to me, but how I respond to what happens" (that matters)

"We can't always change the outcome of a disease, but we can change the way in which we experience that outcome."

"While we're alive, we're living with a life-threatening illness, not dying with a terminal one."

Early chapters deal with topics including:

"Creating the Environment for Healing" (including attitudes to life, the immune system, management of stress, the power of choice)

"Techniques for Living" (i.e. how to enjoy oneself regardless of one's illness, how to interact with doctors and how to identify and dispose of baggage")

"Friends for Life" (including illustrations of the value of support groups and friends)

"Meditation - a Key to Life"

There is much practical information about dealing with some of the problems that can arise with cancer such as depression, pain and the side effects of treatment. There is a chapter on suggestions for diet - what to eat and what to avoid. Personally I was less interested in some of the dietary and homeopathic information, but others will appreciate this material more.

I found this a very encouraging and heart warming book to read. I constantly found myself saying to myself "Aha! She has felt that way too", or "She has had that experience too!" In my view, this book will be very valuable and helpful to many, particularly those who are anxious about their disease or depressed because of it.

- HMT (My rating for relevance for prostate cancer patients:)

5.2 The Patient from Hell by Stephen H Schneider, published by Da Capo Press

The subtitle of this book is "How I worked with my doctors to get the best of modern medicine and how you can too".

Professor Schneider is an eminent and internationally known environmental scientist in the USA, working principally on climate change. In his book, he constantly contrasts the medical protocols he encountered in the course of his treatment for a rare form of cancer with good scientific method, illustrating these with examples from his environmental work. The result is very interesting reading, but rather heavy going at times due to the details of the scientific and medical arguments he presents, much of which I skimmed over. His disease and his treatment are set out in a lot of detail, but much of this is of limited relevance to prostate cancer patients. He makes a number of valuable points, but many of them are most relevant to patients with rare forms of disease, or those undergoing very novel treatment, for which there is little or no reliable data. Prostate cancer, on the other hand, while in varying degrees of aggressiveness and in patients of widely varying age and fitness, is quite common and there is a great deal of information about it to guide doctors.

Nevertheless, the account is sprinkled with observations that are widely applicable. Examples are:

" … if, during your treatment you are feeling good enough, get out and do something!

" One of the most important things about cancer treatment and recovery is support and love …"

"I realised that dealing with (cancer) was more than an experience and a challenge; it was a life-defining, and even death-defining, event that had intense emotional repercussions that I simply had to accept."

The chapter written by his wife, from her perspective as the carer, was particularly illuminating, and would be helpful and interesting reading for a carer.

Because of the nature of his cancer, his treatment was extremely rugged. When at last the treatment seemed to be succeeding, and all his reasoning and discussions and debates with his doctors seemed to be vindicated, he encountered the depression that is common in cancer patients at some stage. He was not shy about admitting this and seeking help from a psychologist. Full marks for honesty and openness!

He is internationally eminent as a scientist and clearly has a feisty personality. His wife is a biologist of high standing who spent hours at a time during his treatment researching on the internet. He cannot be regarded as a typical patient as he was better equipped to debate with his doctors than most of us would be. I am not sure that we could "do so too" as is suggested in the subtitle, at least to anywhere near the extent he did.

However, his principal message is important. It is that to get the best possible treatment one should become as fully informed as possible about the disease. Doctors, being human, are bound to overlook some details on some occasions. Once one is informed, one can:

talk with one's doctors from a position of knowledge;

understand the treatments they propose;

ask them to explain their recommendations;

be better able to make informed choices rather than blindly accepting what is offered;

query any proposed treatment that is not what one expected.

- HMT (My rating for relevance for prostate cancer patients:)

(We hope to include a book review each month. If you would like to write one, please e-mail it to me for inclusion)

6. Information Update

6.1 Publications Received

Copies of all of the following are available for borrowing from our Lending Library:

Prostate News. Prostate Cancer Foundation of Australia, Issue 27, September, 2006.

It includes a report on the Inaugural PCFA Men¹s Health Promotion Conference held in Melbourne on 12 August, 2006.

Cancer Central (Australia). On-line Newsletter from SE Perth Prostate Cancer Support Group. This new website was publicised in our Newsletter 47, July, 2006 and covers all cancers. The address is: www.cancer central.com.au. Accessing the links requires joining the group for a fee of $2.00 per month.

Cancer Support Groups. A guide to setting up and maintaining a group. The Cancer Council NSW, 2006.

Smart Living, Spring/Summer 2006. The Cancer Council NSW, 2006.

6.2 Found

A medallion has been found in the Palliative Care Cottage with the following inscription:

1970 To commemorate the safe return of the SS Great Britain from the Falkland Islands to Bristol

If this belongs to any member of the Group, please contact John Conroy: 9918 9358.

Thanks

I have taken on the role of Editor of the Newsletter to ease the workload on John Conroy, who has done this until now. Preparation of the Newsletter is only a small part of the work done by him in getting the Group going and in keeping it going so well. He has identified and invited speakers, prepared the meeting room, taken notes of the talks and written them up, restored the meeting room to its normal layout, searched other sources for news, publicised the Group, represented the Group at meetings and attended conferences to gather information, compiled the newsletter, photocopied it, folded it and posted it, compiled and updated the membership list, and undertaken numerous other tasks. This he has done with vigour, enthusiasm, insight and courtesy. The smoothness and apparent effortlessness with which the Group functions is proof of how well he has done all this backroom work, most of which he is still doing…!

Thank you from us all, John.

Mark Tweeddale

YOUR CONTACT NUMBERS

Program Co-ordinator Dr Peter Moore Northern Beaches Palliative Care 9997 3555	Group Leader John Conroy 9918 9358 conroyjs@bigpond.com
NSW Cancer Council Cancer Support Helpline 13 11 20	Prostate Cancer Foundation of Australia 1800 220 099