Gynaecological oncology research

Every day in Australia 18 women are diagnosed with a gynaecological cancer. In Australia, more than 6,500 women a year are diagnosed with a gynaecological malignancy including ovarian, endometrial, cervical and vulval cancers.

Our research aims to improve the outcomes and quality of life for these women and focuses on patient-reported outcomes and the supportive care of patients affected by these cancers. We also conduct research in gynaecological cancer genetics, the epidemiology of gynaecological malignancies, and biomarkers to predict relapse in women with high-grade serous ovarian cancer, the most common type of ovarian cancer. We are a recruiting site for clinical trials in gynaecological cancer and lead national and international multicentre randomised trials.

Getting the MOST out of follow-up: a randomised controlled trial to compare three-monthly nurse-led telephone follow-up, including monitoring serum CA125 and patient reported outcomes using the MOST (Measure of Ovarian Symptoms and Treatment concerns) with routine clinic-based follow-up, following completion of first-line chemotherapy in patients with epithelial ovarian cancer.

We were awarded competitive funding - a total of $370,000 - to lead a national phase II trial that will investigate the feasibility of a novel approach to the follow-up of women with ovarian cancer after completion of surgery and chemotherapy. Patients will have nurse led follow-up with three-monthly telephone calls and will complete a patient-reported symptom assessment called the Measure of Ovarian Symptoms and Treatment concerns (MOST) questionnaire and also have a blood test for the ovarian cancer tumour marker CA125 to diagnose ovarian cancer recurrence. Many patients, particularly those living in rural and remote locations may find it difficult and costly to travel to their hospital clinic appointments. We will assess the health-related quality of life of women undergoing this novel type of follow-up compared to conventional hospital clinic-based follow-up that includes completion of the MOST.

This study will also inform the design of a larger phase III randomised controlled trial. Secondary aims of both the pilot and subsequent phase III trials include comparing nurse-led telephone follow-up with conventional clinic-based follow-up and whether the nurse-led follow-up method is more cost-effective than the conventional model. St John of God Subiaco Hospital is the sponsor for this study. The study opened for recruitment in Perth in February 2021.

EXCISE Trial

The EXCISE Trial was an investigator-initiated, international, multicentre, open-label, parallel-group, phase II, randomised study. St John of God Subiaco Hospital was the lead site and sponsor for this study. Patients were enrolled at seven hospitals in Australia and New Zealand. We randomly assigned women aged 18 to 45 years with screen detected precancerous cervical cells (adenocarcinoma in situ) to one of two commonly used treatments - loop electrosurgical excision procedure (LEEP) or cold knife cone biopsy (CKC). 40 patients were randomly assigned 2:1 to LEEP or CKC. Patients in the CKC group had more post-operative complications (64.3% compared to 15.4% for LEEP). The results of the EXCISE Trial were published in the journal Gynecologic Oncology in December 2020.

Director Gynaecological Cancer Research Group
A/Prof Paul Cohen

Gynaecological Oncologists
Dr Stuart Salfinger
Dr Ganendra Raj Kader Ali Mohan

Pathologists
Dr Adeline Tan
Professor Colin Stewart

Medical Oncologists
Dr Andrew Dean
Dr Martin Buck
Dr Tarek Meniawy

Project Manager
Sanela Bilic

Post-doctoral Research Fellow
Dr Aime Powell PhD

Research Nurse
Issy Black

Research Officers
Stephanie Jeffares
Maria Beilin

Clinical Trials Pharmacist
Naomi Van Hagen

1. Butler, J., Finley, C., Norell, C. H., Harrison, S., Bryant, H., Achiam, M. P., Altman, A. D., Baxter, N., Cohen, P. A., Chaudry, M. A., Dixon, E., Farrell, R., Fegan, S., Hashmi, S., Hogdall, C., Jenkins, J. T., Kwon, J., Mala, T., McNally, O., Merrett, N. & 11 others, Jul 2020. New approaches to cancer care in a COVID-19 world. The Lancet Oncology. 21, 7, p. e339-e340

2. Norell, C. H., Butler, J., Farrell, R., Altman, A., Bentley, J., Cabasag, C. J., Cohen, P. A., Fegan, S., Fung-Kee- Fung, M., Gourley, C., Hacker, N. F., Hanna, L., Høgdall, C. K., Kristensen, G., Kwon, J., McNally, O., Nelson, G., Nordin, A., O'Donnell, D., Schnack, T. & 3 others, , 30 Jul 2020. Exploring international differences in ovarian cancer treatment: a comparison of clinical practice guidelines and patterns of care. International Journal of Gynecologic Cancer.

3. Cohen, P. A., Leung, Y., Anderson, L., van der Griend, R., Chivers, P., Bilic, S., Bittinger, S., Brand, A., Bulsara, M. K., Codde, J., Eva, L., Farrell, L., Harker, D., Herbst, U., Jeffares, S., Loh, D., McNally, O., Mohan, G. R., Nicholson, T., Powell, A. & 10 others, , Dec 2020. Excisional treatment comparison for in situ endocervical adenocarcinoma (EXCISE): A phase II pilot randomised controlled trial to compare histopathological margin status, specimen size and fragmentation after loop electrosurgical excision procedure and cold knife cone biopsy. Gynecologic Oncology. 159, 3, p. 623-629.

4. COVIDSurg Collaborative including Cohen P.A., 2021. Elective cancer surgery in COVID-19–Free surgical pathways during the SARS-cov-2 pandemic: An international, multicenter, comparative cohort study. Journal of Clinical Oncology. 39, 1, p. 66-78 13.

5. Hardcastle, S. J., Maxwell-Smith, C., Hince, D., Bulsara, M. K., Boyle, T., Tan, P., Levitt, M., Salama, P., Mohan, G. R. K. A., Salfinger, S., Makin, G., Tan, J., Platell, C. & Cohen, P. A., 24 Apr 2021. The Wearable Activity Technology And Action-Planning trial in Cancer survivors: physical activity maintenance post-intervention. Journal of Science and Medicine in Sport.