Implementing optimal care

Optimal care pathways implementation

Lung optimal care pathway

• Medical oncology clinic referral and triage processes streamlined to enable more coordinated and appropriate care prioritisation and management at Alfred Health and Peninsula Health
• Lung MDM referral form developed to improve timeliness of referral to treatment
• Median time from diagnosis to first palliative chemotherapy was maintained at Alfred Health despite a 30 per cent increase in newly diagnosed patients

Colorectal optimal care pathway

• The number of patients with rectal cancer who had their treatment discussed at an MDM prior to first treatment increased from 81.8 per cent to 98 per cent
• Terms of reference developed and approved for Peninsula Health’s newly established colorectal multidisciplinary team meeting
• Bowel surgery preparation brochure available in seven languages and will be provided to approximately 190 patients treated for bowel cancer at Dandenong Hospital per year

Head and neck cancer optimal care pathway

• General practitioner (GP) lecture series delivered across southern Melbourne to 52 attendees
• Direct referrals to Monash Health’s head and neck cancer service increased from 23 per cent to 67 per cent
• Clearly established referral pathways for new patients were developed and are available on the Monash Health website, Health Pathways and the SEMPHN website

Prostate cancer optimal care pathway

Two hundred men (71 per cent) newly diagnosed with prostate cancer in southern Melbourne received written information about their diagnosis and treatment plan

• 96 per cent of men recalled received direct contact details for a prostate nurse
• 69 per cent received information about their local support group
• Sexual health issues were discussed with 80 per cent of patients

Oesophagogastric cancer optimal care pathway

• Prospective MDM presentation rates increased from 85 per cent to 100 per cent at Alfred Health and from 77 per cent to 90 per cent at Monash Health
• Time from diagnosis to first treatment reduced from 44 to 40 days at Alfred Health and 42 to 40 days at Monash Health
• Reduction in time from receipt of referral to first treatment from 48 days to 20 days at Alfred Health
• 200 oesophagogastric patient care plans were provided for use with newly diagnosed patients across southern Melbourne

Pancreatic cancer resectability project

SMICS has partnered with North Eastern Melbourne Integrated Cancer Service (NEMICS) to engage key stakeholders from across Victoria, including radiologists and surgeons working in key pancreatic surgery centres, to agree to adopt the International consensus on definition and criteria of borderline resectable pancreatic ductal adenocarcinoma 2017 to classify resectability in non-metastatic pancreatic ductal adenocarcinoma (PDAC) for use in Pancreatic Protocol CT reporting in Victorian health services.

A standard structured radiological synoptic reporting template has been developed to determine the PDAC resectability criteria and will be implemented at Alfred Health and Austin Health to classify and document disease resectability at multidisciplinary meetings (MDMs) during a 12-month pilot commencing in October 2020.

SMICS and NEMICS have engaged with the Upper Gastrointestinal Cancer Registry (UGICR) to collect the data from pilot sites via the registry REDCap database. The UGICR is a quality cancer registry that already collects similar data, creating an opportunity for a central collection point for the project.

The lack of agreed common criteria to define resectability to date has been a barrier to determining appropriate treatment for pancreatic patients and leads to a known variation of care. The adoption of a standard statewide definition on resectability and the development of a reporting tool based on that standard will help ensure appropriate and consistent management of patients. Furthermore, it is suggested that by being able to clearly define borderline resectable disease, further treatment options may become available to patients.

Aboriginal and Torres Strait Islander optimal care pathway

The government’s Victorian cancer plan recognises that there are inequities for Aboriginal Victorians across the entire cancer pathway and that cancer incidence and mortality rates are higher. Collaboration and culturally appropriate care is supported throughout the southern Melbourne healthcare services. However, actual barriers or gaps for the management and support of Aboriginal and Torres Strait Islander people with cancer in the SMICS catchment are not specifically known. Data validity, disparate data sources and low numbers add to the challenges of accurately reviewing service delivery.

Partnering with Aboriginal communities and cancer and Aboriginal health services, this project has begun by mapping the journey and understanding the barriers and gaps in service delivery for the southern Melbourne area. By mapping services and the cancer journey taken by Aboriginal and Torres Strait Islander people in the area, different clinical and consumer perspectives will be explored and will provide insight into gaps and barriers. Education for staff (cancer service staff and Aboriginal health workers) will be developed to ensure care is delivered in a culturally appropriate way. A journey map specific to each participating healthcare service will be developed to support Aboriginal and Torres Strait Islander people diagnosed with cancer and their families navigating the cancer pathway in the southern Melbourne area.