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Central Cancer Network
regional workshop
Cancer nurse co-ordinator
roles
Monica O’Reilly
Cancer Pathway Facilitator
Hutt Valley DHB
11 October 2012
• Cancer registrations
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Prostate
Breast
Colorectal
Lung
Melanoma
Non Hodgkins
96
89
86
60
42
25
626
Current resources
• Breast care nurses most comprehensive
• Plastic surgery services – OP RN
involved in melanoma pathway
including MDM
surgical pre-assessment
• All other services RNs or CNS as part of
OP or surg pre-assessment roles
Gaps and issues
• No overarching co-ordination for any
tumour stream
• Regional plastic surgery services coordination sits as part of a number of
different roles
• IT issues
• How allocate roles across region/sub
region given requirement for DHB
placement
Care co-ordination priorities
• Regional service provision
Breast reconstruction
Head and neck cancer
Melanoma
• Sub regional lung cancer
Breast reconstruction
• Current pathway well covered for subregional screening entry patients and
local symptomatic entry patients
• ? potential to extend role for regional
reconstruction or develop from within
plastic surgical service
Head and Neck Cancer
• Regional service
• Not big numbers but complex pathway
Complex melanoma
Pathway to treatment decision
Head and Neck Cancer Pathway HVDHB P1
Provider other than HVDHB
Pathway to treatment decision
Private Specialist
ENT, plastics, oral
-confirms
diagnosis
Patient sees GP/
dentist.
Referral made
or
Surgery
performed
or
Referral
direct to
Radiotherapy.
See
Radiation/
Medical
oncology map
Process
Legend of
shapes
Decision
either
Local DHB
Patient seen by DHB Specialist
(Surgeon - general, plastics, ENT,
oral.
Physician – dermatologist)
either
Referral to MDM
Separate
process
map
Local DHB
If referrer is to be treatment
provider,
relevant specialist
communicates advised
treatment plan from MDM
Prepara
-tion
End of process
Supportive care
delivered locally
Either
Referral has
cancer diagnosis
confirmed
HVDHB
Referral triaged
- by named
consultant
or
H & N Clinic
Consultant
HVDHB
Referal received
- named specialist
or ‘general’(eg.
Head and Neck
Clinic, Plastic
Surgery OPD)
Yes
No
Assessment in
general plastics
OP Clinic
FSA
Head and Neck
Multidisciplinary
Clinic – at Hutt or
nearest (to pt)
Cancer Treatment
Centre
Lead specialist/s
decided on
No
Treatment plan
discussed with
patient
Active
treatment
or
MDM led by Radiation Oncologist
Hutt Maxillo-Facial surgeon attends
WBCC and Midcentral MDMs
Yes
Combination
of treatments as appropriate
Investigations as
indicated Biopsy
Radiology (CT,
MRI, ultrasound,
OPG)
Endoscopy
Surgery
- refer
Surgical
pathway map
If MDM at RCTS and surgery to be
performed at Hutt, information booklet
given to patient at time of MDM. Travel
and accomodation arranged by local
DHB
Radiotherapy
+/- Chemotherapy
treatment
delivered at
Wellington Cancer
Treatment Centre
- refer Radiation/
Medical Oncology
pathway map
Surgical treatment pathway
Head and Neck Cancer Pathway HVDHB P2
Local Services
Surgical treatment pathway
Surgery performed
by local DHB
specialist if
appropriate
HVDHB
General
Surgery Unit
Booking through
ENT booking
clerk
Preassessment
clinic
Discharge liaison follow-up
appointment
made
Patient admitted
for surgery
Patient discharged
to follow-up
No
Attendees
Clinical Nurse Managers, Ward
and OPD
Service Manager
Theatre Manager
Pre-assessment Nurse
HVDHB regional plastic surgery services
Re-constructive
surgery required
Wkly ward
planning meeting
- ICU, equipment,
research, allied
health arranged
as necessary
Surgeon gives
booking card to
secretary
Surgery scheduled
Patient notified
W/L notified
Yes
Surgery at Hutt
Hospital Plastic
Surgery Unit
Yes
Patient admitted
for surgery
Length of stay
varies according
to complexity
Urgent
No
Assessment of
pathology and
referral to
radiotherapy if
required
Surgeon gives
booking card to
secretary
Surgery booked
through Hutt W/L
Wkly ward case
conference
– referrals as
needed sent on
day of meeting
to prepare for
discharge
Patient discharged
to follow-up
Patient seen by
pre-assessment
nurse (in week
prior, or day
prior if from out
of area)
Community support
as needed
- social work,
physiotherapy
dietitian, speech
language therapy,
nursing, home help
Follow-up clinic
appointments
arranged
Radiation and medical oncology
Head and Neck Cancer Pathway HVDHB P3
HVDHB
Radiation and medical oncology treatment pathway
Referral made by
assigned lead
consultant as
result of MDM
treatment
decision, or postsurgery pathology
indicates radiation
needed
Adjuvant
Chemotherapy
No
Referral from
private specialist
Referral to
Community Cancer
Nurse, Oncology
Social Worker. Visits
as needed until
treatment effects/
issues resolved
FSA
Radiation
Oncologist
(at combined clinic –
plastics, or general
radiotherapy clinic)
Yes
FSA
Medical
Oncologist
to fit with
scheduled
radiotherapy
treatment
Dental
clearance
(Dental
department)
Placement
of PEG
(Gastroenterology)
CCDHB
No
Referral to
Community
Dietitian - visits as
needed until
treatment effects
resolved
Yes
Nutritional
compromise
expected
Prophylactic
dental clearance
needed
Yes
Patient attends
RTplanning
and mask
making
appointments
Private system
follow up and
surveillance Wgtn
or Hutt
No
Yes
Chemotherapy
treatment (IP or OP)
scheduled to align with
radiotherapy. Seen by
medical oncologist
regularly according to
regime.
No
Radiotherapy prebooked
(from MDM or post
surgery) for
treatment to follow
surgery
Follow up and
then surveillance
at Hutt or Wgtn
Clinic (MDM or
general)
Yes
No
Surgery
as part of
treatment
If post treatment
swallowing
difficulties, Speech
Language Therapist
assessment and
follow-up
Radiotherapy treatment
as scheduled (usually
daily for 5 - 7 weeks)
Sees radiotherapy
oncologist weekly/on
request more often if
needed. Also monitored
by radiation nurse
specialist and allied
health.
Yes
Possible
delayed
PEG, RIG
or NG
insertion
Specialist
public system
Completion of
treatment
Lung cancer
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Fourth highest registrations for HVDHB
Highest mortality
Disproportionate impact on Maori
Pilot in HVDHB respiratory services