Download September 2014 - Central Cancer Network

National Cancer Programme Update: September 2014
Welcome to the latest edition of our National Cancer Programme Update. We will send you a new
update every few months to keep you informed about key areas of our work programme.
Please forward this update to colleagues who you think may find it useful. If you don‟t want to receive
these updates, please reply to this email with “unsubscribe” in the subject line.
Faster cancer treatment across the pathway
The new Faster Cancer Treatment health target for District Health Boards will be introduced from 1
October 2014.
The new target is that patients receive their first cancer treatment within 62 days of being referred with
a high suspicion of cancer. It is contingent on the hospital doctor receiving the referral also believing
there is a need for an appointment within two weeks.
The 62-day wait is measured from receipt of the referral by the hospital triaging clinician to the date
treatment (or other management) begins. By July 2016, 85 percent of patients meeting the criteria
should begin treatment within 62 days of referral, increasing to 90 percent by June 2017.
The new 62-day cancer target replaces the Shorter waits for cancer treatment: radiotherapy and
chemotherapy target which has been consistently achieved for all patients by all DHBs.
It extends the scope of the previous health target, with the aim of ensuring that people with suspected
cancer receive faster access to services, from diagnostic tests to surgery or other treatment.
The new target reflects the progress so far in improving cancer waiting times. It supports continued
reduction in waiting times, as well as highlighting opportunities for better co-ordination and integration
along the whole care pathway.
The 62-day timeframe is an international benchmark that allows time for all necessary tests and
investigations to be completed in order to confirm a diagnosis and to agree an appropriate treatment
plan in conjunction with the patient and multidisciplinary team. A 62-day wait target is in place in the
UK and Canada, and has led to big improvements in the time people wait for their first treatment.
Preliminary data from DHBs suggests that about two-thirds of patients meeting the criteria for the 62day wait target currently receive their first treatment within the target period. DHBs are expected to
steadily improve their performance against the target over the next two years and to improve the
quality and transfer of data.
The 90 percent threshold allows for a small percentage of exclusions – for example, in some cases
there will be clinical reasons why a patient should wait longer before treatment begins, or in some
circumstances patients may not choose to start their treatment straight away.
It is estimated that the target will apply to approximately 25 per cent of newly-diagnosed cancer
patients. The remainder of newly-diagnosed cancer patients will access treatment through pathways
that fall outside the 62-day target, including those diagnosed through screening programmes or
following an acute hospital admission or in the private sector.
All patients with a confirmed cancer diagnosis are expected to receive their first treatment within 31
days of a decision to treat, which remains a health indicator.
The first quarterly results on the new target (for quarter two 2014/15) will be published in February
2015.
DHB audit of Faster Cancer Treatment indicator process
The Ministry has contracted with Central TAS, the shared services agency owned by the six central
region DHBs, to develop a Faster Cancer Treatment (FCT) Self-Assessment Audit Tool.
The tool, which is similar to an on-line survey monkey, will help assess how consistent FCT indicator
reporting is across DHBs.
It is expected the tool (based on the updated FCT Indicators Business Rules and Data Definitions v3)
will be released to DHBs at the end of October 2014, once testing is completed.
The audit is expected to take about 40 minutes to complete. Results will be submitted to the Ministry
for analysis. A link to the audit tool will also be provided, along with information on who should
complete it and the required timeframe.
National tumour standards work programme
The 10 tumour standards developed last year are now being used to promote quality, consistent
services across New Zealand.
Since their publication in December 2013, regional cancer networks and DHBs have started using the
tumour standards as a service improvement tool by reviewing their services against the standards
and implementing improvements.
Chair of the National Sarcoma Tumour Standards Working Group, Michael Flint, says he has already
noticed a shift in clinician behaviour as the standards are circulated and reviewed around the country.
He says the Standards have improved communication and awareness of pathways.
Michael Flint sees a strong commitment and support for the Standards from those working with
sarcoma patients.
“It‟s difficult to state anything concrete,” he says, “but there appear to be trends in behaviour that
hopefully will translate into better care for patients."
This month, the second phase of the tumour standards work programme begins. The key deliverables
for this phase are:
Stage A (from September 2014)
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Tumour specific core datasets (including data definitions) for 10 tumour streams
An agreed consistent definition for „high suspicion of cancer‟ for each of the 10 tumour
streams. Draft definitions will be developed by the end of December 2014 and will be
consulted on through to early February. It is expected the finalised definitions will be ready
for use at the end of March 2015.
Stage B (by the end of December 2015)
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Follow-up and surveillance guidance for 10 tumour streams
Prioritisation guidance for multidisciplinary meetings for 10 tumour streams
Stage C (by the end of June 2016)
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A high level review of the tumour standards published in December 2013
The tumour standard working groups have reconvened to carry out this work. Sapere Research
Limited, in collaboration with the Southern Cancer Network, has been contracted by the Ministry to
provide technical analysis and to coordinate the work.
A pan-Chairs group will meet regularly to ensure a consistent approach across the tumour standards.
Its members are:
Bowel - Chris Jackson, medical oncologist
Breast - Ian Campbell, breast and general surgeon
Gynaecological - Peter Sykes, gynaecological oncologist
Head and Neck - Nick McIvor, head and neck surgeon
Lymphoma - Leanne Berkahn, haematologist
Melanoma - Richard Martin, consultant surgical oncologist
Myeloma - Peter Ganly, haematologist
Sarcoma - Michael Flint, orthopaedic oncologist
Upper Gastrointestinal - John Windsor, consultant surgeon
Thyroid – to be confirmed
Lung – Charles de Groot (through the National Lung Cancer Working Group)
Progress towards nurses performing endoscopy
The advisory group established to guide the expanding role of nurses in endoscopy has canvassed
DHBs to gauge their interest in developing the new roles.
All responses to date have expressed support. It is expected that endoscopy training for nurses,
gastroenterologists, and general surgeons will be subject to identical standards and, expectations and
that there will be common governance of the training available to all three professions.
The training of nurses in endoscopy will be subject to sites being accredited for training and will take
full account of available supervision and support.
The advisory group is currently holding discussions with tertiary providers regarding the educational
framework for nurses performing endoscopy. It is likely that nurses will require a Post Graduate
Diploma in Nursing (PGDipNurs) for entry into the endoscopy training and it will involve two specialist
papers and a practicum.
The endoscopy nurse role is not seen as a substitute for the role of gastroenterologists and general
surgeons. Having trained nurses available to perform endoscopies will enable medical staff to
undertake more complex procedures and improve service delivery.
The advisory group includes representatives from Health Workforce New Zealand, the Ministry of
Health, the National Endoscopy Quality Improvement Programme, national nursing organisations,
DHBs, New Zealand Society of Gastroenterology, Royal Australasian College of Surgeons and
private providers.
For more information please contact [email protected]
Guidance developed for management of men with prostate cancer
Guidance is being developed to help specialist and primary care services provide nationally
recommended active surveillance care plans to men with prostate cancer.
Active surveillance is a programme of care suitable for some men whose prostate cancer is
considered at low risk of becoming life-threatening. It involves monitoring through repeated clinical
evaluation, including PSA measurements, prostate biopsy and MRI scans.
The active surveillance guidance draws on current evidence, best practice and the 2013
recommendations of the Prostate Cancer Taskforce. It has been developed by a specialist sub-group
of the Prostate Cancer Working Group. The group includes urologists, radiation oncologist and
representative from the Australia and New Zealand Urological Nurses Association. Input has also
been provided by primary care representatives.
A copy of the draft active surveillance guidance will shortly be sent to all DHB urology, radiation
oncology and radiology departments, and other interested parties, for their review and feedback. The
Ministry is also seeking input from a wide range of health care services and clinicians involved in
prostate cancer care. A revised draft will be considered at this year‟s national meeting of the
Urological Society of Australia and New Zealand in November 2014.
A final version of the guidance will be circulated to all specialist and primary care services so it can be
introduced into pathways and clinical practice from early 2015. Once introduced, the guidance will
help ensure there is a consistent approach to active surveillance across the country.
The guidance is one of a number of resources being developed as part of the Ministry of Health‟s
prostate cancer Awareness and Quality Improvement Programme.
Palliative Care Council adopts broader leadership role
With the completion of a number of palliative care projects across the Ministry‟s cancer work
programme, there has been some focussed discussion between the Ministry and sector leaders about
future palliative care direction and leadership.
The Palliative Care Council (PCC) is seen as best placed to lead the strategic policy direction for
palliative care now that the Palliative Care Advisory Group‟s (PCAG) work programme has been
completed.
Ministry of Health Deputy Director-General, Sector Capability and Implementation, Cathy O‟Malley,
says PCAG contributed greatly to the completion of several significant projects over the past six
years.
They include the Gap Analysis of Specialist Palliative Care, the Resource and Capability Framework
for Palliative Care, and the Specialist Palliative Care Service Specifications.
She says it is now more appropriate to hand the mantle for palliative care to the PCC.
“Palliative care is broader than just cancer. Increasingly it is in aged care settings where there is the
greatest focus on good access to palliative care and this is reflected in the PCC‟s increasing work
programme,” says Cathy O‟Malley.
“An ageing population and better management of some chronic conditions are contributing to an
increasing demand for specialist palliative services.
“Quality palliative care contributes to the achievement of several strategic priorities for the health
sector and remains an important part of the National Cancer Programme‟s broader pathway
approach. It is included in all 11 tumour standards of service provision. It is also a component of the
faster cancer treatment indicators work (as a treatment modality).”
Faster Cancer Treatment Service Improvement Fund initiatives
Local and regional initiatives have started around the country as part of the first round of the
dedicated $11.2 service improvement fund designed to improve cancer services and the experience
of patients throughout their treatment.
More than 43 proposals were received, and 23 were funded across 13 providers. A number of
projects took a regional approach and are detailed below.
Midland Cancer Network:
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Map inter-DHB referral pathways across the Midland region and develop a mechanism to
identify and monitor patients on the 62-day pathway.
Coordinate tumour standards implementation initiatives including reviewing and updating the
Midland supportive care service directory, identifying DHB specific patient information
resources and implementing a web based repository, identifying and adopting an education
tool for cancer nurse specialists and coordinating DHB self-assessment, stocktake and gap
analysis against tumour standards.
Develop and implement the Midland gynae-oncology model of service across the Midland
region.
Northern Cancer Network:
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Establish a single point of access clinic which will allow lung cancer patients in the northern
region to receive first specialist assessments and diagnostic activities, including computerised
tomography scans, fine needle aspiration, biopsy extra thoracic lesion and bronchoscopy, on
the same day.
Central Cancer Network and Northern Cancer Network (Computerised Tomography
Colonography Initiatives):
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The Central Cancer Network will identify current capacity and demand for CT colonography
(CTC) across the central region and develop a regional implementation plan.
The Northern Cancer Network has identified CTC as a key area and will develop, deliver and
monitor a pilot of CTC scanning for patients with a suspicion of bowel cancer across the
Northland, Auckland, Waitemata and Counties Manukau DHBs.
A second round of funding will be made available in 2015. The Ministry will hold a forum near the end
of round one to share learning's and project outcomes.
AYA research underway
A national retrospective case review of Adolescent and Young Adult (AYA) bone tumours diagnosed
in the previous decade is well-underway and will be completed later this year.
It is part of work aimed at better understanding disparities in AYA cancer survival identified in a recent
analysis paper. The analysis of AYA cases between 2000 and 2009 indicated that outcomes for some
young people with cancer are poorer in New Zealand than in other countries.
It indicated there are poorer outcomes for those aged 15 to 19 years, Maori and Pacific youth and
young people with particular types of cancer.
In December 2013, the Government announced an additional $650,000 over two years to help fund a
national approach to AYA cancer services and improve outcomes for young people.
An AYA Governance Group has been established to provide leadership and set a national strategic
direction. Its membership includes senior level specialists and sector experts, including NGO
services and consumers. The group aims to identify factors which have contributed to New Zealand‟s
poorer survival in order to identify improvements that can be made to the future delivery of cancer
services for this at-risk group.
A priority for the governance group is to appoint a national clinical lead and establish the AYA Cancer
Network to connect health professionals and providers involved in AYA cancer care. The network will
use small working groups of health and voluntary sector specialists to examine specific issues and
develop best practice advice to guide the delivery of care.
The AYA Governance Group met for the first time in July 2014 and set priorities for action over the
next two years. They are to:
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develop a strategy for AYA cancer care in New Zealand
develop infrastructure to support establishment of the AYA Cancer Network, including
appointing a clinical leader
develop national standards of care for AYA cancer
implement a monitoring and evaluation framework
undertake targeted research into current gaps in survivorship for specific AYA groups.
More information on the work of the AYA Governance Group, including details on how to register your
interest in upcoming vacancies, visit www.ayacancernetwork.org.nz
Psychological and social support services for people with cancer
An advisory group will be established in October 2014 to support work to improve psychological and
social services for people with cancer.
Budget 2014 provided funding to establish additional supportive care services throughout New
Zealand to ensure that the emotional and psychological needs of cancer patients are properly
assessed and patients and their families receive the support and care they need.
The Budget funding is for:
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up to 20 new cancer psychological and social support workers
6 new psychologists – one for each cancer centre
a national leader to provide overall guidance and professional support
the development of training standards and tools to assess patient needs.
The Ministry will shortly begin working with DHBs, regional cancer networks, non-government
organisations and health professionals to implement the services.
The advisory group‟s work will include:
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updating a 2011 stocktake of supportive care services
service design
a service specification
role descriptions for the new positions
an implementation plan
a monitoring and evaluation plan.
The Ministry will also seek expressions of interest for the national lead role later this year. DHBs can
expect that funding will be available for them to start filling the new psychologist and psychological
and social support worker positions from July 2015.