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Cancer Care
The Wellington Experience
Paul Smith and Dr A. O'Donnell
A Regional “Cancer Centre”
Wide variation and impromptu care
Mixed degree of involvement in the patient
journey, specifically around the waiting
time initiatives
Certain tumour streams have minimalist
nursing coordination
Area’s of good practice
Silo effect
► Perceived
lack of common goals between
cancer treatment specialties
► The focus feels inward and the responsibility
is upward, not across
► This makes timely coordination and
communication difficult to achieve
► Frustration amongst patients who
increasingly expect information to be readily
available and complete at point of contact.
Where are the gaps
► Secondary
to tertiary
 Lung, Gynaecology, Sarcoma, Upper GI, Head
& Neck
► Complexity
of care
 Head & Neck, Sarcoma, AYA
► Special
 Adolescents, Maori and Pacific, non English
Where are the gaps {continued}
► Curative
Intent – the need for speed
 Proven benefits of early diagnosis and
commencement of treatment for Colorectal,
Breast, Lymphoma, Sarcoma and Gynae
High Psychological impact
 When initial diagnosis is metastatic disease and
requires palliative cancer management
Local issues
► Strength
of our local Community Cancer Nurses
 How do we augment role and change scope to truly
engage primary health care for all cancer treatment
 Shared model enhanced with District nursing
 Complexity of need assessment
 Referral process
► Medical
Oncology waiting lists
► Senior Nurses doing administration
Risky example
► Recent
example of a 15 year old
► Presented to GP/Practice Nurse and
referred to Orthopedic surgeon
► Then referred to Auckland surgeon, but
Wellington AYA, Ortho nurses and
Paediatric oncologist involved
► Also referred to Medical Oncology SMO and
Registrar/CNS/Community Cancer Nursing
► Also
seen by Fertility Associates,
Nuclear Medicine, Cardiology,
Haematology for marrow assessment
► Imaging with CT / PET CT
► Liaison with school, social worker,
Canteen, Child Cancer Foundation and
Ward Staff
Planned action
► Integration
with our District colleagues
► Regional MDM / MDT
► Develop web-based integration
► Integrate existing roles
► Highest need, volume and priority
► Develop systems and process, not person