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Gynaecological Oncology
Patient Pathway
Cecile Bergzoll
Gynaecological Oncologist
Wellington
Gynaecological Oncology Patient Journey
Symptom Tests
Diagnosis
Tests Review tests results
Treatment
TTT
Plan
F/U
Gynaecological Oncology treatment resources
Surgery
Radiation
oncology
(external)
Hawke's Bay Wlgtn
HB/Wellington
PN
Wellington
PN/HB
HB
Tairawhiti
Wlgtn
HB/Wellington
PN
Wellington
PN/HB
0
Taranaki
Wlgtn
T/Wellington
PN
Wellington
PN/T
0
Midcentral
Wlgtn
PN/Wellington
PN
Wellington
PN
PN?
Wanganui
Wlgtn
PN/Wellington
PN
Wellington
PN/W
0
Wairarapa
Wlgtn
Wellington
Wellington
Wellington
Wellington
Wellington
Hutt
Wlgtn
Hutt/Wellington
Wellington
Wellington
Wellington
Wellington
Capital
Wlgtn
Wellington
Wellington
Wellington
Wellington
Wellington
DHB of
origin
MDT
Radiation
Gynaeoncology
Medical oncology
oncologist F/U
(brachytherapy)
Standards agreed Clusters
1.Timely access to services
Symptom Tests
Diagnosis
Tests Review tests results
Treatment
TTT
Plan
28-31 days
14 days
62 days
F/U
2.Investigations, staging and diagnosis
• Pathology review: structured/synoptic report ?
GOAL =
< 31 days
2.Investigations, staging and diagnosis
• Investigations guidelines:
– What test for what patient ?
– Get an a timely answer
– Regional/National guidelines
– Web based tool ?
• Radiology protocols review
3.Multidisciplinary care
• MDM current issues
– Time= 60 to 80 min  max 17-19 patients
– Triage and referral
– Specialist resources attending the MDM:
• nb of members
• Job sizing
– Video conference technology
– Partnership with PN
– Up to 20% cases deferred = why ?
4. Provision of Gynae cancer treatment
4. Provision of Gynae cancer treatment
Gynaecological oncology centres (National Standards document definition)
– specialist surgery by a gynaecological oncologist (vulva, ovary, cervix)
– hosting the regional multidisciplinary team (MDT)
– convening and coordinate multi-disciplinary conferences (MDMs), and
ensuring all women in the region have timely access to the MDM
– referring patients whose surgical treatment can be appropriately
provided at local level back to their local surgeon
– providing consultation & liaison services to secondary and sub regional
centres
– ensuring regional information flows and patient pathways are in place
and understood by key stakeholders
– Staffing, Fellow position
4. Provision of Gynae cancer treatment
• Why
centralize
care ?
Bristow, JCO, 2002
4. Provision of Gynae Cancer treatment
Gynaecological oncology units (National Standards document definition)
– Providing timely, comprehensive information and referral to the
regional multidisciplinary conference (MDM)
– Providing 24/7 local gynaecology assessment and treatment services,
including surgical treatment of cancers by appropriately credentialed
surgeons on advice from the MDM
– Providing consultation & liaison services to primary care providers
– Ensuring local information flows and patient pathways are in place and
understood by key stakeholders.
5.Communication and coordination of care
e-referrals
Cancer
nurses
“% of women with
gynaecological cancer
that receive contact
with their care
coordinator or CNS
within 2/52 of receipt
of their diagnosis”
“The lead clinicians in gynaecological
oncology units and gynaecological oncology
tertiary centres should develop a structure for
liaison to ensure seamless care coordination “
6. Supportive care
• Ministry of Health travel Policy
– Equity
– Information
– Nurse coordination
• Access to extended allied health services
• Lymphedema services
• OT/dietitian/wound care/social services
7. Follow up, Recurrence and survivorship
• National/Regional policies
– Location
– Frequency
– Tests
• Survivorship program / low risk patients
• Recurrences discussed at MDT
– Inclusion in trials
– Radical surgery offer
8. Palliative care
• Women are offered early access to
palliative care services when there are
complex symptom control issues or when
curative treatment cannot be offered or
is declined
9. Clinical performance, monitoring, research
• Participation in international trials informs centres as to what is
considered international best practice and enables patients and
clinicians to access promising new management strategies
• Gynaecological cancer centres should have a process for auditing
and reporting outcome data
– 0.2 FTE datamanager
– Access database non updated = registering tool of NHI lists
– A national minimum dataset should be agreed upon and a
system of outcome reporting agreed and implemented
• National discussion for MDM/Database Information System
•
Conclusion
• Working together is the key
connectivity
standardisation and equity
• Availability of current resources
sustainability ? New tools ? More staff ?
• National Standard Service Provision Audit
– Begin implementing ? Working group in CCN
Thank you for your attention