Output 1.4 Cancer Services
Capital Region Cancer Service provides a comprehensive range of screening, assessment, diagnostic, treatment, and palliative care services. Services are provided in inpatient, outpatient, and community settings.
The key strategic priorities for cancer care services are early detection and timely access to diagnostic and treatment services. These include ensuring that population screening rates for breast cancer meet targets, waiting times for access to essential services such as radiotherapy are consistent with agreed benchmarks, and increasing the proportion of women screened through the BreastScreen Australia program for the target population (aged 50 to 69 years) to 70 per cent over time.
The Capital Region Cancer Service (CRCS) Division is responsible for the provision of oncology, clinical haematology, radiation oncology, BreastScreen and immunology services to the ACT and surrounding region. Services are offered in the form of screening, inpatient and outpatient services and community-based psycho-social support services. The division also manages and coordinates clinical Outpatient administrative support, Health Centre Administration, Community Health Intake and Transcription Services.
The clinical services of CRCS integrate existing cancer services across the ACT and surrounding region to ensure a continuum of care for consumers, ranging from prevention and screening through to diagnosis, treatment, rehabilitation and palliative care. Services are provided on an area-wide basis and delivered at a number of locations, including hospital and community settings and the patient’s home.
- The Radiation Oncology department commenced operation of a fourth linear accelerator in July 2012. Additional staff recruited to support this expansion included a radiation oncologist, radiation therapists and nursing staff. This resulted in an increase in services provided.
- Demand for radiotherapy treatment services increased by 3.4 per cent, with 1,330 courses of treatment provided in 2012‑13 compared to 1,286 courses in 2011‑12.
- CRCS provided care for 1,566 new radiation oncology patients in 2012‑13. This is a 2.7 per cent increase on the 1,525 new patients in the same period last year. CRCS provided care for 649 new patients from interstate; 642 of these patients were from NSW, representing 41.4 per cent of new patients provided with care.
- Brachytherapy treatment services provide a highly focused treatment option to a specific group of prostate cancer patients and cervical cancer patients. Indications are that demand for prostate cancer treatment is increasing. However, due to the success of screening and immunisation programs for cervical cancer, there has been a significant decrease in demand for cervical cancer treatment.
- Over the past 12 months, Radiation Oncology has developed the stereotactic radiosurgery (SRS) capability offered with the new linear accelerator to treat brain cancers. The SRS service was released for clinical operation in June 2013, with the first patient scheduled for treatment in early July 2013.
- The implementation of the ‘CHARM’ cancer information management system has provided a single system for scheduling, billing and ordering complex chemotherapy regimes for Medical Oncology, Haematology and Immunology. Medical Oncology, Haematology and Immunology have implemented electronic signing of chemotherapy orders and commenced the electronic documentation of patient notes, with the aim of eliminating paper records.
- The Haematology department achieved an end-of-year result 9 per cent over target for outpatient services despite critical haematologist shortages throughout the year. This was achieved through the significant commitment of the haematologists in ensuring that all urgent, category 1 and category 2 patients received appointments within the recommended timeframes.
- CRCS provided representation on the Cancer Council Australia Oncology Education Committee and the Therapeutic Goods Administration Advisory Committee on Prescription Medicine.
- The Medical Oncology Office Manager, Marilyn Cooper, was the recipient of the ACT Government Health Directorate Australia Day 2013 Achievement Medallion.
- Three new haematologists were recruited to CRCS this year, providing much needed specialist support to the department. Two of the specialists have commenced and the third is due to start in August 2013.
- The implementation of a Radiation Oncology Nurse Led Clinic in January 2013 has improved access for patients following radiation treatment. The clinic provides advice, treatment and medical review, as needed, for patients who have completed a course of radiation treatment.
- The first peripheral blood stem cell transplant was successfully trialled in an outpatient setting, achieving a reduction of four inpatient days for the overall care.
- Participation in radiotherapy clinical trials has increased with the appointment of a clinical trials data manager. Participation in technically based trials supports credentialing of processes and independent audit of dosimetry systems for the implementation of new radiotherapy techniques.
- All nine consultants in Medical Oncology have achieved academic appointments with the Australian National University Medical School and participate in teaching and research. Medical Oncology published four papers in 2012‑13 and gave 16 conference presentations.
- Radiation Oncology successfully applied for an Allied Health Research Support grant to support the establishment of the Palliative Radiotherapy Rapid Access Clinic (PRRAC). This clinic will provide streamlined care for palliative patients requiring radiotherapy treatment. The grant funding is to support salary costs of a radiation therapist engaged in developing the communication aspects of the project.
- Canberra Hospital Outpatient Services commenced the initial phase of planning for the refurbishment of the waiting areas for Central Outpatients, Ear, Nose and Throat Department, Fracture Clinic, Sleep & Respiratory Department and Diabetes/Endocrinology departments. The refurbishment plans to increase seated waiting areas by at least 50 per cent, with specific consideration given to the needs of bariatric patients, wheelchair access, children’s play area and improved signage.
- Breastscreen ACT achieved a participation rate of 56 per cent for women in the target age group of 50 to 69. This is the highest level achieved in the past five years.
- BreastScreen ACT underwent a two-day data audit as part of the BreastScreen Australia accreditation process. For the first time all criteria were met.
- CRCS developed and commenced a clinical audit project to introduce a regular program of clinical audit across all areas of CRCS. Initial baseline data was received for the areas of Patient Identification, Schedule 8 medication register, hand hygiene and falls assessment.
- The Care of the Dying Patient Collaborative Pathway pilot was implemented on wards 11A, 14B and 10A.
The pathway reflects a shift from life-prolonging treatment to palliative care. This enhances comfort and acknowledges the need to actively make decisions that promote sensitive and appropriate care for the patient in the last predicted days of life. It also takes into account the wishes of the patient and family under their Respecting Patient Choices and advanced care plan needs. The pilot has produced excellent feedback to date.
- Gungahlin Community Health Centre opened in September 2012, offering a wide range of health services. Tuggeranong Health Centre was temporarily relocated to an alternative site at Greenway Waters Suites in January 2013, facilitating the commencement of work to refurbish and extend the existing centre.
- 4,111 cost-weighted admitted separations were provided by Cancer Services in 2012‑13 against the target of 4,142. This constitudes a 2 per cent increase on those provided in 2011‑12.
- 65,462 non-admitted occasions of service were provided by Cancer Services in 2012‑13 against the target of 59,260. This is a 14 per cent increase on those provided in 2011‑12 and reflects the high demand for services.
- Against a target of 100 per cent, 99.9 per cent of women received the results of their normal breast screen within 28 days.
- Against a target of 90 per cent, 94 per cent of women screened who required an assessment were assessed within 28 days of their screening appointment.
Issues and challenges
- Continued growth and increased demand for all CRCS services has challenged the physical space and resources across inpatient and outpatient services. The move to the new Canberra Region Cancer Centre will provide increased outpatient capacity. New models of service are being developed to reflect changes to treatment options and will be implemented in readiness for the move to the new centre.
- The Haematology department experienced shortages in the haematologist workforce, resulting in extremely high workloads and an increase in the number of less urgent patients waiting to be seen. With the commencement of new specialists in March and April the wait time is being reduced.
- Breastscreen continues to have challenges in recruiting women to the screening program. Activities continue to promote the program to new women and lapsed attendees.
- The Canberra Region Cancer Centre is due to open in the second half of 2013. The new facility and improved models of care will enhance services for patients.
- The Palliative Radiotherapy Rapid Access Clinic (PRRAC) model of care will be established. This is a patient-centred approach to care whereby appointments are coordinated around patients and their requirements and the waiting time for treatment is reduced. A Radiation Therapist Advanced Practitioner role to support the clinic is being developed, and the clinic is planned to commence operation in August 2013.
- There will be further development of the stereotactic radiotherapy service to include treatment of a wider range of cancers.
- BreastScreen ACT is due to complete the National BreastScreen program accreditation process in November 2013. The data audit has been completed and the two-day site visit is scheduled for August 2013.
- The development of the Cancer Triage and Rapid Assessment model of care is nearing completion, with the implementation of a pilot planned for August 2013. This model of care aims to provide timely access to information and assessment for patients receiving outpatient treatment through CRCS Oncology and Haematology. It will focus on assessing concerns early, allowing treatment and support within the outpatient setting with the aim of reducing and diverting presentations to the emergency department.
- Belconnen Community Health Centre is scheduled to open for business on 11 November 2013. This is the largest of the new community health centres and it will provide a much wider range of services than was previously available in community health centres, and these will include renal dialysis.