Central Cancer Network regional workshop Cancer nurse co-ordinator roles Monica O’Reilly Cancer Pathway Facilitator Hutt Valley DHB 11 October 2012

Cancer registrations 626 Prostate 96 Breast 89 Colorectal 86 Lung 60 Melanoma 42 Non Hodgkins 25 Cancer registrations – average 2007-2009 6 highest registrations by number – average years 2007-2009

Breast care nurses most comprehensive Plastic surgery services – OP RN 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 BreastScreen Central nurses involved in all sub-regional screening pts referred on, whether or not cancer. Also involved from time of referral for HVDHB symptomatic referrals Plastic Surgery services – regional provider (and including Nelson-Marlborough) for complex melanoma and head and neck surgery, and regional breast reconstruction. Nurse co-ordinates the regional melanoma MDM. Surgical pre-assessment nurses include co-ordination of specific events All other services include some co-ordination of specific parts of pathway in relation to their role. Processes developed within each service in relation to specific needs.

No overarching co-ordination for any tumour stream Gaps and issues No overarching co-ordination for any tumour stream Regional plastic surgery services co-ordination sits as part of a number of different roles IT issues How allocate roles across region/sub region given requirement for DHB placement No job description that includes co-ordination that links from time of referral to treatment.

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 sub- regional screening entry patients and local symptomatic entry patients ? potential to extend role for regional reconstruction or develop from within plastic surgical service

Not big numbers but complex pathway Complex melanoma Head and Neck Cancer Regional service Not big numbers but complex pathway Complex melanoma Head and neck cancer – Hutt provides regional complex surgical services. Regional total 110 (CCN data) Complex pathway eg. 6 specialties can be involved in treatment – plastic surgery, medical onc, radiation onc, dental, gastroenterology, ENT Also multiple nursing and allied health services – dietitian, social worker, speech language therapist, ambulatory care nurses, community nurses, community oncology nurses – can be team of each in different DHBs

Pathway to treatment decision

Surgical treatment pathway If reconstructive surgery is required people from Central region DHBs will all have that done at Hutt Hospital.

Radiation and medical oncology The need for radiation is identified either at the MDM or by post-surgery pathology. When treatment is across DHBs people link in and out Dental clearance? - Done Hutt Can also link between private and public

Fourth highest registrations for HVDHB Highest mortality Lung cancer Fourth highest registrations for HVDHB Highest mortality Disproportionate impact on Maori Pilot in HVDHB respiratory services Sub-regional lung cancer focus Fouth highest registrations 60 highest mortality 50 There is a disproportionate impact on Maori and increasingly on Pacific peoples. In the Hutt Valley Maori have 2.5 times greater risk of lung cancer and are 2.5 times more likely to die from this cancer than other Hutt Valley residents. Pilot in 2010 showed that the co-ordination role required 0.1 FTE – patient focus only – service improvement would increase to 0.2.