1. Gynaecological Oncology Patient Pathway Cecile Bergzoll Gynaecological Oncologist Wellington

2. Gynaecological Oncology Patient Journey Symptom Tests Review tests resultsDiagnosisTests Treatment Plan TTT F/U

3. Gynaecological Oncology treatment resources DHB of origin MDTSurgery Radiation oncology (external) Radiation oncology (brachytherapy) Medical oncology Gynae- oncologist F/U Hawke's Bay WlgtnHB/WellingtonPNWellingtonPN/HBHB Tairawhiti WlgtnHB/WellingtonPNWellingtonPN/HB0 Taranaki WlgtnT/WellingtonPNWellingtonPN/T0 Midcentral WlgtnPN/WellingtonPNWellingtonPN PN? Wanganui WlgtnPN/WellingtonPNWellingtonPN/W0 Wairarapa WlgtnWellington Hutt WlgtnHutt/WellingtonWellington Capital WlgtnWellington

6. Standards agreed Clusters

7. 1.Timely access to services Symptom Tests Review tests resultsDiagnosisTests Treatment Plan TTT F/U 14 days 28-31 days 62 days

8. 2.Investigations, staging and diagnosis Pathology review: structured/synoptic report ? GOAL = < 31 days

9. Investigations guidelines: – What test for what patient ? – Get an a timely answer – Regional/National guidelines – Web based tool ? Radiology protocols review 2.Investigations, staging and diagnosis

10. 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 ?

11. 4. Provision of Gynae cancer treatment

12. 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

13. Why centralize care ? 4. Provision of Gynae cancer treatment Bristow, JCO, 2002

14. 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. 4. Provision of Gynae Cancer treatment

15. 5.Communication and coordination of care e-referrals “% 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 “ Cancer nurses

16. 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

17. 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

18. 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

19. 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

20. 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

21. Thank you for your attention