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

2. Cancer registrations 626 Prostate 96 Breast 89 Colorectal 86 Lung 60
Melanoma
Non Hodgkins
Cancer registrations – average
6 highest registrations by number – average years

3. 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.

4. 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.

5. Care co-ordination priorities
Regional service provision
Breast reconstruction
Head and neck cancer
Melanoma
Sub regional lung cancer

6. 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

7. 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

8. Pathway to treatment decision

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

10. 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

11. 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.