Unwarranted variations in endometrial cancer care and outcomes across Victoria
The VICS Optimal Care Summits program, supported by the Victorian Department of Health, has identified 22 ‘unwarranted variations’ in endometrial cancer care and outcomes in Victoria.
An unwarranted variation is a difference not explained by differences in illness or preferences – that is, a chance to improve the quality and equity of clinical care.
The VICS use a mixed-methods approach used to identify and prioritise such variations, including:
- linked health data and analysis from the Department of Health
- a rapid literature review
- analysis of general practice variations
- surveying the Victorian health workforce on barriers, enablers, and preferences
- consumer engagement to collect and summarise lived experience.
VICS Optimal Care Summits
We define variations with reference to Australia’s Optimal Care Pathways (OCPs) – national guidelines for consistent, safe, high-quality, and evidence-based cancer care. Each OCP comprises the same 7 steps. The unwarranted variations listed below are arranged by those steps, not yet in priority order.
Using the methods above, we will prioritise 3 variations for discussion at our Endometrial Cancer Summit on 22 November.
OCP Step 1: Prevention and early detection
- (No data examined)
OCP Step 2 – Presentation, initial investigations and referral
- Increasing proportion of patients who presented to an emergency department before their diagnosis
- Higher proportion, in Loddon Mallee, of patients who present to emergency departments before diagnosis.
OCP Step 3 – Diagnosis, staging and treatment planning
- Lower proportion, in regional areas, of patients being discussed at multidisciplinary meetings (MDMs)
- Low rates of supportive care screening, statewide
- Low rates, in some areas, of recording cancer stage in multidisciplinary meetings
- Low rates, statewide, of recording patients’ ‘ECOG’ status in multidisciplinary meetings
- Low rates, statewide, of communicating treatment plans to patients’ GPs
OCP Step 4 – Treatment
- Lower proportion of patients, in Southern Melbourne, staying in hospital less than 3 days after a hysterectomy
- Increasing delay between diagnosis of low-grade tumours and starting treatment, statewide
- Variation, between areas, in delay between diagnosis of low-grade tumours and starting treatment
- Increasing delays between diagnosis of high-grade tumours and starting treatment, statewide
- Variation, between areas, in delay between diagnosis of high-grade tumours and starting treatment
- Decreasing proportion, statewide, of patients aged 50+ who receive surgery within 6 weeks of diagnosis with low-grade tumours
- Decreasing proportion, statewide, of patients aged 50+ who receive surgery within 6 weeks of diagnosis with high-grade tumours.
OCP Step 5 – Care after initial treatment and recovery
- Decreasing rates, statewide, of referrals to a physiotherapist within 3 months of diagnosis
- Low proportion of patients, statewide, who see a dietitian in hospital within 3 months of diagnosis
- Low proportion of patients, statewide, who see a psychologist in hospital within 3 months of diagnosis
- Low proportion of patients, statewide, who see a social worker in hospital within 3 months of diagnosis
- Lower survival rates in the Loddon Mallee region, for patients with high-grade tumours
- Decreasing survival rates, in the Barwon South West region, for patients with high-grade tumours.
OCP Step 7 – End-of-life care
- Low proportion of patients, statewide, who had an advance care directive in place before they died
- Increasing proportion of patients, statewide, presenting to emergency departments in the month before they die.