VICS Optimal Care Summits oesophagogastric cancer consultation 2016

The first oesophagogastric (OG) cancer consultation of the VICS Optimal Care Summits program was held in 2016.

Eighty multidisciplinary professionals involved in OG cancer care across Victoria gathered on 26 August 2016, to review variations in care and identify opportunities to improve the outcomes and experiences of care.

Recommendations

Based on discussion at the summit, the advisory group below recommended the following actions:

1. Healthcare institutions to examine their referral and waiting times for opportunities to improve times between diagnosis and first treatment (esp. factors contributing to delayed surgical intervention for patients with non-metastatic oesophageal cancer)
2. Reasons for the low rate of treatment for non-metastatic OG patients to be investigated
3. Hospitals to review their OG cancer patient surgical procedure volumes, and centres that do not have integrated expertise in endoscopy, imaging, interventional radiology, surgery, and histopathology, or perform a high volume of radical OG surgery, to refer such cases to centres with greater expertise
4. The expert working party to provide advice to the QOOL-VIC implementation project to ensure an upper gastrointestinal (UGI) cancer minimum dataset
5. Each region to consult with OG/UGI clinicians and establish procedures to ensure both that all OG patients are discussed at an MDM, and that information and recommendations from such MDMs are documented per the optimal care pathway
6. The variance in incidence and relative survival rates in the Western & Central Melbourne (WCMICS) area to be further investigated
7. The higher incidence and lower relative survival rates for OG cancer patients in regional Victoria be further investigated (esp. the higher proportion of patients with metastatic disease at the time of diagnosis of oesophageal cancer in the Barwon, Grampians, Gippsland, and Loddon Mallee regions).

After the summit, the VICS undertook a detailed audit of newly diagnosed OG cancer patients – identifying areas of delay at an individual health service level at each step through referral, diagnosis and treatment planning to first treatment.

Impacts

Informed by the findings above, the VICS and the Victorian Department of Health funded an Oesophagogastric Cancer Service Redesign program to help health services improve the timeliness of OG cancer care and multidisciplinary meeting (MDM) presentation rates. From February 2018, 8 Victorian health services were funded to develop systems and interventions that would enable:

• newly diagnosed OG cancer patients to have their first cancer treatment within 42 days of referral by the health service
• 85% of newly diagnosed OG cancer patients to have their treatment planned at MDMs.

By June 2019, improvements were seen in the number of patients who received their care in the identified timeline, and 75–98% (depending on health service) of newly diagnosed OG cancer patients had their treatment planned at MDMs.

This and other progress was considered in preparation for a repeat oesophagogastric cancer summit in 2024.

Summit records

• Summit presentation video
• Summit summary (PDF)
• Summit data presentation (PDF)
• Summit data report (PDF)
• Summit recommendations (PDF)

Expert advisory group

• Mr Ahmad Aly (Chair) – Head of upper gastrointestinal (UGI) surgery, Austin Health
• Dr Paul Burton – UGI surgeon, Alfred Health
• Dr Paul Cashin – Head of UGI surgey, Monash Health
• Dr Gary Crosthwaite – UGI surgeon, Epworth Healthcare
• Dr David Deutscher – UGI surgeon, Ballarat Heralth Services
• Dr Cuong Duong – UGI surgeon, Peter MacCallum Cancer Centre
• Dr Samuel Harris – Medical oncologist, Bendigo Health
• Dr Matthew Leong – UGI surgeon, Geelong
• Dr Trevor Leong –Radiation Oncologist, Peter MacCallum Cancer Centre
• Dr Kiat Lim – UGI surgeon, Austin Health
• A/Prof. Sue-Anne McLachlan – Director of Oncology, St Vincent’s Hospital
• A/Prof. Peter Nottle – Head of UGI surgery, Alfred Health
• Dr John Spillane – UGI surgeon, Peter MacCallum Cancer Centre
• Dr Niall Tebbutt – Medical oncologist, Austin Health
• Dr Zee Wan Wong – Medical oncologist, Goulburn Valley Health.