Paediatric to adult transition program

About
Region Paediatric (statewide), Western & Central Melbourne
Type of Service Dedicated outpatient survivorship clinic
Tumour Stream General, Leukemia
Mode of Delivery Face to face appointments, Video call/ telehealth

Multi-site service for adolescent cancer patients

Implementation of a clinical pathway for transition from paediatric (Royal Children’s Hospital)  to adult services at Peter MacCallum Cancer Centre (PMCC) for AYA diagnosed with cancer. This includes an introduction and orientation to the adult sector, and adolescent health and psychosocial assessment. Pre-clinic measures will inform referral to the other members of the AYA-MDT at PMCC.

Service eligibility

  • Age: <18 – 25 years old
  • Patient eligibility: up to 1 year post treatment completion
  • Referral source: Specialist eg. oncologist, haematologist at treating health service

Service details

  • Appointment length: >1 hour
  • Service operations: 1-5 patients, 1 day per week
  • Funded service: Yes, Philanthropic source and grants
  • Survivorship care providers: Nurses, Specialist clinician service eg. Oncologist, haematologist
  • Does your health service record patient survivorship encounters? Yes, through electronic medical record and manual spreadsheets eg. Excel, Microsoft List

Communications with community services: Through electronic medical record and email

Utilising NCCN Distress Thermometer and Problem List, ​Quality of life screening tools eg. UW-QOL, PROMIS measures, PAT 3.0, TRAQ 20, information needs, global assessment measure, the service are able to address:

  • ​​Information for patients
  • Psychological concerns
  • Social concerns
  • Family concerns
  • Practical concerns eg. transport, housing, accommodation
  • Physical concerns eg. lymphoedema

  • ​​Tailored cancer survivorship care plan
  • ​​Important contact details
  • Treatment summary
  • Government resources
  • Non-profit organisation resources
  • Health service generated resources

Health service: Royal Children’s Hospital & Peter MacCallum Cancer Centre

Treatment Provided: Chemotherapy, Radiotherapy, Surgical

Survivorship policy in place? Yes

AYA-PACT Program

updated April 2025

Projects

Contact