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Update Thursday 15/11/2018:

Update Monday 05/11/2018:

Update Wednesday 24/10/2018:

Update Tuesday 25/09/2018:

  • Preliminary data and the agenda for the Summit are now available below

Who are leading the Summit?
clinical working party, co-chaired by Mr Stephen Tudge and Dr Andrew Coleman, has convened to guide the Summit planning, oversee data  analysis and refine recommendations after the Summit. Clinical representatives from health services within each ICS are invited to attend the Summit. Organisations with a stake in improving head and neck cancer care outcomes and experience of care will also be represented at the event. 

Which data will be presented at the Summit?
The working party has identified key points of enquiry for data analysis: 

  • Outcomes including incidence, mortality, and survival compared across Victoria
  • Treatment patterns for patients with head and neck cancer,  including utilisation of  treatment
  • Hospital volumes of surgery of head and neck procedures across Victoria

Why does this matter to clinicians?
Clinician participation in the Summit is critical. At the Summit, participants will have the opportunity to:

  • Review data on multidisciplinary clinical practice and outcomes across the state
  • Identify variations in care that are unwarranted and important to address
  • Agree on statewide priority areas through facilitated group discussion

Summit Highlights

The Head and Neck Cancers Summit working party of multidisciplinary clinicians, co-chaired by Stephen Tudge and Andrew Coleman, presented seven variations based on existing data sources for discussion at the Summit.

The seven variations were:

  1. Many centers provide treatment for less than 10 patients per year (39 surgical, 12 radiotherapy)
  2. Many patients have treatment outside their ICS of residence
  3. The proportion of patients with evidence of an MDM discussion of their treatment was lower in Barwon & South Western and Loddon Mallee ICS
  4. Fewer regional patients treated locally (66%) start their radiotherapy within 8 weeks of diagnosis than regional patients treated in metro (76%) and metro patients treated in metro centers (80%)
  5. Of all patients having adjuvant radiotherapy, only 37% started within 6 weeks of surgery, with lower rates in Barwon & South Western and Grampians ICS and in 1 metro and 1 regional center
  6. The proportion of patients receiving dietetic care may be lower in regional treatment centers
  7. There was poorer survival for oropharyngeal and base of tongue cancer patients who were treated with radiotherapy only compared to other treatment types

Two additional variations raised by attendees were:

  1. Use of data from clinical sources
  2. Increasing subspecialty input at remote MDMs

The aim of the subsequent discussion was for the attendees to prioritise several variations for statewide action. Prioritising proved somewhat challenging.  During the first small groupwork exercise, all seven variations were assessed by attendees as high impact on an impact/effort matrix.

Variations assessed as easiest to achieve with a high impact were numbers 3 and 6.

Seven out of nine groups assessed variation 2 as the hardest to achieve with a high impact. This variation is implicitly linked to variations 1, 6 and 9, and has the potential to improve appropriate care for patients within the framework of patient-centred care. Ideas for this improvement were: 

  • The use of telemedicine to access dietetic care
  • Formalisation of links between centres    
  • Standardisation of multidisciplinary team meeting (MDM) documentation
  • Implementation of a patient information package on subsidies for travel and accommodation costs  
  • Multidisciplinary team agreement on criteria for PEG insertion

Despite the challenges of high impact/ high effort variations, attendees assessed many variations as within their sphere of influence to investigate and improve upon at a local level with post-Summit action. Some of the ideas shared on the day were:

  • Document the MDM treatment plan in the medical record
  • Assist less experienced doctors with documenting the reason why there has been a delay in patient treatment in patient notes
  • Reflect on the possible reasons a health service provider or region is not meeting the statewide average and discuss the Summit with colleagues who did not attend
  • In order to increase knowledge of the Optimal Care Pathways (OCP) across all stages of treatment, attach the two-page OCP reference guide to patient notes in MDMs and send to GPs and referring clinicians

Improving Oral Cancer Care 

Dental Health Services Victoria is leading development of a statewide educational package for oral health professionals on early recognition of oral cancers.

Resources

Quit Smoking Video
https://education.eviq.org.au/rapid-learning/smoking-cessation

Beyond Five is an online resource for patients with head and neck cancers
https://www.beyondfive.org.au/


We are always seeking feedback to improve summit attendance and events. Please join us on our Linkedin group to add your voice and share any suggestions for improvement with the Victorian Tumour Summits Communications Officer Rebecca Miller.

Head & Neck Summit working party

Alam Alamgeer Stephen Brown Penny Chapman Andrew Coleman David Deutscher Tsien Fua Hui Gan
Mark Guirguis Colin Hornby Rhys Hughes Tim Iseli Hari Jeyarajan Bernard Lyons Maithum Mathlum
Rodney Mitchell Stephen Tudge Eliza Tweddle Mori Wada David Wiesenfeld

Jane Harrowfield

 

Project team

Mirela Matthews Rebecca Miller Paul Mitchell Claire Porter
Amy Sercombe Luellen Thek Ella Stuart Luc te Marvelde

Related documents below

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