Oesophagogastric Cancer Redesign Program
Oesophagogastric (OG) cancer is a small volume cancer with approximately 588 people diagnosed with stomach cancer and 395 people diagnosed with oesophageal cancer in Victoria in 2017. Survival rates are low; 22% of patients with OG cancer and 30% of patients with stomach cancer survive for five years or more.
The Victorian Tumour Summit focused on the low survival rates for these cancers. It reviewed state-wide data and considered unwarranted variations from recommended (optimal) care. Apparent variations were then investigated at a health service level via a coordinated state-wide audit (Victorian OG Cancer Audit – 2017). Outcomes of this provided baseline data for the OG Redesign Program, a state-wide project, led by NEMICS.
The program ran from 2018 to June 2019 at eight health services across Victoria.
1. Increase the number of patients with a new diagnosis of OG cancer discussed at an multidisciplinary meeting (MDM) for treatment planning to 85% by the end of 2018, and
2. Commence treatment within 42 days of receipt of referral as recommended in the optimal care pathway for people with OG cancer.
1. Addressing MDM presentation rates
- MDM presentation rates increased for newly diagnosed OG cancer patients from 76% (range 39% to 91%) to 93% (range 73% to 98%). This was 7% more than the Program target of 85%.
- MDM Terms of Reference were reviewed and updated at all participating health services.
- The number of patients with multiple MDM presentations was reduced.
- The number of patients diagnosed with Stage IV/metastatic OG cancer presented at MDM for treatment planning increased.
- Additional MDM meetings are now scheduled, where fortnightly MDMs fall on a public holiday. This prevents lengthy delays for multidisciplinary treatment planning.
2. Addressing treatment timelines:
- Data suggests a trend towards increasing the number of patients who receive care within the recommended 42 days.
At baseline 63% of patients met the timeline; this increased to 66% at program completion. The outer range reduced by over 100 days, from 357 to 245 days.
- Health services reviewed their GP referral information and templates to ensure the ‘Red Flags’ for OG cancer are included, assisting triage staff to fast-track patients at risk of cancer.
- Individual health service triage and referral pathways and processes have been reviewed and updated where needed.
- Health services adopted a number of strategies to address the challenge of meeting the 14-day timeline from MDM to treatment. These include:
* diagnostics completed prior to MDM
* early referral to Medical Oncology; and
* referrals generated at MDM are completed at the meeting
3. Four projects increased information provision to patients through the provision of ‘My Cancer Care Record’, the OG ‘What to Expect Guide’, CCV information and locally produced OG cancer information.