Oral Presentation Victorian Integrated Cancer Service Conference 2015

Guidelines for timely initiation of chemotherapy - a proposed framework for access to medical oncology and haematology cancer clinics and chemotherapy services in Victoria (#7)

Marliese Alexander 1 , Natalie Love 1 , Robert Blum 2 , Jenny Byrne 3 , James Downie 4 , Rhonda Beattie-Manning 5 , Colin Hornby 6 , Chris Kearny 1 , Jane McGlashan 3 , Sandy McKiernan 7 , Jeremy Millar 8 , Danielle Murray 1 , Phillip Parente 9 , Stephen Opat 10 , Joan Thomas 11 , Nicole Tweedle 12 , Craig Underhill 13 , Katherine Whitfield 6 , Sue Kirsa 1 , Danny Rischin 1
  1. Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
  2. Bendigo Health, Bendigo, Victoria, Australia
  3. Western and Central Integrated Cancer Service, Melbourne, Victoria, Australia
  4. Independent Hospital Pricing Authority, New South Wales, Australia
  5. Western Health, Melbourne, Victoria, Australia
  6. Department of Health Victoria, Melbourne, Victoria, Australia
  7. Cancer Nurses Society of Australia, Perth, Western Australia, Australia
  8. Alfred Health, Melbourne, Victoria, Australia
  9. Eastern Health, Melbourne, Victoria, Australia
  10. Monash Health, Melbourne, Victoria, Australia
  11. Peninsula Health, Mornington Peninsula, Victoria, Australia
  12. Victorian Comprehensive Cancer Centre, Melboune , Victoria, Australia
  13. Greater Southern Area Health Service, East Hume / Border Clinical Network, Albury, New South Wales, Australia

Background: Internationally, cancer waiting times are routinely measured and reported. In Australia guidelines exist for the timeliness of cancer care for surgery and radiation therapy; equivalent guidance for chemotherapy is lacking.
Aim: To develop guidelines for the timely initiation of systemic chemotherapy for the treatment of cancer.
Method: The development process followed National Health and Medical Research Council (NHMRC) guidelines including a strategy to identify best available evidence and governance structure inclusive of multidisciplinary clinical and administrative personnel and consumers. Literature reviews were undertaken for 6 priority cancers – the most commonly diagnosed cancers in which systemic chemotherapy is included as part of the primary treatment plan. Evidence was reviewed by multidisciplinary panels convened from Victorian health services. Recommendations, informed by the evidence and drafted by these panels, were presented and refined at an open consensus meeting, then finalised by the project steering committee prior to external review and consultation (currently underway).
Results: 3841 papers were screened and 130 papers selected for full review. Evidence was generally low level – NHRMC level III. While large populations and consistent results across studies provided certainty for some cancers, there was a reliance on best clinical judgement for others. More than 50 representatives from Victorian cancer services and relevant professional organisations attended the consensus meeting and contributed to the development of recommendations for timely access to medical oncology and haematology clinics (chemotherapy prescription) and chemotherapy day units or inpatient wards (chemotherapy administration). Evidence suggests that timeliness or ‘urgency’ varies by cancer type. Chemotherapy initiation is recommended within 48hours for urgent cases and from 2 to 12 weeks for other cases dependant on cancer type.
Conclusion: Following a validated process with multidisciplinary and consumer input we were able to develop guidelines, informed by best available evidence and expert opinion, for the timely initiation of systemic chemotherapy.