NEMICS health services and program staff work together to identify and implement improvements in cancer services. The priority areas for improvement include multidisciplinary care, supportive care, coordinated care and the provision of evidence-based care. The planning and implementation of service improvements involve active consumer participation.
The role of Victoria’s Integrated Cancer Services (VICS) is to promote system integration across structural boundaries and to encourage collaborative approaches to evidence-based service development. The VICS bring together a range of stakeholders, clinicians, researchers and consumers who have the ability to influence the development, and implementation of, evidence-based care. A key focus of the clinical networks is to reduce inappropriate variation in access and delivery of patient care.
Current activities include:
Addressing variation in outcomes related to disadvantaged groups
Cancer care coordination
Community Ambassador program podcasts
Implementation of the Optimal Care Pathways
My Cancer Care Record refresh
NEMICS grants program
Referral processes to palliative care
Regional service planning
Specialist programs and referrals pathways scoping project
VICS branding refresh
VICS consumer engagement peer group
Partnering With Consumers
NEMICS recognises that one of the best ways of enhancing patient care is to listen to and value the voice of people who have been diagnosed with cancer and have experience of the health care services.
It was because of this understanding that NEMICS formed a Consumer Reference Group(CRG). Our consumers provide advice and make an active contribution to improving cancer services by working with the NEMICS program office and health services within the region.
The NEMICS consumer participation strategy has four key strategic directions:
develop the NEMICS consumer network and consider other structures to participation
consumer participation at all levels
consumer and carer participation in research activities
support the capacity of consumers and carers to participate effectively in their own care
Consumer participation is supported at a national and state government level.
Older People With Cancer
A focus area of the Victorian Cancer Plan 2016-2020 is to ensure all Victorians have equal cancer outcomes. Currently the outcomes of cancer care are poorer for certain populations, including older people, socioeconomic insecurity, cultural diversity and Aboriginal and Torres Strait Islanders.
People over 60 years make up a significant proportion of our cancer population. A priority for NEMICS is to ensure that older cancer patients receive individually planned cancer care and support. NEMICS has engaged with its partner health services to identify strategies and models of care to better meet the needs of older cancer patients.
Outcomes are often poorer because older cancer patients:
• present late and are diagnosed at a later stage of disease
• experience poorer response to treatment
• experience complicated management due to comorbidities and functional status
• have complex polypharmacy issues
• are less likely to participate in clinical trials (less than 10%) with a resulting lack of evidence based treatment
• risk over and under treatment due to this lack of evidence
• experience a decline in function following treatment and a return to previous function can be unrealistic.
Working Towards Optimal Cancer Care
The nationally endorsed Optimal Cancer Care Pathways (OCPs) describe the optimal care for specific tumour types. They form the basis of our service improvement work across the region.
For more information about the OCPs please visit:
NEMICS are currently working on two local OCP projects:
Pancreatic Cancer Resectability Project
Research has demonstrated that surgery offers the most effective treatment for patients diagnosed with pancreatic cancer. Our challenge is to identify patients who are eligible and who would benefit from surgery in borderline cases. This relies on consistent reporting of diagnostic tests. Establishing a standard would ensure patients with suspected pancreatic cancer are appropriately and consistently managed.
In partnership with Southern Melbourne ICS, NEMICS worked to achieve statewide consensus on a standard approach to borderline resectable pancreatic cancer.
An expert reference group, comprised of hepatopancreatobiliary surgeons, radiologists and oncologists from metropolitan and regional Victoria, adopted as a statewide standard the ‘International consensus definition and criteria of borderline resectable pancreatic ductal carcinoma 2017’.
The radiological synoptic report tool was developed by clinical leads from sites treating high numbers of pancreatic cancer patients. The tool was ratified for a pilot implementation project.
Data included in the synoptic report will also inform patient outcome research into the disease. A collaboration with the Upper Gastrointestinal Cancer Registry (UGICR) has been established to collect the pilot data in a single location for this purpose.
The pilot project is occurring in two sites – Austin Health and the Alfred Hospital.
"We are now able to start managing and caring for our H&N patients sooner”.
- Oncology specialist nurse
Streamlining oncology referral for Head & Neck cancer patients at Austin Health
Austin Health has commenced trialing the use of an ‘Expedited Oncology Referral Form’ in the multidisciplinary meeting (MDM) to address variations in care for Head & Neck cancer patients.
Surgeons now refer patients directly from the MDM to shorten the interval from surgery to adjuvant treatment. Using a structured form means that referrals contain all information needed by the multidisciplinary team, including prompts to ensure ancillary testing (e.g. audiology & orthopantomogram (OPG) is completed well before oncologist consultations.
Patients are now connected earlier with their oncology care providers (consultants, nursing and allied health staff) and receive better coordinated care.
Early feedback indicates the clinicians are satisfied with receiving clear staging information to guide their treatment planning.
Other MDMs at Austin Health have shown interest to expand use of the ‘Expedited Oncology Referral Form’.
For further information on these projects contact:
Regional Service Planning
A collaborative event, involving NEMICS health services, focused on increasing the proportion of residents who receive safe and high-quality cancer care close to home, rather than accessing treatment in other regions. Discussion centred on how to improve the delivery of population-based cancer care in the NEMICS region.
NEMICS Consumer Reference Group member Graeme Down, shared his experiences and insights gained during diagnosis and treatment. Representatives from the health services presented an overview of their current and desired future state for delivery of cancer services.
Opportunities were identified and prioritised for each health service and for the region. The consumer perspective provided a strong theme during discussions and planning exercises.
Three areas were identified for action:
specialist programs and referral pathways – a scoping project commenced April 2020
care outside of hospital – the home-based cancer care framework and toolkit was released in May 2020 by Department of Health and Human Services
cancer care coordination – a scoping project commenced March 2020
Improving self-sufficiency within NEMICS region
Increasing the awareness of services available in our region is an important first step towards more people in our region being treated in our region.
A map of all cancer and support service locations has been updated and clinically validated in 2019 and can be downloaded below.
It provides a snapshot of:
• location and access arrangements for services not on-site
• public and private providers of cancer care
• general services or oncology specific services
• full onsite services, or partial services or sessional appointments
The service map is available for NEMICS network partners to inform a common understanding of cancer service provision in the region. This document is intended for use as a service planning tool. It enables providers to identify where opportunities exist to improve current service provision. The map will be reviewed 6 monthly with updates published in June and December each year.
NEMICS Grant Program
Service Improvement Grants
Each year NEMICS offers funding to support small quality improvement and scoping projects not funded within existing hospital resources.
The aim of the program is to improve patient or carer experiences/outcomes through supporting projects that address one or more of the following quality dimensions:
• patient centeredness
Projects must align with the Optimal Care Pathways and/or Victorian Cancer Plan.
More information about applying can be found in Top Tips for Applying and 2019 guidelines
Current service improvement grants underway
VidEx: development and evaluation of a new education VIDeo on EXercise during active cancer treatment
Translation of existing radiation therapy treatment video
Feasibility of a network-wide approach to multidisciplinary haematology patient survivorship management
Patient RepOrted Symptom Monitoring for Adaptive Reviews during radiation Treatment (PROSMART)
Scoping a framework for cancer care coordination at Austin Health
Development of a survivorship care plan for patients who have completed treatment
Personalised care plans in early stage bowel cancer to improve the patient cancer journey and enhance GP communication
Improving patient experience by reducing time to first chemo dose for planned haematology admissions
Improving outcomes for patients with chronic haematological malignancies
Gather information and data to implement a new patient pathway after surgery
Improving efficacy and delivery or pre-treatment education sessions to cancer patients
Implementation of Breast Cancer Survivorship Clinic
Undertake a co-design process to create a feasible and acceptable group-based psycho-oncology program to reduce wait times and relieve stress