level 2, bricc building 2018-19 annual reportannual report level 2, bricc building 2018-19 ballarat...

ANNUAL REPORT2018-19Level 2, BRICC Building

Ballarat Health Services

P: (03) 5320 4782 www.gics.com.auwww.gics.com.au

GICS 2018-19 ANNUAL REPORT 02

CONTENTSWho we are 02

Our Message 03

Victorian Cancer Plan 04

Primary Prevention and Early Detection 06

Patient Experience Survey Results 08

Treatment 10

Multidisciplinary Meetings 14

Wellbeing and Support 16

Research 18

Workforce Development 19

A Networked Cancer System 20

Our Governance 22

Financial Summary 23

GICS VISIONImproving patient experiences and outcomes by connecting cancer care and driving best practice

GICS MISSIONGICS will achieve the vision by:

understanding the needs of people affected by cancer;

building and supporting collaboration between health professionals, health services and consumers;

driving quality improvement in cancer care;

supporting the development of cancer workforce;

facilitating system-wide engagement in cancer research.

WHO WE AREEstablished in 2004, Grampians Integrated Cancer Service (GICS) is a cancer service improvement organisation covering the Grampians Region, with the primary aim of improving the experiences and outcomes of those affected by cancer.

The Victorian Cancer Plan 2016-2020 (Department Health and Human Services) provides the overall strategic policy direction for Integrated Cancer Service’s activities. GICS is funded by the Department of Health and Human Services (DHHS) with Ballarat Health Services (BHS) acting as fund holder.

GICS is not a direct provider of services, but facilitates system development and service improvement by supporting local and regional services. As an independent organisation GICS is governed by a Governance Group comprised of key regional stakeholders. The governance of the organisation is further underpinned by a Memorandum of Understanding between GICS and health service providers across the Grampians Region.

The Grampians Region stretches from the South Australian border in the west to Bacchus Marsh in the east, and from Edenhope to Hopetoun in the north. The area covers almost 50,000 square kilometres and a population of nearly 220,000 people.

Front cover image: Kindly provided by Ian Kemp

www.iankempphotography.com

ABOUT THIS REPORTThis report aims to give our stakeholders an insight into the diversity of the activities undertaken by GICS during 2018/19. A financial summary is also contained within this report.

We acknowledge Aboriginal and Torres Strait Islander people as the Traditional Custodians of the land and acknowledge and pay respect to their Elders, past and present.


GICS’ role is to support local implementation of the Victorian Cancer Plan (2016-2020). We do this through ongoing engagement with doctors, nurses, allied health professionals and consumers, representing the many Victorians who are living with or have lived the experience of cancer. We also promote access to high-quality services and care, delivered as closely as possible to where patients live.

Clinician engagement is critical in designing and delivering service improvement. To further this GICS coordinated a number of workshops around colorectal cancer treatment, multi-disciplinary team meetings and optimal care pathways to gain clinician perspective and insight.

Our work in rural areas has included health literacy projects in the Wimmera Southern Mallee and Pyrenees; trialling of telehealth in delivering wellness programs/clinician consultations, enhancing supportive care, nursing and exercise physiology education and professional development.

At the regional level, GICS has supported health services with service planning, data analysis, consumer co-design and testing service improvement interventions. Indeed, using patient feedback from the Victorian Cancer Patient Experience Survey, together with performance indicators from the Cancer Performance Monitoring Framework, stakeholders now have more access to information about the quality of cancer care in our region.

At the state level we have worked hard to ensure the regional/rural voice is heard in service and policy development.

GICS has been actively involved in state-wide projects; such as the Tumour Summits Program, and have encouraged and supported our health care professionals to provide their regional perspectives to these projects.

This year saw a focus on enhancing governance across the Integrated Cancer Services, which included a new Memorandum of Understanding (MoU) signed by 23 services across the Grampians Region. Work to align internal governance processes with a new MoU has also commenced.

Following Dale Fraser’s completion of his term as Chair, we appointed Alex Demidov, CEO of St John of God Hospital. This appointment supports our commitment to private/public partnerships in cancer service improvement. We also welcomed Phil Catterson, Andrew Freeman, Ben Kelly and Dr Stephen Brown. Dr Jonathan Tomaszewski and Libby Fifis stepped down from the Governance Group and we thank them for their contribution.

GICS’ focus for the next year will be informed by the refresh of the Victorian Cancer Plan, and our regional planning consultations with health services and consumers.

We sincerely thank the wide range of health professionals, executives and consumers involved in supporting our work, for their continued advice and we look forward to working with you again next year.

From the Chair, Clinical Director and Strategic Director

On behalf of Grampians Integrated Cancer Service (GICS), we are delighted to share our work and achievements over the past year.

Mr. David Deutscher Clinical Director

Ms. Joanne Gell Strategic Director

Mr. Dale Fraser Former Chair

Mr. Alex Demidov Chair (Appointed Feb 2019)

OUR MESSAGE


VICTORIAN CANCER PLAN

Authorised and published by the Victorian Government, 1 Treasury Place, Melbourne.© State of Victoria, August, 2016. (1605044)

Victorian cancer plan 2016–2020Summary

Victorians are supported to reduce risks

of cancer

Victorians know their risk and have cancers

detected earlier

Victorians with cancer have

timely access to optimal treatment

Victorians with cancer and their families live well

Victoria has a strong and

integrated research system

By 2040 we willhalve the proportion of Victorians diagnosed with preventable cancers double the improvement in one- and five-year survival of Victorians with cancerensure Victorians have the best possible experience of the cancer treatment and care systemachieve equitable outcomes for all Victorians.

Making it happen – action areas

Focus for 2016–2020

System supports

Underpinned by principles

Cancer plan prioritiesWe will work together to ensure

We will save 10,000 lives by 2025

Primaryprevention

Screening and early detection Treatment

Wellbeing and support Research

Reduce risk factors related to lifestyle and environment

Prevent cancers related to viral

infections

Equity in screening

participation

Increase access to familial risk assessment for people at risk

Improve cancer awareness and

primary care capacity

Consistent quality through

Optimal Care Pathways

Improve patient’s

experience of care

Optimise infrastructure,

data and system design

Maintain quality of life through strengthening

supportive care and

self-management, recovery,

survivorship, palliative care

and end of life care

Improve access to clinical trials

Support researchers to

collaborate

Accelerate translation of research into

clinical outcomes

Integration: working together to deliver optimal care pathways

Innovation: supporting and systematic scaling-up of innovative practice

Investment: in infrastructure, outcome-focused service models and research platforms

Intelligence: better access to and use of data and information to drive continuous improvements

Workforce: ensuring a workforce that can meet the future needs of cancer prevention and care

*Person-centred care with equitable access *Prevention focused across the care pathway

*Quality and safe care *Evidence informed *Sustainable system


of cancer


detected earlier









System supports




Primaryprevention





infections

Equity in screening

participation






Improve patient’s

experience of care




supportive care and






collaborate


clinical outcomes









of cancer


detected earlier









System supports




Primaryprevention





infections

Equity in screening

participation






Improve patient’s

experience of care




supportive care and






collaborate


clinical outcomes









of cancer


detected earlier









System supports




Primaryprevention





infections

Equity in screening

participation






Improve patient’s

experience of care




supportive care and






collaborate


clinical outcomes








To download a copy of the Victorian cancer plan 2016–2020 go to www.health.vic.gov.au/cancer

An annual workplan in line with the Victorian Cancer Plan Action areas guides the activity of the GICS Program office:

1. Prevention 2. Screening and Early Detection

3. Treatment 4. Wellbeing and support

5. Research

78% of GICS workplan activities were achieved between July 2018 and June 2019. Outcomes are reported in the subsequent pages.

To download a copy of the Victorian cancer plan 2016-2020 go to www.health.vic.gov.au/cancer

5 YEAR SURVIVAL STATISTICS

78%

For the Grampians Region, our challenge is to:

• Reduce the number of preventable cancer deaths by 50 people each year. Improvements in healthy lifestyle behaviours across our region has been noted in the Victorian Population Health Survey – but there is more to do.

• Improve one year and five year survival rates. Our trends are improving, but we still need to reduce the gap in comparison with state average.

• Ensure quality and safe care. Data across 29 performance indicators indicates that Grampians health services met or exceeded the State average for 79% of indicators (source SCIP).

• Provide care as close to home as possible and where appropriate. Data indicates that for most communities, care is provided locally and within the Grampians.

LGA Local HS Neighbouring LGA Grampians HS Other ICS region HS Total

Ararat 34% 52% 0.1% 13.9% 100%

Ballarat 92% 0.1% 0.1% 7.8% 100%

Golden Plains 0% 53% 0% 47% 100%

Hepburn 5% 70% 1% 24% 100%

Hindmarsh 6% 76% 9% 9% 100%

Horsham 65% 1% 20% 14% 100%

Moorabool 0.5% 43.5% 0.4% 55.7% 100%

Northern Grampians 40% 5% 30% 26% 100%

Pyrenees 1% 89% 0% 10% 100%

West Wimmera 6.5% 64.4% 15.9% 13.2% 100%

Yarriambiack 8.2% 51.4% 21.0% 19.4% 100%

ALL CANCER TREATMENT FOR GRAMPIANS RESIDENTS BY LGA (PROPORTION BY CLOSENESS OF TREATING HEALTH SERVICE)


CANCER SERVICES PERFORMANCE INDICATORS 2018

The Cancer Services Performance Indicators are utilised to measure progress across Victoria in relation to multidisciplinary care, supportive care and care coordination.

Data collected by Integrated Cancer Services, via medical record audits informs four Cancer Services Performance Indicators:

• Documented evidence of multidisciplinary team recommendations

• Documented evidence of disease staging in the multidisciplinary team recommendations

• Documented evidence of communication of initial treatment plan to GP

• Documented evidence of supportive care screening

In 2018, Grampians Integrated Cancer Services (GICS) performed above the state average in documented evidence of disease staging in MDM recommendations. At the local level, supportive care screening rates increased to 35% compared with 23% in the previous audit, although improvements still need to be made in this area.

DOCUMENTED EVIDENCE OF MULTIDISCIPLINARY TEAM RECOMMENDATIONS

2018 RESULTS

DOCUMENTED EVIDENCE OF COMMUNICATION OF INITIAL TREATMENT PLAN TO GP

DOCUMENTED EVIDENCE OF DISEASE STAGING IN THE MULTIDISCIPLINARY TEAM RECOMMENDATIONS

DOCUMENTED EVIDENCE OF SUPPORTIVE CARE SCREENING

(Cancer Services Performance Indicators Report 2018)

GICS 40%

GICS 88%

State 69%

State 72%

Target 80%

Target 100%

GICS 38%

State 78%

Target 100%

GICS 35%

State 39%

Target 80%


HEALTH LITERACY IN SMALL TOWNSIn 2018-2019, the Ophelia Grampians Project - Optimising Health Literacy and Access to Cancer Care in the Grampians – focussed on interventions in small towns in the Grampians region.

Early analysis conducted by Deakin University looked at health literacy factors contributing to a higher cancer incidence and mortality in the Grampians region. It discovered residents of small towns overall have lower health literacy rates.

Subsequently in 2018, in collaboration with Wimmera Primary Care Partnership, interventions aimed at overcoming health literacy barriers for cancer patients were introduced in Nhill and Warracknabeal.

Interventions included free skin cancer checks, a men’s health night including guest speaker Stu Willder (Nurse Practitioner), a CFA fitness program, the development of a transport factsheet, a cooking program for cancer survivors living alone and tools to promote the Cancer Resource Nurse (CRN).

In 2019 with the help of the Central Highlands Primary Care Partnership, a community event was held in Avoca “Let’s MEAT up for Farmer’s Health”. Highlights included skin cancer checks, other general health checks, educational showbags and guest speaker Sharon Gibbs, Senior Radiation Therapist, talking about the new radiation outreach service in Stawell.

ACTION AREA: PRIMARY PREVENTION AND EARLY DETECTION

Skin check clinic: Stu Willder, Men’s Health/Urology Nurse Practitioner, Western District Health Service and Janine Clark, Registered Nurse, West Wimmera Health Service

PRIMARY HEALTH CAREIn 2018, GICS collaborated with the three primary care partnerships in the Grampians Region on a range of strategies to improve health literacy and promote healthy eating and active living. We were excited to be involved in the Central Highlands Obesity Prevention Lab, which aims to drive locally appropriate initiatives aimed at getting the community moving, and reducing obesity rates by 5% by 2025. We worked with businesses, community members, local government as well as health services – developing prototypes and testing new ways of thinking and working.

Our partnership with the Western Victoria Primary Health Network has been strengthened with our joint work in implementing optimal care pathways for Prostate and Oesophagogastric cancers. This has included the addition of 10 cancers in Health Pathways – a web based information portal for general practitioners and other primary care providers and acts as a central source of health services information, providing condition specific information on assessment, management and local referral options.

HealthPathways have been developed for:

A further 7 cancer optimal care pathways will be included into HealthPathways for Western Victoria over the next year. See https://westvic.healthpathways.org.au

Bowel Cancer

Lung Cancer

Breast Cancer

Pancreatic Cancer

Endometrial Cancer

Prostate Cancer

Oesophagogastric Cancer

Melanoma

Ovarian Cancer

Liver Cancer


A GICS/BHS Colonoscopy Access Working Group was formed in 2016 to look at issues in relation to timely diagnosis for the major treating hospital in the Grampians.

The intention of the Colonoscopy Access project was to:

• describe the current referral handling processes in detail, from receipt of referral to intervention or rejection of referral

• identify waste and non-standard processes in the handling of referrals for bowel investigation at BHS

• provide clarity about the impacts of the current system on people with colorectal cancer diagnosed in 2017

• focus attention on processes within the system which are not currently part of improvement efforts

Diagnostic Findings:

A Colorectal Cancer Patient Audit identified 38 patients were diagnosed in 2017 at BHS.

The audit found that 22 of 38 (58%) waited more than 4 weeks for scope, including 7 of 38 (18%) who waited more than 12 weeks.

Big picture map highlighted several issues and variation with handling of referrals for colonoscopy including:

1. Quality of referrals from GPs and lack of GP awareness of BHS processes (addressed through the BPAC pilot).

2. Delays to triage and inconsistency in triage (addressed through the Categorisation project)

3. Delays in receipt of Patient Health Questionnaire from patient after completion

4. Other patient initiated delays

COLONOSCOPY ACCESS PROJECTPoorer outcomes occur for people diagnosed with colorectal cancer living in the Grampians in relation to:

• higher rate of advanced disease at diagnosis

• higher proportion of ED admissions leading to surgery

• poorer 5 year survival

In 2018, Ballarat Health Services committed to undertake a redesign of the Outpatient Department and invested in an e-Referral mechanism for handling incoming referrals to Ballarat Health Services. This is expected to have flow on effects which will improve access to colonoscopy for Grampians’ patients.


How satisfied were you with the overall care you received from all health professionals involved in your treatment?

Throughout your treatment, has there been a time when you thought the health professionals involved in your care were not passing on information to one another?

94% of consumers rated their overall care as

excellent or very good

1 in 9 consumers thought health

professionals did not pass information to one

another, at least once.

VICTORIAN PATIENTS’ EXPERIENCE OF CANCER CARE SURVEY

The Department of Health and Human Services (DHHS) funded GICS to support local implementation of the Victorian Patients’ Experience of Cancer Care Survey (VPECCS) Toolkit.

The VPECCS is a questionnaire designed to collect information about the care experiences of patients treated for cancer in Victorian hospitals. The survey aims to understand patients’ experiences regarding their interactions with healthcare providers and provision of information and supportive care services throughout their cancer journey. The information collected through the survey is being utilised by hospitals and health services in their quality improvement initiatives.

1288 surveys were sent with 847 returned complete (66% response rate).

Here is a snapshot of results for all six health services combined. For the full report go to: http://gics.com.au/files/161/Grampians_Region__Experiences_of_Cancer_Care_Survey.pdf

The following health services participated in the survey:

OTHER RESULTS:

1 in 4 consumers not given information about who to contact for support.

1 in 4 consumers not told how to get more information about their cancer.

PATIENT EXPERIENCE SURVEY RESULTS


Were you involved as much as you wanted to be in decisions about your care and treatment?

Throughout your treatment, has there been a time when the results of your tests, X-rays or scans were not available when they were needed for an appointment?

Did the health professionals involved in your diagnosis talk to you with respect and understanding?

Throughout your treatment, has there been a time when you received conflicting information or advice from different doctors or health professionals?

77% of consumers said they were involved as

much as they wanted in decisions about their care

and treatment.

1 in 10 consumers thought results, x-rays or scans were not available when they were needed,

at least once.

91% of consumers said they were treated with

respect and understanding

1 in 7 consumers thought there was

conflicting information or advice between health

professionals, at least once.

1 in 12 consumers said work, other commitments or how far to travel was not considered when scheduling appointments.

1 in 3 consumers when finished treatment were not given a written plan that included information about follow-up care.

1 in 8 consumers would have liked a health professional to talk about any financial support programs.

1 in 5 consumers not given information about how to get extra support if they or their family wanted it.


ACTION AREA: TREATMENT

PANCREATIC CANCER

Each year in the Grampians Region approximately 35 patients will be diagnosed with Pancreatic Cancer.

People with Pancreatic Cancer are likely to present late, often initially to an Emergency Department and be diagnosed with advanced cancer. A high proportion will be referred for Palliative Care support.

Quality improvement efforts. This includes working to ensure all people diagnosed with Pancreatic Cancer in the region are presented for multidisciplinary discussion of their treatment options. Early dietetics referral for all people with Pancreatic Cancer is also being put in place in recognition of the role that unintended weight loss and malnutrition can play in supporting treatment outcomes.

A medical record audit of all pancreatic patients diagnosed in 2017, identified pleasingly, that care is provided in line with OCP.

OCP IMPLEMENTATION THREE YEARS ON…Optimal Care Pathway implementation has now entered its third year. Developing overall awareness of OCP’s continues to be a key focus of activity with the Victorian Department of Health and Human Services leading a staged approach to the implementation of individual OCP’s:

The period 2018 /19 incorporates ongoing work arising from Lung, Colorectal, Prostate and Oesophagogastric OCP implementation, in addition to commencing work for Head and Neck and Pancreatic Cancer Streams.

Prostate and Oesophagogastric Cancer OCP implementation in the spotlight.


HEAD AND NECK CANCER

Approximately 54 people will be diagnosed in the Grampians Region with Head and Neck Cancer each year.

Whilst evident that a high proportion of patients will be presented for multidisciplinary discussion OCP implementation will focus on timeframes to MDT presentation in improving timeliness of care. Access to timely, appropriate and understandable patient information is an aspect that will be further explored within Head and Neck OCP implementation.

Interviews held with people with Head and Neck Cancer living in the Grampians Region indicated that access to tailored information particularly in the time following diagnosis and commencing on treatment could be improved.

“I think perhaps if there was a bit more positive presenting of the information, like recovery options, like here are some people who have had your surgery and this is the way they can speak, this is what will happen to you next and this is what could happen in terms of recovery rather than the negative aspects. I probably would’ve gone into the surgery first go.’

“I probably had the choice to ask questions but it all happened so quick that you don’t ask, you don’t think to ask questions, you know?”

65% of patients were provided with information in a format that they were happy with & provided with information about treatment options for their cancer.

50% of patients were told how they could access more information

65% of patients completely understood the explanation of their diagnosis provided to them.

65% 65% 50%

An analysis of 29 patients diagnosed with Head and Neck Cancer during 2017 found that while care was delivered largely in line with the optimal care pathways, timeliness to treatment was an area for improvement.


Statewide OG Cancer Audit data provided data to evaluate the current state of MDMs and the timeliness of care for OG cancer patients at their local health service and across Victoria

INFORMED BY THE RECOMMENDATIONS OF THE VICTORIAN OESOPHAGOGASTRIC CANCER TUMOUR SUMMIT

95%Blanket MDM referral

adopted for all patients newly

diagnosed with OG Cancer

ACHIEVEMENTS TO DATE (July 2019)

GRAMPIANS REGION 2018/19

IDENTIFIED SOLUTIONS

That work be undertaken at a local level to improve

MDM presentation rates for patients with OG cancersTimeliness of care.

Action areas identified

LEADING TO THE ADOPTION OF THE FOLLOWING TARGETS FOR OG IMPLEMENTATION - DHHS

85% of all newly diagnosed OG cancers have documented evidence of Multidisciplinary Team meetings (MDTs) recommendations by end of 2018 and 100% by 2020

EXPLORING THE 'PROBLEMS' IN THE GRAMPIANS REGION

On average referral to dietetics at Ballarat Health Services occurs after diagnosis.

57% of patients with OG cancer in the Grampians region were presented for

discussion at an MDM

STATEWIDE OG CANCER PATIENT AUDIT

Align time of dietetics referral for all patients diagnosed with OG cancer closer to the point of diagnosis.

5 quarterly meetings of the OG OCP Working Party informed design, delivery and monitoring of project activities

Broad representation

Surgery

Medical Oncology

Allied Health

Consumers

Radiation Oncology

Consensus adoption of blanket MDM referral for all newly diagnosed OG cancer patients.

Adoption of blanket referral to dietetics for all newly diagnosed OG cancer patients.

Referral pathways developed to support dietetics referral for all newly diagnosed OG

patients.

On average referral to dietetics for patients with

OG cancer occurs

OG OCP WORKING PARTY

Patients from the Grampians Region were audited

37days

19

BASELINE MEASURES (2017)

BHS Dietetics Audit 2017

13 days after diagnosis.

OESOPHAGOGASTRIC (OG) CANCER OCP IMPLEMENTATION


PROSTATE CANCER OCP IMPLEMENTATIONGRAMPIANS REGION 2018/19

INFORMED BY THE RECOMMENDATIONS OF THE VICTORIAN PROSTATE CANCER TUMOUR SUMMIT

Ballarat Urology registration to PCOR.

Data collection commenced in March 2018. Data

collected for

IDENTIFIED SOLUTIONS

ACHIEVEMENTS TO DATE (June 2019)

Universal contribution to Prostate Cancer Outcomes Registry & share data with local clinical groups to evaluate impact on reducing variation & improving outcomes.Better access to MRI scans for regional patients.Improve experience & quality of life for survivors through existing & innovative models of careMinimise the risk of over treating lower risk disease. Better access to Multidisciplinary Team Meetings especially for rural patients.Early diagnosis through the appropriate use of NHMRC PSA testing & early management of test detected prostate cancer guidelines.

Action areas identified

Men are routinely provided with an opportunity to explore all available

management options.

Appropriate support is accessible to men's supportive care needs up to 24

months post treatment.

Upskilling primary health care professionals within general practice in

the Prostate Cancer OCP


of men interviewed reported being aware of a range of treatment options available and felt

supported to make informed decisions regarding their treatment.

79%of men indicated that their supportive care

needs were met in the period up to 24 months post treatment end.

Through

We found 100%

195 Survey ResponsesGrampians Region Experiences of

Care Survey 2018

2 Networking events

attended by 24 Grampians Region clinicians and consumers

19 patient interviews

conducted by phone or in person

Regional Model of Prostate Cancer Care developed ensuring

embedding of processes.

Introduction of a pilot patient seminar providing

education on the side effects and management of

patients on ADT.

Commence inputting data to the

Prostate Cancer Outcomes Registry.

Partner with WestVic PHN in awareness raising of prostate

OCP and role of the GP.

200+ patients

Regional Model of Prostate Cancer Care

endorsed.

Participants reported high degrees of satisfaction with

program content & format

17 participants8 Clinician presenters

2 Patient ADT Seminars held in Ballarat & Horsham

27 primary care events where OCP's were the

primary focus.63 views to PSA testing a shared decision newsletter

article1138 I-PACED Resource cards distributed to GP's,

Practice Nurses and Practice Managers

LEADING TO THE ADOPTION OF 3 PROBLEM STATEMENTS FOR IMPLEMENTATION - DHHS



MULTIDISCIPLINARY MEETINGS

Multidisciplinary care is an integrated team approach to health care in which medical and allied health care professionals consider all relevant treatment options and develop collaboratively an individual treatment plan for each patient.

MDM BY YEAR

Individuals MeetingsDiscussions

Ballarat Meeting stream

# Meetings # discussions # individualsAverage

Incidence (CCV)

Breast

Invasive Primaries

24

-

230 (163)

-

186 (139)

141

-

198

GI – ALL - Includes:

Colorectal

Upper GI

23

-

-

224 (227)

-

-

190 (177)

78*

73*

-

215

122

Head & Neck

Primary H&N

Endocrine

25

-

-

120 (126)

-

-

91 (88)

44

14

-

54

27

Neuro-oncology 10 27 (25) 24** (21) CNS 26

Thoracic

Lung Primaries

22

-

160 (147)

-

122 (119)

91

-

140

Gynae (link to MMC)

11 32 (38) 28 (33) 70

Notes:

• Average incidence incorporates the entire Grampians health region.

• Colorectal / Upper GI - new diagnoses only.

• ** Neuro-oncology discusses both primary CNS cases and metastatic cases from other primary sites.

In Ballarat, multidisciplinary meetings are a joint initiative of Ballarat Health Services and St. John of God Ballarat Hospital. Six meetings, spanning seven tumour streams, are supported by GICS.

In the 2018-2019 financial year, 115 meetings were held in Ballarat incorporating 793 discussions of 635 individuals. This represents a 9% average increase over the previous year with a significant increase in the number of breast cases discussed - 34%.

Wimmera Health Care Group (WHCG) run a combined MDM in Horsham. This multi-tumour MDM discussed 59 patients this financial year, including 11 Breast, 25 Colorectal and 8 Upper GI.

In the table, figures for the previous year are shown in parentheses ().


MDM SOFTWARE IMPLEMENTATIONThe long awaited MDM management software - QOOL-VIC was delivered in May 2019. Following a brief training period, BHS adopted it for the 6 tumour streams previously managed by GICS. The software has been generally well received, with clinicians benefiting from an easier process to refer cases, ease in following the information recorded at the meeting and improved documentation of recommendations. A synchronous review of administration processes has also been beneficial.

The next steps involve improving the process to distribute GP letters, surveying clinicians to assess their response to the software change, rolling out QOOL-VIC to other MDMs in our region and engaging with other users to propose further software enhancements.

OPTIMAL CARE PATHWAY TARGETSThe Grampians working parties set 100% MDM discussion targets for pancreatic and OG (oesophagus and stomach) cancers. It is impossible to compare absolute incidence and discussion rates with the available data. However, we have 2017 Grampians-wide diagnoses data as an indicator of annual incidence to compare with Ballarat MDM discussion rates as shown in the graph. Anecdotally, there has been a decrease in the number of stomach primaries recently and we look forward to 2018 incidence data to see if this is an accurate interpretation.

In 2016-2017, the local clinical group set a 100% discussion target for newly diagnosed rectal cancers. 2018-19 saw this target unmet with 21 cases discussed, significantly fewer than in the previous 2 years. The graph includes both Ballarat and Wimmera MDM 2018-19 discussions.

IMPROVING MDM DISCUSSION RATES

MDM QUALITY STANDARDSQS1: Infrastructure and organisational support

QS2: Meeting organisation

QS3: Membership

QS4: Leadership

QS5: Consent

QS6: Patient referral

QS7: Streaming patient discussion - for MDMs which use prioritisation (optional)

QS8: MDM recommendations and communication

HEALTH SERVICE LEVEL(oversight, resourcing, governance)

STRUCTURE OF MEETING: INPUT(who attends, when, where, how)

WORKLFOW OF MEETING: OUTPUT(referrals protocols, data, timeliness

communication)

QUALITY AUDITUnder the auspices of DHHS, the ICS funded the development of the Victorian cancer multidisciplinary team meeting quality framework which was published in 2018 and sets standards, indicators and measures for all cancer MDMs in Victoria. BHS was audited against this framework in June 2019. Three tumour streams were examined with 77% of indicators met. The report highlighted governance deficits and these will be the focus of a quality improvement project for 2020.

MDM TRANSITIONProgress has been made in transitioning MDM management to BHS with the administration position set to change management in September 2019.


CANCER SURVIVOR GUIDE PODCASTHosted by ABC broadcaster, Penny Johnston and the GICS Consumer Advisory Group have created a series of five podcasts to help newly diagnosed patients. Launched in September 2018 the podcasts have been downloaded over 1300 times.

Penny Johnston was awarded the best oral presentation prize at the 2019 Victorian Integrated Cancer Services conference.

The podcasts include interviews with local medical specialists and take you gently through what might be involved in the common treatment paths. We hope the podcasts will be a helpful addition to the information patients receive from their treatment team. The website can be found at: www.cancersurvivorguide.com

ACTION AREA: WELLBEING & SUPPORT

MY CANCER CARE RECORD EVALUATIONMy Cancer Care Record (My CCR) is a hand held folder, designed specifically for newly-diagnosed cancer patients. It seeks to help patients store, record and organise their cancer and other related health information.

The folder was designed by consumers for consumers, and was trialled and distributed within 13 service providers across the Grampians and North Eastern Melbourne regions - as part of a partnership between North Eastern Melbourne Integrated Cancer Service (NEMICS) and GICS. 400 folders were distributed to patients within the Grampians region.

Cancer carer Ian Kemp, is delighted, “My Cancer Care Record empowers patients and their carers to make informed decisions about their treatment options.

It is something that allows clinicians and their care teams to develop information specifically for their patients. Patients can take copies of their test results, medications can be recorded, visits can be documented, questions for their next visit to an oncologist can be prepared in advance.”

Kate Pascale & Associates were engaged to provide an independent evaluation of the My CCR and the final report is now available http://www.gics.com.au/my-cancer-care-record.php.

On the right are some highlights:

13 11 20 – INFORMATION AND SUPPORT LINE In this podcast you will meet two of the nurses, Katherine Lane and Craig Morton, who work on the Cancer Council 13 11 20 Information and Support line.

SURGERY What are the surgeons looking for when they’re operating on your cancer? In this podcast you’ll meet surgeons Miss Caroline Baker and Mr David Deutscher.

CHEMOTHERAPYWhat can you expect when you start chemotherapy? New treatments are more targeted with less side effects. In this podcast you will meet Dr Craig Carden and Oncology Nurses Elizabeth McEncroe and Heather McErvale.

RADIATION THERAPY What’s involved in this high tech cancer treatment and what can you expect? In this podcast you’ll meet Dr Simone Reeves and radiation therapists Sharon Gibbs and Chris Hoyne.

ABORIGINAL HEALTH Great support services are available for the Indigenous community. In this podcast you will meet Emma Leehane, Aboriginal Support Worker and practice nurses Anthony Harrison & Sandy Anderson.

FIND THE PODCASTS AT:


TELEHEALTH: PROJECT OUTCOMESThe Telehealth for Supportive Survivorship Care project was completed in June 2019. This Victorian Cancer Survivorship Program project was led by Cancer Council Victoria and involved Wimmera Health Care Group, Rural Northwest Health and Stawell Regional Health. Its aim was to develop, pilot and assess a telehealth model for the sustainable delivery of a comprehensive survivorship education, exercise and wellness program across two Victorian Integrated Cancer Services.

From a consumer perspective it:

• Created access to an 8-week exercise and education program closer to home in 3 Grampians health services

• Improved emotional health, wellbeing, social connections of participants

• Demonstrated self-reported increased levels of physical activity and uptake of fruit and vegetables

For health professionals the outcomes were:

• Increased workforce capacity through training of local nursing and allied health professionals

• Established regional cancer education program planning teams including rural and community services

• Ongoing sustainability underpinned by local champions, targeted facilitator development to future-proof the program and using available funding models

For health services it has:

• Created an accessible program to benefit cancer patients

WIMMERA SUPPORTIVE CARE MULTIDISCIPLINARY MEETINGThe two-weekly supportive care MDM is now in its second year. Telehealth links participants across the region to enable discussion and formation of supportive care plans for patients. Recommendations are then discussed with the patient and agreed referrals organised. Follow up actions are presented at the next meeting.

Specialist and generalist nursing, and allied health professionals participate in the meeting process. The Cancer Wellness Program is the most recommended and accepted referral. A quality improvement review is underway using patient experience and staff surveys as guidance.

Qtr (18-19) MDMs per Qtr Cases discussed

Q1 7 33

Q2 5 22

Q3 4* 17

Q4 5* 20

Total 21 92

*some cancelled

HOW OFTEN HAVE YOU TAKEN MY CCR TO YOUR HEALTHCARE APPOINTMENTS?

HOW HAVE YOU USED MY CANCER CARE RECORD? OVERALL, HOW USEFUL HAVE YOU FOUND MY CCR?

WOULD YOU USE MY CCR IF IT WAS AVAILABLE AS AN APP?

Never 34% No 55%

Often 15%

Always 25% Yes 45%

Occasionally 26%


Oncology E-Prescribing Grant (collaboration with Ballarat Health Services, Stawell Regional Health and Wimmera Health Care Group) - successful

Implementing the Optimal Care Pathway for Aboriginal and Torres Strait Islander people with cancer: A survey of clinician needs. (with Monash University and Gippsland Integrated Cancer Service) - successful

Symptom Urgent Review Clinic Grant - unsuccessful

ACTION AREA: RESEARCH

WORKFORCE CAPACITY BUILDING

RESEARCH GRANTS

GICS supports health services apply for grants and research funding, and this year supported a number of applications processes:

GICS also works with MDMs to encourage access to clinical trials as a consideration in patient treatment planning.

UPSKILLING IN GROUP FACILITIESTo enable sustainability of the Telehealth Survivorship Project, 11 new Cancer Council program facilitators received training at the Wimmera Cancer Centre in May 2019.

The 2-day event was attended by nursing and allied health professionals from Wimmera Health Care Group, Rural Northwest Health, East Grampians Health Service, Stawell Regional Health and West Wimmera Health Service.

Group with Jane Auchettl from CCV.


CANCER NURSE EDUCATOR GICS co-funds a Cancer Nurse Educator to deliver evidenced based cancer care education throughout the Grampians region.

Overall, 116 education events were held across the Grampians Region, attracting more than 844 participants. 15% of events were held in regional settings, which is a slight increase from the previous year. The education delivered continues to be been highly valued by participants, both in the breadth of topics and quality of content delivered.

The map below illustrates the education delivered throughout the Grampians region for the 2018-2019 financial year.

CNSA WORKSHOP

By 2040, 58% of Australians with a history of cancer will be aged 70 years or older.

Older people with cancer are a diverse group that may have unique challenges. Newer models of care are emerging to cater for this growing group.

An opportunity for cancer nurses to develop an understanding of these newer models was provided at the Cancer Nurses Society of Australia national congress held in Melbourne in June. The day was sponsored by the Victorian Integrated Cancer Services and provided a consumer and multidisciplinary approach to the program.

Over 40 nurses from all states and territories and New Zealand participated. Presentations displayed expert and practical examples from metropolitan and regional areas of Victoria.

GICS has been a long time sponsor of the conference. Our display table featured the new ‘WeCan’ supportive care resources, the GICS Cancer Survivor podcast postcard and Optimal Care Pathway information.

PALLIATIVE CARE CONFERENCE - RACV GOLDFIELDS RESORT (CRESWICK) MAY 2019

‘Eat, Pray, Love’ was the theme for the Grampians Regional Palliative Care Team conference held in May. The conference was aimed for health professionals wishing to expand their knowledge of Palliative Care.

The speakers were handpicked to educate, but to also start minds wondering about all the good things in life that keep us alive, while working with people who are dying.

The program commenced with Kylie Joyce’s touching account of their family’s experience of the death of her husband. Some novel presentations were on fabulous food in palliative care, genetic counselling and laughter. A panel discussion on Voluntary Assisted Dying completed the program. Innovated inclusions were the use of the throwable ‘Catchbox’ microphone and the Sli.do Q&A app to enhance audience participation.

Clinical Nurse Educator – Oncology 2019 Education Overview (July 2018, to June 2019)

Abbreviations: (IS) - In-service, (SC ) – Short Course, (SD) Study Day, (TW) - Twilight, (WK) –WorkshopCourse abbreviations: ADAC – Antineoplastic Drug Administration Course; CVADs – Central Venous Access Devices; PPE – Personal Protective Equipment

EWHS –Charlton Campus No. AttendCVADs / Syringe divers & general cancer update

1 12

Total 1 12

MDHS (Maryborough) No. Attend

ADAC 1 4

Total 1 4

BHS Other

Participants (n=) 844 656 77.7% 188 22.3%

Events (n=) 116 99 85.4% 17 14.6%

WHCG (Horsham) No. AttendADAC refresher 1 10CVAD SD 1 25

Introduction to cancer (SD) 2 38Total 4 73

LBBNC No. Attend

Chemotherapy in the home 2 12

Total 2 12

DjHS (Melton & Bacchus Marsh No. Attend

CVAD (WS) 2 17

PIVC 1 11

Total 3 28

SRH – Stawell No. Attend

CVAD (SD) 1 14

Post Grad cert (SD) 2 2

Total 3 16

EGHS - Ararat

Family violence (IS) 3 43

Total 3 43

BHS & Ballarat Services No. AttendADAC modules 2 10ADAC skills (WS) 2 11Basic life support (assessments) 2 11Blood cancers (IS) 1 8Clinical update – solid tumours 2 18Clinical update – solid tumours BOHS & SJoG

2 8

Common side effects of chemo (IS) 1 8

Common side effects of RT 2 12CVAD (IS) 8 89CVAD (IS) Non-coring needles 9 25CVAD (SD) Grads 2 60CVAD (WK) 10 60CVAD assessments @ BRICC 17 17Extravasation (IS) 1 5Family violence (IS) 2 22

Febrile neutropenia (IS) 4 57Immunotherapy & targeted therapy (IS)

4 32

Immunotherapy (TW) 1 32Introduction to cancer (SC) (regional staff linked via zoom)

8 44

Oncology & palliative care emergencies (SD)

1 28

Post Grad Cert (SD) 2 2

PPE & management of cytotoxic waste 1 11Sepsis & clinical response in residential services

1 7

Supportive Care Communication Skills (WK)

1 4

Syringe driver (IS) 13 86Total 99 656


QUALITY STANDARDS FOR CANCER MDMS

The VICS jointly funded the development of a quality standards for Cancer MDMs, following a review which identified significant variation across the State in the operation of MDMs.

The Quality framework contains an agreed set of standards, indicators and measures for all cancer MDMs in Victoria as well as a set of tools for monitoring their quality.

The framework can be found here: http://gics.com.au/files/179/Victorian_Cancer_MDM_Quality_Framework_

Sept_2018.pdf

A NETWORKED CANCER SYSTEM

TUMOUR SUMMITS

The state-wide Tumour Summits Program is being undertaken by the Victorian Integrated Cancer Services in conjunction with the Department of Health and Human Services and Cancer Council Victoria, to facilitate clinician led discussions around pathways of care.

The summits are clinician led forums held to identify and discuss unwarranted variation in clinical practice and cancer outcomes that could potentially be addressed via state-wide action. Last year tumour summits for Head and Neck and Lung Cancer were run, with CNS and Melanoma planned for 2020.

Recommendations from the two Summits are being discussed locally with clinicians. To date, a “deep dive” audit is being undertaken in Head and Neck Cancer, and a business case for the introduction of Endo Bronchial Ultrasound (EBUS) procedure to Ballarat has been submitted.

STATE-WIDE INITIATIVES

The Victorian Integrated Cancer Services and DHHS collaborate on a range of initiatives when state-wide benefit and application is identified.

SURVEYING THE UNMET NEEDS OF MEN WITH PROSTATE CANCER

Victorian Integrated Cancer Services have collaborated with the Prostate Cancer Outcomes Registry (PCOR) to develop and deploy a Survivorship Needs Survey to men with prostate cancer receiving treatment in Victorian public hospitals.

Reports will be available to clinicians and health services in late 2019.

DISADVANTAGED POPULATIONS: A REVIEW OF THE LITERATURE

Disadvantaged populations experience poorer cancer outcomes. A scoping report was commissioned via NEMICS to identify initiatives and programs that are effective in improving outcomes for specific populations. This scoping report will be used to inform future projects and can be found at: http://gics.com.au/files/181/Addressing_variation_in_disadvantaged_groups.pdf


PIPELINE WORK

Victorian Integrated Cancer Services have agreed to support and fund the following projects to be delivered over the next few years:

• Datathon

The VICS have funded an inaugural CancerTHON - to be held in Bendigo in 2020. The event will allow teams of clinicians, researchers and data scientists to interrogate a very wide range of DHHS held data about cancer patients. Once the date has been set, an expressions of interest process will be initiated to identify the teams and team questions for the event.

• Cancer and older people

Treatment of cancer in older adults is more complex than younger persons because of comorbidities, competing risks of death, potentially altered treatment tolerance, and variable patient preferences (Singh & Lichtman, 2015).

The VICS are undertaking a scoping exercise to develop a comprehensive understanding of geriatric oncology guidelines, the services available to elderly patients, and the various screening and assessment tools available for use. This will inform the development of a proposal for state-wide project funding.

• Palliative care

VICS will work in collaboration with the Victorian palliative care sector to undertake a scoping exercise to progress the following aims:

- Based on need rather than prognosis (in accordance with the OCP recommendations), all patients with metastatic or progressing cancer receive a timely and appropriate referral to palliative care.

- That all patients with a cancer diagnosis are routinely encouraged to develop an advance care plan in accordance with the OCP recommendations.

• Tailored information for cancer patients

The aim of the project is to make information about a cancer diagnosis that is specific for an individual consumer easy to understand. The tool will be designed to complement existing resources provided to consumers at the time of their first appointment. They are not intended to replicate existing resources. This is a co-design project of individualised consumer information tools for use at the time of a cancer diagnosis for pancreatic cancer, head and neck cancers and a tool for Aboriginal and Torres Strait Islander people with cancer.

VICTORIAN INTEGRATED CANCER SERVICES CONFERENCEThe Victorian Integrated Cancer Services (VICS) Conference is a biennial forum which provides an opportunity to showcase the work undertaken by the Integrated Cancer Services to a broader audience and highlight work being undertaken across all areas of cancer reform.

The fourth VICS Conference was held in Melbourne 9 & 10th May 2019 and attracted 269 delegates. GICS was nominated as the lead organisation for the conference and the Strategic Director Chaired the Organising Committee.

Feedback from delegates indicates that the conference was a resounding success.

More than 60% rated the program quality and relevance as very good or excellent.

86% said the Conference improved their cancer knowledge regarding innovation and care delivery.

100% said the Conference provided good networking opportunities.

94% said they would probably or definitely attend the next conference.

60%

86%

100%

94%


GOVERNANCE

GICS OPERATIONAL TEAM

The GICS Advisory Network provides timely advice and input in relation to cancer system reform.

This network comprises the:

• Consumer Advisory Group (advising on the design and implementation of engagement activities, and leading the delivery of consumer driven projects)

• Lead Clinicians Group (providing specialist advice and input on clinical matters, and supporting effective MDM),

• Grampians Cancer Clinical Network (provides advice and input on nursing and allied health matters, and supportive care).

ORGANISATIONAL STRUCTURE


Revenue and Expenditure (July 1 2018 to June 30 2019)

INCOME

Integrated Cancer Services $1,259,808 DHHS grant other $650

Income Other $221,360

Income total $1,481,818

EXPENDITURE

Salaries & wages (inc oncosts) $1,004,839

Project funds 240,725

General expenses $254,233

Expenditure total $1,499,797

Current surplus/(deficit) -$17,979

Accumulated surplus/(deficit) $199,026

Total equity $181,047

Expenditure Percentage Break Down

● Salaries and wages 67%

● Project funds 16%

● General expenses 17%

FINANCIAL SUMMARYGOVERNANCE GROUP 2018-19 MEMBERSMr Alex Demidov (Chair) St John of God Ballarat Hospital

Ms Libby Fifis (Dep Chair) Stawell Regional Health

Mr Ben Kelly Ballarat Health Services

Prof George Kannourakis Ballarat Oncology & Haematology Services

Ms Carmel O’Kane Wimmera Cancer Centre

Mr Andrew Freeman East Grampians Health Service

Dr Simone Reeves Ballarat Austin Radiation Oncology Centre

Mr Ian Kemp GICS Consumer Advisory Group

Mr Phil Catterson Hepburn Health Service

Ms Anne Scott GICS Consumer Advisory Group

Dr Swe Htet Ballarat Cancer Care

Dr Diane Sartori Western Victoria Primary Health Network

Mr Steve Medwell Ballarat Regional Integrated Cancer Centre

Dr Stephen Brown Ballarat Regional Integrated Cancer Centre

Ms Judy Perkins Dept of Health and Human Services Regional Office

Dr Jonathan Tomaszewski Ballarat Austin Radiation Oncology Centre

Mr Dale Fraser Ballarat Health Services

ANNUAL REPORT2018-19Level 2, BRICC Building

Ballarat Health Services

P: (03) 5320 4782 www.gics.com.auwww.gics.com.au

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