Advanced breast cancer project Eastern Health

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Advanced breast cancer projectEastern Health

• Dr Jacquie Chirgwin
• Ms Jane Stephens
• Ms Spiri Galetakis

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Overview of presentation

• Background -Dr. Jacquie Chirgwin
• Project proposal -Dr. Jacquie Chirgwin
• Models and Pathways -Dr. Jacquie Chirgwin
• Progress of Project -Jane Stephens
• Recent Developments -Jane Stephens
• Future Directions -Jane Stephens

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Background to ABC Project

• Management of Advanced Breast Cancer
• wide range of medical issues
• many and varied non-medical issues
• diverse groups of clinicians involved
• many unmet needs

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Background to ABC Project

• NBCC Clinical Practice Guidelines
• improve length and QOL
• minimise physical and psychosocial impact
• ensure coordination and continuity of care
• provide a team approach
• provide a designated responsible clinician

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Background to ABC Project

• NBCC Clinical Practice Guidelines
• optimise information provision
• provide access to services and aids
• allow good communication between health
  professionals
• provide care to the whole family

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Background to ABC Project

• Victorian Performance Indicator Project
• Lack of identification of patients in system
• Lack of coordinated, evidence-based care pathway
• Lack of/poor documentation

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Background to ABC Project

• The Early Breast Cancer Model
• MD Team and meetings
• BCN role
• Well established pathways/processes
• Focus on Psychosocial support
• Medical Guidelines (eg. St.Gallen, NIH)

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Background to ABC Project

• Gaps in the ABC Service model
• no multidisciplinary approach
• limited BCN involvement
• no central contact point / coordinator
• poor continuity of care
• variable psychosocial support
• no established mechanisms for GP involvement
• lack of targeted information resources

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EBC
ABC

• Objective outcomes
• CURE
• Survival figures
• major treatment related complications (mortality,
  morbidity)
• Subjective outcomes
• QOL
• service and information provision
• the human factor
• kindness/compassion/availability/dependability/con
  tinuity

• Subjective outcomes
• QOL
• service and information provision
• the human factor
• kindness/compassion/availability/dependability/con
  tinuity
• Objective outcomes
• median survival
• major treatment related complications (mortality,
  morbidity)

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Eastern Health ABC Project

• Breast Services Enhancement Program
• Collaboration with Dr. Claire Phillips (Peter
  MacCallum)
• Funding from BreastCare Victoria for ABC Project
  (Eastern Health)
• multidisciplinary care
• GP involvement

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ABC Project Proposal

• To develop MD team for management of ABC to
  include
• MD team meeting
• Terms of reference for MDT and MDM
• Define and develop a liaison role
• Advanced Breast Care Nurse

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ABC Project Proposal

• Bridging the community/hospital gap
• how to involve the GP
• how to increase access to community providers (eg
  practical supportive care)
• Information provision
• To develop a model to describe the ABC pathway

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ADVANCED BREAST CANCER PATHWAY
CEASE ACTIVE TREATMENT
END OF LIFE / TERMINAL CARE
PROGRESSION OF DISEASE
DIAGNOSIS OF METASTATIC DISEASE
TREATMENT
Very variable time frame
Few days to many months
RESPONSE TO TREATMENT
FOLLOW UP
Greatly variable timeframe
Little time to several years
Supportive and Palliative Care needs
Information needs
Coordination / continuity of care
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Specific needs along continuum
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2 Jura Crt Park Orchards
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Eastern Health ABC Project

• Stakeholder and consumer interviews undertaken by
  BSEP
• confirmed and clarified consumer needs and gaps
  in the service
• Multi-disciplinary working party established
• Models developed that aimed to represent
• the disease pathway over time and patients
  varying needs
• patients interaction with the system

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Working party aims for 2003

• Establish a regular multi-disciplinary meeting
  dedicated to discussing advanced breast cancer
  cases
• Create a sustainable liaison position to allow
  a single point of contact for advanced breast
  cancer patients and to facilitate communication
  within the system and with the community

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Multi-disciplinary meeting objectives

• facilitate a coordinated MD approach to care for
  women with ABC
• monitor standard of care improve communication
• clarify psycho-social issues / needs and
  facilitate referrals
• educate and inform clinicians attending meetings
• involve GPs in MD meetings

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Multi-disciplinary meetings

• Commenced March 2003
• Fortnightly meetings
• Held at Box Hill Hospital
• Involving clinicians from Box Hill Hospital,
  Maroondah Hospital and Peter MacCallum Cancer
  Institute (BH)
• Supported by Inner and Eastern Melbourne BSEP
  project staff

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Multi-disciplinary meetings

• 12 meetings held since March 2003
• 35 cases discussed in total
• 5 patients discussed on 2 occasions
• 14 patients were newly diagnosed with ABC
• 21 patients with progression of disease

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Multi-disciplinary meetings

• Core team identified
• Medical Oncology Consultant
• Medical Oncology Registrar
• Radiation Oncology Consultant
• Radiation Oncology Registrar
• Oncology Nurses
• Palliative Care Liaison Nurse
• Social workers
• Research Nurse
• Attended on a regular basis

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Multi-disciplinary meetings

• Extended team
• Breast Care Nurse
• GPs
• Physiotherapist
• Palliative Care Physician
• Palliative Care Nurses (EPC)
• Psychologist
• Attended less regularly or on a case by case basis

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Presenting issues

• pain 10 cases
• medical management 9
• social support 6
• depression / anxiety 6
• family support 6
• palliative care 4
• physical dysfunction 4
• dyspnoea 4
• nausea vomiting 3
• cognitive deterioration 2

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Referrals arising from case discussions

• Palliative Care 9
• Radiotherapy 4
• Social work 3
• Physiotherapy 3
• Rehabilitation 3
• Systemic therapy 2
• Psychology 2
• OT 2

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Recent survey of MDT members

• What do clinicians gain from the meetings?
• Identification and referral of patients
• insight into support services available
• kept in the loop
• improved continuity of care
• clarity around psycho-social issues
• more work!

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Recent developments

• Planned collaboration with new palliative care
  partnership in Eastern Health
• Clinical nurse consultant position
• shared role palliative care and advanced breast
  cancer
• coordinate multi-disciplinary meetings
• limited liaison position to facilitate
  communication within the system and within the
  community

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Future Directions

• GP involvement in ABC pathway
• Bridging the gap between hospital and community
  providers
• Information provision
• Increasing value of MD meetings
• Enhancing communication

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Acknowledgments

• Dr Claire Phillips
• Christine Scott
• Dr Josie Samers
• Dr Roslyn Drummond
• Greg Deacon
• Shaun ONeill
• Simone Carroll
• Hamlata Bhana
• Carolyn Dalton
• Carmela Corfield

• Wendy Sansom
• Jacinta Mac Cormack
• Dr David Rogers
• Dr Elizabeth Banks
• Dr David Kenner
• Dr Peter Martin
• Dr Adam Broad
• Dr Leigh-Anne Hughes
• Ruth Anderson Smith
• Teri van Geelen

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NEVER EVER GIVE UP