Best-practice & improving services Ian Olver CEO Cancer Council Australia
Jun 19, 2015
Best-practice & improving servicesIan Olver CEO Cancer Council Australia
Cancer Statistics
• Estimated incidence (2012) is 120,700 "
• Prostate, Bowel, Breast, melanoma and Lung"
• 56% male"
• Deaths from cancer 42,800 in 2010 (1/3 Aust deaths)"
Age standardised mortality decreased by 17% from 210/100,000 to 174/100,000 in 2010"
5 year survival has increased from 47% in 1982-87 to 66% in 2006-2010"
Prevalence of cancer
What is Personalised Medicine?"
• Personalized medicine is the customization of healthcare, the tailoring of treatment to the individual patient by use of genetic or other information"
• Cancer is based on mutations in genes. There is individual variability in these changes which could mean individual treatments"
May 2001
Glivec"
• It blocks proteins from overexpressed defective genes found in some cancers"
• Effective in chronic myeloid leukaemia"• Effective in GIST Gastrointestinal stromal
tumours which over express c-kit"• Side effects"
• Nausea, muscle pains, fluid retention, diarrhoea, blood count suppression, LFT’s early “storm”"
Pre- and Post-STI571
0 1 2 3 4 5 50
60
70
80
90
100
0 1 2 3 4 5 50
60
70
80
90
100
Disease-Free Survival B-31 N9831
ACTH 864 83 ACT 872 171 ACT 807 90
ACTH 808 51
N Events N Events
HR=0.45, 2P=1x10-9 HR=0.55, 2P=0.0005
ACT ACT
74%
87% 85%
66%
78%
87% 86%
68%
Years From Randomization
%
• Microbeam Radiation Therapy (MRT) uses highly collimated, quasi-parallel arrays of X-ray microbeams of 50-600 keV, produced by 3rd generation synchrotron sources"
• The main features of highly brilliant Synchrotron sources are an extremely high dose rate in fractions of seconds and very small beam divergence "
iKnife
Delays in diagnosis and treatment"
• Most cancer operations are within 30 days"
• Of 12,699 operations for breast, bowel and lung cancers 97% were in 45 days"
• Nationally, 1090 patients waited longer than 30 days and 382 longer than 45 days"
www.myhospitals.gov.au/compare-hospitals"
Disparities"
• ATSI experience higher incidence and mortality"
• Remoteness is associated with a lower incidence and survival"
• Incidence rises and survival falls with socioeconomic status"
Multidisciplinary Interactions
• Received audits of MDCs across 123 hospitals and 5 cancer types breast prostate gynaecological, lung and cervix (520 surveys)"
• 60-70% hospitals had no MDTs in the 5 tumours"• Most did not have the core members of a MDT"• Most were face to face but 10-30% were
telemedicine"• Less that half were 1 or 32 weekly"
77-85% told patients that their case would be discussed by a MDT"
Specialists communicated the results to the patients"
Most meetings did not have links to supportive care (33-78% to palliative care)"
One third did not communicate their findings to GPs"Sporadic collection of data "
Reasons for not implementing an MDT"Lack of time"
Lack of co-ordination time"
Lack of staff resources"
Small case load"
Funding"
Taylor C et al Multidisciplinary team working in cancer: what is the evidence?BMJ 2010; 340 doi: http://dx.doi.org.ezproxy1.library.usyd.edu.au/10.1136/bmj.c951 (Published 23 March 2010) Cite this as: BMJ 2010;340:c951
• In the UK, MDTs are associated with improved 5 year survival in colorectal, oesophageal, lung cancer and improved 2 year survival in head + neck cancer"
• In Sweden, MDT show improved seven year relative survival from breast"
• The relation between specialist surgery and improved survival in breast cancer and oesophageal cancer is now well established"
• Evidence for multidisciplinary teams improving patient experience of care while effect on team members is equivocal"
• The impact of multidisciplinary teams on team members is not well understood. "
http://canceraustralia.gov.au/publications-and-resources/cancer-australia-publications/clinical-practice-guidelines-psychosocial-care-adults-cancer-summary-guide-health-professionals
Integrative Care and CAMs Joske D Creating an Integrative Oncology Centre: the SolarisCare Experience in Olver I, Robotin M Perspectives on Complementary and Alternative Medicines"
• There are centres such as the Solaris Centre at Sir Charles Gairdner Hospital "
• CAMs are medicines that don’t have the same evidence base as traditional medicines"
• The issues in integrating care:"– Select treatments"– Select therapists"– Train volunteers "– Research and measuring efficacy"– Minimise medica-legal risk"