Cancer control - Cancer Control Work Programme

Cancer Control in New Zealand
Cancer Control Work Programme

The Ministry of Health and District Health Boards (DHBs) are working to implement actions identified by the New Zealand Cancer Control Strategy Action Plan 2005-10 (the Action Plan) through a cancer control work programme.

This programme will help implement the Action Plan through a number of interrelated projects that align with the six goals of the Action Plan. Priorities for the programme are influenced by the phasing in the Action Plan.

Reducing inequalities with respect to cancer is one of the two overarching purposes of the Action Plan, and is a focus in all the projects.

More information on the Cancer Control Work Programme is provided below:

Stakeholders

Stakeholders involved in the cancer control work programme include:

the Ministry of Health and DHBs, which are jointly managing the programme via a Steering Group
the New Zealand Cancer Treatment Working Party (NZCTWP) and its workgroups. The workgroups represent the professional cancer control community, and are contributing to the design and execution of many of the projects in the programme.
NGOs, Maori, and consumer groups, who will be involved or consulted as an important aspect of all of the projects
the Principal Advisor Cancer Control, who is leading the programme, working closely with all stakeholders, and linking with the Cancer Control Council as an ex-officio member
the Cancer Control Council, which will review progress in the Action Plan, provide independent advice on cancer control, and report to the Minister about progress towards achieving the goals of the Cancer Control Strategy
the developing regional cancer control networks, which will increasingly become key partners in the implementation of the Action Plan.

Improving the Journey for Maori and Pacific Cancer Patients, their Families, and Whanau Hui

On 17 April 2007, the Ministry hosted a hui in Auckland, focused on improving the journey for Maori and Pacific cancer patients, their families, and their whanau.

The hui was held in response to the considerable discussion of inequalities in cancer patient experiences at the November 2006 Cancer Symposium, Sharing the Learning.

The hui included discussion of the following:

Recent research into cancer inequalities
Maori and Pacific cancer patient experiences
The Ministry of Health’s policy response to inequalities with respect to cancer
Challenges and successes in reducing inequalities in cancer screening
Current strategies and initiatives in the health sector to address inequalities – including Regional Cancer Networks and DHB led initiatives

More information on the Cancer hui, including the programme and the speakers' presentations

Projects

The Ministry of Health has existing programmes relating to the primary prevention of cancer and cancer screening, which will contribute to the goals of the Action Plan. Therefore, the cancer control work programme largely focuses on actions relating to: diagnosis and treatment; palliative care; support and rehabilitation; and data and research.

In 2006 work commenced on a dozen projects approved by the Steering group. A number of these projects will be further developed in 2007 to address the remaining phase one priorities from the Action Plan.

The nationally-led projects in the programme are:

In 2006 the Ministry funded 23 local projects to advance goals Three to Five of the Action Plan. These, included projects to review the “journey” experienced by cancer patients, and identify gaps in access to important services, particularly for Maori, Pacific, and rural cancer patients. Many of these projects are being developed further.

View summaries of the 23 projects.

Cancer Control Targets and Indicators for 2007

Ten national health targets have been set in 2007/08 for DHBs and the Ministry. Aligned with the Minister’s strategic priorities, these targets will act as indicators of performance and the effectiveness of services.

The national health target for cancer control is:

Reducing cancer waiting times - All patients wait less than 8 weeks between first specialist assessment and the start of radiation oncology treatment (excluding category D).

Two other national health targets relate to cancer control (and also to other priority health areas such as diabetes and cardiovascular disease):

Reduce the harm caused by tobacco
Improve nutrition, Increase physical activity, Reduce obesity.

The Ministry cancer control implementation team will be working with the DHBs to achieve the national cancer health target. This will include accurate reporting against the target, sharing of best practice in demand management, coordination of capacity planning, and contingency planning. .

The Steering group has indicated the need to establish a series of targets and indicators for the cancer control programme, derived from the goals of the Action Plan. The implementation team will develop these indicators, targets and monitoring against them, as part of this year’s programme.

View more information on the Reducing Cancer Waiting Times Health Target.

Guidance to improve cancer care

The Action Plan proposes at least 14 actions related to the development of clinical standards, guidelines and protocols. Three actions emphasise the need for specific standards and guidelines to address access for Māori.

The project for the first year focuses on:

producing updated breast cancer and melanoma guidelines
developing national guidance on access and referral to cancer services
establishing a web site enabling national sharing of existing local cancer guidelines and protocols.

Work is in progress on these initiatives.

Improving care provided to adolescents with cancer

Although a relatively small group, adolescents with cancer have special needs that can be readily addressed. Key objectives of the Action Plan include improving care provided to adolescents through an adolescent cancer service, and a late assessment effects programme (LEAP) for survivors of childhood and adolescent cancer.

The adolescent sub-group of the NZCTWP has drafted a new service specification which will provide the basis for a national specialized adolescent cancer service. The draft will now undergo a formal review process.

LEAP is now being implemented in three lead DHBs, which are employing clinical nurse specialists to coordinate the long-term assessment of the medical, psychological and educational needs of all young people who have completed cancer treatment.

Improving colorectal cancer outcomes

Colorectal cancer is one of the most significant cancers in New Zealand. A report to the Ministry from the Colorectal Cancer Screening Advisory Group advised that development of the colorectal surveillance and treatment workforce is a fundamental step towards improving colorectal cancer outcomes.

A recent report to the Minister has also recommended a colorectal cancer screening feasibility study.

A plan for a programme of work that covers both workforce development and the feasibility study will commence in 2007. It will be overseen by a national colorectal cancer working group.

Regional cancer control networks development

Because of the complexity of cancer service provision, a lack of coordination of services can negatively affect experiences and outcomes for people with cancer. The Action Plan outlines a number of actions to address fragmentation of cancer services, including studies of patient care pathways, strengthening of multidisciplinary teams and development of regional cancer networks.

Regional cancer networks will provide a formal structure to improve coordination of care for patient groups across geographic areas, and integration of care between primary, secondary and tertiary care providers. Networks will provide collaborative links within and across DHBs which will help improve equity of access, reduce gaps and duplication, and allow co-ordination of service planning and delivery. Four regional cancer networks are now being established across the country.

The Ministry of Health is supporting the development of regional cancer networks by sponsoring a series of national meetings to discuss issues around network development. To date there has been an initial national seminar on 30 March 2006, a two day symposium in November 2006 for DHBs to share their knowledge gained from the different projects, and a national hui on April 17 to share Maori and Pacific perspectives on cancer control. The Principal Advisor is working with each of the regional teams to help them to create the structures and processes appropriate to their specific circumstances.

Improving palliative care

A key priority of the Action Plan is improving access to palliative care by developing integrated comprehensive palliative care services for cancer patients throughout the country.

The palliative care working group of the NZCTWP has developed a project plan, which
is focused on:

producing a common definition of palliative care for all stakeholders
producing new service specifications for specialist palliative care
improving specialty education for palliative care and cancer nurses
developing a national approach to palliative care medical training
Addressing community palliative medicine supply limitations.

Based on agreed definitions of generalist and specialist palliative care, developed through wide consultation with the palliative care community. a draft specialist service specification will be completed in 2007. This will provide a framework for comprehensive integrated palliative care services throughout the country. Work on medical and nursing education in palliative care will complement the service specification.

Developing the Cancer Workforce

The Action Plan proposes the production of a national cancer workforce stocktake to inform cancer workforce planning.

A stocktake and needs assessment of the cancer control workforce is in working draft format, and the Ministry of Health is seeking further input from expert contacts in the cancer control sector. This input is expected by April 2007, after which it is intended that a draft document will be available for wider circulation. This document will provide a basis for future workforce planning in cancer control. It will include recommendations for further detailed investigation, and some possible workforce development actions.

Several workforce initiatives are already in progress. These include:

improving specialty education for palliative care and cancer nurses
developing a national approach to palliative care medical training
developing the colorectal cancer surveillance and treatment workforce .

Information and support for people experiencing cancer

The Action Plan makes a number of recommendations in relation to support for people with cancer, as well as their families and whānau, and caregivers. These recommendations cover the following broad areas for action:

Promoting leadership in supportive care
Policy development for supportive care
Improving access to supportive care services
Ensuring information about cancer and the cancer journey is accessible, appropriate, and of high quality

The Ministry is currently undertaking a number of projects to achieve these objectives:

An Expert Advisory Group has been established to develop national level guidance on supportive care
The Ministry is funding a number of pilot community cancer support services. One will address the gap in kaupapa Maori support services, while the other will address issues faced by cancer patients and their families living in rural areas.
A national hui to discuss ways of improving the cancer journey for Maori and Pacific cancer patients and their families and whanau.

Coordinating Development of Cancer Data Management

The Action Plan makes a number of recommendations towards improving the use, efficiency and scope of cancer-related data collection and reporting. Several streams of cancer data work are currently being undertaken in the Ministry, including:

the business case for a national cancer management database
upgrading current cancer statistical collections at the New Zealand Health Information Service
updating statistics collection methodology in the National Screening Unit
a commissioned overview of current cancer information capacity and needs.

A commissioned overview, the Cancer Collections Framework Final Report, has been published to guide the national approach to cancer data collection. This links the other three workstreams, which are in progress.

Cancer Capacity and Capability

The Action Plan makes a number of recommendations about national planning for cancer treatment services. This project will provide the basis for such planning, by modeling the required sector capacity to meet current and future demand for cancer services and implement the Action Plan.
The project will:

Clarify the relationship between changes in cancer incidence, volumes and complexity of cancer treatment, and health care costs
Identify any historical inequalities in treatment by geography or ethnicity
Model scenarios of capacity / cost growth over the next five years based on assumptions of maintaining or improving current intervention rates
Identify the cost impacts of known likely changes in treatment interventions over the next five years, e.g. new cancer drugs.

Phase I of this project involves a high-level report, which is expected to be delivered by October 2007. Stakeholders will then determine the directions for more detailed analysis in Phase II.

Page last updated: 14 May 2007