Ovarian Cancer Control A Strategy for the Management of Ovarian Cancer in New Zealand.

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Ovarian Cancer ControlA Strategy for the
Management of Ovarian Cancer in New Zealand.

• Peter Sykes
• RANZCOG
• 2007

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Why do we need a strategy?

• Need to minimise the impact of this disease.
• National Cancer Control innitiative.
• Development of gynae oncology services in NZ.

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Age distribution
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300 New Zealand women get and 175 die of ovarian
cancer per year
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Goal 1 Prevention

• Incessant ovulation
• Diet and obesity
• Vitamin D
• genetics

• Healthy living
• Breast feeding
• Contraception practice?
• Identification familial risk
• Genetic counselling
• Prophylactic surgery
• Support research

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Goal 2 Early detection

• Currently no screening
• Opportunities for earlier detection

• Ovarian cancer awareness
• Primary care education
• Availability of ultrasound.
• Support research

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Goal 3 and 4 treatment and supportive care

• Survival
• Stage
• Age
• Debulking surgery
• Chemotherapy
• Second line treatment
• Other treatments

• Quality of life
• Disease control
• Control of symptoms
• Treatment related effects
• Psychological
• empowerment
• Social and emotional support
• Financial issues
• Access to care
• Quality of care

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Challenges of ovarian cancer care

• Debulking surgery
• perioperative care
• rehabilitiation
• coordinated multidisciplinary care
• Chemotherapy
• coordination with other health professionals
• follow up
• second line treatment
• palliative care
• identification and management of familial cancer

• Inform patient
• Inform care givers
• Easy access to care
• Provide emotional support
• Ensure social support
• Timely provision of services
• Initial assessment/ radiology
• Pathologic diagnosis
• Curative surgery
• Staging surgery

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people

• patient load
• trained surgical staff
• trained nursing staff
• experienced pathologist/s
• experienced radiologist/s
• experienced oncologists
• counselling/ dietician/ OT/ physio/ Pastoral
  care/social work

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Facility

• Outpatient service
• dedicated inpatient beds
• Radiology, nuclear medicine / CT/MRI/PET
• Perioperative facilities HDU/ICU
• Access to adequate elective and acute operating
  time
• administration

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Goal 5 improve provision of services /organisation

• Regional services
• Sustainable infrastructure
• Appropriate funding
• Transport /family support
• national guideline development and maintenance.
• system of surveillance
• financial accountability

• Working relationship with referring clinicians
• community health services
• palliative care services
• NGO
• genetic services
• education (univ ranzcog)

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Goal 6 improve outcomes by research and
surveillance

• Database
• Outcome reporting
• Research infrastructure
• participation in international trials
• international liason

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A Model

• All cases of suspected or established ca ovary
  offered referral
• 3or 4 units at least 2 of all key staff
• satellite units
• early contact community oncology nurse
• equal access free of cost regardless of domicile
• national waiting times and guidelines
• funding transparent and sufficient
• trial participation
• coordinated follow up
• outcome and financial reporting

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What and Who needs to do it

• MOH
• Cancer Control
• DHB
• Gynae units
• Oncology units
• RANZCOG
• trainees
• Cancer society
• Surgical working group
• SISSAL
• NZGCG

• Recognise need for Gyn oncology services
• Establish Gyn Oncology units.
• Appoint and accredit and train staff.
• Establish system of funding.
• Expect and fund outcome reporting.

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My Concerns

• Lack of transparency of funding
• Split of surgical and non surgical oncology
• Lack of incentive for collaboration between dhb
• Inability to attract suitably trained staff
• Lack of unified voice
• Little political interest

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What Next?

• A written strategy?
• RANZCOG?
• Lobby?
• wait to be asked?
• make it work locally?