Welcome to Midland Cancer Network December Update

Manager's update:

Kia ora and welcome to our last newsletter for 2011.

The end of the year provides an opportunity to reflect and celebrate our key achievements in 2011 listed below.

Establishment of Hei Pa Harakeke (Midland Māori Advisory Work Group) and plan.
The publication of the Standards of Service Provision for Lung Cancer Patients in New Zealand, an outcome of the National Lung Cancer Work Group led by Dr Charles de Groot (our clinical director) and supported by Loryn Scanlan. A national stocktake and gap analysis of lung cancer services against the standards has commenced.
Implementation of endobronchial ultrasound (EBUS) for the region based at Waikato Hospital. EBUS can be used for the diagnosis of lung cancer. This is the second service to be established within New Zealand.
Developed patient resource for ‘Diagnosing your lung disease (including lung cancer)’. Other stakeholders in New Zealand and Australia are considering adopting this.
Findings from the Waikato and Tairawhiti DHBs Cancer Collaborative project were presented to the Tairawhiti Board for consideration. This initiative looked at the feasibility of Waikato to be the potential provider of adult cancer treatment services for Tairawhiti. The report is under consideration.
The network has published our first Monitoring and Evaluation Report. This provides a snapshot of indicators along the cancer continuum and provides a dashboard of where each DHB is with progress against cancer continuum targets/indicators.
The development of the Midland Chemotherapy Nursing Certification Framework. This is in its final stage of development.
Upgrade to Aesculapius chemotherapy system for the region to enable regional reporting. Purchase of Aria Activity capture licences to assist with radiotherapy reporting.
Review of audiovisual equipment in the MCN main hospitals radiology meeting rooms that support cancer treatment multidisciplinary meetings. As a result over $120,000 has been devolved to support the upgrade of equipment.
Rotorua Hospital opened their new ambulatory chemotherapy facility.
Midland DHBs have entered into a partnership agreement with Midland PET-CT that has resulted in improved access for people within Midland and improved systems and processes for clinicians.
Waikato web based palliative care directory is live and now being developed for Lakes and Bay of Plenty.

I hope you find our news and updates helpful on keeping you up to date with cancer control sector news.

I would like to thank you for your contribution and ongoing support over the year and wish you and your family/whānau a very Merry Christmas and fun and safe holiday season.
The team is taking a break and the office will be closed from 23rd December. We are back on Monday 9th January 2012.

I look forward to working up with you and continuing cancer control progress in 2012.

Jan Smith

Network Manager

Please use the hyperlinks immediately below to quickly access specific topics of interest to you:

Upcoming Events

Regional Updates

National Updates

Upcoming/events for 2012

Midland Cancer Network Executive Meeting, 21 February
Hei Pa Harakeke (Midland Māori Cancer Advisory Group), early February - date tbc
Lung Cancer Advanced Course 15 March
4th National Lung Cancer Conference 16 March
Midland Care Co-ordination meeting 22 March

Latest released documents

Bone Marrow Transplant Services in New Zealand for Adults - Service Improvement Plan
The Implementation Plan for the Guidance for Improving Supportive Care for Adults with Cancer in New Zealand

All the above documents are available on the Midland Cancer Network website New Publication page.

Regional updates

Māori Health Service Providers Palliative Care Hui

On Wednesday 16 November a group of representatives from the Bay of Plenty District Health Board, Waipuna Hospice, Māori Health poviders, Midland Cancer Network and other cancer support services participated in an education day. The kaupapa for the day was to improve people’s understanding of palliative care and knowledge of the current services.

Participants found the day very informative especially the opportunity to meet with those who provide palliative care services in the community, what the palliative care services offer, as well as discussion from Māori on their views pertaining to Tikanga (customs) in relation to death and dying.

Future priorities were identified such as increasing Māori participation on Palliative Care work groups, building continued relationships between services, promotion of earlier referrals to services and proposed future education and awareness training sessions within communities.

It is envisaged that hui such as these will continue to ensure patients and whānau accessing services are fully informed and aware of palliative care services, and that the services are developed and delivered in a culturally appropriate way.

Mini Lung Cancer Conference - Karen Middleton and Leonie Brown, Lung Cancer Nurse Specialists, Waikato DHB

On Monday 7 November 2011 we were proud once again to host our 5th annual Waikato Regional Lung Cancer Mini Conference. This year was particularly well attended with around 60 visitors from the Midland region including medical, nursing and community professionals.

We were also very excited to have our first international speaker, Professor Kwun Fong, Thoracic Physician, from Prince Charles Hospital, Brisbane, Australia. A very big thank you to Midland Cancer Network for their sponsorship that enabled this to happen. He gave two impressive presentations, the first on lung cancer screening and early detection and the other on lung cancer translational research, data collection and the use of EBUS (endobronchial ultrasound).

This was a very valuable forum in which health professionals were able to share ideas, update their knowledge and contribute to the improvement of the journey for the patient with lung cancer.

HRC and the Ministry of Health jointly invest in major new cancer research initiative - Prostate Cancer

Funding has been awarded to Professor Ross Lawrenson, based at Waikato Clinical School, for research which will study the pathways of care following an abnormal PSA test for prostate cancer. The research team will investigate the complications of screening for prostate cancer, comparing Māori and non - Māori and estimate the costs of care to individuals and the health service.

"We are thrilled to have been awarded the grant. It has provided a real boost to the Midland Cancer Network, providing a focus for our urological cancer research," says Professer Lawrenson.

"It also has been a wonderful opportunity to involve general practitioners in a study of the cancer pathway and I believe its already demonstrating the value of closer relationships between GPs and specialists."

"It has also allowed us to engage with Māori providers across the region and provided an opportunity for local Māori staff and researchers to take a leadership role and it has been a fantastic opportunity for intersectoral working that we are sure will provide sustainable benefits for the future," he says.

What's blocking the stream? Bladder cancer surgical pathway audit - Tiffany Schwass, Clinical Nurse Specialist, Waikato DHB.

The bladder cancer audit was to ascertain the time taken from diagnosis of invasive bladder cancer to cystectomy as definitive treatment. The aim was to identify any delays and work to eliminate or minimise them if possible.

It has been proven that cystectomy should be done within 12 weeks of diagnosis to maximise benefit for the patient. All patients who waited longer than 12 weeks had an explainable delay such as preoperative chemotherapy. However delays were evident in the patients who waited between 6 and 12 weeks for surgery. The delays were mostly in getting radiological imaging.

I will now track all invasive bladder cancer patients from time of diagnosis to ensure all imaging, investigations and follow - up appointments are done in a timely manner to eliminate these delays and get the patient to cystectomy as fast as possible.

Waipuna Hospice Looks Towards the Future

Waipuna Hospice is changing the services they offer. From 1 September they have adopted an increased Day Services programme. Over the next 6 to 12 months, Waipuna Hospice will be offering more opportunities for patients and families to come into Waipuna Hospice for nurse and doctor led outpatient clinics (including some procedures), access to specialist physiotherapy, day respite, art therapy, young person groups and care giver education.

This change is part of Waipuna Hospice's long-term strategic plan, where Waipuna Hospice is predicted to see large increases in patient numbers in an environment of an ever increasingly pressured dollar. By offering more opportunities for patients who are able to visit the hospice site for their care, Waipuna Hospice can manage the increasing patient numbers in a more cost effective manner while actually increasing service level.

Waipuna Hospice will of course continue to provide "Hospice in the Home" with our community nursing team - this is an extremely vital part of their service, as is the inpatient unit.

Māori Staff Keen to Become Quit Coaches

The Iwi Māori Council and the Kaumātua Kaunihera Tobacco Cessation Plan Tupeka Kore was launched on the 10 and 11 November with the convening of Quit Coach training held at Kingsgate Conference Centre, Hamilton for over 50 Māori staff predominantly from Māori providers across the greater Waikato DHB district.

Ditre Tamatea, General Manager Māori Health at Waikato DHB, said that smoking was the largest contributor to death and illness for Māori, but that this trend is entirely avoidable.

Mr Tamatea acknowledged the sacrifice and courage of the Māori Battalion in World War 2, but said that greater numbers of Māori are lost each year to tobacco-related diseases than died during all of that war.

“I believe tobacco use has moved beyond just a health issue to being a threat to the development of entire generations of Māori whom had something to contribute to their whānau to their community and to their iwi.

“Smoking affects the entire whānau as well as the person who smokes,” he said. “It contributes to the death of adults but also our tamariki and our pepi.”

Mr Tamatea acknowledged that smoking is not an easy issue to address but the investment in a Māori approach and investment in kaupapa Māori services was a significant component to the way forward.

Midland Māori Advisory Group Update

Hei Pa Harakeke (Midland Māori Cancer Advisory Group) met during November to discuss a number of action plans and initiatives. The group has strong Māori representation from Te Tairawhiti, Taranaki, Waikato, BOP, and Lakes with Ditre Tamatea (GM Māori Waikato) the current chair.

It was proposed that a Māori cancer plan be developed with stakeholder input. A three year action programme is to be embedded into the MCN work plan. It is envisaged that Midland cancer services and the Midland Māori Advisory Group will form strong alliances to ensure Māori participation and advice is implemented into any future strategic and regional cancer work plans.

The group meets again in early February 2012.

Midland Cancer Network Supportive Care Directory

A reminder to all stakeholders that this web based directory containing contact details for a range of supportive care services is on the Midland Cancer Network website at http://www.midlandcancernetwork.org.nz/page/pageid/2145862568

Palliative Care Education Calendar

The Palliative care education calendar for nurses and carers for 2012 is now available on the Midland Cancer Network website at http://www.midlandcancernetwork.org.nz/page/pageid/2145868076

Rainbow Place take out the 'Every Child Counts' Award for 2011

The Every Child Counts Awards have been in place for five years and acknowledge the work people and organisations do in support of children and their families in communities throughout New Zealand. Nominees must be recognised in their community or sector for a significant achievement promoting children’s interest

The winner of this years Every Child Counts organisational award is Rainbow Place – the Children & Young Peoples’ service of Hospice Waikato. Hospice Waikato is the only hospice in New Zealand to have a totally separate, designated service for children. Rainbow Place has grown from small beginnings in 2003 to a case load of 300+ in 2011.

The service supports children and young people who have a life limiting or life threatening illness, or who are going through change, loss and grief because of the serious illness and/or death of a loved one. They believe passionately that children are not little adults and that they need very different and specialised support and care. Packages of care include one on one counselling, family therapy and group workshops. The team can provide art therapy, play therapy and sand play therapy to name but a few.

Congradulations to Penny Parsons and the Rainbow Place Team who have won the “Every Child Counts” national Award for 2011. Penny and the Team should be rightly proud of this award as it is awarded to a team who are making a difference to children and youth in New Zealand.

Penny received the award, on behalf of Rainbow Place, in Parliament from the Hon Paula Bennett. Midland Cancer Network would like to personally congratulate the Rainbow Place team for a well deserved award and a great achievement to cap off the year.

For more information on this award please visit http://www.everychildcounts.org.nz/

National updates

The Price of Cancer: The Public Price of Registered Cancer in New Zealand

The price of cancer in New Zealand has been estimated before, but not for all registered cancers and not with the same level of granularity.

This report calculates the annual price of all cancers registered with the New Zealand Cancer Registry in 2008, and then estimates the drivers and likely magnitude of price change 10 years into the future, based on previous cancer incidence projections.

More than $500 million dollars a year is spent by the public health system on diagnosing and treating cancer and this is set to increase more than 20 per cent by 2021.

Identifying each cancer when it is diagnosed and how much it costs to treat, makes it easier to see where future cost pressures are likely and how best to manage them.

To read the full report click here.

Bone Marrow Transplant (BMT) Services in New Zealand for Adults - Service Improvement Plan

This document has been developed by the Ministry of Health and the Haematology Work Group and endorsed by the Cancer Treatment Advisory Group. The Cancer Control Steering Group endorsed the plan with the proviso that if new evidence on clinical indications or eligibility emerged the plan would have to be reviewed.

You can access the plan at http://www.moh.govt.nz/moh.nsf/pagesmh/10829/$File/bmt-services-plan-new-zealand.pdf.

This service improvement plan is the start of a process for ensuring sufficient capacity exists for the delivery of BMT services in New Zealand. It has been developed to assist DHBs to plan for adult BMT services over the next 3-5 years with the immediate focus being on capacity in the Northern region.

Bowel Screening Pilot Resources

Resources have been developed for people taking part in the Government's BowelScreening programme which will run in the Waitemata District Health Board (DHB) area from October 2011.

The four year programme will test whether bowel screening should be introduced throughout New Zealand.

BowelScreening is a free programme to check people for early signs of bowel cancer. It is being offered to all men and women aged 50 to 74 years who live in the Waitemata DHB area and who are eligible for publicly funded healthcare.

To view the resources available please click here.

Advance Care Planning

A guide for the New Zealand health care workforce

Advance Care Planning (ACP) is a concept that internationally was introduced in the late 1980s but has only gained momentum in New Zealand in recent years.

ACP assists in the provision of quality health care and treatment and is becoming increasingly important, particularly with the growing range of medical treatment options available and the enhanced recognition of the importance of patient involvement in medical decisions.

ACP is a process of discussion and shared planning for future health care which assists the individual to identify their personal beliefs and values and incorporate them into plans.

Advance Care Planning: A guide for the New Zealand health care workforce, was prepared as a response to an increasing sector focus on the need for clear and accurate information and guidance regarding ACP in the New Zealand context.

The intended audience encompasses providers, funders and planners in all areas of health care. It is not aimed at the general public. It provides standardised information about ACP principles and legislation in New Zealand and aims to promote consistency in practice.

A resource aimed specifically at consumers (both patients and their families/whanau) has been produced to complement this document. It is available at www.advancecareplanning.org.nz.

Bowel Cancer - An Internal Examination of Colorectal Cancer Management in New Zealand

Cancer Trials New Zealand (CTNZ) secured a contract led by Professor Michael Findlay to conduct the largest and most comprehensive study of patient outcomes from colorectal cancer undertaken in New Zealand.

This study will look at urban/rural disparities as well as socioeconomic and ethnicity factors in the management of colorectal cancer patients following diagnosis across New Zealand. The hypothesis is that rural patients have inferior access to timely and appropriate treatment options and therefore worse outcomes.

The aim of the project is to use Key Performance Indicators (KPIs) of service delivery to identify differences in the management of urban and rural patients, and through formation of a national advisory group develop recommendations for service change that can later be used to assess improvement.

The project is expected to run over 35 months (until August 2014) and cost $1 million. The Midland Cancer Network is supportive of this important research initiative.

Completion of Dr Simon Allan's post with the Ministry of Health

In 2008 the Ministry of Health seconded a palliative care clinical leader for one day a week to provide clinical leadership for the national palliative care work programme. Dr Simon Allan was appointed to this role on a three year secondment. The secondment is now up and the Ministry has decided not to extend the term of this secondment.

There were a number of factors behind this decision. These included:

the availability of clinical advice via the Palliative Care Advisory Group
the availability of advice from groups such as the Palliative Care Council (PCC) and Hospice New Zealand (HNZ) and
the MoH work programme direction for the next year which is heavily focused on planning and developing service frameworks rather than implementation.

The Ministry remains committed to ensuring strong leadership and engagment in the palliative care work programme. The Midland Cancer Network would like to acknowledge Simon's contribution to the sector and personally thank him for the support he has provided to Midland.

PONZ Conference

On 18 and 19 November in Hamilton the 10th National Psycho-Social Oncology (PONZ) Conference was held. The theme of the conference was 'Shaking up Psychology Oncology Practice, Practicalities and Possibilities'.

Midland Cancer Network staff supported this conference as did a wide range of Midland stakeholders who were involved either on the organising committee or as presenters. A big thank you to Graham Harbutt as conference organiser for a very successful conference. The very interesting and informative presentations are on their website.

To view presentations please click here.

Winners of the Writemark Best Plain English Document Award - Cancer Society of New Zealand 'Bowel cancer and bowel function'

The Cancer Society of New Zealand has been awarded the Writemark Best Plain English Document Award for its booklet 'Bowel Cancer and Bowel Function'.

The high prevalence of bowel cancer in New Zealand was the key reason they made the decision to produce this booklet . The subject can be a difficult one for people to discuss.

The aim was to provide people with information that will help them talk about their situation with health professionals. The booklet’s tips and strategies will help people to enjoy activities with new found confidence.

The judges commented on the "outstanding strength of this booklet being the language. The writer spoke to the reader and managed to balance directness with humanity, and simplicity with usefulness".

"The booklet’s structure was logical, the layout appealing and it made good use of diagrams and quotes from people who were prepared to share their own experiences of being treated for bowel cancer".

"Writing this booklet must have been a particularly challenging assignment — dealing with frightening and intimate information. It was the best of several excellent entries from the Cancer Society. Patients and their families would be grateful for the Cancer Society’s communication skills".

Midland Cancer Network would like to acknowledge Judy Warren, Clinical Nurse Specialist Waikato DHB and Maira Stapleton, Clinical Nurse Specialist, MidCentral Health for their huge contribution to this valuable resource.

To view the booklet please visit http://www.cancernz.org.nz/assets/files/info/BowelCancerAndBowelFunction.pdf