New optimal care pathways launched for 12 cancer types

Cancer care

By Michael Woodhead

21 Jul 2021

Updated optimal care pathways have been released that define and steer national best practice for 12 cancer types.

The second edition of the care pathways, endorsed by Cancer Australia and the Cancer Council cover the common cancers such as melanoma, breast, colorectal, prostate and lung cancers, as well as ovarian, pancreatic, endometrial, glioma and head and neck cancers.

There are also OCPs for three haematological cancers such as acute myeloid leukaemia

The pathways outline nationally agreed best practice for the best level of care in areas such as prevention and early detection, initial investigations and referral, as well as diagnosis, staging and treatment planning. They also cover care after initial treatment, prevention and management of recurrence and metastatic disease, and end-of-life care.

According to the developers, the pathways “describe the standard of care that should be available to all cancer patients treated in Australia. The pathways support patients and carers, health systems, health professionals and services, and encourage consistent optimal treatment and supportive care at each stage of a patient’s journey.”

In his introduction to the second editions of the pathways, Professor Robert Thomas, Chair of the Project Steering Committee, says they should be read and understood by all those involved in cancer care.

“This includes all health professionals, from surgeons, oncologists, haematologists, radiologists, general practitioners and other doctors to allied health professionals, nurses and managers of cancer services. Trainees in all disciplines should absorb the messages contained in the optimal care pathways.”

Guidance is provided in relation to seven key principles of patient-centred care; safe and quality care; multidisciplinary care; supportive care; care coordination; communication; and research and clinical trials.

Each pathway comes with a summary section that outlines key actions for best practice, with a checklist and recommended timeframe.

With breast cancer, for example, the pathway states that diagnostic investigations should be completed within two weeks of the initial specialist consultation.

The timeframes recommend that:

  • Surgery should ideally occur within 5 weeks of the decision to treat (for invasive breast cancer) or 4–6 weeks after neoadjuvant systemic treatments are complete.
  • Neoadjuvant chemotherapy should begin within 4 weeks of the decision to treat.
  • Adjuvant chemotherapy should begin within 6 weeks of surgery.
  • Adjuvant chemotherapy for triple-negative breast and HER2-positive breast cancer should begin within 4 weeks of surgery.
  • Endocrine therapy should begin as soon as appropriate after chemotherapy, radiation therapy and/or surgery is complete.
  • Radiation therapy should begin 3–4 weeks after chemotherapy, or within 8 weeks of surgery, for patients who do not have adjuvant chemotherapy.

However the authors say that while the pathways are government endorsed and intended to improve the quality of care, they are not prescriptive.

“It’s important to note that the optimal care pathways are cancer pathways, not clinical practice guidelines. The decision about ‘what’ treatment is given is a professional responsibility and will usually be based on current evidence, clinical practice guidelines and the patients’ preferences,” Professor Robert Thomas writes.

The pathways are accompanied by quick reference guides aimed at consumers.

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