New optimal care pathways released for melanoma and keratinocyte cancer

Skin cancers

By Michael Woodhead

27 Jul 2021

Updated optimal care pathways have been released that define national best practice for people with melanoma and keratinocyte cancers.

The second edition of the care pathways, endorsed by Cancer Australia and the Cancer Council cover melanoma, basal cell carcinoma or squamous cell carcinoma)

The pathways outline nationally agreed 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 skin cancer care, including physicians, surgeons and GPs.

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.

If melanoma is suspected, the OCP recommends that a biopsy or excision should be done within 2 weeks of the initial GP consult, and results provided to the patient within 1 week of the biopsy. Where appropriate, referral to a specialist should occur within 2 weeks, though there will be some patients where management in primary care is appropriate

For BCC and SCC, investigations and/or curative treatment should be performed within 4 weeks of initial presentation to a GP or as soon as practicable. If a diagnosis is required, referral to specialist should be as soon as practicable according to clinical concern (e.g. 4 weeks for a presumed SCC and 8 weeks for a presumed BCC).

The timeframes state that staging investigations for melanoma should be completed within 2 weeks of the specialist’s assessment. Surgery in a primary care setting should occur within 2 weeks of the decision that it is necessary. If not urgent, radiation therapy should begin within 4 weeks of the multidisciplinary meeting.

For keratinocyte cancer surgery, the pathway states that patients will usually be having active treatment within a 3 month period. They advise that adjuvant radiation therapy should start as soon as possible once surgical wounds have healed, usually within 4–6 weeks of surgery.

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 Thomas writes.

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

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