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Remedying the pressure on cancer treatment
May 03, 2013
Future cancer care demand is leading to a rethink of chemotherapy services across New Zealand.
The demand for cancer treatment is expected to double over the next 15 years, creating a challenge as the need for care is rising faster than the number of new oncologists, nurse specialists and other clinical staff.
Dr Claudia Wyss and members of the Cranleigh health team, Pieter Rodenburg and Ena Wong, were asked by the Ministry of Health to develop a new model to improve the country’s chemotherapy services to cope with the increasing demand.
In this article Dr Wyss looks at ways these challenges can be overcome.
Research shows cancer survival rates have reached an all-time high. While there are more survivors, it often means patients need repeated courses of treatment and a higher number of specialist and centre visits, adding an unintended consequence: Further significant pressure on potentially scarce resources.
Chemotherapy can be a lifesaving and, in some instances, highly complex treatment that frequently requires the involvement of a large number of clinicians. It is important that the patient’s and family’s views are considered while providing the best, evidence-based clinical treatments.
The central question was how and where to best treat cancer sufferers in the face of growing cancer care demand on some services. A logical conclusion is for other trained clinicians to take the pressure off oncologists and specialist centres for some of the easier treatments, while also supporting better working practices.
The new model was identified through significant international and local research, working closely with the medical oncology sector and Health Ministry, and engaging with nursing and primary care representatives.
Under the new model, patients with highly complex and rarer cancers could be treated by sub-specialists in a small number of highly specialised centres. Patients with more common, but less complex, cancers that require simpler treatment would still receive treatment advice by a specialised oncologist, but the actual giving of treatment and monitoring of these patients can occur at other hospitals or by other cancer professionals, such as nurse specialists or up-skilled GPs at their own surgeries or community facilities.
Essentially it is an integrated and supported hub-and-spoke model where the specialist centres recommend treatment options at community facilities closer to patients’ homes. This will help ease pressure on services, while also helping to meet the patients’ needs.
The team also proposed new workforce models. These include shifting more of the non-clinical activities from specialists to other caregivers or administrative staff. This will free up the time for nurses and oncologists to work at the top of their level of expertise.
Technology will be central to the new model. Telemedicine and virtual clinics can help reduce clinician travel times, which are estimated to be more than 10% of a specialist’s workload in some regions. These virtual tools can allow sub-specialists to advise other cancer treatment providers throughout a patient’s course of therapy.