Gynaecological cancer pathway for faster cancer treatment: a clinical audit.
Gynaecological cancers make up 10% of cancer cases and 10% of female cancer deaths in New Zealand. The services for investigation and treatment of these women are regionally specific rather than centrally organised; hence we need appropriate standards of service and clear pathways for communication and management of these patients to ensure consistent care that is in line with the Ministry of Health goals for faster cancer treatment.


OBJECTIVE
The aim of this audit is to ensure faster gynaecological cancer management pathways for Northland patients.


METHODS
There were 72 gynaecological cancer cases identified from the gynaecological oncology referral data. These were the patients referred for multidisciplinary discussion of their newly diagnosed gynaecological cancer from June 2014-June 2015. Seventeen cases were excluded from this audit. The patients' information regarding their health care during the investigation and treatment of their cancer was obtained via an electronic patient record system. The time taken for each patient to complete various investigation, referrals, decisions and treatment was then compared against Ministry of Health faster cancer treatment targets and standards of service provision.


RESULTS
The results showed that the overall target of patients having their first treatment within 62 days of initial referral for suspected cancer was being met only in 39% of cases. The best performing area of the pathway was the time from first referral from Northland DHB until the date of the first MDM discussion for a patient with an aim of ≤14 days with 93% of cases meeting this. The worst performing area was the time from decision to biopsy for tissue diagnosis to the time the histology report was produced, aiming for ≤14 days. We met this target in only 35% of cases.


CONCLUSIONS
Over half of Northland patients are not receiving treatment in time that meets national targets. This delay seems to be mainly at the tissue diagnosis stage especially if operative intervention is required and while waiting on a management plan from the multidisciplinary team. Further input into appropriate tracking of cancer patients, management of prioritisation of operating lists and perhaps increased theatre time for gynaecology cancer patients should be considered. Increasing the frequency of multidisciplinary meetings for management plan decisions to be made should also be considered. The standards for service provision should also be altered to have a time course for referral, investigation and management that is in line with the Ministry faster cancer treatment targets.
Department of Obstetrics and Gynaecology, Counties Manukau District Health Board, Auckland.
Catherine
C
Askew
Department of Obstetrics and Gynaecology, Northland District Health Board, Whangarei, New Zealand.
Anand
A
Gangji
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D054869:Clinical Audit; D000066491:Clinical Decision-Making; D019468:Disease Management; D057286:Electronic Health Records; D005260:Female; D005833:Genital Neoplasms, Female / Q000145:classification* / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D009520:New Zealand; D010348:Patient Care Team / Q000592:standards*; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D055815:Young Adult