sykes.ppt

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  • 4000 cancer deaths
  • sykes.ppt

    1. 1. Ovarian Cancer Control A Strategy for the Management of Ovarian Cancer in New Zealand. Peter Sykes RANZCOG 2007
    2. 2. Why do we need a strategy? • Need to minimise the impact of this disease. • National Cancer Control innitiative. • Development of gynae oncology services in NZ.
    3. 3. Age distribution ovarian cancer by age 0 5 10 15 20 25 30 35 40 10 to 14 15 to19 20 to 24 25 to 29 30 to34 35 to 39 40 to 44 45-49 50-54 55-59 60-64 65-69 70-75 75-79 80-85 85-90 90-95 95-100 Series1
    4. 4. 300 New Zealand women get and 175 die of ovarian cancer per year
    5. 5. Goal 1 Prevention • Incessant ovulation • Diet and obesity • Vitamin D • genetics • Healthy living • Breast feeding • Contraception practice? • Identification familial risk • Genetic counselling • Prophylactic surgery • Support research
    6. 6. Goal 2 Early detection • Currently no screening • Opportunities for earlier detection • Ovarian cancer awareness • Primary care education • Availability of ultrasound. • Support research
    7. 7. Goal 3 and 4 treatment and supportive care Survival • Stage • Age • Debulking surgery • Chemotherapy • Second line treatment • Other treatments Quality of life • Disease control • Control of symptoms • Treatment related effects • Psychological • empowerment • Social and emotional support • Financial issues • Access to care • Quality of care
    8. 8. Challenges of ovarian cancer care • Inform patient • Inform care givers • Easy access to care • Provide emotional support • Ensure social support • Timely provision of services • Initial assessment/ radiology • Pathologic diagnosis • Curative surgery • Staging surgery • Debulking surgery • perioperative care • rehabilitiation • coordinated multidisciplinary care • Chemotherapy • coordination with other health professionals • follow up • second line treatment • palliative care • identification and management of familial cancer
    9. 9. people • patient load • trained surgical staff • trained nursing staff • experienced pathologist/s • experienced radiologist/s • experienced oncologists • counselling/ dietician/ OT/ physio/ Pastoral care/social work
    10. 10. Facility • Outpatient service • dedicated inpatient beds • Radiology, nuclear medicine / CT/MRI/PET • Perioperative facilities HDU/ICU • Access to adequate elective and acute operating time • administration
    11. 11. Goal 5 improve provision of services /organisation • Regional services • Sustainable infrastructure • Appropriate funding • Transport /family support • national guideline development and maintenance. • system of surveillance • financial accountability • Working relationship with referring clinicians • community health services • palliative care services • NGO • genetic services • education (univ ranzcog)
    12. 12. Goal 6 improve outcomes by research and surveillance • Database • Outcome reporting • Research infrastructure • participation in international trials • international liason
    13. 13. A Model • All cases of suspected or established ca ovary offered referral • 3or 4 units at least 2 of all key staff • satellite units • early contact community oncology nurse • equal access free of cost regardless of domicile • national waiting times and guidelines • funding transparent and sufficient • trial participation • coordinated follow up • outcome and financial reporting
    14. 14. What and Who needs to do it • Recognise need for Gyn oncology services • Establish Gyn Oncology units. • Appoint and accredit and train staff. • Establish system of funding. • Expect and fund outcome reporting. • MOH • Cancer Control • DHB • Gynae units • Oncology units • RANZCOG • trainees • Cancer society • Surgical working group • SISSAL • NZGCG
    15. 15. My Concerns • Lack of transparency of funding • Split of surgical and non surgical oncology • Lack of incentive for collaboration between dhb • Inability to attract suitably trained staff • Lack of unified voice • Little political interest
    16. 16. What Next? • A written strategy? • RANZCOG? • Lobby? • wait to be asked? • make it work locally?

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