Best-practice & improving servicesIan Olver CEO Cancer Council Australia

Cancer Statistics

•  Estimated incidence (2012) is 120,700 "

•  Prostate, Bowel, Breast, melanoma and Lung"

•  56% male"

•  Deaths from cancer 42,800 in 2010 (1/3 Aust deaths)"

Age standardised mortality decreased by 17% from 210/100,000 to 174/100,000 in 2010"

5 year survival has increased from 47% in 1982-87 to 66% in 2006-2010"

Prevalence of cancer

What is Personalised Medicine?"

•  Personalized medicine is the customization of healthcare, the tailoring of treatment to the individual patient by use of genetic or other information"

•  Cancer is based on mutations in genes. There is individual variability in these changes which could mean individual treatments"

May 2001

Glivec"

•  It blocks proteins from overexpressed defective genes found in some cancers"

•  Effective in chronic myeloid leukaemia"•  Effective in GIST Gastrointestinal stromal

tumours which over express c-kit"•  Side effects"

•  Nausea, muscle pains, fluid retention, diarrhoea, blood count suppression, LFT’s early “storm”"

Pre- and Post-STI571

0 1 2 3 4 5 50

60

70

80

90

100

0 1 2 3 4 5 50

60

70

80

90

100

Disease-Free Survival B-31 N9831

ACTH 864 83 ACT 872 171 ACT 807 90

ACTH 808 51

N Events N Events

HR=0.45, 2P=1x10-9 HR=0.55, 2P=0.0005

ACT ACT

74%

87% 85%

66%

78%

87% 86%

68%

Years From Randomization

%

•  Microbeam Radiation Therapy (MRT) uses highly collimated, quasi-parallel arrays of X-ray microbeams of 50-600 keV, produced by 3rd generation synchrotron sources"

•  The main features of highly brilliant Synchrotron sources are an extremely high dose rate in fractions of seconds and very small beam divergence "

iKnife

Delays in diagnosis and treatment"

•  Most cancer operations are within 30 days"

•  Of 12,699 operations for breast, bowel and lung cancers 97% were in 45 days"

•  Nationally, 1090 patients waited longer than 30 days and 382 longer than 45 days"

www.myhospitals.gov.au/compare-hospitals"

Disparities"

•  ATSI experience higher incidence and mortality"

•  Remoteness is associated with a lower incidence and survival"

•  Incidence rises and survival falls with socioeconomic status"

Multidisciplinary Interactions

•  Received audits of MDCs across 123 hospitals and 5 cancer types breast prostate gynaecological, lung and cervix (520 surveys)"

•  60-70% hospitals had no MDTs in the 5 tumours"•  Most did not have the core members of a MDT"•  Most were face to face but 10-30% were

telemedicine"•  Less that half were 1 or 32 weekly"

77-85% told patients that their case would be discussed by a MDT"

Specialists communicated the results to the patients"

Most meetings did not have links to supportive care (33-78% to palliative care)"

One third did not communicate their findings to GPs"Sporadic collection of data "

Reasons for not implementing an MDT"Lack of time"

Lack of co-ordination time"

Lack of staff resources"

Small case load"

Funding"

Taylor C et al Multidisciplinary team working in cancer: what is the evidence?BMJ 2010; 340 doi: http://dx.doi.org.ezproxy1.library.usyd.edu.au/10.1136/bmj.c951 (Published 23 March 2010) Cite this as: BMJ 2010;340:c951

•  In the UK, MDTs are associated with improved 5 year survival in colorectal, oesophageal, lung cancer and improved 2 year survival in head + neck cancer"

•  In Sweden, MDT show improved seven year relative survival from breast"

•  The relation between specialist surgery and improved survival in breast cancer and oesophageal cancer is now well established"

•  Evidence for multidisciplinary teams improving patient experience of care while effect on team members is equivocal"

•  The impact of multidisciplinary teams on team members is not well understood. "

http://canceraustralia.gov.au/publications-and-resources/cancer-australia-publications/clinical-practice-guidelines-psychosocial-care-adults-cancer-summary-guide-health-professionals

Integrative Care and CAMs Joske D Creating an Integrative Oncology Centre: the SolarisCare Experience in Olver I, Robotin M Perspectives on Complementary and Alternative Medicines"

•  There are centres such as the Solaris Centre at Sir Charles Gairdner Hospital "

•  CAMs are medicines that don’t have the same evidence base as traditional medicines"

•  The issues in integrating care:"–  Select treatments"–  Select therapists"–  Train volunteers "–  Research and measuring efficacy"–  Minimise medica-legal risk"