Cancer treatment and service delivery: Patient experience in NSW

Download: Cancer control in NSW: Annual performance report 2016 (PDF)
Download: This chapter only (PDF)

Read more about the following key performance indicators for cancer treatment and service delivery across cancer control in NSW.

• Patient-reported measures
• Early diagnosis and timely treatment
• Surgical cancer treatment variation
• Clinical cancer services in NSW

Patient-reported measures

• Understanding a patient’s experience throughout each stage of their cancer journey can enable more personalised care and help to improve the overall quality of the health system.[1] 
• Supporting people to provide direct and timely feedback about their cancer experience and outcomes is a key priority within the NSW Cancer Plan.
• The Cancer Institute NSW has partnered with the Bureau of Health Information to report on the experiences of people with cancer in NSW.[2]

Patient-reported measures: Key findings

• 69% of inpatients and 72% of outpatients receiving chemotherapy, radiotherapy or surgery in NSW public hospitals were “definitely” involved in decisions about their care and treatment.
• 85% of inpatients and 89% of outpatients felt that health professionals “always” explained things in an understandable way.
• The Edmonton Symptom Assessment System (ESAS) scale measures the severity of nine common symptoms experienced by patients undergoing cancer treatment. Tiredness and poor general wellbeing were reported to be the most severe. There were no local health districts from which patients reported significantly worse results than the  NSW average.
• The Communication and Attitudinal Self-Efficacy (CASE) scale measures a patient’s confidence and ability to  engage in their care. On average, high scores were achieved across NSW for each category of the scale. No local health district showed significantly worse results than the NSW average, suggesting that outpatients across NSW have a high level of self-efficacy regarding their cancer care.

View the data:

• Self-assessed symptom scores* for outpatients undergoing active cancer treatment in NSW public hospitals at time of survey, LHD results relative to NSW, 2015 (PDF)
• Shared decision-making among patients that received chemotherapy, radiotherapy or surgery in NSW public hospitals, LHD results relative to NSW, 2015*(PDF)
• Information to support patients that received chemotherapy, radiotherapy or surgery in NSW public hospitals, LHD results relative to NSW, 2015* (PDF)
• Self-efficacy scores* for outpatients undergoing active treatment in NSW public hospitals at time of survey, LHD results relative to NSW, 2015 (PDF)

References:

1. Australian Commission on Safety and Quality in Health Care, White & Johnson, 2011.
2. Bureau of Health Information. Patient Perspectives – How do outpatient cancer clinics perform? Experiences and outcomes of care, February and March 2015. Sydney (NSW); BHI; 2016.

Notes:

• Formal publication and reporting of inpatient and outpatient survey data is undertaken by the Bureau of Health Information (BHI). Pre-release results were reproduced with permission from BHI.
• Detailed data for these indicators can be found in the Appendices.

Early diagnosis and timely treatment

• Evidence indicates the earlier someone is diagnosed with cancer, the better their prognosis.
• Developing optimal care pathways and the use of direct access models will help to enable the early diagnosis and timely treatment of cancer. This will provide benefits to patients and the health system in terms of costs, outcomes and quality of life.[1]

Early diagnosis and timely treatment: Key findings

• The five most common cancers diagnosed in NSW are bowel, breast, lung, prostate and melanoma.
• Survival at five years following diagnosis is higher for each of these cancers when diagnosed early. For example, five-year survival from bowel cancer decreases from 89% for localised disease to 72% for regional disease, and 16% for metastatic disease at diagnosis.

View the data:

• Five most common cancers by extent of disease at diagnosis, by LHD (ranked), 2012 - Bowel (PDF)
• Five most common cancers by extent of disease at diagnosis, by LHD (ranked), 2012 - Breast (female) (PDF)
• Five most common cancers by extent of disease at diagnosis, by LHD (ranked), 2012 - Lung (PDF)
• Five most common cancers by extent of disease at diagnosis, by LHD (ranked), 2012 - Prostate (PDF)
• Five most common cancers by extent of disease at diagnosis, by LHD (ranked), 2012 - Melanoma (PDF)
• Five most common cancers by extent of disease at diagnosis in 2012 and five-year relative survival, NSW, 2005–to 2009 (PDF)

References:

1. Ananda S, McLauglin S, Chen F et al. Initial impact of Australia’s National Bowel Cancer Screening Program. MJA 2009;191:378-381.

Notes:

• Bowel cancer staging is reported according to the staging system used in the published source, which is either by TNM (tumour, nodes, metastases) stage groups (e.g. Stage I) or Modified Dukes’ stages (e.g. Dukes’ A). For reporting purposes in this document Stage I, II, III and IV are considered equivalent to Dukes’ Stage A, B, C and Stage D respectively.
• Health network and/or speciality network indicators are not calculated for extent of disease, as they do not form geographical boundaries with resident populations. This applies to St Vincent’s Health Network, Sydney Children’s Hospitals Network, and Justice Health and Forensic Mental Health.
• Extent of disease is the highest degree of spread notified to the NSW Cancer Registry within the first four months of diagnosis and is categorised as localised, regional, metastatic or unknown.
• Localised: Localised to the tissue of origin.
• Regional: Spread to adjacent organs and/or regional lymph nodes.
• Metastatic: Spread from one part of the body to another.

Surgical cancer treatment variation

Surgical cancer treatment variation: Key findings

• 91% of breast cancer resections in 2014–2015 were performed in public hospitals that meet the minimum suggested annual caseload for breast cancer surgery. This is an increase from 87% in 2011–2012.
• Data for breast cancer service delivery show wide variation in multiple measures across hospitals and local health districts. For example, variation in the use of hypofractionated radiation therapy* may indicate missed opportunities to provide treatment with shorter duration and more efficient machine utilisation. Absence of this choice may unnecessarily increase mastectomy rates. The clinical scenarios and context of these measures need to be considered in order to understand the variations shown in this report.
• More than 90% of colon cancer resections were conducted in public and private hospitals that meet the minimum suggested annual caseload.
• The percentages of ovarian cancer resections occurring in specialist hospitals decreased for both public and private patients. Further investigation is needed to understand referral networks and patient flows for ovarian cancer services and treatment. The Cancer Institute NSW website currently lists recommended specialised gynaecological oncology centres in NSW (cancerinstitute.org.au/how-we-help/quality-improvement/optimising-cancer-care/gynaecological-cancertreatment). Additionally, the Canrefer website (canrefer.org.au) can be used to search for gynaecological oncologists who are members of gynaecological MDTs.
• Progress has been made towards consolidating gastric cancer resections in public hospitals, with fewer hospitals performing this surgery and 76% of procedures occurring in specialist hospitals in 2014–2015.
• Considerable progress has been made towards consolidating complex surgical procedures, such as oesophagectomies and pancreatectomies, in specialist hospitals.
• 94% of oesophagectomies were performed in specialist hospitals in 2014–2015, which is an increase from 76% in 2011–2012.

View the data:

Lung cancer

• Lung cancer resections in NSW public hospitals, FY 2011–to 2012 and FY 2014–to 2015 (PDF)
• Lung cancer resections in NSW private hospitals, FY 2011–to 2012 and FY 2014–to 2015 (PDF)

Breast cancer

• Average annual flows of people for breast cancer resections, by LHD of residence, FY 2011–to 2015 (PDF)
• Breast cancer resections in NSW public hospitals, FY 2011–to 2012 and FY 2014–to 2015 (PDF)
• Breast cancer resections in NSW private hospitals, FY 2011–to 2012 and FY 2014–to 2015 (PDF)
• Proportion of breast cancer resections* with sentinel lymph node biopsy (SLNB) and axillary node dissection (AND) in NSW public hospitals, by LHD (ranked), FY 2011–to 2015 (PDF)
• Proportion of breast cancer resections* with sentinel lymph node biopsy (SLNB) and axillary node dissection (AND) in NSW public hospitals, by hospital (ranked), FY 2011–to 2015 (PDF)
• Proportion of breast cancer resections* with sentinel lymph node biopsy (SLNB) and axillary node dissection (AND) in NSW private hospitals, by hospital (ranked), FY 2011–to 2015 (PDF)
• Mastectomy as a proportion of breast cancer resections* in NSW public hospitals, by LHD (ranked), FY 2011–to 2015 (PDF)
• Mastectomy as a proportion of breast cancer resections* in NSW public hospitals, by hospital (ranked), FY 2011–to 2015 (PDF)
• Mastectomy as a proportion of breast cancer resections* in NSW private hospitals, by hospital (ranked), FY 2011–to 2015 (PDF)
• Proportion of early-stage breast cancer* patients receiving standard or hypofractioned regimens of external beam radiotherapy in NSW public facilities, with median age, by LHD (ranked), 2008–to 2012 (PDF)

Ovarian cancer

• Ovarian cancer resections in NSW public hospitals, FY 2011–to 2012 and FY 2014–to 2015 (PDF)
• Ovarian cancer resections in NSW private hospitals, FY 2011–to 2012 and FY 2014–to 2015 (PDF)

Colon cancer

• Average annual flows of people for colon cancer resections, by LHD of residence, FY 2011–to 2015 (PDF)
• Colon cancer resections in NSW public hospitals, FY 2011–to 2012 and FY 2014–to 2015 (PDF)
• Colon cancer resections in NSW private hospitals, FY 2011–to 2012 and FY 2014–to 2015 (PDF)

Rectal cancer

• Rectal cancer resections in NSW public hospitals, FY 2011–to 2012 and FY 2014–to 2015 (PDF)
• Rectal cancer resections in NSW private hospitals, FY 2011–to 2012 and FY 2014–to 2015 (PDF)

Gastric cancer

• Gastric cancer resections in NSW public hospitals, FY 2011–to 2012 and FY 2014–to 2015 (PDF)
• Gastric cancer resections in NSW private hospitals, FY 2011–to 2012 and FY 2014–to 2015 (PDF)

Oesophageal cancer

• Oesophageal cancer resections in NSW public hospitals, FY 2011–to 2012 and FY 2014–to 2015 (PDF)
• Oesophageal cancer resections in NSW private hospitals, FY 2011–to 2012 and FY 2014–to 2015 (PDF)

Pancreatic cancer

• Pancreatic cancer resections in NSW public hospitals, FY 2011–to 2012 and FY 2014–to 2015 (PDF)
• Pancreatic cancer resections in NSW private hospitals, FY 2011–to 2012 and FY 2014–to 2015 (PDF)

Liver cancer

• Liver cancer resections in NSW public hospitals, FY 2011–to 2012 and FY 2014–to 2015 (PDF)
• Liver cancer resections in NSW private hospitals, FY 2011–to 2012 and FY 2014–to 2015 (PDF)

Neurological cancer

• Neurological cancer resections in NSW public hospitals, FY 2011–to 2012 and FY 2014–to 2015 (PDF)
• Neurological cancer resections in NSW private hospitals, FY 2011–to 2012 and FY 2014–to 2015 (PDF)

Head and neck cancer

• Head and neck cancer resections in NSW public hospitals, FY 2011–to 2012 and FY 2014–to 2015 (PDF)
• Head and neck cancer resections in NSW private hospitals, FY 2011–to 2012 and FY 2014–to 2015 (PDF)

* A treatment schedule in which the total dose of radiation is divided into large doses and treatments are given once a day or less often. Hypofractionated radiation therapy is given over a shorter period of time (fewer days or weeks) than standard radiation therapy (https://www.cancer.gov/publicationsdictionaries/cancer-terms?cdrid=558902).

References:

1. Currow DC, You H, Aranda S, et al. What factors are predictive of surgical resection and survival from localised non-small cell lung cancer? MJA. 2014;201(8):475-80.
2. Vinod SK, Sidhom MA, Gabriel GS, et al. Why do some lung cancer patients receive no anticancer treatment? J Thorac Oncol. 2010;5(7):1025-32.
3. Coupland VH, Lagergren J, Lüchtenborg M, Jack RH, Allum W, Holmberg L, Hanna GB, Pearce N, Møller H. Hospital volume, proportion resected and mortality from oesophageal and gastric cancer: a population-based study in England, 2004–2008. Gut. 2013;62(7):961-6.
4. Coupland VH, Konfortion J, Jack RH, et al. Resection rate, hospital procedure volume and survival in pancreatic cancer patients in England: Population-based study, 2005–2009. EJSO. 2016;42(2):190-6.
5. National Breast Cancer Centre. Multidisciplinary meeting for cancer care: a guide for health service providers; 2005.
6. Department of Health Victoria. Multidisciplinary cancer care: literature review; 2012.

Notes:

• Public and private hospitals exclude nursing homes, community, psychiatric, multi-purpose services, hospices, rehabilitation and ungrouped non-acute type hospitals.
• Private hospitals may include private day procedure centres.
• Surgical data are sourced from Ministry of Health reporting data sets and are the most up-to-date information available at the time the data were extracted. There is a potential undercount of surgical volume affecting some hospitals in recent time periods, due to changes in system databases.
• The Cancer Institute NSW reserves the right to monitor, evaluate and amend minimum suggested annual institutional hospital caseloads as part of its ongoing analysis of system performance in cancer services in NSW.

Clinical cancer services in NSW

Clinical cancer services in NSW: Key findings

• Across public facilities in NSW, multiple fraction regimens were most commonly used, with only 28% of patients receiving single fraction treatments.
• The use of single fraction radiotherapy varied widely across local health districts, from 43% of patients in one LHD to 9% in another.
• Patients receiving single fraction treatments tended to be older than those receiving multiple fraction regimens.

View the data:

• Proportion of patients with bone metastases receiving single or multiple fraction regimens of external beam radiotherapy with palliative treatment intent in NSW public facilities, with median age, by LHD (ranked), FY 2013–to 2014 (PDF)

References:

1. Sze WM, et al. Palliation of metastatic bone pain: single fraction versus multifraction radiotherapy. Cochrane Database of Systematic Reviews, 2002(1).
2. Chow E, Zeng L, Salvo N, et al. Update on the systematic review of palliative radiotherapy trials for bone metastases. Clin Oncol. 2012;24(2):112-24.
3. Fairchild A, Barnes E, Ghosh S, et al. International patterns of practice in palliative radiotherapy for painful bone metastases: evidence-based practice? Int J Radiat Oncol Biol Phys. 2009;75(5):1501-10.
4. Bradley NM, Husted J, Sai ML, et al. Review of patterns of practice and patients’ preferences in the treatment of bone metastases with palliative radiotherapy. Support Care Cancer. 2007;15(4):373-85.

Notes:

• Public hospitals exclude nursing homes, community, psychiatric, multi-purpose services, hospices, rehabilitation and ungrouped non-acute type hospitals.