"I was not aware of the [low] uptake/participation rate and will actively discuss and encourage patients to participate." - Participant GP
The NSW Cancer Plan aims to improve outcomes for all cancers across the community. However, it has a specific focus on bowel cancer because of its considerable impact on the community. The bowel is in the lower part of the digestive system. It is divided into the small bowel and the large bowel (colon and rectum). By putting into practice what we know about screening, diagnosing and treating bowel cancer, we can bring about better outcomes.
The impact of bowel cancer
Australia has one of the highest rates of bowel cancer in the world. In NSW, one in 13 men and one in 16 women will develop bowel cancer by the age of 85, and around 32 men and women die each week from bowel cancer.1
Survival rates for bowel cancer are significantly improved when the disease is detected and treated early.
What we are achieving to lessen the impact of bowel cancer
We have been working across NSW to improve outcomes for people with bowel cancer. Over the past 12 months we have achieved the following:
Increasing participation in bowel cancer screening
We continue to deliver mass media campaigns and social marketing activities to promote participation in the National Bowel Cancer Screening Program in NSW.
- The 'Do the Test' Bowel Cancer Screening Campaign ran from January to June 2019. The campaign raised awareness of bowel cancer and motivated 50 to 74-year-old people in NSW to participate in the National Bowel Cancer Screening Program.
- Evaluation of the 2019 campaign showed it had a positive impact on test kit returns. Over the 23-week campaign period, 192,288 bowel screening test kits were returned in NSW. This is an additional 13.3% of kits (22,563 kits) returned above the expected amount for this period.
- This campaign was repeated in 2020 and included television, billboards and bus stops, radio and digital advertising, as well as a partnership with Tennis Australia.
- We continue to work with key stakeholders to improve participation in the National Bowel Cancer Screening Program. We piloted a program of work with general practitioners (GPs) in western Sydney, in which we delivered small group and individual education sessions, aimed at increasing GPs' awareness and knowledge of the program. Participants reported that the activity was a good experience leading to positive changes in knowledge, awareness and intended practice about bowel cancer screening.
- We developed a quality improvement toolkit to support general practices to improve participation rates for the bowel, breast and cervical screening programs.
Addressing the needs of priority population groups
- We supported the National Indigenous Bowel Cancer Screening Pilot, which was led by the Australian Government Department of Health. We also actively promote the Indigenous Bowel Screen website and resources.
- We engaged with multicultural and Aboriginal stakeholders to support bowel cancer screening and community education through our Innovation in Cancer Control Grants. A third series of grants were awarded in 2019, including five grants to multicultural organisations and two grants to Aboriginal health and community organisations in NSW.
- We supported uptake of our Bowel Health and Screening Flipchart and Facilitator Manual among multicultural health and community organisations.
Improving access to colonoscopy in NSW
- Since 2014, we have funded 14 grants, which have all aimed to support the health system to improve timely diagnosis of bowel cancer, by improving access to public colonoscopy services for patients following a positive bowel cancer screening test, called an immunochemical faecal occult blood test (iFOBT).
- Key outcomes for these grants included a consistent reduction in wait times for colonoscopy through the implementation of various models of care.
- We are now leading the statewide implementation of direct access models of care through the Direct Access Colonoscopy (DAC) initiative. This initiative is part of the NSW Health Leading Better Value Care program which aims to achieve system reform by shifting from volume- to value-based healthcare.
- The DAC initiative will primarily focus on increasing access to colonoscopy through:
- the statewide implementation of DAC services for patients with a positive iFOBT
- improved triaging and prioritising of colonoscopy wait lists.
- A DAC model of care document has been developed to support local health districts to implement localised models of DAC services.
Providing the Participant Follow Up Function (PFUF) for bowel cancer screening participants
- We continue to operate the Participant Follow Up Function by arrangement with the Australian Government Department of Health. This service complements the reminder letters and usual care provided through the National Bowel Cancer Screening Program. When someone receives a positive bowel screening result (meaning that microscopic blood was detected, which requires further investigation) they may be contacted by a PFUF Officer who encourages them to continue along the screening pathway and have both a GP assessment and diagnostic colonoscopy. This helps to minimise undue delays in diagnosing bowel cancers.
- Over the first four years that we delivered this service (to September 2020), we followed up with more than 90,000 people in NSW and supported them after their positive test result.
Providing information to help patients and GPs
- We are promoting specialists that are active members of bowel cancer multidisciplinary cancer care teams, and specialist cancer centres that meet agreed criteria on Canrefer.
- We are supporting people with bowel conditions to participate in shared decision making and self-management. We launched Patient Information to provide accurate information for patients about bowel cancer, including diagnosis and treatment and where to find support services and further information.
Supporting clinicians to deliver evidence-based cancer treatment
- We provide free access to evidence-based, consensus driven bowel cancer treatment protocols and information via eviQ. The eviQ information is developed to support health professionals in the delivery of cancer treatments.
- We provide free, evidence-based cancer eLearning resources for health professionals via eviQEd. We developed the ‘Radiation oncology’ and ‘Episode 1: Reflecting on clinical challenges’ online learning resources to support clinicians in understanding and managing bowel cancer.
Supporting clinician-led benchmarking and quality improvement activities.
- We continue to deliver the Reporting for Better Cancer Outcomes (RBCO) Program which provides a key mechanism of engagement with clinicians, managers and executives to:
- highlight and understand variations in cancer screening, prevention, services and outcomes and clinical trials
- identify where we can make the biggest impact in cancer outcomes
- support and facilitate application of best practice, current evidence and continuous quality improvement.
- We continue to report on bowel cancer specific indicators through RBCO and work with services to understand variation and improve outcomes.
- We have held time-limited clinical advisory groups and clinical consultations to provide advice on the definitions for new bowel indicators and to refine existing bowel indicators.
- We are currently funding five clinical variation grant projects relating to bowel cancer.
NSW Cancer Plan initiatives for bowel cancer
The NSW Cancer Plan includes several strategies that will reduce the impact of bowel cancer on the community by building on existing programs, including:
- strategies to improve operation of the National Bowel Cancer Screening Program
- public education campaigns to raise awareness of bowel cancer
- public education campaigns to promote bowel cancer screening
- improving diagnosis pathways to promote early detection
- improving treatment pathways
- primary care engagement initiatives to promote screening
- strategies that focus on high-risk populations, including Aboriginal and multicultural communities
- supporting access to best practice multidisciplinary cancer care through resources such as Canrefer.
Progress of the NSW Cancer Plan is regularly monitored and evaluated. Find more information on the indicators used to track against the Plan's objectives.