Oral Presentation COSA 2015 ASM

Guideline launch - timely initiation of systemic chemotherapy for the treatment of cancer  (#101)

Marliese Alexander 1 2 , Rhonda Beattie-Manning 3 , Robert Blum 4 , Jenny Byrne 5 , Colin Hornby 6 , Chris Kearny 7 , Natalie Love 1 , Jane McGlashan 5 , Sandy McKiernan 8 , Jeremy L Milar 9 , Danielle Murray 1 , Stephen Opat 10 , Phillip Parente 11 , Joan Thomas 12 , Nicole Tweedle 13 , Craig Underhill 14 , Kathryn Whitfield 15 , Sue Kirsa 1 , Danny Rischin 1
  1. Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
  2. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  3. Emergency Medicine & Cancer Services, Western Health
  4. Department of Medical Oncology, Bendigo Health
  5. Western and Central Integrated Cancer Service, Melbourne, Victoria, Australia
  6. Cancer Strategy & Development unit, Victorian Department of Health & Human Services
  7. Specialists Clinics, Peter MacCallum Cancer Centre
  8. Cancer Nurses Society of Australia, Perth, Western Australia, Australia
  9. Department of Radiation Oncology, Alfred Health
  10. Clinical Haematology, Monash Health
  11. Department of Medical Oncology, Eastern Health
  12. Peninsula Health, Mornington Peninsula, Victoria, Australia
  13. Victorian Comprehensive Cancer Centre, Melboune , Victoria, Australia
  14. Greater Southern Area Health Service, East Hume / Border Clinical Network, Albury, New South Wales, Australia
  15. Cancer Strategy & Development unit, Victorian Department of Health & Human Services

Aim: Internationally, cancer treatment waiting times are routinely measured and reported. The most widely adopted time-to-care indicator calls for commencement of cancer treatment within 31days of decision-to-treat for all patients. In Australia guidelines exist for the timeliness of cancer care for surgery and radiation therapy, but not systemic chemotherapy. The aim of this study was to evaluate the evidence and develop guidelines for the timely initiation of systemic chemotherapy for the treatment of cancer.

Method: Literature reviews were undertaken for major cancer groups including colorectal-, lung-, breast- and ovarian cancers, myeloma and lymphoma. Evidence was reviewed by multidisciplinary panels convened from Victorian health services. Draft recommendations were presented and refined at an open consensus meeting, then finalised by the project steering committee prior to external review and consultation.

Results: Evidence was generally low level (NHRMC level III) and while large populations and consistent results across studies provided certainty for some cancers, there was a reliance on best clinical judgement for others. Evidence suggests that timeliness or ‘urgency’ varies by cancer type. This is reflected in these guidelines, which differ from international guidelines, providing recommendations for initiation of chemotherapy dependant on patient presentation, cancer type and treatment aims (within 48hours for urgent cases and from 2 to 12 weeks for other cases). These guidelines have been endorsed by the Cancer Council Victoria, Cancer Nurses Society of Australia, Clinical Oncology Society of Australia and Cancer Pharmacists Group, Medical Oncology Group of Australia and Society of Hospital Pharmacists Australia.   

Conclusion: Following a validated process with multidisciplinary and consumer input we were able to develop guidelines, informed by best available evidence and expert opinion, for the timely initiation of systemic chemotherapy. The guidelines have been published by the Victorian Department of Health and Human Services (DHHS) and are freely available at http://www.health.vic.gov.au/cancer/index.