Output 1.4 Cancer services-Cancer, Ambulatory and Community Health Support

Output Description

Cancer, Ambulatory and Community Health Support (CACHS) provides a comprehensive range of screening, assessment, diagnostic, treatment and palliative care services. Services are provided in inpatient, outpatient and community settings.

The key strategic priorities for cancer care services are early detection and timely access to diagnostic and treatment services. These include ensuring that population screening rates for breast cancer meet targets, ensuring that waiting times for access to essential services such as radiotherapy are consistent with agreed benchmarks, and increasing the proportion of women screened through the BreastScreen Australia program for the target population (aged 50 to 69 years) to 70 per cent over time.

In November 2012, the Nous Group was engaged to review the 2011 restructure of the ACT Health Directorate. From this review, 36 recommendations arose to inform future strategy and organisational design, including in March 2014 the renaming of the division from the Capital Region Cancer Service to Cancer, Ambulatory and Community Health Support (CACHS). The new name reflects the activity and staff of the division, providing and/or supporting the provision of ambulatory and community health services across Canberra Hospital and Health Services.

The CACHS division is responsible for the provision of oncology, clinical haematology, radiation oncology, BreastScreen and immunology services to the ACT and surrounding region. Services are offered in the form of screening, inpatient and outpatient services and community-based psychosocial support services. The division also manages and coordinates clinical outpatients administrative support, Health Centre Administration, Community Health Intake and Transcription Services.

CACHS ensures a continuum of care for consumers ranging from prevention and screening through to diagnosis, treatment, rehabilitation and palliative care.


Cancer Services provided care for 1352 new radiotherapy patients in 2013-14. This is a 2 per cent increase on the 1,330 patients beginning radiotherapy services when compared to the same period last year.

Despite the increase in demand for radiation therapy services, waiting times have maintained the excellent record of recent years, with 100 per cent of all urgency categories receiving access within the standard timeframes.

Waiting times for breast screen appointments have improved as a result of the engagement of additional permanent radiographers (in 2011) as well as locum and casual radiographers. The BreastScreen ACT program no longer provides services to South East New South Wales and this has freed up radiography staff to provide services to women of the ACT. However, women who reside in NSW and who currently work in the ACT are still able to access BreastScreen services in the ACT.

In 2013-14, 97 per cent of women waited less than 28 days for their screening appointment. This is a marked improvement on the 24 per cent reported in 2010-11. Waiting times for the proportion of women who receive an assessment within 28 days has also maintained an excellent record in 2013-14, with a result of 93 per cent, compared to 76 per cent reported for the same period in 2010-11.

Despite ready availability of appointments, recruitment of women into the program to attend for screening is proving difficult. To improve the numbers, BreastScreen ACT has commenced an active recruitment campaign using multiple strategies, such as contacting lapsed attendees and sending letters to general practitioners to encourage women to have a breast screen. These new initiatives appear to be working, as there has been a 17 per cent increase in screenings performed in 2013-14. A total of 16,379 breast screens were performed for ACT residents over 2013-14, compared with the 14,017 screening procedures reported for the same period last year.

Other achievements over the reporting period are set out below.

  • In November 2013, BreastScreen ACT was awarded four years accreditation by BreastScreen Australia.
  • On 16 June 2014, the ACT Minister for Health signed the Commonwealth's National Partnership Agreement for the expansion of the BreastScreen Australia program to include women aged 70 to 74 years in the target age group.
  • An Open Day and Women's Luncheon was held on 9 May 2014 to celebrate 21 years of screening in the ACT.
  • Funding from the Canberra Hospital Foundation was granted for these events.
  • BreastScreen ACT is screening more women than ever before. In the 24 months to 30 June 2014, BreastScreen ACT screened 30,396 ACT women. The estimated resident population for the target age group has increased by 2 to 3 per cent per year and in order to maintain the participation rate the program has been required to screen additional women.
  • The Stereotactic Radiosurgery (SRS) program commenced clinical operation on 12 July 2013 for cranial techniques. SRS is a highly precise form of radiation therapy where treatment delivery is accurate to within one or two millimetres. This procedure delivers targeted radiation at much higher doses in fewer treatments, providing maximum dose delivery to the cancer while minimising the dose to surrounding healthy tissue.
  • To date, 12 patients have received SRS treatment for single and multiple brain metastases. Recent developments have seen extension of the service to provide treatment for non-malignant acoustic neuroma.
  • Radiation Oncology was recently credentialed to participate in a Trans-Tasman Radiation Oncology Group study in which patients can be randomised to receive stereotactic body radiotherapy. Treatment will be given initially in the context of the study but will be available to all eligible patients in the near future.
  • Radiation Oncology has commenced the following clinical projects:
    - Rapid Access Clinic for palliative care patients
    - development and implementation of a simplified mono-isocentric breast technique
    - Information Technology Networking Group focusing on the upgrade of the ARIA Oncology Information System
    - expansion of verification imaging capabilities, including development of a credentialing program
    - development of respiratory gating, including deep inspiration breath hold to reduce the radiation dose to critical organs
    - development of the expanded application of intensity modulated radiation therapy to include treatment for prostate and anal canal cancers in addition to brain, head and neck cancers.

  • The Radiation Oncology Administration team won the ACT Health Administration Excellence Award in 2013 for work undertaken to improve billing processes for patients.
  • Following the successful recruitment of three clinical haematologists, the service has achieved significant reductions in waiting times for initial referrals. This has enabled expansion of the haemophilia and bleeding disorders service, and the establishment of the multidisciplinary lymphoma clinic.
  • A grant was received from Novo Nordisk for a multidisciplinary approach to further develop and improve haemophilia services for the ACT and surrounding region. The project, Changing Possibilities in Haemophilia, is being led by Dr Nalini Pati.
  • The Rapid Assessment Clinic commenced in September 2013, providing assessment for oncology and haematology patients who have symptomatic issues during treatment. The service is aimed at providing patients with access to immediate care by oncology and haematology specialists and diverting patients from presentation to the emergency department.
  • In November 2013, Anastasia Wilson RN; Maria Burgess RN; Dr Philip Crispin, Haematologist; and Professor Matthew Cook, Immunologist, developed and implemented a program to support the change made by the National Blood Authority to make available subcutaneous immunoglobulin replacement products. This transition to subcutaneous therapy represents a significant advance for the management of patients with antibody deficiency to self-administer immunoglobulin at home.
  • Cancer Psychosocial Services developed and consolidated processes to assist with more timely and effective delivery of services. This included a rollout of a formal referral process, including indicators to triage patients and formalisation of the intake process for the community-based services.
  • The Care of the Dying Patient Pathway pilot was implemented in Ward 11A, Ward 14B and Ward 10A. The pathway reflects a shift from acute life prolonging treatment to acute palliative care. This enhances comfort and acknowledges the need to actively make decisions that promote sensitive and appropriate care for the patient in the last predicted days of life. This pilot has produced excellent feedback to date.
  • Dr Matthew Cook was awarded an academic promotion to full professor level, effective January 2014.
  • The Cancer Outreach Team, the Palliative and Supportive Services Team and the Oncology Pharmacy Team won Australia Day Achievement Medallions in 2014. In January 2014 a single administration/reception model of care was introduced across all health centres in the ACT. This involved the consolidation of front-line administration teams from all services within the centres into one team under the management of Community Health Support.
  • The outpatient administration service has continued to redesign processes to address increasing demands and improve responsiveness for people accessing the services. Activities have included: formalised audit processes for waitlists in each specialty; communication strategies for patients, GPs and key stakeholders; changes to referral registration processes; and improved management of booking and scheduling processes.

Issues and challenges

The new Canberra Region Cancer Centre is to open in August 2014. This is an exciting time for staff, including challenges for ongoing transition of services in the new centre.

Achieving a 60 per cent BreastScreen participation rate for women aged 50 to 74 years will involve establishing a process to recruit women using electoral roll data and to increase capacity when the screening service opens at the Belconnen Community Health Centre. Of particular emphasis is the need to increase the number of women from Aboriginal and Torres Strait Islander and culturally and linguistically diverse backgrounds attending regular screening.

Continued review of models of service is occurring across all specialties to meet the increasing demand for cancer services.

Immunology is developing strategies to improve waiting times due to the demand for clinical services. Plans to expand the department are in place and will be implemented in 2015.

Technology capabilities are a critical component of future service delivery in cancer, ambulatory and community health services. To help meet growing demand, ongoing enhancement and adoption of electronic medical record systems is underway, ranging across cancer management information systems and health centre operations, and incorporating client and patient support, such as queue management, Telehealth, better appointment scheduling, replacement of legacy systems and reduction of reliance on paper records.

Future directions

The opening of a breast screening clinic at Belconnen Community Health Centre will ensure the service is able to accommodate the expansion of the target age group to include women aged 70 to 74 years, and increase access to breast screening for women living in Belconnen and Gungahlin.

Using electoral roll data, ACT women in the target age group will be invited to attend breast screening.

  • To increase survivorship support options:
    - a post-treatment group is being developed and will be rolled out in October-November
    - co-facilitation of the TRUCE group will take place with CanTeen for adolescents and young people who have a parent with a cancer diagnosis
    - to facilitate involvement in the survivorship model, a survey will identify psychosocial care questions to help inform service delivery
    - art therapy will complement psychosocial services for both inpatients and outpatients.

Other future directions include:

  • the establishment of research agendas across the clinical departments and a working relationship with the new Centenary Cancer Chair at the John Curtin School of Medical Research
  • further development of disease-streamed clinics and multidisciplinary meetings with clinical haematology
  • partnership with University of Canberra (UC) and the New South Wales Survivorship Clinic (UNSW) to progress development of a Cancer Survivorship Centre at the UC campus
  • development of a business plan with Molecular Oncology, ACT Pathology, for transition of the cancer molecular testing service to the next generation sequencing platform. Cancer molecular testing refers to the detection of so-called driver DNA mutations within cancer cells. This testing will assist with enhancing the diagnosis and detection of the important mutants in tumour samples using next generation sequencing technology, leading to more effective targeted therapies for ACT patients.
  • plans to build on research efforts in genomics to begin to implement personalised medicine in routine patient care in immunology
  • refurbishment of the central outpatient area at the Canberra Hospital campus to improve access and flow and
  • provide a comfortable, calming environment for patients and their families waiting for a specialist appointment.