Output 1.4 - Cancer Services

The division of Cancer, Ambulatory and Community Health Support provides:

  • Canberra Region Cancer Services inclusive of a comprehensive range of cancer screening, assessment, diagnostic and treatment services

  • palliative care services

  • administration support to Ambulatory and Community Health sites.

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 and cervical cancer meet targets

  • ensuring that the waiting time for access to essential services, such as radiotherapy, are consistent with agreed benchmarks

  • 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.

The division is also responsible for providing administrative and clinical support services across Canberra Hospital and Health Services, including:

  • intake

  • referral management

  • booking and scheduling

  • clinic management

  • nursing and allied health to Central Outpatients

  • transcription services.


Services commenced in the Canberra Region Cancer Centre (CRCC) on 18 August 2014. The centre is designed to improve the integration and standard of care to people with cancer in the ACT and surrounding region. A Medical Oncology Nurse Practitioner position has been recruited. In 2015–16, this position will be integrated into the operations of the CRCC Rapid Assessment Clinic.

More information: Detailed information about the CRCC is provided in the Canberra Region Cancer Centre section.

Cancer Services provided 1,428 radiotherapy treatment courses for new and returning patients during 2014–15. This is a 4.4 per cent increase on the same period last year. New referrals increased by 5.9 per cent during 2014–15.

Cancer inpatient services increased with the opening of eight extra beds in ward 11C. This ward is designed to assist patients with their transition:

  • between acute care services and the community prior to discharge

  • during interstate transfers

  • when having radiation treatment that require an inpatient bed

  • from ward 14B to an awaiting a nursing home placement.

During 2014–15, the Centre for Personalised Immunology was established. Clinicians from the Department of Immunology worked in collaboration with the centre and a broader collaborative network of Australian and international clinicians and scientist.

Cancer Services also developed Cancer Psychosocial Service introduction postcards, which are designed to support access to and normalisation of psychosocial support for patients and families/carers following a cancer diagnosis.

Two DVDs were developed and launched in 2014–15 to assist people when they or someone they care for is experiencing cancer:

  • one DVD was for patients requiring radiotherapy, outlining what to expect during treatment

  • the second DVD was for health professionals to assist in end-of-life conversations.

The DVDs were developed with input from patients and carers. Funding sources included Dry July.

Performance against accountability indicators

BreastScreen ACT’s access and uptake has continued to improve during 2014–15:

  • 99 per cent of women wait less than 28 days for a screening appointment.

  • For women requiring further investigation at an assessment clinic, 90 per cent were provided an appointment within 28 days from their initial breast screening appointment.

  • 99.95 per cent of women with a normal result received a letter within 28 days.

Breast and cervical cancer screening

Achieving a 60 per cent participation rate in breast screening in the ACT remains a challenge for the BreastScreen Australia Program.

Despite efforts, breast screening participation for the 50–69 year old cohort in the ACT has remained steady at 55 per cent. Efforts to encourage GPs to refer women to the program will be a focus in the coming year.

More information: Detailed information is provided in the BreastScreen Australia Program section.

Essential services wait times

With the appointment of new specialists within Haematology the waitlist has been reduced from six months to triage category timeframes. This also provides the ability to continue to refine and improve the multidisciplinary approach to Lymphoma care and clinics.

The Haemophilia Treatment Centre (HTC) has been established and provides information and educational material for patients of all ages and their family and carers.

Following receipt of a funding grant, the HTC has commenced an outreach program for:

  • medical practitioners

  • nursing staff

  • paramedics

  • local school teachers

  • patients living in the rural NSW adjoining to ACT region and their families.

To date, two programs have been undertaken involving an education program and follow-up visits by the haemophilia care providers.

Both programs were very successful, increasing the attendee’s knowledge of haemophilia and other bleeding disorders, and identifying the challenges that regional and rural families face.

BreastScreen Australia Program

From November 2014, BreastScreen ACT used Electoral Roll data and lapsed attendee reports to send breast screening invitation letters to women in the target age group (50–74 years). From November 2014 to 30 June 2015, BreastScreen ACT sent invitations to 10,370 women identified from the Electoral Roll.

The program also instigated:

  • follow-up phone calls to lapsed attendees

  • letters and education sessions to GPs

  • community information sessions

  • stalls at various conventions

  • resource distribution.

Also in November 2014, BreastScreen ACT implemented the BreastScreen Information System (BIS). This is an electronic record keeping system, which is linked to the Picture Archival and Communication System (PACS). The implementation of the BIS aims to streamline administration and clinical processes, and better support the program’s reporting requirements.

Within the reporting period, the Breast Cancer Treatment Group completed 15 years of breast cancer treatment data from the ACT and Southern NSW Region. This significant body of work will provide cancer services in the region with data on the treatment outcomes for women with breast cancer. The report is due for release in October 2015.

BreastScreen ACT was awarded a Reconciliation Recognition Certificate for work with the Aboriginal and Torres Strait Islander community in the ACT.

Administrative and clinical support

The Ambulatory Care Administration Model project saw significant progress in relation to standardisation of administration processes across CHHS. This included significant work to address problems with ambulatory care data reporting.

While the Ambulatory Care Administration Model has progressed in relation to standard processes, the required structural changes are still being implemented. The model’s success is dependent on these changes in structure and governance, which will be fully implemented by the end of 2015.

A major restructure of ACTPAS clinics commenced in June 2015. This will enable improved data reporting for all ambulatory services and provide:

  • a clinic hierarchy reflective of the current organisational structure

  • allow for comprehensive territory and national reporting of non-admitted services

  • allow for more comprehensive and flexible reporting at a local level to assist with service planning activities.

Transcription services resolved the backlog in transcribing, which was due to the significant increase in demand for outpatient services at Canberra Hospital. This was achieved by increasing the use of outsource providers. It has resulted in all specialities achieving receipt of letters for approval within the five day performance indicator.

Community Health Intake successfully incorporated the ACT Health Dental Program Intake. This provides a single point of intake for a wider range of community-based services. It resulted in call volumes increasing by 50 percent over the year compared to the previous year.


The Medical Oncology Research Unit received a grant of $50,000 from the Monaro Committee for Cancer Research, to support its research program.

The Department of Medical Oncology continues to contribute to collaborative research with 16 clinical studies open to enrolment. In 2014–15, it:

  • published 18 journal articles and four book chapters

  • had an additional five papers accepted for publication

  • contributed to 42 research abstracts presented at various local, national and international conferences.

ACT Health became a formal research partner of the Centre for Oncology Education and Research Translation (CONCERT), which is:

  • a collaboration between cancer research groups within South Western Sydney, Illawarra Shoalhaven and the ACT Health districts

  • funded by a grant from the Cancer Institute NSW.

The aim is to systematically and collaboratively study specific cancers in-depth and to develop new technologies and methods to improve treatments, quality of life and outcomes for patients with cancer.

Radiation Oncology has increased active participation in clinical trials. The department’s strategic research directions align with national cooperative clinical trial research groups, such as the Trans Tasman Radiation Oncology Group (TROG). There are high levels of representation, engagement and contributions from all clinical groups within the department.

The Radiation Oncology Private Practice Trust Fund continues to support a significant number of research personnel within the department. This has had a positive effect in:

  • progressing the research

  • developing and implementing new technologies and making these available to patients

  • implementing investigator-initiated projects, enabling the education and further specialisation of radiation oncology staff.

Awards and nominations

A number of awards and nominations were received during 2014–15:

  • The Centre for Personalised Immunology was recently awarded a prestigious National Health and Medical Research Council (NHMRC) Centre of Research Excellence grant.

  • The Palliative Radiotherapy Rapid Access Clinic (PRRAC) project team were finalists in the ACT Quality in Healthcare Awards in the category of Access and Efficiency.

  • The 2014 Award for Allied Health Team Excellence was awarded to the Stereotactic Radiosurgery (SRS) team in recognition of outstanding commitment to the development, trial and implementation of a multidisciplinary SRS treatment service.

  • The Palliative Care team were winners in the ACT Public Service Awards for Integrity, with recognition of how the team worked together to take responsibility and accountability for health support and care decisions and actions. All team members provide the upmost patient care with compassion, understanding, dignity and respect.

Future directions

During 2015–2016, Cancer Services will:

  • continue the growth of translational research and clinical trials

  • expand multidisciplinary team services, including a specific Myeloma multidisciplinary team (MDT) and clinic

  • develop a sub specialty thrombosis, haemostasis and platelet service, which will be achieved with the appointment of an eighth staff specialist

Models of Care for cancer services will continue to be developed, to enable improved quality of care while addressing the increasing demand for services

Survivorship Model of Care data is still being analysed to determine future directions that are important in providing this service.

Breast and cervical cancer screening

A breast screening clinic will open at the BCHC in the latter half of 2015. This will increase accessibility and ensure an increased capacity to accommodate the expansion of the target age group to target women aged 70–74 years.

Administrative and clinical support

When the Ambulatory Care Administration Model is fully implemented, the focus across CHHS will be to embed standardised processes and create sustainable systems, supported by appropriate technologies. Ultimately this will allow all processes across the continuum from referral to discharge to be better managed, including ambulatory care waiting list management.

While transcription services have dramatically improved over the past year, a review of the current model is needed. This review will consider a number of options to provide an efficient, timely, flexible and sustainable transcription service across CHHS.

An education package designed to increase awareness of haemophilia in Canberra Hospital and other health care providers is being developed.

Community Health Intake is planned to expand to provide a comprehensive intake service across CHHS over the coming year. This will assist in achieving a single point of intake for consumers of ACT Health services.

Radiation Oncology

Technology capabilities are a critical component of the Radiation Therapy service. Updated technology through the Radiation Oncology Major Equipment program provides efficiencies and improvements to radiation therapy services. Planned future replacement of end-of-life major equipment will provide further efficiencies and improve access to more targeted radiation therapy treatments, such as Intensity Modulated Radiation Therapy (IMRT).

The planned integration of the ARIA oncology information system with other ACT Health systems will support:

  • increased efficiency

  • streamlined processes

  • establishing an electronic medical record.

Implementing new technologies enables improved treatments and outcomes for patients. However, the increasing complexity, planning and treatment time is resulting in an increase in demand for Radiation Oncologists, Radiation Therapists and Physics groups and presents ongoing challenges to ensure patients are treated within safe timelines.

Radiation Oncology will continue developing the following clinical projects:

  • Expanding verification imaging capabilities, including developing a credentialing program.

  • Developing respiratory gating, including:

    • 4D image acquisition, to improve tumour definition

    • deep inspiration breath hold techniques, to reduce the radiation dose to critical organs.

  • Expanding the application of IMRT to include prostate cancer treatment.

  • Expanding the use of ARIA, which is the oncology information management system.

  • Developing scripting to automate radiotherapy treatment planning system processes and provide process efficiencies.

  • Increasing access to IMRT in Radiation Oncology from the current 12 per cent of patients to the recommended 30 to 40 per cent, depending on clinical case mix.