With advancements in early detection and treatments, more people in our community are living longer with cancer and requiring follow-up care over a longer period of time. At Western Health (WH), follow-up of cancer patients has traditionally been the sole responsibility of the cancer specialist team. Increasing demand and current capacity encouraged WH to explore alternative models of care (MOC). In 2010/11 WH provided care for 898 individuals with colorectal cancer this throughput makes this tumour group ideal to trial novel models of care (MOC). In 2008 Western and Central Melbourne Integrated Cancer Service (WCMICS) developed guidelines for colorectal cancer follow-up which provided a platform for the development of an innovative follow-up MOC.
A review of follow-up care for colorectal cancer patients was completed and when compared to the WCMICS guidelines, significant opportunities for improvement were identified. WH’s compliance with the recommendations are as follows; follow-up frequency 54%, blood tests (CEA) 37%, imaging (CT-CAP) 52% for 3 scans in 5 years and 92% for 2 scans in 5 years and colonoscopies 75% of the time. Other observations from file audits indicated over 20% of patients were lost to follow up, poor communication in medical files, patients regularly came to follow-up appointments without having tests done and little supportive care screening or referrals are completed. Overall this showed that follow-up is not performed in a consistent or coordinated manner at WH.
In response to this, a collaborative follow-up model of care is currently being developed and features planned synchronised routine follow-up by the colorectal clinicians, an advanced practice nurse and the patient’s own GP.
To date, WH has commenced the recruitment process for the advanced practice nurse and hopes to have employed into the role by April wherein we will commence to pilot the new model of care for 6 months.