Local Collaborative Tumour Group (LCTG)

The establishment phase of the LCTG included the following steps -

• Clinical leadership - Lead clinicians have been appointed by a consensus process amongst interested clinicians for the breast, thoracic, GI, head and neck, neurosurgical, gynaecological and haematological tumour streams.
• Service development - Regular meetings have been held with the lead clinicians and service development opportunities identified within each tumour stream.
• Patient Management Frameworks - Most of the lead clinicians participated in the local workshop held by the CPCU on the PMF’s. Feedback was delivered to that consultative process both through the workshop, a local submission and through a general submission from the rural integrated cancer services.
• Health and ICS service capacities - Further progress in this area awaits the development of the final patient management frameworks in mid 2006.
• Clinical leadership - This has been established for six tumour streams and is active.
• Tumour specific standards - This task will be undertaken in 2006/07 by the adoption of internationally recognised standards by a process of consensus by the local collaborating tumour groups.
• Audit against standards - This process awaits both the adoption of the standards and the development of IT support to allow efficient audit.
• Advice on capacity - This awaits the collection of further data.
• Referral pathways - Referral pathways in regional and rural areas are largely on a personal basis. In many parts of the region there is only one specialist practitioner who manages referrals to other appropriate specialists and sub-specialists after the initial referral. This process is poorly documented but is perceived by practitioners to work efficiently.

The proposed model for Local Collaborative Tumour Groups

Identifying the Priority Tumour Streams

Prior to the selection of tumour streams the statistical data for the region were closely analysed. Criteria were developed by which the initial three tumour streams would be selected. The criteria were:-

• Volume - There had to be a sufficient volume of tumours of that type in the region to ensure competency as many studies have demonstrated a relationship between the number of tumours managed and outcomes.
• Multi-disciplinary Care - It was important initially to choose tumours where multi-disciplinary care was of established benefit to ensure a wide range of all stake holders were involved in the process.
• Geographic dispersion - It was considered important to select tumours managed both in the major centre (Ballarat) as well as in smaller centres to ensure a regional orientation from the beginning of the programme.
• Metropolitan affiliation - It was felt important that a selected tumour stream ie: (neuro-oncology) where a relationship would have to be developed with a metropolitan centre where it was always be necessary to send patients for at least part of their care eg neuro-surgical.
• Existing programs - As a result of the BSEP program substantial resources have been devoted to the management of breast care and multi-disciplinary processes are fairly well established. On that basis it was not selected as part of the initial assessment although the existing program will continue to be supported and enhancements made when resources allow.
• Subsequent development – Head & Neck, Neuro-Oncology - Subsequent to the development of the GICS program service providers in the region appointed specialists with relevant expertise in head and neck surgery and neurosurgery. Although not initially part of the formal planning process it was felt important that these cancer services be assisted in their initial development and established on sound multi-disciplinary lines. As a consequence there will be five tumour streams selected for initial development.
• Gynaecological and Urological Oncology - Existing gynaecological and urology services already function with a significant multi-disciplinary component. Discussions have taken place with lead clinicians in those areas about further enhancement and documentation of this aspect.
• Other - The remaining three tumour streams (skin, upper GI) will be further developed in the first half of the financial year 06/07

Priority Tumour Streams