Tumour Streams Frequently Asked Questions

What are tumour streams?
What are the categories of tumour streams?
How will the tumour streams be developed?
How will Statewide Reference Groups be established?
What is the purpose of a patient management framework?

What are tumour streams?

Tumour streams are described in "A Cancer Services Framework for Victoria." The concept of tumour streams includes: development of local collaborating tumour groups based on the ten major tumour categories; establishment of Statewide Reference Groups for the ten major tumour categories; standards of care; facility standards; clinical and performance indicators; and role designation of services based on specification of the range of services that could be provided at an institutional level. This process is expected to take some years for complete development.

What are the categories of tumour streams?

Ten tumour streams account for more than 90% of the total cancer incidence in Victoria. "A Cancer Services Framework for Victoria" recommended that organ or system specific tumour streams be adopted to reduce care variation. The recommended tumour streams are:

1. Genito-urinary cancers, including cancers of the prostate, bladder, kidney, and testis
2. Colorectal cancer
3. Breast cancer
4. Lung cancer 
5. Skin cancers, notably melanoma 
6. Haematological malignancies, encompassing lymphoma, leukaemia, and myeloma 
7. Gynaecological cancers 
8. Head and neck cancers 
9. Upper gastro-intestinal cancers, encompassing cancers of the oesophagus, stomach, pancreas, and hepato-biliary system. 
10. Central nervous system tumours

How will the tumour streams be developed?

Tumour streams will take some years for complete development. Clinicians have a strong leadership role in the establishment and implementation of the tumour streams and are encouraged to meet and discuss the most effective way to establish local collaborating tumour groups in their Integrated Cancer Service (ICS).

The Ministerial Taskforce for Cancer has identified that the first stage in the development of tumour streams will be a clear description of the patient journey across the continuum of care identifying the critical points along that pathway and the optimal care required. This description will outline a patient management framework for each of the tumour streams.

How will Statewide Reference Groups be established?

The process for establishing the Statewide Reference Groups is yet to be developed but it is expected that members of the collaborating tumour groups will be nominated to the Statewide Reference Groups for each of the tumour streams. Statewide Reference Groups for each tumour stream will provide a focus of expertise to advise on standards development in each tumour stream and to support local collaborating tumour groups at Metropolitan ICS and Regional ICS level. They will also assist in the development of role designation based on facilities and expertise available to meet standards of care in each tumour category, and a sufficient workload to maintain safe and effective services. Role designation will provide clear guidelines for hospitals to practice within agreed limits and stipulate when to refer to a larger centre.

What is the purpose of a patient management framework?

The purpose of the patient management framework is to provide a consistent statewide approach to care management across each of the tumour streams. The frameworks will provide a basis for mapping of current service provision across the state and identify gaps in service provision and priorities for further development.

The patient management frameworks will include:

• Identification of the critical points for optimal patient management across the continuum of patient care from diagnosis to palliation and terminal care, if applicable. A critical point is defined as a particular place in the care pathway where decisions and care provided at that time will have a significant impact on the outcome for the patient;
• Brief description of the current state of evidence for practice and where appropriate clinical guidelines, care pathways, consensus statements, standards and research that exist to support optimal care at the critical points;
• Consideration of the facility requirements eg clinical expertise and skill mix, resourcing and equipment to ensure optimal care at each critical point of the patient pathway; and
• Description of the investigations, therapies and supports that need to be available at each critical point.