Making a difference to cancer care.
Article Type: Editorial
Subject: Oncologic nursing (Forecasts and trends)
Cancer (Care and treatment)
Cancer (Forecasts and trends)
Author: Hammersley, Lorraine
Pub Date: 02/01/2012
Publication: Name: Kai Tiaki: Nursing New Zealand Publisher: New Zealand Nurses' Organisation Audience: Trade Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2012 New Zealand Nurses' Organisation ISSN: 1173-2032
Issue: Date: Feb, 2012 Source Volume: 18 Source Issue: 1
Topic: Event Code: 010 Forecasts, trends, outlooks Computer Subject: Market trend/market analysis
Product: Product Code: 8000432 Cancer Therapy NAICS Code: 621 Ambulatory Health Care Services
Geographic: Geographic Scope: New Zealand Geographic Code: 8NEWZ New Zealand
Accession Number: 282425913
Full Text: Last month, Health Minister Tony Ryall announced that medical oncology would be added to the cancer waiting time target from the middle of this year. "This means all patients who need either radiation or chemotherapy treatment should get it within the world gold standard of four weeks," he said. (1) The decision signals a demanding year ahead for all those involved in cancer care.

It is clear the Minister will continue to lead a systematic and co-ordinated approach to cancer control through the national work programme, involving district health boards (DHBs) and regional cancer networks. The Ministry of Health (MoH), through its national cancer programme, has identified the key areas that will have the most significant impact on populations in the next five year. They are:

* radiation and medical oncology, and palliative care--developing services that are sustainable and adaptable to change;

* lung and bowel cancer--two of the most significant cancers. The aim is for fewer people to be diagnosed with these cancers and to improve survival rates; and

* information systems--high quality and consistent information is needed.

By adding medical oncology to cancer wait times (as was done with radiotherapy), it is expected current practice will be reviewed to enable new, safe and sustainable models of care to be developed.

With cancer continuing to be the leading cause of death in New Zealand, it is not surprising this new target has been set. Our population is ageing and the community now has a growing awareness of new therapies and higher expectations of treatment availability. The demand for chemotherapy and targeted therapies continues to grow, as technology provides a greater range of therapies. More treatment options for people with cancer, in turn, lead to more courses of treatment. The question is, how can this be managed with limited growth in funding and workforce shortages? We may need to find smarter ways of working.

In late 2010, the MoH contracted private health consultants Cranleigh Health to undertake a review of current practice, demand, resources, and models of chemotherapy services and delivery. The report was distributed to stakeholders for feedback last October. (2) It reviewed approaches taken in comparable health systems internationally and set out proposed new models of care to improve the way chemotherapy is delivered to patients, based on projected demand and workforce capacity.

Workforce capacity will have a major impact on the proposed new models of care. Like many other professions, the health sector continues to lose many skilled professionals who are choosing to work overseas. Although living in New Zealand is appealing from a lifestyle perspective, pay rates compared to many other countries are not as attractive. This is demonstrated time and again when DHBs attempt to recruit experienced oncologists and nurses from overseas. To date, workforce analysis has never accurately captured how many dedicated oncology nurses there are. Last year, NZNO's cancer nurses' section's continued lobbying finally saw oncology nursing added as workforce criteria to annual practising certificates, therefore finally capturing this important data.

The new models of care proposed for consideration this year have been developed in conjunction with the MoH's medical oncology work group and with significant stakeholder input. There are three interdependent components:

* a delineated service component that defines the expected service delivery into a four-level hub and spoke model (key sites and satellite sites), and describes the services, resources and support required at each level;

* a role definition component defining the roles and functions of key staff on the medical oncology treatment pathway. This includes endorsing a broader scope of practice for specialist nursing and initiatives to increase medical oncologist capacity at key delivery points; and

* a tumour-based component that describes how services are linked and the integration, management and supervision of care nationally and regionally, depending on the type of cancer, treatment complexity and how the patient presents.

A national implementation plan is being developed, with some implementation expected to begin this year. Of particular relevance to nursing will be discussion on an extended scope of practice leg follow up and management of some complications); developing national consistency in areas such as chemotherapy administration; more stringent requirements for formal postgraduate national qualifications for oncology nurse specialisation; and increased involvement of other frontline staff.

The Cranleigh report's findings appear to offer great opportunities for nursing to continue to demonstrate the difference it makes to cancer care. (2) Nursing roles will be integral to implementing these changes. Nurses already lead change by managing care in rural centres, leading care co-ordination and developing nurse-led clinics for tumour streams and high-risk population groups. Ryall acknowledged the contribution nurses make to improvements in radiation oncology wait times at a meeting with the section last August.

However, to fulfil the opportunities presented by the Cranleigh report, nurses will need to be recognised for the contribution they can make. Fulfilling new roles will require a commitment to developing cancer nursing frameworks, scoping of roles, support for education, career development and succession planning to enable safe practice. These were the recommendations made by the cancer nurses' section to the report.

Nurses continually demonstrate their adaptability and enthusiasm for innovation and being able to think outside the square, using their skills and knowledge with integrity and professionalism. Safety and caring for patients compassionately remain primary concerns, while facing these new challenges.


(1) Ryall, T. (2012) Media statement January 18. Retrieved 29/01/12.

(2) Cranleigh Health (2011) Report to the Ministry of Health. New models of care for medical oncology. October 5, Retrieved 29/01/12.

Lorraine Hammersley, RN, BHSc, MA (appld) Nursg, is a clinical nurse specialist at Tauranga Hospital's cancer centre. She also co-edits the Cancernet newsletter.
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