Ovarian Cancer ControlA Strategy for the Management

of Ovarian Cancer in New Zealand.

Peter Sykes

RANZCOG

2007

Why do we need a strategy?

• Need to minimise the impact of this disease.• National Cancer Control innitiative.

• Development of gynae oncology services in NZ.

Age distribution ovarian cancer by age

0

5

10

15

20

25

30

35

40

10 to14

15 to19 20 to24

25 to29

30 to34 35 to39

40 to44

45-49 50-54 55-59 60-64 65-69 70-75 75-79 80-85 85-90 90-95 95-100

Series1

300 New Zealand women get and 175 die of ovarian cancer per year

Goal 1 Prevention

• Incessant ovulation• Diet and obesity• Vitamin D• genetics

• Healthy living• Breast feeding• Contraception

practice?• Identification familial

risk• Genetic counselling• Prophylactic surgery• Support research

Goal 2 Early detection

• Currently no screening• Opportunities for

earlier detection

• Ovarian cancer awareness

• Primary care education

• Availability of ultrasound.

• Support research

Goal 3 and 4 treatment and supportive care

Survival• Stage• Age • Debulking surgery• Chemotherapy• Second line treatment• Other treatments

Quality of life• Disease control• Control of symptoms• Treatment related effects• Psychological• empowerment• Social and emotional

support• Financial issues• Access to care • Quality of care

Challenges of ovarian cancer care

• Inform patient• Inform care givers• Easy access to care• Provide emotional support• Ensure social support

• Timely provision of services

• Initial assessment/ radiology

• Pathologic diagnosis• Curative surgery• Staging surgery

• Debulking surgery• perioperative care• rehabilitiation

• coordinated multidisciplinary care

• Chemotherapy• coordination with other

health professionals• follow up• second line treatment

• palliative care• identification and

management of familial cancer

people• patient load

• trained surgical staff

• trained nursing staff

• experienced pathologist/s

• experienced radiologist/s

• experienced oncologists

• counselling/ dietician/ OT/ physio/ Pastoral care/social work

Facility

• Outpatient service

• dedicated inpatient beds

• Radiology, nuclear medicine / CT/MRI/PET

• Perioperative facilities HDU/ICU

• Access to adequate elective and acute operating time

• administration

Goal 5 improve provision of services /organisation

• Regional services• Sustainable

infrastructure• Appropriate funding

• Transport /family support

• national guideline development and maintenance.

• system of surveillance• financial accountability

• Working relationship with referring clinicians

• community health services• palliative care services• NGO

• genetic services

• education (univ ranzcog)

Goal 6 improve outcomes by research and surveillance

• Database• Outcome reporting• Research infrastructure• participation in

international trials

• international liason

A Model• All cases of suspected or established ca ovary

offered referral• 3or 4 units at least 2 of all key staff

• satellite units• early contact community oncology nurse• equal access free of cost regardless of domicile

• national waiting times and guidelines• funding transparent and sufficient• trial participation• coordinated follow up• outcome and financial reporting

What and Who needs to do it

• Recognise need for Gyn oncology services

• Establish Gyn Oncology units.

• Appoint and accredit and train staff.

• Establish system of funding.

• Expect and fund outcome reporting.

• MOH• Cancer Control• DHB• Gynae units

• Oncology units• RANZCOG• trainees• Cancer society• Surgical working group

• SISSAL• NZGCG

My Concerns• Lack of transparency of funding• Split of surgical and non

surgical oncology

• Lack of incentive for collaboration between dhb

• Inability to attract suitably trained staff

• Lack of unified voice• Little political interest

What Next?

• A written strategy?

• RANZCOG?

• Lobby?

• wait to be asked?

• make it work locally?