National Cancer Programme Update: September 2014
Welcome to the latest edition of our National Cancer Programme Update. We will send you a
new update every few months to keep you informed about key areas of our work programme.
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Faster cancer treatment across the pathway
The new Faster Cancer Treatment health target for District Health Boards will be introduced
from 1 October 2014.
The new target is that patients receive their first cancer treatment within 62 days of being
referred with a high suspicion of cancer and the hospital doctor receiving the referral also
believes there is a need for an appointment within two weeks.
The 62-day wait is measured from receipt of the referral by the hospital to the date treatment (or
other management) begins. By July 2016, 85 percent of patients meeting the criteria should
begin treatment within 62 days of referral, increasing to 90 percent by June 2017.
The new 62-day cancer target replaces the Shorter waits for cancer treatment: radiotherapy and
chemotherapy target which has been consistently achieved for all patients by all DHBs.
It extends the scope of the previous health target, with the aim of ensuring that people with
suspected cancer receive faster access to services, from diagnostic tests to surgery or other
treatment.
The new target reflects the progress so far in improving cancer waiting times. It supports
continued reduction in waiting times, as well as highlighting opportunities for better co-ordination
and integration along the whole care pathway.
The 62-day timeframe is an international benchmark that allows time for all necessary tests and
investigations to be completed in order to confirm a diagnosis and to agree an appropriate
treatment plan in conjunction with the patient and multidisciplinary team. A 62-day wait target is
in place in the UK and Canada, and has led to big improvements in the time people wait for their
first treatment.
Preliminary data from DHBs suggests that about two-thirds of patients meeting the criteria for
the 62-day wait target currently receive their first treatment within the target period. DHBs are
expected to steadily improve their performance against the target over the next two years and to
improve the quality and transfer of data.
The 90 percent threshold allows for a small percentage of exclusions – for example, in some
cases there will be clinical reasons why a patient should wait longer before treatment begins, or
in some circumstances patients may not choose to start their treatment straight away.
It is estimated that the target will apply to approximately 25 per cent of newly-diagnosed cancer
patients. The remainder of newly-diagnosed cancer patients will access treatment through
pathways that fall outside the 62-day target, including those diagnosed through screening
programmes or following an acute hospital admission or in the private sector.
All patients with a confirmed cancer diagnosis are expected to receive their first treatment within
31 days of a decision to treat, which remains a health indicator.
The first quarterly results on the new target (for quarter two 2014/15) will be published in
February 2015.
DHB audit of Faster Cancer Treatment indicator process
The Ministry has contracted with Central TAS, the shared services agency owned by the six
central region DHBs, to develop a Faster Cancer Treatment (FCT) Self-Assessment Audit Tool.
The tool, which is similar to an on-line survey monkey, will help assess how consistent FCT
indicator reporting is across DHBs.
It is expected the tool (based on the updated FCT Indicators Business Rules and Data
Definitions v3) will be released to DHBs at the end of October 2014, once testing is completed.
The audit is expected to take about 40 minutes to complete. Results will be submitted to the
Ministry for analysis.
A link to the audit tool will also be provided, along with information on who should complete it
and the required timeframe.
National tumour standards work programme
The 10 tumour standards developed last year are now being used to promote quality, consistent
services across New Zealand.
Since their publication in December 2013, regional cancer networks and DHBs have started
using the tumour standards as a service improvement tool by reviewing their services against
the standards and implementing improvements.
Chair of the National Sarcoma Tumour Standards Working Group, Michael Flint, says he has
already noticed a shift in clinician behaviour as the standards are circulated and reviewed
around the country. He says the Standards have improved communication and awareness of
pathways.
Michael Flint sees a strong commitment and support for the Standards from those working with
sarcoma patients.
“It’s difficult to state anything concrete,” he says, “but there appear to be trends in behaviour that
hopefully will translate into better care for patients."
This month, the second phase of the tumour standards work programme begins. The key
deliverables for this phase are:

Stage A (from September 2014)
 Tumour specific core datasets (including data definitions) for 10 tumour streams
 An agreed consistent definition for ‘high suspicion of cancer’ for each of the 10 tumour
streams. Draft definitions will be developed by the end of December 2014 and will be
consulted on through to early February. It is expected the finalised definitions will be
ready for use at the end of March 2015.

Stage B (by the end of December 2015)
 Follow-up and surveillance guidance for 10 tumour streams
 Prioritisation guidance for multidisciplinary meetings for 10 tumour streams

Stage C (by the end of June 2016)
 A high level review of the tumour standards published in December 2013
The tumour standard working groups have reconvened to carry out this work. Sapere Research
Limited, in collaboration with the Southern Cancer Network, has been contracted by the Ministry
to provide technical analysis and to coordinate the work.
A pan-Chairs group will meet regularly to ensure a consistent approach across the tumour
standards. Its members are:
Bowel - Chris Jackson, medical oncologist
Breast - Ian Campbell, breast and general surgeon
Gynaecological - Peter Sykes, gynaecological oncologist
Head and Neck - Nick McIvor, head and neck surgeon
Lymphoma - Leanne Berkahn, haematologist
Melanoma - Richard Martin, consultant surgical oncologist
Myeloma - Peter Ganly, haematologist
Sarcoma - Michael Flint, orthopaedic oncologist
Upper Gastrointestinal - John Windsor, consultant surgeon
Thyroid – to be confirmed
Lung – Charles de Groot (through the National Lung Cancer Working Group)
Progress towards nurses performing endoscopy
The advisory group established to guide the expanding role of nurses in endoscopy has
canvassed DHBs to gauge their interest in developing the new roles.
All responses to date have expressed support. It is expected that endoscopy training for
nurses, gastroenterologists, and general surgeons will be subject to identical standards and,
expectations and that there will be common governance of the training available to all three
professions.
The training of nurses in endoscopy will be subject to sites being accredited for training and will
take full account of available supervision and support.
The advisory group is currently holding discussions with tertiary providers regarding the
educational framework for nurses performing endoscopy. It is likely that nurses will require a
Post Graduate Diploma in Nursing (PGDipNurs) for entry into the endoscopy training and it will
involve two specialist papers and a practicum.
The endoscopy nurse role is not seen as a substitute for the role of gastroenterologists and
general surgeons. Having trained nurses available to perform endoscopies will enable medical
staff to undertake more complex procedures and improve service delivery.
The advisory group includes representatives from Health Workforce New Zealand, the Ministry
of Health, the National Endoscopy Quality Improvement Programme, national nursing
organisations, DHBs, New Zealand Society of Gastroenterology, Royal Australasian College of
Surgeons and private providers.
For more information please contact Ruth_Anderson@moh.govt.nz
Guidance developed for management of men with prostate cancer
Guidance is being developed to help specialist and primary care services provide nationally
recommended active surveillance care plans to men with prostate cancer.
Active surveillance is a programme of care suitable for some men whose prostate cancer is
considered at low risk of becoming life-threatening. It involves monitoring through repeated
clinical evaluation, including PSA measurements, prostate biopsy and MRI scans.
The active surveillance guidance draws on current evidence, best practice and the 2013
recommendations of the Prostate Cancer Taskforce. It has been developed by a specialist subgroup of the Prostate Cancer Working Group. The group includes urologists, radiation
oncologist and representative from the Australia and New Zealand Urological Nurses
Association. Input has also been provided by primary care representatives.
A copy of the draft active surveillance guidance will shortly be sent to all DHB urology, radiation
oncology and radiology departments, and other interested parties, for their review and feedback.
The Ministry is also seeking input from a wide range of health care services and clinicians
involved in prostate cancer care. A revised draft will be considered at this year’s national
meeting of the Urological Society of Australia and New Zealand in November 2014.
A final version of the guidance will be circulated to all specialist and primary care services so it
can be introduced into pathways and clinical practice from early 2015. Once introduced, the
guidance will help ensure there is a consistent approach to active surveillance across the
country.
The guidance is one of a number of resources being developed as part of the Ministry of
Health’s prostate cancer Awareness and Quality Improvement Programme.
Palliative Care Council adopts broader leadership role
With the completion of a number of palliative care projects across the Ministry’s cancer work
programme, there has been some focussed discussion between the Ministry and sector leaders
about future palliative care direction and leadership.
The Palliative Care Council (PCC) is seen as best placed to lead the strategic policy direction
for palliative care now that the Palliative Care Advisory Group’s (PCAG) work programme has
been completed.
Ministry of Health Deputy Director-General, Sector Capability and Implementation, Cathy
O’Malley, says PCAG contributed greatly to the completion of several significant projects over
the past six years.
They include the Gap Analysis of Specialist Palliative Care, the Resource and Capability
Framework for Palliative Care, and the Specialist Palliative Care Service Specifications.
She says it is now more appropriate to hand the mantle for palliative care to the PCC.
“Palliative care is broader than just cancer. Increasingly it is in aged care settings where there is
the greatest focus on good access to palliative care and this is reflected in the PCC’s increasing
work programme,” says Cathy O’Malley. “An ageing population and better management of
some chronic conditions are contributing to an increasing demand for specialist palliative
services.
“Quality palliative care contributes to the achievement of several strategic priorities for the
health sector and remains an important part of the National Cancer Programme’s broader
pathway approach. It is included in all 11 tumour standards of service provision. It is also a
component of the faster cancer treatment indicators work (as a treatment modality).”
Faster Cancer Treatment Service Improvement Fund initiatives
Local and regional initiatives have started around the country as part of the first round of the
dedicated $11.2 service improvement fund designed to improve cancer services and the
experience of patients throughout their treatment.
More than 43 proposals were received, and 23 were funded across 13 providers. A number of
projects took a regional approach and are detailed below.
Midland Cancer Network:
 Map inter-DHB referral pathways across the Midland region and develop a mechanism
to identify and monitor patients on the 62-day pathway.
 Coordinate tumour standards implementation initiatives including reviewing and updating
the Midland supportive care service directory, identifying DHB specific patient
information resources and implementing a web based repository, identifying and
adopting an education tool for cancer nurse specialists and coordinating DHB selfassessment, stocktake and gap analysis against tumour standards.
 Develop and implement the Midland gynae-oncology model of service across the
Midland region.
Northern Cancer Network:
 Establish a single point of access clinic which will allow lung cancer patients in the
northern region to receive first specialist assessments and diagnostic activities, including
computerised tomography scans, fine needle aspiration, biopsy extra thoracic lesion and
bronchoscopy, on the same day.
Central Cancer Network and Northern Cancer Network (Computerised Tomography
Colonography Initiatives):
 The Central Cancer Network will identify current capacity and demand for CT
colonography (CTC) across the central region and develop a regional implementation
plan.

The Northern Cancer Network has identified CTC as a key area and will develop, deliver
and monitor a pilot of CTC scanning for patients with a suspicion of bowel cancer across
the Northland, Auckland, Waitemata and Counties Manukau DHBs.
A second round of funding will be made available in 2015. The Ministry will hold a forum near
the end of round one to share learning's and project outcomes.
AYA research underway
A national retrospective case review of Adolescent and Young Adult (AYA) bone tumours
diagnosed in the previous decade is well-underway and will be completed later this year.
It is part of work aimed at better understanding disparities in AYA cancer survival identified in a
recent analysis paper. The analysis of AYA cases between 2000 and 2009 indicated that
outcomes for some young people with cancer are poorer in New Zealand than in other
countries.
It indicated there are poorer outcomes for those aged 15 to 19 years, Maori and Pacific youth
and young people with particular types of cancer.
In December 2013, the Government announced an additional $650,000 over two years to help
fund a national approach to AYA cancer services and improve outcomes for young people.
An AYA Governance Group has been established to provide leadership and set a national
strategic direction. Its membership includes senior level specialists and sector experts,
including NGO services and consumers. The group aims to identify factors which have
contributed to New Zealand’s poorer survival in order to identify improvements that can be
made to the future delivery of cancer services for this at-risk group.
A priority for the governance group is to appoint a national clinical lead and establish the AYA
Cancer Network to connect health professionals and providers involved in AYA cancer care.
The network will use small working groups of health and voluntary sector specialists to examine
specific issues and develop best practice advice to guide the delivery of care.
The AYA Governance Group met for the first time in July 2014 and set priorities for action over
the next two years. They are to:
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develop a strategy for AYA cancer care in New Zealand
develop infrastructure to support establishment of the AYA Cancer Network, including
appointing a clinical leader
develop national standards of care for AYA cancer
implement a monitoring and evaluation framework
undertake targeted research into current gaps in survivorship for specific AYA groups.
More information on the work of the AYA Governance Group, including details on how to
register your interest in upcoming vacancies, visit www.ayacancernetwork.org.nz
Psychological and social support services for people with cancer
An advisory group will be established in October 2014 to support work to improve psychological
and social services for people with cancer.
Budget 2014 provided funding to establish additional supportive care services throughout New
Zealand to ensure that the emotional and psychological needs of cancer patients are properly
assessed and patients and their families receive the support and care they need.
The Budget funding is for:
 up to 20 new cancer psychological and social support workers
 6 new psychologists – one for each cancer centre
 a national leader to provide overall guidance and professional support
 the development of training standards and tools to assess patient needs.
The Ministry will shortly begin working with DHBs, regional cancer networks, non-government
organisations and health professionals to implement the services.
The advisory group’s work will include:
 updating a 2011 stocktake of supportive care services
 service design
 a service specification
 role descriptions for the new positions
 an implementation plan
 a monitoring and evaluation plan.
The Ministry will also seek expressions of interest for the national lead role later this year. DHBs
can expect that funding will be available for them to start filling the new psychologist and
psychological and social support worker positions from July 2015.