Facilitators Ian Campbell, Breast and general surgeon , Waikato DHB and interim chair
National Breast Cancer Working Group (NBCWG)
Charles DeGroot, Clinical Oncologist, Waikato DHB and chair National
Lung Cancer Working Group
Jan Smith, Manager, Midland Cancer Network
Presentations Presentations by Ian Campbell, Charles De Groot, John Childs and Jan
Smith are available for viewing
Ian Campbell.ppt Charles DeGroot.ppt
John Childs .ppt
Jan Smith.ppt
I ntroductions Project manager for National Breast Cancer Working Group (NBCWG) is
Loryn Scanlan (Midland Cancer Network)
Loryn.Scanlan@waikatodhb.health.nz
Specialties represented by workshop participants
Specialty
Breast and general surgeons
Plastic surgeons
Number
12
2
Medical oncologists
Radiation oncologists
Breast physicians
Radiologists
Pathologists
Clinical nurse specialist / nurse – breast screening, breast care, oncology
Geneticists
Pharmacists
Consumer representatives
Maori perspective
Pacific perspective
Breast screening representatives
Regional cancer networks
Ministry of Health
Non-government organizations
2
1
4
2
2
4
2
2
6
6
1
4
4
12
There was no primary care physician at the workshop.
Some participants are listed under more than one specialty.
Workshop purpose
To discuss:
 purpose of the national tumour stream working groups o developing national service standards o developing tumour pathway and service framework
 composition of the National Breast Cancer Working Group
 approach to maintain communication with the wider breast cancer sector
Chair
Workshop attendees affirmed Ian Campbell to take the role of chair of
NBCWG
Page 1 of 6

Composition of
NBCWG
Suggested membership that was presented to workshop:

breast surgeons (2)

breast physician (1)

radiation oncologist (2)

medical oncologist (2)

radiologist (2)

pathologist (2)

clinical nurse specialist / nurse (2)

primary care physician (1)

breast screening representative (1)

consumer representatives (2)

Maori perspective (1)

Pacific perspective (1)
With the inclusion of a Breast SIG representative and chairs of existing regional breast work groups (who can also be one of the specialties listed).
Note: Only the Northern and Midland regional cancer networks have established breast cancer work groups.
At the workshop it was agreed that the following disciplines be added to the membership:

plastic surgeon

data specialist

palliative care

public health specialist / researcher
Other disciplines that were suggested to be included in the membership as necessary:

genetics

psychology

social work

MRT

physiotherapy

psychiatry

pharmacy.
Key discussion points

There will be a core membership of the working group. Where there are specific areas of work that require specialist expertise, then experts would be co-opted to those meetings when required.
 radiologist members should have wide knowledge of medical imaging procedures including mammography, ultrasound, MRI and PET-CT
 clinicians with broad knowledge or who are dual trained could potentially cover more than one discipline
 it was felt that Ian Campbell and others had enough knowledge of current breast cancer data to avoid need for additional specific data
Page 2 of 6

Interested persons and possible membership candidates
Next steps
Other key discussion points person at this stage
 need to ensure geographical coverage
 working group so members are required to contribute time
List of persons unable to attend workshop but interested in working group and persons nominated for possible membership by attendees at workshop is attached in Appendix 1.
Interested in being a member
Send completed expression of interest form and bio (not to exceed one page) to loryn.scanlan@waikatodhb.health.nz
by Friday 13 July.
NBCWG EOI form.doc
Appointment process
Chair of NBCWG, clinical directors of regional cancer networks and the
National Clinical Director of Cancer Clinical will make appointment decisions by 31 July 2012.
Membership of the NBCWG will be communicated to stakeholders.
First meeting
Date: Wednesday 26 September 2012
Venue: Miramar Golf Club Conference Facility, Wellington
Time: 9:30am – 3:30pm (tbc)
Topics for breast cancer standards
Please send potential topics for breast cancer standards to Loryn Scanlan
(loryn.scanlan@waikatodhb.health.nz)
Communication

Workshop invitations were sent to: o Breast SIG members o regional cancer networks o members of regional cancer network breast cancer work groups o national DHB chief operating officers, directors of nursing and chief medical advisors o Royal New Zealand College of General Practitioners o New Zealand Society of Pathologists o New Zealand Committee of Pathologists o Royal Australian and New Zealand College of Radiologists o Royal Australasian College of Surgeons o Breast Surgeons of Australia and New Zealand Inc o BreastScreen Aotearoa o New Zealand Breast Cancer Foundation o Sweet Louise o Breast Cancer Network NZ o Breast Cancer Aotearoa Coalition o Cancer Society.

Issues noted with communications o invitation did not get sent to the appropriate people in some areas o short notice especially for radiologists.

Breast cancer stakeholder database will be developed.
Size of breast cancer working group
Page 3 of 6


Breast cancer working group is expected to be of similar size to the
National Lung Cancer Working Group.

National Lung Cancer Working has sixteen members. There were seventeen attendees at its last meeting.
NBCWG work programme

Developing standards not clinical guidance.

The suggestion was made to use cluster topics and standard statements from lung cancer standards and adapt for breast cancer.

Patient pathway describes ideal breast cancer care pathway. Service framework informs the provision of breast cancer services. It brings together standards, guidance, position statements and useful resources to support best practice and improve overall care of patients with breast cancer.
Faster cancer treatment indicators

Indicators to apply to all cancers.

Complexity is not a good enough excuse for delays.

Two of the faster cancer treatment indicators focus on front end of pathway from: o referral to first specialist assessment (14 days) o referral to first treatment (62 days)

Shorter waits for cancer treatment radiotherapy and chemotherapy targets remain in place.

Delivering health care that is timely is a dimension of quality health care.

Standards to act as drivers to establish quality care and to move services forward.

Other national focus areas are care coordination and cancer related multi-disciplinary meetings.
Breast cancer care pathway

Diagnostic and staging work-up for breast cancer is complex.

BreastScreen Aotearoa evaluation target of four weeks from diagnosis to treatment which has been in place for thirteen year is not achieved.

Even in private in the Waikato only 80% of women receiving surgery as their first treatment meet the four week target.

Attendees agreed that: o from a patients perspective we should try to offer treatment within
62 days of secondary care receiving a referral o by becoming more patient focused delays in diagnostic and staging work-up should be reduced.
Use of radiological resources

Need to reduce wait times to access diagnostic imaging examinations.

Need to ensure appropriate use of imaging in the breast care clinical community.

Need for appropriate classification and standardisation of imaging surveillance and care of high-risk women
Page 4 of 6

Appendix 1


Breast and general surgeons Birgit Dijkstra (Canterbury DHB)
Plastic surgeons
Breast physicians
Radiation oncologists
Medical oncologists
Palliative care
Radiologists
Pathologists
Nurses
Garth Poole (Counties Manukau DHB)
Belinda Scott (Auckland)
Malcolm Ward (Canterbury DHB)
Semisi Aiono (Whanganui DHB)
Etienne Truter (Lakes DHB)
Professional group to recommend interested persons for membership
Could be covered by Marli Gregory (Clinical Lead for
BreastScreen Aotearoa and breast physician) or possibly
Morag Baruch (GP and breast physician)
Carol Johnson (Capital & Coast DHB)
Glenys Round (Waikato DHB)
Lyndell Kelly (Southern DHB
David Porter (Auckland DHB; chair Breast SIG)
Marion Kuper (Waikato DHB; chair Midland Breast Cancer
Work Group)
Bridget Robinson (Canterbury DHB)
Vernon Harvey (Auckland DHB)
Richard Isaacs (MidCentral DHB)
Could be covered by Glenys Round (Radiation oncologist and a palliative care physician)
Barbara Hochstein (Lakes DHB)
Gill Beveridge (Counties Manukau DHB)
Jenny Walker (Waitemata DHB)
Marcel Brew (Christchurch Radiology Group)
Deborah McMutrie (Medex Radiology)
Anne Harkness (Hibiscus Radiology)
Madeleine Wall (Capital & Coast DHB)
Stephen Wood (Auckland Radiology Group)
Shelley Boyd (Canterbury DHB)
Gavin Harris (Canterbury DHB)
Murray Thorburn (Pathlab Waikato)
Rachael Collier (Waikato DHB)
Cheryl MacDonald (MidCentral DHB)
Page 5 of 6

Primary care physician (GP)
Consumer representatives
Maori perspective
BreastScreening
Geneticists
Public health expert
NGO representatives
Jan McMullen (Auckland DHB)
Lyn Little (Waikato DHB)
Alison Foster (Wellington)
Morag Baruch (Tauranga)
Phyllida Cotton-Barker (Auckland)
Mary Obele (Christchurch)
Libby Burgess (Breast Cancer Aotearoa Coalition)
Raewyn Calvert (Midland Cancer Network)
Sheldon Ngatai (Central Cancer Network)
Rowena Lewis (Northern Cancer Network)
Rowena has advised that she is happy to input via Northern
Cancer Network
Sheldon Ngatai (Consumer representative, Central Cancer
Network)
Marli Gregory (Clinical Lead BreastScreen Aotearoa and breast physician)
Alison McEwen
Francesca Pigatto (Auckland DHB)
Charlotte Paul (Professor Preventative and Social
Medicine, University of Otago)
Brian Cox (Public Health Physician, University of Otago)
Mark Elwood (Professor of Cancer Epidemiology,
University of Auckland)
Van Henderson (New Zealand Breast Cancer Foundation)
Page 6 of 6