Support and coordination of services post treatment is an evolving area in cancer care. For people in regional settings, access to services, poor survival outcomes and limited specialist services can impact on post-treatment care.
To extend cancer services in a regional setting, enabling supportive and coordinated care post adjuvant cancer treatment by implementing a shared care model between general practitioners and specialists, facilitated by a nurse led clinic (NLC).
In collaboration with Latrobe Regional Hospital (LRH), Bairnsdale Regional Health Service (BRHS), Gippsland Southern Health Service (GSHS), Gippsland Primary Health Network (GPHN), Gippsland Regional Integrated Cancer Services (GRICS) and Monash University, a NLC has been established to support patients from breast, colorectal, prostate and lymphoma tumour streams completing adjuvant treatment, and co-ordinate their follow up care between specialist and general practitioner.
Fifteen breast cancer patients have attended the NLC within 2 months of implementation with a further ten referrals to be coordinated. A breast specific end of treatment care plan has been developed in consultation with the multidisciplinary team. Data is being collected to ensure sustainability and feasibility of the model. Collection measures include Patient Reported Outcome Measures (PROMs), demographic data and qualitative surveys. Additionally, colorectal, prostate and lymphoma pathways are being developed and will be incorporated in the clinic within the next six months.
The GCSP supports cancer patients following treatment and enhances service provision in a regional setting, promoting coordinated and collaborative care that is shared between primary and specialist health providers to minimise identified geographical disparities. This model of care enables the potential to meet increasing health service demands, whilst providing ongoing comprehensive care to cancer survivors.