Clinical Service Capability Framework—Summary of draft cancer module

The following is a summary of the 2007 version CSCF Draft Cancer Module for:

1. Medical oncology services

2. Haematological malignancy services 3. Radiation oncology services.

Palliative care is not included here as this section of the CSCF (Section C7) has been published within version 2 (2005).

As noted earlier in this Plan the CSCF has recently been reviewed and updated with the new version anticipated for release during 2010 assuming all relevant approvals are obtained.

A ‘rule of thumb’ mapping of the 2007 version against the 2010 version of Cancer Module of the CSCF is provided in the following figure.

2007 Version 2010 Version

Primary level Level 2

Level 1 Level 3

Level 2 Level 4

Level 3 Level 5

Superspecialty Level 6

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Medical Oncology Services

Medical Oncology Service Level 1 administers conventional doses of relatively low-risk systemic therapy under protocols⁷², which would not normally be expected to produce prolonged neutropenia. Initial courses of systemic therapy (first cycle) are initiated at and supervised by a Level 3 or super-specialist medical oncology service (or a consultative service offered by them), with subsequent maintenance courses provided at this level. The availability of support services—particularly the pathology turnaround time within 24 hours—is important to manage any complications of treatment, regardless of whether the patient is receiving palliative care or curative treatment.

Table 45 Medical Oncology Service Level 1—summary Required clinical

services

Level Notes

Diagnostic Imaging 1 Accessible within one day’s travel; access to computerised tomography (CT)

Emergency Primary

Endoscopy 1 Accessible within one day’s travel

Medical 1

Nuclear Medicine Primary Accessible within one day’s travel Operating Suite 1 Accessible within one day’s travel Pathology 1

Pharmacy 1

Surgical 2 Accessible within one day’s travel

Radiation Oncology Accessible within six hours’ transport for urgent treatment e.g. spinal cord compression

Palliative Care 1 Accessible

Staffing

Medical • Credentialled specialist in medical oncology for advice—24-hour access

• Credentialled specialist in microbiology for advice—24-hour access

• All medical practitioners credentialled for involvement in the systemic therapy treatment will have appropriate training and skills in the safe administration and handling, including the preparation and disposal, of cytotoxic agents and all associated waste products

• All medical practitioners credentialled for involvement in the systemic therapy treatment will have at least a broad understanding of both common and unusual toxicities associated with systemic therapy

• Access to ambulatory care/consultative services by a specialist in medical oncology or clinical haematology with provision for telephone consultation for complications of treatment and admissions for complications within 24 hours

Nursing • Access to registered nurse with specialised knowledge and experience in medical oncology at a Level 3 or superspecialist medical oncology service

• All nursing staff involved in the systemic therapy treatment will have appropriate training and skills in the safe administration and handling, including the preparation and disposal, of cytotoxic agents and all associated waste products

• All nursing staff involved in the systemic therapy treatment will have at least a broad understanding of both common and unusual toxicities associated with systemic therapy

• All nursing staff should have a general understanding of radiation oncology and the possible adverse events that may occur as a consequence of treatment

• All nursing staff involved in clinically validating prescriptions and the supply of cytotoxic drugs consult with a pharmacist at a higher level with appropriate competency in oncology/haematology

119 Allied Health Access to the appropriate allied health specialties

Medical Oncology Service Level 2 also administers conventional doses of systemic therapy. Similar to Medical Oncology Service Level 1, initial courses of systemic therapy (first cycle) are generally initiated at and supervised by a Level 3 or superspecialist medical oncology service with subsequent maintenance courses provided at this level. Initial (first cycle) and subsequent maintenance courses can be administered at this level for a limited number of protocols where ordered and directly supervised by a medical oncologist. The key difference between Medical Oncology Service Level 1 and Medical Oncology Service Level 2 is the requirement for support services. The pathology turnaround time within one hour is particularly important in order to manage any complications of treatment, regardless of whether the patient is receiving palliative or curative care. Relatively moderate risk systemic therapy protocols⁷³ are managed at this level after first cycle supervised by a Level 3 or 4 medical oncology service. Level 2 also provides maintenance systemic therapy to patients diagnosed with breast, colorectal, lung, upper gastrointestinal malignancies, low-grade lymphoma and prostate cancers, or palliative management.

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Table 46 Medical Oncology Service Level 2—summary Required clinical

services

Level Notes

Critical Care HDU On-site or accessible within 15 minutes

Diagnostic Imaging 2 Accessible within one day’s travel. Access to ultrasound, CT, magnetic resonance imaging (MRI), gallium scans.

MRI for spinal cord compression within 24 hours; non-admitted CT for tumour assessment within seven days

Emergency 2 Accessible

Endoscopy 2

Medical 2

Nuclear Medicine Primary Accessible within one day’s travel Operating Suite 2

Pathology 2 Pharmacy 2 Surgical 2

Radiation Oncology Accessible within six hours’ transport for urgent treatment e.g. spinal cord compression

Palliative Care 2 On-site or accessible Staffing—as for Medical Oncology Service Level 1 plus

Medical Credentialled specialist in internal medicine with experience in medical oncology on call 24 hours (public) or available 24 hours (private) with access to Level 3 or superspecialist medical oncology service 24 hours for emergency advice

Nursing As for Medical Oncology Service Level 1 Allied Health As for Medical Oncology Service Level 1

Medical Oncology Service Level 3 provides for people receiving treatment for all common malignancies (excluding haematological malignancies) in conjunction with multidisciplinary care, including surgeons and radiation oncologists. This level of service is able to initiate initial (first-cycle) courses of systemic therapy and supervise subsequent maintenance courses provided at Medical Oncology Service Levels 1 and 2. Level 3 also manages relatively high-risk systemic therapy protocols⁷⁴ and may provide medical oncology consultative services at lower service levels. This level may also participate in clinical trials.

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Table 47 Medical Oncology Service Level 3—summary Required clinical

services

Level Notes

Critical Care ICU2

Diagnostic Imaging 2 Access to CT; MRI

MRI for spinal cord compression within 24 hours; non-admitted CT for tumour assessment within seven days

Emergency 3 Access within 15 minutes Endoscopy 3

Interventional Radiology

2

Medical 3

Nuclear Medicine 2 Access to positron emission tomography (PET) Operating Suite 3

Pathology 3 Pharmacy 3

Surgical 3 Subspeciality surgeons available e.g. orthopaedics, surgical oncology management by stream e.g. breast, colorectal

Radiation Oncology On-site or accessible within six hours’ transport Palliative Care 3 On-site or accessible

Medical • Credentialled specialist in medical oncology on call 24 hours within 30 minutes (public) or available 24 hours within 30 minutes (private). This responsibility may be shared with the credentialled medical oncologist and clinical haematologist at the facility

• Designated medical oncology registrar for inpatient service (public)

• Credentialled specialist in medical oncology and registrar under supervision for outpatient services (public)

• Part-time training registrars on rotation (e.g. six monthly) with a super-specialist medical oncology service (public)

• Access to specialist in infectious diseases for advice and guidance

Nursing Registered nurse in charge on each shift is supported by adequate nursing staff with demonstrated evidence of ongoing clinical competency and experience appropriate to the oncology and the systemic therapy protocols being delivered on site—24 hours

Registered nurse with specialised knowledge and experience in medical oncology in charge of unit

Allied Health As for Medical Oncology Service Level 2

Data management for evaluation of outcomes and clinical research

Superspecialist Medical Oncology Service — provides for people receiving treatment for all common malignancies (excluding haematological malignancies) in conjunction with multidisciplinary care with disease-specific surgeons, radiation oncologists, pathologists and supportive care specialties. Concurrent chemo-radiation treatment provided for tumours including head and neck tumours, early-stage lung cancers, upper gastrointestinal tumours, and anal and rectal cancers. This service provides treatment of low-volume and highly specialised cancers such as germ cell tumours, gynaecologic malignancies and sarcomas. It also manages relatively high-risk complex protocols and has capability for stem cell transplantation.

This level is a reference centre for all medical oncology service levels, and in the public sector it should be accredited to the standard able to sustain a full-time training registrar. It may also provide medical oncology consultative services at lower service levels (excluding Medical Oncology Service Level 3) and may participate in clinical trials.

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Table 48 Superspecialist Medical Oncology Service—summary Required clinical

services

Level Notes

Critical Care ICU3

Diagnostic Imaging 2 On-site CT; MRI.

MRI for spinal cord compression within 24 hours; non-admitted CT for tumour assessment within seven days

Emergency 3 Access within 15 minutes Endoscopy 3

Interventional Radiology

2

Medical 3

Nuclear Medicine 3 Access to PET Operating Suite 3

Pathology 3 Pharmacy 3

Surgical 3 Subspeciality surgeons available e.g. orthopaedics, surgical oncology management by stream e.g., breast, colorectal, head and neck, upper gastrointestinal, lung, bladder

Radiation Oncology Level 3 on-site or accessible within one hour’s transport Palliative Care 3 Level 3 on-site within one hour’s transport

Staffing – as for Medical Oncology Service Level 3 plus

Medical On call 24 hours within 30 minutes (public) or available 24 hours within 30 minutes (private), must be provided by at least two credentialled medical oncologists

Dedicated medical oncology training registrar Nursing As for Medical Oncology Service Level 3 Allied Health As for Medical Oncology Service Level 3

Haematological Malignancy Cancer Services

Haematological Malignancy Service Level 1 administers conventional doses of relatively low-risk systemic therapy under protocols,⁷⁵ which would not normally be expected to produce prolonged neutropenia. Initial courses of systemic therapy (first cycle) are initiated and supervised by a Level 3 or superspecialist haematological malignancy service with subsequent maintenance courses provided at this level. The availability of support services, particularly the pathology turnaround time within 24 hours, is important to manage any complications of treatment, regardless of whether the patient is receiving palliative or curative care.

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Table 49 Haematological Malignancy Service Level 1—summary Required clinical

services

Level Notes

Diagnostic Imaging 1 Accessible within one day’s travel, plus access to computerised tomography

Emergency Primary

Endoscopy 1 Accessible within one day’s travel

Medical 1

Nuclear Medicine Primary Accessible within one day’s travel Operating Suite 1 Accessible within one day’s travel Pathology 1

Pharmacy 1

Surgical 2 Accessible within one day’s travel

Radiation Oncology Accessible within six hours’ transport for urgent treatment e.g. spinal cord compression

Palliative Care 1 On-site or accessible Staffing—as for Haematology Service Level 3 plus

Medical • Specialist credentialled in clinical haematology for advice—24 hour access for haematology malignancies

• Specialist credentialled in microbiology for advice—24 hour access

• All medical practitioners credentialled for involvement in the systemic therapy treatment will have appropriate training and skills in the safe administration and handling, including the preparation and disposal, of cytotoxic agents

• All medical practitioners credentialled for involvement in the systemic therapy treatment will have at least a broad understanding of both common and unusual toxicities associated with systemic therapy

Nursing • Access to registered nurse with specialised knowledge and experience in clinical haematology at a Level 3 or superspecialist haematological malignancy service

• All nursing staff involved in the systemic therapy treatment will have appropriate training and skills in the safe administration and handling, including the preparation and disposal, of cytotoxic agents and all associated waste products

• All nursing staff involved in the systemic therapy treatment will have at least a broad understanding of both common and unusual toxicities associated with systemic therapy

• All nursing staff should have a general understanding of radiation oncology, the possible adverse events that may occur as a consequence of treatment

Allied Health • Access to the appropriate allied health specialties

Haematological Malignancy Service Level 2 also administers conventional doses of systemic therapy, which would not normally be expected to produce prolonged neutropenia. Similar to Haematological Malignancy Service Level 1, initial courses of systemic therapy (first cycle) are initiated at and supervised by a Level 3 or

superspecialist haematological malignancy service with subsequent maintenance courses provided at this level. The key difference between a Haematological Malignancy Service Level 1 and Haematological Malignancy Service Level 2 is the requirement for support services. In particular, the pathology turnaround time within one hour is important to manage any complications of treatment, regardless of whether the patient is receiving palliative or curative care. Relatively moderate risk systemic therapy protocols⁷⁶ are managed at this level. It provides maintenance

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systemic therapy to patients diagnosed with the same conditions described for Haematological Malignancy Service Level 1.

Table 50 Haematological Malignancy Service Level 2—summary Required clinical

services

Level Notes

Critical Care HDU Access within 15 minutes

Diagnostic Imaging 2 Accessible within one day’s travel. Ultrasound, CT, MRI, gallium scans MRI for spinal cord compression within 24 hours; non-admitted CT for tumour assessment within seven days

Emergency 2 Accessible

Endoscopy 2

Medical 2

Nuclear Medicine Primary Accessible within one day’s travel Operating Suite 2

Pathology 2 Pharmacy 2 Surgical 2

Radiation Oncology Accessible within six hours’ transport for urgent treatment e.g. spinal cord compression

Palliative Care 2 On-site or accessible Staffing – as for Haematological Malignancy Service Level 1 plus

Medical • Credentialled specialist in internal medicine with experience in clinical haematology on call 24 hours (public) or available 24 hours (private) with access to Level 3 or superspecialist haematological malignancy services 24 hours for emergency advice

• Regular and frequent outpatient services available by a credentialled clinical haematologist or medical oncologist with provision for telephone consultation for complications of treatment and admissions for complications 24 hours for emergency advice

Nursing • As for Haematological Malignancy Service Level 1 Allied Health • As for Haematological Malignancy Service Level 1

Haematological Malignancy Service Level 3 provides treatment for intermediate-grade non-Hodgkin’s lymphoma and Hodgkin’s disease and excludes acute

leukaemia and high-grade lymphoma. This level of service is able to initiate the first course of systemic therapy and supervise subsequent maintenance courses provided at haematological malignancy service Levels 1 and 2. All definitive diagnostics and the development of a treatment plan, which may take place at a lower level, are coordinated at this level or a higher level. A Level 3 service also manages relatively high-risk systemic therapy protocols⁷⁷. It may also provide haematological

malignancy consultative services at lower service levels and may participate in clinical trials.

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Table 51 Haematological Malignancy Service Level 3—summary Required clinical

services

Level Notes

Critical Care ICU2

Diagnostic Imaging 2 Access to CT, MRI - MRI for spinal cord compression within 24 hours; non-admitted CT for tumour assessment within seven days

Emergency 3 Access within 15 minutes Endoscopy 3

Interventional Radiology

3

Medical 2

Nuclear Medicine 2 Access PET Operating Suite 3

Pathology 3 Pharmacy 3

Surgical 3 Subspeciality surgeons available e.g. orthopaedics, surgical oncology management by stream e.g. breast, colo-rectal

Radiation Oncology On-site or accessible within six hours’ transport Palliative Care 3 On-site or accessible

Staffing – As for Haematology malignancy services level 2 plus:

Medical • Service provided by a credentialled specialist in medical oncology

• Credentialled specialist in medical oncology on call 24 hours within 30 minutes (public) or available 24 hours within 30 minutes (private). This responsibility may be shared with the clinical haematologist and medical oncologist at the facility

• Designated clinical haematology registrar for inpatient service (public)

Nursing • Registered nurse in charge on each shift is supported by adequate nursing staff with demonstrated evidence of ongoing clinical competency and experience appropriate to the clinical haematology and the systemic therapy protocols being delivered on-site—24 hours

• A registered nurse with specialised knowledge and experience in clinical haematology (haematological malignancies) in charge of unit

Allied health • As for Haematological Malignancy Service Level 2

• Data management for evaluation of outcomes and clinical research

Superspecialist Haematological Malignancy Service provides diagnostics and treatment for leukaemias and myelomas, and has the capability to provide stem cell transplantation. All services at this level can provide autologous transplantation (pending caseload considerations), but not allogeneic transplantation. Allogeneic transplantation services are provided by a small subset of superspecialist

haematological malignancy services due to the need for a critical mass of expertise and recognised volume of work to ensure quality care. The service manages

relatively high-risk complex protocols. All definitive diagnostics and the development of a treatment plan, which may take place at a lower level, are coordinated at this level. This level is a reference centre for all haematological malignancy service levels and in the public sector it should be accredited to the standard able to sustain a training registrar. This level may also provide haematological malignancy consultative services at lower service levels (excluding Haematological Malignancy Service Level 3) and may participate in clinical trials.

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Table 52 Superspecialty Haematological Malignancy Service—summary Required

clinical services

Level Notes

Critical Care ICU3 Diagnostic

Imaging

2 On-site CT, MRI - MRI for spinal cord compression within 24 hours; non-admitted CT for tumour assessment within seven days

Emergency 3 Access within 15 minutes Endoscopy 3

Interventional Radiology

3

Medical 3

Nuclear Medicine 3 Access to positron emission tomography (PET) Operating Suite 3

Pathology 3

Pharmacy 3

Surgical 3 Subspeciality surgeons available e.g. orthopaedics, surgical oncology management by stream e.g. breast, colorectal, head and neck, upper gastrointestinal, lung, bladder Radiation

Oncology

On-site or accessible within one hour’s transport

Palliative Care 3

Staffing – as for medical oncology service level 3 plus:

Medical • On call 24 hours within 30 minutes (public) or available 24 hours within 30 minutes (private); must be provided by at least two specialists credentialled in clinical haematology

• On call 24 hours within 30 minutes (public) or available 24 hours within 30 minutes (private); access to two specialists credentialled in clinical haematology with experience in autografting

• Medical practitioner on-site 24 hours

• Dedicated clinical haematology training registrar

• A medical staff member with credentials in haematology to act as a designated transplant coordinator to liaise with patients, relatives, nursing and medical staff and other professional groups (e.g.

scientists)

• In centres performing matched unrelated donor (MUD) transplants, on call specialist credentialled in clinical haematology must have at least five years’ experience in allogeneic bone marrow transplants Nursing • As for Haematological Malignancy Service Level 3

• Registered nurses trained in collection of Peripheral Blood Progenitor Cells (PBPC)

• Adequate nursing staff with demonstrated evidence of knowledge and skills to be able to support patients following high dose systemic therapy, and during and following transplant

• Haematology nurse practitioner to support coordination of transplant/haematology is highly desirable Allied Health • As for medical oncology service level 3

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In document Queensland Statewide Cancer Treatment Services Plan. Queensland Statewide Cancer Treatment Services Plan (Page 122-132)