pics cancer service paediatric integrated · 2016-09-26 · it is with great pleasure that we...

Paediatric Integrated Cancer Service PICS

Annual Report 2007– 2008

PICS would like to thank The Royal Children’s Hospital Educational Resource Centre (ERC) for producing this Annual Report. Special mention to Lloyd Ellis who has been responsible for the photography. Thanks also to Medical Photography, Health Technology Services at Southern Health and the Public Affairs Department at Peter MacCallum Cancer Centre who have taken and provided the photographs from these sites.

A special thank you to the families and staff who have allowed us to capture their experiences in this report

ContentsPage

2 A word from our PICS Chair and Program Manager

3 Introduction

4 Our vision of care

4 Our organisational structure

5 Our core values and principles

6 Our partners

8 About us: The profile of children with cancer

12 Key areas: Integrated cancer service work

15 Highlighted project: Regional Outreach and Shared Cared Program

18 Looking forward

20 Financial summary 2007 – 2008

21 PICS posters 2005 – 2008

Welcome to the PICS Annual Report 2007– 2008

Paediatric Integrated Cancer Service (PICS) Annual Report 2007– 2008 | 1

It is with great pleasure that we present the 2007– 2008 Annual Report for the Paediatric Integrated Cancer Service (PICS). This is the inaugural report for the PICS and in some ways includes activities undertaken since its commencement in January 2005. PICS has a strategic and operational focus and leads projects at a state-wide level and at the local point of service delivery.

The report provides some background information regarding the PICS, its vision and mission and principles of care. The report provides an outline of our patient population, provides brief details of some of the key projects undertaken over the past year and offers a highlight on our Regional Outreach and Shared Care Program (ROSCP). Finally, the report documents the new projects to be commenced in 2008 – 2009.

We look forward to an exciting year ahead. We welcome input to our program from stakeholders across Victoria to ensure we are best placed to continue to facilitate the provision of safe, effective and high quality services as close to home as possible.

Thank you for your continued support.

Associate Professor David Ashley Jane Williamson Chair, Paediatric Integrated Care Service Program Manager, Paediatric Integrated Care Service

A word from our PICS Chair and Program Manager

| Paediatric Integrated Cancer Service (PICS) Annual Report 2007– 2008 2

Introduction

Key recommendations focus on strengthening integrated services, and establishing better links and transitions between services and sectors. PICS is also part of the Department of Human Services’ (DHS) broader cancer reform strategy known as the Victorian Cancer Service Framework. The framework aims to strengthen access to high quality cancer services for all Victorians, with the Integrated Cancer Service (ICS) initiative being a major platform for this service reform.

As a specialist service supporting children with cancer and their families across Victoria, PICS is the only state-wide integrated cancer service.

The goal of PICS is to improve outcomes for children with cancer and their families through achieving consistent medical, nursing, allied health and psychosocial services across the PICS partnership. The Royal Children’s Hospital (RCH), Southern Health (SH) and the Peter MacCallum Cancer Centre (Peter Mac) form the PICS partnership.

The PICS Coordinating Group (PICS-CG) together with the DHS have established the following seven key target areas:

Table 1: Key target areas to improve outcomes for children with cancer and their families.

No. Key target areas

1To improve the delivery of state-wide specialist paediatric cancer services through the establishment of a state-wide PICS.

2To ensure safe, low risk, best practice, efficient and high quality services to all PICS sites.

3To enable quality improvement, consistent clinical practice and maintenance of professional expertise across the PICS partnership.

4To improve coordination and sharing of expertise across all three paediatric cancer sites.

5To create the capacity to improve state-wide trials, coordination and associated data management within the state-wide PICS.

6To develop a multidisciplinary/multi-campus approach to the provision of psychosocial support services.

7To provide support for regional and community cancer services.

The Paediatric Integrated Cancer Service (PICS) was established in 2004 as part of the Victorian State Government’s Caring for Children package. The Caring for Children package focuses on ensuring all children and their families, and in particular vulnerable children, gain access to a range of health and community services that optimises the child’s developmental growth and family support.


The PICS vision extends across the whole cancer care pathway from diagnosis to long-term survival or death, and through the many developmental stages of the child or adolescent’s life.

The goal for PICS is as follows:

All Victorian children and adolescents with cancer and their families have access to high quality, safe and effective clinical and psychosocial care that is well coordinated and provided in environments that are conducive to healing and coping. This will:

• optimiselong-termsurvival

• maximisethequalityoflifeintheshortandlonger-termforthechild or adolescent and their family

• maximisethechild’s/adolescent’sachievementofdevelopmental and academic milestones and facilitates their successful transition into adulthood.

Our vision of care

The Royal Childr en’ s Hospital

Souther n Health Peter

MacCallum Cancer Centr e

‘The best care, in the best facility, as close to home as possible’

Our organisational structure

Department of Human Services (DHS)

The Royal Children’s Hospital

Chief of Medicine Women’s & Children’s Program Division of Radiation Oncology

Children’s Cancer Centre (Southern Health)

Children’s Cancer Centre (The Royal Children’s Hospital)

PICS Coordinating Group

Paediatric Oncology

Peter MacCallum Cancer CentreSouthern Health

Monash Medical Centre


The core values of PICS and its partners are to work as an effective team together to provide optimal family-centred care. In line with these values, the following principles will guide practice:

Our core values and principles

• Weacceptthattheprovisionofhighquality clinical and psychosocial care is the core business of all PICS sites and agreed regional services.

• Wewillprovidefamily-centredcarewith the child and family as the unit of care.

• Wewillprovideoptimalclinicalcarein line with evidence-based clinical practice and agreed standards of care.

• Wewillsupportandfacilitatethe child / family’s access to appropriate clinical trials.

• Wewillactivelyparticipateinorcontribute to a range of laboratory, clinical or psychosocial research activities that aim to improve outcomes for children and families in the future.

• Weworkinpartnershipwiththefamilyto ensure informed decision-making and to provide care for the child that meets their emotional, social, and developmental needs.

• Wewillproactivelyidentifyand meet the needs of the individual child and family.

• Werecognisethatourfamiliesarehighly stressed and distressed. Wewilltakeapreventativeandearly intervention approach, aimed at building children and families’ resilience, and develop systems and processes that will reduce and not exacerbate distress wherever possible.

• Ourservicesandcarewillbeageanddevelopmentally appropriate.

• Werecognisethatfamiliescomefromdiverse backgrounds with differing capacitiesandskills.Wewillnotmakeassumptions about the capacity of the family to cope practically and emotionally.

• Wewilltakeawholeofsystemapproach to respond to the needs of children and families.

• Wewillworkcooperatively,recognising and respecting the skills of all disciplines and facilitating collaboration and communication between providers within and across services and sectors to optimise outcomes for children and families.

• Wearecommittedtostrengtheninga family’s resilience and on helping families to build a network of support (peer or community).

• Wewillworkcollaborativelywithcommunity providers and consumers to optimise services for the care of children and families.

• Ourservicetakesaproactiveapproach to strategic planning and quality improvement to enhance care for children and families.

• Werecogniseandsupportourstaffto gain the skills and support they need to facilitate optimal clinical and psychosocial care for children and families.


The Royal Children’s Hospital (RCH) is a specialist paediatric hospital and provides a full range of clinical services, tertiary care and health promotion and prevention programs for children and adolescents. The hospital is the major specialist paediatric hospital in Victoria, and also cares for children from Tasmania,southernNewSouthWalesand other states around Australia and overseas.

As the major paediatric hospital in Victoria, RCH provides clinical, academic and advocacy services for children and young people throughout Victoria. It is internationally recognised as a leading centre for research and education. The Murdoch Childrens Research Institute (MCRI) is based at RCH providing a bench to bedside process.

Southern Health (SH) is Victoria’s largest health service uniquely providing in one organisation, primary, secondary and tertiary health services. Through an integrated multidisciplinary team of health professionals, the Children’s Program serves newborn, child and adolescent needs for the rapidly expanding communities south-east of Melbourne.

Monash Medical Centre (MMC) in Clayton provides tertiary paediatric services, including paediatric intensive care, while Dandenong and Casey hospitals provide a full range of primary and secondary paediatric services.

The Children’s Cancer Centre at Monash Medical Centre Clayton cares for 30 per cent of Victoria’s childhood cancer patients closer to their homes. It incorporates purpose-built treatment rooms, a child and parent friendly waiting area, consulting space and family play areas. The centre continues to innovate to improve care, and is the first facility in

the state to be able to anaesthetise children without having to send them to an operating theatre.

Peter MacCallum Cancer Centre (Peter Mac) is the only site in Victoria offering radiotherapy to children under the age of 16 years, and is the largest paediatric radiation centre in Australia. It is a public hospital solely dedicated to cancer research, treatment and care. Each year the paediatric unit receives referrals for 50– 60 new patients and treats about 70–80 patients. A very small number of children (1– 2 per month) are admitted to Peter Mac usually for total body irradiation in preparation for bone marrow transplantation.

In addition to its paediatric service Peter Mac hosts the OnTrac@PeterMac program. This is a state-wide adolescent and young adults program designed to support teenagers or young adults with cancer in Victoria wherever they are treated.

Our partners The Royal Children’s Hospital

Southern Health

Peter MacCallum Cancer Centre

The Royal Children’s Hospital6 | Paediatric Integrated Cancer Service (PICS) Annual Report 2007– 2008

WhilethesethreePICSservicesitesprovide the majority of care for Victorian children, a level of shared care with regional services has developed over the years. In response to the vision that children should be able to access care as close to home as possible, where it is safe to do so, PICS has developed theRegionalOutreachandSharedCareProgram(ROSCP).Formoredetailsplease see page 15.

Finally, the Victorian Paediatric Palliative Care Program (VPPCP – consisting of RCH, SH and Very Special Kids) provides a consultation-liaison team responsible for the facilitation of the care of children with palliative care needs and their families, including children with cancer.

Monash Medical Centre

Peter MacCallum Cancer Centre

Paediatric Integrated Cancer Service (PICS) Annual Report 2007– 2008 | 77Paediatric Integrated Cancer Service (PICS) Annual Report 2007– 2008 |

WhenthePICSwasfirstestablished,a thorough examination was made of the children diagnosed with cancer in that year (2005). Although the extensive data collection has not been repeated, the number of newly diagnosed children with malignancies has been rising by approximately 7–10% per annum in line with population growth in children. Onreview,webelievetheratiosandpercentages relating to the data extracted in 2005 remains the same.

In 2005, 159 children were diagnosed with cancer at one of the two major Victorian treatment services (RCH and SH).1Ofthesechildren:

• Over75%(n=120)occurredinchildren under the age of 13 years

• 45%(n=71)wereaged5years and under

• 31%(n=49)wereaged6–12years

• 25%(n=39)wereadolescents aged over 13 years.

Ofallthedifferentcancersdiagnosed:

• 51.5%wereleukaemiasorlymphomas

• 27%weresolidtumourssuchasWilms’tumoursandbonecancers

• 21.3%werebraintumoursorothertumours of the central nervous system (CNS).

Figure 1: Types of cancers treated at RCH and MMC

In 2005, approximately 70 children received radiotherapy at Peter MacCallum Cancer Centre.

About us: The profile of children with cancer

Pro�les of newly diagnosed children by site and age in 2005

MMCRCH

Num

ber

Peter Mac*

13+0

10

20

30

40

50

60

0 – 5

Age

6 – 12

Figure 2: Profiles of newly diagnosed children by site and age in 2005

1. All children under the age of 15 years were diagnosed within the two major treating services. At least a proportion of older adolescents may be diagnosed and managed within adult services. This data is based on data from RCH and SH.

The following graphs summarise the profiles of newly diagnosed children in 2005 by service site.


* This data was initially provided as part of the PICS Psychosocial Services Review Project in early 2006. Updated data accessed from Peter Mac in June 2006 indicated a total of 71 children or adolescents were treated in 2005 for a total of82separatetreatmentcourses.Weonlyhavetheageordiseasebreakdownontheoriginal68childrenidentified.

Pro�les of newly diagnosed children by site and disease category in 2005

MMCRCH

Num

ber

Peter Mac*

0

10

20

30

40

50

70

60

80

Liquid tumour Brain tumour Solid tumourDisease category

Figure 3: Profiles of newly diagnosed children by site and disease category in 2005


Melbourne CBD area

Location of children diagnosed with cancer in 2005

Approximately 39% percent of the children diagnosed in 2005 lived more than 40km from the Melbourne Central Business District (CBD) with 12% of children and families living greater than 200km from the CBD.

Figure 4: Location in Victoria of children diagnosed with cancer in 2005


Peter Mac provides radiotherapy services to approximately 70–80 children / young adolescents per annum predominantly through ambulatory radiotherapy services. A small number (8–14 per annum) are admitted as in-patients. In addition, an increasing number of children are accessing PET (Positron Emission Tomography) services at Peter Mac.

Comparedto2003–04(n=48),therehasbeena64%increasein the total number of children / young adolescents treated in 2007–08(n=78)(see Figure 5 below).

Figure 6 reflects the very significant expansion of PET services provided for children and adolescents over the past five years.

Increasing capacity at the Monash Medical Centre was a key outcome for PICS. Table 2 demonstrates a gradual increase in care being provided at the MMC campus. The number of monthly chemotherapies delivered is now on average 173 per month, up from 40 in 2005.

Table 2: SH CCC throughput profile 2005–2008

Throughput profile 2005 2006 2007 2008*

Number of medical consultations (not including non-malignant haematology)

1,500 1,500 1,800 2,000

Number of nurse-led clinic patients

– – – 750

Number of new diagnoses 10 24 35 40

* predicted numbers

Increases in number of children/adolescents treated with radiotherapy over �ve years

Num

ber

Year

0

100

80

60

40

20

2003 – 04 2004 – 05 2005 – 06 2006 – 07 2007 – 08

Total number of patients

Figure 5: Increases in number of children/adolescents treated with radiotherapy over five years

Expansion of PET services provided for childrenand adolescents over the past �ve years

Num

ber

Year

0

160

140

120

80

100

60

40

20

2003 2004 2005 2006 2007

Number of PET scans

Figure 6: Expansion of PET services provided by Peter Mac for children over the past five years


Key areas: Integrated cancer service work

Four key priority areas of improvement were identified in the 2003 review A cancer service Framework for Victoria. These are:

1. Multidisciplinary care2. Care coordination3. Supportive care 4. Reducing unwanted variations in care The following table highlights some of the key projects undertaken and completed by PICS. (See page opposite)

12 | Paediatric Integrated Cancer Service (PICS) Annual Report 2007– 2008

Service delivery Description and outcomes DHS priority area

Multidisciplinary Team meetings (MDT)

• Weekly'wardround'reviewedand altered in structure at RCH, implemented and improved at MMC

• Weeklypsychosocialmeetingsintroduced at both sites. Surgical MDT meetings proposed

• Avideoconferenceisheldbetween the RCH and the regional centre team prior to discharge of a child returning home to a regional centre. The two teams meet via video to discuss the treatment plan, the family situation and other relevant matters

Multidisciplinary care, care coordination, supportive care and reducing unwanted variations in care

Consistent service provision Models of care undertaken and completed for:

• Play,musicandarttherapy

• Nutritionanddieteticservice

• LongTermFollowup

• Proceduralpain (Comfort First program)

The model of care/program outlines the agreed service delivery, communication pathways, screening tools and staffing required across the sites. Based on literature reviews, benchmarking and best practice

Reducing unwanted variations in care and care coordination

Communication tools CCCelectroniccommunicationtool(HOdatabase)nowavailableat RCH, MMC, Peter Mac, regional centre wards and paediatricians rooms. Permits real time access to results, communication and referral information. The data base will be expanded to include formats for MDT documentation, procedural pain, social work and nutrition records.


Clinical Trials • Memorandumofunderstanding(MOU)negotiatedbetweenSHand RCH for joint ethics approval process. MMC children now have accesstoChildren’sOncologyGroup(COG)trials

• Worktowardsachievinginternational quality accreditation commenced to permit opening of Bone Marrow Transplant (BMT) related clinical trials

Reducing unwanted variations in care

State-wide programs Description and outcomes DHS priority area

Regional Outreach and Shared Care Program (ROSCP)

TheROSCPhasformalpartnerswith5regionalcentres: Multidisciplinary care, care coordination, supportive care and reducing unwanted variations in care

• GoulburnValleyHealth

• BarwonHealth

• AlburyBaseHospital

• BallaratHealthServices

• SouthWestHealthCare

In 2008–2009, negotiations will commence with Gippsland, Bendigo andFrankston.TheROSCPishighlightedinthenextsectioninthisreport.

Paediatric Surgical Oncology Project (PSOP)

AproposaltodevelopaPaediatricSurgicalOncologyProgramoveraperiodof 3 years has been submitted to the Cancer and Palliative Care Unit within the Department of Human Services. In response, the Department has agreed to provide funding for an initial scoping exercise to better understand the issues and identify opportunities for improvement.

The project will consider views of providers, results of recent clinical audits, published literature, the experience of those who have visited international centres and reviewed relevant data. The report will examine organisational and clinical issues that may affect the quality of care of children with cancer.


Long Term Follow up (LTF) Model of care completed in September 2007. Model includes resources required to develop and implement a sustainable state-wide program for the long term follow up of children and families completing treatment and entering surveillance and survivorship. Submitted to DHS for funding consideration.


Table 3: Key projects undertaken and completed by PICS


Education, training and sharing of expertise

Description and outcomes DHS priority area

Continuing Professional Development Program

Program completed and now delivered across the CCC at both sites. Some courses are also delivered in regional centres. Courses / workshops include:

Care coordination and reducing unwanted variations in care

• IntroductiontoPaediatricOncologyNursing

• Chemotherapyaccreditation

• 12-weekNurseFellowshipprogram

• 5-dayNursingtheChildwithCancer course

• SpecialistBMT2-daycourse

• Proceduralpainmanagement

• AlliedHealth,halfdaycourse.

• Fortnightlyvideoconferencingeducation sessions

• Formalmedicalmentoringforregional paediatricians

State-wide symposium • In2006and2007PICSdelivered the Nutrition and Dietetics symposium for nurses and dieticians full day workshop

• In2008,paediatricpalliativecare full day symposium will be conducted at MMC, Shepparton and Geelong


Consumer focus and engagement Description and outcomes DHS priority area

Consumer participation and Input to service delivery

• State-wideParentAdvisoryGroup formed with representatives of regional, MMC, RCH and Peter Mac. Monthly meetings attended by consumers and hospital representatives

• Customdesigned,validatedPatient satisfaction survey conducted over the last 3 years across the 3 sites, for inpatients, outpatients and therapy consultations

• Consumerchartertitled‘Developing a consumer participation Model’ completed


Access to consistent information

• RCHCCCwebsiteupgraded

• Informationforfamiliesondiagnosis reviewed for use across the sites

• State-wideCCCquarterlynewsletter established for families

• Developmentofaresourcefolderfor regional centres helps maintain a consistent approach

Supportive care, reducing unwanted variations in care

Key areas: integrated cancer service work (continued)

Table 3: (continued) Key projects undertaken and completed by PICS


Highlighted project:

Regional Outreach and Shared Care Program

Jane Templeton – Regional Nurse Coordinator, Dr Peter Downie – Head of Unit SH CCC at MMC and Vice Chair PICS, Jane Williamson – Program Manager PICS with the Bobby Skilton Outreach Car (Donated by the Sporting Chance Cancer Foundation)

In 2005, an audit of new diagnosis at The Royal Children’s Hospital indicated that approximately 39% (thirty-nine percent) of all families lived more than 40km from the Melbourne Central Business District (CBD) and 12% of these lived greater than 200km from the CBD. There are many advantages for families to have part of the careprovidedintheirlocalregionalcommunityandhencetheRegionalOutreach andSharedCareProgram(ROSCP)wasdeveloped.

In each Annual Report, one project will be selected which demonstrates the vision of PICS. The 2007– 2008 Annual Report will highlight the Regional Outreach and Shared Care Program (ROSCP).

The objectives of the regional program are to:

• Developandstrengthenrelationshipsbetween the service providers, encouraging participation and support of the program at an executive level.

• Ensureclinicalpracticesareconsistentreducing variations in care provided by the service providers.

• Developandimplementeffectivecommunication mechanisms between the service providers.

• Increasetheskillsandconfidenceofregional staff when caring for children with cancer.

• Providepaediatriconcologyandpsychosocial education, training and mentoring to regional staff.

• Provideoutpatientclinicservicestoregional patients closer to home.


Highlightedproject:RegionalOutreachand Shared Care Program (continued)

Some of the benefits of the ROSCP to the CCC patients and families

• Improvedcoordinationandstreamlined care

• Reassuranceforparentsthattheregional centre is working with the RCH or MMC, using agreed policies and procedures

• Opportunitytohavesomeoutpatientvisits closer to home

• Accesstoservicesnotpreviouslyoffered by the regional centre.

• Reducedtravelandlesstimeoffworkand time away from family.

• Clearerclinicalguidelinesfortheregional centre in making decisions regarding emergency care

• Onlineelectronicinformationforup to date information regarding treatment plans, admissions and communication.

Nursing and medical mentoring programRCH and SH-based courses open to regional partners include:

• PaediatricBoneMarrowTransplantation

• Nutritionsymposium

• PalliativeCaresymposium (October2008)

• PICSNursingFellowshipprogram (12-week program)

• ComfortFirstworkshops

• Five-dayformalprogramforKeyLinknurses (21 nurses have attended)

The medical mentoring program includes a two-day planned visit to the RCH/SH, annual medical information evenings held in the regional centre and mentoring between RCH consultant and regional paediatrician during joint regional clinics. As at June 2008, 13 paediatricians have attended the RCH and ten information sessions have been held in regional centres. A further ten paediatricians are booked to come to Melbourne in the first half of the 08–09year.OnedinnerhasbeenheldinMelbourne for regional paediatricians to meet and share information.

What are the regional clinics?

As a part of the program, the CCC has increased the number of clinics held in regional centres each year. These clinics are attended by one oftheCCConcologists.Over325patient appointments have been held or scheduled in the 12-month period, 2007–08.

Exciting times

These are exciting times for the regional program. In 2008 – 2009 the program will be further expanded with discussions commenced in Gippsland, Bendigo and Frankston.

REgIONAL CENTRE

Executive Sponsor, Regional Partner

Medical Sponsor Regional Centre

Paediatricians Nurse Unit Manager

Head Regional Link Nurse

Regional Link Nurses

Goulburn Valley Health

Ms Kaye Gall Assistant Director of Nursing

Dr Peter Eastaugh Paediatrician

Dr Peter Eastaugh

Dr Andy Lovett

Dr Dan Garrick

Dr Ian Skelton

Mr Scott Stokes Ms Catherine Jones Ms Veronica Antonello

Ms Noeleen Hale

Albury Base Hospital

Ms Antje Badger Director of Nursing

Dr Mark Norden Paediatrician

Dr Mark Norden

Dr David Christie

Dr John Douglas

Dr Andrew Rechtman

Ms Samantha Peet Ms Samantha Peet Ms Denise Johnson

MsJoannaOwen (February 2009)

Ballarat Health Services

MsGeraldineWebster Executive Director, Nursing Services

Dr John Gallichio Executive Director, Medical Services

Dr Maurice Easton

Dr Fiona Noble

Dr Brendan McCann

Ms Sue Skinner Ms Kathryn Pegg Ms Meryl Thompson

Ms Amy Jones

Barwon Health Ms Therese Cotter Divisional Nursing Director

Dr Kym Anderson Paediatrician

Dr Kym Anderson

Dr Chris Cooper

Dr Mike Forrester

Dr Dave Fuller

Dr Bernie Jenner

Dr Christine Sanderson

Dr Peter Vuillerman

Mr Stewart Neil Ms Leanne Haugh Ms Sandra van Roon

Ms Jackie King

Ms Andrea Corica

South West Health Care

Ms Sue Morrison Director of Nursing

Dr Nick Thies Paediatrician

Dr Nick Thies

Dr Christian Fiedler

Dr Greg Pallas

Ms Sue Marsh Ms Sue Marsh Ms Helen Keegan

Ms Belinda McGifford

Ms Melissa Magilton

Table 4: Key Link CCC staff and regional partners

Above: Madison, her mother and Noeleen (Regional Link nurse). Image originally part of an article published in the GV Health Annual Quality of Care Report 2007–2008.


Bendigo Health Care Group

Goulburn Valley HealthAlbury Base Hospital

Metropolitan hospitals

Planned Regional Outreach

Ballarat Health Services

Barwon Health

South West Healthcare

The Royal Children’s HospitalSouthern Health

Peninsula HealthSale Formalised Regional Outreach

Some of the goulburn Valley Health team

Albury team

Bendigo team

Barwon Health

Warrnambool team


Adolescent and Young Adults (AYA)

A recent audit of children diagnosed with cancer at the RCH indicated that 30% were over the age of 12. An AYA Project Steering Committee will be convened to provide direction and oversight to review the services, standards of care and service gaps for AYAs admitted to RCH and SH Children’s Cancer Centres. The Steering Committee will make recommendations on strengthening services available to AYAs being managed attheCCC.Workwillcommencein2008and it is envisaged will be completed by June 2009. PICS will also be contributing to Victoria’s Cancer Action Plan (VCAP) statewide AYA service to be lead by onTrac. It is envisaged this will be announced at the end of 2008.

Culturally and Linguistically Diverse families (CALD)

Between January 2007 and June 2008, just over 20% of parents of newly diagnosed children were born in one of 27 non-English speaking countries. This project will develop and document a service model which articulates a series of principles to guide practice to respond better to the needs of all CALD families, regardless of their English language proficiency. The model will identify a range of strategies to strengthen the service system, its policies, protocols and processes and will include an implementation strategy. It is estimated this scoping exercise will be completed by December 2008, with recommendations to be reviewed and an implementation plan established early in 2009.

Looking forward


Occupational Therapy Model of Care

A project to develop a best practice service delivery model for OccupationalTherapyservicesforchildrenandadolescentswithcancer across PICS services and associated regional service sites will commence early in 2009. Expected project outcomes include the development of a set of principles and / or standards of practice for paediatric oncology services, identified screening tools, triggers and mechanisms to facilitate timely referral and liaison and a needs-based approach to occupational therapy services. In order to achieve this, benchmarking of current services against identified best practice will be required, other strategies and approaches to strengthen the service system overall e.g. professional education and support, information resources for families, and future research opportunities will be included.

This service model will provide a vision for the future and will provide the evidence to support the development of business cases at the PICS sites to access sustainable resources for the future.

Peter Mac Service Review

PICS has commissioned a review of paediatric services at Peter Mac, scheduled to commence in August 2008. The review will examine the services and standards of care for children referred to Peter Mac and will make recommendations to address identified service gaps and key areas for improvement. These recommendations will support the development by Peter Mac of a strategic plan for Paediatric Care and will make suggestions for improvements to the coordination of care and establish the level of resources, equipment and facilities needed to provide optimal care to children. Finally, recommendations for an education and training program for Peter Mac staff will be included to ensure they have the necessary skills and confidence to care for children.

Palliative care coordination and services

PICS will commence work with the Victorian Paediatric Palliative Care Program (VPPCP) to enhance access to quality palliative care services for all children / adolescents with a life-limiting condition. Scheduled to commence in early 2009, the specific goal is to develop a business case to improve access to clinical skills in paediatric palliative care to children / adolescents and their families wherever they live in Victoria. The scope for this project includes all children / adolescents requiring palliative care whether this is through a cancer diagnosis, other life-threatening conditions or through disability.

Paediatric Surgical Oncology Project (PSOP)

The Department of Human Services has agreed to provide funding for an initial scoping exercise to better understand the issues and identify opportunities for improvement. This project will be completed by December 2008 and will inform the next stageofestablishingasurgicaloncologyspeciality.ThePSOPwill engage stakeholders at SH and RCH to document and impletment an agreed plan to improve surgical outcomes for children suspected of or diagnosed with cancer.

Bone Marrow Transplant (BMT) Services

The CCC and PICS recognises it is currently under-resourced to develop the BMT service in line with international best practice. As a crucial component of the Children’s Cancer Centre, the BMT service seeks to continue to make a high-quality contribution to the ongoing development of the Centre and to improving children’s cancer outcomes. It is essential that the BMT service meet International accreditation and to do this, a revised model of nursing, allied health and quality systems within the unit is required. PICS has agreed to undertake a project in 2009 which will develop a business case to improve the level of service for children requiring a bone marrow transplant.

19Paediatric Integrated Cancer Service (PICS) Annual Report 2007– 2008 |

Financial summary 2007 – 2008

Revenue

DHS specified grant * $1,268,533.66

$ %

1 Direct clinical salaries 446,342.00 35.19

2 Administration, management and data management salaries 374,405.00 29.51

3 Computers and communication 3,193.70 0.25

4 Grant – clinical (neuro psychology) 75,000.00 5.91

5 External project development grants 171,628.68 13.53

6 Patient satisfaction survey 5,000.00 0.39

7 Administration: printing and stationary 24,272.38 1.91

8 Training and conference attendance 12,347.58 0.97

9 Roll over for LTF program 156,569.13 12.34

* includes reimbursement 18.9K from SH for salary expense

Direct clinical salaries

Administration, management and data management salaries

Computers and communication

Grant – clinical (neuro psychology)

External project development grants

Patient satisfaction survey

Administration: printing and stationery

Training and conference attendance

Roll over for LTF program

PICS allocation of funds 2007–2008


2005 Sharingthecare–ThePICSinitiative.ANZCHOG(Melbourne).

2006 AregionaloutreachandsharedcareprogramforVictoria(ROSC). ANZCHOG(NewZealand).

2006 Creation of the CCC nurses resource group; an answer to the challenge of integrating nursing services. Cancer Nurses Society of Australia (Adelaide)

2007 From good to better: Improvements to the provision of general anaesthesia to children with cancer within the Children’s Cancer Centre at Southern Health. CNSA (Melbourne).

2007 Establishment of a framework for a statewide approach to psychosocial careforchildrenwithcancerandtheirfamiliesANZCHOG(Sydney).

2008 Development of a statewide professional development program for nurses caringforchildrenwithcancer.ANZCHOG(Perth).

2008 Developing an improved paediatric pharmacy service to children with canceracrossVictoria.ANZCHOG(Perth).

2008 Strengthening nutrition services for children with cancer – a statewide approach,ANZCHOG(Perth).

2008 Implementation of a professional development program for nurses caring for children with cancer in Victorian regional centres. International Paediatric and Child Health Nursing Conference (Darwin).

PICS posters 2005 – 2008

One of the methods PICS utilises to inform the paediatric oncology community of activities, projects and outcomes is by working with CCC team members to present posters at scientific meetings. The listing of posters below state the title and scientific meeting where the poster was shown and the location of the meeting. Thank you to the CCC team members across all sites who have participated and submitted posters to these conferences.

21Paediatric Integrated Cancer Service (PICS) Annual Report 2007– 2008 |

ERC 090025 April 2009

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