Implementing PAthways for Early Diagnosis (I-PACED)

Transcription

1 Implementing PAthways for Early Diagnosis (I-PACED) Cancer Jeanne Potts Clinical Nurse Specialist Cancer Council Victoria Cancer Council 27 th June 2018 cancercouncil.com.au

2 Background OCPs describe optimal cancer care for specific tumour types I-PACED - Collaborative project between Cancer Council Victoria, University of Melbourne and DHHS, aims to increase GP awareness about critical primary care points along OCPs lung and colorectal prostate and oesophagogastric Mechanisms and outcomes: Tailored primary care tools and resources Extensive practice engagement 320 GP practices visited by Cancer Council nurses Academic detailing 1108 practice staff educated 2

3 I-PACED for 2018 Build and extend reach to state-wide application Prostate and Oesophagogastric cancer OCPs Collaboration with PHN Alliance Multi-pronged education model: Practice visits Forums Webinars Case studies Tonight's presentation: key primary care messages and resources to support optimal care provision for prostate and OG, as well as resources for supportive care 3

4 Oesophageal and Gastric Cancers Cancer Council cancercouncil.com.au

5 Overview Key messages Oesophageal & Gastric cancers have a low incidence Poor outcomes 20-30% 5yr survival Incidence in Victoria in 2016: Oesophageal Cancer 371 Gastric Cancer 611 GP role Delivering prevention messages Being aware of risk factors Knowing how to investigate symptoms Where to refer 5

6 Prevention Healthy eating diet 2 fruit & 5 vegies daily Wholegrains Minimising red and processed meat Maintaining normal BMI Adequate exercise Avoiding or minimizing alcohol Not smoking 6 Oesophageal and Gastric cancers

7 Risk factors Oesophageal cancer Gastric cancer Age Smoking Alcohol Obesity Barrett s Oesophagus Male gender Gastro-oesophageal reflux Caustic injury Achalasia Frequent hot drinks Age Smoking Helicobacter Pylori (H.Pylori) Partial Gastrectomy Pernicious Anaemia Family History Race (Asian descent) 7

8 Screening Recommendations No formal population-based screening programs for either cancer For oesophageal cancer, careful monitoring of Barrett's Oesophagus may lead to early detection of cancer Action points: Barrett's Oesophagus Treat symptoms Treat according to severity of BO Monitor regularly may lead to early detection of Oesophageal cancer may reduce progression to Oesophageal cancer 8

9 Signs & Symptoms RED FLAG SYMPTOMS New or Rapidly progressing dysphagia or Epigastric pain Other symptoms include: Persistent epigastric pain / dyspepsia Pain on swallowing Food bolus obstruction Unexplained weight loss Haematemesis / Melaena Early satiety Unexplained nausea / bloatedness / anaemia PPV chart shows risk of single symptoms versus combination of symptoms in someone over 55 years 9

10 Initial investigations & Referral Investigations Full blood count H. Pylori (in setting of dyspepsia) Liver function test Referral RED FLAG Symptoms: Gastroscopy within two weeks Understand HealthPathways in your local region 10

11 Prostate Cancer Cancer Council cancercouncil.com.au

12 Overview Key messages Most common cancer diagnosed in men Very high 5 year survival rate Significant sub-group report poor quality of life post treatment GP role Delivering prevention messages Being aware of risk factors Informing and assisting men with their decision regarding PSA-based testing Knowing how to investigate symptoms Where to refer 12

13 Risk factors Age most important risk increases from >50 years Family history brother or father Possibly diets high in animal fats, dairy products or calcium Race African descent Genetic factors Known mutations in BRCA1 or BRCA2 genes Lynch syndrome 13

14 Testing recommendations Australian consensus guidelines 2016 Key recommendations about PSA testing Rationale and evidence Implications for practice 14

15 Testing recommendations Offer men opportunity to discuss benefits and harms of PSA testing before making a decision Harms of PSA testing may outweigh benefits particularly in men 70+ years Men at average risk who decide to have regular testing Should be offered PSA every 2 years from years 15

16 Testing recommendations Men at high risk (family history) Father or one brother diagnosed with prostate cancer should be offered PSA testing every 2 years from years Father and 2 or more brothers diagnosed with prostate cancer should be offered PSA testing every 2 years from years DRE is not recommended for asymptomatic men as a routine addition to PSA testing Clearly inform patients if their standard blood tests will include a PSA test 16

17 Patient conversation Decision aids Improve men s knowledge about harms and benefits of PSA testing Reduce decisional conflict / distress Increase men s satisfaction with their decision 17

18 Signs & Symptoms Most men with prostate cancer do not have symptoms Most important predictor on its own is abnormal DRE Loss of weight usually late if associated with cancer PPV chart shows risk of single symptoms versus combination of symptoms 18

19 Supportive care resources Cancer Council Victoria Cancer Information and Support Phone In your own language OCP - quick reference guide & full version What to expect: only if a positive diagnosis LiveLighter program Resources for HPs and Patients Quitline for HP referral GP software link