Optimal cancer care pathways – the ideal versus reality for patient-centric cancer care during COVID-19
Shanuka Samaranayake A * , Daniel Barker B C and Apsara Windsor B D
+ Author Affiliations
- Author Affiliations
A Westmead Hospital, Hawkesbury Road, Westmead, NSW 2145, Australia.
B Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia.
C Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia.
D Gosford Hospital, Holden Street, Gosford, NSW 2250, Australia.
* Correspondence to: Shanukaprasan.samaranayake@health.nsw.gov.au
Australian Health Review 47(4) 472-479 https://doi.org/10.1071/AH23060
Submitted: 3 April 2023 Accepted: 7 June 2023 Published: 28 June 2023
© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA. This is an open access article distributed under the Creative Commons Attribution 4.0 International License (CC BY).
Abstract
Objectives To assess whether compliance with the nationally endorsed Optimal Care Pathways is evident in 75% of patients treated with curative intent treatment and if this compliance was impacted by the COVID-19 pandemic (hereinafter COVID-19).
Methods This retrospective study included patients undergoing curative treatment with radiotherapy in head and neck (HN), breast, lung and gastrointestinal malignancies between January 2019 and June 2021 in a single NSW outer metropolitan cancer service. For care delivered within the remit of cancer services, the primary outcome measure was the proportion of patients whose treatment complied with the Optimal Care Pathways recommended time frame. Secondary outcome measures included evaluating the effect of COVID-19 on the proportion of patients being treated within the recommended time frame.
Results There were n = 733 eligible patients across the five tumour streams with the majority being breast cancer patients comprising 65% (n = 479) of the cohort, followed by HN cancer patients (n = 125, 17%). None of the tumour subsites abided by the 75% compliance rate. Oesophageal cancer patients had the lowest compliance rate of 4% (P < 0.001), with a similarly low compliance rate for rectal cancer patients at 33% (P = 0.002). None of the hypothesis tests to assess for detriment in treatment time during COVID-19 were statistically significant (P > 0.05).
Conclusion Despite the availability of best practice guidelines, there is limited compliance throughout all cancer subtypes, which has not been negatively influenced by COVID-19. Improved awareness of the Optimal Care Pathways, and implementation of the associated infrastructure and systems, are required to support compliance.
Keywords: cancer services, clinical pathways, equity, health policy, health services, integrated care, optimal care pathways, radiotherapy.
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