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Cancer services
Overview
Cancer services are a specialised area of medicine involved in diagnosis and management of patients with cancer.
The service needs of patients with cancer vary according to patient characteristics, cancer type, care pathway and the course of the disease. Due to the specialised nature of cancer services, components of care are often interdependent (such as screening, surgery, medical oncology, clinical haematology, radiation oncology and palliative care) and provided over a range of service settings and locations throughout the care journey. As such integrated and co-ordinated care, across care settings, disciplines and sectors is critical to cancer management.
Specialised support services such as nurse co-ordinators, pharmacy, pathology, imaging and allied health services, are also required throughout the care continuum. Ideally people with cancer will experience the journey as seamless, this requires a high level of care co-ordination underpinned by formal network arrangements, service partnership arrangements and multidisciplinary models of care.
Delineating service system roles
The capability of each service level is based on:
- Clinical capability required to diagnose and manage the condition.
- Frequency and complexity of cancer type and appropriate service volumes.
- Availability of, and access to, interdependent cancer service care components.
- Availability of specialised infrastructure.
- Access to clinical support services.
In general, the service system is delineated according to the scope and specialty of cancer services provided as follows:
Level 2 services providing ambulatory cancer prevention, screening and early detection services as supported by access to higher level diagnostic, assessment, treatment. Operates within a program that is co-ordinated, monitored, evaluated and managed by a higher-level service.
Level 3 to 4 services providing a low complexity cancer service consisting of one or more oncology service components often provided on an outreach or consultative basis through formal links with a higher-level service.
Level 5 services providing a multidisciplinary service to manage most common cancers where the individual services may be provided on-site, or accessed locally or via a clearly defined referral pathway to a Level 5 or 6 service (if not local).
Level 6 services providing a more specialised, multidisciplinary service to manage common cancers, as well as rare cancers and specialised interventions. With onsite or local access to all components of cancer care and supportive care services. Providing outreach / consultative services, as well as other support, to other level services as part of a network arrangement. This includes interstate services where Level 6 services are not available in Tasmania.
Service networks
Tasmania is a small jurisdiction with a geographically dispersed population. As such, formal network arrangements between services at all levels is essential for the delivery of high quality and sustainable cancer services in Tasmania. Clinical care coordinators, tumour stream clinical nurse consultants, and nurse practitioners are important to assist patient navigation through the network.
This includes network arrangements within and between:
- cancer service components (such as screening, surgical oncology, medical oncology, haematological malignancy, radiation oncology, rehabilitation and palliative care).
- clinical support services (such as pharmacy, pathology, medical imaging and allied health).
- public and private cancer services.
- Tasmanian and interstate cancer services, particularly for Level 6 services unavailable in Tasmania.
To facilitate strong and effective service networks all oncology services require access to:
- telehealth facilities to support outreach consultation and support.
- videoconferencing facilities to support multidisciplinary team meeting participation.
- information and treatment-management systems, information technology services and clinical information systems to facilitate information sharing.
- clear pathways for referral, service access, emergency support and escalation.
Cancer services workforce requirements
The delivery of cancer care services requires the appropriate mix of staff with competency-based skill levels and defined roles in order to deliver safe and effective care. Staff support and supervision structures are also of key importance to facilitate optimal patient outcomes.
Key workforce considerations:
- Availability of qualified and experienced, specialist, registrar and general medical staff appropriate to the volume of patients, tumour types and treatment protocol requirements.
- Availability of qualified and experienced registered and enrolled nursing staff, clinical nurse consultants with evidence of ongoing competency to provide assessment, care planning, interventions and management of cancer patients and their families in outpatient, inpatient and community settings, and development of protocols using evidence-based practice to support the administration and management of systemic therapy and care of patients in accordance with current best practice.
- Availability of qualified and experienced registered radiation therapists with evidence of ongoing competency to provide radiation therapy simulation, planning and treatment for both routine and specialised techniques in accordance with current best practice
- Availability of qualified and experienced radiation oncology medical physicists with evidence of ongoing competency to support the necessary quality assurance required for radiation therapy simulation, planning and treatment delivery.
- Access to staff qualified and experienced in the delivery of cancer clinical trials.
- Access to staff qualified and experienced in diagnostic and interventional imaging and nuclear medicine services and with the expertise to assist in diagnosis, staging planning treatment, therapy and multidisciplinary team discussion and familiar with the spectrum of survivorship requirements and management of late effects.
- Availability of qualified and experienced clinical support staff including:
- pharmacy staff with evidence of ongoing competency to provide individualised medication supply, specialised clinical pharmacy services, complex medication manufacture (sterile products, chemotherapy and biological agents), medicines information, clinical trials support, and maintenance of treatment protocols in the oncology treatment management system.
- pathology staff able to provide required laboratory services within specified turnaround times.
- allied health professionals with competency in key areas including physiotherapy, dietetics, social work, occupational therapy, speech pathology.
Specialised requirements
Cancer screening
Population screening programs for the prevention, early detection and control of cancer are an important part of cancer services. There are three cancer screening programs in Tasmania: BreastScreen, the National Bowel Cancer Screening Program and the National Cervical Screening Program. These programs are provided in partnership between the State and Federal governments.
Cancer prevention and screening services are described in the medical oncology services module of this Cancer RDF, although it is recognised that cancer prevention and screening services also form part of a care continuum that may include surgery and/or radiation oncology.
Systemic therapy
Systemic therapy is a significant method of treatment for patients with malignancies. All health professionals involved in systemic therapy treatment must have evidence of ongoing competency in the safe prescribing, administration, handling, preparation, and disposal of cytotoxics, systemic therapy consumables and related waste, appropriate to their roles.
Sites prescribing and delivering chemotherapy require a fit-for-purpose electronic medication management system for cancer services, integrated with other relevant electronic medication management systems, and adequately resourced to maintain the protocol library, train new staff and maintain competency of existing staff.
All first cycle chemotherapy protocols/treatment plans are prescribed by a specialist oncologist (including advanced trainee under supervision of a specialist oncologist) with access to all relevant patient information. Subsequent orders for administration of parental and oral chemotherapy cycles or doses are prescribed by an appropriately credentialed medical practitioner or authorised nurse practitioner working in collaboration with a specialist oncologist/haematologist.
All chemotherapy orders are verified by appropriately skilled clinical pharmacists, in accordance with national practice standards. The prescribing and dispensing of oral chemotherapy must be carried out to the same service standards as for parenteral chemotherapy.
Parenteral chemotherapy, biological therapy and other therapies manufactured under sterile conditions must be compounded in TGA registered facilities or in a hospital pharmacy facility that complies with Good Manufacturing Practice (GMP), and by pharmacy staff with ongoing competency in aseptic and cytotoxic medication manufacture.
All health professionals involved in the patient’s treatment are:
- experienced and competent regarding the consequences of both systemic therapy and underlying disease.
- educated in the psychosocial impact of cancer and management of associated issues.
- have a good understanding of both common and unusual toxicities associated with systemic therapy provided in their clinical unit.
- experienced in the management of clinical information supporting clinical audit, clinical trials, outcome analysis and cancer registry requirements.
Radiation therapy
The core radiotherapy workforce is comprised of three main groups: radiation therapists who plan and deliver the radiotherapy, radiation oncology medical physicists who oversee the technical planning and treatment and radiation oncologists, who make decisions about treatment strategies and provided ongoing care to the patient through the duration of their treatment.
Nurses and allied health professionals provide essential expertise in supporting people undergoing radiotherapy. Technical support staff including biomedical engineers, are primarily responsible for equipment maintenance.
Specialised requirements for radiation therapy include:
- Compliance with radiation safety measures and statutory reporting obligations.
- Certified compliance requirements for radiation apparatus, radiation sources, and associated environments.
- Supporting infrastructure, including information management, scientific, biomedical and technical services.
- Policies and procedures for special-case patients, such as pregnant patients and those with an intracardiac defibrillator or pacemaker.
- An approved radiation safety and protection plan.
- Management of clinical information supporting clinical audit, clinical trials, outcome analysis and cancer registry requirements.
- Participation in dosimetric intercomparisons.
This framework
This section of the RDF focuses on the capability requirements for cancer diagnosis and management. It does not encompass the entire cancer control continuum. Services such as palliative care, rehabilitation services and surgical services are described in separate sections of the framework.
The following cancer services are included in this section of the RDF:
Services
Haematology is the branch of medicine concerned with the study of blood, the blood-forming organs and blood diseases. The clinical haematology RDF included here includes both malignant and non-malignant haematology.
| Level | Service Description | Service Requirements | Workforce Requirements |
|---|---|---|---|
| 1 | n/a | n/a | n/a |
| 2 | n/a | n/a | n/a |
| 3 |
A Level 3 service provides outpatient consultation and low-risk ambulatory care. Provides ambulatory care under direct or indirect supervision of registered medical specialist with credentials in haematology, or registered medical specialist with credentials in internal medicine under supervision of registered medical specialist with credentials in haematology. Provides low risk chemotherapy (excluding initial courses) under supervision of a level 5 or 6 Haematology or Oncology service. Provides support before, during and after malignant haematology treatment. Links with general practitioners, social work services, psychosocial support, supportive care and community services, as required. May receive outpatient / outreach (visiting or telehealth) medical oncology consultative services by a Level 4, 5 or 6 medical oncology service. Ineligible to apply for accreditation for training in haematological malignancy medicine. |
Service provision includes administration of conventional doses of low-risk systemic therapy under protocols not normally expected to produce prolonged neutropenia. Provision of low-risk systemic therapy limited to mild to moderate bone marrow suppressive protocols. Provision of chemotherapy under supervision of registered medical specialist with credentials in haematology / oncology who reviews patient locally or at higher level service. Access to pre-prepared, patient-specific aseptic, cytotoxic or biological therapy manufactured in a TGA registered facility or in a hospital pharmacy facility that is compliant with Good Manufacturing Practice (GMP), and staffed by appropriately trained pharmacy staff for reviewing orders and manufacturing therapies. Access to support services, particularly to Level 5 and higher medication services, and pathology turnaround time of within 24 hours to manage any complications of treatment, regardless of whether patient receiving palliative or curative treatment. Documented processes for urgent telephone consultation with Level 5 or 6 hematology service and admission to a level 4, 5 or 6 service for overnight and emergency patient admission. Adherence to protocols for emergency oncology care, intravenous administration of anti-neoplastic agents, cytotoxic handling and disposal, central line care, blood transfusions and infection control. Access to radiation oncology services within 6 hours’ transport for urgent treatment (e.g., spinal cord compression). Access to multidisciplinary consultation group, including registered medical specialists with credentials in medical oncology, radiation oncology and clinical haematology (haematological malignancy), who must be involved in development of management strategy. May manage appropriate cases locally after consultation with haematologist. |
As per module overview, plus: Access (on site, visiting or tele-medicine) to registered medical specialist with credentials in clinical haematology for advice. Access (on site, visiting or tele-medicine) to registered medical specialist with credentials in microbiology for advice. Access to outpatient and/or ambulatory consultative services by registered medical specialist with credentials in medical oncology or clinical haematology for treatment of complications and/or admission for complications. Nursing staffing levels in accordance with relevant industrial instruments. RNs appropriately qualified and competent in the administering and monitoring of systemic therapies. Access to registered nurse with specialised knowledge and experience at Level 5 or 6 haematological service for advice, as required. Access to medicines supplied on individual prescription. Service provided on site, or supervised by an oncology/haematology trained pharmacist located elsewhere. Access (on site, visiting or tele-medicine) to specialist clinical pharmacists haematology / oncology via a formal arrangement with a Level 5 or Level 6 service. Access to appropriately trained pharmacy staff providing aseptic, cytotoxic and biological therapy production services (via a Level 5 or 6 pharmacy service compliant with GMP or outsourced to a TGA registered facility). |
| 4 |
As for Level 3 plus: Provides ambulatory care under registered medical specialist with credentials in haematology and inpatient care under medical practitioner with credentials in haematology. Administers conventional doses of low to moderate risk systemic therapy with a low risk of neutropenic sepsis. Provides low- and medium-risk systemic therapy with moderate bone marrow suppressive protocols. Provides early after-care to patients receiving autologous transplants elsewhere. Part of network with higher level services, ensuring access to information relating to latest evidence-based care and treatment. |
As for Level 3 plus: A day treatment area for procedures, such as venepuncture and administration of systemic therapy, biological agents and blood transfusions. 24-hour access to Level 5 or 6 clinical haematological services for emergency advice. Administers systemic therapies under the supervision of a specialist medical practitioner with credentials in haematology. Access to a central venous access service. Access to a full blood bank service. Has pathology turnaround time of within 2 hours in order to manage any complications of treatment, regardless of whether patient receiving palliative or curative treatment. Access to palliative care, pain management and radiation oncology services. Access to clinical genetics /medical genetics service. |
As for Level 3 plus: On-site 24-hour access to registered medical practitioner if inpatients are treated. On-call registered medical specialist with credentials in internal medicine and experience in clinical haematology, with access to Level 5 or 6 haematological malignancy services for emergency advice. Access to social worker, occupational therapist, physiotherapist, dietitian, podiatrist, speech pathologist, psychological and emotional support services within the network. Clinical pharmacist with oncology/haematology training for inpatients and ambulatory patients. |
| 5 |
As for Level 4 plus: Provides specialist haematology inpatient and outpatient treatment services for patients with haematological diseases. Provides diagnostics and treatment of haematological malignancies where treatment associated with period of severe myelosuppression of less than one week. Provides inter-disciplinary care in conjunction with other consultation services, including medical oncology, radiation oncology, infectious diseases, pathology, pain services, palliative care, psychiatry, radiotherapy, medical imaging, nephrology, respiratory and surgical services. Manages up to high-risk systemic therapy protocols and may perform cell separation/plasmapheresis. Provides initial courses of systemic therapy and supervises subsequent maintenance courses. Coordinates all definitive diagnostics and development of a plan for treatment, which may take place at a lower level, this level or a higher level clinical haematology service. Provides multidisciplinary management of haematology patients, including case conferences and the development of treatment plans. May include autologous transplantation, but not allogeneic transplantation. |
As for Level 4 plus: Inpatient haematology care delivered by a specialist multidisciplinary team. On-site, or documented processes for, access to medical oncology, radiation oncology, infectious diseases, pain services, palliative care, psychiatry, medical imaging, nephrology (including renal dialysis), respiratory, cardiology, intensive care and surgical services. Access to specialist haematology advice 24 hours. On-site access to a radiotherapy unit for patient referral and transfer. Access to radiologist and pathologist advice for scheduled MDTs and during business hours. Onsite 24-hour access to aseptic, cytotoxic, biological and total parenteral nutrition therapy manufacture in a compounding facility that is compliant with GMP and staffed accordingly. Access to a medicines information service. Units providing autologous bone marrow transplants with accreditation under relevant national accreditation bodies. Access to interventional radiology service, PET service and vascular service for management of venous and arterial thrombosis where appropriate. |
As for Level 4 plus: Access to specialist medical practitioners with credentials in infectious diseases, pain, palliative care, psychiatry, radiation oncology, medical imaging, nephrology, respiratory medicine, pathology and surgical disciplines. Nursing staff trained, and with evidence of ongoing competency, in the collection of peripheral blood progenitor cells. Transfusion nurse Specialist haematology RNs Specialist clinical pharmacist oncology/haematology for inpatients and ambulatory patients, with on call access 24 hours 24-hour access to on-site aseptic, chemotherapy, biological therapy, and total parenteral nutrition production services compliant with GMP. Access to specialist pharmacist medicines information. |
| 6 |
As for Level 5 plus: Provides diagnostics and treatment for haematological malignancies where treatment is associated with prolonged period of severe myelosuppression (greater than one week), which, at this level service, may include induction therapy for acute leukaemia, autologous transplantation, allogeneic transplantation and CarT therapy. Provides allogeneic transplantation services delivered by small subset of superspecialist haematological malignancy services. A referral centre for low-volume haematological malignancies. Other cancer specialties provided on-site, including radiation oncology and medical oncology, which are needed to manage this low-volume, specialised, multidisciplinary malignancy service. Has critical mass of expertise and work volume. Plans and provides patient-centred, integrated, multidisciplinary survivorship care, that optimises early and latent outcomes. Partners with community providers and organisations to facilitate holistic (physical, psychological and social) survivorship care that promotes treatment of late effects, primary and secondary prevention, surveillance, and ongoing support for health and wellbeing. |
As for Level 5 plus: Cell separator accessible both for collection of peripheral blood progenitor cells (for units performing bone marrow transplants) and therapeutic apheresis (all Level 6 units), with 24-hour access to appropriately trained nursing staff for operation of cell separators. Dedicated standard isolation rooms. On-site renal dialysis, respiratory, pain management and infectious diseases services. Access to advanced diagnostic and interventional imaging services. Provide high-risk and/or complex protocols, and deliver intensive chemotherapy protocols. Provide haematological malignancy consultative services to lower level services. Units performing allogeneic transplants have accreditation under relevant national (matched family donor transplants) and international (unrelated donor transplants) accreditation bodies. Units performing bone marrow transplants have accreditation with Australian Bone Marrow Donor Registry. Advanced haematological diagnostics and transfusion services provided by a laboratory accredited under relevant national accreditation body. |
As for Level 5 plus: Access 24 hours to registered medical specialist with credentials in clinical haematology. Medical practitioner with credentials in haematology to act as designated transplant coordinator to liaise with patients, relatives, nursing and medical staff, and other professional groups (e.g., scientists). Access to medical specialist with credentials in clinical haematology and experience in allogeneic bone marrow transplants in centres performing matched unrelated donor transplants. Nurse Unit Manager (NUM) providing clinical leadership in haematology including in-reach and outreach. Nurses with credentialled / demonstrated competence:
Access to a specialist clinical pharmacist haematology/oncology with transplant experience. On site access to clinical scientists. |
Medical oncology is the branch of cancer medicine that provides cancer prevention, early detection, screening, diagnosis, assessment and treatment of patients with cancer. Medical oncology care is frequently provided using systemic therapies, such as cytotoxic chemotherapy, biological therapies (i.e., targeted therapies), hormonal therapies and immunotherapy. This module outlines five levels of complexity for medical oncology service provision. The different service levels address the complexity and risk associated with the delivery of medical oncology. Throughout this module, initial and first cycle therapy refers to the first administration of a new systemic therapy protocol within neoadjuvant, adjuvant and palliative treatment care plans.
| Level | Service Description | Service Requirements | Workforce Requirements |
|---|---|---|---|
| 1 | n/a | n/a | n/a |
| 2 |
Provides cancer prevention and screening services. Provides screening recruitment and cancer prevention education in primary care, education and community settings. Provides advice on cancer screening service availability and facilitates access. Provides ambulatory cancer screening services as part of an on-site, visiting or mobile service. Provides supportive care, counselling, care pathway co-ordination and follow up from positive screening result to definitive diagnosis. |
Primary care providers trained and experienced in cancer screening procedures and referral pathways for participants with screen detected abnormality. Imaging equipment for mobile or fixed screening clinics. Counselling, data management, and care-co-ordination services. Access to radiology services with staff trained and experienced in performing cancer screening imaging, image collation, reading and reporting. Access to multidisciplinary team review of screen detected abnormalities. Access to diagnostic assessment services (i.e. colonoscopy). Access to pathology services with staff experienced and trained in cancer screening result analysis, and collation and reporting of registry data. Access to genetic counselling service. |
Prevention Screening recruitment and cancer prevention educators. Screening Program(s) manager with expertise in population-based screening program management and delivery. Population screening program data management staff. Breast cancer screening Visiting or on-site Radiographer. Specialist radiologist to read images, assess and diagnose. CNC providing care co-ordination and network navigation for recipients of an abnormal test result. Nurse counsellor. Cervical cancer screening General practitioners providing screening test and follow up on abnormal results. Pathology technician to conduct analyses, collate and report results. Pathologist for analysis and interpretation of results. Bowel cancer screening Program specific CNC. RNs to provide counselling, follow-up support and network navigation for participants of a positive test result. |
| 3 |
Provides low-risk ambulatory diagnostic, consultation and treatment service with access to limited support services. Provides multidisciplinary assessment of positive or abnormal cancer screening results. Provides chemotherapy under supervision of a registered Medical Oncologist who reviews patients locally or at a higher level service. Services delivered predominantly by medical practitioners, registered nurses and visiting day-only / telehealth specialist medical services. Administers conventional doses of relatively low-risk systemic therapy under protocols not normally expected to produce severe acute reactions or prolonged neutropenia. Provides maintenance courses of systemic therapy subsequent to initial courses (first cycle) commenced at, and supervised by, Levels 4, 5 or 6 medical oncology services. Provides support before, during and after medical oncology treatment provision. |
Capacity to deal with medical oncology complications. Urgent telephone consultation with referring Level 5 or 6 medical oncology service, as required, for all complications of treatment requiring admission. Access to radiation oncology services within six hours transport for urgent treatment (e.g. spinal cord compression). Reports all unexpected events or unanticipated problems within 24 hours, in normal circumstances, to treating registered medical specialist with credentials in medical oncology. Adheres to protocols for emergency oncology care, intravenous administration of anticancer drugs, cytotoxic handling and disposal, central line care, blood transfusions and infection control. Capacity to provide day treatment, with allocated ambulatory day beds for treatment. Access to support services, particularly to Level 5 and above medication services, and pathology turnaround time of within 24 hours to manage any complications of treatment, regardless of whether patient is receiving palliative or curative treatment. Access to medical imaging services. Documented processes for overnight and emergency health admission of patients to nearby health service, where systemic therapy performed in day-health service or other ambulatory setting. Documented processes with multidisciplinary consultation group, including registered medical specialists with credentials in medical oncology, surgery, radiation oncology and pathology. Documented processes with medical practitioners (general practitioners), social work or equivalent, consultation-liaison psychiatry, pain management, palliative care, psychological and emotional support services, supportive care and community services, and other allied health professionals as required and appropriate for service being provided. Access, through a pharmacy service, to pre-prepared, patient-specific, chemotherapy or biological therapy manufactured in a TGA registered facility or in a compounding facility that is compliant with Good Manufacturing Practice (GMP), and staffed by appropriately trained pharmacy staff for reviewing orders and manufacturing therapies. May manage appropriate cases locally after consultation with registered medical specialist with credentials in medical oncology. May have capacity to support outpatient / outreach (visiting or telehealth) medical oncology consultative services by Level 4, 5 or 6 medical oncology service. |
Access (on site, visiting or tele-medicine) to registered medical specialist with credentials in medical oncology for advice. Access (on site, visiting or tele-medicine) to registered medical specialist with credentials in microbiology for advice. Access (on site, visiting or tele-medicine) to ambulatory / consultative services by registered medical specialist with credentials in medical oncology or clinical haematology, with provision for telephone consultation for complications of treatment and admissions for complications. Access (on site, visiting or tele-medicine) to consultative surgical review services. Chemotherapy competency for all staff involved in the administration of chemotherapy. CVAD competency for all staff involved in direct patient care. Access (on site, visiting or tele-medicine) to registered nurse(s) with specialised knowledge and experience in medical oncology, at Level 5 or 6 medical oncology service and/or outreach support as required. Access to stream specific RN/CNCs where available (i.e. Breast Care Nurse, Stomal Therapy Nurse). Access to medicines supplied on individual prescription. Pharmacy service provided on site, or supervised by a pharmacist located elsewhere. Access (on site, visiting or tele-medicine) to clinical pharmacists haematology/oncology via a formal arrangement with a Level 5 or Level 6 service. Access to chemotherapy production services via a Level 5 or 6 pharmacy service. On site sonographers with oncology-related imaging expertise. |
| 4 |
As for Level 3 plus: Provides conventional doses of chemotherapy under supervision of a level 5 or 6 Oncology service. Manages relatively moderate risk systemic therapy protocols with low risk of neutropenic sepsis. Can administer initial (first cycle) courses for a limited number of protocols where ordered and directly supervised by visiting registered medical specialist with credentials in medical oncology. Provides ambulatory care under visiting registered medical specialist with credentials in medical oncology and inpatient care under registered medical specialist with credentials in internal medicine. Part of service network with higher level services, ensuring access to information related to latest evidence-based care and treatments. |
As for level 3 plus: A day treatment area for administration of systemic therapy and biological agents. 24-hour access to Level 5 or 6 clinical oncology services with documented transfer and referral pathways. On site (or documented process for) access, within 24 hours, to renal dialysis, respiratory, cardiology, and infectious diseases services. Administers systemic therapies under the supervision of a specialist medical practitioner with credentials in medical oncology. Access to a central venous access service in the network. Access to a clinical genetics / medical genetics service. Has pathology turnaround time of within 2 hours in order to manage any complications of treatment, regardless of whether patient receiving palliative or curative treatment. Access to palliative care, pain management and radiation oncology services. May have outpatient / outreach (visiting / telehealth) services. |
As for Level 3 plus: Access to medical oncologist in the network 24 hours, seven days a week via telehealth. CVAD credentialled staff. Access to designated allied health services including social worker, occupational therapist, physiotherapist, speech pathologist, dietitian, psychological and emotional support services within the network. Clinical pharmacist with oncology/haematology training for inpatients and ambulatory patients. |
| 5 |
As for Level 4 plus: Provides treatment for all common malignancies, excluding haematological malignancies. Provides multidisciplinary meetings for common tumour streams. Manages relatively high-risk systemic therapy protocols potentially resulting in periods of myelosuppression of less than one week. Administers initial (first cycle) courses of systemic therapy and supervise subsequent maintenance courses provided at Level 3 and 4 medical oncology services. Also treats low-incidence, highly specialized cancers after initial assessment and development of treatment plan at Level 6. |
As for Level 4 plus: Site-specific (breast, lung and colorectal) and general oncology consultative services available. Designated oncology unit for patients, including those requiring admission for systemic therapy, or for treatment of toxicity or complications of therapy. Day treatment area for ambulatory procedures, such as bone trephine biopsies, venepuncture, and administration of chemotherapy, biological agents and blood transfusions. Transfer or referral of highly complex or high-risk patients to Level 6 service. On-site access to, or documented process for, patient referral and transfer to/ from radiotherapy unit for safe provision of concurrent chemoradiation and inpatient treatment. Provides concurrent chemoradiation for protocols with low risk of inpatient care and non-inpatient radiation oncology services. Multidisciplinary management of oncology patients, including case conferences and development of treatment plans with multidisciplinary team, which is composed of health professionals specialising in medical oncology, surgery, radiation oncology, medical imaging, pharmacy services, pathology, palliative care and supportive care. Documented processes for access to palliative care, pain management and radiation oncology services. Appropriate network access to nuclear medicine. Onsite access to intensive care unit, renal dialysis, respiratory, cardiology, and infectious diseases services. Provides active support for lower level services. Part of service network with Level 6 medical oncology service, ensuring access to information related to latest evidence-based care and treatments. May provide consultative service by registered medical specialist with credentials in medical oncology, either in person or via telehealth. On site 24-hour access to Level 5 or 6 pharmacy services including patient-specific manufacture of, sterile products, parenteral nutrition, chemotherapy, and biological therapy, in a TGA registered facility or in a compounding facility that is compliant with Good Manufacturing Practice (GMP). |
As for level 4 plus: Service provided by registered medical specialist with credentials in medical oncology. 24-hour access to registered medical practitioner with credentials in medical oncology, responsibility may be shared with registered medical specialist with credentials in clinical haematology at the service. 24-hour access to specialist medical practitioners with credentials in radiation oncology, haematology, pathology, palliative care, pain management services and infectious diseases for advice and support within the network. RNs with post graduate qualifications and/or nursing experience in medical oncology; RNs may be supported by ENs in providing care to inpatients. Nursing Unit Manager providing clinical leadership in medical oncology. Clinical nurse consultants in specific cancer streams. Specialist clinical pharmacists oncology/haematology for inpatients and ambulatory patients, with on call access 24 hours. 24-hour access to on-site chemotherapy production services. Access to specialist pharmacist medicines information. Access to designated allied health services including social workers, occupational therapists, physiotherapists, speech pathologists, psychological and emotional support services, and a nutrition team, as required. |
| 6 |
As for Level 5 plus: Coordinates comprehensive, multidisciplinary cancer planning, including convening meetings to co-ordinate management of patient care across the network, ensuring adherence to optimal care pathways / best practice models of care by tumour stream. Provides initial assessment, management and treatment plans for common malignancies, in collaboration with disease-specific surgeons, radiation oncologists, pathologists, imaging specialists and supportive care specialties. Provides initial assessment and management of low-incidence and highly specialised cancers (e.g., germ cell tumours, gynaecologic malignancies and sarcomas), which includes treatment plan. Management of relatively high risk complex protocols. Delivery of all systemic therapy protocols, including intensive chemotherapy protocols. Chemoradiation protocols for high risk of inpatient care (e.g., head and neck cancer). Serves as reference centre for all medical oncology service levels. Multidisciplinary cancer specialties on-site, including radiation oncology and surgical oncology, required to manage low-incidence, specialised malignancy service. Statewide cancer screening program, responsible for planning, co-ordination, reporting and quality assurance. Plans and provides patient-centred, integrated, multidisciplinary survivorship care, that optimises early and latent outcomes. Partners with community providers and organisations to facilitate holistic (physical , psychological and social) survivorship care that promotes treatment of late effects, primary and secondary prevention, surveillance, and ongoing support for health and wellbeing. |
As for Level 5 plus: Access to inpatient radiation treatment including radioidodine treatment for thyroid cancer. Concurrent chemoradiation treatment for all tumour types, including head and neck cancer. On-site renal dialysis, respiratory, cardiology, infectious diseases and pain management services. Access to subspecialty surgeon management by stream e.g., breast, colorectal, head and neck, upper gastrointestinal, lung or bladder). Access to advanced diagnostic radiology and nuclear medicine services including PET/CT and interventional radiology services, including (but not limited to) percutaneous transhepatic cholangiogram, stent insertions, hepatic artery embolisation, peripherally inserted central catheters and breast tumour localisation. Access to internal radiotherapy with agents such as Lutetium-177. Provides medical oncology consultative services at lower service levels. |
As for level 5 plus: Site-specific (breast, lung and colorectal) and general oncology consultative services available. Multidisciplinary medical oncology team includes tumour stream care coordinators / nurse practitioners / clinical nurse consultants, specialist allied health team members including social worker, occupational therapist, physiotherapist, speech pathologist, dietitian, psychological and emotional support services. |
Radiation oncology plays a major role in cancer treatment. Radiation therapy is either used alone or combined with surgery, chemotherapy, hormonal therapy and newer biological therapies in curative or palliative treatment of cancer.
The TRDF recognises two levels of complexity for radiation oncology service provision. A Level 5 service provides on-site radiation treatment to patients. A Level 6 service also provides specialised services and treatment planning on-site.
| Level | Service Description | Service Requirements | Workforce Requirements |
|---|---|---|---|
| 1 | n/a | n/a | n/a |
| 2 | n/a | n/a | n/a |
| 3 | n/a | n/a | n/a |
| 4 | n/a | n/a | n/a |
| 5 |
Provides radiation oncology treatment services, primarily for adult patients. Treatment services include external beam therapy, but exclude specialist radiation oncology services, such as brachytherapy. Provides Intensity Modulated Radiation Therapy (IMRT) and Volumetric Modulated Radiation Therapy (VMAT). Formal links with a Level 6 service for complex case referral and workforce support. |
An accredited radiation oncology facility. Access to consultative services (visiting or telehealth) by radiation oncologists, including initial assessment and long-term follow-up of patients within lower-level medical oncology and haematological malignancy services. Appropriate linear accelerator bunker and equipment. On-site, or documented process for, access to palliative care services supporting participation in patient assessment, management and/or referral by a palliative care team. On-site, or documented processes for, access to renal dialysis, respiratory, cardiology and infectious diseases services within 24 hours. On-site, or documented processes for, access to nuclear medicine services. Access to pharmacy service and medicines information service. |
As per module overview, plus: Suitably qualified and experienced registered radiation therapists. Suitably qualified radiation oncology medical physicists on-site during business hours and accessible after hours, as required. Nurse-in-charge and RNs with appropriate radiation oncology training and experience on each shift. On-site access to specialist pharmacist – oncology. On-site access to allied health professionals including social workers, dietitians, speech pathologists, PEG service including dedicated nurse, stomal care nurses, psychological medicine, pastoral care. Access to specialist medical practitioner with credentials in radiation oncology. |
| 6 |
As for Level 5 plus: Provides a range of specialised radiation oncology services, including external beam and/or brachytherapy services, at regional and/or statewide levels. Service model includes multidisciplinary clinics with participation from core members including surgeons, medical oncologists, radiation oncologists, radiologists and pathologists. |
As for Level 5 plus: Acute inpatient beds on-site for specialised procedures or supportive care. May provide stereotactic body radiation therapy (SBRT), and stereotactic radiosurgery (SRS). May provide specialised radiation treatment services for rare tumours. Documented processes with paediatric, adolescent and young adult quaternary referral facilities where required. Access to a clinical genetics / medical genetics service, including genetic counselling. PET service onsite. Capacity for safe delivery of sealed and unsealed radioisotopes /radiopharmaceuticals. |
As for Level 5 plus: Specialist medical practitioner with credentials in radiation oncology. Radiation oncology registrars/RMOs. RNs with appropriate post graduate qualifications and/or extensive experience in radiation oncology. Radiation oncology staff to adequately provide specialised services. |
