Ensuring care coordination

68-year-old Northland farmer John Wintle had been fit and well until he started to have some reflux and difficulty swallowing just before Christmas 2013.

A visit to his GP resulted in a referral for a gastroscopy to investigate the cause, and John travelled from his home in Papamoa to Warkworth for the procedure in mid-February. The biopsy taken confirmed that John had oesophageal cancer.

A PET scan carried out a week later to determine more about the extent of the disease, revealed that fortunately the tumour hadn’t spread.

The scan images, together with other test results, were then reviewed at the multidisciplinary meeting (MDM) held by videoconference between Northland and Waitemata DHBs. The weekly MDMs mean that cases can be discussed with all the specialist staff involved, and that patients can benefit from a range of expert opinion in one place.

Clinicians agreed that John’s tumour looked operable, so on March 5 John saw North Shore Hospital chief of surgery, Michael Rodgers, to discuss his surgery.

John’s care was managed between the medical oncology team at Whangarei and oncology and surgical services at North Shore, with coordination the responsibility of Northland cancer nurse coordinator, Karen Palmer.

‘My role involved helping to streamline John’s care pathway, and I liaised really closely with the clinical nurse specialists and surgeons at North Shore where his surgery took place,’ Karen explained.

‘I’ve been in post for a year now, but before that there was not really anyone to take on this role of liaising and guiding the patients through their treatment.’

Following best practice for treatment of adenocarcinoma of the oesophagus, John started three cycles of pre-operative chemotherapy on March 17. Each cycle involved receiving intravenous chemotherapy as a day patient at Whangarei Hospital, combined with daily oral chemotherapy.

John coped well with his chemo, carrying on working as normal and even finding it easier to eat. A re-staging CT scan at the end of the first phase of chemotherapy was followed by review of John’s case at the MDM.

‘I presented John’s case at our MDM but, in addition to those discussions, I catch up at least weekly with the cancer nurse coordinator at North Shore and just about every day in relation to various patients,’ Karen explained.

Again, following best practice, surgery was scheduled for 4-6 weeks after chemotherapy and John underwent an Ivor Lewis oesophogectomy on June 16.

‘Once surgery was done, then we worked together to get the patient back on board with our oncologists and to complete chemotherapy. The really good thing is the excellent communication the DHBs have with each other and so this means no-one slips through the net,’ Karen explained.

During his regular visits to Auckland for appointments, John and his wife were able to stay in the patient accommodation provided at North Shore.

The operation and John’s recovery went smoothly, and on July 28 he began a further three cycles of chemotherapy. This time, however, he struggled with the side-effects and needed to take time off work as well as having a reduction in his dose.

But by his review appointment on October 2, John was well on the way to recovery.

Karen added: ‘John will have a follow-up appointment in three months and will have regular appointments after that, but he knows that he can contact me at any time in between appointments if needed.’

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