Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2024

Identification of unwarranted variations, causes and improvement priorities in Victorian oesophagogastric cancer care: a mixed-methods analysis  (#326)

Frances Graham 1 , Wanyu Chu 2 , Paul Cashin 3 , David Liu 4 , Norah Finn 2 , Helena Rodi 1 , Tommy Wong 2 , Nick Baje 1 , Linda Nolte 5
  1. Victorian Integrated Cancer Services, Heidelberg, VIC, Australia
  2. Department of Health, Melbourne, Victoria, Australia
  3. Monash Health, Melbourne, Victoria, Australia
  4. Austin Health, Heidelberg, VIC, Australia
  5. North Eastern Melbourne Integrated Cancer Services, Heidelberg, VIC, Australia

Background: An unwarranted variation in cancer care and/or outcome is a disparity that is not explained by differences in patient illness or preferences. The Victorian Integrated Cancer Services (VICS) Optimal Care Summits program identifies unwarranted variations against the standards and targets determined in the Optimal Care Pathways (OCP). The program explores the causes of unwarranted variations and identifies clinician and consumer informed improvement priorities. Addressing unwarranted variations in cancer care is challenging but critical to promoting health equity. 

Aim: To describe the mixed methods, approach and priority unwarranted variations in oesophagogastric cancer (OG) across Victoria.  

Methods: During 2023-24, a mixed methods strategic consultation approach with Victorian OG multidisciplinary stakeholders was applied. It included: 

  • establishment of an expert advisory group 
  • rapid literature review and environmental scan 
  • barriers, enablers, and preferences survey of multidisciplinary clinicians 
  • consumer experience reporting 
  • analysis of 2017-2021 linked administrative cancer datasets 
  • analysis of general practice cancer dataset 
  • implementation of a Delphi survey to prioritise unwarranted variations summit event to explore causes and improvement priorities.  

Qualitative data was subject to thematic analysis and quantitative data was subject to descriptive statistical analysis. Both data was then synthesised. 

Results: Twenty unwarranted variations in OG cancer were identified and three were prioritised for improvement: 

  1. Differing survival among patients living in one regional areas, compared to the statewide average, for gastric cancer. 
  2. Variations in time from diagnosis to patients receiving any treatment within 6 weeks for non-metastatic oesophageal cancer. 
  3. Low rates of OG cancer surgical and/or chemotherapy patients being seen by a dietitian within 3 months of diagnosis. 

The summit identified causes and produced 21 suggested improvement high impact/low resource initiatives for prioritisation.  

Conclusions: This novel mixed methods approach demonstrates an effective strategy for identification of unwarranted variations, causes and improvement priorities to promote alignment with tumour specific OCPs.