Cancer Pathway


Based on what we’ve learnt over the past year or so, we propose approaching the prioritisation of cancer pathways as follows:


Four step process:

  1. Establish and maintain a Cancer Pathways Prioritisation Pool, based on
  1. Tumour Standards which have had a Regional Service Review, and
  2. Primary Care demand
  1. Assess the interest and capacity of diagnosing specialists representing the cancers in the Priority Pool, to allocate time to collaborate on initial draft pathways
  2. Convene (annual, if possible) 3D Cancer Pathway Prioritisation meeting, involving
  • the diagnosing specialists who indicated interest and capacity 
  • Medical and Radiation Oncology Clinical Leads
  • Carey Virtue, Alison Hannah, Justine Lancaster and Antoinette Ehmke
  • CCN – Equity representation (Carol? Jo?)
  1. Establish by consensus the priorities and work programme for the next year, based on  

9 considerations.

Cancer Pathways Prioritisation Pool (updated Dec 2015)

Cancers for which Tumour Standards have been published

  • Bowel (service reviewed 18 months ago; published)
  • Lung (service reviewed 12 months ago; Standards are currently reviewed again)
  • Breast (service review completed;  implementation underway)
  • Gynae (service review completed; implementation underway)


  • Upper GTI cancers (service review starts Feb 2016)
  • Head & Neck Cancers (service review starts April 2016)


  • Melanoma
  • Lymphoma


  • Thyroid Cancer
  • Myeloma
  • Sarcoma

Other cancers – much needed in Primary Care / already live on 3D

  • Prostate Cancer
  • Bladder Cancer
  • Neurology (Headaches)
  • Haematology (several)

Diagnosing Specialists


Dermatology, Plastic Surgeons, Radiologists, Pathology

Upper GTI cancers

Gastroenterologists, upper GI surgeons,    Radiologists, Oncologists; Pathology


Haematology, General surgeons, radiologists; Pathology

Head & Neck Cancers

ENT, plastic surgeons, oral surgeons,  Radiologists; Pathology

Thyroid Cancer

ENT surgeons,   Radiologists; Pathology


Haematologists, radiologists, General physicians; Pathology


General Surgeons, Orthopaedic surgeons,   Radiologists; Pathology

Prostate / Bladder Ca

Urology;  Radiologists; Pathology


Neurologists, neurosurgeons, radiology, (pathology?)


Haematologists, pathology.


9 Considerations to use as a basis to reach consensus about the priorities:

  1. Which diagnosing specialists are available, and when in the next year, to collaborate on initial drafts?  (1 – 3x  90 min meetings, 2 weeks apart, followed by short chunks of time for electronic review and communication)
  2. Which arrangements have to be in place in order for the Medical and Radiation Oncologists to review and comment on the initial drafts?
    (No meetings; just 1 – 2 chunks of 15 -60 minutes for electronic review and commenting)
  3. Which arrangements need to be in place for other members of the MDM to review the 2nd draft and provide input? (No meetings; just 1 – 2 chunks of 15 -60 minutes for electronic review and commenting)
  4. With which cancers lie the greatest needs for improved outcomes in terms of prevention, risk assessment and early diagnosis?


  1. With which cancers lie the greatest needs for improving equity of access to services? The 3 drivers of inequity are
  1.  Determinants of Health
  2. Access to healthcare services
  3. Quality of healthcare services
  1. Which conditions are most common in primary care?
  2. Which conditions are difficult to identify and need clear guidance for work up in primary care?
  3. Which live 3D pathways with associated cancers are ready to be reviewed, and/ or for which cancer-related conditions can existing (Canterbury) Healthpathways Pathways be used as a basis to work from (as opposed to having to start from scratch)?
  4. Which pathways have already been worked on by Mid-Central (MoM)  (i.e. where we can we access work already done relatively locally to avoid duplication of effort ?


3D Cancer Pathway priorities for Jan – June 2016:

  1. Complete Lung Cancer pathways
  2. Complete gynae cancer pathways
  3. Start Prostate & Bladder Cancer pathways*

*Provided that the diagnosing specialists are available from April – July


Potential priorities for July – Dec 2016

Tumour standard service reviews have proven to take around 8 months to complete.  If the review for Upper GTI Cancers starts in Feb, completion (or near-completion) can be expected around October 2016.  If the review for Head & Neck Cancers start in April 2016, completion could be expected around December 2016.  This will give us a gap to fill between July and October 2016.

3D already has live pathways for Headaches in Adults (Neurology) and a large batch of Haematology pathways.  We may suggest bringing either or both of these categories of pathways forward for revision between Jul – Oct 2016  and use the opportunity to integrate cancer-related information into them.  Please note - our cancer work programme for 2016 is still in draft phase.

In summary, our Draft Cancer Work Programme for 2016/17:


Cancer Pathway Schedule