Optimal timeframes & summary
Evidence-based guidelines, where they exist, should inform timeframes. Treatment teams need to recognise that shorter timeframes for appropriate consultations and treatment can promote a better experience for patients. Three steps in the pathway specify timeframes for care. They are designed to help patients understand the timeframes in which they can expect to be assessed and treated, and to help health services plan care delivery in accordance with expert-informed time parameters to meet the expectation of patients. These timeframes are based on expert advice from the Keratinocyte Cancer Working Group.
Timeframes for care
|
Step in pathway |
Care point |
Timeframe |
|
Presentation, initial investigations and referral |
Signs and symptoms |
Presenting symptoms should be promptly and clinically triaged with a health professional |
|
Initial investigations initiated by GP |
Investigations and/or curative treatment should be performed within 4 weeks of initial presentation to a GP or as soon as practicable |
|
|
Referral to specialist |
If diagnosis is required, referral to a specialist should be as soon as is practicable according to clinical concern (e.g. 4 weeks for a presumed SCC and 8 weeks for a presumed BCC) |
|
|
Diagnosis, staging and treatment planning |
Diagnosis and staging |
Higher risk patients should be prioritised, where clinically indicated Biopsy should be considered prior to referral, where appropriate Most patients with keratinocyte cancer only require clinical staging |
|
Multidisciplinary meeting and treatment planning |
Selected patients with advanced stage primary keratinocyte cancer, lymph node metastases and keratinocyte cancer in unusual sites are best managed by a multidisciplinary team in a specialist facility The MDM should be conducted before implementing treatment |
|
|
Treatment |
Surgery |
Patients will be prioritised, depending on their particular tumour type and extent but will usually be having active treatment within a 3-month period |
|
Radiation therapy |
Adjuvant radiation therapy should start as soon as possible once surgical wounds have healed, usually within 4–6 weeks of surgery |
|
|
Other therapies |
Treatment should start as soon as diagnosis and staging has occurred and the treatment modality becomes available, ideally within 4 weeks of the MDM |
Seven steps of the optimal care pathway
Step 1: Prevention and early detection
Step 2: Presentation, initial investigations and referral
Step 3: Diagnosis, staging and treatment planning
Step 4: Treatment
Step 5: Care after initial treatment and recovery
Step 6: Managing recurrent, residual or metastatic disease
Step 7: End-of-life care
This optimal care pathway covers keratinocyte cancer (cutaneous basal cell carcinoma [BCC] and squamous cell carcinoma [SCC]).
The incidence of treated BCC and SCC is more than five times the incidence of all other cancers combined in Australia. Cancer registries do not routinely report skin cancers apart from invasive melanoma, so exact incidence rates are not known.
The costs of screening and treating these usually non-fatal cancers cause a disproportionately high burden on the Australian health system and have a negative effect on the patient’s quality of life through cosmetic ill-effects such as facial disfigurement. The estimated total treatment cost for non-melanoma skin cancers that was forecasted for 2015 (diagnosis, treatment and pathology) was $703 million (Fransen et al. 2012).
Most patients with keratinocyte cancer will not proceed beyond step 2 because the vast majority of patients can be successfully treated in the primary care setting and will not require further management. For patients who require management beyond step 2, a multidisciplinary approach is indicated.
