national maori cancer revolution of cancer care · case study 1. • hine is a 62 y.omaoriwoman...
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National Maori Cancer
Forum 2009
Revolution of Cancer Care
Anna Ruri
Maori Cancer Nurse Coordinator
Te Kupenga O Hoturoa PHO
Kaitiaki Nursing ServicesTAURANGA
Case Study 1.
• Hine is a 62 y.o maori woman with newly diagnosed
Ca Endometrium.
• She has had a TAH/BSO, omenectomy in June 2009.
• Single – 6 grown up children in Auckland who are all
very supportive.very supportive.
• She is a cleaner – but has decided to give up working
as she requires further treatment.
• She is independent with all her cares. All wounds are
well healed.
Case Study 2
• Mrs X is 34 y.o Pacific Island woman who was initially
diagnosed with cervical cancer in August 2008.
• She underwent a simple hysterectomy, partial lymph
node dissection. She received adjuvant combined
weekly cisplatin/irradiation to the pelvis followed by weekly cisplatin/irradiation to the pelvis followed by
internal radiotherapy. She completed treatment in
December 2008.
• In June 2009 she presented with PV bleeding again. An
EUA and biopsy have confirmed recurrence of her
cervical cancer.
• In July I accompanied Mrs X to a gynaecology oncology
follow up appointment.
• She has declined the surgical treatment that she
requires at this stage.
• She has a good understanding of her
diagnosis/prognosis and implications of her decision
• Independent with all cares
Case 3
• Mr x is 62 years old.
• Newly diagnosed with metastatic colon cancer to liver,
wide spread bone disease. His most pain is in his lower
back.
• Married – 6 children in total. 1 daughter + 1 moko at • Married – 6 children in total. 1 daughter + 1 moko at
home
• He has a good relationship with his GP. He is known to
hospice.
• He is mobile with a walking frame. His wife assists with
bathing cares only.
Case 4
• Mr X is 63 y.o. Maori male.
• He had a radical prostatectomy in June 2009 for
Prostate Cancer.
• Post operatively he was troubled by urinary
incontinence, but as time has gone by this has greatly incontinence, but as time has gone by this has greatly
improved.
• He lives by himself – he has a supportive partner.
• Prior to his surgery he was a long haul truck driver. He
hopes to return to work quite shortly
Numbers by Gender
(n=100)
68
50
60
70
80
32
0
10
20
30
40
Male Female
Numbers by Ethnicity
Pacific Island26%
European1%
Chart Title
Maori73%
26%
Numbers by Age
20
26
24
1415
20
25
30
N
u
m
b
e
r
o
f
01
4
6
14
5
0
5
10
15
0-9 Jan-00 20-29 30-39 40-49 50-59 60-69 70-79 80+
f
P
a
t
i
e
n
t
s
Age
Types of Cancer
• Breast Cancer Pancreatic
• Lung Hepatocellular
• Gastric Prostate
• Colon Head & Neck• Colon Head & Neck
• Leukaemia Renal Cancer
• Lymphoma Gynaecological
• Brain Tumours Unknown Primary
Where did Referrals come
from?
Secondary Care
Tertiary Care
Cancer Society
Te Kupenga
O Hoturoa
Internal
Care Society
Hospice
Maori Cancer Service
Who are we?
• 1 experienced registered Nurse
• 1 cultural adviser
• Community health worker• Community health worker
Referral Criteria
• Maori patients and their whanau
• Diagnosed with Cancer
• And live within the Counties ManukauDHBDHB
Counties Manukau District
Boundary MapBoundary Map
Services Provided
• Inpatient support visits
• Community home visits
• Support for whanau
• Education about cancer and its • Education about cancer and its
treatments
• Coordinate referrals to other appropriate
community services
• Advocacy and support at clinic
appointments
• Transport and travel allowance
• Liaising with Kuia and Kaumatua for
whanau support
• Liaising with GP and MDT
•Referring to counselling
• Bereavement follow up support• Bereavement follow up support
BARRIERS TO SERVICE
•Demand exceeds resources
• Ideally would like to have a patient case-
load of 30-35.
•More often there is 50-60 patients•More often there is 50-60 patients
•Geographical area
• Service 4 medical wards