Structured Reporting for Cancer Patients

Structured Reporting for Cancer Patients

The Royal College of Pathologists of Australasia (RCPA) has launched new structured reporting guidelines which will bring huge benefits to patients and specialists in the diagnosis and treatment of cancer.

Associate Professor David Ellis, an Anatomical Pathologist and Chair of the Project Group for the National Structured Pathology Reporting for Cancer Project, says the new reporting templates will enhance communication of critical diagnostic information between pathologists and clinicians, ensuring patients are treated according to world's best practice.

"The new structured reporting format will give cancer specialists a complete, unambiguous and detailed document upon which to base their treatment," says Associate Professor Ellis.

"For patients, the standard reporting format enables treating clinicians to rapidly access and decipher complex and detailed pathological information about cancer type, stage and prognostic biomarkers. This in turn ensures the patient can receive optimised treatment tailored to their particular cancer.

"This new structured reporting format will improve the accuracy and completeness of communication in a standardised template that is easily assimilated and retained by clinicians - it makes sure patients are given the best possible care.

"We are currently collaborating with pathology colleagues in America, Canada and the UK in a process which we are referring to as "Diagnostic Oncology". Our ultimate goal is that the pathology report for every cancer patient in the English-speaking world should be standardised to the same high level of detailed information and in the same clear format, thus enhancing epidemiological research and delivering best practice in patient care on a global level," says Associate Professor Ellis.

President of the RCPA, Associate Professor Paul McKenzie says that this is an important step towards ensuring patients all over Australia have the highest quality of cancer pathology reporting.

"In standardising our report format and content with the US, Canada and UK, we are ensuring that overseas cancer research findings can be directly applicable locally," says Associate Professor McKenzie.

Interview with President of the RCPA, Associate Professor Paul McKenzie

Could you explain the introduction of the structured reporting for cancer patients?

Paul McKenzie: This was instigated by the Professor Bishop the Chief Medical Officer for the Commonwealth of Australia and as a background he was previously the head of the Cancer Institute of NSW who this project, kind of, evolved out of something they were doing a couple of years back. We were concerned that the standard reporting of cancer specimens including biopsies as well as surgically removed specimens was not optimal or perhaps complete across the country. The pathology reporting of these sorts of things largely determines, firstly the types of treatment somebody might get for cancer and also indicates to the patient their likely outcome. In cancer nothing goes anywhere, really, without a tissue diagnoses. Our pathologists are involved, firstly in screening for cancer, things like pap smears, breast screen programs and colon cancer screening. Then, there has to be an initial diagnoses of cancer made and that is usually done by a small tissue biopsy, which is where a piece of tissue is taken and examined under the microscope. We then make that diagnoses of cancer and without that we can not really commit anyone to any serious treatment.

Nearly all cancer diagnoses relies on us; if the patient is treated surgically, say if they have an exhibition of a breast cancer, for instance, the pathologist examines that and determines a number of different things about it, which then is compiled into a report and will determine whether the patient needs chemotherapy, hormone therapy, further surgery or radio therapy. It is based on what we find, combined with some other things, say radiological tests to see if the disease as spread.

In launching this project we have tried to establish the six most common cancers, which are roughly in order of commonest; prostate cancer, breast cancer, colorectal cancer, lymphoma, melanoma and lung cancer. The reporting list will include things like; how big the tumor is, its level of aggressiveness which is known as grades, the extent of spread of the disease that is essentially the stage of the cancer as well as surgical listings such as the measure of complete removal of the tumor.

For women, the fact that it includes breast cancer is important, but not only that, prostate cancer is very important to women too, because many women are married and have fathers. We now have funding through the Federal Government to extend the range of these protocols to include a range of other cancers. The next round does include cancer of the uterus, those will be ready in about another year or so.


How does this benefit the patient and the medical professionals?

Paul McKenzie: Many of these reports are quiet complex and contain a lot of things, which the treating doctors need to further treat the patient. For patients it means that they can be confident that they can get high quality pathology reports no matter where they are in the country. It reduces another pathologist to have to re-examine the tissue and it also means that because we are developing this in line with the American College and also hopefully with the British College any big studies that are done in countries with high populations of cancer patients, the findings will be directly applicable to the local situation. It has a lot of benefits for patients and these days with online forums there is a lot of information available for patients on the internet. Patients are very well informed and will want to know the details of what is in their pathology report.

Usually the doctor will give their patient a copy of the pathology report; I think very informed cancer patients, these days, would demand that. The report is very useful to be kept in their personal records for later on, especially if they see different teams of doctors in different places later on. To understand the report, patients may be required to have some discussion with their doctor. It is surprising how informed patients are about the nature and the significance of some of the things in the pathology report. It is a really important move forward and improvement in quality for patients in cancer.


Will it make it easier for different professionals to be able treat the cancer?

Paul McKenzie: It will be, as the information will be complete and also the reports are designed to be able to transmit and communicate the information back to the treating doctors more effectively.


There is new information available in regards to genetic cancer testing, can you explain this?

Paul McKenzie: Most of this relates to a challenge to the patents of genetics in America, that is the big new item. What has happened is that some companies have patented part of the human gene; which means the genetic makeup of every human, parts of that have been patented by companies in America. We feel that this inhibits the progress of research; it is really inventing because you can see it through a telescope. It isn't an invention, it's a discovery.


How do conferences, like this, help pathologists?

Paul McKenzie: Yes, it is a very successful conference; we have over a thousand delegates here and many international speakers. It is going to be very exciting conference and be very education for all attending.