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Standard Cancer Treatment Protocols

Partner Institute: 
Centre for Health, Economics Research and Evaluation (CHERE), University of Technology, Sydney
Survey no: 
Marion Haas
Health Policy Issues: 
New Technology, Quality Improvement, Responsiveness
Current Process Stages
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no no yes no no
Featured in half-yearly report: Health Policy Developments Issue 6


One goal of the NSW Cancer Plan 2004-2006 is to ensure that clinical practice is driven by evidence from research. The Standard Cancer Treatment (CI-SCaT) protocols are delivered via a website which provides clinicians, patients and carers with information about chemotherapy cancer protocols, including evidence, cost, drug dose calculation, treatments and side effects.

Purpose of health policy or idea

The purpose of CI-SCaT is to provide clincians with information about chemotherapy cancer protocols, including evidence, cost, drug dose calculation, and patients and carers with detailed information regarding treatments and side effects.

Main points

Main objectives

The objectives of CI-SCaT are to ensure that

i) as many cancer clinicians as possible receive up-to-date information about chemotherapy protocols whish are derived from the latest evidence and

ii) that patients and carers have access to the most up-to-date agrred information about alternative treatments for their condition as well as side-effects.

Type of incentives

The program has been developed from an idea of a single clinician (Professor Robyn Ward) and the only incentives are related to improving the information available to clinicians and patients, the quality of care and hence outcomes for patients.

Groups affected

cancer clinicians, patients with cancer, carers of patients with cancer

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Characteristics of this policy

Degree of Innovation traditional rather innovative innovative
Degree of Controversy consensual consensual highly controversial
Structural or Systemic Impact marginal rather marginal fundamental
Public Visibility very low low very high
Transferability strongly system-dependent system-neutral system-neutral

We are aware of two other websites, in Canada and the UK, which record and describe clinical practice and make information available about the effectiveness of protocols for cancer therapies. In Canada, the British Colombia Cancer Agency Systemic Therapy Program have placed summaries of specific treatment protocols on the website. The protocol summaries are those in current use by the Systemic Therapy Program staff at all regional cancer centres. In the UK, the NHS lists Haematology Chemotherapy Protocols (HCP) which are those approved for use in hospitals across the ASWCS Network by the Network Drug and Therapeutics Committee.

As it is recognised that healthcare interventions should be based on the best available evidence and that this is the aim of CI-SCaT, there is unlikely to be any controversy associated with the idea. Some internal controversy may surround the approval and display of individual protocols but this is to be expected given the lack of evaluation of many technologies or the fact that evaluation results cannot be generalised across all populations of interest.

Although the outcomes of the program may have profound impacts on individual clinical practice and therefore individual patients, because there is no information provided about the costs relative to the benefits and because the information may be used without regard to a budget constraint, the impact on the health system as a whole is likely to be rather marginal.

The general public is unaware of the program. The program is system neutral as it is not dependent on any particular structural, organisational or funding arrangements.

Political and economic background


Purpose and process analysis

Current Process Stages

Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no no yes no no

Origins of health policy idea

The CI-SCaT program was originally conceived by Professor Robyn Ward at St Vincent's Hospital in Sydney in 2001. Since 2004 the program has been managed by the Cancer Institute (NSW) with Prof Ward remaining as Director. Her interest in day-to-day clinical practice as a multi-disciplinary activity led her to instigate the CI-SCaT program and the process of identifying and recording best practice in cancer care.

The Cancer Institute (NSW) provides the governance structure and support for the program. A core team of project officers as well as two specialist reference groups comprising medical, nursing specialists (rural, metropolitan and interstate representatives) as well as pharmacists and consumers develop detailed treatment protocols. The protocols include information on drug dosing, administration schedules, evidence of clinical effectiveness and comparative toxicities. The information is published on a dedicated website and is available for use by both health professionals and consumers. The system is updated in real time, thus avoiding delays in the release and display of new clinical information.

Initiators of idea/main actors

  • Scientific Community: The program was initiatied by a scientist-clinician and continues to be supported by the Cancer Institute (NSW) - a scientific organisation.

Approach of idea

The approach of the idea is described as:

Stakeholder positions


Actors and positions

Description of actors and their positions
Scientific Community
Professor Robyn Wardvery supportivevery supportive strongly opposed
Cancer Institute (NSWvery supportivevery supportive strongly opposed
cancer clinciansvery supportivesupportive strongly opposed

Influences in policy making and legislation


Actors and influence

Description of actors and their influence

Scientific Community
Professor Robyn Wardvery strongvery strong none
Cancer Institute (NSWvery strongstrong none
cancer clinciansvery strongvery strong none
Cancer Institute (NSWProfessor Robyn Wardcancer clincians

Positions and Influences at a glance

Graphical actors vs. influence map representing the above actors vs. influences table.

Adoption and implementation

The Ci-SCaT program is directed at clincians and consumers. Therefore, their involvement in the activities which result in the approval and display of protocols is aimed at ensuring the widest possible uptake of the information provided by the program. Membership of reference groups is widely advertised and members are asked to review and edit protocols and to attend workshops where the protocols are discussed and a consensus agreement about what to approve and display is reached.

The obstacles to uptake will be the relative lack of use of web-based protocols by rural-based clinicians, any lack of consensus regarding particular protocols, a lack of information about the impact of adoption on downstream costs and overall budgets (for hospital-based clinicians) and the complexity of the information now available. In addition, the availability of information to both clinicians and consumers may create some conflict about which treatments to adopt and the relative importance of side effects.

Better information about the relative cost-effectiveness of individual protocols and the impact of adoption on downstream costs and overall budgets may facilitate implementation of approved protocols.

There are unlikely to be any opponents to this program of work.

Monitoring and evaluation

The website is monitored on a monthly basis for the number of hits. It is not possible to distinguish between types of users (eg health care professional or patient) but negotiations are under way to build into the website the ability to monitor the IP domain of users. In some cases this will enable the identification of individual hospitals whose staff are downloading information from the site. In addition, it will be possible to monitor the extent of downloads that occur from common IP domains such as Yahoo, BigPond, hotmail etc. It will also be possible to identify which protocols are being downloaded, enabling better scheduling of reviews (ie the more common the useage of a protocol, the more often it should be reviewed).

In 2006, an 8-week online survey will be conducted amongst users of the site. It will investigate their satisfaction with the design of the site, including ease of use, navagatibility etc. In the longer term, plans are being made to examine the extent to which relevant protocols are being used. This will involve the development of a unique ID system for users of the NSW Cancer Registry to enable them to type in the number of the protocol they are using when they report information about cancer for individual patients.

A national roadshow is planned for 2006 to promote use of the website and to alert users of the website to the current plans for monitoring and evaluation.

Results of evaluation


Expected outcome

The policy will certainly achieve its objectives at least partially. That is, a proportion of clinicans, patients and carers will benefit from the information provided, the quality of care is likely to be improved for a proportion of patients and their outcomes are likely to be better than they would otherwise be.

The only unexpected or undesirable effects relate to the potential impact of any proposed protocols on the overall budget for cancer or for the health system as a whole. Because there is no information available about the impact on costs downstream and no evaluation of the use to which resources used in implementing recommended protocols may otherwise be put, there is the potential for inefficiency to be increased.

Whilst the impact on quality of care can be expected to increase, there is no evidence about potential impacts on costs, access to care or equity of outcomes.

Impact of this policy

Quality of Health Care Services marginal rather fundamental fundamental
Level of Equity system less equitable neutral system more equitable
Cost Efficiency very low neutral very high

The quality of care provided to cancer patients could be fundamentally improved if all clinicians adopted the approved protocols. There is no evidence about the impact on equity but given that city-based clincians are most likely to adopt new protocols, the impact, at best, is likely to be neutral. There is no evidence about the impact of the adoption of the approved protocols on the efficiency of health care delivery as no evaluation of this has as yet been undertaken.


Sources of Information

British Colombia, Canada


Author/s and/or contributors to this survey

Marion Haas

Suggested citation for this online article

Marion Haas. "Standard Cancer Treatment Protocols". Health Policy Monitor, October 2005. Available at