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Cancer Care Review

Cancer Care Review

A resource pack to support GPs in undertaking high

quality Cancer Care Reviews

Contents

Introduction

Brief Questionnaire

Carrying out and effective CCR (Macmillan)

Process Map

Concerns Checklist (Macmillan)

Concerns Checklist - easy read (Macmillan)

Cancer Care Review template (Macmillan)

Letter to Practices

3

4

5

7

8

9

12

14

Introduction to the Cancer Care Review pack

Humber Coast and Vale Cancer Alliance, as part of the transformation bid funding; have the following four work streams:

1. Awareness and Early Diagnosis

2. Diagnostics

3. Treatment and Pathway.

4. Living With and Beyond Cancer (LWBC) – Macmillan Recovery Package and Stratified Risk follow-up

The LWBC Programme delivery board had set up a number of task and finish groups, one of which is the Cancer Care Review Group (CCR)

The Task & Finish group are aware of pockets of good practice across the Alliance with regards to Cancer Care Reviews. We know that CCRs are being undertaken in Primary Care; however we cannot be assured of the quality of some of these reviews.

The CCR Task & Finish group would like to share with you a pack for your practice to consider using to improve the quality and consistency of cancer care reviews. Please complete and return the brief questionnaire page 2 within the pack, so that we know that you have received the pack.

We would like to thank Springhead Medical Centre, Hull, for the sharing of their practice leaflet for cancer patients. Please feel free to tailor the information in the pack to your own practice. The Springhead leaflet template and an easy read version (included in this pack) will be sent to you electronically, to amend as required.

The Macmillan CCR template is available on EMIS web but not on SystmOne, so a copy is provided in this pack for SystmOne users to refer to.

3

Brief Questionnaire

Practice name: ...........................................................................

Date received: ...........................................................................

1. Do you currently use a cancer care review template?

Yes No

2. Do you have a leaflet to give out to cancer patients about what your practice can offer the patient?

Yes No

3. Do you have an invitation letter for cancer care reviews?

Yes No

4. Do you give out pre review questions or information?

Yes No

If so, what resources do you use?

Please return to: Charlotte PenningtonCancer AllianceHealth HouseWillerby HU10 6DTcharlotte.pennington@nhs.net

4

1. Carry out the cancer care review face-to-face

While patients derive enormous benefit from any contact from the practice after a cancer diagnosis, it is often more beneficial for both GP and patient to undertake a Cancer Care Review (CCR) face-to-face rather than on the phone. With increasing numbers of people surviving their cancer diagnosis, cancer follow up in primary care is likely to start to resemble that of other chronic diseases like COPD or Diabetes. You should therefore consider involving your practice nurses in the CCR process at the earliest opportunity.

2. Use a dedicated appointment slot

A good CCR needs its own consultation. Ideally a double appointment, but if not, an initial appointment with a follow up. Setting aside an appointment in this way and inviting the patient to attend sends a powerful message that primary care has a useful role for those affected by cancer.

3. Invite patients to bring a family member, carer or close friend

Having a close friend or family member at the cancer care review may make your patient feel more supported, able to raise important issues, and help them to recall more of the conversation later. You will also get a much clearer idea of the impact the diagnosis has had on the wider family group.

4. Help patients to prepare by sending them information in advance

Patients may be unsure about what the purpose of the review is and whether to bring up particular issues with you e.g. sexual problems or finances. It is often useful to send the patient, either with the invitation or in the days before the appointment, a clear idea of what the purpose of the appointment is, and some examples of topics which they might find useful to discuss. Even better is to consider sending them a

paper version of the Holistic Needs Assessment to complete prior to the appointment – this will help better identify the issues that are important for the patient.

5. Check patients understanding of their treatment and possible late consequences

Ask about and record current or planned treatment with chemotherapy or radiotherapy, include what has been given and in the case of radiotherapy, where it has been given. This is a useful opportunity to check the patients understanding of the purpose of any treatment. The type and location of treatments can have profound implications for the development of treatment consequences in the months and years after treatment ends.

6. Choose a review template that suits your consultation style

A basic suggested structure is:• Review medication - Discuss diagnosis,

treatment and potential consequences (physical, emotional, social)

• Discuss any financial implications, and provide further information or signpost to further advice and guidance

• Find out about the patients support network and signpost to other sources of support as appropriate

• Agree a date for the next review, or agree that another will happen at points of transition

• Give the patient the opportunity to raise anything else they wish to discuss

7. Find out what advice and support is available for you and your patients

There may be concerns expressed within the CCR which aren’t strictly medical such as financial difficulties, or ones which you feel are outside your area of expertise such as sexual problems or how

cancER Care REVIEw

CarRying out an

EFfecTIve

5

to discuss the diagnosis with dependents. There is a wealth of comprehensive information produced by Macmillan on different cancer types, treatments, consequences and financial matters. These are available to order online at be.macmillan.org.uk

Additionally there are a range of local and national services set up to address these issues, such as the Macmillan Support Line. Get to know what services your patients can access locally and what the routes to access are.

8. Use the review as an opportunity for health promotion

After a cancer diagnosis patients may be more receptive to high impact health promotion. There is increasing evidence that physical activity can have a significant impact on both physical and psychological health after a cancer diagnosis, as well as reducing the risk or recurrence and the impact of any treatment consequences.

9. Complete the electronic template in the patients’ notes

Macmillan GPs have worked with the main General Practice IT systems including EMIS and Vision (INPS) to produce CCR templates. These can be used as an aide memoir when carrying out a CCR and also provide a helpful record of topics discussed.

10. Consider sharing a copy of the review with the patient’s cancer care team

When you have completed the CCR, consider updating the oncologist or CNS to link in with the Holistic Needs Assessment and to demonstrate positive working between primary and secondary care to ensure the best experience for the patient.

Macmillan Cancer Support, registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Also operating in Northern Ireland. MAC15877

6

Cancer Care Review (CCR)

Letter or Serious Diagnosis Form received at GP Practice

GP delegates initial phone call

If no further information and support required at this time send practices own cancer leaflet to all patients by Receptionist/admin to

include named GP/Nurse/Receptionist

GP/PN calls patientGives information and

support over phoneAppointment given if

required

Receptionist/admin calls patient

Gives information and support over phone

Appointment given with GP/PN if required

See crib sheet

COMPLEX STRAIGHTFORWARD

Making an initial phone call to patient is good practice

NOTEAny phone call or appointment with

GP/PN at initial diagnosis should not be classed as a CCR

Receptionist/admin monitors timescale for all patients to be invited for CCR. Recall added for 4 months. (CCR must be completed within first

six months after diagnosis for QOF points)

Receptionist/admin to send invite letter and concerns checklist to patient asking

them to book appointment for CCR

Macmillan/Benefits adviceHOPE courseH&W Event

Psychological supportSupport groups

Smoking cessation Dietician

Physio/OTSocial Services

Community teamSurvivorship team

Activities/Walking groupsCarers Support

Complimentary therapiesBack to named CNS

CCR completed by GP/NPCan refer to other services

dependant on what is available in the area

Receptionist/admin to chase up patients who have not responded after 2 weeks

GP to check if patient aware of diagnosis

(check correspondence/MDT report)

Appointment booked for 20-30 minutes. Time to best suit the patient

Cancer Care Review - Process Map

7

This

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and

the

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It w

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us

iden

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any

info

rmat

ion

and

supp

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ou m

ay n

eed.

If an

y of

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prob

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have

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you

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and

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wis

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with

a

key

wor

ker,

plea

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core

the

conc

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from

1 to

10,

w

ith 1

0 be

ing

the

high

est.

Leav

e th

e bo

x bl

ank

if

it do

esn’

t app

ly to

you

or

you

don’

t wan

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disc

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now

.

Key

wor

ker:

Dat

e:

Con

tact

num

ber:

Patie

nt’s

nam

e or

labe

l

Cop

y gi

ven

to p

atie

nt

Phys

ica

l co

nce

rns

Bre

athi

ng d

ifficu

lties

Pas

sing

urin

e

Con

stip

atio

n

Dia

rrho

ea

Eat

ing,

app

etite

or

tast

e

Indi

gest

ion

Sw

allo

win

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Cou

gh

Sor

e or

dry

mou

th o

r ul

cers

Nau

sea

or v

omiti

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Tire

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xhau

sted

or

fatig

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Sw

ellin

g

Hig

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mpe

ratu

re o

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ver

Mov

ing

arou

nd (w

alki

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Tin

glin

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han

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r fe

et

Pai

n or

dis

com

fort

Hot

flus

hes

or s

wea

ting

Dry

, itc

hy o

r so

re s

kin

Cha

nges

in w

eigh

t

Wou

nd c

are

Mem

ory

or c

once

ntra

tion

Sig

ht o

r he

arin

g

Spe

ech

or v

oice

pro

blem

s

My

appe

aran

ce

Sle

ep p

robl

ems

Sex

, int

imac

y or

fert

ility

Oth

er m

edic

al c

ondi

tions

Pra

ctic

al c

on

cern

s

Tak

ing

care

of o

ther

s

Wor

k or

edu

catio

n

Mon

ey o

r fin

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Tra

vel

Hou

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Tra

nspo

rt o

r pa

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g

Tal

king

or

bein

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tood

Lau

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or

hous

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k

Gro

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sho

ppin

g

Was

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and

dre

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g

Pre

parin

g m

eals

or

drin

ks

Pet

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Diffi

culty

mak

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plan

s

Sm

okin

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ion

Pro

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My

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Emotio

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Unc

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Los

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Una

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to e

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elin

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Thi

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out t

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utur

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Reg

ret a

bout

the

past

Ang

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ustr

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Lon

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ess

or is

olat

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Sad

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or

depr

essi

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Hop

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Gui

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Wor

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ear

or a

nxie

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Inde

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Fam

ily o

r re

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ip c

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cern

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Par

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Chi

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Oth

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or

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Per

son

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me

Per

son

who

I lo

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Spir

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al c

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cern

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Fai

th o

r sp

iritu

ality

Mea

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or

purp

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of li

fe

Fee

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at o

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Info

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or

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Exe

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Die

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Com

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Pla

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Mak

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Pat

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This self assessment is optional, however it will help us understand the concerns and feelings you have. It will also help us identify any information and support you may need.

If any of the problems listed have caused you concern recently and you wish to discuss them with a key worker, please score the concern from 1 to 10, with 10 being the highest. Leave the box blank if it doesn’t apply to you or you don’t want to discuss it now.

Key worker:

Date:

Contact number:

Patient’s name or label

Copy given to patient

Physical concerns

Breathing difficulties

Passing urine

Constipation

Diarrhoea

Eating, appetite or taste

Indigestion

Swallowing

Cough

Sore or dry mouth or ulcers

Nausea or vomiting

Tired, exhausted or fatigued

Swelling

High temperature or fever

Moving around (walking)

Tingling in hands or feet

Pain or discomfort

Hot flushes or sweating

Dry, itchy or sore skin

Changes in weight

Wound care

Memory or concentration

Sight or hearing

Speech or voice problems

My appearance

Sleep problems

Sex, intimacy or fertility

Other medical conditions

Practical concerns

Taking care of others

Work or education

Money or finance

Travel

Housing

Transport or parking

Talking or being understood

Laundry or housework

Grocery shopping

Washing and dressing

Preparing meals or drinks

Pets

Difficulty making plans

Smoking cessation

Problems with alcohol or drugs

My medication

Emotional concerns

Uncertainty

Loss of interest in activities

Unable to express feelings

Thinking about the future

Regret about the past

Anger or frustration

Loneliness or isolation

Sadness or depression

Hopelessness

Guilt

Worry, fear or anxiety

Independence

Family or relationship concerns

Partner

Children

Other relatives or friends

Person who looks after me

Person who I look after

Spiritual concerns

Faith or spirituality

Meaning or purpose of life

Feeling at odds with my culture,

beliefs or values

Information or support

Exercise and activity

Diet and nutrition

Complementary therapies

Planning for my future priorities

Making a will or legal advice

Health and wellbeing

Patient or carer’s support group

Managing my symptoms

© Macmillan Cancer Support and its licensors, 2017. All rights reserved. Macmillan Cancer Support, registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Also operating in Northern Ireland. MAC13689_ConcernsChecklist_17

Copy to be sent to GPKey worker to complete

I have questions about my diagnosis, treatments or effects

Concerns Checklist – identifying your concerns

8

1

Letting us know your concerns Name: ……………………………………………………………………….

Date: …………………………………………………………………………

Tick if you have had the concern in the past week and would like to speak to a healthcare professional about it.

1.

Breathing problems Problems weeing Hard to poo Diarrhoea

Eating /appetite Indigestion Sore/dry mouth

Concerns about your body ...

Feeling/being sick

Sleep problems Tiredness Swollen tummy/arm/leg High temperature

Walking/getting about Tingling hands/feet Pain Hot flushes/sweaty

Dry, itchy or sore skin Wound care Weight changes Memory or concentration

Taste/Eyes/Hearing Speech problems What I look like My sex life

I have some questions about my diagnosis or treatment.

9

2

2.

Caring responsibilities Work / college My home Insurance or travel

Transport or parking Communication Contacting NHS staff

Concerns about everyday life ...

Laundry / housework

Making meals/drinks Shopping Washing and dressing

3.

Partner Children Other family Friends

Concerns about family / relationship ...

4.

Hard to make plans. Loss of interest. Can’t say how I feel. Angry or frustrated.

Guilt. Feel hopeless. Lonely / isolated.

Concerns about your feelings ...

Sad / depressed.

Worried / frightened.

5.

Loss of faith.

Spiritual or religious concerns ...

Loss of meaning Other spiritual concerns. Not at peace with the past. and purpose in life.

Money

10

3

6.

Support groups. Other therapies. Eating. Exercise and activity.

Smoking. Alcohol or drugs. Sun protection.

Other concerns and needs ...

Hobbies.

Stay in work / college. Making a will. Other.

How do you feel right now? 7.

The Picture Communication Symbols © 1981– 2016 by Tobii Dynavoxx. All rights reserved worldwide. Used with permission. www.mayer-johnson.com

Produced by The Learning Disability Service: Lynne Taylor, Strategic Health Facilitator TEWV & Victoria Stenhouse, SLA Speech and Language Therapy HDFT. Eastfield Clinic, Scarborough.

11

Macmillan Cancer Care Review Template

Cancer Care Review

Cancer Care Review done (8BAV - Cancer Care Review)

Cancer Care Review next due (8BAV - Cancer Care Review)

Cancer diagnosis discussed

Cancer diagnosis discussed (8CL0 - Cancer diagnosis discussed)

Cancer Therapy

Select which cancer therapy the patient is on:

7M371 - Radiotherapy NEC

8BAD0 - Cancer chemotherapy

7Q0J0 - Cancer hormonal treatment drugs Band 1

Discussion about treatment (8CP - Discussion about treatment)

Discussion about complication of treatment with patient (8CP3 - Discussion about complication of treatment with patient)

Medication review done

Medication review done (8B3V - Medication review done)

Cancer Care plan

Cancer care plan discussed with patient (8CP0 - Cancer care plan discussed with patient)

Health & Wellbeing

Psychological counselling (6779 - Psychological counselling)

Lifestyle advice regarding diet (67H7 - Lifestyle advice regarding diet)

12

Smoking status:

1371 - Never smoked tobacco

137S - Ex smoker

137R - Current smoker

Smoking cessation advice given (8CAL - Smoking cessation advice)

Alcohol consumption (136 - Alcohol consumption)

Lifestyle advice regarding alcohol (67H0 - Lifestyle advice regarding alcohol)

Lifestyle advice regarding exercise (67H2 - Lifestyle advice regarding exercise)

Cancer information offered

Cancer information offered (677H - Cancer information offered)

Social

Benefits counselling (6743 - Benefits counselling)

Prescription payment exemption

9DD - Prescription payment exemption

9DD1 - Has free prescriptions -autom.

9DD2 - Has free prescriptions-low inc

9DD3 - Has free prescriptions-unspec.

... and 4 more

_____________

Carer's details noted

Carer's details (9180 - Carer's details)

Information

Macmillan Information for Patients - http://www.macmillan.org.uk/assets/macmillan-services-and-support-information.pdf

Entitlement to medical exemption from prescription charges - http://www.nhsbsa.nhs.uk/Documents/HealthCosts/Guidance_issued_to_GPs_and_oncology_departments_regarding_cancer.pdf

Macmillan Support home page - https://www.macmillan.org.uk/?gclid=CJqo5bGT6tECFS6T7QodJbQM3g

13

Re: Your recent diagnosis of cancer

Dear

We would like to invite you to attend the practice for a Cancer Care Review. This is a review designed to be undertaken for people who have had a diagnosis of cancer within 6 months

The appointment should last 20-30 minutes.

This is an opportunity for us to discuss any on-going treatment you may have, any side effects you could have from your treatment as well as talking through any concerns and fears that you or those that are close to you may have and identifying what support can be provided.

You should already have been given information about the cancer that you have and the treatment from your Consultant and/or Clinical Nurse Specialist. The hospital where you are being treated will keep us informed of your care and you will have the opportunity to receive copies of these letters if you wish.

Please find enclosed a copy of the concerns checklist to complete and bring with you to your appointment. You are encouraged to bring a friend or family member with you to your appointment if you wish.

Please do not hesitate to contact this practice if you have any concerns or if you do not wish to take this appointment

Yours sincerely

Our Ref: ******

Your Ref: ******

Date: **/**/****

NAME OF ADDRESSEE ADDRESS LINE 1 ADDRESS LINE 2

Name of Practice

xxxxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxxxxxxxxx

xxxxxxxxx

Tel:

Email:

14

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the

9th

Febr

uary

20

09 a

nd w

ill g

ive

exem

ptio

n fro

m c

harg

es fo

r can

-ce

r pat

ient

s in

resp

ect o

f all

pres

crip

tion

item

s di

s-pe

nsed

on

or a

fter 1

st A

pril

2009

. Pa

tient

s ca

n

obta

in th

eir e

xem

ptio

n ce

rtific

ates

from

the

surg

ery

or w

ill be

pos

ted

out o

n re

ques

t.

Sp

rin

gh

ead

Can

cer

Car

e

At S

prin

ghea

d w

e try

to p

rovi

de

the

best

trea

tmen

t for

our

pat

ients

.

Whe

n pe

ople

hav

e re

ceiv

ed a

diag

nosis

of c

ance

r it c

an b

e a

ch

allen

ging

and

con

fusin

g tim

e.

Hos

pita

l spe

ciali

sts w

ill in

form

you

of

the

diag

nosis

and

trea

tmen

t ch

oice

s.

It ca

n be

a p

erio

d of

test

s,

inve

stig

atio

ns, u

ncer

tain

ty a

nd

havi

ng to

wait

for r

esul

ts b

efor

e st

artin

g tre

atm

ent.

Supp

ort s

ervi

ces

are

avail

able

from

hos

pita

l with

sp

ecial

ist n

urse

s, ps

ycho

logi

cal

coun

selin

g an

d th

e M

acm

illan

nu

rsin

g te

am. T

here

is a

lso a

wea

lth

of in

form

atio

n av

ailab

le o

n th

e

inte

rnet

with

som

e ve

ry g

ood

ded

-ic

ated

web

site

s. D

urin

g th

e in

itial

asse

ssm

ent a

nd tr

eatm

ent p

erio

d pe

ople

ofte

n ha

ve fr

eque

nt h

ospi

tal

atte

ndan

ces.

Plea

se N

ote:

We

have

no

con-

trol o

ver h

ospi

tal a

ppoi

ntm

ents

an

d tre

atm

ent.

Ou

r ro

le a

s yo

ur

GP

Th

roug

hout

this

time

the

hosp

ital i

s lea

ding

yo

ur c

are.

As y

our G

P, w

e aim

to p

rovi

de th

e co

ntin

uing

car

e an

d su

ppor

t tha

t you

wan

t. Co

mm

unica

tion

from

the

hosp

ital i

s var

iable

.

We

have

thou

ght a

bout

how

we

mig

ht im

-pr

ove

patie

nts e

xper

ience

dur

ing

this

time.

We

wou

ld li

ke to

prio

ritise

you

r car

e to

ena

ble

you

to

Bo

ok a

ppoi

ntm

ents

in a

dvan

ce w

ith

your

GP

Bo

ok a

long

er a

ppoi

ntm

ent f

or d

iscus

-sio

n w

ith y

our G

P

Ta

lk to

you

r GP

on th

e te

leph

one

Bo

ok a

visi

t fro

m y

our G

P

U

nder

stan

d w

hat t

he ta

blet

s you

hav

e be

en p

resc

ribed

are

for.

G

et h

elp

whe

n yo

u ne

ed it

.

To

enab

le u

s to

prio

ritis

e yo

ur c

are

Car

ol

Lam

bert

and

Chr

istin

e W

alke

r will

act

as

cont

act p

oint

s. T

hey

can

be c

onta

cted

M

on—

Fri 9

am-1

pm

0148

2 33

5224

(ans

wer

phon

e av

aila

ble)

Can

cer

Su

pp

ort

Team

Caro

l and

Chr

istin

e ha

ve k

now

ledg

e of

th

e su

ppor

t ser

vice

s ava

ilabl

e.

We

can

lend

you

som

e bo

oks o

n ca

ncer

and

how

a d

iagno

sis o

f ca

ncer

can

affe

ct y

ou a

nd y

our

fam

ily, w

hich

you

may

find

he

lpfu

l

We

can

dire

ct y

ou to

supp

ort

lines

and

reso

urce

s for

you

r par

-tic

ular

diag

nosis

We

can

prov

ide

info

rmat

ion

re

gard

ing

help

for t

he c

ost o

f tra

nspo

rt to

and

from

hos

pita

l an

d w

here

to se

ek fi

nanc

ial a

d-vi

ce fo

r you

r ind

ivid

ual s

ituat

ion

We

can

cont

act y

ou re

gular

ly ov

er th

e ne

xt fe

w m

onth

s, or

yo

u ca

n co

ntac

t us a

s and

whe

n yo

u ne

ed to

.

If y

ou w

ould

like

us t

o ph

one

you

or a

rran

ge fo

r the

doc

tor t

o ph

one

you

regu

larly

plea

se

phon

e Ca

rol o

r Chr

istin

e