living with and beyond treatment for cancer – the challenge for secondary care nigel acheson...
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Living with and beyond treatment for cancer – the
challenge for secondary care
Nigel AchesonMedical Director
Peninsula Cancer Network
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Health service quality can be defined as provision of care that exceeds patient expectations and achieves the highest possible clinical outcomes with the resources available
Does improving quality save money?Ovreveit J 2009
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The number of patients estimated to have been living with a specified cancer which had been diagnosed between 2004 and 2009
• England figure
• Those diagnosed whilst resident in the Peninsula Cancer Network
5 year prevalence
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South West Cancer Register and National Cancer Data Repository 2008
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South West Cancer Register and National Cancer Data Repository 2008
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The number of patients estimated to have been living with a specified cancer which had been diagnosed from the earliest diagnosis year recorded on the South West Cancer Register started, up to the end of 2009.
• England figures
• Those diagnosed in the Peninsula Cancer Network
Complete prevalence
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South West Cancer Register and National Cancer Data Repository 2008
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South West Cancer Register and National Cancer Data Repository 2008
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Breast, prostate colorectal cancer
Key reason for follow up focused on medical needs:
Detect recurrence Manage early complications Manage late effects
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Wide variation including:
No follow up with rapid access Lifelong follow up +/- surveillance
tests
Variation from tumour site to tumour site, and within tumour sites
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Most patients seen in outpatient clinics
Differences in frequency of visits
Usually time limited to 5 years, and then patients need to be referred by GP if necessary
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Key workers Care plans Rehabilitation Patient support
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Conclusion
Need to review practice against current best evidence to improve quality and outcomes
Assessment of needs and care plans – an area that must be considered in order to ensure patients have informed choice
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Challenge 3 – secondary care approach to elements of
survivorshipPreventionSurveillanceInterventionCo-ordination
=>Plan where and by whom the various elements should be undertaken
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Prevention
Late effects of treatmentRecurrence of cancerNew cancers
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Surveillance
Progression of diseaseRecurrenceNew cancersAssessment of late effects
MedicalPsychosocial
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Intervention
Symptom control eg painEffects of treatment eg lymphoedemaPsychological support eg sexual
dysfunctionSocial and economic
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Coordination
Between specialists, primary care, allied health professionals, social support, employers
This will involve: Care planning Multidisciplinary risk stratification Working with stakeholders to ensure that
resources to meet assessed needs are in place
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“5 shifts” Focus on recovery, health and well-
being after cancer treatment Assessment, information provision
and personalised care planning Self-management Shift from a single model of clinical
follow up to tailored support Emphasis on measuring experience
and outcomes
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“The NCSI vision is that…assessment covers the full range of needs of
individuals, including physical and lifestyle needs, social, financial advice
and occupational support needs, psychological wellbeing and spiritual
needs”
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Challenge 4 – review available models and evaluate locally
Identify models to evaluate
Identify partners and stakeholders in providing care
Plan integrated care
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What do patients want? Macmillan event 2008 (200 patients)
Good quality information Rapid access to specialist care as needed A care plan agreed by all those providing care
and owned by the patient
Peninsula Cancer Network Patient and Carer Working Group to ensure that effective patient, carer and
public involvement is at the heart of cancer service design and delivery across the Peninsula.
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Challenge 5 – work with patients and partner
organisations to implement successful models of care
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Summary of the challenges for secondary care
1. understanding the concept2. assessing the current situation3. who provides elements of
survivorship and where4. review available models and
evaluate locally5. work with patients and partner
organisations to implement successful models of care