Living with and beyond treatment for cancer – the

challenge for secondary care

Nigel AchesonMedical Director

Peninsula Cancer Network

Health service quality can be defined as provision of care that exceeds patient expectations and achieves the highest possible clinical outcomes with the resources availableDoes improving quality save money?Ovreveit J 2009

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

South West Cancer Register and National Cancer Data Repository 2008

South West Cancer Register and National Cancer Data Repository 2008

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

South West Cancer Register and National Cancer Data Repository 2008

South West Cancer Register and National Cancer Data Repository 2008

Breast, prostate colorectal cancer

Key reason for follow up focused on medical needs:

Detect recurrence Manage early complications Manage late effects

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

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

Key workers Care plans Rehabilitation Patient support

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

Challenge 3 – secondary care approach to elements of

survivorshipPreventionSurveillanceInterventionCo-ordination

=>Plan where and by whom the various elements should be undertaken

PreventionLate effects of treatmentRecurrence of cancerNew cancers

SurveillanceProgression of diseaseRecurrenceNew cancersAssessment of late effects

MedicalPsychosocial

InterventionSymptom control eg painEffects of treatment eg lymphoedemaPsychological support eg sexual

dysfunctionSocial and economic

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

“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

“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”

Challenge 4 – review available models and evaluate locally

Identify models to evaluate

Identify partners and stakeholders in providing care

Plan integrated care

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.

Challenge 5 – work with patients and partner

organisations to implement successful models of care

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