rehabilitation in lung cancer jo bayly project lead ahp merseyside & cheshire cancer network...
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Rehabilitation in Lung Cancer
Jo BaylyProject Lead AHP Merseyside & Cheshire Cancer NetworkDecember 14th 2009
Aim of presentation
Rehabilitation pathway for patients with lung cancer
Commissioning Lung Cancer Rehabilitation
Implications for lung cancer services in MCCN
National Context The Cancer Plan (DH 2008) Manual for Cancer Services (2008)
Rehabilitation measures End of Life Care Strategy (DH 2008) Transforming in-patient & community care
(2008) World Class Commissioning Darzi; High Quality for All (2008) Cancer Reform Strategy (DH 2007) NICE IOG Supportive & Palliative Care
(2004)
Manual for Cancer Services (2008)Rehabilitation Measures:
no. 08-1E-101v: Baseline Mapping of current service provision
no.08- 1E103v: Agreed cancer site specific rehabilitation pathway for patients with lung cancer
no.08-1E-113v: Network service specification for cancer rehabilitation
no.08-1E-114v: Network needs assessment no.08-1E-115v: Network Service development
strategy no.08-1E-116v: Network cancer rehabilitation training
& development strategy
National Cancer & Palliative Care Rehabilitation Workforce Project:
Commenced November 2007 Jointly funded by DH & Cancer Action Team Focus on rehabilitation services provided by
AHP’s: Physiotherapists Occupational Therapists Dietitians Speech & Language Therapists
National Cancer & Palliative Care Rehabilitation Workforce Project:
Deliverables: updated tumour specific evidence
basepublished tumour specific
rehabilitation pathwaysquantify level of cancer rehabilitation
required: wte per cancer site populationprovide workforce data to support
network cancer populations
Why do we need a lung cancer rehabilitation pathway?
Effectiveness of rehabilitation services in other conditions is well established i.e. stroke, cardiac & pulmonary care
Increased recognition of need for rehabilitation in cancer care
(Supportive & Palliative Care IOG ch10 / Cancer Reform Strategy ch5 / National Cancer Survivorship Initiative)
Why do we need a lung cancer rehabilitation pathway?
cancer & its treatments impact on patients physical, psychological, social & functional well-being
helps patients maximise the benefits of their cancer treatment
minimise deconditioning/loss of function Adaptation of ADL and routines to new
needs and limitations improve social condition, quality of life
Why do we need a lung cancer rehabilitation pathway?
evidence based interventions available non-pharmacological symptom control
Multi-professional breathlessness management (Lung Cancer Clinical Guideline 24)
supports recovery of skills, return to previous work/ roles
cost effective: reduce utilisation of other healthcare resources, decrease hospital length of stay and hospital admissions
Patients with Lung Cancer may experience the following at any point on the pathway:
Breathing difficulties/cough
Fatigue/tiredness ↓ mobility/exercise
tolerance/weakness Pain Cachexia/weight loss ↓ Appetite Dysphagia
Difficulties with ADL/leisure/work
Specific functional impairment
Equipment needs Anxiety/stress Communication
difficulties Specific Information
needs
Rehabilitation pathway referral triggers:
Problem/need: Refer to:
Breathing difficulties/cough Physio/OT
Fatigue/tiredness Physio/OT/Dietitian
↓ mobility/exercise tolerance/weakness
Physio/OT
Pain Physio/OT/Dietitian
Dysphagia SLT/Dietitian
Cachexia/weight loss/ ↓appetite
Dietitian/
Physiotherapy
Rehabilitation pathway referral triggers:
Problem/need: Refer to:
Specific Information needs Physio/OT/SLT/
Dietitian
Difficulties with ADL/leisure/work
OT/Physio
Specific functional impairment
OT/Physio
Equipment needs OT/Physio
Anxiety/stress OT
Communication difficulties SLT
Diagnosis
MonitoringSurvivorship
Palliative Care
End of Life
Post treatment
Treatment
Rehabilitation in Lung
Cancer
•Maintain exercise tolerance/ function•Nutritional support•Breathlessness/pain/fatigue management
•Maintain exercise tolerance/ function•Nutritional support•Breathlessness/pain/fatigue management
•Breathlessness/pain/fatigue management •Maximise functional independence•Nutritional support•Advanced care planning
•Maintain exercise tolerance/function•Vocational rehabilitation
•Maintain exercise tolerance/ function•Nutritional support•Breathlessness/pain/fatigue management
•Advanced care planning•Equipment provision•Non-pharmacological symptom management
How are rehabilitation needs of Lung Cancer patients identified in MCCN?
No formal assessment tool currently in place Medical/CNS led clinics District Nurses/Community CNS Currently, rehab services mostly in hospices Rehab needs may be present before
symptoms prompt referral to hospice
Rehabilitation Services for patients with lung cancer in MCCN.
Most in-patient & community rehabilitation provided by generic AHP’s
Little planned/ funded specialist cancer rehabilitation outside specialist trusts, hospice & palliative care services
Gaps in service for ambulant patients who are not referred to palliative care
Some generic staff have post graduate training in oncology & palliative care
Funded specialist rehabilitation services for patients with lung cancer in MCCN
Acute Trust
PCT Specialist Trust
Hospice
Physio 0 1.5
(pall care)
1.7 7.36
OT 0 2.15
(pall care)
2.7 8.67
Dietitian 2 1
(pall care)
4 0
SLT 0 1 (vacant, pall care)
0.4 0
Challenges: Despite improvements in treatment outcomes for
lung cancer patients
relatively little increase in rehabilitation support to mitigate functional loss
no evidence of rehabilitation services being specifically commissioned as part of the cancer care package.
Challenges for commissioners and providers in MCCN:
rehabilitation not strongly articulated in commissioning process cancer pathways medically focused rehabilitation not described in Lung Cancer
IOG lack of understanding of the broad nature of
cancer rehabilitation interventions
Challenges for commissioners and providers in MCCN:
cancer- a ‘long term condition’, ‘end of life care’ or both?
variable models of service deliveryperformance monitoring, quality
metrics, KPI’s and outcome measures funding priorities
NCAT Commissioning Framework for rehabilitation services
High quality cancer rehabilitation in MCCN needs to be:
Timely & responsive Generic & specialist AHP’s are accessible Seamless across service boundaries Delivered in appropriate setting Focus on prevention & management of long
term effects
Network Lead AHP & Rehabilitation Group responsibilities:
Consult with local AHP providers, Lung CNG, Lung CNS & Partnership Group
Facilitate local implementation of lung cancer pathway Clear referral guidance and processes Directory of Cancer Rehabilitation Services Patient Information Leaflets New developments i.e. MPT follow up clinics Education & Training Audit
