National Cancer Survivorship Initiative

Living with & Beyond Adult Cancer: What has been achieved so far?

Adam Glaser National Clinical Lead

Adult Cancer Survivorship

• Where were we 3 years ago?

• Where are we now?

• What do we need to do next?

3 years ago

• Lack of clear evidence – Needs – Practice • Variation in practice • Overwhelmed services • Unmet needs – Poorly quantified • Disparate and sceptical clinical teams

Process

• Identified 4 tumour sites – Breast, colorectal, lung, prostate • Robust service improvement methodologies – Expert panels – Pathway mapping – Pilot testing • Partnerships – DH & NHS Improvement – Macmillan Cancer Support and disease specific charities – Service Users, Providers and Commissioners

Testing Hypothesis

– The introduction of stratified pathways and packages of care will improve the patient experience, reduce outpatient attendances and reduce unplanned admissions Prostate Hillingdon Luton North Bristol Ipswich Colorectal North Bristol Guys and St Thomas’ Salford Breast North Bristol Hillingdon Brighton Hull Ipswich Lung Brighton Hull

Then……..

Standard medical follow up pathway Holistic needs assessment – at diagnosis Unmet needs post treatment Verbal care plans Traditional clinic letters Ad-hoc education Little/no lifestyle advice post treatment Clinic visits for test results

Now ……….

 Tailored pathway to meet patient needs  Holistic needs assessment - at diagnosis and post treatment  Needs identified & actioned  Written Care plans  Treatment summaries/ structured letters  Group learning, education and peer support  Improved access to physical activity and other support services  Separated with support of remote monitoring (being implemented)

Risk Stratification - Headlines • Pathways – Breast and Prostate – 2 pathways only • Supported self management – Colorectal – 45% (40%) – Breast – 77% (70%) – Prostate – 28% to 44%(40%) – Lung – some can self manage for periods • Timing – Breast 2-3 months after end of treatment or one year after diagnosis – Prostate could happen at 6 months but most at around 2 year point – Colorectal – 4-6 months after end of treatment or stoma reversal – Lung – n/a • Clinical trials – impact on % that can transfer to self managed

Key enablers

•

Comprehensive assessment

holistic needs – end of treatment or at agreeable point in pathway •

Remote monitoring system

• Personalised

education and information

•

Care co-ordination

and

contact point

– Preferably someone they know •

Rapid re-access

without recourse to GP

Remote Monitoring

–

getting there!

we are

1.

2.

• Breast (5 sites) local solutions all live • • Colorectal (3 sites) NHS Improvement solution - Bristol goes live 1 st April In house solutions - Guys and Salford currently testing with go live April/May 3. Prostate (6 sites) • NHS Improvement solution – all sites 2 sites live, 2 testing and 2 installing

Enhanced Quality Drives up Productivity

• Reduced OP activity 4,985 outpatient slots released across 14 tumour teams • Reduced OP costs £349,000 reduction in cost of OPD attendances

Health warning: Needs to be offset against cost of implementing pathway enablers

• Reduction in unplanned admissions 6-8% in lung cancer

What do we need to do next?

• – – Develop and Spread pathways and learning Whole country Apply key learning and messages to other tumour sites • • – Work with the health economy • Education Service users, commissioners and providers – • • Evidence Safety and impact of risk stratified pathways Consequences of treatment Incorporate all strands of evidence deliverable pathways into applied

Summary

• Huge progress

but job not complete

• Simplified common pathways, providing a framework to further build and develop evidence-based sustainable care pathways • Reduction in unmet needs and enhanced productivity • Not possible without the engagement, enthusiasm, passion and dogged determination of all members of our new “ Survivorship Community ”.