Transcript Colorectal Cancer and Rehabilitation

Brain/CNS Cancer and
Rehabilitation
Report to Brain/CNS NSSG
Sally Donaghey
Macmillan AHP Lead, Ang CN
[email protected]/Tel: 01638 608218
Brain/CNS and Rehabilitation
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Variable survivorship – timing of
rehabilitation
Frequency and severity of disablement
arising from surgery, oncological
treatment and disease itself
Setting of rehabilitation – specialist
neuro in-patient rehab; community;
self-management.
Complications in Brain
Tumour Patients
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Cognitive deficits 80%
Weakness 78%
Visual perceptual deficit 53%
Sensory loss 38%
Bowel/bladder 37%
Cranial nerve palsy 29%
Dysarthria 27%
Dysphagia 26%
Aphasia 24%
Ataxia 20%
Diplopia 10%
Mukand et. al.
American Journal of Physical Medicine & Rehabilitation 2001. 80(5), 346-350
Issues and Initiatives in
Rehabilitation
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Cancer rehabilitation nationally is poorly
developed, evidenced and under
recognised/utilised.
Publication of National Cancer Rehabilitation
pathways and evidence guide.
Development of tumour specific local
rehabilitation pathways
Need for pathways to be integrated into
main care pathway and practice.
Workforce Mapping
Workforce Mapping cont..
Workforce Mapping cont..
Findings
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Relatively low numbers of AHP’s for
population against national average
– Unmet need or
– Need provided by generalist workforce?
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Variablity in specialist service provision
between localities
– Consider referral pathways
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Setting - 53% Acute. 2009 figures indicate
slightly higher then national average cancer
rehab services in community
– Care closer to home?
Workforce Modelling –
Brain/CNS ANG CN
Incidence 2008 = 227
Physiotherapists
Total
FTE
6.3
FTE by professional group, showing break down by pathway
stages
7
Pal & EoL
Occupational Therapists
Total
FTE
5.2
6
Survivorship
Treatment
Dietitians
Total
FTE
0.7
Speech and Language Therapists
Total
FTE
1.9
Lymphoedema Therapists
Total
FTE
1.2
FTE
5
Diagnosis
4
Pre Diagnosis
3
2
1
0
Diet
Lymph
OT
Physio
SaLT
Rehabilitation Triggers
Rehabilitation Triggers ..
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Physiotherapy – Difficulties with function, movement and symptom
control, neurological rehab, muscle tone, fatigue, exercise advise and
information.
OT – Difficulties with ADL, leisure and work, functional assessment,
equipment needs
Dietietics – Nutrition, appetite, nausea, weight loss/gain, fatigue,
swallowing
SLT – Communication strategies, swallowing, impaired speech,
intraoperative communication assessment for awake craniotomy,
language skills/cognitive impairment
Lymphoedema – Skin/tissue assessment
Barriers
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AHP attendance at MDT/clinics
Equity of service in acute and
community setting
Awareness of rehabilitation needs
Co-ordination of rehabilitation needs
Lack of resources
Engagement with Cancer Network
MDT
What Can the
NSSG Do?
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NSSG Workplan
Brain/CNS Care pathway – specific
reference to rehab
Locality/clinician engagement
Audit of referrals/interventions/patient
surveys
Useful Links
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National Brain/CNS Rehabilitation Pathway:
http://ncat.nhs.uk/sites/default/files/NCAT_Rehab_BrainCNS.p
df
Local Colorectal Rehabilitation Pathway:
http://www.angliacancernetwork.nhs.uk/documents/AngCNCCGPS29%20Rehabilitation%20Pathway%20for%20Brain%20and
%20CNS%20Malignancy.pdf
NCAT. Supporting and Improving Commissioning of Cancer
Rehabilitation Services Guidelines:
http://ncat.nhs.uk/sites/default/files/NCAT_Rehab_Commissio
ning.pdf
NCAT. Cancer Rehabilitation Services Evidence Review:
http://ncat.nhs.uk/sites/default/files/NCAT_Rehab_EvidenceRe
view.pdf