09. Adam Glaser Slides 28 March

7/29/2019 09. Adam Glaser Slides 28 March

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National Cancer Survivorship Initiative

Living with & Beyond Adult Cancer:

What has been achieved so far?Adam GlaserNational Clinical Lead


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Adult Cancer Survivorship

Where were we 3 years ago?

Where are we now?

What do we need to do next?


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3 years ago

Lack of clear evidence

Needs

Practice

Variation in practice

Overwhelmed services

Unmet needs

Poorly quantified

Disparate and sceptical clinical teams


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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


5/13

Testing Hypothesis The introduction of stratifiedpathways and packages of care will improve the

patient experience, reduce outpatient attendances

and reduce unplanned admissions

Prostate Breast

Hillingdon

LutonNorth Bristol

Ipswich

North Bristol

HillingdonBrighton

Hull

Ipswich

Colorectal Lung

North Bristol

Guys and

St Thomas

Salford

Brighton

Hull


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Then.. Now .

Standard medical follow up pathway Tailored pathway to meet patientneeds

Holistic needs assessment

at diagnosis

Holistic needs assessment

- at diagnosis and post treatment

Unmet needs post treatment

Needs identified & actionedVerbal care plans Written Care plans

Traditional clinic letters Treatment summaries/

structured letters

Ad-hoc education

Group learning, education andpeer support

Little/no lifestyle advice post

treatment

Improved access to physical

activity and other support services

Clinic visits for test results Separated with support of remote

monitoring (being implemented)


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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


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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


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Remote Monitoringwe are

getting there!

1. Breast (5 sites)

local solutions all live

2. Colorectal (3 sites)

NHS Improvement solution - Bristol

goes live 1st 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


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Enhanced Quality Drives up

Productivity Reduced OP activity4,985 outpatient slots released across 14 tumour teams

Reduced OP costs349,000 reduction in cost of OPD attendancesHealth warning: Needs to be offset against cost of

implementing pathway enablers

Reduction in unplanned admissions6-8% in lung cancer


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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 into applieddeliverable pathways


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Summary

Huge progress but job not complete

Simplified common pathways, providing a framework tofurther 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.

Documents

09. Adam Glaser Slides 28 March