Upload
roger-russell-jackson
View
222
Download
0
Tags:
Embed Size (px)
Citation preview
Consequences of cancer & its treatment
Jane MaherNHS Improvement Lead (cancer)Chief Medical Officer, Macmillan Cancer Support Chair, NCSI Consequences of treatment work stream
Public view of cancer
Incurable cancer
Cured cancer
Integrated care over time
Diagnosis and treatment Rehabilitation Monitoring End of life care
Chronic and Progressive care:
Cancer &/or consequences
transitions
4
Adding the numbers
Using available data and clinically-led assumptions we estimate phases in the survivorship population
Number of people Example Pathways
Using this model we can estimate pathways in different geographies (breast, colorectal and lung)
E.g. Northern Ireland Pathways
Breast cancer care pathway
Colorectal cancer
Lung cancer
Estimating numbers for Northern Ireland
7
End of primary
treatment date
Date of treatment
related illness
Date of recurrence
Type of treatment
Date of DS1500
offer
What else do we need to know?
Risk stratification
Staging
8
9
Recovery
The little things altogether…….
It’s the little things all together that
get us down
Penny Vicary
Open Letter to my oncologist Clinical Oncology 200719:746- 747
More lifestyle illnesses
Move More Daily Mail 08 August 2011CIRC: 2,047,206
*Adjusted for smoking and underweight Matched to non-cancer survivor controls on the basis of age, sex and practice
OR: 1.59
More other chronic conditionsosteoporosis & prostate cancer
Nada KhanIn press BJC
*Adjusted for BMI, smoking Matched to non-cancer survivor controls on the basis of age, sex and practice
OR: 1.33
More chronic conditions Heart failure & breast cancer
Nada Khan In press BJC
*Adjusted for BMI, smoking Matched to non-cancer survivor controls on the basis of age, sex and practice
OR: 1.33
More chronic conditions Heart failure & breast cancer
Nada Khan In press BJC
Investment in 1,100Benefit 7,900 people
17
Monitoring
Literature review concerning current follow-up after cancer
“A poor evidence base and no consensus as to the intensity, duration, setting or type of follow up required for most common forms of cancer”
Evidence to inform the Cancer Reform Strategy: The clinical effectiveness and cost effectiveness of follow up services after cancer treatment ; York Centre for reviews and dissemination October 2007
(report available on request)
Change from a “one size fits all” approach
Pre-planned tests, triage, access back to specialists via trusted person
Trusted individuals able to provide
Information
Access to tests
Access to expertise
Tools
Ongoing support
22
New illnesses
Survivors of childhood cancer
In UK >30,000 survivors of childhood cancer
Increasing by > 1,000/yr
50% are now adults
60% have significant treatment related late consequences which may develop into chronic diseases
23% multiple conditions
No plateau has been reached at 30yrs.
New chronic conditions RT & CT related illnessese.g. pelvic cancers
12 - 17,000/ year pelvic RT (UK)
gynaecological, urological,
colorectal, anal cancers
80,000 living after pelvic RT
Bowel, urinary, sexual issues
6-8,000 new cases radiation related illness
?
LENT SOMA scores for bladder symptoms
LENT SOMA scores for bowel symptoms
Symptom Score
Time after treatment (months)
Worse
Better
Davidson et al 2008
Months/years after pelvic RT
Analysis of symptom clustersBefore RT / End of RT / Up to 3 years after RT
• clusters associated with the highest problem levels usually include faecal urgency & rectal pain.
‘It’s the little things put
together that wear us down.’
‘My GP says for a long time he did not know what was going on…I
thought I was making a fuss.’
‘My oncologist asked how I was – how embarrassing
to tell him.’
Information “prescriptions”
Patients referred to a gastroenterologist a median of 2
years after pelvic RT (n =265)
Rectal bleeding 171
Urgency 82
Frequency 80
Faecal leakage 79
Cancer 12%Unrelated 38%
Most > 1 diagnosis Most could be helped
Andreyev 2005
Guidelines to be published in GUTNovember 2011
Building one team
Diagnosis: Date of Diagnosis: Organ/StagingLocal/Distant
Summary of Treatment and relevant dates: Treatment Aim:
Possible treatment toxicities and / or late effects: Advise entry onto primary care palliative or supportive care register Yes / No
DS 1500 application completedYes/NoPrescription Charge exemption arrangedYes/No
Alert Symptoms that require referral back to specialist team: Contacts for re referrals or queries:In Hours:Out of hours:
Secondary Care Ongoing Management Plan: (tests, appointments etc) .
Other service referrals made: (delete as nec)District Nurse AHPSocial Worker DieticianClinical Nurse Specialist Psychologist Benefits/Advice ServiceOther
Required GP actions in addition to GP Cancer Care Review (e.g. ongoing medication, osteoporosis and cardiac screening) Summary of information given to the patient about their cancer and future progress:
Additional information including issues relating to lifestyle and support needs:
Treatment Summary Insert GP Contact Details
Insert Trust Logo and AddressDear Dr XRe: Add in patient name, address, date of birth and record numberYour patient has now completed their initial treatment for cancer and a summary of their diagnosis, treatment and ongoing management plan are outlined below. The patient has a copy of this summary.
Working with professionals
• To improve care for people living with the effects of cancer • Bridge the gap between research and practice• Individual and collective projects• Influencing UK research and policy agenda
12 Post Doc nurses & AHPS taking the agenda forward.
Nurses & AHPs http://www.cancerconsequences.org/index.html
Raising awareness
Integrated care over time
Diagnosis and treatment Rehabilitation Monitoring End of life care
Chronic and Progressive care:
Cancer &/or consequences
transitions