ACCESS TO PALLIATIVE CARE FOR UPPER GI CANCER PATIENTS A SURVEY OF 5 CANCER NETWORKS DR Bailey 1 C Wood 2 and M Goodman 3 on behalf of the SWCIS Upper GI Tumour Panel 1 SWPHO Cancer Intelligence Service (SWCIS), 2 Salisbury District Hospital, 3 Royal Bournemouth Hospital South West Cancer Intelligence Service Figure 1 Specialist palliative care representation at weekly MDT Introduction  A telephone survey in June 2004 to all upper GI specialist nurses across the five Cancer Networks (Peninsula, Dorset, Avon Somerset and Wiltshire, Three Counties and Central South Coast) identified that palliative care teams were not represented at MDTs in a few Trusts. Some Trusts had problems in the palliative care/MDT interface.  Depending on the services available, there were different models of referral to the palliative care teams, which worked well. In 2004 it was known that many Trusts were in the process of appointing new personnel, which would influence outcomes. However, by 2006 there was concern that palliative care attendance at MDT and referral for patients to palliative care was variable. It was agreed a survey should be undertaken, to determine the different models of palliative care provision across the region, whether they worked and the resources available.  Since the majority of people with diagnoses of upper GI cancer have advanced disease, palliative care should be an integral part of patient management. NICE guidelines for upper GI cancer 1 recommend that for palliative care there is effective coordination and communication between hospital and home-based care and that palliative interventions provided should be audited. 1.Improving Outcomes Guidance in Upper Gastro-intestinal Cancers Department of Health January 2001 Aims and objectives  To determine the different models of upper GI cancer palliative care / provision of care across the region  To determine if all models work  To determine the resources available  To determine if patients with upper GI cancer palliative care needs are supported throughout their illness Methods A questionnaire was agreed by the Upper GI Tumour panel with input from the SWPHO Director and National Cancer Lead. The questionnaire was sent to all Upper GI MDT lead clinicians in the five Cancer Networks (26 hospital Trusts). They were invited to complete it collaboratively with their colleagues at the MDT. Analysis and report writing were undertaken at SWCIS. The results were discussed and agreed by the Upper GI Tumour Panel. Results  22/26 Trusts (85%) responded  20/22 Trusts (91%) had palliative care representation at their MDT, attendance ranging from 5% to 100% (Figure 1).13/22 Trusts (59%) achieved standard that attendance should be more than 50%.  16/20 Trusts (80%) referral made to palliative care at the MDT  Wide variation in method of referral when the patient lived in an area served by a different palliative care service  19/22 Trusts (86%) had adequate resources for urgent stents  9/22 Trusts (41%) had a dietitian attending  19/22 Upper GI clinical nurse specialists (86%) had additional training in symptom control and psychological support  Out of hours support for patients with palliative care needs was variable with 2 MDTs having none  19/22 Trusts (86%) had sufficient resources to support palliative care patients throughout their illness  18/22 Trusts (82%) the model of palliative care provision worked well  For patients admitted as an emergency, when could have been better managed in the community 40% of Trusts said they were admitted ‘fairly often’, 45% ‘sometimes’ and 15% ‘almost never’ Reasons for admission and suggestions for improved service delivery are shown below Figure 1. Reasons for admission Pain control, nausea, dysphagia, analgesic associated constipation Management of effusions, hypercalcaemia, sepsis needing intratravenous treatment, advancing cachexia Patients requiring blood transfusions as no facility for day case transfusions at hospice Suggestions for improved service delivery More hospice beds Out-of hours service at weekends and bank holidays Facility for day case transfusions at hospice Mobile palliative care urgent assessment teams Recommendations  Increase resources for dietetic support  Increase resources for urgent stenting in two Trusts  Increase palliative care staffing in some Trusts where attendance at MDT is low  Each MDT to meet with its local palliative care service to consider what changes in practice or resources are needed to achieve better community support to their patients out of hours  Consider suggestions for improving service delivery Conclusions Although overall specialist palliative care representation at MDT was good at 91%, there was wide variation in attendance with only 59% of Trusts achieving the standard of more than 50% palliative care attendance and only 41% having a dietitian attending. There are concerns over lack of resources for staffing at MDT. There was wide variation in out-of-hours support and method of referral when the patient lives in an area served by a different palliative care service. The resources for palliative procedures such as stents and supporting patients with palliative care needs throughout their Illness were adequate in 86% of Trusts. There is a clear need for closer working between secondary care and local palliative care services. This requires better data collection of palliative care activity, both in primary and secondary care, to enable the burden on services to be quantified and understood. This would allow improvement of services in terms of out-of-hours support, community management of palliative care, and variations between different providers.