Upper GI Cancer and Rehabilitation Report to Upper GI NSSG Sally Donaghey Macmillan AHP Lead, Ang CN sally.donaghey@suffolkpct.nhs.uk/Tel: 01638 608218

Rehabilitation and Upper GI Cancer Evidence based Rehabilitation Care Pathway – local version agreed by NSSG 2010 Optimise treatment (fitness for surgery, responsiveness to treatment) QoL, ADL, physical, social, psychological and functional support Cost-effectiveness/benefits realisation – reduce hospital stays, prevent re-admission, care closer to home. IOG - Specialist OG MDT must be specialists in OG cancer/have specified sessions in job plan for UGI – dietician.

Complications in Upper GI Cancer Weight Loss/Anorexia Malnutrition Fatigue Pain Weakness Reduced mobility/movement Nausea and vomiting Loss of appetite Dysphagia Anaemia Pulmonary function Infection Anxiety Functional impairment/ADL

Issues and Initiatives in Rehabilitation 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/referral pathways and practice Guidance/Protocols at trusts as per pathway Services directory – links to local pathway Audits Patient/User experiences Anticipatory eg nutritional assessments at key stages of pt pathway.

Workforce Mapping

Workforce Mapping cont..

Workforce Mapping cont..

Findings Relatively low numbers of AHP’s for population against national average Unmet need or Need provided by generalist workforce? Variablity in specialist service provision between localities Consider referral pathways Setting - 53% Acute. 2009 figures indicate slightly higher then national average cancer rehab services in community Care closer to home?

Workforce Modelling – Pancreas ANG CN Incidence 2004-8 = 680 (Ecric)

Rehabilitation Triggers

Rehabilitation Triggers .. Dietietics – Weight loss, appetite, nausea, fatigue, dysphagia, anorexia Physiotherapy – Difficulties mobilisation, respiratory fitness, chest clearance, fatigue, pain, exercise advice and information. SLT - dysphagia OT – Difficulties with ADL, leisure and work, functional assessment, energy, fatigue, anxiety

Barriers AHP attendance at MDT/clinics Awareness of rehabilitation needs Co-ordination of rehabilitation needs Lack of resources Not just palliative.

What Can the NSSG Do? NSSG Workplan Upper GI Care pathway – specific reference to rehab Locality/clinician engagement Audit of referrals/interventions/patient surveys