Enhanced Supportive Care Royal Devon & Exeter NHS Foundation Trust Niranjali Vijeratnam 28th February 2019

Background Enhanced Supportive Care = initiative to embed Supportive and Palliative Care earlier for advanced cancer patients Growing evidence that this approach can improve outcomes for advanced cancer patients Earlier involvement of supportive care services in cancer care and chronic liver disease Teams that support cancer patients working more closely together Adopting a much more positive approach to supportive care Cutting edge and evidence-based practice in supportive and palliative care Technology to improve communication and way of working Best practice in care of patients undergoing chemotherapy Temel et al NEJM 2010 RCT – 151 Metastatic Non-Small Cell Lung Ca patients to usual care/early PC ⬇️ Depressive symptoms ⬆️ QOL ⬆️ resuscitation preferences documented ⬇️ aggressive care at EOL ⬆️ survival Projected increase in Ca patient 18%/8yrs 2014-2022 New treatment modalities Survivorship Cancer journey -> chronic condition ESC can provide (Local and national) benefits for patients, providers and commissioners

Oncology/haematology patients Advanced liver disease patients ESC RDE 2 year CQUIN - April 2017 Oncology/haematology patients Advanced liver disease patients Daily clinics (joint assessments) Working hours CNS mobile Weekly MDT meetings/gaps (Consultant, CNS, OT, PT, DT - Psychologist to start) 1/18 providers

886 Oncology/Haematology Patients 2438 contacts - 63% FTF, 37% Tel April 17- Nov 18 886 Oncology/Haematology Patients 2438 contacts - 63% FTF, 37% Tel 35 Advanced Liver Patients (108 contacts)

Doing the right thing for the patient. Patient examples Doing the right thing for the patient. Palliative patient, MDT -> IPOS score reductions Curative treatment – symptom control Complex treatment decision – permission to decline Pembrolizumab

Onc/Haem Patient pathway Stage of illness 25% patients seen at point of diagnosis 10% patients seen at recurrence diagnosis 1% patients seen at End Of Life Treatment intent 14% patients having potentially curative treatment Most patients Palliative intent FUs -> Talking about prognosis/ACP where appropriate -

Clinic feedback cards What went well… I found the consultation to be very useful. I was treated with considerable empathy and respect. Well informed and I actually enjoyed the visit and am looking forward to seeing the team again. Very supportive and assuring consultation. Good advice and hopefully some local support available. It was so helpful to have someone to talk to that understands the whole situation and it is so nice to hear that there are options. What went well… P I found the consultation to be very useful. I was treated with considerable empathy and respect. Well informed and I actually enjoyed the visit and am looking forward to seeing the team again. P Very supportive and assuring consultation. Good advice and hopefully some local support available. C It was so helpful to have someone to talk to that understands the whole situation and it is so nice to hear that there are options. Even better if… P If I had been seen much sooner / earlier in the process. Think would work better if the whole care system worked together and focussed on person centred care and co-ordinated services. P A different venue, not Oncology P I don’t see any way of improving. The system seems to work very well.

Even better if… P If I had been seen much sooner / earlier in the process. Think would work better if the whole care system worked together and focussed on person centred care and co-ordinated services. P A different venue, not Oncology P I don’t see any way of improving. The system seems to work very well.

IPOS Yr2 Q3

BTOG 2019 Poster

The future… Ongoing funding for ESC Presentation to Ca Alliance E-IPOS Virtual clinics governance Non-malignant ESC CQUIN ?2020

Questions Thank you