Living with and beyond treatment for cancer – the challenge for secondary care Nigel Acheson Medical Director Peninsula Cancer Network

Health service quality can be defined as provision of care that exceeds patient expectations and achieves the highest possible clinical outcomes with the resources available Does improving quality save money? Ovreveit J 2009

Breast, prostate colorectal cancer Key reason for follow up focused on medical needs: Detect recurrence Manage early complications Manage late effects

Wide variation including: No follow up with rapid access Lifelong follow up +/- surveillance tests Variation from tumour site to tumour site, and within tumour sites

Most patients seen in outpatient clinics Differences in frequency of visits Usually time limited to 5 years, and then patients need to be referred by GP if necessary

Key workers Care plans Rehabilitation Patient support

Conclusion Need to review practice against current best evidence to improve quality and outcomes Assessment of needs and care plans – an area that must be considered in order to ensure patients have informed choice

Challenge 3 – secondary care approach to elements of survivorship Prevention Surveillance Intervention Co-ordination =>Plan where and by whom the various elements should be undertaken

Prevention Late effects of treatment Recurrence of cancer New cancers

Surveillance Progression of disease Recurrence New cancers Assessment of late effects Medical Psychosocial

Intervention Symptom control eg pain Effects of treatment eg lymphoedema Psychological support eg sexual dysfunction Social and economic

Coordination Between specialists, primary care, allied health professionals, social support, employers This will involve: Care planning Multidisciplinary risk stratification Working with stakeholders to ensure that resources to meet assessed needs are in place

“5 shifts” Focus on recovery, health and well-being after cancer treatment Assessment, information provision and personalised care planning Self-management Shift from a single model of clinical follow up to tailored support Emphasis on measuring experience and outcomes

“The NCSI vision is that…assessment covers the full range of needs of individuals, including physical and lifestyle needs, social, financial advice and occupational support needs, psychological wellbeing and spiritual needs”

Challenge 4 – review available models and evaluate locally Identify models to evaluate Identify partners and stakeholders in providing care Plan integrated care

What do patients want? Macmillan event 2008 (200 patients) Good quality information Rapid access to specialist care as needed A care plan agreed by all those providing care and owned by the patient Peninsula Cancer Network Patient and Carer Working Group to ensure that effective patient, carer and public involvement is at the heart of cancer service design and delivery across the Peninsula.

Challenge 5 – work with patients and partner organisations to implement successful models of care

Summary of the challenges for secondary care understanding the concept assessing the current situation who provides elements of survivorship and where review available models and evaluate locally work with patients and partner organisations to implement successful models of care