National Cancer Survivorship Initiative Living with & Beyond Adult Cancer: What has been achieved so far? Adam Glaser National Clinical Lead

Adult Cancer Survivorship Where were we 3 years ago? Where are we now? What do we need to do next?

3 years ago Lack of clear evidence –Needs –Practice Variation in practice Overwhelmed services Unmet needs –Poorly quantified Disparate and sceptical clinical teams

Process Identified 4 tumour sites –Breast, colorectal, lung, prostate Robust service improvement methodologies –Expert panels –Pathway mapping –Pilot testing Partnerships –DH & NHS Improvement –Macmillan Cancer Support and disease specific charities –Service Users, Providers and Commissioners

Testing Hypothesis – The introduction of stratified pathways and packages of care will improve the patient experience, reduce outpatient attendances and reduce unplanned admissions ProstateBreast Hillingdon Luton North Bristol Ipswich North Bristol Hillingdon Brighton Hull Ipswich ColorectalLung North Bristol Guys and St Thomas’ Salford Brighton Hull

Then……..Now ………. Standard medical follow up pathway Tailored pathway to meet patient needs Holistic needs assessment – at diagnosis Holistic needs assessment - at diagnosis and post treatment Unmet needs post treatment Needs identified & actioned Verbal care plans Written Care plans Traditional clinic letters Treatment summaries/ structured letters Ad-hoc education Group learning, education and peer support Little/no lifestyle advice post treatment Improved access to physical activity and other support services Clinic visits for test results Separated with support of remote monitoring (being implemented)

Risk Stratification - Headlines Pathways – Breast and Prostate – 2 pathways only Supported self management –Colorectal – 45% (40%) –Breast – 77% (70%) –Prostate – 28% to 44%(40%) –Lung – some can self manage for periods Timing –Breast 2-3 months after end of treatment or one year after diagnosis –Prostate could happen at 6 months but most at around 2 year point –Colorectal – 4-6 months after end of treatment or stoma reversal –Lung – n/a Clinical trials – impact on % that can transfer to self managed

Key enablers Comprehensive assessment holistic needs –end of treatment or at agreeable point in pathway Remote monitoring system Personalised education and information Care co-ordination and contact point –Preferably someone they know Rapid re-access without recourse to GP

Remote Monitoring – we are getting there! 1.Breast (5 sites) local solutions all live 2.Colorectal (3 sites) NHS Improvement solution - Bristol goes live 1 st April In house solutions - Guys and Salford currently testing with go live April/May 3. Prostate (6 sites) NHS Improvement solution – all sites 2 sites live, 2 testing and 2 installing

Enhanced Quality Drives up Productivity Reduced OP activity 4,985 outpatient slots released across 14 tumour teams Reduced OP costs £349,000 reduction in cost of OPD attendances Health warning: Needs to be offset against cost of implementing pathway enablers Reduction in unplanned admissions 6-8% in lung cancer

What do we need to do next? Develop and Spread pathways and learning –Whole country –Apply key learning and messages to other tumour sites Work with the health economy –Education Service users, commissioners and providers –Evidence Safety and impact of risk stratified pathways Consequences of treatment Incorporate all strands of evidence into applied deliverable pathways

Summary Huge progress but job not complete Simplified common pathways, providing a framework to further build and develop evidence-based sustainable care pathways Reduction in unmet needs and enhanced productivity Not possible without the engagement, enthusiasm, passion and dogged determination of all members of our new “Survivorship Community”.