SETTING UP THE SERVICE BY LYNN TOBIN

HOW DID WE GET HERE? ABUNDENCE OF EVIDENCE PROVIDING JUSTIFICATION FOR BOWEL CANCER SCREENING

BOWEL CANCER-THE FACTS THIRD MOST COMMON FORM OF CANCER SECOND LEADING CAUSE OF CANCER RELATED DEATHS IN THE WEST USUALLY ASYMPOTOMATIC IN EARLY STAGES 95% OF COLO-RECTAL CANCERS ARISE FROM ADENOMATOUS POLYPS

BOWEL CANCER- THE FACTS IN THE UK 1 IN 20 FEMALES AND 1 IN 18 MALES WILL DEVELOP BOWEL CANCER IN THEIR LIFETIME EVERY DAY 50 PEOPLE DIE FROM BOWEL CANCER THIS EQUATES TO 18,000 DEATHS PER YEAR

SYMPTOMATIC PATIENTS DUKES STAGES DUKES A = 13% DUKES B = 38% DUKES C = 49%

SCREENING PATIENTS DUKES STAGES DUKES A = 48% DUKES B = 25% DUKES C = 27%

C & M DUKES STAGES DUKES A = 53% DUKES B = 21.4% DUKES C = 21.4% DUKES D = 4.2% THESE STATS ARE BASED UPON THE FIRST 115 PATIENTS IN THE PROGRAMME BUT WE HAVE HAD 247 CANCERS TO DATE

SETTING UP THE SERVICE PUT OVERALL PATHWAY SLIDE IN HERE

SETTING UP CLINICS. CONSIDERATIONS; HOW MANY CLINICS WILL YOU NEED TO FACILITATE YOUR POPULATION? WHERE WILL YOU HOLD CLINIC? IF YOU HAVE A SURGE IN FOBT + DO YOU AVAILABILTY FOR EXTRA CLINICS? DO YOUR PATIENTS HAVE A CHOICE OF WHICH CLINIC THEY WISH TO ATTEND?

WHAT MUST BE IN PLACE BEFORE WE SEE A PATIENT AGREED PATHWAYS/ PROFORMAS AGREED MANAGEMENT PLANS FOR PATIENTS WITH COMPLEX CO-MORBIDITY PGD TCI PATHWAY ANTI-COAGULATION POLICY (NEW BSG GUIDELINES) DIABETIC POLICY NOMINATED LEADS FOR; CT X-RAY PATHOLOGY PHARMACY

WHAT DO I NEED TO BRING TO CLINIC WITH ME? PATIENT ASSESSMENT FORMS/LAPTOPS MOBILE PHONES PATIENT JOURNEY STORY BOOKS AGREED HEALTH PROMOTION LEAFLETS CONSENT INFORMATION LEAFLETS RELEVENT LOCAL HOSPITAL INFORMATION C&M HAVE CONDENSED THIS INFORMATION INTO BOOKLETS SPECIFIC TO EACH SCREENING SITE

WHO IS INELIGABLE? IBD PATIENTS ALREADY IN SURVEILLANCE PROGRAMME BARIUM ENEMA WITH FLEXI SIGMOIDOSCOPY OR COLONOSCOPY WITHIN PAST 2 YEARS CURRENTLY UNDER TREATMENT FOR COLO-RECATL CANCER OR ALREADY IN SURVEILLANCE PROGRAMME TOTAL COLECTOMY

COMMONLY ASKED QUESTIONS/ANSWERS WHAT IS MY CHANCE OF HAVING; CANCER = 1 IN 10 (10%) POLYPS = 1 IN 4 (40%) NORMAL RESULT = 1IN 5 (50%)

COMMONLY ASKED QUESTIONS/ANSWERS HOW MANY PEOPLE HAVE ABNORMAL FOBT RESULTS? 2 OUT OF 100 WILL HAVE ABNORMAL RESULTS SO 98 OUT OF 100 WILL BE NORMAL

HOW RELIABLE/EFFECTIVE IS THE FOBT TEST KIT? PROS; NON-INVASIVE CAN DO AT HOME REFLECTS COMPLETE COLON CHEAP AND EASY (£5) COLONOSCOPY £424 CONS; POOR SENSITIVITY AND SPECIFICITY - 10% FOR Ca - 40% FOR ADENOMAS SENSITIVITY 55-92% COLORECTAL CANCERS 10-32% ADENOMAS 12-53% ADENOMAS GREATER THAN 1 CM

COMMONLY ASKED QUESTIONS/ANSWERS IF MY COLONOSCOPY IS NORMAL, WILL YOU DO ANY FURTHER INVESTIGATIONS TO LOOK FOR POSSIBLE EXPLANATIONS OF FOBT POSITIVITY?

COLONOSCOPY INVESTIGATION DATASET CONSENT MDT PATHWAYS, REFERRAL FORMS AND PATIENT CONTACT LETTERS POST SUSPECTED DIAGNOSIS USEFUL TO HAVE AT EACH SCREENING SITE. BCSP STAMPS POST COLONOSCOPY DOCUMENTATION

POST COLONOSCOPY/ TELEPHONE CLINICS IT PROFORMAS POST INVESTIGATION DATASET SIGNED/DISCUSSED HISTOLOGY 8 PATIENTS PER CLINIC WITH 20/30 MINUTE SLOTS (DEPENDING UPON EXPERIENCE OF SSP)

MALIGNANT POLYPS. WHO TELLS THE PATIENT? LIAISE WITH SCREENING CONSULTANT RE; MALIGNANT HISTOLOGY ASSESS SUITABILITY OF SSP GIVING THE RESULT BRING THE PATIENT INTO FACE TO FACE CLINIC

WHAT THE SSP MUST UNDERSTAND BEFORE GIVING MP DIAGNOSIS; CLINICAL DETAILS MACROSCOPIC DESCRIPTION TYPE OF CARCINOMA DIFFERENTIATION RESECTION MARGINS HAGITT STAGE KIKUCHI STAGE NO SPECULATION ON PART OF SSP

BCSP CHALLENGES AGE EXTENSION > DAY TARGET DEC 2008 THIRD WAVE ACTIVITY, WILL LAST FEW SCREENING CENTRES SLIP INTO 2009/2010 CAREER DEVELOPMENT FOR SSP