1. Upper GI Cancer and Rehabilitation
Report to Upper GI NSSG
Sally Donaghey
Macmillan AHP Lead, Ang CN

2. 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.

3. 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

4. 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.

5. Workforce Mapping

6. Workforce Mapping cont..

7. Workforce Mapping cont..

8. 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 figures indicate slightly higher then national average cancer rehab services in community
Care closer to home?

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

10. Rehabilitation Triggers

11. 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

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

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