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

2. 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
New treatment modalities
Survivorship
Cancer journey -> chronic condition
ESC can provide (Local and national) benefits for patients, providers and commissioners

3. 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

4. 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)

5. 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

6. 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 -

7. 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.

8. 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.

9. IPOS Yr2 Q3

10. BTOG 2019 Poster

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

12. Questions
Thank you