Upload
kelly-daniels
View
221
Download
0
Tags:
Embed Size (px)
Citation preview
Beyond Primary Treatment
Professor Jane MaherJoint Chief Medical OfficerMacmillan Cancer Support
Perspectives
• The user voice must be the driver ....
Where do patients want us to go?
• Easy to get concerns heard• Quick diagnosis• Timely treatment • Planned stages of care• Supported rehabilitation and aftercare• Support for carers• Psychological support• Better outcomes
By 2020 almost half of Britons will get cancer in their lifetime
But 38% will not die from the disease
The number of people living with cancer will double by 2030
Long term conditions and multimorbidities
http://www.macmillan.org.uk/Documents/AboutUs/Research/Researchandevaluationreports/Routes-from-diagnosis-report.pdf
70,000 21%
Do well
Estimated prevalence
Estimated incidence
Poor health
Intermediate
95,00029%
127,00038%
460,000 22%
1,170,000 56%
180,000 9%
Three broad groups of cancers
££
TreatmentAftercare
Share of
spend on
Survivorship
Phase
Sub 1 year Survival
Short Term Survival
Short Term Recurrence
Pre Existing Morbidities
Medium Term Recurrence
Living with Cancer
Survivors with Chronic Conditions
Complication Free Survival
0-1 Year Survival
1-5 Year Survival, No Complications
1-3 Year Survival, Cancer Complications
1-5 Year Survival, Non Cancer Complications
3-5 Year Survival, Cancer Complications
Continued Survival, Cancer Complications
Continued Survival, Non Cancer Complications
Continued Survival, No Complications
9% 41% 57% 58% 56% 46% 39% 22%
Spend per Patient In Treatment and Survivorship Phases by Survivorship Outcome Pathway (£K)
( NCSI report 2012)
Increasing length of survivorship
Average Cost Across All Pathways: £13,006
15
Diagnosis & Treatment Recovery Early monitoring End of life careProgressive illnessLater
monitoring
GapsGaps
9
Different cancers have different shapes
NCSI report 2013 Classification of CoT
Rare/complex
Several hundred, requiring highly specialist care
Inter-mediate
Tens of thousands, requiring proactive management by health services
Common Risks affecting hundreds of thousands
Glaser et al 2013 BMJ OpenCorner et al 2013 BMJ Open
Dept of Health survivorship PROMS
•Urinary leakage and difficulty controlling bowels
- rates exceeded general population
•Detectable impact on EQ5D
- no less prevalent 5 years after treatment
=> ~ 40,000
=> ~ 40,000
=> ~ 50,00024%
urinary leakage
19%Poor bowel control
19% sexual difficulties
Estimating prevalence of consequences for colorectal survivors, 2010
1yr 2yrs 5yrs 10yrsTime since diagnosis
Source: Estimates using prevalence data and patient reported outcome measures, Maddams et al; Glaser et al.
Bowel dysfunction 90,000
Bladder dysfunction 150,000
Sexual difficulties 350,000
Estimated number of people affected in UK, up to at least 10 yrs post diagnosis(all cancer types)
Macmillan – ‘Throwing Light’
48 gastroenterologists accepting referrals for PRD16 gastroenterologists thought to be accepting referrals for PRD
Total Prevalence - now
Total Prevalence - 2030
Diagnosis & Treatment
RehabilitationEarly Monitoring
Later Monitoring
Progressive Illness
End of Life Care(Year 1 Deaths)
•Breast 70-80% •Colorectal 50% •Prostate 40-50 %
•Breast 70-80% •Colorectal 50% •Prostate 40-50 %
http://www.evidence.nhs.uk/qipp
Partnership
• Each stage of management and care involves several partners
• Linkage is essential• The key partner is the person with cancer
13
http://www.nationalgalleries.org/collection/artists-a-z/C/3029/artist_name/Ken%20Currie/record_id/2875
Partnership
• Each stage of management and care involves several partners.
• Linkage is essential• The key partner is the patient
• Improvement begins through looking at data and scrutinising it jointly.
• A way of linking and analysing routinely collected data
• Maps the cancer journey from diagnosis through to death
• Describes health outcomes i.e. survival times, incidence, prevalence of cancer and non related cancer morbidities.
• Tells us how patients interact with the system e.g. interaction with health care services, when, how long and cost
10 UK large scale whole systems change programmes
19 CCGs, 26 hospitals, over 30 LAs, 11 Health Boards, 5 H&SC trusts
330,000 cancer population
What will good look like?
• A system that is responsive to each type of cancer to the same level of quality
• A planned personal pathway • Support for cancer patients and families• Responsive and responsible for all
elements of care