Supporting people with active and advanced disease

• Need better data collection

• Discussion at MDT – new diagnosis support

• Identify best practice

• Early palliative care support improves quality and quantity of life

Key survivorship messages

• A shift in professional culture is essential to enable supported self management.

• New models of cancer aftercare gives opportunities to improve quality and reduce cost.

• Many people can self manage their health with support, with rapid access to professionals when needed.

• There is significant unmet need arising from consequences of treatment, which can be successfully addressed through prevention and treatment.

• Good survivorship care requires timely communication across boundaries.

Aligning with the NHS Mandate in England

Taking Action - a ‘how to guide’

Learning from experience: University Hospital SouthamptonStratified pathways for breast, colorectal and testis patients.

Stratification based on:

• Complexity/gravity of the disease

• Complexity /type of patient need

• By type of care provider

Influencing factors:

• Clinical safety

• Patient acceptability

• Cost effectiveness

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Stratified Pathways: Patient ActivityTumour Group

Period covered

Pathway: self managed (low / medium risk)

Period from end of treatment

Pathway : Consultant led ( high risk and complex ongoing issues)

Pathway: Nurse led (stoma management and complex bowel issues)

Breast Jan 12 – March 13

45% 2 – 8 months

55%

Colorectal Jan 12 – March 13

30% 4 – 6 months

45% 25%

Testis Jan 12 – March 13

70% 2 – 6 months

30%

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Clinical indicators which delay entry to a self managed pathway.

Breast Colorectal Testis

Wound problems (delayed healing/seromas)

Complex and distressing bowel management problems

Fertility/hormone treatments

Consequences of treatments

stoma High risk metastatic tumours

Some ongoing hormone treatments

Oncology follow up Depression and anxiety

Psychological/anxiety/ depression

Breast reconstruction7

Other factors which prevent entry to a self managed pathwayPressure of time on clinicians in clinic for sufficient preparation and discussion with patient.

Clinician attitude to their practice.

Patients on clinical trials which mandate face to face consultation with physical examination -around 13% breast and 11 % colorectal patients

Unacceptable to patient.

Limited CNS contribution to aftercare – ie focus on diagnosis and treatment

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Five enablers to implementing stratified pathways of care

1. Remote surveillance system

2. Patient preparation and discussion with the key Consultant

3. Preparation through education or self management ‘event’

4. Coordination and support from the Cancer Support Worker

5. Commissioner engagement and support9

Clinician Engagement

Absolutely key to success of the outcome of the project

Presence of a champion is vital, but even so may be slow to spread.

If slow going assume that as time goes on and service developments take place, that when events impinge on individuals – they will engage!

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What commissioners wantAssurance that patient experience and quality are central and will not be compromised by change.

Communication and collaboration with primary care to ensure appropriate level and place of care provision.

Release of resource – enabling capacity for new diagnoses

To know the pattern of access to Outpatient attendances, and use of primary/community services by self managed patients.

Plans for spread of stratified pathways

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