Transcript Document

Acute Oncology
What is it?
Overview of Acute Oncology
• Encompasses management of patients with severe
complications following the treatment of, or as a
consequence of their previously diagnosed cancer
• Management of patients who present as emergencies
with previously undiagnosed cancer
• AOS brings together expertise from oncology disciplines,
emergency medicine, palliative care, and general
medicine and general surgery
Key Features of an Acute Oncology
Service:
(NCAG Report)
• Early review by an oncologist or oncology nurse specialist
(within 24 hours)
• 24/7 access to telephone advice from an oncologist
• Fast track clinic access from A&E
• Access to information on individual patients across the Trust
• Protocols for the management of oncological emergencies and
referral pathways from A&E and acute admissions unit
• Specific pathways for the investigation and treatment of
malignant spinal cord compression
Acute oncology presentations
The following, as caused by the systemic treatment of cancer:
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Neutropaenic sepsis.
Uncontrolled nausea and vomiting.
Uncontrolled diarrhoea.
Complications associated with venous access devices.
Uncontrolled mucositis.
Hypomagnesaemia.
Extravasation injury.
•Acute hypersensitivity reactions including anaphylactic shock.
Acute oncology presentations
The following, as caused by radiotherapy:
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Acute skin reactions.
Uncontrolled nausea and vomiting.
Uncontrolled diarrhoea.
Uncontrolled mucositis.
Acute radiation pneumonitis.
Acute cerebral/other CNS, oedema.
Acute oncology presentations
The following, as caused directly by malignant disease
and presenting as an urgent acute problem.
•Pleural effusion
•Pericardial effusion
•Lymphangitis carcinomatosa
•Superior superior vena caval obstruction
•Abdominal ascites
•Hypercalcaemia
•Spinal cord compression including MSCC
•Cerebral space occupying lesion(s)
Referral guidelines
The Acute Oncology Service is intended for ACUTE problems
It doses not replace existing pathways for the diagnosis of new
cancers or their planned treatment
•During treatment and after treatment, patients and
GPs are advised to contact the original treating hospital.
•All patients receiving chemotherapy and radiotherapy will have
been given the relevant contact numbers
•GPs and patients will also be advised to refer to/attend their
local hospital/A&E department if patients present with immediate
life threatening complications
Assessment of treatment
complications
All patients should be issued
with an alert card with
24 hour contact numbers.
Chemo units should
rehearse situations with
patients to ensure that
they understand when and
who they should contact if
they have a problem
7/16/2015
Philippa Jones Chemotherapy Redesign
Manager, Greater Midlands Cancer Network
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• ATriage
tool that Tool
will determine “the
patient’s level of risk”
• Prompt the practitioner with
appropriate questions to ask in
order to gain information from the
patient
• Provide a reliable guide to
toxicity/problem grading
• Prioritise the level of urgency
indicated by the presenting
symptoms and will aid in
identifying potential emergency
situations
7/16/2015
Philippa Jones Chemotherapy Redesign
Manager, Greater Midlands Cancer Network
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Contact Record
Triage Log sheet
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7/16/2015
It is vitally important that the
data collection process is
methodical and thorough in order
for it to be useful and provide an
accurate record of the triage
assessment.
A log sheet should be completed
for all calls and unscheduled
patient visits. This will facilitate
audit of the helpline service.
The Triage boxes MUST all be
marked accordingly.
IF YOU HAVEN’T
TICKED
IT,YOU HAVEN’T ASKED IT !!!
Philippa Jones Chemotherapy Redesign
Manager, Greater Midlands Cancer Network
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Assessment tool
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7/16/2015
RED- any toxicities graded here take priority and
assessment should follow immediately.
2 AMBER-Two or more amber toxicities should be
escalated to red action and assessment should follow
immediately..
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Amber one toxicity in amber should be reviewed/
followed up within 24 hours and the caller should be
instructed to call back if they continue to have concerns
or their condition deteriorates
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Green callers should be instructed to call back if they
continue to have concerns or their condition
deteriorates.
Philippa Jones Chemotherapy Redesign Manager,
Greater Midlands Cancer Network
14
A patient has presented with an acute
oncology problem
Is it neutropenic sepsis?
Could it be neutropenic sepsis?
Do they need admission?
How do you treat the complications of chemotherapy?
Could their problem be dealt with by an early review in clinic?
Can they be discharged?
How can the Acute Oncology Service Help?
The Acute Oncology Assessment Service
Available Monday - Friday
•Acute oncology specialist nurses
•Access to consultant oncologist advice and assessment if needed
•Malignant spinal cord compression co-ordinator
Telephone advice is available from a consultant oncologist,
24 hours a day, seven days a week
Patient in A&E/
AAU
CARCINOMA OF
UNKNOWN
PRIMARY
Complication of known
cancer
IS THIS NEUTROPENIC
SEPSIS
Acute medical review/
AOS review
>TREAT WITH ANTIBIOTICS<
On active
treatment
Referral
to AOS
Identified
by alert
AOS review/
AO Specialist nurse
SPINAL CORD
COMPRESSION
Pericardial effusion
Pleural effusion
Brain mets
Ascities
Transfer to
specialist ward
Fast
track
protocols
MSCC
co-ordinator/
On-call oncologist
MRI scan
Advice/review by
Consultant Oncologist
24/7
Review in rapid
access clinic/
acute oncology
assessment unit
Transfer to MSCC
treatment centre
Spinal surgeons/
Radiotherapy
Carcinoma of unknown primary (CUP)
Most patients with newly diagnosed cancer are found to have a
clearly defined primary tumour, and can then be swiftly referred
on to a “site specialist team”
4% patients are found to have cancer without an identifiable
primary site, despite exhaustive tests
Because of the lack of dedicated clinical services, patients who have
malignancy without an identifiable primary site can be denied the
care offered to patients with site-specific cancers
North of England
Cancer Network
MSCC Centres
NCC, Freeman Hospital
James Cook Hospital
Radiotherapy Centres
NCC, Freeman Hospital
James Cook Hospital
Cumberland Infirmary
LOCAL PATHWAYS????
Which services at which hospital
AOS team
24/7 chemo advice service
Fast track clinics
Consultant oncologist on-call service
Out of hours
?
Treatment protocols
Complications of the systemic treatment of cancer:
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•
•
•
•
•
•
Neutropaenic sepsis.
Uncontrolled nausea and vomiting.
Uncontrolled diarrhoea.
Complications associated with venous access devices.
Uncontrolled mucositis.
Hypomagnesaemia.
Extravasation injury.
Remember there is an on-call oncologist available for
telephone advice at the cancer centre 24/7
Acute oncology presentations
The following, as caused directly by malignant disease
and presenting as an urgent acute problem.
•Pleural effusion
•Pericardial effusion
•Lymphangitis carcinomatosa
•Superior superior vena caval obstruction
•Abdominal ascites
•Hypercalcaemia
•Spinal cord compression including MSCC
•Cerebral space occupying lesion(s)
In Hours Metastatic Spinal Cord Compression High level Pathway
Information pack for patients
Known cancer patient (aware of risk)
Discharge
Rehab Centre
(local unless
otherwise agreed)
Patient attends GP
Cancer patient unaware of
the risk (undiagnosed)
Transfer patient to
Centre for
definitive
treatment
Co ordinator
(collate clinical information)
Admission via A&E or Medical Admissions Unit
MRI
local /central
Coordinator link with local /
centre Oncologist
Oncology /
Surgery
patient
discussion
Supportive /
Palliative care
Key worker
Routine O.P. appt.
Discharge
Ward patient
Member of
Primary Care
Team
GP informed (+/- D.N. /
Primary Care Team)
Not Appropriate for
admission / active
treatment
Key worker
EOL
In Hours Metastatic Spinal Cord Compression High level Pathway
Information pack for patients
Known cancer patient (aware of risk)
Discharge
Rehab Centre
(local unless
otherwise agreed)
Patient attends GP
Cancer patient unaware of
the risk (undiagnosed)
Transfer patient to
Centre for
definitive
treatment
Co ordinator
(collate clinical information)
Admission via A&E or Medical Admissions Unit
MRI
local /central
Coordinator link with local /
centre Oncologist
Oncology /
Surgery
patient
discussion
Supportive /
Palliative care
Key worker
Routine O.P. appt.
Discharge
Ward patient
Member of
Primary Care
Team
GP informed (+/- D.N. /
Primary Care Team)
Not Appropriate for
admission / active
treatment
Key worker
EOL
Out of Hours Metastatic Spinal Cord Compression High Level Pathway
Known cancer patient
(aware of risk)
Discharge
Coordinator reviews log next
working day
Cancer patient
(unaware of the risk)
SPR Review
(Newcastle)
clinical information
with on call
Consultant
Oncologist
Patient contacts Primary Care
Log call
Admission via A&E or Medical
Admissions Unit
Consultant
Oncologist / SPR
on Call
(at Centre)
Transfer
patient to
Centre for
definitive
treatment
Ensure MRI
completed local
/ centre
Joint Oncology /
Surgery patient
review
Supportive
&
Palliative
Care
Record clinical
information
Ward patient with or
without a known
cancer
Rehab Centre (local
unless otherwise
agreed)
+/- review with
patients Oncologist
Key worker
Discharge
EOL
Out of Hours Metastatic Spinal Cord Compression High Level Pathway
Known cancer patient
(aware of risk)
Discharge
Coordinator reviews log next
working day
Cancer patient
(unaware of the risk)
SPR Review
(Newcastle)
clinical information
with on call
Consultant
Oncologist
Patient contacts Primary Care
Log call
Admission via A&E or Medical
Admissions Unit
Consultant
Oncologist / SPR
on Call
(at Centre)
Transfer
patient to
Centre for
definitive
treatment
Ensure MRI
completed local
/ centre
Joint Oncology /
Surgery patient
review
Supportive
&
Palliative
Care
Record clinical
information
Ward patient with or
without a known
cancer
Rehab Centre (local
unless otherwise
agreed)
+/- review with
patients Oncologist
Key worker
Discharge
EOL
LOCAL CONTACT DETAILS FOR SPINAL CORD
COMPRESSION PATHWAY ??????
SUMMARISE LOCAL INFORMATION