Transcript Document

Supporting Cancer Survivors
- A New Aftercare System
Adam Glaser
Clinical Director
NCSI
Gilmour Frew
Director: Cancer Improvement
NHS Improvement
Steve Hindle
Survivorship Programme Lead
Macmillan Cancer Support
National Cancer Survivorship Initiative
Goals of cancer care
Adding years to life
&
Adding life to years
National Cancer Survivorship Initiative
Is there a need for change?
• 2 million living with and beyond cancer in UK
– 1.6 m completed therapy
– Prevalence increases by 3.2% p.a.
– 4 million in 20 years
• Late consequences
– 60% adult survivors of young people’s cancer have 1 or
more late consequence 10 years from completion of therapy
– Increasing with time from completion of therapy
National Cancer Survivorship Initiative
Follow-up Current situation
•
>25% of people had unmet needs 1 year post Treatment
Armes JCO, 2009
•
2009 Picker survey of over 2,000 survivors:
1.
2.
3.
43% wanted more information & advice
75% did not have, or did not know if they had, a care plan
75% did not know who to contact for advice outside of
office hours.
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Follow-up Current Situation
– Not meeting all user’s needs
– Inconsistent
– Not evidence based
– Unsustainable
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Cost of 5y Hospital Follow-up
• Breast:
Lung:
Colorectal:
Prostate:
£ 916
£ 546
£1,130
£1,051
• 29% of adult patients' contact with NHS is unplanned (by cost)
• Personal costs range from £227 to £857 for adults at follow up clinics
National Cancer Survivorship Initiative
National Cancer Survivor Initiative
Aims
• To understand the needs of those living with & beyond cancer
• To develop models of care to meet their needs
• To design evidence-based sustainable services to accommodate the
increasing numbers of cancer survivors in the future
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Emerging Principles
• Risk Stratified pathways of care rather than one size fits all
• Dynamic personal care plan which arises from an
assessment of the disease, the treatment, and the
individuals personal circumstances
• Information provision should meet individual needs and
should be timely, accessible and promote confidence,
choice, and control
• Individuals should be encouraged to self manage with
support and rapid access to appropriate professional when
problems arise
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Enablers
• Awareness and education
patients and staff
• Evidence to identify what is being done well & what needs to improve
• Innovation
– Automated surveillance
– Health & well-being reviews
– Education programmes patients and staff
– Exercise programmes
• Sensitivity to current economic climate
• Patient reported outcomes
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Prototype Testing Hypothesis
By introducing 3 risk stratified levels of care
for those living with and beyond cancer
there will be a measurable difference in:
•
The patient experience of care
• Have all the information and advice required to
manage their condition
• Who know who to contact in and out of hours
should they have a problem
• Who have been offered a care plan
•At least a 50% reduction in out patient
attendances, and a 10% reduction in
unplanned admissions
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Testing in Practice
7 prototype communities, testing
– 3 levels of care
– 4 tumour types
• Self managed care
• Breast
• Shared care
• Colorectal
• Complex care
• Lung
• prostate
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Transformed Pathways of Care: Overview
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3 Levels of care and support
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Self-management with support and
appropriate surveillance
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Care Management
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Complex Care
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What is self management?
‘What health services do in order to aid and
encourage people living with a long term condition to
make daily decisions that improve health related
behaviours & clinical, & other outcomes’
 Self management education/training programmes
 Skills development for professionals
 Institutional support for service redesign
Promotes self management skills (goal setting, action planning)
for improved quality of life, knowledge of condition and coping
behaviour.
Testing at Southampton University Hospital Trust.
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Health and Well Being events
 Patients and carers need support and
information to prepare for transition after
treatment.
 Testing HWB events where patients get support
from professionals about managing their cancer,
signs and symptoms, and how to get help.
 Support with lifestyle management, information
about self management and support groups.
 Volunteers will be key, meeting & greeting,
organising and offering peer support.
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Lifestyle change more important for
cancer survivors than others
Obesity
Dietary fat intake
Exercise
Smoking
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Consequences of cancer treatment
• Becomes “part of the cancer story” for patients, professionals
and commissioners
• Patients need to know about effects of treatment, including
how to recognise and get help where necessary
• Working so that professionals know about the problems and
understand that there can be solutions
• Commissioners need to know how to build this in to the
services that they buy.
• We are testing new ways to provide specialist services for
people affected by the consequences of pelvic radiotherapy.
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Work and Cancer
• 109,000 working age people each year
diagnosed with cancer in UK
• Nearly 800,000 people of working age
in UK have had a cancer diagnosis
• Cancer survivors tell us work is
important - restoring normality, social
contact and income
• BUT, 50% of patients not offered
flexible working arrangements & 80%
of employers not aware that cancer is
covered by Equality Act (2010)
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What are we doing about return to work?
• Developed information for employers, employees, and the
self employed – now on Macmillan website
• Testing ways to support people about work concerns in 7
‘vocational rehabilitation’ pilots
• Early results – people want information about work early,
but professionals give mixed messages
• Managers often lack knowledge/skills to manage staff with
cancer
• Patients are unaware of their employment rights
• Expert advisers can predict & help with problems patients
are not yet aware of
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Breakout challenge
Discuss in groups:
How does this fit with the new Health White paper?
What are the enablers?
What are the challenges to implementation?
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Summary
Exciting opportunity to pro-actively influence the delivery
of care to a rapidly increasing percentage of the
population
Challenge to develop practical, sustainable evidence
based pathways offering enhanced quality and
productivity
ncsi.org.uk
National Cancer Survivorship Initiative