Transcript Rehabilitation in Lung Cancer

Rehabilitation in Lung Cancer
Jo Bayly
Project Lead AHP Merseyside & Cheshire
Cancer Network
December 14th 2009
Aim of presentation
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Rehabilitation pathway for patients
with lung cancer
Commissioning Lung Cancer
Rehabilitation
Implications for lung cancer
services in MCCN
National Context
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The Cancer Plan (DH 2008)
Manual for Cancer Services (2008)
Rehabilitation measures
End of Life Care Strategy (DH 2008)
Transforming in-patient & community care
(2008)
World Class Commissioning
Darzi; High Quality for All (2008)
Cancer Reform Strategy (DH 2007)
NICE IOG Supportive & Palliative Care
(2004)
Manual for Cancer Services (2008)
Rehabilitation Measures:
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no. 08-1E-101v: Baseline Mapping of current service
provision
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no.08- 1E103v: Agreed cancer site specific
rehabilitation pathway for patients with
lung cancer
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no.08-1E-113v: Network service specification for
cancer rehabilitation
no.08-1E-114v: Network needs assessment
no.08-1E-115v: Network Service development
strategy
no.08-1E-116v: Network cancer rehabilitation training
& development strategy
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National Cancer & Palliative Care
Rehabilitation Workforce Project:
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Commenced November 2007
Jointly funded by DH & Cancer Action Team
Focus on rehabilitation services provided by
AHP’s:
 Physiotherapists
 Occupational Therapists
 Dietitians
 Speech & Language Therapists
National Cancer & Palliative Care
Rehabilitation Workforce Project:
Deliverables:
 updated tumour specific evidence
base
 published tumour specific
rehabilitation pathways
 quantify level of cancer rehabilitation
required: wte per cancer site population
 provide workforce data to support
network cancer populations
Why do we need a lung cancer
rehabilitation pathway?
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Effectiveness of rehabilitation services in
other conditions is well established i.e.
stroke, cardiac & pulmonary care
Increased recognition of need for
rehabilitation in cancer care
(Supportive & Palliative Care IOG ch10 / Cancer
Reform Strategy ch5 / National Cancer
Survivorship Initiative)
Why do we need a lung cancer
rehabilitation pathway?
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cancer & its treatments impact on patients
physical, psychological, social & functional
well-being
helps patients maximise the benefits of
their cancer treatment
minimise deconditioning/loss of function
Adaptation of ADL and routines to new
needs and limitations
improve social condition, quality of life
Why do we need a lung cancer
rehabilitation pathway?
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evidence based interventions available
non-pharmacological symptom control
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Multi-professional breathlessness
management (Lung Cancer Clinical Guideline 24)
supports recovery of skills, return to
previous work/ roles
cost effective: reduce utilisation of other
healthcare resources, decrease hospital
length of stay and hospital admissions
Patients with Lung Cancer may experience
the following at any point on the pathway:
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Breathing
difficulties/cough
Fatigue/tiredness
↓ mobility/exercise
tolerance/weakness
Pain
Cachexia/weight loss
↓ Appetite
Dysphagia
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Difficulties with
ADL/leisure/work
Specific functional
impairment
Equipment needs
Anxiety/stress
Communication
difficulties
Specific Information
needs
Rehabilitation pathway referral triggers:
Problem/need:
Refer to:
Breathing difficulties/cough
Physio/OT
Fatigue/tiredness
Physio/OT/Dietitian
↓ mobility/exercise
tolerance/weakness
Physio/OT
Pain
Physio/OT/Dietitian
Dysphagia
SLT/Dietitian
Cachexia/weight loss/
↓appetite
Dietitian/
Physiotherapy
Rehabilitation pathway referral triggers:
Problem/need:
Refer to:
Specific Information needs
Physio/OT/SLT/
Dietitian
Difficulties with
ADL/leisure/work
OT/Physio
Specific functional
impairment
OT/Physio
Equipment needs
OT/Physio
Anxiety/stress
OT
Communication difficulties
SLT
Rehabilitation in Lung Cancer
Diagnosis
•Maintain exercise tolerance/ function
•Nutritional support
•Breathlessness/pain/fatigue management
Treatment
•Maintain exercise tolerance/ function
•Nutritional support
•Breathlessness/pain/fatigue management
Post
treatment
•Maintain exercise tolerance/ function
•Nutritional support
•Breathlessness/pain/fatigue management
Monitoring
Survivorship
Palliative
Care
End of Life
•Maintain exercise tolerance/function
•Vocational rehabilitation
•Breathlessness/pain/fatigue management
•Maximise functional independence
•Nutritional support
•Advanced care planning
•Advanced care planning
•Equipment provision
•Non-pharmacological symptom management
How are rehabilitation needs of Lung
Cancer patients identified in MCCN?
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No formal assessment tool currently in place
Medical/CNS led clinics
District Nurses/Community CNS
Currently, rehab services mostly in hospices
Rehab needs may be present before
symptoms prompt referral to hospice
Rehabilitation Services for patients with
lung cancer in MCCN.
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Most in-patient & community rehabilitation
provided by generic AHP’s
Little planned/ funded specialist cancer
rehabilitation outside specialist trusts,
hospice & palliative care services
Gaps in service for ambulant patients who
are not referred to palliative care
Some generic staff have post graduate
training in oncology & palliative care
Funded specialist rehabilitation services for
patients with lung cancer in MCCN
Acute PCT
Trust
Specialist
Trust
Hospice
Physio
0
1.7
7.36
OT
0
2.7
8.67
Dietitian
2
1.5
(pall care)
2.15
(pall care)
1
(pall care)
4
0
SLT
0
1 (vacant,
pall care)
0.4
0
Challenges:
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Despite improvements in treatment outcomes for
lung cancer patients
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relatively little increase in rehabilitation
support to mitigate functional loss
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no evidence of rehabilitation services
being specifically commissioned as part
of the cancer care package.
Challenges for commissioners and
providers in MCCN:
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rehabilitation not strongly articulated in
commissioning process
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cancer pathways medically focused
rehabilitation not described in Lung Cancer
IOG
lack of understanding of the broad nature of
cancer rehabilitation interventions
Challenges for commissioners and
providers in MCCN:
cancer- a ‘long term condition’, ‘end of
life care’ or both?
 variable models of service delivery
 performance monitoring, quality
metrics, KPI’s and outcome measures
 funding priorities
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NCAT Commissioning Framework for
rehabilitation services
High quality cancer rehabilitation in
MCCN needs to be:
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Timely & responsive
Generic & specialist AHP’s are accessible
Seamless across service boundaries
Delivered in appropriate setting
Focus on prevention & management of long
term effects
Network Lead AHP & Rehabilitation
Group responsibilities:
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Consult with local AHP providers, Lung
CNG, Lung CNS & Partnership Group
Facilitate local implementation of lung
cancer pathway
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Clear referral guidance and processes
Directory of Cancer Rehabilitation Services
Patient Information Leaflets
New developments i.e. MPT follow up clinics
Education & Training
Audit
Thank you
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http://www.cancer.nhs.uk/rehabilitation/
index.htm
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Jo Bayly
[email protected]
0151 529 2299