Transcript Consequences of cancer treatments

Consequences of cancer
treatments
Karen Morgan
Macmillan Consultant
Radiographer
Jan 13th 2015
Background - UK / year
Macmillan facts and figures –
▫ 2 million are living with consequences of cancer
treatment
▫ Estimated 500,000 people living with more than
one problem
▫ Physical and emotional
▫ Cancer survivors estimated to rise to 4 million in
next 20 years
(Source - Throwing light on the consequences of cancer and its treatment,
Macmillan Cancer Support 2013)
Of those two million people......
• 40% say they are unaware of long-term side effects.
• 78% have experienced physical health problems in
the last 12 months.
• 40% with emotional problems have not sought help.
• 71% of those who finished treatment 10 years ago
have experienced physical health problems in the last
12 months
(Source - Throwing light on the consequences of cancer and its treatment,
Macmillan Cancer Support 2013)
In addition….
• Healthcare system facing financial pressure
• Innovation and reform
• Redesign of services – quality, value for money
▫ Pressure from follow up appointments (1160 /
month)
▫ Consequences of cancer treatment
▫ Not good at picking up LE in FU
NCSI Vision Document (2010)
“...current follow-up arrangements do not
address the full range of physical,
psychological, social, spiritual, financial and
information needs that cancer survivors may
have following their treatment.”
Quality of Life (Radiotherapy)
Acute toxicities
• Occur in tissues with rapid cell turnover,(eg
mucous membranes)
• Acute inflammatory response
• Peaks at 2-3 weeks
• Usually short lived, resolve within 3 months
• Patients recover, but often need supportive
therapeutic and pharmacological strategies
Quality of Life (Radiotherapy)
Late effects
• Can develop from 6 months to many years later
• Often progressive
• Usually permanent
• Often multi-factoral
• Multi-modality treatments increase risk !
concurrent chemorad = risk of peripheral
neuropathy / renal damage etc
Pre-exisiting injury –
smoking,
Diabetes
Pre-disposition (to late effects
development) – inflammatory bowel
disease, MS, genetic mutation (eg
P53)
Employment issues
/ benefit burden
Physical symptoms
Isolation / loss of
confidence
Not knowing who to
approach for help
Memory /
concentration
problems
Body image issues
Impact on families,
social network
Sexual relationships
Emotional issues
Additional comorbidities
associated with age
Embarrassment /
difficulty coping
Patient with lower GI symptoms
‘How
was I?
On a good day uncomfortable,
using pads, and planning carefully
every time I went out of the house.
On a bad day, I’d rather not eat
than embarrass myself in front of
family and friends and I sleep in a
separate room now.’
Main issues (1)
• Historical legacy – patient treated elsewhere
• SW – Age profile – LE combined with other
co-morbidities
• Little information on the scale of the
problem!
• Symptoms managed poorly, no guidance !
• Unnecessary investigations / ineffective
treatments
• Impact on NHS resources
• Who takes responsibility ?
Main issues (2)
* LE services – few specialist
services over large geographical
area.
* Some services regionally (referrals,
funding, travel)
* LE services traditionally associated
with paediatric oncology
* NCSI recovery package (approach
is not standardised)
Pandora’s
box
Newer treatment
techniques
IMRT / VMAT /
SABR/IGRT
New chemotherapy
drugs
Survival rates
=
Consequences ?
Tiered model of care at The Beacon
During treatment
- Information and
resources
• HNA assessment
• Radar key / toilet
card
• Tailored
discussions re side
effects
At the end of
treatment - HNA
and Treatment
Summary
• Include potential
future consequences
• How to minimise /
monitor
• Healthy choices
• Primary care
management
• ?H + WB clinic
Problems that have
not settled, or
develop 6 or more
months after
LATE EFFECTS
SERVICES +
THOSE
‘IN EVOLUTION’
Late effects services
Nationally –
 Pelvic Radiation Disease Clinic – Royal
Marsden
 2.5 hours by train and tube !!!!
 Hyperbaric Oxygen – Plymouth, Merseyside
 60 treatments is usual, no NICE approval
 Virtual MDT – complex cases, online
password protected platform. 7 day process
Late effects services
Regionally –
• Fatigue and Life Style Management for Cancer
Survivors – Step Up Service, Bath
• Breast Radiation Injury Service, Bath (Manchester and
London no longer taking referrals)
• Emotional wellbeing, comp therapies (Penny
Brohn Cancer Care – Bristol and Talking therapies
(Somerset Partnership) – CBT, psychological
support
• Others? – adult LE clinics associated with
childhood cancers, ProActive (GP exercise referral),
CAB
Late effects services
Locally • Gastroenterologist (interest in PRD)
• Endocrinologist
• Local therapists – (SLT, dietician, physio,
lymphoedema)
• ED clinic
• Pain clinic
• Women’s health
• Nurse Counsellors
Where are we now?
• New guidance for LE symptoms,
other sites to follow –
implementation? Succinct algorithms
for ease ?
• Education for primary care / self
development (RMH e module)
• Assessment / screening tools /
PROMS vital !
• Tiered model of care
• Utilisation of services and resources
• Referral pathways? CCG / Regional
Survivorship groups
Making a difference !
* Prevention to minimise wherever
possible
* Inform patients of potential LE
* Identify those at risk
* Assessment – HNA address unmet
needs
* Support patients through local and
regional LE pathways
* Patients gain independence / return
to work
* Prevents unnecessary hospital
admissions / GP consultations
* Saves NHS money!............................
Golden nuggets !
• For every £1 spent on lymphoedema
treatments, the service estimates the NHS
saves £100 in reduced hospital admissions.
• If just half of breast cancer survivors who
initially return to work but then leave were
helped to stay in work, the economy could
save £30M every year.
Reference: NHS London (2012) Allied Health Professional QIPP pathway for
cancer
Further information or direct referrals
Karen Morgan,
Macmillan Consultant Radiographer
(Late Effects),
c/o The Radiotherapy Dept,
The Beacon Centre,
Taunton,
TA1 5DA.
Telephone 01823 342933
Email: [email protected]