Transcript Colorectal Cancer and Rehabilitation

Skin Cancer and
Rehabilitation
Report to Skin NSSG
Sally Donaghey
Macmillan AHP Lead, Ang CN
[email protected]/Tel: 01638 608218
Skin and Rehabilitation
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Lymph node dissection – risk of
lymphoedema
Disease and treatment related management
issues – nausea/vomiting; fatigue, weight
loss, mobility, pain, prosthesis,
reconstruction.
Supportive care is key element of clinical
management in skin cancer – OT, physio,
prosthetics (IOG 2006)
Issues and Initiatives in
Rehabilitation
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Cancer rehabilitation nationally is poorly
developed, evidenced and under
recognised/utilised.
Establishment of evidence base and
National Cancer Rehabilitation Pathways.
Development of tumour specific local
rehabilitation pathways
Need for pathways to be integrated into
main care pathway and practice.
Workforce Mapping
Workforce Mapping cont..
Workforce Mapping cont..
Findings
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Relatively low numbers of AHP’s for
population against national average
– Unmet need or
– Need provided by generalist workforce?
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Variablity in specialist service provision
between localities
– Consider referral pathways
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Setting - 53% Acute. 2009 figures indicate
slightly higher then national average cancer
rehab services in community
– Care closer to home?
Rehabilitation Triggers
Rehabilitation Triggers ..
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Lymphoedema – Lymph node dissection, risk assessment
for lymphoedema
Physiotherapy – Difficulties with movement, weakness,
fatigue, exercise advice and information.
OT – Difficulties with ADL, leisure and work, functional
assessment, equipment needs
Dietietics – Nutrition, appetite, nausea, weight loss/gain,
fatigue, swallowing
SLT – Swallowing, impaired speech
Prosthetics
Management of Patients at Risk
of Lymphoedema
International Consensus – Best Practice for the Management of Lymphoedema –
Lymphoma Framework (2006)
National Rehabilitation Care
Pathway - Lymphoedema
Prevalence of Lymphoedema in
Melanoma
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Urist et.al. Cancer (1983)
– Inguinal LND 26% leg oedema
– Axillary LND 1% arm oedema
– Total group 8% oedema
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– ILND 30%
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Wrone et.al. Arch Dermatol
(2000)
Starritt et.al. Ann Surg (2004)
– ALND 10%
– ALND + RT 53%
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De Vries et.al. Euro Jnl Surg
Onc (2006)
– SLNB 6%
– SLNB + groin dissection 64%
De Vries et.al. Ann Surg Oncol
(2009)
– SLNB (axillary and inguinal)
8.9%
– CLND (axillary and inguinal)
37%
– SLNB (axillary and inguinal)
1.7%
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Sabel et.al. Surgery (2007)
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Chang et.al. Ann Surg Oncol
(2010)
– ILND
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30% mild
15% moderate
Costs of lymphoedema
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472 melanoma incidence p.a in Anglia CN
accessed 21.11.11)
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Lymphoedema related cellulitis:
– In pt £700 = 2.03 bed days
– 2 GP consultations pp/p.a. £100
– Provision of diuretics pp/p.a.
(Todd et.al. Jnl Lymph 2010)
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NHS In pt £365-482 per day
New Pt £153-227
FUP £69-115
Intensive 10 day programme @ 1hr per day £844-1196
Arm Sleeve £15-29
Glove £38-65
Below Knee Stocking £22-35
Full Thigh £50 pair (Macmillan NLCN Lymphoedema Project 2007-10)
(ECRIC
Key Points
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NICE (IOG 2006)
– Lymphoedema Therapist as part of extended MDT.
– Access to lymphoedema services as required
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Best Practice for the Management of Lymphoedema
(Lymphoedema Framework 2006)
– Those at risk identified early – staff awareness and knowledge of
appropriate pathway
– Pts and carers provided with information/education for early
signs and management
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NCAT (Lymphoedema Rehabilitation Care Pathway 2009)
– At risk pts should be screened and advised of risks
– At risk pts to be provided with information of signs/symptoms
and encouraged to make early presentation.
Barriers to Rehabilitation
Implementation.
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AHP attendance at MDT/clinics
Awareness of rehabilitation needs
Co-ordination of rehabilitation needs
Lack of resources
What Can the
NSSG Do?
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NSSG Workplan and guidelines
Endorsement of needs analysis and service
development
Skin Care pathway – specific reference to rehab
Locality/clinician engagement
Audit of referrals/interventions/patient surveys
Useful Links
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Local Skin Rehabilitation Pathway:
http://www.angliacancernetwork.nhs.uk/documents/AngCNCCGPS28%20Rehabilitation%20Pathway%20for%20Skin%20Canc
er_v2.pdf
NCAT. Supporting and Improving Commissioning of Cancer
Rehabilitation Services Guidelines:
http://ncat.nhs.uk/sites/default/files/NCAT_Rehab_Commissio
ning.pdf
NICE IOG 2006:
http://guidance.nice.org.uk/CSGSTIM/Guidance/Standard2006
/pdf/English