Download Survivors and Chronic Cancer Patients: The English Cancer

The English Cancer Survivorship Initiative:
A shared model of care
Jane Maher
NHS Improvement Lead (Cancer)
Joint CMO Macmillan Cancer Support
Chair NCSI Consequences of Treatment
1. Prevalence
2. Unmet needs
3. Vision
The new, simplified NHS
1. Avoid where possible
2. Acknowledge, measure,
code and report routinely
3. Services to reduce
distress and functional
impairment
http://www.macmillan.org.uk/Documents/AboutUs/Research/Researchandevalu
ationreports/Throwinglightontheconsequencesofcanceranditstreatment.pdf
Some of our achievement in 2008
Diagnosis &
Treatment
Recovery
Early
monitoring
Later
Progressive illness End of life care
monitoring
Gaps
Breast cancer care pathway – estimating the number of women, 2008*
Colorectal cancer care pathway – estimating the number of people, 2008*
Lung cancer care pathway – estimating the number of people, 2008*
Every cancer pathway is different but it is helpful to
consider three groupings
The three groups are based on typical survival
times:
Group 1: long term survival after an "acute illness"
Group 2: "incurable but treatable" - "chronic illness"
Group 3: limited treatment options, short survival
10
Long term conditions and multimorbidities will
become the norm
.
http://www.macmillan.org.uk/Documents/AboutUs/Research/Researchandevaluationreports/Routesfrom-diagnosis-report.pdf
The impact of cancer and its treatment
802 responders with
colorectal cancer (64.3%
response rate)
1, 2, 3 and 5 years post
diagnosis
• difficulty controlling bowels
in 19%
• no less prevalent after 5
years
- this item affected EQ5D
Estimating specific consequences of cancer or its
treatment for colorectal cancer survivors, 2010, UK
Time since
diagnosis
1yr
2yrs
5yrs
10yrs
19% experience
difficulty controlling => ~ 40,000
bowels
Source: Estimates using prevalence data and patient reported outcome measures, Maddams et al; Glaser et al.
http://www.ncsi.org.uk/wp-content/uploads/RMH-Bowel-Algorithm-v7-20111.pdf
Total Prevalence - now
Total Prevalence - 2030
Diagnosis &
Treatment
Rehabilitation
Early Monitoring
Later Monitoring
Progressive
Illness
End of Life Care
(Year 1 Deaths)
Assessment Plus Care Plan
•Breast 70-80%
•Colorectal 50%
•Prostate 40-50 %
http://www.evidence.
nhs.uk/qipp
Survivorship programme: Some highlights
● 2008-2012: Testing of new models of aftercare
● 2013 publication NICE approved case study relating to
new models of aftercare (breast, colorectal, prostate)
● 2013 From innovation to implementation - a how to guide
http://www.ncsi.org.uk/resources/nhs-reports/adults/innovation-to-implementation-stratified-pathways-of-care-forpeople-living-with-or-beyond-cancer-a-how-to-guide/
Pre-planned tests, triage, access back to
specialists via trusted route
Trusted individuals able to provide

Information

Access to tests

Access to expertise

Self assessment Tools
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New ways of working
CNS perspective
www.cancerconsequences
Some priorities so far
• Shared understanding - cancer has changed;
• a good conversation between HCP and patient;
• good communication between HCPs;
• a recovery package, planned investigations
and rapid access back to specialist care can
produce better care without increasing cost.
Playing a long game
Thanks
Charities
Researchers
Primary care
Hospitals
Community organisations
Patients
Cancer networks