Download Colorectal Cancer Care Pathway and Rehabilitation

Colorectal Cancer Care
Pathway and
Rehabilitation
Tessa Aston Macmillan Dietitian
[email protected]
Patrick Sherlock, Marie Curie
Physiotherapist
[email protected]
Key Issues
• Cancer Rehabilitation poorly developed
(particularly in comparison to stroke or cardiac
rehabilitation).
• Outcome of NECN Peer Review of Cancer
Rehabilitation Measures – achieved 6%
compliance
• Colorectal Cancer Rehabilitation pathway needs to
be meaningfully integrated into the main
Colorectal Cancer Care Pathway
AHP Mapping Exercise for NECN 2009
• Many rehab services provided by AHPs working at
level 2 or 3 without specific funding
• < 4.5 WTE Specialist Dietitians and < 7 WTE
Specialist physiotherapists/ per million population
in NECN with specific funding for Cancer patients
(diagnosis to EOL care)
• No AHP is specifically funded for colorectal cancer
and only one AHP is reported to attend a
colorectal MDT (Gateshead)
National Developments
• 9 tumour specific, evidence based
rehabilitation care pathways
• 10 symptom specific pathways of care
with defined therapy intervention
• Published evidence base to support
cancer rehabilitation
www.ncat.nhs.uk
Care Pathways
Cancer Symptom Pathways
•
•
•
•
Breathlessness
Pain
Lymphoedema
Spinal Cord
Compression
• Continence
www.ncat.nhs.uk
• Fatigue
• Mobility and loss
of Function
• Anorexia/cachexia,
weight loss
• Dysphagia
• Communication
Difficulties
Cancer Rehabilitation – referral to
generic or specialist AHP
Is the
symptom
of little
concern or
already
self
adapted?
YES
NO
Encourage
self
management
& offer
supportive
written
information
Is the
symptom
impacting
on function
or quality
of life?
NO
YES
Is the
symptom
likely to
impact
treatment
options or
become
more
debilitating
over time?
YE
S
NO
Refer to Specialist
Cancer AHP
services who can
offer expert advice,
an integrated care
plan and ongoing
support for future
potential problems
Refer to symptom
care pathway &
consider referral to
generic AHP
services for
assessment and
advice
Barriers to referring to AHP’s in NECN
• Number of HCP’s involved – may be delays
in referrals
• Assessment may not include consideration
of rehabilitation need
• No access to AHP’s in colorectal clinics
generally
• HCP’s not being aware of role of AHP’s and
what we can do i.e. not just about supply of
equipment
• Limited time for AHP assessment/
intervention due to staffing availability
Local Developments
• Cancer Rehabilitation Patient Information Leaflet.
• Cancer Rehabilitation Services directory is being
developed.
• Building relationships with Colorectal CNS’s to
raise awareness of AHP roles.
National AHP Workforce Model
for Cancer
• Workforce tool developed with the National
Centre for Workforce Intelligence
• Calculates number of WTE AHP Staff needed
to provide care for a given number of patients
• Tool makes some assumptions
How can the Colorectal NSSG help?
• How can we build the NCAT Colorectal
Care Rehabilitation Pathway into the
NSSG agenda for engagement by
organisations across localities?
• Consider prospective audit of referrals
to AHP’s within NECN to identify when
patients are referred/ by whom (c.f.
Lung audit)