Download Acute Oncology Services - Croydon University Hospital

Acute Oncology Service (AOS)
Monday – Friday
8am – 4pm
Bleep: 946
T: 020 8401 3000 x5726
F: 020 8401 3513
Dr Nicola Beech
Dr Jillian Noble
Dr Susannah Stanway
Miss Robyn Jenkins
Advanced Nurse Practitioner (AOS Lead)
Consultant Oncologist
Consultant Oncologist
AOS Administrator
Croydon Healthcare Services
•
•
•
•
•
•
Population of 346,000
65 years and over (13.8%)
85 years and over (1.9%)
61 GP practices
Croydon University Hospital 572 beds
Member London Cancer Alliance
Diagnostics
Disease sites
•
•
•
•
•
•
•
•
Lung
Upper GI
Lower GI
Breast
Gynaecology
Urology
Skin
Haematology
Cancer MDM
Cancer MDM
Palliative care
Treatment
AOS referrals
2013
JAN
FEB
MAR
APR
MAY
JUN
JULY
AUG
SEP
OCT
NOV
DEC
TOTALS
Number of
referrals
46
45
67
64
57
38
53
48
66
33
41
66
624
Known primary site
26
34
44
43
40
28
25
28
34
28
22
43
395
Suspected
20
11
23
21
17
10
28
20
32
5
19
23
229
Known Cancer
Centre
26
33
36
36
32
20
21
24
30
24
17
41
340
RMH
23
27
32
26
28
19
19
20
28
6
14
33
275
OTHER
3
6
4
10
4
1
2
4
2
18
3
8
65
GP referrals
• 61 GP practices
• 6786 urgent referrals suspected cancer (2012/
2013)
• Conversion rate 9.82 (4th highest LCA)
• 1678 new cancer registrations (2011)
ULCN Received via fax/
AOS nhs.net inbox
U
L
INPATIENT
Review report and
patient clinical records
Assess to see if any AOS
input is required
OUTPATIENT
C
N
Confirm patient has been
put on a pathway
P
If AOS input required,
review on ward
No AOS input required,
patient being
appropriately managed
A
Fax report to GP if not
under any team/ pathway
T
H
Discharge from AOS
once AOS are happy
with management
AOS ULCN Pathway V1 30.04.2014
Monitor as part of audit
for diagnostics, confirmed
diagnosis and treatment
Monitor as part of audit
for diagnostics, confirmed
diagnosis and treatment
W
A
Y
MUO CNS
• To provide support and information to patient
• To improve coordination of diagnostic
pathway
• To speed time to diagnosis
• Source of expertise for GPs and
colleagues
Consultant Oncologist Job plan
• Started in the Trust in November 2012
• Joined in December 2012 by Dr Jill Noble
• Work between RMH (Breast Unit) and CUH
(Acute Oncology Service and Breast Unit)
• RMH employed- similar consultant posts at
Kingston Hospital and Epsom and St Helier
What we can offer
• Cancer expertise
– Diagnostics
– Treatment complications
– Disease complications
• Liaison with Cancer Center where necessary
Job plan
Monday
Tuesday
Wednesday
Thursday
Friday
Acute Oncology Acute Oncology Breast Clinic
RMH
CUP MDT
Breast
Research
Meeting
Acute Oncology
RMH Breast
Academic
meeting
Acute Oncology
Acute Oncology SPA
Breast MDT
CUH/RMH
SPA
Breast Clinic
RMH
Breast Clinic
CUH/SPA RMH
Our aims
•
•
•
•
•
•
Earlier diagnosis
Correct management quicker
Shorter inpatient stays
Ambulatory pathways
Closer to home
Referral to cancer center where
necessary
• Referral to palliative care where
appropriate
• IMPROVED PATIENT EXPERIENCE
• Education
Patient
Staff-hospital
and
community
• Research
CADIAS
Case Study 1
• 55 year old lady
• History of breast cancer
• Presents with nausea and vomiting
Results:
• Calcium level is elevated at 3
• Imaging show she has new bone and liver
metastases (secondary breast cancer)
Treatment:
• IV fluids and bisphosphonates
• Biopsy to confirm metastatic cancer
• Referral to RMH for ongoing outpatient management
Case Study 2
• 70 year old man
• Admitted with a cough and a swollen face
Results:
• CXR - widened mediastinum
• CT - lung mass, enlarged lymph
nodes obstructing superior vena
cava
Treatment
• High dose steroids to reduce swelling
• Referred to respiratory for stenting
• Discussion at CUH MDT (video-linked to RMH)
• Offered radiotherapy
Case Study 3
• 22 year old man
• Admitted with back ache
Investigations
• Examination and blood tests
reveal no abnormalities
• CT scan - large retroperitoneal
mass
Differential diagnoses include sarcoma,
lymphoma, germ cell tumour (amongst others)
Treatment
• His imaging is IEPed to RMH to be discussed at
the sarcoma meeting
• He is transferred as an inpatient to have
surgery
Future developments
• Ambulatory care facility to avoid admission
• Outpatient clinic
• Trust wide dissemination protocols and
pathways
• Trust wide education programme
• Joint teaching with CUH and RMH