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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