Download PCO- Suggestion for LWABC Case Study Following some questions

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PCO- Suggestion for LWABC Case Study
Following some questions from GP colleagues I hope the following is helpful:
The aim of this case study is not to have to seek out a particular patient but to be alert during the
year till 31st March 2017 of a patient you see (or your practice nurse sees) who has completed their
cancer treatment but has concerns with how they are living with and beyond their cancer treatment.
If in the unlikely event you don’t see by 31st March 17 a patient that has come to the end of their
cancer treatment and is living with the effects of treatment it may be helpful to carry out a search of
patients who have had a cancer diagnosis in the last 3 years, remove those who are not current
active patients and review their clinical notes to see if any of their attendances in the last 12 months
have been related to their mood, tiredness, financial worries, physical and psychosexual concerns
after eg pelvic radiotherapy for prostate and gynae cancers, lymphodema sequelae etc.
It would be much easier however if you held a practice meeting with both GPs and practice nurses
and also I think your receptionists as they often might know of patients that are struggling after their
cancer treatment.
This is an innovative requirement of the PCO with no precedent to refer to. Being aware and
addressing cancer patients’ LWABC issues are a national directive embedded in the new Cancer
Strategy so patients move from surviving to thriving.
We are as much looking for your identifications of unmet need in your practice populations to learn
from and address as much as trying to introduce the new concept of unmet needs in patients who
have completed cancer treatement, potentially with curative intent, but at what cost: psychological
and financial hardship, having to manage another LTC as well as their cancer treatment effects. This
is useful as clinical commissioners seeking to improve the support available in our population.
The Macmillan Next Steps pilot open to patients in Gloucester City and North Cotswolds practice
population is an ideal service to mention in your case study if you have identified someone who
might benefit from specific cancer physiotherapy eg after treatment for head and neck cancer or
from exercise and dietetic advice, they are a comprehensive MD Team. We are currently seeking to
make MNS accessible to patients across the county and will keep you updated on this.
Once the end of treatment summaries are fully implemented we would encourage you to code
patients who are in the LWABC phase.
An example case study is as follows:
Mrs NH is a 38 year old lady who completed surgery and radiotherapy for an advanced cervical
cancer in 2014. She had 3 miscarriages before her cervical cancer was diagnosed having been a nonresponder to her cervical screening invitation.
She booked an appointment as she was feeling tired and on further questioning it became apparent
she was quite low. Her treatment had finished a while ago and she couldn’t understand why she
hadn’t been able to pick herself up and move on.
She describes her sense of relief after her treatment had finished but also a sense of feeling
abandoned and anxious about the cancer coming back and needing further treatment which has
really ‘messed me up down below’. She holds a great deal of guilt at her ‘irresponsibility’ of
neglecting her smear invitations and though her husband is supportive, she really feels she has let
him down.
Although she knew of the support centre next to the Oncology Centre, NH was reluctant to go to
Maggie’s Centre as she didn’t want to spend time with other cancer patients.
We had a chat over 2 consultations and I managed to elicit the above. She felt that as she had
completed treatment a while ago that she would not be able to return to Maggie’s. We agreed that
she might after all find it useful to join a group there and volunteer to talk about her experiences
about being young with a cancer diagnosis.