Download Head and Neck Cancer and Rehabilitation

Rehabilitation and
Head and Neck cancer
Head and Neck SSG
Business and Educational Meeting
29 February 2012
Sally Donaghey
Macmillan AHP Lead, Ang CN
[email protected]/Tel: 01638 608218
Head & Neck Cancer and
Rehabilitation
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Evidence based Rehabilitation Care Pathway – local
version agreed by NSSG 2010
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QoL, ADL, physical, social, psychological and
functional support (multi-professional clinics)
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Optimise treatment (nutritional status pre and post
surgery, swallowing)
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Cost-effectiveness/benefits realisation
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QIPP
Issues and Initiatives in
Rehabilitation
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Cancer rehabilitation nationally is comparatively underdeveloped and under-utilised.
Publication of National Cancer Rehabilitation pathways and
evidence guide.
Development of tumour specific local rehabilitation pathways
Need for pathways to be integrated into main care/referral
pathways and practice
–
–
–
–
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Guidance/Protocols at trusts as per pathway
Services directory – links to local pathway
Audits
Patient/User experiences
Rehabilitation evidence reviews 2009/2012
Uniquely anticipatory
Complications in
Head and Neck Cancer Patients
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Dysphagia
Dysgeusia
Communication
impairment
Trismus
Xerostomia
Mucositis
Weight Loss/Anorexia
Nutritional deficiency
Respiratory
compromise
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Fatigue
Pain
Weakness
Reduced
mobility/movement
Oedema
Anxiety
Functional
impairment/ADL
Equipment needs
c
(In
A
S
D W
at
a)
P
L& * *
en
in
S SC
us
su
s
la
(In T ex
V
c C
C
D N
S
C
at
C
a)
N
*
(6 Y *
0% C
N
r
H es)
Y *
C
C
M N
G
C
rM
C
an A N
n
& g
G C lia
re he
at s
er h
M
S id
W
N S
N W H
or LC
th N
Tr
e
E nt
K P ss
en a e
t/ nB x
M irm
ed
w
a
A y
rd
S e
W n
LC
N N
E
C
3C N
C
D N
M or
t V se
er t
N non
E
L
S CN
E
LC
N
E
as
tM
id
Total WTE Head and Neck Cancer AHPs
Specialist Head and Neck AHP’s
(per 1million Pop.)
Total WTE Head and Neck Specialist AHP Cancer Posts per 1 Million Population by Network
9.00
8.00
7.00
6.00
5.00
4.00
WTE/ 1 Million Population
National Average
3.00
2.00
1.00
0.00
Network
Workforce Mapping
Current WTE Specialist Posts for SLT and
Dietetics in Head and Neck Cancer by Locality
Cambs
Norfolk
Suffolk
Beds
GTYW
P’boro
(In
ANGCN)
SLT
1.6
1.0
1.0
0
0
(0.8)
Dietetics 1.5
1.5
0.4
0
0
0
Physio
0.2
0
0
0
0
0
WTE Specialist Posts in Head and Neck Cancer
(all identified professions) per 100,000
population of locality.
Findings
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Relatively low numbers of AHP’s for
population against national average
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Variablity in specialist service provision
between localities
– Consider referral pathways
– ? Significant unmet need
– Community support provided out of acute
centres over a very large geographical area
– ? Rehab needs provided by generalist workforce
– ?potential significant risk for people with head
and neck cancer
NICE 2004
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Establishment of Local Support Team (LST) by
every Cancer Unit or Cancer Centre which may also
work on an out-reach basis and contribute to
continuous assessment in an out-patient setting
LST to have access to the expertise required to
manage the after-care and rehabilitation needs of
all of its patients, working closely with Cancer
Centre staff and primary health care teams to
provide seamless care.
The local support team should aim to ensure that
the long-term needs of patients and carers are met.
NICE 2004
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SLT and dietician must form part of core
membership of multi-disciplinary team
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SLT must be a specialist in head and neck cancer
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Dietician must have specific expertise in managing
head and neck cancer patients.
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Physiotherapy and OT practitioners should form
part of the extended MDT and must have an
interest in head and neck cancers and experience
of dealing with these patients.
NICE 2004
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The SLT in the MDT may delegate rehabilitation
work to an SLT working in the community, but
remain available to provide expert advice and
assistance to the community SLT.
Where the (LST) dietician does not have specialised
knowledge of head and neck cancer, there should
be close liaison between the dietician in the
community and their counterpart in the MDT
Ongoing physiotherapy and input from OT will often
be required by patients who have undergone radical
treatment to the neck.
NICE 2004
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The IOG estimates that each Network
of approximately 1.5 million population
will require an additional 5.3 WTE SLT
and an additional 4.7 WTE dieticians
Anglia Cancer Network population of
2.671 million: this = an additional 9.4
WTE SLT and an additional 8.4 WTE
dieticians.
IOG recommended additional WTE Specialist
Posts for SLT and Dietetics in Head and Neck
Cancer by Locality, less current specialist
provision.
Cambs
Norfolk
Suffolk
Beds in
Ang CN
GTYW
P’boro
SLT
0.6
1.7
1.1
1.0
0.75
0 (once
0.8 post
in
place)
Dietetics
0.4
0.9
1.5
0.9
0.7
0.5
National Workforce Modelling –
Head and Neck ANG CN Incidence 2008
= 494
Speech and Language Therapists
Total
FTE
26.0
FTE by professional group, showing break down by pathway
stages
30
Pal & EoL
FTE
14.1
25
Survivorship
Treatment
FTE
Dietitians
Total
20
Physiotherapists
Total
Diagnosis
FTE
4.3
Pre Diagnosis
15
Lymphoedema Therapists
Total
FTE
3.9
Occupational Therapists
Total
FTE
3.1
10
5
0
Diet
Lymph
OT
Physio
SaLT
National Workforce Model WTE Workforce
Requirements per Locality and Profession
Cambs
(96)
Norfolk
(167)
Suffolk
(111)
Beds in
Ang CN
(40)
GTYW
(48)
P’boro
(32)
Physio
0.8
1.5
1.0
0.3
0.4
0.3
OT
0.6
1.0
0.7
0.2
0.3
0.2
LT
0.8
1.3
0.9
0.3
0.4
0.3
SLT
5.0
8.8
5.8
2.1
2.5
1.7
Dietetics
2.7
4.8
3.2
1.1
1.4
0.9
Day to day barriers
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Awareness of rehabilitation needs
AHP attendance at MDT/clinics
Assessment tool for rehabilitation
Co-ordination of rehabilitation needs
Commissioning of rehabilitation
Network Guidelines – treatment/diagnostic
focus
Lack of resources
What Can the
NSSG Do?
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NSSG Workplan
Head and Neck Care Pathway – specific
reference to rehab
Locality/clinician engagement
Rehabilitation awareness
Audit of referrals/interventions/patient
surveys
Key Messages
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Head and neck cancer rehabilitation is highly
specialised
– Needs clinical experience (case-load maintenance) +
formalised learning
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Majority of rehabilitation and support for people
with head and neck cancer extends well beyond the
acute phase
Need to consider the whole pathway when planning
service
Commissioning
Awareness of rehabilitation
Importance of rehabilitation
Head & Neck Rehabilitation
Service Specification
Hub
Spoke
Shared services
with MVCN
Useful Links
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NCAT(2009). Supporting and Improving Commissioning of Cancer Rehabilitation Services Guidelines:
http://ncat.nhs.uk/sites/default/files/NCAT_Rehab_Commissioning.pdf
NCAT(2009). Cancer Rehabilitation Services Evidence Review:
http://ncat.nhs.uk/sites/default/files/NCAT_Rehab_EvidenceReview.pdf
NCAT (2012) Cancer and Palliative Care Rehabilitation Evidence Review- Update:
http://ncat.nhs.uk/sites/default/files/NCAT_Rehab_EvidenceReview__2012FINAL24_1_12.pdf
NICE Supportive and Palliative Care IOG 2006:
http://www.nice.org.uk/nicemedia/live/10893/28816/28816.pdf
QIPP: https://www.qippeast.nhs.uk/
NCAT (2011) Cancer Rehabilitation Workforce Model:
http://ncat.nhs.uk/sites/default/files/NCAT%20Rehab%20Workforce%20model%20Briefing%20Paper.p
df
NCAT (2010) Cancer Rehabilitation Workforce Mapping Exercise:
http://ncat.nhs.uk/sites/default/files/NCAT_Mapping_Report_0.pdf
NCAT (2009) Rehabilitation care Pathway – Head & Neck:
http://ncat.nhs.uk/sites/default/files/NCAT_Rehab_HeadAndNeck_0.pdf
Anglia Cancer Network (2010) Local Rehabilitation care Pathway – Head & Neck:
http://www.angliacancernetwork.nhs.uk/documents/AngCN-CCGPS27%20Rehabilitation%20Pathway%20for%20Head%20and%20Neck%20Cancer_v2.pdf
Anglia Cancer Network (2011) Interim Service Specification and Needs Analysis:
http://www.angliacancernetwork.nhs.uk/documents/AngCN-CCG-PS48_v1r.pdf
NICE (2004) Improving Outcomes in Head and Neck Cancers – The Manual:
http://www.nice.org.uk/nicemedia/live/10897/28851/28851.pdf