Download Presentation-for-Cancer52-Member-Workshop-March

MDT Provision
for Rare Cancer
Recommendation 40 of the
Independent Cancer Taskforce
Report
Agenda
•
Welcome and Introductions (Jane Lyons)
•
Overview (Rupi Dev, NHS England)
•
CRUK Report/What we already know about rare cancer MDTs
(Cath Taylor/James Green)
•
Q&A session/discussion
•
Summary and Next Steps
www.england.nhs.uk
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Overview
NHS England
www.england.nhs.uk
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Background
•
Rare cancers are generally defined as those with an incidence less
than 6 per 100,000 population.
•
In Europe, there are 186 types of rare cancer, accounting for 22% of all
new cancer incidence
•
1 in 5 people with cancer have a rare cancer, and out of those with a
rare cancer, 1 in 3 people have a particularly rare form of cancer (with
an incidence less than 3 per 100,000 population).
•
Outcome data shows that the five year survival rate for people with
rare forms of cancer is lower than that for people with more common
cancers
www.england.nhs.uk
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Background cont…
•
In 2015, the Independent Cancer Taskforce Report made a series of
recommendations to drive improvements in outcomes for patients with
cancer
•
Recommendation 40 of the report was focused on the provision of
multi-disciplinary teams and/or networks for rarer cancers
•
The recommendation references the use of national video conferences
to enable local specialists to access national expertise and suggests
the possibility of holding annual audits for rare cancers, where every
death is discussed and performance metrics are produced for units
allowing for comparison against the national average mortality rate
www.england.nhs.uk
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Recommendation 40
•
Recommendation 40 of the Cancer Taskforce Report states:
“The Trust Development Authority, Monitor and NHS England
should strongly encourage the establishment of national or regional
MDTs for rarer cancers where treatment options are low volume
and/or high risk. Clinical reference groups will need to play a key
role in supporting these.”
www.england.nhs.uk
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Progress so far
•
Agreed scope of work with the Cancer Programme of Care Board
(NHS England)
•
Engaged with individuals with experience of MDT effectiveness and
specialist MDTs
•
Reviewed data from PHE regarding outcomes for rare cancer (in
particular identifying cancers with low incidence/high mortality and
high incidence/high mortality)
www.england.nhs.uk
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Progress so far cont…
•
Engaged with Clinical Reference Group Chairs within the Cancer
Programme of Care
•
Observed national MDTs already in place for paediatric cancers
•
Engaging members of Cancer52 via a questionnaire and arranging
workshop to gather views and feedback
www.england.nhs.uk
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Purpose of Today’s
Workshop
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To understand what works well currently in the provision of specialist
MDT and networks of care
•
To get a better understanding of where good practice already exists for
rare cancers and any learning from this
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To understand where delays occur in the pathway for you patients (e.g
referral, accessing specialist care)
•
To work with you all to identify potential tumour types and patient
cohorts that would benefit from a national sharing of expertise
www.england.nhs.uk
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Cancer Research UK
MDT Research
www.england.nhs.uk
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Cancer Research UK: Improving MDT effectiveness (2017)
Methods:
• Survey of MDT members to identify key issues [2294
responses] and test recommendations [1258 responses]
• Survey of patients [48 responses]
• Observed 624 patient discussions [24 MDMs, across 10 sites]
Findings:
• Not enough time to discuss complex patients
• Current MDT meeting attendance is not optimal
• The right information is often not used to inform discussions
• MDTs are unable to fulfil their secondary roles (data
validation, audit and education)
http://www.cancerresearchuk.org/about-us/we-develop-policy/our-policy-on-nhs-cancerservices/improving-the-effectiveness-of-mdts-in-cancer-services
CRUK Research – Findings
•
•
•
•
Received 2,300 responses to surveys
Most common raised was time to discuss patients (not enough
time)
During MDT observations, it was noted:
• Average length of discussion was 3.2 minutes
• Over half discussions less than 2 minutes long
• Meetings lasting up to 5 hours
74% agreed with the principle of streamlining MDTs
www.england.nhs.uk
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CRUK Research – Findings
Cont…
•
•
•
•
Issues highlighted with MDT attendance
Individual members are required to attend 66% of all MDTs; this was
noted to be very difficult for those working across multiple MDTs
In addition, individual member contribution in meetings varied
• on average only 3 people out of the whole MDT were involved in
discussions
• in over 75% of meetings, Clinical Nurse Specialists did not speak
at all
Feedback supported the need to move towards specialty cover in
MDTs rather than individual attendance
www.england.nhs.uk
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CRUK Research – Findings
Cont…
•
Issues identified with the use of information
• 7% of discussions were deferred due to either missing
information (usually diagnostic imaging results) or missing MDT
members
• Only 25% of the patients surveyed were satisfied with the
amount of information they were able to contribute to the MDT
discussion
•
It was felt that MDT were unable to fulfil their secondary roles in
data validation, audit and collection
www.england.nhs.uk
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What we already know
about the provision of
MDTs for rare and less
common cancers
www.england.nhs.uk
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Common vs less common vs rarer or rare
COMMON (“BIG FOUR”)
Breast
Prostate
Lung
Colorectal
55,000 F (M v rare)
40,000 M
46,000
new cases per year
41,000
NOT COMMON
Lymphoma NHL 17,000 HL 2,000 (rare)
Uterine (womb)
9,000 F
Ovarian
7,000 F
Brain
11.000
Pancreatic 9,600
RARE
Sarcoma
soft 3,200 bone 600
Teenage Cancers
2,100
Cholangio carcinoma 2000
Penile
500 M
Myeloproliferative neoplasms 520
Waldenstrom’s macroglobulaemia 400 a subtype of NHL
THIS IS ABOUT CANCER TEAMS
what works and what can be improved
WHAT DO WE KNOW ABOUT TEAMS
AND PATIENTS WITH RARER CANCERS ?
IMPROVING CANCER
TEAMS
MDT
FIT
Multi Disciplinary Team
Feedback for Improving
Teamworking Winner: Digital Innovation in the
Treatment of Cancer
Qic Oncology Award 2016
Web based Tool
Impeial, Barts Health, Kings, Surrey,
UCLP
And over
100 NHS Trusts
Recent CRUK SURVEY Data
• WAS THERE A BIAS
TOWARDS COMMON TUMOURS ?
• ARE THERE DIFFERENCES ?
– Depending on tumour type
Do you agree with the idea that some cases could be streamlined ?
Tumour Site
What percentage of patients do you feel could be
resolved outside of the meeting - for example, through
clearly defined treatment protocols and review by a
smaller group?
Yes
No
Percentage in favour
Number of responses
Overall
802
278
74%
1080
31.00%
Skin
80
10
89%
90
37.80%
Urology
116
17
87%
133
35.30%
Other (please specify)
25
6
81%
31
28.50%
19
5
79%
24
31.40%
Lung
98
27
78%
125
26.90%
Gynaecology
60
17
78%
77
28.20%
Upper GI
58
19
75%
77
30.70%
Breast
110
37
75%
147
33.70%
Haematology
53
18
75%
71
32.90%
Brain
26
9
74%
35
26.70%
Sarcoma
8
3
73%
11
21.10%
Palliative Care
16
8
67%
24
42.90%
Colorectal
75
44
63%
119
27.90%
Head and Neck
48
48
50%
96
25.00%
CUP
6
8
43%
14
12.20%
Children and Young People
Source: Online MDT follow up survey, data downloaded 27 May 2016
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CANCER STRATEGY
3 recommendations
on MDTeams
38
39
40
38
Self Assess to Improve
• MDTs should be supported to use validated tools to
self assess and improve their effectiveness.
MDT
FIT
Focusing of complex cases
• MDT discussions should focus more on difficult cases and
processes should be put in place to enable swifter decisions
on patients going through standard treatment pathways.
• Recommendation 38: NHS England should encourage
providers to streamline MDT processes such that specialist
time is focused on those cancer cases that don’t follow
well-established clinical pathways, with other patients
being discussed more briefly.
WHAT MAKES A CASE COMPLEX ?
Elements that add complexity to Patients Cancer Cases
Element
4
Level of complexity added
3
2
Mean Score
5- Adds a
significant amount
of complexity
1- Does not add
any complexity
4.1
40%
42%
12%
4%
2%
1083
4.1
39%
41%
15%
4%
2%
1075
3.9
27%
44%
20%
7%
2%
1074
3.7
21%
41%
26%
10%
2%
1083
3.5
15%
39%
29%
12%
4%
1074
3.4
11%
41%
33%
13%
3%
1078
3.4
10%
41%
31%
15%
3%
1083
3.4
9%
39%
36%
14%
3%
1081
3.1
7%
31%
30%
22%
10%
1084
3.0
7%
27%
34%
26%
7%
1076
2.9
4%
27%
34%
27%
7%
1080
2.8
4%
19%
39%
30%
8%
1082
Medical: Patient discussed in the meeting has unusual or rare tumour type
Treatment: There is a conflict of opinion regarding the best treatment option for
a patient
Treatment: Guidelines/pathway do not account for patients' specific situation,
(i.e. exceptional case)
Psychological/Cognitive: Patient has a significant mental health or cognitive comorbidity (e.g. they are sanctioned under the Mental Health Act, have
schizophrenia, dementia from stroke or Alzheimer's disease)
Treatment: Patient has treatment failure (i.e., there is cancer progression despite
current treatment)
Treatment: Patient experienced treatment toxicity and/or contraindications to
standard treatment
Medical: Patient has significant physical co-morbidity (e.g. diabetes, congestive
heart failure, kidney or vascular disease, immunocompromised or suppressed).
Surgical: Patient has a significant past surgical history (e.g. relevant previous
surgeries that may affect surgical options)
Medical: Patient has a poor performance status (i.e., they are frail and/or need
assistance with care/mobility)
Social and Behavioural: Patient has socio-economic issues, such as for example,
they are a sole parent with young children, there is a lack of social, family and/or
financial support and/or housing issues
Social and Behavioural: Patient has lifestyle risks for the success of treatment,
such as for example smoking, excess weight, alcohol/drug abuse
Medical: Patient has significant drug history (e.g., polypharmacy)
Source: Online MDT follow up survey, data downloaded 27 May 2016
Number of respondents
27
Learning, Audit of End of Life
• More emphasis should be placed on learning from patients
who have gone through treatment, to improve decisionmaking.
– For example, patients dying within weeks of active treatment.
• Recommendation 39:
• NHS England should require MDTs to review a monthly audit
report of patients who have died within 30 days of active
treatment
– to determine whether lessons can be learned about patient safety
or avoiding superfluous treatment.
Recommendation 40 of the report was focused on rarer cancers
The recommendation proposes the use of national video conferences to
enable local specialists to access national expertise and suggests the
possibility of holding annual audits for rare cancers, where every death is
discussed and performance metrics are produced for units
Recommendation 40 of the Cancer Taskforce Report
“The Trust Development Authority, Monitor and NHS England
should strongly encourage the establishment of national or
regional MDTs for rarer cancers where treatment options are
low volume and/or high risk.
Clinical reference groups (CRGs) will need to play key role in
supporting these.
Q&A
Session
www.england.nhs.uk
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Question 1.
What works well?
www.england.nhs.uk
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Question 2.
Any examples of best
practice and learning?
www.england.nhs.uk
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Question 3.
Where are the
bottlenecks in service
provision?
www.england.nhs.uk
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Question 4.
Where do you think
national MDT set-ups
could have the biggest
impact?
www.england.nhs.uk
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Next Steps
•
Collating feedback from workshop alongside all other evidence
gathered
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Identification of potential areas for focus and support through this
piece of work
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Feedback at Cancer Programme of Care Board end of April 2017
for sign-off and approval of next steps
www.england.nhs.uk
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