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MACMILLAN AFTERCARE REHABILITATION TEAM (MARS) Anne Hope Head and Neck CNS. Background to MARS • Lack of local specialist aftercare services in Surrey/Hampshire/Sussex • Non- compliant with National /local policies and guidelines, e.g. (NICE, 2004) • Post treatment HNC patients lacked local support in rehabilitation and support following treatment. • Number of cancer survivors growing • Inconsistent access to support services and specialist follow up across cancer alliance. AIMS OF THE MARS TEAM • To provide a multi-disciplinary, holistic specialist service to HNC patients and their families throughout follow up. • To provide follow up closer to patients home. • To promote self management in a supportive environment and facilitate/sign post to local support services. • To meet national and local policies and guidelines on cancer survivorship and rehabilitation. MARS OBJECTIVES • • • • Improve patient and career experience. Facilitates patient choice. Reduce avoidable / inappropriate hospital admissions. Reduce post surgical treatment complications, e.g. chest infections/tube site infections. • Reduce oral and enteral nutritional supplementation through SALT/dietetic. • Proactive support for laryngectomy patients reducing emergency laryngectomy replacements and support self management of laryngectomy and stoma. Planning of MARS • • • • Discussions with local PCT’S Time line devised on clinical activity and need. Models of potential teams devised Support and funding obtained from Macmillan Cancer Support • Steering group commenced. • Discussions with commissioners. Head and Neck Cancer Diagnosis and Treatment at RSCH Feeding tube insertion Treatment Completed at RSCH (Surgery, Chemoradiation, Radiotherapy) Holistic Needs Assessment Final Multidisciplinary Clinic Clear scan and/or histology Referred to Local Hospital for Consultant and MARS team review Nutrition Nurse Dietitian Speech Therapist Care Support Worker Advice and on-going support/referral onto other services as required Referral back to acute MDT for patients with recurrence, further treatment, palliation NEW PATIENTS REFERRED FOR TREATMENT TO CANCER CENTRE (Surgery/Radiotherapy/Chemo-radiation /palliative care) RT/CRT Followed up at centre 3/12 Surgery @RSCH Palliative Care No further treatment – refer to MARS PORT/CRT Palliative Treatment @RSCH Disease recurrence –refer to MDT @RSCH On completion of palliative treatment refer to MARS / Local Palliative care services Benefits of MARS • More effective clinics at Cancer Centre. • Improved patient/carer experience. • Multi-disciplinary team approach for rehabilitation and cancer survivorship locally. • Reduced admissions for SVR emergencies. Reduce rate of feeding tube infections. • Reduction in the cost nutritional supplements in the community. CHALLENGES Funding Fixed term contracts Band 4 role Referral to MARS Clinic space Continuity/productivity of clinics in locality What would we do differently? • • • • • Team leader ? Avoid fixed term contracts Tariff based? Include nurses in team. Include admin role. THANK YOU Any Questions ?