Download Cancer Survivorship Lung SSG

Cancer Survivorship: Transforming
how we deliver cancer care
Catherine Neck
Macmillan Cancer Rehabilitation/
Recovery Package Project Lead
The Current Picture
• 2 million people currently living with and
beyond cancer now in UK
• Predicted to reach 4 million by 2030
• More new patients and more living much
longer lives following a cancer diagnosis/
treatment
• Many patients are experiencing negative
consequences of treatment which may
continue for years post treatment
My Role
• Funded by Macmillan to assist clinical teams
to process map and redesign pathways of care
across ASW region
• Involves the introduction of the ‘Recovery
Package’ into the pathway
• Supports teams to adjust to new ways of
working that are better for the patient and
result in increased clinical capacity
• Reduces unnecessary waste in the system
The Recovery Package
The Recovery Package
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Risk stratification of patients
Holistic Needs Assessments
Health & Wellbeing advice
Treatment summaries
Remote Surveillance
Cancer Care reviews
Improve Information and Support at
the outset
• Prehabilitation – encourage patients to take
an active role in improving their outcomes at
the start
• Provide a clear pathway of care from the
outset. Manage patient expectations
• Provide early health & wellbeing advice
around consequences of treatment, physical
activity, nutrition, work & finance support,
emotional support
End of Treatment
• Holistic Needs Assessment including Care Plan
• Provide clear and comprehensive information
to the patient and GP – Treatment Summary
• Support the patient to self-manage by being
able to identify signs and symptoms of
recurrence and providing timely open access
support
• Identify and act on early negative
consequences of treatment/ late effects
‘Prehab’
• Support to increase physical activity levels and
optimise physical function from diagnosis
• Includes input from dietetics, smoking
cessation, work & finance support
• Fast track to existing pulmonary rehab
programmes – ideal model
• Pilot in Birmingham demonstrated positive
results
Birmingham results
• Reduced post-operative complication rates
from 18.7% to 11.4%
• Reduced length of stay from 7.2 days to 5.7
days
• Reduced intensive care admissions from 3.2%
to 2.9%
• Fewer readmissions from 16.1% to 5.7%
• Achieved per patient savings of £1257.42
Current Local Pilots
• UHB Upper GI, HPB and gynae-oncology
teams have begun pilots
• Using Macmillan Cancer Support Worker to
deliver home-based walking and exercise
programmes, plus offer wider holistic support
• Support from physiotherapy dept
Results
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Improved physical function at point of surgery
Reduced hospital LOS (average 6 days)
Reduced post-operative complications
Improved patient & carer experience
• Programme is cost-effective to deliver and
easily replicable across other cancer sites
Contact Details
If you and your team want support to process
map and look at pathway redesign, introduction
of the Recovery Package and prehab please
contact me on:
Email:
Phone:
[email protected]
07730 286356
Prehabilitation
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Smoking cessation
Nutrition
Patient education
Pulmonary rehabilitation
National perioperative outcomes of pulmonary
lobectomy for cancer: the influence of nutritional status
Thomas PA et al
Eur J Cardiothorac Surg 2014 Apr;45(4):652
Association of body mass index and outcomes after
major lung resection
Ferguson MK et al
Eur J Cardiothorac Surg 2014 Apr;45(4):e94-9
• If BMI < 18.5:
– Increased mortality (OR 1.89-2.96)
– Increased pulmonary complications
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12 high risk patients
VO2max <15
4 weeks pulmonary rehab
Improved VO2max of 2.8
with unchanged spirometry
and gas transfer
• No deaths, but long LOS and
significant post op
respiratory morbidity
EJCTS 2008
• 40 patients with COPD undergoing lobectomy
• 20 randomised to pre-op pulmonary rehab
• Cardiopulmonary exercise testing performed
Before intervention
After intervention
Post-op
Standard group
14.8
14.5
11.4
Pre-op pulmonary
rehab
14.9
17.8
15.1
VO2 max (ml/kg/min)
EJCTS 2013
• Outpatient-based pre-op intervention:
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Pulmonary rehab
Smoking cessation
Nutritional assessment
Patient education
• Improvement in pre-op FEV1 and 6MW
• Trend towards:
– reduced pulmonary complications
– Reduced re-admissions
EJCTS 2013