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Living with and beyond treatment
for cancer – the challenge for
secondary care
Nigel Acheson
Medical Director
Peninsula Cancer Network
Health service quality can be defined
as provision of care that exceeds
patient expectations and achieves the
highest possible clinical outcomes
with the resources available
Does improving quality save money?
Ovreveit J 2009
5 year prevalence
The number of patients estimated to have
been living with a specified cancer which
had been diagnosed between 2004 and
2009
• England figure
• Those diagnosed whilst resident in the
Peninsula Cancer Network
South West Cancer Register and National Cancer Data Repository 2008
South West Cancer Register and National Cancer Data Repository 2008
Complete prevalence
The number of patients estimated to have
been living with a specified cancer which had
been diagnosed from the earliest diagnosis
year recorded on the South West Cancer
Register started, up to the end of 2009.
• England figures
• Those diagnosed in the Peninsula Cancer
Network
South West Cancer Register and National Cancer Data Repository 2008
South West Cancer Register and National Cancer Data Repository 2008
Breast, prostate colorectal cancer
Key reason for follow up focused on
medical needs:
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Detect recurrence
Manage early complications
Manage late effects
Wide variation including:
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No follow up with rapid access
Lifelong follow up +/- surveillance tests
Variation from tumour site to tumour site,
and within tumour sites
Most patients seen in outpatient clinics
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Differences in frequency of visits
Usually time limited to 5 years, and then
patients need to be referred by GP if
necessary
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Key workers
Care plans
Rehabilitation
Patient support
Conclusion
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Need to review practice against current
best evidence to improve quality and
outcomes
Assessment of needs and care plans – an
area that must be considered in order to
ensure patients have informed choice
Challenge 3 – secondary care
approach to elements of
survivorship
Prevention
Surveillance
Intervention
Co-ordination
=>Plan where and by whom the various
elements should be undertaken
Prevention
Late effects of treatment
Recurrence of cancer
New cancers
Surveillance
Progression of disease
Recurrence
New cancers
Assessment of late effects
Medical
Psychosocial
Intervention
Symptom control eg pain
Effects of treatment eg lymphoedema
Psychological support eg sexual dysfunction
Social and economic
Coordination
Between specialists, primary care, allied health
professionals, social support, employers
This will involve:
 Care planning
 Multidisciplinary risk stratification
 Working with stakeholders to ensure that
resources to meet assessed needs are in place
“5 shifts”
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Focus on recovery, health and well-being
after cancer treatment
Assessment, information provision and
personalised care planning
Self-management
Shift from a single model of clinical follow
up to tailored support
Emphasis on measuring experience and
outcomes
“The NCSI vision is that…assessment covers
the full range of needs of individuals,
including physical and lifestyle needs, social,
financial advice and occupational support
needs, psychological wellbeing and spiritual
needs”
Challenge 4 – review available
models and evaluate locally
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Identify models to evaluate
Identify partners and stakeholders in
providing care
Plan integrated care
What do patients want?
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Macmillan event 2008 (200 patients)
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Good quality information
Rapid access to specialist care as needed
A care plan agreed by all those providing care and
owned by the patient
Peninsula Cancer Network Patient and Carer
Working Group

to ensure that effective patient, carer and public
involvement is at the heart of cancer service design
and delivery across the Peninsula.
Challenge 5 – work with patients
and partner organisations to
implement successful models of
care
Summary of the challenges for
secondary care
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3.
4.
5.
understanding the concept
assessing the current situation
who provides elements of survivorship
and where
review available models and evaluate
locally
work with patients and partner
organisations to implement successful
models of care