Dr Hilary Williams. Consultant in Medical Oncology at Velindre Cancer Centre

Transcription

1 Dr Hilary Williams. Consultant in Medical Oncology at Velindre Cancer Centre

2 Thinking about Acute Oncology. Why do we need acute oncology locally? What the Hub VCC provides The Future

3 Where acute oncology began for me ~ (2000) Maggie s Centre Kirkcaldy opened 2006

4 Why do we need acute oncology locally? But doctor if I had been diagnosed earlier would any of this be different? - 3 -

5 NCIN briefing on colorectal cancer Feb KEY MESSAGES: Almost 10% of people diagnosed with colorectal cancer die within one month of diagnosis. 56% of people dying within one month are 80 or more years old. 60% of early deaths present initially as emergency cases to hospital. At least 50% of patients who die within one month receive no active treatment. Raising the level of public awareness of colorectal cancer and increasing early diagnosis may help to improve survival rates for colorectal cancer.

6 The data behind the patient stories 3 Sources ABHB activity figures Outcome of calls to 24 hour chemotherapy patient support line (Viv Cooper) Cancer Unknown Primary data for SE Wales (Dr Paul Shaw) - 5 -

7 10% of emergency admissions to ABHB have diagnosis of cancer e.g. ~ 6000 pts a year or 17 pts a day. 2010/2011 Admissions Emerg adm, primary diagnosis cancer Emerge adm, All cancer diagnosis Cancer All admissions % % % Total 10% of emergency pts have active cancer Thanks to Sarah Thatcher & Jayne Harding at ABHB

8 Length of stay by cancer site and admission Cancer site Royal Gwent Nevill Hall Total Avg LoS Total Avg los Lung Colorectal Upper GI Other GI Haematolo gy CUP Total Average LoS in ABHB 12.3 days 17% of patients LoS > 22 days

9 SE Wales Site of CUP Emergency Admissions General surgery Thoracic medicine Gastroenterology Geriatric medicine Endocrinology Gynaecology Cardiology General medicine Trauma and orthopaedics Urology Ear, nose and throat Infectious diseases Clinical haemotology

10 SE Wales Site of Colorectal Cancer Emergency Admissions General surgery Gastroenterology Geriatric medicine Endocrinology General medicine Thoracic medicine Gynaecology Cardiology Infectious diseases Urology Accident and emergency Clinical haemotology

11 What happens to patients admitted following call to Chemotherapy pager? Audit of all calls to emergency chemotherapy support pager. April patients were admitted following a call Around 50% admitted outside Cancer Centre (VCC) ~ 200 patients a year admitted to ABHB with acute complication of chemotherapy Length of stay available on 37 patients admitted to RGH Average LoS of 6-7 days, range 1-20 days (Nb- other patients admitted directly & aim for 50% of chemotherapy to be given outside VCC. )

12 Audit of CUP in SE Wales Cancer Network (Dr Paul Shaw) Reviewed management of CUP patients referred to VCC over 12 months 166 patients identified Median age 68 Patients on average received a total of: 19 investigations for metastatic carcinoma unknown primary, liver 13 investigations for metastatic carcinoma unknown primary, bone In addition Data from PEDW (Patient Episode Data Wales) 944 admissions in 2009 Length of stay (average) 9 days

13 10% of emergency admissions to ABHB have diagnosis of active cancer ~ 6000 pts a year or 17 pts a day with active cancer Acute care takes 25% of NHS cancer spend 10-15% of all acute beds used for cancer care Can we afford not to invest in AOS? Anecdotally patient experience variable

14 So how do we do it? Hub and spoke model

15 What is VCC providing & how is this developing?

16 Acute Complications of Cancer - What the Medical Team Needs To Know Hilary Williams Consultant Oncology at Velindre Cancer Centre

17 Thinking about shape acute oncology in AB Health Board. Patient focused care Appropriate rapid decision making Benefit- Patient Direct Clinical Role Support management complications of treatment Rapid focused pathway cancer unknown primary Predict 5 patients admitted every 24 hours to ABH with known or likely cancer Benefit- cost Reduced length stay Reduced investigations Reduced admissions Mon-Fri Service at RGH & NHH Link with Visiting Consultants Costs Admin Office & Clinic space IT 2 Specialist nurse per hospital Rapid liaison VCC & rapid access clinics Engage Palliative care Radiology Current pathways Education Admitting & A & E teams Protocols e. g. Unknown primary Spinal Cord Compression Education junior doctor teams - - Developmental Role

18 In more detail Key roles of CNS Review all admissions acute complications chemotherapy New presentation metatastic disease MSCC co-ordinator Education Challenges Establish key links with Chemo day unit Local palliative care VCC hub Link visiting consultants Link with established service s Link with community Establishing outcomes s Out of hours service Engagement Management Review CONFIDENTIAL

19 South East Wales Cancer Network CUP Pathway ( Pall care/oncology Review need for investigations/biopsy Refer to site specific cancer MDT Yes Patient with suspected Metastatic Malignancy of undefined Primary on imaging or pathology PS3/4 or Unsuitable for cancer specific Rx? No Liase with site specific oncologist to consider special diagnostic tests (B) & biopsy Yes Likely primary tumour identified? Uncertain Patient with specific CUP syndromes No Patient with confirmed CUP Refer Non-epithelialmalignancies to site specific MDT/oncologist Lymphoma Haematology team Melanoma Dr Kumar Sarcoma Dr Tilsley Tel AEB sec and patient allocated next available Oncology OPC with appropriate consultant Squamous carcinoma involving upper/mid head and neck nodes Adenocarcinoma involving axillary nodes Squamous carcinoma involving inguinal nodes Solitarymetastasis (brain, bone, skin, lung, liver) Radical treatment possibility Dr M Evans/ Dr N Paniapan Sec Head and Neck Poorly differentiated carcinoma with a midline nodal distribution Dr M Button/ Dr J Lester Sec Urology Dr S Waters/ Dr H Passant Sec (Daphe) Breast Female with predominant peritoneal adenocarcinoma Dr E Hudson/ Dr R Jones Sec (Name) Gynaecology Dr E Hudson/ Dr R Jones Sec (Name) Gynaecology Poorly differentiated neuroendocrine tumour Dr H Williams Sec Gastrointestinal Dr O Tilsley (BRAIN/BONE) Sec Dr A Brewster (LUNG) or Lung MDT/Lung physcians Sec Dr H Williams (LIVER) or HPB MDT Sec Dr S Kumar (SKIN) & skin MDT Sec

20 With acute oncology service in place future opportunities Earlier cancer diagnosis metastati c disease & improved one year survivals And measure it all

21 And if you don t remember anything else 10% of emergency admissions to ABHB have diagnosis of active cancer ~ 6000 pts a year or 17 pts a day with active cancer Acute care takes 25% of NHS cancer spend 10-15% of all acute beds used for cancer care Can we afford not to invest in AOS? Anecdotally patient experience variable