Lung Cancer and Rehabilitation

Transcription

1 Lung Cancer and Rehabilitation Report to Lung NSSG Sally Donaghey Macmillan AHP Lead, Ang CN

2 Lung Cancer and Rehabilitation Evidence based Rehabilitation Care Pathway local version agreed by NSSG 2010 Optimise treatment (pulmonary rehabilitation pre and post surgery) QoL, ADL, physical, social, psychological and functional support (multi-professional breathlessness clinics) Cost-effectiveness/benefits realisation reduce hospital stays, prevent re-admission, care closer to home.

3 Issues and Initiatives in Rehabilitation Cancer rehabilitation nationally is poorly developed, evidenced and under recognised/utilised. Publication of National Cancer Rehabilitation pathways and evidence guide. Development of tumour specific local rehabilitation pathways Need for pathways to be integrated into main care/referral pathways and practice Guidance/Protocols at trusts as per pathway Services directory links to local pathway Audits Patient/User experiences National Workforce Model Anticipatory

4 Complications in Lung Cancer Patients Breathlessness Fatigue Pain Weakness Reduced mobility/movement Weight Loss/Anorexia/Cachexia Nausea and vomiting Loss of appetite Dysphagia Anxiety Functional impairment/adl Equipment needs

5 Workforce Mapping

6 Workforce Mapping cont..

7 Findings Relatively low numbers of AHP s for population against national average 20% below national ave Unmet need or Need provided by generalist workforce? Variablity in specialist service provision between localities Consider referral pathways Setting - 53% Acute figures indicate slightly higher then national average cancer rehab services in community Care closer to home?

8 Workforce Modelling Lung ANG CN Incidence 2008 = 1686 Physiotherapists FTE Total 35.4 Occupational Therapists FTE Total 25.1 Dietitians FTE Total 13.4 Speech and Language Therapists FTE Total 2.2 Lymphoedema Therapists FTE Total 0.9 FTE FTE by professional group, showing break down by pathway stages Pal & EoL Survivorship Treatment Diagnosis Pre Diagnosis 5 0 Diet Lymph OT Physio SaLT

9 Rehabilitation Triggers

10 Barriers AHP attendance at MDT/clinics Assessment tool for rehabilitation Awareness of rehabilitation needs Co-ordination of rehabilitation needs Commissioning of rehabilitation Network Guidelines treatment/diagnostic focus Lack of resources

11 What Can the NSSG Do? NSSG Workplan Lung Care Pathway and clinical guidelines specific reference to rehabilitation Locality/clinician engagement Rehabilitation awareness Audit of referrals/interventions/patient surveys

12 Something that may help ROC West Midlands Initiative Aimed at Post-surgical pulmonary complications (PPC) Baseline PPC is 15% following major resection PPC mortality increasing from 0.5 to 12% PPC ITU admissions increase from 1.5 to 26% PPC LoS increasing from 5 to 14 days Independent risk factors for PPC: Post op mobility Nutritional status COPD Smoking The solution = rehabilitation programme to modify risk factors

13 ROC Pre-hab Programme 4 elements: Smoking cessation Nutritional intervention Patient self-management and education Pulmonary rehab/exercise programme Pt identified at MDT Rehab assessment at first clinic Programme commences pre-op and post op. Pt status optimised for surgery, and supported in recovery

14 ROC Primary Outcomes Measures 6 th May ST December 2011 Intervention (n=58) Non-Intervention (n=305) PPC Rate 9% 16% Unplanned ITU admission rate Unplanned ITU admission median LOS 3% 3% 2 days 3 days HDU median LOS 1 days 2 days Hospital LOS 5 days 5 days Readmission rate 5% 14%

15 Cost Savings Economics: Cash releasing to PCT s HDU/ITU admission, LoS and readmission New service cost (Pulmonary rehab) = per patient Total cost saving per patient (includes new service costs) = With thanks to Amy Bradley, Heart of England NHS Foundation Trust.

16 Useful Links National Lung Rehabilitation Pathway: Local Lung Rehabilitation Pathway: PS21_v2.pdf NCAT. Supporting and Improving Commissioning of Cancer Rehabilitation Services Guidelines: NCAT. Cancer Rehabilitation Services Evidence Review: NICE Clinical Guideline 121: NICE Supportive and Palliative Care IOG 2006: ROC Amy Bradley

17 Survivorship Report to Lung SSG

18 What is survivorship? It s not new 2004 Supportive and Palliative Care IOG: Holistic needs assessment and care plans Cancer Reform Strategy- living with and beyond cancer Vision document and Survivorship Initiative launched in 2010 by DoH & Macmillan. Supported by NHS Improvements and NCAT. It s not difficult Needs assessments Care Plans Communication treatment summaries It s not avoidable:

19 Survivorship Context Increasing incidence of cancer Improved survival from cancer 2 million people in UK living with and beyond cancer; over 3 million by 2030 Anglia 14,500 new cases per year; 100,000 survivors now Anglia Lung 1300 incidence p.a Patient needs in survivorship Health and social care capacity and resources Cancer as a long term condition Effectiveness of follow-up appointments?value for patient and professional. Detection of recurrence outside follow-up Cancer as a purely acute illness/medical model.

20 Cancer as a LTC Long Term Conditions Compendium DoH 2008

21 Survivorship Aim = those living with and beyond cancer receive the care support they need to lead as healthy and active a life as possible. National work via pilot sites to test survivorship work streams across breast, prostate, colorectal, lung Consideration of PROMS rather than clinical activity Analysis of use of health/social care services by cancer pts in comparison with general population/other conditions. Promotion of self-management with rapid re-access as required. New report due December 2012

22 NCSI 2012: Support through primary treatment from point of diagnosis Promoting recovery Sustaining recovery Reducing the burden of consequences of treatment Supporting patients with active and advanced disease interfacing with end of life care services

23 Survivorship Work streams: Assessment, care planning and immediate post treatment care Managing active and advanced disease Consequences of cancer and its treatment Survivors of CYA Self management Work and finance Research Commissioning, workforce and information

24 Pilot site and roll out Ipswich = Anglia pilot site 3 tumour groups: breast, urology, colorectal Main areas of work: holistic needs assessment care plans treatment summaries risk stratified follow-up/remote surveillance Cancer care review by GP 6/12 follow-up self management/information days evaluation of benefits/costs Support from Cancer Network to identify gaps and support changes in practice to deliver on the strategy across region. Outcomes = Patient satisfaction and QoL, reduced followup/unplanned admissions, savings to health economy, improved self-management, QIPP agenda.

25 Risk Stratified Model of Care

26 Lung Pilot Sites Hull and East Yorkshire Hospitals NHS Trust Brighton and Sussex University Hospitals NHS Trust Tested degree to which risk stratified pathways could be applied in lung cancer Proactive rather than reactive approach

27 Brighton Health and Well Being Clinic anorexia, weight loss, breathlessness, fatigue and financial issues Pre-clinic telephone assessment for pts not on active treatment 6-8% reduction in unplanned admissions 25% reduction in bed days 20-25% of clinic appts cancelled and rescheduled as result of telephone assessment 18% of appointment arranged at patient/hcp request avoiding emergency admission

28 Hull Flexible approach to appointments added or removed as patient needs changed Criteria developed to support transfer of immediate care responsibility to community teams Nurse-led end of tx review clinics established, building on needs assessment carried out at diagnosis 33% of pts seen in nurse-led clinic met criteria for discharge to community team care Clinic timed at 4-6 weeks post tx 6-8% reduction in unplanned admissions 34 fewer admissions over eight month period 2011 in comparison with 2010

29 Stratified Pathway of Care - Lung

30 What Can the NSSG Do? Clinician/health professional engagement Service review Commissioning Access opportunities for support and information from pilot sites and Network

31 Useful Links /survivorship/lung_pathway.pdf /NCSI_posters_2012.pdf