Taking Stock of Durban: Review of Key Outcomes and the Road Ahead
Developing the NCSI 2012 document: taking action to improve outcomes
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Transcript of Developing the NCSI 2012 document: taking action to improve outcomes
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National Cancer Survivorship Initiative
Developing the NCSI 2012 document: taking action to improve outcomes
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National Cancer Survivorship Initiative
What I will cover
• Why now?
• Purpose
• Process
• Emerging thoughts
• What we need from you
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National Cancer Survivorship Initiative
Why now? (1)
• Cancer survivors needs are not being fully met
• Poor survivorship:– Damages outcomes (mortality, quality of life, patient
experience)– Costs money (preventable ill health, avoidable emergency
admissions more expensive treatment and care)
• We can’t do more of the same - from 1.7 million survivors now to 3 million in 2030...
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National Cancer Survivorship Initiative
Why now? (2)
• To date focus has been:– Researching – extent, needs, impact– Developing – communities of interest– Testing – new approaches– Evaluating – feasibility, effectiveness
• But not many patients have benefitted in the ‘real world’...
• Some interventions are ‘rollout ready’ - now we need to deliver better survivorship support at scale
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National Cancer Survivorship Initiative
Enga
gem
ent w
ith c
linic
ians
&
com
miss
ione
rs
2009 2015 Time
InvestigateInnovate
Implement
We are here
2012 should be a step change
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National Cancer Survivorship Initiative
If we go no further, we’ve failed
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National Cancer Survivorship Initiative
Turn promising examples into routine practice
Our challenge:
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National Cancer Survivorship Initiative
Moving on from uncertainty
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National Cancer Survivorship Initiative
Good survivorship will...
1 Help people live longer
2 Improve their quality of life
3 Support them in making a faster and fuller recovery from cancer
4 Enhance their experience of care
5 Protect them from avoidable harm
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National Cancer Survivorship Initiative
Developing the document
Next steps document
NDP workshops
NCSI workstreams
Feedback from patients Feedback
from clinicians
Pilots and test sites
Research NCSI Symposium
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National Cancer Survivorship Initiative
Testing our thinking
• NCSI project templates
• ‘Dragon’s Den’
• NDP workshops
• Macmillan clinical advisory board
• Today
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National Cancer Survivorship Initiative
Taking action
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National Cancer Survivorship Initiative
Treatment
Promoting recovery
Sustaining recovery
Managing consequences
of treatment
Active & recurrent disease
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National Cancer Survivorship Initiative
Support from point of diagnosis• Survivorship starts from the point of diagnosis – work discussions
start now
• Patient experience and quality of life are linked: taking action to improve one will benefit the other
• Critical role of CNSs / AHPs
• Peer Review?
• National Cancer Patient Experience Survey?
• Information prescriptions?
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National Cancer Survivorship Initiative
Promoting recovery• The package (assessment and care planning, treatment summary,
cancer care review and health and wellbeing clinics)
• Prehabilitation
• ‘Rehabilitation prescriptions’?
• Tariffs for phases of care? Best practice tariffs? CQUINs?
• Peer Review?
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National Cancer Survivorship Initiative
Sustaining recovery• If physical activity was a drug, its efficacy would mean it was
considered a ‘wonder drug’
• Follow-up: tailored and risk stratified
• Efficiencies in follow-up need to be matched by investments in other areas of the survivorship pathway – but whose responsibility is this?
• Cancer care review template?
• National Cancer Patient Experience Survey?
• Best practice tariff?
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National Cancer Survivorship Initiative
Managing the consequences of treatment• Most patients will need to manage some consequences of their
treatment
• The nature of consequences will vary – ‘the Maher classification’
• Failure to manage the consequences costs money and lives
• Breast Radiotherapy Injury Rehabilitation Service (BRIRS)
• READ codes
• CQUIN for use of PROMs
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National Cancer Survivorship Initiative
Managing the consequences of treatment – key principles• Prevent or minimise consequences where possible
• Inform patients of potential consequences when these are known and document these in treatment summaries
• Identify groups at increased risk of late effects (long term follow-up of patients in trials; recording through national datasets)
• Monitor at risk patients consistently
• Respond where a new risk is identified, utilising PROMs and health service datasets and informing patients
• Provide appropriate services for patients suffering from the consequences of treatment
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National Cancer Survivorship Initiative
Active and recurrent disease• Key principles for survivorship apply
• CNSs and palliative care really matter
• Addressing weaknesses in the intelligence is a priority
• What does the metastatic MDT look like?
• What are the true costs of active and recurrent disease?
• Which outcomes matter most to patients?
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National Cancer Survivorship Initiative
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National Cancer Survivorship Initiative
Your task
• Have we identified the right issues?
• How do we get the whole system to prioritise survivorship support?
• Will the levers work?
• What are we missing?
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National Cancer Survivorship Initiative
It’s as easy as x, y, z...
X% of providers implementing rollout ready interventions
Y% of patients being managed differently at the point of recovery
X% being managed remotely during follow-up