Issues in systemic therapy

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					The Acute Oncology Project

       Mrs Jenny Almond
Project Lead for Acute Oncology
• Recent reports from NCEPOD and NCAG
  recommend reform in the way acute oncology is
  structured and managed
• Acute Oncology Team at each Trust with an
  Emergency Department
• CCO is leading local design of acute oncology
  service in collaboration with MCCN
         Project Management Structure
• An Acute Oncology Project Steering Group
  established with representation from MCCN

                        Vision 2020 Steering
  MCCN Clinical         Chair: Silas Nicholls
  Advisory Group
  Chair: Ged Corcoran

                        Acute Oncology
                        Project Steering
                        Chair: Jenny Almond
              Acute Oncology Issues
• High level bed occupancy in acute Trusts
• Acute oncology patients have complex medical
  needs and can be classified as:
  – Known cancer patients with complications of
  – Known cancer patients with complications of their disease
  – Patients with Unknown Primary disease (~5% of all
    cancer pts)
         NatCanSAT Data Analysis
• CCO & MCCN have jointly commissioned a
  detailed data analysis
• Led by Brian Cottier
• Understanding current and future ‘acute
  oncology’ workload
• Better understanding of emergency admissions

                                            NA T C A N S A T
                                        The National Cancer Services Analysis Team
  UKP Audit at St Helens & Knowsley
• Focus on early referral to oncologist
• Use of UKP pathway
  – Reduced time to diagnosis
  – Earlier planning and delivery of treatment
  – Reduced LOS from 22 to 11 days
• Similar results seen at Sherwood Forest
  Hospitals NHS Trust
       Aims of Acute Oncology Project
• Establish an Acute Oncology Team at each
  Trust with an ED (7 Trusts)
• This should lead to:
  – Faster and better care of patients with complications
    of chemotherapy
  – Faster and better care of patients with complications
    of cancer
  – Appropriate investigation of UKP patients

• Acute oncology requires collaboration between:
  – Oncology
  – Palliative care
  – Acute Medicine
  – ED
  – Haematology
       Acute Oncology Clinical Model
• Monday – Friday, 9-5 service
• Consultant Oncologist to provide one clinical
  session per day at each Trust
• Clinical Nurse Specialist support to level of 1
  FTE per Trust
• Secretarial support
• AOT Office
                 Acute Oncology

               Patient admitted via ED or AMU

Portfolio of         ‘Onco Alert’ to AOT
protocols /
pathways          Oncologist / CNS review

                Diagnostic & Treatment Plan
                 Out of hours advice

• Initial contact with CCO’s triage service
• Triage being redesigned to meet the needs of acute
• On-call oncologist available for telephone
        Acute Oncology -Peer review
NCAG has recommended:
• Establishment of an acute oncology service with
  appropriate professional involvement
• Numbers of patients presenting with cancer as
• Interval between admission and oncological
• Time to referral to appropriate specialist team
• Total length of stay for previously undiagnosed
  cancer patients
        Local Implementation Plan

• Subject to agreement by commissioners the
 service will be rolled out in 3 phases:
  – Two early implementer sites (2009/10)
  – Three further Trusts (2010/11)
  – Final two Trusts (2011/12)
         Acute Oncology Progress
• Draft case in need produced for review
• Discussions are underway with RLBUHT and
• Information will be cascaded at both Trusts by
  Cancer Lead
• Acute oncology meeting - April at RLH
• Plan to have an AOT at RLH in October 2009
      Acute Oncology Progress cont…
• Re-design of triage service commenced
 (Kim Barrow / Mike Varey)
• CCO Medical Director planning medical
• Develop CNS job descriptions / plans
Thank you for your attention
     Any questions?

    Further information: