1. Di Riley Associate Director, Clinical Outcomes NCIN
Commissioning Patient Centered Care & Improving Outcomes for People with Cancer
Di Riley
Associate Director, Clinical Outcomes
NCIN

2. To cover: Improving Outcomes Long Term Conditions in Cancer
Commissioning Patient Centred Services
When commissioning need to understand the situation you are dealing with. Nos & types of cases, pathways, conflicting priorities, etc.
Cancer changed from an acute to a chronic condition as survival improves & more people are living with cancer

3. National Cancer Intelligence Network?
What are Outcomes
Clinical v Patient
Survival Quality of Life
Stage of disease Return to normality
Co-morbidity
Treatment
Toxicity & side effects
Role of
National Cancer Intelligence Network?

4. NCIN Goal
Goal for NCIN: To develop the best cancer information service of any large country in the world
Why?
To provide feedback on performance to clinical teams
To promote stronger commissioning
To provide informed choice for patients
To provide a unique opportunity for health services research
i.e. To improve outcomes
Build on current strengths of cancer registry system
PCTs mandated for collection of defined datasets
Collected via MDTs and sent to cancer registries

5. NCIS Example: Trends in one year cancer survival, breast cancer, females, England, (five-year moving average)
NCIN Publications
Cancer Incidence by Ethnicity **June 2009**
Cancer Incidence by Deprivation, England, **NEW**
Cancer Prevalence (undertaken by Thames Cancer Registry)
Cancer Incidence and Mortality by Cancer Network, UK, 2005
1 Year Survival Trends (incl. 1 year Survival by Cancer Network), Eng,

6. Improving Outcomes Public awareness Stage at diagnosis Co-morbidities
at & after diagnosis
Children and Young Peole
‘Outcomes Measures’
clinical
patient reported
International Benchmarking

7. Long Term Conditions:
A condition that cannot at present be cured, but can be controlled by medication and other therapies e.g. Diabetes Heart Disease Chronic obstructive pulmonary disease Over 15.4 million people in England with a LTC (~30%)

8. UK Population
Between 1983 & 2008 % >65 and over, inc. from 15% to16%, an increase of 1.5 m people.
By 2033, 23% of population will be >65 years of age
nos people with a LTC will increase due to increasingly ageing population & unhealthy lifestyles
By 2033, only 18% will be <16 years
Population by age, UK, 1983, 2008 and 2033, ONS
In 2008, median ages
Women 40 years
Men 38 years

9. Population aged 65+ years

10. Cancer Incidence
Since 1977, incidence rate for cancer has increased in Great Britain, by 25%
14% increase in men
32% increase in women

11. Since 1977, incidence rate for cancer has increased in Great Britain, by 25%
14% increase in men
32% increase in women

12. Lung Cancer Incidence
The lung cancer incidence rate is set to continue falling. Between 1975 and 2024 the lung cancer rate is projected to drop by more than one-third
Lung cancer incidence increases with age and because we expect a higher number of older people in the UK population in the future, the numbers of lung cancer cases are set to increase even though the age-specific incidence rates are expected to drop.

13. Prostate Cancer Survival
Beware PSA testing
5 year relative survival rates
Increased by an average of 12%
every 5 years between 1986 & 1999
42% to 65%

14. Breast Cancer Survival
For women diagnosed with breast cancer in (England)
5-year relative survival rates - 82%
compared with only 52% thirty years earlier in
CR-UK

15. Incidence and Mortality

16. UK Cancer Prevalence Breast (female) 550,000 Large bowel 250,000
UK 2008 estimates
(based on diagnoses applied to 2008 population; Thames Cancer Registry, 2008)
Breast (female)
550,000
Large bowel
250,000
Prostate
215,000
Lung
65,000
Other
920,000
All cancers
2,000,000

17. So.....the implications! Ageing population
Increasing presence of long term conditions
Increasing risk of cancer
Increasing cancer incidence
Increased survival
Reductions in mortality
More living with cancer
So, more people with LTC will also have cancer
What about treatment effects?

18. Treatment Effects Treatment Long-term side effects Late side effects
Chemotherapy
Fatigue Menopausal symptoms Neuropathy Heart failure Kidney failure Infertility Liver problems
Cataracts Infertility Liver problems Lung disease Osteoporosis Reduced lung capacity Second primary cancers
Radiotherapy
Fatigue Skin sensitivity
Cataracts Cavities and tooth decay Heart problems Hypothyroidism Infertility Lung disease Intestinal problems Memory problems Second primary cancers
Surgery
Scars / Chronic pain
Lymphoedema
Long term side effects – side effects that start during Rx & linger for months/years, but most lessen or resolve with time
Late effects of cancer treatment – apparent after Rx has ended – few months or years after

19. Commissioning considerations
Long term conditions
(Ageing population)
Inc. cancer incidence
Increasing survival
Increasing prevalence
Late effects
Long term effects/conditions
What drives Commissioning – cancer or condition?

20. Patient Centred Commissioning
Strong cancer commissioning is vital to ensure:
high quality services are delivered
reflect needs of local populations
reflect national priorities
cost effective
Responsibility for the implementation of most of this strategy will rest with Primary Care Trust (PCT) Boards as the statutory bodies responsible for commissioning the full range of services for their population within their allocated budgets.

21. Commissioning is Complex?
Many types of cancer
Many different care pathways
Clinical teams in the community, DGHs and specialist centres.
Some aspects require highly specialised commissioning at a national or SHA level.
Other aspects overlap with non-cancer services (diagnostics & ?LTC) and commissioned at a more local level.

22. An example? A known cancer patient visits GP with breathlessness
Refer back to oncology team?
Refer to a cardiologist?
Refer to a respiratory physician?
Commissioners view:
Commission patient pathways
Underlying cause identified and treated
Establish a ‘MDT breathlessness clinic’
Cancer MDT involved

23. The Cancer Commissioning Toolkit (CCT)
Is a web tool – can access from anywhere
You will be given passwords – Richard to discuss
This is what you will see when you arrive - 23

24. Programme Budgeting

25. Sets out the key issues and questions for commissioners for:
Cancer Commissioning Guidance was launched in January 2009 as a ‘sister’ product to the CCT
Sets out the key issues and questions for commissioners for:
Assessing health needs
Reviewing services
Monitoring performance
Service specifications
Easy to use format
Interactive
Quick links

26. Each section of the Cancer Commissioning Guidance contains Key Questions for commissioners – and where to find the answers

27. Patient Centred Care Late Effects Long Term Conditions
Long Term Effects
Holistic Needs
Pat. Reported Outcomes
Rehabilitation Services
Survivorship

28. Commissioning considerations
Long term conditions
(Ageing population)
Inc. cancer incidence
Increasing survival
Increasing prevalence
Late effects
Long term effects/conditions
What drives Commissioning – Patient Pathways?

29. Any Questions? www.ncin.org.uk