1 Di Riley Associate Director, Clinical Outcomes NCIN Commissioning Patient Centered Care & Improving Outcomes for People with CancerDi RileyAssociate Director, Clinical OutcomesNCIN
2 To cover: Improving Outcomes Long Term Conditions in Cancer Commissioning Patient Centred ServicesWhen 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 OutcomesClinical v PatientSurvival Quality of LifeStage of disease Return to normalityCo-morbidityTreatmentToxicity & side effectsRole ofNational Cancer Intelligence Network?
4 NCIN GoalGoal for NCIN: To develop the best cancer information service of any large country in the worldWhy?To provide feedback on performance to clinical teamsTo promote stronger commissioningTo provide informed choice for patientsTo provide a unique opportunity for health services researchi.e. To improve outcomesBuild on current strengths of cancer registry systemPCTs mandated for collection of defined datasetsCollected 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 PublicationsCancer 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, 20051 Year Survival Trends (incl. 1 year Survival by Cancer Network), Eng,
6 Improving Outcomes Public awareness Stage at diagnosis Co-morbidities at & after diagnosisChildren and Young Peole‘Outcomes Measures’clinicalpatient reportedInternational 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 PopulationBetween 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 agenos people with a LTC will increase due to increasingly ageing population & unhealthy lifestylesBy 2033, only 18% will be <16 yearsPopulation by age, UK, 1983, 2008 and 2033, ONSIn 2008, median agesWomen 40 yearsMen 38 years
10 Cancer IncidenceSince 1977, incidence rate for cancer has increased in Great Britain, by 25%14% increase in men32% increase in women
11 Since 1977, incidence rate for cancer has increased in Great Britain, by 25% 14% increase in men32% increase in women
12 Lung Cancer IncidenceThe 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-thirdLung 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 testing5 year relative survival ratesIncreased by an average of 12%every 5 years between 1986 & 199942% 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 inCR-UK
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)550,000Large bowel250,000Prostate215,000Lung65,000Other920,000All cancers2,000,000
17 So.....the implications! Ageing population Increasing presence of long term conditionsIncreasing risk of cancerIncreasing cancer incidenceIncreased survivalReductions in mortalityMore living with cancerSo, more people with LTC will also have cancerWhat about treatment effects?
18 Treatment Effects Treatment Long-term side effects Late side effects ChemotherapyFatigue Menopausal symptoms Neuropathy Heart failure Kidney failure Infertility Liver problemsCataracts Infertility Liver problems Lung disease Osteoporosis Reduced lung capacity Second primary cancersRadiotherapyFatigue Skin sensitivityCataracts Cavities and tooth decay Heart problems Hypothyroidism Infertility Lung disease Intestinal problems Memory problems Second primary cancersSurgeryScars / Chronic painLymphoedemaLong term side effects – side effects that start during Rx & linger for months/years, but most lessen or resolve with timeLate effects of cancer treatment – apparent after Rx has ended – few months or years after
19 Commissioning considerations Long term conditions(Ageing population)Inc. cancer incidenceIncreasing survivalIncreasing prevalenceLate effectsLong term effects/conditionsWhat drives Commissioning – cancer or condition?
20 Patient Centred Commissioning Strong cancer commissioning is vital to ensure:high quality services are deliveredreflect needs of local populationsreflect national prioritiescost effectiveResponsibility 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 cancerMany different care pathwaysClinical 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 pathwaysUnderlying cause identified and treatedEstablish a ‘MDT breathlessness clinic’Cancer MDT involved
23 The Cancer Commissioning Toolkit (CCT) Is a web tool – can access from anywhereYou will be given passwords – Richard to discussThis is what you will see when you arrive -23
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 CCTSets out the key issues and questions for commissioners for:Assessing health needsReviewing servicesMonitoring performanceService specificationsEasy to use formatInteractiveQuick 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 EffectsHolistic NeedsPat. Reported OutcomesRehabilitation ServicesSurvivorship
28 Commissioning considerations Long term conditions(Ageing population)Inc. cancer incidenceIncreasing survivalIncreasing prevalenceLate effectsLong term effects/conditionsWhat drives Commissioning – Patient Pathways?