1. Colorectal Cancer Care Pathway and Rehabilitation Tessa Aston Macmillan Dietitian tessa.aston@nyypct.nhs.uk Patrick Sherlock, Marie Curie Physiotherapist Patrick.sherlock@mariecurie.org.uk

2. Key Issues Cancer Rehabilitation poorly developed (particularly in comparison to stroke or cardiac rehabilitation). Outcome of NECN Peer Review of Cancer Rehabilitation Measures – achieved 6% compliance Colorectal Cancer Rehabilitation pathway needs to be meaningfully integrated into the main Colorectal Cancer Care Pathway

3. AHP Mapping Exercise for NECN 2009 Many rehab services provided by AHPs working at level 2 or 3 without specific funding < 4.5 WTE Specialist Dietitians and < 7 WTE Specialist physiotherapists/ per million population in NECN with specific funding for Cancer patients (diagnosis to EOL care) No AHP is specifically funded for colorectal cancer and only one AHP is reported to attend a colorectal MDT (Gateshead)

4. National Developments 9 tumour specific, evidence based rehabilitation care pathways 10 symptom specific pathways of care with defined therapy intervention Published evidence base to support cancer rehabilitation www.ncat.nhs.uk

5. Care Pathways

6. Cancer Symptom Pathways Breathlessness Pain Lymphoedema Spinal Cord Compression Continence Fatigue Mobility and loss of Function Anorexia/cachexia, weight loss Dysphagia Communication Difficulties www.ncat.nhs.uk

7. Cancer Rehabilitation – referral to generic or specialist AHP Is the symptom of little concern or already self adapted? Is the symptom impacting on function or quality of life? Encourage self management & offer supportive written information NO YES Refer to Specialist Cancer AHP services who can offer expert advice, an integrated care plan and ongoing support for future potential problems Is the symptom likely to impact treatment options or become more debilitating over time? NO Refer to symptom care pathway & consider referral to generic AHP services for assessment and advice YE S NO

8. Barriers to referring to AHPs in NECN Number of HCPs involved – may be delays in referrals Assessment may not include consideration of rehabilitation need No access to AHPs in colorectal clinics generally HCPs not being aware of role of AHPs and what we can do i.e. not just about supply of equipment Limited time for AHP assessment/ intervention due to staffing availability

9. Local Developments Cancer Rehabilitation Patient Information Leaflet. Cancer Rehabilitation Services directory is being developed. Building relationships with Colorectal CNSs to raise awareness of AHP roles.

10. National AHP Workforce Model for Cancer Workforce tool developed with the National Centre for Workforce Intelligence Calculates number of WTE AHP Staff needed to provide care for a given number of patients Tool makes some assumptions

11. How can the Colorectal NSSG help? How can we build the NCAT Colorectal Care Rehabilitation Pathway into the NSSG agenda for engagement by organisations across localities? Consider prospective audit of referrals to AHPs within NECN to identify when patients are referred/ by whom (c.f. Lung audit)