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Consequences of cancer treatments Karen Morgan Macmillan Consultant Radiographer Jan 13 th 2015.

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Presentation on theme: "Consequences of cancer treatments Karen Morgan Macmillan Consultant Radiographer Jan 13 th 2015."— Presentation transcript:

1 Consequences of cancer treatments Karen Morgan Macmillan Consultant Radiographer Jan 13 th 2015

2 Background - UK / year Macmillan facts and figures – ▫2 million are living with consequences of cancer treatment ▫Estimated 500,000 people living with more than one problem ▫Physical and emotional ▫Cancer survivors estimated to rise to 4 million in next 20 years (Source - Throwing light on the consequences of cancer and its treatment, Macmillan Cancer Support 2013)

3 Of those two million people % say they are unaware of long-term side effects. 78% have experienced physical health problems in the last 12 months. 40% with emotional problems have not sought help. 71% of those who finished treatment 10 years ago have experienced physical health problems in the last 12 months (Source - Throwing light on the consequences of cancer and its treatment, Macmillan Cancer Support 2013)

4 Healthcare system facing financial pressure Innovation and reform Redesign of services – quality, value for money ▫Pressure from follow up appointments (1160 / month) ▫Consequences of cancer treatment ▫Not good at picking up LE in FU In addition….

5 NCSI Vision Document (2010) “...current follow-up arrangements do not address the full range of physical, psychological, social, spiritual, financial and information needs that cancer survivors may have following their treatment.”

6 Quality of Life (Radiotherapy) Acute toxicities Occur in tissues with rapid cell turnover,(eg mucous membranes) Acute inflammatory response Peaks at 2-3 weeks Usually short lived, resolve within 3 months Patients recover, but often need supportive therapeutic and pharmacological strategies

7 Quality of Life (Radiotherapy) Late effects Can develop from 6 months to many years later Often progressive Usually permanent Often multi-factoral Multi-modality treatments increase risk ! concurrent chemorad = risk of peripheral neuropathy / renal damage etc

8 Pre-exisiting injury – smoking, Diabetes Pre-disposition (to late effects development) – inflammatory bowel disease, MS, genetic mutation (eg P53)

9 Isolation / loss of confidence Employment issues / benefit burden Memory / concentration problems Impact on families, social network Body image issues Not knowing who to approach for help Sexual relationships Additional co- morbidities associated with age Physical symptoms Emotional issues Embarrassment / difficulty coping

10 ‘ How was I? On a good day uncomfortable, using pads, and planning carefully every time I went out of the house. On a bad day, I’d rather not eat than embarrass myself in front of family and friends and I sleep in a separate room now.’ Patient with lower GI symptoms

11 Main issues (1) Historical legacy – patient treated elsewhere SW – Age profile – LE combined with other co-morbidities Little information on the scale of the problem! Symptoms managed poorly, no guidance ! Unnecessary investigations / ineffective treatments Impact on NHS resources Who takes responsibility ?

12 Main issues (2) * LE services – few specialist services over large geographical area. * Some services regionally (referrals, funding, travel) * LE services traditionally associated with paediatric oncology * NCSI recovery package (approach is not standardised)

13 Pandora’s box Newer treatment techniques IMRT / VMAT / SABR/IGRT New chemotherapy drugs Survival rates = Consequences ?

14 Tiered model of care at The Beacon During treatment - Information and resources HNA assessment Radar key / toilet card Tailored discussions re side effects At the end of treatment - HNA and Treatment Summary Include potential future consequences How to minimise / monitor Healthy choices Primary care management ?H + WB clinic Problems that have not settled, or develop 6 or more months after LATE EFFECTS SERVICES + THOSE ‘IN EVOLUTION’

15 Late effects services Nationally –  Pelvic Radiation Disease Clinic – Royal Marsden  2.5 hours by train and tube !!!!  Hyperbaric Oxygen – Plymouth, Merseyside  60 treatments is usual, no NICE approval  Virtual MDT – complex cases, online password protected platform. 7 day process

16 Regionally – Fatigue and Life Style Management for Cancer Survivors – Step Up Service, Bath Breast Radiation Injury Service, Bath (Manchester and London no longer taking referrals) Emotional wellbeing, comp therapies (Penny Brohn Cancer Care – Bristol and Talking therapies (Somerset Partnership) – CBT, psychological support Others? – adult LE clinics associated with childhood cancers, ProActive (GP exercise referral), CAB Late effects services

17 Locally - Gastroenterologist (interest in PRD) Endocrinologist Local therapists – (SLT, dietician, physio, lymphoedema) ED clinic Pain clinic Women’s health Nurse Counsellors Late effects services

18 Where are we now? New guidance for LE symptoms, other sites to follow – implementation? Succinct algorithms for ease ? Education for primary care / self development (RMH e module) Assessment / screening tools / PROMS vital ! Tiered model of care Utilisation of services and resources Referral pathways? CCG / Regional Survivorship groups

19 * Prevention to minimise wherever possible * Inform patients of potential LE * Identify those at risk * Assessment – HNA address unmet needs * Support patients through local and regional LE pathways * Patients gain independence / return to work * Prevents unnecessary hospital admissions / GP consultations * Saves NHS money! Making a difference !

20 For every £1 spent on lymphoedema treatments, the service estimates the NHS saves £100 in reduced hospital admissions. If just half of breast cancer survivors who initially return to work but then leave were helped to stay in work, the economy could save £30M every year. Reference: NHS London (2012) Allied Health Professional QIPP pathway for cancer Golden nuggets !

21 Karen Morgan, Macmillan Consultant Radiographer (Late Effects), c/o The Radiotherapy Dept, The Beacon Centre, Taunton, TA1 5DA. Telephone Further information or direct referrals


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