1. Acute Oncology Service (AOS) Monday – Friday 8am – 4pm Bleep: 946 T: 020 8401 3000 x5726 F: 020 8401 3513 Dr Nicola Beech Dr Jillian Noble Dr Susannah Stanway Miss Robyn Jenkins Advanced Nurse Practitioner (AOS Lead) Consultant Oncologist AOS Administrator

2. Croydon Healthcare Services Population of 346,000 65 years and over (13.8%) 85 years and over (1.9%) 61 GP practices Croydon University Hospital 572 beds Member London Cancer Alliance

3. Disease sites Lung Upper GI Lower GI Breast Gynaecology Urology Skin Haematology Diagnostics Cancer MDM Treatment Palliative care Cancer MDM

4. 2013JANFEBMARAPRMAYJUNJULYAUGSEPOCTNOVDECTOTALS Number of referrals 464567645738534866334166624 Known primary site263444434028252834282243395 Suspected20112321171028203251923229 Known Cancer Centre 263336 3220212430241741340 RMH232732262819 202861433275 OTHER3641041242183865 AOS referrals

5. GP referrals 61 GP practices 6786 urgent referrals suspected cancer (2012/ 2013) Conversion rate 9.82 (4 th highest LCA) 1678 new cancer registrations (2011)

7. MUO CNS To provide support and information to patient To improve coordination of diagnostic pathway To speed time to diagnosis Source of expertise for GPs and colleagues

8. Consultant Oncologist Job plan Started in the Trust in November 2012 Joined in December 2012 by Dr Jill Noble Work between RMH (Breast Unit) and CUH (Acute Oncology Service and Breast Unit) RMH employed- similar consultant posts at Kingston Hospital and Epsom and St Helier

9. What we can offer Cancer expertise – Diagnostics – Treatment complications – Disease complications Liaison with Cancer Center where necessary

10. Job plan MondayTuesdayWednesdayThursdayFriday Acute Oncology CUP MDT Acute OncologyBreast Clinic RMH Breast Research Meeting Acute Oncology RMH Breast Academic meeting Acute Oncology SPABreast Clinic RMH Breast MDT CUH/RMH Breast Clinic CUH/SPA RMH SPA

11. Our aims Earlier diagnosis Correct management quicker Shorter inpatient stays Ambulatory pathways Closer to home Referral to cancer center where necessary Referral to palliative care where appropriate IMPROVED PATIENT EXPERIENCE Education Patient Staff-hospital and community Research CADIAS

12. Case Study 1 55 year old lady History of breast cancer Presents with nausea and vomiting Results: Calcium level is elevated at 3 Imaging show she has new bone and liver metastases (secondary breast cancer)

13. Treatment: IV fluids and bisphosphonates Biopsy to confirm metastatic cancer Referral to RMH for ongoing outpatient management

14. Case Study 2 70 year old man Admitted with a cough and a swollen face Results: CXR - widened mediastinum CT - lung mass, enlarged lymph nodes obstructing superior vena cava

15. Treatment High dose steroids to reduce swelling Referred to respiratory for stenting Discussion at CUH MDT (video-linked to RMH) Offered radiotherapy

16. Case Study 3 22 year old man Admitted with back ache Investigations Examination and blood tests reveal no abnormalities CT scan - large retroperitoneal mass

17. Differential diagnoses include sarcoma, lymphoma, germ cell tumour (amongst others) Treatment His imaging is IEPed to RMH to be discussed at the sarcoma meeting He is transferred as an inpatient to have surgery

18. Future developments Ambulatory care facility to avoid admission Outpatient clinic Trust wide dissemination protocols and pathways Trust wide education programme Joint teaching with CUH and RMH