1. The Macmillan Aftercare Rehabilitation Service (“MARS”) Providing a service for people who have, or have had, head and neck cancer

2. Content Who are the MARS team? Why have we formed? What do we do? Where are we going?

3. Who are the MARS Team? A team of Allied Health Professionals (“AHP”) specialising in Head and Neck cancer (“HNC”), comprising: Dietitians, Speech & Language Therapist, Nutrition Nurses, Care Co-ordinator Based at the Royal Surrey County Hospital, (RSCH) Guildford, with outreach clinics at Frimley Park, East Surrey, St Peter’s and Basingstoke Hospitals Working alongside the H&N Consultants Close liaison with the CNS

4. Why have we formed? Lack of local specialist aftercare services in Surrey Number of cancer survivors continues to grow; HNC rates ↑ by >20% past 30yrs, particularly in those <65years and both sexes (NICE, 2004) Need for support & care may be greatest at treatment end (Roing et al, 2007, Semple et al, 2008) Post-treatment HNC pts report high unmet supportive care needs, most vulnerable in the post-treatment phase + unprepared for lifestyle changes (Ziegler et al, 2004, Larsson et al, 2005, Chen et al, 2009)

5. The long and winding road…. Treatment end and recovery starts... Rehabilitation Peak

6. Aims of the MARS team: To provide a collaborative patient-centred specialist service to address the complex needs of this patient group, at a location close to the patients home To help obtain optimal functioning after treatment (within limits of the disease + personal situation) To promote self-care/management in a supportive environment + access to resources To meet national and local policies & guidelines on cancer survivorship

7. To help more people survive cancer, all cancer pts to receive a recovery package of ongoing support after treatment. Aim for a seamless effective integrated discharge service (Department of Health: GB, 2013) To improve Quality of Life as well as longevity ; better outcomes/experience for ca survivors, unplanned +unnecessary hospital appts + admissions. (NCSI, 2011) (Healthy People, Department of Health: GB, 2010) To provide a uniform high quality multidisciplinary local support service for HNC patients (Calmine Hine report, BAHNO, 1996) (IOG, 2004) To encourage patients with long-term conditions towards self-empowerment to manage their own health (Cancer Workforce Development Strategy 2010-2015) Compliance with National and Local policies & guidelines:

8. Benefits of service provision One-stop MDT approach Continuity of care Frees up appointments at RSCH Clinics local to patient homes Enables patients to remain at home longer Improved patient experience and satisfaction

9. MARS Dietetic Intervention 72% HNC pts on modified textured diets, supplements +/- tube feeds 1 yr post-treatment (Garcia-Peris et al, 2007) Acute/chronic side-effects of HNC treatment Regular assessment of tube feeds & supplement usage Advice & support on all aspects of nutritional intake, weight management & healthy lifestyle choices following recovery from treatment

10. MARS Nutrition Nurse Intervention Advice and support post feeding tube insertion Regular assessment of feeding tubes Early detection of complications or potential complication Timely removal of feeding tubes Prevention of unnecessary hospital admissions

11. MARS Speech & Language Therapy Intervention Advice, support and exercises to maximise speech and swallow function Including providing diet/fluid modification advice & conducting bedside/instrumental swallow assessments Without speech and swallowing intervention, 12 months post treatment the oral cancer patients speech and swalow function is no better than 3 months post treatment (Pauloski et al, 1994) Advice and support for patients, carers and the MDT following laryngectomy Including surgical voice restoration, stoma care, filtration/humidification, use of artificial larynx etc Acute/in-patient visits

12. MARS Care Co-ordinator role The Care Co-ordinator acts as the single point of access for acute and local Head and Neck teams Closely liaising with the RSCH Head & Neck CNS Involves referral processing, telephone triage and patient support Tasks include: Triage of patients, sign-posting and problem solving Providing individualised information Giving advice on: Recurrence avoidance and recognition Long Term side effect management Finance- Macmillan healthcare grants, or Macmillan CAB Smoking cessation support Patient feedback projects

13. Treatment End Rehabilitation Supported by MARS

14. Where are we going? Development: Resources Outcome measures Practical support sessions: - smoking cessation sessions, texture modification sessions, survivorship study days Clinics at other outreach locations Implementation of AHP clinics Evolving roles And…?

15. Thank you - Any Questions? Contact details: rsc-tr.MarsTeam@nhs.net 01483 408379 Claire Hanika – Macmillan Dietitian Anna Clayton – Macmillan Dietitian Kate Edwards – Macmillan Speech and Language Therapist Emma Papworth – Macmillan Nutrition Nurse Elizabeth Seymour – Macmillan Care Co-ordinator