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Acute Oncology Dr Nicola Storey.

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Presentation on theme: "Acute Oncology Dr Nicola Storey."— Presentation transcript:

1 Acute Oncology Dr Nicola Storey

2 Lifetime risk of developing cancer in the UK

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7 Overview of Acute Oncology
Encompasses management of patients with severe complications following the treatment of, or as a consequence of their previously diagnosed cancer Management of patients who present as emergencies with previously undiagnosed cancer AOS brings together expertise from oncology disciplines, emergency medicine, palliative care, and general medicine and general surgery

8 Key Features of an Acute Oncology Service: (NCAG Report)
Early review by an oncologist or oncology nurse specialist (within 24 hours) 24/7 access to telephone advice from an oncologist Fast track clinic access from A&E Access to information on individual patients across the Trust Protocols for the management of oncological emergencies and referral pathways from A&E and acute admissions unit Specific pathways for the investigation and treatment of malignant spinal cord compression

9 Patient in A&E/ AAU Acute medical review/ AOS review MSCC
Complication of known cancer IS THIS NEUTROPENIC SEPSIS >TREAT WITH ANTIBIOTICS< Acute medical review/ AOS review SPINAL CORD COMPRESSION Referral to AOS On active treatment Pericardial effusion Pleural effusion Brain mets Ascities Identified by alert MSCC co-ordinator/ On-call oncologist AOS review/ AO Specialist nurse Transfer to specialist ward Fast track protocols MRI scan Advice/review by Consultant Oncologist 24/7 Review in rapid access clinic/ acute oncology assessment unit Transfer to MSCC treatment centre Spinal surgeons/ Radiotherapy

10 Triage Tool A tool that will determine “the patient’s level of risk”
Prompt the practitioner with appropriate questions to ask in order to gain information from the patient Provide a reliable guide to toxicity/problem grading Prioritise the level of urgency indicated by the presenting symptoms and will aid in identifying potential emergency situations 4/23/2017 Philippa Jones Chemotherapy Redesign Manager, Greater Midlands Cancer Network 10

11 South Tees NHS FT

12 Day 89 year old lady 0 Admitted with abdominal pain, kidneys not working 1 CT scan requested CT scan performed – ?blocked kidneys Evidence of widespread cancer Ultrasound scan requested 3 Blocked kidneys confirmed Referred to nephrologists 10 Nephrology review – likely cause of problems bladder or pelvic malignancy CT scan with contrast recommended 11 Xrays reviewed at meeting - ? Endometrial malignancy CT cancelled, MRI scan advised 12 Nephrostomies inserted to relieve blocked kidneys 14 Referred to gynaecology 15 Seen by gynaecology with MRI result ? Ovarian or peritoneal malignancy US guided biopsy suggested 16-22 ? Gynaecology taken over care 22 Urology review – patient probably has gynae malignancy, chase gynaecology review

13 Day 23 Gynae review, US guided biopsy requested 24-36 Not well, infections, biopsy postponed 36 Biopsy attempted and abandoned 38 Gynae Oncology MDT meeting – refer for supportive care and to elderly care 42 Elderly care referral 44 Elderly care ward transfer 56 Discharged to nursing home

14 What should an acute oncology service aim to deliver?
Timely and approachable support from an experienced oncologist in managing acute treatment related emergencies Easy referral pathways that can be accessed by all Rapid alert system to highlight when any patients known to be receiving chemotherapy are admitted Regularly updated, easy to follow, protocols for managing oncological emergencies such as spinal cord compression Earlier involvement in the patient pathway in those suspected to have cancer Fast tract outpatient access for those who do not require admission

15 North of England Cancer Network MSCC Centres NCC, Freeman Hospital
James Cook Hospital Radiotherapy Centres Cumberland Infirmary

16 What should today aim to deliver?
An overview of the important acute oncological presentations A masterclass in how to manage some of the more serious of these A chance to talk to one another about how we continue to improve patient experience


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