1. Cancer Survivorship: Transforming how we deliver cancer care
Catherine Neck
Macmillan Cancer Rehabilitation/ Recovery Package Project Lead

2. The Current Picture
2 million people currently living with and beyond cancer now in UK
Predicted to reach 4 million by 2030
More new patients and more living much longer lives following a cancer diagnosis/ treatment
Many patients are experiencing negative consequences of treatment which may continue for years post treatment

3. My Role
Funded by Macmillan to assist clinical teams to process map and redesign pathways of care across ASW region
Involves the introduction of the ‘Recovery Package’ into the pathway
Supports teams to adjust to new ways of working that are better for the patient and result in increased clinical capacity
Reduces unnecessary waste in the system

4. The Recovery Package The recovery package consists of 4 key elements:
Holistic Needs Assessment
Treatment Summary to patient AND a GP / Cancer Care Review by GPs
An education event such as Health and Wellbeing event that includes physical activity and lifestyle information

5. The Recovery Package Risk stratification of patients
Holistic Needs Assessments
Health & Wellbeing advice
Treatment summaries
Remote Surveillance
Cancer Care reviews

6. Improve Information and Support at the outset
Prehabilitation – encourage patients to take an active role in improving their outcomes at the start
Provide a clear pathway of care from the outset. Manage patient expectations
Provide early health & wellbeing advice around consequences of treatment, physical activity, nutrition, work & finance support, emotional support

7. End of Treatment Holistic Needs Assessment including Care Plan
Provide clear and comprehensive information to the patient and GP – Treatment Summary
Support the patient to self-manage by being able to identify signs and symptoms of recurrence and providing timely open access support
Identify and act on early negative consequences of treatment/ late effects

8. ‘Prehab’
Support to increase physical activity levels and optimise physical function from diagnosis
Includes input from dietetics, smoking cessation, work & finance support
Fast track to existing pulmonary rehab programmes – ideal model
Pilot in Birmingham demonstrated positive results

9. Birmingham results
Reduced post-operative complication rates from 18.7% to 11.4%
Reduced length of stay from 7.2 days to 5.7 days
Reduced intensive care admissions from 3.2% to 2.9%
Fewer readmissions from 16.1% to 5.7%
Achieved per patient savings of £

10. Current Local Pilots
UHB Upper GI, HPB and gynae-oncology teams have begun pilots
Using Macmillan Cancer Support Worker to deliver home-based walking and exercise programmes, plus offer wider holistic support
Support from physiotherapy dept

11. Results Improved physical function at point of surgery
Reduced hospital LOS (average 6 days)
Reduced post-operative complications
Improved patient & carer experience
Programme is cost-effective to deliver and easily replicable across other cancer sites

12. Contact Details
If you and your team want support to process map and look at pathway redesign, introduction of the Recovery Package and prehab please contact me on: Phone:

13. Prehabilitation Smoking cessation Nutrition Patient education
Pulmonary rehabilitation

14. National perioperative outcomes of pulmonary lobectomy for cancer: the influence of nutritional status Thomas PA et al Eur J Cardiothorac Surg 2014 Apr;45(4):652
Association of body mass index and outcomes after major lung resection Ferguson MK et al Eur J Cardiothorac Surg 2014 Apr;45(4):e94-9
If BMI < 18.5:
Increased mortality (OR )
Increased pulmonary complications

15. Improved VO2max of 2.8 with unchanged spirometry and gas transfer
12 high risk patients
VO2max <15
4 weeks pulmonary rehab
Improved VO2max of 2.8 with unchanged spirometry and gas transfer
No deaths, but long LOS and significant post op respiratory morbidity
EJCTS 2008

16. 40 patients with COPD undergoing lobectomy
20 randomised to pre-op pulmonary rehab
Cardiopulmonary exercise testing performed
Before intervention
After intervention
Post-op
Standard group
14.8
14.5
11.4
Pre-op pulmonary rehab
14.9
17.8
15.1
VO2 max (ml/kg/min)
EJCTS 2013

17. Outpatient-based pre-op intervention:
Pulmonary rehab
Smoking cessation
Nutritional assessment
Patient education
Improvement in pre-op FEV1 and 6MW
Trend towards:
reduced pulmonary complications
Reduced re-admissions
EJCTS 2013