Consequences of cancer treatments Karen Morgan Macmillan Consultant Radiographer Jan 13 th 2015.
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Transcript of Consequences of cancer treatments Karen Morgan Macmillan Consultant Radiographer Jan 13 th 2015.
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)
Of those two million people......
•40% 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)
•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….
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.”
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
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
Pre-exisiting injury – smoking, Diabetes
Pre-disposition (to late effects development) – inflammatory bowel disease, MS, genetic mutation (eg P53)
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
‘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
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 ?
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)
Pandora’s box
Newer treatment techniques IMRT / VMAT / SABR/IGRT
New chemotherapy drugs
Survival rates = Consequences ?
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
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
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
Locally - •Gastroenterologist (interest in PRD)•Endocrinologist •Local therapists – (SLT, dietician, physio,
lymphoedema) •ED clinic •Pain clinic•Women’s health •Nurse Counsellors
Late effects services
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
* 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 !
•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 !
Karen Morgan, Macmillan Consultant Radiographer (Late Effects),c/o The Radiotherapy Dept,The Beacon Centre,Taunton,TA1 5DA.Telephone 01823 342933Email: [email protected]
Further information or direct referrals