Prehab4Cancer...Service Model Prehab up to 12 weeks Rehab 12 weeks Lung Colorectal Upper E GI...
Transcript of Prehab4Cancer...Service Model Prehab up to 12 weeks Rehab 12 weeks Lung Colorectal Upper E GI...
Prehab4Cancer
Dr John Moore Prehab4Cancer Clinical Director
Manchester Foundation Hospital
University of Manchester
THE TEAM
PREHAB:
PHYSICAL ACTIVITY
NUTRITION
WELL-BEING
SMOKING
MEDICAL OPTIMISATION
@GMCEducation I #GMCHeadAndNeck2019
Associated with
Poorer chemo response
More post-op complications
Worse outcomes
Increased muscle apoptosis and reduced regeneration
Sarcopenia
@GMCEducation I #GMCHeadAndNeck2019
COMMUNITY BASED PREHAB
Service level agreement – agreed
KPIs
Gym – healthcare team developed
80+ facilities
14 evaluation centres
GM Cancer Prehab and Rehab
Cancer Surgery Phase 1
15 Evaluation clinics
PREHAB
01
REHAB PREHAB
90 day hospital
length of stay
2 year mortality
MD
T d
ecisio
n to
operate
Combination of HIT and Strength
CVS aiming for High intensity
MUSCLE strengthening
Progressive programme
Aiming for 3x week
PREHAB
Supervised
programme
Universal
programme
6MWT
<400m
GM Cancer Prehab - Nutrition
Nutrition advice delivered through community
Supported by specialist dieticians
Weight monitoring during programme wth
safeguards
Move to exercise recovery nutritional
supplementation at gyms
Psychosocial
Support
HOLISTIC NEEDS
ASSESSMENT &
STEPPED CARE MODEL
(NICE 2009)
Level Group Assessment Intervention
1
All the health and social care
professionals
Recognition of
psychological
needs
Effective
information giving
compassionate
communication and
general
psychological
support.
Solution focused.
2
Health and social care
professionals with additional
expertise
Screening for
psychological
distress
Psychological
techniques such as
problem solving,
fatigue
management etc.
3
Trained and accredited
professional
Assessed for
psychological
distress and
diagnosis of some
psychopathology
Counselling and
specific
psychological
interventions such
as anxiety
management and
solution-focused
therapy, delivered
according to explicit
theoretical
framework
4
Mental health specialists Diagnosis of
psychopathology
Specialist
psychological and
psychiatric
interventions such
as psychotherapy,
including cognitive
behavioural therapy
(CBT
Outcome
Measures
Expected
Benefits
Physiological
• Dynamic Test 6MWT/ISWT/CPET
• Height & Weight (BMI)
• Heart rate/BP
• Resistance
• Grip Strength
Patient Reported Outcome Measures • EQ-5D (QOL)
• EORTC QLQ-C30 (cancer specific)
• WHODAS 2.0 (Disability)
• IPAQ-SF (Physical Activity)
• Self-Efficacy Exercise Scale (SEE)
Patient Outcomes
• Complications
• LOS/Mortailty/90 day hospital free period
• Long-term survival
Prehab & Recovery Programme
Sept
2018
Jan
2019
Apr
2019
Sept
2019
Jun
2020
Aug
2020
LAUNCH
Service Design
Referral process
User involvement
MDT visits
GM Active SLA
Prehab4Cancer core team / local teams recruitment &
upskilling
Preparation
Jan - April 2019
Full service delivery
Ongoing evaluation / data collection / research
Digital platform incorporated
Delivery Phase
Sept – Aug 2020
Stakeholder engagement – patient engagement
Understanding the evidence base
Scoping
Sept – Dec 2018
Service delivery
Colorectal, Lung & Upper GI surgical cohorts
Monthly performance review meetings
Confirm digital platform, evaluation & ethics approval
Further stakeholder engagement
Chemo / Rad & other tumour groups
Pilot Phase
April – Aug 2019
Data analysis
Business case
Agree sustainability & evolution of project / service
Revise GM Active service delivery & financial model
Sustainability Phase
Sept – Dec 2018
Version 1
Project Timeline
GM Cancer Prehab and Rehab
Surgery Phase – launches 25th April ‘19
600 patients referred to programme
Upper GI, Lung, Colorectal
>80% attending - Initial results suggest we can improve fitness
Planning H and Neck and Transformation 2
GM Cancer
Head and Neck Chemo/Dxt
PREHAB
01
REHAB MULIT-MODAL PREHAB
PROMS
Completion of
treatment
2 year mortality
MD
T d
ecisio
n to
operate
Primary Care
Cancer Surgical Pathway
PREHAB 01
2 year survival
MD
T d
ecisio
n to
operate
Public Health
95% 5%
DIGITAL DIGITAL 10 year survival
Prevent CVS
events and
cancer
2 w
eek w
ait
Prehab4Cancer
Kirsty Rowlinson-Groves Prehab4Cancer Programme Manager
Specialist for Manchester
Team Structure
Kirsty
Rowlinson-Groves
Programme Manager
Manchester
Nathan Valentine
Administrator
Jack Murphy
Salford & Trafford
Rob Mentha
Wigan, Stockport &
Tameside
Karly Baguley
Bolton & Bury
Sarah-Jayne Hurst
Oldham, Rochdale &
Tameside
GM Active Structure & Staff Development
is a collective of 12 leisure and community organisations from
across Greater Manchester that are all part of the same movement, to get more
people physically active. The group accounts for 87 leisure and sports facilities
across the region which are available for the Prehab4Cancer team to deliver
sessions in. • Each specialist is supported by local instructors
• Huge piece of development work across GM Active to upskill and standardise
training
• Our Local instructors are minimum L3 and will shadow specialist in clinics and
sessions
• GM Active have just hosted a L4 Cancer Rehab course, L4 Pulmonary Rehab
course to upskill instructors
• CPD opportunities held with GM Cancer to upskill locality staff via event days
and training days with guest speakers
Service Model
Prehab up to 12 weeks Rehab 12 weeks
Lung
Colorectal
Upper
GI
Supervised • 3 monitored sessions
per week
• Intensity/Duration/Mode
prescribed by specialist
Universal • 1-1 session with
specialist to prescribe
exercise programme
• Weekly progress
updates
• Independent exercise at
local leisure centre
S
U
R
G
E
R
Y
B
R
E
A K
Post Surgery update
• Contact 4 – 6 weeks post
• Establish plan of action for
commencing rehab with Post
Op Assessment
Patient centred Rehab
• 12 week pass to local gym
• Prescribed exercise
programme and supported
sessions with specialist
• Signposted to local
community activities to
promote long term exercise
adherence and improvement
of health
• Positive exit strategy
A
S
S
E
S
S
M
E
N
T
Assessment Clinic Overview
Referral
Portal 48 Hr Contact
Baseline
Assessment 4 working
days
Post
Chemo
Upper GI only
Pre-Op
Assessment Within 5 days
Post-Op
Assessment 6,8,12 weeks
End of
Rehab
12 Week
intervention
Health checks
• Blood pressure
• Height
• Weight
• Resting HR
• Oxygen stats
Functional Capacity
• ISWT or 6 Min
Walk
• Hand Grip
Dynamometry
• 1 Minute Sit to
stand
Questionnaires
• EQ5D-5L
• IPAQ
• Self Efficacy Scale
• Rockwood Frailty
• WHODAS 2.0
• EORTCQLQ-C30
Each borough of Greater
Manchester hosts 1-3
assessment clinics based
on population make up
and referral numbers
Exercise sessions can
take place in one of the
80+ GM active leisure
centres
Assessment Clinics
Within 5 miles of
residential postcode
but we also host Adhoc
sessions where needed
17 Assessment
Clinics set up and
running across
Greater
Manchester
Assessment Locations
Exercise Prescription
Re-HIIT
• Interval type exercise
• Work : Active
Recovery
• RPE & HR monitoring
• MSE combat
sarcopenia
• 3x weekly sessions
Progressive/Continuous
• Steady State CV
• Progressing intensity
based on HR & RPE
• MSE combat
sarcopenia
• 3x weekly sessions
The screening process
during the assessment
clinic determines the
exercise format and
prescription, taking into
account associated
comorbidities and
potential risk factors
Re-HIIT Progressive
Continuous
• Specialists and referrer’s are able to communicate quickly and easily
• Reports presented at the Clinical Subgroup meetings
• Specialists have attended Subgroup meetings in local hospitals
• Issues raised or concerns fed back to clinical team
• Nutrition database with ‘red flag’ system integrated to monitor patients weight and refer to dieticians
Link between Team and Clinicians
Patient Testimonials
“I have really felt
an improvement in
my fitness”
“I have really enjoyed the
exercises and never
thought I would.
I thought I’d be unable to
do most things but the
instructor took time to make
the exercises suit me but
also push me. I can tell
things are getting better as
I feel less aches and pains.
After a session I feel really
energised!”
“Having the support of the
instructors has been great.
They have really helped
me relax and feel less
stressed out”
“The prehab exercise has been fantastic. It
has built up my confidence and fitness.
The instructor has been wonderful, has
answered my questions on so many
different aspects of my fitness and
reassured me. Thank you so much and I
am looking forward to my rehab sessions”
“The staff have been
amazing. They really
make the exercise
challenging but fun”
Julie P4C Participant
QUESTIONS &
ANSWERS
Interactive Poll: Mr Smith (PABC 1)
Mr Smith is a 68 year old diagnosed with colorectal cancer,
planned for surgery. He runs once a week and enjoys
walking. He had a Cardio Pulmonary Exercise Test (CPET)
with an Anesthetist and was found to have a good level of
fitness.
Would you still refer him to the Prehab4Cancer programme?
YES – I WOULD REFER HIM
NO – I WOULD NOT REFER HIM
Interactive Poll: Mrs Jones (PABC 2)
Mrs Jones has been diagnosed with lung cancer. She was
originally told she was going to have surgery but her treatment
plan has changed and she will now have radiotherapy instead.
She has already been referred to the Prehab4Cancer programme.
Should she still engage in exercise and other interventions via
the Prehab4Cancer programme?
YES – SHE SHOULD STILL ATTEND
NO – SHE NO LONGER NEEDS TO ATTEND
Interactive Poll: Mr Patel (PABC 3)
Mr Smith is an 85 year old diagnosed with oesphago-gastric
cancer, planned for surgery. He has severe osteoarthritis in
his knees, which has led to him to have poor mobility and
sometimes need to use a wheelchair.
Would you still refer him to the Prehab4Cancer programme?
YES – I WOULD REFER HIM
NO – I WOULD NOT REFER HIM
Interactive Poll: Ms Davis (PABC 4)
Ms Davis is a 65 year old diagnosed with lung cancer,
planned for surgery. She has been smoking for 20 years. She
is participating in the Prehab4Cancer programme. Her
specialist instructor has contacted her GP to request
smoking cessation advice.
What would you expect the response from her GP to be?
YES - I will refer her to local smoking cessation services.
NO – She has been unable to quit smoking for a long time and
it is too late to make any difference.