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Aggarwal A, Simcock R, Price P, Rachet B, Lyratzopoulos G, Walker K, Spencer K, Roques T, Sullivan R. NHS cancer services and systems-ten pressure points a UK cancer control plan needs to address. Lancet Oncol 2024; 25:e363-e373. [PMID: 38991599 DOI: 10.1016/s1470-2045(24)00345-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 06/12/2024] [Accepted: 06/13/2024] [Indexed: 07/13/2024]
Abstract
In this Policy Review we discuss ten key pressure points in the NHS in the delivery of cancer care services that need to be urgently addressed by a comprehensive national cancer control plan. These pressure points cover areas such as increasing workforce capacity and its productivity, delivering effective cancer survivorship services, addressing variation in quality, fixing the reimbursement system for cancer care, and balancing of the cancer research agenda. These areas have been selected based on their relative importance to ensuring sustainable cancer services, persistence as key issues in the NHS, and their impact on delivering better and more equitable and affordable patient outcomes. Many of these pressure points are not acknowledged explicitly in any current discourse. The evidence we provide points to their impact on the ability to deliver world class cancer care, but also to their amenability to affordable solutions if given the relevant prioritisation and investment. The current narrative needs to move away from a technocentric approach to improving care, to one focused on understanding the complexity of cancer services and the wider health system to drive improvements in survival, quality of life, and experience for patients.
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Affiliation(s)
- Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK; Department of Oncology, Guy's & St Thomas' NHS Trust, London, UK.
| | - Richard Simcock
- Department of Oncology, University Hospitals Sussex NHS Trust, Brighton, UK
| | - Pat Price
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Bernard Rachet
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Kate Walker
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Katie Spencer
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK; Department of Oncology, Leeds Teaching Hospitals NHS Trust, Leeds
| | - Tom Roques
- Department of Oncology, Norfolk and Norwich NHS Foundation Trust, Norwich, UK
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Wiltshire J, Grout J, Krotosky M, Gerry P, Ashcroft P, White R, Lillis A, Betteley A, Minton O. An Analysis of Healthcare Usage & Place of Death in England for All Adults Who Died in 2021/22. Am J Hosp Palliat Care 2024:10499091241247183. [PMID: 38623845 DOI: 10.1177/10499091241247183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024] Open
Abstract
OBJECTIVE We wanted to examine the healthcare use and non-elective activity in the UK population of expected deaths over an 1-year period to highlight and examine the reasons for variation. We did this to identify areas to focus interventions or resources on to reduce unnecessary emergency care use at the end of life. METHODS AND ANALYSIS We assembled a data set of approximately 400 000 adults who died in England in the financial year 2021/22 (April 2021-March 2022). Any adults classified as a 'sudden death' were excluded. We used available data to ensure outcome measures were relevant used expert consensus to agree what to examine. We recorded place of death and examined urgent care in terms of admissions in the last year and 90 days of life. We also used recorded hospital care days as elective and non-elective usage. RESULTS There were over 400 000 decedents included in our regression models. Close to half died in hospital (44%). Three-quarters (77%) had at least one day of unplanned hospital care in the 90 days before they died, and half (56%) had at least one day of planned hospital care. CONCLUSION Reliance on urgent care for those approaching end-of-life may indicate poor care planning and integration of services. A relatively modest increase in the amount of community care a person receives at end-of-life can substantially reduce the likelihood of dying in hospital. Those with a cancer cause of death are far less likely to die in hospital.
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Affiliation(s)
| | - Jacqueline Grout
- Midlands and Lancashire Clinical Support Unit, West Bromwich, UK
| | | | | | | | | | | | | | - Ollie Minton
- Macmillan Cancer Support, London, UK
- University Hospitals Sussex, Worthing, UK
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Jordan T, Nuamek T, Fornacon-Wood I, Califano R, Coote J, Harris M, Mistry H, Taylor P, Woolf D, Faivre-Finn C. A study demonstrating users' preference for the adapted-REQUITE patient-reported outcome questionnaire over PRO-CTCAE ® in patients with lung cancer. Front Oncol 2024; 14:1328871. [PMID: 38660130 PMCID: PMC11039780 DOI: 10.3389/fonc.2024.1328871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/27/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction The use of patient-reported outcomes (PROs) has been shown to enhance the accuracy of symptom collection and improve overall survival and quality of life. This is the first study comparing concordance and patient preference for two PRO tools: Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE®) and the adapted-REQUITE Lung Questionnaire. Materials and Methods Patients with lung cancer were recruited to the study while attending outpatient clinics at a tertiary cancer centre. Clinician-reported outcomes were generated through initial patient assessment with CTCAE v4.03. Participants then completed the PRO-CTCAE® and adapted-REQUITE questionnaires. Concordance between the 2 questionnaires was assessed by calculating Pearson correlation coefficient. PRO-CTCAE® and CTCAE concordance was demonstrated by calculating Pearson correlation coefficient from the linear predictors of an ordinal logistic regression. P-values were also calculated. Results Out of 74 patients approached, 65 provided written informed consent to participate in the study. 63 (96.9%) patients completed both PRO-CTCAE® and adapted-REQUITE questionnaires. Pearson correlation coefficient between PRO tools was 0.8-0.83 (p <.001). Correlation between CTCAE and PRO-CTCAE® ranged between 0.66-0.82 (p <.001). Adapted-REQUITE and CTCAE correlation was higher for all symptoms ranging between 0.79-0.91 (p <.001). Acceptable discrepancies within one grade were present in 96.8%-100% of symptom domains for REQUITE and in 92.1%-96.8% for all domains in the PRO-CTCAE®. 54% of the total participant cohort favored the adapted-REQUITE questionnaire due to reduced subjectivity in the questions and ease of use. Conclusion The adapted-REQUITE questionnaire has shown a superior correlation to clinician-reported outcomes and higher patient preference than the PRO-CTCAE®. The results of this study suggest the use of the REQUITE questionnaire for patients with lung cancer in routine clinical practice.
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Affiliation(s)
- Thomas Jordan
- Division of Cancer Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom
- The Christie NHS Foundation Trust, Manchester, United Kingdom
- Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, United Kingdom
| | | | - Isabella Fornacon-Wood
- Division of Cancer Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Raffaele Califano
- Division of Cancer Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Joanna Coote
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Margaret Harris
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Hitesh Mistry
- Division of Cancer Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom
| | - Paul Taylor
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - David Woolf
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Corinne Faivre-Finn
- Division of Cancer Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom
- The Christie NHS Foundation Trust, Manchester, United Kingdom
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Monnery D, Droney J. Enhanced supportive care. Br J Hosp Med (Lond) 2024; 85:1-8. [PMID: 38557099 DOI: 10.12968/hmed.2023.0416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Enhanced supportive care is a care model providing earlier access to multiprofessional, coordinated care for patients from the point of cancer diagnosis. As a proactive model of care, it stands as a contrast to providing access to a multidisciplinary team once a patient has hit a crisis point, or when their prognosis has become sufficiently poor that they are able to access traditional end-of-life services. Its arrival in the UK through palliative care teams working in cancer care has led to enhanced supportive care being synonymous with early palliative care. While enhanced supportive care has enabled early palliative care, as it has become more embedded in the UK, it has taken on a wider remit for patients living longer with cancer and the management of side effects. Enhanced supportive care services have also begun to provide care for cancer survivors. Enhanced supportive care services have a key role in modern cancer care in maintaining and improving patients' quality of life alongside cancer treatment and ensuring that patients' priorities and preferences for treatment are considered. Furthermore, enhanced supportive care has been shown to support the wider healthcare system by creating capacity within the NHS, reducing demand on hospital services and saving money. As enhanced supportive care services continue to grow and venture into the care and support of cancer survivors and those receiving potentially curative treatments, ongoing work is needed to determine how these services can be made available throughout the NHS and how a shared vision of the way enhanced supportive care operates can be realised.
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Affiliation(s)
- Daniel Monnery
- Department of Supportive and Palliative Care, The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - Joanne Droney
- Department of Symptom Control and Palliative Care, The Royal Marsden NHS Foundation Trust, London, UK
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Monnery D, Tredgett K, Hooper D, Barringer G, Munton A, Thomas M, Vijeratnam N, Godfrey N, Summerfield L, Hawkes K, Staley P, Holyhead K, Liu Y, Lockhart J, Bass S, Tavabie S, White N, Stewart E, Droney J, Minton O. Delivery Models and Health Economics of Supportive Care Services in England: A Multicentre Analysis. Clin Oncol (R Coll Radiol) 2023; 35:e395-e403. [PMID: 36997458 DOI: 10.1016/j.clon.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/16/2023] [Accepted: 03/02/2023] [Indexed: 03/30/2023]
Abstract
AIMS Improvements in cancer treatment have led to more people living with and beyond cancer. These patients have symptom and support needs unmet by current services. The development of enhanced supportive care (ESC) services may meet the longitudinal care needs of these patients, including at the end of life. This study aimed to determine the impact and health economic benefits of ESC for patients living with treatable but not curable cancer. MATERIALS AND METHODS A prospective observational evaluation was undertaken over 12 months across eight cancer centres in England. ESC service design and costs were recorded. Data relating to patients' symptom burden were collected using the Integrated Palliative Care Outcome Scale (IPOS). For patients in the last year of life, secondary care use was compared against an NHS England published benchmark. RESULTS In total, 4594 patients were seen by ESC services, of whom 1061 died during follow-up. Mean IPOS scores improved across all tumour groups. In total, £1,676,044 was spent delivering ESC across the eight centres. Reductions in secondary care usage for the 1061 patients who died saved a total of £8,490,581. CONCLUSIONS People living with cancer suffer with complex and unmet needs. ESC services appear to be effective at supporting these vulnerable people and significantly reduce the costs of their care.
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Affiliation(s)
- D Monnery
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK.
| | - K Tredgett
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - D Hooper
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - G Barringer
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - A Munton
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - M Thomas
- Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - N Vijeratnam
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - N Godfrey
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - L Summerfield
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - K Hawkes
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - P Staley
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - K Holyhead
- Somerset NHS Foundation Trust, Taunton, UK
| | - Y Liu
- NHS England Specialised Services Improving Value Team, UK
| | - J Lockhart
- NHS England Specialised Services Improving Value Team, UK
| | - S Bass
- University Hospitals Sussex NHS Foundation Trust, Worthing, UK
| | - S Tavabie
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - N White
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - E Stewart
- University Hospitals Sussex NHS Foundation Trust, Worthing, UK
| | - J Droney
- The Royal Marsden NHS Foundation Trust, London, UK
| | - O Minton
- University Hospitals Sussex NHS Foundation Trust, Worthing, UK
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Payne A, Horne A, Bayman N, Blackhall F, Bostock L, Chan C, Coote J, Eaton M, Fenemore J, Gomes F, Halkyard E, Harris M, Lindsay C, McEntee D, Neal H, Pemberton L, Sheikh H, Woolf D, Price J, Yorke J, Faivre-Finn C. Patient and clinician-reported experiences of using electronic patient reported outcome measures (ePROMs) as part of routine cancer care. J Patient Rep Outcomes 2023; 7:42. [PMID: 37140730 PMCID: PMC10160312 DOI: 10.1186/s41687-023-00544-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/05/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Cancer and its treatment can have significant impacts on health status, quality of life and functioning of patients. Direct information from patients regarding these aspects can be collected via electronic platforms in the form of electronic Patient Reported Outcome Measures (ePROMs). Research has shown that the use of ePROMS in cancer care leads to improved communication, better symptom control, prolonged survival and a reduction in hospital admissions and emergency department attendance. Acceptability and feasibility of routine ePROM collection has been reported by both patients and clinicians but to date their use has predominantly been limited to clinical trials. MyChristie-MyHealth is an initiative from a UK comprehensive cancer centre The Christie NHS Foundation Trust which incorporates the regular collection of ePROMs into routine cancer care. This study, carried out as part of a service evaluation, explores patient and clinician experiences of using the MyChristie-MyHealth ePROMs service. RESULTS 100 patients with lung and head and neck cancers completed a Patient Reported Experience questionnaire. All patients reported that MyChristie-MyHealth was easy to understand and, almost all found it timely to complete and easy to follow. Most patients (82%) reported it improved their communication with their oncology team and helped them to feel more involved with their care (88%). A large proportion of clinicians (8/11) felt ePROMs helped communication with their patients and over half (6/10) felt they led to consultations being more patient focused. Clinicians also felt that the use of ePROMs resulted in patients being more engaged in consultations (7/11) and their cancer care in general (5/11). Five clinicians reported that the use of ePROMs altered their clinical decision making. CONCLUSIONS Regular ePROMs collection as part of routine cancer care is acceptable to both patients and clinicians. Both patients and clinicians feel their use improved communication and increased the feeling of patient involvement with their care. Further work is needed to explore the experiences of patients that did not complete the ePROMs as part of the initiative and to continue to optimize the service for both patients and clinicians.
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Affiliation(s)
| | - Ashley Horne
- University of Manchester, Manchester, UK
- Christie NHS Foundation Trust, Manchester, UK
| | - Neil Bayman
- Christie NHS Foundation Trust, Manchester, UK
| | - Fiona Blackhall
- University of Manchester, Manchester, UK
- Christie NHS Foundation Trust, Manchester, UK
| | | | - Clara Chan
- Christie NHS Foundation Trust, Manchester, UK
| | | | - Marie Eaton
- Christie NHS Foundation Trust, Manchester, UK
| | | | - Fabio Gomes
- Christie NHS Foundation Trust, Manchester, UK
| | | | | | | | | | - Hilary Neal
- Christie NHS Foundation Trust, Manchester, UK
| | | | | | - David Woolf
- Christie NHS Foundation Trust, Manchester, UK
| | - James Price
- Christie NHS Foundation Trust, Manchester, UK
| | - Janelle Yorke
- University of Manchester, Manchester, UK
- Christie NHS Foundation Trust, Manchester, UK
| | - Corinne Faivre-Finn
- University of Manchester, Manchester, UK
- Christie NHS Foundation Trust, Manchester, UK
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Crockett C, Price J, Pham M, Abdulwahid D, Bayman N, Blackhall F, Bostock L, Califano R, Chan C, Coote J, Cove-Smith L, Eaton M, Fenemore J, Gomes F, Harris M, Halkyard E, Hughes S, Lindsay C, Neal H, McEntee D, Pemberton L, Sheikh H, Summers Y, Taylor P, Woolf D, Yorke J, Faivre-Finn C. Experience With the Routine Use of Electronic Patient-Reported Outcome Measures for Patients With Lung Cancer. JCO Clin Cancer Inform 2023; 7:e2200150. [PMID: 37071029 PMCID: PMC10281443 DOI: 10.1200/cci.22.00150] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 11/27/2022] [Accepted: 02/27/2023] [Indexed: 04/19/2023] Open
Abstract
PURPOSE The Christie NHS Foundation Trust launched their electronic patient-reported outcome measures (ePROMs) service in January 2019 in the routine clinical setting. The lung cancer questionnaires consist of 14 symptom items, adapted from the Common Terminology Criteria for Adverse Events (version 5.0) and the EuroQol EQ-5D-5L quality-of-life (QoL) tool. Patients with lung cancer are invited to complete questionnaires assessing their symptoms and QoL using an online platform. METHODS The ePROM responses and clinical, pathologic, and treatment data for patients who completed the questionnaires between January 2019 and December 2020 were extracted from electronic medical records. The symptom and QoL scores of patients who completed baseline pretreatment ePROMs and also those who completed ePROMs pre- and postpalliative lung systemic anticancer therapy (SACT) or radical thoracic radiotherapy were evaluated. Pretreatment questionnaires were analyzed according to age, Eastern Cooperative Oncology Group performance status (ECOG PS), and Adult Comorbidity Evaluation-27 (ACE-27) comorbidity score. RESULTS One thousand four hundred eighty patients with lung cancer were included. There were no statistically significant differences in symptoms and QoL scores between age groups. Cough (P = .006) and EQ-5D-5L mobility scores (P = .006) were significantly worse for patients with an ECOG PS of 0-1. Dyspnea (P = .035), hemoptysis (P = .023), nausea (P = .041), mobility (P = .004), and self-care (P = .0420) were significantly worse for those with higher ACE-27 scores (2-3 v 0-1). Palliative SACT was associated with a significant improvement in cough (P < .001) and hemoptysis (P = .025), but significantly negatively affected mobility (P = .013). Patients receiving radical thoracic radiotherapy reported a significant improvement in hemoptysis (P = .042) but worse pain (P = .002) and fatigue (P = .01). Other changes in symptom and QoL scores were not significant. CONCLUSION The symptoms and QoL reported at baseline and before and after both palliative SACT and radical thoracic radiotherapy are clinically relevant and meaningful. We have demonstrated that routine implementation of ePROMs into clinical practice is feasible and can inform clinical practice and future research.
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Affiliation(s)
| | - James Price
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Mai Pham
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | - Neil Bayman
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Fiona Blackhall
- The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Layla Bostock
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Raffaele Califano
- The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Clara Chan
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Joanna Coote
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | - Marie Eaton
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | - Fabio Gomes
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Margaret Harris
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Emma Halkyard
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Sarah Hughes
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Colin Lindsay
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Hilary Neal
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Delyth McEntee
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Laura Pemberton
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Hamid Sheikh
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Yvonne Summers
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Paul Taylor
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - David Woolf
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Janelle Yorke
- The Christie NHS Foundation Trust, Manchester, United Kingdom
- Christie Patient-Centred Research, Division of Nursing, Midwifery & Social Work, The University of Manchester, Manchester, United Kingdom
| | - Corinne Faivre-Finn
- The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
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Stewart E, Tavabie S, McGovern C, Round A, Shaw L, BAss S, Herriott R, Savage E, Young K, Bruun A, Droney J, Monnery D, Wells G, White N, Minton O. Cancer centre supportive oncology service: health economic evaluation. BMJ Support Palliat Care 2022; 13:bmjspcare-2022-003716. [PMID: 35850958 DOI: 10.1136/spcare-2022-003716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/21/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES There have been many models of providing oncology and palliative care to hospitals. Many patients will use the hospital non-electively or semielectively, and a large proportion are likely to be in the last years of life. We describe our multidisciplinary service to treatable but not curable cancer patients at University Hospitals Sussex. The team was a mixture of clinical nurse specialists and a clinical fellow supported by dedicated palliative medicine consultant time and oncology expertise. METHODS We identified patients with cancer who had identifiable supportive care needs and record activity with clinical coding. We used a baseline 2019/2020 dataset of national (secondary uses service) data with discharge code 79 (patients who died during that year) to compare a dataset of patients seen by the service between September 2020 and September 2021 in order to compare outcomes. While this was during COVID-19 this was when the funding was available. RESULTS We demonstrated a reduction in length of stay by an average of 1.43 days per admission and a reduction of 0.95 episodes of readmission rates. However, the costs of those admissions were found to be marginally higher. Even with the costs of the service, there is a clear return on investment with a benefit cost ratio of 1.4. CONCLUSIONS A supportive oncology service alongside or allied to acute oncology but in conjunction with palliative care is feasible and cost-effective. This would support investment in such a service and should be nationally commissioned in conjunction with palliative care services seeing all conditions.
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Affiliation(s)
- Eleanor Stewart
- University Hospitals Sussex NHS Foundation Trust, Worthing, UK
| | - Simon Tavabie
- Palliative Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | | | | | | | - Stephen BAss
- Palliative Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Rob Herriott
- University Hospitals Sussex NHS Foundation Trust, Worthing, UK
| | - Emily Savage
- University Hospitals Sussex NHS Foundation Trust, Worthing, UK
| | - Katie Young
- University Hospitals Sussex NHS Foundation Trust, Worthing, UK
| | - Andrea Bruun
- Marie Curie Palliative Care Research Department, UCL, London, UK
| | - Joanne Droney
- Palliative Care, The Royal Marsden NHS Foundation Trust, London, UK
| | - Daniel Monnery
- Palliative Medicine, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Geoffrey Wells
- Medical Education, Brighton and Sussex Medical School, Brighton, UK
| | - Nicola White
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Ollie Minton
- Palliative Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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